A qualidade da assistência médica e dos serviços de saúde é uma questão que nas últimas décadas passou a ser motivo de crescente interesse tanto nos meios científicos e políticos, como na sociedade como um todo. À medida que foram se tornando conhecidos uma grande quantidade de problemas que afetam a prestação de serviços de saúde, a questão da avaliação da qualidade de cuidados médicos passou a ser não apenas um motivo de interesse, mas também uma prioridade entre os responsáveis pela formulação de políticas sociais e de saúde. Enquanto que em vários países a avaliação da qualidade de serviços vem ocorrendo de forma sistemática, no Brasil isso não tem ocorrido, principalmente no que diz respeito à avaliação qualitativa. O estudo desenvolvido nesta tese se propõe a avaliar qualitativamente um serviço ambulatorial de saúde mental. Os principais objetivos deste trabalho são: 1) avaliar o grau de satisfação dos pacientes com o tratamento recebido no serviço estudado; 2) analisar a interrelação entre o processo de prestação de serviços e os resultados finais do tratamento para se avaliar a qualidade da atenção prestada; e 3) determinar o peso que diferentes fatores, tais como processo de prestação de serviço, características individuais dos pacientes, e fatores relacionados à doença, podem ter na determinação de que o resultado final do tratamento possa ser considerado positivo ou negativo. Foram sujeitos deste estudo os pacientes atendidos no Ambulatório de Saúde Mental da Faculdade de Medicina de Botucatu como \"casos novos\" (1a consulta) de Psiquiatria durante os anos de 1989 e 1990, procedentes de Botucatu e São Manoel e portadores dos diagnósticos da \"CID\"-9 (1975) \"Transtornos neuróticos\", \"Reações de ajustamento\" e diagnósticos do \"Código V\" (V.61, V.62 e V.ll). Os dados sobre o tratamento dos pacientes foram coletados das fichas de agendamento de consultas, dos prontuários médicos e de questionários aplicados aos pacientes em entrevistas domiciliares. Dos 1155 pacientes atendidos como \"casos novos\" foram incluídos nesta pesquisa 289 pacientes. Em função dos pacientes que não puderam responder às entrevistas domiciliares, contamos com um total de 211 pacientes dos quais obtivemos informações tanto dos prontuários médicos, como das entrevistas domiciliares. A análise estatística realizada pode ser dividida em duas fases: 1) onde foram obtidas informações através da distribuição de freqüências e associações entre variáveis, e 2), onde foram utilizados métodos de análise multivariada. Em 66.5 por cento dos casos os pacientes referiram sentir-se \"melhor\" como resultado do tratamento recebido, índice bastante similar ao da percepção do médico de \"melhora com o tratamento\" (65,7 por cento). Em 70,1 por cento dos casos os pacientes referiam estar satisfeitos com o tratamento. Neste estudo, as pessoas relacionadas com o tratamento como o médico e funcionários da recepção foram avaliados positivamente enquanto que alguns fatores organizativos foram avaliados mais negativamente. Como em outros estudos, a satisfação geral esteve altamente associada com a percepção de melhora do paciente. Diferentemente de outros trabalhos, neste, a satisfação também esteve fortemente associada à percepção de melhora por parte do médico. São apresentados e discutidos vários aspectos do processo de assistência que estiveram associados aos resultados finais do tratamento. Analisando-se a interrelação de muitas das variáveis do processo com os resultados obtidos, podemos chegar à algumas conclusões \"aproximadas\" sobre a qualidade do serviço, que poderão servir para que se possam tomar ·decisões pragmáticas sobre a organização do serviço, ainda que em última instância não nos permitam responder de forma precisa à pergunta contida em um de nossos objetivos: \"qual foi o nível de qualidade da assistência prestada?\". Isso porque nos faltam critérios e \"standards\" explícitos aplicáveis a nosso meio. O desenvolvimento desses critérios e padrões explícitos de qualidade deveriam ser um objetivo prioritário de futuras pesquisas na área da avaliação qualitativa em Saúde Mental. Com relação ao \"peso que diferentes fatores podem ter na determinação do resultado final do tratamento\", pode-se dizer que algumas características da doença tiveram pouco peso na determinação dos resultados, enquanto que certas características do paciente como sexo e renda per-cápita estiveram associadas de forma significante com os resultados do tratamento. Comentamos com detalhes esses dados, e salientamos que tais achados são válidos no contexto \"deste\" estudo. Além dessas duas características, também descrevemos outras variáveis ligadas ao processo, que estiveram altamente associadas à determinação dos resultados, através da análise multivariada. A \"satisfação com o tratamento\" foi a variável que mais fortemente esteve associada aos resultados finais. Do referido acima poderíamos concluir que atingimos o objetivo de verificarmos em que extensão, certos fatores podem interferir nos resultados finais. Para finalizar, pudemos avaliar o grau de satisfação dos pacientes com o tratamento recebido. Tal avaliação foi de extrema importância nesta pesquisa, no sentido da complementaridade de informações que possibilitou, ao proporcionar a visão subjetiva do usuário que pôde ser somada aos dados obtidos do