The Open Public Health Journal




ISSN: 1874-9445 ― Volume 12, 2019
RESEARCH ARTICLE

Evaluation of Patient Satisfaction with Cardiology Services



Tengiz Verulava1, *, Revaz Jorbenadze2, Leila Karimi3, Beka Dangadze1, Temur Barkalaia1
1 School of Business, Public Health and Insurance Institute, Ilia State University, Tbilisi, Georgia
2 G. Chapidze Emergency Cardiology Center, Tbilisi, Georgia
3 School of Psychology and Public Health, La Trobe University, Melbourne, Australia

Abstract

Background:

Patient satisfaction is widely used as an important component in evaluating quality of health care. The current study aimed to evaluate patient satisfaction with the quality of healthcare.

Methods:

The study was carried out by a cross-sectional method for evaluation of hospitalized patient satisfaction with provided services. Participants of this research include patients who have been hospitalized during the last 5 years (2012-2016). Research tools were prepared on the basis of specially developed “Medical Outcomes Study, Patient Satisfaction Questionnaire” (MOS PSQ-III).

Results:

Most of the patients positively evaluated financial accessibility and quality of health services, even though some aspects of health care need improvement. This may be related to the introduction of the Universal Health Care Program in 2013, which increased population coverage. The international quality accreditation of the Emergency Cardiology Center has also played an important role in raising patient's satisfaction levels and in achieving higher standards in the sectors of patient safety and quality management. However, the study indicated, that there was a moderate level of satisfaction with the accessibility of healthcare services. So the further revisions and actions are needed to expand and refine the Universal Health Care Program. We also found an evidence that gender, age and education act as the socioeconomic determinants of satisfaction with healthcare quality.

Conclusion:

The patient satisfaction study, as one of the most important quality indicators, should be developed throughout the country. It will promote the development of healthy competitive environment among medical organizations and will improve the quality of medical services.

Keywords: Hospital Services, Patient S+atisfaction, Quality of healthcare, Cardiology services, Medical outcomes study, Socioeconomic determinants.


Article Information


Identifiers and Pagination:

Year: 2018
Volume: 11
First Page: 201
Last Page: 208
Publisher Id: TOPHJ-11-201
DOI: 10.2174/1874944501811010201

Article History:

Received Date: 8/1/2018
Revision Received Date: 6/5/2018
Acceptance Date: 8/5/2018
Electronic publication date: 25/05/2018
Collection year: 2018

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© 2018 Verulava et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


* Address correspondence to this author at the School of Business, Public Health and Insurance Institute, Ilia State University, Kakutsa Cholokashvili Ave 3/5, Tbilisi 0162, Georgia; Tel: +995 32 577294849; E-mail: tengiz.verulava@iliauni.edu.ge




1. INTRODUCTION

Quality is a key determinant of market share and the ability of an organization to meet or exceed customer expectations [1Anderson C, Zeithaml CP. Stage of the product life cycle, business strategy and business performance. Acad Manage J 1984; 27: 5-24., 2Parasuraman A, Zeithaml V. Berry L. SERVQUAL: A multiple-item scale for measuring consumer perceptions of service quality. J Retailing 1988; 64(1): 12-40.]. There are two forms of quality: technical quality and functional quality [3Gronroos CA. Service quality model and its marketing implications. Eur J Mark 1984; 18(4): 36-44.[http://dx.doi.org/10.1108/EUM0000000004784] ]. Technical quality in the healthcare environment is defined primarily on the basis of the technical accuracy of the diagnoses and procedures [4Babakus E, Mangold WG. Adapting the SERVQUAL scale to hospital services: An empirical investigation. Health Serv Res 1992; 26(6): 767-86.[PMID: 1737708] ]. Functional quality refers to the manner in which the healthcare service is delivered to the patient [5Donabedian A. The Definition of Quality and Approaches to Its Assessment Explorations in Quality Assessment and Monitoring.11980; ]. Since patients are often unable to accurately assess the technical quality of a health care service, the functional quality is usually the primary determinant of patients' quality perceptions [5Donabedian A. The Definition of Quality and Approaches to Its Assessment Explorations in Quality Assessment and Monitoring.11980; ].

