Sławomir Chlabicz

Open-ended questions in surveys of patients' satisfaction with family doctors.

Objective: To compare replies to open-ended and closed questions about patient satisfaction with family doctors. Methods: Two centres of primary health care in Białystok in northeast Poland were chosen. A self-administered questionnaire was mailed to 1000 people (500 from each centre) aged 18 years and over, randomly selected from the practices. Possible responses to the one closed question were: very good, good, bad, very bad or difficult to say. Replies to two open-ended questions were categorized as positive, neutral, negative or ambivalent. Results: The response rate was 57.9%. There were some discrepancies between the closed-question response and the open-ended question replies. Some of those who replied good or very good to the closed question expressed negative views in response to the two open-ended questions (14.0% and 12.4%). Conclusions: Answers to open-ended questions add value to a patient satisfaction survey by providing information that answers to closed questions may not elicite.

Antibiotics in the treatment of upper respiratory tract infections in Poland. Is there any improvement

What is known:  Acute upper respiratory tract infections are among the most frequent reasons for encounters in primary health care. Relevant data about antibiotics use in respiratory tract infections in Poland are scarce.

Understanding patient satisfaction with family doctor care

RATIONALE, AIMS AND OBJECTIVES Patient satisfaction is receiving increased attention in the evaluation of health care quality. However, qualitative methods have seldom been used to study patient satisfaction. The purpose of this study was to explore how satisfaction is understood from the perspective of patients receiving care from family doctors. METHOD We used a qualitative approach consisting of in-depth interviews with 36 patients attending clinics in Poland. Interviews were audiotaped and transcribed, and content analysis performed. RESULTS There was no single definition of satisfaction among study participants; however, some core characteristics of satisfaction emerged. These characteristics were: (1) good doctor-patient interaction; (2) health improvement or resolution of health problems; (3) fulfillment of prior expectations; (4) availability of health care; (5) combination of multiple characteristics; and (6) absence of dissatisfaction. CONCLUSION Because patients have differing concepts of satisfaction with health care provided by family doctors, quality assessments should focus on components of satisfaction whereas questions about satisfaction itself should be avoided.

High prevalence of genotype 4 among hepatitis C virus-infected intravenous drug users in north-eastern Poland.

The aim of this study was to describe the distribution of hepatitis C genotypes among intravenous drug users in north‐eastern Poland. The study group included intravenous drug users recruited at a drug treatment center and a clinic for HIV‐infected patients. HCV infection was confirmed by qualitative nested RT‐PCR to test for the presence of HCV RNA. Genotypes were determined by 5′UTR sequencing and comparing the results with known genotype sequences. Among 111 HCV‐infected and HCV–RNA‐positive intravenous drug users, the most prevalent genotypes were 1 (38.7%), 3 (37.8%), and 4 (23.4%). Most infections with genotype 4 (88.5%) were found among HCV–HIV‐coinfected drug users. The study demonstrated a high prevalence of genotype 4 (23.4%) among HCV‐infected Polish drug users. J. Med. Virol. 80:615–618, 2008.

Hepatitis B virus vaccine for patients with hepatitis C virus infection.

SummaryHepatitis C is a disease with varying rates of progression. The role of hepatitis B virus (HBV) as a cofactor in the development of hepatitis C virus (HCV)-related cirrhosis and hepatocellular carcinoma (HCC) has been suggested and the use of HBV vaccine in all HCV-infected patients has been advocated. This review presents the implications of HBV and HCV coinfection and addresses the issues of HBV vaccine immunogenicity and safety in patients with chronic HCV infection.

Exploring negative evaluations of health care by Polish patients: an attempt at cross-cultural comparison.

Understanding patient dissatisfaction is essential as it provides information on how to improve the relationship between healthcare users and medical professionals. The aim of this paper is to determine how Polish patients verbally express negative opinions of their healthcare services, and to compare the patterns of opinion-giving behaviour between patients in Poland and Western Europe. A qualitative approach employing in-depth interviews was used. Nine primary healthcare centres were chosen in various regions of Poland, taking into account both type of practice, i.e. small and large, and location of residence, i.e. urban (small and large towns) and rural. In every centre, interviews were performed with four patients coming consecutively to their family physician. Thirty-six patients aged 20-78 years were interviewed. Their views could be categorised into eight reasons for avoiding expressing negative opinions: unpleasant emotions induced by giving a negative evaluation; avoiding offending healthcare providers; fear that their utterances could have a negative effect on their further medical care; fear of giving a hasty evaluation based on their own inexpert medical knowledge; determinants from recent Polish history; prestige of the medical profession; entrusting the most important aspect of life, i.e. health, to a doctor; and lack of faith that their opinions could cause change for the better. The respondents used certain rhetorical tricks to soften their criticisms. Patients face cultural barriers to expressing dissatisfaction about their health care. In the Polish context, these are the high social status of the physician and the low position of the patient. In their spontaneous utterances, the respondents gave detailed suggestions for raising the level of patient satisfaction with health care.

