A quantitative and qualitative study on factors influencing dental care satisfaction

Transcription

1 Volume 118 No , ISSN: (printed version); ISSN: (on-line version) url: ijpam.eu A quantitative and qualitative study on factors influencing dental care satisfaction Min-Ji Kim 1 and Jung-Eun Ha 2 1 Dept. Dental Hygiene, Dongseo University, 47011, South Korea icealswl@gdsu.dongseo.ac.kr 2 Dept. Dental Hygiene, Baekseok University, 31065, South Korea hajungeun@bu.ac.kr January 27, 2018 Abstract Background/Objectives: The purpose of this study was to identify the factors affecting the satisfaction of dental care to establish a new dental clinic management strategy. Methods/Statistical analysis: This cross-sectional study was conducted with 210 adults, aged 20 years or older by convenience sampling method and the criteria of dental clinic selection and medical satisfaction were surveyed by questionnaire. Out of 210 research subjects, 166 patients were admitted to the dentist for the past one year and for those having dental visits more than two years were excluded from the final analysis to minimize recall bias. Findings: The most important factor when select the dental clinic was accessibility (84.5%), professional treatment (37.2%) respectively. Especially, it was found that the most important consideration for dental treatment in women was medical expenses, and the score of importance was very high as 9.1 out of 10 points. In addition, the

2 dental treatment considerations according to the residence area differed in score distribution by item, but overall, it was somewhat higher in metropolitan city. In the case of caries, periodontitis, and prosthodontic treatment, the higher the degree of reflection to treatment planning of the patient, the higher the satisfaction level. As a result of examining the effect of the expense difference between the actual expense of dental treatment and the reasonable expense of treatment considered by the study subjects on satisfaction, the satisfaction level is lowered in prosthetic treatment. The contents related to satisfaction with dental care were shown as appropriate treatment expense, friendly counseling and explanation, steady oral health care, and thorough infection control through in-depth interviews. Improvements/Applications: There was a most important thing to consider when choosing a dental clinic was accessibility and professional care. Theses might be considered to establish a new dental clinic management strategy. Key Words : Dental care, Dental clinic, Expense of dental treatment, Satisfaction, Qualitative study 1 Introduction Medical demand continues to increase due to socioeconomic improvements, population aging, and chronic disease these days. In addition, due to the expansion of national health insurance and the statutory health checkups increase the utilization rate of medical institutions and it leads to increasing the demand for high quality medical services as the demand for healthy living increases 1. However, in recent years, the number of medical institutions and the number of medical personnel have increased in which entered into competition among them in the Korean medical system such being the case, the choice of medical institutions for consumers (patients) is widening due to the intensification of competition 2. The same applies when considering the dentistry. Dentists are over controversial due to a sharp increase in dentists (increased more than five times over last 30 years, the greatest increase in the medical category in Korea) and the individual-operated dental clinic needs to actively cope with the internal and external medical environment since the large size of the network dentistry promoting the low cost

3 of the clinic. Therefore, it is necessary to establish a marketing strategy that induces patients by providing the best dental care service that the patient perceives 3. The satisfaction of the medical service is defined as the individual s assessment of the quality of care received from the medical staff and the medical institution, as well as indicating the level of individual satisfaction 4. The satisfaction of such medical services and the trust of medical staff can be linked to the reuse rate of medical institutions which leads to the profitability of medical institutions so that not only high-quality management service can be provided but also the medical care itself 5,6. Since the introduction of the concept of hospital marketing in the 1980s, patient satisfaction surveys have emerged as an important area of activity in hospital management and quality improvement activities 7. However, to date, the satisfaction level of the contents of the medical service, the overall service satisfaction evaluation of the specific medical institution, or the quantitative survey was mainly performed, so that it was limited to analyze the opinions of the patients related to the satisfaction in depth Therefore, the purpose of this study was to identify the factors affecting the satisfaction of dental care and to use it as a basic data to establish a new dental clinic management strategy by conducting an in-depth interview - one of the kinds of qualitative research - to investigate patient-centered dental clinic selection criteria. 2 Materials and Methods 2.1 Research subjects This cross-sectional study was conducted with 210 adults, aged 20 years or older by convenience sampling method and the criteria of dental clinic selection and medical satisfaction were surveyed by questionnaire. Out of 210 research subjects, 166 patients were admitted to the dentist for the past one year and for those having dental visits more than two years were excluded from the final analysis to minimize recall bias. Residents of the research subjects of Seoul, Incheon, Gwangju, and Busan was classified as metropolitan city, and other areas were classified as non-metropolitan city

