Supervisors info:
Δάφνη Καϊτελίδου, Αναπληρώτρια Καθηγήτρια, Τμήμα Νοσηλευτικής, ΕΚΠΑ
Ιωάννης Μαντάς, Καθηγητής, Τμήμα Νοσηλευτικής, ΕΚΠΑ
Αθηνά Καλοκαιρινού, Καθηγήτρια, Τμήμα Νοσηλευτικής, ΕΚΠΑ
Summary:
INTRODUCTION: Primary care units are very important for an integrated health system. Effective communication and collaboration of primary care with secondary and tertiary health care is essential for effective functioning. Nevertheless what is more of a concern to health service researchers in recent years is to ensure the quality of services. The means used for quality assurance is to measure users' satisfaction with the services provided. The studies that have taken place in our country in this area are limited.
PURPOSE OF THE STUDY: The purpose of this study is to measure users’ satisfaction by recording their experience from the services provided to hospital outpatient clinics and health centers, as well as comparing the quality of services in different health units in province and city.
MATERIAL AND METHOD: This is a cross-sectional study that was conducted in four major public hospitals and two health centers in Attica and in the General Hospital of Lamia and a health center of the region of Lamia. The studied population consisted of 250 people who visited outpatient clinics and health centers for the period December-January 2019. The data collection was done through 2 questionnaires, one referring to public hospitals and one referring to health centers. The statistical program SPSS 22.0 was used for the analysis. Pearson's x2 test, Fisher's exact test and Student's t-test were performed. The significance levels are two-sided and the statistical significance was set at 0.05.
RESULTS: 72.8% of the participants were women and 97.2% were Greeks. Also, 87.6% of the participants had public insurance and 6.4% were uninsured. 60.0% of the participants came from outpatient clinics and the remaining 40.0% from a health center, while 72.0% of the participants were in a health facility in Athens and the remaining 28.0% in a health facility in the province. 45.8% of the participants had scheduled the appointment by phone in a 5-digit number. The percentage was higher in outpatient clinics, while in health centers the appointments were mainly scheduled by phone in the secretariat. 33.2% of people waited a week from appointment planning to visit and 24.2% of people waited from one week to one month. Also only 4.0% of participants from health centers saw a nurse or other health care practitioner without seeing a doctor.
The waiting time from the appointment planning to the visit, as well as the time of completion of the administrative procedures were significantly higher in the outpatient clinics compared to the health centers. The time from the completion of these procedures until a doctor sees them was also significantly higher in the outpatient clinics compared to the health centers. Scheduling appointments was much more common in health units in Athens compared to the province. Scheduling was made by phone in a 5-digit number, while in the province was mainly made by phone at the secretariat. The waiting time from the appointment planning to the visit as well as the waiting time for the completion of the administrative procedures was significantly higher in Athens than in the province.
The referral rate to another doctor within the health unit was higher in Athens, while the referral rate to a health center outside the health unit was higher in the province. Participants' satisfaction has been found to increase successively in terms of the following variables: characteristics of the facilities, quality of nursing care and care provided by other health professionals, accessibility, quality of medical care, care content and continuity of care and co-ordination of care. Participants' satisfaction from the accessibility was found to be higher in health centers than in outpatient clinics, while in the area of care content it was found that satisfaction was greatest in outpatient clinics by health centers.
Also, the satisfaction from the accessibility, the continuity and the coordination of care, the content of care as well as the overall satisfaction of participants was found to be greater in the province than in Athens. Moreover, it was found that the older the participants were, the more satisfied they were in terms of continuity and coordination of care, the characteristics of the facilities and the overall satisfaction of the participants. As for people with chronic diseases, the more the diseases they had, the more satisfied they were from the medical care. The worse the health condition of the participants was, the less satisfied they were with the characteristics of the facilities. Participants with health insurance and Greeks also found themselves less satisfied in this area than uninsured participants and foreigners. Finally, men showed less satisfaction than women in the quality of nursing care and care by other health professionals.
CONCLUSIONS: The characteristics of the facilities of a health unit and the accessibility seem to be the areas where individuals are less satisfied with the provision of primary health care. On the one hand, in health centers the accessibility of patients is better and the time spent by doctors on visit is plenty, but the medical equipment is limited there. On the other hand, in outpatient clinics of the hospitals the level of doctors' knowledge is much higher and the medical equipment is more. This is the reason why people are more pleased with the content of care there. It seems that people are more satisfied with the providing services in health units in the province than with those in health units in Athens in all sectors.
Older and uninsured people are more satisfied with the overall provision of services. People with chronic diseases are very positive about the quality of medical care. The use of telemedicine, the empowerment of the role of nurses, the development of home-based hospitalization and a better allocation of resources and staff are some of the steps that need to be taken to better manage and care for patients.
Keywords:
Primary health care, Patients’ satisfaction, Users’ experiences of health services, Quality, Primary health care in Greece, Primary health care in Europe
