Patient Satisfaction and Treatment Adherence Flashcards
What is patient satisfaction?
The difference between the patient’s perception of services they receive vs their expectations of what they should receive. I.e. if not what expected=dissatisfied
Specific to different health experiences and professionals
Measures quality of health care and this has an impact on financial support, not only for resources and research investment, but also public confidence in health services and staff moral
Why is it necessary to measure patient satisfaction?
To maintain and improve quality of care
To identify problem areas and reduce complaints
To assess the impact on adherence to treatment
What are the consequences of dissatisfaction?
Poor adherence to treatment: poor health outcome
Changing Dr/hospital: discontinuity, distribution imbalance
Using unorthodox treatments: safety, effectiveness, cost,
Using OTC medications with prescribed medication: possible drug interactions
Poor health status: low perceived health status, time off work, financial impact, prolonged recovery, reduced QOL
How is satisfaction measured?
Surveys produce simple quantitative data, easy to analyse
Interviews= qualitative data
Focus groups= advantage of being the least contaminated by the researchers views
Anecdotal evidence -eg thank you letters/gifts or complaints
What factors influence patient satisfaction?
Interpersonal skills of HCP (comms skills, patient centred approach)
Technical quality (accuracy of diagnosis)
Accessibility (distance from patient’s home)
Availability (waiting lists, choice of provider)
Cost
Physical environment (cleanliness, condition of room, quality of food)
Continuity
Health outcome
Demographics
Draw a diagram to explain the relationship between patient dissatisfaction and treatment adherence
What is patient adherence vs compliance?
Adherence is the extent to which patients’ follow the advice of the clinician.
Compliance implies the patient is more passive, HCP is more authoritarian
Thus, resistance of the patient is seen as non-rational or deviant behaviour
What is concordance?
Implies a fundamental shift in the traditional power balance, between doctor and patient
Implies an equal partnership where treatment is negotiated between Dr and Pt
The ideal approach that in most instances HCPs should be striving for in a modern health service
What are the consequences of non-adherence?
Lack of improvement
* Increased hospitalisation
* Increased morbidity and mortality
* Increased GP visits
* More sick leave/days off school
* Financial implications, Poor QoL
Adherence is measured in subjective and objective ways. What are the subjective measures of patient adherence and what are its pros and cons?
Mostly subjective measures:
Self-report questionnaires or diaries: ask patient, relatives, care givers
Pros: these measures are easy, convenient and cheap
Cons: patients tend to underestimate their non-adherence by around 20%
Adherence is measured in subjective and objective ways. What are the objective measures of patient adherence and what are its pros and cons?
- Physicians estimate - poorest correlation (0.2)
- Pill counts
- Mechanical devices – electronic pill counters/inhalers
- Direct observation – OPA attendance, TB clinic
- Prescription refills – pharmacy monitoring
- Physiological tests/markers – blood, urine, BP, non-toxic markers
- Health outcomes – BP, weight, BF
Who is to blame for non-adherence?
- NICE – Non-adherence should not be seen as the patient’s problem/fault
- HCP has responsibility
- Non-adherence due to bad explaining or lack of support
Outline the factors that may increase or decrease adherence
Not related to severity of disease
No consistent relationship with age and gender
Only some studies show +ve correlation w socioeconomic status
Not related to personality traits, but many HCPs wrongly think this is the most important factor
Depressed patients more likely to be non-adherent
Cohesive families are 3x more likely to adhere
Patients taking medication 4x per day are likely to achieve adherence of only 50%
Fewer symptoms = poorer adherence
What is the perceptual practical model of adherence?
Unintentional (most common): Patients feel they can comply/want to BUT can’t due to physical barriers, e.g. lack of resources/capacity
Solve this using: Patient reminders, financial support for prescriptions, help with dexterity problems
Intentional: Deliberate decision based on beliefs and preferences not to comply.
Check patient understands treatment/illness fully + consequences of medicine withdrawal. Address patients concerns
What are the three main factors for nonadherence?
Self regulation model
1) The health beliefs of the patient
2) The characteristics of the treatment regime
3) Communication between the HCP and the patient
This is the SELF REGULATION MODEL
Necessity-concerns framework?
operationalises the perceptual factors involved in intentional and non intentional adherence