Patient satisfaction is widely used in the modern world as an important component in evaluating the quality of healthcare as well as the health care system [6Healy JM Jr, Govoni LA, Smolker ED. Patient reports about ambulatory care. Qual Manag Health Care 1995; 4(1): 71-81.[http://dx.doi.org/10.1097/00019514-199504010-00009] [PMID: 10151629] ]. Some countries have implemented policies to monitor patient approaches through surveys [7Confederation NHS. Patient Involvement in the new NHS, Action Points 25 2010.]. At the same time, private insurance providers regularly measure patient satisfaction and patient experience as indicators of a performance [8Jennings BM, Heiner SL, Loan LA, Hemman EA, Swanson KM. What really matters to healthcare consumers. J Nurs Adm 2005; 35(4): 173-80.[http://dx.doi.org/10.1097/00005110-200504000-00006] [PMID: 15834256] ]. It is used for measuring the compliance between the patients’ preferences, expectations and received medical care. Medical service providers use the patient satisfaction research studies to constantly improve the quality of healthcare in a competitive market. It is an important tool to identify why the patient chooses a given hospital compared to others and how it assesses services that are provided.

The information obtained as a result of research studies on patient satisfaction increases the level of awareness of healthcare services. The results of the research enable the patient ability to compare the clinics and study the information about the quality of healthcare at medical institutions. Accordingly, it has a significant impact on their decision regarding the medical services, and it also increases the patient’s confidence in the medical institution [9Bennett PD, Mandell RM. Prepurchase information seeking behavior of new car purchases – the learning hypothesis. J Mark Res 1969; 430-3.[http://dx.doi.org/10.2307/3150076] ].

Patient satisfaction has a significant impact on the continuity of medical care. Satisfied patients are more likely to develop a deeper and long-lasting relationship with their medical provider, leading to an improved compliance, continuity of care [10Jones RB, Carnon AG, Wylie H, Hedley AJ. How do we measure consumer opinions of outpatient clinics? Public Health 1993; 107(4): 235-41.[http://dx.doi.org/10.1016/S0033-3506(05)80502-5] [PMID: 8356205] ], which increases the adequacy of the services and consequently results in better health outcomes [11Cleary PD, McNeil BJ. Patient satisfaction as an indicator of quality care. Inquiry 1988; 25(1): 25-36.[PMID: 2966123] -13Larsen DE, Rootman I. Physician role performance and patient satisfaction. Soc Sci Med 1976; 10(1): 29-32.[http://dx.doi.org/10.1016/0037-7856(76)90136-0] [PMID: 1265486] ].

A concept of patient satisfaction is relatively new in Georgia. However, in today’s highly competitive healthcare environment, medical organizations are more aware of the need to focus on the quality of service. In 2013, Georgia introduced the Universal Health Care Program to increase an accessibility of healthcare services by removing financial barriers [14Asatiani M, Verulava T. Georgian welfare state: preliminary study based on esping-andersen’s typology. Econ Sociol 2017; 10(4): 21-8.[http://dx.doi.org/10.14254/2071-789X.2017/10-4/2] ]. As a result, there has been a drastic increase in service utilization at ambulatory and hospital levels. For instance, after introduction of the Universal Health Program the number of visits to family doctors has increased by 43%, to specialized doctors – by 18%; the number of a laboratory analysis taken in hospitals has increased by more than 17%, and the number of instrumental examinations has increased by 9% [15Verulava T, Jorbenadze R, Barkalaia T. Introduction of universal health program in Georgia: Problems and perspectives. Georgian Med News 2017; 262(262): 116-20.[PMID: 28252441] ].

However, such increase in utilization did not provide considerable improvements in quality of service provision [15Verulava T, Jorbenadze R, Barkalaia T. Introduction of universal health program in Georgia: Problems and perspectives. Georgian Med News 2017; 262(262): 116-20.[PMID: 28252441] ]. According to the studies conducted in hospitals over the years, the quality assurance and quality-related activities were unreliable. Therefore, the quality of healthcare services in Georgia is inadequate both by objective measures and by the opinion of patients [15Verulava T, Jorbenadze R, Barkalaia T. Introduction of universal health program in Georgia: Problems and perspectives. Georgian Med News 2017; 262(262): 116-20.[PMID: 28252441] ]. The percentage of respondents reporting trust to the services at their clinic was lower at approximately 65% [15Verulava T, Jorbenadze R, Barkalaia T. Introduction of universal health program in Georgia: Problems and perspectives. Georgian Med News 2017; 262(262): 116-20.[PMID: 28252441] ].

