當今社會高齡人口正快速擴張，失能人口數也與日俱增，面對不同的長期照護型態，各國的研究調查莫不指出失能者大都期待能居家接受照護，而「居家終老」更是他們的心願，台灣也不例外，尤以發展「以人為本」的居家照護服務模式，提供安全、有品質的居家照護，充分支持，並延續失能者及照顧者的居家生活型態，以落實「在地老化」的目標。此研究從服務使用者的觀點來了解影響居家醫療照護服務使用的相關影響因素，以期有效促進或提升失能者居家照護之使用，增進持續使用服務的意圖。此外，同時考慮服務使用經驗、服務品質滿意度、持續使用意圖間的中介效果，以增強理論模型的解釋能力。
本研究以使用居家醫療照護失能者之家庭照顧者為研究對象，採用問卷調查法，收集了282份資料，經分析的結果顯示，社會人口學特性不會影響居家照護服務品質滿意度與持續使用的意圖，但受到其服務使用期間長短的影響，隨著被照顧者服務使用期間越長，其持續使用意圖明顯越高。換言之，服務使用經驗及服務品質滿意度對於持續使用的意圖皆具有顯著的影響，當服務使用經驗越多，對居家醫療的服務品質滿意度和持續使用意圖就顯著越高。此外，前傾因素及需求因素兩者在居家醫療照護服務品質滿意及持續使用意圖間並不存在中介效果。但是「服務使用經驗」會透過「服務品質滿意度」的部分中介效果，進一步對「持續使用意圖」產生顯著的正向影響。綜合研究結果，本研究建議政府在修正居家照護政策及實施資源配置調整時，應該同步考量服務使用者的需要及觀點，以作為未來長照3.0居家醫療照護推動及發展策略的參考，使居家醫療照護服務更符合使用者之需求，奔赴雙贏局面，以臻至圓滿。

Today, the elderly population is expanding rapidly, and the number of disabled people is also increasing day by day. The different types of long-term care, research and surveys from various countries have pointed out that most disabled people expect to receive care at home, and "living at home" is their wish. , Taiwan is no exception, especially in developing a "people-centered" home care service model, providing safe, high-quality home care, fully supporting, and continuing the home lifestyle of the disabled and caregivers to implement "aging in place" ” goal. This study wished to understands the relevant factors that influence the use of home medical care services from the perspective of service users. We aim to effectively promoting or enhancing the use of home care for people with disabilities and increasing the intention to continue using services. In addition, the mediating effects between service usage experience, service quality satisfaction, and continuation intention are also considered to enhance the explanatory power of the theoretical model.
This study focused on family caregivers who use home medical care to care for the disabled. It used a questionnaire survey method to collect 282 pieces of information. The results of the analysis showed that sociodemographic characteristics will not affect the quality, satisfaction and continuity of home care services. Intention to use, but is affected by the length of the service use period. As the care recipient's service use period is longer, the intention to continue using the service is significantly higher. In other words, service usage experience and service quality satisfaction have a significant impact on the intention to continue using. The more service usage experience there is, the higher the satisfaction with service quality and the intention to continue using home health care are. In addition, there is no mediating effect between forwardness factors and demand factors on satisfaction with the quality of home medical care services and intention to continue using them. However, "service usage experience" will further have a significant positive impact on "continuing use intention" through the partial mediating effect of "service quality satisfaction". Based on the research results, this study recommends that the government should simultaneously consider the needs and opinions of service users when revising home care policies and implementing adjustments to resource allocation, as a reference for future long-term care 3.0 home medical care promotion and development strategies, so that home medical care services are more in line with the needs of users and strive for a win-win situation to achieve perfection.

目 錄
論文審定書 i
誌 謝 ii
中文摘要 iii
Abstract iv
目 錄 v
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 研究目的與研究問題 6
第三節 研究的重要性與預期貢獻 8
第四節 重要名詞解釋 8
第二章 文獻探討 10
第一節 台灣居家醫療照護 10
第二節 國外居家醫療照護 13
第三節 安德森健康照護利用模式 14
第四節 PZB服務品質缺口模式 16
第五節 使用意圖 20
第三章 研究方法 27
第一節 研究設計 27
第二節 研究架構 29
第三節 研究假設 34
第四節 研究對象 35
第五節 研究工具 35
第六節 變項定義 42
第七節 資料處理及統計方法 51
第八節 倫理審查 52
第四章 研究結果 53
第一節 描述性統計 53
第二節 以人為本的居家醫療照護服務 60
第三節 居家醫療照護服務差異性分析 68
第四節 研究變數間之迴歸分析及中介效果 95
第五章 研究討論與結論 108
第一節 研究對象社會人口學現況分析 108
第二節 研究對象對居家醫療照護服務之差異性分析 110
第三節 研究假設之驗證分析 111
第四節 結果與理論架構及現象之對話 117
第五節 研究結論 120
第六節 研究限制 121
第七節 建議 122
參考文獻 124
附錄一 專家效度審查 142
附錄二 人體研究倫理證明書 203
附錄三 失能者居家照護調查問卷 204

