Healthcare Experiences Of Patients Research Articles

A comparative study of patients satisfaction with the quality of nursing care in public and private hospitals in Uttar Pradesh, India

This research paper presents a comparative study on patients' satisfaction with the quality of nursing care in public and private hospitals within Uttar Pradesh, India. The study is motivated by the need to address the disparities in healthcare services and patient experiences between these two sectors. To accomplish this, a comprehensive framework has been developed encompassing literature review, research design, data collection, variables and measures, data analysis, findings, and recommendations. The study's primary objectives are to identify the factors that influence patients' satisfaction with nursing care and to assess the variations in quality between public and private hospitals. Through the analysis of data collected from a representative sample of patients, this study aims to provide valuable insights for policymakers, healthcare providers, and stakeholders in Uttar Pradesh's healthcare system. The findings and recommendations of this research are expected to contribute to the improvement of nursing care quality, ultimately enhancing the overall healthcare experience for patients in both public and private hospitals in the region.

(127) Is Artificial Intelligence Ready to Help Urologists?

Abstract Introduction ChatGPT is a language model developed by OpenAI. It's a variant of the GPT (Generative Pretrained Transformer) architecture, a transformer-based neural network used for natural language processing tasks. The model has been trained on a massive corpus of text data and can generate human-like responses to topics and questions. ChatGPT can be used for chatbots, conversation agents, and language translation. The integration of AI into urology has the potential to improve patient outcomes, increase efficiency, and reduce costs, ultimately leading to a better healthcare experience for patients. Objective The objective of this study is to assess the current state of artificial intelligence (AI) when it comes to urologic problems and to determine whether it is sufficiently developed and prepared to provide useful assistance to urologists in their clinical practice. This study aims to assess the accuracy, reliability, and potential benefits of one AI language model (ChatGPT) in efficiently answering common patient questions, providing patients with accurate educational information, minimizing patient harm, and guiding patients towards appropriate management. By exhibiting ChatGPT's capabilities and limitations in the context of urology, the study aims to demonstrate how AI can be helpful in everyday urological practices. Methods ChatGPT (chat.openai.com) was presented with typical clinical scenarios and patient questions. Results AI wrote the introduction answering “What is ChatGPT?” and “How can AI help urologists?”. For the conclusion, AI was prompted with “Is artificial intelligence ready to help urologists?”. Figures summarize the answers to common patient questions given by ChatGPT. Conclusions The use of AI in the field of urology is still in its early stages and more research is needed to determine its full potential. However, there have already been some promising developments and successful applications. For example, AI algorithms have been used to accurately diagnose prostate cancer, predict patient outcomes, and improve surgical planning. While AI has the potential to revolutionize the field of urology, it is important to note that AI is not a substitute for human expertise and judgment. AI algorithms can provide valuable insights and assistance, but the ultimate decision making and treatment planning should still be done by experienced urologists. Additionally, it is important to ensure that AI systems are developed and used in a way that respects patient privacy and data security, and that the outcomes of AI-assisted decision making are transparent and explainable. In summary, AI has the potential to greatly benefit the field of urology. Still, it is important to approach its use with caution and continue evaluating its impact as more research is conducted. Disclosure No.

Healthcare : A Transformer Network Based Chatbot

Medical chatbots are becoming more and more common as the healthcare industry changes and places more and more focus on automated and remote services. These digital assistants provide cost savings, prompt answers to healthcare inquiries, and access to medical guidance around-the-clock. The effectiveness of these chatbots depends on how well-informed they are about healthcare. Our project's main goal is to employ Transformer network architecture to create a sophisticated chatbot for healthcare. It includes gathering data, choosing a model, recognizing intent and entities, managing conversations, producing responses, integrating knowledge databases, creating user-friendly designs, doing thorough testing, adhering to regulations, and continuously improving. Our objective is to develop a smart conversational agent that can respond to a broad range of healthcare inquiries, provide advice and recommendations tailored to individual diseases, and eventually improve patient satisfaction and healthcare experiences

