Zhongguo quanke yixue (May 2022)
Factors Associated with Community-dwelling Chronic Disease Patients' Experience of Integrated Medical-elderly-nursing Services
Abstract
Background The integrated medical-elderly-nursing (IMEN) services are promising to be very effective in addressing healthcare problems in multiple chronic disease patients in an aging society, but the quality of the services has been less focused. Objective To identify the factors associated with community-dwelling chronic disease patients' experience of IMEN services, so as to provide a reference for improving the quality of IMEN services and the experience of this group. Methods From June to September 2020, a questionnaire survey was conducted with a convenience sample of 525 community-dwelling chronic disease patients with IMEN services selected from Hanghou, Zhejiang Province, to collect their individual characteristics, process of IMEN services, and experience of IMEN services. The Chinese version of SERVQUAL developed based on the GAP Model of Service Quality was used to measure the discrepancy between patients' expectations for IMEN services and their perceptions of the services. With referring to the structure-process-outcome model, a structural equation model was developed, assuming that the features of IMEN services (process factors) were influenced by patients' individual characteristics (structure factors) , and both of them affected patients' experience of IMEN services (outcome factors) . Results The total average score of feeling and expectation of IMEN services for community patients with chronic diseases in Hangzhou was (5.14±0.44) , (6.80±0.01) , and the total average score of the gap between feeling and expectation was (-1.65±0.44) . Multiple linear regression analysis showed that gender, monthly income, payment method of medical expenses, number of illnesses suffered, prevalence of changing the service team, service items and number of service delivery patterns were associated with the discrepancy between patients' expectations for IMEN services and their perceptions of the services (P<0.05) . The analysis based on the structural equation model revealed that patients' experience of IMEN services was mainly directly affected by the features (duration of contracting the IMEN services, service items, and delivery patterns, smart medical care) of IMEN services (path coefficient=-0.51, P<0.001; direct effect size=-0.51, P=0.002) . Moreover, patients' experience of IMEN services was also directly influenced by individual characteristics (age, education level, self-care ability, number of illnesses) (direct effect size=-0.14, P=0.026) , and indirectly influenced by such individual characteristics through features of IMEN services (indirect effect size=-0.24, P=0.002) . Conclusion Community-dwelling chronic disease patients accepted the IMEN services, but their service experience needed to be improved further by interventions such as improving the utilization of IMEN services, enriching the service delivery patterns, making full use of smart medical care and providing more personalized services.
Keywords
