| Abstract|| |
Context: Patient satisfaction is a determinant of treatment uptake and adherence to Directly Observed Treatment Short course (DOTS) therapy for Tuberculosis (TB). Waiting time, staff's attitude and improvement in symptoms may affect patient's satisfaction. Aims: The rationale of the present study is to assess the levels of satisfaction among patients utilizing the DOTS services and the factors contributing toward patient satisfaction. Settings and Design: Cross-sectional study. Study Duration: Jan 2009 to March 2009. Study Area: Four Designated Microscopic Centers (DMCs) of District Jhansi. Materials and Methods: Exit interviews of all the patients who were diagnosed as TB cases and put on DOTS in the first quarter of 2009 (i.e., subjects registered from 1 st January 2009 to 31 st March 2009) at four selected DMCs were taken on pre-tested questionnaire. Statistical Analysis: Results are expressed in percentages. Results: Average waiting time at center reported was 5-10 minutes by majority of cases (42.7%). Approx.78.6% patients were fully satisfied with the services provided at the centers. Lack of financial burden was the most common reason for satisfaction (95.4%), followed by improvement in symptoms (75%). Most common problems faced by the patients was difficult in coming on alternate days (30.0%) followed by loss of wages and transport charges (26.8%). Conclusion: The study findings could potentially be explored to improve DOTS services to attain maximum satisfaction among TB patients.
Keywords: DOTS, satisfaction, tuberculosis
|How to cite this article:|
Srivastav S, Mahajan H. Satisfaction levels among patients availing DOTS services in Bundelkhand Region (UP), India: Evidence from patient exit-interviews. Ann Trop Med Public Health 2014;7:116-9
|How to cite this URL:|
Srivastav S, Mahajan H. Satisfaction levels among patients availing DOTS services in Bundelkhand Region (UP), India: Evidence from patient exit-interviews. Ann Trop Med Public Health [serial online] 2014 [cited 2019 Sep 17];7:116-9. Available from: http://www.atmph.org/text.asp?2014/7/2/116/146398
| Introduction|| |
Tuberculosis (TB) is a global health concern. More than 90% of global TB cases and deaths occur in the developing world.  World Health Organization (WHO) recommends the Directly Observed Treatment Short-course (DOTS) strategy for control of TB. 
Promoting patient's compliance through a patient-centered approach is the key factor in the treatment success.  Satisfied patients are more likely to utilize health services and comply with medical treatment. 
The present study aims to assess the levels of satisfaction among patients utilizing the DOTS services and the factors contributing toward patient's satisfaction, as working on these factors would help in improvement of services.
| Materials and Methods|| |
Cross-sectional study design.
Jan 2009 to March 2009.
Four Designated Microscopic Centers (DMCs) of District Jhansi.
Diagnosed TB cases on DOTS registered in study area between Jan 2009-March 2009.
The present study on implementation of DOTS strategy was conducted in the District of Jhansi (Uttar Pradesh). Jhansi has a population of approximately 20 lakhs (20, 079, 89). It has 4 TB Units (TU) covering a population of approximately 5 lakhs each: TU District Hospital Jhansi, TU Moth, TU Mauranipur and TU Gursarai. To select the study subjects, two-stage sampling technique was used. In the first stage of sampling, out of 4 TUs, one urban and one rural TU were selected. Since there is only one TU District Hospital Jhansi functional in urban area, so it was selected for the study. Out of three rural TUs, TU Moth was selected by simple random sampling technique. TU District Hospital Jhansi has 6 DMCs and TU Moth has 5 DMCs. In the second stage of sampling, 2 DMCs were selected from respective TU by simple random sampling technique.
Selected DMCs were
1. TU District Hospital Jhansi - DMC at District Hospital Jhansi and DMC at Medical College, Jhansi.
2. TU Moth - DMC at Primary Health Center (PHC) Baragaon and DMC at PHC Chirgaon.
To ascertain the socio-demographic profile of patients and assess the satisfaction levels, exit interviews of all the patients who were diagnosed as TB cases and put on DOTS in the first quarter of 2009 (i.e., subjects registered from 1 st January 2009 to 31 st March 2009) at four selected DMCs were taken on pretested questionnaire. Total patients put on DOTS during this period in study area were 220. Data was analyzed and results recorded in terms of percentages.
| Results|| |
Of the total TB cases, 72.7% were males and 27.2% were females. Maximum TB cases were reported in the 26-45 years of age group in both the sexes. In reference to place of dwelling, majority of cases were from rural areas (62.7%) as compared to urban areas (37.3%) [Table 1].
