OBJECTIVE:
To
examine the associations between perceived quality of care and patient
satisfaction among HIV and non-HIV patients in Zambia.
PRIMARY INDEPENDENT VARIABLES:
Five
dimensions of perceived quality of care (health personnel practice and conduct,
adequacy of resources and services, healthcare delivery, accessibility of care,
and cost of care).
METHODS:
Indices
of perceived quality of care were modelled using principal component analysis.
Statistical associations between perceived quality of care and patient
satisfaction were examined using random-effect ordered logistic regression models,
adjusting for demographic, socioeconomic, visit and facility characteristics.
RESULTS:
Average
satisfaction was 6.9 on a 10-point scale for non-HIV services and 7.3 for HIV
services. Favourable perceptions of health personnel conduct were associated with
higher odds of overall satisfaction for non-HIV (OR=3.53, 95% CI 2.34 to 5.33)
and HIV (OR=11.00, 95% CI 3.97 to 30.51) visits. Better perceptions of
resources and services were also associated with higher odds of satisfaction
for both non-HIV (OR=1.66, 95% CI 1.08 to 2.55) and HIV (OR=4.68, 95% CI 1.81
to 12.10) visits. Two additional dimensions of perceived quality of
care-healthcare delivery and accessibility of care-were positively associated
with higher satisfaction for non-HIV patients. The odds of overall satisfaction
were lower in rural facilities for non-HIV patients (OR 0.69; 95% CI 0.48 to
0.99) and HIV patients (OR=0.26, 95% CI 0.16 to 0.41). For non-HIV patients,
the odds of satisfaction were greater in hospitals compared with health centres/posts
(OR 1.78; 95% CI 1.27 to 2.48) and lower at publicly-managed facilities
(OR=0.41, 95% CI=0.27 to 0.64).
CONCLUSIONS:
Perceived
quality of care is an important driver of patient satisfaction with health
service delivery in Zambia.
Below: Composition of overall
ratings, at facilities with at least 10 surveys conducted with patients of the
specified visit type. Note: each vertical bar represents a health facility.
Within each bar, each colour shows the proportion of patients interviewed at that
facility that gave the rating associated with that colour in the legend.
- 1Department of Public Health, Institute for Health Metrics and Evaluation, Seattle, Washington, USA.
- 2Department of Economics, University of Zambia, Lusaka, Zambia.
- 3Department of Public Health, University of North Carolina, Chapel Hill, North Carolina, USA.
- 4Department of Economics & International Business, Sam Houston State University, Huntsville, Texas, USA.
- BMJ Open. 2015 Dec 30;5(12):e009700. doi: 10.1136/bmjopen-2015-009700.
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