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Pogorzelska K, Marcinowicz L, Chlabicz S. Understanding satisfaction and dissatisfaction of patients with telemedicine during the COVID-19 pandemic: An exploratory qualitative study in primary care. PLoS One 2023; 18:e0293089. [PMID: 37847684 PMCID: PMC10581451 DOI: 10.1371/journal.pone.0293089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/05/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Due to the COVID-19 pandemic, healthcare organizations had to face challenging circumstances and modify the usual modality of service provision, introducing telehealth services in their routine patient care to lessen the risk of direct human-to-human exposure. Patients expressed concerns about personal visits to healthcare units and the possibility of accessing telemedicine turned out to be an effective tool for the continuity of care. Due to the limited experience with telemedicine before the COVID-19 pandemic in Poland, we sought to fill this gap by studying the experiences of Polish patients. Our study aimed to understand how patients define satisfaction and dissatisfaction with telemedicine during the COVID-19 pandemic in primary care. MATERIAL AND METHODS Twenty semi-structured interviews with primary care patients in the Podlaskie Voivodeship, Poland were conducted to understand satisfaction with telemedicine. Interview transcripts were analyzed using qualitative content analysis. The qualitative content analysis process involved familiarizing ourselves with the data, extracting text regarding satisfaction and dissatisfaction with the teleconsultation, condensing it into meaningful units assigning codes to them, and organizing codes into subcategories and categories. The entire analysis process was done through reflection and discussion until a consensus was reached between the researchers. RESULTS From the participants' perspective, satisfaction with telemedicine was associated with receiving enough space to express their concerns. It was reported that they trusted their primary care physicians and felt comfortable during telemedicine consultations. Participants noted that connecting with a known, trusted doctor was more important than having a face-to-face visit with an unfamiliar physician. In our study, the participants equated satisfaction with treatment effectiveness. It was emphasized that in the event of unknown or unstable conditions, patients would prefer to be seen in person and receive a physical examination. CONCLUSION In our research telemedicine met with a positive reception and was recognized by the majority of patients who made use of it as a valuable channel of contact with a primary care physician. In order to increase the level of patient satisfaction, the focus should be on improving aspects such as physician engagement and showing empathy during telemedicine, as well as providing complete, exhaustive information on the treatment process. Respecting patient needs and preferences during performing telemedicine visits is the goal of patient-centered care.
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Affiliation(s)
- Karolina Pogorzelska
- Department of Family Medicine, The Medical University of Bialystok, Bialystok, Poland
| | - Ludmila Marcinowicz
- Department of Obstetrics, Gynecology and Maternity Care, The Medical University of Bialystok, Bialystok, Poland
| | - Slawomir Chlabicz
- Department of Family Medicine, The Medical University of Bialystok, Bialystok, Poland
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Rebolho RC, Raupp FM. Implementation costs of telephone nurse triage service. CAD SAUDE PUBLICA 2023; 39:e00095522. [PMID: 37075414 DOI: 10.1590/0102-311xen095522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 01/25/2023] [Indexed: 04/21/2023] Open
Abstract
Telephone nurse triage services are becoming increasingly common in healthcare systems worldwide. Florianópolis (Santa Catarina State, Brazil) is the first municipality in the country to provide this service in its public health system. This study adopted a quantitative, descriptive, and analytical methodology to evaluate the impact of this program on overall costs of the public health system. The research examined all 33,869 calls received by the telephone triage service from March 16 to October 31 in 2020, and calculated the program costs during the period. Avoided cost were calculated by the difference between estimated consultation costs considering patient-stated first alternative and the program recommendation after triage. Analyzing only the costs for the municipality of Florianópolis, the program's costs exceeded avoided costs by almost BRL 2.5 million during the period. By expanding the analysis to include costs of emergency department consultation - not administered by the municipality - based on data from previous research, we found that the program spares BRL 34.59 per call, a 21% cost reduction for the health system. Considering the preliminary results of the study and its limitations, it is understood that the service of telephone nurse triage can reduce costs in the healthcare system.
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Lize N, Raijmakers N, van den Berg M, Emmaneel L, Kok A, Lagendijk M, van Leeuwen-Bouwhuis K, van Lieshout R, Nagel Z, Beijer S. Patients with cancer experience high impact of emotional consequences of reduced ability to eat: A cross sectional survey study. Eur J Cancer Care (Engl) 2022; 31:e13595. [PMID: 35474252 DOI: 10.1111/ecc.13595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 03/16/2022] [Accepted: 03/28/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Patients with cancer can experience emotional consequences of reduced ability to eat, their impact is unknown. This study assesses the impact of these emotional consequences, and patients' satisfaction with healthcare professionals' (HCPs) support. METHODS A cross-sectional survey was conducted among patients with head/neck, lung cancer and lymphoma, who experienced reduced ability to eat in the past year. Patients were recruited through patient organisations and hospitals. The questionnaire encompassed the impact of emotional consequences of reduced ability to eat (scale 1-10) and satisfaction with HCPs' support for reduced ability to eat (scale 1-10). The differences in patient characteristics between unsatisfied (Score < 6) and satisfied patients (score ≥6) were tested using independent t-tests and the chi-square or Fishers' exact tests. RESULTS Overall, 116 patients (48%) responded and 98 were included in the analyses. The most impactful emotional consequences were as follows: disappointment (mean ± SD: 8.31 ± 1.49), grief/sadness (7.90 ± 1.91), and anger (7.87 ± 1.41). Patients were less satisfied when more time had passed since their diagnosis (p < 0.002) and when they expected no improvements regarding their eating problems (p < 0.001). CONCLUSION The impact of emotional consequences of reduced ability to eat is high. Support for emotional consequences is needed, especially for patients with reduced ability to eat, which persists in recovery and remission.
