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目的了解定点医院防治模式下结核病患者的满意度,并为定点医院防治模式的改进提供依据。方法选取全球基金结核病项目2009年10月启动定点医院模式的40个县(区)级定点医院作为研究现场,通过病案查询了解诊疗信息,通过问卷调查了解患者满意度情况。共发放问卷907份,最终收回有效问卷795份,问卷有效率为99.38%。采用卡方检验的统计分析方法,比较不同类型患者的满意度,P<0.05为差异有统计学意义。结果94.65%(752/795)的患者愿意推荐患结核病的亲友到定点医院就诊,患者对定点医院各方面满意度从高到低依次是医疗技术(86.79%,690/795)、服务态度(86.79%,690/795)、健康宣传教育(简称“宣教”)(83.02%,660/795)、就诊流程(76.60%,609/795)、门诊环境(73.84%,587/795)、宣教效果(73.21%,582/795)和费用承担(41.89%,333/795)。涂阳患者在医疗技术、宣教效果、费用负担方面的满意度(82.76%,264/319;69.59%,222/319;36.99%,118/319)均低于涂阴患者的满意度(89.43%,423/473;75.90%,359/473;45.45%,215/473)(χ2值分别为7.371、4.673、5.436,P值均<0.05)。服药时有人督导的患者对健康宣教的满意度(84.16%,558/663)高于无人督导的患者(75.76%,100/132)(χ2=4.195,P<0.05)。服药时有人督导的患者能承担费用的比例(39.06%,259/663)低于无人督导的患者(55.30%,73/132)(χ2=12.944,P<0.001)。结论结核病患者对定点医院模式总体比较认可,但定点医院仍需改进门诊环境和就诊流程,落实结核病诊治优惠政策,进一步提高患者的满意度。
Objective To understand the satisfaction of patients with tuberculosis under the mode of prevention and treatment in designated hospitals and to provide basis for the improvement of the mode of prevention and treatment in designated hospitals. Methods Forty counties (districts) fixed-point hospitals that started the designated hospital mode in October 2009 were selected as the research site, and medical information was obtained through the medical record query, and the patient satisfaction was analyzed through questionnaire. A total of 907 questionnaires were distributed, and finally 795 valid questionnaires were returned. The effective rate of the questionnaires was 99.38%. Using chi-square test statistical analysis methods to compare the satisfaction of different types of patients, P <0.05 for the difference was statistically significant. Results 94.65% (752/795) of patients were willing to recommend relatives and friends of tuberculosis to designated hospitals. The patients’ satisfaction with all aspects of designated hospitals was medical technology (86.79%, 690/795), service attitude (86.79% %, 690/795), health education and publicity (83.02% and 660/795 respectively), treatment procedure (76.60% and 609/795), outpatient setting (73.84% and 587/795) Results (73.21%, 582/795) and cost (41.89%, 333/795). The smear-positive patients were less satisfied with smear-negative patients (89.43%) than those with smear-negative patients (82.76%, 264/319; 69.59%, 222/3119; 36.99%, 118/319) , 423/473; 75.90%, 359/473; 45.45%, 215/473) respectively (χ2 = 7.371,4.673,5.436, P <0.05). Patients who were supervised at the time of taking medication had higher satisfaction with health education (84.16%, 558/663) than those without supervision (75.76%, 100/132) (χ2 = 4.195, P <0.05). The proportion of patients who were supervised at the time of taking medication was 39.06% (259/663) lower than that of the non-supervised patients (55.30%, 73/132) (χ2 = 12.944, P <0.001). Conclusion TB patients generally agree with the designated hospital model. However, the designated hospitals still need to improve the outpatient setting and treatment flow, implement preferential treatment policies for tuberculosis and further improve their satisfaction.