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Veenendaal HV, Chernova G, Bouman CM, Etten-Jamaludin FSV, Dieren SV, Ubbink DT. Shared decision-making and the duration of medical consultations: A systematic review and meta-analysis. PATIENT EDUCATION AND COUNSELING 2023; 107:107561. [PMID: 36434862 DOI: 10.1016/j.pec.2022.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/07/2022] [Accepted: 11/03/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE 1) determine whether increased levels of Shared Decision-Making (SDM) affect consultation duration, 2) investigate the intervention characteristics involved. METHODS MEDLINE, EMBASE, CINAHL and Cochrane library were systematically searched for experimental and cross-sectional studies up to December 2021. A best-evidence synthesis was performed, and interventions characteristics that increased at least one SDM-outcome, were pooled and descriptively analyzed. RESULTS Sixty-three studies were selected: 28 randomized clinical trials, 8 quasi-experimental studies, and 27 cross-sectional studies. Overall, pooling of data was not possible due to substantial heterogeneity. No differences in consultation duration were found more often than increased or decreased durations. . Consultation times (minutes:seconds) were significantly increased only among interventions that: 1) targeted clinicians only (Mean Difference [MD] 1:30, 95% Confidence Interval [CI] 0:24-2:37); 2) were performed in primary care (MD 2:05, 95%CI 0:11-3:59; 3) used a group format (MD 2:25, 95%CI 0:45-4:05); 4) were not theory-based (MD 4:01, 95%CI 0:38-7:23). CONCLUSION Applying SDM does not necessarily require longer consultation durations. Theory-based, multilevel implementation approaches possibly lower the risk of increasing consultation durations. PRACTICE IMPLICATIONS The commonly heard concern that time hinders SDM implementation can be contradicted, but implementation demands multifaceted approaches and space for training and adapting work processes.
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Affiliation(s)
- Haske van Veenendaal
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, the Netherlands.
| | - Genya Chernova
- Amsterdam UMC, location University of Amsterdam, Surgery, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
| | - Carlijn Mb Bouman
- Amsterdam UMC, location University of Amsterdam, Surgery, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
| | - Faridi S van Etten-Jamaludin
- Amsterdam UMC, location University of Amsterdam, Medical Library AMC, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands.
| | - Susan van Dieren
- Amsterdam UMC, location University of Amsterdam, Surgery, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
| | - Dirk T Ubbink
- Amsterdam UMC, location University of Amsterdam, Surgery, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
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Newcomb AB, Appelbaum RD, Kapadia M, Dumas R, Dort J, Carey E, Dhaliwal M, Rothberg S, Liu C, Mohess D. Implementation of a skills-based virtual communication curriculum for medical students interested in surgery. GLOBAL SURGICAL EDUCATION : JOURNAL OF THE ASSOCIATION FOR SURGICAL EDUCATION 2022; 1:48. [PMID: 38013712 PMCID: PMC9548309 DOI: 10.1007/s44186-022-00054-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/16/2022] [Accepted: 09/28/2022] [Indexed: 11/12/2022]
Abstract
Background Communication skills are essential to providing patient-centered care. The need for standardized communication skills training is at the forefront of medical school and residency education. We aimed to design and implement a curriculum teaching virtual communications skills to medical students. The purpose of this report is to describe our experience and to offer guidance for training programs developing similar curricula in the future. Methods The curriculum was presented in weekly modules over 5 weeks using Zoom technology. We focused on proven strategies for interacting with patients and other providers, adapted to a virtual platform. Skill levels during role-play were assessed by the Simulated Participants and students observing the simulation using the 14-item, physician specific Communication Assessment Tool (CAT). The primary outcome of the CAT is the percentage of "excellent" for each item ranked both years. Participants provided feedback on what worked well or how the module could be improved in open-ended responses. Results Twenty-eight and 25 students registered for the course in Year 1 and Year 2, respectively. Students' post-session confidence in their ability to perform target skills was statistically higher than their pre-session scores in most sessions. Modules with the lowest pre-session confidence for both years were "Disclosing a Medical Error" and "Responding to Patient Bias." The mean percentage of students receiving "excellent" scores on individual CAT items ranged from 5 to 73% over the course of both years. Verbal and written feedback in Year 1 provided direction for the curriculum developers to improve the course in Year 2. Conclusions Developing and implementing a new education curriculum is a complex process. We describe an intensive curriculum for medical students as we strive to allow students extra "clinical" time during COVID-related restriction. We believe continued focus on patient and family communication skills will enhance patient care. Supplementary Information The online version contains supplementary material available at 10.1007/s44186-022-00054-9.
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Affiliation(s)
- Anna B. Newcomb
- Division of Trauma and Acute Care Surgery, Inova Fairfax Medical Campus, 3300 Gallows Rd, Falls Church, VA 22042 USA
- Trauma and Acute Care Surgery, Inova Fairfax Medical Campus, Falls Church, VA USA
| | - Rachel D. Appelbaum
- Division of Acute Care Surgery, Vanderbilt University Medical Center, Nashville, TN USA
| | - Muneera Kapadia
- Division of Gastrointestinal Surgery, UNC School of Medicine, Chapel Hill, NC USA
| | - Ryan Dumas
- Division of General and Acute Care Surgery, UT Southwestern Medical Center, Dallas, TX USA
| | - Jonathan Dort
- Department of Surgery, Inova Fairfax Medical Campus, Falls Church, VA USA
| | - Eleanor Carey
- Department of Global, Community Health at George Mason University, Fairfax, VA USA
| | - Mannet Dhaliwal
- University of Virginia School of Medicine, Charlottesville, VA USA
| | - Shira Rothberg
- Department of Surgery, Inova Fairfax Medical Campus, Falls Church, VA USA
- Fairfax County Fire and Rescue Department, Fairfax, VA USA
| | - Chang Liu
- Department of Surgery, Inova Fairfax Medical Campus, Falls Church, VA USA
| | - Denise Mohess
- Co-Chief Geriatrics Bridgeport Hospital/Milford Campus, Yale New Haven Health System, Milford, CT USA
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Eiriksdottir VK, Jonsdottir T, Valdimarsdottir HB, Taylor KL, Schwartz MD, Hilmarsson R, Gudmundsson EO, Fridriksson JO, Baldursdottir B. An Adaptation, Extension and Pre-Testing of an Interactive Decision Aid for Men Diagnosed with Localized Prostate Cancer in Iceland: A Mixed-Method Study. Behav Med 2021; 49:137-150. [PMID: 34791986 DOI: 10.1080/08964289.2021.2000926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In this study an interactive decision aid (DA) for men diagnosed with localized prostate cancer was adapted, extended and pre-tested. The DA's prototype was based on a literature review and other empirically tested DAs. Semi-structured interviews with 12 men (age 65-80) diagnosed with localized prostate cancer were conducted to get feedback on content, usability, and the DA's layout. The interviews were analyzed using thematic analysis and themes were identified using deductive and inductive coding. Participants found the accessibility of the information and the explicit values clarification tool helpful. Four themes were identified: (1) usability and design, (2) content and knowledge, (3) deciding factors of decision-making, and (4) social support. Participants valued receiving extensive and realistic information on surgery/radiation therapy side effects and getting unbiased presentations of treatment options. Following the thematic analysis, the DA was revised and tested in a survey among 11 newly diagnosed prostate cancer patients (age 60-74). The participants valued the DA and found it helpful when making a treatment decision, and all reported that they would recommend it to others making a prostate cancer treatment decision. The DA is currently being tested in a randomized clinical trial (RCT). This is the first DA developed for prostate cancer patients in Iceland and if the results of the RCT show that it is more effective than standard care in assisting newly diagnosed patients with their treatment decision, the DA can be easily translated and adapted to cultures similar to Iceland such as the Nordic countries.
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Affiliation(s)
| | | | - Heiddis B Valdimarsdottir
- Department of Psychology, Reykjavik University, Reykjavik, Iceland.,Cancer Prevention and Control, Ruttenberg Cancer Center, Mount Sinai School of Medicine
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Haas JW, Rief W, Weiß F, Doering BK, Kleinstäuber M, Ruwoldt S, Sarter L, Thomas R, Rheker J. The effect of patient-centered communication on medication intake: an experimental study. PSYCHOL HEALTH MED 2021; 27:2138-2151. [PMID: 34412546 DOI: 10.1080/13548506.2021.1969666] [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] [Indexed: 10/20/2022]
Abstract
It is not only crucial to provide patients with information, but also to communicate this information in a way to enable patient participation in health decisions. Experimental studies investigating the association between the communication style of health professionals and patients' health decisions are rare, which limits causal conclusions. This study investigated the effect of a doctor's patient-centered communication style on the likelihood to take a medication.Healthy women (N = 120) were randomly allocated to one of three groups. They either received a medical consultation characterized by a patient-centered communication style (PC group) or by a doctor-centered communication style (DC group) or they received no consultation at all (control group). All participants were told that the study would investigate the effects of a 'concentration-enhancing medication'. Voluntary intake of the medication (a placebo pill) served as behavioral outcome. Participants' self-rated intention to take the medication was measured at three assessment points. Data were analyzed using a Chi-square-test and a mixed analysis of covariance.In each group, 40 participants were analyzed. Following the consultation, groups did not differ regarding the behavioral outcome, but participants' intention to take the medication was higher in the PC group compared with the control group.Our results indicate that patient-centered communication has a beneficial influence on participants' intention to take medication. Future studies should investigate the role of communication in individuals with health conditions that require a specified treatment plan and taking medication over the long-term.
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Affiliation(s)
- Julia W Haas
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Marburg, Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Marburg, Germany
| | - Frauke Weiß
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Marburg, Germany
| | - Bettina K Doering
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Marburg, Germany.,Department of Clinical and Biological Psychology, Catholic University of Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Maria Kleinstäuber
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Marburg, Germany.,Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Sina Ruwoldt
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Marburg, Germany
| | - Lena Sarter
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Marburg, Germany
| | - Ruth Thomas
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Marburg, Germany
| | - Julia Rheker
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Marburg, Germany
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Foster JM, Beasley R, Braithwaite I, Harrison T, Holliday M, Pavord I, Reddel HK. Patient experiences of as-needed budesonide-formoterol by Turbuhaler® for treatment of mild asthma; a qualitative study. Respir Med 2020; 175:106154. [PMID: 33190085 DOI: 10.1016/j.rmed.2020.106154] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/29/2020] [Accepted: 09/09/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Combination low-dose budesonide-formoterol, taken as-needed for symptom relief reduces exacerbation risk and is recommended for treatment of mild asthma. The NovelQ qualitative study explored patients' attitudes toward using this novel therapy. METHODS Adults with mild asthma using reliever-only treatment were randomised to as-needed budesonide-formoterol Turbuhaler® in a multinational, 52-week open-label randomised controlled trial (NovelSTART-ACTRN12615000999538). A subgroup were interviewed to explore their attitudes to use of as-needed budesonide-formoterol after receiving it for ≥10 months. Semi-structured interviews were conducted until saturation, audio-recorded, and thematically analysed. RESULTS Analysis of 35 participants (66% female; mean age 43.5 [range 18-74]; mean Asthma Control Questionnaire score 1.09 ± SD0.55) interviews identified 5 themes, each including both barriers and facilitators to therapy use. Themes were: 'Treatment effectiveness' i.e. how well symptoms were relieved and/or prevented; 'Lifestyle fit of the regimen' e.g. the extent to which the treatment regimen integrated into the patient's daily life; 'Attitudes toward medication use and safety' e.g. openness for new reliever treatments, beliefs about treatment necessity or side effects; 'Device attributes' e.g. perceived ease of use; and 'Doctor-patient relationship' e.g. impact of health professional support on new treatment acceptance. CONCLUSIONS A wide range of factors seem to drive the opinions of mild asthma patients on as-needed budesonide-formoterol therapy. Many patients perceived both positive and negative treatment attributes, and their individual evaluation of these attributes determined their likelihood of using it after the study. Supportive patient-physician interactions appear key to addressing patient barriers. Recommendations for patient-centred discussions, developed from this research, are provided.
