title: Patient satisfaction with ambulatory care in Germany: effects of patient- and medical practice-related factors.
abstract: OBJECTIVE
  The study aimed to illustrate the effect of the patients' sex, age, self-rated health and medical practice specialization on patient satisfaction.
  
  
  METHODS
  Secondary analysis of patient survey data using multilevel analysis (generalized linear mixed model, medical practice as random effect) using a sequential modelling strategy. We examined the effects of the patients' sex, age, self-rated health and medical practice specialization on four patient satisfaction dimensions: medical practice organization, information, interaction, professional competence.
  
  
  METHODS
  The study was performed in 92 German medical practices providing ambulatory care in general medicine, internal medicine or gynaecology.
  
  
  METHODS
  In total, 9888 adult patients participated in a patient survey using the validated 'questionnaire on satisfaction with ambulatory care-quality from the patient perspective [ZAP]'.
  
  
  METHODS
  We calculated four models for each satisfaction dimension, revealing regression coefficients with 95% confidence intervals (CIs) for all independent variables, and using Wald Chi-Square statistic for each modelling step (model validity) and LR-Tests to compare the models of each step with the previous model.
  
  
  RESULTS
  The patients' sex and age had a weak effect (maximum regression coefficient 1.09, CI 0.39; 1.80), and the patients' self-rated health had the strongest positive effect (maximum regression coefficient 7.66, CI 6.69; 8.63) on satisfaction ratings. The effect of medical practice specialization was heterogeneous.
  
  
  CONCLUSIONS
  All factors studied, specifically the patients' self-rated health, affected patient satisfaction. Adjustment should always be considered because it improves the comparability of patient satisfaction in medical practices with atypically varying patient populations and increases the acceptance of comparisons.
authors.affiliation: Department of Medicine, Institute for Health Systems Research, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, D-58448 Witten, Germany.
authors.forename: Silke
authors.initials: S
authors.lastname: Auras
authors.affiliation: Department of Psychology, Chair of Research Methodology and Statistics in Psychology, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, D-58448 Witten, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Ostermann
authors.affiliation: Department of Medicine, Institute for Health Systems Research, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, D-58448 Witten, Germany.
authors.forename: Werner
authors.initials: W
authors.lastname: de Cruppé
authors.affiliation: Department of Public Health and Health Education, University of Education, Kunzenweg 21, D-79117 Freiburg, Germany.
authors.forename: Eva-Maria
authors.initials: EM
authors.lastname: Bitzer
authors.affiliation: Department for Cross-Sectoral Quality Improvement, National Association of Statutory Health Insurance Physicians (NASHIP), Herbert-Lewin-Platz 2, D-10623 Berlin, Germany.
authors.forename: Franziska
authors.initials: F
authors.lastname: Diel
authors.affiliation: Faculty of Medicine, Institute for Health Services Research and Clinical Epidemiology, Philipps-University Marburg, Karl-von-Frisch-Straße 4, D-35043 Marburg, Germany.
authors.forename: Max
authors.initials: M
authors.lastname: Geraedts
mesh_terms: D000328:Adult; D000367:Age Factors; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D003142:Communication; D005260:Female; D058006:General Practice / Q000706:statistics & numerical data; D005858:Germany; D006176:Gynecology / Q000706:statistics & numerical data; D006304:Health Status; D006801:Humans; D007388:Internal Medicine / Q000706:statistics & numerical data; D008297:Male; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D011216:Practice Management, Medical / Q000706:statistics & numerical data*; D011361:Professional Competence / Q000706:statistics & numerical data; D012737:Sex Factors; D011795:Surveys and Questionnaires
keywords: ambulatory care; patient satisfaction; quality measurement; quality of healthcare