長期照護相關機構醫師參與服務現況之調查：以雲林縣與台北市爲例

我國長期照護之需求，在未來30年間將因人口結構高齡化之快速發展而增加，其中護理之家與安養護機構在機構式長期照護中，將扮演著重要的角色。這些機構中的住民無可避免地將會有醫療服務的需求，因此將醫師納入服務之一環有其必要性。本研究的目的是調查護理之家與安養護機構醫師參與照顧服務之現況。研究對象，在雲林縣包括縣內全部登記有案的護理之家與安養護機構，各有8及11所；在台北市則以隨機抽樣之方式分別從13所護理之家中選取8所，及從199所私立安養護機構中選取8所，加上全部之公立機構有3所，共計11所安養護機構。再用半結構式問卷以電話訪談機構之護理長或負責人方式進行資料的收集。全部38家樣本機構中有35家(92.1%)有醫師固定參與健康照顧，其中31家(88.6%)之醫師爲兼任或特約。財務負擔考量是機構無醫師參與之重要因素。認爲有固定醫師參與健康照顧必要之機構高達97.3%，認爲尋求醫師容易的比例亦達77.4%。受訪之機構普遍具有強烈聘請固定醫師之意願，醫師的工作內容以「住民入住期間之健康評估」及「疾病診療」爲主。護理之家每位住民每週醫師服務人時在雲林縣爲0.22±0.03，台北市爲0.12±0.07；安養護機構在雲林縣爲0.21±0.20，台北市爲0.06±0.06。醫師之專科以家醫科(50.0%)與內科(50.0%)爲主。目前長期照護機構中有醫師參與服務之比率頗高，但就醫師服務內容仍有提昇的空間。

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並列摘要

The need for long-term care is expected to increase rapidly as the population soars in the coming thirty years. The nursing home and residential care house can play important roles in the delivery of such care. When the residents living there develop some health care needs, the physicians' adequate interventions are essential to meet those demands. This study intends to survey and analyze the current status of physician's involvements at nursing homes and residential care houses in Taiwan. Our study covered all 8 licensed nursing homes, and 11 licensed residential houses in Yunlin County (YC). While in Taipei City (TC), we selected randomly 8 private nursing homes out of 13; eight private residential care houses from 199, along with 3 public houses, all of them are licensed. We conducted the study through semi-structured questionnaire by telephone-interview. As the results showed, out of 38 facilities surveyed, there were 35 settings (92.1%) with regular physicians' involvement, most of them (31 settings, 88.6%) were provided part-time or contractedly though. The remaining 3 settings had no regular physician's visit. Financial burden were the main reason to blame for no physician service. Thirty-seven (97.3%) settings emphasized the importance of physician role in health care, and 29 (77.4%) settings said it was easy to reach the doctors, and most facilities expressed strong willingness to invite physician to get involved in their health care delivery. Among the service contents, general health evaluation during admission and case management were the two main parts of service in these settings. The average service time for physician to one resident was 0.22±0.03 person-hour per week in nursing home in YC, and 0.12±0.07 in TC; as for elderly residential care house, it was 0.21±0.20 in YC and 0.06±0.06 in TC. About the professional background of physicians, Family Medicine (50.0%) and Internal Medicine (50.0%) comprised the two leading fields. So, we concluded that long-term care facilities providing physician service seemed high in proportion, yet the care contents of physician could be improved further.

並列關鍵字

physician role ； nursing home ； elderly residential care house ； long-term care

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長期照護相關機構醫師參與服務現況之調查：以雲林縣與台北市爲例

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