Patient-Assessed Chronic Illness Care (PACIC) scenario in an Indian homeopathic hospital.

Homeopathy research has focused on chronic conditions; however, the extent to which current homeopathic care is compliant with the Chronic Care Model (CCM) has been sparsely shown. As the Bengali Patient-Assessed Chronic Illness Care (PACIC)-20 was not available, the English questionnaire was translated and evaluated in a government homeopathic hospital in West Bengal, India. The translation was done in six steps, and approved by an expert committee. Face validity was tested by 15 people for comprehension. Test/retest reliability (reproducibility) was tested on 30 patients with chronic conditions. Internal consistency was tested in 377 patients suffering from various chronic conditions. The questionnaire showed acceptable test/retest reliability [intraclass correlation coefficient (ICC) 0.57-0.75; positive to strong positive correlations; p < 0.0001] for all domains and the total score, strong internal consistency (Cronbach's α = 0.86 overall and 0.65-0.82 for individual subscales), and large responsiveness (1.11). The overall mean score percentage seemed to be moderate at 69.5 ± 8.8%. Gender and presence of chronic conditions did not seem to vary significantly with PACIC-20 subscale scores (p > 0.05); however, monthly household income had a significant influence (p < 0.05) on the subscales except for "delivery system or practice design." Overall, chronic illness care appeared to be quite promising and CCM-compliant. The psychometric properties of the Bengali PACIC-20 were satisfactory, rendering it a valid and reliable instrument for assessing chronic illness care among the patients attending a homeopathic hospital.

A validation study of homeopathic prescribing and patient care indicators.

A preliminary version of the homeopathic prescribing and patient care indicators was available. The instrument was modified further in this study with an intention to address formally its validity and reliability, audit prescriptions, identify areas of sub-optimal prescribing, and highlight target areas for improving the quality of practices. A cross-sectional study with record analysis was conducted on systematically sampled 377 patients of Mahesh Bhattacharyya Homeopathic Medical College and Hospital (MBHMC and H), Howrah, West Bengal, India. The outcome measures were homeopathic prescribing indicators (6 items) and patient care indicators (5 items). Individualized homeopathic prescriptions predominated in the encounters. Areas demanding immediate attention were extremely poor labeling of drugs dispensed from the hospital pharmacy, improper record of case history and disease diagnosis, ongoing therapies, and investigational findings in the prescriptions. Internal consistency of the overall instrument was estimated to be good (Cronbach's alpha: Prescribing indicators 0.752 and patient care indicators 0.791). The prescribing indicators, except items 1 and 3, reflected acceptable item-corrected total correlations - Pearson's r from 0.58 (95% CI: 0.52-0.65) to 0.74 (95% CI: 0.69-0.78). The patient care indicators, except item 2, showed acceptable correlations - Pearson's r from 0.40 (95% CI: 0.31-0.48) to 0.82 (95% CI: 0.78-0.85). The instrument also showed high discriminant validity (prescribing indicators P < 0.0001 and patient care indicators P < 0.0001). Improper prescribing practice was quite rampant and corrective measures are warranted. The developed indicators appeared to be validated and reliable; however, they are amendable for further development.

Patient activation measures in a government homeopathic hospital in India.

The American Patient Activation Measure-22 questionnaire (PAM-22) quantifies the knowledge, skills, and confidence essential to manage own health and health care. It is a central concept in chronic illness care models, but studied sparsely in homeopathic hospitals. PAM-22 was translated into Bengali and a cross-sectional study was undertaken in chronically ill 417 patients visiting the outpatient clinic of Mahesh Bhattacharyya Homeopathic Medical College and Hospital, India. Response rate was 90.41%. Data were analyzed using Rasch rating scale model with Winsteps. Activation score was 54.7 ± 8.04 or 62.13% of maximum score. PAM scores differed significantly by age, education, income, and health status (P < .05). The items had good data quality fit statistics and good range of difficulty. The construct unidimensionality was confirmed by good model fits for Rasch model and principal component analysis of residuals found no meaning structure. The questionnaire showed acceptable psychometrics. Patient activation was moderate and needs to be improved.

