Keywords: Quality, Satisfaction, Users, Outpatient consultation, SERVQUAL.

ABSTRACT

The quality of medical care is a right of the Nicaraguan population that guarantees humanized supportive care. It has a preventive and a corrective function; Both functions are a fundamental pillar to provide maximum benefit to users who receive health care. Objective: To analyze the perception of quality of care of patients attending the outpatient clinic of the Villa Libertad health center in the city of Managua in the period from June to July 2022. Methodological Design: It was a descriptive cross-sectional study, with a universe of 600 users and, a sample of 245 users, was a survey, which included the SERVQUAL questionnaire adapted to health services, containing 22 questions of expectations and 22 perceptions, with five dimensions: tangible goods, reliability, responsiveness, security, and empathy. The collected data were entered into an Epi info database. Results: Se conducted 245 surveys of which the age that most attended the unit were 28 to 37 years, the majority was male (53.5%), the marital status that predominated was married (58.4%), the urban population prevailed (8 8.57%), the secondary education level predominated (57.1%) and the working occupation prevailed (35.9%). The appearance of the equipment was in excellent condition (51.02%)), the appearance of workers was satisfactory (50.2%)), the perception of cleanliness (40.8%)), with a high level of problem-solving (50 .2%), scheduled schedule attention was satisfactory (50.2%), the information provided by the outpatient clinic was satisfactory (5 3.5%), they are very satisfied with the waiting time (50.2 %), the duration of attention received was satisfactory (5 2.7%), regarding the stable and appropriate hour of attention users said they felt very satisfied (5 5.9%), most users said that if they received information on hours of operation ( 56.3%). Conclusions: The results indicate that the population feels very satisfied with the services provided in the outpatient clinic of the unit.

INTRODUCTION

Donabedian defines quality in health as the ability of health services to provide the greatest benefits with the least risks to the user based on available resources and social values.

The SERVQUAL quality of service model was proposed by Parasuraman, Zethaml, and Berry in 1988, whose purpose of evaluating the quality of services includes five dimensions: reliability, responsiveness, security, empathy, and tangible elements. This instrument contrasts what the user expects from the service they are consulting with what they perceive from it. It is worth mentioning that SERVQUAL is a generic model, which has been used internationally and was validated for the first time in Latin America in 1992 by Michelsen Consulting and the Latin American Institute for Quality in Services.

In Nicaragua there is no validation at the national level, however, a meta-analysis: Evaluation of the quality of health services was carried out with the SERVQUAL survey in academic research of master’s programs at the CIES UNAN HEALTH RESEARCH AND STUDY CENTER MANAGUA, NICARAGUA. (Bolaños, 2018)

Nicaragua’s national health policy, in its fifth principle, focuses on the quality of health care provided to the population.

Health actions and services must be proven effective, accepted, and generate satisfaction in the population at the lowest possible cost and risk, and it should be noted that these principles are based on Article 59 of the Political Constitution of the Republic.

Various research studies have been carried out related to the satisfaction of users, both external and internal, at the different levels of health care, among which we can mention:

In 2019, Moreno said he evaluated the quality of care at the Matagalpa hospital, finding that 80% of patients were very satisfied with the care they received.

In 2019, Castellón also found a satisfaction of 95% at the Baptist Hospital in Managua.

In 2017, Orozco determined adequate satisfaction at 85.6%.

In 2018, Bedoya, Chacón, and Noquera pointed out that the quality of the health care they receive from health professionals and the perception of the institution’s infrastructure is perceived to be satisfied with the care received.

Nowadays, strategies are being implemented to improve the quality of services, user satisfaction is a fundamental indicator in terms of quality care. To this end, the SERVQUAL instrument is used, which objectively measures the quality of care provided by health services according to the level of satisfaction. The data obtained through this instrument will enhance the response capacity.

The quality of care provided by health services, measured through the level of user satisfaction, is an important evaluation axis of the current health system. Therefore, the present study aims to identify the satisfaction of the users of different services attended in the outpatient clinic of the Villa Libertad Health Center.

The aim is for the opinions expressed by external users to contribute to organizational decision-making, as well as to provide input and motivate workers to achieve an improvement in their quality.