Transgender Patient Preferences When Discussing Gender in Health Care Settings

Transgender (trans) patients report frequent discriminatory and harmful experiences in health care settings; gender-affirming, competent health care improves trans individuals' health and well-being. To identify factors influencing trans patients' decision-making regarding sharing gender-related information with providers (clinicians, health care organizations, health care systems) and trans patient preferences for gender-related questions, as well as the subsequent impact on health care experiences. A qualitative, interpretivist phenomenological study was conducted via telephone or video (using Zoom) in English and Spanish from August 10 to September 11, 2020. Participants were recruited via trans-specific social media groups and email listservs. Interviews were transcribed verbatim and analyzed from October 2020 to January 2022 using thematic analysis by a majority trans research team. Semistructured interviews explored patient health care experiences and preferences. Participants included 27 trans and/or nonbinary adults (mean [SD] age, 30.9 [10.4] years; range, 21-69 years) from 13 US states. Four themes were identified: (1) impact of provider behaviors, (2) engaging in relational risk assessment, (3) receiving affirming vs medically competent care, and (4) "how are you going to fit [me] into your system?" The first theme reflected the impact of provider actions, including level of flexibility in care and interpersonal interactions, ability to explain medical relevance of gender-related questions, and preparedness to work with trans patients. Second, respondents weighed a variety of implicit or explicit safety cues when deciding whether and how to share information with providers. Third, participants spoke at length about affirming and medically competent care, noting that they have had to prioritize one over the other. Last, participants reported their needs often being at odds with health care system norms and standards of care. In this qualitative study of trans patient preferences when discussing gender-related information with providers, it was found that equitable, gender-affirming, and competent health care requires flexibility and responsiveness to patient preferences. It requires provider humility and engagement, as well as institutional policies that support competent and gender-affirming spaces. Future research could identify additional roles that providers, administrators, and systems can play in ensuring competent care for trans patients.

Perceived weight stigma in healthcare settings among adults living with obesity: A cross‐sectional investigation of the relationship with patient characteristics and person‐centred care

AbstractIntroductionPatients living with obesity often experience weight stigma in healthcare settings, which has worrying consequences for their healthcare experiences. This cross‐sectional study aimed to: (1) provide an overview of stigmatising experiences in healthcare settings reported by adults living with varying classes of obesity, (2) identify associations among patient characteristics and perceived weight stigma and (3) investigate the association between perceived weight stigma and person‐centred care (PCC).MethodsDutch adults living with obesity classes I (body mass index [BMI]: 30 to <35 kg/m2; n = 426), II (BMI: 35 to <40 kg/m2; n = 124) and III (BMI: ≥40 kg/m2; n = 40) completed measures of perceived weight stigma in healthcare settings and PCC. Descriptive, correlational and multivariate analyses were conducted.ResultsOf patients living with classes I, II and III obesity, 41%, 59% and 80%, respectively reported experiences of weight stigma in healthcare settings. Younger age, greater obesity severity and the presence of chronic illnesses were associated with greater perceived weight stigma. Greater perceived weight stigma was associated with lower PCC.ConclusionThe results of this study emphasise the significant role of weight stigma in the healthcare experiences of patients living with obesity. Reducing weight stigma is expected to improve PCC and the overall quality of care for these patients. Minimising weight stigma will require efforts across various healthcare domains, including increasing awareness among healthcare professionals about sensitive communication in weight‐related discussions.Patient ContributionOur sample consisted of patients living with obesity. Additionally, patients were involved in the pilot testing and refinement of the PCC instrument.

