摘要
由於人口急速老化、失能人口激增，台灣的長期照護需求大幅增加。據行政院推估，2018年全國人口中失能比例與65歲以上人口失能比例將分別上升到3.26%及16.04%，人數分別為773,070人及560,781人。然而台灣的醫療長久以來偏重於急性照護，缺乏對長期照護的相關準備。長期照護乃是多層級的團隊照護，需要跨專業的成員（包括醫師）對個案進行評估與轉介所需服務。本文將分析現況與探討醫師在長期照護體系中可以扮演的角色。綜合來說，醫師應當周全地了解病人的疾病進程與失能狀況，診治未發現、新發生或治療不足的疾病，並透過適當轉介照會，安排其所需的照護資源。本文參酌國外經驗，對我國醫師在長照系統中該如何介入提出建議。醫師角色會隨不同的長照服務而有所差異，包括：一、在病人進入長照體系時，個案管理師對其進行評估，並照會醫師，以引導個案接受適當的長照資源；二、醫師進行居家和社區式長照，須在不同層面照護中扮演持續性的角色；三、醫師須在機構式長照中扮演整合與管理性角色。在跨專業團隊中，醫師應期許自己擔負起模式規劃者、團隊協調者、照護創新者，以健全長照服務系統。
並列摘要
The need for long-term care has been on a rapid rise in Taiwan because of the constant increase in the aging population at higher risk for disability. It is estimated by the Executive Yuan that the percentage of disabled people will escalate to 3.26% in Taiwan's total population and 16.04% in the aged population (aged over 65 years old) by 2018; that would be approximately 773,070 and 560,781 cases respectively. However, in spite of the pressing demand for long-term care, the government continues to place greater emphasis on acute care. The long-term care system provides multi-level services that require multidisciplinary members (including physicians) collaborating with each other to assess patients and arrange needed care. Our study investigates the current status of long-term care in Taiwan and reviews the roles and responsibilities of physicians in long-term care. In general, physicians are able to perform comprehensive assessment of patients' disease progression, disability status, and remediable diseases and facilitate referral and consultation for appropriate care for needed patients. After reviewing papers about foreign long-term care experiences, our research team proposes some suggestions concerning the involvement of physicians in the long-term care system. The roles of a physician roles vary along the different stages of the long-term care process. First, at the entrance of a patient into the long-term care system, the physician should be consulted for providing comprehensive medical services based on the initial assessment by the case manager. Second, the physician should play an active role to provide continuous care at different levels of care services in home and community-based long-term care. Third, the physician should be in charge of service integration and administration in institutional long-term care. In a multidisciplinary team of long-term care, the physician is expected to develop care models, coordinate the works among team members, and initiate innovations to help build up a well-rounded long-term care system.
延伸閱讀
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