Despite the decrease observed in visits to the ED among
patients satisfied with their health care use, spending and overall outcomes,
patient satisfaction was associated with increased inpatient use, mortality and
drug expenditures. The findings were published in Archives of Internal
Medicine.
“Our findings raise concerns that efforts to
satisfy patients may have downsides if they lead to unnecessary care that comes
with health risks without benefits,” Joshua J. Fenton, MD, MPH, of
the University of California, Davis, told Endocrine Today.
For the prospective cohort study, Fenton and colleagues
pooled data on 51,946 adults included in the national Medical Expenditure Panel
Survey between 2000 and 2007. Patient satisfaction was assessed during the
first year; health care utilization and expenditures during the second year;
and mortality during an average follow-up of 3.9 years.
Compared with patients in the lowest satisfaction
quartile, patients in the highest satisfaction quartile were less likely to
visit the ED (OR=0.92; 95% CI, 0.84-1.0); more likely to be admitted to the
hospital (OR=1.12; 95% CI, 1.02-1.23); had 8.8% greater total expenditures (95%
CI, 1.6-16.6); 9.1% greater prescription drug expenditures (95% CI, 2.3-16.4);
and higher mortality (HR=1.26; 95% CI, 1.05-1.53).
“[Patients] should be satisfied with doctors who
provide timely, personalized care and advice in an empathic way,” Fenton
said. “Patients who are satisfied with doctors who provide requested tests
or treatments may be in danger of getting over-tested, over-treated or
inappropriately treated with potential risks and no benefits.
“Evaluating patient satisfaction is a very
important practice for health care institutions, and patients should be
satisfied with the care they receive,” he said. “Striving for patient
satisfaction, however, should not overpower the doctor–patient
relationship. A weakness of most health systems in the United States is that
doctors do not have enough time to do this, even though it could have huge
health benefits while also reducing costs. We also need to establish wise
policies — including physician incentive policies — so that patient
satisfaction is not the sole driver of
quality
improvement.”
For more information:
Disclosure: The researchers report no relevant
financial disclosures.