Validation of a Spanish-Language Scale for Evaluating Perceived Quality of Care of Medical Abortions Before 9 Weeks Gestation

Background: Spanish Organic Law 2/2010 legalizes abortion within 14 weeks of gestation. Medical abortion with mifepristone and misoprostol is around 97% effective and is offered at primary care centers during the first 9 weeks of gestation. It consists administration of 200 mg of mifepristone by healthcare professional and of the self-administration 800 mg of misoprostol by the patient at home, along with prescribed analgesics. However, the quality of this process as perceived by patients has never been assessed. This study aims to validate a scale designed to assess the perceived quality of this process.Methods: Validation study of a Spanish adaptation of the SERVPERF scale. In total, 289 patients completed a self‑administered questionnaire consisting of 26 items previously evaluated by a group of experts. A re-test was performed on 53 of these patients 15 days later to assess interobserver consistency.Results: The non-response rate did not exceed 2.1%. The floor effect was 26% and the ceiling effect did not surpass 83%. The linearly weighted Kappa coefficient was good to excellent, in general. An exploratory factor analysis was performed with varimax rotation, obtaining a total of 7 dimensions that explain 65.9% of the variability. The internal consistency (Cronbach's alpha) for all items was 0.862.Conclusion: This psychometric instrument is valid and reliable for assessing the quality of care of medical abortion.Medical abortion is efficient, effective and eliminates the need for hospital care, anesthesia and surgical risk. However, user satisfaction has yet to be determined. This study offers a validated scale to assess perceived quality of care, their quality experience and person-centered care for abortion as a fundamental part of overall service quality as a fundamental part of overall service quality.

Patient Perspectives on Use of Video Telemedicine for Type 1 Diabetes Care in the United States during the COVID-19 Pandemic

The COVID-19 pandemic has resulted in widespread adoption of telemedicine for management of chronic conditions such as type 1 diabetes (T1D), but few data have been collected about the patient experience and perceived quality of care during this time. We surveyed members of the T1D Exchange patient registry and online community regarding their experiences with and opinions about telemedicine care during the pandemic. Among 2235 survey respondents, 65% had utilized telemedicine. The most common reasons for adopting telemedicine were providers not offering in-person care (66%), concerns about the health risks of in-person care (59%), providers offering (52%) or insurance covering (19%) telemedicine for the first time, and local or state orders to stay home (33%). Among telemedicine users, 62% felt video care was as effective as or more effective than in-person care, and 82% hoped to use telemedicine in the future. The most-cited reason for non-use of telemedicine was that providers were not offering it (49%). Our findings highlight the role of telemedicine in maintaining access to T1D care during the COVID-19 pandemic. Respondents’ satisfaction with telemedicine and interest in its continued use signifies the need for ongoing access to this care modality and for the development of telemedicine best practices within T1D care.

The influence of job crafting on the quality of care provided by nursing home employees: The moderating effect of organizational identification

Our goal was to analyze the positive effect of job crafting activities involving nursing home employees on their perceived quality of care, and the moderating effect of organizational identification. A two-wave non-experimental design (with an interval of 12 months) was used. The Job Crafting Questionnaire, the Identification-Commitment Inventory, and the Quality of Care Questionnaire (QoC) were administered to 226 nursing home employees in two waves. The results of the hierarchical regression analyses found significant association between job crafting subdimensions and quality of care twelve months later. Organizational identification was shown to play a moderating role in these relationships when analyzing the effect of cognitive crafting. In this sense, the effect of cognitive crafting on quality of care is only found with high levels of identification. The findings highlight the importance of the job crafting dimensions (task, relational and cognitive) when it comes to enhancing quality of care in residential homes for the elderly. This is especially relevant for cognitive crafting among employees with high levels of organizational identification. This research provides managers with guidance when allocating job crafting opportunities aimed at making improvements in quality of care. In this respect, organizations must offer job crafting training to stimulate and support their employees and, on the other hand, managers should encourage employees to craft their jobs, gearing their needs, abilities, and goals to corporate values and competencies.

