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Granja M, Alves L, Correia S. First contact with the health system: a survey study in northern Portugal. BMJ Open 2023; 13:e076849. [PMID: 37945304 PMCID: PMC10649470 DOI: 10.1136/bmjopen-2023-076849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 10/19/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVE The objective of this study is to characterise the self-reported first contact with the health system and the reasons stated for each choice, testing associations with population characteristics. DESIGN Cross-sectional survey. SETTING Primary care department of a local health unit in northern Portugal. PARTICIPANTS Random sample of 4286 persons, retrieved from all registered adults. OUTCOMES Participants who stated they usually see the same doctor when a health problem arises were considered to adopt first-contact care and were asked to identify their regular doctor. Participants were asked why they adopt first-contact care or why they choose to do otherwise. Associations between personal characteristics and the adoption of first-contact care were tested using logistic regression. RESULTS There were 808 valid questionnaires received (19% response rate). The mean age of respondents was 53 years, 58% were women and 60% had a high school or higher degree. Most (71%) stated always seeing the same doctor when facing a health problem. This was a general practitioner (GP) in 84%. The main reasons were previous knowledge and trust in the doctor. When this doctor was not a GP, the main reason was the need to obtain an appointment quickly. Participants who chose first-contact care were less likely to have university degrees than those who did not (OR 0.31; 95% CI 0.13 to 0.76). Being registered with the same GP for over 1 year increased the odds of adopting first-contact care: twice as likely for those registered for 1-4 years with the same GP (2.07; 95% CI 1.04 to 4.11), and three times more likely for those registered for over 10 years (3.21; 95% CI 1.70 to 6.08). CONCLUSIONS The high adoption of first-contact care and the reasons given for this suggest a strong belief in primary care in this population. The longer patients experience continuity, the more they adopt first-contact care. The preferences of higher-educated patients regarding first-contact care deserve reflection.
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Affiliation(s)
- Mónica Granja
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
| | - Luís Alves
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
| | - Sofia Correia
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
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Granja M, Correia S, Alves L. Access to General Practitioners during the second year of the COVID-19 pandemic in Portugal: a nationwide survey of doctors. BMC PRIMARY CARE 2023; 24:46. [PMID: 36782109 PMCID: PMC9924884 DOI: 10.1186/s12875-023-01994-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 01/23/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND The Portuguese National Health System (NHS) provides universal coverage and near-free health care, but the population has high out-of-pocket expenses and unmet care needs. This suggests impaired accessibility, a key dimension of primary care. The COVID-19 pandemic has further affected access to health care. Understanding General Practitioners' (GP) experiences during the pandemic is necessary to reconfigure post-pandemic service delivery and to plan for future emergencies. This study aimed to assess accessibility to GPs, from their perspective, evaluating determinants of accessibility during the second pandemic year in Portugal. METHODS All GPs working in NHS Family Practices in continental Portugal were invited to participate in a survey in 2021. A structured online self-administered anonymous questionnaire was used. Accessibility was assessed through waiting times for consultations and remote contacts and provision of remote access. NHS standards were used to assess waiting times. Descriptive statistics were used to characterize the study sample. Associations between categorical variables were tested using the χ2 statistic and the Student t-test was used to compare means of continuous variables. RESULTS A total of 420 GPs were included (7% of the target population). Median weekly working hours was 49.0 h (interquartile range 42.0-56.8), although only 14% reported a contracted weekly schedule over 40 h. Access to in-person consultations and remote contacts was reported by most GPs to occur within NHS time standards. Younger GPs more often reported waiting times over these standards. Most GPs considered that they do not have enough time for non-urgent consultations or for remote contacts with patients. CONCLUSIONS Most GPs reported compliance with standards for waiting times for most in-person consultations and remote contacts, but they do so at the expense of work overload. A persistent excess of regular and unpaid working hours by GPs needs confirmation. If unpaid overtime is necessary to meet the regular demands of work, then workload and specific allocated tasks warrant review. Future research should focus on younger GPs, as they seem vulnerable to restricted accessibility. GPs' preferences for more in-person care than was feasible during the pandemic must be considered when planning for the post-pandemic reconfiguration of service delivery.
