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The UHS report
ANALYTICAL REPORT
Conducted for: Harvard University Health Services (HUMS)
Conducted by: Axiom Research Company
2 Tyler Court, Cambridge MA 02140; Phone: 617-441-9944; Fax: 617-1441-9966; www.axiomresearch.com
I. METHODOLOGY
This report summarizes the findings of quantitative research conducted by Axiom Research Company on behalf of Harvard University Health Services (HUHS). The purpose of the study was to measure student satisfaction with University Health Services, identify areas for improvement, and explore students' awareness and use of various services provided by HUHS with the goal of improving the care and services provided to students.
All data was collected during April and May 1999. A total of 1,650 Harvard University undergraduates were invited to complete the questionnaire. The survey consisted of 64 closed- ended questions, 7 open-ended questions, and 2 demographic questions. The majority of the data was collected via a traditional mail survey (with an Internet follow-up to boost the response rate).
However, as a test, a small number of students received an Internet survey only.
Mail survey. A random sample of 1,450 students was selected to complete a 6-page questionnaire. The methodology was as follows:
Each student received a mailing including a cover letter on HUHS stationery explaining the purpose of the survey, a survey instrument, and a business reply envelope addressed to Axiom Research.
One week after the initial mailing, non-respondents received a reminder postcard.
One week later, remaining non-respondents received a second survey packet.
Later, all non-respondents received an e-mail with a hotlink to an Internet survey.
Internet survey. A random sample of 200 students was chosen for an Internet survey.
Each student received an e-mail invitation to participate, including a hotlink to the Internet survey and simple instructions.
Three days after the initial invitation, a reminder message was e-mailed to non- respondents.
One week later, a final reminder message was e-mailed to all non-respondents.
Page 2
Overall, Axiom received a total of 709 completed questionnaires, resulting in a response rate of 43%. When reviewing results, keep in mind that a sample of 709 interviews is subject to a sampling error of + 3.68 percentage points (at the 95% confidence level). In other words, if one were to conduct the survey 100 times, 95 out of 100 times the results would fall within 3.68 percentage points (plus or minus) of the true population-wide figures.
The following graph illustrates the increased effectiveness and efficiency of the Internet survey methodology compared to the mail survey methodology (keep in mind that Contact 4 for the mail survey was an Internet reminder).
The report includes an "Executive Summary," which summarizes the research findings, and "Research Results," which offer a descriptive analysis of students' responses to all research questions, including differences and similarities between subgroups where notable. A copy of the survey instrument with aggregate responses is included in Appendix A. "Data Tables," furnished to HUHS under a separate cover, include all of the survey questions cross-tabulated by
a key set of demographic and attitudinal variables.
Page 3 II. EXECUTIVE SUMMARY The 1999 survey of undergraduates conducted by Axiom Research Company (ARC) on behalf of Harvard University Health Services (HUMS) indicates that HUHS fares generally well among undergraduates. In particular, students give HUHS high ratings for its physicians and nurse practitioners, and for the convenience it provides. Furthermore, the study shows that HUHS has made some significant improvements over the past few years. Most notable, the level of satisfaction with HUHS health care overall has improved. In 1992, a total of 20% of students rated their satisfaction as "very good" or "excellent". In 1999, this number increased to 29%, with the greatest increase occurring among those who rate their satisfaction as "very good". Furthermore, the percentage of students who rated the overall quality of care and services provided by HUHS to be "very good" or "excellent" has increased from 29% in 1992 to 34% in 1999. Despite this good news, this study does reveal that a core group of students continue to be unsatisfied with the care and services that HUHS provides. With the exception of specialty services, at least one third of students are dissatisfied with each type of service offered by HUHS. Furthermore, while a slight majority of students would recommend HUHS to others in the Harvard community, almost as many would not recommend it. The primary reasons for this dissatisfaction appear to be the delays, the misdiagnoses, the poor attitudes of staff members, and the care given by some providers at HUMS. Students who tend to be most dissatisfied are those without a PCP or those who are unaware of the benefits and services to which they are entitled as Harvard University undergraduates. It is clear that HUHS has made some improvements in these areas over the past seven years. This study highlights the importance of not only continuing, but stepping-up those efforts, particularly those aimed at improving access to care, boosting staff morale, educating students to the health benefits to which they are entitled, and ensuring students have and like their PCP. Clearly, these goals cannot be achieved by any one department of the HUHS system, but through teamwork between the administrative executives, reception staff, and caregivers. Page 4 A. Overall Satisfaction Although a majority of students (58%) say they are satisfied ("good" or better) with HUHS health care overall, this consists of only 3% who gave the highest rating of "excellent". Furrthermore, a substantial number of students (41%) say they are dissatisfied ("fair" or "poor"). This pattern holds true for a variety of aspects of care, however, overall levels of satisfaction are slightly higher in some areas. Specialty Services. 81% of students gave favorable ratings to satisfaction with specialty services, with 14% giving a rating of "excellent." Approximately two in ten (19%) gave unfavorable ratings. Quality of Care. Close to two out of three (66%) students gave favorable ratings to satisfaction with quality of care, with 7% giving a rating of "excellent." One in three (34%) gave unfavorable ratings. Mental Health. Similarly, two out of three (65%) gave favorable ratings to satisfaction with Mental Health Services, with 10% giving it a rating of "excellent." Slightly over one third (36%) gave unfavorable ratings. After Hours. 57% of students gave favorable ratings to satisfaction with the After Hour Urgent Care Clinic, with 8% giving it a rating of "excellent." Over four in ten (42%) gave unfavorable ratings. While office practices and administrative issues such as delays and courtesy of receptionists are correlated with overall satisfaction, care-related factors are of greater significance. Specifically, overall satisfaction is strongly correlated with: "extent to which your concerns were addressed by the physician or nurse practitioner," "focus and clarity of the treatment plan provided by the physician or nurse practitioner," "your physician or nurse practitioner's explanation of your illness," "how much you were helped by the care you received", and "satisfaction with physicians and nurse practitioners." Page 5 B. Perceived Strengths Health Care Providers. Students regard the health care providers to be among HUHS' greatest strengths. In fact, physicians were rated "good" or better by nearly 80% of students. Nurse practitioners and health-assistants receive positive marks as well. Specifically, students are pleased with the attentiveness and thoroughness of their primary care physicians (PCP) and nurse practitioners. Not surprisingly, many of these factors are those that are highly correlated with overall satisfaction. "the attention they were given by providers" (77% "good or better"), "the extent to which their concerns were addressed" (72%), "the focus and clarity of the treatment plan provided to them" (70%), and "the clarity of follow-up instructions" (69%). Two interesting findings emerge from the subgroup analysis (See Data Tables, furnished under a separate cover). First of all, students who have a PCP are more satisfied with the care provided by doctors, nurse practitioners and health assistants than those who do not have a PCP. Secondly, those who are satisfied with their health care provider are more apt to be satisfied overall with HUHS than are those who are less satisfied with their health care provider. These findings illustrate the impact having a PCP has on overall satisfaction with HUMS. Convenience. In response to an open-ended question addressing what students liked best about HUMS, 56% responded that the best thing about the service is the convenience it offers. Page 6 C. Primary Concerns Delays. Students who rated their overall satisfaction with HUHS less than "very good" indicated that delays were a primary cause of dissatisfaction (42%). Delays are also a major factor in students' dissatisfaction with After Hours Urgent Care, Mental Health Services, and Specialty Services. Delays occur at all stages in the process of care: In trying to get through to a receptionist to make an appointment; In the length of time between making an appointment and the day of the visit; In waiting for care once they have arrived for a scheduled appointment; and, In waiting for care in an emergency situation. Poor Care/Misdiagnoses. Students who rated their overall satisfaction with HUHS less than "very good" complain of misdiagnoses, poor attitudes of providers, and poor, incomplete, or rushed care. Over one-third (36%) of students said that misdiagnoses were the source of their dissatisfaction when rating HUHS overall care. These students are disproportionately likely to be dissatisfied ("poor" or "fair") overall care. Receptionists. Students report having difficulty with the receptionists at HUMS. In fact, 39% rated their satisfaction with the receptionists to be either "fair" or "poor" and 35% rated the courtesy and respect shown to you by the receptionists to be "fair" or "poor." The majority of students who do not have a PCP expressed dissatisfaction with the receptionists. This is perhaps because more of a dialogue is required between those students without a PCP and receptionists when making an appointment or calling with questions. Administrative Services. Students gave low ratings to the services provided by HUHS Member Services Department. For example, roughly half rated the ease of getting claims problems resolved (51 %) and the ease getting your questions answered, or problems solved regarding eligibility and services covered (46%) either "fair" or "poor." Knowledge of Plan Benefits. 63% of students reported the availability of information from your plan about covered services and cost of care to be either "fair" or "poor." Furthermore, only 22% agree with the statement "I understand my benefits under the Student Health Plan." Page 7 D. Other Findings While many students are aware of the existence of HUHS sponsored services, very few students have used them. Eighty-three percent have made at least one visit to HUHS in the past year and. 64% made two or more. Students are prompted to visit because of minor health problems such as the flu or colds, routine check-ups, and emergency care needs. E. Comparisons to Previous Studies University Health Services commissioned research among undergraduates in 1992 and Harvard University's faculty and staff in 1997. Due to different methodologies and question wording, not all questions can be directly compared from year to year. That said, there are a few overarching trends worth noting. Areas Of Improvement Levels of Overall Satisfaction with HUHS Have Improved. The level of satisfaction with HUHS health care overall has improved. In 1992, a total of 20% of students rated their satisfaction as "very good" or "excellent" when asked to evaluate health care at University Health Services. In 1999, when asked to rate their satisfaction with the HUHS health care overall this number increased to 29%, with the greatest increase occurring among those who rate their satisfaction as "very good". However, the positive ratings for overall satisfaction with HUHS has remained constant (56% in 1992 vs. 58% in 1999). Page 8 Overall Quality of Care and Services. Undergraduates' view of the overall quality of care and services provided by HUHS has improved slightly since 1992. Students gave a higher rating in 1999 to the overall quality of care and services provided by HUHS than in 1992 (34% rating "very good" or "excellent" in 1999 vs. 29% in 1992). In 1997, 50% of faculty and staff rated the overall quality of care and services as "very good" or "excellent." Length of Time Waiting Once at Office. Students in 1999 gave better ratings to the length of time you usually had to wait to see your provider once you got to your provider's office for a scheduled appointment than they gave in 1992 to the length of time spent waiting at the office to see the clinician. In 1992, 52% of students gave it a rating of "good" or better; this number has increased to 60% in 1999. Attention Given to Patient. Students in 1999 gave higher ratings to the attention given to what you had to say than they did in 1992. The percentage of students who rated it "good" or better has increased from 68% in 1992 to 77% in 1999. Areas Unchanged Length of Time Waiting Between Making Appointment and Visit. Student satisfaction with the length of time waiting between making an appointment and the day of the visit remains statistically unchanged from 1992 to 1999. Awareness of Services Awareness of Rape Crisis Services Has Increased. Awareness of rape crisis services has increased dramatically since 1992. In 1992, only 27% of students surveyed were aware of these services, while 63% were aware in 1999. Awareness of Student Health Advisory Council Has Increased. Awareness of SHAC has increased since 1992. Only 16% of students surveyed in 1992 had heard of SHAC compared to 32% in 1999. Number of Students with a PCP Has Increased. The number of students with a primary care physician (or a provider that they generally see when possible) has increased from 1992 to 1999 (48% vs. 66% respectively). Students Are Less Aware that They Can Charge Prescription Filling to the Term Bill. Undergraduates in 1999 were less aware that prescription filling at HUHS. Pharmacy can be charged to your term bill without disclosure of the drugs/items purchased than they were in 1992. This number has decreased from 78% aware in 1992 to 39% aware in 1999. Page 9 F. Recommendations As mentioned earlier, it is clear that HUHS has made some improvements over the past few years that have had a positive impact on students' overall satisfaction with HUMS. To continue on this path, HUHS must improve access to care, boost staff morale, educate students to plan benefits, and encourage students to have a PCP. In executing these recommendations it is important to keep in mind that while one department may be primarily responsible for executing the recommendations, they will only be successful if all departments work together to meet these goals. Improve Access to Care. Students complain of long waits to get appointments as well as to see a physician once they arrive for a scheduled appointment. To the extent that it is possible, additional clinicians would ease the waiting time. Furthermore, if a health care provider is aware that he/she is running behind schedule, an effort should be made to contact students to inform them of the delay. Any consideration of this nature shown to a student should help to increase satisfaction. Boost Staff Morale. Offer customer service training to the receptionists. HUHS should continue to encourage receptionists to be helpful, informative, and polite to students. Encourage students to have a PCP. Students who have a PCP are more satisfied overall with HUHS than those who do not. Therefore, HUHS should continue to make every effort to foster relationships between PCPs and students. Educate Students to Plan Benefits and Encourage Use. Benefit information could be placed on the HUHS website or a mass mailing of pamphlets and informational material could be done to increase awareness. A significant portion of undergraduates expressed that they would prefer to receive the majority of their information about HUHS via e-mail. Consider using e-mail to educate students about plan benefits. Consider utilizing both the website and e-mail to inform students of the peer counseling and support groups and peer education programs at HUMS. Offer stress-reduction seminars and circulate pamphlets on the wellness programs and anonymous and confidential HIV counseling and testing. Perhaps have an open-house where students could learn how and why they should take advantage of these services. Encourage doctors to communicate with patients. Because doctors are an integral component in making students feel satisfied with HUMS, PCPs should focus on listening to their patients, explaining the diagnoses carefully, and offering follow-up instructions. Page 10 III. RESEARCH RESULTS A. Use of Services The vast majority of students surveyed are taking advantage of the health care services provided by HUHS facilities. Nearly two-thirds of the students (64%) have made two or more visits to a HUHS facility for health care in the last 12 months, and an additional two out of ten (19%) made one visit. Only 17% did not make any visits at all. A full 93% of respondents enjoy "good" or better health, while only 7% rated their health as either "fair" or 'poor." Rather than visiting HUHS for major health concerns, students are most frequently prompted to visit HUHS because of minor health problems such as the flu or a cold (44%), the need for routine care (26%), and emergency injuries or care (19%). At