Otani Koichiro, Kurz Richard S, Harris Lisa E
School of Public and Environmental Affairs, Indiana University-Purdue University, Fort Wayne, Indiana, USA.
J Healthc Manag. 2005 Sep-Oct;50(5):311-24; discussion 324-5.
Our study aimed to identify which attributes of a primary healthcare experience have the most impact on patient satisfaction as well as which aspects of each attribute are most significant in patients' response to the services they receive. The three attributes examined in this study were access, staff care, and physician care. Analyses of the aspects of each attribute controlled for age, gender, and race. Data used in this study were obtained through a survey questionnaire with random sampling, resulting in the sample size of 8,465. The psychometric properties of the questionnaire were also examined and showed appropriate reliability and validity. The multiple regression analysis showed that among the three attributes, physician care was most influential, closely followed by staff care, with access having much less influence. Further analyses revealed that specific aspects of each attribute were more influential on patient satisfaction. Within the physician care attribute, patients were found to be rational consumers who were looking for surrogate indicators of correct diagnosis and treatment options among the measures available to them. They were much less likely to be influenced by so-called bedside manner. Within the staff care attribute, willingness and compassionate behaviors of staff and prompt service were most important. Within the access attribute, patients sought caring interaction with appointment personnel. After considering the findings, we discuss possible actions for healthcare managers.
我们的研究旨在确定初级医疗保健体验的哪些属性对患者满意度影响最大,以及每个属性的哪些方面在患者对所接受服务的反应中最为重要。本研究考察的三个属性是可及性、医护人员关怀和医生关怀。对每个属性的各个方面进行分析时控制了年龄、性别和种族因素。本研究使用的数据通过随机抽样的调查问卷获得,样本量为8465。还对问卷的心理测量特性进行了检验,结果显示具有适当的信度和效度。多元回归分析表明,在这三个属性中,医生关怀的影响最大,其次是医护人员关怀,可及性的影响则小得多。进一步分析发现,每个属性的具体方面对患者满意度的影响更大。在医生关怀属性方面,患者被发现是理性消费者,他们在自身可获取的衡量标准中寻找正确诊断和治疗方案的替代指标。他们受所谓“临床态度”的影响要小得多。在医护人员关怀属性方面,医护人员的意愿和同情行为以及迅速的服务最为重要。在可及性属性方面,患者寻求与预约人员进行关怀性互动。在考虑研究结果后,我们讨论了医疗保健管理者可能采取的行动。