EVALUATION OF SATISFACTION WITH DENTAL SERVICES IN PATIENTS REFERRED TO PUBLIC DENTAL CENTERS (KERMAN, IRAN)

Headnote

Abstract

Introduction: Patient satisfaction is one of the most important goals of treatment-related organizations and a means to increase patient commitment. Satisfaction will attract patients' participation to the treatment, being a key indicator related to efficiency. The purpose of this study was to evaluate the level of patient satisfaction with dental services in public treatment centers of Kerman, in 2020. Materials and methods: This descriptive-analytical and cross-sectional study was performed on 385 patients referred to Kerman treatment centers, selected by a two-stage systematic method. Data was collected using instruments including demographic information (age, gender, level of education, job and economic status, oral health assessment, last dental visit and reason for referral), and a 9 item standard questionnaire on dental patients' satisfaction on clinical quality, quality of services, their ease and availability, pain and discomfort during the treatment, dentists' responsibility, cost and accessibility. Data analysis was done by SPSS21, using t-test chi-square (X2), ANOVA, and linear regression at a significant level of 0.05. Results and discussion: In this study, 66.5% of the subjects were females. The mean age of the participants in this study was 37.22 ± 11.01 years. Most of the respondents (59.2%) had a BA degree. The economic status of 30.9% of individuals and the oral health of 31.4% of them was moderate, the most common cause of referral (46.8%) being pain. 61.8% of patients were satisfied with the dental services. The mean value of the questionnaire was 42.87 ± 6.76, out of 95. In this study, young patients referred because of pain, and self-employed individuals were significantly more satisfied. Conclusions: The results of this study showed that 61.8% of the patients were satisfied with the dental services offered. As patient satisfaction is an important indicator for the assessment of the health care system, further studies are recommended in different private and public dental centers.

Keywords: patient satisfaction, dentistry, dental care, oral health.

1.INTRODUCTION

Analysis of patient satisfaction is the best and the most important indicator for measuring the quality and quantity of services, [1] and a key indicator relevant of organizational efficiency in treatment-related organizations [2,3]. Patient satisfaction can attract them toward care and treatment [4]. Satisfaction level can be considered as an appropriate criterion to assess the quality of treatment and the doctor-patient relationship in healthcare services. Periodic analysis of satisfaction in health care centers is recommended, to meet the possible shortcomings and problems [5]. Satisfaction includes various dimensions of the dental treatments. Hence, multiple instruments should be used to measure it. Among these factors, some are related to dentists, some others - to patients. Communicative skills, paying attention to the patient, informing and proper response to pain, the working hours in clinic or dental centers, the waiting time and the time consumed for work represent the main factors to be considered. Patient-related factors include age, gender, regular visits to the dentist, and stress [6]. For the dentist, the respect and behavior of the secretary with patients, and the way of making appointments are the most important priorities for the improvement of dental services [7].

The study showed that patient satisfaction may be irrelevant to the quality of treatment [8,9]. Evaluation of patient satisfaction can enhance their satisfaction for better outcomes of the new plans and policy-making organizational processes [10].

There are a few studies on dental centers of Kerman, and lack of using the Persian validated questionnaire measuring all items related to patient satisfaction - such as technical ability of the dentist, dentist-patient interaction, availability and ease of getting services, paying attention to pain and stress control of patients, and general satisfaction. Hence, the present study is conducted to measure the satisfaction of individuals referred to public dental centers of Kerman, Iran.

2.MATERIALS AND METHODS

The descriptive-analytical survey was done on patients referred to dental centers of Kerman. Sample size was equal to 384 participants, selected based on Cochran formula ((ProQuest: ... denotes formula omitted.)), with regard to z=1.96, d=0.05, and p=0.5. To prevent sample dropping, the sample size was considered equal to 400 persons.

At first, the city of Kerman was divided into five geographical regions, of which 2 were health centers with dental units. The method was simple sampling of the patients referred to the selected health centers. After explaining the purpose of the study, the questionnaires were distributed among patients. They entered the study by personal consent. Inclusion criteria were age above 18 years, the wish to participate, and reading-writing literacy to understand the questionnaire.

The data collection instrument in this study was the questionnaire, which included two sections: 1demographic information (age, gender, education, job, and economic status), patient evaluation on oral health status, and last dental visit; 2 - standardized Persian questionnaire (6), which measured patient satisfaction and contained 18 items on clinical quality (5 items), quality of services (3 items), ease and availability of services (2 items), pain and suffering during the treatment (2 items), responsibility and sympathy of the dentist (3 items), accessibility (2 items), and expenses (1 item). The scoring was based on a 5-point Likert scale from "totally disagree" to "totally agree". Score 1 was relevant to "totally disagree" and score 5 was relevant to "totally agree". Therefore, the total range of scoring was (1-90).

Data analysis was done by SPSS21, using T-test, ANOVA, Chi-square (X2), and linear regression, at a significance level of 5%.

The objectives of the research project were confirmed under the ethics code of IR.KMU. REC.1398.604 (#98000662) by the Ethics Committee of the University of Medical Sciences.

3.RESULTS

The results obtained on 385 individuals referring to the dental services in Kerman city are as follows:

129 men (33.5%) and 256 women (66.5%) participated in the study. In terms of education, the majority of individuals had a BA degree (59.2%). In terms of economic status, 119 of them (30.9%) reported moderate economic status. In terms of oral health, 22 individuals (5.7%) described an excellent level. The last referral to the dentist was during the last 1-2 years in 126 individuals (32.7%). The main cause of referral in 180 individuals (46.8%) was pain. In terms of job, 165 individuals (42.9%) were employed. The mean age range of participants was 37.22±11.01 years, with a minimum age range of 18 and a maximum range of 62 years (Table 1).

