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Meldrum D, Kearney H, Hutchinson S, McCarthy S, Quinn G. Wearable sensor and smartphone assisted vestibular physical therapy for multiple sclerosis: usability and outcomes. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1406926. [PMID: 39050817 PMCID: PMC11267627 DOI: 10.3389/fresc.2024.1406926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 06/05/2024] [Indexed: 07/27/2024]
Abstract
Introduction Vertigo, dizziness, gaze instability and disequilibrium are highly prevalent in people with MS (PwMS) and head movement induced dizziness is commonly reported. Vestibular physical therapy (VPT) is a specialised, non-invasive and effective therapy for these problems but usually involves travel for the person to a specialist center with both personal and carbon costs. The use of wearable sensors to track head movement and smartphone applications to deliver and track programs has potential to improve VPT in MS. Methods This study investigated the usability and effects of a commercially available digital VPT system (wearable head sensor, smartphone app and clinician software) to deliver VPT to PwMS. A pre/post treatment design was employed and the primary outcome was the System Usability Scale (SUS). Other patient reported outcomes were the Service User Acceptability Questionnaire (SUTAQ), the Patient Enablement Instrument (PEI) and the Dizziness Handicap Inventory (DHI). Physical outcomes measurements included Mini-BESTest (MB), Modified Dynamic Gait Index (mDGI), Gait Speed (GS), Dynamic Visual Acuity (DVA) and head kinematics and symptoms during exercise. Results Sixteen PwMS (14 female), mean age 44(±14) years were recruited to the study and twelve completed VPT. Mean adherence to exercise, measured digitally was 60% (±18.4). SUS scores were high at 81 (±14) and SUTAQ scores also demonstrated high levels of satisfaction and acceptability of the system. Statistically significant improvements in MB (mean change 2.25; p = 0.004), mDGI (median change 1.00; p = 0.008), DVA (median change -1.00; p = 0.004) were found. Head frequencies significantly improved with concurrent decreased intensity of dizziness during head movements (mean change across 4 gaze stabilization exercises was 23 beats per minute; p < 0.05). Non-significant improvements were seen in DHI (p = 0.07) and GS (p = 0.15). 64.5% of follow up visits were conducted remotely (video or phone), facilitated by the system. Discussion This study had two main outcomes and benefits for PwMS. Firstly, we showed that the system used was both acceptable and could be used by PwMS. Secondly, we demonstrated an improvement in a range of dizziness, balance and gait metrics with remotely delivered care. This system has the potential to positively impact on MS physiotherapy service provision with the potential to deliver effective remote care.
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Affiliation(s)
- D. Meldrum
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - H. Kearney
- School of Medicine, Trinity College Dublin, Dublin, Ireland
- MS Unit, Department of Neurology, St. James’s Hospital, Dublin, Ireland
| | - S. Hutchinson
- School of Medicine, Trinity College Dublin, Dublin, Ireland
- MS Unit, Department of Neurology, St. James’s Hospital, Dublin, Ireland
| | - S. McCarthy
- Physiotherapy Department, St. James’s Hospital, Dublin, Ireland
| | - G. Quinn
- Physiotherapy Department, St. James’s Hospital, Dublin, Ireland
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Åkesson KS, Hansson EE, Pawlikowska T, Sundén A, Stigmar K, Ageberg E. Factors associated with empowerment after participating in a supported osteoarthritis self-management program: An explorative study. OSTEOARTHRITIS AND CARTILAGE OPEN 2024; 6:100464. [PMID: 38584596 PMCID: PMC10998234 DOI: 10.1016/j.ocarto.2024.100464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 03/18/2024] [Indexed: 04/09/2024] Open
Abstract
Objective To explore factors associated with change in empowerment in patients that have participated in a 3-month Supported Osteoarthritis Self-Management Program (SOASP). Further, to evaluate empowerment in the longer term. Design An explorative analysis including patients from a cohort study conducted in primary healthcare in Sweden was performed. Univariable linear regression models were performed to assess associations between demographics and patient-reported outcome measures (explanatory factors), respectively, and change in empowerment from baseline to 3-month follow-up (outcome variable). Long-term follow-up of empowerment was at 9 months. Results Self-reported increase in enablement at the 3-month follow-up was associated with a greater improvement in empowerment (B = 0.041, 95% CI (0.011, 0.07), p = 0.008). Living alone was associated with less improvement in empowerment (B = -0.278, 95% CI (-0.469, -0.086), p = 0.005) compared to living together. Physical exercise >120 min per week at baseline was associated with less improvement in empowerment (B = -0.293, 95% CI (-0.583, -0.004), p = 0.047) compared to reporting no exercise at baseline. No other associations were observed (p > 0.05). Empowerment improved from baseline to the 3-month follow-up (mean 0.20 (SD 0.5), p < 0.001) but there was no change from baseline to the 9-month follow-up (mean 0.02 (SD 0.6), p = 0.641). Conclusions Self-reported increased enablement may lead to greater improvement in empowerment after SOASP. Greater efforts may be needed to support those that live alone, are physically active, and to sustain empowerment in the longer term after SOASP. More research is needed on empowerment to provide personalized support for patients with OA after SOASP.
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Affiliation(s)
| | - Eva Ekvall Hansson
- Department of Health Sciences, Health Science Centre, Box 157, SE-221 00, Lund, Sweden
| | - Teresa Pawlikowska
- Health Professions Education Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Anne Sundén
- Department of Health Sciences, Health Science Centre, Box 157, SE-221 00, Lund, Sweden
| | - Kjerstin Stigmar
- Department of Health Sciences, Health Science Centre, Box 157, SE-221 00, Lund, Sweden
| | - Eva Ageberg
- Department of Health Sciences, Health Science Centre, Box 157, SE-221 00, Lund, Sweden
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Pereira Gray D, Sidaway-Lee K, Johns C, Rickenbach M, Evans PH. Can general practice still provide meaningful continuity of care? BMJ 2023; 383:e074584. [PMID: 37963633 DOI: 10.1136/bmj-2022-074584] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Affiliation(s)
| | | | | | - Mark Rickenbach
- Park and St Francis Surgery, Chandler's Ford, UK
- University of Winchester, Winchester, UK
| | - Philip H Evans
- St Leonard's Research Practice, Exeter, UK
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
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Åkesson KS, Sundén A, Stigmar K, Eek F, Pawlikowska T, Hansson EE. Empowerment and enablement and their associations with change in health-related quality of life after a supported osteoarthritis self-management programme - a prospective observational study. Arch Physiother 2023; 13:18. [PMID: 37735517 PMCID: PMC10514979 DOI: 10.1186/s40945-023-00172-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 08/28/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Osteoarthritis is a leading cause of disability worldwide. Current treatment supports coping strategies to improve health-related quality of life (HRQoL). The need to predict response to treatment has been raised to personalise care. This study aims to examine change in HRQoL from baseline to three and nine months follow-up after participating in a Supported Osteoarthritis Self-Management Programme (SOASP) and to examine if empowerment and/or enablement were associated with change in HRQoL after a SOASP. METHODS Patients participating in a SOASP were recruited consecutively between April 2016 and June 2018. The EQ-5D was used to measure HRQoL, the Swedish Rheumatic Disease Empowerment Scale (SWE-RES-23) (score range 1-5) to measure empowerment and the Patient Enablement Instrument (PEI) (score range 0-12) to measure enablement. The instruments were answered before (EQ-5D, SWE-RES-23) and after (EQ-5D, SWE-RES-23, PEI) the SOASP. A patient partner was involved in the research process to enhance the patient perspective. Changes in outcome were examined with paired sample t-test and standardized effect sizes (Cohen´s d). Multiple linear regression analysis was performed to assess potential associations. RESULTS One hundred forty-three patients participated in baseline measurement. Mean EQ-5D-5 L index score increased significantly from baseline to three months corresponding to a standardised effect size (Cohen´s d) of d = 0.43, 95% CI [0.24, 0.63] (n = 109), and from baseline to nine months d = 0.19, 95% CI [0.01, 0.37] (n = 119). The average EQ VAS score increased significantly from baseline to three months corresponding to a standardised effect size of d = 0.26, 95% CI [0.07, 0.45] (n = 109), and from baseline to nine months d = 0.18, 95% CI [0.00, 0.36] (n = 119). Neither SWE-RES-23 nor PEI at three months follow-up nor the change in the SWE-RES-23 score from baseline to three months follow-up were associated with change in either EQ-5D-5 L index (p > 0.05) or the EQ VAS (p > 0.05). CONCLUSIONS Health-related quality of life increased after participating in a SOASP. Empowerment and enablement as measured with the SWE-RES-23 and the PEI were not associated with change in HRQoL among patients participating in a SOASP. TRIAL REGISTRATION ClinicalTrials.gov. Identification number: NCT02974036. First registration 28/11/2016, retrospectively registered.
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Affiliation(s)
| | - Anne Sundén
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Kjerstin Stigmar
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Frida Eek
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Teresa Pawlikowska
- Health Professions Education Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Eva Ekvall Hansson
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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Louwen C, Reidlinger D, Milne N. Profiling health professionals' personality traits, behaviour styles and emotional intelligence: a systematic review. BMC MEDICAL EDUCATION 2023; 23:120. [PMID: 36803372 PMCID: PMC9938999 DOI: 10.1186/s12909-023-04003-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 01/04/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Non-cognitive traits have been theorised to predict characteristics, career choice and outcomes of health professionals and could represent a homogenous group. This study aims to profile and compare personality traits, behaviour styles and emotional intelligence of health practitioners across a variety of professions. METHODS Empirical literature was systematically reviewed. A two-concept search strategy was applied to four databases (CINAHL, PubMed, Embase, ProQuest). Title/abstract and full text articles were screened against inclusion and exclusion criteria. Methodological quality was assessed using Mixed Methods Appraisal Tool. Data was synthesised narratively and meta-aggregated where feasible. RESULTS Three hundred twenty-one studies representing 153 assessment tools of personality (n = 83 studies), behaviour (n = 8), and emotional intelligence (n = 62) were included. Most studies (n = 171) explored personality (medicine, nursing, nursing assistants, dentistry, allied health, paramedics), revealing variation in traits across professions. Behaviour styles were least measured with only ten studies exploring these across four health professions (nursing, medicine, occupational therapy, psychology). Emotional intelligence (n = 146 studies) varied amongst professions (medicine, nursing, dentistry, occupational therapy, physiotherapy, radiology) with all exhibiting average to above-average scores. CONCLUSION Personality traits, behaviour styles and emotional intelligence are all key characteristics of health professionals reported in the literature. There is both heterogeneity and homogeneity within and between professional groups. The characterisation and understanding of these non-cognitive traits will aid health professionals to understand their own non-cognitive features and how these might be useful in predicting performance with potential to adapt these to enhance success within their chosen profession.
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Affiliation(s)
- C. Louwen
- Faculty of Health Sciences and Medicine, Bond Institute of Health and Sport, Bond University, Robina, Gold Coast, QLD 4226 Australia
| | - D. Reidlinger
- Faculty of Health Sciences and Medicine, Bond Institute of Health and Sport, Bond University, Robina, Gold Coast, QLD 4226 Australia
| | - N. Milne
- Faculty of Health Sciences and Medicine, Bond Institute of Health and Sport, Bond University, Robina, Gold Coast, QLD 4226 Australia
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Åkesson KS, Sundén A, Stigmar K, Fagerström C, Pawlikowska T, Ekvall Hansson E. Enablement and empowerment among patients participating in a supported osteoarthritis self-management programme - a prospective observational study. BMC Musculoskelet Disord 2022; 23:555. [PMID: 35676666 PMCID: PMC9175380 DOI: 10.1186/s12891-022-05457-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 05/19/2022] [Indexed: 11/23/2022] Open
Abstract
Background In Sweden, core treatment for osteoarthritis is offered through a Supported Osteoarthritis Self-Management Programme (SOASP), combining education and exercise to provide patients with coping strategies in self-managing the disease. The aim was to study enablement and empowerment among patients with osteoarthritis in the hip and/or knee participating in a SOASP. An additional aim was to study the relation between the Swedish version of the Patient Enablement Instrument (PEI) and the Swedish Rheumatic Disease Empowerment Scale (SWE-RES-23). Methods Patients with osteoarthritis participating in a SOASP in primary health care were recruited consecutively from 2016 to 2018. The PEI (score range 0–12) was used to measure enablement and the SWE-RES-23 (score range 1–5) to measure empowerment. The instruments were answered before (SWE-RES-23) and after the SOASP (PEI, SWE-RES-23). A patient partner was incorporated in the study. Descriptive statistics, the Wilcoxon’s signed rank test, effect size (r), and the Spearman’s rho (rs) were used in the analysis. Results In total, 143 patients were included in the study, 111 (78%) were women (mean age 66, SD 9.3 years). At baseline the reported median value for the SWE-RES-23 (n = 142) was 3.6 (IQR 3.3–4.0). After the educational part of the SOASP, the reported median value was 6 (IQR 3–6.5) for the PEI (n = 109) and 3.8 (IQR 3.6–4.1) for the SWE-RES-23 (n = 108). At three months follow-up (n = 116), the reported median value was 6 (IQR 4–7) for the PEI and 3.9 (IQR 3.6–4.2) for the SWE-RES-23. The SWE-RES-23 score increased between baseline and three months (p ≤ 0.000). The analysis showed a positive correlation between PEI and SWE-RES-23 after the educational part of the SOASP (rs = 0.493, p < 0.00, n = 108) and at follow-up at three months (rs = 0.507, p < 0.00, n = 116). Conclusions Patients reported moderate to high enablement and empowerment and an increase in empowerment after participating in a SOASP, which might indicate that the SOASP is useful to enable and empower patients at least in the short term. Since our results showed that the PEI and the SWE-RES-23 are only partly related both instruments can be of use in evaluating interventions such as the SOASP. Trial registration ClinicalTrials.gov. NCT02974036. First registration 28/11/2016, retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05457-9.
