Patient Expectations of General Practitioner Care - Middle East ...

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Middle East Journal of Family Medicine, 2005; Vol. 3 (3)• to consider the role of the general practitioner inhealth promotion,• to obtain patient views about other servicesprovided in health centers and how these servicescan be improved.METHODSQualitative and quantitative methods were used.Initially focus group discussion took place, which wasfollowed by questionnaire survey.Focus GroupFocus group discussion took place in one of the urbanhealth centers in Abu Dhabi serving the population of35,000 people. An advertisement was put on the noticeboard and patients were invited to register their namesat the reception desk. Out of 25 registered patients ahomogenous group of 12 patients was selected. 8patients confirmed participation and 4 did not attend onaccount of other commitments. The proceedings wereaudio recorded and subsequently analysed to extractrelevant themes and issues.Questionnaire SurveyThe second part of the survey involved a questionnairesurvey of 25 patients randomly selected according totheir order of attendance at the reception desk in thesame primary health centre where the focus groupdiscussion was conducted. The target population was 25years and above and included both nationals as well asexpatriates. The instrument of study was aquestionnaire which was developed after literaturesurvey and focus group discussion. Out of 25 patientswho agreed to participate only twelve agreed tocontinue upon receiving the detailed questionnaire.The questionnaire was in three parts; the first covereddemographic details, the second inquired aboutexpectations of general practitioner attitudes and thefinal part about expectation of other services providedby the health centre. The questionnaire consisted of 23items both categorical and non-categorical based onseven sub-scales (factors). Basic demographicinformation was asked from the patients using ordinalscale.Patient expectations of general practitioner attitude wasassessed by using 5 sub - scales (factors) comprising of14 items. These subscales were:• Doctor patient relationship.• Communication.• Concern about patients' social and psychologicalproblems.• Patient involvement in decision making.• Health promotion.Patients were asked to rate their responses on a 5 pointlikert scale. At the end information about barriers togetting good medical care were sought in two openended question.Data AnalysisThis was done by doing the frequency analysis andfactor analysis of the data collected from respondents.Mean score of each item was calculated and from thismean score each factor was determinedRESULTSFocus groupA wide range of topics regarding patient expectationswere discussed and valuable insight was gained aboutpatient perceptions and experience of generalpractitioner care.Doctor patient relationshipAll participants agreed that good doctor patientrelationship is very important for the outcome ofconsultations. It was a general view that attentivelistening and a caring attitude is very important fordeveloping good doctor patient relationship. All theparticipants agreed that they were enjoying good doctorpatient relationship and were satisfied with the qualityof the consultation.Qualities of a general practitionerParticipants unanimously agreed that the mostimportant qualities of a general practitioner are attentivelistening, understanding and compassion. Theyexpected their general practitioners to possess thesequalities. Knowledge and the skills though importantfor being a good general practitioner were rated second.Involvement decision makingMost of the participants expected that patients shouldbe actively involved in management of their problemsand in case there is conflict of the opinion, the doctorshould use his skills to find some common ground.They were also of the opinion that patients should bekept fully informed about their illness, drugs prescribedand their side effects.Health promotion and educationAll the participants agreed that health education wasvery important for health maintenance. They expectedthe primary health teams to be actively involved in thehealth education of their patients.Other servicesParticipants showed overall satisfaction with the otherservices provided in the health centre. However, theyshowed dissatisfaction with the referral system, servicecharges and waiting time. They also wanted to receivevaccination for infectious diseases before proceeding onvacations to their native countries. .Results of questionnaire surveyDoctor patient relationshipThis sub scale measures the importance of doctorpatient relationship for the successful outcome of theconsultation and obtained a mean score of 4.2.Frequency analysis of various items in this sub-scale7
