Patients' satisfaction with outpatient psychiatric care

Treatment Preferences of Adolescents and Young Adults with Depressive Symptoms: A Discrete Choice Experiment

BACKGROUND

Depression in adolescents and young adults is common and causes considerable disease burden while hampering their development, leading to adverse consequences in later life. Although treatment is available, young people are a vulnerable group regarding uptake and completion of treatment. To improve this, insight into youth's preferences for treatment is essential.

OBJECTIVE

The aim of this study was to investigate patient preferences for depression treatment in a Dutch sample aged 16-24 years using a discrete choice experiment (DCE).

METHODS

The study was conducted in The Netherlands between October 2018 and June 2019, and included 236 adolescents and young adults with current depressive symptoms or previous treatment. The DCE included five attributes (treatment type, frequency of appointment, waiting time, effectiveness, evaluation of therapeutic alliance) with corresponding levels. Results were analysed using latent class analysis.

RESULTS

Results show a general preference for individual psychotherapy, treatment with high frequency, high effectiveness, short waiting time and a standard evaluation of the therapeutic alliance ('click' with the therapist) early in treatment. Latent class analysis revealed three different patterns of preferences regarding treatment type and willingness to engage in therapy. The first class showed a strong preference for individual therapy. The second class, including relatively older, higher educated and treatment-experienced participants, preferred high frequency treatment and was more open to different forms of therapy. The third class, including lower educated, younger and treatment-naïve adolescents showed reluctance to engage in therapy overall and in group therapy specifically.

CONCLUSION

In this DCE, three classes could be identified that share similar preferences regarding treatment effectiveness, waiting time and evaluation of the therapeutic alliance, but varied considerably in their preference for treatment type (individual, group, or combined psychotherapy) and their willingness to engage. The results from this study may inform mental health care providers and institutions and help optimize professional care for adolescents and young adults with depressive symptoms, improving engagement in this vulnerable group.

Quality in Psychiatric Care in the Community Mental Health Setting from the Perspective of Patients and Staff

The current paradigm of mental health care focuses on care provided in the community, increasingly moving away from hospital care models that involve considerable economic burden. Patient and staff perspectives on the quality of psychiatric care can highlight strengths and areas for improvement to ensure better care provision. The aim of this study was to describe and compare perceptions of quality of care among patients and staff in community mental health services and to determine possible relationships between these perceptions and other study variables. A comparative cross-sectional descriptive study was conducted in a sample of 200 patients and 260 staff from community psychiatric care services in the area of Barcelona (Spain). The results showed high overall levels of quality of care from patient (m = 104.35 ± 13.57) and staff (m =102.06 ± 8.80) perspectives. Patients and staff both gave high scores to Encounter and Support factors, while factors concerning patient Participation and Environment received the lowest scores. Continuous assessment of the quality of psychiatric care in the community setting is essential to ensure the highest quality of care, taking the perspectives of those involved into account.

Adaption and Cultural Validation of the Quality in Psychiatric Care-Outpatient Staff (QPC-OPS) Instrument to a Norwegian Community Mental Health Context

The aim was to culturally adapt and validate the Swedish Quality in Psychiatric Care-Outpatient Staff (QPC-OPS) instrument for use in a Norwegian community mental health service context. The translated and culturally adapted instrument was named Quality in Psychiatric Care-Community Outpatient Staff (QPC-COPS). Three expert panels of mental health staff (n = 9) assessed the face and content validity. The internal consistency and test–retest reliability were assessed on a sample of community mental health staff (n = 64). The QCP-COPS had adequate face and content validity, and the full instrument showed excellent internal consistency (alpha = 0.90) and test–retest reliability (ICC = 0.87:0.94). In conclusion, the QPC-COPS is a valid and reliable instrument suitable for measuring staff’s perception of the quality of care they deliver in community mental health services.

COVID-19 and Pakistan: a survey assessing the awareness of patients presenting to the outpatient departments of health care centers

Background: The coronavirus pandemic is one of the most disastrous calamities of modern times. The outpatient departments of health centers have an important role in the appropriate health education of the patients and their attendants regarding disease prevention and control.

Objective: The objective of this study was to help the health authorities in devising an effective strategy of educating the vulnerable population at their point of first contact with a health professional.

