146 Bangladesh Journal of Medical Science Vol. 14 No. 02 April’15 Original article Patient’s satisfaction with orthodontic treatment at King Khalid University, College Of Dentistry, Saudi Arabia Shahrani I1, Tikare S2, Togoo RA3, Qahtani F4, Assiri K5, Meshari A6 Abstract: Introduction: Patient satisfaction is important for ensuring patient’s adherence in orthodontic treatment. As teaching institutions, dental college clinics must constantly strive to find a balance between satisfyingthe needs of the patients and ensuring proper training of the students. The ob- jective of the present studywas to assess dental patient’s satisfaction with orthodontic treatment and related services at King Khalid University,College of Dentistry (KKU COD), Saudi Arabia. Materials and methods: A 19 item closed end questionnaire was developed and pretested to as- sess patient’s satisfaction with orthodontic care. The questionnaire items were designed under three domains: 1) Reception and work environment, 2) doctor-patient relationship, and 3) treat- ment expectations and satisfaction. The study sample consisted of all patients consulting the or- thodontic clinics during the time frame of the survey and those who were willing to participate. Results: A total of 72 patients completed the survey within the time framework. The mean age of the patients was 21.2 ± 8.06 of which males were 69.5% and Females 30.5%. The highest subscale score was found to be with patient’s treatment expectations and satisfaction (92.6%) followed by reception and work environment (89.3%) and Dentist-patient relationship (82.7%). The overall patient’s satisfaction for orthodontic services among the patients was found to be 87.1%. Conclusion: There was a high dental patient’s satisfaction with orthodontic services at COD KKU, Saudi Arabia as a teaching institution.The dentist-relationship wasfound to be key factor in determining dental patient’s satisfaction. Keywords: orthodontic treatment; patient satisfaction; Saudi Arabia Corresponds to: Dr. Ibrahim Al Shahrani, Assistant Professor, Division of Orthodontics, Department of Preventive Dental Sciences, King Khalid University College of Dentistry, Kingdom of Saudi Arabia. Email: ishahrani@gmail.com 1. Dr. Ibrahim AlShahrani, Assistant Professor, Division of Orthodontics, Department of Preventive Dental Sciences, King Khalid University College of Dentistry, Kingdom of Saudi Arabia 2. Dr. Shreyas Tikare, Lecturer, Division of Dental Public Health, Department Preventive Dental Sciences, King Khalid University College of Dentistry, Kingdom of Saudi Arabia 3. Dr. Rafi A. Togoo, Associate Professor, Division of Pedodontics, Department of Preventive Dental Sci- ences, King Khalid University College of Dentistry, Kingdom of Saudi Arabia 4. Fahad Al Qahtani, Intern student, King Khalid University College of Dentistry, Kingdom of Saudi Arabia 5. Khalid Assiri, Intern student, King Khalid University College of Dentistry, Kingdom of Saudi Arabia 6. Ahmad Al Meshari, Intern student, King Khalid University College of Dentistry, Kingdom of Saudi Arabia Introduction Satisfaction is the contentment one feels when on fulfilment of a desire, need, or expectation1. Over the past decade, consumer satisfaction has gained wide- spread recognition as a measure of quality in many public sector services. The service relationships of doctors with patients are now commodities2,3. As the health care industry shifts towards a consumer-ori- ented approach in the delivery of care dentists are now considered as service providers and dental pa- tients as customers4. Patient satisfaction is an important and widely ac- cepted measure of health care efficiency5. It provides crucial information on what the patient’s expecta- tions are and how they perceive the quality of care, which may be different from that of all staff provid- ing that care. Giving the patient an opportunity to voice their opinions about the care they receive can influence the whole quality improvement agenda and provide an opportunity for organizational learning DOI: http://dx.doi.org/10.3329/bjms.v14i2.17837 Bangladesh Journal of Medical Science Vol.14(2) 2015 p.146-150 147 Patient’s satisfaction with orthodontic treatment at King Khalid University, College of Dentistry, Saudi Arabia and development6. With the advent of information era, information dis- semination has assumed unimaginable proportions. Scientific information has now reached the public domain and public is now-a-days well informed about dental care. The dental patient visiting a den- tist might harbour certain expectations regarding the provision of oral health services. Satisfaction of dental patients is the ultimate motive of oral health care professionals. Patient