Factors determining patients' satisfaction in a family practice residency teaching center

A primary function of family medicine teaching centers is to provide residents with ongoing experiences with patients and their families. A critical issue in maintaining a stable patient population for such teaching is patient satisfaction. In the study reported here, the authors examined the factors determining patients' satisfaction. A questionnaire was mailed to a representative sample of 10 percent of the patients in a family practice in a family medical center. Seventy-eight percent of the sample responded; these respondents were representative of the sample population. Four variables were identified as significant in determining the patients' satisfaction: whether the patients felt that the time spent with their identified family physician was adequate and that the physician's explanations regarding their health care and the teaching program were clear; whether the patients felt comfortable in expressing their concerns about the teaching program to the permanent staff members; whether the patients had a positive attitude regarding the teaching program; and whether the patients felt that their identified family physician was available to them.     

Patients' evaluation of outpatient medical care

150 patients attending an outpatient clinic at the University of Oklahoma Hospital over a 5-week period were asked whether the clinic care they were receiving was better than, as good as, or worse than the care they had received from local physicians. The patients were drawn from the general medicine, cardiology, and oncology-hematology units and tended to be elderly and chronically ill. Most of the patients viewed favorably the care they received in the medical outpatient clinics. 65% reported they had experienced pain or discomfort in the week prior to their visit, but there was no association between these factors and degree of satisfaction with clinic care. Patients averaged about 30 minutes with the physician, and 80% felt the doctor adequately explained their medical condition to them. Patients who rated the clinic care as being worse than the care of private practitioners felt that their condition was not adequately explained. When asked to define a "good doctor," patient responses were "interest in the patient," "skilled and thorough," and "explains things to you." Characteristics identified as being most important in a "good clinic" were; good doctors, well-trained staff, and information from doctors. Of all the factors examined, the one associated most directly with patient satisfaction was personal interest on the part of the physician in the patients.     

Use of Electronic Medical Records in Oman and Physician Satisfaction

The Electronic Medical Record (EMR) is a computerized record of clinical, demographic and management information. EMR is an enabling technology that allows physicians to utilize quality improvement processes in the practice of medicine. Oman is one of the Middle Eastern Countries that has implemented an integrated electronic hospital information system at government health care institutions. The system was first applied in primary health care centers and then implemented in hospitals. Survey research highlights factors that affect physician satisfaction and utilizing of this new technology in a hospital setting. Outcome survey data suggests areas for improvement. Specific concerns about patient confidentiality are discussed as well as quality improvement in patient care.     

患者满意度调查及门诊护理质量改进的效果分析

目的对患者满意度进行调查，观察本院护理质量改进的效果。方法调查对象2628人，采用患者满意度调查表，对护理中存在的问题进行改进前后的患者满意度比较。结果共有252份（8．6％）问卷反映不满意问题，其中护理因素和管理因素分别为99份（3．8％）、153份（5．8％），实施护理质量改进后患者的满意度与实施护理质量改进前比较明显提高，差异有显著性（P〈0．05）。结论对患者及家属进行护理满意度调查，有利于及时地发现并改进护理中存在的问题，有利于护理质量的提高。     

质控小组管理模式在手术室护理管理中的应用效果评价

目的：探讨质控小组管理模式在手术室护理管理中的应用效果。方法首先设立6个质控小组,通过构建科护士长-护士长-质控员-专科组长四级质控体系,进行系统、有效、全方位、全过程的护理质量控制。比较质控前后护理差错率、护理纠纷率、医生护理满意度、患者满意度、季度检查各质控小组评分情况。结果（1）质控后护理差错及护理纠纷率分别为1.67%、2.50%,均显著低于质控前（6.67%、9.17%）,差异均有统计学意义（P〈0.05）,且质控后医生及患者的护理满意度评分[（96.28±15.38）分、（95.25±14.09）分]均显著高于质控前[（82.79±12.11）分、（79.96±11.08）分],差异均有统计学意义（P〈0.05）;（2）质控后各小组总体质量评分均显著高于质控前,差异均具有统计学意义（P〈0.05或P〈0.01）。结论质控小组管理模式在手术室护理管理中应用效果显著,可有效降低护理差错率及护理纠纷率,有效提高医生及患者护理满意度,值得在临床上推广应用。     

An Evaluation of Patients’ Opinions of Primary Care Physicians: the Use of EUROPEP in Gaza Strip-Palestine

