- Email: [email protected]
Patient perception of osteopathic training in the UK and patient reported experience
International Journal of Osteopathic Medicine (2013) 16, 187e191
www.elsevier.com/ijos
Patient perception of osteopathic training in the UK and patient reported experience I.P. Drysdale, H. Hinkley, K.J. Rolfe* British College Osteopathic Medicine, Lief House, Finchley Road, London NW3, UK Received 28 December 2012; accepted 8 April 2013
KEYWORDS Education; Osteopathy; Patient outcome; Satisfaction
Background: Osteopathy is a recent addition to the modern day healthcare community. The majority of patients attending osteopathic practices in the United Kingdom are self funders, and studies have reported a high rate of satisfaction in patients receiving osteopathic treatment. Objective: This study aimed to determine patient perception of osteopathic education and relate that to patient reported experience. Method: The study was conducted through newspapers, GP surgeries and osteopathic clinics. A questionnaire was either completed on-line or a paper copy was returned to the investigator. Results: Over seven hundred people respondent though for this part of the study 202 were excluded either because they reported both good and bad experiences or did not complete the section on osteopathic education. Similar to other studies this current study reported that the majority of respondents reported a good experience (88.7%). However, there was no statistical significance demonstrated for any of the patient demographics or for the respondents perception of osteopathic education and experience. Discussion and conclusion: Further work is required to assess what patients require for a ‘good’ experience and what osteopathic patients determine as key competencies required in an osteopath. ª 2013 Elsevier Ltd. All rights reserved.
Abstract
Introduction
* Corresponding author. Tel.: þ44 (0) 20 7435 6464; fax: þ44 (0) 20 7431 3630. E-mail addresses: [email protected], work@kerstinrolfe. com (K.J. Rolfe).
Osteopathy is a relatively recent addition to healthcare, with the UK Government passing the Osteopaths Act in 1993. However, even with it’s fairly recent inception a study conducted in 2006, by the General Osteopathic Council, showed that
1746-0689/$ - see front matter ª 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ijosm.2013.04.001
188 83% of adults living in the United Kingdom were aware of the term ‘osteopathy’.1 Osteopathy appears to have a high satisfaction rate within its patient population with a number of studies reporting a high satisfaction rate.1e3 However, in one study four percent of those that visited an osteopath had a concern regarding the competency of the osteopath.1 Patient satisfaction is a complex process influenced by a number of patient characteristics (for example age, gender, ethnicity, level of education), as well as previous experiences, expectations, communication, pain severity, timing, psychological and societal values4e12. There is an increasing awareness concerning patient satisfaction, outcome and expectations with outcome being strongly influenced by both patient expectation and patient satisfaction.13 Satisfied patients have been shown to have a better outcome, most likely as these patients are more active in the participation of their care14, but further, satisfied patients not only adhere to their treatment plans but are loyal to their provider,15 important with the majority (80%) of UK patients funding their own osteopathic treatment.1 Patient expectation is also known to be influenced by a number of individual factors such as gender, education level, age, race, psychological factors, acuity of pain, and marital status.15 Further, patient expectations and clinical outcomes are known to be related.16e24 Patients expectations appear to be the most important predictive factor for treatment outcome, though most studies have focused on subjective outcomes18,25. Myers et al.26 showed that patients with higher expectations of specific treatments showed functional improvements in patients with low back pain. Osteopathy is a healthcare profession where recent graduates are able to set up practice as single practitioners. Osteopathic education in UK, therefore aims to produce students that are safe to commence autonomous clinical practice. Our aim was to understand the public’s perception of osteopathic education in the UK conducted by survey and to assess any correlation related to the public perception of the educational requirements and patient outcome.
I.P. Drysdale et al. general practitioner surgeries and osteopathic clinics. The questionnaire could be completed either on line or by post. The questionnaire consisted of three parts: part one was general information, and then part two was for those who had a bad experience and part three was for those who had a good experience. However, respondents were invited to answer all sections. Not all fields needed to be completed and all information was anonymous. A large number of questions were asked including what the respondents understood about osteopathic training. Chi square test was used with statistical significance set at p < 0.05.