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Affiliation(s)
- Mónica Granja
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, N° 135, 4050-600, Porto, Portugal.
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, N° 135, 4050-600, Porto, Portugal.
| | - Sofia Correia
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, N° 135, 4050-600, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, N° 135, 4050-600, Porto, Portugal
| | - Luís Alves
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, N° 135, 4050-600, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, N° 135, 4050-600, Porto, Portugal
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Cha E, Mathis NJ, Joshi H, Sharma S, Zinovoy M, Ru M, Cahlon O, Gillespie EF, Marshall DC. Bias in Patient Experience Scores in Radiation Oncology: A Multicenter Retrospective Analysis. J Am Coll Radiol 2022; 19:542-551. [PMID: 35247326 PMCID: PMC9017791 DOI: 10.1016/j.jacr.2022.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 01/05/2022] [Accepted: 01/09/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE Patient experience scores are increasingly important in measuring quality of care and determining reimbursement from payers, including the Hospital Value-Based Purchasing Program and the Radiation Oncology Model. However, the role of bias in patient experience scores in oncology is unknown, raising the possibility that such payment structures may inadvertently perpetuate bias in reimbursement. Therefore, the authors characterized patient-, physician-, and practice-level predictors of patient experience scores in patients undergoing radiation therapy. METHODS The authors retrospectively reviewed patient experience surveys for radiation oncology patients treated at two large multisite academic cancer centers. The outcome was responses on four survey questions. Covariates included self-reported patient demographics, physician characteristics, practice setting characteristics, and wait-time rating linked to each survey. Multivariable ordinal regression models were fitted to identify predictors of receiving a higher score on each of the survey questions. RESULTS In total, 2,868 patients completed surveys and were included in the analysis. Patient experience scores were generally high, with >90% of respondents answering 5 of 5 on the four survey items. Physician gender was not associated with any measured patient experience outcomes (P > 0.40 for all). Independent predictors of higher score included a wait-time experience classified as "good" as compared with "not good" (q < .001 for all). CONCLUSIONS Oncology practices aiming to improve patient experience scores may wish to focus their attention on improving wait times for patients. Although a difference in patient experience scores on the basis of physician gender was not observed, such bias is likely to be complex, and further research is needed to characterize its effects.
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Affiliation(s)
- Elaine Cha
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Noah J Mathis
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Himanshu Joshi
- Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York; Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sonam Sharma
- Assistant Program Director, Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Melissa Zinovoy
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Meng Ru
- Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Oren Cahlon
- Deputy Physician-in-Chief for Strategic Partnerships and Vice Chair, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Erin F Gillespie
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Deborah C Marshall
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York.
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Ly O, Price D, Saskin R, Howard M. Low-acuity emergency department use among patients in different primary care models in Hamilton and Ontario. Healthc Manage Forum 2021; 34:234-239. [PMID: 33969739 PMCID: PMC8225686 DOI: 10.1177/08404704211012027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Jurisdictions such as Hamilton, Ontario, where most primary care practices participate in patient enrolment models with enhanced after-hours access, may demonstrate overall improved health equity outcomes. Non-urgent Emergency Department (ED) use has been suggested as an indicator of primary care access; however, the impact of primary care access on ED use is uncertain and likely varies by patient and contextual factors. This population-based, retrospective study investigated whether or not different primary care models were associated with different rates of non-urgent ED visits in Hamilton, a city with relatively high neighbourhood marginalization, compared to the rest of Ontario from 2014/2015 to 2017/2018. In Ontario, enrolment capitation-based practices had more non-urgent ED visits than non-enrolment fee-for-service practices. In Hamilton, where most of the city's family physicians are in enrolment capitation-based practices, differences between models were minimal. The influence of primary care reforms may differ depending on how they are distributed within regions.