Evaluación de la satisfacción de los pacientes en un hospital homeopático gubernamental en Bengala Occidental, India / Assessment of patient satisfaction in a government homeopathic hospital in West Bengal, India

Introducción y objetivos: la determinación del grado de satisfacción de los pa¬cientes de un hospital homeopático puede producir un impacto sustancial en los esfuerzos para mejorar el estado de salud y la calidad de la atención proporcionada. En este trabajo, los investigadores evaluaron el grado de satisfacción de los pacientes después de recibir consulta médica, al igual que la validez y la confiabilidad del interrogatorio al que se sometieron. Métodos: estudio transversal con diseño observacional realizado en febre¬ro de 2013, con 390 voluntarios, en cinco unidades de consulta externa de la Facultad y Hospital de Medicina Homeopática Mahesh Bhattacharyya, perteneciente a la red pública de Bengala Occidental (Howrah, India). Fue auto-aplicado un breve cuestionario de satisfacción con consultas médicas, elaborado en Japón y traduci¬do al bengalí, con 12 ítems de respuesta múltiple en una escala tipo Likert de cinco puntos. El cuestionario generó cinco subescalas: satisfacción general, examen completo, cuidado completo de la persona, duración de la consulta y centralidad en el paciente. Las respuestas de cada ítem y sub-escala también incluían una escala visual analógica (EVA) de 100 mm. Resultados: el cuestionario se mostró válido y confiable. Su consistencia interna fue comprobada por valores entre 0.7 y 0.9 del coeficiente alfa de Cronbach (α), y la confiabilidad test-retest por el coeficiente kappa de Cohen (κ), cuyo valor fue superior a 0.7 en todos los ítems. La validez concurrente del coeficiente r de Pearson correspondiente al puntaje total del cuestionario y las EVA fue de 0.60, p<0.001; puntaje de cada escala 0.8 < r < 0.9, p<0.0001, y puntaje de cada ítem 0.8 < r < 0.9, p<0.0001.[...] En general, los pacientes reportaron alta satisfacción. Nuevos estudios son necesarios para adaptar el cuestionario utilizado en este trabajo a otros idiomas para uso global.

Discovering the degree of patient satisfaction in a homeopathic hospital setting may put substantial impact in improving health status and quality of care provided. In this study, the researchers evaluated the degree of patient satisfaction following medical encounters and re-examined the validity and reliability of the used questionnaires. An institutional, cross-sectional, observational study was carried out involving 390 participants in February, 2013 in five out-patient clinics of Mahesh Bhattacharyya Homeopathic Medical College and Hospital, Govt. of West Bengal, Howrah, India. A 12-item Japanese short-form self-administered consultation satisfaction questionnaire translated into Bengali with a five-point Likert scale was used. The questionnaire generated five subscales - overall satisfaction, complete examination, whole person care, examination time, and patient centeredness. Visual analogue scales (VASs) of 100 mm were provided with each single question item and each subscale. The questionnaire appeared reliable and valid. Internal consistency scores Cronbach’s alpha (α) were between 0.7-0.9 and test-retest reliability Cohen’s kappa (κ) was greater than 0.7 for each item. Concurrent validity Pearson’s r between total questionnaire and VASs was 0.60, p<0.001; each subscale scores 0.8 < r < 0.9, p<0.0001, and each question score 0.8 < r < 0.9, p<0.0001. Comparison of mean scores of five different subscales for five different outpatient clinics yielded F ratios between 4.3-9.8 (p< 0.05, df=4.95% CI) establishing discriminant validity. Overall, the patients’ satisfaction appeared to be high. Further works should be undertaken adapting the questionnaire globally in different languages.

