Patient satisfaction with teledermatology: quantitative and qualitative results from a randomized controlled trial

As part of a randomized controlled trial involving 208 dermatology patients, a quantitative and qualitative study was undertaken to explore patients' satisfaction with a specialist dermatological opinion and further management obtained through either a traditional outpatient consultation (control group) or an asynchronous teleconsultation (telemedicine group). There was a response rate of 71% to the quantitative patient satisfaction survey (148 replies from 208 distributed questionnaires). The responders comprised 80 of the 111 telemedicine patients (72%) and 68 of the 97 control patients (70%). Overall levels of patient satisfaction were high in both groups, and there was no significant difference between them. Ninety per cent of patients in the control group were satisfied with their overall care, compared with 81% in the telemedicine group, and 87% of patients in the control group were satisfied with their overall management, compared with 84% in the telemedicine group. Follow-up qualitative interviews with 30 of the participants also suggested that patients were generally positive about their care and management, regardless of group, age or gender. Receiving a diagnosis, treatment and cure, receiving adequate information and explanations, the need to be taken seriously, the need for individualized personal care, and the importance of a short waiting time for an appointment and treatment were all aspects of care and management most likely to result in patient satisfaction, regardless of modality.     

The role of expectations in patients' hospital assessments: a Turkish university hospital example

PURPOSE: This paper aims to conduct a preliminary assessment of patient attitudes regarding important aspects of service dimensions using SERVQUAL. DESIGN/METHODOLOGY/APPROACH: The SERVQUAL scale is routinely used at the Baskent University Hospitals Network, Turkey. The study consisted of 550 randomly chosen patients who presented to any member of the hospital network during January and February 2006 and received treatment as inpatients or outpatients at those healthcare facilities. FINDINGS: The patients' perceived scores were higher than expected for an ordinary hospital but lower than expected for a high-quality hospital. Young patients had a high-expected service score gap and a low adequate service score difference. Highly educated patients had a high-expected service score difference. Uninsured patients had a low adequate service score difference. ORIGINALITY/VALUE: Baskent University multidisciplinary healthcare teams have performed periodic patient satisfaction surveys in order to identify strengths and problem areas, formulate the quality improvement objectives and monitor progress towards achieving these objectives. However, patient satisfaction survey results are often highly positive. In these cases, improving care is not easy because measures are not sensitive enough to changes. Therefore a more sensitive measurement tool based on the SERVQUAL scale was developed. The authors believe that patient opinions are extremely important because they provide information that is not necessarily emphasized by managers or health care professionals, resulting in a more complete assessment of past performance and a clearer road map for future action.     

What patients want: A content analysis of key qualities that influence patient satisfaction

We sought to identify key qualities of healthcare that influence patient appraisal of satisfaction with primary care. An Internet survey of patients was used to collect anonymous ratings of physicians on several dimensions of healthcare experiences, as well as comments about aspects of care that were excellent and those that could be improved. Qualitative data analysis was used to discern content clusters and relate them to high and low ratings of patient satisfaction. Content analysis revealed that patients perceive and value at least seven domains of healthcare in defining outstanding quality (access, communication, personality and demeanor of provider, quality of medical care processes, care continuity, quality of the healthcare facilities, and office staff. All seven were cited as reasons for rating physicians as excellent, while four domains (communication, care coordination, interpersonal skills, and barriers to access) drove negative ratings. We conclude that patient satisfaction ratings are highly influenced by a core of communication and follow-up care. Physicians who do not possess these traits will not likely attain high ratings, while having these core traits does not necessarily ensure high patient satisfaction.     

Determinants of customer satisfaction with the health care system, with the possibility to choose a personal physician and with a family doctor in a transition country

Many Eastern and Central European counties are reforming their health care systems. The aim of this study was to determine customer satisfaction with a reformed health care system, with the possibility of free choice of a family physician and patient satisfaction with the family physician in Slovenia and their major determinants. We used a postal survey of the patients who attended their family physician's offices during the study period. We obtained an 84% response rate. Some 72.9% of the respondents were satisfied with the current organisation of health care services, 95.5% of the respondents were satisfied with the possibility of choosing their own family physician and 58% of participants were very satisfied with the level of care received from their personal family practitioners. It was shown that higher patient satisfaction with the family physician was the most powerful predictor of patients' satisfaction with the health care system. The results show that health care reform in Slovenia has a positive impact on the consumers' perceptions of health care quality, measured in terms of consumer satisfaction with the health care system, the possibility to choose a family physician and the overall satisfaction with the family physician.     

