Patient Satisfaction with Primary Care Office-Based Buprenorphine/Naloxone Treatment
Open accessAbstract
Background Factors associated with satisfaction among patients receiving primary care-based buprenorphine/naloxone are unknown.Objective To identify factors related to patient satisfaction in patients receiving primary care-based buprenorphine/naloxone that varied in counseling intensity (20 vs 45 minutes) and office visit frequency (weekly vs thrice weekly).Design and participants One hundred and forty-two opioid-dependent subjects.Measurements Demographics, drug treatment history, and substance use status at baseline and during treatment were collected. The primary outcome was patient satisfaction at 12 weeks.Results Patients' mean overall satisfaction score was 4.4 (out of 5). Patients were most satisfied with the medication and ancillary services and indicated strong willingness to refer a substance-abusing friend for the same treatment. Patients were least satisfied with their interactions with other opioid-dependent patients, referrals to Narcotics Anonymous, and the inconvenience of the treatment location. Female gender (beta = .17, P = .04) and non-White ethnicity/race (beta = .17, P = .04) independently predicted patient satisfaction. Patients who received briefer counseling and buprenorphine/naloxone dispensed weekly had greater satisfaction than those whose medication was dispensed thrice weekly (mean difference 4.9, 95% confidence interval 0.08 to 9.80, P = .03).Conclusions Patients are satisfied with primary care office-based buprenorphine/naloxone. Providers should consider the identified barriers to patient satisfaction.
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- Findingown data
Baseline substance use status was not associated with treatment satisfaction.
“Furthermore, baseline substance use status was not associated with treatment satisfaction.”
- Also stated in: § Factors Associated with Patient Satisfaction · plain
“In univariate analyses, overall patient satisfaction was significantly associated with sex, race, and the percentage of opiate-free urine tests during treatment but was not associated with drug treatment history or baseline substance use status.”
Quote in the paperNot a substantial claim - Also stated in: § Factors Associated with Patient Satisfaction · plain
- Findingown data
Patients in the SMM-1 condition had significantly higher satisfaction than those in the SMM-3 condition, with a mean difference of 4.9, 95% CI 0.08 to 9.80, and P = .03.
“Patients who received briefer counseling and buprenorphine/naloxone dispensed weekly had greater satisfaction than those whose medication was dispensed thrice weekly (mean difference 4.9, 95% confidence interval 0.08 to 9.80, P = .03).”
- Also stated in: § Factors Associated with Patient Satisfaction · plain
“The SMM-1 treatment group had significantly higher patient satisfaction than the SMM-3 treatment group (mean difference 4.9, 95% confidence interval [CI] 0.08 to 9.80, P = .03) but did not differ significantly from the EMM-3 treatment group (mean difference 2.6, 95% CI −2.22 to 7.39, P = .42).”
- Also stated in: § DISCUSSION · plain
“Patients who received buprenorphine/naloxone weekly (SMM-1) had higher satisfaction than those who received it thrice weekly (SMM-3).”
Quote in the paperSubstantial claim - Also stated in: § Factors Associated with Patient Satisfaction · plain
- Findingown data
Drug treatment history was not associated with overall patient satisfaction.
“In univariate analyses, overall patient satisfaction was significantly associated with sex, race, and the percentage of opiate-free urine tests during treatment but was not associated with drug treatment history or baseline substance use status.”
Quote in the paperNot a substantial claim - Findingown data
The SMM-1 group did not differ significantly from the EMM-3 group in satisfaction, with a mean difference of 2.6, 95% CI −2.22 to 7.39, and P = .42.
“but did not differ significantly from the EMM-3 treatment group (mean difference 2.6, 95% CI −2.22 to 7.39, P = .42).”
Quote in the paperNot a substantial claim - Findingown data
Interactions with other opioid-dependent patients were among the least satisfying aspects of treatment.
“Patients were least satisfied with their interactions with other opioid-dependent patients, referrals to Narcotics Anonymous, and the inconvenience of the treatment location.”
