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。     

患者就医等候时间、就医便利性和就医感知价值关系研究

文章针对患者就医感知价值中的“看病难”问题,围绕患者就医等候时间、就医便利性和就医感知价值的关系展开理论研究,并结合台州医院的案例进行了实证检验。研究发现,在知名度较高的大型医院里,患者个人时间充裕程度与就医感知便利性无相关性,患者就医感知便利性与就医感知价值呈正相关性;患者个人就医时间充裕程度与就医感知价值无相关性,而患者特征对其时间充裕程度、就医感知便利性有一定影响。     

基于结构方程探索最优竞争模型——患者感知服务态度与服务质量、患者满意及其行为意向间关系

目的应用结构方程模型(SEM)推断患者感知服务态度、服务质量、患者满意及行为意向间的关系,得到最优竞争模型。方法通过6家医院706位门诊和住院患者问卷调查,结合美国顾客满意指数模型及专业文献,建立初始模型,通过SEM拟合,获得患者感知服务态度、服务质量、感知价值、患者满意及行为意向之间的关系。结果通过比较理论模型和3个竞争模型,最终得到最优竞争模型III,即服务态度、服务质量、患者满意与感知价值是患者行为意向的原因变量;服务质量与患者满意、感知价值及行为意向、感知价值与患者满意及行为意向、患者满意与行为意向、服务态度与服务质量、感知价值及患者行为意向均呈正相关;服务态度与患者满意呈间接相关。结论结构方程分析方法证实患者感知服务态度直接影响患者行为意向,服务态度与患者满意之间存在直接或间接效应。     

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.     

基于ACSI和ECSI模型的住院患者满意度影响因素研究

目的利用美国顾客满意度指数(ACSI)和欧洲顾客满意度指数(ECSI)模型,研究住院患者满意度的因子构成和效应值,构建住院患者满意度评价模型,分析影响住院患者满意度的相关因素。方法通过查阅文献和咨询相关专家,自行设计住院患者满意度调查问卷。采用偶遇抽样法进行问卷调查,并对问卷进行信度、效度分析。结果住院患者满意度评价模型包含了医院形象、患者期望、感知质量、感知价值和患者满意度5个变量。感知质量对患者满意度的影响最大,总效应值为0.905,医院形象和感知价值的总效应值分别为0.394和0.588,患者期望对患者满意度的直接效应为负面效应(效应值-0.226),间接效应为正面效应(效应值0.696),总效应值为0.470。结论在医疗服务活动中,可以通过患者期望、感知质量和感知价值3个途径提高患者满意度,其中以提高感知质量为重点。同时医生应尽可能详细地为患者解释病情,让患者参与诊疗计划的制定。     

日间手术医疗安全和病人感知调查与分析

目的 调查日间手术病人术后安全性及患者的价值感知、风险感知.方法 问卷调查和电话调查.结果 609例患者调查结果显示:日间手术患者对医疗服务的满意度为96.2％,对医疗质量的满意度为95.9％;日间手术患者出院后再住院率为0.05％,再就诊率为2.9％;64.9％的患者意识到日间手术模式较住院手术具有更高的便利价值,49.1％的患者意识到日间手术模式的货币价值,57.0％的患者意识到日间手术的社会价值;风险感知方面,50.4％的患者担心如果出现不适后,不能得到及时处理;22.0％的患者对没有医护人员照护下的康复,在心理上准备不足.结论 日间手术模式是一种安全有效的医疗模式,对这种模式患者具有较高的价值感知,同时也存在较高的风险感知.     

基于需求层次理论的异地互联网医疗患者感知价值体系的构建△

目的：构建基于需求层次理论的互联网医疗患者感知价值体系。方法：利用文献分析法和异地患者价值需求调查问卷结果，初步形成互联网医疗患者感知价值的相关评价指标。利用李克特五级量表设计咨询调查问卷，采用德尔菲法对35名专家进行两轮问卷咨询，采用层次分析法进行各项指标权重排序，采用权威系数检验专家咨询的可靠性。结果：经过两轮专家咨询后，确定包含5个一级指标（生存、安全、社交、尊重、自我价值）、10个二级指标（名誉价值、精神价值、技术价值等）、28个三级指标的互联网医疗患者感知价值指标体系。结论：构建的指标体系具有较高的科学性、稳定性和社会意义，能够切实反映患者互联网医疗的价值需求及感知，为进一步构建“以患者为中心”的互联网诊疗模式提供理论基础。     

