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Alkhaibari RA, Smith-Merry J, Forsyth R. "I am not just a place for implementation. I should be a partner": a qualitative study of patient-centered care from the perspective of diabetic patients in Saudi Arabia. BMC Health Serv Res 2023; 23:1412. [PMID: 38098092 PMCID: PMC10722796 DOI: 10.1186/s12913-023-10391-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 11/28/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION Patient involvement in care is a major component of high quality of care and is becoming recognized worldwide with many beneficial for improving patient outcomes. However, a little is known about patient involvement in the Middle East region and Saudi Arabia in particular. OBJECTIVES To evaluate patients' perceptions of their involvement during their interactions with healthcare providers in Saudi Arabia. METHODS A qualitative exploratory study using semi structured interview was conducted from February 2022 to March 2022. Responses were transcribed and analyzed using a thematic analysis approach. RESULTS We conducted seven interviews with patients with diabetes ranging in age from 19 to 69 years old. We identified the following themes:1) patients' perceptions of their involvement in care, 2) barriers to patient involvement, 3) effective communication, 4) empathy, and 5) culture. We found that patients had minimal knowledge of patient involvement in care. CONCLUSION There is a clear need to improve education and awareness of patient involvement in Saudi Arabia. By educating patients about the possibilities of patient involvement and explaining their role it will make it easier for patients to understand appropriate levels of involvement. In addition, there is a need to understand the patient-centred care culture in Saudi Arabia through establishing frameworks with the focus on culture and patient-centred healthcare delivery.
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Affiliation(s)
- Reeham Ahmed Alkhaibari
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, NSW, Australia.
- College of Nursing, Taif University, Taif, Saudi Arabia.
| | - Jennifer Smith-Merry
- Centre for Disability Research and Policy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Rowena Forsyth
- Cyberpsychology Research Group, Biomedical Informatics and Digital Health Theme, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Rahaman RR, Motilal MS, Khan R, Maharaj RG. Are primary care consultations in Trinidad patient-centered? A cross-sectional study of patients with non-communicable diseases. BMC PRIMARY CARE 2023; 24:215. [PMID: 37865738 PMCID: PMC10589933 DOI: 10.1186/s12875-023-02149-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/03/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND The aim of this study was to measure the patient's perception of patient centeredness in their consultations for non-communicable diseases (NCDs). We also measured consultation length and patient enablement. METHOD A cross-sectional study was conducted over 2 months at four primary care clinics at the St. Joseph cluster of the North Central Regional Health Authority (NCRHA) in Trinidad and Tobago. Interviewers timed the consultation and completed post-consultation questionnaires using the Patient Perception of Patient-Centeredness (PPPC) questionnaire and the Patient Enablement Index (PEI). The PPPC is a 14-item (each scored 1-4) Likert-scaled instrument. The total score is averaged and a PPPC score of 4 is the maximum. The PEI measures the ability of the patient to cope with life and their disease. The PEI consists of 6 questions scored 0-2, with a maximum score of 12. RESULTS There were 180 respondents (response rate = 82.5%). Participants were female (75.6%), aged over 65 years (50.6%), married (51.1%), Indo-Trinidadian (52.2%), and Christian (60.6%). Half achieved a primary school education, and 37.2% secondary. The consultation length ranged between 1.32 and 31.22 min. The average, median and mode of the consultation length were 8.5, 7.74 and 10 min, respectively. The average, median and mode of the measures of patient-centeredness were PPPC (3.67, 3.86 and 4) and PEI score (5.93, 6 and 6). The PPPC average was lower in patients with a stroke (p = 0.022), and higher among those with more than 2 consultation interruptions (p = 0.015) and those who knew the doctor very well (p = 0.015). The PEI score was lower in patients with heart disease (p = 0.022). The consultation length was longer in those with tertiary education (p = 0.044) and those with two consultation interruptions (p = 0.032). PPPC Average and PEI Score correlated well (ρ = 0.408, p < 0.001). The consultation length correlated with the PPPC Average (ρ = 0.168,p = 0.025). CONCLUSION Primary Care consultations in this cluster of health centres in NCRHA in Trinidad were often patient centered. The consultation length, patient-centeredness, measured with the PPPC instrument, and patient enablement scores, measured with the PEI instrument, in consultations for NCDs in Trinidad compare favourably with international reports.
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Affiliation(s)
- Reisa R Rahaman
- Faculty of Medical Sciences, Department of Paraclinical Sciences, The University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad
| | - M Shastri Motilal
- Faculty of Medical Sciences, Department of Paraclinical Sciences, The University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad
| | - Raveed Khan
- Faculty of Medical Sciences, Department of Paraclinical Sciences, The University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad
| | - Rohan G Maharaj
- Faculty of Medical Sciences, Department of Paraclinical Sciences, The University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad.
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Koster ES, Philbert D. Communication and relationship building in pharmacy education: Experiences from a student-patient buddy project. CURRENTS IN PHARMACY TEACHING & LEARNING 2023:S1877-1297(23)00072-2. [PMID: 37160409 DOI: 10.1016/j.cptl.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 02/17/2023] [Accepted: 04/16/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND AND PURPOSE In order to deliver patient-centred pharmaceutical care, pharmacy students need to develop the appropriate competences and skills. During their regular study program, they have limited long-term patient contact. We therefore implemented a student-patient buddy project to give students opportunity to practice and learn from the patient contact. EDUCATIONAL ACTIVITY AND SETTING A student-patient buddy project was implemented in a 10-week first-year master experiential learning course, including a community pharmacy internship. The pharmacist paired the student with a community-dwelling patient. Student learning activities included: (1) three meetings at the university to prepare and discuss buddy contact moments, (2) three buddy contact moments, (3) discussion with the internship providing pharmacist, and (4) a written reflection report. FINDINGS In total, 66 students participated from April to June 2021. Most students found patient contact fun and a useful learning experience. Students mentioned that patients were very open and there was opportunity to build a relationship. The first conversation was experienced as exciting and sometimes difficult. Understanding the person was perceived as important. Internship pharmacists were positive about the project and saw learning benefits for students, as well as added value for the pharmacy, mainly because patients seemed to appreciate the contact. SUMMARY A student-patient buddy project is a good way to expand the limited long-term "real" patient care experiences of pharmacy students. This enables them to practice communication and building relationships with patients.
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Affiliation(s)
- E S Koster
- Utrecht University, Utrecht Institute of Pharmaceutical Sciences, Division of Pharmacoepidemiology and Clinical Pharmacology, PO Box 80082, 3508, TB, Utrecht, the Netherlands.
| | - D Philbert
- Utrecht University, Utrecht Institute of Pharmaceutical Sciences, Division of Pharmacoepidemiology and Clinical Pharmacology, PO Box 80082, 3508, TB, Utrecht, the Netherlands.
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Identifying the value of a clinical information system during the COVID-19 pandemic. TECHNOVATION 2023; 120:102446. [PMCID: PMC8702406 DOI: 10.1016/j.technovation.2021.102446] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 12/14/2021] [Accepted: 12/17/2021] [Indexed: 08/03/2023]
Abstract
The COVID-19 pandemic has significantly augmented the urgency for service providers to identify and develop clinically urgent system alterations into healthcare systems to facilitate antibody testing and treatment interventions. However, it has been difficult to determine how users assess the value of an information system in terms of its functionality and features. Conversely, the system development process to address urgent user requirements, for example, developing new functionality for COVID antibody testing, has been beset by a myriad of difficulties as research to understand the value of specific aspects of clinical information systems has been elusive. This study addresses this knowledge gap by identifying specific aspects of a national clinical information system in Wales, UK. Through a series of semi-structured interviews, a quantitative study of 559 clinical users and a focus group, the study deconstructs system-related value into 14 unique attributes that have been found to vary according to different types of user roles and geographic location. Attribution theory is identified in this study as a novel and effective way to study this multifaceted concept of system value. The identification of component attributes of the value of a clinical information system provides insights for service users, system developers, and organization managers to prioritize and focus their system development activity by using an importance ranking identified through this study.
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The association between patients' illness perceptions and longitudinal clinical outcome in patients with low back pain. Pain Rep 2022; 7:e1004. [PMID: 35505791 PMCID: PMC9049027 DOI: 10.1097/pr9.0000000000001004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 01/16/2023] Open
Abstract
Initial perceptions regarding prognosis and treatment effects were prominent perceptions explaining longitudinal outcomes in patients with low back pain, including explaining patients' development of self-management strategies. Introduction: Illness perception is suggested to influence outcome in patients with low back pain (LBP). It is unknown if specific illness perceptions are of more importance for longitudinal outcomes, including development of self-management strategies. Objectives: This study explores whether patients' initial illness perceptions were associated with disability, pain, health-related quality of life, and self-care enablement outcomes in patients with LBP after 3 and 12 months. Methods: Four hundred sixty-seven consecutive patients seeking physiotherapeutic primary care for LBP were eligible to participate in this prospective cohort study, providing data at baseline and after 3 and 12 months (mean age 45 years, 56% women). Multiple linear regression analysis was used to explore whether patients' illness perceptions at baseline were associated with outcome in the Oswestry Disability Index (ODI), Numeric Rating Scale–LBP (NRS-LBP), EuroQol Five Dimensions, and Patient Enablement Instrument (PEI). Results: Stronger beliefs that the back problem will last a long time at baseline were associated with worse outcome in ODI, NRS-LBP, and PEI at 3 and 12 months and in EuroQol Five Dimensions at 12 months. Negative beliefs regarding treatment's ability to improve LBP were associated with worse outcome in NRS-LBP and PEI at 3 and 12 months and in ODI at 12 months. Conclusions: Illness perceptions regarding prognosis and treatment's ability to improve symptoms were the most prominent perceptions explaining several longitudinal clinical outcomes. These expectations should be addressed in an early stage in the delivery of interventions for LBP. These expectations were also important for patients' development of coping and self-management strategies.
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Olson AW, Isetts BJ, Stratton TP, Vaidyanathan R, Hager KD, Schommer JC. Addressing Hidden Curricula That Subvert the Patient-Centeredness "Hub" of the Pharmacists' Patient Care Process "Wheel". AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2022; 86:ajpe8665. [PMID: 34301574 PMCID: PMC8887054 DOI: 10.5688/ajpe8665] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 06/23/2021] [Indexed: 05/22/2023]
Abstract
Objective. This systematic review's purpose is to improve clarity for the meaning of patient-centered care in the JCPP Pharmacists' Patient Care Process and to provide an initial foothold for faculty to address "hidden curricula" that undermine the concept. Our corresponding objectives were to identify and describe the conceptualizations defining patient-centered care from the pharmacy literature; and compare the meaning of patient-centeredness in the pharmacy literature with the construct's seminal conceptualizations from other professional groups.Findings. The search protocol produced 61 unique sources from the pharmacy literature. More than two-thirds of these results lacked precise use of terminology consistent with the literature or operational depth or theoretical exploration of the term's meaning. The remaining sources yielded two separate conceptualizations of patient-centeredness with three commonalities but key differences between their grounding in the construct's seminal sources in the broader health care literature.Summary. The pharmacy literature clarifies the meaning of patient-centered care in the patient-pharmacist encounter, but additional understanding is needed at meso- (ie, health care) and macro-levels (ie, legislation, accreditation, payment, workforce dynamics) of care. This expansion of understanding may reduce dissonance between the formal and hidden curricula on patient-centeredness associated with health professional student disillusionment, contempt for faculty and institutions, and reductions in empathy and ethics. Increasing use of integrative case-based training, equitably blending patient-centeredness considerations with other curricular content, represents one strategy for reducing the presence and negative impact of hidden curricula.
