試論中醫在居家復能專業服務中扮演的角色

On the Role of Chinese Medicine in the Professional Service of Home-Based Reablement

黃柏銘(Bo-Ming Huang)；周律廷(Lu-Ting Chou)；吳麗靜(Jing-Li Wu)；郭淑芬(Shu-Fen Kuo)；游淑如(Shu-Ru Yu)

復能 ； 中醫 ； 優劣分析 ； 功能性能力 ； Reablement ； Chinese medicine ； SWOT ； Functional ability

若瑟醫護雜誌

16卷1期（2022 / 03 / 01）

19 - 29

繁體中文

世界衛生組織WHO 2015年提出的全球老化與健康報告中強調對於日常生活功能需要協助的長者，促進其「功能性能力」的重要性，台灣當局推估至2026年需要長期照顧的人數約在92萬至100萬人之間。因此，衛福部於2017年開始推展長照專業服務，2018年中醫師首次列入長照專業服務人員。我們回溯了2019年中醫居家復能的經驗，服務了9名、68人次案家，依工具性日常生活活動能力IADL評估，重度失能案家由88.9%減少至55.6%。同時SWOT優劣分析居家復能計畫，中醫介入的優勢在於容易協調其他醫事人員，共同去執行跨專業的復能訓練；劣勢在於案家多不知居家復能有中醫專業服務，照管專員對於運用及媒合中醫專業亦大多不熟悉。居家復能多屬一對一服務，反而有助於住院醫師的學習養成教學；但因專業服務與居家照顧服務同屬長照共同額度支付，難免有選擇上的排擠效應。

The WHO's Global Aging and Health Report in 2015 emphasized the importance of promoting ＂functional abilities＂ for the elderly who need assistance in daily life functions. The Taiwan authorities estimate that the number of people who need long-term care will be about between 920,000 and 1 million people by 2026. Therefore, the Ministry of Health and Welfare began to promote long-term care professional services in 2017. In 2018, Chinese medicine practitioners were included in the long-term care professional service staff for the first time. We reviewed the experience of TCM home-based reablement in 2019 for 9 cases with 68 person-times. According to the IADL assessment of instrumental activities of daily living, the number of cases with severe disability decreased from 88.9% to 55.6%. At the same time, SWOT analyzes the pros and cons of the home-based reablement plan. The strength of TCM intervention is that it is easy to coordinate other medical personnel to jointly perform inter-professional reablement training; the weakness is that patient's family does not know that home-based reablement has professional TCM services, and the commissioners are not familiar with it applied to cases. Home -based reablement is mostly a one by one service, which can help residents learn and develop teaching; however, because professional services and home care services are both in the same paid for long-term care, it is inevitable that there will be a selective crowding out effect.

1. 柯莉珊,張媚,胡文郁(2017)。運用SWOT分析預立醫療照護諮商之推行－以某醫學中心之高齡病房為例。領導護理，18(2)，13-28。
   連結：
2. 陳亮宇,陳亮恭(2016)。以人為本的整合居家醫療照護模式。臨床醫學，78(6)，311-319。
   連結：
3. 趙品諭,黃奎祐,許中華(2019)。中醫居家照護病患之病種、體質及可行性之敘述。中醫內科醫學雜誌，17(1)，1-12。
   連結：
4. 衛福部長照專區：長照復能服務操作指引108/05/08。https://1966.gov.tw/LTC/cp-4444-47438-201.html
5. 衛生福利部：長期照顧十年計畫2.0（106~115年）。https://www.mohw.gov.tw/
6. Chang, LH,Wang, J(2013).Institutional contexts contribute to the low priority given to developing self-care independence in a rehabilitation ward: A qualitative study.Clinical rehabilitation,27(6),538-545.
7. Fan, H,Lu, F,Yangm A,Dong ,Y,Liu, P,Wang, YA(2019).Review on the Nonpharmacological Therapy of Traditional Chinese Medicine with Antihypertensive Effects.Evid Based Complement Alternat Med,1317842
8. Fausset, CB,Kelly, AJ,Rogers, WA,Fisk, AD(2011).Challenges to Aging in Place: Understanding Home Maintenance Difficulties.Journal of housing for the elderly,25(2),125-141.
9. Helms, MM,Nixon, J(2010).Exploring SWOT analysis where are we now? A review of academic research from the last decade.Journal of Strategy and Management,3(3),215-251.
10. Jackson, GL,Powers, BJ,Chatterjee, R(2013).Improving patient care.The patient centered medical home. A Systematic Review.Ann Intern Med,158,169-178.
11. Kelly, AJ,Fausset, CB,Rogers, W,Fisk, AD(2014).Responding to home maintenance challenge scenarios: the role of selection, optimization, and compensation in aging-in-place.J Appl Gerontol,33(8),1018-1042.
12. Mishra, V,Barratt, J(2016).Barratt J: Reablement and older people.IFA Copenhagen summit 2016
13. Miyata, Y,Mukohara, K.(2015).Patient Centered Medical Home: Suggestions for the Health Care Delivery System Reform in Japan: Guidelines for Patient-Centered Medical Home (PCMH) recognition and accreditation programs.Nihon Naika Gakkai zasshi,104,817-823.
14. Resnick, B(2004).Restorative care nursing for older adults：A guide for all care settings.Springer Publishing Compan.
15. Shi, L,Lee, DC,Chung, M(2016).Patient-Centered Medical Home Recognition and Clinical Performance in U.S. Community Health Centers.Health Serv Res
16. Tuncay, M(2015).SWOT analysis in strategic management and a sample application in public.International Research Journal of York University,2(3),276-301.
17. 李宜玲,李世代,曹昭懿,胡名霞(2018)。居家物理治療改善日常生活活動功能之因素分析。物理治療，43(3)，229-246。
18. 邱彥瑜：長照公聽會檢討B單位資源分佈不均、競爭激烈成隱憂。政策觀察站 - 產業動態 109 。https://www.ankecare.com/2020/20688
19. 郭卜瑄,黃儀婷,簡鈺珊(2012)。台灣失智照護模式的演進。台灣老年學論壇，16
20. 湯明哲(2011)。從SWOT到SCOTT。天下雜誌，389
21. 黃惠玲,徐亞瑛,黃秀梨,陳獻宗(2008)。失智症照顧服務之可行模式。研考雙月刊，32(6)，22-33。
22. 衛福部長照專區：長照專業服務手冊 107/11/06 。 https://1966.gov.tw/LTC/cp-4216-44996-201.html