四川大学学报（医学版）2025，Vol.56Issue(6)：1481-1491,11.DOI:10.12182/20251160602
紧密型县域医共体中慢性病患者就医满意度现状及影响因素:一项混合方法研究
Current Status and Influencing Factors of Healthcare Satisfaction Among Chronic Disease Patients Under the Background of Compact County-Level Medical Alliances:A Mixed Methods Study
摘要
Abstract
Objective To analyze the current status of patient satisfaction with outpatient care and the relevant influencing factors among patients with chronic diseases in a compact county-level medical alliance,and to provide evidence for optimizing chronic disease management in primary care settings.Methods Based on the Andersen's Behavioral Model of Health Services Use,an explanatory sequential mixed-methods design was employed in the study.In the quantitative phase,a questionnaire survey was conducted among 297 patients with chronic diseases to collect data on patient satisfaction.The influencing factors were analyzed using ordinal logistic regression,and pathway effects were examined using structural equation modeling.In the qualitative phase,semi-structured interviews were conducted and 13 patients with the highest and lowest scores for patient satisfaction were involved.Then,the key themes were extracted using thematic analysis.Results The overall patient satisfaction score was rather high([4.67±0.58]points on a 5-point scale).Significant influencing factors included age(odds ratio[OR]=1.03,95%CI:1.01-1.06),education(senior high school or above:OR=3.34,95%CI:1.21-9.24),knowledge of health insurance reimbursement(moderately informed:OR=0.54,95%CI:0.31-0.96),annual out-of-pocket expenditure for chronic diseases(>1 500 yuan:OR=0.40,95%CI:0.17-0.90),satisfaction with facility environment(OR=2.59,95%CI:1.38-4.84),and satisfaction with service capability(OR=3.00,95%CI:1.29-6.97).By influencing the contextual characteristics,individual characteristics had a positive effect on healthcare provider behaviors and medical outcomes,and healthcare provider behaviors also had a direct positive effect on medical outcomes.Thematic analysis of the interviews revealed four key areas of improvement—suboptimal diagnosis and treatment processes,insufficient healthcare professional competence,underutilization of facilities,and inadequate health education and management.Conclusion Measures such as strengthening training for village doctors,optimizing referral mechanisms,promoting telemedicine,and improving health education approaches are recommended to enhance patient experience and satisfaction.关键词
紧密型县域医共体/慢性病/患者满意度/基层医疗服务Key words
Compact county-level medical alliance/Chronic disease/Patient satisfaction/Primary health care services引用本文复制引用
LIAO Chuanyu,WENG Lingling,CHEN Chu..紧密型县域医共体中慢性病患者就医满意度现状及影响因素:一项混合方法研究[J].四川大学学报（医学版）,2025,56(6):1481-1491,11.基金项目
中国博士后科学基金(No.2020M683298)和福建省创新战略研究计划项目(No.2023R0037)资助 （No.2020M683298）