- Also stated in: § Description of Patient Satisfaction · plain
“The lowest rated satisfaction items were interaction with other opioid-dependent patients and the convenience of the primary care location, which had mean ratings of 2.9 and 3.7, respectively.”
Quote in the paperNot a substantial claim - Also stated in: § Description of Patient Satisfaction · plain
- Findingown data
The EMM-3 group did not differ significantly from the SMM-3 group in satisfaction, with a mean difference of 2.4, 95% CI −2.43 to 7.14, and P = .48.
“Although the EMM-3 treatment group reported higher satisfaction than the SMM-3 treatment group (mean difference 2.4, 95% CI −2.43 to 7.14, P = .48), it was not at a level of statistical significance (P = .48).”
Quote in the paperNot a substantial claim - Findingown data
Mean satisfaction ratings across all measured domains were greater than 4.
“Patients were satisfied with their primary care buprenorphine/naloxone treatment: their mean satisfaction ratings for overall satisfaction, overall and specific service components, staff expertise, concern, and responsiveness, and helpfulness of overall and specific treatment components were all greater than 4.”
- Also stated in: § DISCUSSION · plain
“Overall, patients reported high levels of satisfaction with this treatment, including overall and specific service components; staff expertise, concern, and responsiveness; and helpfulness of overall and specific treatment components.”
Quote in the paperSubstantial claim - Also stated in: § DISCUSSION · plain
- Findingown data
Patient satisfaction varied significantly across treatment conditions, with F[2, 139] = 3.16 and P = .03.
“Whereas treatment outcomes did not vary significantly by treatment condition,5 patient satisfaction did (F[2, 139] = 3.16, P = .03).”
Quote in the paperSubstantial claim - Findingown data
Non-White participants reported significantly greater satisfaction than White participants, with t = 2.63, df = 140, and P = .01.
“Non-White participants reported significantly greater patient satisfaction than Whites (t = 2.63, df = 140, P = .01).”
- Also stated in: § DISCUSSION · plain
“non-White participants reported greater satisfaction than Whites.”
Quote in the paperNot a substantial claim - Also stated in: § DISCUSSION · plain
- Findingown data
Referrals to Narcotics Anonymous were among the least satisfying aspects of treatment.
“Patients were least satisfied with their interactions with other opioid-dependent patients, referrals to Narcotics Anonymous, and the inconvenience of the treatment location.”
- Also stated in: § Description of Patient Satisfaction · plain
“The lowest rated item concerned the helpfulness of referrals to Narcotics Anonymous or other self-help groups, which had a mean rating of 3.2.”
Quote in the paperNot a substantial claim - Also stated in: § Description of Patient Satisfaction · plain
- Findingown data
Non-White ethnicity/race independently predicted greater patient satisfaction, with a standardized coefficient of .17 and P = .04.
“Female gender (β = .17, P = .04) and non-White ethnicity/race (β = .17, P = .04) independently predicted patient satisfaction.”
- Also stated in: § Predictors of Patient Satisfaction · hedged
“Significant standardized regression coefficients were found for female gender (β = .17 [P = .04]) and non-White ethnicity/race (β = .17 [P = .04]), indicating that these variables were significantly associated with greater patient satisfaction.”
- Also stated in: § DISCUSSION · plain
“Female gender and non-White ethnicity/race were significant independent predictors of patient satisfaction even after controlling for other baseline factors.”
Quote in the paperNot a substantial claim - Also stated in: § Predictors of Patient Satisfaction · hedged
- Findingown data
Patients assigned to the condition with the fewest medication dispensing appointment requirements reported the most satisfaction, even after controlling for substance use during treatment.
“Specifically, patients who were assigned to the condition with the fewest medication dispensing appointment requirements reported the most satisfaction, even after controlling for substance use during treatment.”
Quote in the paperSubstantial claim - Findingown data
Patients reported the greatest satisfaction with the medication and ancillary services.
