Assessment of Patient Satisfaction Level to Dental Health Care Services in Indonesia

Objective: To know the level of patient satisfaction with dental healthcare services in Bantaeng, Indonesia. Material and Methods: This pilot pathfinder survey was conducted at Dental and Oral Health Services in Bantaeng and Pa'jukukang Sub-districts of Bantaeng Regency of South Sulawesi Indonesia. The ShortForm Patient Satisfaction Questionnaire (PSQ-18) scaled was used and it consists of 18 questions and seven subscales. The t-test and ANOVA were used with a significance level set at 5% (p<0.05). Results: The female participation (72.8%) was greater than the male (27.2). Regarding age, 74.6% were <40 years, 21.1% were between 40-60 years old and 4.4% were over 60 years old. On the subscale of technical quality, there was significant value in the age variable (p=0.45), education level (p=0.031), job (p=0.026), waiting time (p=0.46), distance to dentist=0.026), and location (p=0.007). There were significant values on the interpersonal aspect subscale that were present at age (p=0.016), education level (p=0.038), and occupation (p=0.007). The highest satisfaction score was found on the technical quality subscale (13.04 ± 1.75) and the lowest satisfaction score was seen on the general satisfaction subscale (4.11 ± 1.75). There was a significant difference between the value of patient satisfaction with age, education, and occupation. Conclusion: Patients from the District Bantaeng and Pa'jukukang Bantaeng regency of South Sulawesi were more satisfied with the service provided. The highest satisfaction score was found on the technical quality subscale and the lowest satisfaction score was found in the general satisfaction subscale.


Introduction
Patient satisfaction is an important measurement result for healthcare and as defined by Pascoe, patient satisfaction is the patient's response to a significant aspect of his or her healthcare experience [1].
Donabedian said that patient satisfaction is essential as a measure of the quality of care because it provides information about the success of the service provider in meeting the patient's values and expectations, the issues on which the patient's authority is based. And also said that health services can be evaluated according to the structure, work process, results, and user satisfaction [2][3][4]. Patient satisfaction with healthcare can be assessed from various dimensions, such as general satisfaction, technical quality, interpersonal aspects, communication, financial, time spent in the dentist, and access/convenience [5].
A total of 25.9% of Indonesians have dental and oral problems in the last 12 months (potential demand). In South Sulawesi, Indonesia has a high dental and mouth problem (>35%) of 36.2% with an Effective Medical Demand (EMD) score of 10.3% [5]. This can be due to the insufficient number of medical personnel and facilities/access. Bantaeng is one of the districts in South Sulawesi [6]. In Bantaeng District Health Profile 2016, the number of health personnel and facilities/access for health services in Bantaeng Regency in 2016 is still considered inadequate. The aim of this study was to determine the level of patient satisfaction on dental and oral healthcare services in Bantaeng and Pa'jukukang Sub-districts of Bantaeng Regency of South Sulawesi.

Study Design and Sample
This pilot pathfinder survey was conducted in Dental and Oral Health Services in Bantaeng and Pa'jukukang Sub-districts of Bantaeng Regency of South Sulawesi from 29th -31st January 2018. This study had a non-probabilistic sample comprising 114 participants.

Data Collection
Trained researchers collected data. To assess the level of patient satisfaction, the short-form Patient Satisfaction Questionnaire (PSQ-18) was taken from a previous study [7,8], which was preceded by several questions about demographic data (gender, age, education level and occupation) and visit (type, waiting time, distance and location). Standardized PSQ-18 questionnaires include 18 statements focusing on the quality of healthcare services provided. Respondents are free to choose the answer on a five-point Likert scale ranging from one (strongly agree) to five (strongly disagree). Statements are divided into 7 subscales: General satisfaction (Q3 and Q17); technical quality (Q2, Q4, Q6, and Q14); Interpersonal aspects (Q10 and Q11); Communications (Q1 and Q13); Financials aspects (Q5 and Q7); Time spent with the doctor (Q12 and Q15); Access/convenience (Q8, Q9, Q16, and Q18). Based on the results of the class interval calculation found that the level of satisfaction range to not satisfied (18-54) and satisfied (55-90).

Data Analysis
Data were analyzed using IBM SPSS Statistics for Windows Software, version 23 (IBM Corp., Armonk, NY, USA). Descriptive statistics were used to calculate the absolute and relative frequencies, mean and standard deviation. The t-test and ANOVA were used with a significance level set at 5% (p<0.05).

