Medical student interviewing skills and mother-reported satisfaction and recall

BACKGROUND: Providing feedback to medical students about their interviewing skills is an important component of teaching programmes. There is very little information about mothers' views of medical student consultations in paediatrics, and in particular about what mothers consider to be the key elements of a successful consultation. Patient-centred interviewing is a model which emphasizes the active seeking of patient views. In association with appropriate clinical skills, it is reported to promote improved health outcomes. OBJECTIVES: To examine whether greater medical student clinical competence and more frequent use of patient-centred techniques is associated with higher maternal satisfaction, higher maternal rating of the medical student's interpersonal skills, and greater maternal recall of relevant diagnosis and treatment recommendations. METHOD: Two standardized 'medical student' videotaped interviews were created based on actual senior medical student consultations. Interview A demonstrated both higher student clinical competence and higher patient-centredness compared with interview B. Both videotaped interviews were viewed and then rated, using a questionnaire, by 11 mothers attending a teaching general practice. RESULTS: Significantly higher mean scores, indicating greater maternal satisfaction, were associated with interview A (P < 0.01 for all measures). Accurate recall for diagnosis and management was also significantly greater after interview A (mean diagnosis recall, interview A 35%, interview B 14%, P < 0.01; mean management recall, interview A 95%, interview B 57%, P < 0.01). CONCLUSIONS: Maternal satisfaction and recall were higher following a more clinically competent and patient-centred medical student interview. Maternal ratings of student interviews could be used as an additional method of assessment as well as providing feedback to medical students on their interview skills development.     

Consent for teaching: the experience of women attending a gynaecology clinic

OBJECTIVES: To examine women's experience of the consent process for involvement in medical education in a teaching hospital. DESIGN: Questionnaire survey. PARTICIPANTS: The study involved 181 (90% response rate) women aged 17-79 years who attended 1 gynaecology clinic. SETTING: A gynaecology clinic in an inner London teaching hospital. RESULTS: Women were broadly positive about the presence of students in gynaecology clinics. The current process relies on implied consent and women actively opting out of involvement. Despite hospital policy to inform all outpatients in their appointment letter that students may be present at the clinic, 58% of patients did not recall being informed in this way. Although 91% of women did not object to student presence, only 65% reported having been asked if they wanted it. Subjective feeling of choice about the student presence was associated with advance notice, either by letter or previous experience of students at clinics. Women differentiated between consent for different aspects of interaction with students. CONCLUSION: Notification of the presence of students in standard appointment letters does not adequately inform patients. Clinical teachers need to ensure that the measures in place to inform women and to seek their active consent about involvement in teaching are robust.     

Assessing medical student effectiveness from the psychiatric patient's perspective: the Medical Student Interviewing Performance Questionnaire

This study sought to develop and pilot-test a patient-completed rating scale of medical student effectiveness while training in psychiatry. Specifically, the study focused on: (1) examining the statistical reliability and validity of a new scale; (2) using the measure to assess patient satisfaction with medical student care during the psychiatry clerkship; and (3) providing some experience-based recommendations about utilizing patient feedback when training medical students in psychiatry. Data were collected over an entire academic year and involved 35 third-year medical students and ratings of their performance provided by 102 psychiatric inpatients. Participants were recruited from three inpatient units and the rate of participation was 62.5%. Principle components analyses of the Medical Student Interviewing Performance Scale (MSIPQ) showed that the overall scale consisted of two, theoretically relevant subscales called 'Rapport' and 'Treatment Feedback.' Each subscale had adequate reliability. In addition, the two subscales were shown to each account for unique variance in two separate questions assessing the patient's overall ratings of rapport and treatment helpfulness. Finally, patients' mean ratings of medical student effectiveness were examined and showed very high levels of satisfaction with the student-patient relationship and the quality of care received. This study is among the first to examine patient satisfaction with medical student providers among a general population of psychiatric inpatients. Recommendations are made about the ways in which the MSIPQ can be used to strengthen the training of medical students in psychiatry.     

