Modeling determinants of satisfaction with health care in youth with inflammatory bowel disease: a cross-sectional survey

Abstract

PurposePatient 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 methodsIn 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).ResultsA 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.ConclusionAnxiety 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.

<p>Modeling determinants of satisfaction with health care in youth with inflammatory bowel disease part 2: semiparametric distributional regression</p>

“…The baseline characteristics and clinical information of the patients have been published, as well as the descriptive analysis of the quality of care 15,17. We also refer to the first part of our work on modeling determinants of disease satisfaction which focused on covariate selection 12…”

“…The selection of covariates followed the three-step approach introduced in our previous paper of low patient satisfaction 12. The approach can be shortly described as follows: available variables were categorized into 3 groups: patient characteristics, including sociodemographic and disease-related information (step 1), non modifiable health care provider characteristics (step 2) and additional patient reported information indicating quality of care not included in the satisfaction instrument (step 3).…”

“…Where the focus is on improving quality of care, most information may be drawn from the usually small proportion of patients with low satisfaction 11. This would justify approaches where scores are dichotomized, as we did in a previous analysis of the same data 12. However, important information may be lost by transforming a multidimensional weighted score to a simple binary variable based on some arbitrary threshold.…”

“…They pose particular challenges to health care in particular in the transitional age of changing from pediatric to adult specialty care. In a previous publication, we have used standard regression modeling, specifically, multivariate logistic regression, to examine determinants of patient satisfaction 12. It was appreciated that this may constitute an overly simplistic approach.…”

“…In the current analysis, we modeled and estimated GAMLSS to examine differential effects on different levels/features of patient satisfaction. In analogy to our previous work, the underlying clinical questions relate to the identification of patient factors relevant for satisfaction with care (primary research question) and the effect of the type of provider when adjusted for relevant patient characteristics (secondary research aim) 12…”