Mod Care J. In Press(In Press):e67215. doi: 10.5812/modernc.67215. Published online 2018 January 27. Research Article Evaluating Satisfaction Among Recipients of Family Physician Services in Birjand and Khusf, Iran Mohammad Ghasemi,1 Marziye Hadian,1 Hadis Sotoudeh Gagasari,2 and Hakimeh Malaki Moghadam3,* 1Health Care Management, Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran 2Iran University of Medical Sciences, Tehran, Iran 3Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran *Corresponding author: Hakimeh Malaki Moghadam, Social Determination of Health Research Center, Birjand University of Medical Sciences, Birjand, South Khorasan, Iran. Tel: +98-9162607320, E-mail: [email protected] Received 2017 December 12; Accepted 2018 January 25. Abstract Background: Health and security are among primary rights of each society, whose securement falls upon the government. The family physician is responsible for providing comprehensive and high-quality services according to the necessities of the population in order to maintain and promote physical and mental health. The purpose of the present study was to evaluate the satisfaction of the recipients of the family physician services provided throughout the cities of Birjand and Khusf, Iran. Methods: For the purpose of this cross-sectional study, 218 service recipients were randomly selected from 12 health centers of Bir- jand and Khusf using an appropriate allocation method, and standard questionnaires were distributed amongst the individuals. The data were analyzed using multiple analysis of variance (multiple ANOVA), t-tests (or Mann-Whitney tests), and ANOVA (Kruskal- Wallis) with an error coeffection of 5% through the application of the SPSS (v. 18) software. Results: Males made up 38.2% of the study samples, and 77.2% were residents of rural regions with health centers. The overall con- sent score with the family physician services provided was 3.58 ± 0.66 (out of 5). The results of multiple ANOVA indicated that gender, age, and residency in rural areas with health centers had significant effects on the overall satisfaction of the service recipients. Conclusions: The recipients of the family physician services were, in general, satisfied with the offered services of the program. However, the program requires further quality improvements with regards to the facilities and the effectiveness of services. Keywords: Family Physician, Satisfaction, Service Recipients 1. Background tempts to create and improve national referral systems, in- crease responsiveness in health markets, increase access to Health and security are among the primary rights of health services, reduce unwanted and unnecessary costs, a society, whose securement falls on the government. In and increase service coverage. The family physician is re- accordance with the fourth national economical-social- sponsible for providing health services for the entire so- cultural development plan, all the necessary arrange- ciety in accordance with defined limitations and without ments for the family physician-based health insurance and any prejudice towards age, gender, financial-social traits, referral system must be provided by the end of this pro- and disease risk (5). The family physician program in Iran gram (1). was first piloted in the Fars and Mazandaran provinces. Nowadays, family physicians in various countries, such However, the program was not fully carried out due to fi- as North America, Western Europe, and Canada, are re- nancial crisis in the country (6). Also, the program’s cover- sponsible for the provision of health services with the help age in Shiraz increased from 23% to 84% during a 7-month of health teams. The national health systems in Britain, period (7). Overall, the satisfaction levels with the pro- Canada, South Korea, and Chili are based on the referral gram in urban and rural regions of Shiraz were 54.5% and system level and family physicians (2,3). Family physi- 69.2%, respectively (8). Moreover, 76.41% of the study sub- cians provide all sorts of services including preventive, ed- jects from the Markazi province were content with the fam- ucational, promotional, and managerial services related to ily physician program (9). The family physician program health at medical centers (4). The family physician pro- resulted in decreased mortality of infants and children gram, based on family physicians and referral systems, at- throughout Iran (10). Copyright © 2018, Modern Care Journal. