kjhp Korean Journal of Health Promotion Korean J Health Promot 2234-2141 2093-5676 The Korean Society of Health Promotion and Disease Prevention 10.15384/kjhp.2017.17.3.176 kjhp-17-176 Original Article Experience of Lifetime Health Maintenance Clinic in a Tertiary Hospital: Patients Satisfaction and Associated Factors LeeSeung Woo ChoNa Ra YooSeung Hyun SunwooSung Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Corresponding author : Sung Sunwoo, MD, PhD Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olymphic-ro 43-gil, Songpa-gu, Seoul 05505, Korea Tel: +82-2-3010-3813, Fax: +82-2-3010-3815 E-mail: sws@amc.seoul.kr 012017 19012017 173176 183 18072017 23082017 Copyright © 2017 The Korean Society of Health Promotion and Disease Prevention 2017 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Background:

Lifetime health maintenance program (LHMP) is designed for individualized disease prevention and health promotion through regular health checkups and improving risk factors. This study aimed to investigate patients’ satisfaction of lifetime health clinic (LHC) in a tertiary hospital and to evaluate associated factors in order to support primary health care strengthening policy.

 Methods:

We conducted surveys for patients, who visited LHC in a department of family medicine at a tertiary hospital from March 1st 2016 to December 31st 2016. We analyzed proportions and characteristics associated with patients, who were willing to recommend LHC. The relationship between willingness to recommend LHC and associated factors were evaluated by multivariate logistic regression analyses.

 Results:

Among the patients who answered the questionnaires, 83.7% responded that they would recommend LHC to others. Results from multivariate analyses suggested that patients living in provinces (odds ratio [OR] 4.21, 95% confidence interval [CI], 1.36-13.02), patients who were recommend by others to visit LHC (OR 3.99, 95% CI, 1.29-12.35), and those who had a large number of medical service preference items (OR 5.91, 95% CI, 1.48-23.58) were significantly associated with willingness to recommend LHC.

 Conclusions:

LHC pursues the goal of primary care. Findings highlight the fact that high quality health service should be provided in small and municipal hospitals to improve patients’ satisfaction. Furthermore, it is essential to establish family physician networks and health service infrastructure that can reflect various opinions.

 Lifetime Health Maintenance Program Patient satisfaction Primary care REFERENCESStarfield B Shi L Macinko J Contribution of primary care to health systems and health Milbank Q 2005833 457502 Starfield B Shi L Policy relevant determinants of health: an international perspective Health Policy 2002603 20118 Atun R What are the advantages and disadvantages of restructuring a health care system to be more focused on primary care services? 2004 World Health Organization Regional Office for Europe 2004 [cited 2004 Jan 20]. Available from: http://www.euro.who.int/document/e82997.pdf Macinko J Starfield B Shi L The contribution of primary care systems to health outcomes within Organization for Economic Cooperation and Development (OECD) countries, 1970-1998 Health Serv Res 2003383 83165 Kim EJ Yoon SJ Jo MW Kim HJ Measuring the burden of chronic diseases in Korea in 2007 Public Health 20131279 80613 Strong K Mathers C Leeder S Beaglehole R Preventing chronic diseases: how many lives can we save? Lancet 20053669496 157882 Cho HJ Shim JY Lee HR Lee SH Factors associated with possession of regular doctor in Korea J Korean Acad Fam Med 20012211 161221 Bong SW Kim TH Kim SS Kim YS An interview survey on opinions concerning the necessity for family doctor registration program and its major services J Korean Acad Fam Med 2006273 3705 Cho HJ Shim JY Lee HR Lee SH What do Korean people think of family doctor registration program? J Korean Acad Fam Med 2002232 1718 Huh BY Kim CH Park TJ Lee KY Cho BL Kim HJ Development and evaluation of home doctor registration program J Korean Acad Fam Med 19981910 80110 Park M Kim SY Kim YS Sunwoo S Cho JJ Periodic Health Examination and Prevention Guidelines for Koreans Korean J Fam Med 20093010 7618 Kim SY Kim YS Park MS Sunwoo S Cho JJ Methodology of Korean lifetime health maintenance program Korean J Fam Med 20093010 76976 Hwang J Park HA Patient satisfaction as an outcome indicator J Korean Acad Adult Nurs 2001131 2939 Pascoe GC Patient satisfaction in primary health care: a literature review and analysis Eval Program Plann 198363-4 185210 Linder-Pelz SU Toward a theory of patient satisfaction Soc Sci Med 1982165 57782 Kim KS Ree SB Empirical study on customer satisfaction and others factor influencing "would recommend" in NPS(Net Promoter Score) - Focus on Kitchen furniture - J Korean Soc Quality Manage 2009372 5867 Ghorbani A Raeissi P Saffari E Reissi N Patient satisfaction with the Family Physician Program in Sabzevar, Iran Glob J Health Sci 201682 21929 Pini A Sarafis P Malliarou M Tsounis A Igoumenidis M Bamidis P Assessment of patient satisfaction of the quality of health care provided by outpatient services of an oncology hospital Glob J Health Sci 201465 196203 Jeong H Lee H Lee JH Lee T Payment reform for the improvement of primary care in Korea J Korean Med Assoc 20135610 88190 Dourgnon P Naiditch M The preferred doctor scheme: a political reading of a French experiment of gate-keeping Health Policy 2010942 12934 Kralj B Kantarevic J Primary care in Ontario: reforms, investments and achievements Ont Med Rev 2012792 1824 Ganasegeran K Perianayagam W Manaf RA Jadoo SA Al-Dubai SA Patient satisfaction in Malaysia's busiest outpatient medical care ScientificWorldJournal 20152015 714754 Li J Wang P Kong X Liang H Zhang X Shi L Patient satisfaction between primary care providers and hospitals: a cross-sectional survey in Jilin province, China Int J Qual Health Care 2016283 34654 Sun J Hu G Ma J Chen Y Wu L Liu Q Consumer satisfaction with tertiary healthcare in China: findings from the 2015 China National Patient Survey Int J Qual Health Care 2017292 21321 Park SM Cho JJ Park YG Kim YS Public perception of the need for regular family doctors, their major role, and appropriate training duration Korean J Fam Pract 201332 12431 Seo HG Kang JH Kim CH Kim SW A telephone survey on the opinions about family doctor Korean J Prev Med 1998312 31022 Tables

