Original Article
ASSESSMENT OF SATISFACTION LEVEL AMONG
ORTHODONTIC PATIENTS
SHAKEEL QUTUB KHAN, BDS
BABUR ASHRAF, BDS, FCPS, MOrth RCS (Edin)
3
NABEEL QUTUB KHAN, BDS
4
SYED SHAZIL HUSSAIN, BDS
1
2
ABSTRACT
This study was done to determine the level of satisfaction among patients undergoing Orthodontic
treatment. At the end of Orthodontic session, a questionnaire containing 17 close ended questions was
handed out to patients who were willing to participate in the study. Questionnaire addressed four
main categories; 1) Appointment facilities, 2) Behavior of dentist and staff, 3) Quality, efficiency and
cost of treatment provided, 4) Infrastructure and other basic facilities. Pearson Chi square test was
used to find association between patient’s age & various factors that can affect satisfaction level among
patients. Three hundred and ninety patients (28.5% male & 71.5% female) voluntarily participated
in this study which was carried out from September 2013 to May 2014. Professional, courteous and
polite behavior of dental professionals showed highest percentage of satisfaction (98.2%). Only 53.1%
of patients reported that they were satisfied with number of chairs in waiting area, which showed
lowest percentage of satisfaction. 89% of the patients stated that they were satisfied with overall
services provided by Orthodontic department. On average, mean percentage of satisfaction among
Orthodontic patients in all four categories was 88%, demonstrating high level of satisfaction. Female
patients showed higher satisfaction level in all categories. Satisfaction rate was highest in 19-24 years
age group. Chi square test revealed that association between patient’s age & factors like behavior of
dental professionals (p = 0.019), cost (p = 0.000), efficiency of treatment (p = 0.000), cleanliness of
equipment (p = 0.001) and neatness of clinical area (p = 0.008) were found to be statistically significant (p < 0.05). Dental practitioners should be careful about the human and emotional aspects of
treatment provided and must be aware that these factors are fundamental components of quality of
care that we provide. Regular feedback & evaluation of patient satisfaction level is essential in order
to further improve quality of Orthodontic services.
Key Words: Patients Satisfaction, Orthodontics, Pakistan.
INTRODUCTION
In the present era people are more concerned about
their dental health and quality of dental treatment that
they are being provided.1 Around the globe, general
public usually depends on dental health care centers
to resolve their major and minor dental problems.2-4
Evaluation of patient satisfaction is important bench Dr Shakeel Qutub Khan, Lecturer and Clinical Instructor, Department of Orthodontics, Fatima Jinnah Dental College & Hospital,
Plot # 1, Street # 1 – 100 Ft. Road, Azam Town, Karachi, Pakistan
Email: [email protected] Phone # 03222195197
2
Associate Professor and Head Department of Orthodontics, Fatima
Jinnah Dental College & Hospital, Karachi
3
Lecturer and Demonstrator, Hamdard College of Medicine &
Dentistry, Karachi
4
Lecturer and Clinical Instructor, Department of Orthodontics,
Fatima Jinnah Dental College & Hospital, Karachi
Received for Publication:
August 28, 2014
Revision Received:
September 20, 2014
Revision Accepted:
September 25, 2014
1
Pakistan Oral & Dental Journal Vol 34, No. 4 (December 2014)
mark to gauge performance of health care system and
it can also affect patient decision in selecting dentist.5-9
Therefore feedback from patient is important factor for
managers of dental care set-ups to assess and improve
quality of services that they provide.10,11 Satisfaction
of patient can be defined as, “level of an individual’s
experience compared with his or her expectations.”12-15
Patient level of satisfaction and success of treatment
provided are strongly associated.2,16 Studies have shown
that patients were not satisfied when their needs or
demands were not fulfilled.17 It is rational to believe
that level of patient’s satisfaction may vary depending
on the dental procedures performed.18 Clinical and non
clinical factors both affect satisfaction of patient.19
Newsome and Wright 16 reported that five basic factors can affect satisfaction level among dental patient:
1) Quality of dental treatment provided, 2) Behavior
of dentist and hospital staff, 3) Cost of treatment, 4)
Infrastructure and 5) Facilities provided. Within every
651
Satisfaction level among Orthodontic patients
health care system there are many highly trained and
enthusiastic people working at every level to improve
health of their patients. The real task is to build and
run health care system that is economical and responds
to patient’s legitimate needs and demands in best
possible way. Studies conducted in the past to assess
satisfaction level among dental patients have largely
focused on dental visits in general.20,21 Unfortunately
very little work has been done to evaluate level of satisfaction among Orthodontic patients. The objective
of this study was to assess level of satisfaction among
patients undergoing Orthodontic treatment.
