Patients' experiences with hospital outpatient anticoagulation services:Dimensions and determinants

Abstract

OBJECTIVES: To characterise patients’ experiences with outpatient anticoagulation clinic services for testing blood coagulation intensity through the measuring of the international normalised ratio (INR) and to identify the latent dimensions and determinants of their experiences.METHODS: A cross-sectional questionnaire survey of a convenience sample of patients (N=350) attending outpatient anticoagulation services at a district general hospital in London. RESULTS: Response rate was 35.7% (n=125). The majority of patients were male (64%), aged ≥71 years (60%), and white / Caucasians (85%). Most of the respondents (55%) attended outpatient anticoagulation services several times in a month for INR testing, 97% of patients received INR test results by a letter and 78% of patients were very satisfied with the current method of getting test results. Eighty per cent of patients maintained a personal record of INR test results that was rated as ‘very useful’ by 77% of those who kept the record. The mean ratings of semantic differential items (SDI) used for characterising patients’ overall experience with outpatient anticoagulation services were detrimental-beneficial = 6.3 (±0.97), useless-useful = 6.2 (±1.01), worthless-valuable = 6.1 (±1.19), difficult-easy = 5.48 (±1.66), undesirable-desirable = 5.29 (±1.55), unpleasant-pleasant = 4.74 (±1.61), dislike-like = 4.71 (±1.42), unenjoyable-enjoyable = 4.28 (±1.61). Exploratory and confirmatory factor analyses of the SDI data determined two latent factors suggesting an ‘affective’ and a ‘value’ dimension of these patients’ experience with anticoagulation services. The duration that participants believed that they would continue to undergo INR testing was statistically a significant and negatively related predictor (β -0.306, P <0.05) of the affect dimension. The satisfaction with the current method of getting INR test results (β 0.362, P <0.001) and usefulness of keeping a personal record of results of INR tests (β 0.215, P <0.05) were statistically significant and positive predictors of the ‘value’ dimension. CONCLUSION: The overall experience of outpatient anticoagulation service users has ‘affect’ and ‘value’ dimensions, which may determine their use of the service. Identification of these two significant dimensions of patients’ experiences can help in studying experiences of users of other types of outpatient services. There is however a need for identifying other dimensions and predictors of patients’ experiences with outpatient services.