家庭醫師整合性照護計畫成效探討－以病患滿意度評量－

The Patient Satisfaction Analysis of “Family Doctor Comprehensive Care System Plan”

楊耀城(Yaw-Cheng Yang)

指導教授 ： 蘇喜

國立臺灣大學/公共衛生學院/醫療機構管理研究所/碩士(2007年)

https://doi.org/10.6342/NTU.2007.10520

摘要

行政院衛生署及中央健康保險局於民國92年3月試辦「全民健康保險家庭醫師整合性照護計畫」，計畫推動策略是藉由社區醫療群，以群體力量落實分級醫療和轉診制度，以提供民眾周全性、協調性與持續性的服務；計畫目的在建立家庭醫師制度，建立以民眾健康為導向，以病人為中心的醫療觀念，期望能減少醫療浪費，提升醫療服務品質。
本研究主要目的在探討政府為推動「家庭醫師整合性照護計畫」建立家庭醫師制度之成效，以臺北縣社區醫療群診所之就醫民眾醫療品質滿意度來測量，分析民眾基本特質對參加家醫計畫情形、醫療利用、醫療服務品質之相關，進而探討參加家醫計畫會員與非會員對醫療利用、醫療服務品質滿意度之影嚮因素，希望藉由醫療服務使用者對醫療服務利用及醫療服務品質滿意度之調查來評量其結果，據以提供政府賡續推動本土化家庭醫師制度政策之參考，以建構完善的基層醫療服務網絡。
文獻探討針對研究主題與研究方法進行回顧，探討有關「家庭醫師整合性照護計畫」之家庭醫師及家庭醫師制度定義、國內外家庭醫師制度之發展、服務品質的發展與應用、醫療服務的利用等；研究工具參考國內外相關文獻，以Parasuraman，Zeithaml＆Berry於1988年針對服務品質5個構面22個項目提出之SERVQUAL評量表為範本，搭配民眾基本特質、醫療服務利用情形等，發展出探討病患對醫療服務品質滿意度之結構式問卷－「家庭醫師整合性照護計畫醫療品質調查表」。
本研究採橫斷性研究（cross sectional research），調查時間自96年5月10日至96年6月15日止，以立意抽樣方式針對臺北縣社區醫療群診所就醫診之民眾為調查對象，派訪員以面訪方式調查，實際回收問卷共計340份，去除填答不完整之問卷，有效問卷共338份，進行統計上的驗證。
研究假設不同基本特質之民眾在參與家醫計畫、醫療服務利用、醫療滿意度上有所差異；參與家醫計畫之民眾對社區醫療群診所滿意度比沒有參加家醫計畫民眾滿意度高；參與家醫計畫之民眾醫療服務利用比沒有參加家醫計畫民眾低。使用之統計工具為SPSS(13.0)版，其統計方法則包括使用Reliability analysis-scale分析量表的信度，用Descriptive statistics對受訪民眾之基本特質、就醫地區及醫師執業科別、家戶會員對家醫制度觀感、非家戶會員對加入家醫制度的態度等相關議題作描述性的分析。在推論統計方面用卡方檢定（chi-square）、t檢定及ANOVA分別對受訪民眾之性別、教育程度、職業、慢性病、自覺健康狀況以及受訪民眾醫療服務利用、醫療服務品質滿意度等作雙變項分析，再依據統計分析結果進行羅吉斯迴歸（logistic regression）、複迴歸（multiple regression）模式驗證，本研究所有變項均以P值小於0.05界定為統計上有顯著意義。
依據問卷統計結果分析：（1）民眾基本特質與家醫計畫參與情形，經羅吉斯迴歸模式分析，發現「年齡」、「有無慢性病」有顯著關聯，表示年齡（＞41－60歲以上）、有無慢性病二個變項是影嚮民眾參加家醫計畫之重要因素。（2）家戶會員與非家戶會員對醫療服務品質的滿意度，經複迴歸（multiple regression）模式驗證，發現有顯著的差異，家戶會員對社區醫療群診所提供醫療服務品質之滿意度，無論在「有形性」、「反應性」、「可靠性」、「保證性」、「關懷性」、「整體醫療服務」各構面均比未參加家醫計畫非會員高，故家醫試辦計畫對提升醫療服務滿意度有其成效。（3）家戶會員與非家戶會員對醫療服務之利用，經複迴歸模式驗證，發現家戶會員在「本診所門診次數」的醫療服務利用上低於非家戶會員；由此推論，家醫試辦計畫對減少醫療資源浪費有一定成效。
茲針對研究結果，對衛生主管機關建議應持續推動「家庭醫師整合性照護試辦計畫」，並應比照醫院評鑑制度，訂定外部評核機制，確保基層醫療品質及其成效。另外為建立本土化家庭醫師制度，政府應積極推動家醫計畫相關實證研究，健保主管機關應釋出健保資料庫資料供學術研究，據以建立符合世界潮流的家庭醫師制度。

