A study on satisfaction level among patients attending sexually transmitted infections clinic.

INTRODUCTION: Patient satisfaction has become a favourite debate for enhancing quality of OPD services, however it still needs a lot of improvement for the better delivery of health care services. AIM: The aim was to study the satisfaction level among STI (Sexually transmitted infection) patients regarding quality of care and services provided in STI clinic.
MATERIALS AND METHODS: The present study was a cross sectional study conducted on 88 patients with ages ranging from 16-65 years attending STI clinic at the department of Dermatology, Venereology and Leprology of a tertiary care hospital in Gujarat, India from December 2016 to april 2017. An effort was made to bring into focus significant areas to target for improvement. Satisfaction was assessed using 13 questions modified from patient satisfaction questionnaire by Wirral Community NHS Trust.Patients were asked to give rating to these questions. Likert's 5 point rating scale was used.
RESULTS: It was noticed that total satisfaction in present study was 82.9%. Most of the questions of patient satisfaction were statistically highly significant (p <0.0001).
CONCLUSION: Overall patient satisfaction with services provided at our STI Clinic was high (93.2%) except length of waiting time (<30 minutes), waiting area & other amenities of the hospital. Copyright:

INTRODUCTION

Satisfaction, like many psychological concepts, is easy to understand but hard to define. A simple definition of satisfaction would be the degree to which desired goals have been achieved. Patient/client satisfaction is an attitude – a person's general orientation toward a total experience of health care. Patient satisfaction has been given a lot of importance in recent years, but still, a lot more should be done in this field. Outpatient Department (OPD) is considered to be the first point of contact of hospital with patients that's why it has a significant influence on patient satisfaction level. OPD is known as the “SHOP WINDOW” of the hospital.

Patient satisfaction has become a favourite debate for enhancing the quality of OPD services; however, it still needs a lot of improvement for the better delivery of health-care services.[1]

Patient satisfaction is an important and commonly used indicator for measuring the quality in health care. Patient satisfaction affects clinical outcomes, patient retention, and medical malpractice claims. It affects the timely, efficient, and patient-centered delivery of quality health care. Patient satisfaction is, thus, a proxy but a very effective indicator to measure the success of doctors and hospitals. Certain features of dermatological practice in relation to the above-mentioned factors and certain specific features of dermatological practice should be emphasized: many dermatological disorders are characterized by chronicity. Thus, adherence to topical and/or systemic therapies for a long period of time is essential for successful management. It is estimated that more than one-third of patients fail to take medications as prescribed, especially for chronic disorders.[2] This may lead to poor compliance and further to treatment failure and thereby to poor patient satisfaction. Poor communication with physicians, lack of empathy, and the chronicity of many of the disorders lead to dissatisfaction.

A dermatologist's professional job satisfaction and a patient's satisfaction need not necessarily complement each other. We rate our job satisfaction by our professional knowledge, attending Continuing Medical Educations, conferences, mastering new skills, and keeping pace with new technologies. All these factors are not always relevant to the patient. Ultimately, however, whether a patient is happy with a doctor's approach depends on different nonclinical factors such as listening to him or her, promptness of services, and how we talk and gesture.[3]

Satisfaction with a health-care service is dependent on patient expectation and experience and can be used as a patient-based outcome measure in evaluating the quality of clinical care.[4]

The Joint Commission on Accreditation of Health Care Organizations (1994) has embraced patient/client satisfaction as a valid indicator and mandated in its standards for accreditation that “the organization gathers, assesses, and takes appropriate action on information that relates to patient/client satisfaction with services provided.”[5]

MATERIALS AND METHODS

The present cross-sectional study was conducted among patients attending sexually transmitted infections (STIs) clinic in Dermatology Department of tertiary care hospital, Gujarat, after Institutional Ethics Committee clearance.

The study period was from December 2016 to April 2017. A total of 88 patients were included in the study. Patients attending STI Clinic within the age group of 16–65 years as per the inclusion criteria were included in the study after taking written informed consent. Patients not willing to participate in the study were excluded from the study.

The study included a simple questionnaire method. Patients were asked to fill the closed-ended questionnaire in their preferred language (English/Gujarati) after counseling and examination. Data collection procedure was as per the questionnaire. Processing was done manually. Data include various variables (e.g., age, sex, education, socioeconomic status, marital status, and type of visit) and questions regarding satisfaction.

Satisfaction was assessed using 13 questions modified from patient satisfaction questionnaire by Wirral Community NHS Trust.[6] Patients were asked to give rating to this questionnaire. Likert 5-point rating scale was used.[7] The rating was done as follows: 5 = strongly agree, 4 = agree, 3 = neutral, 2 = disagree, and 1 = strongly disagree. Patients who were rating 1 and 2 scale considered as unsatisfied and who did 3, 4, and 5 were considered as satisfied. On an average, 10 min time was given to fill up the questionnaire.

