The patient's view of quality in psychiatric outpatient care.

The influence of demographic characteristics on patients' ratings of the quality of psychiatric outpatient care has been given little attention in research. The aim of the present study is to elucidate the quality of psychiatric care among outpatients and investigate demographic and clinical factors associated with the way in which this quality is perceived. A sample of 1340 outpatients from 15 general adult psychiatric clinics in Sweden completed the quality in psychiatric care-out-patient (QPC-OP), with a response rate of 71%. The patients' highest ratings were for Encounter; the lowest were for discharge. Most notably, quality of care was rated higher by women, older people, those with a partner, those with a lower educational level and those who were gainfully employed. In regard to visits to the clinic, higher quality of care was associated with shorter waiting time, better information and fewer professions encounters. Older people and those gainfully employed reported better mental health. Thus the QPC-OP was associated with both demographic and clinical factors. In particular, 'wanting to come back to the clinic' was the single strongest predictor of quality.

Push or pull? Relationships between lung cancer patients' perceptions of quality of care and use of complementary and alternative medicine.

UNLABELLED: Little is known about relationships between quality of care (QoC) and use of complementary and alternative medicine (CAM) among patients with lung cancer (LC). PURPOSE: This study examines CAM-use among patients with LC in Sweden, associations between QoC and CAM-use among these patients, and reported aspects of LC-care perceived as particularly positive and negative by patients, as well as suggestions for improving QoC. METHODS: Survey data from 94 patient members of the Swedish LC patient organization about CAM-use and QoC as measured by the instrument "Quality from the patient's perspective" were analyzed. RESULTS: Fifty (53%) LC-patients used CAM, with 40 of the CAM-users reporting that CAM helped them. The most common CAMs used were dietary supplements and natural remedies, followed by prayer. Significantly more patients reported using prayer and meditation for cure than was the case for other types of CAM used. Less than half the CAM-users reported having spoken with staff from the biomedical health care system about their CAM-use. Patients provided numerous suggestions for improving LC-care in a variety of areas, aiming at a more effective and cohesive care trajectory. No differences in QoC were found between CAM-users and non-CAM-users, but differences in CAM-use i.e. type of CAM, reasons for using CAM, and CAM-provider consulted could be associated with different experiences of care. CONCLUSIONS: It is important to recognize that CAM-users are not a homogeneous group but might seek different types of CAMs and CAM-providers in different situations depending on experiences of care.

Effects of acupuncture and care interventions on the outcome of inflammatory symptoms of the breast in lactating women.

OBJECTIVES: To compare modes of care and treatment for lactating women with inflammatory symptoms of the breast, with special focus on the use of acupuncture. METHOD: Eighty-eight mothers were randomized into three treatment groups. All three groups were given advice regarding emptying of the breasts and care in the form of comfort interventions. Acupuncture was included in the treatment regime for two of the groups. A severity index was created by adding together scores for signs and symptoms: breast tension, erythema and pain. FINDINGS: Mothers in all groups expressed relative satisfaction with the breastfeeding situation despite considerable discomfort. There was no significant difference between the groups for the number of mothers requiring more than three contact days for recovery nor for their severity index scores on day 3. These findings must be interpreted with care but may suggest that care interventions play as great a part in the recovery of these women as acupuncture treatment or the use of oxytocin spray. Antibiotic therapy was used in 9% of the study population, which is in contrast to other studies. PROPOSED FUTURE ACTION: Based on these results, a new study has been designed to test the hypothesis that acupuncture hastens recovery from inflammatory processes in the lactating breast and approximately 200 mothers will be randomized in a new expanded study.