Are Patients Satisfied with Government Health Care? A Study on Patient’s Level of Satisfaction and Their Perception of Violence Against Doctors at A Government Hospital in North Karnataka, India

Background: The level of patient satisfaction must be evaluated periodically to assess the quality of health care provided by the government and to improve health care delivery in developing nations. The purpose of the study is to determine the level of patient satisfaction and their perception of violence against doctors among in-patients attending government teaching hospital. Methodology: It was a cross-sectional study among in-patients of government teaching hospital in North Karnataka. A predesigned structured Patient Satisfaction Questionnaire –18 (PSQ–18), along with self-framed violence questionnaire was used as study tools. Descriptive Statistics, ANOVA & Kruskal - Wallis tests were done using SPSS version 16. Results: The mean score for overall satisfaction was 3.72± 0.387. The mean patient satisfaction was highest for interpersonal manner (4.00 ±0.72) & the least was accessibility and convenience (3.52±0.58). Among the study subjects47.5% had heard about the violence against the doctors, 33.5% said violence against doctors is on rise. Violence against doctors was unethical according to 57.5% and 60% said it must summon punish-ment. Conclusions: The overall patient satisfaction was good; accessibility and convenience need to be improved. The study helps in understanding patient’s needs in various dimensions of health care.

Translation and cross-cultural adaptation of the pediatric sleep questionnaire (PSQ*) into Brazilian Portuguese / Tradução e adaptação transcultural do pediatric sleep questionnaire (PSQ*) para o português do Brasil

Abstract Introduction Obstructive sleep apnea is a frequent entity in childhood that can lead to important consequences for the health and children's quality of live. Polysomnography is the gold-standard exam to diagnose obstructive sleep apnea, but it is expensive, complex, and poorly affordable in Brazil. The pediatric sleep questionnaire has shown to be a valuable screening test for obstructive sleep apnea. It is a simple questionnaire with good sensitivity and specificity compared to polysomnography in the countries where it has been validated. Objective Translation and cross-cultural adaptation of the pediatric sleep questionnaire (PSQ), into Brazilian Portuguese. Methods The translation of the PSQ into Brazilian Portuguese was carried out in accordance with good practices. The validated and adapted questionnaire was applied to parents/caregivers of 60 children (40 of them with obstructive sleep apnea and 20 controls) aged 2-18 years. Retest was applied to 30 children with obstructive sleep apnea. The following tests were performed: internal consistency, test-retest, validation of questionnaire (the latter by ROC curve). Results Brazilian PSQ has shown high internal consistency by Cronbach's alpha (0.86 for the total test, 0.83 for subscale "snoring", 0.64 for "sleepiness" and 0.65 for "behavior"). Test-retest presented a correlation of 0.89 for subscale "snoring", 0.93 for "sleepiness" and 0.86 for "behavior". Accuracy by ROC curve was 0.99. Nine was considered the optimal value to discriminate patients with obstructive sleep apnea from controls, with a sensitivity of 0.92 and specificity of 1.0. Conclusion The translation and cross-cultural adaptation of the PSQ into Brazilian Portuguese proved to be successful. In places with difficult access to polysomnography, PSQ can be a useful tool in screening and follow-up of children with obstructive sleep apnea.

