台灣中醫偏遠地區巡迴醫療病患就診特性與服務滿意度研究

Patients' Characteristics and Satisfaction on Mobile Medicine of Traditional Chinese Medicine at Rural Areas in Taiwan

探討偏遠地區中醫巡迴醫療照護的成效，包括醫療人力、服務率、巡迴醫療鄉數，以及民眾醫療的滿意度和病患常見的疾病。採用結構式問卷與健保署資料庫調查民國99-103年中醫巡迴醫療服務資訊，調查巡迴醫療就醫民眾的醫療可近性與滿意程度。有關問卷評估的項目包含地點的環境衛生及舒適性、醫療設備、看病流程、交通方便性、中醫師的說明，包括病情、治療方法及對疾病的指導、其他醫護人員的說明指導、中醫師的診斷及治療等醫術方面、中醫師的服務態度、其他醫護人員的服務態度、治療的效果（症狀的改善程度）、整體醫療品質、門診診次安排。資料蒐集後再採用描述性的統計方法，分析中醫巡迴醫療服務民眾就診疾病特性以及民眾就醫的可近性與滿意度。本研究發現整體中醫於改善無中醫鄉方面的推行，合併中醫師開業服務與巡迴醫療服務參與中醫師人數從民國99年153人增加至103年230人，服務病患人數與服務人次由22635人/121660人次增加至33779人/183779人次，中醫醫療服務偏鄉數由61鄉增至85鄉，服務率也從9.97%上升至15.05%。而於中醫巡迴醫療統計中，偏鄉民眾滿意度最高的前三項目為中醫師的態度99.34%，中醫師的診斷及治療等醫術方面98.25%，以及中醫巡迴醫療的治療效果98.25 %；相反地滿意度較低的前三項目為門診診次安排，醫療設備以及看病流程。另外本研究也發現偏遠地區中醫醫療服務常見的疾病為：肌痛及肌炎、腰痛、咳嗽、關節痛、急性鼻咽炎（感冒）、睡眠障礙、頭痛、坐骨神經痛及其他。政府的專案補助與中醫師的積極參與，有助於改善偏遠地區民眾中醫就醫的可近性與滿意度，也才能符合醫療的公平性與全民健保守護全民健康的目標。另外，本文發現偏鄉就醫民眾多疼痛、失眠與呼吸系統疾病的特性，可提供中醫師選擇攜帶藥物至偏鄉的參考。

To explore the effectiveness of the mobile medical care with traditional Chinese medicine (TCM) in the rural area, including medical manpower, service rate, the number of mobile medical townships, the patients satisfaction and common diseases. Using a structured questionnaire and the information of the Health Insurance Agency database on mobile medical services in Chinese medicine since 2000 to 2014, we investigated the accessibility and satisfaction of the patients in the rural area. Questionnaire items includes place, equipment, process, traffic, disease explanation by TCM physician or other staff, diagnosis and treatment techniques, service attitude of physician or other staff, treatment effect, overall quality of care, and outpatient arrangement. Shortly after data collection, we would use descriptive statistical methods to analyze the characteristics, accessibility and satisfaction of the patients with TCM mobile medical services. The study found that the number of physicians increased from 153 in 2010 to 230 in 2014, service number of patients and service visits increased from 22,635 person / 121660 visitors to 33,779 person / 183,779 visitors, the number of TCM mobile medical townships increased from 61 to 85, and service rate also rose from 9.97 percent to 15.0.5%. The three highest satisfaction of the patients were TCM physician attitude (99.34%), medical skill (98.25%), and treatment effect (98.25%). Conversely, the three dissatisfaction of the patients were outpatient arrangement, medical equipment and medical treatment processes. In addition, we found the commonest diseases of the rural residents seeking for mobile traditional Chinese medical service including myositis, lumbago, cough, arthralgia, common cold, sleeping disorder, headache, sciatica etc. TCM practitioners actively involved the project grants supported by government could improve the patients’ accessibility and satisfaction in the rural area. It also can meet medical fairness and the guardian of national health goals. Finally, our research findings such as pain, insomnia, and respiratory diseases would provide a reference for carrying drugs selected by TCM physicians on mobile medical services.