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Freeman-Hildreth Y, Aron D, Cola PA, Jr RB, Wang Y. Empowering diabetes management: The impact of patient-provider collaboration on type 2 diabetes outcomes through autonomy support and shared decision-making. PATIENT EDUCATION AND COUNSELING 2024; 127:108348. [PMID: 38870706 DOI: 10.1016/j.pec.2024.108348] [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: 08/21/2023] [Revised: 05/18/2024] [Accepted: 06/06/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVES Through the lens of self-determination theory, this quantitative study investigates how patient-provider collaboration through perceived shared decision-making (SDM) and autonomy support impact type 2 diabetes (T2D) outcomes. METHODS We sampled 474 individuals over 18 years old who self-identified as having T2D. Completed and valid responses were received from 378 participants from two separate groups in an online survey. Data was analyzed using the IBM Statistical Package for Social Sciences (SPSS), AMOS package, version 28, and Mplus, version 8.8. RESULTS Patient-provider collaboration through autonomy support improved treatment satisfaction (β = .16, ρ < .05) and self-management adherence (β = .43, ρ < .001). While collaboration through SDM improved treatment satisfaction (β = .25, ρ < .01), it worsened SM adherence (β = -.31, ρ < .001). The negative impact of SDM on self-management adherence was mitigated by our moderator, coping ability. However, coping ability minimally impacted treatment satisfaction and SM adherence when autonomous support was provided. CONCLUSIONS Autonomy support increases treatment satisfaction and self-management adherence. SDM enhances treatment satisfaction but may adversely affect self-management adherence. The study also suggests that coping ability can mitigate the negative effect of SDM on self-management adherence, although its influence is limited when autonomy support is provided by the provider. PRACTICAL IMPLICATIONS For providers, SDM and autonomy support permits shared power over treatment decisions while fostering independence over self-management tasks. Providers should evaluate patients' coping ability and adapt their approach to care based on the patient's coping capacity.
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Affiliation(s)
| | - David Aron
- Department of Medicine, Case Western Reserve University, Louis Stokes VA Medical Center, Cleveland, OH, USA
| | - Philip A Cola
- Weatherhead Department of Management, Design and Innovation, Case Western Reserve University, Cleveland, OH, USA
| | - Richard Boland Jr
- Weatherhead Department of Management, Design and Innovation, Case Western Reserve University, Cleveland, OH, USA
| | - Yunmei Wang
- Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
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Cushnahan A, Sie BS, Wadhwa V. Impact of a codesigned and coproduced patient-centred discharge form on communication and understanding. Singapore Med J 2024:00077293-990000000-00125. [PMID: 38967376 DOI: 10.4103/singaporemedj.smj-2019-224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 03/17/2020] [Indexed: 07/06/2024]
Abstract
INTRODUCTION Adverse clinical outcomes and patient dissatisfaction with care often have elements of poor communication. Factors such as illness and pharmacotherapy can affect cognition, and overestimation of patients' health literacy may contribute to suboptimal communication with patients regarding their hospitalisation and post-discharge instructions. Improved patient understanding and recall of their diagnoses and treatment is critical for adherence to treatment, follow-up and optimal clinical outcomes. The aim of the study was to assess whether a coproduced and codesigned patient-centred discharge form (PCDF) improves patients' understanding of their discharge diagnosis, in-hospital treatment and post-discharge plan. METHODS A sample of 111 patients was enrolled through simple randomisation by admission to one of two identically operating general medicine wards. Over a 3-month period, 59 patients received the coproduced and codesigned form and 52 patients were controls. Assessment of patients' understanding of diagnosis, in-hospital management, post-discharge instructions and overall experience of care was undertaken by a blinded phone survey conducted approximately 6 days after discharge. RESULTS Patients who received PCDF were significantly more likely to report adequate understanding of their hospital management (P < 0.001) and the post-discharge plan (P < 0.001). There was no statistically significant difference between the intervention and control groups in terms of understanding of diagnosis. Patients who received PCDF reported better understanding of care and recall of admission. CONCLUSION The use of PCDF is associated with improved patient understanding with respect to their hospital management and post-discharge instructions. It is also associated with high levels of satisfaction as assessed by measures of patient experience.
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Affiliation(s)
- Aiden Cushnahan
- Department of Medicine, Eastern Health, Monash and Deakin Universities, Melbourne, Victoria, Australia
| | - Boon Shih Sie
- Department of Medicine, Eastern Health, Monash and Deakin Universities, Melbourne, Victoria, Australia
| | - Vikas Wadhwa
- Department of Medicine, Eastern Health, Monash and Deakin Universities, Melbourne, Victoria, Australia
- Eastern Health Clinical School, Monash and Deakin Universities, Melbourne, Victoria, Australia
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Kuchinad K, Park JR, Han D, Saha S, Moore R, Beach MC. Which clinician responses to emotion are associated with more positive patient experiences of communication? PATIENT EDUCATION AND COUNSELING 2024; 124:108241. [PMID: 38537316 DOI: 10.1016/j.pec.2024.108241] [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: 11/01/2023] [Revised: 02/12/2024] [Accepted: 03/03/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVES To identify communication strategies that may improve clinician-patient interactions, we assessed the association between clinician response to emotion and patient ratings of communication. METHODS From a cohort of 1817 clinician-patient encounters, we designed a retrospective case-control study by identifying 69 patients who rated their interpersonal care as low-quality and 69 patients who rated their care as high-quality. We used the Verona Coding Definitions of Emotional Sequences (VR-CoDES) to identify patient emotional expressions and clinician responses. Using mixed-effects logistic regression, we evaluated the association between clinician responses to patients' emotions and patient ratings of their interpersonal care. RESULTS In adjusted analyses, explicit responses that reduced space for further emotional communication were associated with high ratings of care (OR 1.94, 95% CI 1.25, 2.99); non-explicit responses providing additional space were associated with low ratings (OR 0.54, 95% CI 0.36-0.82). In terms of specific response types, neutral/passive responses were associated with low ratings (OR 0.59, 95% CI 0.39-0.90), whereas giving information/advice was associated with high ratings (OR, 95% 1.91 CI 1.17-3.1). CONCLUSIONS Patients may prefer responses to their expressed emotions that demonstrate clinician engagement, with or without expressions of empathy. PRACTICE IMPLICATIONS These findings may inform educational interventions to improve clinician-patient communication.
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Affiliation(s)
- Kamini Kuchinad
- Department of Rheumatology, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Jenny Rose Park
- Oregon Health and Science University, Portland, OR, United States
| | - Dingfen Han
- Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Somnath Saha
- Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Richard Moore
- Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Mary Catherine Beach
- Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, MD, United States; Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, United States; Center for Health Equity, Johns Hopkins University, Baltimore, MD, United States.
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Jayanti S, Rangan GK. Advances in Human-Centered Care to Address Contemporary Unmet Needs in Chronic Dialysis. Int J Nephrol Renovasc Dis 2024; 17:91-104. [PMID: 38525412 PMCID: PMC10961023 DOI: 10.2147/ijnrd.s387598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 03/12/2024] [Indexed: 03/26/2024] Open
Abstract
Advances in the treatment of kidney failure with chronic dialysis have stagnated over the past three decades, with over 50% of patients still managed by conventional in-hospital haemodialysis. In parallel, the demands of chronic dialysis medical care have changed and evolved due to a growing population that has higher frailty and multimorbidity. Thus, the gap between the needs of kidney failure patients and the healthcare capability to provide effective overall management has widened. To address this problem, healthcare policy has increasingly aligned towards a human-centred approach. The paradigm shift of human-centred approach places patients at the forefront of decision-making processes, ensuring that specific needs are understood and prioritised. Integration of human-centred approaches with patient care has been shown to improve satisfaction and quality of life. The aim of this narrative is to evaluate the current clinical challenges for managing kidney failure for dialysis providers; summarise current experiences and unmet needs of chronic dialysis patients; and finally emphasise how human-centred care has advanced chronic dialysis care. Specific incremental advances include implementation of renal supportive care; home-assisted dialysis; hybrid dialysis; refinements to dialysis methods; whereas emerging advances include portable and wearable dialysis devices and the potential for the integration of artificial intelligence in clinical practice.
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Affiliation(s)
- Sumedh Jayanti
- Department of Renal Medicine, Westmead Hospital, Sydney, NSW, Australia
- Michael Stern Laboratory for Polycystic Kidney Disease, Centre for Transplant and Renal Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Gopala K Rangan
- Department of Renal Medicine, Westmead Hospital, Sydney, NSW, Australia
- Michael Stern Laboratory for Polycystic Kidney Disease, Centre for Transplant and Renal Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
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Khaleghzadegan S, Rosen M, Links A, Ahmad A, Kilcullen M, Boss E, Beach MC, Saha S. Validating computer-generated measures of linguistic style matching and accommodation in patient-clinician communication. PATIENT EDUCATION AND COUNSELING 2024; 119:108074. [PMID: 38070297 PMCID: PMC11349046 DOI: 10.1016/j.pec.2023.108074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 11/07/2023] [Accepted: 11/13/2023] [Indexed: 12/29/2023]
Abstract
OBJECTIVE To explore the validity of computer-analyzed linguistic style matching (LSM) in patient-clinician communication. METHODS Using 330 transcribed HIV patient encounters, we quantified word use with Linguistic Inquiry and Word Count (LIWC), a dictionary-based text analysis software. We measured LSM by calculating the degree to which clinicians matched patients in the use of LIWC "function words" (e.g., articles, pronouns). We tested associations of different LSM metrics with patients' perceptions that their clinicians spoke similiarly to them. RESULTS We developed 3 measures of LSM: 1) at the whole-visit level; (2) at the turn-by-turn level; and (3) using a "rolling-window" approach, measuring matching between clusters of 8 turns per conversant. None of these measures was associated with patient-rated speech similarity. However, we found that increasing trajectories of LSM, from beginning to end of the visit, were associated with higher patient-rated speech similarity (β 0.35, CI 0.06, 0.64), compared to unchanging trajectories. CONCLUSIONS Our findings point to the potential value of clinicians' adapting their communication style to match their patients, over the course of the visit. PRACTICE IMPLICATIONS With further validation, computer-based linguistic analyses may prove an efficient tool for generating data on communication patterns and providing feedback to clinicians in real time.
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Affiliation(s)
- Salar Khaleghzadegan
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD, USA; The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA.
| | - Michael Rosen
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Anne Links
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alya Ahmad
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Molly Kilcullen
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Emily Boss
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mary Catherine Beach
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Somnath Saha
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA; Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, USA
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Altshuler L, Wilhite JA, Hardowar K, Crowe R, Hanley K, Kalet A, Zabar S, Gillespie C, Ark T. Understanding medical student paths to communication skills expertise using latent profile analysis. MEDICAL TEACHER 2023; 45:1140-1147. [PMID: 36961759 DOI: 10.1080/0142159x.2023.2193303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
PURPOSE To describe patterns of clinical communication skills that inform curriculum enhancement and guide coaching of medical students. MATERIALS AND METHODS Performance data from 1182 consenting third year medical students in 9 cohorts (2011-2019), on a 17-item Clinical Communication Skills Assessment Tool (CCSAT) completed by trained Standardized Patients as part of an eight case high stakes Comprehensive Clinical Skills Exam (CCSE) were analyzed using latent profile analysis (LPA). Assessment domains included: information gathering (6 items), relationship development (5 items), patient education (3 items), and organization/time management (3 items). LPA clustered learners with similar strength/weakness into profiles based on item response patterns across cases. One-way analysis of variance (ANOVA) assessed for significant differences by profile for CCSAT items. RESULTS Student performance clustered into six profiles in three groups, high performing (HP1 and HP2-Low Patient Education, 15.7%), average performing (AP1 and AP2-Interrupters, 40.9%), and lower performing profiles (LP1-Non-interrupters and LP2, 43.4%) with adequate model fit estimations and similar distribution in each cohort. We identified 3 CCSAT items that discriminated among learner's skill profiles. CONCLUSION Clinical communication skill performance profiles provide nuanced, benchmarked guidance for curriculum improvement and tailoring of communication skills coaching.
