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

What constitutes a quality community aged care service-client perspectives: An international scoping study

Overwhelmingly, older Australians (people aged 65 years and older or 50 years and older for Aboriginal and Torres Strait Islander people) prefer to remain living in their own home rather than moving into residential care. To enable older Australians who require assistance to remain living at home, the Federal Government provides a wide range of community care services, the provision of which has increased substantially over the last 15 years. The importance of client preferences, prefaced by the introduction of consumer directed care across community aged care services, has gathered momentum in Australia following legislation in 2015. Older peoples' preferences differ in comparison to younger people with disability and those with mental health concerns. Older people focus more on the provision of services rather than the notion of independent living itself. This scoping review aimed to explore what aspects people aged 65 years and older consider to be important qualities of aged care services delivered in the community. A computerised search in MEDLINE, CINAHL, PubMed and PsychINFO and hand searches of the Cochrane database and Google Scholar were completed in May 2022. Sixty-two articles met the selection criteria and were included in the review. Data were extracted using a fit-for-purpose protocol and analysed using the Miles and Huberman Model for thematic analysis. Results identified five themes representing quality domains that describe features that are important to clients: staff knowledge, respect for clients, a person-centred approach, a collaborative partnership with clients and clear communication. When providers of community aged care services are planning to assess the quality of their services, these findings could be used to guide their evaluation. This will ensure that future services delivered accommodate the needs and preferences of clients who receive them.

Rural-urban disparities in patient satisfaction with oral health care: a provincial survey

Background

Identifying spatial variation in patient satisfaction is essential to improve the quality of care. Thus, the objective of this study was to investigate rural–urban disparities in patient satisfaction and to determine the factors that could influence satisfaction with oral health care.

Methods

Data from 1788 parents/caregivers of children who participated in the Quebec Ministry of Health clinical study were subject to secondary analysis. The Perneger model of patient satisfaction was used as the conceptual framework for the study. Satisfaction with oral health care was measured using the WHO-sponsored International Collaborative Study of Oral Health Outcomes (ICS-II). Explanatory variables included predisposing factors and enabling resources. Statistical analyses included descriptive statistics, as well as bivariate and linear regression models.

Results

Individuals with higher income, dental insurance coverage, having a family dentist, reporting ease in finding a dentist, and having access to a private dental clinic were more satisfied with oral health care (p < 0.001). There were statistically significant differences between rural and urban Quebec residents in their ratings of patient satisfaction on four items, including dental office location (p = 0.013), dental equipment (p = 0.016), cost of dental treatment (p < 0.001), and cleanliness of dental office (p = 0.004), with greater satisfaction for urban dwellers. The multiple linear regression model showed that major determinants of patient satisfaction were being born in Canada, income ≥ 40,000$ CAD, having a family dentist, and having visited the dentist in the last year for regular checkups. However, ethnicity, having difficulty finding a dentist, and being in need of dental treatment negatively influenced patient satisfaction with oral health care.

Conclusions

These findings suggest that Quebec rural–urban disparity exists in patient satisfaction with care and that determinants of health influence this outcome. Intensive and powerful knowledge dissemination activities are needed to mobilize policymakers in implementing public health strategies to reduce this disparity.

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.

Patient satisfaction in the context of public–private partnerships

Purpose

This study aims to provide insights into the public–private partnerships (PPP) concept and its performance measurement in the health-care sector, identifying and refining critical success factors, including the perceived quality of health care, as evidenced by patient satisfaction and policy requirements for successful PPP implementation.

Design/methodology/approach

This theoretical study explores the existing literature on the relationship between service quality and patient satisfaction, to propose a culture-specific conceptual model interlinking the drivers of patient satisfaction with PPP. The in-depth theoretical research focuses on the qualitative performance indicators of PPPs, as well as their corresponding peripheral factors.

