Assessing patient satisfaction in a novel frontier: the model of ambulatory surgery center in rural eastern Uganda.

Abstract

Background: Standalone ambulatory surgery centers (ASCs) are still an innovative concept in most low- and middle-income countries (LMICs), and patients' satisfaction with this model remains uninvestigated. In the US, patient satisfaction with ASCs is assessed by the validated Consumer Assessment of Healthcare Providers and Systems (CAHPS). This study leveraged the CAHPS to quantify patient satisfaction of ASCs in rural Uganda and assess key patient-related and institutional correlates.

Methods: This prospective study was conducted at Kyabirwa Surgical Center (KSC), the first standalone ASC in rural Eastern Uganda, where patients were interviewed postoperatively regarding their perioperative experiences. A modified version of CAHPS with appropriate internal consistency was used to evaluate satisfaction, and SPSS 26 was used for binomial regression analyses.

Results: Among 124 patients, 120 (97%) reported satisfaction across all care stages, scoring ≥ 80% on the modified CAHPS instrument. This level of satisfaction aligns with top-performing U.S. hospitals and resource-limited settings, where satisfaction rates have been as low as 33% and 8%, respectively. The mean age of the sample was 46 (SD = 16.3) and 70% of patients were male. Satisfaction was more prevalent among patients who had visited another healthcare facility within 2 months (p = 0.046); dissatisfaction was more prevalent among patients who felt providers didn't proactively give diagnoses or advice (p = 0.028), suggest exams (p = 0.028), or prepare them for recovery (p = 0.004). Significant barriers to care included 38.7% expressing insufficient income to address basic needs, 69.3% experiencing severe or very severe symptoms before presenting to KSC, and 33.1% having difficulty accessing the facility. Patients suggested improvements in staffing, wait times, a canteen, and beds in waiting areas.

Conclusion: The ASC model can result in high patient satisfaction in rural, resource-limited LMICs, confirming its capability to fulfill patient expectations despite diverse living conditions, travel constraints, and lifestyle circumstances.