数据加载中.....
|
jsp.display-item.identifier=請使用永久網址來引用或連結此文件:
https://ir.csmu.edu.tw:8080/ir/handle/310902500/3285
|
| 题名: | 基層社區醫師提供安寧緩和醫療的意向行為及相關因素之研究
A Survey of Community Doctor' Intention Towards Providing Hospice Palliative Care |
| 作者: | 周希諴;賴允亮;呂宗學;黃安年;葉志嶸
Chou, Hsi-Hsie;Lai, Yuen-liang;Lu, Tsung- Hsueh;Wong, On-nin;Yeh, Chih-Jung |
| 贡献者: | 中山醫學院醫學研究所 |
| 关键词: | 社區醫師;安寧緩和;認知;意向;行為
primary care physician;hospice care;knowledge;intention;behavior |
| 日期: | 2005 |
| 上传时间: | 2010-12-17T02:58:17Z (UTC)
|
| 摘要: | 末期病患的末期照護與臨終關懷，近年來已在世界各國、特別是已開發國家中成為先進的醫療指標之一。國內至民國91年通過健保安寧病房試辦計畫的有15家，總床數共計255床，該年度國內因癌症死亡人數為34,342人，這些安寧病床對於眾多的末期病人來說，應該是供不應求的情況才對，然而根據趙可式等學者的研究，安寧居家與安寧住院的利用率並不如預期的高，住院病床平均佔床率只有54.33％，而安寧居家的服務量更低，從民國88年到90年全國服務量全年都不超過1,500個案數。因為近年來社區醫療末期照顧能力，已成為各國在安寧緩和照護需努力的方向（2003年APHN大阪會議）。根據本院安寧病房所服務之六百位病患之經驗統計，直接由基層社區醫師轉診至安寧緩和醫療門診，或是直接轉診住院者（透過急診）的比率非常的少（<1％）。然而基層社區醫師轉診病患至本院其他專科之比率卻不少（根據本院轉診中心之統計）。而基層社區醫師對於轉診安寧緩和醫療個案數之不高，其原因雖仍然不明，然而造成此種現象之原因何在？卻值得我們探討並改進。為了檢討安寧療護在基層社區醫療推展阻滯的原因，以及設計出更有效推展社區基層醫師願意提供安寧療護的方案，以使癌末病患能於家中安享末期生活與善終，又可以同時減少醫療資源的耗費，故希望透過本計畫找出具體的改善方案，藉以作為未來提昇基層社區醫師願意提供安寧緩和醫療行為之參考。 研究方法本計畫以全國所有基層醫師（包括診所、聯合診所及衛生所等）為研究母群體，經由篩選進行普查，研究樣本共7,874人。以郵寄問卷的方式進行資料收集，問卷內容包括：個人基本資料、個人經歷與經驗、安寧療護知識、安寧療護態度、安寧緩和醫療條例知識、嗎啡使用知識與態度及參與安寧療護意願等。在問卷回收上，於問卷寄出第二週後，開始進行電話聯絡，確認問卷收件情形並給於解釋及催收，對於未收到者重新補寄一份問卷。於期中報告時，依專家意見針對基層醫師進行8場焦點團體討論，初步瞭解基層醫師對安寧緩和醫療的看法，並依據此調查結果調整問卷內容，結果以附件形式附上。 主要發現 1.普遍基層醫師對安寧療護持正向的態度，認為安寧療護不是在病人瀕死狀態時才需轉介（90.1％），且認為開業醫適合執行安寧療護的工作（52.0%）。 2.有六成的醫師認為，當病人使用嗎啡達到穩定控制疼痛後，就應該採疼痛時才給藥的方式，而實際上應該採規則的定時給予。當法律明文規範並合理保障醫師可以適量持有鴉片類止痛藥時，有65.4％的醫師願意在診所放置嗎啡。 3.「擔心毒癮患者上門恐嚇」、「鴉片類止痛藥的取得與管制程序過於繁瑣」、「擔心病患裝痛，騙取鴉片類止痛藥」及「擔心家屬或病患領取鴉片類止痛藥進行變賣或交易」是基層醫師不願使用嗎啡最主要的因素。 4.有54.7％的基層醫師願意參與安寧療護工作，另外45.3％的醫師反對原因依序為「避免醫療糾紛」、「無任何保障法規」、「健保制度不成熟」、「相關知識不足」、「工作上無此需求」等。 5.經強迫表態後，有73.5%的醫師願意以提供安寧療護諮詢或轉介服務、由診所配合醫院的安寧居家團隊、由診所執行安寧居家或簡單的診間治療等來從事安寧療護的工作。 6.在參與意願上，以衛生所、有加入社區醫療群、有修習過安寧療護相關課程、有參與照顧臨終病患等人的意願最高。 7.基層醫師對安寧的知識得分越高，態度越正向，態度越正向則越願意參與安寧療護照顧工作。 結論及建議事項 1.大多數基層醫師對於安寧療護的知識與態度已有一定的認知，但對於其照護方式及內容等認知不足，未來在宣導上需加強此部份。 2.建立良好的法規制度環境，將提高基層醫師參安寧療護的意願。 3.在初期基層試辦對象的挑選上建議，以衛生所、有加入社區醫療群、有修習過安寧療護相關課程、有參與照顧臨終病患等醫師為優先。 4.由基層醫師執行安寧療護的可行性並非沒有，但實際執行上建議從提供安寧療護諮詢或轉介服務做起。如要更實際的運作，建議可建立一套診所與醫院安寧居家團隊合作的模式，來執行安寧療護。
Terminal care for patients with different diseases of end-stage is becoming more and more important all over the world, especially in those developed countries. The quality of the end-of-life care is also recognized as one of the most important hallmarks representing the medical achievement of that country. How to increase the willingness of providing the hospice care in the community by the primary care physician is necessary at the present time (APHC 2003 Osaka). To understand the low referral of hospice patients from the primary care physicians in Taiwan and to decrease futility of medical resource, the present study was done to increase the terminally ill patients quality of life. We hope taht a better way could be found to increase the primary care physicians willingness for providing hospice palliative care in the basic level community. Methods: