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International Journal of Nursing Practice 2014; ••: ••–••
RESEARCH PAPER
Patient satisfaction with primary health-care services in Kuwait Muhammad Alotaibi PhD Assistant Professor, Health Information Administration Department, Faculty of Allied Health Sciences, Kuwait University, Sulaibikhat, Kuwait, Kuwait
Talal Alazemi MB BCH Head, Fahaheel Specialty Clinic, Ministry of Health, Kuwait, Fahaheel, Kuwait
Fahad Alazemi MB BCH MRCGPI-Kuw Head, South Sabahiya Clinic, Ministry of Health,Kuwait, Sabahiya, Kuwait
Yusif Bakir PhD Senior Lecturer, Radiologic Sciences Department, Faculty of Allied Health Sciences, Kuwait University, Sulaibikhat, Kuwait, Kuwait
Accepted for publication June 2013 Alotaibi M, Alazemi T, Alazemi F, Bakir Y. International Journal of Nursing Practice 2014; ••: ••–•• Patient satisfaction with primary health-care services in Kuwait The study aims to evaluate patient satisfaction with respect to primary health-care services in Kuwait.A total of 245 patients completed the General Practice Assessment Questionnaire postconsultation version 2.0. Two statistically significant differences of patients’ satisfaction with sex and level of education were found. Overall satisfaction was higher among men than women (P = 0.002), and it was also higher among those with university degree of education than the other levels of education (P = 0.049). We also found statistically significant differences of patients’ responses over sex for three themes, namely: satisfaction with receptionists, satisfaction with access and satisfaction with communication; and over the age for one theme: satisfaction with access. There was no statistically significant differences of patients’ responses over nationality for all themes. Satisfaction is a multifactorial and no one factor alone could provide satisfaction with primary health services in Kuwait. Key words: General Practice Assessment Questionnaire, Kuwait, patient satisfaction.
INTRODUCTION Patient satisfaction is considered as a legitimate and an important measure to the quality of health care provided.1–3 Moreover, it has been shown to be associated
Correspondence: Muhammad Alotaibi, Health Information Administration Department, Faculty of Allied Health Sciences, Kuwait University, PO Box 31470, Sulaibikhat 90805, Kuwait. Email: alotaibi@ hsc.edu.kw doi:10.1111/ijn.12257
with better outcomes.4 This perception has prompted research to perform patient assessment surveys to elicit patients’ views and opinions regarding general practice care.5–10 Kuwait is a country that lies at the north-west corner of the Arabian Gulf, between latitudes 28° and 30° North and longitudes 46° and 48° East. It has a total area of 17 818 sq km and is divided into six health regions, namely the Capital, Hawalli, Al-Sabah, Al-Ahmadi, AlFarwania and Al-Jahra health regions.11 The availability of © 2014 Wiley Publishing Asia Pty Ltd
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a health-care delivery system is a constitutional right accorded to all Kuwaitis. The Ministry of Health provides care to all Kuwaiti citizens free of charge. If a Kuwaiti citizen needs specialized medical care which cannot be provided in Kuwait, the Ministry of Health sends him or her abroad free of charge, to a facility where the necessary treatment can be obtained.12 Free health care was provided to non-Kuwaiti citizens until August 1999 when a medical insurance scheme was introduced. In addition to annual health insurance, expatriates must now also pay one Kuwaiti Dinar (K.D.) for a visit to a Ministry of Health clinic and two K.D. for a visit to a hospital. This covers the cost of most medicines which might be prescribed. However, expatriate patients are charged for medical procedures such as X-rays, ultrasound, etc., as well as some medicines.13 In our review of national and international publications, we found few references to patients’ satisfaction with primary health care in Kuwait.7,14 Therefore, in this study we decided to investigate this neglected aspect of health care in Kuwait. The research questions were as follows: Are the patients at Southern Sabahia Clinic in Ahmadi Health Region generally satisfied? Is there a statistically significant difference between the patients’ demographic variables and the overall patients’ satisfaction? Is there a statistically significant difference between the patients’ demographic variables and the five themes of care, namely: reception, access, continuity of care, communication and enablement?
• • •
METHODS In October 2009, we conducted a descriptive crosssectional study. The study was conducted in Southern Sabahyia Practice Clinic in Ahmadi Health Region of Kuwait. This clinic provides health care to 12 000 registered patients annually.15 Data were collected using the consultation version of the General Practice Assessment Questionnaire (GPAQ) version 2.0.16 The GPAQ version 2.0 is a patient-completed measure consisting of 25 questions evaluating key domains of general practice, including five themes of care: reception (1 question), access (11 questions), continuity of care (2 questions), communication (8 questions) and enablement (3 questions). The GPAQ was developed by the National Primary Care Research and Development Center at Manchester University and Dana Gelb Safran of the New England Medical © 2014 Wiley Publishing Asia Pty Ltd
Center Hospitals, which adapted the best available questionnaire, the Primary Care Assessment Survey (PCAS)17,18 which has been extensively validated in the United States. PCAS has also been modified, in collaboration with the Health Institute in Boston, for use in British general practice. The modified PCAS was called the General Practice Assessment Survey (GPAS). GPAS has been used in large studies in the UK, and detailed research data on it have been published.17,19–22 Further modifications to GPAS resulted in the General Practice Assessment Questionnaire (GPAQ) which is shorter and more suitable for use by patients. We chose to use GPAQ because some questions in the GPAS questionnaire which was developed for use in the UK are not appropriate for Kuwait, and because we felt that the longer GPAS would give us a poorer response rate. The GPAQ recommends that 50 questionnaires are collected per doctor for statistical reliability. Because there were six doctors in the Clinic, we selected a convenient sample of 300 patients. The inclusion criteria for the patients were: age 16 and above, registered in the same health center area, who were available at the clinic during the time of the study and were willing to participate. Patients were excluded from the study if they were severely ill and under 16 years of age. Fifty-five patients refused to participate, due to lack of time on their part. Hence, a total of 245 questionnaires were used in the final analysis, giving a response rate of 82%.
Ethical consideration Ethical approval was granted by the research ethics committee in Ministry of Health. An information sheet explaining the purpose of the study was provided to the participants who were informed that their confidentiality would be maintained and that they could withdraw from the study at any time. Parents or guardians were allowed to consent to research and complete the questionnaires on behalf of patients who were less than 21 years of age.
Data analysis Data analysis was performed using the program SPSS versions 17 and 19 for windows.23,24 The raw data of each question were saved in certain column according to selected choices of participants. For two choices selected, it will take 0 or 1; for three choices questions, the selection was 0, 1 and 2. For four choices questions, the selection was 0, 1, 2 and 3, etc. Scores of question items were
Patient satisfaction with primary care
summed to obtain the mean score (M) for each question; in addition, descriptive statistics were obtained for all the variables in the study, including the percentage of responses split into each demographic data. Test of normality was performed for the total score of responses. Analysis of variance was used to analyse the equal variance distribution to compare mean between demographic variables where they split up into two groups or more. Pearson chi-square test and Mann–Whitney U-statistics were used to test for the association between different demographic variables with each theme. Most of the data presented in tables showed that most of the results were not significant, indicating that groups in each demographic variable have similar responses. Other results were significant, highly significant and very highly significant. The level of patient satisfaction on various questions can be evaluated on the basis of Mean and P-value (asymptotic significant (two-tailed)). A P-value of < 0.05 was considered as a cut-off point for significance.