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Affiliation(s)
- Nora Lize
- Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Natasja Raijmakers
- Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.,Netherlands Association for Palliative Care, Utrecht, The Netherlands
| | | | | | - Annemieke Kok
- University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | | | | | - Zola Nagel
- Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Sandra Beijer
- Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
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Ayvat P, Arslan Yurtlu D, Özgürbüz U, Güntürkün F, Katircioğlu K, Kizilkaya M. Does Preoperative Anxiety Decrease with BATHE Method? A Prospective Randomized Study. ACTA ACUST UNITED AC 2020; 57:141-147. [PMID: 32550781 DOI: 10.29399/npa.24853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 12/04/2019] [Indexed: 11/07/2022]
Abstract
Introduction Preoperative anxiety due to anesthesia is a common situation and decreases with preoperative evaluation. The aim of this study is to determine whether utilization of BATHE method further decreases the anxiety scores of patients who are evaluated at an anesthesia clinic for preoperative examination. Methods The patients were randomized into "BATHE" and "Control" groups by using the closed envelope technique. State-Trait Anxiety Inventory (STAI) scores were recorded as entrance STAI for all patients. During preoperative evaluation, BATHE method was applied to the BATHE Group whereas it was not applied to the Control Group. Post-examination, STAI scores were recorded as exit STAI and the patients were later asked questions about their contentment. Results Data of 463 patients were included in the analysis. Demographic data was similar in the groups. In both groups the exit STAI scores (BATHE: 34.27±10.30, Control: 34.90±9.54) were lower in comparison to the entrance STAI scores (BATHE: 38.21±9.86, Control: 37.09±9.93). The mean gap between the entrance STAI and exit STAI scores of the BATHE (3.94±6.05) and Control groups (2.19±6.14) were statistically significant (p<0.001). Conclusion Utilization of BATHE method decreases the anxiety scores of preoperative patients to a greater extent, as measured by STAI index, in comparison to standard preoperative evaluation.
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Affiliation(s)
| | - Derya Arslan Yurtlu
- İzmir Katip Çelebi University, Atatürk Education and Research Hospital, Anesthesia Clinic, İzmir, Turkey
| | - Uğur Özgürbüz
- İzmir Katip Çelebi University, Atatürk Education and Research Hospital, Anesthesia Clinic, İzmir, Turkey
| | - Fatma Güntürkün
- University of Tennessee Health Science Center, Memphis, TN, USA
| | - Kaan Katircioğlu
- İzmir Katip Çelebi University, Atatürk Education and Research Hospital, Anesthesia Clinic, İzmir, Turkey
| | - Mehmet Kizilkaya
- İzmir Katip Çelebi University, Atatürk Education and Research Hospital, Anesthesia Clinic, İzmir, Turkey
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Zinger ND, Blomberg SN, Lippert F, Collatz Christensen H. Satisfaction of 30 402 callers to a medical helpline of the Emergency Medical Services Copenhagen: a retrospective cohort study. BMJ Open 2019; 9:e029801. [PMID: 31597649 PMCID: PMC6797474 DOI: 10.1136/bmjopen-2019-029801] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To keep healthcare systems sustainable for future demands, many countries are developing a centralised telephone line for out-of-hours primary care services. To increase the quality of such services, more information is needed on factors that influence caller satisfaction. The aim of this study was to identify demographic and call-related characteristics that are associated with the patient satisfaction of callers to a medical helpline in Denmark. DESIGN Retrospective cohort study on patient registry data and questionnaire results. SETTING Non-emergency medical helpline in the Capital Region of Denmark. PARTICIPANTS A random sample of 30 402 callers to the medical helpline between May 2016 and May 2018. PRIMARY AND SECONDARY OUTCOME MEASURES Responses of a satisfaction questionnaire were linked to demographic and call-related dispatch data. Associations between the characteristics were analysed with multivariable logistic regression analysis with satisfaction as the dependent variable. A subgroup analysis was performed on callers for children aged between 0 and 4 years. RESULTS Of the 30 402 analysed callers, 73.0% were satisfied with the medical helpline. Satisfaction was associated with calling for a somatic injury (OR: 1.96, 95% CI: 1.72 to 2.23), receiving a face-to-face consultation (OR: 2.27, 95% CI: 2.04 to 2.50) and a waiting time less than 10 min (OR: 1.82, 95% CI: 1.56 to 2.08). Callers for a 0-year to 4-year-old patient were more likely to be satisfied when they called for a somatic illness or received a telephone consultation, compared with the rest of the population (p<0.0001). CONCLUSION Callers were in general satisfied with the medical helpline. Satisfaction was associated with reason for encounter, triage response and waiting time. People calling for 0-year to 4-year-old patients were, compared with the rest of the population, more frequently satisfied when they called for a somatic illness or received a telephone consultation.
