研究背景：急診壅塞問題是全球最受重視的急診醫療議題之一。儘管學者專家及政府有許多解決方案，卻鮮少由急診病人與家屬的角度對此議題深入討論。本研究目的為探討急診五級檢傷分類中，非緊急病人及家屬對「急診壅塞」之認知態度，藉此直接了解民眾想法，提供政府及醫療單位作參考。
研究方法：研究對象為南部某醫學中心急診，接受檢傷分類非緊急病人或家屬。收集資料期間為2017年9月1日至2018年1月15日；實際發放問卷700份，回收問卷共602份。刪除空白卷及不完整問卷57份，並排除問卷中全部勾選一樣答案者共20份，最後樣本數為問卷525份。依此進行敘述性及推論性之統計分析。
研究結果：病人與家屬對急診壅塞及利用急診資源時機仍感模糊，並將全民健保制度視為政府社會福利；這些因素可能影響民眾對於急診就醫醫院選擇。在轉診制度上，民眾認知仍有改善空間。對於政府已設置「全民健保行動快易通」APP資訊平台，病人與家屬願意使用卻不知道其功能。
研究建議：教育影響民眾就醫習慣。建議學校、社區與職場設計緊急醫療相關課程；社區醫療群不定期舉辦流行疾病相關講座，增加民眾對社區診所之信任。醫院可善用e化系統衛教病人與家屬正確使用急診資源，並針對疾病護理提供e化衛教，讓病人與家屬理解疾病之自我照護。建議政府利用電視媒體宣導「全民健保行動快易通」APP資訊平台，提供民眾即時醫療資訊，全面改變民眾就醫習慣、改善急診壅塞情形。

Background: Overcrowding in emergency departments is one of the emergency medical problems that attract most attention worldwide. Although experts and governments have proposed numerous solutions, few discussed the problem from the perspectives of patients who require emergency care and their families in terms of their level of understanding of emergency department overcrowding. The purpose of this study was to explore views and attitudes of noncritical patients and their family members toward emergency department overcrowding.
Methods: The research participants were noncritical patients after triage and their family members in an emergency department of a medical center in southern Taiwan. The data were collected from September 1, 2017 to January 15, 2018. A total of 700 questionnaires were distributed and 602 were returned. After deleting 57 unanswered or incomplete questionnaires and removing those with the same responses to all questions, the number of valid questionnaires was 525. Descriptive and inferential statistical analyses were conducted.
Results: The patients and their family members had obscure impression on emergency department overcrowding and were unsure of when to use emergency resources. They tended to consider the National Health Insurance (NHI) system as a governmental social welfare system. This thought affected their selection of hospitals for emergency care. Therefore, their acceptance of the cooperative mechanism of the hospital transfer system and the emergency medical resources has a considerable room of improvement. The government has established an APP information platform “NHI Mobile APP,” which the patients and their family members are willing to use but know little of its functions.
Suggestions: Education affects the public’s medical seeking behavior. Emergency care-related courses should be designed for schools, communities, and work places. Community health care groups should hold forums regarding epidemics to increase the public’s trust in clinics. Hospitals may consider use electronic systems and health education to promote proper use of emergency department resources. Electronic health education should be provided to emergency department patients to help them understand the importance of disease self-care. The government may use television media to promote the NHI mobile APP, which can provide medical information to the public whenever they need it, thereby mitigating the overcrowding of emergency departments.

論文審定書 i
致 謝 ii
中文摘要 iii
Abstract iv
圖 次 viii
表 次 ix
第 一 章 緒 論 1
第一節 研究背景與動機 1
第二節 研究目的與重要性 4
第 二 章 文 獻 討 論 5
第一節 造成急診壅塞之因素 5
第二節 急診壅塞之影響 9
第三節 急診檢傷分類與急診醫療利用 12
第四節 醫療利用與部分負擔 16
第 三 章 研 究 方 法 18
第一節 研究目標及設計 18
第二節 研究假設與架構 19
第三節 研究對象及抽樣方法 21
第四節 研究問卷設計及說明 22
第五節 信效度分析 26
第六節 資料處理與統計分析 29
第 四 章 研 究 結 果 31
第一節 個人基本資料：描述性統計 31
第二節 人口學變項與「急診壅塞」認知、選擇就醫場所態度、對醫院與政府「急診壅塞」措施認知之關係：推論性統計 38
第三節 人口學變項與是否贊成提高急診部分負擔之關係 41
第 五 章 研 究 討 論 43
第一節 討論 43
第二節 研究限制 46
第 六 章 結 論 與 建 議 47
文獻參考 48
附 錄 58
附錄一 人體試驗委員會核准同意函 58
附錄二 專家名單及問卷調查專家審查表 59
附錄三 正式研究調查問卷 60
附錄四 專家內容問卷評分表說明 64
 

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