Does the presence of medical students affect quality in general practice consultations?

Context  Previous studies have suggested that the patient's experience of a consultation with a doctor is not affected by the presence of medical students. However, no study has looked at the effect of student presence on conventional UK general practice consultations.
Objectives  This study aimed to measure the quality of the consultation as experienced by patients when students are present, to explore patients' attitudes to the presence of medical students, and to look at the relationships between these factors.
Methods  We conducted a cross-sectional questionnaire study in general practices in north-east England. General practitioners (GPs) from practices teaching fourth and final year students administered questionnaires to patients who were seen in either teaching or non-teaching consultations. The questionnaire comprised previously validated measures of empathy and enablement as measures of quality, attitudinal statements regarding the presence of students, a scale rating pertaining to the patient's degree of acquaintance with the doctor, and items on demographic data.
Results  Results showed no significant differences in enablement scores between the 2 groups. Consultations with student presence last longer. Empathy scores were significantly lower in the 'student present' group, but the size of the difference was small. Attitudinal statements regarding the presence of students showed a high proportion of positive responses, and some groupings of negative ones. Further analysis demonstrated some significant links between attitudinal statements and enablement and empathy scores.
Conclusions  The quality of general practice consultations was not adversely affected by medical student presence. However, significant numbers of patients who agreed to be seen with a student present were resistant to the student's presence.     

Undergraduate surgical teaching utilizing telemedicine

OBJECTIVES: To evaluate the concept of a new telemedicine orientated educational application by exposing junior medical students to surgical teaching via video-conferencing from the operating theatre and comparing this to the traditional method currently employed, which requires the presence of students in the operating room. To determine student satisfaction with this novel method and identify deficiencies associated with traditional surgical teaching. DESIGN: Students were connected by video-conferencing equipment 2 Mbit/s permanent virtual circuits that provided two-way picture and voice communication. Traditional tutoring involved students attending the operating theatre in set numbers. Video recordings were made during the telemedicine transmission for highlighting important factors relevant to the operative procedure. A questionnaire was used to assess the quality of time spent and information obtained by the students. SETTING: Telemedicine centre and operating theatre, St Mary's Hospital, London. SUBJECTS: Junior clinical students. RESULTS: The median score for surgical teaching utilizing video-conferencing was 9 (scale 0-10) compared to 5 for traditional operating theatre surgical teaching. All 46 (100%) subjects indicated a willingness to return for the telemedicine influenced method of tutoring compared to 65% of students exposed to the conventional method. CONCLUSIONS: Our early experience with telemedicine assisted surgical teaching indicate high acceptance and satisfaction rates by clinical students. Further studies to evaluate the objective gain in knowledge associated with this method is required prior to its implementation in any future medical curriculum.     

"It's much easier than going to the dentist": high levels of satisfaction in a mammography screening program

OBJECTIVES: To develop a suitable instrument for measuring client satisfaction in the BreastScreen New South Wales (NSW) program and to use the instrument to measure client satisfaction. METHOD: The survey was designed and administered to 2,091 women who attended mammography screening in the BreastScreen NSW program during 2001 (85% response rate). The survey evaluated experiences of making appointments, the screening environment, the screening procedure, and the receipt of results. Socio-demographic differentials in client satisfaction were examined using logistic regression models. RESULTS: The majority of women were highly satisfied with their experience, with transport/parking, breast discomfort and time to results causing the most dissatisfaction (8-9%). The main source of dissatisfaction was during the appointment and related to discomfort during the mammogram (9%) and breast problems following the mammogram (9%). Predictors of dissatisfaction with screening (p<0.05) included high education level (OR=1.4), non-Australian born (OR=1.4), and aged 40-49 years (OR=1.6). CONCLUSIONS: Although overall satisfaction was high, the survey indicated service functions where improvements could be made. IMPLICATIONS: This research has developed an appropriate tool for assessing and monitoring client satisfaction with breast screening services.     