least 70% of students have used the internal medicine facilities. Nearly half of the respondents (46%) have visited the After Hours Urgent Care Clinic in the past year and nearly 20% have visited a specialty service area such as mental health or orthopedics (For a complete list, see Appendix A.) Not surprisingly, students who are frequent visitors to HUHS (5 or more visits per year) are more likely to have a PCP than infrequent visitors (1 or 0 visits per year). Women are more likely to be frequent visitors than men are (29% versus 15%). Page 11 B. Satisfaction of Services Overall While a small majority of students seem generally satisfied with HUHS health care overall, four out of ten students surveyed are dissatisfied, and few are willing to give HUHS a rating of "excellent." When asked how they would rate their satisfaction with HUHS health care overall, the majority of students (58%) gave HUHS a rating of "good" or better. However, only 3% offered a rating of "excellent." Also troubling is that 41% of students are dissatisfied with HUHS health care (27% rated overall care to be "fair," and 14% rating it "poor.") Regardless of how frequently students visit, their level of dissatisfaction with HUHS remains consistent. Individuals who do not have a PCP are less satisfied (53% "poor" or "fair" combined) than those who do have a PCP (35%). While we cannot through statistical analysis determine what drives satisfaction, we can determine which of the variety of factors tested are correlated with satisfaction. It is interesting to note that the factors most strongly correlated with overall satisfaction tend to be care related. Office practices and administrative issues are also significantly correlated, but to a lesser degree. Page 12 Not surprisingly, overall satisfaction is most strongly correlated with "the extent to which your concerns were addressed by the physician or nurse practitioner," "the focus and clarity of the treatment plan provided to you by the physician or nurse practitioner," "your physician or nurse practitioner's explanation of your illness," "how much you were helped by the care you received", and satisfaction with physicians and nurse practitioners." Satisfaction with overall quality of care and services is strongly correlated with the aspects of health care just listed in addition to "attention given to what you had to say by the physician or nurse practitioner", "clarity of follow-up instructions", and "ease of getting a referral to see a specialist". Both overall satisfaction and satisfaction with overall quality of care and services are also significantly correlated with other service issues such as waiting time, courtesy shown by receptionists, and ease of getting claims resolved‹although to a lesser degree than the above factors. Page 13 When asked whether they would recommend HUHS to others in the Harvard community, students further displayed their dissatisfaction. Just over half (53%) said that they would recommend HUMS. However, almost as many said they would not recommend it (47%), and only 6% said they would definitely recommend HUMS. Reasons for Dissatisfaction The reasons students are dissatisfied are varied, but complaints seem to center around delays/waiting (42%), misdiagnoses (36%), poor attitudes of care providers (22%), and poor, incomplete, or rushed care (18%). Students find getting an appointment to be difficult (27%) and they experience long waits to see providers even with scheduled appointments (18%). When asked what HUHS could do to improve the quality of care and services it provides, students suggested better care (37%), which would entail better diagnoses and explanations of treatments (16%), better doctors (10%), and more time spent with patients (5%). Nearly a quarter of respondents said that HUHS needs more staff/doctors to help decrease the waiting time (24%). Approximately two out of ten would like it to be easier to make appointments (21%). Page 14 Two-thirds of those students who gave HUHS ratings of "fair" or "poor" on overall care, did so because of negative care experiences. For example, 70% of students who reported misdiagnoses as a barrier to satisfaction gave HUHS a rating of "fair" or "poor" for overall care. Of those who gave a "fair" or "poor" rating to HUHS for overall care, 61% like the convenience that HUHS has to offer. The open-ended responses elicited comments that reflected experiences of delays, misdiagnoses, and incomplete care. For example: "Brushed me off (Gave me a pat on the head and sent me away) because they couldn't diagnose me. " "I was sent away / made to wait even though it was an emergency. "My diagnosis was incorrect - with serious consequences." Page 15 "HUHS would be wonderful if they would only take the time to treat each patient instead of acting as a medical drive-thru (with huge linesl) and trying to get to the next patient." Student satisfaction may be affected to some degree by HUHS' perceived reputation. A small number (7%) of students volunteered at various places throughout the survey, that they had heard of other students' bad experiences with HUHS. These reports appear to have had a negative impact on the satisfaction of students hearing them. Eleven percent of this group rated their overall satisfaction "very good" or "excellent" compared to 31% of those who did not report hearing of bad experiences. These findings are, however, somewhat anecdotal since students were not directly asked what they believed HUHS' reputation to be or whether that had an impact on their satisfaction: "...Even if the doctor didn't say this, the fact that she arrived [my roommate] back in the room w/this idea is not good and spreads/adds to the "UHS horror story" collection." "...Also, it seems to be almost cool to have a UHS "horror story"." Page 16 Best Features of HUHS When asked what they like best about HUHS, more than half of the students noted the convenience of HUHS. Other aspects of HUHS that students like best are the ease of making appointments (13%) and their specific doctor or clinician (12%). A similar pattern emerges when comparing satisfaction with the After Hours Urgent Care Clinic and HUHS heath care services overall. Over half of the respondents (57%) rated the After Hours Urgent Care "good" or better. However, nearly half of the students (42%) gave the clinic a rating of "fair" or "poor." Less than 10% were willing to rate it "excellent." Page 17 Again, dissatisfaction stems from delays/waiting (49%), misdiagnoses (22%), poor attitudes of providers (18%), and poor, incomplete, or rushed care (18%). Students had the following to say about their After Hours Urgent Care Clinic experiences which illustrate the reasons for their dissatisfaction: "They didn't take my situation seriously / not a big enough emergency." "Staff unprofessional / inattentive." Mental Health Services While students rated the Mental Health Services provided by HUHS generally high, roughly a third (36%) rated it either "fair" or "poor." Furthermore, only 10% deemed Mental Health Services to be "excellent." Reasons for dissatisfaction with Mental Health Services remain consistent with other care services: poor, incomplete, rushed care (33%), delays (27%), and poor attitudes of providers (18%). Misdiagnoses (14%) are less of a problem in Mental Health Services when compared to other services, but are still a barrier to student satisfaction. In response to an open-ended question about what prevents students from being more satisfied, some wrote: "Inattentive counselors & bad advice." "Reception process embarrassing / no privacy." Page 18 Specialty Services People are satisfied with the specialty services offered by HUHS (81%). However, only 14% rated specialty services "excellent," reflecting an overall lack of enthusiasm about HUHS. People are less dissatisfied with specialty services than they are with other services (19% rating specialty services either "poor" or "fair"). Consistent with other health care services, delays (46%), misdiagnoses (27%), poor, rushed, or incomplete care (16%), and poor attitudes of providers (14%) remain primary reasons for dissatisfaction with Specialty Services offered by HUHS. Students explain their reasons for dissatisfaction, using the following words: "Didn't find helpful." "Need more services." "Diagnosis incorrect." "Wouldn't prescribe medication when I needed it. " "Just give medication - no good diagnosis." Page 19 C. Satisfaction with Providers Students are generally satisfied with HUHS health care providers, but are less so with receptionists. Students are particularly satisfied with their physicians, indicated by nearly 80% rating their satisfaction as "good" or better. Roughly 70% of students rated nurse practitioners and health assistants to be at least "good." Even though the majority of students rated their satisfaction with the receptionists (61 %) "good" or better, nearly 40% claim to be dissatisfied, offering a rating of"poor" or "fair." "[My doctor] is wonderful. She is one of the best doctors I have ever had. However, I had a very negative experience with the rest of the staff. I have experienced everything from a doctor obviously not listening to me to extreme rudeness by receptionists." "I felt like I knew more about health than the nurse practitioner did when we met. " "My experience with UHS over the last 12 months has been overwhelmingly positive. However, this is largely because of a change in my primary care physician. " Of the students who gave a rating of "poor" or "fair" to HUHS care overall, 42% reported dissatisfaction with their physicians, 52% were dissatisfied with nurse practitioners and health assistants, and 61% were dissatisfied with the receptionists. Students who have a PCP tend to be more satisfied with their physicians, nurse practitioners, and health assistants than those who do not have a PCP. Students who do not have a PCP (52% rated receptionists "fair" or "poor") are more dissatisfied with the receptionists than are those who do have a PCP (39%). Page 20 D. Personal Experience with Health Care and Administrative Services Health Care Students were asked to evaluate their own recent experiences with HUHS health care. Office practices, and administrative services. Students are pleased with their experiences with doctors and nurse practitioners, but have negative attitudes about the ease of getting referrals to specialists and getting their phone calls about their health answered. Nearly two-thirds of students rated overall quality of care and services to be "good" or better. However, a solid third (34%) rated the quality of care and services to be "fair" or "poor." Only 7% rated the care to be "excellent." Students rated the experiences with their doctors highly. A majority of students offered favorable ratings to the attention given to what they had to say by the physician or nurse practitioner (77%), the extent to which their concems were addressed by the physician or nurse practitioner (72%), the focus and clarity of the treatment plan provided to them by the physician or nurse practitioner (70%), and the clarity of follow-up instructions (69%). Half of students gave unfavorable ratings to the ease of getting their phone calls about health answered (54% saying "poor" or "fair") and getting a referral to see a specialist (50% saying "poor" or "fair"). Furthermore, at least a third of students had only "fair" or "poor" experiences with their physician or nurse practitioner's explanation of their illness (36%), how much they were helped by the care that they received (35%), and the clarity of follow-up instructions (3 1%). Page 21 Nearly four out of ten of students who visited HUHS five or more times in the past year gave low ratings to the overall quality of care and services provided by HUHS. Students who do not have a PCP rated the overall quality of care and services lower than those who have a PCP (48% vs. 30%). Students who have a PCP rate the attentiveness of the physicians or nurse practitioners higher (53% "excellent" and "very good") than those who do not have a PCP (37%) Students who do not have a PCP find it harder to get a referral to see a specialist (67% rating "fair" or "poor") than those who do have a PCP (46%). Page 22 Office Practices Students gave HUHS high ratings for having convenient clinic hours, but reported being unhappy with the appointment delays and waiting time. Three quarters of respondents (76%) feel the convenience of the clinic hours is "good" or better. Nearly seven out of ten students gave high ratings to the ease of making appointments for medical care by phone (69%). Nearly 60% of students rated the length of time spent waiting between making an appointment and the day of their visit as too long (31% rating it "fair" and 27% rating it "poor.") Furthermore, 41% rated the length of time waiting at the provider's office for a scheduled appointment "fair" or "poor." In addition, while the majority of students gave receptionists "good" or better ratings, a third of students (35%) rated the courtesy and respect shown to them by the receptionists to be "fair" or "poor." Administrative Services When asked to consider the HUHS Member Services Department, students rated the services provided negatively. Nearly two thirds of students (63%) rated the availability of the information about their plans and costs of care as "fair" or "poor." Roughly half of the students thought negatively of the ease of getting claims problems resolved (51%) and the ease of getting their questions answered regarding eligibility and services (46%). Page 23 Female students (56% rating "fair" or "poor") find it more difficult to get their questions answered or their problems solved regarding eligibility of services than do male students (33%). Students without a PCP (85%) find it much more difficult to get their claims problems resolved than students with a PCP do (45%). Page 24 E. Patient Preferences Appointment Preferences When the need arises for a student to see a physician or a nurse practitioner on a weekday, students prefer to call ahead to be assured of a definite appointment time (75%). However, when students need to see a medical professional on nights or weekends, they prefer to go to the After Hours Urgent Care Clinic without a definite appointment (75%). A vast majority (84%) of students who have frequently visited HUHS in the past 12 months prefer to call ahead to make an appointment on weekdays. Conversely, 80% of frequent visitors would choose to go to After Hours Urgent Care without an appointment on nights or weekends. Primary Care Physician Selection Forty percent of students continue with a PCP or nurse practitioner that is assigned to them on their first HUHS visit (40%). An additional 39% are more pro-active in their doctor selection by making a selection via the HUHS web site (12%), from the Clinician Directory at the beginning of the academic year (10%), from the 'Select your primary care clinician' event (9%), or from making a choice at the time they enroll at Harvard University (8%). Others prefer to set-up an appointment to meet with a physician or nurse practitioner (21%). Page 25 Sources for Health Information Less than a quarter of respondents turn to HUHS for the majority of their health-related information (16% through HUHS medical personnel and 2% from the Center for Wellness and Health Communications). Three quarters of respondents get the majority of their health-related information from their family. An additional 42% get information of this nature from their friends, while still another 29% receive information from their physician or nurse practitioner at home. Communication with Health Care Provider and HUHS While students are comfortable with e-mail, they do not want to rely on it for communicating with their doctor or nurse practitioner. In non-emergency situations, 56% of students prefer to communicate with their physician or nurse practitioner through face to face visits. A third of students opt for the telephone (32%), while only 12% would prefer to utilize e-mail. Interestingly, while they would not use e-mail to communicate with their health provider, 39% of students would like to receive information about HUHS and health-related activities via e-mail. Two out of ten would prefer to have information sent to their house or dorm. Fifteen percent would like to get this information by visiting the HUHS web site. Page 26 F. Awareness of Services While many students are aware of the existence of HUHS sponsored services, few students have used them. For example, 95% of students are aware of Room 13, 92% of students are aware of Eating Concerns Hotline and Outreach (ECHO), and 89% are aware of Peer Contraceptive Counseling (PCC). However, only 2%, 3%, and 3% have used these services, respectively. Among the services, students are least aware of The Health Resource Center at HUHS (25% aware), The Mind Body Medical Institute at HUHS (15%), and the Patient Advocate (15%). Overall, regardless of the level of awareness, no more than 5% of students have used any of these 16 tested services in the past year. Students are aware that their medical records are confidential (79%) and their primary care services include preventive care (64%). However, students are unaware that mental health visits are not part of their regular medical record (84%), that a 24-hour advice nurse is available for health information (82%), and that same day appointments with mental health personnel are available when needed (74%). A majority of students strongly agree that they know how to access health care from HUHS if they are not feeling well (75%), know what to do if they have an acute illness or injury (72%), and know how to access reliable health care information (51%). Forty-four percent of students disagree with the statement "I understand my benefits under the Student Health Plan." Undergraduates who have a PCP are more knowledgeable on how to access reliable health care information than students without a PCP (60% vs. 44%).
