Randomized trials evaluating volar locking plates against casting of distal radius fractures are statistically fragile: A systematic review

Introduction

Despite randomized controlled trials (RCTs) largely supporting volar locking plates (VLPs) for the management of distal radius fractures (DRFs), surgeons often opt for non-invasive interventions such as casting. This study used the fragility index (FI), reverse fragility index (rFI), and fragility quotient (FQ) to assess the statistical robustness of RCTs assessing the efficacy of VLP in DRF management.

Methods

PubMed, Embase, and MEDLINE were queried for RCTs evaluating VLP versus casting for DRFs published from January 1st, 2000-June 30, 2024. FI and rFI were quantified for all dichotomous outcomes, and represent the number of event reversals required to alter statistical significance or non-significance, respectively. The FQ was then determined by dividing the FI or rFI by the sample size. A subanalysis was performed for outcomes pertaining to patient satisfaction, healing/function, and adverse events.

Results

A total of 699 RCTs were identified in the initial literature search. 13 RCTs were eventually included in the final analysis, yielding 36 dichotomous outcomes. The median FI across these outcomes was 3 (IQR 3-5) and the median FQ was 0.037 (IQR 0.014-0.067). Among the 15 significant outcomes, the median FI was 2 (IQR 2-4) and the median FQ was 0.029 (IQR 0.013-0.055). The remaining 21 non-significant outcomes yielded a median rFI of 4 (IQR 2-5) and a median FQ of 0.042 (IQR 0.021-0.091). The most statistically fragile outcome category was patient satisfaction, with a median FI of 2 (IQR 2-3.5) and median FQ of 0.016 (IQR 0.013-0.030). Among 21 of the included outcomes (58.3 %), the number of patients lost to follow up exceeded the respective FI or rFI.

Conclusion

A statistical fragility analysis of VLP versus casting for DRFs demonstrated fragile outcomes, reporting a median FQ of 0.037, or 3.7 %. Statistically significant outcomes and patient satisfaction results were particularly fragile, and large losses to follow up were found to be an important contributor to RCT fragility. Although VLP is largely recommended by level I evidence, its superiority may not be as ubiquitous as argued by contemporary literature.

Patient Satisfaction with Primary Health Care Services in Riyadh, Saudi Arabia

Background

Patient satisfaction emerges as an indicator for enhancing the quality of health organizations, facilitating the evaluation and identification of the most significant characteristics of patient experience and their corresponding satisfaction levels. This can guide decisions to improve healthcare services and develop policies for better care. This study seeks to assess the level of patient satisfaction with primary healthcare (PHC) services in a large military hospital in Riyadh, Saudi Arabia, and to determine the extent of association between the level of satisfaction and patients' social and demographic factors.

Methods

A cross-sectional study was carried out on a convenient sample who received primary health care at the Security Forces Hospital in Riyadh, Saudi Arabia, between January and June 2023. Comparisons between qualitative variables were made using the chi-square to test significance and the One-Way ANOVA test was used to compare the means of total patient satisfaction scores, p < 0.05 was considered significant.

Results

Among the 379 participants, 268 (70.7%) were males, 271 (71.2%) were married, 222 (58.6%) were military personnel, and 207 (54.6%) were between the ages of 31 and 49. The average satisfaction with PHC clinics was 52.1 (SD=4.9, highest score=60) while the average satisfaction with general evaluation was 27.6 (SD=3.4, highest score=35). Male participants exhibited greater satisfaction levels (M= 117.8, SD=12.8) than their female counterparts (M= 115.7, SD=15.3, p-value = 0.01). Patients aged 18-30 had greater satisfaction levels (M= 117.5, SD=16.8, p-value = 0.02). Individuals who were single reported higher levels of satisfaction (M= 118.3, SD=16.2, p-value = 0.001). Participants with lower earnings (less than 5000 SR) had greater satisfaction levels compared to individuals having a greater income (p-value = 0.002).

Conclusion

Patients attending a PHC center in a large military hospital in Riyadh generally reported high levels of satisfaction, particularly among male, single, younger, and low-income individuals. Despite these favorable results, several aspects of healthcare need enhancement to fulfill patient expectations and guarantee optimal healthcare provision. Therefore, healthcare practitioners must persist in determining and addressing these areas to guarantee that patients obtain optimal care and experience in primary healthcare clinics.

Recommending Surgery Increases Patient Satisfaction With Their Arthroplasty Surgeon

BACKGROUND

Current guidelines recommend shared decision-making in the treatment of hip and knee osteoarthritis, but the impact of individual treatment decisions on patient satisfaction scores is unknown. We hypothesized that clinic Press Ganey satisfaction ratings would be higher for patients who later underwent arthroplasty than patients who did not have surgery.

METHODS

Press Ganey satisfaction surveys were obtained from all patient visits at a single academic institution's arthroplasty clinic from 2010 to 2018. We identified those patients who went on to have a total joint arthroplasty after shared decision-making. Among 1,133 patients who filled out a Press Ganey survey, 559 (49%) patients underwent surgery and 574 (51%) patients did not. We then compared differences in provider 5-star ratings and mean star ratings between patients who did or did not have surgery using Chi-square, logistic regression, and t-tests.

RESULTS

Patients who had surgery were more likely to give a 5-star rating (75 versus 70%, P = 0.001) and had 62% higher odds of giving a 5-star rating for the likelihood to recommend the provider (odds ratio: 1.62, 95% confidence interval: 1.19 to 2.19, P = 0.001). Each provider received a higher mean star rating from patients who underwent arthroplasty (4.66 ± 0.67) when compared to those who did not receive surgery (4.57 ± 0.80, P = 0.001). Providers who had a higher percentage of their patients receive surgery also had higher overall mean star ratings (P = 0.001).

CONCLUSIONS

Press Ganey satisfaction scores may be influenced by the decision to pursue operative treatment for hip and knee arthritis. Providers who do not recommend surgery may receive lower satisfaction scores, despite using a shared decision-making approach. Patient satisfaction, therefore, may not be a valid proxy for quality of care in arthroplasty and must be questioned as a quality or reimbursement metric.

LEVEL OF EVIDENCE

Level II.

Prehospital emergency care family satisfaction scale for care provided by emergency medical technicians: Scale development and validation

RATIONALE

To date, family satisfaction with emergency medical technicians (EMTs) has only been reported through narrative statements in subjective evaluations. Although a quantitative assessment of healthcare professional satisfaction is desirable, no specific measures have been devised to assess family satisfaction with the healthcare and care provided by EMTs.

AIMS AND OBJECTIVES

This study aimed to develop and validate an EMT care family satisfaction scale to measure patient satisfaction with prehospital emergency care.

METHODS

The study population comprised 216 family members (N = 216) of patients who used ambulances between November 2020 and May 2021 in a single region in Japan. Questionnaires were distributed to the participants who provided informed consent. An exploratory factor analysis of construct validity was performed to validate the Family Satisfaction Scale. The Cronbach's alpha was used to validate the internal consistency reliability of the scale.

RESULTS

The exploratory factor analysis results revealed a four-factor structure: 'explanation and communication,' 'physical treatment,' 'psychological support,' and 'environment in the ambulance.' The Cronbach's range (0.80-0.93) for the total score for each of these four factors and the overall total score confirmed favorable internal reliability of this study.

CONCLUSIONS

The family satisfaction scale developed in this study was constructed and validated to highlight the role of EMTs and needs of the families in the prehospital care settings. Moreover, this scale can be applied in the evaluation and consideration of interventions to improve family satisfaction with EMTs.

Quality of Postoperative Pain Management in Orthopedic Patients and Its Impact on Sleep Quality and Patient Satisfaction: An Integrative Review

Pain is one of the most common manifestations in the postoperative stage and it has a detrimental effect on both sleep and patient satisfaction. Consequently, this integrative review seeks to identify the outcomes of pain management specifically concerning sleep quality and patient satisfaction among the patients receiving orthopedic surgeries. In a stepwise manner, peer-reviewed articles manually searched in four databases including Scopus, Science Direct, PubMed, and CINAML (Cumulated Index to Nursing and Allied Health Literature) published between 2019 and 2023 were selected. The current review finally encompassed 22 studies. The review elaborates and reaffirms the notion that pain after surgery is still a critical issue that impacts the quality of patients' sleep as well as their overall satisfaction. Chronic sleep disturbance is generally linked with pain while other factors such as light exposure and hospital environment were found to influence sleep quality. It is thus crucial to develop clear multifaceted pain management guidelines that include patient-tailored pharmacological and non-pharmacological interventions aimed at helping patients recover better, sleep better, and be satisfied with the procedures and results.

Building evidence to advance health equity: a systematic review on care-related outcomes for older, minoritised populations in long-term care homes

BACKGROUND

Advancing health equity requires more contextualised evidence.

OBJECTIVES

To synthesise published evidence using an existing framework on the origins of health disparities and determine care-related outcome disparities for residents of long-term care, comparing minoritised populations to the context-specific dominant population.

