Evaluation of ophthalmologic assistance from the perspective of users

The prevalence of need of, access to, and dissatisfaction with ophthalmic assistance was estimated among those who were assisted in such services in the last year; factors associated with dissatisfaction were identified. Complex probabilistic sample was used. A descriptive, bivariate, and multiple analysis with correction for design effect was conducted. Of 2.582 participants, 76% needed assistance and, of those, 82.5% possessed access to it. Among patients who received assistance in the last year, 13.1% were dissatisfied. Dissatisfaction was higher among older patients, those who went walking or cycling to the location of assistance, and those who described the following aspects as regular/bad/terrible: being received and treated with respect, the clarity with which the service provider explained things, and their autonomy to choose their provider of ophthalmic assistance. Most of them was in need of and possessed access to assistance. Dissatisfaction was low. Patient's age, means of transport used to get to the local of the assistance, patient-professional relationship, and autonomy to choose are factors that interfere for the outcome of dissatisfaction.

Keywords:
Patient satisfaction; Health services; Quality of health care; Ophthalmology; Health services evaluation; Health services accessibility

Authorship

Andréa Maria Eleutério de Barros Lima Martins

Department of Dentistry, Universidade Estadual de Montes Claros, Faculdades Unidas do Norte de Minas - Montes Claros (MG), Brazil.Universidade Estadual de Montes ClarosBrazilMontes Claros, MG, BrazilDepartment of Dentistry, Universidade Estadual de Montes Claros, Faculdades Unidas do Norte de Minas - Montes Claros (MG), Brazil.

Ariadna Borges Muniz

Medical School, Faculdades Unidas do Norte de Minas - Montes Claros (MG), Brazil.Faculdades Unidas do Norte de MinasBrazilMontes Claros, MG, BrazilMedical School, Faculdades Unidas do Norte de Minas - Montes Claros (MG), Brazil.

Marise Fagundes Silveira

Department of Exact Sciences, Universidade Estadual de Montes Claros - Montes Claros (MG), Brazil.Universidade Estadual de Montes ClarosBrazilMontes Claros, MG, BrazilDepartment of Exact Sciences, Universidade Estadual de Montes Claros - Montes Claros (MG), Brazil.

Danilo Lima Carreiro

Federal Institute for Education, Science and Technology at Norte de Minas - Januária(MG), Brazil.Federal Institute for Education, Science and Technology at Norte de MinasBrazilJanuária, MG, BrazilFederal Institute for Education, Science and Technology at Norte de Minas - Januária(MG), Brazil.

João Gabriel Silva Souza

Departament of Physiological Sciences, Faculdade de Odontologia de Piracicaba, Universidade Estadual de Campinas - Piracicaba (SP), Brazil.Universidade Estadual de CampinasBrazilPiracicaba, SP, BrazilDepartament of Physiological Sciences, Faculdade de Odontologia de Piracicaba, Universidade Estadual de Campinas - Piracicaba (SP), Brazil.

Efigênia Ferreira e Ferreira

Departament of Social and Preventive Dentistry, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil.Universidade Federal de Minas GeraisBrazilBelo Horizonte, MG, BrazilDepartament of Social and Preventive Dentistry, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil.

Corresponding author: Andréa Maria Eleutério de Barros Lima Martins. Avenida Rui Barbosa, 126, Vila Mauriceia, CEP: 39401-089, Montes Claros, MG, Brazil. E-mail: martins.andreamebl@gmail.com

Conflict of interests: nothing to declare

Financial support: Research Supporting Foundation of Minas Gerais State (FAPEMIG), 01/2010, Universal Quest, Process CDS-APQ-02161-10. Andréa Maria Eleutério de Barros Lima Martins bears a Jr. Post doctoral scholarship by the National Council for Scientific and Technological Development (CNPq), protocol 151080/2014-3. Efigênia Ferreira e Ferreira is productivity scholar of CNPq.

SCIMAGO INSTITUTIONS RANKINGS

Figures | Tables

Figures (1)
Tables (2)

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Figure 1:
Flowchart of participation in the survey conducted to identify the assessment of ophthalmic care from the perspective of users in a household sample in Montes Claros, MG, 2012.

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Table 1:
Description of the variables and bivariate analysis of associated factors (p ≤ 0.20) to dissatisfaction with the ophthalmic care among users of Montes Claros, MG, 2012 (n = 659).

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Table 2:
Multiple analysis of factors associated with dissatisfaction (p ≤ 0.05) with ophthalmic care among users in Montes Claros, MG, 2012 (n = 659).

Figure 1: Flowchart of participation in the survey conducted to identify the assessment of ophthalmic care from the perspective of users in a household sample in Montes Claros, MG, 2012.

Table 1: Description of the variables and bivariate analysis of associated factors (p ≤ 0.20) to dissatisfaction with the ophthalmic care among users of Montes Claros, MG, 2012 (n = 659).