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Affiliation(s)
- Lisa Altshuler
- NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA
| | - Jeffrey A Wilhite
- NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA
| | - Khemraj Hardowar
- NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA
| | - Ruth Crowe
- NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA
| | - Kathleen Hanley
- NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA
| | - Adina Kalet
- Kern Institute, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sondra Zabar
- NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA
| | - Colleen Gillespie
- Institute for Innovations in Medical Education, NYU Grossman School of Medicine, New York, NY, USA
| | - Tavinder Ark
- Kern Institute, Medical College of Wisconsin, Milwaukee, WI, USA
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Kim NJ, Lee MK. Structural equation modeling for associated factors with self-care behavior among young and middle-aged hypertensive patients: a cross-sectional study. Contemp Nurse 2023:1-15. [PMID: 37335772 DOI: 10.1080/10376178.2023.2226252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 06/08/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Self-determination theory (SDT) states that the self-care behaviors of patients with chronic illnesses are affected by an autonomy-supportive healthcare climate, satisfaction of autonomy, competence, and relatedness. Autonomy-supportive healthcare climate means to provide interpersonal conditions that support the person's volition, initiative, and integrity. OBJECTIVE The aim of this study was to explore the structural relationships of an autonomy-supportive healthcare climate, as well as the perception of illness consequences, autonomy, competence, and relatedness with self-care behaviors among adult outpatients with hypertension. DESIGN A cross-sectional survey was conducted in 2020 across three hospitals outpatient clinics in South Korea. METHODS A questionnaire package containing instruments measuring the perception of autonomy-supportive healthcare climate, autonomy, competence, relatedness, perception of illness consequence, self-care behaviors, sociodemographic data, and disease-related characteristics among the patients. The hypothetical model was derived from the SDT. Data were analyzed to test the hypothetical model and propose the final model. RESULTS Complete survey data was provided by 228 participants. Overall, the findings supported the hypothesized model (Goodness-of-Fit Index = 0.90 and Comparative Fit Index = 0.99). An autonomy-supportive healthcare climate and autonomy, competence, and relatedness directly influenced the self-care behaviors of adult hypertensive patients. However, the perception of illness consequences did not have a significant direct effect on self-care behavior. CONCLUSION Improving the autonomy-supportive healthcare climate, as well as positive perception of illness consequences, autonomy, competence, and relatedness among patients positively affects self-care behavior. Thus, an authentic partnership between healthcare providers and hypertensive patients is required to enhance trust, cooperation, and adaptation, consequently improving self-care behaviors among patients. IMPACT STATEMENT Autonomy-supportive healthcare climate was both directly and indirectly associated with self-care behavior that mediates autonomy, competence, and relatedness among young and middle-aged hypertensive patients.
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Affiliation(s)
- Nam Jo Kim
- College of Nursing, Suseong University, Daegu, Korea
| | - Myung Kyung Lee
- College of Nursing, Research Institute of Nursing Science, Kyungpook National University, Daegu, Korea
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Büdenbender B, Köther AK, Grüne B, Michel MS, Kriegmair MC, Alpers GW. When attitudes and beliefs get in the way of shared decision-making: A mediation analysis of participation preference. Health Expect 2023; 26:740-751. [PMID: 36639880 PMCID: PMC10010103 DOI: 10.1111/hex.13699] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 11/26/2022] [Accepted: 12/22/2022] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Certain sociodemographic characteristics (e.g., older age) have previously been identified as barriers to patients' participation preference in shared decision-making (SDM). We aim to demonstrate that this relationship is mediated by the perceived power imbalance that manifests itself in patients' negative attitudes and beliefs about their role in decision-making. METHODS We recruited a large sample (N = 434) of outpatients with a range of urological diagnoses (42.2% urooncological). Before the medical consultation at a university hospital, patients completed the Patients' Attitudes and Beliefs Scale and the Autonomy Preference Index. We evaluated attitudes as a mediator between sociodemographic factors and participation preference in a path model. RESULTS We replicated associations between relevant sociodemographic factors and participation preference. Importantly, attitudes and beliefs about one's own role as a patient mediated this relationship. The mediation path model explained a substantial proportion of the variance in participation preference (27.8%). Participation preferences and attitudes did not differ for oncological and nononcological patients. CONCLUSION Patients' attitudes and beliefs about their role determine whether they are willing to participate in medical decision-making. Thus, inviting patients to participate in SDM should encompass an assessment of their attitudes and beliefs. Importantly, negative attitudes may be accessible to change. Unlike stable sociodemographic characteristics, such values are promising targets for interventions to foster more active participation in SDM. PATIENT OR PUBLIC CONTRIBUTION This study was part of a larger project on implementing SDM in urological practice. Several stakeholders were involved in the design, planning and conduction of this study, for example, three authors are practising urologists, and three are psychologists with experience in patient care. In addition, the survey was piloted with patients, and their feedback was integrated into the questionnaire. The data presented in this study is based on patients' responses. Results may help to empower our patients.
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Affiliation(s)
- Björn Büdenbender
- Department of Psychology, School of Social SciencesUniversity of MannheimMannheimGermany
| | - Anja K. Köther
- Department of Psychology, School of Social SciencesUniversity of MannheimMannheimGermany
| | - Britta Grüne
- Department of Urology and Urosurgery, University Medical Center MannheimUniversity of HeidelbergMannheimGermany
| | - Maurice S. Michel
- Department of Urology and Urosurgery, University Medical Center MannheimUniversity of HeidelbergMannheimGermany
| | - Maximilian C. Kriegmair
- Department of Urology and Urosurgery, University Medical Center MannheimUniversity of HeidelbergMannheimGermany
| | - Georg W. Alpers
- Department of Psychology, School of Social SciencesUniversity of MannheimMannheimGermany
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Chang MW, Kung CT, Yu SF, Wang HT, Lin CL. Exploring the Critical Driving Forces and Strategy Adoption Paths of Professional Competency Development for Various Emergency Physicians Based on the Hybrid MCDM Approach. Healthcare (Basel) 2023; 11:healthcare11040471. [PMID: 36833005 PMCID: PMC9957007 DOI: 10.3390/healthcare11040471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/26/2023] [Accepted: 01/31/2023] [Indexed: 02/09/2023] Open
Abstract
The implementation of competency-based medical education (CBME) focuses on learners' competency outcomes and performance during their training. Competencies should meet the local demands of the healthcare system and achieve the desired patient-centered outcomes. Continuous professional education for all physicians also emphasizes competency-based training to provide high-quality patient care. In the CBME assessment, trainees are evaluated on applying their knowledge and skills to unpredictable clinical situations. A priority of the training program is essential in building competency development. However, no research has focused on exploring strategies for physician competency development. In this study, we investigate the professional competency state, determine the driving force, and provide emergency physicians' competency development strategies. We use the Decision Making Trial and Evaluation Laboratory (DEMATEL) method to identify the professional competency state and investigate the relationship among the aspects and criteria. Furthermore, the study uses the PCA (principal component analysis) method to reduce the number of components and then identify the weights of the aspects and components using the ANP (analytic network process) approach. Therefore, we can establish the prioritization of competency development of emergency physicians (EPs) with the VIKOR (Vlse kriterijumska Optimizacija I Kompromisno Resenje) approach. Our research demonstrates the priority of competency development of EPs is PL (professional literacy), CS (care services), PK (personal knowledge), and PS (professional skills). The dominant aspect is PL, and the aspect being dominated is PS. The PL affects CS, PK, and PS. Then, the CS affects PK and PS. Ultimately, the PK affects the PS. In conclusion, the strategies to improve the professional competency development of EPs should begin with the improvement from the aspect of PL. After PL, the following aspects that should be improved are CS, PK, and PS. Therefore, this study can help establish competency development strategies for different stakeholders and redefine emergency physicians' competency to reach the desired CBME outcomes by improving advantages and disadvantages.
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Affiliation(s)
- Meng-Wei Chang
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
- Chang Gung Medical Education Research Centre (CG-MERC), Taoyuan 333, Taiwan
- Graduate Institute of Adult Education, National Kaohsiung Normal University, Kaohsiung 802, Taiwan
| | - Chia-Te Kung
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Shan-Fu Yu
- Graduate Institute of Adult Education, National Kaohsiung Normal University, Kaohsiung 802, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan
| | - Hui-Ting Wang
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
- Chang Gung Medical Education Research Centre (CG-MERC), Taoyuan 333, Taiwan
- Graduate Institute of Adult Education, National Kaohsiung Normal University, Kaohsiung 802, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Chia-Li Lin
- Department of International Business, Ming Chuan University, Taipei 111, Taiwan
- Correspondence:
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Mavragani A, Schoonman GG, Maat B, Habibović M, Krahmer E, Pauws S. Patients Managing Their Medical Data in Personal Electronic Health Records: Scoping Review. J Med Internet Res 2022; 24:e37783. [PMID: 36574275 PMCID: PMC9832357 DOI: 10.2196/37783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 07/31/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Personal electronic health records (PEHRs) allow patients to view, generate, and manage their personal and medical data that are relevant across illness episodes, such as their medications, allergies, immunizations, and their medical, social, and family health history. Thus, patients can actively participate in the management of their health care by ensuring that their health care providers have an updated and accurate overview of the patients' medical records. However, the uptake of PEHRs remains low, especially in terms of patients entering and managing their personal and medical data in their PEHR. OBJECTIVE This scoping review aimed to explore the barriers and facilitators that patients face when deciding to review, enter, update, or modify their personal and medical data in their PEHR. This review also explores the extent to which patient-generated and -managed data affect the quality and safety of care, patient engagement, patient satisfaction, and patients' health and health care services. METHODS We searched the MEDLINE, Embase, CINAHL, PsycINFO, Cochrane Library, Web of Science, and Google Scholar web-based databases, as well as reference lists of all primary and review articles using a predefined search query. RESULTS Of the 182 eligible papers, 37 (20%) provided sufficient information about patients' data management activities. The results showed that patients tend to use their PEHRs passively rather than actively. Patients refrain from generating and managing their medical data in a PEHR, especially when these data are complex and sensitive. The reasons for patients' passive data management behavior were related to their concerns about the validity, applicability, and confidentiality of patient-generated data. Our synthesis also showed that patient-generated and -managed health data ensures that the medical record is complete and up to date and is positively associated with patient engagement and patient satisfaction. CONCLUSIONS The findings of this study suggest recommendations for implementing design features within the PEHR and the construal of a dedicated policy to inform both clinical staff and patients about the added value of patient-generated data. Moreover, clinicians should be involved as important ambassadors in informing, reminding, and encouraging patients to manage the data in their PEHR.
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Affiliation(s)
| | - Guus G Schoonman
- Department of Communication and Cognition, Tilburg School of Humanities and Digital Sciences, Tilburg University, Tilburg, Netherlands.,Department of Neurology, Elisabeth-TweeSteden Hospital, Tilburg, Netherlands
| | - Barbara Maat
- Department of Pharmacy, Elisabeth-TweeSteden Hospital, Tilburg, Netherlands
| | - Mirela Habibović
- Department of Medical and Clinical Psychology, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | - Emiel Krahmer
- Department of Communication and Cognition, Tilburg School of Humanities and Digital Sciences, Tilburg University, Tilburg, Netherlands
| | - Steffen Pauws
- Department of Communication and Cognition, Tilburg School of Humanities and Digital Sciences, Tilburg University, Tilburg, Netherlands.,Department of Remote Patient Management & Connected Care, Philips Research, Eindhoven, Netherlands
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Lee JJ, Hu HY, Lin SY, Huang CM, Huang SJ, Huang N. Factors Associated with Having Home Care Physicians as an Integrated Source of Medications for Chronic Conditions Among Homebound Patients. Int J Qual Health Care 2022; 34:6617285. [PMID: 35748484 DOI: 10.1093/intqhc/mzac055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 03/30/2022] [Accepted: 06/24/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Inappropriate management of medications is a major threat to homebound patients with chronic conditions. Despite many efforts in improving medication reconciliation in ambulatory and inpatient settings, little research has focused on home care settings. In 2016, Taiwan initiated the Integrated Home Health Care programme, which was intended to reduce potentially inappropriate medication management and risks of uncontrolled polypharmacy through the integration of different medication sources for chronic conditions among homebound patients. This study investigated factors associated with having home care physicians as an integrated source of medications for chronic conditions among homebound patients. METHODS This retrospective cohort study enrolled 3,142 community-dwelling homebound patients from Taipei City Hospital. Homebound patients' adherence to using home care physicians as an integrated source of chronic condition medications was defined as having all prescriptions for their chronic conditions prescribed by a single home care physician for at least six months. Both patient and home care physician characteristics were analysed. Multivariable logistic regression was applied. RESULTS Of the 3,142 patients with chronic conditions, 1,002 (31.9%) had consistently obtained all medications for their chronic illnesses from their home care physicians for 6 months and 2,140 (68.1%) had not. The most common chronic diseases among homebound patients were hypertension, diabetes mellitus, dementia, cerebrovascular disease, and constipation. Oldest-old patients with poor functional status, fewer daily medications, no co-payment exemption, and no recent inpatient experience were more likely to adhere to this medication integration system. In addition, patients whose outpatient physicians were also their home care physicians were more likely to adhere to the system. CONCLUSION The finding suggests that building trust and enhancing communication among homebound patients, caregivers, and home care physicians are critical. Patient and provider variations highlight the need for further improvement and policy modification for medication reconciliation and management in home care settings. The improvement in medication management and care integration in home care settings may reduce misuse and polypharmacy and improve homebound patients' safety.
