Different Aspects Of Care Research Articles

Quality of post-abortion care in public health facilities in Ethiopia

Abstract Background: Comprehensive quality Post Abortion Care (PAC) is one of the important strategies to save lives where access to safe abortion is restricted by Law and services are inaccessible. Objective: The objective of the study was to assess the status of quality of PAC in health facilities of Amhara and Oromiya regional states. Methods: The study was cross-sectional by design and was conducted from November 2002 to March 2003. Patient interview, provider interview and direct service delivery observation were utilized to capture different aspects of care. Eleven health facilities (five in Oromiya and six in Amhara Regions), 103 post-abortion patients and 87 health service providers were included in the study. Results: although facilities were found to be prepared to manage abortion complications, some patients were delayed from receiving services because of requirement to pay before getting services, and to buy drugs and supplies from other sources. Patient-provider interaction was generally satisfactory as viewed by the respondents. Majority (88.3%) of patients felt that PAC services maintained confidentiality. Patients were not informed about the steps of each procedure. Nearly two-third of service providers informed the patients about the cause of their problem, but only 50.5% of them told the outcome of treatment. Information provision regarding important precautions and warning signs was uniformly very low in all study facilities. Only 53.4% of patients left the facilities counseled about family planning and 44.7% with contraceptives. But, 84.5% of women do not plan pregnancy within three months following the abortion. Great majority of the patients responded that they were satisfied with services they have obtained. Dissatisfaction included maltreatment by service providers, and inconvenient setup of service delivery. Patient assessment was principally based on last menstrual period and bimanual pelvic examination in most of the facilities. Service providers do not usually stick to infection prevention and universal precautions. Conclusion: the study has shown areas of improvement for better services to respond to various needs of the postabortion patients. [Ethiop.J.Health Dev. 2008;22 (1):26-33]

Criteria for clinical audit of women friendly care and providers' perception in Malawi

BackgroundThere are two dimensions of quality of maternity care, namely quality of health outcomes and quality as perceived by clients. The feasibility of using clinical audit to assess and improve the quality of maternity care as perceived by women was studied in Malawi.ObjectiveWe sought to (a) establish standards for women friendly care and (b) explore attitudinal barriers which could impede the proper implementation of clinical audit.MethodsWe used evidence from Malawi national guidelines and World Health Organisation manuals to establish local standards for women friendly care in three districts. We equally conducted a survey of health care providers to explore their attitudes towards criterion based audit.ResultsThe standards addressed different aspects of care given to women in maternity units, namely (i) reception, (ii) attitudes towards women, (iii) respect for culture, (iv) respect for women, (v) waiting time, (vi) enabling environment, (vii) provision of information, (viii) individualised care, (ix) provision of skilled attendance at birth and emergency obstetric care, (x) confidentiality, and (xi) proper management of patient information. The health providers in Malawi generally held a favourable attitude towards clinical audit: 100.0% (54/54) agreed that criterion based audit will improve the quality of care and 92.6% believed that clinical audit is a good educational tool. However, there are concerns that criterion based audit would create a feeling of blame among providers (35.2%), and that manager would use clinical audit to identify and punish providers who fail to meet standards (27.8%).ConclusionDeveloping standards of maternity care that are acceptable to, and valued by, women requires consideration of both the research evidence and cultural values. Clinical audit is acceptable to health professionals in Malawi although there are concerns about its negative implications to the providers.

Setting priorities for improving the preoperative assessment clinic: the patients’ and the professionals’ perspective

The quality of the preoperative assessment clinic (PAC) is determined by many factors. Patients' experiences are important indicators, but often overlooked. We prepare to set priorities to improve the PAC by obtaining detailed patients' feedback on the quality of the PAC, and establishing the value patients and professionals attach to different care aspects, using the Patient Experiences with the Preoperative Assessment Clinic questionnaire. The PAC's standard of service was determined for five care aspects (dimensions), using patients' feedback. The importance of a dimension to patients was determined by calculating the effects of the dimensions on patients' overall appraisal. In addition, professionals were asked to rate the importance of the different care aspects. Patients had the most positive experiences with the nurse, and the least positive experiences with waiting. However, waiting was least important to patients. When combining the PAC's standard of service with the value given to the dimensions by patients and professionals separately, we found in both instances that waiting was in greatest need of improvement. This was followed by reception, the anaesthetist, remaining experiences, and finally the nurse. Quality improvement of the PAC can be achieved by obtaining patients' feedback on the quality, determine a PAC's standard of service, recognize service areas that require improvement, and identify actions appropriate to bring about improvement. The value patients and professionals attach to different aspects of care can then be used to prioritize improvements.

