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研究生:朱玉如
研究生(外文):Yu-Roo Chu
論文名稱:牙醫師與牙科病患對牙醫醫療品質的感受與滿意度的探討
論文名稱(外文):The Perception and Satisfaction of Dental Service Quality of Dentists and Their Patients
指導教授:季麟揚季麟揚引用關係周碧瑟周碧瑟引用關係
指導教授(外文):Lin-Yang ChiPesus Chou
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:公共衛生研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2000
畢業學年度:89
語文別:中文
論文頁數:112
中文關鍵詞:牙醫醫療品質感受滿意度
外文關鍵詞:dental service qualtiyperceptionsatisfaction
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研究目的
本研究的目的在於探討牙醫師與牙科病患對於牙醫醫療品質的感受與滿意度,與其影響因素,以及瞭解牙醫師與病患認為健保實施前後牙醫醫療品質是否改變等。此外,還要瞭解牙醫師與其親自診治的病患對牙醫醫療品質等議題的看法的一致性。最後要瞭解牙醫師幫病患做「全口檢查與治療計畫說明」是否是較好的牙醫醫療品質,以及需要花費多少時間與費用。
材料與方法
本研究設計一份「牙醫初診檢查表」與兩份結構式問卷,包括「牙醫師問卷」與「病患問卷」。問卷內容刻意設計讓牙醫師與病患回答相同的問題。立意取樣台北縣市358位牙醫師,請每位牙醫師從其病患中選取10到12位病患,為他們做「全口檢查與治療計畫說明」,治療之後請病患填寫「病患問卷」。當牙醫師做完10到12位病患的全口檢查與治療計畫說明之後,再請牙醫師填寫「牙醫師問卷」。利用次數分配、百分比、卡方檢定、以及多重類別邏輯模式分別描述與分析牙醫師與病患對於牙醫醫療品質的感受與滿意度,以及其影響因素等。
結果
回收有效牙醫師問卷72份(20﹪),有效病患問卷662份,以及564份有效牙醫初診檢查表。牙醫師認為影響牙醫醫療品質的重要因素依序為:「牙醫師的專業訓練」、「牙醫師與病患的溝通與互動」、以及「病患對治療結果的滿意度」。而病患認為影響牙醫醫療品質的重要因素依序為:「牙醫師的專業訓練」、「病患對治療結果的滿意度」、以及「牙醫師與病患的溝通與互動」。牙醫師對於目前台灣地區牙醫醫療品質的滿意度為「滿意」、「普通」、「不滿意」、與「不於置評」的比例分別為5.6﹪、56.9﹪、32﹪、與5.6﹪。而病患對於目前台灣地區牙醫醫療品質的滿意度為「滿意」、「普通」、「不滿意」、與「不於置評」的比例則分別為44.8﹪、46.6﹪、4.8﹪、與3.8﹪。牙醫師認為健保實施前後牙醫醫療品質為「有改善」、「沒有改變」、與「變得更差」的比例分別為33.8﹪、32.4﹪、與33.8﹪。而病患認為健保實施前後牙醫醫療品質為「有改善」、「沒有改變」、與「變得更差」的比例則分別為51.4﹪、43.1﹪、與5.5﹪。牙醫師與其親自診治的病患對於牙醫醫療品質的感受、滿意度、以及健保實施前後牙醫醫療品質是否提昇這三個議題的看法的一致性百分比分別為12.1﹪、22.4﹪、與29.3﹪。牙醫師的性別、年齡、最高學歷、是否曾在教學醫院接受住院醫師訓練、是否具有專科醫師資格、與執業機構這些因素,與牙醫師對牙醫醫療品質的滿意度之間沒有顯著相關。而病患對牙醫醫療品質的滿意度則與下列因素有顯著相關,包括:病患的性別、年齡、最高學歷、自覺口腔健康狀況、是否固定看同一位牙醫師或是固定到同一家牙醫診所(醫院)就診、以及病患的牙周健康狀況。牙醫師與病患認為,牙醫師幫病患做「全口檢查與治療計畫說明」是較好的牙醫醫療品質者分別為95.8﹪與84.6﹪。而牙醫師與病患認為,牙醫師幫病患做「全口檢查與治療計畫說明」需要花費的時間與費用分別為:12.9分鐘、546.3元,與11.3分鐘、382.8元。
結論