The Effects of Integrative Palliative Oncology on Health System Burden

Background: Early integration of palliative care in oncology has been shown to benefit patients on an individual level, especially regarding mood and quality of life. These patients both have a difficult disease course – where palliative care can help with interpersonal, spiritual, physical, and care planning concerns – and represent a substantial burden on inpatient facilities like intensive care units and emergency departments. This study explores relationships between early palliative oncology, patient healthcare experience, and broader burden on the health system. 
 Methods: A retrospective chart review was performed comparing oncology patients at Parkview Regional Medical Center in Fort Wayne, IN. Cohort A (200 patients) received palliative care along with standard oncology care while cohort B (200 patients) received standard oncology care alone. Post-diagnosis emergency department visits, inpatient stays, and intensive care unit stays were compared. So were in-hospital deaths, referrals to hospice, and record of advance care planning documents. 
 Results: Two endpoints evaluated by Chi2 analysis were statistically significant (p values <0.01): Cohort A was more likely than cohort B to be referred to hospice (79.5% vs 31.5%) and more likely to have advance care planning documents on file (38.5% vs 21%). Additionally, a T-test showed statistically significant difference (p=.001) for inpatient stays post-palliative care encounter versus patients who had no palliative care (1.75 vs 2.41). 
  Conclusion: This study shows correlation between integrated oncology care with patients filing ACP documents and being referred to hospice. Additionally, it finds that cancer patients who visit the palliative care office have fewer inpatient stays after their visit than those who don’t visit at all.  
  Future Implications: Future studies in this area should explore the latter finding from new perspectives, perhaps focusing on the differences between palliative care visit promptly after diagnosis/staging and palliative care implemented long after diagnosis/staging or not administered at all.  

Healthcare experiences of fibromyalgia patients and their associations with satisfaction and pain relief. A patient survey.

The etiology of fibromyalgia (FM) is disputed, and there is no established cure. Quantitative data on how this may affect patients' healthcare experiences are scarce. The present study aims to investigate FM patients' pain-related healthcare experiences and explore factors associated with high satisfaction and pain relief. An anonymous, online, and patient-administered survey was developed and distributed to members of the Norwegian Fibromyalgia Association. It addressed their pain-related healthcare experiences from both primary and specialist care. Odds ratios for healthcare satisfaction and pain relief were estimated by binary logistic regression. Directed acyclic graphs guided the multivariable analyses. The patients (n = 1,626, mean age: 51 years) were primarily women (95%) with a 21.8-year mean pain duration and 12.7 years in pain before diagnosis. One-third did not understand why they had pain, and 56.6% did not know how to get better. More than half had not received satisfactory information on their pain cause from a physician, and guidance on how to improve was reported below medium. Patients regretted a lack of medical specialized competence on muscle pain and reported many unmet needs, including regular follow-up and pain assessment. Physician-mediated pain relief was low, and guideline adherence was deficient. Only 14.8% were satisfied with non-physician health providers evaluating and treating their pain, and 21.5% were satisfied (46.9% dissatisfied) with their global pain-related healthcare. Patients' knowledge of their condition, physicians' pain competence and provision of information and guidance, agreement in explanations and advice, and the absence of unmet needs significantly increased the odds of both healthcare satisfaction and pain relief. Our survey describes deficiencies in FM patients' pain-related healthcare and suggests areas for improvement to increase healthcare satisfaction and pain relief. (REC# 2019/845, 09.05.19).

An evaluation of staff experiences of the Royal Literary Fund writer-in-residence service to support improvements in written communication in healthcare.

Written communication is essential to staff and patient experience in healthcare. The Royal Literary Fund has hosted a writing fellow in an NHS Trust since 2018 providing professional writing training. The aim of this evaluation was to explore the experiences of staff using the service. Semi-structured interviews were conducted with 21 staff members from a range of professions who had accessed the service. Data were analysed using thematic analysis. Findings: The writing service was highly valued. Three themes emerged: feelings about writing at work, reported benefits of attending sessions, and perceived barriers to accessing them. Staff felt underskilled in professional writing and described the wish to write more succinctly and reflectively. Self-reported confidence increased after sessions. Stigma around writing skills prevented some staff from recommending the service. Wider adoption of professional writing skills training through the NHS could have benefits in terms of increasing self-perceived skills and confidence.

