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Comparative evaluation of conventional medical treatment alone versus conventional medical treatment with amniotic membrane transplantation in infective corneal ulcer.

Byline: Muhammad Naeem, Mushtaq Ahmad, Hina Mehwish Khan and Mohammad Naeem Khan

: ABSTRACT

Objective: To compare the effect of amniotic membrane transplantation along with conventional therapy and the conventional therapy alone for the treatment of infective corneal ulcer.

Methodology: This study was conducted at Ophthalmology Department, Hayatabad Medical Complex Peshawar. The duration of study was 6 months, i.e., from April 2010 to October 2010, in which a total of 68 patients were included using WHO software for sample size determination. They were divided into two equal groups of 34 each. Non probability purposive sampling technique was used.

Results: In this study, mean age was 500.24 years. Forty six (67.6%) patientswere male while 32.4% (n=22) patients were female. Conventional Medical Treatment alone was effective in 87% (n=30) cases while Conventional Medical Treatment with Amniotic Membrane was effective in 96% (n=33) cases with a p-value of 0.03.

Conclusion: This study showed encouraging results of amniotic membrane transplantation along with conventional treatment in corneal ulcer in improving both symptoms and signs.

Key Words: Corneal ulcer, Conventional medical treatment, Amniotic membrane transplantation (AMT).

INTRODUCTION

Corneal ulcer continues to be sight threatening disease and may lead to permanent corneal opacity or persistent epithelial defect. In spite of intensive antibiotic treatment, corneal damage can occur as a result of keratolytic and inflammatory process caused by infection or scarring and of neovascularisation relating to the healing process1. The ophthalmic literature describes a multitude of surgical procedures for corneal reconstruction. Recently, preserved human amniotic membrane has emerged as a useful tool in the reconstruction of the ocular surface disorders2.

Amniotic membrane transplantation (AMT) in ocular surgery has become wide spread and the number of clinical situation in which it has been applied has rapidly expanded3, 4. Much has been published on its use in persistent epithelial defect and corneal perforation5, limbal stem cell deficiency, conjunctival reconstruction following excision of neoplasia6, and for reformation of fornices as well as in acute ocular burns7. There are only few randomized control clinical trials evaluating the effectiveness of amniotic membrane for ptergium surgery, acute ocular burns and neurotrophic ulcers8,9. Certain characteristics like anti-inflammatory, antiangiogenic, antiinfective, antifibroblastic activities make the amniotic membrane ideal for application in ocular surface disorders2. When amniotic membrane acts as a graft with epithelium growing on it, amniotic tissues persist and integrate with the superficial corneal stroma10. Sudesh et al reported significant relative improvement in symptoms like pain in two groups, improvement was 24% in patients without AMT and it was 48% in patients with AMT. Similarly improvement in signs like corneal ulcer size was in 10% patients without AMT and it was 35.2% in patients with AMT.All the characteristics of amniotic membrane e.g. anti-inflammatory, anti-angiogenic, anti-infective and anti-fibroblastic are useful in corneal ulcer healing. When amniotic membrane is used in the management of corneal epithelial defects in the presence of intact limbus, complete re-epithelialization is readily achieved12. Limited data is available regarding AMT along with conventional medical treatment of corneal ulcer in our region. Therefore, this study was designed to compare the efficacy of AMT in addition to conventional therapy and conventional therapy alone in patients with infective corneal ulcer presenting to Ophthalmology Department Hayatabad Medical Complex Peshawar.

METHODOLOGY

This study was conducted at Ophthalmology Department Hayatabad Medical Complex Peshawar. Duration of study was 6 months (from 26th April 2010 to 26th October 2010) in which a total of 68 patients were included and were divided into two equal groups (Group A: Conventional Medical Treatment alone and Group B: Conventional Medical Treatment with Amniotic Membrane Transplantation). Non probability purposive sampling technique was used in this comparative study.

