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Lerch SP, Hänggi R, Bussmann Y, Lörwald A. A model of contributors to a trusting patient-physician relationship: a critical review using a systematic search strategy. BMC PRIMARY CARE 2024; 25:194. [PMID: 38824511 PMCID: PMC11143600 DOI: 10.1186/s12875-024-02435-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 05/17/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND The lack of trust between patients and physicians has a variety of negative consequences. There are several theories concerning how interpersonal trust is built, and different studies have investigated trust between patients and physicians that have identified single factors as contributors to trust. However, all possible contributors to a trusting patient-physician relationship remain unclear. This review synthesizes current knowledge regarding patient-physician trust and integrates contributors to trust into a model. METHODS A systematic search was conducted using the databases MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid), and Eric (Ovid). We ran simultaneous searches for a combination of the phrases: patient-physician relationship (or synonyms) and trust or psychological safety. Six-hundred and twenty-five abstracts were identified and screened using pre-defined criteria and later underwent full-text article screening. We identified contributors to trust in the eligible articles and critically assessed whether they were modifiable. RESULTS Forty-five articles were included in the review. Patient-centered factors that contributed modifiable promoters of trust included psychological factors, levels of health education and literacy, and the social environment. Physician-centered factors that added to a trusting patient-physician relationship included competence, communication, interest in the patient, caring, the provisioning of health education, and professionalism. The patient-physician alliance, time spent together, and shared decision-making also contributed to trusting relationships between patients and physicians. External contributors included institutional factors, how payments are made, and additional healthcare services. DISCUSSION Our model summarized modifiable contributors to a trusting patient-physician relationship. We found that providing sufficient time during patient-physician encounters, ensuring continuity of care, and fostering health education are promising starting points for improving trust between patients and physicians. Future research should evaluate the effectiveness of interventions that address multiple modifiable contributors to a trusting patient-physician relationship.
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Affiliation(s)
- Seraina Petra Lerch
- Faculty of Behavioural and Cultural Studies, Ruprecht Karls-University, Heidelberg, Germany.
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
- Institute of Medical Psychology, Heidelberg University Hospital, Bergheimer Str. 20, DE-69115, Heidelberg, Germany.
| | - Rahel Hänggi
- Institute for Medical Education, Department for Assessment and Evaluation, University of Bern, Bern, Switzerland
| | - Yara Bussmann
- Institute for Medical Education, Department for Assessment and Evaluation, University of Bern, Bern, Switzerland
| | - Andrea Lörwald
- Institute for Medical Education, Department for Assessment and Evaluation, University of Bern, Bern, Switzerland
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Zimney KJ, Puentedura E, Kolber MJ, Louw A. The relationship between trust and outcomes during physical therapy care for chronic low back pain. Physiother Theory Pract 2024; 40:1164-1171. [PMID: 36282774 DOI: 10.1080/09593985.2022.2138731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 09/14/2022] [Accepted: 10/07/2022] [Indexed: 10/31/2022]
Abstract
INTRODUCTION Enhancing the therapeutic alliance has been associated with improved outcomes for patients with chronic low back pain (CLBP). Qualitatively trust has been described to be part of the therapeutic alliance, but it has not been measured quantitatively within the physical therapy literature. OBJECTIVE Examine the relationship between trust and outcomes during physical therapy for CLBP. METHODS Observational study of patients with CLBP being seen for physical therapy were assessed through self-report measures. The Primary Care Assessment Survey (PCAS) trust measurement scale was completed by patients at initial, post-initial, and discharge visit. These measurements were compared for correlations with patient reported outcome measures for pain and function recorded at initial visit and discharge. RESULTS A convenience sample of 29 patients (49.3 ± 15 years old) with CLBP were measured. The PCAS showed correlations for changes in trust throughout treatment for improvements in pain and discharge pain rating. Average discharge pain rating correlated to changes in the PCAS (rs = -0.692, p < .001), with lower pain ratings relating to higher changes in trust over time. Average change in pain (rs = 0.745, p < .001) throughout treatment also correlated with higher changes in trust. Higher trust scores at discharge also correlated with improved Global Rating of Change and Oswestry Disability Index scores at discharge. The linear regression model showed adjusted R2 values for the trust scores and outcomes varied between 0.247 and 0.642. CONCLUSION Both increases in trust throughout the treatment and end trust scores during physical therapy were related to improved outcomes for patients with CLBP.
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Affiliation(s)
- Kory J Zimney
- School of Health Sciences, Department of Physical Therapy, University of South Dakota, Vermillion, SD, USA
| | | | - Morey J Kolber
- Department of Physical Therapy, Nova Southeastern University, Fort Lauderdale, FL, USA
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Rowland S, Ahmed R, Roman MJS, Ramos AK. Workplace health culture and trust in the occupational health office: A descriptive study of meatpacking workers. Am J Ind Med 2024. [PMID: 38770904 DOI: 10.1002/ajim.23617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/20/2024] [Accepted: 05/07/2024] [Indexed: 05/22/2024]
Abstract
INTRODUCTION Worker trust in employer-provided occupational health services has not been explored in essential industries, such as meatpacking. The purpose of this study was to describe workplace health culture and trust in the occupational health office and highlight meatpacking workers' experiences with the occupational health office. METHODS Meatpacking workers were surveyed between February 2021 and October 2022. Descriptive statistics and nonparametric tests were used to explore trust across demographic variables, including workplace health culture. Thematic analysis was used to examine the short-answer qualitative data. RESULTS Among workers who completed surveys (n = 731), health culture was rated low (M = 1.3 (0.73); possible range 0-3). Trust in the occupational health office was also rated low (M = 8.2 (5.06); possible range 0-20). Workers' descriptions of interactions with the occupational health office were mostly unfavorable (287 negative opinion units; 97 positive opinion units) and primarily focused on quality of care, communication, the supervisor as gatekeeper to health services, and the prioritization of company interests. CONCLUSION Meatpacking worker health may be improved by building worker trust in the occupational health office. Suggested strategies include enhanced communication, protection of confidentiality, prioritization of worker well-being, and promotion of a stronger health culture in plants and throughout the industry. Supporting workers without a regular healthcare provider to establish a relationship with a primary care provider of their choice is also recommended.
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Affiliation(s)
- Sheri Rowland
- College of Nursing, University of Nebraska Medical Center, Lincoln, Nebraska, USA
| | - Rishad Ahmed
- Department of Health Promotion, College of Public Health - Center for Reducing Health Disparities, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Maria Jose Sanchez Roman
- Department of Health Promotion, College of Public Health - Center for Reducing Health Disparities, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Athena K Ramos
- Department of Health Promotion, College of Public Health - Center for Reducing Health Disparities, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Li L, Zhu L, Zhou X, Zeng G, Huang H, Gan Y, Lu Z, Wang X, Chen Z, Sun K, Yang D, Zhang Q, Wu C. Patients’ trust and associated factors among primary care institutions in China: a cross-sectional study. BMC PRIMARY CARE 2022; 23:109. [PMID: 35524197 PMCID: PMC9075926 DOI: 10.1186/s12875-022-01709-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 04/14/2022] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Empirical evidence on patients’ trust and the factors among primary care institutions (PCIs) in China is limited. This study aimed to investigate patients’ trust and explore some associated factors among PCIs in the central region of China.
Methods
The data was collected through a multistage stratified sampling method with a structured self-administered questionnaire, which was distributed from January to March 2021 among 2,287 Chinese patients ever involved in seeking healthcare among PCIs. Patients’ trust was measured with the Chinese version of the Wake Forest Physician Trust Scale (C-WFPTS). Differences in C-WFPTS scores among groups were estimated by t-tests or ANOVA analyses. Multiple linear regression analysis was used to analyze influencing factors for patients’ trust in primary care physicians.
Results
Based on the C-WFPTS with a full score of 50, the average score of patients’ trust was 34.19 (SD = 5.83). Multiple linear analyses indicated that the patients who were older aged, married, with education of higher level, living in urban regions, under better health status and with a family doctor contract reported a higher level of patients’ trust.
Conclusion
Patients’ trust in primary care physicians was at a medium but slightly improved level in the central region of China. Age, marital status, education, residential area, health status, and a family doctor contract were significant predictors of patients’ trust.
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Moore A, Chavez C, Fisher MP. Factors Enhancing Trust in Electronic Communication Among Patients from an Internal Medicine Clinic: Qualitative Results of the RECEPT Study. J Gen Intern Med 2022; 37:3121-3127. [PMID: 35048293 PMCID: PMC8768442 DOI: 10.1007/s11606-021-07345-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 12/15/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Electronic health records are now the norm in US healthcare. Bidirectional patient portals allow frequent communication between patients and their healthcare team. Many studies have examined the importance of patient engagement and trust between patients and their healthcare team, typically in the context of face-to-face interactions. Little is known about how patient trust and engagement are built or enhanced through electronic communications. COVID-19 provided a unique time in history for this novel exploration. OBJECTIVE Our objective was to learn how patients experience trust formation through electronic communication (patient messaging and video visits) with their healthcare team. DESIGN Our research was guided by grounded theory methodology. Qualitative interviews were conducted between February and December 2020 with patients or their caregivers from an internal medicine clinic in Colorado. PARTICIPANTS Fifty-one participants were recruited by age group and gender to represent the clinic's adult ambulatory care demographics. Seven were patients' caregivers who were purposefully recruited. Average age was 53 with an educated, middle class, and largely white predominance in our eventual sample. APPROACH Thirty-minute semi-structured interviews were conducted using an interview guide informed by a validated physician-patient trust scale. Interviews were conducted by telephone, recorded via Zoom, and transcribed. Results were analyzed and coded in ATLAS.ti utilizing the constant comparative method, with two coders. KEY RESULTS Patients experienced enhanced trust in their healthcare team through electronic communications. Interpersonal and system factors contributed to trust formation. Promptness of reply was the most salient factor in trust formation with a majority desiring same day response. CONCLUSIONS Patients now rely on electronic communication with their healthcare team. Opportunities exist to leverage this to improve health outcomes. Important research in expanded demographic groups, along with ambulatory healthcare redesign, will be necessary to optimize benefits of electronic communication with patients and meet patient expectations.
