基層醫師參與品質報告卡實施之意願與影響因素; Willingness of Primary Care Physicians Participating in the Quality Report Card and its Associated Factors

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Title:	基層醫師參與品質報告卡實施之意願與影響因素;Willingness of Primary Care Physicians Participating in the Quality Report Card and its Associated Factors
Authors:	陳慧珊;Chen Hui-shan
Contributors:	中國醫藥大學醫務管理研究所
Keywords:	西醫基層;醫療品質;品質報告卡;Primary Care Medicine;Healthcare Quality;Quality Report Card
Date:	2004
Issue Date:	2010-01-20 16:49:55 (UTC+8)
Abstract:	中文摘要目的：在台灣醫療市場中，因就醫的財務障礙降低，民眾擁有高度的就醫選擇，民眾所得到的就醫相關資訊是否足夠就更顯得非常重要。有鑑於此，本研究希望藉由全國性之調查，一方面希望能研擬可能的品質報告卡指標項目內容，另一方面了解影響基層開業醫師贊成實施品質報告卡之因素。方法：本研究對象為中央健康保險局有參與健保之基層診所，針對全台灣西醫基層診所，依據各縣市診所比例，以隨機取樣方式抽取問卷，最後合計共抽出4,000 位西醫基層診所之開業醫師。以結構式問卷透過中國民國基層醫療協會合作，藉由郵寄方式進行問卷調查，有效回收問卷共574份，有效回收率為14.35%。同時以羅吉斯迴歸分析（Logistic Regression Analysis）探討影響基層開業醫師是否贊成實施品質報告卡之相關因素。結果：有68%的醫師贊成實施品質報告卡，醫師也多表示以自由加入的方式並且應該考量分科別。而資料更新的週期以一年為佳，希望由醫師相關公會來舉辦與公告，並透過網路作為公告管道。對於實施品質報告卡之影響認知方面，愈重視「是否會對病患更用心更在意病患的需求」此項指標的醫師，其贊成實施品質報告卡的機率顯著較高（勝算比為1.47）；在推行品質報告卡後，認為對於醫療或服務品質有所助益的醫師其贊成實施品的機率顯著高於認為沒有助益的醫師（勝算比為1.49）；醫師愈贊成以品質報告卡的結果為依據給予醫師實質的獎勵者，其贊成實施品質報告卡的機率越高（勝算比為2.06）。結論與建議：由本研究結果可知大部分的醫師皆贊成實施品質報告卡且多為願意加入，也表示應該分科別。依據本研究結果，建議衛生主管機關：（1）應推廣實施基層診所品質報告卡；（2）分科別且區分「特定指標」與「共同指標」；（3）了解醫師與民眾認知之落差；（4）公佈的方式須考量適切性；（5）應使醫師更加瞭解品質報告卡之優點。關鍵詞：西醫基層、醫療品質、品質報告卡; Abstract Objective: In Taiwan’s healthcare market, where the financial barrier of seeking medical services has been lowered, people now have many choices of receiving medical treatments. Hence, the availability of sufficient healthcare information is a vital issue. The purpose of this research was first to provide a reference for the general public in their choices of healthcare services by conducting nationwide questionnaires. Second, it also aimed to obtain a comprehensive understanding of the underlying factors of primary care physicians’ supports for implementing the quality card. Method: The study samples of this research were physicians in the primary care clinics which had joined the Bureau of National Health Insurance. After randomly sampling the primary care clinics in Taiwan based on the proportions of clinics in different administration districts, a total of 4,000 well-structured questionnaires were administrated to primary care physicians by mail; 574 questionnaires were collected and the response rate was 14.35%. In terms of data analysis, logistic regression analysis was applied to investigate the relevant factors that influence private practice doctors’ agreement on the implementation of quality report card. Results: The results showed that 68% doctors agreed to implement quality report card; most of the doctors expressed to participate in the quality report card freely; furthermore, the report card should be designed based on different division. Moreover, the data of quality report card should be annually updated and be held and announced by relevant doctor associations on Internet. With respect to the willingness of participation, doctors with higher willingness to participate in the quality report card highly agreed with implementing the quality report card; in terms of the perceived cognition of influences of implementing the quality report card, doctors who emphasized more on the indicator, “the focus on patients and their needs,” was statistically significant to agree with the implementation of quality report card (OR=1.47). Doctors who considered the future implementation of the quality report card is helpful to the quality of medication and services was significantly higher than those who didn’t (OR=1.49). A great percent of the doctors who agreed to provide practical rewards according to the results of the quality report card tended to agree with the implementation of quality report card (OR=2.06). Conclusions and recommendation: It was concluded that most of the doctors agreed with the implementation of the quality report card based on different divisions. Therefore, the following suggestions are provided according to the findings of this study: (1) to promote the quality report card to clinics; (2) to implement the quality report card based on different divisions and to classify “specific indicators” and “common (or core) indicators;” (3) to understand the cognition differences between doctors and the public; (4) to consider the appropriateness of announcement; (5) to enable doctors to have a better understanding on the advantages of the quality report card. Keywords: Primary Care
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