Patient satisfaction in basic dental care clinic

Satisfação dos pacientes atendidos em Clínica de Atenção Básica Odontológica

ABSTRACT

The interaction between dental students and patients is essential for practical and realistic learning, providing community services, and establishing a dental school clinic. Simultaneously, studies on public healthcare user satisfaction are crucial, contributing to corrective measures planning based on obtained information. The study aimed to understand the demographic and economic profile of patients treated at the Basic Dental Care Clinic of a public university and to assess patient satisfaction with the services and infrastructure. A cross-sectional observational study was conducted, collecting socioeconomic and general health data from patients through dental anamnesis. Validated questionnaires were used: Questionnaire for User Satisfaction with Public Oral Health Services, covering seven quality dimensions, and the Pompeu Questionnaire, addressing dental care aspects. Responses were tabulated for descriptive statistical analysis. Results: Questionnaire for User Satisfaction with Public Oral Health Services results indicate high patient satisfaction in various dimensions, such as human relations, treatment effectiveness, accessibility, and technical-scientific quality. The Pompeu Questionnaire reinforces these findings, emphasizing the students’ and professors’ receptiveness, effective guidance on oral care, and a high clinic recommendation rate by patients. In summary, both questionnaires reveal an overall positive patient satisfaction. In the study’s context, the majority of patients treated in the mentioned clinic expressed satisfaction with the physical structure, service, and dental treatment offered.

Indexing terms
Dentistry; Patient satisfaction; Unified Health System

RESUMO

A interação entre alunos de odontologia e pacientes é essencial para um aprendizado prático e próximo da realidade, oferecendo serviços à comunidade e configurando uma clínica-escola. Paralelamente, estudos sobre a satisfação do usuário do sistema público de saúde são fundamentais, contribuindo para o planejamento de medidas corretivas com base nas informações obtidas. O estudo teve os objetivos de conhecer o perfil demográfico e econômico dos pacientes atendidos na Clínica de Atenção Básica Odontológica de uma Faculdade pública; e avaliar a satisfação dos pacientes em relação ao serviço prestado e a infraestrutura da Clínica. Realizou-se um estudo transversal observacional, coletando dados socioeconômicos e de saúde geral de pacientes por meio de anamneses odontológicas. Utilizaram-se questionários validados: Questionário de Satisfação dos Usuários com os Serviços Públicos de Saúde Bucal, que abrange sete dimensões de qualidade, e o Questionário Pompeu, que contém aspectos do atendimento odontológico. As respostas foram tabuladas para análise estatística descritiva. Resultados: Os resultados do Questionário de Satisfação dos Usuários com os Serviços Públicos de Saúde Bucal indicam elevada satisfação dos pacientes em diversas dimensões, como relações humanas, eficácia do tratamento, acessibilidade e qualidade técnico-científica. O Questionário de Pompeu reforça esses achados, destacando a receptividade dos alunos e professores, orientações eficazes sobre cuidados bucais e uma alta taxa de recomendação da clínica pelos pacientes. Em resumo, ambos os questionários revelam uma satisfação geral positiva dos pacientes. Diante do cenário no momento do estudo, a grande maioria dos pacientes atendidos na referida clínica, sentem-se satisfeitos com a estrutura física, de atendimento e tratamento odontológico oferecidos.

Termos de indexação
Satisfação do paciente; Odontologia; Sistema Único de Saúde

INTRODUCTION

The Unified Health System (UHS) was established by the 1988 Federal Constitution with the aim of addressing inequality in healthcare services [¹]. Since its creation, UHS has undergone continuous changes to meet its needs. UHS is an ongoing construction, and oral health is part of this process. In the year 2000, the need to promote and reorganize oral health through actions within the Family Health Strategy was established, integrating dentists into the family health program, with a focus on comprehensiveness, universality, and equity, achieved through health promotion and disease prevention [²]. The quality pursued by these services and this care model should contribute to the improvement of UHS [³].

Considering that approximately thirty million people have never visited a dentist and that there is a significant demand with limited access to dental care, public dental schools play a fundamental role in improving access to free and universal dental treatment for the population [⁴].

