الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 158 |  |  |
| | | from | 158 | | |
Abstract
Non-communicable diseases (NCDs) are silent killers that endanger health since they
don’t manifest symptoms until the condition has advanced. Hence To reduce the impact of
NCDs on global health, current public health initiatives place a strong emphasis on the need
for prevention, detection, and correction of modifiable risk factors. The most common way
that people enter the healthcare system is through primary care, which makes it the best
place to identify high-risk persons who might be using the services. The PHC strategy can
be used to deliver high impact important NCDs interventions to support early detection and
prompt treatment.
In today’s competitive health care market, quality is developing as a dominating and
complicated subject; it has a significant impact on the healthcare setting that clients choose.
Client satisfaction, which is a function congruent with scientific understanding and
generally acknowledged professional standards, is a component of quality of care that is
partially a function of the demand for care. Hence, this study was conducted to assess the
quality of NCDs services provided at family health centres in Alexandria and its relation to
patient satisfaction.
A descriptive correlational research design was used to conduct this study. It was carried
out in sixteen family health centres affiliated to the MOHP in Alexandria. El-Montaza, East,
West, Middle, El-Gomrouk, El-Amreya, Borg El-Arab, and El-Agamy.
The current study subjects included a total of 400 hypertensive and/ or diabetic patients,
a total of 48 health care personnel (physician, Nurse, Administrator) who are involved in
NCDs in the previously mentioned settings.
Tools for data collection
Three tools were used to collect the study’s data. 1st tool: Patient semi structured interview
schedule. It is composed of two parts: Sociodemographic characteristics of the patients /
Patient’s Health profile. 2nd tool: The patient Satisfaction Questionnaire Short Form (PSQ-
18). 3rd tool: Quality of non-communicable diseases services assessment tool. Before data
collection, the study tools were tested for content validity through a jury consisting of five
experts.
The main findings revealed from the study:
❖ Part I: General characteristics of studied patients.
➢ Section A: Socio-demographic characteristics of studied patients
- Slightly more than three-quarter (76.5 %) of patients were females and more than onefifth
(23.5%) were males.
- Highest percentage of patients aged from 50- >70 years with a mean of 59.89 ± 12.08 years.
- More than half of them (59.5%) were married and the rest (39.5%) of them were single,
divorced, or widowed.
- The majority (93.8%) of them were living in urban areas, and only (6.3%) of them were
living in rural areas. Those who were close to the family health center were more than
two-thirds (68.3%), while the rest (31.8%) were far from the family health center that
provides health services.
- less than one-quarter (15%) of patients were illiterate or read and write. On the other
hand, about three-quarter (75.5%) of them completed their basic education, less than
one-tenth (7%) of them completed their secondary education and the rest (2.5%) of them
obtained a university education or higher. Slightly more than half (56.5%) of patients
were not employed.
- About three-quarters of the patients (73%) felt that their income was enough to meet
their needs.
- The majority (91%) of the patients had medium socioeconomic level.
➢ Section B: Patient’s Health profile.
- The majority (82.5 %) of patients had hypertension, two thirds (66%) of them were
diabetic, around one quarter (25.5%) of them had cardiovascular diseases, one quarter
(25%) of them had respiratory diseases and the rest (6%) had cancer or endometriosis.
- Only 1.5% of patients were diagnosed recently (less than five years), 67.3% since 5 to
less than 10 years, while the rest (31.3%) for 10 years or more.
- Just over half (56%) of the patients realized that they had chronic disease from the signs
and symptoms that appeared, and 28% of them when they had complications and the rest
(16%) during checkup.
- Half (50%) of patients eat three meals per day, more than one quarter (28%) of patients
eat two meals per day, more than one-tenth (12%) of them eat one meal per day and the
rest (10%) of patients eat three meals and snacks per day.
- The majority (96.5%) of them don’t practice any kind of sport. Slightly more than threequarters
(79%) of the patients do not smoke. Slightly less than three quarters (72%) of
patients take over the counter medications.
- Slightly more than a third quarter (76%) of patients claimed to attend regularly for followup.
The majority (88.5%) of the patients attended six visits during the past 6 months.
Slightly less than one-tenth (8%) of them attended five visits during the same period,
while the remaining patients (3.5%) attended four visits during the past 6 months.
- The majority (87%) of patients take their medications, according to the treatment plan written by their physician.
- More than one quarter (31.5%) of patients claimed that their normal diet is in accordance
to the diet prescribed by their health care provider, less than half (43.5%) of patients
claimed that their normal diet is sometimes in accordance to the diet prescribed by their
health care provider and the rest (25%) of patients claimed that their normal diet is not in
accordance to the diet prescribed by their health care provider.
- less than one third (32%) of patients reported practicing exercise, about one third (33.5%)
of them reported that they practice exercise sometimes and more than one third (34.5) of
patients reported that they don’t practice exercises.
❖ Part II: patients’ satisfaction with the provided non-communicable
diseases services.
- More than half (54%) of the patients expressed a moderate level of satisfaction with NCDs.
Furthermore, 45.5% of them reported a high level of satisfaction, while only 5% expressed
a low level of satisfaction.
- The mean satisfaction levels were higher in the dimensions of interpersonal manner (4.30
± 0.89) and financial aspects of care (4.28 ± 0.91) compared to the mean satisfaction levels
of technical quality (3.83 ± 0.94), accessibility and convenience (3.68 ± 0.82), doctorpatient
communication (3.52±1.28), general patients’ satisfaction (3.46 ± 1.03), and time
spent with the doctor (3.19 ± 1.57).
