The role of psychiatric diagnosis in satisfaction with primary care - Data from the department of veterans affairs
The role of psychiatric diagnosis in satisfaction with primary care - Data from the department of veterans affairs
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DOI：
10.1097/01.mlr.0000185747.79104.90
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发表时间：
2005-12-01
期刊：
影响因子：
3
通讯作者：
Rosenheck, RA
中科院分区：
文献类型：
--
作者：
Desai, RA;Stefanovics, EA;Rosenheck, RA
背景：虽然患者满意度被广泛用作质量指标，但大多数这样的衡量标准没有考虑到患者亚群，如精神疾病患者。关于精神病患者对医疗服务满意度的数据也非常少。目的：本研究的目的是评估精神疾病在退伍军人事务部(VA)门诊初级保健服务满意度中的作用。方法：将退伍军人事务部(VA)客户反馈调查(N 50532)的数据与行政数据合并，以确定诊断和其他特征。结果：在控制了患者特征(如性别、年龄、残疾、急性就诊与常规就诊)和主观健康后，精神分裂症、创伤后应激障碍、药物滥用、抑郁和其他精神疾病患者对门诊初级护理的满意度显著降低。结论：尽管退伍军人管理局的特点可能被认为可以提高满意度(例如，由于整合退伍军人制度，更容易获得专业的初级卫生服务)，但精神障碍患者的满意度明显低于非精神障碍患者。可能的解释包括较低的技术护理质量和较差的精神疾病提供者和患者之间的人际沟通，包括耻辱的负面影响。这些发现突显了满意度评级需要根据病例组合进行调整，包括纳入健康和精神健康诊断，以及需要进一步研究，以阐明较低满意度背后的原因。
Background: Although patient satisfaction is widely used as a quality indicator, most such measures do not account for patient subgroups such as those with psychiatric illness. There is also very little data on satisfaction of psychiatric patients with their medical care.Objective: The objective of this study was to assess the role of psychiatric illness in satisfaction with outpatient primary care services in the Department of Veterans Affairs (VA).Method: Data from the VA Customer Feedback Survey (n 50,532) were merged with administrative data to determine diagnoses and other characteristics. Satisfaction ratings were compared across psychiatric diagnoses and across various aspects of satisfaction with care.Results: After controlling for patient characteristics (eg, gender, age, disability, acute vs. routine visit) and subjective health, patients with schizophrenia, posttraumatic stress disorder, drug abuse, depression, and other psychiatric disorders reported significantly lower satisfaction with their outpatient primary care. Dissatisfaction was particularly reported for access to care and overall coordination of care.Conclusions: Despite VA characteristics that might be thought to improve satisfaction (eg, easier access to specialty menial health services as a result of the integrated VA system), patients with psychiatric disorders are significantly less satisfied than patients without such disorders. Possible explanations include both lower technical quality of care and poorer interpersonal communication between providers and patients with mental illness, including the negative effects of stigma. These findings highlight the need for satisfaction ratings to be case-mix-adjusted, including the incorporation of health and mental health diagnoses, and the need for further research that elucidates the reasons behind lower satisfaction ratings.