Chinese and white Canadian satisfaction and compliance with physicians

BACKGROUND: Patient satisfaction has become an important indicator of primary care and healthcare system performance. Ethnic disparities in patient satisfaction and compliance with physician care have been studied in several countries. However, this issue has not received significant attention in Canada. The unique characteristics of the Canadian healthcare system and ethnic population make it worthwhile to examine this issue in this population. Therefore, we conducted a survey among Chinese and Whites in a Canadian city to determine their reported satisfaction, and perceptions of physicians. METHODS: The survey was conducted in English, Mandarin and Cantonese in 2005 among Chinese and White Canadians, 18 years of age or older, who had visited at least one physician in Canada. RESULTS: We analyzed 746 Chinese and 711 Whites in the general practitioner (GP) visit group and 485 Chinese and 637 Whites in the specialist visit group. A lower proportion of Chinese compared to Whites reported that they were very satisfied or satisfied with GP (73.7% vs. 92.8%) and specialist care (75.5% vs. 85.6%) and the differences between the two groups remained after adjustment for demographic variables and chronic conditions (risk adjusted OR: 0.70, 95%CI: 0.42–1.18 for the GP visit group and OR: 0.77, 95%CI: 0.48–1.23 for the specialist visit group). A similar proportion of Chinese and Whites reported that they always followed a physician's advice (59.4% vs. 59.6% for the GP visit group and 67.2% vs. 62.8% for the specialist visit group). Non-English speaking Chinese and recent arrivals in Canada were less likely to be satisfied with GPs than Chinese born in Canada [risk adjusted OR: 0.5, 95%CI: 0.3–0.9, 0.2 and 0.1–0.7, respectively]. CONCLUSION: Chinese Canadians reported lower satisfaction with physicians and perceived physicians slightly more negatively than White Canadians. Particularly, Chinese with limited English and short length of stay in Canada were less satisfied than Canadian born Chinese

Patients' satisfaction with information at discharge

Background: Adequate patient knowledge and engagement with their condition and its management can reduce re-hospitalisations and improve outcomes after acute admission for circulatory system disease. Aim: To evaluate the perceptions of cardio- or cerebrovascular patients of their satisfaction with discharge processes and to determine if this differs by demographic groups. Methods: A sample of 536 eligible public hospital inpatients was extracted from a consumer experience surveillance system. Questions relating to the discharge process were analysed using descriptive statistics to compare patient satisfaction levels against demographic variables. Results: Dissatisfaction rates were highest within the ‘Written information provided’ (37.8%) and ‘Danger signals communicated’ (34.7%) categories. Women and people aged ≥80 were more likely to express dissatisfaction. Conclusion: Although respondents were largely satisfied, there are important differences in the characteristics of those that were dissatisfied. The communication of important discharge information to older people and women was less likely to meet their perceived needs

At the coalface and the cutting edge: general practitioners’ accounts of the rewards of engaging with HIV medicine

The interviews we conducted with GPs suggest that an engagement with HIV medicine enables clinicians to develop strong and long-term relationships with and expertise about the care needs of people living with HIV ‘at the coalface’, while also feeling connected with a broader network of medical practitioners and other professionals concerned with and contributing to the ever-changing world of science: ‘the cutting edge’. The general practice HIV prescriber is being modelled here as the interface between these two worlds, offering a rewarding opportunity for general practitioners to feel intimately connected to both community needs and scientific change

Factorial validity of the Toronto Alexithymia Scale (TAS-20) in clinical samples: A critical examination of the literature and a psychometric study in anorexia nervosa

There is extensive use of the 20-item Toronto Alexithymia Scale (TAS-20) in research and clinical practice in anorexia nervosa (AN), though it is not empirically established in this population. This study aims to examine the factorial validity of the TAS-20 in a Portuguese AN sample (N = 125), testing four different models (ranging from 1 to 4 factors) that were identified in critical examination of existing factor analytic studies. Results of confirmatory factor analysis (CFA) suggested that the three-factor solution, measuring difficulty identifying (DIF) and describing feelings (DDF), and externally oriented thinking (EOT), was the best fitting model. The quality of measurement improves if two EOT items (16 and 18) are eliminated. Internal consistency of EOT was low and decreased with age. The results provide support for the factorial validity of the TAS-20 in AN. Nevertheless, the measurement of EOT requires some caution and may be problematic in AN adolescents.Center for Psychology at the University of Porto, Portuguese Science Foundation (FCT UID/PSI/00050/2013) and EU FEDER through COMPETE 2020 program (POCI-01-0145-FEDER-007294info:eu-repo/semantics/acceptedVersio

Multidimensionality and Structural Coefficient Bias in Structural Equation Modeling: A Bifactor Perspective

In this study, the authors consider several indices to indicate whether multidimensional data are "unidimensional enough" to fit with a unidimensional measurement model, especially when the goal is to avoid excessive bias in structural parameter estimates. They examine two factor strength indices (the explained common variance and omega hierarchical) and several model fit indices (root mean square error of approximation, comparative fit index, and standardized root mean square residual). These statistics are compared in population correlation matrices determined by known bifactor structures that vary on the (a) relative strength of general and group factor loadings, (b) number of group factors, and (c) number of items or indicators. When fit with a unidimensional measurement model, the degree of structural coefficient bias depends strongly and inversely on explained common variance, but its effects are moderated by the percentage of correlations uncontaminated by multidimensionality, a statistic that rises combinatorially with the number of group factors. When the percentage of uncontaminated correlations is high, structural coefficients are relatively unbiased even when general factor strength is low relative to group factor strength. On the other hand, popular structural equation modeling fit indices such as comparative fit index or standardized root mean square residual routinely reject unidimensional measurement models even in contexts in which the structural coefficient bias is low. In general, such statistics cannot be used to predict the magnitude of structural coefficient bias. © The Author(s) 2013