Electronic questionnaires for measuring parent satisfaction and as a basis for quality improvement.

BACKGROUND: Using paper questionnaires to measure quality of care from the perspective of the patient is a time consuming procedure resulting in very slow feedback. Response rates are low and patients who cannot read the local language are usually excluded. OBJECTIVE: To investigate the applicability of an electronic questionnaire by evaluating the response rate. To study whether computer-based continuous monitoring could elucidate reasons for parents being less satisfied with care and treatment and to compare parent satisfaction with the results of a study performed in 2003. METHODS: Parents were asked to assess the quality of care and treatment by answering questions on a touch-screen computer. The questions, which were translated into seven languages, corresponded to the indicators selected by the department for monitoring parents' satisfaction. The system was developed in cooperation with a software company. RESULTS: A total of 780 parents answered (69%). Of these, 2% parents answered in a foreign language. The main reasons for being less satisfied were perceived difficulties in getting in contact with the staff, having experienced unnecessary long waiting time and having the impression that the nurses did not have enough time. Significant improvements in satisfaction had occurred as compared to a study from 2003. CONCLUSION: By using electronic questionnaires, it was possible to focus on the small percentage of parents not satisfied, to identify reasons for being less satisfied and to respond immediately to the feedback from the parents. Electronic surveys produce a satisfactory response rates.     

Consumer satisfaction with occupational health services: should it be measured?

OBJECTIVES—To find answers in the literature to the questions if, why, and how consumer satisfaction with occupational health services (OHSs) should be measured.
METHODS—Publications about the concept of consumer satisfaction with health care and surveys of consumer satisfaction with occupational health care were reviewed.
RESULTS—For care providers, surveys of consumer satisfaction can be useful to improve quality or as indicators of non-compliant behaviour among patients. For clients, satisfaction surveys can be helpful for choosing between healthcare providers. Satisfaction is made up of an affective component of evaluation and a cognitive component of expectations. Also, in occupational health care, patient satisfaction is measured by dimensions such as the humanness and competence of the care provider similar to health care in general. However, there are dimensions that are specific to occupational health—such as the perceived independence of the physician, unclear reasons for visiting an OHS, and the perceived extent of knowledge of OHS professionals about the patient's working conditions. Dimensions of client satisfaction are mostly similar to patient satisfaction but include more businesslike aspects. They are different for the two groups of client, employers and employees. To measure consumer satisfaction in occupational healthcare specific questionnaires must be constructed. To achieve the highest possible reader satisfaction guidelines are provided for construction of a questionnaire.
CONCLUSIONS—Consumer satisfaction is a complex theoretical concept, but it is relatively easy to measure in practice and can be a valuable tool for quality improvement. Consumers' evaluations of occupational health services will become increasingly important due to changes in the organisation of occupational health care. Occupational healthcare providers are encouraged to measure the consumer satisfaction of their services.


Keywords: consumer satisfaction; occupational health services     

The Need for Another Look at The Patient in General Practice Satisfaction Surveys

Although patient satisfaction research has looked at the aspectsof care which patients are satisfied with and at which patientsare satisfied with their care, few studies have looked at whichpatients are satisfied with which aspects of care. A retrospectiveanalysis of data collected from 1599 patients attending 43 GPswas undertaken to examine the way that different patient characteristicsinfluenced responses to a 31 item survey completed at the surgeryafter a consultation. Information on perceived distress [asmeasured by the Nottingham Health Profile (N HP)] was collectedfrom patients prior to the consultation and further informationabout the patient and the consultation was recorded by the doctorafter the consultation. Levels of satisfaction were high, withonly seven of 31 items producing more than 5% of negative responses.These seven items covered whether the waiting time was too long,whether the doctor was relaxed, whether the doctor was in ahurry, whether there was anything else the patient would haveliked to talk about had there been more time, whether the doctorhad said or done anything to reduce the patient's worries, whetherthe doctor gave the feeling that the patient's opinions wereimportant and whether there was anything about the consultationwhich disappointed the patient. Age, waiting time prior to thecon sultation, consultation length and positive scores on thesix NHP dimensions of distress were all significantly associatedwith responses to one or more of these seven items. Patientsexperiencing pain and those with emotional distress were dissatisfiedwith different aspects of the consultation. It was concludedthat if patient surveys are to contribute to developing andmonitoring good practice they must take into account differingexperiences of illness and distress.     

