1
FROM,
Dr Deepa L S
Preliminary M.D.(Ayu),
Department of Post Graduate Studies in Samhita,
S.D.M College of Ayurveda and Hospital,
Hassan -573201.
TO,
The Registrar,
Rajiv Gandhi University of Health Sciences Bangalore,
Karnataka.
THROUGH:
The Principal
S.D.M College of Ayurveda and Hospital,
Hassan 73201.
SUBJECT: Submission of completed proforma for registration of subject for dissertation.
Respected Sir,
I request you to kindly register the mentioned subject against my name for the submission of the dissertation to the Rajiv Gandhi University of Health Sciences Karnataka, Bangalore for partial fulfillment of M.D (Ayurveda).
Title of the Dissertation:
“Patient Satisfaction Survey of Ayurveda Healthcare system based on Chikitsa Chatushpada”
Here with I am enclosing completed proforma of synopsis for registration of subject for dissertation.
Thanking you,
Yours faithfully
Date:
Place: Hassan (Deepa LS)
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA.
ANNEXURE- 2
COMPLETED PROFORMA FOR REGISTRATION OF SUBJECT OF DISSERTATION
NAME OF CANDIDATE DEEPA LS,
AND ADDRESS: PRELIMINARY M.D (AYU)
SCHOLAR, DEPARTMENT OF
POST GRADUATE STUDIES IN
SAMHITA,
S.D.M COLLEGE OF AYURVEDA,
HASSAN.
PERMANENT ADDRESS: SRISHAILA, KARIMANE (VILLAGE)
KALKERE (P),
KOPPA (T),
CHIKMAGALORE-577213,
KARNATAKA.
NAME OF THE INSTITUTION: S.D.M COLLEGE OF AYURVEDA
AND HOSPITAL HASSAN, KARNATAKA.
COURSE OF THE STUDY M.D AYURVEDA
AND SUBJECT: (SAMHITA)
DATE OF ADMISSION: .29-11-2010
TITLE OF TOPIC: “PATIENT SATISFACTION SURVEY OF AYURVEDA HEALTHCARE SYSTEM BASED ON CHIKITSA CHATUSHPADA”
-
Title of the Dissertation:
“Patient Satisfaction Survey of Ayurveda Healthcare system based on Chikitsa Chatushpada”
6. BRIEF RESUME OF THE STUDY
6.1 NEED FOR THE STUDY
Chikitsa is the outcome of efforts and proper employment of Chatushpada. Efforts have to be put forward to achieve Dhatusamyata from Dhatu Vaikrita Avastha.1 Efforts of Vaidya includes his judgment about his duties, Aushadha includes therapeutic action, when to be administered, Upasthata action includes preparation of medicaments and nursing. The efforts of the Rogi lies in following the instructions of the Vaidya and in giving correct the disease.2 16 qualities of Chikitsa Chatushpada are explained3,4 and while other authorities have explained qualities of Chatushpada discretely.5
Ultimate goal of Chikitsa Chatushpada is to deliver quality healthcare and patient satisfaction. Patient satisfaction is the extent to which the patients feel that their needs and expectations are being met by the service provided.6 There is evidence that satisfied patients were more likely to comply with treatment,7a,b,c keep follow up appointments6,8a,b,c and utilize health services.
There is strong need for health professionals to take patient satisfaction seriously as a measurement of quality healthcare extended to community, because of three reasons besides external pressures from governments, professional bodies, and health authorities. Firstly, there is convincing evidence that satisfaction is an important outcome measure.9 It may be a predictor of whether patients follow their recommended treatments, and is related to whether patients reattend for treatmentand change their provider of health care.10Secondly, patient satisfaction is an increasingly useful measure in assessing consultations and patterns of communication (such as the success of giving information, of involving the patient in decisions about care, and of reassurance).11 Thirdly, patient feedback can be used systematically to choose between alternative methods of organizingor providing health care (such as length of consultation or arrangements for out of hours care).12
There are various problems faced by the patients in the out-patient department (OPD) like overcrowding, delay in consultation, lack of proper guidance that leads to patient dissatisfaction.13a,b This study became necessary because of the need to incorporate feedback from periodic patient satisfaction surveys into service improvement plans. The objectives of the study is to assess the satisfaction of patients and quality of healthcare received from Chikitsa Chatushapada.