Results A total of 772 patients completed the questionnaire. Five hundred and seventy respondents completed the questionnaire describing either a good experience or a bad experience, the remaining were excluded from this part of the study either because they reported both a good and bad experience or did not complete the information regarding osteopathic training. Four hundred and ninety-one (88.7%) described a good experience while 62 (11.3%) described a bad experience. Seventy-one percent (392) of the respondents were female compared to 29% males (161). The majority of the respondents (59%) were in the 31e60 year age group, with 35.4% being 61 or over. The mean age was 54 14.3 y. Over 38% of respondents described themselves as professional and 25.6% described themselves as retired (Table 1). No statistical significance was demonstrated for outcome (best, or worse experiences) for age, gender or occupation of the respondents (Table 1). The majority of respondents who described a good experience stated that osteopathic education is in the main full time (76.7%) compared to 8% who reported a bad experience. Forty two percent of respondents who reported that osteopathic education was 4e5 y duration also reported a good outcome (Table 2). However, there was no statistical significance for outcome for any of the questions in relation to osteopathic training. (Table 3).
Methods Discussion Institutional ethical approval was granted. Adverts were placed in a number of national newspapers (red top and broad sheet), health magazines and posters advertising the research were placed in
Patient satisfaction is a complex process and the literature remains mixed concerning the importance of the patients demographics and satisfaction
Patient perception of osteopathic training in the UK
189
Table 1 Socio-demographic details, good or bad experiences. Pearson Chi-squared, degrees of freedom and p value. N ¼ 570. Categories
Age <10 y 11e20 y 21e30 y 31e40 y 41e50 y 51e60 y 61e70 y 71e80 y 81e90 91e100 Gender Male Female Occupation Professional Manual House person Clerical Self-employed Unemployed Retired Student Other a
Outcome Best (%)
Worse (%)
Total n (%)
7 3 18 48 98 150 114 47 10 1
(1.25) (0.5) (3.2) (8.6) (17.6) (26.9) (20) (8.4) (1.8) (0.2)
0 0 3 (0.5) 10 (1.8) 6 (1.1) 17 (3) 20 (3.6) 4 (0.7) 2 (0.4) 0
7 3 21 58 104 167 134 51 12 1
143 (25.8) 348 (62.9)
18 (3.3) 44 (0.7)
161 (29.1) 392 (70.8)
195 10 32 39 60 6 123 15 19
20 (3.6) 0 5 (0.9) 5 (0.9) 4 (0.7) 2 (0.3) 20 (3.6) 2 (0.3) 2 (0.3)
215 10 37 44 64 8 143 17 21
(34.8) (1.8) (5.7) (6.9) (10.7) (1.1) (22) (2.7) (3.4)
(1.25) (0.5) (3.76) (10.4) (18.6) (29.9) (24) (9) (2.2) (0.2)
(38.5) (1.8) (6.6) (7.9) (11.5) (1.4) (25.6) (3) (3.7)
c2
dfa
p
9.986
10
0.442
0.477
2
0.788
9.48
9
0.394
df: degrees of freedom.
Table 2 Questions regarding education and numbers and percentage in relation to outcome reported. Reported a good outcome (%)
Reported a bad outcome (%)
Is osteopathic education: FT 268 (76.7) 28 (8) PT 48 (13.7) 5 (1.4) Length of training: <3 y 23 (4.2) 6 (1) 3y 178 (32.3) 29 (5.3) 4e5 y 232 (42) 19 (3.5) Unsure 57 (10.3) 6 (1) Do osteopaths have to be registered? Yes 455 (85) 19 (3.5) No 57 (10.6) 3 (0.56) Qualification obtained: Diploma 172 (31.2) 26 (4.7) BSc 162 (29.5) 15 (2.7) MSc 27 (4.7) 4 (0.7) Unsure 109 (19.8) 15 (2.7) All 20 (3.6) 0
with some studies suggesting that demographics represents 90%e95% variance in the rates of satisfaction27,28. Age is the most consistent finding with satisfaction, with older patients tending to be more satisfied,29 although this was not found in this current study. Other demographics such as gender and occupation have been found to be contradictory in
Table 3
c2 results for expectation.
