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Determinants of patient satisfactionafter cataract surgery in 3 settings

Marjan D. Nijkamp, MHSc, Rudy M.M.A. Nuijts, MD, PhD,Bart van den Borne, PhD, Carroll A.B. Webers, MD, PhD,Frans van der Horst, PhD, Fred Hendrikse, MD, PhD

ABSTRACT

Purpose: To analyze the determinants of satisfaction and postoperative visual function

after cataract surgery in 3 settings in The Netherlands.

Setting: University Hospital Maastricht (outpatient care), Atrium Medical Center Heerlen(inpatient care), and Medical Center Maastricht Annadal (outpatient care), Maastricht,

The Netherlands.

Methods:This cross-sectional study consisted of 150 patients of 50 years and older who

had first-eye phacoemulsification with intraocular lens implantation. Data were collected

by a written questionnaire. The following parameters were measured: medical outcome,

postoperative function, patient satisfaction with medical outcome and hospital care,

and overall patient satisfaction.

Results: In general, patients were very satisfied (mean score 8.43 on a 10-point scale

ranging from 1 very bad to 10 excellent). The 3 centers did not differ regarding the

patient satisfaction (P .092). However, postoperative visual function (P .012),

counseling (P .010), and waiting time (P .001) were different among the settings.

Patient satisfaction with hospital care had a stronger correlation with overall satisfaction

than patient satisfaction with the medical outcome (r 0.669 versus r 0.543,

respectively).

Conclusions: A causal model of patient satisfaction was tested, indicating that satisfac-

tion was related to the patients preoperative expectations and the quality of care given

during the hospital stay and follow-up at the outpatient clinic. This emphasizes the

relevance of patient education (to set realistic expectations) and counseling (need for

care) by hospital staff in a cataract surgery setting. J Cataract Refract Surg 2000; 26:

13791388 2000 ASCRS and ESCRS

It is generally agreed that modern cataract surgery iseffective in terms of postoperative increase in visionand safe with respect to the low incidence of surgical

complications.1 However, the measurement of visual

function after cataract surgery is a better outcome mea-

sure than visual acuity alone.2 Therefore, outcome stud-

ies in cataract surgery should focus on both functional

status and quality of life after surgery.3

Although after cataract surgery, most patients ben-

efit from an increase in visual acuity and visual function

and an improvement in quality of life, their satisfaction

may be limited because of a lack of perceived quality of

care. By combining the evaluation of functional and

technical quality-of-care aspects, clinician and patient

evaluations of quality of care can be related.4

Accepted for publication April 12, 2000.

Reprint requests to R.M.M.A. Nuijts, MD, PhD, Department of Oph-thalmology, University Hospital Maastricht, PO Box 5800, 6202 AZ

Maastricht, The Netherlands. E-mail: [email protected].

2000 ASCRS and ESCRS 0886-3350/00/$see front matterPublished by Elsevier Science Inc. PII S0886-3350(00)00501-0

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A general problem of satisfaction studies is the

high number of satisfied patients, which accounts for

low sensitivity of measurement methods.5 To im-

prove the sensitivity of the study, problem definitions

are based on a classification of satisfaction into 3 di-

mensions: satisfaction with cure (the medical outcome),satisfaction with care given during hospital stay and

follow-up in the outpatient clinic, and overall satis-

faction. A research model was formed to map the

expected relationships between the research variables

(Figure 1).

This study analyzed the determinants of satisfaction

and postoperative function in patients who had cataract

surgery. Three treatment settings were compared, pro-

viding data on cataract surgery on an inpatient and out-

patient basis.

