Beliefs about medications: measurement and relationship to adherence in patients with severe mental disorders.

OBJECTIVE: To determine if the Beliefs about Medicines Questionnaire (BMQ) has satisfactory psychometric properties in patients with severe mental disorders and if their scores differ from those of patients with severe medical disorders. To investigate if the scores are related to medication adherence. METHOD: Two hundred and eighty psychiatric patients completed the BMQ and reported how much of their medication they had taken the past week. Serum concentrations of medications were analyzed. BMQ scores were compared with those of patients with chronic medical disorders. RESULTS: Cronbach's alpha was satisfactory for all subscales. The psychiatric group scored lower on the necessity of taking medication than the medical group. Non-adherent patients felt medication to be less necessary and were more concerned about it than adherent patients. The necessity subscale predicted adherence fairly well. CONCLUSION: The BMQ has satisfactory psychometric properties for use in patients with severe mental disorders. The constructs measured by the BMQ are related to adherence in these patients.

[PS-RESKVA (Patient Satisfaction, Results and Quality)--patient satisfaction in hospitals]. / PS-RESKVA--pasienttilfredshet i sykehus.

The reliability and acceptability of a 39-question patient-satisfaction questionnaire (PS-RESKVA) for use in hospitals is assessed. Postal questionnaires were sent to 19,395 patients, aged between 15 and 100 years, who were discharged from the medical, surgical, gynaecological, and neurological wards of two Norwegian hospitals; they were followed up with one reminder. The response rate was 59% for all patients, and 71% among those who were considered medically capable of answering. Six underlying factors were identified in the PS-RESKVA profile, which contained 11 different aspects satisfaction. The PS-RESKVA satisfied the psychometric criteria for internal consistency. Results indicate that the PS-RESKVA is a possible measure of patient satisfaction after discharge from hospital. It seems acceptable to patients in general, and is a reliable measure of satisfaction for a wide range of patients. Further studies on its validity are warranted.

[Patients' stories about their hospital stay. "Of course one special physician was responsible for me--what a question?"]. / Pasientfortellinger om sykehusopphold. "Selvfølgelig var det én lege som hadde hovedansvaret for meg--hvordan skulle det ellers ha gått?"

Data on patients' experiences are usually collected by questionnaires with fixed response categories. An analysis of 3,600 questionnaires showed that almost every fifth responder elaborated on his/her multiple choice answers by writing additional comments. Nearly all the comments were related to topics in the questionnaire. However, the number of comments relating to each of the questions varied. The patients' additional comments may give a clearer indication of what experiences they were anxious to provide feedback on than their multiple choice answers. Additional comments to the questionnaires provide the health service with supplementary information on which its quality assurance efforts can be based.

[Hospital infections as quality indicators. DRG-based financing, did it change therapeutic quality?]. / Sykehusoppståtte infeksjoner som kvalitetsindikator. DRG-basert stykkprisfinansiering, endret behandlingskvalitet?

In 1991, four Norwegian hospitals switched from 100% global budgeting to a combination of 40% DRG-based per case payment and 60% fixed grant financing. In order to monitor quality of care, the prevalences of infections acquired in hospital were registered in medical and surgical departments during the two first years after changing the system of financing. The total cumulative prevalence of hospital acquired infections was 6.3%. There was no change in the occurrence of hospital acquired infections during the observation period. The prevalence of nosocomial infection was significantly higher among patients receiving long-term care than among other patients (18.9% vc. 4.2%, p < 0.0001).

[Myocardial infarction as indicator in a time study. DRG-based financing, did it change therapeutic quality?]. / Hjerteinfarkt som markørtilstand i en tidsstudie. DRG-basert stykkprisfinansiering, endret behandlingskvalitet?

In Norway, four hospitals switched from 100% global budgeting to a combination of 40% DRG-based per case payment and 60% fixed grant financing in 1991. In order to assess changes in the quality of care in acute medicine during the two first years after changing the system of financing, delays before initiation of thrombolytic therapy in patients with acute myocardial infarction were registered. The time from arrival in hospital to initiation of thrombolytic therapy was unchanged, median time was 50 minutes in the first registration period and 55 minutes in the second. 45% of the patients in the intensive care unit/coronary care unit with acute myocardial infarction received thrombolytic therapy.

Age-related discrimination in the use of fibrinolytic therapy in acute myocardial infarction in Norway.

Age-related use of fibrinolytic therapy in acute myocardial infarction was studied for patients admitted to the intensive care unit in four hospitals comprising 10% of the national hospital bed capacity in Norway. Altogether, 446 patients were included. All had validated acute myocardial infarction or acute ischaemic coronary heart disease treated with fibrinolytic medication. The fibrinolytic treatment rate decreased linearly from 74% among patients younger than 50 years to 15% among those older than 80 (p < 0.0001). In a multiple logistic regression, low age, short pre-hospital time and no previous myocardial infarction strongly predicted use of fibrinolytic therapy (p < 0.0001), and male sex was a significant predictor for use of fibrinolytic therapy (p = 0.01).

When time is precious--time lags as indicators of quality of care in acute myocardial infarction.

Intravenous thrombolytic therapy is known to reduce mortality in acute myocardial infarction. The effect is highly time dependent and is uncertain 12 hours or more after onset of major symptoms. In order to assess aspects of quality of care for the initial treatment of acute myocardial infarction, pre- and in-hospital time lags were recorded in four Norwegian hospitals for patients admitted to the intensive care unit with acute myocardial infarction and for patients who received thrombolytic therapy for acute ischemic coronary heart disease. Four hundred and forty-six patients were included, of whom 45% (199) received thrombolytic medication, 159 after the initial assessment and 40 after observation and reassessment. All patients receiving thrombolytic therapy had a history of pain, and 94% (187) had significant ECG-changes. Median pre-hospital time was 240 (1. and 3. quartil 120, 519) min for the total sample and 155 (91, 280) min for those who received thrombolytic medication after the primary assessment. Median in-hospital time before thrombolysis was 55 (35, 75) min for the latter group, and 177 (111, 335) for those who were observed and reassessed. We conclude that there is considerable potential for reducing the time lag for initiation of thrombolytic medication in acute myocardial infarction. Audits, written guidelines and standards are necessary to reduce in-hospital time.