This research will study the nation wide primary care physicians in all Taiwan, including physicians working in the private hospitals, clinics, local health stations and group practice centers etc. A total number of 7874 physicians were surveyed. The study tool was a constructional questionnaire designed by specialists of hospice palliative medicine. Results: Most of the community doctors had positive attitude toward hospice care. 90.1 % of the community doctors disapproved of referring the patients to the hospice ward only when the patients were in a dying condition. 52.0 % of the community doctors approved of that community doctors were suitable for providing the hospice care. 60.5 % of community doctors considered prescribing morphine to the terminally ill patients only when pain were complained though regular using is recommended. 65.4 % of community doctors were willing to keep morphine at their clinics if the laws and regulations for the administering morphine was reasonable. The main reasons why the community doctors wouldnt like to using morphine including threatened by the addicted patients, complicated procedure restricted by laws and regulations when using morphine, getting morphine by pretending pain of patients and fraud of getting morphine by the family of the patients. 54.7 % of community doctors approved of providing hospice care. 45.3 % of community doctors disapproved of providing hospice care. The main reasons were to avoid legal problem, to avoid using narcotic analgesics such as morphine, no protection from law, no related knowledge and not necessary for their present work. 73.5 % of community doctors were willing to provide hospice counseling, hospice referral, assistance to the hospice team of hospital and outpatient hospice service. The community doctors who had the will to provide hospice care including; those of local health station, of whom had joined the community medical group, of whom had learn hospice related lessen and of whom had the experience of caring the terminally ill patients. For the community doctors, the higher knowledge of hospice the more positive attitude toward hospice care; and the more positive attitude the stronger willing to provide hospice. Conclusion and suggestion: The knowledge of hospice and the attitude toward hospice in most of community doctors in Taiwan were satisfied to a certain degree. More propaganda and education about hospice are needed in the future. Establishing more suitable environment by improving laws and regulations will increase the willing of providing hospice care from the community doctors. A practical way for the beginning of providing hospice care from the community doctors is to call up community doctors who belonged to local health station, who had joined the group practice center, who had learned lessons about hospice and who had the experiences of taking care of terminally ill pati |
| URI: | https://ir.csmu.edu.tw:8080/handle/310902500/3285 |
| 显示于类别: | [醫學研究所] 研究計劃
|
在CSMUIR中所有的数据项都受到原著作权保护.
|
