CONSUMER’S SATISFACTION OF MEDICAL LABORATORY SERVICES IN OUTPATIENT CARE IN MUNICIPALITY VARNA

The purpose of the medical laboratory service is to satisfy the needs of the patient and the community, which determines the social aspect of healthcare. Achieving real quality in the health system aims to provide and maintain a good level of health, functional capacity and patient satisfaction. Medical diagnostic tests have a key role in monitoring the pathological process, which is a set of measures and activities for prevention of the emergence, development and spread of diseases in people.


INTRODUCTION
Laboratory tests, in their nature, fall in the "services" category and are greatly influenced by the condition of the user -age, type of disease, stage, seriousness, will, consent and other.The teamwork in laboratory activities is connected with many types of medical care and a large number of providers, with everyone influencing the quality [1].The quality of laboratory services in the recent years, acquired a whole new meaning, with "the creation of a medical care market", by turning into a primary marketing tool [2].It is maintained by new standards that are updated periodically and contribute to the competitiveness of the medical laboratories, by allowing rationalization of their activity [3].Patient satisfaction with the quality of medical care and the quality of the provided medical service, according to Ivanov D. and collective is a problem, that in recent years, is gaining popularity.The "quality" concept takes a significant place in specialized economic literature, where user satisfaction, is a model for the quality of provided services [4].

OBJECTIVE
To establish the level of satisfaction amongst the users of the provided medical laboratory services in non-hospital care in Varna region.

MATERIAL AND METHODS
The research studies the opinion of 569 respondents.Based on an anonymous individual questionnaire, was researched the opinion of patients, general practitioners, laboratory scientists and clinical physicians, working in the non-hospital care in Varna region, in the period between August and October 2014, which statistically includes 90% of all laboratory specialists in non-hospital care and 64.3% of all general practitioners.Documentary, statistical and sociological methods were used.During the data analysis and situation analysis, were applied qualitative and quantitative methods, as well as comparative analysis of the condition of the regional medical diagnostic laboratories.

RESULTS AND DISCUSSION
The satisfaction of patients and general practitioners by the provided services from the medical diagnostic laboratories, may be influenced by different factors, related to the quality of the laboratory services; the conditions, that they provide (meeting the deadline for the results, facilities for wheelchairs and strollers); the attitude of the medical staff and others.The satisfaction of the patients, strongly depends on their condition -age, type of disease, stage, seriousness, will, consent and other.
Data analysis show, that a significant part of the patients, made an independent choice for a laboratory and rely on previous visits "I'm familiar with it" 33.9%.With little difference, they are followed by those, relying on their personal general practitioner (29.1%).Those, who made a choice, based on a recommendation by the close ones are 18.5% and those, relying on recommendations by other specialists are 6.3%.A small part of the patients have given different answers (9%), including the fact, that there is only on laboratory nearby, as well as "I found it on the internet" (3.2%) (figure1).
Most of the medical diagnostic laboratories are built on easily accessible locations, according to the patients (67.6%).The respondents, unsatisfied by the absence of facilities for wheelchairs and strollers are 15.1% and one quarter think, that their preferred laboratory is at a difficult location (14%).Only few are those, answering "other" (3.4%), in regard to the distance from the laboratory (figure 2).
"indifferently", are only 17.8%.The absence of negative rating, speaks for a high professionalism of the experts, working in medical diagnostic laboratories (figure 4).The service quality in the medical diagnostic laboratories has a great influence on patient satisfaction.Research data shows a positive rating of the laboratory services -82% of the patients are positively satisfied and the "partly satisfied" ones, are 18%.It is interesting to point out, that none of the respondents are giving a negative rating (figure 3).The attitude of laboratory experts (laboratory scientists and clinical practitioners) towards the patients is rated mostly as "good" (82.2%) and those rating the attitude as The comparison analysis shows a link between the satisfaction from the laboratory service and the attitude rating, that is statistically significant (Õ 2 å 36,214; ð<0,05).Most of those, rating the attitude of the laboratory experts as "good", are satisfied by the services of the laboratory.By correlation analysis it is found, that the link is moderate and reverse (r=-0,41; ð<0,05).
1. Lohr KN.Guidelines for clinical practice: applications for primary care.Int J Qual Health Care. 1994 Mar;6(1):17-25. [PubMed] [CrossRef] 2. Grol R. National standard setting for quality of care in general practice: attitudes of general practioners and re-sponse to a set of standards.Br J Gen Pract. 1990 Sep;40(338)

REFERENCES:
Statistically significant is the link, found between the distance from the closest laboratory and the staff attitude rating (Õ 2 å 9,784; ð0,04<0,05).Most satisfied are the respondents, living close to the laboratory (500 meters to 3 kilometers).No link was found between the distance to the closest laboratory and the satisfaction from the services.Concerning the deadline for the results, a significant percentage from the patients are giving a positive answer (96.3%) and only for 3.7%, the deadline was not met.General practitioners are also mostly satisfied (91%) with the result deadlines and of those, working in medical diagnostic laboratories, 96.7% confirm, that they are meeting the deadline for the results (figure 5).

CONCLUSION
Summarized research data shows, that the responsibility of the medical diagnostic laboratories is related to the good and professional practice and the ethical code, aiming to satisfy the patients and the general practitioners, which is a primary goal.
The main factors for the satisfaction of the laboratory service users, are a result from the work of the qualified staff, the precision and speed in the laboratory testing and the good attitude towards the patients.
Restructuring and technological innovation of healthcare, increases the importance of laboratory activity of highest quality.The policy of the medical diagnostic laboratories, should be aiming towards satisfying the requirements and expectations of the users, complying with the legal requirements and the medical standards for the services, as well as constantly researching the satisfaction of the patients.

Fig 4 .
Fig 4. Attitude of laboratory experts towards the patients