Abstract
Purpose:
The study aims to systematically assess patient satisfaction concerning eye care services provided during and after the coronavirus disease 2019 (COVID-19) pandemic at a tertiary care academic institution. This work seeks to analyze the various dimensions influencing the holistic measure of overall patient contentment.
Methods:
A cohort of 2485 patients seeking physical consultation for ocular conditions at a tertiary care academic institution between April 2020 and December 2022 were recruited in a cross-sectional study. They were divided into two groups, viz. during the COVID period and post-COVID period. The primary focus was on evaluating overall satisfaction, measured through a validated patient satisfaction questionnaire (PSQ-18).
Results:
The study encompassed a total of 2485 participants, with 1242 individuals in the cohort during the COVID period and 1243 in the post-COVID phase. Within the COVID period subgroup, the mean age of male and female patients was 39.46 ± 19.31 and 39.58 ± 19.07 years, respectively. In the post-COVID subgroup, the mean age of male and female patients was 45.26 ± 19.38 and 45.36 ± 19.22 years, respectively. Examining the COVID subgroup, the highest satisfaction scores were observed in the domain of time spent with the doctor (3.3453 ± 0.59), followed by financial aspects (3.0816 ± 0.47), interpersonal manner (3.0589 ± 0.37), and accessibility and convenience (3.0585 ± 0.37). Notably, technical quality received the lowest satisfaction score (2.4763 ± 0.42). A statistically significant difference (P < 0.0001) was noted in the PSQ-18 scores between the two groups. In the post-COVID subgroup, patients expressed higher satisfaction with the technical quality of treatment, irrespective of the mode of management. However, financial satisfaction was better in the COVID group.
Conclusion:
Our study using the PSQ-18 questionnaire highlights significant variations in patient satisfaction with ophthalmology clinic services during and after the COVID era. Notably, time spent with the doctor scored the highest, emphasizing its positive impact. However, addressing concerns related to technical quality is crucial for overall improvement.
Keywords: COVID, patient satisfaction, PSQ-18
The surge in viral infections, as evident from outbreaks like Crimean Congo hemorrhagic fever, Ebola, and the widespread impact of coronavirus disease 2019 (COVID-19), presents a conjugation of public health concerns and economic implications. Originating in Wuhan, China, in December 2019, COVID-19 swiftly attained global pandemic status by January 30, 2020, according to the World Health Organization.[1,2]
The predominant person-to-person transmission of COVID-19 prompted widespread preventive measures, including lockdowns, mask mandates, hand hygiene practices, social distancing, vaccination campaigns, and travel restrictions. Amidst these constraints, routine medical services, including eye care, faced considerable disruptions, presenting notable challenges for patients in obtaining essential health care.[3] Use of personal protective equipment in sweaty environments, face shields or shields over slit lamps, and fear of contracting COVID made physical examination quite challenging and adversely affected doctor–patient relationship.
Patient satisfaction stands as a crucial benchmark for evaluating health-care service performance, encapsulating patients’ values and expectations, particularly during times of health-care turbulences such as the COVID-19 pandemic.[4]
Existing studies on patient satisfaction lack homogeneity, necessitating further research to determine optimal techniques for measuring health-care service quality and understanding the predictors influencing patient satisfaction.[5] Despite the importance of this inquiry, there is a paucity of information regarding patient satisfaction with tertiary eye care facilities in India. This study aims to fill this gap by assessing patient satisfaction with eye care services provided at a tertiary referral clinic staffed with ophthalmologists, both during and after the COVID pandemic. Furthermore, it seeks to explore the impact of various dimensions like technical quality, doctor interpersonal relationship, financial aspects, etc., on overall patient satisfaction.
Methods
This cross-sectional study, conducted in compliance with the Declaration of Helsinki, received ethical clearance from the Institutional Ethics Committee (IEC AIIMS/ICE/2021/3627) at a tertiary care academic institution. The study enrolled all consecutive patients seeking physical consultation in the ophthalmology outpatient department, ward, and casualty between April 2020 and December 2022, who gave written informed consent.
