Factors determining patients' satisfaction in a family practice residency teaching center

A primary function of family medicine teaching centers is to provide residents with ongoing experiences with patients and their families. A critical issue in maintaining a stable patient population for such teaching is patient satisfaction. In the study reported here, the authors examined the factors determining patients' satisfaction. A questionnaire was mailed to a representative sample of 10 percent of the patients in a family practice in a family medical center. Seventy-eight percent of the sample responded; these respondents were representative of the sample population. Four variables were identified as significant in determining the patients' satisfaction: whether the patients felt that the time spent with their identified family physician was adequate and that the physician's explanations regarding their health care and the teaching program were clear; whether the patients felt comfortable in expressing their concerns about the teaching program to the permanent staff members; whether the patients had a positive attitude regarding the teaching program; and whether the patients felt that their identified family physician was available to them.     

深圳新型社区首诊制实施效果分析与思考

目的 通过对深圳市社区卫生服务机构的病人满意度调查,了解不同社区、不同人群的病人满意度,评估社区首诊制与病人满意度的相关性,从而评价社区首诊制的实施效果.方法采用专家咨询法,选定深圳市范围内6个街道,共30个社区卫生服务中心.应用"本地化"的国际标准化满意度调查问卷(EUROPEP),对在社区卫生服务中心就诊的病人进行调查(1 765例).结果劳务工社区病人总满意度、沟通满意度、技术满意度和组织满意度与非劳务工社区比较,差异有统计学意义(P＜0.01).劳务工病人的总满意度和组织满意度与非劳务工病人比较,差异有统计学意义(P＜0.01).经历转诊与未经历转诊的病人在"给你提供有关预防疾病的服务"、"告诉你做好转诊上级医院的准备"两个问题方面的非常满意率间差异有统计学意义(P＜0.05).结论社区首诊制的实施加剧了病人对服务组织方面的不满,应改善社区医生服务的组织安排和调整社区首诊制的激励政策.     

Patient satisfaction with primary health care services in Riyadh

OBJECTIVE: To assess the level of patients' satisfaction with primary health care PHC services in health centers affiliated to Riyadh Military Hospital RMH, Riyadh, Kingdom of Saudi Arabia. METHODS: A cross-sectional study was conducted in 3 PHC centers, affiliated to Riyadh Military Hospital RMH, Riyadh, Kingdom of Saudi Arabia, over 2 months period in 2006, data was collected using a self-administered questionnaire to assess patients' overall satisfaction with PHC services and their level of satisfaction with 5 PHC domains: reception services, accessibility, continuity of care, communication, and enablement. RESULTS: Seven hundred questionnaires were distributed yielding 86.6% response rate, 39.6% of our patients were 20-30 years old, 51.5% of the respondents were females, 76.4% were married and 34.5% of them showed a medical visit frequency of a minimum of 8 times per year. The domains of PHC with the highest level of reported satisfaction was enablement (70.6%). The poorest level of satisfaction was at the continuity of care (56.3%). The mean score of satisfaction with reception was 70.0%, communication 69.2%, and accessibility to care was 62.4%. The overall satisfaction level was 64.2%. Patients of older age were more satisfied with PHC services than their younger counterparts (p-value<0.001) and patients with lower education level were more satisfied (p-value<0.001). Patients' satisfaction was inversely related to their average annual visit frequency to PHC centers (p-value =0.015). There was no relation found between patients' satisfaction and their gender, marital status, occupational status, and their average monthly income. CONCLUSION: The level of satisfaction with PHC services in health centers affiliated to RMH is relatively low, results identified areas in which quality improvement is required, mainly accessibility and continuity of care.     

Doctor-patient relationship: from medical paternalism to enhanced autonomy

For centuries, physicians have been allowed to interfere and overrule patient's preferences with the aim of securing patient benefit or preventing harm. With the radical rise in emphasis on individual control and freedom, medical paternalism no longer receives unquestioned acceptance by society as the dominant mode for decision-making in health care. But neither is a decision-making approach based on absolute patient autonomy a satisfactory one. A more ethical and effective approach is to enhance a patient's autonomy by advocating a medical beneficence that incorporates patients' values and perspectives. This can be achieved through a model for shared decision making, acknowledging that though the final choices reside ultimately in patients, only through physician beneficence can the patient be empowered to make meaningful decisions that serve them best. For such a model to function effectively, the restoration of trust in doctor-patient relationship and the adoption of patient-centred communication are both crucial.     

