Patient Satisfaction in Primary Health Care Center Service

KingAbdulAzizUniversity

Faculty of Medicine and Allied Science

Nursing department ..

Patient Satisfaction ofPrimary Health Care Service .

Done by :

Maram Banakhar .

Sara Al-Khafee Salma Fllatah Hawaa Al- Abdul Aziz Faigah Al-Shibily.

Amirah Al-Amri

Supervised by :

Dr. Khairiah Nasser

Date : 28/5/2006

Abstract ..

Primary health care (PHC) can be considered the first contact between the patient and the health care system .It includes all the basic health care services to be provided to the community .Thus, PHC is essential for attaining an acceptable level of health for the public .It is also an integral and critical component of the health care system of any country..(Badran A .Al-Omar1999)

The study objectives are::

1- To assess the patients satisfaction level with the different aspects of primary health care services offered by Al- Balad Jeddah center.

2-To determine strategies for improvement as perceived by the patients .

3-To determine the effect of certain independent variables on the patients satisfaction level.

Methodology:

The study was carried out at (11-4- 2006) .

The data was collected by questionnaire method.

The study sample consistent of 27 patients to hom the questionnaires were disseminated randomly in Al- Balad primary health care center .

Their age varies from 20 to 60 year of both genders . (SPSS) software was used for statistical analysis .

Results:we found that the patient satisfaction about the different services offered by the primary health care center was as follows:

Al-bald region very large, also this area very crowded

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because, most of the people prefer to live in this area due to its position in the central region in Jeddah.

we found the patients didnot satisfy with number of doctors was due to large number of patients serviced by Al-Balad primary health care center.

This result represent all patients generally satisfy with nurses number ,education and nursing services but From asking the patient we saw that patientsare not satisfied from nurses listening skills in Al -Balad primary health care centre.

unsatisfied patient the about level ofinvestigation maybe due to poor machine technology of laboratoryinvestigation in the primary health care centers as general and not all the investigation method can be done in the primary health care center.

Patients generally satisfy with any way of appointment method. But complete satisfaction occur to patient when they take their appointment through telephone.

Most of patients want or wish to include home care to nursing services because this increase satisfaction of patient by saving their time and to decrease the cost for primary care center.

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Introduction ..

Primary health care (PHC)can be considered the first contact between the patient and the health care system .It includes all the basic health care services to be provided to the community .Thus, PHC is essential for attaining an acceptable level of health for the public .It is also an integral and critical component of the health care system of any country. Therefore, PHC services should be accessible and available to the entire population, regardless of their economic or social class and geographical location.(Badran A .Al-Omar1999)

The primary health care approach is a relatively new concept in the kingdom of Saudi Arabia .In 1978 , the kingdom of Saudi Arabia adopted the strategy of (health for all the year 2000) .By 1984 , the gradual implementation of a comprehensive plan of primary health care was already started . This step was accompanied by an increase in the number of health centers all over the kingdom.(S.A.AL-Shammari1991 )

It is defined by the world health organization as essential health care made universally accessible to individuals and families in the community by means acceptable to them through their full participation and at a cost the community and the country can afford

(Mansour A.1993and Al-Osimy. M 1993 )

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Services offered include health education , proper nutrition and food supply education, adequate safe water and basic sanitation , maternal and child health care , prevention and control of endemic diseases , treatment of common diseases , immunization and provision of essential drugs(WHO,1978)

The modern approach to healthcare seeks to engage the attention of both patients and the public in developing healthcare services and equity of access, but this is not easy to achieve, requiring time, commitment, political support and cultural change to overcome barriers to change

Patient's satisfaction regarding health care has often been considered as an objective of the health care .It has also been considered as one of the most important measures for evaluating the health care . For this reason, nursing staff play a main role in patient's satisfaction in primary health care centers ,which includes education, care giving and counselling , for this reason all of the nursing staff should be competent in practical skills, level of education, and interpersonal relation ship skills. Other factors that may affect patient satisfaction about primary health care center are medical services, laboratory services and pharmacological services. In our study we focused on nursing services factor.( Yahia MAQ1997)

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Satisfaction can be defined as the extent of an individual's experience compared with his or her expectations

Patients' satisfaction is related to the extent to which general health care needs and condition-specific needs are met.

