Translated Titles

Patient complexity and services provided by primary care clinics in Taiwan





Key Words

西醫基層診所 ; 病人複雜度 ; 基層醫療服務項目 ; 家庭醫師 ; 都市化程度 ; primary care clinic ; patient complexity ; primary care service ; family physician ; urbanization



Volume or Term/Year and Month of Publication

37卷3期(2018 / 06 / 19)

Page #

265 - 279

Content Language


Chinese Abstract


English Abstract

Objectives: The primary care system is responsible for the management and coordination of patient care. This study will explore how many primary care clinics are able to take on the functions of family physicians. This will be accomplished through exploring the patient complexity and the services provided by primary care clinics in Taiwan. Methods: In this study, we calculated patient complexity using different dimensions, including quantity, variability, and diversity. We assessed patient complexity in terms of diagnoses, exams, age distributions, medications, specific diagnosis and treatments provided by primary care clinics. In addition, we referenced the quality care indicators used in other countries and then summed up eleven primary care services indicators. Through linear regression and logistic regression, we examined the relationships between division, urbanization and patient complexity and services provided by primary care clinics. We also took into account the relationship between physicians' specialty, demographic characteristics, and primary care services. Results: Patient complexity is the highest for family medicine providers, followed by internal medicine and pediatrics clinics. In 2013, the results suggest that the eleven primary care services that primary care clinics can provide are: fasting blood lipids 36.45%, glycosylated hemoglobin 30.80%, microalbuminuria 25.53%, eye examination 8.69%, health examination 35.26%, influenza vaccine 21.53%, pap smears 8.31%, fecal occult blood test 18.7%, and smoking cessation clinic 7.46%. In cancer screening services, colorectal cancer screening are only 1.32%, and breast cancer screening only 0.17%. Fewer than 10% of primary care clinics provide the five most common services, and nearly 40% of those clinics did not provide any of the above services. In general, the degree of urbanization in the clinics is inversely proportional to the patient complexity and the ratio of clinics providing primary care services. Conclusions: Overall, family medicine, internal medicine and pediatrics clinics in Taiwan are able to take on the functions of primary care providers, but fewer than 10% of the primary care clinics provide top 5 primary care services. Ideally, primary care services could be spread more evenly between providers. Any effort to improve the referral system should be aimed at strengthening the clinics that aren't currently able to meet primary care service needs. This is particularly true of primary care clinics in highly urbanized areas.