RESULTS Table 1 shows overall satisfaction according to demographic data of patients. A hundred and seven (45%) were men and 129 (55%) were women. The majority, 192 (78%), were between 16 and 39 years of age, and the remaining 52 (22%) were 40 and above. The vast majority, 201 (82%), were Kuwaitis and the remaining 43 (18%) were non-Kuwaitis. Over one third, 84 (34%), completed high school, 58 (24%) held a diploma, 45 (18%) had a bachelor’s degree and the remaining, 58 (24%), held other qualifications. The majority, 177 (72%), were married, 51 (21%) were single, and the remaining, 17 (7%), were widowed, divorced or separated. Nearly two thirds, 160 (66%), were employed, 72 (30%) were unemployed, and the remaining, 11 (5%), were retired. More than half, 138 (56%), reported that they had no long-standing illness, disability or infirmity, whereas the remaining, 107 (44%), reported that they had long-standing illness, disability or infirmity. Our study showed that patients at Southern Sabahiya Clinic in Ahmadi Health Region were generally satisfied. In Table 1, two statistical significant differences of overall patients’ satisfaction with sex and level of education were found. The level of satisfaction was higher (P = 0.002) among women (mean score (M = 2.51)) than men (M = 3.19), and it was also marginally higher among those with other qualifications (M = 2.33) than the other
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Table 1 Overall satisfaction according to patient’s demographic variables Characteristics Gender Male Female Age 16–19 20–29 30–39 40–49 50+ Nationality Kuwaiti Non-Kuwaiti Education High school Diploma BSc Other qualifications Marital status Single Married Others Employment Employed Unemployed Retired Long-standing illness, disability or infirmity No Yes
n
%
Mean
107 129
45.3 54.7
3.19 2.51
14 89 89 38 14
5.7 36.5 36.5 15.6 5.7
3.36 2.85 2.69 2.79 3
201 43
82.4 17.6
2.88 2.56
84 58 45 58
34.3 23.7 18.3 23.7
2.9 2.86 3.22 2.33
51 177 17
20.8 72.2 7
2.96 2.78 2.76
160 72 11
65.8 29.6 4.6
2.86 2.74 2.91
P-value HS 0.002** NS 0.437
NS 0.262 S 0.049*
NS 0.437
NS 0.869
NS 138 107
56.3 43.7
2.84 2.79
0.785
* S (significant ‘P’ < 0.05). ** HS (highly significant ‘P’ < 0.005). NS (not significant ‘P’ > 0.05). Mean range: 1 (completely satisfied) to 7 (completely not satisfied).
levels of education (P = 0.049). Other different demographic results have similar satisfaction level (P > 0.05) between various subgroups. Tables 2–4 show descriptive and inference statistics for the patients’ responses over three demographic variables, namely: sex, age and nationality. In Table 2, we found statistically significant differences of patients’ responses over sex for theme 1: satisfaction with receptionists; theme 2: satisfaction with access; and theme 3: satisfaction with communication. Regarding theme 1: satisfaction © 2014 Wiley Publishing Asia Pty Ltd
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Table 2 Descriptive and statistical inference for the responses over the sex
Theme 1: Satisfaction with receptionists Q1. How do you rate the way you are treated by receptionists at your practice (Means range from 1 to 6) Theme 2: Satisfaction with access Q2a. How do you rate the hours that your practice is open for appointments? (Means range from 1 to 6) Q2b. What additional hours would you like the practice to be open? (Means range from 0 to 1) Q3a. How quickly do you usually get to see that doctor? (Means range from 1 to 7) Q3b. How do you rate this? (Means range from 1 to 7) Q4a. How quickly do you usually get seen? (Means range from 1 to 7) Q4b. How do you rate this? (Means range from 1 to 7) Q5a. How long do you usually have to wait at the practice for your consultations to begin? (Means range from 1 to 5) Q5b. How do you rate this? (Means range from 1 to 6) Q6a. How do you rate the ability to get through to the practice on the phone? (Means range from 1 to 7) Q6b. How do you rate the ability to speak to a doctor on the phone when you have a question or need medical advice? (Means range from 1 to 7) Theme 3: Satisfaction with communication Q7a. How thoroughly the doctor asked about your symptoms and how you are feeling? (Means range from 1 to 7) Q7b. How well the doctor listened to what you had to say? (Means range from 1 to 7) Q7c. How well the doctor put you at ease during your physical examination? (Means range from 1 to 7) Q7d. How much the doctor involved you in decisions about your care? (Means range from 1 to 7) Q7e. How well the doctor explained your problems or any treatment that you need? (Means range from 1 to 7) Q7f. How do you rate the amount of time your doctor spent with you today? (Means range from 1 to 7) Q7g. How do you rate the doctor’s patience with your questions or worries? (Means range from 1 to 7) Q7h. How do you rate the doctor’s caring and concern for you? (Means range from 1 to 7) Theme 4: Satisfaction with enablement Q8a. Do you feel able to understand your problems or illness? (Means range from 1 to 4) Q8b. Do you feel able to cope with your problems or illness? (Means range from 1 to 4) Q8c. Do you feel able to keep yourself healthy? (Means range from 1 to 4)
M
F
P-value
Mean =
? 4.24
4.71
HS 0.009**
Mean =
3.96
4.55
Mean =
0.36
0.21
Mean =
3.02
2.78
Mean =
3.94
4.62
Mean =
2.95
2.64
Mean =
3.97
4.48
Mean =
3
3.4
Mean =
3.42
3.78
Mean =
4.21
4.91
Mean =
4.4
4.95
Mean =
3.82
4.37
Mean =
3.76
4.53
Mean =
4.01
4.47
Mean =
3.93
4.34
Mean =
3.89
4.45
Mean =
3.54
4.19
Mean =
3.79
4.21
Mean =
3.75
4.34
Mean =
1.79
1.75
Mean =
1.77
1.74
Mean =
1.9
1.78
VHS 0*** S 0.013* NS 0.437 HS 0.001** NS 0.29 S 0.015* S 0.018* S 0.041* HS 0.006** NS 0.061 HS 0.004** VHS 0*** S 0.01* S 0.025* HS 0.002** HS 0.001** S 0.022* HS 0.001** NS 0.86 NS 0.71 NS 0.732
* S (significant ‘P’ ≤ 0.05). ** HS (highly significant ‘P’ ≤ 0.005). *** VHS (very highly significant ‘P’ ≤ 0.0005). NS (not significant ‘P’ > 0.05). Mean range: low to high.
