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Clair KS, Bean-Mayberry B, Schweizer CA, Chanfreau C, Jackson L, Than CT, Finley EP, Hamilton A, Farmer MM. Factors Associated with Delayed Care Among Women Veterans Actively Engaged in Primary Care. J Womens Health (Larchmt) 2024; 33:604-612. [PMID: 38386795 DOI: 10.1089/jwh.2023.0227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024] Open
Abstract
Background: Delaying needed medical care contributes to greater health risks and higher long-term medical costs. Women Veterans with complex medical and mental health needs face increased barriers to timely care access. Objectives: In a sample of women Veterans with recent engagement in Veterans Administration (VA) primary care, we aimed to compare characteristics of women Veterans who delayed care in the past 6 months with those who did not and examine factors associated with self-reported delayed care. Our study aims to inform interventions focused on eliminating health care access disparities among women Veterans. Materials and Methods: An innovation to improve women Veterans' engagement and retention in evidence-based health care for cardiovascular (CV) risk reduction (CV Toolkit) was implemented across five primary care sites within the VA. Women Veterans who were exposed to at least one CV Toolkit component participated in a mailed survey (n = 253). We used multivariate logistic regression to model factors associated with delaying care, including trust in VA providers, positive mental health screening (i.e., positive screen for either depression or anxiety), traumatic experience, self-rated health, and age. Results: Women with any mental health symptoms (odds ratio [OR] 2.42, 95% confidence interval [CI]: 1.23-4.74) and women who had experienced a traumatic event (OR 2.61, 95%CI: 1.11-6.14) were significantly more likely to report delaying care. Conclusions: Our study identified high rates of delayed care-over one-third of respondents-among women Veterans with recent primary care engagement. Mental health symptoms were the most common reported reason for delay among those who delayed care. Clinical Trial registration: NCT02991534.
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Affiliation(s)
- Kimberly S Clair
- VA Health Service Research and Development, Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Bevanne Bean-Mayberry
- VA Health Service Research and Development, Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - C Amanda Schweizer
- VA Health Service Research and Development, Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Catherine Chanfreau
- VA Informatics and Computing Infrastructure (VINCI), VA Salt Lake City Healthcare System, Salt Lake City, Utah, USA
| | - LaShawnta Jackson
- VA Health Service Research and Development, Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Claire T Than
- VA Health Service Research and Development, Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Erin P Finley
- VA Health Service Research and Development, Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Medicine, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Alison Hamilton
- VA Health Service Research and Development, Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, California, USA
| | - Melissa M Farmer
- VA Health Service Research and Development, Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
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MERENSTEIN ZACHARY, SHUEMAKER JILLC, PHILLIPS ROBERTL. Measuring Trust in Primary Care. Milbank Q 2023; 101:841-880. [PMID: 37167452 PMCID: PMC10509519 DOI: 10.1111/1468-0009.12654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 04/06/2023] [Accepted: 04/13/2023] [Indexed: 05/13/2023] Open
Abstract
Policy Points Trust in primary care clinicians is essential for effective patient care and is associated with better health outcomes, but it is rarely assessed, and existing measures have not been thoroughly evaluated. This scoping review reveals that research assessing patients' trust in primary care clinicians largely stopped more than a decade ago but offers candidate measures for future testing, implementation, and policy applications. CONTEXT Trust is a fundamental aspect of any human relationship, and medical care is no exception. An ongoing, trusting relationship between clinicians and patients has shown demonstrable value to primary care. However, there is currently no measure of trust in general use, and none endorsed for use by most value-based payment programs. This review searched the literature for any existing measures of patient trust in primary care clinicians and assessed their potential to be implemented as a patient-reported outcome measure. METHODS A keyword search on PubMed along with scanning references was conducted to find any trust measures in health care. Measures that did not address primary care clinicians were eliminated and the remaining measures were then assessed for their utility to primary care. RESULTS This purposeful, scoping review found four tested measures for assessing patients' trust in primary care clinicians that are candidates for general use. Of these four, the revised Trust in Physicians Scale and Wake Forest Physician Trust Scale are the most tested and viable options. CONCLUSION Renewed national interest in trust in health care should focus on the capacity to measure it. This review informs the effort to test trust measures for use in research, practice improvement, and value-based payment. Measuring trust, how it relates to outcomes, and learning how it is produced or lost are key to assisting practices and health systems toward earning it.