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Affiliation(s)
- Annie Moore
- Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA. .,University of Colorado School of Medicine, Aurora, USA.
| | - Catia Chavez
- ACCORDS, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Michael P Fisher
- Department of Health Sciences, Towson University, Towson, MD, USA
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Li C, Khan MM. Public trust in physicians: empirical analysis of patient-related factors affecting trust in physicians in China. BMC PRIMARY CARE 2022; 23:217. [PMID: 36042408 PMCID: PMC9427175 DOI: 10.1186/s12875-022-01832-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 08/24/2022] [Indexed: 11/10/2022]
Abstract
Background Trust between the parties is essential for the efficient functioning of the healthcare market. Physician-patient relationship represents an asymmetric information situation and trust in physicians is critical for improving health and wellbeing of patients. In China, trust in physicians appears to be quite low creating conflicts between physicians and patients. This study aims to identify some general factors associated with trust in physicians in general using a nationally representative survey. Methods A cross-sectional analysis using data from 2018 China Family Panel Study (CFPS). Survey responses of individuals aged 16 years or above were extracted from CFPS and the final sample consisted of 29,192 individuals. An ordered probit model was used to identify factors causing heterogeneity in the levels of trust in physicians. Results Higher educational attainment and having medical insurance coverage are associated with higher likelihood of trusting physicians. Older adults (> = 30 years), males, urban residents, wage-earners, and self-employed persons are less likely to trust physicians. People who are diagnosed as chronic diseases or current smokers indicate lower level of trust in physicians. Higher perceived quality of services improves trust. Conclusion Socioeconomically disadvantaged population groups and uninsured individuals are less likely to trust physicians. Health care delivery system needs to address the concerns of these specific population groups to reduce tensions between physicians and patients. Increasing health insurance coverage and offering insurance with low out-of-pocket expenses should reduce the perception that physicians are more guided by their income rather than the wellbeing of patients. The system should also develop a comprehensive bill of rights of patients to improve patient-physician relationship. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01832-6.
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Abstract
OBJECTIVE To develop and validate a short measure of trust in the surgical decision making process. SUMMARY OF BACKGROUND DATA Having a reliable and valid measure of trust is important to assess the quality of the patient-surgeon relationship when decisions about surgical procedures are made. METHODS A previously published 10-item trust scale was qualitatively tested with patients, and a revised set of 14 items was tested using a web-based survey of 300 people who had hip, knee or back surgery in the past 2 years. The 14 items were evaluated using patterns of correlations and relevance to medical decision making to create a 5-item version. A 5-item subset was compared to the 14-item version to assess reliability and validity of patient's trust in the surgical decision making process. RESULTS Of the 300 participants, 32% had hip surgery, 33% had knee surgery, and 34% back surgery. Mean age was 53 years, 45% female, 80% White, and 36% had a high school degree or less. The item intercorrelations for the 14 items were 0.43-0.72 and 0.58-0.71 for the 5 items. Correlation between the versions was 0.96 (P < 0.01). The 14- and 5-item versions were positively correlated with participants' shared decision making process scores (0.42 and 0.41, both P = 0.01), internal consistency reliability scores were 0.95 and 0.89, respectively, and were negatively correlated with their Decision Regret scores (-0.51 and -0.48, both P = 0.01). CONCLUSION The 5-item Trust in the Surgical Decision Scale has strong evidence of validity and reliability for patients who underwent common orthopedic procedures.
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Wong YK, Low KL, Pooke TG. Factors Associated With Dimensions of Patients’ Trust in Chiropractic Doctors in the International Medical University Healthcare Chiropractic Center: An Exploratory Study. J Chiropr Med 2022; 21:83-96. [DOI: 10.1016/j.jcm.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/23/2022] [Accepted: 02/08/2022] [Indexed: 11/29/2022] Open
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ANDERSON ANDREW, GRIFFITH DEREKM. Measuring the Trustworthiness of Health Care Organizations and Systems. Milbank Q 2022; 100:345-364. [DOI: 10.1111/1468-0009.12564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Affiliation(s)
| | - DEREK M. GRIFFITH
- Racial Justice Institute and Center for Men's Health Equity Georgetown University
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10
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Michael T, Filc D, Davidovitch N. What motivates physicians to propose private services in a mixed private-public healthcare system? A mixed methods study. BMC Health Serv Res 2022; 22:51. [PMID: 35012548 PMCID: PMC8750864 DOI: 10.1186/s12913-022-07474-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 12/20/2021] [Indexed: 11/30/2022] Open
Abstract
Background Implementation of private elements, including private insurances, in public healthcare system is now common in many countries, and its impacts have been well studied. Little, however, is known about the motives leading physicians, major role players in the system, to promote the usage of private services. The aim of this study was to explore the various motives leading physicians within public systems to propose private services to their patients, while examining the possible associations to their specialty and level of commitment. Methods A total of 197 physicians from specialisms loaded more to private/public sectors participated in a cross-sectional telephone survey regarding their attitudes on their practices, private insurances, access to healthcare, and job satisfaction. The association between the likert scale questions to their recommendation to purchase private insurance, and the commitment they felt towards patients were analyzed using Generalized Estimating Equations (GEE) as well as logistic regression models. Results Our findings suggest physicians engaged in dual practice are less likely to promote private insurances among their patients if they are satisfied with their public job (OR = 0.92, 95%CI 0.89,0.94). Physicians perceived private insurances as beneficial for patients, were found likely to promote them (OR = 1.65, %95CI 1.16, 2.35). The commitment physicians felt toward patients who paid out-of-pocket money was associated to their sense of being trusted and valued (OR = 1.99, 95%CI 1.33, 2.88; OR = 1.5, 95%CI 1.05, 2.13 respectively). Conclusion This study suggests a deeper understanding of physicians’ daily experience of the private-public mix and it’s consequences, and could provide a platform for future studies. Further studies on physician’s role in health privatization processes are needed, and could aid policymakers in their efforts to strengthen healthcare systems around the world. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07474-9.
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Affiliation(s)
- Tal Michael
- School of Public Health, Ben-Gurion University of the Negev, POB 653, 84105, Be'er-Sheva, Israel.
| | - Dani Filc
- Department of Politics and Government, Ben-Gurion University of the Negev, Be'er- Sheva, Israel
| | - Nadav Davidovitch
- School of Public Health, Ben-Gurion University of the Negev, POB 653, 84105, Be'er-Sheva, Israel
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Rotaru TȘ, Frățilă OC, Bărboi O, Ciortescu I, Mihai C, Anton C, Ștefănescu G, Drug V. A comparison using standardized measures for patients with irritable bowel syndrome: Trust in the gastroenterologist and reliance on the internet. Neurogastroenterol Motil 2021; 33:e13977. [PMID: 32875697 DOI: 10.1111/nmo.13977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/09/2020] [Accepted: 08/01/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Irritable bowel syndrome (IBS) patients' use of the Internet for health information interacts with the way they trust their gastroenterologist. No standardized measure has targeted IBS patients and gastroenterologists specifically, nor their use of the Internet. The aims of this paper were as follows: the development of a scale that measures an IBS patient's trust in their gastroenterologist, the development of a scale measuring an IBS patient's reliance on Internet health information, and testing the hypothesis that IBS patients, who use the Internet for IBS-related information, trust their gastroenterologist less than those who do not. METHOD A total of 82 patients (mean age 49, SD = 14.62) diagnosed with IBS completed two questionnaires: one about trust in their gastroenterologist and the other about the reliance on Internet health information regarding IBS. The two questionnaires were built using current literature as well as our previous qualitative research. The statistical computations were performed using the SPSS 20 program. KEY RESULTS Both questionnaires proved to be reliable in measuring gastroenterologist-IBS patient trust (alpha = 0.87) and Internet information reliance (alpha = 0.88), respectively. The IBS patients who did not look for information about IBS over the Internet had significantly higher trust in their gastroenterologist compared with those who did (U = 535.5; z = -2.26; P < 0.05). CONCLUSIONS We developed two ready-to-use scales to measure both the gastroenterologist-IBS patient's trust and the IBS patient's reliance on the Internet. Further studies will be able to explore the interaction among all variables in IBS patients' trust.
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Affiliation(s)
| | | | - Oana Bărboi
- University of Medicine and Pharmacy «Gr. T. Popa» Iași, Iași, Romania.,Institute of Gastroenterology and Hepatology, University Hospital St Spiridon, Iași, Romania
| | - Irina Ciortescu
- University of Medicine and Pharmacy «Gr. T. Popa» Iași, Iași, Romania.,Institute of Gastroenterology and Hepatology, University Hospital St Spiridon, Iași, Romania
| | - Cătălina Mihai
- University of Medicine and Pharmacy «Gr. T. Popa» Iași, Iași, Romania.,Institute of Gastroenterology and Hepatology, University Hospital St Spiridon, Iași, Romania
| | - Carmen Anton
- University of Medicine and Pharmacy «Gr. T. Popa» Iași, Iași, Romania.,Institute of Gastroenterology and Hepatology, University Hospital St Spiridon, Iași, Romania
| | - Gabriela Ștefănescu
- University of Medicine and Pharmacy «Gr. T. Popa» Iași, Iași, Romania.,Institute of Gastroenterology and Hepatology, University Hospital St Spiridon, Iași, Romania
| | - Vasile Drug
- University of Medicine and Pharmacy «Gr. T. Popa» Iași, Iași, Romania.,Institute of Gastroenterology and Hepatology, University Hospital St Spiridon, Iași, Romania
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"You Helped Create This, Help Me Now": A Qualitative Analysis of Patients' Concerns about Breast Implants and a Proposed Strategy for Moving Forward. Plast Reconstr Surg 2021; 147:16e-24e. [PMID: 33370046 DOI: 10.1097/prs.0000000000007422] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Some women with breast implants express concern about the safety of implants, fearing the possibility of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) and breast implant-related illness. METHODS A qualitative analysis was performed to examine the perceived challenges, barriers, and worries experienced by these women. Convenience sampling was used to elicit responses from members of Canadian BIA-ALCL Facebook advocacy groups. Three independent coders read and reread the transcripts, using thematic analysis to identify emerging themes. RESULTS Sixty-four women answered questions posed by the president of the Canadian Society of Plastic Surgeons regarding concerns about their breast implants. Five themes were identified: informing, listening, acknowledging, clarifying, and moving forward. Patients desire improved communication about possible risks before implantation and as new information becomes available (informing), sincere listening to their concerns (listening), acknowledgement that these disease entities may be real and have psychosocial/physical impact on patients (acknowledging), clarification of implant-related problems and their treatment (clarifying), and improved processes for monitoring and treatment of patients with identified problems (moving forward). Consideration of these themes in the context of the five domains of trust theory (i.e., fidelity, competence, honesty, confidentiality, and global trust) suggests significant breakdown in the doctor-patient relationship for a subset of concerned women. CONCLUSIONS Concerns related to BIA-ALCL and breast implant-related illnesses have undermined some women's trust in plastic surgeons. Consideration of these five themes and their impact on the five domains of trust can guide strategies for reestablishing patients' trust in the plastic surgery community.