Resolving the gatekeeper conundrum: what patients value in primary care and referrals to specialists.

CONTEXT: Few data are available regarding how patients view the role of primary care physicians as "gatekeepers" in managed care systems. OBJECTIVE: To determine the extent to which patients value the role of their primary care physicians as first-contact care providers and coordinators of referrals, whether patients perceive that their primary care physicians impede access to specialists, and whether problems in gaining access to specialists are associated with a reduction in patients' trust and confidence in their primary care physicians. DESIGN, SETTING, AND PATIENTS: Cross-sectional survey mailed in the fall of 1997 to 12707 adult patients who were members of managed care plans and received care from 10 large physician groups in California. The response rate among eligible patients was 71%. A total of 7718 patients (mean age, 66.7 years; 32 % female) were eligible for analysis. MAIN OUTCOME MEASURES: Questionnaire items addressed 3 main topics: (1) patient attitudes toward the first-contact and coordinating role of their primary care physicians, (2) patients' ratings of their primary care physicians (trust and confidence in and satisfaction with), and (3) patient perceptions of barriers to specialty referrals. Referral barriers were analyzed as predictors of patients' ratings of their physicians. RESULTS: Almost all patients valued the role of a primary care physician as a source of first-contact care (94%) and coordinator of referrals (89%). Depending on the specific medical problem, 75% to 91% of patients preferred to seek care initially from their primary care physicians rather than specialists. Twenty-three percent reported that their primary care physicians or medical groups interfered with their ability to see specialists. Patients who had difficulty obtaining referrals were more likely to report low trust (adjusted odds ratio [OR], 2.7; 95% confidence interval [CI], 2.1-3.5), low confidence (OR, 2.2; 95% CI, 1.6-2.9), and low satisfaction (OR, 3.3; 95% CI, 2.6-4.2) with their primary care physicians. CONCLUSIONS: Patients value the first-contact and coordinating role of primary care physicians. However, managed care policies that emphasize primary care physicians as gatekeepers impeding access to specialists undermine patients' trust and confidence in their primary care physicians.     

Patient satisfaction with physician care

Patient satisfaction is known to be related to many desired outcomes in medical care. This study employees multidimensional scaling techniques to identify factors affecting satisfaction with physician care in 1,210 patients. Stepwise regression analysis of factors that met predetermined criteria showed that accessibility explained the greatest amount of variance in patient satisfaction. The patient's perceived efficacy of physician care and greater continuity of care also have significant correlations with satisfaction. Perceived susceptibility to illness, utilization of physician services, and levels of education have lesser but significant effects on patient satisfaction. Despite methodological constraints, economic and psychological benefits make evaluation of patient satisfaction an important exercise.     

社区卫生服务机构就诊患者对基本医疗服务的评价分析

目的调查分析天津市社区卫生服务（CHS）机构就医患者对基本医疗服务的现状评价,并针对存在的问题提出对策及建议。方法分层抽取天津市6个中心城区的CHS中心与站各15家,随机拦截300例就诊患者进行问卷调查,了解其接受基本医疗服务情况与意向评价满意度。结果患病时首先选择到社区就诊的比例为52．3％（157／300）,原因中第一位是离家近及方便,占89．2％（140／157）;习惯找固定医生就诊者占25．3％（76／300）。有17．7％（53／300）患者不常看病。患者对医护人员服务能力与态度的综合满意度为78．7％,其中,对医生解释病情满意度最高,为83．7％（251／300）;患者对医生疾病诊断、体格检查与辅助检查信任度均达92．0％以上。患者认为医生与其进行沟通交流的占87．O％（261／300）,有85．0％（255／300）的患者在就诊过程中得到过医生健康指导,82．O％（246／300）患者认为医生注意了保护其个人隐私。患者对CHS机构服务环境设施与流程管理的综合满意度为73．6％,其中,药品种类、服务价格、仪器设备与服务环境的满意度均低于综合满意度。结论CHS机构就诊患者对所接受的医疗服务基本满意;患者对CHS的利用不足;CHS机构的医疗服务能力需要提高。     

How was your hospital stay? Patients' reports about their care in Canadian hospitals.

