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Patients' Desires and Expectations for Medical Care: A Challenge to Improving Patient Satisfaction

Center for Practice Management and Outcomes Research, Ann Arbor VA Medical Center Health Services Research and Development Field Program and Department of Internal Medicine, University of Michigan, Ann Arbor, Mich, judiz{at}umich.edu

Rodney A. Hayward, MD

Departments of Internal Medicine and Health Management and Policy, University of Michigan, Ann Arbor, Mich, and the Department of Veterans Affairs Medical Center, Ann Arbor, Mich

Kimberly A. Skarupski, PhD

Center for Health Outcomes and Pharmaco Economic Research, College of Pharmacy, University of Arizona, Tucson, Ariz

Steven J. Katz, MD, MPH

Departments of Internal Medicine and Health Management and Policy, University of Michigan, Ann Arbor, Mich

Patients' desires and expectations for medical care warrant scrutiny because of their potential influence on health care use and patient satisfaction and their effects on patients' perceptions of quality of care. To determine if desires and expectations for selected elements of medical care and specialty referral differ between VA outpatients and non-VA outpatients, we conducted a cross-sectional survey of patients at a VA medical center site and 2 primary care sites of its university affiliate. Of 390 eligible patients at the VA medical center site, 270 (69Wo) consented to participate and returned completed self-administered questionnaires. At its university affiliate sites, 119 (73%) of the 162 eligible patients completed questionnaires. Overall, patient desire and expectation for elements of medical care and specialty referral were similar and high at all study sites. Desire ranged from 33% for a blood test to check for anemia to 80% for heart auscultation. Desire for specialty referral for hypothetical scenarios averaged 71% and 61% among VA Medical Center patients and university affiliate patients, respectively. Patient demographics and socioeconomic status were poor predictors of desire for care. These results suggest (a) that VA medical center outpatients' desires and expectations for preventive medical care are not significantly different from those of non-VA outpatients, (b) that desire is often high for both highly recommended care and care that is not generally recommended or is controversial, and (c) that high levels of desire are not limited to patients of higher levels of socioeconomic status. In an effort to improve satisfaction, it is important to examine ways in which to address patients' desires and expectations for medical care, even while faced with competing health care spending priorities.

American Journal of Medical Quality, Vol. 14, No. 1, 21-27 (1999)
DOI: 10.1177/106286069901400104


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