Η σχέση μεταξύ των επιστημόνων της υγείας και των ασθενών-πελατών αυτών διαρκώς εξελίσσεται και έχει συγκεντρώσει το ενδιαφέρον της διεθνούς βιβλιογραφίας. Οι ασθενείς είναι αυτοί που καθορίζουν την επιτυχία ή αποτυχία του συστήματος της υγείας. Για το λόγο αυτό γίνονται προσπάθειες ώστε να ανιχνευτούν οι πεποιθήσεις τους όχι μόνο για τις υπηρεσίες που τους προσφέρονται αλλά και για τους παρόχους των υπηρεσιών αυτών. Στόχος της εργασίας αυτής της ήταν να μελετήσει την σχέση μεταξύ των ασθενών-πελατών και του φαρμακοποιού στο σύγχρονο φαρμακείο. Πιο συγκεκριμένα, εξετάζεται κυρίως η ενσυναίσθηση του φαρμακοποιού και κατόπιν η επικοινωνία με τον φαρμακοποιό και η εμπιστοσύνη σε αυτόν. Επίσης διερευνάται η ικανοποίηση των ασθενών-πελατών. Για την διεξαγωγή της παρούσας έρευνας διαμοιράστηκε ανώνυμο ερωτηματολόγιο το οποίο συμπληρώθηκε από 113 άτομα. Οι συμμετέχοντες κάλυπταν όλες τις ηλικίες και έγινε προσπάθεια να βρίσκονται σε διάφορες περιοχές της Ελλάδας. Τα αποτελέσματα της έρευνας έδειξαν ότι γενικά ο Έλληνας φαρμακοποιός διαθέτει ενσυναίσθηση και την εφαρμόζει στην καθημερινότητα του για την αποτελεσματική επικοινωνία με τους πελάτες του. Ακόμα βρέθηκε ότι η εμπιστοσύνη στον φαρμακοποιό είναι υψηλή. Οι ασθενείς-πελάτες εμφανίζονται ιδιαίτερα ικανοποιημένοι γενικά όσον αφορά τις συναλλαγές τους στο φαρμακείο. / --

