Demographic Characteristics
Patients were similarly distributed throughout the age groups, and all patients were over 18 years old (all child patients in Kazakhstan are treated at separate hospitals). However, doctors and nurses, all current practitioners with licenses, were distributed more heavily in the younger age groups (25≤30 years old). The nurses were almost all female, while the sex distribution of doctors was similar to that of patients. The distribution of participants by age and sex is shown in Table 1. We found no differences in the sex distribution of providers between different hospital departments.
PPOS Data for Providers (Doctors and Nurses)
We found no significant differences in PPOS scores between doctors and nurses or between male and female providers (doctors and nurses). Table 2 shows the proportions of providers who could be characterized as patient-oriented. Two features are noteworthy. First, the vast majority of providers were doctor-oriented. Overall, only 10,6 % of providers identified themselves through the PPOS as patient-oriented. Second, the proportions were similar between males and females, but the proportion of patient-oriented providers was smaller among doctors (8,7%) than among nurses (15,7%). The proportion of patient-orientated providers is higher among the ages of 31-40 years old (16,2%) and 41-50 years old (10,4%) than among the ages of 25- 30 years old (5,1%) and older than 50 years old (5,3%).
Other Variables for Providers and Correlations with PPOS Data
The other variables collected from providers were life satisfaction, job satisfaction, job effort, job reward, and the ER ratio as a measure of ER imbalance. Most variables were distributed symmetrically, and we found no major differences between doctors and nurses or between males and females. Table 3 shows the correlation coefficients between the PPOS and other factors measured in providers. Correlation coefficient estimates the direction and strength of association between 2 continuous variables; the square of the coefficient indicates the proportion of variation in dependent variables (PPOS) explained by independent variables.
There was a negative correlation between PPOS and age (R -0,18, P value 0,000218), and PPOS and life satisfaction (R -0,23, P value 0,000001).
Other Variables for Patients and Correlations with PPOS Data
The other variables collected from patients were SLS (mean 3.4±1.37), and CAT (mean 5.0±0.99). Our findings showed that score for SLS and CAT were higher among the females (mean 3.55±1.47 and 5.21±0.96, respectively) compared to males (3.19±1.12 and 4.58±0.93, respectively) (p=0.009 for SLS and p<0.0001 for CAT).
Table 2 shows the proportions of patients who could be characterized as patient-oriented. Overall, 13.8% of patients identified as patient-oriented from their PPOS score. The proportion of patient-orientated patients was higher among the ages ≤ 40 years old (34,6%) and ≥60 years old (35,3%).
The correlations between PPOS and other variables (age, sex, SLS, CAT for patients suggest that life satisfaction was significantly associated with PPOS; patients with higher scores on life satisfaction were more patient-oriented (R 0,44, P value 2,659E-21). The age variable was inversely associated with PPOS; elder patients were less patient-oriented (R -0,10, P value 0,040). (Table 4).
Comparing the PPOS between Providers and Patients
Using the dichotomized PPOS scale with a cutoff at 3.5 points, the proportion of patient-oriented participants was highest among nurses (15,7%) compared to patients (13.8%) and doctors (8.7%). The difference between the 3 groups was statistically significant (P=0.049). (Not shown in the table). In a multivariable analysis, the difference between providers and patients could be explained by adjusting for age (OR:1,07 (95% CI 1.00-1.15), P value 0,040 – for nurses) and for life satisfaction (OR:0,19 (95% CI 0.08-0.50), P value 0,01- for nurses; OR:1,99 (95% CI 1.59-2.49), P value 1,261E-9 - for patients) (Table 5).
ANOVA results:
Job satisfaction among doctors (mean score 4.4) was higher when compared to nurses (mean score 4.2), (P=0.047). Job satisfaction among all medical providers was higher among males (mean score 4.6) compared to females (mean score 4.2), (P=0.001) (not shown in table).
Interpretation of results
Our study shows that the overwhelming majority of health care providers and even patients are doctor-centered. The patient-centered orientation of health care providers is negatively correlated with age (P=0.000218) and life satisfaction (P=0.000001). In patients, contrarily, patient-centeredness is enhanced by higher life satisfaction (P=0.040), although negatively correlated with age (P=2.659E-21).
Our data shows that only 10,6 % of overall medical providers identify themselves as patient-oriented, but this proportion was smaller among doctors (8,7%) compared to that of nurses (15,7%) with no difference between males and females. The proportion of patient-orientated providers is higher among the ages of 31-40 years old (16,2%) and 41-50 years old (10,4%) than among the ages of 25- 30 years old (5,1%) and older than 50 years old (5,3%). The proportion of patients who identify as patient-oriented is 13,8%. The proportion of patient-orientated patients was higher among the ages ≤ 40 years old (34,6%) and ≥60 years old (35,3%).
Limitations of the study
Limited time and resources constrained the number and representativeness of the participants. To have access to a more representative and diverse group of participants, more formal arrangements with hospital administrations will be necessary. Additionally, the duration of hospitalized patients typically lasts no longer than 3-6 days, giving us a limited window to approach patients and secure their participation. Hospital administration allowed the research team to approach patients in a stable condition with predominantly chronic diseases which were able to complete provided questioners without assistance.
An additional challenge in this study is the lack of published data covering this research area of patient dissatisfaction with health care and providers, as well as the convoluted official information about the exact number and types of patient complaints in the Republic of Kazakhstan. The available information is from scattered newspaper and news website articles, and some articles published as official reports for the World Health Organization [1, 4, 11].
Improvements based on the limitations of a previous pilot study
In a previous pilot study [2], we confirmed our hypothesis that the majority of doctors and nurses in the general hospital of Astana city (Nur-Sultan city from 2019), Kazakhstan, are doctor-oriented, but surprisingly the majority of patients in that study showed the same results [2]. One problem in our previous research design was the modification of the PPOS scale, to increase the ease of answering by patients. In all questions we reduced six variants of answers into four, while for doctors and nurses the original form of the scale with six variants was used. Another limitation is that we had a smaller number of patients and departments where they have been hospitalized. In the present study we used the original version of the PPOS scale for medical providers and patients, and number of all participants were increased and recruited from several different departments and hospitals.