Disease Management & Health Outcomes

, Volume 14, Issue 3, pp 171–183 | Cite as

Analysis of Factors Affecting Patient Satisfaction

Focus on Asthma Patients
  • Bayram Sahin
  • Mehtap Tatar
Original Research Article



Patient satisfaction is regarded as an important indicator in assessing the quality of care. Over the past 20 years, in particular, there has been increasing interest in patients’ perceptions about the provision of healthcare. Although asthma is a disease that increases the burden on health expenditure and has high cost requirements, there have been few studies evaluating the views of asthma patients about their treatment. The aims of this study were to identify factors affecting the satisfaction of asthma patients and to contribute to the sparse literature on this topic.


The study sample consisted of 387 asthma patients who were referred to Hacettepe University’s Chest Diseases Polyclinic and Allergy Unit in Ankara, Turkey, between August 2000 and March 2001. A questionnaire consisting of 66 questions was developed to explore demographic characteristics (11 questions), quality of life (32 questions), severity of disease (2 questions), and patient satisfaction with the care received (21 questions). The items for the satisfaction part of the questionnaire were selected from three separate questionnaires used in three independent studies, including the Patient Satisfaction Questionnaire. Factor analysis was performed on the satisfaction items, which revealed five dimensions in which the items were grouped: (i) doctor competency; (ii) provision of information; (iii) quality of care; (iv) waiting time; and (v) hospital quality. The general reliability coefficient was 0.87. Regression analyses were carried out to determine how patient’satisfaction with their medical treatment was affected by the following variables: demographic characteristics (age, other diseases, sex, education, duration of treatment), severity of disease, quality of life, whether medical tests were performed, and whether treatment was received from academic physicians (professors and associate professors) or from consultants and assistants.


The results of the regression analyses revealed that patients who had undergone medical tests or who had received treatment from academic physicians (rather than from consultants or assistants) had higher satisfaction levels than their counterparts. Furthermore, female patients had higher levels of satisfaction than their male counterparts. In addition, it was found that the five satisfaction dimensions were all significantly correlated with each other and that patients’ general satisfaction was also significantly correlated with all five satisfaction dimensions. The percentages of patient satisfaction that were likely to be explained by the variables used in the study were 22.7% for doctor competency, 25.6% for provision of information, 46.2% for quality of care, 13.7% for waiting time, and 9% for hospital quality. Overall, 32.4% of satisfaction was explained by the variables used in the study.


The fact that only 32.4% of general patient satisfaction was explained by the variables used in the study indicates that there are still very important gaps in our understanding of factors affecting patient satisfaction. This study found that the levels of patient satisfaction with care were influenced by provider characteristics (academic status) rather than patient characteristics. After controlling for patient characteristics, patients of professor and associate professor physicians were more satisfied than patients of assistant physicians, especially in regard to doctor competency, quality of care, provision of information, waiting time, and overall satisfaction. Medical education should continue to emphasize the importance of these aspects of the physician-patient encounter. A qualitative approach could be used in further research to investigate the variance that cannot be explained by other models.


Asthma Patient Satisfaction Asthma Patient Satisfaction Level Medical Test 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors gratefully acknowledge Dr Fuat Kayoncu and colleagues at Hacettepe University’s Chest Diseases Polyclinic and Allergy Unit (Ankara, Turkey) for their assistance throughout the project. Funding for this project was provided by Hacettepe University. The authors have no conflicts of interest that are directly relevant to the content of this study.


