兒科醫師對兒童預防保健認知、態度與參與意願之探討

Survey of Pediatricians' Awareness, Attitudes, and Willingness to Provide Child Healthcare Prevention

紀櫻珍(Ying-Chen Chi) ； 古智愷(Chih-Kai Gu) ； 吳振龍(Chen-Long Wu) ； 黃富源(Fu-Yuan Huang)

《北市醫學雜誌》 2卷12期 (2005/12) Pp. 1107-1116

https://doi.org/10.6200/TCMJ.2005.2.12.04

摘要

目的：有鑑於臺灣生育率明顯下降，少子化以及新移民女性生育的新生兒比率漸增的現今社會裡，照護兒童的身體健康與心理之健全發展日益重要，本研究欲探討兒科醫師對現行兒童預防保健服務的認知、態度及參與意願的模式，希藉此研究提昇兒童預防保健服務之品質、提高家長重視其子女的身心健康發展及對此項服務之接受度及使用率。方法：本研究採取橫斷式的研究法，研究期間為2004年7月至同年12月底，研究對象包括兒科醫學會理監事、會員代表與各層級醫院兒科主任、縣市衛生所主任等共123位醫師，研究工具以結構式問卷為主，用郵寄的方式進行調查。結果：研究對象資料以男性居多81.1%，平均年齡為46.35歲，平均執業年資為16.29年，執業場所醫學中心30.9%最多，大部分為無特約補助院所佔61.0%。有提供「兒童健康身心發展評估」服務者佔90.8%，平均花費9.91分鐘；提供「兒童健康檢查」佔99.1%，平均花費8.02分鐘；提供「兒童保健指導」佔93.8%，平均花費6.94分鐘；以上三項服務大部分由主治醫師親自執行，可同時執行一般疾病診療與健康檢查者佔52.8%；贊成將兒童健康檢查納入醫師再教育者佔88.1%；認為易降低醫師執行兒童預防保健意願之因素則以支付金額太低(73.3%)佔最多，其次依序為花費時間太多(59.5%)、檢查過程太繁瑣(28.4%)等。結論：在出生率降低、新移民女性生育的新生兒比率漸增、少子化併發症、家暴問題等日趨嚴重的今日，兒童預防保健更形重要。本研究建議政策執行者能考量及時提高兒童預防保健之給付及制訂出一套適合臺灣國情的標準兒童預防保健檢查項目及其程序，如此不但可以讓醫師、家長重視兒童身心之健康，且能兼顧其兒童預防保健之品質。兒科醫師的首要任務則為確保兒童身體與心理健康，並解決家長在兒童健康上的疑惑，尤其是迫切需要解決新移民女性照顧其子女之困擾，提供兒童連續性且完整性的健康保健服務，進而提昇父母親對其子女正常生長發育的認知及具備預防醫學、加強衛生教育防患未然的概念。

關鍵字

兒科醫師 ； 兒童預防保健

並列摘要

Background and Purpose: In recent years, the birth rate has continuted to drop and people are having fewer children; furthermore, more and more babies are born to new immigrant females in Taiwan. The situation necessitates better attention to the healthy physical and mental development of children. The aim of the survey was to examine pediatricians' awareness, attitude and willingness to provide child healthcare prevention. This was in an effort to improve the quality of preventive child healthcare, and to raise the parents' awareness of the child's physical and mental health development as well as their acceptance and utilization of prevention child healthcare. Methods: From July to the end of December 2004, a cross-sectional method was used for the survey. The research included 18 directors and supervisors of the Taiwan Pediatric Association, 123 member representatives of the same association, the heads of the Pediatrics Department at various hospitals and 46 heads of county/city health offices. Questionnaires were sent to these individuals by mail. Results: The majority of those surveyed were males and had an average age of 46.35 years. On average, the surveyed doctors had practiced pediatrics for an average of 16.29 years. Of these doctors, 30.9% were pediatricians at medical centers and 74.0% practiced outside of Taipei City. Among them, 90.8% provided ”an evaluation of the child's physical and mental health development”, while 99.1% provided ”child health examinations” and these took an average of 8.02 minutes. In addition, 93.8% of them provided ”children healthcare instruction”, which took an average of 6.94 minutes. The above three services were mostly administered by the attending pediatricians themselves. Of the pediatricians, 52.8% were able to perform the regular pediatrics and health examinations concurrently and 88.1% were in favor of including children health exams in medical reeducation. The primary causes of a reduced willingness of pediatricians to provide preventive children healthcare was that the compensation was too low (73.3%) the examinations were too time-consuming (59.5%), and the procedures were too complex (28.4%). Conclusion: These factors together with increased domestic violence mean that preventive child healthcare is becoming increasingly important. This survey suggests that policy implementers should consider raising the payments made to doctors for preventive child healthcare and that they should draw up a standard list of health exam items and procedures. These should suit Taiwan's current situation and this will result in an increased awareness by physicians of the child physical and mental health and improve the quality of prevention children healthcare; this, in turn, will increase parental awareness of the same issues. The pediatrician's first priority is to ensure the child's physical and mental health, and respond to the concerns that parents have about their child's health. In particular, pediatricians need to solve the problems that new immigrant females face over child healthcare. They need to provide parents with continuous complete child healthcare services and raise parents' awareness of the child's normal growth and development, as well as equipping the parents with knowledge of preventive medicine and hygiene.

並列關鍵字

pediatrician ； child healthcare prevention