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  • 學位論文

護理之家主要照顧者對遠距藥事照護使用意願之研究-以台南市為例

The Study of Exploring Nursing Home Caregivers Intention In Telepharmacy

指導教授 : 張晴翔

摘要


背景與動機: 隨著人口高齡化,長期照護制度建立越顯急迫,但觀察目前長照制度對藥事照護均無人員設置標準,僅於長照機構評鑑條文中提到:「每3個月提供藥事照護服務有記錄」,讓長照機構主要照顧者(執業登記於該機構之醫療從業人員),在面臨機構內住民常見之重複用藥問題時常求助無門,使老人用藥安全的未來讓人感到憂心。而拜資訊科技的發達所賜,各式醫療照護科技開始應用長期照護服務上。 研究目的: 本研究目的有二。(1)探討護理之家主要照顧者對遠距藥事照護服務之使用意願。(2)探討影響護理之家主要照顧者使用遠距藥事照護服務各構面之相關性。 研究方法: 採用以修正科技接受模式(Technology Acceptance Model,TAM2)為研究架構基礎,並結合有關醫療資訊系統使用意願之因子,透過主觀規範、形象、自願性、工作關聯性、照護品質、成果可展現性及資訊素養等七構面與「有用性認知」及「易用性認知」之關係分析「使用意願」;另設計遠距藥事照護服務之模擬情境並藉由製作動畫檔案,經由DVD、Youtube下載觀看及文字說明,說明遠距藥事照護服務系統之架構及執行方式。 自2011年6月至2011年10月以電話詢問台南市衛生局所管轄之51家護理之家負責人,以機構內執業登記之醫事人員且有意願填寫問卷者,以郵寄方式發放250份問卷,共計回收192份問卷,回收率為76.8%;回收後之問卷剔除20份無效問卷以及遺漏題數七題以上者後,共以168份問卷進行分析。 資料以結構方程式(Structural Equation Modeling, SEM)為分析架構,線性結構分析式(Liner Structural Relation, LISREL) 8.54及SPSS 12.0等統計方法進行分析並驗證研究假說。 研究結果: (1)本研究整體信度Cronbach α值均在0.798至0.942之間,在效度方面,所有構面總解釋的變異量為83.2%;另研究對象於「使用意願」之各構面平均分數為3.83±0.59。 (2)以SEM分析各構面間之相關性,其修正後路徑之適配度指標(Goodness of Fit Index, GFI)達0.858,表示此修正模型已有一定的解釋力,並得到「有用性認知」與相關顯著構面(共變係數)關係分別為「資訊素養(0.11)」、「形象(0.12)」、「工作關連性(0.20)」及「成果可展現性(0.22)」,而「有用性認知」對於「使用意願」的路徑共變係數為0.53。 研究結論: (1)護理之家主要照顧者不論在年齡、教育程度、工作年資及職業別,對於遠距藥事照護系統具有高度使用意願,顯示本研究所設計之遠距藥事照護服務系統在介入長期照護機構方面,具有極大的可行性。 (2)「資訊素養」、「形象」、「工作關連性」及「成果可展現性」等四構面,均對「有用性認知」有高度之影響力,而護理之家主要照顧者對系統之「有用性認知」在遠距藥事照護系統之「使用意願」上亦呈現出有高度之相關性,顯示未來本系統在介入機構服務時,由前述四構面加強,可使機構人員更迅速接受並熟悉服務介面。

並列摘要


Background and Motive: With regard to the aging population, it’s more significant and urgent to establish long-termed care system. But when looking into the current long-termed care system, the standards of pharmaceutical care were not established in the long-termed care institutions. Only in the evaluative provisions it was mentioned: "the pharmaceutical care record is provided once every three months", so that the primary caregivers in long-termed care institutions (practicing medical practitioners) worried about this situation that the residents with repeated drug problems often feel hopeless with frequency. Therefore, the future of drug safety for the elderly is considerable worried. However, thanks to the advances in technology and information, the medical care technology have been applied to a long-termed care services. Research Purpose: This study included two purposes : (1) to explore the nursing home caregivers intention of telepharmacy, and (2)to examine the association between impacts of nursing home caregivers intention about telepharmacy. Research Method: This study adopted the Technology Acceptance Model 2(TAM2) as the theoretical framework and combined the willingness factors of using medical information system. To examine the association between "social norm", "image", "voluntary", "job relevance", "care quality", "result demonstration", "information literacy", "perceived usefulness", "perceived ease of use", and "intention to use telepharmacy". Designing telepharmacy simulated situations and animated films (with DVD, youtube, and text) to describe telepharmacy service and how it works. For knowing how many registered caregivers willing to fill out the questionnaire by asking the person in charge of the 51 nursing homes in Tainan City from June 2011 to October 2011. There were a total of 250 copies mailed with return rates 76.8%(192 copies) respectively. The collected data of 168 questionnaires, without 20 invalid questionnaires and missing more than seven questions, were analyzed. With Structural Equation Modeling(SEM) analyzing framework by statistic methods of Liner Structural Relation 8.54(LISREL) and SPSS 12.0 to verify the hypotheses. Research Results: (1)In this study, the overall reliability Cronbach α values were 0.798 to 0.942.In validity, the total explained variance of all dimensions was 83.2%. The average scores of intention between each dimension was 3.83 ±0.59. (2)The goodness-of-fit index (GFI) of this study was 0.858, after correcting the path, and this indicated that the modified model has a explanatory power. With significant dimension (variable coefficients) were "information literacy (0.11)", "image (0.12)", "job relevance (0.20) " and "result demonstration (0.22)". The variable coefficients between "perceived usefulness" and "intention" was 0.53. Conclusion: (1)Nursing home caregivers has a high degree of intention to use telepharmacy, regardless of age, education, job experience and career. So, the designed telepharmacy service system was involved in long-term care institutions with greatly feasibility. (2)The four dimensions, "information literacy", "image", "job relevance" and "result demonstration" were high degree of influence to "perceived usefulness". There was a high degree of correlation between "perceived usefulness" and "intention" in nursing home caregivers. By strengthening the four dimensions will let the telepharmacy be accepted quickly and familiar in the future.

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