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Thomas H, Lynch J, Burch E, Best M, Ball L, Sturgiss E, Sturman N. Where the joy comes from: a qualitative exploration of deep GP-patient relationships. BMC Prim Care 2023; 24:268. [PMID: 38087212 PMCID: PMC10717859 DOI: 10.1186/s12875-023-02224-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/26/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Relationship-based, whole person care is foundational to quality general practice. Previous research has identified several characteristics of deep General Practitioner (GP)-patient relationships and their association with improved patient concordance, satisfaction and perceived health outcomes. Psychological attachment theory has been used to understand therapeutic relationships, but has only been explored to a limited extent in the general practice context. Additionally, evolving changes in sociocultural and commercial practice contexts may threaten relationship-based care. In view of this, we aimed to explore the nature and experience of deep GP-patient relationships, as identified by patients, from GP and patient perspectives. METHODS Semi-structured interview design. An initial survey assessed patients' perceived depth of their relationship with their GP, using the Health Care Provider Attachment Figure Survey and Patient-Doctor Depth of Relationship Scale. Patients who reported a deep relationship, and their GPs, were purposively selected for individual interviews exploring their experience of these relationships. A post-interview survey assessed interviewees' attachment styles, using the Modified and Brief Experiences in Close Relationships Scale. Patient interviewees also rated the patient-centredness of their GP's clinic using the Person-Centred Primary Care Measure. Transcripts were analysed using thematic analysis. RESULTS Thirteen patients and five GPs were interviewed. Four themes characterised deep relationships: the 'professional'; human connection; trust; and 'above and beyond'. Patient, GP and practice team all contributed to their cultivation. CONCLUSIONS We present a revised conceptual framework of deep GP-patient relationships. Deep relationships come to the fore in times of patient trouble. Like attachment relationships, they provide a sense of safety, caring and support for patients experiencing vulnerability. They can stretch GP boundaries and capacity for self-care, but also provide joy and vocational satisfaction. Patients may not always desire or need deep relationships with their GP. However, findings highlight the importance of enabling and cultivating these for times of patient hardship, and challenges of doing so within current healthcare climates.
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Affiliation(s)
- Hayley Thomas
- General Practice Clinical Unit, Faculty of Medicine, The University of Queensland, Level 8, UQ Health Sciences Building (Building 16/901), Royal Brisbane and Women's Hospital, Herston, QLD, 4006, Australia.
| | - Johanna Lynch
- General Practice Clinical Unit, Faculty of Medicine, The University of Queensland, Level 8, UQ Health Sciences Building (Building 16/901), Royal Brisbane and Women's Hospital, Herston, QLD, 4006, Australia
| | - Emily Burch
- Faculty of Health, Southern Cross University, Gold Coast, QLD, Australia
| | - Megan Best
- Institute for Ethics and Society, University of Notre Dame Australia, Sydney, NSW, Australia
| | - Lauren Ball
- Centre for Community Health and Wellbeing, The University of Queensland, Springfield, QLD, Australia
| | - Elizabeth Sturgiss
- School of Primary and Allied Health Care, Monash University, Frankston, VIC, Australia
| | - Nancy Sturman
- General Practice Clinical Unit, Faculty of Medicine, The University of Queensland, Level 8, UQ Health Sciences Building (Building 16/901), Royal Brisbane and Women's Hospital, Herston, QLD, 4006, Australia
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Jung HW, Lee WR. Association between initial continuity of care status and diabetes-related health outcomes in older patients with type 2 diabetes mellitus: A nationwide retrospective cohort study in South Korea. Prim Care Diabetes 2023; 17:600-606. [PMID: 37865571 DOI: 10.1016/j.pcd.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/17/2023] [Accepted: 10/08/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND AND AIM Timely and continuous care is necessary for patients with diabetes to prevent hospitalization and complications. This study investigated the association between initial Continuity of Care Index (COCI) status after diagnosis of type 2 diabetes mellitus (T2DM) and short- and long-term diabetes-related health outcomes. METHODS It targeted elderly patients aged 60 years and above diagnosed with T2DM and used the National Health Insurance Service Senior cohort data from 2008 to 2019. The outcome measures were diabetic avoidable hospitalization and diabetic complication incidence for a five-year period. The main independent variable was the first-year COCI status after T2DM diagnosis. Survival analyses were performed using the Cox proportional hazards model. RESULTS Participants with a good COCI status within the first year of being diagnosed with T2DM experienced a reduced risk of diabetes-induced avoidable hospitalization (five years: Hazard ratio (HR) 0.39, 95 % Confidence interval (CI) 0.27-0.57; overall period: HR 0.56, 95 % CI 0.43-0.72) and diabetic complications (five years: HR 0.74, 95 % CI 0.68-0.80; overall period: HR 0.77, 95 % CI 0.71-0.82). CONCLUSIONS In the short- and long-term, there is a need for early management and improved healthcare accessibility of diabetes to prevent diabetes-avoidable hospitalization and diabetes-related complications.
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Affiliation(s)
- Hyun Woo Jung
- Department of Health Administration, Graduate School·BK21 Graduate Program Of Developing Glocal Experts in Health Policy And Management, Yonsei University, Wonju, South Korea
| | - Woo-Ri Lee
- Department of Research and Analysis, National Health Insurance Service Ilsan Hospital, Goyang, South Korea.
