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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 12  |  Issue : 2  |  Page : 168-173

Patient satisfaction over changing dental treatment trends during COVID-19 pandemic-a cross-sectional study


1 Department of Dentistry, Pramukh Swami Medical College, Bhaikaka University, Karamsad, Anand, Gujarat, India
2 Department of Pedodontics, Ahmedabad Dental College and Hospital, Ahmedabad, Gujarat, India
3 Department of Preventive Dentistry, Ahmedabad Dental College and Hospital, Ahmedabad, Gujarat, India
4 Private Dental Practitioner, Fellow of American Academy of Implant Dentistry, United States
5 Department of Prosthodontics and Implantology, Ahmedabad Dental College and Hospital, Ahmedabad, Gujarat, India

Date of Submission02-Sep-2021
Date of Decision20-Jan-2022
Date of Acceptance16-Feb-2022
Date of Web Publication13-May-2022

Correspondence Address:
Aalap Sureshkumar Prajapati
Department of Dentistry, Pramukh Swami Medical College, Bhaikaka University, Karamsad- Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aihb.aihb_133_21

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  Abstract 


Introduction: Patient satisfaction in health care describes the degree to which patients' needs 'meet their expectations and provide an acceptable standard of care'. Therefore, their opinion should be incorporated to understand factors affecting patients' satisfaction with the health-care setting. The recent COVID-19 pandemic has posed a significant challenge for the field of dentistry owing to its working characteristics. It is difficult for dentists to provide optimum satisfaction to patients receiving dental care with such changes proposed. A study aiming to evaluate the patient's satisfaction receiving treatment in the Department of Dentistry during the pandemic was planned. Materials and Methods: A cross-sectional observational study from September to November 2020 was conducted. A self-administered printed questionnaire drafted in English/Gujarati was provided to 225 patients on completion of their dental treatment. Thirteen close-ended questions were included in determining the patient's satisfaction. Descriptive statistical analysis was used to describe the parameters of the questionnaire. The Chi-square test was used to find a significant association between parameters, and P < 0.05 was considered statistically significant. Results: About 74.3% of the participants were satisfied with dentist–patient communication. Positive response (80%) by patients where they were able to get an appointment as per their suitability and were informed in advance by the department if there were any changes. One hundred and sixty-eight (84%) patients responded that the waiting area was hygienic. One hundred and thirty-seven (68.5%) patients assured that their arrival was intimated to the respective dentist by supporting staff and that they were taken into an operatory for treatment within 10 min of arrival. Participants said that they were informed about the delay from their allotted appointment schedule with reasons; hence, better compliance (79%) was obtained from them. Conclusions: This cross-sectional study indicated that with proper communication, a positive response by participants over satisfaction was obtained even due to changing treatment patterns due to pandemic.

Keywords: COVID-19, dental services assessment, pandemic, patient's satisfaction, quality of care, rural area patients


How to cite this article:
Prajapati AS, Solanki PK, Sodani V, Shah H, Gurjar K, Patel R. Patient satisfaction over changing dental treatment trends during COVID-19 pandemic-a cross-sectional study. Adv Hum Biol 2022;12:168-73

How to cite this URL:
Prajapati AS, Solanki PK, Sodani V, Shah H, Gurjar K, Patel R. Patient satisfaction over changing dental treatment trends during COVID-19 pandemic-a cross-sectional study. Adv Hum Biol [serial online] 2022 [cited 2022 May 25];12:168-73. Available from: https://www.aihbonline.com/text.asp?2022/12/2/168/345208