Patient and counselor satisfaction with structured contraceptive counseling by health center staff in federally qualified health centers

ObjectivesTo characterize patient and counselor satisfaction with structured, tier-based contraceptive counseling provided by a nonclinician.Study DesignWe conducted a planned secondary analysis of patient and counselor surveys from a study that enrolled women in 2 contraceptive care programs. All participants received structured contraceptive counseling from trained staff members. Women and counselors completed a confidential post-visit survey regarding satisfaction with counseling and medical mistrust. We used univariate and multivariable regressions to examine differences in high satisfaction with counseling (top score), perceived counselor influence, and perceived counselor judgment by participant characteristics.ResultsNine hundred forty-two participants completed surveys; most reported they felt respected (100.0%), trusted the counseling information (99.5%), and that counseling helped them choose a contraceptive method (83.8%). Black race, high school education, public insurance, an income below the federal poverty level, and enrollment site were associated with high medical mistrust. Participants with high medical mistrust were less likely to be highly satisfied with counseling (adjusted relative risk (RR) 0.72; 95% confidence interval [CI] 0.63–0.82), more likely to perceive influence (RR 1.77; 95% CI 1.37–2.28), and more likely to perceive judgment (adjusted odds ratio 8.91; 95% CI 3.61–22.01). Mostly, counselors felt they were able to answer participant questions (98.8%), establish good rapport (95.9%), and that participants understood the information presented (98.0%).ConclusionsOverall, participants were satisfied with tier-based contraceptive counseling delivered by nonclinician staff members. Those with high levels of medical mistrust were less likely to be satisfied. The majority of women found the information beneficial in contraceptive decision making.ImplicationsOverall, women reported high satisfaction with tier-based contraceptive counseling delivered by a nonclinician in 3 federally qualified health centers. However, women with high medical mistrust were less likely to report high levels of satisfaction and more likely to report perceived influence or judgment from the counselor.     

Family caregiver satisfaction with care at end of life: report from the cultural variations study (CVAS)

The objective of this study was to examine differences in family caregiver satisfaction with care at end of life based on site of death, in an observational study involving advanced cancer patients and their family caregivers. The study was based on follow-up interviews with 28 family caregivers of 28 patients who died during a two-year prospective study involving 68 patients and 68 family caregivers. Telephone interviews addressed the circumstances of the patients 'death, their satisfaction with the care provided to the patient, and their satisfaction with how well they were attended to by health providers. There were no associations between site of death (died at home vs. did not die at home) and family caregiver satisfaction with the overall care provided to the patient. However family caregivers of patients who died at home responded that they thought the patient was more at peace (with respect to spiritual and religious matters) than did family caregivers of patients who did not die at home (p = 0.003). Family caregivers of patients who died at home appeared to feel less satisfied with the attention paid to their own wishes regarding the patient's care (p = 0. 13), less satisfied with the emotional support provided to them by healthcare personnel taking care of the patient (p = 0. 08), and less satisfied with communication from health providers (p = 0. 11). Findings indicate that although dying at home appears to provide a more peaceful death for the patient, it may also distance family caregivers from health professionals and leave them feeling less supported during the patient's last days of life.     

