Patient experience Silvia Coretti Università Cattolica del Sacro Cuore, Rome Christine Bond, University of Aberdeen MUNROS is funded by the European Commission FP7 programme, HEALTH-F3-2012-305467EC. Project co-ordinators Prof Bob Elliott, r.elliott@abdn.ac.uk and Prof Christine Bond, c.m.bond@abdn.ac.uk www.abdn.ac.uk/munros
Describe patients. demographic characteristics Objectives gender, education, clinical condition, other co-morbidities, overall health use of services focus on the skill mix of the health care teams who provided their care experiences of and satisfaction with care association with task substitution
Measures from patient survey Who they saw and when in the clinical pathway Experiences of care Feeling involved in treatment decisions Perceived attention to individual needs and preferences Information and information tools provided Involvement of different professional categories Satisfaction Awareness of task substitution
Data Sources Norway, 5.36 Turkey, 10.91 Poland, 8.09 England, 7.56 Scotland, 14.42 Germany, The 3.61 Netherlands, 5.36 Norway, 5.36 Poland, 8.09 England, 7.56 Scotland, 14.42 Germany, The 3.61 Netherlands, 5.36 Chez Republic, 10.2 BC pathway: 1047 patients Italy, 34.48 Turkey, 10.91 Chez Republic, 10.2 Italy, 34.48 HD pathway: 1137 patients England Norway 8% 5% Poland 8% Scotland 14% Germany The Netherlands Turkey 11% Chez Republic 10% T2D: 775 patients Italy 35%
Demography Across countries, mean age of sample ranges between 50-62 years in BC pathway, 55-76 years in HD pathway and 54-69 years in T2D pathway Gender composition is homogeneous across countries
Results: SE status Not reported Level of Education Primary school BC 2% 14% 31% 21% 15% 11% 7% Seconday School High Scool/Trade Qualification Bachelor degree HD 2% 36% 26% 19% 9% 4% 5% Postgraduate Degree T2D 2% 32% 30% 16% 10% 5% 6% Other 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Not reported Employed BC 3% 39% Self-employed Looking for job Student HD 2% 23% 6% Not looking for job Retired T2D 2% 30% Employment Status 5% 3% 16% 29% 2% 3% 60% 5% 2% 8% 2% 9% 48% 2% Other 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Self-reported health status Charlson's Index 0 2-3 4-5 6-7 8+ BC 5% 75% 13% 2% 3% HD 47% 28% 13% 4% 8% T2D 56% 29% 5% 5% 6% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Who patients saw 100% 80% 60% 40% 20% 0% Professionals providing information and education 67% 69% 58% 58% 83% 70% 24% 28% 27% 21% 25% 3% 3% 4% BC HD T2D 49% MEDICAL STAFF PHYSICIAN ASSISTANT NURSING STAFF PHARMACIST ALLIED PROFESSIONAL 100% 80% 60% 40% 20% 0% Professionals providing monitoring 82% 75% 68% 66% 71% 67% 53% 19% 24% 41% 31% 14% 3% 5% 3% BC HD T2D MEDICAL STAFF PHYSICIAN ASSISTANT NURSING STAFF PHARMACIST ALLIED PROFESSIONAL
Who patients saw: key points Breast cancer pathway: Doctors and nurses are main providers of information and education Allied professionals have wider involvement in monitoring in some countries (ENG, SCO) Heart disease pathway: Doctors and nurses are the main providers Pharmacists have greater involvement in the information phase (NL, IT, SCO) Type 2 Diabetes pathway Doctors have prominent role in all countries Nurses and allied professionals have greater involvement in education and monitoring (NO, IT, SCO)
Patient experiences 4.0 3.5 3.0 3.4 3.4 3.3 2.8 3.6 3.5 3.6 3.6 3.0 3.1 3.0 3.1 Mean Score 2.5 2.0 1.5 1.0 0.5 0.0 BC HD T2D Felt Involved in medical decisions Perceived attention to individual needs Information and tools provided Involvement of other professionals
Perception of task substitution 100% 100% Patients reporting task substitution 90% 80% 70% 60% 50% 40% 30% 20% 10% 31% 35% 69% 65% 42% 58% No(%) Yes (%) Agreement between patients perceptions of substitution and MORNI 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% BC HD T2D 0% BC HD T2D In each pathway about 50% do not see always the same professional when visiting hospital or GP clinic Some patients reported task substitution among professionals, mainly between doctors and nurses Reported task substitution is similar but nothe sames as the MORNI
Association of experience with reported task substitution Felt involved in medical decisions Perceived attention to individual needs Were given information and tools Breast cancer = *No = = Heart disease = *Yes = *Yes Type 2 diabetes = *Yes = *Yes *Statistically significant correlation = no correlation Had involvement of other professionals
Association of satisfaction with task substitution Did not report substitution Breast cancer Overall satisfaction with last visit 5.6 6.1 p 0.0017 Reported substitution Heart disease Overall satisfaction with last visit 5.7 5.9 p 0.1022 Type 2 diabetes Overall satisfaction with last visit 4.9 5.8 p 0.0001
Overall Conclusion The study sample is well-balanced across countries in terms of age gender and SE factors. Patients report a moderately good health state. The medical and nursing staff are the main providers of care. Patients are more likely to report a good experience of care in terms attention to their needs and, in HD and T2D pathway, referral to other professionals when they report task substitution. Those patients also report higher overall satisfaction score in BC and T2D pathways.