| 摘要: | 本研究探討臺灣地區民眾個人特質、心理過程因素、中醫醫療資源對中醫醫療服務利用之影響。本論文結合Aday and Andersen 和John Deway二種模式構成本研究架構，其分析重點包括：民眾個人特質與中醫醫療服務利用的關係，心理過程因素與中醫醫療服務利用的關係和環境醫療資源與中醫醫療服務利用的關係。本研究問卷採郵寄方式於民國90年5月寄發5,000份問卷，回收有效問卷1,407份，有效問卷回收率28.14%。樣本對象平均每人每年中醫醫療服務利用次數為2.35次，而在有使用中醫之平均每人每年中醫醫療服務利用次數為3.99次。 是否使用中醫之邏輯斯迴歸分析，得到心理過程低度涉入、心理過程中度涉入、自覺健康狀況、中醫偏好信念、中醫生理知識、中醫基本知識、醫療差異信念、性別、是否罹患慢性病等均有影響，並依勝算比高低順序排列。在高低度使用中醫之邏輯斯迴歸分析，得到心理過程低度涉入、中醫偏好信念、2年住院天數、醫療基本信念、中醫生理知識、中醫基本知識、醫療差異信念、性別、是否罹患慢性病等均有影響，並依勝算比高低順序排列。 中醫醫療知識和中醫醫療信念會影響是否使用中醫和高低度使用中醫，且會依健保分局別而有不同的影響。民眾在中醫醫療知識的平均分數在普通程度，而在中醫醫療信念的平均分數則是低於普通程度(小於3)。 在環境變項方面，每萬人口平均中醫師數與每人每年平均中醫門診件數比較呈現正相關。每萬人口平均中醫師數與各健保分局民眾使用中醫和每萬人口平均中醫師數與各健保分局民眾高度使用中醫，均呈現正相關。 在是否使用中醫自變項具有顯著差異的有：年齡、性別、家庭組成、教育程度、居住地、居住時間、中醫可近性、西醫可近性、近2年使用西醫、罹患慢性病、自覺健康狀況、近2年住院天數、生病時的處理、有固定中醫師、有固定中醫醫療院所、有固定西醫師、有固定西醫醫療院所、主動收集資訊習慣、生病時優先看中/西醫、生病時影響看西醫因素、因疾病嚴重而收集資訊等二十一項。在高低度使用中醫自變項具有顯著差異的有：年齡、家庭組成、教育程度、居住地、使用西醫次數、有固定西醫師等六項。 本研究對醫療政策之重要建議如下：提昇民眾對中醫醫療的知識與信念，中醫應對患者做詳盡的診療及病情解說，寓教於診療過程，以此增加民眾對中醫醫療的認識與信心及對中醫師與中醫院所的忠誠與信賴。將中醫病証用辭與西方醫學對照解說，並將中醫療效以現代醫療儀器及數據顯現，使中醫走向証據醫學，讓中醫學能更為民眾接受與瞭解。心理過程因素對民眾使用中醫與否具有極高的影響力，在進行醫療行銷時，應對民眾使用中醫的心理過程因素深入研究。政府及中醫團體均應加強中醫醫療社會行銷，政府單位應將正確之中醫藥知識及信念列入正規教育及社會教育之中，如大學生物學應包括中醫藥內容，以使民眾能獲得正確中醫藥知識。增設公立中醫醫院或在現有公立醫醫院設立中醫部，以增加民眾對中醫的可近性。; This study seeks to explore resident characteristics, psychological process factors, and Chinese medicine resources affect the utilization of chinese medicine in Taiwan. This study combines Aday and Anderson model with John Deway model to form this research framework. This study focus on (1) the relationship between resident characteristics (predisposition, enabling and need factors) and the utilization of Chinese medicine services, (2) the relationship between psychological process factors and the utilization of Chinese medicine services, and (3) the relationship between environmental medical resources and the utilization of Chinese medicine services. This sampling design was conducted by sending 5,000 copies of questionnaires to sample objects by mail in May 2001, with 1,407 of them returned that makes a response rate of 28.14%. On average each responder has 2.35 Chinese medicine service visits, compared to 3.99 service visits per person among those who have utilized Chinese medicine treatment. The major findings are summarized as follows: Factors concerning simple and uncomplicated psychological processes, beliefs of preference for Chinese medicine, days of hospitalization within two years, basic beliefs of medical treatment, physiological knowledge of Chinese medicine, basic knowledge of Chinese medicine, differences of beliefs toward medical treatment, gender, and whether suffered from chronic diseases using logistic regression analysis show significant influence on the utilization of Chinese medicine services, and the sequence is according to odds ratio ranking. Factors concerning uncomplicated psychological processes, beliefs of preference for Chinese medicine, days of hospitalization within two years, basic beliefs of medical treatment, physiological knowledge of Chinese medicine, basic knowledge of Chinese medicine, differences of beliefs toward medical treatment, gender, and whether suffered from chronic diseases using logistic regression analysis found significant influence on high or low utilization of Chinese medicine services, and the sequence is according to odds ratio ranking. Knowledge and beliefs of Chinese medicine may affect whether using Chinese medicine services and the degree of high or low utilization of Chinese medicine. Responders score average on the knowledge of Chinese medicine treatment, but the average score on the beliefs of Chinese medicine treatment is below 3. Regarding environmental variables analysis, positive correlation is presented by comparing the average number of Chinese medical doctors and number of Chinese medical institutes established per 10,000 people with number of outpatient service visits. The result sh |
