Patient satisfaction with primary healthcare services: are there any links with patients' symptoms of anxiety and depression?

Development and validation of a patient reported experience measure for experimental cancer medicines (PREM-ECM) and their carers (PREM-ECM-Carer)

BACKGROUND

Our aim was to develop a validated Patient Reported Experience Measure (PREM) to capture patient and carer experience during participation in experimental cancer medicine trials (ECM): called PREM-ECM.

METHODS

Mixed method design, consisting of four stages. Questionnaire items were produced for both patients and carers using interviews, focus groups, and cognitive interviews with patients and carers separately. For both patient and carer PREMs, a cross-sectional questionnaire study was conducted to identify final items for inclusion using hierarchical item reduction and Rasch analysis. Questionnaire validity and reliability were assessed, including administration feasibility.

RESULTS

Initial interview participants suggested the need for three PREMs, two specific to patients: (i) a 'prior' questionnaire that captured experiences of trial introduction, screening, consenting, and early trial experience (< 6 weeks post consent); and (ii) 'on-trial' that captured experiences of ongoing consent and trial participation; and (iii) a PREM specific for carers. The draft 25-item 'prior' questionnaire was completed by 162 patients and 162 patients completed the draft 35-item 'on-trial' questionnaire. Hierarchical and Rasch analysis produced a 14-item 'prior' list and a 15-item list for 'on-trial'. Both patient PREM's demonstrated a good fit to the Rasch model following Bonferroni correction (X2p = 0.008). The carer 34-draft item questionnaire was completed by 102 participants. Hierarchical and Rasch analysis produced a 13-item list for PREM-ECM-Carer, with good fit to the Rasch model ( X2p = 0.62). The pilot testing demonstrated the feasibility of all the PREMs in capturing patient and caregiver experiences in routine clinical settings.

CONCLUSIONS

The three PREM-ECM questionnaires will be the first validated experience measures for ECM trial patients and their carers. These questionnaires may be used to assess patients' and their carers' experiences of ECM and enable robust comparisons across cancer trial units highlighting areas for service improvement.

Latent profiles of telehealth care satisfaction during the COVID-19 pandemic among patients with cardiac conditions in an outpatient setting

Background

During the COVID-19 pandemic, telemedicine was advocated and rapidly scaled up worldwide. However, little is known about for whom this type of care is acceptable.

Objective

To examine which patient characteristics (demographic, medical, psychosocial) are associated with telehealth care satisfaction, attitude toward telehealth, and preference regarding telehealth over time in a cardiac patient population.

Methods

In total, 317 patients were recruited at the Elisabeth-TweeSteden Hospital in The Netherlands. All patients who had received telehealth care (telephone and video) in the previous 2 months were approached for participation. Baseline, 3-month, and 6-month questionnaires were administered online. A 3-step latent class analysis was conducted to identify trajectories of telehealth use over time and the possible association of the found trajectories with external variables.

Results

Five trajectories (classes) were identified for satisfaction with telehealth and 4 for attitude toward telehealth. Patients with higher distress, lower physical and mental health, higher scores on pessimism, and negative affectivity were more likely to be less satisfied. Patients with no partner, more comorbidities, higher distress, lower physical and mental health, and higher scores on pessimism were more likely to hold a negative attitude toward telehealth. For the future application of telehealth, marital status, comorbidities, digital health literacy, and pessimism were significantly related.

Conclusion

Results show that patients' profiles should be considered when offering telehealth care and that the "one size fits all" approach does not apply. Results can inform clinical practice on how to better implement remote health care in the future while considering a personalized approach.

Assessment of parental satisfaction with paediatric health services in public sector tertiary hospitals within a low-income setting using Patient Satisfaction Questionnaire (PSQ-18)

INTRODUCTION

Patient satisfaction is an integral part of healthcare quality, impacting treatment adherence, patient loyalty and healthcare utilisation. Parental satisfaction is particularly crucial as parents influence decision-making for their child's healthcare.

OBJECTIVE

The objective was to assess parental satisfaction levels (as measured by Patient Satisfaction Questionnaire-18 (PSQ-18)) related to paediatric healthcare services and identify specific factors significantly influencing parental satisfaction with paediatric healthcare services.

METHODOLOGY

This is a descriptive cross-sectional study that used a structured questionnaire based on the PSQ-18. The study was conducted in Faisalabad, Islamabad, Peshawar and Swat. Seven subscales measured satisfaction across various dimensions.

RESULTS

We found 882 suitable responses indicating a diverse participant demographic, with the largest group in the 6-12 years age category. The overall mean parental satisfaction score was 2.0±0.5 (40.0%). Notably, financial aspects scored highest at 2.8 (55%), followed by accessibility and convenience at 2.0 (40.5%). However, lower satisfaction scores in the interpersonal relationship (1.8±0.5) and technical quality (1.8±0.5) domains were recorded. Sociodemographic analysis indicated age, education and occupation significantly influenced satisfaction. Conversely, factors such as gender, residence and the presence of chronic disease did not significantly impact satisfaction levels.

