南區診所醫師對參與家醫計畫看法及滿意度之研究

Views and Level of Satisfaction of Primary Care Physicians in the South District on Participating the Family Doctors Integrated Health Delivery System

目標：中央健保月於民國九十二年起公告實施「家庭醫師整合性照護制度試辦計畫」，整合醫療院所的寶源及提升服務品質外希望能吸引被保險人的參與，進而達到預防醫學以及降低整體醫療費用的成效。醫師滿意度是醫病關係及醫療照護過程的重要預測因素，故本研究旨在探討醫師對「家醫整合計畫」的滿意程度及看法，與醫師滿意度之影響因素。方法：以九十十三年度，南區二十九個社區醫療群的全部200家診所之醫師為研究母群，在九十四年七月以郵寄問卷調查法收集資料，總共發出200份問卷，共問收有效問卷105份，以描述性分析。因素分析。單變項分析、相關分析及逐步複回歸分析，探討醫師滿意度與看法，及滿意度主要影響因素。結果：發現醫師平均滿意度分數為3.59分，醫師平均認同度分數為3.4分，醫師滿意度經由因素分析後可分為四構面：1)診所與醫院診療、行政管理合作面；2)主管機關對家醫制度管理面；3)醫療群運作情形及診所服務提供；4)病患對家醫制度的接受及參與度。在「診所特性」中開業年資、醫療資訊系統是否與合作醫院連結、是否建立平行轉診及「醫師特性」中是否為社區醫療群執行中心長、參與「家庭醫師繫合性照護制度試辦計畫」動機數目、是否贊成「家庭醫師整合性照護制度試辦計畫」寶施與醫師對「家醫撚合計畫」認同度都會影響醫師對計畫的滿意度。結論：衛生主管機關應加強診所醫師對家醫整合計畫的認同。強化診所與醫院間資訊系統連結的暢通、建立診所平行轉診以提升醫師的滿意，俾利家醫整合計畫之功效。

Objective: As the level of satisfaction of physicians is an important predictive factor for the relationship between the healthcare provider, the patient and the healthcare process, this study aims to investigate the level of satisfaction and views of physicians on the ”Family Doctor Integrated Health Delivery System” and the factors influencing the level of satisfaction. Methods: Taking primary care physicians of the 200 clinics in the 29 healthcare communities of the South District in 2004 as subjects, this study adopts questionnaire survey method; a total of 200 questionnaires were mailed in July 2005 and 105 valid questionnaires were retrieved. Descriptive analysis, factor analysis, one-way ANOVA, and stepwise regression analysis were adopted to investigate the level of satisfaction and views of physicians and the major factors influencing the level of satisfaction. Results: The mean score of the level of satisfaction and agreement of physicians are 3.59 and 3.4 respectively. Through factor analysis, the level of satisfaction may be divided into 4 constructs: 1. cooperation between healthcare and the administration management of clinics and hospitals; 2. management of competent authorities on the family doctor system; 3. operation of healthcare institutes and services provided by clinics; 4. level of acceptance and participation of patients on the family doctor system. Factors influencing the level of satisfaction of physician include: 1. Characteristics of clinic: including the years of operation, if the healthcare information system is connected to cooperative hospitals and if a horizontal referral system is established; 2. Characteristics of Physicians: if the physician is the chief of the community healthcare center, the motivation of participating the ”Family Doctor Integrated Health Delivery System”, if the physician agrees to the implementation of the ”Family Doctor Integrated Health Delivery Pilot System” and the level of agreement to the ”Family Doctor Integrated health Delivery System”. Conclusions: The health policy makers should reinforce the level of agreement of physicians to the ”Family Doctor Integrated Health Delivery System”, strengthen the connection of information system between clinics and hospitals; establish horizontal referral system between clinics in order to improve the level of satisfaction of physicians to increase the effects of the ”Family Doctor Integrated Health Delivery System”.