Statistical analysis

The data were tabulated in Microsoft excel and then analysis was done. Statistically functions of excel were used to calculate the frequencies and percentages. Comparison of two proportions and Chi-square test was used to find P value.

RESULTS

The present study was a cross-sectional study conducted on 88 patients with age ranges from 16 to 65 years attending STI clinic, Department of Dermatology, Venereology, and Leprology, Gujarat, from December 2016 to April 2017.

Sociodemographic characteristics of patients attending sexually transmitted infection Clinic (n = 88)

Out of 88 patients, 69 (78.4%) were males and 19 (21.6%) were females. Male-to-female ratio was 3.6:1. A maximum number of patients were in the age group of 16–35 years. Maximum were single (48 [54.5%]) and 28 (31.8%) patients were graduate. A maximum number of patients were of upper lower class (29 [32.9%]) followed by lower middle class (24 [27.3%]). Sixty-two (70.5%) patients visited for the first time to the STI clinic, whereas 16 (18.2%) were of follow-up.

Table 1 shows the results as per the Patient Satisfaction Questionnaire in STI clinic services (n = 88). Patients who were rating 1 and 2 scale were considered as unsatisfied and those with 3, 4, and 5 were considered as satisfied.

Table 1

Results as per the patient satisfaction questionnaire in sexually transmitted infection clinic services (n=88)

Patient Satisfaction Questionnaire	Likert’s 5 point scale
	5	4	3	2	1
Satisfaction about length of waiting time <30 min	12	26	19	17	14
Satisfaction about waiting area and other amenities of hospital	22	25	18	13	10
Satisfaction about doctor - patient communication	26	38	14	6	4
Satisfaction about explanation given by health care person about treatment	26	34	24	3	1
Satisfaction about involvement in decision of care	25	28	18	9	8
Satisfaction about privacy during examination and explanation	24	36	23	3	2
Satisfaction about confidentiality of their personal identity	23	37	22	4	2
Satisfaction about cleanliness and safe environment of examination room	29	38	14	5	2
Satisfaction about faith in doctor treating them	32	29	18	5	4
Satisfaction about dignity of treatment all times	22	31	15	12	8
Satisfaction about helpfulness of information they receive for their health to their family’s health	21	27	15	19	6
Satisfaction about recommendation of STI clinic services to their friends/relatives in future	21	42	17	6	2
Satisfaction about receiving medication for their condition*	4	6	4	1	0

*Out of 88 patients, 16 cases of follow up filled this question. 5=Strongly agree; 4=Agree; 3=Neutral; 2=Disagree; 1=Strongly disagree. STI=Sexually transmitted infection

Only 57 (64.7%) patients were satisfied with convenience of waiting time before consultation to doctor and about 23 (26.1%) patients were found unsatisfied with waiting area arrangement and other amenities of hospital.

About 78 (88.6%) patients were satisfied with doctor–patients communication, whereas only 4 (4.5%) cases were found unsatisfied with examination and explanation given by doctor about their health condition.

About 71 (80.7%) patients were satisfied regarding involvement in the decision of care after informed for the same by health-care person.

Eighty-three (94.3%) patients were found satisfied with privacy during examination and explanation for their health condition and 82 (93.2%) cases were satisfied with confidentiality of their personal identity.

About 81 (92.1%) patients were satisfied regarding cleanliness and safe environment of examination room. Seventy-nine (89.7%) patients had faith on doctor treating them.

About 20 (22.7%) patients were found unsatisfied regarding treatment with dignity about their health condition.

Twenty-five (28.4%) patients were unsatisfied about helpfulness of information they receive about their health condition in understanding owns and family health.

About 80 (90.9%) patients agreed to recommend this STI clinic services to their friends or relatives.

Out of 16 patients of follow-up, 15 (93.7%) patients were found satisfied about receiving medications for their health condition.

Most of the questions of patient satisfaction questionnaire were statistically highly significant (P < 0.0001).

Table 2 shows the satisfaction level in comparison with the age, education, and socioeconomic status of the patient. P > 0.05 which suggests that age, education, and socioeconomic status are not significantly correlated to the satisfaction level.

