探討影響醫療服務滿意度之因素-以臺北市某醫院特殊健檢為例

Determinants of Service Satisfaction for Healthcare – Example from a Special Preventive Program in A Taipei Hospital

陳美瑾(Chin-mei Chen)

指導教授 ： 張武修

臺北醫學大學/公共衛生暨營養學院/公共衛生學研究所/碩士(2011年)

https://doi.org/10.6831/TMU.2011.00149

摘要

1983年國內放射核種管制失當致異常鈷六十射源誤回收製成近兩萬噸汙染建材用於一般民宅與學校。1996年起，臺北市政府衛生局針對年暴露劑量於超過背景值之1至5毫西弗之市民，規劃由市立醫院提供每年乙次全套輻射暴露預防健康檢查。本研究主要目的為探討影響前述市民於接受每年健康照護滿意度之因素，及深入了解有無其他因素會影響民眾對臺北市政府此項輻射健檢政策的接受度。

本研究執行期間於2010年7月至2010年12月，針對前往臺北市政府委託進行輻射預防性健康檢查之某市立醫院的受檢者，進行滿意度問卷調查，其中有效問卷為524份，以SPSS12與SAS9.1版進行基本人口學特徵、雙變項分析與邏輯斯回歸分析。

雙變項分析結果顯示，受檢者之「年齡」 (P =0.049)、「對於去年健檢滿意度」(P<0.001)、「對健檢好處之認知」(P<0.001) 、「對健檢避諱程度」（P=0.039）等因素與「今年健檢滿意度」間有顯著差異。邏輯思回歸分析結果顯示，「對於去年健檢滿意度」越高者今年健檢滿意度越高(OR=53.764，CI 95%：12.214-236.656)；認為「輻射健檢好處越多者」今年健檢滿意度越高(OR=5.692，CI 95%：2.222-14.579 ；OR=57.698，CI 95%：7.145-465.953)。健檢時段為平日者，其今年滿意度越可能提升(OR=1.479，CI 95%：1.016-2.1510)；去年滿意度越高者，其今年滿意度越不易提升(OR=0.056，CI 95%： 0.032-0.098)，皆達統計上顯著相關。今年健檢滿意度越高，「明年健檢意願」(OR=6.122，CI 95%：1.374-27.278；OR=4.036，CI 95%：1.006-16.198)與「鼓勵他人健檢意願」(OR=5.969，CI 95%：2.275-15.663；OR=7.855，CI 95%：2.980-20.704)皆會越高。

另以目的性抽樣選取10位受檢者進行質性深入訪談。經分析發現健檢滿意度會受下列因素影響：一、過去健檢經驗及其他醫院健檢經驗。二、對疾病或健康的認知。三、自認為「受害者」的認知。四、看診時間與醫師看診態度的認知。五、受檢者對看診醫師個人特質的認知。六、受檢者認知參與醫療決策的程度。七、對醫護人員的同情心、同理心與熟稔度之影響。

對於前述輻射健檢族群之影響滿意度研究結果可知，該族群對在以往與今年健檢滿意度方面皆受到諸多因素之影響，並可供相關醫療院所與政府單位作為健檢執行上的參考，在有關健檢的安排、健檢內容與其他與健檢相關措施等方面，應多加注意受檢者實際之需求給予協助。又因影響醫療滿意度之潛在因素眾多，故有關此類研究有持續進行之必要性。

關鍵字

輻射 ； 健康檢查 ； 醫療滿意度

並列摘要

In 1982 to 1983, due to inappropriate handling of lost orphan Cobalt-60 sources, more than 20,000 tons of contaminated steels were used in more than 200 buildings for schools and residential buildings in northern. Since 1996, the Taipei City Government Department of Health started to provide a prevent health examination once a year to the citizens who had been exposed to excess radiation of up to 5 mSv per year in the past in these registered contaminated buildings in Taipei City. The purpose of this research is to explore the variables and determinants which might be associated with the rates of satisfaction for the above mentioned health evaluation program by the Taipei City Government for the above cohort population.

The study was conducted during July to December 2010 in a designated Taipei Municipal Hospital to collected aforementioned information for those participated in the health services. 524 valid questionnaires were collected and the data was analyzed by bivariate analysis and logistic regression analysis via SPSS12 and SAS9.1 to evaluate the associations of the characteristics of the individuals and the satisfaction ratings.

It was noted that "age" (P = 0.049), "satisfaction for the health examination of last year" (P <0.001) ,"the potential benefits of this examination" (P <0.001) and "degree of avoiding to be known for participation in this healthcare program” " (P = 0.039) were with significant association with “satisfaction for health program this year”. By logistic regression analysis, it was noted that "the higher satisfaction scores in last year, the higher satisfaction scores in this year" (OR=53.764，CI 95%：12.214-236.656) , "recognizing the examination with more benefits, the satisfaction scores will be higher in this year (OR=5.692，CI 95%：2.222-14.579 ；OR=57.698，CI 95%：7.145-465.953), "those received the examination during working days of a week will have higher satisfaction scores" (OR=1.479，CI 95%：1.016-2.1510) , "those with higher satisfaction for examination at the last year will have less satisfaction scores in this year "(OR = 0.056, CI 95%: 0.032-0.098). Who were "with higher satisfaction scores in this year would be with higher willingness to come to the health program next year" (OR=6.122，CI 95%：1.374-27.278；OR=4.036，CI 95%：1.006-16.198) and "to encourage others to participate at this health program" (OR=5.969，CI 95%：2.275-15.663；OR=7.855，CI 95%：2.980-20.704).

On the other hands, purposive sampling was conducted to identify 10 subjects for in-depth interview. The subjects’ satisfaction toward to health program were affected by (1) previous experiences of the examinations in the above and other hospitals; (2) the awareness of health risks and the health concerns; (3) the awareness of being a victims from the incident; (4) the appreciation for the time by the doctors and doctors’ attitude during the health visit; (5) the perception toward the characteristics of the doctors’ personal traits; (6) the level of involvement in healthcare decision-making processes ; (7) the finally , empathy and acquaintance with the medical staff.

The results showed that satisfaction toward the health care program were determined by many factors. This study could provides related governments and hospitals useful information and to pay more attention on the needs of the subjects involved.

並列關鍵字

Radiation ； Health examination ； Satisfaction for Healthcare

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