Identification of factors influencing patient satisfaction with orthopaedic outpatient clinic consultation: A qualitative study

Dissatisfaction-considered waiting time prediction for outpatients with interpretable machine learning

Long waiting time in outpatient departments is a crucial factor in patient dissatisfaction. We aim to analytically interpret the waiting times predicted by machine learning models and provide patients with an explanation of the expected waiting time. Here, underestimating waiting times can cause patient dissatisfaction, so preventing this in predictive models is necessary. To address this issue, we propose a framework considering dissatisfaction for estimating the waiting time in an outpatient department. In our framework, we leverage asymmetric loss functions to ensure robustness against underestimation. We also propose a dissatisfaction-aware asymmetric error score (DAES) to determine an appropriate model by considering the trade-off between underestimation and accuracy. Finally, Shapley additive explanation (SHAP) is applied to interpret the relationship trained by the model, enabling decision makers to use this information for improving outpatient service operations. We apply our framework in the endocrinology metabolism department and neurosurgery department in one of the largest hospitals in South Korea. The use of asymmetric functions prevents underestimation in the model, and with the proposed DAES, we can strike a balance in selecting the best model. By using SHAP, we can analytically interpret the waiting time in outpatient service (e.g., the length of the queue affects the waiting time the most) and provide explanations about the expected waiting time to patients. The proposed framework aids in improving operations, considering practical application in hospitals for real-time patient notification and minimizing patient dissatisfaction. Given the significance of managing hospital operations from the perspective of patients, this work is expected to contribute to operations improvement in health service practices.

Maximizing Satisfaction in Orthopedic Outpatient Clinics: Evidence From Ireland

Background Patient satisfaction is a critical metric in healthcare, reflecting the quality of care provided and influencing clinical outcomes and healthcare utilization. In orthopedic outpatient clinics, patient satisfaction affects patient adherence to treatment plans and overall health outcomes. This study aims to identify and analyze key factors influencing patient satisfaction in orthopedic outpatient clinics. Methodology This cross-sectional study was conducted from April to May 2024 across 10 orthopedic outpatient clinics. In this study, family members were included as respondents to the Patient Satisfaction Questionnaire (PSQ) when patients were unable to complete the survey due to age, cognitive impairment, or physical disabilities. This approach was adopted to ensure that the experiences of all patients, particularly minors, elderly individuals, and those with disabilities, were accurately captured. The PSQ assessed various aspects of patient satisfaction, including communication, treatment plans, addressing concerns, clinic environment, and overall satisfaction. Quantitative data were analyzed using SPSS version 27.0 (IBM Corp., Armonk, NY, USA). Results The study included 172 respondents. High levels of overall satisfaction were reported, with 142 (82.6%) respondents very satisfied and 28 (16.2%) somewhat satisfied. Significant associations were found between overall satisfaction and several factors, namely, effective communication, thorough explanation of treatment plans, addressing patient concerns, and a clean, comfortable clinic environment. Shorter waiting times were also associated with higher satisfaction. Regression analysis revealed that staff rating and the thoroughness of treatment plans were significant predictors of overall satisfaction. Conclusions Effective communication, thorough treatment explanations, addressing patient concerns, and maintaining a clean clinic environment are key determinants of patient satisfaction in orthopedic outpatient clinics. Reducing waiting times and investing in staff training on communication and empathetic care can further enhance patient satisfaction. These findings provide valuable insights for healthcare providers and administrators aiming to improve patient experiences in orthopedic outpatient settings. Further research is recommended to explore these relationships in diverse settings and develop targeted interventions.

Patient perception of group consultations for knee osteoarthritis and influence of area-level deprivation: A service evaluation in a physiotherapy musculoskeletal setting

INTRODUCTION

Group consultations are considered valuable for managing musculoskeletal (MSK) conditions. This service evaluation aimed to assess the perception of knee osteoarthritis (OA) patients regarding group consultations in NHS Lanarkshire's MSK service. It also explored the impact of area-level deprivation on patient engagement.

METHODS

Surveys were developed to gauge patient satisfaction, preferences, and experiences in virtual and face-to-face (FTF) group consultations. Patients were categorised into opt-out, did not attend (DNA), or opt-in groups. We used the Scottish Index of Multiple Deprivation for area-level deprivation analysis. Descriptive statistics were used for quantitative data, while qualitative data were thematically analysed.

RESULTS

A total of 84 patients participated, and area-level deprivation was similar across groups. Common engagement barriers included disinterest and transportation issues in opt-out and DNA groups, and IT problems in the DNA virtual group. Most patients expressed a preference for one-on-one consultations. FTF opt-in patients reported high satisfaction and increased confidence in managing their condition post-consultation. Virtual opt-in patients had a more neutral satisfaction level and mixed confidence. They were also less comfortable interacting with others during the consultation. Thematic analysis revealed positive experiences, and areas for improvement such as individual privacy concerns and additional resources.

CONCLUSION

Overall, patients were generally satisfied with group consultations for knee OA. The evaluation identified strategies to enhance engagement. Area-level deprivation did not significantly impact patient participation in group consultations.

RECITAL: a non-inferiority randomised control trial evaluating a virtual fracture clinic compared with in-person care for people with simple fractures (study protocol)

INTRODUCTION

Most simple undisplaced fractures can be managed without surgery by immobilising the limb with a splint, prescribing medication for pain, and providing advice and early rehabilitation. Recent systematic reviews based on retrospective observational studies have reported that virtual fracture clinics can deliver follow-up care that is safe and cost-effective. However, no randomised controlled trial has investigated if a virtual fracture clinic can provide non-inferior physical function outcomes compared with an in-person clinic for patients with simple fractures.

METHODS AND ANALYSIS

312 participants will be recruited from 2 metropolitan hospitals located in Sydney, Australia. Adult patients will be eligible if they have an acute simple fracture that can be managed with a removable splint and is deemed appropriate for follow-up at either the virtual or in-person fracture clinic by an orthopaedic doctor. Patients will not be eligible if they have a complex fracture that requires a cast or surgery. Eligible participants will be randomised to receive their follow-up care either at the virtual or the in-person fracture clinic. Participants at the virtual fracture clinic will be reviewed within 5 days of receiving a referral through video calls with a physiotherapist. Participants at the in-person fracture clinic will be reviewed by an orthopaedic doctor within 7-10 days of receiving a referral. The primary outcome will be the patient's function measured using the Patient-Specific Functional Scale at 12 weeks. Secondary outcomes will include health-related quality of life, patient-reported experiences, pain, health cost, healthcare utilisation, medication use, adverse events, emergency department representations and surgery.

ETHICS AND DISSEMINATION

The study has been approved by the Sydney Local Health District Ethics Review Committee (RPAH Zone) (X23-0200 and 2023/ETH01038). The trial results will be submitted for publication in a reputable international journal and will be presented at professional conferences.

TRIAL REGISTRATION NUMBER

ACTRN12623000934640.

Factors Associated With Patient Satisfaction Measured Using an Iterative Scale

BACKGROUND AND OBJECTIVES

Patient experience measures tend to have notable ceiling effects that make it difficult to learn from gradations of satisfaction to improve care. This study tested 2 different iterative satisfaction measures after a musculoskeletal specialty care visit in the hope that they might have less ceiling effect. We measured floor effects, ceilings effects, skewness, and kurtosis of both questionnaires. We also assessed patient factors independently associated with the questionnaires and the top 2 possible scores.

METHODS

In this cross-sectional study, 186 patients completed questionnaires while seeing 1 of 11 participating orthopedic surgeons in July and August 2019; the questionnaire measured: (1) demographics, (2) symptoms of depression, (3) catastrophic thinking in response to nociception, (4) heightened illness concerns, and (5) satisfaction with the visit on 2 iterative satisfaction scales. Bivariate and multivariable analyses sought associations of the explanatory variable with the satisfaction scales.

RESULTS

There is a small correlation between the 2 scales ( r = 0.27; P < .001). Neither scale had a floor effect and both had a ceiling effect of 45%. There is a very small correlation between greater health anxiety and lower satisfaction measured with one of the scales ( r = -0.16; P = .05).

CONCLUSION

An iterative satisfaction questionnaire created some spread in patient experience data, but could not limit ceiling effects. Additional strategies are needed to remove ceiling effects from satisfaction measures.

Understanding Racial, Ethnic, and Socioeconomic Differences in the Ambulatory Care Experience

BACKGROUND AND OBJECTIVE

Racial and ethnic and socioeconomic differences in patient experience are prevalent and can negatively impact health outcomes. Our objective was to examine differences in family experience of care in the pediatric ambulatory setting.

METHODS

We conducted interviews with parents of patients from different demographic groups who had received care at 1 of 3 clinics at a quaternary children's hospital. Multidisciplinary team conducted inductive and deductive thematic analysis of transcribed interviews. Sentiments and recurring themes were compared within and between racial and ethnic groups, insurance status, and language.