prontuário. Levando-se em consideração a situação atual das pesquisas qualitativas em nosso meio, sugere-se os estudos na linha da avaliação da satisfação com a assistência recebida sejam os que se mostrem mais factíveis de serem realizados, e em termos de resultados produzidos, poderiam ser tão bons quanto outros métodos para a avaliação da qualidade de serviços de saúde mental. / The interest in the quality of medical care and health services has been an issue that, in the last decades, has grown not only in the scientific and political arenas, but in the society as a whole. As the problems concerning the quality of health care delivery were known, the issue of their evaluation has been not only an issue of interest, but also a priority among the decision makers in the field of social and health policy. While in several countries the evaluation of health services is being sistematically developed, this has not been so in Brazil, and with special emphasis in qualitative evaluation. The aim of this thesis is to develop a qualitative evaluation of a mental health outpatient service. The main objectives of this dissertation are: 1) to evaluate the patients satisfaction level with the treatment that they received in the service; 2) to analyze the relationship between the health care delivery process and the final treatment outcome in order to evaluate the health care delivery quality; and 3) to determine the weight that several factors, such as the health delivery process, the patients individual characteristics, and factors related to the illness, can have in the final positive or negative treatment outcome. The subjects of this study were the patients treated in the outpatient mental health service of the Botucatu Medical School as \"New Patients\" (1st visit) during the years 1989 and 1990, coming from Botucatu and São Manoel Municipalities, and with the ICD-9 (1975) diagnosis \"neurotic disorders\", \"adjustment reactions\" and some \"V Code\" diagnosis (V.61, V.62, V.ll). The patients\' treatment data were collected from the scheduling records, medical records and home interviews applied to the patients. Among the 1155 patients that were examined as \"new patients\" 289 were included. From these, we obtained data from both, home interviews and the medical record with a final total of 211 patients. The statistical analysis can be divided into two phases: 1) when the information was obtained from the frequency distribution and correlations among variables, and 2) from multivariate analysis techniques. From all the patients, 66.5 per cent of them said to feel \"better\" after receiving treatment, a percentage quite similar to that o f the physician\'s perception of \"improvement with the treatment\" (65.7 per cent). In 70,1 per cent of the cases the patients said to be satisfied with the treatment. In our case, while people related with treatment such as the physicians and the reception employees were positively evaluated, some organizational factors related to the service were evaluated negatively. As in other studies, the overall satisfaction was highly correlated to the patients\' perception of improvement. Contrary to other studies, in this one, satisfaction was also highly correlated to the perception of improvement by the physician. Several aspects of the health delivery process related to treatment outcomes are presented and discussed. Analysing the relationship of several process variables with the outcomes, we obtained some conclusions about the service quality. These conclusions can be used to make decisions about the service organization, although these cannot be used to answer in a strict sense the question: \"what was the quality level of health care achieved?\". This is due to the lack of explicit crieteria and standards that can be used in our cultural context. The development of these explicit crieteria should be a prioritary goal of further research in the area of quality evaluation in mental health care. With regards to the \"weight that different factors can have in the treatment outcome\", while some illnesses\' characteristics had a relatively low weight in the outcome, some patients characteristics such as sex and personal income were highly weighted. These results are extensively presented, and we stress that our conclusions are valid within the context of this study. Besides these two characteristics, we also describe other variables related to the process that we found to be highly related to the outcome using multivariate analysis. The \"treatment satisfaction\" was the most significant variable related to the final outcome. From these results we concluded that the objective of verifying that some factors can interfere in the final results has been achieved. Finally, we were able to fully evaluate the patients\' satisfaction level with the treatment received. Such evaluation was quite important for our research, because the subjective point of view of the patient provided complementary information to the data obtained from medical records. If we take into account the actual state of the art of the research on quality in our country, possibly the studies based on the evaluation of patients\' satisfaction with the treatment received are the most feasible and, in terms of the results obtained, as good as other methods of mental health service quality valuation.

