| 摘要: | 目標：醫師意願為影響慢箋釋出之首要因素，故本研究希望了解影響基層診所醫師釋出慢性病連續處方箋之意願及相關因素。方法：依健保局特約醫事機構名冊篩選符合研究條件之8,830位西醫基層醫師為研究對象，從中隨機抽取4,000位，以郵寄結構式問卷的方式進行問卷調查，共計回收有效問卷813份。除描述性分析外，並以複迴歸分析探討影響基層醫師釋出慢箋意願之相關因素。結果：50.5%的基層醫師表示願意或非常願意釋出慢箋，但也有32.7%醫師表示不願意或非常不願意；不願意理由前三項主因為「醫療糾紛責任區分不明」、「領藥流程造成民眾不便」、「藥師可能私自更換藥品」。五成以上基層醫師表達對於慢箋釋出制度不滿意。在控制其他變項下，影響基層醫師釋出慢箋意願之因素為「醫師認為無法即時掌握病情」、「增加醫師用藥困擾」、「對社區藥師協助用藥安全之認知」及「是否應制定社區藥局處方箋獨立總額之看法」、「對處方交付費滿意度」、「是否自聘藥師協助調劑」、「執業年資」、「平均每週病患人數」及「醫師主要診治之疾病」。結論：約一半基層醫師願意釋出慢性病連續處方箋，但仍有不少醫師不願釋出，若能針對研究中提出之不願意釋出因素加以改善，將能提升慢性病連續處方箋之釋出。
Objectives: Physicians willingness is the main factor determining the approval of prescription refills for chronic diseases. The aim of the current study was to investigate the factors influencing the willingness of clinic physicians to approve prescription refills. Methods: Of 8,830 clinic physicians in the National Health Insurance database, 4,000 physicians were randomly surveyed with structured questionnaires. Of the 4,000 questionnaires mailed to the physicians, 813 were returned. Descriptive and multiple regression analyses were performed to identify those factors determining clinic physicians’ willingness to approve prescription refills. Results: Of the physician respondents, 50.5% were willing, or very willing, to approve prescription refills for chronic diseases, whereas 32.7% of clinic physicians were unwilling, or very unwilling, to do so. The three major reasons determining a physician's unwillingness to approve prescription refills were: 1) concerns related to medical malpractice, 2) inconvenience associated with the process, and 3) the possibility of the prescription being changed. One-half of physicians were not satisfied with the policy pertaining to the approval of prescription refills. After controlling for other factors, the factors significantly associated with the physicians' willingness to approve prescription refills included: 1) empathy for the patient's medical condition, 2) increased medication problems, 3) the pharmacist's competence in safely dispensing medications, 4) establishing a separate global budget payment schedule for prescription refills, 5) satisfaction with the reimbursement for prescription refills, 5) hiring the pharmacist, 6) years of practice, 7) weekly patient volume, and 8) a physician's speciality. Conclusions: One-half of the clinic physicians sampled in the current study were willing to approve prescription refills for chronic diseases. By focusing on the factors associated with the physicians' unwillingness to approve prescription refills and working to overcome them, the rate of approving prescription refills may be increased. |
