Timmer, Antje and Sordi, Dominik de and Menke, Elise and Peplies, Jenny and Claßen, Martin and Koletzko, Sibylle and Otto-Sobotka, Fabian
(2018)
Modeling determinants of satisfaction with health care in youth with inflammatory bowel disease: a cross-sectional survey.
Clinical epidemiology, 10.
pp. 1289-1305.
ISSN 1179-1349
Abstract
Purpose: Patient satisfaction is frequently used as a health care quality measure despite
methodological challenges. By the example of pediatric inflammatory bowel disease (IBD), we
assessed factors associated with low satisfaction and examined differences by type of provider.
Patients and methods: In a cross-sectional design, a 32-item questionnaire and global
questioning were used to assess satisfaction in patients aged 15–25 years. Determinants of low
satisfaction were identified by logistic regression (OR with 95% CI). Separate models were
calculated for patient-related variables such as age, socioeconomic status (SES), health status
(emotional, somatic, quality of life) or region of residence (step 1), and impact of provider
(pediatric specialist, adult specialist, no specialist) (step 2). As secondary analysis, we studied
the effect of additional indicators such as waiting time, consultation time, and an IBD Management
Quality Index (IMQI) on effect estimates (step 3).
Results: A total of 567 cases were available for analysis (response 48.2%). The strongest predictors
of low satisfaction were anxiety symptoms (OR 2.49, CI 1.14 to 5.45). In step 2, not
being seen by a specialist (1.89, 1.16 to 3.10) and having been with the new provider for less
than 12 months (1.71, 1.03 to 2.83) were associated with low satisfaction. Satisfaction with
adult care provider was similar to pediatric care if adjusted for anxiety, health status, and time
with provider (0.95, 0.59 to 1.51). Presence of other quality indicators (step 3), waiting time >30
minutes, consultation time <15 minutes, and low IMQI were all associated with low satisfaction.
Age, SES, and region of residence were not found to affect satisfaction in any of the models.
Conclusion: Anxiety symptoms were most strongly associated with low patient satisfaction. The
relevance of recent provider change and not being seen by a specialist underlines the importance
of well-planned transition in this age group.
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