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目的探讨卫生人才激励机制改革背景下患者的就诊满意度。方法于2015年6月15日—8月15日,在享受《关于加强浦东新区农村卫生人才队伍建设的实施意见》(“卫生八条”)政策的A(偏远农村12家)、B(一般农村11家)、C(城郊结合9家)3类共32家社区卫生服务中心,选取政策实施(2014-07-01)前后均有相应社区卫生服务中心就诊经历的患者3 520例(每家110例)。采用自行设计的问卷对纳入患者进行调查,主要内容包括患者的基本信息、选择至社区卫生服务中心就诊的原因、就诊满意度、自感社区卫生服务变化及对社区卫生服务中心不满意之处。结果共回收有效问卷3 091份(A类1 210份、B类995份、C类886份),问卷有效回收率为87.8%。患者选择至社区卫生服务中心就诊的原因排在前3位的分别为离家近(86.3%,2 667/3 091)、价格便宜(48.0%,1 484/3 091)、服务态度好(47.7%,1 474/3 091)。患者对社区卫生服务的总体满意度为84.7%(2 568/3 032),对候诊时间、就诊环境、服务态度、解释清楚程度、认真程度、信任程度、就诊花费的满意度分别为54.1%(1 625/3 003)、77.1%(2 308/2 995)、93.5%(2 859/3 057)、94.6%(2 911/3 078)、94.9%(2 915/3 071)、93.8%(2 880/3 071)、48.6%(1 489/3 066)。不同地区患者对社区卫生服务的总体满意度及对就诊环境、服务态度、解释清楚程度、认真程度、信任程度、就诊花费的满意度比较,差异有统计学意义(P<0.05)。“卫生八条”政策实施后,81.1%(2 466/3 041)患者认为就诊方便程度有大幅/部分改善,77.0%(2 311/3 001)患者认为医生技术水平有大幅/部分提高,53.1%(1 613/3 038)患者认为就诊费用有大幅/部分下降;80.2%(2 318/2 890)患者认为药品种类少,48.2%(1 393/2 890)患者认为设备条件差,15.9%(459/2 887)患者认为等候时间长。结论患者的总体就诊满意度较高,卫生人才激励政策在一定程度上促进了偏远农村地区医疗卫生服务质量的提升;建议改善就诊环境、调整医疗费用模式,同时关注药品问题,进一步提高患者满意度。
Objective To explore the satisfaction of patients in the reform of health personnel incentive mechanism. Methods From June 15 to August 15, 2015, while enjoying the policy of “Implementing Opinions on Strengthening the Construction of Rural Health Talent Ranks in Pudong New Area” (“Health 8”), A (12 outlying rural areas), B 11 in general rural areas) and 32 community health service centers in 3 (C) (suburban and 9) categories. Before and after the implementation of the selection policy (2014-07-01), there were 3 520 cases of patients visiting the corresponding community health service centers Home 110 cases). The questionnaire was designed to investigate the patients. The main contents include the basic information of the patients, the reason of choosing to the community health service center, the satisfaction of the visit, the change of the community health service and the dissatisfaction with the community health service center. Results A total of 3 091 valid questionnaires were recovered (1 210 copies of category A, 995 copies of category B, and 886 copies of category C). The effective rate of questionnaires was 87.8%. The reason why the patients choose to go to community health service center is the first three are close to home (86.3%, 2667/309), the price is cheap (48.0%, 1484/309), and the service attitude is good (47.7 %, 1 474/3 091). The overall satisfaction of patients with community health services was 84.7% (2 568/3 032). Satisfaction with waiting time, visiting environment, service attitude, clarity of explanation, degree of seriousness, degree of trust, and treatment expenditure were 54.1% 93.6% (2 911/3 078), 94.9% (2 915/3 071), 93.8% (2 915/3 071), 93.1% (2 308/2 995), 93.5% 2 880/3 071), 48.6% (1 489/3 066). The overall satisfaction of community health services and the satisfaction of patients in different regions with regard to the treatment environment, service attitude, clarity of explanation, degree of seriousness, degree of trust, and treatment spending were statistically significant (P <0.05). 81.1% (2 466/3 041) of patients considered the convenience of medical treatment to be significantly / partially improved after the implementation of the “Eight Measures for Health” policy. 77.0% (2 311/3 001) of patients considered that the technical level of doctors was significantly / partially improved, 53.1% (1613/3 038) of the patients considered the cost of the visit significantly / partially reduced; 80.2% (2 318/2 890) considered fewer kinds of medicines and 48.2% (3993/2 890) considered the equipment as poor, 15.9 % (459/2 887) patients think the waiting time is long. Conclusion The patient’s satisfaction with the overall treatment is high, and the incentive policies for health personnel promote the quality of medical and health service in remote rural areas to a certain extent. It is suggested to improve the treatment environment and adjust the mode of medical expenses while paying attention to the drug problem and further improve patient satisfaction .