Development of the physical therapy outpatient satisfaction survey (PTOPS).
BACKGROUND AND PURPOSE: The purposes of this 3-phase study were (1) to identify the underlying components of outpatient satisfaction in physical therapy and (2) to develop a test that would yield reliable and valid measurements of these components. SUBJECTS: Three samples, consisting of 177, 257, and 173 outpatients from 21 facilities, were used in phases 1, 2, and 3, respectively. METHODS AND RESULTS: In phase 1, principal component analyses (PCAs), reliability checks, and correlations with social desirability scales were used to reduce a pool of 98 items to 32 items. These analyses identified a 5-component model of outpatient satisfaction in physical therapy. The phase 2 PCA, with a revised pool of 48 items, indicated that 4 components rather than 5 components represented the best model and resulted in the 34-item Physical Therapy Outpatient Satisfaction Survey (PTOPS). Factor analyses conducted with phase 2 and phase 3 data supported this conclusion and provided evidence for the internal validity of the PTOPS scores. The 4-component scales were labeled "Enhancers," "Detractors," "Location," and "Cost." Responses from subsamples of phase 3 subjects provided evidence for validity of scores in that the PTOPS components of "Enhancers," "Detractors," and "Cost" appeared to differentiate overtly satisfied patients from overtly dissatisfied patients. "Location" and "Enhancer" scores discriminated subjects with excellent attendance at scheduled physical therapy sessions from those with poor attendance. CONCLUSION AND DISCUSSION: In this study, we identified components of outpatient satisfaction in physical therapy and used them to develop a test that would yield valid and reliable measurements of these components. (+info)
Toward sensitive practice: issues for physical therapists working with survivors of childhood sexual abuse.
BACKGROUND AND PURPOSE: The high rates of prevalence of childhood sexual abuse in the United States and Canada suggest that physical therapists work, often unknowingly, with adult survivors of childhood sexual abuse. The purposes of this qualitative study were to explore the reactions of adult female survivors of childhood sexual abuse to physical therapy and to listen to their ideas about how practitioners could be more sensitive to their needs. The dynamics and long-term sequelae of childhood sexual abuse, as currently understood by mental health researchers and as described by the participants, are summarized to provide a context for the findings of this study. SUBJECTS AND METHODS: Twenty-seven female survivors (aged 19-62 years) participated in semistructured interviews in which they described their reactions to physical therapy. RESULTS: Survivors' reactions to physical therapy, termed "long-term sequelae of abuse that detract from feeling safe in physical therapy," are reported. Participant-identified suggestions that could contribute to the sense of safety are shared. CONCLUSIONS AND DISCUSSION: Although the physical therapist cannot change the survivor's history, an appreciation of issues associated with child sexual abuse theoretically can increase clinicians' understanding of survivors' reactions during treatment. We believe that attention by the physical therapist to the client's sense of safety throughout treatment can maximize the benefits of the physical therapy experience for the client who is a survivor. (+info)
Projective identification, countertransference, and the struggle for understanding over acting out.
Projective identification is examined as an intrapsychic and interpersonal phenomenon that draws the analyst into various forms of acting out. The therapist struggles to use understanding and interpretation as the method of working through the mutual desire to act out the patient's core fantasies and feelings. Clinical material is used to illustrate the ways in which projective identification affects the analytic relationship. The focus is on methods of using interpretation to shift from mutual acting out to mutual understanding. (+info)
Diabetes care: who are the experts?
OBJECTIVES: To identify issues that patients and professionals consider important in diabetes care and differences in their priorities for care and to determine patients' and professionals' judgements of the relative importance of their chosen priorities. DESIGN: Structured group interviews using the nominal group technique. SETTING: Five district health authorities on Tyneside. SUBJECTS: Five nominal groups: expert (seven), non-expert (seven) health care professionals; insulin dependent (four), non-insulin dependent patients (eight); and carers of diabetic patients (eight). MAIN MEASURES: Items important in diabetes care to each nominal group (themes of care), ranked into a series of "top 10" items for each group, and allocated a score according to relative importance to individual members; scores were standardised by individual weighting and group weighting for comparison within and between groups. RESULTS: Patients and professionals agreed that information given to patients, interaction between professionals and patients, patient autonomy, and access were important for good diabetes care, but the importance assigned to each differed. Thus the professionals emphasised empathy and aspects of good communication and patients the desire to know enough to live a "normal" life. Differences were also found within the patient groups; these related to changes in patients' needs at specific points in the development of their illness and in their orientations to care. CONCLUSION: Patients differ from professionals in their orientation to diabetes care, and they can, and should, be involved in setting priorities for care. Since these priorities are dynamic further work is needed to explore the nature of patient satisfaction with diabetes care. (+info)
Lack of knowledge in health professionals: a barrier to providing information to patients?