DESIGN

Systematic review.

SUBJECTS

Residents of 24-hour long-term care homes.

METHODS

The protocol was registered a priori with PROSPERO (CRD42021269489). Literature published between 1 January 2000 and 26 September 2021, was searched, including studies comparing baseline characteristics and outcomes in minoritised versus dominant populations. Dual screening, two-reviewer verification for extraction, and risk of bias assessments were conducted to ensure rigour. Studies were synthesized using a conceptual framework to contextualise evidence according to multi-level factors contributing to the development of care disparities.

RESULTS

Twenty-one of 34 included studies demonstrated disparities in care outcomes for minoritised groups compared to majority groups. Thirty-one studies observed differences in individual-level characteristics (e.g. age, education, underlying conditions) upon entry to homes, with several outcome disparities (e.g. restraint use, number of medications) present at baseline and remaining or worsening over time. Significant gaps in evidence were identified, particularly an absence of literature on provider information and evidence on the experience of intersecting minority identities that contribute to care-related outcome disparities in long-term care.

CONCLUSION

This review found differences in minoritised populations' care-related outcomes. The findings provide guidance for future health equity policy and research-supporting diverse and intersectional capacity building in long-term care.

Patient Satisfaction with Virtual Clinic Encounters: Analysis of Factors that Impact the Press Ganey Survey in the Hand Surgery Population

Purpose

Our purpose was to identify patient characteristics and visit components that affect patient satisfaction with virtual new patient visits in an outpatient hand surgery clinic as measured by the Press Ganey Outpatient Medical Practice Survey (PGOMPS) total score (primary outcome) and provider subscore (secondary outcome).

Methods

Adult patients evaluated through virtual new patient visits at a tertiary academic medical center between January 2020 and October 2020 who completed the PGOMPS for virtual visits were included. Data regarding demographics and visit characteristics were collected via chart review. Factors associated with satisfaction were identified using a Tobit regression model on the continuous score outcomes (Total Score and Provider Subscore) to account for substantial ceiling effects.

Results

A total of 95 patients were included: 54% were men and the mean age was 54 ± 16 years. Mean area deprivation index was 32 ± 18, and the mean driving distance to the clinic was 97 ± 188 mi. Common diagnoses include compressive neuropathy (21%), hand arthritis (19%), hand mass (12%), and fracture/dislocation (11%). Treatment recommendations included small joint injection (20%), in-person evaluation (25%), surgery (36%), and splinting (20%). Multivariable Tobit regressions showed notable differences in satisfaction by the provider on the Total Score but not on the Provider Subscore. Other factors known to affect the PGOMPS scores for in-person visits were not notably associated with the Total or Provider Sub-Scores for virtual visits (area deprivation index, age, and offer of surgery or injection) other than the body mass index.

Conclusions

Virtual clinic visit satisfaction was affected by the provider. Wait time strongly affects satisfaction with in-person visits but is not accounted for by the PGOMPS scoring system for virtual visits, which is a limitation of their survey. Further work is required to determine how to improve the patient experience with virtual visits.

Type of study/level of evidence

Prognostic IV.

Prehospital emergency care patient satisfaction scale [PECPSS] for care provided by emergency medical teams: Scale development and validation

The purpose of this study was to develop and validate an emergency medical technician (EMT) care patient satisfaction scale to measure patient satisfaction with prehospital emergency care. To date, patient satisfaction surveys of EMTs have been performed subjectively, e using each facility's questionnaire, without the use of a validated patient satisfaction scale. However, no specific scale has been devised to assess patient satisfaction with EMTs. The study population comprised patients who used an ambulance between November 2020 and May 2021 (N = 202). A survey instrument was administered to participants who provided informed consent. In the process of validating the patient satisfaction scale, an exploratory factor analysis (EFA) of construct validity was performed. The results of the EFA showed a factor structure consisting of five factors: "teamwork", "explanation and communication", "physical treatment and psychological support", "quickness of transport", and "environment in the ambulance". In addition, domain and summary scores showed good internal reliability (Cronbach's range = 0.82-0.94). The patient satisfaction scale developed in this study was designed and validated considering the role of EMTs and patients' needs for prehospital care. This scale may be useful in the development of assessments and interventions to improve patient satisfaction with EMTs.

Patient Satisfaction with Healthcare Services and the Techniques Used for its Assessment: A Systematic Literature Review and a Bibliometric Analysis

Patient satisfaction with healthcare provision services and the factors influencing it are be-coming the main focus of many scientific studies. Assuring the quality of the provided services is essential for the fulfillment of patients' expectations and needs. Thus, this systematic review seeks to find the determinants of patient satisfaction in a global setting. We perform an analysis to evaluate the collected literature and to fulfill the literature gap of bibliometric analysis within this theme. This review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) approach. We conducted our database search in Scopus, Web of Science, and PubMed in June 2022. Studies from 2000-2021 that followed the inclusion and exclusion criteria and that were written in English were included in the sample. We ended up with 157 articles to review. A co-citation and bibliographic coupling analysis were employed to find the most relevant sources, authors, and documents. We divided the factors influencing patient satisfaction into criteria and explanatory variables. Medical care, communication with the patient, and patient's age are among the most critical factors for researchers. The bibliometric analysis revealed the countries, institutions, documents, authors, and sources most productive and significant in patient satisfaction.

Predictors of the experience of a Cytosponge test: analysis of patient survey data from the BEST3 trial

BACKGROUND

The Cytosponge is a cell-collection device, which, coupled with a test for trefoil factor 3 (TFF3), can be used to diagnose Barrett's oesophagus, a precursor condition to oesophageal adenocarcinoma. BEST3, a large pragmatic, randomised, controlled trial, investigated whether offering the Cytosponge-TFF3 test would increase detection of Barrett's. Overall, participants reported mostly positive experiences. This study reports the factors associated with the least positive experience.

METHODS

Patient experience was assessed using the Inventory to Assess Patient Satisfaction (IAPS), a 22-item questionnaire, completed 7-14 days after the Cytosponge test.

STUDY COHORT

All BEST3 participants who answered ≥ 15 items of the IAPS (N = 1458).

STATISTICAL ANALYSIS

A mean IAPS score between 1 and 5 (5 indicates most negative experience) was calculated for each individual. 'Least positive' experience was defined according to the 90th percentile. 167 (11.4%) individuals with a mean IAPS score of ≥ 2.32 were included in the 'least positive' category and compared with the rest of the cohort. Eleven patient characteristics and one procedure-specific factor were assessed as potential predictors of the least positive experience. Multivariable logistic regression analysis using backwards selection was conducted to identify factors independently associated with the least positive experience and with failed swallow at first attempt, one of the strongest predictors of least positive experience.

RESULTS

The majority of responders had a positive experience, with an overall median IAPS score of 1.7 (IQR 1.5-2.1). High (OR = 3.01, 95% CI 2.03-4.46, p < 0.001) or very high (OR = 4.56, 95% CI 2.71-7.66, p < 0.001) anxiety (relative to low/normal anxiety) and a failed swallow at the first attempt (OR = 3.37, 95% CI 2.14-5.30, p < 0.001) were highly significant predictors of the least positive patient experience in multivariable analyses. Additionally, sex (p = 0.036), height (p = 0.032), alcohol intake (p = 0.011) and education level (p = 0.036) were identified as statistically significant predictors.

CONCLUSION

We have identified factors which predict patient experience. Identifying anxiety ahead of the procedure and discussing particular concerns with patients or giving them tips to help with swallowing the capsule might help improve their experience. Trial registration ISRCTN68382401.

Satisfaction of Tuberculosis Patients with Directly Observed Treatment Strategy under Pakistan Health Care Policy: A Mixed-Method Study

(1) Background: Patients' satisfaction is based on the perceived health care services of individuals and is influenced by the level of care provided by the health care system. It is often based on the patients' expectations of care and self-assessment of their experiences. The success of the Directly Observed Treatment Strategy (DOTS) also depends on the quality of health care provided at the Tuberculosis (TB) centers, which can be evaluated by satisfaction levels of the patients. (2) Methods: A tuberculosis facility-based cross-sectional study was carried out in Khyber Pakhtunkhwa province in Pakistan. A mixed-method approach was adopted for data collection. An interviewer-administered questionnaire was used for quantitative data collection from 269 patients who were registered at 11 TB centers and private clinics. Qualitative data were collected through 20 in-depth interviews, 15 key informant interviews, and a focus-group discussion. Binary logistic regression was employed for analysis of the data. (3) Results: More than half of the respondents (63.94%) were satisfied with the DOTS strategy. A high percentage of patients were dissatisfied with the availability of safe water, waiting space for patients, waiting time, privacy, and the processing of appointments. Results from the binary logistic regression showed that gender (AOR = 2.21, CI 1.07-4.58, p = 0.033), marital status (AOR = 3.12, CI 1.45-6.73, p = 0.004), employment status (AOR = 5.22, CI 2.44-1.21, p = 0.000), home ownership (AOR = 3.82, CI 1.94-7.54, p = 0.000), literacy (AOR = 2.17, CI 1.11-4.25, p = 0.023), households' main occupation (AOR = 4.42, CI 1.12-17.38, p = 0.033), and level of income (AOR = 2.39, CI 1.13-5.04, p = 0.023) were the significant factors affecting satisfaction levels of the patients. (4) Conclusion: There are a number of areas that need improvement for successful TB eradication. Significant work is required to improve the quality of TB care in these specific areas from the patients' perspective. For instance, female health workers' involvement in the DOTS program can solve the problems of female respondents in rural areas. Improving the infrastructure facilities at the TB centers, allocation of doctors and nurses at the rural health centers would result in positive outcomes of the DOTS in Pakistan as well as in other developing countries.