Satisfaction with organizational aspects of health care provision among Lithuanian physicians

BACKGROUND: Physician satisfaction is considered an important factor influencing quality of health care provision, patient compliance, and costs to health care systems. Dissatisfaction leads to an increase in turnover of physicians and early retirement, which has a negative impact on continuity and quality of health care. Physician dissatisfaction with certain aspects of health care provision may also help to identify potential weaknesses in satisfactory functioning of health care systems. The aim of the current research project is to study the satisfaction with different organizational aspects of health care provision in Lithuania as judged by a selection of physicians. METHOD: The study was conducted in Lithuania in June 2004. Physicians in randomly selected health care centers were invited to take part in the survey, 505 primary and secondary care physicians were interviewed by external interviewers during the study period. Physicians were asked to express their satisfaction on items presented in a questionnaire. The questionnaire consisted of 22 questions, evaluating different aspects of health care services - working conditions, workload, financial remuneration, organization of health care infrastructure and availability of laboratory services. Answers were presented by the 5 point Likert type scale, ranging from "very satisfied" (5) to "very dissatisfied" (1). RESULTS: Physicians who were most satisfied with their working conditions were working in private primary health care practices (91.1% satisfied or very satisfied), as compared with 54% of physicians working in state-owned primary care institutions and 49.7% in hospitals. Physicians working in cities and regional centers or towns were more satisfied with organizational aspects of health care services than physicians working in rural health care centers. Satisfaction with their financial remuneration showed that 74% of respondents stated they were "dissatisfied" or "very dissatisfied". While asked about potential deficiencies in their health care institutions, the most important identified by respondents in all localities was a perceived lack of financial support for these institutions. CONCLUSIONS: There is a significant difference in the perception of physicians in private and state health care institutions with regard to financial remuneration as well as availability of laboratory diagnostic and treatment equipment and working conditions. Based on the study findings, possibilities to increase Primary Care financing should be considered in order to improve the quality of the delivery of health care services as well as retain physicians within the health care system. Results of this study demonstrate a need of further research to quantify what could be reasonably expected from diagnostic and investigative resources to support health care in Lithuania in current economic situation.     

Better Self-report Health Status and Provider–Patient Communication in Dental Service Can Improve the Patient Experience: A Cross-year Comparison from the NHI Survey

ABSTRACT

Several factors, including healthcare outcomes and quality, influence patients’ expectations of healthcare services. Currently, as patients have more understanding about dental care services, patient satisfaction is essential for continually improving the services being provided. The purpose of this study is to analyze the multiyear annual National Health Insurance (NHI) patient experience survey in Taiwan to explore the factors associated with the satisfaction rate from 2012–2016. This study used the annual NHI survey to explore patients’ experiences of receiving medical service in dental care from 2012 to 2016. There were over 40 major items in the survey each year; however, we only selected suitable items that followed the Andersen model. We ran a logistics regression testing the relationship between the covariates and the items related to satisfaction in outcomes in different years. Patients who received health education from a provider in most time, self-reported better health status, felt that cost of care was not expensive, did not wait too long for counseling time and found it easy to make an appointment, had two to ten times greater satisfaction in outcomes compared with those who did not (OR: 1.83–10.06). Individuals working in the healthcare industry should implement communication strategies to improve patients’ experience in the care process by including easy-to-understand explanations or sharing decision-making with patients. Furthermore, in patient experience surveys in dental care, less attention should be paid to whether patients can provide meaningful quality measures and more attention to ways in which patient experiences can be improved. This can be achieved by providing easy-to-understand explanations, giving patients an opportunity to express their concerns, and by sharing decision-making with patients     

Disparities in Patient Satisfaction Among Hispanics: The Role of Language Preference

Hispanic and Spanish-speaking patients experience lower satisfaction with their health care when compared to whites and English speakers. We attempt to clarify the relationship between language preference and patient satisfaction in Hispanics. Study participants were Hispanic patients recruited from two clinics that serve an exclusively Hispanic population. We compared baseline levels of patient satisfaction among English-speaking, Spanish-speaking, and bilingual participants. Multivariate linear regression was used to model the effect of language preference on patient satisfaction. Baseline comparisons revealed that bilingual patients experienced higher satisfaction with doctor–patient communication and the office staff than Spanish-speaking patients. Multivariate analysis demonstrated that language preference was not significantly associated with patient satisfaction. Patient language preference was not a consistent predictor of satisfaction in this cohort of Hispanic patients receiving linguistically competent primary care. The analysis of local data in this study provides a crude adjustment for healthcare quality that is missing from previous research.     

