Comprehensive pediatric care: the patient viewpoint

Patients' expectations for medical care: an expanded formulation based on review of the literature

An expanding literature on patients' expectations for medical care suffers from definitional confusion and lack of a conceptual model linking patients' expectations to important antecedents and consequences. This article aims to (1) provide a clear and inclusive definition of patients' expectations for care, (2) place patients' expectations in a conceptual framework built around patient satisfaction, and (3) develop a taxonomy of patients' expectations that promotes improved clinical care and research. Patients' expectations may be understood as beliefs or attitudes that interact with perceived occurrences to produce care-related evaluations. Research over the past 30 years indicates that patients' expectations may express probabilities or values related to a specific visit or to ongoing care, that the content of patients' expectations is broad, and that it makes a difference when expectations are elicited. This framework raises numerous questions for future research.

Expectations, goals, and perceived effectiveness of child health supervision: a study of mothers in a pediatric practice

The purpose of the study was to assess parent expectations and goals in child health supervision and variability by socioeconomic status (SES), family size, social support, and pediatrician. Home interviews were conducted with mothers and their pediatricians were surveyed. Two hundred mothers with at least one child age 2-3 years who see one of five pediatricians in a staff model health maintenance organization were asked to participate. Mothers' and pediatricians' goals in the following seven areas of health supervision were assessed: biomedical, development, behavior, family functioning, safety education, and interpersonal and system interaction. Mothers stated physicians were their main source of parenting information. Assurance of physical health and normal development were more important than discussion of behavioral, family, or safety issues. Mothers of low SES were more likely to feel that physical aspects of health should be the focus and were less interested in psychosocial issues. Physicians stressed interpersonal, safety, and behavioral goals more than mothers. Individual physician responses did not predict the responses of mothers in their practice. Our data suggest either that mothers do not feel that psychosocial and safety issues are the highest priorities in health supervision or that physicians are not effectively reaching mothers on these issues.

Regular source of primary medical care and patient satisfaction

As hypothesized, results indicate the greater the degree of continuity in the physician/patient relationship, the higher the level of patient satisfaction. The level of continuity was related to each of the five scale items individually and to the overall patient satisfaction scale. Even when patient background characteristics were controlled, continuity remained a key predictor of satisfaction with primary care received. This study demonstrates the importance of conceptualizing continuity on a continuum, or at least across several categories, rather than reducing it to an either/or construct. Important differences in patient satisfaction occur between and among patients who see the same physician for each episode of primary care, who attend a small group of physicians working together, who attend a clinic or medical center where a different physician may be seen on each occasion, and who do not have a regular source of care. To the extent that patient satisfaction is accepted as a worthwhile objective for the delivery of medical care, emphasis should be placed on providing the maximum feasible level of continuity. This goal is applicable to nurses and other members of the health care team as well as to physicians. It is certainly relevant for those in position to determine an institution's commitment to providing continuous care. For example, directors of prepaid medical plans are increasingly favoring arrangements that include some degree of continuity between physician and patient. Many medical schools that offer courses in patient management are expanding their emphasis on the value of continuity in the physician/patient relationship.(ABSTRACT TRUNCATED AT 250 WORDS)

Psychosocial problems in chronically ill children: physician concern, parent satisfaction, and the validity of medical records

This study concerns the psychosocial aspects of treatment for chronically ill children. The English-speaking parents of 44 children 5-13 years of age being seen at five specialty clinics at a large county hospital in Los Angeles, and their attending physicians, were the subjects in this study. The parents were interviewed concerning their expectations for the current visit, and the doctor-patient interaction was tape-recorded. Identical categories of information were abstracted from the tape recording and from a chart review of the patients' medical records. Although parents expected 76% of the psychosocial aspects of care to be covered by the doctor, only one fourth were actually discussed in the visit. These unfulfilled expectations were associated with lower satisfaction with medical care received (r = .47, p less than 0.01). Finally, while doctors recorded about 80% of discussions of symptoms and physical examinations in the patient's medical record, they recorded only 25% of discussion of psychosocial problems.