43卷3期

• Link 政策論壇 Policy Forum
• 台灣愛滋病毒感染防治：距離愛滋消除的最後一哩路Progress of HIV control programs in Taiwan: the last mile to elimination of HIV infection as a health threat
• 洪健清
  Chien-Ching Hung
• 愛滋病毒
  HIV
• 台灣通過多項措施，如全面治療、篩檢、預防性投藥（PrEP）等，使每年新增之感染人數降低。而聯合國愛滋病組織（UNAIDS）設定在2030年達成"95-95-95"的目標，台灣2023年已達成”91-96-95”。文章指出仍面臨的挑戰包括新診斷的感染者多屬晚期感染，且延遲就醫的比例高。建議優化個案管理師制度以促進照護品質，提升PrEP取得之可近性以減少新感染者。
  無none
• 211-213
• 10.6288/TJPH.202406_43(3).PF03

• Link 公衛論壇 Public Health Forum
• 新冠肺炎遺體是否需嚴格限制火化及禁止打開屍袋瞻仰遺容？An overview of whether deceased persons with COVID-19 need strict cremation protocols and if viewing should be prohibited
• 賴柏亘、林室均
  Po-Hsuan Lai, Shih-Chun Lin
• 新冠肺炎遺體
  deceased persons with COVID-19
• 新冠疫情爆發以來，各國對於確診死亡者遺體處理方式存在差異。台灣需在中央主管機關公告之期限內入殮並火化，且家屬無法瞻仰遺容；美國、歐盟等地允許在採取降低傳播風險措施下瞻仰遺容；澳洲允許瞻仰遺容，僅接觸遺體後須進行清潔、消毒；日本初期採取嚴格在24小時內火化之措施，且禁止在家中停棺及相關喪葬活動，2023年後才放寬；南韓採取禁止停棺探視等等措施，2022年4月底解除限制；中國曾嚴格限制只能火化、禁止打開屍袋，2023年後才放寬；越南2023年底將COVID-19從A類調整為B類傳染病後才未強制24小時內火化；新加坡、印度則無火化或瞻仰遺容相關限制。建議政府未來可參考國際規定，並依本土民情制定指引，確保相關政策之合理性與必要性。
  無none
• 214-218
• 10.6288/TJPH.202406_43(3).113014

• Link 公衛論壇 Public Health Forum
• 從引進印度移工爭議談社會與制度性歧視Long-standing discrimination revealed by plans to introduce Indian workers
• 張靜年、曾育慧
  Jing-Nian Jhang, Yu-Hwei Tseng
• 引進印度移工
  introduce Indian workers
• 本文討論台灣引進印度勞工的爭議，揭示了長期存在的歧視問題。文章分析反對聲浪背後的三個主要爭議，包括移工與社會安全、失聯移工與犯罪、移工與本土勞動環境等議題，並進一步提出社會面、制度面對移工之差別待遇與歧視。作者指出台灣為緩解勞動力短缺而引進外籍勞動力之下，也應正視台灣社會所帶有的偏見與歧視、改善移工之權益與相關制度性環境，待政府與民間更充分的對話與思辨。
  無none
• 219-227
• 10.6288/TJPH.202406_43(3).113020

• Link 原著 Original Article
• 公衛學會五十周年紀念專文二：台灣「公共衛生核心課程基本能力測驗」的發展歷史與回顧分析Taiwan Public Health Association 50th Anniversary Commemorative Article Ⅱ: development history and retrospective analysis of "The Credential Examination on Public Health Core Course Competencies" in Taiwan
• 蕭朱杏、蘇千蘅、陳為堅
  Chuhsing Kate Hsiao, Chian-Heng Su, Wei J. Chen
• 公共衛生核心課程基本能力測驗、五大核心領域、命題大綱、鑑別度、難易度
  core competency exam, five domain areas, exam content outline, item discrimination, item difficulty
• 目標：公共衛生核心課程基本能力測驗（簡稱：核心能力測驗）從民國98年至109年舉辦了十二年。本研究目的欲藉由核心能力測驗發展的回顧（包括題庫建置過程），分析歷年報名與通過率，及試題難易度與鑑別度，以為未來發展強化核心能力課程之參考。方法：本研究使用文獻回顧台灣公共衛生學會舉辦之核心能力測驗的歷史發展，檢閱由台灣公共衛生學會提供之試務發展過程的文本與資料，並以次級資料的分析方法，（生物統計、流行病學、社會行為科學、環境與職業衛生、衛生行政與管理）的測驗結果。本文利用正確率、難易度、鑑別度分析歷年的考試結果。使用統計軟體為R（版本4.0.4），統計方法包括次數分配與百分比、皮爾森相關係數、變異數分析、無母數變異數分析與卡方檢定。結果：98-109年之報名人數為4,225；2,183人通過，佔未缺考者的60.4%。自99年起五科全採選擇題，因而以99-109年資料進行試題難易度與鑑別度分析。結果顯示每年考試通過率約在六成上下（55.6%~71.5%）。其中，生物統計與環境與職業衛生的平均正確率（標準差），分別為0.54（0.19）及0.51（0.26），略低於其他科目如流行病學的0.56（0.22）、社會行為科學0.67（0.25）、衛生行政與管理0.58（0.25）；但生物統計的鑑別度0.39（標準差0.17）則較其他科目（鑑別度落在0.14~0.31之間）顯著較好（p<0.001）。若比較試題的試前認定難易程度（容易、適中、困難）與試後考生填答的正確率（高、中、低），這兩者的分布在生物統計沒有太大關係，但這兩種分布在其他科目則比較相符（p<0.001）。結論：公共衛生核心能力測驗之通過率穩定，但不同科目之間的難易度及鑑別度有明顯不同，未來或許應該檢驗加強某些特別科目，或是發展參考教材。
