1

Contents

ABSTRACT .............................................................................................................. 2

1. INTRODUCTION ............................................................................................... 3

2. METHODOLOGY ............................................................................................... 5

3. RESULTS ........................................................................................................... 5

4. SATISFACTION.................................................................................................. 6

5. UNDERSTANDING ............................................................................................ 8

6. CONVENIENT ................................................................................................. 11

7. FLEXIBILITY .................................................................................................... 13

8. RECOMMEND ................................................................................................ 16

9. CONTINUE ..................................................................................................... 18

10. ENVIRONMENT .............................................................................................. 21

11. FINDINGS ....................................................................................................... 24

12. CONCLUSION ................................................................................................. 25

13. REFERENCES .................................................................................................. 27

2

ABSTRACT

Diabetes is a very serious and complex disease whose patients require very individual

treatment by doctors and nurses basing upon their diabetes type and other medical conditions.

The amount of commitment and support provided by doctors and nurses will increase patient

satisfaction in them and their treatment. Healthcare providers see patient satisfaction surveys

as a tool to measure the service and care being provided by them. In this way, healthcare

providers identify their strengths where they have given satisfactory services and similarly areas

of concern where they need improvements to create a more responsive patient-centered

service. In Pakistan, due to changing way of life and increase in poverty, diabetes prevalence is

increasing and more diabetes patients are being treated in hospitals/clinics. Healthcare

providers in Pakistan need these satisfaction surveys to measure their quality of service and

identify areas for improvement. This research has focused on finding those areas where

diabetes patient feel satisfied with the treatment and areas where improvement is needed. For

this purposes, a questionnaire based satisfaction survey with diabetes treatment was carried

out in major hospitals of Rawalpindi, Abbottabad and Peshawar. A total of 105 responses were

received and analysis of results was then carried out by using StatPro. In this research study, it

was observed to involve satisfaction with treatment, understanding of treatment and diabetes,

convenience, flexibility, recommendation of treatment to others with similar condition,

continuance of treatment and environment of hospital/clinic as variables which will measure

the patient satisfaction with the diabetes treatment. The objective was to measure patient

satisfaction with the diabetes treatment they are receiving and find variables which patient

consider more critical for their treatment. Healthcare providers will also benefit a lot from this

research as it will tell them about areas of concern which needs further improvement as patient

views about diabetes treatment will be put for analysis.

3

1. INTRODUCTION

Healthcare providers can achieve quality when services provided by them increases patients

satisfaction with the treatment and resultantly improves their health outcomes. According to

institute of medicine, healthcare providers can achieve this quality in service by giving

importance to patient safety, patient centeredness, efficiency and effectiveness of treatment,

equity and timeliness [1]. As prevalence of diseases like diabetes is growing at an alarming rate,

it has become essential for healthcare providers to know about patient feedback on the

treatment, medication and self care education so that further improvements can be made in

the services. Diabetes is a very serious and complex disease, and its treatment is very

individualized depending upon the type of diabetes and other medical conditions existing in the

patient [2]. Pakistan with a population of over 160 million has 12% people above the age of 25

suffering from this disease and it is continuously increasing. Lifestyle changes, economic and

socio-cultural situation have resulted in 37% of men and 79% of women with diabetes as obese

[3]. Cost of diabetes treatment is also very high which is not affordable by all. In order to find

the cost of treatment, a questionnaire based study was conducted in outpatient clinics at

Karachi, Pakistan and data was collected from 345 diabetes patient. It was found out that

average cost for treatment per person with diabetes is around Pakistani rupees 11,580 (US$

197) and around 18% of family income is being spent on diabetes care [4]. So it has become

very necessary for healthcare providers to run programs which provide better and effective

treatment at low cost with the feedback from patient satisfaction surveys.