Patients and Methods

The study population consisted of 3 subgroups

based on the institution at which cataract surgery was

performed. One group of patients was treated at a gen-

eral hospital (Atrium Medical Center Heerlen

[AMCH]) on an inpatient basis, 1 group was treated at a

private daycare center (Medical Center Maastricht An-

nadal [MCMA]), and 1 group was treated at an aca-

demic hospital on an outpatient basis (University

Hospital Maastricht [UHM]). Inclusion criteria were

first-eye cataract surgery to prevent bias from earlier ex-

periences and age older than 50 years. The required

sample size of 150 patients was calculated by power

analysis.To correct for an anticipated nonresponse, 235 pa-

tients were asked to participate in the study. The re-

sponse rate to the questionnaire was 64% (150 of 235

patients). Mean age was 77.4 years 7.48 (SD) (range

54 to 90 years), 74.6 9.74 years (range 51 to 94 years),

and 72.3 9.95 years (range 52 to 89 years) in the

UHM, MCMA and AMCH groups, respectively (P.022). The male/female ratio among the 3 settings was

comparable: 21/30, 27/31, and 16/25, respectively (P.731). There were no significant differences in education

level (P .727) or civil status (P .253) parameters(Table 1).

Surgical TechniqueCataract surgery was performed from January

through July 1997 by 1 of 4 surgeons using a standard

divide and conquer phacoemulsification technique. A

3.2 mm corneoscleral incision was made and a poly-

(methyl methacrylate) intraocular lens (IOL) (SN53,

Allergan) implanted.

Figure 1. (Nijkamp) Research model used tomap the expected relationship among research

variables.

PATIENT SATISFACTION AFTER CATARACT SURGERY

J CATARACT REFRACT SURGVOL 26, SEPTEMBER 20001380

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Outcome MeasuresThe determinants of patient satisfaction were eval-

uated by analyzing objective medical outcome measure-

ments and subjective patient evaluations. Medical

outcome parameters for patient satisfaction were post-

operative logMAR visual acuity and vision improve-

ment defined as at least2 lines on the Snellen scale.6 In

addition, the incidence of intraoperative complications,

vision in the contralateral eye, and ocular co-morbiditywere recorded. Ocular co-morbidity consisted of glau-

coma, corneal disease, age-related macular degeneration

(ARMD), diabetic retinopathy, retinal detachment, am-

blyopia, and uveitis.

A questionnaire was sent to patients 6 months after

surgery to measure subjective patient evaluations. To

evaluate postoperative function, the following variables

were studied: ability to perform specific vision-depen-

dent activities (Dutch version of the VF-14), with 1

question reflecting overall trouble with vision, 5 ques-

tions related to the patients opinion of quality of life,

and 3 questions on subjective general health. Patient

satisfaction was measured by 3 dimensions: satisfaction

with medical outcome; satisfaction with care; overall

satisfaction.

The VF-14, which has been described in detail,2was

adapted for use in The Netherlands. Considerable atten-

tion was given to conceptual and cultural equivalence

and to ensuring the instrument was translated accurately

(translation-back translation method) (Table 2). Ques-

tions 7, 9, and 10 were changed because they referred to

handwork (crocheting), a game (mahjong), and sports

(golf) less familiar to the Dutch population. Two

questions relating to cycling (during the day and

nighttime) and 1 question on the use of public

transportation, common activities for the older pop-

ulation in The Netherlands, were added. Otherwise,

the questions and scoring were performed as described

by Steinberg et al.2

The VF-14 scores ranged from 0(worst level of function) to 100 (best level of func-

tion/no disability).2,7

Validity and reliability of the Dutch version of

VF-14 were tested by an expert panel and in a pilot

study in a fashion similar to that reported by Alonso

et al.8 Cronbachs alpha was similar to that in the

original VF-14 ( 0.98), and factor analysis

supported the Dutch version of VF-14 to be a single

index of visual function. The criterion validity of the

VF-14 instrument was assessed by examining the corre-

lation between VF-14 scores and visual acuity and be-

tween VF-14 scores and patient satisfaction with their

vision. The correlation between the VF-14 and visual

acuity and between the VF-14 and patient satisfaction

with vision was 0.28 and 0.64, respectively. These values

are comparable to those in the study by Steinberg et al.2

In addition, patients were asked to rate their overall

amount of trouble with vision. Response options were

4 none; 3 a little; 2 a moderate amount; 1 a

great deal.7,9

Table 1. Sociodemographic characteristics of the study population.

