復能服務規範調整對接受長期照顧十年計畫2.0對象使用服務的影響因素分析──基於安德森健康服務利用行為模式的實證研究

Factors influencing service utilization of reablement services after specification adjustments of the 10-Year Long-Term Care Plan 2.0 in Taiwan: Andersen’s Behavioral Model of Health

目標：本研究旨在探討衛福部於2020年前、後居家復能服務作業規範改變，服務使用者對服務與政策滿意度的影響。方法：本研究採橫斷面調查研究設計，援引Andersen健康服務利用行為模式為架構，設計具信效度結構式問卷，資料來源為現居台中市並於2018年1月起曾使用過居家復能者。結果：受訪者對服務滿意度為94.1%；另外相對於低度需求者，對照顧問題清單具中度需求者服務滿意度較低（OR = 0.317）。2020年前、後均接受過服務者（n = 177），對2020年前與後的政策滿意度分別為96.0%及50.3%。雖然以目標導向的補助次數是影響政策滿意度的共通決定因子，但服務手冊指引內容改變與部分服務組合評量適用性，可能是導致服務使用者滿意度差異的根本原因。復能服務規範調整對復能計畫執行的影響因素，並沒有明顯差異。結論：2020年根據長照復能服務操作指引相關規定執行後，政策滿意度明顯下滑。宜建立多面向照顧思維，不應以單一標準衡量所有專業服務組合，並藉由評值使服務期程與次數動態性合理化，讓不同失能程度者均能獲得符合所需的專業服務。

Objectives: This study explored changes in the operating norms of home reablement services implemented by the Ministry of Health and Welfare before and after 2020 and their effects on service users’ satisfaction levels. Methods: This study adopted a cross-sectional survey design with Andersen’s Behavioral Model of Health Services Use as the framework. A structured questionnaire was designed and distributed to individuals in Taichung who had used home reablement services since January 2018. Results: The respondents’ level of satisfaction with the services was 94.1%, and those with moderate needs on the list of care problems were less satisfied than those with low needs (OR = 0.317). Those who had received services before and after 2020 (n = 177) had satisfaction levels of 96.0% and 50.3% with the policy before and after 2020, respectively. Although goal-oriented satisfaction with a subsidy program is often employed as a determinant of policy satisfaction, changes in service manual guidelines and the applicability of some service package measures may be the underlying causes of differences in service user satisfaction. The reablement service specification adjustments did not significantly affect the implementation of the reablement plan. Conclusions: After implementing changes in the operational guidelines for long-term care reablement services in 2020, users’ satisfaction level with services declined significantly. Policymakers are advised to adopt a multidimensional approach to patient care and to not measure all professional service combinations by a single standard. Furthermore, policymakers should implement evaluations to assess the effectiveness of various combinations of service duration and frequency to ensure that service users with varying degrees of disability receive professional services that meet their needs. (Taiwan J Public Health.