Abstract
Background: Satisfaction surveys are periodically necessary to evaluate services rendered to
clients/patients as a means of quality assurance and service improvement.
Aim: To determine satisfaction to services rendered to ophthalmic patients in an outpatient eye
clinic.
Material and methods: It was an observational study carried out with validated questionnaires
complemented with a focused group discussion. Statistical Package for Social Sciences (version 150)
15
was used for data analysis.
Observation: A total of 251 questionnaires were analyzed comprising 139 males and 112 females
(M: F= 1: 08).
8). Age range and mean age were 17-92
17
years and 372 + 156
6 years respectively. Overall
satisfaction with quality of services was 801%.
80
Specifically, 956%, 92%, 809%,
9%, 709%, and 598%
were satisfied with cleanliness of hospital premises, doctors willingness to listen to complaints,
complaints
nursing care; doctors following-up
following
on treatment, and time nurses administered treatments
respectively. However, only 378%,
8%, 386%, 398%, and 474% were satisfied with drug costs, cost of
transportation to hospital, laboratory charges, and record keeping profile respectively.
Conclusion: Costs of uptake of eye care services and record keeping profile were key sources of
dissatisfaction in this study.
International Archives of Integrated Medicine, Vol. 1, Issue. 4, December, 2014.
Copy right 2014, IAIM, All Rights Reserved.
Page 1
Key words
Nigeria, Calabar,
r, Ophthalmic patient, Satisfaction,
S
Eye clinic.
Introduction
Today's users of health care services in Nigeria
are better informed, a condition being driven by
greater levels of information available to them
through telecommunication revolution since the
year 2000. Dissatisfaction has far-reaching
far
implications including failure to follow
treatment
regimen,
non-compliance
compliance
to
medications and dissuasion
ion of others from
accessing local health facilities [1, 2, 3, 4, 5, 6, 7,
8, 9]. About 78 billion naira (over $500 million
US dollars) is spent by Nigerians annually to seek
health care services overseas largely from
perceived shortcomings in the local healthcare
he
delivery system [10].
Satisfaction surveys are fraught with inability to
compare empirical results due to lack of
methodological standardization and nonnon
uniformity of definitional framework [11, 12, 13,
14, 15, 16, 17]. Consequently, the definition
definiti of
satisfaction should be contextually adapted [18,
19].. The current study therefore considers
satisfaction in the context of patient-provider
patient
relationships, ease with which patients accessed
care, socio-demographic
demographic characteristics, costs of
services, and state of providers facilities. This
study sought to determine
termine the influence of
these parameters on satisfaction to services
rendered to ophthalmic patients in University of
Calabar Teaching Hospital outpatient eye clinic.
Page 2
Results
A total of 251 patients were analyzed comprising
139 males (554%)
4%) and 112 females (446%) with
a male to female ratio of 1: 08.
8. The ages of the
patients studied ranged from 17 to 92 years with
a mean of 372 + 156
6 years. Ages of participants
were broadly classified into two: <40 years and
>40 years. The adoption of this age grouping
was not on any pre-determined
determined statistical bias
but on the premise that each category shares
similar ideologies and likely to perceive
per
experiences in a similar fashion. The 17-40
17
years
sub-class
class constituted the highest age group.
Cross tabulation of sex with age, marital status,
occupation and educational status showed pp
values of 0047,
047, 0008, 0044 and 0323
respectively. Only the p-value
value of educational
status was not statistically significant.
Satisfaction with overall quality of services was
801%.
1%. Overall satisfaction was cross-tabulated
cross
with individual variable in a bivariate analysis.
None of the parameters showed statistical
significance. With age and sex as co-variates
co
in a
multiple logistic regression analysis, place of
domicile, courtesy by nurses and record profile
became statistically significant as per Table - 1.
As per Table 2,, level of satisfaction ranged
from 168 (669%)
9%) for doctors appropriately
discussing patients condition to 231 (92%) for
doctors showing willingness to listen to patients
complaints. As per Table 3, 203 (809%)
subjects were satisfied with nursing care and
only a modest number of (598%)
8%) were satisfied
with the time nurses administered treatments.
Discussion
There is paucity of patient satisfaction surveys
especially among ophthalmic
thalmic patients in Nigeria
[21]. This has implications on how health care
services are ultimately perceived or utilized. In
Nigeria satisfaction to public health care is
considerably low [22]. While the plethora of
approaches to studying patient satisfaction
satisfact
represent intense interest in giving voice to the
patients in the developed world, satisfaction
surveys in developing countries such as Nigeria,
patients have very little voice [1, 2, 3, 4]. The
present study used patients responses to
compare with related
lated local and international
studies on similar subjects.
The age distribution of the patients showed that
majority 159 (633%)
3%) were 40 years or less
similar to a study by Illiyasu in Kano, Northern
Nigeria [22]. In African settings, males are more
economically
mically empowered being the working
group and able to afford hospital bills. Perhaps
this explains the preponderance of male in this
study similar to the finding of Olawoye in SouthSouth
Western Nigeria [21].