All patients age 15 years and above with infective corneal ulcer of 3 mm or more were included in the study. Patients with typical viral ulcer (because non availability of diagnostic methods for viruses), perforated corneal ulcer (due to their different management plan) and ulcers with endophthalmitis (as management of such cases can affect the conventional medical treatment) were excluded from the study.

The study was approved by the ethical committee of Hayatabad Medical Complex Peshawar. Patients who fulfilled the inclusion criteria were enrolled in the study after taking informed written consent. Detailed history of ocular pain, watering and discharge was taken followed by ocular examination in all the patients. Ocular examination included visual acuity testing on Snellen's chart and thorough slit lamp examination of conjunctiva, cornea, anterior chamber, iris, pupil, and lens. Ulcers were diagnose by slit lamp examination after staining with flouresin and confirmed by scrapings. Patients were divided into two equal groups randomly by lottery method. One group received medical treatment with AMT and another group received Medical treatment alone. Ulcer size score was noted at 3rd and 42nd post-operative days. Data was analyzed by SPSS 10.0. Mean and standard deviation was calculated for quantitative variables like age. Frequency and percentage was calculated for qualitative variables like gender and size of ulcers. Student Chi square test was used to compare the reduction of ulcer size between age and gender. Pvalue of = 0.05 was considered significant.

RESULTS

Among 68 patients, 6(9%) were of less than 20 years,10(15%) were in age range 21-30 years, 14(20%) were in age range 31-40 years, 18(26%) were in age range 41-50 years, and 20(30%) were in age range 51-60 years, respectively. The mean age of the sample was 50 0.24 years. Forty six (67.6%) patients were males while 22 (32.4%) patients were females.

Pre-operative and post-operative observations of corneal ulcer size between two groups i.e., Conventional Medical Treatment alone (Group A) and Conventional Medical Treatment with Amniotic Membrane Transplantation (Group B) respectively, is shown in Table 1.

The treatment of corneal ulcer with Conventional Medical Treatment alone was effective in 30 (87%) cases (Table 2). In these 30 patients, two were of less than 20 years age, 4 were in the age range 21-30 years, 6 were in the age range 31-40 years, 9 were in the age range41-50 years and 9 were in the age range 51-60 years. There were 18 males and 12 females.

Treatment with Conventional Medical Treatment with Amniotic Membrane Transplantation was effective in 33 (96%) cases (Table 2). Out of these 33 patients, two were of less than 20 years age, 4 were in the age range 21-30 years, 6 were in the age range 31-40 years, 10 were in the age range 41-50 years and 11 were in the age range51-60 years. There were 20 males and 13 females.

DISCUSSION

Corneal ulcer is more common in males as is evident by various studies. Basak et al13 in their study reported 70.6% males and 29.4% females. In another study by Srinivasan et al14, 61.3% were males and 38.7% were females. In our study also there were 68% males and only 32% females. Males get corneal infection more commonly because they usually work in the fields where chances of corneal trauma are more. Predisposing risk factors for microbial keratitis vary tremendously with geographical location. Non-surgical trauma to the eye accounted for 48.665.4% of all corneal ulcers in the developing countries like Nepal15 and India14. In the United States it is contact lens wearing that is a major risk factor for microbial keratitis. In our study, history of injury to the cornea was present in 52% patients. The most common mode of injury (30%) was organic matter. Basak et al13 found history of injury to cornea in 82.9% of patients, with vegetative matter being the most common mode of injury, present in 59.6% of patients. In another study by Srinivasan et al14 injury to the cornea was

Table 1: Observations of corneal ulcer size (n=68)

###Pre-operative corneal###Post-operative corneal ulcer size (mm)

###ulcer size (mm)###Day 01###Day 03###Day 42

###3-5###6-8###greater than 8###3-5###6-8###greater than 8###3-5###6-8###greater than 8###less than 3###3-5 6-8 greater than 8