Satisfaction with care in peritoneal dialysis patients

Patient satisfaction is an important aspect of dialysis care, only recently evaluated in clinical studies. We developed a tool to assess peritoneal dialysis (PD) customer satisfaction, and sought to evaluate and validate the Customer Satisfaction Questionnaire (CSQ), quantifying PD patient satisfaction. The CSQ included questions regarding administrative issues, Delivery Service, PD Training, Handling Requests, and transportation. The study was performed using interviews in all Hungarian Fresenius Medical Care dialysis centers offering PD. CSQ results were compared with psychosocial measures to identify if patient satisfaction was associated with perception of social support and illness burden, or depression. We assessed CSQ internal consistency and validity. Factor analysis explored potential underlying dimensions of the CSQ. One hundred and thirty-three patients treated with PD for end-stage renal disease for more than 3 months were interviewed. The CSQ had high internal consistency. There was high patient satisfaction with customer service. PD patient satisfaction scores correlated with quality of life (QOL) and social support measures, but not with medical or demographic factors, or depressive affect. The CSQ is a reliable tool to assess PD customer satisfaction. PD patient satisfaction is associated with perception of QOL. Efforts to improve customer satisfaction may improve PD patients' quantity as well as QOL.

A qualitative study of an integrated maternity, drugs and social care service for drug-using women.

BackgroundThe care of drug-using pregnant women is a growing health and social care concern in many countries. A specialist clinic was established offering multidisciplinary care and advice to pregnant drug users in and around Aberdeen (UK) in 1997. The majority of women stabilise and reduce their drug use. By determining the needs and views of the women more appropriate services and prevention strategies may be developed. There has been little research conducted in this area and none in Scotland.MethodsThis is a qualitative study that aimed to gain an understanding of the experiences of women drug users, seeking and receiving prenatal care and drug services from a specialist clinic. Twelve women participated in semi-structured one-to-one interviews.ResultsThe women preferred the multidisciplinary clinic (one-stop shop) to traditional prenatal care centred within General Practice. The relationships of the clients to the range of Clinic professionals and in hospital were explored as well as attitudes to Clinic care. The study participants attributed success in reducing their drug use to the combination of different aspects of care of the multi-agency clinic, especially the high level prenatal support. It is this arrangement of all aspects of care together that seem to produce better outcomes for mother and child than single care elements delivered separately. Some women reported that their pregnancy encouraged them to rapidly detoxify due to the guilt experienced. The most important aspects of the Clinic care were found to be non-judgemental attitude of staff, consistent staff, high level of support, reliable information and multi-agency integrated care.ConclusionThere is an impetus for women drug users to change lifestyle during pregnancy. The study highlighted a need for women to have access to reliable information on the effects of drugs on the baby.Further research is required to determine whether positive outcomes related to clinic attendance in the prenatal period are sustained in the postnatal period. Early referral to a specialist clinic is of benefit to the women, as they reported to receive more appropriate care, especially in relation to their drug use. A greater awareness of needs of the pregnant drug user could help the design of more effective prevention strategies.

What is important in evaluating health care quality? An international comparison of user views

BackgroundQuality of care from the perspective of users is increasingly used in evaluating health care performance. Going beyond satisfaction studies, quality of care from the users' perspective is conceptualised in two dimensions: the importance users attach to aspects of care and their actual experience with these aspects. It is well established that health care systems differ in performance. The question in this article is whether there are also differences in what people in different health care systems view as important aspects of health care quality. The aim is to describe and explain international differences in the importance that health care users attach to different aspects of health care.MethodsData were used from different studies that all used a version of the QUOTE-questionnaire that measures user views of health care quality in two dimensions: the importance that users attach to aspects of care and their actual experience. Data from 12 European countries and 5133 individuals were used. They were analysed using multi-level analysis.ResultsAlthough most of the variations in importance people attach to aspects of health care is located at the individual level, there are also differences between countries. The ranking of aspects shows similarities. 'My GP should always take me seriously' was in nearly all countries ranked first, while an item about waiting time in the GP's office was always ranked lowest.ConclusionDifferences between countries in how health care users value different aspects of care are difficult to explain. Further theorising should take into account that importance and performance ratings are positively related, that people compare their experiences with those of others, and that general and instrumental values might be related through the institutions of the health care system.

