偏鄉地區衛生所復健醫療服務量與品質之研究

Research of Medical Service Quantity and Quality of Rehabilitation in a Rural Public Health Center

陳冠伯(Guan-Bo Chen) ； 蘇弘慈(Hung-Tzu Su) ； 李建輝(Chien-Hui Li) ； 李永恆(Yung-Heng Lee) ； 陳峰毅(Fung-Yi Chen) ； 林鴻(Hong Lin) ； 段生輝(Sheng-Hui Tuan)

《台灣復健醫學雜誌》 49卷2期 (2021/12) Pp. 159-172

https://doi.org/10.6315/TJPMR.202112_49(2).0003

摘要

目的：高雄市六龜區位居屏東平原與中央山脈之丘陵交會，為全民健保醫療資源缺乏地區，2017年10月於高雄市衛生局協助下成立全國第一家設立於衛生所之獨立經營健保特約物理治療所，並由衛福部旗山醫院每兩周支援復健科醫師一次進行診療，服務範圍除六龜區之外，更涵蓋深山桃源及茂林兩大交通不便之原民鄉。本研究旨在探討該合作模式於偏鄉地區之服務量能及品質。方法：本研究統計2018年1月至2019年8月之復健服務量資料，另外於2019年8月至9月於六龜衛生所發送問卷進行醫療品質分析，醫療品質問卷共30題，以PZB服務品質缺口模式為基礎設計，改編自22題的SERVQUAL量表，內容包括五個構面，分別為（1）有形性（2）可靠性（3）反應性（4）確實性（5）關懷性，以評估復健病患對所接受醫療服務的期望與滿意度之落差。結果：發現服務量統計期間日平均復健人次為35.1人，單次復健門診看診人次為61.4人，物理治療服務業務包括早療，神經及骨關節物理治療，服務對象中65歲長者佔52.3%，診斷中以頸、腰椎退化為大宗；醫療品質方面，有效問卷47份，問卷回收率為100%，量表內容效度指標為0.91，量表五大構面的Cronbach's α係數為0.854-0.929，具高信度，五大構面除有形性中部分題目病人之期望值與滿意度有顯著差異外，其餘皆無顯著差異。結論：本研究結果顯示偏鄉之獨立經營健保特約物理治療所在與當地衛生所及衛生主管機關合作下之復健服務模式是可行的，惟因復健提供之專業人員短缺，民眾在有形性構面上與期望有所落差，未來仍有待更多資源之投入與整合，以期達到永續經營之目標並方便偏鄉民眾之復健需求。

關鍵字

PZB模式（PZB model） ； SERVQUAL量表（SERVQUAL） ； 醫療服務品質（medical service quality） ； 病患滿意度（patient satisfaction） ； 衛生所（public health center）

並列摘要

Background: Liugui District, that locates in the rural Kaohsiung city, is defined as the area with insufficient medical resources by National Health Insurance. In 2017, service of rehabilitation was established in Liugui District with the help from Department of Health, Kaohsiung City Government. It's an innovative model by combining the private physical therapy clinic with public health center and it was the first one in Taiwan. The physical therapy clinic was run by a private therapist and it was set up in the Liugui public health center. The rehabilitation outpatient clinic service was provided by one physiatrist from Ci-Shan hospital (a rural public local hospital) every two weeks and the physical therapy was provided by one regular therapist who owns the physical therapy clinic daily. This government-civilian cooperation model serves patients not only in Liugui but also two indigenous district (Taoyuan and Maolin District). We aimed to evaluate the quantity and quality of rehabilitation service based on this novel cooperation model. in a rural local public hospital in southern Taiwan. Methods: The data for quantity was collected from January, 2018, to August, 2019. We applied questionnaire based on the concept of Parsuraman,- Zeithaml,- Berry (PZB) service quality gap model and expected zone of tolerance to determine the difference in the medical service quality between the expectations and satisfaction of patients and their caregivers who received rehabilitation in Liougui public health center. The questionnaire was a 30-item structured, modified from the 22- item SERVQUAL instrument, with high validity and reliability that compromised five dimensions: (1) tangible, (2) reliability, (3) responsiveness, (4) assurance, and (5) empathy. The questionnaire was given to patients or their caregivers, who took regular rehabilitation in Liougui public health center for more than one month, from August to September in 2019 during the rehabilitation clinic (by convenience sampling). The paired t- test was used to analyze the gap in service quality between the expectation and satisfaction scores. Results: In the aspect of quantity evaluation, the mean number of patients who took rehabilitation and who used rehabilitation clinic in Liougui public health center was 35.1 daily and 61.4 per time, respectively. The rehabilitation service included early intervention, physical therapy for orthopedic and neurologic diseases. Patients aged more than 65 years accounted for 52.3% of the total patients. The most two common diagnoses of them were degenerative joint disease of lumbar and cervical spine. In the aspect of quality evaluation, a total of 47 patients (or their caregivers) were enrolled for analysis. The effective response rate was 100 %. The content validity index was 0.91, and the Cronbach's alpha for internal reliability was 0.854-0.929. Significant differences between the expectation and the satisfaction scores were only foud in part of the questions in the tangible aspect. Conclusion: Our study observed that the novel government-civilian cooperation model in rehabilitation service is feasible in rural regions. The medical service quality gap in the scores of the patients and their caregivers presented only partially in the tangible aspects, which meant that the rehabilitation we currently provided could meet their expectations except for the shortage of the health professional providers. To enhance the medical service quality and sustainable operation of this model, we need to improve the integration of government-civilian resources and recruit more health professional providers in the near future.

並列關鍵字

PZB model ； SERVQUAL ； medical service quality ； patient satisfaction ； public health center

參考文獻

孫宏禹、林盈利：長期照顧十年計畫2.0與居家醫療整合的銜接。血管醫學防治季刊 2018:22-3.

俞佳鈴、趙子傑、洪芳明等：以重要性－表現分析法評估兒童復健醫療服務品質及優勢－以某區域教學醫院為例。 臺灣職能治療研究與實務雜誌2018；14：75-87.

陳全裕、楊宜青：提昇高齡化無醫鄉之醫療照護水準－以田寮模式巡迴醫療爲例。台灣老年醫學雜誌2007；2：209-24.

余泰魁、丁秋瑤、蘇純繒：醫療服務品質評量模式：以雲林縣衛生所為例。 公共行政學報2006：55-89。

Liou I-H, Sun S-F, Hwang C-W, et al. Applying the PZB Model in Evaluating the Service Quality of Pediatric Rehabilitation. Tw J Phys Med Rehabil 2015;43:41-52.