1. Introduction
Monitoring the quality of medical care in healthcare systems is not a new phenomenon; however, it is still insufficiently researched. Patient satisfaction with care is a measure of the degree of agreement between his/her expectations of care and the perception of what he/she actually receives [
1]. One of the most significant issues concerning measuring satisfaction with care is to determine the likely impact of individual expectations on the level of satisfaction with medical services [
2,
3]. In order to assess the quality of care, the patient needs to compare his/her own experiences and feelings to his/her expectations [
4].
Satisfaction is an aspect that can significantly influence the position of a healthcare entity on the medical services market [
5]. The primary objective of undertaking healthcare-satisfaction survey in medical institutions is to bring about improvements of the quality of services. As studies have confirmed that low patient satisfaction with non-hospital services causes more frequent hospitalizations [
6,
7,
8], conducting research on patient satisfaction and the associated loyalty of patients can benefit healthcare facilities. Understanding a patient’s needs and requirements in terms of services and overall healthcare provision can serve as a basis in the process of improving the quality of care. The quality of provided medical services translates not only into the trust and safety of patients, but, above all, into positive health outcomes [
5,
9,
10,
11].
The issue of assessing the quality of medical services, especially in the context of civilization diseases, is important to many institutions, e.g., healthcare providers and recipients, local governments, managers of medical entities, politicians and taxpayers [
12,
13]. Based on epidemiological data and cost analyses related to its prevention, diagnosis and treatment, osteoporosis, a metabolic bone tissue disease, is considered a social and economic problem [
14,
15,
16]. Osteoporosis is recognized by the World Health Organization as a civilization disease and an epidemic of the 21st century [
17,
18,
19]. It is the most common bone disease in humans, affecting both genders and all races [
20]. By analyzing the epidemiology data of osteoporosis, it can be concluded that it is a disease that requires particular attention from health professionals and public health experts [
21,
22,
23]. As care for people and their health represent the essence of any healthcare system, patients’ needs and expectations should be a major focus of medical personnel [
13]. Healthcare recipients are the main figures in the process of providing care; they have the right to high-quality medical services and to co-decide on the course of their treatment and nursing process [
24]. Patient satisfaction is a multidimensional phenomenon; its assessment makes it possible to analyze discrepancies between what the patient considers to be good medical service and what the healthcare provider considers appropriate.
The aims of this research are to assess the level of satisfaction with medical care among patients treated in osteoporosis clinics and to determine the relationship between the frequency of visits to the doctor, the duration of treatment, socio-demographic factors, and patient satisfaction with medical care.
4. Discussion
The performed analysis showed that the key element for the general assessment of the quality of services supplied by specialist osteoporosis clinic is the doctor. In this regard, patients most often negatively assessed three aspects: range of information received from the doctor on procedures in case of deterioration/lack of health improvement, time devoted to the patient by the doctor, and range of information received from the doctor on planned tests/procedures. Sociodemographic factors significantly determined degree of satisfaction with medical care. Our analysis showed that women better assessed clinics in overall terms. Additionally, the higher the study participant’s age, the lower the general assessment of the clinic. Our analysis showed that the better the financial situation of the respondents and the higher the level of education, the higher the general assessment of the clinic.
Patient satisfaction has become one of the most important measures of healthcare assessments and is increasingly used in the determination of the quality of care, partnerships between patients and healthcare providers and in the planning of health services [
26,
27]. Bleich, Özaltin and Murray hold that patient experience measures are very important in capturing the “responsiveness” of a healthcare system, and will ultimately lead to the definition of clearer priorities for quality improvements. The concept developed by the WHO is likely to gain even greater attention, as doctors and hospitals are under increasing pressure to improve the quality of care and patient safety while reducing the cost of medical services [
28]. American researchers Dunsch et al. pointed to factors influencing satisfaction to the greatest extent, i.e., short waiting time for an appointment, clean rooms, and healthcare providers who respond to patients’ needs and treat them with respect [
29]. Researchers Xesfing and Vozikis, who analyzed the impact of socioeconomic factors on satisfaction with care, indicated that the efficiency of health care systems translates directly into patient satisfaction [
30], which may be the basis for the development of a satisfaction index for future health system assessments.
In our study, satisfaction with medical care was analyzed on the basis of the opinions of patients treated in osteoporosis clinics. We applied the PASAT POZ tool, and supplemented this with our own tool. One factor that influences overall satisfaction with medical care is waiting time for an appointment in the waiting room. A study by Med, Sci et al. in primary health care outpatient clinics in Riyadh indicated that a long waiting period, especially between registration and medical consultation, results in a higher percentage of dissatisfied patients [
31]. This was confirmed by studies by Al-Harajin et al., carried out in Saudi Arabia, describing the results of patient satisfaction, which significantly differ depending on the waiting time for an appointment. Here, over 90% of all dissatisfied patients waited longer than 20 min between arrival, registration and medical consultation (
p < 0.01) [
32]. Unfortunately, studies indicate that the waiting time for an appointment in the Polish health care system is longer, e.g., research by Plentara et al., carried out in primary healthcare entities in the West Pomeranian Voivodeship, where 38% of all respondents noted a waiting time of more than 30 min [
33].
