參與「家庭醫師整合性照護試辦計畫」民眾對計畫實施成效之觀感

The Viewpoints of Consumers Joining the “Family Physician Integration Trial Plan (FPITP)” toward the Effectiveness of the Plan

本研究旨在探討參與「家庭醫師整合性照護試辦計畫」民眾對計畫成效之觀感。本研究以結構式問卷為測量工具，立意選取大台北地區2004年6月參與「家庭醫師整合性照護制度試辦計畫」所成立之二個社區醫療群，共計10家診所，以其診所登記參與家醫試辦計畫之家戶會員為研究母群體，以研究期間曾就醫之全體家戶會員為受訪對象，探討家戶會員藉由家醫試辦計畫感知得到之實際效益，以及家庭醫師提供服務狀況與試辦計畫整體成效之相關性，隨後在控制基本資料下探討影響民眾對「家庭醫師整合性照護試辦計畫」整體成效觀感產生差異之因素。經由t檢定或卡方檢定分析後發現，填答者對於家醫試辦計畫所提供之服務有七成以上均感到“滿意”或“非常滿意”；對於家醫試辦計畫之整體實際成效之負面評價僅有7.1%，但是整體實際成效之正面評價亦僅止於47.5%；有73.7%填答者“有意願”或“非常有意願”繼續參加家醫試辦計畫。在羅吉斯迴歸分析中，在控制基本資料後發現：對於家醫試辦計畫提供之預防保健服務滿意者（勝算比＝2.3, 95%信賴區間為1.2~4.4），對家醫試辦計畫之整體成效觀感較佳。茲針對研究結果，對衛生主管機關提出三點建議：（一）拓展落實家庭醫師制度；（二）擴大宣導國內家醫試辦計畫；（三）衛生主管機關和家庭醫師除了提供基本的醫療服務外，可在預防保健服務加強提供。

The purpose of this study was to explore the views of those consumers joining the ”Family Physician Integration Trial Plan (FPITP)” toward the effectiveness of the plan. A structured questionnaire was used as a measure tool. The consumers comprising the sample were selected from 10 clinics in two groups who joined the ”FPITP” since June 2004. Student t or chi-square tests were used to examine the relationships between perceived benefits and quality of care provided to the consumers and the effectiveness of the plan. Logistic regression analysis was also used to examine the relationships between perceived benefits and quality of care provided to the consumers and the effectiveness of the plan after adjusting for consumer characteristics. The study showed that ＞70% of respondents were ”satisfied” or ”very satisfied” with the ”FPITP.” Altogether, 7.1% had negative feelings about the ”FPITP.” However, only 47.5% of the respondents had positive feelings about the ”FPITP.” A total of 73.7% of the respondents were ”willing” or ”very willing” to maintain membership in the ”FPITP.” Logistic regression analysis showed that those consumers who were satisfied with the preventive care services (OR=2.3, 95% CI=1.2~4.4) tended to feel positive toward the ”FPITP.”Based on the current study, we would like to suggest the following for health authority in this country: (1) expand the service scope of family physicians, (2) promote the effectiveness of the ”FPITP,” and (3) strengthen the provision of preventive care by family physicians.