Use of telephone interviews to follow up patients after total hip replacement

We studied the feasibility of telephone interviews to assess hip function in patients who had had a total hip replacement. One hundred patients attending the orthopaedic clinic for follow-up after undergoing total hip replacement were studied. A modified Harris hip score was used. Since range of motion and deformity cannot be assessed by telephone, only pain and function were assessed. The maximum possible score was 100. Patients attending follow-up clinics were contacted by telephone one to two weeks prior to their appointment and a telephone assessment was completed. This was then compared with a face-to-face assessment in the subsequent clinic. The mean hip score obtained with the telephone interview was 85.2 and the mean hip score at face-to-face assessment was 86.1. The mean of the differences between the individual scores was -0.9 (SD 5.5). This difference was not significant ( P=0.11). Only three patients had a clinically significant difference (>20 points) between the two methods. Telephone questionnaires may be a useful adjunct to face-to-face assessment for patient follow-up after total hip replacement.     

Does telephone follow-up predict patient satisfaction and readmission?

Nursing telephone calls after hospital discharge are commonly adopted as a tool to improve patient satisfaction and continuity of care. Previous research, however, has been inconclusive on the impact of telephone follow-up. The purpose of this study was to comparatively examine patients who received telephone follow-up for response differences on a mail satisfaction survey and 30-day readmission rates for a large health system in southeast Texas. Telephone follow-up, patient satisfaction, and administrative billing data from 2008 to 2009 were retrospectively examined across 10 nursing units that routinely performed calls after patient discharge. Patients eligible to receive a nursing call (N = 10,559) were categorized based on responses to nursing questions or if no contact was made. Logistic regression was used to evaluate whether call data significantly predicted survey response and 30-day readmission rates. Nonparametric analysis was used to evaluate whether survey ratings varied between groups. Completion of telephone follow-up was a significant (P < 0.01) predictor of patient response to the mail survey, with 62% more patients returning surveys after contact. Completion of a nursing call with a patient who reported a physician appointment was a significant predictor (P = 0.04) of lower 30-day readmissions. Readmission rates were 10.8% for patients who did not receive telephone follow-up compared to 9.5% for patients who received a call and who had a scheduled physician appointment. Mean nursing and overall satisfaction scores varied minimally between groups and telephone follow-up was not a significant predictor of patient satisfaction. Telephone follow-up shows significant predictive value for mail survey response and 30-day readmission rates but does not correlate with patient satisfaction scores in the hospital setting.     

Determinants of adolescents’ satisfaction with health care providers and intentions to keep follow-up appointments

Objective: To better understand the determinants of adolescents' satisfaction with their health care providers and to examine the relationship among satisfaction, intention to return for follow-up, and appointment-keeping behavior.

Methods: One hundred and twenty-four adolescent patients attending a university-based general adolescent medicine clinic were surveyed prior to the visit about their attitudes regarding provider behavior. After the visit, subjects completed a questionnaire on provider behavior during the visit, satisfaction with the visit, and intention to keep their follow-up appointment.

Results: Multivariate regression analysis revealed that pre-visit attitudes about providers' style of behavior predicted satisfaction (β = 0.252; p < 0.01). After controlling for pre-visit attitudes, perceptions about providers' style of behavior proved to be a strong predictor of visit satisfaction (β = 0.512; p < 0.01). Visit satisfaction was associated with intention to keep scheduled follow-up appointments (r = 0.327; p < 0.01). However, subjects with greater intention to return were not more likely to keep their follow-up appointments.

Conclusion: Provider behavior is an important determinant of adolescents' satisfaction with their health care.     

Receipt of Home Health Care After Early Discharge: Results from a National Managed Care Organization

Objectives: To determine the frequency of home visits during the postpartum period among women discharged within 24 hours after childbirth, to identify characteristics of women who received at least one home visit, and to examine whether a home visit was related to postpartum experiences. Method: Women who were enrolled in a Prudential HealthCare® plan and had a recent normal vaginal delivery completed a 15-minute telephone survey (N = 5201). Only women who were discharged within 24 hours after delivery were included in this analysis (N = 3121). Selected variables, including maternal characteristics, pregnancy-related and postpartum experiences, and social support factors, were compared for women who received visits and those who did not receive visits within two weeks after delivery. Results: Slightly more than 30% of women participating in the survey received at least one home health care visit within 2 weeks after delivery discharge. Women who received a home visit were more likely to be Black, employed, primaparous, enrolled in a health maintenance organization, or not living in the Southern United States. Compared with women who did not receive a home visit, women who received a visit were more likely to have their newborn receive a phenylketonuria test after discharge, receive a follow-up phone call or housekeeping service, and access to a 24-hour hotline. Conclusions: Managed care organizations as well as other organized systems of care should be focused on improving the quality of prenatal and postpartum services, and increasing satisfaction of women using these services.     