A finalidade da pesquisa foi produzir uma versão confiável do instrumento Quality in Psychiatric Care Outpatientes (QPC-OP) na língua portuguesa, adaptada para o contexto brasileiro, e contribuir com a política de saúde mental identificando a qualidade da assistência a partir da perspectiva de usuários de Centros de Atenção Psicossocial (CAPS) da cidade de São Paulo. O QPC-OP é um instrumento composto por oito dimensões da qualidade, desenvolvido na Suécia, que se propõe a mensurar a percepção do usuário sobre a qualidade da assistência em serviços extra-hospitalares de saúde mental. Esta investigação pressupõe que o QPC-OP é um instrumento válido para compor uma avaliação para a gestão no contexto brasileiro e que a qualidade da assistência em saúde mental percebida por usuários de CAPS da cidade de São Paulo seria boa, mas com aspectos a ser melhorados. Trata-se de um estudo metodológico de abordagem mista, desenvolvido em três etapas: a primeira foi o processo de adaptação do QPC-OP, que envolveu a tradução e retrotradução por profissionais da área independentes, a avaliação da primeira versão do QPC-OP por um comitê de sete especialistas e um pré-teste com 31 usuários de CAPS; a segunda foi a avaliação das propriedades psicométricas do QPC-OP, que testou a confiabilidade e validade do instrumento em uma amostra de 253 usuários. Para testar a confiabilidade da escala, foi avaliada a consistência interna do instrumento; para a validade, foi utilizada a Análise Fatorial Confirmatória (CFA). Já na terceira etapa, foram realizadas análises descritivas dos dados obtidos pela aplicação do QPC-OP e testes de associação dos dados produzidos pelo QPC-OP com informações sociodemográficas e de atendimento, utilizando-se os coeficientes de correlação de Pearson, de Kendall e o de Bisserial, com intervalo de confiança de 95%. As análises foram realizadas utilizando o Software R. Sobre o processo de adaptação transcultural, a equivalência conceitual do QPC-OP foi comprovada com a revisão narrativa da literatura, a avaliação do comitê de especialistas e a avaliação de usuários de CAPS. A equivalência semântica dos itens foi mantida, mas alguns sofreram modificações na versão brasileira em relação à extensão das questões e ao tempo verbal, de modo a apresentar linguagem mais coloquial. Três novos itens específicos do contexto brasileiro foram acrescidos na dimensão Direitos dos usuários, o que limitou a equivalência técnica, mas aumentou a significância prática. A CFA revelou que a versão brasileira do QPC-OP foi aceita com base nos resultados dos testes de adequação e possui estrutura de fatores correspondente à versão original, com exceção do fator alta. A consistência interna da escala completa foi avaliada como boa, porém a consistência interna de alguns fatores foi baixa, provavelmente devido ao número reduzido de itens por fator. Avançamos ao apresentar um instrumento validado, útil para monitoramento, avaliação e potencial qualificação dos CAPS na perspectiva do usuário, de atenção psicossocial, o que não existia até o momento. / The purpose of the research was to produce a reliable version of the instrument Quality in Psychiatric Care - Outpatients (QPC-OP) in the Portuguese language, adapted to the Brazilian context, and to contribute to the mental health policy by identifying the quality of care from the perspective of users of Psychosocial Care Centers (CAPS) in the city of São Paulo. The QPC-OP is an eight-dimensional quality instrument, developed in Sweden, which aims to measure the quality of care in outpatient mental health services from user\'s perspective. The assumption of the research is that the QPC-OP is a valid instrument to compose an evaluation for the management in the Brazilian context and that the quality of the mental health care perceived by users of CAPS of the city of São Paulo would be good, but with aspects that need to be improved. It is a methodological study, with mixed approach, developed in three stages: the first was the cross-cultural adaptation of the QPC-OP, which involved translation and back-translation by independent professionals, the evaluation of the first version of QPC-OP by A committee of seven experts and a pre-test with 31 CAPSs users; The second was the evaluation of the psychometric properties of QPC-OP, which tested the reliability and validity of the instrument in a sample of 253 users. To test the reliability of the scale, the internal consistency of the instrument was evaluated; For validity, the Factorial Confirmatory Analysis (CFA) was used. In the third stage, descriptive analyzes of the data obtained by the application of QPC-OP and tests of association of the data produced by QPC-OP with sociodemographic and care information were carried out, the Pearson correlation coefficients of Kendall and the Of Bisserial