The cataract service satisfaction tool: Development and validation of a new tool to assess patient satisfaction with cataract services

An evaluation of intracameral mydriasis for routine cataract surgery

BACKGROUND

Intracameral Mydrane might facilitate a more streamlined cataract service and improve the patient experience. There is limited 'real-world' evidence of its use in a UK setting.

METHODS

As part of a local evaluation of cataract surgery using intracameral Mydrane (group 2; n=60), data were collected on intraoperative pupil size and postoperative visual acuity (VA), as well as the rate of mechanical pupil dilation, intraoperative floppy iris syndrome (IFIS) and complications. Preoperative and theatre turnaround time was recorded and patients completed a validated measure of satisfaction postoperatively. Data were compared with a previous cohort subjected to the existing standard regime of preoperative topical mydriatics (group 1; n=60).

RESULTS

Postoperative VA was comparable between groups (0.09±0.16 vs 0.08±0.15; p=0.59). Pupil size in group 2 was 7.0±1.0 mm prior to capsulorhexis and 6.5±0.29 mm after cortical aspiration, with a smaller pupil in patients on alpha-antagonists (4.7±1.1 mm; p=0.004) at this later time point. Comparing group 2 with group 1, preoperative waiting was less (87 vs 146 min; p<0.0001) and satisfaction was higher (76.0±11.2 vs 66.3±8.6; p<0.0001), although theatre turnaround time was longer (25 min vs 22 min).

CONCLUSION

Intracameral mydriasis was clinically effective in most patients undergoing cataract surgery and might be associated with an improved patient experience and a more streamlined preoperative flow. Mydrane represents a licensed alternative to the off-label use of other intracameral mydriatic agents, but was not judged to be a cost-effective intervention for routine use in this particular setting.

Patient satisfaction with clinicians in colorectal 2-week wait clinics

AIM

To determine if patient satisfaction is affected by the clinician (nurse or doctor), conducting the colorectal 2-week wait (2ww) clinics.

METHODS

A prospective non-randomised comparative cohort study of 339 consecutive patients (divided by blind allocation into nurse-led (n=216) and doctor-led (n=123) cohorts) conducted over a 3-month period. Patient satisfaction in both cohorts was assessed by an adapted version of the Grogan et al validated patient satisfaction questionnaire. The questionnaire was piloted first and was found to have high internal reliability (Cronbach's alpha=0.91).

RESULTS

The study had a response rate of 78% (n=258/331) and overall satisfaction scores showed 85% (n=149/175) of patients in the nurse-led cohort and 65% (n=54/83) of patients in the doctor-led cohort strongly agreed that they were satisfied with the care they received. Mean overall satisfaction scores in the two cohorts revealed that the nurse-led cohort achieved significantly more 'strongly agree' responses than the doctor-led cohort (p<0.001, CI: 95%). Further analysis of the responses to each question demonstrated statistical significance when comparing the two cohorts.

CONCLUSIONS

The study offered patients the opportunity to reflect on service delivery enabling a more responsive approach to health care within the colorectal 2ww service. It found that patient satisfaction was affected by the clinician conducting the 2ww clinic, in that the nurse-led cohort displayed significantly higher patient satisfaction. However, there are areas that merit further research.

Indonesian public healthcare service institution’s patient satisfaction barometer (IPHSI-PSB)

Purpose

– The purpose of this paper is to develop and test a new public healthcare patient satisfaction index (PSI) in Indonesia. More clearly, the index measures overall patient satisfaction and its determinants.

Design/methodology/approach

– Literature review was performed to identify the determinants of patient satisfaction. Data collection was carried out by using survey with questionnaire. The survey involves 161 patients of one public healthcare service institution in Tangerang, Indonesia. The authors conducted some statistical analyses, namely exploratory factor analysis, Cronbach α analysis, and multiple regression analysis.

Findings

– A new public healthcare PSI was developed and tested. The index consists of overall patient satisfaction and its determinants. The determinants include the quality of healthcare delivery, the quality of healthcare personnel, the adequacy of healthcare resources, the quality of administration process, perceived value, perceived sacrifice, and image. Furthermore, the new index was called as IPHSI-PSB.

Research limitations/implications

– This research was carried out only in Tangerang, Indonesia and only involved one public healthcare service. Hence, the index needs to be tested in different cities in Indonesia. Furthermore, it is also needed to involve more public healthcare service institutions in future researches.

Practical implications

– Public healthcare service managers can use IPHSI-PSB to monitor, measure, and improve the patient satisfaction of the public healthcare service institution they manage.

Originality/value

– This paper has developed and tested a new public healthcare patient satisfaction index.

Meta-analysis: methodological confounders in measuring patient satisfaction

The study aimed to identify methodological confounding factors affecting patient satisfaction survey results. The data gathered from CINAHL and PubMed databases consisted of 355 surveys published from 2006 to 2012. Linear regression and Bayesian models, with seven potential survey-related confounders together with patient age and gender as explanatory variables, were constructed. According to the linear model, up to 12% of the original variation in patient satisfaction was explained by confounding variables, not by the actual variation in satisfaction. The presence of an interviewer resulted in lower satisfaction levels, and the satisfaction results correlated negatively with the number of items in the questionnaire. According to the Bayesian model, if patients were over 60 years old and the questionnaire consisted mainly of positively phrased items, the probability of rating their experiences as very satisfied was 75%. The Bayesian and linear models endorsed each other and revealed specifically that the surveys reporting high patient satisfaction could be predicted on the basis of confounding variables. The following recommendations are given for constructing a patient satisfaction survey: use neutral rather than negatively or positively phrased items, and use enough items to increase the likelihood that the least satisfactory care components are also included in order to better enable comparisons across sporadic surveys.