Attitudes of elderly patients to medical students

The attitudes of elderly patients towards clinical teaching of medical students was assessed by a structured interview carried out by a doctor unknown to the patient immediately prior to discharge. One hundred and thirty alert patients were approached on three acute geriatric medicine wards in the Royal Liverpool (Teaching) Hospital. A total of 106 (81.5%) patients were suitable for inclusion in the study (mean age, 80.2 years). Twenty-nine per cent did not know what a medical student was despite having been interviewed and examined by one. Fifty-nine per cent of patients had no prior knowledge that clinical teaching occurred. Fourteen patients (13 women, 1 man, P < 0.05) objected to being examined. Nineteen women patients were examined by a man student without a chaperone. Students usually (95%) asked permission to interview and examine the patients whereas doctors only asked patients in the context of bedside teaching (33%). Elderly patients were sympathetic towards ('They have to learn') and positive about ('It's good to have them') medical students. However, 29% of patients were not aware that a medical student was going to be a doctor despite being interviewed and examined. We suggest that the term should be used either with explanation or abandoned in favour of 'student doctor'. The level of awareness of clinical teaching was poor and examination of women patients without a chaperone caused distress and should be rectified.     

Patient satisfaction with primary health care services in the United Arab Emirates.

OBJECTIVE: This study evaluated the suitability of a patient satisfaction questionnaire to survey health care consumers of traditional Arabic background. DESIGN: A cross-sectional survey using an Arabic language questionnaire that drew upon concepts of patient satisfaction measurement in Western research literature. All participants were interviewed once by experienced interviewers to ascertain their levels of satisfaction with their health care service. SETTING: Patient satisfaction was compared between the only resource-intensive clinic (RIC) in the United Arab Emirates and one resource-thrifty clinic (RTC) located in an adjacent suburb and serving essentially the same population. STUDY PARTICIPANTS: A random sample of patients attending the RIC and RTC over a 5-day period. MAIN OUTCOME MEASURES: Six domains of patient satisfaction were measured. RESULTS: Compared with the RTC (n = 125), the RIC (n = 156) scored significantly higher in continuity (P = 0.001), comprehensiveness (P < 0.001), health education (P = 0.05), effectiveness (P = 0.001), and overall satisfaction (P < 0.001), while accessibility (P = 0.130) and humaneness (P = 0.102) were not significantly different. Humaneness scored the highest and continuity the lowest at both clinics. Older people's satisfaction was higher for comprehensiveness but otherwise the same as those who were younger. More highly educated people's satisfaction was lower for effectiveness, but otherwise the same as those who were less educated. Men and women had equal levels of satisfaction. CONCLUSIONS: The significantly higher patient satisfaction in the RIC compared with the RTC was a strong a priori expectation, suggesting that this satisfaction questionnaire is a useful quality assurance tool in this setting.     

The effect of health status on patients' satisfaction with out-of-hours care provided by a family doctor co-operative

BACKGROUND: Systems for providing primary care outside normal hours have changed significantly in Europe over the last 20 years. The impetus for this change has come almost entirely from the medical profession, and it is important to consider the patients' perspective. Although patient's satisfaction with out-of-hours care has been studied extensively, the effect of patient's health status on satisfaction level has not been examined previously. OBJECTIVES: The primary objective of this study was to investigate whether health status has an influence on patient satisfaction with out-of-hours care provided by a family doctor co-operative. The secondary objective of this study was to investigate the impact of age, gender, socio-economic status and call outcome on patients' satisfaction with out-of-hours care. METHODS: All patients contacting the service over a designated 24 day period were forwarded a postal questionnaire. Health status was recorded using the Short Form-12 (SF-12) health survey. Patients' satisfaction was measured by using a version of the McKinley questionnaire. RESULTS: The response rate was 55% (531 out of 966). Overall satisfaction levels were high, with 88% of patients rating the service as either excellent or good. Logistic regression, modelling for the simultaneous effects of age, gender, socio-economic status, call outcome and health status on overall satisfaction, found that patients with lower physical and mental health status scores were significantly less likely to be satisfied with their out-of-hours care [odds ratio (OR) 1.04, 95% confidence interval (CI) 1.01-1.07, P = 0.017; and 1.03, 95% CI 1.00-1.06, P = 0.046, respectively]. Patients with higher socio-economic status were also significantly less likely to be satisfied (OR 0.25, 95% CI 0.11-0.55, P = 0.001). Patient's age and gender, and call outcome did not significantly affect overall satisfaction levels. CONCLUSION: Family doctor co-operatives have significantly altered the way out-of-hours care is delivered. Patients with lower health status are significantly less likely to be satisfied with this new form of out-of-hours care. This finding has important implications for the future planning of out-of-hours primary care services.     

