Comparison of patients' and general practitioners' evaluations of general practice care

Perceptions of bariatric surgery in patients with type 2 diabetes: data from a self-administered questionnaire

BACKGROUND

Although bariatric surgery (BS) is recommended for patients with type 2 diabetes (T2D) and moderate to severe obesity, only approximately 2% of patients undergo surgery.

OBJECTIVE

To compare the knowledge and perception of BS with that of other treatments for diabetes among patients with diabetes.

SETTING

French social media platforms.

METHODS

A self-administered questionnaire was distributed from May 13 to June 3, 2020, via different French social media, including patients with T2D (main target), and patients with type 1 diabetes (control population). Different profiles of reluctance to BS were identified using a factorial analysis.

RESULTS

Of the 4481 responders (50.4% women, 33.9% aged over 65), 60% had T2D. Of the 1736 patients who had heard of BS (38.7%), 1493 declared they never addressed it with their physician. Among T2D patients, BS is the treatment that elicits the most negative response, with more than 10% showing reluctance. Four reluctance profiles were identified: (1) cluster 1 (43.4%), fear of consequences on their eating habits and irreversibility of the procedure; (2) cluster 2 (34.9%), fear of poorer diabetes control; (3) cluster 3 (9.3%), fear of surgical risk; and (4) cluster 4 (12.4%), fear of side effects. In all clusters, the opinion of their physician would be the most important factor to change their mind.

CONCLUSION

Bariatric surgery for T2D is rarely addressed in routine medical visits. Fear of operative risks and irreversibility of the procedure largely explains the reluctance to BS. Information and education campaigns on the benefit of metabolic surgery for patients with T2D remain necessary.

Prerequisites, barriers and opportunities in care for Q-fever patients: a Delphi study among healthcare workers

BACKGROUND

Q-fever is a zoonotic disease that can lead to illness, disability and death. This study aimed to provide insight into the perspectives of healthcare workers (HCWs) on prerequisites, barriers and opportunities in care for Q-fever patients.

METHODS

A two-round online Delphi study was conducted among 94 Dutch HCWs involved in care for Q-fever patients. The questionnaires contained questions on prerequisites for high quality, barriers and facilitators in care, knowledge of Q-fever, and optimization of care. For multiple choice, ranking and Likert scale questions, frequencies were reported, while for rating and numerical questions, the median and interquartile range (IQR) were reported.

RESULTS

The panel rated the care for Q-fever patients at a median score of 6/10 (IQR = 2). Sufficient knowledge of Q-fever among HCWs (36%), financial compensation of care (30%) and recognition of the disease by HCWs (26%) were considered the most important prerequisites for high quality care. A lack of knowledge was identified as the most important barrier (76%) and continuing medical education as the primary method for improving HCWs' knowledge (76%). HCWs rated their own knowledge at a median score of 8/10 (IQR = 1) and the general knowledge of other HCWs at a 5/10 (IQR = 2). According to HCWs, a median of eight healthcare providers (IQR = 4) should be involved in the care for Q-fever fatigue syndrome (QFS) and a median of seven (IQR = 5) in chronic Q-fever care.

CONCLUSIONS

Ten years after the Dutch Q-fever epidemic, HCWs indicate that the long-term care for Q-fever patients leaves much room for improvement. Facilitation of reported prerequisites for high quality care, improved knowledge among HCWs, clearly defined roles and responsibilities, and guidance on how to support patients could possibly improve quality of care. These prerequisites may also improve care for patients with persisting symptoms due to other infectious diseases, such as COVID-19.

Primary Health Institutions and Service Quality in China: Implications for Health Policy

BACKGROUND

To protect and improve the health of populations, the important role of primary health institutions has been strengthened through a series of health policies, especially the implementation of a national hierarchical diagnosis and treatment system. In this light, we aim to evaluate the development of primary health institutions between 2013, before the implementation of the hierarchical diagnosis and treatment system, and 2020 as well as people's perception of the quality of primary healthcare services.

METHOD

The national-level data (e.g., the numbers of primary health institutions, personnel, beds, visits, and hospitalizations) regarding primary health institutions were collected from the Health Statistics Yearbook, and the perceptions of the quality of primary healthcare services were collected by a web-based questionnaire survey using an internationally recognized assessment tool (i.e., PCAT-AE). In total, 10,850 persons were surveyed, and 10,419 participants were incorporated into the final analysis after removing invalid questionnaires. A descriptive statistical analysis (i.e., frequency and percentage) was used to analyze the national-level characteristics of primary health institutions and people's perceptions of the quality of primary healthcare services. Moreover, a logistic regression model was used to analyze the factors influencing the perceptions of the quality of primary healthcare services.

RESULTS

From the macro perspective, the number of primary health institutions, beds, and personnel per 10 thousand residents slightly increased from 2013 to 2020, especially in the eastern and central areas. However, the average number of visits and the hospitalization rate in primary health institutions showed a decrease, especially in central and eastern areas. Among participants, 92.2% (9606/10,419) of them had previously sought healthcare services in primary health institutions, and most were seeking general outpatient services (57.06-63.45%), followed by medicine purchasing (16.49-21.51%), physical examinations (9.91-11.49%), preventive health services (5.11-6.48%), and hospitalization services (3.17-5.67%). The total perception scores on the quality of primary healthcare services reported by the participants were 26.19 and 27.00 for rural and urban areas, respectively, which accounted for 65.5% and 67.5% of the total score, respectively, and 26.62, 26.86, and 25.89 for the eastern, central, and western areas, respectively, with percentages of 66.6%, 67.2%, and 64.7%. The perception score on the quality among people contracted with a family doctor (29.83, 74.58%) was much higher than those who were not (25.25, 63.13%), and the difference was statistically significant (p < 0.001). Moreover, people who were female, married, had higher incomes, and were diagnosed with various diseases had better perceptions of the primary healthcare services compared to their counterparts (p < 0.05).

CONCLUSION

Improvements were seen for primary health institutions, especially in terms of hardware resources such as beds and personnel. However, the service utilization in primary health institutions did not improve between 2013 and 2020. The perception score on the quality of primary healthcare was moderate to low in rural and urban as well as eastern, central, and western areas, but it was significantly higher among people contracted with a family doctor than those who were not. Therefore, it is important for policy makers to take or adjust measures focusing on quality improvement and increasing the service utilization in primary health institutions with good first contact, accessibility, continuity, comprehensiveness, and coordination, such as raising the enrollment rate of family doctors and promoting the provision of high-quality services.

The perception of health care quality by primary health care managers in Ukraine

Background

Ukraine is reforming its health care system to improve quality of health care. Insight into how primary health care managers perceive quality is important for the ongoing reform as well as for the improvement of medical services.

Methods

An online survey was conducted as part of the Ukrainian-Swiss project “Medical Educational Development” in April–May 2019 based on the contact list of USAID project “Health Reform Support”, and additionally on the database of the National Health Service of Ukraine and other channels. Data were analyzed using descriptive statistics and qualitative data analysis.

Results

In total, 302 health care managers took part in the study. The majority of primary health care managers perceive quality in health care as process quality. They associate quality mostly with compliance to standards. At the same time, primary health care managers prefer to assess outcome quality via a system of indicators and feedback. There appears to be a lack of consensus about health care quality. This may be due to a lack of awareness of the national strategy for better quality of health care service.

