從嚴重特殊傳染性肺炎(COVID-19)經驗探討台灣偏鄉遠距健康照護方案的發展策略

The Telehealth Development in Rural and Remote Areas of Taiwan: a Collaborative Strategy Based on COVID-19 Experiences

目的：遠距健康照護可以突破時空限制，增進醫療可近性，讓偏鄉民眾有機會獲得更好的在地醫療保健服務。嚴重特殊傳染性肺炎(COVID-19)的全球疫情，促使遠距健康照護更為廣泛且快速地發展。本研究目的在於說明遠距健康照護在台灣偏鄉的應用限制，並探討可行的發展策略。

方法：透過「專科醫療會診」、「COVID-19疫情視訊診療」的方案設計和執行內容比較，本研究分析主題包括：（一）歸納現行遠距醫療方案的執行內容，並和民眾端的健康需求差異作比較，探討現行方案發展的各項限制條件和考量、（二）對照國內和國際方案間的發展差異，探討在台灣突破現行發展限制，並回應偏鄉民眾健康照護需求的彈性策略。

結果：「COVID-19疫情視訊診療」的服務內容，相較於「專科醫療會診」來得廣泛而便利，形式上更接近偏鄉民眾所需。「專科醫療會診」則透過專業把關的設計，降低民眾遠距看診的風險，是遠距醫療的審慎做法。但若想改善民眾就醫不便的訴求，在診療項目、視訊平台、處方開立、藥物配送等限制上，都還有調整的空間。

結論：遠距健康服務在偏鄉應用發展的建議策略包括二點：（一）增進民眾參與的系統發展模式、（二）專業端的服務轉型以及管理權限的釋放配套。配合民眾端主體意見進行應用工具的開發和調整，可以讓遠距平台的建置和服務範圍，更貼近使用者需求。身份識別、遠距生理量測、雲端病歷應用、藥物處方和配送管理等流程改善，是落實民眾使用遠距健康服務的關鍵，也是相關單位協商調整的轉型重點。

 

Purpose: Residents living in rural and remote areas often experience difficulty accessing adequate medical services due to geographical isolation and shortage of medical professionals, and the problem can be largely overcome by the delivery of healthcare services via telehealth, whose usage has surged after the outbreak of the COVID-19 pandemic. The study examined the limitations of current telehealth programs in Taiwan and offered suggestions for further development.

Methods: (1) Comparing the differences between the “Specialty Consultation” program and the “COVID-19 Telemedicine” program to examine the gap between the programs and the health needs of rural and remote residents. (2) Comparing current developments of telehealth reported in the literature to help formulate potential strategies and solution for meeting the health needs of rural and remote residents in Taiwan.

Results: The range and form of services in the “COVID-19 Telemedicine” program were more flexible than those in the “Specialty Consultation” program and therefore more suitable for the rural and remote population. On the other hand, the risk of teleconsultation in the “Specialty Consultation” program was relatively lower. It is worth considering to modify the design of the consultation platform, the range of the provided services, and the flow of the prescription and pharmacy services to better meet the health needs of local rural and remote residents.

Conclusion: The study proposes two strategies to improve the telehealth development in the rural and remote areas of Taiwan: (1) Enhancing patient engagement during virtual care; and (2) Modifying the range and scope of professional services with relevant supporting measures to promote the participation of non-professionals. For a better user experience, more room for negotiation between stakeholders is needed to improve identity authentication, remote patient monitoring, use of cloud healthcare data, and telepharmacy programs.