Home Mechanical Ventilation: A Patient’s Perspective

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The seldom-described experiences of patients undergoing HMV show that this treatment causes distress and anxiety in the patients’ lives [29], as they have a constant feeling
of dependence. In the German study of Schaepe and Ewers, one of the respondents described the total necessity of trusting one’s nurse [30], which reflects this high feeling of
dependence. Similar feelings of patients concerning their caregivers were described in a
Scottish study by MacLaren et al. [31].
The reflections of a patient who is treated with HMV in the context of satisfaction
with the received services were investigated only vary rarely. In the study from Taiwan,
the satisfaction of HMV patients was assessed with the SERVQUAL method. The authors
of this study described very small gaps between the level of expectations and perceived
quality in every examined dimension [17]. It reflects a high satisfaction of patients with
the received medical services, which correlates with the results of our study. In the Taiwan
study, the gap in the tangibility dimension is smaller than in the present study. Here, this
Int. J. Environ. Res. Public Health 2021, 18, 4048 6 of 8
dimension reflects the material and living conditions of respondents. However, patients in
the Taiwan study were treated in health care institutions.
The functioning of the HMV system is rarely investigated and has not been examined
in Poland. The HMV services in Poland are delivered in the patient’s place of living [2].
There are many health care providers in the HMV system in Poland, which are all covered
by a public payer (National Health Fund) [2]. Ventilators, oxygen concentrators, and
respiratory care equipment are delivered by the health care providers at the cost of the
taxpayer. The nurse, physiotherapist, and physician care takes place in the patient’s home
and is provided by the health care provider. The physician is a specialist of anesthesiology,
pulmonology or neurology. The frequency of follow up depends on the type of ventilation
(NIV or IV). The IV patients are supervised more often than the NIV patients. The NMD
patients are followed up more often than the COPD patients (similarly to the IV patients
and NIV patients).
The calculated PSI for five and four dimensions are high (91.2% and 87.16% accordingly). However, there are significantly statistical differences in the expected and perceived
components of care. Moreover, in the present study, patients’ expectations concerning care
are close to the perceived quality of care in the majority of assessed components. It reflects
patient’s satisfaction with the care system. It reflects the high quality of health care in this
area of medicine.
The biggest gap between the expectations and the perceptions of quality was found
in the tangibility dimension, which may reflect the material and living conditions of
respondents. This is the area, which if better, could improve the perceived quality of
health care and the level of patient satisfaction. Supporting respondents with better living
facilities, which are helpful when it comes to caring for themselves or optimizing local
conditions, could decrease the gap in the tangibility dimension.
Special attention should be paid to the fact that the smallest gap is in the empathy
dimension. The perceived respect and understanding of a patient’s needs are close to the
expectations. It reflects the high competences of personnel in this dimension and the high
satisfaction of a patient with this dimension of care.
In the confidence dimension, the gap was relatively small, as well. The patients feel
safe in this system of care. The competence of personnel, availability of the nurse, and
courtesy of the personnel are very close to the patient’s expectations.

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