目的：衛生福利部為因應高齡社會失能者不易到醫療院所就醫，於2019年開辦居家失能個案家庭醫師照護方案，但派案成效在台北區偏低。本研究欲以問卷調查照顧管理人員認知態度、派案成效及困難之處。

方法：本研究於2022年7月以網路發送臺北市衛生局照管專員及照管督導之不記名問卷，內容包括基本資料、居家失能家醫方案之派案經驗、認知與態度等，並將影響方案成功派案之可能因素進行統計分析。

結果：本研究共蒐集臺北市轄內91位照管專員及12位照管督導之問卷（佔現有照管人員84.4%），其中以女性居多(85.4%)，平均年齡38.0歲，擁有的專業證照最多為護理師(33.0%)及社工師(25.2%)。在有派案經驗之92位照管人員中，91.3%之照管人員每月平均派案成功在5次以下，38%之照管人員每月被個案拒絕超過20次。照管人員認同影響方案派案成功之前三大可能因素為「個案已有固定醫師」、「缺乏參與方案的醫師」、「醫師量能不足」。邏輯斯迴歸分析顯示，照管人員年齡越大及有護理師證照者較認為醫師家訪對居家失能家醫方案較有幫助。

結論：被個案拒絕是居家失能家醫方案派案效果不彰的主因，顯現派案醫師端整合與量能問題。建議整合個案原有家庭醫師、建立媒合平台，考量對個案熟悉度、醫師專科、個案就醫習慣派案；增加居家失能家醫方案給付並廣為宣傳，以提高基層醫師參與意願；加強派案照管人員的教育訓練、改善與家庭醫師的溝通管道。

Objective: The Ministry of Health and Welfare in Taiwan launched the Family Physician Home Care Program for Individuals with Disabilities in 2019 to address the difficulty of disabled individuals in accessing medical care. However, the program’s case assignment effectiveness in Taipei City has been low. This study therefore aims to investigate the perceptions and attitudes of care managers regarding the program’s assignment effectiveness and difficulties through a questionnaire survey.

Methods: In July 2022, an anonymous online questionnaire was distributed to care managers in Taipei City Department of Health. The questionnaire covered demographics, experience with the program, and perceptions and attitudes concerning its assignment effectiveness. Statistical analysis was conducted to identify potential factors affecting successful case assignment.

Results: A total of 103 effective questionnaires were collected, including 91 care management specialists and 12 care management supervisors (together accounting for 84.4% of existing care management staff at Taipei City Department of Health). Most respondents were female (85.4%) with an average age of 38 years old. The most common professional licenses held were those of registered nurses (33.0%) and social workers (25.2%). Among the 92 care managers with case assignment experience, 91.3% reported an average of fewer than 5 successful case assignments per month, and 38% experienced over 20 case rejections per month. The top three factors perceived to influence case assignment success were “existence of regular physicians for patients” “shortage of available physicians,” and “inadequacy of physician capacity.” Logistic regression analysis showed that older care managers and those with nursing licenses were more likely to perceive physician home visits as beneficial to the program’s success.

Conclusion: Case rejection is the main cause of the program’s poor assignment effectiveness, highlighting issues with physician integration and capacity. To address these challenges, we recommend: 1. Integrating patients’ existing family physicians into the program; 2. Establishing a matching platform taking into consideration physician-patient familiarity, physician specialty, and patient’s medical habits; 3. Increasing program payments as an incentive to boost physician participation; and 4. Strengthening care managers’ training for enhancing care assignment success and improving communication with family physicians.