- More than two-thirds (70%) of the patients stated that the care they received was perfect.
However, slightly more than half (54.5%) of them - expressed dissatisfaction with certain
aspects of the care they received.
- Slightly more than half (55.5%) of the patients stated that the doctors’ offices are prepared
to provide complete medical care. Additionally, more than two-thirds (70%) of them
stated that their doctors check everything carefully during examination. Furthermore,
slightly more than three-quarters (77%) of them had no doubt about the doctors’ diagnosis,
and slightly less than three-quarters (72.5%) expressed confidence in their doctors’
abilities.
- The majority (89.5%) of the patients stated that doctors did not act in a dry and unfriendly
way with them.
- Slightly less than two-thirds (65%) of the patients reported that their doctors explained
the importance of medical tests in a good way. Additionally, slightly more than half (53%)
of them stated that the doctors did not ignore what the clients were telling them.
- The majority (89%) of the patients were able to access health services without facing a
financial burden. Additionally, 79.5% of them reported that they did not have to pay more
for care than they could afford.
- Slightly less than half (47%) of the patients stated that the doctors did not hurry when
treating them, indicating that the doctors took their time. Additionally, 49.5% of the patients reported that the doctors spent a significant amount of time with them during their
appointments.
- The majority (84.5%) of the patients had easy access to specialists when needed.
However, 65% of them reported experiencing long waiting times to receive care. On the
other hand, 85.5% of the clients did not find it difficult to secure immediate appointments
for care, and 69.5% stated that they could access care whenever needed.
❖ Part III: Quality of non-communicable diseases services
- Among the studied healthcare centers, the overall mean quality performance of NCDs was
fair (74.52 ± 2.45). Among the eight dimensions of quality, the quality improvement
program showed the highest compliance (95.13 ± 1.77), while patient care showed the
lowest compliance (46.42 ± 0.97). The management of information was rated at (90.47 ±
0.00), management of the organization at (89.06 ± 0.69), patient rights at (83.33 ± 1.32),
safety at (79.09 ± 0.31), family practice at (73.33 ± 0.00), and support services at (71.72 ±
7.68).
- Among the support services, the laboratory department demonstrated the highest
compliance with standards (91.66 ± 0.00), indicating that it performed well in meeting
quality requirements. On the other hand, the radiology department had the lowest
compliance (46.29 ± 47.81), The compliance scores for other support services were as
follows Pharmacy services: (76.19 ± 0.00), Emergency services: (71.11 ± 0.00), and
housekeeping services: (61.11 ± 0.00). These scores reflect the level of compliance and
adherence to quality standards in each respective support service.
❖ Part IV: Relation between score of quality of non-communicable diseases
services of the studied family health centers with score of patient
satisfaction.
- There was a statistically significant relationship (P=0.000) between the total quality score
of non-communicable disease services at the facility and the level of patient satisfaction.”
Part V: Correlation between quality of non-communicable diseases
services and patients’ satisfaction with the provided non-communicable
diseases services.
- There was a positive and statistically significant relation between the quality of noncommunicable
diseases services and patients’ level of satisfaction (r = 0.113).
❖ Part VI: Relation between sociodemographic characteristics of studied
patients and patients’ satisfaction.
- The majority (96.0%) of the patients who had moderate level of satisfaction were rural
dwellers, while (48.3%) of those from urban areas had high level of satisfaction with a
statistically significant relation between patient’s place of residence and level of satisfaction (P= 0.000). less than two thirds (60.6%) of not working patients had a moderate level of
satisfaction, while (54.6) of working patients had a high level of satisfaction with a
statistically significant relation between patient’s working condition and level of
satisfaction (P= 0.003). No statistically significant differences were observed between other
patients’ demographic characteristics and their satisfaction level.
❖ Part VII: Relation between Patient’s Health profile and patients’ level of
satisfaction.
- significant differences between patients’ presence of diabetes mellitus and their
corresponding levels of satisfaction. less than two-thirds (62.5%) of the patients exhibiting
a moderate level of satisfaction were afflicted by diabetes mellitus, while (61.8%) of those
who don’t have the disease exhibited a high level of satisfaction.
- There is a statistically significant relation between the patients’ disease condition and their
level of satisfaction (P=0.000). No statistically significant differences were observed
between other patients’ disease conditions and their level of satisfaction.
➢ In light of the study findings, the following recommendations are suggested:
- Allocate a specific clinic in the primary health care settings for NCDs education and
examination.
- Motivate health care providers with proper financial incentives.
- Follow-up on quality and continuous assessment of applying quality standards.
- Monitor Quality improvement activities and report results to the governing body.
- Provide an adequate number of health workers according to the load of work.
- Increase physical resources and strengthen radiology services.
- Improve workflow and decrease waiting time spent by patients in the center.
- Conduct regular surveys annually using different methods to enhance the quality of NCD’s
services in health care settings.
- Organizing a quality committee regularly to ensure that standards are implemented.
- Develop improvement projects according to the defects and results of KPI analysis.
- Periodical appraisal evaluation for nurses’ performance should be performed.
- Disseminate information about NCDs through formal and informal education and media publicity.
Recommendations for further research:
- Effects of quality training program on nurses’ performance.
- Design and application of comprehensive health education programs about quality standards
and the importance of patient satisfaction.
- Ways to improve non communicable diseases services in family health centers.