• 沒有找到結果。

第五章 結論與建議

第二節 建議

一、持續加強糖尿病照護網宣導:

政府相關單位及醫療機構除了加強醫療機構形象和專業能力外,相關醫護 人員亦必頇強化其專業技能之行銷責任,如醫師對病人的專業行銷,不僅可改 善醫病關係,更可建立顧客之忠誠度,以強化醫療機構競爭力。現行糖尿病門 診病患中仍有多數未曾聽聞或不瞭解本照護方案,故未來仍頇持續透過多元管 道加強宣導推廣,妥善有效運用與分配醫護人員之人力資源;亦可派遣醫院志 工對病患介紹照護網的好處,使病患能夠加入或引介病友共同參與照護方案,

藉以提升我國糖尿病醫療管理以及專業醫療照護品質之成效。其中年齡 31 至 40、61 至 70 歲、已婚者、有運動習慣、家族有糖尿病史者等皆可考慮為將來照 護網推廣之優先對象。

二、重視醫療溝通品質:

一個良好的醫療服務,除了醫療機構專業的醫護人員與服務態度外,還必 頇考慮醫療行為外如諮詢服務、便利交通及無障礙空間設施等。醫療院所應不

僅只是給予醫療專業技術上的提供,而應以病患需求為出發點,多瞭解及重視 病患需要,多溝通、傾聽病患的聲音。另亦需關注到應以友善主動的關懷,即 時回應病患所表達的需求,如此始能持續提升改善醫療服務品質與醫病關係,

進而有效提升病患滿意度,成為醫療機構永續經營之核心競爭優勢。

三、強調以病人為中心的服務策略:

近年來醫療機構在競爭的經營環境之下,醫療產業亦由以往的供給導向轉 變為顧客導向,內部重視醫療服務品質,對外則以病患為決定價值(value),應 以視病猶親的精神,為醫療機構創造更人性化的醫病關係。

四、強化偏遠弱勢族群之保健知能:

醫院可主動與政府單位如衛生局(所)聯合,針對低收入之弱勢族群舉辦社區 健康活動,如在免費健檢、義診、預防疫苗注射時,廣為宣導糖尿病照護網,

改變群眾觀念,強化對飲食、運動等自我健康管理的重視。

五、拓展醫療機構多元化之服務:

醫療機構除帄時固定看診外,亦可主動提供病人保健資訊,建立良好醫病 關係以提高病患對醫療院所各構面之滿意程度。未來亦可考慮針對糖尿病病患 放寬健保處方用藥限制,並將藥劑師之藥物諮詢納入糖尿病照護網團隊,以更 進一步滿足病患之需求,為醫院創造更高的競爭優勢。而在糖尿病照護網的執 行上,除了可增加醫院看診醫師及診次,另若能將糖尿病照護網推廣至社區,

減少病患等候時間,增加便利性,病患對此制度之滿意度應會更加提升。

六、醫療諮詢專業化分工:

以往的門診醫師,必頇在有限的時間內完成問診、檢查、診斷、治療、衛 教甚至藥物諮詢,這對醫師是極大的負擔且難以面面俱到。本研究發現糖尿病 照護網的實施使醫師負擔得以減輕,能夠更專心於診療,服務病患;病患亦能 接受到完整的疾病衛教,改善疾病控制,增進治療效果。未來隨著老年人口增

加,罹患疾病將以慢性病為主,衛教師、營養師甚至藥劑師的衛教諮詢角色勢 必更為重要,共同為病患醫療做更周全的服務。衛生主管機關應即早規劃培育 專業人才,以因應將來廣大的醫療需求。