Group A

(n=34) 21(61.8%) 12(35.3%) 1(2.9%) 21(61.8%) 12(35.3%) 1(2.9%) 23(67.7%) 10(29.4%) 1(2.9%) 30(88.2%) 4(11.8%) 0###0

Group B 19(55.9%) 12(35.3%) 3(8.8%) 19(55.9%) 12(35.3%) 3(8.8%) 24(70.6%) 9(26.5%) 1(2.9%) 33(97.1%) 1(2.9%) 0###0

(n=34)

Total###40###24###4###40###24###4###27###19###2###63###5###0###0

Table 2: Effectiveness of corneal ulcer between two groups (n=68)

Effectiveness Of Corneal###Groups

###Total

Ulcer###Group A###Group B

Yes###30(88.2%)###33(97.1%)###63

No###4(11.8%)###1(2.9%)###5

Total###34###34###68

present in 65.4% patients, with injury from paddy 25.4%being the most common followed by vegetative matter15.1%. In our study, fungal corneal ulcers were the commonest amongst all types of ulcers which is similar to study reported by Basak et al13 in which 59.3% patients were having fungal infection. In another study by Leck et al16 fungi were identified as the principal etiological agents causing corneal ulceration in 44% of all cases in Ghana.

In various studies, amniotic membrane has been found to provide symptomatic relief in various forms of ocular surface disorders. Pires et al performed AMT in50 consecutive eyes with symptomatic bullous keratopathy and found that 43(90%) of eyes became free of pain postoperatively. Epithelial defect healed rapidly in45 out of 50 (90%) eyes within 3 weeks17. Heiligenhaus et al studied retrospective, non-comparative case series of seven patients with acute ulcerative and necrotizing herpetic stromal keratitis18. Single or multilayer AMT with epithelial side facing up was performed. The main outcome measures were wound healing of the corneal ulcers and decrease of stromal inflammation18. In our study, there was definite improvement in symptoms as compared to patients not undergoing AMT. In our study, signs of infective corneal ulcers improved more in patients with amniotic membrane transplantation as compared to the control group.

In our study 1 (5%) patient without AMT and 6 (30%)patients with AMT were having hypopyon of more than3 mm. After 1 week, hypopyon of more than 3 mm was still present in 1 (5%) of the patient without AMT while in patients with AMT, only 2 (10%) patients had hypopyon more than 3 mm. After 1 week, the improvement in hypopyon was significantly more in patients with amniotic membrane transplantation. The results of this study indirectly indicate that the actions of anti-bacterial and anti-fungal drugs were not hampered by amniotic membrane. Topical drugs might have reached the cornea through the amniotic membrane itself or entered from the gap between the sutures of amniotic membrane. Kim et al19 evaluated penetration and drug levels in tears after topical ofloxacin instillation in rabbit eyes with AMT. The mean tear levels of ofloxacin in AMT group were higher than those in non-AMT group. So he concluded that amniotic membrane has some potential to act as an effective drug delivery system. Faster heal-might be because of anti-inflammatory, anti-angiogenic, anti-infective and anti-fibroblastic activity of amniotic membrane15. The above discussion, compared with the results of our study clearly demonstrates that amniotic membrane transplantation is beneficial in infective corneal ulcers. Combined with conventional treatment, it can be used as a treatment modality in cases of moderate size ulcers, and as a temporary measure for symptomatic relief in severe ulcers.

LIMITATION

Effectiveness of corneal ulcer size was based on relief of symptoms and the answers were taken as Yes and No. However, we understand that this may not be sufficient and should be considered as a limitation of this study.

CONCLUSION

This study showed encouraging results of amniotic membrane transplantation along with conventional treatment in corneal ulcer in improving both symptoms and signs, but small size of sample was the limiting factor in our study. Hence large prospective and controlled trials with more number of patients are required for better assessment of role of amniotic membrane transplantation in addition to conventional medical treatment in patients with corneal ulcer.

REFERENCES

1. Nordlund ML, Pepose JS. Corneal response to infection.Krachmer JH Mannis MJ Holland EJ eds. Cornea, Fundamentals, Diagnosis and Management. Mcra hill 2005;95-114.

