臺灣醫院長者友善照護模式之發展與現況初探

Development and investigation of the age-friendly health care model in Taiwanese hospitals

胡芳文(Fang-Wen Hu) ； 王英偉(Ying-Wei Wang) ； 李佳綺(Chia-Chi Lee) ； 岳芳如(Fang-Ru Yueh) ； 羅玉岱(Yu-Tai Lo) ； 吳建遠(Chien-Yuan Wu) ； 王麗娟(Li-Chuan Wang) ； 鍾遠芳(Yuan-Fang Chung) ； 沈珊妤(Shan-Yu Shen) ； 陳宜君(I-Chun Chen) ； 黃基彰(Chi-Chang Huang) ； 林岱嬋(Dai-Chan Lin) ； 張家銘(Chia-Ming Chang)

《醫療品質雜誌》 14卷6期 (2020/11) Pp. 20-26

https://doi.org/10.3966/199457952020111406005

摘要

目的：本研究使用經由文獻查證與專家會議所發展之「醫院推動長者友善照護模式檢核表」，來調查臺灣醫院提供長者友善照護模式之現況，以期提供未來長者友善照護政策推動之參考。方法：以2019年至2020年參加國民健康署「建構延緩失能之長者友善照護模式試辦計畫」之醫院為對象，分別針對急診、住院與門診端，發放醫院推動長者友善照護模式檢核表，進行資料收集及分析。結果：總計36家醫院參與50個試辦計畫，急診、住院與門診端檢核表指標達成率為65.3-97.1%。門診端計畫於「在擬定照護計畫時，有納入公告預防性檢查與討論」及「預立醫療照護諮商之討論」達成率較低（47.8%）。急診端計畫於「訂定照護目標時，將長者的存活餘命、功能狀態、認知功能與生活品質納入考量」達成率僅有28.6%。住院端計畫則在成效指標「減少住院譫妄發生率」與「減少帶尿管出院比率」達成率較低（37.5%）。結論：臺灣醫院長者友善照護模式仍處於發展階段，在過程與結果面達成率較差。不論在急診、門診或住院端，針對照護計畫的擬定達成率皆較低，可能仍習慣於單一疾病為主的醫療照護模式，非處理長者多重慢性病況交錯的健康問題來制定照護計畫，未來建議除強化醫院流程制定以協助執行長者友善照護模式，另亟需提供醫療專業人員高齡照護相關教育訓練，以系統性全面落實醫院長者友善照護模式。

關鍵字

高齡 ； 醫院 ； 長者友善照護

並列摘要

Objective: We investigated the current practice of age-friendly health care in Taiwanese hospitals using self-developed checklists that incorporated data obtained from a literature review of recent studies and several expert meetings. Methods: In this cross-sectional exploratory research, we used the ＂Checklists for Promoting Acute Care in Older Adults,＂ designed for emergency, inpatient, and outpatient services to conduct a survey. We surveyed hospitals that participated in a pilot program initiated by the Health Promotion Administration from 2019 to 2020 for promoting age-friendly health care and preventing disability among older adults. Data were collected, and descriptive analyses were performed. Results: A total of 36 hospitals participated the pilot program, with 50 subprograms (23 outpatient, 20 inpatients and 7 emergency programs). The overall achievement rates were 65.3%-97.1% among the indicators in the checklists for various clinical settings. Several items had low achievement rates. For example, the achievement rates for ＂while developing care plans, take preventive examinations and discussions into consideration＂ and ＂advance care planning discussion＂ were 47.8% for outpatient services, and that of ＂while setting care goals, take survival, functional status, cognitive function, and quality of life into consideration＂ was only 28.6% for emergency services. For inpatient services, the achievement rates of ＂reducing the incidence of delirium＂ and ＂reducing the prevalence of urinary catheter placement at discharge＂ were 37.5%. Conclusion: In Taiwan, the age-friendly health care model in hospitals is in the developmental stage, and the achievement rate is low in terms of process indicators and outcome indicators, including the development of holistic care plans. Our results implied that hospitals may still be accustomed to a single disease-based medical care model, despite the fact that older patients with multiple comorbidities require integrated and comprehensive care. Hospitals wishing to engage systematically in the age-friendly health care model should focus on strengthening their implementation processes and proactively providing medical professionals with education and training regarding geriatric medicine.

並列關鍵字

elderly ； hospital ； age-friendly health care