Does Patient Satisfaction Reflect Differences in Care Received After Stroke?

Abstract

Background and Purpose-Despite the volume of research into patient satisfaction, it is not clear whether satisfaction ratings reflect differences in care received after stroke or the characteristics of patients. The aim of this study is to test the hypothesis that patient satisfaction is independently related to differences in care received after stroke. Methods-Stroke patients participating in a randomized controlled trial of early discharge to community therapy completed a satisfaction questionnaire and physical and psychological outcome measures at 4 and 12 months. Two hundred seventy-four patients (83%) were followed up at 4 months and 262 patients (79%) at 12 months. Use of therapy and community services was quantified. Logistic regression was used to investigate associations between satisfaction, patient characteristics, and service provision. Results-The more therapy, meals on wheels, and home help visits patients received, the more likely they were to be satisfied. Patients in the conventional arm of the trial were less likely to express satisfaction than those discharged early to community therapy. Women, older people, anxious people, and those more functionally independent were more likely to be satisfied, while those with depression, speech and swallowing deficit, motor deficit, and poor subjective health were less likely to be satisfied. Conclusions-The finding that satisfaction assessments reflect real differences in the provision of care and occur independently of any associations with patient characteristics is new. Patient satisfaction should be taken seriously as an outcome. (Stroke. 1999;30:49-55.)

Patient Dissatisfaction With Acute Stroke Care

“…ADL function at 3 months was strongly linked to satisfaction with in-hospital care. The association with functional outcome has been evident in some 4,13 but not all 3 previous studies on patient satisfaction with stroke care. Our results also indicate that depressive mood and poor self-perceived general health 3 months after stroke are, independent of each other and independent of ADL function, strong predictors of dissatisfaction.…”

“…For most variables, the multinomial logistic model showed good consistency regarding predictors of dissatisfaction vs uncertainty. Previous descriptive and analytic studies of stroke patient satisfaction have been performed in acute hospital, rehabilitation hospital, and outpatient settings, [3][4][5]13,15 sometimes using comprehensive and well-validated questionnaires 4,16 or a qualitative research approach. 17 The single question used as the main outcome variable in this study has not been tested for test-retest repeatability or other clinimetric characteristics.…”

“…In stroke rehabilitation, conflicting views between patients and the treating team about realistic aims are clearly associated with patient dissatisfaction. 15 When Pound et al 4 found that women and elderly people were more likely to express satisfaction with their care, they speculated that this may be attributable to low expectations. It is then interesting that, after adjustment for covariates, we found no major differences between men and women in Riks-Stroke ( 20 and this study).…”

“…Emotional stress, depression, and unmet care demands have been found to be associated with dissatisfaction. 3,4 A small Scottish prospective study on acute stroke care showed that most patients were satisfied and that they were more content with the care than their care givers were. 5 Most dissatisfaction occurred in the areas of information and social advice.…”

“…The register covers all hospitals in the country admitting acute stroke patients. As in previous articles on the subject, [3][4][5] this report on Ͼ100 000 patients focuses on patient dissatisfaction rather than satisfaction, because of the disproportionate impact dissatisfaction may have on patients and staff.…”