II. EXECUTIVE SUMMARY
The 1999 survey of undergraduates conducted by Axiom Research Company (ARC) on behalf of Harvard University Health Services (HUMS) indicates that HUHS fares generally well among undergraduates. In particular, students give HUHS high ratings for its physicians and nurse practitioners, and for the convenience it provides. Furthermore, the study shows that HUHS has made some significant improvements over the past few years. Most notable, the level of satisfaction with HUHS health care overall has improved. In 1992, a total of 20% of students rated their satisfaction as "very good" or "excellent". In 1999, this number increased to 29%, with the greatest increase occurring among those who rate their satisfaction as "very good". Furthermore, the percentage of students who rated the overall quality of care and services provided by HUHS to be "very good" or "excellent" has increased from 29% in 1992 to 34% in 1999.
Despite this good news, this study does reveal that a core group of students continue to be unsatisfied with the care and services that HUHS provides. With the exception of specialty services, at least one third of students are dissatisfied with each type of service offered by HUHS. Furthermore, while a slight majority of students would recommend HUHS to others in the Harvard community, almost as many would not recommend it. The primary reasons for this dissatisfaction appear to be the delays, the misdiagnoses, the poor attitudes of staff members, and the care given by some providers at HUMS. Students who tend to be most dissatisfied are those without a PCP or those who are unaware of the benefits and services to which they are entitled as Harvard University undergraduates.
It is clear that HUHS has made some improvements in these areas over the past seven years. This study highlights the importance of not only continuing, but stepping-up those efforts, particularly those aimed at improving access to care, boosting staff morale, educating students to the health benefits to which they are entitled, and ensuring students have and like their PCP. Clearly, these goals cannot be achieved by any one department of the HUHS system, but through teamwork between the administrative executives, reception staff, and caregivers.
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A. Overall Satisfaction
Although a majority of students (58%) say they are satisfied ("good" or better) with HUHS health care overall, this consists of only 3% who gave the highest rating of "excellent". Furrthermore, a substantial number of students (41%) say they are dissatisfied ("fair" or "poor"). This pattern holds true for a variety of aspects of care, however, overall levels of satisfaction are slightly higher in some areas.
Specialty Services. 81% of students gave favorable ratings to satisfaction with specialty services, with 14% giving a rating of "excellent." Approximately two in ten (19%) gave unfavorable ratings.
Quality of Care. Close to two out of three (66%) students gave favorable ratings to satisfaction with quality of care, with 7% giving a rating of "excellent." One in three (34%) gave unfavorable ratings.
Mental Health. Similarly, two out of three (65%) gave favorable ratings to satisfaction with Mental Health Services, with 10% giving it a rating of "excellent." Slightly over one third (36%) gave unfavorable ratings.
After Hours. 57% of students gave favorable ratings to satisfaction with the After Hour Urgent Care Clinic, with 8% giving it a rating of "excellent." Over four in ten (42%) gave unfavorable ratings.
While office practices and administrative issues such as delays and courtesy of receptionists are correlated with overall satisfaction, care-related factors are of greater significance. Specifically, overall satisfaction is strongly correlated with:
"extent to which your concerns were addressed by the physician or nurse practitioner,"
"focus and clarity of the treatment plan provided by the physician or nurse practitioner,"
"your physician or nurse practitioner's explanation of your illness,"
"how much you were helped by the care you received", and
"satisfaction with physicians and nurse practitioners."
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B. Perceived Strengths
Health Care Providers. Students regard the health care providers to be among HUHS' greatest strengths. In fact, physicians were rated "good" or better by nearly 80% of students. Nurse practitioners and health-assistants receive positive marks as well.
Specifically, students are pleased with the attentiveness and thoroughness of their primary care physicians (PCP) and nurse practitioners. Not surprisingly, many of
these factors are those that are highly correlated with overall satisfaction.
"the attention they were given by providers" (77% "good or better"),
"the extent to which their concerns were addressed" (72%),
"the focus and clarity of the treatment plan provided to them" (70%), and
"the clarity of follow-up instructions" (69%).
Two interesting findings emerge from the subgroup analysis (See Data Tables, furnished under a separate cover). First of all, students who have a PCP are more satisfied with the care provided by doctors, nurse practitioners and health assistants
than those who do not have a PCP. Secondly, those who are satisfied with their health care provider are more apt to be satisfied overall with HUHS than are those who are less satisfied with their health care provider. These findings illustrate the impact having a PCP has on overall satisfaction with HUMS.
Convenience. In response to an open-ended question addressing what students liked best about HUMS, 56% responded that the best thing about the service is the convenience it offers.
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C. Primary Concerns
Delays. Students who rated their overall satisfaction with HUHS less than "very good" indicated that delays were a primary cause of dissatisfaction (42%). Delays are also a major factor in students' dissatisfaction with After Hours Urgent Care, Mental Health Services, and Specialty Services.
Delays occur at all stages in the process of care:
In trying to get through to a receptionist to make an appointment;
In the length of time between making an appointment and the day of the visit;
In waiting for care once they have arrived for a scheduled appointment; and,
In waiting for care in an emergency situation.
Poor Care/Misdiagnoses. Students who rated their overall satisfaction with HUHS less than "very good" complain of misdiagnoses, poor attitudes of providers, and poor, incomplete, or rushed care. Over one-third (36%) of students said that misdiagnoses were the source of their dissatisfaction when rating HUHS overall care. These students are disproportionately likely to be dissatisfied ("poor" or "fair") overall care.
Receptionists. Students report having difficulty with the receptionists at HUMS. In fact, 39% rated their satisfaction with the receptionists to be either "fair" or "poor" and 35% rated the courtesy and respect shown to you by the receptionists to be "fair" or "poor."
The majority of students who do not have a PCP expressed dissatisfaction with the receptionists. This is perhaps because more of a dialogue is required between those
students without a PCP and receptionists when making an appointment or calling with questions.
Administrative Services. Students gave low ratings to the services provided by HUHS Member Services Department. For example, roughly half rated the ease of getting claims problems resolved (51 %) and the ease getting your questions answered, or problems solved regarding eligibility and services covered (46%) either "fair" or "poor."
Knowledge of Plan Benefits. 63% of students reported the availability of information from your plan about covered services and cost of care to be either "fair" or "poor."
Furthermore, only 22% agree with the statement "I understand my benefits under the Student Health Plan."
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D. Other Findings
While many students are aware of the existence of HUHS sponsored services, very few students have used them.
Eighty-three percent have made at least one visit to HUHS in the past year and. 64% made two or more. Students are prompted to visit because of minor health problems such as the flu or colds, routine check-ups, and emergency care needs.
E. Comparisons to Previous Studies
University Health Services commissioned research among undergraduates in 1992 and Harvard University's faculty and staff in 1997. Due to different methodologies and question wording, not all questions can be directly compared from year to year. That said, there are a few overarching trends worth noting.
Areas Of Improvement
Levels of Overall Satisfaction with HUHS Have Improved. The level of
satisfaction with HUHS health care overall has improved. In 1992, a total of 20% of students rated their satisfaction as "very good" or "excellent" when asked to evaluate health care at University Health Services. In 1999, when asked to rate their satisfaction with the HUHS health care overall this number increased to 29%, with the greatest increase occurring among those who rate their satisfaction as "very good". However, the positive ratings for overall satisfaction with HUHS has remained constant (56% in 1992 vs. 58% in 1999).
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Overall Quality of Care and Services. Undergraduates' view of the overall quality of care and services provided by HUHS has improved slightly since 1992. Students gave a higher rating in 1999 to the overall quality of care and services provided by
HUHS than in 1992 (34% rating "very good" or "excellent" in 1999 vs. 29% in
1992). In 1997, 50% of faculty and staff rated the overall quality of care and
services as "very good" or "excellent."
Length of Time Waiting Once at Office. Students in 1999 gave better ratings to the length of time you usually had to wait to see your provider once you got to your provider's office for a scheduled appointment than they gave in 1992 to the length of time spent waiting at the office to see the clinician. In 1992, 52% of students gave it a rating of "good" or better; this number has increased to 60% in 1999.
Attention Given to Patient. Students in 1999 gave higher ratings to the attention given to what you had to say than they did in 1992. The percentage of students who rated it "good" or better has increased from 68% in 1992 to 77% in 1999.
Areas Unchanged
Length of Time Waiting Between Making Appointment and Visit. Student satisfaction with the length of time waiting between making an appointment and the day of the visit remains statistically unchanged from 1992 to 1999.
Awareness of Services
Awareness of Rape Crisis Services Has Increased. Awareness of rape crisis
services has increased dramatically since 1992. In 1992, only 27% of students surveyed were aware of these services, while 63% were aware in 1999.
Awareness of Student Health Advisory Council Has Increased. Awareness of SHAC has increased since 1992. Only 16% of students surveyed in 1992 had heard of SHAC compared to 32% in 1999.
Number of Students with a PCP Has Increased. The number of students with a primary care physician (or a provider that they generally see when possible) has increased from 1992 to 1999 (48% vs. 66% respectively).
Students Are Less Aware that They Can Charge Prescription Filling to the Term Bill. Undergraduates in 1999 were less aware that prescription filling at HUHS. Pharmacy can be charged to your term bill without disclosure of the drugs/items purchased than they were in 1992. This number has decreased from 78% aware in 1992 to 39% aware in 1999.
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F. Recommendations
As mentioned earlier, it is clear that HUHS has made some improvements over the past few years that have had a positive impact on students' overall satisfaction with HUMS. To continue on this path, HUHS must improve access to care, boost staff morale, educate students to plan benefits, and encourage students to have a PCP. In executing these recommendations it is
important to keep in mind that while one department may be primarily responsible for executing the recommendations, they will only be successful if all departments work together to meet these goals.