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Vansimaeys C, Benamar L, Balagué C. Digital health and management of chronic disease: A multimodal technologies typology. Int J Health Plann Manage 2021; 36:1107-1125. [PMID: 33786849 DOI: 10.1002/hpm.3161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/19/2021] [Accepted: 03/13/2021] [Indexed: 11/08/2022] Open
Abstract
This cross-sectional descriptive study aims to (1) describe the current digital technology (DT) use of people with chronic diseases (CD) by identifying different user profiles and (2) determine whether those profiles have specific characteristics regarding health-related variables and patient-doctor relationship quality (RQ). An online questionnaire assessing the uses of multiple types of DT (the Internet, mobile applications and connected devices) and several dimensions related to health and patient-doctor RQ was completed by 954 individuals living with CD. DT user groups were obtained by k-means cluster analysis and then compared using Mann-Whitney tests. The results show three profiles of DT users: (1) hyperconnected (8.9%, regular users of all DTs), (2) biconnected (19.1%, regular users of the Internet and mobile apps) and (3) hypoconnected (72%, casual users of the Internet only). The hyperconnected and biconnected groups are more empowered, more knowledgeable about their treatment and more committed to their doctors than the hypoconnected group. Nonadherence to treatment, health motivations, self-efficacy for health management and the trust dimension of the patient-doctor RQ did not differ between groups. We conclude by discussing the low use of the most recent technologies in the CD population, although these technologies seem to provide access to health information that empowers patients and leads to a better relationship with their doctors.
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Affiliation(s)
- Camille Vansimaeys
- LITEM, Univ Evry, IMT-BS, Université Paris-Saclay, Evry, France.,Université de Paris, LPPS, Boulogne Billancourt, France
| | - Lamya Benamar
- LITEM, Univ Evry, IMT-BS, Université Paris-Saclay, Evry, France
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Alam MZ, Alam MMD, Uddin MA, Mohd Noor NA. Do mobile health (mHealth) services ensure the quality of health life? An integrated approach from a developing country context. ACTA ACUST UNITED AC 2020. [DOI: 10.1080/13527266.2020.1848900] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | | | - Md. Aslam Uddin
- Faculty of Business, Bangladesh University of Business and Technology, Dhaka, Bangladesh
| | - Nor Azila Mohd Noor
- Othman Yeop Abdullah Graduate School of Business, Universiti Utara Malaysia, Kedah, Malaysia
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Zhang W, Huang Y, Zhou H, Lin G, Lu M, Xi Lecturer X. Associations between social capital and trust in general practitioners among the elderly people: Empirical evidence from China. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:1590-1602. [PMID: 32207223 DOI: 10.1111/hsc.12983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 02/16/2020] [Accepted: 03/04/2020] [Indexed: 05/27/2023]
Abstract
Elderly individuals' trust in general practitioners (GPs) is conducive to enhancing their health outcomes and promote healthy ageing. However, this trust has been declining in recent decades. Social capital is associated with patients' trust in healthcare providers in several countries, which make it a potential path for improving the trust of the elderly people in GPs in China, but it is not yet validated. The objective of this study was to explore how social capital influences elderly individuals' trust in GPs in China. The data were collected through a survey conducted with 2,754 people aged 60 and over in China, 2018. Multilevel regression models were employed to analyse the impact of social capital on the trust of the elderly people in GP in China. The results revealed that individual social capital (ISC) and community social capital (CSC) had significant positive correlations with the trust of the elderly people in GPs in China. In addition, CSC has more impact than ISC on the trust of the elderly people in GP. Additionally, older people, women and patients whose highest level of education was junior high school and who had participated in the New Cooperative Medical Scheme tended to have higher trust in GPs. In conclusion, more social capital, especially CSC, contributed more trust of the elderly people in GPs in China.
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Affiliation(s)
- Weiwei Zhang
- The Research Center of National Drug Policy & Ecosystem, China Pharmaceutical University, Nanjing City, China
| | - Yuankai Huang
- The Research Center of National Drug Policy & Ecosystem, China Pharmaceutical University, Nanjing City, China
| | - Hongjie Zhou
- The Research Center of National Drug Policy & Ecosystem, China Pharmaceutical University, Nanjing City, China
| | - Guohua Lin
- The Research Center of National Drug Policy & Ecosystem, China Pharmaceutical University, Nanjing City, China
| | - Mengqing Lu
- The Research Center of National Drug Policy & Ecosystem, China Pharmaceutical University, Nanjing City, China
| | - Xiaoyu Xi Lecturer
- The Research Center of National Drug Policy & Ecosystem, China Pharmaceutical University, Nanjing City, China
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Sacdalan DB, Lucero JA, Ting FI, Sacdalan DL. What Will Keep Me Coming Back to the Clinic: Factors Identified by Filipino Colorectal Cancer Patients Seen at a National Academic Referral Center. J Patient Exp 2020; 7:460-463. [PMID: 33062864 PMCID: PMC7534131 DOI: 10.1177/2374373519857654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Health-care decisions in the Philippines are widely affected by various factors such as family, community, health-care access, and educational attainment. We designed a questionnaire to evaluate patient views at the University of the Philippines-Philippine General Hospital colorectal multidisciplinary clinic to identify factors that contribute to continued follow-up at the colorectal multidisciplinary clinic. A total of 128 patients, 62% of whom were being treated with curative intent participated in the study. We found that trust in their physicians, presence of family support, and affordability of treatment were factors highly valued by patients consulting at the clinic.
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Affiliation(s)
- Danielle Benedict Sacdalan
- Section of Medical Oncology, Department of Medicine, University of the Philippines Manila and Philippine General Hospital, Manila, Philippines
| | - Josephine Anne Lucero
- Section of Hematology, Department of Medicine, University of the Philippines Manila and Philippine General Hospital, Manila, Philippines
| | - Frederic Ivan Ting
- Section of Medical Oncology, Department of Medicine, University of the Philippines Manila and Philippine General Hospital, Manila, Philippines
| | - Dennis Lee Sacdalan
- Section of Medical Oncology, Department of Medicine, University of the Philippines Manila and Philippine General Hospital, Manila, Philippines
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Convie LJ, Carson E, McCusker D, McCain RS, McKinley N, Campbell WJ, Kirk SJ, Clarke M. The patient and clinician experience of informed consent for surgery: a systematic review of the qualitative evidence. BMC Med Ethics 2020; 21:58. [PMID: 32653008 PMCID: PMC7353438 DOI: 10.1186/s12910-020-00501-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 07/05/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Informed consent is an integral component of good medical practice. Many researchers have investigated measures to improve the quality of informed consent, but it is not clear which techniques work best and why. To address this problem, we propose developing a core outcome set (COS) to evaluate interventions designed to improve the consent process for surgery in adult patients with capacity. Part of this process involves reviewing existing research that has reported what is important to patients and doctors in the informed consent process. METHODS This qualitative synthesis comprises four phases: identification of published papers and determining their relevance; appraisal of the quality of the papers; identification and summary of the key findings from each paper while determining the definitiveness of each finding against the primary data; comparison of key themes between papers such that findings are linked across studies. RESULTS Searches of bibliographic databases returned 11,073 titles. Of these, 16 studies met the inclusion criteria. Studies were published between 1996 and 2016 and included a total of 367 patients and 74 health care providers. Thirteen studies collected data using in-depth interviews and constant comparison was the most common means of qualitative analysis. A total of 94 findings were extracted from the primary papers and divided into 17 categories and ultimately 6 synthesised findings related to: patient characteristics, knowledge, communication, the model patient, trust and decision making. CONCLUSIONS This qualitative meta-aggregation is the first to examine the issue of informed consent for surgery. It has revealed several outcomes deemed important to capture by patients and clinicians when evaluating the quality of a consent process. Some of these outcomes have not been examined previously in research comparing methods for informed consent. This review is an important step in the development of a COS to evaluate interventions designed to improve the consent process for surgery. REGISTRATION The study protocol was registered on the international prospective register for systematic reviews (PROSPERO ID: CRD42017077101).
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Affiliation(s)
- L. J. Convie
- Department of General Surgery, Ulster Hospital Dundonald, Belfast, UK
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
| | - E. Carson
- Department of General Surgery, Ulster Hospital Dundonald, Belfast, UK
| | - D. McCusker
- Department of General Surgery, Ulster Hospital Dundonald, Belfast, UK
| | - R. S. McCain
- Department of General Surgery, Ulster Hospital Dundonald, Belfast, UK
| | - N. McKinley
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
| | - W. J. Campbell
- Department of General Surgery, Ulster Hospital Dundonald, Belfast, UK
| | - S. J. Kirk
- Department of General Surgery, Ulster Hospital Dundonald, Belfast, UK
| | - M. Clarke
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
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Vale MD, Good MJD. Transcending the Profession: Psychiatric Patients' Experiences of Trust in Clinicians. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2020; 61:208-222. [PMID: 32368929 PMCID: PMC7774329 DOI: 10.1177/0022146520918559] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Classical medical sociological theory argues patients trust doctors in part because they are professionals. Yet in the past half-century, medicine has seen a crisis of trust as well as fundamental changes to the nature of professionalism. To probe the relationship between professionalism and trust today, we analyzed interviews with 50 psychiatric patients receiving care in diverse clinical settings. We found patients experience trust when they perceive clinicians transcending the formal bounds of professionalism. Patients find clinicians to be trustworthy when clinicians pursue connections to their patients beyond organizational strictures, cross boundaries of professional jurisdiction to provide holistic care, and embrace the limits of their professional knowledge. This dynamic of trust in professionals who transcend the profession highlights novel dimensions of contemporary professionalism, and it makes sense of a seeming contradiction in which patients have high trust in individual clinicians but low trust in institutions.
