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PubMed1998

Using conjoint analysis to elicit the views of health service users: an application to the patient health card.

OBJECTIVE: To demonstrate the application of conjoint analysis (CA) for eliciting the views of health service users. METHODS: A CA study was conducted alongside a randomized controlled trial evaluating the introduction of a patient health card (PHC). The PHC was evaluated with respect to three other aspects of general practice: number of days between making a non-urgent appointment and seeing a doctor; waiting time in reception between the time of the appointment and seeing a doctor; and whether the patient is usually seen by the doctor of their choice. A postal questionnaire was sent to 100 individuals from a general practice in Inverurie, Scotland. RESULTS: Seventy-five individuals returned the questionnaire, of whom 51 answered the CA section. The PHC was the least important of the attributes considered. The number of days between making a non-urgent appointment and seeing a doctor was considered to be the most important. A 1-day reduction in the number of days to appointment was four and a half times more important than having a PHC; a 1-minute reduction in waiting time in the reception area was three and a half times more important than having a PHC; and seeing a doctor of choice was over three times more important than having a PHC. Satisfaction or utility scores for different ways of providing a general practice service also indicated that priority should be given to reducing waiting time to see a doctor or reducing waiting time in reception. CONCLUSIONS: While the PHC is a significant and positive predictor of satisfaction in general practice, it is less important than the other three attributes considered. More generally, CA appears to be a potentially useful instrument for eliciting the views of health service users.

Journal Article↗
PubMed2006

[The treatment received by public health services users in Mexico].

OBJECTIVE: To document the fact that differences in the treatment received by health services users in Mexico are mainly dependent on the type of provider, regardless of the users' socioeconomic status. METHODS: The data were obtained by means of a survey of 18 018 users who visited 73 health services in 13 states within Mexico. They were asked to grade the way the institution had performed in seven of the eight domains that define appropriate user treatment (autonomy, confidentiality, communication, respectful manner, condition of basic facilities, access to social assistance networks, and free user choice). The questionnaire included some vignettes to help determine user expectations. A composite ordinal probit model was applied; the perception of quality in connection with each of the appropriate treatment domains was the independent variable, whereas gender, educational level, age, type of provider, and user expectations were used as control variables. RESULTS: The type of provider was the main factor that determined users' perceptions regarding the treatment they received when visiting health services in Mexico. Institutions belonging to the social security system performed the worst, while the services provided under the program targeting the rural population (IMSS Oportunidades) received the highest scores. Overall, the domain that was most highly ranked was respectful manner, whereas the lowest score was given to the ability to choose the provider. Men felt they had been able to communicate better than women, while respectful manner, communication, and social support showed a significant negative association with educational level (P < 0.05). CONCLUSIONS: Differences were noted in the way different public health service providers in Mexico treat their users, regardless of the latter's socioeconomic status. Social security system providers showed the greatest deficiencies in this respect. Respectful manner was the domain that received the highest scores in the case of all providers. Organizational changes need to be made, since the shortcomings detected are not solely determined by factors related to health personnel, but also by certain aspects of the way the health system is structured in Mexico.

Adolescent↗
PubMedDate not supplied

Involving NHS service users in teaching advanced clinical skills.

With the development of advanced practice roles in nursing, innovative ways of delivering programmes are continually sought by academic staff working within higher education. This study explores the ways in which NHS service users can be included in education programmes to develop clinical examination skills for nurses. Although small scale and exploratory, this study concluded that NHS service users benefit from making a contribution towards the education of healthcare staff and feel empowered in the process.

Adult↗
PubMed2006

Agreement between staff and service users concerning the clientele's mental health needs: a Quebec study.

OBJECTIVES: This article examines the differences found between clientele with severe mental health problems and their key health workers in terms of assessing service users' needs in 6 Quebec service areas. METHOD: We questioned 165 pairs of users and staff, using the Camberwell Assessment of Needs questionnaire. The profile of serious and overall problems encountered by clientele from each of the sites was compared. RESULTS: The sites with the greatest degree of user-staff agreement in identifying problems were also the ones where users considered that local services best met their needs. CONCLUSIONS: The study demonstrated that, in needs assessment, major differences exist between the perceptions of users and their key workers in the various sites. These differences can be explained in part by users' individual characteristics, by types of needs, by local particularities, and by service use.