RESULTS

Eighty parents were interviewed. Three primary themes were identified: (1) mitigation of system issues: parents' mixed experiences with staff or clinicians mitigating system issues impacted their overall perceptions of care; (2) pivotal role of personal interactions: clinicians' interactions positively influenced family-clinician relationships and offset negative experiences; (3) effective explanations: clinicians' clear and thorough explanations were crucial in enhancing parent confidence in care. As an overarching theme, discrimination and disrespect by staff undermined trust in care, affecting all aspects of experience. With the exception of explanations, a higher proportion of publicly-insured parents reported negative experiences across all themes compared to those with private insurance. Asian parents with public insurance had the highest proportion of interviews that were mainly negative in sentiment.

CONCLUSIONS

Our findings offer nuanced insights into differences in the experience of ambulatory care. Insurance status emerged as an important marker of differential perceptions of care. Our study points to areas for improvement and highlights family-clinician interactions as vital to overall positive experience.

Measuring impact of a quality improvement initiative on glaucoma clinic flow using an automated real-time locating system

Background

Lean methodology helps maximize value by reducing waste, first by defining what value and waste are in a system. In ophthalmology clinics, value is determined by the number of patients flowing through the clinic for a given time. We aimed to increase value using a lean-methodology guided policy change, then assessed its impact on clinic flow using an automated radiofrequency identification (RFID) based real-time locating system (RTLS).

Methods

A total of 6813 clinical visits occurred at a single academic institution’s outpatient glaucoma clinic between January 5, 2018 to July 3, 2018. Over that period, 1589 patients comprising 1972 (29%) of visits were enrolled, with 1031 clinical visits occurring before and 941 visits after a policy change. The original policy was to refract all patients that improved with pinhole testing. The policy change was not to refract patients with a visual acuity ≥20/30 unless a specific request was made by the patient. Pre-post analysis of an automated time-motion study was conducted for the data collected 3 months before and 3 months after the policy change occurred on March 30, 2018. Changes to process and wait times were summarized using descriptive statistics and fitted to linear mixed regression models adjusting for appointment type, clinic volume, and daily clinic trends.

Results

One thousand nine hundred twenty-three visits with 1588 patients were included in the analysis. Mean [SD] age was 65.9 [14.7] years and 892 [56.2%] were women. After the policy change, technician process time decreased by 2.9 min (p < 0.0001) while daily clinical patient volume increased from 51.9 ± 16.8 patients to 58.4 ± 17.4 patients (p < 0.038). No significant difference was found in total wait time (p = 0.18) or total visit time (p = 0.83).

Conclusions

Real-time locating systems are effective at capturing clinical flow data and assessing clinical practice change initiatives. The refraction policy change was associated with reduced technician process time and overall the clinic was able to care for 7 more patients per day without significantly increasing patient wait time.

Patient Satisfaction With Otolaryngology Care: Stratification by Race, Age, Gender, Income, and Language

OBJECTIVE

To understand how race, gender, income, and language are correlated with patient satisfaction scores.

STUDY DESIGN

Cross-sectional analysis of patient satisfaction data.

SETTING

An urban/suburban academic otolaryngology practice.

METHODS

Patients presenting for outpatient otolaryngology visits from 2017 to 2020 were surveyed for patient satisfaction following a visit with their otolaryngology provider. Categorical responses and numerical responses were collected regarding overall satisfaction as well as a variety of more specific satisfaction questions. Responses were matched to both provider characteristics and patient demographic data. Differences in satisfaction by demographic data were assessed with descriptive statistics as well as a multivariable mixed-effect model to adjust for repeated responder data and control for confounding factors.

RESULTS

In total, 55,469 surveys were included, the majority of which were from white, English-speaking patients. Overall satisfaction levels were very high across all questions. The individual provider was associated highly with satisfaction, but provider gender was not. Race, age, and gender of the patient had a statistically significant impact on patient satisfaction, with higher levels of satisfaction among patients who were older, white, and male; income and language did not.

CONCLUSION

Patient factors including race, age, and gender had a significant impact on ratings on outpatient otolaryngology patient satisfaction surveys, with nonwhite, younger, female patients reporting lower scores.

Virtual Scribe Services Decrease Documentation Burden Without Affecting Patient Satisfaction: A Randomized Controlled Trial

BACKGROUND

Virtual scribe services (VSS) are a contemporary take on the in-person scribes utilized as a means to reduce administrative burden on physicians and enhance the physician-patient interaction. The purpose of this study was to determine whether VSS use could decrease the time an orthopaedic foot and ankle surgeon spends on documentation without diminishing the patient experience as compared with traditional postencounter dictation (TD).

METHODS

Fifty patients presenting for first-time visits with a single orthopaedic foot and ankle surgeon were prospectively enrolled and randomized to VSS or TD prior to the physician-patient encounter. Time spent with the patient in the exam room and time spent documenting away from the patient were recorded. A postencounter survey assessed patient satisfaction, perception of physician empathy, understanding of the plan, and perception of the amount of time spent with the physician.

RESULTS

Of 50 patients enrolled, 25 were randomized to VSS. Time spent documenting away from the patient differed significantly between VSS and TD (1.2 ± 0.7 minutes for VSS vs 5.8 ± 1.7 minutes for TD, P < .001) as did time elapsed between the end of the visit and the start of dictation (0 ± 0 for VSS vs 118.2 ± 72.7 minutes for TD, P < .001). There was a trend toward more time spent with the patient in the VSS group than in the TD group (14.2 ± 5.9 minutes for VSS vs 11.4 ± 5.1 minutes for TD, P = .069). There were no differences between groups in survey responses regarding satisfaction, empathy, understanding, or perception of sufficient time spent with the physician (P > .05 for each).

CONCLUSIONS

VSS use in an orthopaedic foot and ankle practice significantly decreased documentation time and allowed for completion of documentation during patient visits without differences in quality metrics as compared to TD. Orthopaedic surgeons can consider VSS a HIPAA-compliant documentation option with time savings and no measurable difference in patient satisfaction.

LEVELS OF EVIDENCE

Level II: Randomized controlled trial.

Erwartungen an die physiotherapeutische Behandlung – Ergebnisse einer Online-Befragung von in Deutschland lebenden Erwachsenen

Hintergrund Die Ausbildungswege der Physiotherapie in Deutschland sind heterogen gestaltet. Dadurch lassen sich derzeit keine einheitlichen Kernkompetenzen und somit kein konsistentes Berufsbild der Physiotherapie in Deutschland definieren.

Ziel Untersuchung der Erwartungen von in Deutschland lebenden Erwachsenen an eine physiotherapeutische Behandlung. Diese Erwartungen können als Spiegel betrachtet werden, wie die Gesellschaft die Kompetenzen der Physiotherapierenden wahrnimmt.

Methode Querschnittstudie mit Ad-Hoc-Stichprobe von in Deutschland lebenden Erwachsenen mittels Online-Umfrage. Ermittlung der Erwartungen mit 17 Items zu Maßnahmen in den Kategorien „Aktive Therapie“, „Passive Therapie“ und „Edukation/Beratung“. Die Daten wurden deskriptiv als Häufigkeiten und anhand des Chi-Quadrat-Tests analysiert.

Ergebnisse 325/487 (67 %) Teilnehmende beantworteten die Umfrage vollständig. Von 325 Teilnehmenden sind 68 % weiblich, 76 % zwischen 18 und 34 Jahre alt und 77 % haben ihren Wohnort in Norddeutschland. Die Mehrheit erwarteten Maßnahmen der Kategorie „Aktive Therapie“ (Steigerung der körperlichen Aktivität, der allgemeinen Fitness und des Fitnessniveaus), „Passive Therapie“ (Tapen, Massage und Wärme-/Kältetherapie) und „Edukation/Beratung“ (zur allgemeinen Gesundheit, Verhinderung von Krankheiten, Gewichtsreduktion und Ernährung). Die Erwartungen der Teilnehmenden mit oder ohne vorherige Erfahrungen mit einer physiotherapeutischen Behandlung stimmten annährend überein.

Schlussfolgerung Die Teilnehmenden erwarteten in einer physiotherapeutischen Behandlung eine Kombination aus aktiven, passiven und edukativen Maßnahmen. Damit diese Erwartungen der Teilnehmenden zukünftig den tatsächlichen Kompetenzen der Physiotherapierenden entsprechen, sollten die Ausbildungsinhalte in Deutschland insbesondere hinsichtlich der Edukation angepasst werden.

The Effect of Mobile Care Delivery on Clinically Meaningful Outcomes, Satisfaction, and Engagement Among Physical Therapy Patients: Observational Retrospective Study

Background

Musculoskeletal care is now delivered via mobile apps as a health care benefit. Although preliminary evidence shows that the clinical outcomes of mobile musculoskeletal care are comparable with those of in-person care, no research has examined the features of app-based care that secure these outcomes.

Objective

Drawing on the literature around in-person physical therapy, this study examines how patient-provider relationships and program engagement in app-based physical therapy affect clinically meaningful improvements in pain, function, and patient satisfaction. It then evaluates the effects of patient-provider relationships forged through in-app messages or video visits and timely, direct access to care on patients’ engagement in their recovery.