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Affiliation(s)
| | - JILL C. SHUEMAKER
- American Board of Family Medicine Foundation, The Center for Professionalism & Value in Health Care
| | - ROBERT L. PHILLIPS
- American Board of Family Medicine Foundation, The Center for Professionalism & Value in Health Care
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Lincoln TE, Buddadhumaruk P, Arnold RM, Scheunemann LP, Ernecoff NC, Chang CCH, Carson SS, Hough CL, Curtis JR, Anderson W, Steingrub J, Peterson MW, Lo B, Matthay MA, White DB. Association Between Shared Decision-Making During Family Meetings and Surrogates' Trust in Their ICU Physician. Chest 2023; 163:1214-1224. [PMID: 36336000 PMCID: PMC10258434 DOI: 10.1016/j.chest.2022.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Although trust is central to successful physician-family relationships in ICUs, little is known about how to promote surrogates' trust of ICU physicians in this setting. RESEARCH QUESTION Does the conduct of family conferences and physicians' use of shared decision-making (SDM) within family conferences impact surrogates' trust in the physician? STUDY DESIGN AND METHODS A mixed-methods secondary analysis was done of a multicenter prospective cohort study of 369 surrogate decision-makers of 204 decisionally incapacitated patients at high risk of death or severe functional impairment within 13 ICUs at six US medical centers between 2008 and 2012. Surrogates completed the Abbreviated Wake Forest Physician Trust Scale (range, 5-25) before and after an audio-recorded family conference conducted within 5 days of ICU admission. We qualitatively coded transcribed conferences to determine physicians' use of five SDM behaviors: discussing surrogate's role, explaining medical condition and prognosis, providing emotional support, assessing understanding, and eliciting patient's values and preferences. Using multivariable linear regression with adjustment for clustering, we assessed whether surrogates' trust in the physician increased after the family meeting; we also examined whether the number of SDM behaviors used by physicians during the family meeting impacted trust scores. RESULTS In adjusted models, conduct of a family meeting was associated with increased trust (average change, pre- to post family meeting: 0.91 point [95% CI, 0.4-1.4; P < .01]). Every additional element of SDM used during the family meeting, including discussing surrogate's role, providing emotional support, assessing understanding, and eliciting patient's values and preferences, was associated with a 0.37-point increase in trust (95% CI, 0.08-0.67; P = .01). If all four elements were used, trust increased by 1.48 points. Explaining medical condition or prognosis was observed in nearly every conference (98.5%) and was excluded from the final model. INTERPRETATION The conduct of family meetings and physicians' use of SDM behaviors during meetings were both associated with increases in surrogates' trust in the treating physician.
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Affiliation(s)
- Taylor E Lincoln
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA; Section of Palliative Care and Medical Ethics, University of Pittsburgh, Pittsburgh, PA.
| | - Praewpannarai Buddadhumaruk
- Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Robert M Arnold
- Section of Palliative Care and Medical Ethics, University of Pittsburgh, Pittsburgh, PA
| | - Leslie P Scheunemann
- Division of Geriatrics and Gerontology, University of Pittsburgh, Pittsburgh, PA; Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA
| | | | - Chung-Chou H Chang
- Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA; Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Shannon S Carson
- Division of Pulmonary Disease and Critical Care Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Catherine L Hough
- Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, OR
| | - J Randall Curtis
- Division of Pulmonary, Critical Care, and Sleep Medicine, Harborview Medical Center, University of Washington, Seattle, WA
| | - Wendy Anderson
- Department of Medicine and Division of Hospital Medicine and Palliative Care Program, University of California San Francisco, San Francisco, CA
| | - Jay Steingrub
- Division of Pulmonary and Critical Care Medicine, Baystate Medical Center, Springfield, MA and Tufts University School of Medicine, Boston, MA
| | - Michael W Peterson
- Department of Medicine, University of California San Francisco Fresno Medical Education Program, Fresno, CA
| | - Bernard Lo
- Department of Medicine, University of California San Francisco Fresno Medical Education Program, Fresno, CA
| | - Michael A Matthay
- Division of Pulmonary and Critical Care Medicine, University of Massachusetts Chan Medical School, Baystate, MA
| | - Douglas B White
- Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
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Gardner J, Brown G, Vargas-Correa J, Weaver F, Rubinstein I, Gordon HS. An assessment of Veterans attitudes and willingness to receiving the COVID-19 vaccine: a mixed methods study. BMC Infect Dis 2022; 22:308. [PMID: 35351029 PMCID: PMC8961481 DOI: 10.1186/s12879-022-07269-7] [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: 11/02/2021] [Accepted: 03/13/2022] [Indexed: 11/30/2022] Open
Abstract
Background While several safe and effective COVID-19 vaccines have been available since December 2020, many eligible individuals choose to remain unvaccinated. This vaccine hesitancy is an important factor affecting our ability to combat the COVID-19 pandemic. Methods The objective of the study was to examine the attitudes and willingness among US Veterans toward receiving COVID-19 vaccination. The study used a quantitative qualitative mixed methods design with a telephone survey and then in-depth interviews in a subset of those surveyed. Participants were unvaccinated Veterans (N = 184) selected randomly from a registry of patients who had received VA healthcare during the pandemic and had a diagnostic test for COVID-19. The primary outcome was willingness to accept COVID-19 vaccination. Survey data collection and in-depth interviews were conducted by telephone. Analyses of the survey data compared the primary outcome with demographics, clinical data, and survey responses using bivariate and multiple regression analyses. A subset (N = 10) of those surveyed, participated in an in-depth interview. Interview transcripts were analyzed to derive themes using qualitative content analysis. Results Almost 40% of participants disagreed they would receive a COVID-19 vaccine. Participants who were younger, female, and had fewer comorbid conditions were more likely (P < 0.05) to disagree with COVID-19 vaccination. In multiple regression analysis, willingness to accept vaccination was associated with reliance on a doctor or family member’s recommendation and with a belief that vaccines are effective. In-depth interviews revealed several barriers to COVID-19 vaccination, including lack of trust in the government and vaccine manufacturers, concerns about the speed of vaccine development, fear of side effects, and fear the vaccine was a tool of racism. Conclusions This study illustrates the complexity of patients’ deliberation about COVID-19 vaccination and may help physicians and other health care providers understand patients’ perspectives about COVID-19 vaccination. The results highlight the importance of patients’ trust in physicians, healthcare organizations, pharmaceutical manufacturers and the government when making health decisions. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07269-7.
