Healthcare Experience and their Relationship with Demographic, Disease and Healthcare-Related Variables: A Cross-Sectional Survey of Patients with Chronic Diseases Using the IEXPAC Scale

Abstract

Background Patient experience is acknowledged as a principal aspect of quality healthcare delivery, and it has implications with regard to outcomes. Objectives Our objective was to evaluate the healthcare experience of patients with chronic diseases to identify patient-perceived healthcare gaps and to assess the influence of demographic and healthcare-related variables on patient experiences. Methods A cross-sectional survey was delivered to adult patients with chronic diseases: diabetes mellitus (DM), human immunodeficiency virus (HIV) infection, inflammatory bowel disease (IBD) or rheumatic diseases. Patient experiences were assessed with the Instrument for Evaluation of the Experience of Chronic Patients (IEXPAC) questionnaire, with possible scores ranging from 0 (worst) to 10 (best experience). Results Of the 2474 patients handed the survey, 1618 returned it (response rate 65.4%). Patients identified gaps in healthcare related mainly to access to reliable information and services, interaction with other patients and continuity of healthcare after hospital discharge. The mean ± standard deviation (SD) IEXPAC score was 6.0 ± 1.9 and was higher for patients with HIV (6.6 ± 1.7) than for those with rheumatic disease (5.5 ± 2.0), IBD (5.9 ± 2.0) or DM (5.9 ± 1.9) ( p < 0.001). In multivariate models, better overall IEXPAC experience was associated with follow-up by the same physician, follow-up by a nurse, receiving healthcare support from others and treatment with subcutaneous or intravenous drugs. The multivariate model that confirmed patients with HIV or DM had better experience than did those with rheumatic diseases. Conclusions Through IEXPAC, patients identified aspects for healthcare quality improvements and circumstances associated with better experience, which may permit greater redirection of healthcare toward patient-centered goals while facilitating improvements in social care and long-term healthcare quality. Electronic supplementary material The online version of this article (10.1007/s40271-018-0345-1) contains supplementary material, which is available to authorized users.

Association between non-adherence behaviors, patients’ experience with healthcare and beliefs in medications: a survey of patients with different chronic conditions

“…A total of 1530 patients were suitable for study of medication adherence (336 with rheumatic disease [ (14.6) years, and 59.2% of patients were male. The demographic characteristics and distribution of the current population were similar to the overall population, as described by Orozco-Beltran et al 15 .…”

“…Indeed, a recent systematic literature review that compared different approaches to estimating persistence and adherence in chronic diseases with polypharmacy of oral and subcutaneous treatments concluded that considerations about the route of medication administration, available resources, setting and aim of the assessment should guide decisions about which method to use 27 . Additional limitations of the current study are those previously recognized in surveying patients with chronic diseases 15 . These include possible selection bias of patients with more severe chronic conditions, which was negated to some extent by the selection of consecutive patients attending clinics.…”

“…Assuming an expected response rate of 50%, the final sample size was 628 patients for each disease. Thus, we planned to hand the survey to $2500 patients (625 patients for each chronic disease) 15 .…”

“…A cross-sectional survey was handed to 2474 adult patients with four chronic diseases: diabetes mellitus (DM), human immunodeficiency virus (HIV) infection, inflammatory bowel disease (IBD) or rheumatic diseases, as described previously 15 . The survey content was developed by a group of physicians with experience in the care of the abovementioned patients, with input from members of patients' associations, which reviewed and approved the final content and endorsed the project.…”

The experience of inflammatory bowel disease patients with healthcare

“…We previously reported the outcomes of a survey to assess the experience of patients with 4 different chronic conditions: diabetes mellitus, HIV infection, rheumatic disease, or IBD, with healthcare using the IEXPAC questionnaire. [21] In the current work, we focus on the group of patients with IBD, with the objective of assessing their experience with healthcare using the IEXPAC scale, identifying areas of improvement in healthcare and to explore the potential influence of demographic and healthcare-related variables on patients’ experiences.…”