“Patients were most satisfied with the medication and ancillary services and indicated strong willingness to refer a substance-abusing friend for the same treatment.”
Quote in the paperNot a substantial claim - Findingown data
Patients expressed a strong willingness to refer a substance-abusing friend for the same treatment.
“Patients were most satisfied with the medication and ancillary services and indicated strong willingness to refer a substance-abusing friend for the same treatment.”
Quote in the paperNot a substantial claim - Findingown data
The mean overall satisfaction score among the patients was 4.4 on a 5-point scale.
“Patients’ mean overall satisfaction score was 4.4 (out of 5).”
Quote in the paperNot a substantial claim - Findingown data
Women reported greater satisfaction than men.
“Women reported greater satisfaction than men and non-White participants reported greater satisfaction than Whites.”
Quote in the paperNot a substantial claim - Findingown data
The lowest-rated helpfulness item was referrals to Narcotics Anonymous or other self-help groups, with a mean rating of 3.2.
“The lowest rated item concerned the helpfulness of referrals to Narcotics Anonymous or other self-help groups, which had a mean rating of 3.2.”
Quote in the paperNot a substantial claim - Findingown data
The simultaneous multiple regression model significantly predicted patient satisfaction, with R2 = .16, F[7, 134] = 3.59, and P = .001.
“A simultaneous multiple regression to determine the joint and independent contributions of the specific variables to predicting the strength of patient satisfaction revealed a significant relationship for the overall sample (R2 = .16 [R = .40]; F[7, 134] = 3.59, P = .001 [Adjusted R2 = .11]).”
Quote in the paperNot a substantial claim - Findingown data
Female gender independently predicted greater patient satisfaction, with a standardized coefficient of .17 and P = .04.
“Female gender (β = .17, P = .04) and non-White ethnicity/race (β = .17, P = .04) independently predicted patient satisfaction.”
- Also stated in: § Predictors of Patient Satisfaction · hedged
“Significant standardized regression coefficients were found for female gender (β = .17 [P = .04]) and non-White ethnicity/race (β = .17 [P = .04]), indicating that these variables were significantly associated with greater patient satisfaction.”
- Also stated in: § DISCUSSION · plain
“Female gender and non-White ethnicity/race were significant independent predictors of patient satisfaction even after controlling for other baseline factors.”
Quote in the paperNot a substantial claim - Also stated in: § Predictors of Patient Satisfaction · hedged
- Study design and conductown data
Principal component analysis of the satisfaction measure supported a one-factor solution that accounted for 37.6% of the variance.
“Principal component analysis results indicated that the most parsimonious solution was a one-factor solution, which accounted for 37.6% of the variance.”
Quote in the paperNot a substantial claim - Study design and conductown data
The use of a single time point in treatment limits statements about ongoing effects.
“Our use of a single time point in treatment limits statements concerning ongoing effects.”
Quote in the paperNot a substantial claim - Study design and conductown data
The 19-item satisfaction scale had a Cronbach alpha of 0.89.
“The 19-item scale had a Cronbach alpha of 0.89.”
Quote in the paperNot a substantial claim - Interpretationown data
High patient satisfaction supports the role of office-based buprenorphine/naloxone treatment in increasing access to opioid-agonist therapy.
“Our findings of high patient satisfaction support the role of office-based buprenorphine/naloxone treatment, a relatively new treatment option in the United States, in increasing access to opioid-agonist therapy.”
Quote in the paperSubstantial claim - Study design and conductown data
Item-total correlations for the satisfaction scale ranged from 0.29 to 0.77.
“Item-total correlations ranged from 0.29 to 0.77.”
Quote in the paperNot a substantial claim - Interpretationown data
Patients are satisfied with primary care office-based buprenorphine/naloxone treatment.
“Patients are satisfied with primary care office-based buprenorphine/naloxone.”
- Also stated in: § DISCUSSION · hedged
“In conclusion, this study suggests that office-based buprenorphine/naloxone treatment is associated with high levels of patient satisfaction.”
