Measurement of quality of service in patients with spinal cord injury at CRP, BANGLADESH

Abstract

Background: Continuous quality improvement and client based approach are of great importance when it comes to Spinal cord injury rehabilitation as it deals with patient’s quality of life and well being. The service is considered good enough if only the patients are fully satisfied in various dimensions of care. Quality of service is the evaluation of whether the patient expectations have been met or not in regard to services delivered by the provider. Objectives: To evaluate the quality of service among SCI patients in Centre for Rehabilitation of Paralyzed (CRP) in Dhaka, Bangladesh. Methodology: A cross-sectional study of quantitative design was carried out using SERQUAL questionnaire among 120 SCI in-patients in SCI unit in CRP, Bangladesh. Convenience sampling technique was used to collect data. Data was analyzed by using SPSS. Results: All gap scores were negative which implies that patient’s expectations weren’t met. The data revealed the most significant service gap in tangible (µ=-0.32) followed by reliability (µ=-0.19), assurance (µ=-0.18), empathy (µ=-0.13) and responsiveness (µ=-0.123) at significance level (P<0.05, P<0.01 and P<0.001). In addition, there was a significant association between sociodemographics and service quality gaps. Length of stay [OR = 7.02, 95 % CI (1.28838.26)] was associated with tangible gap and type of SCI [OR = 0.1, 95 % CI (.016.646)] was associated with reliability gap. On the other hand, occupation [OR = 0.085, 95 % CI (.010-0.731)] and marital status [OR = 5.579, 95 % CI (1.220-27.186] were significantly associated with assurance gap. In addition, the gap of empathy was 28.108 times (CI=1.249-632.458) in female respondents than male. Also, there was a significant association between the residential area of participants and assurance gap (χ 2 = 8.585, p value = 0.014). Conclusion: The study concluded that there is an utmost need for modification or update in equipments and structural appearance of physical facilities in CRP. Management should focus on consultation time with doctors, interaction between patient and health professionals, staff’s appearance, convenient operating hours and medicines accessibility. More care and attention must be shifted towards females, daily laborers, unmarried, triplegic SCI patients and those living in rural areas and those staying longer in CRP. Key Words: Quality of service, Spinal Cord Injury, Expectation, Service gap 1

1.1. Background Globally, the incidence of SCI has been increasing with 8 to 246 cases per million populations per year and prevalence ranging from 236 to 1298 million per populations (Furlan, Sakakibara, Miller, & Krassioukov, 2013). In developed countries, SCI is estimated to be prevalent from 490 to 526 per million populations (Kang et al., 2017). In United States, prevalence is found to be highest i.e. 906 per million (Fehlings, Singh, Tetreault, Kalsi-Ryan, & Nouri, 2014). Similarly, the prevalence is higher than 681 per million in Australia (O’Connor, 2004). In Canada, 2,525 per million SCI were prevalent including both traumatic and non-traumatic cases (Noonan et al., 2012). On the other hand, in developing countries SCI incidence ranges from 2..1-130.7 per million per year (Rahimi-Movaghar et al., 2013). Ning, Wu, Li and Feng (2012) conducted a systematic review on epidemiology of traumatic SCI in Asia and concluded 12.06 to 61.6 per million of incidence rates of traumatic SCI. Likewise, the prevalence of SCI in Dharan, Nepal was found to be 849.8 per million in 2002 and prevalence rate in Kashmir, India was estimated to be 236 per million in 1986 (Furlan et al., 2013). Cervical injuries as well as injuries due to fall seems to be increasing (DeVivo, 2012). However, in Bangladesh, it is reverse. The incidence of SCI due to fall is higher which is then followed by traumatic SCI (Rahman et al., 2017). A worldwide literature study in 2006 revealed that 50% of the reported SCI had a complete lesion and about 33% were tetraplegic. Conversely, Bangladesh has different scenario. A study on epidemiology on SCI in Bangladesh concluded that approximately 61% had complete lesion and 52.33% were traumatic paraplegic. Spinal Cord Injury (SCI) is a sudden and devastating condition that affects individual’s physical, mental, familial as well as social life (Quadir et al., 2017). It has variety of causes that includes road traffic accidents, falls, violence, sports related and many others which distinguish its types i.e. traumatic and non-traumatic (Kang et al., 2017). Males are more affected than females especially among low socio-economic groups at the ratio ranging from 1.00:1 to 7.9:1 (Quadir et al., 2017). Traumatic SCI is found to be more prevalent than the other one while RTAs and falls are the major causes affecting mostly males than female (DeVivo, 2012). Major complications followed by SCI are pulmonary infections, Urinary tract infections and bed sores