Satisfacción-Insatisfacción de Pacientes Respecto de la Atención Médica Recibida en Hospitales de Mediana Complejidad en Antioquia: una Relación Dialéctica
Resumen
Introducción. El constructo satisfacción-insatisfacción ha sido insuficientemente estudiado. Objetivo. Explorar las categorías de tensión al interior del constructo “satisfacción-insatisfacción” respecto a servicios de atención médica desde la perspectiva de los pacientes. Método. Investigación hermenéutica que usó la Teoría Fundamentada. Participaron usuarios de servicios médicos de consulta externa, hospitalización y urgencias, en hospitales de mediana complejidad en Antioquia. Fueron 21 entrevistas semiestructuradas, con preguntas abiertas que se modificaron según el avance del análisis sistemático, interactivo e iterativo propio de la metodología que incluyó codificación abierta, axial y selectiva. Resultados. Emergieron cuatro categorías que coexisten e interactúan en el marco del acto médico y por medio de la ley de la unidad, identidad y la lucha de los contrarios explican la tensión existente entre satisfacción-insatisfacción: lo afectivo referido al trato ofrecido por el médico; lo cognitivo relacionado con la capacidad explicativa del profesional; lo ético religioso referido al respeto por las creencias del paciente, y el resultado final del tratamiento y de la atención. Discusión. Una vez los pacientes confrontaron las expectativas previas con la atención recibida, se construyó un concepto que expresa confusos matices tanto positivos como negativos, pudiendo estar presentes ambas sensaciones en el mismo momento como resultado de la atención. Conclusión. El constructo satisfacción-insatisfacción de servicios de salud se entiende en su complejidad y profundo alcance en perspectiva dialéctica, pues no se trata de dos puntos opuestos y excluyentes, sino que se pueden expresar simultáneamente tras una atención.
Palabras clave:
Satisfacción del paciente, calidad de la atención de salud, atención al paciente, relaciones médicopaciente, resultado del tratamiento.
Texto completo:
Referencias
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Kravitz R. Patient satisfaction with health care: Critical outcome or trivial pursuit? J Gen Intern Med [Internet]. 1998;13(4):280–2. [En línea] http://dx.doi.org/10.1046/j.1525-1497.1998.00084.x
Alzoubi MM, Hayati KS, Rosliza AM, Ahmad AA, Al-Hamdan ZM. Total quality management in the health-care context: integrating the literature and directing future research. Risk Manag Healthc Policy [Internet]. 2019;12:167–77. [En línea] http://dx.doi.org/10.2147/RMHP.S197038
Alibrandi A, Gitto L, Limosani M, Mustica PF. Patient satisfaction and quality of hospital care. Eval Program Plann [Internet]. 2023;97(102251):102251. [En línea] http://dx.doi.org/10.1016/j.evalprogplan.2023.102251
Lescher M, Sirven N. Healthcare quality, patients’ satisfaction, and hospital incentives in France. Rev Econ Polit [Internet]. 2019;129(4):525–51. [En línea] http://dx.doi.org/10.3917/redp.294.0525
Pękacz A, Kądalska E, Skoczylas A, Targowski T. Patient satisfaction as an element of healthcare quality - a single-center Polish survey. Reumatologia 15 [Internet]. 2019;57(3):135–44. [En línea] http://dx.doi.org/10.5114/reum.2019.86423
Egbon HO, Barnabas AA. Quality of healthcare services and patients’ satisfaction in University of Benin Teaching Hospital. Accounting and taxation review [Internet]. 2020 4(2): 148-161. [En línea] https://www.atreview.org/home/abstract.php?id=118&aTitle=Quality%20of%20Healthcare%20Services%20and%20Patients
Donabedian A. The epidemiology of quality. Inquiry. Otoño de 1985;22(3):282–92.
