Satisfaction assessment of patient with idiopathic inflammatory myopathies according to the PSQ-III questionnaire: cross-sectional study

INTRODUCTION

Idiopathic inflammatory myopathies (MII) represent a heterogeneous group of rare autoimmune diseases characterized by proximal, symmetrical, slow-progressive muscular weakness and fatigued [1]. Given that idiopathic inflammatory myopathies are chronic diseases with multi-organic involvement, resulting in many consequences and associated with comorbidities, these patients require increased attention from physicians as time and medical resources.

Over the last 20 years, patient satisfaction studies have shown increased attention in the medical field that is essential to identify gaps and addressing an effective action plan to improve quality in healthcare organizations. As a catalyst was the publication of the US Cross-Border Health Survey (2001), which set out the six objectives of the quality of the health system: (a) safety; (b) equity, (c) evidence-based, (d) in time, (e) efficiency and (f) patient-centered, and the last three directly involve patient satisfaction [2].

Although it is identified as an important indicator of the quality of health services, according to literature data, there is no consensus on defining the concept of patient satisfaction in the field of healthcare [3]. Thus, in the Donabedian model of quality measurement, patient satisfaction is defined by three categories: structure, process, and outcome [4]. The structure describes the context in which care is provided, including hospital buildings, staff, financing, and equipment. The process denotes transactions between patients and providers during healthcare. Finally, the outcomes relate to the health effects on patients and populations [5] The team led by Jenkinson C. emphasized that patient satisfaction is mainly the attitude towards care or aspects of care referred by patients [6]. While Rama Mohan et al. (2011) referred to patient satisfaction with their emotions, feelings and subjective reflection on the health services provided [6]. On the other hand, other authors have defined patient satisfaction as the degree of congruence between patient expectations for ideal care and their perceptions of actual care [7]. Patient satisfaction is a complex notion that is determined by multiple variables such as the organization of health services, the technical endowment of medical institutions, but not least the ability to communicate, respect, clarity and clear information that are more essential in some cases than technical skills of the medical staff [3]. Patient perceptions are influenced by their socio-cultural status, beliefs, attitudes, and level of understanding [9]. Research results from socio-economically developed countries can not be fully utilized in developing countries, although they have multiple tangents, they also have unique variables that could be crucial [3].

Patient satisfaction assessment provides insight into medical service quality [9] and is a valid tool to improve them [10], as it is based on user's experiences [11].

In this context, we considered it appropriate to study the degree of satisfaction of patients with idiopathic inflammatory myopathies with reference to the medical services provided.

MATERIAL AND METHODS

A cross-sectional study was conducted in the Department of internal medicine, Discipline of internal medicine-semiology of Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova, at the clinical base of the Institute of Cardiology, between May 2016 and September 2018.

The research received the approval of the Nicolae Testemitanu SUMPh Ethics Research Committee, report no. 66 of May 23, 2016.

Inclusion criteria for the study: adult patients with idiopathic inflammatory myopathies who met the ACR/EULAR 2017 classification criteria and who have expressed informed consent to participate in the research. Exclusion criteria from the study were patients with myopathies associated with neoplasms, endocrinopathies, neuromuscular disorders.

Sample size calculation was performed by applying the formula for descriptive studies.

n = Nt²Pq / (NΔx² + t²Pq)

where

n – representative sample size;

N – population size (71 patients);

t – probability factor (=1.96);

P – probability of occurrence of the phenomenon (=0.5);

q – contra probability (1-P=0.5);

Δx – eroarea limită admisă (=0,03);

n = 71 × 3,84 × 0,25 / (71 × 0,0009 + 3,84 × 0,25) = 67 patients

The registered parameters were: socio-demographic and clinico-statutory status.

The main outcome parameter was the scores obtained by applying the PSQ-III questionnaire.

