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.     

Evaluation of individuals’ satisfaction with health care services in Turkey

Objectives

To demonstrate whether features related to the institution and service provider affect individuals’ level of satisfaction regarding the public health care services they receive.

Patient satisfaction with health care services at a national institute of ophthalmology

Little is known about how patients in developing countries, such as Vietnam, are satisfied with eye care services. The purpose of this study was to assess the satisfaction with health services and its associated factors among patients attending a national institute of ophthalmology in Vietnam. In a cross‐sectional study utilizing quantitative methods, 500 inpatients and their relatives attending a national institute of ophthalmology in Vietnam were approached for data collection. The results indicated that under 50% of the patients were satisfied with eye care services. However, when classified by level of satisfaction, only 6.8% were very satisfied with all domains of care. There was no significant difference in satisfaction by gender and income, while significant differences by department, residence, and education were found. Patients who were from rural areas, were better educated, and used the services of the glaucoma department, were more satisfied with eye care than those from urban areas, were less educated, and used the services of treatment‐on‐demand department. Multivariable regression detected 2 main factors, gender and location, associated with patient satisfaction. Patients who were female and came from rural and remote areas were more likely to be satisfied than patients who were male and living in urban areas. The study suggests that to continue to improve health care quality, it is important to eliminate differences in providing eye care services regardless of whether patients are male or female, and whether they come from a rural or urban area.     

Impacts of managed care patient protection laws on health services utilization and patient satisfaction with care

OBJECTIVE: To assess effects of patient protection laws implemented by the vast majority of states during the 1990s on the public's satisfaction and trust relating to health care, and on key utilization measures. DATA SOURCES/STUDY SETTING: Measures of individuals' health care utilization and satisfaction, and control variables, came from three waves of the Community Tracking Study (CTS) Household Surveys conducted in 1996-1997, 1998-1999, and 2000-2001. The CTS was conducted in 60 randomly selected communities, throughout the U.S. In addition, a supplemental national sample of households from CTS was also included, resulting in a combined sample with cases from 48 states and the District of Columbia. After applying exclusion restrictions, the analysis sample was 149,688 adults. STUDY DESIGN: Using a fixed-effects methodology, we assessed the influence of patient protection laws on satisfaction with care and utilization of services for the entire sample and for subsamples of persons in poor health, with low income, and who were enrolled in HMOs. DATA COLLECTION/EXTRACTION METHODS: One of the authors (Hall) compiled relevant laws in all U.S. states through 2001 from primary legal sources, checking for accuracy by conducting independent research on statutory changes and by asking three to five regulators in each state to verify that the information was correct. PRINCIPAL FINDINGS: Overall, patient protection laws had little or no effect on either trust, satisfaction with care, or utilization. Significance was found postenactment of a state patient protection law only for emergency room visits in the general sample, and only for physician trust in the low-income sample. Because of the number of possible associations examined, occasional findings of significance could occur by chance. CONCLUSIONS: Enactment of managed care patient protection laws did not generally increase utilization of health services or improve patient satisfaction with care.     

Patient satisfaction with prescribed medicines in community health services in China: A cross‐sectional survey 6 years after the implementation of the national essential medicines policy

The National essential medicines policy (NEMP) is promoted by the World Health Organization for affordable medicines that can meet the basic needs of communities. Patient acceptance is essential for achieving the policy goals of the NEMP. This study aimed to assess patient satisfaction with prescribed medicines in community health services under the NEMP context in China. A stratified random sampling strategy was adopted to select 1,037 participants in 40 community health centres from four provinces in China. Patient satisfaction was rated on a five‐point Likert scale (from 1 = “very dissatisfied” to 5 = “very satisfied”) covering four domains: availability, affordability, effectiveness and safety. The results showed that the participants expressed a moderate degree of satisfaction, with a rating in the range of 66–82 out of a total of 100. Older people, those covered by insurance and those with a lower level of education tended to have higher ratings. While eastern (wealthy) residents were more likely to be concerned with “effectiveness,” western (poor) residents were more likely to be concerned with “affordability.” Awareness of the NEMP was negatively associated with patient satisfaction after control for other factors.     

