醫師對醫院推動全人健康照護之認知與滿意度分析

Physicians' Perception and Satisfaction in Response to a Hospital's Holistic Care Initiative at a Medical Center

10.6145/jme.201106_15(2).0005

潘汶榆(Wen-Yu Pan)；林金定(Jin-Ding Lin)；徐尚為(Shang-Wei Hsu)；嚴嘉楓(Chia-Feng Yen)；林易申(I-Shen Lin)；周稚傑(Chih-Chieh Chou)；許佩蓉(Pei-Jung Hsu)；羅慶徽(Ching-Hui Loh)

全人健康照護 ； 醫病關係 ； 醫師 ； 醫務管理 ； holistic care ； physician-patient relationship ； physician ； health service management

Journal of Medical Education

15卷2期（2011 / 06 / 01）

106 - 119

繁體中文

目標：本研究主要目的在於探討醫院醫師對於實施全人健康照護議題認知重要度，與實施結果滿意程度之情形，並分析影響醫院醫師對於推行全人健康照護議題滿意度的相關因素。方法：本研究以台北市某醫學中心509位醫師為研究母群，於98年3-4月期間以結構式問卷為研究工具進行普查，共回收246份份問卷（回收率為48.3%）進行資料分析。結果：整體而言，研究對象普遍認為各類指標皆非常重要（重要度平均分數達八成以上)，其中以「建立和諧良好的醫病關係」之重要度分數最高；但滿意度平均分數皆低於重要度（平均分數介於6.91-7.89），其中對「設計符合個案需求的健康促進計畫」平均分數為最低。對於影響醫院執行整合性服務滿意度之因素，主要為「主動提供個案適當的衛生教育」、「尊重個案的信仰在疾病復原歷程中所發揮的功能」、「主動提供或連結病人所需的醫療社會資源」、「與病人建立良好的醫病關係」、「跨領域團隊應定期召開會議，並提供新進人員參與學習的機會」。而對於影響推行全人醫療專業訓練的滿意度之相關因素，主要為「能主動提供個案適當的衛生教育」、「設計符合病人需求的健康促進計畫」、「尊重個案的信仰在治療中的功能」、「能藉由跨領域國隊合作機制，據以評估與執行相關診療」、「主動評估病人預後狀況並告知病人或家屬」、「具備同理心、正面支持與鼓勵的態度」、「與病人建立和諧良好的醫病關係」、與「跨領域團隊應定期召開會議，並提供新進人員參與學習的機會」等因素。結論：由本研究結果可知該醫院醫師普遍認同全人健康照護各項議題之重要度，然而實際執行面之滿意度則有進步之空間。因此醫院管理者應省思滿意度較低的項目並擬定合適的改善策略，以精進以病人為中心的全人健康照護計畫。

Objectives: The aim of this study was to describe the physicians' perspective with regard to the implementation of a hospital's holistic care initiative and various associated factors. Methods: A total of 509 physicians were recruited as the study population from a medical center in Taipei. A structured questionnaire was distributed from March to April 2009 and 246 valid questionnaires were returned (response rate: 48.3%). Results: Most of the respondents indicated the importance of holistic care indicators to a hospital, particularly the indicator ”build up a good patient-physician relationship”, which was considered the most important issue from the physicians' point of view. However, perception in terms of satisfaction was lower than perception in terms of importance across all holistic care indicators (Mean range: 6.91-7.89). In addition, the indicator ”designing a health promotion program to lit the patient's needs” was the lowest satisfaction indicator. We analyzed the predictive model for satisfaction re holistic care and the factors ”providing appropriate health education to patients”, ”respecting patients' personal spiritual or religious beliefs”. ”providing or linking medical/social resources for the patients”, ”build up a good patient-physician relationship” and ”holding a regular meeting with a cross-field professional team and offering learning opportunities to the new employees” were statistically significant in terms of affecting the physicians' perception of holistic care satisfaction. With regard to the holistic care training, the factors ”providing an appropriate health education to patients”, ”designing the health promotion program for the patients”, ”respect the patients' personal spiritual or religious beliefs”, ”accessing and curing the patients' physical-mental-social problems through an cross-field integration team”, ”evaluating the sickness/prognosis situation and informing the family”, ”being empathic to, positive with and supportive of patients”, ”build up a good patient-physician relationship” and ”holding a regular meeting with a cross-field professional team and offering learning opportunities to the new employees” were significant with respect total satisfaction with holistic care training. Conclusions: Generally, the physicians pay great attention to the importance of the holistic care. However, there are many aspects that need to be improved in the near future when initiating appropriate holistic care policies in hospitals.

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