基于SERVQUAL量表的以家庭医生为主体的社区中医药健康管理服务评价

Service Quality Evaluation of Community-based TCM Health Management Delivered by the Family Doctor-led Team Using the SERVQUAL Scale

背景中医药健康管理服务在预防、保健、医疗、养生、康复等方面具有综合优势,应充分发挥中医药简、便、验、效的优势和特色,实践和探索中医药健康管理融入家庭医生制服务。本文运用修订后SERVQUAL量表了解社区居民对中医药健康管理服务的实际需求,找出期望服务和实际感知服务之间的差距,促进服务质量的持续改进。目的基于经典SERVQUAL量表,探索从患者角度评价医疗服务质量,了解辖区居民对社区卫生服务中心中医药健康管理服务的总体评价,为改善社区中医药健康管理服务质量提供支撑。方法选择2016年2月在大团社区卫生服务中心进行中医药健康管理服务的社区居民。调查其人口学特征,并采用自行设计的修订后SERVQUAL量表调查居民对社区卫生服务中心家庭医生团队提供中医药健康管理服务的期望值及对其重要程度的评价、对实际获得社区中医药健康管理服务的感受值。结果共发放问卷350份,回收有效问卷350份,有效回收率为100.0%。社区中医药健康管理服务所有条目的评分为负值,但趋近于0,对应的百分制评分均在90分以上。中医药健康管理服务的总体服务质量评分为-0.1487分,总体服务质量百分制评分为96.28分。6个维度中,居民对有形性的满意度最高,评分为-0.0750分,百分制评分为98.12分;满意度最低的是费用可接受性,评分为-0.1992分,百分制评分为95.02分。象限分析结果显示,象限1保持区域分布的条目最多(13项),象限4需要改进区域分布的条目最少(2项)。结论 修订后SERVQUAL量表能够科学客观地测量居民对于中医药健康管理服务的真实评价,居民对目前家庭医生团队提供的中医药健康管理服务水平整体非常认可,其中对于规范地提供所承诺服务的能力和就诊环境非常满意,而接受服务的等待环节和相关费用设置方面需要优先重点改进和优化。

Background Traditional Chinese medicine(TCM)health management has comprehensive and remarkable effects in the delivery of prevention services,medical and health services,health maintaining and rehabilitation services.TCM treatment should be given full play to their advantages and characteristics,such as simple and convenient to use,verifiable and effective,and TCM health management can be used in delivering family doctor services in practice in an exploratory way.To promote the continuous improvement of service quality,we used the revised SERVQUAL scale to identify communitydwelling residents'needs of TCM health management,and to find the gap between residents'expected services and self-perceived services.Objective To comprehensively assess the quality of self-reported medical services in patients,and community-based health management in residents using the classic SERVQUAL scale,providing support for improving the quality of communitybased health management.Methods Participants were selected from the community-dwelling residents receiving TCM health management from Datuan Community Health Center in February 2016.Demographic characteristics,and expected quality,importance assessment,and perceived quality of community-based TCM health management were obtained by a survey using a self-developed questionnaire consisting of demographic part and SERVQUAL scale revised by our research team.Results A total of 350 cases participated in the survey,and all of them(100.0%)gave effective responses to the survey.All the interventions covered in the community-based TCM health management program were numerically rated below 0,and tended to 0,and the corresponding satisfaction percentages were all above 90.The overall quality numerical score and corresponding satisfaction percentage score of the community-based TCM health management program were-0.148 7,96.28,respectively.In terms of domain numerical score of the revised scale,tangibles achieved highest residents'satisfaction,was rated-0.075 0 on average,and the corresponding satisfaction percentage score was 98.12.Cost acceptability achieved lowest residents'satisfaction,was rated-0.199 2 on average,and the corresponding satisfaction percentage score was 95.02.According to the analysis results of quadrant diagram,interventions distributed most in the first quadrant(13 in all)and distributed least in the fourth quadrant(2 in all).Conclusion The revised SERVQUAL scale provides scientific and objective support for examining the quality of community-based TCM health management.Investigated patients show high satisfaction on the overall service quality of community-based TCM health management offered by the family doctor-led team,especially on the capability for providing committed services in a standardized way,and medical environment.The waiting links for services and cost issues need highpriority actions to improve and optimize.