在宅醫療觀點分享

Sharing Perspectives on Home Healthcare

許碧珊(Pi-Shan Hsu) ； 陳睿安(Jui-An Chen) ； 陳御左(Yu-Tso Chen) ； 巫翰明(Han-Ming Wu) ； 李思瑩(Szu-Ying Lee) ； 賴仲亮(Chung-Liang Lai)

《護理雜誌》 65卷1期 (2018/02) Pp. 5-10

https://doi.org/10.6224/JN.201802_65(1).02

摘要

二次世界大戰後的戰後嬰兒潮，加上醫療技術與公共衛生突飛猛進，使得全球人口快速老化；亞洲國家老化的速度居世界之冠，台灣估計約7－10年就會從高齡社會變成超高齡社會。長期照護的需求日益增加，對健康威脅的疾病型態由急性轉向慢性，健康照護重心由疾病轉為功能導向，處理健康問題的腳步逐漸由治癒（cure）轉成照護（care）。原先作為照護基石的家庭，因少子化與高齡化的現象顯得難以負擔，加上民眾要求兼顧健康照護與生活品質的浪潮，使得在宅醫療在醫療體系中的角色與日俱增。高齡照顧專業呈現多樣且蓬勃發展的樣貌；從照顧專業、護理專業、家庭醫學、高齡醫學、復健醫學、遠距醫療與醫療輔助器材的發展及社會福利資源的整合趨勢，跨專業團隊使在宅照護服務更有能力提供複雜的醫療照護。生命終了前，安寧居家醫療增加個案在家臨終心願的可行性、降低選擇在家往生者的末期症狀且減低遺族的悲傷。台灣在中央健康保險單一保險人的制度下，為了有效彈性運用醫療資源，抑制醫療費用的上漲，以在宅醫療服務取代部分住院與機構式照護是必然的趨勢。

關鍵字

高齡 ； 在宅醫療 ； 跨專業團隊

並列摘要

The baby boom after World War II, coupled with the rapid advances in medical technology and public health, has led to the current rapid aging in the world's population. Countries in Asia are experiencing a faster rate of aging than most other countries around the world. Taiwan is expected to advance from an aged society to a super-aged society in the next 7~10 years. Consequently, the demand for long-term care is increasing. The focus of healthcare has changed from acute to chronic, from disease-oriented to function-oriented and from cure to care. Families, once the cornerstone of care, have become overwhelmed by the effects of the declining birthrate and aging. Encountering the public demand for a balance between healthcare and quality of life has led to the increasing role of home-based care in the medical system. The elderly-care profession is diverse and growing. The trend of transdisciplinary team which integrating care professions, nursing professions, family medicine, geriatric medicine, rehabilitation medicine, telemedicine, and medical aids with the resource of social welfare enables home health care services to better provide well-rounded medical care. Before end of life, hospice home care services increase the likelihood of dying at home in accordance with the patient's preference, easing the symptoms of terminal illness and reducing the sorrow experienced by family members. The single insurer model used by the National Health Insurance system will inevitably replace some hospital and institutional services with home health care services that more effectively and flexibly use medical resources and attenuate the increase in medical costs.

並列關鍵字

elderly ； home healthcare ； transdisciplinary team

參考文獻

黃喬煜、徐愫萱、孫文榮、李易翰、翁瑞萱、吳孟嬪…黃勝堅（2017）．提升「死亡識能」―推廣在宅善終的高價值照護．北市醫學雜誌，14（3），269–278。[Huang, C. Y., Hsu, S. H., Sun, W. J., Lee, Y. H., Ueng, R. S., Wu, M. P., ... Huang, S. J. (2017). Promoting death literacy - A high value health care for good death at home. Taipei City Medical Journal, 14(3), 269–278.] https://doi.org/10.6200/TCMJ.2017.14.3.01

洪暐傑、莊佳惠、吳美儀、楊宜青、吳晉祥、林季緯（2015）．家庭醫師全人醫療照護模式應用於居家照護．台灣家庭醫學雜誌，25（4），271–278。[Hung, W. C., Chuang, C. H., Wu, M. Y., Yang, Y. C., Wu, J. S., & Lin, C. W. (2015). The holistic health care model of family medicine: Its applications in home health care. Taiwan Journal of Family Medicine, 25(4), 271–278.] https://doi.org/10.3966/168232812015122504006

Gomes, B., Calanzani, N., Curiale, V., McCrone, P., & Higginson, I. J. (2013). Effectiveness and cost-effectiveness of home palliative care services for adults with advanced illness and their caregivers. Cochrane Database of Systematic Reviews, 6, Art. No.: CD007760. https://doi.org/10.1002/14651858.CD007760.pub2

Legg, L., Gladman, J., Drummond, A., & Davidson, A. (2016). A systematic review of the evidence on home care reablement services. Clinical Rehabilitation, 30(8), 741–749. https://doi.org/10.1177/0269215515603220

Nancarrow, S. A., Booth, A., Ariss, S., Smith, T., Enderby, P., & Roots, A., (2013). Ten principles of good interdisciplinary team work. Human Resources for Health, 11, 19. https://doi.org/10.1186/1478-4491-11-19