Rural engagement in primary care for optimizing weight reduction (REPOWER): A mixed methods study of patient perceptions

OBJECTIVE

To report on patients' satisfaction and experience of care across three different modes of weight loss counseling.

METHODS

1407 patients with obesity in the rural Midwest were enrolled to a 2-year weight management trial through their primary care practice and assigned to one of three treatment conditions: in-clinic individual, in-clinic group, phone group counseling. Patients completed surveys assessing seven domains of satisfaction and experience of care at 6 and 24-months. Post-treatment interviews were conducted to add context to survey responses.

RESULTS

1295 (92.0%) and 1230 (87.4%) completed surveys at 6 and 24-months, respectively. Patients in phone group counseling reported lower satisfaction than patients who received in-clinic group or in-clinic individual counseling across all domains at 6-months and five out of seven domains at 24-months. Interviews revealed that patients were more satisfied when they received face-to-face counseling and had meaningful interactions with their primary care provider (PCP) about their weight.

CONCLUSION

Rural patients with obesity have higher satisfaction and experience of care when weight loss counseling is delivered in a face-to-face environment and when their PCP is involved with their treatment.

PRACTICE IMPLICATIONS

Primary care practices looking to offer weight loss treatment should consider incorporating some level of face-to-face treatment plans that involves meaningful interaction with the PCP.

[Importance of health care personnel commitment for patient satisfaction in Primary Care]

To know to what extent the organizational commitment of primary care health professionals is important for patient satisfaction. Observational, cross-sectional, quantitative, retrospective, and uncontrolled study. 40 primary care centers belonging to the health area of Gran Canaria. Primary care. 617 health professionals (46% doctors and 54% nurses) and 1,537 users of primary care centers (35.39% men and 64.60% women). Non-probability sampling for convenience. To evaluate organizational commitment, a self-administered questionnaire was used for health professionals in primary care centers. Patient satisfaction was obtained by telephone survey and control variables from secondary sources. The data were analyzed by multiple linear regression. To deepen the results, semi-structured interviews were also used. The socioeconomic environment of the health centers does not influence patient satisfaction. The organizational commitment of the workers has a positive influence on the satisfaction of the users of the health centers. It was also found that the most committed professionals have less availability in their schedules for short-term appointments. The interviews suggest that it is because they spend more time with their patients, which makes them more satisfied. The affective organizational commitment of health professionals is an attitude that allows improving patient satisfaction, therefore, health managers should use practices aimed at strengthening this attitude.

Dying in times of COVID-19: Experiences in different care settings - An online questionnaire study among bereaved relatives (the CO-LIVE study)

BACKGROUND

The COVID-19 pandemic and restricting measures have affected end-of-life care across different settings.

AIM

To compare experiences of bereaved relatives with end-of-life care for a family member or friend who died at home, in a hospital, nursing home or hospice during the pandemic.

DESIGN

An open observational online survey was developed and disseminated via social media and public fora (March-July 2020). Data were analyzed using descriptive statistics and logistic regression analyses.

PARTICIPANTS

Individuals who lost a family member or friend in the Netherlands during the COVID-19 pandemic.

RESULTS

The questionnaire was filled out by 393 bereaved relatives who lost a family member or friend at home (n = 68), in a hospital (n = 114), nursing home (n = 176) or hospice (n = 35). Bereaved relatives of patients who died in a hospital most often evaluated medical care (79%) as sufficient, whereas medical care (54.5%) was least often evaluated as sufficient in nursing homes. Emotional support for relatives was most often evaluated as sufficient at home (67.7%) and least often in nursing homes (40.3%). Sufficient emotional support for relatives was associated with a higher likelihood to rate the place of death as appropriate. Bereaved relatives of patients who died at a place other than home and whose care was restricted due to COVID-19 were less likely to evaluate the place of death as appropriate.

CONCLUSION

End-of-life care during the COVID-19 pandemic was evaluated least favourably in nursing homes. The quality of emotional support for relatives and whether care was restricted or not were important for assessing the place of death as appropriate.

Emergency Nursing-Care Patient Satisfaction Scale (Enpss): Development and Validation of a Patient Satisfaction Scale with Emergency Room Nursing

This study aimed to develop and validate an emergency nursing-care patient satisfaction scale to measure patient satisfaction with emergency room (ER) nursing. Patient satisfaction scales for ER nursing have been validated without considering the perspectives of the healthcare system or cultural background of the country. Moreover, although nursing care is changing with COVID-19, no scale has been specifically designed to assess patient satisfaction with ER nursing. The study population included patients who visited five ERs in Japan (March to December 2021) (n = 135). The rating scales were provided to patients who visited the ER and gave consent, and the patients were asked to reply. In the process of validating the scale, exploratory and confirmatory factor analyses of the construct and criterion validity were conducted. The confirmatory factor analysis results showed a factorial structure consisting of four factors. The domain and summary scores demonstrated good-to-excellent internal reliability (Cronbach’s range = 0.81–0.89). This patient satisfaction scale was designed and validated from the perspective of the Japanese healthcare system and cultural backgrounds. This scale may be useful for developing assessments and interventions to improve patient satisfaction with ER nursing.

A multicenter survey of patients’ favorite type of nursing care and associated factors in Hebei Province, China

Background

Nursing care service is an important part of the healthcare system; however, patients’ favorite type of nursing care remains unknown. This study aims to investigate inpatients’ and nurses’ favorite types of nursing care and identify nurses’ learning needs.

Method

The study selected a province-representative sample of inpatients and nurses using a stratified random sampling method from 18 selected hospitals, including 9 Level Ⅱ hospitals and 9 Level Ⅲ hospitals in 9 cities of Hebei province. All participants were personally interviewed about their favorite type of nursing care. Multinomial logistic regression analysis was applied to analyze the potential associations between favorite nursing care and factors about inpatients and nurses.

Results

Data from 3,642 inpatients and 371 nurses were included for the final analysis during this survey. Among inpatients, the proportions who selected good attitude-centered, good nursing skill-centered, good environment-centered and good health education guidance-centered as their favorite types of nursing care were 49.9%, 31.8%, 5.8%, and 12.5%, respectively. Concurrently, among nurses, the proportions were 49.9%, 29.6%, 19.1%, and 1.3%, respectively. Multivariate analysis showed that most patients selected good attitude-centered nursing care as their favorite type of nursing care. However, patients who did not live with guardians and had more than one hospitalization per year were more likely to select other nursing care types.

Conclusion

Attitude-centered nursing care service was the favorite type of nursing care for most inpatients and nurses. Health education guidance was another main concern of inpatients. The main factors affecting the patients’ choice of favorite nursing care included patients’ living status and the number of hospitalization events per year. Nursing education should focus on nurse attitude as well as on health education guidance.

The role of migration in mental healthcare: treatment satisfaction and utilization

Migration rates increase globally and require an adaption of national mental health services to the needs of persons with migration background. Therefore, we aimed to identify differences between persons with and without migratory background regarding (1) treatment satisfaction, (2) needed and received mental healthcare and (3) utilization of mental healthcare.In the context of a cross-sectional multicenter study, inpatients and day hospital patients of psychiatric settings in Southern Germany with severe affective and non-affective psychoses were included. Patients' satisfaction with and their use of mental healthcare services were assessed by VSSS-54 and CSSRI-EU; patients' needs were measured via CAN-EU.In total, 387 participants (migratory background: n = 72; 19%) provided sufficient responses for analyses. Migrant patients were more satisfied with the overall treatment in the past year compared to non-migrant patients. No differences between both groups were identified in met and unmet treatment needs and use of supply services (psychiatric, psychotherapeutic, and psychosocial treatment).Despite a comparable degree of met and unmet treatment needs and mental health service use among migrants and non-migrants, patients with migration background showed higher overall treatment satisfaction compared to non-migrants. The role of sociocultural and migrant-related factors may explain our findings.

