| Summary: | 碩士 === 弘光科技大學 === 健康事業管理研究所 === 102 === Background: the core and basis of medical care is based on the primary care setting (PCS), but in Taiwan the free choice of medical care for people caused the wasting of limited medical resource which oriented from the dysfunction of PCS. Therefor the study on the quality and function of PCS in Taiwan’s medical care system is important and significant.
Purpose: the purpose of this study is to evaluate and analyze the quality and satisfaction of PCS in Taiwan.
Methods: the subject is the people lived in Taiwan and the age ranged from 20 to 70, there are 16,435,948 cases (male is 8,187,220 and female is 8,248,728; data got from interior ministry of ROC, 2014) as the studying population. The instrument used primary care assessment tool (PCAT) to assess the quality of PC, and the interviewing tool used by telephone-interviewing (CATI, computerized aid telephone interviewing). In this study, we have 1,062 cases successfully and the successful sampling rate is 6.5‰‰.
Results: the results showed the characteristics of demography that age ranged from 50-59 years old (32.2%), job were full time work generally (48.7%), income attributed to no salary (44.8%), education level were high school (27.6%), living area were in north (42.0%) and gender were female (64.1%). To compare the difference analysis in demography for PCS choice, selection affected factors and caring quality, there were significantly different in age, job, income and education for PCS choice; the most concerning factors in PCS selection were friendly (11.1%), facility (10.6%), caring quality (10.6%), moreover in the selection affected factors the location, waiting time, registrations, and expenditure were significantly different. For the quality assessment of PCS, a higher PCAT score showed a higher caring quality, in general the PC quality showed that in the culture ability (0.75 ± 0.371)、ongoing (0.69 ± 0.278)、first contact utility (0.68 ± 0.280) had a higher quality, and also in the quality of PC, the ongoing care, information coordination, community service and culture there were significantly difference. We also to study the correlation between PCAT factors with satisfaction, the results showed the correlation coefficient of first contact utilization (0.033), first contact access (0.102), ongoing care (0.032), coordination (-0.045) and cultural competence (0.904) that was significantly correlation for each other. Finally, we analyzed the prediction to choice PCS selection; the results of odds ratio (OR) found the first contact access (2.028), community orientation (2.325), cultural competence (1.615), ongoing care (0.516), coordination information system (0.266), there were significantly predictors.
Conclusions: the study results showed the PC caring quality in Taiwan that were better in culture, ongoing care and first contact utility, and the community oriented, comprehensive care, coordination were bad. Therefore we need to through education and teaching to improve the PCS caring quality. However in the evaluation of satisfaction, the first contact utilization, first contact access, ongoing care, culture, coordination were significantly correlation with satisfaction. For the prediction of PCS selection, according to our study the first contact access, ongoing care, coordination information, community oriented and culture ability were significant meaning.
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