Basic characteristics of the patients (n=184)

Characteristic Value
Age, y  
≤59 52 (28.3)
60 to 69 73 (39.7)
≥70 59 (32.1)
Gender  
Male 92 (50.0)
Female 92 (50.0)
Reason for registration
Recommendation by physicians in family department 95 (51.6)
Recommendation by physicians in another department 9 (4.9)
Brochures 10 (5.4)
Recommendation by acquaintance 63 (34.2)
Recommendation by family 7 (3.8)
Registration count  
One time 54 (29.3)
Two times 20 (10.9)
Three times 14 (7.6)
Four times 2 (1.1)
More than five times 94 (51.1)
Comorbidities (multiple choice)
Hypertension 110 (59.8)
Diabetes mellitus 52 (28.3)
Dyslipidemia 104 (56.5)
Osteoporosis 26 (14.1)
Gastrointestinal disease 31 (16.8)
Depression 16 (8.7)
Thyroid disease 17 (9.2)
Prostate disease 25 (8.6)
Menopause 7 (3.8)
Questionnaire items for evaluating satisfaction (multiple choice)
Detailed explanation by family physician 182 (98.9)
Personalized checkups 156 (84.8)
All day helpline 97 (52.7)
Notification of the scheduled date for checkup 96 (52.2)
Offering healthcare newsletters 75 (40.8)
Kindness of medical team 151 (82.1)
Same-day appointment 105 (57.1)
Fast reservation 102 (55.4)
Purpose of visit (multiple choice) 57 (31.0)
Illness visits 57 (31.0)
Wellness visits 129 (70.1)
Consultation visits 35 (19.0)

Values are presented as number (%) or mean (SD). Data are analyzed by Frequency and Descriptive analysis.

Clinical characteristics of the patients according to the willingness to recommend LHC