關鍵字

家庭醫師整合性照護試辦計畫 ； 家庭醫師 ； 家庭醫師制度 ； 社區醫療群 ； 醫療品質 ； 病患滿意度

並列摘要

Department of Health and Bureau of National Health Insurance launched「Trial Plan for the National Public Health Insurance Family Doctor Comprehensive Care System」in March 2003.The purposes of the plan are （1）to implement the hierarchical medical care system and the referring system from providing people comprehensive、coordinate and continuing medical service；（2）to establish the patient-centered healthcare climate ；（3）to reduce the utilization of medical resource and improve the medical service quality.
The report is aimed to discuss the performance of 「Trial Plan for the National Public Health Insurance Family Doctor Comprehensive Care System」from the patient satisfaction analysis. The utilization of medical resource and the medical service quality satisfaction between members and non-members of the plan are used to assess the results. The final outcome of the project will be provided to the government for building more comprehensive basic medical service network and as a consultation for pushing the local family doctor policy.

The references of the research subject and method which include the definition of family doctor and family doctor system、the development of family doctor system in Taiwan and other countries、the utilization and development of service quality and the utilization of medical service …etc.「Medical Quality Questionnaire of Family Doctor Comprehensive care system plan」is based on SERVQUAL Questionnaire which proposed by Parasuraman，Zeithaml＆Berry in 1988 to compare with the background of people and the utilization of medical service。

The cross sectional research is used in the project. The investigating time of it was from 10 May 2007 to 15 June 2007.The investigation were using judgement sampling method to pick the samples from the patient of Primary Community-based Care Networks by interview. 340 questionnaires were enrolled ,338 of them were effective to run the statistics test.

The research assumption are （1） the utilization of medical resource and the medical service satisfaction will be different for people from different background .（2）The satisfaction will be higher for the patient who join Primary Community-based Care Networks.（3）the utilization of medical resource will be lower for the patient who is member of Family Doctor System. The structural equation modeling was verified through the software of SPSS(13.0) . Reliability analysis-scale and Descriptive statistics were used to analyze the patient’s background 、the medical treatment area 、 the subject of their doctors、the members’ impression of the family doctors plan and the reaction of non-members to attend the family doctors system. The patients’ sex、level of education、profession、history of chronic disease 、self-health condition 、the utilization of medical resource and the medical service satisfaction are used as varies in chi-square、t-test and ANOVA. The final results were tested by Logistic regression and multiple regression. If P value＜0.05 means significant difference.

After statistics analysis ,the following results were found（1）from the patients’ background and the attendance of the family doctor plan, age（＞41or over60） and history of chronic disease show significant related by logistic regression ,which means the two varies are the important factors to influence people join the family doctor plan.（2）using multiple regression found out that the satisfaction of member and non-members was significant different, no mater in “reaction”、”reliability” 、”promise”、”concern” and “the whole medical service”, the members have higher satisfaction than non-members. Therefore, the family doctor plan can increase the medical service satisfaction. （3）from using frequency of the outpatient services of members of the family doctor plan was lower than non-members, it means that the family doctor plan can help to reduce the waste of the medical resource.

According to the study results, some suggestions were given to Department of Health : to continue implement “Family Doctor Comprehensive care system plan” ,to establish the exterior assess system to make sure the basic medical quality and the effects. To set up the local family doctor care system. To reward people who do the research about the family doctor plan. To release the health insurance database for academic research.

並列關鍵字

Trial Plan for the National Public Health Insurance Family Doctor Comprehensive Care System ； Family physicians ； Family Doctor System ； Primary Community-based Care Networks (PCCNs) ； Medical quality ； Patient satisfaction

參考文獻

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