Al-Azmi Saadoun F, Mohammed Aida M, Hanafi Manal I
Medical Record Department, Collage of Health Sciences, Kuwait.
J Egypt Public Health Assoc. 2006;81(5-6):277-300.
This study aimed at assessing the level of patients' satisfaction with primary heath care services after implementation of the electronic medical record system (EMR). Also, to explore the relationship of some participants' characteristics with satisfaction which are of importance in planning, managing and evaluation. A descriptive cross-sectional approach was adopted. Ten primary health care centers (out of total 78) related to the five health regions in Kuwait were randomly selected. A random sample of 200 people (at age of 18 years and above) attending the two-shift periods of the chosen centers were included. Through an exit interview, a well trained investigator interviewed them about their satisfaction with the primary heath care services provided after implementation of electronic medical record system. A structured questionnaire for measuring satisfaction was used. The response rate was 93.02% of whom 47.5% were males and 52.5% were females. The mean overall satisfaction percent score as reported by subjects was 85.6% (SD 4.9). There were statistically significant associations between mean percent satisfaction score of the participants and their age, level of education visiting the center at morning shift, and waiting less than 10 minutes before the examination. The vast majority of participants indicated that overall service at the center had greatly improved after EMR implementation. The system also helped in improvement of the physician performance, arrangement of patient's turn, dispense medication from pharmacy, written guidance of medication, accuracy and easiness of follow up for health status, time spent to retrieve medical record and that for receiving medication. However, it didn't achieve much improvement in physician selection or waiting time. The majority of interviewees (96.5%) were totally satisfied with the overall quality of service at the center, location of the center (96.5%), hours when the center is open (96.5%), thoroughness of examination and accuracy of diagnosis (97.0%), advices to avoid illness (96.0%) and outcome of medical care (97.0%). However, the lowest items of satisfaction were those related to explanation of medical procedures and tests (46.5%) and ease of seeing physician of choice (61.0%). Almost 62.0% of the interviewed persons expressed their satisfaction with overall PHC service provided after EMR implementation. The leading two items of dissatisfaction that showed by the majority of dissatisfied participants were non-compliance of physician with good practice in prescription writing (75.0%) and inability to see the same physician in every visit (72.4%). The results showed that although the overall satisfaction was relatively high, certain aspects of the service showed some degree of dissatisfaction. This study demonstrated patient acceptance and support for the electronic medical record system at the primary care setting. These findings should encourage physicians to promote the use of electronic medical record system.
本研究旨在评估电子病历系统（EMR）实施后患者对初级卫生保健服务的满意度水平。此外，探讨一些参与者特征与满意度之间的关系，这在规划、管理和评估中具有重要意义。采用了描述性横断面研究方法。从科威特五个卫生区域的78个初级卫生保健中心中随机选取了10个。纳入了在所选中心两班制期间就诊的200名年龄在18岁及以上的随机样本。通过出院访谈，一名训练有素的调查员就他们对电子病历系统实施后提供的初级卫生保健服务的满意度对他们进行了询问。使用了一份用于测量满意度的结构化问卷。回复率为93.02%，其中47.5%为男性，52.5%为女性。受试者报告的总体平均满意度百分比得分为85.6%（标准差4.9）。参与者的平均满意度百分比得分与他们的年龄、上午班次到中心就诊的教育水平以及检查前等待时间少于10分钟之间存在统计学上的显著关联。绝大多数参与者表示，电子病历系统实施后中心的整体服务有了很大改善。该系统还有助于提高医生的绩效、安排患者就诊顺序、从药房配药、提供用药书面指导、健康状况随访的准确性和便捷性、检索病历的时间以及取药时间。然而，在医生选择或等待时间方面没有取得太大改善。大多数受访者（96.5%）对中心的整体服务质量、中心位置（96.5%）、中心开放时间（96.5%）、检查的彻底性和诊断的准确性（97.0%）、预防疾病的建议（96.0%）以及医疗护理结果（97.0%）完全满意。然而，满意度最低的项目是与医疗程序和检查解释相关的项目（46.5%）以及选择的医生就诊便捷性（61.0%）。近62.0%的受访者对电子病历系统实施后提供的整体初级卫生保健服务表示满意。大多数不满意的参与者表示的两大不满项目是医生在处方书写方面不符合良好规范（75.0%）以及每次就诊无法见到同一位医生（72.4%）。结果表明，尽管总体满意度相对较高，但服务的某些方面仍存在一定程度的不满。本研究证明了患者在初级保健环境中对电子病历系统的接受和支持。这些发现应鼓励医生推广电子病历系统的使用。
