Life style intervention in general practice: Effects on psychological well-being and patient satisfaction

The objectives of this study were to: (1) study if an opportunistic screening of coronary heart disease (CHD) risk factors among male attenders in general practice (GP) influenced the overall subjective satisfaction with life of persons labelled high risk compared to other screened persons; (2) compare psychological well-being and patient satisfaction in a patient centred and self-directive (PCSD) intervention with conventional care (CC); and (3) evaluate patient satisfaction and psychological well-being among subjects with high CHD risk during a one year intervention study. Effects of labelling were evaluated in 115 subjects with high CHD risk in comparison with a low risk reference population. The 22 participating GP centres were randomly allocated to follow either a PCSD intervention or a CC approach. An overall satisfaction with life question was employed and psychological well-being were measured using the General Health Questionnaire (20 item version). Satisfaction measures on health care aspects were also included. No difference of change between the high risk and the reference population was found concerning satisfaction with life after screening. No significant difference of change was found within or between the PCSD and the CC group concerning emotional well-being or overall satisfaction with life during one year intervention. Satisfaction with the care received was significantly better in the CC group as compared with the PCSD group (p=0.02). Satisfaction with own efforts for improving health was, however, more pronounced in the PCSD group (p=0.01). A substantial number (n=61) of the participants reported distaste of being reminded of the risk of heart disease and no more than 60 of the participants were satisfied with their own efforts for improving health. Although no significant change of satisfaction with life and emotional well-being due to screening or intervention could be detected, clinicians should be aware that encouraging patients to change life style may lead to patients' annoyance of being reminded of the risk of disease and dissatisfaction with their own efforts. Increasing patient responsibility and self-determination may improve their satisfaction with their own efforts, but reduce satisfaction with medical care.     

Waiting in the emergency room: how to improve patient satisfaction

The authors conducted a field experiment in which emergency-room patients of a metropolitan hospital were either given or not given an expected waiting time to see a physician. Patients were then surveyed through the mail on their satisfaction and perceptions of service quality. The results revealed that satisfaction levels were higher when patients believed that they had received information on expected waiting time. Regression analysis revealed that service quality dimensions of trust, responsiveness, and staff service were significant predictors of patient satisfaction. In addition, satisfaction was independently influenced by whether patients' prior timeliness expectations were confirmed. The authors discuss the results in terms of the concept that the situational context of the service may influence the quality dimensions that most affect consumer satisfaction.     

The effect of patient origin and relevance of contact on patient and caregiver satisfaction in the emergency room

AIMS: This study examined (1) whether patient and caregiver satisfaction in the emergency room (ER) varies according to patient origin, and (2) whether relevance of visit can explain any variation. METHODS: Data were obtained from a questionnaire survey of walk-in patients and their caregivers at four ERs in Copenhagen. The patient questionnaire was available in nine languages, and addressed patient satisfaction. The caregiver questionnaire addressed caregiver satisfaction and relevance of the patient contact in the ER. A total of 3,809 patients and 3,905 caregivers responded. The response rate among patients was 54%. Only data with both patient and caregiver responses and with patient country of birth were included in the analyses (n=3,426). The effect of patient origin was examined using bivariate, stratified analyses and tested for independence. RESULTS: Patients and caregivers had lower satisfaction rates when patients were of Middle Eastern compared with Danish origin. Satisfaction of both groups was associated with the relevance of the visit as assessed by the caregiver. Visits by patients of Middle Eastern origin were less often assessed as being relevant, but caregivers were less satisfied with visits by these patients even after controlling for relevance. Differences in patient satisfaction by patient origin were no longer significant when stratifying by relevance. CONCLUSIONS: Patient and caregiver satisfaction among patients of foreign origin can be improved by lowering the number of irrelevant visits among patients of foreign origin, e.g. by improving access to general practitioners. Training of caregivers in dealing with patients of different origins might reduce differences in caregiver satisfaction according to patient origin.     

Improved compliance with universal precautions in the operating room following an educational intervention.

Observation of surgical personnel in four specialties (cardiothoracic, general, gynecologic, and orthopedic) in the operating room was performed prior to implementation of an educational intervention designed to improve compliance with Universal Precautions and at 1- and 2-years post-intervention. Use of protective eyewear and double gloving increased following the intervention, whereas the incidence of documented blood and body fluid exposures decreased.     

