Article Info
Year: 2010
Month: October
Issue: 4
Pages: 25-26,31
Reference: Al-Sekaiti M., Choudhry A., .Saudi Epidemiology Bulletin. 2010;17(4):25-26,31.
The Primary Health Care (PHC) service is the most frequently used in any health care system. Evaluation of patient satisfaction has become a standard part of evaluation of any health care system, and patient satisfaction is of value to PHC providers. In hajj, primary health care centers (PHCCs) in Makkah and Mina cater for the first level medical care for millions of hajjis. This study aimed to evaluate patient satisfaction level with services provided by PHCCs in Makkah & Mina among Arab patients visiting these centers during Hajj season 1430 H (2009 G).
A cross-sectional study was conducted at 12 of 33 PHCCs in Makkah and 11 of 28 PHCCs in Mina. All Arab patients visiting these centers during hajj season 1430 H were considered as study population; while considering Makkah and Mina as separate strata. The questionnaire covered information about demographic characteristics, medical problems encountered and satisfaction about different components related to PHC services as well as overall satisfaction. Stratified random cluster sampling was used and a total of 827 patients were selected from both strata. Out of the 827 patients, 425 (51.4%) were recruited from PHCCs of Makkah and 402 (48.6%) from PHCCs in Mina.
Regarding overall satisfaction with PHCC services, among Makkah patients 246 (57.9%) were fully satisfied, 153 (36.0%) were satisfied, 16 (3.8%) were not satisfied and 10 (2.4%) did not comment; while among Mina PHCCs patients 266 (66.2%) were fully satisfied, 111 (27.6%) were satisfied, 15 (3.7%) were not satisfied and 10 (2.5%) did not comment (p=0.077).
The majority of patients were "fully satisfied" with different aspects of PHC services, which included satisfaction with cleanliness of the building [254 (59.8%) in Makkah and 304 (76.0%) in Mina]; receptionist’s attitude [235 (55.3%) in Makkah and 308 (76.6%) in Mina]; nursing [228 (53.6%) in Makkah and 233 (58.4%) in Mina]; physical examination by doctor [206 (48.5%) in Makkah and 196 (49.0%) in Mina]; competency of treating doctor [211 (49.7%) in Makkah and 192 (48.0%) in Mina]; laboratory services [118 (70.7%) in Makkah and 22 (61.1%) in Mina]; X-ray services [24 (47.1%) in Makkah and 17 (63.3%) in Mina]; and pharmacist's explanation [242 (56.9%) in Makkah and 249 (62.6%) in Mina].
Table 1 shows the relationship of some of the explanatory factors with level of patient satisfaction. In Makkah, patients under 30 years of age were less fully satisfied than older patients and the difference was statistically significant. However, in Mina there was no significant difference between different age groups regarding their overall satisfaction with the provided health services. No association was observed between overall satisfaction and gender or whether it was the first or repeat visit, whether in Makkah or Mina. It was also found that “Other Asian Arabs” were most fully satisfied as compared to “African Arabs” or Saudis, and the difference was statistically significant in both Makkah and Mina.
The time required to reach the PHCC was also found to be statistically significantly associated with satisfaction of patients in Makkah but not in Mina.
The study concluded that the level of satisfaction was high in both areas, but was higher among patients in Mina as compared to those in Makkah.
- Reported by: Dr. Mahmoud Al-Sekaiti, Dr. Abdul Jamil Choudhry (Field Epidemiology Training Program).
Editorial note:
In recent years, increasing emphasis has been placed upon issues concerning the evaluation of health care.1 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 Measurement of patient satisfaction has become a common way to elicit patients’ views about the health care delivered in order to increase awareness about the concept of quality and prevent waste of medical resources.
This study was an effort to evaluate patient’s satisfaction with PHC services in Makkah and Mina during the hajj season for a better patient focus. The overall level of satisfaction was 57.9% for services provided by PHCCs in Makkah and 66.2% for Mina. In comparison, a previous study conducted in Saudi Arabia reported an overall patient satisfaction rate of 49.0%, 3 while a Kuwaiti study reported an overall rate of 62.0%. 4 Another Saudi study evaluating the services in PHC affiliated to Riyadh military hospital showed that the overall satisfaction level was 64.2%. 5
In general, it was evident that there was a statistically significant difference between Makkah and Mina for the majority of factors studied. Regarding socio-demographic characteristics of patients, unlike other patient satisfaction studies, this study showed no statistical significant association between most of the demographic factors and overall satisfaction.
