基于患者类型的医患沟通与患者就医感知价值关系研究

沟通性是患者就医感知价值的重要指标因素。文章通过在台州医院进行的实证研究,对医患沟通与患者就医感知价值的关系进行了深入分析,检验了医患沟通与患者就医感知价值间的正相关性。同时,以学历高低、有无不愉快经历为维度,对患者进行分类,检验了患者类型对两者关系的调节作用,探讨了学历高低、有无不愉快经历对患者就医感知价值评价的影响。     

国内外患者就医感知价值研究述评

患者就医感知价值研究是顾客感知价值理论在医疗服务领域研究的延伸.现有的研究主要集中在就医感知价值内容、就医感知价值测量以及患者行为关系影响三个方面.整体来看,国外的患者就医感知价值研究层次与当前的顾客感知价值研究基本保持同步,即已进行到了价值测量和行为关系深入探究阶段.而国内主要停留在概念导入和观点探讨阶段,严重滞后于国外研究和国内其他服务管理领域的相关研究.     

大型综合医院患者就医选择影响因素的调查研究

目的了解哪些因素会影响患者选择医院就医。方法采用自行设计的问卷调查表,对患者进行一系列的问卷调查。结果影响患者就医选择的因素中,医疗技术水平所占比例最高,其次是医院的收费是否合理、医德医风、交通便利性、医护人员服务态度等因素。结论为了吸引更多的患者前来就医,医院应注重医疗质量,加强医德医风教育和医患沟通,改善医院交通环境,加大宣传力度。     

临床医务人员选择性就医行为分析

目的 研究临床医务人员选择性就医行为及影响因素.方法 采用自行编制的调查问卷,对894名临床医务人员进行问卷调查.结果 依据疾病严重程度,归纳出临床医务人员"是否就医"的6个个人影响因素和"就医机构选择"的7个医院影响因素.结论 临床医务人员就医行为受个人因素和医院因素影响,对医疗体制改革和社会群体就医行为具有指导意义.     

患者就医时间影响就医决策的调查研究

目的探讨就医时间在患者就医决策过程中产生的影响。方法 2015年7月选择十堰市一家医院的流动患者为调查对象,共调查100人。调查所有研究对象交通工具的选择、到达医院的时长、就诊等待时长、就诊时长、疾病治疗周期。计数资料比较采用χ2检验和Spearman相关分析,P0.05为差异有统计学意义。结果就医时选择公交车的人数最多,占33.0%(33/100);在到达医疗机构的时间在60~120和≥120 min时,选择公交车的人数最多,分别占45.5%(5/11)、44.4%(4/9)。就诊等待时长15 min的人数最多,占34.0%(34/100)。患者诊疗行为的持续时间主要集中在30 min和30~60min,分别占46.0%(46/100)、38.0%(38/100)。不同疾病复发情况、文化程度的患者,疾病治疗周期不同,差异均有统计学意义(均P0.05)。三种治疗方式的治疗周期都集中在2~7 d,共有61人(61.0%),其中服用药物28人(45.9%),输液24人(39.3%),住院9人(14.8%)。患者治疗方式与治疗周期呈正相关(r=0.219,P0.05)。结论为了提高患者就医决策的科学性和降低决策负担,探索就医决策的时间影响因素,分析各个因素的影响机理,从而做出较为准确的就医决策。     

影响患者就医行为的部分因素调查

通过对上海市十大医院中２所医院４０１名住院患者进行问卷调查，分析了医疗费支付方式、医药费承受能力、患者对医院服务满意程度、患者对医护人员信任程度、疾病严重程度、性别等因素对就医行为的影响，研究了患者就医行为的变化趋势。探讨了医院应采取的对策。     

福建省医联体内群众就医选择影响因素分析

目的 在医联体背景下,调查分析福建省居民就医选择医疗机构的现状,为进一步推进医联体和分级诊疗进程提供参考。方法 采用文献研究和问卷调查等方法对福建省居民对医联体及分级诊疗认知程度、就医选择进行研究,应用SPSS 22.0对调查数据进行χ²检验和对应分析。结果 共调查福建省群众568名,首诊基层医疗机构仅占比17.61%。收入水平越高、受教育程度越高、城镇职工医保、家越靠近高等级医疗机构的群众越倾向首诊高级别医疗机构。结论 基层医疗机构首诊比例低根本原因在于基层医疗机构服务能力弱,高收入、高学历群众更倾向于在高级别医院就诊,就诊便利性是首诊医疗机构偏好的重要影响因素,优化医疗保险制度设计是推进医联体建设的关键,不同城市医联体群众就医选择及其影响因素存在差异。     