OBJECTIVE: To survey adult medical and surgical patients about their concerns and satisfaction with their care in Canadian hospitals. DESIGN: Cross-sectional telephone survey undertaken from June 1991 to May 1992 with a standardized questionnaire. SETTING: Stratified random sample of public acute care hospitals in six provinces; 57 (79%) of the 72 hospitals approached agreed to participate. PATIENTS: Each participating hospital provided the study team with the names of 150 adult medical and surgical patients discharged home in consecutive order. A total of 4599 patients agreed to be interviewed (69% of eligible patients and 89% of patients contacted). MAIN OUTCOME MEASURES: Satisfaction with (a) provider-patient communication (including information given), (b) provider's respect for patient's preferences, (c) attentiveness to patient's physical care needs, (d) education of patient regarding medication and tests, (e) quality of relationship between patient and physician in charge, (f) education of and communication with patient's family regarding care, (g) pain management and (h) hospital discharge planning. RESULTS: Most (61%) of the patients surveyed reported problems with 5 or fewer of the 39 specific care processes asked about in the study. Forty-one percent of the patients reported that they had not been told about the daily hospital routines. About 20% of the patients receiving medications reported that they had not been told about important side effects in a way they could understand; 20% of the patients who underwent tests reported similar problems with communication of the test results. Thirty-six percent of those having tests had not been told how much pain to expect. In discharge planning, the patients complained that they had not been told what danger signals to watch for at home (reported by 39%), when they could resume normal activities (by 32%) and what activities they could or could not do at home (by 29%). Over 90% of the patients reported that they had had a relationship of confidence and trust with their physician and that they had been involved in decision making as much as they wanted to be. Fifteen percent of the patients whose admissions had been scheduled felt that they should have been admitted sooner. CONCLUSION: The self-reported patient data from this survey suggest that hospital routines, medications, tests, pain management and discharge planning are areas of communication to target in future quality-improvement efforts in Canadian hospitals.     

基于不同就诊环节的门诊患者满意度调查及流程改造

目的：明确患者就医需求并获得各环节的具体评价,为就诊流程再造提供思路。方法：一对一访谈形式完成调查问卷。结果：患者对医疗质量表示满意,对时间满意度低于服务态度。讨论：总结影响服务满意度的因素,探讨对策,进行针对性的优化和整改,以提高医疗服务质量。     

An Evaluation of Patients’ Opinions of Primary Care Physicians: the Use of EUROPEP in Gaza Strip-Palestine

The objective of this paper is to identify the level of patients' satisfaction with primary care physicians. Data were gathered from an exit interview using a standardized questionnaire (EUROPEP) and background variables. A total of 956 patients in fifteen primary health care clinics in Gaza Strip participated. Outcome measures is positive patient satisfaction (good and excellent ratings in the EUROPEP Index). As a results, the mean percentage of positive satisfaction with medical services was poor (41.8%). The poorest performance was recorded for: getting through to the clinic on the phone, being able to speak to physician on the telephone, time spent in waiting rooms and helping the patient deal with emotional problems. The comparison between clinical behaviour dimension and organization of care showed that clinical behaviour was evaluated higher. In conclusion, Palestinian patients expressed overall dissatisfaction with services provided by primary care physicians. These findings present a real challenge for Palestinian authority policy makers and administrators in terms of designing appropriate quality improvement strategies.     

New evidence of the prevalence and scope of physician joint ventures.

Physician ownership of health care businesses (outside their own practice) to which they refer patients has attracted considerable attention in the medical literature, in the media, and from federal and state policymakers. Despite the concerns raised about these ownership arrangements, known as joint ventures, the prevalence and scope of joint ventures involving physicians is not well documented. This report examines the prevalence and scope of physician joint ventures in Florida based on data collected under a legislative mandate. Our results indicate that physician ownership of health care businesses providing diagnostic testing or other ancillary services is common in Florida. While this conclusion is based on our comprehensive survey of health care businesses in Florida, it is at least indicative that such arrangements are likely to occur elsewhere. We find that at least 40% of Florida physicians involved in direct patient care have an investment interest in a health care business to which they may refer their patients for services; over 91% of the physician owners are concentrated in specialties that may refer patients for services. About 40% of the physician investors have a financial interest in diagnostic imaging centers. The estimates reported here indicate that the proportion of referring physicians involved in direct patient care who participate in joint ventures is much higher than previous estimates suggest.     

