D. Delnoij

Determinants of patient choice of healthcare providers: a scoping review

BackgroundIn several northwest European countries, a demand-driven healthcare system has been implemented that stresses the importance of patient healthcare provider choice. In this study, we are conducting a scoping review aiming to map out what is known about the determinants of patient choice of a wide range of healthcare providers. As far as we know, not many studies are currently available that attempt to draw a general picture of how patients choose a healthcare provider and of the status of research on this subject. This study is therefore a valuable contribution to the growing amount of literature about patient choice.MethodsWe carried out a specific type of literature review known as a scoping review. Scoping reviews try to examine the breadth of knowledge that is available about a particular topic and therefore do not make selections or apply quality constraints. Firstly, we defined our research questions and searched the literature in Embase, Medline and PubMed. Secondly, we selected the literature, and finally we analysed and summarized the information.ResultsOur review shows that patients’ choices are determined by a complex interplay between patient and provider characteristics. A variety of patient characteristics determines whether patients make choices, are willing and able to choose, and how they choose. Patients take account of a variety of structural, process and outcome characteristics of providers, differing in the relative importance they attach to these characteristics.ConclusionsThere is no such thing as the typical patient: different patients make different choices in different situations. Comparative information seems to have a relatively limited influence on the choices made by many patients and patients base their decisions on a variety of provider characteristics instead of solely on outcome characteristics. The assumptions made in health policy about patient choice may therefore be an oversimplification of reality. Several knowledge gaps were identified that need follow-up research.

How nurses and their work environment affect patient experiences of the quality of care: a qualitative study

BackgroundHealthcare organisations monitor patient experiences in order to evaluate and improve the quality of care. Because nurses spend a lot of time with patients, they have a major impact on patient experiences. To improve patient experiences of the quality of care, nurses need to know what factors within the nursing work environment are of influence. The main focus of this research was to comprehend the views of Dutch nurses on how their work and their work environment contribute to positive patient experiences.MethodsA descriptive qualitative research design was used to collect data. Four focus groups were conducted, one each with 6 or 7 registered nurses in mental health care, hospital care, home care and nursing home care. A total of 26 nurses were recruited through purposeful sampling. The interviews were audiotaped, transcribed and subjected to thematic analysis.ResultsThe nurses mentioned essential elements that they believe would improve patient experiences of the quality of nursing care: clinically competent nurses, collaborative working relationships, autonomous nursing practice, adequate staffing, control over nursing practice, managerial support and patient-centred culture. They also mentioned several inhibiting factors, such as cost-effectiveness policy and transparency goals for external accountability. Nurses feel pressured to increase productivity and report a high administrative workload. They stated that these factors will not improve patient experiences of the quality of nursing care.ConclusionsAccording to participants, a diverse range of elements affect patient experiences of the quality of nursing care. They believe that incorporating these elements into daily nursing practice would result in more positive patient experiences. However, nurses work in a healthcare context in which they have to reconcile cost-efficiency and accountability with their desire to provide nursing care that is based on patient needs and preferences, and they experience a conflict between these two approaches. Nurses must gain autonomy over their own practice in order to improve patient experiences.

Self-referral in a gatekeeping system: patients’ reasons for skipping the general-practitioner

In the Netherlands general practitioners act as the gatekeepers at the primary level to the more specialized and more expensive secondary health-care. As a rule, patients are required to have a referral from their general practitioners to be able to utilize these services. Not all private insurance companies, however, require a referral letter from their customers before reimbursing them for their costs or do not always exert a control whether such referral indeed had taken place. A mail-questionnaire was targeted to a specific group of 2000 privately insured patients to find out the reasons of self-referral. The findings suggest that patients self-refer to a specialist for medical complaints for which they expect to end up at the specialist anyway as they consider these problems as specific for the specialist. Complaints of patients who first visit their general practitioners, however, might be considered as less typical to the specialist. Patients who are living in relatively highly urbanized areas, who are better educated, and who expect to achieve a better quality of communication at the consultation with the specialist, more commonly skip their GPs before visiting a specialist.

The importance of patient-centered care for various patient groups.

OBJECTIVES To assess differences in the importance ascribed to patient-centered care between various patient groups and demographic groups. METHODS Survey data collected using questionnaires were analyzed for patients that underwent hip or knee surgery (n=214), patients suffering from rheumatoid arthritis (n=343), spinal disk herniation (n=145), breast abnormalities (n=596) or congestive heart failure (n=118). A composite for patient-centered care priorities was constructed (α=0.82) and compared to the average importance over all healthcare aspects in the surveys. RESULTS All patient groups considered patient-centered care to be of above-average importance (ps<0.001). Small but significant differences were observed: patient-centered care was more important for patients suffering from congestive heart failure (p<0.001) and patients who were younger, female, well-educated and healthier (ps<0.05). Patients who had undergone hip or knee surgery considered patient-centered care more important than patients with spinal disk herniation did (p<0.05). CONCLUSION Patient-centered care is important to all patient groups. Differential policies regarding patient-centered care for patient subgroups do not seem required. PRACTICAL IMPLICATIONS Given the importance attributed to patient-centered care, it is essential that elements of patient-centered care are included in surveys, indicators of quality of care, and the training of doctors and nurses.

Do patient experiences on priority aspects of health care predict their global rating of quality of care? A study in five patient groups

Background  Patient‐given global ratings are frequently interpreted as summary measures of the patient perspective, with limited understanding of what these ratings summarize. Global ratings may be determined by patient experiences on priority aspects of care.

