Patient satisfaction and perceived quality of care: evidence from a cross-sectional national exit survey of HIV and non-HIV service users in Zambia

OBJECTIVE To examine the associations between perceived quality of care and patient satisfaction among HIV and non-HIV patients in Zambia. SETTING Patient exit survey conducted at 104 primary, secondary and tertiary health clinics across 16 Zambian districts. PARTICIPANTS 2789 exiting patients. PRIMARY INDEPENDENT VARIABLES Five dimensions of perceived quality of care (health personnel practice and conduct, adequacy of resources and services, healthcare delivery, accessibility of care, and cost of care). SECONDARY INDEPENDENT VARIABLES Respondent, visit-related, and facility characteristics. PRIMARY OUTCOME MEASURE Patient satisfaction measured on a 1-10 scale. METHODS Indices of perceived quality of care were modelled using principal component analysis. Statistical associations between perceived quality of care and patient satisfaction were examined using random-effect ordered logistic regression models, adjusting for demographic, socioeconomic, visit and facility characteristics. RESULTS Average satisfaction was 6.9 on a 10-point scale for non-HIV services and 7.3 for HIV services. Favourable perceptions of health personnel conduct were associated with higher odds of overall satisfaction for non-HIV (OR=3.53, 95% CI 2.34 to 5.33) and HIV (OR=11.00, 95% CI 3.97 to 30.51) visits. Better perceptions of resources and services were also associated with higher odds of satisfaction for both non-HIV (OR=1.66, 95% CI 1.08 to 2.55) and HIV (OR=4.68, 95% CI 1.81 to 12.10) visits. Two additional dimensions of perceived quality of care--healthcare delivery and accessibility of care--were positively associated with higher satisfaction for non-HIV patients. The odds of overall satisfaction were lower in rural facilities for non-HIV patients (OR 0.69; 95% CI 0.48 to 0.99) and HIV patients (OR=0.26, 95% CI 0.16 to 0.41). For non-HIV patients, the odds of satisfaction were greater in hospitals compared with health centres/posts (OR 1.78; 95% CI 1.27 to 2.48) and lower at publicly-managed facilities (OR=0.41, 95% CI=0.27 to 0.64). CONCLUSIONS Perceived quality of care is an important driver of patient satisfaction with health service delivery in Zambia.