Patients' and relatives' satisfaction with psychiatric services in a large catchment area in Rome.

OBJECTIVE: To assess the satisfaction of patients and their relatives with psychiatric care and to identify variables associated with any dissatisfaction. METHODS: The study was performed in a defined psychiatric catchment area in south Rome, Italy. All eligible patients and relatives who had contacts with services during a predefined period were asked to participate. Satisfaction with psychiatric services was measured with a previously validated questionnaire. RESULTS: A total of 890 patients were asked to participate in the study and 855 (96%) accepted. Also, 270 relatives were asked to participate and 265 (98%) agreed. The satisfaction with services expressed by outpatients and their relatives was fairly good, with the exception of poor satisfaction with information about treatment and involvement in the treatment programme. The satisfaction of inpatients and their relatives was significantly lower, with the issue of information-giving by staff appearing particularly critical. Among patients, variables associated with dissatisfaction were being an inpatient, having a diagnosis of psychosis, being in contact with services for more than 6 years, and being single. Among relatives, being female and being the relative of an inpatient were associated with dissatisfaction. For both patients and relatives, receiving inpatient care was the strongest predictor of dissatisfaction. CONCLUSIONS: The results suggest that inpatient care, especially for psychotic patients, needs to be improved and that special attention should be devoted to inform adequately and to engage in treatment both patients and their relatives. Lack of information appears to be a crucial determinant of dissatisfaction with psychiatric care among both patients and their relatives.     

Patient satisfaction with inpatient psychiatric care

The aim of the study was to investigate the influence of personality traits, diagnosis and perceived coercion on patient satisfaction with inpatient psychiatric care. The study was performed as a cross-sectional study on 7 inpatient wards in southern Sweden. A cohort of 50 psychiatric inpatients evaluated satisfaction with care and also made ratings on a personality questionnaire. Patients with a higher level of the trait aggressive nonconformity were significantly less satisfied with the ward's physical and psychosocial environment, the treatment design and the treatment program. The phenomenon of acquiescence was not related to the reported level of satisfaction. Analyses of patient satisfaction according to diagnostic groups showed that patients with affective disorders had significantly better satisfaction than patients with a diagnosis of schizophrenia. Patients who perceived that they were involuntarily admitted were measured as being significantly less satisfied with the care in all areas. It is concluded that, to attain a higher specificity in analyses of variation in patient satisfaction, focus may be put on situational and setting factors of the care delivered along with specific patient characteristics. Risk groups, which require great attention in the development of quality assessment and quality assurance policies, are patients with schizophrenia and patients who perceive coercion in connection with inpatient psychiatric treatment.     

Consumer satisfaction with an adolescent inpatient psychiatric unit.

OBJECTIVE: To explore factors influencing the satisfaction of patients, parents, and referring clinicians who used the services of an adolescent inpatient psychiatric unit, and to explore how levels of satisfaction related to the patient's symptomatic and functional improvement during the admission. METHOD: All 105 adolescents, their families, and the referring community clinicians who used an inpatient service over a 1-year period were asked to rate the patient's symptoms and functioning on admission, at discharge, and 4 months after the patient's return to the community. We obtained satisfaction ratings at discharge, and consumers were asked to rate helpfulness of the ward experience at 4 months postdischarge. Ward psychiatrists provided Children's Global Assessment Scale (CGAS) ratings and diagnoses over the course of the inpatient stay. RESULTS: Most of the patients (83%) improved during their admission. Consumer satisfaction ratings correlated with improvement of self-identified problems and with the perceived usefulness of discharge recommendations. Satisfaction did not, however, correlate with the patient's symptomatic and functional progress. Interaction with ward staff was an important source of both positive and negative experiences. CONCLUSION: Our study indicates that inpatient psychiatric staff should attend closely to the consumer's perception of difficulties and the need for practical discharge recommendations.     

Patient satisfaction with psychiatric care. Historical perspective, methods and results from the international literature

Whereas evaluations of patients' satisfaction have been made in the U.S. beginning in the early 50's, there has been an increasing interest in German-language countries only in recent years. The present article summarizes the aims, methods and results of patient satisfaction surveys. A selection of questionnaires comprising the Client Satisfaction Questionnaire (CSQ, 43), the General Satisfaction Questionnaire (GSQ, 37) and the Verona Service Satisfaction Scale (VSSS, 72) is described in detail. The vast majority of the published studies suggest a high rate of general satisfaction with psychiatric inpatient services, whereas most of the more specific findings remain less well demonstrated. The main problem involved with this type of survey seems to be the term "patient satisfaction", which is defined as the relation between the patient's expectations in regard to psychiatric services and the perception of the service the patient has received. This means that the level of patient satisfaction itself does not allow a conclusion to be drawn on the objective quality of a psychiatric treatment. Nevertheless the authors are convinced of the importance of patient satisfaction questionnaires when these questionnaires are part of a quality assurance program.     