Reporting Inpatients' Experiences and Satisfaction in a National Psychiatric Facility: A Study Based on the Random Forest Algorithm

Understanding psychiatric inpatients' experiences is important to establish a culture of patient-centric care and promote trust in healthcare. This study aimed to evaluate nine dimensions of patients' experiences and investigate their association with patient satisfaction, revisit intention, and positive word-of-mouth (WoM) recommendation. Cross-sectional questionnaire data from five years of surveying (2016-2020) in the main psychiatric hospital in Bahrain were statistically analyzed, involving 763 psychiatric inpatients with an overall 65.6 ± 17.2 length of stay (days). The findings show that across the five years 2016-2020, the overall reported satisfaction was "very high" (4.75 ± 0.44) with no significant differences between these five years (F [4, 758] = 0.66, p = 0.620). The experience of confidentiality received the highest rating (4.72 ± 0.45). The experiences of ease of access, hospitality quality, and quality of responsiveness to one's needs significantly correlated with revisit intention (p ˂ 0.05). Patients with high satisfaction had greater potential for revisit intention (r [761] = 0.08, p = 0.027), which was associated with WoM recommendation (r [761] = 0.08, p = 0.033). Overall, men were less likely than women to experience convenient access to psychiatric wards. The findings of the Random Forest algorithm indicate the tendency of female patients with short-term stays to demonstrate lower satisfaction rates, and thus innovative approaches are needed when managing these groups' psychiatric problems.

Analyzing user-generated content using natural language processing: a case study of public satisfaction with healthcare systems

While user-generated online content (UGC) is increasingly available, public opinion studies are yet to fully exploit the abundance and richness of online data. This study contributes to the practical knowledge of user-generated online content and machine learning techniques that can be used for the analysis of UGC. For this purpose, we explore the potential of user-generated content and present an application of natural language pre-processing, text mining and sentiment analysis to the question of public satisfaction with healthcare systems. Concretely, we analyze 634 online comments reflecting attitudes towards healthcare services in different countries. Our analysis identifies the frequency of topics related to healthcare services in textual content of the comments and attempts to classify and rank national healthcare systems based on the respondents' sentiment scores. In this paper, we describe our approach, summarize our main findings, and compare them with the results from cross-national surveys. Finally, we outline the typical limitations inherent in the analysis of user-generated online content and suggest avenues for future research.

The Impact of Chronic Illness on the Patient Experience: Results From a Cross-Sectional Comparative Study in a Comprehensive Tertiary Hospital in China

OBJECTIVE

Improving the satisfaction and medical experience of patients is a basic goal of the comprehensive reform of public hospitals in China. This study aimed to investigate the patient experience and its influencing factors, and to compare medical experiences between patients with and without chronic disease, with a view to providing suggestions for improving the quality of public hospitals in China.

METHODS

A cross-sectional comparative study involving 102 patients discharged from Taizhou Hospital of Zhejiang Province, a tertiary public hospital in China, was conducted. The patients were invited to participate in a survey comprising the Picker Patient Experience Questionnaire (PPE-15), and an overall satisfaction evaluation (on a scale of 1-10). The patients were divided into two groups according to whether or not they had a chronic disease, and the medical experience and overall satisfaction of the groups were compared. Descriptive statistics (frequency, median, mean), chi-square analysis, and Mann-Whitney U tests were used to analyze the data.

RESULTS

No statistical significance was found in overall satisfaction between patients with and without chronic diseases, but there were differences in the patient experience score. Chronic illness had negative impacts on the experience of care coordination for patients and respect for patient preferences. Of the seven dimensions of the PPE-15, the scores for emotional support and respect for patient preferences were the lowest in both groups, and the item "want to be more involved in decisions made about care and treatment" scored the lowest among all items.

CONCLUSIONS

Hospital managers and staff members should pay more attention to the emotional support and preferences of patients. For patients with chronic diseases, the standardization of medical care and patient participation in the medical process should be strengthened. Hospitals should also subdivide patient groups, ascertain the demands and expectations of patients, and carry out targeted evaluation and intervention measures.

Effects of a person-centred and health-promoting intervention in home care services- a non-randomized controlled trial

BACKGROUND

Home care recipients have reported little self-determination and opportunity to influence their own care. Person-centred care focusing on involvement has improved the quality of life of older adults in health care and nursing homes; however, knowledge about the effects of person-centred interventions in aged care at home is sparse. The aim of this study was to study the effects of a person-centred and health-promoting intervention, compared with usual care, on health-related quality of life, thriving and self-determination among older adults, and on job satisfaction, stress of conscience and level of person-centred care among care staff.

METHODS

This is a non-randomized controlled trial with a before/after design. Participants from five home care districts in one municipality in northern Sweden were recruited to an intervention or control group. We evaluated health-related quality of life, thriving and self-determination among older home care recipients, and job satisfaction, person-centred care and stress of conscience among care staff. Evaluation was performed by questionnaires and responses were analysed using parametric and non-parametric statistical analyses.

RESULTS

Eighty-one older adults and 48 staff were included in the study. A clinically moderate and statistically significant difference between the intervention and control groups was found in thriving and negative emotions among older adults. The intervention contributed to maintaining high thriving levels, in contrast to decreased thriving in the control group (intervention: + 1, control: - 4, p 0.026, CI: - 10. 766, - 0.717). However, the intervention group rated an increase in negative emotions, while the control group was unchanged (intervention: - 7 control: + - 0, p 0.048, CI: - 17.435, - 0.098). No significant effects were found among staff.

CONCLUSIONS

The intervention contributed to maintaining high levels of thriving in contrast to low levels found in the control group, and it seems reasonable to consider the intervention focus on staff as more person-centred and health-promoting. The finding that the intervention group had increase in negative emotions is difficult to interpret, and warrants further exploration. Even though the results are sparse, the challenges discussed may be of importance for future studies in the context of HCS.

TRIAL REGISTRATION

NCT02846246. Date of registration: 27 July 2016.

The impact that family members' health care experiences have on patients' trust in physicians

BACKGROUND

A family member's negative experiences with medical care have long-term effects on a patient's attitudes and emotions. However, the impact of family members' experiences on patients' trust in their own physicians and in physicians generally is poorly understood. This study aims to quantify these associations.

METHODS

A cross-sectional online survey involving adults with non-communicable diseases (cardiac disease, diabetes, cancer, depression, and rheumatic disease) was conducted in Japan during April 2020. The main exposure variable was dissatisfaction with the medical care that family members had received. The main outcomes were patients' (N = 661) own trust in their personal physicians and in physicians generally. The study adopted the Japanese version of the Abbreviated Wake Forest Physician Trust Scales. Both 5-item scales (general and individual physician trust) were translated and validated for the study. The total scores were transformed into a scale of 0-100 points. A series of linear mixed-effects models with consideration for clustering effect by prefectures were fit.

RESULTS

The results showed a lower rating for trust in physicians generally as compared to trust in the respondent's personal physician (mean 57.0 vs. 66.4 points; p < 0.001). Furthermore, dissatisfaction with a family member's medical care was associated with lower trust in physicians generally (mean difference - 9.58, 95 %CI -12.4 to -6.76). Interestingly, dissatisfaction with a family member's care was also associated with lower trust in the respondent's personal physician (mean difference - 3.19, 95 %CI -6.02 to -0.36), but the magnitude of this association was weaker. The lower trust in personal physicians may be mediated by reduced trust in physicians generally.

CONCLUSIONS

We suggest that physicians enquire about past patients' negative experiences, including dissatisfaction with family members' medical care, to repair hidden loss of trust, when they sense that patients doubt them or physicians generally.

Building a Caring Arts Program with Oncology Patients: From Inception to Impact

A Caring Arts Program (CAP) was inspired and carried out by the vision of an in-resident nurse-artist and the chief nursing officer in a private, not-for-profit health system. Together they envisioned a program that would impact family, patients, and staff while improving patient/family care practices. The impact of the CAP was evaluated through mixed methods which included stories, fieldnotes, comments, and the Listen360^(R) which rates patient satisfaction scores. The synergy between the evaluations and the attempt to understand what creates patient satisfaction using creative arts was a prime objective of this article. The qualitative results represented by field notes and written patient comments revealed a positive impact on participants. The quantitative results demonstrated an improvement in patient satisfaction scores during the time of the project. The positive trend in the scores combined with the qualitative stories and interviews suggests that the CAP contributed to the improvement in patient satisfaction at Baptist MD Anderson Cancer Center. During a worldwide pandemic, supporting human caring and self-expression was more critical than ever.

Cross-Cultural Adaptation and Validation of the Malay Satisfaction Questionnaire for Osteoporosis Prevention in Malaysia

PURPOSE

The English Satisfaction Questionnaire for Osteoporosis Prevention (SQOP) is validated in Malaysia. However, Malay is the national language of Malaysia spoken by the majority of Malaysians. The aim of this study was to cross-culturally adapt and validate the Malay Satisfaction Questionnaire for Osteoporosis Prevention (SQOP-M) in Malaysia.

PATIENTS AND METHODS

This study was carried out from March to October 2018 at a tertiary hospital in Kuala Lumpur. The SQOP was translated from English to Malay according to international guidelines. Malay-speaking postmenopausal women ≥50 years were recruited and randomized into control and intervention groups. The intervention group received an osteoporosis prevention information booklet and a 15-minute pharmacist counselling session. All patients were asked to answer the SQOP-M questionnaire at baseline and two weeks later. The control group received the intervention after the study was completed.