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Affiliation(s)
| | - Anne Sundén
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Kjerstin Stigmar
- Department of Health Sciences, Lund University, Lund, Sweden.,Department of Research and Education, Skåne University Hospital, Lund, Sweden
| | - Cecilia Fagerström
- Department of Health and Caring Sciences, Linnæus University, Kalmar, Sweden
| | - Teresa Pawlikowska
- Health Professions Education Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Meldrum D, Murray D, Vance R, Coleman S, McConnell S, Hardiman O, McConn Walsh R. Toward a Digital Health Intervention for Vestibular Rehabilitation: Usability and Subjective Outcomes of a Novel Platform. Front Neurol 2022; 13:836796. [PMID: 35422750 PMCID: PMC9001890 DOI: 10.3389/fneur.2022.836796] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/01/2022] [Indexed: 11/13/2022] Open
Abstract
Digital technologies are increasingly available and are reducing in cost. There is an opportunity to move to a digital health approach in vestibular rehabilitation (VR), but there is a paucity of suitable systems available and a consequent lack of evidence to support their use. This study aimed to investigate a novel digital platform developed specifically for VR (comprising clinician software, a wearable sensor, and a patient-facing app). Participants (n = 14, 9F:5M, mean age 59) with vestibular dysfunction and imbalance used the app for treatment, and therapists (n = 4) used the platform to deliver VR in the form of individualized exercise programmes over a mean of 17.4 ± 8.8 weeks. Outcomes included the system usability scale, the patient enablement instrument (PEI), change in subjective symptoms (numerical rating scales), percentage adherence to prescribed exercise, and a semi-structured interview on utility. A significant reduction was found in symptoms of vertigo/dizziness (p < 0.004), imbalance (p < 0.002), oscillopsia (p < 0.04), and anxiety (p < 0.02) after use. System usability scores were high for both clinicians (mean 85/100) and participants (mean 82.7/100) and high enablement was reported (mean PEI 6.5/12). Overall percentage adherence to the exercise prescription was highly variable and ranged from 4 to 78% when measured digitally. At semi-structured interviews, participants reported a high level of acceptance and satisfaction with digital delivery, and no adverse events were recorded. When COVID-19 restrictions eased, 2 participants trialed the head sensor with the application and found it highly usable. Further research is required to investigate the efficacy and how the wearable sensor impacts the delivery of care.
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Affiliation(s)
- Dara Meldrum
- Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Dublin, Ireland
- *Correspondence: Dara Meldrum
| | - Deirdre Murray
- Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Physiotherapy Department, Beaumont Hospital, Dublin, Ireland
| | - Roisin Vance
- Physiotherapy Department, Beaumont Hospital, Dublin, Ireland
| | - Sarah Coleman
- Physiotherapy Department, Beaumont Hospital, Dublin, Ireland
| | - Sonya McConnell
- Physiotherapy Department, Beaumont Hospital, Dublin, Ireland
| | - Orla Hardiman
- Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Department of Neurology, Beaumont Hospital, Dublin, Ireland
| | - Rory McConn Walsh
- Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Department of Otorhinolaryngology, Beaumont Hospital, Dublin, Ireland
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Powell L, Walsh M, Reinhard CL, Jankowski K, Watson B. One Health clinic promotes veterinarian-client trust among underserved pet owners and provides learning opportunities for veterinary students. J Am Vet Med Assoc 2022; 260:931-939. [PMID: 35298404 DOI: 10.2460/javma.21.06.0274] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the impact of a free One Health clinic with human and veterinary services on the veterinary-client relationship for underserved pet owners. A secondary aim was to understand the experience of veterinary students and volunteers who participated in the clinic. SAMPLE 78 pet owners, 55 students and 32 volunteers who attended the Delaware Humane Association One Health Clinic between December 2018 and November 2019. PROCEDURES Pet owners completed an anonymous questionnaire prior to and following their veterinary appointment regarding their trust in the veterinary profession, feelings of enablement and veterinarian-client concordance. Students and volunteers completed a questionnaire within 72 hours of clinic participation about their perceptions of the educational value of the clinic. RESULTS Following the One Health clinic, client trust in the veterinary profession increased significantly (t = -5.50, P < 0.001). Clients also reported high levels of enablement and veterinarian-client concordance. Students and volunteers agreed the clinic was a valuable educational experience (97.7%) and reported increased compassion, enhanced leadership, communication and teamwork skills, and an improved ability to identify social issues and think critically. CLINICAL RELEVANCE The results support the utilization of One Health clinics to improve access to veterinary care for underserved pet owners. Clients reported high levels of trust, enablement and concordance following the clinic which could have long-lasting effects on their willingness to seek veterinary care and comply with veterinarians' recommendations. The positive experiences of students and volunteers also highlights the potential of low-cost veterinary clinics as unique educational experiences.
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Affiliation(s)
- Lauren Powell
- School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - Meriel Walsh
- School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - Chelsea L Reinhard
- School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - Kristin Jankowski
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California Davis, Davis CA
| | - Brittany Watson
- School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
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Continuity of GP care for patients with dementia: impact on prescribing and the health of patients. Br J Gen Pract 2022; 72:e91-e98. [PMID: 35074796 PMCID: PMC8803082 DOI: 10.3399/bjgp.2021.0413] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 11/03/2021] [Indexed: 12/31/2022] Open
Abstract
Background Higher continuity of GP care (CGPC), that is, consulting the same doctor consistently, can improve doctor–patient relationships and increase quality of care; however, its effects on patients with dementia are mostly unknown. Aim To estimate the associations between CGPC and potentially inappropriate prescribing (PIP), and with the incidence of adverse health outcomes (AHOs) in patients with dementia. Design and setting A retrospective cohort study with 1 year of follow-up anonymised medical records from 9324 patients with dementia, aged ≥65 years living in England in 2016. Method CGPC measures include the Usual Provider of Care (UPC), Bice–Boxerman Continuity of Care (BB), and Sequential Continuity (SECON) indices. Regression models estimated associations with PIPs and survival analysis with incidence of AHOs during the follow-up adjusted for age, sex, deprivation level, 14 comorbidities, and frailty. Results The highest quartile (HQ) of UPC (highest continuity) had 34.8% less risk of delirium (odds ratio [OR] 0.65, 95% confidence interval [CI] = 0.51 to 0.84), 57.9% less risk of incontinence (OR 0.42, 95% CI = 0.31 to 0.58), and 9.7% less risk of emergency admissions to hospital (OR 0.90, 95% CI = 0.82 to 0.99) compared with the lowest quartile. Polypharmacy and PIP were identified in 81.6% (n = 7612) and 75.4% (n = 7027) of patients, respectively. The HQ had fewer prescribed medications (HQ: mean 8.5, lowest quartile (LQ): mean 9.7, P<0.01) and had fewer PIPs (HQ: mean 2.1, LQ: mean 2.5, P<0.01), including fewer loop diuretics in patients with incontinence, drugs that can cause constipation, and benzodiazepines with high fall risk. The BB and SECON measures produced similar findings. Conclusion Higher CGPC for patients with dementia was associated with safer prescribing and lower rates of major adverse events. Increasing continuity of care for patients with dementia may help improve treatment and outcomes.
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Little J, Geraghty AWA, Nicholls C, Little P. Findings from the development and implementation of a novel course consisting of both group and individual Alexander Technique lessons for low back pain. BMJ Open 2022; 12:e039399. [PMID: 35058254 PMCID: PMC8783812 DOI: 10.1136/bmjopen-2020-039399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES (1) To develop a mixed course of individual and group lessons in the Alexander Technique (AT) for low back pain, and (2) to explore its: (a) effectiveness and (b) acceptability to both participant AT teachers and patients. DESIGN Single-centre study, mixed methods. SETTING Members of the public in the Brighton area (community recruitment), and patients from six Hampshire General Practices (GP) (National Health Service (NHS) recruitment). PARTICIPANTS People with chronic or recurrent low back pain; AT teachers. INTERVENTIONS Iterative development and implementation of a 10-lesson (6 group, 4 individual) AT course. OUTCOME MEASURES Perceptions from semistructured interviews analysed using inductive thematic analysis. Descriptive analysis of RMDQ (Roland-Morris Disability Questionnaire) over 12 weeks. RESULTS Thirty-nine participants with low back pain were included and 32 AT teachers were interviewed, 7 of whom taught on the course. Some participants had reservations, preferring only individual lessons, but the majority found the sharing of experience and learning in groups helpful. There was also concern regarding group teaching among some AT teachers, but most also found it acceptable. By 12 weeks, RMDQ score among participants fell from 10.38 to 4.39, a change of -5.99. 29 of 39 (74%) participants had a clinically important reduction in RMDQ score of 2.5 or more. CONCLUSION Some patients and practitioners had reservations about group AT lessons, but most found groups helpful. Further development is needed, but the course of individual and group lessons has the potential to cost-effectively deliver clinically important benefits to patients with back pain, who are known to improve little and slowly.
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Affiliation(s)
- Joseph Little
- Primary Care Research Centre, Primary Care Population Sciences and Medical Education Unit, University of Southampton Faculty of Medicine, Southampton, UK
| | - Adam W A Geraghty
- Primary Care Research Centre, Primary Care Population Sciences and Medical Education Unit, University of Southampton Faculty of Medicine, Southampton, UK
| | | | - Paul Little
- Primary Care Research Centre, Primary Care Population Sciences and Medical Education Unit, University of Southampton Faculty of Medicine, Southampton, UK
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Zyzanski SJ, Gonzalez MM, O'Neal JP, Etz RS, Reves SR, Stange KC. Measuring Primary Care Across 35 OECD Countries. Ann Fam Med 2021; 19:547-552. [PMID: 34330714 PMCID: PMC8575509 DOI: 10.1370/afm.2697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 11/14/2020] [Accepted: 01/22/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To examine the psychometric properties and scores of the Person-Centered Primary Care Measure (PCPCM) in 28 languages and 35 Organisation for Economic Co-operation and Development (OECD) countries. METHODS Using a paid online sampling service, we requested age- and sex-representative samples of 360 adults in each country. We administered the Person-Centered Primary Care Measure-a previously validated 11-item, patient-reported measure that was developed using what patients and clinicians said is most important about primary care. We also assessed construct validity through associations with demographics, the Patient-Enablement Instrument, number of years the person had been with their primary care physician and practice, whether the patient thought the doctor knowing the results would improve their care, and whether it was hard to complete the survey. We assessed the psychometric properties of the PCPCM in each country and report the summative and item-specific PCPCM scores for each country. RESULTS The PCPCM exhibited solid psychometric properties across all languages and countries, with Cronbach's alphas ranging from 0.88 to 0.95, and corrected item-total correlations ranging from 0.47 to 0.81, with the vast majority of countries ranging from the low 0.50s to the high 0.70s. Multiple analyses showed strong evidence of concurrent validity. With a potential range from a low of 1 to a high of 4, the overall mean score was 2.74, with a standard deviation of 0.19. Mean PCPCM scores ranged from the lowest in Sweden (2.28) to the highest in Turkey (3.08), with Germany ranking second (3.01), and the United States third (2.99). CONCLUSION The internal consistency and concurrent validity of the PCPCM across multiple countries provides strong evidence of the coherence of the breadth of primary care functions that patients and clinicians say are important. The diversity of total and item-specific scores across countries provokes interesting hypotheses about the influence of each different country's policies, practices, demographics, and culture on primary care, and provides a strong impetus for further ecological and individual data analyses using the Person-Centered Primary Care Measure. Annals "Online First" article.