Question
c2
df
p
Do osteopaths need to be registered with a governing body? (Y/N) How long do you think the training is? (<3 y, 3 y, 4e5 y, unsure) Do you think the training is full time, part time, either unsure? What qualification do you think they receive after graduation? (Diploma, degree, MSc, unsure)
4.04
3
0.257
8.145
4
0.086
4.475
4
0.346
5.115
5
0.402
190 studies, but no statistical significance was seen with any of the demographics and outcome in this study. Research on patient satisfaction and the medical practitioner’s technical skills are mixed with older patients preferring better communication than technical skills30. However, other studies have indicated that a correct diagnosis, design and effective treatment plan and have high technical skills more important than a ‘bedside manner’.31,32 Similar to other studies in patient satisfaction and osteopathy 88.7% of the respondents in this current study reported a ‘good’ outcome.1e3 Previous studies have indicated that allowing the patients to choose their therapy gives a therapeutic advantage33. Further, Myers et al.26 suggest that choosing one’s own treatment may have an impact on expectation and that expectation itself may be therapeutic. Certainly with the majority of osteopathic patients in the UK being self funded the respondents in this current survey may have actively chosen osteopathic treatment. Work is continuing to assess the percentage of patients who were referred or who self-referred themselves to an osteopath. Previous research into factors that affect patient satisfaction have included communication, with patients with work-related low back pain having higher satisfaction rates when their physician took their condition seriously.34 Satisfaction rates were higher than could be explained by symptom relief.34 Patient satisfaction has also been shown to be increased when the physician allowed the patients to express their ideas and concerns35 and when physicians took the patients social and mental status into account.36 However, previous work by Vila et al.37 suggested that the type of doctors training did not influence patient satisfaction.37 This current study showed that the patients’ perception of osteopathic training also did not appear to affect their outcome. However understanding what patients expect from their healthcare practitioner not only results in patient satisfaction, improved outcome, and patient loyalty but also studies have indicated an inverse relationship between satisfaction and risk management episodes.38 Further work is required to study other factors that may contribute to patient expectation, satisfaction and outcome in osteopathic treatment as well as determining what the public determine as key competencies required for an osteopath. Although this study included a relatively large sample size a number of limitations must be acknowledged. The study was a retrospective study with the respondents completing the questionnaire at different time points following their
I.P. Drysdale et al. treatment. This current study does not take into account the previous experiences of the respondent or if indeed they were self referred. The questionnaire used was not a validated questionnaire. However this study did remove a substantial potential bias by removing osteopaths from the recruitment process.
Conclusion This study indicates that even with osteopathy being a fairly recent addition to healthcare there is a generally good understanding of the type, length and level of osteopathic qualification and the necessity for registration amongst its patients. Further, this study has shown that the vast majority of patients appear to have a good outcome following osteopathic treatment. This good outcome does not appear to be related to the patient’s demographic details or to the public’s perception of osteopathic education. Further work is required to study what effects patients’ outcome/satisfaction and how outcome can be improved in patients who report a bad experience.
Author contribution IP, KR and HH conceived the idea for the study. IP and HH contributed to the design and planning of the research. All authors were involved in data collection. KR analyzed the data. KR wrote the first draft of the manuscript. All authors edited and approved the final version of the manuscript.