Conclusions

Our study provides new insights into primary care managers' perceptions of health care quality in Ukraine. The absence of a clear consensus about quality complicates the discussion about quality and how to measure quality in health care. This appears to be one of the obstacles to system-wide quality improvement.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08300-y.

Patient, carer and healthcare professional experiences of complex care quality in multidisciplinary primary healthcare centres: qualitative study with face-to-face, in-depth interviews and focus groups in five French multidisciplinary primary healthcare centres

Objectives

To explore care experiences in multidisciplinary primary healthcare centres from the patients, carers and healthcare professionals perspectives.

Design

This qualitative study used face-to-face, in-depth interviews and focus groups. Patients with multimorbidity monitored by a General Practitioner (GP) and another professional from the health centre were recruited through purposive sampling and included with their carer. They were interviewed together while professionals were interviewed separately. Verbatims were coded with subsequent blind analysis, using an inductive approach, to find aspects and features. The constant comparative method highlighted data consistencies and variations.

Participants

Twenty-six patients, 23 family carers and 57 healthcare professionals.

Setting

Five multidisciplinary primary healthcare centres, in France, between March 2017 and December 2018.

Results

This unique study grouped perspectives into nine core quality of primary care aspects: having accessible, available, and varied care; feeling welcome and enjoying comfortable, well-equipped, and clean premises; having quality medicotechnical care (medical knowledge and technical skills); having a reliable GP; receiving appropriate care from healthcare professionals other than the GP; maintaining an efficient relationship with healthcare professionals; benefiting from organised and coordinated care; being an informed, supported and involved patient; having an informed, supported and involved carer. New areas of interest include the multidisciplinary nature of the centres, appreciation of other professionals within the centre, medicotechnical dimensions of care and the carer’s role in maintaining patient autonomy.

Conclusions

This is the first study to interview patients and carers alongside healthcare professionals. This enhanced knowledge improves understanding of these aspects and can guide implementation of evaluation tools that truly reflect patient and carer needs and enable an efficient experience in terms of quality. To address deficiencies in existing questionnaires, the new perspectives found will be added to former aspects to create a comprehensive quality of primary care evaluation tool.

Trial registration number

NCT02934711, Results.

Public reporting of hospital quality data: What do referring physicians want to know?

OBJECTIVE

To identify ambulatory care physicians' priorities for hospital quality criteria to support them in counselling patients what hospital to choose.

METHODS

Three hundred non-hospital-based stratified randomly sampled physicians, representing the five main referring specialties in Germany participated in a cross-sectional survey. Physicians rated the importance of 80 hospital quality criteria to be used in their counselling of patients in need of hospital care. Criteria selection was based on a literature analysis and the content of Germany's mandatory hospital quality reports. We calculated the most important criteria and performed an ordinal regression analysis to examine whether the physicians' characteristics 'age', 'sex', 'specialty', 'practice type' and 'region' affected physicians' importance ratings.

RESULTS

To counsel patients in need of a hospital referral, physicians preferred hospital quality criteria that reflect their own and their patients' experiences with a hospital. Additionally, hospitals' expertise and results of treatment were rated highly important. In contrast, hospitals' structural characteristics and compliance with external requirements were rated less important. Physicians' characteristics affected importance ratings only negligibly.

CONCLUSIONS

To support referring physicians' counselling of patients regarding what hospital to choose in order to achieve optimal patient outcomes eventually, hospital report cards must be enriched by information on physicians' and their patients' experiences with hospitals. Hospitals' structural characteristics play a minor role in counselling of patients needing hospital care.

The benefits of co-location in primary care practices: the perspectives of general practitioners and patients in 34 countries

Background

There is no clear evidence as to whether the co-location of primary care professionals in the same facility positively influences their way of working and the quality of healthcare as perceived by patients. The aim of this study was to identify the relationships between general practitioner (GP) co-location with other GPs and/or other professionals and the GP outcomes and patients’ experiences.

Methods

We wanted to test whether GP co-location is related to a broader range of services provided, the use of clinical governance tools and inter-professional collaboration, and whether the patients of co-located GPs perceive a better quality of care in terms of accessibility, comprehensiveness and continuity of care with their GPs. The source of data was the QUALICOPC study (Quality and Costs of Primary Care in Europe), which involved surveys of GPs and their patients in 34 countries, mostly in Europe. In order to study the relationships between GP co-location and both GPs’ outcomes and patients’ experience, multilevel linear regression analysis was carried out.

Results

The GP questionnaire was filled in by 7183 GPs and the patient experience questionnaire by 61,931 patients. Being co-located with at least one other professional is the most common situation of the GPs involved in the study. Compared with single-handed GP practices, GP co-location are positively associated with the GP outcomes. Considering the patients’ perspective, comprehensiveness of care has the strongest negative relationship of GP co-location of all the dimensions of patient experiences analysed.

Conclusions

The paper highlights that GP mono- and multi-disciplinary co-location is related to positive outcomes at a GP level, such as a broader provision of technical procedures, increased collaboration among different providers and wider coordination with secondary care. However, GP co-location, particularly in a multidisciplinary setting, is related to less positive patient experiences, especially in countries with health systems characterised by a weak primary care structure.

Primary care patients' expectations regarding medical appointments and their experiences during a visit: does age matter?

INTRODUCTION

There is evidence that meeting patients' expectations toward health care correlates with involvement in the treatment they receive. The most important patient expectations concern certain types of information: explanation of disease and treatment, health promotion, and improvement in quality of life. Other demands include proper rapport and emotional support. The aim of this paper was to examine different patient groups over the age of 50 years and their expectations toward medical visits, evaluated before a visit and after the visit.

PATIENTS AND METHODS

The study group consisted of 4,921 primary health-care patients. The patients received self-administered questionnaires that they filled in before and after the appointment with the doctor. Interviews with patients were conducted individually by specially trained interviewers. The PRACTA Patient Expectations Scale was used to measure the appointment-related expectations of the patients.

RESULTS

We observed differences related to age in patients' expectations before medical visits regarding the following factors: disease explanation, treatment explanation, quality of life, rapport, and emotional support. The same differences were not observed on health promotion. Evaluation of patients' appointment-related experiences after the visit showed that there were significant differences between the age-groups regarding all types of expectations included in the study. Differences between previsit and postvisit measurements were statistically significant in all age-groups. Patients who received less than they expected from doctors outnumbered those who received what they expected or more in all the groups.

CONCLUSION

Patients' expectations toward medical visits are conditioned by age. Therefore, doctors should pay more attention to requirements related to age in their effort to identify and satisfy expectations. This is particularly important in light of the discrepancy between previsit expectations and the actual experiences of patients evaluated after the visit.

Comparison of veterinary health services expectations and perceptions between oncologic pet owners, non-oncologic pet owners and veterinary staff using the SERVQUAL methodology

AIM

Client satisfaction gained great importance in health care as a measurement of service quality. One of the most popular methods to evaluate client satisfaction is the SERVQUAL inquiry which measures service quality by evaluating client expectations and services towards a service in five dimensions: Tangibles, Empathy, Assurance, Reliability and Responsiveness.

MATERIALS AND METHODS

In order to evaluate if owners of pets with cancer constitute a distinctive group from the general pet owner population and if these differences were perceived by the hospital staff we applied a SERVQUAL questionnaire to 51 owners of pet with cancer, 68 owners from the general pet population and 14 staff members.