Patient feedback is very important as it helps to understand between healthcare provider

perception and patient perception of diabetes. The feedback reduces the differences and helps

not only provider but also the patient as well [5]. Provider set action plan for improvement in

areas of concern and create more responsive patient centered service whereas patient in

return gets better healthcare services. Key patient satisfaction components are defined as

interpersonal manners of providers with patients, competency of providers in giving better

treatment and medication, convenience of treatment, continuity of care, environment,

availability, cost of care and health outcomes [6]. A diabetes measurement and evaluation tool

for measuring diabetes disease management programs was developed for assessing not only

4

patient satisfaction with health outcomes but also system of healthcare services at

Philadelphia, USA. The questionnaire consisted of variables like meetings with staff, their

behavior, hospital/clinic environment, understanding of general and severe complications, diet,

exercise and commitment to the program [7]. A self audit over care provided by a diabetic clinic

in Nigeria on 118 patients was carried out and it was found out that quality of care being

provided is low and some key areas like referrals and treatment needs further improvement

[8]. A similar study was carried out in Turkey to find out health related quality of life factors

which can be used by healthcare providers for better management of diabetes. 376 patients

with type II diabetes participated in that study and gave importance to demographics and

medical history [9]. A disease state management program for type II diabetes was delivered by

community pharmacists in Australia and 114 patients reported satisfaction with the services

being provided by pharmacists’, satisfaction with self care and were satisfied with

understanding of their own condition with diabetes [10]. A short version of quality from the

patient’s perspective (QPP) questionnaire was used in primary healthcare centers of Sweden to

assess patient satisfaction with continuity of treatment with the same provider and 10% patient

refused to continue treatment with the same healthcare center [11]. A more specific tool for

measuring diabetes patient satisfaction is diabetes treatment satisfaction questionnaire (DTSQ)

and it consists of six variables for finding patient satisfaction with diabetes treatment (satisfied,

understanding, convenient, flexible, recommend and continue) and two variables for finding

perceived hyperglycemia and hypoglycemia [12]. It works for both type I and type II diabetes

patients and, is a good and effective tool for measuring patient satisfaction with the diabetes

treatment. In present study, it was observed to involve satisfaction with treatment,

understanding of treatment and diabetes, convenience, flexibility, recommendation of

treatment to others with similar condition, continuance of treatment and environment of

hospital/clinic as variables which will measure the patient satisfaction with the diabetes

treatment. While a lot of research has been carried out in other countries about finding patient

feedback with diabetes treatment, there is very less information available here in Pakistan on

getting patient responses on diabetes treatment as there are very limited special diabetes

centers to look after care and treatment of diabetes. Patient with diabetes generally go to

5

hospitals/clinics to see doctors/nurses who are also treating and providing care to patients with

other medical conditions. Present research was therefore focused on finding patient

satisfaction with diabetes treatment from hospitals at Rawalpindi, Abbottabad and Peshawar.

The objective was to measure patient satisfaction with the diabetes treatment they are

receiving and find variables which patient consider more critical for their treatment. Healthcare

providers will also benefit a lot from this research as it will tell them about areas of concern

which needs further improvement as patient views about diabetes treatment will be put for

analysis.

2. METHODOLOGY

A patient satisfaction survey was carried out to find satisfaction with diabetes treatment by

using six variables from DTSQ (satisfied, understanding, convenient, flexible, recommend and

continue) and one variable from QPP (environment) [11, 12]. A total of 10 questions on a seven

point likert scale, with 1 being poor and 7 being excellent, were then used basing upon these

seven variables to measure patient satisfaction and analysis was carried out by using StatPro. A

total of 140 questionnaires were sent out to diabetes patient undergoing treatment in hospitals

at Rawalpindi, Abbottabad and Peshawar. Out of which 105 good responses came back and

data from these questionnaire was then analyzed by StatPro. Strength and weaknesses of

variables were then found to see which aspect of treatment is more critical to the patient

satisfaction and where healthcare providers can work for more improvement.