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Affiliation(s)
- Jason Jiunshiou Lee
- Department of Family Medicine, Taipei City Hospital, Yangming Branch, No. 105, Yusheng Street, Shilin District, Taipei 111, Taiwan.,Institute of Public Health, National Yang Ming Chiao Tung University, No. 155, Sec.2, Linong Street, Taipei 112, Taiwan.,Department of Health and Welfare, University of Taipei, No. 101, Section 2, Zhongcheng Rd, Shilin District, Taipei 111, Taiwan.,Department of Education and Research, Taipei City Hospital, No. 10, Section 4, Ren'ai Rd, Da'an District, Taipei 106, Taiwan
| | - Hsiao-Yun Hu
- Institute of Public Health, National Yang Ming Chiao Tung University, No. 155, Sec.2, Linong Street, Taipei 112, Taiwan.,Department of Health and Welfare, University of Taipei, No. 101, Section 2, Zhongcheng Rd, Shilin District, Taipei 111, Taiwan.,Department of Education and Research, Taipei City Hospital, No. 10, Section 4, Ren'ai Rd, Da'an District, Taipei 106, Taiwan
| | - Shu-Yi Lin
- Department of Education and Research, Taipei City Hospital, No. 10, Section 4, Ren'ai Rd, Da'an District, Taipei 106, Taiwan
| | - Chao-Ming Huang
- Data Office, Superintendent Office, Taipei City Hospital, No. 145, Zhengzhou Rd, Datong District, Taipei 103, Taiwan
| | - Sheng-Jean Huang
- Superintendent Office, Taipei City Hospital, No. 145, Zhengzhou Rd, Datong District, Taipei 103, Taiwan.,Department of Surgery, College of Medicine, National Taiwan University, No. 7, Zhongshan S Rd, Zhongzheng District, Taipei 100, Taiwan
| | - Nicole Huang
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, No.155, Sec.2, Linong Street, Taipei 112, Taiwan
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12
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Toporovsky A, Fuertes JN, Moore MT, Anand P, Hungria FC. Physicians' and Patients' Ratings of the Physician-Patient Working Alliance, Adherence, Satisfaction, and Treatment Outcome. Behav Med 2022; 48:43-53. [PMID: 33750270 DOI: 10.1080/08964289.2020.1870430] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The physician-patient relationship is important and essential to the delivery of effective healthcare. The current study examined a measure of this relationship, which we call the physician-patient working alliance (PPWA). We examined it from both perspectives of the medical dyad, simultaneously, which to date has not been done. Data were analyzed via the Actor Partner Interdependence Model to account for the possibility of interdependence in the ratings provided by each member of the dyad. The sample consisted of sixty-eight physician-patient dyads. Patients' ratings of the PPWA were significantly associated with their ratings of adherence to, and satisfaction with treatment. Physicians' ratings of the PPWA were significantly associated with their ratings of patient adherence and to their own satisfaction with treatment. Significant "partner" effects were uncovered, in that physicians' ratings of the PPWA were significantly associated with patients' ratings of adherence. Significant zero-order correlations were also observed for physician-rated outcome; particularly, significant correlations with patient-rated and physician-rated adherence. We conclude that the PPWA is a significant factor in patients' and physicians' ratings of adherence and satisfaction. This study also provides initial evidence that the PPWA is a dyadic phenomenon (e.g., the perception of the strength of the PPWA in one member of the medical dyad impacts the other member's perception) and that both parts of the medical dyad should be considered in future research and in clinical practice.
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Affiliation(s)
| | - Jairo N Fuertes
- Derner School of Psychology, Adelphi University.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
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13
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Sturmbauer SC, Schwerdtfeger AR, Schmelzle S, Rohleder N. A laboratory medical anamnesis interview elicits psychological and physiological arousal. Stress 2022; 25:57-66. [PMID: 34935585 DOI: 10.1080/10253890.2021.2012145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Since medical communication can be perceived as stressful, the assessment of patients' physiological arousal and behavior during anamnesis interviews may lead to a better understanding of doctor-patient interactions. Therefore, the aim of this study was to test physiological arousal and word use in a laboratory anamnesis interview. In total, sixty-five participants with a mean age of 25.0 years were randomly assigned either to an experimental group (n = 35, 65.7% women) in which they underwent an anamnesis interview or to a control group (n = 30, 73.3% women). Physiological arousal was assessed by salivary cortisol, salivary alpha-amylase (sAA), heart rate (HR) and heart rate variability (HRV). Psychological arousal was assessed using the Positive and Negative Affect Schedule (PANAS). Anamnesis interviews were analyzed using the Linguistic Inquiry and Word Count text analysis tool (LIWC). Participants of the experimental group showed an increase of sAA, HR and negative affect (p's ≤.0.05). Moreover, higher cortisol area under the curve with respect to ground (AUCg) was associated with lesser use of positive emotion words during the interview and subsequent higher negative affect (p's <.05). These results indicate that talking about one's own and family's medical history in anamnesis interview induces physiological arousal. Our findings suggest that anamnesis interviews could not only induce higher negative affect, but also induce physiological arousal, underscoring the importance of good doctor-patient communication.
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Affiliation(s)
- Sarah C Sturmbauer
- Department of Psychology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | | | - Simon Schmelzle
- Department of Psychology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Nicolas Rohleder
- Department of Psychology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
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14
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Alefan Q, Cheekireddy VM, Blackburn D. Cost-Related Nonadherence Can be Explained by A General Non-Adherence Framework. J Am Pharm Assoc (2003) 2022; 62:658-673. [DOI: 10.1016/j.japh.2022.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 01/10/2022] [Accepted: 01/10/2022] [Indexed: 11/24/2022]
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15
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Kokokyi S, Klest B, Anstey H. A patient-oriented research approach to assessing patients' and primary care physicians' opinions on trauma-informed care. PLoS One 2021; 16:e0254266. [PMID: 34242358 PMCID: PMC8270182 DOI: 10.1371/journal.pone.0254266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 06/24/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To gather patients' and primary care physicians' (PCP) opinions on trauma-informed Care (TIC) and to investigate the acceptability of recommendations developed by patient, family, and physician advisors. DESIGN Cross-sectional research survey design and patient engagement. SETTING Canada, 2017 to 2019. PARTICIPANTS English-speaking adults and licensed PCPs residing in Canada. MAIN OUTCOME MEASURES Participants were given a series of questionnaires including a list of physician actions and a list of recommendations consistent with TIC. RESULTS Patients and PCPs viewed TIC as important. Both patients and PCPs rated the following recommendations as helpful and likely to positively impact patient care: physician training, online trauma resource centres, information pamphlets, the ability to extend appointment times, and clinical pathways for responding to trauma. PCPs' responses were significantly more positive than patients' responses. CONCLUSION TIC is important to patients and PCPs. Patients and PCPs believe changes to physician training, patient engagement, and systemic factors would be helpful and likely to positively impact patient care. Future research needs to be conducted to investigate whether these recommendations improve patient care.
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Affiliation(s)
- Seint Kokokyi
- Department of Clinical Health Psychology, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Bridget Klest
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | - Hannah Anstey
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
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16
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Centeno-Gándara LA. Improving the physician-patient relationship utilizing psychodynamic psychology: a primer for health professionals. Health Psychol Behav Med 2021; 9:338-349. [PMID: 34104564 PMCID: PMC8158248 DOI: 10.1080/21642850.2021.1914052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background The quality of the physician-patient relationship is associated with improved healthcare outcomes and patients’ complaints due to dissatisfaction. Factors that influence the quality of the physician-patient relationship include verbal communication, nonverbal communication, and clinical empathy. These factors have been studied from diverse theoretical approaches hindering their integration into a theoretical framework applicable in clinical practice and accessible for lay clinicians. Objective The aim of this paper is to put forward a psychodynamic framework that includes the factors associated with a better quality of the physician-patient relationship and is applicable in clinical practice and accessible for lay clinicians. Theoretical discussion Basic concepts necessary to comprehend transference and countertransference phenomena were outlined. Then, based on the concepts of transference and countertransference, a psychodynamic framework to understand and manage the physician-patient relationship was put forward. Conclusion This is the first paper that presents a psychodynamic framework applicable in clinical practice and accessible to lay clinicians for understanding and managing the physician-patient relationship. Additionally, this work could serve as introductory material to Balint groups.
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Affiliation(s)
- Luis A Centeno-Gándara
- Department of Psychiatry, Faculty of Medicine and University Hospital 'Dr. José Eleuterio González', Autonomous University of Nuevo Leon, Monterrey, Mexico
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17
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Glenn TW, Riekert KA, Roter D, Eakin MN, Pruette CS, Brady TM, Mendley SR, Tuchman S, Fivush BA, Eaton CK. Engagement and Affective Communication During Pediatric Nephrology Clinic Visits: Associations with Medication Adherence. PATIENT EDUCATION AND COUNSELING 2021; 104:578-584. [PMID: 32948401 PMCID: PMC7933303 DOI: 10.1016/j.pec.2020.08.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 08/24/2020] [Accepted: 08/26/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To evaluate whether engagement and affective communication among adolescents and young adults (AYAs) with chronic kidney disease (CKD), caregivers, and pediatric nephrology providers during outpatient clinic visits predicts antihypertensive medication adherence. METHODS AYAs (n = 60, M age = 15.4 years, SD = 2.7, 40% female, 43% African American/Black) and caregivers (n = 60, 73% female) attended audio-recorded clinic visits with pediatric nephrologists (n = 12, 75% female). Recordings were analyzed using global affect ratings of the Roter Interactional Analysis System. Antihypertensive medication adherence was monitored electronically before and after clinic visits. A linear regression model evaluated associations between affect ratings and post-visit adherence. RESULTS AYAs took 84% of doses (SD = 20%) pre-visit and 82% of doses (SD = 24%) post-visit. Higher AYA engagement (β = 0.03, p = .01) and the absence of provider negative affect (β=-0.15, p = .04) were associated with higher post-visit adherence, controlling for pre-visit adherence, AYA sex, age, and race, and clustered by provider. CONCLUSIONS Post-visit adherence was higher when AYAs were rated as more engaged and providers as less negative. PRACTICE IMPLICATIONS AYAs with lower engagement may benefit from further adherence assessment. Communication strategies designed to more actively engage AYAs in their care and diminish provider conveyance of negative affect during clinic visits may positively influence adherence among AYAs with CKD.
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Affiliation(s)
- Trevor W Glenn
- Johns Hopkins University School of Medicine, Baltimore MD - 733 N Broadway, Baltimore, MD, 21205, USA.
| | - Kristin A Riekert
- Johns Hopkins University School of Medicine, Baltimore MD - 733 N Broadway, Baltimore, MD, 21205, USA.
| | - Debra Roter
- Johns Hopkins University School of Medicine, Baltimore MD - 733 N Broadway, Baltimore, MD, 21205, USA.
| | - Michelle N Eakin
- Johns Hopkins University School of Medicine, Baltimore MD - 733 N Broadway, Baltimore, MD, 21205, USA.
| | - Cozumel S Pruette
- Johns Hopkins University School of Medicine, Baltimore MD - 733 N Broadway, Baltimore, MD, 21205, USA.
| | - Tammy M Brady
- Johns Hopkins University School of Medicine, Baltimore MD - 733 N Broadway, Baltimore, MD, 21205, USA.
| | - Susan R Mendley
- University of Maryland School of Medicine, Baltimore MD - 655 W Baltimore St S, Baltimore, MD, 21201, USA.
| | - Shamir Tuchman
- Children's National Medical Center, Washington DC - 110 Irving St NW, Washington, DC, 20010, USA.
| | - Barbara A Fivush
- Johns Hopkins University School of Medicine, Baltimore MD - 733 N Broadway, Baltimore, MD, 21205, USA.
| | - Cyd K Eaton
- Johns Hopkins University School of Medicine, Baltimore MD - 733 N Broadway, Baltimore, MD, 21205, USA.
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18
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Chen AT, Swaminathan A. Factors in the Building of Effective Patient-Provider Relationships in the Context of Fibromyalgia. PAIN MEDICINE 2021; 21:138-149. [PMID: 30980668 PMCID: PMC6953340 DOI: 10.1093/pm/pnz054] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objective Fibromyalgia patients face particular challenges in building relationships with health care providers. In this study, we examine, from patients’ perspectives, factors that influence the formation of effective patient–provider relationships. Design This research employed a qualitative approach to analyze data collected from a study that employed semistructured interviews. Methods Multiple methods were used to recruit 23 fibromyalgia patients for interviews. Semistructured interviews were conducted to explore how participants’ information behaviors, including their communication with and relationships to providers, changed over time. The interview data were analyzed using a qualitative analytic method based on interpretative phenomenological analysis and constructivist grounded theory. Results We identified three important factors that influenced the building of effective relationships: patients and providers’ interactions involving information, identifying health care providers that fit patients’ needs, and realizing shared responsibilities. With regard to information, we described three important themes: information gaps, providers as educators/facilitators, and collaborative information behavior. Conclusions Understanding of the key elements of relationship development between patients and providers can be utilized in various ways to improve clinical care. First, the knowledge gained in this study can inform the design of patient education materials that assist patients to identify providers that fit their needs, prepare for consultations, and develop realistic expectations for providers. The findings of this study can also inform the design of resources and tools to enable clinicians to communicate and relate better with their patients.