were used, with a 95% confidence interval. The analyzes were carried out using Software R. On the cross-cultural adaptation process, the conceptual equivalence of the QPC-OP was verified with the literature review, the evaluation of the expert committee and the evaluation of CAPSs users. The semantic equivalence of the items was maintained, but some items were modified in the Brazilian version in relation to the extension of the questions and the verbal time, in order to present more colloquial language. Three new items specific to the Brazilian context were added in the \"Users Rights\" dimension, which limited the technical equivalence, but increased the practical significance. The CFA revealed that the Brazilian version of the QPC-OP was accepted based on the results of the adequacy tests and has a factor structure corresponding to the original version, with the exception of factor Discharge. The internal consistency of the full scale was evaluated as good, but the internal consistency of some factors was low, probably due to the reduced number of items per factor. We proceeded by presenting a validated tool, useful for monitoring, evaluation and potential qualification of the CAPS from the perspective of the user, of psychosocial attention, which did not exist until the moment.

<p><p>Aim: To examine how midwives describe good and safe postpartum care of mothers with infants in neonatal care, and which prerequisites and obstacles they see to giving good and safe care while minimizing time of separation. Method: Semi structured qualitative interviews with ten midwives at two maternity wards in Uppsala. The interviews were recorded, transcribed verbatim and processed by manifest analysis. Results: Three categories were identified, <em>Good and safe care, Organization as an obstacle </em>and <em>The midwife role.</em> Good and safe postpartum care of mothers with infants in neonatal care required knowledge, appropriate equipment, good guidelines, possibility to see the mother, contact between mother and infant and good collaboration between the maternity and neonatal wards. This collaboration was insufficient. Organizational obstacles were shortage of staff, lack of guidelines and the distance between the wards. The midwives thought that integrated care of mother and child would be optimal, or at least a midwife responsible for the mother at the neonatal ward and a pediatric nurse on the maternity ward. The midwife saw herself as the woman's advocate who perceives the family as a whole. Being responsible for the mother´s care, their dilemma was how to prioritize between medical safety and encouraging her to stay with her infant. Conclusions: This is a topic that midwives are committed to. It causes frustration and feelings of insufficiency, but also of being important and capable of making a difference. Many thoughts about how the nursing care functions and should be provided were found. Many improvements are needed, organizational improvements as well as an increased collaboration between the departments are desired.<strong> </strong></p></p><p> </p>

Aim: To examine how midwives describe good and safe postpartum care of mothers with infants in neonatal care, and which prerequisites and obstacles they see to giving good and safe care while minimizing time of separation. Method: Semi structured qualitative interviews with ten midwives at two maternity wards in Uppsala. The interviews were recorded, transcribed verbatim and processed by manifest analysis. Results: Three categories were identified, Good and safe care, Organization as an obstacle and The midwife role. Good and safe postpartum care of mothers with infants in neonatal care required knowledge, appropriate equipment, good guidelines, possibility to see the mother, contact between mother and infant and good collaboration between the maternity and neonatal wards. This collaboration was insufficient. Organizational obstacles were shortage of staff, lack of guidelines and the distance between the wards. The midwives thought that integrated care of mother and child would be optimal, or at least a midwife responsible for the mother at the neonatal ward and a pediatric nurse on the maternity ward. The midwife saw herself as the woman's advocate who perceives the family as a whole. Being responsible for the mother´s care, their dilemma was how to prioritize between medical safety and encouraging her to stay with her infant. Conclusions: This is a topic that midwives are committed to. It causes frustration and feelings of insufficiency, but also of being important and capable of making a difference. Many thoughts about how the nursing care functions and should be provided were found. Many improvements are needed, organizational improvements as well as an increased collaboration between the departments are desired.