Methods: This descriptive cross-sectional study was conducted from 2 April 2020, to 17 July 2020, in the Punjab province of Pakistan. Data was entered and analyzed using the Statistical Package for Social Sciences (SPSS) version 23.0. A p-value of less than 0.05 was considered significant.

Results: Out of 238, 144 were males and 94 were females and the mean age was 34.53 years. Although television was the most common source of information (51.7%) a significant proportion of the people of Shorkot, i.e., 60.3% relied on word of mouth compared to that of other cities (p < 0.001). Almost 60% of the participants recognized all the symptoms correctly. The majority agreed that wearing a mask was effective in limiting transmission (96.6%) and about 80% of the participants considered the decision of the nation-wide lockdown to be a correct measure. In Shorkot, 32% of the people were against the decision of lockdown, which was significantly higher as compared to people from other cities (p < 0.001).

Conclusions: Our study demonstrated encouraging data regarding awareness of the included population in terms of COVID-19 symptoms and preventive measures.

Patients' perception of user involvement in psychiatric outpatient treatment: Associations with patient characteristics and satisfaction

BACKGROUND

The patient's right to be involved in treatment decisions is anchored in guidelines and legislation in many countries. Previous research suggests challenges in the implementation of user involvement across different areas of health care, including mental health. However, little is known about psychiatric outpatients' experiences of being involved in their treatment.

OBJECTIVE

To investigate how psychiatric outpatients after treatment rate the degree to which they were included in the treatment and explore the associations between perceived user involvement, demographic characteristics of the sample and patient satisfaction.

DESIGN

Cross-sectional.

SETTING AND PARTICIPANTS

The sample consisted of 188 psychiatric outpatients (67% female, mean age 42.2 years) who were discharged in the two years prior to data collection.

MAIN VARIABLES STUDIED

Perceived user involvement in psychiatric outpatient treatment and patient satisfaction as measured by the Psychiatric Out-Patient Experiences Questionnaire.

RESULTS

About half of the participants rated the overall degree of involvement in their treatment as high or very high. The lowest percentage of participants reporting high or very high involvement was found for sufficient information to contribute to treatment decisions (36%). Female gender, higher education and, to a small degree, younger age were associated with more involvement. Perceived user involvement was strongly associated with treatment satisfaction.

DISCUSSION AND CONCLUSION

The findings suggest that user involvement in psychiatric outpatient treatment can be improved. Patient information that facilitates user involvement should be given more attention.

PATIENT OR PUBLIC CONTRIBUTION

The hospital's user panel was involved in the development of items assessing user involvement.

Efficacy of a real-time patient feedback system: patient satisfaction study in psychiatry

Aim: The aim of the study was two-fold: first, to assess the efficacy of an electronic real-time feedback system; second, to examine patient satisfaction.Methods: This was a mixed-method study. Data were collected from two psychiatric outpatient clinics using electronic patient feedback devices. The efficacy of the real-time feedback system was assessed by calculating the overall response rate, and the response rate to each individual five-point Likert scale statement and open-ended question by using descriptive statistics. Patient satisfaction was examined by analyzing the response rate to each statement. Open-ended feedback was analyzed by using inductive qualitative content analysis.Results: The overall response rate was 21.0% (n = 1658) and response rates varied by statements. Most of the patients saw that they received the appointment to the outpatient clinic quickly enough (n = 1404, 85%), the personnel treated them well (n = 1126, 95%), the information about the care was understandable (n = 1066, 94%), and decisions regarding their care were made together with them (n = 1051, 94%). Of the patients, 94% (n = 1052) would recommend the service. Positive open-ended feedback highlighted good service, skilled staff, perceived benefits and help from care. Critique and development areas dealt with the large number of forms that required filling out beforehand, subjective experience of long waiting times, and having too many collaborative professionals present during treatment.Conclusions: The real-time feedback system proved to be an efficient method of gathering patient feedback. Patient satisfaction seemed to be high with received care in all fields.