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Patient satisfaction with primary care
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Table 3 Descriptive and statistical inference for the responses over the age
Theme 1: Satisfaction with receptionists Q1. How do you rate the way you are treated by receptionists at your practice (Means range from 1 to 6) Theme 2: Satisfaction with access Q2a. How do you rate the hours that your practice is open for appointments? (Means range from 1 to 6) Q2b. What additional hours would you like the practice to be open? (Means range from 0 to 1) Q3a. How quickly do you usually get to see that doctor? (Means range from 1 to 7) Q3b. How do you rate this? (Means range from 1 to 7) Q4a. How quickly do you usually get seen? (Means range from 1 to 7) Q4b. How do you rate this? (Means range from 1 to 7) Q5a. How long do you usually have to wait at the practice for your consultations to begin? (Means range from 1 to 5) Q5b. How do you rate this? (Means range from 1 to 6) Q6a. How do you rate the ability to get through to the practice on the phone? (Means range from 1 to 7) Q6b. How do you rate the ability to speak to a doctor on the phone when you have a question or need medical advice? (Means range from 1 to 7) Theme 3: Satisfaction with communication Q7a. How thoroughly the doctor asked about your symptoms and how you are feeling? (Means range from 1 to 7) Q7b. How well the doctor listened to what you had to say? (Means range from 1 to 7) Q7c. How well the doctor put you at ease during your physical examination? (Means range from 1 to 7) Q7d. How much the doctor involved you in decisions about your care? (Means range from 1 to 7) Q7e. How well the doctor explained your problems or any treatment that you need? (Means range from 1 to 7) Q7f. How do you rate the amount of time your doctor spent with you today? (Means range from 1 to 7) Q7g. How do you rate the doctor’s patience with your questions or worries? (Means range from 1 to 7) Q7h. How do you rate the doctor’s caring and concern for you? (Means range from 1 to 7) Theme 4: Satisfaction with enablement Q8a. Do you feel able to understand your problems or illness? (Means range from 1 to 4) Q8b. Do you feel able to cope with your problems or illness? (Means range from 1 to 4) Q8c. Do you feel able to keep yourself healthy? (Means range from 1 to 4)
< 40
≥ 40
P-value
Mean =
4.58
4.31
NS 0.204
Mean =
4.39
4
Mean =
0.27
0.31
Mean =
2.84
3.17
Mean =
4.26
4.5
Mean =
2.79
2.92
Mean =
4.27
4.12
Mean =
3.19
3.25
Mean =
3.63
3.54
Mean =
4.59
4.48
Mean =
4.7
4.58
Mean =
4.16
4.1
Mean =
4.21
4.02
Mean =
4.26
4.23
Mean =
4.14
4.19
Mean =
4.21
4.17
Mean =
3.96
3.79
Mean =
4.07
3.96
Mean =
4.06
4.1
Mean =
1.79
1.65
Mean =
1.76
1.67
Mean =
1.87
1.63
S 0.05* NS 0.601 NS 0.355 NS 0.326 NS 0.708 NS 0.546 NS 0.78 NS 0.661 NS 0.716 NS 0.697 NS 0.794 NS 0.413 NS 0.909 NS 0.814 NS 0.856 NS 0.446 NS 0.639 NS 0.876 NS 0.339 NS 0.537 NS 0.107
NS (not significant ‘P’ > 0.05). S (Significant ‘P’ ≤ 0.05). Mean range: low to high.
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Table 4 Descriptive and statistical inference for the responses over the nationality
Theme 1: Satisfaction with receptionists Q1. How do you rate the way you are treated by receptionists at your practice (Means range from 1 to 6) Theme 2: Satisfaction with access Q2a. How do you rate the hours that your practice is open for appointments? (Means range from 1 to 6) Q2b. What additional hours would you like the practice to be open? (Means range from 0 to 1) Q3a. How quickly do you usually get to see that doctor? (Means range from 1 to 7) Q3b. How do you rate this? (Means range from 1 to 7) Q4a. How quickly do you usually get seen? (Means range from 1 to 7) Q4b. How do you rate this? (Means range from 1 to 7) Q5a. How long do you usually have to wait at the practice for your consultations to begin? (Means range from 1 to 5) Q5b. How do you rate this? (Means range from 1 to 6) Q6a. How do you rate the ability to get through to the practice on the phone? (Means range from 1 to 7) Q6b. How do you rate the ability to speak to a doctor on the phone when you have a question or need medical advice? (Means range from 1 to 7) Theme 3: Satisfaction with communication Q7a. How thoroughly the doctor asked about your symptoms and how you are feeling? (Means range from 1 to 7) Q7b. How well the doctor listened to what you had to say? (Means range from 1 to 7) Q7c. How well the doctor put you at ease during your physical examination? (Means range from 1 to 7) Q7d. How much the doctor involved you in decisions about your care? (Means range from 1 to 7) Q7e. How well the doctor explained your problems or any treatment that you need? (Means range from 1 to 7) Q7f. How do you rate the amount of time your doctor spent with you today? (Means range from 1 to 7) Q7g. How do you rate the doctor’s patience with your questions or worries? (Means range from 1 to 7) Q7h.How do you rate the doctor’s caring and concern for you? (Means range from 1 to 7) Theme 4: Satisfaction with enablement Q8a. Do you feel able to understand your problems or illness? (Means range from 1 to 4) Q8b. Do you feel able to cope with your problems or illness? (Means range from 1 to 4) Q8c. Do you feel able to keep yourself healthy? (Means range from 1 to 4) NS (not significant ‘P’ > 0.05). Mean range: low to high.
© 2014 Wiley Publishing Asia Pty Ltd
Kuwaiti
Others
P-value
Mean =
4.47
4.72
NS 0.288
Mean =
4.27
4.35
Mean =
0.28
0.28
Mean =
2.84
3.23
Mean =
4.29
4.42
Mean =
2.71
3.28
Mean =
4.2
4.42
Mean =
3.15
3.51
Mean =
3.61
3.56
Mean =
4.51
4.91
Mean =
4.61
5.02
0.214
Mean =
4.11
4.26
NS 0.569
Mean =
4.19
4.09
Mean =
4.24
4.3
Mean =
4.12
4.35
Mean =
4.17
4.37
Mean =
3.93
3.88
Mean =
4.04
4.02
Mean =
4.07
4.09
Mean =
1.78
1.7
Mean =
1.75
1.72
Mean =
1.84
1.79
NS 0.731 NS 0.953 NS 0.506 NS 0.634 NS 0.282 NS 0.413 NS 0.105 NS 0.81 NS 0.232 NS
0.685 NS 0.799 NS 0.316 NS 0.41 NS 0.85 NS 0.93 NS 0.92 NS 0.807 NS 0.833 NS 0.775
Patient satisfaction with primary care
with receptionists, women were more satisfied with receptionists than men (M = 4.71 and M = 4.24 respectively, P = 0.009). In theme 2: satisfaction with access, women were more satisfied than men with the hours that their practice is open for appointments (M = 4.55 and M = 3.96 respectively, P = 0.000). They rated the quick ability to see a particular doctor higher than men (M = 4.62 and M = 3.94 respectively, P = 0.001). They also rated the quick ability to get seen by any doctor higher than men (M = 4.48 and M = 3.97 respectively, P = 0.015). Women waited longer than men at the practice for their consultation to begin (M = 3.4 and 3.0 respectively, P = 0.018). They rated this higher than men (M = 3.78 and M = 3.42 respectively, P = 0.041). They were also more satisfied than men with their ability to get through to the practice on the phone (M = 4.91 and M = 4.21 respectively, P = 0.006). In theme 3: satisfaction with communication, women were more satisfied than men in response to all questions under this theme (Means range from 4.53 to 4.19 and Means range from 4.01 to 3.54, respectively, P values range from 0.000 to 0.01). We also found statistically significant differences of patient responses over the age for theme 2: satisfaction with access in Table 3. Patients below 40 years old were more satisfied with the hours that their practice is open for appointments than patients aged 40 and above (M = 4.39 and M = 4.00 respectively, P = 0.05). There were no statistically significant differences of patients’ responses over nationality for all themes as shown in Table 4.