2. Dua HS, Gomes JAP, King AJ, Maharajan VS. The amniotic membrane in ophthalmology. Surv Ophthalmol2004;49:51-77

3. Wylegala E, Taranawska D. Amniotic membrane transplantation with cauterization for keratoconus complicated by persistent hydrops in mentally retarded patients. Ophthalmol 2006;113:561-4.

4. Ainsworth G, Rotchford A, Dua HS. A novel use of amniotic membrane in the management of tube exposure following glaucoma tube shunt surgery. Br J Ophthalmol2006;90:417-9.

5. Hick S, Demers PE, Brunette I. Amniotic membrane transplantation and fibring glue in the management of corneal ulcers and perforations: a review of 33 cases. Cornea2005;24:369-77.

6. Gunduz K, Ucakhan OO, Kanpolat A. Nonpreserved human amniotic membrane transplantation for conjunctival reconstruction other excision of extensive ocular surface 7. Tseng SC, Di Pascuale MA, Liu Dt. Intraoperative mitomycin C and amniotic membrane transplantation for fornix reconstruction in sever cicatricial ocular surface diseases. Ophthalmol 2005;112:896-903.

8. Tamhane A, Vajpayee RB, Biswas NR. Evaluation of amniotic membrane transplantation as an adjunct to medical therapy as compared with medical therapy alone in acute ocular burns. Ophthalmol 2005;112:1963-9.

9. Khokar S, Natung T, Sony P. Amniotic membrane transplantation in refractory neurotrophic corneal ulcers: a randomized controlled clinical trial. Cornea 2005;24:654-60.

10. Resch MD, Schlotzer-Schrehardt U, Hofmann-Rummelt C. Adhesion structures of amniotic membranes integrated into human corneas.Invest Ophthalmol Vis Sci2006;47:1853-61.

11. Arya SK, Aggarwal M, Chander J, Sonika, Sood S. Comparative evaluation of amniotic membrane transplantation with conventional medical treatment verses conventional medical treatment alone in suppurative keratitis. Internet J Ophathalmol Vis Sci 2009;6:6-10.

12. Maharajan VS, Shanmuganathan V, Currie A, Hopkinson A, Powell-Richards A, Dua HS. Amniotic membrane transplantation for ocular surface reconstruction: indications and outcomes. Clin Exp Ophthalmol 2007; 35:140-7.

13. Basak SK, Basak S, Mohanta A, Bhowmick A. Epidemiological and microbiological diagnosis of suppurative keratitis in Gangetic West Bengal, eastern India. Indian J Ophthalmol 2005;53:17-22.

14. Srinivasan M, Gonzales CA, George C, Cevallos V, Mascarenhas JM, Asokan B et al. Epidemiology and aetiological diagnosis of corneal ulceration in Madurai, South India. Br J Ophthalmol 1997;81:965-71.

15. Upadhyay MP, Karmacharya PC, Koirala S, Shah DN, Shakya S, Shrestha JK, et al. The Bhaktapur eye study: ocular trauma and antibiotic prophylaxis for the prevention of corneal ulceration in Nepal. Br J Ophthalmol 2001;85:388-92.

16. Leck AK, Thomas PA, Hagan M, Kaliamurthy J, Ackuaku E, John M. Aetiology of suppurative corneal ulcers in Ghana and South India, and epidemiology of fungal keratitis. Br J Ophthalmol 2002;86:1211-5.

17. Pires RT, Tseng SC, Prabhasawat P, Puangsricharern V, Malskin SL, Kim JC, et al. Amniotic membrane transplantation for symptomatic bullous keratopathy. Arch Ophthalmol1999;117:1291-7.