4 2.2 Quantitative research methods Survey items The questionnaire was structured as follows; the general characteristics of the research subjects, the details of the medical care that has been experienced over the past year, the factors of dental selection, the factors that are considered most during the dental treatment, the degree of reflection of physician in the treatment plan, and the proper medical treatment expense from the research subjects. Semantic differential scale (0-10 points) was used to irradiate the most important factors to consider during the dental treatment that are the functional part of chewing, pronunciation, aesthetics and degree of pain, usual management, medical treatment expense, specialty of the treatment, satisfaction with the treatment, and degree of opinion reflection of the patient in the treatment plan Statistical analysis All data were entered by computer and analyzed using SPSS The general characteristics and medical contents of the subjects were calculated by frequency analysis and the chi-square test was used to compare the dental selection factors according to the general characteristics. Differences in the major components of the dental treatment were analyzed by independent samples t-test. Also, in order to investigate the factors affecting the satisfaction of the dental treatment, the contents of the treatment were selected as the stratification variables and the age, sex, and residence area were corrected for the multivariable linear regression respectively. 2.3 Qualitative research methods We have conducted in-depth interviews and qualitative research in order to further understand the factors affecting the opinions and satisfaction of the dental treatment whom cannot be examined. The in-depth interviews were conducted on men and women from the 20s to 50s, focusing on the list of questions based on the existing data. The questionnaire consisted of a good and bad experience with dental care, satisfaction and reason for recent treatment, consideration in dental selection, and cost of care. This was done by writing a

5 transcript from a recording of the in-depth interviews conducted over a total of seven sessions and then using a continuous comparative analysis method which is a coding method of qualitative data based on the grounded theory. In the continuous comparative analysis method, after reviewing the given data, we have compared them in many aspects, identified the concepts contained in it and reclassified them into meaningful categories. In this study, not only we considered the core research questions but also reviewed the responses to the in-depth interviews carefully and reviewed the data while observing the central issue that appeared. In this review, we found new sub-topic and contents as well as summarized the concepts and contents derived from the data. 3 Results and Discussion The general characteristics of the total research subject were 166 individuals - 51 men (30.7%) and 115 women (69.3%) - and the average age was 29.9 years as shown in the Table people (65.1%) were living in metropolitan cities and 58 people (34.9%) were living in non-metropolitan cities. In the past year, 62 patients (37.3%) were treated with dental caries and 57 patients (34.3%) were treated with periodontitis. Also, 26 patients (15.7%) were examined for prosthesis. Table 1: General characteristics of study subject

6 *Average ± Standard deviation **The contents of the dental treatment within the past one year As shown in Table 2, the most important factor when select the dental clinic was accessibility (84.5%), professional treatment (37.2%) respectively. This distribution was different depending on the residence area. The residents in the metropolitan area selected the dental clinic with a good accessibility and professional care, but the research subjects living in the non-metropolitan area selected the accessible dental clinic 41 (70.7%) responded with the highest response rate (p=0.009). Table 2: Dental clinic selection factors according to general characteristics of the subject (n, %) *Total less than 166 due to the missing responses **Chi-square test Dental treatment considerations according to the general characteristics of the subjects were shown to be higher for each consideration in women overall than for men, as shown in Table 3. Especially, it was found that the most important consideration for dental treatment in women was medical expenses, and the score of importance was very high as 9.1 out of 10 points. In addition, the dental treatment considerations according to the residence area differed in score distribution by item, but overall, it was somewhat higher in metropolitan city. In particular, the subjects living in the metropolitan area showed that the chewing ability and the aesthetic part are more important than those in the non-metropolitan area (P< 0.05)

