Patient satisfaction in health care is a combination of need, expectation and the experience of care. It is an intermediate outcome, and may reflect the standard of service the patient received at a health care facility. Health care which does not satisfy the patient, is less effective, because less satisfied patients do not comply with instructions, they take longer to follow up with appointments and they have a poor understanding of their medical condition (Wilkin, Hallam and Dogget, 1994; Al-Assaf, 1998). Many service providers are motivated by the aim of providing fundamental quality care for their patients and therefore, determining the level of patient satisfaction forms a very important part of managing and fulfulling the patients’ health care needs (Smith, 2001a). The aim of this study was to assess the level of patient satisfaction and gather data on patient behaviour at the Technikon Witwatersrand (TWR) Homoeopathy Clinic, as an approach to improve the quality of care at this facility. The information gathered was further intended to demonstrate the quality of health care delivered to the community. A sample group of one hundred patients was randomly selected from a population of two hundred and one patients who consulted the Technikon Witwatersrand Homoeopathy Clinic from February 2004 to May 2004. The patients’ degree of satisfaction with health care provided at the clinic was obtained by means of a telephonic interview (Appendix A), which explored the patient’s experience at the Technikon Witwatersrand (TWR) Homoeopathy Clinic. Most patients had a positive experience at the clinic. Factors that led to a favourable response were: the affordability of the clinic, the quality of the physical exam, the friendliness, the approachability of the senior I I homoeopathy student and the high level of satisfaction of patients regarding their treatment plan. Areas in which patients expressed dissatisfaction with were: the clinic’s accessibility, the accuracy of their diagnosis, the explanation of their medical condition and the explanation of the homoeopathic case taking procedure. Areas of health care delivery identified as problematic were: aspects of patient education in homoeopathy, patient education on their diagnosed condition and certain aspects of service delivery. Valuable information on patient behaviour and patient satisfaction was gathered by this study at the TWR Homoeopathy Clinic, which could be utilised to improve areas of health care delivery at the clinic. / Dr. N. Wolf Dr. S. van Es

acase@tulane.edu / Underutilization of health services is a persistent problem in low resourced settings. Efforts to strengthen health systems often focus on improving quality of care at health facilities. Low quality is assumed to dissuade people from seeking services, though few studies have addressed this assumption directly. The purpose of this research is to empirically test the hypothesis that quality is associated with utilization of health services. Using data from the 2014 survey of the Access to Primary Health Care project in the Democratic Republic of Congo, this analysis explores the extent to which patients’ assessments of quality of care align with objective assessments of health facilities, examines the extent to which patients’ assessments of quality are associated with their satisfaction, and estimates the impact of patient satisfaction on utilization of health services. Methods utilized include factor analysis and the estimation of multivariate regression models. Findings indicate that patient assessments of quality are impacted by the degree to which they are exposed to an element of quality and the extent to which they understand its importance. Patients’ assessments of access to care are positively associated with their overall satisfaction, while assessments of safety are negatively correlated and assessments of patient-centeredness are not significantly associated. Among pregnant women, satisfaction is associated with utilization of prenatal care but not facility-based delivery. This research suggests that prevailing attitudes toward health care may be a more significant barrier to utilization than the quality of care at a particular health facility. Strategies to improve patients’ abilities to assess quality should emphasize transparency and patient education. Patient satisfaction may be improved through focus on access to services. Future research should explore the impact of changes in both quality and attitudes toward health care on the utilization of a range of services and across a variety of settings. / 1 / Janna Marie Wisniewski

Thesis (M.P.H.M. (Primary Health Care Management))--Mahidol University, 2005.

Thesis (M.S.)--University of Michigan, 1992.

Thesis (M.S.)--University of Michigan, 1976.

Thesis (M.S.)--University of Michigan, 1992.

Thesis (M.S.)--University of Michigan, 1992.

Thesis (M.S.)--University of Michigan, 1992.

Thesis (M.S.)--University of Michigan, 1976.

Doctor of Philosophy (PhD) Orthoptics / The aim of this study was to evaluate the safety and efficacy of LASIK as a refractive surgical procedure, using a repeated measures design to assess satisfaction of patients who had LASIK and to correlate clinical outcomes with detailed measures of patient satisfaction to document long-term viability, monitor changes over time and patients’ functional abilities post-operatively. Method In the study 216 post-LASIK subjects were randomly selected from among patients who underwent simultaneous bilateral LASIK using the Chiron Technolas 217C plano-scan excimer laser with the Chiron ACS (Automated Corneal Shaper) and the Hansatome microkeratome. The subjects were recruited from within one centre, and the procedures were performed by any one of three surgeons. The study also included 100 non-LASIK subjects as a control group, to compare and differentiate ocular symptoms and visual difficulties between LASIK and non-LASIK patients. Clinical data documented included visual acuity, subjective refraction, record of glasses and/or contact lenses prescription, corneal topography with EyeSys and Orbscan, slit lamp examination, surgical details, and any pre-existing eye disease/conditions and previous surgery or injury that might prevent the subjects from achieving their desired visual outcome post-operatively. Subjective patient satisfaction evaluation of the treatment group was assessed by subjects completing a survey questionnaire at 3 months, 6 months, 12 months and 24 months post-operatively. The control group subjects completed a comparable questionnaire and were assessed at baseline and 3 months later. Because the control group subjects did not have any surgical alterations, it was unnecessary for them to have more than one follow-up. Results LASIK achieved relatively high patient satisfaction, with only a small number of dissatisfied patients. It was effective in correcting myopia, hyperopia and astigmatism. However, there was some persistent under-correction in myopic spherical and minus cylindrical refractive errors. Hyperopic spherical correction was less effective, as there were more under- as well as over-correction, and the plus cylindrical correction tended to be under-corrected. The LASIK subjects’ post-operative distance uncorrected visual acuity was not as good as their pre-operative best corrected visual acuity, but it did not significantly correlate with patient satisfaction. The findings were consistent with other studies and confirmed the concept that patient satisfaction is not unidimensional and is not related to outcome solely in terms of visual acuity and residual refractive errors. Other contributing factors included problems with glare, rating of unaided distance and near vision, ability to drive at night, change in ability to perform social/recreational, home and work activities, change in overall quality of life, amount of information given prior to surgery, rating of surgery success, and surgery outcome relative to pre-operative expectations. These variables demonstrated distinctive differences between subjects who were satisfied and dissatisfied. Conclusions The findings of this study are consistent with those of earlier studies. However, the repeated measures design and the comparisons between LASIK subjects and the control group revealed some new insights that were previously undocumented. LASIK achieved high patient satisfaction, and factors associated with satisfaction were predictable, but sources of dissatisfaction were more idiosyncratic and contributing factors were identified.