In patient satisfaction studies, the subject of assessment is most often a medical appointment, which is the basis for the health system. Interdisciplinary research by Leźnicka et al. [
34], conducted with the help of the PASAT toolkit in the Kuyavian-Pomeranian Voivodeship, showed that almost half (49%) of 2280 patients assessed the attending physicians very well when it came to listening carefully to the patient. In contrast, in our study, the same aspect was assessed as very good only by 22.1% and as good by 34.3% of all respondents. Ensuring intimacy by a doctor in the study by Leźnicka et al. was assessed very well by 45%, while in our study, this was the case for only 22.1%. The doctor talking in a way that is understandable to the patient in the study in the Kuyavian-Pomeranian Voivodeship was rated the highest by 45% of the respondents, and in our own study by 27.9%. It is also worth pointing out that in the study by Leźnicka et al., the amount of time devoted to the patient by the doctor was assessed as bad and very bad by only 6.8% of respondents, while in our study, negative assessments (bad and very bad) were indicated by as many as 43.6% of respondents, which may be an indication for health care units to take corrective actions [
34].
As seen from such comparisons among studies, patients differ in their preferences as to the hierarchy of importance of medical care aspects; nonetheless, professionalism and the availability of a doctor comprise core factors. This was confirmed by the 2014 and 2015 study of satisfaction with care conducted by Faye et al. from Columbia University in New York on people with celiac disease. In that study, respondents declared significantly higher satisfaction if they felt that their doctor or dietitian was easily accessible if necessary (87%,
p < 0.001) [
35]. Other researchers, including Kotzian, Kutney Lee and McHugh, concluded that a relatively low percentage of doctors per capita may significantly reduce satisfaction rates [
36,
37]. Patient satisfaction with nursing care in our own study was assessed on a higher level than that with doctor’s care. On the basis of a satisfaction survey, Przychodzka et al. indicated areas of nursing care that were poorly rated by patients, i.e., related to aspects including information provided by the nurse and the amount of time that nurses were available to talk with them [
38]. In our study, the lowest evaluation of nurses’ work, in the opinion of patients of osteoporosis clinics, concerned talking in a way that patient could understand.
The Pareto-Lorenz analysis allowed us to identify the most relevant negative factors in the functioning of a medical facility. It is a tool that can be applied to improve quality, as its use enables the elimination of false flags and indicates ways of enhancing current activities, and, consequently, increasing efficiency [
25]. The Pareto analysis of data in a study by Gupta et al. on the satisfaction of patients from nine district hospitals in Bihar indicated that increasing patient satisfaction by more than 60% can be achieved by referring to the three highest attributes of dissatisfaction, i.e., a lack of availability of medicines, unsatisfactory time of consultation and cleanliness of the rooms [
39]. The Pareto analysis of the research conducted by the Leźnicka et al., carried out with the help of the PASAT toolkit on 2280 patients, indicated that as many as one in four respondents (25%) declared a problem with information on patients’ rights. In our study, two aspects accounted for 26.5% of all problems: little information received from a doctor on procedures in case of deterioration/lack of health improvement, and limited amount of time devoted to the patient by the physician. Respondents in our study expected more attention from the doctor and the extension of the information process. Ghose and Adhish observed that patient satisfaction was largely influenced by the time devoted to the patient and by the ordering of tests, and a high percentage of patients were satisfied with the services provided by their doctor in terms of attributes such as doctor availability, medical care and treatment received [
40].
Many researchers have attempted to determine the relationship between sociodemographic data and satisfaction with care. Our study showed that there is a relationship between age and the level of satisfaction with care, i.e., the higher the age, the lower the general assessment of the clinic (
p < 0.05). An example of different dependencies is evident in Uzun [
41], in which patients over 65 provided significantly better assessments of quality of care than did patients under the age of 65.
The health care sector is a specific area of activity; it is highly sensitive to quality issues, because where human life and health are concerned, high-quality services should be available and considered a right [
42]. Our study is the first to show the degrees of satisfaction with medical care of patients treated for a chronic disease based on the use of a validated tool. The present study revealed the strengths and weaknesses of patient care and the functioning of the clinics.
A literature review provided information on a large number of studies on patient satisfaction with medical services. However, the analyses presented by researchers were often not unified and were carried out with the use of non-validated tools, which is why it is difficult to compare them reliably. In this work, the indicators of the quality of medical care and satisfaction with medical services of people suffering from osteoporosis were also not analyzed. Foreign researchers have undertaken analyses of satisfaction with osteoporosis treatment, but these studies covered issues related to treatment regimens, adherence to medical recommendations and comparisons of effects in the treatment of osteoporosis, rather than patients’ feelings about the care they had received.
This study ensured the anonymity of the respondents. Access to patients’ medical documentation would allow more detailed analyses to be made of other medical aspects and their possible impact on satisfaction with medical care. These limitations warrant further investigations with regard to satisfaction of medical care and chronic disease such as osteoporosis. Furthermore, more detailed analyses of the treatment process would enable better assessments of quality of care.
Future Directions
It is advisable for health service providers to regularly monitor the quality of the health care they offer and make improvements in order to increase patient satisfaction rates. Therefore, further research is needed, especially in relation to chronic diseases such as osteoporosis. Research showing the subjective feelings of patients regarding the medical procedures performed may be a hint for management staff regarding the expectations of patients, and may indicate possible directions for the implementation of new solutions.