Patient dissatisfaction occurs when the patients’ experience of the service falls short of expectations, while patients’ satisfaction occurs when the patients’ experience of the service exceeds their expectation .The importance of the differentiation is needed because though satisfaction is essential for keeping high loyalty of the patient, dissatisfaction is crucial because it may lead to unwanted patient future behaviour. Therefore ,a well designed, implemented and used patient satisfaction evaluation systems expected to help PHC improve both clinical and managerial activities (badran Al-omar2000)

The purpose of this study was to determine patients' satisfaction level with the primary health care services offred in Al -balaad Jeddah center.

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The objectives of the study were:

1- To assess the patients satisfaction level with different aspects of primary health care services in Al-Balad Jeddah center.

2-To determine strategies to improve the services as perceived by the patients.

3-To determine the effect of certain independent variables on the patients' satisfaction level

( Al-Mansour A. 1993and Al-Osimy M. 1993).

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Methodology ..

The study was carried out in the Al- Balad primary health care center in Jeddah city. During the month of April, forone day (11-4- 2006).The data was collected by questionnaire distribution method. The study sample was he total of 27 patients ,to hom the questionnaire was given randomly in Al- Balad primary health care center. Their age varies from20 to 60 years of both genders. The Items included in this questionnaire were socio-demographic data, nursing services data, medical services data, and general services data such as (pharmacological services, laboratory services and appointment services).

(SPSS) software was used for statistical analysis .

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Result ..

Some demographic characteristics of the studied population and their overall satisfaction with the health services provided were shown

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In studying the effect of Doctors number on the services offered by the center we fond that:

In the group of patients that found the services to be good 8 believe that the doctors number was enough for applying the needed services…. While 14 believe that the centre need to have more doctors!!

The other group of patients that found he services level to be bad 1 patient said that the doctors number was enough ,while 2 think that the center need to have more doctors to increase the level of services….

Tow of the patients did not comment about the level of services but they believe that the doctors number was not enough….

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In studiny the effect of investigations on the level of services offered:

in studying the effect of investigation level on the level of services offered we found that 6 of the patient which found the level of services to be good , found that the level of investigations were appropriate, while 16 of them found it to be bad…

And others believe that the level of services is bad with bad investigation level (3) patients& 1 no comment…

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Studying the effect of drugs on the level of services offered:

We found that 22 of the patient who found the level of services to be good 16 of the feel that the drug services good & 6 say that it is bad..

While 3 patients say that the level is bad & so is the drug services & 1 patient did not say any comment…..

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In studying the effect of the nurses number on the services offered:

We found that 22 patients believe that the level is good with 17 of them saying that the nurses number is enough,,, while disagree on that point….

3 patient complain that the level of services offered is bad with enough number of nurses…

One patient did not comment at all ….

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In studying the effect of nurses level on the patient satisfaction:

W found that 22 of the patients agreed about satisfaction with 14 of them satisfied about the level of nurses & 8 claime that their level is not good..

On the other hand,,,3 patients claim that both the level of the services & nurses where bad,,, one patient did not comment…

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In studying the effect of nurses services on the patient satisfaction:

We found that 22 total are satisfied by the services with 15 believing that the nurses are giving good services,, while 7 are not…

3 patients say that the services are not good… 1 claim that the nurses services are bad…..

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The effect of patient education on their satisfaction:

We found 3 patients who are not satisfied whom all from high level of education ( university),,, while 20 satisfied patients from different levels of education…& 4 who did not comment at all…

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In studying the patient preference for arranging the appointments by telephone or attendance & their effect on the level of services offered:

We found that 22 patients who believe the level of services wasgood…19 of them prefer to have their appointment by their attendance,, while 3patients prefer it by telephone…

3 patients believe that the services offered where bad

3 of them prefer their attendance & 1 didnot comment at all…

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In studying the effect of waiting on the level of services offered..

We found that 22 patient agreed that the level of services was good despite that 10 of them think that the waiting time is long… while 3 patients agreed that the services are bad & the waiting time is long…

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Does the nurses listening & explaining to the patients affect their services & patient satisfaction:

We found that 14 0f the patient believe that the nurses are listening & explaining to them that’s why the services are good,,, while 8 believe that the services & listening skills are deficient ..

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Would the nurses level affect their services offered & the patients satisfaction???

We found that 19 patients agreed that the level of services was good,, 11of them said that the nurses level was good, while 8 did not agree..

While8 patients said that the level of services was bad with4 of them saying that the nurses level was bad..

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Would the nurses relation to the patient affect their satisfaction??

