台灣醫師執行戒菸服務之障礙調查

Assessing the Barriers to Smoking Cessation Promotion among Physicians in Taiwan

背景及目的：吸菸嚴重危害國人健康，每年約導致2萬名國人死亡。為了幫助更多吸菸者戒菸，我國於2012年3月推出二代戒菸治療試辦計畫。然而，仍有很多接受過戒菸訓練課程的醫師在受訓完畢後沒有與衛生福利部國民健康署簽約、或是簽約了卻很少或甚至沒有執行戒菸服務。本問卷調查目的在於了解很少或沒有執行戒菸服務醫師所面臨的服務困境以及醫師們建議的改革方向，以增加醫師們提供戒菸治療服務的熱情與行動，並提供給衛生福利部國民健康署作為規劃菸害防制政策之參考依據。
方法：針對完成戒菸治療訓練且與衛生福利部國民健康署完成簽約、在2012年3月至2013年2月底申報戒菸治療次數小於12人次的醫師，可能造成很少或沒有提供戒菸治療服務的原因和改進的方向進行調查。問卷內容分為兩部分，分別為醫師戒菸服務執行現況，和提升醫師執行戒菸治療服務意願的有效措施。
結果：共寄出2,035份問卷，回覆363份，回覆率為17.8%。結果顯示：有66%的醫師仍然願意執行戒菸治療服務，主要障礙為想戒菸的病人太少及申報文書工作繁複。最有效的改革方案包括增加經費補助（尤其是醫師診察費、衛教師費用），改善行政流程（尤其是簡化VPN系統的填寫項目、簡化收案資格確認流程），放寬計畫限制（尤其是給付週數延長至12週、看診次數不設限），更嚴格的禁菸法令與措施以增加病人戒菸意願等。
結論：大多數服務量不足的醫師都是有意願協助戒菸的，只要衛生福利部國民健康署能協助消弭執行障礙、提高戒菸治療給付費用、簡化行政流程、放寬戒菸治療服務計畫限制，相信戒菸治療服務的執行率將會有所提升。
背景及目的：吸菸嚴重危害國人健康，每年約導致2萬名國人死亡。為了幫助更多吸菸者戒菸，我國於2012年3月推出二代戒菸治療試辦計畫。然而，仍有很多接受過戒菸訓練課程的醫師在受訓完畢後沒有與衛生福利部國民健康署簽約、或是簽約了卻很少或甚至沒有執行戒菸服務。本問卷調查目的在於了解很少或沒有執行戒菸服務醫師所面臨的服務困境以及醫師們建議的改革方向，以增加醫師們提供戒菸治療服務的熱情與行動，並提供給衛生福利部國民健康署作為規劃菸害防制政策之參考依據。
方法：針對完成戒菸治療訓練且與衛生福利部國民健康署完成簽約、在2012年3月至2013年2月底申報戒菸治療次數小於12人次的醫師，可能造成很少或沒有提供戒菸治療服務的原因和改進的方向進行調查。問卷內容分為兩部分，分別為醫師戒菸服務執行現況，和提升醫師執行戒菸治療服務意願的有效措施。
結果：共寄出2,035份問卷，回覆363份，回覆率為17.8%。結果顯示：有66%的醫師仍然願意執行戒菸治療服務，主要障礙為想戒菸的病人太少及申報文書工作繁複。最有效的改革方案包括增加經費補助（尤其是醫師診察費、衛教師費用），改善行政流程（尤其是簡化VPN系統的填寫項目、簡化收案資格確認流程），放寬計畫限制（尤其是給付週數延長至12週、看診次數不設限），更嚴格的禁菸法令與措施以增加病人戒菸意願等。
結論：大多數服務量不足的醫師都是有意願協助戒菸的，只要衛生福利部國民健康署能協助消弭執行障礙、提高戒菸治療給付費用、簡化行政流程、放寬戒菸治療服務計畫限制，相信戒菸治療服務的執行率將會有所提升。

Background and Purpose: Cigarette smoking is hazardous to health, causing approximately 20000 deaths each year in Taiwan. To help more smokers to quit, the second-generation smoking cessation program has been implemented by the Health Promotion Administration (HPA), Ministry of Health and Welfare since March, 2012. However, quite a few physicians who had received the training course provided by HPA did not enroll in the program, and for those who did enroll in the program, many were found to never or seldom provide smoking cessation service. The study accordingly aimed to identify the barriers to smoking cessation promotion among the trained physicians and to solicit their suggestions for improvement. Findings of the study can be expected to assist HPA in planning more effective smoking cessation policies in the future.
Methods: To each of the physicians who had completed the HPA training course, signed up to assist the second-generation smoking cessation program, but counseled less than 12 smokers during the one year from March 2012 to February 2013, a questionnaire was sent with the major purposes of learning about the barriers to smoking cessation promotion and requesting their input on how to better promote the HPA smoking cessation program.
Results: A total of 2035 questionnaires were issued and 363 replied, resulting in a response rate of 17.8%. 66% of the responding physicians expressed willingness to continue providing smoking cessation service. The small number of patients interested in quitting smoking and the cumbersome paperwork emerged to be the a major barriers. Some of the most popular suggestions for improvement included: raising reimbursement (especially fees for physicians and counselors), streamlining administrative procedures (notably by simplifying the VPN system and the process for confirming patients qualification), loosening restrictions to strengthen incentive (especially by extending payment to 12 weeks and lifting the cap on the number of visits), and implementing more stringent smoking prevention regulations to help increase the willingness of patients to quit smoking.
Conclusions: Most of the physicians who provided only limited smoking cessation service were willing to do more as long as HPA is committed to enhancing the effectiveness of its smoking cessation program by eliminating the identified barriers, increasing reimbursement, simplifying administrative procedures, and loosening restrictions to strengthen incentive.