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Affiliation(s)
- Nienke Doreen Zinger
- Emergency Medical Services Copenhagen, University of Copenhagen, Copenhagen, Denmark
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Stig Nikolaj Blomberg
- Emergency Medical Services Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Freddy Lippert
- Emergency Medical Services Copenhagen, University of Copenhagen, Copenhagen, Denmark
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Tranberg M, Vedsted P, Bech BH, Christensen MB, Birkeland S, Moth G. Factors associated with low patient satisfaction in out-of-hours primary care in Denmark - a population-based cross-sectional study. BMC FAMILY PRACTICE 2018; 19:15. [PMID: 29325520 PMCID: PMC5765708 DOI: 10.1186/s12875-017-0681-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 12/08/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Low patient satisfaction with the quality of out-of-hours primary care (OOH-PC) has been linked with several individual and organizational factors. However, findings have been ambiguous and may not apply to the Danish out-of-hours (OOH) setting in which general practitioners (GPs) perform the initial telephone triage. This study aimed to identify patient-related, GP-related and organizational factors associated with low patient satisfaction. METHODS The study was based on data from a 1-year population-based survey of OOH-PC (LV-KOS) in the Central Denmark Region in 2010-2011. GPs on OOH duty completed an electronic questionnaire in the OOH computer system, and the registered patients received a subsequent postal questionnaire focusing on contact evaluation, waiting time, demographic characteristics and general self-perceived health. Associations were analysed using multivariable logistic regression with dissatisfaction as the dependent variable. RESULTS The patient response rate was 50.6%. For all contact types, 82.5% of the patients were satisfied with the OOH-PC service. More patients were dissatisfied with telephone consultations than with clinic consultations or home visits (8.5% vs. 6.0% and 4.3%, respectively). Contacts assessed by the GP as 'not severe' were associated with dissatisfaction for telephone consultations and home visits. Poor general self-perceived health was associated with dissatisfaction for all contact types. Living in urban areas was associated with dissatisfaction for telephone consultations, while unacceptable waiting time was associated with dissatisfaction for all contact types. CONCLUSIONS We found a high level of patient satisfaction with the OOH-PC service. The only factors affecting patient satisfaction across all contact types were unacceptable waiting time and poor general self-perceived health. For the other investigated factors, patient satisfaction depended on the type of contact. Generally, patients contacting for GP-assessed non-severe health problem and patients living in urban areas were more dissatisfied.
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Affiliation(s)
- Mette Tranberg
- Department of Public Health Programmes, Randers Regional Hospital, Østervangsvej 68, 8930, Randers NØ, Denmark.
| | - Peter Vedsted
- Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark
| | - Bodil Hammer Bech
- Section for Epidemiology, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark
| | - Morten Bondo Christensen
- Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark
| | - Søren Birkeland
- Department of Psychology, Faculty of Health Sciences, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
| | - Grete Moth
- Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark
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Ifediora CO, Rogers GD. Levels and predictors of patient satisfaction with doctor home-visit services in Australia. Fam Pract 2017; 34:63-70. [PMID: 27587567 DOI: 10.1093/fampra/cmw092] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The Australian after-hours house-call (AHHC) services has grown rapidly in the past few years. Even though recent studies have looked at aspects of the service as it concerns the medical personnel involved, no national study has explored patient satisfaction with the service. OBJECTIVE This study aims to assess patient satisfaction with Australian AHHC services and its predictors, with the hope of improving quality and patient outcomes. The findings might also have international relevance, given the developing nature of the AHHC in most countries. METHODS A cross-sectional survey of all 10838 patients known to have patronized the AHHC service in Australia over a 1-week period. The main outcome measure was the Patient Satisfaction Questionnaire 18 (PSQ-18). RESULTS A total of 1228 questionnaires were returned. General Satisfaction (GS) level was found to be 85.2% (mean 4.16/5). Other Scales of Satisfaction, in decreasing order, were 'Financial Aspects, FA' (87.4%; 4.36/5), 'Communication, CM' (87.3%; 4.18), 'Technical Quality, TA' (82.1%; 4.09), 'Time Spent with Doctor, TSD' (77.7%; 3.91), 'Interpersonal Manner, IM' (75.7%; 3.87) and 'Accessibility and Convenience, A&C' (72.9%; 3.82). The major predictor of increased satisfaction was the time it took the doctor to arrive, with increased satisfaction on GS (T < 4 hours; P < 0.01), IM (T < 30 minutes; P = 0.03), FA (T < 2 hours; P = 0.01), TSD (T < 2 hours; P < 0.01) and A&C (T < 4 hours; P < 0.01). Other positive predictors of aspects of satisfaction included 'being a student', 'age of patient ≤ 16' and 'being Australian born', while 'being on a pension' was negatively associated with Communication (P = 0.03). No associations were found with gender, marital status, employment status, family income or having children in the household. CONCLUSIONS This study concludes that satisfaction in Australian AHHC is high on all scales but recommends that the service providers should aim to attend to patients within 4 hours of their initial calls.
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Affiliation(s)
- Chris O Ifediora
- School of Medicine, Griffith University, Gold Coast Campus, Southport, Queensland, Australia.
| | - Gary D Rogers
- School of Medicine, Griffith University, Gold Coast Campus, Southport, Queensland, Australia
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Keizer E, Smits M, Peters Y, Huibers L, Giesen P, Wensing M. Contacts with out-of-hours primary care for nonurgent problems: patients' beliefs or deficiencies in healthcare? BMC FAMILY PRACTICE 2015; 16:157. [PMID: 26510620 PMCID: PMC4625560 DOI: 10.1186/s12875-015-0376-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 10/21/2015] [Indexed: 12/04/2022]
Abstract
Background In the Netherlands, about half of the patient contacts with a general practitioner (GP) cooperative are nonurgent from a medical perspective. A part of these problems can wait until office hours or can be managed by the patient himself without further professional care. However, from the patient’s perspective, there may be a need to contact a physician immediately. Our objective was to determine whether contacts with out-of-hours primary care made by patients with nonurgent problems are the result of patients’ beliefs or of deficiencies in the healthcare system. Methods We performed a survey among 2000 patients with nonurgent health problems in four GP cooperatives in the Netherlands. Two GPs independently judged the medical necessity of the contacts of all patients in this study. We examined characteristics, views and motives of patients with medically necessary contacts and those without medically necessary contacts. Descriptive statistics were used to describe the characteristics, views and reasons of the patients with medically unnecessary contacts and medically necessary contacts. Differences between these groups were tested with chi-square tests. Results The response rate was 32.3 % (N = 646). Of the nonurgent contacts 30.4 % were judged as medically necessary (95 % CI 27.0-34.2). Compared to patients with nonurgent but medically necessary contacts, patients with medically unnecessary contacts were younger and were more often frequent attenders. They had longer-existing problems, lower self-assessed urgency, and more often believed GP cooperatives are intended for all help requests. Worry was the most frequently mentioned motive for contacting a GP cooperative for patients with a medically unnecessary contact (45.3 %) and a perceived need to see a GP for patients with a medically necessary contact (44.2 %). Perceived availability (5.8 %) and accessibility (8.3 %) of a patient’s own GP played a role for some patients. Conclusion Motives for contacting a GP cooperative are mostly patient-related, but also deficiencies in access to general practice may partly explain medically unnecessary use. Efforts to change the use of GP cooperatives should focus on education of subgroups with an increased likelihood of contact for medically unnecessary problems. Improvement of access to daytime primary care may also decrease use of the GP cooperative.
