Objective To investigate the patients satisfaction with medical services delivered by both city-level hospitals and grassroots medical institutions in Sanming City,comprehensively evaluating the implementation results of medical and health system reform in Sanming.Methods Using typical case sampling,from a district and 2 counties of Sanming,we selected 4 city-level general hospitals and 6 grassroots medical institutions (including 2 community health service centers and 4 township health centers) and from these facilities,we recruited 496 outpatients and inpatients using convenient sampling.In April 2017,we conducted a face-to-face survey among them with a self-developed Sociodemographic Questionnaire and PatientSatisfaction Questionnaire Short-Form (PSQ-18).The response rate for participants from hospitals was 95.6％ (369/386),and that for those from grassroots medical institutions was 99.1％ (109/110).Results In terms of the subscale score of PSQ-18,primary care achieved higher patient satisfaction score than hospital care in all the 7 subscales (general satisfaction,technical quality,interpersonal manner,communication,financial aspects,time spent with doctor,and accessibility and convenience) (P＜0.05).Both primary care and hospital care obtained highest patient satisfaction score in interpersonal manner subscale [(3.97±0.71) for hospital care,and (4.50± 0.59) for primary care],and lowest patient satisfaction score in financial aspects subscale [(3.34± 0.71) for hospital care,and (3.87± 0.67) for primary care].With regard to the item score of PSQ-18,both primary care and hospital care gained similar patient satisfaction score in two items,"I think my doctor's office has everything needed to provide complete medical care" and "Doctors are good about explaining the reason for medical tests" (P＞0.05),but primary care achieved significantly higher patient satisfaction score in the remaining 16 items (P＜0.05).In detail,hospital care achieved higher patient satisfaction score in 2 of the 18 items,which are "My doctors treat me in a very friendly and courteous manner" (4.16± 0.80) and "When I go for medical care,they are careful to check everything when treating and examining me" (4.11 ± 0.73),but gained lower patient satisfaction score in the items of "I feel confident that I can get the medical care I need without being set back financially" (3.33 ± 0.96) and "Where I get medical care,people have to wait too long for emergency treatment" (3.34± 0.94);primary care achieved higher patient satisfaction score in 2 items of "My doctors treat me in a very friendly and courteous manner" (4.62 ± 0.68) and "I have easy access to the medical specialists I need" (4.49± 0.68),but obtained lower patient satisfaction score in 2 items of "I feel confident that I can get the medical care I need without being set back financially" (3.74± 0.99) and "I think my doctor's office has everything needed to provide complete care" (3.77± 0.92).Conclusion In Sanming City,primary care gains higher overall level of patient satisfaction compared with hospital care.Among all the service aspects,service attitude obtains the highest level of patient satisfaction,while economic efficiency gains the lowest.In view of this,the overall level of patient satisfaction with medical services,especially the economic efficiency,should be improved further.%目的 了解三明市医院和基层医疗卫生机构患者对医疗卫生服务的满意度,旨在全面评价三明市医药卫生体制改革的实施成效.方法 采用典型抽样法在三明市的1个区、2个县共选取了4家综合医院、6家基层医疗卫生机构(包括2家社区卫生服务中心、4家乡镇卫生院),采用方便抽样法选取门诊和住院患者496例为调查对象.于2017年4月,采用自行设计的人口社会学特征调查问卷和18条目简明患者满意度问卷进行面对面现场调查.综合医院患者发放问卷386份,回收有效问卷369份,问卷的有效回收率为95.6％;基层医疗卫生机构患者发放问卷110份,回收有效问卷109份,问卷的有效回收率为99.1％.结果 基层医疗卫生机构患者对医疗卫生服务“一般满意度”“技术服务质量”“医生人际交流能力”“医患沟通能力”“服务经济性”“服务时效性”“服务可及性与便利性”7个维度的满意度评分高于医院患者,差异均有统计学意义(P＜0.05).医院和基层医疗卫生机构患者对医疗卫生服务“这里设备齐全,能给我提供完善的服务”“这里的医生通常会向患者解释清楚做生化检查的原因”2个条目的满意度评分比较,差异无统计学意义(P＞0.05);基层医疗卫生机构患者对其余16个条目的满意度评分高于医院患者,差异均有统计学意义(P＜0.05).从具体维度来看,医院和基层医疗卫生机构患者满意度评分最高的维度均为“医生人际交流能力”,分别为(3.97±0.71)、(4.50±0.59)分;满意度评分最低的维度均为“服务经济性”,分别为(3.34±0.71)、(3.87±0.67)分.从具体条目来看,医院患者满意度评分较高的2个条目为“这里的医生对待患者友善礼貌”“这里的医生诊治患者时非常仔细”,分别为(4.16±0.80)、(4.11±0.73)分;满意度评分较低的2个条目为“我确信经济因素不会妨碍我到这里就医”“我在这里需要紧急医疗服务时,等候时间太长”,分别为(3.33±0.96)、(3.34±0.94)分.基层医疗卫生机构患者满意度评分较高的2个条目为“这里的医生对待患者友善礼貌”“我想看这里的任何医生都很方便”,分别为(4.62±0.68)、(4.49±0.68)分;满意度评分较低的2个条目分别为“我确信经济因素不会妨碍我到这里就医”“这里设备齐全,能给我提供完善的服务”,分别为(3.74±0.99)、(3.77±0.92)分.结论 基层医疗卫生机构患者对医疗卫生服务的满意度总体高于医院患者,患者对三明市卫生服务机构医务人员服务态度的满意度最高,对服务经济性满意度最低,整体满意度有待继续提高,尤其需要关注医疗卫生服务的经济性.
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