Research on patients' views in the evaluation and improvement of quality of care

Translation and psychometrics of the Persian version of the Good Nursing Care Scale in Iran

BACKGROUND AND AIM

Identifying and evaluating the strengths and weaknesses of nursing care provided to improve the quality of nursing care is increasingly emphasized, and it requires using valid tools in this field. This study aimed to translate and determine the psychometric properties of the Persian version of the "Good Nursing Care Scale" (GNCS-P).

METHODS

The present study is a methodological study in which the psychometric dimensions of GNCS-P were studied from the perspective of 200 patients who were admitted to the hospitals of Ardabil University of Medical Sciences. After translating the original version of the scale, its validity and reliability were evaluated and data analysis was performed using statistical package for social science (version 16) and analysis of moment structures (version 24).

RESULTS

The effect score of the item in the evaluation of face validity for each item was above 2.4. The content validity ratio for the scale was 0.88, and the content validity index tool was 0.86. The correlation of total instrument scores with the standard instrument was 0.839. According to the results of factor analysis, the values of factor loading of items were between 0.62 and 0.91, which were all significant. Therefore, the seven dimensions introduced in the main tool were approved. In addition, Cronbach's alpha results of 0.865 and correlation of 0.894 in the test-retest showed that the questionnaire has internal consistency and acceptable stability.

CONCLUSION

The Persian version of the GNCS-P has acceptable psychometric properties in the Iranian population and can be used as a valid tool in the areas of quality assessment of nursing care, education, and nursing research.

IMPLICATIONS FOR NURSING PRACTICE

The results showed the validity and reliability of the tool and its usability as a valid tool in evaluating the quality of nursing care.

La culture de la sécurité des patients dans les maternités tunisiennes : Étude analytique

INTRODUCTION

Given the potential risks involved in childbirth, patient safety is of utmost importance in maternity care.

AIM

To compare the level of patient safety culture between physicians and paramedics in public maternity care structures in Sousse, Tunisia.

METHODS

An observational descriptive and cross-sectional study was conducted among health professionals working in all public health maternities of Sousse, Tunisia. A valid Hospital Survey On Patient Safety Culture (HSOPSC) questionnaire was used to gather data, and a score was calculated for each dimension by taking the average of the positive response proportions per item.

RESULTS

The global response rate was 86.4%. Paramedics had a higher response rate compared to physicians (90.6% versus 62.1%). The overall scores for the ten dimensions of patient safety culture showed significantly higher scores for physicians compared to paramedics for the dimensions of "Expectations and actions of superiors regarding care safety" and "healthcare professional-patient relationship and safety culture" (88.43% versus 63.73%; p=0.027 and 75.38% versus 65.73%; p=0.041 respectively). Conversely, a significant difference was found in favor of paramedics compared to physicians regarding the dimension of "Management support for care safety" (37.3% versus 13%; p=0.019).

CONCLUSION

Significant differences in patient safety culture scores among healthcare professionals. It suggest that efforts should be made to improve management support for care safety for physicians, while paramedics could benefit from increased attention to expectations and actions of superiors regarding care safety and healthcare professional-patient relationship.

Quality indicators for knee and hip osteoarthritis care: a systematic review

To provide an overview of quality indicators (QIs) for knee and hip osteoarthritis (KHOA) care and to highlight differences in healthcare settings. A database search was conducted in MEDLINE (PubMed), EMBASE, CINAHL, Web of Science, Cochrane CENTRAL and Google Scholar, OpenGrey and Prospective Trial Register, up to March 2020. Studies developing or adapting existing QI(s) for patients with osteoarthritis were eligible for inclusion. Included studies were categorised into healthcare settings. QIs from included studies were categorised into structure, process and outcome of care. Within these categories, QIs were grouped into themes (eg, physical therapy). A narrative synthesis was used to describe differences and similarities between healthcare settings. We included 20 studies with a total of 196 QIs mostly related to the process of care in different healthcare settings. Few studies included patients’ perspectives. Rigorous methods for evidence synthesis to develop QIs were rarely used. Narrative analysis showed differences in QIs between healthcare settings with regard to exercise therapy, weight counselling, referral to laboratory tests and ‘do not do’ QIs. Differences within the same healthcare setting were identified on radiographic assessment. The heterogeneity in QIs emphasise the necessity to carefully select QIs for KHOA depending on the healthcare setting. This review provides an overview of QIs outlined to their healthcare settings to support healthcare providers and policy makers in selecting the contextually appropriate QIs to validly monitor the quality of KHOA care. We strongly recommend to review QIs against the most recent guidelines before implementing them into practice.

[Telemedicine satisfaction of primary care patients during COVID-19 pandemics]

Objetivo

Evaluar el grado de satisfacción de los pacientes con la telemedicina durante la pandemia de la COVID-19 en la Unidad de Salud Familiar Vitrius. Este trabajo podría obtener información sobre la aceptación de la teleconsulta (TC).

Material y métodos

Estudio transversal con 253 individuos. Se realizó un cuestionario mediante escala Likert (entre 1-nada satisfecho a 5-totalmente satisfecho) en pacientes con diabetes, hipertensión y en sujetos con otras patologías, entre el primero de abril del 2020 y el primero de mayo de ese mismo año. Se recopilaron datos sociodemográficos, citas previas de telemedicina, niveles de satisfacción con la TC y de aclaración de dudas e interés en un mayor seguimiento de telemedicina. Además, se realizó un análisis comparativo entre los períodos de enero-febrero y abril-mayo de 2020 en relación con la edad, el sexo, la hipertensión arterial (HTA), la diabetes mellitus (DM) y el tipo de contacto (presencial o telemático). Las estadísticas se realizaron con el SPSS® y Excel®.

Resultados y discusión

Las consultas de seguimiento de diabetes representaron el 34,4% del total. Mayoritariamente hubo un alto nivel de satisfacción e interés en el seguimiento futuro con telemedicina. Sin embargo, los individuos diabéticos y mayores estaban menos interesados en este tipo de seguimiento. Se encontraron diferencias estadísticamente significativas en satisfacción para la edad, sexo y presencia/ausencia de diabetes. El 70,6% de los pacientes sanos prefirió el contacto por correo electrónico al teléfono. Ha sido analizado el número de consultas entre enero-febrero y abril-mayo de 2020 donde se destaca: una reducción significativa del número de consultas presenciales por diabetes (-50,1%) y por hipertensión (-94,1%). Las consultas presenciales por cualquier razón disminuyeron un 72,6% y las no presenciales aumentaron un 61,9%. Existe un sesgo de selección porque la muestra no fue aleatoria. La mayor prevalencia de consultas de diabetes y la falta de ajuste por factores de confusión también pueden afectar los resultados.

Conclusiones

Este estudio permitió confirmar la importancia de la telemedicina en atención primaria, sobre todo durante la pandemia. En general, los participantes se quedaron satisfechos con la telemedicina y reconocieron su utilidad en el acceso a los cuidados de salud.

Patient perspectives on interpersonal aspects of healthcare and patient-centeredness at primary health facilities: A mixed methods study in rural Eastern Uganda

INTRODUCTION

Patient-centered care (PCC) is an approach to involve patients in health care delivery, to contribute to quality of care, and to strengthen health systems responsiveness. This article aims to highlight patient perspectives by showcasing their perceptions of their experience of PCC at primary health facilities in two districts in Uganda.