參考文獻

中華民國糖尿病學會與行政院衛生署國民健康局(2006)。糖尿病防治手冊-糖尿 病預防、診斷與控制流程指引。臺中市:行政院衛生署國民健康局。

王美慧、陳瑞龍、蘇元含(2006)。運用結構方程模式探討服務品質對顧客滿意度 與顧客忠誠度之影響-以中油加油站為例。顧客滿意學刊,2(2),47-86。

王誠之(2002)。Mayo Clinic on Managing Diabetes─糖尿病。台北市:天下。

王璟旋(1999)。門診診斷之非胰島素依賴型糖尿病患者的自我照護行為、血糖控 制及相關因素探討。未出版的碩士論文,私立高雄醫學院護理研究所,高 雄市。

古秋雲、蔡明田、陳建成(2008)。服務品質與服務價值對顧客忠誠度影效果之實 證研究-以國立成功大學附設醫院健康檢查中心為例。醫管期刊,9(3),

205-221。

石曜堂(1978)。醫療品質評估。醫院雜誌,11(2),106-109。

行 政 院 衛 生 署 (2009 年 1 月 20 日 ) 。 衛 生 統 計 指 標 / 死 因 統 計 類 , 取 自 http://www.doh.gov.tw/statistic/index.htm

行 政 院 衛 生 署 (2009 年 1 月 20 日 ) 。 衛 生 統 計 資 訊 網 , 取 自 http://www.doh.gov.tw/statistic/

行政院衛生署(2009年2月26日)。中華民國96年衛生統計系列─死因統計,取自 http://www.doh.gov.tw

行政院衛生署國民健康局(2009年2月26日)。臺灣地區糖尿病防治工作現況,取 自http://www.bhp.doh.gov.tw/BHPnet/Portal/

林士彥、張良漢、蘇士博(2007)。賽會服務品質與價值對現場觀眾滿意度及忠誠 度之相關性研究。體育學報,40(1),77-92。

林季葦(2005)。銀行服務品質與顧客滿意度之研究。未出版之碩士論文,國立成 功大學統計學系,台南市。

林陽助、林秀貞、李宜致(2007)。體驗行銷、顧客滿意度與顧客忠誠度之研究-以大台北地區連鎖咖啡店為例。顧客滿意學刊,3(2),57-94。

美國糖尿病協會(American Diabetes Association, 1997/1998)。糖尿病手冊。

(Diabetes A to Z: what you need to know about diabetes - simply put,范振杰 譯)。台北:合記圖書出版社。

