Patient satisfaction in primary health care: a literature review and analysis.

This paper reviews the literature on patient satisfaction in primary health care settings. Definitions and models of satisfaction are considered first. Attention is given to the conceptualization of satisfaction by investigators concerned about consumers in general as well as by researchers focusing on consumers of medical services. Research findings are discussed and used to develop a model of patient satisfaction. The measurement of patient satisfaction and the findings of empirical studies are then reviewed, including summaries of effect sizes. It is concluded that patient satisfaction information can provide a dependent measure of service quality and serves as a predictor of health-related behavior. Issues deserving further investigation and recommendations regarding research strategies are presented.     

Patient satisfaction with mental health services: a meta-analysis to establish norms

Patients typically express high rates of satisfaction with their mental health care. This finding and the lack of well controlled studies on patient satisfaction in the literature underscore the need for meaningful guidelines for clinicians and program evaluators in interpreting patient satisfaction data. To address this problem a meta-analysis was undertaken to establish norms on patient satisfaction for various types of mental health programs. Programs were categorized according to three dimensions: inpatient vs. outpatient vs. residential care; chronic vs. non-chronic; and conventional vs. innovative. Meta-analysis procedures were modified to accommodate the single-group study designs that dominate the literature. The analysis revealed that chronic patients express less satisfaction with their treatment compared to non-chronic patients. Innovative programs are viewed more positively than conventional ones. No differences were found in rates of patient satisfaction between inpatient and outpatient programs. Acceptably reliable norms and confidence intervals of patient satisfaction were established for conventional inpatient programs serving either chronic or non-chronic patients; conventional outpatient programs for non-chronic patients; and for all programs combined according to chronic vs. non-chronic, inpatient vs. outpatient, and conventional vs. innovative. However, data were insufficient to compute norms for other program types. The norms thus established can be used for comparative purposes by program evaluators. A cumulative, national data base on patient satisfaction is recommended to further refine these norms.     

The meaning of patient satisfaction with prepaid primary health care in Israel

This paper reports the development of a self-administered Hebrew-language questionnaire for assessing patient satisfaction with primary care in Israel. Four scale measures of patient satisfaction were empirically constructed. These scales pertained to doctor conduct, doctor-patient communication, teamwork, and ease of access. In addition, a single direct question was used to measure overall satisfaction with the care. Ratings of all aspects of care were negatively skewed, with doctor-conduct and doctor-patient communication usually being the most satisfactory aspects and access the least satisfactory. It was shown that different practices, or the same practice at different points in time, can easily and meaningfully be compared, using mean satisfaction scores, measures of standard deviation, or percentages in each practice with ratings above (or below) the overall mean of all practices. The use of specific measures of patient satisfaction for comparison and intervention is discussed.     

Conceptual and methodologic issues in the evaluation of children's satisfaction with their mental health care

The assessment of client satisfaction has become an important aspect of evaluation research in the adult mental health field, but there has been relatively little extension of that approach to the child client population. This is due to the lack of adequate methodologies for assessing treatment satisfaction in children and to the overriding conceptual issues which make it difficult to develop such measures. Further information is needed to clarify developmental differences in the way both healthy as well as medically and psychiatrically ill children conceptualize illness and treatment. The authors suggest that specific methodologies for assessing child satisfaction with treatment can be systematically developed once a more explicit developmental framework has been delineated in the area of children's understanding of medical and psychiatric disorders and their treatments.     

Similarities and differences between mental health and health care evaluation studies assessing consumer satisfaction

This paper compares the literatures assessing consumer satisfaction with health care and mental health treatment. Similarities and differences in the quantity, origins, quality, methodology, results, and utilization of findings are examined. The similarities identified far outweigh the differences. The trend toward carefully constructed high quality studies in the health care field is seen as suggesting a promising direction for future research.     

Power and change: primary health care at the crossroads in Sweden.

This paper is based on in-depth interviews with members of Sweden's medical interest groups involved in a national effort to control health care costs. Sweden is faced with escalating costs due primarily to a growing high technology hospital sector. Simultaneously, consumer demand for primary care services and for gerontological care is rising rapidly. The Swedish way of changing the health care system is described and an analysis of the power struggle between physicians, health care bureaucrats and politicians is presented.     