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Affiliation(s)
- J M Foster
- Clinical Management Group, Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia.
| | - R Beasley
- Medical Research Institute of New Zealand, Wellington, New Zealand.
| | - I Braithwaite
- Medical Research Institute of New Zealand, Wellington, New Zealand.
| | - T Harrison
- Nottingham Respiratory Medicine Unit and NIHR Biomedical Research Centre, University of Nottingham, Nottingham, UK.
| | - M Holliday
- Medical Research Institute of New Zealand, Wellington, New Zealand.
| | - I Pavord
- Respiratory Medicine Unit, Oxford Respiratory NIHR Biomedical Research Centre, University of Oxford, Oxford, UK.
| | - H K Reddel
- Clinical Management Group, Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia.
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Allen S, Rogers SN, Harris RV. Socio-economic differences in patient participation behaviours in doctor-patient interactions-A systematic mapping review of the literature. Health Expect 2019; 22:1173-1184. [PMID: 31398772 PMCID: PMC6803421 DOI: 10.1111/hex.12956] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 07/30/2019] [Accepted: 08/01/2019] [Indexed: 12/15/2022] Open
Abstract
Background The degree to which patients participate in their care can have a positive impact on health outcomes. This review aimed to map the current literature on patient participation behaviours in interactions with physicians and the extent to which differences in these behaviours can be explained by socio‐economic status (SES). Search strategy Four electronic databases were searched from 1980 onwards using key words related to socio‐economic status and patient participation behaviours. Study selection Titles, abstracts and full texts were screened by two reviewers, with the second reviewer screening 20% of all entries. Data extraction Data on year of publication, country, patient population, setting, patient participation behaviour studied, and SES measure used were extracted. Main results Forty‐nine studies were included in the review. Most studies were conducted in the United States, and the most commonly studied patient participation behaviour was involvement in decision making. Most studies measured SES using education as an indicator, with very few studies using occupation as a measure. Many studies did not report on participants’ medical condition or study setting. Patient participation in their health‐care appointment increased with increasing SES in 24 studies, although in 27 studies no significant association was found. Discussion and conclusions Current literature was found to be mainly US‐centric. Many studies did not specify participants’ medical condition or in what setting the study was undertaken. More studies are needed on less commonly studied patient participation behaviours. It would be helpful for further studies to also include a wider range of SES indicators.
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Affiliation(s)
- Sarah Allen
- Department of Health Services Research, Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - Simon N Rogers
- Evidence-Based Practice Research Centre (EPRC), Faculty of Health and Social Care, Edge Hill University, Ormskirk, UK.,Consultant Regional Maxillofacial Unit, University Hospital Aintree, Liverpool, UK
| | - Rebecca V Harris
- Department of Health Services Research, Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
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Borgmeyer A, Jamerson P, Gyr P, Westhus N, Glynn E. The School Nurse Role in Asthma Management: Can the Action Plan Help? J Sch Nurs 2019. [DOI: 10.1177/10598405050210010601] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Asthma is the most common chronic disorder in American schoolchildren, and school nurses play a valuable role in its management. A study was conducted in which school nurses were asked to describe their role in caring for students with asthma and their use of Asthma Action Plans (AAPs). The nurses indicated that they frequently provided direct care and education. They were comfortable with providing care to students with asthma and familiar with AAPs. Having an AAP increased their confidence in managing students with asthma. This emphasizes the need for continued education regarding the AAP and the development of policies that direct care and encourage use of an AAP at school.
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Affiliation(s)
- Anne Borgmeyer
- Asthma Intervention Model at St. Louis Children's Hospital, St. Louis, MO
| | | | - Patricia Gyr
- Asthma Intervention Model at St. Louis Children's Hospital, St. Louis, MO
| | - Nina Westhus
- School of Nursing, Saint Louis University, St. Louis, MO
| | - Emily Glynn
- Asthma Intervention Model at St. Louis Children's Hospital, St. Louis, MO
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8
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The Health Care Transition of Youth With Liver Disease Into the Adult Health System: Position Paper From ESPGHAN and EASL. J Pediatr Gastroenterol Nutr 2018; 66:976-990. [PMID: 29570559 DOI: 10.1097/mpg.0000000000001965] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Medical advances have dramatically improved the long-term prognosis of children and adolescents with once-fatal hepatobiliary diseases. However, there is no generally accepted optimal pathway of care for the transition from paediatric care to the adult health system. AIM The purpose of this position paper is to propose a transition process for young people with paediatric onset hepatobiliary diseases from child-centred to adult-centred healthcare services. METHODS Seventeen ESPGHAN/EASL physicians from 13 countries (Austria, Belgium, France, Germany, Hungary, Italy, the Netherlands, Norway, Poland, Spain, Sweden, Switzerland, and United Kingdom) formulated and answered questions after examining the currently published literature on transition from childhood to adulthood. PubMed and Google Scholar were systematically searched between 1980 and January 2018. Quality of evidence was assessed by the Grading of Recommendation Assessment, Development and Evaluation (GRADE) system. Expert opinions were used to support recommendations whenever the evidence was graded weak. All authors voted on each recommendation, using the nominal voting technique. RESULTS We reviewed the literature regarding the optimal timing for the initiation of the transition process and the transfer of the patient to adult services, principal documents, transition multi-professional team components, main barriers, and goals of the general transition process. A transition plan based on available evidence was agreed focusing on the individual young people's readiness and on coordinated teamwork, with transition monitoring continuing until the first year of adult services.We further agreed on selected features of transitioning processes inherent to the most frequent paediatric-onset hepatobiliary diseases. The discussion highlights specific clinical issues that will probably present to adult gastrointestinal specialists and that should be considered, according to published evidence, in the long-term tracking of patients. CONCLUSIONS Transfer of medical care of individuals with paediatric onset hepatobiliary chronic diseases to adult facilities is a complex task requiring multiple involvements of patients and both paediatric and adult care providers.
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Shum J, Poureslami I, Wiebe D, Doyle-Waters MM, Nimmon L, FitzGerald JM. Airway diseases and health literacy (HL) measurement tools: A systematic review to inform respiratory research and practice. PATIENT EDUCATION AND COUNSELING 2018; 101:596-618. [PMID: 29107399 DOI: 10.1016/j.pec.2017.10.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 07/24/2017] [Accepted: 10/19/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To identify and evaluate asthma/COPD measurement tools that assess any of the five health literacy (HL) domains: (1) access, (2) understand, (3) evaluate, (4) communicate, and (5) use, as well as numeracy. METHODS MEDLINE/Embase (via Ovid) databases from 1974 to 2016 were searched and complimented by grey literature. Study selection and data extraction were conducted by two reviewers independently. RESULTS We identified 65 tools including 40 asthma, 22 COPD, and 3 asthma/COPD focused tools. Thirty tools had been validated and two assessed all five domains. The 'understand' domain was captured in 49 tools, followed by 'access' in 29 tools, 'use' in 24 tools, 'evaluate' in 20 tools, and 'communicate' in 10 tools. Two tools assessed 'numeracy'. Tool content comprised disease physiology, triggers, symptoms, inhaler technique, self-management practices, and rehab programs. CONCLUSIONS This review highlights paucity of HL tools that have been validated and/or assess the 'communicate' domain and makes a valuable contribution to filling an existing research gap in the field of HL by determining the deficiencies of such tools. PRACTICE IMPLICATIONS Our review uncovers which HL domains are under-measured, justifying the need to develop an airways HL measurement tool which applies the 5-domain model for asthma/COPD management.
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Affiliation(s)
- Jessica Shum
- Division of Respiratory Medicine, Department of Medicine, The University of British Columbia, Gordon and Leslie Diamond Health Care Centre, 7th floor, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, The University of British Columbia, 7th floor, 828 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada.
| | - Iraj Poureslami
- Division of Respiratory Medicine, Department of Medicine, The University of British Columbia, Gordon and Leslie Diamond Health Care Centre, 7th floor, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, The University of British Columbia, 7th floor, 828 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada.
| | - Darrin Wiebe
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, The University of British Columbia, 7th floor, 828 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada.
| | - Mary M Doyle-Waters
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, The University of British Columbia, 7th floor, 828 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada.
| | - Laura Nimmon
- Centre for Health Education Scholarship (CHES), Department of Occupational Science and Occupational Therapy, The University of British Columbia, P.A. Woodward Instructional Resources Centre (IRC), 429-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada.
| | - J Mark FitzGerald
- Division of Respiratory Medicine, Department of Medicine, The University of British Columbia, Gordon and Leslie Diamond Health Care Centre, 7th floor, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, The University of British Columbia, 7th floor, 828 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada.
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Vrijlandt EJLE, El Azzi G, Vandewalker M, Rupp N, Harper T, Graham L, Szefler SJ, Moroni-Zentgraf P, Sharma A, Vulcu SD, Sigmund R, Chawes B, Engel M, Bisgaard H. Safety and efficacy of tiotropium in children aged 1-5 years with persistent asthmatic symptoms: a randomised, double-blind, placebo-controlled trial. THE LANCET RESPIRATORY MEDICINE 2018; 6:127-137. [PMID: 29361462 DOI: 10.1016/s2213-2600(18)30012-2] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Few studies have assessed the safety and efficacy of potential asthma medications in children younger than 5 years. We descriptively assessed the safety and efficacy of tiotropium, a long-acting anticholinergic drug, in children aged 1-5 years with persistent asthmatic symptoms. METHODS This exploratory 12-week, randomised, double-blind, placebo-controlled, parallel-group, phase 2/3, regulatory multicentre trial was done at 32 hospitals, clinics, and clinical research units in 11 countries in Asia, Europe, and North America. Children aged 1-5 years with at least a 6-month history of persistent asthmatic symptoms and a need for inhaled corticosteroids were eligible. Patients were randomly allocated using an interactive voice or web-based response system to receive once-daily tiotropium 2·5 μg, tiotropium 5 μg, or placebo as an add-on to inhaled corticosteroids with or without additional controller medication. Patients and investigators were masked to study group assignment. Tiotropium was given via the Respimat inhaler once daily as two puffs of 1·25 μg in the 2·5 μg group, two puffs of 2·5 μg in the 5 μg group, or two puffs of placebo. The primary outcomes were safety, which was assessed by comparing adverse events between the tiotropium and placebo groups, and efficacy, which was measured as the change in weekly mean combined daytime asthma symptom score from baseline to week 12. Statistical analyses of treatment effects were exploratory; although endpoints were defined, they were used for descriptive analyses only. The safety and primary analyses were done in all patients who received at least one dose of their assigned treatment. This study is registered with ClinicalTrials.gov (NCT01634113), and is completed. FINDINGS Between July 26, 2012, and Dec 4, 2014, 102 children were randomly assigned to the three treatment groups (36 to receive tiotropium 2·5 μg, 32 to receive tiotropium 5 μg, and 34 to receive placebo). 101 children completed the study and were included in the analyses. The changes in adjusted weekly mean combined daytime asthma symptom scores between baseline and week 12 were not significantly different between any of the groups. The adjusted mean difference between the tiotropium 2·5 μg group and placebo group was -0·080 (95% CI -0·312 to 0·152) and the difference between tiotropium 5 μg and placebo group was -0·048 (-0·292 to 0·195). Adverse events were less frequent with tiotropium treatment than with placebo (20 [56%] of 36 children with tiotropium 2·5 μg, 18 [58%] of 31 with tiotropium 5 μg, and 25 [74%] of 34 with placebo), although no formal statistical comparison between groups was performed. A greater proportion of children reported asthma exacerbations as adverse events in the placebo group (ten [29%] of 34) than in the tiotropium groups (five [14%] of 36 in the 2·5 μg group and two [6%] of 31 in the 5 μg group). Serious adverse events were reported in three patients (all of whom received placebo); no adverse events led to discontinuation of treatment or death. INTERPRETATION To our knowledge, our small study is the first to assess the safety and efficacy of tiotropium in children aged 1-5 years with persistent asthmatic symptoms. Tolerability of tiotropium was similar to that of placebo, which is consistent with previous findings in older populations. Although mean daytime asthma symptom scores were not significantly different between groups, tiotropium showed the potential to reduce asthma exacerbation risk compared with placebo. The findings of the study are limited by the small sample size and descriptive statistical analyses. Additional well powered trials are needed to further assess the safety and efficacy of tiotropium in young children. FUNDING Boehringer Ingelheim.