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Abstract
Objectives: To assess the effectiveness of continuity of care policies by identifying the impact of a chronic disease management program on the continuity of care in patients with hypertension in South Korea. Methods: The propensity score matching method was used to control selection bias, and the difference-in-differences method was used to compare the impact on the treatment and control groups according to the policy intervention. Results: The continuity of care index of hypertensive patients using the difference-in-differences analysis outcome of the chronic disease management program was higher than that of the non-participating hypertensive patients. Conclusion: Continuous treatment is vital for chronic diseases such as hypertension. However, the proportion of those participating in the intervention was low. Encouraging more hypertensive patients to participate in policy intervention through continuous research and expanding the policy to appropriately reflect the increasing number of chronic diseases is necessary.
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Affiliation(s)
- Woo-Ri Lee
- Department of Health Administration, Yonsei University, Wonju, South Korea
| | - Ki-Bong Yoo
- Department of Health Administration, Yonsei University, Wonju, South Korea
- *Correspondence: Ki-Bong Yoo,
| | - Jiyun Jeong
- Institute of Health and Welfare, Yonsei University, Wonju, South Korea
| | - Jun Hyuk Koo
- Yonsei University Wonju Industry-Academic Cooperation Foundation, Wonju, South Korea
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Wei Y, Wang F, Pan Z, Jin G, Wang D, Lu X, Cao Q. Work Content of General Practitioners in Beijing, China: A Multi-method Study. Front Public Health 2022; 10:870224. [PMID: 35570960 PMCID: PMC9096235 DOI: 10.3389/fpubh.2022.870224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background Despite the dramatic growth of primary care in China, little evidence showed what general practitioner (GP) do and how GP provided medical service in Beijing. Objective This study aimed to explore the work content of GPs in primary care in Beijing. Methods A multi-method study was conducted in five community health service institutions using non-participant observation and critical incident technique interview. Eleven GPs was recruited by purpose sampling, with each GP recording details of 100 patient encounters. Health problems of patients and activities of GPs were observed in consultations. Then, critical incident technique interviews were conducted focusing on GPs' works out of clinics and challenge. Results A total of 1, 100 patients encounters and 1,897 reasons for encounter (RFEs) were recorded from 11 GPs. There were 1897 RFEs (1.72 per encounter) and 2,762 health problems (2.51 per encounter) from 1,100 encounters during our observation. GPs' work related to consultation was focus on disease diagnoses and treatment. Physical examination and investigations were performed in only 15.5 and 17.1% consultations, respectively. Procedures for chronic disease management were infrequently provided to patients (0.4–26.6%). Time spent in each work process in consultations ranged from 0.68 ± 0.27 min for reservation to 4.00 ± 2.45 min for surgical treatment. In addition to clinical work, there were tasks about health files, contracted family doctor services, health education, teaching students, and scientific research. Conclusion This study illustrated the complexity of GPs' work and heavy workload in Beijing, China. More attention and effort are needed to develop GPs performance and release GPs' work workload in primary care.
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Affiliation(s)
- Yun Wei
- Department of General Practice, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Feiyue Wang
- Department of General Practice, School of General Practice and Continuing Education, Capital Medical University, Beijing, China
| | - Zhaolu Pan
- Department of General Practice, School of General Practice and Continuing Education, Capital Medical University, Beijing, China
| | - Guanghui Jin
- Department of General Practice, School of General Practice and Continuing Education, Capital Medical University, Beijing, China
| | - Dawei Wang
- Department of General Practice, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xiaoqin Lu
- Department of General Practice, School of General Practice and Continuing Education, Capital Medical University, Beijing, China
| | - Qiumei Cao
- Department of General Practice, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- *Correspondence: Qiumei Cao
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Chauvin P, Fustinoni S, Seematter-Bagnoud L, Herr M, Santos Eggimann B. Potentially inappropriate prescriptions: Associations with the health insurance contract and the quality of the patient-physician relationship? Health Policy 2021; 125:1146-1157. [PMID: 34266705 DOI: 10.1016/j.healthpol.2021.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 05/19/2021] [Accepted: 06/22/2021] [Indexed: 11/18/2022]
Abstract
CONTEXT Potentially Inappropriate Prescriptions (PIP) are often used as an indicator of potential drug overuse or misuse to limit adverse drug events in older people. OBJECTIVE To determine whether PIP exposure differs as a function of the patient's health insurance scheme and the patient-physician relationship. METHODS Our dataset was collected from two surveys delivered to two cohorts of the Swiss Lc65+ study, together with a stratified random sample of older people in the Swiss canton of Vaud. The study sample consisted of 1,595 people aged 68 years and older living in the community and reporting at least one prescription drug. Logit regression models of PIP risk were run for various categories of variables: health related, socioeconomic, health insurance scheme and patient-physician relationship. RESULTS 17% of our respondents had at least one PIP. Our results suggested that being enrolled in a health plan with restriction in the patient's choice of providers and having higher deductibles were associated with lower PIP risk. PIP risk did not differ as a function of the quality of the patient-physician relationship. CONCLUSION Our study helps to raise awareness about the organizational risk factors of PIP and, more specifically, how health insurance contracts could play a role in improving the management of drug consumption among community-dwelling older people.
