Purpose-This paper aims to review the patient satisfaction literature, specifically meta-analyses, which critically analyses its theory and use; then to present evidence for perceived service quality as a separate and more advanced construct. Design/methodology/approach-Papers that judiciously review the development and application of patient satisfaction were identified; along with studies addressing the conceptual and methodological deficiencies associated with the concept; and the current perceived service quality theory. Findings-Patient satisfaction has been extensively studied and considerable effort has gone into developing survey instruments to measure it. However, most reviews have been critical of its use, since there is rarely any theoretical or conceptual development of the patient satisfaction concept. The construct has little standardisation, low reliability and uncertain validity. It continues to be used interchangeably with, and as a proxy for, perceived service quality, which is a conceptually different and superior construct. Practical implications-The persistent use of patient satisfaction to evaluate the client's perception of the quality of a health service is seriously flawed. The key to solving this dilemma may be for the healthcare sector to focus on perceived health service quality by considering the specific concepts and models that can be found in the services marketing literature. This literature offers more advanced consumer theories which are better differentiated and tested than existing healthcare satisfaction models. Originality/value-The paper points out that there is an urgent need for differentiation and standardisation of satisfaction and service quality definitions and constructs, and argues for research to focus on measuring perceived health service quality.

This study examined the frequency and severity of sickle related pain, its impact on quality of life, and methods of coping for 25 children with sickle cell disease, aged 6-16 years. Subjects were matched with non-affected peers and asked to complete the Central Middlesex Hospital Children's Health Diary for four weeks.Results indicated that sickle pain occurred on average one in 14 days, and total summary pain scores indicated significantly greater pain than for controls. Children with sickle cell disease could discriminate sickle pain and did not adopt sick role responses to ordinary childhood ailments. Nearly all sickle pain was dealt with at home. Sickle pain resulted in over seven times increased risk ofnot attending school and was highly disruptive of social and recreational activities.Careful assessment of sickle pain in the home environment is an essential part ofa community focused pain management service, which effectively supports children's resilience and improves their quality of life.

Frailty is a common syndrome that is associated with vulnerability to poor health outcomes. Frail older people have increased risk of morbidity, institutionalization and death, resulting in burden to individuals, their families, health care services and society. Assessment and treatment of the frail individual provide many challenges to clinicians working with older people. Despite frailty being increasingly recognized in the literature, there is a paucity of direct evidence to guide interventions to reduce frailty. In this paper we review methods for identification of frailty in the clinical setting, propose a model for assessment of the frail older person and summarize the current best evidence for treating the frail older person. We provide an evidence-based framework that can be used to guide the diagnosis, assessment and treatment of frail older people.

Consumer directed care (CDC) is currently being embraced internationally as a means to promote autonomy and choice for consumers (people aged 65 and over) receiving community aged care services (CACSs). CDC involves giving CACS clients (consumers and informal carers of consumers) control over how CACSs are administered. However, CDC models have largely developed in the absence of evidence on clients' views and preferences. We explored CACS clients' preferences for a variety of CDC attributes and identified factors that may influence these preferences and potentially inform improved design of future CDC models. Study participants were clients of CACSs delivered by five Australian providers. Using a discrete choice experiment (DCE) approach undertaken in a group setting between June and December 2013, we investigated the relative importance to CACS consumers and informal (family) carers of gradations relating to six salient features of CDC (choice of service provider(s), budget management, saving unused/unspent funds, choice of support/care worker(s), support-worker flexibility and level of contact with service coordinator). The DCE data were analysed using conditional, mixed and generalised logit regression models, accounting for preference and scale heterogeneity. Mean ages for 117 study participants were 80 years (87 consumers) and 74 years (30 informal carers). All participants preferred a CDC approach that allowed them to: save unused funds from a CACS package for future use; have support workers that were flexible in terms of changing activities within their CACS care plan and; choose the support workers that provide their day-to-day CACSs. The CDC attributes found to be important to both consumers and informal carers receiving CACSs will inform the design of future CDC models of service delivery. The DCE approach used in this study has the potential for wide applicability and facilitates the assessment of preferences for elements of potential future aged care service delivery not yet available in policy.