高齡社會來襲，台灣正面臨老年、失能人口不斷快速進展，也隨之迎來了多元類型的照護問題。而為了扭轉這樣的局面，我國政府自2015年開始陸續推行居家醫療整合計畫，欲整合現行不同類型片段式居家醫療照護服務，並與醫療院所組成跨領域整合性照護團隊，同時建構與基層醫療網絡連結，鼓勵醫護人員走入病人的居處與生活，使照護無縫接軌。
基於目前居家醫療照護整合團隊工作探討焦點多集中於角色期待部分，少有合作與衝突處理之探討，因此，本研究旨為探討台中某醫院居家醫療照護整合團隊執行實務上內、外部合作與衝突因素有哪些，並深入探究居家醫療衝突解決方案，最後針對衝突預防提出建議。
本研究採用質性研究方法，訪談對象為居家醫療照護整合團隊人員，共7名。進行半結構式深度訪談，每位歷時30-120分鐘。資料分析採紮根理論，研究品質則以Patton（1990）研究者三角驗證法以及Lincoln與Guba（1985）一致性分析法提出的研究品為依歸。
研究結果顯示居家醫療照護整合團隊合作內部衝突中，以「工作超載，影響配合」最是衝突點，其次「資源媒合」和「對相關政策不清楚產生資源與傳達錯誤」也容易發生衝突，此衝突造成長照與居家醫療間聯繫難優化，醫院與照管中心間關係亦相當薄弱。本研究則建議面對複雜性高的任務時，團隊必須多方考量之外，並主動表現醫療工作者之責任，以不同溝通形式促進內外部互動。另一方面，長照與居家醫療概念雖早已建立但卻未進入民眾的知識點裡，所以在醫療過度密集下，如何建構起在地社區居家醫療網絡，為當務之急。政府部門亦可藉由本研究對居家醫療提供者的多元觀點分析，如何更有效整合居家醫療與長照間的關係，強化彼此間聯繫橋樑，使得轉銜照護能無縫接軌之目標。 The aged society makes Taiwan facing more and more elderly patients suffering from frailty and multiple chronic diseases. Disable population have difficulty leaving home for seeking medical helps. In order to reverse this situation, the government has been implementing the home medical care since 2015. It intends to integrate the current different types of home medical care services, and establish a cross-disciplinary integrated care team within primary care systems in hospitals. The home medical care system encourages medical staff to walk into patient's residential areas so that the health care can be continued.
There is little discussion about interactions, including the cooperation and conflicts between stakeholders of a home medical service team. Therefore, this study uses matching fit stakeholders theory and aims to explore the interactions of internal and external stakeholders concerning the cooperation and conflicts in the integration of the home medical care. It aims to make recommendations for solutions the interactions between the stakeholders.
This study used a case study approach, and have conducted seven face-to-face interviews with the team members of a home medical care service in a Taichung hospital, each lasting 30-120 minutes. Semi-structured interviews were used to increase the validity of the study. The data were analyzed by grounded theory, and the quality of the research was confirmed using triangulations and consistency analysis method.
The results of the study show that of the internal conflicts of home medical care team members, "work overload, unable to cooperate" is the most conflicted point. Secondly, "resource matching" and "lack of comprehensive understanding of the policies" are also prone to conflicts. This conflict has made it difficult to optimize the relationship between long-term care and home medical care, and the linkage between hospitals and care centers is also rather weak. This study suggests that the team members and stakeholders must consider multiple factors and actively demonstrate the responsibility of medical workers to promote internal and external interactions in different forms of communication. On the other hand, the concept of long-term and home-based medical care has not yet fully understood by the society. It is imperative to construct a home medical network in the local community to cope with the excessive medical care. The government can also realize the multi-perspectives of home medical providers through this study, and figure out a more effectively way to integrate the system of home medical care and long-term care, so that the goal of seamless care can be seamlessly integrated.