The objective of this paper is to identify the level of patients' satisfaction with primary care physicians. Data were gathered from an exit interview using a standardized questionnaire (EUROPEP) and background variables. A total of 956 patients in fifteen primary health care clinics in Gaza Strip participated. Outcome measures is positive patient satisfaction (good and excellent ratings in the EUROPEP Index). As a results, the mean percentage of positive satisfaction with medical services was poor (41.8%). The poorest performance was recorded for: getting through to the clinic on the phone, being able to speak to physician on the telephone, time spent in waiting rooms and helping the patient deal with emotional problems. The comparison between clinical behaviour dimension and organization of care showed that clinical behaviour was evaluated higher. In conclusion, Palestinian patients expressed overall dissatisfaction with services provided by primary care physicians. These findings present a real challenge for Palestinian authority policy makers and administrators in terms of designing appropriate quality improvement strategies.     

The impact on patient trust of legalising physician aid in dying

OBJECTIVE: Little empirical evidence exists to support either side of the ongoing debate over whether legalising physician aid in dying would undermine patient trust. DESIGN: A random national sample of 1117 US adults were asked about their level of agreement with a statement that they would trust their doctor less if "euthanasia were legal [and] doctors were allowed to help patients die". RESULTS: There was disagreement by 58% of the participants, and agreement by only 20% that legalising euthanasia would cause them to trust their personal physician less. The remainder were neutral. These attitudes were the same in men and women, but older people and black people had more agreement that euthanasia would lower trust. However, overall, only 27% of elderly people (age 65+) and 32% of black people thought that physician aid in dying would lower trust. These views differed with physical and mental health, and also with education and income, with those having more of these attributes tending to view physician aid in dying somewhat more favourably. Again, however, overall views in most of these subgroups were positive. Views about the effect of physician aid in dying on trust were significantly correlated with participants' underlying trust in their physicians and their satisfaction with care. In a multivariate regression model, trust, satisfaction, age, and white/black race remained independently significant. CONCLUSION: Despite the widespread concern that legalising physician aid in dying would seriously threaten or undermine trust in physicians, the weight of the evidence in the USA is to the contrary, although views vary significantly.     

Patient ratings of care at a rheumatology out-patient unit

BACKGROUND: Our objective was to determine patient satisfaction with services rendered by health care personnel at the rheumatology out-patient consultation. METHODS: We carried out a cross-sectional survey at a tertiary-level care hospital in Mexico City. A questionnaire on satisfaction with quality of medical care was applied to 347 adult patients who attended the out-patient rheumatology clinic at least twice and who agreed to participate. Questions in the instrument covered three aspects of quality of care, including structure, process, and results. RESULTS: In overall assessment, 83.5% of patients reported satisfaction with care. Structure received worst score and process, the best. Outcomes (e.g., disease improvement) received intermediate scores. Correlations within these areas were strong but correlation with overall satisfaction was not high. The majority of patients stated that physician competence was the most valuable aspect of the visit; the least valuable was waiting time. CONCLUSIONS: Specific strategies need to be implemented to improve certain areas. Overall satisfaction as a measurement renders no specific and useful information due to complexity with regard to different dimensions of satisfaction.     

和谐的医患关系与病人满意度

病人满意度反映了病人的主观感受,它受到诸多因素影响,其中医患关系是影响病人对医院满意程度的重要组成因素。和谐的医患关系,是促进相互理解、信任,加强沟通,提高病人满意度,忠诚度的桥梁。建立确实有效的满意度管理机制,在提高病人满意度以及促进医患和谐的同时,带来的不仅是一个医院的声誉提高,也将促进和谐社会的关键。     

舒适护理在肛肠外科护理工作中的应用

目的：本次研究针对舒适护理在肛肠外科护理工作中的实际应用,借由对照分析证明其有临床应用价值。方法：本次研究选取该院于2014年3月至2015年3月期间就诊的肛肠科患者76例,按照本人意愿分别接受常规护理或舒适护理,每组患者38例。其中常规护理组选择常规护理手法,舒适护理组则采用心理及生理双向舒适护理法进行护理。结果：借由患者出院身体情况分析与针对护理满意度结果分析可知,舒适护理满意度高达100％,并无一例患者出现并发症现象,相较于满意度仅为84．21％,并出现6例并发症患者的常规护理更能保证患者的身心健康。结论：舒适护理在肛肠外科临床护理中拥有极为显著的应用价值,值得临床护理推广使用。     

