長期照護服務提供者及服務使用者對長期照顧管理中心服務品質之認知

研究目的國內對於長期照顧管理中心的研究較少以服務使用個案及服務提供者的角度來檢視長期照顧管理中心的服務品質，也沒有一個通用的量表來測量滿意度情況。因此本研究之目的希望以服務提供者及服務使用者的角度，發展出評估長期照顧管理中心的服務品質滿意度工具，探討高高屏照管中心的服務品質滿意度情況以及相關影響因子做為長期照顧管理中心的改善依據。研究方法本研究為橫斷性研究，利用問卷測量方式探討照管中心服務品質滿意度。研究對象為高高屏四項服務(居家服務、居家護理、居家復健、喘息服務)服務提供者、服務使用者。服務提供者採用發放問卷，自行填答滿意度；服務使用者問卷則由訪員面訪或電訪填答滿意度問卷。本研究第一個研究工具，依據美國聯邦醫療保險及補助計畫中心所發展的服務提供者滿意度問卷(MCPSS)修訂而成，服務提供者滿意度問卷包含溝通與諮詢、專員專業能力、自主權等七個構面；第二個研究工具，服務使用者滿意度問卷包含訊息傳遞、可近性與便利性、中心服務品質、個案服務成效等九個構面。研究工具為自擬式的結構性問卷，透過國內外文獻蒐集，並各經過兩回合的專家效度，問卷回收後進行信度檢定及因素分析過程，與專家效度擬訂之構面比較其差異。有效樣本數長期照顧服務提供者為170人、長期照顧服務使用者為331人；對照管中心滿意度問卷信度Cronbach’s α值分別為0.952、0.927。研究結果長期照顧服務提供者對照管中心整體滿意度分數為3.46±0.55、溝通諮詢3.66±0.54、專員專業能力3.39±0.57、自主權3.76±0.63、轉介流程3.53±0.69、行政說明3.55±0.58、申請給付3.15±0.71；服務提供者滿意度各構面間大多均呈顯著正相關，其中溝通諮詢與整體滿意度相關程度最高(r=0.682,p<0.001)，對溝通諮詢滿意度越高，整體滿意度越高。滿意度影響因子方面，服務類型、個案量高低、長照年資等為滿意度影響因子，其中服務類型為自主權滿意度影響因子，而居家復健自主權滿意度較居家服務滿意度高(OR=7.83，95%CI=1.23~49.95)。長期照顧服務使用者對照管中心整體滿意度分數為4.24±0.47、訊息傳遞3.71±0.53、可近性與便利性4.18±0.45、中心服務品質4.03±0.54、個案成效3.57±0.50、家屬負荷成效3.80±0.44、專員服務品質3.88±0.76、專業能力4.01±0.51、互動與態度4.32±0.49；服務使用者滿意度各構面間呈顯著正相關，其中整體滿意度與專員專業能力構面達到中度正相關(r=0.638,p<0.001)，而專員專業能力與專員態度相關性最高(r=0.684,p<0.001)。服務使用者滿意度影響因子方面，發現自覺健康為很強的預測因子，自覺健康越不好者其對整體滿意度也越差(OR=0.29,95%CI=0.13~0.64)，其他如ADL失能程度、身心障礙等級、子女數、服務類型、專員專業背景等也是影響滿意度的因素。結論與建議本研究兩份研究工具皆具有一致性及可靠性，可真實測量服務提供者及使用者對於照管中心服務品質的真實看法，未來可提供給衛生行政單位做為評估滿意度工具之參考。研究結果發現，服務提供者對於照管中心服務品質滿意度普遍不高，其中又以申請補助款流程最不滿意，其次為專員的專業能力；服務使用者對照管中心服務品質則是有較高的評價，其中又以專員人際互動與態度、可近性與便利性滿意度最高，較不滿意的則是訊息傳遞與專員專業能力方面。不論是服務提供者或是服務使用者，皆認為照管專員的專業能力需要加強，建議照管中心未來除了在各項流程方面進行改善外，對於專員的溝通技巧與專業能力也應提供良好的教育訓練，並充分宣傳長照相關訊息及相關權利，提升服務提供者及服務使用者對照管中心的服務品質。