18. Heiligenhaus A, Li H, Hernandez Galindo EE, Koch JM and necrotising Herpes simplex and zoster keratitis with amniotic membrane transplantation. Br J Ophthalmol 2001;20:628-4.2003;87:1215-9.19. Kim H, Sah W, Kim Y, Kim J, Hahn T. Amniotic membrane, tear film, corneal and aqueous level of ofloxacin in rabbit eyes after amniotic membrane transplantation. Cornea

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EFFECT OF DEMOGRAPHIC CHARACTERISTICS ON PATIENT'S SATISFACTION WITH HEALTH CARE FACILITY

By: Muhammad Afzal, Farwa Rizvi, Abrar Hussain Azad, Abdul Majid Rajput, Ahmed Khan and Nadia Tariq _: ABSTRACT

Objective: To assess the patients' satisfaction level and effect of demographic characteristics on patients' satisfaction with health care facility in a tertiary care hospital.

Methodology: This Descriptive Cross sectional survey was conducted from June through October, 2012 in Out Patients Department of Punjab Social Security Hospital (PESSI), Rawalpindi. Participants were interviewed by trained interviewers (students of 4th year MBBS class) using pre tested questionnaires. The patients were interviewed for their satisfaction and experience in the healthcare facility regarding interaction with doctors, paramedical staff, and facilities in the institution. Demographics like age, gender, educational status, marital status and monthly income were recorded. A five point scale of Strongly Agree (5), Agree (4), Uncertain (3), Disagree (2), and Strongly Disagree (1) was used. The percentage score was calculated for each patient and patient satisfaction was measured in terms of mean percent score.

Results: In sample of 110 patients, age of patient showed significant (p-value= 0.033) relationship with satisfaction score, with maximum satisfaction level(79.86%) in older age patients of greater than 55 years. Gender and occupation of pa-tient did not show significant effect on satisfaction score. The illiterate or lesseducated (p-value = 0.003) and married patients were significantly (p-value= 0.003) more satisfied. Patients with less monthly income were significantly(p-value less than 0.001) more satisfied.

Conclusion: Older and less educated patients with lower income bracket were more satisfied with healthcare facility as compared to younger, highly educated patients and having higher income levels.

Key words: Patients Satisfaction, Demographic characteristics, Percent Satisfaction Score,INTRODUCTION

Patient satisfaction is one of the several ways to evaluate the quality of care, an outcome variable in its own right, and is an indicator of weaknesses in the service. Previous literature shows that satisfaction level can be dependent on many factors other than the quality of service delivery, it may subject to factors like patients' demographics. Among demographic characteristics, age, health status, and race had a consistent, statistically significant effect on satisfaction scores. Some institutional characteristics also showed consistent and significant effect on patient satisfaction score1,2.

Patient satisfaction can be used to investigate the areas having flaws or deficiencies in r quality of services. Previous studies have explored methods to improve ser- vice quality in outpatient departments by analyzing outpatient satisfaction regarding waiting times, courtesy and interpersonal skills, , professionalism, access, coordination of care, education and information provision, emotional support, technical quality of care, and overall quality and satisfaction3-7.

Previous literature showed that older patients tended to have higher satisfaction scores in all respects8. Educational levels of patients also found a contributor to patient satisfaction and those with no education or only primary education had higher satisfaction scores. Marital status was also a major contributor towards the satisfaction of patients with healthcare facilities and those married or cohabitating tended to have higher satisfaction scores,9 but in another study those who were single or divorced had higher satisfaction scores with health care facility10.

Literature also showed gender dependency of patient satisfaction and it was found that males tended to have higher satisfaction scores than females11. The literature shows that job status of a person can have effect on satisfaction level but results of some studies revealed that this variable don't have any influence on patient satisfaction11, 12.

Every human being carries a particular set of thoughts, feelings and needs. By getting to know the patients a little more and to get their views on the care, one ought to know what the patients consider as good care13. Patient compliance is very important for successful treatment outcome and since clinical outcome is always attributed to the provider and never to the patient, the patient compliance with treatment becomes all the more crucial14.