METHODOLOGY
A descriptive cross sectional study was carried out
during the period of September 2013 to May 2014. A
questionnaire containing 17 close ended questions was
used for data collection. All the questions in the survey
form were assessed and redesigned various times to
create a questionnaire that would be friendly and easy
to follow. Questionnaire was tested in-house first, then
in the real situation. The questions addressed four
main categories; 1) Appointment facilities, 2) Behavior
of dentist and staff, 3) Quality, efficiency and cost of
TABLE 1: CROSS TABULATION PATIENTS AGE WITH VARIOUS FACTORS THAT CAN AFFECT
SATISFACTION LEVEL AMONG DENTAL PATIENTS
Factors that can affect satisfaction level
among dental patients
Satisfaction Levels With Respect
To Various Age Groups
12-18 years 19-24 years
n=171
n=144
Total
n=390
ChiSquare
P value
25 years &
above n=75
APPOINTMENTS FACILITIES
1.
It was easy to make appointment
96.5%
96%
96%
96.2%
0.2
2.
You were seen on time for your appointment without any delays
79%
77%
88%
81%
0.411
3.
Your dental treatment was completed
efficiently and in a timely manner.
77.2%
72.9%
76%
75.4%
0.000†
93%
96%
88%
92.3%
0.008†
INFRASTRUCTURE AND OTHER BASIC FACILITIES
4.
The clinical area was neat and clean.
5.
The equipment and instruments were
clean and presentable.
96.5%
87.5%
88%
91%
0.001†
6.
The temperature in the clinic was comfortable.
96.5%
98%
88%
94.1%
0.000†
7.
The lightening in the clinic was sufficient.
93%
96%
92%
94%
0.231
8.
Numbers of seats in waiting area are
enough.
49.1%
54.2%
56%
53.1%
0.238
94.7%
100%
100%
98.2%
0.019†
10. Dental assistant was courteous and polite.
91%
96%
100%
95.6%
0.002†
11. Receptionist was courteous, helpful and
polite.
100%
98%
92%
96.6%
0.001†
BEHAVIOR OF DENTIST AND STAFF
9.
Dentist was professional, courteous and
polite.
COST, QUALITY & EFFICIENCY OF TREATMENT PROVIDED
12. The cost was explained prior to treatment.
87.7%
87.5%
88%
87.7%
0.021†
13. The cost for Orthodontic treatment is fair.
81%
95.8%
96 %
91.2%
0.000†
14. You were pleased with the quality of your
dental treatment.
91%
94%
88%
91%
0.176
15. The Orthodontic treatment session was
completed to your satisfaction.
86%
85%
84%
85%
0.714
16. You plan to remain patient at our practice.
81%
91.7%
92%
88.2%
0.011†
17. You were satisfied with overall services
provided by Orthodontic Department
89%
90%
88%
89%
0.933
MEAN SATISFACTION LEVELS
87%
89%
88%
88%
† Statistically Significant (p < 0.05)
Pakistan Oral & Dental Journal Vol 34, No. 4 (December 2014)
652
Satisfaction level among Orthodontic patients
Fig 1: Distribution according to gender
Fig 5: Satisfaction levels according to age
participate, were included in this study. Receptionist at
front desk of Orthodontic department handed out questionnaires to patients at the end of their Orthodontic
session. Identities of patients were kept confidential by
placing a drop box in the waiting room, for patients to
return completed questionnaires. Patients were divided
into three groups according to age (12-18 years, 19-24
years, 25 years and above). Chi square test was used
to find association between patient’s age and various
factors that can affect satisfaction level among dental
patients. Data collected was analyzed using SPSS
software version 20.
