Nordin Noorfariza, Hairon Suhaily Mohd, Yaacob Najib Majdi, Hamid Anees Abdul, Isa Seoparjoo Azmel Mohd, Hassan Norzaihan
Department of Community Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia.
Unit of Biostatistics and Research Methodology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia.
BMC Public Health. 2021 Feb 2;21(1):268. doi: 10.1186/s12889-021-10320-y.
People with type 2 diabetes mellitus (T2DM) are best managed by a chronic care model that is associated with enhanced quality of care and improved patient outcome. Assessing patients' perceived quality of care is crucial in improving the healthcare delivery system. Hence, this study determined the perceived quality of care among people with T2DM and explored its associations with (i) sociodemographic and clinical characteristics and (ii) types of healthcare clinics to guide future planning.
A cross-sectional study involving 20 primary healthcare clinics in the North East Region of Peninsular Malaysia and people with T2DM as the sampling unit was conducted from February to May 2019. The pro forma checklist, interview-guided Skala Kepuasan Interaksi Perubatan-11, and Patient Assessment of Chronic Illness Care (Malay version; PACIC-M) questionnaire were used for data collection. Univariate analysis and linear regression were used to determine the status of perceived quality of care and the factors associated with the perceived quality of care, respectively.
Overall, data from 772 participants were analyzed. The majority was from the Malay ethnic group (95.6%) with a mean (standard deviation [SD]) glycated hemoglobin A1c (HbA1c) level of 8.91% (2.30). The median (interquartile range [IQR]) of the number of medical officers available at each clinic was 6 (7), with Family Doctor Concept (FDC) clinics having a higher number of medical officers than non-FDC clinics (p = 0.001). The overall mean (SD) PACIC-M score was 2.65 (0.54) with no significant difference between scores of patients treated in the two clinic types (p = 0.806). Higher perceived quality of care was associated with lower number of medical officers (adjusted regression coefficient [Adj.β], - 0.021; p-value [p], 0.001), and greater doctor-patient interaction in all domains: distress relief (Adj.β, 0.033; p, < 0.001), rapport (Adj.β, 0.056; p, < 0.001), and interaction outcome (Adj.β, 0.022; p, 0.003).
Although there was no significant difference found between clinic type, this study reflects that patients are comfortable when managed by the same doctor, which may support a better doctor-patient interaction. A larger specialized primary care workforce could improve diabetes care in Malaysia.
2型糖尿病（T2DM）患者最好通过慢性护理模式进行管理，该模式与更高的护理质量和更好的患者预后相关。评估患者对护理质量的感知对于改善医疗服务提供系统至关重要。因此，本研究确定了T2DM患者对护理质量的感知，并探讨了其与（i）社会人口学和临床特征以及（ii）医疗诊所类型之间的关联，以指导未来规划。
2019年2月至5月，在马来西亚半岛东北部的20家初级医疗诊所开展了一项横断面研究，以T2DM患者作为抽样单位。使用预先设计的检查表、访谈引导式的《医疗互动满意度量表-11》以及《慢性病护理患者评估》（马来语版；PACIC-M）问卷进行数据收集。分别采用单因素分析和线性回归来确定护理质量感知状况以及与护理质量感知相关的因素。
总体而言，对772名参与者的数据进行了分析。大多数参与者为马来族（95.6%），糖化血红蛋白A1c（HbA1c）平均（标准差[SD]）水平为8.91%（2.30）。每家诊所的医务人员数量中位数（四分位间距[IQR]）为6（7），家庭医生概念（FDC）诊所的医务人员数量多于非FDC诊所（p = 0.001）。PACIC-M总体平均（SD）得分为2.65（0.54），两种诊所类型的患者得分之间无显著差异（p = 0.806）。更高的护理质量感知与更少的医务人员数量相关（调整回归系数[Adj.β]，-0.021；p值[p]，0.001），并且在所有领域中医生与患者的互动更强：缓解痛苦（Adj.β，0.033；p值 < 0.001）、融洽关系（Adj.β，0.056；p值 < 0.001）和互动结果（Adj.β，0.022；p值，0.003）。
尽管诊所类型之间未发现显著差异，但本研究反映出患者由同一位医生管理时会感到舒适，这可能有助于更好的医患互动。规模更大的专业初级护理人员队伍可能会改善马来西亚的糖尿病护理。
