台灣民眾對實施家庭醫師制度之意願及相關因素研究—民眾的認知、態度及參與意願

Consumers' Knowledges, Attitudes, and Willingness to Attend Family Physician System in Taiwan

10.7023/TJFM.200412.0159

許佑任(Yu-Jen Hsu)；陳家榆(Chia-Yu Chen)；林恆慶(Herng-Ching Lin)；陳楚傑(Chu-Chieh Chen)

family physician system ； gatekeeper ； family physician

台灣家庭醫學雜誌

14卷4期（2004 / 12 / 01）

159 - 172

繁體中文

本研究旨在探討台灣民眾對家庭醫師制度的認知、態度及參與意願。以結構式問卷為測量工具，以2002年底台灣地區20歲（含）以上的16,191,200位國民為母群體，採配額抽樣(quota sampling)方法，並以性別及年齡為控制特徵，將有效問卷編號並計數，直到有效樣本人數達 l,200位時為止。首先以t檢定或卡方檢定進行雙變項分析，探討台灣民眾基本特質、就醫行為及對家庭醫師制度的看法與參與家庭醫師制度意願之相關性，然後再進行邏輯斯迴歸 (logistic regression)分析影響台灣民眾參與家庭醫師制度意願之相關因素。 研究結果發現，有 50.3%填答者認為台灣目前“適合”或“很適合”實施家庭醫師制度；有61%填答者“贊成”或“很贊成”健保局實施守門員制度（民眾看病從基層開始看起）；有63.3%填答者表示“願意”或“很順意”參與家庭醫師制度。在邏輯斯迴歸分析中，在控制其他變項後，發現認為台灣目前適合實施家庭醫師制度者（勝算比＝6.184, 95%信賴區問為4.686~8.160）及平均月收入40,000至59,999元者（以20,001至39,999元為參考組，勝算比＝1.520, 95％信賴區間為1.022~2.261）較有意願參與家庭醫師制度，且教育程度為國（初）中者（以大專為參考組，勝算比＝0.345, 95%信賴區問為0.190~0.627）及高中（職）者（以大專為參考組，勝算比＝0.673, 95％信賴區問為0.473~0.958）則較無意願參與家庭醫師制度。 本研究發現大多數填答者偏好的模式為(1)生病時可自由決定由「固定一位」或由「一群家庭醫師」共同診治；(2)家庭醫師除一般診療服務外，還需提供預防保健服務、藥物諮詢、營養諮詢及心理諮商；(3)有家庭醫師後，仍應該可以自行到「專科醫師」或「醫院」就診。 (4)能自由選擇「醫院醫師」或「診所醫師」為家庭醫師；(5)一年可更換一次家庭醫師。並根據研究結果，建議衛生主管機關(1)傳播國外實施家庭醫師制度的經驗與現況；(2)宣導「本土化家庭醫師制度」架構；(3)正視民眾喜愛的模式。

The purposes of this study are to explore consumers’ knowledges, attitudes, and willingness to attend the family physician system. A structured questionnaire was used to collect data. A total of 1200 sampled subjects were selected by quota sampling from a population of 16,191,200 people. T-test and chi-square tests were conducted to explore consumers’ willingness to attend and their characteristics. A logistic regression analysis was performed to understand factors related to consumers’ willingness to attend the family physician system. Among the sampled subjects, 50.3% thought it is “very appropriate” or “appropriate” to implement a family physician system, and 61% “agreed” or “greatly agreed” to the implementation of a gatekeeper system. In addition, 63.3% expressed “willing” or “very willing” to attend a family physician system. The logistic regression analysis found that those who thought it is appropriate to implement a family physician system (OR=6.184, 95% CI=4.686~8.160) and who have monthly incomes between 40,000 and 59,000 (OR=1.520, 95% CI=1.022~2.261) were more likely to willingly attend a family physician system. Those who have at most a junior high school degree (OR=0.345, 95% CI=0.190~0.627) and senior high school degree (OR=0.673, 95% CI=0.473~0.958) were less likely to willingly attend a family physician system. As to the model of family physician system, most respondents preferred that (1) they can choose to visit a single or a group of family physicians if they feel sick; (2) family physicians should provide preventive care, drug, nutritional, and mental consultations, as well as routine medical care; (3) they are free to visit any family physicians even after they have their own family physicians; (4) they are free to select hospital-based or clinic-based physicians as family physicians; (5) they can change their family physicians every year. It is recommended (1) to gather other countries’ experiences in the implementation of family physician system; (2) to educate consumers on the framework of Taiwan’s family physician system; (3) to integrate consumers’ opinions into the model of Taiwan’s family physician system.

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