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / FundaÃÃo Cearense de Apoio ao Desenvolvimento Cientifico e TecnolÃgico / A avaliaÃÃo em saÃde tem sido um importante instrumento para o planejamento e a gestÃo de sistemas e de serviÃos de saÃde, nÃo sà no sentido de aferir a efetividade de intervenÃÃes e o uso eficiente dos recursos disponÃveis, mas tambÃm de satisfazer os profissionais de saÃde e a populaÃÃo usuÃria do sistema. Teve-se como objetivo geral avaliar a satisfaÃÃo dos usuÃrios e dos profissionais do Centro Integrado de Diabetes e HipertensÃo de Barbalha-CE. Utilizou-se como marco conceitual o modelo proposto por Avendis Donabedian para avaliar a qualidade em saÃde a partir dos componentes estrutura, processo e resultado. Trata-se de uma pesquisa avaliativa, com abordagem quanti-qualitativa que usou como estratÃgia de pesquisa o estudo de caso Ãnico. O estudo foi realizado com 97 usuÃrios e 8 profissionais do Centro Integrado de Diabetes e HipertensÃo de Barbalha, e, a coleta de dados efetuou-se no perÃodo de fevereiro a marÃo de 2012. Empregou-se, como instrumento para a coleta de dados dos usuÃrios, um questionÃrio semiestruturado, englobando as dimensÃes infraestrutura, acessibilidade e relaÃÃo usuÃrio-equipe. Para os profissionais, utilizou-se o Ãndice de PercepÃÃes Organizacionais, contendo as dimensÃes infraestrutura, gestÃo, clima e cultura organizacional. Os dados foram armazenados no programa Microsoft Excel, sendo processados pelo Statistical Package for the Social Sciences. Para as anÃlises de associaÃÃo, optou-se pelos testes qui-quadrado e razÃo de verossimilhanÃa. Os dados referentes Ãs questÃes abertas foram analisados mediante a anÃlise do conteÃdo. Obteve-se aprovaÃÃo pelo Comità de Ãtica em Pesquisa em Seres Humanos da Universidade Federal do CearÃ, n 324/11. Conforme os resultados mostraram, a maioria dos usuÃrios estava satisfeita com o Centro (63,9%). Quanto Ãs dimensÃes, a relaÃÃo usuÃrio-equipe foi responsÃvel pela maior prevalÃncia de satisfaÃÃo (92,8%) e a acessibilidade pela menor (67,0%). Na anÃlise das falas observou-se que os usuÃrios demonstravam insatisfaÃÃo com alguns aspectos nÃo verificados nas respostas fechadas: falta de adequaÃÃo estrutural para usuÃrios idosos e/ou com alguma deficiÃncia fÃsica; precÃria infraestrutura do banheiro; falta de organizaÃÃo do agendamento das consultas mÃdicas e de coleta de exames. NÃo se verificou associaÃÃo estatisticamente significante entre satisfaÃÃo dos usuÃrios e variÃveis sociodemogrÃficas ou controle glicÃmico. Quanto aos profissionais, a maioria (sete) estava satisfeita em trabalhar no Centro. No referente Ãs dimensÃes, o clima/cultura organizacional foi responsÃvel pela maior frequÃncia de satisfaÃÃo entre os profissionais. Os aspectos relacionados à insatisfaÃÃo foram observados nas dimensÃes infraestrutura, mais especificamente com a ambiÃncia e a seguranÃa; e na gestÃo, quando investigados os quesitos educaÃÃo permanente e remuneraÃÃo. Conclui-se que o Centro Integrado de Diabetes e HipertensÃo de Barbalha possui aspectos positivos, os quais devem ser reforÃados, e negativos, que precisam ser melhorados no tocante à avaliaÃÃo da qualidade, especificamente à satisfaÃÃo dos usuÃrios e dos profissionais. Segundo evidenciado, alguns aspectos avaliados negativamente saem da governabilidade dos profissionais e do gestor local do serviÃo de saÃde, logo, sÃo de responsabilidade da gestÃo municipal. Por isso recomenda-se sensibilizÃ-la. ReforÃa-se a importÃncia de pesquisas de satisfaÃÃo profissional e de usuÃrios como instrumento de gestÃo, pois poderÃo trazer melhoria para ambos. / Health evaluation has been an important tool for the planning and management of health systems and services not only to assess the effectiveness of interventions and the efficient use of available resources, but also to satisfy health professionals and the population user of the system. The objective was to assess the satisfaction of users and professionals of the Integrated Center for Diabetes and Hypertension of Barbalha, CearÃ, Brazil. The model proposed by Avendis Donabedian was used as a conceptual reference to assess the quality of healthcare from the components of structure, process and result. This is an evaluative study of quantitative and qualitative approach that used the single case study as a research strategy. The study was carried out with 97 users and eight professionals of the Center, and the data collection period was from February to March, 2012. The instrument applied for data collection of users was a semi-structured questionnaire encompassing the dimensions of infrastructure, accessibility and the user-staff relationship. For professionals it was used the Organizations Perception Index containing the dimensions of infrastructure, management, and organizational climate and culture. Data were stored in Microsoft Excel, and processed by the Statistical Package for the Social Sciences. The chi-square and the likelihood ratio tests were used for the association analysis. The data related to the open questions were analyzed by content analysis. The study was approved by the Ethics Committee of Research in Human Beings of the Federal University of CearÃ, n 324/11. According to the results most users were satisfied with the Center (63.9%). As for the dimensions, the user-team relationship was responsible for the greatest prevalence of satisfaction (92.8%) and accessibility for the lowest (67.0%). In the analysis of the speeches, users showed dissatisfaction with some aspects not checked in closed responses: lack of structural adequacy for the elderly and/or those with a physical impairment; bathroom poor infrastructure, lack of organization for scheduling medical appointments and sample collection. There was no statistically significant association between user satisfaction and sociodemographic variables or glycemic control. As for professionals, the majority (seven) was satisfied with working in the Center. The dimension of organizational environment/culture was responsible for the highest frequency of satisfaction among professionals. The aspects related to dissatisfaction were observed in the dimension of infrastructure, more specifically with the ambience and safety; and in management when investigating the aspects of continuing education and remuneration. The conclusion is that the Integrated Center for Diabetes and Hypertension has positive aspects that should be reinforced and negative aspects that need to be improved with regard to quality evaluation, more specifically with the satisfaction of users and professionals. According to evidences, some negatively reviewed aspects escape the competence of professionals and managers of the local health service, therefore are responsibility of the municipal management, hence the recommendation to sensitize it. Satisfaction surveys with professionals and users are extremely important management tools, because of the improvements it can bring to both, therefore these surveys should be encouraged.

