Feedback reports to the general practitioner (GP) on the patients' experiences: are GPs interested, and is this interest associated with GP factors and patient experience scores?

BACKGROUND: Patient experience feedback is key in patient centred health systems, but empirical evidence of general practitioner (GP) interest in it is sparse. We aimed to: (i) quantitatively estimate the level of GP interest for feedback reports on patient experience; (ii) explore determinants of such interest; and (iii) examine potential association between a priori interest and patient experience. METHODS: The patient experience survey included maximum 300 randomly selected patients for each of 50 randomly selected GPs (response rate 41.4%, n = 5,623). GPs were sent a postal letter offering feedback reports and were grouped according to their replies: (i) interested in the report; (ii) not interested. Associations between interest and GP variables were assessed with Chi-square tests and multivariate logistic regression, while associations between interest and scores for 5 patient experiences scales were assessed with multilevel regression models. RESULTS: About half (n = 21; 45.7%) of the GPs showed interest in the report by asking to receive the report. The only GP variable associated with a priori interest was being a specialist in general practice (58.6% vs. 23.5% for those without) (P = 0.021). Interest was significantly associated with the practice patient experience scale (4.1 higher score compared with those not interested, P = 0.048). Interest in the report had small and nonsignificant associations with the remaining patient experience scales. CONCLUSIONS: Almost half of the GPs, and almost 3 in 5 of specialists in general practice, were interested in receiving a GP-specific feedback report on patient experiences. Interest in the report was generally not related to patient experience scores.

Patient-reported experiences with general practitioners: a randomised study of mail and web-based approaches following a national survey.

OBJECTIVE: The standard data-collection procedure in the Norwegian national patient experience survey programme is post-discharge mail surveys, which include a pen-and-paper questionnaire with the option to answer electronically. A purely electronic protocol has not previously been explored in Norway. The aim of this study was to compare response rates, background characteristics, data quality and main study results for a survey of patient experiences with general practitioners (GPs) administered by the standard mail data-collection procedure and a web-based approach. DESIGN: Cross-sectional survey. SETTING: GP offices in Norway. PARTICIPANTS: The sample consisted of 6999 patients aged 16 years and older registered with a GP in November 2018. INTERVENTION: Based on a three-stage sampling design, 6999 patients of GPs aged 16 or older were randomised to one of two survey administration protocols: Group A, who were mailed an invitation with both a pen-and-paper including an electronic response option (n=4999) and Group B, who received an email invitation with electronic response option (n=2000). MAIN OUTCOME MEASURES: Response rates, background characteristics, data quality and main study results. RESULTS: The response rate was markedly higher for the mail survey (42.6%) than for the web-based survey (18.3%). A few of the background variables differed significantly between the two groups, but the data quality and patient-reported experiences were similar. CONCLUSIONS: Web-based surveys are faster and less expensive than standard mail surveys, but their low response rates and coverage problems threaten their usefulness and legitimacy. Initiatives to increase response rates for web-based data collection and strategies for tailoring data collection to different groups should be key elements in future research.

Response probabilities and response-mode preferences in a self-administered survey.

OBJECTIVE: Response rates in surveys continue to fall, and electronic online versions are increasingly replacing paper questionnaires in order to save costs and time. This can influence the composition of the respondent group in surveys. Using data from a national survey of patient experiences with maternity care, we aimed to (1) classify all of the women invited to participate in the study according to their different probabilities of responding, based on registry data, and (2) classify all of the respondents according to different probabilities of choosing a paper questionnaire when an online alternative was available, based on registry and self-reported data. RESULTS: We found that the likelihood of responding to surveys is strongly influenced by background variables, with the age, number of previous births and geographic origin predicting the response probability (range 0.25-0.73). Education level predicted the likelihood of choosing a paper questionnaire. Women with less education would more likely (probability 0.50) than women with more education (probability 0.38) choose a paper questionnaire rather than answering online.

[Parent assessment of outpatient child and adolescent mental health services]. / Foresattes vurdering av barne- og ungdomspsykiatriske poliklinikker.