  1. 1.
    Parkerson GR, Broadhead EW, Tse C. Health status and severity of illness as predictors of outcomes in primary care. Med Care 1995; 33(1): 53–66PubMedCrossRefGoogle Scholar
  2. 2.
    Strickland DL. Challenges in measuring patient outcomes. Nurs Clin North Am 1997; 32(3): 495–512PubMedGoogle Scholar
  3. 3.
    McGuire A. Measuring performance in the health care sector: the hows. In: Andersen TF, Mooney G, editors. The challenges of medical practice variation. London: Macmillan Press Ltd, 1990: 95–116Google Scholar
  4. 4.
    Richards JM, Hemstreet MP. Measures of life quality, role performance, and functional status in asthma research. Am J Respir Crit Care Med 1994; 149 (2 Pt 2): S31–43PubMedGoogle Scholar
  5. 5.
    Weingarten SR, Harris J. Update: clinical outcomes management and measurement. Perspectives in medical management 94. Tampa (FL): American College of Physician Executives, 1994Google Scholar
  6. 6.
    Young GJ, Meterko M, Desai KR. Patient satisfaction with hospital care: effects of demographic and institutional characteristics. Med Care 2000; 38(3): 325–34PubMedCrossRefGoogle Scholar
  7. 7.
    Ford RC, Bach SA, Fottler MD. Methods of measuring patient satisfaction in health care organizations. Health Care Manag Rev 1997; 22(2): 74–89Google Scholar
  8. 8.
    Kane RL, Maciejewski M, Finch M. The relationship of patient satisfaction with care and clinical outcomes. Med Care 1997; 35(7): 714–30PubMedCrossRefGoogle Scholar
  9. 9.
    Sixma HJ, Spreeuwenberg PM, Pasch MA. Patient satisfaction with the general practitoner. Med Care 1998; 36(2): 212–29PubMedCrossRefGoogle Scholar
  10. 10.
    Donabedian A. Evaluating the quality of medical care. Milbank Mem Fund Q 1966; 44(3 Suppl.): 166–206PubMedCrossRefGoogle Scholar
  11. 11.
    Wallin E, Lundgren P, Ulander K, et al. Does age, gender or educational background effect patient satisfaction with short stay surgery? Ambul Surg 2000; 8: 79–88CrossRefGoogle Scholar
  12. 12.
    Cleary PD, Keroy L, Karapanos G, et al. Patient assessment of hospital care. QRB Qual Rev Bull 2000; 15(6): 172–9Google Scholar
  13. 13.
    Fitzpatrick R. Measuring measurement of patient satisfaction. In: Hopkins A, Costain D, editors. The outcomes of medical care. London: Royal College of Physicians, 1990: 19–26Google Scholar
  14. 14.
    Dufrene RL. An evaluation of a patient satisfaction survey: validity and reliability. Eval Program Plann 2000; 23: 293–300CrossRefGoogle Scholar
  15. 15.
    Bernhart MH, Wiadnyana IGP, Wihardjo H, et al. Patient satisfaction in developing countries. Soc Sci Med 1999; 48(8): 989–96PubMedCrossRefGoogle Scholar
  16. 16.
    Colman SS, Brod MI, Krishnamurthy A, et al. Treatment satisfaction, functional status, and health-related quality of life migraine patients treated with almotriptan or Sumatriptan. Clin Ther 2001; 23(1): 127–45PubMedCrossRefGoogle Scholar
  17. 17.
    Kemp JP. Approaches to asthma management; realities and recommendations. Arch Intern Med 1993; 153(7): 805–12PubMedCrossRefGoogle Scholar
  18. 18.
    Blanc PD, Katz PP, Henke J, et al. Pulmonary and allergy subspecialty care in adults with asthma: treatment, use of services, and health outcomes. West J Med 1997; 67(6): 398–407Google Scholar
  19. 19.
    Christian RD. Health resources use and outcomes in patients with asthma [thesis]. Ann Arbor (MI): University of Michigan, 1997Google Scholar
  20. 20.
    Mathias SD, Warren EH, Colwell HH, et al. A new treatment satisfaction measure for asthmatics: a validation study. Qual Life Res 2000; 9(7): 873–82PubMedCrossRefGoogle Scholar
  21. 21.
    Moy ML, Fuhlbrigge AL, Blumenschein K, et al. Association between preferencebased health-related quality of life and asthma severity. Ann Allergy Asthma Immunol 2004; 92(3): 329–34PubMedCrossRefGoogle Scholar
  22. 22.
    Kalyoncu AF. Bronş Astmasi. Ankara: Türkiye Akciger Hastaliklari Vakfi Yayinlari No: 4, 1996Google Scholar