Results
The female participation (72.8%) was greater than the male (27.2). Regarding age, 74.6% were <40 years, 21.1% were between 40-60 years old and 4.4% were over 60 years old. Table 1 shows the distribution of 114 subjects based on demographic characteristics. Most participants had junior high school education level (37.7%), were students/university students (43.0%), revealed an early waiting time (41.2%) and 77.2% were from the urban area.  There was a significant value on the time subscale spent with the dentist seen in the gender (p<0.001), employment (p=0.031), and at the waiting time (p=0.003). This suggests a significant difference between time spent with doctors with gender, occupation, and waiting times. Patients with a timely waiting time were significantly more satisfied with the dental healthcare service on the access/comfort subscale (p=0.003) than the other waiting time. The highest satisfaction score was found on the technical quality subscale (13.04 ± 1.75) and the lowest satisfaction score was seen on the general satisfaction subscale (4.11 ± 1.75). Table 3 presents that men showed significantly more satisfaction on the general satisfaction subscale of dental healthcare services than women (4.84 ± 2.10 and 3.84 ± 1.53, p=0.006). Age, education, occupation, type of visit, waiting time, distance, and location have almost no effect on the general satisfaction subscale of dental healthcare services. On the subscale of technical quality, there was significant value in the age variable (p=0.045), education level (p=0.031), job (p=0.026), waiting time (p=0.046), distance to dentist=0.026), and location (p=0.007). There were significant values on the interpersonal aspect subscale that were present at age (p=0.016), education level (p=0.038), and occupation (p=0.007). On the communication and financial subscale there was no significant difference between communication and finance with gender, age, education level, occupation, type of visit, waiting time, distance to the dentist, and location.

Discussion
Patient's satisfaction with the health service provided by the doctor is very important. Thus, it is essential to identify weaknesses in the service system to help improve through patient opinion. This can be done using Patient Satisfaction Questionaire short form (PSQ-18), a validated tool that can be applied to various situations and can compare interventions [7].
In Table 2, the highest value of health service satisfaction is found on the technical quality subscale.
Technical quality contains the competencies of service providers and adherence to high standards of diagnosis and treatment (accuracy, precision, unnecessary risks, making mistakes). Technical quality has a strong relationship with overall satisfaction. Other authors have also obtained similar results in their study [9].
While the lowest satisfaction score is found on the subscale of general satisfaction and communication.
Communication errors between the service provider and the patient may result in a medical failure affecting the patient's condition. The communication-centered approach between communication service providers and patients is regarded a good strategy in creating relationships with patients and is considered a key to improving the quality of health services. The results obtained in this survey are similar to those previously previously reported in the literature [10]. Table 3 shows that the female variable is satisfied while the male feels satisfied. On women, the satisfaction level was higher than men's. Gender has an influence on the services provided. Women are more conscientious in appearance, while men do not care about it [11]. These findings have also been shown in previous studies [10,12].
In this study, the age variable found that the older the patient was not satisfied with the service.
However, other studies have reported different findings. Previous research has found that older patient has higher level satisfaction [10,13]. This survey found that lower education has higher-level service satisfaction.
This may occur because patients with higher education levels expecting better health care services compared to patients with low levels of education, confirming previous findings [4].
For patient satisfaction, the first visit and not the first visit in this study did not show a significant difference in all subscales of health services. This result is similar to the findings of other authors [1], who claim that there is no significant difference, but found high levels of satisfaction. Other studies reported that the difference between first and recurrent patient visits from all dimensions of quality of healthcare is not significant [2,14]. Previous research cannot demonstrate that first-time patients tend to provide a higher satisfaction assessment than recurrent-return patients as reported on emergency medical services [1]. These findings are consistent with studies that found no difference in satisfaction among first-time patients with recurrent patient visits at clinics in the UK [15].
The level of patient satisfaction at the waiting time of the majority of patients was satisfied with the service, and this is similar to the previously reported showing that long waiting time for treatment is a major problem for patient dissatisfaction [16]. Waiting time in the examination room has a more significant negative effect on patient satisfaction than the time spent in the waiting room, and first-time patients are very sensitive to waiting time [17]. Most importantly, longer waiting times can actually reduce the patient's perception of the physician's ability and reduce confidence in the care provided [18].
The level of satisfaction at the rural location is higher than urban. But only on technical quality subscales that have significant value. Rural patients were generally more satisfied with health services than urban and suburban populations. It can be explained that urban residents have the possibility to choose professional care from health care providers [4,[19][20][21][22][23][24][25][26].

Conclusion
Patients from the District Bantaeng and Pa'jukukang Bantaeng regency of South Sulawesi were more satisfied with the service provided. The highest satisfaction score was found on the technical quality subscale and the lowest satisfaction score was found in the general satisfaction subscale.

Financial Support
None.