Topic Category 醫藥衛生 > 預防保健與衛生學
醫藥衛生 > 社會醫學
  1. 林恆慶、吳傳頌、許佑任、陳楚杰(2005)。台灣基層醫師對家庭醫師制度的認知、態度及認可之模式。台灣家醫誌,15,11-24。
  2. 洪壽宏、胡文郁、劉文俊、邱泰源、陳慶餘、謝博生(2005)。畢業後一般醫學訓練社區醫學學習成效之評估。醫學教育,9,33-45。
  3. 徐愫萱、賴韻如、葉琬喻、邱泰源、陳慶餘、郭斐然(2012)。以實證醫學回顧全民健康保險家庭醫師整合性照護計畫之成效。台灣家醫誌,22,11-24。
  4. Agency for Healthcare Research and Quality (AHRQ). PQI. Available at: http://www.qualityindicators.ahrq.gov/modules/pqi_resources.aspx. Accessed August 3, 2017.
  5. Association of American Medical Colleges (AAMC). Physician behavior and practice patterns related to smoking cessation. Available at: https://members.aamc.org/eweb/upload/Physician%20Behavior%20and%20Practice%20Patterns.pdf. Accessed August 3,2017.
  6. Campos-Outcalt, D,Jeffcott-Pera, M,Carter-Smith, P,Schoof, BK,Young, HF(2010).Vaccines provided by family physicians.Ann Fam Med,8,507-10.
  7. Canadian Institute for Health Information=CIHI(2012).Pan-Canadian primary health care indicators.
  8. Centers for Medicare & Medicaid Services (CMS). Consensus core set: ACO and PCMH: primary care measures. Available at: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasures/Downloads/ACO-and-PCMH-Primary-Care-Measures.pdf. Accessed August 3, 2017.
  9. Department of Human Services, Australian Government. Practice Incentives Program. Available at: https://www.humanservices.gov.au/organisations/health-professionals/services/medicare/practice-incentives-program. Accessed August 3, 2017.
  10. Gilchrist, VJ,Stange, KC,Flocke, SA,McCord, G,Bourguet, CC(2004).A comparison of the National Ambulatory Medical Care Survey (NAMCS) measurement approach with direct observation of outpatient visits.Med Care,42,276-80.
  11. Grant, RW,Ashburner, JM,Hong, CC,Chang, YC,Barry, MJ,Atlas, SJ(2011).Defining patient complexity from the primary care physician's perspective a cohort study.Ann Intern Med,155,797.
  12. ISD Scotland. Quality and outcomes framework. Available at: https://www.isdscotland.org/Health-Topics/General-Practice/Publications/2016-10-11/QOF_Scot_201516_practices_achieved_by_clinical_and_public_health_indicators.xls. Accessed August 3, 2017.
  13. Katerndahl, D,Wood, R,Jaen, CR(2015).Complexity of ambulatory care across disciplines.Healthcare,3,89-96.
  14. Katerndahl, D,Wood, R,Jaen, CR(2011).Family medicine outpatient encounters are more complex than those of cardiology and psychiatry.J Am Board Fam Med,24,6-15.
  15. Katerndahl, DA,Wood, R,Jaen, CR(2010).A method for estimating relative complexity of ambulatory care.Ann Fam Med,8,341-7.
  16. Loeb, DF,Binswanger, IA,Candrian, C,Bayliss, EA(2015).Primary care physician insights into a typology of the complex patient in primary care.Ann Fam Med,13,451-5.
  17. Moore, M,Gibbons, C,Cheng, N,Coffman, M,Petterson, S,Bazemore, A(2016).Complexity of ambulatory care visits of patients with diabetes as reflected by diagnoses per visit.Prim Care Diabetes,10,281-6.
  18. National Health Service (NHS). Quality and Outcomes Framework (QOF) - 2015-16. Available at: https://digital.nhs.uk/data-and-information/publications/statistical/quality-and-outcomes-framework-achievement-prevalence-and-exceptions-data/quality-and-outcomes-framework-qof-2015-16. Accessed August 3, 2017.
  19. Organisation for Economic Co-operation and Development (OECD). Health care quality indicators -primary care. Available at: http://www.oecd.org/els/health-systems/hcqi-primary-care.htm. Accessed August 3, 2017.
  20. Peek, CJ,Baird, MA,Coleman, E(2009).Primary care for patient complexity, not only disease.Fam Syst Health,27,287-302.
  21. Romano, MJ,Stafford, RS(2011).Electronic health records and clinical decision support systems: impact on national ambulatory care quality.Arch Intern Med,171,897-903.
  22. Rosen, AK,Reid, R,Broemeling, AM,Rakovski, CC(2003).Applying a risk-adjustment framework to primary care: can we improve on existing measures?.Ann Fam Med,1,44-51.
  23. Sharma, VK,Vasudeva, R,Howden, CW(2000).Colorectal cancer screening and surveillance practices by primary care physicians: results of a national survey.Am J Gastroenterol,95,1551-6.
  24. Starfield, B,Shi, L(2002).Policy relevant determinants of health: an international perspective.Health Policy,60,201-18.
  25. Starfield, B,Shi, L,Macinko, J(2005).Contribution of primary care to health systems and health.Milbank Q,83,457-502.
  26. Valderas, JM,Starfield, B,Sibbald, B,Salisbury, C,Roland, M(2009).Defining comorbidity: implications for understanding health and health services.Ann Fam Med,7,357-63.
  27. Werner, RM,Greenfield, S,Fung, C,Turner, BJ(2007).Measuring quality of care in patients with multiple clinical conditions: summary of a conference conducted by the Society of General Internal Medicine.J Gen Intern Med,22,1206-11.
  28. WHO(2008).The World Health Report 2008: Primary Health Care Now More Than Ever.Geneva:WHO.
  29. Wolff, JL,Starfield, B,Anderson, G(2002).Prevalence, expenditures, and complications of multiple chronic conditions in the elderly.Arch Intern Med,162,2269-76.
  30. Yen, SM,Kung, PT,Tsai, WC(2014).The characteristics and relevant factors of Pap smear test use for women with intellectual disabilities in Taiwan.BMC Health Serv Res,14,240.
  31. Zeng, D,You, W,Mills, B,Alwang, J,Royster, M,Anson-Dwamena, R(2015).A closer look at the rural-urban health disparities: insights from four major diseases in the Commonwealth of Virginia.Soc Sci Med,140,62-8.
  32. 林玟君(2009)。台北=Taipei,台灣大學臨床藥學研究所=Graduate Institute of Clinical Pharmacy, National Taiwan University。
  33. 許碧珊、劉瑞瑤、陳曾基(2001)。都會地區診所醫師醫療服務狀況及與醫院間轉診互動之調查。台灣家醫誌,11,22-32。
  34. 詹其峰、邱泰源、劉文俊、梁繼權、陳慶餘(2003)。基層醫療保健品質評估指標。台灣家庭醫學研究,1,8-21。
  35. 劉介宇、洪永泰、莊義利(2006)。台灣地區鄉鎮市區發展類型應用於大型健康調查抽樣設計之研究。健康管理學刊,4,1-22。
  36. 劉文俊、吳晉祥、邱泰源(2008)。基層醫療與健康照護成效。台灣家庭醫學研究,6,105-11。
  37. 歐陽鍾玲(2006)。台北市醫療設施分佈之地理研究。地理研究,45,51-72。
  38. 衛生福利部中央健康保險署:中央健康保險局台北分局家庭醫師計畫執行概況。台北:衛生福利部中央健康保險署,2008。National Health Insurance Administration, Ministry of Health and Welfare, R.O.C. (Taiwan). Overview on Family Doctors Integrated Care Initiative of Northern Branch, National Health Insurance Administration. Taipei: National Health Insurance Administration, Ministry of Health and Welfare, R.O.C. (Taiwan), 2008. [In Chinese]
Times Cited
  1. 黃興進,翁儷禎,佘明玲(2019)。影響老年病人就診科別醫師使用電子病歷交換意願因素之初探研究。台灣公共衛生雜誌,38(4),416-430。