Cooperative Behavior↗
PubMed2006

Reflective testing--what do our service users think?

BACKGROUND: Reflective testing incorporates the clinical judgement, knowledge and experience of an individual biochemist to request additional tests appropriate to the clinical scenario. Despite being vigorously debated within the biochemistry profession, little is known about how the clinicians directly involved in patient care feel about it. We have conducted a survey to elicit our service users' opinion of reflective testing. METHODS: Ten clinical scenarios, each involving the possible addition of a specific test, were circulated to 520 hospital doctors and 152 general practitioners. The four response options were to add further tests, phone and discuss the case, add a comment to the original results or do nothing. RESULTS: A total of 216 (32%) responses were received. Overall, the majority were in favour of 'adding on' free triiodothyronine (86%), gamma-glutamyltransferase (78%), lipid profile (59%), thyroid peroxidase antibodies (63%), pituitary hormones (58%), troponin (55%) and serum electrophoresis (68%) in the given scenarios. However, only 30% would like a pregnancy test added and only 45% a prostate-specific antigen added without prior consultation. The response differed according to grade and specialty. CONCLUSIONS: Reflective testing is generally welcomed by our service users, provided the nature and implications of the specific test is considered in addition to the full clinical scenario.

Adolescent↗
PubMed2004

Service users' strategies for managing risk in the volatile environment of an acute psychiatric ward.

Previous research shows that too often acute psychiatric inpatient care is neither safe nor therapeutic for patients. Earlier studies focused on promoting safety through good ward design, staff being able to anticipate and prevent violence, and use of medication. The current evidence base overwhelmingly reflects a staff perspective on risk management, and there is little evidence on how service users cope in this environment or about the strategies they employ to manage the risks they face or pose to others. This paper presents findings on this from two studies: (a) ethnographic research on three UK acute psychiatric wards, undertaken between 2000 and 2002, and (b) a content analysis of qualitative data from a 1999/2000 survey of psychiatric wards in England. Findings show that while some users perceive their ward to be comparatively safe--given the crisis they were in before being admitted--it is nonetheless a volatile environment in which risks are concentrated. Many risks, such as physical assault, are attributable to other patients. However, they are better understood as an outcome of the interplay between a range of interactional and contextual factors: for example, low staffing levels/minimal or poor surveillance may increase the risk of assault. Users were found to employ 10 strategies to manage risk on the ward, including actively avoiding risky situations/individuals, seeking staff protection, and getting discharged. Integral to these strategies are the risk assessments that patients make of one another. These findings shed light on how people cope while living in one of the most anxiety-inducing institutions of a 'risk management society'. Service users routinely take an active role in making a safe environment for themselves, in part because they cannot rely on staff to do this for them. Future clinical practice guidelines should consider how to harness what users are already doing to manage risk.

Acute Disease↗
PubMed2006

Satisfaction with community and hospital-based emergency services amongst severely mentally ill service users: a comparison study in South-Verona and South-London.

OBJECTIVE: This study compares the satisfaction with emergency interventions among severely mentally ill (SMI) service users of a community-based and a hospital-based mental health service (South-Verona, Italy and Nunhead, South-London, UK). METHODS: A measurement of the satisfaction with psychiatric emergency services was conducted among all those users in the two catchment areas who, in a 1-year period: (1) had at least two contacts with the service; (2) had a diagnosis of psychosis according to ICD10; (3) had not been living in hospital or sheltered apartment for most of the time. These users completed seven items belonging to the Verona Service Satisfaction Scale (VSSS) regarding their satisfaction with crisis response during and out of office hours and their satisfaction with the different interventions, which may be provided during emergencies, such as consultation for the user, consultation for the relative, day-centre attendance, informal and compulsory admission. RESULTS: Users in South-Verona were generally more satisfied with emergency interventions. The main differences between the two samples were due to contacts outside the hospital setting, whilst satisfaction scores for informal admission were similar. The number of users who did not receive, but would have liked, different types of emergency intervention was smaller in South-Verona than in Nunhead. In South-Verona, users wishes mainly concerned consultation for the relatives during emergencies; in the Nunhead sample, the most requested types of intervention were consultation for the user and the possibility of day-centre attendance during crisis. CONCLUSIONS: The findings suggest that users of a service with a well developed community-oriented approach and with crisis intervention outside the hospital setting are more satisfied of the emergency interventions than users of a mental health service relying mostly on hospital facilities during emergencies.

