Evidence
Thirty-one observational studies were identified that examined the relationship between health status and satisfaction. The majority involved large numbers of participants in varied settings.
A range of methods was used by the investigators.
The main features and findings of these studies are summarised in Table 19 in alphabetical order of first author.
There is evidence that poorer physical health status,194,201,222–227disability,228low quality of life,217 and psychological distress229–231are associated with lower levels of reported satisfaction. One study showed that the existence of a long-term health problem (in contrast to acute distress and pain) did not affect satisfaction in general practice,225 although there is evidence that patients’
preferences vary according to their health status.232 Another study of satisfaction with medical care in
42 TABLE 19 Summary of studies investigating the relationship between health status and satisfaction ReferenceCountryContextNo.responsesMethodMain findings SettingDesign Al Bashir and UKEmpirical760InterviewPreferences about specific aspects of care (e.g.regular check-ups,second 232 Armstrong,1991General practiceObservationalopinions,doctor characteristics) varied with health status of respondent Annandale and UKEmpirical985InterviewReporting disagreements about treatment associated with having a long-standing 222 Hunt,1998Healthcare in generalObservationalillness,and worrying more about own or family’s health 234 Berkatis et al.,1991USA,CanadaEmpirical550Questionnaire in clinicHealth status had no effect on satisfaction with interpersonal skills Primary careObservational 241 Carmel,1985IsraelEmpirical476InterviewPerceived improvement in health status was important prediction of satisfaction In hospitalObservational 238 Cleary et al.,1989USAEmpirical598MailPerceived health positively correlated with satisfaction In hospitalObservational 239 Cleary et al.,1991USAEmpirical1,713InterviewSicker patients reported more problems In hospitalObservationalHealth status was strongest independent predictor of problems with care 237 Cleary et al.,1992USAEmpirical645TelephoneWorse health associated with lower satisfaction In hospitalObservational 223 Cohen,1996UKEmpirical2,569MailPoorer health associated with dissatisfaction Hospital,inpatient/Observational outpatient Covinsky et al.,USAEmpirical445InterviewSatisfaction related to health status on discharge,not to changes in health status 242 1998In hospitalObservationalbetween admission and discharge Esteban De la Rosa SpainEmpirical2,483InterviewNo relation between perceived health and reported satisfaction 235 et al.,1994Healthcare in generalObservational Fitzpatrick and UKEmpirical95InterviewDissatisfaction with consultation related to longer history of problem (migraine) 244 Hopkins,1981Hospital outpatientObservationaland associated with less symptom improvement 1 year after consultation Fitzpatrick and 245 Hopkins,1983 229 Fleming,1981USATheoretical589InterviewMore worried individuals less satisfied with hospital care In hospitalObservational 202 Gray,1980USATheoretical821TelephoneHealth status unrelated to satisfaction Primary careObservational continued
TABLE 19 contd Summary of studies investigating the relationship between health status and satisfaction ReferenceCountryContextNo.responsesMethodMain findings SettingDesign 230 Greenley et al.,1982USATheoretical366InterviewPsychological distress negatively associated with satisfaction Various:primary,Observational outpatient 224 Gross et al.,1998USAEmpirical2315Questionnaire in clinicHealthier patients more satisfied with consultation time spent with doctor Primary careObservational 233 Hall et al.,1990USAEmpirical532InterviewHigher satisfaction associated with better self-rated health,and physical Healthcare in generalObservationalfunctioning and less emotional distress,but not with physicians’ ratings of health, number of diagnoses,and cognitive function 225 Hopton et al.,1993UKEmpirical1,599Questionnaire in clinicHigher satisfaction related to lower health on six dimensions of Nottingham General practiceObservationalHealth Profile Failure of doctors to deal with psychosocial issues reduced satisfaction Existence of long-term health problem did not affect satisfaction Hsieh and Kagle,USAEmpirical650MailLess good health associated with lower satisfaction,but not a strong predictor 194 1991Primary careObservationalcompared with expectations 150 Jackson et al.,2001USAEmpirical500In clinic and mailImmediately after consultation,satisfaction related to patient–doctor interaction Ambulatory careObservationaland functioning After 2 weeks and 3 months,satisfaction depended on symptom improvement Different models are needed for different time lapses 243 Kane et al.,1997USATheoretical2,116MailSatisfaction 6 months after discharge positively related to both absolute health In hospitalObservationalstatus and health status relative to baseline 213 Korsch et al.,1968USAEmpirical800InterviewMothers’ satisfaction in emergency room not related to child’s diagnosis Ambulatory careObservational 240 Krupat et al.,2000USAEmpirical3,602InterviewHealthier patients reported fewer problems with information and In hospitalObservationalhigher satisfaction Linder-Pelz and USATheoretical155InterviewSubjective health status significantly related only to satisfaction with getting 197 Stewart,1986Primary careObservationalappointment (positive) No relation with other dimensions of satisfaction:doctor conduct,convenience, general satisfaction Linn and USAEmpirical519MailHealth status was a significant independent influence on satisfaction,explaining 226 Greenfield,1982Hospital outpatientObservational12% of variance Positive relationship continued 43
