基于SERVQUAL模型与IPA分析的慢性病患者基层卫生服务获得感评价

Evaluation of the sense of acquisition to primary health services for chronic disease patients based on SERVQUAL model and IPA

目的调查河南省嵩县慢性病患者基层卫生服务期望和感受现况,通过重要性-绩效性分析方法(importance-performance analysis,IPA)探讨影响慢性病患者获得感的因素,为提升慢性病患者基层卫生服务获得感,完善基层医疗卫生体系建设提供参考。方法2023年5—9月,运用服务质量评价(service quality,SERVQUAL)模型,设计慢性病患者基层卫生服务期望和感受问卷,利用IPA分析方法,通过构建IPA象限矩阵与IPA指数分析模型,并对河南省嵩县671例慢性病患者进行实际调查,以评价慢性病患者基层卫生服务获得感。结果将24个因子统计均值置于4个象限内,没有1项条目指标可以达到获得感非常高等级;获得感较高等级有2项指标,位于“过度表现”区域;获得感一般等级有13项指标,2项指标位于“缓慢改进”区域,3项指标位于“过度表现”区域,8项指标位于“保持优势”区域;获得感较低等级有6项指标,2项指标位于“重点关注”区域,4项指标位于“缓慢改进”区域;获得感非常低等级有3项指标,2项指标位于“缓慢改进”区域,1项指标位于“重点关注”区域。河南省嵩县671例慢性病患者服务感受(“非常低~非常高”计1~5分)总均分为(3.74±0.63)分,整体服务感受处于中上等水平,各维度得分从高到低依次为移情性[(3.86±0.73)分]、响应性[(3.8±0.7)分]、可靠性[(3.77±0.66)分]、保证性[(3.66±0.71)分]、有形性[(3.6±0.67)分]。服务期望总均分为[(4.11±0.54)分],均高于服务感受得分,服务获得感总均分为(-0.36±0.60)分,感受均未达到期望水平。差距最小的是移情性[(-0.32±0.71)分],差距最大的是保证性[(-0.43±0.67)分]。结论基层卫生服务机构内部环境较差、医务人员技术水平相对较低以及患者的意见和建议得不到重视等,与患者的期望差距很大,患者获得感非常低;基层卫生服务机构专业技术人员短缺、医务人员整体素质不高、工作负荷大,降低了患者的满意度和获得感;患者对医疗检查设备和基本药品种类情况,期望度和满意度均低,降低了患者的获得感。

Objective To investigate the current status of the expectations and feelings of primary health services for patients with chronic diseases in Song County of Henan Province,and to explore the factors affecting the sense of acquisition of patients with chronic diseases through importance-performance analysis(IPA),so as to provide reference for improving the sense of acquisition of primary health services for patients with chronic diseases and perfecting the construction of the primary health care system.Methods From May to September 2023,a service quality(SERVQUAL)model was used to design a questionnaire on the expectations and feelings of primary health services for chronic disease patients.Using the IPA method,an IPA quadrant matrix and IPA index analysis model were constructed,and an actual survey was conducted on 671 chronic disease patients in Song County of Henan Province to evaluate their sense of acquisition in primary health services.Results The statistical mean of 24 factors was placed in 4 quadrants,and no one item index could reach a very high level of sense of acquisition.There were two indicators in the higher level of the sense of acquisition,which were located in the"over-performance"area.There were 13 indicators in the general level of the sense of acquisition,2 indicators were located in the"slow improvement"area,3 indicators were located in the"excessive performance"area,and 8 indicators were located in the"maintain advantage"area.There were 6 indicators in the lower level of the sense of acquisition,2 indicators were located in the"key focus"area,and 4 indicators were located in the"slow improvement"area.There were three indicators in the very low level of the sense of acquisition,two indicators were located in the"slow improvement"area,and one indicator was located in the"key focus"area.The total average score of service perception(1-5 points for"very low to very high")for 671 chronic disease patients in Song County of Henan Province was(3.74±0.63)points,and the overall service perception was at the upper-middle level.The scores of each dimension from high to low were empathy[(3.86±0.73)points],responsiveness[(3.8±0.7)points],reliability[(3.77±0.66)points],assurance[(3.66±0.71)points],and tangibility[(3.6±0.67)points].The total average score of service expectation was(4.11±0.54)points,which was higher than the score of service perception.The total average score of service acquisition was(-0.36±0.6)points,but the perception did not reach the expected level.The smallest difference was in empathy[(-0.32±0.71)points],and the largest difference was in assurance[(-0.43±0.67)points].Conclusion The internal environment of primary health service institutions is poor,the technical level of medical staff is relatively low,and the opinions and suggestions of patients are not taken seriously.There is a big gap with the expectations of patients,and the patients sense of acquisition is very low.The shortage of professional and technical personnel in primary health service institutions,the overall quality of medical staff is not high,the workload is large,which reduces the satisfaction and sense of acquisition of patients.Patients'expectations and satisfaction with medical examination equipment and basic drugs are low,which reduces patients'sense of acquisition.