患者满意度与医院效益间的关系

满意是种感觉状态的水平，就医院而言，患者满意度是指患者所感知的服务价值（价值=医疗质量／患者成本）大于或等于事前的期望。患者满意与否不仅取决于其所感知的获得与付出的比较，而且还取决于这种感知的结果与期望的比较，更取决于医院提供的价值与其竞争对手提供价值的比较。     

远程医疗患者满意度影响因素的Meta分析

目的：系统评价影响远程医疗患者满意度的主要因素。方法：基于“结构-过程-结果”理论,对远程医疗患者满意度影响因素相关研究文献进行Meta分析。结果：纳入12项相关研究,共计4 981例样本;Meta分析结果显示,结构维度的感知系统质量和资费感知、过程维度的感知易用性和感知交互性、结果维度的感知服务质量、感知有用性和感知价值是影响远程医疗患者满意度的主要因素。结论：当前证据表明,远程医疗服务的结构、过程、结果质量均能影响患者满意度,建议采取措施提升远程医疗的结构、过程、结果质量,进一步提高患者对远程医疗的满意度。     

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。     

Key factors in health counselling in the consultation.

To design an effective course in behaviour influence all GPs and general nurses at two health care centres were interviewed concerning procedure and perceived barriers to prevention. The results demonstrated that most doctors and nurses regarded health counselling as important in medical health service. They also maintained that they have time and space for this activity. However, most doctors and nurses were hesitant and/or disappointed concerning their perceived efficacy in affecting people's life habits. The explanation may be that the personnel lack an effective methodology to handle these issues. Few had a more developed educational theory where the starting-point was the patient. Another explanation may be that many doctors and nurses had a non-patient-centred style, which previous studies demonstrate to be less successful in affecting people's behaviour. This was expressed in the notion that the doctor/nurse has to be a model from which the patient can learn the 'right' life habits. It was also expressed in the notion that the reasons why patients do not change behaviour were mostly psychological, but no importance was attached to the role of different values. The results point out the need for education in patient-centred pedagogics.     

浅析临床实验室危急值报告的应用

目的:提高临床医师和检验工作者对危急值报告制度的认识,加强检验与临床的沟通与联系。方法:制定检验项目的危急值范围,认真执行检验项目的危急值报告制度。结果:增强了检验工作者的责任心,增加了临床对检验的理解和信任,使一些重症患者得到及时救治,减少医患矛盾。结论:检验人员需认真执行危急值报告制度,加强与临床的沟通与联系,更好地为广大患者服务。     

Factors Influencing Communication with Doctors via the Internet: A Cross-Sectional Analysis of 2014 HINTS Survey

Based on Street’s (2003) ecological framework of communication in medical encounters, this study examined personal, interpersonal, and media factors that could influence patients’ use of the Internet to communicate with doctors. Results from data analysis of responses from the 2014 Health Information National Trends Survey showed that patient activation and ease of Internet access were two positive predictors of online doctor-patient communication. In addition, patients’ trust in doctors positively moderated the relationships between patient activation and online doctor-patient communication, and between perceived health status and online doctor-patient communication. Finally, the quality of patients’ past experiences communicating with doctors had a positive moderation effect on the association between health information seeking behavior and online doctor-patient communication. Implications and limitations are discussed.     

我国医学新技术临床应用中医患沟通与决策模式探讨

目的分析我国医学新技术临床应用中的医患沟通现况及决策模式,为相关研究和临床实践提供参考。 方法针对高通量基因测序、药物涂层支架两项具体新技术,采用横断面设计和多阶段分层抽样方法,对上海市、福建省、四川省19家医院的患者及医生进行调查。结果共调查了5城市19家医院的950位患者（心内科178位,妇产科233位,其他科室554位）和908位医生（心内科158位,妇产科177位,其他科室556位）;54.9%~63.5%患者会主动向医生表达诉求,52.8%~58.9%得到医生回应;85.3%~96.7%医生会征     

Is GP-patient communication related to their perceptions of illness severity,coping and social support?