There is demand for homeopathy in England amongst both doctors and patients. Exploring this demand remains the key to understanding the extent of integration of homeopathy in Primary and Secondary Care Practice and the potential significance of the role of GPs as gatekeepers. This thesis explores how qualified General Practitioners (GPs) and Medical Homeopathic Physicians in England adopt homeopathy as a healthcare innovation, and employ and integrate homeopathy treatments in their everyday work within healthcare practice in England. This study was conducted prior to the large scale changes that were introduced by NHS Mobilisation June 2010, championing the spread of activity to support the cost and quality agenda across the NHS, captured in the Quality, Innovation, Productivity and Prevention (QIPP) goals, during the period covered by this study. The term, “integrative medicine” has become a common term to describe teams of health care providers working together to provide patient care. It is currently used interchangeably with complementary and alternative medicine, and at other times refers to treatments that combine conventional medicine and alternative modalities. The aim of this thesis is to determine how homeopathy is integrated into healthcare, its clinical and practice benefits and how GP/Medical Homeopath Physicians’ views and experiences effect integration. This two phase study, using an adapted General Practice Assessment Questionnaire (GPAQ), to audit patient satisfaction, explored patient experiences of available homeopathic services in two established Primary Care GP Practices between 2007 and 2008 and further explored in 2009 twenty General Practitioners and Medical Homeopathic Physicians views of the integration of homeopathy, through semi structured telephone interviews. The findings in Phase One confirm that homeopathy has been integrated to a degree within the National Health System (NHS) in England since its inception in 1948. Two Geographical Information Systems Maps utilised in this study identified and illustrated the locality of GP homeopaths in England and explored geographical demographics associated with homeopathy availability and use. A clinical audit of two established homeopathy services report patients satisfaction with the homeopathic services provided in Primary Care settings. Phase Two findings identified that Non-Homeopath GPs were not antagonistic about the use of homeopathy in Primary Care practice. Constraints against full integration of homeopathy were not specifically related to gate keeping but those predominately of the time necessary to fit in homeopathic consultations within regular patient consultation time. This is coupled with findings from the Medical Homeopathic Physicians that indicate it is not the future of homeopathy that is in question but that of the NHS itself.

Magister Scientiae Dentium - MSc(Dent) / BACKGROUND: The concept of consumer satisfaction is gaining momentum across all business sectors worldwide. In keeping with this trend, health care systems are now also being reviewed to assess patient satisfaction with regard to the quality of care provided. Patient satisfaction is an instrumental tool for identifying shortcomings and challenges of the health system, and provides patients with a constructive outlet to rate their hospital experience. AIM: To determine the perceived levels of patient satisfaction with health care services. METHODOLOGY: A descriptive cross-sectional study was conducted using patients who attended the Outpatients Department of Untunjambili Hospital in Kwa-Zulu Natal. A sample of 250 patients was selected using systematic random sampling. The research instrument, a structured questionnaire consisted of 23 questions which were subdivided into five categories, namely: biographical data; accessibility to the hospital; infrastructure; overall satisfaction and general comments. The 5-Point Likert Scale was used to determine the perceived levels of patient satisfaction. Data collected from the responses was analysed using the SPSS Programme, Version 22.0. A Significance level of (p=0.05) was applied. RESULTS: The response rate of the study was 99.2% (n=248).The majority of the respondents were female (75.4%) and aged between 20-30 years old. The relative ratio of males to females was approximately 1:3. Nearly half of the participants (48.4%) had a secondary education, and a high degree of illiteracy was noted (21.8%). The majority of patients relied on taxis as the mode of transport to reach the hospital (71.4%), with 55.2% having to pay more than R15.00 for travel costs. While statements relating to personality such as staff friendliness, and doctors treating patients respectfully scored highly (93.5%), more than two thirds reported dissatisfaction with the lengthy waiting times (71.8%). In terms of infrastructure, respondents were mainly satisfied with the seating arrangements, cleanliness and air circulation, but were unhappy with the state of the toilet facilities and the unavailability of drinking water. Overall, 90.3% of patients were satisfied with the level of care they received at Untunjambili Hospital, with 89.5% suggesting that they would recommend the institution to others.

