目的：衛生福利部為因應高齡社會失能者不易到醫療院所就醫，於2019年開辦居家失能個案家庭醫師照護方案，但派案成效在台北區偏低。本研究欲以問卷調查照顧管理人員認知態度、派案成效及困難之處。
方法：本研究於2022年7月以網路發送臺北市衛生局照管專員及照管督導之不記名問卷，內容包括基本資料、居家失能家醫方案之派案經驗、認知與態度等，並將影響方案成功派案之可能因素進行統計分析。
結果：本研究共蒐集臺北市轄內91位照管專員及12位照管督導之問卷（佔現有照管人員84.4%），其中以女性居多(85.4%)，平均年齡38.0歲，擁有的專業證照最多為護理師(33.0%)及社工師(25.2%)。在有派案經驗之92位照管人員中，91.3%之照管人員每月平均派案成功在5次以下，38%之照管人員每月被個案拒絕超過20次。照管人員認同影響方案派案成功之前三大可能因素為「個案已有固定醫師」、「缺乏參與方案的醫師」、「醫師量能不足」。邏輯斯迴歸分析顯示，照管人員年齡越大及有護理師證照者較認為醫師家訪對居家失能家醫方案較有幫助。
結論：被個案拒絕是居家失能家醫方案派案效果不彰的主因，顯現派案醫師端整合與量能問題。建議整合個案原有家庭醫師、建立媒合平台，考量對個案熟悉度、醫師專科、個案就醫習慣派案；增加居家失能家醫方案給付並廣為宣傳，以提高基層醫師參與意願；加強派案照管人員的教育訓練、改善與家庭醫師的溝通管道。
(台灣家醫誌2025; 35: 87-97) DOI: 10.53106/168232812025063502003
 
關鍵詞：家庭醫師、照管專員、居家失能

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¹台大醫院教學部
²台大醫院家庭醫學部
³台北醫學大學醫學系
⁴洪耳鼻喉科診所
⁵台大醫學院家庭醫學科
受理日期：113年9月10日 修改日期：113年10月15日 同意刊登：113年12月5日
^*通訊作者：詹其峰 通訊地址：臺大醫院家庭醫學部 E-mail：jcf6824@ntu.edu.tw
 

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The Survey on Home Care for Disabled Cases by FamilyDoctors among Care Managers in Taipei
 
Yih-Hsien Kao¹, Chih-Yuan Shih², Chia-Lin Tseng², Te-Jen Hung^3,4and Chyi-Feng Jan^2,5*

Objective: The Ministry of Health and Welfare in Taiwan launched the Family Physician HomeCare Program for Individuals with Disabilities in 2019 to address the difficulty of disabledindividuals in accessing medical care. However, the program’s case assignment effectiveness inTaipei City has been low. This study therefore aims to investigate the perceptions and attitudes ofcare managers regarding the program’s assignment effectiveness and difficulties through aquestionnaire survey.
Methods: In July 2022, an anonymous online questionnaire was distributed to care managers inTaipei City Department of Health. The questionnaire covered demographics, experience with theprogram, and perceptions and attitudes concerning its assignment effectiveness. Statistical analysiswas conducted to identify potential factors affecting successful case assignment.
Results: A total of 103 effective questionnaires were collected, including 91 care managementspecialists and 12 care management supervisors (together accounting for 84.4% of existing caremanagement staff at Taipei City Department of Health). Most respondents were female (85.4%)with an average age of 38 years old. The most common professional licenses held were those ofregistered nurses (33.0%) and social workers (25.2%). Among the 92 care managers with caseassignment experience, 91.3% reported an average of fewer than 5 successful case assignments permonth, and 38% experienced over 20 case rejections per month. The top three factors perceived toinfluence case assignment success were “existence of regular physicians for patients” “shortage ofavailable physicians,” and “inadequacy of physician capacity.” Logistic regression analysis showedthat older care managers and those with nursing licenses were more likely to perceive physicianhome visits as beneficial to the program’s success.
Conclusion: Case rejection is the main cause of the program’s poor assignment effectiveness,highlighting issues with physician integration and capacity. To address these challenges, werecommend: 1. Integrating patients’ existing family physicians into the program; 2. Establishing amatching platform taking into consideration physician-patient familiarity, physician specialty, andpatient’s medical habits; 3. Increasing program payments as an incentive to boost physicianparticipation; and 4. Strengthening care managers’ training for enhancing care assignment successand improving communication with family physicians.
(Taiwan J Fam Med 2025; 35: 87-97) DOI: 10.53106/168232812025063502003

Key words: care manager, family doctors, home care for disabled cases

 

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¹Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan
²Department of Family Medicine, National Taiwan University Hospital, Taipei, Taiwan
³Department of Medicine, Taipei Medical University, Taipei, Taiwan
⁴Dr. Hung’s E.N.T. Clinic, Taipei, Taiwan
⁵Department of Family Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
Received: September 10, 2024; Revised: October 15, 2024; Accepted: December 5, 2024.
^*Corresponding author