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The effects of patient and physician characteristics on early outpatient satisfaction with substance dependence care: results of the SUBUSQOL study.

ABSTRACT: BACKGROUND:Although patient perceptions of health care have increasingly been explored in the literature, little is known about care satisfaction among individuals with substance dependence. This exploratory study assessed the relationships between patient and physician characteristics and early outpatient satisfaction with care for alcohol and opioid dependence. METHODS:Satisfaction was assessed using a multidimensional, self-administered and validated questionnaire during the early care process among a prospective outpatient cohort. In addition to measuring satisfaction and obtaining sociodemographic and clinical data, this study collected data on the self-reported health status and physician characteristics at inclusion. Cross-sectional analysis with multiple linear regression was performed to identify the variables associated with satisfaction level. RESULTS:A total of 249 outpatients were included, and 63.8% completed the satisfaction questionnaire. Patients without a history of previous care for substance dependence were more satisfied with the appointment-making process (?=7.2; P=0.029) and with the doctor consultation (?=10.3; P=0.003) than those who had received care previously. Neither sociodemographic characteristics nor self-reported health status was associated with outpatient satisfaction. CONCLUSION:The factors that affect patients' ratings of early satisfaction with the care that they receive should be studied further because increased understanding of the factors that negatively affect these ratings might enable caregivers and outpatient management facilities to improve the patient experience during the early stages of care, which might in turn improve treatment adherence, continuity of care, and other health-related outcomes.

SUBMITTER: Bourion-Bedes S

PROVIDER: S-EPMC5428790 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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The effects of patient and physician characteristics on early outpatient satisfaction with substance dependence care: results of the SUBUSQOL study.

Bourion-Bédès Stéphanie S Schwan Raymund R Di Patrizio Paolo P Vlamynck Guillaume G Viennet Sarah S Schvartz Maxime M Gaunard Anne A Bédès Alex A Clerc-Urmès Isabelle I Baumann Cédric C

Patient preference and adherence 20170508

<h4>Background</h4>Although patient perceptions of health care have increasingly been explored in the literature, little is known about care satisfaction among individuals with substance dependence. This exploratory study assessed the relationships between patient and physician characteristics and early outpatient satisfaction with care for alcohol and opioid dependence.<h4>Methods</h4>Satisfaction was assessed using a multidimensional, self-administered and validated questionnaire during the ea ...[more]

PMID: 28507432

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Project description:BackgroundUse of electronic health records (EHRs) is associated with physician stress and burnout. While emergency departments and subspecialists have used scribes to address this issue, little is known about the impact of scribes in academic primary care.ObjectiveAssess the impact of a scribe on physician and patient satisfaction at an academic general internal medicine (GIM) clinic.DesignProspective, pre-post-pilot study. During the 3-month pilot, physicians had clinic sessions with and without a scribe. We assessed changes in (1) physician workplace satisfaction and burnout, (2) time spent on EHR documentation, and (3) patient satisfaction.ParticipantsSix GIM faculty and a convenience sample of their patients (N = 325) at an academic GIM clinic.Main measuresA 21-item pre- and 44-item post-pilot survey assessed physician workplace satisfaction and burnout. Physicians used logs to record time spent on EHR documentation outside of clinic hours. A 27-item post-visit survey assessed patient satisfaction during visits with and without the scribe.Key resultsOf six physicians, 100% were satisfied with clinic workflow post-pilot (vs. 33% pre-pilot), and 83% were satisfied with EHR use post-pilot (vs. 17% pre-pilot). Physician burnout was low at baseline and did not change post-pilot. Mean time spent on post-clinic EHR documentation decreased from 1.65 to 0.76 h per clinic session (p = 0.02). Patient satisfaction was not different between patients who had clinic visits with vs. without scribe overall or by age, gender, and race. Compared to patients 65 years or older, younger patients were more likely to report that the physician was more attentive and provided more education during visits with the scribe present (p = 0.03 and 0.02, respectively). Male patients were more likely to report that they disliked having a scribe (p = 0.03).ConclusionIn an academic GIM setting, employment of a scribe was associated with improved physician satisfaction without compromising patient satisfaction.