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Affiliation(s)
| | - Brian J Isetts
- University of Minnesota, College of Pharmacy, Minneapolis, Minnesota
| | | | - Rajiv Vaidyanathan
- University of Minnesota, Labovitz School of Business & Economics, Duluth, Minnesota
| | - Keri D Hager
- University of Minnesota, College of Pharmacy, Minneapolis, Minnesota
| | - Jon C Schommer
- University of Minnesota, College of Pharmacy, Minneapolis, Minnesota
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Stephen Ekpenyong M, Nyashanu M, Ossey-Nweze C, Serrant L. Exploring the perceptions of dignity among patients and nurses in hospital and community settings: an integrative review. J Res Nurs 2021; 26:517-537. [PMID: 35265158 PMCID: PMC8899300 DOI: 10.1177/1744987121997890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Patients have a right to be treated with dignity. However, reports have continually identified concerns regarding the quality of care and dignity in hospitals. Undignified care can have unfavourable impact on the patient’s recovery such as leading to depression and loss of will to live. The aim of this study was to explore dignity as perceived by patients and nurses within hospital and community environments. Methods An integrative review methodological approach was adopted. Nine databases including Medline, CINAHL plus with full text, Web of Science, Embase, Pubmed, Psycinfo, Scopus, Nursing and Allied Health Source, and Science Direct were systematically searched for relevant articles using a predetermined set of inclusion criteria. Articles were included if they were primary empirical studies, peer reviewed, published between 2008–2019, assessing patients’ or nurses’ perception of dignity outside the end-of-life context, conducted in one of the European countries and written in English. Included papers were analysed using constant comparative analysis. The preferred reporting system for systematic review and meta-analysis (Prisma) flow diagram was used for quality appraisal and review. Results Fourteen relevant articles were included in this review. Four overarching themes and 10 subthemes were identified as impacting on patient dignity. Overarching themes include autonomy, healthcare delivery factors, organisational factors and the meaning of dignity, whilst subthemes include dependence/independence, choice, staff attitudes, communication, privacy, structure of services, staff shortages, physical environment, respect and person-centred care. Conclusion There are a wide range of factors impacting on patient dignity. Adopting evidence-based interventions supported by adequate theoretical backing can help to enhance patient dignity in hospital and community settings.
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Affiliation(s)
| | - Mathew Nyashanu
- Health and Social Care/Public Health, Nottingham Trent University, UK
| | | | - Laura Serrant
- Head of Department of Nursing, Department of Nursing, Manchester Metropolitan University, UK
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Bicego A, Monseur J, Collinet A, Donneau AF, Fontaine R, Libbrecht D, Malaise N, Nyssen AS, Raaf M, Rousseaux F, Salamun I, Staquet C, Teuwis S, Tomasella M, Faymonville ME, Vanhaudenhuyse A. Complementary treatment comparison for chronic pain management: A randomized longitudinal study. PLoS One 2021; 16:e0256001. [PMID: 34358272 PMCID: PMC8345881 DOI: 10.1371/journal.pone.0256001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/24/2021] [Indexed: 11/18/2022] Open
Abstract
Background In chronic pain, it seems that the effect of cognitive-behavioral therapy (CBT) is boosted when it is combined with hypnosis. The aim of this study was to assess the efficacy of self-hypnosis combined with self-care (i.e., a type of CBT) compared to music/self-care, self-care and psychoeducation/CBT and to evaluate their long-term effects. Methods An open label randomized clinical trial enrolled patients with chronic pain and was carried out at the University Hospital of Liège (Belgium). Patients were randomized into four groups: self-hypnosis/self-care, music/self-care, self-care, psychoeducation/CBT (7 monthly sessions of 2 hours). Two follow-up sessions were delivered at 6- and 12-month. Levels of pain, fatigue intensity, anxiety, depression, insomnia severity, disability, health locus of control, mental and physical quality of life and attitudes (control, disability, harm, emotion, medical cure, medication, solicitude) towards pain were assessed before and after the treatments, and at follow-up. Results 203 patients were randomized: 52 in self-hypnosis/self-care, 59 in music/self-care, 47 in self-care, and 45 in psychoeducation/CBT. No group effect was found. A significant time effect was showed. Directly after the treatment, all groups decreased in pain attitudes and physical quality of life. Perceived control increased. At 6-month, all patients kept their levels of physical quality of life and perceived control, and showed decrease in pain intensity, harm, emotion and medical cure. At 12-month, scores that had change previously remained ameliorated, a decrease in insomnia severity and an increase in internal locus of control were observed. Conclusions The present findings are encouraging as they display long-term beneficial effects of complementary biopsychosocial-based treatments in chronic pain. It seems that patients continued to apply the learnt strategies as improvements were observed one year after the treatments had ended.
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Affiliation(s)
- Aminata Bicego
- Sensation and Perception Research Group, GIGA Consciousness, University of Liège, Liège, Belgium
- Cognitive Ergonomy and Work Intervention Department, University of Liège, Liège, Belgium
- * E-mail: (AB); (AV)
| | - Justine Monseur
- Public Health Department, Biostatistics, University of Liège, Liège, Belgium
| | | | | | - Robert Fontaine
- Interdisciplinary Algology Department, Hospital University of Liège, Liège, Belgium
| | - Dominique Libbrecht
- Interdisciplinary Algology Department, Hospital University of Liège, Liège, Belgium
| | - Nicole Malaise
- Interdisciplinary Algology Department, Hospital University of Liège, Liège, Belgium
| | - Anne-Sophie Nyssen
- Sensation and Perception Research Group, GIGA Consciousness, University of Liège, Liège, Belgium
- Cognitive Ergonomy and Work Intervention Department, University of Liège, Liège, Belgium
| | - Mélissa Raaf
- Interdisciplinary Algology Department, Hospital University of Liège, Liège, Belgium
| | - Floriane Rousseaux
- Sensation and Perception Research Group, GIGA Consciousness, University of Liège, Liège, Belgium
- Cognitive Ergonomy and Work Intervention Department, University of Liège, Liège, Belgium
| | - Irène Salamun
- Interdisciplinary Algology Department, Hospital University of Liège, Liège, Belgium
| | - Cécile Staquet
- Interdisciplinary Algology Department, Hospital University of Liège, Liège, Belgium
| | - Sandrine Teuwis
- Interdisciplinary Algology Department, Hospital University of Liège, Liège, Belgium
| | - Marco Tomasella
- Interdisciplinary Algology Department, Hospital University of Liège, Liège, Belgium
| | - Marie-Elisabeth Faymonville
- Sensation and Perception Research Group, GIGA Consciousness, University of Liège, Liège, Belgium
- Interdisciplinary Algology Department, Hospital University of Liège, Liège, Belgium
| | - Audrey Vanhaudenhuyse
- Sensation and Perception Research Group, GIGA Consciousness, University of Liège, Liège, Belgium
- Interdisciplinary Algology Department, Hospital University of Liège, Liège, Belgium
- * E-mail: (AB); (AV)
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Bedford LE, Yeung MHY, Au CH, Tse ETY, Yim WY, Yu EYT, Wong CKH, Lam CLK. The validity, reliability, sensitivity and responsiveness of a modified Patient Enablement Instrument (PEI-2) as a tool for serial measurements of health enablement. Fam Pract 2021; 38:339-345. [PMID: 32968812 PMCID: PMC8414911 DOI: 10.1093/fampra/cmaa102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Patient enablement is a core tenet of patient-centred and holistic primary care. The Patient Enablement Instrument (PEI) is a transitional measure limited in its ability to measure changes over time. A modified version, PEI-2, has been developed to measure enablement at a given time-point without comparison to a recalled baseline. OBJECTIVE To assess the validity, reliability, sensitivity and responsiveness of PEI-2. METHODS PEI-2 was modified from the Chinese PEI to assess enablement over 4 weeks in a prospective cohort study nested within a community support programme [Trekkers Family Enhancement Scheme (TFES)] in Hong Kong. Construct validity was assessed by factor analysis and convergent validity by Spearman's correlations with health-related quality of life and depressive symptoms. Internal reliability was assessed using Cronbach's alpha. Test-retest reliability was assessed by intraclass correlation (ICC), responsiveness by 12-24-month change in PEI-2 score and sensitivity by differences in change of PEI-2 score between TFES participants and a control group. RESULTS PEI-2 demonstrated construct validity with all items loading on one factor (factor loadings >0.7). Convergent validity was confirmed by significant correlations with 12-item Short Form Questionnaire, version 2 (r = 0.1089-0.1919) and Patient Health Questionnaire-9 (r = -0.2030). Internal reliability was high (Cronbach's alpha = 0.9095) and test-retest reliability moderate (ICC = 0.520, P = 0.506). Significant improvements in PEI-2 scores among the TFES group suggested good responsiveness (P < 0.001). The difference in change of PEI-2 scores between TFES and control was significant (P = 0.008), indicating good sensitivity. CONCLUSIONS This study supports the validity, reliability, sensitivity and responsiveness of PEI-2 in measuring changes in enablement, making it a promising tool for evaluating enablement in cohort and intervention studies.
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Affiliation(s)
- Laura Elizabeth Bedford
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China
| | - Maegan Hon Yan Yeung
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China
| | - Chi Ho Au
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China
| | - Emily Tsui Yee Tse
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China
| | - Wing Yee Yim
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China
| | - Esther Yee Tak Yu
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China
| | - Carlos King Ho Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China.,Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China
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Lawson HJO, Nortey DNN. Core Values of Family Physicians and General Practitioners in the African Context. Front Med (Lausanne) 2021; 8:667144. [PMID: 34136504 PMCID: PMC8200572 DOI: 10.3389/fmed.2021.667144] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 05/05/2021] [Indexed: 12/30/2022] Open
Abstract
Introduction: Family Medicine is a growing specialty in the medical world. While it is expected that the specialty should have its own unique and established core values and tasks, the breath of the practice in several countries of the world has made this a daunting task. Core values and Tasks have far reaching effects on professions. They guide development of curricula, methods of instruction, standards of performance and even the culture of the profession. We aimed to explore the core value system of Family Physicians and General Practitioners practicing in Africa. Methods: Using the Delphi technique, a purposive selection of African Family Medicine practitioners in academia, public service, private practice and clinical training across Central, East, North, South and West Africa was conducted. Participants were asked to select five core values from an alphabetically collated global list of 29 core values in an online survey. The five most selected core values were collated and sent out in the second round to the participants to rank in order of importance. Results: Practitioners from nine African countries in three out of the five United Nations subregions of Africa completed the study. The first round of the study saw participation of a team of nineteen experts who selected the following five core values-Comprehensive care, Continuity of Care, Collaborative Care, Patient centered care, and Life-long learning. Discussion/Conclusion: The core values selected were not very different from global literature. These core values should guide the development of curricula, standardization of training methods and creation of benchmarks for standards of practice for the specialty in Africa.
