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The aim of this study is to examine patient satisfaction with non‐physician staff as related to patient demographics, satisfaction with physician, and intentions to recommend their physicians to others.

A survey was conducted at two internal medicine primary care clinics affiliated with a major university health system. A latent class analysis was used to detect patient subpopulations based on profiles of response for five satisfaction‐with‐staff indicators.

The response rate was 86.46 percent (479 of 554). Analyses revealed four patient subpopulation segments. Segment I (n=241) patients uniformly indicated a high level of satisfaction across the five satisfaction‐with‐staff indicators. These patients tended to be older and less educated, and have lower incomes relative to patients in other segments. Patients in Segment II (n=83) expressed satisfaction with staff caring and need accommodation, but dissatisfaction with access to their physicians. Patients in Segment III (n=51) indicated high levels of satisfaction with access and low levels of satisfaction with staff caring and need accommodation. Segment IV (n=104) patients uniformly expressed low levels of satisfaction across all indicators and generally were younger and more educated, as well as had higher incomes than other patients.

Patients have different expectations from their non‐physician staff, e.g. younger, more affluent, and educated patients expressed dissatisfaction with staff. This suggests that non‐physician staff should provide extra/further responsiveness to have these patients' needs met. Generally, approaches that are differentially targeted to specific patient subgroups are likely to be more efficient and patient‐oriented than undifferentiated approaches.

The purpose of this paper is to describe current physician scheduling and concomitant opportunities for improvement in public hospital departments in Sweden.

A total of 13 departments spread geographically across Sweden covering seven different specialties participated in the study. Data were collected through interviews with individuals involved in creating physician schedules. All departments investigated provided copies of the documents necessary for physician scheduling.

Physician scheduling required the temporal coordination of patients, physicians, non-physician staff, rooms and equipment. A six-step process for creating physician schedules could be distinguished: capacity and demand overview, demand goal and schedule setting, vacation and leave requests, schedule creation, schedule revision, and schedule execution. Several opportunities for improvement could be outlined; e.g. overreliance on memory, lacking coordination of resources, and redundant data entering.

The paucity of previous studies on physician scheduling lends an exploratory character to this study and calls for a more thorough evaluation of the feasibility and effects of the approaches proposed. The study excluded the scheduling of non-physician staff.

To improve physician scheduling and enable timeliness, three approaches are proposed: reinforcing centralisation, creating learning opportunities, and improving integration.

This paper is among the few to investigate physician scheduling, which is essential for delivering high quality care, particularly concerning timeliness. Several opportunities for improvement identified in this study are not exclusive to physician scheduling but are pervasive in healthcare processes in general.

Breast cancer is one of the most prevalent malignancies worldwide. This study aimed to compare the level of knowledge and attitude of females regarding Breast cancer and to determine the role of knowledge, attitude and barriers in performing regular self-examination.

Non-physician females aged 18 years old or above were enrolled in this cross-sectional study in two groups of usual clients and healthcare staff from January 2018 to January 2019 from a healthcare center in Sari, a major city in the northern district of Iran. A questionnaire was used to score the participants’ knowledge and attitude levels using questions about the participants' knowledge and attitude towards Breast cancer along with their status on Breast self-examination and barriers. Mean scores were used for statistical analysis using SPSS V25. p < 0.05 was considered significant.

A final dataset of 279 females were collected. A significant difference in the knowledge and attitude regarding breast cancer was found between the two study groups (p < 0.001). The practice of BSE was significantly lower in the usual clients compared to non-physician healthcare staff (p < 0.001). The most frequent barriers for not performing a regular BSE were fear of finding a mass in usual clients (17.8%) and lack of confidence in healthcare staff (3.8%).

Limitations include single-centered sample selection.

Given the importance of early detection in breast cancer prevention and the general taboo regarding breast cancer screening methods in certain parts of the world, leading to poor results in early detection and prevention, the authors believe that it is of superior importance to address and promote positive attitudes in general population towards breast self-examination.

Given the importance of early detection in breast cancer prevention, and the general taboo regarding breast cancer screening methods in certain parts of the world, leading to poor results in early detection and prevention, the authors believe that it is of superior importance to address and promote positive attitudes in general population toward breast self-examination. The authors of this study believe that the manuscript represents honest and original work.

This paper aims to explore the value that care from a primary mental health care nurse (PMHCN) can bring to people with mental health (MH) problems in health-care delivery.