Project description:ImportanceThe rapid transition to virtual health care has depended on physician and patient abilities to adopt new technology and workflows. Physicians transitioning more slowly or not at all could result in access challenges for their patients.ObjectiveTo identify physician characteristics associated with the transition to virtual health care in a large regional health care system.Design, setting, and participantsThis retrospective cross-sectional study uses administrative health system databases to analyze data from all 3473 physicians providing ambulatory care through a large New England health care system, which includes 12 hospitals and their ambulatory practices, from October 1, 2019, through December 31, 2020.ExposuresPhysicians characterized based on gender, popularized generational demographic cohort (Silent Generation, born 1928-1945; Baby Boomers, born 1946-1964; Generation X, born 1965-1980; and Millennials, born 1981-1996), specialty (behavioral health, primary care, medical, and surgical), and hospital affiliation as well as selected patient characteristics (number of visits and proportion of patients with self-pay or Medicaid insurance, aged 65 years or older, preference for speaking a language other than English, from a racial or ethnic minority group, and with an active patient portal).Main outcomes and measuresEarly adoption of virtual health care. Bivariate comparisons were made, and regression modeling was used to examine characteristics associated with the likelihood of early adoption of virtual health care.ResultsOf 3473 physicians conducting ambulatory visits during the study period, 1624 (46.8%) were women, 83 (2.4%) were in the Silent Generation, 994 (28.6%) were Baby Boomers, 1637 (47.1%) were in Generation X, and 759 (21.9%) were Millennials. There were 1649 physicians (47.5%) in medical specialties, 749 physicians (21.6%) in surgical specialties, and 248 physicians (7.1%) in behavioral health. After accounting for other characteristics, female (odds ratio [OR], 1.23; 95% CI, 1.06-1.44), behavioral health (OR, 2.92; 95% CI, 2.11-4.04), and primary care (OR, 1.69; 95% CI, 1.36-2.09) physicians had greater odds of being early adopters, and physicians in the Silent Generation (OR, 0.39, 95% CI, 0.24-0.65) and in surgical specialties (OR, 0.46; 95% CI, 0.38-0.57) were less likely to be early adopters. Patient characteristics were less strongly associated with physician adoption.Conclusions and relevanceIn this cross-sectional study, there was physician-level variation in the adoption of virtual health care, with female, primary care, and behavioral health physicians in this system most likely to lead the transformation to virtual health care.

Project description:CONTEXT:Although patient and physician characteristics are thought to be predictive of discretionary interventions at the end of life (EoL), few studies have data on both parties. OBJECTIVE:To test the hypothesis that patient preferences and physician attitudes are both independently associated with discretionary interventions at the EoL. METHODS:We report secondary analyses of data collected prospectively from physicians (n = 38) and patients with advanced cancer (n = 265) in the Values and Options in Cancer Care study. Predictor variables were patient attitudes toward EoL care and physician-reported comfort with medical paternalism, assessed indirectly using a modified version of the Control Preference Scale. We explored whether the magnitude of the physician variable was influenced by the inclusion of particular patient treatment-preference variables (i.e., effect modification). Outcomes were a chemotherapy use score (?14 days before death [scored 2], 15-31 days before death [scored 1], and >31 days [scored 0]) and an emergency department visit/inpatient admission score (two or more admissions in the last 31 days [scored 2], one admission [1], and 0 admissions [0]) in the last month of life. RESULTS:Chemotherapy scores were nearly 0.25 points higher if patients expressed a preference for experimental treatments with unknown benefit at study entry (0.238 points, 95% CI = 0.047-0.429) or reported an unfavorable attitude toward palliative care (0.247 points, 95% CI = 0.047-0.450). A two-standard deviation difference in physician comfort with medical paternalism corresponded to standardized effects of 0.35 (95% CI = 0.03-0.66) for chemotherapy and 0.33 (95% CI = 0.04-0.61) for emergency department visits/inpatient admissions. There was no evidence of effect modification. CONCLUSION:Patient treatment preferences and physician attitudes are independently associated with higher levels of treatment intensity before death. Greater research, clinical, and policy attention to patient treatment preferences and physician comfort with medical paternalism might lead to improvements in care of patients with advanced disease.

Dataset Information

The effects of patient and physician characteristics on early outpatient satisfaction with substance dependence care: results of the SUBUSQOL study.

Publications

The effects of patient and physician characteristics on early outpatient satisfaction with substance dependence care: results of the SUBUSQOL study.

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