Perceived Quality Of Health Care Research Articles

Quality of health care perceived by users in Catalan prisons.

Objectives To describe inmates’ perceptions of healthcare quality in Catalonian prisons.Material and method Transversal study of 6,856 inmates in Catalan prisons in September 2017. Randomized simple screening was used to randomly distribute 1,048 polls in which different aspects of perceived quality of healthcare were evaluated. The results were also categorized according to age, sex, time spent in prison, background and academic levels. We also analysed the differences between results in healthcare quality according to socio-demographic variables.Results84.87% of patients show satisfaction with the quality of healthcare received. Women are more satisfied with consultations than men (OR: 2.04; p = 0.009). Patients with a higher educational level are less satisfied than those with a lower educational level, with significant differences in 11 of the 14 items. Those over 65 years of age were more satisfied than the rest in 11 of the 14 items evaluated. Foreign patients were more satisfied than Spanish inmates in time flexibility (OR: 0.69; p = 0.018) and in waiting times for visits (OR: 0,63; p = 0.006), whereas they are less satisfied with the healthcare professionals’ image (OR: 1.97; p = 0.03).DiscussionNoteble features of our study include the fact that although global satisfaction is high, some dimensions, like reliability, could improve. The results were submitted to the General Directorate to enable more in-depth study of the variables where there is less satisfaction and to design further improvements.

Patients' Perceptions of Healthcare Quality at Hospitals Measured by the Revised Humane Caring Scale.

The patients’ perceptions are central to quality improvement of the healthcare system worldwide. This study aimed to examine patients’ perceptions of quality care and investigate the demographic factors related to the overall patients’ perceptions. The Revised Humane Caring Scale was distributed to 367 adult patients who were admitted at medical, surgical, and obstetrics and gynecology departments in 2 tertiary hospitals in Oman. Overall patients’ perceptions of quality of care were high, with professionalism being rated the highest, and cognition of physical needs and human resources rated the lowest. Significant differences in patients’ perceptions between hospitals as well as in the subscales of interdisciplinary collaboration and outcome variables, between planned- and emergency-admitted patients were found. The linear regression analysis indicated a relationship between gender and overall quality care where male patients reported higher satisfaction compared to counterparts. This study suggested the need to improve the cognition of physical needs (food quality and environmental sanitation) and human resources (staff to patient ratio) as well as pay attention to the individual patients’ needs especially for emergency-admitted patients.

Psychometric evaluation of the German version of the Patient Satisfaction with Cancer-related Care questionnaire

BackgroundPatient satisfaction is a fundamental aspect of perceived health care quality. The original English version of the Patient Satisfaction with Cancer-related Care (PSCC) is a psychometrically validated, one-dimensional instrument with relevance to cancer-related care. The goal of the study was to perform a psychometric validation of the PSCC in German (PSCC-G).MethodsA sample of 394 cancer patients were recruited at oncological clinics in Hamburg, Germany. Patients completed the PSCC-G, three subscales of the Patient Satisfaction and Quality in Oncological Care (PASQOC), and one subscale from the German version of the Recherché Evaluative sur la Performance des Réseaux de Santé (RESPERE-60) questionnaire. We conducted exploratory and confirmatory factor analyses (EFA and CFA) to determine the factorial validity, and we calculated Cronbach’s coefficient alpha (α) to test the internal consistency of the PSCC-G. We examined the correlation between the PSCC-G and four subscales measuring additional dimensions of PS with care. We also conducted a multiple linear regression analysis to determine whether sociodemographics, self-perceived health status, and treatment setting predict scores on the PSCC-G.ResultsThe EFA (using principal axis) revealed a one-factor solution. The Cronbach’s α was 0.92. The convergent validity showed high correlations between three different subscales measuring patient satisfaction and the PSCC-G. Overall, males, older age patients, and those with a higher self-perceived health status were more satisfied with their cancer care based on their higher scores on the PSCC-G.ConclusionThe PSCC-G is a reliable and valid instrument that can assess satisfaction with cancer-related care for German-speaking cancer patients.