Findings

The research presents theoretical evidence that the concept of patient satisfaction can only be viewed through a multifactor perspective that incorporates demographics of patients, perceived service quality factors and emotions. It is found that significant improvements in service quality and patient satisfaction do, indeed, emphasize the effective role of PPP in hospitals.

Practical implications

The theoretical model is based on a comprehensive set of both cognitive and affective determinants. And considering these, as well as their causes, effects and interrelations, sets the foundations for testing and for further research to develop. Moreover, the outcomes of this study can be used as a theoretical base for the development of a PPP qualitative performance measurement framework.

Originality/value

This study attempts to fill the gap in knowledge on service quality and patient satisfaction as qualitative indicators for hospital performance after and toward PPP, while setting explicit factors and opening clear research avenues for further studies to follow.

The Pediatric American Pain Society Patient Outcomes Questionnaire (Pediatric APS-POQ): Development and Initial Psychometric Evaluation of a Brief and Comprehensive Measure of Pain and Pain Outcomes in Hospitalized Youth

Pediatric pain assessment in the hospital traditionally involves the patient's self-report of pain intensity using a numeric rating scale, which does not capture the complexity of the pain experience. No valid, comprehensive measure of pain in hospitalized youth exists. This study was designed to develop and conduct initial psychometric testing of the Pediatric American Pain Society Patient Outcomes Questionnaire (Pediatric APS-POQ), a comprehensive patient-reported measure of pain and pain outcomes in hospitalized youth. A multidisciplinary group of pediatric pain researchers and clinicians collaborated to adapt the adult APS-POQ Revised to pediatrics, including a patient-report and parent proxy version. The adapted measures were administered to 218 pediatric inpatients (age M = 13.4 years, 56% female) and 214 of their parents (80% mothers) at 4 US children's hospitals. The measure was feasible to administer within the inpatient setting and was acceptable and understandable to pediatric patients and their parents. Internal consistency was adequate for both patient-report and parent proxy (α = 0.77). Confirmatory factor analysis supported the following 6 domains, consistent with the adult measure: pain intensity, functional interference, emotional response, side effects, perceptions of care, and usual pain. Additional research is needed to further support the reliability and validity of this measure in diverse clinical populations. PERSPECTIVE: To reduce the impact of pain on hospitalized youth, pediatric pain assessment must move beyond ratings of pain intensity. The Pediatric APS-POQ provides a brief but comprehensive assessment of pain and pain outcomes in hospitalized children and adolescents, which will allow for greater individualization in hospital-based pain management and quality improvement purposes.

What Can We Do to Improve Patient Satisfactıon in the Emergency Department? A Prospective Study in a Turkish University Hospital

Introduction:

In recent years, patients' satisfaction with emergency medical services provided to them has been one of the main criteria in the evaluation of the quality of these services.

Objective:

The goal of our study was to determine the factors that affect the satisfaction of patients admitted to the emergency department (ED) and to provide new regulations.

Methods:

This prospective and descriptive study included 341 patients who utilized the ED services of a university hospital between October 1, 2004, and June 30, 2005. The patients' demographic and visit characteristics, waiting times, and the total duration of stay in the ED were noted in the prepared questionnaire. In addition, all patients were asked to indicate their level of satisfaction with the care received in the ED based on a five-point Likert scale. The results were analyzed using ANOVA, chi-square, and logistic regression tests.

Results:

Of the 341 patients, 219 (64.2%) were satisfied with the care they had received in the ED. Factors such as doctor and nurse behavior, medical information, the frequency of doctors and nurses visits, the ease of access to personnel, the cleanliness of the ED, and the availability of technical equipment had a statistically significant effect on the overall satisfaction of the patients (p < 0.05).

Conclusion:

The quality of patient care provided and the features of the ED determine the patients’ satisfaction with the ED services.

