不同利害關係人對中彰投縣市出院轉銜居家醫療需求供給與期待性的可行性研究

ASIA unversity > 醫學暨健康學院 > 健康產業管理學系 > 健康管理組 > 博碩士論文 > Item 310904400/116918

Please use this identifier to cite or link to this item: http://asiair.asia.edu.tw/ir/handle/310904400/116918

Title:	不同利害關係人對中彰投縣市出院轉銜居家醫療需求供給與期待性的可行性研究
Other Titles:	Study of Different Viewpoints on Home Health Care Services Discharged from Hospital of Vulnerable Groups in Counties of Central Taiwan
Authors:	張庭瑜 ZHANG, TING-YU
Contributors:	廖宏恩 LIAO, HUNG-EN 健康產業管理學系健康管理組
Keywords:	居家醫療;出院準備;主題分析法;醫療可近性;照護連續性 home health care;discharge planning;thematic analysis;medical accessibility;continuity of care
Date:	2023
Issue Date:	2023-11-22 01:25:08 (UTC+0)
Abstract:	目的：出院準備轉銜居家醫療是臺灣近13年來銜接醫院與診所、醫療與長照、老化與偏遠、罕病與末疾、精進健康照護體系的一種新型態照護模式。本研究探索中彰投地區弱勢族群對居家醫療的需求，並分析需求端與供給端等利害關係人對居家醫療的看法。方法：本研究係採主題分析法來進行次級資料庫分析，原始資料取自亞洲大學廖宏恩副教授執行「109年度醫療區域輔導與醫療資源整合計畫」中的問卷調查；該問卷訪問對象有個案（含主要照顧者）與醫療專業人員兩式，分別有110名及62名。問卷內容則包括個案對居家醫療服務流程需求、對居家醫療團隊的期待、服務模式偏好、專業人員對於本身服務團隊的組成架構、運作流程與面臨困難看法。統計推論則兼具質化與採用SPSS 22版的相關量性資料分析。結果：研究初步發現相對於個案本身，其主要照顧者對出院轉銜居家醫療時有專人協助評估與醫師定期居家訪視有更高的需求，以及對居家醫療團隊的各項期待性皆有顯著相關（P<0.05），而民眾對其他連續性的服務（長照與遠距醫療）需求較低的主因分別是「原有照顧支持」與「設備導入障礙」；多數（90.2％）專業人員認同出院準備銜接居家醫療可以為臺灣老人提供良好的醫療照護，並認為適合臺灣本土發展的居家醫療模式為醫院主導模式（36.6％），其次是社區醫療群模式（35.2％），居家醫療團隊基本上應包含醫師、護理師與個管師等成員，且醫師與個管師的訪視頻率以一個月一次較為合理。專業人員認為出院轉銜居家醫療在執行實務上，面臨「團隊規劃與制度設計不完善」與「服務需求端的困難」兩大面向的挑戰，其中又以人力配置不完整為最多人關注的問題。結論：接受居家醫療的個案與其主要照顧者對出院時有個案管師可以提供相關資訊與協助有高度期待，而量能充足、跨專業間能溝通的醫護人員及政府的關注與支持是俾使出院準備銜接居家醫療模式可行的關鍵。 Objective：Discharge planning for transitioning to home health care is a new care model in Taiwan that bridges hospitals and clinics, medical care and long-term care, aging and remote areas, rare diseases and terminal illnesses, and enhances the health care system. This study explores the needs of vulnerable groups in counties of Central Taiwan regarding home health care and analyzes the perspectives of stakeholders on the demand and supply side of home health care.Method：This study adopted a thematic analysis approach to analyze secondary database from the survey conducted in the "2020 Medical Regional Assistance and Medical Resource Integration Project" led by Associate Professor Hong-En Liao from Asia University. The survey targeted two groups: cases (including primary caregivers) and healthcare professionals, with 110 and 62 respondents, respectively. The questionnaire included the case's needs for home health care service processes, expectations of the home health care team, preferences for service models, healthcare professionals' opinions on team composition, operational processes, and challenges faced. Statistical inferences included both qualitative and quantitative data analysis using SPSS version 22.Result：The preliminary findings of the study revealed that p primary caregivers, compared to the patients themselves, have a higher demand for dedicated assistance during the discharge transition to home health care and for regular home visits by physicians. Additionally, their various expectations from the home health care team are significantly correlated (P<0.05). The low demand for other continuity services (long-term care and telemedicine) among the public was primarily attributed to "existing caregiving support" and "barriers to equipment implementation." The majority of healthcare professionals (90.2%) agreed that discharge planning for home health care could provide quality medical care for the elderly in Taiwan. They believed that the hospital-led model (36.6%) was the most suitable home health care model for development in Taiwan, followed by the community medical group model (35.2%). The home health care team should ideally include members such as physicians, nurses, and case managers, with a reasonable visit frequency of once a month for physicians and case managers. Healthcare professionals identified two major challenges in the practical implementation of home health care services discharged from hospital: "inadequate team planning and system design" and "difficulties on the service demand side," with inadequate staffing being the most prominent concern.Conclusion：Individuals receiving home health care and their primary caregivers have high expectations for the provision of case managers to offer relevant information and assistance during the discharge process. Sufficient manpower, effective interprofessional communication among healthcare providers, and government attention and support are key factors for the feasibility of the home health care services discharged from hospital.
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