Current literature search didn’t yield any reference regarding survey studies on patient satisfaction and quality of care extended by Ayurveda healthcare providers. Hence this study is planned to survey the patient satisfaction who are receiving the care from outpatient and in-patient departments of hospitals attached to Ayurveda College spread across Karnataka state.
6.2 REVIEW OF LITERATURE:
Physician, medicine, attendant and patient are four components of therapeutics, when possess requisite and specific qualities can successfully re-establish the homeostasis of Dosha and Dhatus in the event of their equilibrium being disturbed in disease condition.1 In other words, four components are responsible for cure of the diseases.2
Ayurvedic textbooks give clear picture of different types with qualities of physician such as Murkha, Pranabhisara, Raja and Uttama Vaidya.14
Physician is supposed to possess excellent medical knowledge, equipped with extensive practical experience, dexterity and purity of mind and body. Suitable medicines with requisite potency must be abundantly available in multiple forms. It is necessary that medical attendant or nurse must possess adequate knowledge of nursing, expert in delivering nursing care and who is affectionate towards patient and who possess purity of mind and body. At last, the patient must possess good memory and be obedient towards physician, fearless and who express about what he feels.3
In Sushruta Samhita, Chikitsa Pada (components of treatment) have been explained with relevant examples. The textbook has highlighted the importance of physician over other components of Chikitsa pada.15 When the three limbs endowed with good qualities are available with fourth limb the physician possessing good qualities will be able to cure difficult diseases.
Detailed literary research with regards to patient satisfaction about Chikitsa Chatushpada did not yielded any works in Researches in Ayurveda.16
Hence this survey study has been planned to assess the patient satisfaction on Ayurvedic healthcare system based upon Chikitsa Chatushpada.
6.3. OBJECTIVES OF THE STUDY :
1Comparative literary study of contents related to patient satisfaction based on Chikitsa Chatuspada in Brithatrayess.
2.Survey study on patient satisfaction survey based upon qualities of Chikitsa Chatushpada of Ayurvedic healthcare system.
7. MATERIAL AND METHODS
Current study will be carried out in two steps namely 1. Literary study 2. Survey Study.
- Literary study :
Brithatrayees will be thoroughly scanned with regards to contents of patient satisfaction based on performance of Chikitsa Chatushapada and relevant material will be compiled. Compiled material will be reorganized and critically analyzed.
2. Survey study :
Study will be mailed survey study and questionnaire will be prepared by pooling information on patient-satisfaction with reference to Vaidya, Aushadha, Paricharaka of Ayurveda Healthcare system (outpatient and in-patients departments). The same will be distributed to patients treated in outpatient and inpatient departments of hospitals of Ayurveda Colleges of Karnataka state, India. The response will be summarised and outcome will be assessed with the regards to patient satisfaction on Ayurveda healthcare system.
Survey Study Design :
Survey study will be conducted in two phases :
a.Validation of Survey Questionnaire for reliability and consistency
b.Collection of Data from Patients using Survey Questionnaire
Methodology of Survey Study :
Study Design
Survey Method : Mailed survey study
Sampling frame:The sampling frame consists of the patients treated in outpatient and in-patient departments of hospital (i.e. dependent) attached with Ayurveda colleges spread across Karnataka state.
Sample size: The sample size is calculated using the formula,n=Z2(1-α/2)pq/d2 (whereZ(1-α/2)= 1.96 at 95% confidence;p= prevalence of patient satisfaction,q= 1-p;d= absolute allowable error. For this study, we presumed maximum variability, hencep= 0.8;q= 0.2;d=10%. Sample size thus yielded is of 500 Adding 10% for incomplete answers, the total number will be 550. Informed written consent will be sought and obtained from each participant or parent/guardian in case of paediatric patients.
Sampling technique:
Stratified cluster sampling technique will be used to select representative patients. Ayurvedic Hospitals attached with all Ayurvedia collleges in Karnataka state will be taken up for the study.
Inclusion Criteria :
Outpatients : who are under consultation in the hospital for alteast three visits.
