Optimizing primary care telephone access and patient satisfaction

Telephone medicine is often preferred by patients to meet primary care needs and may be associated with high patient satisfaction. This article presents findings about incoming patient calls to primary care for medically based reasons during office hours and reports factors independently associated with telephone encounter satisfaction, considering patient characteristics, call reasons, and staff responsiveness, for a national cohort of primary care users. Interviews were conducted with patients from 18 nationwide primary care clinics during the fall of 2009. Calling for an urgent medical issue was associated with dissatisfaction. Odds of call satisfaction were greater when patients thought staff was friendly (10×), call answer was timely (5×), and needed medical information was provided (7×). These findings can be used for interventions to optimize telephone access and patient satisfaction which is beneficial because satisfactory telephone encounters reduce primary care use and satisfied patients are more likely to be engaged in their health care.     

护理干预在慢性肾炎患者中的护理满意度评价

目的 研究讨论护理干预在慢性肾炎患者中的应用效果。方法 选取某院2017年2月—2018年2月慢性肾炎疾病患者106例,随机将其分为2组,即常规护理的53例为对照组,循证护理服务的53例为研究组,对比2组患者的护理满意度。结果 2组患者经过不同护理服务后,研究组满意度是96.22%,高于对照组的79.24%(P<0.05)。结论 慢性肾炎患者在常规护理的基础上采取循证护理能够有效地提高患者的护理满意度,促进患者病情改善,值得推广和应用。     

Medical advice by telephone at Swedish health centres: who calls and what are the problems?

Advice by telephone is an important activity at Swedish health centres and is mainly dealt with by nurses. This telephone counselling was studied during one week (Monday to Friday) at six Swedish health centres which were representative of rural as well as of urban populations. Based on the figures obtained from this study it could be calculated that about 20 million calls of this type are dealt with at Swedish health centres each year (population of Sweden about eight million). It was more common for women than for men to contact the health centre by telephone. About 70% of the calls were made by the patients themselves. Pain was the most common reason for contacting the health centre by telephone, followed by signs of infection. The majority of the telephone calls dealt with sick care, a minority were classified as administrative. About 40% of all calls were managed by the telephone adviser without involving the doctor at the health centre. Of all incoming calls, 44% resulted in an appointment time for a visit to a physician at the health centre, more than half of these being given for a visit during the same day. As the telephone counsel function is an important part of the activity at a Swedish health centre, it is important to evaluate its content and consequences.     

Inpatient and ambulatory patient satisfaction with nursing care

This study reports on the development and psychometric testing of inpatient and ambulatory patient satisfaction scales designed to measure patient satisfaction using the standards of nursing practice within a medical center. The surveys were administered to patients 4-6 weeks after discharge from the hospital or following a clinic visit. A total of 619 inpatient and 955 ambulatory patient questionnaires were analyzed. Factor analyses suggest there exist four scales for inpatient satisfaction anf five scales for outpatient satisfaction with high reliability and reasonable validity.     

Obtaining information on patient satisfaction with hospital care: mail versus telephone.

Many objectives of the study examined here were to develop a questionnaire useful in eliciting the perceptions of patients regarding their hospital care, to compare the methodologic and substantive differences between a mail survey and a telephone survey of patients done approximately a week post discharge, and to develop methods allowing the questionnaire to be administered by an organization other than the hospital. Two independent surveys were conducted at the same hospital--a telephone survey with a telephone follow-up, and a mail survey with a telephone follow-up. The study demonstrated that an organization external to the hospital can economically conduct a patient satisfaction survey of a representative patient sample while ensuring confidentiality and producing potentially useful results. The mail survey was preferred over the telephone survey due to lower cost, lower chance of biased responses, and complete assurance of confidentiality. The aspects of hospital care most influencing patient satisfaction related to nursing services.     

Role dilemmas among health-workers in cross-cultural patient encounters around dietary advice

AIM: The aim of this paper is to explore Norwegian health workers' experiences from cross-cultural patient encounters, and how they understand and enact their role when meeting patients with Pakistani background to whom they give dietary advice related to type 2 diabetes. METHODS: Qualitative in-depth interviews have been performed with six hospital dietitians and six general practitioners in Oslo. RESULTS: The health workers consider themselves to be patient-centred and stress the importance of the two dimensions, empathy and equality. However, they often experience that patients want them to be more authoritarian, a way of acting that would be totally in disagreement with their convictions, although some occasionally do adopt an authoritarian style. More striking is that some health workers' moral engagement to involve and empower patients actually leads them to be authoritarian. For others, a fear of insulting the patient results in their advice being too diffuse. CONCLUSIONS: A possible explanation for such ways of responding to the patient may be that the health workers, in their articulation of patient-centredness, draw on a repertoire of social conduct that involves an effort to level out, or tacitly deny, hierarchic structures, and that this becomes more pronounced in cross-cultural encounters. Patient-centredness and empowerment are results of long ongoing processes in Western countries, based on ideals of equality and individual freedom. The results from this study indicate that these approaches may pose intricate dilemmas for the health workers in their cross-cultural encounters, and need further attention.     