References 1. GOSc. Public awareness survey 2006. 2. Licciardone J, Gamber R, Cardarelli K. Patient satisfaction and clinical outcomes associated with osteopathic manipulative treatment. JOA 2002;102:13e20. 3. Strutt R, Shaw Q, Leach J. Patients’ perceptions and satisfaction with treatment in a UK osteopathic training clinic. Man Ther 2008;13:456e67. 4. Donabedian A. The quality of care and how can it be assessed. JAMA 1988;260:1743e8. 5. Cleary PD, McNeil BJ. Patient satisfaction as an indicator of quality care. Inquiry 1988;25:25e36. 6. Carr-Hill RA. The measurement of patient satisfaction. J Public Health Med 1992;14:236e46. 7. Lewis JR. Patient views on quality care in general practice: literature review. Soc Sci Med 1994;39:655e70. 8. Sitzia J, Wood N. Patient satisfaction: a review of issues and concepts. Soc Sci Med 1997;45:1829e43. 9. Jackson JL, Chamberlin J, Kroenke K. Predictors of patient satisfaction. Soc Sci Med 2001;52:609e20.
Patient perception of osteopathic training in the UK 10. Zandbelt LC, Smets EMA, Oort FJ, Godfried MH, De Haes HCJM. Satisfaction with the outpatient encounter: a comparison of patients’ and physicians’ views. J Gen Intern Med 2004;19:1088e95. 11. Thiedke CC. What do we really know about patient satisfaction? Fam Pract Manag 2007;14:33e6. 12. Bair MJ, Kroenke K, Sutherland JM, McCoy KD, Harris H, McHorney CA. Effects of depression and pain severity on satisfaction in medical outpatients: analysis of the medical outcomes study. J Rehabil Res Dev 2007;44:143e52. 13. Koyama T, McHaffie JG, Laurienti PJ, Coghill RC. The subjective experience of pain: where expectations become reality. Proc Natl Acad Sci U S A 2005;102:12950e5. 14. Calnan M. Towards a conceptual framework of lay evaluation of healthcare. Soc Sci Med 1988;27:927e33. 15. Hickson GB, Clayton EW, Entman SS, Miller CS, Githens PB, Whetten-Goldstein K, et al. Obstetricians’ prior malpractice experience and patients’ satisfaction with care. Obstet Gynecol Surv 1995;50:351e3. 16. Jourdan C, Poiraudeau S, Descamps S, Nizard R, Hamadouche M, Anract P, et al. Comparison of patient and surgeon expectations of total hip arthroplasty. PLoS One 2012;7:e30195. 17. Burton KE, Wright V, Richards J. Patients’ expectations in relation to total hip replacement surgery. Ann Rheum Dis 1979;38:471e4. 18. Flood AB, Lorebce DP, Ding J, McPherson K, Black NA. The role of expectations in patients’ reports of post-operative outcomes and improvements following therapy. Med Care 1993;31:1043e56. 19. Iversen MD, Daltroy LH, Fossel AG, Katz JN. The prognostic importance of pre-operative expectations of surgery for lumbar spinal stenosis. Patient Educ Couns 1998;34: 169e78. 20. Kalauokalani D, Cherkin DC, Sherman KJ, Koepsell TD, Deyo RA. Lessons from a trial of acupuncture and massage for low back pain: patient expectations and treatment effects. Spine 2001;26:1418e24. 21. Leedham B, Meyerowitz BE, Muirhead J, Frist WH. Positive expectations predict health after heart transplantation. Health Psychol 1995;14:74e9. 22. Linde K, Witt CM, Streng A, Weidenhammer W, Wagenpfeil S, Brinkhaus B, et al. The impact of patient expectations on outcomes in four randomized controlled trials of acupuncture in patients with chronic pain. Pain 2007;128:264e71. 23. Lutz Gk, Butzlaff ME, Atlas SJ, Keller RB, Singer DE, Devo RA. The relation between expectations and outcomes in surgery for sciatica. J Gen Intern Med 1999;14:740e4. 24. Tielsch JM, Steinberg EP, Cassard SD, Schein OD, Javitt JC, Legro MW, et al. Preoperative functional expectations and postoperative outcomes among patients
191
25.