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Affiliation(s)
- Ellen Keizer
- Radboud University Medical Center, Radboud Institute for Health Sciences, 114 IQ Healthcare, P.O. Box 9101, Nijmegen, 6500 HB, The Netherlands.
| | - Marleen Smits
- Radboud University Medical Center, Radboud Institute for Health Sciences, 114 IQ Healthcare, P.O. Box 9101, Nijmegen, 6500 HB, The Netherlands.
| | - Yvonne Peters
- Radboud University Medical Center, Radboud Institute for Health Sciences, 114 IQ Healthcare, P.O. Box 9101, Nijmegen, 6500 HB, The Netherlands.
| | - Linda Huibers
- Radboud University Medical Center, Radboud Institute for Health Sciences, 114 IQ Healthcare, P.O. Box 9101, Nijmegen, 6500 HB, The Netherlands. .,Aarhus University, Research Unit for General Practice, Aarhus, Denmark.
| | - Paul Giesen
- Radboud University Medical Center, Radboud Institute for Health Sciences, 114 IQ Healthcare, P.O. Box 9101, Nijmegen, 6500 HB, The Netherlands.
| | - Michel Wensing
- Radboud University Medical Center, Radboud Institute for Health Sciences, 114 IQ Healthcare, P.O. Box 9101, Nijmegen, 6500 HB, The Netherlands.
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Sebo P, Herrmann FR, Bovier P, Haller DM. What are patients' expectations about the organization of their primary care physicians' practices? BMC Health Serv Res 2015; 15:328. [PMID: 26272100 PMCID: PMC4536867 DOI: 10.1186/s12913-015-0985-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 08/05/2015] [Indexed: 11/10/2022] Open
Abstract
Background To our knowledge no study has at the same time assessed patients’ satisfaction and their expectations concerning the organizational and contextual aspects of health care provided by their primary care physician (PCP). Assessing these aspects is important to inform future primary healthcare service planning. Our objective was thus to document patients’ satisfaction with and expectations from their PCP, in terms of availability and organization of their practices, and to assess whether these indicators varied across age groups and type of practice (solo, duo, group). Methods Cross-sectional study based on the answers to questionnaires completed by patients consulting their PCP in Geneva, Switzerland. A random sample of PCPs was asked to recruit consecutively between 50 and 100 patients coming to the practice for a scheduled medical consultation. The patients were asked to complete an anonymous questionnaire centered on their satisfaction levels and expectations towards their PCP. Results One thousand six hundred thirty-seven patients agreed to participate (participation rate: 97 %, women: 63 %, mean age: 54 years). Patient satisfaction was high for all the items, except for the availability of the doctor by phone and for the waiting time in the waiting room. The satisfaction rate increased with age and was higher for small practices. In relation to patients’ expectations from their doctor, older patients and patients visiting larger practices tended to be more demanding. Conclusions Patients are generally highly satisfied with their PCP. They have a wide range of expectations which should be taken into account when considering potential improvements.
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Affiliation(s)
- Paul Sebo
- Primary Care Unit, Faculty of medicine, University of Geneva, Geneva, Switzerland.
| | - François R Herrmann
- Geriatrics Division, Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland.
| | | | - Dagmar M Haller
- Primary Care Unit, Faculty of medicine, University of Geneva, Geneva, Switzerland. .,Department of Community, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland. .,Department of Pediatrics, Geneva University Hospitals, Geneva, Switzerland.
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Allemann Iseli M, Kunz R, Blozik E. Instruments to assess patient satisfaction after teleconsultation and triage: a systematic review. Patient Prefer Adherence 2014; 8:893-907. [PMID: 25028538 PMCID: PMC4077851 DOI: 10.2147/ppa.s56160] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patient satisfaction is crucial for the acceptance, use, and adherence to recommendations from teleconsultations regarding health care requests and triage services. OBJECTIVES Our objectives are to systematically review the literature for multidimensional instruments that measure patient satisfaction after teleconsultation and triage and to compare these for content, reliability, validity, and factor analysis. METHODS We searched Medline, the Cumulative Index to Nursing and Allied Health Literature, and PsycINFO for literature on these instruments. Two reviewers independently screened all obtained references for eligibility and extracted data from the eligible articles. The results were presented using summary tables. RESULTS We included 31 publications, describing 16 instruments in our review. The reporting on test development and psychometric characteristics was incomplete. The development process, described by ten of 16 instruments, included a review of the literature (n=7), patient or stakeholder interviews (n=5), and expert consultations (n=3). Four instruments evaluated factor structure, reliability, and validity; two of those four demonstrated low levels of reliability for some of their subscales. CONCLUSION A majority of instruments on patient satisfaction after teleconsultation showed methodological limitations and lack rigorous evaluation. Users should carefully reflect on the content of the questionnaires and their relevance to the application. Future research should apply more rigorously established scientific standards for instrument development and psychometric evaluation.