Concern and Maintenance During Twilight Years

The present article focuses on the perception of elderly regarding younger generation in rural Odisha. Data for this study were collected from the rural areas of Bargarh district using semi-structured interview schedule. For this study, 310 males and females were interviewed by using systematic sampling technique. Various issues like condition of the aged in context of respect and care have been taken into consideration. Other factors like their level of satisfaction from the care provided by their children and how they perceive today’s youth has been analysed. ANOVA was conducted to see which socio-demographic variables have the most significant effect on the perception of elderly later, factor analysis is used and the results show that the elderly have a negative perception regarding the younger generation. Results show that the elderly feels that today’s youth is selfish and least bothered about their needs and demands.

Public evaluation of health services across 21 European countries: The role of culture

AIMS

This work examined the role of cultural values in understanding people's satisfaction with health services across Europe.

METHODS

We used multilevel linear regression analysis on the seventh round of the European Social Survey from 2014, including c. 40,000 respondents from 21 countries. Preliminary intraclass correlation analyses led us to believe that some explanations of variance in the dependent variable were to be found at the country level. In search of country level explanations, we attempted to account for the role of national culture in influencing citizens' attitudes towards health systems. This was done by using Hofstede's dimensions of power distance, individualism, masculinity and uncertainty avoidance, giving each country in the survey a mean aggregated score.

RESULTS

In our first model with individual level variables, being female, having low or medium education, experiencing financial strain, and reporting poor health and unmet medical needs were negatively associated with individual satisfaction with national healthcare systems, with the latter variable showing the strongest effect. After including Hofstede's cultural dimensions in our multilevel model, we found that the power distance index variable had a negative effect on the dependent variable, significant at the 0.1 level.

CONCLUSIONS

Citizens are likely to evaluate their national health system more negatively in national cultures associated with autocracy and hierarchy.

Determinants of patient satisfaction: a systematic review

AIM

A large number of studies have addressed the detection of patient satisfaction determinants, and the results are still inconclusive. Furthermore, it is known that contradicting evidence exists across patient satisfaction studies. This article is the second part of a two-part series of research with a goal to review a current conceptual framework of patient satisfaction for further operationalisation procedures. The aim of this work was to systematically identify and review evidence regarding determinants of patient satisfaction between 1980 and 2014, and to seek the reasons for contradicting results in relationships between determinants and patient satisfaction in the literature to design a further robust measurement system for patient satisfaction.

METHOD

This systematic review followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. The search was conducted in PubMed, CINAHL, and Scopus in October 2014. Studies published in full in peer reviewed journals between January 1980 and August 2014 and in the English language were included. We included 109 articles for the synthesis.

RESULTS

We found several number of determinants of patient satisfaction investigated in a wide diversity of studies. However, study results were varied due to no globally accepted formulation of patient satisfaction and measurement system.

CONCLUSIONS

Health care service quality indicators were the most influential determinants of patient satisfaction across the studies. Among them, health providers' interpersonal care quality was the essential determinant of patient satisfaction. Sociodemographic characteristics were the most varied in the review. The strength and directions of associations with patient satisfaction were found inconsistent. Therefore, person-related characteristics should be considered to be the potential determinants and confounders simultaneously. The selected studies were not able to show all potential characteristics which may have had effects on satisfaction. There is a need for more studies on how cultural, behavioural, and socio-demographic differences affect patient satisfaction, using a standardised questionnaire.

Expectations and Level of Satisfaction of Patients and Their Physicians: Concordance and Discrepancies

BACKGROUND

Identifying discrepancies between patients׳ expectations for support provided by their physicians, and physicians׳ appraisal of the support they provide to their patients, is a key factor in constructing effective doctor-patient communication.

OBJECTIVE

The current study proposes and explores a paradigm for assessing possible gaps and overlaps between perceptions of patients with cancer and physicians about the "actual" and the "ideal" (desired) emotional and cognitive support oncologists provide to patients.

