عوامل موثر بر میانگین ویزیت - ساعت در بیمارستانهای وابسته به دانشگاه علوم پزشکی مازندران بعد از اجرا طرح تحول نظام سلامت
محورهای موضوعی : -مدارک پزشکی
محمدعلی جهانی
1
,
رویا فاخته
2
,
علیرضا فتحی
3
,
احمد خسروی
4
,
قهرمان محمودی
5
1 - دانشیار مرکز تحقیقات عوامل اجتماعی موثر بر سلامت، پژوهشکده سلامت ،دانشکده پزشکی، دانشگاه علوم پزشکی بابل، بابل، ایران
2 - کارشناس مامائی، دانشگاه علوم پزشکی مازندران، ساری، ایران
3 - کارشناس واحد اقتصاد و درمان، دانشگاه علوم پزشکی مازندران، ساری، ایران
4 - استادیار گروه اپیدمیولوژی، دانشکده بهداشت، دانشگاه علوم پزشکی شاهرود، شاهرود، ایران
5 - دانشیار مرکز تحقیقات مدیریت بیمارستان، واحد ساری، دانشگاه آزاد اسلامی، ساری، ایران
کلید واژه: بیمارستان‌ها, ویزیت ساعت, پزشکان, طرح تحول,
چکیده مقاله :
مقدمه:پایبند بودن پزشک به زمان استاندارد ویزیت نقش مه‌می‌در تشخیص و درمان وکاهش نیاز به ویزیت مجدد دارد. لذا مطالعه حاضر به تعیین روند تغییرات شاخص ویزیت - ساعت پزشکان بعد از طرح تحول نظام سلامت پرداخته است. روش پژوهش: این مطالعه به صورت مقایسه‌ای ، 6 ماهه دوم سال‌های1393و 1395 مقایسه گردیدند. جامعه آماری کلیه بیمارستانهای دانشگاه علوم پزشکی مازندران (24 بیمارستان) انتخاب شدند، اطلاعات مربوط به ویزیت درمانگاه‌های تخصصی هر بیمارستان (ساعت فعالیت ماهیانه پزشک و تعداد بیمار ویزیت شده، آموزشی / درمانی بودن ، نوع تخصص پزشک، وضعیت استخدام پزشک و ...) استخراج و با استفاده از نرم‌افزار STATA12، با آزمون‌های مرتبط در سطح معنی‌‌داری05/0p< آنالیز گردید. یافته‌ها: شاخص ویزیت - ساعت در سال1393برابر با 17/7± 11/9، درسال 1395 این میزان به 4/2±8/4 ویزیت به ازای یک ساعت فعالیت پزشک بوده است (0/002=p).مقایسه‌این شاخص در سه گروه تخصص نشان داد که میانگین ویزیت - ساعت متخصصین جراحی، 15/7 ±12/0، متخصصین داخلی، 12/4±9/7 و گروه سایر متخصصین، 4/2±7/8 بوده است (0/002=p)، سال 1393 میانگین ویزیت - ساعت در بیمارستانهای درمانی برابر با 12/1±10/3 و در بیمارستانهای آموزشی - درمانی 23/4±14/5 بوده است (0/02=p)، سال 95 در بیمارستانهای درمانی برابر با 3/6±8/1 و بیمارستانهای آموزشی - درمانی برابر با 4/9±8/8 بوده است (0/1=p). میانگین ویزیت - ساعت با تخصص پزشکان (0/001>p) و مالکیت بیمارستان (0/043=p) ارتباط معنی‌دار داشت. نتیجه‌گیری: میانگین شاخص ویزیت - ساعت در سال 1395 نسبت به سال 1393 بهبود یافته است. لذا در عین توجه به بهبود مستمر این روند، نظارت‌های بیشتر در جهت رسیدن به اهداف این بسته خدمتی مهم توصیه می‌شود.
