Psychometric properties of the Greek Diabetes Treatment Satisfaction Questionnaire

<p>Abstract</p> <p>Objectives</p> <p>Measurement of treatment satisfaction in diabetes is important as it has been shown to be associated with positive outcomes, reduced disease cost and better health. The aim of this study was to assess the construct validity and internal consistency reliability of the Greek version of the Diabetes Treatment Satisfaction Questionnaire (DTSQ).</p> <p>Methods</p> <p>A sample of type II diabetes patients (N = 172) completed the DTSQ status version, the SF-36 health survey and also provided data regarding treatment method, clinical and socio-demographic status. Instrument structure, reliability (Cronbach's a) and construct validity (convergent, discriminative, concurrent and known-groups) were assessed.</p> <p>Results</p> <p>The DTSQ measurement properties were confirmed in the Greek version with confirmatory factor analysis (CFA). Scale reliability was high (Cronbach's a = 0.92). Item-scale internal consistency and discriminant validity were also good, exceeding the designated success criteria. Significant correlations were observed between DTSQ items/overall score and SF-36 scales/component scores, which were hypothesized to measure similar dimensions. Known groups' comparisons yielded consistent support of the construct validity of the instrument.</p> <p>Conclusions</p> <p>The instrument was well-accepted by the patients and its psychometric properties were similar to those reported in validation studies of other language versions. Further research, incorporating a longitudinal study design, is required for examining test-retest reliability and responsiveness of the instrument, which were not addressed in this study. Overall, the present results confirm that the DTSQ status version is a reasonable choice for measuring diabetes treatment satisfaction in Greece.</p

The effect of environmental factors on technical and scale efficiency of primary health care providers in Greece

<p>Abstract</p> <p>Background</p> <p>The purpose of this study was to compare technical and scale efficiency of primary care centers from the two largest Greek providers, the National Health System (NHS) and the Social Security Foundation (IKA) and to determine if, and how, efficiency is affected by various exogenous factors such as catchment population and location.</p> <p>Methods</p> <p>The sample comprised of 194 units (103 NHS and 91 IKA). Efficiency was measured with Data Envelopment Analysis (DEA) using three inputs, -medical staff, nursing/paramedical staff, administrative/other staff- and two outputs, which were the aggregated numbers of scheduled/emergency patient visits and imaging/laboratory diagnostic tests. Facilities were categorized as small, medium and large (<15,000, 15,000–30,000 and >30,000 respectively) to reflect catchment population and as urban/semi-urban or remote/island to reflect location. In a second stage analysis, technical and scale efficiency scores were regressed against facility type (NHS or IKA), size and location using multivariate Tobit regression.</p> <p>Results</p> <p>Regarding technical efficiency, IKA performed better than the NHS (84.9% vs. 70.1%, Mann-Whitney <it>P </it>< 0.001), smaller units better than medium-sized and larger ones (84.2% vs. 72.4% vs. 74.3%, Kruskal-Wallis <it>P </it>< 0.01) and remote/island units better than urban centers (81.1% vs. 75.7%, Mann-Whitney <it>P </it>= 0.103). As for scale efficiency, IKA again outperformed the NHS (89.7% vs. 85.9%, Mann-Whitney <it>P </it>= 0.080), but results were reversed in respect to facility size and location. Specifically, larger units performed better (96.3% vs. 90.9% vs. 75.9%, Kruskal-Wallis <it>P </it>< 0.001), and urban units showed higher scale efficiency than remote ones (91.9% vs. 75.3%, Mann-Whitney <it>P </it>< 0.001). Interestingly 75% of facilities appeared to be functioning under increasing returns to scale. Within-group comparisons revealed significant efficiency differences between the two primary care providers. Tobit regression models showed that facility type, size and location were significant explanatory variables of technical and scale efficiency.</p> <p>Conclusion</p> <p>Variations appeared to exist in the productive performance of the NHS and IKA as the two main primary care providers in Greece. These variations reflect differences in primary care organization, economical incentives, financial constraints, sociodemographic and local peculiarities. In all technical efficiency comparisons, IKA facilities appeared to outperform NHS ones irrespective of facility size or location. In respect to scale efficiency, the results were to some extent inconclusive and observed differences were mostly insignificant, although again IKA appeared to perform better.</p

Restructuring the hospital sector in Greece in order to improve effectiveness and efficiency

