Nerea González

Predictors of patient satisfaction with hospital health care

BackgroundWe used a validated inpatient satisfaction questionnaire to evaluate the health care received by patients admitted to several hospitals. This questionnaire was factored into distinct domains, creating a score for each to assist in the analysis.We evaluated possible predictors of patient satisfaction in relation to socio-demographic variables, history of admission, and survey logistics.MethodsCross-sectional study of patients discharged from four acute care general hospitals. Random sample of 650 discharged patients from the medical and surgical wards of each hospital during February and March 2002. A total of 1,910 patients responded to the questionnaire (73.5%). Patient satisfaction was measured by a validated questionnaire with six domains: information, human care, comfort, visiting, intimacy, and cleanliness. Each domain was scored from 0 to 100, with higher scores indicating higher levels of patient satisfaction.ResultsIn the univariate analysis, age was related to all domains except visiting; gender to comfort, visiting, and intimacy; level of education to comfort and cleanliness; marital status to information, human care, intimacy, and cleanliness; length of hospital stay to visiting and cleanliness, and previous admissions to human care, comfort, and cleanliness. The timing of the response to the mailing and who completed the questionnaire were related to all variables except visiting and cleanliness. Multivariate analysis confirmed in most cases the previous findings and added additional correlations for level of education (visiting and intimacy) and marital status (comfort and visiting).ConclusionThese results confirm the varying importance of some socio-demographic variables and length of stay, previous admission, the timing of response to the questionnaire, and who completed the questionnaire on some aspects of patient satisfaction after hospitalization. All these variables should be considered when evaluating patient satisfaction.

The health-related quality of life in eating disorders.

Objective: This study investigated the perception of health-related quality of life (HRQoL) in ambulatory patients with eating disorders in relation to the severity of eating symptomatology and psychological comorbidity. Methods: One hundred ninety-seven study patients were consecutively recruited at the Eating Disorders Outpatient Clinic. Short Form-36 items (SF-36), a generic HRQoL questionnaire, the Eating Attitudes Test (EAT-40), and the Hospital Anxiety and Depression Scale (HAD) were used to measure different aspects of HRQoL. The results of the SF-36 were compared with the norms of the Spanish general population for women 18–34 years of age. Results: Patients with eating disorders were more dysfunctional in all areas of the SF-36 compared with women in the general population. There were no differences among the eating disorder diagnostic groups. Higher scores on the EAT-40 and the HAD were associated with a perception of greater impairment on all SF-36 subscales. Conclusion: The evaluation of HRQoL in these patients confirms the impact of these disorders on daily life in areas not directly related to eating disorders. The SF-36 is useful for discriminating among different levels of severity of eating disorders and other psychological comorbidities of these patients.

Changes in health related quality of life among patients treated for eating disorders

Objective: To prospectively investigate changes in the perception of health-related quality of life (HRQoL) among eating disorder patients after 2 years of treatment and follow-up and clinical predictors of change. Method: One hundred and thirty-one consecutive subjects were recruited from an eating disorder outpatient clinic. Subjects completed a generic HRQoL questionnaire, the Short Form-36 (SF-36), as well as the Eating Attitudes Test (EAT-40) to measure symptom severity and the Hospital Anxiety and Depression scale (HAD), at the first visit and after 24 months. Results: Perception of HRQoL, measured by the SF-36, showed significant improvement in all but the role emotional domain after 2 years. The greatest improvements were observed in the physical function and social function domains, followed by mental health and vitality. Despite significant improvement in the summary mental health scale, scores after 2 years of treatment and follow-up were still below normative population values of women aged 18–34. Severity of eating disorder symptoms and presence of anxiety or depression at baseline significantly affected improvement in various SF-36 domains. Conclusions: Despite improvements in perception of HRQoL, eating disorder patients were more dysfunctional in all domains of the SF-36 even after 2 years of treatment and follow-up compared with women in the general population, and the severity of eating disorder symptoms was correlated with degree of dysfunction.

