Factors associated with hospital service satisfaction in a sample of Arab subjects with schizophrenia

<p>Abstract</p> <p>Background</p> <p>Assessment of patients' satisfaction with health care services could help to identify the strengths and weaknesses of the system and provide guidance for further development. The study's objectives were to: (i) assess the pattern of satisfaction with hospital care for a sample of people with schizophrenia in Kuwait, using the Verona Service Satisfaction Scale (VSSS-EU); ii) compare the pattern of satisfaction with those of similar studies; and iii) assess the association of VSSS seven domains with a number of variables representing met and unmet needs for care, family caregiver burden, severity of psychopathology, level of psychosocial functioning, socio-demographic characteristics, psychological well-being and objective quality of life.</p> <p>Methods</p> <p>Consecutive outpatients in stable condition and their family caregivers were interviewed with the VSSS-EU and measures of needs for care, caregiver burden, quality of life and psychopathology.</p> <p>Results</p> <p>There were 130 patients (66.1%m, mean age 36.8). While over two-thirds expressed satisfaction with the domains of "overall satisfaction", "professionals' skills", "access", "efficacy", and "relatives' involvement", only about one-third were satisfied with the domains of "information" and "types of intervention". The later two domains were the areas in which European patients had better satisfaction than our patients, while our patients expressed better satisfaction than the Europeans in the domain of "relatives' involvement". In multiple regression analyses, self-esteem, positive and negative affect were the most important correlates of the domains of service satisfaction, while clinical severity, caregiver burden and health unmet needs for care played relatively minor roles.</p> <p>Conclusion</p> <p>The noted differences and similarities with the international data, as well as the predictive power of self-esteem and affective state, support the impression that patients' attitudes towards psychiatric care involve a complex relationship between clinical, personal and socio-cultural characteristics; and that many of the factors that impact on satisfaction with service relate to individual psychological characteristics. The weaknesses in the system, highlighted by the pattern of responses of the participants, indicate possible gaps in the provision of comprehensive psychiatric care in the country and obviate the need for public mental health education and development of services to enhance the quality of care.</p

From staff-mix to skill-mix and beyond: towards a systemic approach to health workforce management

Throughout the world, countries are experiencing shortages of health care workers. Policy-makers and system managers have developed a range of methods and initiatives to optimise the available workforce and achieve the right number and mix of personnel needed to provide high-quality care. Our literature review found that such initiatives often focus more on staff types than on staff members' skills and the effective use of those skills. Our review describes evidence about the benefits and pitfalls of current approaches to human resources optimisation in health care. We conclude that in order to use human resources most effectively, health care organisations must consider a more systemic approach - one that accounts for factors beyond narrowly defined human resources management practices and includes organisational and institutional conditions

Substitution of physicians by nurses in primary care: a systematic review and meta-analysis

Background In many countries, substitution of physicians by nurses has become common due to the shortage of physicians and the need for high-quality, affordable care, especially for chronic and multi-morbid patients. We examined the evidence on the clinical effectiveness and care costs of physician-nurse substitution in primary care. Methods We systematically searched OVID Medline and Embase, The Cochrane Library and CINAHL, up to August 2012; selected and critically appraised published randomised controlled trials (RCTs) that compared nurse-led care with care by primary care physicians on patient satisfaction, Quality of Life (QoL), hospital admission, mortality and costs of healthcare. We assessed the individual study risk of bias, calculated the study-specific and pooled relative risks (RR) or standardised mean differences (SMD); and performed fixed-effects meta-analyses. Results 24 RCTs (38,974 participants) and 2 economic studies met the inclusion criteria. Pooled analyses showed higher overall scores of patient satisfaction with nurse-led care (SMD 0.18, 95% CI 0.13 to 0.23), in RCTs of single contact or urgent care, short (less than 6 months) follow-up episodes and in small trials (N 200) RCTs. Higher quality RCTs (with better allocation concealment and less attrition) showed higher rates of hospital admissions and mortality with nurse-led care albeit less or not significant. The results seemed more consistent across nurse practitioners than with registered or licensed nurses. The effects of nurse-led care on QoL and costs were difficult to interpret due to heterogeneous outcome reporting, valuation of resources and the small number of studies. Conclusions The available evidence continues to be limited by the quality of the research considered. Nurse-led care seems to have a positive effect on patient satisfaction, hospital admission and mortality. This important finding should be confirmed and the determinants of this effect should be assessed in further, larger and more methodically rigorous research

Do patient and practice characteristics confound age-group differences in preferences for general practice care? A quantitative study

<p>Background: Previous research showed inconsistent results regarding the relationship between the age of patients and preference statements regarding GP care. This study investigates whether elderly patients have different preference scores and ranking orders concerning 58 preference statements for GP care than younger patients. Moreover, this study examines whether patient characteristics and practice location may confound the relationship between age and the categorisation of a preference score as very important.</p><p>Methods: Data of the Consumer Quality Index GP Care were used, which were collected in 32 general practices in the Netherlands. The rank order and preference score were calculated for 58 preference statements for four age groups (0-30, 31-50, 51-74, 75 years and older). Using chi-square tests and logistic regression analyses, it was investigated whether a significant relationship between age and preference score was confounded by patient characteristics and practice location.</p><p>Results: Elderly patients did not have a significant different ranking order for the preference statements than the other three age groups (r = 0.0193; p = 0.41). However, in 53% of the statements significant differences were found in preference score between the four age groups. Elderly patients categorized significantly less preference statements as 'very important'. In most cases, the significant relationships were not confounded by gender, education, perceived health, the number of GP contacts and location of the GP practice.</p><p>Conclusion: The preferences of elderly patients for GP care concern the same items as younger patients. However, their preferences are less strong, which cannot be ascribed to gender, education, perceived health, the number of GP contacts and practice location.</p>

The Perioperative Management of Partial Knee Arthroplasty: Anesthesia, Pain Management, and Blood Loss

Pain is the body’s physiological reaction to tissue injury and involves nociceptive, inflammatory, and ischemic phenomena. Inflammation can lead to peripheral and central pain sensitization. The extent of this pain will depend on both phenotype and genotype of the patient. The following chapter discusses the advantages of unicompartmental knee arthroplasty (UKA) to reduce pain and blood loss after knee arthroplasty. Optimizing pain management starts with preemptive and preventive analgesia. Today’s modern pain control consists of multimodal pain management by combining different drugs and anesthetic techniques with different mechanisms of action. Most often, acetaminophen and NSAIDs are used with morphine only for breakthrough pain. The latter should be limited as much as possible because of its side effects. Local infiltration analgesia (LIA) or adductor canal blockade is used most commonly to reduce peripheral sensitization. Unicompartmental knee arthroplasty, which is less invasive, will help reduce the intensity of the postoperative pain. Optimizing blood management has the aim to reduce or eliminate blood transfusion. UKA reduces blood loss by its surgical technique, but a multimodal approach is indicated here also. Preoperative hemoglobin optimization, preoperative bleeding risk assessment and bridging strategy, the use of tranexamic acid, and the local hemostatic effect of LIA with the adrenergic properties of ropivacaine should all be part of this multimodal program. Multimodal pain strategies and blood management protocols have proven value after total knee arthroplasty. The same protocols can logically be applied to patients undergoing UKA. Patients undergoing UKA today can expect excellent pain relief, low morbidity, and rapid recovery when advanced pain and blood management protocols are employed