3. RESULTS

Demographics of diabetes patients responding to questionnaire was found to be as shown in

table 1:

6

Gender (n [%])

Male 56 (53.3)

Female 49 (46.7)

Age (n [%])

<20 3 (2.9)

20-30 10 (9.5)

31-40 12 (11.4)

41-50 41 (39.1)

50+ 39 (37.1)

Diabetes Type (n [%])

Type I 24 (22.9)

Type II 81 (77.1) Table 1: Demographics of patients responding to questionnaire (n = 105)

Due to changing lifestyle and socio-cultural situation, 76% of the respondents above the age of

40 are suffering from type II diabetes. They need good responsive treatment which is safe,

caring, efficient and effective provided by the doctors and nurses. Result for each variable in

the questionnaire is also shown in table 2:

Variable n Min Max Mean SD

Satisfied 105 1 7 4.66 1.350

Understanding 105 2 7 4.71 1.278

Convenient 105 1 7 4.49 1.345

Flexible 105 1 7 4.59 1.472

Recommend 105 1 7 4.70 1.611

Continue 105 1 7 4.69 1.654

Environment 105 1 7 5.54 1.330 Table 2: Result for each variable in the questionnaire

4. SATISFACTION

Diabetes treatment is given individually to each patient in two ways, which are medical

treatment by the healthcare providers and self care education to patient. Medical treatment

consist of right diagnosis by the doctors, treating patient in a positive way, giving sincere

answers, showing respect and care, supporting patient emotionally to overcome the disease.

Self care education is a very important part of the diabetes treatment as goals for lifestyle

changes are set mutually between doctor and patient, and periodically those goals are

reviewed. Diet, exercise, quitting smoke and alcohol, and self monitored blood glucose are part

of the life style changes. Self care also includes periodic medical tests after diagnosis which are

7

carried out by the patient at hospital under the supervision of doctors or nurses and home

administered by themselves or by their family. Two questions were asked for this variable

regarding satisfaction with treatment and, care and support being provided by the doctors and

nurses. Data collected for satisfaction with diabetes treatment from patients is shown in figure

1:

Figure 1: satisfaction of patients with diabetes treatment

Following inferences could be drawn from the above figure:

a. Right diagnosis, good treatment and commitment from doctors and nurses have

led to higher satisfaction as 59% patients have rated higher satisfaction with

treatment being provided to them in hospitals. Doctors spent time with the

patients in telling them about their condition, blood sugar control, supporting

them emotionally and telling them about important aspects of self care.

12

15

2524

25

13

0

5

10

15

20

25

30

1 (Poor) 2 3 4 5 6 7 (Excellent)

Category

Histogram for Satisfaction

8

b. Patient also felt greater satisfaction by the respect and care shown by healthcare

providers thus making them feel that doctors and nurses are equally involve with

them in the treatment process and understand their condition.

c. On the other hand, doctors and nurses have to be more responsive to patient

needs and their feelings as 17% respondents rated low satisfaction with

treatment. Doctors were unable to give due time to these patients and didn’t

diagnose them properly which resulted in unsatisfactory treatment.

5. UNDERSTANDING

Patient satisfaction increases when doctor is able to understand his/her situation and

condition. Basing upon this understanding, the doctor is then able to diagnose rightly and start

the treatment process. As doctors have to treat diabetes patient individually therefore not only

they have to understand patient condition but also make patient understand about the

diabetes type, its treatment, goals for lifestyle changes, self care and tests to be monitored

both by the patient and doctor. Two questions were asked for this variable regarding

understanding by doctor of patient situation and patient understanding of his/her diabetes.

Data collected for understanding of diabetes treatment from patients is shown in figure 2:

9

Figure 2: Understanding of patients with diabetes treatment

Following inferences could be drawn from the above figure:

a. Doctors understood the patient situation rightly and were than able to provide

the right treatment and made patient understand as well about diabetes and

information about medication and self care as 71% patients have rated higher

satisfaction with understanding of diabetes.

b. As part of treatment and self care information provided by doctors and nurses,

patients were made aware of the different tests they have to do regularly like

blood glucose tests, blood pressure, checking of cholesterol, kidney function

tests, foot check, eye check and measurement of weight.

c. They were also told about how to maintain their diet plans and to do regular

exercises to control their diabetes which resulted in higher patient satisfaction in

their doctors and nurses, and treatment being provided by them.

