齒列矯正治療醫師與病患對醫療服務品質認知之研究

齒列矯正是近年來台灣牙科醫療重要的新興產業。一般牙醫主要為功能性醫療，而齒列矯正治療則要呈現良好的咬合功能、牙齒與咬合的穩定、顏面與齒列的美觀以及身心靈的健康，因而需要牙醫師與患者充分溝通，讓患者以最適當的治療方式，獲得最健康、理想又美觀的整體性醫療服務。然而，也因為齒列矯正有別於一般功能性牙醫治療，患者對於醫療品質會有較高期望值與不同的滿意度評判標準，可能與牙醫師的專業觀點有所差距。因此，本研究主旨在探討患者與牙醫師，對於齒列矯正治療的品質之認知，從而為牙醫師以及牙科醫療診所對齒列矯正醫療品質提升時提供具體建議與參考。本研究採用問卷進行調查，受測對象包含患者201位，執行齒列矯正的牙醫師32位。透過問卷分析，了解患者對齒列矯正醫療品質的認知，以及牙醫師從專業角度對齒列矯正治療的服務品質認知，同時比較雙方差異。研究結果顯示，在醫師部分，有半數以上為40歲以下的新生代醫師，主要為學士學歷，有半數以上在一般牙科診所從事一般牙科兼齒列矯正業務，顯示台灣目前齒列矯正治療的產業正值蓬勃發展的階段，但是在專科的產業特色與規範方面還有進一步發展的空間。患者方面，高學歷者接受齒列矯正，或者讓家中兒童接受齒列矯正的意願較高。患者獲知齒列矯正的資訊管道以親友為主(72.1%)，其次為牙醫師(42.3%)，而衛教資訊僅有1%，顯示接受齒列矯正與人際關係網絡有極高關聯性。在醫師與診所的選擇上，醫師的醫術醫德、親友介紹、診所內的服務態度，以及距離方便性是主要考量。在材質上，有74.1%使用經濟實惠的金屬材質，不會要求使用較貴的陶瓷或可拆式膠膜，且有13.4%不清楚自己使用何種材質，推論患者主要信賴醫師，且以效果目的性強，對材質較不重視。另外，本研究的樣本中，兒童僅佔1/4，與國外文獻有極大差異，或為抽樣上的問題，但在兒童樣本中，家長是決策關鍵，未來可進一步探究。

關鍵字

齒顎矯正；牙醫醫療品質；家長代理決策；就醫選擇；因素分析

並列摘要

Orthodontic Treatment has flourished in Taiwan in recent years and has largely expanded the turnover of clinics. Different from the functional-purposed general dental treatment, the orthodontic treatment requires good occlusion of teeth, aesthetics of face and dentition, and the care of patients’ mind and health at the same time. Therefore, the dentist needs to communicate with the patients, so the patients get the medical services with the most appropriate treatment. Orthodontic Treatment has generally been self-paid and oftentimes high-priced, patients hence have higher expectation and criteria toward Orthodontic Treatment medical service quality. The main purpose of this study is to explore the factors that influence the cognitions of patients and dentists’ orthodontic treatment service quality. The result of this study would provide specific recommendations for dentists and dental clinic managers to improve the service quality of Orthodontic Treatment. The results of the study infer that more than half of the dentists are under the age of 40. The education levels are mainly bachelor's degrees. More than half of dentists practice in general dental clinics. Furthermore, Taiwan's orthodontic treatment industry is at the stage of vigorous development, young dentists are willing to engage in this paticular field. However, there is still room for further development in the characteristics and norms for the orthodontic treatment to be a special medical division. As for the patients, highly educated people are the main customers of orthodontic treatment, or have higher willingness to let their children receive orthodontic treatment. Patients with orthodontic treatment gathered the information mainly from relatives and friends (72.1%), dentists’ advice (42.3%), and only 1% from dental health education information. The result indicates that Orthodontic Treatment has a high correlation with interpersonal networks. In the choice of doctors and clinics, doctors' medical ethics, family and friends’ advice, service attitudes in the clinic, and transportation convenience are the main considerations. In terms of brace materials, 74.1% use economical metal materials, and 13.4% lack of knowledge about which materials they use. It is inferred that patients care about the curative effect instead of appearances during the treatment, and their decision-making rely on dentists’ advice. In addition, in this study, only 1/4 patients are children, which is very different from the research studies in America and Japan. This result may be caused by the sampling limitation. However, we found the parents’ decision-making is important in their child’s orthodontic treatment decision. Hence, further investigation is needed to understand the parents-child behavior in orthodontic treatment in the future studies.