Improve Access to Care. Students complain of long waits to get appointments as well as to see a physician once they arrive for a scheduled appointment. To the extent that it is possible, additional clinicians would ease the waiting time. Furthermore, if a health care provider is
aware that he/she is running behind schedule, an effort should be made to contact students to inform them of the delay. Any consideration of this nature shown to a student should help to increase satisfaction.
Boost Staff Morale. Offer customer service training to the receptionists. HUHS should continue to encourage receptionists to be helpful, informative, and polite to students.
Encourage students to have a PCP. Students who have a PCP are more satisfied overall with HUHS than those who do not. Therefore, HUHS should continue to make every effort to foster relationships between PCPs and students.
Educate Students to Plan Benefits and Encourage Use. Benefit information could be placed on the HUHS website or a mass mailing of pamphlets and informational material
could be done to increase awareness.
A significant portion of undergraduates expressed that they would prefer to receive the majority of their information about HUHS via e-mail. Consider using e-mail to educate
students about plan benefits.
Consider utilizing both the website and e-mail to inform students of the peer counseling and support groups and peer education programs at HUMS. Offer stress-reduction seminars and circulate pamphlets on the wellness programs and anonymous and confidential HIV counseling and testing. Perhaps have an open-house where students could learn how and why they should take advantage of these services.
Encourage doctors to communicate with patients. Because doctors are an integral component in making students feel satisfied with HUMS, PCPs should focus on listening to their patients, explaining the diagnoses carefully, and offering follow-up instructions.
Page 10 III. RESEARCH RESULTS A. Use of Services The vast majority of students surveyed are taking advantage of the health care services provided by HUHS facilities. Nearly two-thirds of the students (64%) have made two or more visits to a HUHS facility for health care in the last 12 months, and an additional two out of ten (19%) made one visit. Only 17% did not make any visits at all. A full 93% of respondents enjoy "good" or better health, while only 7% rated their health as either "fair" or 'poor." Rather than visiting HUHS for major health concerns, students are most frequently prompted to visit HUHS because of minor health problems such as the flu or a cold (44%), the need for routine care (26%), and emergency injuries or care (19%). At least 70% of students have used the internal medicine facilities. Nearly half of the respondents (46%) have visited the After Hours Urgent Care Clinic in the past year and nearly 20% have visited a specialty service area such as mental health or orthopedics (For a complete list, see Appendix A.) Not surprisingly, students who are frequent visitors to HUHS (5 or more visits per year) are more likely to have a PCP than infrequent visitors (1 or 0 visits per year). Women are more likely to be frequent visitors than men are (29% versus 15%). Page 11 B. Satisfaction of Services Overall While a small majority of students seem generally satisfied with HUHS health care overall, four out of ten students surveyed are dissatisfied, and few are willing to give HUHS a rating of "excellent." When asked how they would rate their satisfaction with HUHS health care overall, the majority of students (58%) gave HUHS a rating of "good" or better. However, only 3% offered a rating of "excellent." Also troubling is that 41% of students are dissatisfied with HUHS health care (27% rated overall care to be "fair," and 14% rating it "poor.") Regardless of how frequently students visit, their level of dissatisfaction with HUHS remains consistent. Individuals who do not have a PCP are less satisfied (53% "poor" or "fair" combined) than those who do have a PCP (35%). While we cannot through statistical analysis determine what drives satisfaction, we can determine which of the variety of factors tested are correlated with satisfaction. It is interesting to note that the factors most strongly correlated with overall satisfaction tend to be care related. Office practices and administrative issues are also significantly correlated, but to a lesser degree. Page 12 Not surprisingly, overall satisfaction is most strongly correlated with "the extent to which your concerns were addressed by the physician or nurse practitioner," "the focus and clarity of the treatment plan provided to you by the physician or nurse practitioner," "your physician or nurse practitioner's explanation of your illness," "how much you were helped by the care you received", and satisfaction with physicians and nurse practitioners." Satisfaction with overall quality of care and services is strongly correlated with the aspects of health care just listed in addition to "attention given to what you had to say by the physician or nurse practitioner", "clarity of follow-up instructions", and "ease of getting a referral to see a specialist". Both overall satisfaction and satisfaction with overall quality of care and services are also significantly correlated with other service issues such as waiting time, courtesy shown by receptionists, and ease of getting claims resolved‹although to a lesser degree than the above factors. Page 13 When asked whether they would recommend HUHS to others in the Harvard community, students further displayed their dissatisfaction. Just over half (53%) said that they would recommend HUMS. However, almost as many said they would not recommend it (47%), and only 6% said they would definitely recommend HUMS. Reasons for Dissatisfaction The reasons students are dissatisfied are varied, but complaints seem to center around delays/waiting (42%), misdiagnoses (36%), poor attitudes of care providers (22%), and poor, incomplete, or rushed care (18%). Students find getting an appointment to be difficult (27%) and they experience long waits to see providers even with scheduled appointments (18%). When asked what HUHS could do to improve the quality of care and services it provides, students suggested better care (37%), which would entail better diagnoses and explanations of treatments (16%), better doctors (10%), and more time spent with patients (5%). Nearly a quarter of respondents said that HUHS needs more staff/doctors to help decrease the waiting time (24%). Approximately two out of ten would like it to be easier to make appointments (21%). Page 14 Two-thirds of those students who gave HUHS ratings of "fair" or "poor" on overall care, did so because of negative care experiences. For example, 70% of students who reported misdiagnoses as a barrier to satisfaction gave HUHS a rating of "fair" or "poor" for overall care. Of those who gave a "fair" or "poor" rating to HUHS for overall care, 61% like the convenience that HUHS has to offer. The open-ended responses elicited comments that reflected experiences of delays, misdiagnoses, and incomplete care. For example: "Brushed me off (Gave me a pat on the head and sent me away) because they couldn't diagnose me. " "I was sent away / made to wait even though it was an emergency. "My diagnosis was incorrect - with serious consequences." Page 15 "HUHS would be wonderful if they would only take the time to treat each patient instead of acting as a medical drive-thru (with huge linesl) and trying to get to the next patient." Student satisfaction may be affected to some degree by HUHS' perceived reputation. A small number (7%) of students volunteered at various places throughout the survey, that they had heard of other students' bad experiences with HUHS. These reports appear to have had a negative impact on the satisfaction of students hearing them. Eleven percent of this group rated their overall satisfaction "very good" or "excellent" compared to 31% of those who did not report hearing of bad experiences. These findings are, however, somewhat anecdotal since students were not directly asked what they believed HUHS' reputation to be or whether that had an impact on their satisfaction: "...Even if the doctor didn't say this, the fact that she arrived [my roommate] back in the room w/this idea is not good and spreads/adds to the "UHS horror story" collection." "...Also, it seems to be almost cool to have a UHS "horror story"." Page 16 Best Features of HUHS When asked what they like best about HUHS, more than half of the students noted the convenience of HUHS. Other aspects of HUHS that students like best are the ease of making appointments (13%) and their specific doctor or clinician (12%). A similar pattern emerges when comparing satisfaction with the After Hours Urgent Care Clinic and HUHS heath care services overall. Over half of the respondents (57%) rated the After Hours Urgent Care "good" or better. However, nearly half of the students (42%) gave the clinic a rating of "fair" or "poor." Less than 10% were willing to rate it "excellent." Page 17 Again, dissatisfaction stems from delays/waiting (49%), misdiagnoses (22%), poor attitudes of providers (18%), and poor, incomplete, or rushed care (18%). Students had the following to say about their After Hours Urgent Care Clinic experiences which illustrate the reasons for their dissatisfaction: "They didn't take my situation seriously / not a big enough emergency." "Staff unprofessional / inattentive." Mental Health Services While students rated the Mental Health Services provided by HUHS generally high, roughly a third (36%) rated it either "fair" or "poor." Furthermore, only 10% deemed Mental Health Services to be "excellent." Reasons for dissatisfaction with Mental Health Services remain consistent with other care services: poor, incomplete, rushed care (33%), delays (27%), and poor attitudes of providers (18%). Misdiagnoses (14%) are less of a problem in Mental Health Services when compared to other services, but are still a barrier to student satisfaction. In response to an open-ended question about what prevents students from being more satisfied, some wrote: "Inattentive counselors & bad advice." "Reception process embarrassing / no privacy." Page 18 Specialty Services People are satisfied with the specialty services offered by HUHS (81%). However, only 14% rated specialty services "excellent," reflecting an overall lack of enthusiasm about HUHS. People are less dissatisfied with specialty services than they are with other services (19% rating specialty services either "poor" or "fair"). Consistent with other health care services, delays (46%), misdiagnoses (27%), poor, rushed, or incomplete care (16%), and poor attitudes of providers (14%) remain primary reasons for dissatisfaction with Specialty Services offered by HUHS. Students explain their reasons for dissatisfaction, using the following words: "Didn't find helpful." "Need more services." "Diagnosis incorrect." "Wouldn't prescribe medication when I needed it. " "Just give medication - no good diagnosis." Page 19 C. Satisfaction with Providers Students are generally satisfied with HUHS health care providers, but are less so with receptionists. Students are particularly satisfied with their physicians, indicated by nearly 80% rating their satisfaction as "good" or better. Roughly 70% of students rated nurse practitioners and health assistants to be at least "good." Even though the majority of students rated their satisfaction with the receptionists (61 %) "good" or better, nearly 40% claim to be dissatisfied, offering a rating of"poor" or "fair." "[My doctor] is wonderful. She is one of the best doctors I have ever had. However, I had a very negative experience with the rest of the staff. I have experienced everything from a doctor obviously not listening to me to extreme rudeness by receptionists." "I felt like I knew more about health than the nurse practitioner did when we met. " "My experience with UHS over the last 12 months has been overwhelmingly positive. However, this is largely because of a change in my primary care physician. " Of the students who gave a rating of "poor" or "fair" to HUHS care overall, 42% reported dissatisfaction with their physicians, 52% were dissatisfied with nurse practitioners and health assistants, and 61% were dissatisfied with the receptionists. Students who have a PCP tend to be more satisfied with their physicians, nurse practitioners, and health assistants than those who do not have a PCP. Students who do not have a PCP (52% rated receptionists "fair" or "poor") are more dissatisfied with the receptionists than are those who do have a PCP (39%). Page 20 D. Personal Experience with Health Care and Administrative Services Health Care Students were asked to evaluate their own recent experiences with HUHS health care. Office practices, and administrative services. Students are pleased with their experiences with doctors and nurse practitioners, but have negative attitudes about the ease of getting referrals to specialists and getting their phone calls about their health answered. Nearly two-thirds of students rated overall quality of care and services to be "good" or better. However, a solid third (34%) rated the quality of care and services to be "fair" or "poor." Only 7% rated the care to be "excellent." Students rated the experiences with their doctors highly. A majority of students offered favorable ratings to the attention given to what they had to say by the physician or nurse practitioner (77%), the extent to which their concems were addressed by the physician or nurse practitioner (72%), the focus and clarity of the treatment plan provided to them by the physician or nurse practitioner (70%), and the clarity of follow-up instructions (69%). Half of students gave unfavorable ratings to the ease of getting their phone calls about health answered (54% saying "poor" or "fair") and getting a referral to see a specialist (50% saying "poor" or "fair"). Furthermore, at least a third of students had only "fair" or "poor" experiences with their physician or nurse practitioner's explanation of their illness (36%), how much they were helped by the care that they received (35%), and the clarity of follow-up instructions (3 1%). Page 21 Nearly four out of ten of students who visited HUHS five or more times in the past year gave low ratings to the overall quality of care and services provided by HUHS. Students who do not have a PCP rated the overall quality of care and services lower than those who have a PCP (48% vs. 30%). Students who have a PCP rate the attentiveness of the physicians or nurse practitioners higher (53% "excellent" and "very good") than those who do not have a PCP (37%) Students who do not have a PCP find it harder to get a referral to see a specialist (67% rating "fair" or "poor") than those who do have a PCP (46%). Page 22 Office Practices Students gave HUHS high ratings for having convenient clinic hours, but reported being unhappy with the appointment delays and waiting time. Three quarters of respondents (76%) feel the convenience of the clinic hours is "good" or better. Nearly seven out of ten students gave high ratings to the ease of making appointments for medical care by phone (69%). Nearly 60% of students rated the length of time spent waiting between making an appointment and the day of their visit as too long (31% rating it "fair" and 27% rating it "poor.") Furthermore, 41% rated the length of time waiting at the provider's office for a scheduled appointment "fair" or "poor." In addition, while the majority of students gave receptionists "good" or better ratings, a third of students (35%) rated the courtesy and respect shown to them by the receptionists to be "fair" or "poor." Administrative Services When asked to consider the HUHS Member Services Department, students rated the services provided negatively. Nearly two thirds of students (63%) rated the availability of the information about their plans and costs of care as "fair" or "poor." Roughly half of the students thought negatively of the ease of getting claims problems resolved (51%) and the ease of getting their questions answered regarding eligibility and services (46%). Page 23 Female students (56% rating "fair" or "poor") find it more difficult to get their questions answered or their problems solved regarding eligibility of services than do male students (33%). Students without a PCP (85%) find it much more difficult to get their claims problems resolved than students with a PCP do (45%). Page 24 E. Patient Preferences Appointment Preferences When the need arises for a student to see a physician or a nurse practitioner on a weekday, students prefer to call ahead to be assured of a definite appointment time (75%). However, when students need to see a medical professional on nights or weekends, they prefer to go to the After Hours Urgent Care Clinic without a definite appointment (75%). A vast majority (84%) of students who have frequently visited HUHS in the past 12 months prefer to call ahead to make an appointment on weekdays. Conversely, 80% of frequent visitors would choose to go to After Hours Urgent Care without an appointment on nights or weekends. Primary Care Physician Selection Forty percent of students continue with a PCP or nurse practitioner that is assigned to them on their first HUHS visit (40%). An additional 39% are more pro-active in their doctor selection by making a selection via the HUHS web site (12%), from the Clinician Directory at the beginning of the academic year (10%), from the 'Select your primary care clinician' event (9%), or from making a choice at the time they enroll at Harvard University (8%). Others prefer to set-up an appointment to meet with a physician or nurse practitioner (21%). Page 25 Sources for Health Information Less than a quarter of respondents turn to HUHS for the majority of their health-related information (16% through HUHS medical personnel and 2% from the Center for Wellness and Health Communications). Three quarters of respondents get the majority of their health-related information from their family. An additional 42% get information of this nature from their friends, while still another 29% receive information from their physician or nurse practitioner at home. Communication with Health Care Provider and HUHS While students are comfortable with e-mail, they do not want to rely on it for communicating with their doctor or nurse practitioner. In non-emergency situations, 56% of students prefer to communicate with their physician or nurse practitioner through face to face visits. A third of students opt for the telephone (32%), while only 12% would prefer to utilize e-mail. Interestingly, while they would not use e-mail to communicate with their health provider, 39% of students would like to receive information about HUHS and health-related activities via e-mail. Two out of ten would prefer to have information sent to their house or dorm. Fifteen percent would like to get this information by visiting the HUHS web site. Page 26 F. Awareness of Services While many students are aware of the existence of HUHS sponsored services, few students have used them. For example, 95% of students are aware of Room 13, 92% of students are aware of Eating Concerns Hotline and Outreach (ECHO), and 89% are aware of Peer Contraceptive Counseling (PCC). However, only 2%, 3%, and 3% have used these services, respectively. Among the services, students are least aware of The Health Resource Center at HUHS (25% aware), The Mind Body Medical Institute at HUHS (15%), and the Patient Advocate (15%). Overall, regardless of the level of awareness, no more than 5% of students have used any of these 16 tested services in the past year. Students are aware that their medical records are confidential (79%) and their primary care services include preventive care (64%). However, students are unaware that mental health visits are not part of their regular medical record (84%), that a 24-hour advice nurse is available for health information (82%), and that same day appointments with mental health personnel are available when needed (74%). A majority of students strongly agree that they know how to access health care from HUHS if they are not feeling well (75%), know what to do if they have an acute illness or injury (72%), and know how to access reliable health care information (51%). Forty-four percent of students disagree with the statement "I understand my benefits under the Student Health Plan." Undergraduates who have a PCP are more knowledgeable on how to access reliable health care information than students without a PCP (60% vs. 44%).