MATERIAL AND METHODS

Type of study: Descriptive cross-sectional study to evaluate the quality of a service provided to the general population.

Study Area: The study was conducted at the Villa Libertad Health Center located in District VII of the Municipality of Managua.

Unit of analysis: The unit of analysis is made up of the users of the outpatient clinic who came to receive care at the Villa Libertad Health Center. come from the areas of General Medicine, Internal Medicine, and Gynecology.

Population under study: The universe consisted of 600 patients who attended during the study period, with a sample of 245, To estimate the sample size, the average daily care of patients during the study period is taken into consideration, in the most demanded services and using purposive or convenience sampling, through the survey it was possible to obtain the Perception of quality of care. The result of the sample was chosen by the non-probabilistic convenience method. This survey, in its structure, collects sociodemographic data of the patients, as well as the assessment of the infrastructure of the institution and the process of care for users, taking into account the efficiency, effectiveness, and effectiveness of the health personnel. This instrument assesses the three essential dimensions of quality, such as structure, process, and results obtained.

Inclusion Criteria:

• Those users > 15 years old were trained to take the survey.

•Patients are seen within the hours established by the center.

•Patients treated in outpatient clinics are then transferred to the pharmacy area.

•Patients seen in outpatient clinics who wish to voluntarily participate in the survey.

Exclusion Criteria:

•Users served outside the outpatient consultation area.

•People who can’t communicate verbally.

•Internal users or workers of the Health Center.

•Patients seen in outpatient clinics who do not wish to participate in the survey voluntarily.

Information collection techniques and methods: The information used was through the application of surveys to study patients, the data were processed electronically using the Epi Info program, recording them in tables for their respective analysis. Concerning ethical considerations, for the collection of information, the information was handled confidentially and only for the study. Authorization was obtained from the corresponding authorities of SILAIS Managua.

RESULTS

Table 1

Sociodemographic characteristics of patients treated at C/S Villa Libertad, Managua, June – July 2022.

Feature	No	%
Age in Years 18 - 27 28 - 37 38 - 47 48 – 58 ≥ to 59	43 85 59 52 03	18% 35% 24% 22% 01%
Sex Female Male	114 131	46.5% 53.5%
Origin Rural Urban	28 217	11.4% 88.6%
Marital status Accompanied Married Bachelor	48 143 54	19.6% 58.4% 22.0%
Schooling Illiterate Primary High school Student	20 39 140 46	8.2% 15.9% 57.1% 18.8%
Occupation Eagerness Housewife Worker Professional Technician	25 48 88 48 36	10.2% 19.6% 35.9% 19.6% 14.7%
n=245

Source: Survey of patients treated at the Villa Libertad Health Center

According to the main sociodemographic characteristics of the patients under study, it was observed that the predominance of the male sex (53.5%), urban origin (88.6%), married marital status (58.4%), as well as secondary education (57.1%) and occupation as a laborer (35.9%) (Table 1).

Figure 1: User satisfaction about the appearance of
care teams. (n=245)

Source: Survey of patients treated at the Villa Libertad Health Center

In the assessment of the “Appearance of the work teams” of the external consultation before the respondents, it was found that 51% (125) were in total agreement with their appearance, followed by 39% (96) who reported “Agree” (Graph 1).

Figure 2

User feedback on the cleaning service. (n=245)

Source: Survey of patients treated at the Villa Libertad Health Center

Graph 2 shows patient satisfaction with the “Cleaning Service”, where 50% (120) of patients “Totally agree” predominated (Graph 2).

Figure 3
Perception of the interest in solving the problems of the users in the external consultation (n=245)

Source: Survey of patients treated at the Villa Libertad Health Center

Regarding the “Interest the external consultation in problem-solving”, 50% (123) of the users were in total agreement with the interest, and 40% (98) agreed. (Figure 3).

Figure 4
User perception regarding health care at scheduled times in the outpatient clinic (n=245)

Source: Survey of patients treated at the Villa Libertad Health Center

About “Health care at scheduled times”, 50% (123) of users said they were in complete agreement with the scheduled schedules, and 33% (81) said they agreed. (Figure 4).

Figure 5
Informacion sobre el servicio a brindar en la consulta externa (n=245)

Source: Survey of patients treated at the Villa Libertad Health Center

When evaluating the information about the service to be provided, users reported 54% (131) who agreed, 39% (96 patients) agreed, and 5% (11). (Figure 5).

