RELATIONSHIP BETWEEN QUALITY OF DIABETES CARE: DISCUSSION
In this population-based study, a number of recommended measures of quality diabetes care (e.g., monitoring of blood glucose and cholesterol concentrations and screening for foot, and eye disease) were positively associated with patient satisfaction. In this sample of African Americans with diabetes, reported satisfaction with care was generally excellent or good. The perception of not having difficulty getting care, having one physician for diabetes care, and receiving diabetes education were each positively and independently associated with patient satisfaction. As previously reported, levels of diabetes care in this population of African Americans seemed comparable to or better than US national averages.
Our finding that a number of preventive care process measures for diabetes care were positively associated with patient satisfaction further supports the idea of promoting patient satisfaction as a measure of quality of care. In addition to measuring perceived quality of care, patient satisfaction may also be a surrogate measure for the actual quality of care. Diabetes is a complex, chronic, and costly disease; the quality of diabetes care is widely sub-optimal; and most interventions for diabetes depend on active involvement and participation of patients. Thus, working through patient satisfaction may be an important way of improving care for this important public health problem. Various studies have concluded that continuity in using services, maintenance of relationships with provider, and compliance with treatments are all more likely among satisfied than unsatisfied patients. Satisfied patients also are more likely to participate in their own treatment and to cooperate with health care providers by disclosing important information and by adhering to prescribed treatment. Self-management training and diabetes education often lead to improvements in knowledge, and better health outcomes may ultimately depend upon approaches that simultaneously improve delivery of preventive care services and enhance self-management. These conclusions support our finding that diabetes education and the elements of diabetes care are associated with patient satisfaction.
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A strength of our study is that the participants were a population-based sample. However, the causal direction of association between the quality of diabetes care and patient satisfaction cannot be confirmed because the study was cross-sectional rather then prospective. Our data showed that those who had received a greater number of preventive care services from providers and those patients who were performing more self-care practices had higher levels of satisfaction. These findings suggest that a higher level of diabetes care aimed at preventing the adverse effects of diabetes leads to greater satisfaction. However, it is also conceivable that more satisfied patients may use care more and comply with care more.
Our measure of patient satisfaction covered a number of domains—namely, overall care received, interpersonal communication and information, time and convenience, and accessibility. Recently developed instruments (e.g., Consumer Assessment of Health Plans Study [CAHPS]) are more extensive and sophisticated and measure additional domains, including referral and amount of paperwork. Our short measure, however, captured most of the items that are important to the patient. A potential bias in surveys of patient satisfaction is that introduced by low response rates, but our response rate was close to 90%. Patient satisfaction has been reported to be affected by racial/ethnic differences, and in this regard, our data in African Americans adds uniquely to the literature. Viagra Online Canadian Pharmacy
In conclusion, we found that several recommended measures of diabetes quality of care were individually positively associated with patient satisfaction, and higher levels of quality of care were associated with higher levels of satisfaction. We think that better delivery and use of diabetes care probably leads to more satisfied patients. Prospective investigations using better measures of patient satisfaction and more objective measures of quality of care are needed. Studies in other populations are also needed to confirm these associations and to further assess the relationship between satisfaction and patient outcomes. In the meantime, our study findings indicate that focusing on certain modifiable factors associated with patient satisfaction (e.g., having one physician for diabetes care, easy access to care, and availability of diabetes education) may be important strategies to improve care for chronic diseases like diabetes.
