Dans la plupart des pays africains, l'accès aux systèmes d'assurance maladie est réservé aux travailleurs du secteur formel. Les travailleurs du secteur informel qui constituent plus de 80 % de la population active du continent se trouvent de ce fait dans une situation de vulnérabilité. Pour faire face aux barrières financières à l'accès aux soins de santé, de nombreux groupes de population africaine ont décidé de développer des formes d'assurances-maladie, telles que les mutuelles de santé. Au Rwanda, pays qui nous intéresse dans le cadre de cette étude, l'idée des mutuelles de santé date des années 1960. Cependant, ce n'est qu'en 1996 qu'elles ont réellement commencé à se développer et actuellement, elles sont implantées dans toutes les provinces du pays. Notre démarche consistait à évaluer le degré de satisfaction des bénéficiaires des mutuelles de santé dans la Mairie de la ville de Kigali au Rwanda et visait à: 1) déterminer les attentes des bénéficiaires des mutuelles de santé en matière de services; 2) déterminer les facteurs qui contribuent à la satisfaction et à l'insatisfaction des bénéficiaires à l'égard des services des mutuelles de santé et 3) proposer des pistes d'actions stratégiques visant l'amélioration des points faibles et le renforcement des points forts des mutuelles de santé. Un devis transversal et observationnel a été retenu étant donné les objectifs visés par l'évaluation et les ressources en présence (temporelles, matérielles, humaines et financières). Une méthodologie qualitative a été privilégiée. Nous nous sommes référés au modèle d'Erin Research Inc. (1988) pour l'évaluation de la satisfaction. Il s'agit d'un modèle multi-attributs comprenant cinq dimensions, à savoir : la rapidité, la courtoisie ou confort, les compétences ou connaissances, l'équité du traitement et les résultats des services reçus. Nous avons mené 48 entrevues semi-dirigées auprès de 36 bénéficiaires des mutuelles de santé, six prestataires de soins et six responsables des centres de santé (CS) choisis aléatoirement dans trois districts de la Mairie de la ville de Kigali (Gasabo, Kicukiro et Nyarugenge). L'analyse des données a été réalisée à l'aide du logiciel N Vivo. Les résultats de notre étude ont révélé que la majorité des bénéficiaires des mutuelles de santé de la Mairie de la ville de Kigali sont satisfaits des services reçus et s'accordent pour affirmer que les mutuelles de santé ont résolu le problème d'accès aux soins de santé. Par ailleurs, les résultats ont révélé qu'en plus des cinq dimensions du modèle d'Erin Research Inc. (1988), l'accessibilité des services, tant financière que géographique représente un élément additionnel qu'il importe de prendre en considération dans la détermination du niveau de satisfaction des bénéficiaires des mutuelles de santé de la Mairie de la ville de Kigali. Pour tous les CS visités, parmi les éléments les plus satisfaisants des services offerts par les mutuelles de santé figurent l'accessibilité financière aux soins de santé et l'équité du traitement. Les éléments les plus contraignants sont: 1) le délai d'attente entre la date d'adhésion et le début d'utilisation des services de santé; 2) l'impossibilité de se faire soigner dans un centre de santé de son choix et 3) les files d'attente dans les centres de santé

Neste estudo foi avaliada a satisfação dos pacientes atendidos na Clínica Integrada do Curso de Odontologia da Universidade Federal do Pará (CICOUFPA), através de uma amostra aleatória simples de 200 usuários dos 600 inscritos, atendidos nos meses de Maio e Junho de 2002. Para esta pesquisa foi aplicado um questionário com 19 questões fechadas e 01 aberta, e os dados coletados foram submetidos a análise estatística utilizando-se o software Epi. Info. 604.d. com um nível de significância de 5% (P<0,05). Os resultados indicaram que 66% dos pacientes da CICOUFPA não sentiram dor e 46% não tiveram medo, 87% procuraram para tratamento especializado, 83% receberam informações sobre