從民眾角度看臺灣地區基層醫療體系之照護品質與其滿意度分析

背景：現今臺灣健保體制提供多元醫療服務，亦因民眾就醫場所選擇自主性高，其中民眾就醫場所選擇多以醫術、滿意度等為就醫考量點，而一個良好的健康醫療照護更應著重於適切的基層醫療照護服務。目的：以民眾觀點探討臺灣地區基層醫療照護體系品質與其滿意度分析之研究調查。方法：研究對象為臺灣地區(不含離島)年滿二十歲至七十歲之成人做為母體，母體數約為16,435,948 人(男8,187,220，女8,248,728;2012 內政部戶政司統計資料)。研究訪問採電話訪問之方式進行，抽樣方法採分區比例隨機抽樣之方法進行。成功樣本數為1,062 份，抽樣率為十萬分之6.5。本研究工具採用基層醫療照護評估工具成人版(PCAT-AE)。結果：本研究結果顯示在民眾基層醫療的就醫選擇上，選擇醫院者299 人(28.15%)、診所763 人(71.85%)。在基本人口學教育程度、年齡、工作狀態、收入之p 值＜0.05 達統計水準，臺灣民眾在就醫選擇是有差異的；其中基層醫療照護品質於持續性照護(0.69 ± 0.278)、協調性(資訊)(0.43 ± 0.240)、社區導向服務(0.17 ± 0.313)、文化能力(0.75 ± 0.371)。結論：民眾所接受基層醫療照護品質在持續性照護、協調性照護(資訊)、以社區為導向服務、文化能力有顯著差異，在醫療院所提供基層醫療服務過程時，應可從這些構面去加強提供基層照護服務，漸而促進當地之民眾健康。

關鍵字

基層醫療照護體系；電話訪問；基層醫療照護評估工具；就醫選擇

並列摘要

Purpose: the purpose of this study is to evaluate and analyze the quality and satisfaction of primary care setting (PCS) in Taiwan. Methods: the subject is the people lived in Taiwan and the age ranged from 20 to 70, there are 16,435,948 cases as the studying population. In this study, we have 1,062 cases successfully and the successful sampling rate is 6.5 per mille. Results:the results showed the characteristics of demography that age ranged from 50-59 years old (32.2%), job were full time work generally (48.7%), income attributed to no salary (44.8%), education level were high school (27.6%), living area were in north (42.0%) and gender were female (64.1%). To compare the difference analysis in demography for PCS choice, selection affected factors and caring quality, there were significantly different in age, job, income and education for PCS choice; the most concerning factors in PCS selection were friendly (11.1%), facility (10.6%), caring quality (10.6%), moreover in the selection affected factors the location, waiting time, registrations, and expenditure were significantly different. For the quality assessment of PCS, a higher PCAT score showed a higher caring quality, in general the PC quality showed that in the culture ability (0.75 ± 0.371)、ongoing (0.69 ± 0.278)、first contact utility (0.68 ± 0.280) had a higher quality, and also in the quality of PC, the ongoing care,information coordination, community service and culture there were significantly difference. We also to study the correlation between PCAT factors with satisfaction, the results showed the correlation coefficient of first contact utilization (0.033), first contact access (0.102), ongoing care (0.032), coordination (-0.045) and cultural competence (0.904) that was significantly correlation for each other. Finally, we analyzed the prediction to choice PCS selection; the results of odds ratio (OR) found the first contact access (2.028), community orientation (2.325), cultural competence (1.615), ongoing care (0.516), coordination information system (0.266), there were significantly predictors. Conclusions:the study results showed the PC caring quality in Taiwan that were better in culture, ongoing care and first contact utility, and the community oriented, comprehensive care, coordination were bad. Therefore we need to through education and teaching to improve the PCS caring quality. However in the evaluation of satisfaction, the first contact utilization, first contact access, ongoing care, culture, coordination were significantly correlation with satisfaction. For the prediction of PCS selection, according to our study the first contact access, ongoing care, coordination information, community oriented and culture ability were significant meaning.