Determinants of patient satisfaction with physician interaction: a cross-sectional survey at the Obafemi Awolowo University Health Centre, Ile-Ife, Nigeria

Background: Patient satisfaction influences the outcomes of the physician-patient encounter. Patient satisfaction has become a significant health care outcome and a useful indicator of the quality of care. The aim of the study was to assess the level of satisfaction among Obafemi Awolowo University Health Centre attendees in relation to physician-patient interaction and ascertain the relationship between the different aspects of physician-patient interaction, patient satisfaction and adherence intent.Methods: Demographic information and information on patients’ feelings about their doctors was collected from 300 consenting patients in a cross-sectional survey, using an adapted Medical Interview Satisfaction Scale self-administered questionnaire. Data were analysed with SPSS version 11. Logistic regression was conducted to identify the factors predicting patient satisfaction and adherence intent.Results: Of the 300 patients studied, 63.3% were generally satisfied with their physician-patient interaction. Nineteen per cent of patients were uncertain of their level of satisfaction. Patient satisfaction was positively associated with adherence intent. Patient confidence in the doctor and good communication skills and information provision on the part of the doctor predicted patient satisfaction, while patient confidence in the doctor and information provision by the doctor predicted adherence intent.Conclusions: A fifth of the study subjects were dissatisfied with their doctor-patient relationship. This study suggests the need for primary care physicians to be aware of the important place of interpersonal skills development in the application of medical knowledge and expertise in the provision of health care.Keywords: patient satisfaction; doctor-patient interaction; adherence intent; patient outcome

Uncovering treatment burden as a key concept for stroke care: a systematic review of qualitative research

<b>Background</b> Patients with chronic disease may experience complicated management plans requiring significant personal investment. This has been termed ‘treatment burden’ and has been associated with unfavourable outcomes. The aim of this systematic review is to examine the qualitative literature on treatment burden in stroke from the patient perspective.<p></p> <b>Methods and findings</b> The search strategy centred on: stroke, treatment burden, patient experience, and qualitative methods. We searched: Scopus, CINAHL, Embase, Medline, and PsycINFO. We tracked references, footnotes, and citations. Restrictions included: English language, date of publication January 2000 until February 2013. Two reviewers independently carried out the following: paper screening, data extraction, and data analysis. Data were analysed using framework synthesis, as informed by Normalization Process Theory. Sixty-nine papers were included. Treatment burden includes: (1) making sense of stroke management and planning care, (2) interacting with others, (3) enacting management strategies, and (4) reflecting on management. Health care is fragmented, with poor communication between patient and health care providers. Patients report inadequate information provision. Inpatient care is unsatisfactory, with a perceived lack of empathy from professionals and a shortage of stimulating activities on the ward. Discharge services are poorly coordinated, and accessing health and social care in the community is difficult. The study has potential limitations because it was restricted to studies published in English only and data from low-income countries were scarce.<p></p> <b>Conclusions</b> Stroke management is extremely demanding for patients, and treatment burden is influenced by micro and macro organisation of health services. Knowledge deficits mean patients are ill equipped to organise their care and develop coping strategies, making adherence less likely. There is a need to transform the approach to care provision so that services are configured to prioritise patient needs rather than those of health care systems

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Epizootiology of Newcastle disease in two live bird markets in Ibadan, South Western Nigeria

Newcastle disease (ND) is a devastating viral disease of poultry worldwide. This study was therefore undertaken to understand the role of live bird markets (LBMs) in the epizootiology of ND in Nigeria. A structured questionnaire was administered to poultry dealers and cloacal swab sampling of live birds in two LBMs in Ibadan was done. Three hundred pooled swab samples were collected from five different apparently healthy bird species sold in the markets over a period of one month. Virus isolation was performed in embryonated chicken eggs using the cloacal swab samples. Twenty one isolates of ND virus were obtained from four of the five bird species. Isolation rates of 24.4%, 20.0%, 18.8%, and 18.5% were obtained from chickens, ducks, guinea fowls, and pigeons respectively. There was no statistically significant difference (p > 0.05) in the ND virus isolation rates from the different bird species. Market level isolation rates of 16.3% and 25.5% were found in Molete and Shasha respectively which was also not statistically different (p > 0.05). The results show that LBMs are important sources of transmission and threat of NDV to the commercial and backyard poultry farms in Nigeria. There is therefore need for surveillance for ND virus and effective control strategies against its continuous circulation in the country.Keywords: Newcastle Disease, Live Bird Markets, Virus Isolation, Epizootiology, Ibadan Nigeri

Human papillomavirus and oropharyngeal cancer in Greenland in 1994–2010

Background. Oropharyngeal squamous cell carcinoma (OPSCC) is associated with the sexually transmitted human papillomavirus (HPV), smoking and alcohol. In Greenland, a high rate of HPV-induced cervical cancer and venereal diseases are found, which exposes the population for high risk of HPV infection. In Greenland, only girls are included in the mandatory HPV vaccination program. Objective. To investigate the annual incidence of OPSCC and the proportion of HPV-associated OPSCC (HPV+ OPSCC) in Greenland in 1994–2010. Design. At Rigshospitalet, University of Copenhagen, we identified all Greenlandic patients diagnosed and treated for OPSCC from 1994 to 2010. Sections were cut from the patient's paraffin-embedded tissue blocks and investigated for p16 expression by immunohistochemistry. HPV analyses were performed with 2 sets of general HPV primers and 1 set of HPV16-specific primer. HPV+ OPSCC was defined as both >75% p16+ cells and PCR positive for HPV. Results. Of 26 Greenlandic patients diagnosed with OPSCC, 17 were males and 9 were females. The proportion of HPV+ OPSCC in the total study period was 22%, without significant changes in the population in Greenland. We found an increase in the proportion of HPV+ OPSCC from 14% in 1994–2001 to 25% in 2002–2010 (p=0.51). Among males from 20 to 27% (p=0.63) and in females from 0 to 20% (p=0.71). The annual OPSCC incidence increased from 2.3/100,000 (CI=1.2–4.2) in 1994–2001 to 3.8/100,000 (CI=2.4–6.2) in 2002–2010: among males from 2.4/100,000 (CI=1.0–5.7) to 5.0/100,000 (CI=2.9–8.9). Conclusion. Even though the population is at high risk of HPV infection, the proportion of 22% HPV+ OPSCC in the total study period is low compared to Europe and the United States. This might be explained by our small study size and/or by ethnic, geographical, sexual and cultural differences. Continuing observations of the OPSCC incidence and the proportion of HPV+ OPSCC in Greenland are needed