  Objectives: The Credential Examination on Public Health Core Course Competencies (or the Core Competency Exam) was conducted annually in Taiwan for 12 years, from 2009 to 2020. This study aims to analyze the initiation and development of the exam, encompassing the creation of the questions database and evaluation of pass rates, item difficulty, and the discrimination index, and provide directions for enhancing core course competencies. Methods: This study sought to understand the history of the exam, its development, and its annual conduction by reviewing documents provided by the Taiwan Public Health Association. Additionally, the exam questions on five subjects (Biostatistics, Epidemiology, Social and Behavioral Sciences, Environmental and Occupational Health, and Public Health Policy and Administration) were analyzed to determine their accuracy, difficulty, and discrimination ability. The statistical analyses included calculation of frequencies, percentages, and Pearson' s correlation coefficients, analysis of variance, nonparametric analysis of variance, and chi-square tests. Results: A total of 4,225 individuals registered for the exam between 2009 and 2020, and 2,183 of them passed, which was approximately 60.4% of the nonabsentees. From 2010, only multiple-choice questions were used for all five subjects. Therefore, item difficulty and the discrimination index were analyzed for the data collected from 2010 to 2020. The average pass rate was approximately 60% (range: 55.6%–71.5%). The participants scored lower in Biostatistics (average accuracy and standard error across problems: 0.54 ± 0.01) and Environmental and Occupational Health (0.51 ± 0.01) than in Epidemiology (0.56 ± 0.01), Social and Behavioral Sciences (0.67 ± 0.01), and Public Health Policy and Administration (0.58 ± 0.01). However, the discrimination index for Biostatistics (0.39 ± 0.01) was significantly higher (p < 0.001) than that for the other four subjects (range: 0.14–0.31). The before-test problem difficulty (easy, fair, or difficult) and the after-test problem accuracy (high, medium, or low) were significantly similar (p < 0.001) for all subjects except Biostatistics. Conclusions: The pass rate of the Core Competency Exam was found to have been stable. However, the difficulty level and item discrimination index varied among the five subjects. Focusing on specific topics and developing reference textbooks for these subjects may be necessary.