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited Ghasemi M et al. Today, most organizations seek to improve customer 2. Methods satisfaction and, consequently, their own durability, through the evaluation of their services and by selecting For the present cross-sectional analytical descriptive customer satisfaction as a key index (11). The ultimate study, 218 service recipients of the family physician pro- objective of quality evaluation is to promote the outcome grams in Khusf and Birjand, during year 2015, were se- and effectiveness of various programs, or in other words, lected as the study population. The precise number of sub- the promotion of service quality and health care (12). jects needed (218) was attained by considering a standard The simplest way one can evaluate the family physician’s deviation of 0.97 for the satisfaction score, according to a services is by evaluating the satisfaction of the service study conducted by Ahmadi Kashkoli et al. (23) wherein an recipients (13). In today’s world, the issue of customers has error rate of 5% and precision of 0.13 resulted in a study found a significantly important stand in case of health- population of 218 individuals. Considering that the pro- care and medical services. The reason for this is that a gram took place at health centers in the rural regions of customer’s inclination or unwillingness towards a service cities with populations of more than 20,000 and all the can significantly influence the permanence of the service health centers of both the urban and rural regions of cities provider organization (14). The evaluation of patient satis- with populations of less than 20,000, the study subjects faction can be looked at as a tool for assessing the quality were selected from 12 rural health centers in Birjand and of healthcare services (15). A survey by Doyle consisting of Khusf. The selection procedure was as follows, questioners 55 reviews indicated patient satisfaction as a significant initially referred to health centers on the 5th of November index in evaluating the quality of service (16). from 8 AM to 1 PM, and questionnaires were filled accord- ing to that day’s referrals per quota of each center’s popula- tion coverage using simple non-statistical sampling (Table Therefore, it was concluded that customer satisfaction, 1). which in the case of family physician services involves the satisfaction of service recipients regarding various services Table 1. Samples Selected from the Family Physician Health Centers of Birjand and provided by the family physician team, is a significant fac- Khusf tor contributing to the increased performance of the team. Evaluating the amount of satisfaction is, therefore, a ma- City Health Population Number of jor index in the development and growth of healthcare ser- Center Covered Selected Samples vices. Studies have indicated the effectiveness of patient Amirabad 17000 63 satisfaction in the amelioration of health services (17-20). Shakhan 5000 18 The study results have shown that patient satisfaction in Gazar 4000 15 return causes patients to refer other individuals, including Birjand khong 4000 15 friends and other patients in need of service to the same service provider hospitals or health centers (21). Out of 378 Marak 3000 11 studies conducted on the relationship between patient ex- Khorashad 2200 8 perience and outcome of treatment, 312 studies confirmed Ghyuk 2500 9 a positive relationship between the 2 parameters (16). Also, Urban center 10000 37 a study on the population of Jiroft indicated that 66% of pa- Majan 4500 17 tients refused to return to the same doctor due to a lack of knowledge on the part of the family physician (22). Khousf Taghab 3500 13 Khour 1700 6 Gol 1800 6 Despite the importance of quality of service and cus- tomer satisfaction, and the significance of their evalua- Total 59200 218 tion in improving health services, and considering that the family physician project in Iran was launched in 2005, The applied questionnaire was designed by Alibabaei studies evaluating the quality of service and customer sat- et al. (24) and had 51 questions with 8 categories, includ- isfaction among the population are still limited. The lack ing quality (4 questions), performance (6 questions), effec- of such studies may result in potential problems in the tiveness (7 questions), accessibility (13 questions), timeli- implementation of this program. Thus, the present study ness (5 questions), applicability (4 questions), stability (5 sought to investigate customer satisfaction alongside the questions), and facilities (7 questions). The questions were assessment and identification of current issues in the area scored according to the Likert scale from strongly disagree of health. to strongly agree. The overall score for each category was 2 Mod Care J. In Press(In Press):e67215. Ghasemi M et al. computed by averaging the scores of each category. Con- Table 2. Frequency Distribution for Demographic Characteristics and Satisfaction sequently, the overall score for each category and the total with the Family Physician Program Amongst Service Recipient score of the questionnaire was from 1 to 5. The question- naire has been justified by the opinion of 12 experts. Cron- Variable No. (%) bach’s alpha coefficient for the Ali Babayi study was com- Gender puted as 0.938, indicative of its reliability (24).