Chandra S, Ward P, Mohammadnezhad M. Factors associated with patient satisfaction in outpatient department of Suva sub-divisional health center, Fiji, 2018: A mixed method study. Front Public Health [Internet]. 2019;7:183. [En línea] http://dx.doi.org/10.3389/fpubh.2019.00183
Manzoor F, Wei L, Hussain A, Asif M, Shah SIA. Patient satisfaction with health care services; An application of physician’s behavior as a moderator.Int J Environ Res Public Health [Internet]. 2019;16(18):3318. [En línea] http://dx.doi.org/10.3390/ijerph16183318
Tucker JL. The moderators of patient satisfaction. J Manag Med [Internet]. 2002;16(1):48–66. [En línea] http://dx.doi.org/10.1108/02689230210428625
Boran ÖF, Günay O, Günay AE, Boran M, Bilal B, Bakacak M, et al. Factors affecting perioperative patient satisfaction with regional anesthesia: A patient-centered survey study. Clin Exp Health Sci [Internet]. 2022;12(2):401–9. [En línea] http://dx.doi.
org/10.33808/clinexphealthsci.1136625
Zikusooka M, Hanna R, Malaj A, Ertem M, Elci OC. Factors affecting patient satisfaction in refugee health centers in Turkey. PLoS One [Internet]. 2022;17(9):e0274316. [En línea] http://dx.doi.org/10.1371/journal.pone.0274316
Leppänen S, Niemeläinen M, Huhtala H, Eskelinen A. Mild knee osteoarthritis predicts dissatisfaction after total knee arthroplasty: a prospective study of 186 patients aged 65 years or less with 2-yearfollow-up. BMC Musculoskelet Disord [Internet].
2021;22(1):657. [En línea] http://dx.doi.org/10.1186/s12891-021-04543-8
Travers JL, Le C, Desai MM, Merrill JA. Factors associated with dissatisfaction in medical care quality among older Medicare beneficiaries suffering from mental illness. J Aging Soc Policy [Internet]. 2021;33(1):51–66. [En línea] http://dx.doi.org/10.1080/08959420.2019.1628624
Sardar T, Khan IA, Khan MA. Patients’ satisfaction about health care delivery in out-Patients Department of Combined Military Hospital Rawalpindi. Pak Armed Force Med J [Internet]. 2020;70(6):1929–34. [En línea] http://dx.doi.org/10.51253/pafmj.v70i6.5850
Weber U, Zhang Q, Ou D, Garritano J, Johnson J, Anderson N, et al. Predictors of family dissatisfaction with support during neurocritical care shared decision-making. Neurocrit Care [Internet]. 2021;35(3):714–22. [En línea] http://dx.doi.org/10.1007/s12028-021-01211-6
Chiloiro G, Romano A, D’Aviero A, Dinapoli L, Zane E, Tenore A, et al. Patients’ satisfaction by SmileInTM totems in radiotherapy: A two-year mono-institutional experience. Healthcare (Basel) [Internet]. 2021;9(10):1268. [En línea] http://dx.doi.org/10.3390/healthcare9101268
Yepes CE. Encuentros dispares generadores de dependencia en la atención en salud: estudio cualitativo sobre la percepción de la calidad en salud. Rev. Fac. Nac. Salud Pública 2002; 20(1): 9-22.
Strauss AL, Corbin J. Basics of qualitative research grounded theory procedures and techniques. 1st ed. Sage Publications; 1990.
Blumer H. Symbolic interactionism: Perspective and method. Univ of California Press, 1986.
Charmaz K. Constructing grounded theory: a practical guide through qualitative analysis. Sage Publications, 2006.
Glaser BG. Emergence vs forcing basics of grounded theory, strategies for qualitative research. 1st ed. Mill Valley: Sociology Press; 1992.
Yepes, C. Teoría Fundamentada para investigación cualitativa en Medicina. Editorial EIA. Primera edición Medellín, Colombia 2023.
Engward H, Davis G. Being reflexive in qualitative grounded theory: discussion and application of a model of reflexivity. J Adv Nurs [Internet]. 2015;71(7):1530–8. [En línea] http://dx.doi.org/10.1111/jan.12653
Al-Assaf AF, Schmele J, eds. The textbook of total quality in healthcare. CRC Press; 1993.
Cleary PD, McNeil BJ. Patient satisfaction as an indicator of quality care. Inquiry. primavera de 1988;25(1):25–36.
Sitzia J, Wood N. Patient satisfaction: a review of issues and concepts. Soc Sci Med [Internet]. 1997;45(12):1829–43. [En línea] http://dx.doi.org/10.1016/s0277-9536(97)00128-7
Ng JHY, Luk BHK. Patient satisfaction: Concept analysis in the healthcare context. Patient Educ Couns [Internet]. 2019;102(4):790–6. [En línea] http://dx.doi.org/10.1016/j.pec.2018.11.013
Henderson A. Perspectives and practice: the satisfaction construct. Qual Res J [Internet]. 2006;6(1):20–35. Disponible en: http://dx.doi.org/10.1108/14439883200600002
Schultz A. The Phenomenology of the Social World. Chicago, IL: Northwestern University Press; 1972.
