The strength of our study was a large sample size, representing all adult primary care patients in Poland. To check the representativeness, the socio-demographic characteristics of study participants were compared to those of the general population. This comparison showed that the study group included more women and more patients with secondary and higher level education than the general population, which could be expected, as female gender and education level are proved to be important determinants of health care seeking behaviors [
19].
The international, uniform methodology of the QUALICOPC study allowed for direct comparisons between countries. However, the national data from particular countries could be limited, as the in-country specific conditions were not taken into consideration when developing the study tool. Another limitation of the study is the use of self-reported questionnaires to gather data, which is linked to response bias caused by misunderstanding, underreport, exaggeration, etc.
As a limitation, we wanted to point out the fact that in our multiple regression analyses R-squared values were low, which is common in health services research in which outcomes are harder to predict [
20]. However, it indicates the existence of other predictors of patient satisfaction, which were not included in our study. Another limitation is relatively low response rate and potential bias caused by this fact. We suppose that this is the result of a “real life” design and data collection system – there were no special invitations and incentives for participants and the recruitment was performed by an anonymous fieldworker. Another limitation and a potential source of bias were that the GPs were contacted before and they were aware of the day of patient’s recruitment; and that the questionnaires were filled by the participants in the waiting hall of PC facility, directly after seeing their GP.
Findings in light of other studies
In the PHAMEU study, Poland was classified as a country with medium PHC strength, characterized by good accessibility and coordination and poorly developed comprehensiveness [
9]. The QUALICOPC survey conducted among primary care physicians in Poland showed that doctors were very critical of the areas of care in process and outcomes of PHC services. Coordination, quality of care and equity were evaluated negatively by PC physicians, while accessibility, continuity, and comprehensiveness received neutral scores [
18]. Contrary to poor evaluations of PC on the system level, patients (users of PC services) in our study had predominantly positive experiences with primary care in Poland. These findings are consistent with several previously published Polish studies on patient satisfaction with primary care. Marcinowicz et al. reported high satisfaction with communication skills of GPs (with scores around 4.5 on 1 to 5 scale) and length of consultation (88% satisfied) [
11]. Kurpas et al. conclude in their paper on satisfaction with PHC of chronically ill patients, that they were at most satisfied with GP consultation (interview and physical examination) and their empathetic attitude, kindness and willingness to help [
21]. In another national survey on patient’s satisfaction, 78% of participants evaluated positively accessibility of PHC with mean satisfaction value +0.32 (range:-1.0 to 1.0), which was the highest score of all areas of care. [
22]. In our study, we found that the length of a doctor’s professional experience was a noticeable predictor of positive PC evaluation. The years of physician’s experience in primary care may be associated with the duration of the relationship and shared experiences with patients and their physician. Although the therapeutic alliance and the long-term patient-doctor relationship are important and beneficial for both of them, it seems to be essential for the patient’s satisfaction. According to Noyes et al., having a primary care physician and duration of that relationship is a key element determining the quality of care perceived by family medicine patients [
23]. Interpersonal continuity with a regular provider is the most important predictor of patient satisfaction, as reported in Balkan populations by Gajovic et al. and in the USA by Nutting et al. [
24,
25]. The findings of Mainous et al. showed that the patients place value on continuity with their regular physician [
26]. According to Plomodon et al., PHC providers turnover was associated with worse patient satisfaction of care [
27].
The difference between patients’ (overall good) and physicians’ (overall skeptical) evaluation of PHC was very likely to be linked to the negative evaluation of economic conditions and the structure of PHC in Poland by physicians. On the other hand, GPs might be more aware of their limitations or diagnostic uncertainty and less optimistic in the evaluation of their abilities to help patients [
18,
28].
Exploring the positive PC experience predictors, we found a positive relationship between increasing age and patient satisfaction in all studied primary care areas. These results are compatible with other literature on patient evaluations of care [
21,
29‐
31]. Kontopantelis et al. suggested that differences in satisfaction by age group could be due to differences in actual care received or to different response tendencies of individual population groups [
31].
Our findings indicate that specialty training in family medicine is one of the desired PC physicians’ characteristics associated with higher patient satisfaction, especially if the physician has more than one specialty. The introduction of family medicine into the primary health care system in Turkey resulted in an increase of patient satisfaction [
32]. Similar observations were found in studies by Gavran et al. [
33]. However, the study conducted by Chu-Weiniger et al. showed that giving patients the possibility of free choice of physician is more important than the doctor’s specialty. The free choice of PC provider helped to establish a trusting relationship [
34].
The American research by Ly and Glied showed that patient satisfaction is not influenced by the number of PC physicians per inhabitant. Unexpectedly, longer waiting times for appointment were observed in practices with a higher physician-to-population ratio [
35]. It may explain at least partially the observed discrepancies in satisfaction between patients from rural PC practices and those visiting PC physicians in big cities. In a national patient survey in Sweden, the higher satisfaction of care was observed among patients from smaller practices and practices where a high proportion of all visits were with a doctor [
36]. According to Tung et al., the doctor’s technical skill was the most important determinant of satisfaction, followed by the doctor’s interpersonal skill. Staff care, access and providing patient education during the visit on prevention and prophylaxis were associated with improved patient satisfaction [
37].
In our study, the infrastructure of facilities did not influence quality assessment. The literature review by Rozenblum et al. reported that the expansion of health information technologies did not significantly improve patient satisfaction [
38]. These results may indicate that investments only in infrastructure and new technologies do not necessarily increase satisfaction.