Middle East Journal of Family Medicine, 2005; Vol. 3 (3)showed that patients consider good doctor patientrelationships very important for their satisfaction (score4.6).CommunicationThis scale measures the extent to which effectivecommunication helps in understanding the patient andhis illness and scored mean 4.2. All the respondentswere of the opinion that listening attentively to thepatient is as important as performing a physical examand investigations (score 4.4). Patients were of the viewthat the doctor and patient speaking the same languagehelps in understanding the patient better (score 4.0) andwanted the doctors to keep them fully informed abouttheir illness (score 4.2) .Social and psychological concernThis sub scale received the highest mean score (4.6)and reflects the importance given by the patient to theinterpersonal aspects of consultations. All the samplesagreed that the general practitioner should not attendonly to the physical disease of his patients but alsoattend to their psychological and social problems (score4.4.) All unanimously agreed that providing emotionalsupport to their patents (score 4.7) and alleviating theiranxieties about the illness (score 4.6) is a part of aGeneral Practitioner's job .Decision makingMost of the respondents were of the view that patientsshould be involved in decision making and agreed thatit will increase the compliance of patients (mean score4.0).Health PromotionAll the sample agreed that doctors should provideadvice about risk avoidance to his patients (score 4.6).however the opinion was divided as to whether all thepatients follow the advice of their doctors (score 3.6).Mean score for the factor was 4.1.Satisfaction with health services facilitiesThis sub scale measures the Patient satisfaction withdifferent facilities available in primary health centers.There was overall satisfaction with the various healthservice facilities (mean score 4.1.) The generalpractitioner consultation obtained the highest meanscore (4.5) and dental service and waiting time lowestmean score (3.6). Two open ended questions wereasked to enquire about difficulties faced by patients ingetting good general practitioner care and their opinionon improving the services. Forty per cent of therespondents felt that health services were too expensiveand wanted a reasonable reduction in the charges.Thirty per cent of the sample felt that big rush in theclinics was the main difficulty they were facing andwanted appointment systems to be introduced.Dissatisfaction was shown by twenty per cent of samplewith referral system to secondary care hospitals and byten percent with laboratory facilities.DISCUSSIONThe general term expectation is often used to indicatewhat patients hope will happen whether or not theyexplicitly verbalise their expectations as requests. (10)The general practitioner faces a dilemma of increasedpatient expectations and the need for recognisingpatient expectations is considered an importantobjective for primary care systems.A number of studies suggest failure to identify patientexpectations can lead to patient dissatisfaction with thecare, lack of compliance and inappropriate use ofmedical resources.(11) Patient's satisfaction with thehealth care is the important health outcome. It has beenobserved that priorities of patients regarding health carehave changed during the last few decades. It has alsobeen recognised that patients may define successdifferently from health care professionals and patientsexpect their definitions, qualities and benefitsrecognised(2). Given the fact that an estimated 15-25%of primary care patients have unmet expectations, it isapparent that identifying the patients' agenda is animportant step to improve patients' satisfaction andother health care outcomes. (10)In order to measure patient assessment of care, variousmethods have been used which include in-depthinterview, focus group discussions and survey. Out ofthese, performing a patient survey is a frequently usedmethod for patient evaluation of general practicecare(12). In this study, a patient survey was conductedin two parts using both qualitative (focus group) &quantitative method (questionnaire survey).This study gives a valuable insight into patientexpectations of general practitioner care. What emergesfrom this study is that although patients expressed theiroverall satisfaction with general practitioner care, theywere not fully satisfied with some components of theservice provided in the health centers.Among scales used for measuring patients' expectationsof general practitioner attitude, scale 3 got highestscore. This scale measures patient perceptions ofdoctor's attitude to social and psychologicaldeterminants of their illness. Patients expect theirgeneral practitioner to attend to their social andpsychological needs and to provide them withemotional support in difficult situations. At the start ofthe 21st century a vital patient centered primary caresystem has much to offer to a changing population withthe increasing and diverse needs and expectations (9).Stephen G.G. states "modern man's health needs requireconsideration of whole and is carried out with contextof personal relationship to doctor and patient" (13).' MCWhinney states, "responding to sufferings is our moralobligation" (1).The participants in the focus group viewed compassion,attentive listening and effective communication as mostimportant qualities of general practitioners. The same8
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