A model of patients' satisfaction with treatment for posttraumatic stress disorder

Portuguese university hospital patient satisfaction and service quality

Purpose The purpose of this paper is to investigate Portuguese hospital inpatient satisfaction. Design/methodology/approach The study was conducted at a major university hospital in Portugal. Using the IAQH-IA mailed questionnaire, data were collected over three months (March to June 2015) from patients and families. From 1,500 former inpatients, 434 participated (29 percent response rate). Using the structural equation modeling, the authors derived satisfaction models and analyzed the relationship between quality, satisfaction and patient attitudes. Inferential statistics (bivariate analysis) were used to deal with global satisfaction determinants. Findings The satisfaction model was confirmed using factor analysis. Results show that developing a system for delivering timely information to both patient and relatives is relevant. Communication is a fundamental aspect for patients, which to date, seems to have been neglected by hospital managers. Education and current perceived health are important global satisfaction determinants. Practical implications Hospital managers can use the authors' findings to measure and improve operational performance. Originality/value Knowledge about patient perception and satisfaction leads to continuing improvement in healthcare quality.

Measuring patient satisfaction following epilepsy surgery

PURPOSE

To systematically review primary research examining patient satisfaction with epilepsy surgery in order to obtain evidence-based estimates of this surgical outcome; to assess methods used to measure epilepsy surgery satisfaction, overall epilepsy surgery satisfaction ratings, and predictors of epilepsy surgery satisfaction.

METHODS

Systematic review of published studies in English up to June 2009, focusing on patient satisfaction with all types of epilepsy surgery in patients of all ages. We excluded studies that focused on satisfaction with epilepsy treatment in general, on quality of life without specific exploration of patient satisfaction with surgery, and on satisfaction with the process of health care delivery, rather than with surgery and its outcomes.

KEY FINDINGS

Eight studies met inclusion criteria. Satisfaction was assessed using one or more global questions. Four epilepsy surgery satisfaction question content patterns emerged: (1) satisfied or dissatisfied, (2) perceived success or failure, (3) overall positive or negative impact, and (4) willingness to repeat surgery or regretting surgery. Overall 71% were satisfied; 64% considered it a success; it had a positive effect for 78%; and 87% would repeat surgery. Seizure freedom was the most common predictor of epilepsy surgery satisfaction, whereas postoperative neurologic deficit predicted dissatisfaction.

SIGNIFICANCE

Patient satisfaction with interventions is an important aspect of patient-centered care, but it has received little attention in epilepsy surgery. Future research is required to develop and validate epilepsy surgery satisfaction tools. We provide preliminary guiding principles for measuring satisfaction after epilepsy surgery.

Predictors of general medical and psychological treatment use among a national sample of peacekeeping veterans with health problems

We investigated general medical and psychological treatment use predictors among peacekeeping veterans with health problems, aiming to find those characteristics most associated with treatment use intensity (i.e., visit counts). One thousand one hundred and thirty-two male Canadian Forces peacekeeping veterans registered with Veterans Affairs for health problems were randomly recruited for a prospective national survey. Regression analyses for treatment use intensity controlled for age, total time deployed and health problems (covariates), and examined the incremental contribution of depression and post-traumatic stress disorder (PTSD) severity on health service use intensity. Results revealed that after controlling for covariates, the depression and PTSD model was associated with increased medical and psychological treatment use intensity. Medical use intensity was significantly predicted by married status, greater depression and health problems; psychological treatment use intensity was predicted by younger age, greater PTSD severity and health problems. This study highlights the importance of an integrated primary care-mental health service delivery model for veterans.

Determinates of youth and parent satisfaction in usual care psychotherapy

OBJECTIVE

Client satisfaction with mental health services is used commonly as an indicator of the quality of care, but there is minimal research on the construct of client satisfaction in youth services, and the extent to which satisfaction is related to improvements in clinical functioning versus other determinants. We examined the relationship between parent and youth satisfaction with youth services, and tested for significant determinants of satisfaction across three major domains: (1) change in youth clinical functioning; (2) youth/family service entry characteristics; (3) treatment/therapist characteristics.

METHOD

The participants were 143 youths receiving community-based outpatient care. Youths and parents were interviewed at service entry and six months later using well-established measures of clinical functioning and service satisfaction.

RESULTS

Youths and parents reported generally high satisfaction, but the correlation between them was low. Despite testing for many potential predictors of satisfaction, very few significant effects were found. In regression analyses of significant predictors of satisfaction, higher youth satisfaction was significantly associated with Caucasian ethnicity and more positive youth expectations about treatment. Higher parent satisfaction was associated with lower caregiver strain at service entry, increased number of sessions, and improvement in youth-reported functional impairment.

CONCLUSIONS

Client satisfaction remains a rather elusive construct, but it is not necessarily a strong indicator of service effectiveness.

The role of psychiatric diagnosis in satisfaction with primary care: data from the department of veterans affairs

BACKGROUND

Although patient satisfaction is widely used as a quality indicator, most such measures do not account for patient subgroups such as those with psychiatric illness. There is also very little data on satisfaction of psychiatric patients with their medical care.

OBJECTIVE

The objective of this study was to assess the role of psychiatric illness in satisfaction with outpatient primary care services in the Department of Veterans Affairs (VA).

METHOD

Data from the VA Customer Feedback Survey (n = 50,532) were merged with administrative data to determine diagnoses and other characteristics. Satisfaction ratings were compared across psychiatric diagnoses and across various aspects of satisfaction with care.

RESULTS

After controlling for patient characteristics (eg, gender, age, disability, acute vs. routine visit) and subjective health, patients with schizophrenia, posttraumatic stress disorder, drug abuse, depression, and other psychiatric disorders reported significantly lower satisfaction with their outpatient primary care. Dissatisfaction was particularly reported for access to care and overall coordination of care.

CONCLUSIONS

Despite VA characteristics that might be thought to improve satisfaction (eg, easier access to specialty mental health services as a result of the integrated VA system), patients with psychiatric disorders are significantly less satisfied than patients without such disorders. Possible explanations include both lower technical quality of care and poorer interpersonal communication between providers and patients with mental illness, including the negative effects of stigma. These findings highlight the need for satisfaction ratings to be case-mix-adjusted, including the incorporation of health and mental health diagnoses, and the need for further research that elucidates the reasons behind lower satisfaction ratings.

A multivariate model of patients' satisfaction with treatment for posttraumatic stress disorder

Prior studies have concluded that patients' pretreatment characteristics contribute more to their satisfaction with mental health treatment than any other domain. We expand the representation of treatment characteristics in an examination of satisfaction across both inpatient and outpatient settings. Data were drawn from an inpatient (n = 831) and an outpatient (n = 554) study of the treatment of PTSD. We used structural equation modeling to specify and evaluate a model of satisfaction with comparable elements for inpatient and both short and long-term outpatient treatment. Results indicate that the quality and quantity of patients' participation in treatment were more important to the development of their satisfaction with treatment than their pretreatment characteristics. Among treatment characteristics, the social climate of the inpatient milieu and the focus on war traumas in outpatient therapy had major effects on the quality and quantity of patients' participation and their satisfaction.