Aim of the study. To assess quality of ambulatory health care services in terms of the patient in accordance with patients’ attitude in the aspects of accessibility, information supply and satisfaction in services. Methods. Object of the research – Parents of the patients and their juridical representatives of the ambulatory consultative department of the public institution Children hospital of Klaipeda city. Research method – anonymous questionnaire inquiry. 502 respondents were questioned. Methods of the statistical analysis – statistical significance of data was measured by the criteria c2, number of the freedom degree (df) and the statistical significance. When the features were analyzed referring to other indexes, differences were found as statistically significant because the significance level p<0,05. Results. The best part of respondents comes to the specialist according to the time indicated in the coupon. Most of respondents, came without the coupon from district or other town, get to the specialist for the consultation at the same day. Most of respondents take up to 5 minutes at the registrar and up to 15 minutes by the doctor’s surgery. The best part of respondents was looking forward the consultation of the specialist for more than 2 weeks; the longest rows are at ophthalmologist, cardioreumatologist and orthopedist-traumatologist. It is estimated that as the acceptance to the specialist lasts longer and longer, more and more respondents say that the doctor... [to full text]

The aim of the study: To evaluate accessibility and quality of health care services in urban and countryside areas. Objectives of the study: · Review of juridical acts that determine services of primary health care and their quality; · Analysis of health care sector of Marijampolė Municipality; · Comparison of accessibility and quality of health care services provided by health care institutions in urban and countryside areas from patients point of view. Investigation methods: Systemic analysis of scientific literature and periodical editions; review of juridical acts and juridical documents; analysis of a sociological survey – anonymous inquiry by a questionnaire. The patients were questionared by Marijampolė Municipality PHC institutions in urban and countryside areas. 300 questionnaires were delivered, 300 respondents answered the questions (response rate 100%). Statistical data analysis was carried out on the basis of program package SPSS 10. Correlation between peculiarities was estimated according to the Chi square criterion test (χ2). As the basis for hypotheses checking was chosen significance level equal to 0,05 or less. Results. The majority of respondents evaluated primary health care from the communication point of view and organization as satisfactory. The bigger part of respondents did not face any problems in: arrival to PHC institution (76,9%), 74,4% of the respondents had to spend not long at the receptionists, spent less time in the waiting hall (57,9%). 8... [to full text]

Darbo tikslas: Įvertinti Lietuvos regioninių stacionarinių asmens sveikatos priežiūros įstaigų teikiamų paslaugų kokybę ir jos netolygumus, remiantis statistiniais kokybės rodikliais. Darbo uždaviniai: 1. Įvertinti Lietuvos regioninių stacionarinių asmens sveikatos priežiūros įstaigų paslaugų kokybę remiantis statistiniais paslaugų kokybės vertinimo rodikliais. 2. Išanalizuoti Lietuvos regioninių stacionarinių asmens sveikatos priežiūros įstaigų paslaugų kokybės rodiklių svyravimus priklausomai nuo amžiaus, lyties, dienos pobūdžio, paslaugos rūšies. 3. Įvertinti atvejų skaičiaus įtaką stacionarinių asmens sveikatos priežiūros įstaigų paslaugų kokybei Tyrimo metodika: Tyrime vertintos 6 regioninės ligoninės. Kokybės rodikliai: Cezario pjūvio (CPO) operacijų dažnis, hospitalinis mirštamumas dėl ūmaus miokardo infarkto per 30 ir per 2 d. (ŪMI 30d. ir 2d.) ir dėl galvos smegenų insulto (GSI 30d. ir ŪMI 2d.). Papildomi rodikliai: vidutinės gulėjimo trukmės (VGT) analizė pagal gimdymo būdą ir tarp ligoninių, vertinta atvejų skaičiaus koreliacija su pasirinktų rodiklių rezultatais ir analizuotas perkeltų į kitą ligoninę tolimesniam gydymui pacientų srautai. Statistinė duomenų analizė atlikta SAS programa. Rezultatai: Bendras CPO dažnis regioninėse ligoninėse buvo 18,45 proc. Amžiaus grupėse svyravo: <25 m. 15,38 proc., 25–35 m. 20,06 proc., >35 m. 20,55 proc. (p<0,05). CPO dažnis darbo dienomis buvo 19,82 proc., laisvadieniais 13,82 proc. (p<0,05). Lyginant tarp ligoninių:... [toliau žr. visą tekstą] / Aim of the study. To measure the quality of care in Lithuanian regional hospitals and its variations with statistical quality indicators. Objectives. 