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Affiliation(s)
- Annie T Chen
- Department of Biomedical Informatics and Medical Education, University of Washington School of Medicine, Seattle, Washington, USA
| | - Aarti Swaminathan
- Department of Biomedical Informatics and Medical Education, University of Washington School of Medicine, Seattle, Washington, USA
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19
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Gomez-Cano M, Wiering B, Abel G, Campbell JL, Clark CE. Medication adherence and clinical outcomes in dispensing and non-dispensing practices: a cross-sectional analysis. Br J Gen Pract 2021; 71:e55-e61. [PMID: 33257460 PMCID: PMC7716871 DOI: 10.3399/bjgp20x713861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 06/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most patients obtain medications from pharmacies by prescription, but rural general practices can dispense medications. The clinical implications of this difference in drug delivery are unknown. This study hypothesised that dispensing status may be associated with better medication adherence. This could impact intermediate clinical outcomes dependent on medication adherence in, for example, hypertension or diabetes. AIM To investigate whether dispensing status is associated with differences in achievement of Quality and Outcomes Framework (QOF) indicators that rely on medication adherence. DESIGN AND SETTING Cross-sectional analysis of QOF data for 7392 general practices in England. METHOD QOF data from 1 April 2016 to 31 March 2017 linked to dispensing status for general practices with list sizes ≥1000 in England were analysed. QOF indicators were categorised according to whether their achievement depended on a record of prescribing only, medication adherence, or neither. Differences were estimated between dispensing and non-dispensing practices using mixed-effects logistic regression, adjusting for practice population age, sex, deprivation, list size, single-handed status, and rurality. RESULTS Data existed for 7392 practices; 1014 (13.7%) could dispense. Achievement was better in dispensing practices than in non-dispensing practices for seven of nine QOF indicators dependent on adherence, including blood pressure targets. Only one of ten indicators dependent on prescribing but not adherence displayed better achievement; indicators unrelated to prescribing showed a trend towards higher achievement by dispensing practices. CONCLUSION Dispensing practices may achieve better clinical outcomes than prescribing practices. Further work is required to explore underlying mechanisms for these observations and to directly study medication adherence rates.
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Affiliation(s)
- Mayam Gomez-Cano
- Primary Care Research Group, Institute of Health Services Research, University of Exeter Medical School, Exeter
| | - Bianca Wiering
- Primary Care Research Group, Institute of Health Services Research, University of Exeter Medical School, Exeter
| | - Gary Abel
- Primary Care Research Group, Institute of Health Services Research, University of Exeter Medical School, Exeter
| | - John L Campbell
- Primary Care Research Group, Institute of Health Services Research, University of Exeter Medical School, Exeter
| | - Christopher E Clark
- Primary Care Research Group, Institute of Health Services Research, University of Exeter Medical School, Exeter
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20
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Reyes M, Fuertes JN, Moore MT, Punnakudiyil GJ, Calvo L, Rubinstein S. Psychological and relational factors in ESRD hemodialysis treatment in an underserved community. PATIENT EDUCATION AND COUNSELING 2021; 104:149-154. [PMID: 32591256 DOI: 10.1016/j.pec.2020.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 05/23/2020] [Accepted: 06/01/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The researchers investigated the association of depression with treatment adherence, and examined the possible moderating roles of social support and of the physician-patient working alliance (PPWA) on treatment adherence, satisfaction with treatment, and quality of life. METHODS The current study sampled ninety-five patients with End Stage Renal Disease who were receiving outpatient hemodialysis (HD) treatment. RESULTS Findings indicated that higher levels of depression were significantly associated with lower ratings of adherence, quality of life, and social support. In contrast, higher levels of social support and of the PPWA were significantly associated with higher ratings of adherence, satisfaction with treatment, and quality of life. Analyses of moderation showed no effect for PPWA between depression and adherence, satisfaction, or quality of life; however, there was a significant moderation effect for social support. CONCLUSION There are mild but significant associations between PPWA and social support. Positive associations between the PPWA and social support on adherence, satisfaction, and quality of life indicate that each one, PPWA and social support, plays its own role on patients' experiences of and behavior in treatment. Affective social support significantly limits the negative influence of depression on adherence. PRACTICE IMPLICATIONS Assessment of depression and social support is essential in hemodialysis treatment.
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Affiliation(s)
- Mariela Reyes
- Derner School of Psychology, Adelphi University, Garden City, NY 11530, USA
| | - Jairo N Fuertes
- Derner School of Psychology, Adelphi University, Garden City, NY 11530, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, 11549 USA.
| | - Michael T Moore
- Derner School of Psychology, Adelphi University, Garden City, NY 11530, USA
| | | | - Luis Calvo
- Nassau University Medical Center, 2201 Hempstead Turnpike, East Meadow, NY 11554, USA
| | - Sofia Rubinstein
- Nassau University Medical Center, 2201 Hempstead Turnpike, East Meadow, NY 11554, USA
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21
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Gidlow CJ, Ellis NJ, Cowap L, Riley VA, Crone D, Cottrell E, Grogan S, Chambers R, Clark-Carter D. Quantitative examination of video-recorded NHS Health Checks: comparison of the use of QRISK2 versus JBS3 cardiovascular risk calculators. BMJ Open 2020; 10:e037790. [PMID: 32978197 PMCID: PMC7520846 DOI: 10.1136/bmjopen-2020-037790] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Quantitatively examine the content of National Health Service Health Check (NHSHC), patient-practitioner communication balance and differences when using QRISK2 versus JBS3 cardiovascular disease (CVD) risk calculators. DESIGN RIsk COmmunication in NHSHC was a qualitative study with quantitative process evaluation, comparing NHSHC using QRISK2 or JBS3. We present data from the quantitative process evaluation. SETTING AND PARTICIPANTS Twelve general practices in the West Midlands (England) conducted NHSHC using JBS3 or QRISK2 (6/group). Patients were eligible for NHSHC based on national criteria (aged 40-74, no existing cardiovascular-related diagnoses, not taking statins). Recruitment was stratified by patients' age, gender and ethnicity. METHODS Video recordings of NHSHC were coded, second-by-second, to quantify who was speaking and what was being discussed. Outcomes included consultation duration, practitioner verbal dominance (ratio of practitioner:patient speaking time (pr:pt ratio)) and proportion of time discussing CVD risk, risk factors and risk management. RESULTS 173 video-recorded NHSHC were analysed (73 QRISK, 100 JBS3). The sample was 51% women, 83% white British, with approximately equal proportions across age groups. NHSHC duration varied greatly (6.8-38.0 min). Most (60%) lasted less than 20 min. On average, CVD risk was discussed for less than 2 min (9.06%±4.30% of consultation time). There were indications that, compared with NHSHC using JBS3, those with QRISK2 involved less CVD risk discussion (JBS3 M=10.24%, CI: 8.01-12.48 vs QRISK2 M=7.44%, CI: 5.29-9.58) and were more verbally dominated by practitioners (pr:pt ratio JBS3 M=3.21%, CI: 2.44-3.97 vs QRISK2=2.35%, CI: 1.89-2.81). The largest proportion of NHSHC time was spent discussing causal risk factors (M=37.54%, CI: 32.92-42.17). CONCLUSIONS There was wide variation in NHSHC duration. Many were short and practitioner-dominated, with little time discussing CVD risk. JBS3 appears to extend CVD risk discussion and patient contribution. Qualitative examination of how it is used is necessary to fully understand the potential benefits of these differences. TRIAL REGISTRATION NUMBER ISRCTN10443908.
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Affiliation(s)
| | - Naomi J Ellis
- Centre for Health and Development, Staffordshire University, Stoke-on-Trent, UK
| | - Lisa Cowap
- Department of Psychology, Staffordshire University, Stoke on Trent, UK
| | - Victoria A Riley
- Centre for Health and Development, Staffordshire University, Stoke-on-Trent, UK
| | - Diane Crone
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Elizabeth Cottrell
- School of Primary, Community and Social Care, Keele University, Staffordshire, UK
| | - Sarah Grogan
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - Ruth Chambers
- Stoke-on-Trent Clinical Commissioning Group, Stoke on Trent, UK
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22
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Lee CT, Vanderwater C, Pickrell W, Wong JC. The association among cancer patients' collaboration with their healthcare providers, self-management and well-being during radiotherapy: An observational, cross-sectional survey. Eur J Cancer Care (Engl) 2020; 29:e13308. [PMID: 32869387 DOI: 10.1111/ecc.13308] [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: 09/12/2019] [Revised: 07/09/2020] [Accepted: 08/07/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Patients adapt to cancer through self-management, which requires collaboration between patients and their healthcare providers. We aimed to describe patterns of patient-provider collaboration during radiotherapy and examine associations among patient-provider collaboration, self-management and well-being. METHODS An observational, cross-sectional study was conducted at a cancer centre in the province of Ontario, Canada. Cancer patients (N = 130) completed a one-time questionnaire during their radiotherapy. The questionnaire assessed three variables: collaboration with healthcare providers, self-management and well-being. Patterns of collaboration were analysed using descriptive statistics. Associations among study variables were assessed through structural equation modelling (SEM). Separate models were tested for patient-nurse and patient-oncologist collaboration. RESULTS Participants reported greater collaboration with oncologists than with nurses or radiation therapists. Most participants reported no collaboration with other providers within healthcare teams (e.g. social workers, dietitians). SEM revealed different patterns for the patient-nurse and patient-oncologist collaboration models, where collaboration predicted one self-management aspect, and both physical and mental well-being. CONCLUSION During radiotherapy, patients collaborated mainly with doctors, nurses and radiation therapists. Collaborative relationships between patients and providers may enhance patient outcomes by fostering their self-management skills. Initiatives to strengthen patient-provider relationships and support self-management should be developed and applied to interprofessional-cancer-care teams. IMPACT This is the first known study to empirically support the links among patient-provider collaboration, self-management and patient outcomes. The study results can enhance practice, research and education.
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Affiliation(s)
| | | | | | - Jason C Wong
- Stronach Regional Cancer Centre, Newmarket, ON, Canada.,Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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Park J, Beach MC, Han D, Moore RD, Korthuis PT, Saha S. Racial disparities in clinician responses to patient emotions. PATIENT EDUCATION AND COUNSELING 2020; 103:1736-1744. [PMID: 32253063 PMCID: PMC7423722 DOI: 10.1016/j.pec.2020.03.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 02/26/2020] [Accepted: 03/18/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE In a previous study of patients newly enrolled in HIV care, we observed that clinicians were less likely to address emotional issues expressed by African-American patients compared to whites. We sought to verify and expand these findings in a larger group of patients established in HIV care. METHODS We used VR-CoDES to analyze transcripts from 342 audio-recorded medical visits in the United States. We used random intercept multilevel logistic regression to assess associations between patient and clinician characteristics and patterns of emotional talk. RESULTS African-American patients were less likely than others to spontaneously express emotions (OR 0.50; 95 % CI 0.29-0.85). Clinicians, who were predominantly white, were more likely to respond to emotional expressions by African-American patients explicitly (OR 1.56; 95 % CI 1.11-2.20) but less likely to offer neutral/passive responses that provide space for emotional conversation (OR 0.56; 95 % CI 0.37-0.84) and more likely to block discussion of the emotional issue (OR 2.20; 95 % CI 1.05-4.63). Emotional talk did not vary by patient age or gender. CONCLUSION These results confirm our prior findings, demonstrating less open emotional communication between African-American patients and their providers. PRACTICE IMPLICATIONS Addressing racial differences in communicating about emotions may reduce disparities in patient-clinician relationships.
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Affiliation(s)
- Jenny Park
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mary Catherine Beach
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
| | - Dingfen Han
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Richard D Moore
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - P Todd Korthuis
- Department of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Somnath Saha
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Medicine, Oregon Health and Science University, Portland, OR, USA; Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA.
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Louw JM, Hugo JFM. Learning person-centred consultation skills in clinical medicine: A randomised controlled case study. S Afr Fam Pract (2004) 2020; 62:e1-e9. [PMID: 32633995 PMCID: PMC8378123 DOI: 10.4102/safp.v62i1.5109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 03/13/2020] [Indexed: 11/03/2022] Open
Abstract
Background: Training institutions need to ensure that healthcare students learn the skills to conduct person-centred consultations. We studied changes in person-centred practice over time following a quality improvement (QI) intervention among Bachelor of Clinical Medical Practice undergraduate students.Methods: Students were randomised to intervention and control groups. The intervention group received training and did a QI cycle on their own consultation skills. Consultations with simulated patients were recorded during structured clinical examinations in June (baseline) and November (post-intervention) 2015.Results: Matched consultations for 64 students were analysed. The total SEGUE (Set the stage, Elicit information, Give information, Understand the patient’s perspective and End the encounter scores) were significantly higher in the final assessment compared to baseline for both the whole group and the intervention group (p = 0.005 and 0.015, respectively). The improvement did not differ significantly between intervention and control groups (p = 0.778). Third-year students improved significantly more than second years (p = 0.007).Conclusion: The person-centred practice (including collaboration) of clinical associate students did improve over the period studied. The results show that students’ learning of person-centred practice also happened in ways other than through the QI intervention. There is a need to develop students’ collaborative skills during the medical consultation.
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Affiliation(s)
- Jakobus M Louw
- Department of Family Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria.