03

16

11

3431

10

0

5

10

15

20

25

30

35

40

1 (Poor) 2 3 4 5 6 7 (Excellent)

Category

Histogram for Understanding

10

d. On the contrary, 18% patients were unsatisfied with the understanding of their

treatment as doctors failed to convey them about the purpose of medical tests

and their results. Also they were given very limited information about the

medication and their side effects.

Correlation between satisfaction with treatment and understanding of treatment was also

plotted to see relation between these two variables as doctors and nurses can only provide

better treatment and care when they understands the situation and condition of the patient.

Better understanding of condition leads to right diagnosis, better medication and self care

awareness for the patient. Correlation plotted between these two variables is shown below in

figure 3:

Figure 3: Correlation between satisfaction with treatment and understanding

A very strong correlation of 0.713 exists between satisfaction with treatment and

understanding showing that patients are satisfied with diabetes treatment being provided to

1

2

3

4

5

6

7

8

1 2 3 4 5 6 7

Sati

sfac

tio

n

Understanding

Satisfaction

Poly. (Satisfaction)

Correlation = 0.713

11

them at hospitals. They understood their condition, implications and purpose of the

medications. Similarly there are 18% patients, as seen from the above figure who are away

from the cluster, unsatisfied with their treatment which is due to poor treatment being

provided to them and resulting in low understanding of their diabetic condition.

6. CONVENIENT

Convenient is related to availability and affordability of treatment to the patient with ease.

Patient satisfaction increases when hospital/clinic is near to them, treatment is provided within

acceptable waiting time, is affordable and if necessary, then able to use the treatment easily by

them or with the help of their family members like using injections. Two questions were asked

for this variable regarding receiving of treatment in acceptable waiting time and convenience of

treatment to patient. Data collected for convenience of diabetes treatment to patients is shown

in figure 4:

Figure 4: Convenience of diabetes treatment to patient

1

7

15 14

34

29

5

0

5

10

15

20

25

30

35

40

1 (Poor) 2 3 4 5 6 7 (Excellent)

Category

Histogram for Convenient

12

Following inferences could be drawn from the above figure:

a. Around 65% diabetes patient have shown higher satisfaction with convenience

of treatment as they have received the treatment in acceptable waiting time and

found medication easy to use at home.

b. Patients got appointment with their doctors easily and subsequently received

the diagnosis, test results and medications within 2-3 days.

c. Patients were also educated on how to use the treatment by themselves like

taking injections at home as part of self care. Their families were also made part

of this learning process so that they may also help patients in the treatment.

d. As diabetes treatment is becoming costly, this was also evident from the results

as its treatment was not very affordable to 22% patients. They also did not

receive the treatment in due time which also added to their unsatisfaction.

Correlation between satisfaction with treatment and convenience of treatment was also

plotted to see relation between these two variables as patient feel satisfaction with the

treatment when they can contact doctors and nurses with ease and treatment is provided

within acceptable cost. Better understanding of diabetes medication use by the patient at

home also leads to satisfaction. Correlation plotted between these two variables is shown

below in figure 5:

13

Figure 5: Correlation between satisfaction with treatment and convenience

A strong correlation of 0.672 exists between satisfaction with treatment and convenience

showing that patients are satisfied with diabetes treatment being provided to them at

hospitals. They had received treatment within acceptable waiting time and have understood

how to use the medication at home as part of self care awareness provided by the doctors and

nurses. Similarly there are 22% patients, as seen from the above figure who are away from the

cluster, unsatisfied with their treatment which is due to high cost of the treatment and longer

waiting time for appointment, diagnosis and test results.