Inpatients:
Patients admitted in inpatient department of Hospitals attached with Ayurveda Collleges in Karantaka state will be taken up for the study. To build up the sampling frame of patients, the number of inpatients whose length of stay in the hospital is 7 days or longer will be counted. If this yields more than 20 patients, then this will be used as sampling frame. If the yield is less than 20 patients, with stay of 5 days will be included recounted and checked if the resultant number reached 20. If it is not yet 20, then patients with stay of three days or longer will be included, even if the total list did not exceed 20. If the total list was less than 20, no further sampling was needed, and everyone in the inpatient department will be taken up for the survey. If the total number of persons in the resultant sampling frame (persons with stays of more than 7,5 or 3 days as the case may be) exceeded 20, then only 20 persons were chosen randomly. The list was stratified by major wards and random samples were drawn from each ward, proportionate to its bed strength.
Exclusion criteria:
A "new" or "referred" patient attending the OPD of the respective health care facility.
Patients working in the health care facility will be excluded from the study.
Patients that were too ill to participate in an interview will be excluded from the study.
Preparation of the Questionnaire
A preliminary list of items with regards to patient satisfaction will be prepared on the basis of each four Gunas of Vaidya, Dravya and Upasthata from Brihattrayee and same will be converted into questions and two versions of questionnaires will be prepared i.e. in English and Kannada language. The questionnaire will comprise of four sections dealing with Vaidyapada, Aushadhapada and Upasthatapada, Rogipada. The respondents will be given the option of recording their responses in the form of 'Strongly Agree', 'Agree', 'Undecided', 'Disagree' and 'Strongly Disagree' by recording a check mark in the respective column provided for the purpose. Respondents will be allowed to explain their answer as to e.g. why they strongly agree, by inserting a free text box at the end of the questionnaire or after particular item or section. Respondents will be instructed along with examples on how to complete free text items in the same way as they do for questions. Apart from these statements, the respondents were also asked to furnish some demographic details such as their age, gender.
Validation of the Questionnaire for its Reliability and Consistency
The preliminary questionnaire will be distributed to respondents who randomly fulfilled the inclusion criteria in a single institution i.e. SDM College of Ayurveda, Hassan. The validation process of the questionnaire will be carried out on the basis of the first 100 completed questionnaires. The data entry will be done using the software 'Statistical Package for Social Sciences', Version 16 (SPSS Inc. Chicago, IL, USA). Demographic data will be fed in the 'String' format and the responses to the questionnaire will be entered in the 'Numerical' format. For the purpose of conversion of responses into the numerical format, the following scoring system will be used: Strongly Agree = 5; Agree = 4; Undecided = 3; Disagree = 2 and Strongly Disagree = 1.
For the purpose of validation, each section of the questionnaire will be considered as an independent scale and these scales will be tested for their reliability using 'Cronbach's Coefficient Alpha’.17 While validating the scales, value of alpha greater than 0.7 and item-total correlation greater than 0.2 will be considered to be acceptable.18Wherever the value of 'Alpha (when item deleted)' will be greater than Cronbach's coefficient alpha, the corresponding item will be deleted and the whole process of validation will be repeated and thereafter, the scales will be finalized. The final questionnaire will contain four sections (technically, four independent scales) comprising of a total of 16 items. Apart from these items, the questionnaire will also contain a copy of confidentiality agreement stating the purpose of the study and assuring strict confidentiality of the respondents.
Collection of Data
After validation and testing the questionnaire in (Kannada and English version) for its reliability, the questionnaire will be printed on the A4-sized paper and will be adminstered to OPD & IPD patients treated in hospitals attached with all Ayurveda Colleges in Karnataka.
The completed questionnaires will then be collected and the data entry will be carried out as explained earlier.
Tabulation and Statistical Tests
The participants will be grouped under two categories: OPD and IPD. Tables of frequency and percentage will be framed on the basis of responses to individual items for each group. Independent samples - t test will be applied to compare the mean scores of the two categories.
7.4HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION? : YES
8. LIST OF REFERENCES:
1. Agnivesha : Charaka, Charaka Samhita with Ayurveda Deepika commentary by Chakrapani Datta, Fourth edition, 1994, Chaukhamba Samskrita samsthana Varanasi; Sutrasthana: 9:5
2. Agnivesha : Charaka, Charaka Samhita with Ayurveda Deepika commentary by Chakrapani Datta, Fourth edition, 1994, Chaukhamba Samskrita samsthana Varanasi; Sutrasthana: 9:3
3. Agnivesha : Charaka, Charaka Samhita with Ayurveda Deepika commentary by Chakrapani Datta, Fourth edition, 1994, Chaukhamba Samskrita samsthana Varanasi; Sutrasthana: 9:6-9
4.Vagbhata: Ashtanga Hridaya with Vidyotini bhasha teeka by Atrideva Gupta and Yadunandan Upadhyaya, thirteenth edition 2000, published by Chaukambha samskrit samsthan, Varanasi; Sutrasthana 1: 28-29
5. Sushruta: Sushruta Samhita, with Nibhanadha Samgraha and Nyaya Chandrika Teeka, Eighth edition, 2005, Chaukhambha Orientalia, Varanasi, Sutra Sthana 34: 19-24
6.Ware JE, Snyder MR, Wright R :Defining and measuring patient satisfaction with medical care. Eval. Prog. Planning, 1983; 6: 247-263
7a.Reeder LG : The patient-client as a consumer: Some observations on the changing professional-client relationship. J. Health Soc. Behav.,1972; 13(4): 406-412.