METHODS

Participants included 1027 patients with cancer and 47 senior oncologists. Patients׳ and physicians׳ levels of expectations and satisfaction with the emotional and cognitive support offered by physicians were assessed using a quantitative measure of discrepancy between the actual and the ideal situation. The measure was developed for this study and tested on a random sample of 200 patients and 17 oncologists.

RESULTS

The results indicated consistency between physicians׳ and patients׳ perceptions of the needs and support that the patients received. Nevertheless, oncologists did not feel highly trusted by their patients, oncologists desired less involvement of patients in the treatment plan than the patients expected. Oncologists thought that they actually provided the desired levels of explanation to patients׳ families, whereas patients thought their families got less explanations than expected.

CONCLUSION

Actual and ideal levels of communication should be described from the points of view of both physicians and patients to better understand the complex picture of patient satisfaction. Oncologists should consider patients׳ expectations for support vs their own expectations to effectively address patients׳ needs.

Measuring patient satisfaction with the Polish version of the Newcastle Satisfaction with Nursing Scale

The measurement of patients' satisfaction is increasingly becoming legal and ethical duty of healthcare providers worldwide. Till now, there were no validated, widely available Polish scales to assess patients' satisfaction with nursing care. The aim of this study was to assess the experiences and satisfaction with nursing care of patients hospitalized in surgical and nonsurgical wards in Poland using Polish version of the Newcastle Satisfaction with Nursing Scale. This is a multicentre, cross-sectional, descriptive study. Eight hospitals were qualified to participate in a convenience manner. The correlations between variables were analysed using the Mann-Whitney or the Kruskal-Wallis tests. In the case of a significant correlation, the Dunn's test was used to conduct multiple comparisons for the group of variables. A significance of α = 0.05 was assumed for the tests. A total 918 patients participated in the study, and 787 (85.72%) questionnaires were correctly filled out. The average result on the 'experience' scale was 73.22 (Me 73.07) and on the 'satisfaction' scale, 74.98 (Me 76.31). Education levels did not affect the experiences of nursing care levels p = 0.2204 and satisfaction with nursing care p = 0.1075. Patient age had a statistically significant impact on the results of the 'experiences of nursing care' scale p = 0.0005 and the 'satisfaction with nursing' scale p = 0.0194. The experiences of nursing care (p = 0.0002) and patients satisfaction (p = 0.0000) were significantly higher in surgical wards than in nonsurgical wards. The experiences of nursing care were significantly lower in the university hospital than in provincial hospitals (p = 0.0374) and district hospitals (p = 0.0183). A comparison of patient satisfaction with nursing in various hospitals shows that patients were most satisfied in district hospitals (average 78.10, Me 82.89), followed by provincial hospitals (average 72.11, Me 76.31) and the university hospital (average 70.64, Me 71.05).

Parents' satisfaction concerning their child's hospital care

AIM

To explore parents' satisfaction concerning their child's care during hospitalization and its determinants.

METHODS

A descriptive, non-experimental correlational design was used. The data collection was based on interviews using a 63 item questionnaire, the Swedish Pyramid Questionnaire. The parents of 206 children (hospitalized in two pediatric and two surgical units) participated in the study.

RESULTS

The independent t-test results demonstrated that the parents showed greater satisfaction with staff attitudes and medical treatment, whereas they were less satisfied with the information concerning routines and the staff work environment. The stepwise multiple regression analysis revealed that adequacy of care, adequate pain management, parents' involvement in care, a trusting relationship, and staff attitudes were the most important determinants of parental satisfaction.

CONCLUSION

Interventions in pediatric care should include measurements of parental and child satisfaction as a tool to assess the quality of care.

What does quality care mean to nurses in rural hospitals?

AIM

This paper is a report of a study conducted to answer the question: 'How do rural nurses and their chief nursing officers define quality care?'

BACKGROUND

Established indicators of quality care were developed primarily in urban hospitals. Rural hospitals and their environments differ from urban settings, suggesting that there might be differences in how quality care is defined. This has measurement implications.