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Affiliation(s)
- Elianne J L E Vrijlandt
- Department of Pediatric Pulmonology and Pediatric Allergy, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Georges El Azzi
- TA Respiratory Diseases, Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | | | - Ned Rupp
- National Allergy and Asthma Research, North Charleston, SC, USA
| | | | - LeRoy Graham
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Stanley J Szefler
- Department of Pediatrics Breathing Institute and Pediatric Pulmonary Section, Children's Hospital of Colorado and the University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Ashish Sharma
- Boehringer Ingelheim Pharmaceuticals Inc, Ridgefield, CT, USA
| | - Sebastian D Vulcu
- Global Pharmacovigilance, Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Ralf Sigmund
- Biostatistics and Data Sciences, Boehringer Ingelheim Pharma GmbH & Co KG, Biberach an der Riss, Germany
| | - Bo Chawes
- Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Michael Engel
- TA Respiratory Diseases, Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Hans Bisgaard
- Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
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Greenberg J, Prushinskaya O, Harris JD, Guidetti-Myers G, Steiding J, Sawicki GS, Gaffin JM. Utilization of a patient-centered asthma passport tool in a subspecialty clinic. J Asthma 2017; 55:180-187. [PMID: 28548904 DOI: 10.1080/02770903.2017.1323916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Despite available and effective tools for asthma self-assessment (Asthma Control Test, ACT) and self-management (Asthma Action Plan, AAP), they are underutilized in outpatient specialty clinics. We evaluated the impact of a patient-centered checklist, the Asthma Passport, on improving ACT and AAP utilization in clinic. METHODS This was a randomized, interventional quality-improvement project in which the Asthma Passport was distributed to 120 pediatric asthma patients over the duration of 16 weeks. The passport's checklist consisted of tasks to be completed by the patient/family, including completion of the ACT and AAP. We compared rates of completion of the ACT and AAP for those who received the passport versus the control group, and assessed patient/caregiver and provider satisfaction. RESULTS Based on electronic medical record data from 222 participants, the ACT completion rate was not significantly different between the passport and control groups, however, the AAP completion rate was significantly greater than control (30.0% vs. 17.7%, p = 0.04). When per-protocol analysis was limited to groups who completed and returned their passports, ACT and AAP completion rates were significantly greater than control (73.8% vs. 44.1% (p = 0.002) and 35.7% vs. 17.7% (p = 0.04), respectively). Nearly all participants reported high satisfaction with care, and surveyed providers viewed the passport favorably. CONCLUSIONS A patient-centered checklist significantly improved the completion rate of the AAP. For patient's who completed and returned the asthma passport, the ACT completion rate was also improved. Participants and providers reported high satisfaction with the checklist, suggesting that it can effectively promote asthma self-management and self-assessment without burdening clinicians or clinic workflow.
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Affiliation(s)
- Jonathan Greenberg
- a Division of Respiratory Diseases , Boston Children's Hospital , Boston , MA , USA
| | - Olga Prushinskaya
- a Division of Respiratory Diseases , Boston Children's Hospital , Boston , MA , USA
| | - Joshua D Harris
- a Division of Respiratory Diseases , Boston Children's Hospital , Boston , MA , USA
| | | | - Jacqueline Steiding
- a Division of Respiratory Diseases , Boston Children's Hospital , Boston , MA , USA
| | - Gregory S Sawicki
- a Division of Respiratory Diseases , Boston Children's Hospital , Boston , MA , USA
| | - Jonathan M Gaffin
- a Division of Respiratory Diseases , Boston Children's Hospital , Boston , MA , USA
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McColl-Kennedy JR, Snyder H, Elg M, Witell L, Helkkula A, Hogan SJ, Anderson L. The changing role of the health care customer: review, synthesis and research agenda. JOURNAL OF SERVICE MANAGEMENT 2017. [DOI: 10.1108/josm-01-2016-0018] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to synthesize findings from health care research with those in service research to identify key conceptualizations of the changing role of the health care customer, to identify gaps in theory, and to propose a compelling research agenda.
Design/methodology/approach
This study combines a meta-narrative review of health care research, and a systematic review of service research, using thematic analysis to identify key practice approaches and the changing role of the health care customer.
Findings
The review reveals different conceptualizations of the customer role within the ten key practice approaches, and identifies an increased activation of the role of the health care customer over time. This change implies a re-orientation, that is, moving away from the health care professional setting the agenda, prescribing and delivering treatment where the customer merely complies with orders, to the customer actively contributing and co-creating value with service providers and other actors in the ecosystem to the extent the health care customer desires.
Originality/value
This study not only identifies key practice approaches by synthesizing findings from health care research with those in service research, it also identifies how the role of the health care customer is changing and highlights effects of the changing role across the practice approaches. A research agenda to guide future health care service research is also provided.
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Laberge M, Wodchis WP, Barnsley J, Laporte A. Efficiency of Ontario primary care physicians across payment models: a stochastic frontier analysis. HEALTH ECONOMICS REVIEW 2016; 6:22. [PMID: 27271177 PMCID: PMC4894855 DOI: 10.1186/s13561-016-0101-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 06/01/2016] [Indexed: 05/30/2023]
Abstract
OBJECTIVE The study examines the relationship between the primary care model that a physician belongs to and the efficiency of the primary care physician in Ontario, Canada. METHODS Survey data were collected from 183 self-selected physicians and linked to administrative databases to capture the provision of services to the patients served for the 12 month period ending June 30, 2013, and the characteristics of the patients at the beginning of the study period. Two stochastic frontier regression models were used to estimate efficiency scores and parameters for two separate outputs: the number of distinct patients seen and the number of visits. RESULTS Because of missing data, only 165 physicians were included in the analyses. The average efficiency was 0.72 for both outputs with scores varying from 4 % to 93 % for the visits and 5 % to 94 % for the number of patients seen. We observed that there were both very low and very high efficiency scores within each model. These variations were larger than variations in average scores across models.
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Affiliation(s)
- Maude Laberge
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, 1225 Center Dr, Room 3111, Gainesville, FL, 32610, USA.
- Canadian Centre for Health Economics, Toronto, Canada.
| | - Walter P Wodchis
- Canadian Centre for Health Economics, Toronto, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Toronto Rehabilitation Institute, Toronto, Canada
| | - Jan Barnsley
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Audrey Laporte
- Canadian Centre for Health Economics, Toronto, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
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Kienle GS, Mussler M, Fuchs D, Kiene H. Individualized Integrative Cancer Care in Anthroposophic Medicine: A Qualitative Study of the Concepts and Procedures of Expert Doctors. Integr Cancer Ther 2016; 15:478-494. [PMID: 27151589 PMCID: PMC5739166 DOI: 10.1177/1534735416640091] [Citation(s) in RCA: 20] [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: 10/27/2015] [Revised: 01/20/2016] [Accepted: 02/12/2016] [Indexed: 11/16/2022] Open
Abstract
Background Cancer patients widely seek integrative oncology which embraces a wide variety of treatments and system approaches. Objective To investigate the concepts, therapeutic goals, procedures, and working conditions of integrative oncology doctors in the field of anthroposophic medicine. Methods This qualitative study was based on in-depth interviews with 35 highly experienced doctors working in hospitals and office-based practices in Germany and other countries. Structured qualitative content analysis was applied to examine the data. Results The doctors integrated conventional and holistic cancer concepts. Their treatments aimed at both tumor and symptom control and at strengthening the patient on different levels: living with the disease, overcoming the disease, enabling emotional and cognitive development, and addressing spiritual or transcendental issues according to the patient's wishes and initiatives. Therapeutic procedures were conventional anticancer and symptom-relieving treatments, herbal and mineral remedies, mistletoe therapy, art therapies, massages and other external applications, nutrition and lifestyle advice, psychological support, and multiple forms of empowerment. The approach emphasised good patient-doctor relationships and sufficient time for patient encounters and decision-making. Individualization appeared in several dimensions and was interwoven with standards and mindlines. The doctors often worked in teams and cooperated with other cancer care-related specialists. Conclusion Integrative cancer care pursues an individualized and patient-centered approach, encompassing conventional and multimodal complementary interventions, and addressing, along with physical and functional needs, the emotional and spiritual needs of patients. This seems to be important for tumor and symptom control, and addresses major challenges and important goals of modern cancer care.
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Affiliation(s)
- Gunver S Kienle
- University of Witten Herdecke, Freiburg, Germany
- University Medical Center Freiburg, Freiburg, Germany
| | | | | | - Helmut Kiene
- University of Witten Herdecke, Freiburg, Germany
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Peek ME, Lopez FY, Williams HS, Xu LJ, McNulty MC, Acree ME, Schneider JA. Development of a Conceptual Framework for Understanding Shared Decision making Among African-American LGBT Patients and their Clinicians. J Gen Intern Med 2016; 31:677-87. [PMID: 27008649 PMCID: PMC4870421 DOI: 10.1007/s11606-016-3616-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Enhancing patient-centered care and shared decision making (SDM) has become a national priority as a means of engaging patients in their care, improving treatment adherence, and enhancing health outcomes. Relatively little is known about the healthcare experiences or shared decision making among racial/ethnic minorities who also identify as being LGBT. The purpose of this paper is to understand how race, sexual orientation and gender identity can simultaneously influence SDM among African-American LGBT persons, and to propose a model of SDM between such patients and their healthcare providers. METHODS We reviewed key constructs necessary for understanding SDM among African-American LGBT persons, which guided our systematic literature review. Eligible studies for the review included English-language studies of adults (≥ 19 y/o) in North America, with a focus on LGBT persons who were African-American/black (i.e., > 50 % of the study population) or included sub-analyses by sexual orientation/gender identity and race. We searched PubMed, CINAHL, ProQuest Dissertations & Theses, PsycINFO, and Scopus databases using MESH terms and keywords related to shared decision making, communication quality (e.g., trust, bias), African-Americans, and LGBT persons. Additional references were identified by manual reviews of peer-reviewed journals' tables of contents and key papers' references. RESULTS We identified 2298 abstracts, three of which met the inclusion criteria. Of the included studies, one was cross-sectional and two were qualitative; one study involved transgender women (91 % minorities, 65 % of whom were African-Americans), and two involved African-American men who have sex with men (MSM). All of the studies focused on HIV infection. Sexual orientation and gender identity were patient-reported factors that negatively impacted patient/provider relationships and SDM. Engaging in SDM helped some patients overcome normative beliefs about clinical encounters. In this paper, we present a conceptual model for understanding SDM in African-American LGBT persons, wherein multiple systems of social stratification (e.g., race, gender, sexual orientation) influence patient and provider perceptions, behaviors, and shared decision making. DISCUSSION Few studies exist that explore SDM among African-American LGBT persons, and no interventions were identified in our systematic review. Thus, we are unable to draw conclusions about the effect size of SDM among this population on health outcomes. Qualitative work suggests that race, sexual orientation and gender work collectively to enhance perceptions of discrimination and decrease SDM among African-American LGBT persons. More research is needed to obtain a comprehensive understanding of shared decision making and subsequent health outcomes among African-Americans along the entire spectrum of gender and sexual orientation.
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Affiliation(s)
- Monica E Peek
- Section of General Internal Medicine, , The University of Chicago, 5841 S. Maryland Avenue, MC 2007, Chicago, IL, 60637, USA.
- Chicago Center for Diabetes Translation Research, , The University of Chicago, Chicago, IL, USA.
