Patient Satisfaction with Quality of Care of a New Multidisciplinary Thrombosis Service

INTRODUCTION

As patient centered healthcare is becoming increasingly popular, it is important to assess patient satisfaction with this approach. We started a new multidisciplinary Adult Outpatient Thrombosis Service (TS) in October 2017 in a Canadian health authority servicing over 300 000 people. The TS is a comprehensive thrombosis and anticoagulation management program with unique, interrelated clinics providing the spectrum of care required for this patient group. The TS includes an Emergency Thrombosis Clinic for care after an acute episode of venous thromboembolism; Thrombosis Clinics addressing non-urgent thrombosis questions and follow up; Anticoagulation Management Clinics for patients on extended duration anticoagulation; and a Perioperative Anticoagulation Management Clinic for patients on anticoagulation requiring surgery or procedures. The TS is staffed by Pharmacists, a Thrombosis Physician/Hematologist, and Clerical staff. The objective of this study was to assess patient satisfaction with the TS.

METHODS

We conducted a cross sectional survey of patients attending at least one appointment at the TS between October 2017 and May 2019 and who had a valid mailing address available in the hospital records. Eligible patients (n=1058) were mailed an anonymous survey with a cover letter and self-addressed, return stamped envelope.

Patient satisfaction with the TS was measured using the seven item Short Assessment of Patient Satisfaction (SAPS), a validated, convenient satisfaction survey tool. The SAPS assesses the core satisfaction domains including treatment satisfaction, explanation of treatment results, clinician care, participation in decision-making, respect by the clinician, time with the clinician, and satisfaction with clinic care. The SAPS utilizes 5-point responses (0-4), with the continuous score range from 0 (extremely dissatisfied) to 28 (extremely satisfied), and categorical responses (0-10 very dissatisfied, 11-18 dissatisfied, 19-26 satisfied, and 27-28 very satisfied). Additionally, five patient characteristic questions were included. Patients were also given the opportunity to respond to an open-ended question regarding the care they received. Participant characteristics and responses are presented using descriptive statistics; linear regression was used to explore variations across characteristics. Qualitative content analysis of open-ended question comments was used to further our understanding of the patient experience and perceived quality of care.

RESULTS

A total of 563 surveys were returned for a response rate of 53%. Nine were excluded due to more than 2 missing SAPS item answers. Most respondents (87%, n=481) were 50 years of age or older, and 51% (n=285) were male. About two-thirds (67%, n=368) had post-secondary education. About half (54%, n=296) were taking a direct oral anticoagulant (DOAC), about one fifth taking warfarin (19%, n=102), or on no anticoagulant (19%, n=104) at the time of survey response. Almost half had taken the anticoagulant for 1 to 5 years at the time of survey response (47%, n=255), with the remainder split between less than 1 year (28%, n=152), and greater than 5 years (25%, n=137). The mean score for the SAPS was 22.1 (SD 4.1, range 8 to 28). Based on the categorical response, 85% were satisfied or very satisfied with the TS. Multivariate analysis showed that patients with post-secondary education were more satisfied with the TS (β=16.153, p=0.024), and patients taking warfarin were less satisfied with the TS (β= -15.832, p=0.039). The SAPS tool demonstrated a high internal consistency when assessed for reliability using Composite reliability tests (0.86).

Forty percent (n=223) provided written responses to the open-ended question. The majority of responses described positive patient experiences and perceptions regarding the TS and quality of care received. Four major themes emerged: service organization and coordination of care, patient-provider relationship, pharmacist-led medication therapy management, and patient-centered delivery and communication of health information.

CONCLUSION

To our knowledge, this is the first survey to assess patient satisfaction with a multidisciplinary TS. We found a high proportion (85%) of respondents were satisfied with the care provided.