Consumer perspective on quality of care

1. Consumer perspective on quality of care Simone de la Rie1, Eric van Furth1, Greta Noordenbos2, Liesbeth Libbers3, 1Robert-Fleury Foundation, 2University of Leiden, 3SABN, The Netherlands srie@robertfleury.nl

2. Outline • Consumer perspective in health care: government policy • Quality of care and consumer perspective • Quality of care for eating disorders from a consumer perspective srie@robertfleury.nl

3. Consumer perspective and government policy • Patient as a consumer (1987) • Introduction of market forces of demand and supply in health care • Strengthening the consumer perspective in health care • “Choosing with care” (2001) srie@robertfleury.nl

4. Government measures • Judicial position • Financial aid for consumer/ patient organisations • Improvement of accessibility of information about health care • Evaluation of quality of care • Certification of high quality care • Guidelines srie@robertfleury.nl

5. Development of guidelines Definition of a guideline (CBO): “ a guideline is a compilation of general acknowledged directions regarding medical care in a specific domain. It serves as a guiding principle” srie@robertfleury.nl

6. Guideline for eating disorders • Evidence based - scientific state of the art • Practice based - consensus expert opinion • Consumer perspective on quality of care - criteria for the quality of care srie@robertfleury.nl

7. Quality of care and consumer perspective • Definition of quality • Assessing quality of care • The consumer perspective on quality of care for eating disorders srie@robertfleury.nl

8. Definition of quality National Council of Health Care: “Quality is the sum of characteristics and features of a product, process or service that is important for meeting the established or self-evident needs” srie@robertfleury.nl

9. Definition of quality II • Quality as a multidimensional construct (Donabedian, 1988) - outcome - process - structure • Quality as a collection of subjective features (Lemmens & Donker 1990) srie@robertfleury.nl

10. Assessment of quality of care • Product - outcome • Process - doctor-patient relationship - content of treatment - participation - information • Structure - accessibility - organisation of care or institution srie@robertfleury.nl

11. Assessment of quality of mental health care • General instruments - Client Satisfaction Questionnaire (Attkinson and Zwick 1982) - Client Thermometer (GGZ Nederland) • Instruments for evaluation of specific domains of mental health care srie@robertfleury.nl

12. Quality of care for eating disorders from a patient perspective Aims of the project: • Development of criteria for quality of care for eating disorders • Implementation of these criteria srie@robertfleury.nl

13. Methods • Nationwide recruitment • Screening for eating disorder pathology • Instruments 1) EDE-Q, Rosenberg self-esteem, SF 36 2) Qualitative and quantitative measures to gain insight in experiences, assess helpfulness of care and satisfaction with care and determine criteria for the quality of care srie@robertfleury.nl

14. Preliminary findings: seeking and finding care • Patient delay - denial of eating disorder pathology - lack of information • Doctor delay - delay of referral by general practitioner - long intake procedures srie@robertfleury.nl

15. Preliminary findings:Experiences with care • Focus of treatment - emphasis on eating disorder pathology or addressing underlying problems? • Indicators for treatment preferences - type of eating disorder - self esteem - comorbid problems - quality of life srie@robertfleury.nl

16. Preliminary findings:Quality of care • Process - therapist-patient relationship - communication skills • Structure - accessibility - expertise - aftercare srie@robertfleury.nl

17. Conclusion • Including the consumer perspective on quality of care in guidelines enhances: - patientcentred care - satisfaction of patients - effectiveness of care srie@robertfleury.nl