Vol. 9, No. 3 Printed in Great Britain
Family Practice © Oxford University Press 1992
Patient Satisfaction in Primary Health Care. A Comparative Study of Two Modes of Treatment For Hypertension ANDERS CARLBERG AND GttSTA TIBBLIN
the care and showed satisfaction with the treatment, and the staff showed the same feelings towards the patients. The question remained whether these spontaneous and positive reactions can be confirmed in a systematic investigation of the patients' subjective experiences of the treatment. Is it possible to measure the patients' degree of satisfaction compared with traditional medical treatment of hypertension? What factors in the treatment influenced the patients in such a positive way? In the attempt to answer these questions, a study of two different modes of management of hypertension was made. The first group of patients was taken from the NPTH study, with its carefully designed treatment, and the other group was recruited from two health centres using traditional medical methods of hypertension treatment. The aim of the first part of this study was to investigate if the groups were comparable with respect to various factors. A second aim was to find out if there were any differences in the degree of satisfaction and evaluation of the care between the two groups.
INTRODUCTION The biomedical treatment of different states of illhealth, for example hypertension, is well described in the literature. There are also reports of the significance of the patients' attitudes towards and satisfaction with medical care for the course and results of the treatment.1"8 There are, however, fewer systematic investigations of patients' subjective experience in different settings of their treatment with respect also to medical outcome.*"12 Unusual and surprisingly positive reactions have been reported both from patients and from staff in a clinical study of hypertension.13 In this study of nonpharmacological treatment of hypertension (NPTH), eight health centres in mid-Sweden were included.14"16 Many patients spontaneously commented positively on
Department of Family Medicine, Uppsala University, Uppsala, Sweden. Correspondence to: Anders Carlberg, Department of Famiry Medicine, Uppsala University, Akademiska sjukhuset, S-751 85 Uppsala, Sweden.
304
Downloaded from http://fampra.oxfordjournals.org/ at Karolinska Institutet on May 25, 2015
Carlberg A and Tibblin G. Patient satisfaction in primary health care. A comparative study of two modes of treatment for hypertension. Family Practice 1992; 9: 304-310. The object of this study was to compare patients' experiences of two different treatments of hypertension (one mainly non-pharmacological and one pharmacological) and study the degree of patient satisfaction and experiences of treatment in general. The 1K3 patients in the non-pharmacological group participated in a two-year-long study of non-pharmacological treatment of hypertension (NPTH) at eight health centres in mid-Sweden. In addition to regular visits to the same doctor at the health centre, patients received monthly check-ups by a nurse at the health centre and participated in information programmes and group activities. The NPTH patients also used cuffs for home measurements of blood pressure. The 85 patients in the control group were recruited from two health centres and received traditional, pharmacological treatments of hypertension. The hypothesis was that the patients in the NPTH group would experience satisfaction with the treatment and perceive the treatment in general as more positive than those in the control group. The 250 patients have answered a postal inquiry with structured and open questions concerning the treatment. The results show that the patients in the NPTH group throughout this study have experienced higher satisfaction with the treatment and had a more positive attitude towards the treatment than the controls. The content and design of the treatment obviously had a positive influence on patient satisfaction.
305
PATIENT SATISFACTION IN HEALTH CARE
METHODS A questionnaire was constructed to study the patients' opinions, attitudes and satisfaction with the treatment. In addition, some background factors were measured. Information about the latest blood pressure was collected from each health centre. The questionnaires were practically identical for both groups. The questions were of VAS -type, 'put a cross' and open questions. Apart from information about latest blood pressure the background facts consisted of age, sex, antihypertensive drugs, the patients' judgement of ideal diastolic blood pressure and judgement of state of health. The NPTH group were asked two questions about the NPTH study and its completion. Based upon a review of the literature, opinions about the treatment were collected in questions about information given about the treatment,4"6-17"22 attitudes towards hypertension, attitudes towards medical treatment and the health services in general,9*23 opinions of the latest visit to the health centre,2-921*24
open questions on positive and negative aspects of the treatment,2-6 and, finally, an overall judgement of the treatment as a whole.2-6-10-18-23 The questionnaires were distributed by post (or via the health centres) to 95 patients in the control group and to 174 of the 400 patients in the NPTH group. The selection of NPTH patients was first planned to comprise all NPTH patients at two health centres to match the control group but was supplemented with every fourth patient from the remaining six NPTH centres. The reason for this was to make the NPTH study more representative. Data were collected from May to December 1987 (control group) and from December 1986 to February 1987 (NPTH group). The drop-out rate was 10.5"% for the controls and 5.2% for the NPTH group, which means that 85 and 165 patients respectively are included in this study. Statistics The SAS computer program was used for the calculation of mean values, SD and t-value and for x2-tests. As there is a rather high difference in variance between the groups the t-value for unequal variance has been used in the t-test. Before the statistical analysis open questions were categorized and coded according to content. Levels of significance used are
Family Practice © Oxford University Press 1992
Patient Satisfaction in Primary Health Care. A Comparative Study of Two Modes of Treatment For Hypertension ANDERS CARLBERG AND GttSTA TIBBLIN
the care and showed satisfaction with the treatment, and the staff showed the same feelings towards the patients. The question remained whether these spontaneous and positive reactions can be confirmed in a systematic investigation of the patients' subjective experiences of the treatment. Is it possible to measure the patients' degree of satisfaction compared with traditional medical treatment of hypertension? What factors in the treatment influenced the patients in such a positive way? In the attempt to answer these questions, a study of two different modes of management of hypertension was made. The first group of patients was taken from the NPTH study, with its carefully designed treatment, and the other group was recruited from two health centres using traditional medical methods of hypertension treatment. The aim of the first part of this study was to investigate if the groups were comparable with respect to various factors. A second aim was to find out if there were any differences in the degree of satisfaction and evaluation of the care between the two groups.
