Primary Care Satisfaction Research Articles

Optimising diagnosis and management of kidney disease: an implementation trial of a clinical decision support system future health today

BackgroundChronic kidney disease affects more than 10% of the world’s population and is a non-communicable disease of global concern and priority. There is a significant implementation gap between best practice guideline recommendations and current kidney disease management. Previous research has shown the need to partner with primary care to improve education, collaboration, and kidney disease awareness. This implementation trial will explore use of an innovative clinical decision support software, Future Health Today, to improve screening, diagnosis, and management of kidney disease in primary care. The program will be supported by tertiary care outreach services. The primary aim is to test the hypothesis that the Future Health Today implementation program will improve screening, diagnosis, and management of kidney disease. Secondary aims are to evaluate primary care satisfaction and broader health service impacts.MethodsThis pre-post implementation trial using an interrupted time series design will evaluate the clinical and service outcomes of Future Health Today, using a mixed methods study in twenty general practices with an estimated population size of 150,000. Deidentified patient data will be extracted from participating practices to examine the primary aims of the study. Surveys and semi-structured interviews with general practice will inform secondary hypotheses. Data linkage between primary care and tertiary care data will examine the broader health service impacts.DiscussionThis investigator driven trial will assess the impact of Future Health Today software coupled with education and clinical outreach support. Investigators hypothesise that there will be improvement in appropriate screening, diagnosis, and management of kidney disease. This program has the potential to be scaled more broadly.Trial RegistrationAustralian New Zealand Clinical Trial Registry: ACTRN12623001096640.

Correlation between consultation time and patient´s satisfaction in primary care

It is important to understand how consultation time relates to patient satisfaction, as these two variables have not been extensively studied together. To determine the correlation between consultation time and patient satisfaction in primary care settings in Mexico. Cross-sectional, observational, and analytical study that included patients over 18 years old. Time was measured using a stopwatch, and satisfaction was assessed using the Patient Doctor Relationship Questionnaire (PDRQ-9). The correlation between both variables was analyzed using the Spearman test, and multiple linear regression was employed to associate satisfaction with the consultation. A total of 115 participants were included. The average consultation duration was 12.1 minutes, and 74% of patients reported that the consultation time was adequate. A weak positive correlation (p < 0.001, r = 0.38) was found between actual consultation time and satisfaction. Multiple linear regression demonstrated that for every minute increase in consultation time, level of satisfaction increased in 0.04 units (p = 0.001, CI95%: 0.016-0.063). Most patients reported satisfaction with the duration of their medical consultation, and longer consultation times were associated with higher satisfaction levels.

Primary Care Management Pathways to Reduce Wait Times in Hematology: Monoclonal Gammopathy of Undetermined Significance