Figure 6
Apreciacion del usuario respecto al timepo de espera para la consulta externa (n=245)

Source: Survey of patients treated at the Villa Libertad Health Center

Regarding the “Waiting time to be attended”, 50% (123) reported being “totally in agreement”, followed by 31% who said they agreed. (Figure 6).

Figure 7
User's assessment regarding the duration of the consultation (n=245)

Source: Survey of patients treated at the Villa Libertad Health Center

About the “Duration of care received”, 53% (129) of users reported that they were in complete agreement and 38% (94) that they agreed (Graph 7).

Figure 8
Apreciacion del usuario respecto a la estable y apropiada hora de atencion en la consulta externa (n=245)

Source: Survey of patients treated at the Villa Libertad Health Center

Regarding “Stability and appropriate hours of service”, 56% (137) of the users who participated responded as “in complete agreement, and 38% (93) with the answer “agree” (Figure 8).

DISCUSSION OF RESULTS

A total of 245 patients who were treated at the Outpatient Clinic of the Villa Libertad Health Center from June to July 2022 were studied. The sociodemographic characteristics of the patients in the study are young people and adults between 28 and 37 years of age, who are the ones who most demand health care services. The results contrasted with the studies and reflect similarity, for the most part. (Moreno, 2019)(Bedoya, Chacon, & Noguera, 2018)

Regarding sex, a predominance of the male sex was found, however, the results obtained in the studies show certain discrepancies with the findings of the latter, which found that the female sex was the most common in the study. (Moreno, 2019)(Castellon, 2019)(73%) and (54%).

However, depending on the source, the results are in line with the studies mentioned by the University of São Paulo, in which he found that the rural population was the one that came to the unit the most (Moreno, 2019)(57%), obtained similar results, where the majority of users reside in urban areas (91%). (Orozco, 2017)

Users of the Villa Libertad Health Center have greater access to both; geographical, as well as transportation, indicating that they are covered by health services.

The predominant level of schooling was the secondary level (57%). These data are consistent with the study, which obtained a higher percentage of (44%).(Bedoya, Chacon, & Noguera, 2018)

About the employment of users, the blue-collar level prevails (36%); These data are consistent with the study, which obtained a (30%) rate.(Bedoya, Chacon, & Noguera, 2018)

Regarding user satisfaction, he agrees with the aforementioned data where he found that the majority of users report that they are generally satisfied with the service. (Bedoya, Chacon, & Noguera, 2018)

Regarding the cleaning service of the outpatient clinic, these data do not coincide with the study carried out, where the perception of cleanliness is positive (60%). (Moreno, 2019)

(Bedoya, Chacon, & Noguera, 2018) Similar results are very satisfactory (66%).

Despite the high demand for the outpatient consultation service, and the time of the consultation, which at times is short, they give a lot of importance to the indications of how to solve the problems, since the users said that they received enough recommendations. This is in line with the study carried out by Colombia that found that the solution to the need provided to the population served is greater than 50% Regarding the waiting time, despite being longer at times, the users surveyed are very satisfied, some said that due to the high demand that the health center has, they understand that they must wait. (Bedoya, Chacon, & Noguera, 2018)This is consistent with the data mentioned in the study because it found results in 65%, and the study found results of (Moreno, 2019)(Bedoya, Chacon, & Noguera, 2018)46%.

Users are very satisfied with the time of the consultation, most of them are satisfied that the doctor can receive it and indicate the appropriate medication to solve their health problem. This is similar to the study conducted where the results were 82%. It is an acceptable figure, to obtain a good quality of care and make the patient feel satisfied. (Moreno, 2019)

CONCLUSIONS

The patients surveyed ranged from 28 to 37 years old, male, and whose trade was mainly worked as laborers. Their schooling did not go beyond high school, with a married marital status and the origin of the urban area.

Regarding the perception of quality in the Villa Libertad health center, considering the opinion of the respondents, it stands out that in general, they feel very satisfied with the comprehensive care received and with the coordination of the outpatient consultation, equipment (instruments), and cleaning. In this way, the efforts of health workers are optimized for the health system and society itself.