Factors Affecting Patient Satisfaction with Community Health Service under the Gatekeeper System:A Cross-sectional Study in Nanjing,China

The gatekeeper policy has been implemented for approximately ten years on a pilot population in China. It is necessary to assess the satisfaction of patients utilizing community health service（CHS） under the gatekeeper system. Our study showed that the cognition of gatekeeper policy was associated with four dimensions including doctor‐patient relationships, information and support, organization of care, and accessibility（P 〈 0.001）. One or more factors such as gender and self‐perceived health scores also affected their satisfaction. General practitioners must be prepared to focus on these aspects of information and support, organization of care, and accessibility as indicators of potential opportunities for improvement. Additionally, policymakers can improve patients＇ satisfaction with CHS by strengthening their awareness of the gatekeeper policy.

Comprehensive reform of community health service in east,middle and west regions of China:from patients’perspective

Objectives:To analyze the satisfaction of patients with community health service(CHS)and the changes of the CHS delivered before and after the new health reform in different regions of China,and to put forward relevant policy recommendations for CHS development.Methods:Twelve community health centers were selected by random sampling in each of the eight typical cities in the east,middle and west regions of China.Questionnaire survey was conducted among patients visiting these institutions during daily work hours.Results:The proportions of the participants who stated that the medical environment,service attitude and medical skills of the doctors were improved were higher in the west region than those of the east and middle regions;but the percentage of patients who held that the drug price had lowered was higher in the east region than those of the middle and west region,the differences were of statistical significance(P<0.0125).The patients’satisfaction rates with medical environment,service attitude,and technical skills of the medical staff in the west region were 88.9%,91.5%and 81.6%respectively,which were higher than those in the east and middle regions.In the east region,the satisfaction rate with the reimbursement for this visit was 58.5%,which was highest among the three regions;in the west region,patients’satisfaction rates with drug types and preventive care were 51.5%and 65.9%,respectively,which was significantly higher than those in the east and middle regions(P<0.0125).As recommended by the participants,the top three aspects of health services that need to be improved were drug type and quality(25.3%),drug prices(21.8%)and technical skills(18.2%)in the east region;infrastructure(28.2%),drug prices(21.8%)and drug types and quality(21.2%)in the middle region;infrastructure(30.8%),drug types and quality(28.1%)and reimbursement(27.9%)in the west region.Conclusions:The comprehensive CHS reform should take the opinions of patients into account;essential drug system should be consolidated continually;and the reform of the payment system should be promoted by actively cooperating with the health insurance organizations.

以全科医疗服务模式为导向的病人满意度调查

为了评价北京市方庄第一医院的社区卫生服务,用全科医疗服务模式为导向的调查问卷,于1995年和1999年对该院的门诊病人进行了两次内容相似的满意度调查。结果显示,由于全科医学模式的引入,该院的总体病人满意度,在几年内获得大幅度提高;自费患者对服务内容和质量的期望明显高于他人付费者。而调查者为建立一套全面、灵敏而特异的病人满意度指标体系的努力,亦取得了初步的效果。

上海市不同类型医院患者生活满意度影响差异分析

目的:比较上海市不同类型医院患者生活满意度影响程度的差异。方法:建立有序Probit模型,对来自公立医院(一级、二级和三级)和民营医院的1310名门诊患者进行回归分析。结果:患者满意度、医疗质量感知和患者信任对患者生活满意度有显著性影响,且在不同类型医院的影响程度不同。公立医院级别越高,患者满意度的影响程度越高;公立医院医院级别越低,技术质量感知、环境质量感知和管理质量感知的影响程度则越高;公立医院级别越高,人际质量感知的影响程度则越高;公立医院级别越低,反应性信任、技术能力信任和诊疗质量的影响程度则越高;级别越高,仁爱信任和沟通能力信任的影响程度则越高。不论公立医院还是私立医院,患者信任中的整体信任维度对患者生活满意度均无显著影响作用。结论:可以针对不同类型医院采取提高患者生活满意度的具体措施提供具体方向性指导。

基于有序PROBIT模型的患者生活满意度的实证研究

目的 :研究上海市门诊患者生活满意度的影响因素,为提高患者生活满意度提供操作参考。方法 :运用文献研究确定影响患者生活满意度的相关因素,通过问卷调查收集实证数据,运用有序PROBIT模型对影响因素进行分析。结果 :医疗服务满意度、患者医疗质量感知以及患者信任是患者生活满意度的影响因素,其影响效果具有显著性。结论 :改进我国医疗卫生服务质量,增强患者医疗服务满意度和信任度能够提高患者生活满意度,而提高患者生活满意度对改善医患关系、促进我国医疗卫生事业的发展具有十分重要的意义。

基于Kano模型对湖北省某口腔医院门诊患者服务需求调查分析

目的调查湖北省某口腔医院门诊患者的服务需求,提高患者满意度和医院的服务质量。方法采用问卷调查法,自行设计问卷,便利抽样法抽取湖北省某口腔医院门诊620例患者,并用Kano分析技术深层次探究医院服务的优势项目和薄弱项目,为医院改善服务质量提供参考依据。结果满意影响力系数(SI)值的服务项目中排名前3的依次是:口腔治疗过程的舒适度(0.92)、候诊时间(0.91)、口腔检查时的仔细程度(0.89)、诊疗操作时的服务态度(0.89)、导医服务态度(0.89)、预约系统(0.89);不满意影响力系数(DSI)绝对分值的服务项目中排名前3的依次是:口腔检查时的仔细程度(-0.88)、医生的诊疗建议(-0.86)和治疗效果(-0.83)。矩阵分析结果显示医院在目前的服务态度上基本达到患者的要求,医院应努力将这些优势发展为医院的竞争优势,而医院的便捷服务(就医指南,收费项目透明度,收费价格,候诊时间,预约系统,叫号服务)有待完善。结论口腔医院门诊在服务态度和诊疗技术方面具有较大优势,需要继续保持。而在收费项目的透明度、收费价格、候诊时间、预约系统等方面需要医院大力举措,重点改进。