The landmark 2001 report Crossing the Quality Chasm, by the National Academy of Medicine, marked a paradigm shift in healthcare by emphasizing patient-centered care as a cornerstone of quality improvement (1). The report identified six essential dimensions of high-quality healthcare: effective, efficient, equitable, safe, timely, and patient-centered. Patient-centered care was defined as “respectful of and responsive to individual patient preferences, needs, and values, ensuring that patient values guide all clinical decisions” (2). These principles have since guided clinicians, researchers, and policymakers as they integrate patient experience measures as critical indicators for evaluating and improving patient-centered care.

Understanding patients’ perceptions and experiences is fundamental for enhancing the quality of healthcare systems. The Beryl Institute defines the patient experience as “the sum of all interactions, shaped by an organization’s culture, that influence patient perceptions across the continuum of care” (3). Similarly, the Agency for Healthcare Research and Quality emphasizes that the patient experience includes key aspects of healthcare delivery valued by patients, such as timely appointments, accessible information, and effective communication with providers (4). Other studies have further demonstrated that higher levels of patient satisfaction are associated with improved adherence to treatment plans, leading to better health outcomes (5).

Primary healthcare (PHC) is widely recognized as the cornerstone of modern healthcare systems. Providing high-quality PHC that aligns with patients’ expectations is essential for achieving their satisfaction and strengthening health system performance. Previous studies have demonstrated that strong, community-based primary care improves both the responsiveness and overall effectiveness of health systems (6).

In a study involving 34 European countries, nearly three-quarters (74%) of patients who consulted a primary care physician reported an improved ability to manage their health conditions following the consultation (7). The same study also highlighted that a longitudinal, continuous relationship between primary care physicians and their patients was associated with a lower likelihood of emergency department utilization. Further evidence suggests that increased investment in PHC not only enhances patient outcomes but also reduces reliance on secondary care services, contributing to significant cost savings. For example, a 4-year study in the United Kingdom found that greater investment in PHC resulted in a £165 million reduction in secondary care expenditures (8).

Like many countries, Saudi Arabia faces significant healthcare challenges driven by demographic transitions, including an aging population and the growing prevalence of chronic diseases. By 2030, the number of individuals aged 50 and above is projected to nearly double, to reach 25% of the population, compared to 15% in 2020 (8). According to the Saudi Health Status Statistics 2022 report, the prevalence of chronic disease among adults is almost 20%. Additionally, Saudi Arabia has one of the highest global prevalence rates of diabetes, affecting 15.8% of the population (9). This demographic trend, coupled with chronic disease prevalence, underscores the urgent need for preventive healthcare and patient adherence initiatives.

To address these challenges, Saudi Arabia’s healthcare sector is undergoing transformative changes under the National Transformation Program and Vision 2030 framework. These reforms aim to establish a new healthcare model that improves the population’s health, enhances equity of access, and reduces the burden on secondary and tertiary care (10). To enhance access to healthcare services and streamline patients’ transitions among different levels of care, the Ministry of Health (MOH) introduced the concept of health clusters in all regions of the Kingdom as one of the national transformation projects in healthcare. Each healthcare provider, including the hospitals and primary healthcare centers (PHCCs) within a cluster, is required to coordinate and collaborate to meet the needs of the defined population (11).

Despite these efforts, the use of PHCCs remains inadequate. A national study found that while 84% of respondents were aware of PHC services in their districts, 30% had never made use of them (12). Additionally, a Riyadh-based study revealed that 63% of participants lacked a regular primary care provider, and 44% perceived emergency department services as superior to PHC (13). Most visits to PHCCs were for immunization services or referrals to secondary or tertiary hospitals (12). In response, the MOH has implemented the Patient Experience Measurement Program as part of its national transformation initiative (14). In partnership with Press Ganey, an independent third-party organization, the program uses patient experience surveys to evaluate care across domains such as appointment processes, provider interactions, and overall satisfaction. These surveys aim to enhance transparency, empower patients, and encourage providers to improve service quality.

PHC plays an essential role in the world’s healthcare systems as it targets individuals, families, and communities and provides a range of preventive and curative healthcare services (6). Understanding patients’ perceptions and experiences is a core element for improving the quality of care in any PHC system. An excellent patient experience increases patient engagement and adherence to providers’ instructions, clinical processes, and health outcomes (15). While the patient experience in PHCCs has been explored in various regions of Saudi Arabia, limited research has focused on public PHCCs in the Eastern region. This study aims to fill this gap by analyzing patients’ experiences in MOH-run PHCCs in the Eastern Province for the years 2022 and 2023. The findings aim to provide actionable insights for improving healthcare quality, advancing PHC services, and aligning healthcare systems with patients’ needs.

