The association of clinical outcomes with patient satisfaction: A cross sectional study of patients with long term conditions
About a third of the UK population have at least on long term condition (LTC) and account for 50% of primary care appointments. Two important domains of quality in the management of patients with LTCs are optimising the achievement of clinical indicators and maximising patient experience. Patient experience is thought to promote improvements in clinical effectiveness primarily via improved communication and we hypothesise that patient satisfaction is likely to be an important factor in the overall achievement of intermediate clinical outcomes. No previous studies have explored patient experience in a national cohort of patients with LTCs and any possible effect on clinical outcomes. By understanding which aspects of patient experience are more closely associated with in the achievement of intermediate clinical outcomes we can better align health care interventions with patients’ needs.
We obtained LTC data from the QOF dataset 2013/2014 (7921 practices) and patient experience data from the 2013 GP Patient Survey (GPPS) results (903,357 responses, response rate 34%). We analysed six clinical outcome measures covering three LTCs: diabetes, hypertension and coronary heart disease (HbA1c, blood pressure, cholesterol), and the following GPPS domains to measure patient experience in LTC: communication, access, continuity of care and overall experience. Data were analysed using multi-level multiple linear regression models.
The communication and overall satisfaction domains of the GPPS displayed the strongest associations between intermediate clinical outcomes and LTC patient survey scores (Receptionist Communication regression coefficient B, 0.16 , Doctor Communication 0.18, Nurse Communication 0.14 and Overall Satisfaction 0.17). Weaker correlations were seen in the access domain and continuity of care (based on a single GPPS question) showed no significant association with quality of care.
Interpersonal aspects of care appear to have a stronger association with achievement of clinical outcomes in patients with LTCs, whereas access to appointments does not appear to be so strongly associated. Our study is the first to link LTC outcomes with estimates of patient satisfaction derived exclusively from patients with LTCs. For methodological reasons, we were unable to select satisfaction scores exclusively from those patients with one of the three LTCs included in our study; the GPPS data included patients with any one of 15 LTCs. Previous research studying the association between clinical outcomes and patient experience included satisfaction scores of patients both with and without LTCs and demonstrated a stronger association for patient access, which may have been attributable to the scores elicited from patients without LTCs (62.8% of GPPS respondents reported they had at least one LTC) Our findings demonstrate the relative importance of communication as a determinant of clinical outcomes in LTCs in comparison with other domains of patient satisfaction, although none of the satisfaction domains elicited from the GPPS was strongly associated with clinical outcomes.