Econometric analysis of oncology patients' Health-Related Quality of Life determinants in Bulgaria.

OBJECTIVES: The present study investigates the determinants of oncology patients' Health-Related Quality of Life (HRQoL) in Bulgaria. Looking at some patients' characteristics, including control variables in the estimated model - demographics and the time from the disease onset, it studies the relevance of HRQoL diverse factors: some of them are related to the physical and psychological dimensions of the patients' illness experience, such as the levels of pain and anxiety/depression; some other concern more specifically the patients' therapeutic path, i.e., the feeling of participation in the therapy, their perceived uncertainty in illness (predictability and complexity), and the quality of the information received from the nurses and other medical personnel. METHODS: A questionnaire collecting information on HRQoL, uncertainty in illness and patients' experience with the hospital treatment has been administered to 306 oncology patients at four oncology centres in Bulgaria. Data has then been employed in the estimation of a Tobit model: the dependent variable selected has been the variation in the Visual Analogue Scale (VAS) score. The econometric model takes into account the characteristics of censoring in the dependent variable. RESULTS: Overall, the coefficients estimated, and the regression itself showed a good level of significance. Some dimensions of EuroQol-5D (EQ-5D) questionnaire - pain and anxiety/depression - have a significant impact on HRQoL, as well as some features of uncertainty in illness, as unpredictability and complexity. As expected, the longer the time elapsed from the diagnosis, the higher the reported HRQoL; the value of the information provided to the patients by the nurses as well as physicians is also relevant. CONCLUSIONS: This study presents an analysis of the impact of uncertainty in illness, feeling of participation in the therapy, and communication with the hospital personnel on oncological patients' HRQoL, which increases the scanty evidence referring to the patient-centred care in the Bulgarian hospital setting. Further deepening might concern a wider sample, including data collected at other medical centres and/or in other geographical areas in Bulgaria as well as in other European countries.

Factors That Predict Overall Patient Satisfaction With Oncology Hospital Care in Bulgaria.

BACKGROUND: The relevance of studies focusing on patient satisfaction becomes imperative for patients with cancer, who often face major changes in their lifestyles. Their perceived uncertainty in illness and their personal experiences with the services received are crucial factors for a qualitatively adequate assistance. OBJECTIVES: To assess the determinants of patient satisfaction, using a sample of 306 Bulgarian oncology outpatients. METHODS: The hypotheses tested concern the extent to which patient satisfaction depends on the uncertainty in illness; the patients' assessment of technical and interpersonal skills of nurses and medical staff; the information provision; and some organizational aspects. Patients were asked to answer a questionnaire composed of internationally validated scales assessing the determinants of patient satisfaction (measured through the European Organization for Research and Treatment of Cancer), uncertainty in illness (assessed through the Mishel Uncertainty in Illness Scale), and patients' health status (assessed through the EuroQol 5-dimensional questionnaire and the visual analogue scale). An ordered logit model was run, using the level of overall patient satisfaction as a dependent variable. RESULTS: This is one of the first studies carried out in Bulgaria for oncology patient satisfaction of subjective factors related to the frailty of the oncology patient status such as age, self-assessed health-related quality of life, and uncertainty in illness. Nevertheless, other determinants, reflecting the quality of the care provided, also have an impact on patient satisfaction, namely, the assessment of the nonmedical personnel, the perception of medical technical skills, and the access to a medical center. CONCLUSIONS: Results stress the relevance of reducing uncertainty in illness in patients with cancer by implementing a satisfactory patient-physician relationship in the management of the disease.

Coping, uncertainty and health-related quality of life as determinants of anxiety and depression on a sample of hospitalized cardiac patients in Southern Italy.

OBJECTIVES: Being hospitalized often causes psychological distress and compromises patients' psychological well-being, thereby augmenting the burden of illness. The aim of this paper is to investigate two possible determinants of anxiety and depression among hospitalized cardiac patients, namely uncertainty in illness, and coping strategies, controlling for the perceived health-related quality of life, and distinguishing between borderline and pathological levels of anxiety and depression. METHODS: Data on anxiety, depression, coping style, uncertainty in illness and self-assessed quality of life concerning 200 cardiac inpatients from a university hospital were collected through validated questionnaires. A biprobit analysis, whose dependent variables are hospital anxiety and depression, was carried out. RESULTS: Uncertainty in illness has a significant impact on the possibility of crossing the borderline level of both anxiety and depression. The coping strategy of Positive Reappraisal and Growth is inversely and significantly correlated to anxiety and depression, be it borderline or pathological; the Restraint Coping strategy is positively and significantly related to borderline anxiety. CONCLUSIONS: The reduction of uncertainty in illness and the development of adequate coping strategies should be promoted in order to decrease the patients' risk of crossing the borderline threshold of anxiety and depression.

