Quality of care and patient satisfaction

Perceived treatment satisfaction in patients with systemic rheumatic diseases treated with biologic therapies: results of a self-reported survey

Biological agents are widely used for the management of systemic rheumatic diseases (SRDs) and their therapeutic implications have been expanded beyond inflammatory arthropathies to more complicated autoimmune disorders, such as systemic lupus erythematosus, vasculitis, and systemic sclerosis. The aim of this study was to investigate treatment satisfaction and overall experience of SRDs' patients receiving biologics as well as to explore patient's perspectives on the quality of services provided by rheumatology departments and to determine factors related to the level of satisfaction. We performed a synchronous correlation study. Patients with SRDs answered an anonymous questionnaire assessing their satisfaction and how treatment with biologics has affected their quality of life and functionality. Sample consisted by 244 patients (65.2% women), with mean age of 50.4 years, and the most common diagnosis was rheumatoid arthritis (37.3%). Sixty one percent of patients received intravenous therapy and 39% subcutaneously. Overall, 80.5% of the patients reported a positive/very positive effect of their treatment on their life. The average total patient satisfaction from the unit was 79.8%. The presence of mental disease was significantly associated with less positive impact of the treatment on patients' life, worse quality of life, and greater pain. In conclusion, patients with a broad spectrum of SRDs were generally satisfied and treatment with biologic regimens appeared to have a positive impact on several aspects of their life. The majority of patients were at least satisfied with all the characteristics of the unit staff and better quality of life was associated with greater satisfaction about the Unit and more positive affect of the treatment in patients' life.

Patients' perspective of a dedicated biologic clinic for inflammatory arthritis

PURPOSE

The purpose of this paper is to assess the patient's perspective on a dedicated clinic set up for patients diagnosed with an inflammatory arthritis who are being treated with a biologic. It proposes that dedicated clinics offer better overall care. The aim of this quality improvement survey is to evaluate the level of patient satisfaction with this clinic and identify any unmet needs.

DESIGN/METHODOLOGY/APPROACH

This study was based on a quality improvement survey, which was developed using Zineldin's five qualities model and assessed various aspects pertaining to service quality and improvement. A structured interview approach was used and 44 consecutive patients were recruited.

FINDINGS

This paper explores key aspects that influence patient satisfaction within a rheumatology outpatient setting such as education on arthritis and biologics and involvement in decision making. It provides insight on what patients value most and it also addresses organizational aspects that can have an impact on patient satisfaction. It suggests that service quality can be linked to the degree of patient satisfaction.

RESEARCH LIMITATIONS/IMPLICATIONS

Direct interviewing of patients could have introduced a source of bias whilst questions are being answered. On the other hand, it provided an opportunity to clarify instantly any doubts and therefore avoiding any inadvertent errors.

PRACTICAL IMPLICATIONS

This paper reinforces that specialized clinics enable the caring rheumatologist to provide better care for patients on biologics. Service providers should continue developing their services around the patient's needs and perspectives in order to continue improving the service.

SOCIAL IMPLICATIONS

Dedicated biologic clinics allow more judicious monitoring of patients who are taking these highly efficacious but costly medications.

ORIGINALITY/VALUE

This survey has reinforced that patients highly value dedicated clinics. These results strengthen the case that healthcare services should continue investing on specialized clinics.

Patients' perception of quality of nursing care; a tertiary center experience from Ethiopia

Background

Nursing care closely influences patients' satisfaction with the overall quality of care, and the importance of measuring patient satisfaction with nursing care cannot be emphasized enough. Data are however scarce regarding patients' perception of quality of nursing care in Ethiopia. We performed this study to assess patient's perception of the quality of nursing care in a tertiary center in Ethiopia.

Methods

Data were collected prospectively using Quality of Nursing Care Questionnaires-patient of Safford & Schlotfeldt. A total of 340 patients were included using systematic random sampling and data were analyzed using SPSS for windows version- 20.

Result

The nursing care performance was highest for nurse-physician relation (mean = 3.95) and low for education and home care preparation and physical care (mean score of 2.79 and 2.89 respectively). The emotional care and nurse administration mean score were 3.5 and 3.83 respectively. The overall nursing quality was neither satisfying nor dissatisfying (mean of 3.39). While only 36% of the respondents were satisfied with the nursing care, patient education has the strongest (AOR of 7.4) association with satisfaction.

Conclusion

Patients perceived low quality of physical care, education and preparation for home care but better nurse-physician relation and nursing administration. However the overall quality measure was neither satisfying nor dissatisfying. This calls for an action from the health care administrators, educators and other stakeholders to improve the patient perception of quality nursing care.