CONCLUSION

The study offers valuable insights into paediatric patient satisfaction in Pakistan, emphasising the need for targeted interventions and improvements in specific domains to enhance overall healthcare quality.

Psychological distress 35 years after the Chornobyl accident in the Lithuanian clean-up workers

The adverse effects on the health of the Chornobyl nuclear power plant accident clean-up workers have been reported previously. However, there is a lack of studies on the mental health of Chornobyl clean-up workers. The current study explored psychological distress in a sample of Lithuanian clean-up workers 35 years after the accident. In total, 107 Lithuanian Chornobyl clean-up workers (M_age = 62.5) and 107 controls were included in the study. The Hospital Anxiety and Depression Scale (HAD) was used for the assessment of anxiety and depression. The depression symptoms were significantly higher in the clean-up workers compared to the control group. The prevalence of severe depression symptoms was 23.4% and 4.7% in the Chornobyl clean-up workers and control groups, respectively. The risk for severe depression was associated with Chornobyl clean-up work (adjusted OR = 5.9). No differences in the anxiety symptoms were found between clean-up workers and controls. The study revealed the deteriorated mental health of the Lithuanian Chornobyl clean-up workers 35 years after the disaster - in particular, high levels of depression. Psychosocial support programmes for clean-up workers should be provided to mitigate the adverse effects of the disaster.

Depression among patients with chronic kidney disease, associated factors, and predictors: a cross-sectional study

BACKGROUND

Depression with diverse etiologies is exacerbated by chronic diseases, such as chronic kidney disease (CKD), coronary artery disease (CAD), cancer, diabetes mellitus, and hypertension. This study aimed to analyse depression, its associations, and predictors among patients attending the kidney clinic of a teaching hospital.

METHODS

Data were collected from 01 August 2017 to 30 September 2017 via face-to-face interviews and examination of the medical records of a convenience sample of 314 patients. The patients were categorised broadly as stages I and II with an estimated glomerular filtration rate (eGFR) > 60 mls/min/1.73 m2, and with stages III, IV, and V or GFR ≤ 60 mls/ min/1.73 m2 (or CKD). The Patient Health Questionnaire (PHQ)-9 was the data collection instrument for depression-related data.

RESULTS

Participants were predominantly male (n = 179; 57.0%), aged over 60 years (n = 211; 67.2%), Indo-Trinbagonian (n = 237; 75.5%), and with stages III, IV, and V CKD. The two leading comorbid conditions were hypertension (83.4%) and diabetes mellitus (56.1%). Of the 261 (83.1%) patients with recorded eGFR, 113 (43.3%) had Stage III CKD. The mean depression (PHQ-9) score was 13.0/27 (±9.15), with 306 (97.5%) patients diagnosed as having depression with the following severities: mild (n = 116; 37.9%), moderate (n = 138, 45.1%), moderately severe (n = 38; 12.4%), and severe (n = 14; 4.6%). Depression was independent of sex. Nine sociodemographic variables were associated with depression; however, 'level of education', was the only predictor of depression with greater severity associated with lower levels of education. eGFR was negatively correlated with the PHQ-9 scores (Pearson's correlation, r = -0.144, p = 0.022). At least 78.3% of the patients who self-reported no depression had clinical depression (moderate, moderately severe, or severe) PHQ-9 scores ≥ 10.

CONCLUSION

Depression was a significant comorbidity among patients with CKD, with the majority displaying clinical depression. "Level of education" was the only predictor of depression. Self-reported depression is an unreliable method for evaluating clinical depression.

Do patients with mental health and substance use conditions experience discrimination and diagnostic overshadowing in primary care in Aotearoa New Zealand? Results from a national online survey

Introduction Quality of health care contributes to poor physical health outcomes for people with mental health and substance use conditions (MHSUC). AIM This study investigated experiences of people with MHSUC who sought help for a physical health condition in primary healthcare services, examining quality of care attributes. Methods An online survey of adults currently or recently accessing services for MHSUC was fielded in 2022. Respondents were recruited nationally through mental health, addiction and lived experience networks and social media. The attributes of service quality assessed were relationships (respect and being listened to), discrimination due to MHSUC, and diagnostic overshadowing (MHSUC diagnosis distracted from physical health care). Results Respondents who had used primary care services were included (n  = 335). The majority of respondents reported both being treated with respect (81%) and being listened to (79%) always or most of the time. A minority of respondents reported diagnostic overshadowing (20%) or discrimination due to MHSUC (10%). People with four or more diagnoses or a diagnosis of bipolar disorder or schizophrenia had significantly worse experiences across all quality measures. Those with a diagnosis of substance use disorders had worse experiences for diagnostic overshadowing. Māori had worse experiences for respect and diagnostic overshadowing. Conclusions Although many respondents reported good experiences in primary care, this was not the case for everyone. Quality of care was affected by type and number of diagnoses and the person's ethnicity. Interventions to reduce stigma and diagnostic overshadowing for people with MHSUC are needed in primary care services in New Zealand.