26.
27.
28.
29.
30.
31.
32.
33. 34.
35. 36. 37.
38.
undergoing first eye cataract surgery. Arch Opthalmol 1995;113:1312e8. Rocoe JA, Morrow DR, Hickok JT, Bushunow P, Pierce HI, Flynn PJ, et al. The efficacy of acupressure and acustimulation wrist bands for the relief of chemotherapy induced nausea and vomiting. A University of Rochester Cancer Center Community Clinical Oncology Program multicenter study. J Pain Symptom Manage 2003;26:731e42. Myers SS, Phillips RS, Davis RB, Cherkin DC, Legedza A, Kaptchuk TJ, et al. Patient expectations as predictors of outcome in patients with acute low back pain. J Gen Intern Med 2008;23:148e53. Hall JA, Dorman MC. Patient socio demographic characteristics as predictors of satisfaction with medical care: a meta analysis. Soc Sci Med 1990;30:811e8. Sixma HJ, Speeuwenberg PM, van der Pasch MA. Patient satisfaction with the general practitioner: a two-level analysis. Med Care 1998;36:212e29. Kong MC, Camacho FT, Feldman SR, Anderson RT, Balkrishnan R. Correlates of patient satisfaction with physician visit: differences between elderly and nonelderly survey respondents. Health Qual Life Outcomes 2007;5:62. Chang JT, Hays RD, Shekelle PG, MacLean CH, Solomon DH, Reuben DB, et al. Patients global ratings of their health care are not associated with the technical quality of their care. Ann Intern Med 2006;144:665e72. Fung CH, Elliott MN, Hays RD, Kahn KL, Kanouse DE, McGlynn EA, et al. Patients’ preferences for technical versus interpersonal quality when selecting a primary care physician. Health Serv Res 2005;40:957e77. Otani K, Kurz RS, Harris LE. Managing primary care using patient satisfaction measures. J Healthc Manag 2005;50: 311e24. McPherson K, Britton A. Preferences and understanding their effects on health. Qual Health Care 2001;10:61e6. Shaw WS, Zaia A, Pransky G, Winters T, Patterson WB. Perceptions of provider communication and patient satisfaction for treatment of acute low back pain. J Occup Environ Med 2005;47:1036e43. Cecil DW, Kileen I. Control, compliance and satisfaction in the family practice encounter. Fam Med 1997;29:653e7. Sherbourne CD, Sturm R, Wells KB. What outcomes matter to patients? J Gen Intern Med 1999;14:357e63. Vila A, Llor C, Rovira MD, Gonzalez MJ, Rodriguez C, Blade J, et al. Influence of gender, age and general practitioners training on satisfaction degree of patients. WONCA Conf Proc 2001. Stelfox HT, Gandhi TK, Orav EJ, Gustafson ML. The relation of patient satisfaction with complaints against physicians and malpractice lawsuits. Am J Med 2005;118: 1126e33.
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www.elsevier.com/ijos
Patient perception of osteopathic training in the UK and patient reported experience I.P. Drysdale, H. Hinkley, K.J. Rolfe* British College Osteopathic Medicine, Lief House, Finchley Road, London NW3, UK Received 28 December 2012; accepted 8 April 2013
KEYWORDS Education; Osteopathy; Patient outcome; Satisfaction
Background: Osteopathy is a recent addition to the modern day healthcare community. The majority of patients attending osteopathic practices in the United Kingdom are self funders, and studies have reported a high rate of satisfaction in patients receiving osteopathic treatment. Objective: This study aimed to determine patient perception of osteopathic education and relate that to patient reported experience. Method: The study was conducted through newspapers, GP surgeries and osteopathic clinics. A questionnaire was either completed on-line or a paper copy was returned to the investigator. Results: Over seven hundred people respondent though for this part of the study 202 were excluded either because they reported both good and bad experiences or did not complete the section on osteopathic education. Similar to other studies this current study reported that the majority of respondents reported a good experience (88.7%). However, there was no statistical significance demonstrated for any of the patient demographics or for the respondents perception of osteopathic education and experience. Discussion and conclusion: Further work is required to assess what patients require for a ‘good’ experience and what osteopathic patients determine as key competencies required in an osteopath. ª 2013 Elsevier Ltd. All rights reserved.
