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How to Evaluate Patient Satisfaction after Dental Treatment

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Omar M. Mahfouz

on 14 April 2015

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Transcript of How to Evaluate Patient Satisfaction after Dental Treatment

How to Evaluate Patient Satisfaction with Dental Treatment
Patient Satisfaction
``Evaluation based on the fulfillment of expectations''
(William 1994)
Patient Interview
How to Evaluate Patient Satisfaction
1- Patient interview
2- Patient questionnaire
a) General Questionnaire
b) Specific Questionnaire
Specific Questionnaire
General Questionnaire
Presented By: Omar Mahfouz
: Ahmed Saad
: Gasser Tarek

Mood of the World
Published 19 march 2015
February 2015,volume 41
Operations Research for Patient. Centered Health Care Delivery.
Patient Satisfaction in Prosthodontics

Satisfaction to be defined differently for different patients and for the same patient at different times.

Journal of the Indian Prosthodontic Society , 2012 Mar, , by Sunila Bukanaker
Journal of Soc. Sci. Med. , Vol 47 , 1998 , by Brian Williams, Joanne Coyle and David Healy
- Consist of two parts.

First section :an unstructured discussion of the user's experience and their views of the service
- Carried out at people's homes

Second section: a more structured discussion the interviewee's responses on a patient satisfaction questionnaire

The questionnaire was used simply as an extra tool
- Misleading results

- Limit the opportunity of patients to express their concerns about diferent aspects of care

- Encourage professionals to believe that patients are satisfied but they are highly discontented

- Evaluation process doubt on the validity

Journal of Dentistry,Issue 40, 2012 by Pierre-Luc Michaud
Denture Satisfaction Instrument
- Evaluate patients’ satisfaction relating to their prostheses.

- This questionnaire is assessing satisfaction relating to several aspects of the prosthesis:

- General satisfaction - Comfort - Stability

- Aesthetics - Chewing ability (ease of chewing)

- Chewing efficiency (ability to crush food in small particles)

- Ease of cleaning -Ability to speak

- Oral condition (condition of their mouth, which can refer to oral health status )
- The subjects answered on 100 mm visual analogue
scales (VAS)
anchored by the words ‘‘not at all satisfied’’
and ‘‘extremely satisfied’’.
In prosthodontics It is sensitive enough to capture clinically significant differences between various prosthodontic treatments
Self-reported denture satisfaction
Objectivity of a Subjective Outcome
Dental Impact on Daily Living (DIDL) questionnaire
assess patients’ satisfaction with their dentition and/or dental prosthesis
-efficient to use
- relatively short
- simple
- easy to understand
-score is a socio-dental instrument
A 14-item patient satisfaction questionnaire
1- Satisfaction with dentist care and communication

2-Satisfaction with staff

3-Satisfaction with the efficiency of the dental office ,

4-Treatment time and costs and labeled time-cost
5-related to transportation and parking , convenience of office hours , and appointment availability and were labeled accessibility.

Main Points
Compelet Denture
Implant Questionnaire
Relationship between Satisfaction & Personality
NEO Five Factor Inventory (NEO-FFI)
-five factors :
openness,connscientiousness,extraversion, agreeableness and neuroticism

- establish a relationship between satisfaction and personality

- it provides a comprehensive measurement of the five dimensions of personality

- it is simple and can be completed in a short time

- it is valid, reliable

- easy to use statistically

This study agreed with the presence of relation between denture satisfaction and personality factors
Eysenck Short Scale Personality Questionnaire (EPQ-R)
It yields scores on a scale from 0 to 12 for each of the three major personality traits,



and Neuroticism.

Patients with neurotic personalities were significantly less satisfied with their complete dentures.
Instrument Testing
The purpose of instrument testing is to show, to as large a degree as possible:

- that instrument measures relevant variables
- that measurement is objective

Objectivity in measurement is basic to all research and has two elements:
- reliability
- validity
(Streiner & Norman 1989,Hinds et al 1990).

General Patient Satisfaction Questionnaire and Design:
Frame Work & Question
Content validity testing of this study was performed using a panel consisting of personnel who served
as administrators of the dental care sector hospital and a professor with extensive experience in thefield.
The questions consisted of:
1- Functional (e.g. “how would you feel if the location of the facility is convenient”
2- Dysfunctional question (e.g. “how would you feel if the location of the facility was not convenient”
3-Determination of level of quality question.
The scale follow kano type questionnaire
so the option will be
“I like it that way”,
“It must be that way”,
“I am neutral”,
“I can live with it that way”,
“I dislike it that way” for functional and dysfunction question,
and on likert scale consists of 5 point scale as a choices for the quality of services
Journal of Dental Science, Dec. 2012 by Wen-Jen Chang
Journal of Taibah University Medical Sciences (2012) 7(2), 104–109, by Mohamed Saad
The DIDL questionnaire was previously tested and was found to have adequate reliability, validity, accuracy and reproducibility
Journal of Dental Research , 1995, vol 74 , Issue 7 by A. Leaol, and A. Sheihaml
Any Questionnaire consists of 3 Parts
Janurary 2015
Journal of Dentistry Issue 35 ,2007, p 744-748, by Michaell Robert Felnono
JADA, sept 2014, by Sara A. Alfadda
Journal of prosthetic entistry ,2013, p 76-82 by Renata Dias
Journal of Dentistry, 2014 , issue 24 , p366-372 by Mahmoud K.. Al Omiri
Journal of Dentistry, issue 35, 2007 , p 744-748, by Mocheal Robert Fenon
European Journal of Oncology Nursing, issue 3, 1999, p 126-140 by John Stizia

Physical Theraby volume 69, number 7 , july 1989
Frame Work
Question Type
Visual Analogue Scale
lines anchored at either end by the extremes of the dimension being measured-no pain, intolerable pain-along which the subjects are asked to place a mark to indicate their status).

