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Tabche C, Raheem M, Alolaqi A, Rawaf S. Effect of electronic health records on doctor-patient relationship in Arabian gulf countries: a systematic review. Front Digit Health 2023; 5:1252227. [PMID: 37877127 PMCID: PMC10593471 DOI: 10.3389/fdgth.2023.1252227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/22/2023] [Indexed: 10/26/2023] Open
Abstract
Background The electronic health record (EHR) has been widely implemented internationally as a tool to improve health and healthcare delivery. However, EHR implementation has been comparatively slow amongst hospitals in the Arabian Gulf countries. This gradual uptake may be linked to prevailing opinions amongst medical practitioners. Until now, no systematic review has been conducted to identify the impact of EHRs on doctor-patient relationships and attitudes in the Arabian Gulf countries. Objective To understand the impact of EHR use on patient-doctor relationships and communication in the Arabian Gulf countries. Design A systematic review of English language publications was performed using PRISMA chart guidelines between 1990 and 2023. Methods Electronic database search (Ovid MEDLINE, Global Health, HMIC, EMRIM, and PsycINFO) and reference searching restricted to the six Arabian Gulf countries only. MeSH terms and keywords related to electronic health records, doctor-patient communication, and relationship were used. Newcastle-Ottawa Scale (NOS) quality assessment was performed. Results 18 studies fulfilled the criteria to be included in the systematic review. They were published between 1992 and 2023. Overall, a positive impact of EHR uptake was reported within the Gulf countries studied. This included improvement in the quality and performance of physicians, as well as improved accuracy in monitoring patient health. On the other hand, a notable negative impact was a general perception of physician attention shifted away from the patients themselves and towards data entry tasks (e.g., details of the patients and their education at the time of the consultation). Conclusion The implementation of EHR systems is beneficial for effective care delivery by doctors in Gulf countries despite some patients' perception of decreased attention. The use of EHR assists doctors with recording patient details, including medication and treatment procedures, as well as their outcomes. Based on this study, the authors conclude that widespread EHR implementation is highly recommended, yet specific training should be provided, and the subsequent effect on adoption rates by all users must be evaluated (particularly physicians). The COVID-19 Pandemic showed the great value of EHR in accessing information and consulting patients remotely.
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Alhajri SM, Aljehani NM, El Dalatony MM, Alsuwayt SS, Alhumaidany TM, Aldossary MS. Patients' Satisfaction With the Quality of Services at Primary Healthcare Centers in Saudi Arabia. Cureus 2023; 15:e45066. [PMID: 37842386 PMCID: PMC10567608 DOI: 10.7759/cureus.45066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 10/17/2023] Open
Abstract
BACKGROUND Patients' satisfaction is an essential indicator used to measure the quality of healthcare services. The evaluation of patients' satisfaction with primary healthcare center (PHC) visits is therefore essential when it comes to assessing the quality of healthcare services provided. AIM To assess patients' overall satisfaction with the quality of services provided at PHCs in different regions of Saudi Arabia. METHODS A retrospective cross-sectional study was conducted using secondary data collected from 2,390 PHCs in different regions of Saudi Arabia. Data were collected by the Patient Experience Measurement Program in the Ministry of Health (MOH) using the Press Ganey Survey from January 2022 to December 2022. The Press Ganey Survey is a standardized tool used by the Saudi MOH to assess patients' satisfaction with the health services provided in different specialties and healthcare facilities. The assessment tool (Press Ganey survey) involves six domains (Access, Moving through, Nurse, Care provider, Personal issue, and Overall assessment). The data were tabulated and analyzed using the Statistical Package for the Social Sciences (SPSS). RESULTS In total, there were 536,406 study participants, with their mean age being 28.7±21.1. The overall patients' satisfaction score was 4.2 out of 5 (83.8%). Male participants reported more satisfaction with PHC services than did females (86.6%, 81%), respectively. The domain with the highest patients' satisfaction scores was that of the Care provider (84.8%), while the domain with the lowest rating was Moving through (82.8%). CONCLUSION This baseline study found that patients were generally satisfied, with the highest levels of satisfaction with their care providers, highlighting the crucial role of professionals in the patient experience. Further research is recommended to give a more in-depth analysis and thus highlight additional correlating and predicted elements of patients' satisfaction with PHC treatments in Saudi Arabia.
