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Woodard LD, Hernandez MT, Lees E, Petersen LA. Racial differences in attitudes regarding cardiovascular disease prevention and treatment: a qualitative study. PATIENT EDUCATION AND COUNSELING 2005; 57:225-31. [PMID: 15911197 DOI: 10.1016/j.pec.2004.06.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2003] [Revised: 05/21/2004] [Accepted: 06/05/2004] [Indexed: 05/02/2023]
Abstract
The objective of this study was to explore coronary heart disease (CHD) health care experiences and beliefs of African-American and white patients to elicit potential causes of racial disparities in CHD outcomes. Twenty-four patients (14 white, 10 African-American) with established CHD participated in one of four focus groups. Using qualitative methods, verbatim transcripts of the groups were analyzed by independent investigators to identify key themes. We identified four themes: risk factor knowledge, physician--patient relationship, medical system access, and treatment beliefs. Racial differences were apparent in the experience of racism as a stress, knowledge of specifics of CHD risk factors, and assertiveness in the physician--patient relationship. These findings suggest that strategies to improve risk factor knowledge and to enable African-American patients to become active partners in their medical care may lead to improved CHD morbidity and mortality in this population. The efficacy of such interventions would need to be tested in further work.
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Affiliation(s)
- Lechauncy D Woodard
- Houston Center for Quality of Care and Utilization Studies, Department of Veterans Affairs, Health Services Research and Development Center of Excellence, Houston Veterans Affairs Medical Center, Houston, TX 77030, USA.
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Abstract
This article provides evidence that the current and growing burden of CKD in racial and ethnic minority populations is likely to be multifactorial involving the interplay of biologic, clinical, social, and behavioral determinants. To eliminate these disparities, crafting successful solutions requires more attention to the constellation of contributing factors not only by specialists, primary care physicians, and other health care providers involved in CKD care, but also clinical and behavioral scientists, payers of health care, and patients.
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Affiliation(s)
- Neil R Powe
- Department of Medicine, Johns Hopkins School of Medicine, 2024 East Monument Street, Suite 2-600, Baltimore, MD 21205, USA.
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253
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Maly RC, Leake B, Silliman RA. Breast cancer treatment in older women: impact of the patient-physician interaction. J Am Geriatr Soc 2005; 52:1138-45. [PMID: 15209652 DOI: 10.1111/j.1532-5415.2004.52312.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To assess the impact of the patient-physician interaction on breast cancer care in older women. DESIGN Cross-sectional survey. SETTING Los Angeles County, California. PARTICIPANTS Two hundred twenty-two consecutively identified breast cancer patients aged 55 and older who were within 6 months of breast cancer diagnosis and/or 1 month posttreatment. MEASUREMENTS Dependent variables were patient breast cancer knowledge, treatment delay, and receipt of breast-conserving surgery (BCS). Key independent variables were five dimensions of the patient-physician interaction by patient report, including physician provision of tangible and interactive informational support, physician provision of emotional support, physician participatory decision-making style, and patient perceived self-efficacy in the patient-physician interaction. Age and ethnicity were additional important independent variables. RESULTS In multiple logistic regression models, only physician interactive informational support had significant relationships with all three dependent variables, controlling for a wide range of patient sociodemographic and case-mix characteristics, visit length, number of physicians seen, social support, and physician sociodemographic and practice characteristics. Specifically, informational support positively predicted patient breast cancer knowledge (adjusted odds ratio (AOR)=1.18, 95% confidence interval (CI)=1.00-1.38), negatively predicted treatment delays (AOR=0.80, 95% CI=0.67-0.94), and positively predicted receipt of BCS (AOR=1.29, 95% CI=1.07-1.56). Age and ethnicity were not significant predictors in these models. CONCLUSION One specific domain of the patient-physician interaction, interactive informational support, may provide an avenue to ensure adequate breast cancer knowledge for patient treatment decision-making, decrease treatment delay, and increase rates of BCS for older breast cancer patients, thereby potentially mitigating known healthcare disparities in this vulnerable population of breast cancer patients.
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Affiliation(s)
- Rose C Maly
- Department of Family Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California 90095, USA.