Background:Prolonged wait times are a worsening barrier to accessing specialist care in Canada and other countries across the globe. The flow of patients between primary care and specialists has been a recognized area for improvement (Liddy et al., 2020; Moir &amp; Barua, 2021). Kingston Health Sciences Centre (KHSC) has aimed to optimize referrals through the implementation of primary care management pathways (PCMPs). PCMPs are diagnostic and/or treatment algorithms, co-developed by local primary care physicians and specialists with input from patients. They are designed to support primary care providers in managing low risk medical conditions in the community while more quickly identifying patients with higher risk conditions to be seen by specialists. A PCMP was implemented in June 2021 for Monoclonal Gammopathy of Undetermined Significance (MGUS) (https://kingstonhsc.ca/refer/hematology). This asymptomatic condition with low levels of monoclonal protein in the blood or urine has an approximately 1% per year risk of transforming to a hematological malignancy such as multiple myeloma (Kyle et al., 2018). The MGUS PCMP outlines diagnostic criteria, management, and monitoring instructions for low-risk MGUS along with patient information. “Red flag” features, such as renal impairment, anemia or significantly increased monoclonal protein levels, are used to highlight those who need urgent referral. The aim of this study is to evaluate the impact of an MGUS PCMP on wait times in Hematology in Kingston, Ontario. Methods:All consecutive outpatient Hematology referrals received at KHSC from January 2021 to December 2022 were reviewed. Monthly outcome measures included the number of new referrals and median wait times for patients seen. Number of MGUS referrals deferred to the PCMP was included as a process measure. Monthly balancing measures included number of re-referrals of PCMP patients, number of deaths without being seen for MGUS, and number of new multiple myeloma diagnoses. To compare 6-month pre-PCMP implementation (January 2021 to June 2021) with 18-month post-PCMP implementation (July 2021 to December 2022), generalized linear regression analysis was conducted. p &amp;lt; 0.05 was considered statistically significant. A survey of primary care providers was distributed through the regional Primary Care Physicians' Council to assess primary care satisfaction with the PCMP. Results: Between January 2021 and December 2022, 4504 Hematology referrals were received, 278 (6%) of which were MGUS referrals. 76 (27%) of MGUS referrals were deferred to the PCMP. There was a significant increase in monthly Hematology referrals from a mean (± standard deviation (SD)) of 163.0 (± 13.9) pre-PCMP to 195.9 (± 27.3) post-PCMP (p&amp;lt;0.0001). There was no significant difference in mean monthly MGUS referrals pre-and post-PCMP (11.7 ± 4.7 versus 11.6 ± 3.5). Hematology's median wait time for those seen fell from a median (interquartile range (IQR)) of 51.3 days (13) pre-PCMP to 28.5 days (11) post-PCMP (p &amp;lt; 0.0001). The MGUS median wait time also fell from a median (IQR) of 40.5 days (59) to 37.0 days (32.5) (p &amp;lt; 0.0001). No significant difference was noted in the balancing measures. Pre-PCMP to post-PCMP, the mean number of deaths without being seen for MGUS (0.17 ± 0.41 versus 0.17 ± 0.38, p=0.36) and mean monthly new multiple myeloma diagnoses (5.17 ± 1.94 versus 5.17 ± 2.50, p = 0.54) remained stable. There were 7/76 (9.2%) re-referrals of patients deferred to the PCMP, with a median (IQR) time to re-referral of 64 days (348). A survey to assess primary care provider satisfaction with the PCMP included a total of 28 respondents; 19/28 (67.9%) reported using PCMPs. On a scale of 0 to 5, where 5 is the highest satisfaction, the median (IQR) overall experience was 4/5 (1.5) and impacts on supporting patient care and changing management were also 4/5 (1). The most common concern, raised by 7/28 respondents (25%), was the downloading of more work to primary care. Conclusion: The MGUS PCMP was associated with reduction in wait times for overall Hematology and MGUS despite an increase in referrals. Limitations of this study include concurrent changes in the program, including staffing and the COVID-19 pandemic. These results suggest that PCMPs may be an effective tool to address Hematology wait times, likely best complemented with other strategies to avoid overburdening primary care providers.

Job satisfaction in primary care after the health reform in a province of Turkey.

Health care reform, which started to be restructured after the Alma Ata Declaration, positively contributed to the development of primary health care administrations around the world. In Turkey, the Ministry of Health launched a "Health Transformation Program" by initiating the "Family Medicine Model" that influenced the working conditions and job satisfaction of primary health care workers (PHCWs). In this cross-sectional study, we evaluated job satisfaction levels of PHCWs and the factors affecting these levels a decade after the introduction of the health care reform in a province of Turkey. A total of 223 PHCWs participated in the study and completed a structured questionnaire that probed their views regarding their jobs and working conditions. Additionally, the short version of the Minnesota Satisfaction Questionnaire (MSQ) was administered to each participant. Participants were also asked to indicate whether they had any intention to quit their job, whether they liked their profession and workplace, and whether they were satisfied with their job. Bivariate analysis and binary logistic regression analysis were performed to determine predictors of job satisfaction. PHCWs were found to be generally dissatisfied with their working conditions and they declared that they were not sufficiently qualified to work in primary care. Their overall satisfaction was found to be moderate (3.21±0.67 out of 5) and the most important predictor for job satisfaction was found to be "Liking the workplace" (OR=3.07; 95% CI=1.46-6.45). The results indicated that environmental factors for job-related issues need to be examined more intensively for future planning and policy making in primary care.

Opportunity loss: care team job satisfaction and urgent care, emergency department, and hospital costs for patients with cardiovascular disease.

