["Münsteraner foot- and shoe score"--objectivation of patient satisfaction after provision with orthopedic shoes]. / "Münsteraner Fuß- und Schuhfragebogen" - Objektivierung der Patientenzufriedenheit nach orthopädischer Schuhversorgung.

BACKGROUND: Means to improve patient satisfaction and their compliance are essential for the successful outcome of medical interventions, e.g. supply of orthopedic shoes or orthoses in orthopedic patients. A useful validated questionnaire to monitor the subjective opinion of the patients is still lacking. METHODS: In a randomised single blinded study we created a new questionnaire with two parts. Part one deals with ten questions on patient data and illness. Part two consists of 13 questions about pain, disabilities in activities of daily life (ADL), use of painkillers, satisfaction, history of ulceration, correction of shoes and orthoses, handling and compliance using a scale of 1-6. Questions were chosen by asking a group of experts (four experienced physicians of two universities and four shoemaker master-craftsmen). Then an items reduction was performed. The reliability was tested in a pre- and retest in 20 patients of our orthopedic clinic. Then the questionnaire was validated by comparing 40 patients of our orthopedic clinic (intervention group) with 180 subjects without orthopedic treatment (control group) chosen at random. The questionnaire was always done anonymously and without the help of the interviewer. Exclusion criteria for the control group were any kind of orthopedic treatment of the lower limb in the last 2 years, orthopedic shoes or lumbar sciatic pain. Exclusion criteria for both groups were minor or major amputations, inability to walk outdoors without help. RESULTS: We demonstrated highly significant differences for each single question and the total score between orthopedic patients and healthy probands. Additionally, we saw significantly poorer scores for patients suffering from diabetes in the control group, patients with polyneuropathy and those without polyneuropathy, as well as for women vs. men. There was a high rate of diabetics (11 %) in the control group in analogy to the current literature. DISCUSSION: The new questionnaire discriminates highly significantly between healthy and ill probands. Interindividually a screening of people at risk is possible or a comparison of different interventions. Intraindividually it could be used to monitor patient satisfaction after interventions. Objectivation of patient satisfaction is important to improve their compliance and outcome.

[Organization model for postoperative pain management in a basic-care hospital]. / Organisationsmodell der postoperativen Schmerztherapie am Beispiel eines Krankenhauses der Regelversorgung.

Small hospitals often lack the financial and personnel resources to realize innovative postoperative pain management concepts. This is not-as shown here-an absolute contradiction. The regular measurement of pain and its documentation by ward nurses as well as the appropriate prescription of analgesics play a key role in our concept. The joint establishment of guidelines, information sessions and the on-going dialog between the various professional groups guarantees the necessary consensus of all specialists involved in postoperative pain control. If an anesthetist is available 24 h a day, a nurse-based acute pain service (APS) becomes available for managing patients with patient-controlled analgesia (PCA) systems. The use of PCA and the performance of pain visits at regular intervals increase patient comfort and satisfaction. In addition, it can contribute to reduced hospitalization time in the context of fast-track rehabilitation programs. In our opinion, embedding the measures in a quality management program has a valuable catalytic effect, although implementation takes at least 1-2 years.

[Development of a questionnaire to assess the quality of the preanesthetic visit]. / Entwicklung eines Fragebogens zur Erfassung der Qualität der Narkoseaufklärung.

In the current study a questionnaire was developed to evaluate the preanesthetic visit to prepare patients for general anesthesia with regard to the effects on in-hospital quality of care. The questionnaire consists of one part pertaining to patient satisfaction and one part pertaining to the information gained from the preanesthetic visit. In a first phase, the questionnaire was generated and then validated in 104 patients undergoing general or vascular surgery at the University of Heidelberg, Germany. As a result of the pretest evaluation, the preliminary pool of questions could be reduced. Consequently, the final questionnaire is composed of six questions on patient satisfaction and six questions on information gained after the preanesthetic visit as well as one question regarding the number of preanesthetic consultations prior to general anesthesia. In the part of the questionnaire on patient satisfaction, responses can be given on a 6-point scale ranging from -3 (statement is not correct) to +3 (statement is correct). The scores -3 to +3 are assigned 1-6 points, in order to calculate a total sum score to measure patient satisfaction. The part on information gained contains multiple-choice questions with four possible answers, of which only one is correct. Analogous to the measurement of patient satisfaction, a total sum score can be calculated to evaluate the information gain after the preanesthetic visit. The present study shows the suitability of a questionnaire to evaluate the quality of health care after the preanesthetic visit with the parameters patient satisfaction and information gain. Such a questionnaire can be used to compare different premedication techniques and, thus, might contribute to improve the quality of health care.