杭州市社区慢性病患者医养护一体化服务体验的现况研究

Quality of Integration of Medical Treatment-nursing-rehabilitation for Chronic Disease Patients in the Community from Patients'Perspective:a Cross-sectional Study in Hangzhou

背景医养护一体化服务在推广过程中的服务质量亟待关注,从患者角度进行的评价尤为缺乏。目的明确杭州市社区慢性病患者医养护一体化服务体验现况,为提升医养护一体化服务质量提供借鉴和参考。方法于2020年6—9月,采用便利抽样法抽取浙江省杭州市5个主城区(江干区、拱墅区、西湖区、上城区和下城区)的10所社区卫生服务中心辖区内的550例慢性病患者进行问卷调查,内容包括患者一般资料、疾病与服务相关资料和医养护一体化服务体验(采用服务体验评价量表,含有形性、有效性、可靠性、交流性、移情性5个方面)。结果525例(95.5%)调查对象的问卷被有效回收。525例慢性病患者中,165例(31.4%)对医养护一体化服务满意。患者的服务感受总均分为(5.14±0.44)分,低于其期望值总均分〔(6.80±0.01)分〕,各维度得分从高到低依次为可靠性〔(5.69±0.87)分〕、有形性〔(5.43±0.85)分〕、移情性〔(5.13±1.81)分〕、交流性〔(4.86±1.53)分〕、有效性〔(4.77±0.98)分〕。服务期望各维度得分间差异较小。感受-期望间差距得分最大的维度为有效性〔(-2.01±0.14)分〕,最小的维度为可靠性〔(-1.11±0.17)分〕。剔除满意度调查时选择“其他”的20例调查对象,共对505例调查对象进行Spearman秩相关分析,结果显示社区慢性病患者对医养护一体化服务的满意度与服务感受总均分呈正相关(r_(s)=0.741,P<0.001);与服务感受-期望间差距总均分呈正相关(r_(s)=0.687,P<0.001)。结论服务体验和服务满意度密切相关,当前医养护一体化服务的有形性、有效性、可靠性、交流性、移情性5个方面尚未达到社区慢性病患者的期望水平,尤其是有效性方面,提示需有针对性地进一步提升医养护一体化服务水平。

Background It's necessary to pay urgent attention to the quality of the integration of medical treatmentnursing-rehabilitation in the service promotion process,especially the evaluation from the perspective of patients is lacking.Objective To investigate patients'perspective on the quality of integration of medical treatment-nursing-rehabilitation for chronic disease patients in the community in Hangzhou,to provide help for improving the quality of such services.Methods A questionnaire survey was conducted from June to September 2020 with 550 chronic disease patients selected by convenient sampling method from the service population of 10 community health centers in five major urban districts(Jianggan,Gongshu,Xihu,Shangcheng,and Xiacheng Districts)of Hangzhou,Zhejiang Province,for collecting their general demographic information,and diseases and treatment-related information,as well as experience of receiving integration of medical treatmentnursing-rehabilitation(using the Chinese version of SERVQUAL Scale consisting of effectiveness,responsiveness,reliability,communication and empathy).Results A total of 525(95.5%)of the respondents returned responsive questionnaire.Among 525 patients with chronic diseases,165(31.4%)were satisfied with integration of medical treatment-nursing-rehabilitation.The patients'total average score of the service perception(5.14±0.44)did not reach their expected level(6.80±0.01).From high to low the scores of each dimension were reliability(5.69±0.87),effectiveness(5.43±0.85),empathy(5.13±1.81),communication(4.86±1.53),responsiveness(4.77±0.98).There was tiny difference among the scores of each dimension of the service expectation.The largest gap between perception and expectation was responsiveness(-2.01±0.14)and the smallest was reliability(-1.11±0.17).Excluding the 20"other"respondents in the satisfaction survey,a total of 505 respondents were analyzed by Spearman rank correlation.The results showed that the patients'service satisfaction was positively correlated with the service perception level in terms of total average score(r_(s)=0.741,P<0.001),and the gap between perception and expectation(r_(s)=0.687,P<0.001).Conclusion The patients'service experience and satisfaction were closely related.Currently,the five aspects of effectiveness,responsiveness,reliability,communication and empathy of integration of medical treatmentnursing-rehabilitation have not reached the level of expectation of patients with chronic diseases in the community,especially the responsiveness,indicating that it is necessary to further improve the level of the service in a targeted manner.