Waiting Rooms and Bus Rides Shape How Chronic Patients Rate Their Care in İstanbul

When people living with long-term illnesses judge their healthcare, they appear to weigh far more than the competence of the doctor in front of them. A new cross-sectional study of 608 adults with chronic conditions in İstanbul suggests that the mundane logistics of getting care—how long patients wait for appointments, how they travel to the clinic, and whether the facility is public or private—leave measurable fingerprints on their overall satisfaction. The research, published in BMC Health Services Research by Kadriye Sönmez of Istanbul Topkapi University, offers one of the more granular portraits to date of how access-related conditions and institutional context intertwine to shape outpatient experience in Türkiye’s largest city.

The study recruited adults aged 18 and older who reported at least one chronic condition and direct experience of follow-up or treatment at a healthcare institution. Data were collected online between January 1 and March 15, 2026, using a self-administered structured questionnaire covering sociodemographic characteristics, healthcare access indicators, and an 18-item Turkish patient satisfaction scale. Rather than treating satisfaction as a single undifferentiated feeling, the analysis separated it into three domains: administrative aspects of care, physician-related care, and the service and environment in which care is delivered. This decomposition proved to be the study’s most revealing analytical move.

The headline numbers tell a story of qualified contentment with clear weak points. The mean overall satisfaction score was 3.43 on a scale with a standard deviation of 0.66. Physician-related satisfaction scored highest, at 3.61 plus or minus 0.75, while service and environment-related satisfaction lagged furthest behind at 3.24 plus or minus 0.72. In other words, patients in İstanbul rated the interpersonal, face-to-face quality of their medical encounters more generously than the organizational shell surrounding those encounters—the scheduling, the waiting, the physical setting, and the flow of services.

Before drawing any conclusions from these scores, the study put its measurement instrument through a demanding statistical vetting. The overall scale showed high internal consistency, with a Cronbach’s alpha of 0.95, indicating that the items hang together as a coherent measure. Exploratory factor analysis supported a three-factor structure corresponding to the administrative, physician-related, and service/environment domains, with a Kaiser-Meyer-Olkin measure of sampling adequacy of 0.946 and a significant Bartlett’s test. These are technical markers, but they matter: they signal that the satisfaction domains the study distinguishes are genuinely distinct dimensions of patient experience rather than statistical artifacts.

The core of the analysis was a robust multivariable regression on complete cases, using HC3 standard errors—a heteroscedasticity-robust estimator that guards against distorted significance when variability differs across respondents. In the primary overall model, which included 445 participants, several access-related variables emerged as significant predictors. Higher appointment waiting category was associated with lower satisfaction, with a coefficient of minus 0.09 and a p-value of 0.014. The direction is intuitive but the quantification is valuable: each step up the waiting-time ladder erodes how patients evaluate their care, independent of the other factors in the model.

Institutional context also mattered. Patients who used private hospitals reported higher satisfaction than those who used state hospitals, with a coefficient of 0.19 and a p-value of 0.013. Meanwhile, relying on public transport rather than a private vehicle was associated with lower satisfaction, at a coefficient of minus 0.21 and a p-value of 0.004. Travel time told a similar story: longer journeys were inversely associated with satisfaction, with a coefficient of minus 0.13 and a p-value of 0.048. Intriguingly, log-transformed distance showed a positive conditional association with satisfaction—a coefficient of 0.16 and a p-value of 0.011—suggesting that once travel time and transport mode are held constant, the raw geographic distance itself does not simply translate into worse experiences, a nuance that complicates any simplistic assumption that closer is always better.

Read together, these coefficients sketch a hierarchy of burden. What corrodes satisfaction most reliably is not the kilometers between home and clinic but the accumulated friction of the journey: the wait for an appointment, the dependence on public transit, and the time spent traveling. For people managing chronic conditions, who typically attend outpatient facilities repeatedly over years, this friction compounds. A patient with diabetes or hypertension who must navigate crowded buses and long appointment queues for every routine check-up is having a fundamentally different service experience from one who drives directly to a private hospital, even if the clinical encounter itself is comparable.

To test whether these patterns were fragile artifacts of missing data, the author conducted a multiple-imputation sensitivity analysis, a technique that fills in plausible values for missing responses across repeated simulated datasets and checks whether conclusions hold. The stability of the findings across this analysis strengthens confidence that the associations are not driven by which respondents happened to answer every question. The study also employed cluster analysis, which identified three distinct satisfaction profiles among the respondents—evidence that outpatient experience in this population is not evenly distributed but clusters into recognizable patterns, likely reflecting different combinations of access conditions and institutional settings.

The study’s conclusions are carefully framed. Patient satisfaction among adults with chronic conditions, the author writes, was associated with both interpersonal care and the organizational experience of accessing services. Appointment waiting, transport conditions, travel burden, and institutional context differentiated the outpatient experience, while physician-related evaluations remained comparatively favorable. This asymmetry is arguably the most policy-relevant finding: the component of care that health systems invest most heavily in training—the clinical encounter—is already the best-rated, while the surrounding infrastructure of access is where dissatisfaction concentrates.

For a megacity like İstanbul, where geography, traffic, and a mixed public-private hospital landscape shape daily life, the implications extend beyond patient surveys. The findings suggest that interventions targeting waiting times, transport accessibility, and the organization of outpatient services could shift satisfaction even without changes in clinical practice. They also highlight a measurement lesson for health services research worldwide: satisfaction scales that collapse everything into a single number risk masking the very dimensions—administrative friction and environmental quality—where improvement is most actionable. As health systems everywhere grapple with aging populations and rising chronic disease, this İstanbul study is a reminder that the road to the clinic, and the wait before it, are part of the medicine.

Subject of Research: Associations between healthcare access conditions and outpatient satisfaction among adults with chronic conditions in İstanbul

Article Title: Access, institutional context, and outpatient satisfaction among adults with chronic conditions in İstanbul: a cross-sectional study

Article References: Sönmez, K. (2026). Access, institutional context, and outpatient satisfaction among adults with chronic conditions in İstanbul: a cross-sectional study. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15689-3

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15689-3

Keywords: patient satisfaction, chronic disease, healthcare access, appointment waiting time, transport burden, outpatient care, İstanbul, health services research, private hospitals, public transport, cross-sectional study, Türkiye