Telephone follow-up and self-performed urine pregnancy testing after early medical abortion: a service evaluation

IntroductionTelephone follow-up with a self-performed low-sensitivity urine pregnancy (LSUP) test was introduced at the Royal Infirmary of Edinburgh, Scotland, as an alternative to routine ultrasonography for confirming successful abortion at 2 weeks following early medical abortion (<9 weeks' gestation). Women who screened ‘positive’ at telephone follow-up on the basis of ongoing pregnancy symptoms, scant bleeding or LSUP test result subsequently attended the clinic for a confirmatory ultrasound.MethodsA service evaluation was conducted of the first 8 months of telephone follow-up consisting of a review of the numbers choosing this method of follow-up, the proportion successfully contacted and the efficacy for detecting ongoing pregnancies. In the last 3 months of the study, women were surveyed about their satisfaction with this method of follow-up.ResultsOpting for telephone follow-up were 476 out of 619 women (77%). Four women (1%) attended the clinic before telephone follow-up because of pain or bleeding. A total of 410 (87%) of the remaining 472 women were successfully contacted by telephone. Sixty women (15%) screened ‘positive’, three of whom had ongoing pregnancies, and one woman falsely screened ‘negative’. The sensitivity of the telephone follow-up was 75% [95% confidence interval (CI) 30.1–95.4], and specificity was 86% (95% CI 82.2–89). The negative predictive value was 99.7% (95% CI 98.4–99.9), and positive predictive value was 5% (95% CI 1.7–13.7). All women surveyed (n=75) would recommend telephone follow-up to a friend.ConclusionA telephone follow-up and an LSUP test at 2 weeks are effective for detecting ongoing pregnancy, have good follow-up rates and are popular choices for women.     

Emotional reactions in women attending a UK colposcopy clinic.

STUDY OBJECTIVE--To assess the emotional responses of women attending a colposcopy clinic for investigation of an abnormal cervical smear, and to elicit the women's views on the screening service and colposcopy clinic. DESIGN--Over 12 months all new attenders at a colposcopy clinic were invited to join the study. They were assessed psychiatrically four weeks before their first clinic appointment, and four weeks and 32 weeks after their first clinic appointment. SETTING--Colposcopy clinic, John Radcliffe Hospital, Oxford. PATIENTS--Of 114 women attending the colposcopy clinic for investigation of an abnormal cervical smear, 102 agreed to enter the study. MEASUREMENTS--Psychiatric symptoms were assessed with a standardised psychiatric interview, the present state examination; and with four self rated mood scales:--the general health questionnaire, the Beck depression inventory, the Leeds depression scale, and the Leeds anxiety scale. MAIN RESULTS--On all these measures, in the whole patient group, psychiatric morbidity was found to be transient and relatively minor. Thus ratings on the present state examination were not significantly higher than the rate found in a community sample of 520 women in Oxford, while on the four self rated mood scales, mean total scores were lower than the cut off value used to distinguished cases. Patient satisfaction with the colposcopy services was generally high but there was some dissatisfaction with delays. CONCLUSIONS--After an abnormal cervical smear, further investigation by colposcopy is generally associated with low levels of anxiety and depression.     

Outpatient satisfaction: validation of a French-language questionnaire: data quality and identification of associated factors

