Patient Satisfaction in Primary Health Care. Dr Andrew Agius MD MSc (Family Medicine) MMCFD

(1)

Patient Satisfaction in

Primary Health Care

Dr Andrew Agius

(2)

Are our patients satisfied?

“

Yesterday I needed treatment because I couldn

’

t

swallow with a bad sore throat and my GP wasn

’

t

available and I was disgusted. I told the doctor I

had bad sore throat, he got a normal torch and saw

my throat, wrote antibiotics and I was out without

any checkups in 20 seconds after 2 hours wait

”

_”

(3)

Are our patients satisfied?

“

Sometimes I really am disgusted by the

_{Sometimes I really am disgusted by the}

behaviour of medics and paramedics towards

patients in waiting rooms, as if they are

invisible. The behaviour of some staff in some

health centres should be questioned

”

_”

(4)

Are our patients satisfied?

“

When it comes to health centres much has to be done.

I went to a clinic suffering abdominal pains one

night. I waited 15 minutes for the so called doctor to

wake up. He came down and sat on a chair in the

corridor and I stood up!!!! He made a wrong

diagnosis verbally because he never palpated me or

did a check up and sent me to Mater Dei Hospital.

Very, very unprofessional

”

(5)

Patient Satisfaction

Increasingly important in evaluating quality of Increasingly important in evaluating quality of

health care

health care (Williams and (Williams and Calnan, 1991)Calnan, 1991)

Depends mainly on the quality of the doctorDepends mainly on the quality of the doctor-

-patient relationship and good communication patient relationship and good communication

skills skills

Higher in the private sector in MaltaHigher in the private sector in Malta (Asciak(Asciak et al., et al., 2003)

(6)

Research Questions

Which factors are associated with patient Which factors are associated with patient

satisfaction in primary health care? satisfaction in primary health care?

Is there a difference in patient satisfaction Is there a difference in patient satisfaction

between public and private sectors of primary between public and private sectors of primary

health care? health care?

Is the level of patient satisfaction achieved from Is the level of patient satisfaction achieved from

a consultation perceived differently by patients a consultation perceived differently by patients

and doctors? and doctors?

(7)

Aims

To identify the characteristics of a family To identify the characteristics of a family

doctor most likely to lead to patient doctor most likely to lead to patient

satisfaction satisfaction

To compare and contrast characteristics of To compare and contrast characteristics of

family doctors in public and private sectors of family doctors in public and private sectors of

primary health care primary health care

To compare patient satisfaction between To compare patient satisfaction between

public and private sectors of primary health public and private sectors of primary health

care care

(8)

Objectives

To identify:

the perceptions of patients in the the perceptions of patients in the government government

health centres

health centres of their doctors_{of their doctors}’’ personality traits, personality traits, professional values, duties and responsibilities,

professional values, duties and responsibilities,

communication skills, and clinical care

the perceptions of patients in the the perceptions of patients in the private primary private primary

health care sector

health care sector of their family doctors_{of their family doctors}’’

personality traits, professional values, duties and

responsibilities, communication skills, and clinical

care

the perceptions of patients in the perceptions of patients in both public and both public and

private sectors

private sectors of primary health care on the most _{of primary health care on the most}

important characteristics of a family doctor that lead

to patient satisfaction

(9)

Objectives

To To comparecompare patient satisfaction between public patient satisfaction between public

and private sectors of primary health care and private sectors of primary health care

To To identifyidentify the perceptions of family doctors as the perceptions of family doctors as

regards critical factors in their practice regards critical factors in their practice

associated with patient satisfaction associated with patient satisfaction

To To provide feedbackprovide feedback on the results of the on the results of the

study to doctors in various sectors of primary study to doctors in various sectors of primary

health care health care

(10)

Research Setting

Malta is a small island with an estimated Malta is a small island with an estimated

population of 410,290

population of 410,290 ((National Statistics OfficeNational Statistics Office, 2008), 2008)

TwoTwo--thirds of primary care provided by private thirds of primary care provided by private

sector sector

Public sector consists of 9 regional health Public sector consists of 9 regional health

centres and 47 district clinics centres and 47 district clinics

2424--hour comprehensive health care services free hour comprehensive health care services free

at point of delivery at point of delivery

(11)

Primary Health Care

PatientsPatients’’ first contact with health care systemfirst contact with health care system

Hub from which patients are guided through the Hub from which patients are guided through the

health system

health system ((The World Health Report, 2008)The World Health Report, 2008)