Measuring Perceived Service Quality in Healthcare Setting in Developing Countries: A Review for Enhancing Managerial Decision-making

Healthcare is vital for the overall well-being of an individual. The service quality in healthcare is a matter of great importance for health institutions across the world. With increasing patient awareness and rising competition among hospitals, patient perception of healthcare quality has become very relevant. This study aims to review the literature to explore the concepts of perceived service quality, customer satisfaction, and behavioural intentions. The study has attempted to look into the relationship between perceived healthcare service quality, patient satisfaction, and behavioural intentions of patients. Healthcare service quality is measured using SERVQUAL dimensions as well as other dimensions specific to the healthcare sector. The findings clearly show that perceived healthcare service quality, patient satisfaction, and behavioural intentions are closely related to each other, and high-quality services lead to satisfied patients who further exhibit positive behavioural intentions.

Caregiver and Adolescent Patient Perspectives on Comprehensive Care for Inflammatory Bowel Diseases: Building a Family-Centered Care Delivery Model.

BackgroundChildren with inflammatory bowel diseases (IBDs) require primary and gastrointestinal (GI) care, but little is known about patient and family preferences for care receipt. We aimed to understand caregiver perceptions of current healthcare quality, describe barriers to receiving healthcare, and elicit caregiver and adolescent preferences for how comprehensive care ideally would be delivered.MethodsThis was an anonymous survey of caregivers of 2- to 17-year olds with IBD and adolescents with IBD aged 13–17 years at a large, free-standing children’s hospital. Surveys assessed patient medical history, family demographics, perceptions of health care quality and delivery, barriers to primary and GI care, and preferences for optimal care delivery.ResultsTwo hundred and seventeen caregivers and 140 adolescents were recruited, 214 caregivers and 133 adolescents consented/assented, and 160 caregivers and 84 adolescents completed the survey (75% and 60% response rate, respectively). Mean patient age was 14 years (SD = 3); 51% male; 79% Crohn’s disease, 16% ulcerative colitis, and 4% indeterminate colitis. Caregivers were primarily female (86%), Caucasian (94%), and living in a 2-caregiver household (79%). Most caregivers reported that their child’s primary care physician (PCP) and GI doctor oversaw their primary care (71%) and their IBD care (94%), respectively. Caregivers were satisfied with communication with their PCP and GI providers (>90%) but did not know how well they communicated with one another (54%). Barriers to primary and GI care varied, and few caregivers (6%) reported unmet healthcare needs. Caregivers and adolescents saw PCPs and GI doctors having important roles in comprehensive care, though specific preferences for care delivery differed.ConclusionCaregivers and adolescent perspectives are essential to developing family-centered care models for children with IBD.

A tool to assess the quality perception of healthcare employees.

The purpose of this project was to determine the validity and reliability of the Healthcare Quality Perception (HQP) questionnaire tool designed to capture employees' perceptions of healthcare quality in Indian hospitals. Two hundred employees in private and public sector hospitals in India were randomly selected and given the HQP tool. It consisted of 38 Likert-scale items and six different subscales: (1) Planning and Documentation (n=7); (2) Employee Participation in Quality Management Activities (n=5); (3) Existence of Policies/Procedures/Guidelines (n=5); (4) Quality and Patient Safety Management (n=9); (5) Perceived Effect of Quality Improvement (n=7) and (6) Training and Development Opportunities (n=5). 156 completed questionnaires were received, demonstrating a 78% response rate. HQP tool subjected to statistical analysis to measure its reliability and validity. A p-value of less than 0.05 was considered as "significant." Factor analysis pulled out six factors that conjointly demonstrated 66.4 % of the variance in healthcare professionals' (HCPs') perception of healthcare service quality in selected Indian hospitals. The overall Cronbach's alpha coefficient was measured at 0.959 for internal consistency reliability. This study demonstrates that the identified six critical factors are important determinants influencing HCPs' perception of the quality of healthcare services in private and public sector hospitals in India. This study provides evidence for the reliability and validity of the newly developed HCP Scale for the assessment of employee perception of the quality of services offered in selected hospitals in India, with potential applications in other contexts.

