Patient satisfaction with health care providers in South Africa: the influences of race and socioeconomic status.

OBJECTIVE: The first democratic government elected in South Africa in 1994 inherited huge inequalities in health status and health provision across all sections of the population. This study set out to assess, 4 years later, the influence of race and socioeconomic status (SES) on perceived quality of care from health care providers. DESIGN: A 1998 countrywide survey of 3820 households assessed many aspects of health care delivery, including levels of satisfaction with health care providers among different segments of South African society. RESULTS: Fifty-one percent (n = 1953) of the respondents had attended a primary care facility in the year preceding the interview and were retained in the analysis. Both race and SES were significant predictors of levels of satisfaction with the services of the health care provider, after adjusting for gender, age, and type of facility visited. White and high SES respondents were about 1.5 times more likely to report excellent service compared with Black and low SES respondents, respectively. CONCLUSION: In South Africa, race and SES are not synonymous and can no longer be considered reliable proxy indicators of one another. Each has distinct and significant but different degrees of association with client satisfaction. Any assessment of equity-driven health policy in South Africa should consider the impacts of both race and SES on client satisfaction as one of the indicators of success.     

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.     

Patient satisfaction in relation to age, health status and other background factors: a model for comparisons of care units.

OBJECTIVE: To analyse the relationship between patient satisfaction and background factors such as age, gender, health status and pain. In addition, to use background factors to create less biased ranking in comparisons of patient satisfaction between medical specialities. DESIGN: A questionnaire was sent by post to patients who had recently received inpatient care at a hospital within the County of Osterg?tland, Sweden. The questionnaire contained 33 questions, 21 of which concerned the quality of health care and patient satisfaction. SETTING: Inpatient departments at all four hospitals in the County of Osterg?tland, Sweden. SUBJECTS: All patients discharged from the hospital during a period of 6 weeks. Approximately 3400 patients aged 1-94 years responded to the questionnaire, resulting in a response rate of 69%. MAIN OUTCOME MEASURES: Patient satisfaction index score (PSI). RESULTS: Of the background factors tested, patient age had the greatest explanatory value regarding the PSI, closely followed by experiencing anxiety during admission. With regard to variations in the PSI, about 20% could be explained by the background factors taken as a whole. Gender did not correlate with the PSI, although males were somewhat more satisfied than females. PSI scores differed among medical specialities and, interestingly, when age and other background factors were controlled for, the picture changed regarding the medical speciality that received the best PSI score. CONCLUSION: The change in ranking among medical specialities after adjustment for background factors emphasizes the importance of including background factors in patient satisfaction analyses in order to obtain less biased comparisons.     

Perception and use of the results of patient satisfaction surveys by care providers in a French teaching hospital.

OBJECTIVE: . The aim of this study was to assess clinical staff's opinions on the results of in-patient satisfaction surveys and their use within the quality improvement process. SETTING: The institution is a 2200-bed teaching hospital of tertiary health care employing 8000 professionals. Patient satisfaction surveys are carried out each year using a validated questionnaire mailed to a random sample of patients. The specific results of each department are sent to the medical and paramedical managers. METHODS: We conducted a questionnaire survey on 500 care providers randomly selected in every medical and surgical department. RESULTS: A total of 261 questionnaires were returned and analysed. Overall, 94% of responders had a favourable opinion of the patient satisfaction surveys. They considered that the patient was able to judge hospital service quality, especially in its relational, organizational, and environmental dimensions. The specific results for the department were less well known than the overall hospital results (60 versus 76%). These results were formally discussed in the department according to 40% of responders; 40% declared that these data resulted in improvement actions and considered that they led to modifications in their behaviour with patients. CONCLUSIONS: Despite a declared interest in satisfaction surveys, the results remain underused by hospital staff and insufficiently discussed within teams.     

Patient satisfaction with and recommendation of a hospital: effects of interpersonal and technical aspects of hospital care.

OBJECTIVES: To examine patient satisfaction with and recommendation of a hospital, with a special focus on the correlation of these measures to patient ratings of interpersonal and technical performance of the hospital. DESIGN: Telephone survey of patients with four specific conditions after their discharge from hospitals. SETTING: Accredited district teaching hospitals and above, nationwide in Taiwan. PARTICIPANTS: A total of 4945 patients from 126 hospitals diagnosed with or undergoing procedures related to stroke, diabetes mellitus, Caesarean section, or appendectomy were interviewed by telephone. MAIN OUTCOME MEASURES: Overall patient satisfaction and recommendation were measured by single-item questions. Interpersonal skills were measured by three items: doctors' explanation, attitude, and caring. Technical skills were measured by another three items: hospital equipment, clinical competence, and outcome of treatment. RESULTS: Interpersonal skills were as influential or more influential than clinical competence on patient satisfaction for three of the four disease categories. In contrast, technical competence was a more influential predictor for recommendation for patients in all four disease categories. CONCLUSION: The preliminary results imply that a hospital with high percentage of patient satisfaction does not necessarily receive a high level of recommendation. This finding provides new insights for researchers and for hospital managers who devote resources exclusively for achieving the highest possible levels of patient satisfaction.     

