- Research
- Open access
- Published:
Satisfaction with local healthcare services and medical need among hypertensive patients: a nationwide study
BMC Public Health volumeΒ 24, ArticleΒ number:Β 781 (2024)
Abstract
Background
Investigating the factors associated with unmet medical needs is important since it can reflect access to healthcare. This study examined the relationship between the unmet medical needs of patients with hypertension and their satisfaction with the healthcare services available in their neighborhoods.
Methods
Data were from the 2021 Korean Community Health Survey. The sample included individuals aged 19 years who were diagnosed with hypertension. The main outcome measure was unmet medical need. The relationship between the outcome measure and independent variables were analyzed using multivariate logistic regressions, along with a subgroup analysis based on whether patients were currently receiving treatment for hypertension.
Results
Unmet medical needs were found in 4.3% of the study participants. A higher likelihood of unmet medical needs was found in individuals not satisfied with the healthcare services at proximity (adjusted ORβ=β1.69, 95% CI: 1.49β1.92) compared to those satisfied with services nearby. Similar tendencies were found regardless of whether individuals were currently receiving treatment for hypertension, although larger differences were found between groups in participants who were currently not receiving treatment.
Conclusions
The findings infer the need to consider patient satisfaction with nearby healthcare services in implementing public health policies that address unmet medical need in patients with hypertension.
Background
Hypertension is a globally prevalent disease affecting approximately 31% of the adult population [1] and is defined as having a systolic blood pressure of 140 mmHg or higher and/or a diastolic blood pressure of 90 mmHg or higher. Further, hypertension is a prevalent and modifiable risk factor for cardiovascular disease (CVD) and overall mortality [1,2,3]. A sizable body of evidence suggests a causal relationship between high blood pressure and CVD, highlighting the importance of managing hypertension. CVD is reported as one of the most serious health problems and the leading cause of mortality worldwide [4, 5]. Overall, high blood pressure and its related complications are estimated to account for approximately 10% of global healthcare spending, increasing the financial burden on healthcare systems [6, 7].
The care cascade for hypertension (i.e., awareness, treatment, and control) has been proposed as a framework for improving the management of blood pressure [8]. Despite improvements in hypertension awareness, treatment, and control rates, along with techniques for controlling blood pressure, notably pharmacotherapy and lifestyle interventions, hypertension management remains a challenge for healthcare systems in many countries [9, 10]. Unmet medical needs are the difference in the medical services required to manage a health-related problem (e.g., hypertension) and the services received by patients, and the factors associated with these unmet medical needs for patients with hypertension require investigation [11]. Since unmet medical needs are an important measure of healthcare systems that reflect how patients subjectively assess their access to healthcare, they may be affected by factors such as the cost of visiting clinics or hospitals [12, 13]. Further, experiencing unmet medical needs has been related to poor health outcomes and may contribute to increasing health disparities [14].
Individualsβ satisfaction with the medical services available in their neighborhoods may correlate with the likelihood of experiencing unmet medical needs in the treatment of patients with chronic diseases, including hypertension, as successful management requires regular care and high treatment adherence [15]. As having access to high-quality medical care is related to patient satisfaction, it is also associated with the unmet medical needs of patients with hypertension [16]. Therefore, this study aimed to investigate the association between the unmet needs of patients with hypertension and their satisfaction with the healthcare services available in their neighborhoods. Further, we conducted a subgroup analysis according to the current receipt of treatment for hypertension.
Methods
Study design
This study used the 2021 Korea Community Health Survey (KCHS) data. As the KCHS data are cross-sectional in nature, a cross-sectional design was applied to investigate the association between the unmet needs of patients with hypertension and their satisfaction with nearby healthcare services. The final study population included 50,068 adults aged 19 years or above that have been diagnosed of hypertension by a physician, which was measured based on self-reports of the study participants.
Data source and collection
The 2021 KCHS data were used for this study. The KCHS are cross-sectional data collected through annual surveys performed by the Korea Disease Control and Prevention Agency (KDCA) using the Computer Assisted Personal Interviewing (CAPI) method. The study sample is selected using stratified, multistage, probability-cluster sampling on the national survey data and hence, the sample can be seen as a representative of the Korean population [17]. The KCHS data contains various information on the sociodemographic, economic, and health related factors of the participants.