Quote in the paperSubstantial claim - Also stated in: § DISCUSSION · hedged
- Study design and conductnone given
The study sample is not necessarily representative of all opioid-dependent patients.
“While participants’ demographic characteristics were similar to those reported in other U.S. and international studies of office-based buprenorphine/naloxone maintenance, our study sample is not necessarily representative of all opioid-dependent patients.13–15”
Quote in the paperNot a substantial claim - Premisecitation
Treatment outcomes did not vary significantly by treatment condition.
“Whereas treatment outcomes did not vary significantly by treatment condition,5 patient satisfaction did (F[2, 139] = 3.16, P = .03).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [5] Fiellin DA, Pantalon MV, Chawarski M, et al. Buprenorphine maintenance in primary care: a randomized controlled trial of counseling conditions and medication dispensing. N Engl J Med. 2006;355:365–74. source
Not checked in the free run.
- Borderline: one of the tests for a substantial claim is unclear. 1
- May combine two claims. 7
- Classified as probably not a substantial claim. 8
Borderline on S1 (asserted), S3 (load-bearing), S4 (based): unclear from the text.
Findingnone givenIn univariate analyses, overall patient satisfaction was significantly associated with sex, race, and the percentage of opiate-free urine tests during treatment.
“In univariate analyses, overall patient satisfaction was significantly associated with sex, race, and the percentage of opiate-free urine tests during treatment but was not associated with drug treatment history or baseline substance use status.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataThe lowest-rated service satisfaction items were interaction with other opioid-dependent patients and convenience of the primary care location, with mean ratings of 2.9 and 3.7, respectively.
“The lowest rated satisfaction items were interaction with other opioid-dependent patients and the convenience of the primary care location, which had mean ratings of 2.9 and 3.7, respectively.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataThe highest-rated helpfulness items were primary care services helping patients cope better with drug abuse problems, the buprenorphine/naloxone medication, and the perception of being treated like a patient rather than a drug addict, with mean ratings of 4.8, 4.8, and 4.6, respectively.
“With regard to the helpfulness of overall and specific treatment components, the highest rated satisfaction items related to the primary care services in helping patients to cope better with drug abuse problems, the buprenorphine/naloxone medication, and the perception of being treated like a patient rather than a drug addict, which had mean ratings of 4.8, 4.8, and 4.6, respectively.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing), S4 (based).
Findingown dataThe inconvenience of the treatment location was among the least satisfying aspects of treatment.
“Patients were least satisfied with their interactions with other opioid-dependent patients, referrals to Narcotics Anonymous, and the inconvenience of the treatment location.”
- Also stated in: § Description of Patient Satisfaction · plain
“The lowest rated satisfaction items were interaction with other opioid-dependent patients and the convenience of the primary care location, which had mean ratings of 2.9 and 3.7, respectively.”
Quote in the paperNot a substantial claim- Also stated in: § Description of Patient Satisfaction · plain
May combine two claims.
Findingown dataThe highest-rated service satisfaction items were the treatment received in the primary care center and the courteousness of staff members, each with a mean rating of 4.7.
“With regard to overall and specific service components, the highest rated satisfaction items were the treatment that participants had received in the primary care center and the courteousness of staff members (both had mean ratings of 4.7).”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataOf the 166 participants enrolled in the trial, 142 completed the patient satisfaction measure at week 12.
“Of the 166 participants who enrolled in the trial, 142 completed the patient satisfaction measure midway (week 12) during treatment.”
- Also stated in: § Design and Participants · plain
“One hundred and forty-two opioid-dependent subjects.”
Quote in the paperNot a substantial claim- Also stated in: § Design and Participants · plain
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationParticipants' demographic characteristics were similar to those reported in other U.S. and international studies of office-based buprenorphine/naloxone maintenance.
