A participatory approach to understanding and measuring patient satisfaction in a primary care teaching setting.

BACKGROUND: Patient satisfaction is a complex, multidimensional concept that is difficult to measure. However, there is agreement that understanding the expectations of a patient community or "what is important to them" is an essential consideration. We chose a participatory approach to address patient satisfaction in the context of a primary care teaching clinic. OBJECTIVES: The objectives of this project were to use a participatory research team of patients staff and researchers to (1) adapt an existing patient satisfaction questionnaire (PSQ) to the specific cultural and organizational elements ofa primary care teaching clinic, (2) administer the revised questionnaire and use the findings as a tool for organizational improvement, with the ultimate goal of increasing patient satisfaction, and (3) ensure that all decision making involved patients and staff to empower them in the process of organizational change. METHODS: We used an iterative, mixed methods approach to conduct this project. An interdisciplinary committee composed of members of the patient community, clinical and administrative staff, and researchers worked together as the primary decision making body. RESULTS: We modified a preexisting questionnaire to address the unique care delivery model of the clinic, issues of cultural sensitivity, and the need for simplified language and response format. Patient dissatisfaction was found to center on continuity and access to care. CONCLUSIONS: The participatory approach was critical to our success in understanding and measuring patient satisfaction from the patients' perspective. The involvement of the interdisciplinary committee and the high level of joint decision making in this project represents a unique contribution to assessing primary care patient satisfaction.

Detecting and addressing adolescent issues and concerns: evaluating the efficacy of a primary care previsit questionnaire.

OBJECTIVE: To assess the efficacy of a previsit questionnaire (PVQ), implemented without formal training, that was designed to screen for biomedical and psychosocial health issues and concerns among adolescent patients in a hospital-based primary care clinic, and to examine the subsequent action taken for health issues and concerns identified with the PVQ. DESIGN: Retrospective review of adolescent medical charts, using a pre-post design. SETTING: An outpatient primary care clinic located in an urban teaching hospital in Montreal, Que. PARTICIPANTS: A total of 210 adolescent patients aged 13 to 19 who visited the clinic between 2000 and 2004. MAIN OUTCOME MEASURES: The type (medical vs psychosocial) and number of issues detected and actions taken by physicians in one-to-one consultations with adolescent patients 2 years before (2000-2002) and 2 years after (2002-2004) PVQ implementation, as noted in the patients' medical charts. RESULTS: In total, 105 charts were reviewed for each group. An increase in the number of psychosocial issues was detected following the introduction of the PVQ. An increase in the frequency of action taken for psychosocial concerns and a decrease in the frequency of medical action taken by physicians were found after PVQ implementation. More notations related to psychosocial concerns were also found in the adolescents' charts after introduction of the PVQ. CONCLUSION: A PVQ is an effective strategy to improve adolescent screening for psychosocial issues and concerns. Implementing such a questionnaire requires no training and can therefore be easily incorporated into clinical practice.