(1)Head of Primary Health Care at Capital Health Region,
(2) Sawaber Health Center,
(3) Preventive Health Department,
(4) Head of Preventive Health Department, Primary Care
Capital Health Region, Ministry of Health, Kuwait

Correspondence:
Ibrahim Al-Eisa, (R.C.G.P.)
P.O. Box : 13061 Kaifan Postal Code:71951

Tel: (965)2541428
Fax: (965)2552358
E-mail: magedradwan@hotmail.com

ABSTRACT

Objective: To evaluate patients' satisfaction with Primary Health Care Centers' (PHCCs) services at Capital Health Region.

Subjects and Methods: A cross sectional survey using an Arabic language questionnaire was conducted between January and August 2003. The questionnaire included socio-demographic characteristics as well as the overall and differential satisfaction with the different aspects of services in the PHCC at Capital Health Region rated from 1- 5 points ranged from very dissatisfied through to very satisfied, the higher the score the higher the satisfaction. A convenient sample of 1250 patients attending the PHCC aged 18 years and above was included in the study.

Results: The response rate of completed questionnaires was 82.8%. Female subjects constituted 52.2% of all participants. More than two-thirds of the subjects were married, about 79.2% were Kuwaitis, 34% were 31-40 years of age, more than one-third of the subjects were clerks and 23.6% completed secondary school. The mean score of overall satisfaction was 4.59 out of a maximum of 5 points. The highest satisfaction was for pharmacy (4.62 mean points) and the lowest for buildings (3.95 mean points). Subjects aged above 50 years showed the highest overall and differential satisfaction. Male subjects and those who completed primary school showed the highest overall satisfaction (4.63 mean points and 4.68 mean points respectively). Other socio-demographic characteristics were not significantly related to overall satisfaction scores.

Conclusion: There is a growing interest in many countries in assessing and assuring quality of health care. It is also being increasingly recognised that consumer satisfaction should be taken in to account as part of the assessment of quality of care. The results of our study showed that although the overall satisfaction was high, some aspects of the services indicated some degree of dissatisfaction. Also, some physicians' service items need suggestions and corrective intervention. Female and young patients appear to need more attention.

Key words: patient, satisfaction, services, primary health care, Kuwait.

INTRODUCTION

The World Health Organization declaration of Alma Ata [1] stated that primary health care (PHC) was the key to achieving ' Health for all by the year 2000' and that it should be an integral part of a country's health care scheme. Also, primary care is seen as an increasingly important substitute for hospital care with a growing number of elderly in the population and greater emphasis on patient autonomy and independence [2]. In recent years increasing emphasis has been placed upon issues concerning the evaluation of health care [3]. Thus, it has been argued that evaluation of health care should not only focus upon measures of clinical effectiveness and economics, but also upon measures of social acceptability to the consumers of health care [2]. The strategies of PHCC in Kuwait include expanding PHCC facilities and strengthening co-ordination between primary, secondary and tertiary health care. PHCCs are staffed by health teams including Physicians, nurses, pharmacy, laboratory technicians, X-ray services and administrative workers.

Patient satisfaction is generally considered as the extent to which the patients feel that their needs and expectations are being met by the services provided[4]. Patient satisfaction predicts both compliances [5] and utilisation [6] and may even be related to improved health [7]. It also contributes to the atmosphere prevailing in a PHCC [7,8]. It is associated with continuity of care [3], the doctor's communication skills [9], the degree of his or her patient centeredness [10] and the congruence between intervention desired and that received by the patient [11] . Other factors influencing satisfaction with medical care include confidence in the system and a positive outlook on life in general[12] . Finally, satisfaction is the judgment of the patient on the care that has been provided [13]. The physician remains a key element in patient satisfaction [14].

Objectives of our study were to evaluate patients' satisfaction with services provided by PHCCs at Capital Health Region and to determine the relationships between overall and differential satisfaction and patients' socio-demographic characteristics (age, nationality, sex, marital status, job and education level).

SUBJECTS AND METHODS

A cross- sectional study of a convenient sample of consecutive patients who attended PHC centers at Capital Health Region during January and August 2003. A self-administered Arabic language questionnaire was used for patients aged 18 years and above. Patients were excluded from the study if they did not speak Arabic, were severely ill and under 18 years of age. The questionnaire consisted of socio-demographic characteristics as well as the overall and differential satisfaction with the different aspects of services in the PHC centers rated from 1-5 points ranged from very dissatisfied through to very satisfied, the higher the score the higher the satisfaction. Subjects were informed about the study objectives and procedures and that data collected would be used only for the stated research purpose.

The data collected was manually checked for completeness, then was coded and fed in to an IBM personal computer.

The Statistical Package for Social Sciences (SPSS) software window version 10.0 was used for data analysis.