儿童家长接受预防接种服务额外消耗时间对总体满意率的影响

目的 了解儿童家长对预防接种服务的总体满意率,以及接受预防接种服务额外消耗时间对其满意率的影响。方法 2019年12月至2020年1月,对0~3岁儿童家长基本情况、接受预防接种服务额外消耗时间以及对预防接种服务的总体满意情况进行问卷调查。共3 178名儿童家长纳入分析。采用二分类logistic回归模型和限制性立方样条模型分析儿童家长接受预防接种服务额外消耗时间对总体满意率的影响。结果 儿童家长对预防接种服务的总体满意率为92.32%。儿童家长从家到预防接种门诊时间M（P₂₅,P₇₅）为10.00（10.00,20.00）min,办理预约登记等候时间M（P₂₅,P₇₅）为10.00（5.00,15.00）min,等待进行注射疫苗时间M（P₂₅,P₇₅）为5.00（3.00,10.00）min,额外消耗总时间M（P₂₅,P₇₅）为30.00（20.00,45.00）min。二分类logistic回归分析结果显示,调整相关因素后,有利于提高儿童家长总体满意率的额外消耗时间因素依次为办理预约登记等候时间（4~min组与8~min组相比,OR=1.863,95%CI：1.307~2.657）、等待进行注射疫苗时间（<4、4~min组与8~min组相比,OR=1.529,95%CI：1.102~2.120;OR=1.534,95%CI：1.104~2.130）、额外消耗总时间（15~min组与30~min组相比：OR=1.470,95%CI：1.094~1.976）。限制性立方样条模型分析显示,儿童家长办理预约登记等候时间（非线性检验χ²=13.18,P=0.001）、等待进行注射疫苗时间（非线性检验χ²=13.50,P=0.001）以及额外消耗总时间（非线性检验χ²=9.38,P=0.009）与总体满意情况的关联强度呈非线性的倒“V”形剂量反应关系。结论 儿童家长办理预约登记等待时间、等待进行注射疫苗的时间和接受预防接种服务额外消耗总时间影响总体满意率。其中,办理预约登记等待时间的影响最大,且该环节等待时间较长,建议预防接种门诊利用信息化技术（如建立微信公众号、APP等）开展分时段预约,并控制单位时间服务人数,对预防接种人群进行有效分流。     

Experiences of volunteer patients during undergraduate examinations: printed information can lead to greater satisfaction

BACKGROUND: Whilst most patients are happy to participate in medical examinations, previous studies have shown that some are dissatisfied with the information that they receive beforehand. OBJECTIVES: To demonstrate that patient satisfaction can be improved by the provision of written information. METHODS: Thirty-seven patients attending the final MBBS examination were sent written information about what to expect. The patients' experiences were assessed by means of an anonymous postal questionnaire 1 week after the examination. Their satisfaction with the level of information received beforehand was compared with that of an historical cohort who had received no written information. RESULTS: The patients had few complaints about their experience of participating in examinations and many enjoyed it. Only 5% of patients registered dissatisfaction with the level of information that was provided, compared with 18% in the previous study (P = 0.077). CONCLUSIONS: Written information led to a (near significant) improvement in patients satisfaction when compared to a previous cohort. We recommend that all patients attending for medical examinations should be provided with written information.     

