鄉鎮衛生所醫護人員參與糖尿病遠距照護意願的探討

The Willingness of Medical Personnel at Township Health Centers to Participate in Diabetes Home Telehealth Services

糖尿病照護需要患者主動參與及自主管理，但鄉村及偏遠地區缺乏專科醫護人力來協助病人建立此能力，如能借助遠距照護，將可提升地方的醫療照護品質。本研究目的在探討地方醫療照護者對引進糖尿病遠距照護的接受度，及他們認為窒礙難行之處。研究設計採質性研究的半結構式深入訪談法。立意取樣10間台南縣衛生所，訪談其醫師及護理長共計21人，研究期間自2009年6月至2010年5月。本研究發現基層衛生所的醫療專業人員對於糖尿病遠距照護的認知有限，連帶影響運用遠距照護協助糖尿病患進行健康自主管理的意願。他們對於投入遠距照護的行動持保留態度，主要影響因素有三個部份，其一在照護提供者自身的相關因素；其二則是照護對象，即病患個人及其所處情境因素；其三則為照護環境因素。總結來說，應對照護提供者予以增能，強化其遠距照護相關認知與照護能力，並強化其健康照護信念與遠距照護的理念一致，還需要深入同理在地病患的個人及環境狀態，針對在地照護條件進行具體規劃，才可能善用遠距照護系統，提高整體健康照護的效能。

Diabetic care requires patients' active participation and self-management. However, in the countryside and the remote areas, there is a shortage of medical specialties to assist patients in building up this ability. If telehealth services could be set up, the quality of local medical care may be improved. The purpose of this study is to investigate local medical personnel's willingness to participate in diabetes home telehealth services, and their perception of obstacles in carrying out the services. The study design uses a qualitative research approach with semi-structured in-depth interview. A total of 21 physician directors and head nurses from 10 purposively sampled health centers of Tainan County were interviewed. The research was carried out from June 2009 to May 2010. It is found that the medical personnel of local health centers have little knowledge of diabetes home telehealth services. This affects their willingness to promote the diabetic's self-management through telehealth. They commonly adopt a conservative attitude towards telehealth related activities, which is influenced mainly by three factors. The first factor is care providers themselves related. The second factor is care objects related, that is individual patient and the situation he or she is in. The third is health environment related. For making good use of telehealth services and raising overall health care efficacy, we must empower the health care providers, enhance their knowledge on telehealth and their ability to take care of patients, strengthen their belief in medical care to be in agreement with that in telehealth, deeply empathize with local patients and their environmental situations, as well as design services based on local conditions.