tratamentos curativos e 68% sobre procedimentos preventivos, a avaliação do atendimento pelo aluno e professor, mereceu uma aprovação de 98%, sendo que 97.5% dos alunos e 62.5% dos professores estavam vestidos adequadamente, as recomendações sobre as melhorias foram relacionadas com a infra-estrutura e o serviço de triagem, 98% dos pacientes recomendariam o serviço, a nota média foi de 8.33, e a avaliação do ambiente de trabalho obteve uma aprovação de 95% dos pacientes. Portanto os pacientes estão satisfeitos com o ambiente físico da CICOUFPA, acreditam na competência dos alunos e professores e indicariam o serviço para outras pessoas. / This study assessed the patient satisfaction in Comprehensive Dental Clinic at Pará Federal University, school of Dentistry, through two hundreds (200) patients amount, into a group of six hundreds (600) patients registrations, that were seen between May and June, 2002. A questionary was used with nineteen (19) closed questions and one open question. The values were found by statistical analyses using the software Epi Info 604.d at 5% of significance (p< 0,05). The results showed that 98% of the patients seen in this work were satisfied with the methods used in the clinic of the school; the medium grade was 8,33; the work environment had an approvable of 95%,but 87% of all the patients had gone to the dental clinic just for an specialized treatment, not for an comprehensive one. 94% of the students and teachers approved the treatment too, and the recomendations for a better work were about the clinic structure and triage service in the School of Dentistry of Pará Federal University.

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]

SUMMARY Management of Public Health PATIENTS‘ SATISFACTION WITH IN-PATIENT HEALTH CARE SERVICES IN TAURAGĖ COUNTY HOSPITAL Saulius Jančys Supervisor Jurgita Vladičkienė, Department of Social Medicine. Faculty of Public Health, Kaunas University of Medicine. - Kaunas, 2005.- P.53 Aim of the study. To evaluate patients’ satisfaction with in-patient health care services. Methods. 20 questions anonymous questionnaire have been used in the study. 179 patients aged 18 and older have been surveyed. Statistic data analysis has been made, using SPSS 10.0 version. Results. Response rate of the surveyed patients was 85%. 70.4% of the participants were woman aged 18 and older. Most of the respondents had basic (40.8%) and secondary (29.6%) education. 82% of the patients were informed about their treatment, results of investigations and diagnose by medical personnel and 93.3% were interested in such information. More than one third of the patients (35.6%) assumed that responsibility for the treatment lies on doctor, and 5.6% maintained that patient is responsible for the treatment. 83.8% of the respondents trust in their doctors’ completely. 68% of the patients suggests that only doctor make decision on his treatment. Communication of staff members was acceptable for 97.2% of the patients. 88.3% of the patients were satisfied with in-patient health care services. 33.5% of the respondents evaluated health care services as very good, 59.2% - as good. 90.5% of the respondents would... [to full text]

Darbo tikslas. Įvertinti VšĮ Alytaus poliklinikos psichikos sveikatos centro pacientų lūkesčius dėl teikiamų paslaugų, informuotumą bei pasitenkinimą paslaugomis. Darbo uždaviniai: Išsiaiškinti VšĮ Alytaus poliklinikos psichikos sveikatos centro pacientų lūkesčius dėl teikiamų paslaugų; įvertinti pacientų informuotumą apie psichikos sveikatos centre teikiamas paslaugas; nustatyti pacientų požiūrį į teikiamas paslaugas ir jas teikiančius specialistus. Tyrimo metodika. Anoniminė anketinė psichikos sveikatos centro pacientų apklausa atlikta 2012 m. Išdalintos 410 anketų, visos jos grąžintos užpildytos. Duomenų statistinė analizė atlikta SPSS 20 programa. Kokybinių požymių palyginimui ir ryšių vertinimui taikytas χ2 arba Fišerio tikslusis kriterijus. Kokybinių požymių poriniams palyginimams