Patient Dissatisfaction Increases With Delays, Short Visits

Jenni Laidman

February 13, 2012

February 13, 2012 — Patients were more satisfied with physicians who booked them in quickly for an appointment, did not keep them lingering in the waiting room, and gave them more than 10 minutes of their time, according to a study published in the February issue of Health Outcomes Research in Medicine.

Michael Adolph, MD, from the Department of Surgery, Ohio State University College of Medicine, Columbus, and colleagues analyzed data from an Internet survey about patient satisfaction. Among 22,626 respondents, the researchers found that although there was no significant difference in patient satisfaction between patients of primary care physicians and patients of specialists, more specialists received extremely low ratings. Patients who visited their physician for a health problem or for follow-up were less likely to be satisfied with their healthcare than those making a routine visit. Further, unlike previous patient satisfaction studies in which older patients are more likely to be unsatisfied with care, in this study, patients older than 45 years were 40% more likely to be satisfied with specialty care, but 24% less likely to be satisfied with primary care, compared with patients younger than 25 years (P < .01 for both comparisons).

The survey, conducted on the DrScore.com Web site, included 11,558 primary care patients and 11,068 patients of specialists. Each patient rated the physicians between January 1, 2005, and January 1, 2008. On a 100-point scale, representing a sum of the ratings of 9 different physician-related items, patient satisfaction was considered to be a score of 70 or more. The mean patient satisfaction rate for primary care was 79.4, and for specialty care it was 75.5, a difference that was not statistically significant (P > .05).

More than 85% of the survey respondents were younger than 45 years, and 70% were women.

The survey found that patients routinely face long delays when making an appointment with a specialist. Half of primary care patients waited 2 or fewer days for an appointment, but 58% of specialists' patients waited more than 6 days (40% waited between 6 days and 1 month; 18% waited more than 1 month).

Patients who saw their primary care physician within 2 days of calling were more likely to be satisfied with their physician than those made to wait 3 to 5 days (odds ratio [OR], 0.46; 95% confidence interval [CI], 0.39 - 0.53; P < .001).

Patients appear somewhat more tolerant of short delays from specialists. Although the odds of being satisfied with specialist care declined when the wait extended to 3 to 5 days, it declined less steeply than the rate for primary care physicians (OR, .62; 95% CI, 0.51 - 0.76; P < .001).

When patients had to wait between 6 days and 2 weeks for an appointment, satisfaction fell equally for primary care and specialty care patients compared with satisfaction seen with a wait of from 0 to 2 days (specialists: OR, 0.39; 95% CI, 0.33 - 0.48; P < .001; primary care physicians: OR, 0.38; 95% CI, 0.32 - 0.46; P < .001).

Although the OR for satisfaction rose again for primary care physicians with waits between 1 and 2 months (OR, 0.50; 95% CI, 0.38 - 0.65; P < .001) compared with from 0 to 2 days, the rate of satisfaction with specialists continued to fall as the length of the wait increased.

Satisfaction ratings for primary care physicians fell again with waits of longer than 2 months for an appointment compared with waits from 0 to 2 days (OR, 0.29; 95% CI, 0.22 - 0.39; P < .001). The likelihood of satisfaction for primary care physicians with this long wait for an appointment is similar to the odds of satisfaction for specialists' patients facing the same wait (OR, 0.26; 95% CI, 0.20 - 0.33; P < .001).

The odds of patients giving a satisfactory rating declined with the length of wait to see the physician after a patient arrived for his or her appointment. Patients were less likely to rate physicians well if they waited from 15 to 30 minutes to see the physician compared with waiting less than 15 minutes (primary care physicians: OR, 0.34; 95% CI, 0.29 - 0.40; P < .001; specialists: OR, 0.45; 95% CI, 0.39 - 0.52; P < .001).

Patients who waited from 30 minutes to an hour were far less likely to be satisfied with their care (primary care: OR, 0.18; 95% CI, 0.15 - 0.21; P < .001; specialty care: OR, 0.22; 95% CI, 0.18 - 0.26; P < .001). Making patients wait an hour or longer led to the lowest OR for satisfaction (primary care: OR, 0.097; 95% CI, 0.078 - 0.12; P < .001; specialty care, OR 0.11; 95% CI, 0.088 - 0.13; P < .001).

Patient satisfaction correlated highly with the amount of time physicians spent with them, and more than 65% of survey respondents reported that physicians spent more than 10 minutes with them. Physicians who spent from 5 to 10 minutes with the patient were far more likely to generate favorable ratings than those who spent less than 5 minutes (primary care, OR 8.24; 95% CI, 6.55 - 10.36; P < .001; specialists: OR, 6.35; 95% CI, 5.11 - 7.88; P < .001). Spending more than 10 minutes brought much goodwill compared with visits of less than 5 minutes, with the likelihood of a satisfactory rating increasing dramatically, especially for primary care physicians (primary care, OR, 82.0, 95% CI, 64.8 - 103.8; P < .001; specialty care, OR, 49.7; 95% CI, 40.1 - 61.7; P < .001).

Eliot N. Mostow, MD, MPH, from Akron Dermatology and head of the Dermatology Section, Northeast Ohio Medical University, Rootstown, told Medscape Medical News that he used DrScore data in a 2008 study evaluating patient satisfaction with dermatology practices. "Surveys like this tend to favor, in my experience, the dissatisfied patients a bit more than the happy ones," he said. However, physicians can still benefit from taking the results seriously.

Dr. Mostow, who was not involved in the study, said the slightly lower ratings for specialists probably result from the increased wait times and higher patient expectations.

"Specialists could consider the importance of good phone triage," Dr. Mostow said, advocating apologies for wait times. "Sympathy is generally a good thing."

In addition, he said, specialists need to "set expectations better, trying for more effective communication in this regard — never a perfect science, but more an art, I think."

One author owns stock in Medical Quality Enhancement Corp, which conducted the DrScore survey. The other authors and Dr. Mostow have disclosed no relevant financial relationships.

Health Outcomes Res Med. 2012;3:e3-e10. Abstract

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