基層診所病患轉診回診率之影響因素

Determinants the Rate of Return Visits of Referred Patients to Primary Care Clinic

目的：中央健康保險局提出醫療分級與雙向轉診制度，有助於醫療資源的有效配置。本研究目的在瞭解我國轉診病患回診之現況，並比較回診與轉診病患人口學特性及其態度之差異。方法：採橫斷式調查研究，從2007年9-11月間，立意選取台中市基層診所的轉診病患500位為對象進行電訪。問卷結果以SPSS 10.0版軟體進行描述性統計分析、卡方檢定及邏輯斯迴歸。結果：電訪問卷共發出500份，共回收403份有效問卷，回收率為80.6%。整體轉診病患回診率為28.3%，本研究發現回診與否不會因病患人口學特性、轉診科別、交通方便、候診時間、部分負擔及掛號費用而有所不同，但會與轉診目的、受轉醫院層級、醫療機構聲譽、醫療環境、專業技能及服務態度而有統計上之顯著差異（p<0.05）。進一步以邏輯斯迴歸分析發現，轉診目的是轉診回診率的顯著影響因子。結論：我國轉診回診率仍低，依研究結果建議應輔導改善服務品質、強化醫師專業能力、推廣分級就醫觀念，以達醫療照護分級的目的。

Purposes: The National Health Insurance Bureau (NHIB) has implemented a hierarchical medical care system and a bi-directional referral system in order to effectively allocate medical resources. The present study explored the factors that might influence attitude and rate of return-visits to their primary care clinics by referred patients. Methods: This study was a cross-sectional survey. Through purposive sampling, data were collected by telephone interviews with a group of 500 patients referred from primary care clinics in the Taichung area from September through November, 2007. Chi-square tests and logistic regression analyses were performed using SPSS 10.0 software. Results: Among this group of patients, 403 completed the interviews (a response rate of 80.6%). Surprisingly, only 28.3% of the referred patients did make return-visits to their original primary care clinics. Among the ten possible contributing factors that may have determined the willingness of the referred patients to return to their primary care clinics, the rank of the hospital, the reputation and excellence of medical instruments in that hospital, the competence of physicians and the excellence of service providers were considered to be significant (p<0.05). Other factors, including demographics, played insignificant roles in the decisions for returnvisits. Results from the logistic regression showed that the purpose of the referral increased the probability of a return-visit. Conclusions: Return-visits within the hierarchical medical care system can be encouraged by improving the quality of service, enhancing the competency of the physicians, and promoting the concept of graded health care.