taikytas z kriterijus. Statistinės hipotezės tikrintos, esant reikšmingumo lygmeniui α=0,05. Skirtumai ar ryšiai vertinti kaip statistiškai reikšmingi, kai p<0,05. Rezultatai. Daugumai pacientų, besilankančių psichikos sveikatos centre labai svarbus teigiamas personalo požiūris, bendradarbiavimas su gydytoju norint gauti informaciją apie savo sveikatos būklę bei teikiamą gydymą, galimybė gauti papildomas paslaugas, reikalingas paslaugas gauti laiku, taip pat pacientai tikėjosi, kad psichikos sveikatos centro aplinka bus maloni bei švari. Medikų pagarba svarbesnė pasirodė moterims negu vyrams. Vyresniems pacientams buvo svarbiau gauti numatytas paslaugas laiku bei tikėtis gauti... [toliau žr. visą tekstą] / Aim of the study: evaluate patients wishes, information and satisfaction for received services in Alytus policlinic mental health centrum. Objectives of the study: clarify patients wishes for services provided in Alytus policlinic mental health centrum; evaluate patients informatikon for these services; set patients attitude to provided services and medical staff. Material and methods: A survey of patients using an anonymous questionnaire was conducted in 2012. 410 questionnaires were distributed and all returned back. Statistical data analysis was performed using “SPSS 20 for Windows” statistical software. Associations were tested using chi-square and z-test. Statistical significance level was set at p<0.05. Results. Most of the patients want possitive staff attitude to themselves, cooperation with doctor to achieve information about their health status and treatment, also a possibility to get extra services, get services on time. They also suspected that environment in mental health center will be nice and cousy. Respect of medical staff was more important for women than for men. For older patients was more important to get services on time more than to get information about their health status. The request to get extra services emphasized more pensioners and people with higher education. Most of respondents specify a request of quiet, relaxing environment in cabinets and simply registration proccess. The biggest part of respondents received information was clear and... [to full text]

Patient satisfaction with the services provided is extensive and actual topic. The goal of this thesis is to find out patient satisfaction with the services of general practitioners for adults in České Budějovice, Trhové Sviny a Borovany. The patient satisfaction is evaluated primarily in connection with the satisfaction of their needs during illness. The thesis is divided into theoretical and practical parts. The theoretical part consists of seven chapters. The first chapter is an introduction to the medical practice and deals with the concept of quality of health care. The sixth chapter examines satisfaction and its impact on the assessment of the quality of services by patients. The last, seventh chapter focous on the relationship of health workers and patients. The practical part deals with the research, which was conducted using quantitative research strategies, methods and questioning survey techniques. Questionnaire that we created for assessing patient satisfaction includes fourteen questions. This part sets out the objective, hypotheses, methodology, results of research, discussion and conclusion. This thesis has two hypotheses. H1: Doctors who have office hours in the afternoon are better at assessment than those who have office hours only in the morning. H2: Patients from smaller towns will be satisfied with the services of general practitioners more than patients from large cities. The research sample consisted of 453 respondents. The data were processed using Microsoft Office Excel 2010 and then were processed into graphs or tables. Hypotheses were tested using the homogeneity test, the Pivot Table. The results of this thesis can serve as an extension of the information for general practitioners for adults on the current topic.