Patients were categorized into “patients of COVID time” (from April 2020 to August 2021) and “patients after COVID time” (from September 2021 to December 2022). Consecutive sampling included all eligible participants who provided consent. A comprehensive evaluation covered demographic details, medical history, symptomatology, family history, treatment history, visual acuity, refraction, intraocular pressure measurements, and thorough examination of the anterior and posterior segments. Relevant investigations were ordered as needed for diagnosis. Only emergency surgeries for diseases like open globe injuries were conducted during the lockdown period, according to All India Ophthalmological Society (AIOS) guidelines.[6] Patients were managed medically with systemic or topical medications wherever possible. Other surgeries like cataract, glaucoma, etc., were started gradually once the COVID situation improved. Patients who were initially medically managed, for example, glaucoma patients, were subjected to glaucoma surgery in the post-COVID period.
Patient satisfaction with physical consultation was assessed using the Patient Satisfaction Questionnaire (PSQ-18).[5] This abbreviated form, derived from the 50-item Patient Satisfaction Questionnaire III (PSQ-III), includes 18 items representing seven dimensions. A five-point Likert scale, ranging from strongly agree to strongly disagree, gauged the responses. Subscale scores were obtained by averaging the item scores within each component.[7] Form completion occurred at the first follow-up.
Descriptive statistics summarized patient characteristics. Continuous variables were expressed as means with standard deviations, while categorical variables were presented as frequencies and percentages. Comparative analyses between patients of COVID time and patients after COVID time were conducted using appropriate statistical tests, considering the nature of the variables. Statistical significance was set at P < 0.05.
Results
This cross-sectional study comprised 2485 participants, who were evenly distributed between two distinct periods: 1242 during the COVID period and 1243 after its resolution. Within the COVID consultation group, gender distribution revealed 767 male patients (61.76%) and 475 female patients (39.58%).
In the during COVID consultation group, 767 patients (61.76%) were male and 475 patients (39.58%) were female. Patients were further divided according to age groups. Maximum patients were within the age group of 21–30 years (21.18%), followed by 41–50 years (19.48%), 51–60 years (14.19%), >60 years (14.57%), 11–20 years (13.45%), 31–40 years (12.24%), and <10 years (4.19%). The mean age of both male and female patients showed similarity, with values of 39.46 ± 19.31 and 39.58 ± 19.07, respectively.
Transitioning to the after COVID consultation group, 795 male patients (63.96%) and 448 female patients (36.04%) participated. Patients were further divided according to age groups. Maximum patients were within the age group of >60 years (30.01%), followed by 21–30 years (18.34%), 51–60 years (15.29%), 41–50 years (13.35%), <20 years (14.72%), and 31–40 years (8.29%). The mean age of male and female patients remained comparable at 45.26 ± 19.38 and 45.36 ± 19.22, respectively.
In our study, the evaluation of patient satisfaction was conducted utilizing the PSQ-18 form on a five-point Likert scale. This questionnaire was administered to patients in both the post-COVID and COVID groups during their initial follow-up, and scores were computed for subsequent comparative analysis [Tables 1–3].
Table 1.
Question-wise distribution of responses to the PSQ-18 questionnaire in patients during COVID time (n=1242)
