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ORIGINAL ARTICLE  
Year : 2013  |  Volume : 6  |  Issue : 2  |  Page : 240-244
A cross-sectional study on patient satisfaction toward services received at rural health center, Chandigarh, North India


1 Department of Community and Family Medicine, AIIMS, Raipur, India
2 Department of Community Medicine, Government Medical College and Hospital, Chandigarh, India

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Date of Web Publication14-Aug-2013
 

   Abstract 

Background : Shortcomings in the delivery of primary health care services at state-run centers and more dependence on private health care service providers has resulted in lesser utilization rates. Feedback from patients is vital if deficiencies are to be identified and improvements achieved. This study attempts to assess client satisfaction of the PHC services provided by a rural health training center. Objectives : The main objective of the study is to measure the satisfaction of OPD patients at a rural health center, and also (1) to know the relationships between the various determinants and OPD patients satisfaction and (2) to correlate patient satisfaction with the sociodemographic profile. Materials and Methods : A cross-sectional study was done to assess the satisfaction of services provided at the rural health center which caters to population of around 40,000. The response was rated on a 5-point Likert scale. SPSS version 15 was used to analyze the data. Average satisfaction of each patient was taken and the overall mean and SD was calculated to know about the overall satisfaction. Results : The mean age is 33.45 ± 10.719 years. The mean waiting time for consultancy was 11.84 ± 8.932 min. The mean consultation time by the physician was 6.06 ± 3.002 min. The mean waiting time for drugs is 5.93 ± 5.213 min. Only 28.5% were highly satisfied with the available lab investigations. 58.5% of the clients were highly satisfied with the doctor's relationship with the patients. 63% felt that adequate privacy was given during consultation. Conclusions : The results of the present study showed that although the overall satisfaction was high, some aspects of services indicated some degree of dissatisfaction.

Keywords: Primary health care, satisfaction, utilization, respondents

How to cite this article:
Galhotra A, Sarpal SS, Gupta S, Goel NK. A cross-sectional study on patient satisfaction toward services received at rural health center, Chandigarh, North India. Ann Trop Med Public Health 2013;6:240-4

How to cite this URL:
Galhotra A, Sarpal SS, Gupta S, Goel NK. A cross-sectional study on patient satisfaction toward services received at rural health center, Chandigarh, North India. Ann Trop Med Public Health [serial online] 2013 [cited 2019 Sep 23];6:240-4. Available from: http://www.atmph.org/text.asp?2013/6/2/240/116501

   Introduction Top


India has rich centuries of old heritage of medical and health services. The philosophy of Ayurveda and surgical skills associated by Charka and Sushruta bear testimony to our ancient tradition in the scientific health care of our people. The approach of our ancient medical systems was of holistic nature, which took into account all aspects of human health and disease over the centuries. With intrusion of foreign influences and mingling of cultures, various systems of medicine evolved and have continued to be practiced widely. However, the allopathic system of medicine has, in a relatively short period of time, made a major impact on the entire approach to health care and pattern of development of health services infrastructure in the country. Over the last five decades, a vast network of health care services has been created. The existing model of health care evolved over the last 200 years. An urban-based top-down elite oriented pattern still continues to dominate the health services, in spite of expansion of primary health care services in the last 50 years of independence. Primary Health Care has been defined in the Alma Ata International Conference as "the essential health care made universally accessible to the individuals and acceptable to them, through their full participation and at a cost the community and country can afford." The Government of India was a signatory to Alma Ata declaration and committed to providing quality primary health care services to achieve health for all. The key principles of PHC are community participation, equitable distribution, intersectoral co-ordination and appropriate technology. [1] PHC services have been made available by the GOI by the establishment of PHC institutions. But, because of shortcomings in the delivery of PHC services, it has resulted in lesser utilization rates and more dependence on private health care service providers. A thorough understanding of the needs and expectations of the community about the health care services can help in better delivery and higher utilization of services. [2] Feedback from patients is vital if deficiencies are to be identified and improvements achieved. Satisfaction can be defined as the extent of an individual's experience compared with his or her expectations. Patient satisfaction is an important indicator of quality of primary care and health care performance. [3],[4] Continuous quality improvement is linked to the use of timely and useful feedback from clients. Patients constitute the hospital's direct clientele. The overall satisfaction is an important aspect of service itself and is considered to be an important outcome measure for health services. Patient care is not considered to be of high quality unless the patient is satisfied. This study attempts to assess client satisfaction of the PHC services provided by RHTC, Palsora.


