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      Perceived doctor-patient relationship and satisfaction with general practitioner care in older persons in residential homes

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          Abstract

          Objective: Understanding patient satisfaction from the perspective of older adults is important to improve quality of their care. Since patient and care variables which can be influenced are of specific interest, this study examines the relation between patient satisfaction and the perceived doctor-patient relationship in older persons and their general practitioners (GPs).

          Design: Cross-sectional survey.

          Subjects and setting: Older persons ( n = 653, median age 87 years; 69.4% female) living in 41 residential homes.

          Main outcome measures: Patient satisfaction (report mark) and perceived doctor-patient relationship (Leiden Perioperative care Patient Satisfaction questionnaire); relationships were examined by comparing medians and use of regression models.

          Results: The median satisfaction score was 8 (interquartile range 7.5–9; range 0–10) and doctor-patient relationship 65 (interquartile range 63–65; range 13–65). Higher satisfaction scores were related to higher scores on doctor-patient relationship (Jonckheere Terpstra test, p for trend <.001) independent of gender, age, duration of stay in the residential home, functional and clinical characteristics. Adjusted for these characteristics, per additional point for doctor-patient relationship, satisfaction increased with 0.103 points (β = 0.103, 95% CI 0.092–0.114; p < .001). In those with a ‘low’ doctor-patient relationship rating, the percentage awarding ‘sufficient or good’ to their GP for ‘understanding about the personal situation’ was 12%, ‘receiving attention as an individual’ 22%, treating the patient kindly 78%, and being polite 94%.

          Conclusion: In older persons, perceived doctor-patient relationship and patient satisfaction are related, irrespective of patient characteristics. GPs may improve patient satisfaction by focusing more on the affective aspects of the doctor-patient relationship.

          Key Points
          • Examination of the perceived doctor-patient relationship as a variable might better accommodate patients’ expectations and improve satisfaction with the provided primary care.

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          Most cited references 16

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          Patient satisfaction: a valid concept?

           B. Williams (1994)
          Over the past 10 yr consumer satisfaction has gained widespread recognition as a measure of quality in many public sector services. This has become manifest in the NHS in the call by the 1983 NHS Management inquiry to ascertain how well the service is being delivered at local level by obtaining the experience and perceptions of patients and the community. Patient satisfaction is now deemed an important outcome measure for health services; however, this professed utility rests on a number of implicit assumptions about the nature and meaning of expressions of 'satisfaction'. Through a review of past research findings this paper suggests that patients may have a complex set of important and relevant beliefs which cannot be embodied in terms of expressions of satisfaction. Consequently, many satisfaction surveys provide only an illusion of consumerism producing results which tend only to endorse the status quo. For service providers to meaningfully ascertain the experience and perceptions of patients and the community then research must first be conducted to identify the ways and terms in which those patients perceive and evaluate that service.
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            Patient satisfaction revisited: a multilevel approach.

            Patient satisfaction surveys are increasingly used for benchmarking purposes. In the Netherlands, the results of these surveys are reported at the univariate level without taking case mix factors into account. The first objective of the present study was to determine whether differences in patient satisfaction are attributed to the hospital, department or patient characteristics. Our second aim was to investigate which case mix variables could be taken into account when satisfaction surveys are carried out for benchmarking purposes. Patients who either were discharged from eight academic and fourteen general Dutch hospitals or visited the outpatient departments of the same hospitals in 2005 participated in cross-sectional satisfaction surveys. Satisfaction was measured on six dimensions of care and one general dimension. We used multilevel analysis to estimate the proportion of variance in satisfaction scores determined by the hospital and department levels by calculating intra-class correlation coefficients (ICCs). Hospital size, hospital type, population density and response rate are four case mix variables we investigated at the hospital level. We also measured the effects of patient characteristics (gender, age, education, health status, and mother language) on satisfaction. We found ICCs on hospital and department levels ranging from 0% to 4% for all dimensions. This means that only a minor part of the variance in patient satisfaction scores is attributed to the hospital and department levels. Although all patient characteristics had some statistically significant influence on patient satisfaction, age, health status and education appeared to be the most important determinants of patient satisfaction and could be considered for case mix correction. Gender, mother language, hospital type, hospital size, population density and response rate seemed to be less important determinants. The explained variance of the patient and hospital characteristics ranged from 3% to 5% for the different dimensions. Our conclusions are, first, that a substantial part of the variance is on the patient level, while only a minor part of the variance is at the hospital and department levels. Second, patient satisfaction outcomes in the Netherlands can be corrected by the case mix variables age, health status and education.
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              The influence of gender on the doctor-patient interaction.

              This paper discusses the research focused on gender issues in healthcare communication. The majority of papers discussed here are based on a research study in which 509 new adult patients were prospectively and randomly assigned to family practice or internal medicine clinics at a university medical center and followed for one year of care. There are significant differences in the practice style behaviors of female and male doctors. Female doctors provide more preventive services and psychosocial counseling; male doctors spend more time on technical practice behaviors, such as medical history taking and physical examination. The patients of female doctors are more satisfied, even after adjusting for patient characteristics and physician practice style. Female patients make more medical visits and have higher total annual medical charges; their visits include more preventive services, less physical examination, and fewer discussions about tobacco, alcohol and other substance abuse (controlling for health status and sociodemographic variables). The examination of gender concordant and discordant doctor-patient dyads provides a unique strategy for assessing the effect of gender on what takes place during the medical visit. Doctor and patient gender can impact the physician-patient interaction and its outcomes. The development of appropriate strategies for the implementation of knowledge about physician and patient gender differences will be crucial for the delivery of high quality gender-sensitive healthcare.
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                Author and article information

                Journal
                Scand J Prim Health Care
                Scand J Prim Health Care
                IPRI
                ipri20
                Scandinavian Journal of Primary Health Care
                Taylor & Francis
                0281-3432
                1502-7724
                2018
                12 April 2018
                : 36
                : 2
                : 189-197
                Affiliations
                Department of Public Health and Primary Care, Leiden University Medical Center , Leiden, The Netherlands
                Author notes
                [*]

                Joint first authorship.

                CONTACT Claudia S. de Waard C.S.de_Waard@ 123456lumc.nl Leiden University Medical Center, Department of Public Health and Primary Care , P.O. Box 9600, 2300 RCLeiden, the Netherlands
                Article
                1459229
                10.1080/02813432.2018.1459229
                6066293
                29644911
                © 2018 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Page count
                Pages: 9, Words: 5342
                Product
                Funding
                Funded by: Dutch Organisation for Health Research
                Award ID: 311060401
                A grant was received from ZonMw, the Dutch Organisation for Health Research, the Netherlands (Project: 311060401).
                Categories
                Research Article

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