RESULTS

Owners of oncologic pets had different expectations of an ideal service granting importance to Assurance questions (6.75 vs 6.5, p= 0.045) while showing unmet needs in Reliability and Empathy dimensions. Veterinarians failed to understand these specificities and over evaluated characteristics of Tangible dimension (6.75 vs 6.25, p=0.027).

CONCLUSION

Owners of pet with cancer seem to constitute a specific subpopulation with special needs and veterinary staff should invest resources towards Assurance instead of privileging tangible aspects of veterinary services. By aligning professionals expectations with those of pet owners veterinarians can achieve better client satisfaction, improved compliance and stronger doctor-owner relationships.

Satisfaction with in vitro fertilization treatment: patients' experiences and professionals' perceptions

BACKGROUND

This paper investigates patients' satisfaction with various aspects of fertility care and seeks to determine to what extent fertility specialists are able to assess patient satisfaction. Patients' experiences with in-vitro fertilization (IVF) services and facilities have been compiled and examined in order to discover whether patients' satisfaction is correlated to psychological factors and demographic, socio-economic, and health characteristics, and whether patients' satisfaction has an influence on the willingness to pay (WTP) for IVF treatment.

METHODS

The study was carried out on 204 patients and 19 fertility professionals from 8 public IVF units in Israel.

RESULTS

The study found that, overall, infertile patients are satisfied with the care they received. Several demographic variables (age; education; income; number of fertility treatments) and psychological factors ('Pessimism' and 'Activeness'), were found to be significantly correlated with patient satisfaction with IVF. The results yielded a negative correlation between the WTP for IVF treatment and the satisfaction with access to care and physical conditions.

CONCLUSIONS

Patient satisfaction is an important component in the evaluation of fertility treatments as well as other medical interventions. Insights into the quality of care as seen from the patients' perspective may help healthcare staff better meet patients' needs, wishes, and priorities.

Complaint handling in healthcare: expectation gaps between physicians and the public; results of a survey study

BACKGROUND

Patients who submit complaints about the healthcare they have received are often dissatisfied with the response to their complaints. This is usually attributed to the failure of physicians to respond adequately to what complainants want, e.g. an apology or an explanation. However, expectations of complaint handling among the public may colour how they evaluate the way their own complaint is handled. This descriptive study assesses expectations of complaint handling in healthcare among the public and physicians. Negative public expectations and the gap between these expectations and those of physicians may explain patients' dissatisfaction with complaints procedures.

METHODS

We held two surveys; one among physicians, using a panel of 3366 physicians (response rate 57 %, containing all kinds of physicians like GP's, medical specialist and physicians working in a nursing home) and one among the public, using the Dutch Healthcare Consumer Panel (n = 1422, response rate 68 %). We asked both panels identical questions about their expectations of how complaints are handled in healthcare. Differences in expectation scores between the public and the physicians were tested using non-parametric tests.

RESULTS

The public have negative expectations about how complaints are handled. Physician's expectations are far more positive, demonstrating large expectation gaps between physicians and the public.

CONCLUSIONS

The large expectation gap between the public and physicians means that when they meet because of complaint, they are likely to start off with opposite expectations of the situation. This is no favourable condition for a positive outcome of a complaints procedure. The negative public preconceptions about the way their complaint will be handled will prove hard to change during the process of complaints handling. People tend to see what they thought would happen, almost inevitably leading to a negative judgement about how their complaint was handled.

What are patients' expectations about the organization of their primary care physicians' practices?

Background

To our knowledge no study has at the same time assessed patients’ satisfaction and their expectations concerning the organizational and contextual aspects of health care provided by their primary care physician (PCP). Assessing these aspects is important to inform future primary healthcare service planning. Our objective was thus to document patients’ satisfaction with and expectations from their PCP, in terms of availability and organization of their practices, and to assess whether these indicators varied across age groups and type of practice (solo, duo, group).

Methods

Cross-sectional study based on the answers to questionnaires completed by patients consulting their PCP in Geneva, Switzerland. A random sample of PCPs was asked to recruit consecutively between 50 and 100 patients coming to the practice for a scheduled medical consultation. The patients were asked to complete an anonymous questionnaire centered on their satisfaction levels and expectations towards their PCP.

Results

One thousand six hundred thirty-seven patients agreed to participate (participation rate: 97 %, women: 63 %, mean age: 54 years). Patient satisfaction was high for all the items, except for the availability of the doctor by phone and for the waiting time in the waiting room. The satisfaction rate increased with age and was higher for small practices. In relation to patients’ expectations from their doctor, older patients and patients visiting larger practices tended to be more demanding.

Conclusions

Patients are generally highly satisfied with their PCP. They have a wide range of expectations which should be taken into account when considering potential improvements.

Satisfacción de pacientes que acudieron al primer nivel de atención durante el 2012 en Bogotá

<p><strong>Objetivo</strong> Estimar la percepción de los pacientes sobre la atención médica en el primer nivel de atención.</p><p><strong>Metodología</strong> Se aplicó una encuesta telefónica a pacientes atendidos en dos meses diferentes del 2012, indagando por variables sociodemográficas, relaciones médico-paciente y acerca del proceso de atención médica.</p><p><strong>Resultados </strong>Se encuestaron 804 pacientes. El tiempo promedio de acceso a la atención fue de 9,6 días. El 78 % refiere haber podido contar todo lo que sentía al médico, el 60 % que el médico le explicó lo que tenía y, uno de cuatro, que indagó por su familia. El 30 % sintió alivio completo luego de la atención médica. La calificación promedio de la atención médica fue de 7,9 (DE ± 1,7). Las variables relacionadas con las calificaciones más altas fueron: Poder contarle todo al médico (OR 7,5 IC 95 % 1,8-31), ser examinado (OR 7,5 IC 95 % 1,5-38,5, explicarle qué tiene (OR 5,2 IC 95 % 1,8-15), preguntar por la familia (OR 5,8 IC 95 % 2,1-16,1) y haberlo atendido antes (OR 3,5 IC 95 % 1,4-8,6).</p><p><strong>Conclusiones </strong>La comunicación extensa con el paciente es tan importante como el enfrentar la enfermedad en el acto médico.</p>

How do GPs in Switzerland perceive their patients' satisfaction and expectations? An observational study

OBJECTIVES

To assess doctors' perceptions of their patients' satisfaction and expectations in primary care.

STUDY DESIGN

Cross-sectional study using questionnaires completed by general practitioners (GPs) and their patients.

SETTING

Primary care practices in Geneva, Switzerland.

PARTICIPANTS

23 GPs from a random list of 75 GPs practising in the canton of Geneva (participation rate 31%), who each recruited between 50 and 100 consecutive patients coming to the practice for a scheduled medical consultation, leading to a total of 1637 patients (participation rate: 97%, women: 63%, mean age: 54 years). Patient exclusion criteria were: new patients, those consulting in an emergency situation or suffering from disorders affecting their ability to consent, and those who did not speak French.

MAIN OUTCOME MEASURES

Patients satisfaction with and expectations from the care they received in this practice; GPs perceptions of their patient's satisfaction and expectations.

RESULTS

GPs underestimated all patient satisfaction items (p<0.001 for all items) whereas they overestimated their expectations, except for equipment (laboratory and X-ray) and some accessibility items. In a multivariate analysis to assess which GP factors were associated with correct assessment of their patients' views, only GPs' certification status was a significant factor.