A total of 106,168 responses from patients who visited the selected PHCCs received the survey; however, only 81,211 participants (76.5%) completed the patient experience survey. Most of the participants (72%) booked their appointment via the Sehaty application, an MOH unified platform that allows users to access health services, as shown in Figure 2. An additional 15% of the respondents booked their PHC appointment via the 937 MOH Call Center (23).

Table 2 displays the demographic characteristics of the study participants. Their mean age was 30.1 years (SD ± 20.9), though a plurality of them were under 18 years of age (33.4%), making this the largest age cohort in the study. Among the participants, 52% were female and 48% were male; 94% were Saudi, while 6% were non-Saudi. Regarding the geographic distribution of the study participants, most of the survey respondents were from Network B (44.4%), followed by Network C (33.3%) and Network A (22.3%).

The overall results of the patient experience scores across the various domains are presented in Table 3. The overall patient experience score was approximately 4.27 out of 5 (85.4%, SD ± 0.85). Among the domains, the “registration” process received the highest mean satisfaction score, 4.43 (88.6%, SD ± 0.96), indicating that more people were confident in and satisfied with this aspect of the service. In contrast, the “moving through” domain recorded the lowest satisfaction score, with an overall satisfaction rate of 79%.

Patients’ overall experience scores varied across age groups, with those aged over 65 reporting a better experience with PHC services compared to those aged 18–34 (Table 4). Further analyses of age-related differences across the patient experience domains revealed an intriguing interaction effect: Most age groups reported the lowest satisfaction with the “moving through” domain, but rated the “registration” services highly. All comparisons were statistically significant (p < 0.05).

Regarding gender differences, male participants reported slightly higher satisfaction levels than female participants (86% vs. 84.6%), as shown in Table 5. Among the patient experience domains, female participants expressed the lowest satisfaction with the “moving through” domain, compared to their male counterparts. Furthermore, the level of satisfaction among survey participants was different between the years 2022 and 2023, with respondents reporting higher levels of satisfaction in 2023 compared to 2022, as presented in Table 6. All comparisons were statistically significant (p < 0.05). In terms of the patients’ mean satisfaction scores by region, the highest score was seen in Network C (4.44; 88.8%), while the lowest patient experience score was in Network B (4.16; 83.2%), as shown in Table 7.

This study has shown that patient experience survey results have exhibited a positive trend over 2 years in Saudi Arabia. Previous studies in Saudi Arabia have reported that patient satisfaction has been increasing annually, with rates rising from 71.7% in March 2018 to 75.1% in March 2019, based on quarterly sample surveys conducted in PHCCs by Press Ganey (24). Our findings align with the literature, as the overall satisfaction rate with PHCs’ services increased from 84% in 2022 to 86.4% in 2023. These results are comparable to studies conducted in Bahrain and Qatar, which reported that approximately 75–80% of patients visiting PHCCs in those countries were generally satisfied (25).

The improvement in PHC patient experience scores can be attributed to recent health reforms in Saudi Arabia, which are devoted to enhancing the patient experience, improving health outcomes, and reducing costs by promoting a patient-centered approach in PHC settings (10). Moreover, by mid-2019, these reforms had increased not only PHC visits, patient satisfaction, and rural community coverage, but also the rate of screening for prevalent chronic diseases (24). Therefore, the findings of our study appear logical, given the significant efforts made by the Saudi MOH to enhance healthcare providers’ professional skills through training programs, continuous medical education, and improved competency in PHC practices and services (26). According to the latest MOH patient experience reports, the overall score has exceeded the Gulf Cooperation Council (GCC) benchmark score of 78.46%. However, the score still falls short of the international benchmark of 92.89% (14).

The results of this study demonstrate that elderly patients (> 65 years) are the most satisfied with PHC services. These results are similar to a review that suggested a positive association between age and the patient experience, with experience ratings tending to increase with a patient’s age. The review reported that patients aged 65 and above generally report better experiences with their care, compared to younger cohorts in several PHCCs in the United States, South Africa, and the United Kingdom (27). Interestingly, despite the general trend showing increasing satisfaction with advancing age, our results contradict a study that was conducted among PHC patients in Saudi Arabia, in which younger patients, those in the 18–30 age group, reported higher levels of satisfaction compared to older patients (28).

Although limited research exists on the causes of age-related differences in patients’ experiences, prior studies have suggested that physicians are more likely to engage in patient-centered interactions with older individuals compared to younger ones (27). Consistent with these findings, our study showed that the care provider domain received the highest experience scores among older individuals, compared to other domains. Similarly, a study conducted in GCC countries reported that older populations were primarily satisfied with physicians’ attitudes (29). In contrast, the “moving through” domain, which assesses wait times, delays, and the comfort of the waiting area, received the lowest scores among young adults (18–34 years), compared to the other domains.

