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Increasing health service access by expanding disease coverage and adding patient navigation: challenges for patient satisfaction.

ABSTRACT: BACKGROUND:Cancer control programs have added patient navigation to improve effectiveness in underserved populations, but research has yielded mixed results about their impact on patient satisfaction. This study focuses on three related research questions in a U.S. state cancer screening program before and after a redesign that added patient navigators and services for chronic illness: Did patient diversity increase; Did satisfaction levels improve; Did socioeconomic characteristics or perceived barriers explain improved satisfaction. METHODS:Representative statewide patient samples were surveyed by phone both before and after the program design. Measures included satisfaction with overall health care and specific services, as well as experience of eleven barriers to accessing health care and self-reported health and sociodemographic characteristics. Multiple regression analysis is used to identify independent effects. RESULTS:After the program redesign, the percentage of Hispanic and African American patients increased by more than 200% and satisfaction with overall health care quality rose significantly, but satisfaction with the program and with primary program staff declined. Sociodemographic characteristics explained the apparent program effects on overall satisfaction, but perceived barriers did not. Further analysis indicates that patients being seen for cancer risk were more satisfied if they had a patient navigator. CONCLUSIONS:Health care access can be improved and patient diversity increased in public health programs by adding patient navigators and delivering more holistic care. Effects on patient satisfaction vary with patient health needs, with those being seen for chronic illness likely to be less satisfied with their health care than those being seen for cancer risk. It is important to use appropriate comparison groups when evaluating the effect of program changes on patient satisfaction and to consider establishing appropriate satisfaction benchmarks for patients being seen for chronic illness.

SUBMITTER: Schutt RK

PROVIDER: S-EPMC7059366 | biostudies-literature | 2020 Mar

REPOSITORIES: biostudies-literature

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Increasing health service access by expanding disease coverage and adding patient navigation: challenges for patient satisfaction.

Schutt Russell K RK Woodford Mary Lou ML

BMC health services research 20200306 1

<h4>Background</h4>Cancer control programs have added patient navigation to improve effectiveness in underserved populations, but research has yielded mixed results about their impact on patient satisfaction. This study focuses on three related research questions in a U.S. state cancer screening program before and after a redesign that added patient navigators and services for chronic illness: Did patient diversity increase; Did satisfaction levels improve; Did socioeconomic characteristics or p ...[more]

PMID: 32143726

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Project description:Despite growing popularity of patient navigation (PN) as a means to improve cancer care quality and reduce cancer-related disparities, there are few well-designed controlled trials assessing the impact of PN on patient outcomes like satisfaction with care. The present controlled study examined effect of PN on satisfaction with cancer-related care.Patients who presented with a symptom or abnormal screening test (n?=?1788) or definitive diagnosis (n?=?445) of breast, cervical, colorectal, or prostate cancer from eight Patient Navigator Research Program sites were included in one of two groups: intervention (PN) or comparison (usual care or usual care plus cancer educational materials). Trained patient navigators met with intervention group participants to help them assess and identify resources to address barriers to cancer diagnostic or treatment care. Using a validated instrument, we assessed participants' satisfaction with their cancer diagnostic or treatment care up to 3 months after diagnostic resolution of a cancer-related abnormality or within 3 months of initiation of cancer treatment.Overall, patients reported high satisfaction with diagnostic care and cancer treatment. There were no statistically significant differences between PN and control groups in satisfaction with cancer-related care (p?>?0.05). Hispanic and African American participants were less likely to report high satisfaction with cancer care when compared to White patients. Middle-aged participants with higher education, higher household income, private insurance, owning their own home, working full-time, and those whose primary language is English had higher satisfaction with cancer-related diagnostic care.PN had no statistically significant effect on patients' satisfaction with cancer-related care. Further research is needed to define the patient populations who might benefit from PN, content of PN that is most useful, and services that might enhance PN.clinicaltrials.gov identifiers: NCT00613275 , NCT00496678 , NCT00375024 , NCT01569672.

Project description:BackgroundGeneral practitioner (GP) system is proved to be effective in over 50 countries worldwide. Guangdong province, as a reform pilot in China, initiated its patient-GP contract service reform in 2014. This study is designed to assess the patients' acceptance of General Practitioners Contract (GPC) reform and explore its influencing factors.MethodsThis survey interviewed 1010 participants from 16 primary health centers (PHCs) chosen from 4 pilot cities in Guangdong during July and December in 2015. Data were collected through face-to-face interviews. The questionnaire was developed to discover the acceptance of GPC and covered three parts: respondents' socio-demographic characteristics, health service utilization, and the patients' assessment of primary health care centers. A binary logistic regression model was used to measure the influencing factors of respondents' acceptance of GPC policy.ResultsA total of 611(60.5%) participants accepted GPC policy. Compared to patients visited PHCs over 7 times in the previous year, those visited PHCs fewer times reported lower acceptance of GPC policy (OR:0.68, 95% CI:0.49-0.96 for visits ≤3 times and OR:0.57, 95% CI:0.38-0.84 for visits = 4-6 times). Patients' satisfaction with medical service coverage was positively associated with patients' acceptance of GPC (OR: 1.72, 95% CI:1.01-3.98 for the satisfied versus the dissatisfied; OR: 1.38, 95% CI:0.92-3.30 for neutral versus the dissatisfied), and the satisfaction with drug list also positively influenced patients' acceptance of GPC policy (OR: 1.44, 95% CI:1.26-2.73 for the satisfied versus the dissatisfied; OR:1.61, 95% CI:1.36-2.99 for neutral versus the dissatisfied). Meanwhile, age and education had positive impacts on the acceptance of the GPC policy.ConclusionThis study finds out that patients' satisfaction with medical service coverage and drug list are the influencing factors for the acceptance of GPC policy. Therefore, improvement of medical service accessibility such as better follow-up of patients with chronic diseases and enhanced referral service, as well as the expansion of drug list, will improve patients' acceptance of GPC policy. It also finds that patients using more primary health service are inclined to accept GPC policy, so more attractive and high-quality service should be provided in PHCs.

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Increasing health service access by expanding disease coverage and adding patient navigation: challenges for patient satisfaction.

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Increasing health service access by expanding disease coverage and adding patient navigation: challenges for patient satisfaction.

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