OBJECTIVE: To assess obstetricians' and midwives' knowledge of routine prenatal screening tests for fetal abnormality and factors associated with such knowledge. DESIGN: Questionnaire assessment of antenatal clinic staff. SETTING: Six hospitals within the United Kingdom (four district general hospitals in London, one district general hospital in Wales, and one teaching hospital in Wales), offering routine prenatal screening tests. SUBJECTS: 29 obstetricians and 97 midwives were invited to participate, of whom 21 and 70 respectively responded to the questionnaire. MAIN MEASURES: Knowledge of prenatal tests, according to 19 item multiple choice questionnaire, reluctance to disclose uncertainty, and clinical experience. RESULTS: The overall response rate was 72% (91/126). In all, 43% of midwives and 14% of obstetricians obtained correct responses on fewer than half the items. Reluctance to disclose uncertainty to patients was associated in obstetricians with having less knowledge about prenatal testing (r = -0.50; p < 0.025, Pearson product moment correlation) and in midwives with more clinical experience (r = 0.43; p < 0.001). CONCLUSIONS: Lack of knowledge and greater clinical experience seem to be important barriers to providing patients with information about prenatal screening tests. (+info)
Evaluation of patients' knowledge about anticoagulant treatment.
OBJECTIVE: To develop a questionnaire to evaluate patients' knowledge of anticoagulation. DESIGN: Anonymous self completed questionnaire study based on hospital anticoagulant guidelines. SETTING: Anticoagulant clinic in a 580 bed district general hospital in London. SUBJECTS: 70 consecutive patients newly referred to the anticoagulant clinic over six months. MAIN MEASURES: Information received by patients on six items of anticoagulation counselling (mode of action of warfarin, adverse effects of over or under anticoagulation, drugs to avoid, action if bleeding or bruising occurs, and alcohol consumption), the source of such information, and patients' knowledge about anticoagulation. RESULTS: Of the recruits, 36 (51%) were male; 38(54%) were aged below 46 years, 22(31%) 46-60, and 10(14%) over 75. 50 (71%) questionnaires were returned. In all, 40 respondents spoke English at home and six another language. Most patients reported being clearly advised on five of the six items, but knowledge about anticoagulation was poor. Few patients could correctly identify adverse conditions associated with poor control of anticoagulation: bleeding was identified by only 30(60%), bruising by 23(56%), and thrombosis by 18(36%). Only 26(52%) patients could identify an excessive level of alcohol consumption, and only seven (14%) could identify three or more self prescribed agents which may interfere with warfarin. CONCLUSION: The questionnaire provided a simple method of determining patients' knowledge of anticoagulation, and its results indicated that this requires improvement. IMPLICATIONS: Patients' responses suggested that advice was not always given by medical staff, and use of counselling checklists is recommended. Reinforcement of advice by non-medical counsellors and with educational guides such as posters or leaflets should be considered. Such initiatives are currently being evaluated in a repeat survey. (+info)
Indigenous perceptions and quality of care of family planning services in Haiti.
This paper presents a method for evaluating and monitoring the quality of care of family planning services. The method was implemented in Haiti by International Planned Parenthood Federation Western Hemisphere Region (IPPF/WHR), the managerial agency for the Private Sector Family Planning Project (PSFPP), which is sponsored by the USAID Mission. The process consists of direct observations of family planning services and clinic conditions by trained Haitian housewives playing the role of 'mystery clients', who visit clinics on a random basis without prior notice. Observations conducted by mystery clients during one year, from April 1990 to April 1991, are presented and illustrate the use of the method. In addition, measurements for rating the acceptability of the services were developed, providing a quantitative assessment of the services based on mystery clients' terms. Statistical results demonstrate that simulated clients ranked some criteria of acceptability higher than others. These criteria are: the interaction provider/client, information adequacy, and competence of the promoter. Likewise, simulated clients' direct observations of the services permitted the identification of deficiencies regarding the quality of care such as the paternalistic attitudes of the medical staff; the lack of competence of promoters; and the lack of informed choice. Based on its reliability since its implementation in 1990 the method has proven to be a useful tool in programme design and monitoring. (+info)
How patients perceive the role of hospital chaplains: a preliminary exploration.
OBJECTIVE: An exploratory study of the attitudes of hospital patients to the service provided by hospital chaplains. DESIGN: Questionnaire study of hospital inpatients in December 1992. SETTING: One large teaching hospital in London. PATIENTS: 180 hospital inpatients in 14 different general wards, 168 (93%) of whom agreed to take part. MAIN MEASURES: Attitudes to chaplains and their role contained in 12 questions developed during a pilot study on hospital inpatients (16) and staff (14) and their relation to patients' age, sex, length of hospital stay, and religious beliefs, according to Kendall rank order correlations. RESULTS: Of 168(93%) respondents, 72(43%) were women; mean age of patients was 63.1 (SD 16.8) years. Forty five (27%) were inpatients of three days or less and 22(13%) for one month or more. 136(81%) were Christian; 17(10%) atheist, agnostic, or had no religion; and 15(9%) were of other religions. In general, patients showed positive attitudes towards the role of hospital chaplains and to the services they provided. The correlation analysis showed that there was a significant tendency for older patients, those who had been inpatients for longer, and those with religious beliefs to be more sympathetic to the role of hospital chaplains. CONCLUSIONS: Hospital chaplains provide a service which is appreciated by patients. This study provides a simple instrument for assessing patients' attitudes to chaplains. (+info)