民眾對「家庭醫師整合性照護計畫」知識、態度及行為之探討--以社區醫療群糖尿病人為例

摘要研究目的在「全民健保家庭醫師計畫」自2003年起試辦，為評價其推動成效，是否達到家醫制度之整體性、協調性、持續性的醫療服務，擬透過社區醫療群提報之罹患糖尿病家戶會員，與未加入試辦計畫之糖尿病患者，進行「全民健保家庭醫師計畫」的知識、態度及行為之探討與分析。研究方法 ․研究設計以類實驗性研究，調查期間自民國94年1月20日至1月31日止。 ․研究對象來源為登記於社區醫療群罹患糖尿病之健康家戶會員及未登記成為健康家戶會員之糖尿病患者。 ․採SPSS for windows 10.0 統計套裝軟體進行描述性及推論性比較分析研究結果 ․實驗組與對照組民眾對「全民健保家庭醫師計畫」知識及態度構面呈顯著性差異，在行為構面，呈無顯著性差異。 ․研究發現在政策推動認知題中，有56.2﹪受訪者知道健保局正在推動「全民健保家庭醫師計畫」；有52.3﹪受訪者瞭解「全民健保家庭醫師計畫」內容。在家醫制度概念題中，有67.6﹪受訪者知道家庭醫師是提供以家庭為單位的照護；有72.9﹪受訪者知道家庭醫師可提供適當之醫療諮詢服務。有96.8﹪受訪者認為醫護人員應該鼓勵民眾加入試辦計畫；有96.7﹪受訪者認為民眾均應加入試辦計畫。在醫療利用選題中，有95.4﹪受訪者認為「全民健保家庭醫師計畫」之推動，能減少醫療資源浪費；有96﹪受訪者認為「全民健保家庭醫師計畫」之推動，能減少逛醫院情形；有95.6﹪受訪者認為「全民健保家庭醫師計畫」推動，能減少醫療重複使用情形。整體而言，支持「全民健保家庭醫師計畫」之受訪者達97.3﹪。結論與建議 ․總額制度之實施，使得醫療品質改善、民眾就醫權益保障及健保財務之穩定成為熱門及眾所關切之議題。中央健康保險局推動之本土化家庭醫師整合性照護計畫亦賦予有效提升醫療品質，健全醫療環境，達到全民健康的重責大任。本研究探討了民眾對家醫制度在知識、態度、行為上差異表現，由結果顯示雖實驗組與對照組在知識與態度構面有明顯之差異，然在家醫制度推動及內容瞭解之程度上，僅五成受訪者知道家醫制度推動之內容，仍顯不足，另研究顯示有七成受訪者具有家醫制度基本概念，因此，建議中央健康保險局應積極加強政策與制度宣導之普及性，透過全民共識來落實家醫制度，共同改善當前醫療行為。 ․研究顯示實驗組與對照組在行為構面無明顯之差異，表示無論實驗組與對照組未因家醫制度之短期介入產生行為上之改變。由文獻資料顯示：透過衛教的方式達到行為改變的目的，行為改變的效果測量，須長期監測，而家庭醫師即是家醫制度中最佳之衛教施行者，為達到有效行為改變之連動，建議中央健康保險局在醫療支付部份應採論人計酬方式，因為在論人計酬的支付制度下將會影響醫師的行為改變，並且會鼓勵醫療體系的整合。在這樣制度下，各醫療組合將以最有效率的方式來運作。關鍵詞：家庭醫師、知識態度行為、社區醫療群、健康家戶會員

關鍵字

行為；知識；態度；社區醫療群；健康家戶會員；家庭醫師

並列摘要

Abstract Objectives The implementation of global budget system, the quality of medical care, right of public medical need and BNHI financial stability became hot public issue. BNHI promoted local family practice IDS that improve quality of medical care, concrete medical environment and achieve the responsibility of health service for everyone. Under the “family practice IDS” trial since 2003, evaluation of efficiency and result of the promotion, whether it meet the unique, balance, continuity of service of family medicine practice system. We try to compare patient’s knowledge, attitude and behavior of diabetic family’s members to those not entering the IDS. Methods Experimental research that started from 20th January till 31th January of 2005. Patients registered to the family practice group that suffering from diabetes and those not registered were included for this study. Descriptive analysis and statistic were done with SPSS for Windows velease 10. Results: The experimental group and control group public was significant different in knowledge, attitude about “family practice IDS”, but show no significant difference in behavior aspect. The study found that in questionnaire about recognition of policy promotion, 56.2% of those interviewed know that BNHI is promoting “family practice IDS”; 52.3% understand the content of “family practice IDS”. In questionnaire about the concept of family practice system, 67.6% understand that family physician provide medical care by family as a unit; 72.9% know that family physician can provide appropriate medical consultation. 96.8% think that medical personnel should encourage public to enter the IDS; 96.7% think that everyone should join the IDS. In questionnaire about medical resource 95.4% think that the promotion of “family practice IDS ”will decrease wasting of medical resource. 96% think that promotion of “family practice IDS ” will decrease patient “hospital shopping”; 95.6% think that promotion of “family practice IDS ”will decrease the repeated usage medical resource. In general, 97.3% support the promotion of “family practice IDS ”. Discussion and Suggestions This study emphasizes on the difference in public knowledge, attitude, behavior towards promotion of “family practice IDS ”. Although result show that there was significant difference in knowledge and attitude aspect between the experimental group and the control group, only 50% of those interviewed understand the content of IDS. This seemed not enough. The study also showed that 70% of those interviewed having the concept of family practice basic concept. We suggest that the BNHI should do more in promoting the policy and system to make it more popular. Through the implementation of “family practice IDS ” to improve the present medical seeking behavior. Study showed that there was no significant difference in behavior aspect between groups. This means that there was no behavior change after the implementation of the family practice system. Reference show that through medical education can change the behavior, and the effect of change in behavior need a long term follow up, while the family physician is the best in providing medical education. In order to achieve the aim of behavior change, we suggest the BNHI to implement capitation in part of its payment system. Keywords: family physicians, knowledge, attitude, behavior, community medical group, healthy family membership