Patient satisfaction can be an important tool to improve the quality of services. It can play an increasingly important role in the growing push toward accountability among health care providers overshadowed by measures of clinical processes and outcomes in the quality of care. This present study was planned to assess the quality of care provided to patients in a tertiary care hospital in terms of patients' satisfaction and relate this satisfaction with demographic characteristics of the patients.

METHODOLOGY

This cross sectional survey was conducted between June 2012 and October 2012. A total 110 participants were included in this study. The patients from out patients department were included after taking informed written consent by consecutive sampling technique. Approval of the study was taken from the hospital ethical committee. Participants were interviewed privately face to face in the hospital Outpatient department of Punjab Social Security Hospital (PESSI), Rawalpindi. Interviews were conducted by trained interviewers (students of 4th year MBBS class) using pre tested questionnaire which was developed according to the international standards of National Technical Information Service (NTIS) Publication No. PB 288-329, Springfield, VA). The patients were interviewed for their experience in the healthcare facility regarding different aspects of doctor's treatment, behavior of the doctor, attitude of paramedical staff, facilities regarding convenience in the institution like parking area, drinking water, toilets, signs to reach to a specific location in the hospital, facilities for pharmacy and cost of treatment. Information regarding demographic characteristics like age, gender, educational status, marital status and monthly income were recorded. Different characteristics of hospital which were considered to have a significant effect on patients treatment and satisfaction level, like behavior of doctor, paramedical staff, waiting time, etc were measured on five point scale of Strongly Agree (5), Agree (4), Uncertain (3), Disagree (2), Strongly Disagree (1). The percent score was calculated for each patient and patient satisfaction was measured in terms of mean percentage score. These percent scores were analyzed with respect to different demographic characteristics. Data was entered and analyzed by using SPSS v 16. Descriptive statistics was used to analyze the data and results were presented by mean SD for quantitative variables and frequencies with percentages for qualitative variables in tabular form. Percent mean score technique was used to show the satisfaction score of the participants. Independent sample t-test was used to compare two categories for percent mean score and One Way ANOVA test for comparison of more than two categories on the basis of percent mean score. P-value less than 0.05 was considered significant.

RESULTS

In this cross sectional study a total of 110 patients were included and were interviewed for their experience in the healthcare facility. In this sample there were 51 (46.4%) males and 59 (53.6%) females in the study. The mean age of patients was 38.99 years with a standard deviation of 15.86 which ranged from 15 to 84 years. In these patients 51.82% belonged to rural area and48.18% were from the urban area. In this study greater part of patients included were illiterate (31.82%) or had very less education that is primary (25.84%) or madrassa level (10%) education. A bulk (40%) of these patients was unemployed or house wives (20.91%) and 30.91% were employed. Similarly majority of the patients included in the study were married (63.64%), followed by (29.09%) patients who were single. Since this study was conducted in a public sector hospital and patients visiting this hospital were retired employees or people belonging to low income class. So in our study sample majority (63.64%) had less than 10,000 income followed by 27.27% patients belonging to middle income class of 10,000-25,000 and only 9.09% patients had income above 25,000 as elaborated in Table 1.

The comparison of patient satisfaction score with respect to different demographic characteristics shows that age of the patient had a significant (p-value = 0.033) relationship with satisfaction score. The mean satisfaction level increased with increase in age and maximum satisfaction level (79.86%) was found in older age of greater than 55 years. Gender of the patient did not show significant effect on satisfaction score although females were comparatively more satisfied. Similarly patients satisfaction was independent of area of living, patients from rural or urban area had almost same level of satisfaction. The education level was also found to be significantly (p-value = 0.003) associated with level of satisfaction of patients. It was noted that the illiterate or less educated patients were more satisfied as compared with literate or high educated persons that is the mean satisfaction level was comparatively less in patients who were graduate or post graduate. The occupation of the patient did not show any relationship with their satisfaction level. In this study the marital status was significantly (p-value =0.003) related to patients satisfaction score. It was found that the single patients had significantly less satisfaction score as compared with married or separated patients. Monthly income level of the patients was found to be a major contributor to patients satisfaction and we found that patients with less monthly income were significantly (p-value = 0.000) more satisfied with health care facility as compared to patients who had high income level of Rs. greater than 25,000 as given with details in table 1.