Previous research in the service industry shows that different generations have distinct preferences when it comes to employee interactions. Older adults (aged 50 and above) often value qualities such as empathy, expertise, and effective problem-solving, while younger people (aged 25 and under) prioritize friendliness, attentiveness, and quick service (30). These generational differences provide valuable insights and highlight the need for further exploration in future studies.

In addition to the above, our study results showed that female participants were less satisfied than male patients were. In contrast, an analysis of the relationship between patient characteristics and overall satisfaction with PHC services in Riyadh found that female participants reported higher levels of satisfaction compared to males (28). Moreover, research assessing the influence of a patient’s gender on their satisfaction with health services in family medical practices revealed no significant difference between men and women in their ratings of various aspects of primary care visits. This study suggested that the absence of differences might be due to cultural, religious, and/or social factors in Saudi Arabia (31). However, the differences observed in these study results might be attributed to the fact that men and women have significantly different patient service needs.

Gender-related disparities are also evident for specific components of healthcare services: females frequently raise concerns related to nursing care, whereas males tend to express dissatisfaction with doctor–patient interactions and wait times (32). By contrast, some studies suggest that gender does not significantly affect overall patient experience ratings. These findings emphasize the complexity of gender’s influence on healthcare experiences, indicating that it should not be regarded as a singular or definitive predictor of patient satisfaction (27).

In the present study, overall patient experience scores varied across the three selected health networks within the Eastern Health Cluster. Specifically, the highest satisfaction level was observed in Network C, followed by Network A, with the lowest level reported in Network B. This disparity may be attributed to differences in the distribution of PHCCs and population density among the three health networks. According to the Saudi General Authority for Statistics, Network A operates 10 PHCCs, serving approximately 658,550 residents; Network B has 22 PHCCs, serving over 1,500,000 residents; and Network C includes 26 PHCCs, catering to 552,442 individuals (33).

The unequal distribution of PHCCs and health workers poses a significant challenge, with these networks appearing to be heavily burdened due to an imbalanced ratio of PHCCs to population. The regional variations of PHCCs justify the differences in patient satisfaction scores among the three health networks. In addition, a national study conducted in Saudi Arabia reported that approximately 56% of PHCCs are located in rural areas. Notably, rural regions tend to have a higher number of PHCCs, compared to urban areas, which can be explained by the very small size of the rural population in Saudi Arabia (only 17% of the population lives in a rural area) (10).

While the use of a third party (Press Ganey) improved data quality and minimized collection bias, not all PHC recipients had an equal opportunity to participate. Although the survey achieved a relatively high response rate (76.5%), response bias may still be present, as dissatisfied patients could have been less likely to complete the survey.

The observed increase in satisfaction between 2022 and 2023 may also have been influenced by factors beyond health system reforms, including the post-pandemic normalization of healthcare access. Enhancements introduced by the MOH in response to COVID-19 may also have contributed to these improvements.

Recall bias is a common limitation in patient-reported experience measures, as responses may be influenced by memory, mood, or external discussions. While quantitative methods offer broad insights, integrating qualitative approaches could provide deeper context.

These findings reflect urban populations within the Eastern Health Cluster and may not be generalizable to rural areas, where healthcare access and expectations differ. Finally, while differences across years, networks, and demographics were statistically significant, effect sizes were modest. Nonetheless, such patterns may still indicate structural inequities and warrant further exploration.

In summary, this study highlights several key factors influencing patients’ experiences with PHC services in Saudi Arabia. The overall improvement in patients’ satisfaction in recent years aligns with national health reforms aimed at enhancing primary healthcare quality through patient-centered approaches. However, disparities in satisfaction scores were observed across different health networks, likely due to variations in PHCC distribution and population density. Additionally, demographic factors such as gender and age emerged as significant determinants of the patient experience. While elderly patients (>65 years) reported the highest satisfaction levels, younger adults (18–34 years) were less satisfied, particularly in the domains related to wait times and comfort. Gender-related differences in satisfaction were also evident, with male and female patients expressing distinct concerns, underscoring the complexity of gender’s role in shaping perceptions of healthcare. These findings suggest the need for tailored interventions addressing the unique needs of diverse patient groups and highlight the importance of equitable resource allocation to further improve PHC services. Although Press Ganey surveys offer a standardized patient experience measurement tool, integrating qualitative research methods, such as analyzing free-text comments, conducting interviews, and organizing focus groups, could provide deeper, more nuanced insights. Future studies should investigate the root causes of these disparities and assess approaches for enhancing the delivery of patient-centered care.