III. RESEARCH RESULTS
A. Use of Services
The vast majority of students surveyed are taking advantage of the health care services provided by HUHS facilities. Nearly two-thirds of the students (64%) have made two or more
visits to a HUHS facility for health care in the last 12 months, and an additional two out of ten (19%) made one visit. Only 17% did not make any visits at all.
A full 93% of respondents enjoy "good" or better health, while only 7% rated their health as either "fair" or 'poor." Rather than visiting HUHS for major health concerns, students are most frequently prompted to visit HUHS because of minor health problems such as the flu or a cold
(44%), the need for routine care (26%), and emergency injuries or care (19%).
At least 70% of students have used the internal medicine facilities. Nearly half of the respondents (46%) have visited the After Hours Urgent Care Clinic in the past year and nearly
20% have visited a specialty service area such as mental health or orthopedics (For a complete list, see Appendix A.)
Not surprisingly, students who are frequent visitors to HUHS (5 or more visits per year) are more likely to have a PCP than infrequent visitors (1 or 0 visits per year).
Women are more likely to be frequent visitors than men are (29% versus 15%).
Page 11 B. Satisfaction of Services Overall While a small majority of students seem generally satisfied with HUHS health care overall, four out of ten students surveyed are dissatisfied, and few are willing to give HUHS a rating of "excellent." When asked how they would rate their satisfaction with HUHS health care overall, the majority of students (58%) gave HUHS a rating of "good" or better. However, only 3% offered a rating of "excellent." Also troubling is that 41% of students are dissatisfied with HUHS health care (27% rated overall care to be "fair," and 14% rating it "poor.") Regardless of how frequently students visit, their level of dissatisfaction with HUHS remains consistent. Individuals who do not have a PCP are less satisfied (53% "poor" or "fair" combined) than those who do have a PCP (35%). While we cannot through statistical analysis determine what drives satisfaction, we can determine which of the variety of factors tested are correlated with satisfaction. It is interesting to note that the factors most strongly correlated with overall satisfaction tend to be care related. Office practices and administrative issues are also significantly correlated, but to a lesser degree. Page 12 Not surprisingly, overall satisfaction is most strongly correlated with "the extent to which your concerns were addressed by the physician or nurse practitioner," "the focus and clarity of the treatment plan provided to you by the physician or nurse practitioner," "your physician or nurse practitioner's explanation of your illness," "how much you were helped by the care you received", and satisfaction with physicians and nurse practitioners." Satisfaction with overall quality of care and services is strongly correlated with the aspects of health care just listed in addition to "attention given to what you had to say by the physician or nurse practitioner", "clarity of follow-up instructions", and "ease of getting a referral to see a specialist". Both overall satisfaction and satisfaction with overall quality of care and services are also significantly correlated with other service issues such as waiting time, courtesy shown by receptionists, and ease of getting claims resolved‹although to a lesser degree than the above factors. Page 13 When asked whether they would recommend HUHS to others in the Harvard community, students further displayed their dissatisfaction. Just over half (53%) said that they would recommend HUMS. However, almost as many said they would not recommend it (47%), and only 6% said they would definitely recommend HUMS. Reasons for Dissatisfaction The reasons students are dissatisfied are varied, but complaints seem to center around delays/waiting (42%), misdiagnoses (36%), poor attitudes of care providers (22%), and poor, incomplete, or rushed care (18%). Students find getting an appointment to be difficult (27%) and they experience long waits to see providers even with scheduled appointments (18%). When asked what HUHS could do to improve the quality of care and services it provides, students suggested better care (37%), which would entail better diagnoses and explanations of treatments (16%), better doctors (10%), and more time spent with patients (5%). Nearly a quarter of respondents said that HUHS needs more staff/doctors to help decrease the waiting time (24%). Approximately two out of ten would like it to be easier to make appointments (21%). Page 14 Two-thirds of those students who gave HUHS ratings of "fair" or "poor" on overall care, did so because of negative care experiences. For example, 70% of students who reported misdiagnoses as a barrier to satisfaction gave HUHS a rating of "fair" or "poor" for overall care. Of those who gave a "fair" or "poor" rating to HUHS for overall care, 61% like the convenience that HUHS has to offer. The open-ended responses elicited comments that reflected experiences of delays, misdiagnoses, and incomplete care. For example: "Brushed me off (Gave me a pat on the head and sent me away) because they couldn't diagnose me. " "I was sent away / made to wait even though it was an emergency. "My diagnosis was incorrect - with serious consequences." Page 15 "HUHS would be wonderful if they would only take the time to treat each patient instead of acting as a medical drive-thru (with huge linesl) and trying to get to the next patient." Student satisfaction may be affected to some degree by HUHS' perceived reputation. A small number (7%) of students volunteered at various places throughout the survey, that they had heard of other students' bad experiences with HUHS. These reports appear to have had a negative impact on the satisfaction of students hearing them. Eleven percent of this group rated their overall satisfaction "very good" or "excellent" compared to 31% of those who did not report hearing of bad experiences. These findings are, however, somewhat anecdotal since students were not directly asked what they believed HUHS' reputation to be or whether that had an impact on their satisfaction: "...Even if the doctor didn't say this, the fact that she arrived [my roommate] back in the room w/this idea is not good and spreads/adds to the "UHS horror story" collection." "...Also, it seems to be almost cool to have a UHS "horror story"." Page 16 Best Features of HUHS When asked what they like best about HUHS, more than half of the students noted the convenience of HUHS. Other aspects of HUHS that students like best are the ease of making appointments (13%) and their specific doctor or clinician (12%). A similar pattern emerges when comparing satisfaction with the After Hours Urgent Care Clinic and HUHS heath care services overall. Over half of the respondents (57%) rated the After Hours Urgent Care "good" or better. However, nearly half of the students (42%) gave the clinic a rating of "fair" or "poor." Less than 10% were willing to rate it "excellent." Page 17 Again, dissatisfaction stems from delays/waiting (49%), misdiagnoses (22%), poor attitudes of providers (18%), and poor, incomplete, or rushed care (18%). Students had the following to say about their After Hours Urgent Care Clinic experiences which illustrate the reasons for their dissatisfaction: "They didn't take my situation seriously / not a big enough emergency." "Staff unprofessional / inattentive." Mental Health Services While students rated the Mental Health Services provided by HUHS generally high, roughly a third (36%) rated it either "fair" or "poor." Furthermore, only 10% deemed Mental Health Services to be "excellent." Reasons for dissatisfaction with Mental Health Services remain consistent with other care services: poor, incomplete, rushed care (33%), delays (27%), and poor attitudes of providers (18%). Misdiagnoses (14%) are less of a problem in Mental Health Services when compared to other services, but are still a barrier to student satisfaction. In response to an open-ended question about what prevents students from being more satisfied, some wrote: "Inattentive counselors & bad advice." "Reception process embarrassing / no privacy." Page 18 Specialty Services People are satisfied with the specialty services offered by HUHS (81%). However, only 14% rated specialty services "excellent," reflecting an overall lack of enthusiasm about HUHS. People are less dissatisfied with specialty services than they are with other services (19% rating specialty services either "poor" or "fair"). Consistent with other health care services, delays (46%), misdiagnoses (27%), poor, rushed, or incomplete care (16%), and poor attitudes of providers (14%) remain primary reasons for dissatisfaction with Specialty Services offered by HUHS. Students explain their reasons for dissatisfaction, using the following words: "Didn't find helpful." "Need more services." "Diagnosis incorrect." "Wouldn't prescribe medication when I needed it. " "Just give medication - no good diagnosis." Page 19 C. Satisfaction with Providers Students are generally satisfied with HUHS health care providers, but are less so with receptionists. Students are particularly satisfied with their physicians, indicated by nearly 80% rating their satisfaction as "good" or better. Roughly 70% of students rated nurse practitioners and health assistants to be at least "good." Even though the majority of students rated their satisfaction with the receptionists (61 %) "good" or better, nearly 40% claim to be dissatisfied, offering a rating of"poor" or "fair." "[My doctor] is wonderful. She is one of the best doctors I have ever had. However, I had a very negative experience with the rest of the staff. I have experienced everything from a doctor obviously not listening to me to extreme rudeness by receptionists." "I felt like I knew more about health than the nurse practitioner did when we met. " "My experience with UHS over the last 12 months has been overwhelmingly positive. However, this is largely because of a change in my primary care physician. " Of the students who gave a rating of "poor" or "fair" to HUHS care overall, 42% reported dissatisfaction with their physicians, 52% were dissatisfied with nurse practitioners and health assistants, and 61% were dissatisfied with the receptionists. Students who have a PCP tend to be more satisfied with their physicians, nurse practitioners, and health assistants than those who do not have a PCP. Students who do not have a PCP (52% rated receptionists "fair" or "poor") are more dissatisfied with the receptionists than are those who do have a PCP (39%). Page 20 D. Personal Experience with Health Care and Administrative Services Health Care Students were asked to evaluate their own recent experiences with HUHS health care. Office practices, and administrative services. Students are pleased with their experiences with doctors and nurse practitioners, but have negative attitudes about the ease of getting referrals to specialists and getting their phone calls about their health answered. Nearly two-thirds of students rated overall quality of care and services to be "good" or better. However, a solid third (34%) rated the quality of care and services to be "fair" or "poor." Only 7% rated the care to be "excellent." Students rated the experiences with their doctors highly. A majority of students offered favorable ratings to the attention given to what they had to say by the physician or nurse practitioner (77%), the extent to which their concems were addressed by the physician or nurse practitioner (72%), the focus and clarity of the treatment plan provided to them by the physician or nurse practitioner (70%), and the clarity of follow-up instructions (69%). Half of students gave unfavorable ratings to the ease of getting their phone calls about health answered (54% saying "poor" or "fair") and getting a referral to see a specialist (50% saying "poor" or "fair"). Furthermore, at least a third of students had only "fair" or "poor" experiences with their physician or nurse practitioner's explanation of their illness (36%), how much they were helped by the care that they received (35%), and the clarity of follow-up instructions (3 1%). Page 21 Nearly four out of ten of students who visited HUHS five or more times in the past year gave low ratings to the overall quality of care and services provided by HUHS. Students who do not have a PCP rated the overall quality of care and services lower than those who have a PCP (48% vs. 30%). Students who have a PCP rate the attentiveness of the physicians or nurse practitioners higher (53% "excellent" and "very good") than those who do not have a PCP (37%) Students who do not have a PCP find it harder to get a referral to see a specialist (67% rating "fair" or "poor") than those who do have a PCP (46%). Page 22 Office Practices Students gave HUHS high ratings for having convenient clinic hours, but reported being unhappy with the appointment delays and waiting time. Three quarters of respondents (76%) feel the convenience of the clinic hours is "good" or better. Nearly seven out of ten students gave high ratings to the ease of making appointments