Variable

Setting

P Value AMCH MCMA UHM

Mean age SD (years) 72.3 9.95* 74.6 9.74 77.4 7.48* .002

Sex .731

Male 16 27 21

Female 25 31 30

Education, frequency (%) .727

Primary school 20 (48.8) 26 (44.8) 19 (37.3)

College/university 0 2 (3.4) 4 (7.8)

Other 21 (51.2) 30 (51.8) 28 (54.9)

Civil status, frequency (%) .253

Live alone 21 (51.2) 28 (48.3) 20 (39.2)

AMCH Atrium Medical Center Heerlen; MCMA Medical Center Maastricht Annadal; UHM University Hospital Maastricht

*Post hoc test (Bonferroni) of which variables differ significantly


J CATARACT REFRACT SURGVOL 26, SEPTEMBER 2000 1381

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Patients opinions about their postoperative quality

of life and subjective general health were measured on a

3-point scale. They were asked whether their quality of

life (self-management, feelings of loneliness, life satisfac-

tion, activity, happiness) or general health (1 got

worse, 2 stayed the same, 3 got better) had changed

Table 2. Translation and back translation of the VF-14.

Original EnglishUnited States Adapted DutchThe Netherlands

A1 Reading small print such as labels on medicine bottles, a

telephone book, food labels

A1 Kleine lettertjes te lezen zoals in telefoonboeken, op

medicijnpotjes, enzovoort

B Reading small print such as telephone book, labels on

medicine bottles, et cetera

A2 Reading a newspaper or a book A2 Een krant of een boek te lezen

B2 Reading a newspaper or a book

A3 Reading a large print book or numbers on a telephone A3 Een grootletterboek te lezen of de nummers op de

toetsen/draaischijf van uw telefoon-toestel te

herkennen

B3 Reading a large print book or numbers of a telephone

A4 Recognizing people when they are close to you A4 Mensen te herkennen als ze dichtbij u in de buurt

staan

B4 Recognizing people when they are close to you

A5 Seeing steps, stairs, or curbs A5 Stoepen, trottoirbanden of afstapjes te zien

B5 Seeing sidewalks, curbs, or steps

A6 Reading traffic signs, street signs, store signs A6 Verkeersborden en wegwijzers te lezen

B6 Reading traffic signs and signposts

A7 Doing fine handwork like sewing, knitting, crocheting, carpentry A7 Fijn handwerk te verrichten zoals naaien, breien, of

timmerwerk

B7 Doing fine handwork like sewing, knitting, or carpentry

A8 Writing checks or filling out forms A8 Een giro uit te schrijven of een brief te schrijven

B8 Writing checks or letters

A9 Playing games such as bingo, dominos, card games, mahjong A9 Spelletjes te doen als bingo, domino, of kaartspelen

B9 Playing games such as bingo, dominos, or card

games

A10 Taking part in sports like bowling, handball, tennis, golf A10 Deel te nemen aan sportactiviteiten zoals bowlen,

tennis, of fietsen

B10 Taking part in sports like bowling, tennis, or cycling

A11 Cooking A11 Te koken

B11 Cooking

A12 Watching television A12 De ondertiteling op de TV te lezen

B12 Reading subtitles when watching television

A13 Driving during day A13 Autorijden overdag

B13 Driving during day

A14 Driving at night A14 Autorijden s avonds/s nachts

B14 Driving at night

B15 Cycling during day B16 Cycling at night A15 Fietsen overdag A16 Fietsens avonds/s nachts

B17 Use of public transport A17 Gebruik maken van openbaar vervoer

Note: Italic not in original VF-14

A original version; B back translation



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postoperatively. Face validity was tested by an expert

panel and a pilot study among patients.

