Beruflich Dokumente
Kultur Dokumente
41]
Original Article
Department of Community Introduction: Many recent studies have shown an increased association between
Abstract
Medicine, Midnapore
Medical College and
patient’s satisfaction levels, patient’s compliance, and success of treatment.
Hospital, Midnapore, Aim: The aim of this study is to assess the level of satisfaction among patients who
1
Department of Community have utilized the outpatient department services provided in the primary care level
Medicine, IPGMER and health institution. Materials and Methods: A health center‑based observational
SSKM Hospital, Kolkata, cross‑sectional study was conducted from July 2011 to October 2011 at Guskara
2
Department of Community Primary health center, Burdwan among 422 patients using a pre‑designed pre‑tested
Medicine, Calcutta National
Medical College, Kolkata,
structured schedule. Results: Overall, mean satisfaction score was 2.97 ± 0.37.
West Bengal, India Highest satisfaction scores were observed among 18–20 years, males were more
satisfied regarding technical quality of care, whereas females reported higher
satisfaction regarding interpersonal manner, unmarried/single group reported
the highest satisfaction with most of the services, literate group reported higher
satisfaction than the illiterate group, affluent patients reported higher satisfaction
regarding technical quality of care, financial aspect. Conclusions: Causes of
dissatisfaction were long waiting time, the inadequacy of seating arrangement in
the waiting area, inadequate cleanliness of surroundings, inadequate toilet facilities,
nonavailability of medicines, and behavior of doctor.
Received: 02‑09‑2017
Accepted: 08-01-2018 Keywords: Causes of dissatisfaction, patient satisfaction, primary care level
326 © 2018 Medical Journal of Dr. D.Y. Patil Vidyapeeth | Published by Wolters Kluwer - Medknow
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Some patients may place more emphasis on technical Nearly 10% of the estimated sample size was added for
competence whereas others, on fulfilment of personal incomplete answers, making the estimated sample size
needs, comfort, dignity, and supportive services. to be 422.
With this background, this study was conducted to assess Selection of patient – the patients attending the OPD of
the level of satisfaction among patients who have utilized that health‑care facility were selected for the interview by
the outpatient department (OPD.) services provided in the systematic random sampling. Depending on the previous
primary care level health institution and to determine the attendance of the particular health facility, a random
relationship between some sociodemographic factors and number was chosen and every 4th patient was selected
the level of satisfaction (if any). for the interview. This process was continued until the
required sample size was completed.
Materials and Methods While selecting patients, it was observed from previous
This was a health center‑based observational study, records that average number of new patients attending
cross‑sectional in design, duration of study being the OPD at Guskara PHC was around 100/day.
3 months, from July 2011 to October 2011 done at Two months were available for data collection. Two
primary level health‑care facility at Guskara primary days in a week were utilized for data collection
health center, Guskara, Burdwan was chosen purposively (total 17 days in 2 months), and a total number of patients
for the study. required to be interviewed at the primary level were 422.
Guskara primary health center Hence, per day 25 patients (in average) were interviewed.
This is a 10‑bedded primary health care facility under In the OPD, the first patient fulfilling the inclusion criteria
Block Ausgram I, District Burdwan and caters to a was identified, and then, every 4th patient (who fulfilled
population of around 28,000, has a general OPD, DOTS the inclusion criteria) was selected systematically. The
clinic and immunization clinic. It is well connected by patients were interviewed maintaining privacy and
railways, highway and is 32 km from Burdwan town. requested not to divulge any information to others.
New adult patients (18 years and above) of both sex, Information was elicited by exit interview of patients
attending OPD and gave informed written consent and review of records (OPD tickets) and information
constituted our study population. regarding the following variables were obtained: age,
sex, education, occupation, socioeconomic status, type of
Seriously ill patients who were unable to participate in the family, religion, marital status, residence, and caste.
interview, patients who were deaf or mute or both, follow‑up
A predesigned and pretested interview schedule was
patients who worked in the same hospital or their relatives
used to record information. The initial part of the
and unwilling patients were excluded from the study.
schedule (Part A) was used to record information on the
Sampling: various socio‑demographic characteristics of the patients.
i. Sample size: Sample size was determined using the Part B of the schedule recorded information on patient’s
following formula.[1] satisfaction. The questions of the schedule were adopted
N = Z2pq/e2 from the short form patient satisfaction questionnaire
18[8] and the third part of schedule recorded the areas and
N = estimated sample size causes of patient dissatisfaction.