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Affiliation(s)
| | - Regina Kunz
- Academy of Swiss Insurance Medicine, University of Basel, Basel, Switzerland
| | - Eva Blozik
- Swiss Center for Telemedicine Medgate, Basel, Switzerland
- Department of Primary Medical Care, University Medical Center Hamburg–Eppendorf, Martinistrasse, Hamburg, Germany
- Correspondence: Eva Blozik, Department of Primary Medical Care, University Medical Center Hamburg–Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany, Tel +49 40 741 052 400, Fax +49 40 741 053 681, Email
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Smits M, Huibers L, Oude Bos A, Giesen P. Patient satisfaction with out-of-hours GP cooperatives: a longitudinal study. Scand J Prim Health Care 2012; 30:206-13. [PMID: 23113756 PMCID: PMC3520414 DOI: 10.3109/02813432.2012.735553] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE For over a decade, out-of-hours primary care in the Netherlands has been provided by general practitioner (GP) cooperatives. In the past years, quality improvements have been made and patients have become acquainted with the service. This may have increased patient satisfaction. The objective of this study was to examine changes in patient satisfaction with GP cooperatives over time. DESIGN Longitudinal observational study. A validated patient satisfaction questionnaire was distributed in 2003-2004 (T1) and 2007-2008 (T2). Items were rated on a scale from 0 to 10 (1 = very bad; 10 = excellent). SETTING Eight GP cooperatives in the Netherlands. SUBJECTS Stratified sample of 9600 patients. Response was 55% at T1 (n = 2634) and 51% at T2 (n = 2462). MAIN OUTCOME MEASURES Expectations met; satisfaction with triage nurses, GPs, and organization. RESULTS For most patients the care received at the GP cooperative met their expectations (T1: 86.1% and T2: 88.4%). Patients were satisfied with the triage nurses (overall grade T1: 7.73 and T2: 7.99), GPs (T1: 8.04 and T2: 8.25), and organization (overall grade T1: 7.60 and T2: 7.78). Satisfaction with triage nurses showed the largest increase over time. The quality and effectiveness of advice or treatment were given relatively low grades. Of all organizational aspects, the lowest grades were given for waiting times and information about the cooperative. CONCLUSION In general, patients were initially satisfied with GP cooperatives and satisfaction had even increased four years later. However, there is room for improvement in the content of the advice, waiting times, and information supply. More research is needed into satisfaction of specific patient groups.
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Affiliation(s)
- Marleen Smits
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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van Ierland Y, Seiger N, van Veen M, van Meurs AHJ, Ruige M, Oostenbrink R, Moll HA. Self-referral and serious illness in children with fever. Pediatrics 2012; 129:e643-51. [PMID: 22371470 DOI: 10.1542/peds.2011-1952] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The goal of this study was to evaluate parents' capability to assess their febrile child's severity of illness and decision to present to the emergency department. We compared children referred by a general practitioner (GP) with those self-referred on the basis of illness-severity markers. METHODS This was a cross-sectional observational study conducted at the emergency departments of a university and a teaching hospital. GP-referred or self-referred children with fever (aged <16 years) who presented to the emergency department (2006-2008) were included. Markers for severity of illness were urgency according to the Manchester Triage System, diagnostic interventions, therapeutic interventions, and follow-up. Associations between markers and referral type were assessed by using logistic regression analysis. Subgroup analyses were performed for patients with the most common presenting problems that accompanied the fever (ie, dyspnea, gastrointestinal complaints, neurologic symptoms, fever without specific symptoms). RESULTS Thirty-eight percent of 4609 children were referred by their GP and 62% were self-referred. GP-referred children were classified as high urgency (immediate/very urgent categories) in 46% of the cases and self-referrals in 45%. Forty-three percent of GP referrals versus 27% of self-referrals needed extensive diagnostic intervention, intravenous medication/aerosol treatment, hospitalization, or a combination of these (odds ratio: 2.0 [95% confidence interval: 1.75-2.27]). In all subgroups, high urgency was not associated with referral type. GP-referred and self-referred children with dyspnea had similar frequencies of illness-severity markers. CONCLUSIONS Although febrile self-referred children were less severely ill than GP-referred children, many parents properly judged and acted on the severity of their child's illness. To avoid delayed or missed diagnoses, recommendations regarding interventions that would discourage self-referral to the emergency department should be reconsidered.
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Affiliation(s)
- Yvette van Ierland
- Department of General Pediatrics, Erasmus MC/Sophia Children’s Hospital, Rotterdam, Netherlands.
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13
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Schweitzer B, Blankenstein N, Deliens L, van der Horst H. Out-of-hours palliative care provided by GP co-operatives in the Netherlands: A focus group study. Eur J Gen Pract 2011; 17:160-6. [DOI: 10.3109/13814788.2011.584182] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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14
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Carr-Bains S, Nightingale AL, Ballard KD. Patients' experiences and satisfaction with out-of-hours GP home visiting provided by a GP cooperative. Fam Pract 2011; 28:88-92. [PMID: 20829278 DOI: 10.1093/fampra/cmq071] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Within the UK, patients place a fairly high value on the out-of-hours GP home visiting service. Although satisfaction with the range of out-of-hours services has been found to be high, little is known about patients' specific experiences of the home visiting services. OBJECTIVE To investigate the satisfaction with, and experiences of, patients receiving a GP out-of-hours (OOH) home visit from a GP cooperative. METHODS A postal questionnaire study sent to all patients receiving a home visit from a single cooperative. The questionnaire asked patients a range of questions about their experiences of the home visiting service that they received and also contained a validated satisfaction measure. RESULTS The OOH home visiting services largely provide care for an older population, most of whom consider that they are either too ill to travel or have limited mobility. The majority (43%) of home visits are made during the daytime at weekends, with just 25% of visits made during the night-time. If the home visit was not available, 67% of patients stated that they would have phoned for an ambulance or gone directly to hospital. The majority of patients (87%) were satisfied with the overall home visiting service that they received; however, 32% of patients were dissatisfied with the time it took for them to see a doctor or a nurse. CONCLUSIONS Although the OOH services have received considerable criticism over the past 5 years, this study reveals that patients remain largely satisfied with the service and would have called 999 or gone directly to hospital if there had been no service.