Patient satisfaction and outcomes of partial wrist denervation in inflammatory arthritis

INTRODUCTION

Inflammatory arthritis frequently affects the wrist, resulting in pain and disability. This study aims to investigate the long-term outcome of patients who underwent posterior interosseous nerve (PIN) denervation for inflammatory arthritis of the wrist.

METHOD

xForty consecutive wrists (36 patients) treated with PIN denervation were identified (mean follow-up 47 months; mean age 62.6 years, 77.5% female). Pain and function scores were objectively measured using the patient-rated wrist-evaluation (PRWE) questionnaires. Data was compared for pre-operation and post-operation (early and long term). The Student's t test was used to compare differences between groups for continuous data, whilst the sign test was utilised for pairwise comparisons. The p value was set at 0.05 for all comparisons.

RESULTS

Three patients died during the course of this study from causes unrelated to wrist surgery, resulting in 93% follow-up. PRWE questionnaires demonstrated a significant improvement following PIN denervation (median pain pre-op 42 vs post-op 16 (p < 0.001); median function pre-op 82 vs post-op 41 (p < 0.001), respectively). There were no differences identified between early and long-term post-operative scores. Four cases (10%) had persistent, ulnar-based pain and required secondary salvage wrist arthrodesis. However, 95% of patients remained "very satisfied" or "satisfied" after surgery.

CONCLUSIONS

This study highlights the effectiveness of PIN denervation as a simple alternative to wrist arthrodesis due to long-term improvement in pain and preservation of function. We recommend this procedure in the presence of a positive diagnostic PIN infiltration test to avoid wrist arthrodesis for as long as possible. In patients with predominantly ulnar-based wrist pain, the outcome is less predictable and this subgroup of patients should be counselled about the possibility of subsequent salvage wrist fusion. Key Points • One of the largest study cohorts which report on the outcome of the wrist PIN denervation procedure with over 2-year follow-up • Clinical outcomes of success are enhanced with the use of validated, objective patient-reported outcome measures relating to overall satisfaction, pain relief and function. • Long-term outcomes are compared to pre-operative and immediate post-operative outcome scores, demonstrating the benefits of PIN denervation and the longevity it provides.

Functional and patient-reported outcome of partial wrist denervation versus the Mannerfelt wrist arthrodesis in the rheumatoid wrist

INTRODUCTION

Wrist arthrodesis offers high success rates in patients with rheumatoid arthritis; however, loss of residual mobility may cause unnecessary disability. This makes wrist denervation an appealing alternative. However, there is a distinct lack of patient-reported outcome measure studies comparing these two procedures. The aim of this study was to report any change in function, pain and satisfaction following wrist arthrodesis compared to denervation in a single surgeon series of rheumatoid patients.

PATIENTS AND METHODS

The results of 16 wrist arthrodesis in 15 patients and 14 partial (PIN) wrist denervations in 13 patients were compared with a mean follow-up period of 39 and 22 months, respectively. The primary outcome measures were the same for both groups and included the validated patient-rated wrist evaluation questionnaire and a satisfaction questionnaire.

RESULTS

Wrist arthrodesis significantly improved the mean total pain and functional outcome scores by 54 and 36 %, respectively, at the time of follow-up. Wrist denervation patients also reported significant improvements of 44 and 42 % in total pain and functional outcomes, respectively; 87 % reported being very satisfied with their wrist arthrodesis procedure compared to 78 % in the denervation group. No statistically significant difference in response between the groups was observed in this series of patients.

CONCLUSIONS

Both procedures enjoyed favourable results amongst patients with excellent satisfaction outcomes. PIN denervation is a simple procedure with low complication rates and we therefore consider it a valid alternative to more difficult treatment options, such as partial or total wrist arthrodesis.

Patients’ Perceptions of Health Related Quality of Life in Rheumatoid Arthritis and Chronic Low Back Pain

OBJECTIVES

To determine how health related quality of life (HRQL) is perceived by patients with rheumatoid arthritis (RA) and chronic low back pain (CLBP) using a textual analysis approach.

PATIENTS

Two-hundred and forty-eight outpatients (85% female), mean age 58+/-13 years (40% RA and 60% CLBP).

METHODS

Observational descriptive study. Sociodemographic and clinical variables were determined. A questionnaire was designed which included an open question "What does health related quality of life mean to you." which patients answered in writing. Textual data analysis was performed using a previous described method based on multivariate descriptive statistical methods.

RESULTS

The two groups were homogenous with respect to gender, educational level, disease duration, comorbid conditions and global functional status. Patients with RA and CLBP used clearly differentiated terms to describe HRQL (RA: to be able (capable), house; CLBP: life, health, quality). RA patients were specific and primarily concerned with functional status and CLBP patients with health and life. The most characteristic phrase used by RA patients was: "to be able to do housework" and for CLBP: "health is the most important thing for quality of life." In the factorial representation, the two pathologies were markedly separated.

