Factors associated with patient satisfaction with care among dermatological outpatients

Understanding Barriers Impacting upon Patient Wellbeing: A Nationwide Italian Survey and Expert Opinion of Dermatologists Treating Patients with Moderate-to-Severe Psoriasis

A nationwide cross-sectional online survey was administered to dermatologists managing patients with moderate-to-severe plaque psoriasis across Italy to obtain real-world dermatologists' perspectives on the impact of psoriasis and its treatment on patients' daily lives and quality of life (QoL). A total of 91 dermatologists (aged 39.1 ± 11.2 years) completed a 31-question survey and workshop sessions were undertaken in order to identify the best management approach to achieve patient wellbeing. Social (4.2 ± 0.1), physical (4.26 ± 0.2) and mental components (4.1 ± 0.3) were rated by dermatologists as contributing to patient wellbeing to similar extents. While a high proportion (85.4%; rating of 4.3 out of 5) of dermatologists felt that they considered the QoL of patients, a lower proportion (69.6%; rating of 3.7 out of 5) felt that patients were satisfied in this regard. The psoriasis area and severity index and body surface area were the instruments most frequently used to assess the physical domain, while interviews/questions and the dermatology life quality index were used to assess social and mental domains, with only 60% of dermatologists following up on these aspects. The importance of investigating the presence of comorbidities was recognized but not always carried out by many dermatologists, (>70%), particularly for obesity and anxiety/depression. This survey identified key components contributing to barriers impacting on the QoL of patients with moderate-to-severe psoriasis from the perspective of the dermatologist.

Patients' Expectations and Satisfaction with the Patient-Doctor Relationship in Hidradenitis Suppurativa

INTRODUCTION

Hidradenitis suppurativa (HS) is a chronic inflammatory dermatosis with a vast psychosocial burden. We analyzed the actual and ideal patient-doctor relationship and patients' satisfaction with the patient-doctor relationship in relation to their satisfaction with life (SWL), HS-related quality of life, and psychopathological symptoms.

METHODS

105 HS patients (53% females; mean age 37.64 ± 14.01 years) were enrolled. Severity of the disease was measured using Hurley staging and the International HS Score System (IHS4). Instruments utilized: Patient Expectation Test; Satisfaction with Life Scale; HS Quality of Life; Patient Health Questionnaire-9; Generalized Anxiety Disorder-7; General Health Questionnaire.

RESULTS

Patients with Hurley I and mild IHS4 had the lowest satisfaction with the patient-doctor relationship. There were significant correlations between the actual patient-doctor relationship and the patients' SWL (r = 0.30; p = 0.002), depressive (r = -0.36; p < 0.01), anxiety (r = 0.37; p < 0.01) and psychopathological symptoms (r = -0.47; p < 0.0001) and between the satisfaction with the patient-doctor relationship and their SWL (r = -0.32; p = 0.00098). Multiple regression analysis revealed a significant influence of the following factors: Hurley II + III, psychopathological symptoms, and severe anxiety about the actual patient-doctor relationship and the satisfaction with the patient-doctor relationship.

CONCLUSIONS

Assessment of relations between patients and doctors is related to the patients' mental health and SWL. The usage of the Patient Expectation Test in clinical practice can improve the patient-doctor relationship and the general quality of care for and compliance by HS patients.

The Effect of Melasma on the Quality of Life in People with Darker Skin Types Living in Durban, South Africa

Melasma is a common skin disorder of acquired hyperpigmentation that appears commonly on the face. Although asymptomatic, melasma causes psychosocial and emotional distress. This study aimed to assess melasma's severity on people with darker skin types, evaluate the effects of melasma on the quality of life (QoL), and establish QoL predictors in affected individuals. This was a cross-sectional analytic study that enrolled 150 patients from three private dermatology clinics in Durban, South Africa who were diagnosed with melasma. The severity of melasma alongside QoL were measured using a melasma area and severity index (MASI) score and melasma quality of life scale (MELASQoL), respectively. The associations among factors and QoL were explored using multivariable methods and stepwise regression analysis. p-values less than 0.05 were considered significant. Enrolled patients were predominantly females (95%), of which 76% were of black African ethnicity, 9% were of Indian ethnicity, and 15% had mixed ancestry, with an average age of 47.30 years. Family history revealed that 61% had no prior melasma cases, while 39% had affected relatives, most commonly mothers (41%). The cheeks were the most common site for melasma. MASI score of Masi (β = 0.209, t = 2.628, p < 0.001), the involvement of cheeks (β = -0.268, t = -3.405, p < 0.001), level of education (β = -0.159, t = -2.029, p = 0.044), and being menopausal (β = -0.161, t = -2.027, p = 0.045) were found to be predictors of QoL. A regression model was created to forecast MELASQoL using these four predictors. This equation's significance lies in its ability to enable the remote assessment of MELASQoL based on these four variables. It offers a valuable tool for researchers and medical professionals to quantitatively and objectively evaluate the impact of melasma on an individual's quality of life.

Predictors of patient satisfaction with Mohs micrographic surgery at time of surgery and 3 months postsurgery: A prospective cohort study

BACKGROUND

Despite the importance of patient satisfaction in ensuring high-quality care, studies investigating patient satisfaction in Mohs micrographic surgery (MMS) are limited.

OBJECTIVE

We investigated the factors associated with patient satisfaction in MMS for nonmelanoma skin cancer and how patient satisfaction changes in the postoperative period.

METHODS

In this prospective cohort study including 100 patients, patient satisfaction surveys were administered at the time of surgery and at 3 months postsurgery. Sociodemographic characteristics, medical history, and surgical parameters were collected by chart review. Univariate linear and logistic regression models were created to examine these relationships.

RESULTS

Decreased satisfaction was observed in patients requiring 3 or more MMS stages both at the time of surgery (P = .047) and at 3 months post-surgery (P = .0244). Patients with morning procedures ending after 1:00 pm had decreased satisfaction at the time of surgery (P = .019). A decrease in patient satisfaction between the time of surgery and 3 months postsurgery was observed in patients with surgical sites on the extremities (P = .036), larger preoperative lesion sizes (P = .012), and larger defect sizes (P = .033).

LIMITATIONS

Single-institution data, self-selection bias, and recall bias.

CONCLUSION

Patient satisfaction with MMS is impacted by numerous factors and remains dynamic over time.

Understanding Discordant Perceptions of Disease Severity Between Physicians and Patients With Eczema and Psoriasis Using Structural Equation Modeling

Importance

Patients and physicians often have differing opinions on the patient's disease severity. This phenomenon, termed discordant severity grading (DSG), hinders the patient-physician relationship and is a source of frustration.

Objective

To test and validate a model explaining the cognitive, behavioral, and disease factors associated with DSG.

Design, Setting, and Participants

A qualitative study was first performed to derive a theoretical model. In this subsequent prospective cross-sectional quantitative study, the qualitatively derived theoretical model was validated using structural equation modeling (SEM). Recruitment was conducted between October 2021 and September 2022. This was a multicenter study in 3 Singapore outpatient tertiary dermatological centers. Dermatology patients and their attending physicians were recruited by convenience sampling. Patients were aged 18 to 99 years with psoriasis or eczema of at least 3 months' duration and recruited only once. The data were analyzed between October 2022 to May 2023.

Main Outcomes and Measures

The outcome was the difference between global disease severity (0-10 numerical rating scale with a higher score indicating greater severity) as independently scored by the patient and the dermatologist. Positive discordance was defined as patient-graded severity more than 2 points higher (graded more severely) than physicians, and negative discordance if more than 2 points lower than physicians. Confirmatory factor analysis followed by SEM was used to assess the associations between preidentified patient, physician, and disease factors with the difference in severity grading.

