病患對於自主決定醫療決策的權益日漸重視，因此醫病溝通成為影響醫療服務品質的重要部分。先前的研究多數集中於醫師與病患雙方交流對療程結果的直接性影響。在本研究中，我們衡量服務過程中每個構面之間的關聯性，以及服務過程構面因素對醫療結果的影響性。本研究使用行為理論擴展Donabedian醫療服務品質結構-過程-結果模型的過程階段，藉以驗證病患的認知變化和醫病溝通反饋共識對病患的依從行為之影響。此外，本研究檢驗醫療機構等級的調節效果。受訪者返回的有效問卷共397份，回覆率為92.11%。本研究設計了三個框架模型來進行分析，包括單向路徑結構方程模型、雙向路徑結構方程模型、調節效果模型。單向路徑模型和雙向路徑模型皆是採用結構方程式藉以測量構面與構面之間的關係；調節效果模型被用於測量不同醫療機構等級的調節作用。分析結果顯示，醫療服務流程中的醫療過程包括三個中介變數：醫病溝通、認知效能、依從行為。醫療服務結構會透過這三個醫療過程變數間接影響療程結果。不僅如此，醫病溝通會直接影響病患對於療程的認知療效 (β = 0.16，p < 0.001)，病患對於療程效用的理解會直接反饋醫病溝通的品質 (β = 0.18，p < 0.001)。而醫師與病患這樣的交流共識與病患對於醫囑的依從行為有直接關聯 (β = 0.38，p < 0.001)。最後，醫療機構等級對於病患感知的服務品質會有顯著的調節作用。具體而言，在醫學中心接受治療的病患之遵從醫囑的行為受醫療機構結構面與醫病溝通的影響大於在區域醫院接受治療的病患。基於本研究的結果發現，證實了醫療服務構面之間潛在且重要的複雜關係。此外，本研究之發現證明醫療服務過程中，醫病共識所扮演的重要角色，並可作為改善醫療服務品質與提升病患依從性之參考。;There is growing interest in patient autonomy, and communication between physicians and patients has become the essential cornerstone for improving the quality of healthcare services. Previous research has concentrated on the direct effect of physician-patient communication on service outcomes. In the present study, we examine the influence of constructs in the service process and the impact on healthcare outcomes. The present study used behavioral theory to expand the process aspect of the Donabedian healthcare service quality structure-process-outcome model to examine the impact of cognitive changes and communication feedback on patients’ adherence behavior. In addition, the moderating effect of hospital facility levels is examined. A conceptual model was developed and tested using a questionnaire administered to patients in eight hospitals. A total of 397 respondents returned usable surveys, with a response rate of 92.11%. This study uses three models to analyze the data, including a recursive (one-way path) model, a non-recursive (bidirectional path) structural equation model, and a moderated model. The recursive structural models and non-recursive structural models are used to test the hypothesized relationships of the constructs; the moderated model is used to measure the effect of moderation between the different levels of hospital facilities. The results identify three mediators of the healthcare process within the healthcare services framework: physician-patient communication, cognitive efficacy, and adherence behavior. Physician-patient communication influence cognitive efficacy (β = 0.16, p < 0.001), and cognitive efficacy influence physician-patient communication (β = 0.18, p < 0.001). The effect of this bidirectional relationship on adherence behavior was positive (β = 0.38, p < 0.001). The healthcare structure influences healthcare outcomes via these three healthcare process constructs. The adherence behavior of patients who were treated in the medical center had a greater influence on the structure and physician-patient communication than that of patients who were treated in the regional hospitals. The findings of this study validate a potentially important and complex relationship between health care components. In addition, this study proves the important role played by the medical-patient consensus in the medical service process, and could be used as a reference for improving the quality of medical services and enhancing patient compliance.