This study evaluates the association between primary care team job satisfaction and urgent care, emergency department, and hospital costs for their patients with cardiovascular disease (CVD). Electronic health record (EHR)-extracted observational study alongside a cross-sectional health care professional survey. A total of 143 health professionals, including physicians and clinical staff, at 5 US primary care clinics participated in a cross-sectional survey about job satisfaction. Urgent care visits, emergency department visits, hospital visit days, and medical costs in the past 12 months for each care team's panel of patients were extracted from the EHR. Three-level hierarchical modelling evaluated the link between team job satisfaction, urgent care visits, emergency department visits, hospital visit days, and medical care costs in the past 12 months for the team's patients with diagnosed CVD. Teams with higher satisfaction with their freedom of work methods, work hours, and income were associated with fewer hospital days (odds ratio = 0.85, 0.72, and 0.81, respectively) and lower medical care costs -$474, -$650, and -$397 per patient, respectively) for their patients with CVD. Overall job satisfaction was not significantly associated with cost of care. Health care employee job satisfaction in primary care is an important factor to consider in efforts to lower medical costs for patients with CVD.

The Benefits of Utilizing Continuous Glucose Monitoring of Diabetes Mellitus in Primary Care: A Systematic Review.

Continuous glucose monitoring (CGM) and intermittently scanned CGM (is-CGM) have shown to effectively manage diabetes in the specialty setting, but their efficacy in the primary care setting remains unknown. Does CGM/is-CGM improve glycemic control, decrease rates of hypoglycemia, and improve staff/physician satisfaction in primary care? If so, what subgroups of patients with diabetes are most likely to benefit? A comprehensive search in seven databases was performed in June 2021 for primary studies examining any continuous glucose monitoring system in primary care. We excluded studies with fewer than 20 participants, specialty care only, or hospitalized participants. The National Heart, Lung and Blood Institute and Grading of Recommendations Assessment, Development and Evaluation were used for the quality assessment. The weighted mean difference (WMD) of HbA1c between CGM/is-CGM and usual care with 95% confidence interval was calculated. A narrative synthesis was conducted for change of time in, above, or below range (TIR, TAR, and TBR) hypoglycemic events and staff/patient satisfaction. From ten studies and 4006 participants reviewed, CGM was more effective at reducing HbA1c compared with usual care (WMD -0.43%). There is low certainty of evidence that CGM/is-CGM improves TIR, TAR, or TBR over usual care. The CGM can reduce hypoglycemic events and staff/patient satisfaction is high. Patients with intensive insulin therapy may benefit more from CGM/is-CGM. Compared with usual care, CGM/is-CGM can reduce HbA1c, but most studies had notable biases, were short duration, unmasked, and were sponsored by industry. Further research needs to confirm the long-term benefits of CGM/is-CGM in primary care.

Factors influencing patient’s satisfaction toward primary health care: Systematic review

Background: PHC position has become increasingly important since it serves as the community's initial and continuing point of contact, acts as a gatekeeper to higher levels of care, and provides coordinated and all-encompassing treatment. The purpose of this study was to evaluate patients' level of satisfaction with the caliber of care they receive at PHC. Method: We carefully searched Google Scholar, EMBASE, and PubMed for original research publications, we took into account articles that were released between 2013 and 2021. We included studies focusing on patients' perceptions and expressions of satisfaction, and contained information on these topics, as well as aspects of primary care that patients consider important. Result: Although the included studies reported a high overall level of satisfaction, we discovered that there is a need for quality improvement in the following areas: access to specialized services such as dental clinics, availability of doctors in all specializations, and provision of appropriate diagnostic methods. It was shown that patients' satisfaction was highly correlated with sociodemographic traits like age and gender as well as services like PHC employees and area pharmacies. It is important to consider further that patients place a great importance on the moral character and interpersonal skills of PHC staff. Conclusion: Specifically at PHC, patient satisfaction in primary care were mostly established by their interactions with the physician.

Daily self-regulation with biofeedback to improve stress and job satisfaction in a primary care clinic.

