Page 206 - Psychology of Wounds and Wound Care in Clinical Practice ( PDFDrive )

Patient Satisfaction and Patient Centred Care 181

has led to interventions in which recovered patients are
recruited and trained to provide social support as lay health
advisors (e.g. Berkman et al. 2000 ; Freidman et al. 2006 ). An
alternative method of tapping into the expertise of patients is
to develop self-help groups (Heaney and Israel 2002 ). A good
example of this approach is provided by the Lindsay leg clubs
(Lindsay 2001 ) which is discussed in more detail in Chap. 8 .
In this model, community-based leg ulcer care is provided to
patients in a non-medical social setting such as a local village
hall. The emphasis is on social interaction, the sharing of
experiences and peer support. Evidence has shown a positive
impact on patient concordance; in a study of 93 leg club
attendees, Lindsay ( 2001 ) found a marked improvement in
concordance from 17 to 5 % over an 11 month period.
The mechanism by which social support promotes concor-
dance is likely to be very complex. Support from family and
friends can be both direct -changing patient behaviours, and
giving practical assistance – and indirect – encouraging opti-
mism, increasing self-esteem, acting as a buffer for the stress
of being ill, reducing patient depression (DiMatteo 2004 ).
However, the exact means by which social support contrib-
utes to concordance is not yet completely understood. The
impact of significant others on treatment concordance may
be purely behavioral, or it may be physiological, impacting on
mechanisms such as immune system and endocrine function-
ing (Druley and Townsend 1998 ). Alternatively social support
may work indirectly by increasing another factor known to
influence concordance – patient satisfaction with medical
care (Da Costa et al. 1999 ).

Patient Satisfaction and Patient Centred Care

Patient satisfaction is thought to be one of the major contrib-
uting factors to concordance. In particular, it is argued that
the extent to which health care providers are able to identify
the specific needs of their patients for information, support,
and reinforcement (Hill 1989 ) is directly related to the level
of satisfaction with health care (Vojnovic et al. 1997 ) and to