  Introduction Top


A novel human coronavirus (CoV) which initially originated in Wuhan referred to as Wuhan CoV, is currently designated as severe acute respiratory syndrome CoV 2 (SARS CoV 2) by the International Committee of the Taxonomy of Viruses,[1] is responsible for the latest pandemic that is affecting human health and economy across the world. Transmission of SARS CoV 2 is mainly through (1) direct contact, (2) indirect route of transmission. Direct transmission is through aerosols produced during surgical/dental treatments in the form of respiratory droplet nuclei through body fluids and secretions. The indirect mode of transmissions includes contact of a susceptible host with contaminated objects and surfaces.[2] Recent studies suggest that the virus may be airborne and can spread through fine infected droplets that remain suspended in the air in a closed environment due to the absence of cross-ventilation, even when not in direct contact with the infected person.[3] It has posed a significant challenge for the field of dentistry which involves the maximum risk of nosocomial infections to dental health care professionals as well as to the patients receiving dental care owing to its working characteristics. This can be attributed to specificities of the branch, which are: (a) Close contact with patient's oral cavity (35–40 cm approximately), (b) Frequent exposure to oropharyngeal fluids and blood, (c) Armamentarium causing aerosolisation and (d) Time consuming and a greater number of visits for dental treatment. To minimise these, various safety guidelines for dental professionals while practising have been proposed by various competent authorities like the Ministry of Health and Family Welfare, India, American Dental Association, etc., Various changes proposed to reduce transmission includes but are not limited to removal of stationery items from the waiting area, practising social distancing and wearing a mask during waiting time before dental procedure, lesser dental visits, not promoting to bring companion during appointment visit if not a minor, deferring dental treatment if not urgent or emergent until the active phase of pandemic wave declines, etc., It is difficult for health care professionals to provide optimum satisfaction to the patients receiving dental care with such changes proposed during this ongoing pandemic. Patient satisfaction in health care describes the degree to which patients' needs 'meet their expectations and provide an acceptable standard of care'. However, what patients want from the services may differ from what the provider thinks is best for them. Therefore, their opinion should be incorporated to provide a holistic view in enhancing the understanding of the factors affecting patients' satisfaction with the health-care setting. Furthermore, such patient satisfaction surveys from health-care facilities of rural areas are less in number and none during the ongoing pandemic. Hence, a study aiming to evaluate the patient's satisfaction receiving dental treatment in the Department of Dentistry during the pandemic was planned. The objective of this study emphasised on assessment of the quality of dental care provided with changes in treatment provision and to improve upon the factors where negative feedback was received. This will ensure a positive impact on patient's satisfaction amidst pandemic.


  Materials and Methods Top


The current cross-sectional observational study was conducted after obtaining ethical approval from Institutional Ethical Committee (IEC/BU/2021/Ex. 20/130/2021). It was conducted at the Department of Dentistry, Pramukh Swami Medical College, which is a tertiary health care medical institute providing service to the people of Karamsad and nearby rural areas.

Inclusion criteria

  • All the patients on completion of dental treatment at the Department of Dentistry
  • Willing to give informed consent.


Exclusion criteria

  • Patients who refused to participate in this study
  • Minor and dependent patients
  • Patients with disabilities
  • Pre- and Post-radiation therapy patients requiring dental treatment and
  • Patients who did not finish their treatment.


The sample size for this study was 200. However, 225 questionnaires were distributed to accommodate incomplete or inadequately filled questionnaires.

The questionnaire was drafted in English and the local language Gujarati. The preliminary draft was designed based on guidelines from experts' opinions, who also evaluated the face and content validity of the questionnaire. A self – administered printed questionnaire was provided to the patients by the nursing staff on completion of their dental treatment. The study duration was from September to November 2020, and a consecutive sampling method was used. The first page of the questionnaire informed participants about the aim and objectives of the study and assured confidentiality of the data provided.

It consisted of questions on demographic data (2); Dentist–Patient relation (2); Appointment (3); Facilities (2); Patient waiting time (3) and Quality of treatment (1) thus forming a total of 13 questions. It has a 4-point response scale ranging from 1 (never) to 4 (always).

Statistical analysis

Microsoft Excel sheet was used to gather data. Descriptive statistical analysis was used to describe the parameters of the questionnaire. The Chi-square test was used to find a significant association between parameters, and P < 0.05 was considered statistically significant. IBM Statistical Package for the Social Sciences (SPSS) for Windows, version 22.0 (IBM Corp., Armonk, NY, USA) was used to perform calculations. This study was conducted in compliance with the Helsinki 2013 declaration.


