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

• Published in: Clinical epidemiology Vol. 10; pp. 1289 - 1305
• Main Authors: Timmer, Antje, de Sordi, Dominik, Menke, Elise, Peplies, Jenny, Claßen, Martin, Koletzko, Sibylle, Otto-Sobotka, Fabian
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press Limited 01.01.2018; Taylor & Francis Ltd; Dove Medical Press
• Subjects: Age; Child health; Clinical medicine; Cross-sectional studies; Epidemiology; Gastroenterology; Gastrointestinal diseases; Health care policy; Hospitals; Inflammatory bowel disease; Medical care quality; Medical research; Original Research; outcomes research; patient reported outcomes; Patient satisfaction; Pediatric diseases; Pediatrics; Perceptions; Public health; Quality; Questionnaires; Recruitment; Regression analysis; Social class; Surveys; Youth; Germany; patient satisfaction; health services research; patient-reported outcomes; outcomes research; inflammatory bowel disease; regression analysis
• ISSN: 1179-1349; 1179-1349
• DOI: 10.2147/CLEP.S165554

Patient 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. In 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). A 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. Anxiety 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.