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Affiliation(s)
- Stephen J Zyzanski
- Center for Community Health Integration, Departments of Family Medicine & Community Health, Population & Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Martha M Gonzalez
- Larry A. Green Center for the Advancement of Primary Health Care for the Public Good, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
| | - Jonathan P O'Neal
- Larry A. Green Center for the Advancement of Primary Health Care for the Public Good, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
| | - Rebecca S Etz
- Larry A. Green Center for the Advancement of Primary Health Care for the Public Good, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
| | - Sarah R Reves
- Larry A. Green Center for the Advancement of Primary Health Care for the Public Good, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
| | - Kurt C Stange
- Center for Community Health Integration, Departments of Family Medicine & Community Health, Population & Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio.,Larry A. Green Center for the Advancement of Primary Health Care for the Public Good, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia.,Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
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12
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Menon S, Sander JW. Effects of the COVID-19 pandemic on medication adherence: In the case of antiseizure medications, A scoping review. Seizure 2021; 93:81-87. [PMID: 34717290 PMCID: PMC8526436 DOI: 10.1016/j.seizure.2021.10.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/24/2021] [Accepted: 10/07/2021] [Indexed: 12/25/2022] Open
Abstract
Since early 2020, an unprecedented public global health emergency caused by coronavirus (COVID-19) resulted in national governments' imposing confinement measures. Lockdowns and isolation during pandemics complicate disease management and medication adherence. Chronic conditions, such as epilepsy, require linear adherence patterns to prevent breakthrough seizures and to reduce the risk of sudden unexpected death. Limited access to health care facilities for routine care and medicines management further hampers this. Social isolation exacerbates stress, depression and decreases social support, which may combine to reduce adherence to antiseizure medication (ASM) during the pandemic. Methods We conducted a literature scoping review to explore ASM adherence among people with epilepsy, non-infected or infected SARS-CoV-2 or recovered from COVID-19 during the pandemic and explore risk factors for adherence. We search Pubmed for articles up to 16 September 2021. Search terms included the thematic of ASM adherence and COVID-19. We adhered to the PRISMA guidelines for reporting scoping reviews. Results Six articles were retained after the screening, which covered four overarching themes: change of ASM compliance and as risk factors, lack of follow-up, difficulties accessing ASM, and behavioural risk factors. Our review underscores the lack of evidence on ASM adherence among people with epilepsy infected or recovered from COVID-19. No study retrieved took place in a low-income setting, warranting a cautionary approach to be employed when extrapolating findings on a global scale. Recommendations for practice Missing information on past SARS-CoV2 infections impact people with epilepsy precludes exploring a direct effect of SARS-CoV2 on ASM adherence. A more comprehensive chronic disease model based on the burden of co-cardiovascular and neuro-behavioural comorbidities should be envisaged for this population in preparation for future pandemics. A monitoring algorithm needs to be in place to establish a telemedicine framework and community pharmacists' potential to contribute to the model recognised.
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Affiliation(s)
- Sonia Menon
- Université de Paris, Centre of Research in Epidemiology and Statistics (CRESS), Inserm, F-75004, Paris, France; Cochrane France, F 75004 Paris, France.
| | - Josemir W Sander
- Department of Neurology, West of China Hospital, Sichuan University, Chengdu, China; NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG; Chalfont Centre for Epilepsy, Chalfont St Peter, Buckinghamshire, UK; Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, Netherlands
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13
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Simões JA, Prazeres F, Maricoto T, Simões PA, Lourenço J, Romano JP, Santiago LM. Physician empathy and patient enablement: survey in the Portuguese primary health care. Fam Pract 2021; 38:606-611. [PMID: 33738481 PMCID: PMC8463900 DOI: 10.1093/fampra/cmab005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Empathy is the capacity to understand and resonate with the experiences of other people. Patient enablement is the degree to which a patient feels strengthened in terms of being able to deal with, understand and manage their disease. METHODS Secondary cross-sectional analysis of existing data from 2 independent datasets (456 primary health care patients), with the application of two validated questionnaires, Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE) and Patient Enablement Instrument (PEI). OBJECTIVE Evaluate medical empathy and patients' enablement after consultation with their family doctors and to verify if there was an association between these two concepts. RESULTS The median value of JSPPPE-VP score was 6.60 (interquartile range 1.00) and of PEI/ICC score was of 1.83 (interquartile range 0.67). Regarding empathy (JSPPPE-VP), patients taking chronic medication had a slight but significantly higher median score than patients not taking them (6.70 versus 6.60, P = 0.049), although regression modelling did not confirm any relevant predictor of JSPPPE-VP score. Regarding enablement (PEI/ICC), we found significantly higher scores on younger patients, as well as, on more educated and professionally active ones (P < 0.001). Multivariable linear regression and Poisson regression modelling confirmed such variables as statistically significant potential predictors. CONCLUSIONS A significant positive association was found between empathy score (JSPPPE-VP) and enablement score (PEI/ICC), when adjusted to sociodemographic cofactors. On this linear regression model, age category and educational level were also significantly associated with empathy score, with the same pattern found on bivariate analysis.
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Affiliation(s)
- José Augusto Simões
- Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal.,Centre for Research in Health Technologies and Services (CINTESIS), Porto, Portugal.,USF Caminhos do Cértoma, ACeS Baixo Mondego/ARS Centro, Coimbra, Portugal
| | - Filipe Prazeres
- Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal.,Centre for Research in Health Technologies and Services (CINTESIS), Porto, Portugal.,USF Beira Ria, ACeS Baixo Vouga/ARS Centro, Aveiro, Portugal
| | - Tiago Maricoto
- Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal.,USF Aveiro-Aradas, ACeS Baixo Vouga/ARS Centro, Aveiro, Portugal.,Clinical Academic Centre of Beiras (CACB), Covilhã, Portugal
| | - Pedro Augusto Simões
- Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal.,USF Pulsar, ACeS Baixo Mondego/ARS Centro, Coimbra, Portugal
| | - Joana Lourenço
- Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
| | | | - Luiz Miguel Santiago
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,General Practice/Family Medicine Academic Clinic, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Centre for Health Studies and Research of the University of Coimbra (CEISUC), Coimbra, Portugal
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14
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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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15
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Association between doctor-patient familiarity and patient-centred care during general practitioner's consultations: a direct observational study in Chinese primary care practice. BMC FAMILY PRACTICE 2021; 22:107. [PMID: 34049489 PMCID: PMC8161971 DOI: 10.1186/s12875-021-01446-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 04/26/2021] [Indexed: 12/30/2022]
Abstract
Background Patient-centred care is a core attribute of primary care. Not much is known about the relationship between patient-centred care and doctor-patient familiarity. This study aimed to explore the association between general practitioner (GP) perceived doctor-patient familiarity and the provision of patient-centred care during GP consultations. Methods This is a direct observational study conducted in eight community health centres in China. Level of familiarity was rated by GPs using a dichotomized variable (Yes/No). The provision of patient-centred care during GP consultations was measured by coding audiotapes using a modified Davis Observation Code (DOC) interactional instrument. Eight individual codes in the modified DOC were selected for measuring the provision of patient-centred care, including ‘family information’, ‘treatment effects’, ‘nutrition guidance’, ‘exercise guidance’, ‘health knowledge’, ‘patient question’, ‘chatting’, and ‘counseling’. Multivariate analyses of covariance were adopted to evaluate the association between GP perceived doctor-patient familiarity and patient-centred care. Results A total of 445 audiotaped consultations were collected, with 243 in the familiar group and 202 in the unfamiliar group. No significant difference was detected in overall patient-centred care between the two groups. For components of patient-centred care, the number of intervals (1.36 vs 0.88, p = 0.026) and time length (7.26 vs. 4.40 s, p = 0.030) that GPs spent in ‘health knowledge’, as well as time length (13.0 vs. 8.34 s, p = 0.019) spent in ‘patient question’ were significantly higher in unfamiliar group. The percentage of ‘chatting’ (11.9% vs. 7.34%, p = 0.012) was significantly higher in the familiar group. Conclusions This study suggested that GP perceived doctor-patient familiarity may not be associated with GPs’ provision of patient-centred care during consultations in the context of China. Not unexpectedly, patients would show more health knowledge and ask more questions when GPs were not familiar with them. Further research is needed to confirm and expand on these findings.
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16
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What mechanisms could link GP relational continuity to patient outcomes? Br J Gen Pract 2021; 71:278-281. [PMID: 34045259 DOI: 10.3399/bjgp21x716093] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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17
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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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18
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Zarafshan H, Wissow LS, Shahrivar Z, Mojtabai R, Khademi M, JafariNia M, Hajebi A, Abolhassani F, Sharifi V. Children and adolescents' mental health in Iran's primary care: Perspectives of general practitioners, school staff and help seekers. GLOBAL SOCIAL WELFARE : RESEARCH, POLICY & PRACTICE 2021; 8:1-10. [PMID: 33738179 PMCID: PMC7962553 DOI: 10.1007/s40609-019-00144-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Iran has well-established networks for primary care staffed by general practitioners who provide services to patients across the lifespan. Iran recently established collaborative care networks to build general practitioners' capacity to provide adult mental health services. In an NIH-funded study, we are designing and evaluating a training program for general practitioners (GPs) to extend this collaboration to include services for children and adolescents. In the formative phase of this project, we conducted a qualitative study to obtain information relevant to the design of the training program. METHODS We conducted semi-structured individual interviews with 28 stakeholders; including 15 GPs working in a collaborative care network, 6 parents and 4 adolescents who had received child mental health care from a GP, and 3 policymakers. We also held a focus group discussion with 8 school teachers and counselors. All interviews were transcribed during the interviews' sessions and then were thematically analyzed. RESULTS GPs reported seeing a range of child emotional and behavioral problems but felt the need for additional training in diagnosis and management, especially in skills for interviewing and communicating with children. GPs also expressed the need to understand legal issues involved in treating children, including cases of possible child abuse. School staff agreed that GPs could help with children's educational and emotional problems but also believed GPs would need extra training. Parents indicated a preference for GPs over psychiatrists (as did adolescents) as a source of mental health care, and for psychological over pharmacological interventions. Adolescents expressed a preference not to speak about private issues in the presence of their parents, and expressed concern that the GPs did not respect their preference. They also desired a more active role during visits. CONCLUSIONS Before expanding the scope of practice of Iranian GPs to provide management of common emotional and behavioral problems in children and adolescents, the concerns and specific needs of these practitioners need to be addressed. Parents and youth in the study expressed a preference for mental health care from a GP rather than a specialist. However, they also commented on the need for restructuring the current GP visits to facilitate youth participation. These findings provide directions for expanding the scope of practice of adult collaborative care networks to meet the mental health care needs of children and adolescents more expeditiously and effectively.
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Affiliation(s)
- Hadi Zarafshan
- Psychiatry and Psychology Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Lawrence S Wissow
- Division of Child and Adolescent Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Zahra Shahrivar
- Department of Psychiatry, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramin Mojtabai
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD., USA
| | - Mojgan Khademi
- Department of Psychiatry, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Morteza JafariNia
- Shahid-Emami Community Mental Health Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Hajebi
- Research Center for Addiction & Risky Behaviors (ReCARB) and Department of Psychiatry, Iran University of Medical Sciences, Tehran, Iran
| | - Farid Abolhassani
- National institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Vandad Sharifi
- Department of Psychiatry, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
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19
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Affiliation(s)
| | - George Freeman
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | | | - Martin Roland
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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20
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Tolvanen E, Koskela TH, Helminen M, Kosunen E. The validity and reliability of the patient enablement instrument (PEI) after GP appointments in Finnish health care centres. J Patient Rep Outcomes 2020; 4:79. [PMID: 32936378 PMCID: PMC7494691 DOI: 10.1186/s41687-020-00243-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 08/25/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The aim of this study was to assess the validity and reliability of the Patient Enablement Instrument (PEI) in Finnish health care centre patients. A pilot study was conducted to assess the content validity of the PEI. A questionnaire study in three health care centres in Western Finland was performed in order to assess acceptability, construct validity, internal consistency, and measurement error of the instrument. A telephone interview 2 weeks after the appointment was performed to evaluate reproducibility. RESULTS The pilot study with 17 participants indicated good content validity of the PEI. In the questionnaire study, altogether 483 with a completed PEI score were included in the analyses. Factor analysis and item-scale correlations suggested high structural validity. The internal consistency of the instrument was high (Cronbach's α = 0.93). The PEI score diminished strongly over the two-week period. CONCLUSIONS The PEI has good content validity and acceptability, good construct validity, high internal consistency but low reproducibility. Thus, the PEI seems to be an applicable tool to measure patient enablement in Finnish primary health care.