Self-referral in point-of-service health plans

CONTEXT: Most health maintenance organizations offer products with loosened restrictions on patients' access to specialty care. One such product is the point-of-service (POS) plan, which combines "gatekeeping" arrangements with the ability to self-refer at increased out-of-pocket costs. Few data are available from formal evaluations of this new type of plan. OBJECTIVES: To comprehensively describe the self-referral process in POS plans by quantifying rates of self-referral, identifying patients most likely to self-refer, characterizing patients' reasons for self-referral, and assessing satisfaction with specialty care. DESIGN: Retrospective cohort analysis using administrative databases composed of members aged 0 to 64 years who were enrolled in 3 POS health plans in the Midwest (n = 265 843), Northeast (n = 80 292), and mid-Atlantic (n = 39 888) regions for 6 to 12 months in 1996, and a 1997 telephone survey of specialty care users (n = 606) in the midwestern plan. MAIN OUTCOME MEASURES: Self-referred service use and charges, reasons for self-referral, and satisfaction with specialty care. RESULTS: Overall, 8.8% of enrollees in the midwestern POS plan, 16.7% in the northeastern plan, and 17.3% in the mid-Atlantic plan self-referred for at least 1 physician or nonphysician clinician visit. The proportions of enrollees self-referring to generalists (4.7%-8.5%) were slightly higher than the proportions self-referring to specialists (3.7%-7.2%) across all 3 plans. Nine percent to 16% of total charges were due to self-referral. The chances of self-referral to a specialist were increased for patients with chronic and orthopedic conditions, higher cost sharing for physician-approved services, and less continuity with their regular physician. Patients who self-referred to specialists preferred to access specialty care directly (38%), reported relationship problems with their regular physicians (28%), had an ongoing relationship with a specialist (23%), were confused about insurance rules (8%), and did not have a regular physician (3%). Compared with those referred to specialists by a physician, patients who self-referred were more satisfied with the specialty care they received. CONCLUSIONS: Having the option to self-refer is enough for most POS plan enrollees; 93% to 96% of enrollees did not exercise their POS option to obtain specialty care via self-referral during a 1-year interval. The potential downside of uncoordinated, self-referred service use in POS health plans is limited and counterbalanced by higher patient satisfaction with specialist services.     

The inner life of physicians and care of the seriously ill.

Seriously ill persons are emotionally vulnerable during the typically protracted course of an illness. Physicians respond to such patients' needs and emotions with emotions of their own, which may reflect a need to rescue the patient, a sense of failure and frustration when the patient's illness progresses, feelings of powerlessness against illness and its associated losses, grief, fear of becoming ill oneself, or a desire to separate from and avoid patients to escape these feelings. These emotions can affect both the quality of medical care and the physician's own sense of well-being, since unexamined emotions may also lead to physician distress, disengagement, burnout, and poor judgment. In this article, which is intended for the practicing, nonpsychiatric clinician, we describe a model for increasing physician self-awareness, which includes identifying and working with emotions that may affect patient care. Our approach is based on the standard medical model of risk factors, signs and symptoms, differential diagnosis, and intervention. Although it is normal to have feelings arising from the care of patients, physicians should take an active role in identifying and controlling those emotions.     

Patient ratings of care at a rheumatology out-patient unit

BACKGROUND: Our objective was to determine patient satisfaction with services rendered by health care personnel at the rheumatology out-patient consultation. METHODS: We carried out a cross-sectional survey at a tertiary-level care hospital in Mexico City. A questionnaire on satisfaction with quality of medical care was applied to 347 adult patients who attended the out-patient rheumatology clinic at least twice and who agreed to participate. Questions in the instrument covered three aspects of quality of care, including structure, process, and results. RESULTS: In overall assessment, 83.5% of patients reported satisfaction with care. Structure received worst score and process, the best. Outcomes (e.g., disease improvement) received intermediate scores. Correlations within these areas were strong but correlation with overall satisfaction was not high. The majority of patients stated that physician competence was the most valuable aspect of the visit; the least valuable was waiting time. CONCLUSIONS: Specific strategies need to be implemented to improve certain areas. Overall satisfaction as a measurement renders no specific and useful information due to complexity with regard to different dimensions of satisfaction.     

