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Am Fam Physician. 2008;77(10):1454

Background: Patient satisfaction with medical services can affect compliance and the physician-patient relationship. Patients' access to their own physician for perceived urgent medical issues varies among communities and local health care systems. Options can include emergency departments, walk-in clinics, after-hour facilities staffed by their own or associated physicians, and telephone advisory lines. Care received in urgent care centers and emergency departments can be more expensive, but walk-in clinics may result in minimal continuity with the patient's family physician. Traditionally, family physicians in Canada provided care only during business hours; patients with urgent after-hours needs had to use alternative sites for care. Changes in the past decade have resulted in some extended-hour services through the family physician's office. To determine if patient satisfaction varied with the site of urgent care, Howard and associates surveyed family practice patients from a city in Northern Ontario with a population of about 115,000.

The Study: The study community included one hospital with a 24-hour emergency department, five unaffiliated walk-in clinics, several Family Health Groups and Networks (which contractually provided evening and some weekend care for their own and partner practices), and several fee-for-service family physicians who did not provide after-hours care. The study authors administered a cross-sectional questionnaire to a random sample of patients from all three family practice models; it asked if the patient had accessed urgent care within the previous six months, and about the type of care provided and the patient's satisfaction with the encounter.

Results: Patient satisfaction was measured on a 7-point scale (very dissatisfied to very satisfied). Demographic data, including age, sex, education level, household income, and self-reported health status, were also analyzed; the results were adjusted to account for clustering of patients within physician groups. Approximately 62 percent of the 9,397 questionnaires that were mailed to valid patients (living patients at correct addresses) were completed. The highest levels of satisfaction were reported among patients who spoke to or saw their family physician or went to their own practice's after-hours clinic. Patients who spoke to or saw their family physician were significantly more satisfied than patients who used the emergency department, a walk-in clinic, a telephone advisory service, or more than one service; however, they were not significantly more satisfied than those who used their own practice's after-hours clinic.

Conclusion: Patients in this study clearly preferred to see their own family physician or go to their own practice's after-hours clinic for perceived urgent health care needs. The authors conclude that access and continuity seem to influence patient satisfaction and may affect practice choices about providing this care.

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