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Affiliation(s)
- Shahad M Alhajri
- Research and Studies General Department, Ministry of Health, Riyadh, SAU
| | - Najla M Aljehani
- Public Health Department, College of Health Sciences, The Saudi Electronic University, Riyadh, SAU
| | - Mervat M El Dalatony
- Research and Studies General Department, Ministry of Health, Riyadh, SAU
- Public Health and Community Medicine Department, Faculty of Medicine, Menoufia University, Shebin Elkom, EGY
| | - Saleh S Alsuwayt
- Family Medicine Department, King Saud Medical City, Ministry of Health, Riyadh, SAU
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Alhenaidi A, Al Nadabi W, Al‐Haqan A, Kelender H. Patient satisfaction of primary care services in Gulf Cooperation Council Countries: A scoping review. J Gen Fam Med 2023; 24:279-287. [PMID: 37727620 PMCID: PMC10506392 DOI: 10.1002/jgf2.640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/08/2023] [Accepted: 07/03/2023] [Indexed: 09/21/2023] Open
Abstract
Patient satisfaction (PS) is an essential element in evaluating and improving healthcare systems. Few studies have gathered evidence about patient satisfaction with primary care (PC) services in the Gulf Cooperation Council (GCC) countries. Therefore, it is important to review the existing literature examining PS with PC services in the GCC countries. This scoping review was conducted for primary data studies published between 2000 to March 2022. Out of 4461 screened articles, 37 met the inclusion criteria. Most studies were conducted in Saudi Arabia and were of cross sectional methodology. PS with primary care in the GCC is affected by multiple provider-related and patient-related factors and users are generally satisfied with the service provided. Future research should focus on the effects of the factors that were not explored and validate the existing results.
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Affiliation(s)
- Abdulaziz Alhenaidi
- Directorate of Planning and MonitoringMinistry of HealthSafatKuwait
- School of Health and WellbeingUniversity of GlasgowGlasgowUK
| | | | - Asmaa Al‐Haqan
- Department of Pharmacy Practice, College of PharmacyKuwait UniversityKuwaitKuwait
| | - Hisham Kelender
- Directorate of Planning and MonitoringMinistry of HealthSafatKuwait
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Gandhi P A, Goel K, Gupta M, Singh A. Effect of digitization of medical case files on doctor patient relationship in an Out Patient Department setting of Northern India: A comparative study. INDIAN JOURNAL OF COMMUNITY HEALTH 2022. [DOI: 10.47203/ijch.2022.v34i04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background: Digitization of health records and health delivery processes in health care settings may have an impact on the Patient-Physician communication, wait times, that affect the overall patient satisfaction with the health care services. Aim & Objective: We ascertained the effect of digitization of medical case files on the doctor patient relationship (DPR) domain of patient satisfaction at an urban primary health center in India. Settings and Design: Comparative, cross-sectional study in primary health centres. Methods and Material: The patient satisfaction was compared between the patients attending the Public Health Dispensary (PHD) that uses digitized medical case file system and a Civil Dispensary (CD) which follows the conventional paper based medical records, using a Patient Satisfaction Questionnaire (PSQ). Statistical analysis used: Univariate analysis was done by chi-square test and adjusted analysis was done by multiple linear regression. Results: Patient satisfaction in DPR was found to be same between the digitized medical case files based and conventional OPD (p=0.453). Significantly higher overall patient satisfaction was reported in the conventional paper based OPD than the digitized OPD (p<0.001). Conclusions: Patient satisfaction towards the doctor-patient relationship (DPR) was same between paper based OPD and the digitized medical case files based OPD.