Background:Burnout in healthcare professions is higher than other careers. An undesirable work-life balance has resulted in declining job satisfaction among primary care physicians. Biofeedback devices teach self-regulation techniques, which reduce stress and increase resilience.Objectives:We assessed whether self-regulation with biofeedback is effective at decreasing stress and improving job satisfaction among primary care clinicians and nurses.Methods:Two naturally occurring cohorts of clinicians and nurses were followed over 12 weeks. The treatment group (N = 9) completed 12 weeks of self-regulation with optional clinic-based biofeedback and received peer support for the first half. The control group (N = 9) started a delayed intervention after 6 weeks without peer support. Descriptive and bivariate analyses were conducted.Results:The treatment group averaged one biofeedback session weekly for 6 min and the control group two sessions for 11 min. Adherence differed by age. Subjects also reported using self-regulation techniques without biofeedback. Perceived stress initially increased in both groups with intervention implementation, more so in the treatment group (P = 0.03) whose stress then decreased but was not significant. Overall and extrinsic job satisfaction similarly increased but were not significance.Conclusion:The initial increase in perceived stress was related to daily biofeedback adherence and clinic responsibilities. Treatment group stress then decreased with self-regulation but was difficult to quantify in a small cohort. Larger studies could increase daily self-regulation adherence by improving biofeedback accessibility for leisurely use. Using self-regulation with biofeedback may be an innovative approach to reduce stress and improve job satisfaction in primary care.

Effects of clinic-level implementation of One Key Question® on reproductive health counseling and patient satisfaction

ObjectiveWe evaluated the effect of clinic level implementation of the One Key Question (OKQ) intervention, including physician and staff training and workflow adjustments, on reproductive counseling and patient satisfaction in primary care and ob/gyn. Study designWe implemented the OKQ intervention in one primary care and one ob/gyn practice, while observing another primary care and ob/gyn practice that each provided usual care (control practices). We surveyed separate patient cohorts at two time points: 26 before and 33 after the primary care practice implemented OKQ, 38 before and 36 after the ob/gyn practice implemented OKQ, 26 and 37 at the primary care control practice, and 31 and 37 at the ob/gyn control practice. We used chi square tests to assess OKQ’s effects on counseling rates and patient satisfaction, comparing intervention to control practices across time points. ResultsIn primary care, from before to after implementation, the intervention practice did not significantly increase reproductive counseling (69–76%, p = 0.58), but increased patient satisfaction (81–97%, p = 0.04) while the control practice demonstrated a decrease in patient satisfaction over the same time periods. In the ob/gyn clinics, no significant change in reproductive counseling or patient satisfaction was seen in the intervention practice, while the control practice demonstrated a decrease in patient satisfaction. ConclusionsImplementing OKQ appears to increase patient satisfaction. Larger studies are needed to assess whether this clinic-level intervention may increase reproductive counseling. ImplicationsFurther studies of the impact of clinic-level implementation of OKQ are needed.

Patients and doctors: what kind of changes in outpatient clinic services can be made in concert?

Abstract Background Search for possible improvements in outpatient clinic services is a key task for health care professionals worldwide. It is important to consider the satisfaction of the main participants in primary care: patients and doctors. If patients unsatisfied with primary care will not seek help again, this will reduce their life quality and life expectancy. Unsatisfied doctors will work not efficiently nor for a long time. The work is devoted to the search for possible factors, which change may affect the improvement of the situation in clinics in terms of both doctors and patients. Methods The opinions of 1672 patients of Krasnoyarsk outpatient clinics were investigated with the usage of semi-structured interviews. The opinions of 283 physicians of the city were collected using an anonymous questionnaire. Data were analyzed using SPSS 22 by the following methods (p &amp;lt; 0.05): descriptive statistics, U test, χ2-test. Results Coherence of doctors' and patients' opinions investigated in different ways such as primary care satisfaction, desirable main changes, optimal time, duration and structure of appointment, physician's mission, the possibilities of additional medical remote consultations and difficulties in doctors' access. At some points, the answers were consistent; at some, a compromise or new ways of the solutions were required. Conclusions Almost 61% of the doctors prefer morning work time (8-12 am) and 15.5% prefer work in the evenings (18-20 pm) while only 38.1% of patients can visit a doctor in the morning time and 39.5% in the evening. The main changes to be made according to the general opinion of doctors and patients is a reduction of a waiting time of doctors' appointment (38.1% and 38.5% respectively) and the creation of an electronic queue (26.5% and 30.5% respectively). Remote consultation service have to be organized for patients: phone service is more appropriate as for the doctors (30.5%) so as for the patients (34.7%). Key messages The reduction of a waiting time of doctors’ appointment, creations of an electronic queue and a remote consultation service have to be organized to improve primary care system. There is inconsistency in time preferences that have to be solved: doctors prefer to work in morning time and many patients can visit clinics only in the evenings.