Response options for satisfaction with medical out-

come were 1 very dissatisfied; 2 dissatisfied; 3

neither satisfied nor dissatisfied; 4 satisfied; 5 very

satisfied. In addition, patients were asked whether theirvision and visual function had changed as expected. Re-

sponse options were 3 better than expected; 2 as

expected; 1 less than expected.

To evaluate patient satisfaction with care, the

SERVQUAL service quality measurement scale10 was

used. This questionnaire was designed to be applicable

across a broad spectrum of services. It was empirically

evaluated for its potential usefulness in a hospital service

environment by Babakus and Mangold.11 Minor

changes were made to tailor the instrument to the spe-

cific characteristics of the department of ophthalmol-

ogy. Translation into Dutch was based on translations

by Kunst and coauthors.12 Content validity was tested

by an expert panel and a pilot study among patients as

described by Babakus and Mangold.11 The final scale

consisted of 13 quality-perception statements measured

on a 5-point scale, with endpoints labeled very good

(score 5) and very poor (score 1). Factor analysis revealed

3 dimensions: education, counseling, and waiting time.

Reliability analysis of these dimensions resulted in

Cronbachs alphas of 0.84, 0.88, and 0.59, respectively.Patients were also asked to rate their satisfaction with

care on a 5-point scale on which 1 very dissatisfied

and 5 very satisfied.

Overall satisfaction was scored on a categorical vi-

sual analog scale ranging from 1 (very bad) to 10 (excel-

lent). In addition, a have it again score, based on an

intention-to-return score developed by Babakus and

Mangold,11was formulated as follows: If I had to un-

dergo a second eye cataract surgery, I would want to

receive my treatment there again. This statement was

measured on a 5-point scale on which 5 strongly agree

and 1 strongly disagree.

Statistical AnalysisDescriptive and inferential data analyses were per-

formed using the SPSS 7.0. In preparation for data re-

duction, a correlational analysis was performed. A mean

relative score [sum score/(number of items missing

values)] was calculated in scale construction to solve the

problem of missing values. The research model was

tested by multiple linear regression. The level of signif-

icance for this study was P .05.Ordinal data based on multi-item factors were in-

terpreted as interval data in the statistical analysis as

described by Tabachnick and Fidell13 and Swanborn.14

Because various items are related to the same conceptand sum scores are calculated, reliability of this proce-

dure is high. The assumption of an underlying normally

distributed continuum was checked by item analyses in

which the following indicators were taken into account:

internal consistency (Cronbachs alpha), skewness, kur-

tosis, median and mean values, and distribution.

Results

Response Versus NonresponseResponse and nonresponse groups were compared

with respect to sex, setting, complications, ocular co-

morbidity, preoperative and postoperative vision, and

vision improvement. No significant difference was

found between respondents and nonrespondents (for

ordinal variables, 1-way analysis of variance; for nominal

parameters, chi-square test).

Objective Medical OutcomeVisual acuity improved in 88.8% of cases (Figure 2,

Figure 2. (Nijkamp) Improvement in visual acuity, logMAR (solid

bars preoperative; cross-hatched bars postoperative).



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Table 3). Preoperatively, 91.8% of the patients had a

visual acuity worse than 20/40 on the Snellen scale; post-

operatively, the median score was 20/25. There was no

significant difference among the 3 settings in preopera-

tive and postoperative visual acuities (P .580; P.710) or improvement in visual acuity (P .229). In 2cases, posterior capsule rupture without vitreous loss

occurred.

Medical outcome was correlated to pre-existing oc-

ular pathology (r 0.264) and preoperative visual acu-ity (r 0.282). The incidence of ocular co-morbidity isshown in Table 3. There was no significant difference

among settings in the incidence of ocular co-morbidity

(P .517); 27.3% of the study population sufferedfrom pre-existing ocular pathology.