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Affiliation(s)
- Henry J O Lawson
- Department of Community Health, University of Ghana, Accra, Ghana
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Olson AW, Stratton TP, Isetts BJ, Vaidyanathan R, C Van Hooser J, Schommer JC. Seeing the Elephant: A Systematic Scoping Review and Comparison of Patient-Centeredness Conceptualizations from Three Seminal Perspectives. J Multidiscip Healthc 2021; 14:973-986. [PMID: 33953566 PMCID: PMC8092624 DOI: 10.2147/jmdh.s299765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/19/2021] [Indexed: 12/30/2022] Open
Abstract
“Patient-Centeredness” (PC) is a theoretical construct made up of a diverse constellation of distinct concepts, processes, practices, and outcomes that have been developed, arranged, and prioritized heterogeneously by different communities of professional healthcare practice, research, and policy. It is bound together by a common ethos that puts the holistic individual at the functional and symbolic center of their care, a quality deemed essential for chronic disease management and health promotion. Several important contributions to the PC research space have adeptly integrated seminal PC conceptualizations to improve conceptual clarity, measurement, implementation, and evaluation in research and practice. This systematic scoping review builds on that work, but with a purpose to explicitly identify, compare, and contrast the seminal PC conceptualizations arising from the different healthcare professional groups. The rationale for this work is that a deeper examination of the underlying development and corresponding assumptions from each respective conceptualization will lead to a more informed understanding of and meaningful contributions to PC research and practice, especially for healthcare professional groups newer to the topic area like pharmacy. The literature search identified four seminal conceptualizations from the healthcare professions of Medicine, Nursing, and Health Policy. A compositional comparison across the seminal conceptualizations revealed a shared ethos but also six distinguishing features: (1) organizational structure; (2) predominant level of care; (3) methodological approach; (4) care setting origin; (5) outcomes of interest; and (6) language. The findings illuminate PC’s stable theoretical foundations and distinctive nuances needed to appropriately understand, apply, and evaluate the construct’s operationalization in contemporary healthcare research and practice. These considerations hold important implications for future research into the fundamental aims of healthcare, how it should look when practiced, and what should reasonably be required of it.
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Affiliation(s)
- Anthony W Olson
- Research Division, Essentia Institute of Rural Health, Duluth, MN, USA.,Department of Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota - College of Pharmacy, Duluth, MN, USA
| | - Timothy P Stratton
- Department of Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota - College of Pharmacy, Duluth, MN, USA
| | - Brian J Isetts
- Department of Pharmaceutical Care and Health Systems, University of Minnesota - College of Pharmacy, Minneapolis, MN, USA
| | - Rajiv Vaidyanathan
- Department of Marketing, University of Minnesota Duluth - Labovitz School of Business and Economics, Duluth, MN, USA
| | - Jared C Van Hooser
- Department of Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota - College of Pharmacy, Duluth, MN, USA
| | - Jon C Schommer
- Department of Pharmaceutical Care and Health Systems, University of Minnesota - College of Pharmacy, Minneapolis, MN, USA
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12
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Molgaard Nielsen A, Hartvigsen J, Kongsted A, Öberg B, Enthoven P, Abbott A, Lauridsen HH. The patient enablement instrument for back pain: reliability, content validity, construct validity and responsiveness. Health Qual Life Outcomes 2021; 19:116. [PMID: 33836764 PMCID: PMC8033700 DOI: 10.1186/s12955-021-01758-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/29/2021] [Indexed: 11/29/2022] Open
Abstract
Background Currently, there are no outcome measures assessing the ability of people with non-specific low back pain to self-manage their illness. Inspired by the ‘Patient Enablement Instrument’, we developed the Patient Enablement Instrument for Back Pain (PEI-BP). The aim of this study was to describe the development of the Patient Enablement Instrument for Back Pain (PEI-BP) and investigate content validity, construct validity, internal consistency, test–retest reliability, measurement error, responsiveness and floor and ceiling effects. Methods The PEI-BP consists of 6 items that are rated on a 0–10 Numeric Rating Scale. Measurement properties were evaluated using the COSMIN taxonomy and were based on three cohorts from primary care with low back pain: The content validity cohort (N = 14) which participated in semi-structured interviews, the GLA:D® Back cohort (N = 272) and the test–retest cohort (N = 37) which both completed self-reported questionnaires. For construct validity and responsiveness, enablement was compared to disability (Oswestry Disability Index), back pain beliefs (Brief Illness Perception Questionnaire), fear avoidance (Fear-Avoidance Beliefs Questionnaire—physical activity), mental health (SF-36), educational level and number of previous episodes of low back pain. Results The PEI-BP was found to have acceptable content validity, construct validity, reliability (internal consistency, test–retest reliability and measurement error) and responsiveness. The Smallest Detectable Change was 10.1 points illustrating that a patient would have to change more than 1/6 of the scale range for it to be a true change. A skewed distribution towards the high scores were found at baseline indicating a potentially problematic ceiling effect in the current population. Conclusions The PEI-BP can be considered a valid and reliable tool to measure enablement on people seeking care for non-specific LBP. Further testing of the PEI-BP in populations with more severe LBP is recommended. Trial registration: Not applicable. Supplementary Information The online version contains supplementary material available at 10.1186/s12955-021-01758-0.
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Affiliation(s)
- A Molgaard Nielsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.
| | - J Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.,Chiropractic Knowledge Hub, Campusvej 55, 5230, Odense M, Denmark
| | - A Kongsted
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.,Chiropractic Knowledge Hub, Campusvej 55, 5230, Odense M, Denmark
| | - B Öberg
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University, Linköping, Sweden
| | - P Enthoven
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University, Linköping, Sweden
| | - A Abbott
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University, Linköping, Sweden
| | - H H Lauridsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
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13
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Arvidsson E, Švab I, Klemenc-Ketiš Z. Core Values of Family Medicine in Europe: Current State and Challenges. Front Med (Lausanne) 2021; 8:646353. [PMID: 33708785 PMCID: PMC7940667 DOI: 10.3389/fmed.2021.646353] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 02/01/2021] [Indexed: 01/08/2023] Open
Abstract
Background: Values are deeply held views that act as guiding beliefs for individuals and organizations. They state what is important in a profession. The aims of this study were to determine whether European countries have already developed (or are developing) documents on core values in family medicine; to gather the lists of core values already developed in countries; and to gather the opinions of participants on what the core family values in their countries are. Methods: This was a qualitative study. The questionnaire was distributed as an e-survey via email to present and former members of the European Society for Quality and Safety in Family Practice (EQuiP), and other family medicine experts in Europe. The questionnaire included six items concerning core values in family medicine in the respondent's country: the process of defining core values, present core values, the respondents' suggestions for core values, and current challenges of core values. Results: Core values in family medicine were defined or in a process of being defined in several European countries. The most common core values already defined were the doctor-patient relationship, continuity, comprehensiveness and holistic care, community orientation, and professionalism. Some countries expressed the need for an update of the current core values' list. Most respondents felt the core values of their discipline were challenged in today's world. The main values challenged were continuity, patient-centered care/the doctor-patient relationship and comprehensive and holistic care, but also prioritization, equity, and community orientation and cooperation. These were challenged by digital health, workload/lack of family physicians, fragmentation of care, interdisciplinary care, and societal trends and commercial interests. Conclusion: We managed to identify suggestions for core values of family medicine at the European level. There is a clear need to adopt a definition of a value and tailor the discussion and actions on the family medicine core values accordingly. There is also a need to identify the core values of family medicine in European countries. This could strengthen the profession, promote its development and research, improve education, and help European countries to advocate for the profession.
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Affiliation(s)
- Eva Arvidsson
- Futurum, Jönköping, Sweden.,School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Igor Švab
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Zalika Klemenc-Ketiš
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Department of Family Medicine, Faculty of Medicine, University of Maribor, Maribor, Slovenia.,Ljubljana Community Health Centre, Ljubljana, Slovenia
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14
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Affiliation(s)
- Johann A. Sigurdsson
- Chair of the Nordic Federation of General Practice, GP, Professor emeritus, Development Centre for Primary Health Care, Iceland; Department of Public Health and Nursing; General Practice Research Unit, Norwegian University of Science and Technology, Trondheim, Norway
| | - Anders Beich
- Chair of the Danish College of General Practice, GP, Copenhagen, Denmark
| | - Anna Stavdal
- WONCA World, GP, President Elect, The Norwegian College of General Practice, Oslo, Norway
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15
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Atherton H, Boylan AM, Eccles A, Fleming J, Goyder CR, Morris RL. Email Consultations Between Patients and Doctors in Primary Care: Content Analysis. J Med Internet Res 2020; 22:e18218. [PMID: 33164902 PMCID: PMC7683246 DOI: 10.2196/18218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 08/31/2020] [Accepted: 09/14/2020] [Indexed: 11/18/2022] Open
Abstract
Background Increasingly, consultations in health care settings are conducted remotely using a range of communication technologies. Email allows for 2-way text-based communication, occurring asynchronously. Studies have explored the content and nature of email consultations to understand the use, structure, and function of email consultations. Most previous content analyses of email consultations in primary care settings have been conducted in North America, and these have shown that concerns and assumptions about how email consultations work have not been realized. There has not been a UK-based content analysis of email consultations. Objective This study aims to explore and delineate the content of consultations conducted via email in English general practice by conducting a content analysis of email consultations between general practitioners (GPs) and patients. Methods We conducted a content analysis of anonymized email consultations between GPs and patients in 2 general practices in the United Kingdom. We examined the descriptive elements of the correspondence to ascertain when the emails were sent, the number of emails in an email consultation, and the nature of the content. We used a normative approach to analyze the content of the email consultations to explore the use and function of email consultation. Results We obtained 100 email consultations from 85 patients, which totaled 262 individual emails. Most email users were older than 40 years, and over half of the users were male. The email consultations were mostly short and completed in a few days. Emails were mostly sent and received during the day. The emails were mostly clinical in content rather than administrative and covered a wide range of clinical presentations. There were 3 key themes to the use and function of the email consultations: the role of the GP and email consultation, the transactional nature of an email consultation, and the operationalization of an email consultation. Conclusions Most cases where emails are used to have a consultation with a patient in general practice have a shorter consultation, are clinical in nature, and are resolved quickly. GPs approach email consultations using key elements similar to that of the face-to-face consultation; however, using email consultations has the potential to alter the role of the GP, leading them to engage in more administrative tasks than usual. Email consultations were not a replacement for face-to-face consultations.
