南區家醫計畫診所病患滿意度影響因素

Influential Factors on the Level of Satisfaction for the Patients of Clinics Participating in the Family Doctors Integrated Health Delivery System in the South District

目標：為強化基層醫療角色，達到分級轉診，健保局於民國九十二年起開辦「家庭醫師整合性照護制度試辦計畫」，病人就醫滿意度是決定醫療照護計畫，醫囑遵從度及照護結果的預測因子，運用病人滿意度測量評估健康照護組織的績效正逐漸增加。本研究旨在探討南區參與家醫計畫診所病患利用基層醫療之滿意度影響因素。方法：本研究以民國九十二至九十三年新加入家醫計畫南區醫療群之診所，以訪視法收集病患資料，病患身份分為有參與家醫計畫的家醫會員及沒有參與家醫計畫的病患，兩年共回收1, 559人。並以郵寄問卷法收集醫師及診所資料，兩年共回收130份，將病患和醫師資料整合後，得有效研究樣本1, 151人。以描述性分析、因素分析、單變項分析、相關分析及逐步複迴歸分析，探討病患利用基層服務的滿意度與主要影響因素。結果：總體之滿意度平均分數介於3.627至4.713分，病患滿意度經由因素分析後可分為三構面；1)診所提供衛教、諮詢及轉診服務；2)診所人員提供基層服務的態度；3)診所流程及設施。總體滿意度及前述三構面滿意度的共同影響因素及滿意度的影響為：上次看病地點是否為同一診所（是＞否）、是否為家醫會員（是＞否）、醫囑是否為電腦化（是＜否）、一星期內看診總診次愈高愈滿意。結論：診所醫師應瞭解病人的反應及需要，鼓勵病患參與家醫會員，進而提供適當的服務，主動視病患需要轉診、促進醫病關係，提升民眾就醫便利、多元化的服務；衛生主管機關在推動診所電腦化之餘，亦應監測照顧品質。

Objective: The Bureau of National Health Insurance implemented the Family Doctors Integrated Health Delivery Pilot System in 2003 to reinforce the role of primary healthcare and realize the hierarchical referral. As the level of patient satisfaction acts as the predictive factor determining a healthcare project, medication adherence and medical outcome, the use of a patient's level of satisfaction in assessing the performance of healthcare organizations has gradually increased. This study aims to investigate the influential factors on the level of satisfaction for patients of clinics participating in the Family Doctor Project in the South District. Methods: Taking clinics participating in the Family Doctor Project in the South District between 2003 and 2004 as subjects, this study adopts the interview method to collect the data of patients. Patients include those who participate in the Family Doctor Project and those who do not. A total of 1559 entries of data were collected. A mail questionnaire method is used to collect the data of physicians and clinics. A total of 130 questionnaires were retrieved during the two years. After compiling the data of patients and physicians, 1151 valid samples were collected. Descriptive analysis, factor analysis, one-way ANOVA, correlation analysis and stepwise regression analysis were adopted to investigate the level of patient satisfaction and major influential factors on the use of primary healthcare. Results: The average overall level of satisfaction is between 3.627 and 4.713. Through factor analysis, the level of patient satisfaction is divided into three constructs including: 1. the provision of health education, consultation and referral services; 2. the attitude of clinic staff when providing primary healthcare services; and 3. the flowchart and facilities of clinics. The mutual influential factor and effects on the level of overall satisfaction and the three constructs are: whether the patient visited the same clinic last time (Yes＞No); if the patient is a member of the Family Doctor Project (Yes＞No); and whether the medication prescription is computerized (Yes＜No). A higher number of clinic visits within a week indicates a higher level of satisfaction. Conclusions: Physicians should understand the responses and needs of patients and encourage them to participate in the Family Doctor Project in order to provide appropriate services. Physicians should also provide referral services when necessary and improve their relationship with patients to offer convenient and multifaceted services. While competent health authorities are promoting clinic computerization, they should also monitor the healthcare quality of clinics.