During the training of dentists, direct contact between students and patients is essential, as it makes the learning process more dynamic and aligned with real-world experiences [⁵], in addition to offering services to the population under the supervision of professors, thus characterizing a teaching clinic.

For this process to be complete, the student must not only experience technical growth but also pay attention to the concerns, doubts, fears, and expectations of patients, thereby fostering human growth in dental students [⁶]. Therefore, it is important to conduct studies on patient satisfaction with the public health system, as these studies can contribute to the planning of measures to address potential failures and limitations based on the information gathered [⁴].

Satisfaction can be defined as the relationship between what the client perceives (perception) and what they expected to perceive (expectation) regarding a specific service provided [⁷]. Thus, if the perception exceeds expectations, there is a greater likelihood of patient satisfaction. Often, evaluations are carried out to assess the quality of care provided in dental school clinics. However, the patients’ opinions regarding their satisfaction with expectations and the way they are treated are routinely overlooked [⁶,⁸].

Previous studies [⁹,¹⁰] indicate that, according to patients, various factors influence satisfaction, such as good communication, calmness, patience, and a pleasant appearance. Moreover, the first impression made on patients holds significant importance in establishing trust during care [¹¹].

The process of evaluating patient satisfaction in healthcare is complex and should be conducted using appropriate tools. The instrument must be based on the patient’s understanding and must express their opinion about the services received [¹²]. In this context, the concept of satisfaction refers to the user’s perception and evaluation of specific dimensions of the health service provided.

In an effort to minimize the subjectivity inherent in this type of evaluation, studies use previously validated questionnaires for the Brazilian context [¹³, ¹⁴]. Studies [¹³-¹⁵] emphasize that patient satisfaction is a necessary evaluative tool and should be the ultimate goal of health services. One of the questionnaires used is the Questionnaire for User Satisfaction with Public Oral Health Services, developed and previously validated by Fernandes [¹²], which considers seven dimensions of quality: accessibility, resolution capacity, physical environment and cleanliness, human relations, technical-scientific quality, efficacy, and acceptability, aiming to measure user satisfaction with the service.

Another questionnaire, developed by Pompeu [¹⁶], aimed to evaluate the degree of satisfaction with dental care in university clinics.

Thus, for this study, the Questionnaire for User Satisfaction with Public Oral Health Services and Pompeu questionnaires were chosen to assess user satisfaction through questions that address various aspects of care, from the physical environment to issues related to the interaction between the dentist and the patient.

Based on the above, this study aimed to understand the demographic and economic profile of patients treated at the Basic Oral Health Care Clinic of a public university and to evaluate patient satisfaction with the services provided and the clinic’s infrastructure.

METHODS

An observational cross-sectional study was conducted, with data collection from dental records and through self-administered questionnaires.

The study included patients treated at the Basic Care Clinic of the School of Dentistry of Araraquara – FOAr/UNESP during 2021, aged 18 years or older, who underwent screening, completed treatment at the clinic, did not have any condition that impaired speech and/or comprehension, and consented to participate in the research by signing the Informed Consent Form, which was approved by the Research Ethics Committee of the School of Dentistry of Araraquara – UNESP, under the protocol number: CAAE 15142018.9.0000.5416.

It was estimated that around 50 patients would receive general clinical procedures focused on public health services, such as emergency procedures, dental scaling and polishing, restorative dentistry, and provisional rehabilitative procedures aimed at restoring the patient’s oral health, aesthetics, and function, before referring them to dental specialties.

The study variables were:

Socioeconomic, educational, and general health conditions

Data characterizing the patient’s demographic (age and gender) and socioeconomic condition (household income) were collected from the patient’s medical history.

Questionnaires

Questionnaires for User Satisfaction with Public Oral Health Services

The Questionnaire for User Satisfaction with Public Oral Health Services was developed for Brazilian health services and previously validated [¹²]. It considers seven dimensions of quality: accessibility, resolution capacity, physical environment and cleanliness, human relations, technical-scientific quality, efficacy, and acceptability, aiming to measure user satisfaction with the service using a Likert-type scale, with response options ranging from excellent to poor [¹⁴,¹⁷].