Factors associated with enrollment for community-based health insurance scheme in Western Ethiopia: Case-control study

Introduction Modern health services utilization in developing countries has continued low. Financial shortage to access health-care services might be averted by stirring from out-of-pocket payment for health care at the time of use. The government of Ethiopia; depend greatly on foreign aid (50%) and out-of-pocket payments (34%) to fund health services for its population. This study was aimed to identify factors associated with households’ enrollment to CBHI scheme membership. Methods Case-control study design was conducted from May 18–July 27, 2019 among 332 participants (166 enrolled and 166 non-enrolled to CBHI scheme). Simple random sampling technique was used to select the study participants. Bi-variable and multivariable logistic regression model were fitted to identify factors associated with enrollment to community based health insurance. Adjusted odds ratio (AOR) with 95% CI was used to report association and significance was declared at P<0.05. Result A total of 332 (100% response rate) were involved in the study. Educational status (College and above, AOR = 3.90, 95%CI; 1.19, 12.75), good awareness about CBHI scheme (AOR = 21.595, 95% CI; 7.561, 61.681), affordability of premium payment (AOR = 3.403, 95% CI; 5.638–4.152), wealth index {(Poor, AOR = 2.59, 95%CI; 1.08, 6.20), (Middle, AOR = 4.13, 95%CI; 1.11, 15.32)} perceived health status (AOR = 5.536; 95% CI; 1.403–21.845), perceived quality of care (AOR: 21.014 95%CI; 4.178, 105.686) and treatment choice (AOR = 2.94, 95%CI; 1.47, 5.87) were factors significantly associated with enrollment to CBHI. Conclusion Enrolment to CBHI schemes is influenced by educational level, awareness level, affordability of premium, wealth index, perceived health status, perceived quality of care and treatment choice. Implementation strategies aimed at raising community awareness, setting affordable premium, and providing quality healthcare would help in increasing enrollment of all eligible community groups to the CBHI scheme.

Perceived quality of primary healthcare post-National Health Insurance pilot implementation

Background: Contracting private medical practitioners for the National Health Insurance pilot project in 2012 by the National Department of Health in South Africa was envisaged to reduce workload at referral district hospitals by reducing self-referral by clients as the perceived quality of care at the primary healthcare level improves.Aim: To describe the effect of contracting private medical practitioners at primary healthcare facilities on the self-referral rate of clients at district hospitals as a proxy for perceived quality of care in a National Health Insurance pilot district.Setting: The study was set in Tshwane National Health Insurance pilot district compared to Ekurhuleni district.Methods: We compared findings before and after implementing the National Health Insurance private medical practitioners contracting between a pilot and a non-pilot district. A quasi-experimental ecological study design was used to compare district hospital outpatient department indicators of clients follow-up, self-referral, self-referral rate and referred in the two districts from June 2012 to May 2014 using single and controlled interrupted time-series analyses.Results: Controlled interrupted time series analysis found decreases in self-referral rate (−1.8 [−2.2, −1.1] [p 0.0001]) and the initial trend of headcounts of self-referral (−516 [−969, −66] [p = 0.0260]), but an increase in headcounts of referred clients (1293 [77, 2508] [p = 0.0376]) in the pilot compared with the non-pilot district.Conclusion: We concluded that the implementation of contracting private medical practitioners in primary healthcare facilities might have resulted in an improved perceived quality of care at primary health care facilities. However, the higher number of outpatient department headcounts for follow-up and the increase in referred cases in the pilot district would need to be investigated.

Physician Beliefs Concerning Structural and Institutional Racism in Health Care

Perceived discrimination in medical settings remains prevalent within the U.S. health care system. However, the details of these experiences and their associations with perceived quality of care are not well understood. This study evaluates any potential difference in African Americans' systemic health care discrimination and Latinx perceived by African American and Latinx patients and physicians. The New England physician alumni from the University of New England College of Osteopathic Medicine were sent surveys. Two hundred fifty-one practicing physicians' responses to the 2018 study address their beliefs toward African Americans and Latinx' racism within the health care system. High scores indicate more significant perceived discrimination among these groups. Physicians have lower discriminatory belief scores across gender, patient racial distribution and specialty.