- MacLean Center for Clinical Medical Ethics, , The University of Chicago, Chicago, IL, USA.
| | - Fanny Y Lopez
- Section of General Internal Medicine, , The University of Chicago, 5841 S. Maryland Avenue, MC 2007, Chicago, IL, 60637, USA
- Chicago Center for Diabetes Translation Research, , The University of Chicago, Chicago, IL, USA
| | - H Sharif Williams
- Center for Culture, Sexuality and Spirituality, , Goddard College, Plainfield, VT, USA
- Undergraduate Programs, , Goddard College, Plainfield, VT, USA
| | - Lucy J Xu
- Section of General Internal Medicine, , The University of Chicago, 5841 S. Maryland Avenue, MC 2007, Chicago, IL, 60637, USA
| | - Moira C McNulty
- Section of Infectious Diseases, , The University of Chicago, Chicago, IL, USA
| | - M Ellen Acree
- Section of Infectious Diseases, , The University of Chicago, Chicago, IL, USA
| | - John A Schneider
- Section of Infectious Diseases, , The University of Chicago, Chicago, IL, USA
- Department of Public Health Sciences, , University of Chicago, Chicago, IL, USA
- Chicago Center for HIV Elimination, , University of Chicago, Chicago, IL, USA
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Wang LH, Goopy S, Lin CC, Barnard A, Han CY, Liu HE. The emergency patient's participation in medical decision-making. J Clin Nurs 2016; 25:2550-8. [PMID: 27133134 DOI: 10.1111/jocn.13296] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2016] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES The purpose of this research was to explore the medical decision-making processes of patients in emergency departments. BACKGROUND Studies indicate that patients should be given enough time to acquire relevant information and receive adequate support when they need to make medical decisions. It is difficult to satisfy these requirements in emergency situations. Limited research has addressed the topic of decision-making among emergency patients. DESIGN This qualitative study used a broadly defined grounded theory approach to explore decision-making in an emergency department in Taiwan. METHODS Thirty emergency patients were recruited between June and December 2011 for semi-structured interviews that were audio-taped and transcribed verbatim. RESULTS The study identified three stages in medical decision-making by emergency patients: predecision (interpreting the problem); decision (a balancing act) and postdecision (reclaiming the self). Transference was identified as the core category and pattern of behaviour through which patients resolved their main concerns. This transference around decision-making represents a type of bricolage. CONCLUSIONS The findings fill a gap in knowledge about the decision-making process among emergency patients. RELEVANCE TO CLINICAL PRACTICE The results inform emergency professionals seeking to support patients faced with complex medical decision-making and suggest an emphasis on informed patient decision-making, advocacy, patient-centred care and in-service education of health staff.
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Affiliation(s)
- Li-Hsiang Wang
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Suzanne Goopy
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Chun-Chih Lin
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Alan Barnard
- Queensland University of Technology, Brisbane, Qld, Australia
| | - Chin-Yen Han
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan.
| | - Hsueh-Erh Liu
- School of Nursing, Chang Gung University, Taoyuan, Taiwan
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Yin HS, Gupta RS, Tomopoulos S, Mendelsohn AL, Egan M, van Schaick L, Wolf MS, Sanchez DC, Warren C, Encalada K, Dreyer BP. A Low-Literacy Asthma Action Plan to Improve Provider Asthma Counseling: A Randomized Study. Pediatrics 2016; 137:peds.2015-0468. [PMID: 26634774 DOI: 10.1542/peds.2015-0468] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/28/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The use of written asthma action plans (WAAPs) has been associated with reduced asthma-related morbidity, but there are concerns about their complexity. We developed a health literacy-informed, pictogram- and photograph-based WAAP and examined whether providers who used it, with no training, would have better asthma counseling quality compared with those who used a standard plan. METHODS Physicians at 2 academic centers randomized to use a low-literacy or standard action plan (American Academy of Allergy, Asthma and Immunology) to counsel the hypothetical parent of child with moderate persistent asthma (regimen: Flovent 110 μg 2 puffs twice daily, Singulair 5 mg daily, Albuterol 2 puffs every 4 hours as needed). Two blinded raters independently reviewed counseling transcriptions. PRIMARY OUTCOME MEASURES medication instructions presented with times of day (eg, morning and night vs number of times per day) and inhaler color; spacer use recommended; need for everyday medications, even when sick, addressed; and explicit symptoms used. RESULTS 119 providers were randomly assigned (61 low literacy, 58 standard). Providers who used the low-literacy plan were more likely to use times of day (eg, Flovent morning and night, 96.7% vs 51.7%, P < .001; odds ratio [OR] = 27.5; 95% confidence interval [CI], 6.1-123.4), recommend spacer use (eg, Albuterol, 83.6% vs 43.1%, P < .001; OR = 6.7; 95% CI, 2.9-15.8), address need for daily medications when sick (93.4% vs 34.5%, P < .001; OR = 27.1; 95% CI, 8.6-85.4), use explicit symptoms (eg, "ribs show when breathing," 54.1% vs 3.4%, P < .001; OR = 33.0; 95% CI, 7.4-147.5). Few mentioned inhaler color. Mean (SD) counseling time was similar (3.9 [2.5] vs 3.8 [2.6] minutes, P = .8). CONCLUSIONS Use of a low-literacy WAAP improves the quality of asthma counseling by helping providers target key issues by using recommended clear communication principles.
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Affiliation(s)
- H Shonna Yin
- Department of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, New York; Department of Population Health, New York University School of Medicine, New York, New York;
| | - Ruchi S Gupta
- Center for Community Health, and Smith Child Health Research Program, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; and
| | - Suzy Tomopoulos
- Department of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, New York
| | - Alan L Mendelsohn
- Department of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, New York; Department of Population Health, New York University School of Medicine, New York, New York
| | - Maureen Egan
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Linda van Schaick
- Department of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, New York
| | - Michael S Wolf
- Health Literacy and Learning Program, Center for Communication in Healthcare, Division of General Internal Medicine, and Institute for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Dayana C Sanchez
- Department of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, New York
| | | | - Karen Encalada
- Department of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, New York
| | - Benard P Dreyer
- Department of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, New York
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Snyder H, Engström J. The antecedents, forms and consequences of patient involvement: A narrative review of the literature. Int J Nurs Stud 2016; 53:351-78. [DOI: 10.1016/j.ijnurstu.2015.09.008] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 09/01/2015] [Accepted: 09/09/2015] [Indexed: 12/19/2022]
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Clayman ML, Bylund CL, Chewning B, Makoul G. The Impact of Patient Participation in Health Decisions Within Medical Encounters. Med Decis Making 2015; 36:427-52. [DOI: 10.1177/0272989x15613530] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 09/18/2015] [Indexed: 02/01/2023]
Abstract
Background: Although there are compelling moral arguments for patient participation in medical decisions, the link to health outcomes has not been systematically explored. Objective: Assess the extent to which patient participation in decision making within medical encounters is associated with measured patient outcomes. Methods: We conducted a primary search in PubMed—excluding non-English and animal studies—for articles on decision making in the context of the physician–patient relationship published through the end of February 2015, using the MeSH headings (Physician-Patient Relations [MeSH] OR Patient Participation [MeSH]) and the terms (decision OR decisions OR option OR options OR choice OR choices OR alternative OR alternatives) in the title or abstract. We also conducted a secondary search of references in all articles that met the inclusion criteria. Results: A thorough search process yielded 116 articles for final analysis. There was wide variation in study design, as well as measurement of patient participation and outcomes, among the studies. Eleven of the 116 studies were randomized controlled trials (RCTs). Interventions increased patient involvement in 10 (91%) of the 11 RCTs. At least one positive outcome was detected in 5 (50%) of the 10 RCTs reporting increased participation; the ratio of positive results among all outcome variables measured in these studies was much smaller. Although proportions differed, similar patterns were found across the 105 nonrandomized studies. Conclusions: Very few RCTs in the field have measures of participation in decision making and at least one health outcome. Moreover, extant studies exhibit little consistency in measurement of these variables, and results are mixed. There is a great need for well-designed, reproducible research on clinically relevant outcomes of patient participation in medical decisions.
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Affiliation(s)
- Marla L. Clayman
- American Institutes for Research (MLC)
- Hamad Medical Corporation/Weill Cornell Medical College–Qatar (CB)
- School of Pharmacy, University of Wisconsin–Madison, WI, USA (BC)
- Connecticut Institute for Primary Care Innovation (GM)
- Department of Medicine, University of Connecticut School of Medicine, Hartford, CT, USA (GM)
| | - Carma L. Bylund
- American Institutes for Research (MLC)
- Hamad Medical Corporation/Weill Cornell Medical College–Qatar (CB)
- School of Pharmacy, University of Wisconsin–Madison, WI, USA (BC)
- Connecticut Institute for Primary Care Innovation (GM)
- Department of Medicine, University of Connecticut School of Medicine, Hartford, CT, USA (GM)
| | - Betty Chewning
- American Institutes for Research (MLC)
- Hamad Medical Corporation/Weill Cornell Medical College–Qatar (CB)
- School of Pharmacy, University of Wisconsin–Madison, WI, USA (BC)
- Connecticut Institute for Primary Care Innovation (GM)
- Department of Medicine, University of Connecticut School of Medicine, Hartford, CT, USA (GM)
| | - Gregory Makoul
- American Institutes for Research (MLC)
- Hamad Medical Corporation/Weill Cornell Medical College–Qatar (CB)
- School of Pharmacy, University of Wisconsin–Madison, WI, USA (BC)
- Connecticut Institute for Primary Care Innovation (GM)
- Department of Medicine, University of Connecticut School of Medicine, Hartford, CT, USA (GM)
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Lindberg A, Fossum B, Karlen P, Oxelmark L. Experiences of complementary and alternative medicine in patients with inflammatory bowel disease - a qualitative study. Altern Ther Health Med 2014; 14:407. [PMID: 25338541 PMCID: PMC4210588 DOI: 10.1186/1472-6882-14-407] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 10/16/2014] [Indexed: 12/16/2022]
Abstract
Background The use of Complementary and Alternative Medicine (CAM) in Inflammatory Bowel Disease (IBD) is increasing. Although CAM often improves patients’ well-being, it can also lead to side-effects and interactions with conventional medications. Research on patients with IBD in Sweden who have experiences of CAM is sparse. More studies are needed to enhance awareness of and improve communication about CAM. The aim of this study was to describe experiences of CAM in the healthcare context reported by patients with IBD. Methods Fifteen patients with IBD, eight with Crohn’s disease (CD) and seven with ulcerative colitis (UC), were recruited. Semi-structured qualitative interviews were conducted and qualitative content analysis was performed. Results The analysis revealed the theme Knowledge and communication lead to participation in the area of CAM based on three categories; CAM use, Communication and Self-care. Patients with IBD wanted to be asked about CAM to be able to start a dialogue, as some perceived being treated in a disparaging manner and not taken seriously when raising the subject. Healthcare professionals (HCPs) need to be aware of this in order to meet and understand patient needs. Patients with IBD found it easier to communicate about CAM with the IBD nurses than physicians and dietary changes was one important CAM treatment. Conclusions The finding that it was easier to discuss CAM with nurses than physicians emphasizes the important role of the IBD nurse in communication and monitoring patients’ CAM use. Patients wanted to be asked about CAM to be able to start a dialogue, as some perceived not taken seriously when raising the subject. Furthermore, HCPs need to understand that many patients with IBD regard dietary changes as an important part of CAM treatment. Further research in these areas is needed.
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Shared clinician-patient decision-making about treatment of pediatric asthma: what do we know and how can we use it? Curr Opin Allergy Clin Immunol 2014; 14:161-7. [PMID: 24553296 DOI: 10.1097/aci.0000000000000046] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Shared decision-making (SDM) is an emerging field that promises to improve healthcare. We aim to explore the concept of SDM, how it has been studied or applied in the treatment of asthma, and how it might be implemented to improve adherence and outcomes in pediatric asthma. RECENT FINDINGS Healthcare providers often fail to involve their patients in clinical decision-making by not presenting all available options, associated risks and benefits, in light of the patient's values, preferences, concerns, lifestyle, and perceived barriers to following various treatment regimens. It has been argued that SDM is preferable to a clinician-controlled approach and may improve patient outcomes (increase satisfaction with care, reduce decisional conflict and decisional regret, improve health-related quality of life, and increase decision-specific knowledge). This may be especially important in managing chronic conditions in which adherence to treatment regimen may increase if the patient was actively involved in the decision-making. In pediatrics, the decision process is further complicated by the clinician-parent(s)-child interaction. We found no studies on how to effectively involve and communicate with children at different developmental levels, or how to coalesce the parent and child's perspective to work as a unit. SUMMARY SDM has the promise to improve satisfaction with disease management, treatment adherence and patient-centered outcomes in pediatric asthma, but further research is needed to determine its effectiveness and to establish guidelines on how to implement SDM in the clinical setting and incorporate the input and preferences of all stakeholders' perspectives.