Neste estudo foi avaliada a satisfação dos pacientes atendidos na Clínica Integrada do Curso de Odontologia da Universidade Federal do Pará (CICOUFPA), através de uma amostra aleatória simples de 200 usuários dos 600 inscritos, atendidos nos meses de Maio e Junho de 2002. Para esta pesquisa foi aplicado um questionário com 19 questões fechadas e 01 aberta, e os dados coletados foram submetidos a análise estatística utilizando-se o software Epi. Info. 604.d. com um nível de significância de 5% (P<0,05). Os resultados indicaram que 66% dos pacientes da CICOUFPA não sentiram dor e 46% não tiveram medo, 87% procuraram para tratamento especializado, 83% receberam informações sobre tratamentos curativos e 68% sobre procedimentos preventivos, a avaliação do atendimento pelo aluno e professor, mereceu uma aprovação de 98%, sendo que 97.5% dos alunos e 62.5% dos professores estavam vestidos adequadamente, as recomendações sobre as melhorias foram relacionadas com a infra-estrutura e o serviço de triagem, 98% dos pacientes recomendariam o serviço, a nota média foi de 8.33, e a avaliação do ambiente de trabalho obteve uma aprovação de 95% dos pacientes. Portanto os pacientes estão satisfeitos com o ambiente físico da CICOUFPA, acreditam na competência dos alunos e professores e indicariam o serviço para outras pessoas. / This study assessed the patient satisfaction in Comprehensive Dental Clinic at Pará Federal University, school of Dentistry, through two hundreds (200) patients amount, into a group of six hundreds (600) patients registrations, that were seen between May and June, 2002. A questionary was used with nineteen (19) closed questions and one open question. The values were found by statistical analyses using the software Epi Info 604.d at 5% of significance (p< 0,05). The results showed that 98% of the patients seen in this work were satisfied with the methods used in the clinic of the school; the medium grade was 8,33; the work environment had an approvable of 95%,but 87% of all the patients had gone to the dental clinic just for an specialized treatment, not for an comprehensive one. 94% of the students and teachers approved the treatment too, and the recomendations for a better work were about the clinic structure and triage service in the School of Dentistry of Pará Federal University.

This research investigates and develops a new approach to the management of service quality with the emphasis on patient and staff satisfaction in the healthcare sector. The challenge of measuring the quality of service in healthcare requires us to view the problem from multiple perspectives. At the philosophical level, the true nature of quality is still debated; at the psychological level, an accurate conceptual representation is problematic; whilst at the physical level, an accurate measurement of the concept still remains elusive to practitioners and academics. This research focuses on the problem of quality measurement in the healthcare sector. The contributions of this research are fourfold: Firstly, it argues that from the technological point of view the research to date into quality of service in healthcare has not considered methods of real-time measurement and monitoring. This research identifies the key elements that are necessary for developing a real-time quality monitoring system for the healthcare environment.Secondly, a unique index is proposed for the monitoring and improvement of healthcare performance using information-theoretic entropy formalism. The index is formulated based on five key performance indicators and was tested as a Healthcare Quality Index (HQI) based on three key quality indicators of dignity, confidence and communication in an Accident and Emergency department. Thirdly, using an M/G/1 queuing model and its underlying Little’s Law, the concept of Effective Satisfaction in healthcare has been proposed. The concept is based on a Staff-Patient Satisfaction Relation Model (S-PSRM) developed using a patient satisfaction model and an empirically tested model developed for measuring staff satisfaction with workload (service time). The argument is presented that a synergy between patient satisfaction and staff satisfaction is the key to sustainable improvement in healthcare quality. The final contribution is the proposal of a Discrete Event Simulation (DES) modelling platform as a descriptive model that captures the random and stochastic nature of healthcare service provision process to prove the applicability of the proposed quality measurement models.

