遠距醫療在偏鄉醫療照顧的應用

The Application of Telemedicine in Rural Health Care

偏鄉離島的醫療服務，因交通、人口分佈及人口結構等因素，醫療供給相對較為不足。統計資料也顯示，偏鄉地區的年齡校正後死亡率，較都會區高。遠距醫療可減少偏鄉醫療就診的交通時間及花費、增加專科醫師照會，改善藥物使用的順從性等好處。遠距醫療從早期無法及時反應，只做不同步的資料傳輸，已經發展到目前與電子病歷整合、即時同步反應的第四代遠距醫療系統。而2020爆發的coronavirus disease 2019，也加速醫療體系及民眾對遠距醫療的接受程度。遠距醫療在偏鄉的應用，也已經有了實證資料，包括急性冠心症、中風、外傷、傳染性疾病，都有加速急重症病人分類、轉診，及早接受治療等好處。對於慢性病像糖尿病、心衰竭、慢性阻塞性肺病、惡性腫瘤等病患，遠距醫療可協助病患做好自我監測、改善用藥、飲食及復健的紀巧及順應性。對於可以使用影像傳輸來協助診斷的科別，如皮膚科、耳鼻喉科等，遠距醫療可以會診專科醫師進行診斷，也可協助手術後的追蹤照護。2018年通過的「通訊診察治療辦法」規定山地離島等偏鄉地區，得透過通訊診查方式，詢問病情並開給方劑。此一規定放寬了醫師法需親自診察的限制，使遠距醫療得以合法的執行，為偏鄉地區醫療照護的一大利多。

Because of the transportation, age distribution and population structure, the health care system is relatively inadequate in rural area. According to recent statistics, the age-adjusted mortality rate is higher in rural area than in urban area. The potential advantages of telehealth in rural area include reduction in transportation, increase in specialty consultation and improvement in the compliance to standard treatment. Telehealth has developed from early non-immediate response, non-immediate data transfer to current fully integrated, immediate data transfer and response, 4th generation telehealth care system. In 2020, the outbreak of coronavirus disease also contributes to the acceptance of telehealth. There is emerging evidence-based data on the use of telehealth in rural area. The use of telehealth in acute coronary syndrome, stroke, trauma and acute infectious disease can speed up the triage and transfer of rural patients to receive definite treatment. The use of telehealth in chronic diseases such as diabetes, heart failure, chronic obstructive pulmonary disease and cancer can help the rural patients to monitor themselves effectively and to improve the compliance of drug use, diet control and rehabilitation. Telehealth can also be applied in the field that image helps greatly in diagnosis and management, including dermatology and otorhinolaryngology. Specialty consultation and post-operation follow-up can be performed via video-consultation. The ''Regulations of Treatment on Telemedicine'' that passed in 2018 ease the limitation set by Physicians Act, which required that physician should not give any medical treatment without a face-to-face approach. This advance will greatly enhance the use of telehealth in rural area.