Το άρθρο αυτό παρουσιάζει τη μελέτη πουαφορούσε στην αναδιάρθρωση του ΕλληνικούΝοσοκομειακού Τομέα Σκοπός της μελέτηςήταν να προτείνει ένα νέο πρότυπο οργάνω-σης των νοσοκομείων σε ομάδες με βάση τηναναμόρφωση της επείγουσας φροντίδας και τηδιαχείριση των πέντε κύριων χρόνιων νοση-μάτων (Οξύ Έμφραγμα του Μυοκαρδίου, Αγγειακό Εγκεφαλικό Επεισόδιο, Καρκίνος, Σακχαρώδης Διαβήτης και Χρόνια ΑποφρακτικήΠνευμονοπάθεια). Στο πλαίσιο της βελτίωσηςτης αποτελεσματικότητας και αποδοτικότηταςτου νοσοκομειακού τομέα παρουσιάστηκανπροτάσεις όπως η συνεργασία ιδιωτικού καιδημόσιου τομέα καθώς και μέτρα περιορισμούτων δαπανών. Η αναδιάρθρωση του δημόσιουνοσοκομειακού τομέα στηρίχθηκε σε έξι δια-κριτά κριτήρια τα οποία συμπεριελάμβαναν τοπληθυσμιακό κριτήριο, τη συγκέντρωση τουπληθυσμού, το μέγεθος του νοσοκομείου, τηνπαλαιότητα των υποδομών, την ένταση της αξιοποίησης της νοσοκομειακής υποδομής και τηνοικονομική αποδοτικότητα του νοσοκομείου.This paper discusses the study focused on thereform of Greek Hospital Sector, also known as“hospital mergers”. The aim of the study was topropose a new pattern of organizing hospitalsin groups based on the reform of emergencycare and the management of five main chronicdiseases (AMI, Stroke, Cancer, Diabetes Mellitusand COPD). The proposals in general concern thecreation of a national network of health servicesprovided mainly by primary healthcare units andthe largest hospitals of the groups in each healthregion. In the context of improving the hospitalsector efficiency, ways of collaborations betweenprivate and public sector and expenditurecontainment measures are presented. Therestructuring of the public hospital sector reliedon six specific criteria including the populationcriterion, catchment area, hospital size,infrastructure age, utilization of hospital facilitiesand cost. Due to its nature, the study was exposedto various factors such as the diversity of actorsbeing involved, collection and compilation of therelevant data in a short term of three months, lastminute adjustments and the variety of audience

Restructuring the hospital sector in Greece in order to improve effectiveness and efficiency

Το άρθρο αυτό παρουσιάζει τη μελέτη πουαφορούσε στην αναδιάρθρωση του ΕλληνικούΝοσοκομειακού Τομέα Σκοπός της μελέτηςήταν να προτείνει ένα νέο πρότυπο οργάνω-σης των νοσοκομείων σε ομάδες με βάση τηναναμόρφωση της επείγουσας φροντίδας και τηδιαχείριση των πέντε κύριων χρόνιων νοση-μάτων (Οξύ Έμφραγμα του Μυοκαρδίου, Αγγειακό Εγκεφαλικό Επεισόδιο, Καρκίνος, Σακχαρώδης Διαβήτης και Χρόνια ΑποφρακτικήΠνευμονοπάθεια). Στο πλαίσιο της βελτίωσηςτης αποτελεσματικότητας και αποδοτικότηταςτου νοσοκομειακού τομέα παρουσιάστηκανπροτάσεις όπως η συνεργασία ιδιωτικού καιδημόσιου τομέα καθώς και μέτρα περιορισμούτων δαπανών. Η αναδιάρθρωση του δημόσιουνοσοκομειακού τομέα στηρίχθηκε σε έξι δια-κριτά κριτήρια τα οποία συμπεριελάμβαναν τοπληθυσμιακό κριτήριο, τη συγκέντρωση τουπληθυσμού, το μέγεθος του νοσοκομείου, τηνπαλαιότητα των υποδομών, την ένταση της αξιοποίησης της νοσοκομειακής υποδομής και τηνοικονομική αποδοτικότητα του νοσοκομείου.This paper discusses the study focused on thereform of Greek Hospital Sector, also known as“hospital mergers”. The aim of the study was topropose a new pattern of organizing hospitalsin groups based on the reform of emergencycare and the management of five main chronicdiseases (AMI, Stroke, Cancer, Diabetes Mellitusand COPD). The proposals in general concern thecreation of a national network of health servicesprovided mainly by primary healthcare units andthe largest hospitals of the groups in each healthregion. In the context of improving the hospitalsector efficiency, ways of collaborations betweenprivate and public sector and expenditurecontainment measures are presented. Therestructuring of the public hospital sector reliedon six specific criteria including the populationcriterion, catchment area, hospital size,infrastructure age, utilization of hospital facilitiesand cost. Due to its nature, the study was exposedto various factors such as the diversity of actorsbeing involved, collection and compilation of therelevant data in a short term of three months, lastminute adjustments and the variety of audience

Comparing Health-Related Quality of Life of Cancer Patients under Chemotherapy and of Their Caregivers