| Question no. | Subscale and item | Strongly agree (1) | Agree (2) | Uncertain (3) | Disagree (4) | Strongly disagree (5) | Mean score in males | Mean score in females | P |
|---|---|---|---|---|---|---|---|---|---|
| General satisfaction | |||||||||
| 3. | The medical care I have been receiving is just about perfect | 347 (27.9%) | 770 (62.04%) | 118 (9.5%) | 6 (0.48%) | 0 | 1.86±0.6 | 1.77±0.6 | 0.040 |
| 17. | I am dissatisfied with some things about the medical care I receive | 7 (0.56%) | 64 (5.1%) | 273 (21.9%) | 608 (48.9%) | 290 (23.3%) | 3.87±0.85 | 3.93±0.82 | 0.215 |
| Technical quality | |||||||||
| 2. | I think my doctor’s office has everything needed to provide complete care | 512 (41.2%) | 644 (51.8%) | 75 (6.03%) | 11 (0.8%) | 0 | 1.67±0.64 | 1.66±0.61 | 0.884 |
| 4. | Sometimes doctors make me wonder if their diagnosis is correct | 0 | 28 (2.2%) | 227 (18.2%) | 614 (49.4%) | 373 (30.03%) | 1.96±0.77 | 1.87±0.73 | 0.048 |
| 6. | When I go for medical care, they are careful to check everything when treating and examining me | 275 (22.1%) | 613 (49.3%) | 288 (23.18%) | 65 (5.2%) | 1 (0.08%) | 2.14±0.81 | 2.09±0.8 | 0.304 |
| 14. | I have some doubts about the ability of the doctors who treat me | 14 (1.1%) | 50 (4.02%) | 202 (16.2%) | 698 (56.2%) | 278 (22.3%) | 3.94±0.82 | 3.96±0.78 | 0.996 |
| Interpersonal manner | |||||||||
| 10. | Doctors act too businesslike and impersonal towards me | 1 (0.08%) | 34 (2.7%) | 138 (11.1%) | 712 (57.3%) | 357 (28.7%) | 4.11±0.72 | 4.13±0.68 | 0.892 |
| 11. | My doctors treat me in a very friendly and courteous manner | 302 (24.3%) | 701 (56.4%) | 158 (12.7%) | 61 (4.9%) | 20 (1.6%) | 2±0.84 | 2.08±0.85 | 0.151 |
| Communication | |||||||||
| 1. | Doctors are good about explaining the reason for medical tests | 524 (42.2%) | 633 (50.9%) | 74 (5.95%) | 11 (0.8%) | 0 | 1.65±0.65 | 1.66±0.6 | 0.669 |
| 13. | Doctors sometimes ignore what I tell them | 5 (0.4%) | 79 (6.3%) | 158 (12.7%) | 607 (48.8%) | 393 (31.6%) | 4.04±0.88 | 4.07±0.81 | 0.753 |
| Financial aspects | |||||||||
| 5. | I feel confident that I can get the medical care I need without being set back financially | 358 (28.8%) | 646 (52%) | 192 (15.4%) | 45 (3.6%) | 1 (0.08%) | 1.96±0.78 | 1.91±0.75 | 0.43 |
| 7. | I have to pay for more of my medical care than I can afford | 10 (0.8%) | 44 (3.5%) | 97 (7.81%) | 659 (53%) | 432 (34.7%) | 4.19±0.74 | 4.15±0.84 | 0.721 |
| Time spent with the doctor | |||||||||
| 12. | Those who provide my medical care sometimes hurry too much when they treat me | 4 (0.33%) | 72 (5.7%) | 97 (7.81%) | 815 (65.6%) | 254 (20.4%) | 4.00±0.73 | 4.01±0.75 | 0.686 |
| 15. | Doctors usually spend plenty of time with me | 182 (14.6%) | 644 (51.8%) | 260 (20.9%) | 149 (11.9%) | 7 (0.56%) | 2.3±0.87 | 2.35±0.91 | 0.359 |
| Accessibility and convenience | |||||||||
| 8. | I have easy access to the medical specialists I need | 135 (10.8%) | 727 (58.5%) | 270 (21.7%) | 100 (8.05%) | 10 (0.8%) | 2.29±0.81 | 2.29±0.77 | 0.972 |
| 9. | Where I get medical care, people have to wait too long for emergency treatment | 0 | 20 (1.6%) | 129 (10.3%) | 838 (67.4%) | 255 (20.5%) | 4.06±0.62 | 4.08±0.59 | 0.619 |
| 16. | I find it hard to get an appointment for medical care right away | 6 (0.48%) | 76 (6.1%) | 150 (12.1%) | 805 (64.8%) | 205 (16.5%) | 3.91±0.73 | 3.9±0.79 | 0.919 |
| 18. | I am able to get medical care whenever I need it | 203 (16.3%) | 470 (37.8%) | 397 (31.9%) | 164 (13.2%) | 8 (0.64%) | 2.45±0.96 | 2.43±0.89 | 0.744 |
Some values have been given in bold to denote significant P values(<0.05). COVID=coronavirus disease, PSQ=patient satisfaction questionnaire
Table 3.
