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首页> 外文期刊>BMC Health Services Research >Ambulatory health service users' experience of waiting time and expenditure and factors associated with the perception of low quality of care in Mexico
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Ambulatory health service users' experience of waiting time and expenditure and factors associated with the perception of low quality of care in Mexico

机译：门诊医疗服务使用者的等待时间和花费的经验以及与墨西哥医疗质量低下相关的因素

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Background A principal reason for low use of public health care services is the perception of inferior quality of care. Studying health service user (HSU) experiences with their care and their perception of health service quality is critical to understanding health service utilization. The aim of this study was to define reference points for some aspects of health care quality and to analyze which HSU experiences resulted in perceptions of overall low quality of care. Methods Data from the National Health Survey 2006 were used to compare the experiences of HSUs with their ambulatory care at Ministry of Health and affiliated institutions (MOH), social security institutions (SSI) and private institutions (PrivI). Reference points of quality of care related to waiting time and expenditure were defined for each of the three types of institutions by analyzing HSU experiences rated as 'acceptable'. A multivariable logistic regression model was used to identify the principal factors associated with the general perception of low quality of care. Results A total of 11,959 HSUs were included in the analysis, of whom 37.6% (n = 4,500) HSUs received care at MOH facilities; 31.2% (n = 3,730) used SSI and 31.2% (n = 3,729) PrivI. An estimated travel and waiting time of 10 minutes respectively was rated as acceptable by HSUs from all institutions. The differences between the waiting time rated as acceptable and the actual waiting time were the largest for SSI (30 min) in comparison to MoH (20 min) and PrivI (5 min) users. The principal factors associated with an overall perception of low quality of care are type of institution (OR 4.36; 95% CI 2.95-6.44), waiting time (OR 3.20; 95% CI 2.35-4.35), improvement of health after consultation (OR 2.93; CI 2.29-3.76) and consultation length of less than 20 minutes (2.03; 95% CI 1.60-2.57). Conclusions The reference points derived by the HSUs' own ratings are useful in identifying where quality improvements are required. Prioritizing the reduction of waiting times and improving health status improvement after consultation would increase overall quality of care ratings.
机译：背景技术公众医疗保健服务使用率低的主要原因是人们对医疗质量的看法较差。研究医疗服务使用者（HSU）的护理和对医疗服务质量的看法对于了解医疗服务的利用至关重要。这项研究的目的是为卫生保健质量的某些方面定义参考点，并分析哪些HSU经历导致对整体卫生质量低下的看法。方法使用2006年《全国健康调查》中的数据比较卫生部，附属机构（MOH），社会保障机构（SSI）和私营机构（PrivI）的HSU及其门诊护理的经验。通过分析被评定为“可接受”的HSU经验，为三种类型的机构中的每一种机构都定义了与等待时间和支出相关的护理质量参考点。使用多变量logistic回归模型来确定与一般人对医疗质量低下的看法有关的主要因素。结果分析中总共包括11,959个HSU，其中37.6％（n = 4,500）的HSU在卫生部设施中接受了护理; 31.2％（n = 3,730）使用的SSI和31.2％（n = 3,729）的PrivI。所有机构的HSU均将估计的旅行时间和等待时间分别定为10分钟。与MoH（20分钟）和PrivI（5分钟）用户相比，SSI（30分钟）被评定为可接受的等待时间与实际等待时间之间的差异最大。与对护理质量低下的总体看法有关的主要因素是医疗机构类型（OR 4.36; 95％CI 2.95-6.44），等待时间（OR 3.20; 95％CI 2.35-4.35），咨询后的健康状况改善（OR 2.93; CI 2.29-3.76）和咨询时间少于20分钟（2.03; 95％CI 1.60-2.57）。结论由HSU自己的评级得出的参考点可用于确定需要改进质量的地方。优先减少等待时间并改善咨询后的健康状况将提高整体护理质量。

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