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Class of 2007 Abstract / Objectives: To assess the level of women’s satisfaction with pharmacist intervention, consultation, and services provided in HRT in order to analyze, and improve patient care at Don’s Compounding Pharmacy, Reno, NV. Methods: This descriptive study was done by offering to complete the 14-th questions survey to 300 female patients who had completed their HRT consultation at Don’s Compounding pharmacy. The data collection was performed from September, 19 2006 till January, 15 2007. The returned surveys were then organized and analyzed using Microsoft Excel. Results: Of the 300 surveys offered to complete, 40 were filled out (a response rate of 13.3%). 90% of the participants were customers of the pharmacy up to 5 years. 65% of the participants have used HRT for up to 5 years. The Biest in combination with progesterone or alone was the most prescribed medication (27.5% and 20% respectively). The most often prescribed dosage form was the cream (47.5%). 57.5% of participants answered that a pharmacist has spent 0-5 minutes in average per consultation. All sources of information (pharmacist, physician, mass media, and family/friends) were helpful or very helpful; a pharmacist had the first place among all of them. However, the difference in helpfulness was not statistically significant (benefits and adverse event: P=0.26 and 0.42 respectively). The total satisfaction score with pharmacist’s intervention, education and services was 3.4 (agree, very agree). Conclusions: The majority of the patients from this local pharmacy were satisfied with services provided, and the education received. Despite this fact, time to spend with patients and the education regarding adverse drug events should be improved. The overall patient satisfaction was above the average. Future studies may be considered in studying improvement of the pharmacist’s services and interventions.

One of the cultural traditions in Saudi Arabia is that the Saudi female patient has to be accompanied by a third-party on her medical visits, thus giving rise to consultations between three parties. By third-party, I mean a chaperone or a family member who can be a patient’s spouse, parent, adult child, sibling, or relative. This person shares responsibility for the patient’s health and the patient relies on them to support them generally with assistance in terms of their health care needs and especially for medical visits. In this research, I focus on the presence of a third party in medical consultations with reference to patient satisfaction, how patients perceive the role of their chaperones during the medical visit and the nature of three-party medical interactions. To investigate these aspects, a convergent parallel mixed method design was used in order to develop a better understanding of doctor-patient-three party interactions, as no mixed method study has been conducted on these issues in medical consultations in Saudi Arabia. Hence, this study addresses this gap in literature by focusing on the interaction between the Saudi female patients, their male physicians and their chaperones. I have concentrated on the Saudi female patients (from different age groups, i.e. 19-75) for religious and cultural reasons. Therefore, the overall aim of this thesis is to understand the phenomenon of three-party consultations in Saudi Arabia through a variety of aspects including patient satisfaction, patients’ perceptions, and what actually happens in three-party medical interactions (e.g., alignment and epistemic asymmetry). The data for this study included quantitative (i.e. questionnaires) and qualitative (i.e. four open-ended questions and observational and audio-recorded) data collected in one phase from 20 clinics in 3 hospitals in Jeddah in Saudi Arabia (two private and one governmental). A total of 117 female patients along with their chaperones were recruited. Statistical analysis of the questionnaire ratings showed that only patient’s education has a positive effect on patient satisfaction with chaperone involvement. Findings from thematic analysis of the open-ended questions data revealed that patients described three supportive roles of the chaperones, namely emotional, informational and logistical support. The patients’ perceptions regarding their chaperones’ supportive roles are re-evaluated in a real-life context by observing the chaperone’s facilitative role in three-party consultations. Therefore, conversation analysis of the audio-recorded data showed three main patterns of alignment: (1) doctor-patient, (2) chaperone-patient (and patient-chaperone), and (3) chaperone-doctor (and chaperone-patient) alignments. All these actions indicate that the participants were collaboratively involved in the positive interaction and this enhanced patient participation. However, in analysing three exceptional cases from the Chemotherapy and Haematology clinics, it was found that the presence of a chaperone dominates as well as complicates doctor-patient interaction and thus can significantly override or ostracise the patient who does not know her illness. For example, by using the Conversation Analysis approach, various epistemic resources used by the interlocutors (i.e. the oncologist and chaperones) are displayed by which the patient’s epistemic primacy is usurped and her epistemic access is controlled in terms of participation and the amount of information given. In comparing the mixed methods used in this study, congruent and discrepant results are found between the quantitative and qualitative data. In terms of congruent results, overall, the findings of this study concurred on the importance of having a supportive chaperone during a female patient’s medical appointment. Chaperones’ supportive roles appear to differently influence female patients’ symptoms, diagnosis or treatment plan. Chaperones in the current study have provided a useful contribution to the doctor-patient interactions. However, in terms of discrepancy, findings yielded by the conversation analysis (in Chapters 6 and 7) showed a discrepancy between what patients reported (see Chapter 5) about their chaperones’ supportive roles and what their chaperones did in the consultation. For example, the thematic analysis of the open-ended questions found that both genders were equally likely to be active in speaking for the patient. However, the conversation analysis of observational data adds and clarifies to what patients reported about their chaperones speaking on their behalf. The conversation analysis has given a good picture of the chaperone’s supportive role during medical visits in orienting towards patients as being the actual owners of their bodies and illness (see Chapter 6). Therefore, patients were given the chance to present their problem. Chaperones, in working collaboratively with patients and physicians, support the patient and facilitate the physician’s understanding. However, in only two exceptional cases (see Chapter 7) of actual medical interactions, the chaperone acts as a surrogate patient and restricts the patient’s own knowledge of their illness. Therefore, the current study contributes to three important areas, namely: (1) the literature of three-party interactions, (2) three-party interactions in Saudi Arabia, and (3) clinical practices in Saudi Arabia.

