Medical Inspection – Health Blog

The methods used in Project DIRECT are described in detail elsewhere. Briefly, the survey was conducted in 1997, among civilian, non institutionalized adults, aged >18 years, by using a multistage, population-based probability sample from census files in predominantly African-American neighborhoods in Raleigh and Greensboro, NC. All data were collected at baseline, before interventions were commenced, from both the intervention and control communities. Field interviewers visited each sample housing unit and selected eligible persons according to a specified protocol. Those selected were asked for a personal interview. The overall interview response rate was 87%. Participants (n=591) who met the following criteria were included in the cross-sectional analyses reported here: self-report of diabetes; being African American; and seeing a physician, nurse, or other health professional for any reason during the last year.

MEASUREMENTS

Information was obtained from interview on demographic variables, including age, gender, marital status, years of education, employment, and family income. Data on health insurance coverage, diabetes education, a visit to a physician for diabetes care during the past year, having one physician for diabetes care, and perception of difficulty getting care during the past year were also assessed by self-report. Participants saying that they were currently employed for wages or that they were currently self-employed were classified as employed. Anyone answering “yes” to the question, “Do you have any kind of health coverage, including health insurance, pre-paid plans such as HMOs, or government plans such as Medicare or Medicaid?” were classified as having health care coverage.
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Quality of Diabetes Care

Participants were asked about 10 preventive care services that may have been delivered during the past year by their health care providers. These were monitoring glycosylated hemoglobin (HbA_lc), blood cholesterol concentrations and blood pressure; eye, foot, and gum examinations; and physician counseling on self-monitoring of blood glucose concentrations, weight reduction, exercise, and reduction of dietary fat. Four preventive practices performed by patients were also assessed by questionnaire: taking medications for diabetes as prescribed; daily self-monitoring of blood glucose (SMBG); performing daily self-examination of the feet; and having an eye examination with dilation of the pupils.

Patient Satisfaction

Patient satisfaction with the health care provider was assessed by interview, and participants rated their satisfaction with respect to 11 items, on a 4-point scale (Table 1). These questions were based on the Medicare Beneficiary Survey (MCBS 1991). Evaluation of the 11 items for internal consistency showed that they were unidimensional. All coefficient alphas were greater than 0.89 indicating that all items were strongly positively intercorrelated. Factor analysis revealed that the majority of the variation was contained in the first eigen value associated with the principal components and that including more than one factor did not make the interpretation of the scales(s) any more reasonable. For the one-factor solution, loadings were similar (range from 0.66 to 0.79). Thus, a single summary score with equal weight to the individual items was adopted.
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Table 1. AVERAGE SCORES AND DISTRIBUTION OF PATIENT RATING OF SATISFACTION WITH PROVIDER FOR CARE OF DIABETES

A patient satisfaction score was calculated for all persons who answered at least 8 of the 11 satisfaction items (n=591). The ratings for each of the items were based on the following four point scale: 3=excellent, 2=good, l=fair, and 0=poor. For each patient, the mean satisfaction score was divided by 3 (the maximum mean score that could be attained), and was multiplied by 100 to yield a percent of maximum score. This is the same as assigning the scores of 100=excellent, 66.7=good, 33.3=fair, and 0=poor and taking the average across items. The resulting percent of maximum score could theoretically range from 0% to 100%; the higher the score the greater the satisfaction. viagra soft

Figure 1. Scores for patient satisfaction (as percentage of maximum), adjusted for age, sex, education, income, and employment, according to provider delivery of diabetes care (number of checks/counseling) and patients’ performance of preventive care (number of practices). Satisfaction scores and p-values are based on weighted analysis.

STATISTICAL ANALYSES

We used SAS for factor analysis to evaluate the internal consistency of the scale for patient satisfaction. All other analyses were conducted using SUDAAN to account for the complex sampling scheme. Survey statistics reported in Tables 1-4 and Figure 1 reflect the application of sampling weights to adjust for the characteristics of the reference population. Adjusting for demographic variables (age, sex, education, employment, and income), we used analysis of covari-ance to compare satisfaction scores (as percentage of maximum) according to dichotomized categories (yes or no) of the variables for delivery of preventive care by the provider and performance of preventive practices by the patient. Relationships between the number of pre-speci-fied preventive care services delivered by the provider or practices performed by patients and satisfaction scores (i.e., ‘dose-response’) adjusted for covariates were also evaluated. online pharmacy uk

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