Patient satisfaction with mental health services: a meta-analysis to establish norms

Patients typically express high rates of satisfaction with their mental health care. This finding and the lack of well controlled studies on patient satisfaction in the literature underscore the need for meaningful guidelines for clinicians and program evaluators in interpreting patient satisfaction data. To address this problem a meta-analysis was undertaken to establish norms on patient satisfaction for various types of mental health programs. Programs were categorized according to three dimensions: inpatient vs. outpatient vs. residential care; chronic vs. non-chronic; and conventional vs. innovative. Meta-analysis procedures were modified to accommodate the single-group study designs that dominate the literature. The analysis revealed that chronic patients express less satisfaction with their treatment compared to non-chronic patients. Innovative programs are viewed more positively than conventional ones. No differences were found in rates of patient satisfaction between inpatient and outpatient programs. Acceptably reliable norms and confidence intervals of patient satisfaction were established for conventional inpatient programs serving either chronic or non-chronic patients; conventional outpatient programs for non-chronic patients; and for all programs combined according to chronic vs. non-chronic, inpatient vs. outpatient, and conventional vs. innovative. However, data were insufficient to compute norms for other program types. The norms thus established can be used for comparative purposes by program evaluators. A cumulative, national data base on patient satisfaction is recommended to further refine these norms.     

The effects of psychiatric symptoms on quality of life assessments among the chronic mentally ill

This study of chronically mentally disabled persons in community residences examined the discriminant validity of subjective quality of life indicators and self-report mental health indices to determine the potential confounding effects of psychopathology on the assessment of quality of life (QOL). Factor analyses and difference-score reliabilities identified a general QOL construct and a general mental health construct with 27% common variance. However, psychiatric symptoms did not significantly (p less than .05) alter the bivariate and multivariate relationships among the QOL ratings, except in the health domain in which the correlations of health-related QOL indicators with global QOL were significantly (p less than .05) attenuated after removing the effects of psychopathology. The results suggest that psychopathology does not introduce bias into the overall structure of QOL data, but they also indicate the importance of controlling for mental health effects in the assessment of patients' self-rated health and satisfaction with health care.     

Some specifics on the brain drain from the Andean region

An analysis of the brain drain from the Andean countries of Bolivia, Chile, Colombia, Ecuador, and Peru to the United States is presented. The data are from a survey of 62 persons from those countries who are currently residing in the United States and are listed in the current edition of "American Men and Women of Science". The reasons why they left their country of origin and are staying in the United States are considered. (summary in FRE, SPA)     

Errata

My article entitled "Replications, Significance Tests, and Confidencein Findings in Survey Research" (POQ 47:261–69) is marredby a serious error which has implications for most of the contentsof the article. Table 1, which is adapted from a table published by Rosenthaland Hall,¹ gives the critical values of required for significance at several levels; itdoes not give the critical values of Trans , or () (). Rather, the latter should be referreddirectly to a table giving the areas under the normal curve,or, in other words, it should be treated as though it were aZ from a single-sample test. This means that the comparisons of significance test resultsfrom pooled data and from series of replications in Tables 2and 3 do not support the conclusion that using a replicate designrather than pooled data lessens the probability of Type II errors.In the case of Table 2, the probability from the pooled sampleis lower than the correct one from the series of replications,and in the case of Table 3, the probabilities are about thesame. The data in Table 4 illustrate a kind of situation in whicha replicate design may be the preferred one for another reason.The replicate design allows an estimate of sampling variabilityfrom the actual variability among a small number of samples,whereas the single-sample and pooled-sample significance testresults may be substantially in error due to the unstable meaningof the "zero" assigned to the reference category for the dummyvariables. However, the estimated probability for the arrayof replications should be .05 rather than the probability reported. Another error with less serious implications for the paper asa whole is that the third "alternative formula" for Trans is incorrect as printed. One of thefirst two formulas, or () (), should be used instead. The major error resulted from a misreading of the paper by Rosenthaland Hall. I apologize to Rosenthal and Hall and to any readersof my paper who have used the table of critical values incorrectlyin their research.     

The meaning of patient satisfaction with prepaid primary health care in Israel

This paper reports the development of a self-administered Hebrew-language questionnaire for assessing patient satisfaction with primary care in Israel. Four scale measures of patient satisfaction were empirically constructed. These scales pertained to doctor conduct, doctor-patient communication, teamwork, and ease of access. In addition, a single direct question was used to measure overall satisfaction with the care. Ratings of all aspects of care were negatively skewed, with doctor-conduct and doctor-patient communication usually being the most satisfactory aspects and access the least satisfactory. It was shown that different practices, or the same practice at different points in time, can easily and meaningfully be compared, using mean satisfaction scores, measures of standard deviation, or percentages in each practice with ratings above (or below) the overall mean of all practices. The use of specific measures of patient satisfaction for comparison and intervention is discussed.