Ayakta ve Yatarak Tedavi Gören Hastaların Hizmet Kalitesi Algılarının Farklı Hastane Türleri İçin İncelenmesi (An Investigaiton of Inpatients and Outpatients Perceptions of Healthcare Quality for Different Hospital Types)

Purpose – This paper investigates the inpatients’ and outpatients’ perception of healthcare quality and aims to reveal if their perceptions differ in terms of hospital type. Services before the treatment, physician services, personal needs-laboratory services and physical environment were used as sub-dimensions of healthcare services. Design/methodology/approach – The research was conducted in Mugla-Turkey, and the data were collected via questionnaires from inpatients and outpatients treated in state, private and university hospitals. Analysis of variance test and t-test were used to analyze the data. Findings – For all dimensions, outpatients’ service quality perceptions of private hospitals are higher than public hospitals and university hospitals except physician services for the latter. Inpatients’ service quality perceptions of private hospitals are higher than public and university hospitals for the sub-dimensions of services before the treatment and personal needs-laboratory services. Besides, inpatients’ service quality perceptions of private hospitals are higher than public hospitals for only dimension of physical environment. Discussion – Service quality perceptions of inpatients’ and outpatients’ are not significantly different for both university and private hospitals. However, for public hospitals, inpatients perceive a higher quality than outpatients for only the dimension of personal needs-laboratory services. In this context, except in spesific services, inpatients and outpatients cannot be seen as separate stakeholders in terms of service quality evaluations.

Predictors of Patient Satisfaction and the Perceived Quality of Healthcare in an Emergency Department in Portugal.

IntroductionThe predictors of patient satisfaction in emergency medicine (EM) have been widely studied and discussed in the scientific literature; the results vary depending on the specific EM attributes, cultural aspects, researchers’ preferences, and approaches. However, it is not clear whether the same predictors of patient satisfaction can contribute to a better-perceived quality of healthcare or whether patients’ perceptions form a different attitude toward satisfaction and perceived quality of healthcare. The goal of this study was to identify the key predictors of patient satisfaction and perceived quality of healthcare in the framework of an emergency department (ED).MethodsWe conducted a retrospective study of patients seen at an ED between January –December 2016. Data collection took place in the public hospital in Lisbon, Portugal, between May – November 2017. The total sample size included 382 patients. The sample distribution had a 5% margin of error and a 95% confidence interval. Data for this research, using a questionnaire, was collected by mail or e-mail according to the respondent’s preference.ResultsA detailed analysis showed that three out of the 18 predictors had a statistically significant relationship with satisfaction: overall satisfaction with doctors, with a positive correlation (r = 0.14, p ≤ 0.01); qualitative perceived waiting time for triage, with a positive correlation (r = 0.08, p ≤ 0.05); and meeting expectations, with a positive correlation (r = 0.53, p ≤ 0.01). Furthermore, a detailed analysis showed that only two out of the 18 predictors had a statistically significant relationship with the perceived quality of healthcare (PQHC): overall satisfaction with doctors, with a positive correlation (r = 0.43, p ≤ 0.01) and meeting expectations, with a positive correlation (r = 0.26, p ≤ 0.01).ConclusionThe main predictors of satisfaction and perceived quality of healthcare were overall satisfaction with doctors and meeting expectations. We should note that “meeting expectations” plays the most important role in terms of satisfaction; however, in terms of PQHC the predictor “overall satisfaction with doctors” plays the most important role due to its stronger correlation. In addition, the qualitative perceived waiting time for triage could be considered as another predictor, influencing satisfaction only, thus emphasizing similarities and differences between satisfaction and the PQHC in an ED context.

