Economics, University of Fort Hare Faculty of Management and Commerce, Alice, South Africa
Economics, Stellenbosch University Faculty of Economic and Management Sciences, Stellenbosch, South Africa.
BMJ Glob Health. 2021 Apr;6(4). doi: 10.1136/bmjgh-2020-004360.
Universal Health Coverage is not only about access to health services but also about access to high-quality care, since poor experiences may deter patients from accessing care. Evidence shows that quality of care drives health outcomes, yet little is known about non-clinical dimensions of care, and patients' experience thereof relative to satisfaction with visits. This paper investigates the role of non-clinical dimensions of care in patient satisfaction.
Our study describes the interactions of informed and non-informed patients with primary healthcare workers at 39 public healthcare facilities in two metropolitan centres in two South African provinces. Our analysis included 1357 interactions using standardised patients (for informed patients) and patients' exit interviews (for non-informed patients). The data were combined for three types of visits: contraception, hypertension and tuberculosis. We describe how satisfaction with care was related to patients' experiences of non-clinical dimensions.
We show that when real patients (RPs) reported being satisfied (vs dissatisfied) with a visit, it was associated with a 30% increase in the probability that a patient is greeted at the facilities. Likewise, when the RPs reported being satisfied (vs dissatisfied) with the visit, it was correlated with a 15% increase in the prospect that patients are pleased with healthcare workers' explanations of health conditions.
Informed patients are better equipped to assess health-systems responsiveness in healthcare provision. Insights into responsiveness could guide broader efforts aimed at targeted education and empowerment of primary healthcare users to strengthen health systems and shape expectations for appropriate care and conduct.
全民健康覆盖不仅关乎获得医疗服务，还关乎获得高质量的医疗服务，因为较差的就医体验可能会阻碍患者寻求医疗服务。有证据表明，医疗质量会影响健康结果，但人们对医疗服务的非临床维度知之甚少，也不了解患者对这些维度的体验及其与就诊满意度的关系。本文探讨了医疗服务非临床维度在患者满意度方面的作用。
我们的研究描述了在南非两个省份的两个大都市中心的 39 家公立医疗保健机构中，有信息的患者和无信息的患者与初级保健工作者之间的互动。我们使用标准患者（有信息的患者）和患者的就诊结束访谈（无信息的患者）分析了 1357 次互动。这些数据包括避孕、高血压和结核病三种类型的就诊。我们描述了患者对非临床维度的体验与对护理满意度的关系。
我们发现，当真实患者（RP）报告对就诊满意（vs 不满意）时，患者在设施中受到欢迎的可能性增加了 30%。同样，当 RP 报告对就诊满意（vs 不满意）时，患者对医疗保健工作者对健康状况的解释感到满意的可能性增加了 15%。
有信息的患者更能评估医疗服务中卫生系统的反应能力。对反应能力的了解可以指导更广泛的努力，针对初级保健用户进行有针对性的教育和赋权，以加强卫生系统并塑造对适当护理和行为的期望。