Involvement of family nurses in home visits during an 8‐year period encompassing primary healthcare reforms in Poland

Home visits by doctors and nurses are considered an important indicator of the quality of healthcare. Published data are scarce regarding the role of family nurses in providing professional home care in Central and Eastern European countries that have recently introduced reforms to their primary care systems. The objective of the present study was to describe the involvement of family nurses in home visits in the context of organizational and legal changes in service provision, that is, to analyse the role of the family nurses employed by family doctors (1998) versus family nurses working in autonomous positions (2002 and 2006). The proportion of patients in the community receiving a home visit from a family nurse, the purpose of the family nurses home visit and patient expectations towards the family nurse were studied. A series of cross-sectional studies were conducted in a small town in northeastern Poland, based on three consecutive surveys taken at 4-year intervals (1998, 2002, 2006, surveys I, II and III, respectively). During each survey, 1000 patients were interviewed (face to face) with structured questionnaires. In 1998, family nurses were employed by family doctors, but by 2002, nurses had established their own practices and held direct contracts with the National Health Fund. A significant increase in the percentage of patients receiving home visits from a family nurse was observed between surveys I and II (12.8% and 30.0%); however, the number of respondents reporting a home visit in survey III decreased to 23.9%. Patients over 75 years of age were the major demographic group receiving family nursing at home. This study suggests that reform of the primary healthcare system in Poland has produced changes in the family nursing system. Independence, contractual obligations and self-employment of Polish family nurses have resulted in their greater participation in home visits.

A short questionnaire for measuring the quality of patient visits to family practices

OBJECTIVE To describe a short questionnaire for measuring the quality of patient visits to family physician practices, and to assess the questionnaires validity and reliability. DESIGN Multi-stage research was carried out in three phases: Phase I--qualitative research based on 36 in-depth interviews; Phase II--quantitative research using a questionnaire to survey 360 respondents; and Phase III--quantitative research using a shortened version of the questionnaire to survey 1330 respondents. The reliability of the questionnaire was measured by using Cronbachs alpha coefficient. SETTING Family physician practices in Poland. PARTICIPANTS Adult patients of family physicians. INTERVENTION None. MAIN OUTCOME MEASURES The patient-doctor relationship and primary health care availability. RESULTS A final questionnaire was produced with 16 items in three components: (1) patient-doctor relationship and consultation outcome; (2) barriers and difficulties; and (3) accessibility of care. For each component, the Cronbachs alpha values were 0.92, 0.82 and 0.64, respectively. The overall reliability for all 16 items was 0.92. CONCLUSIONS The Quality of Visit to Family Physician questionnaire is a reliable tool that can be used by family physicians to obtain feedback from patients about patient-doctor relationships and visit outcomes, barriers and difficulties experienced by patients in seeking family physician care, and the availability of care.

Which factors hinder the decision of Polish HIV-positive patients to take up antiretroviral therapy?

Abstract The implementation of highly active antiretroviral therapy (HAART) in 1996 has significantly reduced mortality and morbidity for HIV-positive patients worldwide. However not all eligible persons start HAART. To identify reasons for therapy refusal by HIV-positive persons we performed a questionnaire study. The investigation was conducted among 321 HIV-positive individuals and focused on the decision to take up antiretroviral treatment. Out of 71 untreated patients, 34 (47.9%) admitted that in their case the therapy was not indicated, whereas 20 (28.3%) were afraid of potential side effects that might change their appearance, e.g. face lipoatrophy. Only the treated patients had been prepared to take up therapy, although 17 patients (6.0%) had not received any explanation of the therapy principles, aims or necessity to comply with medication regime. The therapy is generally not discussed with the patients for whom it is not currently indicated, which may contribute to the fixation of fears and prejudices. Doctors who treat HIV-positive patients should be aware of the prejudices and fears their patients have towards antiretroviral therapy in order to react properly and by means of the available antiretroviral drugs help prolong life and improve its quality.

Search for hepatitis delta virus (HDV) infection in hepatitis C patients in north-eastern Poland. Comparison with anti-HDV prevalence in chronic hepatitis B

Hepatitis C virus and hepatitis D virus have been shown to suppress HBsAg synthesis. Thus it is possible that HDV infection occurs despite the lack of detectable HBsAg. The aim of our study was to (a) determine the prevalence of HDV infection in patients with chronic hepatitis C (b) compare it with the prevalence of HDV infection in HBsAg positive patients with hepatitis B. The study group consisted of 51 chronic hepatitis C patients, 30 HIV infected drug addicts (27 of them were also positive for anti-HCV) and 102 hepatitis B patients. The participants were tested for anti-HDV, anti-HCV and HBsAg. All anti-HCV positive patients were negative for anti-HDV. Four individuals with anti-HDV belonged to hepatitis B group and constituted 3.9% of all HBsAg positive subjects. We conclude that (a) there is currently no evidence of HDV infection among HCV infected patients in our region (b) hepatitis delta infection is rare in north-eastern Poland.