• 228-240
• 10.6288/TJPH.202406_43(3).113024

• Link 原著 Original Article
• 影響持續使用居家醫療服務因素之探討Exploring factors influencing continuation of home healthcare services
• 王美雯、陳雅美
  Mei-Wen Wang, Ya-Mei Chen
• 居家醫療、持續使用意圖、安德森模型、長期照護、質性研究
  Home healthcare, continuance intention, Andersen Model of healthcare utilization, long-term care, qualitative research
• 目標：居家醫療有助於提升患者的生活品質也能夠減輕醫療體系的壓力，長照政策在台灣受到大力的推動，為了提供並促進高效能的居家醫療服務持續使用，了解居家醫療訪視之案家的被訪意圖或者對於服務提供的期望是必要的。方法：本研究採立意抽樣方式由患者及其案家之家屬或照護者協助訪問研究。採用質性研究法藉由深度訪談來了解案家對於居家醫療訪視的使用持續意圖與態度與其相關因子。結果：依安德森模型歸納發現，使能因素的影響是最常被提起的因素，其餘依次為傾向、需求因素，其中以醫療品牌的選擇、隨時保持聯繫、多樣化的服務及有正向態度的服務提供者為最多，因此在討論提升居家醫療持續使用意圖時，使能及傾向因素應該是較需被重視的條件。結論：本研究從使能、傾向、需求及其成效探討了解案家期待在一個高度可近及可用性條件下的可選擇自己喜愛的醫療品牌，在固定的條件之下，獲得能同時照護到身心靈的居家醫療服務，並且讓患者能夠願意持續接受醫療服務。
  Objectives: Home healthcare contributes to improving patients' quality of life and alleviating pressure on the healthcare system. As such, long-term care policies have been vigorously promoted in Taiwan. To provide and promote the continuous use of efficient home healthcare services, it is essential to understand the intentions or service expectations of patients and their families regarding home healthcare visits. Methods: Employing purposive sampling, interviews were conducted with patients and their family members or caregivers. A qualitative research method was adopted using in-depth interviews to understand the intentions of and attitudes toward the continuous use of home healthcare visits and their related factors. Results: According to the Andersen Healthcare Utilization Model, enabling factors are the most frequently mentioned influences, followed by predisposing factors and need factors. Among these, the most critical aspects include having the choice of healthcare brand, maintaining constant communication, and having access to diversified services, and service providers with positive attitudes. Therefore, in order to enhance the intentions to continue using home healthcare utilization, enabling and predisposing factors should be prioritized. Conclusions: This study explores the importance and effectiveness of enabling, predisposing, and need factors, and how they impact home healthcare. Being able to choose a healthcare brand is an enabling factor that is crucial for patients when deciding to use home healthcare. Given consistent conditions, the availability of home healthcare services that address physical, mental, and spiritual well-being encourage patients to receive medical care continually.