Patient satisfaction with medical services was determined using the Patient Satisfaction Questionnaire (PSQ III) variant III. The questionnaire is a generic, self-administered tool, divided into 7 domains containing 50 questions for general satisfaction assessment, technical quality satisfaction, interpersonal issues, communication, financial aspects, time spent with the doctor and access, comfort and availability section [13]. Possible scores published by authors, both minimum, maximum, and average for the general population are shown in Table 1 [14].

The investigated patients were divided into 2 batches depending on the duration of the disease: the lot <2 years and the lot ≥2 years.

The statistical processing of the data was done through the MedCalc v.1.2 and Excel program, the arithmetic mean, the standard deviation was calculated. The t-Student test was used to test the statistical difference. Correlation analysis was performed by the Pearson test. Values of p<0.05 were considered statistically significant.

RESULTS

The characteristic of the socio-demographic parameters of the study patients is shown in Table 2. The mean age at the time of the research was 53.1±12.5 years, while patients aged 25-78 years were examined. The mean age at onset of the subjects in the study group was 45.0±13.4 years. The duration of the disease and we determined its oscillation from 6 to 324 months, with wide varied ranges, with an average of 99.1±72.6 months. Women prevailed in the study group with a 3.2: 1 female: male ratio. Higher education level prevailed in both: lot <2 years and the lot ≥2 years. The employment rate found among patients in the lot <2 years was mainly by full-time employment and retired people versus in the lot ≥2 years – retired people due to retirement age (Table 2). The hospitalization rate identified in study patients was 0.79 patients per year, the most frequent cause of IIM was flares – 29.4% of cases. During hospitalization, patients with IIM have received paraclinical investigations such as chest X-ray, radioscopy of the gastrointestinal tract with contrast substance, echocardiography, MRI etc., to detect the consequences of the disease.

The PSQ III questionnaire results in patients with idiopathic inflammatory myopathies are shown in the statistical data in Table 3. Thus, the level of satisfaction was lower than the average of the general population across all domains in both groups. Also, no statistically significant differences were found between the subscale results in the two lots.

In the lot ˂2 years, the general satisfaction showed a direct and close correlation with the "communication" domain, but also with the "time spent with the doctor" (r=0.9, r=0.8, p˂0.05). Also, a direct relationship, closely related to technical quality, communication, interpersonal aspects and access/comfort/availability, was identified (r=0.89, r=0.76, r=0.8, respectively, p˂0.05). For patients in the lot ≥2 years, was established correlations were established between access/comfort/availability and overall satisfaction, technical quality and communication (r=0.72, r=0.73, r=0.66, respectively, p˂0.05).

DISCUSSION

The results of the study showed that patients with idiopathic inflammatory myopathies have a low level of satisfaction with the medical act and the duration of the disease does not significantly affect this parameter, higher scores on the general satisfaction domain were determined in 7.46% of cases in the lot ˂2 and 10.45% of patients in the lot ≥2 years. Obtained results were compared to the literature data, but there were no publications that had a similar purpose, explained by the fact that the idiopathic inflammatory myopathies are rare and by the existence of several questionnaires for the determination of satisfaction. The results were compared with data from 2 studies performed on patients with osteoarthritis and systemic lupus erythematosus, diseases belonging to the group of rheumatologic pathologies [15, 16]. Thus, in the case of osteoarthritis patients, the results were lower than the available media, with the exception of the access/availability/comfort scores, where the patients in the study group have accumulated results above the proposed general population scores [15]. The data found in patients with systemic lupus erythematosus were below the median of scores proposed in all 7 domains [16]. Thus, the obtained scores are justified by the specificity of the pathology, the necessity of requesting the various performing and expensive medical services. The established correlations allow the assumption that for the lot ˂2 years the general satisfaction is dictated by a number of variables such as communication, time spent with the doctor, interpersonal aspects but also access/comfort/availability to medical services. This can be explained by the complexity of pathology, its chronic and progressive nature, as well as the serious consequences of the illness that lead to increased attention from medical staff and patient needs. For patients in the lot ≥2 years, the correlations determined between access/comfort/availability and general satisfaction, technical quality and communication indicate that prevails the convenience dictated by physical condition as the disease progresses.

