Factors associated with positive user experience with primary healthcare providers in Mexico: a multilevel modelling approach using national cross-sectional data

Abstract

ObjectiveThis study aimed to investigate factors associated with patient experience with primary care in a large public health system in Mexico and determine the amount of variability in experience attributable to facility-level and state-level factors.MethodsWe analysed cross-sectional 2016 national satisfaction survey data from the Mexican Social Security Institute (IMSS). Patient-level data were merged with facility-level data and information on poverty by state. We assessed general contextual effects and examined the relationship of patient, facility and state factors with four patient experience measures using random effects logistic regression.Results25 745 patients’ responses from 319 facilities were analysed. The majority experienced good communication (78%), the opportunity to share health concerns (91%) and resolution of doubts (85%). 29% of visits were rated as excellent. Differences between facilities and states accounted for up to 12% and 6% of the variation in patient experience, respectively. Inclusion of facility-level contextual effects improved model predictions by 8%–12%; models with facility random effects and individual covariates correctly predicted 64%–71% of individual outcomes. In adjusted models, larger patient population was correlated with worse reported communication, less opportunity to share concerns and less resolution of doubts. Men reported more positive communication; older individuals reported more positive communication and experiences overall, but less opportunity to share concerns; and more educated individuals were less likely to report positive communication but more likely to report resolution of doubts and overall positive experiences. Preventive care visits were rated higher than curative visits for resolution of doubts, but lower for opportunity to share concerns, and specific conditions were associated with better or worse reported experiences in some cases.ConclusionQuality improvement efforts at IMSS facilities might bolster individual experiences with primary care, given that up to 12% of the variation in experience was attributable to facility-level differences. The relationship between individual characteristics and experience ratings reinforces the importance of patients’ expectations of care and the potential for differential treatment by providers to impact experience.

Inpatient Experience Surveys and Overall Hospital Rating: A Correlation Analysis for a Private Hospital in Central America

“…Correlation analyses between domains of patient experience and patients' overall rating of care allow for identifying priority interventions for improving the overall experience of care. The latest correlation analysis done by the Centers for Medicare & Medicaid Services (CMS) demonstrated that, similar to studies performed in China and Canada, communication and respect from nurses and doctors were best associated with high overall patient experience ratings (6,8–10). These results seem to transcend boundaries and types of care, as studies done in Mexico and the USA, within primary care or post-operative surgical care, attained similar results (9,11).…”

“…The latest correlation analysis done by the Centers for Medicare & Medicaid Services (CMS) demonstrated that, similar to studies performed in China and Canada, communication and respect from nurses and doctors were best associated with high overall patient experience ratings (6,8–10). These results seem to transcend boundaries and types of care, as studies done in Mexico and the USA, within primary care or post-operative surgical care, attained similar results (9,11). The World Health Organization (WHO), through a study measuring the relative importance of non-clinical aspects of care, demonstrated that across regions, population surveys emphasized the importance of prompt attention (access to care), dignity, and communication as part of the medical care they receive (12).…”

Relational Continuity of Chronic Patients with Primary and Secondary Care Doctors: A Study of Public Healthcare Networks of Six Latin American Countries

“…In Uruguay, the high level of RC perceived at both care levels may be attributable to the smaller size of the study areas, which were located in smaller urban zones, and to the co-location of PC and SC doctors in the same health centres. These characteristics encourage doctors to get to know their patients [ 26 , 39 ], strengthening trust and mutual understanding, and creating a sense of responsibility in professionals towards their patients [ 3 , 41 ].…”

“…Most of the Latin American studies available, some of which are comparative between countries [ 8 , 21 , 22 , 23 ], come mainly from Brazil [ 8 , 22 , 23 , 24 ], Mexico [ 21 , 22 , 25 , 26 ], and Colombia [ 8 , 21 , 22 , 23 , 27 ]. Likewise, very few of these study RC in a comprehensive way, with the majority focusing on analysing just one attribute of RC in PC—the consistency of the doctor [ 22 ], the doctor–patient bond [ 24 , 25 ], or communication with the doctor [ 27 ]—through either qualitative methods [ 27 ] or surveys of health services users [ 8 , 21 , 22 , 23 , 24 , 25 ] or people with social security in general [ 26 ]. Quantitative studies on chronic patients and SC doctors RC are extremely limited to date.…”

“…There is only one study analysing it in patients with chronic diseases [ 25 ]. Some of the few studies that have comprehensively analysed RC through surveys show a negative perception of RC in PC—limited consistency and poor communication with the PC doctor is associated with perceived low quality of health systems in the region [ 22 , 26 ].…”