CONCLUSIONS

A series of characteristic answers on HRQL may be identified in patients with RA and CLBP, showing that they have different perceptions about what HRQL is according to their pathology. The use of open questions in a group of homogenous patients with specific pathologies could result in more disease-specific responses. Textual statistical analysis of open questions may provide more information than standard methods, and may be considered as valid for the analysis of subjective issues such as quality of life.

Occupational therapy during the first 10 years of rheumatoid arthritis

OBJECTIVE

To describe disease development and occupational therapy during the first 10 years of rheumatoid arthritis (RA), and to assess patients' experiences of occupational therapy and comprehensive care.

METHODS

A total of 168 early RA patients with variable disease severity were followed up with regular team visits. The occupational therapist evaluated hand function and activity and performed the necessary interventions. These were recorded and the number of visits generating interventions was calculated. Semi-structured interview of 11 patients regarding their views of occupational therapy and team contact was performed.

RESULTS

Impairments of hand function were in general mild to moderate and remained fairly unchanged over time. Activity limitations increased slowly. Half of the follow-up visits generated interventions. Most common were prescriptions of assistive devices and orthoses, hand-training instructions and patient education. The patients interviewed were positive regarding occupational therapy and felt safe with comprehensive care.

CONCLUSION

RA patients in all stages of the disease benefit from regular contact with an occupational therapist and team care.

Rheumatology: the expectations and preferences of patients for their follow-up monitoring care: a qualitative study to determine the dimensions of patient satisfaction

BACKGROUND

Patient satisfaction has rarely been defined. It is a multi-dimensional concept and relates to expectations and preferences for care. This paper reports the findings of a study to determine the expectations and preferences of rheumatology patients for their follow-up monitoring care.

AIMS AND OBJECTIVES

To identify the dimensions of satisfaction important to rheumatology patients in the provision of their care in two locations; primary and secondary. The objectives were to determine the expectations and preferences of this group and to gather data to inform a larger study of patient satisfaction.

DESIGN

This small qualitative study used semi-structured interviews with a convenient sample of 10 patients; five from each location.

METHODS

Interviews were recorded and transcribed. Qualitative data analysis revealed a framework and conceptual categories.

RESULTS

Empathy, specialism, information provision, technical aspects, time, and continuity of care were identified as being important in the provision of care for this group of patients.

CONCLUSIONS

These categories had already been found in a validated questionnaire and justified the use of this tool in the larger comparative study.

RELEVANCE TO CLINICAL PRACTICE

Patient satisfaction cannot be accurately assessed unless important categories of care are identified and used in the measurement tool.

Rehabilitation of people with rheumatoid arthritis

Rehabilitation, as an adjunct to pharmacological and surgical therapies in patients with rheumatoid arthritis (RA), aims to minimize the consequences of the disease. For a systematic assessment of the consequences of disease, an appropriate definition and evaluation of the goals of therapy and interventions, and an active partnership with the patient, a structured approach to rehabilitation management is needed.Despite widespread positive clinical experience with rehabilitative interventions, the scientific evidence of their effectiveness is, in general, scanty, owing to a lack of studies with sufficient methodological quality. Further well-designed clinical studies are warranted with respect to several interventions where evidence is falling short.

Outcomes research: a review

PURPOSE

The purpose of this article is to review the history of the medical outcomes movement as well as the methodologies used in outcomes research.

CONCEPT

Outcomes research refers to a genre of clinical investigation that emphasizes the measurement of patient health outcomes, including the patient's symptoms, functional status, quality of life, satisfaction with treatment, and health care costs.

RATIONALE

Outcomes research evolved from studies that demonstrated the presence of wide geographic variations in the practice of medicine and surgery. Such differences in utilization were unaccompanied by any discernible difference in patient outcomes. With escalating health care costs, there has been a growing interest in measuring the outcomes of medical intervention to determine the quality and appropriateness of medical care.

DISCUSSION

Outcomes may be measured both directly and indirectly, over differing periods of time, and with varying degrees of objectivity, reliability, and validity. Current research has focused on quality of life issues, which include the extent to which a patient's usual or expected physical, emotional, and social well-being have been affected by a medical condition or treatment. The true value of health care can be determined only by a systematic examination of patient outcomes. To accomplish this goal, methods are required that are relatively unfamiliar to many clinical researchers. Future clinical research should include patient-oriented outcome measures that would otherwise focus solely on physiological or anatomic outcomes. Such information will be essential in determining which medical and surgical treatment strategies should be abandoned and which will gain acceptance in the future.