   Materials and Methods Top


This study was conducted in a Rural Health Training Centre attached with the department of community medicine of Govt. Medical College, Sector 32, Chandigarh (U.T). The R.H.T.C. is located in Sector 56 of Chandigarh and it caters to a population of around 40,000. The center has an average OPD of 100-110 clients per day. The services offered here include General OPD services, ANC services every Tuesday, and Immunization services on Wednesdays and Saturdays. Apart from these, every Saturday there is Psychiatry OPD and along with it there is an Eye OPD where refraction and common eye problems are dealt with by experts from the Medical College. The General OPD of the center is manned by faculty and medical officers from the Department of Community medicine.

A cross-sectional study was planned to assess the satisfaction of services provided at the center. The study included both male and female adult patients attending the OPD of the said center. Subjects were selected by using a systematic random sample at the registration counter by taking every fifth patient according to their order of attendance, between March and May 2011. For this study, we presumed maximum variability; hence, we considered prevalence of patient satisfaction as 50%. Keeping logistics and feasibility in mind, it was decided to include 200 exit interviews. A patient attending the OPD and having age above 18 years was included in the study after taking informed consent. Patient working in the health care facility and patients with serious physical or mental pathologies, such as terminal disease and psychosis, were excluded from the study.

Interview schedules were developed with inputs from the existing literature. The interview schedule was prepared in English and translated in Hindi-Punjabi. Pre-testing was done and relevant modifications were made. The interview schedule included demographic details of the respondents, patient's choice of health facility, behavior of doctors, skills of doctors, drugs available in pharmacy, other facilities available in the waiting area, etc.

The survey was administered by a specially trained medical social worker working in the same facility. A verbal consent was taken from the patient before starting to fill the questionnaire. The response was rated in a 5-point Likert scale as "strongly agree," "agree," "neither agree nor disagree," "disagree," and "strongly disagree."

SPSS version 15 was used to analyze the data. The mean, standard deviation, and frequency distribution were calculated. Chi-Square, ANOVA, and t-test were done to analyze the data. Average satisfaction of each patient was taken and the overall mean and SD was calculated to know about the overall satisfaction.


   Results Top


The total number of respondents was 200. In the study sample, the mean age is 33.45 ± 10.719 years. 74.5% (149) respondents were female while 25.5% (51) respondents were males. 25% of the study group were illiterate, 14% were educated up to primary level, 15.5% up to middle level, 15% were matriculate, 24% were 10+2, while 6.55 were graduates. 61% of the study subjects were house wives. 20.5% were skilled workers, 9.5% were unskilled workers, 6% were unemployed, and 3% were students. Majority (84.5%) had visited RHTC for health care needs in the last 3 months while 6.5% consulted private practitioners and 5% visited the civil hospital. 54% of the illiterates visit RHTC due to free availability of drugs. 94.5% cited "nearer to home" as a reason for choosing RHTC as a health facility, while 59% attributed the pleasant behavior of staff as the reason for choosing RHTC [Table 1]. 57.5% and 63.5% were highly satisfied with the availability of the drugs and health information provision, respectively. Only 28.5% were highly satisfied with the available lab investigations. The mean waiting time for consultancy is 11.84 ± 8.932 min (1-45 min). The mean consultation time by the physician is 6.06 ± 3.002 min (2-20 min). The mean waiting time for drugs is 5.93 ± 5.213 min (1-20 min).
Table 1: Reasons for choosing RHTC as a health facilitya