METHODS

Focus groups with staff nurses and interviews with chief nursing officers were conducted in 2006 at four rural hospitals in the South-Eastern United States of America. Data were analysed using conventional content analysis.

FINDINGS

The staff nurse and chief nursing officer data were analysed separately and then compared, exposing two major themes: 'Patients are what matter most' and 'Community connectedness is both a help and a hindrance'. Along with conveying that patients were the utmost priority and all care was patient-focused, the first theme included established indicators of quality such as falls, pressure ulcers, infection rates, readmission rates, and lengths of stay. A new discovery in this theme was a need for an indicator relevant for rural settings: transfer time to larger hospitals. The second theme, Community Connectedness, is unique to rural settings, exemplifying the rural culture. The community and hospital converge into a family of sorts, creating expectations for quality care by both patients and staff that are not typically found in urban settings and larger hospitals.

CONCLUSION

Established quality indicators are appropriate for rural hospitals, but additional indicators need to be developed. These must include transfer times to larger facilities and the culture of the community.

Experiences of hospital care reported by bereaved relatives of patients after a stroke: a retrospective survey using the VOICES questionnaire

AIM

This paper is a report of a study conducted to explore the determinants of satisfaction with health and social care services in the last 3 months and 3 days of life as reported by bereaved relatives of those who died from a stroke in an institutional setting.

BACKGROUND

There is limited research about how best to meet the needs of those who die from stroke. A thorough understanding of the determinants of satisfaction with end of life care is crucial for effective service provision to increase awareness of the needs of dying patients.

METHODS

During a six-month period in 2003, a population-based survey of bereaved relatives of patients after stroke was conducted using a stroke-specific version of the Views of Informal Carers Evaluation of Services postal questionnaire (183 informants, response rate 37%). The sub-sample included those informants who reported that the deceased person had died in an institutional setting (91%, n = 165). The analysis was divided into two phases: univariate (Pearson chi-square test) and multivariate phase (logistic regression).

RESULTS

Logistic regressions showed that discussing any worries about the treatment of the deceased person and feeling that the doctors and nurses knew enough about their condition were predictors of satisfaction with doctors and nurses in the last 3 months of life. Meeting the personal care needs of the deceased person, being involved in decisions and feeling that the deceased person died in the right place were predictors of satisfaction with care in the last 3 days of life.

CONCLUSION

End of life care needs to address the individual needs of patients who die from stroke and those close to them. This study shows that individualised end of life care increases satisfaction and, although the data reported in this paper reflect care in 2003, there is no more recent evidence that contradicts this important overall finding.

Meeting expectations of patients with cancer: relationship between patient satisfaction, depression, and coping

PURPOSE

This study assessed satisfaction of patients with cancer and the correlation between patient levels of satisfaction and the sociodemographic, medical, and psychological variables. Satisfaction measures were based on patient expectations for emotional and cognitive support by the oncologists.

PATIENTS AND METHODS

A total of 1,027 patients with cancer were recruited from the outpatient departments and daycare treatment centers of four oncology institutes in Israel. Patient levels of expectations and satisfaction were assessed by using measures developed for this study. Patient psychological variables were assessed by using the Brief Symptoms Inventory, Impact of Events Scale, and Mental Adjustment to Cancer. chi(2) and Student t tests were used to assess differences between the highly satisfied group and the less satisfied group.

RESULTS

Lower values of satisfaction were reported on the dimensions that included the patient in the treatment plan and that included explanations to the family. Higher percentages of women, single patients, younger patients, and patients in stages II to III were found in the less satisfied group. This group reported significantly higher levels of psychological distress, anxious preoccupation, and helplessness and lower levels of fighting spirit.

CONCLUSION

Given the importance of patient satisfaction to treatment compliance, oncologists should consider evaluating patient expectations for support, especially in issues concerning planning the treatment and involving the family in medical decisions. Oncologists should take into account the possible interdependence between psychological variables and medical-care satisfaction.