Abstract
Introduction
* Corresponding author. Tel.: þ44 (0) 20 7435 6464; fax: þ44 (0) 20 7431 3630. E-mail addresses: [email protected], work@kerstinrolfe. com (K.J. Rolfe).
Osteopathy is a relatively recent addition to healthcare, with the UK Government passing the Osteopaths Act in 1993. However, even with it’s fairly recent inception a study conducted in 2006, by the General Osteopathic Council, showed that
1746-0689/$ - see front matter ª 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ijosm.2013.04.001
188 83% of adults living in the United Kingdom were aware of the term ‘osteopathy’.1 Osteopathy appears to have a high satisfaction rate within its patient population with a number of studies reporting a high satisfaction rate.1e3 However, in one study four percent of those that visited an osteopath had a concern regarding the competency of the osteopath.1 Patient satisfaction is a complex process influenced by a number of patient characteristics (for example age, gender, ethnicity, level of education), as well as previous experiences, expectations, communication, pain severity, timing, psychological and societal values4e12. There is an increasing awareness concerning patient satisfaction, outcome and expectations with outcome being strongly influenced by both patient expectation and patient satisfaction.13 Satisfied patients have been shown to have a better outcome, most likely as these patients are more active in the participation of their care14, but further, satisfied patients not only adhere to their treatment plans but are loyal to their provider,15 important with the majority (80%) of UK patients funding their own osteopathic treatment.1 Patient expectation is also known to be influenced by a number of individual factors such as gender, education level, age, race, psychological factors, acuity of pain, and marital status.15 Further, patient expectations and clinical outcomes are known to be related.16e24 Patients expectations appear to be the most important predictive factor for treatment outcome, though most studies have focused on subjective outcomes18,25. Myers et al.26 showed that patients with higher expectations of specific treatments showed functional improvements in patients with low back pain. Osteopathy is a healthcare profession where recent graduates are able to set up practice as single practitioners. Osteopathic education in UK, therefore aims to produce students that are safe to commence autonomous clinical practice. Our aim was to understand the public’s perception of osteopathic education in the UK conducted by survey and to assess any correlation related to the public perception of the educational requirements and patient outcome.
I.P. Drysdale et al. general practitioner surgeries and osteopathic clinics. The questionnaire could be completed either on line or by post. The questionnaire consisted of three parts: part one was general information, and then part two was for those who had a bad experience and part three was for those who had a good experience. However, respondents were invited to answer all sections. Not all fields needed to be completed and all information was anonymous. A large number of questions were asked including what the respondents understood about osteopathic training. Chi square test was used with statistical significance set at p < 0.05.
Results A total of 772 patients completed the questionnaire. Five hundred and seventy respondents completed the questionnaire describing either a good experience or a bad experience, the remaining were excluded from this part of the study either because they reported both a good and bad experience or did not complete the information regarding osteopathic training. Four hundred and ninety-one (88.7%) described a good experience while 62 (11.3%) described a bad experience. Seventy-one percent (392) of the respondents were female compared to 29% males (161). The majority of the respondents (59%) were in the 31e60 year age group, with 35.4% being 61 or over. The mean age was 54 14.3 y. Over 38% of respondents described themselves as professional and 25.6% described themselves as retired (Table 1). No statistical significance was demonstrated for outcome (best, or worse experiences) for age, gender or occupation of the respondents (Table 1). The majority of respondents who described a good experience stated that osteopathic education is in the main full time (76.7%) compared to 8% who reported a bad experience. Forty two percent of respondents who reported that osteopathic education was 4e5 y duration also reported a good outcome (Table 2). However, there was no statistical significance for outcome for any of the questions in relation to osteopathic training. (Table 3).