Methods

We conducted an observational, retrospective study of 814 pre- and postsurveyed participants enrolled in a mobile app physical therapy program where physical therapists prescribed workouts, education, and therapeutic activities after a video evaluation from February 2019 to December 2020. We estimated generalized linear models with logit functions to evaluate the effect of program engagement on clinical outcomes, minimal clinically important differences (MCIDs) in pain (ΔVisual Analogue Scale ≤−1.5) and function (ΔPatient Specific Functional Scale ≥1.3), and the effects of patient-provider relationships and clinical outcomes on patient satisfaction—participant reported likelihood to recommend the program (Net Promoter Scores of 9-10). We estimated Poisson generalized linear models to evaluate the effects of stronger patient-provider relationships and timely access to physical therapy within 24 hours on engagement including the number of weekly workouts and weeks in the program.

Results

The odds that participants (N=814) had a pain MCID increased by 13% (odds ratio [OR] 1.13, 95% CI 1.04-1.23; P=.003) with each weekly workout and the odds of a function MCID by 4% (OR 1.04, 95% CI 1.00-1.08; P=.03) with each week in the program. Participants with MCIDs in function and large changes in pain (Δ Visual Analogue Scale ≤−3.5) were 1.85 (95% CI 1.17-2.93; P=.01) and 2.84 times (95% CI 1.68-4.78; P<.001) more satisfied, respectively. Those with video follow-up visits were 2 to 3 times (P=.01) more satisfied. Each physical therapist’s message increased weekly workouts by 11% (OR 1.11, 95% CI 1.07-1.16; P<.001). Video follow-up visits increased weekly workouts by at least 16% (OR 1.16, 95% CI 1.04-1.29; P=.01) and weeks in the program at least 8% (OR 1.08, 95% CI 1.01-1.14; P=.02). Access was associated with a 14% increase (OR 1.14, 95% CI 1.05-1.24; P=.003) in weekly workouts.

Conclusions

Similar to in-person care, program engagement positively affects clinical outcomes, and strong patient-provider relationships positively affect satisfaction. In app-based physical therapy, clinical outcomes positively affect patient satisfaction. Timely access to care and strong patient-provider relationships, particularly those forged through video visits, affect engagement.

High Patient Satisfaction with Examination by Advanced Practice Physiotherapists in an Orthopaedic Outpatient Shoulder Clinic: A Cross-Sectional Study Using Quantitative and Qualitative Methods

Purpose: To evaluate patients’ satisfaction with being examined and diagnosed in an orthopaedic outpatient shoulder clinic, determine whether a difference exists between levels of satisfaction among patients examined by advanced practice physiotherapists (APPs) and orthopaedic surgeons (OSs), and explore patients’ experiences with being examined by APPs. Method: One hundred and thirty-three patients participated in a cross-sectional questionnaire study using the Visit-Specific Satisfaction Instrument (VSQ-9). Primary outcome was satisfaction with “The visit overall” (item 9). Nine patients participated in semi-structured interviews, which were thematically analyzed. Results: There was no significant difference in satisfaction with “The visit overall” between patients examined by an OS (median: 75, 1st–3rd quartiles: 75–100) and an APP (median: 100, 1st–3rd quartiles: 75–100). The VSQ-9 total score was not significantly different between groups, but some items regarding direct interaction with the health provider were scored significantly higher in the APP group. Patients were particularly satisfied with APPs’ ability to explain during the consultation. Conclusions:The results showed high levels of satisfaction with examinations performed by both OSs and APPs with no difference between groups concerning “The visit overall.” From a patient perspective, the results support the use of APPs to examine and diagnose selected patients in an orthopaedic outpatient shoulder clinic.

In Orthopaedic Speciality Care, Longer Explanations Are Not More Caring or More Satisfying

BACKGROUND

Research consistently documents no correlation between the duration of a musculoskeletal specialty care visit and patient experience (perceived empathy of the specialist and satisfaction with care). Based on a combination of clinical experience and other lines of research, we speculate that longer visits are often related to discordance between specialist and patient interpretation of symptoms and weighting of available test and treatment options. If this is true, then the specific duration of time discussing the specialist's interpretations and options with the patient (expertise transfer) might correlate with satisfaction with care and perceived empathy of the clinician even if the total visit time does not.

QUESTIONS/PURPOSES

(1) What demographic or mental health factors are associated with the duration of expertise transfer? (2) What factors, including the duration of expertise transfer, are associated with the patient's satisfaction with the visit and perceived clinician empathy?

METHODS

In a cross-sectional study, 128 new and returning English-speaking adult outpatients seeking care from one of three orthopaedic specialists in two urban practices between September and November 2019 were enrolled and agreed to audio recording of the visit. A total of 92% (118) of patients completed the questionnaire and had a usable recording. Participants completed a sociodemographic survey, the Patient-Reported Outcome Measure Information System Depression computer adaptive test (PROMIS Depression CAT; a measure of symptoms of depression), the Short Health Anxiety Index (SHAI-5; a measure of symptoms of hypochondriasis, a form of symptoms misinterpretation), the Pain Catastrophizing Scale (PCS-4; a measure of misinterpretation of symptoms), an ordinal measure of patient satisfaction (dichotomized into satisfied or not because of strong ceiling effects), and the Jefferson Scale of Patient Perception of Physician Empathy (JSPPPE; a measure of perceived clinician empathy). The duration of expertise transfer and the total duration of the visit were measured by two raters with acceptable reliability using software that facilitates segmentation of the visit audio recording. To determine factors associated with the duration of expertise transfer, satisfaction, and empathy, we planned a multivariable analysis controlling for potential confounding variables identified in exploratory bivariable analysis. However, there were insufficient associations to merit multivariable analysis.

RESULTS

A longer duration of expertise transfer had a modest correlation with catastrophic thinking (r = 0.24; p = 0.01). Complete satisfaction with the visit was associated with less health anxiety (6 [interquartile range 5 to 7] for complete satisfaction versus 7 [5 to 7] for less than complete satisfaction; p = 0.02) and catastrophic thinking (4 [1 to 7] versus 5 [3 to 11]; p = 0.02), but not with the duration of expertise transfer. Greater perceived clinician empathy had a slight correlation with less health anxiety (r = -0.19; p = 0.04).

CONCLUSION

Patients with greater misinterpretation of symptoms experience a slightly less satisfying visit and less empathetic relationship with a musculoskeletal specialist despite a longer duration of expertise transfer. This supports the concept that directive strategies (such as teaching healthy interpretation of symptoms) may be less effective then guiding strategies (such as nurturing openness to alternative, healthier interpretation of symptoms using motivational interviewing tactics, often over more than one visit or point of contact).

LEVEL OF EVIDENCE

Level II, therapeutic study.

Consideration factors of older adults seeking medical treatment at outpatient services in Taiwan

BACKGROUND

Taiwan will become a super-aged society by 2025, leading to the more frequent use of outpatient services by older adults for medical treatment compared with other age groups. Understanding the outpatient service consideration factors of older adults seeking medical treatment can improve health care quality. This study explored the selection factors and crucial considerations of older adults for outpatient services.

METHODS

Qualitative study was conducted. Purposive sampling was used to recruit 16 older adults over 65 years of age with chronic disease who were patients of an internal medicine department and regularly returned for checkups. Data including reasons for receiving medical treatment, factors affecting their choice of hospitals, and health care and environmental considerations were collected through structured interviews.

RESULTS

The older adults identified four factors. (1) The care of doctors: The doctors possessed professional skill, allocate sufficient consultation time, and undertake effective communication. (2) The care of other medical professionals: Other medical professionals provided services in a cordial manner. (3) The accessibility and convenience of outpatient services: Convenient transportation and registration as well as short consultation wait time. (4) Environment and equipment: The hospital had the novel facilities and satisfactory barrier-free equipment.

CONCLUSIONS

The older adults cared most about the adequacy of diagnosis and treatment by doctors and other medical professionals. In addition, they reported having higher satisfaction with hospitals that provide comprehensive medical facilities, fast and convenient medical procedures, and short wait times.

Outpatient satisfaction with primary health care services in Vietnam: Multilevel analysis results from The Vietnam Health Facilities Assessment 2015

Patient satisfaction has implications for resource distribution across primary, secondary, and tertiary care, as well as accessibility of quality services and equity of service delivery. This study assessed outpatient satisfaction with health services and explored the determinants at the individual and contextual levels in Vietnam. Data on 4372 outpatients were extracted from the Vietnam Health Facility Assessment survey 2015. Three levels of logistic regression were applied to examine the association between outpatient satisfaction and three types of explanatory variables. Outpatients satisfied with their community health center or district hospital accounted for relatively high proportions (85% and 73%, respectively). Patients’ age, occupation, and individual characteristics were significant predictors of patient satisfaction, whereas provincial level factors were not significantly associated with the dependent variable. When individual-level characteristics were controlled, outpatients who had a longer waiting time for health services were less likely to report being satisfied. Interventions for improving outpatient satisfaction should pay attention to simplifying the health procedure at health facilities to reduce patients’ waiting time and increase their examining time.