“While participants’ demographic characteristics were similar to those reported in other U.S. and international studies of office-based buprenorphine/naloxone maintenance, our study sample is not necessarily representative of all opioid-dependent patients.13–15”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites [13] Sullivan LE, Chawarski M, O’Connor PG, Schottenfeld RS, Fiellin DA. The practice of office-based buprenorphine treatment of opioid dependence: is it associated with new patients entering into treatment? Drug Alcohol Depend. 2005;79(1):113–6. source
Not checked in the free run.
- cites [14] Fudala PJ, Bridge TP, Herbert S, et al. Office-based treatment of opiate addiction with a sublingual tablet formulation of buprenorphine and naloxone. N Engl J Med. 2003;349:949–58. source
Not checked in the free run.
- cites [15] Vignau J, Duhamel A, Catteau J, et al. Practice-based buprenorphine maintenance treatment (BMT): how do French healthcare providers manage the opiate-addicted patients? J Subst Abuse Treat. 2001;21:135–44. source
Not checked in the free run.
May combine two claims.
Study design and conductown dataThe total satisfaction score correlated with weeks in treatment, with r = .22 and P = .007, providing an estimate of predictive validity.
“We correlated the total satisfaction score (obtained midway during treatment) with weeks in treatments (r = .22, P = .007) to obtain an estimate of the measure’s predictive validity.”
Quote in the paperNot a substantial claimMay combine two claims.
InterpretationreasoningBuprenorphine/naloxone treatment appears to be accepted by patients who are new to opioid-agonist treatment and by those who have previously received treatment.
“Buprenorphine/naloxone treatment appears to be accepted by patients who are new to opioid-agonist treatment and those who have previously received treatment.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
InterpretationcitationThe study's findings extend those of a recent study on acceptance of office-based agonist treatment among primary care providers.
“These findings extend those reported in a recent study concerning the acceptance of office-based agonist treatment among primary care providers.10”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [10] Becker WC, Fiellin DA. Provider satisfaction with office-based treatment of opioid dependence: a systematic review. Subst Abuse. 2006;26:15–22. source
Not checked in the free run.
Probably not a substantial claim: may not pass S2 (checkable).
InterpretationreasoningHigh patient satisfaction supports ongoing efforts to expand opioid-dependent patients' treatment options.
“This finding supports ongoing efforts to expand opioid-dependent patients’ treatment options.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationIn community-based drug treatment programs, patients who spent more time with a drug counselor reported greater satisfaction.
“Studies on community-based drug treatment programs found that patients who spent more time with a drug counselor reported greater satisfaction,11,12 although a different pattern of findings emerged in our study.”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [11] Hser YI, Evans E, Huang D, Anglin DM. Relationship between drug treatment services, retention, and outcomes.[see comment]. Psychiatr Serv. 2004;55(7):767–74. source
Not checked in the free run.
- cites [12] Rohrer JE, Hilsenrath P. Client satisfaction with substance abuse treatment. Health Mark Q. 1999;17(2):31–42. source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationPatient satisfaction has increasingly been viewed as an important health care outcome and has been used as a measure of quality of care in different health care settings, including addiction treatment, mental health services, and primary care.
“Patient satisfaction has increasingly been viewed as an important health care outcome and has been used as a measure of quality of care in different health care settings, including addiction treatment,1 mental health services,2 and primary care.34”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites [1] Perez de los Cobos J, Fidel G, Escuder G, et al. A satisfaction survey of opioid-dependent clients at methadone treatment centres in Spain. Drug Alcohol Depend. 2004;73(3):307–13. source
Not checked in the free run.
- cites [2] Stallard P. The role and use of consumer satisfaction surveys in mental health services. J Mental Health. 1996;5:333–48. source
Not checked in the free run.
- cites [34]
Not checked in the free run.
May combine two claims.
Interpretationown dataParticipants appeared to be more satisfied with fewer medication appointments and possibly with more intense counseling.
“Thus, it appears that participants were more satisfied with fewer medication appointments and possibly more intense counseling.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationOffice-based buprenorphine/naloxone treatment has demonstrated efficacy.