Perceptions of Psychotherapy Waiting Rooms: Design Recommendations

Objective: This study fills the gap in literature by examining the design elements preferred in psychotherapy waiting rooms. Background: Studies have examined waiting rooms in hospitals and doctors’ offices, but there is little published literature on waiting rooms in psychotherapy offices. Waiting rooms in psychotherapy offices may affect clients’ perceived quality of care and their comfort level. Method: Psychotherapists in Connecticut and Rhode Island were interviewed and agreed to have the waiting rooms (20 in total) of their practices photographed. Then, in a within-subjects design, 250 participants (225 retained for analyses) from MTurk answered questions about the quality of care and comfort in the environment expected in those 20 waiting rooms. Results: Factor analytic results showed that waiting rooms that were welcoming and comfortable as well as large and spacious rated higher for the quality of care and comfort in the environment anticipated by the participant; those that were cramped and crowded rated lower. Few therapists reported any design education about counseling environments and none about the waiting room. Conclusion: Information from this study can guide the design of psychotherapy waiting rooms and enhance healthcare experience.

Intravitreal injections during COVID-19 outbreak: Protective measures, total duration of care and perceived quality of care in a tertiary retina center

Purpose: To assess patient satisfaction regarding the sudden reorganization of care during the COVID-19 pandemic in the outpatient intravitreal injection (IVI) clinic. Methods: A survey of patients with ongoing IVIs for retinal diseases was carried out between April 23rd and May 12th, 2020. We designed a questionnaire to assess patient satisfaction concerning: personal protective equipment (PPE), social distancing, the perceived quality of care, and the total time spent in the department, using a Likert scale. We also collected the time spent per patients in the outpatient IVI clinic. Results: A hundred and twenty-seven eyes of 108 patients were included. The mean time spent in the IVI outpatient clinic was 31.87 +/− 16.61 min. In our survey, 99.1% of the patients were satisfied (highly satisfied or satisfied) with the new type of care provided, 89.8% with the duration of care, and 93.5% with the PPE. Satisfaction was associated with total time spent in hospital ( p = 0.005), with dissatisfied patients spending about 50% more time in the hospital than satisfied patients (43.91 min vs 30.50 min). Conclusion: Despite the crisis-related adjustment, our survey revealed high patient satisfaction with PPE, quality of care, and total time spent in outpatient IVI clinic.

Disparities in Telemedicine Use for Subspecialty Diabetes Care During COVID-19 Shelter-In-Place Orders

Background: During the COVID-19 pandemic, telemedicine use rapidly and dramatically increased for management of diabetes mellitus. It is unknown whether access to telemedicine care has been equitable during this time. This study aimed to identify patient-level factors associated with adoption of telemedicine for subspecialty diabetes care during the pandemic. Methods: We conducted an explanatory sequential mixed-methods study using data from a single academic medical center. We used multivariate logistic regression to explore associations between telemedicine use and demographic factors for patients receiving subspecialty diabetes care between March 19 and June 30, 2020. We then surveyed a sample of patients who received in-person care to understand why these patients did not use telemedicine. Results: Among 1292 patients who received subspecialty diabetes care during the study period, those over age 65 were less likely to use telemedicine (OR: 0.34, 95% CI: 0.22-0.52, P < .001), as were patients with a primary language other than English (OR: 0.53, 95% CI: 0.31-0.91, P = .02), and patients with public insurance (OR: 0.64, 95% CI: 0.49-0.84, P = .001). Perceived quality of care and technological barriers were the most common reasons cited for choosing in-person care during the pandemic. Conclusions: Our findings suggest that, amidst the COVID-19 pandemic, there have been disparities in telemedicine use by age, language, and insurance for patients with diabetes mellitus. We anticipate telemedicine will continue to be an important care modality for chronic conditions in the years ahead. Significant work must therefore be done to ensure that telemedicine services do not introduce or widen population health disparities.