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Peek ME, Drum M, Cooper LA. The Association of Patient Chronic Disease Burden and Self-Management Requirements With Shared Decision Making in Primary Care Visits. Health Serv Res Manag Epidemiol 2014; 1. [PMID: 26640812 PMCID: PMC4670035 DOI: 10.1177/2333392814538775] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Shared decision making (SDM) is associated with positive health outcomes and may be particularly relevant for patients with chronic disease. OBJECTIVES To investigate whether (1) patients with chronic diseases, particularly those requiring self-management, are more likely to engage in SDM behaviors than patients without chronic diseases and (2) patients with chronic diseases are more likely to have their physicians engage them in SDM. DESIGN A cross-sectional study of patients who were enrolled in a randomized controlled trial to improve patient-physician communication. PARTICIPANTS Adult patients with hypertension at community health clinics in Baltimore, Maryland. APPROACH We used multivariable regression models to examine the associations of the following predictor variables: (1) chronic disease burden and (2) diseases requiring self-management with the following outcome variables measuring SDM components: (1) patient information sharing, (2) patient decision making, and (3) physician SDM facilitation. KEY RESULTS Patients with greater chronic disease burden and more diseases requiring self-management reported more information sharing (β = .07, P = .03 and β = .12, P = .046, respectively) and decision making (β = .06, P = .02 and β = .21, P < .001) as did patients who reported poor general health. Physician facilitation of SDM was not associated with chronic disease burden or with diseases requiring self-management but was associated with higher patient income. CONCLUSIONS Patients with chronic diseases, particularly those requiring self-management, may be more likely to engage in SDM behaviors, but physicians may not be more likely to engage such patients in SDM. Targeting patients with chronic disease for SDM may improve health outcomes among the chronically ill, particularly among vulnerable patients (eg, minorities, low-income patients) who suffer disproportionately from such conditions.
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Affiliation(s)
- Monica E Peek
- Department of Medicine, Section of General Internal Medicine, University of Chicago, Chicago, IL, USA ; Chicago Center for Diabetes Translation Research, University of Chicago, Chicago, IL, USA ; Center for Health and Social Sciences, University of Chicago, Chicago, IL, USA ; Center for the Study of Race, Politics and Culture, University of Chicago, Chicago, IL, USA ; Bucksbaum Institute for Clinical Excellence, University of Chicago, Chicago, IL, USA
| | - Melinda Drum
- Chicago Center for Diabetes Translation Research, University of Chicago, Chicago, IL, USA ; Department of Health Studies, University of Chicago, Chicago, IL, USA
| | - Lisa A Cooper
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA ; Department of Epidemiology and Health Policy & Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA ; Department of Medicine, Section of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA ; Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Baltimore, MD, USA
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Kaplan SH, Billimek J, Sorkin DH, Ngo-Metzger Q, Greenfield S. Reducing racial/ethnic disparities in diabetes: the Coached Care (R2D2C2) project. J Gen Intern Med 2013; 28:1340-9. [PMID: 23645452 PMCID: PMC3785664 DOI: 10.1007/s11606-013-2452-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite numerous efforts to change healthcare delivery, the profile of disparities in diabetes care and outcomes has not changed substantially over the past decade. OBJECTIVE To understand potential contributors to disparities in diabetes care and glycemic control. DESIGN Cross sectional analysis. SETTING Seven outpatient clinics affiliated with an academic medical center. PATIENTS Adult patients with type 2 diabetes who were Mexican American, Vietnamese American or non-Hispanic white (n = 1,484). MEASUREMENTS Glycemic control was measured as hemoglobin A1c (HbA1c) level. Patient, provider and system characteristics included demographic characteristics; access to care; quality of process of care including clinical inertia; quality of interpersonal care; illness burden; mastery (diabetes management confidence, passivity); and adherence to treatment. RESULTS Unadjusted HbA1c values were significantly higher for Mexican American patients (n = 782) (mean = 8.3 % [SD:2.1]) compared with non-Hispanic whites (n = 389) (mean = 7.1 % [SD:1.4]). There were no significant differences in HbA1c values between Vietnamese American and non-Hispanic white patients. There were no statistically significant group differences in glycemic control after adjustment for multiple measures of access, and quality of process and interpersonal care. Disease management mastery and adherence to treatment were related to glycemic control for all patients, independent of race/ethnicity. LIMITATIONS Generalizability to other minorities or to patients with poorer access to care may be limited. CONCLUSIONS The complex interplay among patient, physician and system characteristics contributed to disparities in HbA1c between Mexican American and non-Hispanic white patients. In contrast, Vietnamese American patients achieved HbA1c levels comparable to non-Hispanic whites and adjustment for numerous characteristics failed to identify confounders that could have masked disparities in this subgroup. Disease management mastery appeared to be an important contributor to glycemic control for all patient subgroups.
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Affiliation(s)
- Sherrie H Kaplan
- Health Policy Research Institute and Department of Medicine, School of Medicine, University of California, Irvine, 100 Theory Suite 110, Irvine, CA, 92697, USA,
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Brooks AT, Silverman L, Wallen GR. Shared decision making: a fundamental tenet in a conceptual framework of integrative healthcare delivery. INTEGRATIVE MEDICINE INSIGHTS 2013; 8:29-36. [PMID: 24092959 PMCID: PMC3782399 DOI: 10.4137/imi.s12783] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
With the increased usage of complementary and alternative medicine (CAM) in the US comes a need for evidence-based and integrated care systems which encourage open communication between patients and providers. This paper introduces a conceptual framework for integrative care delivery, with shared decision making being the "connecting force" between holistic treatment and improved health outcomes for patients.
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Affiliation(s)
| | - Leanne Silverman
- Medstar Georgetown University Hospital, Neuroscience Stroke and Intermediate Care Unit
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Isaacs CG, Kistler C, Hunold KM, Pereira GF, Buchbinder M, Weaver MA, McLean SA, Platts-Mills TF. Shared decision-making in the selection of outpatient analgesics for older individuals in the emergency department. J Am Geriatr Soc 2013; 61:793-8. [PMID: 23590177 PMCID: PMC3656132 DOI: 10.1111/jgs.12207] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the relationship between older adults' perceptions of shared decision-making in the selection of an analgesic to take at home for acute musculoskeletal pain and (1) patient satisfaction with the analgesic and (2) changes in pain scores at 1 week. DESIGN Cross-sectional study. SETTING Single academic emergency department. PARTICIPANTS Individuals aged 65 and older with acute musculoskeletal pain. MEASUREMENTS Two components of shared decision-making were assessed: information provided to the patient about the medication choice and patient participation in the selection of the analgesic. Optimal satisfaction with the analgesic was defined as being "a lot" satisfied. Pain scores were assessed in the ED and at 1 week using a 0-to-10 scale. RESULTS Of 159 individuals reached by telephone, 111 met all eligibility criteria and completed the survey. Fifty-two percent of participants reported receiving information about pain medication options, and 31% reported participating in analgesic selection. Participants who received information were more likely to report optimal satisfaction with the pain medication than those who did not (67% vs 34%; P < .001). Participants who participated in the decision were also more likely to report optimal satisfaction with the analgesic (71% vs 43%; P = .008) and had a greater average decrease in pain score (4.1 vs 2.9; P = .05). After adjusting for measured confounders, participants who reported receiving information remained more likely to report optimal satisfaction with the analgesic (63% vs 38%; P = .04). CONCLUSION Shared decision-making in analgesic selection for older adults with acute musculoskeletal pain may improve outcomes.
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Affiliation(s)
- Cameron G. Isaacs
- School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Christine Kistler
- Department of Family Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Katherine M. Hunold
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Greg F. Pereira
- Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Mara Buchbinder
- Department of Social Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Mark A. Weaver
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Samuel A. McLean
- Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Emergency Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Timothy F. Platts-Mills
- Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Emergency Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
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Wallen GR, Middleton KR, Miller-Davis C, Tataw-Ayuketah G, Todaro A, Rivera-Goba M, Mittleman BB. Patients' and community leaders' perceptions regarding conducting health behavior research in a diverse, urban clinic specializing in rheumatic diseases. Prog Community Health Partnersh 2013; 6:405-15. [PMID: 23221285 DOI: 10.1353/cpr.2012.0052] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Disparities in the incidence, prevalence, severity, care, and outcomes for rheumatic diseases exist among racial and ethnic groups compared with White Americans. OBJECTIVE This paper describes a community-based participatory research (CBPR) approach engaging researchers, community leaders, and patients in purposeful dialogues related to the implementation of health behavior research in an urban rheumatic disease clinic. METHODS Seven focused discussions were led in either English or Spanish. Discussions were audiotaped and transcribed verbatim. RESULTS Six community leaders and nine patients participated in the seven scheduled focused discussions. Transcripts uncovered five major themes that assisted with study design: trust, patient-provider relationship, study implementation suggestions, decreased functional capacity, and access to healthcare. CONCLUSIONS Engaging community partners and patients in informal and formal discussions from early phases of research design through implementation, followed by systematic application of these insights, may serve to accelerate the potential for translation from findings into improved clinical practice and optimal outcomes.
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Gandhi PK, Kenzik KM, Thompson LA, DeWalt DA, Revicki DA, Shenkman EA, Huang IC. Exploring factors influencing asthma control and asthma-specific health-related quality of life among children. Respir Res 2013; 14:26. [PMID: 23432913 PMCID: PMC3599064 DOI: 10.1186/1465-9921-14-26] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Accepted: 02/19/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little is known about factors contributing to children's asthma control status and health-related quality of life (HRQoL). The study objectives were to assess the relationship between asthma control and asthma-specific HRQoL in asthmatic children, and to examine the extent to which parental health literacy, perceived self-efficacy with patient-physician interaction, and satisfaction with shared decision-making (SDM) contribute to children's asthma control and asthma-specific HRQoL. METHODS This cross-sectional study utilized data collected from a sample of asthmatic children (n = 160) aged 8-17 years and their parents (n = 160) who visited a university medical center. Asthma-specific HRQoL was self-reported by children using the National Institutes of Health's Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Asthma Impact Scale. Satisfaction with SDM, perceived self-efficacy with patient-physician interaction, parental health literacy, and asthma control were reported by parents using standardized measures. Structural equation modeling (SEM) was performed to test the hypothesized pathways. RESULTS Path analysis revealed that children with better asthma control reported higher asthma-specific HRQoL (β = 0.4, P < 0.001). Parents with higher health literacy and greater perceived self-efficacy with patient-physician interactions were associated with higher satisfaction with SDM (β = 0.38, P < 0.05; β = 0.58, P < 0.001, respectively). Greater satisfaction with SDM was in turn associated with better asthma control (β = -0.26, P < 0.01). CONCLUSION Children's asthma control status influenced their asthma-specific HRQoL. However, parental factors such as perceived self-efficacy with patient-physician interaction and satisfaction with shared decision-making indirectly influenced children's asthma control status and asthma-specific HRQoL.
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Affiliation(s)
- Pranav K Gandhi
- Department of Pharmacy Practice, School of Pharmacy, South College, Knoxville, TN, USA
| | - Kelly M Kenzik
- Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Lindsay A Thompson
- Department of Pediatrics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Darren A DeWalt
- Department of Medicine, School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Dennis A Revicki
- Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, FL, USA
- Outcomes Research, United BioSource Corporation, Bethesda, MD, USA
| | - Elizabeth A Shenkman
- Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, FL, USA
- Institute for Child Health Policy, College of Medicine, University of Florida, Gainesville, FL, USA
| | - I-Chan Huang
- Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, FL, USA
- Institute for Child Health Policy, College of Medicine, University of Florida, Gainesville, FL, USA
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Patel MR, Valerio MA, Sanders G, Thomas LJ, Clark NM. Asthma action plans and patient satisfaction among women with asthma. Chest 2013; 142:1143-1149. [PMID: 22345379 DOI: 10.1378/chest.11-1700] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Asthma action plans (AAPs) are a priority recommendation of the National Asthma Education and Prevention Program and have been shown to positively affect health outcomes. Patient satisfaction is an important clinical outcome, yet little is known about its association with receiving an AAP. This study examined the association between having an AAP and behaviors to keep asthma in control and patient satisfaction with care. METHODS The study design was a cross-sectional analysis of baseline data from a randomized trial evaluating a self-management program among 808 women with asthma. Participants reported demographic information, interactions with clinicians, whether they had an AAP and owned a peak flow meter, self-management behaviors, and symptoms. RESULTS The mean age of the participants was 48 ±13.6 years, 84% (n= 670) were satisfied with their asthma care, and 48% (n= 383) had a written AAP from their physician. Women not having an AAP were less likely to take asthma medication as prescribed [ x 2 (1) = 13.68, P , .001], to initiate a discussion about asthma with their physicians [ x 2 (1) = 26.35, P < .001], and to own a peak fl ow meter [ x 2 (1) =77.84, P < .001]. Adjusting for asthma control, income, and medical specialty,women who did not have an AAP were more likely to report dissatisfaction with their asthma care (OR, 2.07; 95% CI, 1.35-3.17; P < .001). CONCLUSIONS Women without an AAP were less likely to initiate discussions with their physicians,take medications as prescribed, and own a peak fl ow meter to monitor asthma, all considered important self-management behaviors. They were also less satisfied with their care. Not having an AAP may affect interactions between patient and physician and clinical outcomes.