Jenkinson C, Coulter A, Bruster S, Richards N, Chandola T. Patients’ experiences and satisfaction with health care: results of a questionnaire study of specific aspects of care. Qual Saf Health Care [Internet]. 2002;11(4):335–9. [En línea] http://dx.doi.
org/10.1136/qhc.11.4.335
Makirriain, JMZ. El materialismo dialéctico, fundamento de la psicología soviética.IJP&PT. 2006;6(1): 21-50.
Melesse D, Tesfu M, Mantefard B. Level of clients’ satisfaction and associated factors with the service of out-patient department in Dilla university referral hospital, southern Ethiopia, 2021. Adv Public Health [Internet]. 2022;2022:1–8. [En línea] http://dx.doi.org/10.1155/2022/6451755
Chandra S, Mohammadnezhad M, Ward P. Trust and Communication in a Doctor-Patient Relationship: A Literature Review. J Healthc Commun. 2018; 3(3):36. [En línea] https://doi.org/10.4172/2472-1654.100146.
Williams B. Patient satisfaction: a valid concept? Soc Sci Med [Internet]. 1994;38(4):509–16. [En línea] http://dx.doi.org/10.1016/0277-9536(94)90247-x
Tallman K, Janisse T, Frankel RM, Sung SH, Krupat E, Hsu JT. Communication practices of physicians with high patient-satisfaction ratings. Perm J [Internet]. invierno de 2007;11(1):19–29. [En línea] http://dx.doi.org/10.7812/TPP/06-106
Kee JWY, Khoo HS, Lim I, Koh MYH. Communication skills in patient-doctor interactions: Learning from patient complaints. Health Prof Educ [Internet]. 2018;4(2):97–106. [En línea] http://dx.doi.org/10.1016/j.hpe.2017.03.006
Broniatowski DA, Klein EY, Reyna VF. Germs are germs, and why not take a risk? Patients’ expectations for prescribing antibiotics in an innercity emergency department. Med Decis Making [Internet]. 2015;35(1):60–7. [En línea] http://dx.doi.org/10.1177/0272989X14553472
Alby JC. Milagros de curación en la tradición médica tardo-antigua. Teol Vida [Internet]. 2015;56(2):219–38. [En línea] http://dx.doi.org/10.4067/s0049-34492015000200003
Shakespeare W. Macbeth. 1623.
Prestes C. Religión como tratamiento complementario, posibles consecuencias en la terapéutica. Revisión. Humanidades Rev la Univ Montevideo. 2017;135–53. [En línea] https://doi.org/10.25185/1.8.
Kuipers SJ, Cramm JM, Nieboer AP. The importance of patient-centered care and co-creation of care for satisfaction with care and physical and social wellbeing of patients with multi-morbidity in the primary care setting. BMC Health Serv Res [Internet]. 2019;19(1). [En línea] http://dx.doi.org/10.1186/s12913-018-3818-y
Kravitz R. Patient satisfaction with health care: Critical outcome or trivial pursuit? J Gen Intern Med [Internet]. 1998;13(4):280–2. [En línea] http://dx.doi.org/10.1046/j.1525-1497.1998.00084.x
Alzoubi MM, Hayati KS, Rosliza AM, Ahmad AA, Al-Hamdan ZM. Total quality management in the health-care context: integrating the literature and directing future research. Risk Manag Healthc Policy [Internet]. 2019;12:167–77. [En línea] http://dx.doi.org/10.2147/RMHP.S197038
Alibrandi A, Gitto L, Limosani M, Mustica PF. Patient satisfaction and quality of hospital care. Eval Program Plann [Internet]. 2023;97(102251):102251. [En línea] http://dx.doi.org/10.1016/j.evalprogplan.2023.102251
Lescher M, Sirven N. Healthcare quality, patients’ satisfaction, and hospital incentives in France. Rev Econ Polit [Internet]. 2019;129(4):525–51. [En línea] http://dx.doi.org/10.3917/redp.294.0525
Pękacz A, Kądalska E, Skoczylas A, Targowski T. Patient satisfaction as an element of healthcare quality - a single-center Polish survey. Reumatologia 15 [Internet]. 2019;57(3):135–44. [En línea] http://dx.doi.org/10.5114/reum.2019.86423
Egbon HO, Barnabas AA. Quality of healthcare services and patients’ satisfaction in University of Benin Teaching Hospital. Accounting and taxation review [Internet]. 2020 4(2): 148-161. [En línea] https://www.atreview.org/home/abstract.php?id=118&aTitle=Quality%20of%20Healthcare%20Services%20and%20Patients
Donabedian A. The epidemiology of quality. Inquiry. Otoño de 1985;22(3):282–92.