牙醫師與病患都認為影響牙醫醫療品質最重要的三個因素為:「牙醫師的專業訓練」、「牙醫師與病患的溝通與互動」、以及「病患對治療結果的滿意度」,雖然順序略有不同。牙醫師對於目前台灣地區牙醫醫療品質的滿意度比病患低。關於健保實施前後牙醫醫療品質是否提昇,牙醫師的評價比病患負面。牙醫師與其親自診治的病患對於牙醫醫療品質的感受、滿意度、以及健保實施前後牙醫醫療品質是否提昇這三個議題的看法的一致性都偏低。而病患的性別、年齡、最高學歷、自覺口腔健康狀況、是否固定看同一位牙醫師或是固定到同一家牙醫診所(醫院)就診、以及病患的牙周健康狀況,與病患對牙醫醫療品質的滿意度有顯著相關。此外,絕大多數的牙醫師與病患都認為,牙醫師幫病患做「全口檢查與治療計畫說明」是較好的牙醫醫療品質。與病患比較起來,牙醫師認為幫病患做「全口檢查與治療計畫說明」需要花費較久的時間與較高的費用。
建議
建議牙醫師多參加牙醫師的專業訓練課程,而且多與病患溝通。建議未來能定期持續進行全國牙醫師與病患對台灣地區牙醫醫療品質滿意度的調查,並且針對牙醫師對牙醫醫療品質的滿意度做深入訪談等質性研究,以瞭解牙醫師對牙醫醫療品質的不滿意處,以便改進。另外,建議牙醫師應該要幫初診病患做「全口檢查與治療計畫說明」。至於牙醫師幫病患做「全口檢查與治療計畫說明」所需花費的時間與費用,則建議相關單位能綜合牙醫師、病患、與中央健康保險局三方面的實際情況與需要,做成合理的決議。(感謝行政院衛生署撥款補助本研究部份經費DOH88-TD)
Objectives: One of the purposes of this paper was to investigate the perception and satisfaction of the dentists and their patients toward the dental service quality they provided/received, and the relevant factors. The second purpose was to understand that how the dentists and their patients thought about whether the dental service quality has changed after the implementation of the National Health Insurance. The third purpose was to understand the consistency of perception and satisfaction of the dental service quality between the dentists and their patients. Finally, we wanted to evaluate whether it constitutes a better dental service quality for a dentist to perform the full mouth examination and to explain the treatment plan to his patients. The reasonable range of time spent and fee charged were also explored.
Methods: A clinical dental evaluation record and two sets of structured questionnaires including dentist''''''''s questionnaire and patient''''''''s questionnaire were sent to a convenient sample of 358 dentists in Taipei Metropolitan area. After receiving full mouth oral examination, treatment plan explanation, and dental treatment, 10-12 patients from each dentist were asked to complete the patient''''''''s questionnaires. Frequency distribution, percentage, Chi-square test, and multicategory logit model were used to describe and analyze the perception and satisfaction of the dentist and their patients toward the dental service quality, and the relevant factors.