Data management and variables
The outcome and independent variables were extracted from the retrieved KCHS data for analysis. The outcome variable was the experience of unmet medical needs. Self-reported unmet medical needs were measured using the question, βIn the past 1 year, were you in need of receiving a diagnosis or treatment in a clinic or hospital (excluding a dental clinic) but were unable to receive one? Responses to the questions were βyes,β βno,β and βnot applicable (did not need a diagnosis or treatment.β Those who responded βyesβ were identified as having unmet medical need.
The independent variable of interest was satisfaction level with the healthcare services available in the study participantsβ neighborhoods. This variable was measured based on self-reports to the phrase βI am satisfied with the medical services (public health centers, clinics, hospitals, traditional Korean clinic and hospitals, and pharmacies)β available in our neighborhood.β Available responses were a βyesβ or a βnoβ in which individuals were categorized as βsatisfiedβ or βnot satisfiedβ accordingly.
The covariates included in this study were sex, age group, educational level, income, occupation, obesity, subjective health status, perceived stress status, depressive symptoms, current smoking, monthly drinking, moderate-to-vigorous physical activity, diabetes, current hypertension treatment status, and region of residence. The Body Mass Index (BMI) was used to categorize body weight (i.e., <18.5, underweight status; 18.5β24.9, normal weight; β₯25.0, overweight or obese status). The Korean version of the Patient Health Questionnaire-9 (PHQ-9) assessed participantsβ depressive symptoms. As suggested in previous studies, a cutoff score of 10 was used to indicate depressive symptoms. In the KCHS, individuals were asked by a physician whether they had been diagnosed with hypertension by a physician. Individuals who replied that they were diagnosed with hypertension were asked whether they were currently receiving treatment. Current hypertension treatment status was measured based on whether the study participants were currently receiving pharmacological treatment for at least 20 days.
Data analysis
The general characteristics of the study participants were examined using chi-square tests. Multivariate logistic regression was conducted to study the association between unmet medical needs and satisfaction with the healthcare services available in the participantsβ residential neighborhoods. Additionally, a subgroup analysis was performed based on the receipt of treatment for hypertension. All analyses were conducted with adjustments for all covariates, namely sex, age group, educational level, income, occupation, obesity, subjective health status, perceived stress status, depressive symptoms, current smoking, monthly drinking, moderate-to-vigorous physical activity, diabetes, current hypertension treatment status, and region of residence. The results are presented as adjusted odds ratios (OR) and their 95% confidence intervals (95% CI). P-values were two-sided and significant at Pβ<β0.05. Analyses were performed using the SAS software (version 9.4 SAS Institute, Cary, NC, USA).
Results
The main results of the analysis on the association between medical needs and satisfaction with healthcare services available in the study participantsβ residential neighborhoods are presented in TablesΒ 1 and 2. The results of TableΒ 1 shows that unmet medical needs were more prevalent in individuals not satisfied with nearby healthcare services than those who are satisfied. Similar tendencies can be found in TableΒ 2, which reveals confirms the investigated association as individuals not satisfied with nearby healthcare services show a higher likelihood of reporting unmet medical need.
Specifically, the general characteristics of the participants are shown in TableΒ 1. Unmet medical needs were found in 1,765 (4.3%) of 50,068 individuals diagnosed with hypertension. A total of 39,070 (82.4%) participants were satisfied with the healthcare services available in their neighborhood, whereas 10,998 (17.6%) participants were not satisfied. Unmet medical needs were more prevalent in the βnon satisfiedβ group (7.1%) compared to the βsatisfiedβ group (3.7%).
The results of the multivariable logistic regression analysis are revealed in TableΒ 2. Individuals who were not satisfied with the healthcare services in their neighborhoods were more likely to have unmet medical needs (adjusted ORβ=β1.69, 95% CI: 1.49β1.92) compared to individuals satisfied with healthcare services available nearby. Lower odds of unmet medical needs were found in individuals currently receiving treatment for hypertension compared to those not receiving treatment.
The results of the subgroup analysis based on the current hypertension treatment status are shown in TableΒ 3. The patterns observed in the main findings were generally maintained, regardless of the current hypertension treatment status. However, larger differences were found between the two groups according to the satisfaction reported by individuals who were not receiving treatment (adjusted ORβ=β2.50, 95% CI: 1.89β3.30) compared to those currently receiving treatment (adjusted ORβ=β1.64, 95% CI: 1.44β1.87).