The distribution of overall patient's satisfaction score is given in fig 1. Which show that the mean overall satisfaction score was 75.60 % with a standard deviation of8.175%. The minimum patient satisfaction level found in our study was 55% and maximum satisfaction level was97%. Majority of the patients had a satisfaction level between 70 to 80% as given in histogram (Figure 1).

The distribution of responses from patients regarding different parameters used to find out the satisfac- tion of patients regarding health care facility is listed in Table 2. It was noted that most of the patients were dissatisfied with washroom facility provided in the hospital followed by availability of clean drinking water. Many patients were dissatisfied with office hours when doctors can be seen in OPD and waiting time to perform different tests in the hospital as given in detail in table 2.

DISCUSSION

In today's epoch of competition with increased levels of competition and the emphasis on consumerism, patient satisfaction has become an important measurement for monitoring health care performance. This measurement has developed along with a new feature in the patient's perspective of quality of care15, 16.

Patient satisfaction surveys frequently are used to provide measures of the quality of care from the patient perspective. The objective of this study was to estimate the effects of different predictors of

overall patient satisfaction with this health care facility and effect of patient's age, gender, marital status, education and income on their satisfaction level.

According to the previous researches gender might affect the mean level of patient satisfaction or the relative strength of predictors of satisfaction. Evidence for gender differences in mean satisfaction levels is mixed. Some authors report that women are more satisfied than men with medical care received, and some report that women are more critical of medical care than men17,18. In this present study it was found that gender of the

Table 1: Demographic characteristics

###Distribution###Patients Satisfaction Score

Characteristics###P-value

###Frequency (%)###Mean###SD

Age of patients

Mean SD###38.9915.859

less than 25 years###28 (25.45)###72.54###9.41

25 40 years###38 (34.55)###75.63###8.12

###0.033

40 55 years###27 (24.55)###76.06###6.92

reater than 55 years###17 (15.45)###79.86###6.27

Gender of Participants

Male###51 (46.36)###75.07###8.40

###0.529

Female###59 (53.64)###76.07###8.01

Area of living

Rural###57 (51.82)###76.48###8.11

###0.245

Urban###53 (48.18)###74.65###8.21

Education of Patients

Illiterate###35 (31.82)###77.49###6.41

Madrassa###11 (10.00)###75.35###7.14

Primary###28 (25.45)###77.30###6.95

###0.003

Secondary###17 (15.45)###76.80###10.03

College###13 (11.82)###69.48###9.53

University###6 (5.45)###67.33###6.76

Occupation of the Respondent

Unemployed###44 (40.00)###76.42###8.57

Private Job###34 (30.91)###73.39###7.74

Govt. Servant###7 (6.36)###78.63###8.55###0.290

Business###1 (0.91)###68.80###0.00

House wife###23 (20.91)###76.70###7.72

Marital Status

Single###32 (29.09)###71.10###9.03

Married###70 (63.64)###77.09###7.27

Separated###3 (2.73)###77.33###2.31###0.003

Divorced###2 (1.82)###85.20###0.57

Widowed###3 (2.73)###79.47###6.80

Family/Personal Income (Rs.)

less than 10,000###70 (63.64)###76.70###6.82

10,000-25,000###30 (27.27)###76.52###9.06###less than 0.001

above 25,000###10 (9.09)###65.28###7.71

Table 2: Distribution of responses from patients regarding different parameters of satisfaction