7b.Wilson P, McNamara JR : How perceptions of a simulated physician-patient interaction influence intended satisfaction and compliance. Soc. Sci. Med., 1982; 16(19): 1699-1704.
7c.Linn MW, Linn BS, Stein SR : Satisfaction with ambulatory care and compliance in older patients. Med. Care, 1982;20(6): 606-614.
8a.Hertz P, Stamps PL : Appointment keeping behaviour re-evaluated. Am. J. Public Health, 1977; 67: 1033-1036.
8b.Reeder LG : The patient-client as a consumer: Some observations on the changing professional-client relationship. J. Health Soc. Behav.,1972; 13(4): 406-412.
8c.Hulka BS, Zyzanski SJ, Cassel JC, Thompson JS :Scale for measurement of attitude towards physicians and primary medical care. Med. Care, 1970; 8(5): 429-436.
9.Kincey J, Bradshaw P, Ley P : Patients' satisfaction and reported acceptance of advice in general practice. ] R Coll Gen Pract 1975;25:558-66.
10.W'eiss B, Senf J : Patient satisfaction survey instrument for use in health maintenance organisations. Med Care 1990;28:434-45.
11.Savage R, Armstrong : Effect of a generalpractitioner's consulting style on patients' satisfaction: a controlled study. BM] 1990;301:968-70.
12.Bollam M, McCarth 1M, Modell M. Patients' assessments of out of hours care in general practice. BA 1988;296:829-32.
13a.Srinivasan AV : Managing a modern hospital. Response Books - a division of sage Publishers India (P) Ltd., New Delhi, 2000: 53-69.
13b.Llewelyn R : Davies, HMC Macaulay. Hospital planning and administration. WHO, Geneva, 1996: 105-111.
14. Agnivesha : Charaka, Charaka Samhita with Ayurveda Deepika commentary by Chakrapani Datta, Fourth edition, 1994, Chaukhamba Samskrita samsthana Varanasi; Sutrasthana: 9 : 17-19
15. Sushruta: Sushruta Samhita, with Nibhanadha Samgraha and Nyaya Chandrika Teeka, Eighth edition, 2005, Chaukhambha Orientalia, Varanasi, Sutra Sthana 34: 15-24
16.Baghel MS : Researches in Ayurveda, 2nd Edition, 2005, Mridu Publications, Jamnagar.
17.Bland JM, Altman DG : Statistics notes: Cronbach's alpha. BMJ. 1997;314:572. [PMCID: PMC2126061] [PubMed: 9055718]
18.Streiner D, Norman G : Health measurement scales: a practical guide to their development and use. Oxford: Oxford University Press; 1995. 2nd ed.
9. SIGNATURE OF CANDIDATE:
10. REMARKS OF THE GUIDE:
11. NAMES AND DESIGNATION OF:
11.1 GUIDE : Dr. Mallika KJ, M.D (Ayu),
Reader and HOD,
Department of P.G Studies in Samhita
S.D.M.C.A. & H, Hassan, Karnataka.
11.2 SIGNATURE :
11.3 COGUIDE: Dr Rajeshwari N M, M.D.(Ayu.)
Lecturer, Department of P.G Studies in Samhita
S.D.M.C.A. & H, Hassan, Karnataka.
11.4 SIGNATURE:
11.5 H.O.D : Dr. Mallika KJM.D (Ayu),
Reader and HOD,
Department of P.G Studies in Samhita
S.D.M.C.A. & H, Hassan, Karnataka.
11.6 SIGNATURE :
12. REMARKS OF THE
CHAIRMAN AND PRINCIPAL:
12.1 SIGNATURE :