Characteristic Outpatients
Total (n=184) Recommend (n=154) Not recommend (n=30) Pa
Age, y   64.53±12.19 64.33±11.65 0.957
≤59 52 (28.3) 43 (82.7) 9 (17.3)  
60-69 73 (39.7) 61 (83.6) 12 (16.4)  
70≥ 59 (32.1) 50 (84.7) 9 (15.3)  
Gender       0.000
Male 92 (50) 77 (83.7) 15 (16.3)  
Female 92 (50) 77 (83.7) 15 (16.3)  
Reason for registration       0.017
Recommendation by physicians 104 (56.5) 80 (76.9) 24 (23.1)  
Brochures 10 (5.4) 9 (90.0) 1 (10.0)  
Recommendation of acquaintance 70 (38.0) 65 (92.9) 5 (7.1)  
Registration count       0.219
One 54 (29.3) 43 (79.6) 11 (20.4)  
Two-four 36 (19.6) 28 (77.8) 8 (22.2)  
More than five 94 (51.1) 83 (88.3) 11 (11.7)  
Area       0.008
Metropolitan (Seoul) 114 (62.0) 89 (78.1) 25 (21.9)  
Provinces 70 (38.0) 65 (92.9) 5 (7.1)  
Numbers of disease       0.701
One 54 (29.3) 47 (87.0) 7 (13.0)  
Two 70 (38.0) 57 (81.4) 13 (18.6)  
More than three 60 (32.6) 50 (83.3) 10 (16.7)  
Questionnaire items for evaluating satisfaction (multiple choice)       0.042
Less than three 52 (28.3) 41 (78.8) 11 (21.2)  
Four-six 71 (38.6) 56 (78.9) 15 (21.1)  
Seven-eight 61 (33.2) 57 (93.4) 4 (6.6)  
Purpose of visit (multiple choice)        
Illness visits       0.461
Yes 57 (31.0) 46 (80.7) 11 (19.3)  
No 127 (69.0) 108 (85.0) 19 (15.0)  
Wellness visits       0.376
Yes 129 (70.1) 110 (85.3) 19 (14.7)  
No 55 (29.9) 44 (80.0) 11 (20.0)  
Consultation visits       0.386
Yes 35 (19.0) 31 (88.6) 4 (11.4)  
No 149 (81.0) 123 (82.6) 26 (17.4)  

Abbreviation: LHC, lifetime health clinic. Values are presented as number (%) or mean±standard deviation.

P-values are analyzed by chi-square test

Multivariate analyses of the characteristics associated with willingness to recommend LHC

Variable Crude OR (95% Cl) P Multivariable ORa (95% Cl) Pb
Age, y        
≤59 1 N/A 1 N/A
60-69 1.06 (0.41-2.75) 0.898 1.79 (0.58-5.58) 0.314
≥70 1.16 (0.42-3.19) 0.770 2.22 (0.65-7.55) 0.202
Gender        
Male 1 N/A 1 N/A
Female 1.00 (0.46-2.19) 1.00 1.15 (0.46-2.86) 0.763
Area        
Metropolitan (Seoul) 1 N/A 1 N/A
Provinces 3.65 (1.33-10.05) 0.012 4.21(1.36-13.02) 0.013
Reason for registration        
Recommendation of medical staff 1 N/A 1 N/A
Brochures 2.70 (0.33-22.40) 0.358 4.14 (0.39-44.33) 0.240
Recommendation of acquaintance 3.90 (1.41-10.79) 0.009 3.99 (1.29-12.35) 0.016
Registration Count        
One 1 N/A 1 N/A
Two-four 0.90 (0.32-2.50) 0.833 0.78 (0.23-2.70) 0.696
More than five 1.93 (0.77-4.81) 0.158 2.22 (0.75-6.62) 0.152
Numbers of disease        
One 1 N/A 1 N/A
Two 0.65 (0.24-1.77) 0.402 0.52 (0.16-1.66) 0.279
More than three 0.75 (0.26-2.12) 0.580 0.78 (0.24-2.52) 0.782
Questionnaire items for evaluating satisfaction        
Less than three 1 N/A 1 N/A
Four-six 1.00 (0.42-2.41) 0.997 1.26 (0.45-3.50) 0.657
Seven-eight 3.82 (1.14-12.86) 0.030 5.91 (1.48-23.58) 0.012
Purpose of visits (multiple choice)        
Illness visits        
No 1 N/A 1 N/A
Yes 0.74 (0.32-1.67) 0.463 1.19 (0.32-4.38) 0.795
Wellness visits        
No 1 N/A 1 N/A
Yes 1.45 (0.64-3.29) 0.377 1.17 (0.44-6.53) 0.448
Consultations visits        
No 1 N/A 1 N/A
Yes 1.64 (0.53-5.04) 0.389 1.62 (0.34-7.76) 0.547

Abbreviations: LHC, lifetime health clinic; OR, odds ratio; CI, confidence interval; NA, not applicable.

Multivariable OR are adjusted for age, gender, area, cause of registration, counts of registration, numbers of disease, satisfaction question, purpose of visit.

P-values are analyzed by logistic regression and statistically significant P<0.05 are shown.