Introduction. Cancer is a major disorder physically and psychologically affecting both patients and their caregivers. In this study, health-related quality of life (HRQoL) of patient-caregiver dyads during the period of chemotherapy was assessed. Material and Methods. Two hundred twenty-two cancer patient-caregiver dyads were enrolled in the study, which was conducted from October 2008 to March 2009. HRQoL was evaluated with EQ-5D. Results. The mean age of the sample was 57.4 and 48.9 for patients and caregivers, respectively. The EQ-5D descriptive system indicates that female patients more frequently experience anxiety and depression than male patients. Male and higher-education caregivers had higher VAS scores, while demographic factors did not seem to influence patients' HRQoL. Anxiety and depression of caregivers were correlated with patients' problems in self-care and usual activities. Conclusions. Quality of life is highly influenced during the period of chemotherapy for both patients and caregivers and is often under reported. Interventions that can improve HRQoL, especially in the domain of mental health for both cancer patients and their caregivers, need to be implemented

Validation of the Kidney Disease Quality of Life-Short Form: a cross-sectional study of a dialysis-targeted health measure in Singapore

<p>Abstract</p> <p>Background</p> <p>In Singapore, the prevalence of end-stage renal disease (ESRD) and the number of people on dialysis is increasing. The impact of ESRD on patient quality of life has been recognized as an important outcome measure. The Kidney Disease Quality Of Life-Short Form (KDQOL-SF™) has been validated and is widely used as a measure of quality of life in dialysis patients in many countries, but not in Singapore. We aimed to determine the reliability and validity of the KDQOL-SF™ for haemodialysis patients in Singapore.</p> <p>Methods</p> <p>From December 2006 through January 2007, this cross-sectional study gathered data on patients ≥21 years old, who were undergoing haemodialysis at National Kidney Foundation in Singapore. We used exploratory factor analysis to determine construct validity of the eight KDQOL-SF™ sub-scales, Cronbach's alpha coefficient to determine internal consistency reliability, correlation of the overall health rating with kidney disease-targeted scales to confirm validity, and correlation of the eight sub-scales with age, income and education to determine convergent and divergent validity.</p> <p>Results</p> <p>Of 1980 haemodialysis patients, 1180 (59%) completed the KDQOL-SF™. Full information was available for 980 participants, with a mean age of 56 years. The sample was representative of the total dialysis population in Singapore, except Indian ethnicity that was over-represented. The instrument designers' proposed eight sub-scales were confirmed, which together accounted for 68.4% of the variance. All sub-scales had a Cronbach's α above the recommended minimum value of 0.7 to indicate good reliability (range: 0.72 to 0.95), except for Social function (0.66). Correlation of items within subscales was higher than correlation of items outside subscales in 90% of the cases. The overall health rating positively correlated with kidney disease-targeted scales, confirming validity. General health subscales were found to have significant associations with age, income and education, confirming convergent and divergent validity.</p> <p>Conclusions</p> <p>The psychometric properties of the KDQOL-SF™ resulting from this first-time administration of the instrument support the validity and reliability of the KDQOL-SF™ as a measure of quality of life of haemodialysis patients in Singapore. It is, however, necessary to determine the test-retest reliability of the KDQOL-SF™ among the haemodialysis population of Singapore.</p

Motivation and job satisfaction among medical and nursing staff in a Cyprus public general hospital

<p>Abstract</p> <p>Background</p> <p>The objective of this study was to investigate how medical and nursing staff of the Nicosia General Hospital is affected by specific motivation factors, and the association between <it>job satisfaction </it>and <it>motivation</it>. Furthermore, to determine the motivational drive of socio-demographic and job related factors in terms of improving work performance.</p> <p>Methods</p> <p>A previously developed and validated instrument addressing four work-related motivators (<it>job attributes, remuneration, co-workers and achievements</it>) was used. Two categories of health care professionals, medical doctors and dentists (N = 67) and nurses (N = 219) participated and motivation and job satisfaction was compared across socio-demographic and occupational variables.</p> <p>Results</p> <p>The survey revealed that <it>achievements </it>was ranked first among the four main motivators, followed by <it>remuneration</it>, <it>co-workers </it>and <it>job attributes</it>. The factor <it>remuneration </it>revealed statistically significant differences according to gender, and hospital sector, with female doctors and nurses and accident and emergency (A+E) outpatient doctors reporting greater mean scores (p < 0.005). The medical staff showed statistically significantly lower job satisfaction compared to the nursing staff. Surgical sector nurses and those >55 years of age reported higher job satisfaction when compared to the other groups.</p> <p>Conclusions</p> <p>The results are in agreement with the literature which focuses attention to management approaches employing both monetary and non-monetary incentives to motivate health care professionals. Health care professionals tend to be motivated more by intrinsic factors, implying that this should be a target for effective employee motivation. Strategies based on the survey's results to enhance employee motivation are suggested.</p