Fig 2 : Distribution according to age
Fig 3: Distribution according to duration of visits
Fig 4 : Satisfaction levels according to gender
treatment provided, 4) Infrastructure and other basic
facilities. All patients attending Orthodontic department during that period, who voluntarily agreed to
Pakistan Oral & Dental Journal Vol 34, No. 4 (December 2014)
RESULTS
390 patients, 28.5% male and female 71.5% (Fig
1), voluntarily participated in the study. Mean age
of sample was 19.4 years with standard deviation ±
5.6. As shown in Fig 2, maximum number of patients
were in 12-18 year age group (43.8%) followed by
19-24 year age group (36.9% ). Total of 57.7% of the
patients who participated in this study were visiting
practice for more than 12 months (Fig 3). Professional,
courteous and polite behavior of dental professionals
showed highest percentage of satisfaction (98.2%).
96.2% of the patients agreed that it was easy to make
an appointment. More than two third of the patient’s
agreed that cleanliness of clinical area, cost, efficiency and quality of treatment provided by Orthodontic
department was up to the mark. In response to the
question concerning number of seats in waiting area,
only 53.1% of patients reported that they were satisfied
with the amount of chairs in the waiting area, which
took the lowest percentage of satisfaction. 89% of the
patients were satisfied with overall services provided
by Orthodontic department. On average, mean percentage of satisfaction among Orthodontic patients in all
four categories was 88%, demonstrating high level of
satisfaction (Table 1). Female patients showed higher
satisfaction rate in all categories than male patients
(Fig 4). Satisfaction rate was highest in 19-24 years
age group (Fig 5). Pearson Chi square test revealed
that association between patient’s age and factors like
behavior of dental professionals (p = 0.019), cost (p =
0.000), efficiency of treatment (p = 0.000), cleanliness
of equipment (p = 0.001) and neatness of clinical area
653
Satisfaction level among Orthodontic patients
(p = 0.008) were found to be statistically significant
with p value less than 0.05 (Table 1).
DISCUSSION
In any health care set up, patient satisfaction with
regards to quality of services and treatment provided
is a very important and sensitive issue. In Pakistan,
little work has been done to evaluate level of satisfaction among dental patients.22 Even those studies which
were conducted in past focused on general dental visits,
but not even a single study has been done in Pakistan
to investigate level of satisfaction among Orthodontic
patients. Results of current study showed that 98.2%
of Orthodontic patients were happy with the behavior of dentist while 95.6% of patients found dental
assistants to be courteous and polite. Various studies
conducted around the globe have established that
patient and dentist interaction is the most important
factor which can influences satisfaction level among
dental patients.7,18,23-25 Patients judge dentist skills
and quality of care they receive on the basis of their
personal interaction with dentist.18 Behavior of dentist
with patient, which must include showing empathy to
patient and reassuring them regarding their expectations and demands, needs to be given top priority by
all dental professionals.24 A study conducted in Australia by Sbaraini et al25 concluded that almost every
patient appreciated having a dedicated, supportive and
compassionate dentist and dental team who respected
them and paid attention to their concerns. They also
reported that as a result of courteous and polite behavior of these dental professionals, profound changes
were not only seen in oral health care routines of these
patients but it also changed patients attitude towards
their own oral health. These patients stated that they
complied with their dentists because they were treated
like a person and not as a patient. Khan26, El Amin27and
Lahti28 reported that qualifications and skills of dental
professionals were of secondary importance than their
behavior with patient. Few other studies conducted on
patients preferences of dental professional behavior
reported that majority of patients preferred a dentist
who explained to them before hand about the treatment
and procedures that needs to be performed.29
Adhering to strict protocols of sterilization and
cross-infection control is vital for every dental practice.
