Chimbindi Natsayi, Bärnighausen Till, Newell Marie-Louise
Wellcome Trust Africa Centre for Health and Population Sciences, University of KwaZulu-Natal, Durban, South Africa.
BMC Health Serv Res. 2014 Jan 23;14:32. doi: 10.1186/1472-6963-14-32.
Patient satisfaction is a determinant of treatment uptake, adherence and retention, and an important health systems outcome. Queues, health worker-patient contact time, staff attitudes, and facility cleanliness may affect patient satisfaction. We quantified dimensions of patient satisfaction among HIV and TB patients in a rural sub-district of KwaZulu-Natal, South Africa, and identified underlying satisfaction factors that explained the data.
We conducted patient-exit interviews with 300 HIV and 300 TB patients who were randomly selected using a two-stage cluster random sampling approach with primary sampling units (primary healthcare clinics) selected with probability-proportional-to-size sampling. We performed factor analysis to investigate underlying patient satisfaction factors. We compared the satisfaction with HIV and TB services and examined the relationships between patient satisfaction and patients' socio-demographic characteristics in multivariable regression.
Almost all patients (95% HIV, 97% TB) reported to be globally satisfied with the healthcare services received on the day of the interview. However, patient satisfaction with specific concrete aspects of the health services was substantially lower: 52% of HIV and 40% of TB patients agreed that some staff did not treat patients with sufficient respect (p = 0.02 for difference between the two patient groups); 65% of HIV and 40% of TB patients agreed that health worker queues were too long (p < 0.001). Based on factor analysis, we identified five factors underlying the HIV data and the TB data (availability, accommodation, acceptability and communication for HIV and TB patients; health worker preference for HIV patients only; and global satisfaction for TB patients only). The level of satisfaction did not vary significantly with patients' socio-demographic characteristics.
In this rural area, HIV and TB patients' evaluations of specific aspects of health services delivery revealed substantial dissatisfaction hidden in the global assessments of satisfaction. A wide range of patient satisfaction variables could be reduced to a few underlying factors that align broadly with concepts previously identified in the literature as affecting access to healthcare. Increases in health systems resources for HIV and TB, but also improvements in facility maintenance, staff attitudes and communication, are likely to substantially improve HIV and TB patients' satisfaction with the care they receive in public-sector treatment programmes in rural communities in South Africa.
患者满意度是治疗接受度、依从性和持续性的一个决定因素，也是卫生系统的一项重要成果。排队情况、医护人员与患者的接触时间、工作人员态度以及设施清洁程度可能会影响患者满意度。我们对南非夸祖鲁 - 纳塔尔省一个农村地区的艾滋病毒和结核病患者的患者满意度维度进行了量化，并确定了解释这些数据的潜在满意度因素。
我们采用两阶段整群随机抽样方法，以概率与规模成比例抽样选择初级抽样单位（基层医疗诊所），对300名艾滋病毒患者和300名结核病患者进行了出院访谈。我们进行了因子分析以调查潜在的患者满意度因素。我们比较了对艾滋病毒和结核病服务的满意度，并在多变量回归中研究了患者满意度与患者社会人口学特征之间的关系。
几乎所有患者（95%的艾滋病毒患者、97%的结核病患者）报告在访谈当天对所接受的医疗服务总体满意。然而，患者对医疗服务具体方面的满意度要低得多：52%的艾滋病毒患者和40%的结核病患者认为一些工作人员没有给予患者足够的尊重（两组患者之间的差异p = 0.02）；65%的艾滋病毒患者和40%的结核病患者认为医护人员排队时间太长（p < 0.001）。基于因子分析，我们在艾滋病毒数据和结核病数据中确定了五个因素（艾滋病毒和结核病患者的可及性、便利性、可接受性和沟通；仅艾滋病毒患者对医护人员的偏好；以及仅结核病患者的总体满意度）。满意度水平与患者的社会人口学特征没有显著差异。
在这个农村地区，艾滋病毒和结核病患者对医疗服务提供具体方面的评价显示，在总体满意度评估中隐藏着大量不满。广泛的患者满意度变量可以归结为几个潜在因素，这些因素与文献中先前确定的影响医疗服务可及性的概念大致相符。增加用于艾滋病毒和结核病的卫生系统资源，同时改善设施维护、工作人员态度和沟通，可能会大幅提高南非农村社区公共部门治疗项目中艾滋病毒和结核病患者对所接受护理的满意度。 满意度。
