title: Patient satisfaction in outpatient healthcare services at secondary level vs. tertiary level.
abstract: BACKGROUND
  Patients satisfaction is a very important part of any clinical practice both for evaluation and improvement of healthcare services.
  
  
  OBJECTIVE
  The aim of this study was to determine patient satisfaction with public outpatient healthcare services at secondary and tertiary level and to assess possible differences between the two levels.
  
  
  METHODS
  In a quantitative cross-sectional study, a convenient sample of 646 patients who experienced public outpatient healthcare services at the secondary and tertiary level during the last two months were interviewed. Patient satisfaction questionnaires, with statements regarding various aspects of satisfac- tion, were completed during face-to-face interviews (response rate 84.6%).The research instrument was tested for internal consistency using the Cronbach's coefficient alpha estimate.
  
  
  RESULTS
  The patients were significantly more satisfied in tertiary than in secondary outpatient healthcare facilities in almost all aspects of assessment related to general settings, nurse/administrative staff performance and physician performance (p < 0.001). The patients in the secondary healthcare services (SHCS) were more satisfied than in the tertiary healthcare services (THCS) but only regarding the information on location (83.9% vs. 78.3%) and possibilities to enter and move inside the department (88.8% vs. 83.3%). Analysis of data for SHCS and THCS showed that there was no significant difference between the mean overall satisfaction scores with regard to patients' gender, age, marital status, educational level, employment and number of visits.
  
  
  CONCLUSIONS
  There is a need to improve the current level of patient-provider relationship and communication, as well as that of hospital environment, while special efforts should be made to address the problem of patient waiting time and hospital bureaucracy.
authors.forename: Vesna Velikj
authors.initials: VV
authors.lastname: Stefanovska
authors.forename: Miodraga Stefanovska
authors.initials: MS
authors.lastname: Petkovska
mesh_terms: D000553:Ambulatory Care / Q000592:standards*; D003142:Communication; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D010045:Outpatients; D017060:Patient Satisfaction; D010820:Physicians; D011795:Surveys and Questionnaires