Clinical Epidemiology (Sep 2018)
Modeling determinants of satisfaction with health care in youth with inflammatory bowel disease: a cross-sectional survey
Abstract
Antje Timmer,1,2 Dominik de Sordi,1 Elise Menke,1 Jenny Peplies,2 Martin Claßen,3 Sibylle Koletzko,4 Fabian Otto-Sobotka1 1Division of Epidemiology and Biometry, Medical Faculty, Carl von Ossietzky University, Oldenburg, Germany; 2Epidemiological Methods and Etiology, Leibniz Institute for Prevention Research and Epidemiology – BIPS GmbH, Bremen, Germany; 3Childrens Hospital, Klinikum “Links der Weser“, Bremen, Germany; 4Division of Pediatric Gastroenterology and Hepatology, Dr. von Hauner Children’s Hospital, Ludwig Maximilian University, Munich, Germany Purpose: Patient satisfaction is frequently used as a health care quality measure despite methodological challenges. By the example of pediatric inflammatory bowel disease (IBD), we assessed factors associated with low satisfaction and examined differences by type of provider.Patients and methods: In a cross-sectional design, a 32-item questionnaire and global questioning were used to assess satisfaction in patients aged 15–25 years. Determinants of low satisfaction were identified by logistic regression (OR with 95% CI). Separate models were calculated for patient-related variables such as age, socioeconomic status (SES), health status (emotional, somatic, quality of life) or region of residence (step 1), and impact of provider (pediatric specialist, adult specialist, no specialist) (step 2). As secondary analysis, we studied the effect of additional indicators such as waiting time, consultation time, and an IBD Management Quality Index (IMQI) on effect estimates (step 3).Results: A total of 567 cases were available for analysis (response 48.2%). The strongest predictors of low satisfaction were anxiety symptoms (OR 2.49, CI 1.14 to 5.45). In step 2, not being seen by a specialist (1.89, 1.16 to 3.10) and having been with the new provider for less than 12 months (1.71, 1.03 to 2.83) were associated with low satisfaction. Satisfaction with adult care provider was similar to pediatric care if adjusted for anxiety, health status, and time with provider (0.95, 0.59 to 1.51). Presence of other quality indicators (step 3), waiting time >30 minutes, consultation time <15 minutes, and low IMQI were all associated with low satisfaction. Age, SES, and region of residence were not found to affect satisfaction in any of the models.Conclusion: Anxiety symptoms were most strongly associated with low patient satisfaction. The relevance of recent provider change and not being seen by a specialist underlines the importance of well-planned transition in this age group. Keywords: inflammatory bowel disease, patient-reported outcomes, outcomes research, regression analysis, patient satisfaction, health services research