“This paucity of research is particularly noteworthy given the increasing availability and demonstrated efficacy of office-based buprenorphine/naloxone treatment.5–7”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites [5] Fiellin DA, Pantalon MV, Chawarski M, et al. Buprenorphine maintenance in primary care: a randomized controlled trial of counseling conditions and medication dispensing. N Engl J Med. 2006;355:365–74. source
Not checked in the free run.
- cites [6] Fiellin DA, Pantalon MV, Pakes JP, O’Connor PG, Chawarski M, Schottenfeld RS. Treatment of heroin dependence with buprenorphine in primary care. Am J Drug Alcohol Abuse. 2002;28(2):231–41. source
Not checked in the free run.
- cites [7] O’Connor PG, Oliveto AH, Shi JM, et al. A randomized trial of buprenorphine maintenance for heroin dependence in a primary care clinic for substance users versus a methadone clinic. Am J Med. 1998;105(2):100–5. source
Not checked in the free run.
The paper relies on this without support.
The factors linked to satisfaction among patients receiving primary care-based buprenorphine/naloxone are not known.
“Factors associated with satisfaction among patients receiving primary care–based buprenorphine/naloxone are unknown.”
The paper relies on this without support.
Research on patient satisfaction with buprenorphine/naloxone treatment in primary care, and on its link to treatment outcome, is limited.
“There is limited research that examines patient satisfaction with buprenorphine/naloxone treatment in primary care settings or the association between patient satisfaction and treatment outcome.”
The paper relies on this without support.
This study is among the first to examine patient satisfaction in buprenorphine/naloxone-maintained patients in a primary care office-based setting.
“This study, to our knowledge, is among the first to examine patient satisfaction in buprenorphine/naloxone-maintained patients in a primary care office-based setting.”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The satisfaction scale's stated minimum is too low
MinorFor 19 items scored from 1 to 5, the minimum total is 19, not 15. The stated maximum of 95 is consistent with 19 items.
Reported 15 · recomputed 19
“PCBSS items were scored on a 5-point Likert-type scale (possible satisfaction scores ranged from 15 to 95). Principal component analysis results indicated that the most parsimonious solution was a one-factor solution, which accounted for 37.6% of the variance. Item-total correlations ranged from 0.29 to 0.77. The 19-item scale had a Cronbach alpha of 0.89.”
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References 15 · Cited by 74
- Authors
- Barry, D. T., Moore, B. A., Pantalon, M. V., Chawarski, M. C., Sullivan, L. E., O’Connor, P. G., Schottenfeld, R. S., & Fiellin, D. A.
- Affiliations
- Yale University (US)
- Corresponding author
- Barry, Declan T.
- ORCID
- Venue
- Journal of General Internal Medicine
- Published
- 2007-01-18
- Volume
- 22
- Issue
- 2
- Pages
- 242-245
- ISSN
- 0884-8734 (ISSN-L)
- 1525-1497
- PMC
- PMC1824745
- OpenAlex
- W2050232084
- Cited by
- 74
- References
- 15
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 2 · 2023: 5 · 2022: 4 · 2021: 10 · 2020: 1 · 2019: 4 · 2018: 1 · 2017: 2 · 2016: 2 · 2015: 4 · 2014: 7 · 2013: 3 · 2012: 4
- FWCI
- 5.11
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Journal of General Internal Medicine (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Pfizer
- Sanofi
- Yale University
- Stryker
- Raymond and Beverly Sackler Institute for Biological, Physical and Engineering Sciences, Yale University
- National Institute on Drug Abuse (K24DA000445, R01DA009803, K23DA015144, K12DA000167)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Keywords
- patient satisfaction, buprenorphine/naloxone, opioid use disorder, office-based opioid treatment, primary care, gender differences, racial and ethnic differences, Narcotics Anonymous
- MeSH terms
- Adult, Buprenorphine, Female, Humans, Male, Middle Aged, Naloxone, Opioid-Related Disorders, Office Visits, Primary Health Care, Treatment Outcome, Patient Satisfaction
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