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Danielsen K, Bjertnaes OA, Garratt A, Forland O, Iversen HH, Hunskaar S. The association between demographic factors, user reported experiences and user satisfaction: results from three casualty clinics in Norway. BMC FAMILY PRACTICE 2010; 11:73. [PMID: 20925930 PMCID: PMC2967516 DOI: 10.1186/1471-2296-11-73] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Accepted: 10/06/2010] [Indexed: 11/16/2022]
Abstract
Background User reported experiences and satisfaction are increasingly used as basis for quality indicators in the health sector. However, there is limited understanding of factors associated with user reported experiences and satisfaction with casualty clinics. Methods A random sample of 542 patients that had contacted any of three casualty clinics from mid April to mid May 2008 was mailed a questionnaire. A reminder was sent to non-respondents after six weeks. Descriptive statistics for four user reported experiences scales and 20 single items are presented. Multivariate regression analysis was used to assess associations between background variables and user reported experiences, and between user reported experiences and user satisfaction. Results 225 (41.5%) patients, carers and guardians returned a completed questionnaire. Users reported most positive experiences with the doctor services and the nursing services at the casualty clinics; on a scale from 0 to 100, where 100 is the best possible experience the doctor scale was 82 and the nursing scale 81. Users reported least positive experiences with the organization of the casualty clinic, with a scale score of 65. Self perceived health was associated with user satisfaction, while self perceived health and age were associated with user reported experiences with organization of the clinics. A range of user reported experience domains were related to user satisfaction, after controlling for socio-demographic variables, including experiences with doctor services at the clinics, organization of the clinics, information and self perceived incorrect treatment. Conclusions Users report positive experiences with the three casualty clinics, with organization as the aspect with largest improvement potential. The importance of age and health status for users' experiences and satisfaction with casualty clinics was shown, but a range of user reported experiences with the clinics were the most important predictors for user satisfaction.
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Affiliation(s)
- Kirsten Danielsen
- Norwegian Knowledge Centre for the Health Services, PO Box 7004 St, Olavs plass, 0130 Oslo, Norway.
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16
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Hammink A, Giesen P, Wensing M. Pre-notification did not increase response rate in addition to follow-up: a randomized trial. J Clin Epidemiol 2010; 63:1276-8. [PMID: 20566266 DOI: 10.1016/j.jclinepi.2010.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2009] [Revised: 03/05/2010] [Accepted: 03/12/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Although there is growing evidence on the effectiveness of pre-notification and follow-up on response rates in patient surveys, no studies report the effectiveness of pre-notification in addition to follow-up. The aim of this study was to determine the effect of a pre-notification by mail on the response rate in a patient survey with follow-up, compared with follow-up or pre-notification only. STUDY DESIGN AND SETTING Randomized trial that compared (1) a combination of pre-notification and follow-up with (2) pre-notification only and (3) follow-up only. The trial was integrated in a survey study among patients, which measured their experiences with general practice cooperatives for out-of-hour care. RESULTS Of the total number of 880 patients who received the questionnaire, 45% returned it. No significant effect was found of the combination of pre-notification and follow-up compared with the two other arms of the trial. CONCLUSION Adding pre-notification to follow-up in a patient survey had no additional effect on the response rate. This finding must be interpreted with respect to the questionnaire and the study population.
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Affiliation(s)
- Alice Hammink
- IQ healthcare, Radboud University Nijmegen Medical Centre, Geert Grooteplein 21, Nijmegen, The Netherlands.
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17
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Garratt AM, Danielsen K, Forland O, Hunskaar S. The Patient Experiences Questionnaire for Out-of-Hours Care (PEQ-OHC): data quality, reliability, and validity. Scand J Prim Health Care 2010; 28:95-101. [PMID: 20433404 PMCID: PMC3442324 DOI: 10.3109/02813431003768772] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To develop and evaluate the Patient Experiences Questionnaire for Out-of-Hours Care (PEQ-OHC) in Norway. DESIGN Questionnaire development was based on a systematic literature review of existing questionnaires, interviews with users, and expert group consultation. Questionnaire testing followed a postal survey of users who had attended out-of-hours centres in the North, West, and South of Norway. SETTING Primary care out-of-hours services. SUBJECTS The questionnaire was pre-tested with 13 users and was then mailed to 542 users who had had telephone contact and/or had a consultation with one of three out-of-hours centres. MAIN OUTCOME MEASURES Data quality, internal consistency, reliability, and construct validity. RESULTS The questionnaire was considered to have good content validity by the expert group. There were 225 (41.51%) respondents to the postal questionnaire. Levels of missing data at the item and scale level were acceptable. Principal component analysis supported the four scales of user experiences relating to telephone contact, doctor services, nursing services, and organization. Item-total correlations were all above 0.5 and Cronbach's alpha was above 0.80 for all scales. Statistically significant associations based on explicit hypotheses were evidence for the construct validity of the PEQ-OHC. CONCLUSION The development of the PEQ-OHC followed a rigorous process based on a systematic review, interviews with users, and an expert group which lend the questionnaire content validity. The PEQ-OHC has evidence for data quality, internal consistency, reliability, and construct validity.
