Entwicklung eines Fragebogens zur Patientenzufriedenheit in der stationären Psychotherapie

Due to health policy and economic needs as well as a changing role of patients, efforts to adopt quality assurance programs such as satisfaction surveys in the psychiatric and psychotherapeutic inpatient care are increasing. Furthermore the importance of subjective evaluation for the medical treatment and as a criterion of quality was recognized. The aim of this dissertation was to produce a new questionnaire based on existing methods. The new questionnaire is intended to capture patient satisfaction in a more sophisticated manner. Since there are no weighted studies in the German-speaking regions of Europe of this type regarding the various and different aspects of patient satisfaction within the arena of Psychotherapy, a paper using and inductive research approach investigating which aspects of inpatient care in Psychotherapy are of real importance to the patients and their patient satisfaction. The empirical part of the dissertation consisted of three components. Study I of 242 patients interviewed using well-established questionnaire on patient satisfaction called ZUF-8 (Schmidt et al. 1989, Spießl et al. 1996). This questionnaire was to be examined regarding its suitability to evaluate the overall satisfaction in the field of psychotherapy and psychiatry in Marburg. The study using ZUF-8, confirms the high level of satisfaction based on findings of other well known studies. The trial instrument proves to be a reliable one-dimensional scale. The acceptable characteristic values of ZUF-8 from former studies could be convincingly replicated in the this study. Hence, the ZUF-8 is an extremely economically viable method and seems rather appropriate to quantify patient satisfaction as an indicator of outcome quality. Study II concentrated on the development of a questionnaire based on the findings of Study I. The questionnaire was to help to identify the concrete expectations of a patient going into psychotherapy. In order to do this the questionnaire included a half-standardised interview, the evaluation of the 30 patient interviews were performed by a content-analytic process, which led to the creation of a category system.As a result of the second study, which was based on the free expression of opinion, a category system - consisting of 17 main categories - could be established. Of particular importance to the patients were the ward facilities, the range of therapies on offer, staff supervision and the personal care provided by the nursing staff. In study III the newly designed questionnaire (SpezFB) contained 35 content-analytic generated statements from the second study and also covered the area of specific patient satisfaction, which was to be captured at the end of an inpatient psychotherapy. This information was captured using two groups of patients. Finally SpezFB was tested on reliability and dimensionality, in addition a possible influence on socio-demographic variables and response differences between the two samples were analysed. As a result of the main survey a scale with a total of 20 items is available, which can be divided into five subscales: "Satisfied with Doctors and therapists", "Satisfied with the nursing care", "Satisfied with the possibilities of the personal therapeutic and recreational activities as well as the cooperation of the team", "Implementation and achievement of the goals of treatment", "Facilities of the ward". The survey demonstrates very good internal consistency. The assessment is largely independent of sociodemographic variables and confirmed the high level of satisfaction among the patients. The investigation of the response behaviour of the two samples only showed a few insignificant differences using the t-Test at the level of individual items. Finally the result of this third study showed that the SpezFB is an easily deployable, coherent, economic survey instrument which is easy to implement and to evaluate. The results of the survey using SpezFB are relevant both for the daily work with patients and for the conceptual design of treatment strategies and quality enhancing measures. In any further studies it would seem to be useful to improve the items obtained from patient interviews regarding their structure, in order to obtain a reliable, valid and economic measuring instrument for patient satisfaction, which is suitable for the survey of all inpatient psychiatric and psychotherapeutic patients.