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Affiliation(s)
- Jessica Gardner
- Jesse Brown Veterans Affairs Medical Center, 820 S. Damen Ave (151), Chicago, IL, 60612, USA
| | - Gabriel Brown
- Jesse Brown Veterans Affairs Medical Center, 820 S. Damen Ave (151), Chicago, IL, 60612, USA
| | - Jadisha Vargas-Correa
- Jesse Brown Veterans Affairs Medical Center, 820 S. Damen Ave (151), Chicago, IL, 60612, USA
| | - Frances Weaver
- VA Center of Innovation for Complex Chronic Healthcare, Chicago, IL, USA.,Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Chicago, USA
| | - Israel Rubinstein
- Jesse Brown Veterans Affairs Medical Center, 820 S. Damen Ave (151), Chicago, IL, 60612, USA.,Division of Pulmonary, Critical Care, Sleep, and Allergy Medicine, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Howard S Gordon
- Jesse Brown Veterans Affairs Medical Center, 820 S. Damen Ave (151), Chicago, IL, 60612, USA. .,VA Center of Innovation for Complex Chronic Healthcare, Chicago, IL, USA. .,Division of Academic Internal Medicine, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA. .,Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA.
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5
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Michel KG, Ocampo JMF, Spence AB, Wang C, Kikkisetti A, Doyle A, Merenstein D, Goparaju L, Kassaye SG. High Provider Trust Associates with High HIV Antiretroviral Adherence Among Women Living with HIV in a Metropolitan Washington, DC Cohort. AIDS Patient Care STDS 2022; 36:17-25. [PMID: 34910888 PMCID: PMC8905303 DOI: 10.1089/apc.2021.0110] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Trust in providers and health care systems (HCSs) has been associated with higher HIV antiretroviral (ART) adherence; however, most previous studies enrolled primarily men and did not concurrently assess provider trust, HCS distrust, and clinical/biological outcomes. We enrolled 239 Washington, DC Women's Interagency HIV Study (WIHS) women: 167 with HIV (WWH) and 72 without HIV. In 2006 and 2017-2018, women completed surveys on provider trust and HCS distrust. Clinical, social, and demographic covariates were obtained during the 2017-2018 WIHS study visit. Descriptive analyses included chi-squared and Mann-Whitney tests. Wilcoxon signed-rank tests assessed trust measure change over time. Logistic (provider trust) and linear (HCS distrust) models were constructed in R. The majority of women were African American/Black (76.9%) with a median age of 52 (interquartile range 48, 58) and currently insured (99.6%). In multi-variable analyses, women with HIV (WWH) had higher odds of high provider trust [adjusted odds ratio (aOR) 2.90, 95% confidence interval (CI) 1.34, 6.45], with ≥95% ART adherence associated with high provider trust among only WWH (aOR 4.13, 95% CI 1.14, 15.92). Multi-variable models also showed 3.40-point higher HCS distrust scores among WWH who reported ≥95% ART adherence (p = 0.03). CD4 count and HIV viral load were not associated with provider trust or HCS distrust. Provider (p = 0.67) and HCS (p = 0.65) trust did not significantly change in this population at two time points for 10 years. Self-reported antiretroviral therapy adherence significantly associated with high provider trust, yet also with high HCS distrust, revealing a nuanced relationship to providers and the HCS among WWH.
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Affiliation(s)
- Katherine G. Michel
- Division of Infectious Diseases, Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia, USA.,Address correspondence to: Katherine G. Michel, PhD, MPH, Georgetown University, 2115 Wisconsin Avenue NW, Suite 130, Washington, DC 20007, USA
| | - Joanne Michelle F. Ocampo
- Division of Infectious Diseases, Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Amanda Blair Spence
- Division of Infectious Diseases, Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Cuiwei Wang
- Division of Infectious Diseases, Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Anjali Kikkisetti
- Department of Biological Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Allison Doyle
- Department of Pediatrics, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Daniel Merenstein
- Department of Family Medicine, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Lakshmi Goparaju
- Division of Infectious Diseases, Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Seble G. Kassaye
- Division of Infectious Diseases, Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia, USA
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Distancing Adherence and Negative Emotions among the Israeli Elderly Population during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168770. [PMID: 34444515 PMCID: PMC8394362 DOI: 10.3390/ijerph18168770] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 11/21/2022]
Abstract
Social distancing was found to prevent COVID-19 contagion. Therefore, understanding the factors associated with the public’s adherence is important. Acknowledging the importance of emotional wellbeing regarding older people’s health, and understanding their emotional state during the pandemic, are crucial. This study assessed factors associated with older people’s adherence to social distancing and their emotional status. A cross-sectional online survey was conducted among 1822 respondents above the age of 60. Distancing adherence, negative emotion, trust, social support, threat perception, attitudes, and subjective norms were assessed, and a path analysis was performed. Adherence was positively associated with attitudes (β = 0.10; p < 0.001), and with subjective norms (β = 0.19; p < 0.001). Negative emotions were positively associated with threat perception (β = 0.33; p < 0.001), and negatively associated with social support (β = −0.13; p < 0.001) and subjective norms (β = −0.10; p < 0.001). Attitudes mediated the relationship of threat perception (95% CI = 0.009, 0.034), trust (95% CI = 0.008, 0.029), and social support (95% CI = 0.006, 0.023) with distancing adherence. Subjective norms mediated the relationship between threat perception (95% CI = 0.014, 0.034), trust (95% CI = 0.026, 0.055), and social support (95% CI = 0.002, 0.048) with distancing adherence. Subjective norms mediated the relationship between threat perception (95% CI = −0.022, −0.006), trust (95% CI = −0.034, −0.010), and social support (95% CI = −0.029, −0.009) with negative emotions. When promoting social distancing adherence, subjective norms and attitudes must be considered, as they play a role in promoting adherence and negative-emotion regulation.
