Gleason Jessica L, Beck Kenneth H
Department of Behavioral and Community Health, University of Maryland School of Public Health, 2242 Valley Drive, College Park, MD 20742-2611.
Mil Med. 2017 May;182(5):e1657-e1664. doi: 10.7205/MILMED-D-16-00191.
The purpose of this study was to determine how frequent permanent change of station moves and turnover in primary care providers are associated with continuity of care and patient satisfaction in military spouses. These domains have been studied extensively in civilian populations, but this study seeks to begin filling a gap in the literature surrounding military spouses and their experiences with the military health system.
Spouses were recruited via social media to complete a brief online questionnaire to examine factors related to continuity of care and satisfaction with military health care. Results were analyzed using analysis of variance and χ tests, and through logistic regression.
Continuity of care scores were significantly lower as the number of moves and providers increased. Patient satisfaction was also significantly associated with continuity. In logistic regression analyses, patient-provider relationship and health status were the only significant predictors across two measures of patient satisfaction. Respondents with higher relationship scores were nearly two times more likely to report being satisfied than those with lower scores. Qualitative results indicated that the majority of dissatisfied spouses were unhappy with their military providers, which supported quantitative findings related to patient-provider relationship.
No studies have previously been conducted to determine why military health system beneficiaries are less satisfied with care than their civilian counterparts. Discontinuous care is an ongoing issue for military families, which can impact satisfaction and potentially lead to poorer health outcomes. Although the military culture may not allow for fewer relocations, these results indicate that taking steps to promote enduring, trusting relationships with primary care providers may improve patient satisfaction.
本研究的目的是确定基层医疗服务提供者的永久性换防调动和人员更替频率如何与军属的医疗连续性及患者满意度相关联。这些领域在平民群体中已得到广泛研究，但本研究旨在填补围绕军属及其在军事医疗系统经历的文献空白。
通过社交媒体招募军属，让他们完成一份简短的在线问卷，以调查与医疗连续性及对军事医疗保健满意度相关的因素。使用方差分析、χ检验以及逻辑回归对结果进行分析。
随着调动次数和医疗服务提供者数量的增加，医疗连续性得分显著降低。患者满意度也与连续性显著相关。在逻辑回归分析中，医患关系和健康状况是两项患者满意度衡量指标中仅有的显著预测因素。关系得分较高的受访者报告满意的可能性几乎是得分较低者的两倍。定性结果表明，大多数不满意的军属对其军事医疗服务提供者不满意，这支持了与医患关系相关的定量研究结果。
此前尚未有研究确定为何军事医疗系统的受益者对医疗服务的满意度低于平民。间断性医疗对军属家庭来说是一个持续存在的问题，这可能影响满意度，并可能导致更差的健康结果。尽管军事文化可能不允许减少调动，但这些结果表明，采取措施促进与基层医疗服务提供者建立持久、信任的关系可能会提高患者满意度。
