The Effects of Quality and Accessibility of Telehealth Service for Patient with Chronic Disease on Patient Satisfaction, Compliance, and Intention to Reuse

보건진료소 만성질환 원격의료서비스의 질과 접근성이 환자만족도, 치료순응도, 재이용 의도에 미치는 영향

  • Lee, Jae-Gook (Department of Emergency Medical Technology, Sun Moon University)
  • 이재국 (선문대학교 건강보건대학 응급구조학과)
  • Published : 2010.12.31

Abstract

Objectives: The purpose of this study was to investigate the causal relationships among quality of care, accessibility, patient satisfaction, compliance, and intention to reuse of telehealth service in the rural underserved area. Methods: The subjects were patients who experienced telehealth services for chronic diseases (hypertension and/or diabetes) in 24 primary healthcare posts in Gangwon province. Data were collected by telephone survey questionnaire for 8 days from July 18th 2006 to July 25th from 172 hypertension patients. The causal relationships among variables were examined by structural equation modeling(SEM). Results: It was found that the quality and accessibility of telehealth service positively affects to patient satisfaction, compliance, and patient intention to reuse, and indirectly affects to patient intention to reuse through patient satisfaction. Patient satisfaction was revealed as a mediating variable from quality of the service and accessibility to intention to reuse. However, patients' compliance, influenced by quality of care and accessibility, does not affect patients' intention to reuse significantly. Conclusions: Telehealth service will contribute to enhancing management and care of chronic disease patients in the rural underserved areas. Therefore, the improvement of accessibility to qualified healthcare services through telehealth system will contribute to enhancing management and care of chronic disease patients in the underserved area.

