dialysis patient Patient satisfaction in a Dialysis Unit. What factors modulate patient satisfaction in dialysis?

Patient satisfaction in a Dialysis Unit. What factors modulate patient satisfaction in dialysis?





Patient satisfaction in a dialysis unit: what factors influence patient satisfaction in dialysis?

Tais Pérez Domínguez1, Armando Rodríguez Pérez2, Jesús Suárez Álamo3, Leire Rodríguez Castellano3, Miguel Ángel García Bello4, José Carlos Rodríguez Pérez5

1 Degree in Psychology. RTS Center for Hemodialysis (Baxter) of Gran Canaria, and Nephrology Service of Hosp. U. de Gran Canaria Dr. Negrín, and University of Las Palmas de Gran Canaria.
2 Doctor in Psychology. University of La Laguna.
3 Diploma in Nursing. RTS Center for Hemodialysis (Baxter) of Gran Canaria.
4 Bachelor of Psychology. Research Unit, University Hospital of Gran Canaria Dr. Negrín and University of Las Palmas de Gran Canaria.
5 Doctor in Nephrology. Nephrology Service, University Hospital of Gran Canaria Dr. Negrín and University of Las Palmas de Gran Canaria.

Address for correspondence

SUMMARY

Introduction. Renal disease requires prolonged health care, which combines both professional competence and other emotional and psychosocial skills. In these chronic processes, the user becomes the "center of the system", needing professionals capable of serving them in a multidisciplinary way. In this context, health policies can not be developed without taking into account the opinion of the patient that will add value to the perception of their health or well-being.
Objective. To know the degree of satisfaction of patients with chronic kidney disease on hemodialysis. Secondly, to know the variables that are associated with the increase or decrease in patient satisfaction in the dialysis units.
Material and method. 187 patients participated in the investigation. The average age was 66 years. We use the modified SERVQHOS questionnaire.
Results Satisfaction levels were high and similar to those of other units in Spain. The aspects most valued by our patients were the "waiting time", "the ambulance service" and the "quality of the food". Factors such as age, time on dialysis, sex and the dialysis shift (morning or afternoon shift) modulate the scores in the questionnaire.
Conclusions Identifying the factors that modulate satisfaction is as important as evaluating it. The inherent variables of the patient, which are conditioning the perceived satisfaction, must be taken into account.

Key words: Patient satisfaction, Hemodialysis, Perceived quality.

ABSTRACT

Introduction: Kidney disorders require prolonged medical treatment, in which professional competence is combined with other skills, both emotional and psychosocial. In these chronic processes, the user becomes the "center of the system", "being able to attend to them in a multi-disciplinary way". In this context, health policy can not work without taking into account the patient's opinion, which represents added value in terms of the perception of their health or well-being.
Aim: To find out the degree of satisfaction among patients with chronic kidney disorders in haemodialysis. Secondly, to establish the variables associated with greater or lesser satisfaction on the part of patients in dialysis units.
Material and Method: 187 patients took part in the research. Their average age was 66. We used a modified SERVQHOS questionnaire.
Results: Satisfaction levels were high and similar to those in other units in Spain. The worst-rated aspects of these patients were "waiting time," "the ambulance service" and the "quality of the food." Factors such as age, time on dialysis, sex and dialysis shift (morning or afternoon shift) affect the ratings on the questionnaire.


Terjemahkan dari: Inggris
Conclusions: Identifying the factors affecting satisfaction is as important as assessing it. This must take into account the variables inherent to the patient which are influencing perceived satisfaction.

Key words: Patient satisfaction, Haemoialysis, Perceived quality.

Introduction

The increase in life expectancy generates increasingly elderly populations with greater needs and demands. This leads to an increase in chronic diseases in the population, with a new type of patient that has certain needs. This brings with it a demand for improvement in health processes1. Patients with chronic kidney disease (CKD) must undergo non-curative, highly invasive treatments that involve high costs for the patient and their family, both physically, psychologically, socially and economically. These long-term treatments will produce important changes in the styles and habits of life, affecting factors such as the degree of social, physical and cognitive functioning, mobility and personal care to perform activities of daily life, as well as the emotional well-being and the general perception of health.

Renal disease requires prolonged health care, which combines both professional competence and other emotional and psychosocial skills. In these chronic processes, the user becomes the "center of the system", needing professionals capable of serving them in a multidisciplinary way. In this context, health policies can not be developed without taking into account the opinion of the patient that will add value to the perception of their health or well-being. Therefore, the concept of quality is emerging more strongly in the different fields of management in general and health and care management in particular.

Hemodialysis is a complex treatment in which different professional categories act, and in which facilities and infrastructures are needed to be able to be carried out in an effective way. All these elements will affect the well-being and the degree of patient satisfaction. Thus, the evaluation of quality regains special importance.