Discussion
This study examined the relationship between the unmet medical needs of patients with hypertension and their satisfaction with healthcare services available in their neighborhoods. The current results showed that the likelihood of experiencing unmet medical needs was related to participantsβ satisfaction with the healthcare services available in their neighborhoods. Similar patterns of relationships were observed between those patients currently receiving and those not receiving treatment for hypertension, although the difference between individuals who were satisfied and unsatisfied with the available local healthcare resources and in the likelihood of experiencing unmet needs was magnified in those currently not receiving treatment. These findings suggest the importance of patient satisfaction with existing healthcare services in their neighborhood in addressing the unmet medical needs of patients with hypertension.
Several factors have previously been identified as determinants of unmet medical needs, which have also been accounted for in the analysis investigating the association between unmet medical need and satisfaction with healthcare services available nearby in patients with hypertension. A recognizable factor is socioeconomic status, as individuals with lower income or education are more likely to report unmet medical needs [18, 19]. Further, having a low income was associated with increased unmet medical needs, even in countries with universal health coverage [20]. Accordingly, the findings also reveal an association between lower income or education level and a higher likelihood of experiencing unmet medical need. In addition, employment status has been identified as a possible influencing factor, as comparatively vulnerable individuals, including precarious workers, report increased unmet medical needs [21]. In this study, workers in sales and service or agriculture and fishery reported higher levels of unmet healthcare need. Such tendencies may have been influenced by the fact that workers in the cited industries tend to report longer work hours, which in turn has been related to unmet need for accessing healthcare facilities [22,23,24]. Lastly, females were more likely to report unmet healthcare need, as in that in the results of previous studies [25].
Interestingly, chronic medical conditions have been previously related to unmet medical needs, highlighting that unmet medical needs indicate inadequate access to healthcare when the appropriate management of chronic diseases requires regular, ongoing care [26]. Healthcare access is particularly critical because inadequate access can lead to poor health outcomes and increased health disparities [14]. The current findings provide important insights by indicating that satisfaction with the availability of healthcare services in oneβs neighborhood is associated with the likelihood of perceived unmet medical needs in patients with hypertension. Patients who are dissatisfied with the locally available services may experience barriers in regularly accessing care in healthcare institutions and facilities due to the increased distances to travel for treatment [27]. Otherwise, patients lacking the resources to travel further may continuously receive care at nearby institutions but perceive that they have unmet medical needs or show decreased treatment adherence for their hypertension. In fact, previous literature on developing countries cite inadequate services as a barrier to visiting health facilities and report preferring clinics and hospitals that provide better access to specialists and higher quality medications and laboratory testing [28]. Patient satisfaction with available healthcare services has also been associated with increased treatment adherence, and low adherence is a notable concern since it can result in reduced effectiveness and efficiency of pharmacological treatments, which is important for reducing blood pressure and decreasing the risk of CVDs [29,30,31].
These findings also show that the degree of association between the unmet medical needs of patients with hypertension and satisfaction with locally available healthcare services is magnified among those who currently not receiving hypertension treatment. These results are noteworthy because pharmacological and non-pharmacological treatments are critical for controlling blood pressure and reducing the risk of CVD or mortality in patients with hypertension [32, 33]. Moreover, patient adherence is essential for enhancing blood pressure control and minimizing hypertension-related risks [34]. Considering the importance of hypertension treatment, the potential factors associated with the unmet medical needs of patients who do not receive treatment need to be understood.
This study had some limitations. First, this study was cross-sectional; thus, the analyzed results could not infer causality. Second, although previous studies have shown that unmet medical needs can be adequately assessed through self-report in population-based national surveys, limitations may apply because unmet medical needs were measured solely using self-report [14]. Third, the possibility of residual confounding factors cannot be entirely ruled out, although we adjusted for a number of covariates in the analyses. However, one notable strength of this study is its large random sample of the entire South Korean population, which was extracted from reliable nationwide data. Our current findings are also unique since this study is the first to examine the association between the unmet medical needs of patients with hypertension and their satisfaction with the healthcare services available in their neighborhood.
Conclusions
In patients with hypertension, unmet medical needs were related to satisfaction with healthcare services in the patientsβ neighborhoods. A stronger association was observed among those patients currently receiving treatment for hypertension compared to those who were not being treated. The results indicated the significance of patient satisfaction in the likelihood of reporting unmet medical needs among those patients with hypertension. As the management of hypertension remains a challenge in many countries, in which its importance is increasing owing to population aging and the rise in the number of affected individuals, the findings infer the need to consider patient satisfaction with nearby healthcare services in implementing public health policies that address unmet medical need in patients with chronic disease. An emphasis should be made on ensuring access to appropriate and high-quality care for patients with hypertension.