The aim of the study was to explore the relationship between the communicative behaviour of general practitioner and patient on the one hand and the perception of the coping behaviour of the patient, the severity of the complaint and the presence of social support on the other hand. From 20 general practitioners (GP), 15 consultations per GP were videotaped and analysed using the Roter Interaction Analysis System. Doctors and patients rated their perceptions on questionnaires. The finding was that doctors and patients used predominantly task-oriented (instrumental) behaviour, with some exceptions. With older patients and patients with low social support the GPs used more affective communication, mainly consisting of social talk and mutual agreement. In the case of complex problems, the GP paid special attention to the relationship with the patient. Within the domain of instrumental communication, some differences between doctor and patient were observed. Although doctors and patients exchanged a lot of information about medical issues, patients gave information about their lifestyle and emotions, which the doctors did not verbally explore. In consultations where the patient perceived the complaint as severe, he or she was more focussed on the medical content. When the GP considered psychosocial issues important, doctor and patient communicated about lifestyle, emotions and social relations. This doctor-patient correlation was not found when patients perceived their problem as psychosocial.     

医院开展患者就医体验管理的思考与展望

医院开展患者就医体验管理,有利于提升患者满意度,为此建议采取优化就医流程,改善医患沟通方式,加强医疗机构基础设施管理,优化电子信息平台等措施。针对公立医院面临的困惑和难题,提出提高医疗水平,保证医疗质量,重视网络评价,重视医疗人文关怀,提升医院文化水平等建议,以期改善服务质量,增强患者舒适度体验。     

Functional needs: agreement between perception of rural patients and health professionals in China

This study aimed to investigate the common areas of functional needs of patients with different chronic diseases and to compare the level of agreement between patients and doctors, and patients and an occupational therapist, on perceived priority functional goals. A sample of 113 rural patients from Hebei Province attending outpatient neurology, orthopaedic and cancer clinics completed the COOP/WONCA Charts. These charts are a screening tool that assesses limitations in a set of functional domains. The 80 patients who indicated significant functional difficulty on the charts, 11 doctors and one occupational therapist then responded to questionnaires to elicit the perceived priority functional needs. Respondents remained blind to one another's responses. A consulting doctor and the occupational therapist saw each patient's COOP/WONCA Charts before interviewing the patient. Additional questionnaire items and a focus group interview provided data by professionals on health services thought to be beneficial to improve the function of clinic patients. The difference between the mean percentage of agreement on perceived functional difficulty in therapist/patient matches and doctor/patient matches was 18.5% (95% CI for the difference = 12.4% to 24.6%). The therapist on average agreed or matched with patients significantly more often than did doctors (p<0.0001). The discrepancy between the doctor's and patient's perception of priority functional goals was substantial, indicating a need for initiated effort to narrow this gap. The match rate of doctors with patients in choosing priority goals was significantly lower than for the therapist with patients in this study. Doctors expressed a desire for closer involvement in clinics by appropriate rehabilitation staff. This could expedite the process towards the starting level of a patient-centred approach to health care, within the natural context of teamwork, and with little disruption to clinic routines. Replication of this study using a control group would allow direct comparison of patient incidents when the charts are used and when they are not.     

医患双方对沟通认知状况的调查分析与对策

目的 了解医患双方对医患沟通的认知现状,分析存在问题,给出对策。方法 采用自行设计的调查问卷,发放患者及医务人员调查问卷400份,收回有效问卷384份。对问卷运用SPSS等软件进行统计学分析处理。结果 医患双方对医患关系重要性的认知一致,而对目前状况和障碍主要因素,对医患沟通障碍的责任主体、有效提高医患沟通能力方式的认知状况均存在着显著性差异。结论 医患双方对医患沟通的认知差异是建立和谐医患关系的主要障碍之一。最主要的3个障碍因素是医患信任度、医方态度及患者要求过高。树立“以人为中心”的宗旨,努力提高医务人员人文修养;加强医务人员的沟通技能培训;开展健康教育,缩小医患医学知识差距可以缩减医患双方认知差异。     

慢性病患者自我管理研究进展

病人主动参与慢性病管理的最终目的是提高病人的自我效能(self-efficacy)并开展有效的自我管理。慢性病自我管理的实质为通过"医患合作,患者互助,自我管理"来提高患者对疾病的认识水平,改善患者心理状态,改变患者不良健康行为,促进患者功能恢复,减少医疗费用支出。该文从心理学、生态学、伦理学、卫生经济学等领域对患者自我管理在不同角度、不同层次的研究进行探索,深入了解患者自我管理的科学性和有效性,同时就目前研究中存在的问题进行探讨。