Elkahtib Zoheir
Department of Health, United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), Gaza Field Office, Gaza, occupied Palestinian territory.
Lancet. 2018 Feb 21;391 Suppl 2:S52. doi: 10.1016/S0140-6736(18)30418-5.
Most health-care organisations are increasingly interested in assessing the quality of their services. Patient satisfaction has a central role in the quality assessment in health care because it reflects the appropriateness of services from the clients' perspectives. The aim of this study was to assess the level of satisfaction in patients with non-communicable diseases (mainly diabetes and hypertension) who receive services from UNRWA health centres in Gaza governorates.
In this cross-sectional study we chose a random sample of participants who presented to the randomly selected six health centres for treatment of non-communicable diseases. Through an exit interviewing technique, participants were chosen according to the study eligibility criteria and were requested to complete a questionnaire. The total instrument reliability (Cronbach's Alpha) was very high (0·936). To examine construct validity, we used Factor Analysis Principal Component Extraction with Varimax Rotation and Kaiser Normalisation with a cutoff point of 0·4. The reported variance was 42·28%, indicating high validity. Ethical approval from the Palestinian Ministry of Health (the Helsinki committee) was obtained, and verbal consent was obtained from the participants.
327 (82%) of 400 eligible patients completed the questionnaire. The reported overall satisfaction level with services for non-communicable diseases was moderately high (72%). The study extracted six domains that could constitute a framework for patient satisfaction with services at UNRWA clinics for non-communicable diseases. Elicited satisfaction scores about these domains varied and ranged from 57% to 84%. Although high satisfaction levels were found with general impressions, accessibility, communication, and interpersonal relationships, patients had a low level of satisfaction with the technical quality of services, clinic environment, and convenience of the services. People who were unmarried, working, living in the southern governorates of Gaza, educated, and had received educational materials were more satisfied than their counterparts. Patients who were seen by a specific health provider, who received all their medications from UNRWA, and who had not been turned away from a clinic without receiving the service they came for were more satisfied than their counterparts. The level of patient satisfaction did not differ by sex, age, presence of disability, presence of complications associated with non-communicable diseases, control status, kind of non-communicable disease, type of treatment provided, or duration of the non-communicable disease.
Increasing the convenience and promoting the technical quality of work are important to improve the experience of patients with non-communicable disease. Furthermore, health managers and health providers could use these study findings to focus on those who are at risk of losing their satisfaction with services.
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大多数医疗保健机构对评估其服务质量越来越感兴趣。患者满意度在医疗保健质量评估中起着核心作用，因为它从客户的角度反映了服务的适宜性。本研究的目的是评估在加沙地带从近东救济工程处保健中心接受服务的非传染性疾病（主要是糖尿病和高血压）患者的满意度水平。
在这项横断面研究中，我们从随机选择的六个治疗非传染性疾病的保健中心中随机抽取了一组参与者样本。通过出院访谈技术，根据研究纳入标准选择参与者，并要求他们填写一份问卷。整个问卷的信度（克朗巴哈系数）非常高（0·936）。为了检验结构效度，我们使用了主成分提取的因子分析，采用方差最大化旋转和凯泽标准化，临界值为0·4。报告的方差为42·28%，表明效度较高。获得了巴勒斯坦卫生部（赫尔辛基委员会）的伦理批准，并获得了参与者的口头同意。
400名符合条件的患者中有327名（82%）完成了问卷。报告的对非传染性疾病服务的总体满意度中等偏高（72%）。该研究提取了六个领域，这些领域可以构成近东救济工程处非传染性疾病诊所患者服务满意度的框架。关于这些领域的满意度得分各不相同，从57%到84%不等。虽然在总体印象、可及性、沟通和人际关系方面发现了较高的满意度，但患者对服务的技术质量、诊所环境和服务便利性的满意度较低。未婚、有工作、居住在加沙南部省份、受过教育且收到过教育材料的人比其他人更满意。由特定医疗服务提供者诊治、从近东救济工程处获得所有药物且未在未得到所寻求的服务的情况下被诊所拒之门外的患者比其他人更满意。患者满意度水平在性别、年龄、是否残疾、是否存在与非传染性疾病相关的并发症、控制状况、非传染性疾病类型、所提供的治疗类型或非传染性疾病持续时间方面没有差异。
提高便利性和提升工作技术质量对于改善非传染性疾病患者的体验很重要。此外，卫生管理人员和医疗服务提供者可以利用这些研究结果关注那些有可能对服务失去满意度的人群。
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