Pandemic Patient Engagement Success: Maintaining Family Presence Through Partnership

This presentation is relevant for patients of hospitals and residents of long-term care facilities, their loved ones and essential partners in care, and staff and leadership of healthcare facilities.
 A painful pandemic challenge for patients, families and staff in hospitals was the absence of loved ones or essential care partners through Family Presence/Visitor Policy restrictions. Leadership at Kingston Health Sciences Centre (KHSC) worked proactively with the Patient and Family Advisory Council and a small, diverse group of Patient Experience Advisors to plan for possible restrictions and consider how best to approach ongoing changes and challenges to the policy expected in the face of the pandemic. The group continues to work together at this time of uncertainty.
 An initial meeting of eight advisors and leaders took place prior to the World Health Organization’s official announcement of the pandemic. Due to growing concern about hospital infections, the meeting venue was a local coffee shop, hence the group became known throughout the hospital as The Balzac’s Group. Synchronous virtual meetings and asynchronous communication were employed by the group to address concerns and create family presence opportunities on a rapid response basis. Group collaboration remains evident as new concerns arise with the ongoing ebb and flow of COVID-19 hospitalizations, staff shortages and less restrictive family presence policies. This partnership has been pivotal to the organization’s pandemic planning and response, enabling family presence while respecting government directives, organizational challenges, and patient/family priorities.
 This collaboration informed several new and sustained initiatives including: a virtual visits process, ePostcards, a Care Partner Program, expanded cell phone use in restricted areas, resources for loved ones traveling distances, careful and measured increases in family presence and a family presence policy Exceptions Committee.
 An unexpected outcome was an increased level of respect and strengthened patient engagement. Factors influencing this success were transparency and trust in sharing sensitive or confidential information, mutual decision-making, frank and honest sharing of both personal and professional perspectives, and active listening. Many KHSC advisors increased their patient partnership activities during the pandemic and felt an enhanced sense of agency in their efforts to improve the patient experience in healthcare.
  
 This initiative may be a source of new ideas, inspiration, and encouragement for patient partners and hospital leaders to actively partner in co-design and delivery of compassionate person-centred policies and care, especially during times of crisis.
 The group continues to be the “go-to” group for family presence policy questions. The strengthened relationship with Patient Advisors has had a spillover effect more broadly into other hospital initiatives and increased awareness of the value of their input.  We hope to continue to share this success story broadly to encourage other healthcare facilities to partner with the precious resource of patients, families, and patient advisors, at all levels of health care. We are considering a Patient Advisor led publication in the future.

Opportunities to improve asthma and COPD prevention and care: insights from the patient journey obtained through focus groups

BackgroundThe healthcare experiences of patients hold valuable insights for improving the quality of services related to their well-being. We therefore invited and explored the perspectives of patients living with asthma...

The role of nurses in implementing patient safety in hospitals to achieve patient safety goals: Literature review

Patient safety is an action taken to minimize hazards during a patient's healthcare experience, particularly in hospitals. Patient safety can be described as a system in which hospitals implement improved nursing care processes. Objectives: To understand and analyze the role of nurses in implementing patient safety in hospitals to achieve the standards of patient safety goals. Methods: The article search was conducted through the PubMed, ScienceDirect, and Google Scholar databases using the keywords "patient safety" AND "nurse's role" OR "nurse" AND "hospital" AND "patient safety goals". The search yielded a total of 119 articles, but only 10 articles met the inclusion criteria. Result: A study conducted in 7 hospitals in Indonesia and other countries revealed several roles of nurses in implementing patient safety. The most commonly found role was nurses providing nursing care using the nursing process. Nurses also delivered optimal nursing care and services while ensuring equitable distribution of care. Additionally, nurses supported and advocated for the well-being of patients. Conclusion: The roles of nurses in implementing patient safety in hospitals can be grouped into three categories: care roles, education roles, advocacy roles, and collaboration roles.

