Department of Biostatistics, Harvard T.H. Chan School of Public Health, 655 Huntington Ave., Building 2, Boston, MA, USA.
Ifakara Health Institute, Dar es Salaam, Tanzania.
Health Policy Plan. 2019 Sep 1;34(7):508-513. doi: 10.1093/heapol/czz071.
Knowing how patients are treated in care is foundational for creating patient-centred, high-quality health systems and identifying areas where policies and practices need to adapt to improve patient care. However, little is known about the prevalence of disrespectful treatment of patients in sub-Saharan Africa outside of maternity care. We used data from a household survey of 2002 women living in rural Tanzania to describe the extent of disrespectful care during outpatient visits, who receive disrespectful care, and determine the association with patient satisfaction, rating of quality and recommendation of the facility to others. We asked about women's most recent outpatient visit to the local clinic, including if they were made to feel disrespected, if a provider shouted at or scolded them, and if providers made negative or disparaging comments about them. Women who answered yes to any of these questions were considered to have experienced disrespectful care. We report risk ratios with standard errors clustered at the facility level. The most common reasons for seeking care were fever or malaria (33.9%), vaccination (33.6%) and non-emergent check-up (13.4%). Disrespectful care was reported by 14.3% of women and was more likely if the visit was for sickness compared to a routine check-up [risk ratio (RR): 1.6, 95% confidence interval (CI): 1.1-2.2]. Women who did not report disrespectful care were 2.1 times as likely to recommend the clinic (95% CI: 1.6-2.7). While there is currently a lot of attention on disrespectful maternity care, our results suggest that this is a problem that goes beyond this single health issue and should be addressed by more horizontal health system interventions and policies.
了解患者在医疗护理中的待遇是创建以患者为中心、高质量卫生系统的基础，也是确定需要调整政策和实践以改善患者护理的领域的基础。然而，除了产妇保健之外，人们对撒哈拉以南非洲地区患者受到不尊重待遇的普遍程度知之甚少。我们使用了来自坦桑尼亚农村地区 2002 名妇女的家庭调查数据，描述了门诊就诊期间不尊重护理的程度、谁接受了不尊重护理，并确定了与患者满意度、服务质量评分和向他人推荐该医疗机构的关联。我们询问了女性最近一次到当地诊所的门诊就诊情况，包括她们是否感到不受尊重、是否有医护人员对她们大喊大叫或辱骂、医护人员是否对她们发表负面或贬低的评论。如果女性对这些问题中的任何一个回答“是”，则认为她们经历了不尊重护理。我们报告了在医疗机构层面聚类的风险比及其标准误差。寻求护理的最常见原因是发烧或疟疾（33.9%）、接种疫苗（33.6%）和非紧急检查（13.4%）。14.3%的女性报告了不尊重护理，如果就诊是因为疾病而不是常规检查，则更有可能发生不尊重护理[风险比（RR）：1.6，95%置信区间（CI）：1.1-2.2]。未报告不尊重护理的女性推荐该诊所的可能性是其 2.1 倍（95%CI：1.6-2.7）。虽然目前人们非常关注不尊重产妇护理的问题，但我们的研究结果表明，这不仅是一个单一的卫生问题，还应该通过更多横向的卫生系统干预和政策来解决。