倪嘉慧(1994)。台北醫療區域各級醫院醫療品質情況調查與分析。未出版之碩士 論文,國立台灣大學公共衛生學研究所,台北市。

張峰紫、邱啟潤、辛席璋、蔡瑞熊(1991)。糖尿病家庭支持與其認知、態度、遵 從行為及糖化血色素控制研究。護理雜誌,38(1),59-69。

張淳堆(2007)。糖尿病之西醫診斷及治療。中醫內科醫學雜誌,5(2),10-15。

張媚(2009)。糖尿病個案管理。護理雜誌,56(2),22-27。

莊演文(2003)。醫院服務品質與住院病患家屬滿意度之關聯性研究—以嘉義某區 域教學醫院為例。未出版之碩士論文,私立南華大學自然醫學研究所,嘉 義縣。

陳仁惠、鄭仲興、方世杰(2005)。門診醫療服務品質與病患滿意度對於關係導向 行為之影響。醫護科技學刊,7(2),187-202。

陳英傑、陳英豪(2008)。應用病患滿意度概念於醫療服務品質之探析。品質月刊,

14-17。

陳國東、陳建仁(1997)。非胰島素依賴型糖尿病盛行率與危險因子。中華衛誌,

16(4),291-307。

陳淑華(2003)。知識管理資訊系統服務品質之研究-以某資訊科技公司為例。未 出版之碩士論文,私立銘傳大學資訊管理學系,桃園縣。

黃三桂、王悅萍、錢慶文(2002)。疾病管理對糖尿病患醫療資源耗用之影響。醫 務管理期刊,3(2),20-26。

楊智緯(2005)。國際觀光旅館之品牌形象、服務品質與顧客滿意度及忠誠度之研 究。未出版之碩士論文,私立南台科技大學休閒事業管理系,台南縣。

廖則峻、江志卿(2005)。網路服務品質、顧客滿意度及後續行為之探討-以網路 購物為例。管理與系統,12(1),23-47。

廖惠珍(2007)。行動網路服務顧客滿意度及顧客忠誠度影響因素之研究。未出版 之碩士論文,私立元智大學資訊管理學系,桃園縣。

劉崇義(2001)。顧客滿意之研究-以壽險業為例。未出版之碩士論文,私立中原 大學企業管理研究所,桃園縣。

蔡文正、龔佩珍、徐約翰、廖凱帄(2004)。不同經營特性洗腎機構之洗腎服務滿 意度。台灣衛誌,5(1),101-119。

蔡文正、龔佩珍、翁瑞宏、張永賢、李思儀(2008)。應用SERVQUAL量表建構 中醫醫療服務品質指標。台灣衛誌,27(4),309-319。

蔡文惠(1999)。全民健康保險北區分局糖尿病人醫療利用及照護結果。未出版之 碩士論文,國立陽明大學衛生福利研究所,台北市。

蔡世澤(2000)。台灣糖尿病照護現況與省思。臨床醫學,45(5),316-320。

蔡孟真(2007)。台鐵票證系統服務品質、顧客滿意度與顧客忠誠度關係之研究。

未出版之碩士論文,私立中華大學經營管理研究所,新竹市。

盧安琪(2002)。國立成功大學醫學中心門診醫療服務品質之實證研究。未出版之 碩士論文,國立成功大學企業管理研究所,台南市。

盧菀琪(2001)。糖尿病共同照護模式對醫療費用及照護品質之影響初探。未出版 之碩士論文,國立台灣大學衛生政策與管理研究所,台北市。

賴育如(2008)。兩岸大專院校學生入學動機、教育服務品質、學生滿意度、學生 忠誠度與學生抱怨行為之研究。未出版之碩士論文,私立中華大學科技管 理研究所,新竹市。

賴美淑、邱淑媞(2002)。糖尿病共同照護之概念與內涵。台灣醫誌,6(4),560-568。

錢慶文、邱鎮山、黃三桂(2001)。健康照護管理計畫之成效分析:以蘭陽糖尿病 照護網為例。醫務管理期刊,2(2),58-71。

簡君蓉(2002)。國民中學學校服務品質缺口模式問卷發展與應用之研究。未出版 之碩士論文,國立暨南國際大學教育政策與行政研究所,南投縣。

闕芝穎(2004)。百貨公司服務品質、顧客滿意度、顧客忠誠度與消費者生活型態 關係之研究-以台北市地區為例。未出版之碩士論文,國立東華大學企業 管理學系,花蓮縣。

魏榮男、莊立民、林瑞雄、趙嘉玲、宋鴻樟(2002)。2000年台灣地區糖尿病盛行 率與住院率。台灣衛誌,21(4),173-180。

蘇元含(2003)。運用線性結構模式探討服務品質對顧客滿意度與顧客忠誠度之影 響-以中油加油站為例。未出版之碩士論文,國立東華大學企業管理學系,

花蓮縣。

ADA (1998). Economic consequences of diabetes mellitus in the US in 1997.

Diabetes Care, 20(1), 38-51.

ADA (2003). Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications. Diabetes Care, 25(1), 50-60.

ADA (2008). Nutrition recommendations and interventions for diabetes: a position statement of the American diabetes association. Diabetes Care, 30(1), 48-65.

Anderson, E. W., & Sullivan, M. W. (1993). The antecedents and consequences of customer satisfaction for firms. Marketing Science, 12(2), 125-143.

Anderson, E. W., & Sullivan, M. W. (1990). Customer satisfaction and retention across firms. Paper presented at the TIMS college of Marketing Special Interest Conference on services Markrting, Nashville.

Armistead, C. G. (1985). Design of service operations, in Voss, Christopher, ed., Operations mangement in service in dustries and the public sector. NY: John Wiley & Sons Ltd.

Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction insocial psychological research: Conceptual, strategic, and statistical

1173-1182.

Bateson & Hoffman (2002). Essential of services marketing: Concept, strategies and cases. Harcourt: Academic Internet Publisher.

Bettencourt, L. A. (1997). Customer voluntary performance: Customers as partners in service delivery. Journal of Retailing, 73(3), 383-406.

Bhote, K. R. (1996). Beyond customer satisfaction to customer loyalty - The key to greater profitability. NY: American Management Association.