Impact of insurance and hospital ownership on hospital length of stay among patients with ambulatory care-sensitive conditions

PURPOSE Some studies suggest proprietary (for-profit) hospitals are maximizing financial margins from patient care by limiting therapies or decreasing length of stay for uninsured patients. This study examines the role of insurance related to length of stay once the patient is in the hospital and risk for mortality, particularly in a for-profit environment. METHODS We undertook an analysis of hospitalizations in the National Hospital Discharge Survey (NHDS) of the 5-year period of 2003 to 2007 for patients aged 18 to 64 years (unweighted n = 849,866; weighted n = 90 million). The analysis included those who were hospitalized with both ambulatory care-sensitive conditions (ACSCs), hospitalizations considered to be preventable, and non-ACSCs. We analyzed the transformed mean length of stay between individuals who had Medicaid or all other insurance types while hospitalized and those who were hospitalized without insurance. This analysis was stratified by hospital ownership. We also examined the relationship between in-hospital mortality and insurance status. RESULTS After controlling for comorbidities; age, sex, and race/ethnicity; and hospitalizations with either an ACSC or non-ACSC diagnosis, patients without insurance tended to have a significantly shorter length of stay. Across all hospital types, the mean length of stay for ACSCs was significantly shorter for individuals without insurance (2.77 days) than for those with either private insurance (2.89 days, P = .04) or Medicaid (3.19, P <.01). Among hospitalizations for ACSCs, in-hospital mortality rate for individuals with either private insurance or Medicaid was not significantly different from the mortality rate for those without insurance. CONCLUSIONS Patients without insurance have shorter lengths of stay for both ACSCs and non-ACSCs. Future research should examine whether patients without insurance are being discharged prematurely.     

Patient satisfaction with availability of general practice: an international comparison.

OBJECTIVE: To identify associations between the characteristics of general practitioners and practices, and patients' evaluations of the availability of general practice. DESIGN: Written surveys completed by patients. SETTING: General practice care in nine European countries: Denmark, Germany, The Netherlands, Norway, UK, Belgium (Flanders and Wallonia), Switzerland, Slovenia and Spain. STUDY PARTICIPANTS: 15996 adult patients consecutively visiting the general practitioner (response rates per country varied between 47 and 89%). MAIN MEASURES: The Europep instrument to assess patients' evaluations of five aspects of the availability of general practice care: (1) getting an appointment, (2) getting through on the phone, (3) being able to speak to the practitioner on the telephone, (4) waiting time in the waiting room, and (5) providing quick services for urgent health problems. Each general practitioner recorded age, sex, number of years in the practice, number of practitioners and other care providers in the practice, and urbanization level of the practice. RESULTS: Patients' more positive evaluations were associated with fewer general practitioners in the practice, except for quick services for urgent health problems (range of conditional overall odds ratios, 1.69-2.02). In addition, a number of significant unconditional overall odds ratios were found, particularly those related to the number of general practitioners' working hours and the number of care providers in the practice. None of the associations was found consistently in all countries. CONCLUSION: Patients favour small practices and full-time general practitioners, which contradicts developments in general practice in many countries. Policy makers should consider how the tensions between patients' views and organizational developments can be solved.     

The relationship between health status, social support and satisfaction with medical care among patients with systemic lupus erythematosus.

OBJECTIVE: To examine the effect of physical and mental health status and social support on patient satisfaction with health care in patients with systemic lupus erythematosus (SLE). STUDY DESIGN: Using a cross-sectional design, 220 SLE patients were recruited from rheumatology departments in two hospitals in the Montreal (Canada) area. Data comprised physician-rated indices of health status and patient-completed questionnaires. MEASURES: Independent variables included demographics, disease duration, physician-rated indices of disease activity (SLAM-R) and disease damage (SLICC/ACR), patient self-reported health status (SF-36), and perceived social support (ISEL). Patient satisfaction with medical care (PSQ-IV) was the dependent variable. ANALYSES: Univariate analyses were performed to describe the sample and examine univariate associations between the independent variables and patient satisfaction with medical care. A hierarchical multiple linear regression analysis was computed to determine the relative importance of physician-rated indices of health status, self-reported physical and mental health status and social support on patient satisfaction after controlling for demographic variables. RESULTS: A multivariate hierarchical regression computed to predict patient satisfaction included the following variables in the equation: age, education, income (step 1), disease duration, SLAM-R, SLICC/ACR (step 2), mental and physical health status (step 3), and perceived social support (step 4). Less education (P< 0.01), better self-reported mental (P< 0.05) and physical health status (P< 0.005) and higher perceived social support (P< 0.005) were significant predictors of patient satisfaction (R2 = 0.15, P< 0.0001). CONCLUSION: The findings suggest that self-reported physical and mental health status and social support are more important than clinical status variables in understanding patient satisfaction with medical care.     