This study used a focus group of 20 PMHCNs working in primary care (PC) health settings in Saudi Arabia before using thematic content analysis to describe and explore their views and experiences of the integration of MH care into PC units. The researchers used a semi-structured interview format, which began with open-ended probes and proceeded to use of theoretical sampling based on emerging data related to their experiences and perceptions in the integration process.

Four main themes were derived from the thematic analysis of interviews: collaboration, knowledge and experience, awareness and orientation care and influential role.

This study’s use of qualitative research methods has certain limitations, including the small sample size of 20 participants, which means that it may not be representative of all primary MH nurses in primary health-care centers in Saudi Arabia. To make the results applicable to a broader audience, the researcher sought to moderate this limitation by including participants with extensive experience in multiple settings and nurses of different ages.

The cost implications of the PMHCN service are not yet comprehensively understood, but it is apparent that this model is not only regarded extremely positively by MH practitioners but may also have significant benefits in terms of patient outcomes. The configuration of local services and relevant patient demographics will affect the extent to which this study’s findings are transferable. Meanwhile, further research in this area could seek to provide further evidence about the aspects of the PMHCN service model, such as secondary care referrals and waiting times, accident and emergency attendances and patient recovery rates and the impact of providing such a service on health-care practitioners as well as its cost-effectiveness.

This study’s findings suggest that PMHCNs believe that their care improves the quality of PC for patients in PC settings. Elements of the PC placement that professionals particularly valued include their ability to assist patients in their own community and the inclusion of volunteer stakeholders who act as preceptors. The participants expressed a need for improvement of policy related to referrals within the clinics.

Criminalization of drug use in Malaysia has concentrated people who inject drugs (PWID) and people living with HIV into prisons where health services are minimal and HIV-related mortality is high. Few studies have comprehensively assessed the complex health needs of this population. The paper aims to discuss these issues.

From October 2012 through March 2013, 221 sequentially selected HIV-infected male prisoners underwent a comprehensive health assessment that included a structured history, physical examination, and clinically indicated diagnostic studies.

Participants were mostly PWID (83.7 percent) and diagnosed with HIV while incarcerated (66.9 percent). Prevalence of hepatitis C virus (90.4 percent), untreated syphilis (8.1 percent), active (13.1 percent), and latent (81.2 percent) tuberculosis infection was several fold higher than non-prisoner Malaysian adults, as was tobacco use (71.9 percent) and heavy drinking (30.8 percent). Most (89.5 percent) were aware of their HIV status before the current incarceration, yet few had been engaged previously in HIV care, including pre-incarceration CD4 monitoring (24.7 percent) or prescribed antiretroviral therapy (ART) (16.7 percent). Despite most (73.7 percent) meeting Malaysia’s criteria for ART (CD4 <350 cells/μL), less than half (48.4 percent) ultimately received it. Nearly one-quarter (22.8 percent) of those with AIDS (<200 cells/μL) did not receive ART.

Drug addiction and communicable disease comorbidity, which interact negatively and synergistically with HIV and pose serious public health threats, are highly prevalent in HIV-infected prisoners. Interventions to address the critical shortage of healthcare providers and large gaps in treatment for HIV and other co-morbid conditions are urgently needed to meet the health needs of HIV-infected Malaysian prisoners, most of whom will soon transition to the community.

Hospital length of stay (LOS) is not only a function of patient- and disease-related factors, but is also determined by other health system-wide variables. Managers and clinicians strive to achieve the best possible trade-off between patients’ needs and efficient utilisation of hospital resources, while also embracing ethical decision making. The purpose of this paper is to explore the perceptions of the hospital’s major stakeholders as to what affects the duration of LOS of inpatients.

Using a data-triangulated case study approach, 50 semi-structured interviews were performed with management, doctors, nurses and patients. Additionally, the hospitals’ standard operating procedures, which are pertinent to the subject, were also included in the thematic analysis.

This study shows that LOS is a multi-dimensional construct, which results from a complex interplay of various inputs, processes and outcomes.

The findings emerging from a single case study approach cannot be generalised across settings and contexts, albeit being in line with the current literature.

The study concludes that a robust hospital strategy, which addresses deficient organisational processes that may unnecessarily prolong LOS, is needed. Moreover, the hospital’s strategy must be sustained by providing good primary care facilities within the community set-up, as well as by providing more long-term care and rehabilitation beds to support the hospital turnover.