for medical care by phone (69%). Nearly 60% of students rated the length of time spent waiting between making an appointment and the day of their visit as too long (31% rating it "fair" and 27% rating it "poor.") Furthermore, 41% rated the length of time waiting at the provider's office for a scheduled appointment "fair" or "poor." In addition, while the majority of students gave receptionists "good" or better ratings, a third of students (35%) rated the courtesy and respect shown to them by the receptionists to be "fair" or "poor." Administrative Services When asked to consider the HUHS Member Services Department, students rated the services provided negatively. Nearly two thirds of students (63%) rated the availability of the information about their plans and costs of care as "fair" or "poor." Roughly half of the students thought negatively of the ease of getting claims problems resolved (51%) and the ease of getting their questions answered regarding eligibility and services (46%). Page 23 Female students (56% rating "fair" or "poor") find it more difficult to get their questions answered or their problems solved regarding eligibility of services than do male students (33%). Students without a PCP (85%) find it much more difficult to get their claims problems resolved than students with a PCP do (45%). Page 24 E. Patient Preferences Appointment Preferences When the need arises for a student to see a physician or a nurse practitioner on a weekday, students prefer to call ahead to be assured of a definite appointment time (75%). However, when students need to see a medical professional on nights or weekends, they prefer to go to the After Hours Urgent Care Clinic without a definite appointment (75%). A vast majority (84%) of students who have frequently visited HUHS in the past 12 months prefer to call ahead to make an appointment on weekdays. Conversely, 80% of frequent visitors would choose to go to After Hours Urgent Care without an appointment on nights or weekends. Primary Care Physician Selection Forty percent of students continue with a PCP or nurse practitioner that is assigned to them on their first HUHS visit (40%). An additional 39% are more pro-active in their doctor selection by making a selection via the HUHS web site (12%), from the Clinician Directory at the beginning of the academic year (10%), from the 'Select your primary care clinician' event (9%), or from making a choice at the time they enroll at Harvard University (8%). Others prefer to set-up an appointment to meet with a physician or nurse practitioner (21%). Page 25 Sources for Health Information Less than a quarter of respondents turn to HUHS for the majority of their health-related information (16% through HUHS medical personnel and 2% from the Center for Wellness and Health Communications). Three quarters of respondents get the majority of their health-related information from their family. An additional 42% get information of this nature from their friends, while still another 29% receive information from their physician or nurse practitioner at home. Communication with Health Care Provider and HUHS While students are comfortable with e-mail, they do not want to rely on it for communicating with their doctor or nurse practitioner. In non-emergency situations, 56% of students prefer to communicate with their physician or nurse practitioner through face to face visits. A third of students opt for the telephone (32%), while only 12% would prefer to utilize e-mail. Interestingly, while they would not use e-mail to communicate with their health provider, 39% of students would like to receive information about HUHS and health-related activities via e-mail. Two out of ten would prefer to have information sent to their house or dorm. Fifteen percent would like to get this information by visiting the HUHS web site. Page 26 F. Awareness of Services While many students are aware of the existence of HUHS sponsored services, few students have used them. For example, 95% of students are aware of Room 13, 92% of students are aware of Eating Concerns Hotline and Outreach (ECHO), and 89% are aware of Peer Contraceptive Counseling (PCC). However, only 2%, 3%, and 3% have used these services, respectively. Among the services, students are least aware of The Health Resource Center at HUHS (25% aware), The Mind Body Medical Institute at HUHS (15%), and the Patient Advocate (15%). Overall, regardless of the level of awareness, no more than 5% of students have used any of these 16 tested services in the past year. Students are aware that their medical records are confidential (79%) and their primary care services include preventive care (64%). However, students are unaware that mental health visits are not part of their regular medical record (84%), that a 24-hour advice nurse is available for health information (82%), and that same day appointments with mental health personnel are available when needed (74%). A majority of students strongly agree that they know how to access health care from HUHS if they are not feeling well (75%), know what to do if they have an acute illness or injury (72%), and know how to access reliable health care information (51%). Forty-four percent of students disagree with the statement "I understand my benefits under the Student Health Plan." Undergraduates who have a PCP are more knowledgeable on how to access reliable health care information than students without a PCP (60% vs. 44%).
B. Satisfaction of Services
Overall
While a small majority of students seem generally satisfied with HUHS health care overall, four out of ten students surveyed are dissatisfied, and few are willing to give HUHS a
rating of "excellent." When asked how they would rate their satisfaction with HUHS health care overall, the majority of students (58%) gave HUHS a rating of "good" or better. However, only 3% offered a rating of "excellent." Also troubling is that 41% of students are dissatisfied with HUHS health care (27% rated overall care to be "fair," and 14% rating it "poor.")
Regardless of how frequently students visit, their level of dissatisfaction with HUHS remains consistent.
Individuals who do not have a PCP are less satisfied (53% "poor" or "fair" combined) than those who do have a PCP (35%).
While we cannot through statistical analysis determine what drives satisfaction, we can determine which of the variety of factors tested are correlated with satisfaction. It is interesting to note that the factors most strongly correlated with overall satisfaction tend to be care related.
Office practices and administrative issues are also significantly correlated, but to a lesser degree.
Page 12
Not surprisingly, overall satisfaction is most strongly correlated with "the extent to which your concerns were addressed by the physician or nurse practitioner," "the focus and clarity of the treatment plan provided to you by the physician or nurse practitioner," "your physician or nurse practitioner's explanation of your illness," "how much you were helped by the care you received", and satisfaction with physicians and nurse practitioners."
Satisfaction with overall quality of care and services is strongly correlated with the aspects of health care just listed in addition to "attention given to what you had to say by the physician or nurse practitioner", "clarity of follow-up instructions", and "ease of getting a referral to see a specialist".
Both overall satisfaction and satisfaction with overall quality of care and services are also significantly correlated with other service issues such as waiting time, courtesy shown by receptionists, and ease of getting claims resolved‹although to a lesser degree than the above factors.
Page 13
When asked whether they would recommend HUHS to others in the Harvard community, students further displayed their dissatisfaction. Just over half (53%) said that they would recommend HUMS. However, almost as many said they would not recommend it (47%), and only 6% said they would definitely recommend HUMS.
Reasons for Dissatisfaction
The reasons students are dissatisfied are varied, but complaints seem to center around delays/waiting (42%), misdiagnoses (36%), poor attitudes of care providers (22%), and poor, incomplete, or rushed care (18%). Students find getting an appointment to be difficult (27%) and they experience long waits to see providers even with scheduled appointments (18%). When asked what HUHS could do to improve the quality of care and services it provides, students suggested better care (37%), which would entail better diagnoses and explanations of treatments (16%), better doctors (10%), and more time spent with patients (5%). Nearly a quarter of
respondents said that HUHS needs more staff/doctors to help decrease the waiting time (24%). Approximately two out of ten would like it to be easier to make appointments (21%).
Page 14
Two-thirds of those students who gave HUHS ratings of "fair" or "poor" on overall care, did so because of negative care experiences. For example, 70% of students who reported misdiagnoses as a barrier to satisfaction gave HUHS a rating of "fair" or "poor" for overall care.
Of those who gave a "fair" or "poor" rating to HUHS for overall care, 61% like the convenience that HUHS has to offer.
The open-ended responses elicited comments that reflected experiences of delays, misdiagnoses, and incomplete care. For example:
"Brushed me off (Gave me a pat on the head and sent me away) because they couldn't diagnose me. "
"I was sent away / made to wait even though it was an emergency.
"My diagnosis was incorrect - with serious consequences."
Page 15
"HUHS would be wonderful if they would only take the time to treat each patient instead of acting as a medical drive-thru (with huge linesl) and trying to get to the next patient."
Student satisfaction may be affected to some degree by HUHS' perceived reputation. A small number (7%) of students volunteered at various places throughout the survey, that they had heard of other students' bad experiences with HUHS. These reports appear to have had a negative impact on the satisfaction of students hearing them. Eleven percent of this group rated their overall satisfaction "very good" or "excellent" compared to 31% of those who did not report hearing of bad experiences. These findings are, however, somewhat anecdotal since students were not directly asked what they believed HUHS' reputation to be or whether that had an impact on their satisfaction:
"...Even if the doctor didn't say this, the fact that she arrived [my roommate] back in the room w/this idea is not good and spreads/adds to the "UHS horror story" collection."
"...Also, it seems to be almost cool to have a UHS "horror story"."
Page 16
Best Features of HUHS
When asked what they like best about HUHS, more than half of the students noted the convenience of HUHS. Other aspects of HUHS that students like best are the ease of making appointments (13%) and their specific doctor or clinician (12%).
A similar pattern emerges when comparing satisfaction with the After Hours Urgent Care Clinic and HUHS heath care services overall. Over half of the respondents (57%) rated the After Hours Urgent Care "good" or better. However, nearly half of the students (42%) gave the clinic a rating of "fair" or "poor." Less than 10% were willing to rate it "excellent."
Page 17
Again, dissatisfaction stems from delays/waiting (49%), misdiagnoses (22%), poor attitudes of providers (18%), and poor, incomplete, or rushed care (18%). Students had the following to say about their After Hours Urgent Care Clinic experiences which illustrate the reasons for their dissatisfaction:
"They didn't take my situation seriously / not a big enough emergency."
"Staff unprofessional / inattentive."
Mental Health Services
While students rated the Mental Health Services provided by HUHS generally high, roughly a third (36%) rated it either "fair" or "poor." Furthermore, only 10% deemed Mental Health Services to be "excellent." Reasons for dissatisfaction with Mental Health Services remain consistent with other care services: poor, incomplete, rushed care (33%), delays (27%), and poor attitudes of providers (18%). Misdiagnoses (14%) are less of a problem in Mental Health Services when compared to other services, but are still a barrier to student satisfaction.
In response to an open-ended question about what prevents students from being more satisfied, some wrote:
"Inattentive counselors & bad advice."
"Reception process embarrassing / no privacy."
Page 18
Specialty Services
People are satisfied with the specialty services offered by HUHS (81%). However, only 14% rated specialty services "excellent," reflecting an overall lack of enthusiasm about HUHS. People are less dissatisfied with specialty services than they are with other services (19% rating specialty services either "poor" or "fair").
Consistent with other health care services, delays (46%), misdiagnoses (27%), poor, rushed, or incomplete care (16%), and poor attitudes of providers (14%) remain primary reasons for dissatisfaction with Specialty Services offered by HUHS.
Students explain their reasons for dissatisfaction, using the following words:
"Didn't find helpful."
"Need more services."
"Diagnosis incorrect."
"Wouldn't prescribe medication when I needed it. "
"Just give medication - no good diagnosis."