Validation of a Patient Questionnaire Assessing Patient Satisfaction With Orthopedic Outpatient Clinic Consultation

Previous qualitative research has identified a number of factors which influence patient satisfaction with orthopedic outpatient clinic visits. To further evaluate these factors, the authors initially generated a number of items or statements representing these factors. This cohort of items was then subjected to analysis by an expert group to assess which 3 items best represented each factor. These items formed the basis of a draft survey which was then administered to 323 orthopedic outpatients to assess these factors as characteristics of patient satisfaction. Items and factors were also assessed against 2 global measures of patient satisfaction. One hundred and one survey responses were returned and subjected to factorial analysis. Results indicated that factors of trust, empathy, and relatedness were not distinguishable and subsequently combined to represent a single factor, the therapeutic relationship. A final 5-factor model is proposed incorporating 3 interpersonal factors (communication, expectation, therapeutic relationship) and 2 environmental factors (clinic wait time, clinical contact time). The factors identified by this study should be considered in surveys evaluating patient satisfaction with orthopedic outpatient services.

Monitoring, implementation and reporting of interventions in a selection of trials assessing exercise therapy for the management of shoulder subacromial pain: a cross-sectional investigation

OBJECTIVES

To review the reporting of monitoring and implementation of interventions in a selection of trials that assessed the effectiveness of manual therapy and exercise in the management of shoulder subacromial pain.

DESIGN

A review of trials assessing the effectiveness of manual therapy and exercise in the management of patients with shoulder subacromial pain.

METHODS

We included in our review a selection of 10 trials that were included in a Cochrane review and compared manual therapy and exercise intervention with another intervention. Trials were assessed independently by two reviewers using two checklists: the Template for Intervention Description and Replication (TIDieR) and the Health Behavior Change Consortium treatment fidelity (National Institutes of Health Behaviour Change Consortium/NIHBCC).

RESULTS

TIDieR overall scores for individual trials ranged from 11.1% to 45% and fidelity scores ranged from 7% to 50%. On average, trials scored the following within each domain of NIHBCC: study design 51%; training of providers 8%; treatment delivery 15%; treatment receipt 14% and treatment enactment 2.5%.

CONCLUSIONS

Little information about the monitoring, implementation and reporting of interventions was provided by trials and that is a barrier for implementing or replicating these interventions. The lack of information regarding the implementation of interventions needs to be taken into account when assessing whether effectiveness of interventions was impacted by their design or due to deviations from the protocol within trials.

What Are the Priming and Ceiling Effects of One Experience Measure on Another?

Patient-reported experience measures have notable ceiling effects which can hinder efforts to learn and improve. This study tested whether an iterative (Guttman-style) satisfaction questionnaire combined with instructions intended to give people agency to critique us primes responses on an ordinal scale and reduces ceiling effects. Among the 161 subjects randomly assigned to complete an iterative satisfaction questionnaire before or after an ordinal scale, there was no difference in mean satisfaction (no priming). The Guttman scale was more normally distributed and had slightly less ceiling effect when compared to the ordinal scale. Iterative satisfaction scales partially mitigate ceiling effects. The absence of priming suggests that attempts to encourage agency and reflection have limited ability to reduce ceiling effects, and alternative approaches should be tested.

Relationship Between Orthopedic Surgeon's Empathy and Inpatient Hospital Experience Scores in a Tertiary Care Academic Institution

Studies have examined the relationship between physician empathy and patient experience, but few have explored it in surgeons. The purpose of this study was to report on orthopedic surgeon empathy in a mutlispecialty practice and explore its association with orthopedic patient experience. Patients completed the consultation and relational empathy (CARE) measure (March 2017-August 2018) and Canadian Patient Experience Survey-Inpatient Care (CPES-IC; March 2017-February 2019) to assess empathy and patient experience, respectively. Consultation and relational empathy measures were correlated to CPES-IC for 3 surgeon-related questions pertaining to respect, listening, and explaining. Surgeon CARE scores (n = 1134) ranged from 42.0 ± 9.1 to 48.6 ± 2.4 with 50.4% of patients rating their surgeon as perfectly empathic. There were no significant differences between surgeons for CPES-IC continuous and topbox scores (n = 834) for respect and correlations between CPES-IC questions. The CARE measure for both continuous and topbox scores were weak to moderate, but none were significant. Empathy was associated with surgeon respect and careful listening, despite lack of significant correlation. Possible future work could use an empathy tool more appropriate for this surgeon population.

A Service Evaluation after 4 year's use of the Virtual Fracture Clinic model by a District General Hospital in the South West of England

INTRODUCTION

A Virtual fracture clinic (VFC) was set up in 2015. An initial patient satisfaction survey demonstrated satisfaction with the service. The purpose of this service evaluation was to re-evaluate the VFC by reporting on patient satisfaction. A small audit was undertaken alongside to examine the time taken from ED presentation to VFC review against the British Orthopaedic Association Society for Trauma (BOAST) guidelines of 72 h.

PATIENTS AND METHODS

All patients discharged from VFC in August 2019 were eligible to take part in the patient satisfaction survey. The Electronic Patients Records System (EPRS) was used to generate data regarding time of review and patient return for follow up appointments.

RESULTS

The results demonstrated that 88% of patients would recommend the service to friends. More than 80% of patients were satisfied with various elements of the service and 80% of patients are seen within the target time of 72 h.

CONCLUSIONS

Patients continue to be satisfied with the VFC. There seems to be a greater acceptance of not being reviewed by a doctor. In general, patients were seen within 72 h of ED presentation but more work is needed to streamline the process of tertiary referrals.

Exploring patient satisfaction after operative and nonoperative treatment for midshaft clavicle fractures: a focus group analysis

Background

There is no consensus on the optimal treatment for displaced midshaft clavicle fractures. Several studies indicate superior patient satisfaction in favour of operative reconstruction. It is unknown what drives superior satisfaction in this treatment group. The aim of this study was to explore patient satisfaction and identify contributors to patient satisfaction after operative and nonoperative treatment for displaced midshaft clavicle fractures in adults using a focus group approach.

Methods

Four face-to-face and two web-based focus groups were hosted. A total of 24 participants who were treated nonoperatively (n = 14) or operatively (n = 10) agreed to participate. Participants were selected using purposive sampling, ensuring variation in gender, age, treatment complications and outcomes. A question script was developed to systematically explore patient expectations, attitudes and satisfaction with different dimensions of care. All focus groups were voice-recorded and transcribed at verbatim. Thematic analysis was conducted on all face-to-face and web-based transcripts.

Results

The main emerging themes across treatment groups were; need for more information, functional recovery, speed of recovery and patient-doctor interaction. There was no difference in themes observed between operative and nonoperative focus groups. The lack of information was the most important complaint in dissatisfied patients.

Conclusion

Our study shows that informing patients about their injury, treatment options and expectations for recovery is paramount for overall patient satisfaction after treatment for a displaced midshaft clavicle fracture.

Level of evidence

Level III, focus group study.

Patients' expectations and experiences of stem cell therapy for the treatment of knee osteoarthritis

BACKGROUND

Stem cell therapy is a novel treatment option for people living with osteoarthritis. Research investigating stem cell therapy for this debilitating condition has predominantly involved the pathogenesis of the cells and efficacy of the treatment. There is little understanding of patients' expectations and experiences of stem cell therapy treatment.

OBJECTIVE

To explore the expectations and experiences of people undergoing stem cell therapy for the treatment of knee osteoarthritis.

DESIGN

An exploratory, descriptive, qualitative study using semi-structured interviews was conducted.

SETTING AND PARTICIPANTS

Participants were recruited into two groups: (a) Expectations Group (n = 15); the expectations of stem cell treatment were explored with participants that were yet to commence stem cell therapy. (b) Experiences Group (n = 15); the experiences of stem cell therapy were explored with participants 12 months after their initial stem cell treatment. Transcripts were analysed using thematic analysis to identify themes in both groups.

RESULTS

Themes for the Expectations Group were active involvement in the treatment; treatment will improve symptoms; and benefits of treatment outweigh the risks. Themes for the Experiences Group were symptoms of treatment; satisfaction with treatment; and anticipation of further improvement.

DISCUSSION AND CONCLUSIONS

The findings are the first qualitative study to represent patients' perspective on expectations and experiences of stem cell therapy for knee osteoarthritis. They provide insight into the potential areas for improvement within this field to aid patients' preparation and approach to the treatment, promoting patient-centred care.