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Rotaru TȘ, Frățilă OC, Bărboi O, Ciortescu I, Mihai C, Anton C, Ștefănescu G, Drug V. A comparison using standardized measures for patients with irritable bowel syndrome: Trust in the gastroenterologist and reliance on the internet. Neurogastroenterol Motil 2021; 33:e13977. [PMID: 32875697 DOI: 10.1111/nmo.13977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/09/2020] [Accepted: 08/01/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Irritable bowel syndrome (IBS) patients' use of the Internet for health information interacts with the way they trust their gastroenterologist. No standardized measure has targeted IBS patients and gastroenterologists specifically, nor their use of the Internet. The aims of this paper were as follows: the development of a scale that measures an IBS patient's trust in their gastroenterologist, the development of a scale measuring an IBS patient's reliance on Internet health information, and testing the hypothesis that IBS patients, who use the Internet for IBS-related information, trust their gastroenterologist less than those who do not. METHOD A total of 82 patients (mean age 49, SD = 14.62) diagnosed with IBS completed two questionnaires: one about trust in their gastroenterologist and the other about the reliance on Internet health information regarding IBS. The two questionnaires were built using current literature as well as our previous qualitative research. The statistical computations were performed using the SPSS 20 program. KEY RESULTS Both questionnaires proved to be reliable in measuring gastroenterologist-IBS patient trust (alpha = 0.87) and Internet information reliance (alpha = 0.88), respectively. The IBS patients who did not look for information about IBS over the Internet had significantly higher trust in their gastroenterologist compared with those who did (U = 535.5; z = -2.26; P < 0.05). CONCLUSIONS We developed two ready-to-use scales to measure both the gastroenterologist-IBS patient's trust and the IBS patient's reliance on the Internet. Further studies will be able to explore the interaction among all variables in IBS patients' trust.
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Affiliation(s)
| | | | - Oana Bărboi
- University of Medicine and Pharmacy «Gr. T. Popa» Iași, Iași, Romania.,Institute of Gastroenterology and Hepatology, University Hospital St Spiridon, Iași, Romania
| | - Irina Ciortescu
- University of Medicine and Pharmacy «Gr. T. Popa» Iași, Iași, Romania.,Institute of Gastroenterology and Hepatology, University Hospital St Spiridon, Iași, Romania
| | - Cătălina Mihai
- University of Medicine and Pharmacy «Gr. T. Popa» Iași, Iași, Romania.,Institute of Gastroenterology and Hepatology, University Hospital St Spiridon, Iași, Romania
| | - Carmen Anton
- University of Medicine and Pharmacy «Gr. T. Popa» Iași, Iași, Romania.,Institute of Gastroenterology and Hepatology, University Hospital St Spiridon, Iași, Romania
| | - Gabriela Ștefănescu
- University of Medicine and Pharmacy «Gr. T. Popa» Iași, Iași, Romania.,Institute of Gastroenterology and Hepatology, University Hospital St Spiridon, Iași, Romania
| | - Vasile Drug
- University of Medicine and Pharmacy «Gr. T. Popa» Iași, Iași, Romania.,Institute of Gastroenterology and Hepatology, University Hospital St Spiridon, Iași, Romania
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USTA D, KORKMAZ F. Türkiye'deki üçüncü basamak bakım kurumlarından hizmet alan hastaların sağlık sistemine güven düzeyleri. CUKUROVA MEDICAL JOURNAL 2020. [DOI: 10.17826/cumj.647412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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9
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Schroeck FR, St Ivany A, Lowrance W, Makarov DV, Goodney PP, Zubkoff L. Patient Perspectives on the Implementation of Risk-Aligned Bladder Cancer Surveillance: Systematic Evaluation Using the Tailored Implementation for Chronic Diseases Framework. JCO Oncol Pract 2020; 16:e668-e677. [PMID: 32119595 PMCID: PMC10841578 DOI: 10.1200/jop.19.00576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2020] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Many patients living with bladder cancer do not undergo surveillance that is aligned with their risk for recurrence or progression, which exposes them to unnecessary risk and burden of procedures. To implement risk-aligned surveillance as recommended by multiple guidelines, we need to understand patient-, provider-, and system-level factors contributing to the delivery of risk-aligned surveillance. In this study, we sought to systematically assess patient-level factors. PARTICIPANTS AND METHODS Guided by the Tailored Implementation for Chronic Diseases framework, we conducted semistructured interviews with 22 patients with bladder cancer undergoing surveillance cystoscopy procedures at three facilities within the Department of Veterans Affairs. Patients were sampled using quantitative data on bladder cancer risk category (low v high) and on surveillance category (aligned v not aligned with cancer risk). Interview transcripts were analyzed using a priori codes from the Tailored Implementation for Chronic Diseases framework. Quantitative and qualitative data were integrated by cross-tabulating determinants across risk and surveillance categories. RESULTS Participants included seven low-risk and 15 high-risk patients; 10 underwent risk-aligned surveillance and 12 did not. In mixed-methods analyses, perception of risk appropriately differed by risk but not by surveillance category. Participants understood the recommended surveillance schedule according to their risk category. Participants emphatically expressed that adhering to providers' recommendations is prudent; intentions to adhere did not vary across risk and surveillance categories. CONCLUSION Participants intended to adhere to providers' recommendations and strongly endorsed the importance of adherence. These findings suggest implementation strategies to improve risk-aligned surveillance may be most effective when targeting provider- and system-level factors rather than patient-level factors.