P047 PARENT PERSPECTIVES ON COMPREHENSIVE CARE FOR CHILDREN WITH INFLAMATORY BOWEL DISEASES: BUILDING A CARE DELIVERY MODEL FROM THE FAMILY UP

Abstract Background Patients with Inflammatory Bowel Diseases (IBD) require life-long management by gastroenterology (GI) and primary care providers (PCP). Guidelines exist outlining recommended healthcare services, but it is unclear which provider is responsible for which tasks, and what parents prefer. Aims To understand perceptions of healthcare quality and delivery for children with IBD, describe barriers to receiving comprehensive healthcare, and elicit preferences for how care would ideally be delivered. Methods Cross-sectional survey of parents of children ages 2–17 with IBD at a large, free-standing children’s hospital, recruited via an institutional research registry. Surveys assessed patient medical history, family demographics, perceptions of health care quality and delivery, barriers to primary and GI care, and preferences for care receipt. Results 217 parents were recruited, 214 consented, and 161 completed the survey (75% response). Mean patient age 14 years (SD 3); 51% male; 80% Crohn’s, 16% ulcerative colitis, and 4% indeterminate colitis. Most parents were Caucasian (94%), had a bachelor’s degree or higher (61%), and lived in a suburban setting (57%). Most had private insurance (43%) or private primary and public secondary insurance (34%). Most parents (N=149, 94%) thought the GI doctor was responsible for their child’s IBD care, and 8 (6%) reported shared responsibility by the GI doctor and PCP. 113 (71%) said their child’s PCP was responsible for primary care, 8 (5%) said GI doctor, and 37 (23%) said both. 95% of parents were confident in their GI doctor’s primary care knowledge, and 81% with their PCP’s IBD knowledge. 89% were satisfied with their communication with the PCP, and 98% were satisfied with their communication with the GI doctor. 53% did not know how well their PCP and GI doctors were communicating with each other. Only 4% of parents reported unmet healthcare needs, but those who did cited inadequate family support and mental health services. The greatest barriers to PCP care were lack of continuity with providers (22%) and scheduling (24%). The greatest barriers to GI care were scheduling (38%) and traveling to appointments (29%). Parent preferences for specific health care service delivery are found in Figure 1. Conclusions Parents of children with IBD are satisfied with provider knowledge and communication skills with them, though most are unaware how well their PCP and GI doctor are communicating with each other. Healthcare needs are being met for most patients in our cohort, but parents cite different barriers to primary vs. specialty care, and mental health services in particular are lacking. Parents seem to support co-management between their child’s PCP and GI provider. Understanding parent perspectives is essential to the development of family-centered healthcare delivery models for children with IBD.

Gap analysis for health services provided to oncology patients in Sohag Governorate

AbstractPurpose: This study was conducted to identify areas where there are big gaps between oncology and nuclear medicine patients perception and expectation for the services provided to them and need to be improved to assure quality careMethodology: A sample of 550 patients of oncology department of Sohag University Hospita (SUH) and Sohag Cancer Center (SCC) participated in the study. Descriptive statistical techniques and gap analysis were employed.Findings : The results showed that the quality of services provided to patients was significantly lower than their expectations and the quality gaps were statistically significant in all studied dimensions of the SERVQUAL tool which was used to assess the quality of health service provided (P < 0.05). Furthermore, the highest and lowest quality gaps were related to assurance and empathy dimensions respectively. Conclusion: Steps toward improving the quality of services in all dimensions should be taken, especially assurance and tangibility, through planning properly, prioritizing services, and reviewing processes with regard to the patients' expectations.Practical implication : Based on the findings of this study, hospital managers are in a position to recognize the patients' perceptions of health care quality and the level of their satisfaction. Consequently, managers can design strategies that improve the quality of services for increasing patients' satisfaction.

Effect of the presence of student-assistants on the quality of care perception by ambulatory patients

The time dedicated to patients and how they are treated are crucial in the evaluation of health care quality. Medical students acting as medical assistants could improve the perception of a good quality of care among ambulatory patients. To evaluate if the presence of Student-Assistants improves the patients' perception of health care quality in ambulatory primary care. Quasi-experimental exploratory study. In two health care centers, patients answered a questionnaire about their perception of how they were treated at baseline and after an intervention period. In one center, prior to the appointment of the patient with the doctor, the student interviewed patients focusing on chief complaints and registered their vital signs, orally presenting this information to the clinician. In the other center, there was no student intervention. Patients answered the questionnaire at the end of appointments. At baseline 103 patients answered the questionnaire (58 in the experimental and 45 in the control center). After the intervention, 121 patients answered it (56 in the experimental and 65 in the control center). Basal scores were 6,25 and 6,06 in experimental and control center, respectively (p = NS). After the intervention, the scores were 6,49 and 6,15, respectively (p = 0,01). These data support the hypothesis that the presence of a Student-Assistant could improve the perception of patients about how they are treated at primary health care centers.