For all these reasons, the objective of health care must be to provide patients with the most appropriate and efficient level of care2. These attentions must be effective, efficient, acceptable, accessible, valued as useful by the patients themselves and based on evidence whenever possible. But, we must bear in mind that the concept of quality carries with it the concept of patient's expectation. The degree of satisfaction depends not only on the provision of the services, but also on the solution of the expectations, since the patient will have more satisfaction when said services meet or surpass the expected characteristics.

In the assessment of satisfaction, it is especially interesting to consider the doctor-patient relationship in which the results of health care are made from the perspective of the person with chronic disease. So Levinson et al, affirm that affordable and detailed information is an important aspect in this relationship3,4.

The studies carried out in hemodialysis units generally state that the variables that most influence the degree of satisfaction are the waiting times to be attended by the doctor, the punctuality of the hemodialysis sessions, the speed with which that they got what they needed, the interest of the nursing staff for the patients and the good functioning of the means of transport5,6.

The objective of this research is, first of all, to know the degree of satisfaction of patients with CKD in hemodialysis. And, second, to know which variables are associated with the increase or decrease in patient satisfaction in the dialysis units.

Material and methods

Patients


Of the 367 patients receiving renal replacement therapy in the RTS-Gran Canaria and Lanzarote dialysis centers and in the nephrology unit of the University Hospital of Gran Canaria Doctor Negrín, 187 participated in the research (120 men and 61 women), among the months of November 2011 and February 2012. The completion of the questionnaire is voluntary so those who did not answer was because they did not want or because they met exclusion criteria (suffering from cognitive dementia, taking less than a month in hemodialysis and / or not be in psychological and physical conditions to respond to the interview). The mean age was 66 years, with a standard deviation of 12.56, and a range between 24 and 90 years. The patients decided to voluntarily participate in the study, with prior informed consent.

Design

An observational, prospective, descriptive cross-sectional study was carried out.

Material

The nursing staff distributed a questionnaire, providing the information and instructions necessary for each of the patients to complete them at home anonymously. The staff helped those patients who had some type of problem to answer the questions. The instrument of measurement chosen to achieve the first objective was the modified SERVQHOS7 questionnaire. To this end, three questions related to adherence to treatment were included. In recent years, numerous researchers have selected this tool to measure the degree of satisfaction of users in the health field. This was applied, adapting it to the dialysis unit, where the word income was replaced by stay. It consists of 22 items that are answered on a scale (Likert) ranging from 1 (the services provided have been much better than expected) to 5 (the services provided have been much worse than expected) and 3 response items dichotomous (yes / no). In addition, it includes the collection of sociodemographic data and a last open question, where each patient could make any suggestion about any aspect that could be useful to improve the quality of the care received.

Analysis of data

The data processing has been carried out with the statistical program SPSS v. 17.0. First, all the responses of each of the patients were entered, the variables were coded and the descriptive study of the sample was carried out. We used the mean and the standard deviation for this, for each of the quantitative variables and absolute and relative frequencies for the categorical ones. Second, we use Cronbach's Alpha for reliability analysis. Subsequently, we performed the analytical study, looking for association relationships between the variables studied and the scores in the Satisfaction evaluation instrument. The categorical variables were analyzed by Chi square. We use nonparametric tests for continuous variables. We also observe the linear association by linear and the Jonckheere Terpstra test to examine the relationships between the variables.

Results

In the first place, a reliability and validity analysis of the questionnaire data was carried out using Cronbach's Alpha, obtaining a value of 0.95, which indicates that the results are reliable.

The results of the study are presented below, starting with the means and percentages of the scores in the SERQHOS in the different parts of the questionnaire and then a detailed analysis of the variables that influence satisfaction.

First, the analysis of the means of the evaluated attributes shows that the majority of patients are satisfied in the dimensions explored, with a score below 1.84 ("the services provided have been much better / sometimes better than what I expected "). The quality of care received in dialysis was valued at 1.61 ("very good / good").

The analysis of response frequencies for each of the items according to the score obtained on the Likert scale, indicates that the attributes with which patients are less satisfied are the "waiting time to be served" (2,37), the "means of transport, the ambulance service" (1.98) and the "quality of the food" (1.90). We should point out that the item that refers to the professionalism of the cleaning staff presents a lot of dispersion in the answers, which reflects a great variability regarding this dimension (Table 1).

With respect to the information that patients receive about their illness and evolution, 76% think that the theory they gave about their illness was enough to clarify their doubts. On the other hand, only 56% think that the evolution of their health status is always explained to them clearly. And finally, 66.3% perceive that they always have the opportunity to consult their doubts with the staff.

67.3% say that they can always distinguish the staff (know who are doctors, caretakers, nurses, etc.). Of the people who answered the questionnaire and if they need help to make their needs, half believe that the staff helps them efficiently, and 65.9% say that the staff always comes quickly enough. 72% replied that they never lack towels or linen.