7. FLEXIBILITY

Flexibility means how treatment can be changed according to patient’s requirement. Choosing

of time for appointment, choosing doctor, changing dosage and discussing alternative

treatment is very necessary for patient satisfaction. This gives patients great flexibility to

choose their treatment by themselves with the support and care from healthcare providers.

1

2

3

4

5

6

7

8

1 2 3 4 5 6 7 8

Sati

sfac

tio

n

Convenient

Satisfaction

Poly. (Satisfaction)

Correlation = 0.672

14

One question was asked for this variable regarding flexibility of diabetes treatment to patient.

Data collected for flexibility of diabetes treatment to patients is shown in figure 6:

Figure 6: Flexibility of diabetes treatment to patient

Following inferences could be drawn from the above figure:

a. With the help from doctors and nurse, diabetes patients were able to choose

their treatment alternatives and administer their dosages easily thus causing

higher satisfaction among 57% of the respondents.

b. They were able to make healthy diet plans and schedule for regular exercises

with the help from healthcare providers. In this way their quality of life was

maintained and resulted in satisfaction among them.

2

8

17 18

25

29

6

0

5

10

15

20

25

30

35

1 (Poor) 2 3 4 5 6 7 (Excellent)

Category

Histogram for Flexible Q_7

15

c. On the contrary, 26% diabetes patients complained of rigid treatment with no

options for alternative medication. This resulted in lower satisfaction on their

treatment and less confidence on their doctors and nurses.

Correlation between satisfaction with treatment and flexibility of treatment was also plotted to

see relation between these two variables as patient feel satisfaction with the treatment when

they can choose their appointment timings with doctors, choose alternative treatment and able

to change their medications as per their needs. Correlation plotted between these two

variables is shown below in figure 7:

Figure 7: Correlation between satisfaction with treatment and flexibility

A correlation of 0.487 exists between satisfaction with treatment and flexibility showing that

patients are satisfied with diabetes treatment being provided to them at hospitals. Patients

were able to choose alternative treatments, choose their doctors and change their medication

as their requirements changed. Similarly there are 26% patients, as seen from the above figure

1

2

3

4

5

6

7

8

1 2 3 4 5 6 7 8

Sati

sfac

tio

n

Flexible Q_7

Satisfaction

Poly. (Satisfaction)

Correlation = 0.487

16

who are away from the cluster, unsatisfied with their treatment which is due to rigid diabetes

treatment program being given to them at hospitals resulting in low satisfaction.

8. RECOMMEND

Patient satisfaction is also measured once patients recommend their treatment plans, doctors,

nurses, hospital to their relatives, friends and colleagues experiencing similar kind of situation

and condition which they themselves are going through. One question was asked for this

variable regarding recommendation of diabetes treatment by patient to someone else

experiencing similar kind of situation. Data collected for recommendation of diabetes

treatment by patients is shown in figure 8:

Figure 8: Recommendation of diabetes treatment by patient

2

13 1311

20

39

7

0

5

10

15

20

25

30

35

40

45

1 (Poor) 2 3 4 5 6 7 (Excellent)

Category

Histogram for Recommend Q_8

17

Following inferences could be drawn from the above figure:

a. With right diagnosis, positive treatment plans, easy to use medications and

caring attitude by the healthcare providers, 63% patients have rated their

treatment with greater satisfaction and recommend it to someone else with

their kind of situation and condition.

b. Doctors and nurses have made patients understand about their situations and

self care which they have to follow. They have also told them about goals for

changing lifestyle, diet and regular exercise.

c. Patients were satisfied by the total commitment from the healthcare providers

and are willing to recommend this to others facing similar diabetes types like

themselves.

d. On the contrary, 26% patients do not feel recommending their treatment to

others due to high cost of treatment and rigid treatment plans. They were also

not able to understand their condition fully as doctors have not told them about

the purpose of medication and self care awareness.