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Affiliation(s)
- Helen Atherton
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Anne-Marie Boylan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Abi Eccles
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Joanna Fleming
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Clare R Goyder
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Rebecca L Morris
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, United Kingdom
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16
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Jönsson B, Abrahamsson KH. Overcoming behavioral obstacles to prevent periodontal disease: Behavioral change techniques and self‐performed periodontal infection control. Periodontol 2000 2020; 84:134-144. [DOI: 10.1111/prd.12334] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Birgitta Jönsson
- Department of Periodontology Institute of Odontology The Sahlgrenska Academy at the University of Gothenburg Gothenburg Sweden
- The Public Dental Health Service Competence Centre of Northern Norway (TkNN) Tromsø Norway
| | - Kajsa H. Abrahamsson
- Department of Periodontology Institute of Odontology The Sahlgrenska Academy at the University of Gothenburg Gothenburg Sweden
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17
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Chan CHY, Lau BHP, Chan THY, Leung HT, So GYK, Chan CLW. Examining the Moderating Role of Patient Enablement on the Relationship Between Health Anxiety and Psychosomatic Distress: A Cross-Sectional Study at a Traditional Chinese Medicine Outpatient Clinic in Hong Kong. Front Psychol 2020; 11:1081. [PMID: 32655430 PMCID: PMC7325961 DOI: 10.3389/fpsyg.2020.01081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 04/28/2020] [Indexed: 11/13/2022] Open
Abstract
Background Little research effort has been devoted to examining the role of patient enablement in alleviating health anxiety in primary care. In this study, we examined the role of patient enablement as a moderator in the relationship between health anxiety, psychological distress, and treatment seeking in traditional Chinese medicine (TCM). Methods The participants were 634 patients of a government-subsidized Chinese medicine outpatient clinic in Hong Kong. They were asked to complete a series of questionnaires on patient enablement, health anxiety, anxiety, depression, physical distress, annual clinic visits, and service satisfaction and provided various demographic details. Descriptive statistics, correlations, and general linear models were used to analyze the data. Results We found that patient enablement correlated positively with service satisfaction. Patient enablement also interacted significantly with health anxiety in affecting indices of psychological distress (depression, anxiety) and treatment seeking (annual visits). Among highly enabled patients, the positive association between health anxiety and indices of psychological distress was weakened, and they also showed more health anxiety-driven treatment seeking as measured by annual clinic visits. Conclusion These findings suggest a moderating mechanism by which patient enablement weakens the relationship between health anxiety on psychological well-being and increases treatment-seeking behavior in TCM. Practitioners are encouraged to provide sufficient information to patients to foster self-care and disease self-management using complementary and alternative medicine (CAM).
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Affiliation(s)
- Celia H Y Chan
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| | - Bobo H P Lau
- Department of Counselling and Psychology, Hong Kong Shue Yan University, North Point, Hong Kong
| | - Timothy H Y Chan
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| | - H T Leung
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| | - Georgina Y K So
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| | - Cecilia L W Chan
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
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18
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Tavares PDAJ, Ukawa TB, Hamamoto Filho PT, de Avila MAG. Evaluating Educational Material from the Perspective of Informal Caregivers of Children with Hydrocephalus: A Qualitative Study. World Neurosurg 2020; 139:427-433. [DOI: 10.1016/j.wneu.2020.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 04/01/2020] [Accepted: 04/02/2020] [Indexed: 11/28/2022]
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19
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Santiago LM, Silva I, Simões JA. Patients' and tutors' evaluations of medicine students' consultations in general practice/family medicine in Coimbra. BMC MEDICAL EDUCATION 2020; 20:137. [PMID: 32375791 PMCID: PMC7201647 DOI: 10.1186/s12909-020-02042-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 04/13/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Undergraduate teaching of General Practice/Family Medicine (GP/FM) must ensure students acquire the necessary competencies and skills to perform an adequate GP/FM consultation with adequate annotations (the SOAP model) and classifications. So aimed to study and to correlate students' evaluation by tutors and patients in specific consultations in the formal practical evaluation of GP/FM Curricular Unit of the Integrated Masters on Medicine at the Faculty of Medicine of the University of Coimbra (IMM-FMUC) in the academic years of 2017-2018 and 2018-2019. METHODS Observational study of the 2017-2018 and 2018-2019 academic years of the assessment grids for tutor's evaluation of SOAP performance and fluency in consultation and for patient's evaluation of the student 'performance, in the convenience sample of those who chose to be so evaluated. RESULTS We studied a population of 435 (67,7%) out of a universe of 646 students, 125 (28,7%) males, ns by sex and academic year who performed this evaluation. In a mark up to 20 from tutors, difference was found for Plan (P) mark, higher in 2018-2019 (18,38 ± 2,18vs18,54 ± 2,11, p = 0,005) of the SOAP methodology evaluation. Patients' evaluation was not different 19,34 ± 1,70vs19,35 ± 1,40, p = 0,091. A positive significant correlation was found between tutors and patients marks (ρ = 0,278; p < 0,001), as well as between tutor mark and final mark (ρ = 0,958; p < 0,001) and patient and final marks (ρ = 0,465; p < 0,001). Final marks were not different in both years, 18,61 ± 1,38vs18,78 ± 1,15, p = 0,158. CONCLUSIONS This innovative model of evaluation of student's performance in medical appointment, showed a significant positive moderate correlation between patients' and tutors' marks in the setting of GP/FM at the IMM-FMUC, and was not different between years. Yearly evaluation must be continued.
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Affiliation(s)
- Luiz Miguel Santiago
- Faculty of Medicine of the University of Coimbra, General Practice and Family Medicine University Clinic of the University of Coimbra, Coimbra, Portugal.
| | - Inês Silva
- Faculty of Medicine of the University of Coimbra, General Practice and Family Medicine University Clinic of the University of Coimbra, Coimbra, Portugal
| | - José Augusto Simões
- Faculty of Medicine of the University of Coimbra, General Practice and Family Medicine University Clinic of the University of Coimbra, Coimbra, Portugal
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20
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Papadimitriou V, Tosello B, Pfister R. Effect of written outcome information on attitude of perinatal healthcare professionals at the limit of viability: a randomized study. BMC Med Ethics 2019; 20:74. [PMID: 31640670 PMCID: PMC6806555 DOI: 10.1186/s12910-019-0413-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 09/27/2019] [Indexed: 11/11/2022] Open
Abstract
Background Differences in perception and potential disagreements between parents and professionals regarding the attitude for resuscitation at the limit of viability are common. This study evaluated in healthcare professionals whether the decision to resuscitate at the limit of viability (intensive care versus comfort care) are influenced by the way information on incurred risks is given or received. Methods This is a prospective randomized controlled study. This study evaluated the attitude of healthcare professionals by testing the effect of information given through graphic fact sheets formulated either optimistically or pessimistically. The written educational fact sheet included three graphical presentations of survival and complication/morbidity by gestational age. The questionnaire was submitted over a period of 4 months to 5 and 6-year medical students from the Geneva University as well as physicians and nurses of the neonatal unit at the University Hospitals of Geneva. Our sample included 102 healthcare professionals. Results Forty-nine responders (48%) were students (response rate of 33.1%), 32 (31%) paediatricians (response rate of 91.4%) and 21 (20%) nurses in NICU (response rate of 50%). The received risk tended to be more severe in both groups compared to the graphically presented facts and current guidelines, although optimistic representation favoured the perception of “survival without disability” at 23 to 25 weeks. Therapeutic attitudes did not differ between groups, but healthcare professionals with children were more restrained and students more aggressive at very low gestational ages. Conclusion Written information on mortality and morbidity given to healthcare professionals in graphic form encourages them to overestimate the risk. However, perception in healthcare staff may not be directly transferable to parental perception during counselling as the later are usually naïve to the data received. This parental information are always communicated in ways that subtly shape the decisions that follow.
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Affiliation(s)
- V Papadimitriou
- Neonatal and Paediatric Intensive Care Unit, University Hospitals of Geneva, and Geneva University, 1211, Genève, Switzerland
| | - B Tosello
- Neonatal and Paediatric Intensive Care Unit, University Hospitals of Geneva, and Geneva University, 1211, Genève, Switzerland. .,Aix-Marseille Université, CNRS, EFS, ADES, Marseille, France.
| | - R Pfister
- Neonatal and Paediatric Intensive Care Unit, University Hospitals of Geneva, and Geneva University, 1211, Genève, Switzerland
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21
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Johnsson L, Nordgren L. How general practitioners decide on maxims of action in response to demands from conflicting sets of norms: a grounded theory study. BMC Med Ethics 2019; 20:33. [PMID: 31088448 PMCID: PMC6515645 DOI: 10.1186/s12910-019-0360-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 03/27/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The work of general practitioners (GPs) is infused by norms from several movements, of which evidence based medicine, patient-centredness, and virtue ethics are some of the most influential. Their precepts are not clearly reconcilable, and structural factors may limit their application. In this paper, we develop a conceptual framework that explains how GPs respond, across different fields of interaction in their daily work, to the pressure exerted by divergent norms. METHODS Data was generated from unstructured interviews with and observations of sixteen Swedish GPs (who have by definition more than five years of experience after license to practice) and family medicine residents (with less than five years of experience) between 2015 and 2017. Straussian Grounded Theory was used for analysis. RESULTS We found that GPs' maxims of action can be characterised in terms of dichotomous responses to demands from four distinct sets of norms, or "voices": the situation, the self, the system, and the profession. From the interactions between these voices emerge sixteen clusters of maxims of action. Based on the common features of the maxims in each cluster, we have developed a conceptual framework that appears to be rich enough to capture the meaning of the ethical decisions that GPs make in their daily work, yet has a high enough level of abstraction to be helpful when discussing the factors that influence those decisions. CONCLUSIONS Our four-dimensional model of GPs' responses to norms is a first step toward a middle-range theory of quality from GPs' perspective. It brings out the complexity of their practice, reveals tensions that easily remain invisible in more concrete accounts of their actions, and aids the transferability of substantive theories on GPs' ethical decision making. By explaining the nature of the ethical conflicts that they experience, we provide some clues as to why efforts to improve quality by imposing additional norms on GPs may meet with varying degrees of success.
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Affiliation(s)
- Linus Johnsson
- Department of Public Health and Caring Sciences, Uppsala University, BMC, Box 564, 751 22, Uppsala, Sweden.
| | - Lena Nordgren
- Department of Public Health and Caring Sciences, Uppsala University, BMC, Box 564, 751 22, Uppsala, Sweden.,Centre for Clinical Research Sörmland/Uppsala University, Kungsgatan 41, 631 88, Eskilstuna, Sweden
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22
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Johnston JL, Bennett D. Lost in translation? Paradigm conflict at the primary-secondary care interface. MEDICAL EDUCATION 2019; 53:56-63. [PMID: 30443926 DOI: 10.1111/medu.13758] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 05/01/2018] [Accepted: 09/10/2018] [Indexed: 06/09/2023]
Abstract
CONTEXT Historically, primary care (community and family) medicine has often been viewed as lower status than secondary care (hospital) practice. Current evidence suggests this pattern continues to impact medical practice and education. Medical education has however, yet to fully reflect this power dynamic, with undergraduate training in many institutions maintaining the hegemonic position of secondary care as the prime context for learning. METHODS In this paper, we present primary and secondary care as conflicting paradigms of medical practice. Using a sociocultural lens drawing on Figured Worlds theory, implications for medical education are explored. CONCLUSIONS We outline the two paradigms as having distinct epistemologies, identities and practices. Tensions at the primary-secondary care interface can, from a sociocultural perspective, be seen to impact developing identity and day-to-day clinical practice issues such as patient safety. We offer possibilities for engaging with paradigm conflict in meaningful ways and suggest potential changes for future educational policy and practice.
