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A survey on provision of patient-centred care by a government homeopathic hospital in India

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Objective: We derived 32 indicators from the International Alliance of Patients’ Organization’s (IAPO) patient-centred healthcare indicator review those seemed to be applicable for a homeopathic context and intended to test it on the patients
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  Spatula DD 79   Original Research Spatula DD. 2014; 4(2):79-88 A survey on provision of patient-centred care by a government homeopathic hospital in India Hindistan’daki bir homeopatik devlet hastanesinde hasta merkezli bakımın sağlanması üzerine bir anket Subhranil Saha 1 , Munmun Koley 1 , Shubhamoy Ghosh 2 , Goutam Nag 2 , Monojit Kundu 2 , Ramkumar Mondal 2 , Rajib Purkait 2 , Supratim Patra 2 , Seikh Swai !li 2   1 "lini#al Resear#h $nit %&omeopathy', Siliguri, under "entral "oun#il or Resear#h in &omeopathy, Go(ernment o )ndia* 2 Mahesh +hatta#haryya &omeopathi# Medi#al "ollege and &ospital, Go(ernment o est +engal, &owrah, est +engal, )ndia !""A#$ %b&ective'  e deri(ed -2 indi#ators rom the )nternational !llian#e o Patients. /rgani0ation.s %)!P/' patient#entred health#are indi#ator re(iew those seemed to be appli#able or a homeopathi# #ontet and intended to test it on the patients suering rom (arious #hroni# #onditions and (isiting the outpatients o a homeopathi# hospital in est +engal, )ndia* "ethods'  3he patient#entred #are %P""' 4uestionnaire was de(eloped in eight steps, and appro(ed by an epert #ommittee* )t had three subs#ales 5 system le(el indi#ators 6S7)s8 19 items:, patient eedba#k indi#ators 6P;)s8 - items:, and pra#titioner le(el indi#ators 6P7)s8 1< items:* ;a#e (alidity was tested by 1< people or #omprehension* 3estretest reliability was tested on -= patients and internal #onsisten#y on systemati#ally sampled ->> patients* #esults'  3he o(erall P""-2 s#ore? appeared to be moderate, o @>*@-? A 19*-BC and the subs#ale s#ores were @9*D2? A 19*B<, @<*=-? A 2B*9>, and >=*>>? A 11*B@* /nly P;) s#ores diered signii#antly by edu#ation 6P E =*==B: and health status 6P E =*==@:* 3he 4uestionnaire showed a##eptable item#orre#ted #orrelations or the subs#ales 6S7)s8 )"" =*BD %=*B>, =*BD'C P;)s8 =*DB %=*D>, =*B1'C P7)s8 =*BD %=*B>, =*BD':, #onsiderable testrest reliability 6S7)s8 =*1B 5 1*==C P;)s8 =*@= 5 =*@<C P7)s8 =*=> 5 1*==:, strong internal #onsisten#y 6"ronba#h.s alpha E =*D> o(erall and =*D9 5 =*D> or subs#ales:, and #onsiderable responsi(eness 6=*- 5 2*2:* (onclusion'  3he pro(ision o patient#entred #are by a go(ernment homeopathi# hospital in est +engal, )ndia appeared to be 4uite  promising* 3he psy#hometri# properties o the +engali P""-2 were satisa#tory, rendering it a (alid and reliable instrument* )ey*ords' Patient #entred #are, Fisease management, &omeopathy, )ndia +,. Ama/' $luslararas &astalar HrgItI +irliJinin %)nternational !llian#e o Patients. /rgani0ation)!P/' hasta merke0li saJlk gstergesi in#elemesinden homeopatik baJlamda uygulanabilir olan, Leitli kronik durumlardan mu0darip hastalar I0erindeki testler iLin tasarlanm, +at+engal&indistan homeopatik hastanesine ayaktan ba(uran hastalara uygulanmak I0ere -2 indikatr belirlendi* $0ntem' &asta merke0li bakm anketi seki0 aamal olarak tasarland (e u0man bir komite tarandan onayland* !nketin IL alt skalas  bulunmaktaydC system se(iye gstergesi 6S7)s8 19 madde:, hasta geribildirim gstergesi 6P;)s8 - madde: (e uygulay# se(iye gstergesi 6P7)s8 1< madde:* Nominal geLerliliJin anlalmas iLin 1< kii I0erinde test yapld* 3est tekrar test gI(enilirliJi iL tutarllk ile sistematik olarak rneklenmi ->> hastadan -= hasta I0erinde test edildi* 1ulgular'  Genel olarak ? P""-2 skorunun orta se(iyede %? @>*@- A 19*-B' olduJu grIldI, ayr#a alt grup skorlar da ? @9*D2 A 19*B<, ? @<*=- A 2B*9> (e ? >=*>> A 11*B@ eklinde sralanmaktadr* Sade#e P;) skorlarnda eJitim (e saJlk durumu ile arkllk ortaya Lkmtr 6P E =*==B: (e 6P E =*==@:* !nketC alt skalalar iLin kabul edilebilir maddedI0eltmeli korelasyon 6S7)s8 )"" =*BD %=*B>, =*BD'C P;)s8 =*DB %=*D>, =*B1'C P7)s8 =*BD %=*B>, =*BD':, nemli lLIde testtekrar test gI(enilirliJi 6S7)s8 =*1B 5 1*==C P;)s8 =*@= 5 =*@<C P7)s8 =*=> 5 1*==:, gILlI iL tutarllk 6"ronba#h.s alpha E =*D> genel (e =*D9 5 =*D> alt skalalar iLin: (e nemli lLIde duyarllk gstermitir 6=*- 5 2*2:* onu/'  +at +engal&indistan.da homeopatik bir de(let hastanesinde hasta merke0li bakmn saJlanmasnn oldukLa umut (eri#i olduJu grIlmItIr* +engal#e ha0rlanm olan P""-2 anketinin psikometrik 0ellikleri tatmin edi#i dI0eydeydi, bu durum da anketi deJerli (e gI(enilir bir araL yapmaktadr* Anahtar kelimler' (orresponding Author' Subhranil Saha, "lini#al Resear#h $nit %&omeopathy', Siliguri, under "entral "oun#il or Resear#h in &omeopathy, Go(ernment o )ndiaC Gokhel Road, !rabindapally, Siliguri, Farjeeling, est +engal, )ndia* Omail8 drsubhranilsahahotmail*#om Re#ei(ed Mar#h 1=, 2=19 C a##epted !pril 1@, 2=19 F/) 1=*<9<<spatula*2=19=91@=-2D=B Published online in S#opeMed %www*s#opemed*org'* Spatula FF* 2=19C 9%2'8>BDD*  Survey on patient-centred care   80 Spatula DD I2.#%3!(.I%2 Patient#entred #are %P""' is health #are that is respe#tul o, and responsi(e to, the preeren#es, needs and (alues o patients and #onsumers 61:* )t is Qa balan#ed #onsideration o the (alues, needs, epe#tations, preeren#es, #apa#ities, and health and wellbeing o all the #onstituents and stakeholders o the health #are system 61:* 3he widely a##epted dimensions o P"" are respe#t, emotional support,  physi#al #omort, inormation and #ommuni#ation, #ontinuity and transition, #are #oordination, in(ol(ement o amily and #arers, and a##ess to #are 62:* Resear#h demonstrates that P"" impro(es patient #are eperien#e and #reates publi# (alue or ser(i#es* hen health#are administrators, pro(iders, patients and amilies work in partnership, the 4uality and saety o health #are rise, #osts de#rease, and pro(ider satisa#tion in#reases and patient #are eperien#e impro(es* P"" #an also positi(ely ae#t business metri#s su#h as inan#es, 4uality, saety, satisa#tion and market share* )n the 9 th  Gene(a #oneren#e on person#entred medi#ine, held during !pril -= 5 May 9, 2=11, a #onsiderable body o e(iden#e was summari0ed indi#ating that #ru#ial elements o #lini#ianpatient intera#tion su#h as empathy, respe#t, a##eptan#e, non judgmental attitudes, openness, inormationsharing and joint de#isionmaking may lead to greater patient satisa#tion, a##eptan#e o treatment and better health out#omes* !lso emphasi0ed was the importan#e o  building trust and stri(ing to attain proessional #ompeten#e, ethi#s, aithulness and ee#ti(e #ommuni#ation and #ollaboration 6-:* Responses to homeopathi# treatment, patient  beneits, empathy and enablement ha(e pre(iously  been e(aluated in some earlier studies in estern #ountries using the Glasgow &omoeopathi# &ospital /ut#omes S#ale %G&&/S', /ut#ome in Relation to )mpa#t on Faily 7i(ing %/R)F7', Measure oursel Medi#al /ut#ome Proile %MM/P', "onsultation and Relational Ompathy %"!RO', Patient Onablement )nstrument %PO)', Ouropean Tuality o 7ie Tuestionnaire %OTo7', and Short ;orm12 %S;12' 4uestionnaire 69B:* 3he authors themsel(es studied  patient satisa#tion using a translated (ersion o Uapanese #onsultation satisa#tion 4uestionnaire or the irst time in any )ndian homeopathi# hospital and reported elsewhere 61=:* &owe(er, P"" has not been e(aluated beore in the true sense o the term* e deri(ed -2 indi#ators rom the )!P/ Patient#entred &ealth#are )ndi#ator Re(iew %or #onsultation' those seemed to be appli#able or a homeopathi#  perspe#ti(e and tested it on the patients (isiting the outpatients o a homeopathi# hospital in est +engal, )ndia* !ssessment o #urrent pra#ti#e with a (alid set o indi#ators is the key to su##essully impro(ing the 4uality o P""* ".H%3%4%5$ Othi#s appro(al or this study was obtained rom the )nstitutional Othi#s "ommittee o M+&M"V&* !ll parti#ipants were pro(ided with patient inormation sheets in lo#al (erna#ular +engali and inormed #onsents were obtained* 3he sur(ey matter and 4uestion items were also eplained (erbally to the  parti#ipants by the resear#h