CONCLUSIONS

GPs tend to underestimate patients' satisfaction but overestimate their expectations in primary care. These findings may help GPs to understand patients' views in order to adequately meet their expectations and concerns.

Mothers' perceptions of primary health-care providers: thematic analysis of responses to open-ended survey questions

General practitioners and maternal, child and family health nurses have a central role in postpartum primary health care for women and their infants. Positive client-provider relationships are particularly important for women experiencing mental health problems or unsettled infant behaviour. However, little is known about their experiences of postnatal primary health care. The study aimed to describe views of postnatal primary health care among women completing a residential early parenting programme and to identify potential strategies to enhance provider-patient interactions. Participants (n=138) were women admitted with their infants to a private or a public early parenting service in Melbourne, Australia. Women completed a detailed self-report survey, including open-ended questions about experiences of primary health-care services, and a structured psychiatric interview to diagnose anxiety and depression. Survey responses were analysed thematically. Womens' experiences of primary health care were influenced by their perceptions of provider competence and the quality of interactions. While similar positive characteristics of doctor and nurse care were valued, medical and nursing practices were judged in different ways. Women described GPs who listened, understood and were thorough as providing good care, and maternal, child and family health nurses were valued for providing support, advice and encouragement. Threats to therapeutic relationships with doctors included feeling rushed during consultations, believing that GPs were not mental health-care providers and the clinician not being 'good' with the infant; with nurses, problems included feeling judged or given advice that was inconsistent or lacked an evidence-base. Postpartum primary health care will be improved by unhurried consultations, empathic recognition, encouragement, evidence-informed guidance and absence of criticism.

Patient and staff views of quality in forensic psychiatric inpatient care

The study describes and compares perceived quality of care among patients and staff using the Quality in Psychiatric Care-Forensic In-Patient and the Quality in Psychiatric Care-Forensic In-Patient Staff questionnaires. The questionnaires are both based on the perception of the quality of the forensic psychiatric care given to the patients, but the wording is adjusted to fit patients or staff. The study sample consisted of 66 patients and 202 staff members from 12 forensic units in Sweden. Using multiple regression analyses to adjust for demographic variables, it was found that patients perceived the quality of support and secluded environment lower than did staff, whereas staff had lower perceptions than patients of the quality of secure environment. The combination of these questionnaires provides new possibilities for assessing the quality of forensic psychiatric care and evaluating interventions, important factors in the management and planning of forensic care.

Establishing components of high-quality injury care: Focus groups with patients and patient families

BACKGROUND

Each year, injuries affect 700 million people worldwide, more than 5 million people die of injuries, and 68,000 survivors remain permanently impaired. Half of all critically injured patients do not receive recommended care, and medical errors are common. Little is known about the aspects of injury care that are important to patients and their families. The purpose of this study was to explore the views of patients and families affected by injury on desired components of injury care in the hospital setting.

METHODS

With the use of a grounded theory approach, this qualitative study involved focus groups with injured patients, family members of survivors, and bereaved family members from four Canadian trauma (injury care) centers.

RESULTS

Thirty-eight participants included injured patients (n = 16), family members of survivors (n = 13), and bereaved family members (n = 9) across four trauma (injury care) centers in different jurisdictions. Participants articulated numerous themes reflecting important components of injury care organized across three domains as follows: clinical care (staff availability, professionalism, physical comfort, adverse events), holistic care (patient wellness, respect for patient and family, family access to patient, family wellness, hospital facilities, supportive care), and communication and information (among staff, with or from staff, content, delivery, and timing). Bereaved family members commented on decision making and end-of-life processes. Subthemes were revealed in most of these themes. Trends by site or type of participant were not identified.

CONCLUSION

The framework of patient- and family-derived components of quality injury care could be used by health care managers and policy makers to guide quality improvement efforts. Further research is needed to extend and validate these components among injured patients and families elsewhere. Translating these components into quality indicators and blending those with measures that reflect a provider perspective may offer a comprehensive means of assessing injury care.

Perceptions of quality in primary health care: perspectives of patients and professionals based on focus group discussions

Background

The EUprimecare project-team assessed the perception of primary health care (PHC) professionals and patients on quality of organization of PHC systems in the participating countries: Estonia, Finland, Germany, Hungary, Italy, Lithuania and Spain. This article presents the aggregated opinions, expectations and priorities of patients and professionals along some main dimensions of quality in primary health care, such as access, equity, appropriateness and patient- centeredness.

Methods

The focus group technique was applied in the study as a qualitative research method for exploration of attitudes regarding the health care system and health service. Discussions were addressing the topics of: general aspects of quality in primary health care; possibilities to receive/provide PHC services based on both parties needs; determinant factors of accessibility to PHC services; patient centeredness. The data sets collected during the focus group discussions were evaluated using the method of thematic analysis.

Results

There were 14 focus groups in total: a professional and a patient group in each of the seven partner countries. Findings of the thematic analysis were summarized along the following dimensions: access and equity, appropriateness (coordination, continuity, competency and comprehensiveness) and patient centeredness.

Conclusions

This study shows perceptions and views of patients in interaction with PHC and opinion of professionals working in PHC. It serves as source of criteria with relevance to everyday practice and experience. The criteria mentioned by patients and by health care professionals which were considered determining factors of the quality in primary care were quite similar among the investigated countries. However, the perception and the level of tolerance regarding some of the criteria differed among EUprimecare countries. Among these dissimilar criteria we especially note the gate-keeping role of GPs, the importance of nurses' competency and the acceptance of waiting times. The impact of waiting time on patient satisfaction is obvious; the influence of equity and access to PHC services are more dependent on the equal distribution of settings and doctors in urban and rural area. Foreseen shortage of doctors is expected to have a substantial influence on patient satisfaction in the near future.

Patient and provider perspectives on quality and health system effectiveness in a transition economy: evidence from Ukraine

Facing a severe population health crisis due to noncommunicable diseases, Ukraine and other former Soviet republics and Eastern European countries have a pressing need for more effective health systems. Policies to enhance health system effectiveness should consider the perspectives of different stakeholder groups, including providers as well as patients. In addition, policies that directly target the quality of clinical care should be based on objective performance measures. In 2009 and 2010 we conducted a coordinated series of household and facility-level surveys to capture the perspectives of Ukrainian household members, outpatient clinic patients, and physicians regarding the country's health system overall, as well as the quality, access, and affordability of health care. We objectively measured the quality of care for heart failure and chronic obstructive pulmonary disease using CPV(®) vignettes. There was broad agreement among household respondents (79%) and physicians (95%) that Ukraine's health system should be reformed. CPV(®) results indicate that the quality of care for common noncommunicable diseases is poor in all regions of the country and in hospitals as well as polyclinics. However, perspectives about the quality of care differ, with household respondents seeing quality as a serious concern, clinic patients having more positive perceptions, and physicians not viewing quality as a reform priority. All stakeholder groups viewed affordability as a problem. These findings have several implications for policies to enhance health system effectiveness. The shared desire for health system reform among all stakeholder groups provides a basis for action in Ukraine. Improving quality, strengthening primary care, and enhancing affordability should be major goals of new health policies. Policies to improve quality directly, such as pay-for-performance, would be mutually reinforcing with purchasing reforms such as transparent payment mechanisms. Such policies would align the incentives of physicians with the desires of the population they serve.