The impact of waiting time on patient outcomes: Evidence from early intervention in psychosis services in England

Recently, new emphasis was put on reducing waiting times in mental health services as there is an ongoing concern that longer waiting time for treatment leads to poorer health outcomes. However, little is known about delays within the mental health service system and its impact on patients. We explore the impact of waiting times on patient outcomes in the context of early intervention in psychosis (EIP) services in England from April 2012 to March 2015. We use the Mental Health Services Data Set and the routine outcome measure the Health of the Nation Outcome Scale. In a generalised linear regression model, we control for baseline outcomes, previous service use, and treatment intensity to account for possible endogeneity in waiting time. We find that longer waiting time is significantly associated with a deterioration in patient outcomes 12 months after acceptance for treatment for patients that are still in EIP care. Effects are strongest for waiting times longer than 3 months, and effect sizes are small to moderate. Patients with shorter treatment periods are not affected. The results suggest that policies should aim to reduce excessively long waits in order to improve outcomes for patients waiting for treatment for psychosis.     

Group work in a hospital waiting room.

For students who have determination, field-work placements offer an opportunity not only to learn, but to develop innovative services. The authors give a personal account of how, as students, they initiated a program of group work in a hospital waiting room.     

广州市属医院门诊候诊室室内空气质量调查

候诊室是就诊人群求医治疗的等候场所 ,除具有一般公共场所的特点外 ,还有其特殊性。因此提高医院门诊候诊室内空气质量 ,提供良好的候诊环境是医院和卫生监督部门的重要任务。现将 2 0 0 0年和 2 0 0 1年对广州市属各医院门诊候诊室进行的常规监测情况总结分析如下。1　材料和     

An educational intervention to enhance nurse leaders' perceptions of patient safety culture

OBJECTIVE: To design a training intervention and then test its effect on nurse leaders' perceptions of patient safety culture. STUDY SETTING: Three hundred and fifty-six nurses in clinical leadership roles (nurse managers and educators/CNSs) in two Canadian multi-site teaching hospitals (study and control). STUDY DESIGN: A prospective evaluation of a patient safety training intervention using a quasi-experimental untreated control group design with pretest and posttest. Nurses in clinical leadership roles in the study group were invited to participate in two patient safety workshops over a 6-month period. Individuals in the study and control groups completed surveys measuring patient safety culture and leadership for improvement prior to training and 4 months following the second workshop. EXTRACTION METHODS: Individual nurse clinical leaders were the unit of analysis. Exploratory factor analysis of the safety culture items was conducted; repeated-measures analysis of variance and paired t-tests were used to evaluate the effect of the training intervention on perceived safety culture (three factors). Hierarchical regression analyses looked at the influence of demographics, leadership for improvement, and the training intervention on nurse leaders' perceptions of safety culture. PRINCIPAL FINDINGS: A statistically significant improvement in one of three safety culture measures was shown for the study group (p<.001) and a significant decline was seen on one of the safety culture measures for the control group (p<.05). Leadership support for improvement was found to explain significant amounts of variance in all three patient safety culture measures; workshop attendance explained significant amounts of variance in one of the three safety culture measures. The total R(2) for the three full hierarchical regression models ranged from 0.338 and 0.554. CONCLUSIONS: Sensitively delivered training initiatives for nurse leaders can help to foster a safety culture. Organizational leadership support for improvement is, however, also critical for fostering a culture of safety. Together, training interventions and leadership support may have the most significant impact on patient safety culture.     

Effects of patient demands on satisfaction with Japanese hospital care.

OBJECTIVE: The objective of this study was to detect whether there was any difference among the characteristics of patient satisfaction between two patient emphasis groups: patients demanding technical elements of hospital care and patients demanding interpersonal elements. DESIGN AND SETTING: The sample for this study was drawn from in-patients discharged from 77 voluntarily participating hospitals throughout Japan. The relationship between overall satisfaction with hospital care and patient satisfaction, and the evaluation of a hospital's reputation, was explored by stepwise multiple regression analysis of 33 variables relevant to aspects of hospital care for each patient group. RESULTS: In the interpersonal emphasis (IE) group, 'nurse's kindness and warmth' was associated significantly with overall satisfaction, while 'skill of nursing care' and 'nurse's explanation' were significant predictors of overall satisfaction in the technical emphasis (TE) group. On the other hand, 'doctor's clinical competence', 'recovery from distress and anxiety', and items pertaining to the hospital's reputation were significantly related to overall satisfaction in both emphasis groups. CONCLUSION: For overall patient satisfaction, it is essential to satisfy specific items related to the aspect of hospital care emphasized by the patient. Specific significant predictors of overall satisfaction (e.g. 'doctor's clinical competence') were indispensable measures of professional performance in hospital care, irrespective of the patients' emphasis. A positive perception of hospital reputation items might increase overall patient satisfaction with Japanese hospitals.     