DISCUSSION To our knowledge, ours is the first study to evaluate patients’ satisfaction with respect to primary health-care services in Kuwait using the GPAQ postconsultation version 2.0. The aim of this study was to evaluate patients’ satisfaction with primary health care in Kuwait. Our findings suggested that the level of patients’ satisfaction at Southern Sabahyia clinic in Ahmadi Health Region was high. This is consistent with several local, regional and international studies that reported similar findings.7,25–28 We also found two statistically significant differences of patient satisfaction with sex and level of education. The level of satisfaction was higher among men than women, and it was also higher among those with university degree of education than the other levels of education. This
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finding is supported by other studies.7,29,30 However, this is inconsistent with another study.31 Our study showed that both men and women were satisfied with all themes of care. Women were more satisfied with receptionists than men. This is consistent with another study.30 However, another study showed that the majority of patients were dissatisfied from receptionists’ services.32 Both men and women were satisfied with the accessibility of the clinic. This is consistent with an international study that reported similar findings in nine European countries.25 Women were more satisfied with regard to the current opening hours of the clinic, how quickly they can see a particular doctor or any doctor, waiting time before consultation and their ability to contact the practice on the phone. This finding coincides with the findings of another study.33 Our study showed that all patients’ age groups were satisfied with all themes of care. Regarding the practice opening hours for appointments, patients below 40 years old were more satisfied than patients aged 40 and above. This is consistent with another study.34 However, this is inconsistent with the findings of another study.30 This could be explained by the fact that older people are generally in worse health and have greater need for medical care.35 They also have higher morbidity and consulting rates, and they might have more contact with primary care and thus have more opportunity to be favourably influenced by the services provided. Regarding the doctors’ consultation skills, women have shown more satisfaction than men. They agreed that doctors asked about their symptoms and feelings, listened to them, and put them at ease during physical examination. They also agreed that their doctors involved them in decisions about their care, explained their problems or any treatment they needed, and spent enough time to answer their questions and relieve their anxieties. This is supported by other studies.30,36 However, this is inconsistent with other studies.31,37,38 Sex is a significant variable when accounting for sex differences in health-care provider–patient communication. Female health-care providers generally tend to conduct longer consultations, give more information and engage in more partnership building. They are also less directive, express more interest in psychological aspects of health and more reassuring than men.39,40 Our study showed that there were no statistically significant differences of patients’ responses over nationality for all themes of care. This is consistent with results of © 2014 Wiley Publishing Asia Pty Ltd
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other studies.7,41,42 However, this is unlike the findings of another study.28 In their study, they found a significant difference in satisfaction between Qatari and non-Qatari patients.
Limitations of the study This study has a number of limitations. The results are limited to one government primary health-care practice and to the time period in which the study was conducted. This study also confined to a sample of patients who visited one practice and the results might not be sufficient to represent primary care as a whole in Kuwait. Therefore, generalizability of results beyond this setting is always a question.
Practical implications The data from this study reveal several practical applications for decision makers in the Ministry of Health in Kuwait who are interested in increasing patient satisfaction with regard to primary health-care services. Because patient satisfaction is related to quality of health care provided, efforts to increase patient satisfaction should also focus on improving the quality of all themes of primary health care. The findings of this study also might help doctors to understand patients’ views which can be utilized in providing better primary health-care services.
Implications for future research In addition to the practical implications, this study has also revealed implications for future research. The crosssectional research design limits our ability to draw casual inferences from these findings. A suggestion for future study would be a longitudinal research design. This study also focused on the GPAQ consultation version 2.0. This instrument does not assess patient dissatisfaction with services which cannot be assumed to be simply the alternative of a satisfactory assessment of service.43 Other direction could include comparing samples from other primary health practices in other health regions, namely Capital, Hawalli, Farwanyia and Al-Jahra health regions. Future studies could analyse the utilization of the primary health care, on the basis of those variables examined in the current study, which have not been found to be statistically significant and to validate significant relationship found in this study.
CONCLUSIONS This study represents an attempt to evaluate patients’ satisfaction with primary health care in Ahmadi Health © 2014 Wiley Publishing Asia Pty Ltd
Region, Kuwait. Our study showed that patients at Southern Sabahyia Practice Clinic in Ahmadi Health Region were generally positive about their experience. It concluded that satisfaction is multifactorial and no one factor alone could provide satisfaction with primary health services in Kuwait. Therefore, these results should not be generalized for all practices in Kuwait.
REFERENCES 1 Kimberley JR, Minivielle E. The Quality Imperative: Measurement and Management of Quality in Healthcare. London: Imperial College Press, 2000. 2 Jha AK, Orav EJ, Zheng J, Epstein AM. Patients’ perception of hospital care in the United States. The New England Journal of Medicine 2008; 359: 1921–1931. 3 Isaac T, Zaslavsky AM, Cleary PD, Landen BE. The relationship between patient perception of care and measures of hospital quality and safety. Health Services Research 2010; 45: 1024–1040. 4 Glickman SW, Boulding W, Manary M et al. Patient satisfaction and its relationship with clinical quality and inpatient mortality in acute myocardial infarction. Circulation: Cardiovascular Quality and Outcomes 2010; 3: 188–195. 5 Campbell JL, Ramsay J, Green J. Age, gender, socioeconomic, and ethnic differences in patient’s assessments of primary health care. Quality in Health Care 2001; 10: 90–95. 6 Vingerhoets E, Wensing M, Grol R. Feedback of patients’ evaluations of general practice care: A randomized trial. Quality in Health Care 2001; 10: 224–228. 7 Al-Eisa IS, Al-Mutar MS, Rawdan MM, Al-Terkit AM. Patients satisfaction with primary health care services at Capital Health Region, Kuwait. Middle East Journal of Family Medicine 2005; 3: 10–16. 8 Kersnik J. Patients’ recommendation of doctors as an indicator of patient satisfaction. Hong Kong Medical Journal 2003; 9: 247–250. 9 Margolis SA, Al-Marzouqi S, Revel T, Reed RL. Patient satisfaction with primary health care services in the United Arab Emirates. International Journal for Quality in Health Care 2003; 15: 241–249. 10 Anderson RT, Camacho FT, Balkrishan R. Willing to wait? The influence of patient wait time on satisfaction with primary care. BMC Health Services Research 2007; 7: 1–5. 11 Kennedy PD. Kuwait Pocket Guide. Kuwait: Kuwait Publishing House, 2011. 12 Casey MS. The History of Kuwait. Westport, CT, USA: Greenwood Publishing Group, 2007. 13 Ministry of Health. Health in Kuwait. Kuwait: Ministry of Health, 2010. 14 Al-Doghaither AH, Abdelrhman BM, Wahid S. Patient’s satisfaction with physician in primary health care centres in Kuwait. Journal of the Royal Society for the Promotion of Health 2000; 120: 170–174.