Factors Associated With Patient Satisfaction Measured Using a Guttman-Type Scale

Patient experience measures such as satisfaction are increasingly tracked and incentivized. Satisfaction questionnaires have notable ceiling effects that may limit learning and improvement. This study tested a Guttman-type (iterative) Satisfaction Scale (GSS) after a musculoskeletal specialty care visit in the hope that it might reduce the ceiling effect. We measured floor effects, ceiling effects, skewness, and kurtosis of GSS. We also assessed factors independently associated with GSS and the top 2 possible scores. In this cross-sectional study, 164 patients seeing an orthopedic surgeon completed questionnaires measuring (1) a demographics, (2) symptoms of depression, (3) catastrophic thinking in response to nociception, (4) heightened illness concerns, and (5) satisfaction with the visit (GSS). Bivariate and multivariable analyses sought associations of the explanatory variable with total GSS and top 2 scores of GSS. Accounting for potential confounding using multivariable analysis, lower satisfaction was independently associated with greater symptoms of depression (β: -0.03; 95% CI: -0.05 to -0.00; P = .047). The top 2 scores of the GSS were independently associated with women (compared to men: odds ratio [OR]: 2.12, 99% CI: 1.01-4.45, P = .046) and lower level of education (masters' degree compared to high school; OR: 0.16, 95% CI: 004-0.61, P = .007). The GSS had no floor effect, a ceiling effect of 38%, a skewness of -0.08, and a kurtosis of 1.3. The 38% ceiling effect of the iterative (Guttman-style) satisfaction measure is lower than ordinal satisfaction scales, but still undesirably high. Alternative approaches for reducing the ceiling effect of patient experience measures are needed.

Mining User-generated Content of Mobile Patient Portal

Patient portals are positioned as a central component of patient engagement through the potential to change the physician-patient relationship and enable chronic disease self-management. The incorporation of patient portals provides the promise to deliver excellent quality, at optimized costs, while improving the health of the population. This study extends the existing literature by extracting dimensions related to the Mobile Patient Portal Use. We use a topic modeling approach to systematically analyze users’ feedback from the actual use of a common mobile patient portal, Epic's MyChart. Comparing results of Latent Dirichlet Allocation analysis with those of human analysis validated the extracted topics. Practically, the results provide insights into adopting mobile patient portals, revealing opportunities for improvement and to enhance the design of current basic portals. Theoretically, the findings inform the social-technical systems and Task-Technology Fit theories in the healthcare field and emphasize important healthcare structural and social aspects. Further, findings inform the humanization of healthcare framework, support the results of existing studies, and introduce new important design dimensions (i.e., aspects) that influence patient satisfaction and adherence to patient portal.

Outpatient Versus Inpatient Posterior Lumbar Fusion for Low-Risk Patients: An Analysis of Thirty-Day Outcomes From the National Surgical Quality Improvement Program

BACKGROUND

Outpatient spine surgery has been increasingly used recently owing to its perceived cost benefits and its ability to offset the volume from the inpatient setting. However, the 30-day outcomes of outpatient posterior lumbar fusion (PLF) for low-risk patients have not been extensively studied. In the present study, we assessed the 30-day outcomes of outpatient PLF surgery for low-risk patients using a national surgical quality registry.

METHODS

For the present study, we queried the American College of Surgeons National Surgical Quality Improvement Program for patients who had undergone PLF from 2009 to 2016. Only patients with an American Society of Anesthesiologists grade of 1-2 were included. The 30-day outcomes, including any complications, readmissions, and reoperations, were studied using multivariable logistic regression after adjustment for an array of patient-specific factors.

RESULTS

A total of 29,830 cases were identified. Of these 29,830 cases, 1016 (3.4%) had been performed as outpatient cases and 28,814 (96.6%) as inpatient. After adjusting for an array of patient-specific factors, we did not find any significant association between the procedure setting and complication rate (odds ratio [OR], 0.8; 95% confidence interval [CI], 0.6-1.1; P = 0.15) or 30-day readmission rate (OR, 0.9; 95% CI, 0.6-1.4; P = 0.76). Patients undergoing outpatient PLF were more likely to have required a 30-day reoperation (OR, 1.6; 95% CI, 1.1-2.4; P = 0.02).

CONCLUSION

Our results have demonstrated that the 30-day outcomes of patients who have undergone outpatient PLF might be comparable to those of patients who have undergone PLF in an inpatient setting. However, outpatient surgery might be associated with a greater overall reoperation rate.

Attempts to Limit Censoring in Measures of Patient Satisfaction

Background:

Measures of patient satisfaction are increasingly used to measure patient experience. Most satisfaction measures have notable ceiling effects, which limits our ability to learn from variation among relatively satisfied patients. This study tested a variety of single-question satisfaction measures for their mean overall score, ceiling and floor effect, and data distribution. In addition, we assessed the correlation between satisfaction and psychological factors and assessed how the various methods for measuring satisfaction affected net promoter scores (NPSs).

Methodology:

A total of 212 patients visiting orthopedic offices were enrolled in this randomized controlled trial. Patients were randomized to 1 of 5 newly designed, single-question satisfaction scales: (a) a helpfulness 11-point ordinal scale from 0 to 10, (b) a helpfulness ordinal 11-point scale from 0 to 5 (ie, with 1.5, 2.5, etc), (c) a helpfulness 100-point slider, (d) a satisfaction 11-point ordinal scale from 0 to 10, and (e) a willingness to recommend 11-point ordinal scale from 0 to 10. Additionally, patients completed the 2-item Pain Self-Efficacy Questionnaire (PSEQ-2), 5-item Short Health Anxiety Inventory (SHAI-5) Scale, and Patient-Reported Outcomes Measurement Information System (PROMIS) Depression. We assessed mean and median score, ceiling and floor effect, and skewness and kurtosis for each scale. Spearman’s correlation tests were used to test correlations between satisfaction and psychological status. Finally, we assessed the NPS for the various scales.

Results:

Ceiling effects ranged from 29% to 68%. The 11-point ordinal helpfulness scale from 0 to 10 had the least ceiling effect (29%). All of the scales were asymmetrically distributed, with the 11-point ordinal scale from 0 to 5 having the most Gaussian distribution (skew = 0.64 and kurtosis = 2.3). Satisfaction scores did not correlate with psychological factors: PSEQ-2 (r = 0.04; P = .57), SHAI-5 (r = 0.01; P = .93), and PROMIS Depression (r = −0.04; P = .61). Net promoter scores varied substantially by scale design, with higher scores corresponding with greater ceiling effects.

Conclusions:

Variations in scale types, text anchors, and lead-in statements do not eliminate the ceiling effect of single-question measures of satisfaction with a visit to an orthopedic specialist. Further studies might test other scale designs and labels.

Level of Evidence:

Diagnostic; Level II

Preparing for an orthopedic consultation using an eHealth tool: a randomized controlled trial in patients with hip and knee osteoarthritis

BACKGROUND

To evaluate the effect of a stand-alone mobile and web-based educational intervention (eHealth tool) compared to usual preparation of a first orthopedic consultation of patients with hip or knee osteoarthritis (OA) on patients' satisfaction.

METHODS

A two-armed randomized controlled trial involving 286 patients with (suspicion of) hip or knee OA, randomly allocated to either receiving an educational eHealth tool to prepare their upcoming consultation (n = 144) or usual care (n = 142). Satisfaction with the consultation on three subscales (range 1-4) of the Consumer Quality Index (CQI - primary outcome) and knowledge (assessed using 22 statements on OA, range 0-22), treatment beliefs (assessed by the Treatment beliefs in OsteoArthritis questionnaire, range 1-5), assessment of patient's involvement in consultation by the surgeon (assessed on a 5-point Likert scale) and patient satisfaction with the outcome of the consultation (numeric rating scale), were assessed.

RESULTS

No differences between groups were observed on the 3 subscales of the CQI (group difference (95% CI): communication 0.009 (- 0.10, 0.12), conduct - 0.02 (- 0.12, 0.07) and information provision 0.02 (- 0.18, 0.21)). Between group differences (95% CI) were in favor of the intervention group for knowledge (1.4 (0.6, 2.2)), negative beliefs regarding physical activities (- 0.19 (- 0.37, - 0.002) and pain medication (- 0.30 (- 0.49, - 0.01)). We found no differences on other secondary outcomes.

CONCLUSIONS

An educational eHealth tool to prepare a first orthopedic consultation for hip or knee OA does not result in higher patient satisfaction with the consultation, but it does influence cognitions about osteoarthritis.

TRIAL REGISTRATION

Dutch Trial Register (trial number NTR6262). Registered 30 January 2017.

Patient satisfaction with pain relief following major abdominal surgery is influenced by good communication, pain relief and empathic caring: a qualitative interview study

Background

Monitoring and improving the quality of care is an ever increasing concern for health care organisations. Measuring the effectiveness of clinical outcomes is done by looking at specific markers of high quality care. Pain management is considered one of the markers of high quality care and satisfaction with pain management is a crucial and important quality assurance marker; yet, we know little about what contributes to a patient's decision about satisfaction.

Methods

A qualitative study drawing on phenomenological approach aiming to evaluate the perspective of patients experiencing post-operative pain. Patients undergoing major abdominal surgery were recruited from a Renal Transplant and Urology ward in the North of England, UK. Data were collected using in-depth semi-structured interviews and were analysed using Colaizzi's approach.