assistant to a#ilitate easy understanding* )n#lusion #riteria were patients aged 1D years and abo(e, suering rom #hroni# diseases or more than a year, #ompleting their physi#ian.s #onsult, gi(ing written inormed #onsent, and being ready to share inormation* O#lusion #riteria were patients, who were too si#k or #onsultation, unable to read patient inormation sheets, unwilling to stay ater the do#tor.s (isit, not gi(ing #onsent to join the sur(ey, and  patients in(ol(ed in the ongoing resear#h proje#ts in the institution to minimi0e Wetra #are. bias pro(ided to this sample*  No patients. identiiable inormation was re4uired, ensuring anonymi0ed prote#tion o patient.s pri(a#y* !lso the illedin 4uestionnaires by the resear#h assistants were #on#ealed by putting those inside opa4ue en(elops, whi#h were sealed at the sur(ey site* !ll these were sent or data etra#tion in a spe#ially designed Mi#rosot O#el master #hart that was subje#ted to statisti#al analysis in dierent statisti#al #omputational websites* 3he eight dierent stages that were needed or the de(elopment o the study 4uestionnaire are seen in ;igure 1* tage 6 7draft of initial version8' )tems were deri(ed rom the )!P/ re(iew 62: and the initial (ersion was drated by in#orporating the items those seemed to be appropriate in homeopathi# perspe#ti(e* tage 9 7committee approval8'  !ter little modii#ations, the items were inali0ed in the #ommittee meeting* tage : 7for*ard translation8'  ;or the orward translation rom Onglish into +engali, two independent nati(e +engali speaking translators translated the Onglish (ersion o P""-2 into the target language +engali %3 1  and 3 2 '* /ne o the translators was a #lini#ian and thereore aware o the #on#epts that were being measured with the P""-2 and the other translator was a language spe#ialist with no medi#al ba#kground*  Saha et al. Spatula DD 81 ;igure 6<  3ranslation and de(elopment se4uen#e o the +engali P""-2 4uestionnaire tage = 7synthesis of . 6  and . 9  into . 6>9 8'  3he two translators had to then agree on one new #onsensus (ersion o the translation %3 1,2 '* 3his #onsensus (ersion was o(erseen by the epert #ommittee o(erseeing the proje#t* tage ? 7back translation8'  ;or the ba#k translation rom +engali into Onglish, two Onglish language translators %+3 1  and +3 2 ' were re4uired* 3hough born in )ndia, they both ha(e been residing in the $nited States or o(er 1< years* 3hey both independently translated 3 1,2  ba#k into Onglish* 3hey were blinded to the srcinal Onglish (ersion o the P""-2 during this pro#ess* tage @ 7epert committee8'  3he #ommittee #onsisted o methodologists, health proessionals, translators and a language proessional* 3he #ommittee re(iewed all the translations %3 1  and 3 2 , 3 1,2 , + 1  and + 2 ' and the written report #omparing the  ba#ktranslations with the orward translation 3 1,2 * +ased on those translations, the preinal (ersion was de(eloped* tage B 7face validity8'  3he preinal (ersion o the 4uestionnaire was tested on randomly %simple random sampling' #hosen 1< patients (isiting out patients o M+&M"&* Oa#h #ompleted the 4uestionnaire and was then asked the meaning o ea#h 4uestionnaire item as well as whether or not they had  problems with the 4uestionnaire ormat, layout, #ontent, #larity, language, instru#tions or response s#ales* !ny dii#ulties were noted and in#luded in the inal report* ! detailed report written by the inter(iewing person, in#luding proposed #hanges o the preinal (ersion based on the results o the a#e (alidity test was then submitted to the epert #ommittee* tage C 7committee appraisal8'  3he inal (ersion o the +engali P""-2 was de(eloped by the #ommittee based on the results o the a#e (alidity testing and the written report* 3hus all stages 1D were su##essully #ompleted* 3he inal (ersion o the P""-2 or patients #an be ound in igures 2a and 2b*  Survey on patient-centred care   82 Spatula DD ;igure 9a<  P""-2 sur(ey 4uestionnaire Onglish (ersion %page 1'  Saha et al. Spatula DD 83 ;igure 9b<  P""-2 sur(ey 4uestionnaire Onglish (ersion %page 2'
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