Resumo Introdução A apneia obstrutiva do sono é uma doença comum na infância que pode trazer consequências importantes para a saúde e qualidade de vida das crianças. O exame padrão‐ouro para o diagnóstico (polissonografia) é um exame caro, complexo e disponível em poucos centros. O pediatric sleep questionnaire, PSQ, tem demonstrado ser um bom teste de triagem para apneia obstrutiva do sono, por ser um questionário simples e com boa sensibilidade e especificidade quando comparado à polissonografia nos países em que foi validado. Objetivo Tradução e adaptação transcultural do PSQ para o português do Brasil. Método Foi feita a tradução do PSQ para o português do Brasil, de acordo com as boas práticas. O questionário validado e adaptado foi aplicado aos pais/responsáveis de 60 crianças com 2-18 anos, 40 com apneia obstrutiva do sono e 20 controles. O reteste foi feito em 30 crianças com apneia obstrutiva do sono. Foram avaliados: consistência interna, teste‐reteste, validação do conteúdo e acurácia do questionário, pela curva ROC (do inglês receiver operating characteristic curve). Resultados O PSQ‐Brasil apresentou alta consistência interna, pelo coeficiente Alfa de Cronbach (0,86 para o teste total; 0,83 para o subdomínio "ronco"; 0,64 para "sonolência" e 0,65 para "comportamento". O teste‐reteste teve concordância de 0,89 para o subdomínio "ronco"; 0,93 para sonolência" e 0,86 para "comportamento". A acurácia medida pela curva ROC foi de 0,99. O valor de 9,0 foi considerado ideal para diferenciar os pacientes com apneia obstrutiva do sono e controles, com sensibilidade de 0,92 e especificidade de 1,0. Conclusão A tradução e adaptação transcultural do PSQ para o português do Brasil mostrou‐se bem‐sucedida. Em locais com dificuldade de acesso à polissonografia, o PSQ pode ser uma ferramenta útil na suspeição diagnóstica e seguimento das crianças com apneia obstrutiva do sono.

Prevalencia de trastornos respiratorios del sueño en pacientes asmáticos que se controlan en el Hospital Roberto del Río: estudio piloto / Prevalence of sleep breathing disorders in asthmatic patients monitored at Roberto del Río Hospital: a pilot study

Introducción. El asma es una de las enfermedades crónicas más frecuentes en niños. Múltiples estudios han sugerido que en la infancia presenta una asociación significativa con los trastornos respiratorios del sueño, con una prevalencia en niños asmáticos de un 24%. El objetivo fue determinar la prevalencia de trastornos respiratorios del sueño (TRS) en pacientes con asma controlados en un hospital pediátrico (6-15 años). Pacientes y Método. Estudio transversal descriptivo. Se aplicaron los cuestionarios de sueño pediátrico validado en español (pediatric sleep questionnaire, PSQ) y el Cuestionario de Control del Asma en Niños (CAN) a los padres de los niños con diagnósticos de asma controlados en Hospital Roberto del Río, vía telefónica y vía email. Resultados: La prevalencia de TRS fue de 34,8%. Un 20% presenta mal control de asma definido como CAN >8. Un 58,1% de los padres reportaron sobrepeso en los pacientes Conclusiones: la prevalencia de TRS en los niños estudiados es alta y obliga a investigar en cada consulta por estos síntomas. Aplicar la encuesta en cada consulta, de forma online podría aportar al conocimiento de estos pacientes y mantener la prevalencia del problema actualizada, para focalizar las intervenciones apropiadas.

Introduction. Asthma is one of the most frequent chronic diseases in children, multiple studies have suggested that in childhood it presents a significant association with sleep-disordered breathing, with a prevalence in asthmatic children of 24%.The objective was to determine the prevalence of sleep-disordered breathing (RRT) in patients with asthma controlled in a pediatric hospital (6-15 years). Patients and Methods. Descriptive cross-sectional study. The pediatric sleep questionnaire (PSQ) and the Child Asthma Control Questionnaire (CAN) were applied to the parents of children with controlled asthma diagnoses at Hospital Roberto del Río, by telephone and via e-mail. Results: The prevalence of RRT was 34.8%. 20% have poor asthma control defined as CAN> 8. 58.1% of parents reported overweight in patients Conclusions: the prevalence of RRT in the children studied is high and makes it necessary to investigate these symptoms at each visit. Applying the survey in each consultation, online, could contribute to the knowledge of these patients and keep the prevalence of the problem updated, in order to focalized the interventions.