Sociodemographic	Total	Dissatisfied	OR*	95%CI^*	p-value
Sociodemographic	%	%	OR*	95%CI^*
Sex
Male	27.2	7.5	1.00
Female	72.8	10.2	1.40	0.68 - 2.88	0.349
Race or color**					0.349
White/Asian	31.9	6.2	1.00
Black/brown	68.1	11.1	1.90	0.89 - 4.04	0.093
Age (years)					0.093
Up to 39	37.3	6.6	1.00
40 - 59	36.9	11.0	1.77	0.79 - 3.95	0.157
60 or more	25.7	11.6	1.88	0.90 - 3.93	0.092
Age (discrete variable, age in years)		-	1.01	1.00 - 1.03	0.114
Education (years)**					0.114
13 or more	37.6	7.6	1.00
9 to 12	27.8	9.3	1.28	0.52 - 3.16	0.580
Up to 8	34.6	12.3	1.76	1.01 - 3.06	0.047
Education (discrete variable, years of schooling)		-	0.96	0.92 - 1.01	0.114
Marital status**					0.114
Married/common-law marriage	49.1	10.8	1.00
Single/separated/divorced/widowed	50.9	8.1	0.73	0.35 - 1.50	0.376
Per capita income**					0.376
Greater or equal to 1 MW	28.4	6.4	1.00
Less than 1 MW	71.6	10.6	1.73	0.57 - 5.21	0.317
Income per capita (discrete variable, in reais)		-	1.00	1.00 - 1.00	0.236
Work**					0.236
Active	50.5	10.2	1.00
Retired/pensioner	20.8	12.5	1.26	0.56 - 2.83	0.564
Never worked/unemployed	28.7	6.3	0.60	0.28 - 1.28	0.173
Characteristics of ophthalmic assistance/structure
Query site**
Private hospital or clinic/covenant	62.9	8.4	1.00
Hospital or public clinics	37.1	11.6	1.43	0.77 - 2.65	0.245
Payment service**					0.245
Particularly without refund	29.9	9.6	1.00
Health insurance	34.6	5.8	1.70	0.22 - 1.55	0.265
Not paid/public system	35.6	12.6	1.35	0.77 - 2.37	0.285
Means of transportation used to get to the site of consultation**					0.285
Private car/bike/taxi/public transport	48.7	14.8	1.00
Public transport	29.3	8.1	1.98	1.15 - 3.41	0.015
Walking/bike	22.0	-
QRSAO ... in your last visit, how would you rate...
Domain readiness for meeting/case
The travel time to the ophthalmiccare provider**
Excellent/good	74.7	8.0	1.00
Fair/poor/very bad	25.3	14.7	1.99	1.13 - 3.53	0.020
Time you waited before being assisted**					0.020
Excellent/good	58.2	6.0	1.00
Fair/poor/very bad	41.8	14.8	2.73	1.40 - 5.33	0.005
Domain dignity/process
The experience of being welcomed and treated with respect**
Excellent/good	95.5	8.2	1.00
Fair/poor/very bad	4.5	40.1	7.48	2.62 - 21.33	0.001
Domain privacy/process
Your privacy being respected during examinations and treatments**
Excellent/good	96.5	9.0	1.00
Fair/poor/very bad	3.5	22.3	2.89	0.92 - 9.11	0.069
The way the service ensured you could talk privately**					0.069
Excellent/good	86.6	7.3	1.00
Fair/poor/very bad	13.4	24.3	4.09	1.74 - 9.61	0.002
Domain communication/process
The clarity with which the provider explained things to you**
Excellent/good	90.1	6.6	1.00
Fair/poor/very bad	9.9	35.1	7.63	3.67 - 15.84	0.000
Having enough time to ask questions about your vision problem or treatment**					0.000
Excellent/good	84.3	6.8	1.00
Fair/poor/very bad	15.7	22.1	3.89	1.70 - 8.88	0.002
The experience of having information about additional types of tests or treatments**					0.002
Excellent/good	72.8	5.7	1.00
Fair/poor/very bad	27.2	19.3	3.93	2.20 - 7.01	0.000
Domain autonomy/process
The experience of being involved in making decisions about your treatment**
Excellent/good	82.0	5.8	1.00
Fair/poor/very bad	18.0	27.3	6.05	2.90 - 12.60	0.000
Domain autonomy/process
The autonomy you had to choose your ophthalmiccare provider**
Excellent/good	73.4	4.8	1.00
Fair/poor/very bad	26.6	21.9	5.59	2.84 - 11.01	0.000
Domain infrastructure/structure
The cleaning of the rooms within the test site, including the restrooms **
Excellent/good	92.0	8.8	1.00
Fair/poor/very bad	8.0	19.3	2.49	1.11 - 5.56	0.028
The space in the waiting room and the room where you were examined**					0.028
Excellent/good	79.7	9.5	1.00
Fair/poor/very bad	20.3	16.4	2.34	1.25 - 4.38	0.010

OR: odds ratio; *correction by the design effect; **number of respondents was smaller than number of participants; MW: minimum wage (current R$ 622.00; $1.00 = R$ 2.01; May 2012); QRSAO: Questionnaire on Responsiveness to Ophthalmic Care System.

Table 2: Multiple analysis of factors associated with dissatisfaction (p ≤ 0.05) with ophthalmic care among users in Montes Claros, MG, 2012 (n = 659).

OR: odds ratio; *correction by design effect; **controlled by the variable "time of travel to the ophthalmic care service"; QRSAO: Questionnaire on Responsiveness to Ophthalmic Care System.

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Evaluation of ophthalmologic assistance from the perspective of users

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[1] Corresponding author: Andréa Maria Eleutério de Barros Lima Martins. Avenida Rui Barbosa, 126, Vila Mauriceia, CEP: 39401-089, Montes Claros, MG, Brazil. E-mail: martins.andreamebl@gmail.com