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Affiliation(s)
- Andrew M. Garratt
- National Resource Centre for Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo
- Norwegian Knowledge Centre for the Health Services, Oslo
| | | | - Oddvar Forland
- National Centre for Emergency Primary Care, Bergen
- Haraldsplass Deaconess University College, Bergen
| | - Steinar Hunskaar
- National Centre for Emergency Primary Care, Bergen
- Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway
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Schweitzer B, Blankenstein N, Willekens M, Terpstra E, Giesen P, Deliens L. GPs' views on transfer of information about terminally ill patients to the out-of-hours co-operative. BMC Palliat Care 2009; 8:19. [PMID: 20028504 PMCID: PMC2807852 DOI: 10.1186/1472-684x-8-19] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2008] [Accepted: 12/22/2009] [Indexed: 12/04/2022] Open
Abstract
Background In the Netherlands, the increase in of out-of-hours care that is provided by GP co-operatives is challenging the continuity of care for the terminally ill in general practice. Aim of this study is to investigate the views of general practitioners (GPs) on the transfer of information about terminally ill patients to the GP co-operatives. GPs were asked to give their view from two different perspectives: as a GP in their daily practice and as a locum in the GP co-operative. Methods Retrospective web based questionnaire sent to all 424 GPs in the Amsterdam region. Results With a response rate of 42%, 177 physicians completed the questionnaire. Transfer of information to the GP co-operative about most of their terminally ill patients was reported by 82% of the GPs and 5% did not do so for any of their patients. A faster than foreseen deterioration of the patient's situation was the most frequently reported reason for not transferring information. Of those who transferred information to the GP co-operative, more than 95% reported that they provided information about the diagnosis and terminally ill status of the patient. Information about medication, patient wishes regarding treatment, and prognosis was reported by respectively 90%, 87%, and 74% of the GPs. Less than 50% of the GPs reported that they transferred information about the patient's awareness of both the diagnosis and the prognosis, about the psychosocial context, and intolerances. In their role as locum, over 90% of the GPs wanted to receive information about the diagnosis, the terminally ill status of the patient, the medication and the patient's wishes regarding treatment. Conclusions Although most GPs reported that they transferred information about their terminally ill patients to the GP co-operative, the content of this information varies considerably. Only 21% of the GPs, working out of hours as a locum, were satisfied with the quality of the information transferred.
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Schweitzer BPM, Blankenstein N, Deliens L, van der Horst H. Out-of-hours palliative care provided by GP co-operatives: availability, content and effect of transferred information. BMC Palliat Care 2009; 8:17. [PMID: 19943956 PMCID: PMC2789043 DOI: 10.1186/1472-684x-8-17] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2009] [Accepted: 11/28/2009] [Indexed: 11/26/2022] Open
Abstract
Background Out-of-hours GP care in England, Denmark and the Netherlands has been reorganised and is now provided by large scale GP co-operatives. Adequate transfer of information is necessary in order to assure continuity of care, which is of major importance in palliative care. We conducted a study to assess the availability, content and effect of information transferred to the GP co-operatives. Methods Cross-sectional exploratory study of all palliative care phone calls during a period of one year to a GP co-operative. Results The total number of phone calls about patients who needed palliative care was 0.75% of all calls to the GP co-operative. Information was transferred by GPs on 25.5% of palliative care patient calls, and on 12% of palliative care patient calls from residential care homes. For terminally ill patients the number of information transfers increased to 28.9%. When information was transferred, the content consisted mainly of clinical data. Information about the diagnosis and current problems was transferred in more than 90% of cases, information about the patient's wishes in 45% and information about the patient's psychosocial situation in 30.5% of cases. A home visit was made after 53% of the palliative care calls. When information was transferred, fewer patients were referred to a hospital. Conclusion GPs frequently fail to transfer information about their palliative care patients to the GP co-operatives. Locums working at the GP co-operative are thus required to provide palliative care in complex situations without receiving adequate information GPs should be encouraged and trained to make this information available to the GP co-operatives.
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Affiliation(s)
- Bart P M Schweitzer
- Department of General Practice, and EMGO+Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.
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Users' reports and evaluations of out-of-hours health care and the UK national quality requirements: a cross sectional study. Br J Gen Pract 2009; 59:e8-15. [PMID: 19105911 DOI: 10.3399/bjgp09x394815] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND National standards for delivery of out-of-hours services have been refined. Health service users' preferences, reports, and evaluations of care are of importance in a service that aims to be responsive to their needs. AIM To investigate NHS service users' reports and evaluations of out-of-hours care in the light of UK national service quality requirements. DESIGN Cross sectional survey. SETTING Three areas (Devon, Cornwall, Sheffield) of England, UK. METHOD Participants were 1249 recent users of UK out-of-hours medical services. Main outcome measures were: users' reports and evaluations of out-of-hours services in respect of the time waiting for their telephone call to the service to be answered; the length of time from the end of the initial call to the start of definitive clinical assessment ('call back time'); the time waiting for a home visit; and the waiting time at a treatment centre. RESULTS UK national quality requirements were reported as being met by two-thirds of responders. Even when responders reported that they had received the most rapid response option for home visiting (waiting time of 'up to an hour'), only one-third of users reported this as 'excellent'. Adverse evaluations of care were consistently related to delays encountered in receiving care and (for two out of four measures) sex of patient. For 50% of users to evaluate their care as 'excellent', this would require calls to be answered within 30 seconds, call-back within 20 minutes, time spent waiting for home visits of significantly less than 1 hour, and treatment centre waiting times of less than 20 minutes. CONCLUSION Users have high expectations of UK out-of-hours healthcare services. Service provision that meets nationally designated targets is currently judged as being of 'good' quality by service users. Attaining 'excellent' levels of service provision would prove challenging, and potentially costly. Delivering services that result in high levels of user satisfaction with care needs to take account of users' expectations as well as their experience of care.