The Mediation Effect of Perceived Attitudes toward Medical Service on the Association between Public Satisfaction with the Overall Medical Service and Self-Rated Health among the General Population in China: A Cross-Sectional Study

This study aimed to examine the association between public satisfaction with the overall medical service and individuals' self-rated health among 18,852 Chinese adults aged 16-60 years by using data from the 2018 China Family Panel Studies. We further test whether such an association is mediated by perceived attitudes toward the medical service. The logistic regression model is used to explore the association between public satisfaction with the overall medical service and individuals' self-rated health (SRH) outcomes. Mediation analysis was conducted by using the Karlson-Holm-Breen (KHB) method. We found that public satisfaction with the overall medical service was associated with good SRH. Additional results indicated that the association between public satisfaction with the overall medical service and SRH was significantly mediated by perceived attitudes toward the medical service. The degree of mediation is much larger for individuals' satisfaction with the level of medical expertise than for trusting in doctors, attitudes toward medical service problems, and the attitude toward the level of the hospital. Targeted medical policy interventions are designed to promote individuals' perceived attitudes toward the medical service, which might help to improve individuals' health benefits.

The relationship between mood disorder diagnosis and experiencing an unmet health-care need in Canada: findings from the 2014 Canadian Community Health Survey

BACKGROUND

Despite Canada's universal health-care system, millions of Canadians experience unmet health-care needs (UHCN). People with mood disorders may be at higher risk of UHCN due to barriers such as stigma and gaps in health-care services.

AIM

We aimed to examine the relationship between having a diagnosed mood disorder and experiencing UHCN using a recent, nationally representative survey.

METHODS

Using the 2014 Canadian Community Health Survey, we used multivariate logistic regression to estimate the association between mood disorder and UHCN in the past 12 months, adjusting for sociodemographic variables and health status.

RESULTS

Among 52,825 respondents, 11.8% reported UHCN. Respondents with a diagnosed mood disorder were more likely to report UHCN [adjusted odds ratio (OR) 1.61, 95% confidence interval (CI) 1.38, 1.89]. Among respondents with a regular doctor, people with mood disorders were still more likely to report UHCN (OR 1.63, 95% CI 1.38, 1.93). Sensitivity analyses using propensity score and missing data imputation approaches resulted in similar estimates.

CONCLUSIONS

Adults diagnosed with a mood disorder are more likely to report UHCN in the past year, even those with a regular doctor. Our findings suggest that barriers beyond physician attachment may impact access to care for people with mood disorders.

Symptoms of depression and anxiety, and unmet healthcare needs in adults during the COVID-19 pandemic: a cross-sectional study from the Canadian Longitudinal Study on Aging

BACKGROUND

The COVID-19 pandemic disrupted access to healthcare services in Canada. Research prior to the pandemic has found that depression and anxiety symptoms were associated with increased unmet healthcare needs. The primary objective of this study was to examine if mental health was associated with perceived access to healthcare during the pandemic METHODS: A cross-sectional study was conducted using data from 23,972 participants (aged 50-96) in the Canadian Longitudinal Study on Aging COVID-19 Exit Survey (Sept-Dec 2020). We used logistic regression to estimate how the presence of depression and anxiety symptoms, defined using scores of ≥10 on the Center for Epidemiologic Studies Depression Scale and ≥10 on the Generalized Anxiety Disorder Scale, were associated with the odds of reporting: 1) challenges accessing healthcare, 2) not going to a hospital or seeing a doctor when needed, 3) experiencing barriers to COVID-19 testing. Models were adjusted for sex, age, region, urban/rural residence, racial background, immigrant status, income, marital status, work status, chronic conditions, and pre-pandemic unmet needs.

RESULTS

The presence of depressive (aOR=1.96; 95% CI=1.82, 2.11) and anxiety symptoms (aOR=2.33; 95% CI=2.04, 2.66) compared to the absence of these symptoms were independently associated with higher odds of challenges accessing healthcare. A statistically significant interaction with sex suggested stronger associations in females with anxiety. Symptoms of depression (aOR=2.88; 95% CI=2.58, 3.21) and anxiety (aOR=3.05; 95% CI=2.58, 3.60) were also associated with increased odds of not going to a hospital or seeing a doctor when needed. Lastly, depressive (aOR=1.99; 95% CI=1.71, 2.31) and anxiety symptoms (aOR=2.01; 95% CI=1.58, 2.56) were associated with higher odds of reporting barriers to COVID-19 testing. There was no significantly significant interaction with sex for the latter two outcomes.

CONCLUSION

The presence of depression and anxiety symptoms were strongly associated with perceived unmet healthcare needs during the COVID-19 pandemic. Interventions to improve healthcare access for adults with depression and anxiety during the pandemic may be necessary.

Patient-Derived Framework for Quality in Hand Surgery: A Qualitative Analysis

PURPOSE

Despite the growing attention to evaluating care from the patient perspective, the most common definitions and measurements of quality are currently defined by physicians and health systems. Studies have demonstrated how a lack of patient input can lead to discrepancies between patients' and physicians' assessments of quality and, subsequently, worse patient outcomes. Although quality measures are increasingly used in hand surgery, insufficient work has examined whether these quality measures align with what matters to patients. We completed a qualitative study to assess how patients define high-quality care through the pre-, peri-, and postoperative phases of care in hand surgery.

