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Access to care for rural Medicare beneficiaries

JOURNAL OF RURAL HEALTH 2000年第1期16卷 31-42页

作者： Stearns, SC Slifkin, RT Edin, HM Univ N Carolina Dept Hlth Policy & Adm Chapel Hill NC 27599 USA Univ N Carolina Program Hlth Care Econ & Finance Cecil G Sheps Ctr Hlth Serv Res Chapel Hill NC 27599 USA

This paper examines variations between urban and rural Medicare beneficiaries in three measures of access to care: self-reported access to care, satisfaction with care received and use of services. The assessment focuses on these measures and their relationship to adjacency to metropolitan areas. Comparisons are also provided for the relative effects of adjacency versus broader access barriers such as income. Data from the 1993 Medicare Current Beneficiary Survey are used. The analyses offer several new perspectives on access in rural areas. First, as perceived by respondents, rural residence does not indicate access problems;instead, Medicare beneficiaries in rural counties that are adjacent to urban areas and that have their own city of at least 10,000 people report higher levels of satisfaction and fewer self-reported access problems than do residents of urban counties. These results may stem either from differences in rural residents' expectations regarding access or willingness to accept appropriate substitutions. Preventive vaccination rates in rural areas are on par with or better than rates by beneficiaries in urban areas. The only services where utilization in rural areas was limited relative to urban areas were preventive cancer screening for women and dental care. Development of policies to address these specific service gaps may be warranted. Low income has a more pervasive and problematic relationship to self-reported access, satisfaction and utilization than does rural residence per se.

关键词：残疾人/统计学和数值数据卫生服务易得程度/统计学和数值数据纵向研究 Medicare/统计学和数值数据 Medicare/利用病人满意度/统计学和数值数据回归分析农村人口/统计学和数值数据美国/流行病学市区人口/统计学和数值数据老年人老年人 80以上女(雌)性人类男(雄)性中年人

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The value of patient feedback in the audit of TMJ arthroscopy

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BRITISH DENTAL JOURNAL 2000年第1期188卷 37-39页

作者： Godden, DRP Robertson, JM Peterborough Dist Gen Hosp Dept Oral & Maxillofacial Surg Peterborough PE3 6DA England

Aim This study assessed the patients' and clinicians' perception of the outcome Of temporomandibular joint arthroscopy. Method All patients who underwent TMT arthroscopy for both diagnostic and therapeutic purposes over a 6-year period were sent a questionnaire that asked about various symptoms attributable to the TMJ. Additionally a review of the clinical notes was performed. Results 83 patients underwent arthroscopy to 127 temporomandibular joints. The mean follow up was 3.6 years. 55% of patients assessed their jaw function as being effective, jaw movement, pain control, and overall satisfaction were satisfactory in 37%;57%, and 48% of cases respectively The clinicians' assessment revealed that 45% of patients had no joint tenderness, 74% of patients were able to open to >35 mm and 74% of patients were free of any joint noise. 65% of patients were prepared to undergo a second procedure if indicated. Conclusion Overall, 50% of patients seemed to view arthroscopy favourably although many patients still felt that jaw opening was restricted. The outcome was not related to the position and:reducibility of the disc at surgery and other variables may be responsible. The disparity between the clinical evaluation and the patients' perception of effectiveness emphasises the importance of patient feedback.

关键词：关节镜检查/统计学和数值数据口腔医疗质量评定/方法口腔医疗质量评定/统计学和数值数据反馈病人满意度/统计学和数值数据回顾性研究颞下颌关节/外科学颞下颌关节障碍/诊断颞下颌关节障碍/外科学治疗结果青少年成年人老年人女(雌)性人类男(雄)性中年人

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Dissatisfaction with cataract surgery in relation to visual results in a population-based study in Sweden

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JOURNAL OF CATARACT AND REFRACTIVE SURGERY 1999年第8期25卷 1127-1134页