Patient choice in general practice: the implications of patient satisfaction surveys

OBJECTIVES: To identify factors that explain patient satisfaction with general practice physicians and hence that may drive patients' choice of practice. METHODS: Logistic regression analysis of English National Health Service national patient survey data is used to identify the aspects of general practice care that are associated with high levels of overall satisfaction among patients. RESULTS: Confidence and trust in the doctor is the most important factor in explaining the variation in overall patient satisfaction (predicting 82% of satisfaction levels accurately). The seven variables relating to the relationship between patient and doctor have stronger explanatory power than other aspects of the general practitioner (GP) experience. The variables with the lowest overall predictive power are whether the patient was told how long they would have to wait in the surgery (72%), the length of time they had to wait after their appointment time (74%) and ability to get through to the surgery on the phone (74%). CONCLUSIONS: Patients value the quality of their relationship with their doctor more than the appearance of the surgery, accessibility of appointments and their experience in the waiting room. This suggests that, if current restrictions on choice of GP were removed, we would in theory expect a patient's choice to be driven by the quality of the doctor-patient relationship. Once a patient establishes a good relationship with a GP, however, we might expect them to be loyal and therefore unlikely to change practice unless the relationship with the doctor breaks down. Although relationship factors are important to the satisfaction of patients, it is not clear that they will lead large numbers of people to change their GP.     

Developing a standard short questionnaire for the assessment of patient satisfaction with out-of-hours primary care

BACKGROUND: Governmental reviews of out-of-hours services in England and Scotland have recommended that a standard questionnaire should be used to assess patient satisfaction. This is important because of the rapid introduction of new forms of care. OBJECTIVE: To produce a brief, reliable and valid measure of patient satisfaction for use by a wide variety of providers of out-of-hours primary care. METHODS: The Short Questionnaire for Out-of-Hours care was designed and compared with a longer questionnaire which had been validated and used in earlier research. Questionnaires were sent to 1906 people contacting an out-of-hours GP co-operative. Three versions of the short questionnaire were used with different formats. Analysis compared the response rates, measurement properties, concurrent and construct validity of the short and long questionnaires, and of different versions of the short questionnaire. RESULTS AND CONCLUSIONS: There was no significant difference in the overall response rates obtained from the short or long questionnaires (45.7% versus 41.9%; P = 0.17). The effective response rate of questionnaires from which all satisfaction scales could be calculated was higher for the short questionnaire (43.0% versus 36.4%; P = 0.01). There were no significant differences in response rates or distribution of responses between different versions of the short questionnaire. There was moderate agreement between items on the short questionnaire and corresponding scales on the long questionnaire. Scores using the short questionnaire showed anticipated relationships with the age and sex of patients and with characteristics of how the service was delivered. The SQOC is valid and reliable for routine service use.     

Is personality a determinant of patient satisfaction with hospital care?

OBJECTIVE: We investigated to what extent personality is associated with patient satisfaction with hospital care. A sizeable association with personality would render patient satisfaction invalid as an indicator of hospital care quality. DESIGN: Overall satisfaction and satisfaction with aspects of care were regressed on the Big Five dimensions of personality, controlled for patient characteristics as possible explanatory variables of observed associations. PARTICIPANTS: A total of 237 recently discharged inpatients aged 18-84 years (M = 50, SD = 17 years), 57% female, who were hospitalized for an average of 8 days. INSTRUMENTS: The Satisfaction with Hospital Care Questionnaire addressing 12 aspects of care ranging from admission procedures to discharge and aftercare and the Five-Factor Personality Inventory assessing a person's standing on Extraversion, Agreeableness, Conscientiousness, Emotional stability, and Autonomy. RESULTS: Agreeableness significantly predicted patient satisfaction in about half of the scales. After controlling for shared variance with age and educational level, the unique contribution of Agreeableness shrank to a maximum of 3-5% explained variance. When one outlier was dropped from the analysis, the contribution of Agreeableness was no longer statistically significant. CONCLUSION: Patient satisfaction seems only marginally associated with personality, at least at the level of the broad Big Five dimensions.     