A study of women's views of maternity services in the Northern Sydney Area Health Service was conducted as a result of the changing patterns of use of the Area's 7 obstetric hospitals. 340 primiparous women living in the Northern Sydney Area who had given birth in the previous six months were approached in Early Childhood Health Centres and asked to complete a survey exploring the factors influencing their choice of obstetric hospital, postnatal length of stay in hospital, and overall satisfaction with their choice of hospital. Of the 315 eligible women, 312 (99%) consented to participate and 297 (94%) completed the survey. Overall, reputation of the hospital and quality of nursing care were the most frequent reasons given for choice of hospital and there was some evidence that women selected different hospitals for distinct reasons. Women's postnatal length of stay ranged from less than 1 day to 11 days with an average of 5.3 days. Private patients stayed an average of 1 day longer than public patients, after adjusting for delivery type and pregnancy induced hypertension. There was little evidence that women in the Northern Sydney Area Health Service desire a shorter postnatal stay with the majority of women reporting they were satisfied with their length of stay. Overall, women displayed high levels of satisfaction with their choice of hospital; at least 90% of women attending all hospitals except one reported that they would choose the same hospital for the birth of another baby. This study provides valuable information, based on the experiences of the service users, to help guide the Northern Sydney Area Health Service in the provision of its maternity services to ensure they meet the changing needs of women and their families.

Despite the many interventions and trials aimed at improving coordination of health care, there is currently no accepted measurement of coordination. My professional interests and an opportunity provided by the Care Plus (Coordinated Care) Trial in the ACT led me to consider client perceptions as a potentially appropriate measure. My research question is “can coordination of health care be usefully measured through client perceptions?” ¶ I addressed this question by developing and testing an instrument to measure perceptions of coordination called the Client Perceptions of Coordination Questionnaire (CPCQ). In the thesis I describe the processes of developing the instrument, testing it through use in several studies and considering how useful such an instrument may be for health services research. In addition to the Coordinated Care Trial, I conducted two validation studies - in a chronic pain population and a general practice sample. ¶ In Part 1 of the results I demonstrate good face, content and discriminant validity, and reliability of the instrument. Psychometric analysis of the CPCQ did not support scaling, and identified areas were the instrument could be improved. Nevertheless the underlying construct of client perception of coordination as a measure is entirely new, and it is therefore worthwhile to explore its associations with other health outcome data. In Part 2 I use a single item from the CPCQ, “how often did you feel the care you received was well-coordinated?” to explore this construct. I explore the influences upon on client perceptions of coordination, and examine its associations with service utilisation and health outcome data. ¶ The construct of ‘perceived coordination’, and the capacity of the CPCQ to measure it accurately show considerable promise as measures of health care. Consistent trends were found that suggested coordination was a complex construct, and that a stronger theoretical base was needed to interpret this complexity. Theory is the first of the ‘phases’ of instrument development, and so I revisit these in order to summarise the strengths and weaknesses of the current CPCQ. Overall, the perceptions of coordination have surprisingly plausible associations with other health data, the effort to improve the instrument should be worthwhile for a wide range of health service evaluation and research.