Data availability
Data can be downloaded after application from the Korea Community Health Survey website (https://chs.kdca.go.kr/chs/main.do).
References
Mills KT, Bundy JD, Kelly TN, Reed JE, Kearney PM, Reynolds K, Chen J, He J. Global disparities of hypertension prevalence and control: a systematic analysis of Population-Based studies from 90 countries. Circulation. 2016;134(6):441β50.
Collaborators GBDCoD. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980β2017: a systematic analysis for the global burden of Disease Study 2017. Lancet. 2018;392(10159):1736β88.
Collaborators GBDRF. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990β2017: a systematic analysis for the global burden of Disease Study 2017. Lancet. 2018;392(10159):1923β94.
Fuchs FD, Whelton PK. High blood pressure and Cardiovascular Disease. Hypertension. 2020;75(2):285β92.
Amini M, Zayeri F, Salehi M. Trend analysis of cardiovascular disease mortality, incidence, and mortality-to-incidence ratio: results from global burden of disease study 2017. BMC Public Health. 2021;21(1):401.
Gaziano TA, Bitton A, Anand S, Weinstein MC. International Society of H: the global cost of nonoptimal blood pressure. J Hypertens. 2009;27(7):1472β7.
World Health Organization (WHO).: A global brief on hypertension-silent killer, global public health crisis. In. Switzerland; 2013.
Foti K, Wang D, Appel LJ, Selvin E. Hypertension awareness, treatment, and control in US adults: Trends in the Hypertension Control Cascade by Population Subgroup (National Health and Nutrition Examination Survey, 1999β2016). Am J Epidemiol. 2019;188(12):2165β74.
Parati G, Lombardi C, Pengo M, Bilo G, Ochoa JE. Current challenges for hypertension management: from better hypertension diagnosis to improved patientsβ adherence and blood pressure control. Int J Cardiol. 2021;331:262β9.
Collaboration NCDRF. Long-term and recent trends in hypertension awareness, treatment, and control in 12 high-income countries: an analysis of 123 nationally representative surveys. Lancet. 2019;394(10199):639β51.
Herr M, Arvieu JJ, Aegerter P, Robine JM, Ankri J. Unmet health care needs of older people: prevalence and predictors in a French cross-sectional survey. Eur J Public Health. 2014;24(5):808β13.
FjΓ¦r E, Stornes P, Borisova L, McNamara C, Eikemo T. Subjective perceptions of unmet need for health care in Europe among social groups: findings from the European social survey. Eur J Pub Health. 2014;27:82β9.
Pappa E, Kontodimopoulos N, Papadopoulos A, Tountas Y, Niakas D. Investigating unmet health needs in primary health care services in a representative sample of the Greek population. Int J Environ Res Public Health. 2013;10(5):2017β27.
Allin S, Grignon M, Le Grand J. Subjective unmet need and utilization of health care services in Canada: what are the equity implications? Soc Sci Med. 2010;70(3):465β72.
GascΓ³n J, SΓ‘nchez-OrtuΓ±o M, Llor B, Skidmore D, Saturno P. Treatment Compliance in Hypertension Study Group: why hypertensive patients do not comply with the treatment: results from a qualitative study. Fam Pract. 2004;21(2):125β30.
Chambers-Richards T, Chireh B, DβArcy C. Unmet health care needs: factors predicting satisfaction with health care services among community-dwelling canadians living with neurological conditions. BMC Health Serv Res 2022, 22(1256).
Kang YW, Ko YS, Kim YJ, Sung KM, Kim HJ, Choi HY, Sung C, Jeong E. Korea Community Health Survey Data profiles. Osong Public Health Res Perspect. 2015;6(3):211β7.
Zavras D, Zavras AI, Kyriopoulos II, Kyriopoulos J. Economic crisis, austerity and unmet healthcare needs: the case of Greece. BMC Health Serv Res. 2016;16:309.
Kang J, Kim C. The relationship between Unmet Healthcare needs due to financial reasons and the experience of Catastrophic Health expenditures. J Korean Acad Community Health Nurs. 2021;32(1):95β106.
Lee S, Yeon M, Kim C-W, Yoon T-H. The Association among Individual and Contextual Factors and Unmet Healthcare Needs in South Korea: a Multilevel Study using National Data. J Prev Med Public Health. 2016;49:308β22.
Ha R, J-C K, Kim C-Y. Employment status and self-reported Unmet Healthcare needs among South Korean employees. Int J Environ Res Public Health. 2019;16(1):9.