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The Impact of Joining a Team on the Initial Trust in Online Physicians. Healthcare (Basel) 2020; 8:healthcare8010033. [PMID: 32041333 PMCID: PMC7151224 DOI: 10.3390/healthcare8010033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/24/2020] [Accepted: 02/05/2020] [Indexed: 11/16/2022] Open
Abstract
Introduction: Trust is a major challenge for the online market and this is especially the case for e-consultation platforms. Research that promotes online physician trust is highly desirable. In this study, we focus on whether joining a team led by a well-known physician will increase physician trust and what team characteristics will affect this trust. Materials and Methods: Brand extension theory is applied to the healthcare context to explain the impact of joining a team on physician trust. Specifically, both team strength and team similarity are hypothesized to have the main effects. In addition, team size is hypothesized to have a moderating effect. A 2 × 2 × 2 experiment was conducted to test the proposed research model. Results: The results indicated that joining a team would significantly increase physician trust (p < 0.001). Both team strength (p < 0.001) and team similarity (p < 0.001) had positive impacts on physician trust. In addition, a larger team size resulted in a reduced positive effect of team strength on physician trust (p < 0.001). Conclusions: Joining a physician team is an effective and low-cost method to address the initial trust problem of unknown online physicians.
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Erickson SM, Outland B, Joy S, Rockwern B, Serchen J, Mire RD, Goldman JM. Envisioning a Better U.S. Health Care System for All: Health Care Delivery and Payment System Reforms. Ann Intern Med 2020; 172:S33-S49. [PMID: 31958802 DOI: 10.7326/m19-2407] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The American College of Physicians (ACP) has long advocated for universal access to high-quality health care in the United States. Yet, it is essential that the U.S. health system goes beyond ensuring coverage, efficient delivery systems, and affordability. Fundamental restructuring of payment policies and delivery systems is required to achieve a health care system that puts patients' interests first and supports physicians and their care teams to deliver high-value, patient- and family-centered care. The ACP calls for reform of U.S. payment, delivery, and information technology systems to achieve this vision. The ACP's recommendations include increased investment in primary care; alignment of financial incentives to achieve better patient outcomes, lower costs, reduce inequities in health care, and facilitate team-based care; freeing patients and physicians of inefficient administrative and billing tasks and documentation requirements; and development of health information technologies that enhance the patient-physician relationship.
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Affiliation(s)
- Shari M Erickson
- American College of Physicians, Washington, DC (S.M.E., B.O., S.J., B.R., J.S.)
| | - Brian Outland
- American College of Physicians, Washington, DC (S.M.E., B.O., S.J., B.R., J.S.)
| | - Suzanne Joy
- American College of Physicians, Washington, DC (S.M.E., B.O., S.J., B.R., J.S.)
| | - Brooke Rockwern
- American College of Physicians, Washington, DC (S.M.E., B.O., S.J., B.R., J.S.)
| | - Josh Serchen
- American College of Physicians, Washington, DC (S.M.E., B.O., S.J., B.R., J.S.)
| | - Ryan D Mire
- Heritage Medical Associates, Nashville, Tennessee (R.D.M.)
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Du L, Wu R, Chen X, Xu J, Ji H, Zhou L. Role of Treatment Adherence, Doctor-Patient Trust, and Communication in Predicting Treatment Effects Among Tuberculosis Patients: Difference Between Urban and Rural Areas. Patient Prefer Adherence 2020; 14:2327-2336. [PMID: 33262582 PMCID: PMC7700001 DOI: 10.2147/ppa.s277650] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/02/2020] [Indexed: 12/14/2022] Open
Abstract
PURPOSE China is the second highest tuberculosis (TB) burden in the world, and TB patients in the rural areas are about twice as many as urban patients. The purpose of present study was to explore the roles of medication adherence, doctor-patient trust and communication on treatment effects, and its inequality between urban and rural areas. METHODS There were 564 eligible TB patients, from four tuberculosis hospitals in China, participating in this cross-sectional study. They filled out questionnaires regarding socio-demographic characteristics, medication adherence, treatment effect, doctor-patient trust, and communication. The structural equation model (SEM) was applied to explore the hypotheses in this study. All statistical analysis was done by SPSS 25.0 and Mplus 7.0 statistical software. RESULTS This study included 267 (47.34%) urban and 297 (52.66%) rural eligible TB patients. The data fitted the research model well, and the urban TB patients reported better treatment effect than the rural ones (P=0.027). Overall, treatment adherence positively predicted treatment effect (Est.=0.353, P<0.001); doctor-patient communication positively influenced treatment adherence (Est.=0.214, P=0.002); and treatment adherence positively mediated the role of communication on treatment effect (Est.=0.076), 95% CI (0.026, 0.152). While in the grouping model, the urban patients' treatment effect was only influenced by adherence (Est.=0.286, P=0.003); for the rural patients, treatment adherence (Est.=0.464, P<0.001) and doctor-patient trust (Est.=0.382, P=0.019) directly predicted treatment effects, and treatment adherence positively mediated the role of doctor-patient communication on treatment effect (Est.=0.175, P=0.006). CONCLUSION The treatment effect of TB patients, from urban and rural China, was influenced by a different mechanism, among which rural TB patients need not only improve the treatment adherence but also establish good doctor-patient trust and communication to improve treatment effects. These findings provided a theoretical guide on treatment and control for rural TB patients.
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Affiliation(s)
- Liang Du
- School of Public Health, Dalian Medical University, Dalian, Liaoning116044, People’s Republic of China
| | - Ruiheng Wu
- School of Public Health, Dalian Medical University, Dalian, Liaoning116044, People’s Republic of China
| | - Xu Chen
- School of Public Health, Dalian Medical University, Dalian, Liaoning116044, People’s Republic of China
| | - Jia Xu
- School of Public Health, Dalian Medical University, Dalian, Liaoning116044, People’s Republic of China
| | - Haoqiang Ji
- School of Public Health, Dalian Medical University, Dalian, Liaoning116044, People’s Republic of China
| | - Ling Zhou
- School of Public Health, Dalian Medical University, Dalian, Liaoning116044, People’s Republic of China
- Correspondence: Ling Zhou School of Public Health, Dalian Medical University, 9 Western Section, Lvshun South Street, Lvshunkou District, Dalian116044, People’s Republic of ChinaTel +86-411-8611-0368 Email
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Crits-Christoph P, Rieger A, Gaines A, Gibbons MBC. Trust and respect in the patient-clinician relationship: preliminary development of a new scale. BMC Psychol 2019; 7:91. [PMID: 31888759 PMCID: PMC6937966 DOI: 10.1186/s40359-019-0347-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 10/28/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Trust and respect may be an important component of client-provider relationships. This study aimed to develop and report preliminary psychometric analyses of a new brief measure to evaluate a patient's level of trust and respect for their clinician. The scale was designed to be applicable in multiple healthcare contexts, with a particular focus on mental healthcare. METHODS Adult patients completed the study survey in an academic outpatient psychiatric clinic waiting room. Classical and Item Response Theory (IRT) analyses were utilized to examine the adequacy of scale items. Validity was examined in relation to the patient-therapist alliance and to willingness to share private information (social media content) with one's clinician. RESULTS Beginning with 10 items, a final 8-item version of the measure was created with an internal consistency reliability of .91. Principal components analysis indicated that the scale was best viewed as capturing one overall dimension. A Graded Response Model IRT model indicated that all items contributed information on the latent dimension, and all item curves were not flat at any region. The correlation of the trust/respect total score with the alliance was .53 when respect-related items were deleted from the alliance score. The trust/respect scale was significantly associated with patient willingness to share social media posts with their clinician but the alliance was not. CONCLUSIONS The brief measure of patient trust and respect towards their clinician was unidimensional, showed good internal consistency, and was not redundant with existing measures of the alliance. The scale has the potential to be used in a wide variety of healthcare settings.
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Affiliation(s)
- Paul Crits-Christoph
- University of Pennsylvania, 3535 Market St (Room 650), Philadelphia, PA, 19104, USA.
| | | | - Averi Gaines
- University of Pennsylvania, 3535 Market St (Room 650), Philadelphia, PA, 19104, USA
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Huang ECH, Pu C, Huang N, Chou YJ. Resident burnout in Taiwan Hospitals—and its relation to physician felt trust from patients. J Formos Med Assoc 2019; 118:1438-1449. [DOI: 10.1016/j.jfma.2018.12.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 09/15/2018] [Accepted: 12/19/2018] [Indexed: 10/27/2022] Open
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Cockroft JD, Adams SM, Matlock D, Dietrich MS. Reliability and construct validity of 3 psychometric trust scales for women seeking substance abuse treatment in a community setting. Subst Abus 2019; 41:391-399. [PMID: 31368857 DOI: 10.1080/08897077.2019.1635967] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background: Women with a history of substance use disorder (SUD) constitute a unique population with gender-specific needs in treatment. Most notable is high rates of prior trauma and the need for a trauma-informed care framework. Given theoretical links between trauma and interpersonal trust, understanding quantitatively how trust may impact outcomes for women in this population requires confirmation of validity of existing psychometric instruments. Objective: This study sought to confirm reliability and construct validity of the Rotter Interpersonal Trust Scale, Wake Forest Trust in Physician Scale, and the Revised Health Care System Distrust Scale (RHCSDS) for use in women with a history of SUD seeking treatment in a community-based setting. Methods: A total of 301 participants were enrolled between August 2017 and March 2018 at an urban, community-based residential substance abuse treatment program in the mid-South. Participants were given an electronic survey containing questions about demographics/clinical characteristics, the Rotter, Wake Forest, and RHCSDS scales, Socially Desirable Response Five-Item Survey (SDRS-5), and the Adverse Childhood Experiences (ACEs) questionnaire. All participants also completed a modified protocol of the "Trust Game." Statistical analysis was completed for each trust scale in regard to scale means and distribution, internal consistency, interscale correlation, and scale correlation to the ACE score. Results: Results confirm statistically significant (P < .001) differences in global trust and trust of health care providers compared with general population samples in prior studies. Internal consistency of scales is comparable to reliability testing in prior studies (α > .70 for all scales). Interscale correlation between individual scales is statistically significant, with the strongest relationship between the 2 health care-specific scales (r = -.740, P < .001). There was a weak, negative correlation between the ACE score and interpersonal trust (r = -.135, P = .019). Individual scales do not have statistically significant correlation with "Trust Game" scores. Discussion: Findings suggest reliability and construct validity of scales for use in this population.