British residents’ views about general practice care in France – a telephone survey

Background

Many studies have been published over the past decade on patients’ views about the provision of health care. Though there is a high level of migration within the European Union, there are no studies on migrants’ views about the provision of care in the country to which they moved. Given the wide spectrum of primary care in Europe, we hypothesised, without prejudging the outcome, that patients’ confidence in the system they left, used as a proxy of ‘the experience of care’, may influence their preferences regarding specific aspects of care in the host country. The objective of the study was to analyse British migrants’ views on general practice care in France.

Methods

A telephone survey was conducted with a random sample of the adult population of British people residing in France. Participants were 437 women and 423 men, aged 18 and over, who had consulted a general practitioner at least once during the past 12 months. The main outcome measures were the responses to the 23-item Europep questionnaire evaluating different aspects of general practice care, using a five-point answering scale with the extremes labelled as “poor” and “excellent”.

Results

Participants were generally satisfied with the GP care provided. The aspects that were rated the highest were related to the doctor-patient relationship which over 80% of the respondents judged as excellent or very good. Some aspects of the organisation of services received relatively negative evaluations. For instance, “waiting time in the waiting room” was evaluated as excellent or very good by only 40% of the respondents. Twenty seven percent of the respondents were not confident in the National Health Service (NHS) when they were still living in UK. After adjusting for age, sex and number of years of residence in France, the respondents who were not confident in the NHS provided a score of “excellent” significantly more frequently (on 11 out of the 23 aspects of care) than did the patients who were confident in the NHS. Most of these aspects concerned the doctor-patient relationship and information and support during the consultation.

Conclusions

British migrants’ views on general practice care in France varied with the degree of confidence they had in the NHS. This finding is in line with the discussion on whether the ‘experience of care’ influences patient satisfaction. A better understanding of this phenomenon should provide valuable insights to make the services more responsive to the patients.

Patient-physician concordance and discordance in gynecology: do physicians identify patients' reasons for visit and do patients understand physicians' actions?

OBJECTIVE

To assess physician-patient concordance on reasons for consultation and actions taken during consultation in five different gynecological practices, and to investigate patient and physician factors influencing discordance in reporting.

METHODS

1667 post-encounter questionnaires completed by patients and physicians were compared in terms of reasons for consultation and actions taken during consultation. Patient-physician concordance was assessed using kappa statistics. Multivariable regression analyses served to identify determinants of discordance.

RESULTS

A moderate to high level of patient-physician concordance on reasons for consultation and actions taken during the consultation was found. Discordance regarding reasons for consultation was associated with patient and practice characteristics, discordance regarding actions taken during the consultation only with practice characteristics. Counseling emerged as a particular source of patient-physician discordance.

CONCLUSION

In gynecological practices, discordance depends on the reason or action assessed, but is particularly pronounced when it comes to counseling. The influence of physician characteristics on patient-physician concordance needs more attention in research.

PRACTICE IMPLICATIONS

Gynecologists need to establish a mutual understanding with their patients about the reason of the consultation and the actions taken in the consultation, in particular with regard to counseling.

Patients' and professionals' evaluations of quality of care in oncology outpatient clinics

PURPOSE

The purpose of this study is to compare patients' and professionals' evaluations of the quality of care in oncology outpatient clinics.

METHODS

The data were drawn from a 2011 survey of 1,379 patients and 155 professionals conducted in 15 % of oncology outpatient clinics in Quebec, Canada. Respondents completed self-administered questionnaires that addressed the aspects of timeliness (TIM), patient-centred care (PCC), communication (COM), quality of the physical environment (QPE), and continuity (CONT). Patients' and professionals' mean scores (maximum = 4) for each aspect were compared using mixed model analysis.

RESULTS

Patients' and professionals' perceptions of quality of care were largely positive, with mean scores for all items of 3.66 and 3.37, respectively. However, for the majority of aspects of quality, the professionals' scores were lower than those of patients. The aspects rated most positively by both groups were PCC, COM and CONT. Timeliness was the least positively evaluated, with mean scores of 3.34 for patients and 3.16 for professionals.

CONCLUSIONS

In many respects, cancer patients and professionals share relatively common views about the most and least positive aspects of the quality of care, although professionals tend to be more critical. Aspects evaluated less favourably by both groups and those on which opinions differ are good candidates for improvements. Some ideas for solutions are proposed. Positive patient feedback is especially important in cancer care, where attraction and retention of professionals is a key concern.

Effects of Guided Care on providers' satisfaction with care: a three-year matched-pair cluster-randomized trial

It is important to understand the effects of a new care model on health professionals' satisfaction, which may help inform organizations' decisions regarding the adoption of the model. This study evaluates the effect of the Guided Care model of primary care on physicians', Guided Care Nurses' and practice staff satisfaction with processes of care for chronically ill older patients. In Guided Care, a specially educated registered nurse works with 2-5 primary care physicians, performing 8 clinical activities for 50-60 chronically ill older patients. This model was tested in a 3-year matched-pair cluster-randomized controlled trial with 14 pods (teams of physicians and staff) randomly assigned, within pairs, to provide Guided Care or usual care. Physicians and Guided Care Nurses were surveyed at baseline and annually for 3 years. Staff were surveyed at baseline and 2 years later. Physicians' satisfaction with chronic care processes, knowledge of patients, and care coordination were measured, as well as Guided Care Nurses' satisfaction with chronic care processes and staff perceptions of quality of care. Findings suggest that Guided Care improved physician satisfaction with patient/family communication and management of chronic care, and it may bolster staff beliefs that care is patient oriented. Differences in other aspects of care were not statistically significant.

The Missing Evaluation at the End of GP's Consultation

Evaluation at the end of a consultation is an element of a successful encounter. The doctor should inquire if patient's expectations were fulfilled and sum up the information given, the examinations performed, and the decisions made with the patient. This way the patient would be fully aware of what has been decided and that the problems and expectations of the patient had been taken into account. Twenty consultations of four general practitioners (GPs) in Finland were videotaped. The doctors were men and women, two of them had a long experience and two were trainees in general practice. The data (videotapes, questionnaires, and interviews) were analysed by multiple research methods with investigator and methodological triangulation. MAAS-Global Rating List was used as an assessment tool. The evaluation of the consultation was often missing or having shortages; only one-third was assessed to be better than doubtful. The assessments done by experienced GPs and the medical student were similar. According to the result of this study as well as the information in the current literature, doctors in all periods of their career should repeatedly be reminded about the importance of the evaluation at the end of the consultation.

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.

Challenges in primary care relationships: seeing it from both sides

OBJECTIVE

This qualitative study explored perspectives of primary care providers and patients in challenging relationships.

METHODS

In 2007, we conducted semi-structured interviews with providers recruited from 12 clinics affiliated with a U.S. academic center. Providers identified patients with whom they had ongoing "challenging relationships," and we interviewed the first consenting patient for each provider. We compared numeric ratings of relationship quality statistically. Using an editing analysis style, ≥2 investigators coded transcripts to identify themes.

