Patient satisfaction and quality of life in cancer outpatients: results of the PASQOC study.

BACKGROUND: Satisfaction with care and quality of life (QoL) are indicative of the quality of care of cancer patients. The purpose of this study was to lay a cornerstone for patient-centred quality management by assessing the current status of satisfaction with care and QoL among oncological outpatients in Germany, and by identifying the key factors that determine a patient's willingness to recommend a medical facility. PATIENTS AND METHODS: A self-constructed and validated patient satisfaction questionnaire plus the SF-36 were distributed to a random sample of 3384 cancer patients who presented at 24 investigators' offices nationwide within a defined recruiting period and who met the inclusion criteria. The return rate was 81.9% (n=2772). A total of 2659 (78.6%) questionnaires were evaluable. The most common cancer types were breast (22.9%) and intestine (19.8%). RESULTS: Overall satisfaction was high, but specific reporting questions revealed many areas for improvement such as shared decision making, doctor-patient communication and organization of care. QoL was significantly impaired in many domains. Patient-provider relationship, facility setting and information on diagnosis and treatment options are major determinants of a patient's willingness to recommend a facility to a friend or relative if needed. CONCLUSIONS: This multicentre study focusing on patient perspectives highlights that, although the overall degree of satisfaction was quite high, there are numerous areas for improvement.

[Quality in public health. Deficits, concepts and political quality key issues from the ministerial viewpoint]. / Qualität im Gesundheitswesen. Defizite, Konzepte und qualitätspolitische Eckpunkte aus ministerieller Sicht.

To preserve the quality of the German health care system as well as continuously optimize it towards the needs stated by ethics and law, an inter-professional and inter-institutional quality policy is required. It should be patient-centered, focus on process management and be based on EN ISO-Standards adapted to the specific needs of health care. The latter could provide internationally compatible models for quality management and quality improvement including economic efficiency. The 40 nation Council of Europe's 5th European Conference of Health Ministers in Warsaw as well as the 69th Conference of German Federal State Health Ministers (GMK) at Cottbus, who tackled the issue in November 1996, pointed out essential aspects. The GMK stated a lack of effective general concepts, quality control and patients' rights protection in Germany. Both conferences demanded equity, social justice and an active participation of patients in the setting of quality standards and the conception, functioning and control of health care. This includes rationalisations by using the limited funds in a most effective way.

The surgical treatment of Graves' disease.

A series of 215 patients treated surgically for Graves' disease between 1981 and 1988 were studied and compared with an earlier series of 105 patients operated upon in the same establishment between 1966 and 1980. More than 85 percent of the patients in the two series had long term follow-up evaluation. Surgical complications were rare in both series, with an overall morbidity rate of 2.7 percent, the rate of permanent recurrent laryngeal paralysis decreasing from 1 to zero percent and that of permanent hypoparathyroidism increasing from 1.0 to 1.9 percent. The incidence of residual or recurrent hyperthyroidism decreased markedly from 11.0 to 3.7 percent. This improvement can no doubt be attributed to bilateral subtotal lobectomy having been abandoned in favor of total lobectomy on one side and subtotal on the other. In contrast, this approach increases the incidence of hypothyroidism, with the rate rising from 13.0 to 48.7 percent. Long term monitoring is always necessary because results change during the course of time.

The impact of population growth on national economic development.

PIP: Economic models have been used to evaluate the effects of different fertility levels upon economic development and percapita income. Ruprecht and Wahren contend that the economic impact of decreased population is dismissed as being insignificant in the short run since advantages accrued from the reduction are not recognized for 20 to 30 years after onset. Additionally the authors show the relationship between population and percapita income under 3 varying conditions of economic sucess.^ieng

Family planning programs in developing countries.

PIP: Family planning programs in various developing countries are reviewed in the following areas: history, current activities, the role of foreign assistance, success, and future effectiveness. Foreign assistance--1st, private; then foundation and governmental--has played a major role in the formation of most developing nation family planning programs. Programs differ according to their national population policies and the degree of government involvement. Funding for selected programs is duscussed and tabulated. International aid has been instrumental in the last 2 decades in creating a generally favorable public opinion toward family planning. It is felt that foreign assistance will provide less operational aid in the future and be used more for research and evaluative activities. The programs will be considered to be progressing as less foreign aid is needed and more domestic aid provided. The problems with evaluating family planning programs by crude birth rate or births averted measurements are mentioned. Evaluation is made more difficult by the fact that programs receive credit for other socioeconomic changes which occur in the community. A multiple regression fertility model can be used to assess quantitative success in family planning programs. Contraceptive usage levels and continuation rates as part of the measure of success of any family planning program are discussed. These programs must struggle against loss of momentum.^ieng