Assessing Medicaid recipient access and satisfaction. Fee-for-service, case management, and capitation

Medicaid increasingly requires enrollment in managed care programs. This study assessed access to care, satisfaction with care, and appointment wait times during the transition from fee for service to managed care using three annual Medicaid recipient surveys. There was little evidence of dissatisfaction or poorer access among managed care recipients. Fee-for-service recipients, compared to primary care case management, reported greater general (91 vs. 78%, p < .01) and specialty care access (92 vs. 80%, p < .01). When appointments were required, adult HMO enrollees, compared to case management, had longer waits for routine care in the second (5.8 +/- 8.2 days vs. 4.0 +/- 6.6) and third surveys (5.5 +/- 6.9 days vs. 3.8 +/- 7.3); waits for other appointments did not consistently differ by program. There were no significant program differences in overall satisfaction. Findings are tempered by the potential for response bias and geographic confounding. Continued monitoring is crucial to assure that access and satisfaction remain high in Medicaid managed care.     

Perceived quality of reproductive care for girls in a competitive voucher programme. A quasi-experimental intervention study, Managua, Nicaragua.

OBJECTIVE: To determine whether female adolescents from low-income areas in Managua were satisfied with the sexual and reproductive health (SRH) care provided through a competitive voucher programme and to analyse the determinants of their satisfaction. DESIGN: A community-based quasi-experimental intervention study from 2000 to 2002. SETTING: Low-income areas of Managua. INTERVENTION: Distribution of 28,711 vouchers giving adolescents free-access to SRH care in 19 clinics; training and support for health care providers. STUDY PARTICIPANTS: A random sample of 3009 girls from 12 to 20 years completed self-administered questionnaires: 700 respondents had used this care in the last 15 months, 221 with voucher (users-with-voucher) and 479 without voucher (users-without-voucher). MAIN OUTCOME MEASURES: User satisfaction; Satisfaction with clinic reception; Clarity of doctors' explanations. RESULTS: User satisfaction was significantly higher in users-with-voucher compared with users-without-voucher [Adjusted odds-ratio (AOR) = 2.2; 95% confidence interval (95% CI) = 1.2-4.0]. Voucher use was associated with more frequent satisfaction with clinic reception, especially among sexually active girls not yet pregnant or mother (AOR = 6.9; 95% CI = 1.5-31.8). The clarity of doctors' explanations was not perceived differently (AOR = 1.4; 95% CI = 0.9-2.2). User satisfaction was highly correlated to satisfaction with clinic reception and clarity of doctors' explanations (P < 0.001). Longer consultation times, shorter waiting times, older age, and having a female doctor positively influenced user satisfaction. CONCLUSION: Voucher use by teenage girls was associated with a better perceived SRH care. This is an important result, given the crucial role user satisfaction plays in adoption and continued use of health care and contraceptives. Though more research is needed, confidential and guaranteed access appear key factors to voucher success.     

Influence of Shared Medical Appointments on Patient Satisfaction: A Retrospective 3-Year Study

PURPOSE

Shared medical appointments (SMAs) are becoming popular, but little is known about their association with patient experience in primary care. We performed an exploratory analysis examining overall satisfaction and patient-centered care experiences across key domains of the patient-centered medical home among patients attending SMAs vs usual care appointments.

METHODS

We undertook a cross-sectional study using a mailed questionnaire measuring levels of patient satisfaction and other indicators of patient-centered care among 921 SMA and 921 usual care patients between 2008 and 2010. Propensity scores adjusted for potential case mix differences between the groups. Multivariate logistic regression assessed propensity-matched patients’ ratings of care. Generalized estimating equations accounted for physician-level clustering.

