定点医疗机构门诊肺结核患者满意度及其影响因素分析

Satisfaction of Tuberculosis Outpatients in Designated Medical Institutions and Influencing Factors

目的了解泸州市结核病定点医疗机构门诊肺结核患者结核病防治服务满意度及其影响因素,为提高结核病定点医疗机构诊疗服务质量提供依据。方法自设统一问卷对泸州市结核病定点医疗机构门诊2016-10-01/2017-09-30登记治疗并结束疗程的肺结核患者,随机抽取10.00%,共计280例进行问卷调查,采用Logistic二元回归对肺结核患者总体满意度及影响因素进行分析。结果肺结核患者总体满意度88.21%,对服务态度、治疗效果、健康宣传、影像检查、技术水平、其他检查、痰涂片检查、结核病免费政策、门诊环境、候诊时间、就诊便利性、医保政策和费用负担满意度分别为93.93%、93.57%、93.21%、92.14%、91.43%、88.57%、87.86%、87.14%、85%、83.93%、81.79%、80.71%和68.57%,30岁以下、30～49岁、50岁以上总体满意度分别为92.5%、95%和83.75%(χ~2=7.988,P<0.05),学生、农民、家务及待业、其他总体满意度分别为96.55%、84.39%、85.71%和98%(χ~2=13.02,P<0.05),初治、复治患者总体满意度分别为89.85%、57.14%(χ~2=9.258,P<0.05)。Logistic二元回归显示,影响患者总体满意度的因素为医保政策(OR=13.759,P=0.002)、候诊时间(OR=8.54,P=0.003)、治疗效果(OR=8.256,P=0.046)、费用负担(OR=6.681,P=0.017)、门诊环境(OR=5.736,P=0.032)、职业(OR=23.031,P=0.002)、年龄(OR=0.059,P<0.01)、治疗分类(OR=0.003,P=0.002)。结论患者对定点医疗机构门诊诊疗服务、治疗效果满意度较高,对门诊环境、候诊时间、医疗保障政策、费用负担满意度较低,50岁以上人群、农民、家务及待业、复治患者满意度较低。应强化门诊诊疗管理,巩固和提高门诊诊疗服务质量,改善就诊环境,增加诊疗力量,简化就诊流程,缩短候诊时间,加强医保政策协调,出台有利于结核病患者医疗保障政策,对重点人群实施医疗救助,降低患者费用负担,提高结核病患者满意度。

Objective To understand satisfaction of tuberculosis outpatients with tuberculosis prevention and treatment services in designated medical institutions in Luzhou and influencing factors so as to provide a basis for further improvement of the medical service quality of designated medical institutions. Methods By random sampling, 280 (10.00%) of outpatients with tuberculosis who registered and completed treatment between October 1, 2016 and September 30, 2017 were surveyed using a self- designed unified questionnaire;Parents' overall satisfaction and influencing factors were analyzed by binary logistic regression. Results The overall satisfaction degree of tuberculosis patients was 88.21%;the degree of satisfaction with service attitude, treatment effects, health promotion, imaging examination, technical level, other tests, sputum smear test, freetreatment policy, clinic environment, waiting time, convenience, medical insurance policy and medical expenditures was 93.93%, 93.57%, 93.21%, 92.14%, 91.43%, 88.57%, 87.86%, 87.14%, 85%, 83.93%, 81.79%, 80.71% and 68.57%, respectively;the overall degree of satisfaction of patients < 30 years, between 30 and 49 years and ≥50 years of age was 92.5%, 95% and 83.75%(X^2 = 7.988, P<0.05), respectively;the overall degree of satisfaction of students, peasants, house workers and unemployed people and people doing other jobs was 96.55%, 84.39%, 85.71% and 98%(X^2 = 13.02, P< 0.05), respectively;the overall degree of satisfaction of initially treated and retreated patients was 89.85% and 57.14%(X^2 = 9.258, P<0.05), respectively. Binary logistic regression showed that the factors influencing the overall satisfaction of patients were medical insurance policy (OR = 13.759, P= 0.002), waiting time (OR = 8.54, P = 0.003), treatment effects (OR = 8.256, P = 0.046), medical expenditures (OR = 6.681, P = 0.017), clinic environment (OR = 5.736, P = 0.032), occupation (OR = 23.031, P = 0.002), age (OR = 0.059, P<0.001), and treatment classification (OR = 0.003, P= 0.002). Conclusion The patients were highly satisfied with the outpatient services and treatment results of designated medical institutions but not very satisfied with clinic environment, waiting time, medical insurance policy and medical expenditures. Patients ≥ 50 years of age, peasants, house workers and employed patients, and treated patients were not very satisfied. Outpatient diagnosis and treatment management should be enhanced;clinic environment should be improved;diagnosis and treatment forces should be strengthened;the medical service procedure should be simplified;the waiting time should be reduced;medical insurance policies favoring tuberculosis patients should be enacted to implement intensive medical help for key populations, lower patients1 medical burdens and improve satisfaction of tuberculosis patients.