Accessibility to PHC is one of the principles of health for all, as stated in the Alma Ata declaration on primary health care in 1978.6 In our study, more than half of the patients in both Makkah and Mina were able to reach the PHCC in less than 10 minutes. The relation of distance from home on patient satisfaction and utilization of services was reported in many studies where utilization is increased by travelling shorter distance to PHC centers.7, 8
The results of this study revealed certain areas in which quality improvement is required such as the physical examination and the medical advice offered by doctors.
Table 1: Relationship between selected demographic characteristics and overall satisfaction of Arab patients visiting PHCCs in Makkah and Mina during hajj season 1430 H.
|
Makkah
|
Mina
|
|||
|
N
|
Fully satisfied
|
N
|
Fully satisfied
|
|
|
Age group
|
||||
|
< 30 years
|
51
|
39.2%
|
89
|
69.7%
|
|
30- 39 years
|
67
|
52.2%
|
136
|
64.0%
|
|
40- 49 years
|
103
|
66.0%
|
97
|
67.0%
|
|
50- 59 years
|
113
|
61.1%
|
58
|
69.0%
|
|
60 yrs and above
|
91
|
59.3%
|
17
|
47.1%
|
|
p=0.021
|
p=0.438
|
|||
|
Gender
|
||||
|
Male
|
218
|
56.4%
|
317
|
67.8%
|
|
Female
|
207
|
59.4%
|
85
|
60.0%
|
|
p=0.531
|
p=0.176
|
|||
|
Nationality
|
||||
|
Saudi
|
130
|
49.2%
|
60
|
50.0%
|
|
Other Arab Asian countries
|
122
|
68.9%
|
115
|
69.6%
|
|
Arab African countries
|
173
|
56.6%
|
224
|
68.3%
|
|
p=0.006
|
p=0.018
|
|||
|
Hajji Status
|
||||
|
Hajji
|
302
|
61.3%
|
384
|
66.4%
|
|
Non Hajji
|
123
|
49.6%
|
18
|
61.1%
|
|
p=0.014
|
p=0.896
|
|||
|
First visit to PHCC
|
||||
|
Yes
|
269
|
59.5%
|
362
|
34.8%
|
|
no
|
156
|
55.1%
|
39
|
25.6%
|
|
p=0.381
|
p=0.0.251
|
|||
|
Distance to PHCC
|
||||
|
<10 min.
|
215
|
60.5%
|
211
|
71.1%
|
|
10-30 min.
|
145
|
47.6%
|
59
|
61.0%
|
|
>30 min.
|
52
|
76.9%
|
58
|
65.5%
|
|
p<0.001
|
p=0.300
|
|||
References:
1. Williams SJ, Calnan M. Key determinants of consumer satisfaction with general practice. Family Practice 1991; 8: 237-242.
2. Calnan M, Katsouyiannopoulos V, Ovcharov VK, Prokhorskas R, Ramic H, Williams S. Major determinants of consumer satisfaction with health care in different health systems. Family Practice 1994; 11: 468-478.
3. Al-Doghaither AH, Saeed AA. Consumer’s satisfaction with primary health services in the city of Jeddah, Saudi Arabia. Saudi Med J 2000; 21: 447-454.
4. Al-Doghaither AH, Abdelrahman BM, Saeed AA. Patients’ satisfaction with physician's services in primary health care centers in Kuwait city, Kuwait. JR Soc Health 2000; 120: 170-174
5. Al-Sakkak MR, Al-Nowaiser NA. Patient satisfaction with primary health care services offered in Riyadh health centres. Saudi Med J 2008; 29(3): 432-436
6. Primary health care: Report of the International Conference on Primary Health Care, Alma-Ata, USSR, 6-12 September 1978 joint sponsored by the World Health Organization and the United Nations Children's Fund. Geneva, World Health Organization, 1978
7. Saeed A, Effect of distance on the utilization of health services. CAMS Newsletter 1985; 1: 7-9.
8. Al-Faris EA, Khoja TA, Falouda M, Saeed AA. Patients' satisfaction with accessibility and services offered in Riyadh health centres. Saudi Med J 1996; 17 (1):11-17
دراسة رضاء المرضى العرب عن الخدمات الصحية المقدمة من مراكز الرعاية الصحية الأولية بمكة ومنى خلال موسم حج 1430 هـ.
يعتبر رضاء المرضى عن الخدمات الصحية ذي أهمية بالغة لدى مقدمي الرعاية الصحية وهو أيضا مؤشر على جودة الرعاية و أداء النظام الصحي. تخدم مراكز الرعاية الصحية الأولية في مكة ومنى الملايين من المرضى خلال موسم الحج، ولذلك فإن قياس درجة رضائهم عن هذه الخدمات هو أحد مؤشرات جودة الخدمات الصحية. هدفت الدراسة إلى تقييم مستوى رضاء المرضى العرب عن الخدمات الصحية المقدمة من مراكز الرعاية الصحية الأولية بمكة ومنى خلال حج 1430 هـ.
