Evaluation of patient satisfaction after primary care system interventions: a follow-up study.

Background: The Philippine Primary Care Studies implemented interventions that aimed to improve primary care services in selected urban, rural and remote communities. This study aims to describe trends in patient satisfaction in years 2 and 3 after implementation of primary care interventions.

Methods: This study is a serial cross-sectional study that assessed patient satisfaction under the domains of healthcare availability, service efficiency, technical competency, environment, location, health communication, handling and general perception in three primary care sites. Patient satisfaction was obtained via a 16-item questionnaire at baseline, and at 2 and 3 years after implementation. Pairwise testing was conducted to compare significant changes across sites over the time points.

Results: There were 200 respondents per time point for each of the three sites. Despite the cessation of funding, system changes allowed significant improvements in patient satisfaction at the urban site. The improvements were noted in 12 out of 16 items in year 3 compared with baseline. These items belonged to the domains of healthcare availability, service efficiency, technical competency, health communication, handling and general perception. At the rural site, patient satisfaction decreased in 4 out of 16 items by year 3. These items belonged to the domains of handling and general perception. At the remote site, a significant decline in patient satisfaction was noted in 8 out of 16 items by year 3. These items belonged to the domains of healthcare availability, service efficiency, environment, location and health communication.

Discussion: Patient satisfaction increased in the urban site and declined in the rural and remote site 3 years after implementation of a primary care system, when funding ended. This suggests that patient satisfaction in the urban centre was related more to the system improvements rather than fund augmentation.In contrast, it was more difficult to improve patient satisfaction in the rural and remote sites for two reasons. First, baseline satisfaction was much higher in these areas. This was probably because patients did not have alternative options for care and were therefore more appreciative. Second, cessation of financial aid led to an inability to sustain the system changes that were implemented on initiation. Their brief experience with primary care enhancements may have added perspective on pre-existing deficiencies they previously did not notice.

Conclusions: Modest financing and systemic improvements in primary care can lead to a significant increase in patient satisfaction. If funding is not sustained, however, patient satisfaction may decline significantly, especially in remote and underserved areas.