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Zadovoljstvo bolnikov kot merilo kakovosti dela zdravnika splošne medicine
Avtor: Damjan Vidovic
Mentor: doc. Igor Švab, dr. Med
Somentor: as. Janko Kersnik, dr. Med
IZHODIŠCA: Kakovost dela zdravnika splošne medicine postaja vedno bolj pomemben clen v verigi zagotavljanja kakovosti zdravstvene oskrbe. Zadovoljstvo bolnikov je eden izmed izidov zdravstvene oskrbe in ga lahko uporabljamo kot merilo kakovosti. S pravico bolnikov do izbire osebnega zdravnika je zadovoljstvo bolnikov še pridobilo na pomenu. Z raziskavo sem želel opredeliti vzroke za zamenjavo osebnega zdravnika; vpliv posameznih prvin zdravnikovega dela in organizacije ambulante na zadovoljstvo bolnikov; vpliv spola, starosti in izobrazbe bolnikov na njihovo zadovoljstvo in povezanost vzrokov za zamenjavo osebnega zdravnika s stopnjo zadovoljstva. Predpostavljal sem, da med vzroki za zamenjavo osebnega zdravnika prevladujejo preselitev, nezadovoljstvo z organizacijo dela in zdravstveno oskrbo; da na nezadovoljstvo bolnikov vpliva tudi njihov spol, starost in izobrazba; ter da je pri bolnikih, ki so kot vzrok zamenjave navedli delo zdravnika in medicinske sestre njihovo nezadovoljstvo vecje.
METODE: Nakljucnemu vzorcu 300 zavarovancev, ki so v letih 1995 in 1996 zamenjali osebnega zdravnika v Obmocni enoti Kranj Zavoda za zdravstveno zavarovanje Slovenije sem razposlal anketo o zadovoljstvu z delom zdravnika splošne medicine. Uporabil sem prevod angleške ankete A method for surveying patient satisfaction. Odgovori na vprašanja o zadovoljstvu so bili ocenjeni po petstopenjski lestvici, kjer nižja vrednost predstavlja višjo stopnjo zadovoljstva.
REZULTATI: Najpogostejši vzroki za zamenjavo osebnega zdravnika med anketiranimi bolniki je bilo zdravnikovo delo (44,4 %), sledila je oddaljenost (18,9 %), delo medicinske sestre (12,2 %), preselitev (11,1 %), organizacija dela (11,1 %) in oprema ambulante (1,1 %). Bolniki so pri posameznih vprašanjih izrazili najvecje nezadovoljstvo s pogovorom z zdravnikom (4,06), najbolj pa so bili zadovoljni z obiskovanjem istega zdravnika (2,01 ). Pri posameznih prvinah so bili bolniki najmanj zadovoljni s casom, ki jim ga je zdravnik posvetil (3,47), sledile so: sporazumevanje (3,21 ), zaupanje v zdravnika (2,99) in zdravnikov pristop (2,93). Vprašani so bili najbolj zadovoljni z obiskovanjem istega zdravnika (2,01 ) in s prijaznostjo zdravnika (2,02). Starejši bolniki so izrazili vecje skupno zadovoljstvo z zdravnikovim delom (p = 0,02) in z ambulanto (p = 0,004). Spol in izobrazba nista vplivala na skupno zadovoljstvo. Pri posameznih prvinah zadovoljstva pa so bili moški manj zadovoljni z prijaznostjo zdravnika kot ženske (p = 0,04). Bolniki z visokošolsko izobrazbo so izrazili vecje nezadovoljstvo s casom obiska (p = 0,03).Bolniki, ki so kot vzrok zamenjave navedli delo zdravnika in medicinske sestre, so izrazili vecje nezadovoljstvo pri splošnem zadovoljstvu (p < 0,001), zaupanju (p < 0,001), tehniki zdravnikovega dela (p = 0,001), pojasnjevanju (p < 0,001) in prijaznosti zdravnika (p < 0,001), pri sporazumevanju (p < 0,001) ter pri zadovoljstvu z ambulanto (p = 0,03) in s kakovostjo z zdravstvene oskrbe (p = 0,02). S tem so bili doseženi cilji raziskave. Uspel sem potrditi dve postavljeni hipotezi. Prve hipoteze nisem uspel v celoti potrditi zaradi nizkega odstotka odgovorjenih anket in zato ker bolniki, ki so se preselili, niso bili dosegljivi z našim nacinom anketiranja.
ZAKLJUCKI: Na podlagi rezultatov predlagam uvedbo novega obrazca o zamenjavi osebnega zdravnika, stalno sporocanje vzrokov za zamenjavo osebnim zdravnikom ter uvedbo dodatnega strokovnega izpopolnjevanja, na katerem bi bil poudarek na ucenju sporazumevanja.
[Abstract / English version]
Patient satisfaction as a measure of quality of general practitioner's work
Author: Damjan Vidovic
Mentor: doc. Igor Švab, dr. Med
Co-mentor: as. Janko Kersnik, dr. Med
BACKGROUND: The work of a general practitioner (GP) is becoming an increasingly important in quality assurance. Patient satisfaction can be used as a measure of quality. With the introduction of the personal doctor concept patient satisfaction became important. The aims of the study were to define the reasons for changing the GP; to examine the influence of various elements of his work and practice organisation on patient satisfaction; to examine the influence of patient's sex, age and education on their satisfaction and to examine the correlation between the reasons for changing the GP with the degree of satisfaction. The hypotheses were that the moving, dissatisfaction with practice organisation and medical care are the main reasons for dissatisfaction; that patient's sex, age and education have an influence on patient satisfaction and that the patients who have listed GP's and nurse's work as a reason for changing have a higher level of dissatisfaction.
METHODS: A random sample of 300 people who have changed their GP in 1995 and 1996 in the region of Kranj have been sent a questionnaire about satisfaction with their former GP. A translation of an English questionnaire A method for surveying patient satisfaction was used for this purpose. The answers to the questions were listed on a five-point scale with lower value indicating higher satisfaction.
RESULTS: The main reasons for change were GP's work (44,4%), followed by distance from surgery (18,9%), nurse's work (12,2%), moving ( 11,1 %), practice organisation (11,1 %) and equipment (1,1 %). The greatest reason for dissatisfaction was communication with the GP (4,06), the greatest reason for satisfaction was visiting the same doctor (2,01 ). Among the various elements the greatest reason for dissatisfaction was the time for consultation (3,47), followed by communication (3,21 ), trust in GP (2,99) and GP's approach (2,93). The greatest reason for satisfaction were visiting the same doctor (2,01) and politeness (2,02). Elderly patients were more satisfied with the GP's work overall (p=0,02) and practice (p=0,004). Sex and education did not show any influence on satisfaction. Men were less satisfied with politeness by the doctor (p=0,04). Patients with higher education were less satisfied with the duration of the visit (p=0,03). The patients who have listed the GP's and nurse's work as a reason for changing the practice, had a lower overall satisfaction (p<0,001), trust (p<0,001), working technique (p=0,001), explanation (p<0,001), politeness (p<0,001), communication (p<0,001), practice satisfaction (p=0,03) and quality of care (p=0,02). The aims of the study were thus achieved and two hypotheses were confirmed. The first hypothesis could not be confirmed due to a low response rate and because the patients who have moved could not be reached.
CONCLUSIONS: A new form for changing the doctor is suggested, together with a constant feedback of the reasons for changing and the introduction of educational activities aimed at communication skills.