Stationäre psychiatrisch-psychotherapeutische Depressionsbehandlung

During 1998-2000 a quality assurance program for diagnosis and treatment of depression was conducted in 24 hospitals for psychiatry and psychotherapy in Baden-Wurttemberg (southern Germany). Process and outcome quality of 3,000 depressive patients was documented at admission and discharge. The article focuses on therapeutic measures, duration, outcome, patient satisfaction, and their interactions. The results show that the patients' satisfaction with the care received is very high and the pre-post effect sizes of inpatient treatment for depression are high.     

Evaluation of an inpatient service by consumer feedback.

Over the past few years, the Sound View-Throgs Neck Community Mental Health Center has conducted a number of studies of client satisfaction with our services. The findings suggest that the majority of clients are generally satisfied with the help they receive. However, the level of satisfaction apparently depends on specific aspects or features of the program being evaluated, as well as the particular unit which is providing the services. We have used face-to-face, telephone, and mail survey procedures in these studies; and we have sampled both clients who have completed their treatment and those in the early phases of the treatment process. In one of the studies, the former SVTN-CMHC patients we surveyed had been hospitalized in the inpatient unit located at Bronx Municipal Hospital Center. We randomly selected one hundred patients who had been discharged from the unit during the first six months of 1971. After excluding children under the age of sixteen, patients who were subsequently hospitalized or were too symptomatic to be interviewed, and those living outside New York City, we interviewed twenty-five ex-patients. We asked questions about their feelings related to the need for hospitalization, their present problems, whether hospitalization had helped them, their satisfaction or dissatisfaction with ward life, and their feelings about discharge. The results indicated that these ex-patients felt at least moderately satisfied with their hospital experience. However, they were relatively dissatisfied with provisions for privacy on the ward, the fact that doctors and other hospital staff were not readily available to them, the doctor's understanding of their problems, and the evening recreation programs. There was some discrepancy between the ratings, which were mostly favorable, and the comments, which were predominantly unfavorable. There are various possible explanations for this, ranging from the limited validity of rating items in such a study to the possibility that this group of ex-patients were so accustomed to negative experiences that their overall assessments were not significantly influenced by them. There is some possibility that the highly positive ratings may stem from an unexpected source. For approximately half of the sample, the major purpose of hospitalization was to provide an opportunity to get away from their usual surroundings. The in-hospital treatment per se was relatively unimportant to them, and their favorable ratings may be a way of indicating that the hospital simply served as a refuge, which they were seeking. Since a patient may approach the hospital with self-defined needs either for treatment or mainly for refuge--it may be worth while to provide alternative programs to meet these different needs. A "refuge" program, for example, may not require an in-hospital environment; and even if it does, the staffing pattern should be different from that of a hospital with a treatment-oriented program.     

Patient satisfaction with gender identity clinic services in the United Kingdom

Measuring patient satisfaction is important in assessing healthcare outcomes due to the growing emphasis on greater partnership between providers and consumers. National Health Service (NHS) commissioning bodies in the United Kingdom increasingly expect patient satisfaction to be included as a service performance indicator as it is regarded as part of the definition of quality of care. The aim of this survey is to better understand levels of satisfaction with current gender identity clinic services (GICs) provision and to identify areas for improvement. A Patient Satisfaction Questionnaire (PSQ-GD) was developed specifically for use in GICs in the United Kingdom, which was given to all patients during one month. PSQ-GD covers clinical care, administrative and procedural issues as well as patient experience of local service provision from their General Practitioner, local psychiatric services and speech therapy. A total of 330 PSQ-GD were given with a response rate of 85%. Ninety-four percent would recommend the services if a friend or relative had a gender-related problem. Twenty percent were dissatisfied with the level of support for others close to the patient. Thirty-one percent were dissatisfied with local psychiatric services. Twenty-seven percent were dissatisfied with the wait for the first appointment. Administration scored high on satisfaction. A total of 222 positive and 131 negative comments were made. The PSQ-GD offers an opportunity to understand levels of satisfaction with current gender service provision and identifies areas for improvement, most notably the interface between GICs and local psychiatric services. Findings from this study put individual complaints in perspective and show that despite the challenges inherent in providing transgender care good satisfaction can be achieved. We encourage gender care providers to implement quality assurance and improvement procedures to give people with gender dysphoria the opportunity to provide feedback and have a voice in shaping their own health care.     