The most frequently used scale in the reviewed
studies was the VAS-100 mm,

Journal of Pain & Symptoms Management,June 2011,vol 41 by Marianne Jensen Hjermstad
The VAS-P (Paper) consisted
of a horizontal 10 cm black line on a
white piece of

level was marked as a vertical line crossing that line.

The measured to the closest millimeter (mm)

using a ruler (1 mm was a score of 0.1 on a scale of 0 to 10).

The VAS-D(Digital)

administered on a touch screen.

level was marked by moving a slider
(8 mm or 28 pixels long) on a horizontal
line (10 cm or 334 pixels long).

Major Advantages
That it is relatively easy to use and to understand, particularly by less educated raters

-VAS has a better responsiveness (i.e.ability to detect clinically significant change) than the Likert scale and might also be more reliable and valid

Some researchers claim that VAS is preferred by the raters
International Electronic Journal of Health Education, 2005; 8:178-192 by Dan Hasson
Journal of hand therapy, 2011 by BS Sindhu
Vas Ruler
Pain Faces
Likert Scale
Scale Points
using 5 or 7 scale points are common.

use only two points

use 100 (percentages).

some research say four points as opposed to five, thus eliminating neutral mid-points and forcing the respondents to make a choice
International Journal of Clinical and Health Psychology (2013) 13, 83−86, by James hartley

- it is easier to use and understand both for the researcher and the respondent

- that coding as well as interpretation is easier compared to VAS.

- It also takes less time to explain to patients.

- easier for young children to
understand and answer correctly compared to VAS

Supporting statements

-wording of the descriptive categories most probably affect the responses and artificial categories might not be sufficient to describe a complex phenomenon

-. too many categories may lead to difficulties in choosing and too few may not provide enough choice or sensitivity, forcing the respondent to choose an answer that does not represent the person’s true intent.

International Electronic Journal of Health Education, 2005; 8:178-192 by Dan Hasson
International Electronic Journal of Health Education, 2005; 8:178-192 by Dan Hasson
Kano Scale
Advantage & Limitation of Questionnaire
European Journal of Oncology Nursing, issue 3, 1999, p 126-140 by John Stizia
Physical Theraby volume 69, number 7 , july 1989
- An important patient-reported outcome,

- It allows the direct quantification of patients’ opinions of different aspects of a given treatment.

- its simplicity and comprehensibility for clinical

- patient satisfaction does influence health - related behavior by:
-increasing compliance
-decreasing broken appointments
- decreasing perception of pain and anxiety

- can alter practice policy;

- improve patient,staff, and dentist satisfaction

- effective way o f lowering barriers to dental care

- is vital for continuous

- improvement of the service delivery process and outcome.

some patients systematically over estimate their degree of satisfaction

- The quality of medical care (competent health professional, adequate infrastructure and health services, appropriate diagnostic and therapeutic procedures)

- Equity in the accessibility to diagnostic, therapeutic and preventive measures,

- Participative approach of care and prevention (i.e. integration of the patient and his family in the decision procedures)

- Reasonable costs and affordable health insurance system for the individual and the community,

- Adequate information on disease and therapy,

- Acceptable “waiting time” and appropriate “hostelry”.

Key concepts of patient satisfaction
Health Policy isssue 100, 2011, p140-150 by Emmanuel Kabengele
How to Develope Your own Questionnaire
The measurement of subjective clinical outcomes is one of the most perplexing areas within the arena of clinical decision making

A subjective outcome is where an entity is perceptible only to the person being assessed.

Subjective test as a measure that is determined or influenced by the ideas or feelings of the person doing the assessment,

In measuring subjective clinical outcomes,what we strive for are measurement processes that reflect the perceptions or feelings of the person being assessed and not the feelings or judgments of the person doing the measurement procedure

Physical Therapy/Volume 69, Number 7/July 1989 by Alan M Jette
Reliability testing aims to demonstrate that the instrument is measuring something in a consistent and reproducible manner.

Validity testing aims to determine whether or not the findings reflect reality.

There are two distinct aspects of validity.
1- content validity concerned with whether the instrument covers the content area satisfactorily.

2- Criterion Validity : objective measurement of the accuracy of the instrument.

This may be achieved by comparing the results from the new instrument to those from another validated instrument.
Alternatively, if no suitable instrument exists, results from the new instrument may be predicted using a research-based hypothesis.

This test is known as 'construct validity'.

Take Home Message
Heydecke found a poor correlation between patients’ and clinicians’ ratings of the same variable.

Van Waas found moderate positive correlation between the technical quality of new complete dentures and patient satisfaction

The authors concluded that the initial clinical quality of the dentures was not a significant factor with regard to patient satisfaction two years after the completion of treatment.

JADA, sept 2014, by Sara A. Alfadda
Patient Satisfaction Versus Quality
To choose the most suitable satisfaction instrument
from several one must answer this question:
which instrument’s scores permit making the most
valid, reliable, and generalisabile inferences about
patient satisfaction?

Evidence-based Healthcare (2004) 8, 125–127 by Stephen J. Aragon
Language & Population Problem
Omar Mahfouz


Classification to the evaluation methods

Questionnaire Components
Ahmed Saad
General Questionnaire

Specific Questionaire
Gasser Tarek
Objectivity of a Subjective Outcome

Instrument Testing

Relation between Patient Pschycology & Patient Satisfaction

Take home Message
Full transcript