Patients' experiences and satisfaction with health care: results of a questionnaire study of specific aspects of care

Objective: To determine what aspects of healthcare provision are most likely to influence satisfaction with care and willingness to recommend hospital services to others and, secondly, to explore the extent to which satisfaction is a meaningful indicator of patient experience of healthcare services.

Design: Postal survey of a sample of patients who underwent a period of inpatient care. Patients were asked to evaluate their overall experience of this episode of care and to complete the Picker Inpatient Survey questionnaire on specific aspects of their care.

Sample: Patients aged 18 and over presenting at five hospitals within one NHS trust in Scotland.

Method: 3592 questionnaires were mailed to patients' homes within 1 month of discharge from hospital during a 12 month period. Two reminders were sent to non-responders; 2249 (65%) questionnaires were returned.

Results: Almost 90% of respondents indicated that they were satisfied with their period of inpatient care. Age and overall self-assessed health were only weakly associated with satisfaction. A multiple linear regression indicated that the major determinants of patient satisfaction were physical comfort, emotional support, and respect for patient preferences. However, many patients who reported their satisfaction with the care they received also indicated problems with their inpatient care as measured on the Picker Inpatient Survey; 55% of respondents who rated their inpatient episode as "excellent" indicated problems on 10% of the issues measured on the Picker questionnaire.

Discussion: The evidence suggests that patient satisfaction scores present a limited and optimistic picture. Detailed questions about specific aspects of patients' experiences are likely to be more useful for monitoring the performance of various hospital departments and wards and could point to ways in which delivery of health care could be improved.

     

A study of satisfaction among primary health care patients in Saudi Arabia

Primary Health Care is essential health care based on delivering integrated health services (curative and preventive). The Kingdom of Saudi Arabia adopted this approach in 1980, and by the year 1987 the Ministry of Health had established 1477 Primary Health Care centers. The expansion in Primary Health Care created a need for various types of evaluation. Theorists recommended the study of patients' satisfaction as a way of evaluating care. The aim of this study was to assess the satisfaction of patients with different aspects of Primary Health Care services in Riyadh. The sample consisted of 300 patients chosen systematically from three Primary Health Care centers in Riyadh. The data were collected by personal interviews. The tool consisted of demographic data, a 4-point rating scale of 40 statements measuring satisfaction with different aspects of Primary Health Care services, and an open question eliciting the patients' suggestions for improvements. The analysis of variance (ANOVA) was used to determine the difference in level of patient satisfaction between the three centers. The results show that the patients were moderately satisfied with the services. They were most satisfied with the effectiveness and humane aspects of care, and least satisfied with the thoroughness and continuity aspects of care. It is recommended that the Ministry of Health develop programs for its personnel to sensitize them to the different aspects of Primary Health Care.Ahlam A. Mansour was Assistant Professor, King Saud University, College of Applied Medical Sources, Riyadh, Saudi Arabia. Muneera H. Al-Osimy is Director of Primary Health Care Services, Jeddah, Saudi Arabia.     

A Multi-Method Assessment of Satisfaction with Services in the Medical Home by Parents of Children and Youth with Special Health Care Needs (CYSHCN)

OBJECTIVE: To assess satisfaction of parents of children with special health care needs with treatment by office staff, communication with the pediatrician, involvement in decision-making and coordination of services outside the practice. PATIENTS AND METHODS: We used a mixed-method (qualitative and quantitative) approach to collect parental perceptions of the Medical Home services provided by their pediatricians. Six practices were selected to participate in the study based on geographic and patient demographic characteristics. In total, 262 (75% response rate) families completed surveys, and 28 families of these participated in focus groups. The Family Survey collected information (corroborated and enriched with focus group interviews) on parent and child demographics, severity of the child's condition and the burden on parents. We assessed parental satisfaction with treatment by office staff, communication with the pediatrician, involvement in decision-making, and connection to services outside the practice. Survey responses were analyzed using SAS with all associations considered significant at the P < 0.05 level. Focus groups were recorded, transcribed into EZ-Text and analyzed by a team of three researchers to identify patterns and themes inherent in the data. RESULTS: Families reported in focus group interviews that they experienced significant stress due to the demands of caring for a child with special health care needs. Overall, only a small percentage of families reported being dissatisfied with their treatment by office staff (13-14%), communication with the pediatrician (10%), and involvement in decision-making (15-16%). However, a majority of families (approximately 58%) were dissatisfied with the ability of the pediatrician and his/her office to connect the families with resources outside the pediatric office. Families whose children had more severe conditions, or whose conditions had more of an impact on the families, reported being less satisfied with all aspects of communication and care coordination Families of youth with special health care needs (>12 years of age) were less satisfied than families of younger children with the practice's ability to connect them to resources outside the practice. CONCLUSIONS: Both the focus groups and surveys demonstrated that families of children with special needs are under very significant stress. Pediatricians must become better equipped to identify and communicate more proactively with families of CYSHCN that are experiencing significant parent burden. Pediatricians and their staff also need to improve their knowledge of community resources and proactively make referrals to community services needed by families of CYSHCN.     