METHODS

Based on our prior work, we created an open-ended interview guide and conducted semistructured interviews with 43 hand surgery patients at 5 tertiary-care institutions during various phases of care. We completed a thematic analysis to generate subcodes and open codes, to identify themes in high-quality care from the patient perspective.

RESULTS

Patients defined high-quality care as a process of (1) setting and meeting clear expectations; (2) achieving functional goals after surgery; and (3) feeling comfortable with and cared for by the care team. We identified the following 4 patient-centered themes that contributed to high-quality care: (1) communication between the patient and care team through all phases of care; (2) efficient and accurate diagnosis and treatment; (3) satisfactory treatment outcomes and postsurgical experience; and (4) acceptable systemic aspects of care.

CONCLUSIONS

Efforts to improve health care delivery should include areas of care that are important to patients. Our results suggest that measuring aspects of care that often go without assessments, such as communication, can maximize care quality as defined by patients.

CLINICAL RELEVANCE

The themes identified in this study can inform efforts towards patient-centered quality measure development.

Analysis of Factors Contributing to Perioperative Mohs Micrographic Surgery Anxiety: Patient Survey Study at an Academic Center

BACKGROUND

High perioperative patient anxiety is predictive of worse postoperative pain and quality of life. Several Mohs micrographic surgery (MMS) patient characteristics influence anxiety; however, the contributions of certain factors remain uncertain.

OBJECTIVE

Investigate factors influencing perioperative MMS patient anxiety, especially those with debated impact or unclear data.

METHODS

The authors surveyed 145 adult patients receiving MMS performed by a single MMS surgeon from 2018 to 2020. Patients self-reported demographics, history, and 10-point visual analog scale anxiety assessments at multiple stages. Health care provider (HCP)-perceived anxiety assessments were queried. A stepwise multiple regression modeling approach was used to explore potential factors.

RESULTS

Younger age, female sex, and a self-reported history of anxiety confirmed by prior HCP diagnosis were significant predictors of pre-MMS anxiety. Postoperative anxiety increased with more layers removed and higher pre-MMS anxiety. HCP-perceived patient anxiety increased with younger patient age, more layers removed, prior skin cancer removal, and HCP-perceived pre-MMS patient anxiety.

CONCLUSION

Anxiety-reducing interventions should target young female patients with a history of HCP-diagnosed anxiety, and patients with more layers removed. Prior skin cancer removal is associated with increased HCP-perceived intraoperative patient anxiety; however, it is not significant for patient-reported anxiety. Pre-MMS consultation may not be effective for anxiety reduction.

Association of mental health outcomes and lower patient satisfaction among adults with alopecia: A cross-sectional population-based study

Background

Previous studies have found the increasing use of patient satisfaction scores by patients and insurance payers. Less is known about how patient mental health affects health care satisfaction.

Objective

To examine the association between baseline mental health and health care satisfaction among adults with alopecia.

Methods

We examined 543 adults with alopecia in the 2004-2016 Medical Expenditure Panel Survey. Mental health burden was assessed by the 6-item Kessler Psychological Distress Scale (K6) and 2-item Patient Health Questionnaire (PHQ2). Patient satisfaction was determined using the Consumer Assessment of Healthcare Providers and Systems survey.

Results

Adults with versus without alopecia had higher rates of positive PHQ2 (adjusted odds ratio [95% CI], 1.37 [1.05-1.78]); positive K6 (1.57 [1.02-2.41]), and comorbid anxiety (1.85 [1.30-2.63]) and depression (1.68 [1.19-2.39]). Positive PHQ2 (2.15 [1.13, 4.11]) and positive K6 (6.04 [2.60, 14.05]) were associated with low patient satisfaction. Whereas, there were no differences in the rates of low patient satisfaction associated with comorbid anxiety (0.74 [0.33-1.67]) and depression (1.42 [0.72-2.78]).

Limitations

Data are unavailable on alopecia areata phenotypes and treatment.

Conclusions

Adults with alopecia and greater mental health symptoms report lower patient satisfaction. Clinicians may wish to adapt their communication style to support these patients and improve overall health care satisfaction.

Mobile phone addiction and depression among Chinese medical students: the mediating role of sleep quality and the moderating role of peer relationships

The literature has shown that mobile phone addiction is an important risk factor for depression. However, the internal mechanisms of mobile phone addiction leading to depression are still not clear. This study examined the mediating role of sleep quality and moderating role of peer relationships in the association between mobile phone addiction and depression. A sample of 450 Chinese medical students were recruited to complete measures of mobile phone addiction, depression, sleep quality and peer relationships. In this study, SPSS 25.0 and macro PROCESS were used to conduct statistical analysis on the collected data. The results showed that sleep quality partially mediated the association between mobile phone addiction and depression. Moreover, the effect of sleep quality on depression was moderated by peer relationships. The present study can advance our understanding of how and when mobile phone addiction leads to depression. Limitations and implications of this study are discussed.