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Affiliation(s)
- Olivia Ly
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - David Price
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Michelle Howard
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
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Nowaskie DZ, Fogel RS, Fogel JM. Impact on patient satisfaction and importance of medical intake and office staff in a multidisciplinary, one-stop shop transgender program in Indianapolis, Indiana. J Multidiscip Healthc 2019; 12:665-673. [PMID: 31616155 PMCID: PMC6699507 DOI: 10.2147/jmdh.s216969] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 07/02/2019] [Indexed: 11/23/2022] Open
Abstract
Background Historically, the transgender population has postponed seeking primary care due to discrimination within social and medical settings. Very few studies have considered patient satisfaction with transgender care and whether there are differences in staff satisfaction. This cross-sectional study focuses on the satisfaction of transgender patients who receive primary care at a comprehensive, “one-stop shop” program in Indianapolis, IN, USA. Methods Sixty-two patients completed a patient satisfaction survey. Items consisted of 5-point Likert scales with anchors of satisfaction, caring, competence, and doctor recommendation. Results Overall, there were positive responses to all items, ranging from moderately high to very high. There was high overall satisfaction in the program’s trans-friendliness, office visits, and “one-stop shop” model. Lower scoring items concerned medical intake with appointment making and timing. There were no statistical differences across age, gender, education, duration at the program, and number of visits in the past 12 months. There were clear differences between how respondents viewed the care and competence of the program’s staff. In particular, the doctor was viewed most positively and office staff least positively with medical staff rated in-between. Conclusion There is high patient satisfaction with this comprehensive, “one-stop shop” care model among the transgender population. We recommend that transgender programs routinely conduct quality improvement measures, maintain sufficient workforce coverage, and provide cultural competency training which should include appropriate care standards and patient-centered concerns regarding appointment making and burdens associated with timing, traveling, and cost.
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Affiliation(s)
- Dustin Z Nowaskie
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Rachel S Fogel
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Janine M Fogel
- Transgender Health & Wellness Program, Eskenazi Health, Indianapolis, IN, USA
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Silver N, Weber RS, Lozano M, Hessel A, Meade J, Moore J, Hanna E, Lewis C. Reducing patient wait times in a head and neck cancer outpatient clinic: A pilot study. Laryngoscope 2019; 130:E151-E154. [PMID: 31070242 DOI: 10.1002/lary.28020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/05/2019] [Accepted: 04/04/2019] [Indexed: 11/12/2022]
Abstract
OBJECTIVES 1) Identify causes of increased patient wait times in a high-volume outpatient cancer clinic; and 2) use quality improvement tools to implement changes to reduce patient wait times. METHODS Baseline patient wait times for 10 faculty members in the Department of Head and Neck Surgery at the University of Texas MD Anderson Cancer Center (Houston, TX) outpatient head and neck cancer clinic were calculated. Patient workflow and scheduling processes were recorded and analyzed. The faculty with the lowest patient wait times was interviewed, and best practices were identified. Two physicians piloted interventions. Clinic templates were standardized and load-leveled, and the total patients scheduled per hour was based on the physician's calculated capacity per hour. Paired t tests were used to analyze data, and P values <0.05 were considered significant. RESULTS The baseline patient wait time average was 71 minutes (range 33-122 minutes). Several factors were found to increase patient wait times, including scheduling too many patients in a short time interval at the beginning of clinic hours and exceeding the physician's patient capacity per hour. For physicians implementing changes, the patient wait time was reduced significantly. For physician 3, the average wait time was reduced from 122 minutes to 52 minutes (57% decrease, P < 0.01) For physician 5, the wait time was reduced from an average of 89 minutes to 62 minutes (30% decrease, P < 0.01). CONCLUSION By applying principles for quality improvement, such as identifying and benchmarking best practices, load-leveling, and standardizing clinic scheduling, patient wait times were significantly reduced. LEVEL OF EVIDENCE 4 Laryngoscope, 130:E151-E154, 2020.