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15 Ministry of Health. Health Services Guide in Ahmadi Health Region. Kuwait: Ministry of Health, 2006. 16 National Primary Care Research and Development Centre, University of Manchester. General Practice Assessment Questionnaire. 2007. Available from URL: http:// www.gpaq.info. Accessed 10 June 2007. 17 Safran DG, Taira DA, Rogers WH, Kosinski M, Ware JE, Tailor AR. Linking primary care performance to outcomes of care. The Journal of Family Practice 1998; 47: 213–220. 18 Murray A, Safran DG. The primary care assessment survey: A tool for measuring, monitoring and improving primary care. In: Maruish M (ed.). Handbook of Psychological Assessment in Primary Care Settings. Mahwah, NJ, USA: Lawrence Erlbaum Associates, 2000; 623–652. 19 Taira DA, Safran DG, Seto TB et al. Asian American patient ratings of physician primary care performance. Journal of General Internal Medicine 1997; 12: 237–242. 20 Ramsey J, Campbell J, Schorter SS, Green J, Roland M. The General Practice Assessment Survey (GPAS): Tests of data quality and measurement properties. Family Practice 2000; 17: 372–379. 21 Bower P, Mead N, Roland M. What dimensions underlie patient responses to the General Practice Assessment Survey? A factor analytic study. Family Practice 2002; 19: 489–495. 22 Bower P, Ronald M, Campbell J, Mead N. Setting standards based on patients views on access and continuity: Secondary analysis of data from the general practice assessment survey. British Medical Journal 2003; 326: 258. 23 SPSS Inc. SPSS version 17.0. for Windows. Chicago, USA: 2008. 24 SPSS Inc. SPSS version 19.0. for Windows, Chicago, USA: 2010. 25 Wensing M, Vedsted P, Kersnik J et al. Patient satisfaction with availability of general practice: An international comparison. International Journal for Quality in Health Care 2002; 14: 111–118. 26 Gadallh M, Zaki B. Patient satisfaction with primary health care services in two districts in lower and upper Egypt. Eastern Mediterranean Health Journal 2003; 9: 422– 430. 27 Al Dousari H, Al Mutawa A, Al Mithen N. Patient satisfaction according to type of primary health care practitioner in the Capital health region. Kuwait Medical Journal 2008; 40: 31–38. 28 Al Emadi N, Falmarzi S, Al Kuwari M, Al Ansari A. Patients’ satisfaction with primary health care services in Qatar. Middle East Journal of Family Medicine 2009; 7: 4–9. 29 Saeed AA, Mohamed BA, Magzoub ME, Al-Doghaither AH. Satisfaction and correlates of patients’ satisfaction with
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physician’s services in primary health care centers. Saudi Medical Journal 2001; 22: 262–267. Bu-Alayyan S, Mostafa M, Al-Etabi B, Sorkhou E, Al-Taher H, Al-Weqayyan A. Patient satisfaction with primary health care services in Kuwait. Kuwait Medical Journal 2008; 40: 25–30. Alhashem A, Alquraini H, Chowdhury RI. Factors influencing patient satisfaction in primary health care clinics in Kuwait. International Journal of Health Care Quality Assurance 2011; 24: 249–262. Al-Doghaither AH, Saeed AA. Consumer’s satisfaction with primary health care services in the city of Jeddah, Saudi Arabia. Saudi Medical Journal 2000; 21: 447–454. Phaswana-Mafuya N, Davids AS, Senekal I, Munyaka S. Patient satisfaction with primary health care services in a selected district municipality of Eastern Cape of South Africa. In: Eldin AB (ed.). Modern Approaches to Quality Control. Rijeka: Intech Open Access, 2011; 85–98. Kontopantelis E, Roland M, Reeves D. Patient experience of access to primary care: Identification of predictors in a national patient survey. Family Practice 2010; 11: 61. Coleman D. Population and family. In: Halsey AH, Webb J (eds). Twentieth-century British Social Trends. London: Macmillian Press, 2000; 27–93. Katic M, Budak A, Ivankovic D et al. Patients views on the professional behavior of family physicians. Family Practice 2001; 18: 42–47. Mercer LM, Tanabe P, Pang PS et al. Paient perspectives on communication with the medical team: Pilot study using the communication assessment tool-team (CAT-T). Patient Education and Counseling 2008; 73: 220–223. Lin YB, Lin CC, Lin YK. Patient satisfaction evaluation in different clinic care models: Care stratification under a national demonstration project. Health and Place 2010; 16: 85–92. Roter DL, Hall JA 1998 Why physician gender matters in shaping the physician-patient relationship. Journal of Women’s Health, 7: 1093–1097. Bertakis KD, Franks P, Azari R. Effects of physician gender on patient satisfaction. Journal of the American Medical Women’s Association 2003; 58: 69–75. Al Qatari G, Haran D. Determinants of users’ satisfaction with primary health care settings and services in Saudi Arabia. International Journal for Quality in Health care 1999; 11: 523–531. Kersnik J, Ropret T. An evaluation of patient satisfaction amongst family practice patients with diverse ethnic backgrounds. Swiss Medical Weekly 2002; 132: 121–124. Coyle J. Exploring the meaning of ‘dissatisfaction’ with health care: The importance of personal identity threat. Sociology of Health and Illness 1999; 21: 95–123.
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International Journal of Nursing Practice 2014; ••: ••–••
RESEARCH PAPER
Patient satisfaction with primary health-care services in Kuwait Muhammad Alotaibi PhD Assistant Professor, Health Information Administration Department, Faculty of Allied Health Sciences, Kuwait University, Sulaibikhat, Kuwait, Kuwait
Talal Alazemi MB BCH Head, Fahaheel Specialty Clinic, Ministry of Health, Kuwait, Fahaheel, Kuwait
Fahad Alazemi MB BCH MRCGPI-Kuw Head, South Sabahiya Clinic, Ministry of Health,Kuwait, Sabahiya, Kuwait
Yusif Bakir PhD Senior Lecturer, Radiologic Sciences Department, Faculty of Allied Health Sciences, Kuwait University, Sulaibikhat, Kuwait, Kuwait
Accepted for publication June 2013 Alotaibi M, Alazemi T, Alazemi F, Bakir Y. International Journal of Nursing Practice 2014; ••: ••–•• Patient satisfaction with primary health-care services in Kuwait The study aims to evaluate patient satisfaction with respect to primary health-care services in Kuwait.A total of 245 patients completed the General Practice Assessment Questionnaire postconsultation version 2.0. Two statistically significant differences of patients’ satisfaction with sex and level of education were found. Overall satisfaction was higher among men than women (P = 0.002), and it was also higher among those with university degree of education than the other levels of education (P = 0.049). We also found statistically significant differences of patients’ responses over sex for three themes, namely: satisfaction with receptionists, satisfaction with access and satisfaction with communication; and over the age for one theme: satisfaction with access. There was no statistically significant differences of patients’ responses over nationality for all themes. Satisfaction is a multifactorial and no one factor alone could provide satisfaction with primary health services in Kuwait. Key words: General Practice Assessment Questionnaire, Kuwait, patient satisfaction.
INTRODUCTION Patient satisfaction is considered as a legitimate and an important measure to the quality of health care provided.1–3 Moreover, it has been shown to be associated
Correspondence: Muhammad Alotaibi, Health Information Administration Department, Faculty of Allied Health Sciences, Kuwait University, PO Box 31470, Sulaibikhat 90805, Kuwait. Email: alotaibi@ hsc.edu.kw doi:10.1111/ijn.12257
with better outcomes.4 This perception has prompted research to perform patient assessment surveys to elicit patients’ views and opinions regarding general practice care.5–10 Kuwait is a country that lies at the north-west corner of the Arabian Gulf, between latitudes 28° and 30° North and longitudes 46° and 48° East. It has a total area of 17 818 sq km and is divided into six health regions, namely the Capital, Hawalli, Al-Sabah, Al-Ahmadi, AlFarwania and Al-Jahra health regions.11 The availability of © 2014 Wiley Publishing Asia Pty Ltd
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a health-care delivery system is a constitutional right accorded to all Kuwaitis. The Ministry of Health provides care to all Kuwaiti citizens free of charge. If a Kuwaiti citizen needs specialized medical care which cannot be provided in Kuwait, the Ministry of Health sends him or her abroad free of charge, to a facility where the necessary treatment can be obtained.12 Free health care was provided to non-Kuwaiti citizens until August 1999 when a medical insurance scheme was introduced. In addition to annual health insurance, expatriates must now also pay one Kuwaiti Dinar (K.D.) for a visit to a Ministry of Health clinic and two K.D. for a visit to a hospital. This covers the cost of most medicines which might be prescribed. However, expatriate patients are charged for medical procedures such as X-rays, ultrasound, etc., as well as some medicines.13 In our review of national and international publications, we found few references to patients’ satisfaction with primary health care in Kuwait.7,14 Therefore, in this study we decided to investigate this neglected aspect of health care in Kuwait. The research questions were as follows: Are the patients at Southern Sabahia Clinic in Ahmadi Health Region generally satisfied? Is there a statistically significant difference between the patients’ demographic variables and the overall patients’ satisfaction? Is there a statistically significant difference between the patients’ demographic variables and the five themes of care, namely: reception, access, continuity of care, communication and enablement?