上海市黄浦区市级综合医院候诊输液室空气质量调查

[目的]了解上海市黄浦区市级综合性医院候诊输液室的空气质量及影响因素。[方法]对医院候诊及输液区域的室内卫生指标和集中空调通风系统卫生指标进行检测,根据《公共场所卫生监测技术规范》要求设点检测,以《医院候诊室卫生标准》和《公共场所集中空调通风系统卫生规范》进行评价。[结果]室内卫生学指标中噪声及二氧化碳合格率分别为0.00%和24.07%。集中空调通风设备卫生学指标中可吸入颗粒物(PM10)及细菌总数合格率分别为52.78%和83.33%。空气中二氧化碳浓度与人员密度呈直线正相关,在人员密度相同的情况下,通风条件不同的场所空气中二氧化碳浓度差异有统计学意义(P0.01)。[结论]医院候诊输液区域噪声和二氧化碳问题最为突出,二氧化碳浓度与通风条件及人员密度密切相关。医院集中空调通风设备的卫生管理亟待规范。     

A multifaceted intervention improves patient satisfaction and perceptions of emergency department care.

OBJECTIVE: . We aimed to evaluate the effectiveness of a multifaceted intervention, targeting staff-patient communication, in improving emergency department patient satisfaction. METHODS: We undertook a pre- and post-intervention study in a university-affiliated emergency department, over a 12-month period. The intervention included communication workshops, a patient education film, and a patient liaison nurse. At the patient level, the patient liaison nurse ensured optimal staff-patient community communication and played a role in staff communication education. The intervention was evaluated using patient surveys (containing general and communication-specific satisfaction items scored out of 100), complaint rates, and patient liaison nurse activity data. RESULTS: A total of 321 and 545 patients returned questionnaires in the pre- and post-intervention periods, respectively. Significant improvements were observed in patients' perceptions of being 'informed about delays' [score difference, 5.3; 95% confidence interval (CI), 0.6-10.0], that 'staff cared about them as a person' (difference, 4.4; 95% CI, 0.7-8.1), the overall emergency department facility assessment (difference, 3.9; 95% CI, 0.4-7.5) and overall emergency department care (difference, 3.8; 95% CI, 0.3-7.3). Non-significant improvements were seen in all other satisfaction items. In the post-intervention period, there was a 22.5% (95% CI, 14.6-32.8) decrease in the number of complaints received and a decrease in the complaint rate of 0.7 (95% CI, -0.3 to 1.6) complaints per 1000 patients. The patient liaison nurse activities included orientation of the patient including (i) explanation of tests, procedures, and delays; (ii) communication with a range of hospital staff; and (iii) general comfort measures including analgesia quality control. CONCLUSION: Significant improvements in a variety of patient satisfaction measures were achieved with an intervention comprising staff communication workshops, a patient education film, and a patient liaison nurse.     

The importance of patient expectations as a determinant of satisfaction with waiting times for hip and knee replacement surgery

Objectives

The disconfirmation model hypothesizes that satisfaction is a function of a perceived discrepancy from an initial expectation. Our objectives were: (1) to test the disconfirmation model as it applies to patient satisfaction with waiting time (WT) and (2) to build an explanatory model of the determinants of satisfaction with WT for hip and knee replacement.

Methods

We mailed 1000 questionnaires to 2 random samples: patients waiting or those who had received a joint replacement within the preceding 3-12 months. We used ordinal logistic regression analysis to build an explanatory model of the determinants of satisfaction.

Results

Of the 1330 returned surveys, 1240 contained patient satisfaction data. The sample was 57% female; mean age was 70 years (SD 11). Consistent with the disconfirmation model, when their WTs were longer than expected, both waiting (OR 5.77, 95% CI 3.57-9.32) and post-surgery patients (OR 6.57, 95% CI 4.21-10.26) had greater odds of dissatisfaction, adjusting for the other variables in the model. Compared to those who waited 3 months or less, post-surgery patients who waited 6 to 12 months (OR 2.59, 95% CI 1.27-5.27) and over 12 months (OR 3.30, 95% CI 1.65-6.58) had greater odds of being dissatisfied with their waiting time. Patients who felt they were treated unfairly had greater odds of being dissatisfied (OR 4.74, 95% CI 2.60-8.62).

