參與家庭醫師整合性照護試辦計畫民眾對醫療服務品質之觀感 A Study on People’ Attitudes Toward Perceived Quality of Health Care Provided under The Family Physician Trial Plan in Taiwan
中文摘要
本研究旨在探討參與家庭醫師整合性照護試辦計畫民眾對醫療服務品質之觀感。
以大台北地區參與「家庭醫師整合性醫療照護計畫」之二個醫療群，共12 家診所
的就醫民眾為對象，將該試辦計畫逾半年後之12 家診所就醫民眾分成簽約組與
非簽約組。二組隨機各抽100 名就醫民眾，年齡未滿 20 歲者由年滿 20 歲之陪病 者代答，一家診所共200 名，12 家診所總計 2,400 名樣本。以 PZB 模式研發之結 構式問卷為測量工具，由診所行政人員發放，並於測量完成後當面回收。將資料 鍵入電腦統計軟體中進行除錯，並進行信度檢測，隨即進行描述性及推論性統 計分析。並在控制民眾基本特質情形下，進行複迴歸（multiple regression）模式 之建立，並藉由迴歸分析結果來探討「參與家醫試辦計畫民眾對醫療服務品質之 觀感」。
研究結果發現「參與家醫試辦計畫就醫民眾」（簽約組）與「非參與家醫試辦計 畫就醫民眾」（非簽約組）在醫療服務品質觀感上的差異已達統計上顯著意義。
無論在「有形性」（診所的醫療設備、建築外觀及設施、醫護人員制服整齊清潔與
各種服務項目的標示及說明）、「可靠性」（醫師對病患病情解說的清晰度、診治
的過程、遭遇問題時盡力解決、候診時間與治療解說的清晰度）、「反應性」（看 病的整個流程、醫療諮詢得到的答覆、服務熱忱與不會因太忙而疏於回應病患的 問題）、「保證性」（醫護人員的專業行為、保障病患服務過程的安全、進行醫療 行為時仍溫文有禮與團隊合作）與「關懷性」（給予不同病患不同的照顧、安排 適當的服務時間、對個別病患的關心、以病患的權益為優先考量與了解個別 病患的需要），「簽約組」對醫療服務品質的滿意度均高於「非簽約組」，由此可 知，家醫試辦計畫的醫療服務品質確實受到簽約民眾的主觀肯定。此外，針對就 醫忠誠度的研究發現，家戶會員對「看診的滿意度」、「再回來看診的意願」及「推 薦醫師給親友的意願」均高於非家戶會員，由此可知，家醫試辦計畫對提升醫療 服務品質確有一定成效，使得在同一醫療群就醫之家戶會員比非家戶會員有較 高之就醫忠誠度。
茲針對研究結果，對衛生主管機關提出三點建言：（一）持續補助社區醫療群 提升醫療服務品質；（二）以實證數據宣導國內家醫試辦計畫成效；（三）建 立社區醫療群定期評鑑制度。
英文摘要
Objectives: This study aims to explore people’ perceived quality of medical services under the family physician trial plan in Taiwan.
Methods: The study subjects were those people who visited 12 office-based clinics
that attended the family physician trial plan in metropolitan Taipei area. We randomly selected 200 each from these 12 office-based clinics. In total, 2400 subjects were selected from these office-based clinics. We developed a self-administered questionnaire based on PZB model. The questionnaires were distributed by administrative personnel to study subjects in each office-based clinics. After collecting data, a multiple regression analysis was performed to compare people’s perceived quality of medical services and whether or not people has attended family physician trial plan.
Results: The study found that people who attended family physician trial plan
perceived better quality of medical service than their counterparts who did not attend family physician trial plan in the dimensions of tangibles, reliability, responsiveness, assurance and empathy. In addition, people who attended family physician trial plan had higher global satisfaction with the encounter, willingness to return to the clinic, and willingness to recommend the physicians to others than those who did not attend family physician trial plan.
Conclusions: Based on the results, we have three suggestions to the health authority:
(1) to continue to sponsor office-based clinics which attend family physician trial plan to increase the quality of medical services; (2) to conduct empirical studies to
examine the effectives of family physician trial plan; and (3) to build accreditation system on those office-based clinics which attend family physician trial plan.
