Objective To analyze the current status of patient satisfaction with outpatient care and the relevant influencing factors among patients with chronic diseases in a compact county-level medical alliance, and to provide evidence for optimizing chronic disease management in primary care settings.

Methods Based on the Andersen's Behavioral Model of Health Services Use, an explanatory sequential mixed-methods design was employed in the study. In the quantitative phase, a questionnaire survey was conducted among 297 patients with chronic diseases to collect data on patient satisfaction. The influencing factors were analyzed using ordinal logistic regression, and pathway effects were examined using structural equation modeling. In the qualitative phase, semi-structured interviews were conducted and 13 patients with the highest and lowest scores for patient satisfaction were involved. Then, the key themes were extracted using thematic analysis.

Results The overall patient satisfaction score was rather high (4.67 ± 0.58 points on a 5-point scale). Significant influencing factors included age (odds ratio OR = 1.03, 95% CI: 1.01-1.06), education (senior high school or above: OR = 3.34, 95% CI: 1.21-9.24), knowledge of health insurance reimbursement (moderately informed: OR = 0.54, 95% CI: 0.31-0.96), annual out-of-pocket expenditure for chronic diseases (> 1500 yuan: OR = 0.40, 95% CI: 0.17-0.90), satisfaction with facility environment (OR = 2.59, 95% CI: 1.38-4.84), and satisfaction with service capability (OR = 3.00, 95% CI: 1.29-6.97). By influencing the contextual characteristics, individual characteristics had a positive effect on healthcare provider behaviors and medical outcomes, and healthcare provider behaviors also had a direct positive effect on medical outcomes. Thematic analysis of the interviews revealed four key areas of improvement— suboptimal diagnosis and treatment processes, insufficient healthcare professional competence, underutilization of facilities, and inadequate health education and management.

Conclusion Measures such as strengthening training for village doctors, optimizing referral mechanisms, promoting telemedicine, and improving health education approaches are recommended to enhance patient experience and satisfaction.