都會地區診所醫師醫療服務狀況及與醫院間轉診互動之調查

In order to promote a more efficient inter-referral among private clinics and hospitals and to better utilize medical resources in a community, we performed a survey of private clinics in Shin-Lin and Pei-Tou areas of Taipei City by mailing them questionnaires to investigate their service styles, laboratory test capabilities & equipments, current referral status, and the interactive relationship with neighboring hospitals. There were total 90 replies to the questionnaires with the responding rate of 52%. Most clinice were solo practice. About 19% were group practice. The mean age of private clinic doctors was 50 year old (range from 35 to 77 years). Their average year of practice was 14 years (range from 1 to 47 years). 13.5% of them were female doctors. Lven though the most private clinic doctors (83%) had board certification as specialist, as much as two-third of them practiced as generalists. Only one-third of the total private clinics surveyed provided about preventive services. Generalists tended to provide more preventive services such as preventive health examination and vaccination for infant and young children than specialists (p＜0.001, respectively). Less than one-fifth of private clinics could provide laboratory tests, x-ray, sonography or electrocardiography examinations. 80% or private clinic doctors indicated that the area hospitals and medical centers should open medical resources to them. The medical resources most desirable to them were active inter-referral, continued medical education credit, and sharing of medical journal. Private clinic doctors with younger age, shorter practice year, having a specialist accreditation and previously trained in medical center would more like to establish active inter-referral relationship with neighboring hospitals(P＜0.001, ＜0.01, ＜0.05 and ＜0.05, respectively). However, only 44% of them had ever transferred patient to area hospitals or medical centers using a formal transfer sheet. The choice of transferal hospital was mostly according to patient’s will and consultant doctor’s clinical expertise. Only 52 (57.8%) clinics had ever received a referral response from the transferred hospitals.
Our conclusion is that most private clinics with their roles as gatekeeper of primary health care hope neighboring hospitals or medical centers to open medical resources and strengthen inter-referral relationship. Integration of medical resources among private clinics and hospital will certainly create a more coordinative health care system.