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Affiliation(s)
- Pauline Chauvin
- LIRAES - EA4470, Université de Paris, Centre des Saints-Pères, 45 rue des Saints-Pères, 75006 Paris, France.
| | - Sarah Fustinoni
- Center for primary care and public health (Unisanté), University of Lausanne, Biopôle 2 SV-A, Route de la Corniche 10, 1010 Lausanne, Switzerland
| | - Laurence Seematter-Bagnoud
- Center for primary care and public health (Unisanté), University of Lausanne, Biopôle 2 SV-A, Route de la Corniche 10, 1010 Lausanne, Switzerland
| | - Marie Herr
- Université Paris-Saclay, UVSQ, Inserm,CESP, Echappement aux anti-infectieux et pharmaco-épidémiologie, 94807, Montigny-le-Bretonneux, France; Département Hospitalier d'Epidémiologie et de Santé Publique, AP-HP. Université Paris-Saclay, 2 avenue de la source de la Bièvre, 78180 Montigny-le-Bretonneux, Paris, France
| | - Brigitte Santos Eggimann
- Center for primary care and public health (Unisanté), University of Lausanne, Biopôle 2 SV-A, Route de la Corniche 10, 1010 Lausanne, Switzerland
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Wilson BN, Murase JE, Sliwka D, Botto N. Bridging racial differences in the clinical encounter: How implicit bias and stereotype threat contribute to health care disparities in the dermatology clinic. Int J Womens Dermatol 2021; 7:139-144. [PMID: 33937479 PMCID: PMC8072500 DOI: 10.1016/j.ijwd.2020.12.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 12/24/2020] [Accepted: 12/26/2020] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Positive interactions that build good relationships between patients and providers demonstrate improved health outcomes for patients. Yet, racial minority patients may not be on an equal footing in having positive interactions. Stereotype threat and implicit bias in clinical medicine negatively affect the quality of care that racial minorities receive. Dermatology, one of the least racially diverse specialties in medicine, further falls short in providing patients with options for race-concordant visits, which are noted to afford improved experiences and outcomes. OBJECTIVE This study aimed to analyze implicit bias and stereotype threat in a dermatology clinical scenario with the goal of identifying actions that providers, particularly those that are not racial minorities, can take to improve the quality of the clinical interactions between the minority patient and provider. METHODS We illustrate a hypothetical patient visit and identify elements that are susceptible to both stereotype threat and implicit bias. We then develop an action plan that dermatologists can use to combat stereotype threat and implicit bias in the clinical setting. RESULTS The details of an action plan to combat the effect of stereotype threat and implicit bias are as follows: 1) Invite practices that increase representation within all aspects of the patient visit (from wall art to mission statements to creating a culture that embraces difference and not just diversity); 2) employ communication techniques targeted to invite and understand the patient perspective; and 3) practice making empathic statements to normalize anxiety and foster connection during the visit. CONCLUSION Knowledge of stereotype threat and implicit bias and their sequelae, as well as an understanding of steps that can be taken preemptively to counteract these factors, create opportunities to improve clinical care and patient outcomes in racial minority patients.
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Affiliation(s)
- Britney N. Wilson
- School of Medicine, Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Jenny E. Murase
- Department of Dermatology, University of California-San Francisco, San Francisco, CA, United States
- Department of Dermatology, Palo Alto Foundation Medical Group, Mountain View, CA, United States
| | - Diane Sliwka
- Department of Medicine, University of California-San Francisco, San Francisco, CA, United States
| | - Nina Botto
- Department of Dermatology, University of California-San Francisco, San Francisco, CA, United States
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Mazza D, McCarthy E, Singh N, Carey M, Turner L, Harris M. "There's always something else": Patient perspectives on improving the implementation of obesity guidelines in general practice. Obes Res Clin Pract 2020; 14:437-442. [PMID: 32962956 DOI: 10.1016/j.orcp.2020.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 09/08/2020] [Accepted: 09/11/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The prevalence of obesity in Australia is rising. National guidelines for the management of overweight and obesity exist but our previous work demonstrates poor implementation of key elements in general practice. The aim of this study was to describe patient perspectives on the implementation of obesity guidelines in general practice. METHODS Qualitative study of 40 people living with obesity (PwO) who were recruited through general practices in Melbourne, Australia. PwO had a recorded BMI in the overweight range or above (>25), had attended a consultation in the last 6 months and had a diagnosis of at least one of the following: diabetes, kidney disease, hyperlipidemia, hypertension, or cardiovascular disease. Semi-structured telephone interviews were conducted with patients. Interviews were audio-recorded, transcribed verbatim and analysed thematically. RESULTS While a strong general practitioner (GP)-patient relationship enabled conversation to occur about weight management there was uncertainty as to whether patients or GPs should broach the topic of weight. Patients described complacency regarding their weight and often being unprepared to take up GP advice. Other health issues were felt to take precedence, and patients described inconsistent provision of information and resources to assist them in tackling their weight problems. CONCLUSIONS It is imperative to take into account patient perspectives on obesity management in general practice in order to improve health outcomes. This study provides valuable insights into how PwO can be better managed. Interventions should also include strategies to help patients maintain motivation in making lifestyle changes to support healthy weight loss.
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Affiliation(s)
- D Mazza
- Department of General Practice, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia.
| | - E McCarthy
- Department of General Practice, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| | - N Singh
- Department of General Practice, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| | - M Carey
- School of Medicine and Public Health, University of Newcastle, Australia
| | - L Turner
- Department of General Practice, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| | - M Harris
- School of Public Health and Community Medicine, University of New South Wales, Australia
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Abstract
OBJECTIVES To explore preferences of the patients attending King Abdulaziz Medical City (KAMC), Jeddah, Saudi Arabia, in their treating physicians and to determine demographic and personal factors influencing their preferences. METHODS Through a cross sectional design, 366 patients attending KAMC were systematically selected, and were requested to a pre-designed valid questionnaire. The study conducted between November 2017 and January 2018. The Statistical Package for Social Sciences was used for statistical analysis which included independent sample t-test, ANOVA and Pearson correlation. A p-value less than 0.05 was considered significant. RESULTS The study showed that females were significantly more preferring to get information, careful examination and receiving attention. Older respondents were interested in nding out how serious is their problem and having enough time for talking about their condition. Higher income respondents focused on necessity of physician caring for their personal situation. Highly educated individuals were concerned about getting enough information, and patients with chronic diseases were much interested by the truth of their condition. Each dimension of the personality traits was significantly correlated with different package of preferences in their treating physician. CONCLUSION Respondents' preferences in their treating physician are significantly influenced by their demographic characteristics as well as their personality traits. It is highly recommended that physicians, generally, should be attentive listener, informative while discussion, maintaining eye contact and showing interest and empathy for adult middle-aged patient. Also, to consider other preferable features based on patients' demographics and personalities.
