Patient satisfaction with medical consultations among adults attending Mulago hospital assessment centre

Impact of patient-centered communication on patient satisfaction scores in patients with chronic life-limiting illnesses: an experience from Kenya

Background

Patient satisfaction remains a key area of interest worldwide; utilizing a patient-centered communication approach, particularly with patients with chronic life-limiting illnesses may be one way to achieve this. However, there is a dearth of empirical information on the effect of patient-centered communication strategies in patients with chronic life-limiting illnesses in Kenya on patient satisfaction.

Objectives

The objective of this study was to assess the impact of patient-centered communication on patient satisfaction.

Methods

We conducted our study at a tertiary teaching and referral hospital in Kenya. We utilized a quasi-experimental pre-test post-test study design and engaged 301 adult medical in-patients with chronic life limiting conditions. We randomized them to receive patient-centered communication, and evaluated the change in patient satisfaction scores using an adapted Medical Interview satisfaction Scale 21 (MISS 21).

Results

Two hundred and seventy-eight out of 301 recruited participants completed the study. The baseline characteristics of the participants randomized to the control and intervention arms were similar. Although both the control and intervention arms had a decline in the mean difference scores, the intervention arm recorded a larger decline, -15.04 (-20.6, -9.47) compared to -7.87 (-13.63, -2.12), with a statistically significant mean difference between the two groups at -7.16 (-9.67, -4.46). Participants in the intervention arm were less likely to: understand the cause of their illness (p < 0.001), understand aspects of their illness (p < 0.001), understand the management plan (p < 0.001), receive all the relevant information on their health (p < 0.001), and to receive adequate self-care information (p < 0.001). They were also less likely to acknowledge a good interpersonal relationship with the healthcare providers (p < 0.001), to feel comfortable discussing private issues (p < 0.004), and to feel that the consultation time was adequate (p < 0.001).

Conclusion and recommendation

Contrary to expectation, patient-centered communication did not result in improved patient satisfaction scores. Further studies can evaluate factors affecting and explaining this relationship and assess intermediate and long-term effects of provision of a patient-centered communication in diverse global contexts.

Doctor Attributes That Patients Desire during Consultation: The Perspectives of Doctors and Patients in Primary Health Care in Botswana

Doctor attributes contribute significantly to the quality of the doctor–patient relationship, consultation, patient satisfaction, and treatment outcomes. However, there is a paucity of research on this topic in many settings in developing countries, including Botswana, where accessibility and availability of care itself are a challenge. The study examined doctor attributes that patients in Botswana desire from the perspectives of doctors and patients in selected public clinics located in four health districts of Botswana. We used a qualitative design and conducted face-to-face interviews with 32 adult patients and 17 doctors selected through the purposive sampling technique. Interviews were audio-recorded and transcribed. Data analysis followed the six steps of qualitative thematic data analysis. We found both discordance and congruence between the doctors and patients on key attributes that patients desire in a doctor during consultation. Both agreed that effective communication and listening skills were key desirable doctor attributes that improve the doctor–patient relationship. Conducting the consultation in the language of the patients enhances effective communication. Doctors cited clinical expertise and competence as key desirable doctor attributes, whereas patients cited interpersonal and social attributes including kindness, empathy, and respect as key doctor attributes that increase trust in the doctor. However, patients expected the doctor to have clinical knowledge, which they perceived as essential to improve doctor–patient interaction and health outcomes. The findings highlight a need to enhance the interpersonal and communication skills of doctors to improve the quality of doctor–patient interactions. To optimise and enhance the consultation, continuing professional development should be adopted as a strategy to improve the communication and interpersonal skills of doctors.

Development of a video-observation method for examining doctors' clinical and interpersonal skills in a hospital outpatient clinic in Ibadan, Oyo State, Nigeria

BACKGROUND

Improving the quality of primary healthcare provision is a key goal in low-and middle-income countries (LMICs). However, to develop effective quality improvement interventions, we first need to be able to accurately measure the quality of care. The methods most commonly used to measure the technical quality of care all have some key limitations in LMICs settings. Video-observation is appealing but has not yet been used in this context. We examine preliminary feasibility and acceptability of video-observation for assessing physician quality in a hospital outpatients' department in Nigeria. We also develop measurement procedures and examine measurement characteristics.