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Affiliation(s)
- Natalie Silver
- University of Florida, Department of Otolaryngology-Head and Neck Surgery, Gainesville, Florida
| | - Randal S Weber
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - Miguel Lozano
- Office of Performance Improvement, University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - Amy Hessel
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - Jeremy Meade
- Office of Performance Improvement, University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - Judy Moore
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - Ehab Hanna
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - Carol Lewis
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
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Patel I, Chapman T, Camacho F, Shrestha S, Chang J, Balkrishnan R, Feldman SR. Satisfied patients and pediatricians: a cross-sectional analysis. PATIENT-RELATED OUTCOME MEASURES 2018; 9:299-307. [PMID: 30214333 PMCID: PMC6118272 DOI: 10.2147/prom.s161621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background There is a lack of research in the USA comparing patient satisfaction with pediatricians and other primary care physicians (PCPs). We examined and compared patient satisfaction toward their pediatricians and PCPs and characterized factors associated with higher patient satisfaction in these two groups. Methods A random coefficient model with random slope and intercept was fit to the data, with patient satisfaction as a function of pediatrician/PCP, covariates, and physician random effects. Effect heterogeneity was assessed by allowing slope to vary as a function of covariates. Mediation analysis using the random coefficient model was conducted to calculate average total effect, average natural direct effect, and average indirect effect of pediatrician/PCP on satisfaction mediated by waiting/visit times. Results Pediatricians had higher predicted satisfaction ratings than PCPs (total effect = 4.8, 95% CI 3.7–5.9), with population-averaged mean of 82.2 (0.54) vs 77.4 (0.13). The direct effect was 3.9 (2.8–5.0) and the indirect effect was 0.9 (0.9–0.9), suggesting that part but not all of the total effect can be explained by pediatricians having decreased waiting/visit times leading to increased satisfaction. Predictions by subgroup suggested that pediatricians had lower ratings than PCPs for first visit, but higher ratings for all other covariate strata considered. Having longer waiting times and decreased visit times coincided with closer mean ratings between pediatricians and PCPs, other significant effect modifiers included patient sex, provider sex, and region of practice. Conclusion Pediatricians scored higher patient satisfaction ratings than the combined group of other PCPs. Pediatricians had shorter wait times to see their patients compared to PCPs. Shorter wait times and longer visit times were associated with higher patient satisfaction ratings.
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Affiliation(s)
- Isha Patel
- Department of Pharmacy Practice, Administration and Research, Marshall University School of Pharmacy (MUSOP), Marshall University, Huntington, WV, USA,
| | | | - Fabian Camacho
- Department of Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Shameen Shrestha
- Bernard J Dunn School of Pharmacy, Shenandoah University, Winchester, VA, USA
| | - Jongwha Chang
- Department of Pharmacy Practice and Clinical Sciences, School of Pharmacy, University of Texas at El Paso, El Paso, TX, USA
| | - Rajesh Balkrishnan
- Department of Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Steven R Feldman
- Department of Dermatology, Pathology and Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Donahue R, Russell D, de Riese C, Smith C, de Riese WTW, Medway A. Patients Willing to Wait: Arrival Time, Wait Time and Patient Satisfaction in an Ambulatory Urology Clinic. UROLOGY PRACTICE 2017; 4:1-6. [PMID: 37592589 DOI: 10.1016/j.urpr.2016.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION We evaluated the relationship of patient satisfaction to arrival and wait times. We also sought to determine factors that patients considered important to the visit experience. METHODS A total of 361 participants completed a survey in clinic to record wait times in various areas of the clinic and then rate satisfaction levels with these times and with the care received. A total of 211 participants ranked 6 factors related to the patient experience in the order considered important. RESULTS Early, on time and late arriving patients spent 26.0, 15.5 and 17.1 minutes in the waiting room and had a total visit duration of 82.5, 67.9 and 72.0 minutes, respectively. Significant differences existed between these times when the early group was compared with the on time and late groups. Early patients were significantly more satisfied with wait time in the waiting room and total clinic visit time compared to late patients. Receiving treatment or relief from a medical problem was the most important factor valued by this population. CONCLUSIONS Surprisingly, patients with longer waits were more satisfied with the time in the waiting room and overall visit duration, indicating that other variables influence patient satisfaction with perceived wait times. This study provides evidence that wait time might not be as important to patients or impact patient satisfaction as previously thought. On average wait time was ranked fifth in regard to what was important. Longer wait times did not seem to impact patient satisfaction when asked about overall satisfaction with the care received.
