A Multilevel Model on the Factors Affecting Quality of Health Service and Patient Satisfaction at Community Health Centers in North Lampung, Sumatera

Abstract

Background: WHO defined quality of care as the extent to which health care services provided to individuals and patient populations improve desired health outcomes. To achieve this, health care must be safe, effective, timely, efficient, equitable and people-centred. Assessing the quality of health service and patient satisfaction are an important for continuous improvement of health services. Positive feedback from the customer leads to the goodwill of service providers in the market, which indirectly expands their business, whereas negative feedback makes it shrink. This study aimed to examine the factors affecting quality of health service and patient satisfaction in community health centers in North Lampung, Sumatera, Indonesia. Subjects and Method: This was a cross-sectional study conducted at 25 community health centers in North Lampung, Sumatera, in January 2017. A total sample of 200 out-patients was selected for this study by simple random sampling, and stratified random sampling for community health center. The dependent variables were quality of service and patient satisfaction. The independent variables were education, income, frequency of visit, and accreditation status of community health center. Contextual effect was measured by accreditation status of community health center. The data were collected by questionnaire and analyzed by linear regression multilevel model. Results: Factors affecting quality of health service were income (b= -1.09, 95% CI= -5.71 to 3.52, p= 0.641), education (b= -11.48, 95% CI= -16.07 to -6.88, p< 0.001), and frequency of visits (b= 6.88, 95% CI= 2.53 to 11.23, p= 0.002).Intraclass correlation= 6%. Factors affecting patient satisfaction were income (b= -1.07, 95% CI= -1.58 to -0.56, p< 0.001), education (b= -0.77, 95% CI= -1.31 to -0.23, p= 0.005), frequency of visits (b= 0.88, 95% CI= 0.39 to 1.38, p< 0.001), and quality of service (b= 0.04, 95% CI= 0.02 to 0.06, p< 0.001). Intraclass correlation= 13.79% indicating considerable contextual effect of accreditation status of community health center. Conclusion: Quality of service is affected by income, education, and frequency of visits in community health center. Patient satisfaction is affected by income, education, frequency of visits, and quality of service. Accreditation status of community health center has a considerable contextual effect on patient satisfaction. Keywords: quality of service, patient satisfaction, accreditation status, community health center, multilevel analysi