RESULTS

Overall, 230/348 patients were recruited (C=115, I=115, response rate=66.1%). Exploratory factor analysis extracted four domains. Cronbach's α ranged from 0.230 to 0.938. Kappa measurement of agreement values ranged from 0.124 to 0.627, where 10/23 (43.5%) items were in moderate to substantial agreement. Wilcoxon signed rank test values were statistically significant (p<0.005) for 4/23 items. Item 17 was an optional question and excluded from analysis. Total satisfaction score was significantly higher for intervention group patients [76.9 (47.6-53.9) vs 50.4 (47.6-53.9), p<0.001] indicating higher satisfaction compared to control group.

CONCLUSION

The SQOP-M was found to be valid and reliable in assessing patient satisfaction of osteoporosis screening and prevention services provided to Malay-speaking patients in Malaysia.

Access to medicines in the Brazilian Unified Health System's primary health care: assessment of a public policy

In 2008, the Programa Rede Farmácia de Minas (RFM, literally translated: 'Minas Gerais Pharmacy Network' program) was created as a strategy to expand access to medicines. Aim: Measure access to medicines in public pharmacies through comparison between municipalities that joined or not the RFM. Materials & methods: Cross-sectional, evaluative study, gathering information from a representative sample of the municipalities in Minas Gerais between July 2014 and May 2015. The Poisson regression results were obtained by calculating the prevalence ratios. Results: Adequate access to medicines in Minas Gerais was 69.9%, being 75.8% in municipalities with and 69.2% without the RFM. The municipalities with the RFM showed statistically higher percentages in the Availability, Adequacy/Accommodation, and Acceptability dimensions. Conclusion: RFM appears an efficient strategy for promoting access to medicines.

The Effect of Perceived Value, Trust, and Commitment on Patient Loyalty in Taiwan

Increasing patient loyalty through improved health care quality and patient–provider relationships becomes the key factor in medical providers’ successes. This study explored the mediated relationship of patients’ perceived value, patient commitment, and patient loyalty and the moderating effect of patient trust on the mediated relationship. A cross-sectional research design was adopted. Mediation and moderated mediation were tested using the PROCESS macro v3.5 for the SPSS supplement. Convenience sampling was used for the distribution of questionnaires to members of the public with experience of seeking medical attention in Taiwan. Among the 254 valid questionnaires recovered, 59.4% of the respondents were male, 38.6% were married, 90.2% were in the 20 to 49 year age range, and 54.7% had a bachelor’s degree or above. This study indicated a significant mediated relationship among patients’ perceived value of medical services, commitment to the patient–provider relationship, and patient loyalty. Furthermore, when the patient demonstrated higher levels of trust in a healthcare provider, the relationship of perceived value, commitment, and patient loyalty was also enhanced. This study discussed and demonstrated the effect of perceived value, trust, and commitment on patient loyalty. The research suggests that improving patient loyalty benefits sustainable operation of medical providers and the treatment effects for patients.

Quality of health care perceived by users in Catalan prisons

Objectives

To describe inmates’ perceptions of healthcare quality in Catalonian prisons.

Material and method

Transversal study of 6,856 inmates in Catalan prisons in September 2017. Randomized simple screening was used to randomly distribute 1,048 polls in which different aspects of perceived quality of healthcare were evaluated. The results were also categorized according to age, sex, time spent in prison, background and academic levels. We also analysed the differences between results in healthcare quality according to socio-demographic variables.

Results

84.87% of patients show satisfaction with the quality of healthcare received. Women are more satisfied with consultations than men (OR: 2.04; p = 0.009). Patients with a higher educational level are less satisfied than those with a lower educational level, with significant differences in 11 of the 14 items. Those over 65 years of age were more satisfied than the rest in 11 of the 14 items evaluated. Foreign patients were more satisfied than Spanish inmates in time flexibility (OR: 0.69; p = 0.018) and in waiting times for visits (OR: 0,63; p = 0.006), whereas they are less satisfied with the healthcare professionals’ image (OR: 1.97; p = 0.03).

Discussion

Noteble features of our study include the fact that although global satisfaction is high, some dimensions, like reliability, could improve. The results were submitted to the General Directorate to enable more in-depth study of the variables where there is less satisfaction and to design further improvements.

Patient Satisfaction and Physician Empathy at a Hellenic Air Force Health Service

INTRODUCTION

Patient satisfaction and physician empathy are important indicators of health care services quality. The purpose of this study is to investigate the factors related to the health care users' perception about physician empathy and their satisfaction with the services offered by the Medical Department of a Hellenic Air Force Combat Wing Health Service.

MATERIALS AND METHODS

One hundred and twenty six individuals who randomly visited the Medical Department from January to February 2019 participated in the survey. The "Measuring the satisfaction of visitors to hospital outpatient clinics" questionnaire by Aletras et al. and the Greek version of the "Jefferson Scale of Patient Perceptions of Physician Empathy" questionnaire were used for data collection.

RESULTS

High satisfaction scores were found in relation to the medical staff (mean 20.45, max 25), the examination room (mean 18.23, max 25), the nursing staff/secretarial support (mean 16.93, max 25), and the overall satisfaction (mean 17.15, max 25). The satisfaction score related to the infirmary was low (mean score 8.8, max 25). Physician empathy score was extremely high (mean 21.2, max 25). Statistically significant correlations were detected between physician empathy satisfaction score and the medical staff, nursing staff/secretarial support, and the overall satisfaction scores (P < .001).

CONCLUSION

Health care users reported high physician empathy and overall satisfaction scores but low infirmary satisfaction scores. The more positively that patients evaluated physician empathy, the more satisfaction that patients had with other measures.

Determinants of caregiver satisfaction with child neurodevelopmental assessment in neuropaediatric clinics

BACKGROUND

In addition to patient evaluations, caregiver evaluations and experiences are important indicators of the quality of health services. The aim of this study was to examine determinants of caregiver satisfaction with and perceived benefit of child neurodevelopmental assessment in neuropaediatric clinics.

METHODS

The study was conducted among caregivers of children and adolescents aged 4-18 years (N = 330) referred for neurodevelopmental assessment in two neuropaediatric clinics in the specialised health service in Northern Norway. The Generic Short Patient Experiences Questionnaire (GS-PEQ) for child psychiatric outpatient patients was distributed to caregivers immediately following the assessment, and two of its items were used as measurements of caregiver satisfaction with and perceived benefit of the assessment.

RESULTS

Caregiver satisfaction with the assessment was correlated with a better general level of function in the child, higher socioeconomic status, Norwegian mother tongue, referral from a specialist, and the respondent being a woman. Higher perceived benefit of the assessment was correlated with higher socioeconomic status, Norwegian mother tongue, and younger age of the child. Regression analysis revealed that caregivers' perception that the assessment was suited to their child's situation and that there was good cooperation with other public services (e.g., primary care and social/educational services) seemed more fundamental to caregiver satisfaction with neuropaediatric clinics' services than any background variable. Younger age of the child, in addition to caregivers' perception that the assessment was suited to their child and receiving sufficient information about the child's diagnosis/afflictions, were essential to the perceived benefit of the assessment.

CONCLUSIONS

Caregiver satisfaction with child neurodevelopmental assessment in neuropaediatric clinics partly depends on variables not related to the assessment experience per se. An assessment that was suited to the child, good cooperation with other public services such as primary health care and social/educational services, and giving sufficient information about the child's diagnosis are essential to an overall positive caregiver evaluation of neurodevelopmental assessments.

Shared decision-making in early stage non-small cell lung cancer: A systematic review

BACKGROUND

The United Kingdom National Institute for Health and Care Excellence guidelines recommend that patients and professionals make shared decisions between surgery and stereotactic ablative radiotherapy (SABR) when treating early stage non-small cell lung cancer (NSCLC). Variation by centre suggests treatment decisions may be disproportionately influenced by clinician judgment and treatment availability rather than patient preference. This systematic review critically evaluates studies of patient and clinician preferences for treatment of early stage NSCLC.

METHODS

Primary empirical research up to 30 April 2020 was identified from searches of MEDLINE, EMBASE, PsycInfo and Web of Science databases. Data extracted included: study characteristics and methods, preferences for NSCLC treatment and involvement in decision-making and risk of bias using the Mixed Methods Appraisal Tool. Findings were synthesized using descriptive data and narrative synthesis.

RESULTS

23 studies were included in the review; 18 measured patient preferences, 4 clinician preferences and 1 both clinician and patient preferences. Patients and clinicians were both most likely to prefer a collaborative role in treatment decisions. Most patients did not recall there being a choice between surgery or SABR options, and thus experienced minimal decisional conflict.

CONCLUSIONS

For professionals to support patients in making informed, value based decisions about NSCLC treatments, better quality evidence is needed of the clinical and quality of life trade offs for both surgery and SABR.