Financial difficulties are associated with greater total pain and suffering among patients with advanced cancer: results from the COMPASS study

The Universal Health Coverage goals call for access to affordable palliative care to reduce inequities in "total pain" and suffering. To achieve this, a patient-centred understanding of these inequities is required. To assess association of total pain and suffering (i.e. physical, psychological, social, and spiritual health outcomes) and perceived health care quality with financial difficulties among stage IV solid malignancy patients. Using baseline data from the COMPASS cohort study, we assessed total pain and suffering including physical (physical and functional well-being, pain, symptom burden), psychological (anxiety, depression, emotional well-being), social (social well-being), and spiritual (spiritual well-being, hope) outcomes and perceived health care quality (physician communication, nursing care, and coordination/responsiveness). Financial difficulties were scored by assessing patient perception of the extent to which their resources were meeting expenses for their treatments, daily living, and other obligations. We used multivariable linear/logistic regression to test association between financial difficulties and each patient-reported outcome. Six hundred stage IV solid malignancy patients in Singapore. Thirty-five percent reported difficulty in meeting expenses. A higher financial difficulties score was associated with worse physical, psychological, social, spiritual outcomes, and lower perceived quality of health care coordination and responsiveness (i.e. greater total pain and suffering) (all p < 0.05). These associations persisted after adjustment for socio-economic indicators. Results identify advanced cancer patients with financial difficulties to be a vulnerable group with greater reported total pain and suffering. A holistic patient-centred approach to care at end-of-life may help meet goals for Universal Health Coverage.

Incorporar la satisfacción del paciente de hemodiálisis a la gestión de la calidad

IntroductionApplication of Quality Function Deployment (QFD) methodology can be used to identify the requirements that determine patient perception of health care quality. The objective was to identify patient requirements in a Hemodialysis unit using QFD. Material and methodsSetting was Hemodialysis unit at the Infanta Sofia Hospital (Madrid). Matrix analysis based on the QFD method was performed from the qualitative approaches of the patient satisfaction. This was expressed by the Donabedian quality measurement model with a focus group for qualitative data. ResultsThe analysis of the matrix revealed the characteristics of the process which have a major influence on the service quality, related to patient satisfaction, this were recorded for future designs, services and improvements of the process, through a reliable healthcare monitoring service. ConclusionsQFD allows understanding patients requirements and to include them for continuous improvement of quality in services.

Measurement of Patients' Perceptions of the Quality of Acute Stroke Services: Development and Validation of the STROKE Perception Report.

Patients' perceptions of healthcare quality have become an important part of quality measurement. We explored patients' and family's lived experiences during acute stroke hospitalization to develop a quantitative instrument. Focus groups were conducted using open-ended scripted questions. Interview data were coded and analyzed using an inductive approach to thematic analysis. Symmetric patient and family instruments were developed based on qualitative domains and serially refined to a set of 30 survey items, 12 stroke knowledge test items, and 5 subject demographic fields. Scales were evaluated for internal consistency reliability using Cronbach α; construct validity with exploratory factor analysis using principal components with varimax rotation was performed to determine the extent to which items in a scale measure the same underlying factor. Feasibility of an electronic cloud-based survey was also tested. Three main themes emerged: fast action to diagnose and treat stroke, genuine caring, and education to prevent and respond to stroke. A total of 1029 subjects completed the final instrument with no differences in perception found by race, ethnicity, or length of stay. Scales showed satisfactory internal consistency reliability (Cronbach α scores, .89-.94); factor loadings across each scale ranged from 0.55 to 0.87. Data entry by electronic pad was perceived by 77% to be more confidential than paper surveys; median score for difficulty was 4 ("easy to use"). The STROKE Perception Report enables understanding of patients' and family's beliefs about the quality of acute stroke care in essential new domains never explored before.

