Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland; Swiss Paraplegic Research, Nottwil, Switzerland.
Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland; Centre for Primary and Community Care, University of Lucerne, Lucerne, Switzerland.
Z Evid Fortbild Qual Gesundhwes. 2023 Apr;177:48-56. doi: 10.1016/j.zefq.2022.12.004. Epub 2023 Mar 22.
The primary objective of this study was to investigate the effect of having a general practitioner (GP) as a first point of contact for care on the satisfaction with care services in persons with spinal cord injury (SCI), and how this effect is related to socio-demographic and health-related factors.
This is a cross-sectional survey conducted within the framework of the Swiss Spinal Cord Injury Cohort Study Community Survey 2017. Outcome measures comprised three aspects of care (treatment with respect, understandability of explanations, and involvement in decision-making) and satisfaction with GP care and SCI centres. Information was grouped by first contact of care (GP or SCI specialist) and compared using the Mann-Whitney U test and logistic regression analysis.
Out of 3,959 invitees, 1,294 participants (33%) completed the survey. No significant association was found between the three aspects of care and the first contact of care. Persons who first contacted a GP and lived within a 10-minute travel distance to the GP practice were significantly less likely to be satisfied with their GP care (-5.7 percentage points, CI 95% = -10.7, -0.7), as compared to those living farther away. Persons who first contacted a GP rather than an SCI specialist were more likely to be satisfied with their GP care if married (7.1 percentage points, CI 95% = 1.4, 12.7), employed (6.6 percentage points, CI 95% = 0.9, 12.3), had a high social status (11.0 percentage points, CI 95% = 2.0, 20.1), or had tetraplegia (10.8 percentage points, CI 95% = 3.6, 18.1). For the same group, satisfaction with SCI centres was significantly higher in persons with good (10.1 percentage points, CI 95% = 0.1, 20.1) or very good health (8.2 percentage points, CI 95% = 1.0, 15.4), as compared to those with poor health.
The majority of participants were satisfied with the services offered by their first contact point for care, with variations due to factors endogenous to the participants. Socio-demographic and health-related factors should be integrated into health care planning strategies and improvement initiatives to ensure equitable access and better quality of health care services.
本研究的主要目的是调查将全科医生（GP）作为医疗服务的第一接触点对脊髓损伤（SCI）患者对医疗服务满意度的影响，以及这种影响与社会人口学和健康相关因素的关系。
这是一项在 2017 年瑞士脊髓损伤队列研究社区调查框架内进行的横断面调查。结果测量包括三个方面的护理（尊重治疗、解释易懂性和决策参与）和对全科医生护理和 SCI 中心的满意度。信息按护理的第一接触点（全科医生或 SCI 专家）分组，并使用曼-惠特尼 U 检验和逻辑回归分析进行比较。
在 3959 名受邀者中，有 1294 名参与者（33%）完成了调查。在护理的三个方面与第一接触点之间没有发现显著关联。与居住在距离全科医生实践 10 分钟车程以外的人相比，首次接触全科医生且居住在距离全科医生实践 10 分钟车程以内的人对他们的全科医生护理的满意度显著降低（低 5.7 个百分点，95%CI95%=−10.7，−0.7）。与首次接触 SCI 专家的人相比，首次接触全科医生的人如果已婚（高 7.1 个百分点，95%CI95%=1.4，12.7）、有工作（高 6.6 个百分点，95%CI95%=0.9，12.3）、社会地位较高（高 11.0 个百分点，95%CI95%=2.0，20.1）或患有四肢瘫痪（高 10.8 个百分点，95%CI95%=3.6，18.1），则对他们的全科医生护理更满意。对于同一组人群，如果健康状况良好（高 10.1 个百分点，95%CI95%=0.1，20.1）或非常好（高 8.2 个百分点，95%CI95%=1.0，15.4），则他们对 SCI 中心的满意度明显高于健康状况较差的人群。
大多数参与者对他们的第一接触点提供的服务感到满意，由于参与者自身的因素，满意度存在差异。社会人口学和健康相关因素应纳入医疗保健规划策略和改进举措中，以确保公平获得更好的医疗服务质量。
