奇美醫院傷口外展醫療服務 把治療搬到您家
2023-4-21 記者田靖／台南報導
奇美醫療財團法人奇美醫院傷口照護中心主任林祐丞門診示意圖。
臥床病人到宅服務，解決奔波之苦
案例：65歲的王女士是肺癌的末期病人，自從腦轉移後幾乎多是臥床狀態。病人有非常好的家中支持，不僅幫病人安排獨立的住處，還請有外藉看護全天照護，即使如此，病人的薦椎及兩側髖骨處仍發生數個皮膚潰瘍。
近日，病人偶而會發燒，居家護理師訪視發現病人傷口發紅，懷疑發燒可能為傷口感染造成。若是過去，居家護理師會建議病人到醫院，透過急診就醫請外科醫師協助清創傷口，之後住院使用抗生素，等傷口情況改善後再出院返家。雖然病人的家屬有能力也願意讓病人就醫，但無論是工作請假、往返的車程、或是這過程裡的搬運，對病人或家屬都是挑戰。
而今，奇美醫療財團法人奇美醫院傷口照護中心提供傷口外展醫療服務，居家護理師只要電話聯絡，和整形外科醫師約好時間，醫師透過傷口外展醫療計劃到病人家中，針對感染的傷口進行清創及適當處置。妥善治療後，病人不再發燒，傷口感染也在口服抗生素後逐步痊癒，無需住院就醫。
困難癒合傷口非一蹴可及，無法按時就醫，導致癒合緩慢，甚至惡化！
國發會發佈最新一次人口推估報告，臺灣即將於2025年進入超高齡社會(老年人口佔比大於20%)，這個現象在古都臺南尤其明顯。眾多老年人口除了改變醫療疾病的比例，更讓老人及病人照護問題愈來愈明顯。以「傷口治療」為例，許多長輩身上帶著「困難癒合」的傷口，數年都無法治癒，追根究底常常是因病人無法往返醫院按時就醫之故。
奇美醫療財團法人奇美醫院傷口照護中心林祐丞主任表示：「身為『困難傷口專門科』醫師，我們常觀察到許多帶有『面積超大』、『嚴重感染』或『數年長期無法癒合』傷口的病人，因為長期就醫不便，而讓傷口持續惡化。我們也很常接收到許多養護機構或居護所的傷口諮詢，都是因為病人行動不便而無法到院。這些行動不便的病人要來一趟醫院，都讓照護者費盡心力，還要花費不少時間及金錢。更何況傷口癒合不是一蹴可及，常常需要數月的時間，許多照護者都無法配合長期頻繁的就醫，只好任由傷口治療進展緩慢，甚至惡化。」
奇美醫院優化慢性傷口治療，強化照護服務
根據衛生福利部統計，臺灣慢性傷口的人數約有37萬人，約佔總人口的1.5%。慢性傷口是指多個療程，或單一療程長時間未能療癒的傷口，通常是因為身體產生的自癒能力不足，或是治療方式不當所導致。這些慢性傷口也和臺灣370萬糖尿病人口，及77萬洗腎人數有關，儼然成為社會一大負擔。奇美醫療財團法人奇美醫院傷口照護中心自2018年成立以來，就已接受居家護理機構委託，在無法申報健保給付的情況下，以報備支援的方式到個案家中，免費服務部分帶有困難癒合傷口病人，執行所需之清創及傷口處置，成效顯著。今(2023)年，中央健康保險署南區業務組攜手奇美醫院等共四家醫院提供傷口照護視訊門診以及外展醫療，對於長照機構或家中的長者之慢性傷口問題，先以視訊門診方式讓醫師評估傷口狀況，再評估是否提供醫師外展傷口照護服務，有效減少病人與家屬往返奔波之苦。
奇美醫院傷口照護服務流程。
奇美醫療財團法人奇美醫院傷口照護中心林祐丞醫師說：「感謝健保的支持，讓奇美醫療財團法人奇美醫院更有力量照顧那些在家中或是在長照機構無法到醫院的慢性傷口病人。今年初至今，我們已經幫助了十多位在家不方便的病人改善傷口情況。雖然多數的慢性傷口不會致命，但是對這些長期臥病在床、行動不便的病人來說，能擺脫傷口的折磨，對生活品質的改善將有莫大助益。
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