Page 19 C. Satisfaction with Providers Students are generally satisfied with HUHS health care providers, but are less so with receptionists. Students are particularly satisfied with their physicians, indicated by nearly 80% rating their satisfaction as "good" or better. Roughly 70% of students rated nurse practitioners and health assistants to be at least "good." Even though the majority of students rated their satisfaction with the receptionists (61 %) "good" or better, nearly 40% claim to be dissatisfied, offering a rating of"poor" or "fair." "[My doctor] is wonderful. She is one of the best doctors I have ever had. However, I had a very negative experience with the rest of the staff. I have experienced everything from a doctor obviously not listening to me to extreme rudeness by receptionists." "I felt like I knew more about health than the nurse practitioner did when we met. " "My experience with UHS over the last 12 months has been overwhelmingly positive. However, this is largely because of a change in my primary care physician. " Of the students who gave a rating of "poor" or "fair" to HUHS care overall, 42% reported dissatisfaction with their physicians, 52% were dissatisfied with nurse practitioners and health assistants, and 61% were dissatisfied with the receptionists. Students who have a PCP tend to be more satisfied with their physicians, nurse practitioners, and health assistants than those who do not have a PCP. Students who do not have a PCP (52% rated receptionists "fair" or "poor") are more dissatisfied with the receptionists than are those who do have a PCP (39%). Page 20 D. Personal Experience with Health Care and Administrative Services Health Care Students were asked to evaluate their own recent experiences with HUHS health care. Office practices, and administrative services. Students are pleased with their experiences with doctors and nurse practitioners, but have negative attitudes about the ease of getting referrals to specialists and getting their phone calls about their health answered. Nearly two-thirds of students rated overall quality of care and services to be "good" or better. However, a solid third (34%) rated the quality of care and services to be "fair" or "poor." Only 7% rated the care to be "excellent." Students rated the experiences with their doctors highly. A majority of students offered favorable ratings to the attention given to what they had to say by the physician or nurse practitioner (77%), the extent to which their concems were addressed by the physician or nurse practitioner (72%), the focus and clarity of the treatment plan provided to them by the physician or nurse practitioner (70%), and the clarity of follow-up instructions (69%). Half of students gave unfavorable ratings to the ease of getting their phone calls about health answered (54% saying "poor" or "fair") and getting a referral to see a specialist (50% saying "poor" or "fair"). Furthermore, at least a third of students had only "fair" or "poor" experiences with their physician or nurse practitioner's explanation of their illness (36%), how much they were helped by the care that they received (35%), and the clarity of follow-up instructions (3 1%). Page 21 Nearly four out of ten of students who visited HUHS five or more times in the past year gave low ratings to the overall quality of care and services provided by HUHS. Students who do not have a PCP rated the overall quality of care and services lower than those who have a PCP (48% vs. 30%). Students who have a PCP rate the attentiveness of the physicians or nurse practitioners higher (53% "excellent" and "very good") than those who do not have a PCP (37%) Students who do not have a PCP find it harder to get a referral to see a specialist (67% rating "fair" or "poor") than those who do have a PCP (46%). Page 22 Office Practices Students gave HUHS high ratings for having convenient clinic hours, but reported being unhappy with the appointment delays and waiting time. Three quarters of respondents (76%) feel the convenience of the clinic hours is "good" or better. Nearly seven out of ten students gave high ratings to the ease of making appointments for medical care by phone (69%). Nearly 60% of students rated the length of time spent waiting between making an appointment and the day of their visit as too long (31% rating it "fair" and 27% rating it "poor.") Furthermore, 41% rated the length of time waiting at the provider's office for a scheduled appointment "fair" or "poor." In addition, while the majority of students gave receptionists "good" or better ratings, a third of students (35%) rated the courtesy and respect shown to them by the receptionists to be "fair" or "poor." Administrative Services When asked to consider the HUHS Member Services Department, students rated the services provided negatively. Nearly two thirds of students (63%) rated the availability of the information about their plans and costs of care as "fair" or "poor." Roughly half of the students thought negatively of the ease of getting claims problems resolved (51%) and the ease of getting their questions answered regarding eligibility and services (46%). Page 23 Female students (56% rating "fair" or "poor") find it more difficult to get their questions answered or their problems solved regarding eligibility of services than do male students (33%). Students without a PCP (85%) find it much more difficult to get their claims problems resolved than students with a PCP do (45%). Page 24 E. Patient Preferences Appointment Preferences When the need arises for a student to see a physician or a nurse practitioner on a weekday, students prefer to call ahead to be assured of a definite appointment time (75%). However, when students need to see a medical professional on nights or weekends, they prefer to go to the After Hours Urgent Care Clinic without a definite appointment (75%). A vast majority (84%) of students who have frequently visited HUHS in the past 12 months prefer to call ahead to make an appointment on weekdays. Conversely, 80% of frequent visitors would choose to go to After Hours Urgent Care without an appointment on nights or weekends. Primary Care Physician Selection Forty percent of students continue with a PCP or nurse practitioner that is assigned to them on their first HUHS visit (40%). An additional 39% are more pro-active in their doctor selection by making a selection via the HUHS web site (12%), from the Clinician Directory at the beginning of the academic year (10%), from the 'Select your primary care clinician' event (9%), or from making a choice at the time they enroll at Harvard University (8%). Others prefer to set-up an appointment to meet with a physician or nurse practitioner (21%). Page 25 Sources for Health Information Less than a quarter of respondents turn to HUHS for the majority of their health-related information (16% through HUHS medical personnel and 2% from the Center for Wellness and Health Communications). Three quarters of respondents get the majority of their health-related information from their family. An additional 42% get information of this nature from their friends, while still another 29% receive information from their physician or nurse practitioner at home. Communication with Health Care Provider and HUHS While students are comfortable with e-mail, they do not want to rely on it for communicating with their doctor or nurse practitioner. In non-emergency situations, 56% of students prefer to communicate with their physician or nurse practitioner through face to face visits. A third of students opt for the telephone (32%), while only 12% would prefer to utilize e-mail. Interestingly, while they would not use e-mail to communicate with their health provider, 39% of students would like to receive information about HUHS and health-related activities via e-mail. Two out of ten would prefer to have information sent to their house or dorm. Fifteen percent would like to get this information by visiting the HUHS web site. Page 26 F. Awareness of Services While many students are aware of the existence of HUHS sponsored services, few students have used them. For example, 95% of students are aware of Room 13, 92% of students are aware of Eating Concerns Hotline and Outreach (ECHO), and 89% are aware of Peer Contraceptive Counseling (PCC). However, only 2%, 3%, and 3% have used these services, respectively. Among the services, students are least aware of The Health Resource Center at HUHS (25% aware), The Mind Body Medical Institute at HUHS (15%), and the Patient Advocate (15%). Overall, regardless of the level of awareness, no more than 5% of students have used any of these 16 tested services in the past year. Students are aware that their medical records are confidential (79%) and their primary care services include preventive care (64%). However, students are unaware that mental health visits are not part of their regular medical record (84%), that a 24-hour advice nurse is available for health information (82%), and that same day appointments with mental health personnel are available when needed (74%). A majority of students strongly agree that they know how to access health care from HUHS if they are not feeling well (75%), know what to do if they have an acute illness or injury (72%), and know how to access reliable health care information (51%). Forty-four percent of students disagree with the statement "I understand my benefits under the Student Health Plan." Undergraduates who have a PCP are more knowledgeable on how to access reliable health care information than students without a PCP (60% vs. 44%).
C. Satisfaction with Providers
Students are generally satisfied with HUHS health care providers, but are less so with receptionists. Students are particularly satisfied with their physicians, indicated by nearly 80% rating their satisfaction as "good" or better. Roughly 70% of students rated nurse practitioners and health assistants to be at least "good." Even though the majority of students rated their satisfaction with the receptionists (61 %) "good" or better, nearly 40% claim to be dissatisfied, offering a rating of"poor" or "fair."
"[My doctor] is wonderful. She is one of the best doctors I have ever had. However, I had a very negative experience with the rest of the staff. I have experienced everything from a doctor obviously not listening to me to extreme rudeness by receptionists."
"I felt like I knew more about health than the nurse practitioner did when we met. "
"My experience with UHS over the last 12 months has been overwhelmingly positive. However, this is largely because of a change in my primary care physician. "
Of the students who gave a rating of "poor" or "fair" to HUHS care overall, 42% reported dissatisfaction with their physicians, 52% were dissatisfied with nurse practitioners and health assistants, and 61% were dissatisfied with the receptionists.
Students who have a PCP tend to be more satisfied with their physicians, nurse practitioners, and health assistants than those who do not have a PCP.
Students who do not have a PCP (52% rated receptionists "fair" or "poor") are more dissatisfied with the receptionists than are those who do have a PCP (39%).
Page 20 D. Personal Experience with Health Care and Administrative Services Health Care Students were asked to evaluate their own recent experiences with HUHS health care. Office practices, and administrative services. Students are pleased with their experiences with doctors and nurse practitioners, but have negative attitudes about the ease of getting referrals to specialists and getting their phone calls about their health answered. Nearly two-thirds of students rated overall quality of care and services to be "good" or better. However, a solid third (34%) rated the quality of care and services to be "fair" or "poor." Only 7% rated the care to be "excellent." Students rated the experiences with their doctors highly. A majority of students offered favorable ratings to the attention given to what they had to say by the physician or nurse practitioner (77%), the extent to which their concems were addressed by the physician or nurse practitioner (72%), the focus and clarity of the treatment plan provided to them by the physician or nurse practitioner (70%), and the clarity of follow-up instructions (69%). Half of students gave unfavorable ratings to the ease of getting their phone calls about health answered (54% saying "poor" or "fair") and getting a referral to see a specialist (50% saying "poor" or "fair"). Furthermore, at least a third of students had only "fair" or "poor" experiences with their physician or nurse practitioner's explanation of their illness (36%), how much they were helped by the care that they received (35%), and the clarity of follow-up instructions (3 1%). Page 21 Nearly four out of ten of students who visited HUHS five or more times in the past year gave low ratings to the overall quality of care and services provided by HUHS. Students who do not have a PCP rated the overall quality of care and services lower than those who have a PCP (48% vs. 30%). Students who have a PCP rate the attentiveness of the physicians or nurse practitioners higher (53% "excellent" and "very good") than those who do not have a PCP (37%) Students who do not have a PCP find it harder to get a referral to see a specialist (67% rating "fair" or "poor") than those who do have a PCP (46%). Page 22 Office Practices Students gave HUHS high ratings for having convenient clinic hours, but reported being unhappy with the appointment delays and waiting time. Three quarters of respondents (76%) feel the convenience of the clinic hours is "good" or better. Nearly seven out of ten students gave high ratings to the ease of making appointments for medical care by phone (69%). Nearly 60% of students rated the length of time spent waiting between making an appointment and the day of their visit as too long (31% rating it "fair" and 27% rating it "poor.") Furthermore, 41% rated the length of time waiting at the provider's office for a scheduled appointment "fair" or "poor." In addition, while the majority of students gave receptionists "good" or better ratings, a third of students (35%) rated the courtesy and respect shown to them by the receptionists to be "fair" or "poor." Administrative Services When asked to consider the HUHS Member Services Department, students rated the services provided negatively. Nearly two thirds of students (63%) rated the availability of the information about their plans and costs of care as "fair" or "poor." Roughly half of the students thought negatively of the ease of getting claims problems resolved (51%) and the ease of getting their questions answered regarding eligibility and services (46%). Page 23 Female students (56% rating "fair" or "poor") find it more difficult to get their questions answered or their problems solved regarding eligibility of services than do male students (33%). Students without a PCP (85%) find it much more difficult to get their claims problems resolved than students with a PCP do (45%). Page 24 E. Patient Preferences Appointment Preferences When the need arises for a student to see a physician or a nurse practitioner on a weekday, students prefer to call ahead to be assured of a definite appointment time (75%). However, when students need to see a medical professional on nights or weekends, they prefer to go to the After Hours Urgent Care Clinic without a definite appointment (75%). A vast majority (84%) of students who have frequently visited HUHS in the past 12 months prefer to call ahead to make an appointment on weekdays. Conversely, 80% of frequent visitors would choose to go to After Hours Urgent Care without an appointment on nights or weekends. Primary Care Physician Selection Forty percent of students continue with a PCP or nurse practitioner that is assigned to them on their first HUHS visit (40%). An additional 39% are more pro-active in their doctor selection by making a selection via the HUHS web site (12%), from the Clinician Directory at the beginning of the academic year (10%), from the 'Select your primary care clinician' event (9%), or from making a choice at the time they enroll at Harvard University (8%). Others prefer to set-up an appointment to meet with a physician or nurse practitioner (21%). Page 25 Sources for Health Information Less than a quarter of respondents turn to HUHS for the majority of their health-related information (16% through HUHS medical personnel and 2% from the Center for Wellness and Health Communications). Three quarters of respondents get the majority of their health-related information from their family. An additional 42% get information of this nature from their friends, while still another 29% receive information from their physician or nurse practitioner at home. Communication with Health Care Provider and HUHS While students are comfortable with e-mail, they do not want to rely on it for communicating with their doctor or nurse practitioner. In non-emergency situations, 56% of students prefer to communicate with their physician or nurse practitioner through face to face visits. A third of students opt for the telephone (32%), while only 12% would prefer to utilize e-mail. Interestingly, while they would not use e-mail to communicate with their health provider, 39% of students would like to receive information about HUHS and health-related activities via e-mail. Two out of ten would prefer to have information sent to their house or dorm. Fifteen percent would like to get this information by visiting the HUHS web site. Page 26 F. Awareness of Services While many students are aware of the existence of HUHS sponsored services, few students have used them. For example, 95% of students are aware of Room 13, 92% of students are aware of Eating Concerns Hotline and Outreach (ECHO), and 89% are aware of Peer Contraceptive Counseling (PCC). However, only 2%, 3%, and 3% have used these services, respectively. Among the services, students are least aware of The Health Resource Center at HUHS (25% aware), The Mind Body Medical Institute at HUHS (15%), and the Patient Advocate (15%). Overall, regardless of the level of awareness, no more than 5% of students have used any of these 16 tested services in the past year. Students are aware that their medical records are confidential (79%) and their primary care services include preventive care (64%). However, students are unaware that mental health visits are not part of their regular medical record (84%), that a 24-hour advice nurse is available for health information (82%), and that same day appointments with mental health personnel are available when needed (74%). A majority of students strongly agree that they know how to access health care from HUHS if they are not feeling well (75%), know what to do if they have an acute illness or injury (72%), and know how to access reliable health care information (51%). Forty-four percent of students disagree with the statement "I understand my benefits under the Student Health Plan." Undergraduates who have a PCP are more knowledgeable on how to access reliable health care information than students without a PCP (60% vs. 44%).
