Patients ’ satisfaction with government health care and services in the Taung district , North West Province

Curationis 29(2): 12-15 This was a descriptive study that determined patients’ satisfaction with health care in the Taung district state health institutions, North West Province. One hospital, three health centres and five clinics were randomly selected, and consecutive patients were recruited at outpatients during 17 May 2000 17 June 2000. The patients completed a questionnaire regarding the service or care provided. Five hundred and sixty seven patients participated in the study. The median age was 30 years, and most patients were female (76.7%). More than half of patients (56.8%) were not satisfied with the availability of medicines and other supplies. Approximately two thirds of patients (65.2%) did not know about the quality of telephone services rendered. There was a high level of dissatisfaction (63.1 %) among patients regarding accessing doctors after hours. Most patients were satisfied with the general attitude of health workers (62.1 %) but 21.2% were dissatisfied. Few (11.7%) patients felt rushed during consultation. Most patients felt they received good health education when their illness was discussed (74.6%). Words and explanations used were easy to understand (76.7%); and they were not discouraged from asking questions (69.9%, n=539). Generally the level of satisfaction among the patients was high except for difficulty in accessing doctors after hours and lack of medicines. Introduction Historically, patients were regarded as passive recipients of health care (Larrabee, 1995). Despite the passive recipient role, patients have become more educated, aware of their rights and are able to demand quality and adequate information to make informed choices about their health care (Lumsdon, 1993). In South Africa, the authoritarian approach to patient care is being replaced by a patient centred approach as reflected in the Batho Pele policy and Patients Rights charter (Department of Health, 2000). Every patient has a right to complain about the health service they receive (Department of Health, 2000). The patients’ rights, responsibilities and procedure for complaint encourage patients’ involvement in assessing the quality of health care they receive. One of the measurements of health care quality is patient satisfaction. There are various reasons why health professionals should take patient satisfaction 12 Curationis May 2006


Introduction
Historically, patients were regarded as passive recipients of health care (Larrabee, 1995).Despite the passive recipient role, patients have become more educated, aware of their rights and are able to demand quality and adequate information to make informed choices about their health care (Lumsdon, 1993).
In South Africa, the authoritarian approach to patient care is being replaced by a patient centred approach as reflected in the Batho Pele policy and Patients Rights charter (Department of Health, 2000).Every patient has a right to complain about the health service they receive (Department of Health, 2000).The patients' rights, responsibilities and procedure for complaint encourage patients' involvement in assessing the quality of health care they receive.One of the measurements of health care quality is patient satisfaction.There are various reasons why health professionals should take patient satisfaction  Buxton clinic 6.3 m easurem ents seriously: they reflect outcom e m easures, may be used in assessing consultations, and enable the patient to choose between alternative treatments (Fitzpatrick, 1991).
This study grew out of concern about the patients' satisfaction with health care available in the Taung district state health institutions, North West Province.

Methods
A descriptive observational study was co n d u cted using a stru ctu re d questionnaire, which was compiled after a literature study.In order to produce additional data, open-ended questions were also included.
The only hospital, three health centres and five clinics were randomly selected from five health centres and eleven clinics.Consecutive patients day were recruited as they waited in the outpatients department to see a nurse or doctor at the health facility.This recruitment was c o n tin u ed for each h o sp ital/h e alth ce n tre /c lin ic fo r the d u ra tio n o f the study period (17 May 2000-17 June 2000).Participation w as v o lu n tary and patients who were older than 18 years, not too ill and literate, were offered q u e stio n n a ire s by the trained research assistant at each facility.In order to lim it recall b ias, only patients who had visited any of the selected state health institutions at least once in the previous year were included.Completed q u estio n n aire s w ere folded and deposited in a marked box.The boxes were only opened at the end of the collection period.
A pilot study included 10 patients visiting a district clinic (not included in main study ) after which only the coding blocks had to be am ended.The E thics Com m ittee o f the Faculty of Health Sciences (University of the Free State) and the Taung D istrict M anager approved the study.The recru ited patients gave written informed consent after they were informed of the study and co n fid e n tia lity was ensured.The q u estio n n aire was anonym ous and p re sen ted in E nglish and Tswana.Regarding the service or care provided, patients could indicate whether they did  13.7 69.9 not know of the service (had not used the service before), were satisfied, 50% satisfied (unsure), or dissatisfied.The trained research assistant was available to clarify any questions.
D escrip tiv e statistics, nam ely freq u en cies and percen tag es for cate g o rica l data and m edians and percentiles for continuous data was calculated.