Results

Ten patients participated in the study and three themes emerged from the analysis. The findings of this study revealed that in order to achieve satisfaction with the management of pain, patient care has to include information delivery which is timely and adequate according to a patient's individual needs, nurses should have a caring attitude and pain should be well controlled.

Conclusion

Satisfaction with pain management is influenced by good communication and information transfer, appropriate pain management and an empathic presence throughout.

Advanced musculoskeletal physiotherapy practice: The patient journey and experience

BACKGROUND

As many patients referred to orthopaedic and rheumatology services do not require medical or surgical interventions, advanced practice physiotherapists (APPs) have been introduced into hospital services to triage the care of these patients. Patient perspectives are critical to review the acceptance of this model of care and potential for expansion into primary care. This study aimed to explore the clinical journeys, and the experiences and perceptions of patients attending APP services.

METHOD

Semi-structured interviews (n = 10) were conducted with patients across two hospital sites, with narrative data subjected to a thematic analysis. MSK journeys were mapped via medical chart and interview data, with surveys collecting demographics.

RESULTS

Patient journeys involved multiple contact points and some duplication in MSK health services. Overall, experiences of the APP service were positive, with faster access into the hospital system and patients valued the interpersonal and professional skills of the APP. Having already attended a physiotherapist, some patients did have a preconception of what the APP could offer them. However, initial concerns were mitigated following the APP appointment, as the APP had extensive MSK knowledge. Hospitals remained the preferred location for MSK appointments due to availability of diagnostics and 'specialists', and close proximity of the doctor.

CONCLUSION

Patients were positive about the new MSK APP service and benefits related to shorter wait times and seeing a specialist who listened and involved them in their management. However, a cultural shift regarding patient perceptions of the 'specialists' in hospitals and the role of a physiotherapist is required.

Patients' ideas, concerns, expectations and satisfaction in primary health care - a questionnaire study of patients and health care professionals' perspectives

Objective: Explore the perceptions of patients and health care professionals about patients' ideas, concerns, expectations (ICE), and satisfaction in consultations with general practitioners (GPs), district nurses (DNs) and physiotherapists (PTs).Design: Cross-sectional questionnaire study of participants in planned consultations.Setting: Five primary health care centers and two rehabilitation centers in Stockholm, Sweden.Subjects: Pairs of patients and GPs (n = 156), patients and DNs (n = 73), and patients and PTs (n = 69).Main outcome measures: Multiple-choice questions about patients' ICE and satisfaction.Results: Approximately 75% of patients and GPs reported that patients' thoughts and explanations about their symptoms emerged during the consultation. For patient-DN pairs, the figure was 60%, and for patient-PT pairs, 80%. A majority of patients reported not having concerns and anxiety about the investigation/treatment, whereas health care professionals thought patients were more concerned. One-third of patients consulting GPs and PTs expected to receive a reason/explanation for their symptoms. Figures were lower for the DNs. About 70% of patients were satisfied with the consultation.Conclusions: Most patients expressed their ideas, a minority had concerns, and a minority expected an explanation of their illness. Patients and health care professionals rated patient satisfaction high, but health care professionals tended to believe patients were less satisfied than patients reported they were.Key pointsPatient surveys show that important aspects of patient-centeredness remain weak in Swedish primary health care; for example, shared decision-making.In this study of planned consultations, few patients expected to receive an explanation of their symptoms, but most were satisfied with the consultation.Health care professionals thought patients' experiences were more negative than they were.This discrepancy was observed in responses to questions about patients' concerns, expectations and satisfaction.

An Electronic Health Tool to Prepare for the First Orthopedic Consultation: Use and Usability Study

Background

The use of electronic health (eHealth) technology to prepare patients with hip or knee osteoarthritis (OA) for their first orthopedic consultation seems promising. Exploration of the use and usability of an educational eHealth tool may highlight potential modifications that could increase patient engagement and effectiveness.

Objective

This study aimed to (1) identify the use and usability of a stand-alone educational eHealth tool for patients with suspected hip or knee OA, (2) explore whether the recorded questions in the eHealth tool were in line with an existing widely used question prompt list, and (3) investigate whether user characteristics are related to use and usability.

Methods

We used data from 144 participants in the intervention group of a randomized controlled trial, who were asked to use the educational eHealth tool to prepare for their upcoming first orthopedic consultation. We defined users and nonusers based on whether they had opened the tool at least once. Users were characterized as active or superficial depending on the extent of their use of the tool. The recorded questions for the consultation preparation were categorized into themes fitting 3 predefined questions or in a remaining category. Usability was measured using the System Usability Scale (SUS, 0-100). Data were collected including the patient demographic and clinical characteristics, knowledge of OA, and internet and smartphone usage in daily life. The characteristics associated with users and nonusers were analyzed using a multivariable logistic regression analysis.

Results

A total of 116/144 (80.6%) participants used the educational eHealth tool, of whom 87/116 (75.0%) were active users. Of the three components of the tool (information, my consultation, and medication), medication was the least used (34%). On the basis of recorded questions of the users, the fourth predefined question could be proposed. The mean (SD) SUS score was 64.8 (16.0). No difference was found between the SUS scores of superficial and active users (mean difference 0.04, 95% CI −7.69 to 7.77). Participants with a higher baseline knowledge of OA (odds ratio [OR] 1.2, 95% CI 1.0 to 1.4) and who used the internet less frequently in their daily life (OR 0.6, 95% CI 0.5 to 0.9) were more likely to use the educational eHealth tool. We found no differences between the demographics and clinical characteristics of the superficial and active users.

Conclusions

Based on the results of this study, it can be concluded that the use of an educational eHealth tool to prepare patients with hip and knee OA for the first orthopedic consultation is feasible. Our results suggest some improvements that should be made to the content of the tool to improve its usability. No clear practical implications were found to support the implementation of the educational eHealth tool in specific subgroups.

Trial Registration

Netherlands Trial Register NTR6262; https://www.trialregister.nl/trial/6262

Integration of online and offline health services: The role of doctor-patient online interaction

OBJECTIVE

This study aims to investigate how doctor-patient online interaction affects the integration of online and offline health services. Drawing on justice theory and the stimulus-organism-response (S-O-R) framework, justice perceptions are conceptualized as online health communication in influencing patient experiences and subsequent responses.

METHODS

Data were collected from 241 online consultation patients. Partial least squares structural equation modeling (PLS-SEM) approach was used to test the research model and 12 hypothesized relationships.

RESULTS

Distributive justice, procedural justice, and interpersonal justice significantly affect trust, which in turn affects satisfaction and the continued intention to consult. Distributive justice and informational justice significantly affect satisfaction, which in turn affects the continued intention to consult. Finally, the continued intention to consult significantly affects the behavioral intention to visit.

CONCLUSION

Doctors can attract patients to visit them in physical hospitals by providing good online health services. Before physically visiting doctors, patients can also search for a suitable doctor that meets their needs through online consultations. To the best of our knowledge, this study is the first to integrate online and offline health services.

PRACTICE IMPLICATIONS

From the perspective of health communication, the understanding of doctor-patient online interaction offers doctors and hospitals guidance to improve doctor-patient relationships.

Australian adults expect physiotherapists to provide physical activity advice: a survey

QUESTIONS

Do Australian adults think that physiotherapists are likely to provide physical activity (PA) advice, general health advice, and physical interventions? Do Australian adults think it is important for physiotherapists to provide each of these services? What factors are associated with adults' expectations of receiving these services from physiotherapists?

DESIGN

Online nationwide cross-sectional survey.

PARTICIPANTS

Australian adults aged < 18 years who have or have not had a physiotherapy appointment before.

OUTCOME MEASURES

The survey instrument included questions asking respondents if it was both important and likely that a physiotherapist would provide services pertaining to PA and general health-related advice as well as physical interventions. Responses were measured on a 6-point Likert scale.

RESULTS

Full responses were obtained from 587 respondents. Most respondents reported that it is likely (40%) or extremely likely (29%) and important (47%) or extremely important (29%) that a physiotherapist provides advice to help them increase their PA levels. This was similar to the percentage of respondents reporting that it is likely (46%) or extremely likely (19%) and important (43%) or extremely important (24%) that a physiotherapist provides advice to help them improve their general health. A similar number of respondents also reported that it is likely (37%) or extremely likely (29%) and important (42%) or extremely important (26%) that a physiotherapist provides massage. The odds of respondents expecting physiotherapists to provide PA advice were higher for those who were older (OR 1.2, 95% CI 1.1 to 1.5), chose to see a physiotherapist to feel better and receive a home exercise program (OR 2.0, 95% CI 1.0 to 3.9), and felt that physiotherapists met their expectations (OR 4.5, 95% CI 2.2 to 9.3).

CONCLUSION

Australian adults believe it is likely and important that physiotherapists provide PA and general health advice in addition to specific physical interventions.

