Psychometric evaluation of a Patient Satisfaction Survey Questionnaire to assess advanced practice nurse ambulatory services in primary care.

AIM: To determine the construct validity and test-retest reliability of the Patient Satisfaction Survey Questionnaire (PSSQ). BACKGROUND: Advanced practice nurses (APNs) co-manage patients with non-communicable diseases (NCDs) with public primary care physicians in Singapore. The original Nurse Practitioner Satisfaction Survey (NPSS) instrument was adapted (renamed as PSSQ) to assess satisfaction with APN service. METHOD: A total of 209 patients self-administered the PSSQ at first visit and repeated it in a retest through phone within the next 2 weeks in 2018. Cronbach's alpha and intra-class correlation (ICC) coefficients were performed to evaluate the internal consistency and test-retest reliability. Construct validity was determined by confirmatory factor analysis (CFA). RESULTS: The overall Cronbach's alpha (>0.7) and ICC scores (0.697-0.729) indicated excellent test-retest reliability and good internal consistency, respectively. The CFA results of three-factor model showed poor fit. Additional exploratory factor analysis (EFA) and principal component analysis (PCA) with varimax rotation revealed that adding another factor (communication with physician) resulted in a better model (eigenvalue > 1). The ICC for the four-factor model ranged from 0.664 to 0.825, indicating fair to excellent reliability. CONCLUSION: The PSSQ shows good internal consistency and test-retest reliability. The four-factor model is a better instrument to assess APN service in local populations. IMPLICATIONS FOR NURSING MANAGEMENT: The validated PSSQ can be used as instrument to assess the quality of services provided by various categories of nurses, including registered nurses, nurse clinicians and APNs.

Position Statement on Secukinumab in the Management of Plaque Psoriasis: The Malaysian Perspective.

Psoriasis is a chronic inflammatory skin disease affecting nearly 10% of dermatologic patients in Malaysia. Treatment options include topical agents and phototherapy as well as nonbiologic and biologic systemic therapy. Mild psoriasis can often be managed with topical agents. However, managing moderate to severe psoriasis is more challenging and may require systemic treatment with nonbiologics or biologics. Despite the availability of several biologics, there are many unmet clinical needs, which may be addressed by secukinumab, an IL-17A inhibitor. This position statement is based on an expert panel discussion and is intended to provide dermatologists an overview of existing options as well as to provide a better understanding of secukinumab and how it can be integrated into current practice. During the discussion, panel members examined current approaches and the role of secukinumab in plaque psoriasis management. Panel members estimated that up to 30% of patients have moderate to severe psoriasis but only 1-2% receive biologics. Highlights from the discussion were that (i) the threshold for biologic use should be lower, in line with international guidelines; (ii) studies have shown that secukinumab has several advantages over other biologics which are greater efficacy, sustained efficacy over time, rapid onset of action, and early evidence of possible disease-modifying potential; and (iii) ideal candidates for secukinumab are all patients of moderate to severe psoriasis, including those with history of treatment failure, difficult-to-treat patterns of psoriasis (nail, scalp, and palmoplantar psoriasis), psoriatic arthritis, and comorbidities and those aiming for clear skin. Panel members recommend that secukinumab be considered first line option among biologic therapies.

Test-retest reliability of the Mandarin versions of the Hypertension Self-Care Profile instrument.

Self-efficacy in essential hypertension can be measured using scales, such as the "Hypertension Self-Care Profile" (HTN-SCP) questionnaire. It assesses "Behavior", "Motivation", and "Self-efficacy" in 3 domains, respectively. This study aimed to validate the Mandarin version of HTN-SCP instrument (HTN-SCP-Mn) targeted at patients of Chinese ethnicity with hypertension.Our study recruited Chinese patients, aged 40 years and older, with essential hypertension from a public primary healthcare clinic in Singapore. The 60-item HTN-SCP-Mn questionnaire was completed online using a tablet or smartphone on enrolment. A retest was conducted 2 weeks after the initial test. Reliability was assessed by internal consistency and test-retest reliability using Cronbach alpha and intraclass correlation coefficients (ICC). Differences between the overall HTN-SCP-Mn scores of the patients and their self-reported self-management activities were also determined using independent t test.Of the 153 patients who completed the HTN-SCP-Mn during the initial test, 79 responded to the test-retest evaluation. Reliability of the 3 domains "Behavior", "Motivation", and "Self-efficacy" obtained high internal consistency (Cronbach alpha = 0.838, 0.929, and 0.927, respectively). The item total correlation ranged from 0.058 to 0.677 for Behavior, 0.374 to 0.798 for Motivation, and 0.326 to 0.767 for self-efficacy. The ICC indicated fair to good test-retest reliability with scores of 0.643, 0.579, and 0.710 for the respective domains.The results showed face validity of the HTN-SCP-Mn instrument, indicating its potential application in mandarin-proficient patients. Further study is needed to correlate its scores with objective demonstration of self-efficacy.