BACKGROUND: Parent assessment of outpatient child and adolescent mental health services (CAMHS) is now part of the Norwegian quality indicator system. This national survey included a validated questionnaire that assessed three aspects of care from a parental perspective. MATERIAL AND METHODS: Questionnaires were mailed to 17,080 parents of children and adolescents receiving care from CAMHS on an outpatient basis between 1 September and 31 December 2006. Two postal reminders were sent and telephone interviews were conducted with a sample of non-respondents. 7 906 (46%) parents returned a completed questionnaire. Three scales about treatment providers, treatment outcome and information/influence were identified (scales scored 0 to 100 where 100 represent the best experiences). RESULTS: The parents were most satisfied with the treatment providers (national mean 75). The national mean for the treatment outcome was 72 and for the scale concerning information and patients' possibilities to influence decisions the mean score was 59. The clinic scores varied considerably; the score for information and influence varied most (48-68). Few scores were however significantly different from the national average. INTERPRETATION: Most parents have good experience with the CAMHS. The scale concerning information and influence has the greatest potential for improvement. Several CAMHS had higher scores for all aspects of parent experience and may have useful information to convey to other clinics.

The Norwegian patient experiences with GP questionnaire (PEQ-GP): reliability and construct validity following a national survey.

OBJECTIVES: The aim of this study was to test the reliability and validity of a new questionnaire for measuring patient experiences with general practitioners (PEQ-GP) following a national survey. SETTING: Postal survey among patients on any of 500 GPs patient lists in Norway. GPs were stratified by practice size and geographical criteria. PARTICIPANTS: 4964 patients who had at least one consultation with their regular GP in the foregoing 12 months were included in the study. The patients were randomly selected after the selection of GPs. 2377 patients (49%) responded to the survey. PRIMARY AND SECONDARY OUTCOME MEASURES: The items were assessed for missing data and ceiling effects. Factor structure was assessed using exploratory factor analyses. Reliability was tested with item-total correlation, Cronbach's alpha and test-retest correlations. Item discriminant validity was tested by correlating items with all scales. Construct validity was assessed through associations of scale scores with health status, the patients' general satisfaction with the services, whether the patient had been incorrectly treated by the GP and whether the patient would recommend the GP to others. RESULTS: Item missing varied from 1.0% to 3.1%, while ceiling effects varied from 16.1% to 45.9%. The factor analyses identified three factors. Reliability statistics for scales based on these three factors, and two theoretically derived scales, showed item-total correlations ranging from 0.63 to 0.85 and Cronbach's alpha values from 0.77 to 0.93. Test-retest correlation for the five scales varied from 0.72 to 0.88. All scales had the expected association with other variables. CONCLUSIONS: The PEQ-GP has good evidence for data quality, internal consistency and construct validity. The PEQ-GP is recommended for use in local, regional and national surveys in Norway, but further studies are needed to assess the instrument's ability to detect differences over time and between different GPs.

The Universal Patient Centeredness Questionnaire: reliability and validity of a one-page questionnaire following surveys in three patient populations.

BACKGROUND: This study developed and tested the reliability and validity of the Universal Patient Centeredness Questionnaire (UPC-Q). METHODS: The UPC-Q developed in this study has three parts: 1) the aspects that patients consider the most important when receiving a relevant health care service, rating the health care services on these aspects and their prioritization, 2) the overall experiences of patients using the relevant health care service, and 3) suggestions for improvements. The UPC-Q was tested in four different patient-experience surveys in 2015, including psychiatric inpatients (n=109), general practitioner (GP) patients (n=1,059), and inpatients from two hospital samples (n=973, n=599). The UPC-Q was tested for item completeness and ceiling effects, while the UPC-Q scale consisting of the first part of the UPC-Q was tested for internal consistency reliability and construct validity. RESULTS: The percentage of patients rating at least one aspect was 70.6% for psychiatric inpatients, 77.6% for hospital inpatients, and 90.6% for GP patients, while 88.9% of the psychiatric inpatients, 93.1% of the hospital inpatients, and 95.3% of the GP patients were able to prioritize the aspects. The internal consistency reliability of the UPC-Q scale was acceptable in all samples (Cronbach's alpha >0.7), and construct validity was supported by 20 of 21 significant associations between the UPC-Q and related variables. The UPC-Q total score was skewed toward positive evaluations, but the ceiling effect was smaller for an unbalanced response scale than for a balanced scale. CONCLUSION: The UPC-Q includes ratings of what is most important for individual patients, while at the same time providing data for improving the quality of health care and making it possible to monitor trends within and across patient populations. This study included psychiatric inpatients, hospital inpatients, and GP patients, and found that the UPC-Q performed well in terms of acceptance, internal consistency reliability, and construct validity.

The Cancer Patient Experiences Questionnaire (CPEQ): reliability and construct validity following a national survey to assess hospital cancer care from the patient perspective.

