影響病患使用可攜式電子病歷「滿意度」之相關因素

The Factors Affecting Patients’ Satisfaction of Portable Electronic Health Record

林勝義(Sheng-Yi Lin)

指導教授 ： 溫信財

臺北醫學大學/公共衛生暨營養學院/醫務管理學研究所/碩士(2010年)

https://doi.org/10.6831/TMU.2010.00055

摘要

目前電子病歷(Electronic Health Record)已成為國際間，以資訊科技提升醫療照護品質的主要發展趨勢，像美國、加拿大、英國及日本等國的大學、研究機構及廠商皆展開電子病歷標準制訂及推行各種資訊交換計畫。我國衛生署於 2007 年推動「建構以病人為中心之電子病歷跨院資訊交換環境案」，提出以病人為中心之電子病歷交換模式，期望將分散於各醫療院所內之電子病歷能作交換，以達到「把健康資訊還給民眾」的概念，讓病人掌握自己的病歷資訊，使全體國民不論身處何地，均享有無差距的醫療資源，並可避免民眾重複就醫而浪費醫療資源，而病歷的主要使用者為病患，若無病患的支持及參與，電子病歷導入的效益將無法發揮，故本研究目的為瞭解病患對可攜式電子病歷使用後之滿意度，及探討影響病患使用可攜式電子病歷滿意度之相關因素，以作為政府未來推動是項政策之參考。
　　本研究對象為參與衛生署試辦計畫醫院之病患，涵括了北、中、南及東部共計10家醫學心。研究工具採自填式結構性問卷，滿意度以Likert量表五點尺度衡量，問卷寄發2000 份，共計回收有效問卷為388份，回收率19.50%。所得研究資料利用 SPSS14.0版統計套裝軟體進行描述性統計、獨立樣本 t 檢定、變異數分析、相關分析及複迴歸分析等統計方法進行資料分析。
　　結果發現：樣本病患使用可攜式電子病歷前後，認知有用性平均數分別為4.32與4.30，認知易用性分別為4.29與4.28，隱私及安全性認知分別為4.28與4.33，表示其對電子病歷使用前後，在知覺與期望之間並無明顯差異；另電腦自我效能平均數為4.30；整體滿意度平均數為4.22。而變項間之相關統計顯示：整體滿意度與電腦自我效能(γ = 0.230)、隱私及安全性(γ = 0.725)、科技認知-有用性(γ = 0.718)及科技認知-易用性(γ= 0.714)呈現顯著的正相關。進一步複迴歸分析發現，年齡以60歲以上(β=0.177，p<0.01)、專科 (β=-2.007，p<0.05)，大學(β= -0.271，p<0.01)與研究所(β= -1.78，p<0.05)，科技認知有用性 (β=0.216，p<0.001)、科技認知易用性 (β=0.169，p<0.001)、電腦自我效能(β=0.427，p<0.001)及隱私及安全 (β= 0.142，p<0.05)對整體滿意度有顯著的影響，可解釋 29.1%之變異量(Adjusted R2 =0.291)。
科技認知因素、電腦自我效能及安全隱私性等變項是影響可攜式電子病歷使用滿意度之重要因素。由於樣本病患對於電子病歷整體滿意度高，此結果可視為醫院推動電子病歷發展的契機，故建議政府衛生主管機關督促試辦醫院加強宣傳、推廣及教育訓練，並補貼醫療院所資訊系統建置所需經費、建立醫院評鑑加分機制及結合健保給付獎勵誘因制度。

關鍵字

可攜式電子病歷科技接受模式 ； 病患 ； 滿意度

並列摘要

At present, the use of electronic health record (E H R) to improve the quality of patient care has become a major trend in international medical community. For example, in the United States, Canada, the United Kingdom and Japan, many universities, research institutes and manufacturers are starting to set up standards for electronic patient records and implementing various information exchange programs. In 2007, Department of Health of Taiwan promoted a program called ‘patient-focused inter-hospital electronic health record information exchange platform’. It offered a platform on which the patient records that scattered around various medical institutions could be centralized on individual patient basis. The purpose was to ‘return health information back to the people‘, which will allow patients to keep their own medical records so they can get the same medical services anywhere in the country. This will also avoid waste of medical resources due to repeated hospital visits. Since the health record is created for and would be used by patients, their support and participation is essential to the success of the HER program. The purpose of this study was to understand patients’ satisfaction level towards portable HER and to analyze the contributing factors. The results can be used as a reference for the government to set up its policy for the future HER program.
The study included 10 medical centers in North, Central, Southern and Eastern parts of Taiwan. A total of 2000 questionnaires were sent out to these hospitals of which 388 responded. The recovery rate was 19.50%. The satisfaction rate was measured by the five-point scale on Likert scale. The data was analyzed using SPSS14.0 software for descriptive statistics, independent sample t test, analysis of variables, number of objections, correlation analysis and multiple regression analysis and so on.
The results showed that: the average perceived usefulness before and after the use of EHR were 4.32 and 4.30 respectively; perceived convenience level were 4.29 and 4.28 respectively, and perceived privacy and safety level were 4.28 and 4.33 respectively. The data suggested that there was little difference in perception and expectation before and after the use of HER. Additionally, the average computer self-efficacy was 4.30 and the average overall satisfaction was 4.22. Other statistic variable such as overall satisfaction and the computer self-efficacy (γ = 0.230), privacy and safety (γ = 0.725), perceived usefulness (γ = 0.718) and perceived convenience (γ = 0.714) all showed positive correlation. Further multiple regression analysis showed the following variables having significant impact on the satisfaction level : patients more than 60 years of age (β = 0.177, p <0.01), professional school (β =- 2.007, p <0.05), college (β = -0.271, p <0.01), graduate school (β = -1.78, p <0.05), perceived usefulness of technology (β = 0.216, p <0.001), perceived convenience of technology (β = 0.169, p <0.001), computer self-efficacy (β = 0.427, p <0.001), and privacy and safety (β = 0.142, p <0.05). The above explained the abnormal variability of 29.1% (Adjusted R2 = 0.291).
The important factors affecting the user satisfaction level of the portable electronic health record included: awareness of the technology, computer self-efficacy and safety of privacy. As the overall satisfaction rate was high, the result of this study could be used as a positive signal for the government to start promoting EHR. We recommend government health authorities urge hospitals to start the promotion and education of the EHR system, allocate fund to help set up the information system in each hospital, implement an accreditation mechanism to evaluate hospital’s performance and provide incentives to hospitals through National Health Insurance reimbursement scheme.

並列關鍵字

portable electronic health record ； technology acceptance model ； patient ； satisfaction level

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