The Influence of Patient and Hospital Characteristics on Inpatient Satisfaction at Beijing District-Level Hospitals

PURPOSE

Patient satisfaction is a key indicator of healthcare quality and hospital performance. This study aims to assess inpatient satisfaction at district-level hospitals and explore the determinants of inpatient satisfaction.

PATIENTS AND METHODS

A total of 1458 adults from inpatient departments of 47 district-level hospitals in 16 districts across Beijing were recruited with a multi-stage stratified sample at Beijing in 2019. Univariate analysis and multivariate logistic regression were used to identify the influence of patient and institutional characteristics on inpatient satisfaction in four domains - administrative process, hospital environment, medical care, hospitalization expenses, and overall satisfaction.

RESULTS

Of the 1458 participants, 577 (39.6%) were men, 581 (39.8%) were over 60 years of age. The average value of satisfaction score measured by a 5-point Likert scale were 4.37, 4.00, 4.44, 3.89, and 4.33 for the four domains and overall satisfaction. Patient and institutional characteristics were strongly associated with inpatient satisfaction. Patients with higher educational level were more satisfied with administrative process (P<0.05). Elder patients and patients with worse self-reported health status were less satisfied with hospital environment (P<0.05). Female, higher monthly family income and Urban Employees Basic Medical Insurance were positively associated with patient satisfaction in hospitalization expenses (P<0.05). And patients receiving care in suburban hospitals were less satisfied with administrative process, hospital environment and overall satisfaction (P<0.05). Patients receiving care in Traditional Chinese Medicine hospitals were more satisfied with medical care and expenses but less satisfied with environment (P<0.05). Chronic disease and hospital grade were not significantly associated with satisfaction in all domains.

CONCLUSION

Patient satisfaction was influenced by demographic characteristics and hospital features. These determinants should be considered in hospital evaluation.

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.

Tradeoff between efficiency and perceived quality: evidence from patient-level data

Objectives

To estimate technical efficiency scores of District Headquarter Hospitals (DHQHs) for obstetric services and to explore the relationship between the efficiency of DHQHs and the patients’ satisfaction about the quality of services provided.

Design, Setting and Participants

Data from Health Facility Assessment (HFA) survey is used for efficiency measurement. The data on patient’s perceptions and other control variables are taken from Client Exit Interviews part of the HFA survey. Two-stage residual inclusion, Ordered Logistic Regression and Least square dummy variable techniques are used to investigate the relationship between technical efficiency and patients’ satisfaction level.

Main Outcome Measure(s) and Results

The average efficiency score for Pakistan’s DHQHs is 0.52, and not a single hospital is fully efficient. Moreover, the relationship between technical efficiency and patients’ satisfaction is found to be negative and statistically significant indicating that an increase in hospital efficiency tends to decrease patients’ satisfaction. The disaggregated analysis reveals that patients’ satisfaction associated with the healthcare provider attitude and communication is more affected by technical efficiency.

Conclusion

Patients’ satisfaction level is more sensitive to physician’s attitude and communication. This makes sense because the longer the consultation time, the more accurate the diagnosis would be. This, together with a comforting and confident physician, is likely to achieve better patients’ satisfaction.

The influence of collecting patient-reported outcome measures on visit satisfaction in rheumatology clinics

Objectives

Patient-reported outcome measures (PROMs) can direct patient-centred care and increase patient satisfaction with the visit. The objective of this study was to assess the relationship between the collection of PROMs and visit satisfaction, as measured by the Clinician and Group Practice Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) survey.

Methods

An electronic platform for collection of patient-reported information was implemented in rheumatology clinics between August and September 2016. Adult patients were included in the study if they completed CG-CAHPS after an ambulatory visit. The pre-implementation cohort consisted of patients seen between January and June 2016; the post-implementation cohort consisted of patients seen between January and June 2017. The CG-CAHPS scores were compared between cohorts. Mixed effect models were constructed to identify predictors of visit satisfaction.

Results

Characteristics were similar between the 2117 pre- and 2380 post-implementation patients. Visit satisfaction was high in both cohorts but did not differ [odds ratio = 0.97 (95% CI: 0.79, 1.19)]. Predictors of improved satisfaction included being an established patient, being male, older age and reporting higher quality of life. However, sensitivity analyses in the post-implementation cohort suggested that implementing PROMs might convey benefits for new patients, in particular.

Conclusion

Collection of PROMs had no effect on visit satisfaction in rheumatology clinics, although there might be benefits for new patients. These largely null findings might be attributable to high satisfaction levels in our cohorts or to lack of provider review of PROM data with patients. Further research is indicated to determine the impact of provider communication of PROM results to patients on different domains of visit satisfaction.

The evaluation of nursing students by patients instrument (ENSPA): Development and validation

BACKGROUND

Patient participation is increasingly used in different aspects of healthcare due to its positive outcomes. Still, instruments for involving patients in the evaluation of nursing students during their internship are scarce.

OBJECTIVES

To develop and validate an instrument that enables patients to evaluate nursing students during their internship.

DESIGN AND METHODS

A 3-phased validation process was conducted: (1) development of an instrument through literature and patient interviews; (2) content and response process validation by use of cognitive interviews and pilot-testing; (3) testing construct validity and reliability of the instrument which was completed by 244 hospitalized patients.

SETTINGS AND PARTICIPANTS

Patients from a variety of wards in a general hospital were recruited for the different phases. In phase 1, 17 interviews and 47 thought shower sessions with patients were performed. In phase 2, 9 cognitive interviews and pilot testing by 4 patients evaluating actual nursing students were used to refine the instrument. In phase 3, 380 patients were eligible to participate. Of these patients, 317 completed the instrument. A sample of 244 completed instruments was useful to perform the psychometric analyses. To assess the test-retest reliability, 50 patients completed the instrument twice with a 4 hour time interval.

RESULTS

The 19-item Evaluation of Nursing Students by Patients instrument (ENSPa) is designed. The ENSPa-instrument comprises 7 items that assess whether the patient can place trust in the student, 5 items evaluating person-oriented skills, 4 items appraising caring and 3 items to grade the integrity and honesty of the nursing students. Each item is scored both for importance and rating. The instrument shows high reliability and consistency ratings.

CONCLUSIONS

The ENSPa-instrument is a valuable instrument for collecting data on the performance and skills of nursing students during their internship from the patient's perspective. By receiving structured feedback from patients, important learning opportunities are created for nursing students.

Client satisfaction on Emergency department services and quality of emergency medical care in Ethiopia: A systematic review

BACKGROUND

The utilization of the emergency department to provide an emergency medical services is crucial for the communities who need an urgent medical care that is associated with various cases. This aim of this review was to describe the client satisfaction on the services of Emergency department and the quality of emergency medical care in Ethiopia.

METHOD

We searched peer-reviewed published articles related to clients' satisfaction on emergency department services and the quality of emergency medical care between January 2000 and December 2017. The articles were retrieved from databases of PubMed, Scopus, Ovid, Google Scholar, MEDLINE, EMBASE and ScienceDirect. Furthermore, studies published in other language than English was excluded.

RESULTS

A total of 2094 participants: 906 (43%) males and 1188 (57%) females were recruited in those reviewed papers to express their satisfaction on the service and the quality of emergency medical care of the Emergency department. Based on the study findings, majority 1177 (56%) of the participants were satisfied by emergency outpatient department (OPD) services. The majority 1018 (83%) of the participants were satisfied with the manner that was showed by the staffs working at the Emergency OPD. In similar manner, the satisfaction level of the participants in the Emergency OPD towards the accessibility of the emergency care services, courtesy of the staffs, quality of the services, physical environments, and existence of good communication with services provider were 72%, 97%, 81.5%, 55%, and 66%, respectively while 97.2% of them were dissatisfied with their privacy. On the other hand, 76% of the participants were satisfied with the service provided in the radiology section and other laboratory work.

CONCLUSION

This study finding shown that there was the variety of client perception on the emergency department and its quality care. Therefore, Emergency outpatient department should be raised progressively further by health care managers, governmental executives, EMS directorate, and others to address the efficient attribute of deprived value of health care and continuity of care delivery system being tied with new policy in Ethiopia.

User satisfaction in the spanish health system: trend analysis

OBJECTIVE

To analyze the trend of opinion and satisfaction indicators of the Spanish national health system from 2005 to 2017.

METHODS

Ecological study of time series analyzing the trend of eight indicators of opinion and satisfaction on the Spanish national health system and its autonomous communities from 2005 to 2017. The data was obtained from the Ministry of Health, Social Services and Equality and from the Health Barometer. The Prais-Winsten regression method was used.

RESULTS

A static tendency was observed in the perception of users on how the health system works (APC = 1.898, 95%CI -0.954 – 4.751) and decreasing opinion on the improvement of primary care (APC = -0.283; 95%CI -0.335 – -0.121), specialized (APC = -0.241, 95%CI -0.74 – -0.109) and hospitalization (APC = -0.171, 95%CI -0.307 – -0.036). Satisfaction with knowledge and follow-up by the family doctor and pediatrician showed an increasing trend (APC = 7.939, 95%CI 3.965 – 11.914). Satisfaction with medical and nursing professionals was static. No large differences were observed in the trends of the indicators studied in the autonomous communities.