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Affiliation(s)
- Ryan Donahue
- School of Medicine, Texas Tech University Health Science Center, Lubbock, Texas
| | - Douglas Russell
- Department of Urology, Texas Tech University Health Science Center, Lubbock, Texas
| | - Cornelia de Riese
- Department of Obstetrics and Gynecology, Texas Tech University Health Science Center, Lubbock, Texas
| | - Cynthia Smith
- Department of Urology, Texas Tech University Health Science Center, Lubbock, Texas
| | - Werner T W de Riese
- Department of Urology, Texas Tech University Health Science Center, Lubbock, Texas
| | - Allen Medway
- School of Medicine, Texas Tech University Health Science Center, Lubbock, Texas
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Schwind JK, McCay E, Metersky K, Martin J. Development and Implementation of an Advanced Therapeutic Communication Course: An Interprofessional Collaboration. J Nurs Educ 2016; 55:592-7. [DOI: 10.3928/01484834-20160914-11] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 06/22/2016] [Indexed: 11/20/2022]
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Teunis T, Thornton ER, Jayakumar P, Ring D. Time Seeing a Hand Surgeon Is Not Associated With Patient Satisfaction. Clin Orthop Relat Res 2015; 473:2362-8. [PMID: 25475717 PMCID: PMC4457762 DOI: 10.1007/s11999-014-4090-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 11/25/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Previous studies, predominantly in the primary care setting, identified time spent with the physician as an important predictor of satisfaction. It is unknown if the same holds true in hand surgery. QUESTIONS/PURPOSES Is patient satisfaction measured immediately after an office visit associated with the duration of time spent with the hand surgeon? What other factors are associated with satisfaction directly after the visits and 2 weeks after the appointment? METHODS We prospectively enrolled 81 patients visiting our hand and upper extremity surgery outpatient clinic. We recorded their demographics and measured physical function, pain behavior, symptoms of depression, time spent in the waiting room, time spent with the physician, and patient satisfaction. Office times were measured using our patient ambulatory tracking system and by a research assistant outside the clinic room. To assess satisfaction we used items from the Consumer Assessment of Healthcare Providers and Systems survey (a federally developed standardized survey instrument) relevant to our study. Two weeks later, 51 (64%) patients were available for telephone followup and the same measures were completed. Mean time spent with the hand surgeon was 8 ± 5 minutes and mean in-office wait time to see the hand surgeon was 32 ± 18 minutes. A priori power analyses indicated that 77 patients would provide 80% power to detect an effect size f(2) = 0.18 for a regression with five predictors. This means that we would detect time spent with the physician as a significant factor if it accounted for 7% or more of the variability in satisfaction. RESULTS Time spent with the hand surgeon was not associated with patient satisfaction measured directly after the visit (r = -0.023; p = 0.84). Longer time waiting to see the physician correlated with decreased patient satisfaction (r = -0.30; p = 0.0057). The final multivariable model for increased satisfaction directly after the office visit included shorter waiting time (regression coefficient [β] -0.0014; partial R(2) 0.094; 95% confidence interval [CI], -0.0024 to -0.00042; p = 0.006) and being married/living with a partner (β 0.057; partial R(2) 0.11; 95% CI, 0.021-0.093; p = 0.002 [adjusted R(2) 0.18; p < 0.001]). Similarly, multivariable analysis found higher patient satisfaction 2 weeks after the visit to be independently associated with shorter waiting time (β -0.0037; partial R(2) 0.10; 95% CI, -0.0070 to -0.00054; p = 0.023) and being married/living with a partner (β 0.15; partial R(2) 0.12; 95% CI, 0.033-0.26; p = 0.012 [adjusted R(2) 0.16; p = 0.0052]). CONCLUSIONS Patient satisfaction among patients undergoing hand surgery may relate more to shorter time in the waiting room and to the quality more than the quantity of time spent with the patient. LEVEL OF EVIDENCE Level II, prognostic study.
