影響精神科門診病患就醫考量因素及就醫醫院類型之相關因素探討

Factors Influencing the Selections of Medical Care and Types of Hospitals for Ambulatory Services of Psychiatric Outpatients

劉宗憲(Tzong-Hsien Liu)

指導教授 ： 黃國哲

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(2003年)

摘要

本研究之目的是要探討影響精神科門診病患就醫考量因素及就醫醫院類型之相關因素。以分層隨機抽樣方法選取600位精神科門診病患，其中150位選自一家精神科專科醫院，而另450位選自三家綜合醫院之精神科門診，以問卷進行研究，共回收有效問卷442份，有效回收率達73.67﹪。 研究結果顯示，病患選擇醫院時最重視的就醫考量因素，依序為醫師因素、其他人員態度因素、醫院因素、便利性因素、及宣傳因素。而病患的個人特質及就醫狀況會影響就醫考量因素的重視程度。以邏輯斯迴歸分析，檢定可能影響病患選擇不同類型醫院就醫的相關因素後發現，依勝算比高低順序排列，「疾病類型為精神官能症（相對於精神病）」、「疾病類型為其他（相對於精神病）」、「自覺疾病嚴重程度為普通（相對於很嚴重）」、「年齡為30歲至39歲（相對於60歲以上）」、以及重視「醫師是否有好的醫療技術」、「醫院是否能提供精神科慢性復健（如慢性病房、日間留院等）的服務」、「醫院是否具備有其他醫療科別（如：內科、外科）以方便轉介別科治療容易」、「醫師是否有好的服務態度」、「醫院的醫療設備是否新穎先進」、「醫院所在地的交通是否便利」、「到選擇的醫院就醫，是否會被對精神疾病有偏見的社會大眾投以異樣眼光」、「精神科病床是否足夠使得轉收住院治療容易」、「醫師是否有好的醫德及操守」等因素，會顯著影響選擇綜合醫院精神科或精神科專科醫院看診。 根據本研究的結果，我們可以瞭解影響精神科門診病患就醫考量因素及就醫醫院類型之相關因素，並提供不同類型醫院的經營管理者在擬定鞏固既有客源及吸引新病患的市場策略時做參考。

關鍵字

精神科門診 ； 醫院類型 ； 邏輯斯迴歸

並列摘要

The aim of this study was to find out the factors influencing the selections of medical care and types of hospitals for ambulatory services of psychiatric outpatient. This study took a sample of 600 psychiatric outpatients with a stratified random sampling, where 150 out of 600 patients were selected from one psychiatric hospital and 450 from three general hospitals. The program was conducted by questionnaire. Of the total questionnaires received, 442 (73.67%) were deemed effective. The results of this study revealed that the most concerned factor when choosing a hospital for ambulatory services of psychiatric outpatients were in order as follow: factors about physicians, factors about staff’s attitude, factors about hospital facilities, factors about convenience, and factors about advertising. In addition, patient’s characters and situations of medical seeking also influence the factors about selections of medical care. After carrying out Logistic Regression analysis, the factors that affect whether patients choose the psychiatric department of a general hospital or a psychiatric hospital are prioritized by odds-ratio as follows: ? Whether the mental illness is neurosis (as opposed to psychosis) ? Whether it is a different mental illness (as opposed to psychosis and neurosis) ? Whether it is average sick (as opposed to severe sick) by patient’s perception. ? Whether the age range of the patient is from 30 to 39 (as opposed to over 60) ? Whether the psychiatrist is well skilled ? Whether a psychiatric rehabilitation service is available (such as wards for chronic mental illness patients and day hospital, etc.) ? Whether there is other medical specialist besides psychiatry for referral ? Whether the psychiatrist has good services attitude ? Whether the hospital has advanced equipment ? Whether there is convenient public transportation ? Whether the public attitude about getting treatment in the selected hospitals is negative ? Whether there are enough beds for admissions ? Whether the medical ethics of the psychiatrist are of a high caliber According to this study’s results, we can realize the factors influencing the selections of medical care and types of hospitals for ambulatory services of psychiatric outpatient, and provides information useful to administrators of different types of hospitals in planning and implementing marketing efforts directed toward existed and potential consumers.

並列關鍵字

psychiatric ambulatory services ； types of hospitals ； logistic regression

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