Comparison of PSQ-18 scoring on a five-point Likert scale in various subclasses of questionnaire between both the groups of the study population (n=2485)
| Questionnaire | Overall (n=2485) (Mean±SD) | COVID group (Mean±SD) | After COVID group (Mean±SD) | P |
|---|---|---|---|---|
| General satisfaction | 2.8869±0.43 | 2.8595±0.48 | 2.9143±0.38 | 0.0016 |
| Technical quality | 2.4763±0.42 | 2.4144±0.38 | 2.5382±0.47 | <0.0001 |
| Interpersonal manner | 3.0589±0.37 | 3.0748±0.44 | 3.0430±0.31 | 0.0374 |
| Communication | 2.9246±0.53 | 2.8526±0.52 | 2.9967±0.54 | <0.0001 |
| Financial aspects | 3.0816±0.47 | 3.0579±0.55 | 3.1053±0.4 | 0.0141 |
| Time spent with the doctor | 3.3453±0.59 | 3.1602±0.55 | 3.5305±0.63 | <0.0001 |
| Accessibility and convenience | 3.0585±0.37 | 3.1775±0.35 | 2.9396±0.39 | <0.0001 |
Some values have been given in bold to denote significant P values(<0.05). COVID=coronavirus disease, PSQ=patient satisfaction questionnaire, SD=standard deviation
Table 2.
Question-wise distribution of responses to the PSQ-18 questionnaire in patients after COVID time (n=1243)
| Question no. | Subscale and item | Strongly agree (1) | Agree (2) | Uncertain (3) | Disagree (4) | Strongly disagree (5) |
|---|---|---|---|---|---|---|
| General satisfaction | ||||||
| 3. | The medical care I have been receiving is just about perfect | 605 (48.7%) | 624 (50.24%) | 14 (1.04%) | 0 | 0 |
| 17. | I am dissatisfied with some things about the medical care I receive | 0 | 0 | 31 (2.5%) | 802 (64.5%) | 410 (33%) |
| Technical quality | ||||||
| 2. | I think my doctor’s office has everything needed to provide complete care | 402 (32.28%) | 373 (30.03%) | 412 (33.17%) | 56 (4.5%) | 0 |
| 4. | Sometimes doctors make me wonder if their diagnosis is correct | 0 | 235 (18.9%) | 314 (25.28%) | 473 (38.08%) | 221 (17.7%) |
| 6. | When I go for medical care, they are careful to check everything when treating and examining me | 534 (42.9%) | 709 (57.08%) | 0 | 0 | 0 |
| 14. | I have some doubts about the ability of the doctors who treat me | 0 | 0 | 327 (26.24%) | 552 (44.4%) | 364 (29.3%) |
| Interpersonal manner | ||||||
| 10. | Doctors act too businesslike and impersonal towards me | 0 | 0 | 56 (4.5%) | 562 (45.16%) | 625 (50.32%) |
| 11. | My doctors treat me in a very friendly and courteous manner | 519 (41.7%) | 668 (53.8%) | 56 (4.5%) | 0 | 0 |
| Communication | ||||||
| 1. | Doctors are good about explaining the reason for medical tests | 454 (36.47%) | 789 (63.5%) | 0 | 0 | 0 |
| 13. | Doctors sometimes ignore what I tell them | 0 | 0 | 186 (14.9%) | 427 (34.38%) | 630 (50.72%) |
| Financial aspects | ||||||
| 5. | I feel confident that I can get the medical care I need without being set back financially | 401 (32.28%) | 477 (38.4%) | 291 (23.34%) | 74 (5.9%) | 0 |
| 7. | I have to pay for more of my medical care than I can afford | 0 | 107 (8.6%) | 92 (7.4%) | 512 (41.2%) | 532 (42.75%) |
| Time spent with the doctor | ||||||
| 12. | Those who provide my medical care sometimes hurry too much when they treat me | 0 | 0 | 355 (28.58%) | 434 (34.86%) | 454 (36.5%) |
| 15. | Doctors usually spend plenty of time with me | 0 | 449 (36.15%) | 369 (29.62%) | 425 (34.2%) | 0 |
| Accessibility and convenience | ||||||
| 8. | I have easy access to the medical specialists I need | 489 (39.37%) | 469 (37.68%) | 285 (22.9%) | 0 | 0 |
| 9. | Where I get medical care, people have to wait too long for emergency treatment | 0 | 0 | 314 (25.28%) | 715 (57.44%) | 214 (17.23%) |
| 16. | I find it hard to get an appointment for medical care right away | 0 | 0 | 266 (21.33%) | 523 (42.1%) | 454 (36.5%) |
| 18. | I am able to get medical care whenever I need it | 337 (27%) | 755 (60.78%) | 151 (12.15%) | 0 | 0 |
COVID=coronavirus disease, PSQ=patient satisfaction questionnaire
The subgroup of time spent with the doctor had the best scoring (3.3453 ± 0.59), followed by financial aspect (3.0816 ± 0.47), interpersonal manner (3.0589 ± 0.37), and accessibility and convenience (3.0585 ± 0.37). Patients were least satisfied with the technical quality, which had a score of 2.4763 ± 0.42 in the total study population.