When we focus on the opinion they have about the medical care received, 64.9% of patients believe that the time they are on dialysis can discuss with the staff those aspects that concern them. In addition, 54.8% say that they always get answers that are easy to understand. But only 40.4% value the professionalism of the medical staff as very good. And finally, in 26.9% he perceives that the same doctor always attends him during his stay.

The professionalism of the nursing staff is valued as "very good" by 51.4% of the respondents, while 55.8% say that they always obtain answers that are easy to understand. In contrast, nursing assistants are rated as "very good" by only 43.3%, and 7.7% think that the caretakers who attend them are "very good".

On the other hand, 78.4% of the patients think that the cleaning staff does their job trying not to disturb, but only 39.4% value their professionalism as "very good".

Regarding technological means, 71.6% believe that the necessary means are used to remove the most common discomforts that may arise, such as cramps, headaches and vomiting. 43.3% say that the food they give during their stay is "good". Of those who use an ambulance to reach their dialysis center, half believe it is "very good". And the waiting time since arriving at the dialysis unit until they connect to the machine is valued by 25.5% as "regular".

Finally, if we look at the answers referring to adherence to treatment we see that 30.3% evaluate themselves as "quite compliant", and 32.2% as "very compliant". 42.3%% do not perceive difficulty when taking their medication and only 20.7% use some strategy to remember to take their medication. In contrast, only 10.6% report having forgotten to take their medication some day since their treatment began.

42.3% of patients describe the quality of care received in the dialysis unit as "very good".

Second, we carried out an analysis to determine which variables were associated with satisfaction in a statistically significant way (Table 2).

Discussion

The study carried out allowed us to detect that the aspects most valued by our patients were the "waiting time", "the ambulance service" and the "quality of the food". This places us before possible areas of improvement on which we can act directly. This will probably affect a greater degree of patient satisfaction in our centers.


The present study has offered us the possibility of knowing the reality in which dialysis patients live. According to the paradigm of disconfirmation8, satisfaction in health care is achieved when the user perceives that the service provided exceeds their expectations. The studies carried out in primary care and outpatient consultations highlight "the time dedicated to each patient" and the "wait to be attended" 9, as the attributes most valued by patients.

We found some significant associations between demographic variables and questionnaire items. Among them, men rated the "speed of care" and the "ambulance service" higher than women. In addition, the farther the patient lives, the worse the "ambulance service" scores, but instead they say "answers that are easier to understand by the medical staff". The latter may be because people who reside further from their dialysis center feel more vulnerable and pay much more attention to what the doctor recommends.

An analysis of the different shifts we have in the dialysis centers revealed that the afternoon shifts punctuated worse the "professionalism of the caretakers", the "waiting time to be taken care of" and the "quality of the food". People who received dialysis treatment in the afternoon shifts were worse assessing themselves with regard to "taking medication" and perceived it to be harder to take. The latter may be due to the fact that the treatment schedule interferes with the food, which makes it more complicated to remember.

The age in our project had a clear influence on adherence to treatment, specifically in "stop taking medications" and in the use of "strategies to remember medications". The importance of taking into account the age of the patient has been demonstrated in recent studies10. In our work, the average age was 66 years, so we must use other sources of support to provide information, such as family and friends. In addition, older people rated better the "professionalism of nursing" and the "use of necessary means". Finally, patients who spend more time in dialysis more easily distinguish the staff that serves them and believe that they are clearly explained the evolution of their health status, compared to those who spend less time on dialysis.

Technological innovation and information systems have made citizens more and more informed about health services, demand a more personalized, intimate and confidential attention, know their rights in greater depth and have higher expectations regarding their centers health

The present study has offered us the possibility of knowing the reality in which dialysis patients live. The data obtained allows us a detailed analysis of the situation of patients and gives us clues about the way forward, issues to be modified and investigated in greater depth. The attention given to our patients should not only be the one we consider best, but also the one that takes into account what they expect from us as professionals.

The process of improving the services related to dialysis in our context must cover several areas. Among them, the most relevant are the improvement of transport, the quality of the food and the reduction of waiting times.

In short, we believe that it is absolutely necessary to ask and listen to our patients to know what they really expect from us as professionals and to focus our assistance in this way. Not only to meet their needs, but also to meet their expectations, thus serving the individual as being biopsychosocial ensuring an efficient, effective and effective service.

Thanks

This article has been made thanks to the help and collaboration of Rosa Crujeiras Pérez, Manager of the dialysis centers of Las Palmas de Gran Canaria and Lanzarote.

We also have the collaboration of Olga Betancor Martín (nurse supervisor of the nephrology department of the University Hospital of Gran Canaria Dr. Negrín), Cristina García Laverick (nurse supervisor of the RTS dialysis center of Las Palmas de Gran Canaria), Sonia González Martínez (nursing supervisor of the RTS dialysis center in Las Palmas de Gran Canaria) and Estefanía Mota Payarés (nursing supervisor of the RTS dialysis center in Lanzarote)