Conclusions

In patients on waiting lists and post-surgery for hip and knee replacement, satisfaction with waiting times is related to fulfillment of expectations about waiting, as well as a perception of fairness. Measures to modify expectations and increase perceived fairness, such as informing patients of a realistic WT and communication during the waiting period, may increase satisfaction with WTs.     

手术室等候系统的设计与开发

本系统通过后台电脑控制、等候室中多个显示系统同时显示等候信息，滚动显示通知信息，来为病人家属提供一个理想的手术等候环境，同时也方便了医护人员的工作。     

Accurate sampling in general practice waiting room surveys: methodological issues

OBJECTIVES: This is a pilot study to test the validity of using one research assistant to train and support reception staff at five clinics to obtain waiting room data in general practice surveys. DESIGN: A research assistant trained reception staff at five randomly chosen general practices to administer a survey to all eligible women over a two-week period. Practices were audited daily by their appointment books and where possible by billing records to check total numbers of eligible women to determine the denominator of the sample. SETTING: Five metropolitan general practices in one divisional area. PARTICIPANTS: Twenty-five receptionists distributed surveys to 1,298 women. Main outcome measures: Number of eligible women missed at each clinic. RESULTS: The number of potential subjects missed by the reception staff ranged from nil to 18% with the appointment book audit. A second audit using billing records at three clinics revealed inaccuracies of up to 50%. The ability to accurately capture eligible patients for waiting room surveys depends on good administrative systems within the practice and motivated staff. CONCLUSIONS: It is important for general practice researchers to consider and account for eligible participants who are missed from the denominator with a waiting room survey method. Valid sampling using this method can be achieved in certain practices, however this may limit the generalisability of the findings.     

Predictors of patient satisfaction

Correlates of patient satisfaction at varying points in time were assessed using a survey with 2-week and 3-month follow-up in a general medicine walk-in clinic, in USA. Five hundred adults presenting with a physical symptom, seen by one of 38 participating clinicians were surveyed and the following measurements were taken into account: patient symptom characteristics, symptom-related expectations, functional status (Medical Outcomes Study Short-Form Health Survey [SF-6]), mental disorders (PRIME-MD), symptom resolution, unmet expectations, satisfaction (RAND 9-item survey), visit costs and health utilization. Physician perception of difficulty (Difficult Doctor Patient Relationship Questionnaire), and Physician Belief Scale. Immediately after the visit, 260 (52%) patients were fully satisfied with their care, increasing to 59% at 2 weeks and 63% by 3 months. Patients older than 65 and those with better functional status were more likely to be satisfied. At all time points, the presence of unmet expectations markedly decreased satisfaction: immediately post-visit (OR: 0.14, 95% CI: 0.07-0.30), 2-week (OR: 0.07, 95% CI: 0.04-0.13) and 3-month (OR: 0.05, 95% CI: 0.03-0.09). Other independent variables predicting immediate after visit satisfaction included receiving an explanation of the likely cause as well as expected duration of the presenting symptom. At 2 weeks and 3 months, experiencing symptomatic improvement increased satisfaction while additional visits (actual or anticipated) for the same symptom decreased satisfaction. A lack of unmet expectations was a powerful predictor of satisfaction at all time-points. Immediately post-visit, other predictors of satisfaction reflected aspects of patient doctor communication (receiving an explanation of the symptom cause, likely duration, lack of unmet expectations), while 2-week and 3-month satisfaction reflected aspects of symptom outcome (symptom resolution, need for repeat visits, functional status). Patient satisfaction surveys need to carefully consider the sampling time frame as well as adjust for pertinent patient characteristics.     

Playing for children in waiting room at an infant outpatient clinic

This study aims at reporting on undergraduate students'experience in the implantation of a play group that uses playing/toys as a therapeutic intervention strategy for care delivery to children in the waiting room of an infant outpatient clinic. These activities were developed during the period before outpatient care and include drawings, games, story telling, among others. Through this intervention mode, playing/toys can be used as an instrument to facilitate the communication between the care team and the child, as well as to stimulate global development. This resource can be important for the professional to understand the moment the child is going through since, besides providing the opportunity to release fears and anxiety, it offers leisure while waiting for care.     

病人满意度测评指标体系研究

病人满意度测评是对传统医疗质量评价方法的补充和完善。作者遵循一定的原则，对病人满意度指数模型的各个结构变量进行层层分解，设计出具体的医疗机构病人满意度测评指标体系（四级指标体系），并讨论了指标的量化、指标权重的确定及病人满意度计算等方法。