Δάφνη Καϊτελίδου, Αναπληρώτρια Καθηγήτρια, Τμήμα Νοσηλευτικής, ΕΚΠΑ Ιωάννης Μαντάς, Καθηγητής , Τμήμα Νοσηλευτικής, ΕΚΠΑ Παναγιώτα Σουρτζή, Καθηγήτρια, Τμήμα Νοσηλευτικής, ΕΚΠΑ
Introduction: Patient satisfaction is one of the most important indicators of the quality of health services. Increasingly, in the field of Endoscopic Gastroenterology, there are being efforts to study, understand and portray the dimensions and factors influencing patient satisfaction with the quality of provided health care and the impact on clinical outcomes, and vice versa.
Aim of the study: The purpose of this study was to investigate the effect of providing clear and explanatory verbal instructions in hospitalized patients undergoing colonoscopy, regarding the degree of satisfaction, the quality of bowel preparation and the assessment of cost in cases of inadequate preparation.
Sample and method: The studied population consisted of 75 patients, hospitalized in a public tertiary general university hospital from July to December of 2017 and underwent colonoscopy, based on specific inclusion criteria and after providing written consent. Patients were randomized into two groups. The intervention group was given detailed verbal instructions about the preparation and the control group was given the usual instructions in the manner provided at each clinic. For the assessment of satisfaction, a standardized questionnaire composed of two parts-before and after the colonoscopy, was used. The clinical data were recorded on special sheets during endoscopy, while the estimation of the cost of inadequate preparation was calculated according to the DRGs and the National Tariff payment system.
Results: The clinical results concerning the quality of preparation were presented as improved in the intervention group. Specifically, 97,3% of the patients who received special instructions accomplished adequate preparation, while the rate for those who did not receive instructions was 86,8%. The intervention group achieved a perfect cumulative score (grade 9) in Boston Bowel Preparation Scale (BBPS) at a rate of 40,50% versus 28,9% in the control group. The colonoscopies performed in the intervention group revealed findings related to the indication at a rate of 64,9% while the percentage related to the control group was 60,5%. The duration of colonoscopy due to the need of additional manipulations was increased in the control group (325 sec compared to 260,5 sec in the intervention group). The group that received special instructions scored higher satisfaction (8,7 versus 8,1), although the control group showed higher scores at the individual dimensions. Inadequate preparation increased the cost of health services from € 97,66 to € 212,12 per patient.
Conclusions: The educational intervention seems to positively influence the clinical results of colonoscopy and patient satisfaction. However patient satisfaction is multidimensional and presents various interdependencies between the factors that is influenced by. Research combining patient experiences and their health outcomes, brings hope in achieving the designing and implementation of quality assurance and cost retention programs.
Key words: patient satisfaction, colonoscopy, lower gastrointestinal endoscopy, colonoscopy preparation, bowel preparation, bowel cleansing, quality assurance, bowel preparation quality, patient education, inpatients.
Patient satisfaction, Colonoscopy, Lower gastrointestinal endoscopy, Colonoscopy preparation, Bowel preparation, Bowel cleansing, Quality assurance, Bowel preparation quality, Patient education, Inpatients