糖尿病患者就醫選擇因素探討－以桃園縣龜山鄉為例

Investigation on the Factors Affecting Diabetic Patients’ Choice of Hospital - Using Gueishan Township, Taoyuan County for Example

郭怡辰(Yi-Chen Kuo)

指導教授 ： 李顯章

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)

摘要

背景：糖尿病是一種常見的慢性疾病，近年來在國內十大死因中一直排名前五名，每年都有很多的國民因為糖尿病而死亡，糖尿病不只在台灣造成重大的影響，也是全世界共同面臨的醫療問題，了解糖尿病患者的就醫選擇有助於提升醫療品質、減少醫療資源濫用。
目的：本研究以探討龜山鄉糖尿病患者就醫選擇為主要目的，並了解糖尿病患者對目前就醫場所的滿意度，提出提升民眾至基層醫療院所的建議。
方法：以結構式問卷為主要研究工具，收集民國96至民國98年參加龜山鄉整合性預防保健服務的成人預防保健服務中有糖尿病病史的民眾共277人，於民國99年4月至5月為問卷發放及回收時間，總共回收問卷180份，有效回收率為65％，另外收集非糖尿病者(一般民眾)199人做為比較。
結果：龜山鄉糖尿病患者就醫選擇重要性排序前三名分別為：「醫師的醫術和專業」、「藥比較好、比較有效」和「醫師的服務態度」，一般民眾前三名選擇為「醫師的醫術和專業」、「醫師的服務態度」、「藥比較好、比較有效」。糖尿病患者和一般民眾、糖尿病個人屬性之間差異、疾病史之間差異和疾病狀態之間差異用MANOVA統計分析後發現和就醫選擇重要性大多無顯著差異，糖尿病患者的整體就醫場所滿意度利用Pearson相關係數檢定後發現和「醫師的醫術和專業」、「醫師的服務態度」、「等候看診和領藥時間」、「醫院的設備和規模」、「藥比較好比較有效」、「看診總費用」和「就醫場所環境」呈現正相關。
結論與建議：龜山鄉糖尿病患者和一般民眾及糖尿病特質之間對就醫重要性選擇大多無顯著差異，究竟是疾病本身因素或是健保制度的影響尚待研究，建議醫療機構可依就醫選擇項目來評估自身的優劣勢，改善服務品質並提升滿意度，醫療主管機關應訂定具體措施讓醫療資源更有效分配，以減少醫療浪費。

關鍵字

糖尿病 ； 整合性預防保健服務 ； 成人預防保健服務 ； 就醫選擇 ； 病患滿意度

並列摘要

Background:
Diabetes mellitus is a common chronic disease. In recent years, it has ranked top five among ten leading causes of death. Every year, many citizens pass away because of diabetes. Diabetes not only has a significant impact in Taiwan, but also is a common medical issue for the world. To understand diabetic patients’ choice of hospital can help improve medical quality and reduce the abuse of medical resources.
Objective:
This study aimed to investigate the factors affecting the choice of hospital of diabetic patients in Gueishan Township, to understand diabetic patients’ satisfaction with current hospitals, and to propose suggestions to increase people’s visit to primary health care institutions.
Methods:
A structured questionnaire was used as the main research tool to collect the data of a total of 277 diabetic patients who had participated in the program of the Adults' Preventive Care Service of the Integrated Preventive Healthcare Services in Gueishan Township. The questionnaires were distributed and returned in April and May, 2010. A total of 180 questionnaires were returned and the return rate of effective questionnaires was 65%. The data of 199 non-diabetic patients (general public) were collected additionally for comparison.
Results:
The top three factors affecting the choice of hospital of diabetic patients in Gueishan Township are “medical skills and expertise of the doctor,” “better efficacy of the drug,” and “service attitude of the doctor.” As for general public, the top three factors are “medical skills and expertise of the doctor,” “service attitude of the doctor,” and “better efficacy of the drug.” MANOVA was used to compare the difference in personal attributes, medical history, and disease status between diabetic patients and general public. Results showed that there is no significant difference in the factors affecting their choice of hospital. Pearson's correlation coefficient test was use to measure diabetic patients’ overall satisfaction with hospital, and it was found that “medical skills and expertise of the doctor,” “service attitude of the doctor,” “waiting time spent on the visit and at dispensary,” “Medical equipment and scale of hospital,” “better efficacy of the drug,” “total expense of outpatient service,” and “environment of hospital” have a significant positive influence on overall satisfaction.
Conclusion and Suggestions:
For diabetic patients and general public in Gueishan Township, there is no significant difference in the factors affecting their choice of hospital. Therefore, whether the disease itself or the national health insurance system affects the choice of hospital is left to be discovered. It is advised that medical institutions may evaluate their own pros and cons, improve service quality, and increase the level of satisfaction according to the factors affecting patients’ choice of hospital, and the competent authority of medical institutions shall formulate specific measures to allocate medical resources more efficiently to reduce medical waste.

並列關鍵字

Diabetes Mellitus ； Integrated Preventive Healthcare Services ； choice of hospital ； patient satisfaction

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