The influence of intolerance of uncertainty on the correlation between the severity of symptoms and satisfaction with oral state in patients with burning mouth syndrome

OBJECTIVE

Intolerance of uncertainty (IU) is thought to be involved with the psychological factors that influence the symptoms in patients with burning mouth syndrome (BMS) and affect their limited satisfaction with the treatments provided. However, the influence of IU on satisfaction has not been explored in detail. Therefore, the purpose of this study was to investigate whether IU can affect the satisfaction of patients with BMS.

METHODS

A total of 34 patients with BMS and 100 patients without the disease who visited the general dental clinic were included in the study. They were required to complete a questionnaire measuring the subjective severity of their symptoms and satisfaction with their oral state, and a short IU scale. The BMS patients were separated from the control patients based on the IU score. The coefficients between the severity of symptoms and satisfaction were calculated to examine the influence of IU on the relationship between the two variables.

RESULTS

The relationship between satisfaction and severity of symptoms was significant in BMS patients with high IU, but not in control patients with low IU.

CONCLUSION

This study demonstrated that IU in BMS patients influences the relationship between the severity of symptoms and the satisfaction, thus indicating that the dissatisfaction in BMS patients with high IU might be prevented by decreasing the IU.

CLINICAL RELEVANCE

Limited satisfaction experienced by BMS patients can influence the patient-doctor relationship. This study provides suggestions for building a good patient-doctor relationship.

Intensive Care Unit-Specific Virtual Reality for Critically Ill Patients With COVID-19: Multicenter Randomized Controlled Trial

Background

Although psychological sequelae after intensive care unit (ICU) treatment are considered quite intrusive, robustly effective interventions to treat or prevent these long-term sequelae are lacking. Recently, it was demonstrated that ICU-specific virtual reality (ICU-VR) is a feasible and acceptable intervention with potential mental health benefits. However, its effect on mental health and ICU aftercare in COVID-19 ICU survivors is unknown.

Objective

This study aimed to explore the effects of ICU-VR on mental health and on patients’ perceived quality of, satisfaction with, and rating of ICU aftercare among COVID-19 ICU survivors.

Methods

This was a multicenter randomized controlled trial. Patients were randomized to either the ICU-VR (intervention) or the control group. All patients were invited to an COVID-19 post-ICU follow-up clinic 3 months after hospital discharge, during which patients in the intervention group received ICU-VR. One month and 3 months later (4 and 6 months after hospital discharge), mental health, quality of life, perceived quality, satisfaction with, and rating of ICU aftercare were scored using questionnaires.

Results

Eighty-nine patients (median age 58 years; 63 males, 70%) were included. The prevalence and severity of psychological distress were limited throughout follow-up, and no differences in psychological distress or quality of life were observed between the groups. ICU-VR improved satisfaction with (mean score 8.7, SD 1.6 vs 7.6, SD 1.6 [ICU-VR vs control]; t₆₄=–2.82, P=.006) and overall rating of ICU aftercare (mean overall rating of aftercare 8.9, SD 0.9 vs 7.8, SD 1.7 [ICU-VR vs control]; t₆₄=–3.25; P=.002) compared to controls. ICU-VR added to the quality of ICU aftercare according to 81% of the patients, and all patients would recommend ICU-VR to other ICU survivors.

Conclusions

ICU-VR is a feasible and acceptable innovative method to improve satisfaction with and rating of ICU aftercare and adds to its perceived quality. We observed a low prevalence of psychological distress after ICU treatment for COVID-19, and ICU-VR did not improve psychological recovery or quality of life. Future research is needed to confirm our results in other critical illness survivors to potentially facilitate ICU-VR’s widespread availability and application during follow-up.

Trial Registration

Netherlands Trial Register NL8835; https://www.trialregister.nl/trial/8835

International Registered Report Identifier (IRRID)

RR2-10.1186/s13063-021-05271-z

Psychosocial and Clinical Predictors of Patient Satisfaction with Cancer Care

Purpose

Patient satisfaction with healthcare was recognized as an indispensable component of healthcare quality assurance programs for decades. Limited research has explored psychosocial variables impacting patient satisfaction with cancer care. The objective of our study was to identify the level of patient satisfaction with cancer care in Riyadh, Saudi Arabia and determine the psychosocial and clinical predictors of patient satisfaction.

Methods

A cross-sectional observational study was carried out in 2018–2019 with patients with cancer at the Outpatient Oncology Clinic at King Saud University Medical City in Riyadh, Saudi Arabia. The questionnaire contained a visual analog scale (VAS) of satisfaction with cancer care, a VAS of satisfaction with social support, the Patient Health Questionnaire-9 Depression scale, and the Generalized Anxiety Disorder 7-item scale.