Regarding the dimensions: Accessibility refers to how accessible the service is to users. Resolution capacity reflects the service’s ability to address the users’ needs. Physical Environment and Cleanliness refer to the comfort and cleanliness of the facility. Human Relations address interpersonal interactions between the professional and the service user. Technical-Scientific Quality concerns the adequacy of the equipment used in the service to current technological standards. Efficacy relates to the service’s ability to achieve the expected outcomes. Acceptability refers to whether the service provision aligns with cultural, social norms, and user expectations.

Responses ranged from 1 to 5, where 1 indicates “poor” and 5 indicates “excellent”.

Pompeu Questionnaire

This questionnaire was created and validated by Pompeu in a study conducted at NOVAFAPI College in Teresina, PI. It consists of 18 closed-ended questions, addressing issues related to the patient’s profile, preventive procedures, the behavior of students and professors, pain, fear, humanization, environment, care, and the reasons for seeking the service. Its objective is to assess the level of satisfaction with the dental care provided at a university clinic.

The patient is asked to select the most appropriate response based on their experience at the Basic Care Clinic. The responses are evaluated individually, as each question requires a specific type of answer.

The data collected were tabulated for descriptive statistical analysis.

RESULTS

Due to the pandemic, patients did not receive clinical care in 2020. Services resumed in January and concluded in July 2021, but with restrictions on the number of patients treated in the clinic to avoid crowding, which could have increased the risk of COVID-19 transmission. Additionally, many patients who were called for appointments did not attend, as they were afraid of contracting the virus and vaccination had not yet begun. Consequently, the number of appointments fell short of initial expectations.

Moreover, considering that the questionnaires were administered at the end of treatment and the challenges of access due to the pandemic, the number of participants is justified. We believe that maintaining this study was important, particularly to evaluate patient satisfaction in the context of the pandemic.

A total of 20 patients, aged 18 or older, who were treated at the Basic Care Clinic in 2021, participated in this study.

Data were collected through patient records (age, gender, socioeconomic conditions) and questionnaires (Questionnaire for User Satisfaction with Public Oral Health Services and Pompeu’s Questionnaire for Satisfaction with Dental Care). The questionnaires were provided by the clinic receptionist to be completed in the waiting room after the patients’ final appointment at the clinic.

The data obtained were tabulated in Excel for descriptive statistical analysis.

Regarding gender distribution, 60% of the participants were female and 40% were male. The majority of participants were between 51 and 60 years old (35%), followed by those aged 61 to 70 (15%) and over 70 years old (20%). In terms of occupation and income, 50% of participants were unemployed, 25% were retired, and 25% were employed. The most prevalent household income was between 1 to 2 minimum wages (40%), followed by 2 to 3 minimum wages (30%).

Results from the Questionnaire for User Satisfaction with Public Oral Health Services:

• Human Relations Dimension:

  Dentist/patient relationship: Excellent (100%)

  Relationship with other professionals: Excellent (90%)

• Efficacy Dimension:

  After dental treatment, did you feel any discomfort? No discomfort (80%)

• Accessibility/Availability Dimension:

  Ease of getting an appointment? Easy (20%); Neither easy nor difficult (55%); Difficult (15%)

  Waiting time between arrival and care? Very short (40%); Short (20%); Neither long nor short (25%)

• Technical-Scientific Quality Dimension:

  Dental equipment in terms of technological advancement? Super modern (15%); Modern (60%)

• Physical Environment – Cleanliness Dimension:

  Cleanliness of the waiting room? Excellent (70%); Good (30%)

  Cleanliness of the bathrooms? Excellent (60%); Good (25%)

• Acceptability Dimension:

  Does the professional explain the most appropriate treatment for your oral health issue? Always explains everything (95%)

• Effectiveness/Resolution Dimension:

  Satisfaction with the appearance of treated teeth?

  Totally satisfied (55%); Very satisfied (10%); Satisfied (35%)

  Satisfaction with the treatment of posterior teeth (chewing ability)?

