Defense Date

7-29-2019

Graduation Date

Fall 12-20-2019

Availability

One-year Embargo

Submission Type

thesis

Degree Name

MS

Department

Pharmacy Administration

School

School of Pharmacy

Committee Chair

Jordan R Covvey

Committee Member

Vincent Giannetti

Committee Member

Khalid M Kamal

Keywords

Patient satisfaction, substance use disorder, substance abuse, drug abuse, rehabilitation, patient reported outcome, satisfaction tool

Abstract

Background: Patient satisfaction is considered as an important indicator in the evaluation of healthcare quality across an array of treatments and services. It is deemed vital especially in the field of substance use disorder (SUD) research due to an increased emphasis on understanding patients’ perceptions regarding their treatment and the attributes that drive their progress towards recovery. Despite the potential value, gaps have been recognized in the exploration of these satisfaction-related assessments among patients undergoing SUD treatment in residential rehabilitative settings. Thus, there is a need for understanding the dimensions contributing to satisfaction which would facilitate the development of a tool tailored to assist SUD treatment in residential rehabilitative services.

Objectives: The purpose of this study was to (1) assess dimensions of patient satisfaction relevant to SUD rehabilitation, and (2) develop a comprehensive disease-specific instrument to assess satisfaction among patients with SUD.

Methods: The study was conducted in two phases at the Salvation Army Harbor Light Center, an inpatient drug and alcohol rehabilitation center in Pittsburgh, PA. The first phase included semi-structured qualitative interviews. A total of 18 participants (14 patients and four clinical staff) were recruited using convenience sampling, with recruitment initiated by advertisement within the facility. A systematic literature review formed the basis of the semi-structured interviews by providing information regarding critical characteristics of patient satisfaction that were employed in the development of the interview guide. Inclusion criteria included adult male patients with a history of SUD who were enrolled in the program for at least two weeks and support/counseling staff currently employed at the facility involved in the care of these individuals. Directed content analysis with non-statistical relational analysis of the interview data was undertaken by three raters utilizing a precisely constructed codebook to identify dimensions relevant to patient satisfaction and conceptualize relations among the identified themes. The second phase of the study consisted of development and pilot testing of a standardized patient satisfaction questionnaire. The results of the qualitative analysis were applied in the conception of items for the questionnaire tool. The questionnaire was then assessed for face validity and suggestions elicited from the clinical staff were incorporated in the questionnaire. The tool was pilot-tested in a sample of 17 patients seeking treatment for SUD at the facility for at least two weeks. Descriptive statistics, item reliability and bivariate correlations across items in the pilot data were analyzed using SPSS Statistics 25 (Armonk, NY).

Results: The content analysis of the interview transcripts resulted in the emergence of five prominent themes: (1) counselor (skill); (2) programmatic structure (adhering); (3) skill development (personal responsibility); (4) comparison to other programs; and (5) case management facilitation. For the pilot test, the average age of men was 49.06 years with a mean length of stay of five weeks. The majority of men were previously engaged in the use of alcohol (n=8, 47%), crack cocaine (n=2, 11.7%), or multiple substances (n=4, 23.5%) as their drug(s) of choice. The men primarily reported being satisfied with the program along with depicting high levels of satisfaction with skills demonstrated by the counselors and making progress in building their own skills. The overall reliability of the instrument was 0.869. Items within the counselor scale, skills scale, and the program scale demonstrated moderate to high correlations with each other; however, the preference scale showed negative inter-item correlations.

Conclusion: The study provided valuable insights regarding the underlying characteristics of patient satisfaction that were efficiently incorporated to guide the instrument development process. The pilot test results demonstrate that the instrument successfully assessed patient satisfaction in a residential rehabilitative setting. With further exploration and establishment of convergent validity, this instrument can serve as a significant evaluator in substance abuse research arena.

Language

English

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