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Muacevic A, Adler JR, Alomar N, Almotreb L, Alkhofi A, Alsaleh Z, Alessa J, Alhabrati A, Alarbash A. Patient Satisfaction With Primary Healthcare Services in Al-Ahsa, Saudi Arabia. Cureus 2022; 14:e31478. [PMID: 36408313 PMCID: PMC9662087 DOI: 10.7759/cureus.31478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2022] [Indexed: 11/16/2022] Open
Abstract
Background Patient satisfaction is regarded as a valid and significant indicator of the quality of medical care delivered. Additionally, it has been shown to be linked to better health outcomes. The goal of the study is to assess patients' overall satisfaction regarding primary healthcare (PHC) services. Methodology In this cross‑sectional study conducted in Al-Ahsa, we used the General Practice Assessment Questionnaire and its four subscales with standard cutoffs. A sample of 287 patients was conveniently selected from PHC centers. Results A total of 287 patients were included. Patients' ages ranged from 18 to more than 65 years with a mean age of 32.5 ± 13.9 years old. In total, 177 (61.7%) patients were female, and 225 (78.4%) reviewed the physician for their own problems. A total of 95 (33.1%) patients had chronic health problems. Overall, of the study patients, a total of 38 (13.2%) were highly satisfied regarding provided services, while 45 (15.7%) had a low overall satisfaction level. In general, the mean score (%) of patient satisfaction was 61.9 ± 11.8. Conclusions The level of satisfaction with the services provided by PHC centers in Al-Ahsa is moderate. The level of satisfaction concerning some services provided by PHC centers differs significantly according to age, gender, presence of chronic health problems, and employment status.
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Ibrahim AA, Ahmad Zamzuri M‘AI, Ismail R, Ariffin AH, Ismail A, Muhamad Hasani MH, Abdul Manaf MR. The role of electronic medical records in improving health care quality: A quasi-experimental study. Medicine (Baltimore) 2022; 101:e29627. [PMID: 35905245 PMCID: PMC9333510 DOI: 10.1097/md.0000000000029627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The Teleprimary Care-Oral Health Clinical Information System (TPC-OHCIS) is an updated electronic medical record (EMR) that has been applied in Malaysian primary healthcare. Recognizing the level of patient satisfaction following EMR implementation is crucial for assessing the performance of health care services. Hence, the main objective of this study was to compare the level of patient satisfaction between EMR-based clinics and paper-based clinics. The study was a quasi-experimental design that used a control group and was conducted among patients in 14 public primary healthcare facilities in the Seremban district of Malaysia from May 10, to June 30, 2021. Patient satisfaction was assessed using the validated Short-Form Patient Satisfaction Questionnaire, which consisted of 7 subscales. All data were analyzed using the IBM Statistical Package for Social Sciences version 21. A total of 321 patients consented to participate in this study, and 48.9% of them were from EMR clinics. The mean score for the communication subscale was the highest at 4.08 and 3.96 at EMR-adopted clinics and paper-based record clinics. There were significant differences in general satisfaction and communication subscales, with higher patient satisfaction found in clinics using EMR. With the utilization of EMR, patient satisfaction and communication in delivering healthcare services have improved.
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Affiliation(s)
- Ariff Azfarahim Ibrahim
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Fakulti Perubatan UKM, Cheras, Kuala Lumpur, Malaysia
| | - Mohd ‘Ammar Ihsan Ahmad Zamzuri
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Fakulti Perubatan UKM, Cheras, Kuala Lumpur, Malaysia
| | - Rosnah Ismail
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Fakulti Perubatan UKM, Cheras, Kuala Lumpur, Malaysia
| | - Ahmad Husni Ariffin
- Family Health Development Division, Seremban District Health Office, Ministry of Health, Seremban, Negeri Sembilan, Malaysia
| | - Aniza Ismail
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Fakulti Perubatan UKM, Cheras, Kuala Lumpur, Malaysia
| | - Muhamad Hazizi Muhamad Hasani
- Family Health Development Division, Seremban District Health Office, Ministry of Health, Seremban, Negeri Sembilan, Malaysia
| | - Mohd Rizal Abdul Manaf
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Fakulti Perubatan UKM, Cheras, Kuala Lumpur, Malaysia
- *Correspondence: Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, 6th Floor, Blok Praklinikal, Fakulti Perubatan UKM, Cheras, Kuala Lumpur 56000, Malaysia (e-mail: )
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Jaber MJ, Al-Bashaireh AM, Alqudah OM, Khraisat OM, Hamdan KM, AlTmaizy HM, Lalithabai DS, Allari RS. Nurses’ Views on the Use, Quality, and Satisfaction with Electronic Medical Record in the Outpatient Department at a Tertiary Hospital. Open Nurs J 2021. [DOI: 10.2174/1874434602115010254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Many nurses perceive that the Electronic Medical Record (EMR) reduces the workload, improves the quality of documentation, and improves safety and patient care. However, other nurses reported that the system and environment of healthcare might impede EMR documentation at the bedside.