Promoting OPD Patient Satisfaction through Different Healthcare Determinants: A Study of Public Sector Hospitals

Patient satisfaction is a core tool for measuring the performance of the hospitals as well as the service provider and the services that they are providing to the patients. The aim of this research is to evaluate how information received, medical equipment, distance from the hospital, and physical infrastructure influenced patient satisfaction at public hospitals in Southern Punjab, Pakistan. An exploratory research technique was used. We distributed 700 questionnaires through a random method, and 579 provided proper responses. A confirmatory factor analysis (CFA) and a regression analysis were used for the data analysis. The study results illustrated that medical equipment, information received, distance from the hospital, and physical infrastructure had significantly positive impacts (p = 0.001) on patient satisfaction. To promote higher level of satisfaction, there is a need to take appropriate steps for improvement.

Effectiveness and acceptance of a web-based depression intervention during waiting time for outpatient psychotherapy: study protocol for a randomized controlled trial

BACKGROUND

Due to limited resources, waiting periods for psychotherapy are often long and burdening for those in need of treatment and the health care system. In order to bridge the gap between initial contact and the beginning of psychotherapy, web-based interventions can be applied. The implementation of a web-based depression intervention during waiting periods has the potential to reduce depressive symptoms and enhance well-being in depressive individuals waiting for psychotherapy.

METHODS

In a two-arm randomized controlled trial, effectiveness and acceptance of a guided web-based intervention for depressive individuals on a waitlist for psychotherapy are evaluated. Participants are recruited in several German outpatient clinics. All those contacting the outpatient clinics with the wish to enter psychotherapy receive study information and a depression screening. Those adults (age ≥ 18) with depressive symptoms above cut-off (CES-D scale > 22) and internet access are randomized to either intervention condition (treatment as usual and immediate access to the web-based intervention) or waiting control condition (treatment as usual and delayed access to the web-based intervention). At three points of assessment (baseline, post-treatment, 3-months-follow-up) depressive symptoms and secondary outcomes, such as quality of life, attitudes towards psychotherapy and web-based interventions and adverse events are assessed. Additionally, participants' acceptance of the web-based intervention is evaluated, using measures of intervention adherence and satisfaction.

DISCUSSION

This study investigates a relevant setting for the implementation of web-based interventions, potentially improving the provision of psychological health care. The results of this study contribute to the evaluation of innovative and resource-preserving health care models for outpatient psychological treatment.

TRIAL REGISTRATION

This trial has been registered on 13 February 2017 in the German clinical trials register (DRKS); registration number DRKS00010282 .

Impact and change of attitudes toward Internet interventions within a randomized controlled trial on individuals with depression symptoms

BACKGROUND

Most individuals with depression do not receive adequate treatment. Internet interventions may help to bridge this gap. Research on attitudes toward Internet interventions might facilitate the dissemination of such interventions by identifying factors that help or hinder uptake and implementation, and by clarifying who is likely to benefit. This study examined whether attitudes toward Internet interventions moderate the effects of a depression-focused Internet intervention, and how attitudes change over the course of treatment among those who do or do not benefit.

METHODS

We recruited 1,004 adults with mild-to-moderate depression symptoms and investigated how attitudes toward Internet interventions are associated with the efficacy of the program deprexis, and how attitudes in the intervention group change from pre to post over a 3 months intervention period, compared to a control group (care as usual). This study consists of a subgroup analysis of the randomized controlled EVIDENT trial.

RESULTS

Positive initial attitudes toward Internet interventions were associated with greater efficacy (η²_p  = .014) independent of usage time, whereas a negative attitude (perceived lack of personal contact) was associated with reduced efficacy (η²_p  = .012). Users' attitudes changed during the trial, and both the magnitude and direction of attitude change were associated with the efficacy of the program over time (η²_p  = .030).

CONCLUSIONS

Internet interventions may be the most beneficial for individuals with positive attitudes toward them. Informing potential users about evidence-based Internet interventions might instill positive attitudes and thereby optimize the benefits such interventions can provide. Assessing attitudes prior to treatment might help identify suitable users.