  Totally satisfied (35%); Very satisfied (30%); Satisfied (25%)

Results from Pompeu’s Questionnaire for Satisfaction with Dental Care:

• Were you advised on diet, use of a toothbrush, dental floss, fluoride, and oral cancer? Yes (90%)

• Was the student wearing a uniform? Yes (100%)

• Did you feel pain during the treatment? No (90%)

  When did you feel pain? During anesthesia (20%)

  Did the student relieve the pain? Yes (40%)

  Intensity of the pain? Mild to moderate (40%)

• Were you afraid of the dental treatment? No (75%)

  What caused the most fear? Anesthesia (10%); Root canal treatment (5%); Instruments (10%)

• Receptiveness by the student? Excellent (95%)

  Receptiveness by the professor? Excellent (95%)

• Did it bother you to be treated alongside other people? No (100%)

• Main reason for seeking the clinic? Recommendation from friends (40%); Lack of financial resources (30%); To receive specialized treatment (30%)

• Would you recommend the clinic? Yes (100%)

  If you had another option, would you go to another clinic? No (85%)

• On a scale from 0 to 10, how would you rate the care? Score 10 (90%)

• Suggestions for improving care: It’s already good (60%); More available appointments (25%).

DISCUSSION

Public dental schools play a fundamental role, particularly in ensuring the population’s access to free and universal dental care. The direct interaction between dental students and patients not only contributes to the technical growth of the students but also fosters their human development, as they learn to address the patients’ needs, doubts, fears, and expectations. The establishment of teaching clinics, where students provide supervised care, is presented as a means to ensure more dynamic and realistic training.

User satisfaction within the public healthcare system is a valuable tool for assessing the effectiveness of the services provided. This satisfaction is influenced by various factors, such as good communication, calmness, patience, and a positive first impression. It is essential for the continuous improvement of the UHS [¹⁸,¹⁹].

The Questionnaire for User Satisfaction with Public Oral Health Services and Pompeu questionnaires are valid tools for measuring user satisfaction with oral health services. Both questionnaires address several dimensions, including accessibility, problem-solving capacity, physical environment, human relations, technical-scientific quality, effectiveness, and acceptability [²⁰].

The study results indicate that, despite the restrictions caused by the pandemic, the clinic attended to 20 patients in 2021. Descriptive statistical analysis reveals demographic data, such as the predominance of female participants, mostly aged between 51 and 70 years. In terms of occupation and income, the majority of patients were unemployed, with a smaller proportion being retirees or workers.

The data obtained from the Questionnaire for User Satisfaction with Public Oral Health Services highlight patient satisfaction across various dimensions, including excellent human relations, effective treatment with no significant discomfort, relatively balanced accessibility and availability, modern equipment reflecting technical-scientific quality, and a well-rated, clean physical environment. The acceptability of the professional and the effectiveness of the treatment also received high scores, demonstrating an overall positive patient satisfaction.

The Pompeu questionnaire reinforces the general satisfaction, emphasizing the reception of guidance on oral care, a low incidence of pain during treatment, high receptivity from both students and professors, and a high rate of clinic recommendation by patients.

Based on the results, a detailed view of patient satisfaction regarding oral health services provided by a public university clinic can be observed. Largely, patients expressed positive satisfaction, reflecting the effectiveness of dental care and the importance of teaching clinics in shaping future professionals.

CONCLUSION

Given the circumstances at the time of the study and according to the results obtained, the vast majority of patients treated at the clinic expressed satisfaction with the physical structure, care, and dental treatment provided.

How to cite this article

• Rosell FL, Valsecki Junior A, Genaro LE, Pinotti FE. Patient satisfaction in basic dental care clinic. RGO, Rev Gaúch Odontol. 2024;72:e20240042. http://dx.doi.org/10.1590/1981-86372024004220240002

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Edited by

• Assistant editor: Luciana Butini Oliveira

Publication Dates

• Publication in this collection
  11 Nov 2024
• Date of issue
  2024

History

• Received
  23 Jan 2024
• Accepted
  19 Sept 2024