作者： Mönestam, E Wachtmeister, L Umea Univ Dept Ophthalmol SE-90185 Umea Sweden

Purpose: To evaluate dissatisfied patients and those with subjectively worse visual ability after cataract surgery and to analyze how these factors relate to poor visual acuity results (worse than 20/40). Setting: Department of Ophthalmology, Norrlands University Hospital, Umea Sweden. Methods: A prospective, population-based study of cataract surgery outcome was conducted. All patients (459 surgeries) who had cataract surgery during a 1 year period were studied using seif-administered questionnaires and data from patient records. Outcome measures were (1) patient degree of satisfaction with the result, (2) subjective visual ability after surgery of visually demanding tasks such as reading, television viewing, orientation in unfamiliar surroundings, and distance estimation far and near, and (3) visual acuity results, Results: After surgery, 37 of the 459 cases (8%) were dissatisfied. These patients had a significantly lower age-corrected visual acuity in the operated eye than the satisfied patients (P < .0001). Ten percent said 1 or more visual ability was worse after their cataract surgery, logistic regression analysis revealed that the visual acuity in the better eye before surgery and age-related maculopathy were the most significant risk factors. Poor visual acuity after surgery in the operated eye was found in 22%, mostly as a result of concurrent age-related maculopathy, diabetes, or glaucoma. Four percent had no improvement in visual acuity in the operated eye. Conclusions: Dissatisfaction seemed to rely mostly on visual acuity in the operated eye. Low visual acuity in the better eye before surgery and age-related maculopathy were the most significant risk factors for subjectively worse visual ability after surgery. The degree of satisfaction after cataract surgery and changes in visual ability differed in important ways from visual acuity as a measure of visual function. (C) 1999 ASCRS and ESCRS.

关键词：日常生活活动白内障摘除术/统计学和数值数据病人满意度/统计学和数值数据前瞻性研究瑞典/流行病学视敏度老年人老年人 80以上女(雌)性人类男(雄)性

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Patients' satisfaction with dental services provided by a university in Hong Kong

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INTERNATIONAL DENTAL JOURNAL 1999年第1期49卷 53-59页

作者： Chu, CH Lo, ECM Univ Hong Kong Fac Dent 34 Hosp Rd Hong Kong Peoples R China

This study was a consumer evaluation of the dental care services provided by a university dental clinic in I-long Kong which provides dental care to all university students and staff and their dependants. The objectives of this study were to study the consumers' satisfaction with the dental services;to identify their reasons for not using the dental services;and to compare the opinions of the students with those of the university staff and their spouses. A total of 140 students and 180 staff and their spouses were randomly selected for this study. The response rates were 100 per cent for students and 77 per cent for staff and their spouses. Results showed that both groups of respondents were satisfied with the quality of dental services provided by the university dental clinic. However, they were not satisfied with the long waiting time for an appointment. Students who had not attended the university dental clinic commonly stated that they were busy and had no time for a dental visit. Conversely, many staff and their spouses did not seek care from the university dental clinic because they thought that the fees were high. Although the overall Dental Satisfaction Index (DSI) scores for the students (64.5) and staff and their spouses (65.1) were similar, there were differences in the aspects of the services with which the two group were satisfied or dissatisfied. Thus if the university dental clinic wants to implement changes so as to improve consumer satisfaction and utilisation, a careful analysis of the specific opinions of its various consumer groups is required.

关键词：卡方分布牙科保健服务/人力牙科保健服务/统计学和数值数据牙科保健服务/利用香港病人满意度/统计学和数值数据问卷调查学生保健服务/人力学生保健服务/统计学和数值数据学生保健服务/利用学生/统计学和数值数据人类

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Use of N-butyl-2-cyanoacrylate in elective surgical incisions -: Longterm outcomes

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JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS 1999年第1期189卷 21-25页

作者： Amiel, GE Sukhotnik, I Kawar, B Siplovich, L Bnai Zion Med Ctr Dept Urol Haifa Israel Haemek Med Ctr Dept Pediat Surg Afula Israel Technion Israel Inst Technol Bruce Rappaport Fac Med IL-31096 Haifa Israel

Background: Histoacryl Blue (N-Butyl-2-cyanoacrylate) is a tissue adhesive that has been used clinically for more than 20 years. In the last decade, N-Butyl-2-cyanoacrylate has been used for cutaneous closure of low-tension lacerations in children and adults and has become a preferred method for closure of pediatric facial lacerations in many emergency rooms outside the United Stares. Many pediatric elective surgical procedures are performed in tension-free areas and may be suitable for closure with a tissue adhesive. In order to assess this approach, a retrospective study was conducted to evaluate the cosmetic outcomes and complications of the application of N-Butyl-2-cyanoacrylate for the approximation of elective surgical incisions in a pediatric population. Study Design: Records of 1,098 patients, ages 1 month to 16 years, who, between January 1995 and December 1996, underwent one of the following: orchidopexy, inguinal hernia, umbilical hernia, or hydrocele repair were analyzed. In all patients, N-Butyl-2-cyanoacrylate was applied to close the surgical incision. A 12-item questionnaire was created to assess the presence of complications and to determine shortterm and longterm cosmetic outcomes of the incision. Data were collected by conducting telephone interviews of family members. Results: Among the 1,033 children who were treated, 66% had inguinal hernias, 15% hydroceles, 15% undescended testis, and 4% umbilical hernias. Redness or tenderness at the incision site (5.5%), discharge from the surgical wound (1.9%), and wound dehiscence (1.1%) were the main immediate complications after surgery. Overall satisfaction with the cosmetic outcomes of the surgical scar was high, with an average score of 4.73 out of 5 (94.6%). Conclusions: Our results demonstrate that administration of N-Butyl-2-cyanoacrylate for the closure of small low-tension surgical incisions in the pediatric population is safe, has a low complication rate, and produces excellent cosmetic outcomes