METHODS

A mixed methods cross-sectional study was conducted in three public and two private primary health care facilities in rural eastern Uganda. In total, 300 patient exit survey questionnaires, 31 semi-structured Interviews (SSIs), 5 Focus Group Discussions (FGDs) and 5 feedback meetings were conducted. Data analysis was guided by a conceptual framework focusing on (1) understanding patients' health needs, preferences and expectations, (2) describing patients perceptions of their care experience according to five distinct PCC dimensions, and (3) reporting patient reported outcomes and their recommendations on how to improve quality of care.

RESULTS

Patient expectations were shaped by their access to the facility, costs incurred and perceived quality of care. Patients using public facilities reported doing so because of their proximity (78.3% in public PHCs versus 23.3% in private PHCs) and because of the free services availed. On the other hand, patients attending private facilities did so because of their perception of better quality of care (84.2% in private PHCs versus 21.7% in public PHCs). Patients expectations of quality care were expressed as the availability of medication, shorter waiting times, flexible facility opening hours and courteous health workers. Analysis of the 300 responses from patients interviewed on their perception of the care they received, pointed to higher normalized scores for two out of the five PCC dimensions considered: namely, exploration of the patient's health and illness experience, and the quality of the relationship between patient and health worker (range 62.1-78.4 out of 100). The qualitative analysis indicated that patients felt that communication with health workers was enhanced where there was trust and in case of positive past experiences. Patients however felt uncomfortable discussing psychological or family matters with health workers and found it difficult to make decisions when they did not fully understand the care provided. In terms of outcomes, our findings suggest that patient enablement was more sensitive than patient satisfaction in measuring the effect of interpersonal patient experience on patient reported outcomes.

DISCUSSION AND CONCLUSION

Our findings show that Ugandan patients have some understanding of PCC related concepts and express a demand for it. The results offer a starting point for small scale PCC interventions. However, we need to be cognizant of the challenges PCC implementation faces in resource constrained settings. Patients' expectations in terms of quality health care are still largely driven by biomedical and technical aspects. In addition, patients are largely unaware of their right to participate in the evaluation of health care. To mitigate these challenges, targeted health education focusing on patients' responsibilities and patient's rights are essential. Last but not least, all stakeholders must be involved in developing and validating methods to measure PCC.

Relationship Between Patient Satisfaction and Willingness to Comply With Physicians' Recommendation in Referral Surgical Outpatient Clinic in Nigeria

The relationship between patient satisfaction with surgical care and their willingness to comply with doctors’ recommendations has not been studied in the country. This study determined the relationship between ambulatory patients’ satisfaction with care and their willingness to adhere to the surgeons’ recommendations in the surgical outpatient clinic (SOPC) of the University Teaching Hospital. This analytical cross-sectional study was conducted among 490 adult respondents at the SOPC selected through a systematic sampling method with a sample interval of 1:2. The short form of the Patient Satisfaction Questionnaire with 7 domains and tool developed for patient willingness to comply with surgeons’ recommendations were used. Descriptive and inferential analyses were performed, and P values of <.05 were considered significant. A total of 466 respondents’ data were analyzed, giving a response rate of 95.1%. About 52.8% were males and 47.2% were females. The associations between domains of patient satisfaction and willingness to surgical instructions were mostly weak and nonsignificant. Their satisfaction with communication with the surgeons was the most consistent predictor of patient willingness and showed significant relationships with their willingness to accept follow-up visits (P = .002), drug prescription (P < .001), and further investigation (P < .001). Access/convenience and general satisfaction were significantly associated with their willingness to recommend the surgery clinic to close friends and relatives. Patient satisfaction with care has a significant relationship with their willingness to adhere to surgical recommendations.

Validation of the patient measure of safety (PMOS) questionnaire in Australian public hospitals

Objective

Patients can provide a unique perspective on the safety of care in hospitals. Understanding that the extent to which the way hospitals are organized for quality and safety is associated with patient perceptions of care is becoming increasingly valued and necessary for the direction of targeted interventions across healthcare systems. The UK-developed patient measure of safety (PMOS) assesses eight domains of ward safety from the patient point of view and has recently been adapted and piloted in Australia. The aim of this study is to test the psychometric properties of PMOS-Australia (PMOS-A) amongst a large cohort of hospitalized patients.

Design

Cross-sectional questionnaire validation assessment.

Setting and participants

As part of the DUQuA project, the PMOS-A survey was distributed within acute myocardial infarction, hip fracture and stroke departments across 32 large public hospitals in Australia. Patients could complete the PMOS-A independently, or request the assistance of a family member/guardian, or staff on the wards—space was included to record mode of completion.

Main outcome measures

Confirmatory factor analysis (CFA) was undertaken on a calibration sample to generate the model, and a validation sample was used to cross-validate the model. A subset of only those participants who received assistance for PMOS-A completion was also tested using CFA on a calibration and validation sample. Model fit indices (chi-square to degrees of freedom ratio [Chi-square:DF], root mean square error of approximation [RMSEA], comparative fit indices [CFI], standardized root mean squared residual [SRMR]), Cronbach’s α, average inter-item correlations, construct reliability and cross-loadings were examined with reference to recommended thresholds to establish the extent of convergent validity and discriminant validity. A marker of criterion validity was assessed through testing associations between the PMOS-A and adherence to clinical guidelines.

Results

Across the calibration and validation samples of the full (N = 911) and assisted completers only subset (N = 490), three (Chi-square:DF, SRMR, RMSEA) of the four indices consistently or almost always met thresholds for acceptable model fit. CFI indices did not meet the recommended limits (0.72–0.78, against a target &gt; 0.9). Positive relationships were found for all tests between PMOS-A and adherence to clinical guidelines, and these were significant when assessed in the calibration datasets for the full and assisted completion samples.

Conclusion

A sufficiently reliable and valid measure of patient perceptions of safety has been developed. These findings should provide adequate support to justify the use of this measure to assess patient perceptions of safety in Australian hospitals and can be modified for use elsewhere.

User-experience and patient satisfaction with quality of tuberculosis care in India: A mixed-methods literature review

BACKGROUND

Tuberculosis affected 2.7 million people in India in 2017. The Revised National TB Control Programme has achieved milestones in coverage, however quality of TB care remains highly variable and often poor, with significant gaps in provider knowledge, practices, and patients consistently lost to follow-up. These quality gaps are largely informed by studies on provider practices or objective chart abstractions and case data. Per the knowledge of the author, no review has been conducted on first-hand patient perspectives on the quality of TB care they receive. This mixed-methods literature review aims to synthesize evidence on user-experience and patient satisfaction with TB care in India and inform areas for service quality improvement.

METHODS

Five medical databases, including PubMed, EMBASE, Global Health (Ovid), Web of Science, and CINAHL were searched for empirical studies on patient perspectives on TB health services published between January 1st, 2000 to December 31st, 2017. Studies in English with adult patients with any form of TB in the public or private health system were included. Studies prior to entering the health system, on distance to health facilities and cost were excluded. Seven Indian journals were hand searched and a grey literature search was conducted in GoogleScholar. Studies were assessed for methodological quality and thematic analysis was conducted by categorizing data using NVivo 12.