Satisfaction with mental health services. A user participation approach

User participation in the delivery and evaluation of mental health services has become an important policy element in the development of these services. An important area where user involvement could be especially useful concerns satisfaction with care, which has become considered an important indicator of service excellence. The overall aim of this study was to investigate user satisfaction with mental health services in a county in southern Sweden. The study design used persons with own experience from being a patient or a close relative to a patient as active participants in the data collection. A group of 20 persons with experience from being users or relatives to users were recruited and trained to be interviewers in the study. Together they performed 227 interviews focusing user satisfaction regarding both inpatient and outpatient care. The interview had one quantitative part and one qualitative part. The interviewers' experiences from participation in the project were evaluated through focus groups. In these groups, the topics were the interviewers' impression of the content of their interviews and their experience from being an interviewer. The analysis showed a high satisfaction with care in the quantitative part. In the qualitative part a significant dissatisfaction with many aspects of the care were expressed. The focus group evaluation largely supported the findings from the analyses of the dataset. Experiences of being user and interviewer were generally positive and perceived as rewarding.     

Development and application of a brief multi-faceted tool for evaluating inpatient psychiatric care

Increasingly, hospitals are expected to monitor and document service delivery variables, such as treatment outcome and patient satisfaction with care, which are thought to be associated with the quality of care received by patients. Documenting the patient's collaboration in the treatment-planning process also has become more important. However, for many clinically oriented units, translating these expectations into a useable instrument and an efficient measurement procedure is a complex and difficult task. This paper outlines the development of a brief multi-faceted program evaluation instrument and assessment process for completing these tasks. The authors describe the rationale behind their approach to these measurement issues, and they introduce an instrument capable of effectively measuring both outcome and satisfaction. They also provide an overview of how they apply the instrument in their inpatient psychiatry service. The strengths and weakness of this assessment strategy are reviewed.     

Satisfaction with care reported by psychiatric inpatients Relationship to diagnosis and medical treatment

In this survey, 274 patients were sent a questionnaire concerning satisfaction with psychiatric treatment and the ward 1 month after their discharge from hospital. Fifty-two percent of the patients responded. Answers to the 56 items of patient satisfaction were analyzed in relation to patient diagnoses and treatment given. Patients who were diagnosed as suffering from affective disorders or from reactive psychoses were more satisfied than patients with schizophrenia or paranoia or with transitory adjustment reactions. Patients who had no personality disorder diagnosis and patients with character neurosis were more satisfied than patients with antisocial or borderline personality disorders. Patients on antidepressant medication were much more satisfied than other patients. The results of the study are discussed with regard to the need of further research in this area and to quality assurance.     

Psychopharmacology training in psychiatric residency programs: the Canadian scene

A survey among psychiatric residents about their satisfaction with and concerns about their training in psychopharmacology was conducted. One hundred and seventy responders (61%) from ten post-graduate psychiatric programs in Canada completed the questionnaire. The questionnaire assessed the residents' satisfaction with the training they had received over the previous six months as well as over their entire residency period. The questionnaire inquired specifically about the quantity and quality of supervision in the use of different medications for different therapeutic purposes. It also looked at the quality of supervision of drug therapies within hospital services, inpatient, outpatient, consultation and emergency services. Residents also were asked about coverage of specific topics and ranked different methods of learning. The survey uncovered a number of deficiencies mostly related to the teaching of basic psychopharmacology, integration of psychopharmacological and psychosocial issues and the lack of teaching of clinical appraisal of recent advances. Factors that may have contributed to the development of such deficiencies as well as specific recommendations are discussed.     

