機構內持續性醫療對榮民醫療利用、健康狀況與滿意度之探討—以退輔會南部安養機構為例

近年來由於醫療科技快速進步，醫療專業領域分化越來越細，醫師朝向高度專科化發展，關注在特定疾病的治療甚於民眾及社區整體的健康，而醫療費用也逐漸升高，為改善目前的醫療服務體系，推動的基層醫療為未來的重點。過去的研究也顯示持續性基層醫療服務可減少民眾就醫率，醫療滿意度高且降低醫療費用。目的：在探討機構內保健組門診醫療服務模式不同，一為有固定醫師的持續性醫療服務，一為支援醫師門診醫療服務，對榮民的醫療利用情形、健康狀況及醫療滿意度是否有差異。並探討影響榮民醫療利用及健康狀況的相關因素。方法：研究採橫斷性調查，以退輔會南部地區四家安養機構榮民為研究對象，有效個案有232位。研究工具為結構性問卷，內容包括榮民基本資料、醫療利用情形、SF-36健康相關生活品質量表及對保健組醫療滿意度量表，利用SPSS 10.0 for windows電腦統計套裝軟體進行統計分析。結果：研究對象皆為男性，平均年齡為80.4歲，平均罹患2.1種疾病的人最多，其中以高血壓患者佔最多，有48.7﹪，平均門診就醫次數為39.1次/年。在有固定醫師提供持續性醫療服務的安養機構，榮民有固定就醫場所者較多；保健組門診就診次數、就診率及急診就診次數較高，達顯著性差異；身體功能角色限制情況及活力狀態兩個健康相關構面分數較高，達顯著性差異；對保健組門診醫療的滿意度較高，達顯著性差異。醫療利用情形的相關因素為慢性疾病數、運動習慣、健康狀況、對保健組醫療服務的滿意度。以複迴歸分析生理健康面向的重要預測因子為慢性疾病數、運動習慣、住院次數及保健組門診就診次數。心理健康面向的重要預測因子為對保健組醫療滿意度、慢性疾病數及急診次數。結論：本研究顯示機構內保健組有固定醫師門診者，因為提供一持續性基層醫療服務，因此榮民固定就醫比率高、機構內保健組門診的就診率高，健康狀況較佳，對機構門診醫療的滿意度較高。建議：醫療逐漸趨向專科化，醫院朝向大型化發展，而民眾也習慣到區域醫院，醫學中心追求高科技化的醫療服務，造成基層醫療不被重視而漸漸萎縮；希望未來能重視基層醫療的重要性，推動家庭醫師制度；在設立養護機構門診醫療時，應設立專任醫師以提供連續性及周全性的疾病照護與健康諮詢，使機構內榮民能得到全人照護，促進健康。另一方面，藉由本研究探討機構內榮民，瞭解醫療利用情形、健康狀況及對醫療照顧的滿意度，以作為未來建構安養機構的參考。

關鍵字

基層醫療；持續性醫療照顧；醫療利用情形

並列摘要

Nowadays the rapidly changing medical technology develops toward specific medical specialties. Doctors focus on learning professional knowledge, paying more attention to medical therapy of particular diseases than the health of people and the whole community. Medical expenses are promoted as well. In order to have the present medical services system improved, more attention in the future should be paid to the primary medical cares. The previous studies have shown that the continuity of primary care can contribute to the health of patients, reduce medical expenses, and promote the medical satisfaction. Objectives: this study is to research on the different models of outpatient services of Health Care in institutions. One is the continuous medical service with fixed doctors, and the other is with supporter doctors. Differences in the medical treatment, health status, and satisfaction with medical care of veterans are discussed here. Also the relevant factors about medical treatment and health condition of the veteran servicemen are studied. Methods: transverse methodology has been used to survey on the veteran servicemen in the four public care institutions. 232 effective research samples have been used. Structural questionnaires have helped to record their basic information, medical utilization, SF-36 health-related life of quality, and satisfaction with medical services. Results: all the objects of this study are male with the average age of 80.4 years old. Most of them suffer from 2.1 diseases averagely, and high blood pressure is in the majority of 48.7%. The average times of total outpatient services are 39.1 times per year. The care institutions with the fixed doctors and continuous medical services have more veterans that go to the steady doctors. These patients have a higher use of institutions clinics, and higher rate of institutions clinics , higher use of emergency Furthermore, they have better body function and vitality, higher satisfaction with primary medical cares in institutions. The relevant factors of using the medical services are the number of chronic diseases, exercise habits, health condition, and satisfaction with the medical services in Health Care. In physical health, the major elements are the number of chronic diseases, exercise habits, and numbers of times of hospitalization and outpatient services in Health Care. In mental health, the major elements are satisfaction with the medical treatment in Health Care, the number of chronic diseases, and the number of times of emergency cases. Conclusion:This research appeals that the veterans have higher rate of using the medical services , and higher satisfaction with the primary medical care when the Health Care in an institution offers fixed doctors and continuous medical services. Suggestion:Medical services are toward specialization. Hospitals develop toward large-size model. People are used to going to the area hospital. Medical centers look forward high technology medical services. Along this line, the primary medical care are ignored and gradually atrophying. Hopefully the importance of the primary medical care will receive more attention in the future, and the system of family physicians can be promoted. A care institution with outpatient services should be established with full-time doctors and continuous, complete medical treatment and health counseling, which can have the veterans with complete care and better health condition. On the other hand, this research about the needing of medical services, health condition, and satisfaction with medical care of the veteran servicemen can be reference materials for organizing a care institution in the future.