تم عمل دراسة مقطعية شملت عينة من المرضى العرب الذين قاموا بزيارة مراكز الرعاية الصحية الأولية بمكة ومنى خلال الفترة من 3 إلى 10 ذو الحجة 1430 هـ. تم تحليل 827 استبيانا شملت 425 من مكة و 402 من منى. بلغ متوسط أعمار المرضى في مكة 46.8 عاما (إنحراف معياري 14) أما في منى فقد بلغ 38.3 عاما (إنحراف معياري 10.7)، وشكلت الفئة العمرية 50-59 سنة أعلى النسب في مكة (26.6%) في حين شكلت الفئة العمرية 30-39 سنة أعلى النسب في منى (34.3%). شكل الذكور ما نسبته 51.3% في مكة و 78.9% في منى. و شكلت الجنسيات العربية الأفريقية ما نسبته 40.7% من جملة الجنسيات العربية في مكة و 56.1% في منى.
وعند السؤال عن المدة المستغرقة للوصول إلى المركز الصحي فإن نسبة المرضى الذين أجابوا بأنها أقل من 10 دقائق كانت 50.6% في مكة و52.5% في منى، وغالبيتهم لم يواجهوا أي صعوبات للوصول إلى المركز الصحي ( 77.6% في مكة و80.4%في منى).
بالنسبة لدرجة الرضى العام عن الخدمات المقدمة من مراكز الرعاية الأولية بمكة ومنى فإن معظم المرضى كانوا راضين تماما ( 57.9% في مكة و 66.2%في منى) يليهم الراضون ( 36.0% في مكة و27.6%في منى) ثم غير الراضون ( 3.8% في مكة و3.7%في منى) أما البقية فلم يعلقوا ( 2.4% في مكة و2.5%في منى).
كان نسبة المرضى الراضون تماما عن المبنى والإستقبال 59.8% في مكة و 76% في منى، و عن نظافة المركز 55.3% في مكة و 76.6% في منى، و عن سلوك موظفي الاستقبال. أما فيما يتعلق بوقت غرفة الإنتظار ووقت مقابلة الطبيب فإن معظم المرضى (85.7% في مكة و93.8% في منى) أجابوا بأن وقت الإنتظار كان مناسبا وغرفة الإنتظار كانت مريحة (86.1% في مكة و 96.2% في منى)، كما أجاب الأغلبية بأن وقت المقابلة مع الطبيب كان مناسبا (74.1% في مكة و69.5% في منى).
أما بالنسبة للعلاقة مع الطبيب فإن 53.9% من المرضى في مكة و67.4% في منى كانوا راضين تماما عن ترحيب الطبيب، فيما بلغت نسبة الرضى التام عن طريقة استماع الطبيب للشكوى المرضية 52.2% في مكة و59.4% في منى. كما أظهرت النتائج إنخفاض نسبة الرضى التام حول النصيحة المقدمة من قبل الطبيب. أما بالنسبة لدرجة الرضى التام عن كفاءة الطبيب فقد بلغت 49.7% في مكة و48% في منى.
غالبية المرضى الذين تم إرسالهم للمختبر كانوا راضين تماما عن خدمة المختبر (70.7% في مكة و 61.1% في منى) أما بالنسبة لخدمة الأشعة فقد بلغت نسبة الرضى التام 47.1% في مكة و 63.0% في منى، و بالنسبة لمدى الرضى عن خدمات الصيدلية فكانت 95.5% في مكة و92.4% في منى، و شرح الصيدلي للأدوية الموصوفة 56.9% في مكة و 62.6% في منى.
أظهرت الدراسة إرتفاع مستوى الرضى العام لدى المرضى العرب عن الخدمات المقدمة من مراكز الرعاية الصحية الأولية بمكة ومنى خلال موسم حج 1430 هـ، خاصة بين أولائك الذين زاروا مراكز الرعاية الصحية الأولية بمنى.
على الرغم من أن مستوى الرضى العام كان مرتفعاً، إلا ان بعض الجوانب المتعلقة بالعلاقة مع الطبيب و التمريض تحتاج إلى تحسين. تمت التوصية على تطوير برامج لمنسوبي وزارة الصحة من أجل التوعية بأهمية رضاء المرضى و الحاجة إلى إجراء دراسات لاستطلاعها بشكل دوري من أجل تحسين جودة خدمات الرعاية الصحية الأولية و إطلاع صانعي القرار على الوضع القائم.
إعداد: د. محمود بن حميد السكيتي، د. عبد الجميل شودري، د. محمد المزروع (برنامج الوبائيات الحقلي).