RESULTS

A total of 498 studies were screened, of which 23 met the inclusion criteria. 16 supplementary studies were identified from Indian journals and grey literature. Of the 39 total studies included most were quantitative (29; 74%), based in South India (17; 44%) and focused on drug-sensitive TB patients (19; 49%) within the public health system (25; 64%). Data collection methods were highly heterogenous which limited synthesis and comparisons across population demographics, health sectors, or regions. Overall quantitative patient satisfaction measured in seven studies was high. Two major themes identified were provider-related factors (n = 26 studies) and convenience (n = 25), and six minor themes were supplies and equipment availability (n = 12), confidence (n = 10), information and communication (n = 10), waiting time (n = 8), stigma (n = 4), and confidentiality (n = 4). Each reported positive and negative user-experiences. Most significantly, DOTS did not fit the daily needs and obligations of many patients, particularly due to conflicts with employment and frequency of visits; while positive provider support, information, and flexibility helped patients adhere to treatment.

CONCLUSION

Although quantitative patient satisfaction was found to be high, data were not collected using robust, validated tools. Qualitative and quantitative user-experiences in each theme were variable, making them both barriers and facilitators of good quality TB care. Poor user-experiences were often responsible for patients interrupting treatment or dropping out of TB care. Patient-centeredness, or user-friendliness of TB care can be improved by introducing individualized or flexible DOTS that is responsive to user circumstances and needs. User-experience data should be systematically collected using a standardized, national tool for identification of specific bottlenecks and successes in quality of TB care from the patients' perspective.

"Good care" throughout the prostate cancer pathway: Perspectives of patients and health professionals

PURPOSE

Men in follow up for prostate cancer represent the largest proportion of patients with the illness. In the United Kingdom, primary care is increasingly involved in caring for these patients. Little is known however regarding the factors that determine men's evaluation of their care and primary healthcare professionals' perceptions of the care they provide. This study aimed to investigate patient and primary care based health professionals' perspectives of what constitutes 'good care' for men with prostate cancer, including limiting or facilitating factors.

METHOD

Semi-structured interviews were conducted with ten patients and eight primary care based healthcare professionals and thematically analysed in collaboration with a patient representative group.

RESULTS

Good care was identified by patient participants, with aspects of communication, including information, active participation, sensitivity of approach and context being highlighted. Healthcare professionals also prioritised communication as the basis of good care and recognised the benefits of locally based services.

CONCLUSIONS

Treatments in prostate and other cancers continue to improve with corresponding increases in survival. To further develop and sustain the good care that patients require to help them cope with diagnosis, treatment and long term adjustment, investment in resources, training and innovative communication systems between patients, generalist and specialist services are required.

Findings and Predictors of Patient-Reported Experience of Primary Health Care in Nigeria

OBJECTIVE

The study reports findings and patients' characteristics that predict their experiences of primary health care (PHC) in Nigeria.

METHODS

A cross-sectional survey of 1680 patients attending 24 primary health centers in 6 states from the 6 geopolitical subdivisions in Nigeria. The patient evaluation scale was used for exit survey of patients' experiences with PHC. Categorical findings and mean ratings on experiences of PHC were analyzed using both descriptive and inferential statistics.

RESULTS

The mean response rate was 98%, and most respondents were female (73%) and married (72%). A higher proportion of patients gave positive feedback on their relationships with staff (84%) than they did available space in the waiting area (60%). Higher self-rated health status and nonpayment for care at the point of receipt were consistent predictors of positive patient experiences from the multilevel analysis.

CONCLUSION

Study reported findings and drivers of patient experiences with PHC. Aspects of PHC showing less positive patient experiences and some patients' factors associated with these are amenable to change and can form the focus of quality improvement actions.

Development and validation of the patient evaluation scale (PES) for primary health care in Nigeria

BACKGROUND

Questionnaires developed for patient evaluation of the quality of primary care are often focussed on primary care systems in developed countries. Aim To report the development and validation of the patient evaluation scale (PES) designed for use in the Nigerian primary health care context.

METHODS

An iterative process was used to develop and validate the questionnaire using patients attending 28 primary health centres across eight states in Nigeria. The development involved literature review, patient interviews, expert reviews, cognitive testing with patients and waves of quantitative cross-sectional surveys. The questionnaire's content validity, internal structures, acceptability, reliability and construct validity are reported. Findings The full and shortened version of PES with 27 and 18 items, respectively, were developed through these process. The low item non-response from the serial cross-sectional surveys depicts questionnaire's acceptability among the local population. PES-short form (SF) has Cronbach's α of 0.87 and three domains (codenamed 'facility', 'organisation' and 'health care') with Cronbach's αs of 0.78, 0.79 and 0.81, respectively. Items in the multi-dimensional questionnaire demonstrated adequate convergent and discriminant properties. PES-SF scores show significant positive correlation with scores of the full PES and also discriminated population groups in support of a priori hypotheses.

CONCLUSION

The PES and PES-SF contain items that are relevant to the needs of patients in Nigeria. The good measurement properties of the questionnaire demonstrates its potential usefulness for patient-focussed quality improvement activities in Nigeria. There is still need to translate these questionnaires into major languages in Nigeria and assess their validity against external quality criteria.

Exploring patient strategies in response to untoward healthcare encounters

BACKGROUND

Increasing attention to patients' rights and their ability to choose their healthcare provider have changed the way patients can respond to untoward, disempowering and abusive healthcare encounters. These responses are often seen as crucial for quality improvement, yet they are little explored and conceptualized.

OBJECTIVE

To explore patients' potential responses to untoward healthcare encounters and looking at their possible consequences for care quality improvement as well as for the individual patient.

RESEARCH DESIGN

The article is structured looking at two primary strategies: patient exit (leaving a healthcare provider) and patient voice (expressing grievances), derived from Hirschman (1970). These strategies were explored by the use of theoretical and empirical literature and applied to an individual patient case. The case functions as a pedagogical tool to illustrate and problematize what exit and voice strategies can mean for a single patient. Ethical considerations: The patient case is my version of a generalized scenario that is described elsewhere. It does not represent an individual patient's story, but aims to be realistic and recognizable.

FINDINGS AND CONCLUSION

Based on the existing literature, it is hypothesized that, in their current form, exit and voice strategies have a limited effect on care quality and can come at a price for patients. However, both strategies may be of value to patients and providers. Therefore, the healthcare system could empower patients to engage in action and could further develop ways for providers to effectively use patients' responses to improve practice and find ways to prevent patients from untoward experiences in healthcare.

What do patients want from their endoscopy experience? The importance of measuring and understanding patient attitudes to their care

Understanding and addressing patient attitudes to their care facilitates their engagement and attendance, improves the quality of their experience and the appropriate utilisation of resources. Gastrointestinal endoscopy is a commonly performed medical procedure that can be associated with patient anxiety and apprehension. Measuring patient attitudes to endoscopy can be undertaken through a number of approaches with contrasting benefits and limitations. Methodological validation is necessary for accurate interpretation of results and avoiding bias. Retrospective post-procedure questionnaires measuring satisfaction are easily undertaken but have limited value, particularly in directing service improvements. Patient experience questionnaires indicate areas of poor care but may reflect the clinician's not the patient's perspective. Directly assessing patient priorities and expectations identifies what is important to patients in their healthcare experience (patient-reported value) that can also provide a basis for other forms of evaluation. Published studies of patient attitudes to their endoscopy procedure indicate the importance of ensuring that endoscopists and their staff control patient discomfort, have adequate technical skill and effectively communicate with their patient relating to the procedure and results. Environmental factors, including noise, privacy and the single-sex environment, are considered to have less value. There are contrasting views on patient attitudes to waiting times for the procedure. Implementing patient-centred care in endoscopy requires an understanding of what patients want from their healthcare experience. The results from available studies suggest implications for current practice that relate to the training and practice of the endoscopist and their staff.