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254
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Abstract
Decision making is central to health policy and medical practice. Because health outcomes are probabilistic, most decisions are made under conditions of uncertainty. This review considers two classes of decisions in health care: decisions made by providers on behalf of patients, and shared decisions between patients and providers. Considerable evidence suggests wide regional variation exists in services received by patients. Evidence-based guidelines that incorporate quality of life and patient preferences may help address this problem. Systematic cost-effectiveness analysis can be used to improve resource allocation decisions. Shared medical decision making seeks to engage patients and providers in a collaborative process to choose clinical options that reflect patient preferences. Although some evidence indicates patients want an active role in making decisions, other evidence suggests that some patients prefer a passive role. Decision aids hold promise for improving individual decisions, but there are still few systematic evaluations of these aids. Several directions for future research are offered.
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Affiliation(s)
- Robert M Kaplan
- Department of Health Services, School of Public Health, University of California, Los Angeles, California 90095-1772, USA.
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255
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Bosworth HB, Olsen MK, Goldstein MK, Orr M, Dudley T, McCant F, Gentry P, Oddone EZ. The veterans' study to improve the control of hypertension (V-STITCH): design and methodology. Contemp Clin Trials 2005; 26:155-68. [PMID: 15837438 DOI: 10.1016/j.cct.2004.12.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2004] [Revised: 11/08/2004] [Accepted: 12/09/2004] [Indexed: 11/19/2022]
Abstract
BACKGROUND Among the 60 million Americans with hypertension, only approximately 31% have their blood pressure (BP) under control (<140/90 mm Hg). Despite the damaging impact of hypertension and the availability of evidence-based target values for BP, interventions to improve BP control have had limited success. OBJECTIVES A randomized controlled health services intervention trial with a split-plot design is being conducted to improve BP control. This 4-year trial evaluates both a patient and a provider intervention in a primary care setting among diagnosed hypertensive veterans. METHODS In a cluster-randomization, 30 primary care providers in the Durham VAMC Primary Care Clinic were randomly assigned to receive the provider intervention or control. The provider intervention is a patient-specific electronically generated hypertension decision support system (DSS) delivering guideline-based recommendations to the provider at each patient's visit, designed to improve guideline-concordant therapy. For these providers, a sample of their hypertensive patients (n=588) was randomly assigned to receive a telephone-administered patient intervention or usual care. The patient intervention incorporates patients' need assessments and involves tailored behavioral and education modules to promote medication adherence and improve specific health behaviors. All modules are delivered over the telephone bi-monthly for 24 months. In this trial, the primary outcome is the proportion of patients who achieve a BP < or =140/90 mm Hg at each outpatient clinic visit over 24 months. CONCLUSION Despite the known risk of poor BP control, a majority of adults still do not have their BP controlled. This study is an important step in testing the effectiveness of a patient and provider intervention to improve BP control among veterans in the primary care setting.
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Affiliation(s)
- Hayden B Bosworth
- Center for Health Services Research in Primary Care, Durham VAMC, Durham NC, USA.
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256
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Bosworth HB, Olsen MK, Gentry P, Orr M, Dudley T, McCant F, Oddone EZ. Nurse administered telephone intervention for blood pressure control: a patient-tailored multifactorial intervention. PATIENT EDUCATION AND COUNSELING 2005; 57:5-14. [PMID: 15797147 DOI: 10.1016/j.pec.2004.03.011] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2003] [Revised: 03/25/2004] [Accepted: 03/26/2004] [Indexed: 05/24/2023]
Abstract
OBJECTIVES A randomized controlled trial involving a nurse administered patient-tailored intervention is being conducted to improve blood pressure (BP) control. METHODS Veterans with hypertension from an outpatient primary care clinic completed a baseline assessment and were randomly allocated to either a nurse administered intervention or to usual care. In this ongoing study, intervention patients receive the tailored intervention bi-monthly for 2 years via telephone; the goal of the intervention is to promote adherence with medication and improve health behaviors. Patient factors targeted for intervention include perceived risk of hypertension, memory, literacy, social support, patients' relationship with their health care provider, side effects of therapy, pill refill, missed appointments, and health behaviors. RESULTS The sample randomized to the nurse intervention consisted of 294 veterans with hypertension (average age = 63 years; 41% African-American). A comparable sample of veterans was assigned to usual care (n = 294). We have maintained a 97% retention rate for the first 12 months of the study. The average phone call has lasted 3.7 min ranging from less than 1 to 40 min. At 6-month post-enrollment, individuals receiving the nurse intervention had a greater increase in confidence with following hypertension treatment (P < 0.007) than the usual care group. DISCUSSION The intervention is easily implemented and is designed to enhance adherence with prescribed hypertension regimen. The study includes both general and patient-tailored information based upon need assessment. The study design ensures internal validity as well as the ability to generalize study findings to the clinic settings.