D. Personal Experience with Health Care and Administrative Services
Health Care
Students were asked to evaluate their own recent experiences with HUHS health care. Office practices, and administrative services. Students are pleased with their experiences with doctors and nurse practitioners, but have negative attitudes about the ease of getting referrals to specialists and getting their phone calls about their health answered.
Nearly two-thirds of students rated overall quality of care and services to be "good" or better. However, a solid third (34%) rated the quality of care and services to be "fair" or "poor." Only 7% rated the care to be "excellent."
Students rated the experiences with their doctors highly. A majority of students offered favorable ratings to the attention given to what they had to say by the physician or nurse practitioner (77%), the extent to which their concems were addressed by the physician or nurse practitioner (72%), the focus and clarity of the treatment plan provided to them by the physician or nurse practitioner (70%), and the clarity of follow-up instructions (69%).
Half of students gave unfavorable ratings to the ease of getting their phone calls about health answered (54% saying "poor" or "fair") and getting a referral to see a specialist (50% saying "poor" or "fair"). Furthermore, at least a third of students had only "fair" or "poor" experiences with their physician or nurse practitioner's explanation of their illness (36%), how much they were helped by the care that they received (35%), and the clarity of follow-up instructions (3 1%).
Page 21
Nearly four out of ten of students who visited HUHS five or more times in the past year gave low ratings to the overall quality of care and services provided by HUHS.
Students who do not have a PCP rated the overall quality of care and services lower than those who have a PCP (48% vs. 30%).
Students who have a PCP rate the attentiveness of the physicians or nurse practitioners higher (53% "excellent" and "very good") than those who do not have a PCP (37%)
Students who do not have a PCP find it harder to get a referral to see a specialist (67% rating "fair" or "poor") than those who do have a PCP (46%).
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Office Practices
Students gave HUHS high ratings for having convenient clinic hours, but reported being unhappy with the appointment delays and waiting time. Three quarters of respondents (76%) feel the convenience of the clinic hours is "good" or better. Nearly seven out of ten students gave high ratings to the ease of making appointments for medical care by phone (69%).
Nearly 60% of students rated the length of time spent waiting between making an appointment and the day of their visit as too long (31% rating it "fair" and 27% rating it "poor.")
Furthermore, 41% rated the length of time waiting at the provider's office for a scheduled appointment "fair" or "poor." In addition, while the majority of students gave receptionists "good" or better ratings, a third of students (35%) rated the courtesy and respect shown to them by the receptionists to be "fair" or "poor."
Administrative Services
When asked to consider the HUHS Member Services Department, students rated the services provided negatively. Nearly two thirds of students (63%) rated the availability of the information about their plans and costs of care as "fair" or "poor." Roughly half of the students thought negatively of the ease of getting claims problems resolved (51%) and the ease of getting their questions answered regarding eligibility and services (46%).
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Female students (56% rating "fair" or "poor") find it more difficult to get their questions answered or their problems solved regarding eligibility of services than do male students (33%).
Students without a PCP (85%) find it much more difficult to get their claims problems resolved than students with a PCP do (45%).
Page 24 E. Patient Preferences Appointment Preferences When the need arises for a student to see a physician or a nurse practitioner on a weekday, students prefer to call ahead to be assured of a definite appointment time (75%). However, when students need to see a medical professional on nights or weekends, they prefer to go to the After Hours Urgent Care Clinic without a definite appointment (75%). A vast majority (84%) of students who have frequently visited HUHS in the past 12 months prefer to call ahead to make an appointment on weekdays. Conversely, 80% of frequent visitors would choose to go to After Hours Urgent Care without an appointment on nights or weekends. Primary Care Physician Selection Forty percent of students continue with a PCP or nurse practitioner that is assigned to them on their first HUHS visit (40%). An additional 39% are more pro-active in their doctor selection by making a selection via the HUHS web site (12%), from the Clinician Directory at the beginning of the academic year (10%), from the 'Select your primary care clinician' event (9%), or from making a choice at the time they enroll at Harvard University (8%). Others prefer to set-up an appointment to meet with a physician or nurse practitioner (21%). Page 25 Sources for Health Information Less than a quarter of respondents turn to HUHS for the majority of their health-related information (16% through HUHS medical personnel and 2% from the Center for Wellness and Health Communications). Three quarters of respondents get the majority of their health-related information from their family. An additional 42% get information of this nature from their friends, while still another 29% receive information from their physician or nurse practitioner at home. Communication with Health Care Provider and HUHS While students are comfortable with e-mail, they do not want to rely on it for communicating with their doctor or nurse practitioner. In non-emergency situations, 56% of students prefer to communicate with their physician or nurse practitioner through face to face visits. A third of students opt for the telephone (32%), while only 12% would prefer to utilize e-mail. Interestingly, while they would not use e-mail to communicate with their health provider, 39% of students would like to receive information about HUHS and health-related activities via e-mail. Two out of ten would prefer to have information sent to their house or dorm. Fifteen percent would like to get this information by visiting the HUHS web site. Page 26 F. Awareness of Services While many students are aware of the existence of HUHS sponsored services, few students have used them. For example, 95% of students are aware of Room 13, 92% of students are aware of Eating Concerns Hotline and Outreach (ECHO), and 89% are aware of Peer Contraceptive Counseling (PCC). However, only 2%, 3%, and 3% have used these services, respectively. Among the services, students are least aware of The Health Resource Center at HUHS (25% aware), The Mind Body Medical Institute at HUHS (15%), and the Patient Advocate (15%). Overall, regardless of the level of awareness, no more than 5% of students have used any of these 16 tested services in the past year. Students are aware that their medical records are confidential (79%) and their primary care services include preventive care (64%). However, students are unaware that mental health visits are not part of their regular medical record (84%), that a 24-hour advice nurse is available for health information (82%), and that same day appointments with mental health personnel are available when needed (74%). A majority of students strongly agree that they know how to access health care from HUHS if they are not feeling well (75%), know what to do if they have an acute illness or injury (72%), and know how to access reliable health care information (51%). Forty-four percent of students disagree with the statement "I understand my benefits under the Student Health Plan." Undergraduates who have a PCP are more knowledgeable on how to access reliable health care information than students without a PCP (60% vs. 44%).
E. Patient Preferences
Appointment Preferences
When the need arises for a student to see a physician or a nurse practitioner on a weekday, students prefer to call ahead to be assured of a definite appointment time (75%).
However, when students need to see a medical professional on nights or weekends, they prefer to go to the After Hours Urgent Care Clinic without a definite appointment (75%).
A vast majority (84%) of students who have frequently visited HUHS in the past 12 months prefer to call ahead to make an appointment on weekdays. Conversely, 80% of frequent visitors would choose to go to After Hours Urgent Care without an appointment on nights or weekends.
Primary Care Physician Selection
Forty percent of students continue with a PCP or nurse practitioner that is assigned to them on their first HUHS visit (40%). An additional 39% are more pro-active in their doctor selection by making a selection via the HUHS web site (12%), from the Clinician Directory at the beginning of the academic year (10%), from the 'Select your primary care clinician' event (9%), or from making a choice at the time they enroll at Harvard University (8%). Others prefer to set-up an appointment to meet with a physician or nurse practitioner (21%).
Page 25
Sources for Health Information
Less than a quarter of respondents turn to HUHS for the majority of their health-related information (16% through HUHS medical personnel and 2% from the Center for Wellness and Health Communications). Three quarters of respondents get the majority of their health-related information from their family. An additional 42% get information of this nature from their friends, while still another 29% receive information from their physician or nurse practitioner at home.
Communication with Health Care Provider and HUHS
While students are comfortable with e-mail, they do not want to rely on it for communicating with their doctor or nurse practitioner. In non-emergency situations, 56% of students prefer to communicate with their physician or nurse practitioner through face to face visits. A third of students opt for the telephone (32%), while only 12% would prefer to utilize e-mail.
Interestingly, while they would not use e-mail to communicate with their health provider, 39% of students would like to receive information about HUHS and health-related activities via e-mail. Two out of ten would prefer to have information sent to their house or dorm. Fifteen percent would like to get this information by visiting the HUHS web site.
Page 26 F. Awareness of Services While many students are aware of the existence of HUHS sponsored services, few students have used them. For example, 95% of students are aware of Room 13, 92% of students are aware of Eating Concerns Hotline and Outreach (ECHO), and 89% are aware of Peer Contraceptive Counseling (PCC). However, only 2%, 3%, and 3% have used these services, respectively. Among the services, students are least aware of The Health Resource Center at HUHS (25% aware), The Mind Body Medical Institute at HUHS (15%), and the Patient Advocate (15%). Overall, regardless of the level of awareness, no more than 5% of students have used any of these 16 tested services in the past year. Students are aware that their medical records are confidential (79%) and their primary care services include preventive care (64%). However, students are unaware that mental health visits are not part of their regular medical record (84%), that a 24-hour advice nurse is available for health information (82%), and that same day appointments with mental health personnel are available when needed (74%). A majority of students strongly agree that they know how to access health care from HUHS if they are not feeling well (75%), know what to do if they have an acute illness or injury (72%), and know how to access reliable health care information (51%). Forty-four percent of students disagree with the statement "I understand my benefits under the Student Health Plan." Undergraduates who have a PCP are more knowledgeable on how to access reliable health care information than students without a PCP (60% vs. 44%).
F. Awareness of Services
While many students are aware of the existence of HUHS sponsored services, few students have used them. For example, 95% of students are aware of Room 13, 92% of students are aware of Eating Concerns Hotline and Outreach (ECHO), and 89% are aware of Peer Contraceptive Counseling (PCC). However, only 2%, 3%, and 3% have used these services, respectively.
Among the services, students are least aware of The Health Resource Center at HUHS (25% aware), The Mind Body Medical Institute at HUHS (15%), and the Patient Advocate (15%). Overall, regardless of the level of awareness, no more than 5% of students have used any of these 16 tested services in the past year.
Students are aware that their medical records are confidential (79%) and their primary care services include preventive care (64%). However, students are unaware that mental health visits are not part of their regular medical record (84%), that a 24-hour advice nurse is available for health information (82%), and that same day appointments with mental health personnel are available when needed (74%).
A majority of students strongly agree that they know how to access health care from HUHS if they are not feeling well (75%), know what to do if they have an acute illness or injury
(72%), and know how to access reliable health care information (51%). Forty-four percent of students disagree with the statement "I understand my benefits under the Student Health Plan."
Undergraduates who have a PCP are more knowledgeable on how to access reliable health care information than students without a PCP (60% vs. 44%).
G. Other Care Providers
In addition to HUHS, 41% percent of students are covered by Harvard University's BCBS plan for Students and Affiliates, while the remainder is covered by other insurance plans.
Two-thirds of students have a PCP or nurse practitioner at HUHS while 34% do not.
Those who tend to rate HUHS poorly are enrolled in Harvard's BCBS Plan for Students and Affiliates. Similarly, those who rated HUHS "good'' are disproportionately enrolled in another plan.
At the end of the survey, students were given the opportunity to provide additional comments, observations, and suggestions. In reading through the verbatim comments (see Appendix B) it is important to remember that the responses are qualitative in nature since just under a third (27%) of students surveyed chose to comment. That said, the comments provide valuable insight into students' experiences with HUHS, and can help HUHS fine tune its efforts to provide superior health care services.
Students gave a number of positive comments, however, the majority of comments pointed out areas where improvements could be made. This should not be surprising in light of the fact that students who rated their overall satisfaction with HUHS "fair" or "poor" were more likely to provide comments than those who rated their overall satisfaction "good," "very good'' or "excellent" (32% vs. 23% respectively.)
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