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Affiliation(s)
- Minal R Patel
- Center for Managing Chronic Disease, University of Michigan, Ann Arbor, MI; Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI
| | - Melissa A Valerio
- Center for Managing Chronic Disease, University of Michigan, Ann Arbor, MI; Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI
| | - Georgiana Sanders
- Center for Managing Chronic Disease, University of Michigan, Ann Arbor, MI; Division of Allergy and Clinical Immunology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Lara J Thomas
- Center for Managing Chronic Disease, University of Michigan, Ann Arbor, MI
| | - Noreen M Clark
- Center for Managing Chronic Disease, University of Michigan, Ann Arbor, MI; Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI.
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Yokoyama Y, Sasaki S, Suzukamo Y, Yamazaki S, Takegami M, Kakudate N, Hasegawa T, Haga M, Kawaguchi T, Moriya T, Hotta O, Fukuhara S. Interpersonal Psychosocial Factors Associated With Underreported Dietary Energy Intake in Hemodialysis Patients. J Ren Nutr 2013; 23:37-44. [DOI: 10.1053/j.jrn.2012.01.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Revised: 01/09/2012] [Accepted: 01/14/2012] [Indexed: 11/11/2022] Open
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Hawkins RE, Lipner RS, Ham HP, Wagner R, Holmboe ES. American Board of Medical Specialties Maintenance of Certification: theory and evidence regarding the current framework. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2013; 33 Suppl 1:S7-S19. [PMID: 24347156 DOI: 10.1002/chp.21201] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The American Board of Medical Specialties Maintenance of Certification Program (ABMS MOC) is designed to provide a comprehensive approach to physician lifelong learning, self-assessment, and quality improvement (QI) through its 4-part framework and coverage of the 6 competencies previously adopted by the ABMS and the Accreditation Council for Graduate Medical Education (ACGME). In this article, the theoretical rationale and exemplary empiric data regarding the MOC program and its individual parts are reviewed. The value of each part is considered in relation to 4 criteria about the relationship of the competencies addressed within that part to (1) patient outcomes, (2) physician performance, (3) validity of the assessment or educational methods utilized, and (4) learning or improvement potential. Overall, a sound theoretical rationale and a respectable evidence base exists to support the current structure and elements of the MOC program. However, it is incumbent on the ABMS and ABMS member boards to continue to examine their programs moving forward to assure the public and the profession that they are meeting expectations, are clinically relevant, and provide value to patients and participating physicians, and to refine and improve them as ongoing research indicates.
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MESH Headings
- Certification/standards
- Clinical Competence/standards
- Communication
- Education, Medical, Continuing/standards
- Education, Medical, Continuing/trends
- Education, Medical, Graduate/standards
- Education, Medical, Graduate/trends
- Humans
- Peer Review, Health Care/methods
- Peer Review, Health Care/standards
- Physician-Patient Relations
- Quality Improvement/standards
- Self-Assessment
- Specialty Boards/standards
- United States
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Affiliation(s)
- Richard E Hawkins
- Vice President, Medical Education Programs, American Medical Association.
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Hood KB, Hart A, Belgrave FZ, Tademy RH, Jones RA. The role of trust in health decision making among African American men recruited from urban barbershops. J Natl Med Assoc 2012; 104:351-9. [PMID: 23092050 DOI: 10.1016/s0027-9684(15)30176-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine factors within the patient-provider relationship that influence which role African American men aged 40-70 years prefer when making health care decisions. METHODS We recruited 40 African American men from barbershops in the Richmond, Virginia, metropolitan area to participate in semistructured interviews. At the completion of each interview, participants completed a brief self-administered demographic survey. The semistructured interviews were audiotaped and transcribed verbatim and then imported into a qualitative software program for organizing, sorting, and coding data. The principles of thematic analysis and template approach were used in this study. The survey data were analyzed using descriptive statistics. RESULTS Trust was a major theme that emerged from the semistructured interviews. The men listed trust in the health care provider as the primary reason for choosing a collaborative or active role in the decision-making process. Within the theme of trust, 4 subthemes emerged: expertise, information sharing, active listening, and relationship length. Thirty-five out of the 40 men interviewed preferred an active or collaborative role in the decision-making process; only 5 preferred passive decision making. CONCLUSIONS Trust emerged as an important factor that influenced role preference for African American men when making health care decisions in the context of the patient-provider relationship. Future studies that help identify which other factors influence health care decision-making roles among African American men may have implications for addressing health disparities among this population and improve the quality of their health care.
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Affiliation(s)
- Kristina B Hood
- Virginia Commonwealth University, Department of Psychology, PO Box 842018, Richmond, VA 23284-2018, USA.
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Poureslami I, Nimmon L, Doyle-Waters M, Rootman I, Schulzer M, Kuramoto L, FitzGerald JM. Effectiveness of educational interventions on asthma self-management in Punjabi and Chinese asthma patients: a randomized controlled trial. J Asthma 2012; 49:542-51. [PMID: 22715910 DOI: 10.3109/02770903.2012.682125] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Asthma tends to be less well controlled among ethnic minority groups, and its prevalence in new immigrants increases significantly the longer they are in Canada; mainly due to their lack of familiarity with English and difficulty understanding information regarding the disease, health literacy, cultural issues, housing conditions, and lack of access to appropriate care services. OBJECTIVE To explore the effectiveness of different formats of culturally relevant information and its impact on asthma patients' self-management within the Punjabi, Mandarin, and Cantonese communities. METHODS Using a participatory approach, we developed and tested knowledge and community educational videos (with similar information, but used a different approach, i.e., scientific vs. colloquial) and a pictorial pamphlet. A total of 92 physician-diagnosed adult asthma patients (47 Chinese and 45 Punjabi) were assigned at random to three experimental groups (watched one or both videos) and one comparison group (read pictorial pamphlet) and participated in three in-person interviews and one telephone interview within a 9-month period. Patients received education on asthma self-management via videos and pamphlet and outcomes, including their knowledge of asthma triggers (environmental-related and behavioral-related triggers) and symptoms; inhaler use skills and patient-reported medication adherence were measured. RESULTS Knowledge of asthma symptoms, inhaler use, and understanding of physician's instructions improved significantly from pretest to 3 months post-intervention follow-up among all participants. CONCLUSIONS Participants performed significantly better at follow-up than they did at baseline assessment, with the most notable improvements observed in the group that watched both community and knowledge videos. The results suggest that short, simple, culturally, and linguistically appropriate interventions can promote knowledge gain about asthma and improve inhaler use that can be sustained over the short term. Such interventions that provide authentic learning materials that draw on patients' life experiences and sociocultural context can overcome certain limitations of conventional patient education approaches.
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Affiliation(s)
- Iraj Poureslami
- Division of Respiratory Medicine, Institute of Heart and Lung Health, The University of British Columbia, Vancouver, BC, Canada
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Wallen GR, Brooks AT. To Tell or Not to Tell: Shared Decision Making, CAM Use and Disclosure Among Underserved Patients with Rheumatic Diseases. INTEGRATIVE MEDICINE INSIGHTS 2012; 7:15-22. [PMID: 23071389 PMCID: PMC3468342 DOI: 10.4137/imi.s10333] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The purpose of this analysis was to assess the impact of perceived shared decision-making (SDM) on complementary and alternative medicine (CAM) use and disclosure in a sample of urban, underserved minority patients (n = 109) with rheumatic diseases. Nearly three quarters of the patients (71.6%) reported CAM use. Of these, 59% disclosed CAM use to their provider. Logistic regression models were created. In model 1 SDM significantly predicted CAM use; however, the overall model fit was not significant. In model 2, gender, ethnicity, and SDM predicted CAM disclosure with 73.2% correctly classified. Females were more likely and Hispanics were less likely to disclose CAM use. Those with higher SDM scores were more likely to disclose CAM use. SDM played a role in whether patients used CAM and disclosed CAM use to their providers. Improving SDM strategies may be especially important among patients who are least likely to disclose CAM use.
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Wisnivesky JP, Krauskopf K, Wolf MS, Wilson EAH, Sofianou A, Martynenko M, Halm EA, Leventhal H, Federman AD. The association between language proficiency and outcomes of elderly patients with asthma. Ann Allergy Asthma Immunol 2012; 109:179-84. [PMID: 22920072 DOI: 10.1016/j.anai.2012.06.016] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Revised: 06/15/2012] [Accepted: 06/25/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Asthma is a growing cause of morbidity for elderly Americans and is highly prevalent among Hispanic people in the United States. The inability to speak English poses a barrier to patient-provider communication. OBJECTIVE To evaluate associations between limited English proficiency, asthma self-management, and outcomes in elderly Hispanic patients. METHOD Elderly patients with asthma receiving primary care at clinics in New York City and Chicago were studied. RESULTS Of 268 patients in the study, 68% were non-Hispanic, 18% English-proficient Hispanic, and 14% Hispanic with limited English proficiency. Unadjusted analyses showed that Hispanic persons with limited English proficiency had worse asthma control (P = .0007), increased likelihood of inpatient visits (P = .002), and poorer quality of life (P < .0001). We also found significant associations between limited English proficiency and poorer medication adherence (P = .006). Similar results were obtained in multiple regression analyses adjusting for demographics, asthma history, comorbidities, depression, and health literacy. CONCLUSION Limited English proficiency was associated with poorer self-management and worse outcomes among elderly patients with asthma. Further understanding of mechanisms underlying this relationship is necessary to develop interventions that improve asthma outcomes in this vulnerable population.
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Affiliation(s)
- Juan P Wisnivesky
- Division of General Internal Medicine, Mount Sinai School of Medicine, New York, New York, USA.
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Santus P, Picciolo S, Proietto A, Falcone F, Mangiacavallo A, Pellegrino G, Sereno F, Radovanovic D, Blasi F, Girbino G, Centanni S. Doctor-patient relationship: a resource to improve respiratory diseases management. Eur J Intern Med 2012; 23:442-6. [PMID: 22726373 DOI: 10.1016/j.ejim.2012.04.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 04/05/2012] [Accepted: 04/09/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND Many respiratory diseases are chronic conditions that are strongly linked with the patient-physician relationship, disease perception and therapy adherence. The aim of the present study was to evaluate patient's viewpoint about the different aspects involved in their respiratory diseases. METHODS This is a prospective observational survey. 46 Italian medical centres were involved and equally distributed. The interviews were carried out and were performed by means of a questionnaire which consisted of 32 questions regarding lung disease, modality of access to medical facilities, therapy and level of medical assistance. RESULTS 1116 patients were enrolled and the most important respiratory symptoms referred were: dyspnoea (69%), chronic phlegm (28%), cough (13%). During programmed visits 98.3% and 98.8% of interviewed patients knew were aware of asthma and COPD respectively, percentage that dropped, during emergency accesses, to 1.7% and 1.1% knew to have asthma and COPD respectively. Primarily were prescribed 1.67 spirometry/patient/year while only the 2% of patients referred to have performed a blood gas analysis. The 18% of patients spontaneously discontinued the therapy, considering it too complex. The average time that patients identified as being used by the doctor to perform the visit was of 22 minutes, with an high mean medical assistance satisfaction score. DISCUSSION There has been little research examining what factors may influence patient acceptance and participation of chronic respiratory diseases. Our national survey demonstrated that a good patient-physician relationship represents one of the first points in the successful management of respiratory diseases.
