頁籤選單縮合
題 名 | 都會地區診所醫師醫療服務狀況及與醫院間轉診互動之調查=A Survey of Referral and Medical Resources Provision among Private Clinics and Hospitals in a Metropolitan Area |
---|---|
作 者 | 許碧珊; 劉瑞瑤; 陳曾基; 黃信彰; 蔡世滋; 郭英調; 何橈通; 張茂松; | 書刊名 | 臺灣家庭醫學雜誌 |
卷 期 | 11:1 2001.03[民90.03] |
頁 次 | 頁22-32 |
分類號 | 419.5 |
關鍵詞 | 醫療服務; 轉診; 醫療資源; Transferal; Coordinative care; Semi-open hospital; Medical resources integration; |
語 文 | 中文(Chinese) |
中文摘要 | 為建立診所與醫院間良好暢通的雙向轉診管道、促進診所與醫院間醫療資源的整合,本研究針對士林、北投地區開業醫師作問卷的訪查,以獲得診所執業型態、服務項目、設備、轉介方式、與醫院的特約關係、及是否想使用醫院的醫療資源等資料。針對回收的90份問卷(回收率:52%)分析:大部分診所為單獨執業,有五分之一為聯合執業,診所醫師年齡平均為50歲(35至77歲),平均執業14年(1至47年),有13.5%的診所醫師為女性。診所執業科別以一般科為多,佔三分之二的比例,其餘為專科診所。83.3%的診所醫師具有專科醫師執照。大約只有三分之一的診所提供預防保健服務,有28家(31.1%)診所提供全民健康保險成人預防保健檢查,27家(30.0%)診所提供全民健康保險嬰幼兒健康檢查,32家(35.6%)診所提供疫苗接種。其中一般科診所提供嬰幼兒健康檢查、疫苗接種的比例明顯的較專科診所高(p值均<0.001),而一般科診所提供成人預防保健檢查的比例亦有較專科診所稍高的傾向(p=0.06)。不到五分之一的診所具有檢驗或檢查設備。至於診所和醫院間互動的調查發現,80%的診所希望醫院開放醫療資源給診所使用,而診所想利用醫院的資源以雙向轉診為多(81%),其次為繼續教育學分的獲得(61%)及使用醫學圖書期刊(61%)。希望與醫院建立雙向轉診的醫師年齡較輕、執業年數較短、有專科醫師執照及曾於醫學中心受訓比例較高(p值分別<0.001,<0.01,<0.05及<0.05)。診所醫師轉介病患至醫院的顧慮以不知病患轉介後的結果最多(74%),轉介的考量以病患之意願(73%)及醫師的專業能力(72%)為先。只有44%的診所曾以正式轉診函轉介病患至醫院。只有52家診所(57.8%)曾接到醫院的轉診回函。 本研究結論為診所醫師可藉由提供更好的持續性以及預防性的照顧作為醫療體系守門員的角色,醫院方面則可開放醫療資源供診所利用、加強轉診函之回覆;這樣一來有助於促進醫學中心與基層診所建立良好的合作管道,提升醫院醫療資源的利用率及診所醫療品質,使病人接受更好的協調性照顧。 |
英文摘要 | In order to promote a more efficient inter-referral among private clinics and hospitals and to better utilize medical resources in a community, we performed a survey of private clinics in Shih-Lin and Pei-Tou areas of Taipei City by mailing them questionnaires to investigate their service styles, laboratory test capabilities & equipments, current referral status, and the interactive relationship with neighboring hospitals. There were total 90 replies to the qustionnaires with responding rate of 52%. Most clinics were solo practice. About 19% were group practice. The mean age of private clinic doctors was 50 years old (range from 35 to 77 years). Their average year of practice was 14 years (range from 1 to 47 years). 13.5% of them were female doctors. Even though the most private clinic doctors (83%) had board certification as specialist, as much as two-third of them practiced as generalists. Only one-third of the total private clinics surveyed provided about preventive services. Generalists tended to provide more preventive services such as preventive health examination and vaccination for infant and young children than specialists (p<0.001, respectively). Less than one-fifth of private clinics could provide laboratory tests, x-ray, sonography or electrocardiography examinations. 80% of private clinic doctors indicated that the area hospitals and medical centers should open medical resources to them. The medical resources most desirable to them were active inter-referral, continued medical education credit, and sharing of medical journal. Private clinic doctors with younger age, shorter practice year, having a specialist accreditation and previously trained in medical center would more like to establish active inter-referral relationship with neighboring hospitals (p<0.001, <0.01, <0.05 and <0.05, respectively). However, only 44% of them had ever transferred patient to area hospitals or medical centers using a formal transfer sheet. The choice of transferal hospital was mostly according to patient's will and consultant doctor's clinical expertise. Only 52 (57.8%) clinics had ever received a referral response from the transferred hospitals. Our conclusion is that most private clinics with their roles as gatekeeper of primary health care hope neighboring hospitals or medical centers to open medical resources and strengthen inter-referral relationship. Integration of medical resources among private clinics and hospitals will certainly create a more coordinative health care system. |
本系統中英文摘要資訊取自各篇刊載內容。