Westaway M S, Rheeder P, van Zyl D G, Seager J R
Clinical Epidemiology Unit, Faculty of Health Sciences, University of Pretoria.
Curationis. 2002 Aug;25(3):68-75. doi: 10.4102/curationis.v25i3.789.
Although there is general agreement that patient satisfaction is an integral component of service quality, there is a paucity of South African research on reliable and valid satisfaction measures and the effects of health status on satisfaction. A 25-item patient satisfaction scale was developed and tested for evaluating the quality of health care for black diabetic outpatients. It was hypothesised that: (1) the underlying dimensions of patient satisfaction were interpersonal and organisational; and (2) patients in poor health would be less satisfied with the quality of their care than patients in good health. The questionnaire was administered to 263 black outpatients from Pretoria Academic Hospital and Kalafong Hospital. Factor analysis was conducted on the patient satisfaction scale and three factors, accounting for 71% of the variance, were extracted. The major items on Factor I were helpfulness, communication, support and consideration, representing the interpersonal dimension. Factors II and III were mainly concerned with service logistics and technical expertise, with the emphasis on waiting time, follow-up and thoroughness of examination. The three factors had excellent reliability coefficients, ranging between 0.82 (technical), 0.85 (logistics) and 0.98 (interpersonal). Multiple analyses of co-variance showed that patients in poor general health were significantly less satisfied with the logistical (p = 0.004) and technical (p = 0.007) quality of their care than patients in good health; patients in poor mental health were significantly less satisfied with the interpersonal quality of their care (p = 0.05) than patients in good mental health. These findings provided support for both hypotheses and suggested that patients in poor health attend to different aspects of their care than patients in good health. Of more importance to clinical practice, the results endorsed the need for a multidisciplinary health team comprising nurse/social worker (Factor I: support, communication), health service managers (Factor II: service logistics) and physician (Factor III: technical expertise) to enhance treatment outcome for diabetic patients. It is recommended that: (1) further research is conducted on this patient satisfaction scale with diverse populations in different settings to complement and validate the scale for generalised use in South Africa; (2) the scale is used to collect information on patient satisfaction before and after implementing an intervention to improve the quality of health care, and (3) measurement of health status is an essential adjunct to assessment of patient satisfaction.
尽管人们普遍认为患者满意度是服务质量的一个重要组成部分，但南非在可靠且有效的满意度测量以及健康状况对满意度的影响方面的研究却很少。为评估黑人糖尿病门诊患者的医疗保健质量，开发并测试了一个包含25个条目的患者满意度量表。研究假设如下：（1）患者满意度的潜在维度是人际方面和组织方面；（2）健康状况较差的患者对其医疗质量的满意度低于健康状况良好的患者。该问卷被发放给了比勒陀利亚学术医院和卡拉方医院的263名黑人门诊患者。对患者满意度量表进行了因子分析，提取了占方差71%的三个因子。因子I上的主要项目是帮助性、沟通、支持和体贴，代表人际维度。因子II和III主要涉及服务后勤和技术专长，重点是等待时间、随访和检查的彻底性。这三个因子具有出色的信度系数，范围在0.82（技术方面）、0.85（后勤方面）和0.98（人际方面）之间。多元协方差分析表明，总体健康状况较差的患者对其医疗后勤质量（p = 0.004）和技术质量（p = 0.007）的满意度明显低于健康状况良好的患者；心理健康状况较差的患者对其医疗人际质量的满意度（p = 0.05）明显低于心理健康状况良好的患者。这些发现为两个假设都提供了支持，并表明健康状况较差的患者关注其医疗护理的不同方面，与健康状况良好的患者不同。对临床实践更重要的是，结果认可了需要一个多学科健康团队，包括护士/社会工作者（因子I：支持、沟通）、卫生服务管理者（因子II：服务后勤）和医生（因子III：技术专长），以提高糖尿病患者的治疗效果。建议如下：（1）针对不同环境中的不同人群对该患者满意度量表进行进一步研究，以补充和验证该量表，以便在南非广泛使用；（2）在实施提高医疗保健质量的干预措施之前和之后，使用该量表收集患者满意度信息；（3）健康状况测量是评估患者满意度的重要辅助手段。
