患者对医患共享决策和医疗价值的感知分析

Analysis of Patient Perception on Shared Decision Making and Medical Care Value

目的 分析上海市公立医疗机构门诊和住院患者对医患共享决策和医疗价值的感知。方法 通过对2022年和2021年上海市公立医疗机构门诊和住院患者的问卷调查,分析患者对医患共享决策和医疗价值的感知,并采用多层广义线性混合模型分析影响患者对医患共享决策和医疗价值评价的因素。结果 2022年和2021年,上海市公立医疗机构门诊患者相比于医疗服务的医疗费用合理性评分均值分别为4.79分和4.71分,住院患者对医患共享决策和医疗价值总体评分均值分别为4.46分和4.50分。但2022年81.87%和80.55%的住院患者认为自费外购药物或器械会增加医疗不便和经济负担,比2021年(74.85%和72.43%)显著增加。此外,多层广义线性混合模型分析显示,患者对医患共享决策和医疗价值的感知受患者社会人口特征、健康状况、门诊就诊时间和诊疗状况等因素影响。结论 医疗服务的提供不能忽略患者的社会属性,应更多考虑患者的期望与偏好,以体现高质量发展和价值竞争的核心。

Objective To analyze the perception of outpatients and inpatients on shared decision making(SDM) and medical care value in public medical institutions in Shanghai.Methods The perception on SDM and medical care value of outpatients and inpatients in public medical institutions in Shanghai was analyzed after questionnaire surveys conducted in 2022 and 2021.Multi-level generalized linear mixed models were applied to analyze the factors that influence SDM and medical care value evaluation.Results In 2022 and 2021,the average score of outpatients on cost rationality compared to medical care were 4.79 and 4.71,respectively,and the overall average score of inpatients on SDM and medical care value were 4.46 and 4.50,respectively,in public medical institutions in Shanghai.However,81.87% and 80.55% inpatients believed that self-purchase of medicine or medical devices outside of medical institutions would increase inconvenience in medical care and economic burden to patients,which were significantly higher than that in 2021(74.85% and 72.43%).In addition,the multi-level generalized linear mixed models showed that the perception of patients on SDM and medical care value were affected by demographic characteristics,health conditions,duration of stay in outpatient departments,medical care,etc.Conclusion To reflect the cores of high-quality development and value-based competition,the social nature of patients should not be ignored in medical care,while patients' expectations and preference should be more considered.