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Affiliation(s)
- Khalid S Alraddadi
- Department of Family Medicine, King Abdulaziz Medical City, Jeddah, Kingdom of Saudi Arabia. E-mail.
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Trabjerg TB, Jensen LH, Sondergaard J, Trabjerg ND, Sisler JJ, Hansen DG. Investigating whether shared video-based consultations with patients, oncologists, and GPs can benefit patient-centred cancer care: a qualitative study. BJGP Open 2020; 4:bjgpopen20X101023. [PMID: 32238390 DOI: 10.3399/bjgpopen20X101023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 09/29/2019] [Indexed: 12/12/2022] Open
Abstract
Background Guidelines have proposed that GPs should have a central role as coordinators of care and support patients with cancer during all stages of treatment, follow-up, and rehabilitation. Multidisciplinary video consultation involving the patient with cancer, the oncologist, and the GP may help to define roles and tasks, and this resulting clarity may enable greater support for patients with cancer. Aim To explore the consultation structure, content, and task clarification when a GP and an oncologist are attending a video consultation with a patient with cancer. Design & setting A qualitative study took place in the Region of Southern Denmark to investigate multidisciplinary video consultations, based on thematic analysis. Method Recordings of 12 video consultations were analysed using the framework method. A combined deductive and inductive approach was undertaken. The deductive themes were selected based on a consultation guide given to the doctors before the consultations. Results The study identified 15 themes, which were grouped into the following three categories: the implications of sharing a consultation; consultation structure; and health concerns. Conclusion Multidisciplinary video-based consultations with a patient and two health professionals succeeded in having a patient-centred communication style. In clarifying tasks between the GP and oncologist to support the patient, work-related issues and professional support for psychosocial challenges were always a task for the GP. Dissemination of this first-line evidence may improve acceptability among medical specialists and help assist GPs in supporting patients with cancer. However, focus on the involvement of relatives should be emphasised.
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de Bever S, van Rhijn SC, van Dijk N, Kramer A, Visser MRM. Professionals' perspectives on factors affecting GP trainees' patient mix: results from an interview and focus group study among professionals working in Dutch general practice. BMJ Open 2019; 9:e032182. [PMID: 31843835 PMCID: PMC6924856 DOI: 10.1136/bmjopen-2019-032182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Seeing and treating patients in daily practice forms the basis of general practitioner (GP) training. However, the types of patients seen by GP trainees do not always match trainees' educational needs. Knowledge about factors that shape the mix of patient types is limited, especially with regard to the role of the professionals who work in the GP practice. AIM We investigated factors affecting the mix of patients seen by GP trainees from the perspective of professionals. DESIGN AND SETTING This qualitative study involved GP trainees, GP supervisors, medical receptionists and nurse practitioners affiliated with a GP Specialty Training Institute in the Netherlands. METHODS Twelve focus groups and seven interviews with 73 participants were held. Data collection and analysis were iterative, using thematic analysis with a constant comparison methodology. RESULTS The characteristics of patients' health problems and the bond between the doctor and patient are important determinants of GP trainees' patient mix. Because trainees have not yet developed bonds with patients, they are less likely to see patients with complex health problems. However, trainees can deliberately influence their patient mix by paying purposeful attention to bonding with patients and by gaining professional trust through focused engagement with their colleagues. CONCLUSION Trainees' patient mix is affected by various factors. Trainees and team members can take steps to ensure that this mix matches trainees' educational needs, but their success depends on the interaction between trainees' behaviour, the attitudes of team members and the context. The findings show how the mix of patients seen by trainees can be influenced to become more trainee centred and learning oriented.
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Affiliation(s)
- Sarah de Bever
- Department of General Practice/ GP Specialty Training Program, Amsterdam UMC, University of Amsterdam, Amsterdam School of Public Health, Amsterdam, The Netherlands
| | - Suzanne C van Rhijn
- Department of General Practice/ GP Specialty Training Program, Amsterdam UMC, University of Amsterdam, Amsterdam School of Public Health, Amsterdam, The Netherlands
| | - Nynke van Dijk
- Department of General Practice/ GP Specialty Training Program, Amsterdam UMC, University of Amsterdam, Amsterdam School of Public Health, Amsterdam, The Netherlands
| | - Anneke Kramer
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Mechteld R M Visser
- Department of General Practice/ GP Specialty Training Program, Amsterdam UMC, University of Amsterdam, Amsterdam School of Public Health, Amsterdam, The Netherlands
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Tammes P, Payne RA, Salisbury C, Chalder M, Purdy S, Morris RW. The impact of a named GP scheme on continuity of care and emergency hospital admission: a cohort study among older patients in England, 2012-2016. BMJ Open 2019; 9:e029103. [PMID: 31548353 PMCID: PMC6773345 DOI: 10.1136/bmjopen-2019-029103] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To investigate whether the introduction of a named general practitioner (GP, family physician) improved patients' healthcare for patients aged 75 and over in England. SETTING Random sample of 27 500 patients aged 65 to 84 in 2012 within 139 English practices from the Clinical Practice Research Datalink linked with Hospital Episode Statistics. DESIGN Prospective cohort approach, measuring patients' GP consultations and emergency hospital admissions 2 years before/after the intervention. Patients were grouped in (i) aged over 74 and (ii) younger than 75 in both periods in order to compare who were or were not subject to the intervention. Adjusted associations between the named GP scheme, continuity of care and emergency hospital admission were examined using multilevel modelling. INTERVENTION National Health Service policy to introduce a named accountable GP for patients aged over 74 in April 2014. MAIN OUTCOME MEASURES (A) Continuity of care index-score, (B) risk of emergency hospital admissions, (C) number of emergency hospital admissions. RESULTS The intervention was associated with a decrease in continuity index-scores of -0.024 (95% CI -0.030 to -0.018, p<0.001); there were no differences in the decrease between the two age groups (-0.005, 95% CI -0.014 to 0.005). In the pre-intervention and post-intervention periods, respectively, 15.4% and 19.4% patients had an emergency admission. The probability of an emergency hospital admission increased after the intervention (OR 1.156, 95% CI 1.064 to 1.257, p=0.001); this increase was bigger for patients over 74 (relative OR 1.191, 95% CI 1.066 to 1.330, p=0.002). The average number of emergency hospital admissions increased after the intervention (rate ratio (RR) 1.178, 95% CI 1.103 to 1.259, p<0.001); this increase was greater for patients over 74 (relative RR 1.143, 95% CI 1.052 to 1.242, p=0.001). CONCLUSION The introduction of the named GP scheme was not associated with improvements in either continuity of care or rates of unplanned hospitalisation.