Evaluación de la satisfacción de los pacientes en un hospital homeopático gubernamental en Bengala Occidental, India / Assessment of patient satisfaction in a government homeopathic hospital in West Bengal, India

Introducción y objetivos: la determinación del grado de satisfacción de los pa¬cientes de un hospital homeopático puede producir un impacto sustancial en los esfuerzos para mejorar el estado de salud y la calidad de la atención proporcionada. En este trabajo, los investigadores evaluaron el grado de satisfacción de los pacientes después de recibir consulta médica, al igual que la validez y la confiabilidad del interrogatorio al que se sometieron. Métodos: estudio transversal con diseño observacional realizado en febre¬ro de 2013, con 390 voluntarios, en cinco unidades de consulta externa de la Facultad y Hospital de Medicina Homeopática Mahesh Bhattacharyya, perteneciente a la red pública de Bengala Occidental (Howrah, India). Fue auto-aplicado un breve cuestionario de satisfacción con consultas médicas, elaborado en Japón y traduci¬do al bengalí, con 12 ítems de respuesta múltiple en una escala tipo Likert de cinco puntos. El cuestionario generó cinco subescalas: satisfacción general, examen completo, cuidado completo de la persona, duración de la consulta y centralidad en el paciente. Las respuestas de cada ítem y sub-escala también incluían una escala visual analógica (EVA) de 100 mm. Resultados: el cuestionario se mostró válido y confiable. Su consistencia interna fue comprobada por valores entre 0.7 y 0.9 del coeficiente alfa de Cronbach (α), y la confiabilidad test-retest por el coeficiente kappa de Cohen (κ), cuyo valor fue superior a 0.7 en todos los ítems. La validez concurrente del coeficiente r de Pearson correspondiente al puntaje total del cuestionario y las EVA fue de 0.60, p<0.001; puntaje de cada escala 0.8 < r < 0.9, p<0.0001, y puntaje de cada ítem 0.8 < r < 0.9, p<0.0001.[...] En general, los pacientes reportaron alta satisfacción. Nuevos estudios son necesarios para adaptar el cuestionario utilizado en este trabajo a otros idiomas para uso global. (AU)

Discovering the degree of patient satisfaction in a homeopathic hospital setting may put substantial impact in improving health status and quality of care provided. In this study, the researchers evaluated the degree of patient satisfaction following medical encounters and re-examined the validity and reliability of the used questionnaires. An institutional, cross-sectional, observational study was carried out involving 390 participants in February, 2013 in five out-patient clinics of Mahesh Bhattacharyya Homeopathic Medical College and Hospital, Govt. of West Bengal, Howrah, India. A 12-item Japanese short-form self-administered consultation satisfaction questionnaire translated into Bengali with a five-point Likert scale was used. The questionnaire generated five subscales - overall satisfaction, complete examination, whole person care, examination time, and patient centeredness. Visual analogue scales (VASs) of 100 mm were provided with each single question item and each subscale. The questionnaire appeared reliable and valid. Internal consistency scores Cronbach’s alpha (α) were between 0.7-0.9 and test-retest reliability Cohen’s kappa (κ) was greater than 0.7 for each item. Concurrent validity Pearson’s r between total questionnaire and VASs was 0.60, p<0.001; each subscale scores 0.8 < r < 0.9, p<0.0001, and each question score 0.8 < r < 0.9, p<0.0001. Comparison of mean scores of five different subscales for five different outpatient clinics yielded F ratios between 4.3-9.8 (p< 0.05, df=4.95% CI) establishing discriminant validity. Overall, the patients’ satisfaction appeared to be high. Further works should be undertaken adapting the questionnaire globally in different languages. (AU)

A study on drug utilization and prescription habits of physicians in a government homeopathic hospital in West Bengal, India.

OBJECTIVE: Improper prescribing habits and inappropriate drug use lead to serious health and economic consequences. This study was undertaken to evaluate drug utilization services and prescription patterns of homeopathic doctors in a government homeopathic teaching hospital in India. METHODS: No standardized homeopathic drug use indicators are available. The researchers used indicators for health care setting (drug availability)-modified prescribing indicators and patient care indicators, based on World Health Organization's core drug use indicators. A cross-sectional, prospective, institutional, observational study of 2-month duration with record analysis was conducted on 600 patients visiting seven different outpatient departments (OPDs) for the first time at Mahesh Bhattacharyya Homeopathic Medical College and Hospital, Howrah, West Bengal, India, using the developed indicators. RESULTS: Overall availability of prescribed drugs was quite satisfactory (92.28%). Centesimal potencies accounted for the majority of prescriptions (74.76%). There was a poor record of diagnosis (39.17%) except in the OPDs of Gynecology and Obstetrics (68.48%, P < 0.01) and Dermatology (64.58%, P < 0.01). Records of investigational findings and ongoing therapies, if any, were also poor except OPDs of Gynecology and Obstetrics, and Pediatrics. Structure of prescriptions was maintained satisfactorily in all the OPDs. Though tendency of using 'individualized homeopathy' predominated, there also existed the use of 'polypharmacy'. Mean consultation time was 5.9 min. Labeling was extremely poor and is an area needing improvement. The prescriptions were highly legible. CONCLUSION: This was a preliminary study, conducted for the first time in homeopathy using newly developed indicators that yield meaningful results. Further studies are necessary in order to evaluate the different factors involved and to plan future interventions to improve the quality of care in healthcare settings.