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All (100%) patients were satisfied with sitting arrangement, cleanliness, and fans, while 99% were satisfied with the lighting arrangement. 11.5% of the respondents were of the view that toilets are available but dirty and 14.5% said that there was no drinking water facility.85.5% were aware about drinking water facilities, while 14.5% were not aware about the same. 58.5% of the clients were highly satisfied with the doctor's relationship with the patients. 61% and 72% were highly satisfied with the physician's advice and medical skills, respectively. 63% felt that adequate privacy was given during consultation [Table 2]. A significant relationship between the educational status of the patient and perception of patient relationship with the doctors wasseen in the study.= Pearson's Chi-Square value = 13.921; df = 5, P-value = 0.016 [Table 3]. The mean overall satisfaction was 1.81 with a standard deviation of 0.465.
Table 2: Distribution of highly satisfied respondents with doctors

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Table 3: Educational status vs. satisfaction with doctors

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   Discussion Top


The result of the present study shows that majority of the respondents were female (74.5%) and 61% were house wives. A large number of female patients may be explained due to the fact that OPD hours are in the morning when most of the men are at work.

45.5% of the study subjects were educated up to either matric or above. The mean age of the study sample was 33.45 ± 10.719 years. A study done in Qatar [3] showed that 46.5% of the study samples were graduate whereas a study done by Sodani et al. [4] showed that 39% of respondents were illiterate or primary passed (18%).

In the present study, RHTC, being nearer to home (94.5%) was the major reason for choosing it as a health facility. The study by Sodani et al. [5] showed that inexpensiveness and good infrastructure was one of the (83%) most cited reasons for choosing the public health facilities by the OPD patients whereas in the present study 38% and 1.5% cited inexpensiveness and good infrastructure as the reasons for choosing this particular public health facility.

In the study by Sodani et al. most of half of the respondents (54%) found sitting arrangement adequate whereas in the present study 100% found sitting arrangement adequate. In the present study, the respondents were satisfied with the basic amenities such as seating arrangement, cleanliness, lighting arrangement and fans, etc. 81% of the respondents found that toilets were available and clean and 11.5% found that toilets were available but dirty. 94% of the illiterate clients felt toilets were available and clean. May be as the literacy level increases the awareness about personal hygiene also increases.

In a study in a similar setting, Sodani found that 49% of the respondents said that toilets are available but dirty.

In the present study, the mean waiting time for consultancy is 11.84 ± 8.932 min, the mean consultation time by the physician is 6.06 ± 3.002 min. In a similar study from Bangladesh, [6] the average waiting time was 30 ± 2.5 min and average consultation time was 2.3 min.

Patro et al. [2] found that the average waiting time for consultancy was approximately 30-35 min and the consultation time was approximately 5 min. The waiting time for getting the drugs from the pharmacy after consultation with the physician was 15-20 min.In a similar study in Lucknow district authors concluded that average waiting time was more than 30 min for 62.5% of the patients [7] whereas in the present study the mean waiting time for drugs is 5.93 ± 5.213 min.

The present study shows a significant relationship between the educational status of the patient and perception of patient relationship with the doctors. As the educational status increases, they tend to be less satisfied in their relationship with the doctors. Less educated patients feel that they have a better relationship with the doctors [Table 4]. Less educated patients are more satisfied with the time devoted by the doctors. Similar findings were observed in a study in rural Bengal by Palas Das et al. [8]
Table 4: Client's perception of inexpensiveness versus their educational status

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In the present study, 63% were satisfied with the privacy during consultation. In the study by Palas Das et al., [8] 86.75% were satisfied with privacy whereas Jawahar [9] found that 97.5% of the patients were satisfied with regard to privacy in consultation. In a study in Kuwait, authors have satisfaction was high on pharmacy and low on building. [10] In a study in Andhra Pradesh authors have shown level of satisfaction was about 65%. [11]


   Conclusions Top


Recently, there has been growing interest in assessing and assuring quality of health care. It is being increasingly recognized that consumer satisfaction should be taken into account as part of assessment of quality of care. The results of the present study showed that although the overall satisfaction was high, some aspects of services indicated some degree of dissatisfaction. These gaps may be overcome by generating awareness among community by holding meetings and extensive IEC programs, inviting opinions and suggestions from clients and encouraging enhanced community participation. Simultaneously, measures are to be taken by policy makers and hospital administrators to increase the patient satisfaction at public health facilities.

