[A satisfied patient--a good doc? To what extent is patient satisfaction an indicator of quality in general practice? A systematic review]

Abstract

Background: "How can I find a good doctor?" is one of the most frequent requests patients' help desks receive. The aim of the present study is to appraise whether current available patient satisfaction surveys reflect the quality of ambulatory care from the patients' perspective, and whether this information can be used to choose an adequate care facility.

Method: Systematic literature searches and critical appraisal of validated German instruments for the evaluation of patient satisfaction in ambulatory care were conducted.

Results: Four instruments were evaluated (ZAP; EUROPEP, Qualiskope-A, GEB/QP-Qualitätspraxen). For each instrument, multistage development processes are reported. The instruments are intended to survey patient satisfaction in terms of subjective process-related aspects of ambulatory care. Constructs of satisfaction and items used in the instruments differ substantially. External criteria that are necessary to evaluate the quality of care have not been considered. Data about the availability and quality of patient information have not been retrieved. Patient participation in decision-making has been assessed in a subjective manner. Individual expectations and patient preferences are only accounted for by GEB/QP-Qualitätspraxen. Controlled trials proving the efficacy of the instruments were not identified. It remains unclear whether the use of these instruments has beneficial or adverse effects.

Conclusion: Patient satisfaction is an aspect of ambulatory care. However, quality of ambulatory care is not reflected by patient satisfaction alone. Evidence-based information is decisive for the patient's judgement of the quality of medical care. The instruments analysed cannot be used to answer the question: "Is this a good doctor?", unless they consider the availability of adequate patient information.