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Affiliation(s)
- Elina Tolvanen
- Faculty of Medicine and Health Technology, Tampere University, c/o coordinator Leena Kiuru, Arvo Building B, 33014, Tampere, Finland. .,Pirkkala Municipal Health Centre, Pirkkala, Finland. .,Research, Development and Innovation Centre, Tampere University Hospital, Tampere, Finland.
| | - Tuomas H Koskela
- Faculty of Medicine and Health Technology, Tampere University, c/o coordinator Leena Kiuru, Arvo Building B, 33014, Tampere, Finland
| | - Mika Helminen
- Research, Development and Innovation Centre, Tampere University Hospital, Tampere, Finland.,Faculty of Social Sciences, Health Sciences, Tampere University, Tampere, Finland
| | - Elise Kosunen
- Faculty of Medicine and Health Technology, Tampere University, c/o coordinator Leena Kiuru, Arvo Building B, 33014, Tampere, Finland.,Centre for General Practice, Pirkanmaa Hospital District, Tampere, Finland
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21
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Tolvanen E, Groenewegen PP, Koskela TH, Bjerve Eide T, Cohidon C, Kosunen E. Patient enablement after a consultation with a general practitioner-Explaining variation between countries, practices and patients. Health Expect 2020; 23:1129-1143. [PMID: 32602205 PMCID: PMC7696125 DOI: 10.1111/hex.13091] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/08/2020] [Accepted: 05/22/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Patient enablement is a concept developed to measure quality in primary health care. The comparative analysis of patient enablement in an international context is lacking. OBJECTIVE To explain variation in patient enablement between patients, general practitioners (GPs) and countries. To find independent variables associated with enablement. DESIGN We constructed multi-level logistic regression models encompassing variables from patient, GP and country levels. The proportions of explained variances at each level and odds ratios for independent variables were calculated. SETTING AND PARTICIPANTS A total of 7210 GPs and 58 930 patients in 31 countries were recruited through the Quality and Costs of Primary Care in Europe (QUALICOPC) study framework. In addition, data from the Primary Health Care Activity Monitor for Europe (PHAMEU) study and Hofstede's national cultural dimensions were combined with QUALICOPC data. RESULTS In the final model, 50.6% of the country variance and 18.4% of the practice variance could be explained. Cultural dimensions explained a major part of the variation between countries. Several patient-level and only a few practice-level variables showed statistically significant associations with patient enablement. Structural elements of the relevant health-care system showed no associations. From the 20 study hypotheses, eight were supported and four were partly supported. DISCUSSION AND CONCLUSIONS There are large differences in patient enablement between GPs and countries. Patient characteristics and patients' perceptions of consultation seem to have the strongest associations with patient enablement. When comparing patient-reported measures as an indicator of health-care system performance, researchers should be aware of the influence of cultural elements.
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Affiliation(s)
- Elina Tolvanen
- Faculty of Medicine and Health Technology, c/o coordinator Leena Kiuru, Tampere University, Tampere, Finland.,Pirkkala Municipal Health Centre, Pirkkala, Finland.,Science Centre, Pirkanmaa Hospital District, Tampere, Finland
| | - Peter P Groenewegen
- Nivel-Netherlands Institute for Health Services Research, Utrecht, The Netherlands.,Department of Sociology, Utrecht University, Utrecht, The Netherlands.,Department of Human Geography, Utrecht University, Utrecht, The Netherlands
| | - Tuomas H Koskela
- Faculty of Medicine and Health Technology, c/o coordinator Leena Kiuru, Tampere University, Tampere, Finland
| | - Torunn Bjerve Eide
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Christine Cohidon
- Department of Family Medicine, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Elise Kosunen
- Faculty of Medicine and Health Technology, c/o coordinator Leena Kiuru, Tampere University, Tampere, Finland.,Centre for General Practice, Pirkanmaa Hospital District, Tampere, Finland
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22
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Zeng C, Zhang W, Doherty M, Persson MSM, Mallen C, Swain S, Li X, Wei J, Lei G, Zhang Y. Initial analgesic prescriptions for osteoarthritis in the United Kingdom, 2000–2016. Rheumatology (Oxford) 2020; 60:147-159. [DOI: 10.1093/rheumatology/keaa244] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 04/09/2020] [Indexed: 12/14/2022] Open
Abstract
Abstract
Objectives
To examine trends in the initial prescription of commonly-prescribed analgesics and patient- as well as practice-level factors related to their selection in incident OA.
Methods
Patients consulting with incident clinical OA between 2000–2016 were identified within The Health Improvement Network in the United Kingdom (UK) general practice. Excluded were patients who had history of cancer or were prescribed the analgesics of interest within 6 months before diagnosis of OA. Initial analgesic prescription included oral non-selective NSAID, oral selective cyclooxygenase-2 inhibitor, topical NSAID, paracetamol, topical salicylate or oral/transdermal opioid within 1 month after OA diagnosis.
Results
∼44% of patients with incident OA (n = 125 696) were prescribed one of these analgesics. Incidence of oral NSAID prescriptions decreased whereas other analgesic prescriptions, including oral opioid prescriptions, increased (all P-for-trend < 0.001). Patients with a history of gastrointestinal disease were more likely to receive topical NSAIDs, paracetamol or oral/transdermal opioids. Only 38% of patients with history of gastrointestinal disease and 21% of patients without it had co-prescription of gastroprotective agent with oral NSAIDs. Oral/transdermal opioid prescription was higher among the elderly (≥65 years), women, obesity, current smoker, and patients with gastrointestinal, cardiovascular or chronic kidney disease. Prescription of oral opioids increased with social deprivation (P-for-trend < 0.05) and was highest in Scotland, whereas transdermal opioid prescription was highest in Northern Ireland (all P-for-homogeneity-test < 0.05).
Conclusion
The initial prescription pattern of analgesics for OA has changed over time in the UK. Co-prescription of gastroprotective agents with oral NSAIDs remains suboptimal, even among those with prior gastrointestinal disease.
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Affiliation(s)
- Chao Zeng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital
- The Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Weiya Zhang
- Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham
- Pain Centre Versus Arthritis UK, Nottingham
| | - Michael Doherty
- Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham
- Pain Centre Versus Arthritis UK, Nottingham
| | - Monica S M Persson
- Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham
- Pain Centre Versus Arthritis UK, Nottingham
| | - Christian Mallen
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, UK
| | - Subhashisa Swain
- Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham
- Pain Centre Versus Arthritis UK, Nottingham
| | - Xiaoxiao Li
- Hunan Key Laboratory of Joint Degeneration and Injury
| | - Jie Wei
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital
- The Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Health Management Center, Xiangya Hospital, Central South University
| | - Guanghua Lei
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Joint Degeneration and Injury
- Hunan Engineering Research Center of Osteoarthritis, Changsha, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yuqing Zhang
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital
- The Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Sharp G, Bourke L, Rickard MJFX. Review of emotional intelligence in health care: an introduction to emotional intelligence for surgeons. ANZ J Surg 2020; 90:433-440. [PMID: 31965690 DOI: 10.1111/ans.15671] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim of this review is to explain the components of emotional intelligence (EI) and explore the benefits within today's health care system with an emphasis on surgery. EI is a person's ability to understand their own emotions and those of the individuals they interact with. Higher individual EI has multiple proposed benefits, such as reducing stress, burnout and increasing work satisfaction. The business world recognizes EI as beneficial in terms of performance and outcomes. Could surgeons benefit from being more cognisant of EI and methods of assessing and improving EI to reap the aforementioned benefits? METHODS A search of Embase, Cochrane and Medline databases using the following search terms; emotional intelligen*, surg*, medic* yielded 95 articles. After review of all the literature 39 remaining articles and five text books were included. RESULTS To perform optimally, surgeons must be aware of their own emotions and others. EI differs from IQ and can be taught, learnt and improved upon. EI is measured via validated self-reporting questionnaires and 'multi-rater' assessments. High EI is positively associated with leadership skills in surgeons, non-technical skills, reduction in surgeon stress, burnout and increased job satisfaction, all of which translate to better patient relationships and care. Future implications of EI have been postulated as a measure of performance, a selection tool for training positions and a marker of burnout. EI should be an explicit part of contemporary surgical education and training.
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Affiliation(s)
- Gary Sharp
- Department of General Surgery, Royal Prince Alfred Hospital, Institute of Academic Surgery, Sydney, New South Wales, Australia
| | - Lorna Bourke
- Department of Psychology, Liverpool Hope University, Liverpool, UK
| | - Matthew J F X Rickard
- Department of Colorectal Surgery, Concord Hospital, Sydney, New South Wales, Australia.,Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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Hajebrahimi S, Janati A, Arab-Zozani M, Sokhanvar M, Haghgoshayie E, Siraneh Y, Bahadori M, Hasanpoor E. Medical visit time and predictors in health facilities: a mega systematic review and meta-analysis. INTERNATIONAL JOURNAL OF HUMAN RIGHTS IN HEALTH CARE 2019. [DOI: 10.1108/ijhrh-05-2019-0036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeVisit time is a crucial aspect of patient–physician interaction; its inadequacy can negatively impact the efficiency of treatment and diagnosis. In addition, visit time is a fundamental demand of patients, and it is one of the rights of every patient. The purpose of this paper is to determine factors influencing the consultation length of physicians and to compare consultation length in different countries.Design/methodology/approachMEDLINE (PubMed), Web of Science, Cochrane, ProQuest, Scopus, and Google Scholar were searched. In addition, references of references were checked, and publication lists of individual scholars in the field were examined. We used data sources up to June 2018, without language restriction. We used a random-effects model for the meta-analyses. Meta-analyses were conducted using Comprehensive Meta-Analysis Version (CMA) 3.0.FindingsOf 16,911 identified studies, 189 studies were assessed of which 125 cases (67 percent) have been conducted in the USA. A total of 189 studies, 164 (86.77 percent) involved face-to face-consultations. The effects of three variables, physician gender, patient gender, and type of consultation were analyzed. According to moderate and strong evidence studies, no significant difference was found in the consultation lengths of female and male doctors (Q=42.72, df=8,I2=81.27,p=0.891) and patients’ gender (Q=55.98, df=11,I2=80.35,p=0.314). In addition, no significant difference was found in the telemedicine or face-to-face visits (Q=41.25, df=5,I2=87.88,p=0.170).Originality/valueIn this systematic review and meta-analysis, all of physicians’ visits in 34 countries were surveyed. The evidence suggests that specified variables do not influence the length of consultations. Good relationship is essential to a safe and high-quality consultation and referral process. A high-quality consultation can improve decisions and quality of visits, treatment effectiveness, efficiency of service, quality of care, patient safety and physician and patient satisfaction.
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Kellezi B, Wakefield JRH, Stevenson C, McNamara N, Mair E, Bowe M, Wilson I, Halder MM. The social cure of social prescribing: a mixed-methods study on the benefits of social connectedness on quality and effectiveness of care provision. BMJ Open 2019; 9:e033137. [PMID: 31727668 PMCID: PMC6887058 DOI: 10.1136/bmjopen-2019-033137] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/20/2019] [Accepted: 10/18/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES This study aimed to assess the degree to which the 'social cure' model of psychosocial health captures the understandings and experiences of healthcare staff and patients in a social prescribing (SP) pathway and the degree to which these psychosocial processes predict the effect of the pathway on healthcare usage. DESIGN Mixed-methods: Study 1: semistructured interviews; study 2: longitudinal survey. SETTING An English SP pathway delivered between 2017 and 2019. PARTICIPANTS Study 1: general practitioners (GPs) (n=7), healthcare providers (n=9) and service users (n=19). Study 2: 630 patients engaging with SP pathway at a 4-month follow-up after initial referral assessment. INTERVENTION Chronically ill patients experiencing loneliness referred onto SP pathway and meeting with a health coach and/or link worker, with possible further referral to existing or newly created relevant third-sector groups. MAIN OUTCOME MEASURE Study 1: health providers and users' qualitative perspectives on the experience of the pathway and social determinants of health. Study 2: patients' primary care usage. RESULTS Healthcare providers recognised the importance of social factors in determining patient well-being, and reason for presentation at primary care. They viewed SP as a potentially effective solution to such problems. Patients valued the different social relationships they created through the SP pathway, including those with link workers, groups and community. Group memberships quantitatively predicted primary care usage, and this was mediated by increases in community belonging and reduced loneliness. CONCLUSIONS Methodological triangulation offers robust conclusions that 'social cure' processes explain the efficacy of SP, which can reduce primary care usage through increasing social connectedness (group membership and community belonging) and reducing loneliness. Recommendations for integrating social cure processes into SP initiatives are discussed.