The patient satisfaction questionnaire included seven domains. Table 2 shows the mean value and standard deviation for each domain,

The ANOVA test showed no significant statistical difference between the gender of participants and the total value of the satisfaction questionnaire and relevant domains (Table 3).

There was no significant correlation between patient satisfaction and variables such as education, economic status, oral health selfassessment, dentist visits. There was a marginally significant correlation between the cause of referral to the dentist and patient satisfaction (p=0.060). The mean value of satisfaction was low in those referred for a checkup. There was a significant correlation between job and patient satisfaction (p=0.058). Employed patients showed higher satisfaction than others (Table 4).

Regression analysis showed that younger individuals referred for pain, and also that employed and self-employed individuals were more satisfied than others (Table 5).

In this study, 238 (61.8%) individuals were satisfied with the provided services, and 147 (28.2%) were neither satisfied, nor dissatisfied. No significant correlation was observed between satisfied individuals and variables such as gender, education, job, economic status, health status, and cause of referral.

4.DISCUSSION

Patient satisfaction is vital for the evaluation of the total quality of health care, and improvement of care services may result in clinical outcomes in addition to dental care consequences [11]. Recognition of the factors affecting patient satisfaction can lead to a significant effect on providing conditions for a patient benefitting from dental services, and, ultimately, on promoting their health level [12,13]. In this study, a significant statistical (marginal) correlation was observed between the cause of referral to a dentist and the mean value of patient satisfaction. People referred for pain were more satisfied than others. This could be because of dentist's control of pain, which has resulted in more satisfaction. According to Ghapanchi et al. [14], pain control was the most important factor for patient satisfaction. Mitchell et al. [15], found no significant difference between the treatment type of primary decay and patient satisfaction. In the present study, no significant difference was observed between the education level and mean value of patient satisfaction, yet those with higher education levels reported low satisfaction. The results can be compared with similar domestic works, in which higher educated subjects showed low satisfaction levels [16-18]. Also, similar studies reported a significant statistical correlation between education level and patient satisfaction. Individuals with higher education showed low satisfaction [19-21], which is consistent with the findings of the present study.

The findings of Aldosari et al. [22] showed that less-educated individuals were more satisfied with primary dental care. It seems that a higher awareness of educated people about their rights, their expectations and attention to their rights has made them less satisfied with the dental services.

In the present study, no significant difference was observed between gender and patient satisfaction in all domains, although men were slightly more satisfied than women. These results are consistent with the findings of Nur Al-Nisa et al. [7] and Owaidh et al. [19], showing that men were more satisfied than women. Also, Adeniyi et al. [23] showed a significant difference between gender and patient satisfaction.

In the present study, a significant statistical correlation was observed between job and satisfaction value. The results were consistent with the findings of Nur Al-Nisa et al. [7] on clinics of Fasa city, showing a significant correlation between job and patient satisfaction. In our study, self-employed and retired people were more satisfied than others. In the findings of Nur Al-Nisa, self-employed people were more satisfied than others, possibly because this study was conducted in dental clinics. In the present study, there was a significant correlation between age and patient satisfaction based on a regression test. Younger patients were more satisfied than older ones. This result is inconsistent with the findings of Owaidh et al. [19], showing no correlation between age and satisfaction of patients with health services.

This result was also inconsistent with the findings of Eslamipour et al. [24], showing that older people are more satisfied than younger ones. The causes of such inconsistency could be the instrument used for the measurement of satisfaction and the studied population.

In the present study, 58.9% of individuals agreed that getting a dentist appointment is easy in emergencies. According to Balhaddad et al. [20], 84% of patients agreed that dental services are satisfying.

According to the mean value of the questionnaire (42.87±6.76 of 95), satisfaction of individuals with dental services in public centers is at an average level. The findings of Tahaní et al. [6] showed a mean value of patient satisfaction at 63.1±8.5 and 60.59 [12] in Norway, higher than the values of the present study. In the present study, 238 (61.8%) individuals were satisfied with the dental services. Mitchell et al. [15] showed that one-fourth of individuals are dissatisfied, while Ghapanchi et al. [14] showed that 87.5% were satisfied. The cause of these differences could be the studied population and the measurement instrument. It should be observed that public dental centers provide services in which dentist plays no key role. Hence, the services have been evaluated based on overall factors.

In this study, 66.6% of individuals agreed and were satisfied with the dental services. According to Ghapanchi et al. [14], in Shiraz, 84.5% of them were satisfied with the Dental University of Shiraz, a value higher than in the present study. This can be because Ghapanchi conducted a study in an Educational-Medical Center and all dental units.

In the present study, 5.5% of the subjects agreed that dentists are not sufficiently careful in this field. The lowest level of answers was about clinical services, possibly because the present study is conducted on patients from public dental centers, which could affect their opinions.

41.3% of individuals agreed that the expenses of dental services are higher than their income. The findings of Tahani et al. [6] are consistent with the results of the present study, possibly because of the high costs of dental materials and equipment.

In the present study, 75.6% of participants agreed that dentists carefully check the oral health of patients. They reported average satisfaction with the quality of clinical services. A systematic study revealed that the determinant factors of patient satisfaction vary in different studies [25].

One of the limitations of the present study was that the project was based on self-report, which can make unreal answers, because of the cross-sectional nature of the study and manner of gaining information by the questionnaire. Such limitation is out of author's control.

5.CONCLUSIONS

The results obtained in this study showed that 68.1% of individuals were satisfied with dental services. No significant correlation was observed among gender, last dental visits, and education level of patients. Also, there was a significant difference between the cause of dentist appointment and the age of patients. As the measurement of patient satisfaction is useful for health system evaluation, further studies in different public and private dental centers are recommended.

References

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