Patient satisfaction with ophthalmic outpatient services

INTRODUCTION

Patient satisfaction is the correlation between clients’ expectations of ideal care and their perception of the real care they receive. It is an important criterion for assessing the quality of healthcare services.^[1] The predictors of patients’ satisfaction are largely grouped into two: ^[2] Healthcare provider-related and patient-related characteristics.

A patient who accesses health care services in <24 h is considered an outpatient. The kind of health service such patients receive is called ambulatory care.^[3] The outpatient department in any hospital is the patient’s first point of contact with the hospital, and so it offers the hospital the opportunity to showcase the quality of its healthcare services.^[4]

Notably, today’s healthcare service users are better informed, a situation being driven by greater levels of information available to them through telecommunication.^[5] As a result, they have a higher expectation of quality care. Therefore, there is a need to improve healthcare quality to meet their expectations and achieve patient satisfaction.

Furthermore, patients who are satisfied with healthcare services are more likely to suggest them to other potential clients, which will increase the health institution’s income and profile. It is said that word of mouth is the best form of advertisement. The ripple effect of this in the “social media age” cannot be underestimated.^[6] This is particularly important because healthcare is now increasingly privatized and economically competitive.^[7] In addition, patient satisfaction increases the likelihood of compliance with treatment and keeping follow-up appointments. This could positively affect the outcome of care.^[1]

This study aimed to investigate the level of patient satisfaction, its predictors, and average pre-consultation waiting time in the ophthalmic outpatient unit and integrate the feedback into the health system for service improvement.

MATERIAL AND METHODS

This was a prospective, cross-sectional study carried out in the Ophthalmology Department of Jos University Teaching Hospital (JUTH) which is a tertiary health institution located in Jos, the capital city of Plateau State in the North-Central geopolitical zone of Nigeria.

The sample size was calculated using Fisher’s formula,^[8] based on a proportion (p) of 35.2% of participants who were satisfied with ophthalmic outpatient clinic services in a previous study in Calabar^[4], giving a sample size of 389 participants.

The booking list for each clinic formed the sampling frame, and participants were selected using a systematic sampling technique. The sampling interval was obtained by dividing the number of participants (1612) expected to be seen in the clinic within the 3 months of the study as obtained from the institution’s record by the sample size (389). The first participant was selected from each sampling frame using simple random sampling by balloting. Thereafter, subsequent participants were selected using a sampling interval of four. In an event where the next participant in line for selection was not eligible or was already enrolled, the participant was skipped, and the next eligible participant was picked. This was done on clinic days during the study period.

Participants who were 18 years and older, who visited the outpatient ophthalmology clinic and were willing to give consent were included, but all consenting adult participants with cognitive impairment or who were too ill to respond appropriately to the questions were excluded from the study.

After receiving ophthalmic outpatient care, the participants were interviewed using the short-form patient satisfaction questionnaire (PSQ-18) and the visit-specific satisfaction questionnaire (VSQ) (item 4).

The PSQ-18 contains 18 questions with 5-point Likert scale-type answers.^[9]

After item scoring, items (questions) within the same section were averaged together to give the mean satisfaction score for that section. This was done for all the sections. Then, the overall average satisfaction score was determined by the average of all the satisfaction scores of the sections of the PSQ-18. Participants who had a satisfaction score that was above or equal to the mean score were considered satisfied, while those with a satisfaction score below the mean score were considered dissatisfied.

The timing chart contains the patients’ clinic arrival time, and the pre-consultation waiting time (time spent waiting to be attended to by the doctor) in minutes.^[10]

The waiting time aspect of the VSQ was adopted to assess satisfaction with the pre-consultation waiting time (VSQ-waiting time, VSQ 4).^[11] The VSQ item 4 is scored using a 5-point scale ranging from 1 (poor) to 5 (excellent). The average satisfaction score with the waiting time was calculated. Participants who had a satisfaction score that was above or equal to the mean score were considered satisfied, while those with a satisfaction score below the mean score were considered dissatisfied.

All data were entered into a Microsoft Excel database and exported to a statistical package for social sciences version 23 (IBM Corp., Armonk, N.Y., USA) for analysis. Data entry was validated by double entry.

Frequencies and percentages were determined for qualitative variables, and mean and standard deviation were calculated for quantitative variables. The association between variables was assessed using Chi-square or Fisher Exact if Chi-square assumptions were not met and multivariate logistic regression was done to analyze predictors of patient satisfaction among participants. The level of statistical significance (P-value) was set at P <0.05.

Ethical approval was obtained from the Research Ethics Committee of Jos University Teaching Hospital (JUTH) (JUTH/DCS/IREC/127/XXXI/2270). Written informed consent was also obtained from participants) before enrollment into the study.

RESULTS

Patient satisfaction with ophthalmic outpatient services at JUTH

Most participants, 336 (86.4%) were satisfied with the ophthalmic outpatient services’ technical quality, next to it is communication, accounting for 301 (77.4%). Participants were least satisfied with the financial aspect, 208 (53.6%) [Table 2].

Table 2: Patients’ satisfaction with ophthalmic outpatient services at Jos University Teaching Hospital.

