Background/Purpose:

Patient satisfaction has emerged as an important measure of physician performance and criterion for compensation in the US. Factors contributing to patient satisfaction are incompletely understood especially in chronic rheumatic diseases. The aim of this study was to identify various factors associated with patient satisfaction.

Methods:

This was a cross-sectional study conducted at Oregon Health & Science University’s rheumatology clinic. Consented patients’ satisfaction of their clinic visit was measured on a 0 to 10 numerical rating visual analogue scale, anchored by 10 verbal descriptions ranging from extremely dissatisfied to extremely satisfied. We collected demographic and clinical data including diagnosis; size of problem list; depression (identified by documentation or antidepressant use in absence of other indications); use of narcotics, biologic agents, or steroid injections; investigations like blood tests, x-rays, or MRI; or hospitalization in past 1 year. The impact of characteristics like attending physician versus  physician in training, provider’s gender, new versus follow up visit, wait time, number of telephone and email encounters was studied. Statistical analysis was performed using descriptive statistics and quantile regression.

Results:

We enrolled 300 patients between January and June of 2013. Mean age was 50 years (s.d. 15.2); 74.3% were female; 92% were white. Common diagnoses included lupus/MCTD (n=49, 16.3%), fibromyalgia (42, 14.0%), seronegative arthritides (39, 13.0%), rheumatoid arthritis (35, 11.7%), vasculitides (26, 8.7%), osteoarthritis (20, 6.7%) and others (89, 29.7%). In the univariate analysis, female gender (regression coefficient [rc] 4.62; 95% CI 0.52, 8.71; p=0.03) and follow-up visits (rc 8.01; 95% CI 6.74, 9.44; p <0.01) were associated with higher satisfaction. Afternoon appointments (rc -5.20; 95% CI -8.73, -1.67; p <0.01), female providers (rc -7.50; 95% CI -9.54, -5.48; p <0.01), use of narcotics (rc -4.62; 95% CI -8.8, - 0.44; p=0.03) or an MRI in the past year (rc -5.78; 95% CI -10.83, -0.72; p=0.03) were associated with lower patient satisfaction. At multivariate analysis, an MRI in the past year (rc -4.42; 95% CI -5.86, -0.44; p=0.02) and afternoon appointments (rc -3.15; 95% CI -5.86, -0.44; p=0.02) remained significantly associated with lower satisfaction. Other factors like age, race, diagnosis, presence of fibromyalgia, depression, obesity, biologic use, steroid injections and quality of life did not affect satisfaction.

Conclusion:

Patient satisfaction is playing an increasing role in patient centered outcomes and physician reimbursement. Accordingly, it is critical to understand what drives satisfaction.

We found that female gender, follow-up visits, male providers and morning appointments were associated with higher satisfaction. Contrary to our expectations, use of narcotics and an MRI in the past year had a negative influence on satisfaction when controlling for covariates. Interestingly, diagnosis of fibromyalgia, obesity, depression, steroid injections and use of biologic agents did not affect satisfaction. The validation of these results should be tested in other practices.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/determinants-of-patient-satisfaction-in-an-academic-rheumatology-practice/