Kijima Tsunetaka, Matsushita Akira, Akai Kenju, Hamano Tsuyoshi, Takahashi Satoshi, Fujiwara Kazushige, Fujiwara Yuko, Sato Makoto, Nabika Toru, Sundquist Kristina, Sundquist Jan, Ishibashi Yutaka, Kumakura Shunichi
Department of General Medicine, Faculty of Medicine, Shimane University, 89-1, Enya-cho, Izumo-shi, Shimane, 693-8501, Japan.
Nagi Family Clinic, Tsuyama Family Clinic, Yunogou Family Clinic, Family Practice Centre of Okayama, 292-1, Toyosawa, Nagi-cho, Katsuta-gun, Okayama, 708-1323, Japan.
BMC Health Serv Res. 2021 Mar 25;21(1):274. doi: 10.1186/s12913-021-06276-9.
This study aimed to explore associations between various elements of primary care, patient satisfaction, and loyalty.
This cross-sectional study used a modified version of the Primary Care Assessment Tool (PCAT), which was adapted for Japan. We distributed the PCAT questionnaire to patients aged 20 years or older at five rural primary care centres in Japan. We confirmed the validity and reliability of the measure for our study. Next, we examined which elements of primary care were related to patient satisfaction and loyalty using Spearman's correlation and structural equation modelling.
Of 220 eligible patients, 206 participated in this study. We developed nine component scales: first contact (regular access), first contact (urgent access), longitudinality, coordination, comprehensiveness (variety of care), comprehensiveness (risk prevention), comprehensiveness (health promotion), family-centeredness, and community orientation. Longitudinality and first contact (urgent access) were related with patient satisfaction. Longitudinality, first contact (regular access), and family-centeredness were related to patient loyalty. In the structural equation modelling analysis, two variables were significantly related to loyalty, namely a combined variable including longitudinality and first contact (regular access), along with family-centeredness.
While a patient satisfaction model could not be distilled from the data, longitudinality, first contact (urgent access), and family-centeredness were identified as important elements for the cultivation of patient loyalty. This implies that primary care providers need to develop a deep understanding of patients' contexts and concerns and pay attention to their level of access to cultivate greater patient loyalty.
本研究旨在探讨初级保健的各个要素、患者满意度和忠诚度之间的关联。
这项横断面研究使用了初级保健评估工具（PCAT）的一个修改版本，该版本是针对日本进行调整的。我们向日本五个农村初级保健中心20岁及以上的患者发放了PCAT问卷。我们确认了该测量方法在我们研究中的有效性和可靠性。接下来，我们使用Spearman相关性分析和结构方程模型来研究初级保健的哪些要素与患者满意度和忠诚度相关。
在220名符合条件的患者中，206名参与了本研究。我们开发了九个分量表：首次接触（常规就诊）、首次接触（紧急就诊）、连续性、协调性、全面性（护理种类）、全面性（风险预防）、全面性（健康促进）、以家庭为中心和社区导向。连续性和首次接触（紧急就诊）与患者满意度相关。连续性、首次接触（常规就诊）和以家庭为中心与患者忠诚度相关。在结构方程模型分析中，有两个变量与忠诚度显著相关，即一个包含连续性和首次接触（常规就诊）的组合变量以及以家庭为中心。
虽然无法从数据中提炼出患者满意度模型，但连续性、首次接触（紧急就诊）和以家庭为中心被确定为培养患者忠诚度的重要要素。这意味着初级保健提供者需要深入了解患者的背景和关注点，并关注他们的就诊机会，以培养更高的患者忠诚度。