###Uncer###Strongly

S.###Strongly Agree###Disagree

###Questions Regarding Satisfaction###tain###disagree

No###Agree %###%###%

###%###%

1###Parking is good###16###45###34###5###1

2###Waiting area is good###8###65###18###9###0

3###OPD is neat and clean###10###52###26###11###1

4###Registration is a quick process###8###51###27###14###0

5###OPD staff is courteous###8###55###20###15###1

6###Waiting time to see doctors is reasonable###6###61###20###13###0

###Time spent with doctors in exam room is

7###20###57###14###8###1

###reasonable

###Waiting time for tests to be performed is

8###4###52###25###15###4

###good

###Reports of diagnostic tests are given without

9###9###45###25###19###3

###any delay on the due date

10 X-ray room and lab is conveniently located###15###56###22###6###1

###Sign posting of the hospital departments is

11###13###50###32###5###0

###convenient and understandable

12 Clean drinking water is available easily###4###35###17###34###11

###Washroom facility is available and in clean

13###3###24###12###46###16

###condition

###wheel chairs are available to shift patients

14###8###51###27###14###0

###from one place to another

###All the medicines are easily available which

15###13###44###37###6###0

###doctors recommend

16 Medicines have standard packing###8###58###19###13###2

###Medicines are free of cost or on nominal

17###12###60###17###9###2

###charges

###The office hours when a doctor can be seen

18###25###44###13###15###4

###at OPD are convenient

###Referred patients are seen by medical special-

19###11###63###15###8###3

###ists when required

###Doctor listens to problems with care and

20###20###48###24###6###2

###patience

###Doctors do not use medical terms without

21###27###55###11###5###1

###explaining what they mean

22 Total cost of care is affordable###26###44###19###10###2

###Paramedical staff is honest, (Nobody de-

23###21###55###13###11###1

###manded for a tip)

###The treatment in emergency department is

24###14###66###14###5###2

###given quickly and adequately

###Do you recommend others to get treatment

25###13###57###25###5###1

###from this facility

patient did not have significant effect on satisfaction score although females were comparatively more satisfied than males but this difference was not statistically significant. It was found in a meta-analysis of 110 studies of patient satisfaction, using standard instruments, that there was no average difference in satisfaction with medical care between women and men19.

In a study it was reported that women, older patients, those with low education levels, and those who were married or cohabitating have higher satisfaction scores20. In another study it was seen that older patients, males and those with a lower level of education, were more satisfied with both their healthcare and health plan than their opposite counterparts21.

Results of this present study show that the age of the patient had a significant relationship with satisfaction score, the mean satisfaction level increased with increase in age and maximum satisfaction level was found in older age patients. This result is in accordance with literature results. The education level was significantly associated with level of satisfaction of patients. It was noted that the illiterate or less educated patients were more satisfied as compared with literate or highly educated persons that is the mean satisfaction level was comparatively less in patients who were more educated. These results are also same as were noted in previous studies. Similarly the marital status was significantly related to patients satisfaction score. It was found that single patients had significantly less satisfaction score as compared with married or separated patients which also have resemblance with results of previous studies conducted17,19.

Previous studies have documented significant disparities in health care according to patient socioeconomic status (SES). For example, lower patient's SES is associated with avoidable or preventable hospitalizations, hospital readmissions, and delivery of less preventive care.Studies of the effect of patient SES on satisfaction with health care have reported mixed findings, but it has been noted that patients having less income have less expectations and shows more satisfaction with healthcare providers22.

In this present study we also noted that the patients having less monthly income showed a significantly higher level of satisfaction as compared to patients having higher monthly income. .

CONCLUSION

From the results of this study it can be concluded that patients of higher age, having no education or lower level of education, married and patients with less monthly income showed higher level of patient's satis- faction as compared with their counter parts. This can lead to the conclusion that former group might not have enough access to knowledge about good standard health care. The gender of patient, area of living and occupation of patient did not show any effect on patients' satisfaction level.

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Author:Naeem, Muhammad; Ahmad, Mushtaq; Khan, Hina Mehwish; Khan, Mohammad Naeem
Publication:Journal of Postgraduate Medical Institute
Article Type:Report
Date:Jun 30, 2014
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