Title:	Factors Influencing Quality of Doctor-Patient Relationship and an Intervention to Improve Patient Satisfaction : A study in Inner Mongolia of China
Authors:	Alan Frederick Geater Tingting Qiao Faculty of Medicine (Epidemiology) คณะแพทยศาสตร์ สาขาวิชาระบาดวิทยา
Keywords:	Patient satisfaction Evaluation China
Issue Date:	2017
Publisher:	Prince of Songkla University
Abstract(Thai):	Background Doctor-patient relationship (DPR) in China is known to be tense. This study aimed to (1) provides some explanation by exploring factors influencing the DPR from doctors' and patients' perspective, (2) compile suggestions for resolution measures of DPR from different stakeholders, and 3) test whether an intervention program providing individualized feedback to doctors by patients could improve patients' satisfaction in an outpatient setting. Methodology For the first objective, a cross-sectional study was conducted in a province and a city level general public hospital in Inner Mongolia Autonomous Region of China. The Difficult Doctor-Patient Relationship Questionnaire (DDPRQ-10) and Patient-Doctor Relationship Questionnaire (PDRQ-9) were used to assess the quality of the DPR from doctors (n = 226) and patients (n = 713). Multivariate linear regression modeling was used to identify factors influencing the doctors' and patients' perception of the DPR. For the second objective, a qualitative study was conducted to collect factors influencing DPR and suggestions for resolution from stakeholders using in-depth interview (IDI). Data from IDIs were organized by using Ethnographic version 6.0 and content analysis method was used. The findings were coded according to the main themes. Comparisons were made between different participants, and recurring pattern of the themes and subthemes were noted. Findings of the IDIs were analyzed and conclusions drawn. For the third objective, an intervention study was conducted. Before the program started, patients attending each group of clinics were asked to fill in the Short-Form Patient Satisfaction Questionnaire (PSQ-18). In the experimental period, patients attending the intervention clinics were requested to rate their perception of the doctor's quality of care in various domains on an 8-question feedback card immediately after exiting from the examination room and to drop the completed card into the feedback box for the particular doctor. The cards were then collected by the doctor confidentially at the end of each day. There was no feedback in the control clinics. After the experimental period ended, the doctors in both groups of clinics were reassessed by a new series of patients using PSQ-18. The PSQ-18 scores were compared within the same group of clinics over time, and the changes in satisfaction score compared between intervention and control clinics. Results (1) Province-level doctors had on the average 1.66 (total effect coefficient, 95%CI, 0.08-3.24) higher DDPRQ-10 score than city-level doctors. Worse DDPRQ-10 scores were also seen for working in an Internal Medicine clinic, age between 31 to 40, a master level education, dissatisfaction with income, working >40 hours per week, feeling pressure, considering the hospital environment to be bad, being often affected by the negative media, and having defensive behaviors. Patients at the provincial level hospital had on average 1.28 (95%CI, 2.39, 0.17) lower PDRQ-9 score than those from city level hospital. Lowering effects on the PDRQ-9 score were also seen for Mongolian ethnicity, dissatisfaction with income, longer waiting time, shorter consultation time, the lower expectation of treatment result, low level of trust in the doctor, hospital environment regarded as poor, and more frequent negative media influence. (2) Using a qualitative approach of in-depth interview with stakeholders, it was revealed that poor communication and cold attitude led to patient dissatisfaction and tense DPR; the tense DPR also came from low-level of medical competency of doctors, lack of mutual trust, expensive fees, unreasonable expectations, negative media influence, unreasonable health system, uneven distribution of medical resources, poor hospital management, and some reasons from government. (3) There were 189 and 190 raters in the intervention group and 190 and 200 in the control group, before and after the intervention period, respectively. Scores in all domains increased significantly (P < 0.001) in the intervention group but not in the control group. Significant improvement in the patient satisfaction scores in the intervention clinics compared with the control clinics was confirmed by mixed effects linear regression controlling for the effects of gender, age, marital status, education and household income in the domains of general satisfaction, technical quality, communication, and accessibility and convenience. Conclusions (1) Enhancing the income satisfaction, improving hospital environment, and reducing the negative media reports are potential ways to improve the DPR from both doctors' and patients' perspectives. Reducing doctors' workload, relieving their pressure of work, controlling their defensive behaviors, inding a solution to the long waiting times and too short consultation times, and fostering patients' trust in the doctors should also help to improve the DPR. This study may provide a useful model to raise the quality of the DPR and to supply evidence for health policy makers and administrators to formulate strategies for reducing the problem of tense DPR in Chinese hospitals. (2) From the hospital and doctor side, strengthening hospital management and improving communication skill and competency of doctors are potential ways to improve the DPR. From the patient side, gaining more medical knowledge and establishing reasonable expectation of hospital and doctors are potential ways to improve the DPR. From the government side, increasing the health care investment, reducing medical costs, optimizing the allocation of health resources, reinforcing health legislation, and perfecting health insurance should be considered. From the social aspect, improving the trust between doctors and patients and guiding the media to provide positive reports should be considered. (3) Timely feedback to doctors of patients' perception of quality of care received can improve outpatient satisfaction in a Chinese hospital.
Description:	Thesis (Ph.D., (Epidemiology (International Program))--Prince of Songkla University, 2017
URI:	http://kb.psu.ac.th/psukb/handle/2016/17235
Appears in Collections:	350 Thesis

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