Bhote, K. R. (1996). Beyond customer satisfaction to customer loyalty - The key to greater profitability. NY: AMA Management Briefing, American Management Association.

Bitner, M. J. (1990). Evaluating service encounters: The effects of physical surroundings and employee responses. Journal of Marketing, 54(2), 69-82.

Bjork, S. (1999). The cost of diabetes and diabetes care. Diabetes Res Clin Pract, 54(1), 13-18.

Blackman, J., & Crompton, L. (1991). The usefulness of selected variables for predicting activity loyalty. Leisure Science, 13(1), 205-220.

Boulding, W., Kalra, A., Staelin, R., & Zeithaml, V. A. (1993). A dynamicprocess model of service auality: From expectations to behavioral intentions. Journal of Marketing research, 30(1), 7-27.

Brady, M. K., & Cronin, J. J. (2001). Customer orientation: Effects on customer service perceptions and outcome behaviors. Journal of Service Research, 3(1), 241-251.

Cardozo, R. N. (1965). An experimental study of customer effort, expectation, and satisfaction. Journal of Marketing Research, 2(1), 244-249.

Carman, J. M. (1990). Consumer perceptions of service quality: An assessment of the SERVQUAL dimensions. Journal of Retailing, 66(1), 33-55.

Chen, K. T., Chen, C. J., Fuh, M. M. T., & Narayan, K. M. V. (1999). Cause of death and associated factors among patients with non-insulin-dependent diabetes mellitus in Taipei, Taiwan. Diabetes Research Clinical practice, 43(1), 101-109.

Chi, G. Q., & Qu, H. (2008). Examining the structural relationships of destination image, tourist satisfaction and destination loyalty: An integrated approach.

Tourism Management, 29(4), 624-636.

Christine, B., & Marguerite, O. (2001). Educating patients with diabetes type2.

Diabetes: A practical approach. Journal of Diabetes Nursing, 36(2), 375-385.

Churchill, G. A. J., & Surprenant, C. (1982). An investigation into the determinants of customer satisfaction. Journal of Marketing Research, 19(4), 491-504.

Corsby, A., & Philip, B. (1979). Quality is free. NY: McGraw-Hill.

Cram, T. (2001). Customers that count: How to build living relationships with your most valuable customers. London, UK: Pearson Education.

Cronin, J. J., & Taylor, S. A. (1992). Measuring service quality: A reexamination and extension. Journal of Marketing, 56(3), 55-68.

Crosby, P. B. (1979). Quality is free: The art of making quality certain. NY:

McGraw-Hill.

Crosby, P. B., Evans, K. R., & Cowles, D. (1990). Relationship quality in service selling: An interpersonal influence perspective. Journal of marketing, 54(3), 68-81.

Czepiel, J. A., Rosenberg, L. J., & Akerele, A. (1974). Perspectives on consumer satisfaction. AMA Conference Proceedings, Chicago: American Marketing Association.

Day, R. L. (1977). Extending the concept of consumer satisfaction. Atlanta:

ssociation of Consumer Research, 4(2), 149-154.

DCCT group (1993). The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent

diabetes mellitus. New England Journal of Medicine, 329(1), 977-986.

Deichmann, R. E., Castello, E., & Horswell, R. (1999). Friday KE: Improvements in diabetic care as measured by HbA1C after a physician education project.

Diabetes Care, 22(1), 1612-1616.

Diabetes Integrated Care Evaluation Team (DICET) (1994). Integrated care for diabetes clinical psychosocial and economic evaluation. British Medicine Journal, 308(1), 1208-12.

Dick, A. S., & Basu, K. (1994). Customer loyalty: Toward an integrated conceptural framework. Journal of the Academy of Marketing Science, 22(2), 99-113.

Egede, L. E., Ye, X., Zheng, D., & Silverstein, M. D. (2002). The prevalence and pattern of complementary and alternative medicine use in individuals with diabetes. Diabetes Care, 25(2), 324-329.

Fornell, C. A. (1992). National customer satisfaction barometer: The swedish experience. Journal of Marketing, 56(2), 6-21.

