Improving patient satisfaction in Philippine Primary Care through patient-centered services
By Carla Marie L. Asis, Leonila F. Dans and Josephine T. Sanchez
SUMMARY
Patient satisfaction is a vital factor influencing health outcomes and the quality of healthcare services. Satisfied patients are more likely to engage positively with the healthcare system, leading to better compliance, continuity of care, and overall health results. As such, enhancing patient satisfaction has become a key focus in the restructuring of healthcare systems worldwide. In its efforts to improve primary healthcare delivery in the Philippines, the Philippine Primary Care Studies (PPCS) conducted a study to assess the impact of primary care strengthening interventions on patient satisfaction across urban, rural, and remote sites. The findings reveal significant disparities in the effectiveness of these interventions, highlighting the need for context-specific strategies to ensure equitable access to quality healthcare. Specific recommendations tailored to address the challenges faced by different geographic areas are outlined in this policy brief.
============================================
PATIENT-CENTERED SERVICE IN PRIMARY CARE
Providing patient-centered services is a fundamental characteristic of effective health service delivery and a crucial building block of robust health systems. This enables individuals to view health services as responsive and tailored to their needs. Moreover, it fosters active participation from the target population in designing and assessing these services, empowering people to become partners in their own healthcare journey. This collaborative approach not only enhances the overall experience but also improves health outcomes by ensuring that services align with patients’ preferences and values.
Patient-reported experiences is one of the ways by which patient centeredness and satisfaction – the ability of the health system to meet non-medical and non-financial expectations – are measured. These data serve as a valuable complement to standard disease-specific measures allowing health workers and leaders the opportunity to deliver more impactful quality improvement initiatives.
The Philippine government enacted the Universal Healthcare Law to improve primary care, increase accessibility, and promote equitable healthcare for its citizens. Patient satisfaction—how individuals perceive the usefulness, effectiveness, and benefits of their healthcare—is a vital indicator of progress in health service delivery and utilization. However, experiences with the healthcare system differ among patients in various geographic areas. The success of new healthcare interventions may vary based on the context, highlighting the importance of adopting context-specific interventions and sustained efforts to achieve equitable and patient-centered care in diverse geographical settings.
PATIENT SATISFACTION IN PHILIPPINE PRIMARY CARE
The PPCS implemented interventions to strengthen primary care in urban (University of the Philippines Health Service, Diliman), rural (Municipality of Samal, Province of Bataan), and remote (Municipality of Bulusan, Province of Sorsogon) pilot sites in the Philippines. These interventions focused on health financing, health information systems, health worker training, and community engagement. A study was conducted to evaluate patient satisfaction levels at these sites before and one year after the implementation of the primary care interventions. The following are the key findings:
- Urban site: The urban site showed the greatest increase in patient satisfaction across most domains (healthcare availability, service efficiency, technical competency, and health communication). This was attributed to improvements in health information systems (electronic health records, EHR), increased healthcare worker training, and expanded healthcare networks.
- Rural site: The rural site also saw improvements, particularly in service efficiency, environment, location, health communication, and handling. This was linked to the introduction of an EHR system and healthcare worker However, satisfaction decreased in some areas (contacting physicians during office hours, waiting times), potentially due to increased patient load and unfamiliarity with new physicians.
- Remote site: The remote site experienced the least improvement and some decreases in satisfaction, likely due to persistent challenges with internet connectivity hindering EHR system
implementation and impacting service delivery. Challenges with access to healthcare providers and resources also persisted.
TOWARDS RESPONSIVE AND ACCEPTABLE PATIENT SERVICES
| POLICY IMPLICATIONS | RECOMMENDATIONS |
| ● Invest in infrastructure | Improve internet connectivity in remote areas to ensure effective EHR implementation and improve service delivery. Invest in transportation and well-equipped healthcare facilities. |
| ● Strengthen workforce | Increase the number of healthcare professionals, particularly in rural and remote areas while providing adequate support to encompass (1) ongoing training, including access and effective use of clinical decision support tools, (2) continuous supervision, (3) appropriate compensation and benefits, and (4) professional development opportunities. |
| ● Address resource disparities | Implement targeted strategies to address the specific needs and challenges of different geographical settings, acknowledging the “inverse equity hypothesis” where well- resourced areas readily adapt interventions while underserved areas experience delays. Rural and remote areas require more sustained, context-specific strategies that focus on resource allocation, infrastructure development, and digital connectivity. |
| ● Monitor and evaluate | Conduct regular monitoring and evaluation of primary care interventions to track patient satisfaction and identify areas for improvement. |
| ● Engage the community | Foster strong partnerships and collaboration with local communities to ensure interventions are culturally appropriate and address the specific needs of the population.
Enhance communication to manage expectations and build trust in primary care systems. |
THE PATH FORWARD
Providing patient-centered care in our setting requires an approach that considers the unique needs of diverse communities. Prioritizing targeted interventions, improving healthcare infrastructure and workforce capacity, and fostering strong community partnerships are vital steps towards ensuring equitable access to high-quality primary care and improving patient satisfaction. Continuous monitoring and evaluation of interventions are essential to ensure effectiveness and to facilitate changes as needed. Further research should explore the most impactful strategies to address specific challenges in underserved areas.
=========================================
Citations
Al-Abri, R., & Al-Balushi, A. (2014). Patient satisfaction survey as a tool towards quality improvement. Oman medical journal, 29(1), 3–7. https://doi.org/10.5001/omj.2014.02
Panganiban, J. M. S., Loreche, A. M., De Mesa, R. Y. H., Camiling-Alfonso, R., Fabian, N. M. C., Dans, L. F., Galingana, C. L. T., Lopez, J. F. E., Casile, R. U., Aquino, M. R. N., Rey, M. P., Sanchez, J. T.,
Javelosa, M. A. U., Tan-Lim, C. S. C., Marfori, J. R. A., Paterno, R. P., & Dans, A. L. (2024). Promoting equitable and patient-centred care: an analysis of patient satisfaction in urban, rural and remote primary care sites in the Philippines. BMJ open quality, 13(1), e002483. https://doi.org/10.1136/bmjoq-2023-002483
Web Annex. Technical specifications. In: Primary health care measurement framework and indicators: monitoring health systems through a primary health care lens. Geneva: World Health Organization and the United Nations Children’s Fund (UNICEF), 2022. Licence: CC BY-NC-SA 3.0 IGO.