Results

Of the 1053 patients (mean [SD] age, 43.5 [17.5] years), a total of 579 (55.0%) patients were male, 802 (76.2%) had eczema, and 251 (23.8%) had psoriasis. Of 44 physicians recruited, 20 (45.5%) were male, 24 (54.5%) were aged between 31 and 40 years, 20 were senior residents or fellows, and 14 were consultants or attending physicians. The median (IQR) number of patients recruited per physician was 5 (2-18) patients. Of 1053 patient-physician pairs, 487 pairs (46.3%) demonstrated discordance (positive, 447 [42.4%]; negative, 40 [3.8%]). Agreement between patient and physician rating was poor (intraclass correlation, 0.27). The SEM analyses showed that positive discordance was associated with higher symptom expression (standardized coefficient B = 0.12; P = .02) and greater quality-of-life impairment (B = 0.31; P < .001), but not patient or physician demographics. A higher quality-of-life impairment was in turn associated with lower resilience and stability (B = -0.23; P < .001), increased negative social comparisons (B = 0.45; P < .001), lower self-efficacy (B = -0.11; P = .02), increased disease cyclicity (B = 0.47; P < .001), and greater expectation of chronicity (B = 0.18; P < .001). The model was well-fitted (Tucker-Lewis: 0.94; Root Mean Square Error of Approximation: 0.034).

Conclusions and Relevance

This cross-sectional study identified various modifiable contributory factors to DSG, increased understanding of the phenomenon, and set a framework for targeted interventions to bridge this discordance.

Determining Optimal Intervals for In-Person Visits during Video-based Telemedicine in Patients with Hypertension: A Cluster Randomized Controlled Trial

BACKGROUND

Introducing telemedicine in outpatient treatment may improve patient satisfaction and convenience. However, the optimal in-person visit interval for video-based telemedicine in patients with hypertension remains unreported in Japan.

OBJECTIVE

We determined the optimal in-person visit interval for video-based telemedicine in patients with hypertension.

METHODS

Design: This was a cluster randomized controlled noninferiority trial. Participants: The target sites were eight clinics in Japan that had a telemedicine system, and the target patients were individuals with essential hypertension. Among patients receiving video-based telemedicine, those who underwent in-person visits at 6-month intervals were included in the intervention group, and those who underwent in-person visits at 3-month intervals were included in the control group. Main Measures: The follow-up period of the participants was 6 months. The primary endpoint of the study was the change in systolic blood pressure, and the secondary endpoints were the rate of treatment continuation after 6 months, patient satisfaction, health economic evaluation, and safety evaluation.

RESULTS

Overall, 64 patients were enrolled. Their mean age was 54.5 ± 10.3 years, and 39 (60.9%) patients were males. For the primary endpoint, the estimated difference in the change in systolic blood pressure between the two groups was 1.18 (90% confidence interval: -3.68 to 6.04). Notably, the criteria for noninferiority were met. Patient satisfaction was higher in the intervention group than in the control group. Furthermore, the indirect costs indicated that lost productivity was significantly less in the intervention group than in the control group. Moreover, the treatment continuation rate did not differ between the intervention and control groups, and there were no adverse events in either group.

CONCLUSIONS

Blood pressure control status and safety did not differ between the intervention and control groups. In-person visits at 6-month intervals may cause a societal cost reduction and improve patient satisfaction during video-based telemedicine.

CLINICALTRIAL

UMIN000040953.

Association between patient characteristics and dissatisfaction after cranial neurosurgery: A prospective observational study

Objectives

Patient satisfaction is an indicator of the quality of healthcare. It can improve treatment adherence and health outcomes. This study aimed to determine the incidence, predictive factors, and impact of post-operative patient dissatisfaction with perioperative care after cranial neurosurgery.

Materials and Methods

This was a prospective observational study conducted in a tertiary care academic university hospital. Adult patients undergoing cranial neurosurgery were assessed for satisfaction 24 h after surgery using a five-point scale. The data regarding patient characteristics that may predict dissatisfaction after surgery were collected along with ambulation time and hospital stay. Shapiro-Wilk test was used to assess normality of data. Univariate analysis was performed using Mann-Whitney U-test and significant factors were entered into binary logistic regression model for identifying predictors. The level of significance was set at P < 0.05.

Results

Four hundred and ninety-six adult patients undergoing cranial neurosurgery were recruited into the study from September 2021 to June 2022. Data of 390 were analyzed. The incidence of patient dissatisfaction was 20.5%. On univariate analysis, literacy, economic status, pre-operative pain, and anxiety were associated with post-operative patient dissatisfaction. On logistic regression analysis, illiteracy, higher economic status, and no pre-operative anxiety were predictors of dissatisfaction. The patient dissatisfaction did not impact ambulation time or duration of hospital stay after the surgery.

Conclusion

One in five patients reported dissatisfaction after cranial neurosurgery. Illiteracy, higher economic status, and no pre-operative anxiety were predictors of patient dissatisfaction. Dissatisfaction was not associated with delayed ambulation or hospital discharge.

Developing relationships with patients, staff, and industry in dermatology

Maintaining a thriving dermatology practice requires thoughtful and intentional investment in relationships with patients, staff, and industry. Growing the patient-physician relationship involves optimizing patient satisfaction and outcomes, which can provide improved ratings and reimbursement. Cultivating an environment of employee engagement is also essential for promotion of patient satisfaction, employee satisfaction, and practice productivity. Additionally, relationships with industry require careful navigation to maximize its great potential for medical advancement and benefit for all parties. There are inherent conflicts of interest between physician motivation for improved patient outcomes and industry goals of increased profits. Successful management of these relationships can be a difficult task, but it remains important.

Patient Satisfaction with Healthcare Services and the Techniques Used for its Assessment: A Systematic Literature Review and a Bibliometric Analysis

Patient satisfaction with healthcare provision services and the factors influencing it are be-coming the main focus of many scientific studies. Assuring the quality of the provided services is essential for the fulfillment of patients' expectations and needs. Thus, this systematic review seeks to find the determinants of patient satisfaction in a global setting. We perform an analysis to evaluate the collected literature and to fulfill the literature gap of bibliometric analysis within this theme. This review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) approach. We conducted our database search in Scopus, Web of Science, and PubMed in June 2022. Studies from 2000-2021 that followed the inclusion and exclusion criteria and that were written in English were included in the sample. We ended up with 157 articles to review. A co-citation and bibliographic coupling analysis were employed to find the most relevant sources, authors, and documents. We divided the factors influencing patient satisfaction into criteria and explanatory variables. Medical care, communication with the patient, and patient's age are among the most critical factors for researchers. The bibliometric analysis revealed the countries, institutions, documents, authors, and sources most productive and significant in patient satisfaction.

Evaluation of the Satisfaction of Patients Seen in the Dermatology Department of a Spanish Tertiary Hospital

Patient satisfaction is of great importance and is a key factor in the quality of care. The most commonly used measure of this factor is satisfaction surveys. This study used the modified SERVQHOS healthcare quality survey model, which adapts the SERVQUAL survey. The main objective was to determine the degree of satisfaction of patients seen in the outpatient department of the Dermatology Service, as well as to describe and detect those aspects that could be improved to offer better quality care. A total of 250 patients responded to the survey. The mean Likert scale score for the 19 items on the perceived quality of care was 4.17 ± 0.796 points. Up to 92.8% were satisfied or very satisfied with the care received. All items were statistically correlated with overall satisfaction (p < 0.001). In the multivariate study, the variables with predictive capacity in relation to overall satisfaction (p < 0.05) were “the technology of the medical equipment”; “the directions to the consultation”; “the confidence that the staff transmits”; “the state of the consultation”; and “the interest of the staff in solving problems”. Satisfaction was significantly higher in men (p < 0.05), with a level of education up to primary school (p < 0.05) and no work activity (p < 0.001). The final mean score in the degree of perceived satisfaction was very high, indicating that the expectations of the patients were exceeded, and showing that satisfaction is closely linked to the qualities and skills of the staff in their relationship with the patient.

