研究背景及目的：癌症一直是台灣地區人口之首要死因。許多癌症治療已朝向多專科（Multidisciplinary）整合的模式進行，亦證實多專科診療確實可提升病患的存活率及生活品質。癌症諮詢規劃費（Fee for Cancer patient treatment planning and consultation）強調多專科整合的癌症治療規劃，以提升病患診療品質為目的的支付制度。而癌症諮詢規劃費施行至今尚未得知其成效為何，本研究欲瞭解醫師自覺癌症諮詢規劃費對病患診療的影響。
方法：研究對象為區域級以上醫院中參與癌症診療之醫師，以郵寄結構式問卷進行問卷調查，共寄出520份問卷，回收有效問卷300份，有效回收率57.7%。除描述性分析及雙變項分析外，並用複迴歸分析影響醫師自覺癌症諮詢規劃費對病患診療幫助性之相關因素。
結果：42.7%的受訪醫師認為癌症諮詢規劃費對病患診療有幫助或非常有幫助，其中最有幫助之前三項為「治療規劃完整性」（65.7%）、「治療計畫適切性」（59.7%）以及「促進各科間溝通與協調」（57.5%）；40.8%的醫師認為癌症諮詢規劃費對多專科團隊診療之促進有幫助或非常有幫助；19.6%的醫師對癌症諮詢規劃費整體的評價表示滿意或非常滿意，25.6%表示非常不滿意或不滿意。複迴歸分析結果顯示，影響醫師自覺癌症諮詢規劃費對病患診療幫助性之顯著因素包含「規劃費對多專科團隊幫助性之認知」、「是否贊成將規劃費預算改聘個管師」、「醫師對規劃費整體的評價」、「規劃費對醫生工作負擔增加之程度」以及「醫師是否為主管」。
結論：近半數醫生認為癌症諮詢規劃費對病患診療有所幫助，若能適度提高癌症諮詢規劃費給付費用，並將規劃費排除於個別醫院預算之外，將提高癌症諮詢規畫費之成效。
Background and Objectives: Cancer has been the major cause of death in Taiwan for several years. The treatment of cancer has orient to multidisciplinary treatment model. Several studies verified that multidisciplinary treatment can increase patients’ survival rate and quality of life. The objective of “Fee for cancer patient treatment planning and consultation” (CPTPC) is to integrate multidisciplinary treatment to improve patients’ quality of life. But the outcome of CPTPC has not been exposed. This study is going to understand the physicians’ perception of the impact of planning and consultation fee on cancer treatments.
Methods: The subjects of this study were cancer physicians practiced in medical centers and metropolitan hospitals. 520 questionnaires were mailed to physicians, and received 300 effective questionnaires (receive rate is 57.7%). Except descriptive and bivariate analysis, multiple regression analysis was conducted to investigate the associated factors with physicians’ perception of the helpful and impact of planning and consultation fee on cancer treatments.
Results: 42.7% of physicians indicated CPTPC did help patients’ treatment, which the most 3 remarkable categories were “completed treatment planning” (65.7%), “suitability of treatment planning” (59.7%), and “improving negotiation and coordination within departments” (57.5%). 40.8% of physicians considered that CPTPC did greatly promote multidiscipline medical treatments. As respect to global satisfaction of CPTPC, 19.6% of physicians were satisfied or very satisfied whereas 25.6% of them were dissatisfied or very dissatisfied. According to the result of regression analysis, the significant factors that influenced the physicians who thought the consultation fee was helpful to patient treatment were the followings: “physicians’ perceptions of levels of help on CPTPC to multidisciplinary treatment”, “agree or disagree the budget of consultation fee to be switched to hire case managers”, “physicians’ overall evaluation of consultation fee”, “the increased level of physicians’ working loading due to implemented consultation fee”, and “physicians as a manager or not”.
Conclusions: More than half of physicians thought CPTPC did greatly improve the patients’ treatment. If the government can increase the consultation fee appropriately and exclude the consultation fee from individual hospital’s budget, the outcome of CPTPC will be more effectiveness.
