台中都會區民眾對家庭醫師照護制度態度之研究

The Study on the Civilians’ Attitude toward the Family Physician System in Metropolitan Area of Taichung City

蔡文仁(Wen-Jen Tsai)

指導教授 ： 周明智

中山醫學大學/醫學院/醫學研究所/碩士(2006年)

摘要

根據世界家庭醫學會組織 (WONCA) 於1981年對基層健康照護所下之定義，家庭醫師應扮演四個角色：（一）處理病人目前表現出來的健康問題；（二）養成病人正確的求醫行為；（三）注意並處理慢性或不活動性的健康問題；（四）推動促進健康的預防保健措施。
本研究研究目的：（1）探討加入與未加入醫療群家庭臺中市都會會員之病患區對於家庭醫師照護制度的重要性之態度之差異（2）探討病患個人特性對家庭醫師照護制度態度之影響。（3）瞭解民眾自覺健康狀態與是否患有慢性病對於家庭醫師照護制度服務之需求。
本研究採橫斷面調查研究法，主要工具為自填式結構性問卷，於94年12月15日至95年2月15日，針對台中市、山線、海線各一家診所進行調查，最後有效問卷為191份。
本研究的重要研究結果如下：
一、 整體民眾對於家庭醫師照護制度的態度是重視的，台中都會區民眾較重視家庭醫師在醫治者與協調者的角色，對於家庭醫師擔任朋友、教師、顧問的角色則較不重視，儘管民眾開始重視家庭醫師照護制度，但是對家庭醫師的看法仍維持在醫師的傳統角色。
二、 加入醫療群家庭會員之受訪者，其對家庭醫師照護制度的重視程度顯著高於未加入者，顯示目前的家庭醫師照護計畫仍具有一定的成效，透過家庭醫師計畫的推展，家庭醫師制度可慢慢深植於民眾內心，或許可以改變目前不正常的就醫行為。
三、 自覺健康狀態不良之受訪者較為重視家庭醫師對於診療或諮詢的提供，尤其是假日與非門診時間；自覺健康狀態不良之受訪者亦家庭醫師對個人病歷與用藥記錄的完整以及專科醫師的轉介；此外，自覺健康狀態不良之受訪者較為重視家庭醫師提供健康諮詢與預防保健服務。自覺健康狀態與是否有慢性病等需要因素會影響對家庭醫師照護制度的態度。
根據研究結果，本研究提出以下建議：
一、 目前家庭醫師照護制度之推展仍有其成效，若能持續推展，應能漸漸改變民眾的就醫習慣，長遠來看，不但可使醫療產業結構正常化，亦可減少不必要的醫療資源支出。
二、 民眾對家庭醫師的概念仍停留在傳統的醫治者角色，建議相關單位應加強家庭醫師在健康諮詢的繼續教育，而主管機關應提供相關誘因，以提升家庭醫師與社區民眾對於健康諮詢的注意。
三、 由於目前不論是否加入醫療群家庭會員，其就醫時之權利義務並無分別，家庭會員仍可自由選擇其他醫療院所就醫，建議主管機關應提供家庭會員誘因，使得家庭會員選擇其他願所就醫的比例盡可能降至最低。

關鍵字

家庭醫師 ； 家庭醫師制度 ； 本土化家庭醫師整合性照護制度

並列摘要

According to the definition of WONCA in 1981, family physicians should act four roles: (1) deal with the presented health problems of patients; (2) correct the health-seeking behavior of patients; (3) attention and deal with the chronic or inactive health problems; (4) facilitate the preventive activities for health promotion.
The objectives of this study are as following: (1) the attitude toward family physicians system between participants and non-participants; (2) the attitude toward family physicians system between different personal characteristics; (3) the attitude toward family physicians system between different need factors.
This study adopt a cross-sectional methodology, the main tool is self-administration structured questionnaire. Three clinics (Taichung city, Taichung mountain area, and Taichung coastal area) were selected, the investigation processed form 12/15/2005 to 2/15/2006. Finally, the effective responses are 191.
The results are as following:
1. The overall attitude attaches importance to family physician system. The civilians’ attitude comparatively take family physicians in the treatment and the coordination role, the role of the friend, the teacher and the consultant are stepchild. Despite the civilians begin to attaches importance to family physician system, they just focus on the traditional roles of a physician.
2. The emphasis of participants is more than non-participants that shows the effect of family physician system is visible. With the facilitation pf family physician system, the health-seeking behavior would be corrected.
3. The response with poor health status attach more importance to the providing of treatment and consultation, the completeness of personal record and medication, the referral of specialty, the services of health consultation and primary care.
According to the results, the suggestions are as following:
1. Continuously facilitating the family physician system could correct the health-seeking behavior, normalize the structure of health industry, and diminish the health expenditure.
2. The attitude just focuses on the traditional role of a physician. Regulators must make incentive to reinforce the health consultation.
3. The regulators must make incentive to encourage the people to select their family physician as their usual source of care.

並列關鍵字

family physician ； family physician system ； localized family physician integrated care system

參考文獻

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