OBJECTIVES: Following 1996 legislation requiring French hospitals to assess patient satisfaction, this study developed and validated a brief French-language multidimensional questionnaire designed to measure outpatient satisfaction with hospital visits and compared data quality for two patient-satisfaction survey methods. DESIGN: Authors developed a 19-item questionnaire following a strict procedure (identification of dimensions to explore, formulation, and selection of items). SETTING: Validation data were obtained from patients of six outpatient clinics in a teaching hospital. PARTICIPANTS: 586 consenting eligible patients were randomized to receive the questionnaire 2 weeks after their visit with one of two survey methods: a mailed self-administered questionnaire or a telephone interview. RESULTS: The response rate (79%) was not significantly different between the two survey methods. The risk of having one or more missing values was higher in the mail survey group (odds ratio, 1.65; 95% confidence interval, 1.03-2.63), but mail respondents were less likely to use the "extremely positive" response category. Principal component analysis identified four factors that accounted for 56% of the variance: interpersonal skills and information transfer, physical surroundings, convenience, and appointment delay. Patients' comments on open-ended questions validated the semantic content of the factorial construct. The internal consistency coefficient was greater than 0.70 for three of four subscales. Patient background characteristics accounted for less than 10% of the factorial score variance. Patient satisfaction was correlated with age, type of visit, and, to a lesser extent, gender and education level. CONCLUSION: This easily administered, multidimensional out-patient-satisfaction questionnaire provided encouraging preliminary psychometric characteristics.     

Predictors of acceptance of a postpartum public health nurse home visit: findings from an Ontario survey

OBJECTIVES: To determine 1) rates of offer and uptake of a home visit provided through Ontario's universal Hospital Stay and Postpartum Home Visiting Program, and 2) predictors of acceptance of a home visit. METHODS: Women were eligible to participate if they had given birth vaginally to a live singleton infant, were being discharged with the infant to their care, were competent to give consent, and could communicate in one of the four study languages. A self-report questionnaire was used to collect data from 1,250 women recruited from five hospitals across the province; 890 (71.2%) women completed a structured telephone interview 4 weeks following discharge. RESULTS: Most women (81.4% to 97.8%) reported having received a telephone call from a public health nurse, although not necessarily within 48 hours of discharge. While the offer of a home visit reportedly was high across sites, there were statistically significant differences in rates of acceptance (40.8% to 76.2%). Important predictors of acceptance were first live birth, lower social support, lower maternal rating of services in labour and delivery, poorer maternal self-reported health, probable postpartum depression, lower maternal rating of services on the postpartum unit, and breastfeeding initiation. CONCLUSION: The home visiting component of the universal program is reaching most women through telephone follow-up. However, rates of acceptance of a home visit differed greatly across study sites. The findings suggest that it is women with specific problems or needs who are accepting a visit. Further research is necessary to guide the development of evidence-based programs and policies regarding postpartum nurse home visits.     

Compliance with follow-up appointments generated in a pediatric emergency room

We studied all follow-up visits generated by initial emergency room (ER) visits made over the course of one year by patients enrolled in a pediatric primary care clinic (PCC). A total of 2,552 ER visits were made by 714 patients, 960 (37.6 percent) of these resulting in a follow-up visit. Of the 960, (82.4 percent) resulted in appointments to the PCC, with a 53.9 percent compliance rate; and 169 (17.6 percent) resulted in appointments to the ER, with an 89.3 percent compliance rate (p less than .001). Factors found to be associated with greater compliance with follow-up appointments were (1) the appointment being made to the ER rather than to the clinic, (2) the child being less than 18 months of age, (3) the patient having private insurance, and (4) an initial ER diagnosis of trauma, seizure, or burn. Factors found to be unrelated to compliance with follow-up visits were the patient's sex (when corrected for trauma cases), race, having a chronic condition, having a telephone, length of time as a clinic enrollee, distance from home to hospital, and type of primary provider (physician versus nurse practitioner).     

Can computerized decision support help patients make complex treatment decisions? A randomized controlled trial of an individualized menopause decision aid.

PURPOSE: To compare the effectiveness of an individualized decision aid (DA) with standard educational materials on decisions about menopausal treatments and to assess the feasibility of integrating this DA into clinical practice, with and without coaching. METHODS: We conducted a 3-armed randomized controlled trial in 3 clinics, enrolling menopausal women between the ages of 45 and 65 years with primary care appointments. Of the 145 women included, 99 completed a 2-week follow-up. The control group received generic educational materials, 1 intervention group received an individualized computer-generated DA mailed to patients and their clinicians before clinic appointment, and the 2nd intervention group received the same DA along with coached care before clinic appointment (DA + CC). Decisional conflict, satisfaction, and knowledge were measured 2 weeks after clinic appointment. RESULTS: Participants' mean age was 52 years, and 97% were white. Most women (98%) read all or most of the documents. Decisional conflict was significantly lower in both intervention groups but not in the control group. DA reduced decisional conflict from preintervention to postintervention (pre-post change) by 0.70 (SD = 0.56) points (on a 1-5 scale), compared to reductions of 0.51 (SD = 0.51) and 0.09 (SD = 0.44) for the DA + CC group and the control group, respectively. Satisfaction with the decision made was significantly higher at 2 weeks in the DA v. control group. Self-reported knowledge significantly improved in DA + CC compared to controls. CONCLUSION: Our decision aid lowered decisional conflict and improved patient satisfaction; adding coaching provided little additional benefit.     