Results

Out of the 400 patients approached, 280 agreed to participate in the study. Of the 280 patients participating in the study, 65% were satisfied with cancer care. Higher satisfaction was associated with being non-Saudi, being employed, having fewer household residents (≤4), being satisfied with social support, not receiving radiotherapy, and receiving hormonal or biological therapy. Having anxiety or depression was also associated with lower satisfaction. After adjustment for sociodemographic and clinical characteristics, being satisfied with social support, having ≤ 4 household residents, receiving hormonal therapy, and receiving biological therapy rather than radiotherapy were all independent predictors of higher satisfaction with cancer care.

Conclusion

This study found an inadequate level of patient satisfaction with cancer care. Higher levels of satisfaction were associated with being satisfied with social support, using biological and hormonal therapy, while lower satisfaction was associated with a larger number of household residents (>4), depression, anxiety and using radiotherapy.

Nonlinear Associations between Medical Expenditure, Perceived Medical Attitude, and Sociodemographics, and Older Adults’ Self-Rated Health in China: Applying the Extreme Gradient Boosting Model

Background: although China’s total health expenditure has been dramatically increased so that the country can cope with its aging population, inequalities among individuals in terms of their medical expenditures (relative to their income level) have exacerbated health problems among older adults. This study aims to examine the nonlinear associations between each of medical expenditure, perceived medical attitude, and sociodemographics, and older adults’ self-rated health (SRH); it does so by using data from the 2018 China Family Panel Studies survey. Method: we used the extreme gradient boosting model to explore the nonlinear association between various factors and older adults’ SRH outcomes. We then conducted partial dependence plots to examine the threshold effects of each factor on older adults’ SRH. Results: older adults’ medical expenditure exceeded their overall income. Body mass index (BMI) and personal health expenditure play an essential role in predicting older adults’ SRH outcomes. We found older adult age, physical exercise status, and residential location to be robust predictors of SRH outcomes in older adults. Partial dependence plots of the results visualized the nonlinear association between variables and the threshold effects of factors on older adults’ SRH outcomes. Conclusions: findings from this study underscore the importance of medical expenditure, perceived medical attitudes, and BMI as important predictors of health benefits in older adults. The potential threshold effects of medical expenditure on older adults’ SRH outcomes provide a better understanding of the formation of appropriate medical policy interventions by balancing the government and personal medical expenditure to promote health benefits among older adults.

Institutional Satisfaction and Anxiety Mediate the Relationship Between Social Support and Depression in Hypertension Patients in Elderly Caring Social Organizations: A Cross-Sectional Study

Background: Depression is a prevalent health condition among hypertension patients in elderly caring social organizations (SOs). Patients with hypertension and depression symptoms have worse health outcomes than those without depression. As the population ages, chronic and mental health issues such as depression of hypertension patients in elderly caring SOs have become prominent. However, the combined effects of social support, institutional satisfaction, and anxiety on depression among hypertension individuals in elderly caring SOs remain unclear. This study aimed to explore the mediating effects of institutional satisfaction and anxiety on the relationship between social support and depression among hypertension patients in elderly caring SOs in Anhui Province, China.

Methods: A cross-sectional study was conducted using a multi-stage stratified random sampling method. A questionnaire was used to collect data on demographic characteristics, the satisfaction of elderly caring SOs, social support, anxiety, and depression. A multiple linear regression model was utilized to investigate depression-related factors, and structural equation modeling (SEM) was employed to examine the relationships between social support, institutional satisfaction, anxiety, and depression among patients with hypertension in elderly caring SOs.

Results: Our results indicated that the mean scores of social support were 20.19 ± 6.98 and 1.92 ± 3.18 for anxiety, and 6.24 ± 5.03 for depression; besides, 33.3% of participants were very satisfied with elderly caring SOs, 48.5% were satisfied, and only 6.0% were dissatisfied or very dissatisfied. Comorbid chronic diseases were significantly associated with depression. Institutional satisfaction was directly negatively related to depression, whereas anxiety was directly positively correlated with depression. Social support had an indirect negative association with depression by the mediating effects of institutional satisfaction and anxiety.

Conclusions: The study highlights the importance of social support in maintaining mental health among hypertension patients residing in elderly caring SOs. To alleviate depression among hypertension patients in elderly caring SOs, strategies that target enhancing social support, institutional satisfaction, and anxiety reduction should be prioritized. More importantly, more attention should be paid to patients with comorbid chronic diseases.

Factors Affecting the Satisfaction Levels of Patients who Underwent Orthopedic Knee Surgery in the Early Postoperative Period

The aim of this study was to investigate the effects of biopsychosocial parameters in the early postoperative period on the satisfaction of patients. Seventy-seven patients (female/male: 61/16, age: 40.28 ± 17.67 years) who underwent arthroscopic meniscectomy (n = 43), anterior cruciate ligament reconstruction (n = 25) and total knee arthroplasty (n = 9) were included in this study. The satisfaction levelwas evaluated using the Orthopedics Service Inpatient Satisfaction Survey (OTISS). In addition, the pain intensity, anxiety, depression, and independence level in daily living activities of the patients were evaluated. There was a very weak negative correlation between the anxiety and the satisfaction level with the physiotherapist and secretary (r: -0.274, p: 0.016; r:-0.265, p: 0.020). A very weak negative correlation was found between the pain intensity at activity and satisfaction with the nurse (r: -0.227, p: 0.048). There were very weak correlations between feeding and satisfaction with the physiotherapist (r: 0.292, p: 0.010), secretary (r: 0.285, p: 0.012), doctor (r: -0.269, p: 0.018), nurse (r: 0.300, p: 0.008) general satisfaction (r: 0.251, p: 0.028) and OTISS total score (r: -0.305, p: 0.007). In conclusion, the pain intensity, anxiety, and independence level in the early postoperative period were related to the satisfaction levels of patients who have undergone orthopedic knee surgery.