Transcultural adaptation of the Karen Personal instrument to measure the nurses’ perception of healthcare quality in hospitals

ObjectiveTo adapt cross-culturally and validate the Karen Personal scale to measure the perception of the quality of care of hospital nurses of the public health care network in Chile. MethodFor the transcultural adaptation to Spanish of the scale, the inverse method was applied with translation-back translation and the judgement of 41 nursing professionals from a medium complexity public hospital. Then in a sample of 290 nurses from three high complexity public hospitals, exploratory factor analysis (varimax rotation) and confirmatory (maximum likelihood) and structural equations were applied. The programmes Stata 13.0 and R 3.2.2 were used. ResultsA linguistically adapted version of the instrument was obtained and presented a factorial solution of four factors that together explain 63.8% of the variance, and the scale presented a good fit according to the indicators used: CFI (.961); TLI (.950); RMSEA (.65); SRMR (.67). ConclusionsThe abbreviated version proposed in this study was adapted cross-culturally and shows adequate metrics and factorial analysis, it is necessary to continue evaluating its clinimetric properties in future studies.

Brief report: Impact of healthcare quality on prostate specific antigen screening for the early detection of prostate cancer.

With recent guidelines emphasizing patient values, patient preferences and shared decision-making in regards to prostate specific antigen (PSA) screening it is important for primary care providers and urologists to identify factors that influence men's decisions to undergo PSA screening. We sought to evaluate the impact of men's perceptions of healthcare quality on obtaining a screening PSA for the early detection of prostate cancer. A retrospective secondary data analysis was conducted of men ages 55–69 without a history of prostate cancer using 2015 Medical Expenditure Panel Survey (MEPS) data. The relationship between Consumer Assessment of Healthcare Providers and Systems (CAHPS) questions captured in MEPS and PSA screening in the last two years were assessed using multiple logistic regression. The analysis was carried out in October 2018 at Dartmouth-Hitchcock Medical Center. The final survey sample consisted of 1249 men that equated to 15,313,605.5 once weighted; 69.5% underwent PSA screening. Men who were offered help with filling out forms in the office (OR: 1.86, 95% CI: 1.14–3.01) or rated the quality of healthcare from their doctors ≥7 (OR: 1.63, 95% CI: 1.10–2.44) on a scale from 0 (worst healthcare) to 10 (best health care) had significantly greater adjusted odds of undergoing PSA screening. Men who rated the quality of healthcare delivered to them as high had significantly greater odds of undergoing PSA screening compared to those who rated it lower. Our results may suggest that improvements in healthcare quality and patient experience of care have the potential to positively influence PSA screening.

The Mediating Effect of Patient Satisfaction on the Patient's Perception of Healthcare Quality and Patient Trust

Background: Patients‟ experiences with quality of care and patient satisfaction in hospital are considered to be important elements in quality improvement of work in hospitals, and are also seen as indicators of quality of healthcare. The Aim of this study was to investigate the impact of patient satisfaction in the patients‟ perceptions of healthcare quality and patient trust Research design: A descriptive study was used. Setting: the study conducted in Minia General Hospital. Subjects: Includes all patients (200 patients) admitted to general Medical and Surgical Departments. Tools of study: three tools were used include personal characteristics data, SERVQUAL questionnaire, patient satisfaction questionnaire, and patient trust questionnaire. Results: more than half of the studied subjects strongly disagree toward prompt services (no waiting time), services provided as expected, efficiency of admitting procedure, friendly and courteous staff/doctors, and healthy, neat and clean environment. Also, there were positive correlations between patient satisfaction, patient trust and healthcare quality items with highly statistically significant differences. Conclusion: the patients are not satisfied about healthcare quality and they haven't trust and satisfaction about their services. Recommendation: Hospitals have to running a study on managers/doctors/staff perceptions of hospitals' services.

