title: Effect of organizational features on patient satisfaction with care in Italian multiple sclerosis centres.
abstract: Receiving clear, complete and up-to-date information and having a satisfying relationship with the health professional (HP) are of primary importance for MS patients. Healthcare organization plays a key role in promoting an effective relationship and communication between patients and HPs. The present study aims to explore which care organization and service characteristics provided by Italian MS centres best predict patients' satisfaction with healthcare.
  
  
  
  Eighty-one centres and 707 patients (502 women, mean age 40.5 years, SD 10.2; mean education 12.2 years, SD 3.6; time since diagnosis 5.9 years, SD 1.5) were included in the analysis. The care organization and service provided by each centre were evaluated in comparison with the National Institute for Health and Care Excellence (NICE) guidelines on management of MS. Patients' satisfaction with care was measured using the patient self-assessed questionnaire 'Comunicazione medico-paziente nella Sclerosi Multipla, revised' section 2 (COSM-R section 2).
  
  
  
  The clinical characteristics of patients significantly affected their satisfaction. A multivariate regression model showed that higher patients' satisfaction (COSM-R score) was inversely associated with hospital size (number of patients under care) (β = -0.21, 95% confidence interval -0.35; -0.07) and directly associated with psychological interventions (β = 2.44, 95% confidence interval 0.29; 4.59).
  
  
  
  Multiple sclerosis patients from larger hospitals are less satisfied with the information received and the relationship with HPs. Building an individualized relationship between patients and HPs and tailoring the communication of information improve patients' satisfaction. Such a goal is probably less likely to be accomplished in larger centres with many incoming patients. Moreover, when the centres also provide structured psychological interventions, the patients are more satisfied.
authors.affiliation: Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy.
authors.forename: K
authors.initials: K
authors.lastname: Mattarozzi
authors.affiliation: Epidemiology and Biostatistics Service, IRCCS, Institute of Neurological Sciences of Bologna, Bellaria Hospital, Bologna, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Baldin
authors.affiliation: Epidemiology and Biostatistics Service, IRCCS, Institute of Neurological Sciences of Bologna, Bellaria Hospital, Bologna, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Zenesini
authors.affiliation: Neuroepidemiology Unit, Foundation IRCCS Neurological Institute C. Besta, Milan, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Solari
authors.affiliation: Department of Neurofarba, Section of Neurosciences, University of Florence, Florence, Italy.
authors.forename: M P
authors.initials: MP
authors.lastname: Amato
authors.affiliation: SC Neurologia, Department of Medical Sciences, IRCCS 'Casa Sollievo della Sofferenza', San Giovanni Rotondo, Italy.
authors.forename: M
authors.identifier: 0000-0002-6339-5738
authors.initials: M
authors.lastname: Leone
authors.affiliation: Department of Neurological Sciences and Vision, University of Genoa, Genoa, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Mancardi
authors.affiliation: Department of Neurology, MS Centre, San Raffaele Scientific Institute, Vit-Salute San Raffaele University, Milan, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Martinelli
authors.affiliation: Experimental Biomedicine and Clinical Neurosciences, University of Palermo, Palermo, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Savettieri
authors.affiliation: Neurology Unit, ASL 3 Genovese, Genoa, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Solaro
authors.affiliation: Neurology Unit, University of Ferrara, Ferrara, Italy.
authors.forename: M R
authors.initials: MR
authors.lastname: Tola
authors.affiliation: Epidemiology and Biostatistics Service, IRCCS, Institute of Neurological Sciences of Bologna, Bellaria Hospital, Bologna, Italy.
authors.forename: R
authors.initials: R
authors.lastname: D'Alessandro
mesh_terms: D000328:Adult; D003695:Delivery of Health Care / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000628:therapy*; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011795:Surveys and Questionnaires
keywords: care organization; health professional-patient relationship; multiple sclerosis; patients’ satisfaction; psychological support