title: Patient satisfaction and perceived quality of care: evidence from a cross-sectional national exit survey of HIV and non-HIV service users in Zambia.
abstract: OBJECTIVE
  To examine the associations between perceived quality of care and patient satisfaction among HIV and non-HIV patients in Zambia.
  
  
  METHODS
  Patient exit survey conducted at 104 primary, secondary and tertiary health clinics across 16 Zambian districts.
  
  
  METHODS
  2789 exiting patients.
  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).
  Respondent, visit-related, and facility characteristics.
  
  
  METHODS
  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.
authors.affiliation: Department of Public Health, Institute for Health Metrics and Evaluation, Seattle, Washington, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Dansereau
authors.affiliation: Department of Economics, University of Zambia, Lusaka, Zambia.
authors.forename: Felix
authors.initials: F
authors.lastname: Masiye
authors.affiliation: Department of Public Health, Institute for Health Metrics and Evaluation, Seattle, Washington, USA.
authors.forename: Emmanuela
authors.initials: E
authors.lastname: Gakidou
authors.affiliation: Department of Public Health, University of North Carolina, Chapel Hill, North Carolina, USA.
authors.forename: Samuel H
authors.initials: SH
authors.lastname: Masters
authors.affiliation: Department of Public Health, Institute for Health Metrics and Evaluation, Seattle, Washington, USA.
authors.forename: Roy
authors.initials: R
authors.lastname: Burstein
authors.affiliation: Department of Economics & International Business, Sam Houston State University, Huntsville, Texas, USA.
authors.forename: Santosh
authors.initials: S
authors.lastname: Kumar
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000628:therapy*; D006282:Health Personnel; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006761:Hospitals; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012424:Rural Population; D011795:Surveys and Questionnaires; D055815:Young Adult; D015024:Zambia
keywords: Exit interview; HIV; Patient satisfaction; Perceived quality of care; Zambia