Determinants of users' satisfaction with primary health care settings and services in Saudi Arabia.

OBJECTIVE: To identify the components of primary health care that cause most concern to service users and to identify socio-demographic and other factors associated with satisfaction among the users of primary health care centres. DESIGN: Interviews conducted by well-trained interviewers with a random sample of heads of households. The questionnaires were composed of questions that measure the extent of satisfaction with settings and services in the primary health care centres using a 5-point rating scale from very satisfied to very dissatisfied. SETTING: The community of Qateef, eastern Saudi Arabia. Study PARTICIPANTS: A sample of 802 households representing 838 families was chosen randomly from the housing lists of the primary health care centres in Qateef. There were 40 vacant houses and nine refusals. Thus the number of heads of households actually interviewed was 789. RESULTS: Waiting area structure, confidentiality measures and environmental structure were the areas that caused most concern to service users. The factors that showed the greatest association with satisfaction were the type of the primary health care centre building (purpose-built or rented), literacy status of the household head (literate or illiterate), the extent of the primary health care centre utilization (regular or infrequent). Surprisingly, age showed no association when other characteristics of the respondents were adjusted for, and sex was less important than in other studies. CONCLUSION: How regular the respondent was in using his or her primary health care centre was more predictive in deciding the extent of satisfaction with the various components in the study than the other variables. Socio-demographic factors played minor roles in deciding the extent of satisfaction, although each had a deciding role with one or more, but not all, components.     

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.     

Financing of health care services in Hungary

In this paper we give a practical overview of the changes in the financing of health care in Hungary. We describe the financing system of general practitioners, home care (nursing), out-patient care and the acute and chronic care of hospitals. We show how the financial system has changed after the political changes of 1990. The global budget approach of the 1980s was replaced by performance-related financing methods including the ICPM (International Classification of Procedures in Medicine) code system of the WHO (World Health Organization) in out-patient care and the introduction of HBCS (Homogén Betegségcsoportok, Homogeneous Disease Groups) in in-patient care. We underline that the efforts made towards reforming health care financing resulted in an activity-related financing system.     

杭州市拱墅区中医药社区卫生服务满意度调查分析

目的 了解杭州市拱墅区中医药社区卫生服务满意度现状和影响因素.方法 采用随机抽样方法,确定1000名研究对象,采用自制问卷进行满意度调查.运用单因素分析、多因素分析方法对调查对象的中医药社区卫生服务满意度现状及影响因素进行分析.结果 杭州市拱墅区中医药社区卫生服务满意度为83.3%.X2检验结果显示,不同生活状况、体育锻炼情况、自身健康满意度、吸烟情况、中医药方法保健情况、中医药治疗次数和自评医疗技术水平的居民的医药社区卫生服务满意度之间差异均有统计学意义(P<0.05).多因素logistic回归分析结果显示,每天锻炼、不吸烟、总是进行中医药保健、中医药治疗次数大于等于5次、自评医疗技术水平很好、对中医药持正面看法的居民对中医药社区卫生服务满意度较高(均P<0.05).结论 杭州市拱墅区中医药社区卫生服务满意度较高,体育锻炼情况、吸烟情况、中医药方法保健情况、中医药治疗次数、自评医疗技术水平和对中医药的看法是中医药社区卫生服务满意度的重要影响因素.     

Patient satisfaction with transgender health services

Measuring patient satisfaction (i.e., patients' subjective evaluation of health care services received) is increasingly important in assessing health care outcomes because of the current emphasis on greater partnership between providers (therapist, doctor, staff) and consumers (patients) in health care. In care of transgender persons, achieving good patient satisfaction is particularly challenging given the primary role mental health professionals play as arbiters of who has access to sex reassignment and when such candidates are ready. Dependence on a mental health professional in this "gate-keeping" role is perceived by some members of the transgender community as unnecessarily pathologizing. This study compared satisfaction ratings of 180 transgender and 837 other sexual health patients with psychotherapeutic, psychiatric, and sexual medicine services provided at a university-based sexual health clinic. Five consecutive surveys conducted during 1993-2002 showed high patient satisfaction. We found few significant differences between transgender and other sexual health patients, except that in 1995, transgender patients had higher satisfaction on their perceived ability to handle the problems that originally had led them to therapy. Survey results helped target areas in need of improvement (e.g., friendliness and courtesy of staff, handling of phone calls), and efforts by the providers to improve services resulted in significant increases in patient satisfaction. These findings put individual complaints in perspective and showed that despite the challenges inherent in providing transgender care good satisfaction can be achieved. We encourage providers to implement quality assurance and improvement procedures to give patients the opportunity to provide feedback and have a voice in shaping their own health care.     