Patient satisfaction with health services in Bangladesh

Concern over the quality of health care services in Bangladesh has led to loss of faith in public and private hospitals, low utilization of public health facilities, and increasing outflow of Bangladeshi patients to hospitals in neighbouring countries. Under the circumstances, assessment of the country's quality of health care service has become imperative, in which the patient's voice must begin to play a greater role. This study attempts to identify the determinants of patient satisfaction with public, private and foreign hospitals. A survey was conducted involving inpatients in public and private hospitals in Dhaka City and patients who have experienced hospital services in a foreign country. Their views were obtained through exit polls using probability and non-probability (for foreign hospital patients) sampling procedures. Regression models were derived to identify key factors influencing patient satisfaction in the different types of hospitals. Doctors' service orientation, a composite of 13 measures, is the most important factor explaining patient satisfaction. Policy implications are discussed.     

Influence of length of stay on patient satisfaction with hospital care in Japan.

OBJECTIVE: The objective of this study was to identify specific patient satisfaction items related to overall satisfaction by different length of stay (LOS) for patients in Japanese hospital settings. METHODS: This cross-sectional study involved a participant sample, drawn from 77 voluntarily participating hospitals throughout Japan, of in-patients discharged to the community. Older patients and psychiatric, pediatric, obstetric and gynecologic patients were excluded. The 1050 respondents analyzed (response rate > or = 5l.1%) were divided into three groups based on their LOS: group 1, LOS < or = 1 week; group 2, LOS < or = 1 month; and group 3, LOS > 1 month. Using stepwise multiple regression analysis, we explored for each LOS group the relationship between overall patient satisfaction and satisfaction with 33 individual items, including three regarding perceived reputation of the hospital in question. RESULTS: Some unique satisfaction items for each group (e.g. 'skill of nursing care' in group 1, 'Recovery of physical health', 'skill of nursing care', and 'respect for patients opinions and feelings' in group 2, and 'relief from pain' and 'respect for patients' opinions and feelings' in group 3) were significantly associated with overall satisfaction. In all three groups, common items (e.g. 'recovery from distress and anxiety' and 'doctor's clinical competence') also related significantly to overall satisfaction. Two items pertaining to the hospital reputation dimension (e.g. 'family member's evaluation of the hospital' and 'hospital reputation among other patients') were also significant predictors of overall satisfaction in all three groups. CONCLUSION: The findings show that according to LOS, unique items could determine significantly the achievement of overall satisfaction, while some common predictors across all three LOS groupings also seemed to be indispensable for inpatient's assessment of hospital care. It was also confirmed in this study that a positive perception of hospital reputation might have an important role in patient satisfaction in Japan.     

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.     

Evidence of a non-linear influence of patient age on satisfaction with hospital care.

BACKGROUND: Patient age is the main socio-demographic factor influencing patient satisfaction with care but the nature of the relationship between age and patient satisfaction is controversial. OBJECTIVE: This study aims to clarify whether the association of age with satisfaction is linear or shows some other configuration. METHODS: Data were obtained from two different satisfaction studies conducted in 27 short-stay teaching hospitals. Study 1 included 1547 inpatients, who completed the EQS-H questionnaire at the time of discharge. Study 2 included 7624 inpatients interviewed by phone at home after discharge, who answered the SAPHORA questionnaire. On the basis of the results of the exploratory analysis, three models for adjustment of age on satisfaction were compared: a simple linear model, a five-group step function and a linear model with a change in slope. RESULTS: The most suitable model for adjusting patient age to satisfaction scores for quality of medical and nursing care, whether for the EQS-H or the SAPHORA scale, was not a linear relationship: patient age was linearly and positively correlated to satisfaction before 65 years and negatively thereafter. Adjustment of patient age to accommodation and premises satisfaction scores proved to be different, closer to a linear relationship. CONCLUSION: These results suggest considering the patient age variable as a non-linear factor for adjusting satisfaction scores, in particular in relation to care. Further studies are needed to confirm the evidence of a threshold around 65 years beyond which satisfaction scores for the quality of medical and nursing care decrease.     