优化互联网医院门诊就医流程的设计与构建

随着信息技术的飞速发展和“互联网+”作为国家战略的逐步崛起,互联网医院也得到了很大的发展,充分发挥互联网医院平台就医模式在缓解就医难方面的作用,还有很多工作有待更好落实。本研究根据互联网医院已开展的业务、拓展新模块,将线上线下联合,从方便患者、节省患者就医时间、提高患者就诊体验的角度出发,优化门诊就医流程设计与构建。     

以就医者价值管理塑造忠诚就医者

就医者价值管理是以就医者潜在价值最大化为核心整合在一起的管理模式。这一模式的推崇，将促进医院转变服务观念，提升医疗服务水平，扩展服务内容，在服务中注重人性化关怀，从而扩展忠诚就医者数量，达到提高医院投资回报率的目标，并使医院和就医者为双方创造最佳价值，实现双方目标的整合。     

老年患者就医流向及影响因素调查研究

目的 分析老年患者就医流向的原因与因素,为合理引导老年患者适宜就医、提高医疗有效利用率、缓解医疗供需矛盾提出参考建议.方法 利用SPSS20.0描述性统计和x2检验对数据进行分析.结果 老年患者在生病时首选三级医院就医的比例最高,其次为社区卫生服务中心,二级医院比例最低.就医流向的影响因素有:年龄、医疗保障情况、文化程度、家庭平均月收入.结论 应通过加强宣教、合理引导,强化社区医疗机构服务能力建设,畅通双向转诊/转查渠道,积极推进二级医院的转型发展,来吸引老年就医群,优化老年人群就医流向,提高医疗资源的有效使用效率.     

患者价值差异模型的构建及启示

患者价值是顾客价值理论在医疗领域的延伸,由于医疗行业的特殊性,患者和医生在不同的角度对患者价值的理解具有差异。通过剖析患者价值维度,构建了患者价值差异模型,探索医疗服务提供方与患者在患者价值方面存在的差异。根据模型启示,提出将患者价值纳入患者满意度评价范畴,注重患者情感需要来提高患者感知价值,以及将患者价值纳入制度化建设从而实现患者价值与医疗机构价值的统一。     

患者医疗服务价格感知机理与影响因素研究

文章聚焦于患者医疗服务价格感知的影响因素及其影响机理,采用理论与实证研究方法,探寻了把握患者医疗服务价格感知影响因素的具体方法,并根据研究结果提出了以患者类型及医疗服务项目类型为维度的改善患者医疗服务感知价值的管理策略。     

Towards patient-centered health services in India--a scale to measure patient perceptions of quality.

OBJECTIVE: . (i) To develop a reliable and valid scale to measure in-patient and outpatient perceptions of quality in India and (ii) to identify aspects of perceived quality which have large effects on patient satisfaction. DESIGN: Cross-sectional survey of health facilities and patients at clinics. SETTING: Primary health centers, community health centers, district hospitals, and female district hospitals in the state of Uttar Pradesh in north India. MAIN OUTCOME MEASURES: Internal consistency, validity, and factor structure of the scale are evaluated. The association between patient satisfaction and perceived quality dimensions is examined. RESULTS: A 16-item scale having good reliability and validity is developed. Five dimensions of perceived quality are identified-medicine availability, medical information, staff behavior, doctor behavior, and hospital infrastructure. Patient perceptions of quality at public health facilities are slightly better than neutral. Multivariate regression analysis results indicate that for outpatients, doctor behavior has the largest effect on general patient satisfaction followed by medicine availability, hospital infrastructure, staff behavior, and medical information. For in-patients, staff behavior has the largest effect followed by doctor behavior, medicine availability, medical information, and hospital infrastructure. CONCLUSIONS: The scale developed can be used to measure perceived quality at a range of facility types for outpatients and in-patients. Perceived quality at public facilities is only marginally favorable, leaving much scope for improvement. Better staff and physician interpersonal skills, facility infrastructure, and availability of drugs have the largest effect in improving patient satisfaction at public health facilities.     

