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International Journal of Environmental... Dec 2022Patient opinion surveys have become a widely used method for assessing key aspects of the functioning of medical facilities and, thus, of the functioning of the entire...
INTRODUCTION
Patient opinion surveys have become a widely used method for assessing key aspects of the functioning of medical facilities and, thus, of the functioning of the entire health care system. They are a prerequisite for developing patient-centered care and an essential component of quality improvement programs. In many countries, including Poland, patient opinion surveys are written into the accreditation standards of medical institutions. Patient's readiness to recommend a hospital is a recognized indicator of the quality of patient-centered care. In a report on strategies for improving the quality of health care in Europe published in 2019 by WHO and the OECD (Organisation for Economic Cooperation and Development), patient's readiness to recommend a hospital was cited as one of the basic indicators of 'patient centeredness' along with patient satisfaction. Therefore, as well consideration of the quality of medical care, a patient recommendation index was also used in the study presented in this paper. The index was based on the answers to questions about the patient's readiness to recommend a hospital ward to family and friends.
AIM
The aim of the study was to investigate patients' opinions on the quality of services in particular hospital wards. A patient opinion survey can be used to improve the quality of services and monitor the effects of health-related activities, identify areas that need improvement, motivate medical staff and prevent their burnout, build a trusting relationship with patients, and compare the quality of health care in various facilities.
MATERIAL AND METHODS
The study was carried out in March 2022. The patient opinion survey was conducted using the CAWI (Computer-Assisted Web Interview). The sample selection was purposive. The respondents were patients with a history of hospitalization. The sample selection used an algorithm for the random selection of patients who met the criteria for the sample. The inclusion criterion was hospitalization in the 12 months prior to the study. A standardized questionnaire was used that was aimed at the assessment of the quality of medical care and the patient's rights to information. Additionally, the survey contained questions about the demographic characteristics of the respondents.
RESULTS
A total of 38% of patients with a history of hospitalization expressed criticisms. The majority of statistically significant differences were observed when differentiating respondents according to age. Elderly persons significantly more often declared having been treated with respect and interest. They also rated more highly the meals served in the hospital, effective pain treatment, and respect for the patient's dignity and intimacy during diagnosis and treatment. Younger persons assessed all these aspects of hospitalization less favorably.
CONCLUSIONS
Variables including age and the level of income had a statistically significant influence on the opinion of the respondents. Elderly persons assessed most aspects of the quality of care in a hospital ward more favorably. There were a similar number of "promoters" (36%) and "detractors" (38%) of the quality of hospital services. Detractors mainly pointed to long waiting times for hospital admission, the poor quality of medical and nursing care, and unappealing meals. The promoters emphasized the high quality of medical and nursing care and the favorable conditions of the accommodation. Regular patient satisfaction surveys are helpful in identifying areas in which the functioning of a medical entity requires changes.
Topics: Humans; Aged; Poland; Delivery of Health Care; Surveys and Questionnaires; Hospitals; Inpatients; Patient Satisfaction
PubMed: 36612739
DOI: 10.3390/ijerph20010412 -
BMC Health Services Research Jun 2023COVID Watch is a remote patient monitoring program implemented during the pandemic to support home dwelling patients with COVID-19. The program conferred a large...
COVID Watch is a remote patient monitoring program implemented during the pandemic to support home dwelling patients with COVID-19. The program conferred a large survival advantage. We conducted semi-structured interviews of 85 patients and clinicians using COVID Watch to understand how to design such programs even better. Patients and clinicians found COVID Watch to be comforting and beneficial, but both groups desired more clarity about the purpose and timing of enrollment and alternatives to text-messages to adapt to patients' preferences as these may have limited engagement and enrollment among marginalized patient populations. Because inclusiveness and equity are important elements of programmatic success, future programs will need flexible and multi-channel human-to-human communication pathways for complex clinical interactions or for patients who do not desire tech-first approaches.
Topics: Humans; COVID-19; Pandemics; Patient Preference; Patients; Monitoring, Ambulatory; Program Evaluation; Attitude of Health Personnel; Attitude to Health; Qualitative Research; Program Development; Male; Female; Middle Aged; Adult; Aged; Telemedicine
PubMed: 37370059
DOI: 10.1186/s12913-023-09684-1 -
Israel Journal of Health Policy Research Aug 2023In order to reduce patient no-show, the Israeli government is promoting legislation that will allow Health Plans to require a co-payment from patients when reserving an...
