Determinants of patient satisfaction with the medical consultation

Abstract

This study assessed patient satisfaction with the medical consultation in ambulatory settings. A multistage sampling method, stratified by geographical location in metropolitan Sydney and type of medical practice, was employed. Two hundred and seventy-two patients attending medical consultations completed a brief questionnaire and interview immediately following a medical consultation with either a general practitioner or a medical specialist. Factor analysis of the questionnaire indicated that 58% of the variance in patient satisfaction ratings was accounted for by the level of interpersonal warmth and respect and the amount of information communicated by the doctor. Other factors impacting on satisfaction included the number of patient requests perceived to be met by the doctor, and the characteristics of the medical encounter, such as the length of the consultation and whether the visit was a first or subsequent consultation. There was no association between level of satisfaction and gender of doctor or the type of medical practice attended.     

Cognitive and Social Factors Associated with NSSI and Suicide Attempts in Psychiatrically Hospitalized Adolescents

Although non-suicidal self-injury (NSSI) and suicide attempts (SA) frequently co-occur among youth, there is increasing evidence that both the risk factors and the phenomenology of the behaviors are distinct. This study examined how individuals who engage in NSSI only, individuals who attempt suicide only, and those who have histories of both NSSI and at least one suicide attempt may differ in terms of cognitions and perceived social support. Participants were 185 adolescents (78.1 % female) between the ages of 13 and 18 recruited from a psychiatric inpatient facility in the northeastern United States. One hundred forty-eight teens were identified with a history of self-injurious behavior and divided into three groups: NSSI only (n?=?45), SA only (n?=?24) or both NSSI and SA (NSSI+SA; n?=?79). Analyses showed that the NSSI+SA group exhibited more cognitive errors, negative self-statements, and negative views of self, world, and future, as well as less perceived familial support than either the NSSI or SA only groups. There were no differences between groups on perceived support from teachers or peers. No significant demographic or diagnostic differences were found between the NSSI and SA groups. Limitations and clinical implications of the current research are discussed.     

Client perceptions of effective and ineffective therapeutic alliances during treatment for stuttering

The treatment components that contribute to and account for successful therapeutic outcomes for people who stutter are not well understood and are debated by many. The purpose of this phenomenological study was to describe in detail the underlying factors that contribute to a successful or unsuccessful therapeutic interaction between clients and their clinicians. Twenty-eight participants, 19 men and 9 women, who had received from 6 months to more than 12 years of therapy for stuttering were studied. The participants were asked to consider their experience with one or more speech-language pathologists with whom they had received fluency therapy and to describe the characteristics that made that individual effective or ineffective in promoting successful change in their ability to communicate. Analysis of these data resulted in 15 primary categories. Finally, the essential structure of an effective and ineffective therapeutic interaction was described. Results highlighted the importance for effective therapy of understanding the stuttering experience, forming a positive client-clinician, alliance, and being knowledgeable about stuttering and its treatment. Educational objectives: The reader will be able to: (1) describe, from the perspective of a select group of adults who stutter, the themes associated with an effective therapeutic interaction, (2) describe, from the perspective of a select group of adults who stutter, the themes associated with an ineffective therapeutic interaction, and (3) describe the ways in which an effective or ineffective therapeutic interaction could impact a person who stutters.     

Interpersonal sensitivity, status, and stereotype accuracy

A classic question in social and organizational psychology is whether low-status persons are more accurate in the perception of their high-status partners than the latter are in their perception of their subordinates. In a series of studies, Snodgrass (1985, 1992) tested this idea. She found that subordinates were more accurate at judging how their bosses viewed them than bosses were at judging how their subordinates viewed them, but that bosses were more accurate at judging how subordinates viewed themselves than subordinates were at judging how bosses viewed themselves. We believe, however, that these results were obscured by stereotype accuracy. Using previously collected data, we found that stereotype accuracy does lead to the pattern previously observed by Snodgrass. We also discovered that when we controlled for stereotype accuracy, subordinates' perceptions were generally more accurate than those of their bosses, which supports Snodgrass's original hypothesis.     

Communalism, familism, and filial piety: are they birds of a collectivist feather?