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Affiliation(s)
- Peter Tammes
- Bristol Medical School: Population Health Sciences, Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Rupert A Payne
- Bristol Medical School: Population Health Sciences, Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Chris Salisbury
- Bristol Medical School: Population Health Sciences, Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Melanie Chalder
- Bristol Medical School: Population Health Sciences, Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Sarah Purdy
- Bristol Medical School: Population Health Sciences, Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Richard W Morris
- Bristol Medical School: Population Health Sciences, Centre for Academic Primary Care, University of Bristol, Bristol, UK
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Abstract
BACKGROUND Memory and cognitive deficits post stroke are common and associated with increased risk of future dementia. Rehabilitation tends to focus on physical recovery; however, once in the community, it is unclear what happens in the longer term to the stroke-survivor with new memory difficulties. OBJECTIVE The aim of this qualitative study was to examine in stroke-survivors what factors influence contact with health professionals. METHOD Semi-structured interviews were conducted with stroke-survivors and their family carers where memory difficulties were reported at 6 months post stroke. A topic guide was used which sought to critically examine participants care experience following their stroke diagnosis. All participants were interviewed at baseline (around 6 months post stroke) and offered an interview at around 12 months post stroke. All interviews were conducted in the North East of England. All transcripts were coded and thematically analysed. RESULTS Ten stroke-survivors (age range 72-84 years) were interviewed alongside five carers at baseline; eight stroke-survivors and four carers agreed to a follow-up interview. Three main barriers were identified: (i) fear of a dementia diagnosis; (ii) denial or minimization of symptoms leading to adaptation and (iii) obstacles to seeking help in the community. CONCLUSIONS With an ageing population and increase in stroke-survival, the burden of post-stroke cognitive impairment and dementia will only increase. Stroke-survivors and their family carers in this study have identified issues that may hinder their presentation to health care professionals at a personal and organizational level. Health professionals need to be aware of these potential issues when planning services for stroke-survivors.
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Affiliation(s)
- Eugene Y H Tang
- Institute of Health and Society, Newcastle University, Baddiley-Clark, Richardson Road, Newcastle upon Tyne, UK.,Newcastle University Institute of Ageing, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Christopher Price
- Institute of Neuroscience, Stroke Research Group, Newcastle University, Newcastle, UK
| | - Blossom C M Stephan
- Institute of Health and Society, Newcastle University, Baddiley-Clark, Richardson Road, Newcastle upon Tyne, UK.,Newcastle University Institute of Ageing, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Louise Robinson
- Institute of Health and Society, Newcastle University, Baddiley-Clark, Richardson Road, Newcastle upon Tyne, UK.,Newcastle University Institute of Ageing, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Catherine Exley
- Faculty of Health and Life Sciences, Northumberland Building, Northumbria University, Newcastle upon Tyne, UK
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Ball LE, Barnes KA, Crossland L, Nicholson C, Jackson C. Questionnaires that measure the quality of relationships between patients and primary care providers: a systematic review. BMC Health Serv Res 2018; 18:866. [PMID: 30453957 PMCID: PMC6245854 DOI: 10.1186/s12913-018-3687-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 11/05/2018] [Indexed: 11/10/2022] Open
Abstract
Background International guidance on models of care stress the importance of good quality, continuous patient-provider relationships to support high quality and efficient care and hospital avoidance. However, assessing the quality of patient-provider relationships is challenging due to its experiential nature. The aim of this study was to undertake a systematic review to identify questionnaires previously developed or used to assess the quality of continuous relationships between patients and their provider in primary care. Methods MEDLINE, PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL) and SCOPUS databases were searched for English language studies published between 2009 and 2017. Key terms used identified studies conducted in the primary care setting examining relationships between patients and providers. Studies that focused on the conceptualisation, development, testing or review of a questionnaire, or studies that used a questionnaire for assessing the quality of continuous relationships between patients and providers were eligible. Studies that did not assess quality via a questionnaire, only assessed single aspects of relationships, only assessed single encounters, assessed transitions between settings or assessed relationships using an index were excluded. Information on validity testing of each relevant questionnaire identified from articles was reviewed to inform recommendations for future research and evaluation. Results Twenty-seven studies met the eligibility criteria, including 14 unique questionnaires. The questionnaires were diverse in length, scope, focus and level of validity testing. Five questionnaires were considered not feasible for future use due to size and lack of development work. Three questionnaires were considered strongest candidates for use in future work based on being relevant to the topic and primary care setting, freely available in English and not needing additional pilot work prior to use. These three questionnaires were the Care Continuity Across Levels of Care Scale, the Nijmegan Continuity Questionnaire and the Patient-Doctor Depth of Relationship Tool. Conclusions This study provides an overview of 14 unique questionnaires that have been used to assess the quality of continuous relationships between patients and primary care providers. The decision to use one of the questionnaires in future work requires careful consideration, including the scope, length, validation testing, accessibility of the questionnaires and their alignment with the initiative being evaluated.
