遠距照護的發展與效能評估之探討——技術、人性、管理的整合觀點

The Development and Effectiveness of Telecare From an Integrated Technological, Humanistic and Management Perspective

由於出生率下降及高齡化人口持續攀升，人口結構老化現象越加明顯，長期照護、銀髮健康管理等議題也逐漸受到高度的關注。近年來，資訊通信科技與生物醫學技術的快速發展，使得全球各國逐漸地重視應用遠距醫療技術以增進或擴展現今病患照護與服務。然而，近年來有關遠距照護之學術論述，率多注重技術的發展與系統的建構，鮮少以病患或顧客的角度，針對遠距照護的服務過程，進行全面性與通盤性的評估與測量，以致於無法發掘高齡者的真正需求或問題所在，在臨床的應用上有其侷限，並造成知識發展上之障礙。本文透過回顧歷來重要之遠距照護的文獻，簡述其演進過程。並針對效能評估的議題，進行深入的探討，歸納整理評估或測量的面向，界定為三大面向與八個指標，分別為技術面：系統品質，人性面：體制信任與隱私風險，管理面：服務品質、成本效益、滿意程度、使用意向、健康影響等。用以詮釋遠距照護的成功必須具備三大面向整合服務的觀點與條件，而非僅是單方面的引進或建置創新科技，即可克其功。期望藉由本文之探討，激發學術理論與實務臨床的深入之探究與洞見，共同型塑與創造在地「安全、安心、安老」的照護網絡之美好願景。

A decreasing birthrate coupled with a growing elderly population has lead to an increased focus on elderly-centric issues such as long-term care and senior healthcare. Recent advances in information, communication and biomedical technologies have combined to allow the development of various types of telemedicine technology designed to enhance or expand patient services and care. To date, most telecare studies have focused on the development of underlying technologies rather than on patient (customer) perceptions regarding service mechanisms. The lack of the latter makes obtaining an effective understanding of the actual needs and problems of the elderly population difficult, and limits the potential for clinical implementation of study findings and further knowledge development. This article reviews important articles in the literature on telecare and evaluates the effectiveness of telecare-related technologies. Three key aspects associated with eight sub-indictors were identified. These included the aspects of technology (system quality); humanism (institutional trust and privacy risk); and management (service quality, cost benefit, satisfaction, use intention, and influence on health). An integrated perspective combining social and technological aspects is needed to facilitate increasing utilization of and satisfaction with telecare. Simply implementing new systems built around this innovative technology is not sufficient, and may be counterproductive. This article was written to help stimulate deeper exploration and insights into academic theory and clinical practice in order to help shape and create a better vision of aging in place.