Tsai W, Kung P; AcademyHealth. Meeting (2003 : Nashville, Tenn.).
Abstr AcademyHealth Meet. 2003; 20: abstract no. 708.
China Medical College, Graduate Institute of Health Services Management, 11 Ln16 Sec.3 Chungching Rd., Taya, Taichung, 428 Tel. 886-4-25603149 Fax 886-4-25603149
RESEARCH OBJECTIVE: Taiwan's health care system is without a mandatory referral system for patients. Many patients (43%) choose hospitals' physicians rather than clinic physicians for primary care. Hospitals' physicians have heavy burdens for taking care many patients without serious diseases. In order to increase the patients' willingness to use clinics for primary care, this study was to investigate the service quality gaps between patients and clinic physicians for primary care services at Taiwan clinics, and to determine the factors affecting patients' satisfaction for clinic care. STUDY DESIGN: Compare the perception of primary care services between patients and clinic physicians. This study used the structured questionnaire to ask patients and clinic physicians. Based on the patients' picking numbers at the pharmacy department, patients were randomly selected from 18 hospitals and 40 clinics. The patients were interviewed to answer the questionnaires, and the clinic physicians were asked with the mailed questionnaires. The multiple regression analysis was applied to determine the factors associated with the patients' satisfaction for clinic services. Important- Performance Analysis (IPA) was used to examine the service quality gaps for clinic care between patients and clinic physicians. POPULATION STUDIED: 1148 effective questionnaires were received from patients, which 754 were from hospitals' patients and 394 from clinics' patients. A total of 760 effective questionnaires from clinic physicians were returned by mail. PRINCIPAL FINDINGS: In general, the illness explanation, sanitation, and physician professional competence were the three most important factors for patients' choices for medical services. The major reasons for choosing clinic physician services were shorter waiting time and transportation time while the major reasons for not choosing clinic care were same as the reasons choosing hospital's physicians, which were hospital's physicians having higher professional competence, hospitals having more medical equipments, and more choices on specialists. Another important reason that patients choose hospital's physicians instead of clinic phycians was low deductible for using hospital's services without physician referral. The significantly affecting factors for patients' satisfaction with clinic care included patient's education level, transportation distance, physician's professional competence, service attitudes of nurses and pharmacists, diagnosis time, and illness explanation. Clinic physicians evaluated themselves with higher satisfaction than patients' evaluation for them. Comparing the perception of physicians with that of patients, we found clinic physicians seriously underestimated the importance on the aspect of illness explanation, sanitation, and explanation of medicine prescription at medical care services. CONCLUSIONS: The study results showed that there are important service quality gaps for clinic care between patients and clinic physicians. In order to decrease the service gaps and attract more patients to use clinics for primary care, we propose the following recommendations: (1) For clinic physicians: improving clinic service quality, establishing group medical practice, and increasing physician continual education; (2) For health policy makers: increasing the deductible for using hospital services without physician's referral, or implementing a mandatory physician referral system, and educating patients with the concept of physician referral services. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: Quality service gaps, primary care practice, and patient satisfaction
Publication Types:
Keywords:
- Ambulatory Care Facilities
- Communication
- Health Services
- Health Services Research
- Humans
- Interviews as Topic
- Patient Satisfaction
- Physicians
- Primary Health Care
- Questionnaires
- Referral and Consultation
- Research
- Taiwan
- hsrmtgs
Other ID:
UI: 102275677
From Meeting Abstracts