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Affiliation(s)
- Lauren E Ball
- Centre for Health System Reform and Integration, UQ-Mater Research Institute, Brisbane, Australia. .,Menzies Health Institute Queensland, Griffith University, Parklands Drive, Southport, Gold Coast, QLD, 4222, Australia.
| | - Katelyn A Barnes
- Menzies Health Institute Queensland, Griffith University, Parklands Drive, Southport, Gold Coast, QLD, 4222, Australia
| | - Lisa Crossland
- Centre for Health System Reform and Integration, UQ-Mater Research Institute, Brisbane, Australia
| | - Caroline Nicholson
- Centre for Health System Reform and Integration, UQ-Mater Research Institute, Brisbane, Australia
| | - Claire Jackson
- Centre for Health System Reform and Integration, UQ-Mater Research Institute, Brisbane, Australia
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14
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Vellappally S, Al Kheraif AA, Anil S, Assery MK, Kumar KA, Divakar DD. Analyzing Relationship between Patient and Doctor in Public Dental Health using Particle Memetic Multivariable Logistic Regression Analysis Approach (MLRA2). J Med Syst 2018; 42:183. [PMID: 30155746 DOI: 10.1007/s10916-018-1037-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 08/20/2018] [Indexed: 10/28/2022]
Abstract
In the developing technology managing patient and doctor relationship and communication process is one of the critical factors because the patient may take high risk surgery, treatment and diagnosis. Due to the importance of the patient-doctor relationship, in this paper investigate the various aspects of relation between the doctor and dental problem related patients. During the analyzing process, data has been collected from adults who are facing dental problems and other dental injuries in which data has been gathered from 423 individuals by conducting interviews. The gathered data is investigated with the help of particle-memetic multivariable logistic regression analysis method which examines the patient income, dental surgical details, injuries and other factors relationship has been investigated. From the analyzed data, how the patients are treated by doctors examined for improving the relationship between patient and doctor in public dental health aspects.
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15
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Tammes P, Purdy S, Salisbury C, MacKichan F, Lasserson D, Morris RW. Continuity of Primary Care and Emergency Hospital Admissions Among Older Patients in England. Ann Fam Med 2017; 15:515-522. [PMID: 29133489 PMCID: PMC5683862 DOI: 10.1370/afm.2136] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 05/11/2017] [Accepted: 06/05/2017] [Indexed: 01/15/2023] Open
Abstract
PURPOSE Secondary health care services have been under considerable pressure in England as attendance rates increase, resulting in longer waiting times and greater demands on staff. This study's aim was to examine the association between continuity of care and risk of emergency hospital admission among older adults. METHODS We analyzed records from 10,000 patients aged 65 years and older in 2012 within 297 English general practices obtained from the Clinical Practice Research Datalink and linked with Hospital Episode Statistics. We used the Bice and Boxerman (BB) index and the appointed general practitioner index (last general practitioner consulted before hospitalization) to quantify patient-physician continuity. The BB index was used in a prospective cohort approach to assess impact of continuity on risk of admission. Both indices were used in a separate retrospective nested case-control approach to test the effect of changing physician on the odds of hospital admission in the following 30 days. RESULTS In the prospective cohort analysis, the BB index showed a graded, non-significant inverse relationship of continuity of care with risk of emergency hospital admission, although the hazard ratio for patients experiencing least continuity was 2.27 (95% CI, 1.37-3.76) compared with those having complete continuity. In the retrospective nested case-control analysis, we found a graded inverse relationship between continuity of care and emergency hospital admission for both BB and appointed general practitioner indices: for the latter, the odds ratio for those experiencing least continuity was 2.32 (95% CI, 1.48-3.63) relative to those experiencing most continuity. CONCLUSIONS Marked discontinuity of care might contribute to increased unplanned hospital admissions among patients aged 65 years and older. Schemes to enhance continuity of care have the potential to reduce hospital admissions.
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Affiliation(s)
- Peter Tammes
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Sarah Purdy
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Chris Salisbury
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Fiona MacKichan
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Daniel Lasserson
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.,Department of Gerontology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, Oxford, United Kingdom
| | - Richard W Morris
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, United Kingdom
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16
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Yuguero O, Marsal JR, Buti M, Esquerda M, Soler-González J. Descriptive study of association between quality of care and empathy and burnout in primary care. BMC Med Ethics 2017; 18:54. [PMID: 28950853 PMCID: PMC5615449 DOI: 10.1186/s12910-017-0214-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 09/19/2017] [Indexed: 12/22/2022] Open
Abstract
Background The doctor-patient relationship is a crucial aspect of primary-care practice Research on associations between quality of care provision and burnout and empathy in a primary care setting could improve this relationship. Methods Cross-sectional study of family physicians (108) and nurses (112) of twenty-two primary care centers in the health district of Lleida, Spain. Empathy and burnout were measured using the Jefferson Physician Empathy Scale and the Maslach Burnout Inventory, while quality of care delivery was evaluated using Quality Standard Indicator scores. JPSE and MBI results were grouped into low, medium, and high scores to analyze associations with QSI scores and sociodemographic variables. Results The mean QSI score recorded for the family physicians and nurses was 665 (out of a total of 1000). Higher, albeit insignificant, QSI scores were observed for practitioners with high burnout. No differences were observed according to level of empathy (p > 0.05). The differences with respect to sex, age, and area of practice (urban vs rural center) were not significant. Practitioners with low empathy had higher QSI scores than those with high empathy (672.8 vs. 654.4) while those with high burnout had higher scores than those with low burnout (702 vs. 671). Conclusions Burnout and empathy did not significantly influence quality of care delivery scores in 22 primary care centers. More studies, however, are needed to investigate the unexpected trend observed that suggests that physicians and nurses with higher levels of burnout provide higher quality care.
