民眾對基層診所評價與就醫選擇影響因素

Consumers' Assessment of Clinic Services and its Affecting Factors

蔡文正(Wen-Chen Tsai) ； 龔佩珍(Pei-Tseng Kung)

《台灣公共衛生雜誌》 22卷3期 (2003/06) Pp. 181-193

https://doi.org/10.6288/TJPH2003-22-03-04

摘要

目標：為提升民眾至基層診所就醫意願，以減少民眾小病看大醫院的現象，本研究探討民眾對基層診所各項醫療服務之評價及分析其就醫選擇影響因素，以提出提升民眾至基層診所就診意願的方案。方法:本研究以問卷調查方式，依各層級醫院領藥號碼採隨機系統抽樣，有效樣本1148份，並應用描述性統計分析、逐步迴歸分析探討民眾對基層診所之整體評價與主要影響因素。結果:影響民眾對基層診所評價之因素除了包括教育程度與分級就醫觀念外，另包括醫術、護士或藥師的服務態度、醫師診斷時間、醫師對病情的解說等之滿意度。在民眾對選擇診所就醫因素重要性評價方面，以病情解說、環境衛生與醫術為最重要。而對診所醫療服務滿意度評價方面，前三名為醫師看病態度、醫病關係、醫術。結論：本研究依研究結果提出下列兩方面建議：一、對基層診所:病患導向之推廣活動、改善服務品質、設立聯合診所或聯合門診、醫師專業能力的強化；二、對衛生主管機關:調高越就醫之部分負擔、分級就醫觀念的推廣、加強基層醫師專業教育。

關鍵字

基層診所 ； 診所就醫評價 ； 就醫選擇因素

並列摘要

Objectives: In order to decrease the utilization of hospital outpatient services by patients with minor illnesses and to increase the willingness to visit primary care clinics, this study investigated the consumers' assessment of the types and quality of services delivered by clinics. The study also examined the factors determining the low preference for clinic-based services compared o hospital outpatient care. Based on the results, a number of policy interventions are proposed to improve the utilization of clinic-based care. Method: Structured questionnaires were used to interview patients selected randomly from four levels of the health service delivery system. A total of 1148 patients were interviewed. Descriptive statistics provide the basic information about patient's opinion and assessment of services received from clinics and the stepwise regression method was used to identify the factors affecting the assessment scores of clinics. Results: Factors affecting the patient's preference include the educational status of individuals, perception about physician's referral pattern, satisfaction with physician's competence, attitudes of nurses and pharmacists, time needed to diagnose illnesses, and the patient satisfaction with physician's explanation about the illness. From the patient's point of view, the three most important factors determining the quality of clime care were the explanations given by physicians about the illnesses, cleanliness of the clinic and perceived knowledge and competence of the physician. The top three factors affecting patients' satisfaction with clinics were the physician's manner and attitude, rapport between physicians and patients, and the physician's knowledge and competence. Conclusion: The results indicate that the utilization of clinics win improve if the physicians perform patient-oriented promotional activities, improve service quality, establish group medical practice, and enhance physician's competence. The health policy decision makers may also consider increasing the out-of-pocket payment for patients at the hospital level if not referred by a primary care physician. The health care delivery system can also promote the adoption of a well-defined protocol for patient referrals from primary to secondary and tertiary levels. Finally, continuing educational programs to update the knowledge and skills of clinic physicians will he1p to improve the confidence of patients in physicians in the primary care clinics.

並列關鍵字

Primary Care Clinics ； Assessment of Clinic Services ； Medical Care Choices

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