METHODS

Cross-sectional study at a large tertiary care hospital in Ibadan, Nigeria. Consecutive physician-patient consultations with adults and children under five seeking outpatient care were video-recorded. We also conducted brief interviews with participating physicians to gain feedback on our approach. Video-recordings were double-coded by two medically trained researchers, independent of the study team and each other, using an explicit checklist of key processes of care that we developed, from which we derived a process quality score. We also elicited a global quality rating from reviewers.

RESULTS

We analysed 142 physician-patient consultations. The median process score given by both coders was 100 %. The modal overall rating category was 'above standard' (or 4 on a scale of 1-5). Coders agreed on which rating to assign only 44 % of the time (weighted Cohen's kappa = 0.26). We found in three-level hierarchical modelling that the majority of variance in process scores was explained by coder disagreement. A very high correlation of 0.90 was found between the global quality rating and process quality score across all encounters. Participating physicians liked our approach, despite initial reservations about being observed.

CONCLUSIONS

Video-observation is feasible and acceptable in this setting, and the quality of consultations was high. However, we found that rater agreement is low but comparable to other modalities that involve expert clinician judgements about quality of care including in-person direct observation and case note review. We suggest ways to improve scoring consistency including careful rater selection and improved design of the measurement procedure for the process score.

Evaluating the validity and reliability of the Medical Interview Satisfaction Scale in South African primary care consultations

BACKGROUND

Effective primary care is vital for improving health outcomes. Patient-centred consultations are important and one way of assessing this is to evaluate patient satisfaction. The Medical Interview Satisfaction Scale (MISS) has not been used in South Africa.

AIM

To test validity and reliability of the MISS and evaluate patient satisfaction with consultations.

SETTING

Primary care facilities in the Helderberg sub-district, South Africa.

METHODS

The MISS tool was adapted and validated by a panel of experts. The internal consistency was evaluated on 150 consultations. The level of patient satisfaction on 23 items, in consultations by nurses and doctors, was measured. Respondents indicated agreement with each item on a scale (1 = very strongly disagree, 7 = very strongly agree).

RESULTS

The wording of the items were adapted and translated into Afrikaans and Xhosa. There was good overall internal consistency (Cronbach alpha 0.889), but not in all subscales. Patients were most satisfied with rapport (Median score 6.2 (IQR 5.3-5.9)) and understanding of their concerns, fears and beliefs (5.7 (IQR 5.1-6.3)). They were less satisfied with the ability to foster an acceptable management plan (5.5 (IQR 4.5-6.5)) and with accuracy of information (5.0 (IQR 4.2-5.8)). Scores for nurses and doctors were not significantly different.

CONCLUSION

Further work is needed to improve the reliability of MISS subscales in the South African context and the best internal consistency was found with 21 items. Patients showed high levels of satisfaction with primary care consultations, although other studies suggest this may reflect low expectations rather than high quality consultations.

Patients satisfaction with consultation at primary health care centers in Abha City, Saudi Arabia

Aim of Study

This study aims to assess patients satisfaction regarding consultations at the General Clinics of primary health-care (PHC) centers, in Abha City.

Patients and Methods

This cross-sectional study design was conduct among adult patients attending training PHC centers in Abha City, Saudi Arabia during September 2016. The researcher designed a data collection sheet that comprised patients' personal characteristics and the consultation satisfaction questionnaire, which contained 18 questions within four dimensions, i.e., general satisfaction; professional care; depth of relationship; and length of consultation.

Results

The total number of the patient included in this study was 400, more than half of them were male (54%). Most of them were Saudi (90%), married (79%), and educated (93%). More than half 53% were dissatisfied, 20% were satisfied with consultation while 27% were natural. The most important factor affecting satisfaction with consultation was age, education level and income.

Conclusions

Patients satisfaction toward their consultation experience at general clinics of training PHC centers in Abha City was suboptimal. Total consultation scores differ significantly according to their age groups, education level, and monthly income.

Recommendations

PHC physicians should be more concerned with improving medical consultations provided to their patients. Continuing medical education and training of PHC physicians about provision of medical consultation.