Chandra S, Ward P, Mohammadnezhad M. Factors associated with patient satisfaction in outpatient department of Suva sub-divisional health center, Fiji, 2018: A mixed method study. Front Public Health [Internet]. 2019;7:183. [En línea] http://dx.doi.org/10.3389/fpubh.2019.00183
Manzoor F, Wei L, Hussain A, Asif M, Shah SIA. Patient satisfaction with health care services; An application of physician’s behavior as a moderator.Int J Environ Res Public Health [Internet]. 2019;16(18):3318. [En línea] http://dx.doi.org/10.3390/ijerph16183318
Tucker JL. The moderators of patient satisfaction. J Manag Med [Internet]. 2002;16(1):48–66. [En línea] http://dx.doi.org/10.1108/02689230210428625
Boran ÖF, Günay O, Günay AE, Boran M, Bilal B, Bakacak M, et al. Factors affecting perioperative patient satisfaction with regional anesthesia: A patient-centered survey study. Clin Exp Health Sci [Internet]. 2022;12(2):401–9. [En línea] http://dx.doi.
org/10.33808/clinexphealthsci.1136625
Zikusooka M, Hanna R, Malaj A, Ertem M, Elci OC. Factors affecting patient satisfaction in refugee health centers in Turkey. PLoS One [Internet]. 2022;17(9):e0274316. [En línea] http://dx.doi.org/10.1371/journal.pone.0274316
Leppänen S, Niemeläinen M, Huhtala H, Eskelinen A. Mild knee osteoarthritis predicts dissatisfaction after total knee arthroplasty: a prospective study of 186 patients aged 65 years or less with 2-yearfollow-up. BMC Musculoskelet Disord [Internet].
2021;22(1):657. [En línea] http://dx.doi.org/10.1186/s12891-021-04543-8
Travers JL, Le C, Desai MM, Merrill JA. Factors associated with dissatisfaction in medical care quality among older Medicare beneficiaries suffering from mental illness. J Aging Soc Policy [Internet]. 2021;33(1):51–66. [En línea] http://dx.doi.org/10.1080/08959420.2019.1628624
Sardar T, Khan IA, Khan MA. Patients’ satisfaction about health care delivery in out-Patients Department of Combined Military Hospital Rawalpindi. Pak Armed Force Med J [Internet]. 2020;70(6):1929–34. [En línea] http://dx.doi.org/10.51253/pafmj.v70i6.5850
Weber U, Zhang Q, Ou D, Garritano J, Johnson J, Anderson N, et al. Predictors of family dissatisfaction with support during neurocritical care shared decision-making. Neurocrit Care [Internet]. 2021;35(3):714–22. [En línea] http://dx.doi.org/10.1007/s12028-021-01211-6
Chiloiro G, Romano A, D’Aviero A, Dinapoli L, Zane E, Tenore A, et al. Patients’ satisfaction by SmileInTM totems in radiotherapy: A two-year mono-institutional experience. Healthcare (Basel) [Internet]. 2021;9(10):1268. [En línea] http://dx.doi.org/10.3390/healthcare9101268
Yepes CE. Encuentros dispares generadores de dependencia en la atención en salud: estudio cualitativo sobre la percepción de la calidad en salud. Rev. Fac. Nac. Salud Pública 2002; 20(1): 9-22.
Strauss AL, Corbin J. Basics of qualitative research grounded theory procedures and techniques. 1st ed. Sage Publications; 1990.
Blumer H. Symbolic interactionism: Perspective and method. Univ of California Press, 1986.
Charmaz K. Constructing grounded theory: a practical guide through qualitative analysis. Sage Publications, 2006.
Glaser BG. Emergence vs forcing basics of grounded theory, strategies for qualitative research. 1st ed. Mill Valley: Sociology Press; 1992.