• • •
METHODS In October 2009, we conducted a descriptive crosssectional study. The study was conducted in Southern Sabahyia Practice Clinic in Ahmadi Health Region of Kuwait. This clinic provides health care to 12 000 registered patients annually.15 Data were collected using the consultation version of the General Practice Assessment Questionnaire (GPAQ) version 2.0.16 The GPAQ version 2.0 is a patient-completed measure consisting of 25 questions evaluating key domains of general practice, including five themes of care: reception (1 question), access (11 questions), continuity of care (2 questions), communication (8 questions) and enablement (3 questions). The GPAQ was developed by the National Primary Care Research and Development Center at Manchester University and Dana Gelb Safran of the New England Medical © 2014 Wiley Publishing Asia Pty Ltd
Center Hospitals, which adapted the best available questionnaire, the Primary Care Assessment Survey (PCAS)17,18 which has been extensively validated in the United States. PCAS has also been modified, in collaboration with the Health Institute in Boston, for use in British general practice. The modified PCAS was called the General Practice Assessment Survey (GPAS). GPAS has been used in large studies in the UK, and detailed research data on it have been published.17,19–22 Further modifications to GPAS resulted in the General Practice Assessment Questionnaire (GPAQ) which is shorter and more suitable for use by patients. We chose to use GPAQ because some questions in the GPAS questionnaire which was developed for use in the UK are not appropriate for Kuwait, and because we felt that the longer GPAS would give us a poorer response rate. The GPAQ recommends that 50 questionnaires are collected per doctor for statistical reliability. Because there were six doctors in the Clinic, we selected a convenient sample of 300 patients. The inclusion criteria for the patients were: age 16 and above, registered in the same health center area, who were available at the clinic during the time of the study and were willing to participate. Patients were excluded from the study if they were severely ill and under 16 years of age. Fifty-five patients refused to participate, due to lack of time on their part. Hence, a total of 245 questionnaires were used in the final analysis, giving a response rate of 82%.
Ethical consideration Ethical approval was granted by the research ethics committee in Ministry of Health. An information sheet explaining the purpose of the study was provided to the participants who were informed that their confidentiality would be maintained and that they could withdraw from the study at any time. Parents or guardians were allowed to consent to research and complete the questionnaires on behalf of patients who were less than 21 years of age.
Data analysis Data analysis was performed using the program SPSS versions 17 and 19 for windows.23,24 The raw data of each question were saved in certain column according to selected choices of participants. For two choices selected, it will take 0 or 1; for three choices questions, the selection was 0, 1 and 2. For four choices questions, the selection was 0, 1, 2 and 3, etc. Scores of question items were
Patient satisfaction with primary care
summed to obtain the mean score (M) for each question; in addition, descriptive statistics were obtained for all the variables in the study, including the percentage of responses split into each demographic data. Test of normality was performed for the total score of responses. Analysis of variance was used to analyse the equal variance distribution to compare mean between demographic variables where they split up into two groups or more. Pearson chi-square test and Mann–Whitney U-statistics were used to test for the association between different demographic variables with each theme. Most of the data presented in tables showed that most of the results were not significant, indicating that groups in each demographic variable have similar responses. Other results were significant, highly significant and very highly significant. The level of patient satisfaction on various questions can be evaluated on the basis of Mean and P-value (asymptotic significant (two-tailed)). A P-value of < 0.05 was considered as a cut-off point for significance.
RESULTS Table 1 shows overall satisfaction according to demographic data of patients. A hundred and seven (45%) were men and 129 (55%) were women. The majority, 192 (78%), were between 16 and 39 years of age, and the remaining 52 (22%) were 40 and above. The vast majority, 201 (82%), were Kuwaitis and the remaining 43 (18%) were non-Kuwaitis. Over one third, 84 (34%), completed high school, 58 (24%) held a diploma, 45 (18%) had a bachelor’s degree and the remaining, 58 (24%), held other qualifications. The majority, 177 (72%), were married, 51 (21%) were single, and the remaining, 17 (7%), were widowed, divorced or separated. Nearly two thirds, 160 (66%), were employed, 72 (30%) were unemployed, and the remaining, 11 (5%), were retired. More than half, 138 (56%), reported that they had no long-standing illness, disability or infirmity, whereas the remaining, 107 (44%), reported that they had long-standing illness, disability or infirmity. Our study showed that patients at Southern Sabahiya Clinic in Ahmadi Health Region were generally satisfied. In Table 1, two statistical significant differences of overall patients’ satisfaction with sex and level of education were found. The level of satisfaction was higher (P = 0.002) among women (mean score (M = 2.51)) than men (M = 3.19), and it was also marginally higher among those with other qualifications (M = 2.33) than the other
3
Table 1 Overall satisfaction according to patient’s demographic variables Characteristics Gender Male Female Age 16–19 20–29 30–39 40–49 50+ Nationality Kuwaiti Non-Kuwaiti Education High school Diploma BSc Other qualifications Marital status Single Married Others Employment Employed Unemployed Retired Long-standing illness, disability or infirmity No Yes
n
%
Mean
107 129
45.3 54.7
3.19 2.51
14 89 89 38 14
5.7 36.5 36.5 15.6 5.7
3.36 2.85 2.69 2.79 3
201 43
82.4 17.6
2.88 2.56
84 58 45 58
34.3 23.7 18.3 23.7
2.9 2.86 3.22 2.33
51 177 17
20.8 72.2 7
2.96 2.78 2.76
160 72 11
65.8 29.6 4.6
2.86 2.74 2.91
P-value HS 0.002** NS 0.437
NS 0.262 S 0.049*
NS 0.437
NS 0.869
NS 138 107
56.3 43.7
2.84 2.79
0.785
* S (significant ‘P’ < 0.05). ** HS (highly significant ‘P’ < 0.005). NS (not significant ‘P’ > 0.05). Mean range: 1 (completely satisfied) to 7 (completely not satisfied).