Symptom Severity, Mood, and Healthcare Use Are Associated With Satisfaction in Patients With Irritable Bowel Syndrome

BACKGROUND & AIMS

Patient satisfaction is an important, but largely overlooked, component of management of functional gastrointestinal disorders. We aimed to identify demographic, clinical, psychosocial, and health-care use factors associated with satisfaction of patients with irritable bowel syndrome (IBS).

METHODS

We collected data from consecutive patients at an outpatient gastroenterology clinic of a tertiary care center from 2017 through 2019; the patients completed an electronic symptom survey at their initial visit and 3-6 months later. Patients were included in the study if they met Rome IV criteria for IBS with no organic cause for their symptoms. Patient satisfaction was measured using the irritable bowel syndrome satisfaction with care scale. We collected demographic, clinical, psychosocial, and healthcare use information from survey responses and review of medical records.

RESULTS

Of the 137 patients who completed the study, most were satisfied a great deal (34.9%) or completely (18.6%), whereas 6.2% were not satisfied at all and 14.7% were a little satisfied. Among the 5 satisfaction subscales, the highest proportion of patients were satisfied with connection with their provider (93.4%). The subscale benefits of the visit had the lowest satisfaction rate (70.8%). Factors associated with overall satisfaction scores in the 3-6 months after initial consultation included decreased severity of IBS, higher number of follow-up gastroenterology visits, higher number of diagnostic tests during the follow-up period, and higher number of recommendations made at initial visit. Additionally, lower depression score at initial visit associated with higher satisfaction after 3-6 months.

CONCLUSIONS

Based on a survey of 137 patients with IBS, factors associated with satisfaction 3-6 months after establishing care with a gastroenterologist include reduced IBS severity, lower depression score at initial visit, higher number of recommendations, and higher number of follow-up gastroenterology visits.

Depression, anxiety and treatment satisfaction in the parents of children on antiretroviral therapy in South Africa

Parents of children living with HIV are at increased risk of emotional distress, with negative implications for both their health outcomes. There is limited data on depression and anxiety symptoms in the biological parents as caregivers of children on antiretroviral therapy (ART) in South Africa. We investigated the prevalence and correlates associated with depressive and anxiety symptoms in 200 biological caregiving parents of children on ART at a public hospital in KwaZulu-Natal Province, South Africa. Data were obtained from the Patient Health Questionnaire (PHQ-9) for depressive symptoms and the Generalized Anxiety Depression (GAD-7) for anxiety symptoms, along with sociodemographic questionnaire. Most of the parent caregivers assessed were female (n = 190, 95%), younger than 40 years (n = 151, 75.5%), single (n = 173, 86.5%), unemployed (n = 156, 78%) and HIV+ (n = 183, 91.9%). Sixty-five (32.5%) parents screened positive for depression, 37 (18.5%) for anxiety and 31 (n = 31, 15.5%) for both disorders (i.e. depression/anxiety comorbidity). There were significant associations between death of a child to HIV (aOR = 4.66, 95% CI: 1.33-16.28) with depression/anxiety comorbidity as well as with treatment dissatisfaction (aOR = 13.98, CI: 2.09-93.66), but not with other socio-demographic factors. The high prevalence of depression and anxiety amongst the parent caregivers of children living with HIV suggests the need for mental health screening and care among parents of children attending pediatric HIV services, and particularly for those with history of children lost to HIV.

Relationships among hope, meaning in life, and post-traumatic growth in patients with chronic obstructive pulmonary disease: A cross-sectional study

AIM

This study aimed to investigate the relationships among hope, meaning in life, and post-traumatic growth (PTG) in patients with chronic obstructive pulmonary disease.

DESIGN

A cross-sectional study design.

METHODS

Between October 2018-September 2019, 221 chronic obstructive pulmonary disease patient completed the questionnaires including sociodemographic information, Chinese Version of Herth Hope Index, Meaning in Life Questionnaire, and Post-traumatic Growth Inventory. Descriptive analysis, Spearman's correlation analysis, the Kruskal-Wallis H test, the Mann-Whitney U test, and the ridge regression analysis were used for analysis.

RESULTS

Spearman's correlation analysis showed that hope and meaning in life were positively interrelated with PTG (r = 0.20-0.45, r = 0.36-0.54, p < 0.01). Ridge regression analysis results showed that hope, meaning in life, time since diagnosis, habitation, medical insurance, and monthly income could explain 47.30% of the variance in PTG (F = 33.863, p < 0.001).