關鍵字

長期照顧；照管中心；服務品質；服務提供者；服務使用者；滿意度

並列摘要

Purpose There is a few of case studies from either the prospective of service or prospective of service provider to review the caring quality in domestic, not to mention an appropriate measuring scale to evaluate the real situation. As a result, the purpose of this study hopes to develop service quality instrument from the prospective of service user to explore the Long-term Care Management Centers around Kaohsiung City & County with related factors to make a referral on the basis of Long-term Care Management Centers. Method This study was part of cross-sectional study, which made use of questionnaire to measure satisfaction among Long-term Care Management Centers, whereas the research subject aims to four main service items in Kaohsiung City & County, such as resident care, home care, rehabilitation, and breaking time care, to provide those needed users. Based on service provider satisfaction questionnaire issued by U.S.A federal health insurance and benefits plans (MCPSS), the first research tool of this study is ready to offer satisfaction questionnaire, which includes 7 dimensions, such as counseling, communication, professional skill, and decision-making power; as for second research tool, it covers 9 dimensions, containing information transmission, accessibility and convenience, service quality of center, as well as effectiveness of the service cases. The research tool is made up of self-style structured questionnaire and reviewed by two rounds of expert validity along with domestic and foreign literature collection. After recycled questionnaire, it is necessary to conduct test of reliability and factor analysis process, comparing the difference with the dimension of expert validity. The effective sampling includes 170 people of long-term care service provider as well as 331 people of long-term care service users; the questionnaire reliability of Cronbach's α value for was 0.952 and 0.927, respectively. Result The long-term service provider only gave the overall satisfaction score for 3.46±0.55, communication for 3.66±0.54, professional skill for 3.39±0.57, decision-making power for 3.76±0.63, transferred procedure for 3.53±0.69, administrative instruction for 3.55±0.58, paid subsidy for 3.15±0.71; There are significantly positive correlations among different dimension of service provider satisfaction, especially the dimension of communication (r=0.682,p<0.001), indicating that the higher score, the higher of overall satisfaction. On the other hand, the affecting factor of satisfaction includes service type, case quantity, and seniority factor, while the service type is subject to the affecting factor of decision-making factor. Meanwhile, the satisfaction level of home rehabilitation higher than that of home service satisfaction(OR=7.83，95%CI=1.23~49.95).The long-term service provider only gave the overall satisfaction score for 4.24±0.47, signaling for 3.71±0.53, accessibility and convenience for 4.18 ± 0.45, service center quality for 4.03 ± 0.54, case effective for 3.57 ± 0.50, the effective of family burden for 3.80±0.44, personnel service quality for 3.88 ± 0.76, expertise for 4.01 ± 0.51, interaction and attitude for 4.32 ± 0.49; there are significantly positive correlations among different dimension of service provider satisfaction. The dimension between overall satisfaction and professional skill has a middle positive correlation (r=0.638,p<0.001), while the highest positive correlation is between professional skill and attitude (r=0.684,p<0.001). Regarding the satisfaction factor of service users, the more strong predictor of perceived health, the worse for overall satisfaction (OR = 0.29,95% CI = 0.13 ~ 0.64), other factors includes the ADL degree of disability, physical or mental disability levels, the number of children, type of service, the professional personnel background and so on. Recommendation and Suggestion The two main research tools in this study are consistent and reliable, can be offered as a reference tool for assessing satisfaction for health department. This study found out that service provider is not very satisfied with the quality of Long-term Care Management Centers, especially the aspect of subsidy application, followed by professional skill of personnel; meanwhile, the service user has a higher evaluation for service quality of Long-term Care Management Centers, especially the interaction attitude of personnel, accessibility and convenience, whereas it is unsatisfied with messaging capabilities and professional skill of personnel. Whether it is service provider or service user, they all agreed that the caring personnel are needed to strengthen his professional capacity. The centers should also provide personnel with good educational training to promote long-term related caring information, enhancing the quality of service management center.