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

Patient satisfaction in chronic disease care reflects clinical encounters as well as the conditions under which healthcare services are accessed and organized. This study examined associations between access-related conditions and patient satisfaction among adults living with chronic conditions in İstanbul, Türkiye. This analytical cross-sectional study included 608 adults aged 18 years and older who reported at least one chronic condition and experience of receiving follow-up or treatment from a healthcare institution. Data were collected online between January 1, 2026 and March 15, 2026 using a self-administered structured questionnaire including sociodemographic characteristics, healthcare access indicators, and the Turkish 18-item patient satisfaction scale. Satisfaction was analyzed as an overall score and across administrative, physician-related, and service/environment-related domains. Exploratory factor analysis, reliability analysis, complete-case robust multivariable regression with HC3 standard errors, multiple-imputation sensitivity analysis, and cluster analysis were performed. The mean overall satisfaction score was 3.43 ± 0.66. Physician-related satisfaction had the highest mean (3.61 ± 0.75), whereas service/environment-related satisfaction had the lowest (3.24 ± 0.72). The overall scale showed high internal consistency (Cronbach’s α = 0.95), and exploratory factor analysis supported a three-factor structure (KMO = 0.946; Bartlett’s test, p < 0.001). In the primary complete-case overall model ( n = 445), higher appointment waiting category was associated with lower satisfaction (B = −0.09, SE = 0.04, p = 0.014). Private-hospital use was associated with higher satisfaction than state-hospital use (B = 0.19, SE = 0.08, p = 0.013), whereas public transport was associated with lower satisfaction than private-vehicle use (B = −0.21, SE = 0.07, p = 0.004). Longer travel time was inversely associated with satisfaction (B = −0.13, SE = 0.07, p = 0.048), while log-transformed distance showed a positive conditional association (B = 0.16, SE = 0.06, p = 0.011). Three satisfaction profiles were identified. Patient satisfaction among adults with chronic conditions was associated with both interpersonal care and the organizational experience of accessing services. Appointment waiting, transport conditions, travel burden, and institutional context differentiated outpatient experience, while physician-related evaluations remained comparatively favorable.