Objective:
The study aimed to describe the nurses' views of the use, quality, and satisfaction with EMR in daily practice in outpatient settings. Furthermore, the relationships among the use, quality, and user’s satisfaction of EMR were assessed in the study.
Methods:
The proposed study employed a cross-sectional, descriptive correlational design. Inclusion criteria were nurses willing to participate in the study, fluent in the English language, and have been working in the Outpatient Department for more than three months until the time of study implementation. A self-reported questionnaire with strong validity and reliability was used to assess nurses’ views of use, quality and satisfaction of EMR.
Results:
The response rate was 77.2% (170 out of 220), 91.2% of the participants were females. Results about the use of EMR have shown positive views ranging from 51.2% to 84.7%, with the lowest scores reported when to write nurse care worksheets (Kardex). For the quality of EMR, the results have shown positive views ranging from 70% to 87.6% with the lowest scores reported related to the EMR system problems and crashes, and for the user’s satisfaction, the results have shown positive views ranging from 76.5% to 87.1%. There were significant positive correlations between the three elements use, quality, and user’s satisfaction of EMR.
Conclusion:
Participants reported positive views in the domain of use, quality, and satisfaction with EMR. Furthermore, positive correlations were reported between the use, quality, and satisfaction domains of EMR.
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Peng D, Edwardes N, Granchi N, Reid J, Maddern G. The impact of computers on the surgical consultation. ANZ J Surg 2021; 91:1965-1967. [PMID: 34665494 DOI: 10.1111/ans.17008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 06/05/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Dangyi Peng
- School of Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Discipline of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - Nicholas Edwardes
- Discipline of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - Nelson Granchi
- Discipline of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - Jessica Reid
- Discipline of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - Guy Maddern
- Discipline of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
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Albagmi S. The effectiveness of EMR implementation regarding reducing documentation errors and waiting time for patients in outpatient clinics: a systematic review. F1000Res 2021; 10:514. [PMID: 35035887 PMCID: PMC8738966 DOI: 10.12688/f1000research.45039.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Electronic medical records (EMRs) refer to the digital copies of paper notes prepared in the physician’s office, outpatient clinics and other departments in health care institutes. EMRs are considered to be significant and preferable to paper records because they allow providers to keep accurate track of patient data and monitoring over time, thus reducing errors, and enhance overall health care quality. The aim of this systematic review was to highlight the significance of EMRs and the effectiveness of implementation regarding reducing documentation errors and waiting time for patients in outpatient clinics. Methods: PubMed, Central, Ovid, Scopus, Science Direct, Elsevier, Cochrane , WHO website and the McMaster University Health Evidence website from 2005-2020 were searched to identify studies that investigated the association between the EMR implementation and documentation error and waiting time for patients. A reviewer screened identified citations and extracted data according to the PRISMA guidelines and data was synthesized in a narrative manner. Results: After full text examination of the articles selected for this literature review, the major themes of relevance that were identified in the context of reducing documentation errors and waiting time for patients in outpatient clinic include: reduction of medical errors because of fewer documentation errors resulting from EMR implementation and reduction of waiting time for patients due to overall improvement of system workflow after use of EMRs. Conclusion: In summary of the reviewed evidence from published material, the implementation of an EMR system in any outpatient setting appears to reduce documentation errors (medication dose errors, issues of prescription errors). It was also seen that in many settings, waiting time for patients in outpatient clinics was reduced with EMR use, while in other settings it was not possible to determine if any significant improvement was seen in this aspect after EMR implementation.
