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THE EFFECT OF PSYCHOSOCIAL COUNSELLING ON PATIENT SATISFACTION AMONG PATIENTS WITH CHRONIC ILLNESS ATTENDING THE GENERAL OUT PATIENTS DEPARTMENT OF THE JOS UNIVERSITY TEACHING HOSPITAL
Abstract
Introduction: Chronic illness is becoming a pressing public health issue. The attendant isolation and effect on social and family relationships, among others, has demanded for a holistic approach to management.
Aim: The study therefore aimed at evaluating the effect of BATHE technique on patient satisfaction among patients with diabetes mellitus and hypertension.
Methods: A randomized controlled trial involving 68 adults on follow-up at the GOPD of the Jos University Teaching Hospital aged 18 years and above. Consecutive patients were recruited and data was gathered through interviewer administered questionnaire.
Subjects were randomly allocated to the control and intervention group of 34 participants each.
The control group received usual care while the intervention group received usual care and BATHE counselling. Data collected from the subjects include socio-demographic data, diagnosis and subscales of doctor/ patient interaction. Analysis was done using EPI info 3-5-3 (Centers for Disease Control and Prevention, Atlanta, Georgia, USA) and represented using tables. Significance was determined using T- test, chi-square test and logistic regression at a P-value of 0.05.
Results: The study demonstrated an increase in patient satisfaction scores in the BATHE group
(P= 0.001). The variables that were found to be predictors of patient satisfaction were doctor’s concern (OR: 3.5, CI: 1.62-7.56, P-value = 0.0014) and patients’ confidence in their doctor (OR:
15.7, CI: 2.67-92.2, P-value = 0.0023)
Conclusion: The study has shown that the use of BATHE technique among patients who are either hypertensive or diabetic improved patient satisfaction scores. The levels of patient satisfaction were found to be at least good. Doctor’s concern and patients’ confidence in their doctor were found to be predictors of satisfaction.
TABLE OF CONTENTS
CONTENTS PAGE
Title page……………………………………………………………………………………I
Certification…………………………………………………………………………………II
Dedication…………………………………………………………………………………III
Declaration…………………………………………………………………………………IV
Acknowledgement………………………………………………………………………….V
Table of contents……………………………………………………………………………VI
List of figures…………………………………………………………………………….. X
List of tables………………………………………………………………………………..X
List of abbreviations……………………………………………………………………….XI
Summary………………………………………………………………………………….. 1
CHAPTER ONE (INTRODUCTION)
1.0 Background……………………………………………………………………………2
1.1Statement of the problem………………………………………………………………7
1.2 Justification of study…………………………………………………………………..7
1.3 Study hypothesis………………………………………………………………………..8
1.4 Aims and objectives……………………………………………………………………8
CHAPTER TWO (LITERATURE REVIEW)
2.0 Background of chronic illness…………………………………………………………9
2.1Diabetes mellitus………………………………………………………………………..13
2.2 Classification/diagnosis…………………………………………………………….14
2.3 Management………………………………………………………………………..16
2.4 Psychosocial effects of diabetes……………………………………………………22
2.5 Psychological interventions in diabetes…………………………………………….24
2.20 Hypertension……………………………………………………………………….31
2.21 Epidemiology………………………………………………………………………31
2.22 Pathogenesis and diagnosis………………………………………………………..32
2.23 Management………………………………………………………………………34
2.24 Psychosocial effects of hypertension……………………………………………..38
2.25 Psychological interventions for hypertension…………………………………….39
2.26 Psychosocial counseling………………………………………………………….40
2.27 The BATHE technique……………………………………………………………41
2.28 Concept of Patient satisfaction……………………………………………………43
2.29 Determinants of Patient satisfaction………………………………………………44
2.30 Components of Patient satisfaction……………………………………………….45
CHAPTER THREE (MATERIALS/METHODS)
3.1 Study area…………………………………………………………………………49
3.2 Type of study……………………………………………………………………..50
3.3 Study hypothesis………………………………………………………………….50
3.4 Study population………………………………………………………………….50
3.5 Study period………………………………………………………………………51
3.6 Inclusion criteria………………………………………………………………..51
3.7 Exclusion criteria……………………………………………………………….51
3.8 Sample size determination………………………………………………………52
3.9 Ethical considerations…………………………………………………………..53
3.10 Recruitment and randomization……………………………………………….53
3.11 Instruments of data collection…………………………………………………54
3.12 Data collection…………………………………………………………………54
3.13 Statistical analysis and tests……………………………………………………56
CHAPTER FOUR (RESULTS)
4.1 Baseline characteristics of the study…………………………………………….59
4.2 Baseline information on chronic illness…………………………………………61
4.3 Mean patient satisfaction scores…………………………………………………63
4.4 Level of patient satisfaction……………………………………………………..64
4.5 Demographic/ subscale factors………………………………………………….65
CHAPTER FIVE (DISCUSSION)
5.1 Socio-demographic characteristics………………………………………………73
5.2 Baseline on chronic illness………………………………………………………74
5.3 Levels of satisfaction……………………………………………………………75
5.4 Improving patient satisfaction…………………………………………………..76
5.5 Conclusion……………………………………………………………………….80
5.9 Strength and limitation of study………………………………………………….81
5.10 Recommendations……………………………………………………………….81 REFERENCE…………………………………………………………………………82