Darbo tikslas. Įvertinti pacientų pasitenkinimą terapinio profilio (neurologo, kardiologo, endokrinologo) ambulatoriškai teikiamomis paslaugomis apskrities ligoninės Konsultacinėje poliklinikoje. Tyrimo metodai. 2008-01-21 – 01-31 apskrities ligoninės Konsultacinėje poliklinikoje atlikta pacientų besikreipiančių neurologo, kardiologo ir endokrinologo konsultacijai anoniminė anketinė apklausa. Išdalinta 400 anketų. Užpildytos 387 anketos (atsako dažnis 96,75%). Statistinė duomenų analizė buvo atlikta personaliniu kompiuteriu, naudojant statistinės analizės SPSS 10.03 programinį paketą. Įvairūs pasitenkinimo aspektai įvertinti pagal Licherto skalę 5 balų sistemoje. Rezultatai. 89,2% respondentų buvo patenkinti arba labai patenkinti paslaugos kokybe. Labiausiai respondentus tenkino neurologo konsultacijos kokybė ir jų pasitenkinimas, išreikštas balų vidurkiu buvo 4,44 iš 5 galimų. 93,7% apklaustųjų buvo patenkinti gydytojų bendravimu. Gydytojų bendravimas labiausiai tenkino neurologo pacientus ir išreikštas balų vidurkiu buvo 4,52. 40,9% respondentų pateko pas gydytojus konsultacijai tą pačią ar kitą dieną, 20,7% - per 3-10 dienų nuo registravimosi. 10,6% respondentų laukė 11-14 dienų, 23,3% pateko po 2-4 savaičių, 4,5% laukė ilgiau nei mėnesį. Laukimo laikas tenkino 65,2% respondentų. Aukštesnio išsilavinimo ar jaunesnio amžiaus respondentai buvo mažiau patenkinti laukimu. Pasitenkinimas kardiologo konsultacijos laukimu buvo didžiausias (4,21 balo). 89,4%... [toliau žr. visą tekstą] / Aim of the study: to evaluate the patients satisfaction with out-patient care services in therapeutic care (neurology, cardiology, and endocrinology) at consultation clinics of county hospital. Material and methods. The anonymous survey was conducted in January 2008 at consultation clinics of county hospital. The sample comprised of patients seeking consultation of neurology, cardiology or endocrinology specialists. Altogether, 400 questionnaires were distributed, out of which 387 counted as properly fulfilled (response rate 96.75%). Statistical data analysis was performed using statistical package „SPSS for Windows 10.03“. The satisfaction items were evaluated using Likert scale (scoring 1 to 5). Results. Altogether, 89.2% of responders were satisfied with the quality of care. Mostly, they were satisfied with neurology consultations (average Likert score 4.44). The communication with physician was also evaluated highly – 93.7% of responders were satisfied with it. Again, this was mostly expressed in neurology (average Likert score 4.52). Access to consultation was different: 40.9% of patients got consultation the same or following day after registration, 20.7% following 3–10 days, 10.6% following 11–14 days, 23.3% following 2–4 weeks, and 4.5% waited for longer than one month. The duration of waiting time was evaluated as satisfactory by 65.2% of responders, with the highest scores in cardiology (average Likert score 4.21). Higher education and younger age was related with... [to full text]

El dolor es un síntoma muy común y la práctica asistencial diaria nos muestra que, a pesar de todas las herramientas que tenemos para combatirlo, aún somos incapaces de controlarlo adecuadamente en muchos pacientes. La evaluación del dolor es de vital importancia para el diagnóstico y el tratamiento de las enfermedades que cursan con éste síntoma y, aún más, cuando el síntoma se convierte en la enfermedad. En el presente trabajo se describen varios estudios en los cuales se valoraron la prevalencia y características del dolor, y en el que se ha desarrollado un instrumento para la valoración del dolor hospitalario y la satisfacción de los pacientes. Posteriormente lo hemos utilizado para evaluar si el dolor en los pacientes hospitalarios está bien controlado y, de no ser así, intentar establecer las razones por las cuales no lo está. Los objetivos del presente trabajo fueron la construcción de un instrumento para evaluar la satisfacción de los pacientes con el tratamiento analgésico. Posteriormente se determinó la prevalencia y las características del dolor en una muestra de pacientes hospitalizados, así como los métodos de valoración del mismo. Inicialmente se realizó una prueba piloto con el nuevo instrumento en 255 pacientes, la cual mostró que las puntuaciones de dolor en los pacientes hospitalizados eran elevadas. Además, la intensidad del dolor era incongruente con la satisfacción de los pacientes con el tratamiento recibido, ya que ésta estaba más relacionada con el trato recibido por los profesionales sanitarios que con el alivio del dolor. Posteriormente se utilizó el mismo instrumento en 1675 pacientes de 15 hospitales catalanes, para confirmar