BACKGROUND
In order to reduce patient no-show, the Israeli government is promoting legislation that will allow Health Plans to require a co-payment from patients when reserving an appointment. It is hoped that this will create an incentive for patients to cancel in advance rather than simply not show up. The goal of this policy is to improve patient access to medical care and ensure that healthcare resources are utilized effectively. We explore this phenomenon to support evidence-based decision making on this issue, and to determine whether the proposed legislation is aligned with the findings of previous studies.
MAIN BODY
No-show rates vary across countries and healthcare services, with several strategies in place to mitigate the phenomenon. There are three key stakeholders involved: (1) patients, (2) medical staff, and (3) insurers/managed care organizations, each of which is affected differently by no-shows and faces a different set of incentives. The decision whether to impose financial penalties for no-shows should take a number of considerations into account, such as the fine amount, service type, the establishment of an effective fine collection system, the patient's socioeconomic status, and the potential for exacerbating disparities in healthcare access. The limited research on the impact of fines on no-show rates has produced mixed results. Further investigation is necessary to understand the influence of fine amounts on no-show rates across various healthcare services. Additionally, it is important to evaluate the implications of this proposed legislation on patient behavior, access to healthcare, and potential disparities in access.
CONCLUSION
It is anticipated that the proposed legislation will have minimal impact on attendance rates. To achieve meaningful change, efforts should focus on enhancing medical service availability and improving the ease with which appointments can be cancelled or alternatively substantial fines should be imposed. Further research is imperative for determining the most effective way to address the issue of patient no-show and to enhance healthcare system efficiency.
Topics: Humans; No-Show Patients; Israel; Health Services Accessibility
PubMed: 37550725
DOI: 10.1186/s13584-023-00575-8 -
Clinical Oral Investigations Oct 2021The aim of this study was to evaluate the postoperative course in patients undergoing oral mucosal biopsies, considering clinical and patient's perception variables... (Observational Study)
Observational Study
OBJECTIVE
The aim of this study was to evaluate the postoperative course in patients undergoing oral mucosal biopsies, considering clinical and patient's perception variables potentially correlated to poor healing.
SUBJECTS AND METHODS
Eighty patients underwent oral biopsies. All the variables connected with the surgery were recorded, and the harvested volume was calculated through image software (ImageJ, NIH, Betesda, USA). To evaluate the postoperative discomfort, the OHIP-14 and the numeric rating scale of pain (NRS) were administered at 6 h, 7 days and 21 days after biopsy.
RESULTS
Six hours after the biopsy, 22 (OHIP-14 ≥ 20) and 24 (NRS ≥ 4) patients experienced a troublesome or painful healing, respectively. A significant statistical correlation between poor healing and high scores of NRS and OHIP was detected (Pearson's correlation test p < 0.05). Higher values of OHIP-14 were correlated to the type of lesion (OR = 1.165; p < 0.05), whereas high values of NRS were correlated to the use of systemic drugs (p < 0.05). No surgical variable had a significant statistical correlation with any of the outcomes.
CONCLUSIONS
The clinical evaluation was correlated with the patient's perception of pain and discomfort. This finding could be suggestive of the fact that wound healing can be reliably monitored with the help of these tools.
CLINICAL RELEVANCE
Patient perception can be a predictor of the healing of biopsied tissues.
Topics: Biopsy; Humans; Mouth Mucosa; Oral Health; Outpatients; Perception; Quality of Life; Surveys and Questionnaires
PubMed: 33704571
DOI: 10.1007/s00784-021-03870-3 -
Pediatric Critical Care Medicine : a... Feb 2023Several studies have investigated the impact of diaries in adult ICUs, which have been used as a tool to support recall and reduce post-traumatic stress disorder in... (Review)
Review
OBJECTIVE
Several studies have investigated the impact of diaries in adult ICUs, which have been used as a tool to support recall and reduce post-traumatic stress disorder in patients and their families. We conducted a scoping review to determine the definition of ICU diaries, and the extent, range, and nature of research conducted on NICU and PICU diaries, describe their use and impact, as well as identify gaps in knowledge and areas for future research.
DATA SOURCES
The following databases were searched from inception to March 2022: Cumulated Index to Nursing and Allied Health Literature, Cochrane Library, Embase, PubMed, and American Psychological Association PsycINFO. Searches were also conducted in the following gray literature databases: Google Scholar, University of South Australia, and WorldCat.
STUDY SELECTION
All studies that discussed the use and impact of diaries or journals involving patients (<18 yr old) in PICUs and NICUs and/or their family members were included.