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Louw JM, Marcus TS, Hugo J. How to measure person-centred practice - An analysis of reviews of the literature. Afr J Prim Health Care Fam Med 2020; 12:e1-e8. [PMID: 32129646 PMCID: PMC7136800 DOI: 10.4102/phcfm.v12i1.2170] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/29/2019] [Accepted: 11/14/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Facilitation and collaboration differentiates person-centred practice (PcP) from biomedical practice. In PcP, a person-centred consultation requires clinicians to juggle three processes: facilitation, clinical reasoning and collaboration. How best to measure PcP in these processes remains a challenge. AIM To assess the measurement of facilitation and collaboration in selected reviews of PcP instruments. METHODS Ovid Medline and Google Scholar were searched for review articles evaluating measurement instruments of patient-centredness or person-centredness in the medical consultation. RESULTS Six of the nine review articles were selected for analysis. Those articles considered the psychometric properties and rigour of evaluation of reviewed instruments. Mostly, the articles did not find instruments with good evidence of reliability and validity. Evaluations in South Africa rendered poor psychometric properties. Tools were often not transferable to other socio-cultural-linguistic contexts, both with and without adaptation. CONCLUSION The multiplicity of measurement tools is a product of many dimensions of person-centredness, which can be approached from many perspectives and in many service scenarios inside and outside the medical consultation. Extensive research into the myriad instruments found no single valid and reliable measurement tool that can be recommended for general use. The best hope for developing one is to focus on a specific scenario, conduct a systematic literature review, combine the best items from existing tools, involve multiple disciplines and test the tool in real-life situations.
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Affiliation(s)
- Jakobus M Louw
- Department of Family Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria.
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Abstract
Education on its own doesn't make people take their treatment as intended. However, when it follows shared decision making, in which patient and doctor together agree on the best course of therapeutic action, education helps patients take their treatment. http://bit.ly/2G2XswD.
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Affiliation(s)
- Ellen M. Driever
- Dept of Innovation and Science, Isala Hospital, Zwolle, The Netherlands
| | - Paul L.P. Brand
- Dept of Medical Education and Faculty Development, Isala Hospital, Zwolle, The Netherlands
- LEARN network, University of Groningen and University Medical Centre, Groningen, The Netherlands
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Patient Activation as a Pathway to Shared Decision-making for Adults with Diabetes or Cardiovascular Disease. J Gen Intern Med 2020; 35:732-742. [PMID: 31646455 PMCID: PMC7080922 DOI: 10.1007/s11606-019-05351-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 09/11/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Shared decision-making (SDM) is widely recognized as a core strategy to improve patient-centered care. However, the implementation of SDM in routine care settings has been slow and its impact mixed. OBJECTIVE We examine the temporal association of patient activation and patients' experience with the SDM process to assess the dominant directionality of this relationship. DESIGN Patient activation, or a patients' knowledge, skills, and confidence in self-management, was assessed using the 13-item Patient Activation Measure (PAM). Patient-reported assessment of the SDM process was assessed using the 3-item CollaboRATE measure. Patients at 16 adult primary care practices were surveyed in 2015 and 2016 on PAM (α = 0.92), CollaboRATE (α = 0.90), and demographics. The relationship between PAM and CollaboRATE was estimated using a cross-lagged panel model with clustered robust standard errors and practice fixed effects, controlling for patient characteristics. PARTICIPANTS 1222 adult patients with diabetes and/or cardiovascular disease with survey responses at baseline (51% response rate) and a 1-year follow-up (73% response rate). RESULTS PAM (mean 3.27 vs 3.28 on a range of 1 to 4; p = 0.082) and CollaboRATE (mean 3.62 vs 3.63 on a range of 1 to 5; p = 0.14) did not change significantly over time. In adjusted analyses, the path from baseline PAM to follow-up CollaboRATE (β = 0.35; p < 0.0001) was stronger than the path from baseline CollaboRATE to follow-up PAM (β = 0.04; p = 0.001). CONCLUSIONS The relationship between patient activation and patients' experiences of the SDM process is bidirectional, but dominated by baseline patient activation. Rather than promoting the use of SDM for all patients, healthcare organizations should prioritize interventions to promote patient activation and engage patients with relatively high activation in SDM interventions.
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Fuertes JN, Anand P, Toporovsky A, Wolpoff A, Reyes M, Hungria FC, Fernandez D, Taborga M. A Training Program in Working Alliance Communication Skills. MEDICAL SCIENCE EDUCATOR 2019; 29:987-994. [PMID: 34457575 PMCID: PMC8368696 DOI: 10.1007/s40670-019-00789-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The current paper presents the results from two studies. The first study examined the effectiveness of a training program designed to enhance medical residents' working alliance communication skills. The second study surveyed patients to examine if the resident training program resulted in significantly improved adherence and satisfaction for their patients. The first study used an experimental design, and 104 residents were randomly assigned to one of two groups: one group received working alliance training and the other served as a control and received no training. In the second study, after the training was completed, we surveyed one patient treated by each of the residents who participated in the first study to assess differences by resident group on patient self-reported adherence and satisfaction. In all, 68 patients participated and these patients were blind to whether the resident had participated in the training. For the first study, post-test data for the two groups showed that residents in the training group reported higher working alliance skills than residents in the control group. For the second study, patients cared for by residents who participated in the training reported better adherence and higher satisfaction with treatment than patients of residents in the control group. Thus, the training program appears to enhance residents' working alliance communication skills and is related to self-reported improvement in patient adherence and satisfaction. Further research is warranted to better understand these findings.
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Affiliation(s)
- Jairo N. Fuertes
- Gordon F Derner School of Psychology, Adelphi University, Hy Weinberg Center- Rm 319, 158 Cambridge Avenue, Garden City, USA
- Donald and Barbara Zucker School of Medicine, Hofstra/Northwell, Hempstead, USA
| | - Prachi Anand
- Nassau University Medical Center, 2201 Hempstead Turnpike, East Meadow, NY 11554 USA
| | - Arielle Toporovsky
- Gordon F Derner School of Psychology, Adelphi University, Hy Weinberg Center- Rm 319, 158 Cambridge Avenue, Garden City, USA
| | - Alexxa Wolpoff
- Gordon F Derner School of Psychology, Adelphi University, Hy Weinberg Center- Rm 319, 158 Cambridge Avenue, Garden City, USA
| | - Mariela Reyes
- Gordon F Derner School of Psychology, Adelphi University, Hy Weinberg Center- Rm 319, 158 Cambridge Avenue, Garden City, USA
| | | | - Damian Fernandez
- Nassau University Medical Center, 2201 Hempstead Turnpike, East Meadow, NY 11554 USA
| | - Marcelo Taborga
- Nassau University Medical Center, 2201 Hempstead Turnpike, East Meadow, NY 11554 USA
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Du X, He Q, Yang T, Wang Y, Xu H, Hao C, Zhou K, Gu J, Hao Y. Intention to start ART after the launch of expanded treatment strategy among people living with HIV in China: a behavioral theory-based cross-sectional study. AIDS Care 2019; 32:1182-1190. [PMID: 31690087 DOI: 10.1080/09540121.2019.1686601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study investigated the prevalence of intention to start antiretroviral therapy (ART) immediately among people living with HIV (PLWH) in China and associated perceptions toward ART based on behavioral theories. The study was initiated after the launch of an expanded ART strategy. A cross-sectional study was conducted among 450 PLWH who were ART naive in the city of Guangzhou, China, from June 2016 to February 2017. Among the participants, 311 (69.1%) showed intention to start ART immediately. The summary logistic regression analysis indicated that intention to start ART immediately was significantly associated with perceived severity [multivariate odds ratios (ORm) = 1.62, 95%CI = 1.15-2.28, p < 0.01], perceived barriers (ORm =0.56, 95%CI = 0.38-0.84, p < 0.01), self-efficacy (ORm =2.90, 95%CI = 2.05-4.09, p < 0.001), and subjective norms (ORm =1.95, 95%CI = 1.17-3.25, p < 0.05). The intention to start ART immediately among PLWH in Guangzhou was below the 90-90-90 target. Further promotion research should focus on these perceptional factors.
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Affiliation(s)
- Xuan Du
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China.,Training and Evaluation Center of Guangdong Power Grid Company Limited, Guangzhou, People's Republic of China
| | - Qiangsheng He
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Tinglong Yang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yu Wang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China.,Sun Yat-sen Global Health Institute, Institute of State Governance, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Huifang Xu
- Department of HIV/AIDS Prevention and Control, Guangzhou Center for Disease Prevention and Control, Guangzhou, People's Republic of China
| | - Chun Hao
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China.,Sun Yat-sen Global Health Institute, Institute of State Governance, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Kai Zhou
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Jing Gu
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China.,Sun Yat-sen Global Health Institute, Institute of State Governance, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yuantao Hao
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China.,Sun Yat-sen Global Health Institute, Institute of State Governance, Sun Yat-sen University, Guangzhou, People's Republic of China
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Emotional Communication in HIV Care: An Observational Study of Patients' Expressed Emotions and Clinician Response. AIDS Behav 2019; 23:2816-2828. [PMID: 30895426 DOI: 10.1007/s10461-019-02466-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Emotional support is essential to good communication, yet clinicians often miss opportunities to provide empathy to patients. Our study explores the nature of emotional expressions found among patients new to HIV care, how HIV clinicians respond to these expressions, and predictors of clinician responses. Patient-provider encounters were audio-recorded, transcribed, and coded using the VR-CoDES. We categorized patient emotional expressions by intensity (subtle 'cues' vs. more explicit 'concerns'), timing (initial vs. subsequent), and content (medical vs. non-medical). Emotional communication was present in 65 of 91 encounters. Clinicians were more likely to focus specifically on patient emotion for concerns versus cues (OR 4.55; 95% CI 1.36, 15.20). Clinicians were less likely to provide space when emotional expressions were repeated (OR 0.32; 95% CI 0.14, 0.77), medically-related (OR 0.36; 95% CI 0.17, 0.77), and from African American patients (OR 0.42; 95% CI 0.21, 0.84). Potential areas for quality improvement include raising clinician awareness of subtle emotional expressions, the emotional content of medically-related issues, and racial differences in clinician response.
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Lee CT, Wong JC. Perceived levels of collaboration between cancer patients and their providers during radiation therapy. Can Oncol Nurs J 2019; 29:110-115. [PMID: 31148696 DOI: 10.5737/23688076292110115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
This study described the patterns within collaborative relationships between patients and health care professionals during radiation therapy (RT). A one-time survey was administered to cancer patients (N=130) receiving RT at one Ontario cancer centre. The key study variables were collaboration between patients and health care providers and participants' well-being. Participants reported higher levels of collaboration with nurses, radiation oncologists, and radiation therapists than with dietitians, social workers and spiritual support personnel [F(5, 760) = 430.42, p < .001]. Participants with more symptom distress collaborated more with some health care professionals than those with less distress, but this was only true for collaboration with social workers (p < .05) and dietitians (p < .05). We postulated that participants did not require services from dietitians and social workers when symptom burden was low. Future directions regarding integration of patient-centred measures (e.g., self-management education) into interprofessional models for cancer care are discussed.
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Affiliation(s)
- Charlotte T Lee
- Assistant Professor, Daphne Cockwell School of Nursing, Ryerson University, 350 Victoria Street, Toronto, ON M5B 2K3, x7992,
| | - Jason C Wong
- Radiation Oncologist, Southlake Regional Health Centre, The Princess Margaret Cancer Centre University of Toronto, ,
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Sheridan SL, Donahue KE, Brenner AT. Beginning with high value care in mind: A scoping review and toolkit to support the content, delivery, measurement, and sustainment of high value care. PATIENT EDUCATION AND COUNSELING 2019; 102:238-252. [PMID: 30553576 DOI: 10.1016/j.pec.2018.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 05/01/2018] [Accepted: 05/15/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To create a shared vision for the content, delivery, measurement, and sustainment of patient-centered high value care. METHODS We performed a scoping review and translated findings into toolkit for system leaders. For our scoping review, we searched Medline, 2005-November 2015, for literature on patient-centered care (PCC) and its relationship to a high value care change model. We supplemented searches with key author, Google Scholar, and key website searches. One author reviewed all titles, abstracts, and articles for inclusion; another reviewed a random 20%. To develop our toolkit, we translated evidence into simple, actionable briefs on key topics and added resources. We then iteratively circulated briefs and the overall toolkit to potential users, making updates as needed. RESULTS In our scoping review, we found multiple interventions and measures to support the components of PCC and our change model. We found little on the overall effects of PCC or how PCC creates value. Potential users reported our toolkit was simple, understandable, thorough, timely, and likely to be globally useful. CONCLUSIONS Considerable evidence supports patient-centered high value care and a toolkit garnered enthusiasm. PRACTICE IMPLICATIONS The toolkit is ready for use, but needs comparison to other approaches.
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Affiliation(s)
| | - Katrina E Donahue
- Reaching for High Value Care Team, Chapel Hill, NC, USA; Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Family and Community Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alison T Brenner
- Reaching for High Value Care Team, Chapel Hill, NC, USA; Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Isaac LM, Buggy E, Sharma A, Karberis A, Maddock KM, Weston KM. Enhancing hospital care of patients with cognitive impairment. Int J Health Care Qual Assur 2018; 31:173-186. [DOI: 10.1108/ijhcqa-11-2016-0173] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The patient-centred management of people with cognitive impairment admitted to acute health care facilities can be challenging. The TOP5 intervention utilises carers’ expert biographical and social knowledge of the patient to facilitate personalised care. The purpose of this paper is to explore whether involvement of carers in the TOP5 initiative could improve patient care and healthcare delivery.