A telephone survey of patient satisfaction with realtime telemedicine in a rural community in Colombia

We conducted a telephone survey of all patients referred to a realtime telemedicine consultation at the Centre for Telehealth in Bogotá. Over a six-month period, 281 teleconsultations were conducted, and we were able to retrieve telephone numbers for 156 patients. Of these, 121 patients (78%) agreed to answer the questionnaire. Eighty percent of the respondents were satisfied or very satisfied with the teleconsultation and 63% would use telemedicine again. Sixty-five percent thought that telemedicine improved their medical care. More than 50% believed that telemedicine had a positive effect in terms of medical care improvement, time- and cost-savings. Twenty-seven percent felt that teleconsultation was not as good as a traditional face-to-face consultation. Lack of familiarity with ICT did not appear to act as a major barrier to telemedicine, and cognitive factors may be more important in acceptability to patients and their satisfaction. The results of the present study may also be relevant to the poorest countries of the world, where two-thirds of the population live in rural areas.     

Distance from practice moderates the relationship between patient management involving nurse telephone triage consulting and patient satisfaction with care

The ESTEEM trial was a randomised-controlled trial of telephone triage consultations in general practice. We conducted exploratory analyses on data from 9154 patients from 42 UK general practices who returned a questionnaire containing self-reported ratings of satisfaction with care following a request for a same-day consultation. Mode of care was identified through case notes review. There were seven main types: a GP face-to-face consultation, GP or nurse telephone triage consultation with no subsequent same day care, or a GP or nurse telephone triage consultation with a subsequent face-to-face consultation with a GP or a nurse. We investigated the contribution of mode of care to patient satisfaction and distance between the patient׳s home and the practice as a potential moderating factor. There was no overall association between patient satisfaction and distance from practice. However, patients managed by a nurse telephone consultation showed lowest levels of satisfaction, and satisfaction for this group of patients increased the further they lived from the practice. There was no association between any of the other modes of management and distance from practice.     

某医院住院病人满意度调查及其影响因素分析

目的了解医院住院及出院病人的满意度情况，为提高医疗服务质量提供参考。方法采用自制的调查表，分别调查医院的住院及出院病人满意度。结果本调查表测得克朗巴哈的α信度系数为0．98．调查表总分与各项目分的相关系数绝大部分大于0.5。绝大部分病人的满意度评分在8分以上。行风情况得分最高，医护人员（包括医生、护士和其它医务人员）次之，出入院处理和工作效率及辅助检查位居第3，后勤管理是第4位，收费情况得分最低。住院病人与出院病人对医院的评价没有统计学差异。影响病人总评分的关键因素是护士的技术水平、等候手术时问、经治医生检查是否认真负责、病房的整洁安静程度和是否有乱收费现象等指标。病人的建议集中在后勤管理方面。结论①本调查表的信度和效度较高，可尝试作为量表使用；②病人对该医院的总体评价较高，但对后勤管理和收费方面的评价相对较低并要求改进；③出院病人和住院病人对医院的评价没有差别；④提高病人满意度应该从技术、服务、效率和费用等方面入手。     

A comparison of patient satisfaction among prepaid and fee-for-service patients

This study compares levels of patient satisfaction (a valid, indirect measurement of quality of care) between prepaid and fee-for-service patients. A chart audit approach was used to determine whether prepaid and fee-for-service patients seen in an academic family health center at the end of the first six months of a new cost-containment program were comparable in terms of demographic characteristics and indirect measures of health and health behavior. Next, using a 26-item patient satisfaction questionnaire, 436 patients from a single group of providers in the same family health center seen six months after the programs began were randomly surveyed. Sociodemographic and health-related characteristics of prepaid and fee-for-service patients were similar for both groups in the chart audit. There was no statistically significant difference between the overall satisfaction levels of prepaid and fee-for-service patients. Individual constructs that comprise general satisfaction were also statistically similar except for an unexpected finding of dissimilar levels of satisfaction with "physician conduct/humaneness" (P less than .05). Assessed from at least one standpoint, cost containment does not seem to affect overall quality of care, but further investigation is needed, especially in the realm of "physician conduct/humaneness."     

Predictors of leaving nursing care: a longitudinal study among Swedish nursing personnel

Objectives

Despite extensive research on turnover among nursing personnel very little is known about the impact of physical workload and health on leaving. The aim of this study was to find predictors for leaving nursing care with special reference to physical working conditions and musculoskeletal problems.