A Portal Adoption Program to Enhance Patient Satisfaction in Primary Care

Patient engagement technologies have become a focal point for defining quality in government and medical practice arenas. Patient portals are recognized as a promising mechanism to foster patient engagement and, as such, have become embedded in major healthcare reform initiatives. Despite sweeping implementation endeavors, portal adoption rates among patients remain low and create a significant gap in quality-based reimbursement. The purpose of this research was to evaluate a 12-week portal adoption program in the primary care setting featuring customized tablets with a patient-centric design for targeted point-of-contact portal registration. This project focused on three objectives: (1) achieve a 75% metric for portal adoption to align with highest tier adopters; (2) evaluate patient satisfaction for measuring perceived ease-of-use and usefulness of system; and (3) assess cost-effectiveness in determining sustainability and potential to replicate the initiative throughout other primary care settings. An outcome evaluation of the program revealed a 90% portal utilization rate, 94% new patient portal adoption rate, and 79% existing patient portal adoption rate during the data collection period. A χ analysis revealed a statistically significant difference in patient satisfaction scoring relative to efficiency, quality of care, and safety of information based on sex and insurance carrier demographics.

Do Collaborative Care Managers and Technology Enhance Primary Care Satisfaction with Care from Embedded Mental Health Providers?

To improve mental health care access, the Veterans Health Administration (VA) implemented Primary Care-Mental Health Integration (PC-MHI) in clinics nationally. Primary care clinical leader satisfaction can inform model implementation and may be facilitated by collaborative care managers and technology supporting cross-specialty collaboration. (1) To determine primary care clinical leaders' overall satisfaction with care from embedded mental health providers for a range of conditions and (2) to examine the association between overall satisfaction and two program features (care managers, technology). Cross-sectional organizational survey in one VA region (Southern California, Arizona, and New Mexico), 2018. Sixty-nine physicians or other designated clinical leaders in each VA primary care clinic (94% response rate). We assessed primary care clinical leader satisfaction with embedded mental health care on four groups of conditions: target, non-target mental health, behavioral health, suicide risk management. They additionally responded about the availability of mental health care managers and the sufficiency of information technology (telemental health, e-consult, instant messaging). We examined relationships between satisfaction and the two program features using χ2 tests and multivariable regressions. Most primary care clinical leaders were "very satisfied" with care for targeted anxiety (71%) and depression (69%), but not for other common conditions (37% alcohol misuse, 19% pain). Care manager availability was significantly associated with "very satisfied" responses for depression (p = .02) and anxiety care by embedded mental health providers (p = .02). Highly rated sufficiency of communication technology (only 19%) was associated with "very satisfied" responses to suicide risk management (p = .002). Care from embedded mental health providers for depression and anxiety was highly satisfactory, which may guide improvement among less satisfactory conditions (alcohol misuse, pain). Observed associations between overall satisfaction and collaborative care features may inform clinics on how to optimize staffing and technology based on priority conditions.

Electronic Consultation Systems: Impact on Pediatric Orthopaedic Care

The demand for pediatric orthopaedic surgery consultation has grown rapidly, leading to longer wait times for elective consultation in some regions. Some specialties are addressing this increased demand through electronic consultation services. We wanted to examine the impact of pediatric orthopaedic e-consultations in Canada's Eastern Ontario region. We developed a cross-sectional study of all the cases directed to a pediatric orthopaedic surgery specialist using the Champlain Building Access to Specialists through eConsultation (BASE) eConsult service over a 2-year period and examined their impact on in-person referrals, time of e-consultation and primary care satisfaction as well as types of clinical questions that were asked. Electronic consultations avoided in-person appointments in 68% of the submitted cases. The median response by specialists received by the primary care providers (PCPs) was <20 hours. A total of 69% of consultations involve >1 type of clinical questions, most commonly about basic trauma/fracture care and management recommendations. Ninety-seven percent of the PCPs found the overall value for the care of the patients to be good or excellent. This cross-sectional study demonstrates the effective and timely use of eConsult in pediatric orthopaedic surgery. It also shows a significant reduction in the number of in-person consultations required and demonstrates a high satisfaction rate by PCPs using the service. In addition to the efficacy and time-sensitive care provided to the patients, the study shows that, professionally, 89% of PCPs found this service to be excellent or good. The broader implications of electronic consultation on overall quality of care, population health, and patient satisfaction requires further investigation.