Results: Seventy-two copies of dentist''''''''s questionnaire (20%) and 662 copies of patient''''''''s questionnaire together with their clinical evaluation records were sent back to the investigators. The top three factors influencing the dental service quality from the patients'''''''' viewpoint were dentists'''''''' technical competence, patients'''''''' satisfaction to treatment outcome and dentists'''''''' interpersonal communication. Dentists and patients shared the most important factor i.e. dentists'''''''' technical competence. However, the dentists ranked dentists'''''''' interpersonal communication higher than patients'''''''' satisfaction to treatment outcome. When the satisfaction was graded as satisfied, fair, unsatisfied, and no comment, the percentages from the dentists'''''''' opinion were 5.6%, 56.9%, 32%, and 5.6% respectively. The corresponding percentages from the patients'''''''' viewpoint were 44.8%, 46.6%, 4.8%, and 3.8% respectively. There was no significant correlation between the dentists'''''''' satisfaction and their gender, age, further education, residency training, qualification of specialty, and the practice type. It was shown that patients who were more satisfied with the quality of dental service tend to be male, older, less educated, with better self-rated oral health, used to see the same dentist or visit the same dental clinic, and with better periodontal status. When the dental service quality after the implementation of the National Health Insurance, comparing to that before, was graded as better, no change, and worse, the percentages from the dentists'''''''' opinion were 33.8%, 32.4%, and 33.8% respectively. The corresponding percentages from the patients'''''''' viewpoint were 51.4%, 43.1%, and 5.5% respectively. The percentages of the agreement between each dentist and his own patients about the perception, satisfaction of the dental service quality, and the opinion about the dental service quality after the implementation of the National Health Insurance were 12.1%, 22.4%, and 29.3% respectively. There were 95.8% of the dentists and 84.6% of the patients felt that it stands for a better dental service quality for a dentist to perform the full mouth examination and to explain the treatment plan to his patients. The average time and fee needed for a dentist to perform the full mouth examination and to explain the treatment plan to his patients were 12.9 minutes, 546.3 NT dollars from the dentists'''''''' viewpoint, and 11.3 minutes, 382.8 NT dollars from the patients'''''''' viewpoint.
Conclusions: Both the dentists and the patients had similar concerns about factors influencing the dental service quality although there were different orders between the dentists and the patients. However, it was obvious that the dentists were less satisfied to the dental service quality than their patients did, and that the dentists ranked the dental service quality after the implementation of the National Health Insurance worse than their patients did. There was a low agreement between each dentist and his own patients about the perception, satisfaction of the dental service quality, and the opinion about the dental service quality after the implementation of the National Health Insurance. Most of the dentists and the patients felt that it stands for a better dental service quality for a dentist to perform the full mouth examination and to explain the treatment plan to his patients. Comparing to the patients, the dentists thought that it would take more time and should be charged for a higher fee for a dentist to perform the full mouth examination and treatment plan explanation to his patients.
Implications: According to our study, the dentists should pay more attention to their technical competence training and the communication with their patients. It would be very informative to conduct a periodic series of survey of the satisfaction of the dental service quality of the dentists and the patients. On the other hand, qualitative studies such as in-depth interviews with the dentists should be organized to understand the dissatisfaction of the dentists to the dental service quality. It is recommended for a dentist to perform the full mouth examination and treatment plan explanation to his patients. As to the time and fees required for a dentist to perform the full mouth examination and treatment plan explanation to his patients, the author suggests the Bureau of the National Health Insurance to investigate the thoughts and the actual situations of the dentists and their patients to reach a common consensus. (This study is partly supported by the DOH88-TD)
第一章 緒論1
第一節 前言1
第二節 研究目的3
第二章 文獻探討4
第一節 牙醫醫療品質4
第二節 評估牙醫醫療品質的方法7
第三節 病患對醫療品質的感受9
第四節 醫師與病患對醫療品質的滿意度14
第三章 研究材料與方法26
第一節 研究架構與假說26
第二節 研究樣本28
第三節 研究工具29
第四節 研究方法30
第五節 研究變項的操作型定義31
第六節 資料收集33
第七節 資料處理與統計分析33
第四章 結果38
第一節 樣本回收38
第二節 樣本特性39
第三節 牙醫醫療品質的感受與滿意度的描述性研究結果43
第四節 影響感受的因素的分析結果50
第五節 影響滿意度的因素的分析結果51
第六節 牙醫師與其親自診治的病患的看法的一致性55
第五章 討論56
第一節 研究結果討論56
第二節 研究特色81
第三節 研究限制82
第六章 結論與建議84
第一節 重要結論84
第二節 建議85
參考文獻89
附錄
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