The purpose of this exploratory descriptive study was to determine orthopedic patients' perceptions of satisfying and/or dissatisfying nursing care behaviours during their emergency room experience. The conceptual framework selected for this study was based on Risser's (1975) criterion to evaluate patient satisfaction with nursing care. Risser's evaluative criterion consists of four dimensions which include: technical-professional behaviour, trusting relationship, inter-intrapersonal relationship, and educational relationship. The study was conducted in a large metropolitan hospital in the Vancouver area. The sample consisted of seven men and three women. Their ages ranged from 23 to 81 years. All subjects were admitted to the emergency room and subsequently transferred to an orthopedic ward as a result of an orthopedic injury and/or illness. An interview guide was designed by the researcher to collect retrospective data of subjects' perceptions of their emergency room experience. Data were collected through taped semi-structured interviews with all the subjects during their stay on the orthopedic ward. Data were analyzed by categorizing the identified nursing care behaviours under the four dimensions of Risser's (1975) evaluative criterion. The findings indicated that subjects were able to recall satisfying or dissatisfying nursing care behaviours. They appraised and/or commented on the nursing care behaviours which met their basic physical and psychosocial needs. The nursing care behaviours related to the trusting relationship dimension were an integral component of patient satisfaction. The role of the triage nurse was significant in influencing subjects' perceptions of satisfaction or dissatisfaction with nursing care. Overall, subjects expressed satisfaction with the nursing care behaviours in each of the four dimensions. / Applied Science, Faculty of / Nursing, School of / Graduate

The purpose of this thesis was two-fold: first, to develop a Patient Satisfaction Questionnaire which reflects patient satisfaction with dressings used in the care of ulcerating metastatic skin lesions; and second, to evaluate patient satisfaction and patient preference with two types of dressings: Mesalt dressings and continuous wet saline dressings. The Patient Satisfaction Questionnaire was developed to measure patient satisfaction with dressing performance. Patients with ulcerating metastatic skin lesions were asked to identify important characteristics for evaluating patient satisfaction with dressings. These questions were validated and reviewed for clarity by the patients. A visual analogue scale was used as the response scale. Testing for reliability was limited. Mesalt dressings were compared to continuous wet saline dressings by evaluating patient satisfaction with pre-defined criteria. The criteria for evaluation included ease of application and removal, discomfort during and between dressing changes, control of odor, and patient preference. The study used a cross-over design in which each patient used one dressing for a month and the other dressing for the next month. Although 14 patients were involved in the study, only 10 were statistically analyzed. The remaining four patients were excluded because they were unable to complete a portion of each treatment. Two major findings were identified. First, regarding the Patient Satisfaction Questionnaire, patients with ulcerating metastatic skin lesions had numerous ideas about what should be asked to evaluate patient satisfaction with dressings. They considered the questionnaire to be an appropriate format and the questions generated by the investigator to be both important and understandable. Second, the findings of the study indicated that the Mesalt dressings received significantly more positive ratings when compared with continuous wet saline dressings for ease of application and odor control. Mesalt dressings were also significantly preferred to continuous wet saline dressings. The knowledge gained through this study is useful when helping patients decide which dressings to use in the care of ulcerating metastatic skin lesions. The Mesalt dressing appears to be a favorable choice, particularly when ease of application and odor control is important. / Applied Science, Faculty of / Nursing, School of / Graduate

Magister Scientiae Dentium - MSc(Dent) / The edentulous jaw is a common feature in elderly patients that had lost their teeth during life due to local reasons such as poor oral hygiene and dental caries as well as periodontal disease. Hence these patients are the victims of biological phenomenona that lead to difficulties in different aspects of patient comfort with dentures. Clinicians are always concerned to minimize these difficulties and increase patient comfort through manufacturing a proper prosthesis to substitute for the loss of the natural teeth as well as the surrounding structures for optimum satisfaction and improved quality of life of the patient. The aim of this study was to evaluate patient satisfaction regarding function and aesthetics with conventional mandibular dentures and implant retained mandibular overdentures in denture wearers. / South Africa