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Affiliation(s)
| | | | | | | | | | - Mhairi Bowe
- Psychology, Nottingham Trent University, Nottingham, UK
| | - Iain Wilson
- Psychology, Nottingham Trent University, Nottingham, UK
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Chan JMH, Fang AHS, Shah M. Factors affecting patient enablement in an Asian setting: a mixed methods study. Singapore Med J 2019; 61:647-660. [PMID: 31598731 DOI: 10.11622/smedj.2019125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Patient-centred medical care has been rising in importance since the turn of the century. It entails treating patients in relation to their biopsychosocial outlook so as to support the management of their conditions. The extent to which a patient is enabled to acquire skills and knowledge can be measured with the Patient Enablement Instrument (PEI) proposed by Howie and colleagues, and it has been noted to be more reflective of a good consultation compared to patient satisfaction scores. This study aimed to determine the level of patient enablement in the Singaporean context and the factors facilitating it. METHODS We conducted an embedded mixed method study with primary care patients in two phases: (a) a PEI questionnaire was completed by 150 patients; and (b) a qualitative approach using focused group discussions and individual interviews was used to explore factors associated with high enablement. RESULTS The mean PEI score was 4.5 ± 4.4, with significantly higher scores among patients attending specialised primary care clinics. Important physician factors were doctors' advice, attitude and relationship with the patient. Critical system factors included good continuity of care, workload and financial support, while patient factors included their beliefs, preparedness, inquisitiveness and trust, with considerable impact from the influence of community. CONCLUSION The PEI score in the Singaporean context is similar to that of other Asian contexts, but slightly higher than that reported in Western studies. Good doctor-patient relationships, efficient systems facilitating continuity of care, and motivated and informed patients all contribute to increased enablement.
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Sandvik H. Doctors' characteristics and the use of long consultations at out-of-hours services 2008-2017: a registry-based follow-up study in Norway. Scand J Prim Health Care 2019; 37:366-372. [PMID: 31293197 PMCID: PMC6713110 DOI: 10.1080/02813432.2019.1639929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objective: The aim was to analyse whether there was a change in percentage of long consultations over a 10-year period, and whether individual doctors changed their use of time as they got more experience and specialisation during the same period. Design and setting: This is a registry based study encompassing all consultations in primary care out-of-hours service in Norway in 2008 and 2017. Subjects: For both years all doctors were included in cross sectional analyses. In addition, doctors who participated both years were included in a separate follow-up analysis. Main outcome measures: Long consultations (>20 min) were identified by a time fee in the claims' database. Results: There were 4610 doctors in 2008 and 5620 in 2017, 904 participated both years. In 2008 a time fee was claimed in 38% of consultations, in 2017 in 47%. Older doctors made less use of the time fee, as did doctors who had many consultations, regular general practitioners, and general practice specialists. The general practitioners who participated both years increased their use of the time fee from 33% to 38% of consultations. Those who specialised in general practice during the 10-year period increased their use of the time fee from 34% to 37%. Conclusions: Experienced doctors have fewer long consultations than inexperienced doctors. Over years there is a strong trend towards increasing the use of time fee during out-of-hours consultations. This trend is only partly offset by increasing the experience of the doctors. KEY POINTS Although consultation length may be associated with patient satisfaction there is also a cost-efficiency aspect to be taken into account •Percentage long consultations out-of-hours increased from 38% in 2008 to 47% in 2017 •Experienced doctors had fewer long consultations •Experience only partly offset the trend towards more long consultations.
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Affiliation(s)
- Hogne Sandvik
- National Centre for Emergency Primary Health Care, NORCE Research AS, Bergen, Norway
- CONTACT Hogne Sandvik National Centre for Emergency Primary Health Care, NORCE Research AS, Kalfarveien 31, 5018 Bergen, Norway
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Jeffrey D. Communicating with a human voice: developing a relational model of empathy. J R Coll Physicians Edinb 2019; 48:251-256. [PMID: 29465105 DOI: 10.4997/jrcpe.2017.312] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The medical profession has adopted a cognitive model of empathy, or detached concern, in its professionalism and practice. As a consequence there is now an empathy gap which has been demonstrated by lapses in patient care in the UK. There may also be an empathy gap developing in medical students during their training. This paper argues for the adoption of a relational view of empathy which embraces emotional and moral dimensions of the concept, acknowledges the importance of the clinical context and prioritises the relationship between the doctor and patient. A relational model extends to encompass the patient's family and all members of the healthcare team. By exploring the process of empathising in clinical practice I develop a relational model that is more appropriate for modern patterns of patient care and medical education than detached concern. Adoption of a relational model of empathy in training and practice can help bridge the empathy gap.
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Affiliation(s)
- D Jeffrey
- D Jeffrey, Department of Primary Palliative Care, University of Edinburgh, Medical School, Teviot Place, Edinburgh EH8 9AG, UK.
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Tolvanen E, Koskela TH, Kosunen E. Comparison of the Patient Enablement Instrument (PEI) with two single-item measures among Finnish Health care centre patients. BMC Health Serv Res 2019; 19:376. [PMID: 31196088 PMCID: PMC6567660 DOI: 10.1186/s12913-019-4182-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 05/27/2019] [Indexed: 11/29/2022] Open
Abstract
Background The Patient Enablement Instrument (PEI) is an established patient-reported outcome measure (PROM) that reflects the quality of appointments with general practitioners (GPs). It is a six-item questionnaire administered to the patient immediately after a consultation. The aim of this study was to evaluate whether a single-item measure could replace the PEI when measuring patient enablement among Finnish health care centre patients. Methods Two single-item measures, Q1 and Q2, were chosen for comparison with the PEI. Firstly, a pilot study with questionnaire testing and brief interviews with the respondents were performed in order to assess the content validity of the PEI and the single-item measures. Secondly, a questionnaire study after a single appointment with a GP was carried out in three health care centres in Western Finland in order to evaluate the construct and criterion validity of the single-item measures. A telephone interview was performed 2 weeks after the appointment in order to assess the test-retest reliability of the single-item measures. The sensitivity, specificity, and both positive and negative predictive values of Q1 and Q2 were calculated with different PEI score cut-off points. Results Altogether 483 patients with a completed PEI were included in the questionnaire study analyses. Altogether 149 and 175 patients had completed Q1 and Q2, respectively, both in the questionnaire and the telephone interview. The correlations between the PEI and Q1 and Q2 were 0.48 and 0.84, respectively. Both the single-item measures had a high sensitivity and a negative predictive value in relation to patients with lower PEI scores. The reliability coefficients were 0.24 for Q1 and 0.76 for Q2. The test-retest values of Q1, Q2, and the PEI were low. Conclusions Q2 seems to be a valid and reliable measure of patient enablement. Q1 seems to be less correlated with the PEI, but it also has a high negative predictive value in relation to low enablement scores.
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Affiliation(s)
- Elina Tolvanen
- Faculty of Medicine and Health Technology, Tampere University, c/o coordinator Leena Kiuru, Arvo Building B, 33014, Tampere, Finland. .,Pirkkala Municipal Health Centre, Pirkkala, Finland. .,Science Centre, Pirkanmaa Hospital District, Tampere, Finland.
| | - Tuomas H Koskela
- Faculty of Medicine and Health Technology, Tampere University, c/o coordinator Leena Kiuru, Arvo Building B, 33014, Tampere, Finland.,Centre for General Practice, Pirkanmaa Hospital District, Tampere, Finland
| | - Elise Kosunen
- Faculty of Medicine and Health Technology, Tampere University, c/o coordinator Leena Kiuru, Arvo Building B, 33014, Tampere, Finland.,Centre for General Practice, Pirkanmaa Hospital District, Tampere, Finland
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Fusar-Poli P. Integrated Mental Health Services for the Developmental Period (0 to 25 Years): A Critical Review of the Evidence. Front Psychiatry 2019; 10:355. [PMID: 31231250 PMCID: PMC6567858 DOI: 10.3389/fpsyt.2019.00355] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 05/07/2019] [Indexed: 12/12/2022] Open
Abstract
Background: The developmental period from 0 to 25 years is a vulnerable time during which children and young people experience many psychosocial and neurobiological changes and an increased incidence of mental illness. New clinical services for children and young people aged 0 to 25 years may represent a radical transformation of mental healthcare. Method: Critical, non-systematic review of the PubMed literature up to 3rd January 2019. Results: Rationale: the youngest age group has an increased risk of developing mental disorders and 75% of mental disorders begin by the age of 24 and prodromal features may start even earlier. Most of the risk factors for mental disorders exert their role before the age of 25, profound maturational brain changes occur from mid-childhood through puberty to the mid-20s, and mental disorders that persist in adulthood have poor long-term outcomes. The optimal window of opportunity to improve the outcomes of mental disorders is the prevention or early treatment in individuals aged 0 to 25 within a clinical staging model framework. Unmet needs: children and young people face barriers to primary and secondary care access, delays in receiving appropriate treatments, poor engagement, cracks between child and adult mental health services, poor involvement in the design of mental health services, and lack of evidence-based treatments. Evidence: the most established paradigm for reforming youth mental services focuses on people aged 12-25 who experienced early stages of psychosis. Future advancements may include early stages of depression and bipolar disorders. Broader youth mental health services have been implemented worldwide, but no single example constitutes best practice. These services seem to improve access, symptomatic and functional outcomes, and satisfaction of children and young people aged 12-25. However, there are no robust controlled trials demonstrating their impact. Very limited evidence is available for integrated mental health services that focus on people aged 0-12. Conclusions: Children and young people aged 12-25 need youth-friendly mental health services that are sensitive to their unique stage of clinical, neurobiological, and psychosocial development. Early intervention for psychosis services may represent the starting platform to refine the next generation of integrated youth mental health services.
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Affiliation(s)
- Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
- Department of Brain and Behavioral Science, University of Pavia, Pavia, Italy
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Bener A, Alayoglu N, Çatan F, Torun P, Yilmaz ES. Health Services Management in Turkey: Failure or Success? Int J Prev Med 2019; 10:30. [PMID: 30967916 PMCID: PMC6425761 DOI: 10.4103/ijpvm.ijpvm_422_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Accepted: 02/23/2018] [Indexed: 11/17/2022] Open
Abstract
Background: The unfair distribution and delivery of health-care resources have been recognized as a problem in the worldwide. In the past 18 years, Turkey has undergone rapid social, cultural, and economic changes. The lifestyle and dietary habits of its people have also been changing, and the rates of diabetes, obesity, cancer, and other chronic diseases have increased dramatically over the past two decades. The health transformation program (HTP) has improved the Turkish health-care system since 2003. The main goal of HTP was to progress government, to provide equality between citizens, to give satisfaction to users and providers, and to subsidise the health-care system in Turkey. Aim: The aim of this study is to assess health-care services and health care quality delivery in the Republic of Turkey with special emphasis on governmental hospitals, university hospitals, primary healthcare centers (PHC) and to make comparison with low-, medium- and high-income countries. Methods: This is a retrospective, descriptive study. The ministry of health Annual Reports, websites of the Central Intelligence Agency (CIA), The World Fact Book, organization for economic cooperation and development report, Compendium of Health Statistics, the Google engine, and PubMed were searched for information about Turkey's health-care system and its history. Papers and websites in English were evaluated. There was no restriction on types of articles and sources. Results: Turkey has made outstanding reforms in health status in the last two decades, especially after the implementation of the HTP. The doctor's perception has more influence regarding consultation length and visit than the patient’s. The results of consultations in volunteer practices in Istanbul showed that the mean and SD of the consultation length for the whole sample of 360 patients was 7.95 ± 4.38, (with range = 3–25 min). Consultation time has been affected by the patients’ diseases, genders that women got longer consultation time, medical practices at the urban or rural areas, and ages which older patients required longer consultation time. The current study revealed that increasing doctor's workload leads to decrease the length of consultations. Moreover, average life expectancy reached 75.3 for men and 80.7 for women in 2015. The infant mortality rate decreased to 10.7/1000 live births in 2015, down from 117.5 in 1980. The leading causes of death are diseases of the circulatory system followed by cancer. Conclusions: The Turkish health system and health-care delivery have been improved over the last decade. Still far from perfect, there is a particular planning to increase medical workforce in PHC including well-trained staffs for a specific area. An urgent need is to acquire more accurate and reliable data from hospital and PHC centers in Turkey. Additional some attempts should be made to assess quality of healthcare in relation to services and process.
