住院病人信任與對醫師照護評價關係之探討

Abstract

背景與目標：信任是「醫病關係品質」的重要元素之ㄧ，而且是預測醫療服務成效的最佳指標；雖然「病人信任」是普遍被關心的議題，但在許多不同醫病關係的威脅下，信任有逐漸下降的情形。文獻中已經有許多關於基層照護醫師的研究，然而住院病人對於醫師的信任情形之研究則較缺乏，本研究的目的是為了解住院病人對醫師的信任與病人對醫師照護評價間的關係。 方法：本研究引用由美國Wake Forest大學Professor Hall等學者發展並已加以應用的病人對醫師之信任度量表(Interpersonal Physician Trust Scale, IPTS)，來測量病人對醫師的信任度。同時獲得原作者的授權，中文化過程包括英翻中、中翻英的回譯，並邀請Professor Hall作為回譯版本翻譯品質標準，並依其給分予以修正，最後依前測結果修改後完成定稿。本研究採橫斷性研究，在經徵詢院方同意與倫理委員會審查後，最後以大台北地區2家私立醫學中心、1家公立醫學中心、1家公立區域教學醫院、1家私立地區教學醫院為個案醫院，以其中照護之住院病人為分析單位。本研究採立意取樣，於2006/5/01至2006/6/19收案期間共計收集397位有效樣本。 結果：本研究中病人信任度量表共有10題具有高度內部一致性(Cronbach α係數為0.884)。經複迴歸分析，發現年齡、有無其他科別會診與醫院別等變項，與病人信任度有顯著相關；病人信任度、婚姻狀況與醫院別等，與病人滿意度有顯著相關。經羅吉士迴歸分析，發現與病人信任度、婚姻狀況與住院途徑等，與是否尋求另一醫師意見有顯著相關；病人信任度與住院科別，和病人懷疑醫師的話有顯著相關；病人信任度與醫院別，和病人是否遵從醫師建議有顯著相關；病人信任度與職業，和更換醫師意願有顯著相關。 結論：在控制其他變項後，病人信任度與病人對醫師照護的評價有顯著相關。

Background and objective：Trust is a fundamentally important aspect of medical treatment relationship. Experience in USA has shown that trust between physician and patient has become one of the most serious problems under managed care systems. Patient trust is concerned in physician patient relationship, but it is destroyed under different threat to patient trust. It had been done by previous research on trust in primary care physicians. However, research in hospitalized care is still not enough. The purpose is to explore the relationship between hospitalized patient’s trust and evaluation toward physician. Method：This study adopted Interpersonal Physician Trust Scale developed by professor Hall etc. in Wake Forest University to measure patients’ trust in physicians. The study obtained the authorization directly from Professor Hall. The modification procedures included translation from English to Chinese, back- translation from Chinese to English, rated of English by Professor Hall as gold standard, and modified the Chinese according to his rating. The final version was decided after pretest of the draft. This is a cross-sectional study. After searching for cooperation from hospitals and approved by the Institutional Review Board procedure, five hospitals in Taipei agreed to join this study that included two private medical centers, one public medical center, one public regional hospital and one private local hospital. Hospitalized patients in sample hospitals were treated as unit of analysis. All samples came from convenient sampling. There were 397 valid samples with collection period from May first to June 19, year 2006. Result：There are 10 questions in IPTS with high internal consistency (the coefficient of Cronbach α= 0.884). From multiple regression analysis, the results found that age, whether consultations on other specialist and hospitals as a whole had significant relationship with patients’ trust in their physician; patients’ trust in their physician, marriage status and hospital as a whole had significant relationship with patients’ satisfaction in their physician. From logistic regression analysis, patients’ trust in their physician, marriage status and route of admission had significant relationship with searching second opinion; patients’ trust in their physician and admission department had significant relationship with disputing physician; patients’ trust in their physician and hospital as a whole had significant relationship with complying with physicians’ recommendation; patients’ trust in their physician and occupation had significant relationship with intention for switching physician. Conclusion：After controlled for other variables, patient’s trust in their physicians is related to patient’s evaluation toward physician.