It is worth to note, that according to the Decree of the Ministry of Labor, Health and Social Affairs of Georgia adopted on 2012, the medical institution is obliged to evaluate the satisfaction of patient and personnel in order to improve the quality of medical care. Surveys conducted in Georgia on patient satisfaction confirm that patients are more focused on communication with the medical personnel than on treatment [16Verulava T, Jorbenadze R, Dangadze B, Karimi L. Nurses’ work environment characteristics and job satisfaction: Evidence from Georgia. Gazi Medical Journal 2018; 29(1): 12-6.]. While assessing a satisfaction, the patients also attached importance to the duration of the waiting period when visiting doctors, although making a preliminary appointment is considered as one of the means of solving the problem [17Verulava T, Maglakelidze T, Jorbenadze R. Hospitalization timeliness of patients with myocardial infarction. East J Med 2017; 22(3): 103-9.].

Some countries use patient satisfaction research as an instrument of accreditation for medical organizations. The National Committee for Quality Assurance requires the healthcare organizations to provide data on patient satisfaction research as a requirement for accreditation [18Terry K. How to get the best reading of patient satisfaction. Med Econ 1996; 73(13): 101-122, 105-106, 108 passim.[PMID: 10158799] ]. This enables the patients to make a more informed choice according to the quality of services.

Low financial accessibility of medical services has a negative impact on patient satisfaction [19Verulava T, Gabuldani M. Accessibility of urgent neurosurgery diseases by the state universal healthcare program in georgia (country). Gazi Medical Journal 2015; 26(2): 42-5.-21Verulava T, Jincharadze N, Jorbenadze R. Role of primary health care in re-hospitalization of patients with heart failure. Georgian Med News 2017; 264(264): 135-9.[PMID: 28480866] ]. In 2013, the Government of Georgia launched the Universal Health Care Program to improve the accessibility of health care services and strengthen financial protection [14Asatiani M, Verulava T. Georgian welfare state: preliminary study based on esping-andersen’s typology. Econ Sociol 2017; 10(4): 21-8.[http://dx.doi.org/10.14254/2071-789X.2017/10-4/2] ]. After enactment of the Universal Health Care Program, accessibility to medical services by the population has been significantly increased [22Verulava T, Maglakelidze T. Health financing policy in the south caucasus: Georgia, Armenia, Azerbaijan. Bulletin of the georgian national academy of sciences 2017; 11(2): 143-50.]. As a result, there has been a drastic increase in service utilization at all levels. Patients are more likely to consult a health care provider, when there are sick, than before; financial barriers to access and out-of-pocket payments have fallen, especially for outpatient visits and hospital care; and user experience of the health system has improved [23Zoidze A, Rukhazde N, Chkhatarashvili K, Gotsadze G. Promoting universal financial protection: Health insurance for the poor in Georgia--a case study. Health Res Policy Syst 2013; 11: 45.[http://dx.doi.org/10.1186/1478-4505-11-45] [PMID: 24228796] ]. Georgia's significant movement towards the universal healthcare coverage was made possible by a much-needed increase in public spending on health [22Verulava T, Maglakelidze T. Health financing policy in the south caucasus: Georgia, Armenia, Azerbaijan. Bulletin of the georgian national academy of sciences 2017; 11(2): 143-50.]. In regard to this, further studies are needed to evaluate customer satisfaction with the quality of healthcare.

Thus, our focus is to empirically assess patient satisfaction with the quality of healthcare delivery. Specifically, the present study examines how communication, showing courtesy towards patients and an environment of the facility significantly predicts patients’ satisfaction with the quality of healthcare. It is also important to study how the introduction of the Universal Health Care Program in Georgia and the measures taken by medical organizations to obtain an international accreditation influences patient satisfaction.