7 Table 3: Dental treatment considerations according to the general characteristics of the research subjects *By the independent samples t-test The multivariable linear regression model was analyzed adjusting for age, gender, and residence area in subgroups, the dental treatment contents in order to investigate the factors affecting the satisfaction of dental treatment and the result is shown in table 4. In the cases of caries, periodontitis, and prosthodontic treatment, the higher the degree of reflection to treatment planning of the patient was shown the higher the satisfaction level. In the treatment of caries, it was found that the degree of satisfaction with dentistry increased with the increase of 1 point in the degree of reflection to treatment plan, times in periodontitis treatment and times in prosthodontic treatment. As a result of examining the effect of the expense difference between the actual expense of medical treatment and the reasonable expense of treatment considered by the study subjects on satisfaction, there was no correlation between the two factors in caries, periodontitis and orthodontic treatment whereas the satisfaction level is lowered in prosthetic treatment (p=0.033). Table 4: Factors affecting satisfaction with dental treatment

8 *By multivariable linear regression analysis adjusting for age, gender, and residential district The contents related to satisfaction with dental care were shown in Table 5 as appropriate treatment expense, friendly counseling and explanation, steady oral health care, and thorough infection control through in-depth interviews. Table 5: Main contents and major opinions about dental treatment satisfaction By investigated the selection criteria of patient-centered dental clinic, the purpose of this study was to investigate the effect of dental treatment on the satisfaction of dental care and to utilize it as a basic data to establish a new dental clinic management strategy. As a result, the most important thing to consider when choosing a dentist was accessibility and professional care. This distribution was different depending on the residence area. The respondents living in the metropolitan area selected the dental clinic that had

9 good accessibility and professional care whereas the research subjects living in the non-metropolitan area selected the accessible to dental clinic. These results are similar to those of previous study 13 who showed that the percentage of respondents who answered, I prefer the nearest place was the highest when the patient did not have the desired dentistry. Patients in metropolitan areas do not have to consider accessibility because the number of dental clinics such as general hospitals and networked-dentists is larger than nonmetropolitan areas. Hence, it is thought that experience in distant places of dental medical institutions is relatively smaller than that of non-metropolitan areas, so research subjects in non-metropolitan areas consider the accessibility of dental clinic as the first consideration. In order to investigate the factors affecting the satisfaction of dental treatment, multivariate linear regression model was used to analyze general characteristics of the subjects such as sex, age, and residence area. As a result, it was found that the higher the degree of reflection of the patient, the higher the satisfaction level in the treatment plant of the caries, periodontal and the prosthodontic treatment except for the orthodontic treatment. It is considered that the degree of satisfaction with the treatment plan does not affect the satisfaction of the treatment plan because the consultation about the treatment plant between the dental staff and the patient is relatively clear as the diagnostic process with the precision of the dental correction. On the other hand, there was a significant positive correlation between the degree of patient reflection and satisfaction in caries, periodontitis, and prosthodontic treatment. Also, in-depth interviews showed that the detailed explanation and consultation of the medical staff had a positive effect on satisfaction respectively. As previous research revealed that patient satisfaction was the most influential factor in the degree of dental staff s kindness and communication 12, in order to improve the satisfaction of dental treatment, sufficient consultation and explanation about the treatment plan should be taken into place between the medical staff and the patients. Patients who did not receive dental care was investigated that one-fifth of the patients 14. Thus, economic factors were found to have a great influence on the dental visits. This study was examined the effect of the cost difference between the actual cost