  Results Top


Among 200 study participants, 106 (53%) were males, and 94 (47%) were females [Figure 1]. Eighty-eight (44%) participantswere <50 years of age, while 112 (56%) were above or 50 years of age [Figure 2]. One hundred and thirty-eight (69%) participants reported that they were explained about the disease treatment plan, including treatment cost. One hundred and fifty-nine (79.5%) patients said that apart from basic information about the disease, further required information was also provided by the dentist [Table 1]. The overall positive response by patients over appointment was obtained with approximately 80% were able to get an appointment as per their suitability and were informed well in advance by the dental department if there were changes with future appointment schedules. One hundred and sixty-one (80.5%) patients said they got treated by the same dentist, maintaining consistency required to build a patient–dentist rapport for the dental treatment [Table 2]. One hundred and sixty-eight (84%) patients responded that the waiting area was hygienic.
Figure 1: Distribution of study subjects according to gender

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FIgure 2: Distribution of study subjects according to Age

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Table 1: Patient's response to dentist - Patient relation (n=200)

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Table 2: Patient's response to appointment (n=200)

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Nearly half of the study participants reported that it was hard for them to engage in the waiting area as stationary informative pamphlets were removed as per guidelines to be followed during the COVID-19 pandemic [Table 3]. One hundred and thirty-seven (68.5%) patients assured that their arrival was intimated to the respective dentist by supporting staff and that they were taken into an operatory for treatment within 10 min of arrival. They were informed about the delay from their allotted appointment schedule with reasons; hence better compliance (79%) was obtained for the same [Table 4]. Positive feedback was obtained by patients over the quality of treatment care and professional behaviour of the dentist as well as the team [Table 5]. There was no statistical significance found between the above-mentioned parameters and age as well as gender.
Table 3: Patient's response to facilities (n=200)

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Table 4: Patient's response to patient waiting time (n=200)

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Table 5: Patient's response to quality of treatment care (n=200)

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  Discussion Top


Satisfaction involves intellectual, emotional, psychological parameters and previous experience as well as the expectation of the subject.[4] Kotler defined satisfaction as: “a person's feeling of pleasure or disappointment resulting from comparing a product's perceived performance or outcome, in relation to his or her expectations.”[5] The health-care industry is becoming consumer-oriented, where dental professionals are seen as service providers and patients their consumers.[6] Patient's feedback is one of the essential components of health-care quality management.[7],[8] Although patients cannot assess a dentist's competence or knowledge, the holistic experience of their dental treatment underlines their perception of the quality of care.[9] Patient satisfaction surveys are a widely accepted method to evaluate health-care efficiency and service utilisation.[9],[10] This survey was conducted with the main aim to evaluate patients' satisfaction with regard to dentist–patient relationship, appointments, patient waiting time, facilities and quality of treatment care during the COVID-19 pandemic. The response rate was 100% which is higher compared to previous studies.[11],[12],[13],[14],[15] The overall mean percentage score of this study was 74.5% which is higher than the study by Othman and Abdul Razak.[16] However, it was lower than a few studies that reported an overall mean percentage score as high as 80%–90%.[11],[14],[17] As such, the overall proportion for satisfaction does not serve the purpose of evaluating incompetency on a large scale.[14] From all the evaluated parameters, the highest overall mean value was received for the quality of treatment care (82%) by patients. This can be due to the ongoing pandemic where patients were cautious and looking for a centre where infection control protocols are followed stringently. Compared to studies where the highest score was received for communication,[18],[19],[20],[21] patients in this study were more satisfied with appointment scheduling and handling (79.5%) than dentist–patient relations (74.3%).

Communication is an important factor in determining patient's satisfaction. A good dentist–patient relationship relies on soft communication, including cognitive and emotional aspects with patient.[22] It has been demonstrated to increase patient compliance with clinical advice and regularity with revisits.[23],[24] An earlier study by Othman and Abdel-Rizal showed only 45.6% dentist–patient relationship.[16] A high score in this study can be due to the methodical way used by dental professionals of the department involving patients in decision-making for their treatment plan before and during the procedure. However, it is lesser than a few recent studies[15],[18],[25],[26] where compliance received by the study sample was more than 90%. It can be explained as the guidelines department followed during pandemic where elective treatments were deferred till the end of the active phase of COVID-19 wave,[27],[28],[29] which would impact the patient's expectations towards the dentist.