Karydis24 reported that main concern of majority of
patients visiting dental surgery was regarding sterilization and cross infection control. Patients confidence
in dental surgery can be hampered if patient is not
satisfied with sterilization and cross infection control
policies and practices of the clinics.30,31 Majority of
patients in this study were satisfied with the hygiene
of the clinical area and equipment used.
Cost is a key factor from patient’s perspective.32
High dental charges is one of the important factors
that can cause hindrance in patients visiting dental
professionals and seeking dental treatment.33 Results
of this study showed that 91.2% of patients visiting
Orthodontic department found cost of treatment to be
legitimate. Multiple studies in the past have reported
that patients prefer to visit teaching hospitals due to
decreased treatment cost and concession available on
Pakistan Oral & Dental Journal Vol 34, No. 4 (December 2014)
different dental services.30,34-36 Khan26 and Lahti28 reported that in Saudi patients cost was not an important
factor as major proportion of Saudi citizens are affording
and paying for their dental treatment does not affect
their monthly budget.
Long waiting time in dental clinics and lack of proper
waiting area is one of the main reasons of disappointment among dental patients.22,29,33,37-43 Extensive waiting
time just to get a dental appointment can also be one of
the main reasons of patient’s dissatisfaction.43 In this
study 96.2% of the patients agreed that it was easy
to make an appointment while only 53.1% of patients
were happy with amount of chairs in the waiting area.
Although a separate patient waiting area with ample
amount of chairs is available just adjacent to entrance
gate of Orthodontic clinical area, but for patient’s
convenience that area needs to be sign posted. Proper
appointments system with time schedule is followed to
minimize long waiting time that is the reason that 81%
of patients stated that they were seen on time, without
any delays, for their Orthodontic session and 75.4% of
the patient agreed that their treatment session was
completed efficiently in timely manner.
Results of this study showed that satisfaction level in
female patients were higher in all categories than male,
which is in agreement with various studies condwucted
around the globe.16,33,43 These higher satisfaction rates
among female patients can be due to their increased
exposure to dental care facilities and their modest
expectations and demands which are more likely to be
attained.16
In this study, mean percentage of satisfaction
among Orthodontic patients in all four categories was
88% while 89% of the patients stated that they were
satisfied with overall services provided by Orthodontic
department, demonstrating good level of satisfaction.
Results of this study are slightly lower than Bedi et al44
but they are better than those reported by Mahrous34
and Othamn.45 British Dental Association independent
polls reported that 9 out of 10 patients have confidence
in the dental treatment they receive.46 If dental professionals meet needs and demands of their patients and
consider patients best interest at heart, then patients
will be more satisfied with quality of care that their
dentist provide.
CONCLUSION
Mean percentage of satisfaction among Orthodontic
patients in all four categories was 88%. Satisfaction rate
was highest in 19-24 years age group. Female patients
showed higher satisfaction level in all categories than
male patients.
Evaluation of satisfaction is significant for almost
every dental care set-up. In Pakistan, more work needs
to be done in this domain. Regular feedback and evaluation of patient satisfaction level is essential in order
to further improve quality of services.
REFERENCES
1
Danish KF, Khan UA, Chaudhry T, Naseer M. Patient satisfaction; An experience at Islamic International Medical College/
Railway Hospital. Rawal Med J. 2008; 33: 245-48.
654
Satisfaction level among Orthodontic patients
2
3
4
5
6
7
8
9
Ntabaye MK, Scheutz F, Poulsen S. Patient satisfaction with
emergency oral healthcare in rural Tanzania. Comm Dent Oral
Epi.1998; 26: 289-95.
Howard JE. Customer service: The key to remaining competitive
in managed care. Managed Care. 2000; 8: 22-29.
Zeynep Or. Improving the performance of health care systems:
from measures to action. Review of experiences, in four OECD
countries. OECD. 2002; 87.
Ball R. Practical marketing for dentistry, part 3: Relationship
marketing and patient/customer satisfaction. Br Dent J. 1996;
180(12): 467-72.