Introduction: A doctor's obligation to follow standard time of visiting patients has an important role in diagnosis and treatment of diseases and decreasing in visiting times. This study aimed to determine the trend of changes in the rate of Physicians' visiting-hour indicator after carrying out the Health System Reform Plan. Methods: This comparative study compared the indicator from September 23, 2014 to 20 March 2015 and from September 23, 2016 to 20 March 2017.Research population included all 24 hospitals located in Mazandaran. Information on visiting activities in private clinics in each hospital (including the hours of Physicians' activity and the number of visited patients, teaching vs. non-teaching hospital, Physician's employment kind and his/her profession, etc.) was extracted and analyzed in pResults: The mean rates of visiting-hour indicator were 11.9±17.7 and 8.4±4.2 first year and second year, respectively (p=.002). The mean rates of this indicator amounted to 12/0±15.7, 9.7±12.4 and 7.8±4.2 for surgery, internal medicine and other professions, respectively (p=.002). In first year, the mean rates of the indicator amounted to 10.3±12.1 and 14.5±23.4 in non-teaching and teaching hospitals, respectively (p=.02). In second year, the mean rates of the indicator were 8.1±3.6 and 8.8±4.9 in non-teaching and teaching hospitals, respectively (p= .1). The mean rates of visiting-hour indicator were significant difference with Expertise (p< .001) and Ownership (p= .43) Conclusion: The mean of visiting-hour indicator recovered in second year (2016-2017) in comparison with that of first year (2014-2015). Therefore, while paying attention to continuous improvement of this process, more monitoring is recommended to achieve the objectives of this important service package.
1- Leite RC, Makuch MY, Petta CA, Morais SS. Women's satisfaction with physicians’ communication skills during an infertility consultation. Patient education and counseling. 2005; 59(1): 38-45. Doi:10.1016/j.pec.2004.09.006.
2- Lynn J. When does quality improvement count as research? Human subject protection and theories of knowledge. Quality and Safety in Health Care. 2004; 13(1): 67-70. Doi: 10.1136/qshc.2002.002436.
3- Schinkel S, Schouten BC, Street Jr RL, van den Putte B, van Weert JC. Enhancing Health Communication Outcomes among Ethnic Minority Patients: The Effects of the Match between Participation Preferences and Perceptions and Doctor–Patient Concordance. Journal of Health Communication. 2016; 21(12): 1251-9. Doi:10.1080/10810730.2016.1240269.
4 -Kessomboon P, Sinsupan N, Rattanasiri A, Ditsatapornjaroen W, Kuhirunyaratn P, Bumreourach S. Communication Skills for Medical Consultation. Srinagarind Medical Journal. 2008; 23(3): 250-7.
5 -Solomon J. How strategies for managing patient visit time affect physician job satisfaction: a qualitative analysis. Journal of general internal medicine. 2008; 23(6): 775-80. Doi: 10.1007/s11606-008-0596-y.
6 -Hu P, Reuben DB. Effects of managed care on the length of time that elderly patients spend with physicians during ambulatory visits: National Ambulatory Medical Care Survey. Medical care. 2002; 40(7): 606-13. Doi: 10.1097/01.MLR.0000017791.85577.3B.
7 -Hutchinson PL, Do M, Agha S. Measuring client satisfaction and the quality of family planning services: a comparative analysis of public and private health facilities in Tanzania, Kenya and Ghana. BMC health services research. 2011; 11(1): 203. Doi: 10.1186/1472-6963-11-203.
8 -Shaw MK, Davis SA, Fleischer AB, Feldman SR. The duration of office visits in the united s, 1993 to 2010. The American journal of managed care. 2014; 20(10): 820-6. PMID: 25365685.
9 -Cayirli T, Veral E. Outpatient scheduling in health care: a review of literature. Production and operations management. 2003; 12(4): 519-49.Doi /10.1111/j.1937-5956.10 -Moghaddam AV, Damari B, Alikhani S, Salarianzedeh M, Rostamigooran N, Delavari A, et al. Health in the 5th 5-years Development Plan of Iran: main challenges, general policies and strategies. Iranian journal of public health. 2013; 42(1): 42-49. Doi: PMCID: PMC3712611.
11 -Mohebbifar R, Hasanpoor E, Mohseni M, Sokhanvar M, Khosravizadeh O, Isfahani HM. Outpatient waiting time in health services and teaching hospitals: a case study in Iran. Global journal of health science. 2014; 6(1): 172-80. doi:10.5539/gjhs.v6n1p172.
12 -French MT, Homer JF, Klevay S, Goldman E, Ullmann SG, Kahn BE. Is the United States ready to embrace concierge medicine? Population Health Management. 2010; 13(4): 177-82. Doi: 10.1089/pop.2009.0052.
13 -Linz AJ, Haas PF, Fallon LF, Metz RJ. Impact of concierge care on healthcare and clinical practice.Journal-american osteopathic association. 2005; 105(11): 515-20. Doi : PMID:16368915.
14 -Goold SD, Lipkin M. The doctor–patient relationship. Journal of general internal medicine. 1999; 14(S1): 26-33. Doi: 10.1046/j.1525-1497.1999.00267.x.
