Identification of users according to degree of satisfaction with geriatric care services using cluster analysis

The aim of this study was to identify groups of users according to their degree of satisfaction with geriatric care services and determine the primary factors associated with satisfaction. This was a cross-sectional study of 181 people enrolled in 36 modules pertaining to the State Workers Social Security Institute (ISSSTE) in Mexico. Degree of satisfaction was measured according to the following three areas: general characteristics of services offered, friendliness of staff and infrastructure. A cluster analysis was performed to identify groups of users according to their level of satisfaction, and an ordinal logistic regression model was used to determine the associated factors. Fifty-three percent were satisfied with the services, 34.3% were fairly satisfied and 12.7% were dissatisfied. The main characteristics associated with a greater degree of satisfaction were being female, older and the head of household. The health system must address this growing population and ensure the development of quality care to meet their needs. dEScRiPtoRS Aged Patient satisfaction Health Services for the Aged Mexico RESUmEn Se objetivó identificar grupos de usuarios según grado de satisfacción con la atención recibida en Módulos Gerontológicos, y determinar los principales factores asociados. Estudio transversal, muestra de 181 pacientes de los 36 módulos del Seguro Social de Trabajadores Estatales, en México. El nivel de satisfacción fue evaluado bajo tres aspectos: características generales de la atención recibida; amabilidad en el trato e infraestructura. Se realizó análisis de conglomerados para identificar grupos de pacientes según grado de satisfacción y un modelo de regresión logística ordinal para identificar factores asociados. Resultaron satisfechos con el servicio 53% de los pacientes; medianamente satisfechos 34,3% e insatisfechos 12,7%. Los principales factores asociados a mayor grado de satisfacción fueron: ser mujer, mayor edad, ser jefe/a de familia. El sistema de salud debe dirigir su atención a este grupo poblacional creciente, e incentivar el desarrollo de una atención calificada que contemple sus necesidades. dEScRiPtoRES Anciano Satisfacción del paciente Servicios de Salud para Ancianos México Gustavo Nigenda-López1, Aarón Salinas-Rodríguez2, Mariana Gómez-Camponovo3, Betty Manrique-Espinoza4, José Arturo Ruiz-Larios5, Alejandra Trejo-Rosales6 IdentIfIcação dos usuárIos segundo nível de satIsfação nos módulos gerontológIcos empregando a analIse de conglomerados IdentIfIcacIón de los pacIentes según nIvel de satIsfaccIón en módulos gerontológIcos empleando el análIsIs de conglomerados 1phd in social policy. research director. Harvard global equity Initiative Harvard school of medicine. researcher. national Institute of public Health. mexico. gustavo_nigenda@hms.harvard. edu 2researcher in Health sciences. Institute of public Health of mexico m. sci Biostatistics. address: Instituto de salud Pública. Edifício principal, 3er piso oficina. asalinas@insp.mx 3dr sci public Health. researcher in Health sciences in the Institute of public Health of mexico, and associate professor of social and preventive medicine faculty medicine. university of the republic (udelar). marianagomezc@higiene.edu. uy 4dr sci (c) epidemiology. researcher in Health sciences. Institute of public Health of mexico. bmanrique@insp.mx 5sociologist. researcher in Health sciences. Institute of public Health of mexico. jose.ruiz@insp.mx 6economist. scholar. Institute of public Health of mexico. ale.trejo04@gmail.com received: 04/23/2012 approved: 08/29/2012 português / Inglês www.scielo. br/reeusp 416 Rev Esc Enferm USP 2013; 47(2):415-9 www.ee. usp.br/reeusp/ Identification of users according to degree of satisfaction with geriatric care services using cluster analysis Nigenda-López G, Salinas-Rodríguez A, Gómez-Camponovo M, Manrique-Espinoza B, Ruiz-Larios JA , Trejo-Rosales A intRodUction The older adult (OA) population has been increasing and will continue to represent a greater proportion of the overall worldwide population in the coming years. According to United Nations estimates, the global OA population will increase from 600 million to 2 billion within the next 50 years (from 2000 to 2050). This phenomenon will also occur in the Latin American and Caribbean region, where the OA population is expected to increase from 42 million to 100 million between 2000 and 2025 due to ongoing and substantial changes in the age structure of the population. This process of rapid population aging presents challenges for a number of countries, including Mexico, where the OA population has grown steadily over the past 25 years. Estimates for 2010 indicate a population of individuals 60 years or older of over 10 million, representing 8.9% of the total population. This phenomenon puts pressure on pension and social security systems and increases the demand for health care(1) and the need for skilled labor in geriatric services. Similarly, it will lead to an increased demand for long-term care(2). Published studies widely recognize that the concept of quality is composed of at least two identifiable and analyzable dimensions: the technical and the interpersonal. The former comprises the technical, clinical and administrative processes involved in service production, while the latter refers to the relationship between service providers and users, with a focus on ensuring fundamental rights, fair treatment, access to information and satisfaction with these services. Providing adequate health services for older adults promotes active aging,(3) which is defined as the process of optimizing opportunities for health, active participation and security, which together, increase quality of life as one ages. Social security institutions in Mexico have expressed concern as progressively broader segments of their beneficiary populations have reached 60 or 65 years of age. Of all the public institutions providing health services in the country, the Mexican Institute for Social Security Services for Federal Government Employees (ISSSTE, Spanish acronym) has the oldest beneficiary population, which is why it launched its Geriatric Modules (GM) initiative in 1997 to offer individual and population-based health services to this population. GM are physical spaces located within ISSSTE primary health care units that are specifically equipped to provide outpatient care to people aged 60 or older who have been referred with a diagnosis of a chronic illness. Geriatric Modules are staffed by professional and technical personnel who have received basic training in geriatric health care. The main objective is to provide continuous care to users, including maintaining biological indicators within reasonable ranges, prescribing and filling medications, providing information on managing home-based illnesses and organizing self-help groups to improve illness management through social interaction. Identifying and taking into consideration users’ perspectives(4-5) is one potential strategy for both improving health care delivery and building a strong health care system that actively connects all parties involved. For that reason, and due to the implications of a growing OA population, the objective of this study was to identify groups of users, using cluster analysis, according to their degree of satisfaction with the services received in geriatric care modules and to determine the factors associated with satisfaction.