title: Patient satisfaction and quality of care in walk-in clinics, family practices and emergency departments: the Ontario Walk-In Clinic Study.
abstract: BACKGROUND
  Although walk-in clinics are an increasingly common feature of Ontario's health care system, the quality of care they provide is the subject of continuing debate. In this study we examined differences in patient satisfaction and quality of care for common acute conditions in walk-in clinics, family practices and emergency departments.
  
  
  METHODS
  For this prospective cohort study, we recruited 12 walk-in clinics, 16 family practices and 13 emergency departments from 11 geographic areas in greater Toronto, Hamilton-Burlington and London, Ont. An expert review panel selected and established quality-of-care criteria for 8 common acute conditions. Patients who sought initial care for 1 of the 8 conditions were recruited by an on-site data collector. We used a questionnaire to assess the satisfaction of 433 patients with patient-centred communication, the physician's attitude and any delay in the waiting room during the study visit. Abstractors reviewed 600 charts for the study patients to assess whether the quality-of-care criteria had been met. A quality score for each case was computed as the percentage of applicable criteria that were met. Mean quality scores for the 3 settings were computed, with adjustment for potentially confounding variables (sex, age, city and diagnosis).
  
  
  RESULTS
  After adjustment for 12 patient characteristics, walk-in clinic patients were significantly more satisfied than emergency department patients on all 3 satisfaction scales. Family practice patients were more satisfied than walk-in clinic patients on all 3 satisfaction scales, but the difference was statistically significant only for satisfaction with waiting time. Adjusted mean quality-of-care scores were 73.1% for emergency departments, 69.9% for walk-in clinics and 64.1% for family practices. The scores for walk-in clinics and emergency departments were significantly higher than that for family practices.
  
  
  CONCLUSIONS
  Satisfaction with waiting time was highest among family practice patients. Both family practices and walk-in clinics were perceived more positively than emergency departments on all 3 dimensions of satisfaction. Overall quality-of-care scores were higher in walk-in clinics and emergency departments than in family practices.
authors.affiliation: Department of Family Medicine, Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ont. hutchb@fhs.mcmaster.ca
authors.forename: Brian
authors.initials: B
authors.lastname: Hutchison
authors.forename: Truls
authors.initials: T
authors.lastname: Østbye
authors.forename: Jan
authors.initials: J
authors.lastname: Barnsley
authors.forename: Moira
authors.initials: M
authors.lastname: Stewart
authors.forename: Maria
authors.initials: M
authors.lastname: Mathews
authors.forename: M Karen
authors.initials: MK
authors.lastname: Campbell
authors.forename: Eugene
authors.initials: E
authors.lastname: Vayda
authors.forename: Stewart B
authors.initials: SB
authors.lastname: Harris
authors.forename: Vicki
authors.initials: V
authors.lastname: Torrance-Rynard
authors.forename: Christine
authors.initials: C
authors.lastname: Tyrrell
mesh_terms: D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities / Q000592:standards; D001291:Attitude of Health Personnel; D001991:Bronchitis / Q000175:diagnosis; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000592:standards; D005194:Family Practice / Q000592:standards; D005260:Female; D005759:Gastroenteritis / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009864:Ontario; D017060:Patient Satisfaction; D010612:Pharyngitis / Q000175:diagnosis; D011446:Prospective Studies; D011787:Quality of Health Care / Q000592:standards; D011897:Random Allocation; D012015:Reference Standards; D015203:Reproducibility of Results