Z = 1.96 at 95% Confidence Limit Some questions were modified after pre‑testing and were
p = Prevalence of patient satisfaction validated by experts.
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Data were entered into Microsoft Excel sheet, checked Patient satisfaction and marital status
for accuracy, and analyzed using the software Epi Info The unmarried/single group reported the highest satisfaction
version 6 (CDC; Centers for Disease Control;1990 with most of the services as compared to the others,
Atlanta, Georgia (US)) and Microsoft excel, whereas the widowed group reported lowest satisfaction
proportions, unpaired t‑test, mean, standard deviation, scores. The married group were most satisfied group as far
and one‑way ANOVA was computed using SPSS as time spent with doctor was concerned [Table 3].
version 17.0 (SPSS Inc. Released 2008, Chicago).
Patient satisfaction and literacy status
Results The literate group reported higher satisfaction than the
Patients belonging to 21–30 years age group were illiterate group of patients [Table 3].
found in highest numbers while the percentage of Patient satisfaction and socioeconomic status
patients above 60 years of age was the least, male Affluent patients reported higher satisfaction regarding
patients were more in number than females, higher technical quality of care, financial aspect while the less
percentage of patients were from rural area, the highest affluent groups reported higher satisfaction regarding the
percentage of patients among Hindu belonged to the interpersonal manner, communication and accessibility
general category and maximum proportion of patients and convenience [Table 3].
were married, while the least percentage belonged to
the widowed/separated/divorced category, homemakers Causes of dissatisfaction
contributed to the highest percentage. According to The primary areas of complain of patients in descending
educational status, illiterates were in highest proportions, order were as follows: long waiting time (97.6%), lack
patients belonging to Grade IV socioeconomic status of adequate drinking water in the waiting area (87.2%),
were highest in number and highest percentage of inadequate toilet facilities (82.5%), inadequacy of
patients were from joint family. seating arrangement in the waiting area (79.1%),
inadequate privacy (65.7%), nonavailability of medicines
Overall, mean satisfaction score at primary health‑care
and investigations in hospital (53.5%) l, inadequate
facility was calculated to be 2.97 ± 0.37.
cleanliness of surroundings (39.8%), inadequate
The highest mean satisfaction score was found regarding ventilation and fans in the waiting hall (21.8%), behavior
interpersonal manner while least satisfaction was of doctor (6.6%), and lack of proper signboards/direction
observed regarding financial aspect [Table 1]. guides (6.2%) [Table 4].
Patient satisfaction and age
The highest satisfaction scores were observed among the
Discussion
age group of 18–20 years as compared to the other age The present study was attempted to assess the level of
groups [Table 2]. satisfaction of the patients with the various aspects
of healthcare at a primary level health‑care facility of
Patient satisfaction and sex Burdwan district. Very few similar studies have been
Males were more satisfied regarding technical quality of done in India and abroad, and therefore, we lack the data
care, financial aspect, and time spent with doctor, whereas for comparison.
females reported higher satisfaction regarding the
interpersonal manner, communication and accessibility The sociodemographic profile showed the importance
and convenience [Table 2]. of hospital, as the majority of the respondents were in
the age group of 21–30 years which is economically
Table 1: Patient satisfaction scores according to productive age group for the families belonging to
subscales of satisfaction at primary level health‑care underserved, needy section of the society. Most of them
facility (n=422) were illiterate, home makers and belonged to Grade IV
Satisfaction sub‑scales Patient satisfaction socioeconomic status. This weaker section is largely
scores (mean±SD) dependent on the Government sector hospitals and these
General satisfaction 2.83±0.47 needy people do not have large expectations from the
Technical quality 3.25±0.34 hospital besides their medical treatment and provision
Interpersonal manner 3.37±0.61 of basic amenities which is the right of every human
Communication 2.74±0.71 being that should be well considered and provided by the
Financial aspects 2.68±0.95
Government.