User satisfaction with child and adolescent mental health services

BACKGROUND: Child and adolescent mental health service units (CAMHS) play an important role in the supply of services to children and adolescents with mental illness. The purpose of this study was to examine the service unit effect on parent satisfaction with outpatient treatment. METHOD: The study was undertaken in 49 of 72 Norwegian outpatient CAMHS in 2004. A total of 2253 of the parents who were asked to participate (87%) responded. Parent satisfaction was measured using two summated scales: clinician interaction/information and treatment outcome. Multilevel analyses were used to assess the contribution of the service units to satisfaction and to investigate patient level predictors of parent satisfaction. RESULTS: About 96-98% of the parent satisfaction variance could be attributed to factors within CAMHS, leaving only 2-4% of the variance attributable to the CAMHS level. Parents of patients aged 0-6 years were more satisfied than older patients' parents. Longer treatment episodes were positively associated with satisfaction. Parents whose children had been referred with externalizing symptoms were less satisfied with treatment outcome than those referred for internalizing symptoms. Waiting time was negatively associated with treatment outcome satisfaction. Adjustments for patient characteristics did not substantially change the relative effect of CAMHS on satisfaction ratings. CONCLUSION: The results indicate that information from user satisfaction surveys has clear limitations as an indicator of CAMHS quality. From a quality improvement perspective, the factors affecting the variance within CAMHS are of dominating importance compared to factors affecting between CAMHS variance.     

Determinants of patient satisfaction: treatment and clinical factors,subjective concept of the illness and quality of life

The aim of this study was to examine the associations between treatment factors, clinical factors and treatment satisfaction of psychiatric in-patients. Especially, the authors were interested in the question, whether treatment satisfaction in general and patient experiences in detail are equally affected by the factors mentioned above. Data were obtained from 91 in-patients of the Psychiatric Department of the Ludwig-Maximilians-University of Munich (85 % of all patients who had been in hospital since at least 3 weeks) by questionnaires on a fixed day. Global satisfaction and patients experiences with special aspects of the services were correlated to sociodemographic variables, diagnosis, psychopathological syndromes, actual mood state, patient's concept of the illness and quality of life. Global satisfaction and the rating of special treatment components are differently affected by the patients actual mood state and prior hospitalizations. Effects of gender, diagnosis and psychopathology are low; there is no correlation between education and satisfaction on both levels. In contrast, both rating levels correlate significantly with general trust in medication and physician. There are only weak correlations between global satisfaction and quality of life. Data indicate that global and specific satisfaction ratings are different in regard to some determinants but at the same time they are both affected by attitudinal factors.     

A systematic review of factors associated with service user satisfaction with psychiatric inpatient services

BackgroundSatisfaction is seen as an indicator of the quality of mental health services and has been related to outcomes and compliance with treatment. The current review seeks to examine the factors relating to satisfaction with inpatient services.MethodA search was conducted of PsycInfo, Web of Science, Cinahl, Embase and Medline databases. Screening resulted in 32 papers being included in the review. Papers were subject to quality assessment using the Mixed Methods Appraisal Tool (MMAT).ResultsReview of the included papers suggested factors relating to satisfaction could be broadly classified as either service user or service/ward related. Service user related factors included findings that satisfaction was higher when service users were admitted voluntarily. Service related factors included findings that satisfaction was negatively associated with experiences of coercion and positively associated with being on an open ward.ConclusionIt appears that coercion has a key role in ratings of satisfaction. Additionally, service users reported an impact of staff relationships, and the ward environment. Satisfaction is associated with a range of factors, an awareness of which will allow for the development of quality services that meet the needs of service users.     

Patients' Experiences of and Satisfaction with Care for Their Epilepsy

Summary: Purpose: To determine condition-specific satisfaction with care, we studied patients'experience of general practitioner (primary physician) and hospital clinic care for their epilepsy and their views about the provision of information concerning the management of their condition. Methods: A postal questionnaire was sent to an unselected, community-based population of patients with epilepsy. In addition to clinical and demographic details and previously validated scales of psychosocial well-being, the instrument contained a series of questions about patients'experiences and views of the care they received for epilepsy from both general practice and the hospital services. Results: Doctors'interpersonal skills were the most influential factors affecting both patient satisfaction overall and the likelihood that doctors might discuss with patients certain clinical and social issues surrounding the management of the patient's condition. A sizable proportion of patients reported that they received insufficient information, about epilepsy, both from hospital doctors and general practitioners. Conclusions: Patients with epilepsy place great importance on having a doctor who is approachable, communicative, and knowledgeable and on receiving adequate information about their condition. Clinicians may need to be made more aware of the importance of accessibility and sensitivity to the nonclinical needs of their patients. Such easily implemented changes in the delivery of care would improve services in the United Kingdom for people with epilepsy.     