2. METHODS

The present, cross-sectional study was carried out during the last 5 years (2012-2016) to evaluate the hospitalized patient satisfaction with provided services. The research was conducted in different units of Emergency Cardiology Center (Tbilisi, Georgia). The center was selected because it is the largest cardiology hospital in Georgia.

The respondents of this research include patients who have been hospitalized at least for 24 hours. All patients were interviewed before the release, after obtaining informed consent from them. The Ethical Committee of G. Chapidze Emergency Cardiology Center had approved the study.

Study tools were prepared on the basis of specially developed “Medical Outcomes Study, Patient Satisfaction Questionnaire” (MOS PSQ-III), third edition. It consists of 50 points and includes seven aspects: general satisfaction of medical service, technical quality, interpersonal aspects, communication, financial aspects of service, time spent with physician and availability of services [24Hays RD, Davies AR, Ware JE. Scoring the medical outcomes study patient satisfaction questionnaire, PSQ-III 1987.]. Each variable was measured by asking respondents to rate their overall satisfaction with the quality of services rendered in the hospitals using a five-point Likert scale: Poor (1), average (2), good (3), very good (4), excellent (5). The collected data were analyzed by SPSS program.

3. RESULTS

3.1. Demographic Characteristics

The main characteristics of the participants are summarised in Table 1. The study was carried out during the 2012-2016 years. Over 500 patients were interviewed each year. Overall, women accounted for 35-41% and men - 58-65%. Majorities of patients were 65 years or older (38-42%) and married couples (65-75%). In terms of education, 59-66% of the respondents attained higher education while 34-41% had a secondary level of education.

Table 1
Distribution of patients according to the characteristics and survey periods (unit = %).


3.2. The Domains of Satisfaction with Health Care

The level of satisfaction with health-care services is shown in Table 2. Most of the patients positively evaluate the organization and quality of health care. The number of “very dissatisfied” and “dissatisfied” patients decreased drastically compared to 2012 and the number of “very satisfied” and “satisfied” patients was increased.

In comparison with previous years, there were increased number of patients who have noted that the doctor carefully examines their health condition. Patients were satisfied with the competence, professionalism and knowledge of the latest medical achievements of their doctors. We also noticed that communications and interpersonal relationships are an important factor in patient satisfaction. According to the survey, the patients are satisfied with the polite and respectful attitude from doctors. However, it should be noted that waiting time it is still a problem. The study showed that the patients’ financial accessibility of medical services has increased.

Table 2
Evaluation of the quality of medical services by respondents from the 5-point scale: poor (1), average (2), good (3), very good (4), excellent (5).


Table 3 shows the sociodemographic correlations with patient satisfaction. We’ve found weak evidence that the age significantly correlates with satisfaction with healthcare provision, thus suggesting a nonlinear link between age and satisfaction with health care.

Table 3
The link between the level of patient satisfaction and social factors Evaluation of the quality of medical services by respondents from the 5-point scale:


We’ve also noticed that a gender has an effect on patient satisfaction. According to the research, females were more satisfied with the quality of health care than males. Finally, we’ve found weak evidence for the education/satisfaction with healthcare provision.

4. DISCUSSION

Patients' satisfaction is one of the most important factors for the promotion of the quality of health services. This study assessed the level of client satisfaction from 2012 to 2016 years. Analysis of the data of this period is important because the universal health care program that was launched in Georgia in 2013 allows us to evaluate its impact on patient satisfaction.

We’ve found an evidence of high satisfaction with healthcare services in Georgia. Access to services provided is one of the most important factors for the satisfaction of patients. In regard to this, we should especially note the satisfaction of patients with financial accessibility of health services. This may be related to the introduction of the Universal Health Care Program in 2013, which has increased the coverage of population. However, our study showed that there was a moderate level of satisfaction with accessibility to services. It indicates that the accessibility of medical services in Georgia is not so good and further revisions and actions are needed to expand the Universal Health Care Program.

