個案管理師與醫師臨床實務合作之分析

An Exploration of Case Managers'/Physicians' Perceptions on Collaborative Practice

個案管理重視醫療團隊之協調合作，為民眾或病患提供完整的照護服務，本研究依整合式健康照護之理念，推展個案管理模式並培訓個案管理師，即24小時課室課程後，一年個案輔導之實務訓練。本文目的乃為瞭解及分析個案管理師與醫師間的臨床實務合作情形。本研究為一初步調查型研究，研究對象分個案管理師與醫師兩部份，個案管理師問卷回收69份，醫師部份則回收37份，研究工具為臨床實務合作量表，統計分析採因素分析、集群分析，及區別分析等。主要結果:多數個案管理師與醫師在臨床實務中之互動良好，個案管理師臨床實務合作量表因素分析得「諮詢協商型之互動」及「表達告知型之互動」兩項因素，解釋變異量各為60.01%及10.18%：醫師臨床實務合作量表因素分析則得「商討決策型之互動」及「重視與徵詢配合型之互動」兩項因素，解釋變異量各為68.37%及9.29%。我國整合醫療照護服務正在萌芽階段，本研究期望研究人員共同努力，能漸露曙光建立一個符合民眾需求且有效控制成本的健康照護服務模式。

Collaboration among physicians and nurses has been espoused as a means to improve patients' outcomes. Managed care is defined as a health care system that integrates the financing and delivery of health care services. This study built up a case manager model to organize a community health care system. The purpose of the study was to evaluate the case manager-physician collaboration on patient care. A survey of 69 case managers and 37 physicians using the collaborative practice scales in a medical center was completed. Factor analysis, cluster analysis, and discriminant analysis were performed for data analysis. The important findings were as follows: Two factors were extracted and named from nurse/physician collaborative practice scales respectively. Counseling and informative factors accounted for 60.01% and 10.18% of the total variance on nurse collaborative practice scales. Decision discussing and inquiry factors accounted for 68.37% and 9.29% of the total variance on physician collaborative practice scales. The managed care plans would lower costs for payers while maintaining an acceptable level of services and quality of care. The results of this study may provide essential information for planning health care policy and education in preparation for meeting our nation's increasing health care need.