Methods

This study is based on longitudinal data from a survey of nursing personnel who were employed at various county hospitals in Sweden from 1992–95. A self administrated follow up questionnaire was used to identify their present position in the labour market. The response rate was 73% (n = 1095).

Results

The results showed that nursing personnel reporting musculoskeletal problems of the neck/shoulder or knees and those who had limited use of transfer devices were more likely to leave nursing care.

Conclusions

The study highlights the importance of taking musculoskeletal problems and use of transfer devices into consideration in order to retain nursing personnel.     

Different integration processes of patient satisfaction among four groups

We examined integration processes of patient satisfaction among four groups of patients and found that these groups of patients combined their health care attribute reactions differently to form their overall satisfaction. For the study, we used an emerging noncompensatory model in health care and considered an interaction effect in the analysis. We discuss the implication of the different integration processes of patient satisfaction for health care managers and make practical suggestions for more effective and efficient means of increasing patient satisfaction.     

Calling for confirmation,reassurance, and direction: Investigating patient compliance after accessing a telephone triage advice service

Understanding the influence of a telephone triage advice service (TTAS) on patients seeking care is critical to realize enhancements in patient care, functioning of emergency departments (EDs), and effectiveness of the health system. This study addresses the question: what influence does a TTAS have on a patient's attendance at an ED and the wider health system? Records from 2016 to 2017 of 12,741 calls from a national TTAS were linked to 72,577 ED presentations to a hospital in regional Australia, retrospectively. Matching criteria included patient within the hospital's statistical local area code, age, gender, and ED attendance within 8 hours of TTAS call. Five statistical analyses of the data were conducted. There were 2857 matches. TTAS patients accessing the ED had a slightly higher proportion of women and a greater proportion of children under 4 years than usual. When TTAS confirmed callers' inclination for ED care, however only up to 69% subsequently attended the ED. When TTAS redirected others initially less inclined to more urgent care, up to 62% attended the ED. TTAS empowers vulnerable patients to access appropriate and timely services and promotes clinical and functional integration of care. Improvements of TTAS can come through investigation of callers' compliance factors.     

A follow-up comparison of patient satisfaction among prepaid and fee-for-service patients

This study reports the results of a follow-up patient satisfaction survey that sampled patients enrolled in a capitation program and compared their satisfaction levels with otherwise similar patients in a fee-for-service program two years after the programs began. On a scale of 1 (very dissatisfied) to 5 (very satisfied), the mean general satisfaction level for 158 prepaid patients was 3.17 +/- 0.70, and 3.42 +/- 0.61 for 87 fee-for-service patients (P less than .05). This finding contrasts with no differences seen in a previous study of the same populations at six months after the programs began (mean general satisfaction levels of 3.26 and 3.36 for the prepaid and fee-for-service patients, respectively). A statistically significant difference also existed in the subdimension "technical aspects of quality of care": 3.38 +/- 0.65 for prepaid patients, and 3.61 +/- 0.53 for fee-for-service service patients (P less than .05). Levels of satisfaction within other individual constructs were similar for both groups and tended to remain the same over two years, although satisfaction with access to care decreased among prepaid patients, and satisfaction with continuity of care increased among fee-for-service patients. These data support the hypothesis that overall satisfaction levels and certain aspects of patient satisfaction may be compromised by a capitation program.     

开展优质护理服务对病人满意度的影响

目的?研究提供优质的护理服务对提高病人满意度的影响.方法?随机抽取我科2011年1月—6月及2012年1月—6月各200例住院病人,采用我院自行设计的《护理工作调查表》进行满意度调查.结论?实施优质护理服务后病人满意度对比之前有了较大提高,差异有统计学意义(P<0.05),因此需要坚持以病人为中心,进一步提升护理服务,提高病人满意度.     

Sexual interest,activity, and satisfaction among male nursing home residents

Structured interviews were conducted with all male residents (n = 116) of a Veterans Affairs Nursing Home to gather information on sexual interest, preference, activity levels, satisfaction, and distress. We excluded males with severe cognitive impairment, leaving a sample of 61. Of these, 30 had partners. Sexual interest was significantly higher among those with partners (p = 0.014), although those without partners reported that their interest would have been higher if they had a sexual partner. Sexual preference was strongly in favor of vaginal intercourse, regardless of the presence or absence of a partner. Among those with partners, coitus was reported to occur at least monthly by 17%, and other forms of sexual activity (e.g., hugging, kissing) were practiced at least monthly by 73%. Sexual satisfaction was high, and distress with relative sexual inactivity was remarkably low. We found age, functional status, and intercourse frequency to correlate positively with sexual satisfaction, whereas marital status, cognitive function, libido, and frequency of kissing were positive correlates of sexual distress. Institutionalized elderly males remain sexually interested, especially in coitus, and may benefit from counseling and home visits when a partner is available.