Our results regarding the link between the Universal Health Care Program and satisfaction were compatible with other research findings. In 2014, experts of WHO with the technical assistance of USAID/HSSP carried out the telephone survey of the population on the satisfaction of obtained services and qualitative study of service providers and beneficiaries (Focus groups) for assessment of Universal Health Program [25The Government of Georgia Universal Health Programme: Annual assessment report 2015.]. The survey showed that majority (96.4%) of the beneficiaries of Universal Health program are satisfied or highly satisfied with hospital and outpatient service, 80.3% of beneficiaries are satisfied or highly satisfied with planned outpatient service [25The Government of Georgia Universal Health Programme: Annual assessment report 2015.]. 84.1% of respondents indicated that the financial support of population is the most positive part of the Universal Health [25The Government of Georgia Universal Health Programme: Annual assessment report 2015.]; also, most of the beneficiaries mentioned the rights of a free choice as one of the core positive factors of Universal Health.

The international quality accreditation of the Emergency Cardiology Center has also played an important role in raising patient's satisfaction levels and in achieving higher standards in the sectors of patient safety and quality management. In regard of this, it should be noted that in recent years, medical organizations in Georgia are trying to gain international accreditation of medical quality, one of the major requirements of which is to evaluate the quality of patient satisfaction. One of the first medical institutions that gained international accreditation is Acad. G. Chapidze Emergency Cardiology Center. In November 2016 the certificate from one of the most authoritative organization “Cooperation for Transparency and Quality in Health Care” (KTQ) was awarded to the Emergency Cardiology Center. Over the course of almost one year, the experts of KTQ supported the Cardiology Center in aligning the already well-established quality standards with those expected in European hospitals. Chapidze Emergency Cardiology Center is the first medical facility in the South Caucasus region that received a KTQ certificate. Aspiration of medical institutions to receive an international accreditation quality certificate will enhance the quality of medical services.

We’ve also found an evidence that gender, age and education act as the main socioeconomic determinants of satisfaction with healthcare quality. The results of our analysis is consistent with some of the findings from other studies. Other studies confirm a similar link between age and satisfaction with health care [26Senarath U, Gunawardena N, Lankamali ELS, Senanayake A, Seneviratne A, Sebastiampillai B. Measuring patient perception of the quality of nursing care at the National Hospital Sri Lanka. 2010., 27Tayefi B, Sohrabi MR, Kasaeian A. Patients’ satisfaction with the diabetes control and prevention program in Tehran, Iran: A cross sectional study. J Res Health Sci 2015; 15(4): 239-43.[PMID: 26728910] ]. Some studies show that patient satisfaction level decreases with the increase in age [28Margolis SA, Al-Marzouq S, Revel T, Reed RL. Patient satisfaction with primary health care services in the United Arab Emirates. Int J Qual Health Care 2003; 15(3): 241-9.[http://dx.doi.org/10.1093/intqhc/mzg036] [PMID: 12803352] , 29Ruberu TRC, Dayasiri MBKC. Determinants of patient satisfaction at National Hospital of Sri Lanka College of Oto Rhino laryngologists of Sri Lanka 2009.]. However, according to other studies, age is not a significant determinant of satisfaction [30Cho SH, Kim CY. Trends in patient satisfaction from 1989-2003: Adjusted for patient characteristics. Taehan Kanho Hakhoe Chi 2007; 37(2): 171-8.[http://dx.doi.org/10.4040/jkan.2007.37.2.171] [PMID: 17435400] ]. Gender is in a particularly significant correlation with satisfaction [31Al-Borie HM, Damanhouri AM. Patients’ satisfaction of service quality in Saudi hospitals: A SERVQUAL analysis. Int J Health Care Qual Assur 2013; 26(1): 20-30.[http://dx.doi.org/10.1108/09526861311288613] [PMID: 23534103] ]. However, according to other studies, gender is not a significant determinant of satisfaction [32Mpinga EK, Verloo H, Chastonay P. Patient satisfaction and the right to health: A survey in a rehabilitation clinic in Switzerland. Open Public Health J 2013; 6: 51-8.[http://dx.doi.org/10.2174/1874944501306010051] ]. According to our research, there is a weak evidence for the education/satisfaction with healthcare provision. Other studies confirm a similar connection [28Margolis SA, Al-Marzouq S, Revel T, Reed RL. Patient satisfaction with primary health care services in the United Arab Emirates. Int J Qual Health Care 2003; 15(3): 241-9.[http://dx.doi.org/10.1093/intqhc/mzg036] [PMID: 12803352] ].