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Affiliation(s)
| | - Susie M Adams
- Vanderbilt University School of Nursing, Nashville, Tennessee, USA
| | | | - Mary S Dietrich
- Vanderbilt University School of Nursing, Nashville, Tennessee, USA
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26
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Kanter GP, Carpenter D, Lehmann LS, Mello MM. US Nationwide Disclosure of Industry Payments and Public Trust in Physicians. JAMA Netw Open 2019; 2:e191947. [PMID: 30977850 PMCID: PMC6481437 DOI: 10.1001/jamanetworkopen.2019.1947] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Transparency of industry payments to physicians could engender greater public trust in physicians but might also lead to greater mistrust of physicians and the medical profession, adversely affecting the patient-physician relationship. OBJECTIVE To examine the association between nationwide public disclosure of industry payments and Americans' trust in their physicians and trust in the medical profession. DESIGN, SETTING, AND PARTICIPANTS Survey study using difference-in-difference analyses of a national longitudinal survey comparing changes in states where industry payments were newly disclosed by Open Payments with changes in states where payments information was already available because of state sunshine laws. The US population-based surveys were conducted in September 2014-shortly before the initial public disclosure of industry payments-and again in September 2016. Final analyses were conducted September through December 2018. Participants were adults 18 years and older (n = 1388). EXPOSURES National public disclosure through Open Payments of payments made by pharmaceutical and medical device firms to physicians. MAIN OUTCOMES AND MEASURES Wake Forest measure of trust in one's own physician and Wake Forest measure of trust in the medical profession. RESULTS Of the 3542 original survey respondents, 2180 (61.5%) completed the second survey 2 years later, and 1388 named the same most frequently seen physician in both surveys. The mean age of respondents at the time of the first survey was 53 years, and 749 (54.0%) were women. Race/ethnicity was white in 76.6% (1063 of 1388) and non-Hispanic black in 8.0% (111 of 1388). Public disclosure of payments was associated with lower trust in one's own physician regardless of whether respondents knew their physicians had received payments (decrease in Wake Forest measure of trust in one's own physician of 0.56 point; 95% CI, -0.79 to -0.32 point; P < .001). Open Payments was also associated with lower trust in the medical profession (decrease in Wake Forest measure of trust in the medical profession of 0.35 point; 95% CI, -0.58 to -0.12 point; P = .004). CONCLUSIONS AND RELEVANCE Nationwide public disclosure of industry payments may be associated with decreased trust in physicians and in the medical profession. More judicious presentation of payments information may counteract unintended negative trust and spillover consequences of public disclosure.
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Affiliation(s)
- Genevieve P. Kanter
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Daniel Carpenter
- Radcliffe Institute for Advanced Study, Harvard University, Cambridge, Massachusetts
- Department of Government, Harvard University, Cambridge, Massachusetts
| | - Lisa S. Lehmann
- National Center for Ethics in Health Care, Veterans Health Administration, Washington, DC
| | - Michelle M. Mello
- Stanford Law School, Stanford University, Stanford, California
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California
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Huang ECH, Pu C, Chou YJ, Huang N. Public Trust in Physicians-Health Care Commodification as a Possible Deteriorating Factor: Cross-sectional Analysis of 23 Countries. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2019; 55:46958018759174. [PMID: 29502479 PMCID: PMC5843089 DOI: 10.1177/0046958018759174] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Trust in physicians has declined, and surveys of public opinion show a poor level of public trust in physicians. Commodification of health care has been speculated as a plausible driving force. We used cross-national data of 23 countries from the International Social Survey Programme 2011 to quantify health care commodification and study its role in the trust that patients generally place in physicians. A modified health care index was used to quantify health care commodification. There were 34 968 respondents. A question about the level of general trust in physicians and a 4-item “general trust in physicians” scale were used as our major and minor outcomes. The results were that compared with those in the reference countries, the respondents in the health care–commodified countries were approximately half as likely to trust physicians (odds ratio: 0.47, 95% confidence interval [CI]: 0.31-0.72) and scored 1.13 (95% CI: 1.89-0.37) less on the general trust scale. However, trust in physicians in the health care–decommodified countries did not differ from that in the reference countries. In conclusion, health care commodification may play a meaningful role in the deterioration of public trust in physicians.
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Affiliation(s)
- Ellery Chih-Han Huang
- National Yang-Ming University, Taipei, Taiwan
- Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Christy Pu
- National Yang-Ming University, Taipei, Taiwan
| | | | - Nicole Huang
- National Yang-Ming University, Taipei, Taiwan
- Nicole Huang, Institute of Hospital and Health Care Administration, National Yang-Ming University, No. 155, Section 2, Linong Street, Beitou District, Taipei City 112, Taiwan (R.O.C.).
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Lee TH, McGlynn EA, Safran DG. A Framework for Increasing Trust Between Patients and the Organizations That Care for Them. JAMA 2019; 321:539-540. [PMID: 30676628 DOI: 10.1001/jama.2018.19186] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | | | - Dana Gelb Safran
- The Health Institute, Institute for Clinical Research and Health Policy Studies, Boston, Massachusetts
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Bannon BL, Lucier M, Fagerlin A, Kim J, Kiraly B, Weir P, Ozanne EM. Evaluation of the intensive outpatient clinic: study protocol for a prospective study of high-cost, high-need patients in the University of Utah Health system. BMJ Open 2019; 9:e024724. [PMID: 30782742 PMCID: PMC6361483 DOI: 10.1136/bmjopen-2018-024724] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The University of Utah (UofU) Health intensive outpatient clinic (IOC) is a primary care clinic for medically complex (high-cost, high-need) patients with Medicaid. The clinic consists of a multidisciplinary care team aimed at providing coordinated, comprehensive and patient-centred care. The protocol outlines the quantitative design of an evaluation study to determine the IOC's effects on reducing healthcare utilisation and costs, as well as improving patient-reported health outcomes and quality of care. METHODS AND ANALYSIS High-risk patients, with high utilisation and multiple chronic illnesses, were identified in the Medicaid ACO population managed by the UofU Health plans for IOC eligibility. A prospective, case-control study design is being used to match 100 IOC patients to 200 control patients (receiving usual care within the UofU) based on demographics, health utilisation and medical complexity for evaluating the primary outcome of change in healthcare utilisation and costs. For the secondary outcomes of patient health and care quality, a prepost design will be used to examine within-person change across the 18 months of follow-up (ie, before and after IOC intervention). Logistic regression and hierarchical, longitudinal growth modelling are the two primary modelling approaches. ETHICS AND DISSEMINATION This work has received ethics approval by the UofU Institutional Review Board. Results from the evaluation of primary and secondary outcomes will be disseminated in scientific research journals and presented at national conferences.
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Affiliation(s)
- Brittany L Bannon
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Michelle Lucier
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Angela Fagerlin
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah, USA
- VA Center for Informatics Decision Enhancement and Surveillance (IDEAS), Salt Lake City, Utah, USA
| | - Jaewhan Kim
- Department of Health and Kinesiology, University of Utah, Salt Lake City, Utah, USA
| | - Bernadette Kiraly
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Peter Weir
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Elissa M Ozanne
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Palmer Kelly E, Agne JL, Hyer M, Meara A, Olsen G, Pawlik TM. A systematic review of the methods utilised to measure the relationship between cancer patients and oncologists: Implications for future research and practice. Eur J Cancer Care (Engl) 2018; 28:e12981. [PMID: 30561074 DOI: 10.1111/ecc.12981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 11/13/2018] [Accepted: 11/18/2018] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The patient-physician relationship is a critical component of patient-centred health care. The patient-oncologist relationship is particularly important due to the uncertainties that surround treatment of cancer. The goal of the current review was to summarise current methodological approaches to studying the relationship between cancer patients and oncologists. METHODS A systematic review using PsychInfo, Ebsco, PubMed and Google Scholar was performed using combinations and variations of the MESH terms: "relationship," "doctor-patient," and "oncology." The included studies explicitly measured the "relationship" as an independent or dependent variable. Data were extracted and analysed. RESULTS The 13 studies included in the review were published from 2004 to 2018. There was little agreement between studies on the definition of the patient-oncologist relationship. Trust was most frequently measured, but methods varied. Most studies evaluated the patient perspective (n = 10). The few studies that considered the oncologist perspective did not measure their perception of the relationship. CONCLUSIONS The current review demonstrates that current approaches used to assess the patient-oncologist relationship are inconsistent. These differences may limit our understanding of patient needs in current research and practice. Future research should focus on the use of a relational lens as a theoretical framework to assess the patient-oncologist relationship.