RESULTS

Seventeen dyads participated. Providers averaged 14 years in practice. Most were Caucasian (88%) and female (59%). The mean patient age was 49 years, 59% were Caucasian, and 71% female. Relationships averaged 4.6 years. On a 1-10 scale, patients' ratings of the relationship quality (median 9) significantly exceeded providers' ratings (median 5, p=0.002). Three major themes emerged: patients view relationships more positively than providers, the challenges of guarding emotions, and trust matters in challenging relationships.

CONCLUSION

Patients felt more positively about these relationships than providers perceived. Both sought ways to achieve mutual trust, despite barriers arising from guarded emotions.

PRACTICE IMPLICATIONS

Providers in challenging relationships should consider exploring their patients' views, as they may feel reassured that patients appreciate their efforts and have trust in them.

Study protocol: optimization of complex palliative care at home via telemedicine. A cluster randomized controlled trial

BACKGROUND

Due to the growing number of elderly with advanced chronic conditions, healthcare services will come under increasing pressure. Teleconsultation is an innovative approach to deliver quality of care for palliative patients at home. Quantitative studies assessing the effect of teleconsultation on clinical outcomes are scarce. The aim of this present study is to investigate the effectiveness of teleconsultation in complex palliative homecare.

METHODS/DESIGN

During a 2-year recruitment period, GPs are invited to participate in this cluster randomized controlled trial. When a GP refers an eligible patient for the study, the GP is randomized to the intervention group or the control group. Patients in the intervention group have a weekly teleconsultation with a nurse practitioner and/or a physician of the palliative consultation team. The nurse practitioner, in cooperation with the palliative care specialist of the palliative consultation team, advises the GP on treatment policy of the patient. The primary outcome of patient symptom burden is assessed at baseline and weekly using the Edmonton Symptom Assessment Scale (ESAS) and at baseline and every four weeks using the Hospital Anxiety and Depression Scale (HADS). Secondary outcomes are self-perceived burden from informal care (EDIZ), patient experienced continuity of medical care (NCQ), patient and caregiver satisfaction with the teleconsultation (PSQ), the experienced problems and needs in palliative care (PNPC-sv) and the number of hospital admissions.

DISCUSSION

This is one of the first randomized controlled trials in palliative telecare. Our data will verify whether telemedicine positively affects palliative homecare.

TRIAL REGISTRATION

The Netherlands National Trial Register NTR2817.

Professionals' perceptions of their patients' experiences with fertility care

BACKGROUND

Patient-centredness is one of the core dimensions of quality of care. It can be monitored with surveys measuring patients' experiences with care. The objective of the present study was to determine to what extent gynaecologists, physicians specializing in infertility and nurses can estimate the level of patient-centredness of their clinic.

METHODS

A random sample of 1189 couples with fertility problems and 194 physicians and nurses from 29 Dutch fertility clinics participated in this cross-sectional study. Differences between patients' experiences with fertility care and professionals' perceptions of these experiences as measured with the patient-centredness questionnaire-infertility (PCQ-infertility) were calculated. The questionnaire's structure, comprising one total scale (level 1), seven subscales (level 2) and 46 single items (level 3), was used as a framework.

RESULTS

Response rates were 75% (n = 888) in the patient sample and 83% (n = 160) in the professional sample. Independent sample t-tests, corrected for multiple comparisons with the Bonferroni correction method (P < 0.05), showed no significant differences in mean scores on the total scale of patient-centredness for either professionals or patients. At level 2, professionals underestimated most subscales, namely, 'Accessibility', 'Communication', 'Patient involvement' and 'Competence', whereas 'Continuity of care' was overestimated. Professionals significantly and clinically relevantly misjudged 29 care aspects.

CONCLUSIONS

Professionals within fertility care cannot adequately evaluate their performance regarding patient-centredness, and specifically the care aspects to which their own patients attribute the greatest improvement potential. Providing detailed feedback might start improvement of patient-centredness and quality of care.

A multi-faceted strategy to improve the use of national fertility guidelines; a cluster-randomized controlled trial

BACKGROUND Proper use of clinical practice guidelines can decrease variation in care between settings. However, actual use of fertility guidelines is suboptimal and in need of improvement. Hence, a cluster-randomized controlled trial was designed to study the effects of two strategies to implement national Dutch guidelines on comprehensive fertility care. METHODS Sixteen fertility clinics participated in the trial. A minimal, professional-oriented implementation strategy of audit and feedback was tested versus a maximal multi-faceted strategy that was both professional and patient oriented. The extent of adherence to guideline recommendations, reflected in quality indicator scores, was the primary outcome measure. To gain an insight into unwanted side effects, patient anxiety and depression scores were gathered as secondary outcomes. Data collection encompassed medical record search, patient and professional questionnaires. RESULTS A total of 1499 couples were included at baseline and 1396 at the after-measurement. No overall significant improvement in indicator scores was found for either strategy [odds ratios ranging from 0.23 (95% confidence interval (CI): 0.06-0.95) to 6.66 (95% CI: 0.33-132.8]. Secondary outcomes did not differ significantly for both groups, although selected anxiety scores appeared lower in the maximal intervention group. Process evaluation of the trial revealed positive patient experiences with the intervention material [e.g. an increased understanding of their doctor's treatment policy (61%), an increased ability to ask questions about the treatment (61%)]. Professionals' appreciation of intervention elements varied, and execution of the multi-faceted strategy appeared incomplete. DISCUSSION Absence of an intervention effect may be due to the nature of the strategies, incomplete execution or flaws in study design. Process evaluation data raise the question of whether professionals should be the only stakeholder responsible for guideline implementation. This study therefore contributes to an increased understanding of fertility guideline implementation in general, and the role of patients in particular.

[Patient satisfaction with the patient-doctor relationship measured using the questionnaire (PDRQ-9)]

OBJECTIVE

To describe patient satisfaction of their relationship with the family physician, using the PDRQ-9 questionnaire and assess its psychometric properties.

DESIGN

Cross-sectional study.

SETTING

Six Primary Care Health centres in the Community of Madrid, Spain.

PARTICIPANTS

Four hundred and fifty one patients randomly selected from those who had just visited their family physician.

INTERVENTIONS

Interviews were carried out to collect demographic characteristics, health needs, the accessibility to the service, and the socioeconomic situation of the subjects.

MEASUREMENTS

The PDRQ-9 responses were collected and a synthetic satisfaction index was constructed. A multivariable model was designed to explain differences in satisfaction.

RESULTS

The mean satisfaction index was 4.41 (95% CI: 4.33-4.48) on a scale of 1 (the worst) to 5 (the best satisfaction possible), with a median of 4.78 (interquartile range 4.00-5.00). Four of every 10 subjects expressed the maximum possible satisfaction ("ceiling effect"). A single factor explained 75.3% of the variance, with a Cronbach alpha value of 0.952. Age (OR 1.03, 95% CI: 1.02-1.05) and living in rural areas (OR 1.44, 95% CI: 0.94-2.20) were associated with above average satisfaction.

CONCLUSIONS

Primary care users feel their relationship with their family physicians are very satisfactory, particularly in those who are older and who live in rural areas. The PDRQ-9 questionnaire shows a high internal consistency, but it is not good enough to discriminate in the upper part of the scale.

Agreement in patient-physician communication in primary care: a study from Central and Eastern Europe

OBJECTIVE

Efficient patient-physician collaboration is proven to have a direct benefit on health care outcomes through improved compliance, appointment keeping and use of preventive services. The aim of this study was to evaluate the patient-physician agreement on communication during primary care consultations and consider possible discrepancies.

