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Rehabilitation Practice and Science

Translated Title

偏鄉地區衛生所復健醫療服務量與品質之研究

Abstract

Background: Liugui District, that locates in the rural Kaohsiung city, is defined as the area with insufficient medical resources by National Health Insurance. In 2017, service of rehabilitation was established in Liugui District with the help from Department of Health, Kaohsiung City Government. It's an innovative model by combining the private physical therapy clinic with public health center and it was the first one in Taiwan. The physical therapy clinic was run by a private therapist and it was set up in the Liugui public health center. The rehabilitation outpatient clinic service was provided by one physiatrist from Ci-Shan hospital (a rural public local hospital) every two weeks and the physical therapy was provided by one regular therapist who owns the physical therapy clinic daily. This government-civilian cooperation model serves patients not only in Liugui but also two indigenous district (Taoyuan and Maolin District). We aimed to evaluate the quantity and quality of rehabilitation service based on this novel cooperation model. in a rural local public hospital in southern Taiwan. Methods: The data for quantity was collected from January, 2018, to August, 2019. We applied questionnaire based on the concept of Parsuraman,- Zeithaml,- Berry (PZB) service quality gap model and expected zone of tolerance to determine the difference in the medical service quality between the expectations and satisfaction of patients and their caregivers who received rehabilitation in Liougui public health center. The questionnaire was a 30-item structured, modified from the 22- item SERVQUAL instrument, with high validity and reliability that compromised five dimensions: (1) tangible, (2) reliability, (3) responsiveness, (4) assurance, and (5) empathy. The questionnaire was given to patients or their caregivers, who took regular rehabilitation in Liougui public health center for more than one month, from August to September in 2019 during the rehabilitation clinic (by convenience sampling). The paired t- test was used to analyze the gap in service quality between the expectation and satisfaction scores. Results: In the aspect of quantity evaluation, the mean number of patients who took rehabilitation and who used rehabilitation clinic in Liougui public health center was 35.1 daily and 61.4 per time, respectively. The rehabilitation service included early intervention, physical therapy for orthopedic and neurologic diseases. Patients aged more than 65 years accounted for 52.3% of the total patients. The most two common diagnoses of them were degenerative joint disease of lumbar and cervical spine. In the aspect of quality evaluation, a total of 47 patients (or their caregivers) were enrolled for analysis. The effective response rate was 100 %. The content validity index was 0.91, and the Cronbach's alpha for internal reliability was 0.854-0.929. Significant differences between the expectation and the satisfaction scores were only foud in part of the questions in the tangible aspect. Conclusion: Our study observed that the novel government-civilian cooperation model in rehabilitation service is feasible in rural regions. The medical service quality gap in the scores of the patients and their caregivers presented only partially in the tangible aspects, which meant that the rehabilitation we currently provided could meet their expectations except for the shortage of the health professional providers. To enhance the medical service quality and sustainable operation of this model, we need to improve the integration of government-civilian resources and recruit more health professional providers in the near future.

Language

Traditional Chinese

First Page

159

Last Page

172

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