Keywords

References

  1. 보건복지부, 보건사회연구원 국민건강영양조사 제3기(2005): 총괄편. 보건복지부, 2006.
  2. 국민건강보험공단. 만성질환 건강보험 진료환자수 1,100만명 넘어. 보도자료. 2009. 6. 25
  3. 김경희, 이명옥, 이재국, 류시원 원격 의료시스템올 활용한 보건진료소에 등록된 고혈압 환자의 치료순응도. 한국보건정보통계학회지 2008; 33(2): 59-76.
  4. 류시원, 조재국, 송태민, 이상영, 강은정, 장원익, 이현실, 안무업, 이규은. 공공의료 강화를 위한 원격의료 수용성 제고방안. 한국보건사회연구원, 2004.
  5. 이원재. 농촌의 보건의료문제 해결을 위한 원격보건 미국과 한국의 경험. 병원경영학회지 1996; 1(1): 188-202.
  6. 윤대흥, 김선표, 김성중, 조수형, 조남수 원격화상진료가 무의도 주민의 의료 이용에 미치는 영향. 대한응급의학회지 2008; 19(4): 359-365.
  7. Allen A, Hays J. Patient satisfaction with telemedicine in a rural clinic. Am J Public Health 1994; 84(10): 1693.
  8. Commission of the European Communities. Communication from the Commission to the European Parliament, the Council, the European Economic and Social Committee and the Committee of the Regions on telemedicine for the benefit of patients, healthcare systems and society. The Commission, Brussels, 4 Nov. 2008; COM(2008) 689 final.
  9. 보건복지부. 원격의료서비스 활성화 추진계획 2007. 10.
  10. 보건복지가족부, 한국보건산업진흥원(a). u-Healthcare 활성화 중장기 종합계획 수립 연구보고서. 2008.
  11. 보건복지가족부, 한국보건산업진흥원(b). u-Healthcare R&D 기본계획수립. 2008.
  12. 한국보건산업진흥원. u-Health 시범사업 종합평가. 2009.
  13. Williams TL, May CR, Esmail A Limitations of patient satisfaction studies in telehealthcare: a systematic review of the literature. Telemed J E Health 2001; 7(4): 293-316. https://doi.org/10.1089/15305620152814700
  14. Whitten P, Love B. Patient and provider satisfaction with the use of telemedicine: Overview and rationale for cautious enthusiasm. J Postgrad Med 2005; 51: 294-300.
  15. Reidenbach RE, Sandifer-Smallwood B. Exploring perceptions of hospital operations by a modified SERVQUAL approach. J Health Care Mark 1990; 10(4): 47-66.
  16. 정송원, 서영준, 이해종, 이견직. 국립대학교병원의 환자만족도 및 재이용 의사 결정요인. 병원경영학회지 2005; 10(2): 1-25.
  17. 최귀선 의료서비스 질이 환자만족도,서비스 가치,재이용 의사에 미치는 영향에 대한 구조분석. [박사 학위 논문]. 연세대학교 대학원 보건학과. 1999.
  18. 류시원, 이현실, 이기호, 윤지영. 강원 만성질환 원격의료시스템 운영실태 및 성과 평가. 한국보건사회연구원, 2006.
  19. Georgette M, Zifko-Baliga, Robert FK. Managing perceptions of hospital quality. Mark Health Serv 1997; 17(1): 28-35.
  20. Jun M, Peterson RT, Zsidisin GA. The identification and measurement of quality dimensions in health care Focus Group Interview results. Health Care Manage Rev 1998; 23(4): 81-96. https://doi.org/10.1097/00004010-199810000-00007
  21. Bowers MR, Swan JE, Koehler WF What attributes determine quality and satisfaction with health care delivery? Health Care Manage Rev 1994; 19(4): 49-55. https://doi.org/10.1097/00004010-199401940-00006
  22. Swan JE, Sawyer JC, Van Matre JG, McGee GW. Deepening the understanding of hospital patient satisfaction: fulfillment and equity effects. J Health Care Mark 1985;5(3): 7-18.
  23. Woodside AG, Frey L, Dale RT Linking service quality, customer satisfaction. and behavioral intension. J Health Care Mark 1989; 9(4): 5-17.
  24. 이선아 간호서비스 질에 대한 환자의 인식과 민족도 및 재방문의도와 관계. 간호행정학회지 1998; 4(2):307-319.
  25. 박재산. 병원입원환자가 인지하는 의료서비스 질, 만족도, 서비스가치, 병원 재이용 의사간의 인과관계분석. 병원경영학회지 2002; 7(4): 123-151.
  26. Glanz K, Lewis FM, Rimer BK. Health behavior and health education. Jossey-Bass Publisher, 1997.
  27. Haynes RB, Mattson ME, Chobanian A V, Dunbar JM, Engerbretson TO, Garrity TF, Leventhal H, Levine RJ, Levy RL. Management of patient compliance m the treatment of hypertension. Hypertension 1982; 4(3): 415-423. https://doi.org/10.1161/01.HYP.4.3.415
  28. Eraker SA, Kirscht JP, Becker MH Understanding and improving patient compliance. Ann Internal Med 1984; 100: 258-268. https://doi.org/10.7326/0003-4819-100-2-258
  29. 김장락, 문중갑, 강경희, 이명순, 홍대용. 고혈압의 치료순응과 그 관련 요인에 대한 지역사회 추적조사. 한국보건협회지 1997; 23(1): 79-100.
  30. 배상수, 이인숙, 김순미, 우선옥, 이영조, 김병익, 한달선, 이석구. 고혈압 환자의 치료순응도에 영향을 미치는 요인. 보건행정학회지 1994; 4(1): 25-48.
  31. Donabedian A Explorations m quality assesment and monitoring, Vol 2: The criteria and standards of quality. Ann Arbor, Ml. Health Administation Press, 1982.
  32. Bopp KD. How patients evaluate the quality of ambulatory medical encounters: A marketing perspective. J Health Care Mark 1990; 10(1): 6-16.
  33. Babakus E, Mangold WG. Adapting the SERVQUAL scale to hospital services: An empirical investigation. Health Serv Res 1992; 26(6): 767-786.
  34. Mooney G. Key issues in health economics. Harvester Wheatsheaf, 1994.
  35. Frenk J. The concept and measurement of accessibility. In Helath Services Research and Anthology. White et al. (eds), Pan American Health Organization, Scientific Publication, 1992: 534: 949-955.
  36. 이현주 Retirement village 에 거주하는 노인들의 지역사회 서비스에 대한 욕구 사정. 대한간호학회지 1998; 37(3): 62-67.
  37. 신호성, 정애숙, 허순임. 의료서비스의 지역별 효과적 보장정도: 자궁경부암 검사, 관절염, 고혈압 관리 프로그램을 중심으로. 보건사회연구 2008; 28(2): 135-156.
  38. Linder-Pelz S. Toward a theory of patient satisfaction. Soc Sci Med 1982: 16: 577-582. https://doi.org/10.1016/0277-9536(82)90311-2
  39. Pascoe GC. Patient satisfaction in primary health care: A literature review and analysis. Evaluation Prog Planning 1983; 6: 185-210. https://doi.org/10.1016/0149-7189(83)90002-2
  40. Singh JA multifaceted typology of patient satisfaction with a hospital. J Health Care Mark 1990; 10(4): 8-21.
  41. Becker MH, Mainman LA Strategies for enhancing patient compliance. J Community Health 1980; 6: 113-135. https://doi.org/10.1007/BF01318980
  42. Boulding W, Staelun R, Kalra A, Zeithaml VA A dynamic process model of service quality: From expectations to behavioral intentions. J Mark Res 1993: 30: 7-27. https://doi.org/10.2307/3172510
  43. Zeithaml VA, Bitner MJ. Services marketing. New York: McGraw-Hill Book Company. 1996.
  44. 이학식, 김영. 서비스 품질과 서비스 가치. 한국마케팅저널 1999; 1(2): 77-79.
  45. Hair JF, Anderson RE, Tatham RL, Black WC. Multivariate data analysis and reading(5th ed.), Prentice Hall. 1998.
  46. 이기종. 구조방정식모형. 국민대학교 출판부, 2005.