44 TABLE 19 contd Summary of studies investigating the relationship between health status and satisfaction ReferenceCountryContextNo.responsesMethodMain findings SettingDesign 228 Patrick et al.,1983UKEmpirical1,000InterviewHigher levels of disability associated with more dissatisfaction Healthcare in generalObservational 227 Rogut et al.,1996USAPragmatic3,423TelephoneSignificantly more problems reported by patients in fair/poor health than by In hospitalObservationalthose in better health 201 Sixma et al.,1998NetherlandsTheoretical13,014InterviewSatisfaction significantly related to low morbidity General practiceObservational 236 Soh,1991USAEmpirical1,210InterviewHealth status did not feature as significant determinant of satisfaction Healthcare in generalObservational Weingarten et al.,USAEmpirical2,799MailPeople with higher quality of life recorded higher satisfaction with healthcare 217 1995Primary careObservationalTelephone 231 Wilson et al.,1995UKEmpirical893Questionnaire in surgeryPatients reporting more psychological disturbance less satisfied General practiceObservationalwith consultation Fewer dissatisfied patients in surgeries of doctors who rated psychological component of consultation more highly 48 Zapka et al.,1995USAPragmatic3,151MailHealth status associated with global measure of satisfaction Healthcare in generalObservationalPeople with poor health had stronger feelings (both ways) People in good health or with chronic disease more satisfied
45 general showed that people with poor health had
stronger feelings in either direction, and that the most satisfied groups were those with good health or those suffering a chronic disease.48Diagnosis in the emergency room was not predictive of satisfaction.213 One investigator shows patients’ ratings of their health status to be better predictors of satisfaction than physician ratings.233
Three studies that reported investigation of a wide range of independent variables found health status not to be significantly related to satisfaction.234–236 Another, smaller, study found that health status affected satisfaction with obtaining an appoint-ment in primary care (sicker people were less satisfied) but not other aspects of satisfaction or general satisfaction.197
Among hospitalised patients, poorer health is generally associated with lower satisfaction and reporting more problems with care.237–240Perceived improvement in health has been linked to satis-faction,241although another investigation found satisfaction in elderly patients to be positively associated with health status on discharge, rather than with improvements in health status over the hospital stay.242
Changes in health status have been shown to influence reported satisfaction over longer periods.
Among patients undergoing surgery, those report-ing the greatest absolute or relative improvements in symptoms 6 months after discharge were the most satisfied.243Patients with migraine who had the longest history of illness were most dissatisfied by their consultations and experienced the least symptom improvement after 1 year.244,245A need has been identified to model separately the effect of health status on satisfaction during illness, and in the follow-up period.150,246
Discussion
The available evidence indicates that health status can affect satisfaction, and therefore suggests that accurate interpretations of comparative satisfaction data requires consideration of the illness profile of the population samples involved. For example, to the extent that sicker patients record lower satisfaction, providers that care for more serious illnesses may generate lower satisfaction scores, irrespective of the quality of care they offer.
Further research
The current state of knowledge about how health status affects satisfaction is insufficient to enable accurate adjustments to be made for case-mix effects. Further detailed research is required
to identify how different types of illnesses or disabilities impact on satisfaction. As a start, such research could distinguish chronic from acute conditions. Qualitative approaches, few of which were identified in the present review, could provide insights into the mechanisms at play.
Longitudinal studies may prove particularly valuable to illuminate our under-standing of how health outcomes from treatment affect reported satisfaction. Such information is important for interpreting the results of satisfaction surveys that are administered after different lapses of time from service delivery encounters.
Research in this area should also give consider-ation to the way in which health status is measured.
Existing studies often utilise clinical indicators such as symptoms or broad patient reports about how they feel. There are now several validated health-related quality-of-life instruments that cover physical and social functioning from the patient’s perspective. The use of such measures may offer a clue to the factors underlying the relationship between satisfaction and health status.