Factors Affecting Inpatient Satisfaction: Structural Equation Modeling

Objective: Our study aimed to identify factors affecting patient satisfaction. Data: The study was conducted at a training hospital in Turkey. The final sample consisted of 302 inpatients. In this study, patient satisfaction was examined using a survey questionnaire with 22 questions collected under five dimensions. Method: Factor analysis was used to group 22 questions measuring patients’ satisfaction questions into certain dimensions. Then, structural equation model (SEM) was performed to determine the influence of patient characteristics on patient satisfaction. Results: Our analysis showed the questionnaire has an appropriate reliability and validity. The structural equation model (SEM) was used to determine those factors which could affect patient satisfaction. The results of SEM analysis showed that 15% of the total variance in patients’ satisfaction was explained by the model. The SEM analysis found that variables of education and type of clinic (surgical vs. non-surgical) were significant on patient satisfaction. Persons with a higher level of education were less satisfied when compared to those with a lower level of education. Surgical patients are more satisfied with the care they received when compared to non-surgical patients. Conclusion: The education level of patients and the type of clinics had a significant influence on patient satisfaction.     

医生执业环境满意度的结构方程模型研究

目的 了解公立医院医生执业环境满意度影响因素,据此提出政策建议,优化医疗执业环境,提高医生的工作满意度.方法 对5677名公立医院医生进行执业环境满意度调查,运用结构方程模型对执业环境满意度影响因素进行分析.结果 公立医院医生对执业环境的总体满意度为(2.86±1.09)分;有33.8%的被试对医疗执业环境表示满意;制度环境对执业环境满意度的影响最大(β=0.772,P<0.01),医患沟通次之(β=0.096,P<0.01),社会舆论对执业环境满意度的影响差异无统计学意义.结论 提高医生对执业环境的满意度应以健全宏观制度环境为重点.     

护理标识在手术室护理管理中的应用研究

目的 研究手术室护理标识在手术时风险管理中的应用.方法 2012年1月～2012年12月以四川省简阳市人民医院手术室为单位,将5～8号手术室作为A组（23例）,将9～12号手术室作为B组（23例）,A组患者在常规护理的基础上实施护理标识管理,B组患者全部实施常规的护理风险管理.采用问卷调查的方式对A组的护士工作压力进行分析,并将其与B组护理人员的压力进行对比.比较患者的投诉率和满意度、医生的满意度、护理用药过程中出现的差错率,以及护理人员的主要压力源.结果 A组患者的满意度得分[（72.9±23.6）分]显著低于B组[（86.2±25.1）分],A组患者满意度及医生满意度（96.3％,87.4％）显著高于B组（74.8％,66.7％）.A组投诉率与差错率（0.2％,0.2％）显著低于B组（0.9％,0.6％）.B组护理人员对时间分配、工作量大小等方面的工作问题感到紧张,B组手术室护理人员压力较A组大（P＜0.05）.结论 手术室采用护理标识进行风险管理,可以有效提高患者满意度,减少护理人员的压力源,减轻护理人员工作紧张感,减少差错率,提高效率.     

Ethical dilemmas for house staff physicians. The care of critically ill and dying patients

Winkenwerder describes a disagreement about proper management of a critically ill patient that arose during his tenure as a house staff physician. Despite the attending physician's consideration of the family's wishes and the best interests of the patient, the resident was uneasy with the decision to continue life-prolonging treatment and the role he was to play in implementing such procedures. The author argues that ethical decisions within the group of physicians caring for a patient, especially one who is terminally ill, are not always resolved to everyone's satisfaction. What then are the rights and duties of residents to refuse further participation in care? Winkenwerder suggests dealing with conflicts through recognizing value differences, increasing formal ethics teaching, using consultants, and maximizing communication among members of patient care teams.     

Creating a physician Web site: Part 2

An individual physician web site is a valuable augmentation to a professional practice. Enhancing patient care and increasing customer satisfaction are the most important goals of a physician web venue. Broadening your patient base, improving practice efficiencies, helping ensure corporate compliance, and decreasing liability exposure can also be accomplished by a well thought out and constructed site. Pages presenting information about the practice, the delineation of patient responsibilities, and evidence-based clinical content information will constitute the majority of the site. A user agreement and disclaimer page, feedback page, and corporate compliance page constitute the supplementary pages on the site.     

