探討醫院門診病人之轉診意願及其相關因素

An Investigation of the Willingness and Causative Factors in Patients Who Referred to Other Instituation

本研究目的旨在探討醫院門診病人的轉診經驗、意願、對目前轉診制度的瞭解與滿意度，及影響其轉診意願的相關因素。本研究以台北縣、市三家醫療院所700位門診病人為研究對象，共發出問卷700份，回收有效問卷675份，有效回收率為96.4%。採SPSS for Windows 10.0統計軟體進行回收問卷資料之建檔及統計分析處理。首先以描述性統計描述各變項，其次以t檢定進行雙變項分析，再進行向前邏輯斯迴歸(forward logistic regression)模式之建立，探討影響醫院門診病人轉診意願之因素。研究結果發現，僅有8.7%門診病人當次看診是由原來看診的院所轉診。在接受轉診的意願方面，僅有37.6%的醫院門診病人回答願意或非常願意。對於目前轉診制度的滿意程度，僅佔8.3%的醫院門診病人回答滿意或非常滿意。在影響醫院門診病人轉診意願之因素方面發現，愈同意「轉診可以使病人得到更完善的醫療照護」、「過去至醫院或診所就醫的經驗」、「診所護理人員的服務態度」、「醫院的部份負擔費用」及「醫院的科別或醫師數」會影響其轉診意願的醫院門診病人，其接受轉診的意願愈高；愈同意「醫院的醫師的醫術」及「轉診制度尚未建立好」會影響其轉診意願者，其接受轉診的意願愈低。建議衛生主管機關可定期追蹤、評估轉診制度的實施成效，且推行轉診制度時，應考慮不同患者之就醫需求，諸如：精神病患、癌症病患（如乳癌等），以及該科別的診所比率。轉診制度的對象是否應包括所有患者，抑或可排除部分特殊醫療需求的病患，都值得衛生主管機關再三思考。

The objectives of this study were to explore the experiences, willingness, understanding, and satisfaction in the patients who were referred to other hospitals. The sampled patients were randomly selected from outpatient departments of three hospitals in Taipei City and Taipei County. A total of 675 questionnaires were returned out of 700, yielding a response rate of 96.4%. The SPSS for Windows 10.0 version was used to analyze data. A descriptive analysis was performed on all variables of interest. The t test was also conducted to study the possible factors related to patient's willingness of using the referral system. Thereafter, a forward logistic regression analysis was performed to examine possible factors related to patient's willingness of using the referral system after adjusting for other factors. The study found that 8.7% of the sampled patients were referred from other healthcare institutions. Only 37.6% were very willing or willing to use the referral system, and 8.3% were very satisfied or satisfied with the current referral system. Those who agreed that the referral system could help patients obtain better health services, who agreed that the clinic visiting experience would affect their willingness of referral, who agreed that the attitudes of nurses would affect their willingness of referral, who agreed the copayment would affect their willingness of referral, and who agreed that the number of specialties and physicians would affect their willingness of referral were more likely to be referred. However, those who agreed that physician's technique would affect their willingness of referral and who agreed the referral system needed more improvement were less likely to be referred. It is suggested that the health authority should periodically evaluate the effectiveness of the referral system. The needs from different patient populations should also be considered.