家庭醫師全人醫療照護模式應用於居家照護

The Holistic Health Care Model of Family Medicine: Its Applications in Home Health Care

居家照護服務為一跨領域的整合在宅照護，需要居家照護的個案包含年長者、慢性疾病及失能者等，隨著台灣高齡者逐漸增加，居家照護的需求也日益上升，而醫療訪視為居家照護中的一環，於醫療訪視時，完整性的評估及介入可以使得病患有較好的生活品質。
全人醫療為對一個人的生理健康與所有層面皆進行照護的醫療，而其範圍是從生理、心理到社會、靈性等各層面，針對病患進行完整性而非單一器官或單純身體的評估是家庭醫師所需具備的核心能力，同時也是達成全人醫療所必須的能力，關於完整性評估的方式，Engel提出了包含生物、心理、社會層面的評估模式，如此可以針對病患的功能、疾病等進行完整性的評估與介入，而Engel所提出的生物心理社會模式也適用於居家照護個案，本文以一位73歲產生譫妄並因導尿管及鼻胃管放置而接受居家照護的女性進行全人醫療照護模式的討論，探討居家個案在醫療訪視時應有的照護，包含生理、心理及社會層面，期藉由完整性的評估與介入使接受居家照護的個案能得到適切的照顧。

The rapidly growing elderly population in Taiwan has led to a continuous rise in the demand for home health care services, i.e. integrated multidisciplinary services delivered to the homes of elderly, disabled and other needy people. As an essential part of home health care, medical visits by physicians and nurses provides patients with comprehensive assessments and interventions capable of improving the quality of life to the patients.
Holistic medicine, known for its moving beyond the disease itself to focus on the patient as a “whole person,” can be achieved through comprehensive assessment of the patient, which is one of the core competencies of family medicine physicians. The biopsychosocial model theorized by Engel is suitable in the home care seeting as it performs comprehensive assessments examining all biological, psychological, and social factors that play important roles in human functioning or disease. The study reported and discussed the case of a 73-year-old woman who required home health care due to NG intubation, foley catheterization, and diagnosed delirium, discussing the need of medical visits to examine the biological, psychological, and social aspects of a home care case. By highlighting the importance of comprehensive assessments and interventions in home health care, the study hopes to promote the holistic biopsychosocial model to help provide sufficient care for home health care recipients.