Design/methodology/approach
A small-scale longitudinal study was undertaken in two wards of one acute teaching hospital. The wards admitted patients with cognitive impairment, aged 70 years and over, under geriatrician care. Data for patient falls, allocation of one-on-one nurses (“specials”), and length-of-stay (LOS) over 38 months, including baseline, pilot, and establishment phases, were analysed. Surveys of carers and nursing staff were undertaken.
Findings
There was a significant reduction in number of falls and number of patients allocated “specials” over the study period, but no statistically significant reduction in LOS. A downward trend in complaints related to communication issues was identified. All carers (n=43) completing the feedback survey were satisfied or very satisfied that staff supported their role as information provider. Most carers (90 per cent) felt that the initiative had a positive impact and 80 per cent felt that their loved one benefitted. Six months after implementation of the initiative, 80 per cent of nurses agreed or strongly agreed that it was now easier to relate to carers of patients with cognitive impairment. At nine-ten months, this increased to 100 per cent.
Originality/value
Actively engaging carers in management of people with cognitive impairment may improve the patient, staff, and carer journeys, and may improve outcomes for patient care and service delivery.
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The Role of Emotional Avoidance, the Patient-Provider Relationship, and Other Social Support in ART Adherence for HIV+ Individuals. AIDS Behav 2018; 22:929-938. [PMID: 28265805 DOI: 10.1007/s10461-017-1745-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Adherence to antiretroviral therapy (ART) is associated with positive health outcomes among HIV+ patients. However, non-adherence remains high. Though factors that account for non-adherence remain unclear, social support has been consistently associated with ART adherence. As such, identifying malleable factors that hinder patients' ability to form supportive relationships may have consequence for improving ART adherence. Emotional avoidance (EA) may be one such factor given that it has been linked to difficulties in social situations. The present study examined relations among EA, the patient-provider relationship, other sources of social support, and ART adherence within a sample of HIV+ ART-prescribed patients. High EA was related to poor adherence and patient-provider relationships. EA was indirectly related to poor adherence through poorer patient-provider interactions. The indirect relation of EA to ART adherence through other sources of social support was not significant. Implications for developing targeted behavioral interventions focused on improving ART adherence are discussed.
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Kiotseridis H, Arvidsson P, Backer V, Braendholt V, Tunsäter A. Adherence and quality of life in adults and children during 3-years of SLIT treatment with Grazax-a real life study. NPJ Prim Care Respir Med 2018; 28:4. [PMID: 29434271 PMCID: PMC5809499 DOI: 10.1038/s41533-018-0072-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 12/06/2017] [Accepted: 01/02/2018] [Indexed: 12/28/2022] Open
Abstract
Respiratory allergic disease represents a global health problem, 30% of the population suffers from allergic rhinoconjunctivitis and 20% suffer from asthma. Allergy immunotherapy induce immunological tolerance and thereby modify the response to allergens and sublingual immunotherapy (SLIT) offers the possibility of home administration of allergen therapy, but adherence is more uncertain. The aim of the study was to investigate the adherence with GRAZAX in adults and children ≥ 5 years during three consecutive years of treatment. This was a non-interventional, prospective, observational, multi-center, open-label study to investigate adherence, quality of life, safety and tolerability of GRAZAX in adult and pediatric patients in a real-life setting. During the 3-years study period estimation of adherence was done regularly. Quality of life as well as symptom score was also assessed. In total, 399 patients (236 adults and 163 children) were included in the study. At baseline, 100% suffered from moderate-severe eyes and nose symptoms, and 31% had asthma in the grass pollen season. Overall, 55% completed a 3-years treatment period, whereas 37% stopped before end of study and 8% were lost to follow up. After 3 years, the adherence rate decreased from 98.2% (first month), 93.7% (first year), 93.2% (second year) and 88.9% (third year) and adverse events were the main reason for pre-term termination. The study suggests a good adherence to treatment in a real life setting among the patients finalizing 3-years SLIT therapy. The treatment was effective both on symptoms and HRQL. A three-year trial of the allergy immunotherapy GRAZAX shows good adherence and tolerance among adults and children. Respiratory allergic disease is a significant global health burden, with 30 per cent of Europe’s population suffering from hayfever and 20 per cent from allergic asthma. While antihistamines and steroids can treat symptoms successfully, they do not tackle the underlying allergy. Recent progress in immunotherapies such as GRAZAX—a therapy specifically targeting grass pollen allergy—have shown promise. Hampus Kiotseridis at Lund University, Sweden, and co-workers tracked patient adherence and health in 399 adults and children taking GRAZAX over three years. 55 per cent of patients completed the study treatment, with 85 per cent taking GRAZAX six to seven times a week. GRAZAX proved to be well-tolerated overall, effectively tackling symptoms and improving patients’ quality of life.
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Affiliation(s)
- Hampus Kiotseridis
- Departments of Respiratory Medicine and Allergology, Skåne University Hospital, Lund University, Lund, Sweden.
| | | | - Vibeke Backer
- Respiratory Research Unit, Bispebjerg University Hospital, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Vagn Braendholt
- Vagn Braendholt, Department of medicine, Holbæk Sygehus, Holbæk, Denmark
| | - Alf Tunsäter
- Departments of Respiratory Medicine and Allergology, Skåne University Hospital, Lund University, Lund, Sweden
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Zaugg V, Korb‐Savoldelli V, Durieux P, Sabatier B. Providing physicians with feedback on medication adherence for people with chronic diseases taking long-term medication. Cochrane Database Syst Rev 2018; 1:CD012042. [PMID: 29320600 PMCID: PMC6491069 DOI: 10.1002/14651858.cd012042.pub2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Poor medication adherence decreases treatment efficacy and worsens clinical outcomes, but average rates of adherence to long-term pharmacological treatments for chronic illnesses are only about 50%. Interventions for improving medication adherence largely focus on patients rather than on physicians; however, the strategies shown to be effective are complex and difficult to implement in clinical practice. There is a need for new care models addressing the problem of medication adherence, integrating this problem into the patient care process. Physicians tend to overestimate how well patients take their medication as prescribed. This can lead to missed opportunities to change medications, solve adverse effects, or propose the use of reminders in order to improve patients' adherence. Thus, providing physicians with feedback on medication adherence has the potential to prompt changes that improve their patients' adherence to prescribed medications. OBJECTIVES To assess the effects of providing physicians with feedback about their patients' medication adherence for improving adherence. We also assessed the effects of the intervention on patient outcomes, health resource use, and processes of care. SEARCH METHODS We conducted a systematic search of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Embase, all from database inception to December 2016 and without any language restriction. We also searched ISI Web of Science, two trials registers, and grey literature. SELECTION CRITERIA We included randomised trials, controlled before-after studies, and interrupted time series studies that compared the effects of providing feedback to physicians about their patients' adherence to prescribed long-term medications for chronic diseases versus usual care. We included published or unpublished studies in any language. Participants included any physician and any patient prescribed with long-term medication for chronic disease. We included interventions providing the prescribing physician with information about patient adherence to medication. Only studies in which feedback to the physician was the sole intervention or the essential component of a multifaceted intervention were eligible. In the comparison groups, the physicians should not have had access to information about their patients' adherence to medication. We considered the following outcomes: medication adherence, patient outcomes, health resource use, processes of care, and adverse events. DATA COLLECTION AND ANALYSIS Two independent review authors extracted and analysed all data using standard methodological procedures expected by Cochrane and the Effective Practice and Organisation of Care group. Due to heterogeneity in study methodology, comparison groups, intervention settings, and measurements of outcomes, we did not carry out meta-analysis. We describe the impact of interventions on outcomes in tabular form and make a qualitative assessment of the effects of studies. MAIN RESULTS We included nine studies (23,255 patient participants): eight randomised trials and one interrupted time series analysis. The studies took place in primary care and other outpatient settings in the USA and Canada. Seven interventions involved the systematic provision of feedback to physicians concerning all their patients' adherence to medication, and two interventions involved issuing an alert for non-adherent patients only. Seven studies used pharmacy refill data to assess medication adherence, and two used an electronic device or self-reporting. The definition of adherence differed across studies, making comparisons difficult. Eight studies were at high risk of bias, and one study was at unclear risk of bias. The most frequent source of bias was lack of protection against contamination.Providing physicians with feedback may lead to little or no difference in medication adherence (seven studies, 22,924 patients), patient outcomes (two studies, 1292 patients), or health resource use (two studies, 4181 patients). Providing physicians with feedback on medication adherence may improve processes of care (e.g. more medication changes, dialogue with patient, management of uncontrolled hypertension) compared to usual care (four studies, 2780 patients). None of the studies reported an adverse event due to the intervention. The certainty of evidence was low for all outcomes, mainly due to high risk of bias, high heterogeneity across studies, and indirectness of evidence. AUTHORS' CONCLUSIONS Across nine studies, we observed little or no evidence that provision of feedback to physicians regarding their patients adherence to prescribed medication improved medication adherence, patient outcomes, or health resource use. Feedback about medication adherence may improve processes of care, but due to the small number of studies assessing this outcome and high risk of bias, we cannot draw firm conclusions on the effect of feedback on this outcome. Future research should use a clear, standardised definition of medication adherence and cluster-randomisation to avoid the risk of contamination.
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Affiliation(s)
- Vincent Zaugg
- Georges Pompidou European Hospital, AP‐HPClinical Pharmacy Department20 rue LeblancParisFrance75015
| | - Virginie Korb‐Savoldelli
- Georges Pompidou European Hospital, AP‐HPClinical Pharmacy Department20 rue LeblancParisFrance75015
- Paris Sud UniversityFaculty of PharmacyChatenay‐MalabryFrance
| | - Pierre Durieux
- Georges Pompidou European HospitalDepartment of Public Health and Medical Informatics20 rue LeblancParisFrance75015
- Paris Descartes UniversityParisFrance
| | - Brigitte Sabatier
- Georges Pompidou European Hospital, AP‐HPClinical Pharmacy Department20 rue LeblancParisFrance75015
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Dashtidehkordi A, Shahgholian N, Maghsoudi J, Sadeghian J. The Effects of Motivational Interviewing on the Health Status of Patients Undergoing Hemodialysis. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2018; 23:287-291. [PMID: 30034489 PMCID: PMC6034530 DOI: 10.4103/ijnmr.ijnmr_75_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background: Patients undergoing hemodialysis are exposed to a wide range of physical, psychological, and social problems. One of the most important strategies for health promotion in patients is motivational interviewing. This study investigated the effect of motivational interviewing on the health status of patients undergoing hemodialysis. Materials and Methods: This single-blind, parallel, randomized, clinical trial was conducted on 57 patients undergoing hemodialysis who referred to hemodialysis centers of Alzahra and Amin Hospitals, Isfahan, Iran. The participants were selected through quota sampling method and were assigned to the experimental and control groups. The experimental group received five sessions of motivational interviewing, while the control group received five sessions of group discussion about their disease. The General Health Questionnaire (GHQ) was completed by the participants before and after the intervention. Independent t-test, paired-sample t-test, and Mann–Whitney, Chi-square, and Fisher's exact tests were used to analyze the collected data. In this study, the level of significance was 0.05. Results: Before the intervention, there was no significant difference between the mean scores of general health of the two groups (t = 0.48, p = 0.631). However, one week after the intervention, the mean score of general health in the intervention group was significantly lower than that of the control group (t = 3.12, p = 0.003). Conclusions: It can be concluded that motivational interviewing effectively improved the general health of patients undergoing hemodialysis, and using such interventions in these patients is recommended.
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Affiliation(s)
- Alireza Dashtidehkordi
- Department of Dialysis, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nahid Shahgholian
- Kidney Diseases Research Center, Department of Critical Care Nursing, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Jahangir Maghsoudi
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Jaleh Sadeghian
- Kidney Diseases Research Center, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
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Beach MC, Laws MB, Rose G, Roter D, Lee Y, Chander G, Woodson T, Moore RD, Rogers W, Wilson IB. Effects of Minimal Versus Intensive Intervention to Enhance Motivational Interviewing in HIV Care. AIDS Behav 2018; 22:276-286. [PMID: 28578544 PMCID: PMC5712480 DOI: 10.1007/s10461-017-1794-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We conducted a randomized trial comparing the effect of two different levels of motivational interviewing training on clinician communication behaviors and patient experiences. We enrolled 12 HIV clinicians who attended a one-day MI workshop focusing on behavior change counseling skills. We then randomized clinicians to receive (or not) 3-5 rounds of personalized feedback from the MI trainer. We compared outcomes before and after the interventions and between the intervention groups. We tested time-by-study arm interactions to determine if one group improved more than the other. For all analyses, we used generalized estimating equations to account for clustering of patients within clinicians, with Gaussian or negative binomial distributions as appropriate. Patients of clinicians in both intervention groups rated their visits as more MI consistent (6.86 vs. 6.65, p = 0.005) and audio-recording analysis revealed that visits were more patient-centered (1.34 vs. 0.96, p = 0.003) with a more positive patient affect (22.36 vs. 20.84, p < 0.001) after versus before the intervention, without differences between intervention arms. Several specific clinician behaviors such as empathic statements, asking patient opinions and open-ended questions improved more in the workshop+feedback versus the workshop-only intervention arm. A few specific communication behaviors increased (total and complex reflections) after versus before the intervention, without differences between intervention arms. The workshop alone was as effective as the workshop plus feedback in improving patient experiences and overall communication measures. Certain communication behaviors improved more with the more intensive intervention, but these additional benefits may not warrant the extra financial and logistical resources required.