CONCLUSION

Chinese patients with chronic obstructive pulmonary disease experienced a slightly positive change in meaning in life and a moderate degree of hope and PTG. Results suggested that hope and meaning in life were positively connected with PTG. Therefore, enhancing hope and meaning in life might be crucial for patients with chronic obstructive pulmonary disease to promote PTG.

IMPACT

The findings added better understanding of relationships among hope, meaning in life, and post-traumatic growth in patients with chronic obstructive pulmonary disease which can help nurse give interventions in the early stage of disease diagnosis.

The relationship between trust in primary healthcare providers among patients with diabetes and levels of depression and anxiety

Background

Trust in healthcare providers has been shown to improve several clinical and patient-reported outcomes. However, its relationship with depression and anxiety has not been investigated among patients with chronic health conditions, such as diabetes. Therefore, the aim of this study was to examine whether trust in primary care physicians among patients with diabetes is associated with their levels of depression and/or anxiety.

Method

Adult patients (≥18 years) with a diagnosis of diabetes, confirmed through their electronic health records, were recruited and interviewed from the primary care clinics of three public hospitals. Patient trust in primary care physicians was assessed using the Health Care Relationship (HCR) Trust scale. Depression and anxiety were assessed using the Patient Health Questionnaire 9-item (PHQ-9) and Generalized Anxiety Disorder 7-item (GAD-7), respectively. Two multiple linear regression analyses were conducted to examine the association of HCR-Trust scores with PHQ-9 and GAD-7 scores controlling for age, sex, Charlson comorbidity index score, education, health literacy, annual income, nationality, duration of illness, and research site.

Results

The number of patients who agreed to be interviewed was 367. Most of the participants were female (61.54%) and Saudi (92.86%). High HCR-Trust scores were negatively associated with PHQ-9 scores (β = -0.18; 95% CI: -0.23 –-0.13; P = < .0001), and GAD-7 scores (β = -0.17; 95% CI: -0.22– -0.12; P = < .0001).

Conclusions

Trust in primary care physicians among patients with diabetes was associated with lower levels of depression and anxiety. Therefore, healthcare providers should adopt a patient-centered care approach that fosters trust in the relationship between their patients and themselves. Further research should explore whether interventions that foster shared decision-making and trust in healthcare providers might also improve the health outcomes of patients with diabetes.

Patient's satisfaction beyond hand function in Dupuytren's disease: analysis of 1106 patients

This study investigates the outcomes of 1106 patients with Dupuytren's disease treated with limited fasciectomy or percutaneous needle fasciotomy over 16 years according to the different domains of patient-reported hand function. These patients completed the Michigan Hand Outcomes Questionnaire before and 3 months after surgery. Scores for the various outcome parameters were calculated and linear regression analyses were used to examine associations between the changes in digital extension deficit and change in Michigan Hand Outcomes Questionnaire (sub)scores. We found the largest effects of surgical treatment in the decreases in extension deficit, the appearance of the hand, and the satisfaction with the hand function. However, associations between different domains of evaluation were weak. We conclude that improvement of digital extension deficits is not parallel to varying aspects of patient satisfaction. The findings underline the importance of assessing domains relating to patient satisfaction other than objective hand function measures in Dupuytren's disease. Level of evidence: IV.

Satisfaction with health and community services among homeless and formerly homeless individuals in Quebec, Canada

User satisfaction is a crucial quality indicator in health service provision. Few studies have measured user satisfaction among homeless and formerly homeless individuals, despite the high prevalence of mental health disorders (MHD) in this population. The purpose of this study was to assess overall satisfaction among 455 homeless and formerly homeless individuals who were receiving health and community services, and to identify factors associated with user satisfaction. Data collection occurred between January and September 2017. Study participants were 18 years old or over, with experience of homelessness in the current or recent past. They completed a questionnaire eliciting socio-demographic information, and data on residential history, service use and satisfaction and health profiles. Multivariate linear analysis was performed on overall satisfaction with health and community services in the previous 12 months. Independent variables were organised as predisposing, enabling and needs factors based on the Gelberg-Andersen Behavioral Model. The mean satisfaction score was 4.11 (minimum: 1; maximum: 5). Variables associated with greater user satisfaction included: older age, residence in permanent housing, common MHD (e.g., depression, anxiety), having a family physician, having a case manager, strong social network, good quality of life and, marginally, male sex and having substance use disorders (SUD). By contrast, frequent users of public ambulatory health services were the most dissatisfied. User satisfaction was more strongly associated with enabling factors. Strategies for improving satisfaction include: promoting more tailored primary care programmes (including family physician) adapted to the needs of this population, better integrating primary care with specialised services including SUD integrated treatment and enhancing continuity of care through the reinforcement of case management services. Further efforts aimed at increasing access to permanent housing with supports, and eliciting more active involvement by relatives and friends may also improve user satisfaction with services, and reduce unnecessary service use.