Measuring patient experiences in Europe: what can we learn from the experiences in the USA and England?

There is a growing interest in measuring patients’ experiences in health care. In several European countries, surveys are taking place to map the quality of care as perceived by patients. In a number of countries, this is part of a systematic programme of work that is undertaken at regular intervals. According to a review commissioned by the Organization for Economic Cooperation and Development (OECD), this is the case in Denmark, Norway, England and The Netherlands. Outside Europe, systematic evaluation of patients’ experiences takes place in Canada and the USA. In addition to these national programmes, the Commonwealth Fund, the Picker Institute Europe and the World Health Organization (WHO) have undertaken cross-national comparisons of patients’ experiences.1 The USA and England have by far the longest tradition of measuring patients’ experiences through, respectively, the American CAHPS (Consumer Assessment of Healthcare Providers and Systems) surveys and the surveys of the Picker Institute Europe for the English NHS. These programmes can serve as examples for European health care systems when it comes to measuring patients’ experiences. Countries that wish to embark on systematic and regular evaluations of quality of care from the perspective of patients can learn from the American and English experiences in this field. What are the main lessons learned in these countries? In the 1990s, patient satisfaction had become a widely accepted outcome measure in trials testing new drugs or interventions. In addition to that, patient satisfaction surveys were used to measure the quality of care from the perspective of the health care user. In the second half of the 1990s, however, it became clear that as a tool for quality improvement, patient satisfaction surveys were neither very sensitive nor very useful. One of the problems with patient or consumer satisfaction is its ambiguity. Satisfaction is a multidimensional concept, based …

DOING THE RIGHT THING AND DOING IT RIGHT: TOWARD A FRAMEWORK FOR ASSESSING THE POLICY RELEVANCE OF HEALTH SERVICES RESEARCH

OBJECTIVES Health services research is atypical instance of applied research, meaning that its research findings should contribute to a more evidence-based health policy. A basic assumption for the usefulness of policy research is that it is of good scientific quality, but evaluation of health services research would be incomplete without an assessment of its societal relevance. However, there is no generally accepted framework in which criteria to assess societal relevance are defined. METHODS In this study, we made an effort to specify criteria and indicators for policy relevance. RESULTS AND CONCLUSIONS In general, we concluded that it is important to define from the start of a research project, what kind of answers are being sought to the questions at hand, who the intended users of these answers will be, and how they can be reached. Furthermore, a productive dialogue between researchers and policy makers is indispensable for remaining in tune with policy thinking. In addition, we specified domains and a list of potential criteria for assessing policy relevance. For the purpose of quality assurance, these criteria have to be integrated into a quality improvement cycle. This means that the societal output of health services research should be related to the aims and missions at the level of projects, programs, and institutes. Furthermore, it is important that consensus is reached about (the weighting of) relevant indicators and that routines are developed for collecting information on these indicators.

Importing budget systems from other countries: what can we learn from the German drug budget and the British GP fundholding?

The rising costs of pharmaceutical expenditures are a common problem for policy makers in most European countries. In two countries, budget systems for pharmaceutical spending exist(ed). In Great Britain, between 1991 and 1999 GP fundholders were responsible for prescribing costs, and in Germany an overall expenditure cap for pharmaceutical prescribing has been used since 1993. These two examples are analysed in order to identify the conditions that are needed for successfully implementing budget systems for prescribing costs in other countries. It is argued, that a good budget system balances the provision of enough information for budget holders to monitor their expenditures on the one hand, against an explosive increase of transaction costs on the other hand. Apart from that, it makes doctors responsible only for expenditures that they themselves can actually control, and does not provide them with an incentive to use that discretionary power by shifting expenditures to other health care sectors. A good information infrastructure is needed for the implementation of budget systems in general. For the introduction of fundholding, a number of additional criteria need to be met, such as having gate-keeping GPs with personal lists and having a single-payer system.

Patient involvement in the development of patient-reported outcome measures : A scoping review.

Patient‐reported outcome measures (PROMs) measure patients’ perspectives on health outcomes and are increasingly used in health care. To capture the patients perspective, it is essential that patients are involved in PROM development

Improving cancer patient care: development of a generic cancer consumer quality index questionnaire for cancer patients

BackgroundTo develop a Consumer Quality Index (CQI) Cancer Care questionnaire for measuring experiences with hospital care of patients with different types of cancer.MethodsWe derived quality aspects from focus group discussions, existing questionnaires and literature. We developed an experience questionnaire and sent it to 1,498 Dutch cancer patients. Another questionnaire measuring the importance of the quality aspects was sent to 600 cancer patients. Data were psychometrically analysed.ResultsThe response to the experience questionnaire was 50 percent. Psychometric analysis revealed 12 reliable scales. Patients rated rapid and adequate referral, rapid start of the treatment after diagnosis, enough information and confidence in the healthcare professionals as most important themes. Hospitals received high scores for skills and cooperation of healthcare professionals and a patient-centered approach by doctors; and low scores for psychosocial guidance and information at completion of the treatment.ConclusionsThe CQI Cancer Care questionnaire is a valuable tool for the evaluation of the quality of cancer care from the patient’s perspective. Large scale implementation is necessary to determine the discriminatory powers of the questionnaire and may enable healthcare providers to improve the quality of cancer care. Preliminary results indicate that hospitals could improve their psychosocial guidance and information provision.