All patients who attended the neurological day-care clinic of the Academic Medical Centre from February 2006 until August 2006 for SOs and TRs were included. There were no exclusion criteria. The organization of the day-care admission and the patient characteristics have been described previously [
6]. In short, the day-care clinic provides tailored care for patients referred for a neurological SO or TR. Consultations are prepared by reviewing documents from referring physicians and planning of all necessary ancillary investigations. On the day of consultation patients are admitted for one day to provide sufficient time for history taking, neurological examination and differential diagnostic consideration. By planning ancillary investigations and subspecialist consultations on the same day, the goal is to have a (revised) diagnosis and/or treatment plan at the end of the consultation.
Questionnaires
Patients were asked to fill out two questionnaires: one in the waiting area prior to the consultation (pre-consultation questionnaire), and one afterwards on the same day (post-consultation questionnaire), before leaving the hospital. Post-consultation questionnaires which were not completed were sent to the patient’s home address with a return envelope. If the post-consultation questionnaire was not returned at the end of the study period, multiple attempts were made to contact the patient by telephone. In case the patient had not responded after these attempts, the questionnaire was considered missing.
The pre-consultation questionnaire contained questions about patient characteristics including age, sex, educational level, number of doctors consulted, and duration of symptoms. Patients were asked about their expectations using a multiple choice response format constructed for this study specifically, including: (1) explanation about a diagnosis or treatment, (2) confirmation of a diagnosis or treatment, (3) getting a new diagnosis or treatment, or (4) other, in free text format. Only one answer was allowed. Furthermore, patients were asked to what extent they thought their expectations would be fulfilled.
Also, patients were asked to rate their satisfaction with the referring physician. Satisfaction was assessed using a patient satisfaction questionnaire, originally developed to measure satisfaction in hospitalized oncology patients [
7]. It is a direct measure of the process of the consultation, seeking the patients’ perspective of what occurred rather than the facts. The Dutch version of the instrument has since then been used in various outpatient settings, showing satisfactory reliability and validity, as indicated by internal consistencies of 0.90 and associations in the direction hypothesized [
8‐
10]. The instrument consists of five questions that assess patients’ satisfaction on a visual analogue scale (VAS) for each of the following items: (1) own involvement in the conversation, (2) physician’s information giving, (3) own involvement in decision making, (4) physicians’ emotional support, and (5) general satisfaction. Scores were summated and a mean overall satisfaction score was calculated, with a higher score indicating greater satisfaction (scores from 0 to 10). Internal consistency (Cronbach’s alpha) in the present study was 0.90.
The post-consultation questionnaire assessed satisfaction with the day-care clinic physician directly after the consultation using the same satisfaction questionnaire. Patients were also asked if they had the desire to independently seek an additional opinion from another physician in the future (yes/no).
Day-care physicians filled out a doctor-questionnaire directly after the consultation assessing whether or not a new diagnosis was made or a new treatment was advised.
Statistical analysis
Categorical variables were analyzed using the χ
2 test, and differences between median values were tested with the Mood's median test for non-parametric data. Mean values are presented with range and standard deviation (SD), median values with range and interquartile range (IQR). Differences in satisfaction between the referring physician and the day-care clinic neurologist were analyzed with the paired samples t test and are presented with a 95% confidence interval (CI). To study explanatory variables for satisfaction, multiple linear regression was used. A blockwise entry was chosen to control for expected confounders. Block one contained demographic variables (i.e., age, gender, education), block two contained medical history variables (i.e., number of physicians previously consulted, symptom duration, satisfaction with previous physician), while block three assessed the referral type (SO or TR) as an explanatory variable. The model is provided with a total R
2 (explained variance) to describe the power of the prediction model as well as subsequent R
2 for each step. Differences were considered significant when p ≤ 0.05. Data were analyzed with SPSS version 15.0 (SPSS, Chicago, IL).