DATA SYNTHESIS
Sixteen studies were identified. Most studies defined diaries as daily entries written by nurses and/or family members regarding the patient's condition during their ICU admission. The majority reported that diaries were beneficial to children and their families as they helped to fill in memory gaps, provided a means to express their feelings, and served as effective health communication tools. Several gaps were identified: extent of the use of diaries as a means of communication, the significance of diaries as a coping mechanism for bereaved parents, and the impact of PICU diaries on the children, their families, and healthcare professionals.
CONCLUSIONS
There is a paucity of data on the use of NICU and PICU diaries. Nonetheless, the limited data revealed that NICU and PICU diaries were beneficial to children and their families. Our review demonstrated a heterogeneity in the terminology, content, use of photos, and the author/s of the NICU and PICU diaries. Further research is needed to investigate the impact of the use of NICU and PICU diaries on patient-reported outcomes.
Topics: Child; Infant, Newborn; Adult; Humans; Intensive Care Units, Neonatal; Family; Parents; Patients; Stress Disorders, Post-Traumatic
PubMed: 36521187
DOI: 10.1097/PCC.0000000000003122 -
Journal of Clinical Nursing May 2023To review the current literature to map and explore the interventions that have been considered or used by nurses to support adult patients' self-management during... (Review)
Review
AIMS AND OBJECTIVES
To review the current literature to map and explore the interventions that have been considered or used by nurses to support adult patients' self-management during hospitalisation.
BACKGROUND
Nurses can play an important role in supporting patients' self-management. Currently, however, it is unclear how nurses perform this task during a patient's stay in hospital. Traditionally, nurses take the primary role in managing patients' care during hospitalisation. Ideally, patients should have the opportunity to continue applying strategies to manage their health conditions as much as possible while in the hospital. This can increase patients' self-efficacy and decrease unnecessary readmissions.
DESIGN
Scoping review informed by the Joanna Briggs Institute methodology.
METHODS
A database search was undertaken using Pubmed, CINAHL, PsycInfo, Cochrane, Embase and grey literature sources. Data from the included studies were mapped and summarised in a narrative summary. To synthesise the information that was given about each intervention, we conducted a qualitative inductive content analysis. Results are reported in accordance with the guidelines for reporting Items for systematic review and meta-analyses extension for scoping review (PRISMA-ScR) (Supplementary File 1).
RESULTS
83 documents were included in this review. Based on the information about the interventions, three themes were identified: 'self-management support activities', 'focus of self-management support' and the 'intervention procedure'. Five self-management support activities can be distinguished: 'giving education', 'counselling and coaching', 'enhancing responsibility', 'engaging family-caregivers' and 'supporting transition from hospital to home'. The interventions focused on improving disease-related knowledge and on strengthening several self-management skills. Information about the procedure, development and the theoretical underpinning of the intervention was often limited.
CONCLUSIONS
Most activities within the nursing interventions to support adult patients' self-management during hospitalisation are the part of regular nursing care. However, the transfer of responsibility for care task to the patient is relatively new. Further research could focus on developing interventions addressing all aspects of self-management and that are embedded in the patient's care pathway across settings.
RELEVANCE TO CLINICAL PRACTICE
Clinical nurses may improve nursing care by supporting all aspects of patients' self-management and facilitate patients as much as possible for taking responsibility for self-management tasks during hospitalisation.
Topics: Adult; Humans; Self-Management; Clinical Competence; Patients; Hospitals; Nurses
PubMed: 35118738
DOI: 10.1111/jocn.16242 -
Journal of Mother and Child Oct 2020Diagnosis, treatment, and care of inborn errors of metabolism require well organized interdisciplinary teams. Holistic approaches comprise the system of all elements and... (Review)
Review
BACKGROUND
Diagnosis, treatment, and care of inborn errors of metabolism require well organized interdisciplinary teams. Holistic approaches comprise the system of all elements and relations between elements necessary for an optimal function of the system.
METHODS
Following the rule "structure follows function" based on scientific, academic, and clinical experience the elements of the system providing diagnosis, treatment, and care for inborn errors of metabolism are defined and described.
RESULTS
A holistic approach to inborn errors of metabolism comprising 10 elements is suggested, established, and controlled by an interdisciplinary metabolic team organized as a disease, and a case management program based on evidence-based guidelines is suggested. Quality assurance and quality control will not only improve the treatment of the individual but also the health system.
CONCLUSION
The holistic approach is a joint project of the team of health care professionals and the person with a condition, allowing them to see the patient's individual medical, behavioral, social, legal, and economic context. For practical, technical, and economic reasons this will only be possible in centers caring for a critical number of individuals.