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Affiliation(s)
- Jennifer L Johnston
- Centre for Medical Education, Queen's University Belfast, Belfast, Northern Ireland
| | - Deirdre Bennett
- Medical Education Unit, University College Cork, Cork, Ireland
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23
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Thomas H, Mitchell G, Rich J, Best M. Definition of whole person care in general practice in the English language literature: a systematic review. BMJ Open 2018; 8:e023758. [PMID: 30552268 PMCID: PMC6303638 DOI: 10.1136/bmjopen-2018-023758] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 08/16/2018] [Accepted: 11/08/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The importance of 'whole person' or 'holistic' care is widely recognised, particularly with an increasing prevalence of chronic multimorbidity internationally. This approach to care is a defining feature of general practice. However, its precise meaning remains ambiguous. We aimed to determine how the term 'whole person' care is understood by general practitioners (GPs), and whether it is synonymous with '[w]holistic' and 'biopsychosocial' care. DESIGN Systematic literature review. METHODS MEDLINE, PubMed, EMBASE, CINAHL, PsycINFO, Web of Science, Proquest Dissertations and Theses, Science.gov (Health and Medicine database), Google Scholar and included studies' reference lists were searched with an unlimited date range. Systematic or literature reviews, original research, theoretical articles or books/book chapters; specific to general practice; relevant to the research question; and published in English were included. Included literature was critically appraised, and data were extracted and analysed using thematic synthesis. RESULTS Fifty publications were included from 4297 non-duplicate records retrieved. Six themes were identified: a multidimensional, integrated approach; the importance of the therapeutic relationship; acknowledging doctors' humanity; recognising patients' individual personhood; viewing health as more than absence of disease; and employing a range of treatment modalities. Whole person, biopsychosocial and holistic terminology were often used interchangeably, but were not synonymous. CONCLUSIONS Whole person, holistic and biopsychosocial terminology are primarily characterised by a multidimensional approach to care and incorporate additional elements described above. Whole person care probably represents the closest representation of the basis for general practice. Health systems aiming to provide whole person care need to address the challenge of integrating the care of other health professionals, and maintaining the patient-doctor relationship central to the themes identified. Further research is required to clarify the representativeness of the findings, and the relative importance GPs' assign to each theme. PROSPERO REGISTRATION NUMBER CRD42017058824.
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Affiliation(s)
- Hayley Thomas
- Primary Care Clinical Unit, Faculty of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Geoffrey Mitchell
- Primary Care Clinical Unit, Faculty of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Justin Rich
- Primary Care Clinical Unit, Faculty of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Megan Best
- Psycho-Oncology Co-operative Research Group, Sydney Health Ethics, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
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24
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Analysis of definitions of general practice, family medicine, and primary health care: a terminological analysis. BJGP Open 2017; 1:bjgpopen17X101049. [PMID: 30564677 PMCID: PMC6169928 DOI: 10.3399/bjgpopen17x101049] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background There are numerous definitions of general practice/family medicine (GP/FM) and primary health care (PHC), but the distinction between the two concepts is unclear. Aim To conduct a terminological analysis of a set of definitions of GP/FM and of PHC, to clarify the commonalities and differences between these two concepts. Design Sets of 20 definitions were collected in two 'bags of words' (one for GP/FM and one for PHC terms). A terminological analysis of these two collections was performed to prioritise the terms and analyse their universe of discourse. Method The two collections were extracted with VocabGrabber, configured in two 'term clouds' using Wordle, and further explored for similarities using Tropes. The main terms were analysed using the Aristotelian approach to the categorisation of things. Results Although continuity of care (characterised by a person-centred approach and shared decision making) is common to both sets, the two sets of definitions differ greatly in content. The main terms specific to GP/FM (community, medicine, responsibility, individual, problem, and needs) are different from those specific to PHC (home, team, promotion, collaborator, engagement, neighbourhood, and medical centre). Conclusion Terminological analysis of the definitions for GP/FM and PHC shows two overlapping but distinct entities, necessitating a different taxonomic approach and different bibliographic search strategies.
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25
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Wolters M, van Hulten R, Blom L, Bouvy ML. Exploring the concept of patient centred communication for the pharmacy practice. Int J Clin Pharm 2017; 39:1145-1156. [PMID: 28887610 PMCID: PMC5694524 DOI: 10.1007/s11096-017-0508-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 07/08/2017] [Indexed: 12/30/2022]
Abstract
Background Patient centred communication can improve pharmaceutical care, but is not well described for pharmacists. Aim of the review To provide a comprehensive and accessible overview of the concept of patient centred communication for the pharmacy practice. Method A scoping review and thematic analysis was undertaken to synthesize the extracted data and present it in a model. Results Literature search and selection resulted in eighteen articles. Thematic analysis of the extracted data led to five categories regarding patient centred communication. Two categories refer to phases of a pharmaceutical consultation: (1) shared problem defining and (2) shared decision making; three refer to underlying concepts and assumptions about patient centredness regarding (3) the patient, (4) the pharmacist and (5) the therapeutic relation. The categories were modelled in the so called Utrecht’s Model for Patient centred communication in the Pharmacy. Conclusion Although there might be barriers to implement patient centred communication in the pharmacy, the concept of patient centred communication as described in the literature is relevant for the pharmacy practice.
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Affiliation(s)
- Majanne Wolters
- Division of Pharmacoepidemiology and Pharmacotherapy, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, PO Box 80082, 3508 TB, Utrecht, The Netherlands.
| | - Rolf van Hulten
- Division of Pharmacoepidemiology and Pharmacotherapy, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, PO Box 80082, 3508 TB, Utrecht, The Netherlands
| | - Lyda Blom
- Division of Pharmacoepidemiology and Pharmacotherapy, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, PO Box 80082, 3508 TB, Utrecht, The Netherlands
| | - Marcel L Bouvy
- Division of Pharmacoepidemiology and Pharmacotherapy, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, PO Box 80082, 3508 TB, Utrecht, The Netherlands
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Ricci-Cabello I, Stevens S, Dalton ARH, Griffiths RI, Campbell JL, Valderas JM. Identifying Primary Care Pathways from Quality of Care to Outcomes and Satisfaction Using Structural Equation Modeling. Health Serv Res 2017; 53:430-449. [PMID: 28217876 DOI: 10.1111/1475-6773.12666] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To study the relationships between the different domains of quality of primary health care for the evaluation of health system performance and for informing policy decision making. DATA SOURCES A total of 137 quality indicators collected from 7,607 English practices between 2011 and 2012. STUDY DESIGN Cross-sectional study at the practice level. Indicators were allocated to subdomains of processes of care ("quality assurance," "education and training," "medicine management," "access," "clinical management," and "patient-centered care"), health outcomes ("intermediate outcomes" and "patient-reported health status"), and patient satisfaction. The relationships between the subdomains were hypothesized in a conceptual model and subsequently tested using structural equation modeling. PRINCIPAL FINDINGS The model supported two independent paths. In the first path, "access" was associated with "patient-centered care" (β = 0.63), which in turn was strongly associated with "patient satisfaction" (β = 0.88). In the second path, "education and training" was associated with "clinical management" (β = 0.32), which in turn was associated with "intermediate outcomes" (β = 0.69). "Patient-reported health status" was weakly associated with "patient-centered care" (β = -0.05) and "patient satisfaction" (β = 0.09), and not associated with "clinical management" or "intermediate outcomes." CONCLUSIONS This is the first empirical model to simultaneously provide evidence on the independence of intermediate health care outcomes, patient satisfaction, and health status. The explanatory paths via technical quality clinical management and patient centeredness offer specific opportunities for the development of quality improvement initiatives.
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Affiliation(s)
- Ignacio Ricci-Cabello
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sarah Stevens
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Robert I Griffiths
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - John L Campbell
- APEx Collaboration for Academic Primary Care, Institute for Health Services Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Jose M Valderas
- APEx Collaboration for Academic Primary Care, Institute for Health Services Research, University of Exeter Medical School, University of Exeter, Exeter, UK
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Managing barriers to empathy in the clinical encounter: a qualitative interview study with GPs. Br J Gen Pract 2016; 66:e887-e895. [PMID: 27884917 DOI: 10.3399/bjgp16x687565] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 07/08/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Current daily general practice has become increasingly technical and somatically oriented (where attention to patients' feelings is decreased) due to an increase in protocol-based guidelines. Priorities in GP-patient communication have shifted from a focus on listening and empathy to task-oriented communication. AIM To explore what barriers GPs experience when applying empathy in daily practice, and how these barriers are managed. DESIGN AND SETTING Thirty Dutch GPs with sufficient heterogeneity in sex, age, type of practice, and rural or urban setting were interviewed. METHOD The consolidated criteria for reporting qualitative research (COREQ) were applied. The verbatim transcripts were then analysed. RESULTS According to participating GPs, the current emphasis on protocol-driven care can be a significant barrier to genuineness in communication. Other potential barriers mentioned were time pressures and constraints, and dealing with patients displaying 'unruly behaviour' or those with personality disorders. GPs indicated that it can be difficult to balance emotional involvement and professional distance. Longer consulting times, smaller practice populations, and efficient practice organisation were described as practical solutions. In order to focus on a patient-as-person approach, GPs strongly suggested that deviating from guidelines should be possible when necessary as an element of good-quality care. Joining intercollegiate counselling groups was also discussed. CONCLUSION In addition to practical solutions for barriers to behaving empathically, GPs indicated that they needed more freedom to balance working with protocols and guidelines, as well as a patient-as-person and patient-as-partner approach. This balance is necessary to remain connected with patients and to deliver care that is truly personal.
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Lippert ML, Reventlow S, Kousgaard MB. The uses and implications of standards in general practice consultations. Health (London) 2016; 21:3-20. [PMID: 26112800 DOI: 10.1177/1363459315590245] [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] [Indexed: 11/15/2022]
Abstract
Quality standards play an increasingly important role in primary care through their inscription in various technologies for improving professional practice. While 'hard' biomedical standards have been the most common and debated, current quality development initiatives increasingly seek to include standards for the 'softer' aspects of care. This article explores the consequences of both kinds of quality standards for chronic care consultations. The article presents findings from an explorative qualitative field study in Danish general practice where a standardized technology for quality development has been introduced. Data from semi-structured interviews and observations among 17 general practitioners were analysed using an iterative analytical approach, which served to identify important variations in the uses and impacts of the technology. The most pronounced impact of the technology was observed among general practitioners who strictly adhered to the procedural standards on the interactional aspects of care. Thus, when allowed to function as an overall frame for consultations, those standards supported adherence to general recommendations regarding which elements to be included in chronic disease consultations. However, at the same time, adherence to those standards was observed to narrow the focus of doctor-patient dialogues and to divert general practitioners' attention from patients' personal concerns. Similar consequences of quality standards have previously been framed as manifestations of an inherent conflict between principles of patient-centredness and formal biomedical quality standards. However, this study suggests that standards on the 'softer' aspects of care may just as well interfere with a clinical approach relying on situated and attentive interactions with patients.