The overall satisfaction recorded in this study
was 80.1%. Patient satisfaction surveys across
Nigeria have been reported as 84% [21], [22],
75% [23], and 53% [24]. These studies [21, 22,
23, 24], cutting across multi-ethno
multi
religious
Nigeria, with inequality in the distribution of
social amenities, the diverse
erse satisfaction figures
reported were not unexpected. The different
sampled population, study definition and
settings could also have been contributory. The
above average patient satisfaction reported by
various Nigerian studies is yet to translate to
improved
proved medical tourism. Perhaps patient
satisfaction is multi-faceted
faceted relying not only on
Page 3
Page 4
Conclusion
In conclusion, as health care is becoming
increasingly economically competitive in Nigeria
and patients consciousness of rights evolving, a
robust health system which is patient-centered
patient
and affordable is advocated.
Recommendation
We recommend that grievances redressal
system be available for dissatisfied patients. EHR
or decentralized health record such that eye
department has its own manageable and less
cumbersome record unit should become
available. National
ional Health Insurance Scheme
(NHIS) can be further explored and revamped to
ease access to health services by indigent
populace who constitute the majority in Nigeria.
Additionally, exit suggestion boxes should be
strategically located at patients departure
depart
points to solicit suggestions on how services
could be improved upon. Finally, periodic
patient satisfaction survey should be
institutionalized to provide feedback for
continuous quality improvement.
Limitation
As a limitation of this study, perception
percept
of
satisfaction cannot be measured quantitatively
while the qualitative alternative we employed
could be difficult to interpret because of it
subjective nature. Secondly, our study was
hospital-based
based and biases that bother on
representation cannot be completely
ompletely ruled out.
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Page 6
Variables
Marital status
Occupation
Education
Place of domicile
Hospital was clean
Doctor spent enough time with you.
Doctors were courteous.
Nurses were courteous.
Nurses were quite willing to work
Pharmacists were courteous
Lab scientists were courteous
Other hospital staff were courteous
It was easy to locate eye clinic
Patient records were well maintained
Consultation fee was high.
Lab test fee was high.
Drug cost was high.
Travel cost to hospital was high.
df
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
F
0290
1166
1241
6153
0410
0148
0038
2863
0375
0228
0546
1732
2616
3937
0.098
0.665
0.401
1.048
p-value
0832
0325
0297
0001
0746
0931
0990
0039
0771
0877
0652
0163
0054
0010
0.961
0.575
0.753
0.374
Page 7
S (%)
222 (884)
NS (%)
2 (08)
U (%)
9 (36)
NA %)
5 (20)
(2
NR (%)
13 (52)
231 (920)
2 (08)
11 (44)
3 (12)
(1
4 (16)
179 (713)
16 (64)
25 (10)
28 (112)
(11
3 (12)
209 (833)
11 (4.4)
19 (76)
6 (24)
(2
6 (24)
173 (689)
45 (179)
18 (72)
9 (36)
(3
6 (24)
225 (896)
175 (697)
6 (24)
37 (14.7)
12 (48)
28 (112)
4 (16)
(1
7 (28)
(2
4 (16)
4 (16)
168 (669)
17 (68)
21 (84)
36 (143)
(14
9 (36)
197 (785)
28 (112)
16 (64)
5 (20)
(2
5 (20)
210 (837)
9 (36)
17 (68)
7 (28)
(2
8 (32)
(S=Satisfied,
S=Satisfied, NS=Not Satisfied, U=Undecided, NA=Not Applicable, NR=No Response)
Response
Table - 3: Classification of respondent based on nurses service orientation.
S/N Question
1
Nurses were caring.
2
Nurses were quite willing to
respond when needed.
3
Nurses communicated
patients needs to doctors.
4
Nurses gave individual
attention to patients.
5
Nurses administered
treatment in a timely manner.
S (%)
203 (809)
166 (661)
NS (%)
24 (96)
32 (12.7)
U (%)
16 (64)
38 (151)
NA %)
2 (08)
(0
6 (24)
(2
NR (%)
6 (24)
9 (36)
156 (622)
34 (135)
42 (167)
11 (44)
(4
8 (32)
167 (665)
39 (155)
29 (116)
10 (40)
(4
6 (24)
150 (598)
25 (100)
33 (131)
34 (135)
(13
9 (36)
(S=Satisfied,
S=Satisfied, NS=Not Satisfied, U=Undecided, NA=Not Applicable, NR=No Response)
Response
Page 8
Questions
Hospital was clean
Eye department was clean.
Records were well kept
Consultation fee
Lab test fee
Drug costs
Travel costs to hospital
Pharmacists were courteous
Lab scientists were courteous
Other staff were courteous
S (%)
226 (896)
240 (956)
119 (474)
136 (542)
100 (398)
95 (378)
97 (386)
157 (625)
122 (486)
184 (733)
NS (%)
10 (40)
5 (20)
85 (339)
60 (239)
44 (175)
73 (291)
84 (336)
24 (96)
18 (72)
10 (40)
U (%)
5 (20)
1 (04)
25 (100)
29 (116)
45 (17.9)
42 (167)
25 (100)
28 (112)
46 (183)
34 (135)
NA (%)
2 (08)
(0
2 (08)
(0
17 (68)
(6
20 (80)
(8
54 (215)
(21
32 (127)
(12
29 (116)
(11
38 (15.1)
60 (239)
(23
18 (72)
(7
NR (%)
8 (32)
3 (12)
5 (10)
6 (24)
8 (32)
9 (36)
16 (64)
4 (16)
5 (20)
5 (20)
(S=
S= Satisfied, NS= Not Satisfied, U= Undecided, NA= Not Applicable, NR= No Response)
Response
Source of support: Nil
Page 9