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Affiliation(s)
- Hayden B Bosworth
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center (152), 508 Fulton St., Durham, NC 27705, USA.
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Ibrahim SA, Zhang A, Mercer MB, Baughman M, Kwoh CK. Inner city African-American elderly patients' perceptions and preferences for the care of chronic knee and hip pain: findings from focus groups. J Gerontol A Biol Sci Med Sci 2005; 59:1318-22. [PMID: 15699532 DOI: 10.1093/gerona/59.12.1318] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND African Americans undergo joint replacement less often than do white persons. The authors studied African-American perceptions and preferences for the care of knee and hip pain. METHODS 10 focus groups were conducted in an inner city community. Participants, older persons with chronic knee or hip pain, were asked to discuss their perceptions and preferences for the care of knee and hip pain. Transcripts were coded for thematic structure using NUD*ST software. RESULTS Cultural preferences and perceptions for care emerged as a major theme. Important subcategories of this theme included respect for the patient's faith and religiosity and perceptions of physician ethnicity, race, and sex. CONCLUSIONS This sample of older inner city African Americans expressed unique cultural perceptions and preferences for the care of their knee and hip pain. Respect for patients' faith was important, whereas physicians' race, ethnicity, and religious background were not.
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Affiliation(s)
- Said A Ibrahim
- Center for Health Equity Research and Promotion, VA Pittsburgh HealthCare System, Pittsburgh, PA 15240, USA.
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260
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Sparks L, Mittapalli K. To know or not to know: the case of communication by and with older adult Russians diagnosed with cancer. J Cross Cult Gerontol 2005; 19:383-403. [PMID: 15604650 DOI: 10.1023/b:jccg.0000044690.45414.f7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This paper describes the ways in which group identifications and stereotypes can inform our understanding of cancer treatment and survivorship, as well as the more general social processes surrounding the communicative experiences of older adult Russians diagnosed with cancer, by providing a theoretical essay (with some modest illustrative data) to shed light on salient cross-cultural health and identity issues. Utilizing an approach grounded in social identity theory, it describes the ways in which understanding primary identities associated with large social collectives such as cultural groups, secondary identities associated with health behaviors and tertiary identities associated with a cancer diagnosis can help explain certain cancer-related social processes. Subtle cultural differences in approaches to health care, particularly with older adult populations, are likely influenced by assumptions embedded in their economic, social, and political systems.
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Affiliation(s)
- Lisa Sparks
- Department of Communication, George Mason University, Fairfax, VA 22030, USA. lssparks@gmu
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261
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Willems S, De Maesschalck S, Deveugele M, Derese A, De Maeseneer J. Socio-economic status of the patient and doctor-patient communication: does it make a difference? PATIENT EDUCATION AND COUNSELING 2005; 56:139-46. [PMID: 15653242 DOI: 10.1016/j.pec.2004.02.011] [Citation(s) in RCA: 355] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2003] [Revised: 02/11/2004] [Accepted: 02/27/2004] [Indexed: 05/06/2023]
Abstract
This systematic review, in which 12 original research papers and meta-analyses were included, explored whether patients' socio-economic status influences doctor-patient communication. Results show that patients from lower social classes receive less positive socio-emotional utterances and a more directive and less participatory consulting style, characterised by significantly less information giving, less directions and less socio-emotional and partnership building utterances from their doctor. Doctors' communicative style is influenced by the way patients communicate: patients from higher social classes communicate more actively and show more affective expressiveness, eliciting more information from their doctor. Patients from lower social classes are often disadvantaged because of the doctor's misperception of their desire and need for information and their ability to take part in the care process. A more effective communication could be established by both doctors and patients through doctors' awareness of the contextual communicative differences and empowering patients to express concerns and preferences.
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Affiliation(s)
- S Willems
- Department of General Practice and Primary Health Care, Ghent University, UZ-1K3, De Pintelaan 185, B-9000 Gent, Belgium.
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262
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O'Day BL, Killeen M, Iezzoni LI. Improving health care experiences of persons who are blind or have low vision: suggestions from focus groups. Am J Med Qual 2004; 19:193-200. [PMID: 15532911 DOI: 10.1177/106286060401900503] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Persons who are blind or have low vision face special challenges in obtaining care that is safe, effective, timely, and patient centered. To explore perceptions of care and recommendations for improvements, we conducted 8 interviews with experts and 2 focus groups with 19 persons, all of whom are blind or have low vision. Interviewees perceived that they confront special barriers to care because of being blind or having low vision. Barriers fell into 4 broad categories: basic respect, including concerns about physicians thinking they cannot participate fully in their own care; communication barriers, including difficulties interacting with physicians and office staff; physical access barriers, including difficulties getting to and around physicians' offices; and information barriers, including receiving written materials in inaccessible formats (eg, not in Braille, large print, or audiotape). Using common courtesy and individualized communication techniques, physicians and office staff could improve health care experiences of blind and low-vision patients.
