Harmsen J A M, Bernsen R M D, Bruijnzeels M A, Meeuwesen L
Department of General Practice, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
Patient Educ Couns. 2008 Jul;72(1):155-62. doi: 10.1016/j.pec.2008.03.018. Epub 2008 May 15.
Increased migration implies increased contacts for physicians with patients from diverse cultural backgrounds who have different expectations about healthcare. How satisfied are immigrant patients, and how do they perceive the quality of care? This study investigated which patient characteristics (such as cultural views and language proficiency) are related to patients' satisfaction and perceived quality of care.
Patients (n=663) from 38 general practices in Rotterdam (The Netherlands) were interviewed. General satisfaction with the general practitioner (GP) was measured by a report mark. Perceived quality of care was measured using the 'Quote-mi' scale (quality of care through the patient's eyes-for migrants), which contains an ethnic-specific subscale and a communication process subscale. Using multilevel regression techniques, the relation between patient characteristics (ethnicity, age, education, Dutch language proficiency, cultural views) and satisfaction and perceived quality of care was analysed.
In general, patients seemed fairly satisfied. Non-Western patients perceived less quality of care and were less satisfied than Dutch-born patients. The older the patients and the more modern cultural views they had, the more satisfied they were about the GP in general, as well as about the communication process. However, non-Western patients holding more modern views were the most critical regarding the ethnic-specific quality items. The poorer patients' Dutch language proficiency, the more negative they were about the communication process.
It is concluded that next to communication aspects, especially when the patient's proficiency in Dutch is poor, physician awareness about the patient's cultural views is very important during the consultation. This holds especially true when the immigrant patient seems to be more or less acculturated.
Medical students and physicians should be trained to become aware of the relevance of patients' different cultural backgrounds. It is also recommended to offer facilities to bridge the language barrier, by making use of interpreters or cultural mediators.
移民数量增加意味着医生与来自不同文化背景、对医疗保健有不同期望的患者之间的接触增多。移民患者的满意度如何，他们如何看待医疗质量？本研究调查了哪些患者特征（如文化观念和语言能力）与患者的满意度及感知的医疗质量相关。
对荷兰鹿特丹38家普通诊所的663名患者进行了访谈。通过报告评分来衡量对全科医生（GP）的总体满意度。使用“Quote-mi”量表（从患者角度看移民的医疗质量）来衡量感知的医疗质量，该量表包含一个特定种族子量表和一个沟通过程子量表。运用多水平回归技术，分析患者特征（种族、年龄、教育程度、荷兰语能力、文化观念）与满意度及感知的医疗质量之间的关系。
总体而言，患者似乎相当满意。非西方患者感知到的医疗质量较低，且不如在荷兰出生的患者满意。患者年龄越大，文化观念越现代，他们对全科医生以及沟通过程就越满意。然而，持有更现代观念的非西方患者对特定种族质量项目最为挑剔。患者的荷兰语能力越差，他们对沟通过程的评价就越负面。
得出结论认为除了沟通方面，尤其是当患者荷兰语能力较差时，在诊疗过程中医生对患者文化观念的认知非常重要。当移民患者似乎或多或少已经适应文化时，这一点尤其正确。
医学生和医生应接受培训，以意识到患者不同文化背景的相关性。还建议利用口译员或文化调解人提供设施来消除语言障碍。