分级诊疗背景下患者对“下-上-下”转诊的满意度及影响因素研究

目的　探讨分级诊疗背景下患者对“下-上-下”转诊的满意度及影响因素。方法　于2016年11月—2017年5月,从下级医疗机构转至西安市某医学院附属医院就诊的患者中选取415例患者为调查对象。采用自行设计的调查问卷进行调查。问卷主要内容有：患者的基本情况、患者对下级医疗机构的满意度、对上级医疗机构的满意度、对“下-上”转诊过程的满意度以及对“上-下”转诊过程的满意度情况。共发放问卷415份,回收有效问卷400份,问卷的有效回收率为96.4%。结果　患者对下、上级医疗机构,“下-上”和“上-下”转诊过程的满意度依次为30.0%（120/400）、81.8%（327/400）、65.5%（262/400）、48.3%（28/58）。多因素Logistic回归分析结果显示,患者年龄及对医疗技术水平、医疗服务态度、就诊费用是否满意是对下级医疗机构的满意度的影响因素（P<0.05）;患者人均月收入、参加医疗保险类型及对医疗技术水平、医疗服务态度、就诊费用、就医环境是否满意是对上级医疗机构的满意度的影响因素（P<0.05）;患者年龄、文化程度及对转诊手续便捷度、转诊花费的时间是否满意是对“下-上”转诊过程的满意度的影响因素（P<0.05）;患者文化程度及对转诊手续便捷度、转诊花费的时间是否满意是对“上-下”转诊过程的满意度的影响因素（P<0.05）。结论　患者对上级医疗机构和“下-上”转诊过程的满意度较高,对“上-下”转诊过程的满意度较低,对下级医疗机构的满意度最低;年龄、文化程度、医疗技术水平、医疗服务态度、就诊费用、转诊手续便捷度、转诊花费的时间等是患者对“下-上-下”转诊满意度的影响因素。     

医联体平台下慢性病患者对社区医疗服务的评价及其对就诊机构选择的影响研究

背景　《“健康中国2030”规划纲要》提出，要建设整合型医疗卫生服务体系。分级诊疗制度是实现整合型医疗卫生服务的基础，而慢性病管理又是分级诊疗的重点内容和推进突破口，然而我国基层服务能力不足，未能满足慢性病患者的需求，无法有效引导患者至基层就诊。目的　分析慢性病患者对社区医疗服务的相对满意度及重要性感知，探讨影响患者选择就诊机构的关键因素，为完善医联体建设提供参考。方法　抽取北京市朝阳医院医疗联盟内、外各2家社区卫生服务中心，于2018年7月，对慢性病就诊患者进行问卷调查，了解慢性病患者就医选择情况，以及对社区医疗服务的满意度及重要性感知。采用因子分析法提取社区医疗服务相关因素公因子，建立坐标轴探索各因素相对满意度与重要性关系，进一步应用Logistic逐步回归模型分析患者选择就诊机构的影响因素。结果　因子分析共提取医疗服务质量感知、服务可及性及医疗费用3个公因子。医疗服务质量感知方面，相对满意度评分为（6.4±2.3）~（8.3±1.7）分，联盟内、外患者评分顺位相同；重要性评分为（8.3±1.5）~（9.0±1.2）分，联盟内、外患者评分前3项均属于此公因子。服务可及性方面，相对满意度评分为（8.1±1.8）~（9.0±1.3）分，其中联盟内“候诊时间”短于联盟外（P<0.05）；重要性评分为（8.0±1.7）~（8.5±1.4）分。医疗费用方面，联盟内外患者相对满意度均最低；重要性评分，在两组内顺位相差5位次，联盟内患者对其评分顺位最低（第10），而联盟外则居中（第5）。Logistic回归分析结果显示，医疗服务质量感知、年龄、受教育程度、家庭人均月收入及所在社区是否属于联盟内是患者就医选择的影响因素（P<0.05）。结论　社区医疗服务质量尚未达到患者预期，应补足卫生人员、探索个性化管理方式、提高药品配置能力。服务可及性高，但患者对候诊时间的获得感较低，应科学测算资源配置水平，以应对社区就诊人数增长所带来的挑战。样本地区患者对社区医疗费用的敏感度较低，需完善医保政策及患者管理模式。     