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Affiliation(s)
- Abdulbari Bener
- Department of Biostatistics and Medical Informatics, Cerrahpaşa Faculty of Medicine Istanbul University, Istanbul, Turkey.,Department of Evidence for Population Health Unit, School of Epidemiology and Health Sciences, University of Manchester, Manchester, UK.,Department of Public Health, Istanbul Medipol University, International School of Medicine, İstanbul, Turkey
| | - Nihat Alayoglu
- Department of Public Health, Istanbul Medipol University, Faculty of Management and Administration, Kavacik, İstanbul, Turkey
| | - Funda Çatan
- Department of Biostatistics and Medical Informatics, Cerrahpaşa Faculty of Medicine Istanbul University, Istanbul, Turkey.,Department of Computer Education and Instructional Technologies, Faculty of Education, University of Kastamonu, Kastamonu, Turkey
| | - Perihan Torun
- Department of Evidence for Population Health Unit, School of Epidemiology and Health Sciences, University of Manchester, Manchester, UK.,Department of Public Health, Faculty of Medicine, Bezmialem Vaqif University, İstanbul, Turkey
| | - Esra S Yilmaz
- Department of Economic Evaluations and Drug Supply Management, Ministry of Public Health, Health Technology Assessment Directorate, Ankara, Turkey
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Krusche A, Bradbury K, Corbett T, Barnett J, Stuart B, Yao GL, Bacon R, Böhning D, Cheetham-Blake T, Eccles D, Foster C, Geraghty AWA, Leydon G, Müller A, Neal RD, Osborne R, Rathod S, Richardson A, Sharman G, Summers K, Watson E, Wilde L, Wilkinson C, Yardley L, Little P. Renewed: Protocol for a randomised controlled trial of a digital intervention to support quality of life in cancer survivors. BMJ Open 2019; 9:e024862. [PMID: 30826763 PMCID: PMC6429898 DOI: 10.1136/bmjopen-2018-024862] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 11/09/2018] [Accepted: 12/21/2018] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Low quality of life is common in cancer survivors. Increasing physical activity, improving diet, supporting psychological well-being and weight loss can improve quality of life in several cancers and may limit relapse. The aim of the randomised controlled trial outlined in this protocol is to examine whether a digital intervention (Renewed), with or without human support, can improve quality of life in cancer survivors. Renewed provides support for increasing physical activity, managing difficult emotions, eating a healthier diet and weight management. METHODS AND ANALYSIS A randomised controlled trial is being conducted comparing usual care, access to Renewed or access to Renewed with brief human support. Cancer survivors who have had colorectal, breast or prostate cancer will be identified and invited through general practice searches and mail-outs. Participants are asked to complete baseline measures immediately after screening and will then be randomised to a study group; this is all completed on the Renewed website. The primary outcome is quality of life measured by the European Organization for Research and Treatment of Cancer QLQ-c30. Secondary outcomes include anxiety and depression, fear of cancer recurrence, general well-being, enablement and items relating to costs for a health economics analysis. Process measures include perceptions of human support, intervention usage and satisfaction, and adherence to behavioural changes. Qualitative process evaluations will be conducted with patients and healthcare staff providing support. ETHICS AND DISSEMINATION The trial has been approved by the NHS Research Ethics Committee (Reference 18/NW/0013). The results of this trial will be published in peer-reviewed journals and through conference presentations. TRIAL REGISTRATION NUMBER ISRCTN96374224; Pre-results.
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Affiliation(s)
- Adele Krusche
- Department of Psychology, University of Southampton, Southampton, UK
| | | | - Teresa Corbett
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Jane Barnett
- Primary Care and Population Sciences Division, University of Southampton, Southampton, UK
| | - Beth Stuart
- Primary Care and Population Sciences Division, University of Southampton, Southampton, UK
| | - Guiqing Lily Yao
- Biostatistics Research Group, University of Leicester, Leicester, UK
| | - Roger Bacon
- Patient and Public Involvement team for the CLASP project
| | - Dankmar Böhning
- Mathematical Sciences, University of Southampton, Southampton, UK
| | | | - Diana Eccles
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Claire Foster
- Macmillan Survivorship Research Group, University of Southampton, Southampton, UK
| | | | - Geraldine Leydon
- Primary Care and Population Sciences Division, University of Southampton, Southampton, UK
| | - Andre Müller
- Saw Swee Hock Public School of Health, National University of Singapore, Singapore
| | - Richard D Neal
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | | | - Alison Richardson
- School of Health Sciences, University of Southampton, Southampton, UK
| | | | - Kevin Summers
- Patient and Public Involvement team for the CLASP project
| | - Eila Watson
- School of Nursing and Midwifery, Oxford Brookes University, Oxford, UK
| | - Laura Wilde
- Faculty of Health & Life Sciences, Coventry University, Coventry, UK
| | | | - Lucy Yardley
- Department of Psychology, University of Southampton, Southampton, UK
- School of Experimental Psychology, University of Bristol, Bristol, UK
| | - Paul Little
- Primary Care and Population Sciences Division, University of Southampton, Southampton, UK
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Murphy M, Hollinghurst S, Salisbury C. Patient understanding of two commonly used patient reported outcome measures for primary care: a cognitive interview study. BMC FAMILY PRACTICE 2018; 19:162. [PMID: 30261850 PMCID: PMC6161379 DOI: 10.1186/s12875-018-0850-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 09/17/2018] [Indexed: 01/25/2023]
Abstract
Background Standardised generic patient-reported outcome measures (PROMs) which measure health status are often unresponsive to change in primary care. Alternative formats, which have been used to increase responsiveness, include individualised PROMs (in which respondents specify the outcomes of interest in their own words) and transitional PROMs (in which respondents directly rate change over a period). The objective of this study was to test qualitatively, through cognitive interviews, two PROMs, one using each respective format. Methods The individualised PROM selected was the Measure Yourself Medical Outcomes Profile (MYMOP). The transitional PROM was the Patient Enablement Instrument (PEI). Twenty patients who had recently attended the GP were interviewed while completing the questionnaires. Interview data was analysed using a modification of Tourangeau’s model of cognitive processing: comprehension, response, recall and face validity. Results Patients found the PEI simple to complete, but for some it lacked face validity. The transitional scale was sometimes confused with a status scale and was problematic in situations when the relevant GP appointment was part of a longer episode of care. Some patients reported a high enablement score despite verbally reporting low enablement but high regard for their GP, which suggested hypothesis-guessing. The interpretation of the PEI items was inconsistent between patients. MYMOP was more difficult for patients to complete, but had greater face validity than the PEI. The scale used was open to response-shift: some patients suggested they would recalibrate their definition of the scale endpoints as their illness and expectations changed. Conclusions The study provides information for both users of PEI/MYMOP and developers of individualised and transitional questionnaires. Users should heed the recommendation that MYMOP should be interview-administered, and this is likely to apply to other individualised scales. The PEI is open to hypothesis-guessing and may lack face-validity for a longer episode of care (e.g. in patients with chronic conditions). Developers should be cognisant that transitional scales can be inconsistently completed: some patients forget during completion that they are measuring change from baseline. Although generic questionnaires require the content to be more general than do disease-specific questionnaires, developers should avoid questions which allow broad and varied interpretations. Electronic supplementary material The online version of this article (10.1186/s12875-018-0850-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mairead Murphy
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - Sandra Hollinghurst
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Chris Salisbury
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
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Leydon GM, Stuart B, Summers RH, Little P, Ekberg S, Stevenson F, Chew-Graham CA, Brindle L, Heritage J, Drew P, Moore MV. Findings from a feasibility study to improve GP elicitation of patient concerns in UK general practice consultations. PATIENT EDUCATION AND COUNSELING 2018; 101:1394-1402. [PMID: 29627268 DOI: 10.1016/j.pec.2018.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 02/28/2018] [Accepted: 03/07/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To establish: a) feasibility of training GPs in a communication intervention to solicit additional patient concerns early in the consultation, using specific lexical formulations ("do you have 'any' vs. 'some' other concerns?") noting the impact on consultation length, and b) whether patients attend with multiple concerns and whether they voiced them in the consultation. METHODS A mixed-methods three arm RCT feasibility study to assess the feasibility of the communication intervention. RESULTS Intervention fidelity was high. GPs can be trained to solicit additional concerns early in the consultation (once patients have presented their first concern). Whilst feasible the particular lexical variation of 'any' vs 'some' seemed to have no bearing on the number of patient concerns elicited, on consultation length or on patient satisfaction. The level of missing questionnaire data was low, suggesting patients found completion of questionnaires acceptable. CONCLUSION GPs can solicit for additional concerns without increasing consultation length, but the particular wording, specifically 'any' vs. 'some' may not be as important as the placement of the GP solicitation. PRACTICE IMPLICATIONS GPs can solicit early for additional concerns and GPs can establish patients' additional concerns in the opening of the consultation, which can help to plan and prioritise patients multiple concerns.
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Affiliation(s)
- Geraldine M Leydon
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, UK.
| | - Beth Stuart
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, UK
| | | | - Paul Little
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, UK
| | - Stuart Ekberg
- Faculty of Health, School of Psychology and Counselling, Queensland University of Technology, Brisbane, Australia
| | - Fiona Stevenson
- E-Health Unit, Primary Care & Population Health, University College London, UK
| | | | - Lucy Brindle
- Faculty of Health Sciences, University of Southampton, UK
| | - John Heritage
- Social Sciences, University of California at Los Angeles, USA
| | - Paul Drew
- Social Sciences, Loughborough University, UK
| | - Michael V Moore
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, UK
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Barratt J, Thomas N. Nurse practitioner consultations in primary health care: an observational interaction analysis of social interactions and consultation outcomes. Prim Health Care Res Dev 2018; 20:e37. [PMID: 29979148 PMCID: PMC6536749 DOI: 10.1017/s1463423618000427] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 03/26/2018] [Accepted: 05/25/2018] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To determine the discrete nature of social interactions occurring in nurse practitioner consultations and investigate the relationship between consultation social interaction styles (biomedical and patient-centred) and the outcomes of patient satisfaction, patient enablement, and consultation time lengths. METHODS A case study-based observational interaction analysis of verbal social interactions, arising from 30 primary health care nurse practitioner consultations, linked with questionnaire measures of patient satisfaction and enablement. RESULTS A significant majority of observed social interactions used patient-centred communication styles (P=0.005), with neither nurse practitioners nor patients or carers being significantly more verbally dominant. Nurse practitioners guided the sequence of consultation interaction sequences, but patients actively participated through interactions such as asking questions. Usage of either patient-centred or biomedical interaction styles were not significantly associated with increased levels of patient satisfaction or patient enablement. The median consultation time length of 10.1 min (quartiles 8.2, 13.7) was not significantly extended by high levels of patient-centred interactions being used in the observed consultations. CONCLUSION High usage levels of patient-centred interaction styles are not necessarily contingent upon having longer consultation times available, and clinicians can encourage patients to use participatory interactions, whilst still then retaining overall guidance of the phased sequences of consultations, and not concurrently extending consultation time lengths. This study adds to the body of nurse practitioner consultation communication research by providing a more detailed understanding of the nature of social interactions occurring in nurse practitioner consultations, linked to the outcomes of patient satisfaction and enablement.
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Affiliation(s)
- Julian Barratt
- Head of Community Nursing and Workforce Development, Institute of Health, University of Wolverhampton, Wolverhampton, UK
| | - Nicola Thomas
- Professor of Kidney Care, School of Health and Social Care, London South Bank University, London, UK
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Primary Care Outcomes Questionnaire: psychometric testing of a new instrument. Br J Gen Pract 2018; 68:e433-e440. [PMID: 29581130 PMCID: PMC6001981 DOI: 10.3399/bjgp18x695765] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 09/08/2017] [Indexed: 11/15/2022] Open
Abstract
Background Patients attend primary care for many reasons and to achieve a range of possible outcomes. There is currently no Patient Reported Outcome Measure (PROM) designed to capture these diverse outcomes, and trials of interventions in primary care may thus fail to detect beneficial effects. Aim This study describes the psychometric testing of the Primary Care Outcomes Questionnaire (PCOQ), which was designed to capture a broad range of outcomes relevant to primary care. Design and setting Questionnaires were administered in primary care in South West England. Method Patients completed the PCOQ in GP waiting rooms before a consultation, and a second questionnaire, including the PCOQ and seven comparator PROMs, after 1 week. Psychometric testing included exploratory factor analysis on the PCOQ, internal consistency, correlation coefficients between domain scores and comparator measures, and repeated measures effect sizes indicating change across 1 week. Results In total, 602 patients completed the PCOQ at baseline, and 264 (44%) returned the follow-up questionnaire. Exploratory factor analysis suggested four dimensions underlying the PCOQ items: health and wellbeing, health knowledge and self-care, confidence in health provision, and confidence in health plan. Each dimension was internally consistent and correlated as expected with comparator PROMs, providing evidence of construct validity. Patients reporting an improvement in their main problem exhibited small to moderate improvements in relevant domain scores on the PCOQ. Conclusion The PCOQ was acceptable, feasible, showed strong psychometric properties, and was responsive to change. It is a promising new tool for assessment of outcomes of primary care interventions from a patient perspective.