Exploring the Experiences of Pediatric Patients with Sickle Cell Disease and Their Families

Background: Sickle Cell Disease (SCD) is a common lifelong genetic disorder of red blood cells, which causes abnormal hemoglobin shape often resulting in pain crises and other serious health complications (Ware, et al., 2017). SCD disproportionally affects people of African descent, and several recent surveys have shown that patients with SCD experience discrimination in healthcare settings (Nelson and Hackman, 2013; Haywood, et al., 2014; Kanter, 2020; Oyedeji and Strouse, 2020). In pediatrics, parents of patients with SCD report higher levels of race-related discrimination in healthcare settings compared to families with other chronic illnesses, as well as decreased satisfaction in several areas of their care (Brousseau, 2009; Oyedeji, 2020; Kanter, et al., 2020). This qualitative project aimed to explore further specific, actionable areas of dissatisfaction and any areas of increased satisfaction among pediatric patients with SCD and their families. Methods: Semi-structured interviews were conducted with pediatric patients with SCD and/or their guardians at one academic institution. Any patient with SCD over the age of eight was eligible to participate in an interview, and parents of a child with SCD of any age were eligible to participate, as well. Interviews were audio-recorded and took place in person in clinic. Recordings were then transcribed verbatim. The interviews were qualitatively coded using standard multi-level semantic analysis, working directly from the transcriptions and audio-recordings. Seven (41%) interviews were independently double-coded, and discrepancies were resolved by consensus. Final codes were analyzed, and major themes were identified. Results: Eighteen pediatric patients with SCD and/or their families were asked to participate in the study, and seventeen (94%) agreed. There were twenty-six total participants. Ten family interviews were conducted, and another seven were conducted with parents only because the patients were younger than eight years old. Fifteen families identified as African American, one family identified as Hispanic, and one family identified as African. Patients and their families described five main areas leading to dissatisfaction in the healthcare setting: (1) Long wait times; (2) Neglect for SCD protocols within emergency departments; (3) Biases against patients with sickle cell disease; (4) Frustration with procedures, specifically with blood draws; (5) Lack of empathy and compassionate listening among healthcare providers. Positive experiences were almost all due to aspects of strong patient-provider relationships. Outside of the healthcare setting, patients and their families emphasized the need for improved education and awareness of SCD within the community. Conclusion: While this qualitative study explored perspectives from only a limited number of pediatric families, these conversations provided insight into specific areas of dissatisfaction among patients with SCD. This research provides actionable items that healthcare providers can apply to help improve the healthcare experiences and the everyday lives of children with SCD. Additional efforts and resources should be directed toward addressing social determinants of health and systemic racism to future improve healthcare experiences of patients with SCD.

Shaping the future of chronic disease management: Insights into patient needs for AI-based homecare systems

BackgroundThe rising demand for healthcare resources, especially in chronic disease management, has elevated the importance of Artificial Intelligence (AI) in healthcare. While AI-based homecare systems are being developed, the perspectives of chronic patients, who are one of the primary beneficiaries and risk bearers of these technologies, remain largely under-researched. While recent research has highlighted the importance of AI-based homecare systems, the current understanding of patients’ desired designs and features is still limited. ObjectiveThis paper explores chronic patients’ perspectives regarding AI-based homecare systems, an area currently underrepresented in research. We aim to identify the factors influencing their decision to use such systems, elucidate the potential roles of government and other concerned authorities, and provide feedback to AI developers to enhance adoption, system design, and usability and improve the overall healthcare experiences of chronic patients. MethodA web-based open-ended questionnaire was designed to gather the perspectives of chronic patients about AI-based homecare systems. In total, responses from 181 participants were collected. Using Krippendorff's clustering technique, an inductive thematic analysis was performed to identify the main themes and their respective subthemes. ResultThrough rigorous coding and thematic analysis of the collected responses, we identified four major themes further segmented into thirteen subthemes. These four primary themes were: 1) “Personalized Design”, emphasizing the need for patients to manage their health condition better through personalized and educational resources and user-friendly interfaces; 2) “Emotional & Social Support”, underscoring the desire for AI systems to facilitate social connectivity and provide emotional support to improve the well-being of chronic patients at home; 3) “System Integration & Proactive Care”, addressing the importance of seamless communication, proactive patient monitoring and integration with existing healthcare platforms; and 4) “Ethics & Regulation”, prioritizing ethical guidelines, regulatory compliance, and affordability in the design. ConclusionThis study has offered significant insights into the needs and expectations of chronic patients regarding AI-based home care systems. ‘The findings highlight the importance of personalized and accessible care, emotional and social support, seamless system integration, proactive care, and ethical considerations in designing and implementing such systems. By aligning the design and operation of these systems with the lived experiences and expectations of patients, we can better ensure their acceptance and effectiveness.

