Befragung der Patienten zur Qualität der Krankenhausverpflegung und zu ihrer Einstellung zu Biokost sowie der Kliniken zum Einsatz von Biokost in ihrer Speiseversorgung

Um die Meinung von Krankenhauspatienten zur Qualität ihrer Verpflegung und zu ihrer Einstellung zu Bio-Lebensmitteln zu ermitteln, wurde vom Freiburger Institut für Umweltmedizin und Krankenhausyhgiene eine Umfrage durchgeführt (gefördert durch das Bundesprogramm Ökologischer Landbau). An der Umfrage beteiligten sich 1.500 Patientinnen und Patienten von 25 Akut- und Rehakliniken aus der Umgebung des Universitätsklinikums Freiburg. Auch die Verwaltungen konnten Ihre Meinung äußern. Im Ergebnis sind die befragten Patienten mit ihrer Essensqualität zufrieden, sie würden aber biologisch erzeugte Lebensmittel durchaus begrüßen, insbesondere da sie diese für gesünder halten als konventionell erzeugte Ware. Auch bezüglich Geschmack, Qualität und Umweltfreundlichkeit wurde die Biokost ausgesprochen positiv bewertet. Von Patienten bevorzugte Bio-Komponenten sind Gemüse, Obst und Salat. Generell wird auf eine gute Krankenverpflegung von Seiten der Patienten ein sehr hoher Wert gelegt. Weitgehende Zustimmung fand auch die Aussage, dass die Ernährungsqualität mit Einfluss auf den Behandlungserfolg hat. Allerdings stehen die Klinikverwaltungen finanziell sehr unter Druck. Der durchschnittliche Lebensmitteleinsatz für eine komplette Patienten-Tagesverpflegung lag bei 4,90 Euro und für Mehrausgaben wird von Seiten der Küchen kaum Spielraum gesehen. Die Umfrage zeigt aber, dass Kliniken, die in ihrer Küche trotzdem eine konsequente Strategie für eine sehr gute Verpflegungsqualität, einschließlich der Verwendung von Lebensmitteln in Bioqualität, verfolgen, von ihren Patienten mit einer hohen Zufriedenheit messbar honoriert werden

A theory-based approach to analysing conversation sequences

Aims - To assess the quality of communication generally two procedures are used: one defines categories of utterances and counts their frequency, the other uses global observer ratings. We investigated whether a sequence analysis of utterances yields results which more precisely reflect the process of a conversation. Methods - We re-examined data from a randomised controlled intervention study in which residents' interviews with simulated patients were analysed with the Maastricht History and Advice Checklist (MAAS-R) and the Roter Interaction Analysis System (RIAS). Using the U-file of the RIAS we studied the effect of different types of physician questions (open, closed questions, facilitators, other physician actions) on the length of uninterrupted patients' speech and content of utterances. We investigated also whether reciprocity indices improve after a communication skills training, and whether they correlate with global scores form MAAS-R. Results - Patients respond to a closed question with a mean of 1.78 (± 1.49) utterances as compared to 2.75 (± 2.72) utterances after an open question. The likelihood of a concern was more than lOfold higher after an open question compared to closed questions. Reciprocal sequences make up less than 2 percent of the conversation, Still, they correlate with global items form MAAS-R. The 'empathy index' improves after the training. Declararation of Interest: preparation of the manuscript was supported by a grant from OncoSuiss

Doctors' responses to patients' concerns; an exploration of communication sequences in gynaecology

Aims - Like other medical doctors, gynaecologists have difficulty attending to psychosocial issues and concerns. Communication training has proven to be effective in teaching them to spend more time on discussing these factors. However, whether or not they do this in response to patients' utterances remains unclear. The question is how gynaecologists respond to patients' concerns, whether or not they do this adequately and what the effects of a communication training are on the use of these communication sequences. Methods - Nineteen gynaecologists participated in a study which examined the effects of a three-day residential communication training. Before and after the training the gynaecologists videotaped series of consecutive outpatient visits. The communication during these visits was rated using the Roter Interaction Analysis System. Gynaecologists' responses to patients' concerns were examined at lag one, i.e. immediately following the patient's concern. Results - The most prevalent responses made by the gynaecologists were showing agreement and understanding and giving medical information. Affective responses were observed less. At postmeasurement, the gynaecologists responded neither more adequately nor inadequately to patients' concerns. Conclusions - The gynaecologists did not respond in a very affective way to patients' concerns. However, the patients did not express many concerns. Future studies should focus on more prevalent communication behaviours and incorporate more lags. Declaration of Interest: non

Patient satisfaction with divided anesthesia care.

BACKGROUND Up to now, no prospective cohort study using a validated questionnaire has assessed patients' expectation and perception of divided anesthesia care and its influence on patient satisfaction. OBJECTIVE We assessed patient satisfaction with divided anesthesia care in a district general hospital in Switzerland. We hypothesized that patient expectations, combined with their perceptions of the (un)importance of continuous anesthesia care would influence patient satisfaction. MATERIAL AND METHODS A total of 484 eligible in-patients receiving anesthesia from October 2019 to February 2020 were included and received preoperative information about divided care via a brochure and face-to-face. The primary outcome was the assessment of patient satisfaction with divided anesthesia care using a validated questionnaire. In group 1 continuity of care was considered important but not performed. In group 2 continuity was ensured. In group 3 continuity was regarded as not important and was not performed. In group 4 patients could not remember or did not answer. A psychometrically developed validated questionnaire was sent to patients at home after discharge. RESULTS A total of 484 completed questionnaires (response rate 81%) were analyzed. In group 1 (n = 110) the mean total dissatisfaction score was 25% (95% confidence interval [CI] 21.8-28.1), in group 2 (n = 61) 6.8% (95% CI 4.8-8.7), in group 3 (n = 223) 12.1% (95% CI 10.7-13.4), and in group 4 (n = 90) 15% (95% CI 11-18); ANOVA: p < 0.001, η = 0.43. Of the patients 286 (59%) considered continuity of care by the same anesthetist relatively unimportant (34%) or not important at all (25%). The other 40% considered it important (22%) or very important (18%). CONCLUSION Despite receiving comprehensive preoperative information about divided anesthesia care, 40% of patients still considered continuity of care by the same anesthetist important. We recommend further research evaluating whether and how patient expectations can be modified towards the common practice of divided care and patient satisfaction can be increased