Place where relationships between doctors and Place where relationships between doctors and

patients develop patients develop

Health promotion and disease preventionHealth promotion and disease prevention

Basis consists of good doctorBasis consists of good doctor--patient patient

relationships and continuity of care

relationships and continuity of care ((AzzopardiAzzopardi & & Dixon, 1999)

(12)

Factors Affecting Patient Satisfaction

Good doctorGood doctor--patient relationshippatient relationship

Being empathic; giving the patient time and Being empathic; giving the patient time and

attention attention

Honesty, trustworthiness, able to keep Honesty, trustworthiness, able to keep

confidentiality confidentiality

Meeting the patientsMeeting the patients’’ desires and expectations; desires and expectations;

congruence between doctor

congruence between doctor’’s and patients and patient’’s s perceptions of the consultation

(13)

Factors Affecting Patient Satisfaction

Easy accessibility

Good communication

Good clinical care; giving an explanation of

the symptoms

Continuity of care

(14)

Primary Health Care in Malta

1996 1996 –– public sector public sector -- 60% claim it was 60% claim it was ‘‘very very

good

good’’ and 34.5% claim that it was and 34.5% claim that it was ‘‘goodgood’’

(

(AzzopardiAzzopardi & Dixon, 1999)& Dixon, 1999)

2002 2002 -- higher in the private sector (96.1%) than higher in the private sector (96.1%) than

in the public sector (83.1%)

in the public sector (83.1%) ((AsciakAsciak et al. , 2003)et al. , 2003)

Trend shows deterioration in quality of care in Trend shows deterioration in quality of care in

public sector

(15)

Methodology

4 health centres in representative areas of the 4 health centres in representative areas of the

island island

4 private clinics in the same areas as the health 4 private clinics in the same areas as the health

centres centres

30 patients in each clinic, aged 3030 patients in each clinic, aged 30--70years 70years –– 240 240

patients in total patients in total

Patient questionnaires distributed in each clinicPatient questionnaires distributed in each clinic

(16)

Data Collection Tool

Adapted from questionnaire by Murray Adapted from questionnaire by Murray LoughLough (2006)(2006)

Measures what factors are important for patient Measures what factors are important for patient

satisfaction

7 sections, 32 questions, 7 sections, 32 questions, LikertLikert scale 1scale 1--5, English and 5, English and

Maltese versions

Asks about doctorAsks about doctor’’s personality traits, professional s personality traits, professional

values, duties and responsibilities, communication skills,

clinical care

(17)

Semi

-

_-

structured Interviews

_{structured Interviews}

Carried out on one doctor from each clinicCarried out on one doctor from each clinic

Ask about doctorsAsk about doctors’’ perceptions of patient perceptions of patient

satisfaction and doctor satisfaction satisfaction and doctor satisfaction

Discuss same subjects as those Discuss same subjects as those

in the questionnaire in the questionnaire

(18)

Limitations

Convenience sampling

vs

random sampling

Different methods of data collection in public Different methods of data collection in public

and private sectors and private sectors

Doctors interviewed at health centres assumed Doctors interviewed at health centres assumed

to represent other doctors to represent other doctors

(19)

Results

94% response rate

(226 out(226 out of 240 questionnaires returned) of 240 questionnaires returned)

100 male, 126 female respondents100 male, 126 female respondents

Higher response rate in public sectorHigher response rate in public sector

No significant age or gender difference between No significant age or gender difference between

public and private sectors public and private sectors

85% of public sector respondents have a private 85% of public sector respondents have a private

family doctor family doctor

(20)

Results

How many times have you seen your doctor in How many times have you seen your doctor in

the last year? the last year?

0 10 20 30 40 50 60 70 N ever 1-5 6-10 11-15 16-20 M o re than 20 Public Sector Private Sector

(21)

Results

How many times have you seen another doctor How many times have you seen another doctor

in the last year? in the last year?