Patient satisfaction with access in two interprofessional academic family medicine clinics

BACKGROUND

Satisfaction with access to primary care is one component of overall patient satisfaction. The objectives of this paper were to describe patient satisfaction with access in interprofessional family practices and to examine predictors of being less than satisfied with access.

METHODS

A survey was mailed to 770 randomly selected patients in two academic interprofessional family practices in Hamilton, Canada. Most items were positively worded statements on a five-point scale from strongly agree to strongly disagree. Outcomes were the proportion of respondents agreeing with statements regarding access. For items where > or =25% of respondents did not agree, we examined socio-demographic predictors of disagreement using multiple variable logistic regression.

RESULTS

The response rate was 49.9% (384/770). One-quarter or more of respondents did not agree that they received an explanation if the appointment was delayed at the office, obtain urgent appointments, obtain prescription refills without a visit or that wait times at the office were reasonable. Predictors of not agreeing included younger age, being married or single, more educated, employed and of non-white ethnicity. Less than 10 minutes was the most satisfactory wait time for the appointment to begin; however, the most common wait time reported was 11-20 minutes. One-quarter of respondents had visited the weekend/holiday clinic in the past 12 months; however, use was not associated with perceived ability to obtain an appointment in 1-2 days.

CONCLUSIONS

While satisfaction was generally high, some aspects of access could be improved by changes in practice organization or patient education regarding expectations.

Is patient-centredness in European hospitals related to existing quality improvement strategies? Analysis of a cross-sectional survey (MARQuIS study)

BACKGROUND

There is growing recognition of patients' contributions to setting objectives for their own care, improving health outcomes and evaluating care.

OBJECTIVE

To quantify the extent to which European hospitals have implemented strategies to promote a patient-centred approach, and to assess whether these strategies are associated with hospital characteristics and the development of the hospital's quality improvement system.

DESIGN

Cross-sectional survey of 351 European hospital managers and professionals.

MAIN OUTCOME MEASURES

Patients' rights, patient information and empowerment, patient involvement in quality management, learning from patients, and patient hotel services at the hospital and ward level were assessed. The hypothesis that the implementation of strategies to improve patient-centredness is associated with hospital characteristics, including maturity of the hospital's quality management system, was tested using binary logistic regression.

RESULTS

In general, hospitals reported high implementation of policies for patients' rights (85.5%) and informed consent (93%), whereas strategies to involve patients (71%) and learn from their experience (66%) were less frequently implemented. For 13 out of 18 hospital strategies, institutions with a more developed quality improvement system consistently reported better results (percentage differences within maturity classification ranged from 12.4% to 46.6%). The strength of association between implementation of patient-centredness strategies and the quality improvement system, however, seemed lower at the ward than at the hospital level. Some associations (OR 2.1 to 5.1) disappeared or were weaker after adjustment for potential confounding variables (OR 2.2 to 3.7).

CONCLUSIONS

Although quality improvement systems seem to be effective with regard to the implementation of selected patient-centredness strategies, they seem to be insufficient to ensure widespread implementation of patient-centredness throughout the organisation.

Satisfaction of inpatients with acute coronary syndrome in Bulgaria

Background

Patient satisfaction constitutes an important indicator for the quality of care. During the last years, Bulgaria changed its socialist health care system to a market-driven system. Despite the fact that the improvement of health care quality and patient satisfaction were put on top of the list of goals for the health care reforms, no studies of patient satisfaction with inpatient care have been conducted so far.

Since cardiovascular diseases are amongst the major causes of death in Bulgaria, and strenuous efforts have been made to improve the quality of medical care of patients with acute coronary syndrome (ACS) during the last years, patient satisfaction in this group can be seen as an important example of the Bulgarian reforms. This study therefore investigates patient satisfaction of inpatients with ACS.