Satisfaction	Frequency (n)	Percentages
Satisfaction with communication
Satisfied	301	77.4
Dissatisfied	88	22.6
Satisfaction with technical quality
Satisfied	336	86.4
Dissatisfied	53	13.6
Satisfaction with the financial aspect
Satisfied	208	53.6
Dissatisfied	181	46.5
Satisfaction with interpersonal manner
Satisfied	249	64.0
Dissatisfied	140	36.0
Satisfaction with accessibility and convenience
Satisfied	220	56.6
Dissatisfied	169	43.4
Time spent with the doctor
Satisfied	215	55.3
Dissatisfied	174	44.7

The majority of the participants were satisfied with the overall ophthalmic outpatient services, as shown in Figure 1.

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Figure 1:

Overall satisfaction with ophthalmic outpatient services in Jos University Teaching Hospital.

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Participants’ clinic arrival time

The majority of the participants (74%) presented before work resumption time of 8 am. However, a few of them (1.5%) still came to the clinic very late at noon and later [Figure 2].

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Figure 2:

Arrival time.

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Pre-consultation waiting time (minutes)

The study revealed that a larger percentage of participants (43%) had a pre-consultation waiting time of more than 240 min, while just a few participants (13%) spent ≤120 min waiting for consultation. Overall average pre-consultation waiting time was 227 ± 91.5 min [Figure 3].

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Figure 3:

Pre-consultation waiting time of patients.

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Patients’ satisfaction with the pre-consultation waiting time

Patient satisfaction with the waiting time showed that about 41% of the patients were satisfied, while 59% of the patients were not satisfied with the waiting time [Figure 4].

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Figure 4:

Patient satisfaction with pre-consultation waiting time.

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DISCUSSION

The mean age of the participants in this study was 54 ± 15.8 years. This supports the statement that many causes of visual impairment and blindness are associated with increasing age. Hence, the elderly are more likely to visit the hospital for treatment.^[12] This finding is similar to a study in Ibadan-Nigeria.^[13]

The present study had more female participants. Since many of the causes of visual impairment are age-related and women have a longer life expectancy, more women could have a greater need for ophthalmic care than men.^[12] This is consistent with findings from similar studies in Onitsha-Nigeria^[14] and USA.^[15] However, another study done in South-Western Nigeria has shown that men access eye care services more than women as the men control household finances and women need the permission of men before accessing health care in several societies.^[16]

Overall, patient satisfaction with the ophthalmic outpatient services in JUTH was high. This is because many participants considered the hospital to have highly skilled and qualified staff. This is comparable to findings from studies done in Oghara-Nigeria ^[17] and Gaza.^[18] However, the finding is below the overall satisfaction score from a similar study in Nigeria.^[5] In contrast, the overall satisfaction in this study is higher than the findings from a study in Calabar-Nigeria.^[6]

This study found the following factors; communication, technical quality, and interpersonal relationships, to be predictors of satisfaction with ophthalmic outpatient services. These findings differ between studies due to variations in the sociocultural background of the patients, survey instruments used, inequality in the distribution of social amenities, and methodology, among many other factors.

The predictors of satisfaction with ophthalmic outpatient services found in this study are similar to findings in a study done in Iran.^[19] The present study showed no significant association between sociodemographic characteristics and overall satisfaction with ophthalmic outpatient services. This is consistent with a study in Iran.^[19]

This study revealed that participants were most satisfied with the technical quality of the services provided. This is comparable to what was found in Iran.^[19] Higher satisfaction with technical quality was reported in a study in Enugu-Nigeria^[20], while lower score was recorded in a survey conducted in Calabar-Nigeria.^[6] The financial aspect had the lowest satisfaction score. Some participants expressed dissatisfaction with the cost of services because they expected services to be free since it was a government or public facility. Furthermore, most of the participants were not enrolled under the National Health Insurance Scheme, which ensures patients pay only 10% of the total cost of treatment.^[6]

This is consistent with findings from a study done in Nigeria.^[6] Another study in Nepal^[1] revealed that a greater proportion of participants were satisfied with the cost of services. However, in a study from Enugu-Nigeria,^[20] participants were dissatisfied with the cost of services in the eye clinic.

Participants who were dissatisfied with the accessibility and convenience of the eye clinic attributed it to the bureaucracy experienced when accessing eye care in JUTH.

Similarly, slightly more than half of the participants were satisfied with the time spent with the doctor. High patient load resulting in doctors spending shorter time consulting in an attempt to attend to other patients in good time could explain the short consultation time. This is not unexpected in this setting as the eye clinic is crowded with few doctors attending to all the patients.

This is comparable to reports from a study in Nepal.^[21] The finding is far below the satisfaction scores observed in previous studies done in Nigeria^[15] and Iran,^[19] but higher than the report in a study in Sudan.^[22]

The present study revealed that the average pre-consultation waiting time was long. The long waiting time observed in this study was due to inadequate staffing with a high volume of patients, lack of specific appointment time, limited resources and equipment, etc. This is far longer than the waiting time found in a similar study done in the USA.^[23] The present study discovered that patient satisfaction with the pre-consultation waiting time was <50% because it was long.

It is comparable to the findings from a study done in Ethiopia.^[24] Higher satisfaction with the waiting time was reported in previous studies done in Nigeria,^[6,14] China,^[11] Nepal,^[1] and the USA.^[23]

These can be overcome if the hospital management focuses on the above areas. Other recommendations include regular stakeholder meetings to enlighten and encourage excellent work ethics among eye care workers, such as early work resumption, increased time efficiency, good communication skills, and good interpersonal relationships.

CONCLUSION

Outpatients attending the eye clinic of JUTH are particularly satisfied with the technical quality of services provided, there is however, a need to reduce the waiting time before consultation by staggering the appointment for patients and improving the human resources and infrastructure in the eye clinic.