医患人员门诊就医满意度的综合分析及对策

为了解门诊病人对护理工作满意度的因素，为进一步提高护理服务质量提供依据，采用自行设计的问卷对600例患者进行调查，有针对性地分析影响门诊病人对医院护理工作满意度的因素。通过分析找寻到了有效提高病人满意度的合理途径，建议医院全盘综合考虑，加强护理服务意识，重视人文关怀，落实提高护理质量及护理人员的服务主动性。     

Self-referral in point-of-service health plans

CONTEXT: Most health maintenance organizations offer products with loosened restrictions on patients' access to specialty care. One such product is the point-of-service (POS) plan, which combines "gatekeeping" arrangements with the ability to self-refer at increased out-of-pocket costs. Few data are available from formal evaluations of this new type of plan. OBJECTIVES: To comprehensively describe the self-referral process in POS plans by quantifying rates of self-referral, identifying patients most likely to self-refer, characterizing patients' reasons for self-referral, and assessing satisfaction with specialty care. DESIGN: Retrospective cohort analysis using administrative databases composed of members aged 0 to 64 years who were enrolled in 3 POS health plans in the Midwest (n = 265 843), Northeast (n = 80 292), and mid-Atlantic (n = 39 888) regions for 6 to 12 months in 1996, and a 1997 telephone survey of specialty care users (n = 606) in the midwestern plan. MAIN OUTCOME MEASURES: Self-referred service use and charges, reasons for self-referral, and satisfaction with specialty care. RESULTS: Overall, 8.8% of enrollees in the midwestern POS plan, 16.7% in the northeastern plan, and 17.3% in the mid-Atlantic plan self-referred for at least 1 physician or nonphysician clinician visit. The proportions of enrollees self-referring to generalists (4.7%-8.5%) were slightly higher than the proportions self-referring to specialists (3.7%-7.2%) across all 3 plans. Nine percent to 16% of total charges were due to self-referral. The chances of self-referral to a specialist were increased for patients with chronic and orthopedic conditions, higher cost sharing for physician-approved services, and less continuity with their regular physician. Patients who self-referred to specialists preferred to access specialty care directly (38%), reported relationship problems with their regular physicians (28%), had an ongoing relationship with a specialist (23%), were confused about insurance rules (8%), and did not have a regular physician (3%). Compared with those referred to specialists by a physician, patients who self-referred were more satisfied with the specialty care they received. CONCLUSIONS: Having the option to self-refer is enough for most POS plan enrollees; 93% to 96% of enrollees did not exercise their POS option to obtain specialty care via self-referral during a 1-year interval. The potential downside of uncoordinated, self-referred service use in POS health plans is limited and counterbalanced by higher patient satisfaction with specialist services.     

Service quality in health care

Although US health care is described as "the world's largest service industry," the quality of service--that is, the characteristics that shape the experience of care beyond technical competence--is rarely discussed in the medical literature. This article illustrates service quality principles by analyzing a routine encounter in health care from a service quality point of view. This illustration and a review of related literature from both inside and outside health care has led to the following 2 premises: First, if high-quality service had a greater presence in our practices and institutions, it would improve clinical outcomes and patient and physician satisfaction while reducing cost, and it would create competitive advantage for those who are expert in its application. Second, many other industries in the service sector have taken service quality to a high level, their techniques are readily transferable to health care, and physicians caring for patients can learn from them.     

医院人文关怀制度化对患者满意度的影响及其分析

目的探讨护理人文关怀对整体护理质量的影响。方法对1000例住院患者随机分为实验组和对照组,对照组采用传统的整理护理,实验组实施整理护理的同时进行人文关怀护理,通过问卷调查,以比较两组患者满意度的差异。结果人文关怀组的患者的满意度明显高于对照组,其差异具有统计学意义（P〈0.05）。结论人文关怀制度化对提高患者对医院的满意度具有重要意义。     

PATIENT SATISFACTION IN PROSTHETIC REHABILITATION PROGRAMME

Patient satisfaction is an important outcome measure independent of other outcomes. Its measurement is important to assess the effectiveness of a programme and to gain insight into the patients'' perception of the programme. In this study conducted in a large rehabilitation centre it was found that majority of patients express satisfaction with care inspite of perceived discomfort. Various demographic factors, severity or duration of the disability or the level of rehabilitation do not influence patient satisfaction. Patients express more concern with aspects such as delay in issue of the prosthesis, or hotel component of the hospital services. Patients did not appear too concerned about the level of information provided. Patient satisfaction is an individual reaction to the overall care process and is influenced by the initial expectation level of the patient. Emotional response of the patient appears to be more important determinant of patient satisfaction than the cognitive evaluation. Periodical assessment of patient satisfaction should be an important component of any programme evaluation exercise.KEY WORDS: Amputation, Patient satisfaction, Programme evaluation, Prosthesis, Quality of care, Rehabilitation