Using patient surveys to measure the quality of outpatient care in Kraków, Poland.

OBJECTIVE: To test the feasibility of using patient reported information to create indicators of quality (access, patient experience--including satisfaction, and clinical quality) with the goal of providing Kraków city clinic managers (and potentially other audiences) with information about the quality of outpatient care in selected clinics. Setting and methods. Almost 2,000 patients from 19 outpatient clinics in Kraków, Poland were surveyed in November and December 1997 and January 1998. We prepared a self-completed questionnaire to capture data about the patient's experience with access to services, interactions with registration staff, communication with the doctor, information received from the doctor, and receipt of preventive services. RESULTS: Access varied across clinics. For example, 84% of patients waited less than 10 minutes at registration, whereas only 53% of patients waited less than 30 minutes to see the doctor. Among those who tried to register by telephone, only 72% were successful. Satisfaction was highest with the doctor visit (satisfaction=79, on a scale of 1-100) and lowest with telephone registration (satisfaction = 59). Preventive health care screening was generally disappointing, particularly for Papanicolaou smear and clinical breast examination, although frequent users of a clinic (with more opportunities for screening) generally had higher rates of screening. CONCLUSION: We demonstrated the feasibility of constructing indicators of multiple dimensions of the quality of outpatient care using patient-reported information. Quality dimensions captured by survey included access, patient experience and clinical quality. Results were successfully summarized in easy to read and understand formats for clinic managers and city health department officials.     

医院患者就医满意度问卷调查法和电话调查法的差异化比较

目的：研究问卷调查和电话调查两种方法调查患者满意度的优劣。方法分别采用问卷调查法和电话调查法对出院患者就医满意度进行调查,比较两种方法每小时的调查人数和患者的满意度。结果问卷调查组每小时调查的患者人数为8人,电话调查组每小时调查的患者人数为15人;电话随访组病人满意度为90.73%,问卷调查组患者满意度为95.61%。两种调查方式比较,每小时的调查人数和患者的满意度差异均有统计学意义（P 〈0.01）。结论电话随访调查法优于问卷调查法。     

User satisfaction is influenced by the interval between a health care service and the assessment of the service

In order to improve the quality of patient care, questionnaires are often used to identify user’s experiences and evaluations, but only a few studies have examined whether measuring user satisfaction at different time points influences the assessment of health care. Several studies have shown equivalency between paper and electronic patient reported outcomes; however, none of these studies have considered the fact that electronic questionnaires are usually completed at the hospital, while paper questionnaires are typically completed at home weeks after the visit. In order to ensure that the comparison of results collected by the two different methods are not biased, the aim of this study was to determine if the interval between an outpatient visit and the assessment of the quality of care influences user satisfaction and to compare response rates between questionnaires completed at different times. In a follow-up study, parents from a paediatric outpatient clinic in Denmark were quasi-randomised to 1 of 3 groups: group 1 completed an electronic questionnaire on a touch screen computer in the outpatient clinic and a paper questionnaire 3–6 weeks after the visit; group 2 completed a paper questionnaire in the outpatient clinic and a paper questionnaire 3–6 weeks after the visit; and group 3 completed a paper questionnaire 3–6 weeks after the visit. A total of 1148 parents completed at least 1 questionnaire. User satisfaction was significantly lower when the assessment was made after a visit to the outpatient clinic compared to an assessment made at the clinic. The response rates of questionnaires completed at the clinic were significantly higher than the response rates of questionnaires completed after the visit. Both the timing of surveys and response rates need to be taken into consideration when planning user surveys. Outcomes from surveys conducted at different times are not readily comparable.     