Correlation between satisfaction with treatment and recommendation of treatment was also

plotted to see relation between these two variables as patient feel satisfaction with the

treatment when they can recommend their treatment to others. Correlation plotted between

these two variables is shown below in figure 9:

18

Figure 9: Correlation between satisfaction with treatment and recommend

A correlation of 0.532 exists between satisfaction with treatment and recommend showing that

patients are satisfied with diabetes treatment being provided to them at hospitals. Patients feel

satisfied with the diabetes treatment, diagnosis, medication, acceptable waiting time,

education being provided to them about self care and flexibility of treatment. Therefore they

feel confident in recommending their hospital and its staff to other people with similar

condition. Similarly there are 26% patients, as seen from the above figure that are away from

the cluster, unsatisfied with their treatment which is due to high cost of treatment, rigid

diabetes treatment program and less education about self care being given to them at hospitals

resulting in low satisfaction.

9. CONTINUE

Once patient are satisfied with their doctors and nurses, treatment plans, medication and self

care plans, cost and flexibility of treatment, they feel happy to continue with their treatment.

1

2

3

4

5

6

7

8

1 2 3 4 5 6 7 8

Sati

sfac

tio

n

Recommend Q_8

Satisfaction

Poly. (Satisfaction)

Correlation = 0.532

19

One question was asked for this variable regarding continuation of diabetes treatment with the

same hospital and medical staff. Data collected for continuation of diabetes treatment by

patients is shown in figure 10:

Figure 10: Continuation of diabetes treatment by the patient

Following inferences could be drawn from the above figure:

a. Patients felt happy to continue with their treatment plans currently being run by

their healthcare providers as 63% patients wanted to continue with their

treatment and have rated it with higher satisfaction.

b. They were happy with the hospital environment, doctors/nurses behavior,

treatment plans, medication and self care programs being run by healthcare

providers.

3

1213

11

2628

12

0

5

10

15

20

25

30

1 (Poor) 2 3 4 5 6 7 (Excellent)

Category

Histogram for Continue Q_9

20

c. They also appreciated the choosing of appointments, affordability of treatment,

choosing alternative treatment plans, medications being provided to them and

modern equipment available to them for medical tests.

d. On the contrary, 26% patients do not feel to continue with their treatment due

to long waiting times and delayed information on test results. They were also not

able to understand their condition fully as doctors have not told them about the

purpose of medication and self care awareness.

Correlation between satisfaction with treatment and continuation of treatment was also

plotted to see relation between these two variables as patient feel satisfaction with the

treatment when they are able to continue their treatment plans being provided by the hospital

and its staff. Correlation plotted between these two variables is shown below in figure 11:

Figure 11: Correlation between satisfaction with treatment and continue

1

2

3

4

5

6

7

8

1 2 3 4 5 6 7 8

Sati

sfac

tio

n

Continue Q_9

Satisfaction

Poly. (Satisfaction)

Correlation = 0.666

21

A strong correlation of 0.666 exists between satisfaction with treatment and continuation

showing that patients are satisfied with diabetes treatment being provided to them at

hospitals. Patients feel satisfied with the diabetes treatment, diagnosis, medication, acceptable

waiting time, education being provided to them about self care and flexibility of treatment.

Therefore they feel confident in continuing with the treatment provided to them by their

hospital and its staff. Similarly there are 26% patients, as seen from the above figure that are

away from the cluster, unsatisfied with their treatment which is due to long waiting times,

delayed information on test result and less education about self care being given to them at

hospitals resulting in low satisfaction.