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Affiliation(s)
- Oriol Yuguero
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain. .,Faculty of Medicine, University of Lleida, Lleida, Spain. .,Institut Català de la Salut, Lleida, Spain. .,Institute for Biomedical Research in Lleida Dr. Pifarré Foundation, IRBLLEIDA. Av. Alcalde Rovira Roure, 80, 25198, Lleida, Spain.
| | - Josep Ramon Marsal
- Unitat de Suport a la Recerca Lleida, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain.,Cardiovascular Epidemiological Unit, Vall Hebron Hospital, Barcelona, Spain
| | - Miquel Buti
- Institut Català de la Salut, Lleida, Spain.,Unitat de Suport a la Recerca Lleida, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
| | - Montserrat Esquerda
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.,Faculty of Medicine, University of Lleida, Lleida, Spain.,Borja Institute of Bioethics, Barcelona, Spain
| | - Jorge Soler-González
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.,Faculty of Medicine, University of Lleida, Lleida, Spain
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17
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Schweller M, Ribeiro DL, Celeri EV, de Carvalho-Filho MA. Nurturing virtues of the medical profession: does it enhance medical students' empathy? Int J Med Educ 2017; 8:262-267. [PMID: 28704203 PMCID: PMC5511746 DOI: 10.5116/ijme.5951.6044] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 06/26/2017] [Indexed: 05/19/2023]
Abstract
OBJECTIVES To examine if the empathy levels of first-year medical students are amenable to didactic interventions idealized to promote values inherent to medical professional identity. METHODS This is a pretest-posttest study designed to assess the empathy levels of first-year medical students (n=166) comprising two consecutive classes of a Brazilian medical school, performed before and after a didactic intervention. Students attended a course based on values and virtues related to medical professional identity once a week over four months. Every didactic approach (interviews with patients and physicians, supervised visits to the hospital, and discussion of videotaped simulated consultations) was based on "real-world" situations and designed to promote awareness of the process of socialization. Students filled out the Jefferson Scale of Physician Empathy (JSPE) on the first and last days of this course, and the pretest-posttest analysis was performed using the Wilcoxon Signed Rank Test. RESULTS The mean pretest JSPE score was 117.9 (minimum 92, maximum 135) and increased to 121.3 after the intervention (minimum 101, maximum 137). The difference was significant (z=-5.2, p<.001.), with an effect size of 0.40. The observed increase was greater among students with lower initial JSPE scores. CONCLUSIONS Empathy is a fundamental tool used to achieve a successful physician-patient relationship, and it seems to permeate other virtues of a good physician. This study's results suggest that medical students' empathy may be amenable to early curricular interventions designed to promote a positive development of their professional identity, even when empathy is not central in discussion.
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Affiliation(s)
- Marcelo Schweller
- Department of Emergency Medicine, Faculty of Medical Sciences, University of Campinas, Brazil
| | - Diego Lima Ribeiro
- Department of Emergency Medicine, Faculty of Medical Sciences, University of Campinas, Brazil
| | - Eloisa Valer Celeri
- Department of Psychiatry, Faculty of Medical Sciences, University of Campinas, Brazil
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18
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Abstract
The doctor-patient relationship is an intricate concept in which patients voluntarily approach a doctor and become part of a contract by which they tend to abide by doctor’s instructions. Over recent decades, this relationship has changed dramatically due to privatization and commercialization of the health sector. A review of the relevant literature in the database of MEDLINE published in English between 1966 and August 2015 was performed with the following keywords: doctor-patient relationship, physician-patient relationship, ethics, and Islam. The Muslim doctor should be familiar with the Islamic teachings on the daily issues faced in his/her practice and the relationship with his/her patients.
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Affiliation(s)
- Hassan Chamsi-Pasha
- Department of Cardiology, King Fahd Armed Forces Hospital, Jeddah, Kingdom of Saudi Arabia. E-mail.
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19
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Atherton H, Ziebland S. What do we need to consider when planning, implementing and researching the use of alternatives to face-to-face consultations in primary healthcare? Digit Health 2016; 2:2055207616675559. [PMID: 29942570 PMCID: PMC6001190 DOI: 10.1177/2055207616675559] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 09/23/2016] [Indexed: 11/26/2022] Open
Abstract
Objectives Communications technologies are variably utilised in healthcare. Policymakers globally have espoused the potential benefits of alternatives to face-to-face consultations, but research is in its infancy. The aim of this essay is to provide thinking tools for policymakers, practitioners and researchers who are involved in planning, implementing and evaluating alternative forms of consultation in primary care. Methods We draw on preparations for a focussed ethnographic study being conducted in eight general practice settings in the UK, knowledge of the literature, qualitative social science and Cochrane reviews. In this essay we consider different types of patients, and also reflect on how the work, practice and professional identities of different members of staff in primary care might be affected. Results Elements of practice are inevitably lost when consultations are no longer face-to-face, and we know little about the impact on core aspects of the primary care relationship. Resistance to change is normal and concerns about the introduction of alternative methods of consultation are often expressed using proxy reasons; for example, concerns about patient safety. Any planning or research in the field of new technologies should be attuned to the potential for unintended consequences. Conclusions Implementation of alternatives to the face-to-face consultation is more likely to succeed if approached as co-designed initiatives that start with the least controversial and most promising changes for the practice. Researchers and evaluators should explore actual experiences of the different consultation types amongst patients and the primary care team rather than hypothetical perspectives.