Gurdal P, Cankaya H, Onem E, Dincer S, Yilmaz T. Factors of
patient satisfaction/dissatisfaction in a dental faculty outpatient
clinic in Turkey. Comm Dent Oral Epi. 2000; 28(6): 461-69.
Holt VP, McHugh K. Factor’s influencing patient loyalty to
dentist and dental practice. Br Dent J. 1997; 183(10): 365-70.
Thomson WM, Stewart JF, Carter KD, Spencer J. Patient mobility in Australian dentistry. Comm Dent Health. 1996; 13(2):
99-104.
Williams SJ, Calnan M. Convergence and divergence: assessing
criteria of consumer satisfaction across general practice, dental
and hospital care settings. Soc Sci Med. 1991; 33(6): 707-16.
10 Rao KD, Peters DH, Bandeen-Roche K. Towards patient centered
health services in India- A scale to measure patient perception
of quality. Int J Qual Health Care. 2006; 18: 414-21.
11 Prasad MV. Factors influencing patient satisfaction: Its impacts
on hospital success. Hosp Admn. 1995; 33: 27-35.
12 Kumar PD, Zahra F. Factor’s affecting patient satisfaction
among those attending an outpatient department in Chennai
city -India. J Indian Assoc Public Health Dent. 2008; 12: 15-19.
13 Oliver RL. Satisfaction: A Behavioral Perspective on the Consumer. New York City: Irwin/McGraw-Hill; 1997.
14 Spreng RA, MacKenzie SB, Olshavsky RW. A Re-examination
of the determinants of consumer satisfaction. J Mark. 1996;
60(3): 15-32.
15 Williams B, Healy D. The meaning of patient satisfaction: an
explanation of high reported levels. Soc Sci Med. 1998; 47(9):
1351-59.
16 Newsome PR, Wright GH. A review of patient satisfaction, part
2: dental patient satisfaction: an appraisal of recent literature.
Br Dent J. 1999; 186 (4, special issue): 166-70.
17 Kashinath KR, Bharateesh J, Agali C, Mythri H. “Factors Affecting Patient Satisfaction among those Attending an Outpatient
Department of a Dental College in Tumkur City – A Survey”.
J Dent Sci and Resr. 2010; 2: 1-10.
18 Riley JL, Gordan VV, Rindal DB, Fellows JL, Qvist V, Patel S.
Components of patient satisfaction with a dental restorative
visit: Results from the Dental Practice-Based Research Network.
J Am Dent Assoc. 2012; 143(9): 1002-1010.
19 Sreenivas T, Parsad G. Patient satisfaction, A comparative
study; J Acad Hosp Admn. 2003; 15(2): 07-12.
20 Calnan M, Dickinson M, Manley G. The quality of general
dental care: public and users’ perceptions. Qual Health Care.
1999; 8(3): 149-53.
21 Goedhart H, Eijkman MA. Quality of dental care: the view of
regular attenders. Comm Dent Oral Epi. 1996; 24(1): 28-31.
22 Asghar S, Fatima F. Assessment Of Patient's Satisfaction About
Dental Treatment/ Facilities Provided By Bahria Dental College
Hospital, Karachi. Pak Oral Dent J. 2013; 33(3): 535-38.
23 Dewi FD, Sudjana G, Oesman YM. Patient satisfaction analysis
on service quality of dental health care based on empathy and
responsiveness. Dent Res J. 2011; 8(4): 172-77.
24 Karydis A, Komboli-Kodovazeniti M, Hatzigeorgiou D, Panis
V. Expectations and perceptions of Greek patients regarding
the quality of dental health care. Int J Qual Health Care. 2001;
13(5): 409-16.
25 Sbaraini A, Carter SM, Evans RW, Blinkhorn A. Experiences of
Pakistan Oral & Dental Journal Vol 34, No. 4 (December 2014)
26
27
28
29
30
31
32
dental care: what do patients value? BMC Health Serv Res. 2012;
12:177.