Assessing the accuracy of an online chat-based artificial intelligence model in providing recommendations on arterial hypertension in accordance with the 2018 ESC/ESH guidelines

Abstract Background The rise of online chat-based artificial intelligence (AI) models has opened up new possibilities in the field of medicine. One of the promising contributions of AI chatbots could be their ability to provide accurate and accessible medical information to patients. This could help bridge the gap between patients and healthcare providers, especially in under-resourced areas where access to medical information and care is limited. Purpose We aimed to evaluate the ability of a commercially available AI-based online chat to provide answers to commonly asked questions related to arterial hypertension in accordance with the latest 2018 ESC/ESH guidelines (1). Methods We selected 30 commonly asked questions covering a range of arterial hypertension topics, including risk factors, symptoms, diagnosis, and treatment. These questions were submitted to the online AI interface, and the responses were recorded and evaluated by a team of four experienced cardiologists from our institution. To ensure consistency, each question was asked three times. All questions – except question 2 – were preceded by "according to the 2018 ESC/ESH Guidelines for the management of arterial hypertension". Each answer was rated as "accurate," "inaccurate," or "incomplete" based on the specialists’ clinical judgment, the 2018 ESC/ESH guidelines, and the content of the response. A response was considered "accurate" if it included all essential information, "inaccurate" if information provided was not in accordance with the guidelines, and "incomplete" if any essential information was missing. Results The AI model's responses to 24 out of the 30 questions (80%) were deemed accurate by cardiologists. Three responses were rated as incomplete (10%) and three responses were found to be inaccurate (10%). The AI responses were consistent in 28 out of the 30 questions (93%) (Tables 1-2). Conclusion We found that a popular online AI model provided largely accurate responses to commonly asked arterial hypertension questions. These answers were mostly in accordance with the 2018 ESC/ESH guidelines on the management of arterial hypertension. While the use of chat-based AI in medicine is still in its early stages and current models are not intended for medical use, the potential for such technology to improve the healthcare experience for patients is significant.Table 1:(1) Assessment of AnswersTable 2:(2) Assessment of Answers

Self-reported perceived discrimination and experiences of patients with cancer.

165 Background: Racial discrimination is a significant social determinant of health inequities. Ethnic disparities can indirectly result in different access to care, while healthcare provider ethnic bias can influence healthcare outcomes. National statistics show that Black patients have higher death rates when compared to those of other race and ethnicities. Our study aims to evaluate and compare self-reported and perceived discrimination in day-to-day life and healthcare experiences of patients who receive care at our cancer center. Methods: Cancer patients were surveyed in person at the Cancer Center at Medstar Washington Hospital Center between July 2022 and January 2023. The Everyday Discrimination Scale (EDS) by D.R. Williams and Discrimination in Medical Setting (DMS) questionnaire by M.E. Peek were used to collect data. Results: 100 patients following up at the clinic completed the paper survey. 74% were females and 26% males, 75% Black, 17% White and 8% Other Races (including Hispanic and Asian). The responses to the EDS and DMS were collected and coded as continuous variables, summed together, reported as medians, and compared across the various groups of interest. P-values between medians were reported using Kruskal Wallis test/Wilcoxon rank-sum test. Highest median scores on the EDS were found in Other Races, with a higher score representing higher self-perceived discrimination, followed by Black, and White (p<0.001). Lowest median scores on the DMS questionnaire were found in White, lower score representing lower self-perceived discrimination, followed by Other Races and Black (p<0.001). 30% of our total study population reported feeling that their quality of care was affected due to racial discrimination, out of which 83% were Black and 16% were Other Races, not including White (p= 0.006). Comparison of median scores for both the scales was not statistically different across age, gender, and cancer type. Conclusions: The results of our study demonstrate that self-reported and self- perceived racial discrimination extends to health care, and for some includes self-reported effects on the quality of health care received. Worse responses of the Other Races on the EDS and DMS scales could be explained by the low number of participants. Overall, the negative responses may have been affected by a variety of factors like varying stage of diagnosis, care received at other health-care centers, all of which would attribute to self-reported poorer experience regardless of race. There is a growing need to address these disparities to providing culturally sensitive care and addressing the root causes of systemic racism and inequality. This study is the first step in determining the day-to-day and healthcare experiences among patients at our center. We hope to follow with a prospective survey-based analysis of implicit bias among all healthcare workers.