10. ENVIRONMENT

Environment plays a major role in providing satisfaction to patient. Before seeing a doctor,

patient sees environment of the hospital/clinic and makes opinion about the treatment and

attitude he/she is about to receive from the doctors/nurses. One question was asked for this

variable regarding how patient find the environment of hospital. Data collected for

environment of hospital is shown in figure 12:

22

Figure 12: Environment of hospital

Following inferences could be drawn from the above figure:

a. Patients were found to be very much satisfied with the environment and

atmosphere of the hospitals as 84% patients have rated environment with higher

satisfaction.

b. Patients were attracted to the cleanliness, comfort and helping atmosphere of

the hospitals and felt satisfied about the treatment they have received.

c. They also felt satisfied in talking to doctors and nurses in private about their

condition and knew that their privacy will be valued.

d. Similarly 10% patients were not satisfied with the environment of the hospitals

they visited which was due to untidiness, rude attitude of nurses and patient

rush in the hospitals.

2 26 7

20

46

22

0

5

10

15

20

25

30

35

40

45

50

1 (Poor) 2 3 4 5 6 7 (Excellent)

Category

Histogram for Environment Q_10

23

Correlation between satisfaction with treatment and environment of hospital was also plotted

to see relation between these two variables as patient feel satisfaction with the treatment

when they find good environment of the hospital. Correlation plotted between these two

variables is shown below in figure 13:

Figure 13: Correlation between satisfaction with treatment and environment of hospital

A correlation of 0.501 exists between satisfaction with treatment and environment of the

hospitals showing that patients are satisfied with diabetes treatment being provided to them at

hospitals. Patients feel satisfied with the atmosphere of the hospital, helping attitude of nurses,

value of privacy about their treatment provided to them and cleanliness at the hospital.

Similarly there are 10% patients, as seen from the above figure that are away from the cluster,

unsatisfied with their treatment which is due to untidiness, rude attitude of nurses and patient

rush in the hospitals resulting in low satisfaction.

1

2

3

4

5

6

7

8

1 2 3 4 5 6 7 8

Sati

sfac

tio

n

Environment Q_10

Satisfaction

Poly. (Satisfaction)

Correlation = 0.501

24

11. FINDINGS

Present research lead to following findings:

a. Right diagnosis, good treatment and commitment from doctors and nurses have

led to higher satisfaction among patients. Patient also felt greater satisfaction by

the respect and care shown by healthcare providers thus making them feel that

doctors and nurses are equally involve with them in the treatment process and

understand their condition.

b. Doctors understood the patient situation rightly and were than able to provide

the right treatment and made patient understand as well about diabetes and

information about medication and importance of self care.

c. Diabetes patient have shown satisfaction with convenience of treatment as they

have received the treatment in acceptable waiting time and found medication

easy to use at home.

d. High cost of diabetes treatment and rigid treatment plans was dissatisfaction

among 22% patients as they find it not very affordable.

e. With the help from doctors and nurse, diabetes patients were able to choose

their treatment alternatives and administer their dosages easily showing

flexibility of treatment. They were able to make healthy diet plans and schedule

for regular exercises with the help from healthcare providers. In this way their

quality of life was maintained and resulted in satisfaction among them.

f. Patients were satisfied by the total commitment from the healthcare providers

and are willing to recommend their treatment to others facing similar diabetes

types like themselves.

g. Patients felt happy to continue with their treatment plans currently being run by

their healthcare providers. They were happy with the hospital environment,

25

doctors/nurses behavior, treatment plans, medication and self care programs

being run by healthcare providers.

h. Patients were found to be very much satisfied with the environment and

atmosphere of the hospitals as 84% patients have rated environment with higher

satisfaction.

i. Patients were attracted to the cleanliness, comfort and helping atmosphere of

the hospitals and felt satisfied about the treatment they have received. They also

felt satisfied in talking to doctors and nurses in private about their condition and

knew that their privacy will be valued.

Above findings led to certain conclusions which will help healthcare providers to see areas

where they are providing high satisfaction treatment and care to patients, and some areas of

concern where they need more improvements to provide quality care to patients.

