基層醫師轉檢態度之探討

The purposes of this study are to explore the current profile of referral system of ancillary services, factors affecting the willingness of primary care physicians to refer patients for ancillary services, and the feasible methods to implement the referral system of ancillary services in Taiwan. The study used a systematic sample of 3,407 selected from 10,223 primary care physicians registered in the Department of Health in April 2002. A mailing survey was conducted to collect applicable data. There were 512 questionnaires returned which yielded a response rate of 15.1%. A multiple regression analysis was performed to explore the factors affecting the willingness of primary care physicians to refer patients for ancillary services. Multiple regression analysis showed that the willingness of primary care physicians to refer patients for ancillary services was positively related to the physicians' experience of referring patients for ancillary services (p=0.003) and to the physicians' perceived importance that the referral system of ancillary services can increase the competitive ability of the primary care clinics (p=0.017). Physicians considered the most feasible methods for the implementation of the referral system of ancillary services were to simplify the procedures for the referral system of ancillary services and to provide any medical results of the ancillary services back to the referring physicians. This study revealed that physicians' decisions for the referral of ancillary services are based on patients' medical need rather than the fear of losing the patients. It is suggested that a standardized referral sheet be issued and the amount of co-payment for ancillary services of the referral patients be reduced.