• 241-254
• 10.6288/TJPH.202406_43(3).113025

• Link 原著 Original Article
• 青少年電子煙網路暴露、素養與電子煙及紙菸使用之相關研究Association between online exposure, literacy, and adolescent e-cigarette use and cigarette smoking
• 李翠芬、張得軒、黃資富、張鳳琴
  Tsui-Fen Li, Kevin Chang, Tzu-Fu Huang, Fong-Ching Chang
• 青少年、電子煙、紙菸、網路暴露、媒體素養
  adolescents, e-cigarette, cigarette, online exposure, media literacy
• 目標：本研究目的為探討青少年電子煙網路暴露、媒體素養、電子健康素養與電子煙及紙菸使用意圖與行為之關係。方法：在2020年共計完成調查六個縣市30所學校的問卷調查，計2,595名國中一年級學生完成問卷填寫。結果：研究結果發現2.39%國中一年級學生有使用電子煙經驗，0.88%學生在一年內有使用電子煙，2.20%國中一年級學生有使用紙菸經驗，0.8%學生一年內有使用紙菸。以廣義估計方程式（Generalized Estimating Equations, GEE）分析，結果顯示學生電子煙網路暴露愈頻繁、電子煙情感媒體素養愈低者愈易在過去一年有使用電子煙行為。另在未曾使用電子煙學生中，GEE分析結果顯示學生電子煙網路暴露愈頻繁、電子健康素養愈低、電子煙情感媒體素養愈低者其電子煙使用意圖愈高。此外，GEE分析結果顯示學生電子煙網路暴露愈高、電子煙認知媒體素養愈低、有電子煙使用經驗者，愈易在過去一年有使用紙菸的行為。另在未曾使用紙菸學生，其電子煙網路暴露愈高、電子煙情感媒體素養愈低、有電子煙使用經驗者其紙菸使用的意圖愈高。結論：青少年電子煙網路暴露增加其電子煙使用行為與使用意圖，電子煙使用經驗增加其紙菸使用的風險，而電子煙情感媒體素養可降低其電子煙與紙菸使用行為及使用意圖。
  Objectives: This study examined the relationship between online exposure, media literacy, eHealth literacy, electronic cigarette (e-cigarette) use, cigarette smoking, and intentions to use e-cigarettes and cigarettes. among adolescents. Methods: The study included 2595 seventhgrade students from 30 middle schools in Taiwan to complete a self-administered survey in 2020. Results: Among the participants, 2.4% reported ever using e-cigarettes, with 0.88% using e-cigarettes within the past year. Additionally, 2.2% reported ever smoking cigarettes, and 0.8% reported smoking within the past year. Generalized estimating equations revealed that adolescents' exposure to online e-cigarette marketing and lower levels of attitudinal media literacy were associated with e-cigarette use. Among nonusers, exposure to online e-cigarette marketing and lower conceptual media literacy were associated with greater e-cigarette use intentions. Furthermore, adolescent e-cigarette use was associated with cigarette smoking and cigarette use intentions. Conclusions: Online exposure to e-cigarette marketing was identified as a risk factor for e-cigarette use and e-cigarette use intention, and e-cigarette use was linked to cigarette smoking and intention to smoke. Attitudinal media literacy was a protective factor against e-cigarette use and cigarette smoking.
• 255-266
• 10.6288/TJPH.202406_43(3).113008

• Link 原著 Original Article
• 警消人員精神疾病識能與危機處理信心及相關因子初探Mental illness literacy, crisis intervention confidence, and correlates among police officers and firefighters in Taiwan: a preliminary study
• 施志鴻、謝丹雯、雷文玫、陳娟瑜
  Chih-Hung Shih, Tan-Wen Hsieh, Wenmay Rei, Chuan-Yu Chen
• 精神疾病識能、精神危機處理、警察、消防員
  mental illness literacy, mental crisis intervention, police officers, firefighters
• 目標：2024年11月施行「精神衛生法」，明定警消人員在執行勤務發現疑似精神病患通知與協助護送之義務等，警消人員在精神問題求助歷程及心衛照護服務的角色日趨受到重視。本研究旨在探討現階段我國警消人員精神疾病識能與危機處理信心及相關因素。方法：透過行政及警消社群媒體招募，針對現任警察及消防人員進行精神疾病識能及危機處理信心匿名網路問卷調查，共回收527名警察與338名消防員有效問卷。影響之相關因素以廣義線性模式進行分析評估。結果：警察受訪者修習精神疾患課程及接受危機處理訓練比例為41%與23%，顯著低於消防員中的57%與43%。47%警察曾因業務接觸心衛人員，低於消防員的55%。針對精神疾病識能，警消兩組的正相關因子包括未滿10年之工作年資（β警=1.34, β消=0.99; p<0.01）與親友罹患精神疾患（β警=0.67, p < 0.001; β消=0.55, p<0.05）。有關危機處理信心，因業務接觸心理衛生專業人員及接受危機處理訓練分別是影響警察（β警=0.49）及消防人員(β消=0.80）的重要因子。結論：在精神醫療去機構化的脈絡下，針對在校及在職警消人員提供精神疾患課程與危機處理訓練，是強化社區心理衛生服務品質刻不容緩的議題。
