提昇高齡化無醫鄉之醫療照護水準－以田寮模式巡迴醫療爲例

Improve the Quality of Medical Care in an Aged and Doctor-deficiency Rural Area: The Tianliao Model Mobile Healthcare Program

陳全裕(Chen-Chuan Yu) ； 楊宜青(Yang-Yi Ching)

《台灣老年醫學雜誌》 2卷3期 (2007/02) Pp. 209-224

https://doi.org/10.29462/TGG.200702.0004

摘要

台灣自從1993年開始就邁入高齡化社會，因此老人醫療照護越來越重要，因爲能活得長久，卻也要活得健康，爲了達到「全民均健」，尤其是老人，民眾必須有足夠的基本醫療服務；但是，醫師人力的地理分佈不均一直是健康政策與醫師人力規劃上最關心的議題之一，醫師的執業地點多在人口密集的都會區，城鄉醫師分佈明顯不均，使得偏遠、鄉村地區長期處於醫療資源短缺情況下，例如田寮鄉（老化嚴重的無醫鄉，全鄉唯一的醫療院所是衛生所）；爲了改善此情形，台灣在偏遠地區已經施行數十年的巡迴醫療，提供民眾較方便的醫療。雖然醫療的可近性很重要，我們也不能忽略家醫科最強調的其餘四項特點：全面性、持續性，負責性與協調性，而田寮模式巡迴醫療則依此五特點設計，已經由田寮衛生所執行兩年了(自2005年9月開始)。田寮鄉隸屬高雄縣，赫赫有名的月世界就在鄉內，全鄉人口目前約8600人（2007年7月），不但外流人口多，高齡化也很嚴重，約23%，醫療資源極度缺乏，沒有藥局、醫師只有一位，就是衛生所主任；衛生所星期一至星期五每天上午在所內設有門診，星期一至星期四每天下午則安排全鄉十村巡迴醫療；田寮模式巡迴醫療是依據社區取向之基層醫療的觀念，提供鄉內更高品質的醫療照護，全鄉十村每村都選擇兩處做爲巡迴點，總計20處，每星期全部輪流巡迴一次，也就是每天下午安排五個巡迴點，連續四天恰好有20個點，藉此創新作法強化衛生所服務效能，提供全鄉老人適切醫療照護，進而達到全民均健目標。

關鍵字

巡迴醫療 ； 老年人 ； 老化 ； 基層醫療

並列摘要

Taiwan has been an aging society since 1993; healthcare for the elderly is therefore an issue of mounting importance. The goal of ”health for al” strives to provide sufficient primary care for all the citizens in Taiwan, especially for the elderly people. The mobile healthcare policy has been practiced for decades to facilitate better accessibility to medical care in rural areas in Taiwan. However if we want to take good care of the people in rural areas, it will be very important to notice and practice the five characteristics of family medicine: accessibility, comprehensiveness, continuity, coordination and accountability. The Tianliao-model mobile healthcare program delivered by the township public health center has been practiced for two years for a rural area both highly aging and medicine-absent. Tianliao township incorporates ten villages with less than 9,000 residents relying on one single doctor who is also the chief of Tianliao Township Public Health Center as the sole source of medical care. And there are about 2000 aged residents in Tianliao that reports a degree of aging as high as 23%, far above the average 7%. All these and the absence of any pharmacy make it a challenging task to help Tianliao residents stay as healthy as people living in cities.
Based on community-oriented primary care, Tianliao Public Health Center not only provides usual medical service every morning from Monday to Friday but also practices mobile healthcare in the afternoon. More intensive and rigorous than usual mobile healthcare, the Tianliao model mobile healthcare program provides primary care in 20 points for four consecutive days from Monday to Thursday. In other words, two mobile healthcare points are set up in each of the 10 villages and the program needs to cover 5 points in one afternoon. Integrating medical services with public health education, this unique mobile healthcare model carried out by just one doctor indeed improves the primary care for health for all, especially the elderly.

並列關鍵字

mobile healthcare program ； elderly ； aging ； primary care