10 of medical treatment and the reasonable treatment cost of the research subjects on satisfaction level. As a result, it was found that the cost difference did not affect the satisfaction of the treatment, rather it was found that in the prosthetic treatment, the higher the cost difference, the lower the satisfaction. In Korea, the dental care protection by the National Health Insurance is weak and the prosthodontic treatment is higher than the other dental care costs, the difference between the actual cost and the reasonable cost for the patient was thought to be large, and this difference was considered to affect the satisfaction. Therefore, patients who have to undergo prosthodontic treatment should have adequate consensus on medical expenses as well as counseling about adequate treatment plan with medical staff. The satisfaction of medical service has a significant effect on customer loyalty, if the factors affecting the satisfaction of dental care are searched, it can be used as a basic data for establishing a patient-centered dental clinic selection criteria as well as a new dental clinic management strategy. This study is a cross-sectional study that selected adults with 20 years old or more as a convenience extraction method in some areas which is difficult to generalize the results as a whole. However, in order to minimize the memory convenience, only the patients who visited the dental clinic for the past one year were included in the study and the in-depth interviews with the research subjects of each gender and age group were conducted to confirm the opinions of the patients which could be left out during the quantitative research. 4 Conclusion By investigated the selection criteria of patient-centered dental clinic, the purpose of this study was to investigate the effect of dental treatment on the satisfaction of dental care and to utilize it as a basic data to establish a new dental clinic management strategy. There was a most important thing to consider when choosing a dental clinic was accessibility of dental clinic and professional dental care. Theses might be considered to establish a new dental clinic management strategy

11 5 Acknowledgment This study was supported by the Research Program funded by the Baekseok University. References [1] Andaleeb SS, Service quality perceptions and patient satisfaction: a study of hospitals in a developing country, Social Science and Medicine, 2001, 52(9), pp [2] Cleary PD, McNeil BJ, Patient satisfaction as an indicator of quality care, Inquiry, 1988, 25(1), pp [3] Smith SA, Magnet Hospitals: Higher Rates of Patient Satisfaction, Policy Politics and Nursing Practice, 2014, 15(1-2), pp [4] Donabedian A, The quality of care.how can it be assessed? Journal of the American Medical Association, 1988, 260(12), pp [5] Antoun JM, Hamadeh GN, Adib SM,What matters in the patients decision to revisit the same primary care physician? Journal Medical Libanais, 2014, 62(4), pp [6] Lanfredi M, Candini V, Buizza C, Ferrari C, Boero ME, Giobbio GM, Goldschmidt N, Greppo S, Iozzino L, Maggi P, Melegari A, Pasqualetti P, Rossi G, de Girolamo G, The effect of service satisfaction and spiritual well-being on the quality of life of patients with schizophrenia. Psychiatry Research, 2014, 216(2), pp [7] Creanga AA, Gullo S, Kuhlmann AKS, Msiska TW, Galavotti C, Is quality of care a key 5 predictor of perinatal health care utilization and patient satisfaction in Malawi? BMC Pregnancy Childbirth, 2017, 17(1), p [8] Andaleeb SS, Siddiqui N, Khandakar S.Patient satisfaction with health services in Bangladesh, Health Policy and Planning, 2007, 22(4), pp

12 [9] Mayston R, Habtamu K, Medhin G, Alem A, Fekadu A, Habtamu A, Prince M, Hanlon C, Developing a measure of mental health service satisfaction for use in low income countries: a mixed methods study, BMC Health Services Research, 2017, 17(1), p [10] McFarland DC, Shen MJ, Parker P, Meyerson S, Holcombe RF, Does Hospital Size Affect Patient Satisfaction? Quality Management in Health Care, 2017, 26(4), pp [11] Stahlnacke K, Soderfeldt B, Unell L, Halling A, Axtelius B,Patient satisfaction with dental care in one Swedish age cohort. Part II What affects satisfaction, Swedish Dental Journal, 2007, 31(3), pp [12] Al-Amin M, Makarem SC,The Effects of Hospital-Level Factors on Patients Ratings of Physician Communication, Journal of Healthcare Management, 2016, 61(1), pp [13] Yoshii N, Fushimi K,Factors influencing the selection of a hospital for colon cancer surgery in Japan: analysis of the effects of surgery volume, hospital functions, and geographic conditions, Journal of Medical and Dental Science, 2006, 53(4), pp [14] Dyer TA, Robinson PG, The acceptability of care provided by dental auxiliaries: A systematic review, The Journal of the American Dental Association. 2016, 147(4), pp

13 2323

14 2324