  23. 23.
    Juniper EF, Guyatt GH, Epstein RS, et al. Evaluation of impairment of health related quality of life in asthma: development of a questionnaire for use in clinical trials. Thorax 1992; 47(2): 76–83PubMedCrossRefGoogle Scholar
  24. 24.
    Juniper EF, Guyatt GH, Ferrie PJ, et al. Measuring quality of life in asthma. Am Rev Respir Dis 1993; 147(4): 832–8PubMedGoogle Scholar
  25. 25.
    US Department of Health and Human Services. Practical guide for the diagnosis and management of asthma [online]. Bethesda (MD): National Institutes of Health; 1997 Oct. NIH Publication No. 97-4053. Available from URL: [Accessed 2006 Feb 10]Google Scholar
  26. 26.
    Ware JE, Snyder MK, Wright WR, et al. Defining and measuring patient satisfaction with medical care. Eval Program Plann 1983; 6: 247–63PubMedCrossRefGoogle Scholar
  27. 27.
    Esatoglu AE. Hastanelerde Hasta Tatminin Hastane Yönetimi Açisindan Degerlendirilmesi ve Kullanimina Yönelik Model Önerisi, Yayinlanmamiş Doktora Tezi, H.Ü. Saglik Bilimleri Enstitüsü, Ankara, 1997Google Scholar
  28. 28.
    Carey RG, Scibert JH. A patient survey system to measure quality improvement: questionnaire reliability and validity. Med Care 1993; 33: 834–45CrossRefGoogle Scholar
  29. 29.
    Cleary PD, Keroy L, Karapanos G, et al. Patient assessments of hospital care. QRB Qual Rev Bull 1989; 15(6): 172–9PubMedGoogle Scholar
  30. 30.
    Hall JA, Dornan MC. Meta-analysis of satisfaction with medical care description of research domain and analysis of overall satisfaction levels. Soc Sci Med 1988; 27: 637–44PubMedCrossRefGoogle Scholar
  31. 31.
    Freund DA, Stein J, Hurley R, et al. The Kansas City Asthma Care Project: specialty differences in the cost of treating asthma. Ann Allergy 1988; 60: 3–8PubMedGoogle Scholar
  32. 32.
    Bertakis KD, Callahan EJ, Helms LJ, et al. Physician practice styles and patient outcomes: differences between family practice and general internal medicine. Med Care 1998; 36(6): 879–91PubMedCrossRefGoogle Scholar
  33. 33.
    Jackson JL, Chamberlin J, Kroenke K. Predictors of patient satisfaction. Soc Sci Med 2001; 52: 609–20PubMedCrossRefGoogle Scholar
  34. 34.
    Minnick AF, Roberts MJ, Young WB, et al. What influences patient reports of three aspects of hospital services. Med Care 1997; 35(4): 399–409PubMedCrossRefGoogle Scholar
  35. 35.
    Hall JA, Donran MC. Patient sociodemographic characteristics as predictors of satisfaction with medical care. Soc Sci Med 1990; 6: 811–8CrossRefGoogle Scholar
  36. 36.
    Huang IC, Dominici F, Frangakis C, et al. Is risk-adjustor selection more important than statistical approach for provider profiling? Asthma as an example. Med Decis Making 2005; 25(1): 20–34PubMedCrossRefGoogle Scholar
  37. 37.
    Marple R, Lucey C, Kroenke K, et al. A prospective study of concerns and expectations in patients presenting with common symptoms. Arch Intern Med 1997; 157: 1482–8PubMedCrossRefGoogle Scholar
  38. 38.
    Edlund MJ, Young AS, Kung FY, et al. Does satisfaction reflect the technical quality of mental health care? Health Serv Res 2003; 38(2): 631–45PubMedCrossRefGoogle Scholar
  39. 39.
    Cleary PD, McNeil BJ. Patient satisfaction as an indicator of quality care. Inquiry 1988; 25: 25–36PubMedGoogle Scholar
  40. 40.
    Cleary PD, Edgman-Levitan S, Robertts M, et al. Patients evaluate their hospital care: a national survey. Health Aff 1991; 10: 254–67CrossRefGoogle Scholar
  41. 41.
    Hall JA, Milburn MA, Epstein AM. A causal model of health status and satisfaction with medical care. Med Care 1993; 31(1): 84–94PubMedCrossRefGoogle Scholar
  42. 42.
    Linder-Pelz SU. Toward a theory of patient satisfaction. Soc Sci Med 1982; 16: 577–82PubMedCrossRefGoogle Scholar
  43. 43.
    Sahin B, Tatar M. Factors affecting use of resources for asthma patients. J Med Syst. In pressGoogle Scholar
