Abstract

This descriptive cross sectional study was conducted on 299 patients visiting outpatient department (OPD) of Dhaka Medical College Hospital (DMCH) between November 2005 and April 2006 (6 months) to assess their satisfaction of OPD services. Majority of the patients was male (54.85%) with mean age of 36 years, married (75.92%) with a family size of 5-7; of education level from illiterate to below SSC (71.91%) and from lower (46.44%) and lower middle (38.20%) income group. 53.18% patients visited OPD with medical, followed by surgical (26.76%) and gynaecological (20.06%) problems. The main reasons for choosing DMCH were effective (32.78%), free (24.41) and/or low cost (18.73%) treatment. There was long waiting time (32 minutes). However majority of the patients (81.14%) expressed satisfaction (ranging from fair to good) with respect to adequacy of space, sitting arrangement and cleanliness of the waiting rooms, but were dissatisfied (75.31%) with respect to toilet facilities and supply of drinking water. 74.90% patients were satisfied (ranging from fair to good) with OPD staffs with respect to their availability and readiness to register and make appointment with doctors. However 41.06% were dissatisfied with respect to their willingness to listen with compassion and reassure the patients with their problems. Only 65.1% patients received prescribed drugs from hospital pharmacy and majority of them were dissatisfied with respect to information provided about medication use (58.80%) and side-effects (98.70%). Of the patients advised to have laboratory investigations only 37.61% got them done at OPD laboratory and 59.75% of them were satisfied with the laboratory services. Women were more satisfied with OPD services compared to their male counterparts (c2, p<0.05). Patients’ satisfaction was inversely related to monthly income (c2, p<0.05) and level of education (c2, p<0.05). To improve patients’ satisfaction, most of the patients suggested for more doctors and supporting staff, improvement of waiting room facilities, drug supply and laboratory investigations.

Ibrahim Med. Coll. J. 2008; 2(2): 55-57

Key Words: Patients’ satisfaction, OPD services, socio-economic variables, DMCH

Address for Correspondence: Dr. Md. Ziaul Islam, Assistant Professor, Department of Community Medicine, National Institute of Preventive and Social Medicine(NIPSOM), Mohakhali, Dhaka-1212. Email: [email protected]

Introduction

Studies on patients’ satisfaction have been recognized as ways to identify priorities and problems of health care services. Patients’ satisfaction increases accessibility to health care, which enhance its efficient utilization.1 Attitude and behavior of providers, adequate drug supply, diagnostic and waiting room facilities influence patients’ satisfaction.2,3 Patient’s satisfaction of public health care services continues to remain low despite tangible progress made in the development of health services of Bangladesh.2 Survey on Health and Population Sector Program (1998-2003) showed that the rate of satisfied service users of public health facilities decreased from 66% in 2000 to 56% in 2003.4 Studies on patients’ satisfaction help policy makers to find out the pitfalls of health care delivery system and formulate strategies accordingly.6 Dhaka Medical College Hospital (DMCH) is a tertiary level public health care facility of the country and around 900 patients visit its OPD everyday.5 This study was designed to assess patients’ satisfaction regarding OPD services of DMCH.

Materials and Methods

This descriptive cross sectional study was conducted for a period of 6 months from November 2005 to April 2006 at three (Medicine, Surgery and Gynae & Obstetrics) outpatients Departments of Dhaka Medical College Hospital. 299 patients were selected by systematic random sample technique. The patients were interviewed face to face at the exit point after taking informed consent using a semi structured questionnaire. The level of patients’ satisfaction was graded on a four-point scale – excellent, good, fair and poor. Data was analysed with the help of SPSS software (version 13.0).

Results

Majority of the patients was male (54.85%) with mean age of 35.79±11.29 years, married (75.92%) with a family size of 5-7; (5.66 ±SD 1.98), of education level from illiterate to below SSC (71.91%) and from lower (46.44%, monthly income range: Tk 2000-5000) and lower middle (38.20%, monthly income range: Tk 5001-1000) income group.

Majority of the patients visited OPD with medical (53.18%), followed by surgical (26.76%) and gynaecological (20.06%) problems. The main reasons for choosing DMCH were effective (32.78%), free (24.41) and/or low cost (18.73%) treatment. There was long waiting time (31.74 ±SD 3.74). However, majority (81.14%) of the patients expressed satisfaction (ranging from fair to good) with respect to adequacy of space, sitting arrangement and cleanliness of the waiting rooms, but were dissatisfied (75.31%) with respect to toilet facilities and supply of drinking water (Table-1). Majority (74.90%) of patients were satisfied (ranging from fair to good) with OPD staffs with respect to their availability and readiness to register and make appointment with doctors, but most (41.06%) were dissatisfied with respect to their willingness to listen with compassion and reassure the patients with their problems (Table-1).

Table-1: Patients’ satisfaction regarding different aspects of waiting room and helpfulness of OPD staff

Majority of the patients (81%) were satisfied (ranging from fair to good) about the responsiveness and patience of the doctors to listen to their problem. However almost half of them were dissatisfied (47.9%) because the treatment was not explained and/or enough information was not given.

Only 65.1% patients received the prescribed drug from the hospital pharmacy. However only 41.20% patients were satisfied about the instruction they received from the drug dispenser regarding the use of medication. Only 1.30% patients said that drug dispenser explained them about possible side-effects.

Of the patients advised to have laboratory investigations, only 37.61% got the investigations done at DMCH outpatient laboratory. 59.75% patients were satisfied (ranging from fair to good) with the services provided at the laboratory.

Satisfaction regarding waiting room facilities were inversely related to education and by monthly income (p<0.05). Satisfaction about helpfulness of OPD staff differed by sex. Male patients were less satisfied than female patients and there was a statistical difference between the groups (p<0.05).

Regarding consultation with doctors, patients’ satisfaction varied with sex, females being significantly more satisfied than males (p<0.05). Satisfaction with regard to consultation by doctors was also found to be inversely related both to education and income (p<0.05). Patients put forward various suggestions for improvement of OPD services including increase in number of doctors, OPD staffs, better waiting room facility, adequate drug supply and laboratory investigation services.

Discussion

Dhaka Medical College Hospital being one of the largest tertiary health care hospitals of the country attracts large number of patients in its OPDs. Majority of these patients are male in their productive age, married with a large family of 5-7 members, illiterate to below SSC and from lower to lower middle income group. There was long waiting time (32 min) in OPDs, although most patients were satisfied with waiting room facilities but were highly dissatisfied with toilet facilities and supply of drinking water. With regards to helpfulness of OPD staffs and consultation by doctors, the level of satisfaction was poor in case of 31.71% and 19.0% patients respectively. Most of these patients were dissatisfied with OPD staffs with respect to their willingness to listen and help with their problems and with doctors and dispenser for their failure to provide ‘medication instruction’ and warning about side effects. However, the level of satisfaction varied with sex, females being significantly (p<0.05) more satisfied than males and also inversely related to the level of education and income (p<0.05). Almost similar findings were reported in earlier studies on Dhaka Medical College Hospital8-10 and other health care facilities of the country,6,7 suggesting that little improvement has occurred with respect to services provided in OPDs. Strategic planning, proper monitoring and accountability will be needed to improve quality of OPD services particularly with respect to reducing waiting time, improving waiting room and toilet facilities, making OPD staffs more caring and responsive to patients problems, improving availability of drugs and investigation facilities and ensuring doctors’ and pharmacists’ consultation.

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