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偏遠地區社區醫療照護計劃之評估─花蓮縣秀林鄉之實證研究

Evaluation of Community-Based Medical Care Plans in Remote Areas-an Empirical Study of Shioulin Township, Hualien

摘要


目標:健保局為改善偏遠地區醫療照護,首先委託門諾醫院於花蓮秀林鄉實施社區醫療照護計劃,計畫內容以提供社區巡迴醫療服務為主,本文旨在評估該計畫中短期執行成效。方法:採用準實驗設計已崇德、和平為介入區,銅門、文蘭為對照區,結合縱貫性研究方法,以2年為研究期間,等分為4個階段,分析健保醫療利用資料,評比介入區與對照區介入前後醫療利用的演變,結果:介入前介入區之西醫門診次數為半年4.74次,介入後增至5.80次,對照區則由5.86次增至6.64次,呈平行成長趨勢。介入前介入區之牙科門診次數為0.17次,對照區為0.28次;介入後介入區增至0.24次,對照區降至0.23次,已無顯著差異。兩區住院率介入前後皆無顯著差異。介入後秀林衛生所於介入區服務量變化不大,仍提供介入區9%的西醫門診服務,門諾提供12%的服務,原住民;女性;嬰幼兒、老人等弱勢族群使用巡醫服務比例較高。結論:門諾計劃改善介入區醫療可近性,提昇當地門診利用;巡醫服務為補充性醫療資源,未取代原有衛生單位的醫療業務,提供弱勢族群更多就醫選擇。計劃工作內容濃縮至巡醫服務,門諾計劃中長期成效,現階段無法達成健康促進之目標,僅能以醫療利用的變化來評價其功能。

並列摘要


Objectives: To improve medical care in remote areas has been one of the primary endeavors for the National Health Insurance Bureau (NHIB). Mennonite Hospital was the first institute sponsored by the mill to implement a community-based medical care plan in Shioulin. This program provided itinerant clinical services for the intervened communities. The objective of this study was to evaluate the short- and mid-term effects of the community program. Methods: A longitudinal quasi-experiment was carried out to compare the utilization of outpatient services and hospitalization between the intervened and controlled communities over four 6-month periods. The intervened villages were Chungde and Heping. Wenlan and Tungmen were selected as controls. Results: There was a parallel increase in the utilization of outpatient , services in both intervened and controlled areas. The number of visits was 4.74 before Intervention, and increased to 5.80 after intervention in the intervened area; it was 5.86 and increased to 6.64 in the controlled. Before intervention, the number of dental clinic visits was 0.17 in the intervened, and 0.28 in the controlled. After intervention, the number increased to 0.24 in the intervened, but decreased to 0.23 in the controlled. and the difference in the number of dental clinic visits between the two communities had diminished. There were no significant differences in the utilization of hospitalization between the two communities. After intervention, the total amount of outpatient services provided by the Shioulin Health Station did not change notably in the intervened area, but the share of the services had changed over the study period, it decreased tram 11.7% to 9.4% for the Health Station. The share for the Mennonite itinerant medical team became important and accounted for 11.9% of the outpatient services in the area after intervention. The clients of the two local outpatient facilities consisted mainly of aborigines, females, infants, and elders. Conclusions: The itinerant healthcare services provided by the Mennonite Hospital improve? the accessibility of medical care, and increased utilization significantly in the intervened area. These services were, on one hand, important resources to the community, but on the other hand, supplementary, and did not replace those offered by the Shioulin Health Station. However, the mid- or long-term effects of the community program were not obvious, and the ultimate goal, holistic health promotion, could not be achieved at this stage.

被引用紀錄


楊貴蘭(2004)。探討山地鄉實施「醫療給付效益提升計畫」對民眾醫療服務利用影響與可近性之成效—以屏東縣牡丹鄉為例〔碩士論文,國立臺灣大學〕。華藝線上圖書館。https://doi.org/10.6342%2fNTU.2004.10344
謝春福(2004)。醫療給付效益提昇計劃前後馬祖地區民眾醫療利用與費用之分析〔碩士論文,國立臺灣大學〕。華藝線上圖書館。https://doi.org/10.6342%2fNTU.2004.01932
林宜瑾、郭年真(2019)。中醫資源可近性對於中醫門診利用之影響台灣公共衛生雜誌38(6),604-616。https://doi.org/10.6288%2fTJPH.201912_38(6).108072
張朝琴(2003)。台灣山地鄉原住民醫療照護體系之研究---健康權保障觀點的檢視〔博士論文,國立臺灣師範大學〕。華藝線上圖書館。https://www.airitilibrary.com/Article/Detail?DocID=U0021-2603200719132030
陳天順(2004)。金門縣民眾縣外就醫影響因素之探討〔碩士論文,臺北醫學大學〕。華藝線上圖書館。https://www.airitilibrary.com/Article/Detail?DocID=U0007-1704200714562642

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