y ampliar los resultados de la primera investigación. Al principio se confirmó que la prevalencia del dolor era elevada y que inclusive era mayor durante el ingreso y al alta que a la llegada al hospital. Para analizar las causas de este hallazgo se valoró la utilización de analgésicos en los hospitales. El estudio demostró que, a pesar del alto número de prescripciones analgésicas, de que el tipo de analgésico era el adecuado y de x que las dosis utilizadas eran las correctas, la mayoría de los pacientes presentaba valoraciones de intensidad de dolor más altas de lo deseable ya que solamente el 1% de los pacientes tenían prescritas dosis de rescate analgésicas y que las pautas analgésicas no se cumplían rigurosamente. Posteriormente se valoró el registro de la intensidad del dolor, y se observó que más de la mitad de los pacientes carecían de un registro de la intensidad del dolor y que esta práctica, valorada como indicador de calidad asistencial, no se cumplía de manera rutinaria. En conclusión, hemos observado que los pacientes hospitalizados presentan unas puntuaciones de dolor elevadas, que las recomendaciones para el tratamiento analgésico hospitalario no se cumplen rigurosamente y que no se registra la intensidad del dolor en las historias clínicas de forma sistemática. Sorprendentemente, a pesar de esos hallazgos, los pacientes refieren estar satisfechos con el alivio del dolor. Por esta razón continuamos con la investigación con el propósito de estimar si es la valoración del dolor, la falta de rigor en el seguimiento de las pautas analgésicas hospitalarias o bien las creencias y experiencias previas de los pacientes las que nos llevan a tener esta alta prevalencia de dolor en los pacientes hospitalizados. / Pain is a common symptom and many evidences show us that, in spite of all the tools we have to manage it, we are unable to do so. Pain evaluation is of great importance for the diagnosis and treatment of patients, and even more when the pain symptom becomes the disease. Within the present work, several studies have been conducted in order to evaluate the prevalence and characteristics of pain in the hospital setting. We also have developed a tool for the evaluation of pain and patient satisfaction. Subsequently we have used this tool to appraise if pain is adequately handled and if otherwise, try to establish the main reasons for this finding. The main objective of this work was the construction of an instrument to evaluate patients’ satisfaction with the management of pain, and to assess the prevalence and characteristics of pain in a sample of patients in a hospital setting, as well as the methodology used to assess them. Initially a pilot test of the tool was performed in 255 patients, which showed that the pain scores in inpatients were too high. Moreover, pain intensity was incongruent with patients’ satisfaction with pain relief. Yet, it had a higher correlation with satisfaction with health workers than with satisfaction with the received treatment. Next, the same tool was used with three additional questionnaires in 1675 admitted patients into 15 hospitals in Catalonia, in order to look deeper into the results of the first study. For starters, it was confirmed that pain prevalence was too high and higher during hospitalization and at discharge than before admittance. To analyze the cause of these findings the analgesic use in the hospital was examined. The results showed that, in spite of the high number of analgesic prescriptions and the use of the correct type of analgesic, most of the patients had high pain intensity scores; only 1% of the patients had rescue analgesia prescribed and the analgesic regimes were not properly administered. Subsequently, pain intensity registration in the medical record was xii evaluated, showing that that more than half of patients did not have their pain intensity registered on the medical chart. This practice is valued as an indicator of medical assistance quality, and even though it was not followed as a routine in the hospitals. In conclusion, we have observed that hospital inpatients show high pain intensity scores, the recommendations for analgesic use in a hospital setting are not rigorously followed, and pain intensity scores are not systematically registered in the medical charts. Surprisingly, in spite of theses findings, patients seem to be satisfied with the analgesic treatment. In consequence, we are continuing with the research with the aim of figuring out if the high prevalence of pain in Catalonian hospitals is due to pain evaluation, the absence of rigor in following the analgesic prescriptions or maybe the patients’ previous experiences and beliefs.