The health care experiences of people with head and neck cancer: A scoping review.

Understanding health care experience in head and neck cancer (HNC) is becoming increasingly important due to changes in the disease profile, survivorship, and a greater appreciation of patient health care experience as an important outcome measure. People with HNC encounter many different types of health care professionals and health care touchpoints. Through systematic database searching, this scoping review of qualitative English-language studies describes the self-reported care experiences of those with HNC across the health care continuum, and describes the current state of the literature. Overall, the 95 studies identified were heterogeneous and investigated a broad range of topics. Trends across studies showed research centered on hospital-based care, conducted in developed countries, with more studies on feeding than other aspects of care. Generic qualitative research frameworks, with individual interviews, were the preferred method of data collection. Despite identifying many studies, there are significant gaps in our understanding of the HNC patient experience.

Patient experience with primary health care during the COVID-19 pandemic in Bulgaria

Abstract Background The COVID-19 pandemic has had a profound impact on the primary healthcare experience of patients. Restricted access, delays in routine services, postponed checkups owing to safety concerns led to disruptions in care, missed diagnoses, and delays in treatment. This study investigates primary care service obstacles faced by patients during the COVID-19 pandemic in Bulgaria. Methods A national cross-sectional survey was conducted between November and December 2021 by a poll agency using an online self-administered questionnaire with 800 respondents. Binomial logistic regression was used to examine the association between sociodemographic variables and issues related to the availability of primary care services. Results Around 32% (95% CI 28-35%; p < 0.001) of the respondents reported obstacles related to the primary care, and 25% (95% CI 22-38%; p < 0.001) postponed a visit to the general practitioner due to accessibility and availability issues or fear of infection. The most prevalent obstacle cited by patients was a refusal of a referral for specialized care (26%), followed by a refusal of an out-of-hours or weekend consultation in case of urgent need (25%). Home visits and routine examinations were also denied to patients, albeit less frequently. The multivariable analyses found associations between gender, health status, education, and impediments by obtaining primary care services. The odds of facing obstacles rose as self-rated health deteriorated (OR = 6.0, p < 0.001). The likelihood of experiencing availability issues increased with educational level (OR = 6.2, p < 0.001). Women were 1.6 times more likely (p = 0.009) to report difficulties with primary care. Conclusions The COVID-19 pandemic has created significant barriers for many patients to access primary healthcare services. In addition, it has highlighted the need for a primary healthcare system that is resilient and capable of maintaining its essential functions during public health emergencies. Key messages • Primary health care has a crucial role in supporting patients during public health emergencies. • The health system needs resilient primary health care that can adapt to swiftly changing conditions.

How Virtual Triage Can Improve Patient Experience and Satisfaction: A Narrative Review and Look Forward.

