Editorial |
Patient satisfaction with medication: a challenge for primary health care
Department of Social Medicine, Faculty of Medicine, University of Crete, PO Box 2208, Heraklion 71 003, Crete, Greece
Correspondence to C. Lionis; Email: lionis{at}med.uoc.gr
Good prescribing is a key issue in modern health-care systems: physicians and patients are concerned about outcomes, albeit from different perspectives, funding agencies are worried about costs and benefits and the pharmaceutical industry is interested in sales and customer satisfaction. Of all these, most research has gone into patient compliance and satisfaction. The theoretical basis of much of this research in recent literature is found in the theory of planned behaviour, an extension of the Theory of Reasoned Action that attempts to explain behaviour regarding medication in terms of beliefs about outcomes and the evaluation of these outcomes.1,2 Furthermore, satisfaction with medication is related to broader issues, mainly to satisfaction with the services provided by the physician and the physician–patient relationship, and to considerations about health-care delivery, accessibility and costs.2
Starting from specific sections of the World Health Organization's questionnaire on responsiveness of the health-care system,3 supplemented with questions related to treatment, Geitona et al.4 studied patient satisfaction with medication in Greece. They report that respondents were in general satisfied with all aspects of medication use examined except for costs. However, wide variations were observed in the levels of satisfaction between subgroups of respondents.
The Greek study does not give us any information about the patients' expectations from their medication or about the opinion of the physicians regarding their patients' expectations, both of which seem to be strong determinants of prescribing.5 Also, prescribing practices maybe influenced by conflicting interests, unrelated to scientific evidence.6 Other important determinants of patient satisfaction with medication are the doctor–patient relationship, patient choice and health status.7 The doctor–patient relationship is of special interest to primary health care (PHC), since a long-standing relationship with a particular physician strongly affects satisfaction. In some situations, this practitioner is the GP, while in others it may be a specialist who is the ‘personal physician’.8 Patient choice refers to choice of physician and health-care provider, maybe also of medication. Although the advocates of the gatekeeper function support its usefulness as a point of first contact, it seems that patients are more satisfied in situations where choice of provider includes specialists.9 As for health status, patients with worse health are usually less satisfied with medication.7 These considerations may constitute the hidden or unexplored background against which specific research results should be interpreted.
In order to better understand the results of the Greek study, one has to consider how health care, and especially PHC, is delivered in Greece.10 Health care developed based on traditional Bismarck type public health insurance funds. The main insurers are as follows: IKA, that covers employees in the private sector and provides PHC through specialist doctors in polyclinics; OGA, that covers farmers and provides PHC though a network of Health Centres in rural areas, staffed by GPs; OPAD, covering civil servants, TAE, covering the self employed, and several more schemes covering specific professional groups, all of which work with contracted private practitioners on a fee-for-service basis. In the 1980s, Greece introduced legislation to establish a Beveridge-style National Health System. However, the reform was only partially implemented and the attempt to create an integrated PHC service in towns was abandoned. Thus, it is of interest that in the paper by Geitona et al., patients insured with IKA and OGA (who do not have a choice of first contact provider) and those living in urban areas, where continuity of care is lacking, report less satisfaction with medication. On the other hand, rural residents report increased satisfaction, although they are mostly insured with OGA. Finally, at the time of the study, choice of prescription was limited through a list system, partly explaining the out-of-pocket payments and dissatisfaction with costs. On the other hand, overall high levels of satisfaction with PHC services were reported in another Greek study11 and it has been recognized that ‘a striking feature in the Greek primary care is the communication between practitioner and patient'.12
The study by Geitona et al.4 should also be seen in the context of the increased research carried out in Greece in PHC and in GP/FM in recent years. For example, there is empirical evidence from rural Crete that the bulk of the work of rural Health Centres is devoted to repeat prescriptions, often through a third person, usually a family member or a friend.13 This custom and the dispensation of drugs over-the-counter encourage overuse of medication, as evidenced by the high proportion of outpatient antibiotic consumption in Greece.14,15 On the other hand, it is worth noting that in the UK, expanded prescribing powers were announced in 2006, aiming at seeing ‘patients having quicker access to their medicines and more choice in how they obtain them’ (http://www.medicalnewstoday.com).
The relevance of similar studies for PHC is that patients have expectations from the health delivery system from their physician and from their medications. GPs should respond by discussing with their patients about their medications.16 Therein lies one more challenge for PHC.
Declaration
Funding: None.
Ethical approval: None.
Conflicts of interest: None.
Notes
Lionis C and Philalithis A. Patient satisfaction with medication: a challenge for primary health care. Family Practice 2007; 25: 319–320.
References
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