Internet interventions for depression: new developments

A wide range of Internet interventions, mostly grounded in methods of cognitive behavioral therapy, have been developed and tested for several mental disorders. The evidence to date shows that these interventions are effective in reducing symptoms of depression. Metaanalyses report small-to-medium effect sizes when Internet interventions are delivered as stand-alone self-help interventions (d=0.25-0.36), and medium-to-large effect sizes when delivered as therapist-guided interventions (d=0.58-0.78), both compared with usual care. Only a minority of people suffering from depression receive adequate treatment, and Internet interventions might help bridge the large treatment gap. This review summarizes the current body of evidence and highlights pros and cons of Internet interventions. It also outlines how they could be implemented in mental health care systems and points out unresolved questions, as well as future directions, in this research field.

The effects of patient and physician characteristics on early outpatient satisfaction with substance dependence care: results of the SUBUSQOL study

BACKGROUND

Although patient perceptions of health care have increasingly been explored in the literature, little is known about care satisfaction among individuals with substance dependence. This exploratory study assessed the relationships between patient and physician characteristics and early outpatient satisfaction with care for alcohol and opioid dependence.

METHODS

Satisfaction was assessed using a multidimensional, self-administered and validated questionnaire during the early care process among a prospective outpatient cohort. In addition to measuring satisfaction and obtaining sociodemographic and clinical data, this study collected data on the self-reported health status and physician characteristics at inclusion. Cross-sectional analysis with multiple linear regression was performed to identify the variables associated with satisfaction level.

RESULTS

A total of 249 outpatients were included, and 63.8% completed the satisfaction questionnaire. Patients without a history of previous care for substance dependence were more satisfied with the appointment-making process (β=7.2; P=0.029) and with the doctor consultation (β=10.3; P=0.003) than those who had received care previously. Neither sociodemographic characteristics nor self-reported health status was associated with outpatient satisfaction.

CONCLUSION

The factors that affect patients' ratings of early satisfaction with the care that they receive should be studied further because increased understanding of the factors that negatively affect these ratings might enable caregivers and outpatient management facilities to improve the patient experience during the early stages of care, which might in turn improve treatment adherence, continuity of care, and other health-related outcomes.

Development of a questionnaire measuring Attitudes towards Psychological Online Interventions-the APOI

BACKGROUND

Only a minority of people suffering from depression receive adequate treatment. Psychological Online Interventions (POIs) could help bridge existing treatment gaps and augment the effectiveness of current treatments. Apart from effectiveness, user acceptance of POIs must be achieved if such interventions are to be broadly implemented in existing health-care. Valid measurement tools examining attitudes towards POIs are lacking. Therefore, we examined the dimensionality of attitudes towards POIs, developed a novel questionnaire, the Attitudes towards Psychological Online Interventions Questionnaire (APOI), and gathered data to examine its reliability.

METHODS

We recruited a sample of 1004 adults with mild to moderate depressive symptoms from a range of sources. We constructed a set of 35 items based on literature review as well as expert and patient queries. The initial items were subjected to an exploratory factor analysis (EFA) in a randomly selected subsample. A final set of 16 items was subjected to a confirmatory factor analysis (CFA) to cross-validate the factor structure in a separate subsample.

RESULTS

The EFA revealed four dimensions: "Scepticism and Perception of Risks", "Confidence in Effectiveness", "Technologization Threat" and "Anonymity Benefits". The model fit in the CFA was excellent relating to all applied indices (χ(2)=105.816, p=.651; SRMR=.042; RMSEA=.013; CFI=.994) and the APOI total scale showed acceptable to good internal consistency.

CONCLUSIONS

Further research with the APOI might facilitate the development and dissemination of POIs and, ultimately, help improve the quality of care for people experiencing depressive symptoms.

Participant satisfaction with Wellness Recovery Action Plan (WRAP)

Outpatient programs are often promoted as vehicles for mental health recovery. Yet, few programs include patients' perspectives about their satisfaction with these programs. This descriptive, cross-sectional survey investigated patients' satisfaction with Wellness Recovery Action Plan (WRAP). Participants completed the Mental Health Statistics Improvement Program instrument (n = 26) and qualitative interviews (n = 18). Data were analyzed using multivariate statistics (α = .05) and content analysis. Three composite variables explained 48% of the variance (p = .00) in patient satisfaction. Four themes emerged: Retrospective Desire for Early WRAP Introduction, Pay It Forward, Unconditional Relational Support, and It Takes Time. Future research is warranted to promote WRAP's use in broader settings.

