醫病關係與醫療滿意度之全國性普查

Medical Service Satisfaction and the Physician-Patient Relationship: A National Survey via Computer-Assisted Telephone Interviews

10.6145/jme.200506_9(2).0005

廖士程(Shih-Cheng Liao)；李明濱(Ming-Been Lee)；謝博生(Bor-Shen Hsieh)；李源德(Yuan-Teh Lee)

醫病關係 ； 醫療滿意度 ； 電腦輔助電話訪談 ； 全國性普查 ； 簡式症狀量表BSRS-5 ； physician-patient relationship ； satisfaction of medical service ； computer assisted phone interview CATI ； national survey ； Brief Symptom Rating Scale BSRS-5

Journal of Medical Education

9卷2期（2005 / 06 / 01）

149 - 161

繁體中文

背景與目的：醫病溝通以及醫療態度之陶養，是當代醫學倫理教育中重要的一環，而提昇服務品質及效率亦成為各級醫院重要經營理念。本研究旨在以全台灣地區社區民眾為樣本，實施與醫病溝通關係、心理困擾、與醫療滿意度相關之全國性普查研究。方法：調查對象為全台灣地區年齡於15歲以上之民眾最近一次就醫經驗，採用電腦輔助之電話訪談實施全結構式問卷調查，以台灣地區電話簿為母體，依縣市為分層單位以人口數為基礎之分層比率隨機抽樣。結果：本研究共蒐集1203名有效樣本，結果呈現醫病溝通互動之品質與病患醫療滿意度呈顯著相關。年齡、醫師服務態度、同理心、信任感、診療時間長度、以及病患心理困擾程度，與整體醫療滿意度之相關最為密切。健保對於受訪者健康維護之涵蓋程度，以及主觀判斷健保對於醫師醫療行為之影響，於多變量分析中，對於醫療滿意度之影響力降至不顯著之程度。結論：本研究之推論：良好的醫病溝通與互動關係，可能較民眾對於全民健保之感受，更能影響醫療滿意度。而針對社區民眾滿意度相對較低之醫病互動項目，如看診時間長度以及醫師對於病患痛苦了解程度兩項，在制度面未臻完善時，應可透過良好的醫療諮商技巧，於有限的時間內，提供病患有效情緒支持，以增進醫療滿意度。

Maintaining a good physician-patient relationship and promoting medical service satisfaction are important in medical care and education in this era of managed care. This study aimed at exploring medical service satisfaction of community residents and its association with the physician-patient relationship and psychological distress. We conducted a nationwide survey by proportional stratified random sampling using the telephone directory as the sampling frame. The data was collected via computer-assisted telephone interviews (CATI) and a structured questionnaire developed by our research team. A Brief Symptom Rating Scale Screening Form (BSRS-5) was applied to measure psychological distress. A total of 1,203 subjects were recruited and the results showed a significant positive correlation between medical service satisfaction and a good physician-patient relationship. Age, attitude of the physician, length of the visit, empathetic understanding from the physician, degree of trust in the physician and psychological distress were the most influential factors on medical service satisfaction. Empathetic understanding from the physician and length of visit were the two relatively lowest scoring items of all those measured. In contrast to univariate analysis, subjective evaluation of adequacy of insurance coverage and feelings about medical practice influenced by the insurance system lost their predictability for medical satisfaction on multivariate analysis. Physician-patient relationship was more influential than feelings about medical insurance. Effective medical counseling which ameliorates psychological distress and enhances the physician-patient relationship may also improve medical service satisfaction.

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