[Expectations and satisfaction in mental health center users]. / Expectativas y satisfacción de los usuarios de un centro de salud mental.

INTRODUCTION: The user's satisfaction with the health services is an area of increasing interest. Usually the relation between satisfaction and expectations is not taken into account. The objective [corrected] of this paper is to describe the user's expectations, before treatment, in an out patient Mental Health Center and to investigate their satisfaction with the service adjusted by these expectations. METHODS: During six months all patients attending an outpatient mental health center of the Basque Public Health Service, are interviewed (n=315). The survey included the basic sociodemographic variables, one questionnaire of expectations and another one of clinical symptomatology (SCL-90-R). The patients were reviewed six months later by a new SCL-90-R and a questionnaire on satisfaction (CSQ-8). In order to select the factors which gathered the most important expectations, an analysis of principal components was made. A model, incluiding the best variables to explain satisfaction with the service, was adjusted by means of multiple linear regression, taking the expectations into account. RESULTS: Expectations on psychological explorations and interventions were greater than those on biological characteristics. Three factors called <>, <> and <> explained 10 % of the variance. For each increasing point in the initial SCL-90-R, the index of satisfaction decreased 0.02. For each point added to symptomatic recovery, the same index rose in 0.03. CONCLUSIONS: Satisfaction with the service was associated with less severity in initial psychopathology, symptomatic recovery and biological expectations. The psychological expectations were associated with less satisfaction.

Expectativas y satisfacción de los usuarios de un centro de salud mental / Expectations and satisfaction in mental health center users

Introducción. La satisfacción de los usuarios de servicios de salud es un área de creciente interés. La relación de ésta con las expectativas no suele ser tenida en cuenta habitualmente. El objetivo de este trabajo es describir las expectativas, previas a su tratamiento, entre los usuarios de un centro de salud mental y estudiar su satisfacción con el servicio ajustada por dichas expectativas. Métodos. Se encuestó durante 6 meses a todos los pacientes que acudieron a un centro de salud mental ambulatorio del Servicio Vasco de Salud/Osakidetza (n = 315). La encuesta incluía las variables sociodemográficas básicas, un cuestionario de expectativas y otro de sintomatología clínica (SCL-90-R). Transcurridos 6 meses se pasó de nuevo el SCL-90-R y un cuestionario de satisfacción (CSQ-8). Se realizó un análisis de componentes principales para seleccionar los factores que agrupaban las expectativas más importantes. Mediante regresión lineal múltiple se ajustó un modelo con las variables que mejor explicaban la satisfacción con el servicio, teniendo en cuenta las expectativas Resultados. Las expectativas sobre exploraciones e intervenciones psicológicas fueron más frecuentes que las de tipo biológico. Tres factores, que denominamos "procedimientos psicológicos", "procedimientos biológicos" y "procedimientos invasivos" explicaron un 10 por ciento de la varianza. Por cada incremento de un punto en el SCL-90-R inicial disminuyó un 0,02 el índice de satisfacción. Por cada punto de mejoría sintomática aumentó un 0,03.Conclusiones. La satisfacción con el servicio se asoció con menor severidad psicopatológica inicial, mejoría sintomática y expectativas biológicas. Las expectativas psicológicas se asociaron con menor satisfacción (AU)

Understanding patient-initiated frequent attendance in primary care: a case-control study.

BACKGROUND: Frequent attendance, which accounts for a high proportion of the general practitioner's (GP's) workload, is still poorly understood. AIM: To assess the association and impact of exposure to chronic physical illness, mental disorders, life stress, and sociodemographic factors on the frequent attendance of primary health care medical services. METHOD: Nine general practices in Bizkaia, Spain, participated in a case-control study. Cases were patients who exceeded the 90th percentile in the distribution of the number of visits that they made on their own initiative from January 1993 to March 1994. Controls were those for whom a single, patient-initiated consultation was registered. A total of 102 cases and 100 controls were selected by stratified sampling proportional to the size of each practice. We estimated odds ratios and population attributable fractions for frequent attendance in relation to being exposed to the study variables, adjusted by demographic characteristics by means of logistic regression analysis. RESULTS: Medium-high life stress (adjusted odds ratio (AOR) = 4.5, 95% confidence interval (CI) = 1.7-12.8), chronic physical illness (AOR = 3.1; 95% CI = 1.4-6.9), mental disorder (AOR = 2.5; 95% CI = 1.3-5.1), and age were associated with patient-initiated frequent attendance. The adjusted population attributable fraction for chronic physical illness was 41%, 30.9% for mental disorder, and 15.2% for life stress. CONCLUSION: There is evidence that patient-initiated frequent attendance is related to genuine physical and psychosocial needs; therefore, recognition requires a bio-psychosocial approach on the part of GP.