Caregivers' satisfaction with hospice care in the last 24 hours of life

The goals of this study were to identify elements of care that contributed to positive and negative perceptions of hospice care in the last 24 hours of life, and to define patient and family characteristics that are associated with satisfaction with care during this difficult period. Surveys were sent to 207 primary caregivers, and 112 surveys were returned. This study reports four findings that elucidate the factors that make family members more or less satisfied with the care that their loved one received during the last day of life, and how satisfaction with this period of care should be measured.     

Patient and caregiver satisfaction with end-of-life care: does high satisfaction mean high quality of care?

The purpose of this study was to determine patient and caregiver satisfaction with a hospice program of care. The setting for the study was a home-care hospice in the southeastern United States that provides a full range of services for patients with life-limiting illness and supportive services for family caregivers. Two Likert-type instruments were used to determine satisfaction with staff, communication, education, information provided, symptom management, promptness with service, and overall satisfaction. Some 321 patients and 443 caregivers completed surveys over a two-year period of time. Data indicates the majority of patients and their caregivers were very satisfied with hospice services and the care they received. Providing quality care at the end of life is the goal of hospice. Satisfaction with delivery of care, management of symptoms, and communication with staff are all components of quality care and contribute to quality of life.     

A follow-up comparison of patient satisfaction among prepaid and fee-for-service patients

This study reports the results of a follow-up patient satisfaction survey that sampled patients enrolled in a capitation program and compared their satisfaction levels with otherwise similar patients in a fee-for-service program two years after the programs began. On a scale of 1 (very dissatisfied) to 5 (very satisfied), the mean general satisfaction level for 158 prepaid patients was 3.17 +/- 0.70, and 3.42 +/- 0.61 for 87 fee-for-service patients (P less than .05). This finding contrasts with no differences seen in a previous study of the same populations at six months after the programs began (mean general satisfaction levels of 3.26 and 3.36 for the prepaid and fee-for-service patients, respectively). A statistically significant difference also existed in the subdimension "technical aspects of quality of care": 3.38 +/- 0.65 for prepaid patients, and 3.61 +/- 0.53 for fee-for-service service patients (P less than .05). Levels of satisfaction within other individual constructs were similar for both groups and tended to remain the same over two years, although satisfaction with access to care decreased among prepaid patients, and satisfaction with continuity of care increased among fee-for-service patients. These data support the hypothesis that overall satisfaction levels and certain aspects of patient satisfaction may be compromised by a capitation program.     

Measuring Patient Satisfaction in Primary Care: a Joint Project of Community Representatives, Clinic Staff Members and a Social Scientist

We describe the process of planning and developing a questionnaireand conducting a patient satisfaction survey in a neighbourhoodclinic in Beer-Sheva, Israel. The project was conducted by theclinic staff members, patient representatives and a medicalsociologist. The satisfaction survey was conducted in patients'homes, with a 67% response rate. General satisfaction and satisfactionwith specific components of service are described. Patient satisfactionwas higher among men than among women, and negatively correlatedwith family size. The strongest predictor of general satisfactionwas satisfaction with physicians' services. Implications ofthe survey results were decided upon by active collaborationbetween the clinic staff and the patient representatives. Theinferences drawn from the patients' replies and the changesintroduced as a result of them, are discussed. Health care consumersshould be active participants in carrying out surveys of satisfactionon a regular basis.