Adult↗
PubMed2002

Service-user and professional issues.

A review of the current literature on service-user and professional issues revealed a distinctive pattern of concerns. Whilst these mainly have an origin in the wider world of disability, they have a relevance for forensic services. Advocacy, sexuality, abuse, offending, victimology, emergency management of behaviour, law, social exclusion, models of disability and research ethics dominated the literature. There was a paucity of work on professional development or service design, although this may have been an artefact resulting from the search methodology. In the view of the present author, the striking omissions were economics, the ethics of treatment and confidentiality, and the role of society in making decisions for those who cannot make decisions for themselves. The emphasis was on the 'libertarian' disability agenda and the more 'paternalistic' concerns of forensic services were somewhat neglected.

Crime↗
PubMed2006

Use of traditional medicine and globalized complementary and alternative medicine among low-income cancer service users in Brazil.

BACKGROUND: Complementary and alternative medicine (CAM) has become increasingly high profile in prosperous countries over the past 2 decades. Alongside this has been a renewed interest in the use of traditional medicine (TM) in poorer countries. Academic attention has tended to focus on either CAM in rich countries or indigenous TM in poorer ones. However, such a differentiation leads to a potential to gloss over global complexities, such as the study of countries where both CAM and TM are a potentially significant part of health options. Brazil is just such a country. Brazil is marked by massive socioeconomic inequalities; cancer is its second highest cause of death. To date, there has been little research on CAM/TM in cancer care in Brazil. PURPOSE: The purpose of this study is to provide the first exploratory data on the proportion of the use of CAM and/or TM among low-income cancer service users in Brazil. METHOD: A survey of cancer patients was conducted in November 2004 in a public-sector hospital in a major city in Brazil. A random sample (n = 92) was generated from a list of all appointments scheduled during that month (n = 570). Eighty-nine of the 92 patients contacted (97%) completed the questionnaire. RESULTS: Of the sample, 62.9% had used at least 1 form of CAM or TM. However, this headline figure is potentially misleading. The data reveal an almost total absence of use of non-indigenous international CAM; it also shows prayer to be a major contributor to the relatively high use rate. DISCUSSION: On the basis of this small-scale exploratory study, there is no evidence that those international CAMs ubiquitous in the West are spreading to low-income cancer service users in Brazil (despite anecdotal evidence of its increasing presence in the country generally). Moreover, when excluding prayer, use of indigenous traditional medicine was found to be relatively low. Further research is needed to examine these findings on a larger scale and to explore the relative importance of social, cultural, and economic factors behind them.

Brazil↗
PubMed2004

Listening to young voices: challenges of research with adolescent mental health service users.

Young people who have mental health problems and use the mental health services need to be consulted about their views regarding their experiences of care and treatment in the same way as adults do. Doing research with children and young people is relatively new but it is becoming more common and recent literature highlights a need to balance respect for their voices with responsibility for their best interests. This can be achieved by paying close attention to ethical and methodological issues throughout the course of every study. This paper reviews some of the issues involved in consultation research with adolescent mental health service users, and illustrates them with examples taken from an ongoing study into the experiences of young people in three Scottish child and adolescent mental health services.

Adolescent↗
PubMed1998

[The rights of the hospital patient: the knowledge and perception of their fulfillment on the part of the professional. The Group in Catalonia of the Spanish Society of Care for the Health Services User].

BACKGROUND: The Customer Service Department includes the protection of the patient's rights. To analyze the work performed in this setting, we planned to quantitate and evaluate the knowledge and perception of fulfillment by medical staff. METHODS: Multicentric cross-sectional study. The population included health care professionals in nine Catalonian hospitals. The sample was selected at random with reposition and was segmented according to professional category. Data collection was carried out by personal interview supported by a questionnaire. Differences according to institution size were analyzed. RESULTS: A total of 1,014 professionals were interviewed; 84.4% reported to know the patient's rights and 64.4% to observe them. Significant differences (p < 0.05) according to institution size were observed. CONCLUSIONS: Discussion and diffusion of patient's rights is an useful tool to improve knowledge and evaluate the perception of its fulfillment by health care professionals.