METHODS

A cross-sectional survey using self-administered questionnaires was performed in primary care in four European countries (Lithuania, Slovenia, Serbia and Russia). Post-consultation evaluations of doctor-patient communication were made by patients and physicians and were compared with pre-consultation expectations of the patient. Discrepancies in these evaluations were determined for the entire database, and within groups of expectations, using factor analysis.

RESULTS

One thousand three hundred and thirty-two sets of questionnaires were collected by the study team. In this sample, in more than 90% of consultations physicians and patients agreed about meeting patient expectations. Discrepancies were more likely to be identified when the patients were consulting the physician for the first time or had not seen that physician for more than 12 months (up to 26.1%). There is a significantly lower correlation between the physician recognising patient's unmet expectations for all factors if the physician had been working in Primary Care for between 6 and 10 years (8.6%). The results demonstrate that physicians working more than 16 years in practice are less likely to recognise that they have failed to meet the expectations of patients who are seeking reassurance (9%).

CONCLUSION

Personal continuity of care is associated with a lower discrepancy between the opinions of patients and physicians regarding meeting patient expectations during consultations in primary care. The highest agreement is within first 6 years in practice, which may reflect long-term effects of training.

PRACTICE IMPLICATIONS

Primary care physicians should put more emphasis on identifying and addressing patient expectations in primary care consultation, including agreement with patient. Existing discrepancies may be considered to be indicators of potential opportunities to improve physician's performance and overall quality of care.

Barriers to patient involvement in health service planning and evaluation: an exploratory study

OBJECTIVE

Patient involvement in health service planning and evaluation is considered important yet not widely practiced. This study explored stakeholder beliefs about patient participation in performance indicator selection to better understand hypothesized barriers.

METHODS

Interviews with 30 cancer patients and health professionals from two teaching hospitals were analyzed qualitatively.

RESULTS

All groups believed patients, not members of the public, should be involved in the selection of indicators. Ongoing, interactive methods such as committee involvement, rather than single, passive efforts such as surveys were preferred. Health professionals recommended patients assume a consultative, rather than decision-making role. Older patients agreed with this.

CONCLUSION

Variable patient interest, health professional attitudes, and a lack of insight on appropriate methods may be limiting patient involvement in this, and other service planning and evaluation activities. More research is required to validate expressed views among the populations these stakeholders represent, and to establish effective methods for engaging patients.

PRACTICE IMPLICATIONS

Efforts to encourage a change in health professional attitude may be required, along with dedicated organizational resources, coordinators and training. Methods to engage patients should involve deliberation, which can be achieved through modified Delphi panel or participatory research approaches.

Association between patients' recommendation of their GP and their evaluation of the GP

OBJECTIVE

Patient priorities and patient evaluations indicate that accessibility should receive more attention to increase quality in general practice. The definition of family medicine emphasizes the patient-centred approach, communication skills, continuity, and clinical skills. We aimed to explore the associations between the 23 items in the Europep questionnaire measuring patient evaluation of general practice and the patients' recommendation of their general practitioner (GP) to friends and to study the relationship of these items with the core competences of family medicine.

DESIGN

Cross-sectional study where patients aged 18 years and over attending the practice were included. Patients completed the Danish version of the 23 item Europep questionnaire and an additional item about the degree to which they could recommend their GP to friends.

SETTING

Danish general practice (the DanPEP study).

SUBJECTS

A total of 50 191 patients and 690 GPs were included in the analyses.

MAIN OUTCOME MEASURES

For each item, associations were calculated between a positive answer and the degree to which the patient could recommend the GP. Analyses were made at patient and GP levels.

RESULTS

We found 12 items that covered the 10 most strongly associated items from both analyses: four of six items from the "doctor-patient relationship", two of five items from "medical care", and all items from "information and support" and "organization of services". No items from "accessibility" were among the 12 items.

CONCLUSIONS

Recommending the GP to others was most strongly associated with the "emphatic", "patient-oriented", "informative and coordinating", and "competent/skilled" GP and to a lesser degree with accessibility to general practice.

A comparison of counselee and counselor satisfaction in reproductive genetic counseling

Important insights in the process of genetic counseling can be provided by establishing levels of satisfaction. The aim of our study was to compare counselees' and counselors' satisfaction with the initial consultation in reproductive genetic counseling and to gain insight into the factors associated with their contentment. One hundred and fifty-one women and 11 counselors participated in this study. Pre-test questionnaires included counselees' socio-demographic, physical and psychological characteristics, i.e. their degree of worry, expectations, preferred participation in decision making and experienced degree of control. Post-visit questionnaires asked for counselees' and counselors' satisfaction, counselees' participation in decision making and counselees' Perceived Personal Control (PPC). Little difference was found between counselees' and counselors' overall visit-specific satisfaction (mean 79 vs 74, respectively, on a visual analogue scale from 0 to 100). The correlation between counselees' and counselors' satisfaction was medium sized (r = 0.26, p < 0.01). Counselees' satisfaction was positively associated with being pregnant and with their post-visit PPC. Counselors' satisfaction was positively associated with counselees' post-visit PPC. No other counselee and counselor related variables appeared to be associated with satisfaction, nor was the duration of the consultation. Our findings suggest that, although both groups were satisfied with the consultation, counselees and counselors do not always have equal perceptions of the consultation process and may form their evaluation in different ways. In the assessment of quality of care, evaluation of both counselees' and counselors' satisfaction deserves more attention.

[The "doctor" effect in primary care]

AIM

To characterize the factors associated with the 'doctor' effect in primary care, as reported in randomized controlled trials (RCTs).

METHOD

A systematic search of Medline (1964-2004) sought to identify all original reports of RCTs, as well as those reported in reviews and metaanalyses. We used the following key words: RCT, doctor-patient relationship, doctor-patient communication, knowledge, skill, attitude, non-pharmacologic effectiveness, primary care.

RESULTS

Ten RCTs and one metaanalysis provided evidence that a combination of emotional and cognitive care has a consistently positive effect on health outcomes. This effect relies on specific attitudes and skills: empathy, reassurance, explanation, counseling, influencing patients' 'health beliefs and expectations, promoting change in behavior, thoughts or emotions. These can be integrated into a specific patient-centered approach to general practice. Medical education must provide training in the relational skills needed for effective treatment.

CONCLUSION

Qualitative and quantitative research, including RCTs, are necessary; they should be designed to deal with the heterogenous situations and specific characteristics of general practice.

Effective interviewing and counseling of the adolescent patient

A vast number of successful recommendations are available to physicians who want to learn how to strengthen their interactions with adolescent patients. Understanding that the physician-patient relationship is dynamic is the first step toward building a strong repertoire within this patient sample. Therefore, physicians may assume that adolescent perceptions of the physician-patient relationship and the services provided will change as they change developmentally or as the situation is modified. Finding a balance between family and patient concerns while gaining increased experience with skills less-practiced (eg, communication about sensitive topics) will improve adolescent perceptions of your expertise, knowledge, and abilities. Finally, following up on changes across time in adolescents' concerns, perceptions, abilities, and the physician-patient relationship itself, will help to ensure continued satisfaction and service use by adolescents and their families.