关键词：恩布酯/类似物和衍生物恩布酯/治疗应用病人满意度/统计学和数值数据问卷调查回顾性研究外科手术选择性/统计学和数值数据外科伤口裂开/预防和控制外科伤口感染/流行病学时间因素组织黏合剂/治疗应用治疗结果青少年儿童儿童学龄前女(雌)性人类婴儿男(雄)性

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Determinants of attendance and patient satisfaction at eye clinics in south-western Uganda

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HEALTH POLICY AND PLANNING 1999年第1期14卷 77-81页

作者： Whitworth, J Pickering, H Mulwanyi, F Ruberantwari, A Dolin, P Johnson, G Uganda Virus Res Inst Med Res Council Programme AIDS Entebbe Uganda Masaka Dist Referral Hosp Masaka Uganda UCL Inst Ophthalmol London England

Purpose: To identify the reasons for subjects deciding to attend or not attend local and referral ophthalmology clinics in south-west Uganda, and to establish the levels of satisfaction of clinic attenders with the services they received. Methods: A population survey identified subjects with ocular conditions who were referred to the local clinic or the district hospital. All non-attenders and a group of attenders were interviewed at home. Results: 31% of those referred did not attend the local clinic. The most common reasons were 'too busy' (29%) or 'unwilling to buy spectacles' (17%). Less than half of attenders were satisfied, mainly because of no perceived clinical improvement or having to buy spectacles. Only 13% of those referred to the district hospital clinic attended. The main reasons for non-attendance were high transport cost and fear of the clinic. Conclusion: Attendance and satisfaction with the community ophthalmology service could be improved by more intensive motivation and explanation for patients, and assistance with spectacle and transport costs. The use of aphakic motivators should be tested in this context.

关键词：社区卫生中心/标准社区卫生中心/利用发展中国家卫生保健调查眼科学/组织和管理眼科学/标准门诊部医院/标准门诊部医院/利用病人接受卫生保健的程度/统计学和数值数据病人满意度/统计学和数值数据转诊和会诊乡村卫生服务/组织和管理乡村卫生服务/标准乡村卫生服务/利用乌干达视力普查人类

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Patient satisfaction in Turkey: Differences between public and private hospitals

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JOURNAL OF COMMUNITY HEALTH 1999年第1期24卷 73-91页

作者： Tengilimoglu, D Kisa, A Dziegielewski, SF Univ Cent Florida Coll Hlth & Publ Affairs Sch Social Work Orlando FL 32816 USA Gazi Univ Sch Allied Hlth Ankara Turkey Tulane Univ Dept Int Hlth & Dev Sch Publ Hlth & Trop Med New Orleans LA 70118 USA

This article reports the results of a patient-satisfaction survey administered by interview to 2045 adults discharged from several major public and private hospitals in Turkey. The direct measurement of patient-satisfaction is a new phenomenon for this country. An instrument was designed similar to those available in the United States and administered during exit interviews. Two primary areas of analyses were determined in comparing services provided by these public and private hospitals: demographic factors with regard to accessibility and consumer perceptions of the quality of service provided. Relationships and percentages within and among the five public and two private hospitals are reported. Several statistically significant differences were found between the hospitals, with the private hospitals achieving the greatest satisfaction on most of the quality of services issues examined. Future recommendations outline the need to take into account the public's perception of these hospitals and enhancing customer satisfaction as a means of increasing service utilization.