Subjective Patient EvaluationsPostoperative function. Mean score for postoperative

visual function on the Dutch version of the VF-14 was

80.79 25.31, 92.17 14.53, and 86.73 16.94 for

AMCH, MCMA, and UHM, respectively (P .012,Table 4). The determinants of visual function were post-

operative visual acuity (r0.283) and general health(r 0.331). Regression analysis showed no significantrelation between logMAR visual acuity in the contralat-

eral eye (mean 0.36 0.43) and visual function (P.264).

The median score for overall trouble with vision was

3.00, 4.00, and 3.00 for AMCH, MCMA, and UHM,

respectively (P .023, KruskalWallis). Five patientsfrom the 3 settings stated they were bothered very much

by their postoperative vision in everyday life (score 1 on

the overall amount of trouble question). Four of these

patients had pre-existing ocular pathology (glaucoma,

ARMD, diabetic retinopathy, or retinal detachment). In

the other patient, the IOL power was incorrect; the

achieved minus the predicted refraction was 6.79

diopters.

Table 3. Medical outcome parameters.

Variable

Setting

P Value* AMCH MCMA UHM

LogMAR

Mean preoperative 0.65 0.39 0.64 0.49 0.74 0.60 .580

Mean postoperative 0.16 0.25 0.16 0.26 0.16 0.27 .710

Difference 0.49 0.43 0.49 0.48 0.63 0.52 .355

Snellen VA

In contralateral eye (median) 20/40 20/30 20/40 .418

Mean lines improvement 4.6 3.4 4.1 3.1 5.4 3.1 .229

Co-morbidity, frequency (%) .517

ARMD 3 (7.3) 3 (5.2) 3 (5.9)

Glaucoma 2 (4.9) 5 (8.6) 6 (11.8)

Diabetic retinopathy 3 (7.3) 1 (1.7) 2 (3.9)

Corneal disease 1 (2.4) 6 (10.3) 5 (9.8)

Uveitis 0 1 (1.7) 0

Retinal detachment 0 0 1 (2.0)

Amblyopia 0 0 1 (2.0)

Total 9 (21.9) 16 (27.5) 18 (35.3)

Intraoperative complications, frequency (%) .140

Capsule rupture with no vitreous loss 0 0 2 (3.9)

Note: All means SD; all visual acuities measured with best spectacle correction

AMCH Atrium Medical Center Heerlen; MCMA Medical Center Maastricht Annadal; UHM University Hospital Maastricht; VA visual

acuity; ARMD age-related macular degeneration

*Computed by 1-way analysis of variance for interval and ratio scales; chi-square for nominal variables



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Sixty-one percent of the patients stated their general

health did not change as a result of the cataract surgery.

However, 31.5% of patients reported that their general

health had improved after cataract surgery (mean

3.40 0.87). No significant difference was found

among the 3 settings (P .881).Mean quality-of-life scores were 2.22 0.45,

2.31 0.35, and 2.28 0.39 for AMCH, MCMA, and

UHM, respectively (P .524), with 62.7% of patientsreporting that their quality of life had improved after

surgery. In patients who stated their quality of life was

worse postoperatively, visual acuity did not improve af-

ter surgery.

Patients opinions about postoperative quality of life

were related to subjective general health (r 0.563) andvisual function (r 0.303). Civil status (living togetherversus alone) did not affect the predictive value of a

patients opinion of quality of life.

Satisfaction with medical outcome. Scores for meansatisfaction with medical outcome were 4.12 1.17,

4.51 0.79, and 4.16 0.98 for AMCH, MCMA, and

UHM, respectively (P .089). Eighty percent of re-spondents gave a score of 4 or 5 (satisfied or very satis-

fied) on the 5-point scale. Nine patients stated they were

dissatisfied or very dissatisfied (score 1 or 2) with the

results of surgery. These patients had pre-existing eye

disease. The determinants of this satisfaction score were

analyzed by a series of singular linear regression analyses.

