Perception vs. reality: Self-ratings of care quality by health care provider type

Background

Research has consistently found a positive relationship between prenatal care attendance and positive birth outcomes (Tossounian et al., 1997). While barriers to prenatal care attendance have been identified (e.g., transportation, childcare), less is known about the patient-provider relationship and the extent to which it may influence patient compliance with subsequent prenatal care visits. The present study examined OB/GYN patient and provider ratings of nature and extent of specific office visit behaviors. Variations across provider groups were examined separately for African American and Caucasian patients.

Methods

Anonymous surveys were administered to patients (N=605) and providers (N=787) in an urban hospital-based obstetrics and gynecology clinic over a 10-day period. Providers were asked to complete one survey following every patient visit during data collection. Data included 118 surveys from Attending Physicians, 260 from Residents and Interns, 106 from Nurse Midwives, and 278 from Nurse Practitioners. Similarly, women served by the clinic during the study period were asked to complete a comparable survey following their medical appointment, for which they received a $10 gift certificate for their time and effort. Surveys were designed to assess the provider and patient impressions of the interactions that occurred during the visit. Data were analyzed using chi-square for categorical measures and t-tests for continuous variables.

Results

Nurse midwives (CNMs) were less likely to feel that their female patients liked them (55%) as compared to Attending Physicians (90%) (p<.009). Similarly, CNMs felt their patients had lower levels of trust in their care providers than attending (29% vs. 51%, p<.001). For the quality of communication between patient and provider, Nurse Practitioners gave the lowest ratings (47% positive) as compared to higher ratings that did not differ among Attendings, Residents and CNMs (average 56%).

Discussion

While providers differed in their perceptions of patient satisfaction, patient satisfaction data were uniform across provider type. Further analyses are planned to compare patient and provider perceptions of interactions.

Tossounian, S.A., Schoendorf, K.C., & Kiely, J.L. (1997). Racial differences in perceived barriers to prenatal care. Maternal and Child Health Journal, 1, 229-236.