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Affiliation(s)
| | - Julia L Agne
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Madison Hyer
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Alexa Meara
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Griffin Olsen
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Tsai TI, Yu WR, Lee SYD. Is health literacy associated with greater medical care trust? Int J Qual Health Care 2018; 30:514-519. [PMID: 29608676 DOI: 10.1093/intqhc/mzy043] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 03/12/2018] [Indexed: 02/01/2023] Open
Abstract
Objective To examine the relationship between health literacy and trust in physicians and in the healthcare system. Design A cross-sectional survey of a nationally representative sample of adults. Setting Taiwan. Participants Non-institutionalized adults (N = 2199). Main measures Trust in physicians was a composite measure assessing respondents' general trust in physicians and their perceptions of their physician's communication, medical skills, beneficence, honesty, confidentiality, respect and fairness. Trust in the healthcare system was a single-item measure. Health literacy was measured by four items. Results Respondents with higher health literacy had, overall, higher levels of trust in physicians (P<0.001) and in the healthcare system (P = 0.04). Health literacy remained significantly and positively associated with trust in physicians (P<0.001) and in the healthcare system (P = 0.001) after adjusting for respondents' sociodemographic characteristics. Conclusions Our findings demonstrate that health literacy is positively associated with trust. Actionable plans targeting health literacy at the national and local levels to establish a health literate care environment may contribute to enhancing trust in physicians and the healthcare system.
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Affiliation(s)
- Tzu-I Tsai
- School of Nursing, National Yang-Ming University, Taiwan, No. 155, Sec 2, Linong Street, Beitou District, Taipei, Taiwan
| | - Wen-Ry Yu
- Division of Family Medicine, Taipei City Hospital, Yangming Branch, No. 105, Yusheng St., Shilin District, Taipei City, Taiwan
| | - Shoou-Yih D Lee
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
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Groenewegen PP, Hansen J, de Jong JD. Trust in times of health reform. Health Policy 2018; 123:281-287. [PMID: 30528656 DOI: 10.1016/j.healthpol.2018.11.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 09/07/2018] [Accepted: 11/27/2018] [Indexed: 11/19/2022]
Abstract
Trust is seen as an important condition for the smooth functioning of institutions, such as the health care system. In this article we describe the trust relationships between the three main actors in the Dutch health care system: patients/insured, healthcare providers and insurers. We used data from different surveys between 2006 and 2016. 2006 was the year of the introduction of an insurance reform in the Netherlands towards regulated competition. In the triangle of trust relationships between the three actors we found strong and mutual trust relationships between patients and healthcare providers and weak trust relationships between healthcare providers and insurers as well as between insured and insurance organisations. This hampers the intended role of insurers as selective purchasers of health care on the basis of quality and price.
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Affiliation(s)
- Peter P Groenewegen
- NIVEL - Netherlands Institute for Health Services Research and Department of Sociology, Department of Human Geography, Utrecht University, the Netherlands.
| | - Johan Hansen
- NIVEL - Netherlands Institute for Health Services Research, the Netherlands
| | - Judith D de Jong
- NIVEL - Netherlands Institute for Health Services Research and Department of Health Services Research, Maastricht University, the Netherlands
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Coats H, Downey L, Sharma RK, Curtis JR, Engelberg RA. Quality of Communication and Trust in Patients With Serious Illness: An Exploratory Study of the Relationships of Race/Ethnicity, Socioeconomic Status, and Religiosity. J Pain Symptom Manage 2018; 56:530-540.e6. [PMID: 30025937 PMCID: PMC6242783 DOI: 10.1016/j.jpainsymman.2018.07.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 06/29/2018] [Accepted: 07/06/2018] [Indexed: 12/01/2022]
Abstract
CONTEXT Better understanding of clinicians' skill communicating with their patients and of patients' trust in clinicians is necessary to develop culturally sensitive palliative care interventions. Race/ethnicity, socioeconomic status, and religiosity have been documented as factors influencing quality of communication and trust. OBJECTIVES The objective of this study was to explore associations of seriously ill patients' race/ethnicity, socioeconomic status, and religiosity with patients' ratings of the quality of clinicians' communication and trust in clinicians. METHODS An observational analysis was performed using baseline data from a multicenter cluster-randomized trial of a communication intervention. We enrolled consecutive patients with chronic, life-limiting illnesses (n = 537) cared for by primary and specialty care clinicians (n = 128) between 2014 and 2016 in outpatient clinics in Seattle, Washington. We assessed patient demographics (age, gender, race/ethnicity, education, income, and self-rated health status), Duke University Religion Index, Quality of Communication Scale, and Wake Forest Physician Trust Scale. We used probit and linear regression and path analyses to examine associations. RESULTS Patients providing higher ratings of clinician communication included those belonging to racial/ethnic minority groups (P = 0.001), those with lower income (P = 0.008), and those with high religiosity/spirituality (P = 0.004). Higher trust in clinicians was associated with minority status (P = 0.018), lower education (P = 0.019), and clinician skill in communication (P < 0.001). CONCLUSION Contrary to prior studies, racial/ethnic minorities and patients with lower income rated communication higher and reported higher trust in their clinicians than white and higher income patients. More research is needed to identify and understand factors associated with quality communication and trust between seriously ill patients and clinicians to guide development of patient-centered palliative care communication interventions.
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Affiliation(s)
- Heather Coats
- College of Nursing, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado, USA.
| | - Lois Downey
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA; Division of Pulmonary, Critical Care & Sleep Medicine, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Rashmi K Sharma
- Division of General Internal Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - J Randall Curtis
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA; Division of Pulmonary, Critical Care & Sleep Medicine, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Ruth A Engelberg
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA; Division of Pulmonary, Critical Care & Sleep Medicine, School of Medicine, University of Washington, Seattle, Washington, USA
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Zhao D, Zhao H, Cleary PD. Understanding the determinants of public trust in the health care system in China: an analysis of a cross-sectional survey. J Health Serv Res Policy 2018; 24:37-43. [PMID: 30176742 DOI: 10.1177/1355819618799113] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Despite increasing research attention on public trust in health care systems, empirical evidence on this topic in the developing world is limited and inconclusive. This paper examines the level and determinants of public trust in the health care system in China. METHODS We used data from a survey conducted with a sample of 5347 adults in all Chinese provincial areas between January and February 2016. Trust in the health care system was assessed with a question used by the 2011-2013 International Social Survey Programme (ISSP) to assess public trust in the health care systems of 29 industrialized countries and regions ('In general, how much confidence do you have in the health care system in your country?'). RESULTS Only 28% of respondents reported that they had a great deal or complete trust in China's health care system. Respondents who reported to have more trust in other people in society, more trust in the local government and who were more satisfied with their most recent health care system experience and their health insurance were significantly more likely to trust the country's health care system. Furthermore, respondents who reported a higher level of happiness, better health status and positive attitudes towards social equity were more likely to trust the health care system in China. CONCLUSIONS Our findings suggest that low public trust in China's health care system is a potential problem. Improving health care experiences may be the most practical and effective way of improving trust in the health care system in China.
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Affiliation(s)
- Dahai Zhao
- 1 Associate Professor, School of International and Public Affairs, Shanghai Jiao Tong University, China
| | - Hongyu Zhao
- 2 Ira V Hiscock Professor of Biostatistics, and Chair of the Department of Biostatistics, Yale School of Public Health, USA
| | - Paul D Cleary
- 3 Anna M.R. Lauder Professor of Public Health, Yale School of Public Health, USA
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Zhao D, Zhao H, Cleary PD. International variations in trust in health care systems. Int J Health Plann Manage 2018; 34:130-139. [DOI: 10.1002/hpm.2597] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 07/04/2018] [Indexed: 11/09/2022] Open
Affiliation(s)
- Dahai Zhao
- School of International and Public AffairsShanghai Jiao Tong University Shanghai China
| | - Hongyu Zhao
- Department of BiostatisticsYale School of Public Health New Haven CT USA
| | - Paul D. Cleary
- Department of Health Policy and ManagementYale School of Public Health New Haven CT USA
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Pandey SK, Sharma V. July 1 is National Doctors' Day: How to regain the lost public trust in healthcare? Indian J Ophthalmol 2018; 66:1045-1046. [PMID: 29941770 PMCID: PMC6032718 DOI: 10.4103/ijo.ijo_976_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Suresh K Pandey
- SuVi Eye Institute and Lasik Laser Center, Kota, Rajasthan, India
| | - Vidushi Sharma
- SuVi Eye Institute and Lasik Laser Center, Kota, Rajasthan, India
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Perelman J, Chaves P, de Almeida JMC, Matias MA. Reforming the Portuguese mental health system: an incentive-based approach. Int J Ment Health Syst 2018; 12:25. [PMID: 29853991 PMCID: PMC5975562 DOI: 10.1186/s13033-018-0204-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 05/11/2018] [Indexed: 11/25/2022] Open
Abstract
Background To promote an effective mental health system, the World Health Organization recommends the involvement of primary care in prevention and treatment of mild diseases and community-based care for serious mental illnesses. Despite a prevalence of lifetime mental health disorders above 30%, Portugal is failing to achieve such recommendations. It was argued that this failure is partly due to inadequate financing mechanisms of mental health care providers. This study proposes an innovative payment model for mental health providers oriented toward incentivising best practices. Methods We performed a comprehensive review of healthcare providers’ payment schemes and their related incentives, and a narrative review of best practices in mental health prevention and care. We designed an alternative payment model, on the basis of the literature, and then we presented it individually, through face-to-face interviews, to a panel of 22 experts with different backgrounds and experience, and from southern and northern Portuguese regions, asking them to comment on the model and provide suggestions. Then, after a first round of interviews, we revised our model, which we presented to experts again for their approval, and provide new suggestions and comments, if deemed necessary. This approach is close to what is generally known as the Delphi technique, although it was not applied in a rigid way. Results We designed a four-dimension model that focused on (i) the prevention of mental disorders early in life; (ii) the detection of mental disorders in childhood and adolescence; (iii) the implementation of a collaborative stepped care model for depression; and (iv) the integrated community-based care for patients with serious mental illnesses. First, we recommend a bundled payment to primary care practices for the follow-up of children with special needs or at risk under 2 years of age. Second, we propose a pay-for-performance scheme for all primary care practices, based on the number of users under 18 years old who are provided with check-up consultations. Third, we propose a pay-for-performance scheme for all primary care practices, based on the implementation of collaborative stepped care for depression. Finally, we propose a value-based risk-adjusted bundled payment for patients with serious mental illness. Conclusions The implementation of evidence-based best practices in mental health needs to be supported by adequate payment mechanisms. Our study shows that mental health experts, including decision makers, agree with using economic tools to support best practices, which were also consensual.