The Relationship between Diabetes Mellitus and Health-Related Quality of Life in Korean Adults: The Fourth Korea National Health and Nutrition Examination Survey (2007-2009)

BackgroundDiabetes is a major health problem in Korea. However, interest in the quality of life in patients with diabetes is low. We examined the effects of diabetes on health-related quality of life (HRQoL) and compared it with HRQoL in the general Korean population using the Fourth Korea National Health and Nutrition Examination Survey (KNHANES IV) (2007-2009).MethodsUsing KNHANES IV data, we compared EuroQol (EQ)-5D and EQ-visual analogue scale (VAS) scores after adjusting for sociodemographic and psychosocial factors as well as for comorbidities (hypertension, heart disease, stroke, arthritis, and chronic renal disease). Logistic regressions were used to explore determinants for the lowest quintile HRQoL scales in the diabetes group.ResultsThe mean age of the 14,441 enrolled subjects (6,129 men and 8,312 women) was 52.5±14.5 years. The mean EQ-5D and EQ-VAS scores were significantly lower in the diabetes group (EQ-5D. 0.87; EQ-VAS, 71.94) than in the non-diabetes group (EQ-5D, 0.94; EQ-VAS, 77.40) (P<0.001). Self-reported depressive symptom had a significant effect on lowering the EQ-VAS (odds ratio [OR], 1.7; 95% confidence interval [CI], 1.1 to 2.6) in the diabetes group. Stress level had a significant effect in lowering both the EQ-5D (OR, 2.0; 95% CI, 1.3 to 2.9) and the EQ-VAS (OR, 1.9; 95% CI, 1.3 to 2.9). HbA1c, diabetes duration, and treatment modalities had no significant effect on lowering HRQoL.ConclusionDiabetes was clearly associated with impaired HRQoL compared with the non-diabetic population regardless of comorbidities. Therapeutic approaches should focus much more on the subjective perception of health in patients with diabetes

Trajectories of Low Back Pain From Adolescence to Young Adulthood

Objective: Despite the high prevalence and burden of low back pain (LBP), understanding of its course during the transition from adolescence to adulthood is limited. The aim of this study was to identify and describe trajectories of LBP and its impact among a general population sample followed from adolescence to young adulthood. Methods: Data from followup assessments at years 17, 20, and 22 of the Western Australian Pregnancy Cohort (Raine) Study were used (n = 1,249). Self-reported LBP and its impact on daily life were assessed, and latent class analysis was used to identify clusters. Resultant clusters were profiled on sex, waist circumference, diagnosed comorbid pain, and health-related quality of life. Results: Four clusters were identified: a cluster of participants with a consistently low prevalence of LBP and its impact (53%) during the period from adolescence to young adulthood, a cluster with an increase in the prevalence of LBP and its impact (22%), a cluster with a decrease in the prevalence of LBP and its impact (15%), and a cluster with a consistently high prevalence of LBP and its impact (10%). These clusters differed markedly on the profiling variables. Conclusion: The identified clusters provide unique information on LBP and its impact during the transition from adolescence to young adulthood. Consideration of these trajectories could be important in the design of early prevention and management strategies

From KIDSCREEN-10 to CHU9D: creating a unique mapping algorithm for application in economic evaluation

Background: The KIDSCREEN-10 index and the Child Health Utility 9D (CHU9D) are two recently developed generic instruments for the measurement of health-related quality of life in children and adolescents. Whilst the CHU9D is a preference based instrument developed specifically for application in cost-utility analyses, the KIDSCREEN-10 is not currently suitable for application in this context. This paper provides an algorithm for mapping the KIDSCREEN-10 index onto the CHU9D utility scores. Methods: A sample of 590 Australian adolescents (aged 11–17) completed both the KIDSCREEN-10 and the CHU9D. Several econometric models were estimated, including ordinary least squares estimator, censored least absolute deviations estimator, robust MM-estimator and generalised linear model, using a range of explanatory variables with KIDSCREEN-10 items scores as key predictors. The predictive performance of each model was judged using mean absolute error (MAE) and root mean squared error (RMSE). Results: The MM-estimator with stepwise-selected KIDSCREEN-10 items scores as explanatory variables had the best predictive accuracy using MAE, whilst the equivalent ordinary least squares model had the best predictive accuracy using RMSE. Conclusions: The preferred mapping algorithm (i.e. the MM-estimate with stepwise selected KIDSCREEN-10 item scores as the predictors) can be used to predict CHU9D utility from KIDSCREEN-10 index with a high degree of accuracy. The algorithm may be usefully applied within cost-utility analyses to generate cost per quality adjusted life year estimates where KIDSCREEN-10 data only are available