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Cohidon C, Wild P, Senn N. Coping better with health problems after a visit to the family physician: associations with patients and physicians characteristics. BMC FAMILY PRACTICE 2018; 19:27. [PMID: 29415655 PMCID: PMC5804053 DOI: 10.1186/s12875-018-0712-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 01/24/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Good patient experience is recognized as an important component of a strong primary care system. Among the dimensions related to experience in family medicine, the ability to cope better with health problems is considered to be a measure of the quality of a consultation with a family physician (FP). The objective is to identify factors related to patients, physicians and practice, associated with patients' ability to cope better with their health problems after a family medicine consultation. METHODS The data stemmed from the Swiss part of the Quality and Costs of Primary Care (QUALICOPC) study, an international cross sectional survey aiming to compare quality, cost and equity in primary care. In Switzerland, a random sample of 199 FPs and 1791 patients participated. The negative answer to the question: "After this visit, I feel I can cope better with my health problems" was modeled using multilevel logistic regressions. RESULTS Difficulty to cope better with health problems was positively associated with the following: younger age (OR: 1.58, 95% CI [1.03-2.41]), cultural aspects related to the Swiss area of language (French speaking people declared higher inability than German and Italian ones), presence of chronic disease (OR: 1.54 95% CI [1.00-2.39]). Conversely an intermediate number (1-4) of visits during the last 6 months (OR: 0.37 95% CI [0.23-0.62]) and the satisfaction with the physician (OR: 0.18 95% CI [0.08-0.44]) are negative predictors of the patient inability to cope better with his health problems. A self-reported effort-reward imbalance at work (OR: 0.64 95% CI [0.41-1.00]) was the only predictive FP characteristic (negatively associated). CONCLUSIONS Although the design of the study does not allow causal inference, this study showed that the predictors of patient difficulties to cope better with health problem are mainly centered on the patients' characteristics. The patient-physician relationship both in terms of quality and frequency of visits is probably also important. Organizational practice characteristics do not seem to play a major role but stress at work among physicians should be further investigated.
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Affiliation(s)
- Christine Cohidon
- Institute of Family Medicine, Department of Ambulatory Care and Community Medicine, University of Lausanne, Rue du Bugnon 44, CH-1011, Lausanne, Switzerland.
| | - Pascal Wild
- Institute for Work and Health, Lausanne University and Geneva University, Lausanne, Switzerland.,INRS - National Research and Safety Institute, Vandoeuvre les Nancy, France
| | - Nicolas Senn
- Institute of Family Medicine, Department of Ambulatory Care and Community Medicine, University of Lausanne, Rue du Bugnon 44, CH-1011, Lausanne, Switzerland
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Murphy M, Hollinghurst S, Salisbury C. Qualitative assessment of the primary care outcomes questionnaire: a cognitive interview study. BMC Health Serv Res 2018; 18:79. [PMID: 29391003 PMCID: PMC5796473 DOI: 10.1186/s12913-018-2867-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 01/21/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The Primary Care Outcomes Questionnaire (PCOQ) is a new patient-reported outcome measure designed specifically for primary care. This paper describes the developmental process of improving the item quality and testing the face validity of the PCOQ through cognitive interviews with primary care patients. METHODS Two formats of the PCOQ were developed and assessed: the PCOQ-Status (which has an adjectival scale) and the PCOQ-Change (which has the same items as the PCOQ-Status, but a transitional scale). Three rounds of cognitive interviews were held with twenty patients from four health centres in Bristol. Patients seeking healthcare were recruited directly by their GP or practice nurse, and others not currently seeking healthcare were recruited from patient participation groups. An adjusted form of Tourangeau's model of cognitive processing was used to identify problems. This contained four categories: general comprehension, temporal comprehension, decision process, and response process. The resultant pattern of problems was used to assess whether the items and scales were working as intended, and to make improvements to the questionnaires. RESULTS The problems identified in the PCOQ-Status reduced from 41 in round one to seven in round three. It was noted that the PCOQ-Status seemed to be capturing a subjective view of health which might not vary with age or long-term conditions. However, as it is designed to be evaluative (measuring change over time) as opposed to discriminative (measuring change between different groups of people), this does not present a problem for validity. The PCOQ-Status was both understood by patients and was face valid. The PCOQ-Change had less face validity, and was misunderstood by three out of six patients in round 1. It was not taken forward after this round. CONCLUSIONS The cognitive interviews successfully contributed to the development of the PCOQ. Through this study, the PCOQ-Status was found to be well understood by patients, and it was possible to improve comprehension through each round of interviews. The PCOQ-Change was poorly understood and, given that this corroborates existing research, this may call into question the use of transitional questionnaires generally.
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Affiliation(s)
- Mairead Murphy
- University of Bristol, Centre for Academic Primary Care, School of Social and Community Medicine, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Sandra Hollinghurst
- University of Bristol, Centre for Academic Primary Care, School of Social and Community Medicine, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Chris Salisbury
- University of Bristol, Centre for Academic Primary Care, School of Social and Community Medicine, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
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Tolvanen E, Koskela TH, Helminen M, Kosunen E. Patient Enablement After a Single Appointment With a GP: Analysis of Finnish QUALICOPC Data. J Prim Care Community Health 2017; 8:213-220. [PMID: 28911251 PMCID: PMC5932738 DOI: 10.1177/2150131917730211] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Patient enablement is described as patient’s ability to understand and cope with illness after a consultation. The purpose of this study was to analyze factors associated with enablement in Finnish primary health care. An additional aim was to evaluate whether a single question could be used to measure enablement. Methods: A questionnaire survey was addressed to Finnish general practitioners (GPs) within the Quality and Costs of Primary Care in Europe (QUALICOPC) study framework. A trained fieldworker contacted nine patients for every participating GP. Two to 9 patients per GP (median 9 patients) completed the questionnaire. Patient enablement was measured by a single question based on the Patient Enablement Instrument questionnaire. Multivariate and multilevel analyses were performed to find variables that have an independent association with patient enablement. Results: A total of 1196 patients completed the QUALICOPC questionnaire. A total of 898 patients (75.1%) agreed that they felt better able to cope with their health problem or illness after an appointment with a GP, reflecting patient enablement. In the theme group analyses, 11 factors were found to have a statistically significant (P < .05) association with enablement. In the final multivariable model, positive perceptions of doctor-patient communication and patient satisfaction were positively associated with enablement. Conclusions: The results, using a single question to measure enablement, are comparable to previous findings on factors associated with enablement. Further research is needed and these results should be regarded as preliminary.
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Affiliation(s)
- Elina Tolvanen
- 1 University of Tampere, Tampere, Finland.,2 Pirkkala Municipal Health Centre, Pirkkala, Finland.,3 Pirkanmaa Hospital District, Tampere, Finland
| | | | - Mika Helminen
- 1 University of Tampere, Tampere, Finland.,3 Pirkanmaa Hospital District, Tampere, Finland
| | - Elise Kosunen
- 1 University of Tampere, Tampere, Finland.,3 Pirkanmaa Hospital District, Tampere, Finland
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Gupta R, Singh N, Kumar R. Longitudinal predictive validity of emotional intelligence on first year medical students perceived stress. BMC MEDICAL EDUCATION 2017; 17:139. [PMID: 28821250 PMCID: PMC5563054 DOI: 10.1186/s12909-017-0979-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 08/14/2017] [Indexed: 05/25/2023]
Abstract
BACKGROUND Emotional intelligence has been shown to affect academic performance and perceived stress. But conflicting reports suggest that the relationship between academic performance and emotional intelligence may not be straightforward. Hence, this study explored the relationship between emotional intelligence, perceived stress and academic performance. METHODS First year medical students were invited to participate in this longitudinal study. At Time 1, before mid-semester examinations, they completed the questionnaires on Schutte's Emotional Intelligence Scale (SEIS) and Perceived Stress Scale (PSS) (n = 213). At Time 2, before pre university examinations, students again completed perceived stress scale questionnaire. (n = 138). Academic performance was reported using summative assessment at both T1 and T2. The relationship between academic performance, emotional intelligence and perceived stress was explored using regression analysis. RESULTS Neither PSS nor SEIS were related to academic performance. However, perceived stress was significantly predicted by SEIS both at T1 (r = 0.333, β = 0.149, p < 0.001) as well as T2 (r = 0.240, β = 0.116, p = 0.028). The results were cross-validated at student level both at T1 and at T2. CONCLUSION Medical students with higher trait emotional intelligence perceived lesser stress. Therefore, it might be prudent to train medical students to increase their emotional intelligence to promote their well-being.
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Affiliation(s)
- Richa Gupta
- Department of Physiology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth University, Pondicherry, 607402 India
| | - Nikhilesh Singh
- Department of Physiology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth University, Pondicherry, 607402 India
| | - Ramya Kumar
- Department of Physiology, Government Villupuram Medical College, Villupuram, India
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Vaillancourt S, Seaton MB, Schull MJ, Cheng AHY, Beaton DE, Laupacis A, Dainty KN. Patients' Perspectives on Outcomes of Care After Discharge From the Emergency Department: A Qualitative Study. Ann Emerg Med 2017; 70:648-658.e2. [PMID: 28712607 DOI: 10.1016/j.annemergmed.2017.05.034] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 04/24/2017] [Accepted: 05/24/2017] [Indexed: 11/30/2022]
Abstract
STUDY OBJECTIVE Much effort has been expended to understand what care experiences patients value in the emergency department (ED), yet little is known about which outcomes patients value after ED care. Our goal is to define outcomes of ED care that are valued by patients discharged from the ED, with the goal of informing the development of a patient-reported outcome measure for ED care. METHODS We conducted qualitative semistructured interviews with patients recruited during their care at 1 of 2 EDs and interviewed in either English or French 1 to 9 days after their visit. Patients who were hospitalized were excluded. Interviews focused on perceived outcomes of care since the ED visit and expectations of care before the ED visit. We identified themes with standard descriptive content analysis techniques and a modified version of the constant comparative method, drawing on grounded theory methods. RESULTS We interviewed 46 patients in English (n=38) or French (n=8). Participants with diverse reasons for seeking care appeared to value common outcomes from ED care that centered around 4 themes: understanding the cause and expected trajectory of their symptoms; reassurance; symptom relief; and having a plan to manage their symptoms, resolve their issue, or pursue further medical care. These themes were also reflected in the expectations participants recalled having when they decided to seek care in the ED. CONCLUSION The 4 outcomes defined constitute areas for improvement and will inform the development of an ED patient-reported outcome questionnaire. Consideration should be given to measuring patient-reported outcomes separately from patient experience.