Methods

We performed structured face-to-face interviews with all patients with ACS, residing in a representative Bulgarian region who were discharged from hospitals in this region between September 1st and December 31st, 2004. We surveyed their socio-demographic status, overall satisfaction, change in complaints, self-perceived health status, functional possibilities in activities of daily living, satisfaction with life and self-reported condition at admission. We used descriptive methods as well as t-tests, chi-square tests, and logit models for data analysis.

Results

Face-to-face interviews were carried out in 394 cases, of which 53.6% were men and 46.4% were women. 24% of the patients were satisfied with inhospital treatment, 62% were satisfied to some extent, and 14% were unsatisfied. The overall satisfaction of patients with ACS was significantly associated (p < 0.05) with the type of hospital, the number of family members living together and the severity of the disease at admission. Patients treated in urban and middle-size rural hospitals, patients living together with three or more family members, and patients with more severe conditions at admission reported higher satisfaction scores.

Conclusion

ACS patient satisfaction with inhospital treatment in Bulgaria shows much room for improvement. Information obtained from satisfaction studies could be used at decision-making and hospital-management levels for improving new strategies and structural changes in the Bulgarian health care system.

Patient satisfaction with care for urgent health problems: a survey of family practice patients

PURPOSE

Patient satisfaction is an important health care outcome. This study compared patients' satisfaction with care received for an urgent health problem from their family physician, at an after-hours clinic in which their physician participated, at a walk-in clinic, at the emergency department, from telephone health advisory services, or from more than 1 of those services.

METHODS

We mailed a questionnaire to a random sample of patients from 36 family practices in Thunder Bay, Ontario. We elicited satisfaction with care for the most recent urgent health problem in the past 6 months on a 7-point scale (very dissatisfied to very satisfied).

RESULTS

The response rate was 62.3% (5,884 of 9,397). Of the 5,722 eligible patients 1,342 (23.4%) reported an urgent health problem, and data were available for both services used and satisfaction for 1,227 patients. After adjusting for sociodemographic characteristics and self-reported health status, satisfaction with care received for most recent urgent health problem was significantly higher among patients who visited or spoke to their family physician (mean 6.1; 95% confidence interval [CI], 5.8-6.4) compared with all other services (all P <.004, adjusted for multiple comparisons), with the exception of patients who used the after-hours clinic affiliated with their physician, whose satisfaction was not significantly different (mean 5.6; 95% CI, 5.2-6.0).

CONCLUSIONS

Satisfaction was highest for patients receiving care from their own family physician or their physician's after-hours clinic. These results are important for new primary care models that emphasize continuity and after-hours availability of family physicians.

Understanding and Measuring Patients' Assessment of the Quality of Nursing Care

BACKGROUND

Traditionally, patients have been considered incapable of evaluating the quality of care they receive, leading to their minimal involvement.

OBJECTIVE

To develop the Patient's Assessment of Quality Scale--Acute Care Version (PAQS-ACV) to provide a mechanism through which patients can evaluate meaningfully the nursing care they receive.

METHODS

Developed from qualitative interviews with patients, the original 90-item PAQS-ACV was tested with 1,470 medical surgical patients in 43 units across seven hospitals. The typical patient was a married, 50-year-old, high school-educated patient hospitalized for the fourth time. Every 10th patient was asked to complete the PAQS-ACV 2 weeks later.

RESULTS

After exploratory factor analysis, 45 items remained in five factors, accounting for 54% of the variance. Internal consistency estimates were above.83 for four of the five factors, with the fifth factor being.68. Test-retest reliability ranged from .58 to .71. Content validity was established and construct validity has been explored preliminarily by examining the relationship between the PAQS-ACV scores and patients' compliance.

DISCUSSION

Although the PAQS-ACV is a relatively new measure of quality nursing care, it has met many criteria for an adequate measure of quality care. The instrument fills a void in the assessment of quality by including patients in the direct evaluation of the care received.