We found that 19 patients agreed that the nurse-patient relation ship is an important factor which will improve the patients satisfaction….

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If the nurses are answering the patients questions would this improves the patients’ satisfaction..?

16 patients said that the nurses are answering their questions that’s why they believe that the services offered are good,,, while 8 patients said that the nurses are not answering their questions & therefore the level of services offered are bad…

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Is home care services are important in the nursing services:

Both groups.. those who said that the services where good..21 patient & those 6 who said that the services were bad ,1 didn’t comment all of them agree that they need hoe health care services…

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In studying the effect of crowdness in the center on the patients satisfaction:

22patients replay that the level offered was good,, 10 of them believe that the center is busy ,, while 12 did not …

On the other hand…3 patient said that the level is bad 2of them said that the center is not busy ,,,and one did not comment at all…

Note: all the numbers in the bars are in percentages

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Discussion ..

In this study, patients’ sex had no significant effect on overall satisfaction which conforms with the finding of many earlier studies (Eiad 1996)

Patients who respond that physicians number is enough were 52.9% and their satisfaction were 89% , but 58.6% respond no and their satisfaction were 82% .However doctors number in primary health care center depend on number of services and the population size serviced by the center

Al-bald region very large, also this area very crowded because, most of the people prefer to live in this area due to its position in the central region in Jeddah. we think patient didnot satisfy with number of doctors was due to large number of patients serviced by Al-Blad primary health care center.

Patient said investigation level was good were 26.9% and their satisfactions were, 86%. Patient who written investigation level was bad were 73%, and their satisfactions were 84%.

The cause of unsatisfied patient about level of investigation maybe due to two major causes .The first cause is poor machine technology of laboratory investigation in the primary health care centers as general.

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The second cause isnot all investigation method canbe done in primary health care center.

Patient who written drug services level was good were 65.3%, and their satisfaction about this services was 94%. Patient who written drug services level was bad were 34.6%, and their satisfaction were 67%

the patient satisfaction was good, but the drug services were bad .This can be due to patient expectation regarding drug services that the drugs must be available . Because Al-Balad primary health care center is in the center of Jeddah, this can be considered as a reason for low satisfaction level Previous studies reported that problem faced by patients attending in primary health care centers in Riyadh city including insufficient drug supply and delayed laboratory investigations. ( consumers' satisfaction with primary health care center services in the city of Jeddah,abdullahH.AL-Doghaither,phD.abdulla A.Saeed,MD page 451) Many or most of patients highlighted to increase availability of investigation and drug should increase patient satisfaction by improve the investigations to meet the need of patient and give enough medication to meet their needs.

Patients who written nurses number was good were 80.8%, and their satisfaction about nursing services was 81%. Patients who written nurses number was not enough were 19.5% and their satisfaction were 100%.

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This result represent all patients generally satisfy with nurses number and nursing services in Al -Balad primary health care centre, this can be a good result of having a lot of nursing schools to meet defect in nursing number in the past..

The Saudi nurses may have a good effect on this result, because all patients prefer Saudi nurses as no language barrier between patients and Saudi nurses, which is of importance to say their needs…. Also Saudi nurse know all patients culture and their needs that directly affect patient satisfaction regarding their care. Many primary health care centers physicians (nurses) are not Arabic –speakers & they need translators to accompany them, imposing an extra – financial burden.(.M.El Shabrawy, M.Ali Mahmoud.1993).

There were many suggestion like our suggestion in previous study were raised to improve the services including provision of specialist care for 50% of patients additional radiological investigations (41%), additional laboratory services (35%) and more dentists (33%). About 15-24%for more doctors and nurses, improving emergency and medical record services and expanding waiting and parking areas(Eiad 1996)

53.8 % was the results of patients who accept nurses education level, and their satisfaction with education level of nurses was 100%.And 46% was the results of patients who did not accept nurses education level, and their satisfaction with education level of nurses was 67%.

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Generally the patients satisfy with nursing education level is high but patients who did not accept nursing education level was also high. But not all are the same?? due to increasenumber of nursing education & the availability of different nursing programs (3 months , 2 y,3y ,diploma, bachelor….)For this reason weak nurses in knowledge may be found….

In other words, the level of working nurses is not tenderized …..!!

The vital role of nurses in primary health care center is patient education, for this reason we give this factor more important than other factors, and we divide the patient to five groups according to their level of education.