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Ter Maten-Speksnijder AJ, Dwarswaard J, Meurs PL, van Staa A. Rhetoric or reality? What nurse practitioners do to provide self-management support in outpatient clinics: an ethnographic study. J Clin Nurs 2016; 25:3219-3228. [PMID: 27411952 DOI: 10.1111/jocn.13345] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2016] [Indexed: 11/26/2022]
Abstract
AIMS AND OBJECTIVES To describe how nurse practitioners enact their role in outpatient consultations, and how this compares to their perception of their responsibility for patients with chronic conditions. BACKGROUND Nurse practitioners working with patients with chronic conditions seek to support them in self-managing their diseases. DESIGN An ethnographic study. METHODS Episodic participant observations (in total 48 hours) were carried out combined with formal interviews. The study population consisted of a purposive sample of nurse practitioners working in five outpatient clinics related to chronic care in one university medical centre in the Netherlands. Two different types of clinics were selected, namely (1) for patients with episodic flare-ups and (2) for patients with diseases requiring life-saving procedures. RESULTS The nurse practitioners perceived the monitoring of patients' treatment as their main professional responsibility. Four monitoring strategies could be distinguished: 'assessing health conditions', 'connecting with patients', 'prioritising treatment in daily living' and 'educating patients'. CONCLUSION While nurse practitioners considered building a relationship with their patients of utmost importance, their consultations were mostly based on a conventional medical model of medical history taking. Little attention was paid to the social, psychological and behavioural dimensions of illness. Nurse practitioners in this study seemed quite successful in their extension into medical territory, but moving patients' illness perceptions to the background was not conducive to self-management support. RELEVANCE TO CLINICAL PRACTICE By their medical subspecialty expertise, nurse practitioners have a major role in the longitudinal process of the management of chronic diseases' treatment. Supporting patients to reduce the impact of the disease and its complications requires nurse practitioners to develop new coaching strategies designed to meet patients' individual needs.
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Affiliation(s)
| | - Jolanda Dwarswaard
- Erasmus University Rotterdam and Rotterdam University of Applied Sciences, Rotterdam, the Netherlands
| | - Pauline L Meurs
- iBMG, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - AnneLoes van Staa
- Erasmus University Rotterdam and Rotterdam University of Applied Sciences, Rotterdam, the Netherlands
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Chung VCH, Yip BHK, Yu ELM, Liu S, Ho RST, Sit RWS, Leung AWN, Wu JCY, Wong SYS. Patient Perceptions of Expression of Empathy From Chinese Medicine Clinicians in a Chinese Population: A Cross-Sectional Study. Medicine (Baltimore) 2016; 95:e3316. [PMID: 27124021 PMCID: PMC4998684 DOI: 10.1097/md.0000000000003316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
This study aims to examine the level of empathy perceived by patients receiving care from herbalists, acupuncturists and massage therapists and to investigate the factors that influence levels of perceived empathy.Participants who were 18 years or above; able to provide written informed consent; and able to read and write in Chinese without assistance were included. A total of 514 participants sampled from charity and semipublic Chinese medicine (CM) clinics in Hong Kong were recruited to assess levels of empathy perceived during various length of consultations (1-20 minutes) by the Chinese Consultation and Relational Empathy Measure (Chinese CARE). Multiple linear regressions were conducted to evaluate the associations between perceived levels of empathy and the type of CM practitioner consulted and participants' demographic and health characteristics.The average Chinese CARE total score for participants consulting CM practitioners was 34.3 of a maximum of 50. After adjusting for participants' health and demographic characteristics, acupuncturists received the highest ratings (P < 0.001), whereas massage therapists (P < 0.001) scored the lowest of the 3 modalities. Participants receiving social benefits (P = 0.013), those with longer waiting times (P = 0.002), and those with shorter consultation durations (P = 0.020) scored significantly lower on the Chinese CARE.The level of empathy perceived by participants using CM was similar to results found for those in conventional care, in contrast to findings in other geographical settings, where a high level of perceived empathy was a major motivator for participants to choose complementary medicine.
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Affiliation(s)
- Vincent C H Chung
- From the Jockey Club School of Public Health and Primary Care (VCHC, BHKY, ELMY, SL, RSTH, RWSS, SYSW), Hong Kong Institute of Integrative Medicine (VCHC, RWSS, JCYW, SYSW), and School of Chinese Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China (AWNL)
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Klement A, Oemler M, Wienke A, Richter M, Wolfradt U. [(Expected) Consultation length, mental (co-)morbidity and patient satisfaction in the family practice encounter]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2015; 109:560-9. [PMID: 26704817 DOI: 10.1016/j.zefq.2015.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 07/16/2015] [Accepted: 08/24/2015] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Mental disorders are common in family practice, but their meaning for variables of consultation is rarely considered. Thus, we examined the influence of mental disorders on patients' expectations regarding time, openness and seriousness as well as ratings of satisfaction with the consultation. METHODS Prior to consultation for 219 patients a screening for anxiety (GAD-7), depression (PHQ-9) and hypochondriasis (WI-7) was performed. Before and after the consultation patient expectations and ratings were recorded. Subgroup analysis was based on Mann-Whitney U tests. RESULTS Almost half of the sample were screen-positive. Prior the consultation, screen positive patients had higher ratings for expectations compared with screen negative patients, but did not differ in their experiences after the consultation. There was no association between consultation length and ratings for satisfaction. DISCUSSION Patients screened positive for mental disorders do not necessarily require longer consultation length, if their expectations regarding openness and seriousness are met. This is underlines the importance of communication skills in undergraduate medical education and specialist training for future GPs.
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Affiliation(s)
- Andreas Klement
- Sektion Allgemeinmedizin, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland; Profilzentrum für Gesundheitswissenschaften, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland.
| | - Matthias Oemler
- Sektion Allgemeinmedizin, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - Andreas Wienke
- Institut für Medizinische Epidemiologie, Biometrie und Informatik, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland; Profilzentrum für Gesundheitswissenschaften, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - Matthias Richter
- Institut für Medizinische Soziologie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland; Profilzentrum für Gesundheitswissenschaften, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - Uwe Wolfradt
- Institut für Psychologie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
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Smith J, Cheater F, Bekker H, Chatwin J. Are parents and professionals making shared decisions about a child's care on presentation of a suspected shunt malfunction: a mixed method study? Health Expect 2015; 18:1299-315. [PMID: 23910566 PMCID: PMC5060866 DOI: 10.1111/hex.12106] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2013] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Shunts, the main treatment for hydrocephalus, are problematic as they frequently malfunction. Identifying shunt malfunction requires parents to recognize its symptoms and health professionals to integrate parents' information about the child's symptoms within the clinical assessment to reach a diagnosis. AIM To investigate parent-professional shared decision making during the diagnosis of suspected shunt malfunction in acute hospital admissions. DESIGN AND METHODS A mixed method study involving audio recordings of admission consultations, a shared decision making questionnaire and interviews 1-week post-consultation, was undertaken. Twenty-eight family members and fourteen health professionals participated. The interactions were analysed using conversational analysis, framework approach for the interview data and descriptive statistics for questionnaire responses. FINDINGS Both parents and professionals focussed on establishing a diagnosis and ruling out shunt malfunction when a child with hydrocephalus was ill. Participants' perceived effective collaboration as central to this task: parents wanted to contribute to the process of diagnosis by providing information about the likely cause of symptoms. Professionals were satisfied with the level of involvement by parents, although parent satisfaction was more variable. The challenge for professionals was to integrate parents' expertise of their child's presenting symptoms within clinical decision making processes. CONCLUSION In this context, both parents' and professionals' perceived their interactions to be about problem-solving, rather than making decisions about treatments. Although the shared decision-making model can help patients to make better decisions between treatment options, it is unclear how best to support collaboration between professionals and parents to ensure a good problem-solving process.
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Affiliation(s)
- Joanna Smith
- School of Nursing, Midwifery and Social WorkUniversity of SalfordSalfordGreater ManchesterUK
| | - Francine Cheater
- School of Nursing SciencesUniversity of East AngliaNorwichNorfolkUK
| | - Hilary Bekker
- Institute of Health SciencesUniversity of LeedsLeedsWest YorkshireUK
| | - John Chatwin
- Primary Care Research GroupUniversity of ManchesterGreater ManchesterUK
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Zhou Y, Lundy JM, Humphris G, Mercer SW. Do multimorbidity and deprivation influence patients' emotional expressions and doctors' responses in primary care consultations?--An exploratory study using multilevel analysis. PATIENT EDUCATION AND COUNSELING 2015; 98:1063-1070. [PMID: 26111501 DOI: 10.1016/j.pec.2015.05.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 05/27/2015] [Accepted: 05/30/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To explore whether and how patient multimorbidity and socioeconomic deprivation might influence patients' emotional expression and doctors' responses in the general practice (GP) consultations. METHODS Video recordings of 107 consultations (eight GPs) were coded with the Verona Coding Definitions of Emotional Sequences (VR-CoDES). Multilevel logistic regressions modelled the probability of GP providing space response, considering patient multimorbidity, deprivation conditions and other contextual factors. Further multinomial regressions explored the possible impact of multimorbidity and deprivation on expression of and specific responses to patients' emotional distress. RESULTS It was less likely for GPs to provide space as the consultation proceeded, controlling for multimorbidity and deprivation variables. Patients with multimorbidity were less likely to express emotional distress in an explicit form. GPs were more likely to provide acknowledgement to emotions expressed by patients from more deprived areas. CONCLUSION Multimorbidity and deprivation may influence the dynamics of the GP consultations in specific ways. Rigorous methodologies using larger samples are required to explore further how these two variables relate to each other and influence cue expression, provider response and subsequent patient outcomes. PRACTICE IMPLICATIONS Understanding how multimorbidity and deprivation impact on GP consultations may help inform future service improvement programmes.
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Affiliation(s)
- Yuefang Zhou
- School of Medicine, University of St Andrews, St Andrews, UK.
| | - Jenna-Marie Lundy
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Gerry Humphris
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Stewart William Mercer
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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de Zulueta P. Welcome to the ethics section of the London Journal of Primary Care. LONDON JOURNAL OF PRIMARY CARE 2015; 1:5-7. [PMID: 25949534 DOI: 10.1080/17571472.2008.11493183] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Lippert ML, Kousgaard MB, Bjerrum L. General practitioners uses and perceptions of voluntary electronic feedback on treatment outcomes - a qualitative study. BMC FAMILY PRACTICE 2014; 15:193. [PMID: 25433487 PMCID: PMC4255701 DOI: 10.1186/s12875-014-0193-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 11/10/2014] [Indexed: 11/10/2022]
Abstract
Background Currently, there is a strong focus on the diffusion and implementation of indicator-based technologies for assessing and improving the quality of care in general practice. The aim of this study was to explore how and for what purposes indicator-based feedback is used by the general practitioners (GPs) and how they perceive it to contribute to their work. Methods Qualitative interviews with nine GPs in two regions in Denmark. The main selection criterion was that the informants had experience with retrieving electronic feedback. The data generation was explorative and open-ended and the analysis took an iterative approach with continuous refinement of themes that emerged from the data. Results The study identified two main uses of feedback: i) Administration of a regular disease control schedule for patients with chronic disease and ii) Routine monitoring of outcomes for purposes of resource prioritisation and medication management. Both uses were deemed valuable by the GPs, but also as an additional extra to the clinical core task. All the GPs experienced the feedback to be of limited relevance to the most central and challenging aspects of clinical work understood as the care for individuals. This led to different reactions: Some GPs would use the feedback as a point of departure for broader deliberations about individual patient needs and treatment approaches. For others, the perceived limitations decreased their overall motivation to seek feedback. Conclusions The study points to the importance of clarifying limitations as well as possibilities with respect to different aspects of clinical quality when introducing indicator-based technologies to practitioners. The results also emphasize that an indicator-based approach to quality improvement should not stand alone in general practice since some of the most central and challenging aspects of clinical work are not covered by this approach.