The IRYSS-COPD appropriateness study: objectives, methodology, and description of the prospective cohort

BackgroundPatients with chronic obstructive pulmonary disease (COPD) often experience exacerbations of the disease that require hospitalization. Current guidelines offer little guidance for identifying patients whose clinical situation is appropriate for admission to the hospital, and properly developed and validated severity scores for COPD exacerbations are lacking. To address these important gaps in clinical care, we created the IRYSS-COPD Appropriateness Study.Methods/DesignThe RAND/UCLA Appropriateness Methodology was used to identify appropriate and inappropriate scenarios for hospital admission for patients experiencing COPD exacerbations. These scenarios were then applied to a prospective cohort of patients attending the emergency departments (ED) of 16 participating hospitals. Information was recorded during the time the patient was evaluated in the ED, at the time a decision was made to admit the patient to the hospital or discharge home, and during follow-up after admission or discharge home. While complete data were generally available at the time of ED admission, data were often missing at the time of decision making. Predefined assumptions were used to impute much of the missing data.DiscussionThe IRYSS-COPD Appropriateness Study will validate the appropriateness criteria developed by the RAND/UCLA Appropriateness Methodology and thus better delineate the requirements for admission or discharge of patients experiencing exacerbations of COPD. The study will also provide a better understanding of the determinants of outcomes of COPD exacerbations, and evaluate the equity and variability in access and outcomes in these patients.

Multimorbidity and functional status in community-dwelling older adults

BACKGROUND Multimorbidity is common in older people and may contribute to many adverse health events, such as disability. The aim of the study was to investigate how chronic health conditions (single, paired, and grouped) affect functional independence. METHOD We used two samples (a one-time, convenience sample and a nationally representative cross-sectional survey) of community-dwelling people of 65 years old or over, with a total of 2818 subjects in Spain. To assess functional independence, we used the Barthel index, administered as an interview. Information about the presence of 11 chronic health problems was collected by interview or review of their medical chart. Explanatory factor analysis was performed to assess associations between chronic health conditions. RESULTS Diabetes mellitus and hypertension emerged as the pair of chronic health conditions that most affected functional status [OR 1.98; 95% CI (1.51-2.60)], followed by visual and hearing impairment. A synergistic effect was found (p<0.05) for the cardiovascular disease and hypertension pair. Four multimorbidity groups emerged from the factor analysis: sensory and bone; cancer, lung and gastrointestinal; cardiovascular and metabolic; neuropsychiatric disorders. The neuropsychiatric disorders group was the most strongly associated with physical impairment [OR 4.94; 95% CI (2.71-8.99)], followed by the sensory and bones group [OR 1.90; 95% CI (1.56-2.31)]. CONCLUSION Despite its low prevalence, the neuropsychiatric disorders group was most strongly associated with lower functional status. Analysis of the relationship between chronic medical conditions and functional status could be useful to develop primary health care strategies to improve functional independence in older people with comorbidities.

Changes in health‐related quality of life and activities of daily living after hip fracture because of a fall in elderly patients: a prospective cohort study

The impact of hip fracture because of a fall on health‐related quality of life (HRQoL) and activities of daily living (ADL) have not been well established.

Cost-effectiveness of electroconvulsive therapy compared to repetitive transcranial magnetic stimulation for treatment-resistant severe depression: a decision model.

