Paola Gremigni

Psychological factors associated with medication adherence following renal transplantation

Abstract:u2002 Background:u2002 A relationship exists between non‐adherence and clinical outcomes in health care, including renal transplantation. The aim of this study was to identify the psychological variables associated with non‐adherence to medication after renal transplantation.

Validation of the Health Care Communication Questionnaire (HCCQ) to measure outpatients' experience of communication with hospital staff

OBJECTIVEnAll healthcare workers communication skills are recognised as valuable indicators of quality of care from the patients perspective. Most of the studies measure doctor-patient communication, giving scarce attention to other professionals. This study is aimed at developing and providing preliminary validation of a questionnaire to measure outpatients experience of communication with hospital personnel other than doctors.nnnMETHODSnSmall groups of outpatients and hospital staffs were involved in identifying the domains and generating the items. A quantitative validation phase involving 401 outpatients followed in order to verify the hypothesised dimensionality of selected items and to measure reliability.nnnRESULTSnA 13-item questionnaire emerged, comprising four components of outpatients experience in the healthcare communication domain: problem solving, respect, lack of hostility, and nonverbal immediacy. Psychometric tests were promising as regards factorial validity, evaluated with confirmatory factor analysis, and scales reliability. Factor scores were independent of patients gender, age, and education.nnnCONCLUSIONnThe developed Health Care Communication Questionnaire (HCCQ) is a self-administered brief measure with good psychometric properties.nnnPRACTICE IMPLICATIONSnThe HCCQ gives information that could be taken as an indirect and subjective indicator of the quality of hospital services as provided by non-medical staff. This aspect may have a role in local quality improvement initiatives.

Psychological impact of testing for thrombophilic alterations

We investigated the psychological impact of testing for the presence of thrombophilic alterations. The enrolled subjects received counseling from a physician before blood sampling and after receiving results, with a view to provide clear information about the aim of thrombophilia screening (TS). Participants were requested to complete a pre-test questionnaire during this interview and a post-test questionnaire 20 days after receiving the TS results. One hundred ninety-seven subjects completed the pretest questionnaire and 140/197 (71.1%) returned the post-test one. The TS results were altered in 36 (25.7%, R506Q mutation n = 19; G20210A mutation n = 9; antithrombin deficiency n = 1; LAC phenomenon n = 4; hyperhomocysteinemia n = 3) and normal in 104 subjects. We assessed: perceived health status (PHS), state of anxiety, health fears, depressive reactions, moods, perceived well-being, and perceived daily-life stress. For both groups, both at pre- and post-test, none of the psychological variable scores showed significant worsening, regardless of whether TS resulted altered or normal. Anxiety significantly (p < or = 0.05) decreased at post-test in the altered group and a non-significant improvement in PHS after TS result communication was recorded in both groups. Age was an important factor in mediating psychological impact. In conclusion, diagnosis of thrombophilic alterations seems to be well accepted in the short term and TS should not be discouraged for potential adverse psychological effects. However, the psychological impact over a longer period of receiving altered results needs to be further investigated. The relationship between absence of adverse psychological reactions and quality of counseling program provided before and after TS should also be investigated.