基層醫師轉檢態度之探討

Exploring the Attitudes of the Primary Care Physicians Toward the Referral System of Ancillary Services in Taiwan

10.7023/TJFM.200403.0001

林恒慶(Herng-Ching Lin)；陳楚杰(Chu-Chieh Chen)；許銘恭(Ming-Kung Hsu)

referral of ancillary services ； primary care physician

台灣家庭醫學雜誌

14卷1期（2004 / 03 / 01）

1 - 12

繁體中文

本研究旨在探討台灣轉檢的現況、影響西醫基層醫師轉檢意願之因素及落實轉檢的可行方法。本研究以2002年4月在行政院衛生署醫政處登記執業的10,223位基層開業醫師為研究對象，採用系統抽樣法，共得到3,407位，以郵寄問卷的方式蒐集所需的資料，回收512份，回收率為15.1%。。在統計分析方面，以複迴歸分析影響基層開業醫師轉檢意願之因素。經複迴歸分析，發現醫師在目前健保制度下的整體轉檢意願與有過轉檢病人的經驗(p=0.003)及醫師認為轉檢會提昇診所競爭力的重要性(p=0.017)呈顯著正相關。醫師認為落實轉檢可行的最重要方法為簡化轉檢手續及主動回覆轉檢報告，並會指示病人回原轉檢診所繼續處理。本研究發現醫師決定轉檢的最主要因素為病人是否能得到更好的照顧與治療，而不擔心病人是否會流失。建議衛生署製作制式的轉檢單及減少轉檢病人之部份負擔，以鼓勵轉檢制度的落實。

The purposes of this study are to explore the current profile of referral system of ancillary services, factors affecting the willingness of primary care physicians to refer patients for ancillary services, and the feasible methods to implement the referral system of ancillary services in Taiwan. The study used a systematic sample of 3,407 selected from 10,223 primary care physicians registered in the Department of Health in April 2002. A mailing survey was conducted to collect applicable data. There were 512 questionnaires returned which yielded a response rate of 15.1%. A multiple regression analysis was performed to explore the factors affecting the willingness of primary care physicians to refer patients for ancillary services. Multiple regression analysis showed that the willingness of primary care physicians to refer patients for ancillary services was positively related to the physicians' experience of referring patients for ancillary services (p=0.003) and to the physicians' perceived importance that the referral system of ancillary services can increase the competitive ability of the primary care clinics (p=0.017). Physicians considered the most feasible methods for the implementation of the referral system of ancillary services were to simplify the procedures for the referral system of ancillary services and to provide any medical results of the ancillary services back to the referring physicians. This study revealed that physicians' decisions for the referral of ancillary services are based on patients' medical need rather than the fear of losing the patients. It is suggested that a standardized referral sheet be issued and the amount of co-payment for ancillary services of the referral patients be reduced.

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