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研究生:李慈心
研究生(外文):Tzu-Hsin
論文名稱:台灣身心障礙者口腔健康調查及接受牙科醫療滿意度之研究
論文名稱(外文):A Study of the Oral Health, Treatment Needs, and Dental Treatment Satisfaction for the People with Special Needs in Taiwan
指導教授:周明勇周明勇引用關係
指導教授(外文):Ming-Youn Chou
學位類別:博士
校院名稱:中山醫學大學
系所名稱:醫學研究所
學門:醫藥衛生學門
學類:醫學學類
論文種類:學術論文
論文出版年:2010
畢業學年度:98
語文別:中文
論文頁數:82
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研究目的:本研究的目的在調查身心障礙者的口腔健康,同時探討他們接受身心障礙牙科的醫療服務滿意度。此外本研究希望能提出一個理論模型,說明醫療服務品質與病患滿意度、忠誠度間的關係,並釐清其因果關係。
方法:本研究針對台灣中部地區至中山醫學大學附設醫院牙科部接受全身麻醉牙科醫療服務的身心障礙者,其身心障礙類別是根據身心障礙手冊的分類來登記。我們依據WHO口腔健康調查的研究方法論,設計口腔檢查表,並使用探針進行口腔檢查,共159位 (男性103 位;女性 54位)完成檢查;本文主要是擷取口腔檢查中齲齒指數的部份來做分析。另外進行治療滿意度問卷調查( N = 251)則利用因素分析、路徑分析釐清本院牙科部服務品質、患者滿意度與忠誠度之關鍵因素與因果關係。
研究結果:口腔檢查顯示平均恆牙齲蝕缺牙充填指數(DMFT)為11.45 ± 5.84;乳牙齲蝕缺牙充填指數(deft)為4.59 ± 3.35。問卷調查分析結果顯示:「醫療技術品質」與「醫病互動關係」兩個構面皆對身心障礙病患滿意度有顯著的影響;會間接影響忠誠度,其中以「醫療技術品質」對滿意度影響較大。
結論:根據實證研究結果發現,身心障礙者平均齲蝕缺牙充填指數遠高於一般民眾(DMFT為7.84;deft 為 3.14),顯示其牙科治療需求極大。另外「醫療技術品質」對於身心障礙病患滿意度之效果,大於「醫病互動關係」,這顯示出身心障礙患者較重視「專業技術品質」。因此醫療院所方必須提升專業技術品質與醫病互動關係,透過病患滿意度的增加,方能進而提高病患忠誠度。


In recent years, the dental health of handicapped people has raised great attention. A few studies have investigated the dental status (caries, filling, missing etc) of the people with special needs in Taiwan, but the degree of satisfaction after dental treatment was not mentioned. Therefore, the purpose of this study is to investigate the oral health, treatment needs and degree of satisfaction after dental treatment for handicapped.
In this research, DMFT and deft index was used for dental health survey (N=159); and a questionnaire (N = 251) was filled out by the main care-givers of the handicapped patients for dental treatment satisfaction study. Factor analysis and path analysis were used to investigate the relation between quality of medical care, patients’ satisfaction and patient loyalty.
The result of this study shows that the people with special needs in Taiwan have more caries and more treatment needs (DMFT index 11.4± 5.84;deft index 4.59 ± 3.35). The “quality of medical care“ and “interpersonal relationship between doctor and patient” are key factors for patients’ satisfaction, and patients’ satisfaction leads to loyalty. Above all, “quality of medical care“ had more profound influence on patients’ satisfaction. Based on the study result, we as treatment provider should improve our quality of dental care and treatment outcome for patient satisfaction as well as patient loyalty.


中文摘要…………………………………………………………………………… II
英文摘要 ………………………………………………………………………… III
誌謝………………………………………………………………………………… IV
目 錄…………………………………………………………………………………V
圖目次 ……………………………………………………………………… … VII
表目次…………………………………………………………………………… VIII
壹、緒論………………………………………………………………………………1
第一節 研究動機與目的 …………………………………………………………1
第二節 研究對象與流程 …………………………………………………………5
貳、文獻探討……………………………………………………………………… 7
第一節 身心障礙者福利政策沿革 ………………………………………7
第二節 身心障礙者口腔健康及醫療照護現況 ……………………………14
第三節 醫療服務品質文獻探討討………………………………………………20
第四節 滿意度文獻探討 ……………………………………………………… 27
第五節 忠誠度文獻探討…………………………………………………………30
參、研究方法……………………………………………………………………… 34
第一節 口腔檢查表(DMFT & deft) …………………………………………… 34
第二節 研究假設……………………………………………………………… 35
第三節 研究架構 ……………………………………………………………… 36
肆、模式建構與研究設計………………………………………………………… 37 第一節 治療滿意度問卷設計……………………………………………………37
第二節…資料蒐集與處理……………………………………………………… 38
伍、實證結果分析 …………………………………………………………………44

第一節 敘述統計…………………………………………………………………44
第二節 問卷信效度分析 ……………………………………………………… 52
第三節 模式修正與驗證…………………………………………………………54
第四節 假設驗證…………………………………………………………………62
陸、結論與建議………………………………………………………………………64 參考文獻 中文部份…………………………………………………………………68參考文獻 英文部份…………………………………………………………………71
附件一:問卷…………………………………………………………………………80
附件二:人體試驗委員會認證證書……………………………………………… 82


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中央健康保險局,民眾服務—最新健保數據—全民健康保險統計,網址http://www.nhi.gov.tw/webdata/webdata.asp?menu=1&menu_id=4&webdata_id=805&WD_ID=4。
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