探討影響肺結核病患滿意度因素之分析

The analysis of influential factors for Tuberculosis patient’s satisfaction

黃盈蓁(Huang Ying-Zhen)

指導教授 ： 龔佩珍

亞洲大學/健康學院/健康產業管理學系健康管理組/碩士(2004年)

摘要

肺結核的發生率，近幾年來呈現上升的趨勢。根據目前國內的肺結核完治率，從1996年起完治率為77.1%，到2000年為74.24%，完治率的提升遠不如想像中的容易。肺結核病患從就醫一直到完治，至少須接受六個月的治療，而良好的醫療服務品質，會提昇病患的滿意度進而影響病患再度就醫的意願。故本研究目的除了解肺結核病患個人基本特性、個人健康意識與醫療相關因素等分佈情形外，及比較疾病管制局北、中、南、東四區，肺結核病患對肺結核疾病認知之差異，並探討影響肺結核病患整體治療服務滿意度之顯著相關因素。
本研究以疾病管制局，登錄於民國90年6月至90年11月間之新增肺結核案例，以18個月的觀察期分為完治組與未完治組。並依照每月新增個數及各地區（北、中、南、東四區）肺結核病患個案數，進行比例抽樣，本研究共計回收有效樣本550份。
本研究除了描述性統計外，另採卡方分析及雙因子變異數分析(MANOVA)，分析各變項與是否完治之整體滿意度關係。並以複迴歸統計方法，探討影響肺結核病患整體滿意度之顯著相關因素。
研究結果發現，病患完治的主要原因，為「自己的意志力」和「醫師的提醒與鼓勵」。未完治的原因以「吃了藥不舒服」，和「感覺已經好」，以及「藥的種類太多」為主。此外，北、中、南、東四區完治率，以東區為最高但四區間無顯著差異。不過四區肺結核病患對疾病的認知上，有顯著的不同，其中以東區之患者其認知最高，南區為最低。而肺結核患者對「衛生所護士訪視次數」與「衛生所護士給予的幫助」上，在四區中皆有顯著性的差異，結果並顯示衛生所護士訪視的次數多寡，與認為衛生所護士給予的幫助程度呈正向關係。經複迴歸分析結果顯示，影響肺結核病患滿意度之顯著因素包含：是否完治、性別、年齡、醫師的治療效果與服務態度，以及衛生所護士訪視給予的幫助與病患對使用藥物的認知。
肺結核病患認為完治的主要原因，除了「自己的意志力」與「家人的協助」外，「醫師的鼓勵與提醒」也是重要的因素。由於東區之病患對疾病的認知較高，顯示東區在對肺結核的衛教實施上，可提供給其他三區作為參考。而病人的認知與遵從行為，是影響治療的主要因素，且在肺結核的治療過程中，醫師扮演了極為重要的角色，本研究結果顯示，以「醫師的治療效果」為影響肺結核病患滿意度最顯著的因素，因此在肺結核的治療上更應強調醫病關係重要性，藉此提升病患的就醫意願，以達到早日完治的目標。

關鍵字

肺結核 ； 完治 ； 治療滿意度

並列摘要

The trend of having Tuberculosis has been rising for the past few years. According to current domestic Tuberculosis complete treatment rate, the rate was at 77.1% in 1996, but it dropped down to 74.24% in 2000. Complete treatment rate is hard to improve as easy as imagination. Tuberculosis patients need to be treated at least 6 months from taking medical treatment to complete treatment; moreover, good medical service quality will improve patient’s satisfaction and influence patient willing to re-seek medical advice. Therefore, the purpose of this research is not only to understand fundamental of Tuberculosis patient’s individual characteristic, personal healthy realization, and distribution of medical correlation, but compare patient’s difference of Tuberculosis knowledge at the disease control centers which located at the area of north, midland, south, and east. Also, discuss the influence elements of entire Tuberculosis patient’s satisfaction for treatment service.
This research is base on disease control center’s new Tuberculosis record between June and November in 2001. The records distribute into complete treatment and non-complete treatment groups to be observed for 18 months. According to new individual patient that add monthly from each areas, we collect the amount of 550 valid samples from ratio sampling.
This research is not only gathering a initial statistics, but using chi-square test and MANOVA for analyzing relationship of satisfaction between each variables and whether complete treatment. Besides, using multiple regression to discuss the influence elements of entire Tuberculosis patient’s satisfaction.
The research result shows that there are two primary reasons for patient to complete treatment from Tuberculosis such as self willpower and doctor’s reminder with encouragement. On the other hand, uncomfortable with medicine, self sense of recovery, and variety of medicine are the factors of unsuccessful recovery. In addition to recovery rate in all areas, east region has the highest point, but all of the areas are not much difference. Obviously, Tuberculosis patients have different disease cognitions in all areas. East patients have the highest cognitions, whereas south patients have the lowest. The frequency of public health nurses’ concern and help has distinct diversity cognition within each area of patients. The proportion of frequency nurse concern to degree of help given by nurse is representing a positive relation. Multiple regression indicates that the elements to influence Tuberculosis patient’s satisfaction are whether complete treatment, gender, age, effect of treatment and service attitude by doctor, frequency of public health nurses’ concern and help, and cognition of using medicines.
Tuberculosis patients think that the primary reasons for complete treatment are self willpower and family assistance. Furthermore, doctor’s reminder with encouragement is another critical factor. Due to eastern patients have higher cognition on disease, the disease education in eastern is much more successful than other areas. This success can be provided to other areas for reference. Patient’s cognition and complying behavior are major effect of treatment, but doctors also play a leading role during Tuberculosis treating process. This research result displays the most obvious influence of Tuberculosis patient’s satisfaction is doctors’ treating effect. Therefore, it emphasizes the relationship between doctor and patient is very important on treating Tuberculosis. Improving patient’s willing to seek medical advice, so as to reach complete treatment target earlier.

並列關鍵字

Tuberculosis ； complete treatment ； cured satisfaction

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