satisfaction is important for ensuring patient’s adherence in orthodontic treat- ment7,8. Provision of oral health services by dental institu- tions constitutes an important component of the oral health care delivery system in Saudi Arabia. As teaching institutions, dental college clinics must constantly strive to find a balance between meeting the needs of the patients and those of the students. The recent past has witnessed a sudden increase in the number of dental institutions in the Kingdom of Saudi Arabia9. Although the universities aim at providing good dental services for its patients and spends a considerable amount of money and human resources, little information on patient satisfaction is available. Theprivate dental practice set-ups collect fees for services offered and are usually more con- cerned about their patient’s satisfaction. The objec- tive of the present study was to assess dental patient’s satisfaction with orthodontic services at King Khalid University,College of Dentistry(KKU COD), Saudi Arabia as part of the continuous quality improvement programme. Materials and methods The present study was conducted at the Orthodon- tic SpecialtyClinic, College of Dentistry, KKU. A 19 item closed end questionnaire was developed to as- sess patient’s satisfaction with orthodontic care. The questionnaire items were designed under3 domains: Reception and work environment, doctor-patient re- lationship, treatment expectations and satisfaction. The responses for 10questions had four point Likert scale, 4 questions had dichotomous response and rest had simple multiple choice options. All items were reviewed many times and checked for face validity before subjecting for reliability analysis.The ethi- cal approval was obtained from the Ethical Review Board, KKUCOD (KKUCOD/ERC24/2013). The study sample consisted of all patients consult- ing the orthodontic clinics during the time frame of the survey and those who were willing to participate. The questionnaires were distributed at the OPD reg- istration by the clinic receptionist. The patients filled out the questionnaire in the waiting rooms of ortho- dontics clinics. Each patient was allowed to complete the questionnaire once and was asked to submit the same only at the end of their treatment (final visit in case of multiple appointments). The patient’s feed- back response was collected for two months from the start date of the survey. Given that there were no independent interviewers and dental staff allowed as- sisting in the completion of the questionnaire. The collected data was entered into the computer (Micro- soft Excel)and further analysed using Smith’s Statis- tical Package Version 2.80. Results A total of 72 patients completed the survey within the time framework. The mean age of the patients was 21.2 ± 8.06 of which males were 69.5% and Fe- males 30.5%. Graph 1 shows patient responses as to who suggested orthodontic treatment for them. It can be seen that majority of the patients were either di- rected by a dentist/dental specialist (n=30) or they were self-motivated with parental suggestion (n=38). Only few patients (n=4) were seeking orthodontic 148 Shahrani I, Tikare S, Togoo RA, Qahtani F, Assiri K, Meshari A treatment as suggested by their friends/relatives. Graph 2 shows patient responses for reason to choose university orthodontic clinic for their treatment. The graph clearly indicates that majority of the patients (n=53) had confidence in academic facilities. A very few (n=14) patients chose the university dental clin- ic as their choice for orthodontic treatmentsincethe same treatment is expensive in private dental clinics. The remaining patients (n=5) were referred from the local dentists. The internal consistency of the total scale satisfac- tion questionnaire was satisfactory. Cronbach’s alpha was found to be 0.77. Table 1 shows the mean and the standard deviation sub scale scores for patient’s satisfaction with orthodontic services. The highest sub scale score was found to be with patient’s treat- ment expectations and satisfaction (92.6%) followed by reception and work environment (89.3%) and Dentist-patient relationship (82.7%). The overall pa- tient’s satisfaction for orthodontic services among the patients was found to be 87.1%. Discussion Our findings show that majority of the patients chose to get treated here at KKU because they had high confidence in academic facilities. Many factors go into choosing whether private dental clinics or the academic dental clinics are the right one for seeking the treatment. There are some pros and cons to be- ing treated at academic dental clinics. On the other hand there are some undeniable potential benefits: the residents and fellows are well