Abstract
Background: Understanding predictors of patient satisfaction in primary care is critical to improving healthcare quality. The OECD Patient Reported Indicators Survey (PaRIS) seeks to fill this knowledge gap by exploring how individuals with chronic conditions perceive the quality and outcomes of primary care in Ontario. This pilot study focuses on identifying key factors that influence patient satisfaction with primary care, examining patient-reported experiences and outcomes to better understand the elements that drive care satisfaction.
Approach: Two surveys were administered: one to nurse practitioners and physicians at 16 practices in Ontario and a second to patients within these practices (n=867 respondents). Guided by Andersen’s Behavioral Model of Health Services Use, predisposing and enabling factors that contribute to care satisfaction were selected for analysis. Univariate analyses were used to identify variables that were significantly associated with patient reported satisfaction with care. A random effects multivariate ordinal logistic regression model was conducted using satisfaction of care as the outcome and significant predictors (p <0.15) from the univariate analysis (gender, income, self-rated health, processes of care).
Results: Patients who preferred not to reveal their income had significantly lower satisfaction scores compared to those who had an income of up to $60,000 annually (OR=0.606, p=0.03). Further, patients who were always or usually stressed/worried about having enough money to pay rent/mortgage had significantly lower satisfaction scores (OR = 0.659, p=0.02 and OR=0.469, p=0.04 respectively) than those who were never worried/stressed about having to pay rent/mortgage. Patients who rated their health as “very good” or “excellent” had significantly higher satisfaction with care in comparison to those who rated their health as “good” (OR=1.563, p=0.02 and OR=2.533, p=0.01, respectively). Wait times for appointments also seems to influence patient satisfaction, with shorter wait times resulting in higher satisfaction. Patients who had appointments that took place between a few days/up to a week (OR=2.577, p<0.01), on the next day (OR=4.711, p<0.01), and on the same day (OR=2.772, p=0.01) after initially booking the appointment had significantly higher satisfaction scores than those whose appointments took place more than one month later. Lastly, patients who went to a clinic where the head of practice was a nurse practitioner had significantly higher satisfaction scores than those who saw a physician (OR=1.768, p=0.05).
Implications: Patient satisfaction is now commonly viewed as an important indicator of quality in health care. The findings of this study shed light on several factors that enhance patient satisfaction in primary care – income, self assessed health status, wait times for appointments, and professional background of the provider. Insights into these factors underlying patient satisfaction can help health policymakers and providers to design services and allocate resources to improve patients’ experience. Structuring primary care in ways that address social determinants of health, drawing on the skills and leadership of multidisciplinary teams, creating efficient systems for reducing wait times and attending to patients’ perceptions of their health and ability to function in their daily lives are actions that may enhance patient satisfaction.