Patient-Reported Experiences and Satisfaction with Rural Outreach Clinics in New South Wales, Australia: A Cross-Sectional Study

Introduction: Many studies have been conducted on how physicians view outreach health services, yet few have explored how rural patients view these services. This study aimed to examine the patient experience and satisfaction with outreach health services in rural NSW, Australia and the factors associated with satisfaction. Methods: A cross-sectional study was conducted among patients who visited outreach health services between December 2020 and February 2021 across rural and remote New South Wales, Australia. Data on patient satisfaction were collected using a validated questionnaire. Both bivariate (chi-squared test) and multivariate analyses (logistic regression) were performed to identify the factors associated with the outcome variable (patient satisfaction). Results: A total of 207 participants were included in the study. The mean age of respondents was 58.6 years, and 50.2% were men. Ninety-three percent of all participants were satisfied with the outreach health services. Respectful behaviours of the outreach healthcare practitioners were significantly associated with the higher patient satisfaction attending outreach clinics. Conclusions: The current study demonstrated a high level of patient satisfaction regarding outreach health services in rural and remote NSW, Australia. Further, our study findings showed the importance of collecting data about patient satisfaction to strengthen outreach service quality.

Sharing Patient and Clinician Experiences of Moderate-to-Severe Psoriasis: A Nationwide Italian Survey and Expert Opinion to Explore Barriers Impacting upon Patient Wellbeing

A nationwide survey was conducted in adult patients with psoriasis (PsO) across Italy to obtain their real-world perspective of the impact of PsO on their wellbeing. Patients completed a 26-question survey (based on the patient benefit index; PBI, The Dermatology Life Quality Index; DLQI and the World Health Organization-five; WHO-5 wellbeing index) and workshop discussion sessions were undertaken by dermatologists to interpret results from the survey. 392 patients with PsO completed the survey. Analysis of results was restricted to patients who had moderate-to-severe plaque psoriasis (assessed by patients; n = 252; 64.3%). Dermatologists (n = 32) completed one question from the survey related to wellbeing and rated social, physical and mental domains as contributing to a similar extent, with comparable scores also observed by patients. For treatment, biologics yielded higher scores on average, whereas little difference was observed between topical and conventional systemic treatments. Only 23.8% of patients felt that their dermatologist was taking into consideration their wellbeing and 32.6% of the patients considered their therapy as inadequate in improving signs and symptoms of the disease. This survey identified key factors contributing to barriers impacting on patient wellbeing. Simple, but comprehensive questionnaires can provide important insight to patients’ needs that may significantly increase clinician awareness during visits leading to tailored treatment.

How Can Research on Artificial Empathy Be Enhanced by Applying Deepfakes?

We propose the idea of using an open data set of doctor-patient interactions to develop artificial empathy based on facial emotion recognition. Facial emotion recognition allows a doctor to analyze patients' emotions, so that they can reach out to their patients through empathic care. However, face recognition data sets are often difficult to acquire; many researchers struggle with small samples of face recognition data sets. Further, sharing medical images or videos has not been possible, as this approach may violate patient privacy. The use of deepfake technology is a promising approach to deidentifying video recordings of patients’ clinical encounters. Such technology can revolutionize the implementation of facial emotion recognition by replacing a patient's face in an image or video with an unrecognizable face—one with a facial expression that is similar to that of the original. This technology will further enhance the potential use of artificial empathy in helping doctors provide empathic care to achieve good doctor-patient therapeutic relationships, and this may result in better patient satisfaction and adherence to treatment.

Prevalence and factors associated with gynoid lipodystrophy in Brazilian adolescent girls: a cross-sectional study

BACKGROUND

Gynoid lipodystrophy (GLD), or female cellulitis, is a chronic multifactorial disorder characterized by the irregular appearance of the skin surface on the thighs and gluteal regions, which affects 80-90% of women after puberty. No curative treatments are available, and there is a paucity of epidemiological studies related to its prevalence, quality of life impact, and risk factors. We aimed to identify the prevalence and factors associated with the development of GLD in Brazilian adolescent girls.

METHODS

A cross-sectional study examined adolescent girls from São Paulo, Brazil. The explored factors were grouped: familial history, gynecological and hormonal characteristics, exercise practice, nutrition and diet, anthropometric measures, body mass index, and body composition, according to GLD severity assessed through multivariate hierarchic statistics.

RESULTS

In total, 184 girls, aged from 12 to 18 years, were included in the study. The overall prevalence of GLD was 77.7% (CI 95% 71.7-82.1%); moderate and severe categories of GLD occurred in 56.5% (CI 95% 48.9-62.5%) of the sample. An impact on the quality of life was identified in 39.7% of the girls. GLD was independently associated with higher body mass index, early menarche, higher carbohydrate intake, lower water consumption, menstrual irregularity, familial report of GLD, and less exercise practice.

CONCLUSION

Gynoid lipodystrophy is a multifactorial disorder; its onset in adolescent girls is associated with familial occurrence, body composition, diet habits, exercise, and hormonal factors. These results support further interventions for GLD prevention and treatment.

Patient satisfaction towards health care services provided in Ethiopian health institutions: a systematic review and meta-analysis

The level of patient satisfaction is a direct or indirect measure of services delivered in healthcare institutions. Different primary studies in Ethiopia showed the proportion of satisfied patients toward health services. Patient satisfaction reflects a wide gap between the current experience and the expected services and pushes clients to go to farther located health care facilities and even to more expensive private health care facilities to find quality healthcare services. Inconsistent findings regarding the proportion of patients that are satisfied with the healthcare services in Ethiopia make generalizations difficult at the national level. We have accessed previous studies through an electronic web-based search strategy using PubMed, Cochrane Library, Google Scholar, Embase, and CINAHL and a combination of search terms. The quality of each included article was assessed using a modified version of the Newcastle-Ottawa Scale for cross-sectional studies. All statistical analyses were done using STATA version 14 software for windows, and meta-analysis was carried out using a random-effects method. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed for reporting results. Out of 188 records screened, 41 studies with 17 176 participants fulfilled the inclusion criteria and were included for proportion estimation. The pooled proportion of satisfied patients was 63.7%. Attending a health center (AOR = 2.68; 95% CI = 1.79, 2.85), being literate (AOR = 0.46; 95% CI = 0.28-0.64), being younger than 34 years old (AOR = 2.07; 95% CI = 1.28, 2.85), and being divorced (AOR = 0.58; 95% CI = 0.38, 0.88) were factors identified as being associated with patient satisfaction. The proportion of patient satisfaction in Ethiopia was high based on over 50% satisfaction scale. The Ministry of Health should give more emphasis to improve hospital health care services to further improve patient satisfaction.

A qualitative study of dermatology patients and providers to understand discordant perceptions of symptom burden and disease severity

BACKGROUND

Patients often present with symptoms that are disproportionate to the observed disease state, and grade disease severity differently from healthcare providers (HPs). This discordant symptom burden and severity grading (DSG) results in poorer patient care. Current research on DSG is limited, relying on structured models that are theoretically incomplete.

OBJECTIVE

To fully understand the factors driving DSG.

METHODS

Qualitative study of dermatology patients and HPs. Interview data were analyzed using grounded theory to derive a model of the causes of DSG.

