title: Patient perceptions and expectations of an anticoagulation service: a quantitative comparison study of clinic-based testers and patient self-testers.
abstract: BACKGROUND
  Government initiatives see the provision of technology-assisted self-care as one of the key areas in which there is capacity for improving quality of care whilst reducing costs. However, levels of patient engagement in self-testing and management (STM) remain low. Little emphasis has been placed on understanding the patients' perspectives of the reasons for this limited engagement. Typically, patient engagement in STM is achieved via the provision of patient education programmes, which aim to enable patients to make the changes necessary to become competent self-carers. However, placing the onus to change on the individual patient is unrealistic. If levels of patient engagement are to be improved, patient needs and expectations of clinical services must be better understood and service provision must be adapted accordingly.
  
  
  OBJECTIVE
  Explore patient perceptions and expectations of clinical service provision and their views of having and making choices about care.
  
  
  METHODS
  Participants [N = 191, 103 patient self-tester managers (PSTMs) and 87 clinic-based testers (CBTs)] completed the SERVQUAL and ChQ instruments to capture perspectives on service quality and choice, respectively. A comparative statistical analysis explored the similarities and differences between PSTMs' and CBTs' responses.
  
  
  RESULTS
  Clinic-based testers' perceptions of service quality were significantly more positive than PSTMs', as were their expectations of the 'tangible' aspects of service delivery. PSTMs' expectations of service quality were significantly higher than their perceptions. PSTMs attributed significantly more value to making choices compared with CBTs.
  
  
  CONCLUSIONS
  To close the gap between PSTMs expectations and perceptions of service quality and better cater for their choice preferences, service providers may benefit from taking into account the following practice considerations: maintain frequent, timely, personalised and direct interactions with PSTMs; prioritise investment in resources to facilitate patient/practitioner interaction over tangible facilities; ensure that PSTMs are given the opportunity to make choices about their care.
authors: Department of Computer Science, Brunel University London, Uxbridge, London, UK, UB8 3PH.
authors: Arthur G
authors: AG
authors: Money
authors: Department of Computer Science, Brunel University London, Uxbridge, London, UK, UB8 3PH.
authors: Julie
authors: J
authors: Barnett
authors: Department of Computer Science, Brunel University London, Uxbridge, London, UK, UB8 3PH.
authors: Jasna
authors: J
authors: Kuljis
authors: Haemostasis and Thrombosis Unit, Nottingham University Hospitals NHS Trust, Queen's Medical Centre Campus, Derby Road, Nottingham, NG7 2UH.
authors: Debbie
authors: D
authors: Duffin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001778:Blood Coagulation Disorders / Q000188:drug therapy*; D015510:Clinical Medicine / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011787:Quality of Health Care / Q000458:organization & administration*; D012648:Self Care / Q000523:psychology*; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D000925:Anticoagulants
keywords: having choice; making choice; patient expectations; patient perceptions; self-care; self-management; self-testing; service quality; technology-assisted health care