Methods Discussion Institutional ethical approval was granted. Adverts were placed in a number of national newspapers (red top and broad sheet), health magazines and posters advertising the research were placed in
Patient satisfaction is a complex process and the literature remains mixed concerning the importance of the patients demographics and satisfaction
Patient perception of osteopathic training in the UK
189
Table 1 Socio-demographic details, good or bad experiences. Pearson Chi-squared, degrees of freedom and p value. N ¼ 570. Categories
Age <10 y 11e20 y 21e30 y 31e40 y 41e50 y 51e60 y 61e70 y 71e80 y 81e90 91e100 Gender Male Female Occupation Professional Manual House person Clerical Self-employed Unemployed Retired Student Other a
Outcome Best (%)
Worse (%)
Total n (%)
7 3 18 48 98 150 114 47 10 1
(1.25) (0.5) (3.2) (8.6) (17.6) (26.9) (20) (8.4) (1.8) (0.2)
0 0 3 (0.5) 10 (1.8) 6 (1.1) 17 (3) 20 (3.6) 4 (0.7) 2 (0.4) 0
7 3 21 58 104 167 134 51 12 1
143 (25.8) 348 (62.9)
18 (3.3) 44 (0.7)
161 (29.1) 392 (70.8)
195 10 32 39 60 6 123 15 19
20 (3.6) 0 5 (0.9) 5 (0.9) 4 (0.7) 2 (0.3) 20 (3.6) 2 (0.3) 2 (0.3)
215 10 37 44 64 8 143 17 21
(34.8) (1.8) (5.7) (6.9) (10.7) (1.1) (22) (2.7) (3.4)
(1.25) (0.5) (3.76) (10.4) (18.6) (29.9) (24) (9) (2.2) (0.2)
(38.5) (1.8) (6.6) (7.9) (11.5) (1.4) (25.6) (3) (3.7)
c2
dfa
p
9.986
10
0.442
0.477
2
0.788
9.48
9
0.394
df: degrees of freedom.
Table 2 Questions regarding education and numbers and percentage in relation to outcome reported. Reported a good outcome (%)
Reported a bad outcome (%)
Is osteopathic education: FT 268 (76.7) 28 (8) PT 48 (13.7) 5 (1.4) Length of training: <3 y 23 (4.2) 6 (1) 3y 178 (32.3) 29 (5.3) 4e5 y 232 (42) 19 (3.5) Unsure 57 (10.3) 6 (1) Do osteopaths have to be registered? Yes 455 (85) 19 (3.5) No 57 (10.6) 3 (0.56) Qualification obtained: Diploma 172 (31.2) 26 (4.7) BSc 162 (29.5) 15 (2.7) MSc 27 (4.7) 4 (0.7) Unsure 109 (19.8) 15 (2.7) All 20 (3.6) 0
with some studies suggesting that demographics represents 90%e95% variance in the rates of satisfaction27,28. Age is the most consistent finding with satisfaction, with older patients tending to be more satisfied,29 although this was not found in this current study. Other demographics such as gender and occupation have been found to be contradictory in
Table 3
c2 results for expectation.