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Moll van Charante EP, ter Riet G, Bindels P. Self-referrals to the A&E department during out-of-hours: patients' motives and characteristics. PATIENT EDUCATION AND COUNSELING 2008; 70:256-265. [PMID: 18063340 DOI: 10.1016/j.pec.2007.10.012] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2007] [Revised: 09/26/2007] [Accepted: 10/21/2007] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To determine self-referrals' motives to visit the accident & emergency departments (AED) and to compare their characteristics to patients contacting the GP cooperative. METHODS Postal questionnaires were send to AED self-referrals and logistic regression analysis was used to contrast self-referrals to patients contacting the GP cooperative. RESULTS For a study population of 62,000, during 4 months, 5547 contacts were registered with the GP cooperative, along with 808 AED contacts, 344 of whom (43%) were self-referrals. Main reasons to visit the AED were the perceived need for diagnostic facilities and the conviction that the hospital specialist was best qualified to handle the problem. Dissatisfaction with the GP cooperative among respondents was high. Self-referral to the AED was positively associated with injury, age between 15 and 64, musculoskeletal, cardiovascular and respiratory problems, and distance to the GP centre. CONCLUSION Self-referrals emerge as patients with a strong preference for the AED, mainly based on assumptions on quality of care and necessary facilities. PRACTICE IMPLICATIONS While self-referrals may, in part, make motivated and appropriate choices to visit the AED, new integrated care models should be studied that can adequately deflect those who are eligible for GP care.
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Affiliation(s)
- Eric Peter Moll van Charante
- Department of General Practice, Academic Medical Centre-University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands.
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Giesen P, Moll van Charante E, Mokkink H, Bindels P, van den Bosch W, Grol R. Patients evaluate accessibility and nurse telephone consultations in out-of-hours GP care: determinants of a negative evaluation. PATIENT EDUCATION AND COUNSELING 2007; 65:131-6. [PMID: 16939708 DOI: 10.1016/j.pec.2006.06.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2006] [Revised: 06/27/2006] [Accepted: 06/29/2006] [Indexed: 05/11/2023]
Abstract
OBJECTIVE The shift towards large-scale organization of out-of-hours primary healthcare in different western countries has created an important role for the nurse telephone consultation. We explored the association between negative patient evaluation of nurse telephone consultations and characteristics of patients and GP cooperatives. METHODS A cross-sectional study using postal patient questionnaires sent to patients receiving a nurse telephone consultation from one of 26 GP cooperatives in the Netherlands. RESULTS The total response was 49.3% (2583/5239). Negative evaluations were most frequently encountered for the general information received on the GP cooperative (35%). When patients expected a centre consultation or home visit, but only received a nurse telephone consultation, they were more negative about the accessibility (OR 1.7, CI 1.4-2.1) and nurse telephone consultation (OR 4.2, CI 3.2-5.6). In the presence of a special supervising telephone doctor at the cooperative's call centre, nurse telephone consultation was evaluated significantly less negative (OR 0.4, CI 0.2-0.8). CONCLUSION Expectation of care mode was most strongly associated with a negative evaluation of nurse telephone consultation. The presence of a supervising telephone doctor may lead to a better evaluation of nurse telephone consultations. PRACTICE IMPLICATIONS More attention should be paid to the provision of patient information on the GP cooperative and discrepancies between the care expected and the care offered.
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Affiliation(s)
- Paul Giesen
- Centre for Quality-of-Care Research (WOK), Radboud University, Nijmegen Medical Centre, WOK 117, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
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Moll van Charante EP, ter Riet G, Drost S, van der Linden L, Klazinga NS, Bindels PJE. Nurse telephone triage in out-of-hours GP practice: determinants of independent advice and return consultation. BMC FAMILY PRACTICE 2006; 7:74. [PMID: 17163984 PMCID: PMC1713241 DOI: 10.1186/1471-2296-7-74] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2006] [Accepted: 12/12/2006] [Indexed: 11/10/2022]
Abstract
BACKGROUND Nowadays, nurses play a central role in telephone triage in Dutch out-of-hours primary care. The percentage of calls that is handled through nurse telephone advice alone (NTAA) appears to vary substantially between GP cooperatives. This study aims to explore which determinants are associated with NTAA and with subsequent return consultations to the GP. METHODS For the ten most frequently presented problems, a two-week follow-up cohort study took place in one cooperative run by 25 GPs and 8 nurses, serving a population of 62,291 people. Random effects logistic regression analysis was used to study the determinants of NTAA and return consultation rates. The effect of NTAA on hospital referral rates was also studied as a proxy for severity of illness. RESULTS The mean NTAA rate was 27.5%--ranging from 15.5% to 39.4% for the eight nurses. It was higher during the night (RR 1.63, CI 1.48-1.76) and lower with increasing age (RR 0.96, CI 0.93-0.99, per ten years) or when the patient presented >2 problems (RR 0.65; CI 0.51-0.83). Using cough as reference category, NTAA was highest for earache (RR 1.49; CI 1.18-1.78) and lowest for chest pain (RR 0.18; CI 0.06-0.47). After correction for differences in case mix, significant variation in NTAA between nurses remained (p < 0.001). Return consultations after NTAA were higher after nightly calls (RR 1.23; CI 1.04-1.40). During first return consultations, the hospital referral rate after NTAA was 1.5% versus 3.8% for non-NTAA (difference -2.2%; CI -4.0 to -0.5). CONCLUSION Important inter-nurse variability may indicate differences in perception on tasks and/or differences in skill to handle telephone calls alone. Future research should focus more on modifiable determinants of NTAA rates.
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Affiliation(s)
- Eric Peter Moll van Charante
- Department of General Practice, Academic Medical Centre, University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands
| | - Gerben ter Riet
- Horten Centre, University of Zurich, Bolleystrasse 40, CH-8091 Zurich, Switzerland
| | - Sara Drost
- Department of General Practice, Academic Medical Centre, University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands
| | - Loes van der Linden
- Department of General Practice, Academic Medical Centre, University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands
| | - Niek S Klazinga
- Department of Social Medicine, Academic Medical Centre, University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands
| | - Patrick JE Bindels
- Department of General Practice, Academic Medical Centre, University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands
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