HEALTH SYSTEM FACTORS INFLUENCING CLIENT SATISFACTION WITH ANTIRETROVIRAL THERAPY SERVICES IN PRIVATE HEALTH FACILITIES

(A CASE STUDY OF ABUJA, FCT)

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Author

Presented To

Department of Medicine

ABSTRACT
Patient satisfaction is a personal evaluation of health care services provision. Clients who are not satisfied with health service may have worse outcomes. The potential number of people eligible for ART is set to increase in low and middle income countries and the private health sector has the capacity to meet this need. This study was conducted to determine which health system factors influence the clients’ satisfaction with ART services in private health facilities. From April to July 2015, a cross-sectional study design was used to collect data in F.C.T via quantitative methods. Client characteristics and health system factors associated with patient satisfaction was analyzed using Epi-info 7 and SPSS 18. A total of 313 clients were interviewed. Clients’ mean age was 35±7 years. Females were 64.9%, 56.2% were married, 19.7% earned less than 18000 naira and 23% earned 70000 naira or more monthly. About 2.2% of them were uneducated while 54.3% had up to tertiary level education. Half lived less than one hour from the health facility. Fifty-two percent had been on ART for 5 years or more and 53% had conducted at least two CD4 tests in the past year. The proportions of clients receiving financial support and in a support group were 5.8% and 14% respectively. About one-third of the clients chose a private facility because the staff was discrete about their ART intake. Two hundred and fifty-nine (82.7%) were satisfied overall with services. Majority (65%) of the health facilities were situated in urban wards. Twelve (60%) had at least one adherence counsellor and in 70% of the facilities, healthcare providers spent more than 10 hours in the ART clinic. Seventy-five percent collected clients’ opinions on ART services and 85% has had supervisory visits. In 70% of the clinics, CD4 monitoring was conducted and all stocked Highly Active Antiretrovirals (HAART). Being in a hospital that had at least one adherence counsellor (O.R.=3.2,p=0.000), that had commenced ART services at least 5 years ago (O.R.=3.3,p=0.000), that was located outside Abuja municipal(O.R.=3.8,p=0.000), where at least ten hours was spent in ART clinic per week(O.R.=2.8,p=0.003)and being on ART for at least 5 years (O.R.=2.4, p<0.01) were associated with patient satisfaction with ART services. Also, clients in private hospitals that worked with community ART health workers (O.R.= 3.3, p=0.000), where either suggestion box or survey (O.R.=5.5, p=0.01) was used to collect patients’ opinions and in clinics where supervisors trained staff (O.R.=5.5, p=0.01) or collected data(O.R.=2.8, p=0.003) during visits, were satisfied with services. Clients that received cotrimoxazole prophylaxis (O.R.= 2.0, p=0.020), who had received financial support(O.R.= 4.3, p=0.005), that were in a support group(O.R.= 2.3, p=0.021) and in health facilities that referred patients(O.R.= 4.4, p=0.006) were dissatisfied with services. Following modelling; not receiving financial support, commencing antiretroviral therapy 5 years ago or more and being in a health facility that did not refer clients were predictors of patient satisfaction. Involvement of ART clients in their care and increasing human resources in ART clinic can potentially improve patient satisfaction and impact retention in care. Private hospitals should improve the comprehensiveness of the ART services rendered.