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Affiliation(s)
- Florian R. Schroeck
- White River Junction VA Medical Center, White River Junction, VT
- Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, NH
- Norris Cotton Cancer Center Dartmouth Hitchcock Medical Center, Lebanon, NH
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Hanover, NH
| | - Amanda St Ivany
- Department of Community and Family Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH
| | - William Lowrance
- Salt Lake City VA Healthcare System, Salt Lake City, UT
- Department of Urology, University of Utah, Salt Lake City, UT
| | - Danil V. Makarov
- New York Harbor VA Healthcare System, New York, NY
- Departments of Urology and Population Health, New York University, New York, NY
| | - Philip P. Goodney
- White River Junction VA Medical Center, White River Junction, VT
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Hanover, NH
| | - Lisa Zubkoff
- White River Junction VA Medical Center, White River Junction, VT
- Norris Cotton Cancer Center Dartmouth Hitchcock Medical Center, Lebanon, NH
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Hanover, NH
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10
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Flugelman MY, Jaffe R, Luria G, Yagil D. Trust in the referring physician reduces anxiety in an integrated community-to-hospital care system. Isr J Health Policy Res 2020; 9:7. [PMID: 32393391 PMCID: PMC7216639 DOI: 10.1186/s13584-020-00365-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 02/10/2020] [Indexed: 11/26/2022] Open
Abstract
Background Continuity of care between the community and hospital is considered of prime importance for quality of care and patient satisfaction, and for trust in the medical system. In a unique model of continuity of care, cardiologists at our hospital serve as primary, community-based cardiologists one day a week. They refer patients from the community to our hospital for interventional procedures such as coronary angiography and angioplasty. We examined the hypotheses that patient anxiety during hospital-based coronary angiography is lower when a patient trusts the referring cardiologist and when the performing cardiologist also treated him/her in the community. Methods We administered questionnaires to 64 patients in our cardiology department within 90 min of completion of coronary angiography. The questions assessed anxiety, trust in the medical system and trust in the referring physician. Data were also collected regarding patients’ demographic variables, the number of visits to the referring physician, and whether the physician who performed the coronary angiography was the physician who referred the patient to the hospital. Results Mean levels (on 7-point Likert scales) were 2.1, 5.6 and 6.7 for patient anxiety, trust in the medical system and trust in the referring physician, respectively. Multivariate regression analysis showed that trust in the referring physician was significantly and negatively correlated with anxiety level. The number of visits to referring physicians, patients’ demographic characteristics and whether the physician who performed the angiography was the same physician who referred the patient from the community were not found to be associated with patient anxiety. Conclusion In this study, trusting the referring physician was associated with lower anxiety among patients who underwent coronary angiography. This trust seemed to have more positive impact than did previous contact with the physician who performed the procedure.
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Affiliation(s)
- Moshe Y Flugelman
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, 7 Michal Street, 34632, Haifa, Israel. .,Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel.
| | - Ronen Jaffe
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, 7 Michal Street, 34632, Haifa, Israel.,Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Gil Luria
- Department of Human Services, University of Haifa, Haifa, Israel
| | - Dana Yagil
- Department of Human Services, University of Haifa, Haifa, Israel
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11
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Gordon HS, Sharp LK, Schoenthaler A. "They are talking from the Encyclopedia Britannica brain": diabetes patients' perceptions of barriers to communicating with physicians. BMC Health Serv Res 2020; 20:211. [PMID: 32169058 PMCID: PMC7069201 DOI: 10.1186/s12913-020-5063-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 02/28/2020] [Indexed: 11/10/2022] Open
Abstract
Background Understanding patients’ beliefs about their role communicating in medical visits is an important pre-requisite to encourage patients’ use of active participatory communication, and these beliefs may be particularly relevant for patients with diabetes. Methods Focus groups were conducted to examine patients with diabetes view of their role communicating in medical encounters. Patients had type 2 diabetes, A1C ≥ 8% (64 mmol/mol), and were from an inner-city VA hospital. Guiding questions for the focus groups were based on theoretical models of patient-physician communication. Focus group transcripts were analyzed with the constant comparative method. Results Four focus groups were conducted with a total of 20 male Veterans. Participants mean age was 61 years, 65% self-identified as black or African-American, 80% completed high school or higher education, and mean A1C was 10.3% (89 mmol/mol). Eight themes were identified as to why patients might have difficulty communicating with physicians. These themes were grouped into three overarching categories explaining reasons why patients might avoid participatory communication and included patients’ view about their condition; about physician’s communication behaviors; and about external influences on patient-physician communication. For example, patients described how use of the EHR may deter patients’ use of active participatory communication. Conclusions These results are important for understanding how patients’ use of active participatory communication is influenced by their beliefs and expectations, physicians’ behaviors, and structural factors. The results may be useful for educational efforts to increase patient, physician, and healthcare systems awareness of problems that patients perceive when communicating with physicians.