OBJECTIVES: Patient experience questionnaires have been criticised owing to the lack of supporting psychometric evidence. The objective of this study was to describe the development and psychometric evaluation of the Cancer Patient Experiences Questionnaire (CPEQ) in Norway. DESIGN: Questionnaire development was based on a literature review of existing questionnaires, patient interviews, expert-group consultations, pretesting of questionnaire items and a national survey. Psychometric evaluation included exploratory and confirmatory factor analysis, and tests of internal consistency reliability and test-retest reliability. SETTING: Data were collected using a postal survey of cancer patients attending 54 hospitals in all 4 health regions. The subjects were 14 227 adult cancer patients who had attended an outpatient clinic or who had been discharged from an inpatient ward. Patients with all types of cancer were included. Data quality, internal consistency reliability and construct validity were assessed. RESULTS: Of the 13 846 patients who received the CPEQ, 7212 (52%) responded. Exploratory factor analysis identified six scales of outpatient experiences relating to nurse contact, doctor contact, information, organisation, patient safety and contact with next of kin, and seven scales of inpatient experiences, with the addition of hospital standard to the aforementioned scales. All but two of the scales met the criterion of 0.70 for Cronbach's α testing, and test-retest correlations ranged from 0.57 to 0.85. Confirmatory factor analysis supported the interpretation of six and seven scales for outpatients and inpatients, respectively. Statistically significant associations based on explicit hypotheses provided evidence for the construct validity of the scales. One additional scale measuring the hospital level was identified (α=0.85). CONCLUSIONS: The CPEQ is a self-report instrument that includes the most important aspects of patient experiences with cancer care at hospitals. The instrument was tested following a national survey in Norway; good evidence is provided herein for the internal consistency reliability, test-retest reliability and construct validity.

Determinants of parents' experiences with outpatient child and adolescent mental health services.

BACKGROUND: Few studies have investigated how demographic, clinical and organizational characteristics influence parents' experiences with child and adolescent mental health services (CAMHS). The objective of this study was to determine the effects of these characteristics on parents' experiences using data from a large national postal survey. METHOD: A questionnaire was mailed to 17,871 parents or other primary caregivers whose children were attending 1 of the 86 outpatient CAMHS in Norway in 2006. Multiple regression analysis was used to explore the associations between demographic, clinical and organizational characteristics, and three scales of parents' experiences. RESULTS: The questionnaire was completed by 7906 parents (46%). Organizational characteristics such as involvement of the parents in treatment and accessibility to the clinic explained most of the variation in all three scales of parents' experiences. Although the effects of demographic and clinical characteristics of the children in some instances were statistically significant, they only accounted for a small amount of the total explained variance. CONCLUSION: Accessibility to the clinic and involvement of the parents in treatment are much stronger predictors of parental experiences with outpatient CAMHS than are demographic and clinical variables. Accessibility and involvement are at least partly influenced by the clinics themselves, and hence parental satisfaction may be enhanced by making the clinics more accessible and by involving the parents/caregivers in the treatment.

Parent experiences questionnaire for outpatient child and adolescent mental health services (PEQ-CAMHS Outpatients): reliability and validity following a national survey.

UNLABELLED: ABSTACT: BACKGROUND: Development and evaluation of the PEQ-CAMHS Outpatients, a parent completed questionnaire to measure experiences of outpatient child and adolescent mental health services (CAMHS) in Norway. METHODS: Literature review, parent interviews, pre-testing and a national survey of 17,080 parents of children who received care at one of the 86 outpatient CAMHS in Norway in 2006. Telephone interviews were conducted with a random sample of non-respondents. Levels of missing data, factor structure, internal consistency and construct validity were assessed. RESULTS: 7,906 (46.0%) parents or primary caregivers responded to the questionnaire. Low levels of missing data suggest that the PEQ-CAMHS is acceptable. The questionnaire includes three scales supported by the results of factor analysis: relationship with health personnel (8 items), information and participation (4 items), and outcome (3 items). Item-total correlations were all above 0.6 and Cronbach's alpha correlations ranged from 0.88-0.94. The results of comparisons of scale scores with several variables relating to global satisfaction, outcome, cooperation, information, involvement and waiting time support the construct validity of the instrument. CONCLUSIONS: The PEQ-CAMHS Outpatients questionnaire includes important aspects of outpatient CAMHS from the perspective of the parent. It has evidence for data quality, internal consistency and validity and is recommended in surveys of parent experiences of these services. Future research should assess test-retest reliability and further tests of construct validity that include clinical data are recommended.