Adaptation of the Mishel Uncertainty of Illness Scale (MUIS) for chronic patients in Italy.

RATIONALE, AIMS AND OBJECTIVES: Uncertainty is a component of the illness experience and is likely to increase the burden of managing chronic illness, as cardiac pathologies and renal diseases. The impact of uncertainty should be taken into account and addressed with targeted intervention programmes. The purpose of this study is to contribute to the diffusion of the assessment of uncertainty in illness by validating the Mishel uncertainty in illness scale (MUIS) on chronic Italian patients. METHOD: The MUIS questionnaire was administered to 200 patients suffering from cardiac diseases and 50 patients with renal diseases. A confirmatory factor analysis was run for each of the MUIS dimensions (ambiguity, inconsistency, complexity and unpredictability). RESULTS: After some item reduction, three of the four MUIS scales, namely, ambiguity, inconsistency and complexity, exhibited satisfactory reliability coefficients (with Cronbach's alphas of, respectively, 0.796, 0.778 and 0.705), highly significant standardized regression weights and satisfactory/highly satisfactory fit indexes. Nevertheless, as the correlations among the scales mentioned earlier were high (all above 0.8) and statistically significant, the three subsets of ambiguity, complexity and inconsistency items were allowed to load onto a new single factor. A monodimensional uncertainty construct, grouping the majority of the items encompassed by these three MUIS scales, was successfully validated. CONCLUSIONS: This study provides researchers with an easy-to-administer instrument which is useful to investigate a crucial aspect related with patients' quality of life. Although a unique uncertainty construct is proposed, the in-depth analysis of the replies to each single item of the MUIS could help to monitor patients' emotional responses to the diagnosis and to the course of this disease and it might be useful to define appropriate strategies of coping and to focus on patients' quests for simplicity and clarity of treatment.

An initial validation of the Italian Mishel Uncertainty Illness Scale (MUIS) for relapsing remitting multiple sclerosis patients.

Multiple sclerosis is a chronic disease, likely to condition patients' daily living and quality of life: given the unpredictability of frequency and severity of the attacks, patients experience a high level of uncertainty. While there have been many analyses whose purpose was to monitor multiple sclerosis (MS) patients' quality of life, the role of uncertainty, that is peculiar to the disease, has not been adequately considered so far. The present study is aimed at filling this gap by validating for Italian MS patients the Mishel's Uncertainty Illness Scale (MUIS). The MUIS has been developed in the USA context in order to assess four aspects of uncertainty: ambiguity, complexity, inconsistency and unpredictability. It has been largely applied in the cancer, cardiac and chronic illness population. Data employed in this study have been collected at two neurological centres in Messina (IRCCS Centro Studi Neurolesi "Bonino Pulejo" and Policlinico di Messina) in the first semester of 2013 and refer to 120 MS patients. The confirmatory factor analysis described in this study validates two of the four dimensions of MUIS, namely ambiguity and inconsistency. The validation, though partial, of the MUIS, allows the use of this instrument in studies investigating quality of life for Italian patients.

How are organisational climate models and patient satisfaction related? A competing value framework approach.

Patient satisfaction has become an important indicator of process quality inside hospitals. Even so, the improvement of patient satisfaction cannot simply follow from the implementation of new incentives schemes and organisational arrangements; it also depends on hospitals' cultures and climates. This paper studies the impact of alternative models of organisational climate in hospital wards on patient satisfaction. Data gathered from seven public hospitals in Italy are used to explore this relationship. The theoretical approach adopted is the Competing Value Framework which classifies organisations according to their inward or outward focus and according to the importance assigned to control vs. flexibility. Results show that both a model stressing openness, change and innovation and a model emphasising cohesion and workers' morale are positively related to patient satisfaction, while a model based on managerial control is negatively associated with patient satisfaction.

An economic analysis of rotavirus vaccination in Italy.

We have evaluated health and economic benefits of a universal infant vaccination with two rotavirus vaccines registered in Italy, on the bases of the burden of rotavirus gastroenteritis (RVGE) in a birth cohort of 520,000 Italian infants followed until 5 years of age. Estimates from published and unpublished sources of disease burden, costs, vaccine coverage, efficacy trials of both vaccines, and price were used to estimate cost-effectiveness from the perspectives of the Italian National Health Service (NHS) and society. According to our estimates, a universal rotavirus vaccination program would avoid 10,679 hospitalizations, 39,202 emergency visits, and 44,223 at home visits. At 65.6 euro per vaccination courses, the program would cost 30,700,800 euro and realize a net loss of 9,057,928 euro from the Italian NHS perspective. On the contrary, the program would provide a net savings of 24,324,198 euro from the societal perspective. From the Italian NHS perspective, the break-even price per vaccination course should be reduced at least to 46.25 euro to achieve a zero cost-effectiveness ratio.