International comparisons of patients’ views on quality of care

To compare patients' views on quality of care in different countries using a theory-based instrument, while at the same time controlling for the following potential confounders: type of care system (private vs public), type of care (kind of health problem), gender, age, and subjective wellbeing. Patients capable of communicating in wards (medical and surgical departments) and day surgery departments in England, France, Norway, and Sweden were recruited consecutively, to participate in a programme run by the health-care company Capio. Ward patients: England (n=1236), France (n=1051), Norway (n=226), and Sweden (n=428). Day surgery patients: England (n=887), France (n=544), Norway (n=101), and Sweden (n=742). Average response rate across settings: approximately 75 per cent. Patients evaluated the quality of the care they actually received and the subjective importance they ascribed to different aspects of care. The questionnaire "Quality from the patient's perspective" (QPP) was used (modified short version). Cross-national comparisons were made within each of the two care contexts (wards and day surgery) separately for men and women. Quality of care evaluations were adjusted for age and subjective wellbeing. English and French patients scored significantly higher than Norwegian and Swedish on both kinds of ratings (perceived reality and subjective importance), in both kinds of care contexts, and in both sexes. Cross-national comparisons of patients' views on care can give meaningful guidance for practitioners only if they are context-specific and if well-known confounders are controlled for.

A Survey of the quality of nursing care in several health districts in South Africa.

BackgroundSouth Africa is currently focusing strongly on human resource development. The purpose of this study was to describe and compare the quality of nursing service and care in three health districts in the KwaZulu Natal Province. To identify deficiencies which could be addressed by education and training, it might be useful to measure the quality of care given by nurses.MethodsFrom March to August 2002 a survey was done in six hospitals and six clinics in three health districts of the KwaZulu-Natal province of South Africa. Five different aspects of care was evaluated; hand-over from one nursing shift to another, implementation of universal precautions, patient satisfaction, nursing records, management of chronic illnesses. All these aspects were evaluated using checklists based on record reviews or direct observation, except for patient satisfaction, which was evaluated by questionnaires.ResultsThe average scores on the different aspects varied from 11% (for nursing records) to 73% (for management of chronic diseases). Specific problems became evident. In one district three out of four hand-overs between shifts of nurses scored less than 50%. In all three districts the use of protective gear scored low (43%). While the average score for management of chronic illnesses were high at 73%, the blood pressures of only 23% was within the target range, and the blood sugar of only 38% of patients were controlled. Patient satisfaction averaged 72% across the three districts.ConclusionThe quality of care measurements identified specific training needs, but other management strategies are probably also indicated.

Nurses' perceptions of the Liverpool Care Pathway for the dying patient in the acute hospital setting.

The Liverpool Care Pathway for the dying patient (LCP) was developed to transfer the hospice model of care into other care settings. It is a multiprofessional document that provides an evidence-based framework for the dying phase. It provides guidance on the different aspects of care required including comfort measures, anticipatory prescribing of medication, and discontinuation of inappropriate interventions. Additionally, psychological and spiritual care and family support is included. This article presents the findings of a study to explore hospital nurses' perceptions of the impact of the LCP using focus group interviews. Data were analysed for emerging themes using thematic analysis. The results suggest that the nurses have generally found that the LCP had a positive impact on patients, their families and also on nurses and doctors. This article will explore these benefits, as well as potential barriers to its use.

Perceptions of health care quality in Central America.

To examine user perceptions of health care delivery in selected rural and urban areas of three Central American countries. Three focus group studies were conducted in 1997-98 in Honduras, Costa Rica, and Panama. In each selected region, 10 to 15 groups met to discuss health services available, access to and use of the services, satisfaction with different aspects of care and suggestions for improvement. Regions chosen represented the poorest areas in each country and the dominant health care systems in Central America: the Ministry of Health system and the Social Security system based on mandatory contributions. 351 residents from rural and urban communities represented different genders, ages, occupations, health, and socio-economic status. Participants considered private care to be the best, but too costly. Their main preoccupations focused on prompt access to trusted physicians, effective and inexpensive medication, and quality attention in public hospitals. Hondurans favor the personal care offered in public clinics and rural hospitals, and hope for improved medical services. In Costa Rica and Panama, users prefer Social Security clinics for the medical specialties and perceived sophisticated technology, despite delays and poor attention. The rural poor, especially indigenous people, voice basic needs with little regard for quality. Health care quality is extremely variable in the three regions, requiring increased community participation to improve. Focus groups offered important, confidential and cost-effective information on quality and breadth of health care delivery and should be part of quality monitoring initiatives.