As proposed in the research model (Figure 1), visual

function and patient reports of change in the quality of

life were mediators in the relationship between objective

medical outcome or general health and satisfaction with

medical outcome, respectively (Figure 3).

Perceived quality of care. Mean scores for quality ofcare were 4.45 0.51, 4.48 0.56, and 4.34 0.65

for AMCH, MCMA, and UHM, respectively (P .43);90.0% of patients reported the quality of care was satis-

factory (score 4 or 5). Patients evaluated the waitingtime for cataract surgery the least positive aspect of care

(Table 5). Significant differences were found in waiting-

time scores among the 3 centers: 2.61 0.83, 3.61

0.77, and 2.62 0.79 for AMCH, MCMA, and UHM,

respectively (P .001). Waiting time for cataract sur-

Figure 3. (Nijkamp) Mediators of satisfaction with medical out-

come. All correlations (r) are significant at the 0.01 level (2 tailed).

Table 4. Satisfaction with medical outcome.

Variable

Setting


Self-reported trouble with vision

Median 3.0 4.0 3.0 .023

Distribution (%)

None 31.7 55.2 45.1

A little 36.6 36.2 33.4

Moderate 26.8 5.2 17.6

A great deal 4.9 3.4 3.9

VF-14 (mean SD) 80.7 25.31* 92.17 14.53* 86.73 16.94 .012

Patient opinion of quality of life (mean SD) 2.22 0.45 2.31 0.35 2.28 0.39 .524

Subjective general health (mean SD) 3.54 0.64 3.71 0.71 3.65 0.72 .483





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gery did not predict patient satisfaction with care (P.992).

The mean scores for patient education were 3.54

1.01, 3.79 0.80, and 3.43 1.02 for AMCH,

MCMA, and UHM, respectively (P .120); 20.0% ofpatients rated the education they received as poor (score

1 or 2).

Mean scores for patient counseling were 4.25

0.54, 4.50 0.49, and 4.20 0.58 for AMCH,

MCMA, and UHM, respectively (P .010). Regres-sion analysis indicated that counseling by ophthalmolo-

gists accounted for a greater part of satisfaction with

quality of care (r 0.674) than did patient education(r 0.534).

Overall satisfaction. Mean overall satisfactionscores were 8.37 1.30, 8.66 1.24, and 8.18

1.31 for AMCH, MCMA, and UHM, respectively

(P .146); 91.0% of respondents wanted to betreated in the same center if they had to have second-

eye surgery. The median have it again scores were

4.00, 5.00, and 4.00 for AMCH, MCMA, and UHM,

respectively (P .083).The following parameters were predictors of overall

satisfaction: whether preoperative expectations of med-

ical outcome were met (r 0.407), satisfaction withquality of care (r 0.669), and evaluation of patientcounseling (r 0.674). Patient education and counsel-ing were more strongly correlated with overall satisfac-

tion than medical outcome (r 0.669 versus r 0.543).

Discussion

Studies have proved the usefulness of patient ques-

tionnaires for outcomes evaluation of cataract sur-

gery.2,1518 Several instruments have been developed to

assess subjective visual disability and self-rated quality of

vision in patients with ocular disease.

We chose the VF-14 questionnaire, developed by

the Cataract PORT group, because it has proven test

retest reliability, responsiveness, and international valid-

ity in cataract patients specifically.8,9,19 We modified

the VF-14 for the Dutch population and showed valid-

ity and reliability comparable to the internationally val-

idated VF-14 instruments by Alonso et al.8

Our study found that cataract surgery is an effective

treatment in terms of improvement in visual acuity,

postoperative visual function, and patient opinion of

quality of life. This multidimensional influence of cata-

ract surgery was manifested in a high rate of satisfaction(80.0%) with medical outcome. These findings are

comparable to those of previous studies.9,20,21

The high rate of success achieved by modern cata-

ract surgery1 has created a situation in which patient

expectations of postoperative visual function are very

high; in most cases, such expectations are fulfilled.22

One must be careful in interpreting these positive results

with regard to response rates, however. A nonresponse of

36% can compromise generalization of results. There

were, however, no significant differences among respon-

dents and nonrespondents on available data (sex, setting,

complications, co-morbidity, preoperative and postop-

erative visual acuities, and vision improvement).