RESULTS

Eighteen patients and 12 HPs were interviewed. Results reflect a tendency for patients to grade their conditions more severely than HPs. Factors driving DSG are related to emotional and cognitive disparities in the constructs used to grade severity, varying consequences of disease due to differing resilience and coping methods, socio-psychological factors influencing how patients report their symptoms, and the context of the consult.

CONCLUSION

A better understanding of DSG is required for achieving mutual understanding and patient-centered collaborative care. It is easy to label a patient with high symptom burden as having a low threshold for discomfort, or for a patient to presume that the doctor is unempathetic. This study suggests the causes of DSG are nuanced and multifactorial.

Comparison of Patient Satisfaction in Inpatient Care Provided by Hospitalists and Nonhospitalists in South Korea

Background: A Korean hospitalist is a medical doctor in charge of inpatient care during hospital stays. The purpose of this study is to examine the patient satisfaction of hospitalist patients compared to non-hospitalist patients. Patient satisfaction is closely related to the outcome, quality, safety, and cost of care. Thus, seeking to achieve high patient satisfaction is essential in the inpatient care setting. Design, setting, and participants: This is a case-control study based on patient satisfaction survey by the Korean Health Insurance Review and Assessment Service. We measured patients’ satisfaction in physician accessibility, consultation and care service skills, and overall satisfaction through logistic regression analyses. A total of 3871 patients from 18 facilities responded to 18 questionnaires and had health insurance claim data. Results: Hospitalist patients presented higher satisfaction during the hospital stay compared to non-hospitalist patients. For example, as per accessibility, hospitalist patients could meet their attending physician more than twice a day (OR: 3.46, 95% CI: 2.82–4.24). Concerning consultation and care service skills, hospitalists’ explanations on the condition and care plans were easy to understand (OR: 2.33, 95% CI: 1.89–2.88). Moreover, overall satisfaction was significantly higher (β: 0.431, p < 0.0001). Subgroup analyses were conducted by medical division and region. Hospitalist patients in the surgical department and the rural area had greater patient satisfaction in all aspects of the survey than non-hospitalist patients. Conclusions: Hospitalists’ patients showed higher satisfaction during the hospital stay. Our study discovered that hospitalists could provide high-quality care as they provide onsite care continuously from admission to discharge.

Quality-of-Life Outcomes for Excision and Reconstruction of Periocular Nonmelanoma Skin Cancer

Background: Understanding how periocular nonmelanoma skin cancer (NMSC) impacts quality of life (QoL) provides insight into the patient experience. Objective: To prospectively measure QoL of individuals with surgically treated periocular NMSC. Methods: Responses to the skin cancer index (SCI) and FACE-Q questionnaires were obtained at preoperative (PRE), postoperative week 1 (POW1), and postoperative month 3 (POM3) visits. Statistical analysis was performed using paired t-test and stepwise linear regression. Results: Forty-five patients participated in the study. Improved QoL as reflected in an increased mean difference of the total SCI score at PRE and POM3 visits (25.8, 95% confidence interval [CI 20.0 to 31.6]) and FACE-Q early life impact of treatment score at POW1 and POM3 visits (19.0, 95% CI [14.9 to 23.0), and a decreased mean difference of the FACE-Q adverse effects score at POW1 and POM3 visits (-1.3, 95% CI [-2.4 to -0.1]) was observed. Linear regression of the SCI and FACE-Q scores using demographic and clinical attributes revealed several predictors of postoperative QoL. Conclusions: Surgical management of periocular NMSC results in improved QoL, demonstrated at the final postoperative visit.

Patient Outcomes and Satisfaction After Mohs Micrographic Surgery in Patients With Nonmelanoma Skin Cancer

BACKGROUND

Quality in medicine is increasingly being measured through patient-reported outcome measures. Given the rising incidence and costs for nonmelanoma skin cancer (NMSC) treatment, it is imperative to define quality measures specific to dermatologic surgery.

OBJECTIVE

This study aims to evaluate patient-reported outcomes and satisfaction with Mohs micrographic surgery (MMS) together with patient and tumor factors to better define their use in developing treatment strategies and quality measures.

METHODS AND MATERIALS

A prospective study was conducted among 226 patients undergoing MMS for treatment of NMSC. Patient demographics, quality of life, functional status, satisfaction, and prognostic factors were gathered. Postoperative outcomes were measured at 1 month and included patient-reported problems and provider-reported complications. Relationships between patient factors and outcomes were evaluated through statistical analysis.

RESULTS

Average patient satisfaction in the domain of general satisfaction of the Patient Satisfaction Questionnaire-18 was 4.34 of 5. General patient satisfaction did not differ across age, final defect size, sex, or prognostic scores. At 1-month postoperatively, 97 percent of patients expressed willingness to undergo future MMS if indicated.

CONCLUSION

Patients are generally satisfied with MMS for treatment of NMSC. Specific patient factors that may affect satisfaction include smoking status and anticoagulation use.

Trends in Workplace Violence Involving Health Care Professionals in China from 2000 to 2020: A Review

The safety of health care workers in China has received an increasing amount of attention owing to numerous incidents of hospital-based violence against medical professionals. When pictures and videos of violent injuries are posted on the internet with real-time data, such as gender or location, researchers can access the information to learn about the incident, its causes, and/or threats to survival. We examined the causes and risk factors for workplace violence by analyzing relevant data retrieved from reports by Chinese internet media for all incidents from 2000 to 2020. We present frequency data on hospital-based violence against medical professionals. A total of 345 incidents occurred in health care settings. The person who committed the violent act was a patient or sick person in the workplace or a co-worker in 95.4% of the incidents; 54 of the incidents resulted in the victim’s murder. We provide the characteristics and risk factors of violent criminals. We describe China’s past and current clinical practices and health care policies, and we discuss the challenges faced by medical professionals who are victims of hospital-based violence from the perspectives of patients, physicians, hospital leaders, and the government. We conclude by making recommendations for preventing violence in hospital settings. It is urgent for the public to understand that the occupational safety of health care workers must be protected, and treatment should be provided to patients in a harmonious and safe environment. This review aims to describe the trends in workplace violence involving health care professionals in China from 2000 to 2020 and to discuss possible strategies for improving working conditions in hospitals and other health care settings.

Patient satisfaction with pharmaceutical services in Makkah: A cross-sectional study

Objective:

Patient satisfaction is considered an essential indicator of the treatment outcomes of pharmaceutical services. This study aimed to assess patient satisfaction with the pharmaceutical services at the Ministry of Health (MOH) hospitals in Makkah city in Saudi Arabia.

Methods:

A cross-sectional study was conducted via an interview-based questionnaire that involved patients who visited the outpatient pharmacy in five MOH hospitals from August 2018 to September 2018. The data were collected using a previously published, validated, and reliable questionnaire. The questionnaire was translated and piloted for the local context.

Findings:

Data of 295 respondents were analyzed. The overall mean score of satisfaction level with the pharmaceutical services was found to be 2.50 out of a maximum score of 3. The item that the patients were most satisfied with was, “The extent of cleanliness in the waiting area for the provision of pharmaceutical services” (mean = 2.80) whereas the item the patients were least satisfied with was, “The information the pharmacist gives you about the proper storage of your medication” (mean = 2.00). “Illiterate” patients and those who visited the pharmacy first time had significantly higher satisfaction levels compared to those with other educational categories and those who had visited the pharmacy before, respectively.

Conclusion:

Our study showed that the overall level of satisfaction of patients with pharmaceutical services was high.

