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Home visits by doctors and nurses are considered an important indicator of the quality of healthcare. Published data are scarce regarding the role of family nurses in providing professional home care in Central and Eastern European countries that have recently introduced reforms to their primary care systems. The objective of the present study was to describe the involvement of family nurses in home visits in the context of organizational and legal changes in service provision, that is, to analyse the role of the family nurses employed by family doctors (1998) versus family nurses working in autonomous positions (2002 and 2006). The proportion of patients in the community receiving a home visit from a family nurse, the purpose of the family nurse's home visit and patient expectations towards the family nurse were studied. A series of cross-sectional studies were conducted in a small town in northeastern Poland, based on three consecutive surveys taken at 4-year intervals (1998, 2002, 2006, surveys I, II and III, respectively). During each survey, 1000 patients were interviewed (face to face) with structured questionnaires. In 1998, family nurses were employed by family doctors, but by 2002, nurses had established their own practices and held direct contracts with the National Health Fund. A significant increase in the percentage of patients receiving home visits from a family nurse was observed between surveys I and II (12.8% and 30.0%); however, the number of respondents reporting a home visit in survey III decreased to 23.9%. Patients over 75 years of age were the major demographic group receiving family nursing at home. This study suggests that reform of the primary healthcare system in Poland has produced changes in the family nursing system. Independence, contractual obligations and self-employment of Polish family nurses have resulted in their greater participation in home visits. [ABSTRACT FROM AUTHOR]

Understanding patient dissatisfaction is essential as it provides information on how to improve the relationship between healthcare users and medical professionals. The aim of this paper is to determine how Polish patients verbally express negative opinions of their healthcare services, and to compare the patterns of opinion-giving behaviour between patients in Poland and Western Europe. A qualitative approach employing in-depth interviews was used. Nine primary healthcare centres were chosen in various regions of Poland, taking into account both type of practice, i.e. small and large, and location of residence, i.e. urban (small and large towns) and rural. In every centre, interviews were performed with four patients coming consecutively to their family physician. Thirty-six patients aged 20–78 years were interviewed. Their views could be categorised into eight reasons for avoiding expressing negative opinions: unpleasant emotions induced by giving a negative evaluation; avoiding offending healthcare providers; fear that their utterances could have a negative effect on their further medical care; fear of giving a hasty evaluation based on their own inexpert medical knowledge; determinants from recent Polish history; prestige of the medical profession; entrusting the most important aspect of life, i.e. health, to a doctor; and lack of faith that their opinions could cause change for the better. The respondents used certain rhetorical tricks to soften their criticisms. Patients face cultural barriers to expressing dissatisfaction about their health care. In the Polish context, these are the high social status of the physician and the low position of the patient. In their spontaneous utterances, the respondents gave detailed suggestions for raising the level of patient satisfaction with health care. [ABSTRACT FROM AUTHOR]

Objective: To compare replies to open-ended and closed questions about patient satisfaction with family doctors. Methods: Two centres of primary health care in Białystok in northeast Poland were chosen. A self-administered questionnaire was mailed to 1000 people (500 from each centre) aged 18 years and over, randomly selected from the practices. Possible responses to the one closed question were: very good, good, bad, very bad or difficult to say. Replies to two open-ended questions were categorized as positive, neutral, negative or ambivalent. Results: The response rate was 57.9%. There were some discrepancies between the closed-question response and the open-ended question replies. Some of those who replied good or very good to the closed question expressed negative views in response to the two open-ended questions (14.0% and 12.4%). Conclusions: Answers to open-ended questions add value to a patient satisfaction survey by providing information that answers to closed questions may not elicite. [ABSTRACT FROM AUTHOR]