新北偏區衛生所長照All-In-One計畫之成效評估

Effectiveness of All-In-One program of long-term care in rural health centers of New Taipei City

目標：衛生所是政府守護社區及偏鄉民眾健康的基層機關。新北市為扭轉偏區長照服務資源不足的困境，2018年推展「長照All-In-One計畫」，讓13個偏區衛生所皆成為照管分站，讓偏區民眾可在衛生所獲得長照的服務。本研究目的為評估新北市偏區衛生所執行此計畫之成效。方法：採回溯性世代研究，由新北市衛生局從衛生福利部「照顧服務管理平台」擷取新北市2018年1月至2019年6月長照2.0服務資料，依照管專員每半年對個案至少評估一次，將資料區分為三個半年時段（P1、P2、P3）進行分析，將每個研究時段的使用資料歸人定義長照2.0使用者半年使用費用、人均月費用。以廣義估計模型（Generalized estimating equations, GEE）分析偏區與都會區在三個研究時段使用長照2.0服務的變化趨勢。結果：在2018上半年（P1）計畫剛開始時，新北市偏區長照2.0使用率低於都會區（7.46％ vs 7.72％）；至2019上半年（P3），偏區已明顯高於都會區（14.6％ vs 13.0％）。控制其他變項後，偏區半年長照使用費用於2018上半年（P1）雖然較都會區低（b＝-7,116.76, p＜0.05），但城鄉差距在P2及P3逐漸縮小，至P3偏區增加量已顯著較都會區多（b＝3,113.96及b＝6859.47，p>0.05及p＜0.05）；新北市人均月費用P3顯著較P1低（b＝-1,076.73, p＜0.05），偏鄉降低的情形較都會多，但未達統計上顯著差異（b＝-754.83, p>0.05），可能與偏區使用人數快速增加有關。結論：All-In-One計畫藉由照管專員人力挹注與輔導，使偏區衛生所從傳統提供醫療、公共衛生預防保健服務，擴增為具長照管理中心分站，兼有物理治療與輔具資源中心之功能；此模式值得各縣市參考。

Objectives: A health center is a fundamental governmental institution that protects people's health, particularly in rural districts. For overcoming the shortage of long-term care (LTC) resources in rural districts, the Health Affairs Bureau of New Taipei City has implemented the All- In-One program in 13 rural health centers since 2018. The aim of this study was to evaluate the effectiveness of the All-In-One program. Methods: This retrospective cohort study was conducted through extraction of the data of LTC service users in New Taipei City from January 1, 2018, to June 30, 2019, from the Care Service Management Information Platform database of the Ministry of Health and Welfare. The extracted data were divided into 3 periods: P1 (from January 1, 2018, to June 30, 2018), P2 (from July 1, 2018, to December 31, 2018), and P3 (from January 1, 2019, to June 30, 2019). The trends in the LTC service 2.0 use rate and 6- and 1-month expenditure per user in each period in rural and urban districts were analyzed using generalized estimating equations. Results: Because the All-In-One program began in 2018, the usage rate of LTC service 2.0 in P1 was lower in rural districts than in urban districts (7.46% vs. 7.72%). In P3, the usage rate of LTC service 2.0 in rural districts was significantly higher than that in urban districts (14.6% vs. 13.0%, p < .05). After controlling other variables, the LTC 6-month expenditure per user in rural districts was less than that per user in urban districts during P1 (b = -7,116.76, p < .05). However, the 6-month expenditure per user increased significantly faster in rural districts than in urban districts in P2 and P3 (b = 3,113.96 and 6,859.47, respectively; p > .05 and p < .05). The decline in expenditure per month per user between P1 and P3 was significant (b = -1,076.73, p < .05). However, the decline in expenditure in rural districts tended to be quicker than that in urban districts (b = -754.83, p > .05). This may have been related to the increased usage rate. Conclusions: All- In-One programs in rural districts have empowered rural health centers to provide not only medical and public health services but also physiotherapy and assistive devices as a substation of LTC management centers. The All-In-One program is worth considering by other counties and cities for improvement of LTC in rural districts.