RESULTS

Out of 1250 questionnaires were distributed, and 1035 were completed making a response rate of 82.8%. Of all participants, 495 (47.8%) were males, 429 (41.4%) were clerks and 352 (34%) were in the age group of 31-40 years old. The great majority of subjects were married 715 (69.1%) and were Kuwaitis 820 (79.2%). Less than one-third of the subjects completed secondary school (Table 1). The majority of the subjects were very satisfied with PHCC services in general 661 (63.9%). The overall satisfaction score with PHCC services in general was 4.59 out of a maximum of 5 points (99.6%). Our data showed that males were significantly more satisfied than females (x2 = 5.2, df= 1, P<0.023). Significantly the higher the age the higher patients' satisfaction. 73% of subjects aged above 50 years were highly satisfied (x2 = 12.8, df= 1, P< 0.001). There was no significant difference in overall patients' satisfaction for nationality, marital status and job.

Table 2 shows the satisfaction scores for each service item as assessed by subjects for building, administrative workers, physicians, nurses, pharmacy, laboratory technicians and X-ray services. The mean score for all these services was 4.43 points (88.6%). The highest satisfaction score was for pharmacy (4.62 mean points) and the lowest was for building (3.98 mean points). Satisfaction scores were significantly related to age, for building, administrative workers, physicians and pharmacy services, where older subjects scored the highest scores.

Illiterate subjects also showed significantly higher satisfaction with all items of PHCC services. There was no significant difference between patients' satisfaction of different items of PHCC services and sex except for administrative workers, where males showed higher satisfaction than females. Marital status and nationality were not significantly related to satisfaction of different PHCC services items.

Table 3 shows patients' satisfaction scores with different aspects of physicians' services at PHCC. The majority of subjects were highly satisfied with different aspects of physicians' services, with the highest score being for physicians' relationship with patients and the lowest for physicians' medical skills (4.56 mean points and 3.77 mean points respectively). Satisfaction scores were significantly related to age for all aspect of physicians' services except for attention of patient's complaints and physicians' advice. Older subjects scored the highest satisfaction score except for physicians' skills, where young subjects scored the highest score. Nationality, sex and marital status were not significantly related to satisfaction of different items of physicians' services. There was no significant difference between patients' satisfaction of different items of physicians' services and job except for physicians' skills, where students showed the highest satisfaction. Illiterate subjects showed significantly higher satisfaction with all item of physicians' services except for physicians' skills where the highest satisfaction was among post graduate subjects.

DISCUSSION

A survey of 1035 patients attending PHCC at Capital Health Region showed that the overall patients' satisfaction was relatively high. However, Al-Faris et al [15] showed that the overall patients' satisfaction with Riyadh health centers was 90%. Our data showed a significant association between overall satisfaction and gender, where females found to be less satisfied than males. This was consistence with other study done in other countries [16]. This can be attributed to the fact that females represented their families more often than males, a factor that could have biased the results, since their satisfaction levels were generally low. The literature appears to support this in that older respondents expected less information from their doctor whereas younger patients were less satisfied with issues surrounding the consultation in the primary care setting. Younger patients were also less likely to comply with prescriptions or medical advice [17]. Similar to our study, Babic-Banaszak et al [18] reported that less educated patients were generally more satisfied, since they are less demanding.

The overall satisfaction as reported by subjects was 99.6%, but when subjects were asked about satisfaction for each service item individually the mean overall satisfaction dropped to 88.6%. This is consistent with the study done by Williams SJ et al [19] which showed that general levels of consumer satisfaction are high, however questions of a more detailed and specific nature reveal greater levels of expressed dissatisfaction. Therefore health administrators and planners should not depend only on overall assessment of satisfaction. Each service needs to be assessed individually using the different service items and components involved. Our study showed that pharmacy services scored the highest satisfaction scored, in contrast to other study done in Saudi Arabia which showed that some aspects of pharmacy services scored low satisfaction scores because of the problems faced by patients including insufficient drug supply and lack of information about drug interactions and side effects [15]. The poor satisfaction with buildings in our study may be due to the fact that most of PHCCs buildings were old and the rebuilding is going on. Low satisfaction was scored for some physicians' services particularly for physicians' medical skills. The majority of physicians working at PHCC in Kuwait were of Arabic nationality and the majority of patients trust non-Arabic physicians, where they believe that non-Arabic physicians have more skills than Arabic physicians. On the other hand, high satisfaction was scored for physician's relationship with patients since interpersonal skills of the general practitioner may be one of the primary levers of the therapeutic process [2] .

CONCLUSION
Patient satisfaction is an increasingly important issue, both in evaluation and the shaping of health care. In addition, patient evaluations can help to educate medical staff about their achievements as well as their failure, assisting them to be more responsive to their patients' needs. Therefore, patient satisfaction surveys should be carried out routinely in all aspect of health care to improve the quality of services. Survey results can guide policy makers in introducing changes as competition between health care providers increase. The results of our study showed that although the overall satisfaction was high, some aspect of the services showed some degree of dissatisfaction. Also, some physicians' service items need suggestions and corrective intervention. Female and young patients appear to need more attention.

TABLE 1 Association between socio-demographic characteristics and overall patient satisfaction

TABLE 2 Patients' satisfaction score with different aspects of primary health care services

TABLE 3 Patients' satisfaction score with physician's services

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