Impact of improved primary care on patient satisfaction: Results of a pilot study in the University of the Philippines

Primary care is generally perceived by the public as an inefficient, low‐quality source of health care in the Philippines. Taking a toll on local health policies, the repercussions of these views warrant a more holistic approach in understanding patient experience. This paper evaluates the impact of strengthening primary care services on patient satisfaction at the University of the Philippines Health Service (UPHS). A prevalidated 16‐item, 5‐scale questionnaire was distributed to 200 eligible patients at the start of the study in 2016 and then again in 2017. A significant increase of highly satisfied patients in 13 of 16 questionnaire items was recorded after primary care services in the facility were strengthened. The highest satisfaction scores were reported for overall wait times, coordination of care, and health advice. Our findings suggest that improvements in primary care services through digitalizing health records, financing laboratory and pharmaceutical services, and retraining staff accounts for significant improvements in patient satisfaction. This ultimately bears potential for better clinical outcomes in form of patient retention and long‐term care.     

Health promotion in the market-place: patient satisfaction as the basis of a marketing strategy

This article looks at prevention in the context of recent policyinitiatives in the UK which have created new roles and new opportunitiesfor general practitioners (GPs) and primary care. One such opportunityis the potential to actively market preventive services in orderto retain and attract patients in a competitive market. We firstdescribe this context and then provide an example of how a patientsatisfaction survey can be an effective market-research toolThe results from a district-wide survey are evaluated in termsof socio-demographic differences which stratify the patientmarket into segments which are aware of, users of and are satisfiedwith preventive services and those who are not. This articleillustrates how GPs can use data of this kind when developinginvestment and marketing strategies.     

Patient satisfaction at health centres in Trinidad and Tobago

The aim of this paper is to identify background characteristics of health centre users in Trinidad and Tobago and their perceptions of the services provided. Multi-staged sampling was used to select 1,500 health centre users throughout the country. Data were obtained using structured interviews conducted on regular clinic days.Results show that there is an overwhelmingly large percentage of unemployed persons (80.4%) and women(75.9%) among the users of health centres. The elderly is well represented, with 25.4 percent of the sample being over 60 years of age. Also, occupational status of family wage earners and educational attainment levels of respondents reflect a disproportionately higher number from lower socio-economic groupings among health centre users. On the other hand, proportions of different ethnic and religious groups among the respondents bear a striking similarity to the general population of Trinidad and Tobago.Respondents appear to be generally satisfied with the services of the health centres. When the categories for‘satisfied’ and ‘very satisfied’ were combined, results show that 73.0% of respondents were satisfied with the comfort of the health centre, 81.7% with the ease and convenience of getting to the health centre and 67.4% with the medical care received at the health centre.According to respondents' opinions, the services in greatest need of improvement are the pharmacy anddoctor services, especially through reducing the long waiting period. When the doctors, nurses and pharmacists were compared with respect to ‘courtesy and consideration’, ‘Skills and Competence’ and ‘advice provided’, results show that the generally high levels of satisfaction are remarkably similar in all three cases.     

Health promotion in the market-place: patient satisfaction as the basis of a marketing strategy

This article looks at prevention in the context of recent policyinitiatives in the UK which have created new roles and new opportunitiesfor general practitioners (GPs) and primary care. One such opportunityis the potential to actively market preventive services in orderto retain and attract patients in a competitive market. We firstdescribe this context and then provide an example of how a patientsatisfaction survey can be an effective market-research toolThe results from a district-wide survey are evaluated in termsof socio-demographic differences which stratify the patientmarket into segments which are aware of, users of and are satisfiedwith preventive services and those who are not. This articleillustrates how GPs can use data of this kind when developinginvestment and marketing strategies.     

Association between perceived health status and satisfaction with quality of care: evidence from users of primary health care in Oman

OBJECTIVE: Our aim was to assess the influence of perceived health status, as measured by SF-12, on the client's views of service quality. METHODS: A structured interview of patients was carried out in six primary health care centres in Adh Dhahira region health authority in the Sultanate of Oman. A total of 1226 patients aged 15 and over attending the different health care services within the health centres took part in the study. The main outcome measures were patients' satisfaction with the different aspects of health care and their perceived physical and mental health status. RESULTS: When adjusted for the relevant background factors such as age and gender, poor perceived health status has been found to predict less positive judgements of various aspects of health care quality. Poor mental health status, for example, predicts less positive judgements of aspects that are linked to the accessibility of the service and interpersonal aspects of care such as the working hours of the centre, GP's attitude and time spent with the GP (P < 0.05, <0.05 and <0.01, respectively). Poor physical health status, on the other hand, predicts less positive judgements of aspects such as cleanliness of the building, confidentiality of consultation with the GP, explanation about the visit to the antenatal clinic and standard of antenatal clinic in general (P < 0.05, <0.05, <0.05 and <0.05, respectively). CONCLUSION: Users' perceived health status has to be evaluated concurrently with assessing satisfaction with the quality of health care services. This would provide more valid results with regard to the patients' views on their level of satisfaction with health care quality.