Yepes, C. Teoría Fundamentada para investigación cualitativa en Medicina. Editorial EIA. Primera edición Medellín, Colombia 2023.
Engward H, Davis G. Being reflexive in qualitative grounded theory: discussion and application of a model of reflexivity. J Adv Nurs [Internet]. 2015;71(7):1530–8. [En línea] http://dx.doi.org/10.1111/jan.12653
Al-Assaf AF, Schmele J, eds. The textbook of total quality in healthcare. CRC Press; 1993.
Cleary PD, McNeil BJ. Patient satisfaction as an indicator of quality care. Inquiry. primavera de 1988;25(1):25–36.
Sitzia J, Wood N. Patient satisfaction: a review of issues and concepts. Soc Sci Med [Internet]. 1997;45(12):1829–43. [En línea] http://dx.doi.org/10.1016/s0277-9536(97)00128-7
Ng JHY, Luk BHK. Patient satisfaction: Concept analysis in the healthcare context. Patient Educ Couns [Internet]. 2019;102(4):790–6. [En línea] http://dx.doi.org/10.1016/j.pec.2018.11.013
Henderson A. Perspectives and practice: the satisfaction construct. Qual Res J [Internet]. 2006;6(1):20–35. Disponible en: http://dx.doi.org/10.1108/14439883200600002
Schultz A. The Phenomenology of the Social World. Chicago, IL: Northwestern University Press; 1972.
Jenkinson C, Coulter A, Bruster S, Richards N, Chandola T. Patients’ experiences and satisfaction with health care: results of a questionnaire study of specific aspects of care. Qual Saf Health Care [Internet]. 2002;11(4):335–9. [En línea] http://dx.doi.
org/10.1136/qhc.11.4.335
Makirriain, JMZ. El materialismo dialéctico, fundamento de la psicología soviética.IJP&PT. 2006;6(1): 21-50.
Melesse D, Tesfu M, Mantefard B. Level of clients’ satisfaction and associated factors with the service of out-patient department in Dilla university referral hospital, southern Ethiopia, 2021. Adv Public Health [Internet]. 2022;2022:1–8. [En línea] http://dx.doi.org/10.1155/2022/6451755
Chandra S, Mohammadnezhad M, Ward P. Trust and Communication in a Doctor-Patient Relationship: A Literature Review. J Healthc Commun. 2018; 3(3):36. [En línea] https://doi.org/10.4172/2472-1654.100146.
Williams B. Patient satisfaction: a valid concept? Soc Sci Med [Internet]. 1994;38(4):509–16. [En línea] http://dx.doi.org/10.1016/0277-9536(94)90247-x
Tallman K, Janisse T, Frankel RM, Sung SH, Krupat E, Hsu JT. Communication practices of physicians with high patient-satisfaction ratings. Perm J [Internet]. invierno de 2007;11(1):19–29. [En línea] http://dx.doi.org/10.7812/TPP/06-106
Kee JWY, Khoo HS, Lim I, Koh MYH. Communication skills in patient-doctor interactions: Learning from patient complaints. Health Prof Educ [Internet]. 2018;4(2):97–106. [En línea] http://dx.doi.org/10.1016/j.hpe.2017.03.006
Broniatowski DA, Klein EY, Reyna VF. Germs are germs, and why not take a risk? Patients’ expectations for prescribing antibiotics in an innercity emergency department. Med Decis Making [Internet]. 2015;35(1):60–7. [En línea] http://dx.doi.org/10.1177/0272989X14553472
Alby JC. Milagros de curación en la tradición médica tardo-antigua. Teol Vida [Internet]. 2015;56(2):219–38. [En línea] http://dx.doi.org/10.4067/s0049-34492015000200003
Shakespeare W. Macbeth. 1623.
Prestes C. Religión como tratamiento complementario, posibles consecuencias en la terapéutica. Revisión. Humanidades Rev la Univ Montevideo. 2017;135–53. [En línea] https://doi.org/10.25185/1.8.
Kuipers SJ, Cramm JM, Nieboer AP. The importance of patient-centered care and co-creation of care for satisfaction with care and physical and social wellbeing of patients with multi-morbidity in the primary care setting. BMC Health Serv Res [Internet]. 2019;19(1). [En línea] http://dx.doi.org/10.1186/s12913-018-3818-y
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