Background Electroconvulsive therapy (ECT) is widely applied to treat severe depression resistant to standard treatment. Results from previous studies comparing the cost-effectiveness of this technique with treatment alternatives such as repetitive transcranial magnetic stimulation (rTMS) are conflicting. Method We conducted a cost-effectiveness analysis comparing ECT alone, rTMS alone and rTMS followed by ECT when rTMS fails under the perspective of the Spanish National Health Service. The analysis is based on a Markov model which simulates the costs and health outcomes of individuals treated under these alternatives over a 12-month period. Data to populate this model were extracted and synthesized from a series of randomized controlled trials and other studies that have compared these techniques on the patient group of interest. We measure effectiveness using quality-adjusted life years (QALYs) and characterize the uncertainty using probabilistic sensitivity analyses. Results ECT alone was found to be less costly and more effective than rTMS alone, while the strategy of providing rTMS followed by ECT when rTMS fails is the most expensive and effective option. The incremental cost per QALY gained of this latter strategy was found to be above the reference willingness-to-pay threshold used in these types of studies in Spain and other countries. The probability that ECT alone is the most cost-effective alternative was estimated to be around 70%. Conclusions ECT is likely to be the most cost-effective option in the treatment of resistant severe depression for a willingness to pay of €30 000 per QALY.

Health‐related quality of life and functionality in elderly men and women before and after a fall‐related wrist fracture

To evaluate health‐related quality of life (HRQoL) and functionality among older men and women who suffered a wrist fracture because of a fall and to identify postfracture consequences.

Priorización de pacientes en lista de espera para prótesis de rodilla y cadera: la opinión de los pacientes

Objetivo: Explorar la opinion de los pacientes sobre criterios de priorizacion para las listas de espera en las intervenciones de protesis de cadera y rodilla. Este estudio se enmarca en un proyecto mas amplio, cuyo objetivo es elaborar un instrumento de criterios de priorizacion para las intervenciones de protesis de cadera y rodilla. Material y metodos: Se realizo un estudio descriptivo con metodologia de corte cualitativo, que proporciona informacion muy valiosa sobre como mejorar diferentes aspectos de la practica clinica y detectar soluciones que ayuden en la toma de decisiones. Se establecieron 4 grupos focales en 2 momentos: 2 antes de la elaboracion del instrumento de criterios de priorizacion y 2 despues, con pacientes en lista de espera para ser intervenidos de protesis de rodilla o cadera. Resultados: Un total de 31 pacientes participaron en los grupos focales. Todos los pacientes mostraron descontento con el funcionamiento de las listas de espera en la actualidad. El dolor, la limitacion de la capacidad funcional y la repercusion que todo ello supone en el papel social de los pacientes fueron los aspectos mas destacados en las reuniones. Conclusiones: A pesar de que el instrumento vaya a ser manejado por los profesionales, la participacion de los pacientes en su elaboracion y cumplimentacion permite no solo que se sientan mas implicados en el proceso asistencial, sino tambien que la informacion recogida sea mas completa y, al mismo tiempo, mas representativa de la situacion en la que se encuentran estos pacientes.

Factors affecting cataract surgery complications and their effect on the postoperative outcome

OBJECTIVE To identify factors associated with the development of complications during or after cataract surgery and to determine the effect of complications on improvements in visual acuity and visual function. DESIGN Longitudinal study. PARTICIPANTS A total of 4335 patients at 17 hospitals in the Spanish National Health Service undergoing cataract removal by phacoemulsification. METHODS Clinical data were collected before the intervention and 6 weeks postoperatively. All patients were mailed the Visual Function Index (VF-14) and additional questions concerning their ocular disease, preoperatively and 3 months after surgery. Logistic regression models were used to identify factors associated with the presence of complications, and general linear models to study the effect of complications on changes in visual acuity and VF-14 scores. RESULTS Some type of perioperative complication was found in 10.35% of patients and postoperative complications in 26.63%. Age, visual acuity greater than 0.3, moderate or high technical complexity, and the presence of perioperative complications, such as posterior capsular rupture or vitreous hemorrhage, were most strongly associated with the development of postoperative complications. Patients who had either perioperative or postoperative complications had lower levels of preoperative and postoperative visual acuity levels and visual function, and less improvement was seen for these parameters. CONCLUSIONS We identified factors associated with the development of surgery-related complications and showed that the presence of complications is associated with poorer postoperative visual acuity and function. These findings are useful for health care management, clinical decision making, and providing patients and clinicians with realistic expectations.