Women's satisfaction with their on-going primary health care services: a consideration of visit-specific and period assessments.

Patient satisfaction ratings are routinely collected to assess the quality of primary care and to assist consumers in selecting a primary care provider. Many different tools for assessing patient satisfaction with primary care are available, and much previous research has addressed the aspects of patient experiences that provide the basis for ratings of satisfaction (Linder-Pelz 1982; Brody et al. 1989; Strasser et al. 1993; Peck et al. 2001; Ford, Schofield, and Hope 2003; Scholle et al. 2004). However, there is less clarity in the literature about the role of the time frame for which the rating is made. Current patient satisfaction rating tools ask respondents to rate their health care experiences either for a specific health care visit or for care received over a period of time (e.g., the past 12 months). For purposes of assessing quality of care within a health plan or practice, these different time frames are not likely to be interchangeable. Some aspects of care, such as the quality of communication between patient and provider or the thoroughness of an examination, may be readily assessed for a specific patient visit; other aspects of care, such as trust in the provider or the quality of decision making, are based on cumulative experiences (Peck et al. 2001) and are likely to be evaluated across several encounters or within a treatment period or “episode” of care (Hornbrook, Hurtado, and Johnson 1985). Visit-specific measures are likely to miss issues related to continuity or coordination of care over time, whereas period ratings may miss issues related to interactions with a specific provider or service. Depending on the purpose for which patient satisfaction ratings are obtained, the time frame for the ratings could be important. The distinction between the contexts of a specific visit and on-going care may be particularly important for women, who make more primary care visits than men (Brett and Burt 2001) and who often may see more than one provider (e.g., a generalist and reproductive health care provider) over multiple visits (Weisman and Henderson 2001) to receive comprehensive, age-appropriate clinical preventive services (Weisman 1996; Gallagher, Geling, and Comite 2001; Weisman and Henderson 2001; Henderson, Weisman, and Grason 2002). However, this pattern of care could also imply more costs to the patient, redundancies in services, increased false positives associated with screening, or contradictory advice across visits. Thus, the impact of on going patterns of care on ratings of healthy care quality is largely unknown. We studied the uniqueness of patient appraisals of satisfaction with on-going and visit-specific care in a multicenter sample of 1,202 women making routine primary care visits. We hypothesized that aspects of primary care conceptualized as visit focused, such as doctor's communication and demeanor and performance of the office staff, would correlate most highly with day-of-visit ratings; whereas ongoing care processes (e.g., follow-up on test results and care coordination) would correlate most highly with ratings of care over the past year.