Waiting Time: The Expectations and Preferences of Patients in a Paediatric OPD

Quality healthcare and satisfaction are gradually emerging as important areas, which need much attention. The factors of patient satisfaction have been identified under varied conditions globally. In the Indian context, one key patient satisfaction factor has been attributed to waiting time. Long waiting time has been one of the major reasons of patient dissatisfaction and assumes significance when associated with paediatric events. The following study has successfully identified key attributes, which are associated with long waiting times within paediatric outpatient department (OPD) settings. The possible implications of the long waiting periods have been recorded through semi-structured interviews, and further in-depth analysis of individual factors were carried out to predict the probable outcomes.

The qualitative exploratory study design has helped to understand the perception of parents/care givers (in case of neonates and toddlers) and adolescents, thereby successfully highlighting the need for further study in the patient satisfaction domain involving paediatric population. The various implications which the waiting time has on them have been taken into consideration. The inter-related themes have been identified after analyzing the interviews. These substantiate the fact that designing innovative mitigation strategies on proper and timely communication, updated technological know-how, improvising hospital protocols for better operational processes and coordination among the staff can go a long way in enhancing the patient/parent experience within OPD settings.

Improving patient satisfaction: the virtual breakthrough series collaborative

PURPOSE

The purpose of this paper is to improve the Siloam Hospitals' (SHs) patient satisfaction index (PSI) and overcome Indonesia's geographical barriers.

DESIGN/METHODOLOGY/APPROACH

The topic was selected for reasons guided by the Institute of Healthcare Improvement virtual breakthrough series collaborative (VBSC). Subject matter experts came from existing global quality development in collaboration with sales and marketing, and talent management agencies/departments. Patient satisfaction (PS) was measured using the SH Customer Feedback Form. Data were analysed using Friedman's test.

FINDINGS

The in-patient (IP) department PSI repeated measures comparison during VBSC, performed using Friedman's test, showed a statistically significant increase in the PSI, χ² = 44.00, p<0.001. Post hoc analysis with Wilcoxon signed-rank test was conducted with a Bonferroni correction applied, which resulted in a significant increase between the baseline and action phases ( Z=3.317, p=0.003) between the baseline and continuous improvement phases ( Z=6.633, p<0.001), and between the action and continuous improvement phases ( Z=3.317, p=0.003), suggesting that IP PSI was continuously increasing during all VBSC phases. Like IP PSI, the out-patient department PSI was also continuously increasing during all VBSC phases.

RESEARCH LIMITATIONS/IMPLICATIONS

The VBSC was not implemented using a control group. Factors other than the VBSC may have contributed to increased PS.

PRACTICAL IMPLICATIONS

The VBSC was conducted using virtual telecommunication. Although conventional breakthrough series might result in better cohesiveness and commitment, Indonesian geographical barriers forced an alternative strategy, which is much more cost-effective.

ORIGINALITY/VALUE

The VBSC, designed to improve PS, has never been implemented in any Indonesian private hospital group. Other hospital groups might also appreciate knowing about the VBSC to improve their PSI.

An Exploration of Parental Satisfaction With an Advanced Practice Physical Therapy Clinic in Pediatric Orthopedics

PURPOSE

To evaluate parent satisfaction of patients attending a novel advanced practice physical therapy clinic in pediatric orthopedics.

METHODS

A cross-sectional survey collected data using 2 approaches: a modified version of the VSQ-9 and open-ended responses. The component structure of the Visit Specific Satisfaction Questionnaire (VSQ) was explored and the Cronbach alpha assessed internal consistency. Responses were summarized as mean (95% CI). An inductive content analysis was performed for open-ended responses.

RESULTS

Satisfaction ratings were excellent. A 2-component structure for the VSQ was confirmed. The Cronbach alpha coefficient was 0.85, indicating high internal consistency. Emergent themes were mostly positive in relation to Time, Communication, Professionalism, and Service Delivery, with Physical Resources receiving negative comments.

CONCLUSIONS

This study evaluated parent satisfaction with a novel advanced practice in pediatric orthopedics, demonstrating high levels of satisfaction and identifying positive and negative themes that impact parent perceptions of quality of care.

What Factors Affect Patient Satisfaction in Public Sector Hospitals: Evidence from an Emerging Economy

Patient satisfaction can identify specific areas of improvement in public sector hospitals. However, the Pakistani healthcare system, and quality of service delivery is rarely assessed through the perspective of patient satisfaction. Our study demonstrated the performance of public healthcare systems in Pakistan by interacting with physical services (tangible and environmental), doctor⁻patient communication, and pharmacy and laboratory services based on patient satisfaction. Primary data were collected from the patients by using a random sampling method. Patients who participated in the study were visitors of public hospitals' outpatient departments. A total of 554 questionnaires were circulated, and 445 were received. The confirmatory factor and multiple regression analyses were employed to analyze the collected data. The results revealed that laboratory, as well pharmacy services, had positive significant effects (p = 0.000) on patient satisfaction, while doctor⁻patient communication (p = 0.189) and physical facilities (p = 0.85) had an insignificant relationship with patient satisfaction. Therefore, it is suggested that a significant communication gap exists in the doctor⁻patient setting, and that Pakistan's healthcare system is deprived of physical facilities. Consequently, such services need further improvements.

Visit Duration Does Not Correlate with Perceived Physician Empathy

BACKGROUND

Perceived physician empathy is a strong driver of patient satisfaction. We assessed the influence of wait time, time spent with the surgeon, and surgeon stress level on the way patients rated surgeon empathy.

METHODS

One hundred and fourteen patients visiting 1 of 6 participating surgeons were prospectively enrolled in the study. We recorded patient demographics and assessed the patient rating of perceived physician empathy. Time waiting for the surgeon and time spent with the surgeon were measured with use of ambulatory tracking systems and by research assistants with stopwatches outside the patient rooms. Patient ratings of surgeon empathy were assessed with use of the Jefferson Scale of Patient's Perceptions of Physician Empathy (JSPPPE), and surgeon stress level was assessed with use of the Perceived Stress Score short form. The mean wait time was 30 ± 18 minutes, and the mean time spent with the surgeon was 8.7 ± 5.3 minutes. Two separate multilevel linear regression models were used to compare factors associated with the JSPPPE and time spent with the surgeon.

RESULTS

Neither time spent with the surgeon nor wait time was independently associated with perceived physician empathy; being male, having at least a post-college graduate degree, and higher self-reported surgeon stress levels were independently associated with less perceived empathy. More time spent with the surgeon was independently associated with lower self-reported surgeon stress levels; follow-up visits and visits for a traumatic condition were independently associated with less time spent with the surgeon.

CONCLUSIONS

The results of the present study show that improved communication strategies, rather than shorter wait time or increased time spent with the patient, may increase patient satisfaction. This should be a focus of future research.

Determinants of patient satisfaction in outpatient musculoskeletal physiotherapy: a systematic, qualitative meta-summary, and meta-synthesis

Purpose: To identify and synthesise patient-identified factors that influence satisfaction with outpatient musculoskeletal physiotherapy (O-MSK).Methods: A systematic, qualitative meta-summary and meta-synthesis was conducted by accessing six electronic databases: CINAHL, Embase, MEDLINE, Scopus, Web of Science, and Wiley Online Library, from inception to March 2017. Additional studies were identified by using a "berry-picking" method. Search limits were: primary studies; English language; and involving human subjects. Qualitative peer-reviewed articles describing patient satisfaction in O-MSK were eligible for inclusion. Two reviewers critically appraised eligible studies independently using the critical appraisal of skills programme tool for qualitative studies. Extracted verbatim data of included studies were synthesised using the meta-summary and meta-synthesis by using a purpose-designed form.Results: Eleven studies were included in the article. Factors influencing patient satisfaction were grouped into six broad themes: 1) clinical outcomes; 2) physiotherapist features; 3) patient features; 4) physiotherapist-patient relationship; 5) treatment features, and 6) healthcare setting features.Conclusions: These findings suggest that patient satisfaction in O-MSK is a multidimensional construct influenced by individual patient/provider, clinical, and contextual factors. Future reviews should include a synthesis of findings from both qualitative and quantitative studies to establish a fully comprehensive understanding of this complex health phenomenon.Implications for rehabilitationPatient satisfaction in outpatient musculoskeletal physiotherapy is affected by different factors, thus reflecting a multidimensional construct;Single determinants are not sufficient to affect patient satisfaction;Patient satisfaction is influenced individual patient/provider, clinical outcomes, and contextual factors;Further studies should be designed to investigate the relationships among these factors.

Patient reported outcomes with remote orthopaedic consultations by telemedicine: A randomised controlled trial

Introduction

Decentralised services through outreach clinics or modern technology reduce patient travel time and cost to society. Telemedicine consultation through videoconference is one such modality. Here, we compared patient-reported health outcomes and satisfaction between video-assisted remote and standard face-to-face orthopaedic consultations.