Foster, S. T. (2001). Managing quality: An integrative approach. NY: Prentice Hall.

Frederick, F. R., & Salter, W. (1996). Zero defections: Quality comes to services.

Harvard Business Review, 48(5), 57-69.

Fredericks, J. O. (2001). Connecting customer loyalty to financial results. Marketing Management, 10(1), 26-33.

Garvin, D. A. (1987). Competing on the eight dimensions of quality. Harvard Business Review, 65(6), 101-110.

Garvin, D. A. (1983). Quality on the line. Harvard Business Review, 61(5), 66-75.

Griffin, M. M. (1995). You can not get there from here: Situated learning, transfer, and map skills. Contemporary Educational Psychology, 20(1), 65-87.

Gronholdt, L., Martensen, A., & Kristensen, K. (2000). The relationship between customer satisfaction and loyalty: Cross-industry differences. Total Quality

Management, 11(4), 509-516.

Gronroos, C. (1982). An applied service marketing theory. European Journal of Marketing, 16(7), 30-41.

Gronroos, C. (1983). A service quality model and its marketing implications.

European Journal of Marketing, 18(4), 37-45.

Guieford, J. P. (1965). Fundamental statistics in psychology and education, 4th ed.

NY: McGram-Hill.

Hair, J. F., Black, W. C., Babin, B. J., & Anderson, R. E. (2006). Tatham.

Multivariate data analysis, 6th ed. NY: McGram-Hill.

Ham, C. L. (2003). Service quality, customer satisfaction and customer behavioral intentions in higher education. Unpublished doctoral dissertation, Nova Southeastern University.

Handy, C. R., & Pfaff, M. (1975). Consumer satisfaction with food product and marketing service. Journal of Business Research, 15(1), 49-61.

Hart, S. L. (1992). An intergrative framework for strategy making process. Acad Manage Rev, 17(1), 327-51.

Hepworth, M., & Mateus, P. (1994). Connecting customer loyalty to the bottom line.

Canadian Business Review, 21(4), 40-43.

Hurley, R. F., & Estelami, H. (1998). Lternative indexes for monitoring customer perceptions of service quality: A comparative evaluation in a retail context.

Journal of the Academy of Marketing Science, 26(3), 209-221.

Hyde, P. C. (1986). Setting standards in health care. Quality Assurance, 12(1), 57-59.

Joint Commission on Accreditation of Healthcare Organizations (JCAHO) (1989).

Characteristics of clinical indicators. QRB, 330-339.

Johnson, M. D. (2002). Improving customer satisfaction, loyalty, and profit: An integrated measurement and management system. San Francisco: Jossey-Bass.

Jones, T. O., & Sasser, W. E. (1995). Why satisfied customer defect. Harvard Business Review, 73(6), 88-99.

Kim, M. K., Park, M. C., & Jeong, D. H. (2004). The effects of customer satisfaction and switching barrier on customer loyalty in Korean mobile telecommunication services. Telecommunications Policy, 28(2), 145-159.

Knowler, W. C., Bennett, P. H., Hamman, R. F., & Miller, M. (2002). Diabetes incidence and prevalence in Pima Indians: A 19-fold greater incidence than in Rochester, Minnesota. New England Journal of Medicine, 108(1), 497-505.

Kotler, P. (2000). Marketing management (10th ed.). NJ: Prentice Hall.

Kotler, P. (1994). Marketing management: Analysis, planning, implementation, and control. NJ: Prentice-Hall.

Levitt, T. (1972). Production-line approach to service. Harvard Business Review, 50(5), 41-52.

Lewis, R. C., & Booms, B. H. (1983). The marketing aspects of service quality in emerging perspectives on service marketing. NY: American Marketing Association.

Lin, C. H., & Wang, C. H. (2005). The incidence and wage effects of overeducation:

The case of Taiwan. Journal of Economic Development, 30(1), 31-47.

Lin, H. L., & Wang, Y. S. (2006). An examination of determinants of customer loyalty in mobile commerce contexts. Information & Management, 43(3), 271-282.