1. to assess the quality of care in Lithuanian regional hospitals with statistical quality indicators. 2. To analyse the variations of quality indicators of Lithuanian regional hospitals depending on age, sex, nature of day, and type of delivery. 3. To assess the influence of case volume on service quality of hospitals. Methods. 6 regional hospitals were assessed during the research period from 2010 to 2012. Quality indicators: Caesarean section (CS) rate, in-hospital 30-day and 2-day mortality rates due to Acute Myocardial Infarction (AMI) and in-hospital 30-day and 2-day mortality rates following stroke. Additional indicators: analysis of average length of stay (ALS) according to the mode of childbearing and among hospitals; assessment of correlation of the results between selected indicators and patient case volume; and the analysis of patient flows transferred to another hospital for further treatment. Statistical analysis was performed by means of SAS program. Results. The overall rate of CS in regional hospitals was 18.45 %. Ages in the groups ranged as follows: <25 y.o. - 15.38 %; 25-35 y.o. - 20.06 %; > 35 y.o. - 20.55 % (p <0.05). CS rate on weekdays was 19.82 %, at weekends - 13.82 % (p <0.05). Comparing among hospitals: the rate of CS in hospital performing least CS was 13.19 %; the highest indicator value was 28.9 %... [to full text]

BACKGROUND Quality improvement literature usually conceptualises two principal dimensions of quality, technical and service. Technical quality is what the customers receive relative to what is known to be effective and largely reflects issues related to the health care providers. Service quality is how the customers receive the services and reflects the way and the environment in which health services are provided. This thesis proposes and tests a third principal dimension, Customer Quality, which is the characteristics that customers need for effective involvement in health care processes, decision making and action to improve the quality of care delivered and received. This model is applied in the context of care for people with Type 2 diabetes as an example of the high priority common chronic diseases and one of the most important public health problems in Australia and worldwide. The study also examines the feasibility of using patient reports of received care as a way of measuring service and technical quality on a population basis. OBJECTIVE The present study aims to assess the quality of delivered care as perceived by people with Type 2 diabetes. Specifically it aims to measure service quality, technical quality, customer quality; and finally an overall quality index by combining all three dimensions. METHODS A community based cross-sectional survey of 603 people with Type 2 diabetes was carried out in Queensland, Australia in 2005/06 using a self-administered questionnaire. The eligible participants were Diabetes Australia-Queensland members over 25 years old with diagnosed Type 2 diabetes at least one year prior to the study. Adherence to the eleven clinical, lifestyle and management indicators, derived from standard Diabetes Australia Guidelines, were measured from the patients’ reports as a representative of technical quality to explore the likely gap between received services and what should have been received in the 12-month period. Focus Group Discussions were used to determine the elements of service quality that were important from the patients’ perspective. Twelve service quality indicators, derived from the review of the literature and the focus groups, were assessed to calculate service quality as perceived by people with Type 2 diabetes. The validated, reliable and practical 13- item Patient Activation Measure was used to evaluate customer quality in terms of customers’ knowledge, skills and confidence. Demographic and disease related information was obtained using a self-reported questionnaire. Two types of outcome variables were used in this study: participantreported binary variables (having complications, continuity of care and diabetes control status) and