The patient's view of quality in psychiatric outpatient care

The influence of demographic characteristics on patients' ratings of the quality of psychiatric outpatient care has been given little attention in research. The aim of the present study is to elucidate the quality of psychiatric care among outpatients and investigate demographic and clinical factors associated with the way in which this quality is perceived. A sample of 1340 outpatients from 15 general adult psychiatric clinics in Sweden completed the quality in psychiatric care-out-patient (QPC-OP), with a response rate of 71%. The patients' highest ratings were for Encounter; the lowest were for discharge. Most notably, quality of care was rated higher by women, older people, those with a partner, those with a lower educational level and those who were gainfully employed. In regard to visits to the clinic, higher quality of care was associated with shorter waiting time, better information and fewer professions encounters. Older people and those gainfully employed reported better mental health. Thus the QPC-OP was associated with both demographic and clinical factors. In particular, 'wanting to come back to the clinic' was the single strongest predictor of quality.

Psychometric properties of the quality in psychiatric care - outpatient (QPC-OP) instrument

The purpose of the present study was to test the psychometric properties and dimensionality of the Quality in Psychiatric Care - Outpatient (QPC-OP) instrument, in order to determine whether the model of QPC that is applicable to the inpatient clinic is also applicable to the outpatient clinic, and to briefly describe the patients' perceptions of quality of psychiatric outpatient care. A sample of 1340 outpatients from 15 general adult psychiatric clinics in Sweden participated in the study. A confirmatory factor analysis revealed that the QPC-OP consists of eight dimensions, and has a factor structure largely corresponding to that of the QCP - Inpatient instrument. The internal consistency of the factors was generally acceptable, except in the case of two, where there were not enough items. Thus, the QPC-OP shows adequate psychometric properties. The patients' ratings of quality of care were generally high; the highest rating was for 'encounter' and the lowest for 'discharge'. The quality of discharge was rated as the lowest among the eight dimensions in 14 of the participating outpatient clinics. Thus, this dimension would seem to indicate an important area for improvement. The QPC-OP includes important aspects of patients' assessments of quality of care, and offers a simple and inexpensive way to evaluate psychiatric outpatient care.

Breaking bad news: schizophrenia

The aim of this paper is to help physicians deliver the diagnosis of schizophrenia by adopting and adapting the popular oncology protocol, SPIKES. Data sources for the paper are PubMed searches (1984-2009), entering the phrase "breaking bad news." Of the 269 articles retrieved, those with face relevance to schizophrenia were selected and references contained in them were further searched. The conclusion of the paper is that, as in oncology, revealing a serious psychiatric diagnosis is emotionally difficult for both physician and patient; guidelines help, but individualization is essential.

Patients' rights to complain in Finnish psychiatric care: an overview

Cuts in resources for Finnish psychiatric care may jeopardize the realization of patients' rights in mental health settings. The right to complain is a basic right of all patients in Finland, and is especially important to patients treated involuntarily and also to those who have experienced coercive treatment methods during their hospitalizations. In Finland, a patient's right to complain is guaranteed by law, both in legislation and in national quality recommendations. The complaint process in Finland is very complex, and there are several ways to make a complaint that are not always familiar to patients with severe illnesses. Psychiatric patients may have cognitive impairments that make the formulation of a complaint difficult. Despite help from the patient ombudsman, unbalanced power structures in psychiatric hospitals, insufficient information and long evaluation of appeals makes the complaint process very demanding for psychiatric patients.

Mental health: patients' experiences of patient education during inpatient care

AIMS AND OBJECTIVES

This study aimed to explore psychiatric patients' experiences of patient education on psychiatric inpatient wards.

BACKGROUND

Patient education seems to be an effective way to support psychiatric patients' capacity for independent living, compliance and insight. Despite the development of various patient education interventions there is still a lack of coherent information on how to improve patient education in the field of psychiatric care, especially from patients' own perspectives.

DESIGN AND METHOD

Data were collected through interviews with 51 inpatients during their discharge process. This exploratory study employs a mixed methods design in data collection and analysis. The structured questions were analysed using descriptive statistics (percentages, frequencies, Mann-Whitney U-test, t-test). Open-ended questions were analysed using inductive content analysis.