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Affiliation(s)
- Julian Perelman
- 1Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560 Lisbon, Portugal.,2Centro de Investigação em Saúde Publica, Escola Nacional de Saúde Pública, Avenida Padre Cruz, 1600-560 Lisbon, Portugal
| | - Pedro Chaves
- 1Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560 Lisbon, Portugal.,4Nova School of Business and Economics, Universidade NOVA de Lisboa, Campus de Campolide, 1099-032 Lisbon, Portugal
| | - José Miguel Caldas de Almeida
- 3NOVA Medical School, Campus Sant'Ana, Pólo de Investigação, NMS, UNL, Rua do Instituto, Bacteriológico, no 5, 1150-082 Lisbon, Portugal
| | - Maria Ana Matias
- 1Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560 Lisbon, Portugal.,4Nova School of Business and Economics, Universidade NOVA de Lisboa, Campus de Campolide, 1099-032 Lisbon, Portugal
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They think you earn too much, but they probably don't care. Catheter Cardiovasc Interv 2018; 91:1068-1069. [DOI: 10.1002/ccd.27626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 03/15/2018] [Indexed: 11/07/2022]
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Jager AJ, Tutty MA, Kao AC. Association Between Physician Burnout and Identification With Medicine as a Calling. Mayo Clin Proc 2017; 92:415-422. [PMID: 28189341 DOI: 10.1016/j.mayocp.2016.11.012] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 11/08/2016] [Accepted: 11/14/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the association between degree of professional burnout and physicians' sense of calling. PARTICIPANTS AND METHODS US physicians across all specialties were surveyed between October 24, 2014, and May 29, 2015. Professional burnout was assessed using a validated single-item measure. Sense of calling, defined as committing one's life to personally meaningful work that serves a prosocial purpose, was assessed using 6 validated true-false items. Associations between burnout and identification with calling items were assessed using multivariable logistic regressions. RESULTS A total of 2263 physicians completed surveys (63.1% response rate). Among respondents, 28.5% (n=639) reported experiencing some degree of burnout. Compared with physicians who reported no burnout symptoms, those who were completely burned out had lower odds of finding their work rewarding (odds ratio [OR], 0.05; 95% CI, 0.02-0.10; P<.001), seeing their work as one of the most important things in their lives (OR, 0.38; 95% CI, 0.21-0.69; P<.001), or thinking their work makes the world a better place (OR, 0.38; 95% CI, 0.17-0.85; P=.02). Burnout was also associated with lower odds of enjoying talking about their work to others (OR, 0.23; 95% CI, 0.13-0.41; P<.001), choosing their work life again (OR, 0.11; 95% CI, 0.06-0.20; P<.001), or continuing with their current work even if they were no longer paid if they were financially stable (OR, 0.30; 95% CI, 0.15-0.59; P<.001). CONCLUSION Physicians who experience more burnout are less likely to identify with medicine as a calling. Erosion of the sense that medicine is a calling may have adverse consequences for physicians as well as those for whom they care.
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Affiliation(s)
- Andrew J Jager
- Ethics Standards Group, American Medical Association, Chicago, IL
| | - Michael A Tutty
- Professional Satisfaction and Practice Sustainability Group, American Medical Association, Chicago, IL
| | - Audiey C Kao
- Ethics Standards Group, American Medical Association, Chicago, IL.
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Turner RJ, Brown TN, Hale WB. Race, Socioeconomic Position, and Physical Health: A Descriptive Analysis. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2017; 58:23-36. [PMID: 28661769 DOI: 10.1177/0022146516687008] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A substantial and long-standing body of research supports the widely held conclusion that socioeconomic position (SEP) is a primary determinant of physical health risk. However, supporting evidence derives almost entirely from studies of dominantly white populations, and more recent research suggests that this relationship may vary across race-ethnicity. This article considers the extent to which such evidence applies to African Americans. It does so by examining the within-race relationships between SEP and physical health utilizing alternative research definitions of health and a nearly exhaustive array of measures of SEP. The results offer minimal support for SEP as a fundamental cause of disease among African Americans. They do not challenge the widely held view that health differences are rooted in the fundamental conditions of social context and experience. Rather, they indicate that these conditions tend to be defined more by being black than by being of lower SEP.
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Orom H, Underwood W, Cheng Z, Homish DL, Scott I. Relationships as Medicine: Quality of the Physician-Patient Relationship Determines Physician Influence on Treatment Recommendation Adherence. Health Serv Res 2016; 53:580-596. [PMID: 27981559 DOI: 10.1111/1475-6773.12629] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To determine whether quality of physician-patient relationships influences uptake of physician treatment recommendations in men with clinically localized prostate cancer (PCa). STUDY SETTING Data were collected July 2010 to August 2014 at two cancer centers and three community facilities. STUDY DESIGN Analyses were prospective and cross-sectional. We modeled associations between quality of the patient-physician relationship and influence of physician recommendations on treatment choice using generalized estimating equations (GEE). DATA COLLECTION Data were collected via survey and medical record abstraction. PRINCIPAL FINDINGS Participants (N = 1166) were 14.7 percent minority; 37.1 percent had low-, 47.5 percent had intermediate-, and 15.4 percent had high-risk PCa. Those reporting a better physician-patient relationship perceived that their physician's treatment recommendation was more influential (RR = 1.05, 95 percent CI = 1.04-1.05, p < .001) and were more likely to choose the recommended treatment (OR = 2.92, 95 percent CI = 2.39, 3.58, p < .001). A pattern of interactions emerged indicating that quality of the physician-patient relationship was more strongly associated with influence of recommendations for more, versus less aggressive treatment in those with low-risk, but not intermediate-risk disease. CONCLUSIONS Prioritizing quality of the physician-patient relationship through training, practice change, and patient feedback may increase adherence. However, strategies need to align with efforts to reduce physician recommendations for inefficacious treatments to prevent overtreatment.
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Affiliation(s)
- Heather Orom
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY
| | - Willie Underwood
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY
| | - Zinan Cheng
- Touro College of Osteopathic Medicine, Middletown, NY
| | - D Lynn Homish
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY
| | - I'Yanna Scott
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY
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Samson FL. Support for immigration reduction and physician distrust in the United States. SAGE Open Med 2016; 4:2050312116652567. [PMID: 27621801 PMCID: PMC5006807 DOI: 10.1177/2050312116652567] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 05/04/2016] [Indexed: 11/16/2022] Open
Abstract
Objectives: Health research indicates that physician trust in the United States has declined over the last 50 years. Paralleling this trend is a decline in social capital, with researchers finding a negative relationship between immigration-based diversity and social capital. This article examines whether physician distrust is also tied to immigration-based diversity and declining social capital. Methods: Data come from the 2012 General Social Survey, one of the gold standards of US public opinion surveys, using a national probability sample of 1080 adult US respondents. Key measures included support for reducing levels of immigration to the United States and multiple measures of physician trust. Results: The results of ordinary least squares regressions, using survey weights, indicate that support for reducing immigration is positively linked to physician distrust, bringing physician distrust into the orbit of research on diversity and declining social capital. Models controlled for age, education, income, gender, race, nativity, conservatism, unemployed status, lack of health insurance, and self-rated health. Furthermore, analyses of a subset of respondents reveal that measures of general trust and some forms of institutional trust do not explain away the association between support for immigration reduction and physician distrust, though confidence in science as an institution appears relevant. Conclusion: Consistent with diversity and social capital research, this article finds that an immigration attitude predicts physician distrust. Physician distrust may not be linked just to physician–patient interactions, the structure of the health care system, or health policies, but could also be tied to declining social trust in general.
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Andoh-Adjei FX, Cornelissen D, Asante FA, Spaan E, van der Velden K. Does capitation payment under national health insurance affect subscribers' trust in their primary care provider? a cross-sectional survey of insurance subscribers in Ghana. BMC Health Serv Res 2016; 16:437. [PMID: 27557551 PMCID: PMC4997684 DOI: 10.1186/s12913-016-1622-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 08/02/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ghana introduced capitation payment for primary care in 2012 with the view to containing escalating claims expenditure. This shift in provider payment method raised issues about its potential impact on patient-provider trust relationship and insured-patients' trust in the Ghana National Health Insurance Scheme. This paper presents findings of a study that explored insured-patients' perception about, and attitude towards capitation payment in Ghana; and determined whether capitation payment affect insured-patients' trust in their preferred primary care provider and the National Health Insurance Scheme in general. METHODS We adopted a survey design for the study. We administered closed-ended questionnaires to collect data from insurance card-bearing members aged 18 years and above. We performed both descriptive statistics to determine proportions of observations relating to the variables of interest and chi-square test statistics to determine differences within gender and setting. RESULTS Sixty-nine per cent (69 %) out of 344 of respondents selected hospital level of care as their primary care provider. The two most important motivations for the choice of a provider were proximity in terms of geographical access (40 %) and perceived quality of care (38 %). Eighty-eight per cent (88 %) rated their trust in their provider as (very) high. Eighty-two per cent (82 %) actively selected their providers. Eighty-eight per cent (88 %) had no intention to switch provider. A majority (91 %) would renew their membership when it expires. Female respondents (91 %; n = 281) were more likely to renew their membership than males (87 %; n = 63). Notwithstanding capitation payment experience, 81 % of respondents would recommend to their peers to enrol with the NHIS with rural dwellers (87 %; n = 156) being more likely to do so than urban dwellers (76 %; n = 188). Almost all respondents (92 %) rated the NHIS as (very) good. CONCLUSION Health Insurance subscribers in Ghana have high trust in their primary care provider giving them quality care under capitation payment despite their negative attitude towards capitation payment. They are guided by proximity and quality of care considerations in their choice of provider. The NHIA would, however, have to address itself to the negative perceptions about the capitation payment policy.