15 -Chen B-l, Li E-d, Yamawuchi K, Kato K, Naganawa S, Miao W-j. Impact of adjustment measures on reducing outpatient waiting time in a community hospital: application of a computer simulation. Chinese Medical Journal (English Edition). 2010; 123(5): 574-80. Doi: 10.3760/cma.j.
16 -Becker F, Douglass S. The ecology of the patient visit: physical attractiveness, waiting times, and perceived quality of care. The Journal of ambulatory care management. 2008; 31(2): 128-41. Doi: 10.1097/01.JAC.0000314703.34795.44.
17 -Guy Jr GP, Richardson LC. Visit duration for outpatient physician office visits among patients with cancer. Journal of oncology practice. 2012; 8(3s): 2s-8s. Doi: 10.1200/JOP.2011.000493.
18 -Dadgar R, Jahani MA, Mahmoudi G. The impact of health system reform plan on the hospital's performance indicators of Lorestan University of Medical Sciences. Yafte. 2017; 19(2): 93-102. [Persian]
19- Khori V, Changizi S, Biuckians E, Keshtkar A, Alizadeh A, Mohaghgheghi A, et al. Relationship between consultation length and rational prescribing of drugs in Gorgan City, Islamic Republic of Iran. 2012; 18(5): 480-6. PMID: 22764435.
20- Gorji H, Sokhanvar M. Surveying the Standard of Outpatient Visit Time among General Hospitals: A case study in Qazvin. Journal of Hospital. 2015; 14(3): 75-81 [Persian].
21- Cai S, Qin ZY, Ping C, Fen J. The Effect of Prolonged Duration of Clinic Visits on Asthma Control and Patient-Doctor Relationships. A50 asthma: observational studies: Am Thoracic Soc; 2016; 193:A1733.
22- Omer W, editor. Use of mobile phones to calculate consultation time and comparing with perceived time in private clinics in Erbil city, Iraq. 141st APHA Annual Meeting and Exposition (November 2-November 6, 2013); 2013: APHA.
23- Migongo AW, Charnigo R, Love MM, Kryscio R, Fleming ST, Pearce KA. Factors relating to patient visit time with a physician. Medical Decision Making. 2012; 32(1): 93-104. Doi: 10.1177/0272989X10394462.
24- Ananthakrishnan AN, McGinley EL, Saeian K. Length of office visits for gastrointestinal disease: impact of physician specialty. The American journal of gastroenterology. 2010; 105(8): 1719-25. Doi:10.1038/ajg.2010.172.
25- Ferdosi M, Raeisi A, Ganji H, Vesal S, Jannesari A, Yazdi H. Investigating the Effects of Quality Improvement Package of Outpatient Visit from Iran Health Transformation Plan in Alzahra University Hospital, Isfahan, Iran. Health Inf Manage. 2016; 13(4): 292-6. [Persian]
_||_1- Leite RC, Makuch MY, Petta CA, Morais SS. Women's satisfaction with physicians’ communication skills during an infertility consultation. Patient education and counseling. 2005; 59(1): 38-45. Doi:10.1016/j.pec.2004.09.006.
2- Lynn J. When does quality improvement count as research? Human subject protection and theories of knowledge. Quality and Safety in Health Care. 2004; 13(1): 67-70. Doi: 10.1136/qshc.2002.002436.
3- Schinkel S, Schouten BC, Street Jr RL, van den Putte B, van Weert JC. Enhancing Health Communication Outcomes among Ethnic Minority Patients: The Effects of the Match between Participation Preferences and Perceptions and Doctor–Patient Concordance. Journal of Health Communication. 2016; 21(12): 1251-9. Doi:10.1080/10810730.2016.1240269.
4 -Kessomboon P, Sinsupan N, Rattanasiri A, Ditsatapornjaroen W, Kuhirunyaratn P, Bumreourach S. Communication Skills for Medical Consultation. Srinagarind Medical Journal. 2008; 23(3): 250-7.
5 -Solomon J. How strategies for managing patient visit time affect physician job satisfaction: a qualitative analysis. Journal of general internal medicine. 2008; 23(6): 775-80. Doi: 10.1007/s11606-008-0596-y.
6 -Hu P, Reuben DB. Effects of managed care on the length of time that elderly patients spend with physicians during ambulatory visits: National Ambulatory Medical Care Survey. Medical care. 2002; 40(7): 606-13. Doi: 10.1097/01.MLR.0000017791.85577.3B.
7 -Hutchinson PL, Do M, Agha S. Measuring client satisfaction and the quality of family planning services: a comparative analysis of public and private health facilities in Tanzania, Kenya and Ghana. BMC health services research. 2011; 11(1): 203. Doi: 10.1186/1472-6963-11-203.
