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.