To minimise contact with patients in the waiting area, an appointment was scheduled for each patient.[29] Non-aerosol generating procedures were scheduled for patients in the morning session while aerosol-generating procedures in the afternoon such that maximum work was done for a patient requiring multiple procedures in a single visit. This ensured minimal transmission to patients as well as other dental professionals through aerosols. However, patients were allowed to choose appointment slots as per their accessibility, and any change in appointment was informed to the patient in advance by the department to reduce unnecessary footfall. This was well appreciated by patients in the study, receiving nearly 80% of satisfaction. It is higher than the study done by Nagappan N and John J, where 32% of patients had a problem in appointment scheduling as well as contacting the office.[26] The repercussions of the same are seen in the patient waiting time of this study, where nearly 70% of the patients said that they were taken for treatment within 10 min of arrival. Patients opined that faster treatment with quality of care was what they needed from the institute where they were getting treated, which stresses the patient health-care management system.[14] The result obtained is more than the study by Shetty et al.[25] and Patel.[30] where waiting time was the least satisfactory issue. Limiting the number of patients by scheduling an appointment and timely communication with reasons of delay received better satisfaction from patients in this study.

Every patient desires a good hospital environment during the treatment and also that long waiting hours are compensated by informative media/materials.[31] Guidelines by relevant authorities for delivering dental care proposed more stringent following of infection control protocols and altering of waiting area. Stationery and other objects like patient informative materials, appointment slips and post-procedure instructions from the waiting area, which could not be easily disinfected, were removed.[27],[28],[29] Rearrangement of sitting was done to follow social distancing in the waiting area. Recording of patient's temperature and providing mask and alcohol-based hand rub before entering the operatory were practiced.[29] The habit of accompanying a person with patients was discouraged.[27] In support of all of the above, 84% of patients agreed to follow and appreciated the practice. This positive response can be due to their extra cautious nature towards infection control during pandemic which might have affected their satisfaction. It is higher than the results obtained in a study by Al Saffan et al.[32] where 74% of the respondents were satisfied with the cleanliness. However, it was tough for patients to engage themselves before their procedure in the absence of informative materials and pamphlets.

Due to the above-mentioned care and precaution taken by the department during a pandemic, 82% of the patients were satisfied with the quality of treatment care. This achieved result is higher than studies by Mahrous and Hifnawy,[14] Othman and Razak,[16] Hashim[23] and Shetty et al.[25]

Although various studies showed males and older age group less satisfied than females and young, respectively,[33],[34] unexpectedly no statistically significant association was found between satisfaction and variables of age and gender in this study.


  Conclusions Top


This cross-sectional study represented a self-evaluating approach to measure patient's satisfaction as an indicator for the quality of dental services, which is an integral part of the quality management policy of the institute. The results of the study indicated that with proper communication, the positive response by participants over satisfaction was obtained even due to changing treatment trends due to pandemic. Evaluation of patient's satisfaction should be done at regular intervals during a pandemic by conducting such surveys to maintain a high percentage of satisfaction and for further improvement by acknowledging the limitations and deficiencies of the dental health care delivered. However, there are a few limitations, the first being the cross-sectional nature of the study used to collect data on the prevalence of satisfaction which was not able to determine the cause-effect relationship of satisfaction levels. Furthermore, this cross-sectional study has been subjected to recall bias as patients tend to remember dental problems faced in the past.[35] Second, if satisfaction is considered subjective,[36] then this questionnaire is insufficient to record all the aspects of dental care pertinent to their level of satisfaction. In that case, a qualitative study would ascertain accurate results. It would not be wise to generalise the results to the general population based on findings of this study which involved a subgroup of patients attending the dentistry department. Further study based on qualitative findings with a larger sample size would help to determine the level of satisfaction achieved in this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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