圖 次
圖2-1安德森健康照護利用模型第一版（1968） 16
圖3-1研究架構 30
圖4-1服務品質滿意度中介效果檢定 107

表 次
表3-1 居家醫療照護服務提供者(醫師、護理師)訪談內容 38
表3-2 居家醫療照護服務使用者(家庭照顧者)訪談內容 39
表3-3 前傾因素照顧者基本資料之操作型定義 42
表3-4 前傾因素被照顧者基本資料之操作型定義 43
表3-5 需求因素被照顧者居家醫療照護使用情形 44
表3-6 使能因素使用居家醫療照護的相關影響因素 46
表3-7 對居家醫療照護服務使用經驗之看法 47
表3-8 對居家醫療照護服務品質滿意度 49
表3-9 持續使用居家醫療照護服務之看法 50
表4-1 照顧者社會人口學特徵 54
表4-2 被照顧者社會人口學特徵 56
表4-3 使用居家醫療照護相關影響因素 57
表4-4 被照顧者居家醫療照護使用情形(單選題) 59
表4-5 被照顧者居家醫療照護使用情形(複選題) 60
表4-6 影響使用居家醫療照護重要因素(前五順位) 62
表4-7 使用居家醫療照護重要因素(前五順位) 63
表4-8 居家照護服務項目之重要性(前三順位) 65
表4-9 幫助最大的居家醫療照護成員(前三順位) 66
表4-10 居家醫療照護成員尚可增加成員(前三順位) 66
表4-11 居家醫療照護尚可增加服務項目(前五順位) 67
表4-12 性別(照顧者)對居家醫療照護服務之差異 69
表4-13 性別(被照顧者)對居家醫療照護服務之差異 69
表4-14 有無商業醫療險對居家醫療照護服務之差異 70
表4-15 年齡層(照顧者)對居家醫療照護服務之差異 71
表4-16 年齡層(被照顧者)對居家醫療照護服務之差異 72
表4-17 教育程度(照顧者)對居家醫療照護服務之差異 73
表4-18 教育程度(被照顧者)對居家醫療照護服務之差異 74
表4-19 婚姻狀況(照顧者)對居家醫療照護服務之差異 75
表4-20 婚姻狀況(被照顧者)對居家醫療照護服務之差異 76
表4-21 担任時間(照顧者)對居家醫療照護服務之差異 77
表4-22 現有子女數對居家醫療照護服務之差異 78
表4-23 居家服務階段對居家醫療照護服務之差異 79
表4-24 目前居住屋型對居家醫療照護服務之差異 80
表4-25 同住者人數對居家醫療照護服務之差異 81
表4-26 全家每月收入對居家醫療照護服務之差異 82
表4-27 長期使用三個月以上藥物對居家醫療照護服務之差異 83
表4-28 申請或轉介方式對居家醫療照護服務之差異 85
表4-29 病情穩定服務頻率對居家醫療照護服務之差異 86
表4-30 病情穩定合理服務頻率對居家醫療照護服務之差異 87
表4-31 病情發生狀況服務頻率對居家醫療照護服務之差異 88
表4-32 病情發生狀況合理服務頻率對居家醫療照護服務之差異 89
表4-33 至今使用照護期間對居家醫療照護服務之差異 90
表4-34 門診次數對居家醫療照護服務之差異 91
表4-35 急診次數對居家醫療照護服務之差異 92
表4-36 最近一次住院時間對居家醫療照護服務之差異 93
表4-37 過去一年平均每月自付費用對居家醫療照護服務之差異 94
表4-38 前傾因素合併組次數及虛擬變數表 96
表4-39 需求因素合併組次數及虛擬變數表 97
表4-40 前傾因素對服務品質滿意度之線性迴歸分析 102
表4-41 使能因素對服務品質滿意度之線性迴歸分析 103
表4-43 服務品質滿意度對持續使用意圖之線性迴歸分析 103
表4-45 使能因素對持續使用意圖之線性迴歸分析 103
表4-42 需求因素對服務品質滿意度之線性迴歸分析 104
表4-44 前傾因素對持續使用意圖之線性迴歸分析 105
表4-46 需求因素對持續使用意圖之線性迴歸分析 106

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