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Affiliation(s)
- Salem Albagmi
- Department of Health Information Management, Prince Sultan Military College of Health Sciences, P.O. Box 33048, Dammam, 31448, Saudi Arabia
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Al-Kuwari MG, Al Abdulla S, Abdulla M, Mohammed AM, Haj Bakri A, Shaikhan F, Buhaddoud H. Qualitative Focus Group Study Examining Perceptions of the Community's Important Health Issues, Health Care Needs and Perceived Barriers to Access Among Arabic Speaking Primary Care Clients in the State of Qatar. J Multidiscip Healthc 2021; 14:961-971. [PMID: 33953565 PMCID: PMC8090979 DOI: 10.2147/jmdh.s288194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/21/2020] [Indexed: 12/27/2022] Open
Abstract
Objective This study is a part of the Primary Health Care Corporation’s (PHCC) Health Needs Assessment (HNA) Initiative. It focuses on identifying perceptions of Arabic speaking primary care clients regarding community’s major health issues, their experiences in utilizing health services, and the barriers that limit their access to health care in the State of Qatar. Study Setting and Design A total of 10 focus groups sessions were conducted at different PHCC’s health centers between October of 2019 and March of 2020. Sessions were distributed to cover all PHCC’s three geographical regions. Data were analyzed using thematic analysis. Participants A total of 89 adult Arabic speaking individuals were recruited. Participants included were in the age groups (18–69), native Arabic speaker, and registered at one of the PHCC’s health centers with a valid health card at time of recruitment. Results Areas investigated included perceptions of the community’s health issues, needed health services, and perceived barriers to health care. Priority health issues identified were chronic non-communicable diseases, mental health, timely access to care, cultural competency of delivered services, and integration and coordination across health care settings and sectors. Participants were able to identify socioeconomic and environmental factors such as the need for health and wellness interventions at schools that affects the health of the individual and the community. The importance of raising the community’s awareness about health-related issues and availability of health services was highlighted by study participants. Conclusion Collecting qualitative data provides an opportunity to examine people’s perceptions, and motivations and engage the whole community. This process is very important for strategic planning of health services. The study attempts to fill the knowledge gap and should be linked to health policy and the development of socially and culturally appropriate health programs.
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Affiliation(s)
| | | | - Maha Abdulla
- Strategy Planning and Health Intelligence, Primary Health Care Corporation, Doha, Qatar
| | - Azza Mustafa Mohammed
- Strategy Planning and Health Intelligence, Primary Health Care Corporation, Doha, Qatar
| | - Ahmad Haj Bakri
- Strategy Planning and Health Intelligence, Primary Health Care Corporation, Doha, Qatar
| | - Fahad Shaikhan
- Preventative Health - Health Protection, Primary Health Care Corporation, Doha, Qatar
| | - Hanan Buhaddoud
- Strategy Planning and Health Intelligence, Primary Health Care Corporation, Doha, Qatar
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Shayan M, Safi S, Karimi S, Yaseri M. Patient Satisfaction of Intravitreal Bevacizumab Injection Services at a Referral Center. J Curr Ophthalmol 2021; 33:41-47. [PMID: 34084956 PMCID: PMC8102940 DOI: 10.4103/joco.joco_116_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 06/19/2020] [Accepted: 07/11/2020] [Indexed: 12/02/2022] Open
Abstract
Purpose: To evaluate the patient satisfaction of intravitreal bevacizumab (IVB) injection services for ocular complications of diabetes mellitus (DM) at a referral center. Methods: Patients with diabetic macular edema (DME) and diabetic retinopathy (DR) who had undergone IVB injections between March and September 2018 were interviewed by telephone using two questionnaires. First, demographic information, medical history, and the Patient Satisfaction Questionnaire Short Form (PSQ-18) 5-point scale were collected. Then, the Retinopathy Treatment Satisfaction Questionnaire (RetTSQ) 7-point scale was completed. Total scores are presented on a 100-point scale, with 100 indicating complete satisfaction. Results: Two hundred and fifty patients (145 with DME and 105 with DR) were interviewed (mean age: 61 ± 10 years; male-to-female ratio: 1:1.5). The response rate was 96%. Twenty-one patients had only one injection. Two hundred and forty-eight (99.2%) patients had insurance. The mean number of total injections was 12.2 ± 11.5. Seventy (28%), forty-seven (18.8%), sixty-one (24.4%), and seventy-two (28.8%) patients underwent IVB treatment for <6 months, between 7 and 12 months, between 13 and 24 months, and >25 months, respectively. The mean total and overall scores were 90.8 ± 22.5 (completely satisfied) and 88.7 ± 16.6 (completely satisfied) based on PSQ-18 and RetTSQ, respectively. Financial problems and appointment scheduling systems were the highest cases of dissatisfaction. Conclusion: The majority of patients were highly satisfied with IVB injections for the management of ocular complications of DM. The appointment taking procedure, waiting times, out-of-pocket expenses, and access to the hospital should be improved.
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Affiliation(s)
- Maryam Shayan
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sare Safi
- Ophthalmic Epidemiology Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeed Karimi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, Torfeh Medical Center, Shahid Beheshti University of Medicine Sciences, Tehran, Iran
| | - Mehdi Yaseri
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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