基層醫師對實施品質報告卡之意願與相關因素

Willingness of Primary Care Physicians toward Implementation of a Quality Report Card Program and Associated Factors

10.6288/TJPH2007-26-02-07

蔡文正(Wen-Chen Tsai)；陳慧珊(Hui-Shan Chen)；龔佩珍(Pei-Tseng Kung)；吳守寶(Shou-Bao Wu)；楊志良(Chin-Liang Yang)

品質報告卡 ； 醫療品質 ； 基層診所 ； Quality report card ； quality of care ； primary care physician

台灣公共衛生雜誌

26卷2期（2007 / 04 / 01）

149 - 160

繁體中文

目標：本研究希望能了解基層醫師對健保實施品質報告卡之參與意願及相關態度與認知，同時瞭解醫師對品質報告卡相關指標重要性之看法。方法：針對台灣具健保特約之基層診所醫師，依各縣市家數比例隨機抽取4000位開業醫師。以結構式問卷藉由郵寄方式進行調查，有效回收問卷574份。除了描述性分析外，利用羅吉斯迴歸分析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：69%的基層開業醫師贊成實施品質報告卡，61%的基層開業醫師願意加入，84%的基層開業醫師表示應以自由加入的方式，並有73%的基層開業醫師認為需要分科別。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，而資料更新的週期以一年為佳。對於是否贊成實施品質報告卡之影響因素，包含「小兒科醫師」（勝算比0.54）與「實施後會造成壓力」愈高者（勝算比0.77），其贊成實施品質報告卡的機率顯著較低；醫師對「實施後醫師對病患更用心」（勝算比1.38）、「實施後對醫療或服務品質有助益」（勝算比2.61）、「以品質報告卡的結果為依據給予實質獎勵」（勝算比2.96）之認同程度愈高，其贊成實施品質報告卡的機率顯著較高。結論：由本研究結果可知大部分基層開業醫師贊成實施品質報告卡，認為品質報告卡對醫療服務品質有正面影響認知之基層開業醫師愈贊成實施品質報告卡。

Objectives: This study aimed to understand the willingness, attitudes, and perceptions of primary care physicians toward implementing a quality report card program and associated factors. We also investigated physicians' opinions about the importance of quality-related indicators. Methods: The studied population comprised primary care physicians who had contracted with the Bureau of National Health Insurance. Four thousand primary care physicians were randomly sampled according to numbers of clinics in counties/cities. Structured questionnaires were mailed out and a total of 574 valid questionnaires were returned. Besides description statistics, we used multivariate logistic regression to analyze underlying factors affecting attitudes of primary care physicians toward supporting implementation of a quality report card program. Results: Sixty nine percent of physicians agreed that a quality report card program should be implemented, and 61% agreed to participate in the proposed program. Eighty four percent agreed that physicians should have free choice to participate. Furthermore, 73% thought the quality report card should be designed based on different medical departments and that the program should be administered by physician associations with reports updated annually and published on the Internet. Regarding associated factors supporting implementation of the quality report card program, pediatricians (OR=0.54) and physicians who agreed that implementation would increase stress (OR=0.77) were less supportive. Physicians who agreed that implementing a quality report card program would influence doctors to pay more attention to patients (OR=1.38), or who believed that program implementation would improve the quality of care and services (OR=2.61), or who agreed to receive financial incentives according to results of quality report cards (OR=2.96) were more supportive. Conclusions: Most primary care physicians agreed with implementing a quality report card program. Physicians with positive perceptions of the influence of quality report cards on medical service quality tend to be more supportive of implementing the quality report card program.

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