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Abstract
This essay is a personal review of a research journey extending over 50 years during which time the understanding of medical practice has changed out of all recognition and the quality and standing of the discipline of general practice has improved substantially. Three main bodies of work are reviewed and set against the reasons why they were undertaken. The first, on the pathology of the appendix and the management of possible appendicitis, was carried out almost entirely in the hospital setting. The second, about the prescribing of antibiotics for respiratory illnesses, and the third, about the determinants of good consulting practice, were carried out in general practice. The essay concludes with a reflection on the relevance of the work to some contemporary academic and health service issues. Although the work was carried out in the UK in the context of its National Health Service (NHS), the conclusions are widely generalizable and have contributed to health service and academic developments in many other countries.
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Affiliation(s)
- John G R Howie
- Emeritus professor of general practice, University of Edinburgh, 4 Ravelrig Park, Balerno, Edinburgh EH14 7DL, UK
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Abstract
BACKGROUND Empathy as a characteristic of patient-physician communication in both general practice and clinical care is considered to be the backbone of the patient-physician relationship. Although the value of empathy is seldom debated, its effectiveness is little discussed in general practice. This literature review explores the effectiveness of empathy in general practice. Effects that are discussed are: patient satisfaction and adherence, feelings of anxiety and stress, patient enablement, diagnostics related to information exchange, and clinical outcomes. AIM To review the existing literature concerning all studies published in the last 15 years on the effectiveness of physician empathy in general practice. DESIGN AND SETTING Systematic literature search. METHOD Searches of PubMed, EMBASE, and PsychINFO databases were undertaken, with citation searches of key studies and papers. Original studies published in English between July 1995 and July 2011, containing empirical data about patient experience of GPs' empathy, were included. Qualitative assessment was applied using Giacomini and Cook's criteria. RESULTS After screening the literature using specified selection criteria, 964 original studies were selected; of these, seven were included in this review after applying quality assessment. There is a good correlation between physician empathy and patient satisfaction and a direct positive relationship with strengthening patient enablement. Empathy lowers patients' anxiety and distress and delivers significantly better clinical outcomes. CONCLUSION Although only a small number of studies could be used in this search, the general outcome seems to be that empathy in the patient-physician communication in general practice is of unquestionable importance.
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Wong CKM, Yip BHK, Mercer S, Griffiths S, Kung K, Wong MCS, Chor J, Wong SYS. Effect of facemasks on empathy and relational continuity: a randomised controlled trial in primary care. BMC FAMILY PRACTICE 2013; 14:200. [PMID: 24364989 PMCID: PMC3879648 DOI: 10.1186/1471-2296-14-200] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 12/17/2013] [Indexed: 11/16/2022]
Abstract
Background There is limited evidence to support the use of facemasks in preventing infection for primary care professionals. Negative effects on communication has been suggested when the physician wears a facemask. As communication skills and doctor patient relationship are essential to primary care consultations, the effects of doctor’s facemask wearing were explored. Method A randomised controlled study was conducted in primary care to explore the effects of doctors wearing facemasks on patients’ perception of doctors’ empathy, patient enablement and patient satisfaction. Primary care doctors were randomized to mask wearing and non mask wearing clinical consultations in public primary care clinics in Hong Kong. Patients’ views were gathered using the Consultation and Relational Empathy (CARE) Measure, Patient Enablement Instrument (PEI) and an overall satisfaction rating scale. The effects of face mask wearing were investigated using multilevel (hierarchical) modelling. Results 1,030 patients were randomised to doctor-mask wearing consultations (n = 514) and non mask wearing consultations (n = 516). A significant and negative effect was found in the patients’ perception of the doctors’ empathy (CARE score reduction -0.98, p-value = 0.04). In the more established doctor-patient relationship, the effect of doctors’ mask wearing was more pronounced (CARE score reduction -5.67, p-value = 0.03). Conclusion This study demonstrates that when doctors wearing a facemask during consultations, this has a significant negative impact on the patient’s perceived empathy and diminish the positive effects of relational continuity. Consideration should be taken in planning appropriate use of facemasks in infectious disease policy for primary care and other healthcare professionals at a national, local or practice level. Clinical trial registration This trial was registered on Chinese Clinical Trial Register (ChiCTR). Registration no.: ChiCTR-TTRCC-12002519. URL: http://www.chictr.org/en/proj/show.aspx?proj=3486. Due to administrative error, registration of trial did not take place until after the trial started on 1st August 2011 and registration number was released on 21st September 2012.
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Affiliation(s)
| | - Benjamin Hon Kei Yip
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, 4/F, School of Public Health building, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR.
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McArthur ML, Fitzgerald JR. Companion animal veterinarians' use of clinical communication skills. Aust Vet J 2013; 91:374-80. [PMID: 23980830 DOI: 10.1111/avj.12083] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2013] [Indexed: 11/28/2022]
Affiliation(s)
- ML McArthur
- School of Animal and Veterinary Science; University of Adelaide; South Australia; Australia
| | - JR Fitzgerald
- School of Medicine; University of Queensland; Brisbane; Queensland; Australia
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Reeve J, Lloyd-Williams M, Payne S, Dowrick C. Towards a re-conceptualisation of the management of distress in palliative care patients: the self-integrity model. PROGRESS IN PALLIATIVE CARE 2013. [DOI: 10.1179/096992609x392277] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Hunter J, Leeder S. Patient questionnaires for use in the integrative medicine primary care setting—A systematic literature review. Eur J Integr Med 2013. [DOI: 10.1016/j.eujim.2013.02.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Gruffydd-Jones K, Marsden H, Holmes S, Kardos P, Escamilla R, Dal Negro R, Roberts J, Nadeau G, Leather D, Jones P. Novel study design to assess the utility of the copd assessment test in a primary care setting. BMC Med Res Methodol 2013; 13:63. [PMID: 23663700 PMCID: PMC3667066 DOI: 10.1186/1471-2288-13-63] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 04/22/2013] [Indexed: 11/10/2022] Open
Abstract
The quality of a consultation provided by a physician can have a profound impact on the quality of care and patient engagement in treatment decisions. When the COPD Assessment Test (CAT) was developed, one of its aims was to aid the communication between physician and patient about the impact of COPD. We developed a novel study design to assess this in a primary care consultation. Primary care physicians across five countries in Europe conducted videoed consultations with six standardised COPD patients (played by trained actors) which had patient-specific issues that the physician needed to identify through questioning. Half the physicians saw the patients with the completed CAT, and half without. Independent assessors scored the physicians on their ability to identify and address the patient-specific issues, review standard COPD aspects, their understanding of the case and their overall performance. This novel study design presented many challenges which needed to be addressed to achieve an acceptable level of robustness to assess the utility of the CAT. This paper discusses these challenges and the measures adopted to eliminate or minimise their impact on the study results.
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Affiliation(s)
| | - Helen Marsden
- Respiratory Centre of Excellence, GlaxoSmithKline, London, United Kingdom
| | - Steve Holmes
- The Park Medical Practice, Shepton Mallet, United Kingdom
| | - Peter Kardos
- Gemeinschaftspraxis und Zentrum für Pneumologie, Allergologie, Schlafmedizin, Frankfurt, Germany
| | | | | | - June Roberts
- Salford Royal Hospital Foundation Trust, Salford, United Kingdom
| | - Gilbert Nadeau
- Respiratory Centre of Excellence, GlaxoSmithKline, London, United Kingdom
| | - David Leather
- Respiratory Centre of Excellence, GlaxoSmithKline, London, United Kingdom
| | - Paul Jones
- St George's University of London, London, United Kingdom
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van Olmen J, Ku GM, van Pelt M, Kalobu JC, Hen H, Darras C, Van Acker K, Villaraza B, Schellevis F, Kegels G. The effectiveness of text messages support for diabetes self-management: protocol of the TEXT4DSM study in the democratic Republic of Congo, Cambodia and the Philippines. BMC Public Health 2013; 13:423. [PMID: 23635331 PMCID: PMC3658970 DOI: 10.1186/1471-2458-13-423] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 03/19/2013] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND People with diabetes find it difficult to sustain adequate self-management behaviour. Self-Management Support strategies, including the use of mobile technology, have shown potential benefit. This study evaluates the effectiveness of a mobile phone support intervention on top of an existing strategy in three countries, DR Congo, Cambodia and the Philippines to improve health outcomes, access to care and enablement of people with diabetes, with 480 people with diabetes in each country who are randomised to either standard support or to the intervention. DESIGN/METHODS The study consists of three sub-studies with a similar design in three countries to be independently implemented and analysed. The design is a two-arm Randomised Controlled Trial, in which a total of 480 adults with diabetes participating in an existing DSME programme will be randomly allocated to either usual care in the existing programme or to usual care plus a mobile phone self-management support intervention. Participants in both arms complete assessments at baseline, one year and two years after inclusion.Glycosylated haemoglobin blood pressure, height, weight, waist circumference will be measured. Individual interviews will be conducted to determine the patients' assessment of chronic illness care, degree of self-enablement, and access to care before implementation of the intervention, at intermediate moments and at the end of the study.Analyses of quantitative data including assessment of differences in changes in outcomes between the intervention and usual care group will be done. A probability of <0.05 is considered statistically significant. Outcome indicators will be plotted over time. All data are analysed for confounding and interaction in multivariate regression analyses taking potential clustering effects into account.Differences in outcome measures will be analysed per country and realistic evaluation to assess processes and context factors that influence implementation in order to understand why it works, for whom, under which circumstances. A costing study will be performed. DISCUSSION The intervention addresses the problem that the greater part of diabetes management takes place without external support and that many challenges, unforeseen problems and questions occur at moments in between scheduled contacts with the support system, by exploiting communication technology. TRIAL REGISTRATION ISRCTN86247213.
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Affiliation(s)
- Josefien van Olmen
- Department of Public Health, Institute of Tropical Medicine, Brussels, Antwerp, Belgium
- Department of General Practice & Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The netherlands
| | - Grace Marie Ku
- Department of Public Health, Institute of Tropical Medicine, Brussels, Antwerp, Belgium
- Veterans Memorial Medical Center, Quezon, Philippines
| | | | | | | | | | - Kristien Van Acker
- Diabetologist, working at Algemeen ziekenhuis Heilige Familie, Reet & Centre de Santé des Fagnes, Chimay, Belgium
| | | | - Francois Schellevis
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, Netherlands & Department of General Practice and Elderly Care Medicine/EMGO Institute for Health and Care Research VU University Medical Center, Amsterdam, The Netherlands
| | - Guy Kegels
- Department of Public Health, Institute of Tropical Medicine, Brussels, Antwerp, Belgium
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Kuusela M, Vainiomäki P, Kiviranta A, Rautava P. The Missing Evaluation at the End of GP's Consultation. INTERNATIONAL JOURNAL OF FAMILY MEDICINE 2013; 2013:672857. [PMID: 23365747 PMCID: PMC3556442 DOI: 10.1155/2013/672857] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 12/04/2012] [Accepted: 12/04/2012] [Indexed: 06/01/2023]
Abstract
Evaluation at the end of a consultation is an element of a successful encounter. The doctor should inquire if patient's expectations were fulfilled and sum up the information given, the examinations performed, and the decisions made with the patient. This way the patient would be fully aware of what has been decided and that the problems and expectations of the patient had been taken into account. Twenty consultations of four general practitioners (GPs) in Finland were videotaped. The doctors were men and women, two of them had a long experience and two were trainees in general practice. The data (videotapes, questionnaires, and interviews) were analysed by multiple research methods with investigator and methodological triangulation. MAAS-Global Rating List was used as an assessment tool. The evaluation of the consultation was often missing or having shortages; only one-third was assessed to be better than doubtful. The assessments done by experienced GPs and the medical student were similar. According to the result of this study as well as the information in the current literature, doctors in all periods of their career should repeatedly be reminded about the importance of the evaluation at the end of the consultation.