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Affiliation(s)
- Bonnie L O'Day
- Cherry Engineering Support Services Inc, McLean, Va, USA
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263
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Phipps E, Harris D, Brown N, Harralson T, Brecher A, Polansky M, Whyte J. Investigation of Ethnic Differences in Willingness to Enroll in a Rehabilitation Research Registry. Am J Phys Med Rehabil 2004; 83:875-83. [PMID: 15624565 DOI: 10.1097/01.phm.0000143436.57173.e1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate differences between African American and white respondents in willingness to enroll in a rehabilitation research registry for future research and to determine if reasons for consenting and refusing to enroll differ by ethnicity. DESIGN Inpatient recruitment results from 739 African American and white respondents in which patients were admitted to a rehabilitation hospital with a diagnosis of stroke or traumatic brain injury. RESULTS A similar proportion of African American and white respondents (both patients and surrogates) consented to enroll in the registry (72% of all African American respondents vs. 68% of all white respondents). African Americans and whites provided similar reasons for consenting and refusing to enroll. Demographic variables associated with consent were: higher education, younger age, and facility. The odds of consenting to enroll in the registry were 5 times as high for those who thought they had a great deal to gain from enrollment compared with those who thought they had less to gain and were nearly 2 times as high for those who reported little concern about privacy compared with those who were more concerned about privacy. CONCLUSIONS Ethnicity was not found to be a predictor of willingness to enroll in a study registry. A greater belief of gain and less concern over privacy were associated with willingness to enroll, even after controlling for age, education, facility, and ethnic group.
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Affiliation(s)
- Etienne Phipps
- Albert Einstein Healthcare Network, Center for Urban Health Policy and Research, Philadelphia, Pennsylvania 19144, USA
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264
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Murri R, Ammassari A, Trotta MP, De Luca A, Melzi S, Minardi C, Zaccarelli M, Rellecati P, Santopadre P, Soscia F, Scasso A, Tozzi V, Ciardi M, Orofino GC, Noto P, Monforte AD, Antinori A, Wu AW. Patient-reported and physician-estimated adherence to HAART: social and clinic center-related factors are associated with discordance. J Gen Intern Med 2004; 19:1104-10. [PMID: 15566439 PMCID: PMC1494787 DOI: 10.1111/j.1525-1497.2004.30248.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To evaluate the rate of discordance between patients and physicians on adherence to highly active antiretroviral therapy (HAART) and identify factors related to discordance in these two assessments. DESIGN Prospective, multicenter, cohort study (AdICONA) nested within the Italian Cohort Naive Antiretrovirals (ICONA) study. SETTING Tertiary clinical centers. PARTICIPANTS The patients filled out a 16-item self-administered questionnaire on adherence to HAART. At the same time, physicians estimated the current HAART adherence of their patient. MAIN OUTCOME MEASURE Discordance between patient and physician on adherence to antiretroviral therapy. RESULTS From May 1999 to March 2000, 320 paired patient-physician assessments were obtained. Patients had a mean plasma HIV RNA of 315 copies/ml (64% had undetectable HIV RNA) and a mean CD4+ cell count of 577 cells x 10(6)/L. Nonadherence was reported by 30.9% of patients and estimated by physicians in 45.0% cases. In 111 cases (34.7%), patients and physicians were discordant on adherence to HAART. Kappa statistics was 0.27. Using patient-assessed adherence as reference, sensitivity, specificity, positive predictive value, and negative predictive value of physician-estimated adherence were 64.7%, 66.6%, 81.2%, and 45.8%, respectively. On multivariable analysis, low education level, unemployment, absence of a social worker in the clinical center, and unavailability of afternoon visits were significantly correlated with patient-physician discordance on adherence to antiretrovirals. CONCLUSIONS Physicians did not correctly estimate patient-reported adherence to HAART in more than one third of patients. Both social variables and factors related to the clinical center were important predictors of discordance between patients and physicians. Interventions to enhance adherence should include strategies addressed to improve patient-physician relationship.