The present studies examined the extent to which (a) communalism, familism, and filial piety would pattern onto a single family/relationship primacy construct; (b) this construct would be closely related to indices of collectivism; and (c) this construct would be related to positive psychosocial functioning and psychological distress. In Study 1, 1,773 students from nine colleges and universities around the United States completed measures of communalism, familism, and filial piety, as well as of individualistic and collectivistic values. Results indicated that communalism, familism, and filial piety clustered onto a single factor. This factor, to which we refer as family/relationship primacy, was closely and positively related to collectivism but only weakly and positively related to individualism and independence. In Study 2, 10,491 students from 30 colleges and universities in 20 U.S. states completed measures of communalism, familism, and filial piety, as well as of positive psychosocial functioning and psychological distress. The family/relationship primacy factor again emerged and was positively associated with both positive psychosocial functioning and psychological distress. Clinical implications and future directions for the study of cultural values are discussed.     

The relationship of diabetes knowledge to regimen compliance and metabolic control during pregnancy

Abstract

The relationship of diabetes knowledge to regimen compliance and metabolic control was examined in a sample of pregnant women with preexisting insulin-dependent and noninsulin-dependent diabetes mellitus (N = 27) and women who developed gestational diabetes during pregnancy (N = 45). Subjects completed self-report measures of diabetes knowledge and compliance with their diabetic regimen and blood glucose levels were monitored. Knowledge was positively, although modestly, related to dietary compliance, compliance with insulin administration and insulin reaction management recommendations, as well as fasting blood glucose levels. Findings suggest that among pregnant women, efforts to increase knowledge of diabetes specific to pregnancy may result in some improvement in selected aspects of the diabetic regimen.     

Relationships Between Politics, Supervisor Communication, and Job Outcomes

Perceptions of organizational politics (POPs) are ever present and have been shown to have many negative effects. This study investigated the influence of perceptions of politics on the consequences of turnover intentions and job frustration; 2 important outcomes in the organizational politics literature. Additionally, this study examined the role of supervisor communication as a moderator of these relationships. We investigated the relationships in a sample of 246 alumni from a midwestern university who were working in a wide range of occupations. Our results provide support for positive associations between POPs and intentions to turnover and job frustration; supervisor communication moderated these relationships. Managerial recommendations and suggestions for future research are offered.     

Evaluating Treatments for Functionally Equivalent Problem Behavior Maintained by Adult Compliance with Mands During Interactive Play

A primary goal of behavioral interventions is to reduce dangerous or inappropriate behavior and to generalize treatment effects across various settings. However, there is a lack of research evaluating generalization of treatment effects while individuals with functionally equivalent problem behavior interact with each other. For the current study, the severe problem behavior of two participants with developmental disabilities was targeted for assessment and treatment. Results of a functional analysis indicated that for both participants, problem behaviors occurred when destructive behavior produced reinforcement of participant mands . The use of a multiple schedule that alternated between differential reinforcement of other behaviors and differential reinforcement of alternative behavior (mands) was sufficient to produce a significant reduction in problem behavior for one participant; the addition of differential reinforcement of alternative behaviors via compliance was necessary for the second participant. Extended treatment sessions, which focused on interaction between the two participants, involved one therapist concurrently implementing each participant’s treatment while they were directed to play with one another (a situation that previously evoked problem behavior). Results show that each participant’s treatment produced low to zero rates of problem behavior even during extended interactions.     

The role of the instrumental contingency in the motivational control of performance

In four experiments we investigated an irrelevant incentive effect based upon a transition from hunger to thirst. Hungry rats were trained to lever press either for sucrose solution or for food pellets before performance was tested in extinction while they were thirsty. Reinforcer-specific motivational control was found in the first experiment in that the animals pressed the lever more on tests following training with the sucrose solution rather than with food pellets. Moreover, this effect was seen only when testing was conducted following water, but not following food deprivation. The outcome of the remaining experiments suggests that this motivational control is not mediated by the instrumental contingency between lever pressing and the sucrose reinforcer during training. In these studies lever pressing and chain pulling were reinforced concurrently, one with sucrose and the other with food pellets, in order to equate the noninstrumental functions of the incentives. Following this training, lever pressing in extinction under thirst was unaffected by the type of incentive used as its reinforcer during training.