8 -Shaw MK, Davis SA, Fleischer AB, Feldman SR. The duration of office visits in the united s, 1993 to 2010. The American journal of managed care. 2014; 20(10): 820-6. PMID: 25365685.
9 -Cayirli T, Veral E. Outpatient scheduling in health care: a review of literature. Production and operations management. 2003; 12(4): 519-49.Doi /10.1111/j.1937-5956.10 -Moghaddam AV, Damari B, Alikhani S, Salarianzedeh M, Rostamigooran N, Delavari A, et al. Health in the 5th 5-years Development Plan of Iran: main challenges, general policies and strategies. Iranian journal of public health. 2013; 42(1): 42-49. Doi: PMCID: PMC3712611.
11 -Mohebbifar R, Hasanpoor E, Mohseni M, Sokhanvar M, Khosravizadeh O, Isfahani HM. Outpatient waiting time in health services and teaching hospitals: a case study in Iran. Global journal of health science. 2014; 6(1): 172-80. doi:10.5539/gjhs.v6n1p172.
12 -French MT, Homer JF, Klevay S, Goldman E, Ullmann SG, Kahn BE. Is the United States ready to embrace concierge medicine? Population Health Management. 2010; 13(4): 177-82. Doi: 10.1089/pop.2009.0052.
13 -Linz AJ, Haas PF, Fallon LF, Metz RJ. Impact of concierge care on healthcare and clinical practice.Journal-american osteopathic association. 2005; 105(11): 515-20. Doi : PMID:16368915.
14 -Goold SD, Lipkin M. The doctor–patient relationship. Journal of general internal medicine. 1999; 14(S1): 26-33. Doi: 10.1046/j.1525-1497.1999.00267.x.
15 -Chen B-l, Li E-d, Yamawuchi K, Kato K, Naganawa S, Miao W-j. Impact of adjustment measures on reducing outpatient waiting time in a community hospital: application of a computer simulation. Chinese Medical Journal (English Edition). 2010; 123(5): 574-80. Doi: 10.3760/cma.j.
16 -Becker F, Douglass S. The ecology of the patient visit: physical attractiveness, waiting times, and perceived quality of care. The Journal of ambulatory care management. 2008; 31(2): 128-41. Doi: 10.1097/01.JAC.0000314703.34795.44.
17 -Guy Jr GP, Richardson LC. Visit duration for outpatient physician office visits among patients with cancer. Journal of oncology practice. 2012; 8(3s): 2s-8s. Doi: 10.1200/JOP.2011.000493.
18 -Dadgar R, Jahani MA, Mahmoudi G. The impact of health system reform plan on the hospital's performance indicators of Lorestan University of Medical Sciences. Yafte. 2017; 19(2): 93-102. [Persian]
19- Khori V, Changizi S, Biuckians E, Keshtkar A, Alizadeh A, Mohaghgheghi A, et al. Relationship between consultation length and rational prescribing of drugs in Gorgan City, Islamic Republic of Iran. 2012; 18(5): 480-6. PMID: 22764435.
20- Gorji H, Sokhanvar M. Surveying the Standard of Outpatient Visit Time among General Hospitals: A case study in Qazvin. Journal of Hospital. 2015; 14(3): 75-81 [Persian].
21- Cai S, Qin ZY, Ping C, Fen J. The Effect of Prolonged Duration of Clinic Visits on Asthma Control and Patient-Doctor Relationships. A50 asthma: observational studies: Am Thoracic Soc; 2016; 193:A1733.
22- Omer W, editor. Use of mobile phones to calculate consultation time and comparing with perceived time in private clinics in Erbil city, Iraq. 141st APHA Annual Meeting and Exposition (November 2-November 6, 2013); 2013: APHA.
23- Migongo AW, Charnigo R, Love MM, Kryscio R, Fleming ST, Pearce KA. Factors relating to patient visit time with a physician. Medical Decision Making. 2012; 32(1): 93-104. Doi: 10.1177/0272989X10394462.
24- Ananthakrishnan AN, McGinley EL, Saeian K. Length of office visits for gastrointestinal disease: impact of physician specialty. The American journal of gastroenterology. 2010; 105(8): 1719-25. Doi:10.1038/ajg.2010.172.
25- Ferdosi M, Raeisi A, Ganji H, Vesal S, Jannesari A, Yazdi H. Investigating the Effects of Quality Improvement Package of Outpatient Visit from Iran Health Transformation Plan in Alzahra University Hospital, Isfahan, Iran. Health Inf Manage. 2016; 13(4): 292-6. [Persian]