Topics: Adult; Delivery of Health Care, Integrated; Family; Female; Holistic Health; Humans; Infant; Infant, Newborn; Male; Metabolism, Inborn Errors; Patients; Stress, Psychological
PubMed: 33179604
DOI: 10.34763/jmotherandchild.20202402si.2004.000010 -
Health Services Research Oct 2021To identify opportunities to align care with the personal values of patients from three distinct groups with complex medical, behavioral, and social needs.
OBJECTIVE
To identify opportunities to align care with the personal values of patients from three distinct groups with complex medical, behavioral, and social needs.
DATA SOURCES/STUDY SETTING
Between June and August 2019, we conducted semi-structured interviews with individuals with complex care needs in two integrated health care delivery systems.
STUDY DESIGN
Qualitative study using semi-structured interviews.
DATA COLLECTION METHODS
We interviewed three groups of patients at Kaiser Permanente Washington and Kaiser Permanente Colorado representing three distinct profiles of complex care needs: Group A ("obesity, opioid prescription, and low-resourced neighborhood"), Group B ("older, high medical morbidity, emergency department, and hospital use"), and Group C ("older, mental and physical health concerns, and low-resourced neighborhood"). These profiles were identified based on prior work and prioritized by internal primary care stakeholders. Interview transcripts were analyzed using thematic analysis.
PRINCIPAL FINDINGS
Twenty-four patients participated; eight from each complex needs profile. Mean age across groups was 71 (range 48-86) years. We identified five themes common across the three groups that captured patients' views regarding values-aligned care. These themes focused on the importance of care teams exploring and acknowledging a patient's values, providing access to nonphysician providers who have different perspectives on care delivery, offering values-aligned mental health care, ensuring connection to community-based resources that support values and address needs, and providing care that supports the patient plus their family and caregivers.
CONCLUSIONS
Our results suggest several opportunities to improve how care is delivered to patients with different complex medical, behavioral, and social needs. Future research is needed to better understand how to incorporate these opportunities into health care.
Topics: Aged; Aged, 80 and over; Chronic Disease; Colorado; Delivery of Health Care, Integrated; Female; Humans; Male; Middle Aged; Patient-Centered Care; Patients; Practice Guidelines as Topic; Qualitative Research; Social Determinants of Health; Washington
PubMed: 34363205
DOI: 10.1111/1475-6773.13862 -
AMA Journal of Ethics Jun 2023Over the past decade, ways of defining self in relation to gender identity and forms of expression have widely expanded. Along with this expansion of identifying...
Over the past decade, ways of defining self in relation to gender identity and forms of expression have widely expanded. Along with this expansion of identifying language, there has been an increase in medical professionals and clinics specializing in providing gender care. Yet many barriers to providing this care still exist for clinicians-including their comfort with and knowledge about collecting and retaining a patient's demographic information, respecting the name and pronouns a patient goes by, and providing overall ethical care. This article shares one transgender person's numerous health care encounters over 20 years as both a patient and a professional.
Topics: Humans; Male; Female; Transgender Persons; Gender Identity; Health Personnel; Patients
PubMed: 37285300
DOI: 10.1001/amajethics.2023.452 -
BMJ Open Quality May 2023A satisfactory patient care culture model can help improve most patients' quality of care in a hospital. This study aims to improve patients' experiences (PX) by...
A satisfactory patient care culture model can help improve most patients' quality of care in a hospital. This study aims to improve patients' experiences (PX) by implementing a culture model at King Abdul-Aziz Armed Forces Hospital in Dhahran, Saudi Arabia. To achieve the research aim, a set of interventions were implemented that included a patient and family advisory council, empathy training, recognition of the PX, leadership-patient interviews, PX champions and quality improvement. These interventions were further measured using the Hospital Consumer Assessment of Healthcare Providers and Systems survey in the inpatient, outpatient and emergency departments. The improvement project was conducted in 2020, focusing mainly on transforming the culture and launching activities targeting specific touchpoints identified as priority areas. After making these changes, the hospital saw improvements in all patient relationships, with an average score across all dimensions collectively increasing by more than 4%. The quality improvement project using the PX culture model approach demonstrated significant improvements. In addition, employee involvement in patient care has become a significant factor in improving the quality of care. The critical elements for improving the PX and culture included recognising staff and creating networks across the system through effective leadership, employee engagement and engagement of patients and their families.
Topics: Humans; Organizational Culture; Inpatients; Outpatients; Emergency Service, Hospital; Patient Outcome Assessment
PubMed: 37220993
DOI: 10.1136/bmjoq-2022-002076