Factors affecting bypass of local health care facilities in a tertiary hospital: A key to utilization of primary health care services

Background@#Bypass, is a pattern of seeking health care outside the local community where primary health care facilities are not efficiently utilized. It is common practice for patients to go directly to secondary or tertiary health facilities for primary health concerns, causing heavy traffic at the higher level facilities and corresponding over-utilization of resources.@*Objective@#This study aimed to determine factors associated in the bypass of health care facilities among outpatient department patients and to identify health care facility factors perceived important among patients.@*Method@#The study employed self-administered questionnaire with the assistance of trained research assistants among patients who sought consult at the Baguio General Hospital and Medical Center Outpatient Department during the study period of August 2018 – October 2018. Respondents were asked about demographic characteristics, health insurance status, referral status, health care facility factors and answer the Personal Satisfaction Questionnaire 18 (PSQ 18) survey.@*Results@#The questionnaire survey included 251 patients. The total rate bypassing of local health care facilities was 37.8%. Pearson chi square test revealed that educational attainment was associated with increased bypass of health care facilities (p=0.013). Factors such as age, sex, civil status, employment status, monthly income and health insurance status were significantly associated with bypass. Availability of medical doctors was the most prevelant factor in choosing a health care facility in both bypassers (36%) and non bypassers (46%). PSQ 18 survey revealed that patients are generally satisfied on the availment of health services in both bypassers (mean 3.78) and non bypassers (mean 3.89). The subscales in communication, time spent with doctor and accessibility and convenience were scored highest while technical quality was scored lowest on both groups.@*Conclusion@#Bypass of local health care facilities is a major health concern. Travelling longer distances for health care imposes unnecessary shift of direct health care costs into indirect costs such as transport. Increasing awareness of available local health care facilities and services together with its improvement might help decrease bypass especially on patients with lower educational attainment. The referral system and network of health care providers should be reinforced for better health care service delivery, patient satisfaction and lower health care cost.

Study of satisfaction of diabetic patients attending the diabetic clinic at primary health centers in Abha city, Saudi Arabia.

Background: With the ageing of the population and the advances in the treatment of chronic diseases, the teamwork in the context of chronic diseases needs to be re-examined. Patients with chronic diseases have to pay repeated visits to PHC clinics, usually for the rest of their lives. These patients are usually more difficult to satisfy. Patient satisfaction is the extent to which the patients feel that their needs and expectations are being met by the service provided. It has been a widely recognized indicator of quality of care in medical practice. Aims & Objective: This study aims to assess patients’ satisfaction with the main aspects of primary health care provided at the Chronic Diseases Clinic, identify areas of health care that show low satisfaction and Identify determinants of patients’ satisfaction. Materials and Methods: A cross sectional study was carried out among a representative random sample of registered patients, at randomly selected two PHCCs in Abha, KSA. The tool used for data collection consisted of two parts; the first part was about the personal information of the participants, while the second part was the Arabic version of Modified patient satisfaction questionnaire (PSQ-18). Results: The study include 600 patients, almost one fourth of participants aged above 60 years, while 37% of them aged 50-60 years and 38.7% of them aged below 50 years. Of the respondents, 13% were dissatisfied, while 87% were satisfied (i.e., 44% were moderately satisfied and 43% were highly satisfied).This study revealed significantly lower levels of satisfaction among diabetic patients who attended at Al-Qabel PHCC than those who attended at Al-Manhal PHCC, i.e. pre-clinic items (67.7% vs. 76%, respectively); clinic items (81% vs. 92.3%, p<0.001); post-clinic items (86.3% vs. 92.3%, p<0.001) and overall satisfaction (81.3% vs. 92.7%, p<0.001. Regarding diabetic patients’ grades of overall satisfaction, the highest proportion of dissatisfaction was observed among patients aged <50 years, males, lower levels of education and higher monthly income. Unemployed patients expressed significantly higher grades of satisfaction than employed patients (p=0.005). Conclusion: This study concluded that diabetic patients’ satisfaction grade was least toward pre-clinic (i.e., PHCC accessibility, availability of parking areas, comfortable waiting area, short waiting times and measurement of patient’s vital signs before meeting the physician) followed by post-clinic items (i.e., performing the necessary routine investigations, availability and accessibility of labs within the PHCC, availability of medications within the PHCC’s pharmacy).Patients’ characteristics associated with less satisfaction include younger age, male gender, higher education, employment and higher monthly income.