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.     

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.     

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.     

Patient satisfaction: A review of issues and concepts

This review presents issues arising from an analysis of over 100 papers published in the field of patient satisfaction. The published output appearing in the medical and nursing literature which incorporated the term “patient satisfaction” rose to a peak of over 1000 papers annually in 1994, reflecting changes in service management especially in the U.K. and U.S.A. over the past decade. An introductory section discusses the setting and measurement of patient satisfaction within this wider context of changes in service delivery. Various models are examined that have attempted to define and interpret the idea of determining individual perceptions of the quality of health care delivered. Determinants of satisfaction are examined in relation to the literature on expectations, and demographic and psychosocial variables. These are distinguished from the multidimensional components of satisfaction as aspects of the delivery of care, identified by many authors. The review highlights the complexity and breadth of the literature in this field, the existence of which is often not acknowledged by researchers presenting the findings of studies.     

天津市宝坻区某镇居民卫生服务满意度基线调查分析——国家科技部十一五规划项目“全科型乡镇卫生院建设”项目

目的:了解农村居民对乡镇卫生院卫生服务的满意情况,为发展和提高农村卫生服务提供理论依据。方法:随机抽取587名口东镇居民,通过问卷调查形式,进行就医满意度调查,并对数据进行描述性分析。结果:本次调查结果显示,农村居民对于乡镇卫生院门诊服务的总体满意度为31.8%,各分类的满意度由高到低依次为:护士满意度(80.3%)、就医便捷程度(72.6%)、城镇居民医保报销情况(52.1%)、收费合理性(44.3%)、服务态度(35.3%)、解释交流(33.7%)、慢病防治知识告知(8.6%)、预防保健服务(8.5%)、药品齐全程度(5.3%)、就医设施和环境(4.8%)、医师技术(4.8%)。结论:满意度最低的五项为医师技术、就医设施和环境、药品齐全程度、慢病防治知识告知、预防保健服务,满意度均不足10%,提示乡镇卫生院应多渠道提高医师自身业务水平,不断提高卫生院预防保健职能,优化卫生院就医条件,增加药品种类,为居民提供更优质的卫生服务,以提高卫生院的整体满意度水平。     

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.     

Patient satisfaction in Bangkok: the impact of hospital ownership and patient payment status.

INTRODUCTION: Patient satisfaction with care received is an important dimension of evaluation that is examined only rarely in developing countries. Evidence about how satisfaction differs according to type of provider or patient payment status is extremely limited. OBJECTIVE: To (i) compare patient perceptions of quality of inpatient and outpatient care in hospitals of different ownership and (ii) explore how patient payment status affected patient perception of quality. METHODS: Inpatient and outpatient satisfaction surveys were implemented in nine purposively selected hospitals: three public, three private for-profit and three private non-profit. RESULTS: Clear and significant differences emerged in patient satisfaction between groups of hospitals with different ownership. Non-profit hospitals were most highly rated for both inpatient and outpatient care. For inpatient care public hospitals had higher levels of satisfaction amongst clientele than private for-profit hospitals. For example 76% of inpatients at public hospitals said they would recommend the facility to others compared with 59% of inpatients at private for-profit hospitals. This pattern was reversed for outpatient care, where public hospitals received lower ratings than private for-profit ones. Patients under the Social Security Scheme, who are paid for on a capitation basis, consistently gave lower ratings to certain aspects of outpatient care than other patients. For inpatient care, patterns by payment status were inconsistent and insignificant. CONCLUSIONS: The survey confirms, to some extent, the stereotypes about quality of care in hospitals of different ownership. The results on payment status are intriguing but warrant further research.