levels of education (P = 0.049). Other different demographic results have similar satisfaction level (P > 0.05) between various subgroups. Tables 2–4 show descriptive and inference statistics for the patients’ responses over three demographic variables, namely: sex, age and nationality. In Table 2, we found statistically significant differences of patients’ responses over sex for theme 1: satisfaction with receptionists; theme 2: satisfaction with access; and theme 3: satisfaction with communication. Regarding theme 1: satisfaction © 2014 Wiley Publishing Asia Pty Ltd
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Table 2 Descriptive and statistical inference for the responses over the sex
Theme 1: Satisfaction with receptionists Q1. How do you rate the way you are treated by receptionists at your practice (Means range from 1 to 6) Theme 2: Satisfaction with access Q2a. How do you rate the hours that your practice is open for appointments? (Means range from 1 to 6) Q2b. What additional hours would you like the practice to be open? (Means range from 0 to 1) Q3a. How quickly do you usually get to see that doctor? (Means range from 1 to 7) Q3b. How do you rate this? (Means range from 1 to 7) Q4a. How quickly do you usually get seen? (Means range from 1 to 7) Q4b. How do you rate this? (Means range from 1 to 7) Q5a. How long do you usually have to wait at the practice for your consultations to begin? (Means range from 1 to 5) Q5b. How do you rate this? (Means range from 1 to 6) Q6a. How do you rate the ability to get through to the practice on the phone? (Means range from 1 to 7) Q6b. How do you rate the ability to speak to a doctor on the phone when you have a question or need medical advice? (Means range from 1 to 7) Theme 3: Satisfaction with communication Q7a. How thoroughly the doctor asked about your symptoms and how you are feeling? (Means range from 1 to 7) Q7b. How well the doctor listened to what you had to say? (Means range from 1 to 7) Q7c. How well the doctor put you at ease during your physical examination? (Means range from 1 to 7) Q7d. How much the doctor involved you in decisions about your care? (Means range from 1 to 7) Q7e. How well the doctor explained your problems or any treatment that you need? (Means range from 1 to 7) Q7f. How do you rate the amount of time your doctor spent with you today? (Means range from 1 to 7) Q7g. How do you rate the doctor’s patience with your questions or worries? (Means range from 1 to 7) Q7h. How do you rate the doctor’s caring and concern for you? (Means range from 1 to 7) Theme 4: Satisfaction with enablement Q8a. Do you feel able to understand your problems or illness? (Means range from 1 to 4) Q8b. Do you feel able to cope with your problems or illness? (Means range from 1 to 4) Q8c. Do you feel able to keep yourself healthy? (Means range from 1 to 4)
M
F
P-value
Mean =
? 4.24
4.71
HS 0.009**
Mean =
3.96
4.55
Mean =
0.36
0.21
Mean =
3.02
2.78
Mean =
3.94
4.62
Mean =
2.95
2.64
Mean =
3.97
4.48
Mean =
3
3.4
Mean =
3.42
3.78
Mean =
4.21
4.91
Mean =
4.4
4.95
Mean =
3.82
4.37
Mean =
3.76
4.53
Mean =
4.01
4.47
Mean =
3.93
4.34
Mean =
3.89
4.45
Mean =
3.54
4.19
Mean =
3.79
4.21
Mean =
3.75
4.34
Mean =
1.79
1.75
Mean =
1.77
1.74
Mean =
1.9
1.78
VHS 0*** S 0.013* NS 0.437 HS 0.001** NS 0.29 S 0.015* S 0.018* S 0.041* HS 0.006** NS 0.061 HS 0.004** VHS 0*** S 0.01* S 0.025* HS 0.002** HS 0.001** S 0.022* HS 0.001** NS 0.86 NS 0.71 NS 0.732
* S (significant ‘P’ ≤ 0.05). ** HS (highly significant ‘P’ ≤ 0.005). *** VHS (very highly significant ‘P’ ≤ 0.0005). NS (not significant ‘P’ > 0.05). Mean range: low to high.
© 2014 Wiley Publishing Asia Pty Ltd
Patient satisfaction with primary care
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Table 3 Descriptive and statistical inference for the responses over the age
Theme 1: Satisfaction with receptionists Q1. How do you rate the way you are treated by receptionists at your practice (Means range from 1 to 6) Theme 2: Satisfaction with access Q2a. How do you rate the hours that your practice is open for appointments? (Means range from 1 to 6) Q2b. What additional hours would you like the practice to be open? (Means range from 0 to 1) Q3a. How quickly do you usually get to see that doctor? (Means range from 1 to 7) Q3b. How do you rate this? (Means range from 1 to 7) Q4a. How quickly do you usually get seen? (Means range from 1 to 7) Q4b. How do you rate this? (Means range from 1 to 7) Q5a. How long do you usually have to wait at the practice for your consultations to begin? (Means range from 1 to 5) Q5b. How do you rate this? (Means range from 1 to 6) Q6a. How do you rate the ability to get through to the practice on the phone? (Means range from 1 to 7) Q6b. How do you rate the ability to speak to a doctor on the phone when you have a question or need medical advice? (Means range from 1 to 7) Theme 3: Satisfaction with communication Q7a. How thoroughly the doctor asked about your symptoms and how you are feeling? (Means range from 1 to 7) Q7b. How well the doctor listened to what you had to say? (Means range from 1 to 7) Q7c. How well the doctor put you at ease during your physical examination? (Means range from 1 to 7) Q7d. How much the doctor involved you in decisions about your care? (Means range from 1 to 7) Q7e. How well the doctor explained your problems or any treatment that you need? (Means range from 1 to 7) Q7f. How do you rate the amount of time your doctor spent with you today? (Means range from 1 to 7) Q7g. How do you rate the doctor’s patience with your questions or worries? (Means range from 1 to 7) Q7h. How do you rate the doctor’s caring and concern for you? (Means range from 1 to 7) Theme 4: Satisfaction with enablement Q8a. Do you feel able to understand your problems or illness? (Means range from 1 to 4) Q8b. Do you feel able to cope with your problems or illness? (Means range from 1 to 4) Q8c. Do you feel able to keep yourself healthy? (Means range from 1 to 4)
< 40
≥ 40
P-value
Mean =
4.58
4.31
NS 0.204
Mean =
4.39
4
Mean =
0.27
0.31
Mean =
2.84
3.17
Mean =
4.26
4.5
Mean =
2.79
2.92
Mean =
4.27
4.12
Mean =
3.19
3.25
Mean =
3.63
3.54
Mean =
4.59
4.48
Mean =
4.7
4.58
Mean =
4.16
4.1
Mean =
4.21
4.02
Mean =
4.26
4.23
Mean =
4.14
4.19
Mean =
4.21
4.17
Mean =
3.96
3.79
Mean =
4.07
3.96
Mean =
4.06
4.1
Mean =
1.79
1.65
Mean =
1.76
1.67
Mean =
1.87
1.63
S 0.05* NS 0.601 NS 0.355 NS 0.326 NS 0.708 NS 0.546 NS 0.78 NS 0.661 NS 0.716 NS 0.697 NS 0.794 NS 0.413 NS 0.909 NS 0.814 NS 0.856 NS 0.446 NS 0.639 NS 0.876 NS 0.339 NS 0.537 NS 0.107
NS (not significant ‘P’ > 0.05). S (Significant ‘P’ ≤ 0.05). Mean range: low to high.
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Table 4 Descriptive and statistical inference for the responses over the nationality
Theme 1: Satisfaction with receptionists Q1. How do you rate the way you are treated by receptionists at your practice (Means range from 1 to 6) Theme 2: Satisfaction with access Q2a. How do you rate the hours that your practice is open for appointments? (Means range from 1 to 6) Q2b. What additional hours would you like the practice to be open? (Means range from 0 to 1) Q3a. How quickly do you usually get to see that doctor? (Means range from 1 to 7) Q3b. How do you rate this? (Means range from 1 to 7) Q4a. How quickly do you usually get seen? (Means range from 1 to 7) Q4b. How do you rate this? (Means range from 1 to 7) Q5a. How long do you usually have to wait at the practice for your consultations to begin? (Means range from 1 to 5) Q5b. How do you rate this? (Means range from 1 to 6) Q6a. How do you rate the ability to get through to the practice on the phone? (Means range from 1 to 7) Q6b. How do you rate the ability to speak to a doctor on the phone when you have a question or need medical advice? (Means range from 1 to 7) Theme 3: Satisfaction with communication Q7a. How thoroughly the doctor asked about your symptoms and how you are feeling? (Means range from 1 to 7) Q7b. How well the doctor listened to what you had to say? (Means range from 1 to 7) Q7c. How well the doctor put you at ease during your physical examination? (Means range from 1 to 7) Q7d. How much the doctor involved you in decisions about your care? (Means range from 1 to 7) Q7e. How well the doctor explained your problems or any treatment that you need? (Means range from 1 to 7) Q7f. How do you rate the amount of time your doctor spent with you today? (Means range from 1 to 7) Q7g. How do you rate the doctor’s patience with your questions or worries? (Means range from 1 to 7) Q7h.How do you rate the doctor’s caring and concern for you? (Means range from 1 to 7) Theme 4: Satisfaction with enablement Q8a. Do you feel able to understand your problems or illness? (Means range from 1 to 4) Q8b. Do you feel able to cope with your problems or illness? (Means range from 1 to 4) Q8c. Do you feel able to keep yourself healthy? (Means range from 1 to 4) NS (not significant ‘P’ > 0.05). Mean range: low to high.