Patients were asked about average waiting time at the center for getting drugs. Average waiting time at center reported was 5-10 minutes by majority of cases (42.7%), while 4.5% cases reported waiting time of more than 20 minutes for getting medication [Table 2].
|Table 2: Distribution of T.B patients according to waiting time to receive drugs|
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Patients were asked about number of doses of treatment taken after which improvement in symptoms was observed. Majority of patients (80%) reported improvement in symptoms within 6-12 doses of ATT; however, 14.5% improved with 5 doses, and 5% took more than 12 doses for initial improvement of symptoms [Table 3].
|Table 3: TB patients according to number of doses for initial improvement of symptoms|
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Majority of the patients (52.7%) felt that the DOTS staff was fully sympathetic; however, 9.2% of the patients reported the rude attitude of staff [Table 4].
|Table 4: TB patients according to perceived attitude of DOTS staff toward patients|
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It is encouraging to note that 78.6% patients were fully satisfied with the services provided at the centers, whereas 13.2% patients were unsatisfied with the services [Table 5].
|Table 5: Satisfaction levels of Patients with services provided at Centers|
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Among the reasons for satisfaction with the services, lack of financial burden to patients for availing treatment was the most common reason for satisfaction (95.4%), as well as improvement in symptoms (75.4%) [Table 6].
|Table 6: Reasons for satisfaction with services as enumerated by respondents (multiple responses)|
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Out of total 220 patients interviewed, 201 patients had one or other problem in availing treatment. Most common problems faced by majority of patients were difficulty in coming on alternate days (30%) followed by loss of wages/transport charges (26.8%) and no improvement in symptoms (20%). However, it is encouraging to note that disease's social stigma is reported by only 5% patients [Table 7].
|Table 7: Problems faced by patients in availing treatment (single response)|
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| Discussion|| |
The success of DOTS depends mainly on the quality of services provided under the RNTCP program and the satisfaction levels among the patients taking DOTS.
In the present study, 78.6% patients were fully satisfied, 8.2% were somewhat satisfied and 13.2% were not satisfied with the services provided in the centers. These findings are similar to that found by Gupta et al.,  in Meerut district of Uttar Pradesh where 67.8% were highly satisfied, 16.7% were just satisfied and 15.5% were not satisfied with the services. However, higher satisfaction from DOTS services were found in a study conducted by Nezenega et al.,  in Ethiopia where 90% of the patients were satisfied with the DOTS services.
Among the reasons for satisfaction with the services, lack of financial burden to patients for availing treatment was the most common reason for satisfaction (95.4%) followed by improvement in symptoms (75%). These findings are different from that reported by Kilale et al., in Tanzania where it was found that the most common reason for patient satisfaction was good patient-provider relationship (57.8%), followed by improvement in symptoms (12.5%) and quick and prompt service (9.4%). 
In the present study, it was found that of the total 220 patients interviewed, 201 patients had one or other problem in availing treatment. Most common problems faced by the majority of patients was difficult in coming on alternate days (30%), followed by financial loss in the form of loss of wages/transport charges (26.8%) and non-improvement of symptoms in 20% of patients. In contrast to this, the study conducted by Nezenega et al.,  in Ethiopia showed that the most common reasons for non-compliance of treatment were absence of drugs (58.9%), health facilities far away from home (8.5%) and difficulty in taking so many pills (6.8%).
Another study from Pakistan conducted by Khan et al.,  found that the high costs of attending DOTS center may be deterring patients in coming to these centers and the patients had to lose a lot of time for taking the direct observation treatment. It is important to provide DOTS at a time and place that is convenient and acceptable to patients.
| Conclusion|| |
Although patients reported high levels of satisfaction from RNTCP DOTS services, still dissatisfaction due to financial loss in the form of loss of wages and transport charges and non-improvement of symptoms in patients has been found in the study. These factors leading to dissatisfaction can further be explored to remove them as far as possible, which can further help in improving the performance of RNTCP program in India.
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Department of Community Medicine, School of Medical Sciences and Research, Plot No. 32-34, Knowledge Park 3, Sharda University, Greater Noida - 201 306, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]