Patient Satisfaction Towards Outpatient Pharmacy Services and Associated Factors at Dessie Town Public Hospitals, South Wollo, North-East Ethiopia

BACKGROUND

Satisfaction of patients is a key measure of quality pharmacy service delivery. However, the traditional way of drug inventory and dispensing practice by professionals negatively affects the satisfaction of patients. Hence, assessment of satisfaction level is an important tool to identify gaps in pharmacy service delivery and works for its improvement.

OBJECTIVE

To determine the level of patients' satisfaction towards outpatient pharmacy service and contributing factors at Dessie Town Public Hospitals, South Wollo, North-east Ethiopia, 2020.

METHODS

We implement a facility-based cross-sectional survey on 414 patients over the age of 18 years from the outpatient pharmacy service of Dessie town public hospitals. The study was done from February to June 2020 through a systematic random sampling method and face-to-face pharmacy exit interview using the Self Reporting Questionnaire-17. We used Epi-data version 3.1 for data entry and SPSS-21 software for analysis. We assessed the strength of association in the binary logistic regression with odds ratio and declare statistical significance with p-value <0.05.

RESULTS

Among the total patients participated, 246 (59.4%) were satisfied towards outpatient pharmacy services. In this finding, comfortability of waiting area [AOR=1.87; 95% CI, (1.13, 4.18)], frequency of visit [AOR=2.4; 95% CI, (1.19, 4.80)], and payment status [AOR=2.90; 95% CI, (1.21, 6.95)] showed a positive association towards satisfaction. On the other hand, age (28-37 years) [AOR=0.16; 95% CI, (0.08-0.34)], number of drug dispensed [AOR=0.3; 95% CI, 0.13-0.41] and medication availability [AOR=0.44; 95% CI, (0.26, 0.71)] showed a negative association with patient satisfaction.

CONCLUSION AND RECOMMENDATIONS

The findings of the current study revealed that patients' satisfaction towards outpatient pharmacy services provided by public Hospitals at Dessie town was low. Hence, hospitals need to take attention to and consider the identified gaps like improving the availability of drugs, comfortability of waiting area, payment status, and the number of drugs dispensed, and the frequency of visits.

Dermatological games: Part 2. What has changed 40 years on?

In this two-part report, we review and critically appraise 'Dermatological games' by J. A. Cotterill, a seminal article published in 1981, which attempted to explain the interaction between dermatologists and patients using Berne's game theory. Part 1 described and critically appraised the educational value of Cotterill's original list of games in relation to how they apply to dermatology practice. In Part 2, a list of new 'games' that might be observed in current dermatological practice is introduced. The relevance of Cotterill's paper and an explanation for why his article remains relevant to dermatology practice and training today is scrutinized, in order to stimulate discussion and improve patient care.

Dermatological games: Part 1. Original description and critique

'Dermatological games' by J. A. Cotterill was a seminal article published in 1981, which attempted to explain the interaction between dermatologists and patients using Berne's game theory. In Part 1 of this series of two reviews, we review Cotterill's original list of games and how they applied to dermatology in the context of when they were written. We then critically appraise Cotterill's article and arguments. Although the article was deliberately provocative, we found Cotterill's arguments to be well-structured and logical, and the 'games' described are well-conceived. Cotterill's candid analysis of doctors' motivations and the potential impact on the patient is refreshing and insightful. It is striking that, 40 years on, many of the original 'games' described remain recognizable in current practice. In Part 2, a list of new 'games' that might be observed in modern dermatological practice is introduced. The relevance of Cotterill's paper and an explanation for why his educational article remains relevant to dermatology practice and training today is scrutinized in order to stimulate discussion, promote education and improve patient care.

Level of Patient Satisfaction with Inpatient Services and Its Determinants: A Study of a Specialized Hospital in Ethiopia

Background

The health care industry is undergoing a rapid transformation to meet the ever-increasing needs and demands of its patient population. Level of patients' satisfaction is an important health outcome, which is regarded as a determinant measure for quality of care. This study was performed with the aim of assessing the level of patient satisfaction with inpatient services and its determinants in Black Lion Specialized Hospital, Addis Ababa, Ethiopia.

Methods

A facility-based cross-sectional study was conducted from November 25^th to December 20^th, 2015, using 398 randomly selected patients. Ethical clearance was obtained from the Jimma University research review board, and verbal consent was also received from the study participants during data collection time. A pretested structured interview questionnaire was used to collect data from study participants. The collected data were handled by using SPSS statistical software. Before analysis, relevant explanatory variables were identified using factor analysis with varimax rotation, and bivariate analysis was carried out using linear regression for every independent variable with the outcome variable independently. Explanatory variables scoring p value <-0.05 were used for the final model after checking the assumption. Study findings are presented by using tables, graphs, and description.

Results

A total of 398 patients were participated in the study, yielding a response rate of 100%. A total of 46.2% (95% CI: 41.2%-51.1%) patients were satisfied by the services they received in the hospital. Patient and health care provider interaction and general facility amenity-related domains were found to explain 96.4% of the variability in the net overall satisfaction score. Good quality services provided by hospital physicians, availability of laboratory and radiology services, pain management services, and inpatient pharmacy services of the hospital had positive influences. Besides toilet cleanliness, availability of rooms for accommodation and dietary service had significant relation with level of patient satisfaction. Quality of the inpatient pharmacy service had a great influence on satisfaction; a unit increase in it resulted in 2.3 (95% CI: 2.1-2.5) times increment in patient satisfaction level at p ≤ 0.001. For final predictors, regression estimates for level of satisfaction moved from very dissatisfied to very satisfied when service improves by a unit.

Conclusion

Overall patients' satisfaction is lower than other studies in the nation. A great opportunity is there to improve patient's satisfaction level if the service quality is improved around the time of patient and health care provider interaction and facility amenity services. Besides, improving the health literacy of service providers and devising a strategy to routinely assess satisfaction level of patients in the facility is critical. On top of this, providing tailored on-the-job training for health care workers in the facility is a crucial step in order to improve their knowledge and skills to render patient-centered quality service to improve their patients' satisfaction. Using a checklist during service delivery may improve client patient interaction and ensure the standard. Facility design dimension can be considered for future research activities.

Current measures are not sufficient: an interview-based qualitative assessment of quality of life in cutaneous T-cell lymphoma

BACKGROUND

Cutaneous T-cell lymphoma (CTCL) negatively impacts quality of life (QoL), but existing QoL questionnaires may not comprehensively reflect patients' experience.

OBJECTIVES

To identify the aspects of QoL that are most meaningful to patients with CTCL and to evaluate existing QoL instruments in this context.

METHODS

Semistructured interviews were conducted between May and June 2019 using purposive sampling of patients with CTCL. Data were analysed by an inductive thematic approach using Dedoose Version 8.0.35.

RESULTS

One-on-one interviews lasting a median of 43 min were completed by 18 patients [median age 62 years (interquartile range 52-70); 39% advanced-stage (IIB-IV)]. Itch was the most common clinical symptom reported (16 of 18 patients), followed by pain (12 of 18), skin breaks (11 of 18) and skin flaking (10 of 18). Eleven patients reported that their symptoms interfered with sleep, which impacted daily functioning. Patients also noted a lack of understanding of the disease in the community and felt uncertain (12 of 18), depressed (11 of 18), suicidal (four of 18) and hopeless (nine of 18). Nearly all patients (17 of 18) reported a sense of 'otherness' (not feeling 'normal' or 'like themselves'), and most patients (16 of 18) specifically mentioned concern about their physical appearance. Patients also noted substantial treatment burden. Salient patient concerns, including individual clinical symptoms, concern about appearance and problems with sleep, were not adequately or consistently represented in generic, skin-specific or CTCL-specific QoL measures.