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Affiliation(s)
- Helen Atherton
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Sue Ziebland
- Nuffield Department of Primary Care Health Sciences, University of Oxford Radcliffe Observatory Quarter, Oxford, UK
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20
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Gullbrå F, Smith-Sivertsen T, Rortveit G, Anderssen N, Hafting M. Ill and substance-abusing parents: how can the general practitioner help their children? A qualitative study. BMC Fam Pract 2016; 17:154. [PMID: 27821069 PMCID: PMC5100102 DOI: 10.1186/s12875-016-0553-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 10/29/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND Severe illness among parents may interfere with their parenting. Children having ill or substance-abusing parents are at risk of own health problems and psychosocial difficulties. The health care system should identify families in need of help and provide the help needed. For ill parents, it can be difficult to seek help and advices for their parenting. The aim of this study was to identify important factors for the general practitioner (GP) to bear in mind during encounters with ill and substance-abusing parents, to enable the GP to provide appropriate support for the children. METHOD A qualitative approach was chosen and the data material was semi-structured individual interviews with 12 parents with mental illness, substance abuse or severe somatic illness. The participants were recruited through GPs in Norway, and the interviews were performed in 2014. We used systematic text condensation for analysis. RESULTS It was important for the participants that the GP was oriented about their family and children's situation. They wanted to be regarded as competent parents in ordinary families; however, they were aware that their illness affected their parenting. They expressed a need for advice about how to inform the children of their illness and talk to them about their challenges, and, if necessary, utilize helpers who could inform the children and talk to them directly. There were often many agencies involved, and it was important that the helpers cooperated and shared information. In addition, the parents were in need of information about support services. CONCLUSION Ill parents in this study conveyed a double message to their helpers. They wanted to be considered as responsible and well-intended parents who wished the best for their children. At the same time they needed support in parenting. The GP should take the time to listen to the parents' first spontaneous description about an ordinary daily life (while realising that it may not necessarily be an accurate report), then explore their worries and needs of support.
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Affiliation(s)
- Frøydis Gullbrå
- Research Unit for General Practice, Uni Research Health, Bergen, Norway. .,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| | | | - Guri Rortveit
- Research Unit for General Practice, Uni Research Health, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Norman Anderssen
- Research Unit for General Practice, Uni Research Health, Bergen, Norway.,Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Marit Hafting
- Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Bergen, Norway
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21
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Yuguero O, Ramon Marsal J, Esquerda M, Vivanco L, Soler-González J. Association between low empathy and high burnout among primary care physicians and nurses in Lleida, Spain. Eur J Gen Pract 2016; 23:4-10. [PMID: 27723375 PMCID: PMC5774288 DOI: 10.1080/13814788.2016.1233173] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background: Burnout is a growing problem among healthcare professionals and may be mitigated and even prevented by measures designed to promote empathy and resilience. Objectives: We studied the association between burnout and empathy in primary care practitioners in Lleida, Spain and investigated possible differences according to age, sex, profession, and place of practice (urban versus rural). Methods: All general practitioners (GPs) and family nurses in the health district of Lleida (population 366 000) were asked by email to anonymously complete the Maslach Burnout Inventory (MBI) and the Jefferson Scale of Physician Empathy (JSPE) between May and July 2014. Tool consistency was evaluated by Cronbach’s α, the association between empathy and burnout by Spearman’s correlation coefficient, and the association between burnout and empathy and sociodemographic variables by the χ2 test. Results: One hundred and thirty-six GPs and 131 nurses (52.7% response rate) from six urban and 16 rural practices participated (78.3% women); 33.3% of respondents had low empathy, while 3.7% had high burnout. The MBI and JSPE were correlated (P < .001) and low burnout was associated with high empathy (P < .05). Age and sex had no influence on burnout or empathy. Conclusion: Although burnout was relatively uncommon in our sample, it was associated with low levels of empathy. This finding and our observation of lower empathy levels in rural settings require further investigation. More empathic primary care practitioners have lower burnout scores. Practitioners working in rural areas have significantly lower levels of empathy than their urban counterparts have. Interventions designed to foster attributes and skills such as empathy, resilience, and doctor–patient communication may help to reduce and prevent burnout.
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Affiliation(s)
| | - Josep Ramon Marsal
- b Support Unit , Primary Care Research Institute (IDIAP) Jordi Gol. Autonomous University of Barcelona , Lleida , Catalonia , Spain.,c Epidemiology unit, University Hospital Vall d'Hebron , Barcelona , Catalonia , Spain
| | - Montserrat Esquerda
- d Borja institute of Bioethics , Barcelona , Spain.,e School of Medicine , University of Lleida , Spain
| | - Luis Vivanco
- f Platform for Bioethics and Medical Education , La Rioja Biomedical Research Center , Logroño (CIBIR) , Spain
| | - Jorge Soler-González
- a Primary Care, Lleida Health Region , Spain.,e School of Medicine , University of Lleida , Spain
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