Global Satisfaction With Perinatal Hospital Care: Stability and Relationship to Anxiety, Depression, and Stressful Medical Events

To evaluate the stability of global maternal satisfaction with perinatal hospital care during the post-partum period and its relationship to anxiety, depression, and stressful medical events, a cohort study of 300 mothers delivering at a university hospital was performed during the first month postpartum. Satisfaction, measured on a 4-point Likert scale (0-3), declined from 2.75 +/- 0.03 (mean +/- standard error) before hospital discharge to 2.48 +/- 0.04 at 1 month postpartum (P = .000), and only 69.5% of mothers very much satisfied predischarge remained so at 1 month (P = .000). Predischarge satisfaction declined with greater medical events (adjusted odds ratio [AOR] = 0.85, 95% confidence interval [CI] = 0.74, 0.97, P < .05) and with concomitant anxiety (AOR= 0.92, CI= 0.89, 0.95, P< .001); reduced satisfaction at 1 month was associated with high anxiety (AOR = 0.97, CI = 0.95, 0.98) and depression (AOR = 0.96, CI = 0.93, 0.99) at that time. Thus, perinatal satisfaction may be time-dependent and associated with contemporaneous medical and psychological changes.

Systematic review of patients' views on the quality of primary health care in sub-Saharan Africa

This is the first systematic review of patient views on the quality of primary health care services in sub-Saharan Africa using studies identified from MEDLINE, CINAHL Plus, EMBASE and PsycINFO. In total, 20 studies (3 qualitative, 3 mixed method and 14 quantitative) were included. Meta-analysis was done using quantitative findings from facility- and community-based studies of patient evaluation of primary health care. There was low use of validated measures, and the most common scales assessed were humanness (70%) and access (70%). While 66% (standard deviation = 21%) of respondents gave favourable feedback, there were discrepancies between surveys in community and facility contexts. Findings suggest that patient views could vary with subject recruitment site. We recommend improvement in the methods used to examine patient views on quality of primary health care.

Instruments to measure patient experience of healthcare quality in hospitals: a systematic review

BACKGROUND

Improving and sustaining the quality of hospital care is an international challenge. Patient experience data can be used to target improvement and research. However, the use of patient experience data has been hindered by confusion over multiple instruments (questionnaires) with unknown psychometric testing and utility.

METHODS

We conducted a systematic review and utility critique of questionnaires to measure patient experience of healthcare quality in hospitals. Databases (Medical Literature Analysis and Retrieval System (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Psychological Information (PsychINFO) and Web of Knowledge until end of November 2013) and grey literature were scrutinised. Inclusion criteria were applied to all records with a 10 % sample independently checked. Critique included (1) application of COSMIN checklists to assess the quality of each psychometric study, (2) critique of psychometric results of each study using Terwee et al. criteria and (3) development and critique of additional aspects of utility for each instrument. Two independent reviewers completed each critique. Synthesis included combining findings in a utility matrix.

RESULTS

We obtained 1157 records. Of these, 26 papers measuring patient experience of hospital quality of care were identified examining 11 international instruments. We found evidence of extensive theoretical/development work. The quality of methods and results was variable but mostly of a high standard. Additional aspects of utility found that (1) cost efficiency was mostly poor, due to the resource necessary to obtain reliable samples; (2) acceptability of most instruments was good and (3) educational impact was variable, with evidence on the ease of use, for approximately half of the questionnaires.

CONCLUSIONS

Selecting the right patient experience instrument depends on a balanced consideration of aspects of utility, aided by the matrix. Data required for high stakes purposes requires a high degree of reliability and validity, while those used for quality improvement may tolerate lower levels of reliability in favour of other aspects of utility (educational impact, cost and acceptability).

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42013006754.

Care quality instruments

PURPOSE

The purpose of this paper is to describe instruments used for quality assessment in acute care. Quality care assessment is essential for improving care delivery. Quality instruments can be used to evaluate nurse and patient perspectives in multi-professional care. Therefore, valid and reliable measurement instruments are vital.

DESIGN/METHODOLOGY/APPROACH

A literature search identified several instruments that measure quality from a nurse and patient perspectives. The questionnaires were appraised in several steps with specific criteria: psychometric properties, underlying construct or test theory, study context, sample characteristics and target population.

FINDINGS

Overall, 14 instruments were evaluated, but only eight questionnaires represented nurse and patient views regarding quality. Instruments showed several disparities in their theoretical foundations and their psychometric properties. Two instruments did not provide validity data and one questionnaire did not report reliability data.

PRACTICAL IMPLICATIONS

To inform healthcare managers about acute care quality, the authors demonstrated the need for more valid and reliable measurements by using the Guidelines for Critiquing Instrument Development and Validation Reports to evaluate quality care instruments' psychometric properties.

ORIGINALITY/VALUE

There is a long tradition in quality care evaluations using questionnaires. Only a few instruments can be recommended for practical use.

Patient experiences with intensive combination-treatment strategies with glucocorticoids for early rheumatoid arthritis

OBJECTIVES

To investigate patients' experiences with intensive combination-treatment strategies with glucocorticoids (ICTS-GCs) in the early phase of early rheumatoid arthritis (ERA) treatment.

METHODS

We interviewed 26 participants individually, 4-6 months after initiation of ICTS-GCs (t1). Fourteen participants from the same sample took part in one of three focus groups at least 1 year after treatment initiation (t2). Each interview was audio-recorded, literally transcribed and thematically coded.

RESULTS

The participants described concerns and feelings about ICTS-GCs that changed over time; for example, a fear of side effects diminished when the treatment effects were beneficial or expected side effects did not materialize. Moreover, participants indicated additional information needs at t1 and t2. The most used sources of information were healthcare professionals, relatives, and the Internet. Furthermore, participants reported on their relationship with healthcare professionals and the need for trust and reassurance, especially at t1. Lastly, participants described their personal self-management strategies.

CONCLUSION

Despite their concerns at treatment initiation, most participants had positive experiences with ICTS-GCs.

PRACTICE IMPLICATIONS

Healthcare professionals should be aware that, in the early phase of treatment, they can address patients' concerns, they are the most important information source, they need to create a relationship of trust, and guide patients in self-management strategies.