A prospective study of immediate initiation of depo medroxyprogesterone acetate contraceptive injection

Traditional protocols for depo medroxyprogesterone acetate (DMPA) initiation mandate that women start the method during the first 5-7 days of the menstrual cycle. Women who do not have their initial clinic visit during this time period are generally instructed to return to clinic during menses to begin DMPA, which often leaves them insufficiently protected from pregnancy. An alternative approach is to give women the injection immediately during the clinic visit, regardless of menstrual cycle day. In this prospective study, we evaluated a protocol for immediate DMPA initiation among 149 women who presented on cycle day 8 or later. Ninety-two percent (n = 137) of subjects returned for a follow-up pregnancy test, but half of all subjects required multiple reminders to return for the visit. There were three pregnancies. Forty-seven percent (n = 70) continued to a second DMPA injection or another contraceptive method within 14 weeks of their initial clinic visit. Factors associated with returning for repeat injection included satisfaction with DMPA, older age and finding it easy to return for the follow-up pregnancy test visit.     

出院患者对随访干预形式满意度调查分析

目的:加强对出院患者规范化管理。方法:问卷抽样调查2009年5月唐山市协和医院出院后接受随访的患者200人,内容主要为出院患者对随访这种干预形式的满意度情况。结果:经过六个月的随访后患者的满意度明显高于随访过一个月的患者,包括用药指导、复诊指导、心理帮助等。结论:出院后患者对随访这种干预形式有较高的满意度,医院应重视出院后管理,为出院患者提供更全面的健康服务。     

Patient satisfaction with telemedical access to specialty services in rural California

We assessed patient satisfaction with the use of telemedicine in rural California, in comparison with usual face-to-face care. A standardized patient satisfaction questionnaire was developed using a five-point scale to measure dimensions of care in a telemedicine environment. Twenty-four primary care sites in 18 Californian counties submitted satisfaction data. The patient response rate was 61% (n = 793). Consultations were provided in 27 specialties. The responses to the questionnaires indicated that telemedicine made it easier for patients to receive specialty care (91% of patients satisfied, mean score 4.6). There was general satisfaction with telemedicine (87%, mean 4.5), a willingness to continue receiving services (90%, mean 4.6) and most patients felt that they would not receive better care in person (61%, mean 2.3). Patients stated that they received the necessary information from specialists (85%, mean 4.5) and had their questions answered by a primary care provider or nurse (89%, mean 4.7). Seven hundred and forty-one patients submitted travel information. There was an average decrease in travel distance of 170 km and time savings of 130 min using telemedicine. The average cost of travel to a specialty appointment was $83 (n = 310). The present study suggests that telemedicine is acceptable to patients as a method of improving access to specialty expertise, and compares favourably with face-to-face care.     

Patient satisfaction with store-and-forward teledermatology

We assessed patient satisfaction with a nurse-led store-and-forward teledermatology service in Manchester. A teledermatology nurse obtained the patient's history, took digital photographs of the patient's skin lesion and then sent the information to a hospital dermatologist, who responded with management advice the following week. Of 141 patients who attended their teledermatology appointment, 123 (50 male, 73 female) completed the study questionnaire (87%). The average age of respondents was 42 years (SD 17, range 18-90 years). Ninety-three per cent reported that they were happy with the teleconsultation while 86% reported that it was more convenient than going to the outpatient clinic. Forty per cent agreed that they would feel more comfortable seeing the dermatologist in person while only 58% were comfortable with not speaking to the dermatologist about their skin condition. The absence of interaction with the dermatologist and the delay in receiving management advice may have contributed to the somewhat low satisfaction rates.     

Mental health and satisfaction with primary health care in female patients.

PURPOSE AND OBJECTIVES: Patient satisfaction is an important outcome in patient care and is increasingly being used as an indicator of quality of care within large health systems. This study examined whether consideration of specific mental health factors, including posttraumatic stress disorder (PTSD), can improve our understanding of patient satisfaction in primary care settings. METHODS: Questionnaires were mailed to all women who used the VA San Diego Healthcare System primary care clinic in 1998. Two hundred twenty-one (56%) women who were invited to participate in this study completed questionnaires. Participants provided information about physical and mental health and satisfaction with their primary medical care. RESULTS: Age and general mental health were negatively associated and PTSD was positively associated with overall satisfaction with care and satisfaction with the provider. General mental health was significantly related to satisfaction with the clinic. CONCLUSIONS: These findings support the importance of specific mental health symptoms, and trauma-related symptoms in specific, in determining satisfaction.