Doctor-outpatient communications in Chinese public hospitals: a cross-sectional survey.

BACKGROUND: Communication can be seen as the important component in medical care. The improvement of doctor-outpatient communication can improve not only the doctor-patient relationship, but also the quality of health care. In this study, we aimed to estimate whether the doctor-outpatient communication experience is satisfactory in Chinese public hospitals and how various factors affect this experience.

METHODS: In this cross-sectional study, we used a typical sampling survey. Six sample hospitals were chosen by typical sampling method, and in each hospital, 100 outpatients were invited to participate in the survey when they ended their visits. The respondents were a random sample of 300 outpatients from three tertiary hospitals and 300 outpatients from three secondary hospitals in the Hubei Province, China. We used EpiData 3.1 to establish the database and SPSS19.0 to perform the related statistical analysis. A five-point Likert scale was used in the questionnaire, in which 5 meant best experience and 1 meant worst experience. The total communication experience score was the mean of all item scores and we rated scores under 3 as "bad" communication experience. We used the one-way ANOVA method and multiple linear regression to assess difference between doctor-patient communication experience and the demographic variables and how it influenced the experience. Written ethical approval of the study was obtained from the Ethics Committee of Tongji Medical College, Huazhong University of Science and Technology (IORG Number IORG0003571). Verbal informed consent was also obtained before the survey.

FINDINGS: 600 outpatients participated in the survey between July 5, 2015, and July 22, 2015, and 583 questionnaires were valid. 11·22% of the 583 outpatients had bad doctor-patient communication experience. The mean score of doctor-patient communication experience was 3·72 (SD 0·66). According to the result, the experience dimension of the clarity of doctors' explanation got the highest score (4·12 [0·71]), and the experience of the degree of outpatients' participation in decision-making got the lowest score (3·21 [1·07]). Besides, the age, self-perceived health status, and the type of payment affected communication experience (the standard coefficient were: 0·195 for age, 0·219 for health status, and 0·193 for type of payment, p<0·001 for each), and those socio-demographic factors were positively associated with doctor-patient communication experience. Moreover, the communication experience in the secondary hospitals (3·82 [0·61]) was better than in tertiary hospitals (3·61 [0·68]), p<0·001).

INTERPRETATION: The doctor-patient communication experience needs to be improved. Patients of younger age (<65 years), patients with bad self-perceived health status, and patients who pay out-of-pocket totally have worse communication experience, probably because the patients of younger age and those with bad self-perceived health status have higher communication demands, and the patients who pay out-of-pocket totally have higher expectations for communication. The overload of doctors in tertiary hospitals could mean that they have not enough energy and time to communicate with patients, leading to poor communication experience for patients. Useful ways to improve the outpatients' communication experience include taking measures to meet the needs of different outpatients by concentrating more on their age, health status, and payment type, giving outpatients more opportunities to participate in medical decision-making, and strengthening the system of triage.

FUNDING: This study was supported by the Fundamental Research Funds for the Central Universities (2015AC023). The funders did not participate in study design, data collection, and analysis.