INTRODUCTION The biomedical treatment of different states of illhealth, for example hypertension, is well described in the literature. There are also reports of the significance of the patients' attitudes towards and satisfaction with medical care for the course and results of the treatment.1"8 There are, however, fewer systematic investigations of patients' subjective experience in different settings of their treatment with respect also to medical outcome.*"12 Unusual and surprisingly positive reactions have been reported both from patients and from staff in a clinical study of hypertension.13 In this study of nonpharmacological treatment of hypertension (NPTH), eight health centres in mid-Sweden were included.14"16 Many patients spontaneously commented positively on
Department of Family Medicine, Uppsala University, Uppsala, Sweden. Correspondence to: Anders Carlberg, Department of Famiry Medicine, Uppsala University, Akademiska sjukhuset, S-751 85 Uppsala, Sweden.
304
Downloaded from http://fampra.oxfordjournals.org/ at Karolinska Institutet on May 25, 2015
Carlberg A and Tibblin G. Patient satisfaction in primary health care. A comparative study of two modes of treatment for hypertension. Family Practice 1992; 9: 304-310. The object of this study was to compare patients' experiences of two different treatments of hypertension (one mainly non-pharmacological and one pharmacological) and study the degree of patient satisfaction and experiences of treatment in general. The 1K3 patients in the non-pharmacological group participated in a two-year-long study of non-pharmacological treatment of hypertension (NPTH) at eight health centres in mid-Sweden. In addition to regular visits to the same doctor at the health centre, patients received monthly check-ups by a nurse at the health centre and participated in information programmes and group activities. The NPTH patients also used cuffs for home measurements of blood pressure. The 85 patients in the control group were recruited from two health centres and received traditional, pharmacological treatments of hypertension. The hypothesis was that the patients in the NPTH group would experience satisfaction with the treatment and perceive the treatment in general as more positive than those in the control group. The 250 patients have answered a postal inquiry with structured and open questions concerning the treatment. The results show that the patients in the NPTH group throughout this study have experienced higher satisfaction with the treatment and had a more positive attitude towards the treatment than the controls. The content and design of the treatment obviously had a positive influence on patient satisfaction.
305
PATIENT SATISFACTION IN HEALTH CARE
METHODS A questionnaire was constructed to study the patients' opinions, attitudes and satisfaction with the treatment. In addition, some background factors were measured. Information about the latest blood pressure was collected from each health centre. The questionnaires were practically identical for both groups. The questions were of VAS -type, 'put a cross' and open questions. Apart from information about latest blood pressure the background facts consisted of age, sex, antihypertensive drugs, the patients' judgement of ideal diastolic blood pressure and judgement of state of health. The NPTH group were asked two questions about the NPTH study and its completion. Based upon a review of the literature, opinions about the treatment were collected in questions about information given about the treatment,4"6-17"22 attitudes towards hypertension, attitudes towards medical treatment and the health services in general,9*23 opinions of the latest visit to the health centre,2-921*24
open questions on positive and negative aspects of the treatment,2-6 and, finally, an overall judgement of the treatment as a whole.2-6-10-18-23 The questionnaires were distributed by post (or via the health centres) to 95 patients in the control group and to 174 of the 400 patients in the NPTH group. The selection of NPTH patients was first planned to comprise all NPTH patients at two health centres to match the control group but was supplemented with every fourth patient from the remaining six NPTH centres. The reason for this was to make the NPTH study more representative. Data were collected from May to December 1987 (control group) and from December 1986 to February 1987 (NPTH group). The drop-out rate was 10.5"% for the controls and 5.2% for the NPTH group, which means that 85 and 165 patients respectively are included in this study. Statistics The SAS computer program was used for the calculation of mean values, SD and t-value and for x2-tests. As there is a rather high difference in variance between the groups the t-value for unequal variance has been used in the t-test. Before the statistical analysis open questions were categorized and coded according to content. Levels of significance used are