三甲医院提升患者感知价值策略研究

随机抽取了广州地区10家三甲医院进行问卷调查。结果显示,患者感知价值与预期价值有一定落差。对此,医院应切实采取重视医患有效沟通、改善医护人员态度、提供及时服务、形成良性互动的意见反馈机制、缩短患者就诊等候时间等措施来提升患者感知价值。     

我国医患沟通的不良表现及对策

医患沟通是医患关系的重要组成部分,已引起研究人员和医护人员的重视。文章阐述了医患关系特殊性,我国医患沟通中存在有“说得少、问得少、听得少”的不良表现,提出了树立沟通理念、学会聆听患者的倾诉、注重细节上的沟通技巧、实行人性化的医疗服务、医患沟通的制度化等对策。     

The Expert Patients Programme: a paradox of patient empowerment and medical dominance

Self-care is seen as a key element in managing resource demand in chronic disease and is also perceived as an empowering right for patients. The Chronic Disease Self-Management Programme developed in the USA has been adopted in a number of countries and in the UK has been as adapted as the Expert Patients Programme. However, despite its potential as a lay-led empowering initiative, the Expert Patients Programme has been criticised as perpetuating the medical model and failing to reach those in most need. This paper revisits a critique of the Expert Patients Programme, and drawing upon a qualitative study seeks to explore whether the Expert Patients Programme enables empowerment or replicates traditional patterns of the patient-professional relationship. A grounded-theory approach was adopted utilising focus groups, in-depth interviews and participant observation. Data were analysed through the constant comparative method and the development of codes and categories. Conducted in the relatively affluent area of the south-east of England, this paper draws on data from 66 individuals with a chronic illness who were knowledgeable, active and informed. The study revealed a number of characteristics common to expert patients that were linked to a systematic, proactive and organised approach to self-management, a clear communication style and the ability to compartmentalise emotion. The study included participant observation of an Expert Patients Programme and a professional-led self-management course. The paradoxical nature of the Expert Patients Programme was revealed, for whilst there was evidence that it reinforced the medical paradigm, there was a concurrent acknowledgement and support for the subjective experience of living with a long-term condition. Furthermore, whilst the policy emphasis has been on individual empowerment within the Expert Patients Programme, there is some evidence that it may be triggering a health consumer movement.     

患者就医感知价值及其应用策略研究

患者就医感知价值研究为把握患者就医感受,建立以患者为中心的新型医疗服务体系提供了理论依据和实践方法。患者就医感知价值由一系列关键指标构成,通过分析患者感知价值的各个构成指标及其对患者感知价值的影响作用,可以将患者感知价值指标按照敏感度和易感性分为两个维度,分别找出其中的强感知指标、中等感知指标、弱感知指标、显性指标、隐性指标。结合实际的案例,对这些指标进行归类分析后,可以为提升医疗服务水平提供具有实践指导意义的管理策略。     

Upper abdominal ultrasound in general practice: indications, diagnostic yield and consequences for patient management

BACKGROUND: Abdominal ultrasound (US) is frequently performed in Western societies. There is insufficient knowledge of its diagnostic value in terms of changes in patient management decisions in primary care. OBJECTIVE: To assess the influence of upper abdominal US on patient management in general practice. METHODS: A prospective cohort study with 76 GPs and three general hospitals in The Netherlands. A total of 395 patients aged >or=18 years referred by their GPs for upper abdominal US were included. The main outcome was change in anticipated patient management assessed by means of questionnaires filled in by GPs before and after abdominal US. RESULTS: Mean age of the patients was 54.0 +/- 15.8 years, 35% were male. Clinically relevant abnormalities were found in 29% of the abdominal US, mainly cholelithiasis. Anticipated patient management changed in 64% of the patients following abdominal US. Main changes included fewer referrals to a medical specialist (from 45 to 30%); and more frequent reassurance of the patient (from 15 to 43%). However, this reassurance was not perceived as such in almost 40% of these patients. A change in anticipated patient management occurred significantly more frequently in patients with a prior cholecystectomy (82%). CONCLUSION: Anticipated patient management by the GP changed in 64% of patients following upper abdominal US. Abdominal US substantially reduced the number of intended referrals to a medical specialist, and more patients could be reassured by their GP.     

Tales of time, terms, and patient information-seeking behavior-an exploratory qualitative study

This study explores patients' and physicians' perceptions of the use of medical terminology in patient-physician communication. Perceptions of time emerge as an overarching theme and the relationships between perceived time pressures and medical terms are analyzed. Data for this qualitative exploratory study were collected in 28 semistructured interviews with native and nonnative English-speaking physicians and patients. Interviews were recorded, transcribed and analyzed in NVivo 8, applying principles from grounded theory. Participants commonly perceived time pressures on consultations. Findings indicate that together, perceived time pressures and medical terminology influence patient participation and the development of rapport in medical encounters. Patient information-seeking behavior was reported to be lower in short, terminology-dense consultations and increased in longer, terminology-sparse consultations. Data suggest that monitoring the use of medical terms in combination with taking time to provide appropriate explanations can function as a partnership-building strategy. Physicians who adopt this strategy could foster better patient-physician relationships and facilitate increased patient information-seeking behavior.