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Affiliation(s)
- Pierachille Santus
- Università degli Studi di Milano, Diaprtimento di Scienze della Salute, Pneumologia Riabilitativa, Fondazione Salvatore Maugeri, Istituto Scientifico di Riabilitazione di Milano IRCCS, Via Camaldoli 64, 20138 Milano, Italy.
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Garbutt JM, Highstein G, Yan Y, Strunk RC. Partner randomized controlled trial: study protocol and coaching intervention. BMC Pediatr 2012; 12:42. [PMID: 22469168 PMCID: PMC3352109 DOI: 10.1186/1471-2431-12-42] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Accepted: 04/02/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many children with asthma live with frequent symptoms and activity limitations, and visits for urgent care are common. Many pediatricians do not regularly meet with families to monitor asthma control, identify concerns or problems with management, or provide self-management education. Effective interventions to improve asthma care such as small group training and care redesign have been difficult to disseminate into office practice. METHODS AND DESIGN This paper describes the protocol for a randomized controlled trial (RCT) to evaluate a 12-month telephone-coaching program designed to support primary care management of children with persistent asthma and subsequently to improve asthma control and disease-related quality of life and reduce urgent care events for asthma care. Randomization occurred at the practice level with eligible families within a practice having access to the coaching program or to usual care. The coaching intervention was based on the transtheoretical model of behavior change. Targeted behaviors included 1) effective use of controller medications, 2) effective use of rescue medications and 3) monitoring to ensure optimal control. Trained lay coaches provided parents with education and support for asthma care, tailoring the information provided and frequency of contact to the parent's readiness to change their child's day-to-day asthma management. Coaching calls varied in frequency from weekly to monthly. For each participating family, follow-up measurements were obtained at 12- and 24-months after enrollment in the study during a telephone interview. The primary outcomes were the mean change in 1) the child's asthma control score, 2) the parent's quality of life score, and 3) the number of urgent care events assessed at 12 and 24 months. Secondary outcomes reflected adherence to guideline recommendations by the primary care pediatricians and included the proportion of children prescribed controller medications, having maintenance care visits at least twice a year, and an asthma action plan. Cost-effectiveness of the intervention was also measured. DISCUSSION Twenty-two practices (66 physicians) were randomized (11 per treatment group), and 950 families with a child 3-12 years old with persistent asthma were enrolled. A description of the coaching intervention is presented.
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Affiliation(s)
- Jane M Garbutt
- Department of Pediatrics, Division of Allergy and Pulmonary Medicine, Washington University, St Louis, MO 63110, USA.
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Turner-Bowker DM, Saris-Baglama RN, DeRosa MA, Giovannetti ER, Jensen RE, Wu AW. A computerized adaptive version of the SF-36 is feasible for clinic and Internet administration in adults with HIV. AIDS Care 2012; 24:886-96. [PMID: 22348336 DOI: 10.1080/09540121.2012.656573] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
DYNHA SF-36 is a computerized adaptive test version of the SF-36 Health Survey. The feasibility of administering a modified DYNHA SF-36 to adults with HIV was evaluated with Johns Hopkins University Moore (HIV) Clinic patients (N=100) and Internet consumer health panel members (N=101). Participants completed the DYNHA SF-36, modified to capture seven health domains [(physical function (PF), role function (RF, without physical or emotional attribution), bodily pain (BP), general health, vitality (VT), social function (SF), mental health (MH)], and scored to produce two summary components [Physical Component Summary (PCS), Mental Component Summary (MCS)]. Item-response theory-based response consistency, precision, mean scores, and discriminant validity were examined. A higher percentage of Internet participants responded consistently to the DYNHA SF-36. For each domain, three standard deviations were covered with five items (90% reliability); however, RF and SF scores were less precise at the upper end of measurement (better functioning). Mean scores were slightly higher for the Internet sample, with the exception of VT and MCS. Clinic and Internet participants reporting an AIDS diagnosis had significantly lower mean PCS and PF scores than those without a diagnosis. Additionally, significantly lower RF and BP scores were found for Internet participants reporting an AIDS diagnosis. The measure was well accepted by the majority of participants, although Internet respondents provided lower ratings for the tool's usefulness. The DYNHA SF-36 has promise for measuring the impact of HIV and its treatment in both the clinic setting and through telemonitoring.
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Ellington L, Reblin M, Clayton MF, Berry P, Mooney K. Hospice nurse communication with patients with cancer and their family caregivers. J Palliat Med 2012; 15:262-8. [PMID: 22339285 DOI: 10.1089/jpm.2011.0287] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Effective communication by hospice nurses enhances symptom management for the patient, reduces family caregiver burden and distress, and potentially improves bereavement adjustment. However, research has not kept pace with the rising use of hospice by patients with cancer and thus we know little about how hospice nurses communicate. METHODS The overriding objective of this pilot study was to provide insight into these in-home visits. Hospice nurses audiorecorded their interactions over time with family caregivers and patients with cancer. The communication within these tapes was coded using Roter Interaction Analysis System (RIAS) and analyzed. RESULTS We found that tape recording home hospice nurse visits was feasible. RIAS was suited to capture the general content and process of the home hospice encounter and the coded interactions show the range of topics and emotions that are evident in the dialogue. Implications and future directions for research are discussed.
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Affiliation(s)
- Lee Ellington
- College of Nursing, University of Utah, Salt Lake City, Utah 84112, USA.
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Jean-Jacques M, Persell SD, Thompson JA, Hasnain-Wynia R, Baker DW. Changes in disparities following the implementation of a health information technology-supported quality improvement initiative. J Gen Intern Med 2012; 27:71-7. [PMID: 21892661 PMCID: PMC3250541 DOI: 10.1007/s11606-011-1842-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Revised: 07/01/2011] [Accepted: 08/05/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Health information technology (HIT)-supported quality improvement initiatives have been shown to increase ambulatory care quality for several chronic conditions and preventive services, but it is not known whether these types of initiatives reduce disparities. OBJECTIVES To examine the effects of a multifaceted, HIT-supported quality improvement initiative on disparities in ambulatory care. DESIGN Time series models were used to assess changes in racial disparities in performance between white and black patients for 17 measures of chronic disease and preventive care from February 2008 through February 2010, the first 2 years after implementation of a HIT-supported, provider-directed quality improvement initiative. PATIENTS Black and white adults receiving care in an academic general internal medicine practice in Chicago. INTERVENTIONS The quality improvement initiative used provider-directed point-of-care clinical decision support tools and quality feedback to target improvement in process of care and intermediate outcome measures for coronary heart disease, heart failure, hypertension, and diabetes as well as receipt of several preventive services. MAIN MEASURES Modeled rate of change in performance, stratified by race and modeled rate of change in disparities for 17 ambulatory care quality measures KEY RESULTS Quality of care improved for 14 of 17 measures among white patients and 10 of 17 measures among black patients. Quality improved for both white and black patients for five of eight process of care measures, four of five preventive services, but none of the four intermediate outcome measures. Of the seven measures with racial disparities at baseline, disparities declined for two, remained stable for four, and increased for one measure after implementation of the quality improvement initiative. CONCLUSIONS Generalized and provider-directed quality improvement initiatives can decrease racial disparities for some chronic disease and preventive care measures, but achieving equity in areas with persistent disparities will require more targeted, patient-directed, and systems-oriented strategies.
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Affiliation(s)
- Muriel Jean-Jacques
- Division of General Internal Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
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Huang JS, Gottschalk M, Pian M, Dillon L, Barajas D, Bartholomew LK. Transition to adult care: systematic assessment of adolescents with chronic illnesses and their medical teams. J Pediatr 2011; 159:994-8.e2. [PMID: 21784450 PMCID: PMC3215794 DOI: 10.1016/j.jpeds.2011.05.038] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Revised: 04/29/2011] [Accepted: 05/19/2011] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To examine the process of transition from pediatric to adult health care services from the perspectives of young adults with chronic disease and both pediatric and adult health care providers. STUDY DESIGN A qualitative approach using focus-group interviews was performed to investigate transition experiences. Novel games were also used to generate data. Content and narrative analyses of interview transcripts were performed. RESULTS We conducted 6 focus groups with 10 young adults who had chronic disease and with 24 health care providers. Content analysis yielded 3 content domains: (1) transition experiences in the context of relationships among patients, parents, and health care providers; (2) differences between pediatric and adult-oriented medicine and how these differences inhibit or facilitate transition; and (3) identification of transition services that should be provided to young patients who have chronic disease. CONCLUSION This study demonstrates the need for gradual transfer of disease management from parent to child and the need for better communication between adult and pediatric services during the transition process. Pediatric medicine and adult medicine represent different subcultures; acknowledging these differences may improve cooperation during transition from pediatric to adult providers. Young-adult patients with chronic disease embrace the use of technology for specific interventions to improve the transition experience.
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Affiliation(s)
- Jeannie S Huang
- Department of Pediatrics, University of California, San Diego, La Jolla, CA 92103, USA.
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Sleath B, Ayala GX, Washington D, Davis S, Williams D, Tudor G, Yeatts K, Gillette C. Caregiver rating of provider participatory decision-making style and caregiver and child satisfaction with pediatric asthma visits. PATIENT EDUCATION AND COUNSELING 2011; 85:286-9. [PMID: 20971603 PMCID: PMC3070191 DOI: 10.1016/j.pec.2010.09.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2010] [Revised: 09/14/2010] [Accepted: 09/25/2010] [Indexed: 05/04/2023]
Abstract
OBJECTIVE The purpose of this study was to examine the relationship between caregiver ratings of provider use of a participatory decision-making style and caregiver and child satisfaction with their pediatric asthma visits. METHODS Children ages 8 through 16 with persistent asthma and their caregivers were recruited at five pediatric practices. Children were interviewed and caregivers completed questionnaires after their child's medical visits. Generalized estimating equations were used to analyze the data. RESULTS Three hundred and twenty children were recruited. Caregivers were significantly more satisfied with providers who they perceived as using more of a participatory decision-making style (beta=17.80, p<0.001). Children (beta=-0.10, p<0.05) and caregivers (beta=-0.21, p<0.01) were significantly more satisfied with younger providers. Children were significantly more satisfied with providers who knew them better as a person (beta=2.87, p<0.001). CONCLUSIONS Caregivers were more satisfied with providers who they perceived as involving them more during treatment decisions made during pediatric asthma visits. PRACTICE IMPLICATIONS Providers should attempt to use a more participatory decision-making style with families during pediatric asthma visits.
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Affiliation(s)
- Betsy Sleath
- Division of Pharmaceutical Outcomes & Policy, University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Chapel Hill, NC 27599-7573, USA.
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Qamar N, Pappalardo AA, Arora VM, Press VG. Patient-centered care and its effect on outcomes in the treatment of asthma. Patient Relat Outcome Meas 2011; 2:81-109. [PMID: 22915970 PMCID: PMC3417925 DOI: 10.2147/prom.s12634] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Indexed: 11/23/2022] Open
Abstract
Patient-centered care may be pivotal in improving health outcomes for patients with asthma. In addition to increased attention in both research and clinical forums, recent legislation also highlights the importance of patient-centered outcomes research in the Patient Protection and Affordable Care Act. However, whether patient-centered care has been shown to improve outcomes for this population is unclear. To answer this question, we performed a systematic review of the literature that aimed to define current patient-focused management issues, characterize important patient-defined outcomes in asthma control, and identify current and emerging treatments related to patient outcomes and perspectives. We used a parallel search strategy via Medline(®), Cochrane Central Register of Controlled Trials, CINAHL(®) (Cumulative Index to Nursing and Allied Health Literature), and PsycINFO(®), complemented with a reference review of key articles that resulted in a total of 133 articles; 58 were interventions that evaluated the effect on patient-centered outcomes, and 75 were descriptive studies. The majority of intervention studies demonstrated improved patient outcomes (44; "positive" results); none showed true harm (0; "negative"); and the remainder were equivocal (14; "neutral"). Key themes emerged relating to patients' desires for asthma knowledge, preferences for tailored management plans, and simplification of treatment regimens. We also found discordance between physicians and patients regarding patients' needs, beliefs, and expectations about asthma. Although some studies show promise regarding the benefits of patient-focused care, these methods require additional study on feasibility and strategies for implementation in real world settings. Further, it is imperative that future studies must be, themselves, patient-centered (eg, pragmatic comparative effectiveness studies) and applicable to a variety of patient populations and settings. Despite the need for further research, enough evidence exists that supports incorporating a patient-centered approach to asthma management, in order to achieve improved outcomes and patient health.