Analysing drivers and outcomes of job and professional satisfaction at health centres in Portugal

PurposeThe purpose of this paper is to analyse antecedents, associations and outcomes of job and professional satisfaction of doctors and nurses in Portuguese health centres.Design/methodology/approachThe authors have used structural equation modelling to examine the causal relationships between multiple variables placed in a path model reflecting the theoretical foundation.FindingsThe percentage of those satisfied or very satisfied with their jobs was just above 50 per cent. Doctors’ satisfaction stems from personal achievement and the formal component of work environment, leading them to strongly recommend their work in the health centre to dear ones but not to put aside other job options. Nurses’ level of job satisfaction seems to be affected by co-workers and interpersonal relationships beside personal achievement and has more strong and multifaceted impact on their feelings and behaviour that goes from recommending their job position to considering to quit job and even regretting the option made in terms of career.Originality/valueThis study represents the first attempt to conceptualise and test a simultaneous model comprising antecedents and outcomes of both job satisfaction and professional satisfaction in primary care, investigating also differences between genders and professions. Results shed light on determinants of satisfaction among specialised staff in Portuguese primary care and how they affect commitment to the organisation and the way career choice is regarded.

Analysis of the relationship among health awareness and health literacy, patient satisfaction levels with primary care in patients admitting to primary care health centers

ObjectiveThe aim of the study was to examine the relationships between health literacy, primary care satisfaction levels and health awareness of the patients who were admitted to primary care centers (Family Health Centers). MethodsThis is a cross-sectional study conducted on individuals who were admitted to Family Health Centers (n = 1.055) in Eskisehir province. The study data were collected by using Turkish Health Literacy Scale, the European Patients Evaluate General/Family Practice Scale and Health Awareness Scale. ResultsAs health literacy of participants increases, health awareness and satisfaction with primary care also increases (for each, p < .001). Health awareness increases health literacy by 0.55 points, health literacy increases satisfaction in primary care by 0.26 points. ConclusionIn the province of Eskisehir, the health literacy level of 7 out of 10 patients, who admitted to the primary care institution, is inadequate or problematic. As health awareness of participants increases, their level of health literacy also increases. As health literacy of participants increases, their satisfaction with family physicians also increases. Practice implicationsAs an integral part of preventive health services, studies should be performed to increase and improve the level of health literacy of patients who are admitted to primary care services.

Impact of Medical Scribes on Physician and Patient Satisfaction in Primary Care.

Use of electronic health records (EHRs) is associated with physician stress and burnout. While emergency departments and subspecialists have used scribes to address this issue, little is known about the impact of scribes in academic primary care. Assess the impact of a scribe on physician and patient satisfaction at an academic general internal medicine (GIM) clinic. Prospective, pre-post-pilot study. During the 3-month pilot, physicians had clinic sessions with and without a scribe. We assessed changes in (1) physician workplace satisfaction and burnout, (2) time spent on EHR documentation, and (3) patient satisfaction. Six GIM faculty and a convenience sample of their patients (N = 325) at an academic GIM clinic. A 21-item pre- and 44-item post-pilot survey assessed physician workplace satisfaction and burnout. Physicians used logs to record time spent on EHR documentation outside of clinic hours. A 27-item post-visit survey assessed patient satisfaction during visits with and without the scribe. Of six physicians, 100% were satisfied with clinic workflow post-pilot (vs. 33% pre-pilot), and 83% were satisfied with EHR use post-pilot (vs. 17% pre-pilot). Physician burnout was low at baseline and did not change post-pilot. Mean time spent on post-clinic EHR documentation decreased from 1.65 to 0.76h per clinic session (p = 0.02). Patient satisfaction was not different between patients who had clinic visits with vs. without scribe overall or by age, gender, and race. Compared to patients 65years or older, younger patients were more likely to report that the physician was more attentive and provided more education during visits with the scribe present (p = 0.03 and 0.02, respectively). Male patients were more likely to report that they disliked having a scribe (p = 0.03). In an academic GIM setting, employment of a scribe was associated with improved physician satisfaction without compromising patient satisfaction.