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Affiliation(s)
- Howard S Gordon
- Jesse Brown Veterans Affairs Medical Center and VA Center of Innovation for Complex Chronic Healthcare, Chicago, IL, USA. .,Section of Academic Internal Medicine and Geriatrics, Department of Medicine, University of Illinois at Chicago, MC 275, 1747 W. Roosevelt Ave, Chicago, IL, 60608, USA. .,Institute for Health Research and Policy, University of Illinois at Chicago, MC 275, 1747 W. Roosevelt Ave, Chicago, IL, 60608, USA.
| | - Lisa K Sharp
- Institute for Health Research and Policy, University of Illinois at Chicago, MC 275, 1747 W. Roosevelt Ave, Chicago, IL, 60608, USA.,Department of Pharmacy Systems, Outcomes & Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
| | - Antoinette Schoenthaler
- Center for Healthful Behavior Change, Department of Population Health, NYU School of Medicine, New York, NY, USA
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12
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Brincks AM, Shiu-Yee K, Metsch LR, del Rio C, Schwartz RP, Jacobs P, Osorio G, Sorensen JL, Feaster DJ. Physician Mistrust, Medical System Mistrust, and Perceived Discrimination: Associations with HIV Care Engagement and Viral Load. AIDS Behav 2019; 23:2859-2869. [PMID: 30879211 DOI: 10.1007/s10461-019-02464-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Medical mistrust is an important risk factor for many health outcomes. For individuals with HIV and substance use co-morbidities, mistrust may influence engagement with health care, and affect overall health and transmission risk. Medical mistrust can be measured by an individual's mistrust of his/her physician, or mistrust of the medical system. This study examined both types of mistrust among 801 substance-using individuals with uncontrolled HIV infection. The aims were to determine how physician mistrust, medical system mistrust, and discrimination experiences were associated with engagement in HIV primary care. Findings indicated higher levels of physician mistrust, but not medical system mistrust, were associated with a longer time since the last visit to an HIV provider. Longer time since seeing an HIV care provider was associated with higher viral load. This study refines our understanding of the relationship between mistrust and HIV care engagement for a large, diverse sample of substance-using individuals.
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13
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Chanfreau-Coffinier C, Gordon HS, Schweizer CA, Bean-Mayberry BA, Darling JE, Canelo I, Yano EM. Mental Health Screening Results Associated with Women Veterans' Ratings of Provider Communication, Trust, and Care Quality. Womens Health Issues 2018; 28:430-438. [DOI: 10.1016/j.whi.2018.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 05/22/2018] [Accepted: 05/22/2018] [Indexed: 11/29/2022]
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Mature or Emerging? The Impact of Treatment-Related Internet Health Information Seeking on Patients' Trust in Physicians. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15091855. [PMID: 30154309 PMCID: PMC6165357 DOI: 10.3390/ijerph15091855] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 08/21/2018] [Accepted: 08/22/2018] [Indexed: 11/26/2022]
Abstract
Years of clinical trials have proven the maturity and safety of certain treatments, however, some of these mature treatments may not be highly effective. Several treatments have emerged through technological innovations, but their long-term safety, efficacy, and adverse effects remain unknown. At present, many patients seek information related to their treatments on the Internet, which may impact their attitudes towards different treatments and their trust in physicians. In this study, a research model was developed to examine how patients’ trust in their physicians is influenced by related online information on mature or emerging treatments. The hypotheses were tested using confirmatory factor analysis (CFA) and structural equation modelling (SEM). A total of 336 valid responses were collected through an online survey. Mature treatments related health information was found to significantly improve patients’ trust. Thus, physicians should pay more attention to mature treatments, and encourage their patients to seek related information online. Moreover, the quality of online information should be developed further to increase patients’ satisfaction. Physicians should also consider their patients’ psychological safety in communication with patients to strengthen their trust.
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15
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Building trust: The influence of mentoring behaviors on perceptions of health care managers' trustworthiness. Health Care Manage Rev 2018; 43:69-78. [PMID: 27782971 DOI: 10.1097/hmr.0000000000000130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In health care organizations, trust is critical for effective workplace relationships that ensure patient-centered outcomes. Although research has focused on trust in the relationship between patients and clinicians, less is known about what influences workers to trust their managers. An understanding is needed of the specific behaviors that influence health care workers' evaluations of their managers' trustworthiness. Mentoring research focuses on the developmental assistance that a more experienced worker provides to a less experienced worker. Building upon seminal research on mentoring functions, we argue that health care managers can build trust by providing informational (career-related) and interpersonal (psychosocial) support. PURPOSE The aim of the study was to investigate the influence of health care managers' informational and interpersonal mentoring behaviors on workers' perceptions of their managers' trustworthiness and the mediating role of trustworthiness on trust in the managers. METHODOLOGY/APPROACH Surveys were completed during work hours by 315 health care workers at an acute care hospital and associated clinics in the Midwest. FINDINGS Results showed that managers' mentoring behaviors influenced worker perceptions of their managers' trustworthiness, in terms of ability, integrity, and benevolence. Ability partially mediated the relationship between informational mentoring and trust in managers, whereas integrity and benevolence partially mediated the relationship between interpersonal mentoring and trust in managers. PRACTICE IMPLICATIONS Health care managers can actively build trust through mentoring behaviors that inspire positive assessments of managers' ability, integrity, and benevolence.