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Affiliation(s)
| | - Dennis Cornelissen
- GROW-School of Oncology and Developmental Biology, Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre-The Netherlands, Maastricht, Netherlands
| | - Felix Ankomah Asante
- Institute of Statistical, Social and Economic Research (ISSER) University of Ghana, Legon-Accra, Ghana
| | - Ernst Spaan
- Radboud Institute for Health Science, Department for Health Evidence, Radboud University Medical Center-Netherlands, Nijmegen, Netherlands
| | - Koos van der Velden
- Radboud Institute for Health Science, Department for Primary and Community Health, Radboud University Medical Centre-Netherlands, Nijmegen, Netherlands
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Grembowski DE, Patrick DL, Williams B, Diehr P, Martin DP. Managed Care and Patient-Rated Quality of Care from Primary Physicians. Med Care Res Rev 2016; 62:31-55. [PMID: 15643028 DOI: 10.1177/1077558704271720] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim is to determine the associations between managed care controls and patient-rated quality of care from primary physicians. In a prospective cohort study, 17,187 patients were screened in the waiting rooms of 261 primary care physicians in the Seattle metropolitan area (1996-1997) to identify 2,850 English-speaking adult patients with depressive symptoms and/or selected pain problems. Patients completed 6-month follow-ups to rate the quality of care from their primary physicians. The intensity of managed care was measured for each patient’s health plan, primary care office, and physician. Regression analyses revealed that patients in more managed plans and offices had lower ratings of the quality of care from their primary physicians. Managed care controls targeting physicians were generally not associated with patient ratings.
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van den Berk-Clark C, McGuire J. Trust in health care providers: factors predicting trust among homeless veterans over time. J Health Care Poor Underserved 2016; 25:1278-90. [PMID: 25130239 DOI: 10.1353/hpu.2014.0115] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We examined whether a combination of predisposing, enabling, need, and primary care experience variables would predict trust in medical health care providers for homeless veterans over 18 months. Linear mixed model analysis indicated that, among these variables, race, social support, service-connected disability status, and satisfaction and continuity with providers predicted trust in provider over time. Trust in providers improved during the initial stages of the relationship between patient and provider and then declined to slightly below baseline levels over time. Further research is needed to determine generalizability and effects of provider trust on patient health care status over longer periods of time.
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Schnittker J. Social Distance in the Clinical Encounter: Interactional and Sociodemographic Foundations for Mistrust in Physicians. SOCIAL PSYCHOLOGY QUARTERLY 2016. [DOI: 10.1177/019027250406700301] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although many observers have drawn attention to the low levels of trust in physicians among members of racial/ethnic minorities and those of lower socioeconomic status, the reasons for this mistrust are not well understood. Using a social distance perspective and a large, nationally representative data set, I find that blacks and Hispanics are less trusting of their personal physicians than are whites and that education and income both increase physician trust. A fraction of each of these differences can be explained by physicians' behavior (the perceived thoroughness of the last examination, how well the physician listened, and how well the physician explained), but most of each difference remains well after physicians' behavior is held constant. The otherwise positive, strong effect of physicians' behavior has only a limited capacity to explain these differences because social distance moderates the strength of the effect of that behavior. For blacks, Hispanics, and those of lower socioeconomic status, physicians' behavior exerts much less effect on trust than for whites and those of higher socioeconomic status. A social distance perspective helps to explain this downweighting, as well as the divergent ways in which different sociodemographic groups evaluate physicians. By understanding the inference of trust as a social cognitive process, scholars can understand more clearly why some groups are more receptive to physicians than others, and why some groups' mistrust is more resistant to updating.
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Hoff T, Collinson GE. How Do We Talk About the Physician-Patient Relationship? What the Nonempirical Literature Tells Us. Med Care Res Rev 2016; 74:251-285. [PMID: 27147640 DOI: 10.1177/1077558716646685] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The physician-patient relationship is an important ideal, and a construct central to discussions regarding health systems change and innovation. This review examines the nonempirical literature focused on the physician-patient relationship published over the past 15 years. The review's results show a literature that is heavily context bound, relies on a combination of informational and emotional appeals to influence readers, and is mostly focused on portraying the state of this relationship in negative ways. Characteristics of the relationship such as trust, communication, and information are particularly focused on, while other important features like empathy remain less addressed. The review's findings suggest broadening the perspective regarding how the physician-patient relationship is construed, in order to take advantage of its increased importance in the modern health care marketplace, and to account for new relational dynamics between providers and patients suggested by innovations in care delivery.
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Klein E, Solomon AJ, Corboy J, Bernat J. Physician compensation for industry-sponsored clinical trials in multiple sclerosis influences patient trust. Mult Scler Relat Disord 2016; 8:4-8. [PMID: 27456867 DOI: 10.1016/j.msard.2016.04.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 03/30/2016] [Accepted: 04/05/2016] [Indexed: 01/26/2023]
Abstract
BACKGROUND Perceived physician financial conflicts of interest of can affect patient trust. Payment to physicians for industry sponsored clinical trials in multiple sclerosis is a relatively new potential source of physician conflict of interest. There is limited available data on how physician payment for trial involvement in multiple sclerosis clinical trials may influence patient trust. OBJECTIVE To understand how patient trust is influenced by information about physician payment for multiple sclerosis clinical trials. METHODS An anonymous online instrument was developed. RESULTS 597 people with multiple sclerosis participated in the study. The study found that 61% of patients who had not previously participated in a clinical trial estimated that they would have lower levels of trust in their physician if the physician was paid for involvement in their clinical trial. Among former clinical trial participants, 38% self-reported a lower level of trust. Other potential physician-industry relationships, such as industry consulting or giving industry-sponsored talks, also adversely affected trust, though to a lesser extent than physician payment for subject participation in clinical trials. CONCLUSIONS Results of this study demonstrate that physician payment for study participation in multiple sclerosis clinical trials is a potential conflict that can adversely affect patient trust.
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Affiliation(s)
- E Klein
- Neurology Service, Portland VA Medical Center, United States; Department of Neurology, Oregon Health and Science University, United States; Center for Sensorimotor Neural Engineering and Department of Philosophy, University of Washington, United States.
| | - A J Solomon
- Department of Neurological Sciences, University of Vermont, United States
| | - J Corboy
- Department of Neurology, University of Colorado, United States
| | - J Bernat
- Department of Neurology, Geisel School of Medicine at Dartmouth, United States
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Turner RJ, Thomas CS, Brown TH. Childhood adversity and adult health: Evaluating intervening mechanisms. Soc Sci Med 2016; 156:114-24. [PMID: 27030896 DOI: 10.1016/j.socscimed.2016.02.026] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 02/14/2016] [Accepted: 02/16/2016] [Indexed: 11/17/2022]
Abstract
Substantial evidence has accumulated supporting a causal link between childhood adversity and risk for poor health years and even decades later. One interpretation of this evidence is that this linkage arises largely or exclusively from a process of biological embedding that is not modifiable by subsequent social context or experience - implying childhood as perhaps the only point at which intervention efforts are likely to be effective. This paper considers the extent to which this long-term association arises from intervening differences in social context and/or environmental experiences - a finding that would suggest that post-childhood prevention efforts may also be effective. Based on the argument that the selected research definition of adult health status may have implications for the early adversity-adult health linkage, we use a representative community sample of black and white adults (N = 1252) to evaluate this relationship across three health indices: doctor diagnosed illnesses, self-rated health, and allostatic load. Results generally indicate that observed relationships between childhood adversity and dimensions of adult health status were totally or almost totally accounted for by variations in adult socioeconomic position (SEP) and adult stress exposure. One exception is the childhood SEP-allostatic load association, for which a statistically significant relationship remained in the context of adult stress and SEP. This lone finding supports a conclusion that the impact of childhood adversity is not always redeemable by subsequent experience. However, in general, analyses suggest the likely utility of interventions beyond childhood aimed at reducing exposure to social stress and improving social and economic standing. Whatever the effects on adult health that derive from biological embedding, they appear to be primarily indirect effects through adult social context and exposure.
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Esmaeili R, Hadian M, Rashidian A, Shariati M, Ghaderi H. The Experience of Risk-Adjusted Capitation Payment for Family Physicians in Iran: A Qualitative Study. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e23782. [PMID: 27340558 PMCID: PMC4916528 DOI: 10.5812/ircmj.23782] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Revised: 10/08/2014] [Accepted: 10/25/2014] [Indexed: 11/17/2022]
Abstract
Background When a country’s health system is faced with fundamental flaws that require the redesign of financing and service delivery, primary healthcare payment systems are often reformed. Objectives This study was conducted with the purpose of exploring the experiences of risk-adjusted capitation payment of urban family physicians in Iran when it comes to providing primary health care (PHC). Materials and Methods This is a qualitative study using the framework method. Data were collected via digitally audio-recorded semi-structured interviews with 24 family physicians and 5 executive directors in two provinces of Iran running the urban family physician pilot program. The participants were selected using purposive and snowball sampling. The codes were extracted using inductive and deductive methods. Results Regarding the effects of risk-adjusted capitation on the primary healthcare setting, five themes with 11 subthemes emerged, including service delivery, institutional structure, financing, people’s behavior, and the challenges ahead. Our findings indicated that the health system is enjoying some major changes in the primary healthcare setting through the implementation of risk-adjusted capitation payment. Conclusions With regard to the current challenges in Iran’s health system, using risk-adjusted capitation as a primary healthcare payment system can lead to useful changes in the health system’s features. However, future research should focus on the development of the risk-adjusted capitation model.
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Affiliation(s)
- Reza Esmaeili
- Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, IR Iran
| | - Mohammad Hadian
- Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Mohammad Hadian, Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, IR Iran. Tel: +98-2188794302, Fax: +98-2188883334, E-mail:
| | - Arash Rashidian
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Mohammad Shariati
- Community Medicine Department, School of Medicine, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Hossien Ghaderi
- Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, IR Iran
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