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      Influences on patient satisfaction in healthcare centers: a semi-quantitative study over 5 years

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          Abstract

          Background

          Knowledge of ambulatory patients’ satisfaction with clinic visits help improve communication and delivery of healthcare. The goal was to examine patient satisfaction in a primary care setting, identify how selected patient and physician setting and characteristics affected satisfaction, and determine if feedback provided to medical directors over time impacted patient satisfaction.

          Methods

          A three-phase, semi-quantitative analysis was performed using anonymous, validated patient satisfaction surveys collected from 889 ambulatory outpatients in 6 healthcare centers over 5-years. Patients’ responses to 21 questions were analyzed by principal components varimax rotated factor analysis. Three classifiable components emerged: Satisfaction with Physician, Availability/Convenience, and Orderly/Time. To study the effects of several independent variables (location of clinics, patients’ and physicians’ age, education level and duration at the clinic), data were subjected to multivariate analysis of variance (MANOVA)..

          Results

          Changes in the healthcare centers over time were not significantly related to patient satisfaction. However, location of the center did affect satisfaction. Urban patients were more satisfied with their physicians than rural, and inner city patients were less satisfied than urban or rural on Availability/Convenience and less satisfied than urban patients on Orderly/Time.

          How long a patient attended a center most affected satisfaction, with patients attending >10 years more satisfied in all three components than those attending <1–5 years. Level of education affected patients’ satisfaction only in the component Orderly/Time; patients without a high school education were significantly less satisfied than those with more. Patients in their 40′s were significantly less satisfied in Availability/Convenience than those >60 years old.

          Patients were significantly more satisfied with their 30–40 year-old physicians compared with those over 60. On Orderly/Time, patients were more satisfied with physicians who were in their 50′s than physicians >60.

          Conclusions

          Improvement in patient satisfaction includes a need for immediate, specific feedback. Although Medical Directors received feedback yearly, we found no significant changes in patient satisfaction over time. Our results suggest that, to increase satisfaction, patients with lower education, those who are sicker, and those who are new to the center likely would benefit from additional high quality interactions with their physicians.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s12913-017-2307-z) contains supplementary material, which is available to authorized users.

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          Most cited references17

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          Understanding concordance in patient-physician relationships: personal and ethnic dimensions of shared identity.

          Although concordance by race and sex in physician-patient relationships has been associated with patient ratings of better care, mechanisms through which concordance leads to better outcomes remains unknown. This investigation examined (1) whether patients' perceptions of similarity to their physicians predicted their ratings of quality of care and (2) whether perceived similarity was influenced by racial and sexual concordance and the physician's communication. The research design was a cross-sectional study with 214 patients and 29 primary care physicians from 10 private and public outpatient clinics. Measures included postvisit patient ratings of similarity to the physician; satisfaction, trust, and intent to adhere; and audiotape analysis of patient involvement and physicians' patient-centered communication. Factor analysis revealed 2 dimensions of similarity, personal (in beliefs, values) and ethnic (in race, community). Black and white patients in racially concordant interactions reported more personal and ethnic similarity (mean score, 87.6 and 78.8, respectively, on a 100-point scale) to their physicians than did minority patients (mean score, 81.4 and 41.2, respectively) and white patients (mean score, 84.4 and 41.9, respectively) in racially discordant encounters. In multivariable models, perceived personal similarity was predicted by the patient's age, education, and physicians' patient-centered communication, but not by racial or sexual concordance. Perceived personal similarity and physicians' patient-centered communication predicted patients' trust, satisfaction, and intent to adhere. The physician-patient relationship is strengthened when patients see themselves as similar to their physicians in personal beliefs, values, and communication. Perceived personal similarity is associated with higher ratings of trust, satisfaction, and intention to adhere. Race concordance is the primary predictor of perceived ethnic similarity, but several factors affect perceived personal similarity, including physicians' use of patient-centered communication.
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            Patient-physician social concordance, medical visit communication and patients' perceptions of health care quality.