Purpose: The purpose of this research is to investigate the result and extent of outsourcing, and from this result to rank the future trend of outsourcing in public hospitals. Method: A survey satisfaction questionnaire of inpatient (5 subscales and 35 items) and outpatient (5sbscales and 32 items) were performed by trained social workers. They collected 30 inpatients and 30 outpatient¡¦s satisfaction questionnaire every month from Jan. 2004 to Dec. 2005 as the independent variables. The same period of the hospital revenue and number of the employees are the dependent variables. Result: (1) The hospital revenue improved 24.5% from years of 2004 to 2005 and the patient satisfaction is significantly improved (p<0.05) in the most of subscales of the patient satisfaction. The outsourcing is successful in our hospital. (2) The subscales of the outpatient satisfaction and the subscales of inpatient satisfaction score are significantly related to outpatient and inpatient revenue respectively. It is further proved increased patient satisfaction would increase patient loyalty Increase patient loyalty then increased hospital revenue. (3) The each month¡¦s total outpatient and inpatient satisfaction score showed significantly related to number of each division of medical employee. There is high collinear between medical staff despite omit some divisions of medical staff, so it is need further study. Conclusion: (1) In order to achieve large financial improvement and patient satisfaction, increasing number of medical staff is important. (2) For reducing cost, outsourcing work of non-medical staff or reducing salary is the way.

Patient satisfaction is a key outcome measure being examined by researchers exploring the relationships between patient outcomes and hospital structure and care processes. Only a few non-generalizable studies, however, have explored the relationship of nurse staffing and patient satisfaction with nursing care in emergency departments of hospitals. This dissertation aims to address that gap. Using more than 182,000 patient satisfaction surveys collected over a five-year period from 153 emergency departments (EDs) in 107 hospitals throughout Ontario, this study explores the relationship between nurse staffing and patient perceptions of nursing care in a range of Canadian ED settings, including urban and rural, community and academic, and small and large healthcare institutions with varying sizes and case mix. Using an established conceptual framework for investigating the relationship between nurse staffing and patient outcomes, nineteen nurse staffing variables were initially investigated. Ultimately, however, only five staffing variables were used in the multi-level regression analyzes. These five variables included registered nurse (RN) proportion, RN agency proportion, percent full-time nurse worked hours, RN worked hours per patient length of stay and registered practical nurse (RPN) worked hours per length of stay. Emergency department case mix index, patient age and gender, hospital peer group, size, wait times, cleanliness of the emergency department, physician courtesy, and year of measurement were controlled to account for their effect on the relationship between nursing staffing and patient satisfaction in the ED. The study revealed a subset of six patient satisfaction variables representing the overall variation in patient satisfaction with nursing care in the ED. Although RN proportion and RPN worked hours per length of stay were found to have a statistical association with patient satisfaction in the ED, the association was weak and not administratively actionable. Interpersonal and environmental factors such as physician and nurse courtesy, ED cleanliness and timeliness, however, were areas which hospital administrators should consider since they were highly associated with patient satisfaction in EDs.

Patient satisfaction is a key outcome measure being examined by researchers exploring the relationships between patient outcomes and hospital structure and care processes. Only a few non-generalizable studies, however, have explored the relationship of nurse staffing and patient satisfaction with nursing care in emergency departments of hospitals. This dissertation aims to address that gap. Using more than 182,000 patient satisfaction surveys collected over a five-year period from 153 emergency departments (EDs) in 107 hospitals throughout Ontario, this study explores the relationship between nurse staffing and patient perceptions of nursing care in a range of Canadian ED settings, including urban and rural, community and academic, and small and large healthcare institutions with varying sizes and case mix. Using an established conceptual framework for investigating the relationship between nurse staffing and patient outcomes, nineteen nurse staffing variables were initially investigated. Ultimately, however, only five staffing variables were used in the multi-level regression analyzes. These five variables included registered nurse (RN) proportion, RN agency proportion, percent full-time nurse worked hours, RN worked hours per patient length of stay and registered practical nurse (RPN) worked hours per length of stay. Emergency department case mix index, patient age and gender, hospital peer group, size, wait times, cleanliness of the emergency department, physician courtesy, and year of measurement were controlled to account for their effect on the relationship between nursing staffing and patient satisfaction in the ED. The study revealed a subset of six patient satisfaction variables representing the overall variation in patient satisfaction with nursing care in the ED. Although RN proportion and RPN worked hours per length of stay were found to have a statistical association with patient satisfaction in the ED, the association was weak and not administratively actionable. Interpersonal and environmental factors such as physician and nurse courtesy, ED cleanliness and timeliness, however, were areas which hospital administrators should consider since they were highly associated with patient satisfaction in EDs.

Thesis (Ed. D.)--West Virginia University, 2001. / Title from document title page. Document formatted into pages; contains viii, 164 p. : ill. Includes abstract. Includes bibliographical references (p. 115-123).

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