Defining and measuring patient satisfaction with medical care

This paper describes the development of Form II of the Patient Satisfaction Questionnaire (PSQ), a self-administered survey instrument designed for use in general population studies. The PSQ contains 55 Likert-type items that measure attitudes toward the more salient characteristics of doctors and medical care services (technical and interpersonal skills of providers, waiting time for appointments, office waits, emergency care, costs of care, insurance coverage, availability of hospitals, and other resources) and satisfaction with care in general. Scales are balanced to control for acquiescent response set. Scoring rules for 18 multi-item subscales and eight global scales were standardized following replication of item analyses in four field tests. Internal-consistency and test-retest estimates indicate satisfactory reliability for studies involving group comparisons. The PSQ well represents the content of characteristics of providers and services described most often in the literature and in response to open-ended questions. Empirical tests of validity have also produced generally favorable results.     

Client satisfaction with home care services in rural Russia

The objective of this work is to explore the satisfaction of a sample of 300 frail elders living in a rural Russian area with the support services provided by social service agency staff. The client population lives in extremely difficult conditions in terms of housing and associated communal services. They reported very high levels of satisfaction with the agency-provided services, both general satisfaction and their satisfaction with the specific services received during the reference visit inquired about by the interviewer. The degree of satisfaction is likely related to the difficulty of their living environment and their probable poverty, as well as the quality of services received. Attempts to relate the variance in the satisfaction ratings to the extent of activity limitations and the volume of formal and informal care using multivariate analysis met with limited success, owing in part, at least, to the limited variance in the dependent variables. Nevertheless, the patterns identified are broadly consistent with expectations based on modeling previously done for the U.S. populations receiving at-home care. The results clearly indicate the value of providing such services to frail elders in such circumstances.     

Client satisfaction with live-in and live-out home care workers in Israel

In an era of globalization where the migration of longterm care workers is common, foreign live-in home care workers can compensate for the unavailability of family members and, perhaps, even substitute for institutional care in the provision of long-term care services to disabled older persons. This study examines differences in home care satisfaction between disabled older persons in Israel with "live-in" home care workers and those with "live-out" workers, and explores some differences in sociodemographic and personal characteristics between these two groups. Face-to-face interviews were held with a random sample of 93 older persons in Beer-Sheva. Older persons with live-in home care workers were more satisfied with their home care service than those with live-out workers. Those with live-in workers were more severely disabled, tended not to have any children living in close proximity, although an adult child was available as an informal caregiver. Communication difficulties between the elderly persons and their home care workers were found not to affect negatively the satisfaction with the service.     

Economic change and health benefits: structural trends in employer-based health insurance

Drawing on structural theories of economic outcomes, we investigated how economic change affects the distribution of health benefits, the main source of health insurance for American workers. Through an aggregate level analysis, we show how the effects of industry level characteristics on the level of health benefits change between 1988 and 1997. Due to the increased reliance on women, nonwhite workers, and part-time labor, we expect declines in the effect sizes of gender and race composition and proportion full-time. In contrast, we predict increases in the effects of proportion small firm employment, proportion union, and industry sector due to rising health care costs, the competitive economic environment, and greater union effectiveness. We analyze data from the March Current Population Surveys for 1987 to 1997 using generalized least-squares regression. The positive effect of proportion white increases over time, while the positive effect of level of full-time work declines. The negative effects of small firm employment and being a retail or nonprofessional service industry increase in magnitude. Both union activity and gender composition have stable effects over the period. The results challenge views of a declining significance of race and gender in the labor market.     

Organizational change: The role of climate and job satisfaction in child welfare workers' perception of readiness for change