A maximum difference scaling survey of barriers to intensive combination treatment strategies with glucocorticoids in early rheumatoid arthritis

The objectives of the study were to determine the relative importance of barriers related to the provision of intensive combination treatment strategies with glucocorticoids (ICTS-GCs) in early rheumatoid arthritis (ERA) from the rheumatologists' perspective and to explore the relation between rheumatologists' characteristics and importance scores. A maximum difference scaling (MDS) survey was administered to 66 rheumatologists in Flanders and the Brussels-Capital Region. The survey included 25 barriers, previously being discovered in a qualitative study. The survey included 25 choice sets, each of which contained a different set of four barriers. In each choice situation, respondents were asked to choose the most important barrier. The mean relative importance score (RIS) for each barrier was calculated using hierarchical Bayes modeling. The potential relation between rheumatologists' characteristics and the RIS was examined using Spearman's correlation coefficient, Mann-Whitney U test, and Kruskal-Wallis H test. The three highest ranked barriers included "contraindicated for some patients (e.g., patients with comorbidities, older patients)," "an increased risk of side effects and related complications," and "patients' resistance" with a mean ± SD RIS of 9.76 ± 0.82, 8.50 ± 1.17, and 7.45 ± 1.22, respectively. Comparing the RISs based on rheumatologists' characteristics, a different ranking was found for three barriers depending on the age, university location, and/or frequency of prescribing ICTS-GCs. The dominant barriers hindering ICTS-GCs prescription from a rheumatologists' perspective are patient-related barriers and barriers related to the complexity of prescribing a combination therapy including GCs. A tailored improvement intervention is needed to overcome these barriers and should focus on the familiarity of rheumatologists with ICTS-GC and patient education.

Patient satisfaction from two studies of collaborative doctor-pharmacist prescribing in Australia

BACKGROUND

Pharmacist prescribing has been introduced in several countries and is a possible future role for pharmacy in Australia.

OBJECTIVE

To assess whether patient satisfaction with the pharmacist as a prescriber, and patient experiences in two settings of collaborative doctor-pharmacist prescribing may be barriers to implementation of pharmacist prescribing.

DESIGN

Surveys containing closed questions, and Likert scale responses, were completed in both settings to investigate patient satisfaction after each consultation. A further survey investigating attitudes towards pharmacist prescribing, after multiple consultations, was completed in the sexual health clinic.

SETTING AND PARTICIPANTS

A surgical pre-admission clinic (PAC) in a tertiary hospital and an outpatient sexual health clinic at a university hospital. Two hundred patients scheduled for elective surgery, and 17 patients diagnosed with HIV infection, respectively, recruited to the pharmacist prescribing arm of two collaborative doctor-pharmacist prescribing studies.

RESULTS

Consultation satisfaction response rates in PAC and the sexual health clinic were 182/200 (91%) and 29/34 (85%), respectively. In the sexual health clinic, the attitudes towards pharmacist prescribing survey response rate were 14/17 (82%). Consultation satisfaction was high in both studies, most patients (98% and 97%, respectively) agreed they were satisfied with the consultation. In the sexual health clinic, all patients (14/14) agreed that they trusted the pharmacist's ability to prescribe, care was as good as usual care, and they would recommend seeing a pharmacist prescriber to friends.

DISCUSSION AND CONCLUSION

Most of the patients had a high satisfaction with pharmacist prescriber consultations, and a positive outlook on the collaborative model of care in the sexual health clinic.

Evaluating health services with point of service feedback: perspectives and experiences of patients, staff and community volunteers in an inpatient rehabilitation facility

PURPOSE

To determine patient, staff and community volunteer opinions and experiences of point of service feedback (POSF) in an inpatient rehabilitation facility.

METHOD

Participants were recruited by purposeful sampling. Two researchers conducted in-depth semi-scripted interviews with patients, staff or volunteers until no new issues emerged. Manually transcribed interview data underwent thematic analysis that grouped information into categories of related information.

RESULTS

Twenty patients, 26 staff from 10 different professional groups, and 2 community volunteers were interviewed. Patient and volunteer data were grouped into five main categories: patients wanted their voice heard and acted on; patients could be positively and negatively affected by POSF; patients could be reluctant to evaluate staff; patients preferred POSF to post-discharge mailed questionnaires; and patients' feedback was influenced by the data collector. Staff wanted: feedback to help them improve the patient experience; and feedback that was trustworthy, usable and used. Staff believed that the feedback-collector influenced patients' feedback and affected how feedback could be used.

CONCLUSIONS

Patients, staff and community volunteers identified issues that determine the appropriateness and usefulness of POSF. Policy and practise should address the preferences, needs and experiences of health service users and providers so that POSF produces maximum benefits for both patients and health services. Implications for Rehabilitation POSF can enhance patients' experiences of inpatient rehabilitation by providing a mechanism to be heard and communicating that patients are valued; care must be exercised with patients who find giving feedback stressful. Collecting POSF is most beneficial when coupled with methods to efficiently and effectively respond to feedback. POSF requires interpretation in light of its limitations including patients' ability to accurately and unreservedly communicate their experiences. Who collects POSF requires careful consideration; community volunteers have both advantages and disadvantages.

Involving patients in detecting quality gaps in a fragmented healthcare system: development of a questionnaire for Patients' Experiences Across Health Care Sectors (PEACS)

OBJECTIVE

The purpose of this study was to develop and validate a generic questionnaire to evaluate experiences and reported outcomes in patients who receive treatment across a range of healthcare sectors.

DESIGN

Mixed-methods design including focus groups, pretests and field test.

SETTING

The patient questionnaire was developed in the context of a nationwide program in Germany aimed at quality improvements across the healthcare sectors.

PARTICIPANTS

For the field test, 589 questionnaires were distributed to patients via 47 general practices.

MAIN MEASUREMENTS

Descriptive item analyzes non-responder analysis and factor analysis (PCA). Retest coefficients (r) calculated by correlation of sum scores of PCA factors. Quality gaps were assessed by the proportion of responders choosing a response category defined as indicating shortcomings in quality of care.

RESULTS

The conceptual phase showed good content validity. Four hundred and seventy-four patients who received a range of treatment across a range of sectors were included (response rate: 80.5%). Data analysis confirmed the construct, oriented to the patient care journey with a focus on transitions between healthcare sectors. Quality gaps were assessed for the topics 'Indication', including shared-decision-making (6 items, 24.5-62.9%) and 'Discharge and Transition' (10 items; 20.7-48.2%). Retest coefficients ranged from r = 0.671 until r = 0.855 and indicated good reliability. Low ratios of item-non-response (0.8-9.3%) confirmed a high acceptance by patients.

CONCLUSIONS

The number of patients with complex healthcare needs is increasing. Initiatives to expand quality assurance across organizational borders and healthcare sectors are therefore urgently needed. A validated questionnaire (called PEACS 1.0) is available to measure patients' experiences across healthcare sectors with a focus on quality improvement.

Community assessment workshops: a group method for gathering client experiences of health services

Community assessment workshops were developed to gather client experiences of primary health care services in Australia. Primary health care services are particularly concerned with working with disadvantaged populations, for whom traditional client survey methods such as written surveys may not be inclusive and accessible. Service staff at six Australian primary health care services, including two Aboriginal-specific services, invited participants to attend workshops in 2011-2012. Participants were offered transport, childcare and an interpreter, and provided with reimbursement for their time. Ten workshops were run with a total of 65 participants who accessed a variety of services and programmes. A mix of age and gender was achieved. The workshops yielded detailed qualitative data and quantitative rankings for nine service qualities: holistic, effective, efficient, culturally respectful, used by those most in need, responsive to the local community, increasing individual control, supports and empowers the community, and mix of treatment, prevention and promotion. Discussions were audio recorded and transcribed for qualitative analysis. The workshop approach succeeded in being (i) inclusive, reaching users from disadvantaged sections of the community; (ii) comprehensive, providing ratings and discussion that took account of the whole service; (iii) richly descriptive, with researchers able to generate detailed feedback; and (iv) more empowering than traditional client survey methods, by allowing more control to participants and greater benefits than surveys of individuals. The community assessment workshops are a method that could be widely applied to health service evaluation research where the goal is to reach disadvantaged communities and provide ratings and detailed analysis of the experience of users. The participants and the research benefited from the group approach, and the workshops provided valuable, actionable information to the health services. Recruitment of users, particularly those from culturally diverse backgrounds, remains one of the key challenges facing evaluators.

