An Evaluation of Pediatric Out Patient Department (POPD) of a Private Dental College Hospital by Accompanying Parents of Child Patients

Purpose:The Pediatric Out-patient-department (POPD) of a dental hospital deals with children with different tooth related complaints. Dental treatment of a child patient requires three way interactions between the child, the parent and the dental surgeon. Though health of the patient remains the top priority for caregivers, satisfaction with the delivery system is vital for long lasting doctor-patient relationship. Thepurpose of the study was to evaluate the performance of Pediatric OPD by the accompanying parents of children receiving treatment at the OPD of a private dental college hospital.Methods: A cross sectional study was carried out at the POPD of Sapporo Dental College Hospital, Uttara Model Town of Dhaka city during May-July 2017. Sampling was done by simple random sam- pling method .Data were collected from the parents of 122 children aged between 1-12 years by using a self-administrated questionnaire.Results: Majority of the participating parents were residents of Uttara Model Town or areas in the vicinity and were employed, educated and are middle are middle socioeconomic class. More than sixty percent (62.3 %) of the respondents were parents of children between 4-7 years of age. More than 90% of the patients had waiting time at the department between 0-30 minutes. Treatment cost was described as ‘low or ‘reasonable’ by 87% of the parents. Only 8.2% mentioned ‘unsatisfactory’ regarding the cleanliness of Pediatric OPD. More than 95% of the respond- ents expressed ‘Satisfactory’ and ‘good’ level of satisfaction with general performance of OPD and the treatment provided by the dental team.Conclusion: Parents expressed general satisfaction with the performance of Pediatric Department of Sapporo Dental College Hospital.Update Dent. Coll. j: 2018; 8 (1): 05-10


Introduction
Patient satisfaction is one of the most important aspects of clinical dentistry and requires a combined effort and hardwork from the administration and personnel involved. 1The psychology of getting good care and value for money along with professionalism of the care givers is key factors for developing good patient-doctor relationship and inspiring the patients returning to the facility for further care in the future. 2atering to the needs of the patients is vital to practice management and client satisfaction. 3It has been observed that dissatisfaction with the dentist is the main reason for not going back to the same dentist for further treatment.Studies demonstrated clear association between satisfaction levels, patient compliance and quality of treatment for commercial success of dental health care delivery systems. 4,5ildren treated at an OPD are accompanied by an attendant commonly by their parents, grandparents, elder siblings or a close relative.A pediatric department is different from other departments for children cannot make a decision on their own and an adult attendant must give consent to the treatment regimen.Not only that the overall environment of the department and the departmental staff, the hospitality, sincerity and caring attitude of the whole dental team along with the child behavior management skills of the dentist is under constant scrutiny of the parents. 6The dental team can feel the extra pressure when treating small children partly because of unpredictable nature of the patient and partly the unexpected reaction from a parent, who might become sensitive and react in indiscriminate manner seeing his or her child crying at the chair. 7This type of scenario is not uncommon in Paediatric OPD, testing the patience and skill of the caregiver and also making him a manager for crisis situations.On the other hand, certain factors such as the decoration and cleanliness of the clinic, the waiting time at the reception, the treatment quality and expenses, overall ambience at the clinic among others, might dictate a patient's satisfaction or dissatisfaction level with the caregiver. 8Whatever may be the situation, patient health and satisfaction are the top priorities and for this there should be room for constant improvement by working out on every constructive criticism. 9,10,11As satisfaction is a most important com-ponent of health service performance evaluation, it is important to know about the different factors which affect patient satisfaction using dental services.Since children are in no position to provide correct evaluation of a departmental performance, their parents are required to use their judgment in evaluating and expressing their satisfaction level of the dental care services provided at the Hospitals.According to Bangladesh Medical and Dental Council, Sapporo Dental College and Hospital is the only fully fledged dental college in Uttara Model Town, operating since 2002. 12The population in and around this model town belong to lower to higher middle class, educated and largely employed. 13The general OPD of this hospital receives more than a hundred new patients per day, out of which 18-20% seek treatment at pediatric OPD. 14 These children are mostly aged between 1-12 years and only a handful is older.The parent makes the decision about treatment on behalf of the child after consulting with the doctor.It is important to get feedback from the patients about the standard of treatment they are receiving from their point of view for as part of quality improvement and patient satisfaction.Since children are in not mature enough to understand the integral factors of expectation and satisfaction, their parents should evaluate the performance and state their opinion about the care delivery system.Searching through the available documents, we could not retrieve a single paper which evaluated the level of patient satisfaction for pediatric dental treatment provided either ina private or a government institution in Bangladesh.Therefore, this survey was carried out to evaluate the satisfaction level of the parents accompanying the children receiving treatment at Pediatric OPD of Sapporo Dental College Hospital, a private dental hospital at Uttara, Dhaka.

Methods and materials
This cross-sectional survey was conducted at the PaediatricOPD (POPD) of Sapporo Dental College Hospital, a private dental College located in Uttara Model Town, Dhaka during May-July 2017.A total of one hundred and twenty (N=122) parents / guardians or accompanying attendants of 122 children aged between 1-12 years, were the study subjects.Parents of patients who had visited the OPD more than once were included as participants of this survey while new or first timers were excluded for obvious reasons.A convenience sampling technique was used in this survey.Permission from the hospital authority was obtained before hand and the nature of this survey was explained to the participants prior to the face to face interview.A verbal consent was taken from the parents stating the purpose of the survey and assuring that no harm is expected and the results of the survey would only be used for understanding the parental evaluation of the departmental performance and that confidentiality of the result would be strictly maintained.A self-administered questionnaire having closed ended components in relevance with the objectives of the study was developed for the survey.The First part of the questionnaire was aimed to obtain socio-demographic data, while the second part specifically asked for parental evaluation of the department's performance.The survey personnel were trained both theoretically and practically about accurate data collection procedure.Each question was filled up by the parents and the interviewers readily explained if someone could not understand any specific part.The collected data wereanalyzed byword Excel spreadsheet.Data presentation included frequency distribution tables.