The importance of determining patient satisfaction makes it possible to focus on the assessment of medical services from a patient perspective, which will help improve the quality of health services and assess attitudes towards the financial aspects of health care.

CONCLUSION

The level of satisfaction determined in patients with idiopathic inflammatory myopathies was reduced, the lowest scores were in the financial aspects subscale and highest in the communication domain. The degree of satisfaction does not seem to be influenced by the duration of the disease. A direct and close correlation between the domain of "communication" and "time spent with the doctor" has been established for patients in the lot ˂2 years. For patients in the lot ≥2 years, a moderate positive relationship between access/comfort/availability and overall satisfaction, technical quality and communication.

Declaration of conflicting interests

Nothing to declare.

REFERENCES

1. Lundberg I., Cooper R., Chinoy H. Polymyositis and dermatomyositis. EULAR Textbook on Rheumatic Diseases, 2012; p. 568-593.
2. Washington DC: National Academy Press, 2001. Committee on Quality of Health Care in America, IOM (pp. 39-40). Crossing the quality chasm: a new health system for the 21st Century.
3. Al-Abri R., Al-Balushi A. Patient satisfaction survey as a tool towards quality improvement. Oman Med. J., 2014; 29 (1): 3-7
4. Oyvind A., Ingeborg S., Hilde H. Overall patient satisfaction with hospitals: effects of patient-reported experiences and fulfillment of expectations. British Medical Journal Quality Safety, 2011; Disponibil la adresa: [ http://qualitysafety.bmj.com] Accesat la 15.11.2018.
5. Donabedian, A. The quality of care: how can it be assessed? JAMA, 1988; 260 (12): 1743-8.
6. Jenkinson C., Coulter A., Bruster S. et al. Patients' experience and satisfaction with health care: results of a questionnaire study of specific aspects of care. Quality Safety Health Care, 2003; 11: 335-339.
7. Moan R., Kanagaluru S. A study on the satisfaction of patients with reference to hospital services. International Journal of Business Economics & Management Research, 2011; 1: 3.
8. Iftikhar A., Allah N., Shadiullah K. et al. Predictors of patient satisfaction. Gomal Journal of Medical Sciences, 2011; 9 (2): 183-188
9. Perron N., Secretan F., Vannotti M., Pecoud A., Favrat B. Patient expectations at a multicultural out-patient clinic in Switzerland. Oxford Journals Med. Family Prac., 2003; 20: 428-33.
10. Rao G. How can we improve patient care? Journal of Community Eye Health, 2002;  15:1-3.
11. DeSilva N., Abeyasekera S., Mendis K., Ramanayake J. Patient satisfaction with consultations in ambulatory care settings in Sri Lanka. Medicine Today, 2006; 4: 125.
12. Al-Mahtab M., Choudhury N., Murshed K. et al. Patient expectation vs. satisfaction: a study from Bangladesh. Middle East Journal of Family Medicine, 2007; 5: 52-54.
13. Ware J. et al. Defining and measuring patient satisfaction with medical care. Eval. Program. Plann., 1983; 6: 247-263.
14. Hays R., Davies A., Ware J. Scoring the medical outcomes study Patient Satisfaction Questionnaire: PSQ-III. Disponibil la adresa: [http://www.rand.org/health/surveys_tools/psq.html]. Accesat la 15.11.2018.
15. Șalaru V. Impactul osteoartrozei genunchiului asupra stării de sănătate a pacienților. Teză de doctor în științe medicale. Chișinău, 2014.
16. Cebanu M. Afectarea sistemului respirator în lupusul eritematos sistemic. Teză de doctor în științe medicale. Chișinău, 2015.