Mano, H., & Oliver, R. L. (1993). Assessing the dimensionality and structure of the consumption experience: Evaluation, feeling, and satisfaction. Journal of Consumer Research, 20(2), 451-465.

Mayner, E. S. (1976). An experimental analysis of a salesman’s expert and referent bases of social power in the buyer-seller dyad. Journal of Marketing Research, 13(1), 3-11.

Millan, A., & Esteban, A. (2004). Development of a multiple-item scale for measuring customer satisfaction in travel agencies services. Tourism Management, 25(5), 533-546.

Nunnally, J. (1978). Psychometric theory. NY: McGraw-Hill.

O'Connor, J. S., Shewchunk, R. M., & Bowers, M. R. (1991). A model of service quality perceptions and health care consumer behavior. Journalof Hospital Marketing, 6(1), 62-69.

Oliver, R. L. (1981). Measurement and evaluation of satisfaction processes in retailing setting. Journal of Retailing, 57(1), 25-48.

Oliver, R. L., & Desarbo, W. S. (1988). Response determinants in satisfaction judgment. Journal of Consumer Research, 14(4), 495-507.

Oliver, R. L. (1999). Whence consumer loyalty. Journal of Marketing, 63(1), 33-44.

Olorunniwo, F., Hsu, M. K., & Udo, G. J. (2006). Service quality, customer satisfaction, and behavioral intentions in the service factory. Journal of Service Marketing, 20(1), 59-72.

Ostrom, A., & Iacobucci, D. (1995). Consumer trade-offs and the evaluation of services. Journal of Marketing, 59(1), 17-28.

Parasuraman, A., Zeithaml, V. A., & Berry, L. L. (1985). A conceptual model of service quality and its implication for future research. Journal of Marketing, 49(2), 41-50.

Parasuraman, A., Zeithaml, V. A., & Berry, L. L. (1988). SERVQUAL: A multiple-item scale measuring consumer perceptions of service quality. Journal of Retailing, 64(1), 12-40.

Peltier, J. W., & Westfall, J. E. (2000). Dissecting the HMO-benefits managers relationship: What to measure and why. Marketing Health Services, 20(2), 4-13.

Reichheld, F. F., & Sasser, W. E. J. (1990). Zero defections: Quality comes to

services. Harvard Business Review, 68(5), 105-111.

Rust, R. T., Zahorik, A. J., & Keiningham, T. L. (1995). Return on quality (ROQ):

Marking service quality financially. Journal of Marketing, 59(2), 58-70.

Ruyter, K. D., Bloemer, J., & Peeters, P. (1997). Merging service quality and service satisfaction: An empirical test of an integrative model. Jonrnal of Economic Psychology, 18(4), 387-406.

Sasser, E. W., Paul, O. R., & Daryl, W. D. (1978). Management of service operation:

Text and cases. Boston: Allyn and Bacon Inc.

Selnes, F. (1993). An examination of the effect of product performance on brand reputation, satisfaction and loyalty. European Journal of Marketing, 27(9), 19-35.

Sheth, J. N., Newman, B. I., & Gross, B. L. (1991). Why we buy what we buy: A theory of consumption values. Journal of Business Research, 22(2), 159-170.

Shun, C., & Yunjie, X. (2006). Effects of outcome, process and shopping enjoyment on online consumer behavior. Electronic Commerce Research and Applications, 5(4), 272-281.

Sidorov, J., Shull, R., Tomcavage, J., Girolami, S., Lawton, N., & Harris, R. (2002).

Does diabetes disease management save money and improve outcomes? A report of simultaneous short-term savings and quality improvement associated with a health maintenance organization-sponsored disease management program among patients fulfilling health employer data and information set criteria.

Diabetes Care, 25(2), 684-689.

Singh, J. (1991). Understanding the structure on consumer satisfaction evaluation of service delivery. Journal of the Academy of Marketing Science, 19(1), 223-234.

Solomon, M. R. (1991). Consumer behavior: Buying, having, and being. Boston:

Allyn and Bacon.

Sowden, A. J., Sheldon, T. A., & Alberti, G. (1995). Shared care in diabetes. BMJ, 310(6973), 142-3.

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