Patient Satisfaction: What’s the point?

Let’s have a little fun and compare The Cost of Satisfaction: A National Study of Patient Satisfaction, Health Care Utilization, Expenditures, and Mortality vs. A National Survey of Nurse Practitioners’ Patient Satisfaction Outcomes

Look at these results:

“Findings from a new research study led by Thomas Kippenbrock, a nursing professor at the University of Arkansas, suggest that patients are just as satisfied – or even happier — with care from nurse practitioners as compared with doctors.”1

as compared to:

“In a nationally representative sample, higher patient satisfaction was associated with less emergency department use but with greater inpatient use, higher overall health care and prescription drug expenditures, and increased mortality.”2

            Whereby the first referenced study measured satisfaction in and of itself, the second study measured associated corollary parameters as they relate to patient satisfaction. Maybe they both have their place in the realm of scientific data, however caution must be imparted to look deeper and more critically in order for you as a reader to draw your own conclusions. A news articleseemingly biased highlighted the first study referenced stating:

“Currently, nurse practitioners are helping to fill a gap in providing primary care across the country and especially in the rural communities, which is why it’s important to determine patients’ satisfaction rate.”1

            This is where I have an issue on the writing on the topic. You can already see the bias being set up. The inference here attempting to be made in my opinion is that “NP’s have high satisfaction they therefore must be allowed full practice authority and to fill the primary care physician shortage gap.” The news article concluded: “we believe patients are highly satisfied with a nurse practitioners’ primary care services.”Which is good, but it doesn’t specify as to if these are NP’s with physician collaboration or supervision or with full practice authority. The actual study has an interesting conclusion of:

“Recognizing the factors associated with patient satisfaction with their providers can lead to improvements in patient-provider interactions that can result in increased quality of care.”3

            Interesting because the 2ndstudy referenced here actually had corollary factors associated with patient satisfaction and the outcome wasn’t favorable as there was a negative correlation with things such as “inpatient use, higher overall health care and prescription drug expenditures, and increased mortality.”2Thus is seems that as patient satisfaction goes up, the quality of care goes down which could amount to a null hypothesis in the 1streferenced study. The two studies seem to overlap at least whereby one mentions associated factors and the other actually measured them. 

            The findings in the first study: 

“In the sample, MD providers were disproportionately represented in greater number than NP, DO, or PA. Further analysis comparing patient experiences between providers revealed NP to be rated significantly higher than their colleagues.”3

            The finding in the second study:

“Adjusting for socio-demographics, insurance status, availability of a usual source of care, chronic disease burden, health status, and year 1 utilization and expenditures, respondents in the highest patient satisfaction quartile (relative to the lowest patient satisfaction quartile) had lower odds of any emergency department visit (adjusted odds ratio [aOR], 0.92; 95% CI, 0.84-1.00), higher odds of any inpatient admission (aOR, 1.12; 95% CI, 1.02-1.23), 8.8% (95% CI, 1.6%-16.6%) greater total expenditures, 9.1% (95% CI, 2.3%-16.4%) greater prescription drug expenditures, and higher mortality (adjusted hazard ratio, 1.26; 95% CI, 1.05-1.53).”2

            While these 2 studies have overlap in terms of patient satisfaction, one deals with satisfaction in and of itself, and the other with correlation factors associated with patient satisfaction, they are fundamentally different and as such, one cannot not discount the other. If it is beneficial for NPs to have patient satisfaction, this can only be a good thing. But you must keep in mond the 2ndstudy which itself and in the literature review documents negative correlation for a variety of reasons. If the results of the first study are used to try to justify full practice authority or an argument as to why NPs should fill the primary care physician shortage, then this is a wrong use of it’s conclusions and the conclusions don’t support it. Regarding the 2ndstudy, the determinants of patient satisfaction seemed somewhat surprising and this would be good data to try to replicate for consistency. The study literature review did acknowledge the suspicion in the study that there would be similar negative correlation with health outcomes and patient satisfaction:

“Satisfied patients are more adherent to physician recommendations and more loyal to physicians,but research suggests a tenuous link between patient satisfaction and health care quality and outcomes.”2

Thus the purpose of the study:

“The associations among patient satisfaction, health care intensity, and outcomes have not been studied within a national sample that includes adults of all ages. Therefore, we used Medical Expenditure Panel Survey (MEPS) data to assess the relationship between patient satisfaction and health care utilization, expenditures, and mortality in a nationally representative sample.”2

            All in all, caution must be applied when using patient satisfaction as a determinant of quality care. 

REFERENCES

  1. https://news.uark.edu/articles/48307/as-nurse-practitioners-fill-the-gap-patients-say-they-re-more-than-satisfied-with-care
  2. https://www.researchgate.net/publication/221830192
  3. https://www.sciencedirect.com/science/article/abs/pii/S0029655419300764

Robert Duprey MD

Robert P. Duprey Jr studied medicine as a 2nd career medical student who went to medical school in his 40’s after honorable discharge and ‘retirement’ from 25 years in the US Military (USCG & US Army). He was a registered nurse (RN) with specialty training as a psychiatric RN in the US Army for 15 years. During this time he also became a Master’s level psychotherapist in 2002. While on US Army active duty he also became a Psychiatric Nurse Practitioner while working full time in 2011. He served as a Psych NP on active duty, to include a combat tour in Iraq, until his ‘retirement’ in 2014 and moved to Philippines with his 3 children. At this time he started medical school overseas at Oceania University of Medicine based out of Samoa accredited by Philippine Accrediting Association of Schools, Colleges and Universities (PAASCU). He continued to work as a Psych NP throughout medical school to support his children and to not have to take out loans for medical school tuition. Originally from Rhode Island, he completed medical school clerkship rotations throughout the USA with a graduation in May 2019 earning the esteemed credential of MD. He has successfully completed USMLE Steps 1, 2CS, and 2CK. He will take Step 3 this September as he applies for Psychiatry Residency. Having been and RN, NP and now MD, he is a believer of Physician led multidisciplinary healthcare teams 

  4 comments for “Patient Satisfaction: What’s the point?

  1. RSW
    June 12, 2019 at 12:38 pm

    “Patient Satisfaction: What’s the point?”

    That’s an easy one: to reduce physician pay.

  2. Pat
    June 12, 2019 at 8:58 am

    1. “Currently, nurse practitioners are helping to fill a gap in providing primary care across the country and especially in the rural communities, which is why it’s important to determine patients’ satisfaction rate.” This is gibberish.
    2. “…revealed NP to be rated significantly higher than their colleagues.” What, other NP’s? NP’s are certainly not MY colleagues.

  3. Steve O'
    June 12, 2019 at 8:04 am

    As the American medical industry blindly gropes towards solutions of its own cause, innovation and change are two magical principles which are mythically trusted to produce miraculous answers. The entire canon of the Commercial Retail Business model is faithfully applied to appeal to the gods to make rain; but no rain is made, thus the gods must be angry.
    One tenet of this model is customer satisfaction at the point of sale. Since the goods are all that matter, the model demands an effective and rapid execution of sale. The customer, of course, is not to be skilled in the evaluation of the product itself; that is what advertising is for. The focus of customer “control” over the transaction is how satisfied the customer feels when he/she leaves the point of sale.
    Unfortunately, there is nothing about this approach that allows one to recognize or criticize Quack Medicine. Quacks have some of the highest satisfaction ratings. Their customers are aggressive in defending the quack against any attacks on their miracle snake oil.
    The only apparent solution is to delicense the practice of medicine, and let the most successful prevail. Unfortunately, the field will again prevail with hucksters and charlatans, as was in the 1800’s. Perhaps that’s the best we can do.

    • Pat
      June 12, 2019 at 2:33 pm

      Your ending would be preferable to what we have now.

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