185 Everyone Loves a Popsicle: A Simple and Affordable Intervention to Improve Patient Satisfaction

Value-based purchasing (VBP) is a quality incentive program under the Affordable Care Act that is funded by a 2% reduction from diagnosis-related group (DRG) payments for the 2018 fiscal year. One-quarter of this fund is determined by patient and caregiver-centered experience and care coordination. Therefore, patient satisfaction scores have become an increasingly important component of health care delivery. Few studies have sought to identify low-cost interventions that improve patient experience and subsequently patient satisfaction scores. Here, we aim to explore the impact of popsicle administration in pediatric emergency department (ED) patients on Press Ganey satisfaction scores. A prospective trial was conducted at a tertiary academic pediatric ED and one mid-sized community ED between January 2018 to March 2018. The intervention was to give a popsicle to all eligible patients 0-14 years of age on even-numbered days (popsicle days) versus conventional practice on odd-numbered days. Press Ganey top box scores (response to the question was a “5” or the highest value) between even- and odd-numbered days were then compared using 2-sample t and chi-square tests. Among the 152 pediatric patients included (0-14 years of age), 84 surveys were filled out on even days and 68 surveys were filled out on odd days. Baseline demographics were similar between the groups with an average age of 7.3 ± 6.0 years and no statistical difference between the number of male and female patients. Overall, there was a significant increase in patient satisfaction scores on popsicle administration days for questions that asked about physician’s concern for comfort 74% versus 58% (p < 0.05), physician’s courtesy 77% versus 62% (p < 0.04), and physician taking time to listen 74% versus 57% (p < 0.03). No statistical difference was observed for questions that asked about overall rating of care 64% versus 61% (p= 0.64), likelihood of recommending 66 versus 59% (p=0.37), or informed of treatment 74% versus 60% (p=0.07). Offering popsicles to all eligible pediatric emergency department patients resulted in an increase in Press Ganey patient satisfaction score regarding physician’s concern for comfort, courtesy, and listening. Further studies should increase sample size, assess subsets of age groups, and assess economic rate of return for this and other low-cost interventions that might significantly impact perceived health care quality.

Perceptions of healthcare quality in Ghana: Does health insurance status matter?

This study’s objective is to provide an alternative explanation for the low enrolment in health insurance in Ghana by analysing differences in perceptions between the insured and uninsured of the non-technical quality of healthcare. It further explores the association between insurance status and perception of healthcare quality to ascertain whether insurance status matters in the perception of healthcare quality. Data from a survey of 1,903 households living in the catchment area of 64 health centres were used for the analysis. Two sample independent t-tests were employed to compare the average perceptions of the insured and uninsured on seven indicators of non-technical quality of healthcare. A generalised ordered logit regression, controlling for socio-economic characteristics and clustering at the health facility level, tested the association between insurance status and perceived quality of healthcare. The perceptions of the insured were found to be significantly more negative than the uninsured and those of the previously insured were significantly more negative than the never insured. Being insured was associated with a significantly lower perception of healthcare quality. Thus, once people are insured, they tend to perceive the quality of healthcare they receive as poor compared to those without insurance. This study demonstrated that health insurance status matters in the perceptions of healthcare quality. The findings also imply that perceptions of healthcare quality may be shaped by individual experiences at the health facilities, where the insured and uninsured may be treated differently. Health insurance then becomes less attractive due to the poor perception of the healthcare quality provided to individuals with insurance, resulting in low demand for health insurance in Ghana. Policy makers in Ghana should consider redesigning, reorganizing, and reengineering the National Healthcare Insurance Scheme to ensure the provision of better quality healthcare for both the insured and uninsured.

Medical Care Avoidance Among Older Adults.

Objective: To examine factors and reasons associated with medical care avoidance among older adults in the United States. Method: Analysis of data on 2,155 adults aged 65 and older, who completed the 2008 Health Information National Trends Survey. Results: Nearly one fourth of older adults reported medical care avoidance (n = 449; weighted % = 22.5%). Of these, more than one third reported doing so because of feeling uncomfortable when their body is examined (34.5%) or fearing a serious illness (35.9%) and with fewer reporting avoiding care because it made them think of dying (14.3%). Likelihood of avoidance was higher among those with worse self-reported health status, severe psychological distress, lower health self-efficacy, lower confidence in obtaining health information, lower trust in doctors, less patient-centered communication, lower perceived health care quality, and those who were current smokers. Qualitative reasons for avoidance corroborated quantitative results. Conclusion: Avoidance by older adults appears to be largely associated with evaluations of the quality of care and provider communication.