© 2014 Wiley Publishing Asia Pty Ltd
Kuwaiti
Others
P-value
Mean =
4.47
4.72
NS 0.288
Mean =
4.27
4.35
Mean =
0.28
0.28
Mean =
2.84
3.23
Mean =
4.29
4.42
Mean =
2.71
3.28
Mean =
4.2
4.42
Mean =
3.15
3.51
Mean =
3.61
3.56
Mean =
4.51
4.91
Mean =
4.61
5.02
0.214
Mean =
4.11
4.26
NS 0.569
Mean =
4.19
4.09
Mean =
4.24
4.3
Mean =
4.12
4.35
Mean =
4.17
4.37
Mean =
3.93
3.88
Mean =
4.04
4.02
Mean =
4.07
4.09
Mean =
1.78
1.7
Mean =
1.75
1.72
Mean =
1.84
1.79
NS 0.731 NS 0.953 NS 0.506 NS 0.634 NS 0.282 NS 0.413 NS 0.105 NS 0.81 NS 0.232 NS
0.685 NS 0.799 NS 0.316 NS 0.41 NS 0.85 NS 0.93 NS 0.92 NS 0.807 NS 0.833 NS 0.775
Patient satisfaction with primary care
with receptionists, women were more satisfied with receptionists than men (M = 4.71 and M = 4.24 respectively, P = 0.009). In theme 2: satisfaction with access, women were more satisfied than men with the hours that their practice is open for appointments (M = 4.55 and M = 3.96 respectively, P = 0.000). They rated the quick ability to see a particular doctor higher than men (M = 4.62 and M = 3.94 respectively, P = 0.001). They also rated the quick ability to get seen by any doctor higher than men (M = 4.48 and M = 3.97 respectively, P = 0.015). Women waited longer than men at the practice for their consultation to begin (M = 3.4 and 3.0 respectively, P = 0.018). They rated this higher than men (M = 3.78 and M = 3.42 respectively, P = 0.041). They were also more satisfied than men with their ability to get through to the practice on the phone (M = 4.91 and M = 4.21 respectively, P = 0.006). In theme 3: satisfaction with communication, women were more satisfied than men in response to all questions under this theme (Means range from 4.53 to 4.19 and Means range from 4.01 to 3.54, respectively, P values range from 0.000 to 0.01). We also found statistically significant differences of patient responses over the age for theme 2: satisfaction with access in Table 3. Patients below 40 years old were more satisfied with the hours that their practice is open for appointments than patients aged 40 and above (M = 4.39 and M = 4.00 respectively, P = 0.05). There were no statistically significant differences of patients’ responses over nationality for all themes as shown in Table 4.
DISCUSSION To our knowledge, ours is the first study to evaluate patients’ satisfaction with respect to primary health-care services in Kuwait using the GPAQ postconsultation version 2.0. The aim of this study was to evaluate patients’ satisfaction with primary health care in Kuwait. Our findings suggested that the level of patients’ satisfaction at Southern Sabahyia clinic in Ahmadi Health Region was high. This is consistent with several local, regional and international studies that reported similar findings.7,25–28 We also found two statistically significant differences of patient satisfaction with sex and level of education. The level of satisfaction was higher among men than women, and it was also higher among those with university degree of education than the other levels of education. This
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finding is supported by other studies.7,29,30 However, this is inconsistent with another study.31 Our study showed that both men and women were satisfied with all themes of care. Women were more satisfied with receptionists than men. This is consistent with another study.30 However, another study showed that the majority of patients were dissatisfied from receptionists’ services.32 Both men and women were satisfied with the accessibility of the clinic. This is consistent with an international study that reported similar findings in nine European countries.25 Women were more satisfied with regard to the current opening hours of the clinic, how quickly they can see a particular doctor or any doctor, waiting time before consultation and their ability to contact the practice on the phone. This finding coincides with the findings of another study.33 Our study showed that all patients’ age groups were satisfied with all themes of care. Regarding the practice opening hours for appointments, patients below 40 years old were more satisfied than patients aged 40 and above. This is consistent with another study.34 However, this is inconsistent with the findings of another study.30 This could be explained by the fact that older people are generally in worse health and have greater need for medical care.35 They also have higher morbidity and consulting rates, and they might have more contact with primary care and thus have more opportunity to be favourably influenced by the services provided. Regarding the doctors’ consultation skills, women have shown more satisfaction than men. They agreed that doctors asked about their symptoms and feelings, listened to them, and put them at ease during physical examination. They also agreed that their doctors involved them in decisions about their care, explained their problems or any treatment they needed, and spent enough time to answer their questions and relieve their anxieties. This is supported by other studies.30,36 However, this is inconsistent with other studies.31,37,38 Sex is a significant variable when accounting for sex differences in health-care provider–patient communication. Female health-care providers generally tend to conduct longer consultations, give more information and engage in more partnership building. They are also less directive, express more interest in psychological aspects of health and more reassuring than men.39,40 Our study showed that there were no statistically significant differences of patients’ responses over nationality for all themes of care. This is consistent with results of © 2014 Wiley Publishing Asia Pty Ltd
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other studies.7,41,42 However, this is unlike the findings of another study.28 In their study, they found a significant difference in satisfaction between Qatari and non-Qatari patients.
Limitations of the study This study has a number of limitations. The results are limited to one government primary health-care practice and to the time period in which the study was conducted. This study also confined to a sample of patients who visited one practice and the results might not be sufficient to represent primary care as a whole in Kuwait. Therefore, generalizability of results beyond this setting is always a question.
Practical implications The data from this study reveal several practical applications for decision makers in the Ministry of Health in Kuwait who are interested in increasing patient satisfaction with regard to primary health-care services. Because patient satisfaction is related to quality of health care provided, efforts to increase patient satisfaction should also focus on improving the quality of all themes of primary health care. The findings of this study also might help doctors to understand patients’ views which can be utilized in providing better primary health-care services.
Implications for future research In addition to the practical implications, this study has also revealed implications for future research. The crosssectional research design limits our ability to draw casual inferences from these findings. A suggestion for future study would be a longitudinal research design. This study also focused on the GPAQ consultation version 2.0. This instrument does not assess patient dissatisfaction with services which cannot be assumed to be simply the alternative of a satisfactory assessment of service.43 Other direction could include comparing samples from other primary health practices in other health regions, namely Capital, Hawalli, Farwanyia and Al-Jahra health regions. Future studies could analyse the utilization of the primary health care, on the basis of those variables examined in the current study, which have not been found to be statistically significant and to validate significant relationship found in this study.
CONCLUSIONS This study represents an attempt to evaluate patients’ satisfaction with primary health care in Ahmadi Health © 2014 Wiley Publishing Asia Pty Ltd
Region, Kuwait. Our study showed that patients at Southern Sabahyia Practice Clinic in Ahmadi Health Region were generally positive about their experience. It concluded that satisfaction is multifactorial and no one factor alone could provide satisfaction with primary health services in Kuwait. Therefore, these results should not be generalized for all practices in Kuwait.
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