A study on drug utilization and prescription habits of physicians in a government homeopathic hospital in West Bengal, India / 中西医结合学报

Improper prescribing habits and inappropriate drug use lead to serious health and economic consequences. This study was undertaken to evaluate drug utilization services and prescription patterns of homeopathic doctors in a government homeopathic teaching hospital in India.

Evaluation of patient satisfaction in a Government Homeopathic Hospital in West Bengal, India

Background and aims – Discovering the degree of patient satisfaction in a medical practice setting may put substantial impact in improving health status and quality of care provided. In this study, the researchers evaluated the degree of patient satisfaction following medical encounters and re-examined the validity and reliability of the used questionnaires. Methodology – An institutional, cross-sectional, observational study was carried out involving 390 participants in February, 2013 in five out-patient clinics of Mahesh Bhattacharyya Homeopathic Medical College and Hospital, Govt. of West Bengal, Howrah, India. A 12-item Japanese short-form self-administered consultation satisfaction questionnaire translated into Bengali with a 5-point Likert scale was used. The questionnaire generated 5 subscales – overall satisfaction, complete examination, whole person care, examination time, and patient centeredness. Visual analogue scales (VASs) of 100mm were provided with each single question item and each subscale. Results – The questionnaire appeared reliable and valid. Internal consistency scores Cronbach’s α were between 0.7-0.9 and test-retest reliability Cohen’s κ was greater than 0.7 for each item. Concurrent validity Pearson’s r between total questionnaire and VASs was 0.60, P < 0.001; each subscale scores 0.8 < r < 0.9, P < 0.0001, and each question score 0.8 < r < 0.9, P < 0.0001. Comparison of mean scores of five different subscales for five different outpatient clinics yielded F ratios between 4.3-9.8 (P < 0.05, df = 4, 95% CI) establishing discriminant validity. Conclusions – Overall, the patients’ satisfaction appeared to be high. Further works should be undertaken adapting the questionnaire globally in different languages.

Introdução e objetivos: A determinação do grau de satisfação dos pacientes de um hospital homeopático, pode producir impacto substancial nos esforços para melhorar o o estado de saúde e a qualidade da atenção proporcionada. Neste estudo, avaliamos o grau de satisfação dos pacientes, depois das consultas médicas, bem como a validade e confiabilidade do questionário utilizado. Métodos: Estudo transversal com desenho observacional realizado em fevereiro de 2013 com 390 voluntários em 5 ambulatórios da Facultade e Hospital de Medicina Homeopática Mahesh Bhattacharyya, pertencente a rede pública Bengala Ocidental, Howrah, India. Foi autoaplicado um breve questionário japonês de satisfação com as consultas médicas, traduzido para o bengalí, com 12 ítems respondidos em uma escala tipo Likert de 5 pontos. O questionario gerou 5 sub-escalas: satisfação global; exame completo; atenção do paciente como um todo; duração da consulta; foco no paciente. As respostas de cada ítem e sub-escala também incluíam uma escala visual analógica de 100 mm. Resultados: O questionário se mostrou válido e confiável. Sua consistência interna foi comprovada por valores entre 0,7 e 0,9 do coeficiente α de Cronbach, e a confiabilidade teste-reteste pelo coeficiente kappa de Cohen, cujo valor foi superior a 0,7 em todos os ítens. A validez concorrente do coeficiente r de Pearson correspondente a pontuação total do questionário a as EVAs foram de 0,60, p<0,001; pontuação de cada escala 0,8 < r < 0,9, p<0,0001, e pontuação de cada ítem 0,8 < r < 0,9, p<0,0001. A comparação das pontuações médias das 5 subescalas correspondentes aos 5 ambulatorios resultaram en valores de razão F de 4,3-9,8 (p<0,05, df = 4, intervalo de confiança de 95%), comprovando a validez discriminante do questionário. Em geral, os pacientes reportaram alta satisfação. Novos estudos são necessários para adaptar o questionário utilizado neste estudo a outros idiomas, para uso global.