BackgroundWhen organizations embark on deliberate efforts to increase effectiveness through organizational-level changes, those that demonstrate greater readiness for change tend to have better outcomes. In contrast, when the organization is not ready, a change effort may result in resistance, conflict and, eventually, failure. However, studies addressing how agency climate and job satisfaction influence workers' perception of the organization's readiness for change in child welfare or human service organizations are scarce.MethodsData for this study was obtained from a sample of 356 direct care and clinical child welfare workers employed at eight not-for-profit child welfare agencies under contract to provide a variety of services in a large northeastern state. Workers were surveyed on their agency's readiness for change, organizational climate, and job satisfaction. The Spector Job Satisfaction Survey measured nine subscales and Parker Organizational Climate survey measured four primary domains: role, job, supervision, and organizational dimensions. A confirmatory factor analysis was conducted on nine questions derived from the Organizational Readiness for Change survey that measured workers' perceptions of organizational readiness for change. Structural Equation Modeling (SEM) was utilized to determine climate and satisfaction influences on voluntary child welfare workers' readiness for change.ResultsThe results of SEM confirmed that the exogenous independent indicators of role ambiguity, supervisor goal emphasis, organizational innovation, satisfaction with communication, and the number of years in current position were predictive of workers' perception of readiness for change with significant positive coefficients.ImplicationsThis study highlights the importance of certain organizational climate and job satisfaction factors that child welfare workers' identify for the success of agency change efforts. Workers perceive that organizations may have a higher level of readiness to implement successful change initiatives when: (1) workers feel their role is clear, supervisors articulate change goals, and job performance is held to a high standard and is measurable; (2) agency leaders establish organizational communication that is explicate, and they encourage workers to develop ideas and try new ways of doing the job; and (3) the greater the number of years workers are in their current position, the more likely change initiatives are perceived to be successful. Most importantly, this study suggests that not all organizational climate or job satisfaction factors are recognized by workers as supporting change equally.     

Research assessing consumer satisfaction with mental health treatment: A review of findings

This article reviews the findings of studies examining consumer satisfaction with mental health treatment. Typically, published studies find the vast majority of patients satisfied with treatment. Despite the numerous methodological problems in this research, it remains highly probable that the majority of consumers are satisfied with the services received. More specific findings in this literature remain less well demonstrated; there generally are few studies relevant to each specific question and the methodology of these studies often has been weak. However, trends point to weak relationships between patient demographic variables and satisfaction; significant relationships between patient diagnosis, treatment history, and psychological status and satisfaction; strong relationships between length of treatment and manner of termination and satisfaction; a strong relationship between satisfaction and patient global report of outcome; and a weak relationship between satisfaction and therapist rating of outcome. Satisfaction also appears to be multidimensional, although a large general factor is evident in most studies. A number of additional findings are catalogued; and research lying outside the formal domain of satisfaction research, but relevant to this body of research, is reviewed.     

Linking Migration Intentions with Flows: Evidence and Potential Use

In the absence of reliable, internationally available migration flow data necessary for statistical forecasting, policymakers increasingly turn to survey data on emigration intentions to evaluate future migration trends. The important assumption – i.e. that there is a measurable and systematic relationship between the intention to migrate and actual migration – has not been firmly established at the international level. We examine the association between estimated population averages of emigration intentions and official migration flow data based on data for more than 160 countries. The results show a strong association between emigration intentions and recorded bilateral flows to industrialized countries, as well as between intentions and aggregated out‐migration. The results provide policymakers with a reliability assessment of survey data on emigration intentions and encourage future attempts to incorporate survey data in formal statistical migration forecasting models.     

Artifact in client satisfaction assessment: experience in community mental health settings

Artifact in client satisfaction assessment is discussed and the results of a study of three factors thought to mediate client satisfaction ratings; (a) general life satisfaction, (b) mode of administration, and (c) psychological symptomatology, are reported. A standard client satisfaction questionnaire (CSQ) was modified to yield parallel forms and was administered orally and in writing to 92 clients in two mental health day treatment programs. Satisfaction ratings obtained from these clients were quite similar to out-patient ratings obtained in previous studies conducted in this setting and using the same measures. Oral administration of the CSQ produced 10% higher satisfaction ratings than written administration (p less than .05) and less missing data (p less than .01). Satisfaction ratings were also obtained using a simple graphic instrument. Graphic ratings were comparable to CSQ ratings. Satisfaction with life in general and level of psychiatric symptoms together accounted for 25% of CSQ variance. The implication of these findings for future client satisfaction research is discussed.     

透视新时期我国区域规划的发展与变革

区域规划作为时代发展的产物,是国家和地区调控区域发展的手段.20世纪90年代以来,随着我国政治、经济转型的不断深入,传统计划经济体制和等级官僚管理体系正发生着深刻变化,并对我国区域规划研究产生显著影响.     

Pragmatic decisions in the evaluation of consumer satisfaction with mental health treatment

This article examines pragmatic choices which must be made in conducting consumer satisfaction assessment of mental health treatment. It is argued that choices involving sample, format, and procedure for examining satisfaction may influence the results of such research, and must be considered when creating or evaluating these efforts. These choices are examined in detail.