Study On Physician-Patient Communication Quality And Its Influencing Factors-A Case Study In A Tertiary Hospital’s Outpatient

Research BackgroundAt present, medical dispute has become a social problem which cannot be ignored. Especially with the improving of awareness of legal rights and increasing of the patient’s medical needs, physician-patient dispute is demonstrating its prominence. One of the reasons is the poor communication between physician and patients, therefore, it is of vital importance to identify the reasons and countermeasures of physician-patient communication problems. According to figures,80%of medical dispute were caused by ill communication between physician and patients and20%came from medical techniques also connecting with physician-patient communication quality. Thus, it is fair significant that we should find out the reason and strategy of its influencing factors. Back in2002, physician-patient communication skill has been included in one of the necessary clinical skills of the medical personnel in Kalamazoo Declaration. The study by Boulet JR found that there is a high correlation between the communication skill of the medical personnel and their medical level. Beach MC considered that the likely cause is that good physician-patient communication will lead to better behavior of the patient, such as smoking cessation, increasing physical activity, changing dietary habits and so on, so as to produce a better therapeutic effect. However, physician-patient communication in China starts relatively late. As study of physician-patient is still based on concept discussion, and evaluation method of communication quality based on qualitative research, and research on quantitative evaluation method and quantitative tool have been just started in China, there still is lack of wide approved evaluation tool for physician-patient communication. At present, most studies on influencing factors of physician-patient communication are qualitative research, and their evaluation tools are mostly referred from overseas studies. Due to cultural differences at home and abroad, and different medical system and diagnosis process, foreign scales cannot be directly used for China. As rare quantity of reports on physician-patient communication in China, it is a long-term task with theoretical and practical significance presently on how to use physician-patient communication quality evaluation form that suitable for the situation of China, discussing and analyzing the influencing factors of physician-patient communication barriers from micro physician-patient communication, and searching for the countermeasures of improving physician-patient communication.ObjectivesThe objectives of this paper are aimed to search the influencing factors of physician-patient communication quality from four aspects of communication process, personal factors of the patient, physician and the society through empirical research, and provide scientific reference for continually improving outpatient medical service level, outpatient service quality and physician-patient relationship.Material and MethodsThis study aims to evaluate the service quality with cognitive performance by adopting convenience sampling method, carrying out questionnaire to the patients after seeing a doctor in a tertiary hospital in Tai’an City, referring the scale currently used abroad and items of Physician-Patient Communication Quality Evaluation Scale designed by Liu Benzhi and so on, collecting data by applying Physician-Patient Communication Quality Questionnaire, using5Level Balance Form of the positive scale, and adopting SERVPERF evaluation method. And the statistical methods including testing of validity and reliability, factor analysis, regression analysis etc. were used to study in this paper. Both data input and analysis adopted spss16.0. Main Results1. Cronbach’s a coefficients and split half reliability are used to test the internal reliability. Cronbach’s a is coefficient0.902. Split half reliability test of the scale adopts odd-even split-half method, Spearman-Brown correlation coefficient of the two subscales of up and down is0.919. The above results show the internal reliability is satisfied.2. Statistic of construct validity KMO is0.901, approximate chi-square value is4854.0, dof is325, P value is0, and therefore, this scale is suitable for factor analysis. The three common factors were extracted which explained58.566%variance. The items of therapeutic schedule and burden of expenditure of diagnosis and treatment had higher factor loading. As a result, there were15items of communication contents,7of empathy and4of communication results. Thus,3-dimension of hypothesis was verified.3. All of26items of the communication process have an effect on communication quality score, including8strong correlation factors.4. Personal factors of the outpatients:gender, education, age have no significant effect on the communication quality.5. Gender and departments of the clinic physicians have no effect on the communication quality.6. Payment mode of the outpatients has a significant effect on thecommunication quality. Conclusions and Suggestions1. All26items of communication process had impacts on outpatient physician-patient communication quality and also on comprehensive evaluation.15items from communication method have a significant impact on the overall quality, especially introducing pros and cons of the treatment options to the patient, explaining the reason why it needs to conduct the inspection and the test results to the patient are the most influential top3factors, which are also easily ignored factors by the physicians during their daily clinical reception. Item score within the dimension of "Communication Mode" is associated with overall quality score of the communication mode, including4strong correlative items:explaining to the patient with patience, answering questions with patience, listening patiently and interrogation time.2. Item score of physician-patient communication results is related to the overall quality score of the communication results, in which most relevant is to learn daily health care knowledge.3. Gender and departments of the physicians have no significant effect on the communication quality.4. Personal factors of the patient:gender, education, age have no significant effect on the communication quality score; payment mode has a significant effect on the communication quality evaluation; patients with reimbursement by his (her) unit have higher evaluation than those at his (her) own expense and with payment of health care card in communication quality.5. Suggestions:5.1On the government level, further deepen the reform of hospital system, return to the responsibilities of the major hospitals treating acute critical illness and diagnosing difficult cases, meanwhile, increase propaganda work in medical science knowledge to the public;5.2Regularly carry out training on hospital communication skills and develop standard processes by the hospitals; integrate the physician-patient communication system into medical quality management system by the health administrative department, and rank it as the core system of the hospital, while integrate into the hospital standardized construction system of the health administrative department; hospital administrative department incorporates health education into the annual comprehensive management objectives of the departments; the hospital strengthens humanistic care and professional ethics education, evaluates medical personnel according to the Physician-Patient Communication Quality Evaluation Scale, develops performance appraisal program of physician-patient communication;5.3Hospital administrative department strengthen supervision and establish long-term and effective mechanism to realize real physician-patient communication and achieve harmony and understanding between physician and patients.