Satisfaction studies of patients, the consumers of

care, should also focus on the quality of care given dur-

ing treatment. The Medical Outcomes Study23 advised

including the following variables in outcome studies:

clinical endpoints, functional status, general well-being,

and satisfaction with care. However, few studies have

focused on all 4 outcomes.21,24

Table 5. Perceived quality of care.

Variable

Setting (Mean SD)


Counseling 4.25 0.54 4.50 0.49* 4.20 0.58* .010

Education 3.54 1.01 3.79 0.80 3.43 1.02 .120

Wait 2.61 0.83 3.61 0.77* 2.62 0.79 .001

Satisfaction with care 4.45 0.51 4.48 0.56 4.34 0.65 .430





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Our study compared 3 settings regarding compa-

rable dimensions of outcome: clinical endpoints, vi-

sual function, patient opinion of postoperative quality

of life, subjective general health, and patient satisfaction

with medical outcome and care. Analysis of variance

showed significant differences among the groups in age,visual function, patient evaluation of counseling, and

the waiting time. Although the visual function score was

significantly better in the MCMA group than the

AMCH group, determinants of visual function, post-

operative visual acuity, and general health did not

differ among the settings. Although age differed signifi-

cantly among the 3 settings, regression analysis revealed

that the difference in visual function could not be ex-

plained by the difference in age. Further research is

needed to explain the difference in visual function

among settings.

The differences in evaluation of patient counseling

at MCMA and UHM can be explained by the difference

in the physicianpatient relationship at the 2 settings. At

UHM, an academic hospital, the patient is treated by

various doctors. At MCMA, patients are seen by only 1

or 2 ophthalmologists, which likely benefits the doctor

patient relationship.

Patient waiting time also varied significantly among

the 3 centers. Patients at MCMA had to wait 3 months

to be treated; however, the waiting time at the other 2settings was about 1 year. The patient evaluations reflect

this difference. However, no direct relationship was

found between evaluation of the waiting time and pa-

tient satisfaction with care. This might be explained by

the supporting role of patient education; when patients

are adequately informed about waiting time, they are

often willing to accept a longer time.

Multiple linear regression analysis showed that pa-

tient counseling had more predictive value than medical

outcome with regard to overall patient satisfaction. This

emphasizes the relevance of patient support and educa-

tion by hospital staff in a cataract surgery setting.

In conclusion, to improve overall patient satisfac-

tion after cataract surgery, more emphasis should be

placed on meeting patient expectations of postoperative

vision and visual function. In general, we believe that

current medical outcomes of routine cataract surgery

are excellent and, therefore, quality improvement

should focus more extensively on patient education and

counseling.

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From the Eye Research Institute Maastricht (Nijkamp, Hendrikse),Uni-versity Hospital Maastricht (Nuijts, Webers, Hendrikse), Atrium Med-ical Center Heerlen (Nuijts, Webers, Hendrikse), Maastricht University(Nuijts, Borne, Webers, van der Horst, Hendrikse), and Medical Center

Maastricht Annadal (Webers, Hendrikse), Maastricht, The Nether-lands.

Presented at the European Health Psychology Society Congress, Vienna,Austria, September 1998, and the European Society of Cataract & Re-fractive Surgeons Symposium on Patient Evaluations, Nantes, France,January 1999.

None of the authors has a financial or proprietary interest in any productor device mentioned.

Fred Nieman, PhD, provided statistical support.



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