Results
Five hundred and sixty seven patients participated in the study.The median age (n=559) was 30 years (range 1 8 -8 6 years).Most patients were female (76.7%, n=550).The p ercen tag e p atien t attendance at each health institution is given in Table 1.
Most patients (79.3%) had previously used the same health institution where they completed the questionnaire, 18.6% had not, and 2 .1 % could not remember.The majority (80.4%, n=567) utilised the health services during weekdays.The median number of visits in the preceding year (n=426) was four (range 1 -24 visits).Two (20.4%) and eight (25.1%)visits were the most frequent number of visits for the preceding year.
Patient satisfaction with services is given in Table 2.The health care worker/ patient re la tio n sh ip and h ealth prom otion education responses are given in Table 3.

Discussion
More than half of patients (56.8%, n=556) were not satisfied with the availability of medicines and other supplies.With the contracting of a new medical distributing agent for the whole of the North West Province it was hoped that the problem would be alleviated.
Approximately two thirds of patients (65.2%, n=555) did not know about the quality of telephone services rendered in various health facilities.This was probably because they did not have a phone at home or easy access to a public phone.Few (14.4%) of the patients were not satisfied w ith the standard o f telephone services.In a study by Bollam, McCarthy and Modell (1988) in London only 2 % o f clien ts indicated dissatisfaction with telephone services during business hours.
There was a high level of dissatisfaction (63.1 %, n=548) among patients regarding accessing doctors after hours.Patients indicated in the comment section that when they arrived they were made to wait for a long time if their problems were not urgent until there were about three or more patients before the doctor was called in.Our study did not compare well with that of Bollam et. al. (1988) where 70% of patients as compared to only 16.8% in this study had a positive experience relating to doctors' availability after hours.
Slightly less than half 44.5% (n=555) of patients felt the referral to Taung Hospital was good, while 13.4% (n=545) were dissatisfied with referrals to specialists at other hospitals.It is important to note, however, that 24.3% and 54.3% indicated that they did not know about referral to Taung and referral to other specialists, respectively.Some of the patients (32.9%, n=560) did not know about the quality of the ancillary services probably because they had never used those services.
Almost two thirds (62.7% n=558) of the patients were satisfied with charges for services rendered.Those (21.1%) who were dissatisfied felt that since they were unemployed they should receive free services.
There was some satisfaction regarding the waiting room (56.3%, n=551) and the consulting room (53.1 %, n=550) facilities.In a study by Steven and Douglas (1986) 3% of patients were not happy with the waiting room facilities as compared to 20.5% in this study.Most waiting rooms in government facilities do not have clear directions regarding the availability of toilets, magazines and toys for children.
Only 11.9%(n=555) felt there was over prescribing on the part of nurses and doctors.Most patients were satisfied with the general attitude of their health workers (62.1%, n=557) but 21.2% stated th at they w ere d issatisfied .This com pared poorly w ith only 2 % d issa tisfa c tio n in the S teven and Douglas (1986) study.Only 14.8% of patients felt not cared for as people.Few (11.7%) of the patients felt rushed during consultation, which was similar to the Steven and Douglas (1986) study where 14% of patients felt rushed.Some (29.1% , n=543) patients were dissatisfied with the waiting times.The re aso n s fo r the high lev el of dissatisfaction could be the long waiting tim es norm ally asso c ia te d w ith consultation without appointment.
Most patients felt they received enough health education when their illness was discussed (74.6%, n=563).Words and e x p lan a tio n s used w ere easy to understand (76.7%, n=562); and they were not discouraged from asking questions (69.9%, n=539).Even though only a small percentage had a negative experience with health education, attempts should be made to improve communication of illness to patients.

Conclusion
Generally the level of satisfaction among the patients was high except for difficulty in accessing doctors after hours and lack of medicines.Since it is vitally important to manage health care problems, attempts should be made to reduce the percentage that w ere d issatisfied w ith services rendered.

Table 2 : Patient satisfaction with services
V 13 Curationis May 2006