calculated continuous variables (technical quality rating, service quality and customer quality scores and, finally, the overall quality index). RESULTS The response rate from the 1500 mailed out questionnaires was 40%. Nonrespondents were a little younger (P<0.001) than study participants and matched on gender (P> 0.05). Participants were mostly over 65 years old, over 50% were male, almost half of them were obese and a quarter were studying or had completed tertiary level of education. Almost two-thirds reported well controlled diabetes and 60% had diabetes for more than five years. Most of them were not treated by specialists and maintained continuity of care for their diabetes management. The majority of participants were treated with insulin or oral agents (72%) and 37% reported diabetes complications. Overall adherence rate for top 5 clinical and top 3 management and lifestyle indicators were 49.7% and 18.8% respectively. Over 90% of participants reported an appropriate level of checks of HbA1c, blood pressure and serum cholesterol. For lifestyle and management indicators, reported adherence rates to guidelines were lower than for clinical indicators. Participants who reported care as recommended for blood pressure measurements; feet examinations; self-management, diabetes knowledge and nutritional consultation reviews were more likely to report their diabetes as being well controlled. Participants maintaining continuity of care also reported fewer complications and well controlled diabetes. Of the twelve service quality indicators, the highest service quality score were for support group, basic amenities, dignity and confidentiality. Inadequate quality was identified for overall service quality (86.2), choice of care provider, continuity, timeliness, safety, prevention and accessibility. Younger participants reported lower service quality scores (P=0.001) and participants with good control of their diabetes had higher scores (P<0.001). Overall reported Customer Quality score was 64.5. Ten percent of participants did not achieve the Customer Quality score for the confidence stage and 26% did not reach the actual action stage. Nearly three quarters of respondent reported the capacity to take action for self-management but only 38% reported the highest Customer Quality score equating to perceived ability to change the action by changing health and environment. Participants with a higher level of education and those who maintain continuity of care reported a higher Customer Quality score. Participants with a higher Customer Quality score were also more likely to report well controlled diabetes status. An overall imperfect Quality Index score (70) reflects significant room for overall quality improvement of diabetes care services. The younger participants reported lower Quality Index scores than older ones. Higher Quality Index scores were highly significantly associated with reporting better diabetes control status and continuity of care. There were no significant differences in the Quality Index scores in terms of gender, participants’ education level and diabetes complications. CONCLUSION Customer quality appears to be a useful third dimension in conceptualising quality in health care, particularly in the context of chronic disease where good selfmanagement can improve the outcomes of care. A substantial proportion of Queensland adults with Type 2 diabetes reported receiving suboptimal care. From the perspective of people with Type 2 diabetes there is a notable gap between their expectations and what they have actually received in most aspects of provided care. The overall service quality and choice of care provider, accessibility, prevention, continuity, timeliness and safety were identified to be of inadequate quality. Participants also reported relatively low customer quality scores based on the personal knowledge, skills and confidence as well as low overall quality score for delivered diabetes care. Thus, there was a significant opportunity to improve the quality of diabetes care on all three dimensions. The study demonstrated that a patient selfadministered survey is a potentially useful way of measuring all three dimensions of quality of care for diabetes.

Diss. (sammanfattning) Uppsala : Univ., 2004. / Härtill 4 uppsatser.

Licentiatvhandling (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 2 uppsatser.