後疫情時代的醫院醫學照護模式

Abstract

臺灣在高齡化的情況下，多重疾病、衰弱與失能變得普遍，多重用藥與高醫療耗用的問題隨之浮現。照顧高齡衰弱病人，應重視健康促進與功能維持，將目標由治癒轉向照顧，因此需要跨領域團隊合作進行全人照護，並將照護場域由醫療機構延伸至社區居家。這樣的照護就是整合醫學的核心理念，根據本人意願，以價值為導向，提供全人、全程、全家、全團隊、全社區的五全照護模式。 在這背景下，各國的醫療體系開始面臨重整，包括減少治療疾病的急性病床、擴增以功能回復為目標的急性後期或是回復期病床、也提升在宅醫療的量能。疫情導致的就醫障礙，更使遠距與居家醫療的趨勢獲得普遍重視。後疫情時代的醫院整合醫學照護模式，應有專責病房來照顧多重疾病、高醫療耗用、身心失能的病人，並強化社區連結、建立在宅醫療團隊、提升遠距醫療能力，以提供病人從醫院到社區的全程健康照護服務。  In Taiwan, the multimorbidity, frailty, and disability associated with population aging have aggravated the problem of polypharmacy and resulted in high medical resource consumption. The care for patients who are frail and in an advanced age must emphasize health promotion and function maintenance, focusing on the provision of care rather than the curing of a disease. This requires an interdisciplinary team capable of extending the holistic care provided in medical institutions to patients’ homes. This is a type of care that embodies the core concepts of integrative medicine, namely a value-oriented health care that involves the patient, the medical treatment, the patient’s family, the medical team, and the community based on the patient’s own free will.To meet this requirement, medical systems worldwide are in the process of reorganization, and the measures taken include reducing the number of acute care beds, increasing the number of beds for post-acute and rehabilitative care, and enhancing the capacity for home health care. The barriers to medical access, which are induced by the COVID-19 pandemic, have also turned global attention to telemedicine and home health care. To provide patients with a holistic care that extends from hospital to community, post-pandemic medical institutions must apply integrative medicine; establish dedicated wards for patients with polypharmacy, high medical resource consumption, and physical and mental impairment; strength their ties with local communities; create medical teams proficient in home health care; and improve their abilities in telemedicine.