Effectiveness and Satisfaction Evaluation of Primary Clinic Model of Home-based Healthcare in Nantou Area Under the COVID-19 Pandemic

[[abstract]]目的：居家醫療不僅是醫事服務機構連結社區照護網絡的一環，亦可能是因失能、特殊疾病、新冠疫情無法外出就醫的另類選擇。亞洲大學健康產業管理學系廖宏恩副教授在2020年全國醫療網成果發表會議中提出居家醫療服務的五大面向：可近性、可靠性、服務周全性、服務高度協調性、照護連續性；這份「居家醫療的模式」簡報中亦提到，南投地區的醫療專業人員認為「社區醫療群模式」是較佳的居家醫療服務模式，故本研究的目的係藉由檢視居家醫療服務的五大面向，來了解南投地區社區醫療群之居家醫療服務成效及滿意度，並探討居家醫療專業人員的防疫遵從度與居家醫療個案滿意度之相關性。方法：本研究的研究對象為南投地區符合健保署居家醫療照護整合計畫規定收案條件之病患；研究工具為居家醫療初篩表與具信效度結構式前後測問卷，於110年5~12月面訪166位對象(包括居家醫療使用組93位與居家醫療未使用組73位)，而後進行描述性和推論性分析。結果：若以可近性、可靠性、服務周全性、服務高度協調性以及照護連續性等五大面向來衡量居家醫療服務成效，結果顯示無法證明居家醫療服務比原本前往診所接受服務成效更好，尤其在服務高度協調性(t=-2.152，p<.05)和照護連續性(t=-3.453，p<.001)面向分數低於原本診所服務，但是此結果無法否定居家醫療的重要貢獻度。另外，受訪者對於居家醫療最滿意的地方是個管師的服務態度(平均3.95分)，而較無法認同之處則為「調整藥物後可以減少副作用」(平均3.83分)；最後專業人員防疫遵從情形與居家醫療滿意度則呈現顯著正相關(ρ=.655，p<.001)。結論：新冠疫情期間在協調居家醫療服務安排上，與整合連結轉診、藥物整合、社福、與長照上，仍有改善空間；另外，防疫衛教的落實，實有助提升居家醫療個案滿意度。[[abstract]]Objective: Home-based healthcare is not only a link between medical service providers and community care networks, but also an alternative choice for people with disability, special diseases and COVID-19 epidemic to go out for medical intervention. The purpose of this study is to understand the effectiveness and satisfaction of home-based healthcare services in community medical groups in Nantou area.Meanwhile, to explore the correlation between the epidemic prevention compliance of the home-based healthcare professionals and the satisfaction of home-based healthcare participants.Methods: The study adopted a quasi-experimental design method, and randomly selected 166 patients in Nantou area meeting all the eligibility criteria under the Bureau of National Health insurance were included in the study and were interviewed from May to December 2010. The descriptive and inferential analysis estimated the pre-and-post questionnaire. Results: The results indicated the effective cannot be proved in home-based healthcare from the five major aspects including accessibility, reliability, service completeness, service coordination, and continuity of care, the results show that it is impossible to prove that home medical services are more effective than those who originally went to the clinic to receive services, especially in terms of service high coordination (t=-2.152, p<.05) and care continuity (t=-3.453, p<.001) oriented scores are lower than the original clinic services, but this result cannot negate the important contribution of home medical care, especially , the service from home health care managers are given great satisfaction in home medical care (average 3.95 points). In addition, it shows the most disagreeable point is that &quot; adjustment of medication can reduce side effects. &quot;. (average 3.83 points); Finally, there was a significant positive correlation between the epidemic prevention compliance of the home-based healthcare professionals and the satisfaction of home health care participants (ρ1=.693, p<.001; ρ2=.391,p=<.05)。Conclusion: Finding shows it is insufficient for coordinating home-based healthcare service arrangements, referral, drug, social welfare, and long-term care during the COVID-19 epidemic. However, the implementation of epidemic prevention and health education may help to improve the satisfaction of home-based healthcare participants