CONCLUSION

Satisfaction with quality of medical services in cardiology patients is characterized by increasing tendency. Efforts to obtain international accreditation by the medical organization and attempts to improve the quality contribute to this progress. The positive role of Universal Health Care Program introduced in 2013, which has increased financial availability of medical services and therefore the population's satisfaction should also be taken into consideration.

In highly competitive healthcare environment, hospitals are more aware of a need to focus on the quality of service. The quality of medical care is perceived as an opportunity to improve their competitive position. Patient-oriented services and focus on the improvement of quality increase the motivation of medical personnel to provide high-quality medical services, as well as the patient's trust towards the medical institution.

It is necessary to motivate hospital managers and staff to use the results of patient satisfaction surveys for the improvement of the quality of healthcare services and not merely as an audit instrument for assessing the work of hospital personnel.

The research has shown that some aspects of medical care still need an improvement. It is advisable to conduct training for health personnel to deepen interpersonal relationships and communication skills, regularly assess and report information on components of health system responsiveness and patient satisfaction. Patient satisfaction research can be used as a hospital instrument in terms of accountability with patients. This will facilitate the financial sustainability of the hospital in the long term.

Patient satisfaction study, as one of the important quality indicators, should be developed throughout the country. It will promote the development of healthy competitive environment among medical organizations and it will also improve the quality of medical services.

ETHICS APPROVAL AND CONSENT OF PARTICIPANTS

The Ethical Committee of G. Chapidze Emergency Cardiology Center had approved the study.

HUMAN AND ANIMAL RIGHTS

No Animals were used in this research. All human research procedures followed were in accordance with the ethical standards of the committee responsible for human experimentation (institutional and national), and with the Helsinki Declaration of 1975, as revised in 2008.

CONSENT FOR PUBLICATION

A written informed consent was obtained from all patients when they were enrolled.

CONFLICTS OF INTEREST

The authors declare no conflict of interest, financial or otherwise.

ACKNOWLEDGEMENTS

Declared none.

