以實證醫學回顧全民健康保險家庭醫師整合性照護計畫之成效

The Efficacy of Family Physician Integrated Delivery System: An Evidence-based Review

目的：本研究以實證醫學文獻回顧的研究方法，檢討「全民健康保險家庭醫師整合性照護計畫」是否能提升醫療品質或民眾健康。方法：以實證醫學的文獻回顧，探討此計畫對提升醫療照護品質或民眾健康的成效，由「家庭醫師整合性照護制度」之五大工作目標：成立社區醫療群、建立家庭檔案、與合作醫院互動、建立資訊系統、社區營造與預防保健，依結構面、過程面及結果面，進行成果分析。結果：從162篇文獻中，篩選出29篇文獻。結果發現，民眾對整體制度呈現中高滿意度；醫師對政策滿意度偏向中等，約半數醫療群醫師感到滿意。基層醫師轉診的比率增加，且民眾對轉診的滿意度高。醫療群醫師積極參與社區衛教活動，且會員接受預防保健服務的比率增加。此外，加入醫療群的民眾就醫持續性及忠誠度較高，對照護品質有正面影響。結論：本計畫對民眾及參與醫師皆有正面的效果，有助於家庭醫師制度之推廣，然而多為證據力較低之橫斷面研究。

Purpose: The aim of the study was to explore the effects of 'Family Physician Integrated Care System' project on quality of health care and improvement of health status of enrolled population. Methods: We performed evidence-based review to assess the structure, process and outcome of the five targets of the Family Physician Integrated Care System: to set up community medical service group, to create the electronic health records of family members, interaction between community medical service group and referral hospital, community empowerment and preventive health care. Results: The study disclosed that the satisfaction of enrolled patients was moderate to high. The physicians' satisfaction to the project was moderate. There were about half of the physicians enrolled in the pilot program satisfied with the project. Patient referrals from primary physicians to hospitals increased and the satisfaction of referral system was high. Physicians of community medical service group attended health education activities aggressively. The rate of receiving preventive health services increased in patients attending the program. In addition, there were higher continuity of care and increased loyalty of patients that might have positive influence on healthcare quality. Conclusions: There were positive effects of this project toward enrolled patients and physicians. The project also helped to promote family physician system in Taiwan. However, the level of evidence was lower such as cross-sectional studies.