0 10 20 30 40 50 60 N ever 1-5 6-10 11-15 16-20 M o re than 20 Public Sector Private Sector

(22)

Factors most likely to

lead to patient satisfaction

Being ready to explain what is wrong before Being ready to explain what is wrong before

giving treatment giving treatment

Being up to date with recent developments in Being up to date with recent developments in

the profession the profession

The ability to make the right diagnosisThe ability to make the right diagnosis

Being enthusiasticBeing enthusiastic

Having a nice attitude with patientsHaving a nice attitude with patients

(23)

Scale means most likely to

lead to patient satisfaction

Communication skills

(24)

Comparison of patient satisfaction

between public and private sectors

75.7% in public sector are satisfied with the service that 75.7% in public sector are satisfied with the service that

the doctor provides

98.2% of private sector respondents are satisfied 98.2% of private sector respondents are satisfied

78.2% of patients believe that the doctor at the health 78.2% of patients believe that the doctor at the health

centre is a good family doctor

99.1% of patients believe that their private family 99.1% of patients believe that their private family

doctor is a good family doctor

Difference in patient satisfaction between public and Difference in patient satisfaction between public and

private sectors is highly significant (p<0.001)

(25)

Comparison of public

and private sectors

Factors most likely to lead to patient satisfaction Factors most likely to lead to patient satisfaction

0 20 40 60 80 100 120 140 160 H a s a n ic e a ttit u d e w ith th e p a tie n ts Is e n th u s ia s tic a b o u t h is /h e r j o b H o n e s t a n d tr u s tw o rth y U p to d a te w ith r e c e n t d e v e lo p m e n ts C a p a b le o f m a k in g th e r ig h t d ia g n o s is R e a d y to e x p la in w h a t is w ro n g b e fo re g iv in g tr e a tm e n t Public Sector Private Sector

(26)

Comparison of public

and private sectors

Patient satisfaction in different areas of Malta Patient satisfaction in different areas of Malta

0 20 40 60 80 100 Paola Gzira/San Gwann Qormi/Zebbug Mosta Public Sector Private Sector

(27)

Comparison of scale means between

public and private sectors

Difference between public and private sectors is Difference between public and private sectors is

statistically significant (p<0.001) for all the five statistically significant (p<0.001) for all the five

dimensions dimensions

Largest difference between the means in public Largest difference between the means in public

and private sectors is for communication skills and private sectors is for communication skills

(28)

Doctors

’

_’

perceptions

_perceptions

of patient satisfaction

SemiSemi--structured interviews carried out on structured interviews carried out on

doctors working in the clinics doctors working in the clinics

In the public sector, doctors spend much less In the public sector, doctors spend much less

time with the patient than in the private sector time with the patient than in the private sector

Limited time explains difference in Limited time explains difference in

communication skills between sectors communication skills between sectors

Poor perception of patient satisfaction in the Poor perception of patient satisfaction in the

public sector public sector

(29)

Doctor Satisfaction

Depends on good doctorDepends on good doctor--patient relationships patient relationships

and continuity of care and continuity of care

Very low in public sector, high in private sectorVery low in public sector, high in private sector

Affects level of Affects level of

patient satisfaction patient satisfaction

achieved achieved

R elationship between staff & patient satisfaction

2.7 2.8 2.9 3 3.1 3.2 3.3 3.4 Low High

Sta ff Sa tisfa ction

P a ti e n t S a ti s fa c ti o n Borrill

(30)

Discussion

Communication skills and clinical care most Communication skills and clinical care most

important to achieve patient satisfaction important to achieve patient satisfaction

Good doctorGood doctor--patient relationships and patient relationships and

continuity of care are necessary for doctor and continuity of care are necessary for doctor and

There is a statistically significant difference There is a statistically significant difference

(p<0.001) in patient satisfaction between public (p<0.001) in patient satisfaction between public

and private sectors of primary health care and private sectors of primary health care

(31)

Discussion

The difference in patient satisfaction between The difference in patient satisfaction between

public and private sectors is mainly due to poor public and private sectors is mainly due to poor

communication skills in the public sector communication skills in the public sector

This is the result of an increasing shortage of This is the result of an increasing shortage of

doctors, high workload and limited time for the doctors, high workload and limited time for the

patient in the public sector patient in the public sector

Doctors in the public sector are dissatisfied with Doctors in the public sector are dissatisfied with

their positions and have poor perceptions of their positions and have poor perceptions of

(32)

Barriers to improvement

of the public sector

Adequacy of resourcesAdequacy of resources

Shortage of doctorsShortage of doctors

PublicPublic--private splitprivate split

Lack of staff motivationLack of staff motivation

Abuse of the primary Abuse of the primary

health care system health care system

(33)

Recommendations

Patient registrationPatient registration

Better working conditions for doctorsBetter working conditions for doctors

Control over abuse of resourcesControl over abuse of resources

Increasing access to investigations from the Increasing access to investigations from the

private sector private sector

Computerization of patient recordsComputerization of patient records

Increase motivation for doctorsIncrease motivation for doctors

(34)

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