REFERENCES

[1] Anderson C, Zeithaml CP. Stage of the product life cycle, business strategy and business performance. Acad Manage J 1984; 27: 5-24.
[2] Parasuraman A, Zeithaml V. Berry L. SERVQUAL: A multiple-item scale for measuring consumer perceptions of service quality. J Retailing 1988; 64(1): 12-40.
[3] Gronroos CA. Service quality model and its marketing implications. Eur J Mark 1984; 18(4): 36-44.[http://dx.doi.org/10.1108/EUM0000000004784]
[4] Babakus E, Mangold WG. Adapting the SERVQUAL scale to hospital services: An empirical investigation. Health Serv Res 1992; 26(6): 767-86.[PMID: 1737708]
[5] Donabedian A. The Definition of Quality and Approaches to Its Assessment Explorations in Quality Assessment and Monitoring.11980;
[6] Healy JM Jr, Govoni LA, Smolker ED. Patient reports about ambulatory care. Qual Manag Health Care 1995; 4(1): 71-81.[http://dx.doi.org/10.1097/00019514-199504010-00009] [PMID: 10151629]
[7] Confederation NHS. Patient Involvement in the new NHS, Action Points 25 2010.
[8] Jennings BM, Heiner SL, Loan LA, Hemman EA, Swanson KM. What really matters to healthcare consumers. J Nurs Adm 2005; 35(4): 173-80.[http://dx.doi.org/10.1097/00005110-200504000-00006] [PMID: 15834256]
[9] Bennett PD, Mandell RM. Prepurchase information seeking behavior of new car purchases – the learning hypothesis. J Mark Res 1969; 430-3.[http://dx.doi.org/10.2307/3150076]
[10] Jones RB, Carnon AG, Wylie H, Hedley AJ. How do we measure consumer opinions of outpatient clinics? Public Health 1993; 107(4): 235-41.[http://dx.doi.org/10.1016/S0033-3506(05)80502-5] [PMID: 8356205]
[11] Cleary PD, McNeil BJ. Patient satisfaction as an indicator of quality care. Inquiry 1988; 25(1): 25-36.[PMID: 2966123]
[12] DiMatteo MR, Hays R. The significance of patients’ perceptions of physician conduct: A study of patient satisfaction in a family practice center. J Community Health 1980; 6(1): 18-34.[http://dx.doi.org/10.1007/BF01324054] [PMID: 7430419]
[13] Larsen DE, Rootman I. Physician role performance and patient satisfaction. Soc Sci Med 1976; 10(1): 29-32.[http://dx.doi.org/10.1016/0037-7856(76)90136-0] [PMID: 1265486]
[14] Asatiani M, Verulava T. Georgian welfare state: preliminary study based on esping-andersen’s typology. Econ Sociol 2017; 10(4): 21-8.[http://dx.doi.org/10.14254/2071-789X.2017/10-4/2]
[15] Verulava T, Jorbenadze R, Barkalaia T. Introduction of universal health program in Georgia: Problems and perspectives. Georgian Med News 2017; 262(262): 116-20.[PMID: 28252441]
[16] Verulava T, Jorbenadze R, Dangadze B, Karimi L. Nurses’ work environment characteristics and job satisfaction: Evidence from Georgia. Gazi Medical Journal 2018; 29(1): 12-6.
[17] Verulava T, Maglakelidze T, Jorbenadze R. Hospitalization timeliness of patients with myocardial infarction. East J Med 2017; 22(3): 103-9.
[18] Terry K. How to get the best reading of patient satisfaction. Med Econ 1996; 73(13): 101-122, 105-106, 108 passim.[PMID: 10158799]
[19] Verulava T, Gabuldani M. Accessibility of urgent neurosurgery diseases by the state universal healthcare program in georgia (country). Gazi Medical Journal 2015; 26(2): 42-5.
[20] Verulava T, Sibashvili N. Accessibility to psychiatric services in georgia. Afr J Psychiatry 2015; 18(3): 1-5.
[21] Verulava T, Jincharadze N, Jorbenadze R. Role of primary health care in re-hospitalization of patients with heart failure. Georgian Med News 2017; 264(264): 135-9.[PMID: 28480866]
[22] Verulava T, Maglakelidze T. Health financing policy in the south caucasus: Georgia, Armenia, Azerbaijan. Bulletin of the georgian national academy of sciences 2017; 11(2): 143-50.
[23] Zoidze A, Rukhazde N, Chkhatarashvili K, Gotsadze G. Promoting universal financial protection: Health insurance for the poor in Georgia--a case study. Health Res Policy Syst 2013; 11: 45.[http://dx.doi.org/10.1186/1478-4505-11-45] [PMID: 24228796]
[24] Hays RD, Davies AR, Ware JE. Scoring the medical outcomes study patient satisfaction questionnaire, PSQ-III 1987.
[25] The Government of Georgia Universal Health Programme: Annual assessment report 2015.
[26] Senarath U, Gunawardena N, Lankamali ELS, Senanayake A, Seneviratne A, Sebastiampillai B. Measuring patient perception of the quality of nursing care at the National Hospital Sri Lanka. 2010.
[27] Tayefi B, Sohrabi MR, Kasaeian A. Patients’ satisfaction with the diabetes control and prevention program in Tehran, Iran: A cross sectional study. J Res Health Sci 2015; 15(4): 239-43.[PMID: 26728910]
[28] Margolis SA, Al-Marzouq S, Revel T, Reed RL. Patient satisfaction with primary health care services in the United Arab Emirates. Int J Qual Health Care 2003; 15(3): 241-9.[http://dx.doi.org/10.1093/intqhc/mzg036] [PMID: 12803352]
[29] Ruberu TRC, Dayasiri MBKC. Determinants of patient satisfaction at National Hospital of Sri Lanka College of Oto Rhino laryngologists of Sri Lanka 2009.
[30] Cho SH, Kim CY. Trends in patient satisfaction from 1989-2003: Adjusted for patient characteristics. Taehan Kanho Hakhoe Chi 2007; 37(2): 171-8.[http://dx.doi.org/10.4040/jkan.2007.37.2.171] [PMID: 17435400]
[31] Al-Borie HM, Damanhouri AM. Patients’ satisfaction of service quality in Saudi hospitals: A SERVQUAL analysis. Int J Health Care Qual Assur 2013; 26(1): 20-30.[http://dx.doi.org/10.1108/09526861311288613] [PMID: 23534103]
[32] Mpinga EK, Verloo H, Chastonay P. Patient satisfaction and the right to health: A survey in a rehabilitation clinic in Switzerland. Open Public Health J 2013; 6: 51-8.[http://dx.doi.org/10.2174/1874944501306010051]