To complete a review of the literature on patient experience and satisfaction as relates to the potential for virtual triage (VT) or symptom checkers to enhance and enable improvements in these important health care delivery objectives. Review and synthesis of the literature on patient experience and satisfaction as informed by emerging evidence, indicating potential for VT to favorably impact these clinical care objectives and outcomes. VT enhances potential clinical effectiveness through early detection and referral, can reduce avoidable care delivery due to late clinical presentation, and can divert primary care needs to more clinically appropriate outpatient settings rather than high-acuity emergency departments. Delivery of earlier and faster, more acuity level-appropriate care, as well as patient avoidance of excess care acuity (and associated cost), offer promise as contributors to improved patient experience and satisfaction. The application of digital triage as a front door to health care delivery organizations offers care engagement that can help reduce patient need to visit a medical facility for low-acuity conditions more suitable for self-care, thus avoiding unpleasant queues and reducing microbiological and other patient risks associated with visits to medical facilities. VT also offers an opportunity for providers to make patient health care experiences more personalized.

Patient-reported Primary Care Video and Telephone Telemedicine Preference Shifts During the COVID-19 Pandemic.

Patient perceptions of primary care telephone and video telemedicine and whether COVID-19 pandemic-related telemedicine exposure shifted patients' visit preference is unknown. We examined patient surveys to understand the health care experience of patients seeking primary care through telemedicine and how patients expected their preferences to shift as a result of the COVID-19 pandemic. In an integrated delivery system that shifted to a "telemedicine-first" health care model during the COVID-19 pandemic, we sampled monthly and collected 1000 surveys from adults with primary care telemedicine visits scheduled through the online patient portal between 3/16/2020 and 10/31/2020. Participants reported their preferred primary care visit modality (telephone, video, or in-person visits) across 3 time points: before, during and (hypothetically) after the COVID-19 pandemic, and reported their general assessment of primary care visits during the pandemic. The majority of participants preferred in-person visits before (69%) and after the COVID-19 pandemic (57%). However, most participants reported a preference for telemedicine visits during the pandemic and continue to prefer telemedicine visits at a 12% higher rate post-pandemic. Many participants (63%) expressed interest in using telemedicine at least some of the time. Among participants reporting a recent telemedicine visit, 85% agreed that the visit addressed their health needs. As primary care visit modality preferences continue to evolve, patients anticipate that they will continue to prefer telemedicine visits, both video and telephone, at an increased rate than before the COVID-19 pandemic.

The intervening influence of the quality of health-care administrative process on the relationship between facilities management service quality and patients’ health-care experience in Ghana

PurposePatient-centred strategies should be applied in health-care facilities management (HcFM) to guarantee service quality to meet patients’ needs and ensure quality patient health-care experience. This paper aims to examine the intervening influence of the quality of health-care administrative process (QAP) on the association between health-care facilities service quality and patients’ experiences with medical care.Design/methodology/approachA quantitative technique was used for this cross-sectional study in three Ghanaian teaching hospitals. A total of 622 relevant questionnaires were used for the analysis of the study using SEM-PLS.FindingsThe intervening influence of the QAP on the relationship between HcFM service quality (empathy and tangibility) and patients’ health-care experience (PHcE) were reinforced whilst that of reliability, responsiveness and assurance were not reinforced. The association between the QAP and PHcE was also established.Research limitations/implicationsA high-quality health-care workforce (both core and supporting) and quality work environment provided by the FM department and QAP are essential during quality-of-care delivery, to reduce threats to patient safety to achieve exceptional PHcE. The constraint on the study is that information was gathered from only Ghana. Hence, the generalisation of the findings will be a challenge. Thus, in future, it is proposed that a comparative study across a developed country and a developing country can be conducted. Future research can assess the influence of the health-care internal appearance on patients’ satisfaction.Practical implicationsPractically, the administrative system can be improved by reducing patients overall waiting time. Steps must also be taken to reduce the problem of needless administrative tasks and practices to simplify administrative practices and improve patients’ total health-care experience (core health-care delivery and HcFM), as this influence patients’ total health-care experience.Originality/valueTo the best of the authors’ knowledge, this empirical validation is one of the initial studies in service quality and FM to examine how health-care administrative process quality affects the relationship between FM service quality and patients’ experiences with medical care. This framework can be adapted for research in different countries to extend knowledge.