Adult↗
PubMed2001

[The experience of public service users with group psychotherapy: a qualitative study].

OBJECTIVE: To assess the experience of public service users in a time-limited psychotherapeutic group dynamic intervention. METHODS: Eleven patients were randomly selected from a group of 52 who had participated in an efficacy study and were interviewed in-depth. Their account was submitted to content analysis, according to the Grounded Theory methodology. RESULTS: In general, patients accepted well and positively evaluated the psychotherapy intervention. The main findings were the importance of patient's interaction with the group participants, and their therapeutic course after the intervention, when most of them carried on with psychotherapy. CONCLUSIONS: The psychotherapeutic intervention was well accepted among the patients, had a favorable outcome and stimulated them to proceed with psychotherapy.

Adult↗
PubMed2001

Involving patients in research: setting up a service users' advisory group.

Looks at some of the issues raised by patients' involvment in the research process. Uses the example of a service users' advisory group established as part of a diabetes service evaluation in the north of England. Key conclusions were: a precise role for the group should be specified at the outset; genuine user involvement is needed; wide and accurate representation of all relevant groups in society is essential; and, researchers must approach users with open minds with a view to shared decision making rather than control.

Asia, Southeastern↗
PubMed2004

[Is there a link between continuous quality improvement programs and health service users' satisfaction with prenatal care? An experience in Peruvian hospitals].

OBJECTIVES: 1. To compare the level of health service user satisfaction (US) with antenatal care in hospitals where a program of continuous quality improvement (CQI) was implemented, in comparison to a reference group of patients seen at hospitals that did not participate in the program. 2. To compare the reasons for dissatisfaction in both groups of users. 3. To identify the factors associated with US. METHODS: A quasi-experimental study of a representative sample of pregnant women attending prenatal care services. The women in the intervention group (n = 191) and the reference group (n = 185) were interviewed on leaving the prenatal care clinic. The dependent variable was satisfaction with prenatal care, and the independent variables were satisfaction of expectations, amiability, level of health information, perception of the equipment, waiting time, cleanliness and comfort. Descriptive and multivariate statistics were calculated. RESULTS: The intervention group showed higher rates of US (67.5% versus 55.1% in the reference group, P = 0.014). The main reasons for dissatisfaction were long waiting times and discourteous treatment, which were more frequent in the reference group. The multivariate analysis identified cordiality of the health professionals, information provided during the visit, satisfaction of expectations and implementation of the CQI program as the factors that were significantly associated with US. CONCLUSIONS: Our findings show that the CQI program in maternal and perinatal health services was positively associated with US. These results reinforce the need for cordiality during prenatal care contacts with providers, and the need to provide appropriate information to the user, in order to help increase acceptability of and adhesion to health care recommendations among pregnant women.

Adult↗
PubMed2002

Barriers to communication between health practitioners and service users who are not fluent in English.

This paper reviews the main barriers to effective communication between practitioners and those service users of minority ethnic backgrounds who may not be fluent in English. Barriers are reviewed at an interpersonal level, concerning discrepancies of attitudes and beliefs, and communication skills. Consideration is given to the impact of organisational factors on practitioner-client communication, focusing on provision of bilingual health workers. A key argument is that practitioner education should enhance the ability of health professionals to reflect on both the individual and organisational aspects of transcultural communication competence.

Communication Barriers↗
PubMed2002

Involving mental health service users and carers in curriculum development: moving beyond 'classroom' involvement.

Recent policy statements that address the future priorities for nurse education have emphasized that service users and carers should be actively engaged in partnerships with education professionals in all aspects of the curriculum. The development of this agenda is well advanced; however, examples of 'how to do it' are sparse. The development of a strategy to involve users and carers in the design and delivery of the Diploma of Higher Education in Nursing at Napier University provided an opportunity to evaluate the process of developing partnerships in this area of nurse education. This paper presents the findings from a process evaluation from the various standpoints of the key interest groups. The overall project and evaluation is outlined, along with methodological and practical issues surrounding this type of 'collaborative' evaluation. The importance and satisfaction of practical aspects of the project are examined. The issues of representativeness, expertise in 'involvement' and the importance of the 'process' of involvement are explored. Finally, the challenges to developing 'meaningful involvement' that goes beyond 'classroom involvement' in nurse education are identified and discussed.

Curriculum↗