Satisfaction with primary and specialized mental health care among patients with mental disorders

ABSTRACTThe purpose of this article is to assess the satisfaction of patients who received primary or specialized mental health care, and to identify variables associated with each level of care. This cross-sectional study included 325 patients with mental disorders (MDs). We used a conceptual framework based on Andersen’s behavioral model, comprising predisposing factors, enabling factors, and needs; socio-demographic, clinical, needs-related, service-use, and quality-of-life variables were integrated into the model. We performed adjusted multiple linear regression models. The mean score on patient satisfaction for primary and specialized care was approximately 4 (range: 3.67–5.0). Regarding enabling factors, better continuity of care and having a case manager were associated with patient satisfaction for both types of care; help received from services and relatives was positively associated with patient satisfaction in primary care, whereas patients on welfare were more likely to be dissatisfied with specialized care. Number of needs was negatively associated with patient satisfaction in primary care and, marginally so, in specialized care. Suicidal ideation was marginally associated with patient dissatisfaction for specialized care only.Results revealed a high level of patient satisfaction with each type of care, with significant variables related to continuity of care, case management, and needs. The study suggests the critical importance of addressing patient needs comprehensively, and of establishing long-term, individual recovery plans that promote patient satisfaction. Collaboration between relatives of patients and professionals in patient treatment is closely related to satisfaction with primary care. Accounting for the presence of suicidal ideation and patient vulnerability is fundamental to increasing patient satisfaction with specialized care. Increased patient follow-up in the community, work integration, provision of supported housing, and rapid crisis intervention may help improve patient satisfaction with mental health service (MHS) while supporting recovery.

FACTORS ASSOCIATED WITH THE ASSESSMENT ON HEALTH CARE QUALITY AT COMMUNE HEALTH CENTERS IN THUA THIEN HUE PROVINCE

Background: Patient satisfaction is an important indicator of healthcare quality. Better satisfaction is associated with greater adherence to treatment and better health outcomes. Primary care is considered the basic structure of many healthcare systems. Evaluation of healthcare provision is essential in the ongoing assessment and consequent quality improvement of healthcare services. Objective: To describe and analyze the determinants associated with patient assessment and satisfaction in primary care. Methods: The survey was conducted with 519 households and 209 patients at 18 commune health centers. The questionnaire included sociodemographic variables, health status, and use and satisfaction with primary care services. We undertook descriptive analyses, bivariate correlations to study the relationship between levels of satisfaction and the explanatory variables for demographics, health status and health services for households and patients. Results: The majority of households and patients were satisfied with the health care services at primary health care facilities. Satisfaction of waiting time, communication and counseling by healthcare providers was high. We found significant associations between the level of satisfaction and owning health insurance card, the first contact point assigned at CHCs, the severity of illness episodes, and health condition of participants. Conclusions: The results provide evidence on factors that should be taken into account in the planning and development of health policies with respect to the quality and delivery of primary care services in order to enhancing the satisfaction of clients. Key words: consumer satisfaction, patient satisfaction, primary care, quality indicators

Factors associated with professional satisfaction in primary care: Results from EUprimecare project

Background: Given the importance of primary care to healthcare systems and population health, it seems crucial to identify factors that contribute to the quality of primary care. Professional satisfaction has been linked with quality of primary care. Physician dissatisfaction is considered a risk factor for burnout and leaving medicine.Objectives: This study explored factors associated with professional satisfaction in seven European countries.Methods: A survey was conducted among primary care physicians. Estonia, Finland, Germany and Hungary used a web-based survey, Italy and Lithuania a telephone survey, and Spain face to face interviews. Sociodemographic information (age, sex), professional experience and qualifications (years since graduation, years of experience in general practice), organizational variables related to primary care systems and satisfaction were included in the final version of the questionnaire. A logistic regression analysis was performed to assess the factors associated with satisfaction among physicians.Results: A total of 1331 primary care physicians working in primary care services responded to the survey. More than half of the participants were satisfied with their work in primary care services (68.6%). We found significant associations between satisfaction and years of experience (OR = 1.01), integrated network of primary care centres (OR = 2.8), patients having direct access to specialists (OR = 1.3) and professionals having access to data on patient satisfaction (OR = 1.3). Public practice, rather than private practice, was associated with lower primary care professional satisfaction (OR = 0.8).Conclusion: Elements related to the structure of primary care are associated with professional satisfaction. At the individual level, years of experience seems to be associated with higher professional satisfaction.

