The study results indicate a rather high overall patient satisfaction among our MS patients, as almost 60% scored “to a large extent” or “to a very large extent” on the question “How satisfied are you with the help you have received for your MS disease at Sørlandet Hospital, Kristiansand”. The patients were also rather satisfied with the content of the follow-up, as the majority scored “to a large extent” or “to a very large extent” on trusting the physician’s competence, satisfaction with communication, and involvement in decision making. Among the variables evaluating content issues, the patients were least satisfied with the offered information. This underlines that continuous and customized information is fundamental. Previous studies have also highlighted the importance of satisfactory information being offered MS patients [1, 14].
The scores on questions regarding the structure and frequency of follow-up were generally lower than scores questions regarding content. According to Norwegian recommendations [2], MS patients should be assigned a contact physician, be offered at least annual follow-up, and have easy access to a contact physician between planned visits if required. Our results show that the out-patient follow-up of MS patients at Sørlandet Hospital, Kristiansand is neither as structured nor coordinated as guidelines recommend, and not as accessible as the patients wants. Interestingly, a Swedish study found almost similarly that only 65% of MS patients were satisfied with the accessibility of doctors, but as many as 80–90% were satisfied with engagement and treatment provided by the physician [15]. The identified suboptimal organization of our health care services should be met and efforts provided accordingly. Solutions to be considered may be to ensure allocation of a contact physician to every MS patient, to increase MS nurse services [16], to develop open rapid-access services [17] and to improve the interaction between primary and secondary care. In this context it is noteworthy that as many as 14% of our patients did not consult their GP at all about their MS, and 52% did so but only to a small extent. In a qualitative study from 2003 of care coordination, many patients reported that lack of communication between providers involved in their care was an obstacle to coordinated care [18].
Four variables were positively associated with overall satisfaction namely receiving the disease modifying drug natalizumab, satisfaction with frequency of out-patient appointments, experience that the physician facilitates talking about what is important for the patient, and confidence with the physician’s competence. The high overall satisfaction with health care among patients receiving natalizumab might be related to beneficial effects of natalizumab on disease activity, but might also be related to the close follow-up from specialized nurses and physicians when receiving this drug. Previous studies have also found that treatment with natalizumab have an impact on RR MS patients’ health related quality of life, regardless of disease progression [8].
As expected, satisfaction with accessibility to a physician perceived as trustworthy and qualified was associated with high overall patient satisfaction. Previous studies have also indicated that available physician services of high quality, including good communication and information, influence patient satisfaction and outcome [1, 2, 7, 12, 14, 15, 17].
Demographic factors and patient expectations did not show significant association with overall patient satisfaction. The first finding is in accordance with other studies [13, 14], whereas the latter is in contrast to other findings [12, 19]. The discrepancy may be due to inadequate interrogation of expectations in our study.
Strength and weaknesses
A strength of this study is that all patients with a definite diagnosis of MS with follow-up at Sørlandet Hospital, Kristiansand were invited to report their view. A weakness is that only 48% of them responded. This may have led to a selection bias probably towards overestimation of patient satisfaction. Due to the anonymity of the questionnaires we could not extract further data on the profiles of the non-responders. On the other hand anonymity can be considered beneficial by warranting more honest replies from patients. The distribution of demographics and disease characteristics however, indicate that our patients were quite representative for MS patients, and that our results are applicable for relevant MS care in a general neurology out-patient setting.
An R squared in the multivariate regression analysis of 0.673 indicates that several factors not assessed in this study may influence overall patient satisfaction. Such factors may be depression, side effects, co-morbidity and functional status, or care given by other health care professions than physicians. Further, a weakness with our regression analyses is that several variables significantly associated with overall satisfaction in univariate analyses were excluded due to missing values; for example satisfaction with duration of consultations, opinion of receiving wrong treatment, and availability of health personnel.