Quality of life and cost of illness in patients with psoriasis in Malaysia: a multicenter study.

BACKGROUND: Psoriasis is an immune-mediated, chronic, inflammatory skin disease which affects approximately 2% of the world's population. It has a major impact on the patient's quality of life (QoL), influencing career, social activities, family relationships, and all other aspects of life. Many studies have described the various ways in which psoriasis can affect a patient's life. Very little is known, however, about the impact of psoriasis on the QoL of patients treated in Malaysia and the cost of illness in this region. OBJECTIVES: This study aims to describe the extent to which psoriasis affects the QoL of patients treated in government-run dermatology clinics in Malaysia and to estimate the cost of illness. METHODS: A total of 250 psoriasis patients treated at eight dermatology clinics in government-run hospitals in Malaysia were studied. The severity of psoriasis was assessed by dermatologists. Quality of life was evaluated using the Dermatology Life Quality Index (DLQI) and Version 2 of the 12-Item Short-Form Health Survey (SF-12v2). Scores on the SF-12v2 of healthy subjects and of patients with other medical conditions, such as depression, diabetes mellitus, hypertension, and ischemic heart disease, were also assessed for comparison. The costs of dermatology outpatient consultant fees, medications, investigations, procedures, transportation, over-the-counter medications, and hospitalization were retrospectively estimated using questionnaires. RESULTS: The cohort studied had a median Psoriasis Area Severity Index (PASI) score of 9.9 and a median DLQI score of 10.0. The average SF-12v2 scores were 43.68 (standard deviation [SD] 9.23) and 42.25 (SD 10.7) on the Physical Health Summary and Mental Health Summary, respectively. The impact of disease on QoL was found to be greater in those with more extensive psoriatic lesion involvement, in younger patients, and in those with psoriatic arthropathy. Psoriasis was found to affect QoL in both genders equally. Body mass index had no effect on the severity of psoriasis or QoL. Patients with psoriasis had a significantly lower SF-12v2 score than healthy subjects. Comparisons with data for patients with other chronic medical conditions demonstrated that psoriasis has a negative effect on health-related QoL similar to the impact of other chronic conditions. The estimated cost of illness for psoriasis in the current cohort was ringgit Malaysia (RM) 1307.47 per person per year excluding costs of hospitalization. Patients were noted to spend a large amount of money on over-the-counter products obtained without doctors' prescriptions. CONCLUSIONS: The QoL of patients with psoriasis was significantly impaired compared with that of healthy subjects and was comparable with that of patients with other chronic medical illnesses. The estimated cost of illness of psoriasis in the current study was lower than in other countries, mainly because healthcare costs in public hospitals are heavily subsidized by government and because usage of newer but more expensive treatment options is low in Malaysia.

Impact of cigarette smoking on symptoms and quality of life of adults with asthma managed in public primary care clinics in Singapore: a questionnaire study.

BACKGROUND: Cigarette smoking aggravates asthma exacerbations, yet some patients with asthma continue to smoke. AIMS: To compare the quality of life of adult smokers and non-smokers with asthma. METHODS: Asthma Quality of Life (AQLQ) questionnaires were administered to adult patients with asthma managed in primary care in Singapore. The survey also included data of their asthma status including symptom profiles. Independent two-sample t-test, ANCOVA model, χ2 test and ordinal logistic regression were used to compare the mean domain scores and the effect of smoking on nocturnal symptoms and awakening, respectively. RESULTS: 357 adult asthma patients (183 non-smokers and 174 smokers) were recruited. Smokers were mainly male (p<0.001), single (p=0.008), and younger (mean age 30 years) (p=0.007). They were more affected by nocturnal cough and wheezing (p=0.016). After adjustment for age, gender, and asthma medications, the mean scores of the AQLQ 'symptoms' and 'emotional function' domains of smokers were 0.41 (95% CI 0.10 to 0.72) and 0.50 (95% CI 0.16 to 0.84) points lower than for non-smokers, with no statistical differences in the 'activity limitations' and 'exposure to environmental stimuli' domains. CONCLUSIONS: Adult patients with asthma who smoke are more affected by nocturnal symptoms, with lower 'emotional function' scores in the AQLQ.