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(Indiana University School of Medicine, USA)

"Open access journals represent a major break-through in publishing. They provide easy access to the latest research on a wide variety of issues. Relevant and timely articles are made available in a fraction of the time taken by more conventional publishers. Articles are of uniformly high quality and written by the world's leading authorities."


Robert Looney
(Naval Postgraduate School, USA)

"Open access journals have transformed the way scientific data is published and disseminated: particularly, whilst ensuring a high quality standard and transparency in the editorial process, they have increased the access to the scientific literature by those researchers that have limited library support or that are working on small budgets."


Richard Reithinger
(Westat, USA)

"Not only do open access journals greatly improve the access to high quality information for scientists in the developing world, it also provides extra exposure for our papers."


J. Ferwerda
(University of Oxford, UK)

"Open Access 'Chemistry' Journals allow the dissemination of knowledge at your finger tips without paying for the scientific content."


Sean L. Kitson
(Almac Sciences, Northern Ireland)

"In principle, all scientific journals should have open access, as should be science itself. Open access journals are very helpful for students, researchers and the general public including people from institutions which do not have library or cannot afford to subscribe scientific journals. The articles are high standard and cover a wide area."


Hubert Wolterbeek
(Delft University of Technology, The Netherlands)

"The widest possible diffusion of information is critical for the advancement of science. In this perspective, open access journals are instrumental in fostering researches and achievements."


Alessandro Laviano
(Sapienza - University of Rome, Italy)

"Open access journals are very useful for all scientists as they can have quick information in the different fields of science."


Philippe Hernigou
(Paris University, France)

"There are many scientists who can not afford the rather expensive subscriptions to scientific journals. Open access journals offer a good alternative for free access to good quality scientific information."


Fidel Toldrá
(Instituto de Agroquimica y Tecnologia de Alimentos, Spain)

"Open access journals have become a fundamental tool for students, researchers, patients and the general public. Many people from institutions which do not have library or cannot afford to subscribe scientific journals benefit of them on a daily basis. The articles are among the best and cover most scientific areas."


M. Bendandi
(University Clinic of Navarre, Spain)

"These journals provide researchers with a platform for rapid, open access scientific communication. The articles are of high quality and broad scope."


Peter Chiba
(University of Vienna, Austria)

"Open access journals are probably one of the most important contributions to promote and diffuse science worldwide."


Jaime Sampaio
(University of Trás-os-Montes e Alto Douro, Portugal)

"Open access journals make up a new and rather revolutionary way to scientific publication. This option opens several quite interesting possibilities to disseminate openly and freely new knowledge and even to facilitate interpersonal communication among scientists."


Eduardo A. Castro
(INIFTA, Argentina)

"Open access journals are freely available online throughout the world, for you to read, download, copy, distribute, and use. The articles published in the open access journals are high quality and cover a wide range of fields."


Kenji Hashimoto
(Chiba University, Japan)

"Open Access journals offer an innovative and efficient way of publication for academics and professionals in a wide range of disciplines. The papers published are of high quality after rigorous peer review and they are Indexed in: major international databases. I read Open Access journals to keep abreast of the recent development in my field of study."


Daniel Shek
(Chinese University of Hong Kong, Hong Kong)

"It is a modern trend for publishers to establish open access journals. Researchers, faculty members, and students will be greatly benefited by the new journals of Bentham Science Publishers Ltd. in this category."


Jih Ru Hwu
(National Central University, Taiwan)


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