WHEN ANXIETY MATTERS FOR PATIENTS’ LEVEL OF EXPERIENCE AND SATISFACTION WITH QUALITY OF CARE

INTRODUCTION

In France, since 2016, data on patient satisfaction and experience after a hospital stay are collected through the national programme “e-Satis”, based on self-administered online questionnaires.
The programme produces outcome indicators based on the patients’ point of view at each stage of their care pathway, from their hospital admission to their discharge. We aimed to assess patient and hospital stay characteristics associated with the overall patient experience and satisfaction level during a hospital stay of over 48 hours in Medicine/Surgery/Obstetrics (MCO).

METHODS

As a part of the national e-Satis programme, an overall experience and satisfaction score is calculated for each patient based on their responses to the questionnaire and presented as a rating score out of 100. For this study, we included every patient aged ≥ 18 years hospitalised, between January 1st 2016 and September 30th 2022, over 48 hours in a medical, surgical or obstetrical department, and who fully replied to the questionnaire.
We defined our main outcome by dividing the overall score into the 3 following classes based on quintiles of our study population:
▪ ‘low’ if the overall patient experience and satisfaction score was less than 63.7/100 (1st quintile);
▪ ‘moderate’ if between 63.7/100 and 85.0/100 (2nd to 4th quintiles);
▪ ‘high’ if over 85.0/100 (5th quintile).
Patients can declare if they have experienced pain, anxiety, or other discomforts (such as nausea, uncomfortable position, or dizziness) during their hospital stay. We conducted a multinomial logistic regression model, with the ‘moderate’ overall patient experience and satisfaction level as the reference group.
We chose to include in the final model the composite variable ‘patients’ feelings gradient’ to evaluate the impact of experiencing several feelings (pain, anxiety or other discomforts) during a same hospital stay. Adjusted odds ratios (aOR) and their confidence intervals were estimated and Wald tests were performed. In the model, P < 0.05 was considered statistically significant.

RESULTS

From 2016 to 2022 2,372,668 e-Satis questionnaires were filled in by patients and 1,861,077 were fully completed. Out of all patients, during their hospital stay, 85.5% experienced any kind of pain, 34.9% experienced extremely intense or intense pain; 37.7% declared experiencing anxiety, and 30.8% other discomforts.
In the multinomial multivariable model, we identified a significant association between a low experience and satisfaction level and the experience of extreme/intense pain, anxiety and other discomforts during a same hospital stay (aOR = 5.14 [5.05-5.23]), as compared with patients who did not experience it. The adjusted Odds-ratios stayed high when anxiety had been felt during the hospital stay.

CONCLUSION

This analysis highlighted that there was a significant impact of anxiety on a low overall patient experience and satisfaction level in France. Thus, the detection and the management of patients’ psychological distress, such as anxiety disorders, appear to be an integral part of the management of patients during their hospital stay, that may lead to a forward improvement of the overall experience and satisfaction score.