  44. 44.
    Sox HC, Margulies I, Sox CH. Psychologically mediated effects of diagnostics tests. Ann Intern Med 1981; 95: 680–5PubMedGoogle Scholar
  45. 45.
    Meterko M, Rubin HR. Patient judgments of hospital quality: a taxonomy. Med Care 1990; 28: 10–4CrossRefGoogle Scholar
  46. 46.
    Bell RA, Kratvitz RL, Thom D, et al. Unmet expectations for care and the patientphysician relationship. J Gen Intern Med 2002; 17: 817–24PubMedCrossRefGoogle Scholar
  47. 47.
    Atkinson MJ, Sinha A, Hass SL, et al. Validation of a general measure of treatment satisfaction, the Treatment Satisfaction Questionnaire for Medication (TSQM), using a national panel study of chronic disease. Health Qual Life Outcomes 2004; 2: 1–13CrossRefGoogle Scholar
  48. 48.
    Ahonen A, Leinonen M, Pesonen MR. Patient satisfaction with Easyhaler compared with other inhalation systems in the treatment of asthma: a meta-analysis. Curr Ther Res 2000; 60(2): 61–73Google Scholar
  49. 49.
    Kozma CM, Slaton TL, Monz BU, et al. Development and validation of a patient satisfaction and preference questionnaire for inhalation devices. Treat Respir Med 2005; 4(1): 41–52PubMedCrossRefGoogle Scholar
  50. 50.
    Markson LE, Vollmer WM, Fitterman L, et al. Insight into patient satisfaction with asthma treatment. Arch Intern Med 2001; 161(3): 379–84PubMedCrossRefGoogle Scholar
  51. 51.
    Thapinta D, Anders RL, Wiwatkunupakan S, et al. Assessment of patient satisfaction of mentally ill patients hospitalized in Thailand. Nurs Health Sci 2004; 6: 271–7PubMedCrossRefGoogle Scholar
  52. 52.
    Lessing EE, Beech RP. Use of patient and hospital variables in interpreting patient satisfaction data for performance improvement purposes. Am J Orthopsychiatry 2004; 74: 376–82PubMedCrossRefGoogle Scholar
  53. 53.
    Yancy WS, Macpherson DS, Hanusa BH, et al. Patient satisfaction in resident and attending ambulatory care clinics. j Gen Intern Med 2001; 16: 755–62PubMedCrossRefGoogle Scholar
  54. 54.
    Anderson RM. Revisiting the behavior model and access to medical care: does it matter? J Health Soc Behav 1995; 36: 1–10CrossRefGoogle Scholar
  55. 55.
    Woodring S, Polomano RC, Haagen BF, et al. Development and testing of patient satisfaction measure for inpatient psychiatry care. J Nurs Care Qual 2004; 19: 137–48PubMedCrossRefGoogle Scholar
  56. 56.
    Atkinson M, Zibin S, Chuang H. Characterizing quality of life among patients with chronic mental illness: a critical examination of the self-report methodology. Am J Psychiatry 1997; 154: 99–105PubMedGoogle Scholar
  57. 57.
    Bradburn NM, Rips LJ, Shevell SK. Answering autobiographical questions: the impact of memory and inference on surveys. Science 1987; 236: 157–61PubMedCrossRefGoogle Scholar
  58. 58.
    Otani K, Kurz RS, Harris LE. Managing primary care using patient satisfaction measures. J Healthc Manag 2005; 50: 311–25PubMedGoogle Scholar
  59. 59.
    Woodring S, Polomano RC, Haagen BF, et al. Development and testing of patient satisfaction measure for inpatient psychiatry care. J Nurs Care Qual 2004; 19: 137–48PubMedCrossRefGoogle Scholar
  60. 60.
    Cunningham L. The quality connection in health care: integrating patients satisfaction and risk management. Oxford: Jossey-Bass Publishers, 1991Google Scholar
  61. 61.
    Jatulis DE, Bundek NI, Legorreta AP. Identifying predictors of satisfaction with access to medical care and quality of care. Am J Med Qual 1997; 12: 11–8PubMedCrossRefGoogle Scholar
  62. 62.
    Fontana A, Ford JD, Rosenheck R, et al. A multivariate model of patients’ satisfaction with treatment for posttraumatic stress disorder. J Trauma Stress 2003; 16: 93–106PubMedCrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2006

Authors and Affiliations

  1. 1.School of Health AdministrationHacettepe UniversityAnkaraTurkey

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