The Medical Outcomes Study. An application of methods for monitoring the results of medical care

The Medical Outcomes Study was designed to (1) determine whether variations in patient outcomes are explained by differences in system of care, clinician specialty, and clinicians' technical and interpersonal styles and (2) develop more practical tools for the routine monitoring of patient outcomes in medical practice. Outcomes included clinical end points; physical, social, and role functioning in everyday living; patients' perceptions of their general health and well-being; and satisfaction with treatment. Populations of clinicians (n = 523) were randomly sampled from different health care settings in Boston, Mass; Chicago, Ill; and Los Angeles, Calif. In the cross-sectional study, adult patients (n = 22,462) evaluated their health status and treatment. A sample of these patients (n = 2349) with diabetes, hypertension, coronary heart disease, and/or depression were selected for the longitudinal study. Their hospitalizations and other treatments were monitored and they periodically reported outcomes of care. At the beginning and end of the longitudinal study, Medical Outcomes Study staff performed physical examinations and laboratory tests. Results will be reported serially, primarily in The Journal.     

北京市某社区卫生服务机构患者的体验监测调查分析

目的了解就诊患者对社区卫生服务质量的看法和态度,为持续改进社区卫生服务质量提供科学依据。方法采用澳大利亚RACGP全科医学服务质量监测工具,对北京市某社区卫生服务机构的就诊患者进行问卷调查。结果10.7%和25.7%的患者认为社区卫生服务提供了较好的儿童和老年人的服务设施。有超过50.0%的患者认为等候医生看病的时间过长、挂号室的工作人员的信息服务质量需要改善,特别是80.0%以上的患者认为应该提高医生给幼儿看病的能力。人际服务质量应该得到显著改善,特别是隐私保护和对患者的关怀。认为应该改善复查服务和转诊服务的患者分别为30.7%和22.7%。结论从患者的观点看,社区卫生服务的可及性和有效性需要进一步改善。应针对服务各个阶段的结构、过程和结果进行深入分析,并制定和实施相应的质量改进措施。     

Nurses' views on their involvement in euthanasia: a qualitative study in Flanders (Belgium)

BACKGROUND: Although nurses worldwide are confronted with euthanasia requests from patients, the views of palliative care nurses on their involvement in euthanasia remain unclear. OBJECTIVES: In depth exploration of the views of palliative care nurses on their involvement in the entire care process surrounding euthanasia. DESIGN: A qualitative Grounded Theory strategy was used. SETTING AND PARTICIPANTS: In anticipation of new Belgian legislation on euthanasia, we conducted semistructured interviews with 12 nurses working in a palliative care setting in the province of Vlaams-Brabant (Belgium). RESULTS: Palliative care nurses believed unanimously that they have an important role in the process of caring for a patient who requests euthanasia, a role that is not limited to assisting the physician when he is administering life terminating drugs. Nurses' involvement starts when the patient requests euthanasia and ends with supporting the patient's relatives and healthcare colleagues after the potential life terminating act. Nurses stressed the importance of having an open mind and of using palliative techniques, also offering a contextual understanding of the patient's request in the decision making process. Concerning the actual act of performing euthanasia, palliative care nurses saw their role primarily as assisting the patient, the patient's family, and the physician by being present, even if they could not reconcile themselves with actually performing euthanasia. CONCLUSIONS: Based on their professional nursing expertise and unique relationship with the patient, nurses participating as full members of the interdisciplinary expert team are in a key position to provide valuable care to patients requesting euthanasia.     

Managing Medical and Insurance Information Through a Smart-Card-Based Information System

The continuously increased mobility of patients and doctors, in conjunction with the existence of medical groups consisting of private doctors, general practitioners, hospitals, medical centers, and insurance companies, pose significant difficulties on the management of patients' medical data. Inevitably this affects the quality of the health care services provided. The evolving smart card technology can be utilized for the implementation of a secure portable electronic medical record, carried by the patient herself/himself. In addition to the medical data, insurance information can be stored in the smart card thus facilitating the creation of an "intelligent system" supporting the efficient management of patient's data. In this paper we present the main architectural and functional characteristics of such a system. We also highlight how the security features offered by smart cards can be exploited in order to ensure confidentiality and integrity of the medical data stored in the patient cards.