1/ What were the motivations behind your study?

People aged over 75 account for nearly 10 % of the French population and their health expenditure amounts to over 20 % of the total expenditure in this field. As this population often suffers from multiple chronic conditions, medical care can be complex because of the great diversity of situations and the number of health professionals and medical-social workers involved. However, the knowledge about the quality of care for older patients, their expectations and satisfaction with their care remains very limited in France. The notion of care quality, well developed internationally, covers the appropriateness, safety, and accessibility of care as well as patients' experiences.
Patient experience does not simply reflect health outcomes or adherence to clinical recommendations but also includes more subjective dimensions - not easily measured. Our study thus aims to identify various dimensions of quality of care and satisfaction of the older adults. To this end, we carried out a qualitative survey based on exploring practical experiences in the health system. This approach helps to determine the main aspects which are important for patients and their families so as to identify how to improve their experiences.

2/ What are the key dimensions of satisfaction emerging from this qualitative research?

Firstly there is a great convergence between all respondents. Elements cited as important for quality of care and satisfaction are the same for seniors (living at home or in institutions) and for their informal carers. The relationship with health professionals involved is a crucial element of quality of care and satisfaction. The trust they grant to health professionals builds up through the respect they are given, the feeling that they are listened and the possibility for them to express themselves and get involved in decisions that affect them.
But the organization of care is also important for the quality of care. The lack of coordination between health professionals, the absence of support following hospitalization as well as waiting times in doctors' offices or hospitals, stand out as major sources of dissatisfaction.

3/ What would be the use of these results?

Our study is the first step necessary to collect and integrate the experiences and preferences of older patients and their informal carers about their medical care. The first results show some key elements of satisfaction from the patient's point of view (see above) and the emergence of new elements. For example, older people consider that their healthcare pathway could be improved if coordinated by their GP…
The next step would be to conduct a broader survey to quantify these elements in order to obtain representative results in in terms of experience and level of satisfaction of older people in different areas/regions and in different care settings. Asking seniors about their experience of health care services would give the possibility to monitor the level of perceived quality of care but also to identify the problem areas and find solutions.

Interview by Anne Evans

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