RESULTS

Patients perceived different informational areas to be important for them, although some variation was found. However, patient education was not realized in these same areas. Problems related to patient education described by patients were lack of information, problems in patient-staff interaction and a lack of prerequisite knowledge among patients and staff. Patients' suggestions for future development of patient education were more innovative methods in patient education, paying attention to patient-staff interaction and personnel's professional knowledge. A majority of patients wanted to receive information through discussions with staff. However, other patient education methods were also suggested.

CONCLUSIONS

Patient education in psychiatric hospitals is an important area to be developed, therefore, more innovative methods should be developed and their effectiveness should be tested.

RELEVANCE TO CLINICAL PRACTICE

Development of patient education can be implemented through tailoring patient education to patients' individual needs and provide patient education using more innovative methods.

Measuring patient assessments of the quality of outpatient care: a systematic review

RATIONALE, AIMS AND OBJECTIVES

The aim of the study was to answer three questions: first, what methods have been used to measure patient assessments of the quality of care? Second, how do outpatients rate their care? And third, what needs to be taken into account in measuring patient assessments of the quality of care?

METHODS

Systematic review of the literature. Electronic searches were conducted on Medline, CINAHL and the Cochrane Database of Systematic Reviews. To be included, articles were to deal with patients' assessments of health care in ambulatory units for somatic adult patients. They were to have been published between January 2000 and May 2005, written in English, Swedish or Finnish with an English abstract, and the research was to have been conducted in Europe. The search terms used were: ambulatory care, ambulatory care facilities, outpatient, outpatients, patient satisfaction and quality of health care. The articles were screened by two independent reviewers in three phases.

RESULTS

Thirty-five articles were included. The quality of care was measured using both quantitative and qualitative methods. Only a few studies relied on the single criterion of patient satisfaction for quality measurements. It is easy to identify common sources of dissatisfaction in different studies. Sources of satisfaction are more closely dependent on the target population, the context and research design.

CONCLUSION

Patient satisfaction is widely used as one indicator among others in assessing the quality of outpatient care. However, there is no single, universally accepted method for measuring this.

Collective inquiry: understanding the essence of best practice construction in mental health

Delivering quality services has become a committed aspiration of mental health services over the past decade. Service planners look to validated care models to give guidance on what constitutes best practice. While there are many different views of what is 'best', there is a growing acknowledgement that services need to listen to the experiences of a network of frontline stakeholders in order to create quality mental health services. This paper describes an exploratory study within a regional mental health service that aimed to understand the meaning and enactment of best practice from the perspectives of a representative sample of service users and providers. A number of themes emerged as important and include the inherent value placed on consistent familial style relationships between service user and provider. This was deemed pivotal to the provision of expertise, good clinical decision-making, choice and collaboration. The study also highlighted stakeholder preference for autonomy and openness to inquiry into developing practice. In deconstructing the meaning of best practice, the study prompts a closer consideration of how best practice is created and suggests a view of best practice as a fluid dialogic process that is co-constructed by its participants in ongoing dialogic communication and reflection.

Patients' perspectives on information received in outpatient psychiatry

The purpose of this study is to develop a scale in order to determine the informational needs deemed most important by psychiatric outpatients, and to determine their level of satisfaction with information received. The 'Patients' Perspective on Information Questionnaire' (PPIQ) scale was created and given to a volunteer sample of 86 psychiatric outpatients. The Client satisfaction questionnaire (CSQ-8), assessing global satisfaction, was also completed to assess the convergent validity of the PPIQ-Satisfaction subscale. Internal consistency for the two PPIQ subscales (Information and Satisfaction) is excellent (alpha = 0.90 and 0.91). Convergent validity between the Satisfaction subscale and the CSQ is adequate (r = 0.5). The PPIQ reveals high importance ratings given to items such as 'side effects of medication' and 'confidentiality and access to chart'. Elevated satisfaction ratings are given to items from the conceptual category 'treatment information'. Dissatisfaction on the PPIQ is highest for components of 'information on service modality and organization'. The PPIQ appears to distinguish between information that is important to clients and their level of satisfaction with that information. Satisfaction on multiple components of information, such as treatment, service modality and organization, and clinical difficulties should be assessed to generate feedback to improve services.