  Objectives: With the impending implementation of Taiwan' s Mental Health Act in November 2024, the role of police officers and firefighters in assisting individuals with mental health issues in the community is more important than ever. This study aims to assess levels of mental illness literacy and crisis intervention confidence among police and firefighting personnel in Taiwan and explore potential correlates. Methods: A total of 527 police officers and 338 firefighters completed the anonymous online questionnaire survey. Results: Fewer police officers (41%) had taken courses on mental disorders than firefighters (57%), and only 23% of police officers had received training in mental crisis intervention, compared to 43% of firefighters. About half of police officers and firefighters (47% and 55%, respectively) had ever contacted mental health professionals during duty. For mental illness literacy, work experience under 10 years and having a family or friend affected by a mental disorder were positive correlates for both police officers (β=1.34 and 0.67) and firefighters (β=0.99 and 0.55). Receiving training was a prominent correlate for crisis intervention confidence in firefighters (β=0.80), while work experience with mental health professionals was more salient for police officers (β=0.49). Conclusions: To enhance community-based mental health care quality, integration of mental health into police academy curricula and provision of crisis intervention and team-based service delivery training are urgently recommended.
• 267-279
• 10.6288/TJPH.202406_43(3).113003

• Link 原著 Original Article
• 從價值觀邁向幸福感的十字路口：運用多層次模型探討個體價值、文化價值與主觀幸福感的關係 Intersection of values and well-being: using hierarchical linear models to examine the relationships between personal values, cultural dimensions and subjective well-being
• 林義宏、許義忠、吳美華、何夢玲、陳端容
  Yi-Hong Lin, Yi-Chung Hsu, Mei-Hua Wu, Meng-Ling He, Duan-Rung Chen
• 主觀幸福感、價值觀、文化向度、多層次模型
  subjective well-being, personal values, Hofstede' s cultural dimensions, hierarchical linear model
• 目標：主觀幸福感的預測因子具文化差異，本文由價值觀切入，探討個體之個人自主性與社會共融性對幸福感的效果如何受文化調節。方法：整併第六波《世界價值觀調查》與Hofstede文化向度等資料庫，運用多層次模型分析31國、共40,195筆資料，並視覺化呈現自主性與共融性的效果如何隨不同文化向度而變動。結果：自主性與共融性對幸福感皆有正向效果，且兩者效果皆有顯著跨國變異，其中共融性的效益較穩定。跨層次交互作用分析結果不支持「價值觀同化效益」，而是支持「價值觀互補效益」假設：當一國文化愈偏向集體主義、注重約束性規範、權威與服從，自主性對幸福感的正向效果反而增強；而在強放任主義文化國家，自主性甚至出現負向效果。結論：當個體能夠不被主流文化過度同化，而是發展出異於群體文化價值的傾向，反而可能增進幸福感。故推動相關政策時宜將個體價值觀與文化脈絡納入考量，鼓勵人們了解自身文化所注重與忽略處，兼容學習不同於群體主流的價值觀。
  Objectives: Predictors of subjective well-being vary across cultures. The current study focused on personal value orientation, analyzing how culture moderates the effects of agency and communion on subjective well-being. Methods: Integrating Hofstede's cultural dimensions and data from the sixth wave of the World Values Survey, we used hierarchical linear models to analyze 40,195 responses from 31 countries. How the effects of agency and communion vary across different cultural dimensions was visualized. Results: Agency and communion have positive effects on subjective well-being, with significant cross-national variation in both effects. The results of cross-level interaction analyses do not support the hypothesis of a "value assimilation benefit" but rather support the hypothesis of a "value complementary benefit": the positive effect of agency on well-being is stronger in countries with a stronger cultural emphasis on collectivism, restrained societal norms, and acceptance of power inequality. Moreover, agency may even have a negative effect on well-being in countries with a strong culture of indulgence. Conclusions: Subjective well-being may be enhanced by developing personal value orientations distinct from those of the collective culture rather than by assimilating mainstream cultural values. Policy makers promoting well-being should consider individuals' value orientation within cultural contexts and encourage individuals to understand both the emphasized and neglected aspects of their culture and accept values different from those of the collective mainstream.