The mean PSQ-18 score for both the groups of study population was compared for all components of the questionnaire and was found to be statistically significant (P < 0.0001) [Table 3].
Out of 1242 patients in the during COVID consultation group, 1013 patients (81.56%) were managed medically while 229 patients (18.43%) were managed surgically for cataract, glaucoma, vitrectomy, open globe injuries, etc. Out of 1243 patients in the after COVID consultation group, 715 patients (57.52%) were managed medically while 528 patients (42.47%) were managed surgically. Medically managed patients were more satisfied with the technical quality provided during treatment than surgically treated patients (P = 0.016), while surgically managed patients were more satisfied financially compared to medically managed patients (P < 0.0001) [Table 4].
Table 4.
Association of PSQ-18 scoring on a five-point Likert scale with the mode of treatment in patients during and after COVID time (n=2485)
| Questionnaire | Medically managed patients |
P | |
|---|---|---|---|
| During COVID (Mean±SD) | After COVID (Mean±SD) | ||
| General satisfaction | 2.85±0.49 | 2.93±0.38 | <0.0001 |
| Technical quality | 2.41±0.38 | 2.51±0.45 | <0.0001 |
| Interpersonal manner | 3.08±0.45 | 3.03±0.31 | 0.0013 |
| Communication | 2.84±0.51 | 2.99±0.53 | <0.0001 |
| Financial aspects | 3.05±0.55 | 3.15±0.42 | <0.0001 |
| Time spent with the doctor | 3.16±0.56 | 3.52±0.64 | <0.0001 |
| Accessibility and convenience | 3.17±0.35 | 2.94±0.41 | <0.0001 |
|
| |||
| Questionnaire |
Surgically managed patients
|
P | |
| During COVID (Mean±SD) | After COVID (Mean±SD) | ||
|
| |||
| General satisfaction | 2.86±0.45 | 2.90±0.37 | 0.0156 |
| Technical quality | 2.41±0.36 | 2.57±0.47 | <0.0001 |
| Interpersonal manner | 3.03±0.41 | 3.07±0.29 | 0.005 |
| Communication | 2.88±0.57 | 3.01±0.55 | <0.0001 |
| Financial aspects | 3.09±0.56 | 3.05±0.36 | 0.0343 |
| Time spent with the doctor | 3.12±0.52 | 3.54±0.62 | <0.0001 |
| Accessibility and convenience | 3.20±0.36 | 2.93±0.36 | <0.0001 |
COVID=coronavirus disease, PSQ=patient satisfaction questionnaire, SD=standard deviation
PSQ scoring was also compared between genders and patients’ education levels. No significant difference was observed among various subclasses of questionairre with respires to education levels. However, patients were more satisfied in post-COVID era [Table 5].
Table 5.
Association of PSQ-18 scoring with different levels of education of the patients during and after COVID time (n=2485)
| Questionnaire | During COVID Uneducated | Post COVID Uneducated | P | During COVID Primary | Post COVID Primary | P | During COVID Secondary | Post-COVID Secondary | P | During COVID Graduate | Post-COVID Graduate | P |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| General satisfaction | 2.86±0.47 | 2.88±0.37 | 0.238 | 2.85±0.52 | 2.93±0.37 | <0.0001 | 2.83±0.47 | 2.92±0.37 | <0.0001 | 2.93±0.44 | 2.89±0.38 | 0.0154 |
| Technical quality | 2.44±0.38 | 2.54±0.45 | <0.0001 | 2.40±0.36 | 2.56±0.47 | <0.0001 | 2.37±0.37 | 2.54±0.46 | <0.0001 | 2.45±0.39 | 2.48±0.43 | 0.068 |
| Interpersonal manner | 3.05±0.41 | 3.05±0.29 | 1.0 | 3.03±0.45 | 3.05±0.28 | 0.183 | 3.12±0.45 | 3.03±0.30 | <0.0001 | 3.08±0.49 | 3.04±0.32 | 0.0161 |
| Communication | 2.89±0.52 | 3.00±0.52 | <0.0001 | 2.80±0.50 | 2.98±0.55 | <0.0001 | 2.82±0.53 | 2.98±0.53 | <0.0001 | 2.89±0.49 | 3.04.0.51 | <0.0001 |
| Financial aspects | 3.09±0.55 | 3.07±0.37 | 0.287 | 3.05±0.54 | 3.09±0.38 | 0.032 | 3.04±0.55 | 3.11±0.41 | 0.0003 | 2.98±0.58 | 3.12±0.42 | <0.0001 |