Patient satisfaction with care is associated with personal choice of physician

Objective: To evaluate whether choosing one's own primary care doctor is associated with patient satisfaction with primary health care. To evaluate factors related to population's satisfaction with primary health care. Population: A random sample of Estonian adult population ( N=997). Study design: Cross-sectional study using a pre-categorized questionnaire which was compiled by the research group of the University of Tartu and the research provider EMOR. Results: Altogether 68% of the respondents had been listed in their personal physician. Their overall satisfaction with the physician as well as satisfaction with several aspects of primary health care were significantly higher compared with those of unregistered respondents. Although some other factors (practice size, patient age, health status) also influenced patient satisfaction, presence of a personal physician appeared the most important predictor of high satisfaction with physician's punctuality and understanding, effectiveness of prescribed therapy, clarity of explanations given by the physician as well as with overall satisfaction with the physician. Conclusion: Personal doctor system is associated with patient satisfaction with different aspects of care.

Gender bias in nursing care? Gender-related differences in patient satisfaction with the quality of nursing care.

Gender-related differences in experience with nursing care, was studied using data from a Norwegian survey of patient-satisfaction. The survey included 1469 male and 1226 female patients. Results showed that young female patients were less content with all aspects of nursing care when compared with young male patients. Female patients experienced, quite contrary to their male counterparts, that the nursing staff was less committed and caring, has less time and was less skilled. The young women were also less content with what they felt was a lack of opportunity to provide the staff with information they believed to be important to their condition or ailment. Analysis also revealed that female patients, compared with their male counterparts, indicated a higher score on the subjective importance of the different aspects of care. These findings are discussed on the basis of gender-related research in general. The finding of lower satisfaction amongst younger female patients could be ascribed to the power-balance between nursing staff and patients. The discussion shows, however, that there are a number of possible interpretations as to why female patients are less content with nursing care compared with male patients. As the reasons for the findings may be derived from several sources it becomes evident that there is a need for further research using alternative approaches.

Dementia patients in general practice--results of a survey

In line with the current demographic trends, the number of elderly suffering from dementia is increasing. GPs have a key position in dealing with these patients at the primary care level. Different aspects of care for patients suffering from dementia provided in general practice in Germany were assessed by means of a questionnaire (n = 563). The results highlight the role of GPs in the delivery of medical and psychosocial care. However, diagnosing dementia seems challenging and co-operation could be improved. Three fourths of the GPs diagnose vascular dementia more often than Alzheimer's disease, which is contrary to what is known from epidemiological findings. One third refers patients to a specialist on a regular basis for establishing the diagnosis. Only 4% of the German GPs entertain co-operative relationships with the "Alzheimer society" and the "Brain league". Consequences for improving these for patients with dementia and their families are discussed.

Psychiatric inpatients' satisfaction with services: A pilot study

INTRODUCTION: Fifty-three patients admitted to a psychiatric inpatient unit in South London were interviewed to ascertain their satisfaction with services provided for them. METHOD: The level of satisfaction with various aspects of treatment was evaluated using a 45-item questionnaire. RESULTS: Results showed that patients were generally satisfied with the staff attitudes and care, although two-thirds felt that they had not been sufficiently involved in their own treatment planning. Younger patients reported more frequent difficulties in the relationship with staff. Patients were generally satisfied with the physical environment. Patients with a higher number of previous admissions were more satisfied with the planning of care, and they were less often in conflict with the staff. Patients admitted compulsorily were less satisfied than voluntary patients with the overall quality of the help received and said they would rarely re-contact the service in the future. There was virtually no effect of ethnicity on the levels of satisfaction in different aspects of care. The only worry expressed more frequently by African-Caribbean patients was about re-contacting the service in the future, even though they felt the help received in planning their discharge was good. CONCLUSION: It would be useful to carry out such surveys more often.

Coding data from child health records: the relationship between interrater agreement and interpretive burden.

The relationship between interrater reliability and interpretive burden when coding information from Swedish Child Health records was studied. Information on preschool children's living conditions, health, and different aspects of care was sorted into one of four groups according to degree of interpretive burden. Two interrater assessments were conducted and compared. The results showed that a low degree of interpretive burden correlated to high interrater agreement. It was possible to increase concordance by coder training, clarifying definitions of variables, and coding instructions, but not so as to eliminate totally the general differences between groups of variables that differed regarding interpretive burden.

The quality of general dental care: public and users' perceptions.

BACKGROUND: Systematic evidence about how the public and users perceive and experience the quality of general dental care is in short supply, particularly in light of the recent changes in...

Caring for older people in acute settings: Lessons learned from an action research study in accident and emergency

The health and social care of older people has never been so high on the political agenda. In particular, there has been growing concern about the care of older people in acute settings. This paper reports the findings of an action research study which explored the organisation of care for older people in an accident and emergency (A&E) setting. Although the findings cannot be generalised directly to all acute settings, the action research methodology generated unique exploratory data, which suggest older patients arrive at hospital with low expectations of care and appear to understand many of the constraints under which staff are working. However, while patients appear to be able to identify small ways in which care could be improved easily, staff instead appear to blame the wider organisation for poor care and give the impression of being disempowered to care. This is despite findings which suggest nurses could make changes in the priorities they give to different aspects of care. The lessons learned from this action research study suggest that nurses may need to work more closely together to foster the much-needed improvements in care of older people. With the National Service Framework for Older People on the horizon, nurses cannot afford to ignore the needs of such a significant group of patients under their care.