Quality indicators for continuous monitoring to improve maternal and infant health in maternity departments: a modified Delphi survey of an international multidisciplinary panel

OBJECTIVE

Measuring the quality of inpatient obstetrical care using quality indicators is becoming increasingly important for both patients and healthcare providers. However, there is no consensus about which measures are optimal. We describe a modified Delphi method to identify a set of indicators for continuously monitoring the quality of maternity care by healthcare professionals.

METHODOLOGY AND MAIN FINDINGS

An international French-speaking multidisciplinary panel comprising 22 obstetricians-gynaecologists, 12 midwives, and 1 paediatrician assessed potential indicators extracted from a medical literature search, using a two-round Delphi procedure followed by a physical meeting. Each panellist rated each indicator based on validity and feasibility. In the first round, 35 panellists from 5 countries and 20 maternity units evaluated 26 indicators including 15 related to the management of the overall population of pregnant women, 3 to the management of women followed from the first trimester of pregnancy, 2 to the management of low-risk pregnant women, and 6 to the management of neonates. 25 quality indicators were kept for next step. In the second round, 27 (27/35: 77%) panellists selected 17 indicators; the remaining 8 indicators were discussed during a physical meeting. The final set comprised 18 indicators.

CONCLUSION

A multidisciplinary panel selected indicators that reflect the quality of obstetrical care. This set of indicators could be used to assess and monitor obstetrical care, with the goal of improving the quality of care in maternity units.

Quality indicators for all dimensions of infertility care quality: consensus between professionals and patients

STUDY QUESTION

What is the relative importance of the six dimensions of quality of care according to different stakeholders and can a quality indicator set address all six quality dimensions and incorporate the views from professionals working in different disciplines and from patients?

SUMMARY ANSWER

Safety, effectiveness and patient centeredness were the most important quality dimensions. All six quality dimensions can be assessed with a set of 24 quality indicators, which is face valid and acceptable according to both professionals from different disciplines and patients.

WHAT IS KNOWN ALREADY

To our knowledge, no study has weighted the relative importance of all quality dimensions to infertility care. Additionally, there are very few infertility care-specific quality indicators and no quality indicator set covers all six quality dimensions and incorporated the views of professionals and patients.

STUDY DESIGN, SIZE AND DURATION

A three-round iterative Delphi survey including patients and professionals from four different fields, conducted in two European countries over the course of 2011 and 2012.

PARTICIPANTS/MATERIALS, SETTINGS AND METHODS

Dutch and Belgian gynaecologists, embryologists, counsellors, nurses/midwifes and patients took part (n = 43 in round 1 and finally 30 in round 3). Respondents ranked the six quality dimensions twice for importance and their agreement was evaluated. Furthermore, in round 1, respondents gave suggestions, which were subsequently uniformly formulated as quality indicators. In rounds 2 and 3, respondents rated the quality indicators for preparedness to measure and for importance (relation to quality and prioritization for benchmarking). Providing feedback allowed selecting indicators based on consensus between stakeholder groups. Measurable indicators, important to all stakeholder groups, were selected for each quality dimension.

MAIN RESULTS

All stakeholder groups and most individuals agreed that safety, effectiveness and patient centeredness were the most important quality dimensions. A total of 498 suggestions led to the development of 298 indicators. Professionals were sufficiently prepared to measure 204 of these indicators. Based on importance, 52 (7-15 per dimension; round 2) and finally 24 (4 per dimension; round 3) quality indicators were selected.

LIMITATIONS, REASONS FOR CAUTION

The final quality indicator set does not cover the entire care process, but rather takes a 'sample' of each quality dimension. Although the quality indicators are face valid and acceptable, their psychometric characteristics need to be tested by further research.

WIDER IMPLICATIONS OF THE FINDINGS

Quality management should focus on safety, effectiveness and patient centeredness of care. Clinics can use the quality indicator set to assess all quality dimensions of their care.

An evaluation of patient attitudes to colonoscopy and the importance of endoscopist interaction and the endoscopy environment to satisfaction and value

OBJECTIVE

Understanding patients' attitudes to their medical experience is essential for identifying value in the patient pathway, optimizing care and use of resources. This service evaluation was undertaken to determine patients' preferences and expectations for day case colonoscopy, a common gastrointestinal procedure for which there is limited such data.

METHODS

Patients attending for elective colonoscopy were invited to complete a composite, validated dedicated endoscopy questionnaire, with Likert-scale questions and a 15-point preference (ranking) scale of domains of endoscopy care that were considered most important (1) to least important (15) as contributing to a satisfactory experience.

RESULTS

Two hundred and sixteen out of 224 patients returned questionnaires. Moderate to severe anxiety was recorded in 56% of patients, commonly with respect to anticipation of pain or the results of the procedure. The median values for ranked preference scores consistent with greatest importance for satisfaction were technical skill of the endoscopist (1), discomfort during the procedure (4), and manner of the endoscopist (5). Factors considered of relatively low importance included the single-sex environment (15) (although this was more important to female patients), noise levels (13), and explanation of delay (11). Only 14% of patients responded that they would be prepared to delay an appointment for a single-sex environment.

CONCLUSION

Patients undergoing colonoscopy highly prioritize aspects of care relating to the interaction with the endoscopist and the procedure itself. Environment factors are considered to be less important. These findings may assist in service redesign around patient-identified value within the patient pathway.

An evaluation of patient attitudes to the gastroenterology outpatient experience

OBJECTIVE

To determine patient attitudes in gastroenterology outpatient care, including the preferences and expectations associated with satisfaction, waiting times and quality in the consultation.

METHODS

A service evaluation of patient care in outpatient gastroenterology clinics was carried out using a composite, dedicated self-completed questionnaire; this included demographics, preconsultation and postconsultation Likert scale attitudes to process, interactive and environmental factors and a 16-point ranking questionnaire of domains of the patient pathway considered important to obtaining satisfaction.

RESULTS

Two hundred and twenty-seven patients agreed to participate. The factors considered most important to obtaining satisfaction related to the quality of the consultation, including 'seeing the doctor', 'having confidence in the treatment plan', 'clear and appropriately set explanations', 'being listened to', 'opportunity to express important issues' and 'recognition of needs'. Low importance was attributed to process and environmental aspects including waiting times (appointment and waiting room), explanations for delays and the quietness and privacy of the consultation room, and involvement of the patient's next of kin. Patients reported dissatisfaction with long waiting times and short consultation times, but this did not appear to influence postconsultation satisfaction, the likelihood of reattendance or following the treatment plan.