关键词：卫生服务易得程度医院私立医院公立病人满意度/统计学和数值数据卫生保健质量问卷调查土耳其青少年成年人女(雌)性人类男(雄)性中年人

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Satisfaction with outpatient health care services in Manica province, Mozambique

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HEALTH POLICY AND PLANNING 1998年第2期13卷 174-180页

作者： Newman, RD Gloyd, S Nyangezi, JM Machobo, F Muiser, J Univ Washington Dept Pediat Sch Med Seattle WA 98195 USA Univ Washington Sch Publ Hlth & Community Med Int Hlth Program Seattle WA 98195 USA Dirreccao Prov Saude Manica Chimoio Mozambique Hlth Alliance Int Chimoio Mozambique

The objective of the study was to describe ambulatory health care services, determine the level of client satisfaction, and identify obstacles to care in a rural area of Mozambique. Exit surveys at 34 health clinics in Manica Province were completed on a sample of 879 adults representing between 1% and 2% of the average monthly visit totals at each clinic. Eighty-three per cent of interviewees were women. Just over half of the visits were for paediatric patients. Men were more likely to be at the clinic for their own health care needs than women (81% vs. 40%, p <0.001). Of patients seen for acute illness, 45% were examined, 22% received preventive education, and 23% received prognostic information. Overall, 55% of interviewees believed that the service they received was good or very good, 32% rated it as fair, and 13% as poor. Satisfaction was positively associated with increased training level of the provider (p < 0.005), and shorter waiting times (p < 0.001). The most common complaints about the clinic visits were lack of adequate transportation, long waiting times, lack of physical examinations, and failure to receive prescribed medications. These findings suggest that the majority of Mozambicans interviewed are moderately satisfied with the available outpatient services in Manica. Provider training, provider availability and distribution of medicines were areas identified by respondents as needing improvement.

关键词：门诊医疗/标准卫生服务范围卫生保健调查卫生政策卫生服务易得程度莫桑比克病人满意度/统计学和数值数据方案评价公共卫生管理/标准乡村卫生服务/标准青少年成年人老年人儿童女(雌)性人类男(雄)性中年人

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Assessing client satisfaction in a psychology training clinic

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JOURNAL OF MENTAL HEALTH ADMINISTRATION 1996年第2期23卷 180-189页

作者： Moore, KE Kenning, M HENNEPIN CTY PSYCHOL SERV MINNEAPOLIS MN USA

Client satisfaction with services obtained at a clinical psychology training center was assessed. A modified version of the Client Satisfaction questionnaire was developed to obtain information about levels of satisfaction in such a setting and to evaluate training clinic-specific questions of interest, such as the impact of therapists' experience on satisfaction. Results indicated that client satisfaction is multidimensional. Consistent with other studies, satisfaction was greater among clients who were in therapy for longer periods of time, who completed treatment, and who sought therapy rather than an evaluation. Reasons for dissatisfaction included a wish for more directiveness or advice in therapy and concerns over videotaping procedures. Implications of these results for clinic administrators are discussed.

关键词：门诊医疗设施评价研究卫生设施负责人员卫生服务研究精神卫生服务/标准美国中西部病人满意度/统计学和数值数据心理学/教育问卷调查治疗结果

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Parent satisfaction with children's mental health services in a children's mental health managed care demonstration

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JOURNAL OF MENTAL HEALTH ADMINISTRATION 1996年第1期23卷 69-79页

作者： Heflinger, CA Sonnichsen, SE Brannan, AM VANDERBILT UNIV VANDERBILT INST PUBL POLICY STUDIESCTR MENTAL HLTH POLICY1207 18TH AVE SNASHVILLETN 37212 USA

This article presents findings from a quasi-experiment that included the use of satisfaction scales to compare parent's satisfaction with the services their children received through two different mental health care delivery systems, Satisfaction with the following three types of service were compared: (1) intake assessment during the admission process to any service setting (2) outpatient services, and (3) residential treatment including inpatient hospitalization and residential treatment centers (RTCs). Additionally, satisfaction with several areas of care (e.g., access, treatment process, therapist relationship, parent and family services, discharge and transition planning), as well as global satisfaction, was assessed. In general, parents whose children received services through an innovative continuum of care system reported significantly higher satisfaction with intake assessment and outpatient services than did parents whose children received care in a traditional fee-for-service system. Fewer differences were found in satisfaction with residential services.

关键词：青少年保健服务/标准儿童保健服务/标准病人医护连续性/标准政府机构保健福利计划雇员/标准管理医疗规划/标准军事医学模型组织管理北卡罗来纳/流行病学双亲/心理学病人满意度/统计学和数值数据试点项目青少年儿童人类

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