• 280-299
• 10.6288/TJPH.202406_43(3).113022

• Link 原著 Original Article
• 停經後婦女從事多元運動後停止運動與再訓練對肌肉表現之影響Effects of multicomponent exercise, detraining, and retraining on muscle performance in postmenopausal women
• 王重凱、方怡堯、趙品淳
  Chung-Kai Wang, I-Yao Fang, Pin-Chun Chao
• 肌少症、身體活動、測力板、肌肉記憶、健康促進
  sarcopenia, physical activity, force plate, muscle memory, health promotion
• 目標：女性停經與老化的激素分泌量變化使肌肉力量與質量提早衰退。世界衛生組織和美國運動醫學會皆建議老年人從事多元運動。因此，本研究希望探討多元運動、停止運動與再訓練對停經後婦女肌肉表現之影響。方法：招募停經後婦女33位（年齡：67.2 ± 5.3歲；身高：156.5 ± 5.5 cm；體重：58.1 ± 8.6 kg）。隨機區分實驗組與對照組，實驗組進行12週多元運動，隨後停止運動12週與再訓練8週；對照組維持常態生活。測量介入前（T1）、介入後（T2）、停止運動後（T3）與再訓練後（T4）等四個時間點的坐到站測試之力學特徵與骨骼肌肉質量指數（SMI）。力學參數包括對地面作用力峰值、到達峰值時間與坐姿到站姿時間等，可用以評估下肢肌肉力量、收縮速度及動態平衡能力等。使用二因子混合設計變異數分析力學特徵與SMI變化，α= .05。結果：實驗組的作用力峰值T2顯著高於T1（p< .001），T3顯著低於T2（p<.001），T4顯著高於T3與T1（p< .001; p< .001），並與對照組產生差異（p= .047）。實驗組的到達峰值時間T4顯著小於T1及T3（p= .003; p= .018），亦與對照組T4產生差異（p< .001）。SMI方面實驗組T2與T4顯著高於T1（p= .028; p= .006），對照組無改變。結論：多元運動能提高停經後婦女的肌肉質量與下肢肌肉力量。停止運動12週後，下肢肌肉力量顯著下降，但肌肉質量流失不明顯。再訓練8週能快速恢復肌肉質量與下肢肌肉力量。本研究成果可作為社區據點運動課程設計之參考。
  Objectives: Menopause and aging-related hormonal changes lead to declines in muscle strength and mass in women. The World Health Organization and American College of Sports Medicine both recommend that older adults should engage in multicomponent exercise. This study investigated the effects of multicomponent exercise, detraining, and retraining on muscle performance in postmenopausal women. Methods: Thirty-three postmenopausal women (age: 67.2 ± 5.3 years) were randomly assigned to an experimental or a control group. The experimental group underwent 12 weeks of multicomponent exercise followed by 12 weeks of detraining and 8 weeks of retraining; the control group maintained their normal lifestyle. Regarding mechanical characteristics, the sit-to-stand test was performed and the skeletal muscle mass index (SMI) measured at four time points: before training, after 12 weeks of training, after 12 weeks of detraining, and after 8 weeks of retraining. The mechanical parameters measured were the peak ground reaction force (GRF), time to reach peak force, and time from sitting to standing, which can be used to assess lower-limb muscle strength, contraction speed, and dynamic balance. Results: The peak GRF and SMI of the experimental group were significantly better than those of the control group after the training, decreased during the detraining, but then rapidly recovered during the retraining. Conclusions: Multicomponent exercise enhances muscle strength and mass in postmenopausal women. The results of this study can serve as a reference for the design of community-based exercise programs.