| Time spent with doctor | 3.16±0.53 | 3.55±0.60 | <0.0001 | 3.14±0.51 | 3.54±0.63 | <0.0001 | 3.18±0.59 | 3.50±0.63 | <0.0001 | 3.13±0.61 | 3.55±0.65 | <0.0001 |
| Accessibility and convenience | 3.17±0.34 | 2.90±0.37 | <0.0001 | 3.15±0.35 | 2.96±0.37 | <0.0001 | 3.18±0.35 | 2.98±0.39 | <0.0001 | 3.19±0.36 | 2.93±0.40 | <0.0001 |
COVID=coronavirus disease, PSQ=patient satisfaction questionnaire
Discussion
This research paper investigates various dimensions of patient satisfaction in the context of eye care services during and after the COVID-19 pandemic at a tertiary care academic institution. An exploration of demographic factors, including gender and age, across both the during COVID and after COVID groups ensures a comprehensive understanding applicable to a diverse patient population. The analysis of patient satisfaction dimensions uncovers distinct patterns, with the post-COVID group reporting significantly improved experiences in aspects like time spent with the the doctor, communication, technical quality, and general satisfaction, attributed to removal of any COVID-related restrictions.
While assessing PSQ-18 question-wise in the during COVID group, we found that the subscale of general satisfaction included two questions: “The medical care I have been receiving is just about perfect,” to which the maximum responses were agree (62%) and strongly agree (28%), and “I am dissatisfied with some things about the medical care I receive,” for which the majority responded disagree (49%) and strongly disagree (23%). The second subscale technical quality comprised two questions: “I think my doctor’s office has everything needed to provide complete care” (agree: 52%), “Sometimes doctors make me wonder if their diagnosis is correct” (disagree: 49%), “When I go for medical care, they are careful to check everything when treating and examining me” (agree: 49%), and “I have some doubts about the ability of the doctors who treat me” (disagree: 56%). The third subscale interpersonal manner included two questions – “Doctors act too businesslike and impersonal towards me” (disagree: 57%) and “My doctors treat me in a very friendly and courteous manner” (Agree: 56%). The fourth subscale item was communication with two questions – “Doctors are good about explaining the reason for medical tests” with the maximum response of agree (51%) and “Doctors sometimes ignore what I tell them” with the maximum response of disagree (49%). Another subscale item of financial aspects also included two questions – “I feel confident that I can get the medical care I need without being set back financially,” to which 52% patient agreed, and “I have to pay for more of my medical care than I can afford,” to which majority (53%) disagreed. The subscale of time spent with the doctor had two questions: “Those who provide my medical care sometimes hurry too much when they treat me,” which recorded the majority response of disagree (65%), and “Doctors usually spend plenty of time with me,” which had the majority response of agree (52%). Accessibility and convenience was assessed using four questions: “I have easy access to the medical specialists I need” (agree- 59%), “Where I get medical care, people have to wait too long for emergency treatment” (disagree- 67%), “I find it hard to get an appointment for medical care right away” (disagree- 65%), and “I am able to get medical care whenever I need it” (agree- 38% and uncertain- 31%).