            Social characteristics (e.g. race, gender, age, education) are associated with health care disparities. We introduce social concordance, a composite measure of shared social characteristics between patients and physicians. To determine whether social concordance predicts differences in medical visit communication and patients' perceptions of care. Regression analyses were used to determine the association of patient-provider social concordance with medical visit communication and patients' perceptions of care using data from two observational studies involving 64 primary care physicians and 489 of their patients from the Baltimore, MD/Washington, DC/Northern Virginia area. Lower patient-physician social concordance was associated with less positive patient perceptions of care and lower positive patient affect. Patient-physician dyads with low vs. high social concordance reported lower ratings of global satisfaction with office visits (OR=0.64 vs. OR=1.37, p=0.036) and were less likely to recommend their physician to a friend (OR=0.61 vs. OR=1.37, p=0.035). A graded-response was observed for social concordance with patient positive affect and patient perceptions of care. Patient-physician concordance across multiple social characteristics may have cumulative effects on patient-physician communication and perceptions of care. Research should move beyond one-dimensional measures of patient-physician concordance to understand how multiple social characteristics influence health care quality. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.
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              The effects of primary care physician visit continuity on patients' experiences with care.

              Visit continuity is important to patients and valued by physicians. However, it is virtually impossible for primary care physicians (PCPs) to provide care during every paneled patient visit. It remains unclear whether PCP visit discontinuity can be planned in a way that is least disruptive to patients' experiences with care. This study aims to clarify whether visit continuity affects patients' experiences with primary care equally for all patients. From January 2004 through March 2005, a large multispecialty practice in Massachusetts administered the Ambulatory Care Experience Survey (ACES) monthly to a random sample of patients visiting each of 145 PCPs. The analytic sample includes 14,835 patients with 2 or more primary care visits over the 6 months before being surveyed. Usual Provider Continuity (UPC), an administratively based measure of PCP visit continuity, was calculated for all respondents. Multilevel regression models that accounted for the clustering of patients within physicians modeled the relationship between UPC and each ACES measure. Interaction effects between UPC and gender, education, self-rated health, and PCP-patient relationship duration were tested. Physician-patient interaction quality, including physician communication, knowledge of the patient, health promotion support, and organizational access were more strongly influenced by visit continuity among respondents in early stages of a PCP-patient relationship (P < 0.01) and with worse self-rated health (P < 0.01). Improvements in physician-patient relationship quality can be achieved by targeting visit continuity improvement efforts to patients who benefit most, particularly those in early stages of a PCP-patient relationship and/or perceive their health as poor.
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                Author and article information

                Contributors
                RuthT5418@gmail.com
                Nicolenu@pcom.edu
                Laura.snavely@gmail.com
                Stacey.g.hackett@gmail.com
                Frank.kenice@gmail.com
                215-871-6511 , RobertD@pcom.edu
                Journal
                BMC Health Serv Res
                BMC Health Serv Res
                BMC Health Services Research
                BioMed Central (London )
                1472-6963
                19 May 2017
                19 May 2017
                2017
                : 17
                : 361
                Affiliations
                [1 ]ISNI 0000 0001 0090 6847, GRID grid.282356.8, , Department of Psychology, Philadelphia College of Osteopathic Medicine, ; 4170 City Ave., Philadelphia, PA 19131 USA
                [2 ]North Philadelphia Health System/St. Joseph’s Hospital, Philadelphia, PA USA
                [3 ]ISNI 0000 0004 0433 4040, GRID grid.415341.6, , Geisinger Medical Center, ; Danville, PA USA
                [4 ]GRID grid.459729.4, , Maria Fareri Children’s Hospital, ; Westchester, NY USA
                [5 ]ISNI 0000 0001 2110 718X, GRID grid.255049.f, College of Podiatric Medicine & Surgery, , Des Moines University, ; Des Moines, IO USA
                Article
                2307
                10.1186/s12913-017-2307-z
                5438500
                28526039
                1a34690e-557c-4c69-a5cf-6db01c0d8540
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 3 April 2017
                : 11 May 2017
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2017

                Health & Social care
                patient satisfaction,health care delivery,community health
                Health & Social care
                patient satisfaction, health care delivery, community health

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