Users were then questioned about the possibility of strongly recommending their unit to friends, if medical care was needed. From the responses obtained, it follows that Users were asked if they saw any reason not to move to another health unit. Of the questions corresponding to the overall satisfaction, this one presented the least negative responses 7. For every individual who sees reasons to move to another health unit, there are 12 who consider the opposite. The asymmetry of satisfaction was analyzed taking into account gender, age, family situation, education, employment status, experience with the health unit, and type and size of the unit.
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Table 2 presents the results. As can be seen in this table, men are slightly more satisfied than women with primary care provided.
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Furthermore, the creation of the age groups allowed for the statement that age also has an influence on the evaluation of satisfaction, i. A possible explanation may be the decrease of expectations or better attention devoted to the elderly. This difference in satisfaction is not visible between the first two age groups studied. In relation to family status, statistically significant differences were also found, and many of these differences were influenced by gender and by age of the respondent. The education also shows some influence on satisfaction.
In fact, people less educated are those who reveal best satisfaction ratings. On the other hand, it turns out that retired persons older are the ones that, again, have highest rates of satisfaction. Students younger are those who most penalize the way they were treated by primary care. For users this has been their first contact with this health unit. The remaining Not found any statistically significant difference between these two groups. One of the most challenging points of this study was to check whether user satisfaction is sensitive to the organization and management model of care.
That is, whether we should expect that the UCSP units have the same level of satisfaction than the USF model A and the latter the same level of satisfaction than model B. The size of the functional units was also examined and it was clear that the scale of the health unit has some impact on user satisfaction with regard to the various levels of satisfaction, in particular when we isolate the very large units.
In general, these feature statistically lower values of satisfaction than the other. When all these determinants are analyzed, now from a multivariate perspective, the results previously presented in a univariate form are confirmed Table 3. In fact, we observed the lowest satisfaction among women and among young people and greater satisfaction in adults and the elderly.
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We noted also that the user in active professional situation, regardless of the other determinants, reveals lower satisfaction with the care provided and that, again, to be enrolled in a USF is associated with greater satisfaction. Finally, we noted that the dimension of the health unit makes a negative difference in terms of satisfaction. The null hypothesis of no regional asymmetry was also tested, that is, the variability of the satisfaction ratings among the units of the ACeS of the LVT Region.
Finally, one of the objectives initially set for this study was the comparison, as far as possible, between the results obtained with the USF in and those found in In fact, in , the 42 USF then existing in the region showed an average satisfaction of The questionnaire used followed the conceptual model of the Europep questionnaire with four main dimensions: medical care, non-medical care, organization of care and quality of amenities.
This corresponded to a general rate of responses of Regarding the characteristics of the sample, we can state that As with other authors, we found a satisfaction with a strongly left skewed distribution 20 , The dimensions in which users were most satisfied were those relating to the care and attention provided by doctors In the global, On the other hand, Women showed a slightly lower satisfaction than men In fact, this was an a priori expected result, given the similar results previously obtained by us and by other studies of satisfaction 17 , 19 , 20 , 25 , People with education lesser than the basic education showed the best satisfaction ratings Furthermore, based on the values of satisfaction obtained in in the USF then evaluated in the region, when levels of satisfaction are compared with the values now found, there are statistically significant increases.
Finally, by looking at the results of this study, we can see that we have achieved a very high response rate, which minimizes the risk of selection bias due to withdrawals, and hardly does change the factorial structure of the questionnaire, as well as it leads to very small confidence intervals for the results.
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It was also intended to perform a comparative analysis within the framework of primary health care, among health units with the same organizational model and among health units with different models. As suggested in previous works, this evaluation based on satisfaction indicators should also include other indicators in areas such as availability, access, productivity, continuity, effectiveness and efficiency for exemple 27 to support the decision-making of the decision-makers involved.
In the light of the results obtained, it is considered absolutely necessary, from a perspective of continuous quality improvement, and taking into account previous studies 10 , 19 , to set a system of incentives and interventions to reward those with better results and support those with less good results, so that they improve.
This approach should absolutely take into account the model under consideration USF and UCSP and be supported and actively pursued by the upper instances of the Ministry of Health — macro health governance — and by Regional Health Authorities and by the ACeS — meso health governance — so that effective transformations occur at the level of organizations — organizational governance. This means only that the user experience is poor and, as a consequence, the evaluation they do is penalizing. These interventions may range from the assignment of greater autonomy and control to the highest classified units, up to financial aid and external assistance for the most poorly classified, not leaving out the clear need, taking into account the results obtained, of achieving the transition from the UCSP model to the USF model.
Patients, users and the general public have a right to have information about the performance of healthcare organizations. Each organization also needs to know its position with regard to the others, so that its successes are shared and its weaknesses identified, in such a way that they represent an opportunity and a starting point for new interventions for change. Defining quality of care.
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Health Policy ; 16 1 Global Health Governance: a Conceitual Review. Principles for Good Governance in the 21st Century. Ottawa: Institute on Governance; Reconceitualising Governance. Ferreira PL, Raposo V. Sakellarides C, coordenador.
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Pisco L. Cien Saude Colet ; 16 6 Ferreira PL. In: Ferreira PL. Fam Pract ; 16 1 Primary Health Care Research and Development ; Cien Saude Colet ; 18 1 Rev Saude Publica ; Eur J Gen Pract ; 13 2 Fam Pract ; 28 3 Quality indicators for general practice: a practical guide for health professionals and managers. This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Services on Demand Journal. Key words: Satisfaction; Primary Health Care. Introduction Primary health care aims at being the first and the main contact of citizens with the health system. The Portuguese experience In , with the beginning of a new political cycle, the Mission for Primary Health Care was created, aiming to put into practice the primary health care reform. Methods This observational study, descriptive and cross-sectional and at the national level was developed in June in order to determine the degree of user satisfaction with the care provided in all USF, as determined in Ordinance No.
Conceptual model of analysis This study assumes the conceptual model in Figure 1. Data analysis The values of questions, sub-dimensions and dimensions were estimated using a weighted sum in which the values were previously converted, divided by the total number of valid responses, i. Results The main results of this study, limited to the LVT Region, will now be reported, including the characteristics of the received sample, the respective responses rates and the values corresponding to the CEISUC satisfaction index.
Demographic characterization of the sample The sample of respondents is mostly composed by Satisfaction of special needs Users were asked if their health unit responded to the needs felt for example, by children, the elderly and disabled people. New York: Springer Verlag; Hogikyan ND, Sethuraman G. Gasparini G, Behlau M. J Voice; ;23 1 Rev Soc Bras Fonoaudiologia; supl esp.
Vocal aging and the impact on daily life: a longitudinal study. Acta Otorrinolaringol Esp ; Bloch I, Behrman A. Quantitative analysis of videostroboscopic images in presbylarynges. Laryngoscope ; Voice activity and participation profile: assessing the impact of voice disorders on daily activities. J Speech Lang Hear Res. Costa HO, Matias C. O impacto da voz na qualidade de vida da mulher idosa. Rev Bras Otorrinolaringol. Prevalence of perceived dysphonia in a geriatric population. J Am Geriatr Soc. Quality of life and voice: study of a brazilian population using the voice-related quality of life measure.
The Relationship between ratings of voice quality and quality of life measures. Recebido em Revisado em Clique para ampliar. All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License.