台灣社會另類療法風險管理之專家系統制度初探

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Title:	台灣社會另類療法風險管理之專家系統制度初探 The Exploration of the Expert System for Management of Alternative Medicine in Taiwan.
Authors:	盧孳艷;吳肖琪;李政諦;陳威麗
Contributors:	中國醫藥大學
Keywords:	中老年人;質性分析;專家導引系統;風險管理論述;The middle aged and elderly;Qualitative analysis;Expert system for management of alternative therapy;Risk management
Date:	2006-12
Issue Date:	2010-07-13 16:58:44 (UTC+8)
Abstract:	多元醫療資源運用是台灣社會民眾求醫過程之特色。近年來，在全球化擴張下，人口移動與訊息傳遞加速，使得各種補充與另類療法(CAM)充斥民眾求醫市場。中老年人因身體機能退化，且求助正規醫療不易有明顯療效，更易轉而求助另類療法。但另類療法的治療措施與副作用並不明確，因此消費者也面臨如何選擇適合與安全性醫療措施的挑戰。由於另類療法屬於醫學知識的新概念，且常因歸類困難、定義不清，造成管理上的困擾，目前並無明確的相關條例為依據，也未列入醫療管理之範疇，對民眾之健康安全無法提供確切的保障。本研究的設計兼顧文化及社會結構面向，由使用者角度探討另類療法文化脈絡意涵且分析社會結構與另類療法之生產與再生產之關係，同時將消費者及供給面兩者之視野發展管理制度。擬以中老年人（55歲以上，並患有退化性關節炎之相關性疼痛）為樣本進行發展另類療法專家導引系統。研究方法為質性研究法，根據理論性抽樣之原則，採持續性的比較分析法分析資料。第一年藉由論述分析(Discourse analysis)為主軸，蒐集與分析平面媒體與大眾健康保健書籍對於另類療法之論述，同時訪談不同角色－醫療專家、使用者、政策執行者等所接收到的另類療法風險資訊以及相關研究進行的論述基礎；並將所蒐集報章雜誌有關另類療法之資料，與不同角色專家對於另類療法之論述，並進行比較其異同，初步建構在台灣適用的另類療法專家導引系統。第二年，以焦點團體法了解中老年人另類療法於身體實踐的敘述故事（narratives），同時蒐集與分析歐美先進國家有關另類療法之相關資料與管理機制，並以以上二者資料為基礎，修正第一年所發展之另類療法專家導引系統。第三年，以成員反應分析(member check)測試另類療法專家導引系統之信效度，測試之對象包括相關領域之專家與使用者。測試結果將發展另類療法導引手冊，同時將發展與建立適用於本土性另類療法模組，建構完整之老人群組專家導引系統管理模式。本研究結果將建立另類療法專家導引系統，提供本土中老年人使用另類療法之指引，同時也提供臨床實務者－老人醫學科、家醫科、骨科、公共衛生等醫護人員醫療資源及另類療法照護服務之參考，其最終目標係提供政府單位發展與建立有效與安全的全面性管理機制，作為擬定另類療法相關政策之依據，進而提供民眾安全性與適用性。 Health care pluralism has become a norm in the health-seeking process among Taiwanese. In the recent year, numerous supplement and alternative therapies have emerged in the health market due to population mobility and information dissemination. When the middle aged and elderly failed to show progress from standard medical treatment due to physical deterioration, they turn into alternative therapy for help. However, the mechanism and side-effect of alternative therapy remain unclear. Therefore, consumers face the challenges of how to choose the appropriate and safe alternative therapy. Given the fact that alternative therapy emerges as a new concept in medicine and lacks of mandated regulations , the health of the consumers is in jeopardy. This study includes both cultural and social approaches, to explore the cultural aspects of alternative therapy, to analyze the relationship of production and re-production between social structure and alternative therapy, and to develop a management system based on the perspectives of consumers and providers. Further, the interview data is obtained from the middle aged and elderly with fifty-five year-ole and above complaining pains from deteriorate arthritis, with aim to develop an alternative expert guidance system. The qualitative, comparative analysis method is undertaken and theoretical sampling is used in the three-year project. In first year, we use discourse analysis serving as a guide to collect and analyze data gathered from media report and health books for the public. In particular, we interview medical experts, users, policy-makers with regard to the information of alternative therapy they received in order to establish the foundations of discourse analysis. Furthermore, we collect newspaper and magazines regarding alternative therapy and compare similarities and differences of discourse analysis among expert？HHHHH？HHHHH to develop a preliminary alternative expert guidance system for Taiwanese. In second year, we use focus groups to gain insights of narratives from the elderly who have used alternative therapy themselves. Meanwhile, the management mechanism of alternative therapy in Europe countries and United States is collected. Based on these two mentioned types of information, we revise the alternative therapy expert guidance system developed in the previous year.
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