Khan N, Hattan MA, Al-Qahtani T. A Survey Of Patients'
Opinion For Business And Professional Factors Affecting Private
Dental Practices In Riyadh, Saudi Arabia. J Dow Uni Health
Sci. 2007; 1(1): 3-9.
El-Amin EI, Al-Ghannam NA, Khan NB. Patients’ assessment
of the professional and business aspects of dental practice. Saudi
Dent J. 2004; 16: 107-12.
Lahti S, Tuutti H, Hausen H, Kääriäinen R. Dentist and patient
opinions about the ideal dentist and patient developing a compact
questionnaire. Comm Dent Oral Epid. 1992; 20: 229-34.
Van Groenestijn MAJ, Maas-De Waal CJ, Mileman PA, Swallow
JN. The ideal dentist. Soc Sci Med 1980; 14A: 533-40.
Awliya WY. Patient satisfaction with the dental services provided
by the Dental College of King Saud University. Saudi Dent J.
2003; 15: 11-16.
Boswell S. The patient’s perspective. Tex Dent J. 1994; 111:
30-31.
Tamaki Y, Nomura Y. Correlation between patient satisfaction
and dental clinic credibility in regular dental check-ups in Japan.
J Oral Sci. 2005; 47(2): 97-103.
33 Bamise CT, Bada TA, Bamise FO, Ogunbodede EO. Dental Care
Utilization and Satisfaction of Residential University Students.
Libyan J Med. 2008; 3: 140-3.
34 Mahrous MS, Hifnawy T. Patient satisfaction from dental services provided by the College of Dentistry. Taibah University,
Saudi Arabia. J Taibah Uni Med Sci. 2012; 7(2): 104-09.
35 Bitzer EM Mehrer L, Petrucci M, Hussein R, Micheelis W. Satisfaction with dental care from the patient’s perspective – the Dental-ZAP-V1, Gesundheitswesen; 2013; 75(06): 59-68. https://www.
thieme-connect.com/ejournals/abstract/10.1055/s-0032-1321763
36 Maynard K. Dental patients are largely satisfied with services.
Br Dent J. 2012; 212(12): 578.
37 Shresta A, Doshi D, Rao A, Sequeria P. Patient satisfaction at
rural outreach dental camps- a one year report. The International Electronic Journal of Rural and Remote Health research,
Education practice and Policy. 2008; 1-6.
38 Mascarenhas AK. Patient satisfaction with the comprehensive
care model of dental care delivery. J Dent Educ. 2001; 65: 126671.
39 Mahfouz AA, Al-Sharif AI, El-Gamal MN, Kisha AH. Primary
health care services utilization and satisfaction among the
elderly in Asir region, Saudi Arabia. East Mediterr Health J.
2004; 10: 365-71.
40 Sur H, Hayran O, Yildirim C, Mumcu G. Patient satisfaction
in dental outpatient clinics in Turkey. Croa Med J. 2004; 45:
651-54.
41 El Sabrawy AM, Mahamoud ME. A study of patient satisfaction
with primary health care services in Saudi Arabia. J Community
Health. 1993; 18: 49-54.
42 Evason E, Whittington D. Patient satisfaction studies; problems
and implications explored in a pilot study in Northern Ireland.
Health Educ J. 1991; 50: 73-77.
43 Al-Mudaf BA, Moussa MAA, Al-Terky MA, Al-Dakhil GD,
El-Farargy AE. Patient satisfaction with three dental specialty
sciences – A centre-based study. Med Prin Pract. 2003; 12(1):
39-43.
44 Bedi R, Gulati N, McGrath C. A study of satisfaction with dental
services among adults in the United Kingdom. Br Dent J. 2005;
198: 433-37.
45 Othman N, Razak IA. Satisfaction with school dental service
provided by mobile dental squads. Asia Pac J Public Health.
2010; 22(4): 415-25.
46 British Dental Association. Dentistry facts, Harris poll commissioned by the BDA on how people feel about their dentist.
Press and Parliamentary Department; 2001.
655