The subject of LOS in hospitals has so far been tackled in a fragmented manner. This paper provides a comprehensive and triangulated account of the complexities surrounding the duration in which patients are kept in hospital by key stakeholders, most of whom were hands-on in the day-to-day running of the hospital under study.

The purpose of this paper is to develop a framework for the application of evidence-based management to chronic disease healthcare.

Chronic healthcare is specially characterized by recursive patient-physician interactions in which evidence-based medicine (EBM) is applied. However, implementing evidence-based solutions to improve healthcare quality requires managers to effect changes in many different areas: organizational structure, procedures, technology and in physician/provider behaviors. To complicate matters further, they must achieve these changes using the tools of resource allocation or incentives. The literature contains many systematic reviews evaluating the question of physician and patient behavior under various types and structures of incentives. Similarly, systematic reviews have also been done regarding specific changes to the healthcare process and their effectiveness in improving patient outcomes. Yet, these reviews uniformly lament a lack of appropriate data from well-organized studies on the question of “Why?” solutions may work in one instance while not in another. The authors present a new theoretical framework that aids in answering this question.

This paper presents a new theoretical framework (Influence Model of Chronic Healthcare) that identifies: the critical areas in which managers can effect changes that improve patient outcomes; the influence these areas can have on each other, as well as on patient and physician behavior; and the mechanisms by which these influences are exerted. For each, the authors draw upon, and present the evidence in the literature. Ultimately, the authors recognize that this is a complex question that has not yet been fully researched. The contribution of this model is twofold: first, the authors hope to focus future research efforts, and second, provide a useful heuristic to managers who must make decisions with only the lesser-quality evidence the literature contains today.

This model can be used by managers as a heuristic either ex ante or ex post to determine the effectiveness of their decisions and strategies in improving healthcare quality. In addition, it can be used to analyze why actions or decisions taken achieved a given outcome, and how best to proceed to effect further improvements on patient outcomes. Last, the model serves to focus attention on specific questions for further research.

The purpose of this paper is to examine the relationship between patients’ provider communication effectiveness and courteousness with patients’ satisfaction and trust at free clinics.

This cross-sectional survey (n=507), based on the Consumer Assessment of Healthcare Providers and Systems instrument, was conducted in two Southeastern US free clinics. Latent class analysis (LCA) was used to identify patient subgroups (clusters) with similar but not immediately visible characteristics.

Across the items assessing provider communication effectiveness and courteousness, five distinct clusters based on patient satisfaction, trust and socio-demographics were identified. In clusters where communication and courteousness ratings were consistent, trust and satisfaction ratings were aligned with these domains, e.g., 54 percent rated communication and courteousness highly, which was associated with high patient satisfaction and trust. When communication effectiveness and courteousness ratings diverged (e.g., low communication effectiveness but high courteousness), patient trust and satisfaction ratings aligned with communication effectiveness ratings. In all clusters, the association was greater for communication effectiveness than for provider courteousness. Thus, provider courteousness was important but secondary to communication effectiveness.

Investment in patient-centered communication training for providers will improve patient satisfaction and trust.

The study is the first to examine individual provider communication components and how they relate to patient satisfaction and trust in free clinics. LCA helped to more fully examine communication constructs, which may be beneficial for more nuanced quality improvement efforts.

There is an increasing interest in employing e‐mail or other Internet‐based messaging systems in communication between patients and healthcare professionals. Many projects are put into practice, and numerous studies shed light on patients’ preferences regarding e‐messaging and their experience and use of e‐messaging. We argue in this paper that the conventional research in the field to some extent lacks a discussion about what kinds of knowledge an e‐messaging system generates among its users when it is put into practice. We suggest that placing the concept of knowledge as a discourse in focus, stressing how patients make judgements and distinctions in their use of e‐messaging, exposes important aspects not only regarding how patients relate to the system but also what e‐messaging in the healthcare sector means. We illustrate such a perspective with empirical material based on two focus groups of users of an e‐messaging system via a Swedish healthcare Web portal. Three kinds of knowledge formations are illuminated in this context: how patients develop knowledge by comparing e‐messaging services with traditional ways to contact healthcare; how the system generates a further demand for control by its users; and how the e‐messaging system helps users develop knowledge of the healthcare system in general.