12. CONCLUSION

Diabetes patients need very high quality care as diabetes brings number of other medical

complications which not only affects them and their way of living but most importantly to their

family members. After diagnose and medical treatment, a lot of self care education has to be

given by doctors and nurses to diabetes patients. Due to very limited availability of special

diabetes treatment centre, as present in Canada, England and Ireland where courses and

classes are run for the education of patient about diabetes, doctors and nurses here in Pakistan

have to educate more to patients in order to make them understand about self care and,

regular checkups and tests. Similarly doctors have to give more options to patient in terms of

selecting for alternative treatment plans and choosing appointments. They should also give

flexibility to patients in terms of changing their dosages. Diabetes treatment is becoming costly

and it is becoming difficult for healthcare providers alone to make it affordable for all. For this

government should also intervene in making healthcare facilities accessible for all. By providing

positive treatment, right diagnosis, easy to use medication, interpretation of test results,

getting understanding of patients in the use of medication and their condition, care and

26

emotional support, and better environment at hospitals will make patients continue with their

treatment and will also make them to recommend their treatment to someone else with similar

diabetic condition resultantly showing satisfaction over their treatment.

27

13. REFERENCES

[1] Institute of Medicine, ‘Crossing the Quality Chasm: A New Healthcare System for

the 21st Century’, 2001.

[2] eMedicineHealth Home Page. Available at:

http://www.emedicinehealth.com/diabetes/article_em.htm.

[3] Fatema Jawad, ‘Diabetes in Pakistan’. Diabetes Voice, Vol 48, Issue 2, 12-14, July

2003.

[4] Liaquat A Khowaja, Ali K Khuwaja, Peter Cosgrove, ‘Cost of Diabetes Care in Out-

Patient Clinics of Karachi, Pakistan’. BioMed Central Health Services Research,

7:189, 2007.

[5] James T. Fitzgerald, R. Brent Stansfield, Tricia Tang, Mary Oh, Alice Frohna, Betty

Armbruster, Larry Gruppen, Robert Anderson, ‘Patient and Provider Perceptions

of Diabetes: Measuring and Evaluating Differences’. Patient Education and

Counseling 70 (2008), Elsevier. 118-125, 2007.

[6] John Sitzia, Neil Wood, ‘Patient Satisfaction: A Review of Issues and Concepts’.

Social Science Medicine, Elsevier. Vol 45, No 12, pp 1829-1843, 1997.

[7] Lisa E. Paddock, Jon Veloski, Mary Lou Chatterton, Felicia O. Gevirtz, David B.

Nash, ‘Development and Validation of a Questionnaire to Evaluate Patient

Satisfaction with Diabetes Disease Management’. Diabetes Care, Vol 23, No 7,

July 2000.

[8] E.O. Okoro, A.O. Adejumo, B.A. Oyejola, ‘Diabetic Care in Nigeria: Report of Self-

Audit’. Journal of Diabetes and its Complications 16 (2002), Elsevier. 159-164,

2001.

[9] Fevzi Akinci, Aysegul Yildirim, Hulya Gozu, Haluk Sargın, Ekrem Orbay, Mehmet

Sargın, ‘Assessment of Health-Related Quality of Life (HRQoL) of Patients with

28

Type 2 Diabetes in Turkey’. Diabetes Research and Clinical Practice 79 (2008),

Elsevier. 117-123, 2007.

[10] Ines Krass, Clare Delaney, Susan Glaubitz, Tipaporn Kanjanarach, ‘Measuring

Patient Satisfaction with Diabetes Disease State Management Services in

Community Pharmacy’. Research in Social and Administrative Pharmacy 5 (2009),

Elsevier. 31-39, 2008.

[11] Bodil Wilde-Larsson, Gerry Larsson, ‘Patients’ Views on Quality of Care and

Attitudes Towards Re-Visiting Providers’. International Journal of Health Care

Quality Assurance, Emerald. Vol 22, No 6, pp 600-611, 2009.

[12] Bradley C: Diabetes Treatment Satisfaction Questionnaire (DTSQ). ‘In Handbook

of Psychology and Diabetes’. Amsterdam, the Netherlands, Harwood Academic

Publishers, p. 111–132, 1994.