College of General Education, Hungkuang University, Taichung County, Taiwan.
Med Care. 2010 Jul;48(7):628-34. doi: 10.1097/MLR.0b013e3181dbdf76.
This study used a recent patient survey to examine the relationship between having a usual source of care (USC) and the quality of ambulatory medical care experiences in Taiwan, where there is universal health insurance coverage.
RESEARCH DESIGN, SUBJECTS, AND MEASURES: The study design was a cross-sectional survey of 879 patients in Taichung County, Taiwan. Children and adults visiting hospital-based physicians were included. Quality of care was measured using items from the Primary Care Assessment Tool (PCAT), representing 7 ambulatory medical care domains: first contact (ie, access and utilization), longitudinality (ie, ongoing care), coordination (ie, referrals and information systems), comprehensiveness (ie, services available and provided), family centeredness, community orientation, and cultural competence. USC was defined based on responses to 3 survey items from the PCAT.
Having a USC was significantly associated with higher quality of medical care experiences. Specifically, having a USC was associated with improved accessibility and utilization, ongoing care, coordination of referrals, and healthcare providers' family centeredness and cultural competence. However, having a USC was not strongly related with comprehensiveness of services, coordination of information systems, or healthcare providers' community orientation.
In a region with universal health insurance, patients with a USC reported higher quality of medical care experiences compared with those without a USC. Beyond the provision of health insurance coverage, efforts to improve quality of care should include policies promoting USC.
本研究利用最近的患者调查，考察了在台湾（拥有全民健康保险覆盖），与是否拥有常规医疗服务（USC）与门诊医疗服务体验质量之间的关系。
研究设计、对象和方法：本研究是对台湾台中市 879 名患者的横断面调查。包括了儿科和成人患者，他们是在医院就诊的。使用初级保健评估工具（PCAT）中的项目来衡量医疗质量，该工具代表了 7 个门诊医疗保健领域：第一接触（即，获取和使用）、纵向（即，持续护理）、协调性（即，转介和信息系统）、综合性（即，提供和提供的服务）、以家庭为中心、社区导向和文化能力。USC 是基于 PCAT 中的 3 个调查项目的回答来定义的。
拥有 USC 与更高的医疗服务体验质量显著相关。具体而言，拥有 USC 与改善可及性和利用率、持续护理、转诊协调以及医疗服务提供者的以家庭为中心和文化能力相关。然而，拥有 USC 与服务的综合性、信息系统的协调性或医疗服务提供者的社区导向并没有很强的相关性。
在拥有全民健康保险的地区，与没有 USC 的患者相比，拥有 USC 的患者报告的医疗服务体验质量更高。除了提供健康保险覆盖范围外，改善医疗服务质量的努力还应包括促进 USC 的政策。
