偏鄉地區衛生所復健醫療服務量與品質之研究

陳冠伯; 蘇弘慈; 李建輝; 李永恆; 陳峰毅; 林鴻; 段生輝

doi:10.6315/TJPMR.202112_49(2).0003

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P159 - 172

医药卫生 > 医药总论

DOI： 10.6315/TJPMR

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偏乡地区卫生所复健医疗服务量与品质之研究

Research of Medical Service Quantity and Quality of Rehabilitation in a Rural Public Health Center

陈冠伯(Guan-Bo Chen) ；苏弘慈(Hung-Tzu Su) ；李建辉(Chien-Hui Li) ；李永恒(Yung-Heng Lee) ；陈峰毅(Fung-Yi Chen) ；林鸿(Hong Lin) ；段生辉(Sheng-Hui Tuan)

台湾复健医学杂志； 49 卷 2 期 (2021 / 12 / 01) ， P159 - 172

繁体中文 DOI： 10.6315/TJPMR.202112_49(2).0003

PZB模式（PZB model）； SERVQUAL量表（SERVQUAL）；医疗服务品质（medical service quality）；病患满意度（patient satisfaction）；卫生所（public health center）； PZB model ； SERVQUAL ； medical service quality ； patient satisfaction ； public health center

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摘要 │ 参考文献 (30) │ 国际计量

摘要〈TOP〉

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Background: Liugui District, that locates in the rural Kaohsiung city, is defined as the area with insufficient medical resources by National Health Insurance. In 2017, service of rehabilitation was established in Liugui District with the help from Department of Health, Kaohsiung City Government. It's an innovative model by combining the private physical therapy clinic with public health center and it was the first one in Taiwan. The physical therapy clinic was run by a private therapist and it was set up in the Liugui public health center. The rehabilitation outpatient clinic service was provided by one physiatrist from Ci-Shan hospital (a rural public local hospital) every two weeks and the physical therapy was provided by one regular therapist who owns the physical therapy clinic daily. This government-civilian cooperation model serves patients not only in Liugui but also two indigenous district (Taoyuan and Maolin District). We aimed to evaluate the quantity and quality of rehabilitation service based on this novel cooperation model. in a rural local public hospital in southern Taiwan. Methods: The data for quantity was collected from January, 2018, to August, 2019. We applied questionnaire based on the concept of Parsuraman,- Zeithaml,- Berry (PZB) service quality gap model and expected zone of tolerance to determine the difference in the medical service quality between the expectations and satisfaction of patients and their caregivers who received rehabilitation in Liougui public health center. The questionnaire was a 30-item structured, modified from the 22- item SERVQUAL instrument, with high validity and reliability that compromised five dimensions: (1) tangible, (2) reliability, (3) responsiveness, (4) assurance, and (5) empathy. The questionnaire was given to patients or their caregivers, who took regular rehabilitation in Liougui public health center for more than one month, from August to September in 2019 during the rehabilitation clinic (by convenience sampling). The paired t- test was used to analyze the gap in service quality between the expectation and satisfaction scores. Results: In the aspect of quantity evaluation, the mean number of patients who took rehabilitation and who used rehabilitation clinic in Liougui public health center was 35.1 daily and 61.4 per time, respectively. The rehabilitation service included early intervention, physical therapy for orthopedic and neurologic diseases. Patients aged more than 65 years accounted for 52.3% of the total patients. The most two common diagnoses of them were degenerative joint disease of lumbar and cervical spine. In the aspect of quality evaluation, a total of 47 patients (or their caregivers) were enrolled for analysis. The effective response rate was 100 %. The content validity index was 0.91, and the Cronbach's alpha for internal reliability was 0.854-0.929. Significant differences between the expectation and the satisfaction scores were only foud in part of the questions in the tangible aspect. Conclusion: Our study observed that the novel government-civilian cooperation model in rehabilitation service is feasible in rural regions. The medical service quality gap in the scores of the patients and their caregivers presented only partially in the tangible aspects, which meant that the rehabilitation we currently provided could meet their expectations except for the shortage of the health professional providers. To enhance the medical service quality and sustainable operation of this model, we need to improve the integration of government-civilian resources and recruit more health professional providers in the near future.

参考文献 ( 30 ) 〈TOP〉

吴宛蕙、杨长兴：全民健保对健康差距之影响－以平均余命为测量。台湾公共卫生杂志 2007;26:196-207.
连结：
孙宏禹、林盈利：长期照顾十年计画2.0与居家医疗整合的衔接。血管医学防治季刊 2018:22-3.
连结：
van Dis J. MSJAMA. Where we live: health care in rural vs urban America. Jama. Jan 2 2002;287:108.
连结：
Wong ST, Regan S. Patient perspectives on primary health care in rural communities: effects of geography on access, continuity and efficiency. Rural and remote health. 2009;9:1142.
连结：
蔡文正、龚佩珍、杨志良等：偏远地区民众就医可近性及满意度调查。台湾公共卫生杂志2006;25:394-404.
连结：

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