• 300-312
• 10.6288/TJPH.202406_43(3).113015

• Link 實務 Public Health Practice
• 醫療服務提供者觀點下的門、急診轉診問題與挑戰 Exploring the challenges of outpatient and emergency department referral from the perspective of the health-care provider
• 游翔富、謝嘉容
  Siang-Fu You, Vivian Chia-Rong Hsieh
• 醫療服務提供者、轉診、分級醫療、全民健保、質性研究
  healthcare provider, referral, hierarchical healthcare, National Health Insurance, qualitative research
• 目標：有鑑於臺灣就醫自由度高造成雙向轉診成效不彰，又國內尚未有以醫療服務提供者角度所進行的相關研究，故本研究欲以醫療服務提供者觀點探討與分析執行轉診所遭遇之困難及障礙。方法：本質性研究採半結構式深度訪談，透過立意取樣，以北、中、南部地區各層級醫療機構為主要取樣地區，並以有轉診經驗之醫師、護理師與行政管理人員為研究對象。首先透過網路視訊會議一對一訪談進行資料蒐集，將訪談內容建立逐字稿，再利用主題分析法，進行編碼及尋找初步主題，接著將主題精緻化、主題界定與命名。結果：本研究樣本有15位，包含醫師5位、護理師6位與行政管理人員4位，本研究結果發現轉診時主要的障礙可分為四個層面：成本、過程、品質以及制度。成本面問題包含病人流失與自我轉診、系統與行政作業成本、轉診財務誘因不足與醫師轉診獎金、人力配置等；過程面所發現的挑戰包含資訊系統與平台操作、雙向溝通有效性、病人因素、提供者因素等；品質面上則包括照護連續性、提供者照護品質等問題；以及制度面存在轉診績效指標制定、就醫可近性與部分負擔等問題。結論：本研究發現，在進行轉診時，醫療服務提供者面臨著眾多困難，這些問題涵蓋成本、流程、品質及制度層面，且不同層級醫療院所皆有不同的障礙與考量。本研究結果可作為國內全民健保未來落實分級醫療雙向轉診政策之參考。
  Objectives: Owing to patients' great freedom in choosing their health care in Taiwan, the effectiveness of bilateral referral policy is limited in the country. Research on referral policies from the viewpoint of the health-care provider is currently lacking. Therefore, this study identified and analyzed the challenges faced by health-care service providers during their implementation of the referral policy instituted by Taiwan's health-care system. Methods: The present qualitative study conducted semistructured, in-depth interviews of individuals recruited through purposeful sampling. Health-care facilities in the northern, central, and southern regions of Taiwan were the primary sampling sites, and the recruited participants were clinicians, nurses, and health-care administrators who had experience with the referral process. Data were collected through one-on-one online interviews. Thematic analysis was employed to code and identify initial themes, and this was followed by theme refinement, definition, and coding. Results: Fifteen participants were recruited: five clinicians, six nurses, and four administrators. The results uncovered four main categories of barrier to implementation of the referral policy: cost, process, quality, and system barriers. The primary care providers mainly mentioned cost-related problems, including patient loss and self-referral, system and administrative costs, insufficient financial incentives for referrals by health-care providers, and personnel allocation. Process-related problems included operation of the information system and platform, ineffective bilateral communication, patient factors, and provider factors. Quality-related problems included continuity of care and provider service quality. System-related problems included referral performance indicators, accessibility of care and copayment standards. Conclusions: The findings of this study revealed that health-care service providers continue to face many challenges during the referral process, which can be classified as cost, procedural, quality, and systemic issues. Different considerations and barriers emerged at differing levels of health-care facilities.
• 313-326
• 10.6288/TJPH.202406_43(3).113019