Question
c2
df
p
Do osteopaths need to be registered with a governing body? (Y/N) How long do you think the training is? (<3 y, 3 y, 4e5 y, unsure) Do you think the training is full time, part time, either unsure? What qualification do you think they receive after graduation? (Diploma, degree, MSc, unsure)
4.04
3
0.257
8.145
4
0.086
4.475
4
0.346
5.115
5
0.402
190 studies, but no statistical significance was seen with any of the demographics and outcome in this study. Research on patient satisfaction and the medical practitioner’s technical skills are mixed with older patients preferring better communication than technical skills30. However, other studies have indicated that a correct diagnosis, design and effective treatment plan and have high technical skills more important than a ‘bedside manner’.31,32 Similar to other studies in patient satisfaction and osteopathy 88.7% of the respondents in this current study reported a ‘good’ outcome.1e3 Previous studies have indicated that allowing the patients to choose their therapy gives a therapeutic advantage33. Further, Myers et al.26 suggest that choosing one’s own treatment may have an impact on expectation and that expectation itself may be therapeutic. Certainly with the majority of osteopathic patients in the UK being self funded the respondents in this current survey may have actively chosen osteopathic treatment. Work is continuing to assess the percentage of patients who were referred or who self-referred themselves to an osteopath. Previous research into factors that affect patient satisfaction have included communication, with patients with work-related low back pain having higher satisfaction rates when their physician took their condition seriously.34 Satisfaction rates were higher than could be explained by symptom relief.34 Patient satisfaction has also been shown to be increased when the physician allowed the patients to express their ideas and concerns35 and when physicians took the patients social and mental status into account.36 However, previous work by Vila et al.37 suggested that the type of doctors training did not influence patient satisfaction.37 This current study showed that the patients’ perception of osteopathic training also did not appear to affect their outcome. However understanding what patients expect from their healthcare practitioner not only results in patient satisfaction, improved outcome, and patient loyalty but also studies have indicated an inverse relationship between satisfaction and risk management episodes.38 Further work is required to study other factors that may contribute to patient expectation, satisfaction and outcome in osteopathic treatment as well as determining what the public determine as key competencies required for an osteopath. Although this study included a relatively large sample size a number of limitations must be acknowledged. The study was a retrospective study with the respondents completing the questionnaire at different time points following their
I.P. Drysdale et al. treatment. This current study does not take into account the previous experiences of the respondent or if indeed they were self referred. The questionnaire used was not a validated questionnaire. However this study did remove a substantial potential bias by removing osteopaths from the recruitment process.
Conclusion This study indicates that even with osteopathy being a fairly recent addition to healthcare there is a generally good understanding of the type, length and level of osteopathic qualification and the necessity for registration amongst its patients. Further, this study has shown that the vast majority of patients appear to have a good outcome following osteopathic treatment. This good outcome does not appear to be related to the patient’s demographic details or to the public’s perception of osteopathic education. Further work is required to study what effects patients’ outcome/satisfaction and how outcome can be improved in patients who report a bad experience.
Author contribution IP, KR and HH conceived the idea for the study. IP and HH contributed to the design and planning of the research. All authors were involved in data collection. KR analyzed the data. KR wrote the first draft of the manuscript. All authors edited and approved the final version of the manuscript.
References 1. GOSc. Public awareness survey 2006. 2. Licciardone J, Gamber R, Cardarelli K. Patient satisfaction and clinical outcomes associated with osteopathic manipulative treatment. JOA 2002;102:13e20. 3. Strutt R, Shaw Q, Leach J. Patients’ perceptions and satisfaction with treatment in a UK osteopathic training clinic. Man Ther 2008;13:456e67. 4. Donabedian A. The quality of care and how can it be assessed. JAMA 1988;260:1743e8. 5. Cleary PD, McNeil BJ. Patient satisfaction as an indicator of quality care. Inquiry 1988;25:25e36. 6. Carr-Hill RA. The measurement of patient satisfaction. J Public Health Med 1992;14:236e46. 7. Lewis JR. Patient views on quality care in general practice: literature review. Soc Sci Med 1994;39:655e70. 8. Sitzia J, Wood N. Patient satisfaction: a review of issues and concepts. Soc Sci Med 1997;45:1829e43. 9. Jackson JL, Chamberlin J, Kroenke K. Predictors of patient satisfaction. Soc Sci Med 2001;52:609e20.
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