醫院推行實證醫學現況、醫師認知與推行態度及其影響因素探討-以台北市區域級以上醫院為例

The Implementation EBM in Hospitals in Taipei City and Factors Influencing Physicians' Attitude Toward Applying EBM

李雅惠(Ya-Hui Lee)

指導教授 ： 許怡欣 ； 侯勝茂

臺北醫學大學/公共衛生暨營養學院/醫務管理學研究所/碩士(2003年)

摘要

本研究之主要目的在於瞭解台北市區域級以上醫院推行實證醫學的現況，醫師參與實證醫學之情形及應用上的障礙，並探討醫師對實證醫學的認知與推行態度，及其影響因素，期能作為醫院管理者推動實證醫學之參考。 本研究為橫斷性研究，以台北市區域級以上之醫院為研究對象，研究內容分為質性研究與量性研究兩部份，在質性研究方面，針對5位已推行實證醫學之醫院關鍵人進行深入訪談，以了解醫院推行實證醫學之實際情形。量性研究方面，以結構式問卷進行調查，以了解醫師對實證醫學之認知與推行態度，問卷共發出3,776份，回收之有效問卷為757份，回收率為20.05%。 本研究之主要結果如下： 一、醫院推行實證醫學現況：目前台北市區域級以上醫院中，有5家醫院 已開始推動實證醫學，另有3家醫院表示正在規劃中。 二、醫師參與實證醫學相關活動情形：有37.9%醫師過去曾參與實證醫學 相關課程，但有91.3%表示未來願意參與實證醫學相關活動。 三、醫師在應用實證醫學所遭遇到的障礙主要依序是缺乏實證醫學教育訓 練（49.3%）、沒有時間（48.1%）。 四、醫師對實證醫學之認知與推行態度及其影響因素： 1、醫師對實證醫學英文名詞的了解程度方面，醫師對各項實證醫學英文 名詞的了解程度平均分數介於2.56至3.51分之間（以非常了解為5分， 完全不了解為1分）。而推行範圍、執業年資、過去是否曾參加實證醫 學課程及過去參加實證醫學課程時數對醫師對實證醫學英文名詞的了 解程度有顯著影響。 2、受訪醫師對各項實證醫學敘述的贊同程度平均分數介於3.04至4.12分 之間（以非常贊同為5分，完全不贊同為1分）。而是否擔任教職、未 來參與實證醫學相關活動意願及身邊其他人的贊同程度對於醫師對實 證醫學敘述的贊同程度有顯著影響。 3、醫師自評診療中符合實證醫學的程度平均為54.42%。而醫院權屬別、 是否擔任教職與身邊其他人的贊同程度對於醫師自評診療中符合實證 醫學的程度有顯著影響。 4、醫師自評診療中符合實證醫學的合理程度平均為72.63%，而醫院權屬 別與身邊其他人的贊同程度對於醫師自評診療中符合實證醫學的合理 程度有顯著影響。 根據研究結果，本研究提出下述建議：一、建議衛生主管機關可成立全國性的實證醫學中心，積極鼓勵醫療院所推行實證醫學，也可考慮將實證醫學的相關教育訓練納入醫院評鑑。二、建議教育單位可將實證醫學相關的課程納入正規醫學教育，使醫師未來能更順利、迅速且正確的將實證醫學的方法應用在臨床的診療中。三、醫院若欲推行實證醫學，建議可設置專責單位或運用任務編組的方式成立推動小組或委員會，以整合相關資源及給予醫師適當的援助。四、後續研究者可在實證醫學的推行一段時間後，再調查醫師對其認知與推行態度及應用實證醫學的程度是否有不同，以了解實證醫學推行之成效。

關鍵字

實證醫學 ； 醫師 ； 認知與態度

並列摘要

The purposes of this study were to (1) understand the correct state of hospitals’ implementing Evidence-based medicine (EBM), (2) understand physicians’ participation situation, and the barriers of applying EBM, (3) the explore physicians’ perceptions and attitudes toward EBM, and their related factors. This cross-sectional study employed both qualitative and quantitative methods. For the qualitative method, 15 medical centers and regional hospitals in Taipei city were sampled, and five key persons involved in implementing EBM were interviewed. Regarding the quantitative method, the study population included physicians from 15 participating hospitals as mentioned above. Structured questionnaires were sent to physicians, a total of 3,776 questionnaires were distributed with 757 questionnaires being returned. The response rate was 20.05%. Descriptive statistics, ANOVA, X2 test, correlation analysis, and multiple regression analysis were used in data analysis. The major findings were: 1.Five hospitals had already implemented EBM, and three hospitals were in the process of implementing EBM. 2.There were about one third (37.9%) physicians had taken EBM training courses, while 91.3% expressed their willingness to attend EBM activities in the future. 3.The major barriers of physicians to apply EBM were lack of EBM training (49.3%) and time (48.1%). 4.Physician’s attitude toward EBM: a.The average score in Physicians’ understanding EBM terminologies were from 2.56 to 3.51(score ranged from 1 to 5, 5 represented fully understand). The understanding was found significantly related to the implementation level of hospital, practice field of physician, field experience of physician, hours of EBM training, and the attitudes of physicians’ colleagues. b.In general, physicians hold positive attitudes toward EBM, the average score was from 3.04 to 4.12 (score ranged from 1 to 5, 5 represented the most positive). The score varied significantly according to whether the physician serves as medical college faculty, physicians’ willingness to attend EBM activities in the future, and the attitudes of physicians’ colleagues. c.The degree of EBM applicability in physicians’ opinions was 54.42%. It was found significantly related to the ownership of hospital, whether the physician serves as medical college faculty, and the attitudes of physicians’ colleagues. d.The degree of reasonable EBM applicability in physicians’ opinions was 72.63%. It was influenced by the ownership of hospital, and the attitudes of physicians’ colleagues. Based on the findings, there are four suggestions: (1) The Department of Health can set up a national-wide EBM center and include the EBM training program as one evaluating criteria in healthcare organization accreditation. (2) Medical schools can provide EBM-related courses to train physician with the ability in applying EBM. (3) Hospitals can establish a task force to promote EBM.

並列關鍵字

Evidence-based medicine ； physician ； attitude

參考文獻

邱文達、林曉蕾(2001)醫療品質的新發展。新臺北護理期刊，3(2)，1-7。

郭斐然等(2001)。實證醫學於實習醫師臨床訓練之應用。醫學教育，5(3)，24-29。

邱建勳、黃柏青與李友專(2001)。證據醫學簡介。當代醫學，28(7)，60-63。

盧美秀(2001)。實證醫學、實證護理與實證管理。新臺北護理期刊，3(1)，1-3。

中文部份 李玉春(2002)。醫院總額支付制度之規劃。全民健康保險醫院總額支付制度研討會。台北。 李崇維、侯勝茂(2000)。實證醫學。當代醫學，27(3)，45-51。