Results
Table 1: Distribution of the parents according to their Socio economic status (N=122) Table 1 showed 43.3% parents lived withinUttara Model Town and 31.1% lived in the vicinity of Uttara Model town while 15.6% patient came from Outside Dhaka Metropolitan area.Out of 122 respondents more that 80% (Service 48.4% and business (32.8%)were holding a job or doing business.Fourteen were stay home parents and 9 were occupied otherwise.Almost eighty percent of the parents (54.9% graduates and 23.8% Post graduates) were well educated.Thirty-two( 32%) percent parent had a monthly income of more than 30,000 taka, Fifty nine (n=59) parents' income was between 11-30,000 taka per month while 20 parents had an earning of less than taka 10,000 per month   According to Table 4 more than 95% parents expressed their satisfaction, ranging between satisfactory and good, when asked about patient management skill of the doctor the skill of the assistants (95.1%) and the general satisfaction with treatment provided at the POPD(96%) respectively.Only 6 patientswere not satisfied with the assisting staffs, 5 parents did not rate the doctors' skill satisfactory and same number of parents did not find satisfaction with overall treatment provided by the dental team.

Discussion
Sapporo Dental College and Hospital is the only fully fledged dental college in Uttara Model Town, operating since 2002.It is for obvious reasons the parents who accompanied the children mostly belong to Uttara and the areas in its vicinity.Some even came from Outside of Dhaka metropolitan area.In general, the population of Uttara Model Town belongs to low to higher middle class.With many schools and a number of private and public colleges and a few Private Universities within the town limits, the education level of the inhabitants are expected to be high.13Accordinglythe socio-demographic distribution reflected that the parents are generally educated, earn quite a decent income, and majority lived in nuclear families.Parents were generally employed (service holder 48.4% and business 32.8%),with only 18.7% stay home parents or were doing something else.Majority (86%) of the children attended school with 62.3% belonging to 4-7 years age group.Single child families were common (32.8%) while 54.9% represented 3-4 member families.
The survey results revealed that majority (81.1%) of the patients came to the OPD with various tooth related complaints and the rest for follow-upvisits or routine checkup.According to the parents, they had learnt about Sapporo Dental College Hospital facility by their own interest (52.5%) or by reference from others (46.7%).Only 1 person out of 122 came after seeing an advertisement of the hospital.Waiting time is one of the crucial factors for patient's satisfaction and reason for leaving or returning to the same dentist.Studies have revealed that longer waiting time is the key reason for missed appointments or going to another dental facility. 15In our study the waiting time for appointment for majority of the patients was between 0-15 minutes (68%), followed by 16-30 minutes (22.1%).Only a few had to wait for more than 30 to 60 minutes or more.Fifty-nine percent(59%, N=72) of the attendants stated treatment cost was reasonable at the OPD, while 12.3% of the parentstreatment cost was expensive.Thirty-five parents (28.7%) even stated treatment cost was low.Although there are a remarkable number of private dental clinics operating within Uttara Model Town and nearby areas, the expenses for dental treatment are sure to differ between the clinics and a teaching-learning Hospital.Prices for dental treatment in this hospital are considered quite reasonable by the local population. 16Treatment cost is a major factor for seeking treatment at the same facility and if the parents find the treatment expenses to be reasonable along with good treatment, they are surely getting value for money.These parents would definitely return in future and would be willing to refer other patients. 17Most of the parents said that the cleanliness of the department was satisfactory or good and majority of the participants expressed satisfaction with the overall environment of the pediatric OPD.
More than 95% of the parents said patient management skill of the attending doctor and skill of the assisting staff were'satisfactory' or 'good'.Majority of the parents expressed satisfaction with the treatment providedby the dental team rating them between 'satisfactory' (64%) and 'good' (32%.It is imperative that child patients are comfortable with the dental team; particularly the dentist should be compassionate and warm, so that the child feels safe and remain co-operative.Good communication skill as well as professionalism of the whole dental team is readily recognized by the parents and this would oblige them to bring their children back for follow up or treatment of any new ailment. 4,5,10e must state that this study had some limitations.It was a very basic survey with some very basic questions and small sample size.Parents' satisfaction level was reflected through the questionnaire but the child's experience at the POPD did not reflect through their answers.The open ended part of the questionnaire was also not answer by majority of the participants.Nevertheless, this survey reflected patient opinion in only one private hospital.Further study involving both private and public hospitals could reveal a comparative picture of patient satisfaction level in these two sectors.

Conclusion
The results indicate that the pediatric department of Sapporo Dental College has been successful in achieving parents' satisfaction.Although a major portion of the participants of this survey expressed satisfaction with the overall performance of Pediatric OPD of Sapporo Dental College and Hospital, there remains room for further improvement in certain sectors, eg, waiting time, treatment cost and cleanliness of the department.There should be no space for self-satisfaction even if parents visited the hospital by word of mouth; It is the quality of service that really matters.A satisfied parent would recommend more patients and this commercial success should be ensured only by sincere and patient oriented dental care delivery system.Though health of the patient remains the top most priority of the care giver, satisfaction with the care provided would always be an integral part of overall health of the client.

Table 2 :
Distribution of the patients according to socio-demographic condition (N=122)

Table 3 :
Opinion of the parents about PaediatricOPD and OPD Services at SDCH (N=122)