supervised which means that patients could be consulted and examined by several different people. Academic dental clinics also place a strong emphasis on research, and tend to provide new ways of treating patients with cutting edge facilities which highly subsidized or free. Previous investigations have indicated that the qual- ity of treatment outcomes and overall patient satis- faction are of great importance in influencing a gen- eral dentist to refer a patient to an orthodontist10-13. In our study significant numbers (n=30, 41.6%) of patients were referred by the general dentists, which can be attributed to high quality treatment outcomes at KKU. Almost equal to the number of referred patients (n=38, 52.7%) were those who directly re- ported to KKU since high confidence they have with academic facilities. Patient satisfaction after orthodontic treatment is influenced by a number of factors7,8,14,15. The inves- tigations of patient satisfaction after orthodontic treatment have shown a wide range of satisfaction levels16-18. The use of different questionnaires to as- sess satisfaction makes comparison with other stud- ies difficult. Our questionnaire tries to measure the level of satisfaction as well as performance of qual- ity attributes related to orthodontic treatment. It was observed in our survey that the highest satisfaction rank is with the patient’s expectations of treatment results followed by work environment and recep- tion and dentist-patient relationship. However, the patient’ssatisfaction isrelatively ranked according to total subscale percentage values. Although, the least ranked sub-scale, dentist-patient relationship indi- cates high degree of satisfaction. This fact is evident with undoubtedly high sum satisfaction score of the survey investigation. The inclination of all doctors towards patients is usu- allyto meet the desired treatment expectations. The technical competence of the dentist is often cited as a key determinant factor contributing to patient’s sat- isfaction19,20. Our patients were highly satisfied with technical aspects of the treatment. This fact can be attributed to patient–centred treatment procedures done with due consideration to the current principles of ethics and good clinical practice thereby ensuring reliable and best quality services to the public. This also reflects the dedication and enthusiasm of the dental faculty and technical staff towards the same Questionnaire Domains Mean Score SD Maximum Score Satisfaction Per cent Ranking Reception and Work Environment (4) 14.2917 1.5873 16 89.3 2 Dentist-Patient Relationship (7) 22.3333 3.2501 27 82.7 3 Treatment Expectations and Satisfaction (6) 14.8194 1.5136 16 92.6 1 Sum Satisfaction Sore (17) 51.4 5.0738 59 87.1 Table 1: Total and sub-scale mean patient’s satisfaction scores 149 Patient’s satisfaction with orthodontic treatment at King Khalid University, College of Dentistry, Saudi Arabia end. However, very few patients demonstrated cer- tain levels of dissatisfaction with the dentition after orthodontic treatment which might be because of pa- tient compliance or unrealistic expectations. The patient’s first ever experience of health care fa- cility is at the hospital reception. A dental reception- ist has responsibilities of courteous communication with patients and effective office administration. Our survey results with orthodontic patients revealed av- erage sense of satisfaction as compared to the other two dimensions. Majority of them not very satisfied with the waiting period and duration for comple- tion of treatment. The dental care delivery system in KKU is based on scheduled appointments, and dental faculty carry out dental treatment only during the specialty practice sessions. These factors prob- ably lengthen the treatment period compared to the patient’s expectations. A doctor–patient relationship is important in the practice of dentistry and is essential for the delivery of high-quality care in the diagnosis and treatment. The patients are likely to be more positive when effort is made to build good relationships with pa- tients and not where effort is focused on technical excellence alone. The importance of interpersonal factors (personality and communication) for dental patient satisfaction is most frequently cited in the lit- erature21-23. Our results suggest that the patients were relatively less satisfied regarding interaction with the orthodontist. Most of the patients who participated in this study were dissatisfied with the explanation of the procedure during treatment. This may be ex- plained because the procedures are so common and clear, the orthodontists do not see the importance of talking about them and explaining them to their