Efforts are needed to strengthen infrastructure and human resources at a lower level of health facilities. The findings of this study can be utilized to improve the services at public health facilities of the state resulting in more satisfaction of patients availing such public health facilities.

Recommendations

Based on the findings of the present study, the following recommendations are being suggested for improvement of health services:

  • Length of time of OPD may be increased. Basically, in the present setup, OPD is restricted to morning hours. So, 1 h evening OPD may be planned.
  • More variety of drugs may be made available.
  • Periodic training/retraining of doctors in various specialities may be undertaken.
  • If the logistics permit, more lab. tests like LFT, RFT, etc. may be included.
  • Emphasis should be given for health education. Health Education materials like banners, posters, pamphlets, etc. should be displayed/distributed.
  • Small health educational talks can be arranged for waiting patients in the waiting area.


 
   References Top

1.Park K. Text book of preventive and social medicine. Jabalpur: Banarsidas Bhanot Publishers; 2009. p. 791-3.  Back to cited text no. 1
    
2.Patro BK, Kumar R, Goswami A, Nongkynrih B, Pandav CS. Community perception and client satisfaction about primary health care services in an urban resettlement colony of New Delhi. Indian J Community Med 2008;33:250-4.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
3.Emadi N, Falamarzi S, Al-Kuwari MG, Al-Ansari A. Patient satisfaction with Primary health care services in Qatar. MEJFM Mournal2009;7:4-9.  Back to cited text no. 3
    
4.Gadallah M, Zaki B, Rady M, Anwer W, Sallam I. Patient satisfaction with primary health care services in two districts in Lower and Upper Egypt. East Mediterr Health J 2003;9:422-30.  Back to cited text no. 4
[PUBMED]    
5.Sodani PR, Kumar R, Srivastava J, Sharma L. Measuring patient satisfaction: A case study to improve quality of care at public health facilities. Indian J Community Med 2010;35:52-6.  Back to cited text no. 5
[PUBMED]  Medknow Journal  
6.Aldana MJ, Piechulek H, Al-Sabir A. Client satisfaction and quality of health care in rural Bangladesh. Bull World Health Organ 2001;79:512-7.  Back to cited text no. 6
    
7.Kumari R, Idris MZ, Bhushan V, Khanna A, Agarwal M, Singh SK. Study on patient satisfaction in Government Allopathic health facilities of Lucknow District, India. Indian J Community Med 2009;34:35-42.  Back to cited text no. 7
[PUBMED]  Medknow Journal  
8.Das P, Basu M, Tikadan T, Biswas GC, Mridha P, Pal R. Client satisfaction on maternal and child health services in rural Bengal. Indian J Community Med 2010;35:478-81.  Back to cited text no. 8
[PUBMED]  Medknow Journal  
9.Jawahar SK. A study on out patient satisfaction at a super speciality hospital in India. Internet J Med Update 2007;2:13-7.  Back to cited text no. 9
    
10.Al-Eisa SI, Al-Mutar SM, Radwan MM, Al-Terkit AM. Patient's satisfaction with primary health care services at capital health region, Kuwait. MEJFM Middle East J of Family Medicine 2005;3:10-6.  Back to cited text no. 10
    
11.Mahapatra P, Srilatha S, Sridhar P. A patient satisfaction survey in public hospital. J Acad Hosp Adm 2001;13:11-15.  Back to cited text no. 11
    

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Correspondence Address:
Sandeep Singh Sarpal
House No. 1613, Sector 51 ESIC Society, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1755-6783.116501

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  [Table 1], [Table 2], [Table 3], [Table 4]



 

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