Methods

This randomised controlled trial included two parallel groups: (1) patients receiving video-assisted remote consultation at a regional medical centre (RMC); and (2) patients receiving standard consultation at the orthopaedic outpatient clinic of the University Hospital of North Norway (UNN). This study included patients referred to or scheduled for a consultation at the orthopaedic outpatient clinic. After each consultation, patient satisfaction was determined using patient-completed questionnaires containing questions on patient-reported health (three-level European quality of life five-dimension index (EQ-5D-3L)/European quality of life visual analogue scale (EQ-VAS)) and questions from a validated OutPatient Experiences Questionnaire (OPEQ).

Results

This study included 389 patients, of which 199 received remote consultation and 190 received standard consultation (total of 559 consultations). In all, 99% RMC-randomised patients and 99% UNN-randomised patients evaluated the consultation as very satisfactory or satisfactory. Moreover, 86% RMC-randomised patients preferred video-assisted consultation as the next consultation. No difference was observed in patient-reported health after 12 months between the two groups. EQ-5D index scores were 0.77 and 0.75 for RMC- and UNN-randomised patients, respectively ( p = 0.42).

Discussion

We did not observe any difference in patient-reported satisfaction and health (EQ-5D/EQ-VAS) between video-assisted and standard consultations, suggesting that video-assisted remote consultation can be safely offered to some orthopaedic patients. Moreover, a significantly high proportion of patients selected video-assisted remote consultation as their next consultation, thus strengthening the findings of this study. However, economic aspects should be assessed before widely recommending video-assisted consultation.

Factors associated with patient-satisfaction in student-led physiotherapy clinics: A qualitative study

BACKGROUND AND PURPOSE

Student-led physiotherapy clinics are a valuable means for providing clinical education opportunities for student learning and providing cost-effective services to the public. Understanding patient satisfaction within the student-led physiotherapy clinic setting is important to inform organizational, educational, and clinical processes that aim to balance both student learning experiences and quality patient care.

DESIGN

A cross-sectional qualitative design using semi-structured interviews.

RESULTS

A total of 20 patients from three different university student-led physiotherapy clinics were interviewed. Five major themes were associated with patient satisfaction, style of supervision, student-supervisor relationship, quality of physiotherapy care, student qualities and cost, and location of the service.

CONCLUSION

The results emphasize the importance placed by patients on effective communication, as well as the relationship between the supervisor and student overseeing their care. The findings highlight the influence of both the student and supervisor on patient satisfaction and provide insight into the style of student supervision from the perspective of the patient.

Comparação da satisfação, motivação, flexibilidade e dor muscular tardia entre método Pilates moderno e método Pilates instável

RESUMO O objetivo deste estudo foi comparar a satisfação e motivação para a prática de exercício físico, flexibilidade e dor muscular tardia (DMT) em participantes saudáveis após exercícios de duas modalidades do método Pilates. Para isso, cinquenta participantes saudáveis realizaram uma sessão de exercícios do Pilates moderno e outra do Pilates instável. Foram avaliados os desfechos satisfação e motivação após as sessões, flexibilidade posterior do tronco e membros inferiores (banco de Wells) antes e após cada sessão, e DMT 24, 48 e 72 horas após cada sessão (Escala Numérica de Dor). Os resultados mostraram que não houve diferença estatisticamente significante entre as duas modalidades do Pilates para satisfação e motivação, flexibilidade e DMT 72 horas após a sessão (p>0,05). Para a DMT foi observada diferença estatisticamente significante entre as duas modalidades 24 horas (diferença entre as médias: -0,7; IC a 95%: -1,5 a 0,0) e 48 horas (diferença entre as médias: -0,8; IC a 95%: -1,4 a -0,2) após a sessão, com maior dor no Pilates instável. Como conclusão, as duas modalidades do Pilates apresentaram o mesmo nível de satisfação e motivação e ganho similar de flexibilidade. No entanto, o Pilates instável causou mais DMT após 24 e 48 horas, mas essa diferença não foi clinicamente relevante.

Discordance between 'actual' and 'scheduled' check-in times at a heart failure clinic

Introduction

A 2015 Institute Of Medicine statement “Transforming Health Care Scheduling and Access: Getting to Now”, has increased concerns regarding patient wait times. Although waiting times have been widely studied, little attention has been paid to the role of patient arrival times as a component of this phenomenon. To this end, we investigated patterns of patient arrival at scheduled ambulatory heart failure (HF) clinic appointments and studied its predictors. We hypothesized that patients are more likely to arrive later than scheduled, with progressively later arrivals later in the day.

Methods and results

Using a business intelligence database we identified 6,194 unique patients that visited the Cleveland Clinic Main Campus HF clinic between January, 2015 and January, 2017. This clinic served both as a tertiary referral center and a community HF clinic. Transplant and left ventricular assist device (LVAD) visits were excluded. Punctuality was defined as the difference between ‘actual’ and ‘scheduled’ check-in times, whereby negative values (i.e., early punctuality) were patients who checked-in early. Contrary to our hypothesis, we found that patients checked-in late only a minority of the time (38% of visits). Additionally, examining punctuality by appointment hour slot we found that patients scheduled after 8AM had progressively earlier check-in times as the day progressed (P < .001 for trend). In both a Random Forest-Regression framework and linear regression models the most important risk-adjusted predictors of early punctuality were: later in the day appointment hour slot, patient having previously been to the hospital, age in the early 70s, and white race.

Conclusions

Patients attending a mixed population ambulatory HF clinic check-in earlier than scheduled times, with progressive discrepant intervals throughout the day. This finding may have significant implications for provider utilization and resource planning in order to maximize clinic efficiency. The impact of elective early arrival on patient’s perceived wait times requires further study.

"Take me seriously and do something!" - a qualitative study exploring patients' perceptions and expectations of an upcoming orthopaedic consultation

Background

Patients’ perceptions of care is an important factor in evaluation of health care, in quality assessment, and in improvement efforts. Expectations of assessments or procedures such as surgery have been found to be related to perceptions of outcome as well as satisfaction, and are therefore of interest to both clinicians and researchers. Increased understanding of these patient views is important so that orthopaedic assessments, regardless of who performs them, can be further developed and patient-centred to better meet patients’ needs. The purpose of this study was therefore to explore patients’ perceptions and expectations of an upcoming orthopaedic consultation.

Methods

This was an explorative qualitative study with an inductive approach. Thirteen patients who were referred for orthopaedic consultation were included using a purposeful sampling strategy. Patients participated in individual, semi-structured interviews that were recorded, transcribed verbatim and analysed with qualitative content analysis.

Results

The participants’ expressed perceptions and expectations of the upcoming orthopaedic surgeon consultation were classified into 5 categories: Hoping for action, Meeting an expert, A respectful meeting, Participating in the consultation, and A belief that hard facts make evidence. Across the categories, an overarching theme was formulated: Take me seriously and do something! The participants emphasised a desire to be taken seriously and for something to happen, both during the consultation itself and as a result of the orthopaedic consultation. They described a trust in the expertise of the orthopaedic surgeon and stressed the importance of the surgeon’s attitude, but still expected to participate in the consultation as well as in the decision-making process.

Conclusions

The study findings illuminate aspects that are important for patients in an orthopaedic consultation. The descriptions of patients’ perceptions and expectations can serve to improve patient–clinician relationships as well as to inform the development of new models of care, and a greater understanding of these aspects may improve the patient experience.

Does Value Stream Mapping affect the structure, process, and outcome quality in care facilities? A systematic review

BACKGROUND

Quality improvement within health and social care facilities is needed and has to be evidence-based and patient-centered. Value Stream Mapping, a method of Lean management, aims to increase the patients' value and quality of care by a visualization and quantification of the care process. The aim of this research is to examine the effectiveness of Value Stream Mapping on structure, process, and outcome quality in care facilities.

METHODS

A systematic review is conducted. PubMed, EBSCOhost, including Business Source Complete, Academic Search Complete, PSYCInfo, PSYNDX, SocINDEX with Full Text, Web of Knowledge, and EMBASE ScienceDirect are searched in February 2016. All peer-reviewed papers evaluating Value Stream Mapping and published in English or German from January 2000 are included. For data synthesis, all study results are categorized into Donabedian's model of structure, process, and outcome quality. To assess and interpret the effectiveness of Value Stream Mapping, the frequencies of the results statistically examined are considered.

RESULTS

Of the 903 articles retrieved, 22 studies fulfill the inclusion criteria. Of these, 11 studies are used to answer the research question. Value Stream Mapping has positive effects on the time dimension of process and outcome quality. It seems to reduce non-value-added time (e.g., waiting time) and length of stay. All study designs are before and after studies without control, and methodologically sophisticated studies are missing.

CONCLUSIONS

For a final conclusion about Value Stream Mapping's effectiveness, more research with improved methodology is needed. Despite this lack of evidence, Value Stream Mapping has the potential to improve quality of care on the time dimension. The contextual influence has to be investigated to make conclusions about the relationship between different quality domains when applying Value Stream Mapping. However, for using this review's conclusion, the limitation of including heterogeneous and potentially biased results has to be considered.