CONCLUSIONS

A negative trend was observed in the opinion of the Spanish national health system users. Financing, human resources, quality management systems and differences in the autonomous communities may be some of the causes.

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.

Is patient loyalty associated with quality of care? Results of a patient survey over primary care in Switzerland

OBJECTIVE

The study aimed to evaluate quality of care and to determine which aspects are associated with the willingness to recommend the general practitioner (GP) as a part of patient loyalty.

DESIGN

This was an exploratory study which collected patient data from ambulatory care in the German part of Switzerland between 2013 and 2016.

SETTING

Primary care in Switzerland.

PARTICIPANTS

Included patients from 79 primary care practices who volunteered to participate in the quality management system European Practice Assessment. Patients were afterwards asked to complete the European Task Force on Patient Evaluations of General Practice Care instrument.

INTERVENTIONS

Describing influencing factors of quality of care on recommendation of the GP from the perspective of the patients.

MAIN OUTCOME MEASURES

Patient perspective on quality of care.

RESULTS

Survey respondent rate was 81.3%. Over 69% of the respondents were willing to recommend their GP. 'Listening to you' (94.2%) and 'interest in your personal situation' (93.0%) as a part of the domain 'relationship and communication' were rated as the highest quality criteria. The lowest rate was found for 'being able to speak to the GP on the telephone' (30.0%) and 'waiting time in the waiting room' (50.6%). Patient loyalty, in terms of willingness to recommend the GP, was strongly associated with most of the items under the 'relationship and communication' section but also with having more physician's assistants in the practice.

CONCLUSIONS

The results are important for understanding patients' priorities with regard to general practice care. Patient assessment allows us to identify possible areas for quality improvement within the practice and could provide feedback.

User satisfaction with public oral health services in the Brazilian Unified Health System

Background

User satisfaction represents a patient-centered measure that should be used to assess the quality of oral health services. This study investigated the differences in user satisfaction with public oral health services according to the sociodemographic user profile and the quality of oral health services in primary health care in Brazil.

Methods

Secondary data from a national program obtained through interviews with users were analyzed. Satisfaction was based on the Swan’ model relating to perceptions regarding the service performance, assessment of overall satisfaction and the intention to avoid the service in the future. The exploratory variables were demographic characteristics of the users and the quality of the primary service from the user’s viewpoint, considering the dimensions: access; receptivity of spontaneous demand; integral health care; bonding, accountability, and coordination of care.

Results

A total of 37,262 users participated, and 65.51% reported satisfaction with the oral health service, that was higher among those > 20 years old and beneficiaries of the Family Grant Program and lower among users with a higher level of schooling and those who reported being employed. Users who rated oral health service positively were more satisfied.

Conclusions

Socioeconomically disadvantaged user was more satisfied with oral health services and the satisfaction increased with age. The improvement in the quality of oral health services in primary care can result in greater satisfaction.

Association Between Nonmodifiable Demographic Factors and Patient Satisfaction Scores in Spine Surgery Clinics

The Press Ganey survey is the most widely used instrument for measuring patient satisfaction. Understanding the factors that influence these surveys may permit better use of survey results and may direct interventions to increase patient satisfaction. Press Ganey Clinician and Group Consumer Assessment of Healthcare Providers and Systems surveys administered to ambulatory spine surgery clinic patients within a large tertiary care network from May 2016 to September 2017 were retrospectively reviewed. Mean comparison testing was performed to measure associations between patient demographics and responses to "overall provider rating" and "recommend this provider's office" survey questions. Mean difference to achieve significance was set at α<0.05. A multivariate analysis was performed to determine independent factors. A total of 1400 survey responses from the offices of 11 orthopedic spine surgeons were included. Patients 18 to 34 years old had significantly lower responses to the overall provider rating question than older patients (P<.001), and increasing patient age was correlated with improved ratings. Highest education level was inversely correlated with satisfaction scores, with patients who had attained graduate level education having the lowest satisfaction scores (P=.001). Those with commercial insurance had significantly lower ratings for recommend this provider's office (P=.042) and overall provider rating (P=.022) questions than those with other insurance types. Patients administered the survey on paper had significantly lower ratings than those administered the survey online (P=.006). Provider ratings were significantly higher when the sex and ethnicity of the patient were concordant with the provider (P=.021). This study showed that independent, nonmodifiable factors such as age, education level, and survey mode were significantly associated with the satisfaction of ambulatory spine surgery clinic patients. [Orthopedics. 2019; 42(3):143-148.].

Association Between Patient Experience With Patient-Reported Outcome Measurements and Overall Satisfaction With Care in Neurology

BACKGROUND

There has been increasing focus on both patient-reported outcome measurement (PROM) collection and patient satisfaction ratings; nevertheless, little is known about their relationship.

OBJECTIVES

To determine the association between patient experience with PROM collection and visit satisfaction and to identify characteristics of better ratings for each.

METHODS

This cross-sectional observational study included all patients seen in 15 neurological clinics who completed PROMs as well as 6 questions on the patient experience with PROMs at least once from October 1, 2015 to December 31, 2016. Visit satisfaction was evaluated using a composite measure of physician communication, overall physician rating, and the likelihood of recommending that physician as indicated on the Clinician and Group Consumer Assessment of Healthcare Providers and Systems survey. Predictors of PROM experience and satisfaction were identified using proportional odds and logistic regression models, respectively.

RESULTS

There were 6454 patients (average age 58 ± 15 years, 59% women) who completed PROMs and responded to the Clinician and Group Consumer Assessment of Healthcare Providers and Systems survey. There were significant positive associations between each PROM experience question and visit satisfaction (r = 0.11-0.19; P<.010), although factors predicting visit satisfaction differed from those predicting PROM experience. A differential effect of PROMs on visit satisfaction was identified for patients who were nonwhite, had lower income, and had more comorbidities.

CONCLUSIONS

Although there was a significant association between better PROM experience and higher visit satisfaction, relationships with clinical characteristics differed, providing insights into how PROMs may be associated with patients' visit satisfaction. Further research is necessary to confirm whether PROMs can be used to improve visit satisfaction, particularly in patients who historically have reported lower quality of care.

A Regional Survey on Residents' Preferences on Patient-Centered Medical Home Design in Rural Areas

OBJECTIVES

This study aims to explore the rural residents' preferences on various aspects of the patient-centered medical home (PCMH) model and the associated physical environment features.

BACKGROUND

The PCMH model has gained popularity as an innovative care model that intends to improve patient experience and outcomes while reducing costs. Yet few studies focused on patients' perspective, even less considered the needs of the rural communities.

METHOD

Using a convenience sample, an exploratory survey was completed by 362 rural residents in the Midwestern region. Survey items were designed to gather information on both rural residents' preferences for five key PCMH attributes (comprehensive, patient-centered, coordinated, accessible, and quality) and of the physical environment that supports these attributes. Analyses were arranged along these key attributes.

RESULTS

Results indicated that residents' demographics affect their preferences for spatial features for PCMH. The three most important environmental factors for PCMH for the rural residents are the privacy, extra chairs in the exam room for family, and space that supports information sharing and communication among patient, family, and healthcare staff. Through structural equation modeling analysis, residents' preferences on comprehensive care, patient-centered care, coordinated care, quality, and safety have shown to affect their preference for the space features. The open-ended survey shows that rural residents are mostly satisfied with their current healthcare environment in terms of supporting patient-centered care, while other aspects still have room for future improvement.

CONCLUSIONS

Overall, this exploratory study identified important attributes of the physical environment that can support PCMH from rural residents' perspective.

[The association between normative and subjective oral health conditions and dissatisfaction with dental services among adult Brazilians]

The prevalence of dissatisfaction with dental services and its association with normative and subjective oral health conditions among adult Brazilians was evaluated. This cross-sectional study used data from the last Brazilian National Oral Health Survey (SBBrasil), conducted in 2010. It was considered a representative sample of the adult Brazilian population. Data were analyzed by descriptive, univariate and multiple statistics (OR / 95% CI), with correction by the design effect. Among the 4539 adults included in the study, 614 (13.4%) reported dissatisfaction with dental services. Dissatisfaction was higher among adults who had any decayed teeth (1.61 / 1.06; 2.44), adults who were dissatisfied with their teeth and mouth (2.36 / 1.39; 4.02) and adults who had reported toothache in the previous six months (1.99 / 1.29, 3.07). The conclusion drawn was that the prevalence of dissatisfaction with dental services among Brazilian adults was low and associated to normative and subjective oral health conditions.

The Association of Patient Satisfaction with Pain, Anxiety, and Self-Reported Physical Function

BACKGROUND

A complete understanding of the variables that influence patient satisfaction has yet to be reached. The purpose of this study was to determine whether patient-reported physical function, pain, and/or anxiety are associated with patient satisfaction in a hand and upper-extremity outpatient setting.