Many individuals, especially those in rural areas, experience barriers to accessing medical care. Some barriers are attitudinal and represent perceived quality of care, such as patient satisfaction; however, some rural residents report elevated patient satisfaction scores, regardless of limited access to these services. Identifying how perceived need for medical care is related to patient satisfaction has not been previously explored. Using an online survey to collect data from a national sample (n=535), the current study used the Patient Satisfaction Questionnaire-Short Form (PSQ-18) and a single-item measure of perceived need to examine the association between these two variables, and further, whether rural status, measured by a single-item measure, moderated this association. Results indicated a significant negative correlation between patient satisfaction and perceived need, r(423)=-.12, p=.012. Although the overall moderation model was significant, F(5, 388)=7.10, p<.001, perceived need was not significantly associated with patient satisfaction, b=-.14, p=.20, and rurality status did not significantly moderate the relationship, F(1, 388)=.44, p=.51, ��R2=0.01. However, the covariates of income, b=.11, p<.001, and sexual orientation, b=.23, p=.01, significantly predicted patient satisfaction. This study identified an association between patient satisfaction with perceived need for medical care that has not been previously explored, although this relationship was no longer significant in a larger model, indicating other important factors likely influence this relationship and contribute to the elevated satisfaction scores identified in some rural areas. The lack of moderation by rurality may be due to consistently high barriers to accessing care across all regions of the United States; while rural areas certainly experience unique barriers to care, the barriers present in urban environments may be significant enough that level of rurality in itself does not significantly affect the relationship between perceived need and patient satisfaction. Furthermore, this study highlights the importance of social determinants of health in patients’ perceptions of quality of care. Sexual orientation and income emerged as significant predictors of patient satisfaction, in that higher satisfaction was associated with those who identified as heterosexual and had higher income, consistent with previous literature. Further investigation is necessary to determine the reasons why these relationships exist; however, it is important to acknowledge that individuals with low-income and who identify as sexual minorities experience stigma and discrimination in healthcare settings. These negative experiences with healthcare likely influence perceptions and health disparities that exist within these individuals and may directly impact patient satisfaction levels, which may be influential to these findings.

Introduction Diabetes is highly prevalent among older adults and can result in adverse health and economic outcomes. Patient satisfaction is an important quality of care indicator that often reflects the extent to which individuals have access to care and the ability to engage in preventive screenings and services needed to postpone or delay adverse outcomes associated with diabetes. Few studies have examined the role of patient satisfaction with care, specifically, among Medicare beneficiaries with diabetes. The purpose of the study is to describe provider satisfaction and associated characteristics among Medicare beneficiaries Methods A cross-sectional study was conducted using nationally representative data from the 2019 Medicare Current Beneficiary Survey (MCBS). Analysis was limited to persons 65 years and older who self-reported having diabetes. Satisfaction of care was the primary independent variable of interest, and it was assessed using the MCBS question ‘Have you been very satisfied, satisfied, dissatisfied, or very dissatisfied with the overall quality of health care received over the past year?’ Responses were recoded into dichotomous variables reflecting those with high satisfaction (very satisfied and satisfied) versus those who are not satisfied (dissatisfied and very dissatisfied). Results Approximately 3,852 individuals with diabetes were included in the study. Among study participants, 96.5% (3684) were satisfied with care and 3.5% (132) were dissatisfied with care. Among those satisfied with care, 52% were females, 68% were non-Hispanic Whites, 53% had more than high school education, 69% had more than a household income of more than $2500 married, 82% lived in a metropolitan area, 56% were married and 46% had obesity. Of those satisfied with care, 76% self-reported a general health status ranging from very good to excellent, 79% self-reported not being on insulin treatment and 79% self-reported having concurrent high blood pressure. In addition, about 82% of those satisfied with care, reported a recent HbA1c level of ≤7.5% or an average blood test of ≤140mg/dl, 64% reported self-testing for blood glucose and 65% of respondents reported having an annual foot examination by a doctor or other health professional. However, only 37% of participants satisfied with care reported participating in a diabetes self-management course, and less than 1% of those satisfied with care reported having an annual eye examination. Conclusion Findings from this study suggest that majority of Medicare beneficiaries are satisfied with care. Study participants who are satisfied with care reported low participation in diabetes self-management course and having an annual eye examination. Future studies are needed to examine the association between satisfaction of care and participation in a self-management course and annual eye examinations as these have implications for long-term diabetes outcomes. In addition, it may be important to undertake qualitative research to explore the determinants of dissatisfaction of care among Medicare beneficiaries with diabetes in order to address their specific needs.

Patients with the same underlying concern express this with different styles that predict preference for physician responses. One hundred primary care patients imagined having chest pain and selected from a videotape, the most likely response which they would tell their physician: (1) symptoms only - no disclosure of underlying concern; (2) symptoms and a "Clue" to an underlying concern; or (3) symptom with an explicit concern. Depending on their preferred expression, they were presented videotaped doctors responses to that disclosure and ranked their response preferences. Patients stating they would present with symptoms only (17%) preferred a biomedical question response; patients selecting a symptom and a clue (43%) were equally comfortable with a biomedical question, facilitation or, an exploration of the clue. Of patients presenting with an explicit concern (40%), most wanted the physician to acknowledge and explore the origins of that concern.