Elliott KC, Lincoln JM, Flynn MA, Levin JL, Smidt M, Dzugan J, Ramos AK. Working hours, sleep, and fatigue in the agriculture, forestry, and fishing sector: a scoping review. Am J Ind Med. 2022;65(11):898β912.
Park J, Kim Y. Decrease in Weekly Working hours of Korean workers from 2010 to 2020 according to Employment Status and Industrial Sector. J Korean Med Sci. 2023;38(22):e171.
Soek H, Won J, Lee T, Kim Y, Lee W, Lee J, Roh J, Yoon J. A dose-response relationship between long working hours and unmet need for access to hospital facilities. Scand J Work Environ Health. 2016;42(2):135β43.
Tadiri CP, Gisinger T, Kautzky-Willer A, Kublickiene K, Herrero MT, Norris CM, Raparelli V, Pilote L, Consortium G-F. Determinants of perceived health and unmet healthcare needs in universal healthcare systems with high gender equality. BMC Public Health. 2021;21(1):1488.
Ronksley P, Sanmartin C, Quan H, Ravani P, Tonelli M, Manns B, Hemmelgarn B. Association between chronic conditions and perceived unmet health care needs. Open Med. 2012;6(2):e48β58.
Choi J, Kim O. Factors influencing Unmet Healthcare needs among older Korean Women. Int J Environ Res Public Health. 2021;18(13):6862.
Mahmood KA, Saleh AM. Barriers and facilitators influencing access to and utilization of primary healthcare services in Kurdistan-region, Iraq: a cross-sectional study. Ann Med Surg (Lond). 2023;85(7):3409β17.
Anhang Price R, Elliott MN, Zaslavsky AM, Hays RD, Lehrman WG, Rybowski L, Edgman-Levitan S, Cleary PD: Examining the role of patient experience surveys in measuring health care quality. Med Care Res Rev 2014, 71(5):522β54.
Carretero OA, Oparil S. Essential hypertension: part II: treatment. Circulation. 2000;101(4):446β53.
Oluwole E, Osibogun O, Adegoke O, Adejimi A, Adewole A, Osibogun A. Medication adherence and patient satisfaction among hypertensive patients attending outpatient clinic in Lagos University Teaching Hospital, Nigeria. Niger Postgrad Med J. 2019;26(2):129β37.
Lewington S, Clarke R, Qizilbash N, Peto R, Collins R, Prospective Studies C. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360(9349):1903β13.
Tajeu G, Booth Jr, Colantonio L, Gottesman R, Howard G, Lackland D, OβBrien E, Oparil S, Ravenell J, Safford M et al. Incident cardiovascular disease among adults with blood pressureβ<β140/90Β mm Hg. Circulation. 2017;136(9):798β812.
Carey RM, Muntner P, Bosworth HB, Whelton PK. Prevention and control of hypertension: JACC health promotion series. J Am Coll Cardiol. 2018;72(11):1278β93.
Acknowledgements
Not applicable.
Funding
This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korean government (Ministry of Science and ICT) (No. NRF-2022R1C1C2003977). This work was supported by a National Cancer Center grant (NCC-2210802-3). These funding sources had no involvement in the study design, data analysis and interpretation, writing of the manuscript, or decision to submit the manuscript for publication.
Author information
Authors and Affiliations
Contributions
WK, YJJ, and SYL contributed to the conception of the study. YJJ and SYL contributed to the acquisition and analysis of data. WK drafted the work. All authors revised the final draft and approved the submitted version of the manuscript.
Corresponding author
Ethics declarations
Ethics approval and consent to participate
This study used the Korea Community Health Survey data, which are open data that contain no personal information. All personal information was anonymized prior to release. The data used were exempt from IRB review in accordance with the review list pursuant to Article 2.2 of the Enforcement Rule of Bioethics and Safety Act in Korea. The study was conducted in accordance with the principles of the Declaration of Helsinki.
Consent for publication
Not applicable.
Competing interests
One of the authors, Yeong Jun Ju, is an editorial board member of BMC Public Health. All the other authors declared no competing interests.
Additional information
Publisherβs Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the articleβs Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the articleβs Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
About this article
Cite this article
Kim, W., Ju, Y.J. & Lee, S.Y. Satisfaction with local healthcare services and medical need among hypertensive patients: a nationwide study. BMC Public Health 24, 781 (2024). https://doi.org/10.1186/s12889-024-18130-8
Received:
Accepted:
Published:
DOI: https://doi.org/10.1186/s12889-024-18130-8