CONCLUSIONS

Incorporating the concerns and priorities that distinguish patients with CTCL from other patient populations will be of paramount importance in developing a comprehensive CTCL-specific measure of QoL that adequately captures patients' experience.

Revisiting the trajectory of medical students' empathy, and impact of gender, specialty preferences and nationality: a systematic review

BACKGROUND

Empathy allows a physician to understand the patient's situation and feelings and respond appropriately. Consequently, empathy gives rise to better diagnostics and clinical outcomes. This systematic review investigates the level of empathy among medical students across the number of educational years and how this level relates to gender, specialty preferences, and nationality.

METHOD

In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), the authors conducted a systematic search of studies published between February 2010 and March 2019 investigating the level of empathy among medical students. The databases PubMed, EMBASE, and PsycINFO were searched. Studies employing quantitative methodologies and published in English or Scandinavian language and examining medical students exclusively were included.

RESULTS

Thirty studies were included of which 24 had a cross-sectional and 6 a longitudinal study design. In 14 studies, significantly lower levels of empathy were reported by increase in the number of educational years. The remaining 16 studies identified both higher, mixed and unchanged levels. In 18 out of 27 studies it was reported that females had higher empathy scores than males. Only three out of nine studies found an association between empathy scores and specialty preferences. Nine out of 30 studies reported a propensity towards lower mean empathy scores in non-Western compared to Western countries.

CONCLUSION

The results revealed equivocal findings concerning how the empathy level among medical students develops among medical students across numbers of educational years and how empathy levels are associated with gender, specialty preferences, and nationality. Future research might benefit from focusing on how students' empathy is displayed in clinical settings, e.g. in clinical encounters with patients, peers and other health professionals.

Correct performance of subcutaneous injections in plaque psoriasis: comparison of trained and untrained patients with different application systems in routine clinical care

BACKGROUND

Moderate-to-severe plaque psoriasis can be treated very successfully with systemic therapies. Often the therapeutics must be injected subcutaneously. This prospective observational study aimed to compare the correct preparation and performance of subcutaneous injections in trained and untrained patients with plaque psoriasis.

MATERIALS AND METHODS

We asked 110 patients (29.1% women, 70.9% men, injection system: 75.5% prefilled syringe, 24.5% autoinjector) to what extent they were trained for self-injection. While participants injected a sham injection with their current system, we evaluated the preparation, execution, and follow-up using a newly developed scoring system.

RESULTS

87.3% (n = 96) of the participants declared that they had been trained for self-injection. No statistically significant difference was observed between the trained and untrained participants in performing the injection correctly (p = .458). The most common mistakes were the wrong preparation and follow-up of the injection. A bifactorial rank-variance analysis showed a negative influence of the factor injection system (prefilled syringe) on the total score (p = .005).

CONCLUSION

We can indicate that patients with plaque psoriasis are well prepared for subcutaneous self-injection. Self-injection of systemic therapies is easy to perform, especially with patient-friendly systems, and does not require specialized training.

Using artificial intelligence to analyse and teach communication in healthcare

Communication is a core component of effective healthcare that impacts many patient and doctor outcomes, yet is complex and challenging to both analyse and teach. Human-based coding and audit systems are time-intensive and costly; thus, there is considerable interest in the application of artificial intelligence to this topic, through machine learning using both supervised and unsupervised learning algorithms. In this article we introduce health communication, its importance for patient and health professional outcomes, and the need for rigorous empirical data to support this field. We then discuss historical interaction coding systems and recent developments in applying artificial intelligence (AI) to automate such coding in the health setting. Finally, we discuss available evidence for the reliability and validity of AI coding, application of AI in training and audit of communication, as well as limitations and future directions in this field. In summary, recent advances in machine learning have allowed accurate textual transcription, and analysis of prosody, pauses, energy, intonation, emotion and communication style. Studies have established moderate to good reliability of machine learning algorithms, comparable with human coding (or better), and have identified some expected and unexpected associations between communication variables and patient satisfaction. Finally, application of artificial intelligence to communication skills training has been attempted, to provide audit and feedback, and through the use of avatars. This looks promising to provide confidential and easily accessible training, but may be best used as an adjunct to human-based training.

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Artificial intelligence (AI) applied to health professional-patient communication enables efficient audit and feedback.

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Very recent advances have increased the ability of AI to encode the complexity in human interaction.

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AI can now encode words as well as a person does, as well as emotion and non-verbal aspects of communication.

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AI coding has been shown to be moderately to substantially reliable.

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Translation into the real world has yet to be demonstrated.

Is There a Correlation between Severity of Melasma and Quality of Life?

BACKGROUND:

Melasma is a common chronic acquired hyper melanosis. It has significant impacts on appearance, psychosocial and emotional distress, hence reducing the quality of life of the affected patients. Melasma quality of life scale (MelasQoL) is a new quality of life (QoL) questionnaire consists of 10 questions, scored from 1 to 7, with higher index scores indicating poor QoL. The severity of melasma can be assessed by the Melasma Area and Severity Index (MASI) score.

AIM:

We aimed to determine the correlation between the severity of melasma (MASI score) and quality of life.

MATERIAL AND METHODS:

This was a cross-sectional analytic study involving 30 subjects with melasma. The diagnosis was made based on history, clinical features and by Wood’s lamp examination. MASI score was determined to assess the severity of melasma. Subjects answered 10 items of MelasQol questionnaire. All collected data were processed and statistically analysed by Spearman correlation test to determine the association of MASI score with MelasQoL. Association of quality of life with clinical pattern and depth of lesion were analysed by Mann Whitney test.

RESULTS:

There was no significant correlation between MASI score and MelasQoL (p = 0.797; r = 0.049). Likewise, there was no association of quality of life with clinical pattern type (p = 0.12) and depth of lesion (p = 0.92).

CONCLUSION:

There was no significant correlation between the MASI score and quality of life.

Experience and perceived quality of care of patients and their attendants in a specialized mental hospital in Bangladesh

Background

A person’s perception of health service quality depends on his or her expectations and priorities. If the perception of care is good, then it eventually enhances future health service utilization, adherence to treatment and desired outcomes. Understanding a patient’s perspective is key for delivering a better quality patient-centred health care service. This study explored experience and perception of patients and their attendants of mental health care services at the National Institute of Mental Health (NIMH) which is the only national level mental health institute in Bangladesh. NIMH is located in the capital city and provides specialized mental health care services for the whole population.

Methods

A facility-based cross-sectional study was conducted using a mixed-method design at the NIMH. A total of 40 respondents (patients, or their attendants if the patient was minor or unable to respond due to lack of mental stability) visiting the outpatient department (OPD) of NIMH were selected by purposive sampling. For each of the ten ICD 10 categories (10th revision of International Classification of Diseases by the World Health Organization [WHO]) for mental disorders, four patients were chosen. Finally, 13 patients and 27 attendants (on behalf of 17 minor patients and 10 adult patients unable to respond) participated in the interview.

Results

The respondents rated 34 short statements clustered around four dimensions of care (accessibility, interpersonal communications, condition of the waiting and consultation rooms, and general quality of OPD services) and we interpreted those scores as follows: 7.6–10 very satisfied/very good quality, 5.1–7.5 satisfied/good quality, 2.6–5.0 dissatisfied/poor quality and 1.0–2.5 completely dissatisfied/very poor quality. For accessibility and interpersonal communications, the patients perceived care as very good (average scores on a Likert scale of 1–10 were 8.3 and 7.6, respectively). The respondents considered the condition of the waiting and consultation rooms and general quality of OPD care as good (average scores 5.8 and 7.1, respectively). NIMH had serious lack of resources in terms of functional medical equipment and physicians appointed, which negatively impacted on the service quality.