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Affiliation(s)
- Maisa Kuusela
- Department of Health Care and Social Services, City of Turku, PB 670, 20101 Turku, Finland
| | - Paula Vainiomäki
- Department of Primary Health Care, Turku University Hospital, PB 52, 20521 Turku, Finland
- Family Medicine, University of Turku, Lemminkäisenk 1, 20014 Turku, Finland
| | - Anni Kiviranta
- Säkylä Köyliö Municipal Primary Health Care Centre, Välskärintie 5, 27800 Säkylä, Finland
| | - Päivi Rautava
- Public Health, University of Turku, Lemminkäisenkatu 1, 20014 Turku, Finland
- Turku Clinical Research Centre, Turku University Hospital, PB 52, 20521 Turku, Finland
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Hudon C, Fortin M, Haggerty J, Loignon C, Lambert M, Poitras ME. Patient-centered care in chronic disease management: a thematic analysis of the literature in family medicine. PATIENT EDUCATION AND COUNSELING 2012; 88:170-6. [PMID: 22360841 DOI: 10.1016/j.pec.2012.01.009] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Revised: 12/21/2011] [Accepted: 01/14/2012] [Indexed: 05/16/2023]
Abstract
OBJECTIVE The objective was to provide a synthesis of the results of the research and discourse lines on main dimensions of patient-centered care in the context of chronic disease management in family medicine, building on Stewart et al.'s model. METHODS We developed search strategies for the Medline, Embase, and Cochrane databases, from 1980 to April 2009. All articles addressing patient-centered care in the context of chronic disease management in family medicine were included. A thematic analysis was performed using mixed codification, based on Stewart's model of patient-centered care. RESULTS Thirty-two articles were included. Six major themes emerged: (1) starting from the patient's situation; (2) legitimizing the illness experience; (3) acknowledging the patient's expertise; (4) offering realistic hope; (5) developing an ongoing partnership; (6) providing advocacy for the patient in the health care system. CONCLUSION The context of chronic disease management brings forward new dimensions of patient-centered care such as legitimizing the illness experience, acknowledging patient expertise, offering hope and providing advocacy. PRACTICE IMPLICATIONS Chronic disease management calls for the adaptation of the family physician's role to patients' fluctuating needs. Literature also suggests the involvement of the family physician in care transitions as a component of patient-centered care.
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Affiliation(s)
- Catherine Hudon
- Département de Médecine de Famille, Université de Sherbrooke, Quebec, Canada.
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Beattie M, Shepherd A, Howieson B. Do the Institute of Medicine’s (IOM’s) dimensions of quality capture the current meaning of quality in health care? – An integrative review. J Res Nurs 2012. [DOI: 10.1177/1744987112440568] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Aims: The aim of this study was to determine whether the widely adopted Institute of Medicine’s dimensions of quality capture the current meaning of quality in health care literature. Design: An integrative review was utilised as there has been a multitude of published papers defining quality in relation to health care, therefore collective analysis may provide new insight and understanding. Method: Papers offering a definition or conceptual understanding of quality in relation to health care were identified by searching relevant databases. Papers were excluded according to predefined criteria. An integrative review was conducted and the Institute of Medicine’s dimensions were used as a framework for data extraction and analysis. Findings: The review identified two important additional dimensions of quality; namely caring and navigating the health care system and argues that they require recognition as dimensions in their own right. Conclusion: In the current climate of constrained finances there is a risk that the allocation of resources is directed to current explicit dimensions to the detriment of others. The result may be a reduction in health care quality, rather than improvement.
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Affiliation(s)
- Michelle Beattie
- University of Stirling, UK
- Institute for People-Centred Healthcare Management, Stirling Management School, University of Stirling, UK
| | - Ashley Shepherd
- School of Nursing, Midwifery and Health, University of Stirling, UK
- Institute for People-Centred Healthcare Management, Stirling Management School, University of Stirling, UK
| | - Brian Howieson
- Institute for People-Centred Healthcare Management, Stirling Management School, University of Stirling, UK
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Vaillancourt H, Légaré F, Lapointe A, Deschênes SM, Desroches S. Assessing patients' involvement in decision making during the nutritional consultation with a dietitian. Health Expect 2012; 17:545-54. [PMID: 22512818 DOI: 10.1111/j.1369-7625.2012.00783.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Shared decision making (SDM) represents an interesting approach to optimize the impact of dietary treatment, but there is no evidence that SDM is commonly integrated into diet-related health care. OBJECTIVE To assess the extent to which dietitians involve patients in decisions about dietary treatment. METHODS We audiotaped dietitians conducting nutritional consultations with their patients, and we transcribed the tapes verbatim. Three trained raters independently evaluated the content of the nutritional consultations using a coding frame based on the 12 items of the French-language version of the OPTION scale, a validated and reliable third-observer instrument designed to assess patients' involvement by examining specific health professionals' behaviours. Coding was facilitated by the qualitative research software NVivo 8. We assessed internal consistency with Cronbach's alpha and inter-rater reliability with the intraclass correlation coefficient (ICC). RESULTS Of the 40 dietitians eligible to participate in the study, 19 took part. We recruited one patient per participating dietitian. The overall mean OPTION score was 29 ± 8% [range, 0% (no patient involvement in the decision] to 100% [high patient involvement)]. The mean duration of consultations was 50 ± 26 min. The OPTION score was positively correlated with the duration of the consultation (r = 0.65, P < 0.01). Internal consistency and inter-rater reliability were both good (Cronbach's alpha = 0.72; ICC = 0.65). CONCLUSION This study is the first to use a framework based on the OPTION scale to report on dietitians' involvement of patients in decisions about patients' dietary treatment. The results suggest that involvement is suboptimal. Interventions to increase patients' involvement in diet-related decision making are indicated.
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Affiliation(s)
- Hugues Vaillancourt
- Research Assistant, Institute of Nutraceuticals and Functional Foods (INAF), Laval University, Quebec City, QCAffiliated Researcher, CHUQ Research Center (Centre Hospitalier Universitaire de Québec - Hôpital St-François-d'Assise),Associate Professor, Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, QC,Associate Professor, Department of Food and Nutrition Sciences, Faculty of Agriculture and Food Sciences, Laval University, Quebec City, QC,Affiliated Researcher, Institute of Nutraceuticals and Functional Foods (INAF), Laval University, Quebec City, QC, Canada
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Ritchie L. James Mackenzie Lecture 2010: Beyond the numbers game--the call of leadership. Br J Gen Pract 2012; 62:e64-7. [PMID: 22520684 PMCID: PMC3252542 DOI: 10.3399/bjgp12x616472] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- Lewis Ritchie
- Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK.
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Mercer SW, Fung CSC, Chan FWK, Wong FYY, Wong SYS, Murphy D. The Chinese-version of the CARE measure reliably differentiates between doctors in primary care: a cross-sectional study in Hong Kong. BMC FAMILY PRACTICE 2011; 12:43. [PMID: 21631927 PMCID: PMC3123195 DOI: 10.1186/1471-2296-12-43] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Accepted: 06/01/2011] [Indexed: 12/04/2022]
Abstract
BACKGROUND The Consultation and Relational Empathy (CARE) Measure is a widely used patient-rated experience measure which has recently been translated into Chinese and has undergone preliminary qualitative and quantitative validation. The objective of this study was to determine the reliability of the Chinese-version of the CARE Measure in reliably differentiating between doctors in a primary care setting in Hong Kong METHODS Data were collected from 984 primary care patients attending 20 doctors with differing levels of training in family medicine in 5 public clinics in Hong Kong. The acceptability of the Chinese-CARE measure to patients was assessed. The reliability of the measure in discriminating effectively between doctors was analysed by Generalisability-theory (G-Theory) RESULTS The items in the Chinese-CARE measure were regarded as important by patients and there were few 'not applicable' responses. The measure showed high internal reliability (coefficient 0.95) and effectively differentiated between doctors with only 15-20 patient ratings per doctor (inter-rater reliability > 0.8). Doctors' mean CARE measure scores varied widely, ranging from 24.1 to 45.9 (maximum possible score 50) with a mean of 34.6. CARE Measure scores were positively correlated with level of training in family medicine (Spearman's rho 0.493, p < 0.05). CONCLUSION These data demonstrate the acceptability, feasibility and reliability of using the Chinese-CARE Measure in primary care in Hong Kong to differentiate between doctors interpersonal competencies. Training in family medicine appears to enhance these key interpersonal skills.
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Affiliation(s)
- Stewart W Mercer
- Primary Care Research, General Practice and Primary Care, University of Glasgow, Glasgow, Scotland, UK
| | - Colman SC Fung
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T., Hong Kong
| | - Frank WK Chan
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T., Hong Kong
| | - Fiona YY Wong
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T., Hong Kong
| | - Samuel YS Wong
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T., Hong Kong
| | - Douglas Murphy
- Quality, Safety and Informatics Research Group, Division of Clinical and Population Sciences and Education, University of Dundee, Dundee, Scotland, UK
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Birhanu Z, Woldie MK, Assefa T, Morankar S. Determinants of patient enablement at primary health care centres in central Ethiopia: a cross-sectional study. Afr J Prim Health Care Fam Med 2011. [PMCID: PMC4565461 DOI: 10.4102/phcfm.v3i1.195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Patient enablement is associated with behaviours like treatment adherence and self-care and is becoming a well-accepted indicator of quality of care. However, the concept of patient enablement has never been subjected to scientific inquiry in Ethiopia. Objectives The aim of this study was to determine the degree of patient enablement and its predictors after consultation at primary health care centres in central Ethiopia. Method Data were collected from 768 outpatients from six primary health care centres in central Ethiopia during a cross-sectional study designed to assess patient satisfaction. Consecutive patients, 15 years or older, were selected for the study from each health centre. Multinomial logistic regression was performed to identify predictors of patient enablement using SPSS (version 16.0). Results The study showed that 48.4% of patients expressed an intermediate level of enablement, while 25.4% and 26.2% of the patients expressed low and high levels of patient enablement, respectively. Four models were developed to identify predictors of patient enablement. The first model included socio-demographic variables, showing that residence, educational status and occupational status were significantly associated with patient enablement (p < 0.05). This model explained only 20.5% of the variation. The second and third models included institutional aspects, and perceived doctor–patient interaction and information sharing about illness, respectively. They explained 31.1% and 64.9% of the variation. The fourth model included variables that were significantly associated with patient enablement in the first, second and third models and explained 72% of the variation. In this model, perceived empathy and technical competency, non-verbal communication, familiarity with the provider, information sharing about illness and arrangement for follow-up visits were strong predictors of patient enablement (p < 0.05). Conclusion The present study revealed specific predictors of patient enablement, which health care providers should consider in their practice to enhance patient enablement after consultation.
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Affiliation(s)
- Zewdie Birhanu
- Department of Health Education and Behavioural Sciences, Jimma University, Ethiopia
| | | | - Tsion Assefa
- Department of Health Education and Behavioural Sciences, Jimma University, Ethiopia
| | - Sudhakar Morankar
- Department of Health Education and Behavioural Sciences, Jimma University, Ethiopia
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