CONCLUSION

Patients consider that factors most important to a satisfactory experience in gastroenterology outpatient care relate specifically to the quality of their interaction with their healthcare professional in consultation. The roles of environmental and process issues are considered less important.

The assessment of satisfaction with care in the perinatal period

Patient satisfaction is frequently used to evaluate the quality of medical care and to guide the development of health care services. Improved satisfaction is a goal recommended by the Institute of Medicine and the government of the United Kingdom for health care reform. During the perinatal period, dynamic changes in physical and psychological state impose unique challenges in the assessment of satisfaction. This article reviews the measurement of satisfaction with care, together with factors that may influence satisfaction and its measurement during the perinatal period. Recommendations are also provided for further research and development of satisfaction instruments and potential interventions to improve satisfaction with perinatal care.

Patients' silence following healthcare staff's ethical transgressions

The aim of this study was to examine to what extent patients remained silent to the health care system after they experienced abusive or wrongful incidents in health care. Female patients visiting a women's clinic in Sweden (n = 530) answered the transgressions of ethical principles in Health care questionnaire (TEP), which was constructed to measure patients' abusive experiences in the form of staff's transgressions of ethical principles in health care. Of all the patients, 63.6% had, at some point, experienced staff's transgressions of ethical principles, and many perceived these events as abusive and wrongful. Of these patients, 70.3% had remained silent to the health care system about at least one transgression. This silence is a loss of essential feedback for the health care system and should not automatically be interpreted as though patients are satisfied.

Views of patients and general dental practitioners on the organizational aspects of a general dental practice

OBJECTIVE

To examine the views of patients and general dental practitioners (GDPs) on the organizational aspects of a general dental practice and to see whether their views differ.

BACKGROUND

Health care has increasingly centred on the patient over the last two decades, and the patients' opinions have been taken more seriously. Although in other health-care sectors research on organizational aspects has been performed, research in dental care is lacking on this subject.

DESIGN

We developed two questionnaires covering 41 organizational aspects of a general dental practice: one for GDPs and one for dental patients. The questionnaires were handed out in dental practices to 5000 patients and sent to 500 GDPs.

RESULTS

We describe the results of the organizational aspects mentioned most by 25% of the dental patients. For most aspects, the views of the patients and GDPs differed significantly. However, both respondent groups mentioned the same category the most.

CONCLUSIONS

The results of this study could be used on a policy level for the development of guidelines and on a practice level for individual GDPs to adjust practice management to the preferences of patients.

A survey of patients' attitudes to upper gastrointestinal endoscopy identifies the value of endoscopist-patient interactive factors

OBJECTIVE

To determine patients' self-reported preferences and expectations for outpatient upper gastrointestinal (UGI) endoscopy, including patients' priorities in obtaining a satisfactory healthcare experience, preprocedure anxiety and its causes, and preferred staff roles.

DESIGN

A composite, dedicated endoscopy questionnaire was used. This included demographic information, validated Likert scale anxiety-related questions and a 15-point ranking scale of aspects of care (1=most important to satisfaction; 15=least important).

SETTING AND PATIENTS

Unselected patients attending for an elective UGI endoscopy at two separate units were surveyed on randomly identified days.

RESULTS

A total of 202 out of 254 patients agreed to participate (79.5%). The values identified as most important to patients included technical skill (2.8) and personal manner of the endoscopist (4.9) and the nurses and support staff (5.8), control of discomfort (5.6) and adequacy of the preprocedure explanation (5.8). The factors considered least important included noise levels (12.5), privacy (10.7) and cleanliness (8.7). Moderate to severe anxiety was recorded in half of the patient cohort, predominantly due to anticipation of pain or the results of the procedure. Most patients preferred the endoscopist to discuss the findings of the endoscopy but expressed no preferences regarding the preprocedure explanation.

CONCLUSION

Patients undergoing UGI endoscopy appear to highly prioritise aspects of care relating to interaction with the endoscopist and the procedure itself. Environmental factors are considered to have much less value. These findings may assist in service redesign around patient-centred care and the development of patient satisfaction surveys in endoscopy.

Target for improvement: a cluster randomised trial of public involvement in quality-indicator prioritisation (intervention development and study protocol)

BACKGROUND

Public priorities for improvement often differ from those of clinicians and managers. Public involvement has been proposed as a way to bridge the gap between professional and public clinical care priorities but has not been studied in the context of quality-indicator choice. Our objective is to assess the feasibility and impact of public involvement on quality-indicator choice and agreement with public priorities.

METHODS

We will conduct a cluster randomised controlled trial comparing quality-indicator prioritisation with and without public involvement. In preparation for the trial, we developed a 'menu' of quality indicators, based on a systematic review of existing validated indicator sets. Participants (public representatives, clinicians, and managers) will be recruited from six participating sites. In intervention sites, public representatives will be involved through direct participation (public representatives, clinicians, and managers will deliberate together to agree on quality-indicator choice and use) and consultation (individual public recommendations for improvement will be collected and presented to decision makers). In control sites, only clinicians and managers will take part in the prioritisation process. Data on quality-indicator choice and intended use will be collected. Our primary outcome will compare quality-indicator choice and agreement with public priorities between intervention and control groups. A process evaluation based on direct observation, videorecording, and participants' assessment will be conducted to help explain the study's results. The marginal cost of public involvement will also be assessed.

DISCUSSION

We identified 801 quality indicators that met our inclusion criteria. An expert panel agreed on a final set of 37 items containing validated quality indicators relevant for chronic disease prevention and management in primary care. We pilot tested our public-involvement intervention with 27 participants (11 public representatives and 16 clinicians and managers) and our study instruments with an additional 21 participants, which demonstrated the feasibility of the intervention and generated important insights and adaptations to engage public representatives more effectively. To our knowledge, this study is the first trial of public involvement in quality-indicator prioritisation, and its results could foster more effective upstream engagement of patients and the public in clinical practice improvement.

TRIAL REGISTRATION

NTR2496 (Netherlands National Trial Register, http://www.trialregister.nl).

A telephone survey of patient satisfaction with realtime telemedicine in a rural community in Colombia

We conducted a telephone survey of all patients referred to a realtime telemedicine consultation at the Centre for Telehealth in Bogotá. Over a six-month period, 281 teleconsultations were conducted, and we were able to retrieve telephone numbers for 156 patients. Of these, 121 patients (78%) agreed to answer the questionnaire. Eighty percent of the respondents were satisfied or very satisfied with the teleconsultation and 63% would use telemedicine again. Sixty-five percent thought that telemedicine improved their medical care. More than 50% believed that telemedicine had a positive effect in terms of medical care improvement, time- and cost-savings. Twenty-seven percent felt that teleconsultation was not as good as a traditional face-to-face consultation. Lack of familiarity with ICT did not appear to act as a major barrier to telemedicine, and cognitive factors may be more important in acceptability to patients and their satisfaction. The results of the present study may also be relevant to the poorest countries of the world, where two-thirds of the population live in rural areas.

[Friendly hospitals for adolescents: patients' preferences]

OBJECTIVE

To determine the preferences and priorities of a sample of hospitalized adolescents on potential ways to improve their stay in the hospital.

