居家整合醫療及雙向轉診困境之調查--某區域醫療網參與醫師之觀點

A Survey on Challenges in Implementing the Home Care Services and Bidirectional Referral System in Taiwan – Perspectives from Physicians in a Regional Primary Health Care Program

目的：居家醫療及雙向轉診為迎接高齡社會之重要措施，健保署於2016年起推動「居家醫療照護整合計畫」與雙向轉診系列規劃，本研究擬藉由問卷調查該計畫執行所遇之困難與需求，以利未來協助解決問題並推廣相關業務。 方法：應用自行設計的電子問卷一份，在2018年7月至10月期間，請165位高屏澎區參與「107年度醫療區域輔導與醫療資源整合計畫」的醫師填寫問卷。 結果：填答人數67人(40.6%)，有效問卷為64份(38.8%)，回應者以在診所年齡為51-60歲者居多(45.3%)，回應不曾成功收案居家醫療者佔45.3%，主因是「登錄作業不熟悉」和「診所繁忙無暇訪視」等。無轉診經驗者佔46.9%，主因為對「轉診機制不熟悉」、「團隊內尚未建立雙向轉診機制」。未來課程需求主要是「了解計畫內容、制度及平台」，其次為「基層醫師經驗分享」；與團隊醫院合作事宜則為「協助後送急診、安排住院」。 結論：現時高屏地區參與或推行居家醫療及雙向轉診的情況尚有困難，相關業務的推展上需更多實務工作的介紹和經驗分享。

 

Purpose: Home care services and the bidirectional referral system have been launched for years by the Bureau of National Health Insurance in Taiwan. However, there is still much work to be done with regard to the utilization rate. The study is to explore the obstacles primary care physicians confronted with when providing home care service and referring patients. Methods: A total of 165 physicians who joined in primary health care program in southern Taiwan were invited to answer an online questionnaire during July to October 2018. Results: Totally 40.6% (n=67) physicians answered the questionnaire and 38.8% (n=64) were valid. About 45.3% physicians were in the fifties and practiced in clinics. Also 45.3% of them had never provided home care service. Their major concerns were unfamiliar with the case register system and heavy workload in clinics. We also found 46.9% of physicians no experience of patient referral. The leading causes were unfamiliar with the bidirectional referral system and no referral process in the collaborative medical care team. Their suggestion about future training courses were details of the home care program, the bidirectional referral system, and experience from others colleagues. Assistance of emergency care and patient’s hospitalization from collaborative hospital were needed and concerns. Conclusion: Home care service and bidirectional referral system in southern Taiwan still have problems. Aims to promote those service, practical caring and experience sharing are needed.