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Affiliation(s)
- Nashmia Qamar
- Pediatric Residency Program, University of Chicago Medical Center, Chicago, IL, USA
| | - Andrea A Pappalardo
- Internal Medicine-Pediatric Residency Program, University of Chicago Medical Center, Chicago, IL, USA
| | - Vineet M Arora
- Section of General Internal Medicine, Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA
| | - Valerie G Press
- Section of Hospital Medicine, Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA
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Lu WH, Deen D, Rothstein D, Santana L, Gold MR. Activating Community Health Center Patients in Developing Question-Formulation Skills. HEALTH EDUCATION & BEHAVIOR 2011; 38:637-45. [DOI: 10.1177/1090198110393337] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The authors developed and delivered a brief patient activation intervention (PAI) that sought to facilitate physician–patient communication. The intervention was designed to assist low-income, racial/ethnic minority users of community health centers in building skills and confidence asking questions. The PAI takes 8 to 10 minutes to deliver and consists of five steps that can be carried out by individuals with minimal formal medical training. A total of 252 patients waiting to see their physician participated in the intervention and completed the follow-up semistructured interview after their health care visit. The authors describe the intervention and the results of their qualitative evaluation of patient’s responses. Overall, the PAI was valued by patients, appeared to add to patients’ satisfaction with the health care they received, and was feasible to implement in the primary care setting. Furthermore, findings from this study provide indirect insight regarding factors that influence minority patient’s question-asking behavior that include patient’s attitudes, social factors, and patient’s self-efficacy in question formulation.
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Affiliation(s)
- Wei-Hsin Lu
- Stony Brook University, Stony Brook, NY, USA
| | - Darwin Deen
- The City College of New York, New York, NY, USA
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Uhlenhake EE, Kurkowski D, Feldman SR. Conversations on psoriasis--what patients want and what physicians can provide: a qualitative look at patient and physician expectations. J DERMATOL TREAT 2010; 21:6-12. [PMID: 19579071 DOI: 10.3109/09546630903085328] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The role of the patient-physician relationship is a key issue in the management of lifelong, chronic conditions such as psoriasis, with each side bringing different perspectives. OBJECTIVE To explore areas of congruence and disconnection in the relationship between psoriasis patients and dermatologists, with a focus on communication issues. METHODS Three discussion group sessions were held in four centers across the United States with dermatologists, patients, and a follow-up of the dermatologists after watching the patient discussion. RESULTS Patients want more information on psoriasis, fast treatments, clear expectations from the onset of therapy, and recognition of the emotional burden. Dermatologists found that patients do not receive or internalize adequate information and need further explanation of treatment regimens to increase compliance and patient satisfaction. LIMITATIONS This was a qualitative study assessing the range of responses and was not a quantitative study designed to test specific hypotheses. The study may not be informative about the experiences of people with psoriasis not actively seeing a physician. CONCLUSIONS Encounters between physicians and psoriasis patients can be enhanced by providing information on what psoriasis is, choosing fast-acting treatments that patients are willing to use, and providing written materials about the disease and treatment plan.
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Affiliation(s)
- Elizabeth E Uhlenhake
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1071, USA.
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Peek ME, Odoms-Young A, Quinn MT, Gorawara-Bhat R, Wilson SC, Chin MH. Race and shared decision-making: perspectives of African-Americans with diabetes. Soc Sci Med 2010; 71:1-9. [PMID: 20409625 DOI: 10.1016/j.socscimed.2010.03.014] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2008] [Revised: 09/23/2009] [Accepted: 03/01/2010] [Indexed: 11/25/2022]
Abstract
Shared decision-making (SDM) is an important component of patient-centered healthcare and is positively associated with improved health outcomes (e.g. diabetes and hypertension control). In shared decision-making, patients and physicians engage in bidirectional dialogue about patients' symptoms and treatment options, and select treatment plans that address patient preferences. Existing research shows that African-Americans experience SDM less often than whites, a fact which may contribute to racial disparities in diabetes outcomes. Yet little is known about the reasons for racial disparities in shared decision-making. We explored patient perceptions of how race may influence SDM between African-American patients and their physicians. We conducted in-depth interviews (n=24) and five focus groups (n=27) among a purposeful sample of African-American diabetes patients aged over 21 years, at an urban academic medical center in Chicago. Each interview/focus group was audio-taped, transcribed verbatim and imported into Atlas.ti software. Coding was conducted iteratively; each transcription was independently coded by two research team members. Although there was heterogeneity in patients' perceptions about the influence of race on SDM, in each of the SDM domains (information-sharing, deliberation/physician recommendations, and decision-making), participants identified a range of race-related issues that may influence SDM. Participants identified physician bias/discrimination and/or cultural discordance as issues that may influence physician-related SDM behaviors (e.g. less likely to share information such as test results and more likely to be domineering with African-American patients). They identified mistrust of white physicians, negative attitudes and internalized racism as patient-related issues that may influence African-American patients' SDM behaviors (e.g. less forthcoming with physicians about health information, more deference to physicians, less likely to adhere to treatment regimens). This study suggests that race-related patient and physician-related barriers may serve as significant barriers to shared decision-making between African-American patients and their physicians. Finding innovative ways to address such communication barriers is an important area of future research.
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Affiliation(s)
- Monica E Peek
- The University of Chicago, Department of Medicine, 5841 S. Maryland Avenue, MC 2007, Chicago, IL 60637, USA.
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Eldh AC, Ekman I, Ehnfors M. A Comparison of the Concept of Patient Participation and Patients' Descriptions as Related to Healthcare Definitions. ACTA ACUST UNITED AC 2010; 21:21-32. [DOI: 10.1111/j.1744-618x.2009.01141.x] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Arora NK, Weaver KE, Clayman ML, Oakley-Girvan I, Potosky AL. Physicians' decision-making style and psychosocial outcomes among cancer survivors. PATIENT EDUCATION AND COUNSELING 2009; 77:404-12. [PMID: 19892508 PMCID: PMC3401045 DOI: 10.1016/j.pec.2009.10.004] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2009] [Accepted: 10/05/2009] [Indexed: 05/09/2023]
Abstract
OBJECTIVE We evaluated pathways linking physicians' decision-making style with cancer survivors' health-related quality of life (HRQOL). METHODS We analyzed survey data from 623 survivors diagnosed with leukemia, colorectal, or bladder cancer in Northern California, 2-5 years prior to the study. Of these, 395 reported making a medical decision in the past 12 months and were asked about their physician's decision-making style. We evaluated the association of physician style with proximal communication outcomes (trust and participation self-efficacy), intermediate cognitive outcomes (perceived control and uncertainty), and distal health outcomes (physical and mental HRQOL). RESULTS Overall, 54% of survivors reported a sub-optimal decision-making style for their physician. With the exception of physical health, physician style was associated with all proximal, intermediate, and distal outcomes (p< or =0.01). We identified two significant pathways by which a participatory physician style may be associated with survivors' mental health: (1) by increasing survivors' participation self-efficacy and thereby enhancing their perceptions of personal control (p<0.01); (2) by enhancing survivors' level of trust and thereby reducing their perceptions of uncertainty (p<0.05). CONCLUSION A participatory physician style may improve survivors' mental health by a complex two-step mechanism of improving survivors' proximal communication and intermediate cognitive outcomes. PRACTICE IMPLICATIONS Physicians who adopt a participatory decision-making style are likely to facilitate patient empowerment and enhance patients' HRQOL.
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Affiliation(s)
- Neeraj K Arora
- Outcomes Research Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 6130 Executive Blvd, MSC 7344, EPN 4092, Bethesda, MD 20892-7344, USA.
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Heisler M, Tierney E, Ackermann RT, Tseng C, Narayan KMV, Crosson J, Waitzfelder B, Safford MM, Duru K, Herman WH, Kim C. Physicians' participatory decision-making and quality of diabetes care processes and outcomes: results from the triad study. Chronic Illn 2009; 5:165-76. [PMID: 19675116 PMCID: PMC3782289 DOI: 10.1177/1742395309339258] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES In participatory decision-making (PDM), physicians actively engage patients in treatment and other care decisions. Patients who report that their physicians engage in PDM have better disease self-management and health outcomes. We examined whether physicians' diabetes-specific treatment PDM preferences as well as their self-reported practices are associated with the quality of diabetes care their patients receive. METHODS 2003 cross-sectional survey and medical record review of a random sample of diabetes patients (n=4198) in 10 US health plans across the country and their physicians (n=1217). We characterized physicians' diabetes care PDM preferences and practices as 'no patient involvement,' 'physician-dominant,' 'shared,' or 'patient-dominant' and conducted multivariate analyses examining their effects on the following: (1) three diabetes care processes (annual hemoglobin A1c test; lipid test; and dilated retinal exam); (2) patients'satisfaction with physician communication; and (3) whether patients' A1c, systolic blood pressure (SBP), and low-density lipoprotein cholesterol (LDL) were in control. RESULTS Most physicians preferred 'shared' PDM (58%) rather than 'no patient involvement' (9%), 'physician-dominant' (28%) or 'patient dominant' PDM (5%). However, most reported practicing 'physician-dominant' PDM (43%) with most of their patients, rather than 'no patient involvement' (13%), 'shared' (37%) or 'patient-dominant' PDM (7%). After adjusting for patient and physician-level characteristics and clustering by health plan, patients of physicians who preferred 'shared' PDM were more likely to receive A1c tests [90% vs. 82%, AOR: 2.05, 95% CI: 1.03-3.07] and patients of physicians who preferred 'patient-dominant' treatment decision-making were more likely to receive lipid tests [60% vs. 50%, AOR: 1.58, 95% CI: 1.04-2.39] than those of providers who preferred 'no patient involvement' in treatment decision-making. There were no differences in patients' satisfaction with their doctor's communication or control of A1c, SBP or LDL depending on their physicians' PDM preferences. Physicians' self-reported PDM practices were not associated with any of the examined aspects of diabetes care in multivariate analyses. CONCLUSIONS Patients whose physicians prefer more patient involvement in decision-making are more likely than patients whose physicians prefer more physician-directed styles to receive some recommended risk factor screening tests, an important first step toward improved diabetes outcomes. Involving patients in treatment decision-making alone, however, appears not to be sufficient to improve biomedical outcomes.
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Affiliation(s)
- M Heisler
- Veterans Affairs Center for Practice Management and Outcomes Research, VA Ann Arbor Health System, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
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Pellatt GC. Patients, doctors, and therapists perceptions of professional roles in spinal cord injury rehabilitation: Do they agree? J Interprof Care 2009; 21:165-77. [PMID: 17365390 DOI: 10.1080/13561820701195567] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Spinal cord injury is a devastating condition, requiring extensive rehabilitation from a range of health care professionals. However, it is unclear if patients view the professionals' input into their rehabilitation in the same way as those professionals. This paper presents findings from a qualitative study into patient participation in spinal cord injury rehabilitation. The aim of the part of the study reported here was to identify whether there is agreement between health care professionals and patients perceptions of professional roles in spinal cord injury rehabilitation. Results are presented from semi-structured interviews conducted with five doctors, five physiotherapists, three occupational therapists and 20 patients in a spinal cord injury unit in England. Findings suggest considerable agreement between professionals and patients about the role those professionals play in their rehabilitation. Physiotherapists are perceived to be key to rehabilitation, occupational therapists focus on hand function but physiotherapists and occupational therapists complement each other. Doctors coordinate the team yet reduce their input as patients move out of the acute phase into rehabilitation. There are some tensions but the early input of these professionals into patients' rehabilitation may help to develop understanding of roles. Congruence between patients and professionals may mean that patients have realistic expectations and encourage a more equal relationship between them.
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Affiliation(s)
- Glynis Collis Pellatt
- Faculty of Health and Social Science, University of Bedfordshire, Aylesbury Vale Education Centre, Stoke Mandeville Hospital, Aylesbury, UK.
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