Patient perceptions of the quality of health services

As calls are made for a more patient-centered health care system, it becomes critical to define and measure patient perceptions of health care quality and to understand more fully what drives those perceptions. This chapter identifies conceptual and methodological issues that make this task difficult, including the confusion between patient perceptions and patient satisfaction and the difficulty of determining whether systematic variations in patient perceptions should be attributed to differences in expectations or actual experiences. We propose a conceptual model to help unravel these knotty issues; review qualitative studies that report directly from patients on how they define quality; provide an overview of how health plans, hospitals, physicians, and health care in general are currently viewed by patients; assess whether and how patient health status and demographic characteristics relate to perceptions of health care quality; and identify where further, or more appropriately designed, research is needed. Our aim is to find out what patients want, need and experience in health care, not what professionals (however well-motivated) believe they need or get.

HIV nursing consultants: patients' preferences and experiences about the quality of care

AIM AND OBJECTIVES

We were interested to find out how human immunodeficiency virus (HIV)-patients judge the quality of care received from their HIV nursing consultants, compared with the care delivered by HIV specialists and general practitioners. Furthermore, we were interested in how the opinions of HIV patients on the HIV nursing consultant compared with the opinions of patients with rheumatic diseases on the care they receive from their specialized nurses.

BACKGROUND

The role of nurses has changed over the years. For patients with chronic diseases there seems to be an increasing role for nursing consultants in the delivery of care. In evaluating quality of care, patients' views are considered important especially for the chronically ill who can be seen as experts by experience.

METHODS

Between February 1999 and June 2000, 250 patients, receiving care from both general practitioner and specialist, received a questionnaire [Quality of Care Through the Patient's Eyes (QUOTE)-HIV] to assess HIV-related quality of care, as perceived by them. Aspects were formulated as "importance" and "performance" statements. Items were scored on 4-point scales. A ratio score (R(ij) = P(ij)/I(ij)) was calculated by dividing the perceived performance score (P) of an individual patient (i), on a health service (j) by his importance score (I). A comparison was made with patients with rheumatic diseases by using data from the QUOTE-Rheuma.

RESULTS

Patients judged the quality of care from the HIV nursing consultant as predominantly good. Five aspects showed an unfavourable ratio score (R < 1.0) which indicates room for improvement. On the dimensions "professional performance" and "attitude of the professional" the HIV nursing consultant scores between the general practitioner and the HIV specialist. Patients with rheumatic diseases seemed to be more satisfied than HIV patients with the care from their nurse consultant.

CONCLUSIONS

The HIV nursing consultants have an important role in the care of patients infected with HIV. The HIV nursing consultants are judged as good and are ranked in between the general practitioner and the HIV specialist. Given the orientation towards a more integrated care for chronically ill patients, there should be more attention paid to the position of the HIV nursing consultant.

RELEVANCE TO CLINICAL PRACTICE

In the Netherlands and in the United Kingdom there is a tendency to a greater degree of differentiation of tasks in health care. This study shows that there is room for a position like the nursing consultant and that this is highly valued by patients.

Satisfaction with the outpatient encounter: a comparison of patients' and physicians' views

OBJECTIVE

To compare patients' and physicians' visit-specific satisfaction in an internal medicine outpatient setting, and to explain their respective views.

DESIGN

Patients' and physicians' background characteristics were assessed prior to outpatient encounters. Immediately after the encounter, both patients and physicians completed a questionnaire assessing satisfaction with the visit.

SETTING

The outpatient division of an academic teaching hospital.

PARTICIPANTS

Thirty residents and specialists in general internal medicine, rheumatology, and gastroenterology, and 330 patients having a follow-up appointment with one of these physicians.

MEASUREMENTS AND MAIN RESULTS

Patients' and physicians' visit-specific satisfaction was assessed using 5 Visual Analogue Scales (0 to 100). Patients' overall satisfaction was higher than physicians' satisfaction (mean 81 vs. 66), and correlation of patients' and physicians' overall satisfaction with the specific visit was medium sized (r= .28, P < .001). Patients' satisfaction ratings were associated with their previsit self-efficacy in communicating with their physician (P < .001) and with visiting a female physician (P < .01). Physicians' satisfaction was associated with patients' higher educational level (P < .05), primary language being Dutch (P < .001), better mental health (P < .05), and preference for receiving less than full information (P < .05).

CONCLUSIONS

In an outpatient setting, patients' visit-specific satisfaction ratings were substantially higher than, and only moderately associated with, physicians' ratings of the same visit. The dissimilar predictors explaining patients' and physicians' satisfaction suggest that patients and physicians form their opinion about a consultation in different ways. Hence, when evaluating outpatient encounters, physicians' satisfaction has additional value to patients' satisfaction in establishing quality of care.

Comparison of health care professionals' self-assessments of standards of care and patients' opinions on the care they received in hospital: observational study

OBJECTIVES

To compare the views of healthcare professionals and patients regarding compliance with standards of care concerning patient information.

DESIGN

Self-rated questionnaire survey.

SETTING

Nine wards in short stay French hospitals.

PARTICIPANTS

939 patients and 359 healthcare professionals (physicians, nurses, assistants and other professionals).

MAIN OUTCOME MEASURE

Patients' and healthcare professionals' views of compliance with 20 standards of patient care described in the French accreditation manual. Comparison of the rank order of the standards within the two samples.

RESULTS

The response rate was 61.5% in the patient group and 85.8% in the healthcare professionals. The rank orders for the 20 items were similar in both groups (Spearman rank order correlation 0.6, p = 0.004). The two items ranked highest by healthcare professionals ("consent request for a surgical procedure" and "the doctors ask the visitors to leave the room before examining a patient") were also the two ranked highest by the patients. Three items were ranked low by both groups: "consent request for students to be present", "health education given to patients", and "possibility to express satisfaction during discharge". Patients were more satisfied with their pain management than were healthcare providers. Professionals were more satisfied with the social services than the patients.

CONCLUSION

There are both similarities and differences between patients' and healthcare professionals' views of care. Accurate assessments of quality performed during the accreditation procedure require that both patients' and professionals' views be taken into account.

Comparison of health care professionals' self-assessments of standards of care and patients' opinions on the care they received in hospital: observational study

OBJECTIVES

To compare the views of healthcare professionals and patients regarding compliance with standards of care concerning patient information.

DESIGN

Self-rated questionnaire survey.

SETTING

Nine wards in short stay French hospitals.

PARTICIPANTS

939 patients and 359 healthcare professionals (physicians, nurses, assistants and other professionals).

MAIN OUTCOME MEASURE

Patients' and healthcare professionals' views of compliance with 20 standards of patient care described in the French accreditation manual. Comparison of the rank order of the standards within the two samples.

RESULTS

The response rate was 61.5% in the patient group and 85.8% in the healthcare professionals. The rank orders for the 20 items were similar in both groups (Spearman rank order correlation 0.6, p = 0.004). The two items ranked highest by healthcare professionals ("consent request for a surgical procedure" and "the doctors ask the visitors to leave the room before examining a patient") were also the two ranked highest by the patients. Three items were ranked low by both groups: "consent request for students to be present", "health education given to patients", and "possibility to express satisfaction during discharge". Patients were more satisfied with their pain management than were healthcare providers. Professionals were more satisfied with the social services than the patients.

CONCLUSION

There are both similarities and differences between patients' and healthcare professionals' views of care. Accurate assessments of quality performed during the accreditation procedure require that both patients' and professionals' views be taken into account.