Satisfaction and Compliance in Rehabilitation Medicine

Transcription

1 Satisfaction and Compliance in Rehabilitation Medicine Eva Uher a and Rainer Maderthaner b a Landesklinikum Mistelbach Departement of Physical Medicine and Rehabilitation b Department of Basic Psychological Research and Research Methods Faculty of Psychology - University of Vienna

2 Introduction Rehabilitation medicine operates in an area of conflicts, ranging between providing effective rehabilitation services in line with the recommended guidelines of the scientific societies and economical strains of cost effectiveness, due to the budget strains of the health care providers. What tips the scales: patients health-belief model patients compliance patients satisfaction 2

3 Introduction Patient recruitment : PMR department in a hospital in Lower Austria Literature review : Patients Adherence is to be targeted Find predictors for dropouts compliant and non-compliant behavior Topic: results of a prospective questionaire study in a inpatient and ambulatory setting 3

4 Identification of predictors for satisfaction and compliance Questions: 1. Can you predict non-dropouts or dropouts? 2. Correlation to patient s satisfaction? 4

5 Materials and Methods Sample: n = 957 (orthopedic & trauma patients) excluding criteria's were: dementia, under 18`s, non-german speakers, and non corpus mentis patients (e.g. intensive care patients,..) HBQ (health belief questionnaire consists of Scales of PAREMO-20, FREM-8, IPQ-R, BRQ, NRS pain) PSO-Q (patient satisfaction and organisation: treatment satisfaction, pain reduction, organisational conditions, amount of treatment ) Referral diagnosis, sociodemographic variables 5

6 Sample description Total sample group : n =957 Dropouts: n= 87 (9%) N = 270 filled out both questionnaires (response rate 28,42%) Selection criteria out-/inpatient n= 579 outpatients n=195 both questionnaires response rate = 34% n= 137 inpatients n = 66 both questionnaires response rate= 48% 6

7 Results of Linear Regression Analysis (Sociodemographic Variables) Therapy Units until Dropout R =,34 R 2 adj =,09 p =.015 n = 72 Method: Stepwise =.+23 =.-25 Pain Rating Scale (Range = 1-10) Age (Md = 59; Range = 18-93) 7

8 Results of Linear Regression Analysis (Diagnostic Variables and Health Belief Scales) Therapy Units until Dropout R =,46 R 2 adj =,18 p =.001 n = 72 Method: Stepwise = +.23 = +.23 = +.34 Pain and Physical Complaints (Scale, = 0,71) Low Back Pain Less Social Support and Satisfiying Information about Rehab. purpose (Scale, =,71) 8

9 Results of Prediction Analysis Results of Prediction Analysis* (Health Belief variables) Non-Dropout Z = 2,56 Effect size = 39% p =.005 n = 785 (Statistics of Binomial Test) Propositional Logic Modelling Knowledge about the rehabilitation purpose AND enough time to get information about the rehab. procedure OR Thinking: The disease is fate AND Thinking: The disease is difficult to be treated AND Thinking: No power to alter the course of the disease by themselfes * A. Eye (Ed.) (1991): Prädiktionsanalyse Vorhersagen mit kategorialen Variablen. Weinheim: Psychologie Verlags Union. 9

10 Satisfaction with therapy scale: (items) α=,079 Reaching the therapy goal therapy was important Satisfaction with applied therapy Results of Analysis of Variance (Organisational and Diagnostic Variables) Satisfaction with Therapy F = 7,78 df = 24 R 2 adj =,55 p =.001 n = 136 ANOVA (2 x 3 x 5) 2 p =.+27 Rating of Pain Reduction 2 p =.+23 Organisational Satisfaction 2 p =.+09 Amount of Treatment <10 vs > 10 10

11 Conclusion Take Home Message High prognostic value (55%) for therapy satisfaction by the amount of pain reduction, by organisational satisfaction and by the amount of treatment Older patients tend to drop out as well as patients with low pain scoring Patients are compliant with therapy if they feel well informed on the rehabilitation process or/and they feel helpless (fatalism) to alter their course of the disease by themselves With regard to an individualised future therapy model, the most effective causes for therapy satisfaction and prevention of dropouts are optimal therapy organisation, the experience of pain reduction some aspects of health belief model, such as knowledge about the rehabilitation process and the caregivers information of the patients attitudes in respect to their illness 11

12 Thank you for your compliance! 12