Consumer satisfaction at a child and adolescent state psychiatric hospital

OBJECTIVE: This study examined satisfaction with services among patients in a child psychiatric hospital and their parents, and assessed the relationship between consumer satisfaction and the perception of improvement in the problem that led to hospitalization. METHODS: A consumer satisfaction survey developed by the investigators was administered to three sampling waves of child and adolescent psychiatric inpatients (N=157) and their parents or guardians (N=111). Ninety-five percent of patients contacted and 97 percent of their parents or guardians agreed to participate in the study. The survey provided data about the children's and parents' satisfaction with inpatient care and their perceptions of the children's clinical improvement. RESULTS: Most parents and children reported high satisfaction with patient care. Twenty-eight percent of children and 21 percent of parents reported some form of abuse by the staff during the hospital stay. Those who reported abusive behavior were significantly less satisfied with the hospital experience than those who did not report abuse. The participants' perception of clinical improvement was only weakly related to their satisfaction. CONCLUSIONS: Most child psychiatric patients and their parents will participate in consumer satisfaction surveys about inpatient care. Consumers are critical of a hospital if specific prompts in the survey are provided. An unexpectedly high level of consumer-reported abuse was found. Consumer-perceived clinical improvement was only weakly related to satisfaction.     

Adverse Impact of Coercive Treatments on Psychiatric Inpatients’ Satisfaction with Care

Consumers’ satisfaction with inpatient mental health care is recognized as a key quality indicator that prospectively predicts functional and clinical outcomes. Coercive treatment experience is a frequently cited source of dissatisfaction with inpatient care, yet more research is needed to understand the factors that influence consumers’ perceptions of coercion and its effects on satisfaction, including potential “downstream” effects of past coercive events on current treatment satisfaction. The current study examined associations between objective and subjective indices of coercive treatments and patients’ satisfaction with care in a psychiatric inpatient sample (N = 240). Lower satisfaction ratings were independently associated with three coercive treatment variables: current involuntary admission, perceived coercion during current admission, and self-reported history of being refused a requested medication. Albeit preliminary, these results document associations between patients’ satisfaction ratings and their subjective experiences of coercion during both current and prior hospitalizations.     

Adolescents’ Perspectives About Brief Psychiatric Hospitalization: What is Helpful and What is Not?

Significant numbers of adolescents receive inpatient psychiatric services, yet we know little about their experiences: what about hospitalization is perceived as helpful and what is counter-productive or even harmful? In this study, eighty adolescents hospitalized for the first time in a psychiatric program were interviewed within a week of discharge (using a semi-structured interview format), and asked to describe what did and did not help them. Multiple themes emerged relating to helpful experiences and these were grouped in three categories: interpersonal support, therapy and psycho-education, and environment; Unhelpful/harmful experiences were classified in four categories: rigidity and confinement, lack of treatment responsiveness, frightening/anxiety-provoking experiences, and other. Participants provided rich feedback that both reinforces existing practices and offers ways for programs to change practices to better meet adolescents’ developmental needs. Some factors noted as key therapeutic ingredients, especially the helpful role of peers, have not previously been included in hospital satisfaction surveys.     

Collaboration of the general practitioner and the psychiatrist with the psychiatric hospital. A literature review

Co-operation of physicians in private practice with psychiatric hospitals was investigated in Germany scarcely until now, although evaluation of consumer satisfaction is of great importance to quality assurance in psychiatry. In this paper, findings from previous studies are presented together with data from interviews with general practitioners and psychiatrists, evaluating their expectations regarding psychiatric hospitals. Substantial problem area in collaboration is referral to the psychiatric hospital. Apart from sociodemographic and disease-related variables, referral practice depends on referring physician's attitudes and competence in psychiatry, and provider influences like delay of admission, communication with referring physician, and competence of the hospital. As conclusion, constructive collaboration must be developed at the interface of outpatient and inpatient care. On account of increasing diversification of psychiatric services, functional network should be an ongoing goal to improve treatment continuity of patients with mental disorders.     

Computergestützte Patientenbefragungen als Grundlage für eine moderne Qualitätssicherung in der Psychiatrie Ergebnisse der Pilotstudien

We report on a novel computer system for psychiatric patients that runs an interview procedure on the outcome and quality of care (e.g. well-being, mood, satisfaction with treatment). Patients are asked to perform the interviews on a daily basis and on their own initiative. The information is meant to provide feedback to the therapeutic team. In the pilot studies we investigated the feasibility and acceptance of the computerised interviews. Four computer systems with touchscreen input were integrated into the routine of an open inpatient ward and of the day hospital of a psychiatric university clinic for a period of 17 weeks. The patients' attendance and the acceptance of the interviews were good. Patients were able to interact with the touchscreen terminals without greater problems. Accurate and valid data were recorded. Because of some problems with the administration of the patients' identification numbers we develop suggestions how to improve the computer systems. Possible applications of the computerised interview system in quality assurance and research are discussed.