社區醫療群家庭醫師對全民健保家庭醫師整合性照護試辦計畫政策滿意度調查

Survey of Primary Care Physicians Opinions of the National Health Insurance Family Doctors Integrated Health Delivery System

目的：中央健康保險局為建立家庭醫師制度，於2003年開始推動家庭醫師整合性照護制度試辦計畫。本研究的目的即在參與試辦計畫之基層醫師對本試辦計畫施行3年後之意見調查，以為持續發展本土化家庭醫師制度之參考。研究對象與方法：本研究屬橫斷式研究，於2005年10月至12月間，針對1,546位參與試辦計畫之社區醫療群家庭醫師進行結構式問卷調查。問卷內容包括：受訪醫師基本資料、計畫執行現況、及對試辦計畫之政策滿意度調查。問卷結果以SPSS 13.0版軟體進行單變項分析、卡方檢定、費氏正確概率檢定以及羅輯斯迴歸分析。結果：本問卷共發出1,546份，回收共448份有效問卷，回收率佔29.0%。在政策滿意度方面，醫師對家庭醫師整合性照護制度試辦計畫整體政策滿意度感到非常滿意與滿意者超過半數（56.1%）。滿意度平均分數最高者依序為醫病關係促進（70.1分）、照護病人品質提升（68.6分）、專業能力提升（67.9分）三項；滿意度平均分數最低者依序為個人收入（48.6分）、生活品質（50.4分）、以及健保給付（53.6分）三項。以多變項羅輯斯迴歸分析發現，調整性別、執業科別與加入醫療群之年數之後，年齡較大者其整體滿意度較高（OR=1.04, 95%CI=1.01-1.07）；執業地區為北部 （OR=9.98, 95%CI=1.19-83.74）、中部（OR=9.87, 95%CI=1.16-84.12）與南部地區（OR=9.45, 95%CI=1.12-80.04）之整體滿意度相對於東部地區顯著較高。對執業科別與個別議題滿意度分析，在照護病人品質提升、專業能力提升、得到病人尊重、及健保給付提升四項，家醫科醫師之滿意度均顯著大於非家醫科的醫師（p <0.05）。結論：本研究發現半數以上醫師對整體政策感到滿意。家醫科醫師比其他科醫師之滿意度高，執業地區為北部、中部與南部地區之整體滿意度相對於東部地區較高。家庭醫師整合性照護制度試辦計畫對於醫療品質的提升獲得基層醫師的肯定；但是對於基層醫師在生活品質與收入之面向，仍有待政策面提供基層醫師適當之回饋，以使政策落實並維護民眾之照護品質。

The purpose of this study was to determine the opinions of primary care physicians participating in the Family Doctors Integrated Delivery System for the previous three years. A structured questionnaire was mailed to 1,546 attending physicians from October to December, 2005. A total of 448 replied, with a response rate of 29.0%. Statistical analysis, including univariate analysis, Chi-square test, Fisher’s exact test and logistic regression analysis was performed using SPSS 13.0. More than half (56.1%) of the primary care physicians participating in the Family Doctors Integrated Delivery System were satisfied with the plan. The respondents’ highest satisfaction points were related to improvement of the doctor-patient relationship (70.1 points), quality of care (68.6 points), and professional ability (67.9 points). The respondents felt more dissatisfied with issues of increase in personal income (48.6 points), improvement of life quality (50.4 points), and payment from the National Health Insurance (53.6 points). After adjustment for gender, professional specialty, and duration of participation in the plan, older physicians had 1.04 times (95% C.I.=1.01-1.07) higher satisfaction. Areas of physician practice in the northern, middle and southern parts of Taiwan also had 9.98 (95% C.I.=1.19-83.74), 9.87 (95% C.I.=1.16-84.1), 9.45 (95% C.I.=1.12-80.04) times higher satisfaction than in the eastern part, respectively. Family physicians had higher satisfaction rates than other specialties (p<0.05) related to quality of patient care, promotion of professional performance, increase of patient respect, and increase in personal income. Our study showed high satisfaction rates among primary care physicians participating in the Family Doctors Integrated Delivery System, especially in the dimension of improving quality of health care. It is also important to provide primary care physicians adequate financial compensation and better life quality to assure quality medical care delivery.