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16
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Vandenberg AE, Echt KV, Johnson TM, Bowling CB. Patient discourse on chronic kidney disease monitoring: a qualitative study at a Veterans Affairs Renal Clinic. BMC Nephrol 2018; 19:183. [PMID: 30025520 PMCID: PMC6052681 DOI: 10.1186/s12882-018-0981-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 07/05/2018] [Indexed: 11/15/2022] Open
Abstract
Background Knowing how chronic kidney disease (CKD) patients talk about their encounters with providers (i.e., their discourse) can inform the important clinical goal of engaging patients in their chronic disease self-management. The aim of this study was to analyze patient discourse on ongoing CKD monitoring encounters for health communication strategies that motivate patient engagement. Methods Passages regarding CKD monitoring from 6 focus group transcripts on self-management with a total of 30 participants age ≥ 70 years from the Atlanta Veterans Affairs Renal Clinic across three different CKD trajectories (stable, linear decline, and non-linear) were extracted. These passages were examined using three-stage critical discourse analysis (description, interpretation, explanation) for recurring patterns across groups. Results Focus group participants were an average age of 75.1, 96.7% male, and 60% Black. Passages relating to CKD monitoring (n = 55) yielded predominantly negative communication themes. Perceived negative communication was characterized through a patient discourse of unequal exchange, whereby engaged patients would provide bodily fluids and time for appointments and continued to wait for meaningful, contextualized monitoring information from providers and/or disengaged providers who withheld that information. However, some encounters were depicted as helpful. Perceived positive communication was characterized by a patient discourse of kidney protection, whereby patients and providers collaborate in the mutual goal of preserving kidney function. Conclusions Patient perceived an unequal exchange in CKD monitoring encounters. This perception appears rooted in a lack of easily understandable information. By accessing the positive discourse of protecting the kidneys (e.g., through eGFR level) vs. the discourse of damage (e.g., serum creatinine level), healthcare professionals can clarify the purpose of monitoring and in ways that motivate patient engagement in self-management. Patients being monitored for CKD progression may best be supported through messaging that conceptualizes monitoring as kidney protection and provides concrete contextualized information at each monitoring encounter.
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Affiliation(s)
- Ann E Vandenberg
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs, Atlanta VA Medical Center, Decatur, GA, USA.,Department of Medicine, Division of General Medicine and Geriatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Katharina V Echt
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs, Atlanta VA Medical Center, Decatur, GA, USA.,Department of Medicine, Division of General Medicine and Geriatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Theodore M Johnson
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs, Atlanta VA Medical Center, Decatur, GA, USA.,Department of Medicine, Division of General Medicine and Geriatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - C Barrett Bowling
- Durham Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs, Durham VA Medical Center, Durham, North Carolina, USA. .,Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.
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Victimization and Vulnerability: A Study of Incarceration, Interpersonal Trauma, and Patient-Physician Trust. Psychiatr Q 2017; 88:459-472. [PMID: 27553865 DOI: 10.1007/s11126-016-9463-x] [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] [Indexed: 10/21/2022]
Abstract
Despite the critical importance of patient-physician trust, it may be compromised among vulnerable patients, such as (1) incarcerated patients and (2) those patients who have been victims of trauma. The purpose of this study was to examine patient-physician trust among forensic and civilian psychiatric inpatient populations and to explore whether it varied based on a patient's history of incarceration and/or victimization. A trust survey (WFPTS) and a trauma instrument (LEC-5) were administered to 93 patients hospitalized on forensic and civilian psychiatric hospital units in a large, urban public hospital. Results showed no difference in patient-physician trust between incarcerated and civilian patients. Similarly, there was no effect of a history of physical assault or sexual assault on ratings of patient-physician trust. However, the hospitalized civilian and forensic patients who reported being the victim of weapons assault had significantly lower patient-physician trust scores than their counterparts.
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18
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Dong X, Bergren S, Simon MA. Cross-Sectional and Longitudinal Association Between Trust in Physician and Depressive Symptoms Among U.S. Community-Dwelling Chinese Older Adults. J Gerontol A Biol Sci Med Sci 2017; 72:S125-S130. [PMID: 28575268 PMCID: PMC5861912 DOI: 10.1093/gerona/glx036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 02/22/2017] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Depression is a major public health concern among older adults and health care professionals play a vital role in screening and treatment. However, this process may be impeded by issues like lack of trust in physician (TIP). This study aims to examine the cross-sectional and longitudinal relationships between TIP and depressive symptoms among Chinese older adults in the Chicago area. METHODS Data were collected through the Population Study of Chinese Elderly (PINE), a longitudinal cohort study of Chinese older adults in the greater Chicago area. A total of 2,713 Chinese older adults completed both waves of data collection. TIP was measured through the Trust in Physician scale from Anderson and Dedrick (Anderson LA, Dedrick RF. Development of the Trust in Physician scale: a measure to assess interpersonal trust in patient-physician relationships. Psychol Rep. 1990;67(3 Pt 2):1091-1100. doi:10.2466/pr0.1990.67.3f.1091) (range: 11-55). Depressive symptoms were measured through Patient Health Questionnaire-9. RESULTS Every one point higher in TIP is associated with being 2% less likely to have any depressive symptoms (odds ratio [OR] 0.98, 0.97-0.99) in cross-sectional analysis. Longitudinally, every one-point increase in TIP score was associated with a 2% lower risk of depressive symptoms at Wave 2 (OR 0.98, 0.97-0.99). Improved TIP over 2 years was associated with 25% decreased risk of having any depressive symptoms at Wave 2 (OR 0.75, 0.63-0.89). Additionally, highest tertile of TIP change was associated with a 31% decreased risk of any depressive symptoms compared to lowest tertile (OR 0.68, 0.55-0.84). DISCUSSION Improved TIP over 2 years is associated with less risk of experiencing depressive symptoms. Future research should examine possible pathways and routes of intervention to improve mental health among older adults.
