Context and scope
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a method for profiling based on common patient satisfaction surveys, which is easily replicable in all health systems and contexts;
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a proposal for segments based on the results of a broad-based analysis conducted in the Italian National Health System (INHS).
Background
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frail, vulnerable elderly patients who lack family support, have multiple chronic conditions, are not self-sufficient, have cognitive disorders, are financially distressed, and are unable to express an appropriate demand for health and social services;
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healthy and wealthy elderly patients who are educated and pursue well-being through recurring access to an extended range of health services (preventive, curative, and aesthetic) and are willing to pay out-of-pocket or premium prices for high-quality and additional services.
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| Mainstreamers: the traditional patient; |
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| Allopathic self-care: prefer over-the-counter products or toughing it out rather than seeing a physician; |
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| Maximizers: highly engaged with their physicians and try to get the most out of their health care plans; |
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| Nutritionists: rely on food and diet to prevent illness; |
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| Naturalists: rely on complementary and alternative medicine and their bodies’ natural healing process and dislike using the health care system; |
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| Integrators: those who rely on the health care system for medical diagnoses but also dabble in complementary and alternative medicine (CAM); |
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| Holistics: use the health care delivery system and CAM for the things each modality excels in; |
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| Healthy Lifestylers: dramatically change their lives to maximize their health and look for health benefits across a wide range of products and services. |
Methodology
Survey definition
Data collection
Statistical analyses
Results
Mean
|
Std. Dev.
|
% Missing
| |
---|---|---|---|
Specialist visits | 3.69 | 0.68 | 6.76 |
Diagnostic tests | 3.76 | 0.79 | 2.34 |
Home care (Removed) | 3.96 | 1.27 | 27.69 |
Advisories (Removed) | 4.15 | 0.81 | 31.40 |
Vaccinations (Removed) | 4.04 | 0.76 | 16.98 |
Administrative services | 3.59 | 0.76 | 9.45 |
Kindness of administrative staff | 3.98 | 0.69 | 5.38 |
Professionalism of administrative staff | 3.95 | 0.69 | 5.68 |
Kindness of health care staff | 4.15 | 0.76 | 1.91 |
Professionalism of health care staff | 4.15 | 0.73 | 1.93 |
Coordination of continuity of care service | 3.63 | 0.50 | 8.22 |
Professionalism of after-hours doctors (AHDs)* | 3.85 | 0.52 | 8.17 |
Factor identification
Outpatient clinics’ staff
|
Outpatient clinics’ services
|
Continuity of care
| |
---|---|---|---|
Kindness of administrative staff | 0.863 | ||
Professionalism of administrative staff | 0.841 | ||
Kindness of health care staff | 0.809 | ||
Professionalism of health care staff | 0.775 | ||
Diagnostic tests | 0.910 | ||
Specialistic visits | 0.820 | ||
Administrative services | 0.788 | ||
Organization of continuity of care service | 0.922 | ||
Professionalism of AHDs | 0.835 |
Group creation
Actual group
|
Predicted group membership
| |||
---|---|---|---|---|
1 | 2 | 3 | 4 | |
CLUSTER 1 | 97.7% | 0.6% | 1.7% | 0.0% |
CLUSTER 2 | 0.1% | 99.6% | 0.3% | 0.0% |
CLUSTER 3 | 0.0% | 0.0% | 100.0% | 0.0% |
CLUSTER 4 | 0.0% | 0.0% | 0.0% | 100.0% |
Unpretentious
|
Informed & supported
|
Experts
|
Advanced
|
Total
| |
---|---|---|---|---|---|
SIZE | 2070 | 779 | 531 | 81 | 3461 |
FACTORS* | |||||
Outpatient clinic staff | 0.29 | 0.30 | −1.65 | 0.66 | |
Outpatient clinic services | 0.48 | −1.37 | 0.03 | 0.74 | |
Continuity of care | 0.22 | −0.07 | −0.11 | −4.25 | |
GENDER (%) | |||||
Males | 22.4 | 20.9 | 21.3 | 18.5 | 21.8 |
AGE (%) | |||||
18–45 | 23.7 | 28.7 | 30.7 | 40.5 | 26.3 |
46–65 | 36.7 | 43.1 | 42.1 | 44.3 | 39.1 |
Over 65 | 39.6 | 28.3 | 27.1 | 15.2 | 34.5 |
EDUCATION (%) | |||||
None / Primary school | 38.8 | 31.4 | 28.1 | 16.3 | 34.9 |
Middle school | 24.4 | 25.3 | 28.5 | 32.5 | 25.4 |
High school | 28.6 | 33.1 | 32.3 | 37.5 | 30.4 |
Degree and post degree | 8.2 | 10.1 | 11.2 | 13.8 | 9.2 |
JOB (%) | |||||
Legislator, executives and entrepreneurs | 1.3 | 0.6 | 0.8 | 2.5 | 1.1 |
Intellectual, scientific and highly skilled professions | 3.3 | 5.2 | 5.7 | 12.7 | 4.3 |
Technical professions | 4.0 | 4.4 | 4.4 | 8.9 | 4.3 |
Clerks | 7.1 | 9.3 | 9.4 | 8.9 | 8.0 |
Skilled activity in commerce and services | 5.4 | 6.2 | 7.6 | 5.1 | 5.9 |
