Women's primary health care *satisfaction: A life stage perspective.

Abstract

Ensuring high quality primary health care across the life span is an important goal for improving women's health. Research, however, has been slow to identify how the organization of primary health care may be more or less suited to women's needs and preferences at particular ages. Since satisfaction ratings are increasingly relied upon to measure quality from the patient perspective, this dissertation examines women's satisfaction with primary health care as it relates to experiences and preferences for care at different stages of life. Women's perceptions of the quality of their primary health care, surveyed prior to and immediately following a primary health care visit, were examined in a sample of 1,197 adult women (ages 18 to 87). Multivariate ordinal logistic regression models were estimated to test the influence of health care experiences and preferences on satisfaction with communication, and satisfaction with care coordination and comprehensiveness. Organizational and provider issues important for women's satisfaction with primary health care at specific life stages were identified. Specific provider characteristics and patterns of use influenced satisfaction with primary health care, especially for women in their reproductive years. Women in the peak reproductive years (18 to 34) were most satisfied with communication in visits made to a regular provider, and having an obstetrician/gynecologist (ob/gyn) as a regular provider was related to greater satisfaction with care coordination and comprehensiveness. For women in the later reproductive years (35 to 44), seeing a female provider for a primary health care visit was associated with greater satisfaction with communication. Their satisfaction with coordination and comprehensiveness of care was higher when they had a single regular provider as opposed to both a generalist and an ob/gyn. Few correlates of satisfaction were identified for women in post-reproductive life stages, implying a need to better understand what contributes to women's satisfaction with care beyond the reproductive years. A life stage perspective proved useful for examining the diversity of women's primary health care experiences and preferences. The implications of the findings for policy, practice, and research to improve women's primary health care across the life span are discussed.