The relationship between expectations and satisfaction: a qualitative study of patients' experiences of surgery for gynaecological cancer.

It is important that a patient perspective is introduced to the identification and measurement of the outcomes of health care. The aim of this study was to use qualitative methods to examine the presence or absence of expectations prior to the experience of health care and the relationship between expectations, satisfaction and dissatisfaction in a group of women undergoing surgery in a large teaching hospital. Nineteen women with a diagnosis of gynaecological cancer were interviewed on two occasions, before and after surgery. A thematic analysis was undertaken. The results suggest that there is not a clear relationship between expectations and satisfaction. Women had different levels of expectations about different types of care and different aspects of care. Unfulfilled expectations did not lead to less satisfaction. The women were able to express satisfaction either with the care overall or with specific aspects of care, as well as being able to distinguish aspects of care with which they were dissatisfied.

Patient and Parent Experiences with Health Care Services in Pediatric Rheumatology

The health care received from first admission to a pediatric rheumatology clinic to 9-year follow-up was assessed in 109 patients with chronic inflammatory rheumatic diseases or chronic idiopathic musculoskeletal pain. Ninety-five of the patients had received hospital care after the first admission, of whom 53 patients > or = 18 years, 21 patients < 18 years, and 33 parents of patients < 18 years rated their degree of satisfaction with the health care from 0 to 10. Mean scores of satisfaction with different aspects of care ranged from 6.0 to 9.6. Among patients > or = 18 years, those with idiopathic pain were less satisfied than those with inflammatory rheumatic diseases on the availability of care (mean 6.4 vs. 8.5, p < 0.001), continuity of care (mean 6.5 vs. 8.4, p < 0.001), and empathy of the health care providers (mean 6.7 vs. 7.9, p <0.05). The diagnostic group and the occurrence of remission predicted the level of global satisfaction in patients > or = 18 years. In patients < 18 years, chronic family difficulties predicted patient satisfaction and physical disability and chronic family difficulties predicted parent satisfaction. In conclusion, most parents and patients with inflammatory rheumatic diseases were satisfied with the health care. However, some patients with idiopathic pain had unmet needs for care.

Patient's view of dialysis care: Development of a taxonomy and rating of importance of different aspects of care

Quality assessment efforts to enhance public accountability in dialysis care and to support provider efforts to improve care have lacked patient input. To develop brief patient evaluation or satisfaction surveys suitable for busy clinical settings, knowing patients' priorities can be helpful in deciding which aspects of care should be tracked. We conducted a study to identify salient attributes of dialysis care and to rank the importance of these attributes from the perspective of dialysis patients. We analyzed the content of patient focus group transcripts to characterize dialysis care from the patients' perspective. We then surveyed 86 patients to determine how patients would rank the importance of each aspect to quality of dialysis care. The 18 broad aspects of care identified in the focus group included: (1) care provided by nephrologists, (2) care provided by other physicians (nonnephrologists), (3) care provided by dialysis center nurses, (4) care provided by social workers and psychologists, (5) care provided by dieticians, (6) clergy, (7) care provided by technicians and physician assistants/nurse practitioners, (8) care provided by dialysis center staff in general, (9) supplies, (10) treatment choice and effectiveness, (11) patient education and training, (12) self-care, (13) dialysis machines, (14) unit environment and policies, (15) cost containment, (16) billing, (17) cost of care, and (18) health outcomes. Items ranked in the top 10 by both groups of patients included issues related to nephrologists, other doctors, nurses, and patient education and training. Compared with hemodialysis patients, peritoneal dialysis patients gave higher ratings to hospital doctors' and nurses' attention to cleanliness when working with access sites, how correct the nephrologist's instructions to patients are, whether emergency room doctors check with nephrologists, the amount of information patients get about their diet, and how well nurses answer patients' questions. Patients value certain aspects of dialysis care highly, and these aspects differed in some respects for the relatively small number of hemodialysis and peritoneal dialysis patients studied. Construction of brief questionnaires for quality assessment and assurance requires thoughtful consideration of what questions to include. Knowing patients' priorities regarding the most important aspects of care that have high potential for dissatisfaction may be helpful to continuous quality improvement of end-stage renal disease care.