某醫學中心心臟內科慢性病連續處方箋病患轉診意願調查分析

An Analysis of the Willingness of Cardiovascular Patients to Be Referred from a Medical Center to Affiliated Community Clinics

中央健康保險局日前規範病情較穩定的慢性病患得以在醫師的專業判斷下，回歸到社區的醫療院所就診或社區藥局拿慢性病連續處方箋，以符合中央健康保險資源妥善分配。雖然慢性連續處方箋可節省金錢及時間，仍有許多民眾心態還是認為經過醫師診斷比較心安，因此透過轉診方式至社區診所亦為解決方法之一，惟如何提高病患的意願將是成敗關鍵。本文主要以調查某醫學中心心臟內科病患轉診意願度及其相關影響因素，研究樣本來自某醫學中心2004年7月間持有慢性病連續處方箋的病患資料庫，以立意取樣的方式，將平均每次醫療金額大於1,500元、近一年就診次數小於52次者之心臟內科病患，計有586位，進行電話訪問調查方式，扣除不在家因素後，共完成有效問卷共369份(62.7%)。研究對象年齡平均為65歲，男性(59.3%)多於女性(40.7%)，轉診意願與下列五個變項有顯著相關：就醫是否享有優待、到原醫院交通是否方便、轉診醫療診所的交通是否方便、對於原醫院人員服務態度是否滿意，以及轉診醫療單位的醫師看診時段是否能配合。整體而言，願意接受轉診人數(48.7%)比不願意接受轉診人數略少(51.3%)，但不具顯著差異；研究對象接受轉診主要考慮前五項因素依序為：看診醫師相同、交通方便、等候時間較少、部分負擔較輕或收費低、就診時段可配合。不願意接受轉診主要考慮前五項因素依序為：交通不方便、習慣到原醫院就診、需要時間考慮、就醫身分的優待、原就診醫院設備較好。本研究個案醫院係為公家醫院，因政策任務長期支援建教合作之診所，故醫院與診所間有相同醫師看診及相同成份（或雷同）藥品，此與其他調查研究較為不同之處；本研究結果發現病患於轉診考量因素多半重視交通便利性、對醫師忠誠度高、收費優待與否與固定醫療院所就診等特質，建議醫院可以藉由調查病友來源集中處，增加可雙向看診之建教合作診所及考量延伸接駁車動線，並加強醫院與診所之轉診資訊平台，亦加強向病患宣導轉診之好處，使病患改變就診習慣，安心就近看診，以增加轉診成功機率。

The purpose of the study was to determine the willingness of cardiovascular patients to be referred from a medical center to affiliated community clinics with the same physicians and prescriptions. The research sample consisted of patients with refilling cards in July 2004 and was derived from the database of a medical center. Through purposive sampling, we selected 586 cardiac patients whose visits to physicians in the previous year were fewer than 52 times and the average medical cost per visit is more than NT$1, 500. The survey was conducted through telephone interview, with 369 valid questionnaires (62.7% response rate).The average age of the respondents was 65 years. There were more male respondents (59.3%) than female respondents (40.7%). The willingness of the patients to be referred was mainly influenced by the following five factors: 1) special treatments accompanied by the referral, 2) the traffic to the original medical center, 3) the traffic to the referred clinics, 4) satisfaction with the medical staff of the original hospital, and 5) whether the schedules of physicians at the referred clinics fits those of the patients. Overall, the percentage of the respondents willing to be referred (48.7%) was slightly less than those unwilling to be referred (51.3%), with no statistical significance. The 5 main considerations for the willingness to be referred were: 1) the same physicians, 2) convenient traffic, 3) less waiting time, 4) less medical costs, and 5) flexibility of the treatment schedule. For those unwilling to be referred, the 5 main factors were: 1) inconvenient traffic, 2) the habit of returning to the original hospitals, 3) the need of time for consideration, 4) special privileges in administrative procedures, and 5) better facilities at the original hospitals. The study used telephone interviews to determine the similarities and differences between the reasons why patients accept referrals, and why they chose a certain medical institution for treatment. Most of the respondents value convenience of traffic, loyalty to physicians, and accustomed medical institutions. We recommend hospitals to build up strategic alliances and cooperative systems with local community clinics. The success rate for referrals increases only when patients are able to seek medical treatment within the community, and when their feelings are well taken care of.