METHOD

We performed a prospective, cross-sectional, descriptive study. The participants completed a questionnaire on their preferences and priorities regarding hospitalization, which included data about age, sex, and hospitalization experience. There were 15 questions (Likert-type scale) to score from 1 to 5 the importance they gave to different aspects of the hospital stay, 6 questions with various response options on their preferences concerning roommates and accompanying person at night in the hospital, and 5 open questions to indicate positive and negative aspects on hospitalization and suggestions to improve it.

RESULTS

A total of 96 adolescents completed the questionnaire, which was 76% of the eligible sample. The importance of friendliness of clinical staff and medical tests not to suffer any delay were the aspects that were considered most important to improve adolescents' hospitalization. If they had to share the hospital room, 86.4% (95% CI: 77.9-92.5) preferred to share with someone of the same age. Among the noteworthy suggestions to improve hospitalization were those involving leisure services in the hospital for adolescent patients (56.2% of the references). As a positive aspect of hospitalization, half (50.0%) referred to the relationship with the clinical staff.

CONCLUSIONS

Adolescents express a hospital user perspective that should be taken into account in developing improvements in the health care they receive.

Weaknesses, strengths and needs in fertility care according to patients

BACKGROUND

The patients' role in assessing health care quality is increasingly recognized. Measuring patients' specific experiences and needs generates concrete information for care improvement, whereas satisfaction surveys only give an overoptimistic, undifferentiating picture. Therefore, this study aimed to investigate possible weaknesses, strengths and needs in fertility care by measuring patients' specific experiences.

METHODS

Mixed (qualitative and quantitative) methods were used to identify weaknesses, strengths and needs in fertility care. Four focus groups with 21 infertile patients were used for documenting care aspects relevant to patients. The fully transcribed qualitative results were analysed and converted into a 124-item questionnaire, to investigate whether these aspects were regarded as weaknesses, strengths or needs in fertility care. The questionnaire was distributed to 369 eligible couples attending 13 Dutch fertility clinics. Descriptive statistics were used to determine the quantity of the weaknesses, strengths and needs.

RESULTS

Overall, 286 women (78%) and 280 men (76%) completed the questionnaire. Patients experienced many weaknesses in fertility care, mostly regarding emotional support and continuity of care. Respect and autonomy and partner involvement were considered strengths in current care. Furthermore, women expressed their need for more doctors' continuity during their treatment, and couples strongly desired to have free access to their own medical record. The questionnaire's internal consistency and construct validity were sufficient.

CONCLUSIONS

Infertile couples experience strengths, but also many weaknesses and needs in current fertility care. Lack of patient centredness seems to be a major cause herein. Using mixed methods is a sensitive means for identifying these weaknesses and needs.

Subfertile couples' negative experiences with intrauterine insemination care

OBJECTIVE

To identify subfertile couples' experiences with specific aspects of intrauterine insemination (IUI) care and to determine which patient and hospital characteristics affect their experiences.

DESIGN

Cross-sectional survey with written questionnaires.

SETTING

One large tertiary hospital and nine medium-sized hospitals, including both teaching and nonteaching centers, in the southeast of the Netherlands.

PATIENT(S)

One thousand seventy-nine subfertile couples who underwent IUI treatment between April 2000 and August 2002.

RESULT(S)

The response rate was 71%. Many subfertile couples have had negative experiences with IUI care, particularly regarding the doctor's attitude and coordination of care. Among several patient and hospital characteristics that significantly predicted these negative experiences, the main predictors were no ongoing pregnancy and high education level.

CONCLUSION(S)

From the perspective of subfertile couples, several aspects of IUI care are in serious need of improvement, particularly care aspects regarding the doctor's attitude and coordination of care. These findings are an important incentive for developing tailored interventions that address the reported deficits in IUI care to meet subfertile couples' needs better.

Staff burnout and patient satisfaction with the quality of dialysis care

BACKGROUND

Although there has been increasing interest in assessing patient satisfaction with health care during the past year, relatively few studies investigated hemodialyzed patient satisfaction.

STUDY DESIGN

Cross-sectional study of the relationship between burnout in nephrologists and nurses and patient satisfaction with their care.

SETTING & PARTICIPANTS

Nephrologists (n = 68), nurses (n = 334), and hemodialyzed patients (n = 695) from 10 dialysis centers across northern Italy.

PREDICTOR

Staff burnout was assessed using the Maslach Burnout Inventory. Three staff burnout subscales were developed by using factor analysis: Emotional Exhaustion, Depersonalization, and Personal Accomplishment.

OUTCOMES

Patient satisfaction was assessed by means of a multichoice questionnaire that incorporated 4 patient satisfaction dimensions: (1) completeness of medical information, (2) emotional relationship with health care staff, (3) performance of dialysis center staff, and (4) organizational aspects of health care service. Each item was scored on a 4-point scale ranging from 1 (very dissatisfied) to 4 (very satisfied). Spearman rank-order correlation was used to examine relationships between patient satisfaction and each of the 3 staff burnout subscales for each dialysis center.

RESULTS

Overall, burnout scores were lower than the Italian normative sample, with no significant differences between physicians and nurses. However, considering each dialysis center separately, in 2 centers, nurses registered higher emotional exhaustion levels compared with physicians, with statistically significant differences (P = 0.004 and P = 0.003, respectively). Analysis of patient overall satisfaction assessments showed general appreciation for the "courtesy" and "kindness" of staff, but evidence of problems regarding organizational aspects and structural factors. However, the most critical dimension was for "information." There was a significant positive correlation between staff personal accomplishment and client satisfaction (P < 0.01) and a significant negative correlation between staff emotional exhaustion and patient satisfaction (P < 0.01). No significant correlation was found between staff depersonalization and patient satisfaction level.

LIMITATIONS

Factor analysis should be considered exploratory and confirmed in future use of the questionnaire.

CONCLUSION

Our results suggest that high levels of burnout in physicians and nurses are associated with poor patient satisfaction in dialysis units. Identifying and preventing staff burnout may increase patient satisfaction with health care.

Predicting and comparing patient satisfaction in four different modes of health care across a nation

This study aims to inform strategic policy makers and managers about the value of general population surveys by determining and comparing dimensions of satisfaction in four different health services in Scotland: general practice, domiciliary care, outpatients and inpatients (including day cases). The research design involved secondary data analysis of a national telephone survey conducted to inform the development of a national health plan. The database was created using a stratified quota sample of 3052 people of 16 years and above resident in Scotland in 2000. The main outcome measures investigated were overall measures of patient satisfaction with each type of service. Principal components analysis was used to determine the dimensions. Interest was in the extent to which patients, many of whom were the same (having used more than one service), evaluated different services in similar ways, as well as those factors specific to each service. Using logistic regression, the results demonstrate that interpersonal care and information, and desired improvements in service were universal and key explanatory dimensions in all services, followed by a combination of access, physical facilities, time and quality of food, depending on relevance to the service. These factors, particularly interpersonal care and information, distinguished well the highly satisfied from the others, with age providing further discrimination between non-hospital patients, while gender added to discrimination between inpatients. In conclusion, despite the limitations of telephone interviews, it is feasible to ask about several services at the same time and for the answers to reflect common underlying dimensions of evaluation found in more exhaustive research within each service. These factors offer a set of summary measures by which services can be easily evaluated at a strategic level and point to where efforts to increase patient satisfaction can be maximised.