Assessment of question-wise analysis of PSQ-18 questionnaire in the after COVID group was done in a similar manner. The subscale of general satisfaction had two questions: “The medical care I have been receiving is just about perfect,” to which the maximum responses were agree (50%) and strongly agree (49%), and “I am dissatisfied with some things about the medical care I receive,” for which the majority responded disagree (64%) and strongly disagree (33%). The second subscale technical quality comprised two questions: “I think my doctor’s office has everything needed to provide complete care” (uncertain: 33%, strongly agree: 32%, and agree: 30%), “Sometimes doctors make me wonder if their diagnosis is correct” (disagree: 38%), “When I go for medical care, they are careful to check everything when treating and examining me” (agree: 57%), and “I have some doubts about the ability of the doctors who treat me” (disagree: 44%). The third subscale interpersonal manner included two questions: “Doctors act too businesslike and impersonal towards me” (strongly disagree: 50%, disagree: 45%) and “My doctors treat me in a very friendly and courteous manner” (agree: 54%). The fourth subscale item was communication with two questions: “Doctors are good about explaining the reason for medical tests” with the maximum response of agree (51%) and “Doctors sometimes ignore what I tell them” with the maximum response of disagree (50%). Another subscale item of financial aspects also included two questions: “I feel confident that I can get the medical care I need without being set back financially,” to which 38% patients agreed and 32% strongly agreed, and “I have to pay for more of my medical care than I can afford,” to which majority (43%) disagreed. The subscale of time spent with the doctor had two questions: “Those who provide my medical care sometimes hurry too much when they treat me,” which recorded the majority response of disagree (36%) and strongly disagree (35%), and “Doctors usually spend plenty of time with me,” which had the majority response of agree (36%) followed by disagree (34%). Accessibility and convenience was assessed using four questions: “I have easy access to the medical specialists I need” (strongly agree: 39% and agree: 37%), “Where I get medical care, people have to wait too long for emergency treatment” (disagree: 57%), “I find it hard to get an appointment for medical care right away” (disagree: 42%), and “I am able to get medical care whenever I need it” (agree: 61% and strongly agree: 27%).
This subgroup analysis revealed noteworthy distinctions between the two groups. In the post-COVID group, patients reported significantly superior experiences in terms of the time spent with the doctor (3.3453 ± 0.59 vs. 3.1053 ± 0.54, P < 0.0001), communication (P < 0.0001), technical quality (P < 0.00001), and general satisfaction (P = 0.0016). These improvements were attributed to removal of any COVID-related restrictions in examining patients.
Conversely, the COVID group exhibited statistical significance favoring financial aspects (P = 0.0141) and accessibility and convenience (P < 0.0001). These findings suggest a nuanced pattern of patient satisfaction across different dimensions in response to the prevailing pandemic conditions.
PSQ-18 results were also compared between genders. Out of 18 questions, only two questions were significantly different between males and females. One question was “The medical care I have been receiving is just about perfect” and the second question was “Sometimes doctors make me wonder if their diagnosis is correct,” for which females had a low score compared to males with P values of 0.040 and 0.048, respectively. Other questions had comparable scores without significant difference between them [Table 1].
Furthermore, a detailed subgroup analysis of medical and surgical management indicated that a higher percentage of patients in the COVID group (81.56%) were managed medically, while a relatively lower proportion underwent surgical interventions (18.43%). In contrast, the post-COVID group demonstrated a shift toward a more balanced distribution, with 57.52% managed medically and 42.47% managed surgically. Notably, regardless of the mode of treatment, patients attending clinics in the post-COVID period reported superior satisfaction in general satisfaction, technical quality, interpersonal manner, communication, and time spent with the doctor.
An additional noteworthy observation was that the financial aspects were more effectively addressed in the COVID group, emphasizing the adaptability of different modes of health-care delivery to varying patient needs. This was consistent with the findings of Peterson et al.,[8] Levy S et al.,[9] Sakti et al.,[10] and Aljarallah et al.[11]
Lastly, the comparison of PSQ scoring with respect to patients’ education levels revealed no significant differences between genders across various questionnaire subclasses and educational levels [Table 5]. This suggests a consistent pattern of patient satisfaction irrespective of gender and educational background in the context of the parameters assessed in the study. Our findings offer practical implications for health-care providers and policymakers, so that future research may focus on strategies for maintaining high patient satisfaction beyond the pandemic.[12,13,14]
However, our study is constrained by the lack of assessment regarding the grading of patient satisfaction, a comprehensive examination of participants’ demographic and economic profiles, and an exploration of the potential influence of the treating doctor’s gender. Addressing these limitations is essential for a more thorough understanding of the study’s scope and findings.
Conclusion
In summary, this study throws light on the dynamics of patient satisfaction in the realm of eye care services in India and similar developing nations during the COVID-19 pandemic. It highlights the increased importance of an empathetic and compassionate doctor–patient relationship in improving patient experiences in the post-pandemic landscape. Moving forward, recognizing patient needs and concerns will offer policymakers opportunities to refine strategies, optimize health-care delivery, and ensure continued patient satisfaction.
Conflicts of interest
There are no conflicts of interest.
Funding Statement
Nil.
References
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