pa- tients. Providing the patient with further explanation of their treatment options should be highlighted to achieve high level of satisfaction with service pro- vided. In conclusion, there was a high dental patient’s satis- faction with orthodontic services at COD KKU, Sau- di Arabia as a teaching institution. The importance of establishing social relationship and verbal communi- cation should be strongly emphasized. To obtain ad- equate patient feedback in a reasonable time, regular surveys monitoring patient satisfaction are needed to determine the main weakness in various other servic- es provided in King Khalid University. Continuous evaluations of data from such surveys are essential in monitoring the changes in patient satisfaction levels. Acknowledgements The authors thank all the patients for taking part in the survey and sharing their valuable experiences, thereby making this study a success. 150 Shahrani I, Tikare S, Togoo RA, Qahtani F, Assiri K, Meshari A References: 1. http://www.thefreedictionary.com/satisfaction (As accessed on 06-12-2013) 2. Stoeckle JD. From service to commodity: corporization, competition, commodification, and customer culture transforms health care. Croat Med J. 2000; 41:141- 43. 3. Pellegrino ED. The commodification of medical and health care: the moral consequences of a paradigm shift from a professional to a market ethic. J Med Philos. 1999; 24(3):243-66. http://dx.doi.org/10.1076/jmep.24.3.243.2523 4. Mike Grace. Customers or patients? British Dental Journal. 2003; 194(11): 583. http://dx.doi.org/10.1038/sj.bdj.4810227 5. Fitzpatrick. Surveys of patient satisfaction: II- Designing a questionnaire and conducting a survey. BMJ. 1991; 302:1129-32. http://dx.doi.org/10.1136/bmj.302.6785.1129 6. Wiig S, Storm M, Aase K, Gjestesen MT, Solheim M, Harthug S, Robert G, Fulop N. and the QUASER team. Investigating the use of patient involvement and patient experience in quality improvement in Norway: Rhetoric or reality? BMC Health Services Research 2013; 13:206. http://dx.doi.org/10.1186/1472-6963-13-206 7. Bos A, Vosselman N, Hoogstraten J, Prahl-Andersen B. Patient compliance: a determinant of patient satisfaction? Angle Orthod. 2005; 75:526–31. 8. Keles F. Satisfaction with orthodontic treatment. Angle Orthodontist. 2013; 83(3): 507-11. http://dx.doi.org/10.2319/092112-754.1 9. http://universitiescollegesinsaudi.wordpress.com/ (As accessed on 06-12-2013) 10. McComb J, Wright J, O’Brien K. Dentists’ perceptions of orthodontic services. Br Dent J. 1995; 178:461–64. http://dx.doi.org/10.1038/sj.bdj.4808803 11. American Association of Orthodontists. General dentist survey focuses on perception, communication needs. AAO Bull. 1997:8. 12. Guymon G, Buschang PH, Brown TJ. Criteria used by general dentists to choose an orthodontist. J ClinOrthod. 1999; 33:87–93. 13. Hall JF, Sohn W, McNamara JA. Why do dentists refer to specific orthodontists? Angle Orthod. 2009; 79(1):5-11. http://dx.doi.org/10.2319/011108-15.1 14. Carneiro CB, Moresca R, Petrelli NE. Evaluation of level of satisfaction in orthodontic patients considering professional performance. Dental Press J Orthod. 2010; 15(6):56.e1-12. 15. Maia, Normando, Maia, Ferreira, Alves. Factors associated with patient satisfaction. Angle Orthodontist. 2010; 80(6): 1155-58. http://dx.doi.org/10.2319/120909-708.1 16. Birkeland K, Bøe OE, Wisth PJ. Relationship between occlusion and satisfaction with dental appearance in orthodontically treated and untreated groups. A longitudinal study. Eur J Orthod. 2000; 22:509–18. http://dx.doi.org/10.1093/ejo/22.5.509 17. Al-Omiri MK, Abu Alhaija ES. Factors affecting patient satisfaction after orthodontic treatment. Angle Orthod. 2006; 76:422–31. 18. Bondemark L, Holm A, Hansen K, Axelsson S, Mohlin B, Brattstrom V, Paulin G, Pietila T. Long- term stability of orthodontic treatment and patient satisfaction. Angle Orthod. 2007; 77:181–91. http://dx.doi.org/10.2319/011006-16R.1 19. R. Hashim. Patient satisfaction with dental services at Ajman University, United Arab Emirates. Eastern Mediterranean Health Journal. 2005; 11(5/6): 913- 21. 20. Newsome PRH, Wright GH. A review of patient satisfaction: 1. Concepts of satisfaction. British dental journal, 1999, 186(4): 161–65. 21. Murtomaa H, Masalin K. Public image of dentists and dental visits in Finland. Community dentistry and oral epidemiology, 1982; 10(3):133–35. http://dx.doi.org/10.1111/j.1600-0528.1982. tb01337.x 22. Strauss RP et al. Patients’ attitudes toward quality assurance in dentistry. Journal of the American College of Dentistry, 1980; 47:101–9. 23. Kress GC Jr, Silversin JB. Internal marketing and quality assurance through patient feedback. Journal of the American Dental Association, 1985, 110(1):29–34.