Conclusions

Patients receiving services from the NIMH OPD had a positive perception of the quality of care in general. But, at an individual level, some respondents expressed dissatisfaction. Our findings are informative for quality improvement and client-oriented care service planning at NIMH, Bangladesh.

Satisfaction With Services Among Attendees of Physiotherapy Outpatient Clinics in Tertiary Hospitals in Lagos State

Aim:

To determine outpatients’ satisfaction with physiotherapy services in tertiary hospitals in Lagos State, Nigeria.

Method:

This cross-sectional study utilized a simple random sampling method to recruit 284 participants. Participants responded to a 2-part structured questionnaire with 33-items on a 5-point Likert-type scale. Participants were asked questions about their satisfaction with physiotherapy services, staff attitudes, and the accessibility of outpatient physiotherapy clinics. Data were analyzed using descriptive analysis and χ².

Results:

About 28.8% of the participants were satisfied or very satisfied with the location of the outpatient physiotherapy clinics. The majority of the participants were satisfied or very satisfied with these physiotherapy services in maintaining privacy (86.2%), scheduling convenient clinic appointments (78.2%), prompt scheduling of the first physiotherapy clinic appointment (74.6%) and subsequent visits (78.9%), and providing a calm/relaxing atmosphere (90.1%). While 22.5% of the participants were satisfied or very satisfied with the waiting time in these physiotherapy clinics, 86.3% and 97.9% were satisfied or very satisfied with staff attitudes and the cost of the therapy, respectively. Almost all (97.9%) the participants reported being satisfied or very satisfied with their overall experience in the physiotherapy clinics. While there was an association between marital and educational status with overall satisfaction scores, age and gender showed no association.

Conclusion:

Our findings suggest that patients attending the outpatient physiotherapy clinics in tertiary hospitals in Lagos State, Nigeria, were satisfied or very satisfied with the domain that measured overall satisfaction. Strategies to reduce the waiting time in these physiotherapy clinics and to enhance physical accessibility of the physiotherapy clinics are encouraged.

Effect of Patient Participation on Nurse and Patient Outcomes in Inpatient Healthcare

Using service-dominant logic as a theoretical lens, this study investigated the co-production of healthcare service and service value co-creation between nurses and patients. The main objective of this study was to: (1) examine the effect of patient participation on patient satisfaction and nurses' attitudes and behaviors; (2) examine boundary conditions of the effect of patient participation on patients and nurses. We proposed that patient participation positively impacted patient satisfaction and nurse job satisfaction, work engagement, and helping behaviors. We further proposed that first inpatient stay and length of stay moderated the effect of patient participation on patient satisfaction, and nurses' sociodemographic characteristics moderated the effect of patient participation on nurse job satisfaction, work engagement, and helping behaviors. Using survey data from 282 nurses and 522 inpatients from a public hospital in China, we found that the effect of patient participation on patient satisfaction was contingent upon first inpatient stay and length of stay. We also found that patient participation improved nurse job satisfaction, work engagement, and helping behaviors. Furthermore, nurses' sociodemographic characteristics, namely age and organizational tenure, moderated the effect of patient participation on nurse job satisfaction, but not on work engagement and helping behaviors. Theoretical and practical implications of our findings were discussed.

Satisfaction and Awareness of Systemic Psoriasis Treatments: A National Survey Comparing Biologic and Nonbiologic Users

BACKGROUND:

There is ongoing development of new therapies for psoriasis, including biologic and systemic agents such as interleukin-17, interleukin-23, and phosphodiesterase-4 inhibitors. The development of these agents has changed the landscape of psoriasis treatment options.

OBJECTIVE:

The objective of this study was to characterize the impact of newer biologic and systemic agents approved by June 2016 on patient outcomes. We sought to evaluate and compare biologic users and nonbiologic systemic users with respect to their treatment awareness and satisfaction.

METHODS:

We conducted a national Canadian survey from July to September 2016 on adult patients with moderate-to-severe psoriasis using biologic agents or nonbiologic systemic agents as their current primary treatment modality. Patients were asked to evaluate their overall satisfaction with their treatment agent and their awareness of other treatment options. Responses from biologic and nonbiologic systemic users were compared.

RESULTS:

Overall, 343 participants were included (biologic users: n = 218; nonbiologic users: n = 125). Treatment satisfaction: Biologic users had a higher overall satisfaction score than nonbiologic users ( P < .001). Among nonbiologic agents, apremilast (62%) was associated with the highest satisfaction proportion. Among biologic agents, ustekinumab (77%) and adalimumab (72%) were associated with the highest proportions of satisfaction. With respect to treatment awareness, 30% of nonbiologic patients did not have enough information to form an opinion about biologics.

CONCLUSIONS:

This study demonstrates the greater treatment satisfaction of biologic users compared with nonbiologic users for moderate-to-severe psoriasis. Given that nearly one-third of nonbiologic users did not have enough information to form an opinion about biologic agents, physicians may consider counselling these patients on the use of biologic agents for psoriasis management.

A novel dermo-cosmetic product containing thermal spring water, sucralfate, copper sulfate, and zinc sulfate in the management of hand eczema

Background

The regular use of cosmetic products plays a role in the management of hand eczema (HE) and aids in improving barrier function reducing dryness, roughness, pruritus and improving quality of life (QoL). The aim of this open-label study was to assess the efficacy and the reparative effect of a dermo-cosmetic product on subjects suffering from HE after 7 and 21 days of daily application.

Methods

The product was a water-in-oil (W/O) emulsion containing the active ingredients Avène thermal spring water, sucralfate, and copper and zinc sulfates. In total, 32 subjects suffering from either contact dermatitis or climatic dermatitis participated in the trial. The modified total lesion symptom score and physician global assessment scores were used to describe the severity of HE. The safety of the product was assessed through clinical scoring. The subjective tolerance, and acceptance, were documented using a self-assessment questionnaire completed by the subjects. The impact of the dermatosis on QoL was evaluated using the Dermatology Life Quality Index.

Results

After 7 days of application, both the physician and subjects noticed a significant improvement in HE. The formula was very well tolerated and accepted. These benefits were correlated with a significant improvement in QoL.

Conclusion

The W/O emulsion used in this study demonstrated real benefits for the subjects suffering from contact dermatitis and climatic dermatitis.

Trichologist, Dermatotrichologist, or Trichiatrist? A Global Perspective on a Strictly Medical Discipline

Few dermatologic problems carry as much emotional overtones as the complaint of hair loss. The best way to alleviate the distress related to hair loss is to effectively treat it. In fact, one of the oldest medical professions is the Egyptian physician who specialized on diseases of the head. And yet, from ancient Egypt down to modern times, human hair has been the object of superstition and mystery. Remarkably and despite the genuine advances in effective medical treatments, hair cosmetics, and surgical procedures, phony hair loss solutions continue to be marketed with an amazing success. In 1860, a quasi-scientific interest in hair loss and hair care originated in a London barbershop and became known as trichology, with the Institute of Trichologists being founded. Other corporations successively followed internationally, but it was only in 2010 that the term dermatotrichologist was proposed for board-certified dermatologists dealing with the scientific study of the hair and scalp, in contrast to the trichologist who is rather associated with laity and cosmetics than with medical professionalism, or - worse - offers opportunities to possible imposters with a primary commercial interest. The new term "trichiatrist" is proposed, literally meaning the "medical treatment of the hair," to designate the strictly medical professional dealing with the hair and scalp in health and disease. Trichiatrists differ from trichologists by virtue of being physicians. The quality and stringency of their graduate medical training is identical to that of other physicians.