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Affiliation(s)
- XinQi Dong
- Chinese Health, Aging, and Policy Program, Rush Institute for Healthy Aging, Rush University Medical Center, Chicago, Illinois
| | - Stephanie Bergren
- Chinese Health, Aging, and Policy Program, Rush Institute for Healthy Aging, Rush University Medical Center, Chicago, Illinois
| | - Melissa A Simon
- Department of Obstetrics and Gynecology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
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19
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Bell SK, Mejilla R, Anselmo M, Darer JD, Elmore JG, Leveille S, Ngo L, Ralston JD, Delbanco T, Walker J. When doctors share visit notes with patients: a study of patient and doctor perceptions of documentation errors, safety opportunities and the patient-doctor relationship. BMJ Qual Saf 2017; 26:262-270. [PMID: 27193032 PMCID: PMC7255406 DOI: 10.1136/bmjqs-2015-004697] [Citation(s) in RCA: 116] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 04/12/2016] [Accepted: 04/22/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND Patient advocates and safety experts encourage adoption of transparent health records, but sceptics worry that shared notes may offend patients, erode trust or promote defensive medicine. As electronic health records disseminate, such disparate views fuel policy debates about risks and benefits of sharing visit notes with patients through portals. METHODS Presurveys and postsurveys from 99 volunteer doctors at three US sites who participated in OpenNotes and postsurveys from 4592 patients who read at least one note and submitted a survey. RESULTS Patients read notes to be better informed and because they were curious; about a third read them to check accuracy. In total, 7% (331) of patients reported contacting their doctor's office about their note. Of these, 29% perceived an error, and 85% were satisfied with its resolution. Nearly all patients reported feeling better (37%) or the same (62%) about their doctor. Patients who were older (>63), male, non-white, had fair/poor self-reported health or had less formal education were more likely to report feeling better about their doctor. Among doctors, 26% anticipated documentation errors, and 44% thought patients would disagree with notes. After a year, 53% believed patient satisfaction increased, and 51% thought patients trusted them more. None reported ordering more tests or referrals. CONCLUSIONS Despite concerns about errors, offending language or defensive practice, transparent notes overall did not harm the patient-doctor relationship. Rather, doctors and patients perceived relational benefits. Traditionally more vulnerable populations-non-white, those with poorer self-reported health and those with fewer years of formal education-may be particularly likely to feel better about their doctor after reading their notes. Further informing debate about OpenNotes, the findings suggest transparent records may improve patient satisfaction, trust and safety.
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Affiliation(s)
- Sigall K Bell
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Roanne Mejilla
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Melissa Anselmo
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Joann G Elmore
- Division of General Internal Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Suzanne Leveille
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Long Ngo
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - James D Ralston
- Group Health Research Institute, Group Health Cooperative, Seattle, Washington, USA
| | - Tom Delbanco
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Jan Walker
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Epstein EG, Wolfe K. A preliminary evaluation of trust and shared decision making among intensive care patients' family members. Appl Nurs Res 2016; 32:286-288. [PMID: 27969044 DOI: 10.1016/j.apnr.2016.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 08/18/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE The purpose of this study was to preliminarily evaluate ICU family members' trust and shared decision making using modified versions of the Wake Forest Trust Survey and the Shared Decision Making-9 Survey. METHODS Using a descriptive approach, the perceptions of family members of ICU patients (n=69) of trust and shared decision making were measured using the Wake Forest Trust Survey and the 9-item Shared Decision Making (SDM-9) Questionnaire. Both surveys were modified slightly to apply to family members of ICU patients and to include perceptions of nurses as well as physicians. RESULTS Overall, family members reported high levels of trust and inclusion in decision making. Family members who lived with the patient had higher levels of trust than those who did not. Family members who reported strong agreement among other family about treatment decisions had higher levels of trust and higher SDM-9 scores than those who reported less family agreement. CONCLUSION The modified surveys may be useful in evaluating family members' trust and shared decision making in ICU settings. Future studies should include development of a comprehensive patient-centered care framework that focuses on its central goal of maintaining provider-patient/family partnerships as an avenue toward effective shared decision making.
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Abstract
Patients from racial and ethnic minorities experience higher mortality after cardiac surgery compared to white patients, both during the early postoperative phase as well as long term. A number of factors likely explain poor outcomes in black and minority patients, which include differences in biology, comorbid health conditions, socioeconomic background, and quality of hospital care. Recent evidence suggests that a major factor underlying excess mortality in these groups is due to their over-representation in low-quality hospitals, where all patients regardless of race have worse outcomes. In this review, we examine the factors underlying racial disparities in outcomes after cardiac surgery, with a primary focus on the role of hospital quality.
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