RESULTS

A total of 40% of SMA patients and 31% of usual care patients responded. In adjusted analyses, SMA patients were more likely to rate their overall satisfaction with care as “very good” when compared with usual care counterparts (odds ratio = 1.26; 95% CI, 1.05–1.52). In the analysis of patient-centered medical home elements, SMA patients rated their care as more accessible and more sensitive to their needs, whereas usual care patients reported greater satisfaction with physician communication and time spent during their appointment.

CONCLUSIONS

Overall, SMA patients appear more satisfied with their care relative to patients receiving usual care. SMAs may also improve access to care and deliver care that patients find to be sensitive to their needs. Further research should focus on enhancing patient-clinician communication within an SMA as this model of care becomes more widely adopted.     

The association between maternal ratings of child health interviews and maternal and child characteristics

BACKGROUND: Doctors develop the skills needed to interview parents and children in paediatric settings by practice and by receiving feedback during their medical training. Interviewed parents are ideally placed to provide evaluations of these skills. If parents, as consumers of health care services, are to be consulted, it is important to determine whether factors other than interview skills affect their evaluations. OBJECTIVES: Our aim was to examine the relationship between maternal satisfaction ratings of student doctor interviews, and maternal and child characteristics. METHODS: Sixty mothers of children attending the paediatric medical out-patient clinic at the Women's and Children's Hospital, South Australia were allocated randomly to rate one of four video-taped final year student doctor interviews (15 mothers per interview). The level of skills displayed by the student doctor differed in each interview. Maternal satisfaction was measured using the Medical Interview Satisfaction Scale (MISS) and the Interpersonal Skills Rating Scale (IPS), and interview ratings were compared for a number of maternal and child characteristics. RESULTS: No significant associations were observed between maternal satisfaction ratings and any maternal or child characteristics other than lower satisfaction associated with previous experience of a real student doctor interview (P <0.01). The interview seen by mothers predicted 53% (MISS) and 65% (IPS) of the variance in maternal satisfaction ratings. After controlling for the interview type, the maternal and child characteristics studied predicted 17% additional variance in MISS scores and 7% in IPS scores. CONCLUSION: The quality of the interview skills demonstrated was the principle determinant of maternal satisfaction ratings.     

Interpersonal and organizational dimensions of patient satisfaction: the moderating effects of health status.

OBJECTIVES: Based on Donabedian's structure, process, and outcome model, this study was conducted to identify the underlying dimensions of patient satisfaction for diabetic patients and determine the effects of demographic characteristics and health status on these dimensions. DESIGN: A cross-sectional analytical research design was used with a questionnaire, comprising demographic characteristics, the general and mental health items from the SF-20, and a 25-item patient satisfaction scale. SETTING AND STUDY PARTICIPANTS: The questionnaire was administered to 263 South African black diabetic outpatients from the diabetic clinics at two hospitals. There were 174 females and 89 males, aged between 16 and 89 years (mean = 53.5, sd = 13.9). The average number of years of schooling was 6.3 (sd = 4.1). Main outcome measure. A reliable and valid patient satisfaction scale. RESULTS: Factor analysis was conducted on the patient satisfaction scale and two factors, accounting for 71.6% of the variance, were extracted. The major items on Factor I were support, consideration, friendliness, and encouragement, labelled the interpersonal dimension. Factor II emphasized availability of a seat and toilet in the waiting area and cleanliness, labelled the organizational dimension. The two factors had very good reliability coefficients: 0.85 (organizational) and 0.98 (interpersonal). Multi-trait scaling showed that all items exceeded the item convergent (r > 0.40) and discriminant (Z > 1.96) validity criteria. Patients in poor general health were significantly less satisfied (P = 0.007) with the organizational quality of their care than patients in good health; patients in poor mental health were significantly less satisfied (P = 0.04) with the interpersonal quality of their care than patients in good mental health. CONCLUSIONS: The findings provided support for Donabedian's model. They demonstrated that attributes of providers and settings are major components of patient satisfaction, and showed that the scale is a reliable and valid measure of patient satisfaction for this South African population.