METHODS

This is a cohort study of 1,160 adult patients presenting to an upper-extremity (non-shoulder) clinic from January 1, 2014, to December 31, 2016, who completed functional patient-reported outcome measures (PROMIS [Patient-Reported Outcomes Measurement Information System] Physical Function, PROMIS Upper Extremity, and abbreviated Disabilities of the Arm, Shoulder and Hand scale [QuickDASH]) and psychological patient-reported outcome measures (PROMIS Anxiety and PROMIS Pain Interference) immediately prior to their physician encounter. After the clinic visit, included patients filled out the Press Ganey Medical Practice satisfaction survey online. Logistic regression models were used to predict overall patient satisfaction and satisfaction with the care provider among all, new, and return clinic visit types from the patient-reported functional and psychological measures, controlling for age and provider.

RESULTS

Among all visit types, there was a significant negative association of both pain and anxiety with patient satisfaction, whereby a 10-point increase in PROMIS Pain Interference (higher self-reported pain symptomatology) was associated with a 17% decrease in the odds of overall satisfaction (odds ratio [OR], 0.83 [95% confidence interval (CI), 0.71 to 0.98]; p = 0.03), and a 10-point increase in PROMIS Anxiety (higher self-reported anxiety) was associated with a 16% decrease in the odds of satisfaction with the care provider (OR, 0.84 [95% CI, 0.72 to 0.97]; p = 0.02). A significant positive association was found between higher levels of self-reported physical function and new-patient satisfaction with their care provider (OR, 1.22 [95% CI, 1.02 to 1.47]; p = 0.03). Among return patient visits, there was a negative association with overall patient satisfaction between both pain interference (OR, 0.76 [95% CI, 0.58 to 0.98]; p = 0.04) and anxiety (OR, 0.69 [95% CI, 0.53 to 0.89]; p < 0.01).

CONCLUSIONS

In hand and upper-extremity (non-shoulder) clinic visits, pre-encounter levels of patient-reported physical function, anxiety, and pain were significantly associated with patient satisfaction with the care provided. As the U.S. health-care system increasingly utilizes satisfaction scores in payment models and in quality assessment, these associations may influence how such metrics are interpreted and are utilized.

Physicians' experiences, attitudes and challenges in a Pediatric Telemedicine Service

BACKGROUND

Telemedicine in general, and telephone triage, in particular, is considered a high-stress clinical activity and involves decision making under conditions of uncertainty and urgency.

AIM

We wanted to explore the experiences, attitudes, and challenges of the physicians in a Pediatric Telemedicine Service operated in Israel, and to explore whether the doctors are using non-medical factors (not related to the medical problem), when making the clinical decisions in this setting.

METHODS

We used a qualitative methodology in order to obtain rich data that would reflect the participants' subjective experiences. Fifteen physicians who worked during the last 5 years in the "Pediatrician Online of Clalit" service were interviewed. Data were analyzed thematically.

FINDINGS

Seven main themes concerning the physicians' challenges during their work at this service were revealed, including difficulties diagnosing from a distance, treating unfamiliar patients, working alone, urgency and load of calls, technological obstacles, and a "moral conflict" between the desire to meet parents' expectations and maintain standards of care. The physicians stated that non-medical factors also affect their decisions.

CONCLUSIONS

In telemedicine setting, physicians face various difficulties and challenges, requiring special expertise, qualities and skills. Special measures are needed to obtain proper diagnosis and decisions.

Patients' satisfaction with HIV and AIDS care in Anambra State, Nigeria

Introduction

HIV and AIDS care requires frequent visits to the hospital. Patient satisfaction with care services during hospital visits is important in considering quality and outcome of care. Increasing number of patients needing treatment led to the decentralization of care to lower level hospitals without documented patient perception on the quality of services. The study determined and compared patient satisfaction with HIV and AIDS care services in public and private hospitals and identified the factors that influence it.

Method

This was a cross-sectional comparative study of patients receiving antiretroviral treatment in public and private hospitals in Anambra State. The sampling frame for the hospitals consisted of all registered public and private hospitals that have rendered antiretroviral services for at least one year. There were three public urban, nine public rural, eleven private urban and ten private rural hospitals that met the criteria. One hospital was selected by simple random sampling (balloting) from each group. Out of a total of 6334 eligible patients (had received ART for at least 12 months), 1270 were recruited by simple random sampling from the hospitals proportionate to size of patient in each hospital. Adapted, validated and pretested Patient Satisfaction Questionnaire (PSQ18) was interviewer-administered on consenting patients as an exit interview. A Chi-square test and logistic regression analysis were conducted at 5% level of significance.

Result

There were 635 participants each in public and private hospitals. Of the 408 patients who had primary education or less, 265(65.0%) accessed care in public hospitals compared to 143(35.0%) who accessed care in private hospital (p<0.001). Similarly, of the 851 patients who were currently married, 371 (43.6%) accessed their care in public compared to 480 (56.4%) who accessed care in private (p<0.001). The proportion of participants who were satisfied were more in public hospitals (71.5%) compared to private hospitals (41.4%). The difference in proportion was statistically significant (χ² = 116.85, p <0.001). Good retention in care [AOR: 2.3, 95%CI: 1.5–3.5] was the only predictor of satisfaction in public hospitals while primary education [adjusted odds ratio (AOR); 2.3, 95%CI: 1.5–3.4], residing in rural area [AOR: 2.0, 95%CI: 1.4–2.9], and once-daily dosing [AOR: 3.2, 95%CI: 2.1–4.8] were independent predictors of patient' satisfaction among private hospital respondents.

Conclusion

Satisfaction was higher among patients attending public hospitals. Patient’s satisfaction was strongly associated with retention in care among patients in public hospitals. However, in private hospitals, it was influenced by the patient’s level of education, place of residence, and antiretroviral medication dosing frequency.

Health care quality from the patients' perspective: a comparative study between an old and a new, high-tech hospital

Purpose

Previous studies show that the hospital environment and the behavior of health care personnel may predict patients’ perceptions of care quality. The aim of the study was to explore changes in perceived care quality from the patients’ perspective (QPP) when hospital services are relocated from an old to a new high-tech hospital and to describe what is important for patients in the high-tech hospital.

Patients and methods

A comparative cross-sectional design was used. The questionnaire QPP, which is based on a theoretical model of the quality of care comprising four quality dimensions, was used. Data were collected in 2015 (old hospital) and 2016 (new hospital), with 253 and 324 respondents, respectively, by consecutive sampling. Comparative statistics was used to test differences between patients’ care quality perceptions (perceived reality [PR] and subjective importance [SI]) (P≤0.05).

Results

The patients rated PR of all four quality dimensions (the care organization’s physical-technical conditions and sociocultural approach and the caregivers’ medical-technical competence and identity-oriented approach) higher in the new hospital. However, only the two quality dimensions concerning the care organization were rated significantly more highly. On an item level, five of the 27 items scored significantly higher on patients’ SI than on patients’ PR of the care in the new hospital, indicating a quality deficiency from the patients’ perspective. This comprised receiving effective pain relief, receiving examination and treatment within an acceptable waiting time, receiving useful information on self-care, receiving useful information on which doctors were responsible for their medical care, and having a comfortable bed.

Conclusion

The increase in care QPP was associated with improved environmental conditions, and no significant improvement in care quality was associated with the health care personnel. The results indicate that being in a high-tech environment does not improve patients’ perceptions of care quality provided by health care personnel. The results gave valuable information for quality improvement in clinical practice, based on the patients’ perspective.

Socio-demographic determinants of women's satisfaction with prenatal and delivery care services in Italy

OBJECTIVE

The aim of this study was to examine the extent to which socio-demographic variables affect women's satisfaction regarding antenatal and perinatal care.

DESIGN

To take into account the role of the context in shaping women's satisfaction, we used multilevel models, with women at the lower level, and the health districts of residence, or the hospitals in which the delivery took place, at the higher level.

SETTING

Tuscany (Italy).

PARTICIPANTS

The study is based on a representative survey focused on the satisfaction and experience of 4598 new mothers who gave birth in one of the 25 hospitals in Tuscany (Italy) in 2012.

MAIN OUTCOME MEASURES

Women's overall satisfaction in the prenatal period and their overall satisfaction during hospitalization for delivery.

RESULTS

Regarding pregnancy, women's satisfaction increased with age, and was generally higher among foreign women coming from non-Western countries and among highly educated women. Regarding delivery, age proved insignificant, whereas citizenship and education maintained the same association with satisfaction. Contrary to our expectations, the number of previous pregnancies turned out to be insignificant.

CONCLUSIONS

Our findings suggest that the quality of maternity services was perceived differently in different socio-demographic groups: women's expectations affected satisfaction, but in different ways, in various socio-demographic groups, both during pregnancy and at delivery. Keeping these socio-demographic factors into account in the analysis of satisfaction may help organisations to identify areas where pregnancy and delivery services can be better targeted and where increasing awareness among professionals in their everyday practice is most needed.