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Affiliation(s)
| | | | - Gary Rose
- William James College, Boston, MA, USA
| | - Debra Roter
- Johns Hopkins University, Baltimore, MD, USA
| | - Yoojin Lee
- Brown School of Public Health, Providence, RI, USA
| | | | | | | | - William Rogers
- Institute for Health Care and Clinical Policy Studies, Tufts Medical Center, Boston, USA
| | - Ira B Wilson
- Brown School of Public Health, Providence, RI, USA
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Erb S, Letang E, Glass TR, Natamatungiro A, Mnzava D, Mapesi H, Haschke M, Duthaler U, Berger B, Muri L, Bader J, Marzolini C, Elzi L, Klimkait T, Langewitz W, Battegay M. Health care provider communication training in rural Tanzania empowers HIV-infected patients on antiretroviral therapy to discuss adherence problems. HIV Med 2017; 18:623-634. [PMID: 28296019 PMCID: PMC5599974 DOI: 10.1111/hiv.12499] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2016] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Self-reported adherence assessment in HIV-infected patients on antiretroviral therapy (ART) is challenging and may overestimate adherence. The aim of this study was to improve the ability of health care providers to elicit patients' reports of nonadherence using a "patient-centred" approach in a rural sub-Saharan African setting. METHODS A prospective interventional cohort study of HIV-infected patients on ART for ≥ 6 months attending an HIV clinic in rural Tanzania was carried out. The intervention consisted of a 2-day workshop for health care providers on patient-centred communication and the provision of an adherence assessment checklist for use in the consultations. Patients' self-reports of nonadherence (≥ 1 missed ART dose/4 weeks), subtherapeutic plasma ART concentrations (< 2.5th percentile of published population-based pharmacokinetic models), and virological and immunological failure according to the World Health Organization definition were assessed before and after (1-3 and 6-9 months after) the intervention. RESULTS Before the intervention, only 3.3% of 299 patients included in the study reported nonadherence. Subtherapeutic plasma ART drug concentrations and virological and immunological failure were recorded in 6.5%, 7.7% and 14.5% of the patients, respectively. Two months after the intervention, health care providers detected significantly more patients reporting nonadherence compared with baseline (10.7 vs. 3.3%, respectively; P < 0.001), decreasing to 5.7% after 6-9 months. A time trend towards higher drug concentrations was observed for efavirenz but not for other drugs. The virological failure rate remained unchanged whereas the immunological failure rate decreased from 14.4 to 8.7% at the last visit (P = 0.002). CONCLUSIONS Patient-centred communication can successfully be implemented with a simple intervention in rural Africa. It increases the likelihood of HIV-infected patients reporting problems with adherence to ART; however, sustainability remains a challenge.
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Affiliation(s)
- S Erb
- Division of Infectious Diseases and Hospital EpidemiologyUniversity Hospital BaselUniversity of BaselBaselSwitzerland
| | - E Letang
- Ifakara Health InstituteIfakara BranchIfakaraTanzania
- Swiss Tropical and Public Health Institute of BaselBaselSwitzerland
- ISGlobal, Barcelona Centre for International Health Research (CRESIB)University Hospital Clínic de BarcelonaBarcelonaSpain
| | - TR Glass
- Swiss Tropical and Public Health Institute of BaselBaselSwitzerland
| | | | - D Mnzava
- Ifakara Health InstituteIfakara BranchIfakaraTanzania
| | - H Mapesi
- Ifakara Health InstituteIfakara BranchIfakaraTanzania
| | - M Haschke
- Division of Clinical Pharmacology and ToxicologyUniversity Hospital BaselUniversity of BaselBaselSwitzerland
| | - U Duthaler
- Division of Clinical Pharmacology and ToxicologyUniversity Hospital BaselUniversity of BaselBaselSwitzerland
| | - B Berger
- Division of Clinical Pharmacology and ToxicologyUniversity Hospital BaselUniversity of BaselBaselSwitzerland
| | - L Muri
- Swiss Tropical and Public Health Institute of BaselBaselSwitzerland
| | - J Bader
- Molecular VirologyDepartment of BiomedicineUniversity of BaselBaselSwitzerland
| | - C Marzolini
- Division of Infectious Diseases and Hospital EpidemiologyUniversity Hospital BaselUniversity of BaselBaselSwitzerland
| | - L Elzi
- Division of Infectious Diseases and Hospital EpidemiologyUniversity Hospital BaselUniversity of BaselBaselSwitzerland
- Ospedale Regionale di Bellinzona e ValliBellinzonaSwitzerland
| | - T Klimkait
- Molecular VirologyDepartment of BiomedicineUniversity of BaselBaselSwitzerland
| | - W Langewitz
- Institute of Psychosomatic MedicineUniversity Hospital BaselUniversity of BaselBaselSwitzerland
| | - M Battegay
- Division of Infectious Diseases and Hospital EpidemiologyUniversity Hospital BaselUniversity of BaselBaselSwitzerland
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Chen WT, Shiu C, Yang JP, Chuang P, Zhang L, Bao M, Lu H. A structural equation model of patient-healthcare provider relationships and HIV-infected patient outcomes in Chinese populations. AIDS Care 2017; 30:383-390. [PMID: 28934872 DOI: 10.1080/09540121.2017.1380778] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Obtaining maximum antiretroviral therapy (ART) adherence is critical for maintaining a high CD4 count and strong immune function in PLWHA. Key factors for achieving optimum adherence include good medication self-efficacy, decreased medication-taking difficulties, and positive patient-healthcare provider (HCP) relationships. Limited studies have analyzed the correlation of these factors and ART adherence in Chinese population. In this paper, structural equation modeling was performed to assess the proposed model of relations between patient-HCP relationships and adherence. Audio Computer-Assisted Self-Interview (ACASI) software was used to collect data on ART adherence and patient variables among 227 PLWHA in Shanghai and Taipei. Participants completed a one-time 60-minute ACASI survey that consisted of standardized measures to assess demographics, recent CD4 counts, self-efficacy, patient-HCP relationship, adherence, and medication-taking difficulties. The data shown the relationship between patient-HCP relationships and adherence was significantly consistent with mediation by medication self-efficacy. However, patient-HCP interaction did not directly influence medication-taking difficulties, and medication-taking difficulties did not significantly affect CD4 counts. Furthermore, patient-HCP interactions did not directly impact CD4 counts; rather, the relation was consistent with mediation (by either better medication self-efficacy or better adherence) or by improved adherence alone. Future interventions should be designed to enhance self-management and provide better patient-HCP communication. This improved communication will enhance medication self-efficacy and decrease medication-taking difficulties. This in turn will improve medication adherence and immune function among PLWHA.
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Affiliation(s)
- Wei-Ti Chen
- a School of Nursing , Yale University , Orange , CT , USA
| | - Chengshi Shiu
- b School of Social Work , University of Washington , Seattle , WA , USA
| | - Joyce P Yang
- c Department of Psychology , University of Washington , Seattle , WA , USA
| | - Peing Chuang
- d Kunming Branch , Center of Disease Prevention and Control , Taipei , Taiwan
| | - Lin Zhang
- e Shanghai Public Health Clinical Center , Fudan University , Shanghai , People's Republic of China
| | - Meijuan Bao
- e Shanghai Public Health Clinical Center , Fudan University , Shanghai , People's Republic of China
| | - Hongzhou Lu
- e Shanghai Public Health Clinical Center , Fudan University , Shanghai , People's Republic of China
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Brand PLP, van Dulmen S. Can we trust what parents tell us? A systematic review. Paediatr Respir Rev 2017; 24:65-71. [PMID: 28283301 DOI: 10.1016/j.prrv.2017.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 01/20/2017] [Indexed: 12/11/2022]
Abstract
Taking a history is a key diagnostic instrument in paediatric consultations. Numerous issues potentially reduce the history's reliability. Therefore, paediatricians have always expressed ambivalence regarding history taking from parents, both valuing and distrusting it. In this review, we describe how parents build and present a description of their child's health issues in the conceptual framework of self-regulation theory. We performed a systematic review on the literature on the reliability of history taking. No studies examined the reliability of history taking from parents, but there is a considerable body of evidence on the issue of mutual trust in relationships between health care professionals and patients. Because trust is a dynamic relational phenomenon, taking a patient centred approach in consultations is likely to increase the patients' and parents' trust in the health care professional, and their willingness to follow the health care professional's treatment proposals. We provide evidence based recommendations on how to build and maintain trust in paediatric consultations by taking a patient centred approach in such consultations.
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Affiliation(s)
- Paul L P Brand
- Isala Women's and Children's Hospital, Zwolle, the Netherlands; UMCG Postgraduate School of Medicine, University Medical Centre and University of Groningen, Groningen, the Netherlands.
| | - Sandra van Dulmen
- Dept. of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands; NIVEL (Netherlands institute for health services research), Utrecht, the Netherlands; Faculty of Health Sciences, University College of Southeast Norway, Drammen, Norway
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Edwards LB, Greeff LE. A descriptive qualitative study of childhood cancer challenges in South Africa: Thematic analysis of 68 photovoice contributions. SOUTH AFRICAN JOURNAL OF ONCOLOGY 2017. [DOI: 10.4102/sajo.v1i0.14] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
<strong>Background:</strong> Many childhood cancers are treatable with cure rates between 70% and 80% in well-resourced countries, while approximately 80% of African children with cancer die without access to adequate care. South Africa has an established oncology health care service with overburdened infrastructure, low cancer awareness in the primary health care service and widespread service delivery challenges.<br /><strong>Aim:</strong> The aim of this study was to explore, document and analyse the subjective experience of childhood cancer-related challenges in South Africa, and to make the results available to stakeholders.<br /><strong>Setting:</strong> A total of 58 patient-participants (childhood cancer patients, parents and guardians of children with cancer) and 10 paediatric oncology workers (oncology social workers, oncology nurses and interim home carers) were selected from tertiary oncology centres and from the Childhood Cancer Foundation of South Africa (CHOC) interim care homes across South Africa.<br /><strong>Method:</strong> Participants were selected via convenience sampling and qualitative data were derived from face-to-face photovoice interviews conducted by psychologists and social workers and supported by translators when necessary.<br /><strong>Results:</strong> Nine themes of cancer challenges were identified via thematic content analysis of the photo-narratives, that is, physical and treatment challenges, emotional, poor services, transport, finances, information, powerlessness, stigma and schooling challenges.<br /><strong>Conclusion:</strong> Lack of awareness and knowledge about cancer at the African traditional healer, primary and regional health care service levels were frequent challenges. Important feedback included lack of patient-centred care, separation of children with cancer from guardians, diagnostic delays, permanent disabilities for children because of cancer, emotional trauma, special needs of teenagers and a lack of community and palliative care support.
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Mukherjee P, Leroy G, Kauchak D, Rajanarayanan S, Romero Diaz DY, Yuan NP, Pritchard TG, Colina S. NegAIT: A new parser for medical text simplification using morphological, sentential and double negation. J Biomed Inform 2017; 69:55-62. [PMID: 28342946 PMCID: PMC5933936 DOI: 10.1016/j.jbi.2017.03.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 12/17/2016] [Accepted: 03/20/2017] [Indexed: 12/22/2022]
Abstract
Many different text features influence text readability and content comprehension. Negation is commonly suggested as one such feature, but few general-purpose tools exist to discover negation and studies of the impact of negation on text readability are rare. In this paper, we introduce a new negation parser (NegAIT) for detecting morphological, sentential, and double negation. We evaluated the parser using a human annotated gold standard containing 500 Wikipedia sentences and achieved 95%, 89% and 67% precision with 100%, 80%, and 67% recall, respectively. We also investigate two applications of this new negation parser. First, we performed a corpus statistics study to demonstrate different negation usage in easy and difficult text. Negation usage was compared in six corpora: patient blogs (4K sentences), Cochrane reviews (91K sentences), PubMed abstracts (20K sentences), clinical trial texts (48K sentences), and English and Simple English Wikipedia articles for different medical topics (60K and 6K sentences). The most difficult text contained the least negation. However, when comparing negation types, difficult texts (i.e., Cochrane, PubMed, English Wikipedia and clinical trials) contained significantly (p<0.01) more morphological negations. Second, we conducted a predictive analytics study to show the importance of negation in distinguishing between easy and difficulty text. Five binary classifiers (Naïve Bayes, SVM, decision tree, logistic regression and linear regression) were trained using only negation information. All classifiers achieved better performance than the majority baseline. The Naïve Bayes' classifier achieved the highest accuracy at 77% (9% higher than the majority baseline).
