Whose satisfaction?

Brian Hutchison and colleagues1 described patient satisfaction and quality of care in walk-in clinics and other settings, but their study was biased in favour of lower-acuity illnesses for which there is diagnostic certainty. In this situation, patients' perception of quality of care will be unduly influenced by perceived access to and speed of care. A study using population-based risk and severity categories would have been more informative.

Although the 8 conditions analyzed in the study are common, they are associated with low costs and low overall impact on the health care system, because they tend not to generate consultations, tests or hospital admissions. Patients with chronic conditions and comorbidities make up a smaller proportion of the population, but they account for a large proportion of the costs of care. Furthermore, acute intercurrent illnesses in such patients may result in serious deterioration in health status. Patients from this segment of the population are therefore the most important “customers” in the system.

Continuity of care, in terms of continuity of a relationship with a health care provider and continuity of information management and care planning are also more important in this group. Thus, processes related to continuity of care should come under closer scrutiny, especially in the walk-in clinic setting.

Research into the differences in quality and satisfaction experienced by people with chronic disease and comorbidity who receive care in walk-in clinics, family practices and emergency departments would be of greater overall interest.

Lorne Verhulst Medical Consultant Strategic Planning Division Policy Planning and Legislation Ministry of Health Planning Vancouver, BC