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医疗保健中预约类型与患者报告的体验指标之间的关联:一项基于人群的调查研究。

The association of appointment type in healthcare with patient reported experience measures: a population-based survey study.

作者信息

Heponiemi Tarja, Kainiemi Emma, Virtanen Lotta, Vehko Tuulikki, Aalto Anna-Mari

机构信息

Finnish Institute for Health and Welfare, P.O. Box 30, Helsinki, 00271, Finland.

出版信息

BMC Health Serv Res. 2025 May 20;25(1):726. doi: 10.1186/s12913-025-12869-5.

Abstract

BACKGROUND

Poor access to healthcare and long waiting times are severe challenges in many countries and therefore countries have increasingly adopted teleconsultations such as video, messaging, and phone calls. Patient-reported experience measures (PREMs) assess the quality of care based on patients' insights covering topics like the quality of communication, patient participation, and adequacy of time allocation of the appointment. The present study examined whether the type of appointment (in-person, by phone call or via digital services), service sector, and encountered health professional were associated with patients' experience of appointment quality in healthcare.

METHODS

The data from the population-based cross-sectional Healthy Finland Survey conducted from September 2022 to February 2023 including 22 665 respondents (53% women) were used. Complex samples logistic regression analyses were used to examine the associations of the independent variables (type of appointment, the service sector and encountered healthcare professional) with PREMs (sufficient time allocation, opportunity to ask questions, active participation, and responsiveness to needs) adjusted for self-rated health, age, sex, and urbanization status.

RESULTS

Those whose appointment was conducted by phone call had greater odds of not agreeing that enough time was allocated (OR = 1.57, 95%CI = 1.36-1.81), opportunity to ask was offered (OR = 1.28, 95%CI = 1.10-1.50), active participation possibilities were given (OR = 1.33, 95%CI = 1.15-1.54-), and their needs were met (OR = 1.39, 95%CI = 1.20-1.60) compared to in-person appointments. Those whose appointment was conducted by digital services had greater odds of not agreeing that enough time was allocated (OR = 1.51, 95%CI = 1.21-1.88) and opportunity to ask was offered (OR = 1.38, 95%CI = 1.07-1.78) compared to in-person appointments. Moreover, respondents had greater odds of disagreeing with PREM statements in health centers and when encountering physicians compared to their counterparts.

CONCLUSIONS

It seems that teleconsultations do not allocate enough time, offer opportunity to ask, give possibility to active participation, and meet patients' needs similarly as in-person appointments. Especially appointments conducted by phone call differed negatively from in-person visits regarding all these aspects. Our findings should be kept in mind when planning and developing teleconsultations. Teleconsultations may be a good option in many cases, but not for all patients or for all situations. Moreover, physicians and health centers should adopt means to improve time allocation, patient participation, and responsiveness to patients' needs.

摘要

背景

在许多国家,获得医疗服务的机会有限和等待时间过长是严峻的挑战,因此各国越来越多地采用远程会诊,如视频、信息传递和电话会诊。患者报告体验指标(PREMs)基于患者的见解评估医疗服务质量,涵盖沟通质量、患者参与度和预约时间分配是否充足等主题。本研究调查了预约类型(面对面、电话或通过数字服务)、服务部门以及遇到的医疗专业人员是否与患者对医疗预约质量的体验相关。

方法

使用了2022年9月至2023年2月进行的基于人群的横断面芬兰健康调查的数据,包括22665名受访者(53%为女性)。采用复杂样本逻辑回归分析来检验自变量(预约类型、服务部门和遇到的医疗专业人员)与经过自我评估的健康状况、年龄、性别和城市化状况调整后的患者报告体验指标(充足的时间分配、提问机会、积极参与和对需求的响应)之间的关联。

结果

与面对面预约相比,通过电话进行预约的患者不太可能同意有足够的时间分配(比值比[OR]=1.57,95%置信区间[CI]=1.36-1.81)、有提问机会(OR=1.28,95%CI=1.10-1.50)以及有积极参与的可能性(OR=1.33,95%CI=1.15-1.54),并且不太可能认为他们的需求得到了满足(OR=1.39,95%CI=1.20-1.60)。与面对面预约相比,通过数字服务进行预约的患者不太可能同意有足够的时间分配(OR=1.51,95%CI=1.21-1.88)和有提问机会(OR=1.38,95%CI=1.07-1.78)。此外,与其他情况相比,受访者在健康中心就诊以及遇到医生时,更有可能不同意患者报告体验指标的陈述。

结论

远程会诊似乎没有像面对面预约那样分配足够的时间、提供提问机会、给予积极参与的可能性以及满足患者的需求。特别是通过电话进行的预约在所有这些方面与面对面就诊相比存在负面差异。在规划和发展远程会诊时应牢记我们的研究结果。远程会诊在许多情况下可能是一个不错的选择,但并非适用于所有患者或所有情况。此外,医生和健康中心应采取措施来改善时间分配、患者参与度以及对患者需求的响应。

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