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Affiliation(s)
- Teun Teunis
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114 USA
| | - Emily R. Thornton
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114 USA
| | - Prakash Jayakumar
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114 USA
| | - David Ring
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114 USA
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Tucker CM, Arthur TM, Roncoroni J, Wall W, Sanchez J. Patient-Centered, Culturally Sensitive Health Care. Am J Lifestyle Med 2013. [DOI: 10.1177/1559827613498065] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
In recent years, there have been increasing national calls for patient-centered, culturally sensitive health care (PC-CSHC). The impetus for these calls include (a) the reality that health care providers are increasingly having to provide health care to a more culturally diverse patient population without the necessary training to do so effectively, (b) the growing evidence that culturally insensitive health care is a major contributor to the costly health disparities that plague our nation, and (c) the fact that racial/ethnic minorities and individuals with low household incomes are more likely than their non-Hispanic white and higher-income counterparts to experience culturally insensitive health care and dissatisfaction with health care—health care experiences that have been linked to poorer health outcomes. This article (a) presents literature on the definition of PC-CSHC and the need for this care, (b) presents research on assessing and promoting this care, and (c) offers research-informed strategies and future directions for customizing and institutionalizing this care.
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Affiliation(s)
- Carolyn M. Tucker
- Department of Psychology, University of Florida, Gainesville, Florida
| | - Tya M. Arthur
- Department of Psychology, University of Florida, Gainesville, Florida
| | - Julia Roncoroni
- Department of Psychology, University of Florida, Gainesville, Florida
| | - Whitney Wall
- Department of Psychology, University of Florida, Gainesville, Florida
| | - Jackeline Sanchez
- Department of Psychology, University of Florida, Gainesville, Florida
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Jesmin S, Thind A, Sarma S. Does team-based primary health care improve patients' perception of outcomes? Evidence from the 2007-08 Canadian Survey of Experiences with Primary Health. Health Policy 2012; 105:71-83. [PMID: 22321527 DOI: 10.1016/j.healthpol.2012.01.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 01/09/2012] [Accepted: 01/16/2012] [Indexed: 10/14/2022]
Abstract
BACKGROUND Team-based practice in primary care has been advocated for improved access, quality, effectiveness, and cost-efficiency of primary health care services, but there is limited empirical evidence supporting it. OBJECTIVE To examine the impact of team-based practice on patients' perception of several process and outcome indicators from patients' perspective. DATA AND METHODS Micro data from the 2007-08 Canadian Survey of Experiences with Primary Health Care conducted by Statistics Canada were utilized. Regression techniques and propensity score matching method were used to examine the impact of team-based primary care on several process and outcome indicators of primary care. RESULTS The estimated average treatment effect of team-based care was positively significant and robust for access to after-hours care, quality of care, confidence in the system, overall coordination of care, and patient centeredness. Although the estimated average treatment effects for the two dimensions of follow-up coordination, continuity of care, health promotion and disease prevention initiatives, and utilization of physician and nurse services were statistically significant, sensitivity test results showed that these results were unreliable. CONCLUSIONS Team-based primary care improves patients' perception of process and outcome indicators in the area of access to after-hours care, quality of care, confidence in the system, overall coordination and patient centeredness. Future research needs to establish the causal link between team-based primary care and health outcomes of patients.
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Affiliation(s)
- Shammima Jesmin
- Department of Epidemiology and Biostatistics, University of Western Ontario, Canada.
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Hirsch O, Keller H, Albohn-Kühne C, Krones T, Donner-Banzhoff N. Satisfaction of patients and primary care physicians with shared decision making. Eval Health Prof 2011; 33:321-42. [PMID: 20801975 DOI: 10.1177/0163278710376662] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Satisfaction with treatment is regarded as an important outcome measure, but its suitability has not been thoroughly investigated in the context of shared decision making (SDM). The authors evaluated whether both patients' and physicians' satisfaction ratings differ between an intervention group and a control group within a structured tool for cardiovascular prevention (ARRIBA-Herz). In a pragmatic, cluster-randomized, controlled trial, 44 family physicians in the intervention group consecutively recruited 550 patients whereas 47 physicians in the control group included 582 patients. Main findings were high satisfaction ratings independent of group allocation in patients and physicians. Significant differences had only negligible effect sizes. Compared to global satisfaction ratings, the effects of the shared decision-making process are better measured by a more concrete approach representing different steps of this process. Further research should refine behaviorally oriented questionnaires that measure SDM and a version for physicians should also be created.
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Affiliation(s)
- Oliver Hirsch
- Department of Family Medicine, Philipps University Marburg, Marburg, Germany.
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