Time spent with doctor 2.82±0.72
Accessibility and convenience 3.13±0.45 The present study revealed that younger age group
SD: Standard deviation were more satisfied than the older age group except
328 Medical Journal of Dr. D.Y. Patil Vidyapeeth ¦ Volume 11 ¦ Issue 4 ¦ July-August 2018
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regarding financial aspects. These findings were in were found to be more satisfied.[9] Contrast findings
contrast to findings of Ware et al. where older age were observed in another study by Matteo et al. where
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Table 4: Areas and causes of patient dissatisfaction at satisfaction rating, compared to the availability of
primary level of health care facility (n=422) laboratory tests and X‑ray, ultrasound and computed
Areas of complain n (%) tomography scans. For accessibility of basic health care,
1. Long waiting time 412 (97.6) patients or respondents have low satisfaction ratings to
2. Lack of adequate drinking water in the waiting area 368 (87.2) access of hospital records and access to the laboratory.
3. Inadequate toilet facilities 348 (82.5) As for convenience of the basic health care provided by
4. Inadequacy of seating arrangement in the waiting area 334 (79.1) the OPD, the majority of the respondents gave a low
5. Inadequate privacy 278 (65.7) satisfaction rating on the waiting time to get medical
6. Nonavailability of medicines and investigations 226 (53.5) records as well as for the procedure to get medical
7. Inadequate cleanliness of hospital surroundings 168 (39.8) records. The comfort of the X‑ray waiting area also
8. Inadequate ventilation and fans in the waiting area 92 (21.8)
garnered low satisfaction.[34]
9. Behavior of doctors 28 (6.6)
10. Lack of proper signboards/direction guides 26 (6.2)
Conclusion and Recommendation
Overall mean satisfaction score was 2.97 ± 0.37.
older patients were found to be more satisfied than Highest satisfaction scores were observed among
younger ones.[10] 18–20 years, males were more satisfied regarding
Few more studies also reported that elder respondents technical quality of care while females reported
generally record higher satisfaction.[11‑13] Age is a higher satisfaction regarding interpersonal manner,
well‑known determinant of the patient satisfaction index unmarried/single group reported highest satisfaction
with older patients scoring more highly and being more with most of the services, literate group reported higher
satisfied than young and middle‑aged patients.[14,15] satisfaction than the illiterate group, affluent patients
reported higher satisfaction regarding technical quality
On the contrary, Jenkinson et al. found age was only
of care, financial aspect.
weakly associated with satisfaction.[16]
Causes of dissatisfaction were long waiting time,
In general, it was found that women were more
inadequacy of seating arrangement in the waiting area,
satisfied than males. Evidence about the effects of
inadequate cleanliness of surroundings, inadequate toilet
gender, ethnicity, and socioeconomic status was
facilities, nonavailability of medicines, and behavior of
equivocal due to the small amount of literature
doctor.
available on each.[17‑24] Some studies have indicated
that female report greater satisfaction than male. While Improvement of doctor–patient communication and cost
other studies have contradicted this finding.[25] Women effectiveness of the services provided is important to
tended to rate their care more negatively than men in maintain the bond between the doctors and the patient
some studies[26‑29] for the achievement of the optimal level of health of the
people.
The unmarried/singles were more satisfied as compared
to the widowed or the married. Acknowledgment
The authors are highly thankful to
Hulka et al. found no relationship between marital status
Dr. Krishnadas Bhattacharyya, Dr. Aditya Prasad Sarkar,
and satisfaction[30] while Bashur et al. reported that single
Prof. Indranil Saha, and Dr. Amiya Bhattacharya for their
persons tended to be more satisfied with the technical
support and guidance.
quality of care.[31]
Financial support and sponsorship
Two of the four studies that correlated marital status with
satisfaction variable found no relationship.[29,30] Bashur Nil.
et al. reported that single persons were less satisfied Conflicts of interest
than married persons with a prepaid group practice while There are no conflicts of interest.
another author reported the opposite.[30,32]
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