Evaluation of patient satisfaction in a Government Homeopathic Hospital in West Bengal, India

Background and aims – Discovering the degree of patient satisfaction in a medical practice setting may put substantial impact in improving health status and quality of care provided. In this study, the researchers evaluated the degree of patient satisfaction following medical encounters and re-examined the validity and reliability of the used questionnaires. Methodology – An institutional, cross-sectional, observational study was carried out involving 390 participants in February, 2013 in five out-patient clinics of Mahesh Bhattacharyya Homeopathic Medical College and Hospital, Govt. of West Bengal, Howrah, India. A 12-item Japanese short-form self-administered consultation satisfaction questionnaire translated into Bengali with a 5-point Likert scale was used. The questionnaire generated 5 subscales – overall satisfaction, complete examination, whole person care, examination time, and patient centeredness. Visual analogue scales (VASs) of 100mm were provided with each single question item and each subscale. Results – The questionnaire appeared reliable and valid. Internal consistency scores Cronbach’s α were between 0.7-0.9 and test-retest reliability Cohen’s κ was greater than 0.7 for each item. Concurrent validity Pearson’s r between total questionnaire and VASs was 0.60, P < 0.001; each subscale scores 0.8 < r < 0.9, P < 0.0001, and each question score 0.8 < r < 0.9, P < 0.0001. Comparison of mean scores of five different subscales for five different outpatient clinics yielded F ratios between 4.3-9.8 (P < 0.05, df = 4, 95% CI) establishing discriminant validity. Conclusions – Overall, the patients’ satisfaction appeared to be high. Further works should be undertaken adapting the questionnaire globally in different languages. (AU)

Introdução e objetivos: A determinação do grau de satisfação dos pacientes de um hospital homeopático, pode producir impacto substancial nos esforços para melhorar o o estado de saúde e a qualidade da atenção proporcionada. Neste estudo, avaliamos o grau de satisfação dos pacientes, depois das consultas médicas, bem como a validade e confiabilidade do questionário utilizado. Métodos: Estudo transversal com desenho observacional realizado em fevereiro de 2013 com 390 voluntários em 5 ambulatórios da Facultade e Hospital de Medicina Homeopática Mahesh Bhattacharyya, pertencente a rede pública Bengala Ocidental, Howrah, India. Foi autoaplicado um breve questionário japonês de satisfação com as consultas médicas, traduzido para o bengalí, com 12 ítems respondidos em uma escala tipo Likert de 5 pontos. O questionario gerou 5 sub-escalas: satisfação global; exame completo; atenção do paciente como um todo; duração da consulta; foco no paciente. As respostas de cada ítem e sub-escala também incluíam uma escala visual analógica de 100 mm. Resultados: O questionário se mostrou válido e confiável. Sua consistência interna foi comprovada por valores entre 0,7 e 0,9 do coeficiente α de Cronbach, e a confiabilidade teste-reteste pelo coeficiente kappa de Cohen, cujo valor foi superior a 0,7 em todos os ítens. A validez concorrente do coeficiente r de Pearson correspondente a pontuação total do questionário a as EVAs foram de 0,60, p<0,001; pontuação de cada escala 0,8 < r < 0,9, p<0,0001, e pontuação de cada ítem 0,8 < r < 0,9, p<0,0001. A comparação das pontuações médias das 5 subescalas correspondentes aos 5 ambulatorios resultaram en valores de razão F de 4,3-9,8 (p<0,05, df = 4, intervalo de confiança de 95%), comprovando a validez discriminante do questionário. Em geral, os pacientes reportaram alta satisfação. Novos estudos são necessários para adaptar o questionário utilizado neste estudo a outros idiomas, para uso global. (AU)