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Affiliation(s)
| | - Gondy Leroy
- University of Arizona, Tucson, AZ, United States
| | | | | | | | | | | | - Sonia Colina
- University of Arizona, Tucson, AZ, United States
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Fuertes JN, Toporovsky A, Reyes M, Osborne JB. The physician-patient working alliance: Theory, research, and future possibilities. PATIENT EDUCATION AND COUNSELING 2017; 100:610-615. [PMID: 27773600 DOI: 10.1016/j.pec.2016.10.018] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 10/15/2016] [Accepted: 10/18/2016] [Indexed: 05/24/2023]
Abstract
OBJECTIVE This article discusses the physician-patient working alliance and reviews the empirical research that has been generated on the working alliance to date. METHODS The paper presents a brief history of the study of the physician-patient relationship, and discusses constructs that have examined aspects of the relationship, such as empathy, trust, and shared decision-making. Lastly, a meta-analysis was conducted based on the seven empirical studies (a total N of 1023 patients) that have examined the physician-patient working alliance. RESULTS Results of the meta-analysis found medium to large effect sizes between the working alliance and various behavioral care indices. The working alliance is positively associated with patient adherence, satisfaction, and improved patient outcomes. CONCLUSION Overall, the physician-patient working alliance provides researchers and medical-care providers with a unified construct that combines cognitive and affective dimensions inherent in the relationship in medical care. Furthermore, the PPWAI provides an efficient and inexpensive way to assess the physician-patient relationship in medical treatment. PRACTICE IMPLICATIONS The present findings warrant the development of an intervention focused on working alliance training that could be offered to healthcare providers.
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Affiliation(s)
- Jairo N Fuertes
- Derner Institute of Advanced Psychological Studies, Adelphi University, Garden City, NY 11530, USA.
| | - Arielle Toporovsky
- Derner Institute of Advanced Psychological Studies, Adelphi University, Garden City, NY 11530, USA
| | - Mariela Reyes
- Derner Institute of Advanced Psychological Studies, Adelphi University, Garden City, NY 11530, USA
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Youngson MJ, Currey J, Considine J. Current practices related to family presence during acute deterioration in adult emergency department patients. J Clin Nurs 2017; 26:3624-3635. [PMID: 28102924 DOI: 10.1111/jocn.13733] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2017] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To explore the characteristics of and interactions between clinicians, patients and family members during management of the deteriorating adult patient in the emergency department. BACKGROUND Previous research into family presence during resuscitation has identified many positive outcomes when families are included. However, over the last three decades the epidemiology of acute clinical deterioration has changed, with a decrease in in-hospital cardiac arrests and an increase in acute clinical deterioration. Despite the decrease in cardiac arrests, research related to family presence continues to focus on care during resuscitation rather than care during acute deterioration. DESIGN Descriptive exploratory study using nonparticipatory observation. METHODS Five clinical deterioration episodes were observed within a 50-bed, urban, Australian emergency department. Field notes were taken using a semistructured tool to allow for thematic analysis. RESULTS Presence, roles and engagement describe the interactions between clinicians, family members and patients while family are present during a patient's episode of deterioration. Presence was classified as no presence, physical presence and therapeutic presence. Clinicians and family members moved through primary, secondary and tertiary roles during patients' deterioration episode. Engagement was observed to be superficial or deep. There was a complex interplay between presence, roles and engagement with each influencing which form the other could take. CONCLUSIONS Current practices of managing family during episodes of acute deterioration are complex and multifaceted. There is fluid interplay between presence, roles and engagement during a patient's episode of deterioration. RELEVANCE TO CLINICAL PRACTICE This study will contribute to best practice, provide a strong foundation for clinician education and present opportunities for future research.
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Affiliation(s)
- Megan J Youngson
- School of Nursing and Midwifery, Deakin University, Burwood, Vic., Australia.,Critical Care Department, Ballarat Health Services, Ballarat, Vic., Australia
| | - Judy Currey
- Deakin University, Geelong, Vic., Australia.,School of Nursing and Midwifery/Centre for Quality and Patient Safety Research, Deakin University, Burwood, Vic., Australia
| | - Julie Considine
- School of Nursing and Midwifery/Centre for Quality and Patient Safety Research, Burwood, Vic., Australia.,Eastern Health - Deakin University Nursing and Midwifery Research Centre, Box Hill, Vic., Australia
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Predicting adherence to acupuncture appointments for low back pain: a prospective observational study. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 17:5. [PMID: 28049527 PMCID: PMC5209924 DOI: 10.1186/s12906-016-1499-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 12/06/2016] [Indexed: 01/03/2023]
Abstract
Background Acupuncture is a popular form of complementary and alternative medicine (CAM), but it is not clear why patients do (or do not) follow acupuncturists’ treatment recommendations. This study aimed to investigate theoretically-derived predictors of adherence to acupuncture. Methods In a prospective study, adults receiving acupuncture for low back pain completed validated questionnaires at baseline, 2 weeks, 3 months, and 6 months. Patients and acupuncturists reported attendance. Logistic regression tested whether illness perceptions, treatment beliefs, and treatment appraisals measured at 2 weeks predicted attendance at all recommended acupuncture appointments. Results Three hundred twenty-four people participated (aged 18–89 years, M = 55.9, SD = 14.4; 70% female). 165 (51%) attended all recommended acupuncture appointments. Adherence was predicted by appraising acupuncture as credible, appraising the acupuncturist positively, appraising practicalities of treatment positively, and holding pro-acupuncture treatment beliefs. A multivariable logistic regression model including demographic, clinical, and psychological predictors, fit the data well (χ2 (21) = 52.723, p < .001), explained 20% of the variance, and correctly classified 65.4% of participants as adherent/non-adherent. Conclusions The results partially support the dynamic extended common-sense model for CAM use. As hypothesised, attending all recommended acupuncture appointments was predicted by illness perceptions, treatment beliefs, and treatment appraisals. However, experiencing early changes in symptoms did not predict attendance. Acupuncturists could make small changes to consultations and service organisation to encourage attendance at recommended appointments and thus potentially improve patient outcomes.
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Sidorkiewicz S, Tran VT, Cousyn C, Perrodeau E, Ravaud P. Discordance Between Drug Adherence as Reported by Patients and Drug Importance as Assessed by Physicians. Ann Fam Med 2016; 14:415-21. [PMID: 27621157 PMCID: PMC5394381 DOI: 10.1370/afm.1965] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 04/27/2016] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Among patients on long-term medical therapy, we compared (1) patient and physician assessments of drug adherence and of drug importance and (2) drug adherence reported by patients with drug importance as assessed by their physicians. METHODS We recruited to the study patients receiving at least 1 long-term drug treatment from both hospital and ambulatory settings in France. We compared drug adherence reported by patients and drug importance assessed by physicians using Spearman correlation coefficients. Reasons for nonadherence were collected with open-ended questions and classified as intentional or unintentional. RESULTS Between April and August 2014, we recruited 128 patients taking 498 drugs. Patients and physicians showed only weak agreement in their assessments of drug adherence (r = -0.25; 95% CI, -0.37 to -0.11) and drug importance (r = 0.07; 95% CI, 0.00 to 0.13). We did not find any correlation between physician-assessed drug importance and patient-reported drug adherence (r = -0.04; 95% CI, -0.14 to 0.06). In all, 94 (18.9%) of the drugs that physicians considered important were not correctly taken by patients. Patients intentionally did not adhere to 26 (48.1%) of the drugs for which they reported reasons for nonadherence. CONCLUSIONS We found substantial discordance between patient and physician evaluations of drug adherence and drug importance. Nearly 20% of drugs considered important by physicians were not correctly taken by patients. These findings highlight the need for better patient-physician collaboration in drug treatment.
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Affiliation(s)
- Stéphanie Sidorkiewicz
- Department of General Medicine, Paris Descartes University, Paris, France METHODS Team, INSERM U1153, Epidemiology and Statistics Sorbonne Paris Cité Research Centre, France
| | - Viet-Thi Tran
- METHODS Team, INSERM U1153, Epidemiology and Statistics Sorbonne Paris Cité Research Centre, France Department of General Medicine, Paris Diderot University, Paris, France
| | - Cécile Cousyn
- Department of General Medicine, Paris Diderot University, Paris, France
| | - Elodie Perrodeau
- METHODS Team, INSERM U1153, Epidemiology and Statistics Sorbonne Paris Cité Research Centre, France
| | - Philippe Ravaud
- METHODS Team, INSERM U1153, Epidemiology and Statistics Sorbonne Paris Cité Research Centre, France French Cochrane Centre, Paris, France Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, New York
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Lambers NM, Bolton JE. Perceptions of the quality of the therapeutic alliance in chiropractic care in The Netherlands: a cross-sectional survey. Chiropr Man Therap 2016; 24:18. [PMID: 27280015 PMCID: PMC4897913 DOI: 10.1186/s12998-016-0100-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 05/06/2016] [Indexed: 02/08/2023] Open
Abstract
Background Research in various medical fields demonstrates a consistent and positive association between clinical outcomes and the quality of the therapeutic alliance between the patient and clinician. The aim of this study was to explore how well chiropractors and their patients in The Netherlands perceive the quality of their working relationship. Methods A nationwide survey of chiropractors and their patients was conducted in The Netherlands, using a validated Dutch translation of the Working Alliance Inventory (WAV-12). Data were collected over a 5-week period in September-October 2014. Both patients and chiropractors were requested to reflect on 12 statements about to how well they perceived their collaboration in reaching consensus on treatment goals and treatment strategies, and how well they perceived the existence of an affective bond in their working relationship. A 5-point Likert scale was used to answer each question. Higher ratings reflected a more positive perception of the therapeutic alliance. Furthermore, levels of agreement between patients’ and chiropractors’ perceptions of the quality of their therapeutic alliance were determined. Results In total, 207 working relationships between patients and their chiropractor were analysed. The quality of the therapeutic alliance was perceived as being very positive for both patients (n = 183, mean 49.14 ± 7.12) and chiropractors (n = 202, mean 50.48 ± 4.97). There was no difference in patients’ perceptions whether treated by a male or female chiropractor, nor in relation to the chiropractor’s years of experience. Nevertheless, poor agreement was found between perceptions of patients and chiropractors in the same relationship (ICC = 0.13). Conclusions Both patients and chiropractors perceived the quality of the therapeutic alliance as being very positive. Despite these positive results, patient and chiropractor pairs perceived the level of collaboration in order to reach agreement on treatment goals and strategies and the quality of their affective bond very differently. Clinically, these results suggest that chiropractors should, during the course of treatment, continue to collaborate with their patient and frequently verify whether their patient continues to agree with the treatment goals and treatment plan applied to further develop, improve and maintain a positive therapeutic alliance. Electronic supplementary material The online version of this article (doi:10.1186/s12998-016-0100-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nicoline M Lambers
- Anglo-European College of Chiropractic, 13-15 Parkwood Road, Bournemouth, BH5 2DF UK
| | - Jennifer E Bolton
- Anglo-European College of Chiropractic, 13-15 Parkwood Road, Bournemouth, BH5 2DF UK
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Wright MM, Medved M, Woodgate RL, Roger K, Sullivan D. Narratives of acquired brain injury patients: Their experience of healthcare relationships and medical decision-making. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/17538068.2016.1186337] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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50
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Gerwing J, Indseth T, Gulbrandsen P. A microanalysis of the clarity of information in physicians' and patients' discussions of treatment plans with and without language barriers. PATIENT EDUCATION AND COUNSELING 2016; 99:522-529. [PMID: 26561309 DOI: 10.1016/j.pec.2015.10.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 09/24/2015] [Accepted: 10/15/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Physicians and patients discuss treatment plans. If tasks within plans are not described adequately, patients cannot adhere. We evaluated task descriptions, testing whether patient engagement and language barriers affected task clarity. METHOD We sampled 12 videotaped hospital interactions from a corpus of 497: two encounters each from six hospital physicians, interacting with one native-speaking and one non-native-speaking patient. We used microanalysis of face-to-face dialogue to assess whether the physicians and patients achieved a complete, clear description of each task's three core information elements (who should do what and when). RESULTS We conducted detailed analysis on 78 of the 90 tasks. Core information elements were complete in 62 (0.79) and clear in 37 (0.47). Language barriers had no effect on task clarity. When native-speaking patients were engaged, tasks were clearer (p<0.05). Although non-native-speaking patients were significantly more engaged (p<0.01), their engagement had no effect. CONCLUSION Physicians may be pursuing patients' agreement, motivation, and commitment at the expense of working with the patient to be clear about what needs to be done. PRACTICE IMPLICATIONS Physicians need to improve how clearly they present basic task information. Previous research demonstrated that even a short course can significantly improve the clarity of instructions.
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Affiliation(s)
- Jennifer Gerwing
- Health Services Research Center (HØKH), Akershus University Hospital, Lørenskog, Norway.
| | - Thor Indseth
- Norwegian Center for Minority Health Research (NAKMI), Oslo Universitetssykehus HF, avd. Ullevål, Oslo, Norway.
| | - Pål Gulbrandsen
- Health Services Research Center (HØKH), Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, Campus Ahus, University of Oslo, Norway.
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