Factors associated with quality of life in facial melasma: a cross-sectional study

BACKGROUND

Melasma is a common chronic focal hypermelanosis that affects photexposed areas as face, mainly in women at fertile age. It inflicts a significant impact in quality of life; nevertheless, quality of life scores (e.g. MELASQoL) are not strongly correlated with clinical severity (e.g. MASI) in facial melasma, suggesting that different factors can influence the perception of disease beyond the clinical extension or the intensity of pigmentation.

OBJECTIVES

To explore clinical and socio-demographic aspects that influences MELASQoL scores.

METHODS

Cross-sectional study enrolling 155 adults (>18 y.o.) with facial melasma. MELASQoL, MASI, clinical and demographic information were assessed. The associations among factors were explored by multivariable methods.

RESULTS

The mean (SD) age of the participants was 39 (8) years, and 134 (86%) were females. The correlation (Spearman's rho) between MELASQoL and MASI was 0.35 (P < 0.05). In a multivariate regression, MELASQoL score was associated (P ≤ 0.05) to MASI score (β = 0.6), lower income (β = 6.8), be single (β = 4.2) and low education level (β = 5.0). At multiple correspondence analysis, MASI, sex, marriage, education and income were associated with MELASQoL, as well as MASI was associated to skin phototypes, income and education level.

CONCLUSION

The perception of life quality impairment in melasma is influenced by low scholarly, low family income, single marital status and greater clinical severity.

A Qualitative Investigation of the Impact of Acne on Health-Related Quality of Life (HRQL): Development of a Conceptual Model

INTRODUCTION

The negative impact of acne on aspects of health-related quality of life (HRQL) has been demonstrated in many quantitative studies; however, there has been relatively little qualitative research exploring the impact of acne and the use of topical treatment. The study aimed to explore the impact of moderate-severe acne on HRQL in adolescents and adults with inflammatory and non-inflammatory lesions and to develop a conceptual model to illustrate the impact. In addition, the study aimed to identify the attributes of topical acne treatments that are most important for patients.

METHODS

Thirty-four adolescents and 16 adults with moderate-severe acne who were currently/recently prescribed topical treatment were recruited in this cross-sectional qualitative study in the UK, Italy, and Germany. In-depth, semi-structured telephone interviews explored patients' experiences of acne and the impact it has on their HRQL, and their experience of topical treatments for acne. Data were analyzed using thematic analysis and a conceptual model was developed.

RESULTS

The analysis identified seven main areas of HRQL that are affected by acne: emotional functioning, social functioning, relationships, leisure activities, daily activities, sleep, and school/work. Also common throughout the interviews was the perception and reaction to acne from others, which potentially had an impact on all areas of HRQL. The conceptual model illustrates the impact on HRQL and the links between HRQL domains. For both adolescents and adults, it was most important for acne treatments to be fast-acting, non-irritating, and non-bleaching.

CONCLUSION

The results of this qualitative study demonstrate that moderate-severe acne has an extensive impact on adolescents' and adults' HRQL. The conceptual model illustrates the many areas of HRQL that are affected and draws attention to the importance of effective treatments for acne. The study also highlights topical acne treatment attributes that are most important for patients.

FUNDING

Meda, a Mylan company.

Patient Satisfaction with Pharmacist-Led Collaborative Follow-Up Care in an Ambulatory Rheumatology Clinic

OBJECTIVES

Patient satisfaction is known to increase with pharmacist intervention in general outpatient clinics and with nurse-led care in rheumatology clinics. The aim of the present study was to describe and compare patient satisfaction with two different types of care: a pharmacist physician collaborative model and a traditional physician model in a rheumatology clinic setting.

METHODS

A cross-sectional survey of inflammatory arthritis patients seen during a follow-up visit in Edmonton, Alberta, Canada, was conducted over a ten-week period. Patient satisfaction was measured using a modified version of the validated Leeds Satisfaction Questionnaire, which uses a five-point Likert scale to measure six dimensions of satisfaction, and compared between the collaborative care and traditional physician models.

RESULTS

A total of 62 patients completed the questionnaire (21 collaborative care and 41 traditional physician model). The average age of respondents was 52 years and the majority were female. The mean score for satisfaction across the six dimensions was 4.56 in the collaborative care group and 4.30 in the traditional physician group (p = 0.02). Patient satisfaction in the collaborative care group was consistently higher across all dimensions. No difference was noted between participants seen for the first time compared with those seen two or more times by the pharmacist.

CONCLUSIONS

A collaborative care model can exceed the already high expectations for care of patients with inflammatory arthritis. Our findings support the role of pharmacists using a collaborative care approach to care for patients in rheumatology clinics.

Concordance of Patient and Physician Perceptions of Care in an Orthopedic Clinic

It is essential to study whether physicians' perceptions align with their patients' views, as understanding patient perception leads to superior satisfaction and health outcomes. Previous studies have established differences in physician-patient perceptions, but no studies have been conducted in orthopedic clinics. The authors' primary goal was to evaluate differences in physician and patient perceptions of an orthopedic clinic visit. Their secondary objective was to determine the influence of visit length, demographics, and depression risk-level on patient satisfaction. The authors surveyed 143 new patients being seen by orthopedic surgeons at a level I trauma center. After their appointment, these patients completed surveys on satisfaction and likelihood of depression. The authors recorded wait times and visit lengths. Simultaneously, the physicians completed a self-evaluative satisfaction survey. Patients' and physicians' answers were compared using a Wilcoxon signed-rank test. Mann-Whitney and Spearman correlation analyses were used to assess factors that impact satisfaction. Physicians and patients showed no significant differences on most questions of the satisfaction survey, except that physicians reported feeling less satisfied with their own explanations (P<.001). Length of visit was positively correlated with patient satisfaction (R=0.276, P=.001), while waiting times had no effect. Patients at risk for depression were less satisfied with physicians' effort to include them in decision-making (P=.044). Age was a predictor of greater satisfaction with explanations (P=.032) and instructions (P=.009) from the physician. Thus, orthopedic clinics may not exhibit the same physician-patient perception patterns as primary care clinics, potentially because of differences in patient populations, conditions, or expectations. [Orthopedics. 2017; 40(4):242-246.].

Association between resource utilization and patient satisfaction at a tertiary care medical center

BACKGROUND

The Centers for Medicare and Medicaid Services has emphasized patient satisfaction as a means by which hospitals should be compared and as a component of financial reimbursement. We sought to identify whether resource utilization is associated with patient satisfaction ratings.

DESIGN

This was a retrospective, cohort study over a 27-month period from January 2012 to April 2014 of adult respondents (n = 10,007) to the Hospital Consumer Assessment of Healthcare Providers and Systems survey at a tertiary care medical center. For each returned survey, we developed a resource intensity score related to the corresponding hospitalization. We calculated a raw satisfaction rating (RSR) for each returned survey. Multivariable logistic regression was used to determine the association between resource intensity and top decile RSRs, using those with the lowest resource intensity as the reference group.

RESULTS

Adjusting for age, gender, insurance payer, severity of illness, and clinical service, patients in higher resource intensity groups were more likely to assign top decile RSRs than the lowest resource intensity group ("moderate" [adjusted odds ratio {aOR}: 1.42, 95% confidence interval {CI}: 1.11-1.83], "major" [aOR: 1.56, 95% CI: 1.22-2.01], and "extreme" [aOR: 2.29, 95% CI: 1.8-2.92]).

CONCLUSIONS

Resource utilization may be positively associated with patient satisfaction. These data suggest that hospitals with higher per-patient expenditures may receive higher ratings, which could result in hospitals with higher per-patient resource utilization appearing more attractive to healthcare consumers. Journal of Hospital Medicine 2016;11:785-791. © 2016 Society of Hospital Medicine.