Artisans, skilled labor and farmers | 4.6 | 3.2 | 5.2 | 5.1 | 4.4 |
Semi-skilled labor | 1.3 | 0.9 | 0.8 | 3.8 | 1.2 |
Unskilled labor | 1.3 | 1.6 | 1.7 | 1.3 | 1.4 |
Students | 2.8 | 3.9 | 2.7 | 1.3 | 3.0 |
Housewives | 18.9 | 22.1 | 21.2 | 24.1 | 20.1 |
Unemployed | 1.4 | 2.5 | 1.3 | 2.5 | 1.7 |
Retired | 48.4 | 39.7 | 39.0 | 24.1 | 44.4 |
FAMILY SITUATION (%) | |||||
1 (live alone) | 13.4 | 9.2 | 9.0 | 7.5 | 11.6 |
2 | 35.3 | 34.0 | 30.3 | 18.8 | 33.9 |
3 | 23.4 | 28.5 | 26.7 | 27.5 | 25.1 |
More than 3 | 27.9 | 28.3 | 34.0 | 46.3 | 29.4 |
CHRONIC DISEASES (%) | |||||
Yes | 46.3 | 43.2 | 39.1 | 38.8 | 44.3 |
No. OF VISITS IN OUTPATIENT C. IN THE LAST YEAR (%) | |||||
1 | 32.0 | 27.2 | 26.4 | 23.5 | 29.8 |
2 | 27.1 | 26.7 | 31.6 | 23.5 | 27.6 |
3–4 | 22.1 | 27.7 | 25.6 | 23.5 | 24.0 |
Over 4 | 18.8 | 18.4 | 16.4 | 29.6 | 18.6 |
WHO REFERRED TO OUTPATIENT CLINIC (%) | |||||
Personal initiative | 18.9 | 15.1 | 18.5 | 16.0 | 17.9 |
Relative/Friend | 0.6 | 0.3 | 0.6 | 0.0 | 0.5 |
GP/PD | 65.3 | 74.2 | 70.8 | 77.8 | 68.4 |
Hospital physician | 4.5 | 3.2 | 2.4 | 1.2 | 3.8 |
Private specialist | 2.1 | 2.2 | 1.1 | 1.2 | 2.0 |
Social services worker | 0.1 | 0.0 | 0.0 | 0.0 | 0.1 |
Clinic invitation letters | 8.5 | 5.0 | 6.6 | 3.7 | 7.3 |
SERVICES UTILIZED IN THE OUTPATIENT CLINIC (%)a
| |||||
Specialist visits | 20.9 | 23.5 | 21.5 | 23.9 | 21.7 |
Diagnostic tests | 68.5 | 69.2 | 67.7 | 62.5 | 68.4 |
Home care | 0.6 | 0.2 | 1.2 | 2.3 | 0.7 |
Administrative services | 6.4 | 6.1 | 7.3 | 6.8 | 6.5 |
Advisory | 0.9 | 0.0 | 0.2 | 0.0 | 0.6 |
Vaccinations | 2.6 | 1.0 | 2.1 | 4.5 | 2.2 |
TYPE OF STAFF CONSULTED IN THE OUTPATIENT C. (%)a
| |||||
Administrative staff | 30.3 | 28.8 | 33.9 | 37.8 | 30.7 |
Health care staff | 69.7 | 71.2 | 66.1 | 62.2 | 69.3 |
AHD CONSULTATION (%) | |||||
Yes | 11.5 | 14.2 | 15.1 | 100.0 | 14.8 |
METHOD OF AHD CONSULTATION (%) | |||||
Telephone consultation | 17.6 | 12.6 | 11.3 | 38.3 | 18.8 |
Home visit | 64.4 | 62.2 | 60.0 | 39.5 | 59.3 |
Ambulatory visit | 18.0 | 25.2 | 28.8 | 22.2 | 21.9 |
A&ED VISIT AFTER AHD CONSULTATION (%) | |||||
Yes | 17.6 | 20.7 | 23.8 | 45.7 | 23.7 |
REASON FOR A&ED VISIT AFTER AHD CONSULTATION (%) | |||||
AHD referral | 85.7 | 73.9 | 78.9 | 45.2 | 71.3 |
Unsatisfied with AHD consultation | 7.1 | 17.4 | 21.1 | 48.4 | 22.6 |
Further information on diagnosis/therapy proposed by AHD | 7.1 | 8.7 | 0.0 | 6.5 | 6.1 |
Discussion
Segment 1: The unpretentious patients
Segment 2: The informed and supported patients
Segment 3: The expert patients
Segment 4: The advanced patients
Conclusion: preliminary implications for a policy and research agenda
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First, this knowledge would aid in the design of more effective communication tools and relationship processes. Interactive web design provides an example. How should health organizations use the internet to respond to the expectations and capabilities of different segments? Access processes are another example. Should health organizations diversify channels of access to meet different patient profiles? For example, could some segments have direct access to secondary care, or should everything originate with the GPs?
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Second, strategies for empowering patients might differ. For example, some segments could have more control over their health budgets and could be targets for a policy of healthcare vouchers with more responsibility and the freedom to choose their own providers, thus making them more engaged in appraising their medical services.
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Third, segmentation could become a mechanism to address cultural issues and could provide a good excuse to engage clinicians and health staff to review their patient relationship practices. Do they recognize and pay attention to differences? Different segments might require different language, information, and individual approaches (paternalistic, autocratic, democratic, etc.). In contrast, the segments could be used to cause patients to consider their attitudes toward health issues and clinicians. For example, patients could be asked to identify the segment to which they believe they belong and to discuss the implications with their GP.
Limitations
Endnotes
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hurried practitioners who do not follow established guidelines;
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a lack of active follow-up to ensure the best outcomes;
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patients who are inadequately trained to manage their illnesses.
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64% of those sampled consider a GP or a specialist doctor the primary source;
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54% use the family network;
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47% use specialized web sites;
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32% use specific mailing lists;