Identifying influence of perceived quality and satisfaction on the utilization status of the community clinic services; Bangladesh context

Bangladesh is one among the few countries of the world that provides free medical services at the community level through various public health facilities. It is now evident that, clients' perceived quality of services and their expectations of service standards affect health service utilization to a great extent. The aim of the study was to develop and validate the measures for perception and satisfaction of primary health care quality in Bangladesh context and to identify their aspects on the utilization status of the Community Clinic (CC) services. This mixed method cross sectional survey was conducted from January to June 2012, in the catchment area of 12 Community Clinics (CCs). Since most of the outcome indicators focus mainly on women and children, women having children less than two years of age were randomly assigned and interviewed for the study purpose. Data for the development of perceived service quality and satisfaction tools were collected through Focus Group Discussion (FGD), key informants interview and data for measuring the utilization status were collected by an interviewer administered pretested semi-structured questionnaire. About 95% of the respondents were Muslims and 5% were Hindus. The average age of the respondents was 23.38 (SD ± 4.15) years and almost all of them are home makers. The average monthly expenditure of their family was 7462.92 (SD ± 2545) BDT equivalent to 95 (SD ± 32) US$. To measure lay peoples' perception and satisfaction regarding primary health care service quality two scales e.g. Slim Haddad's 20-item scale for measuring perceived quality of primary health care services (PQPCS) validated in Guinea and Burkina Fuso and primary care satisfaction survey for women (PCSSW) developed by Scholle and colleagues 2004; is a 24-item survey tool validated in Turkey were chosen as a reference tools. Based on those, two psychometric research instruments; 24 items PQPCS scale (chronbach's α =0.89) and 22-items Community Clinic Service Satisfaction (CCSS) scale (chronbach's α = 0.97), were constructed and validated for measuring perceived service quality and satisfaction in Bangladesh context. This study showed mothers with preprimary education [(χ2 = 4.20, p = 0.04), AOR with 95% CI = 1.89 (1.03, 3.53)] utilized the limited curative care services more than educated mothers. On the contrary, higher income families [for income group 5000-10,000 BDT χ2 = 8.83, p = 0.003 and AOR with 95% CI = 0.37(0.19, 0.71)] and [for income group above 10,000 BDT χ2 = 5.02, p = 0.025 and AOR with 95% CI = 0.40 (0.18, 0.89)] and families having cultivable lands [for 5-10 decimal group χ2 = 5.51, p = 0.19, and AOR with 95% CI = 0.56 (0.35, 0.91)] and [for > 10 decimal group χ2 = 6.70, p = 0.010, and AOR with 95% CI = 0.50 (0.29, 0.84)] utilized the limited curative care services less than their poorer and landless counterpart. The same relationship was observed in case of health education and Antenatal Care (ANC) and Postnatal Care (PNC) services. Women who lived in their own residence used health education services more frequently than those who lived in a rental house [χ2 = 24.00, p = 0.000 and AOR with 95% CI = 1.21, (1.12, 1.30)] and they also increasingly used maternal and child health services χ2 = 27.49, p = 0.000 and AOR with 95% CI 1.61, (1.35, 1.93)]. Perceptions concerning skill and competence of the health care provider [χ2 = 16.90, p = 0.000 and AOR with 95% CI = 1.14, (1.07, 1.22)] and satisfaction indicating interpersonal communication and attitude of the care provider [χ2 = 7.07, p = 0.008 AOR with 95% CI = 1.08, (1.02, 1.15)] were found significant predictors for limited curative care service utilization of CC. Perception related to the quality of management, administration, physical environment of the service point and satisfaction addressing health promotion and women health issues also played significant role on CC's services utilization. Besides parental education and income, client's perception and satisfaction played significant role in CC service utilization. Provider's perception of service quality should be studied. The study findings will enable policy-makers .to improve quality of primary health care services, realizing providers' and patients' ideas of CC service quality.