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Affiliation(s)
- Samuel Vaillancourt
- Department of Emergency Medicine, St. Michael's Hospital; Li Ka Shing Knowledge Institute, St. Michael's Hospital; Department of Medicine, University of Toronto.
| | | | - Michael J Schull
- Department of Medicine, University of Toronto; Institute for Health Policy, Management and Evaluation, University of Toronto; Department of Emergency Medicine, Sunnybrook Health Sciences Centre, and the Institute for Clinical Evaluative Sciences
| | - Amy H Y Cheng
- Department of Emergency Medicine, St. Michael's Hospital; Department of Medicine, University of Toronto
| | - Dorcas E Beaton
- Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute for Health Policy, Management and Evaluation, University of Toronto; Department of Occupational Science and Occupational Therapy, University of Toronto; Institute for Work & Health
| | - Andreas Laupacis
- Li Ka Shing Knowledge Institute, St. Michael's Hospital; Department of Medicine, University of Toronto
| | - Katie N Dainty
- Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute for Health Policy, Management and Evaluation, University of Toronto
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Papoutsi C, Hargreaves D, Colligan G, Hagell A, Patel A, Campbell-Richards D, Viner RM, Vijayaraghavan S, Marshall M, Greenhalgh T, Finer S. Group clinics for young adults with diabetes in an ethnically diverse, socioeconomically deprived setting (TOGETHER study): protocol for a realist review, co-design and mixed methods, participatory evaluation of a new care model. BMJ Open 2017; 7:e017363. [PMID: 28637744 PMCID: PMC5726054 DOI: 10.1136/bmjopen-2017-017363] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 04/24/2017] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Young adults with diabetes often report dissatisfaction with care and have poor diabetes-related health outcomes. As diabetes prevalence continues to rise, group-based care could provide a sustainable alternative to traditional one-to-one consultations, by engaging young people through life stage-, context- and culturally-sensitive approaches. In this study, we will co-design and evaluate a group-based care model for young adults with diabetes and complex health and social needs in socioeconomically deprived areas. METHODS AND ANALYSIS This participatory study will include three phases. In phase 1, we will carry out a realist review to synthesise the literature on group-based care for young adults with diabetes. This theory-driven understanding will provide the basis for phase 2, where we will draw on experience-based co-design methodologies to develop a new, group-based care model for young adults (aged <25 years, under the care of adult diabetes services). In phase 3, we will use a researcher-in-residence approach to implement and evaluate the co-designed group clinic model and compare with traditional care. We will employ qualitative (observations in clinics, patient and staff interviews and document analysis) and quantitative methods (eg, biological markers, patient enablement instrument and diabetes distress scale), including a cost analysis. ETHICS AND DISSEMINATION National Health Service ethics approval has been granted (reference 17/NI/0019). The project will directly inform service redesign to better meet the needs of young adults with diabetes in socioeconomically deprived areas and may guide a possible cluster-randomised trial, powered to clinical and cost-effectiveness outcomes. Findings from this study may be transferable to other long-term conditions and/or age groups. Project outputs will include briefing statements, summaries and academic papers, tailored for different audiences, including people living with diabetes, clinicians, policy makers and strategic decision makers. REGISTRATION DETAILS PROSPERO (CRD42017058726).
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Affiliation(s)
- Chrysanthi Papoutsi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Dougal Hargreaves
- UCL Great Ormond St. Institute of Child Health, University College London, London, UK
| | - Grainne Colligan
- Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Ann Hagell
- Association for Young People’s Health, London, UK
| | - Anita Patel
- Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Russell M Viner
- UCL Great Ormond St. Institute of Child Health, University College London, London, UK
| | | | - Martin Marshall
- Department of Primary Care and Population Health, University College London, London, UK
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sarah Finer
- Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Barts Health NHS Trust, London, UK
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Ivetić V, Pašić K, Selič P. The effect of an educational intervention in family phisicians on self-rated quality of life in patients with medically unexplained symptoms. Zdr Varst 2017; 56:91-98. [PMID: 28289468 PMCID: PMC5329772 DOI: 10.1515/sjph-2017-0012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 09/02/2016] [Indexed: 11/15/2022] Open
Abstract
Introduction Medically unexplained symptoms (MUS) are very common in family medicine, despite being a poorly-defined clinical entity. This study aimed to evaluate the effect of an educational intervention (EI) on self-rated quality of life, treatment satisfaction, and the family physician-patient relationship in patients with MUS. Methods In a multi-centre longitudinal intervention study, which was performed between 2012 and 2014, patients were asked to rate their quality of life, assess their depression, anxiety, stress and somatisation, complete the Hypochondriasis Index, the Medical Interview Satisfaction Scale and the Patient Enablement Instrument for assessing the physician-patient relationship, before and after the EI. Results The mean values before and after the intervention showed that after the EI, patients with MUS gave a lower (total) mean rating of their health issues and a higher rating of their quality of life, and they also had a more positive opinion of their relationship with the physician (p<0.05). However, there were no differences in the (total) rating of treatment satisfaction before and after the EI (p=0.423). Significant differences in the symptoms in patients with MUS before and after the intervention were confirmed for stress, somatisation and hypochondriasis (p<0.05). Conclusions It could be beneficial to equip family physicians with the knowledge, skills and tools to reduce hypochondriasis and somatisation in MUS patients, which would improve patients’ self-rated health status.
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Affiliation(s)
- Vojislav Ivetić
- University of Maribor, Faculty of Medicine, Department of Family Medicine, Taborska 8, 2000 Maribor, Slovenia
- SAVA MED, d.o.o., Cesta k Dravi 8, 2241 Spodnji Duplek, Slovenia
| | - Klemen Pašić
- SAVA MED, d.o.o., Cesta k Dravi 8, 2241 Spodnji Duplek, Slovenia
| | - Polona Selič
- University of Ljubljana, Faculty of Medicine, Department of Family Medicine, Poljanski nasip 58, 1000 Ljubljana, Slovenia
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Verbal and non-verbal behaviour and patient perception of communication in primary care: an observational study. Br J Gen Pract 2016; 65:e357-65. [PMID: 26009530 DOI: 10.3399/bjgp15x685249] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Few studies have assessed the importance of a broad range of verbal and non-verbal consultation behaviours. AIM To explore the relationship of observer ratings of behaviours of videotaped consultations with patients' perceptions. DESIGN AND SETTING Observational study in general practices close to Southampton, Southern England. METHOD Verbal and non-verbal behaviour was rated by independent observers blind to outcome. Patients competed the Medical Interview Satisfaction Scale (MISS; primary outcome) and questionnaires addressing other communication domains. RESULTS In total, 275/360 consultations from 25 GPs had useable videotapes. Higher MISS scores were associated with slight forward lean (an 0.02 increase for each degree of lean, 95% confidence interval [CI] = 0.002 to 0.03), the number of gestures (0.08, 95% CI = 0.01 to 0.15), 'back-channelling' (for example, saying 'mmm') (0.11, 95% CI = 0.02 to 0.2), and social talk (0.29, 95% CI = 0.4 to 0.54). Starting the consultation with professional coolness ('aloof') was helpful and optimism unhelpful. Finishing with non-verbal 'cut-offs' (for example, looking away), being professionally cool ('aloof'), or patronising, ('infantilising') resulted in poorer ratings. Physical contact was also important, but not traditional verbal communication. CONCLUSION These exploratory results require confirmation, but suggest that patients may be responding to several non-verbal behaviours and non-specific verbal behaviours, such as social talk and back-channelling, more than traditional verbal behaviours. A changing consultation dynamic may also help, from professional 'coolness' at the beginning of the consultation to becoming warmer and avoiding non-verbal cut-offs at the end.
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Randomised controlled trial of a brief intervention targeting predominantly non-verbal communication in general practice consultations. Br J Gen Pract 2016; 65:e351-6. [PMID: 26009529 DOI: 10.3399/bjgp15x685237] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND The impact of changing non-verbal consultation behaviours is unknown. AIM To assess brief physician training on improving predominantly non-verbal communication. DESIGN AND SETTING Cluster randomised parallel group trial among adults aged ≥16 years attending general practices close to the study coordinating centres in Southampton. METHOD Sixteen GPs were randomised to no training, or training consisting of a brief presentation of behaviours identified from a prior study (acronym KEPe Warm: demonstrating Knowledge of the patient; Encouraging [back-channelling by saying 'hmm', for example]; Physically engaging [touch, gestures, slight lean]; Warm-up: cool/professional initially, warming up, avoiding distancing or non-verbal cut-offs at the end of the consultation); and encouragement to reflect on videos of their consultation. Outcomes were the Medical Interview Satisfaction Scale (MISS) mean item score (1-7) and patients' perceptions of other domains of communication. RESULTS Intervention participants scored higher MISS overall (0.23, 95% confidence interval [CI] = 0.06 to 0.41), with the largest changes in the distress-relief and perceived relationship subscales. Significant improvement occurred in perceived communication/partnership (0.29, 95% CI = 0.09 to 0.49) and health promotion (0.26, 95% CI = 0.05 to 0.46). Non-significant improvements occurred in perceptions of a personal relationship, a positive approach, and understanding the effects of the illness on life. CONCLUSION Brief training of GPs in predominantly non-verbal communication in the consultation and reflection on consultation videotapes improves patients' perceptions of satisfaction, distress, a partnership approach, and health promotion.
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Desborough J, Banfield M, Phillips C, Mills J. The process of patient enablement in general practice nurse consultations: a grounded theory study. J Adv Nurs 2016; 73:1085-1096. [DOI: 10.1111/jan.13199] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Jane Desborough
- Department of Health Services Research and Policy; Research School of Population Health; Australian National University; Canberra Australia
| | - Michelle Banfield
- National Institute for Mental Health Research; Australian National University; Canberra Australia
| | - Christine Phillips
- Social Foundations of Medicine; Australian National University Medical School; Australian National University; Canberra Australia
| | - Jane Mills
- School of Health & Biomedical Sciences; RMIT University; Melbourne Victoria Australia
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Abstract
The principles of patient-centred care are increasingly stressed as part of health care policy and practice. Explanations for why some practitioners seem more successful in achieving patient-centred care vary, but a possible role for individual differences in personality has been postulated. One of these, emotional intelligence (EI), is increasingly referred to in health care literature. This paper reviews the literature on EI in health care and poses a series of questions about the links between EI and patient-centred outcomes. Papers concerning empirical examinations of EI in a variety of settings were identified to determine the evidence base for its increasing popularity. The review suggests that a substantial amount of further research is required before the value of EI as a useful concept can be substantiated.
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Affiliation(s)
- Yvonne F Birks
- Department of Health Sciences, University of York, York YO10 5DD, UK.
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Desborough J, Bagheri N, Banfield M, Mills J, Phillips C, Korda R. The impact of general practice nursing care on patient satisfaction and enablement in Australia: A mixed methods study. Int J Nurs Stud 2016; 64:108-119. [PMID: 27768985 DOI: 10.1016/j.ijnurstu.2016.10.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 09/05/2016] [Accepted: 10/13/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND The numbers of nurses in general practice in Australia tripled between 2004 and 2012. However, evidence on whether nursing care in general practice improves patient outcomes is scarce. Although patient satisfaction and enablement have been examined extensively as outcomes of general practitioner care, there is little research into these outcomes from nursing care in general practice. The aim of this study was to examine the relationships between specific general practice characteristics and nurse consultation characteristics, and patient satisfaction and enablement METHODS: A mixed methods study examined a cross-section of patients from 21 general practices in the Australian Capital Territory. The Patient Enablement and Satisfaction Survey was distributed to 1665 patients who received nursing care between September 2013 and March 2014. Grounded theory methods were used to analyse interviews with staff and patients from these same practices. An integrated analysis of data from both components was conducted using multilevel mixed effect models. RESULTS Data from 678 completed patient surveys (response rate=42%) and 48 interviews with 16 nurses, 23 patients and 9 practice managers were analysed. Patients who had longer nurse consultations were more satisfied (OR=2.50, 95% CI: 1.43-4.35) and more enabled (OR=2.55, 95% CI: 1.45-4.50) than those who had shorter consultations. Patients who had continuity of care with the same general practice nurse were more satisfied (OR=2.31, 95% CI: 1.33-4.00) than those who consulted with a nurse they had never met before. Patients who attended practices where nurses worked with broad scopes of practice and high levels of autonomy were more satisfied (OR=1.76, 95% CI: 1.09-2.82) and more enabled (OR=2.56, 95% CI: 1.40-4.68) than patients who attended practices where nurses worked with narrow scopes of practice and low levels of autonomy. Patients who received nursing care for the management of chronic conditions (OR=2.64, 95% CI: 1.32-5.30) were more enabled than those receiving preventive health care. CONCLUSIONS This study provides the first evidence of the importance of continuity of general practice nurse care, adequate time in general practice nurse consultations, and broad scopes of nursing practice and autonomy for patient satisfaction and enablement. The findings of this study provide evidence of the true value of enhanced nursing roles in general practice. They demonstrate that when the vision for improved coordination and multidisciplinary primary health care, including expanded roles of nurses, is implemented, high quality patient outcomes can be achieved.
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Affiliation(s)
- Jane Desborough
- Department of Health Services Research and Policy, Research School of Population Health, Australian National University, Australia.
| | - Nasser Bagheri
- Department of Health Services Research and Policy, Research School of Population Health, Australian National University, Australia
| | - Michelle Banfield
- National Institute for Mental Health Research, Research School of Population Health, Australian National University, Australia
| | - Jane Mills
- Nursing, School of Health & Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Christine Phillips
- Social Foundations of Medicine, Australian National University Medical School, Australia
| | - Rosemary Korda
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Australia
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