Table 2

Age, education and socioeconomic status versus satisfaction level distribution

Variables	Total (%)	Satisfied (%)	Unsatisfied (%)	χ2	P
Age groups (years)
16-25	32 (36.4)	30 (93.8)	2 (6.3)	5.527	>0.05
26-35	32 (36.4)	29 (90.6)	3 (9.4)
36-45	12 (13.6)	12 (100)	0
46-55	9 (10.2)	7 (77.8)	2 (22.2)
56-65	3 (3.4)	2 (66.7)	1 (33.3)
Education
Up to 7th standard	16 (18.2)	14 (87.5)	2 (12.5)	1.561	>0.05
8th–10th standard	19 (21.6)	17 (89.5)	2 (10.5)
11th and 12th standard	25 (28.4)	22 (88.0)	3 (12.0)
Graduate	28 (31.8)	27 (96.4)	1 (3.6)
Socioeconomic class
Upper class (I)	6 (6.8)	6 (100)	0	1.362	>0.05
Upper middle class (II)	13 (14.8)	12 (92.3)	1 (7.7)
Lower middle class (III)	24 (27.3)	21 (87.5)	3 (12.5)
Upper lower class (IV)	29 (32.9)	27 (93.1)	2 (6.9)
Lower class (V)	16 (18.2)	14 (87.5)	2 (12.5)

Patients were classified as satisfied and unsatisfied with reference to services provided in STI clinic. The mean of total score was 43. Those securing equal or more than mean were labeled as satisfied and those securing less than mean were considered as unsatisfied.

As shown in Figure 1, it was noticed that total satisfaction in the present study was 82.9% and our comparison of two proportions is highly significant (P < 0.0001) for satisfied and unsatisfied patients.

Figure 1

Total satisfaction level (n = 88)

DISCUSSION

Patient satisfaction is recognized as an important parameter for assessing the quality of patient care services.

In the present study, 57 (64.7%) patients had satisfaction about length of waiting time which was <30 min before consulting doctor which is comparable to sexual health service patient satisfaction survey conducted in January 2016 by NHS trust England.[8] However, it is not consistent with a study conducted by Patavegar et al.[9] and by Kumari et al.[10] In their study, patient satisfaction was 39.12% and 37%, respectively.

Regarding cleanliness of waiting area and other amenities of hospital, only 26.1% were found unsatisfied, which is comparable to study conducted by Sodani et al.[11] where 65% were satisfied and 35% were unsatisfied. However, it is not consistent with the study conducted by Patavegar et al.[9] regarding cleanliness of hospital. In their study, 44.45% patients were unsatisfied.

Seventy-eight (88.6%) patients had satisfaction about doctor–patient communication which is comparable to study conducted by Kumari et al. (73.3%).[10]

Eighty-four (95.5%) patients were found satisfied with examination and explanation given by health-care person about a health condition. Similar results were found in a study conducted by Patavegar et al.[9] (93.5%) and Prasanna et al.[12] (97%).

Satisfaction about involvement in the decision of care 71 (80.7%) patients were satisfied, which is not consistent with survey of sexual health service patient satisfaction conducted in January 2016 by NHS trust in England[8] (99%).

Eighty-three (94.3%) patients were satisfied about privacy during examination and explanation of health condition. In a study conducted by Galhotra et al., 63% were satisfied regarding privacy during examination and explanation.[13]

Eighty-two (93.2%) patients were found satisfied with confidentiality of their personal identity which is similar to the survey of sexual health service patient satisfaction conducted in January 2016 by NHS trust in England[8] (91%).

About 81 (92.1%) patients had satisfactions about cleanliness and safe environment of examination room, whereas in a study conducted by Sodani et al., 65% patients were satisfied.[11]

In the present study, 79 (89.7%) patients had faith in doctor treating them which is comparable to study conducted by Sodani et al. which was above 85%.[11] However, not comparable to the study by Kumari et al. (55.4%).[10]

Only 68 (77.3%) patients stated that they were treated with dignity, whereas 98% respondents were satisfied in the survey of sexual health service patient satisfaction conducted in January 2016 by NHS trust England.[8]

Sixty-three (71.6%) patients were found satisfied that information about their health condition will help them to understand their owns and family's health, which is not comparable to the survey of sexual health service patient satisfaction conducted in January 2016 by NHS trust in England where 98% respondents were satisfied.[8]

About 80 (90.9%) patients agreed that they will recommend the STI clinic services to their friends and relatives in the future, which is similar to study conducted by Weston et al. which was 99%.[6]

In this study, 97.9% patients were satisfied regarding receiving medication for their condition, which is comparable to the study conducted by Patavegar et al. (84.9%).[9]

In the present study, total satisfaction with STI clinic services was 82.9%, which is comparable to study conducted by Kumari et al. (73%).[10] However, it is not consistent with a study conducted by Weston et al. that was 98%.[6] In sexual health service, Patients Satisfaction Survey in January 2016 of NHS Trust total satisfaction was 98%.[8]

CONCLUSION

Overall patient satisfaction with services provided at our STI Clinic was high (93.2%) except length of waiting time (<30 min), waiting area, and other amenities of the hospital.

Patient satisfaction is identified as an important quality outcome indicator to measure success of the service delivery system and provides the opportunity to the organization managers and policymakers to yield a better understanding of patient views and perceptions and the extent of their involvement in improving the quality of care and services.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.