CHAPTER ONE
INTRODUCTION
1.0 Background
Chronic illness is proving to be one of the most pressing public health issues of the 21st century.1
The chronically ill add up to the variety of patients on follow up at the General Out Patients Department (GOPD). In spite of the much advancement in treatment and preventive methods, chronic illness is here to stay because many of the marvellous advances in medical knowledge and technology prolong life but tend to bring about certain new problems in living for individuals involved.1 This is more so with the increase in older populations around the world (WHO has estimated that between 2000 and 2050, the proportion of the world’s population over 60 years will double from 11% to 22%. The absolute number of people aged 60 years and over is expected to increase from 605 million to 2 billion over the same period) giving rise to an increase in the
incidence and prevalence of chronic conditions.2
All chronic illnesses have the potential to reduce functional status, productivity, and quality of life (QoL) of people who live with them. It is known that those with chronic illness leave the workforce earlier than their peers, have lower incomes and often need additional support to manage their health and lives.1 The economic effects on families, communities and countries created by chronic diseases are however underappreciated.1
While the terms chronic disease and chronic illness may be used interchangeably, they convey different meanings that require clarification.3 First, chronic disease is defined on the basis of the biomedical diseases classification and includes diabetes, asthma and depression.3 Chronic illness is however the personal experience of living with the affliction that often accompany chronic disease.4 Diseases referred to as chronic include both non-communicable diseases, such as diabetes, heart disease, hypertension, trauma and communicable diseases such as Human Immunodeficiency Virus (HIV) infection, tuberculosis and infectious hepatitis.3 Concomitant with this upsurge, around the world many people with chronic conditions are failing to receive appropriate care. This failure of care is due to both quality and access issues and is experienced, often to the greatest extent, by disadvantaged subgroups of the general population.
Chronic diseases are the major cause of death and disability worldwide. In 2002, the leading chronic diseases- cardiovascular disease, cancer, chronic respiratory disease, and diabetes caused 29 million deaths worldwide.5 The mortality was led by cardiovascular disease (17 million) followed by cancer (7 million), chronic lung disease (4 million), and diabetes mellitus (almost 1 million).6 It was estimated that 35 million people died in 2005. Only 20% of these deaths were in high income countries while 80% occurred in low-income and middle-income countries. This value is projected to rise to 64 million in 2015.7 A substantial share of the chronic disease burden rests on the shoulder of working-age appropriate populations (even when ‘working age’ is conservatively defined as 60 years or younger), particularly in developing countries.8
In the USA alone, more than 90 million people have a chronic illness. The top five are heart disease, cancer, stroke, Chronic Obstructive Pulmonary Disease (COPD) and diabetes. These together cause more than two-thirds of all deaths.9 The medical care cost of people with chronic illness represent 75% of the 2 trillion dollars in U.S annual health care spending.10
Africa carries a significant proportion of the global burden of chronic diseases, along with countries of Asia and Latin America.11 This has been attributed to increased life expectancy, changing lifestyle practices, poverty, urbanization and globalisation.11
In Nigeria, chronic illness might have been responsible for 24% of all deaths in the year 2005 and the situation may become worse by 2015.12 Some of the common ones include diabetes, heart disease and stroke. It was also estimated that Nigeria would loose 40 million dollars in national income from premature deaths due to heart disease, stroke and diabetes. These losses are projected to increase: cumulatively, Nigeria stands to loose 8 billion dollars over the next 10 years.12 Although communicable diseases, as opposed to non communicable diseases, remain top priority in developing countries like Nigeria, diabetes and hypertension contribute a great deal to the high mortality figures already put forward and will therefore be the thrust of this work.12
The modalities of treatment for diabetes and hypertension include nutrition, exercise, and education, negotiating and counselling (not psychosocial) with patients plus the use of oral and / or intravenous medication.13
Psychosocial interventions for chronic illness, such as patient education, support groups, cognitive behavioural therapy, motivational interviewing and problem solving therapy, have been shown to have effects on the health and emotional well being that surpass improvement attained with usual
care alone.14
The BATHE technique though not specific for chronic illness, is an approach modified for primary care as efficient first line treatments. The BATHE technique is a simple patient centred procedure.
BATHE is an acronym for a series of 4 specific questions about the patient’s Background, Affect,
Troubles and Handling of the current situation, followed by an Empathic response by the physician. [Appendix V] . It was pioneered by Stuart and Lieberman in the USA in 1993.15 It was developed specifically for family physicians as a rapid psychosocial intervention for the assessment of factors that may contribute to patient’s physical complaints. It is an initial psychotherapeutic intervention by way of brief counselling, a stepped care approach that is efficient and cost effective. As a first-line therapy, brief counselling is effective for many problems, is acceptable to most patients and reduces the need for more time-intensive, costly treatment and referral for specialty care.16 While the technique may appear elementary; it embodies many essential elements of successful psychotherapy. These elements include the establishment of a therapeutic alliance, empathy on the part of the clinician, identification of central conflict, the discouragement of dependency and encouraging adaptation and the establishment of realistic coping strategies. This is crucial for the physician who must continue to see other patients and for the patient who must continue the activities of the day.
Patient satisfaction on the other hand, has increasingly been viewed as an important health care outcome and has been used as a measure of quality of care in different health care settings, including primary care.17 It is becoming more and more important to deliver medical care that meets the subjective needs of the patients in the context of limited budgets and increasing health care costs. Patient satisfaction could be defined as multiple evaluations of distinct aspects of health care which are determined (in some way) by the individual’s perceptions, attitudes, and comparison processes. It represents in general, the patient’s overall assessment of the physician, delivered care, structure, process and outcome of their care.18
Four specific reasons for investigating patient satisfaction have been described; first, satisfaction is an objective of care, second, satisfaction is also a consequence of that care, and therefore an outcome; third, satisfaction can contribute to the effects of care, as a satisfied patient is more likely to comply with advice; finally, satisfaction is also the patients judgment on the care that has been provided.19 While numerous factors affect patient satisfaction including financing and organisation of care, waiting time, health status and the patient’s own expectation, the problem of care remains key.
1.1Statement of the problem
Worldwide, about 972 million adults are hypertensive out of which 639million are in economically developing countries.20 In Nigeria, 1 out of every 4 adults is hypertensive.21 Over 170 million people worldwide are diabetic. 1-7% of the Nigerian population are diabetic.22 The management of these prevalent conditions is largely focused on a body part or disease, whereas a focus on the patient as a whole with particular values and needs that are contextualized within their own family and sharing control of the consultation and decisions about the management plan with the patient is lacking.23
Since the management and not treatment [since this is not realistic for now] requires long-term follow-up, not only for the condition in question but also for the attendant social and psychological sequelae in both the patient and his/ her family (delay in seeking care, non-adherence to recommended treatment, lack of satisfaction and family dysfunction), a psychosocial approach has become needful.
1.2 Justification of the study
The psychosocial impact of diabetes and hypertension has been recognised as a stronger predictor of morbidity and mortality than many clinical and physiologic variables. Addressing the psychosocial issues is hence a key health care intervention. Considering this, the impact afore mentioned, the growing population of these two chronic non communicable diseases even in Nigeria, and the growing health burden it bears, demands for a holistic approach to care. The study therefore intends to add to the already existing knowledge though meagre in the developed world concerning psychosocial interventions (BATHE technique) in primary care as against behavioural which are more common, and scarce in the developing countries like Nigeria as regards improvement in patient satisfaction taking the social and psychological aspects into account by way of psychosocial counselling.
1.3 Study Hypothesis
Ho: The use of BATHE technique among patients with chronic illness will have no effect on patient satisfaction scores
1.4 Aim and objectives
Aim
To determine the effect of “BATHE” technique on patient satisfaction among patients with chronic illness attending the General Out-Patients Department (GOPD) of JUTH.
Specific objectives
- To determine the effect of BATHE technique on mean patient satisfaction scores among the study population
- To determine the level of patient satisfaction in subjects with chronic illness attending the GOPD of JUTH.
- To determine factors influencing patient satisfaction among the study population.
THE EFFECT OF PSYCHOSOCIAL COUNSELLING ON PATIENT SATISFACTION AMONG PATIENTS WITH CHRONIC ILLNESS ATTENDING THE GENERAL OUT PATIENTS DEPARTMENT OF THE JOS UNIVERSITY TEACHING HOSPITAL