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Affiliation(s)
- Rita Murri
- Clinica delle Malattie Infettive, Università Cattolica del S. Cuore, 00168 Rome, Italy.
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Schneider J, Kaplan SH, Greenfield S, Li W, Wilson IB. Better physician-patient relationships are associated with higher reported adherence to antiretroviral therapy in patients with HIV infection. J Gen Intern Med 2004; 19:1096-103. [PMID: 15566438 PMCID: PMC1494791 DOI: 10.1111/j.1525-1497.2004.30418.x] [Citation(s) in RCA: 369] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND There is little evidence to support the widely accepted assertion that better physician-patient relationships result in higher rates of adherence with recommended therapies. OBJECTIVE To determine whether and which aspects of a better physician-patient relationship are associated with higher rates of adherence with antiretroviral therapies for persons with HIV infection. DESIGN Cross-sectional analysis. SETTING Twenty-two outpatient HIV practices in a metropolitan area. PARTICIPANTS Five hundred fifty-four patients with HIV infection taking antiretroviral medications. MEASUREMENTS We measured adherence using a 4-item self-report scale (alpha= 0.75). We measured core aspects of physician-patient relationships using 6 previously tested scales (general communication, HIV-specific information, participatory decision making, overall satisfaction, willingness to recommend physician, and physician trust; alpha > 0.70 for all) and 1 new scale, adherence dialogue (alpha= 0.92). For adherence dialogue, patients rated their physician at understanding and solving problems with antiretroviral therapy regimens. RESULTS Mean patient age was 42 years, 15% were female, 73% were white, and 57% reported gay or bisexual sexual contact as their primary HIV risk factor. In multivariable models that accounted for the clustering of patients within physicians' practices, 6 of the 7 physician-patient relationship quality variables were significantly (P < .05) associated with adherence. In all 7 models worse adherence was independently associated (P < .05) with lower age, not believing in the importance of antiretroviral therapy, and worse mental health. CONCLUSIONS This study showed that multiple, mutable dimensions of the physician-patient relationship were associated with medication adherence in persons with HIV infection, suggesting that physician-patient relationship quality is a potentially important point of intervention to improve patients' medication adherence. In addition, our data suggest that it is critical to investigate and incorporate patients' belief systems about antiretroviral therapy into adherence discussions, and to identify and treat mental disorders.
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Affiliation(s)
- John Schneider
- Department of Medicine, University of Chicago, Ill., USA
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266
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Abstract
BACKGROUND Patients' trust in their health care providers may affect their satisfaction and health outcomes. Despite the potential importance of trust, there are few studies of its correlates using objective measures of physician behavior during encounters with patients. METHODS We assessed physician behavior and length of visit using audio tapes of encounters of 2 unannounced standardized patients (SPs) with 100 community-based primary care physicians participating in a large managed care organization. Physician behavior was assessed via 3 components of the Measure of Patient-Centered Communication (MPCC) scale. The Primary Care Assessment Survey (PCAS) trust subscale was administered to 50 patients from each physician's practice and to SPs. We used multilevel modeling to examine the associations between physicians' Patient-Centered Communication during the SP visits and ratings of trust by both patients and SPs. RESULTS Component 1 of the MPCC, which explored the patient's experience of the disease and illness, was independently associated with patient's rating of trust in their physician. A I SD increase in this score was associated with 0.08 SD increase in trust (95% confidence interval 0.02-0.14). Each additional minute spent in SP visits was also independently associated with 0.01 SD increase in patient trust. (95% confidence interval 0.0001-0.02). Component 1 and visit length were also positively associated with SP trust ratings. CONCLUSIONS Physician verbal behavior during an SP encounter is associated with trust reported by SPs and patients. Research is needed to determine whether interventions designed to enhance physicians' exploration patients' experiences of disease and illness improves trust. Key Words: physician-patient relationship, patient-centered care, trust, physician behavior
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Affiliation(s)
- Kevin Fiscella
- Department of Family Medicine, University of Rochester School of Medicine & Dentistry, Rochester, New York, USA.
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267
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Henderson JT, Hudson Scholle S, Weisman CS, Anderson RT. The role of physician gender in the evaluation of the National Centers of Excellence in Women's Health: test of an alternate hypothesis. Womens Health Issues 2004; 14:130-9. [PMID: 15324872 DOI: 10.1016/j.whi.2004.04.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2004] [Revised: 04/14/2004] [Accepted: 04/21/2004] [Indexed: 11/18/2022]
Abstract
A 2002 evaluation of the National Centers of Excellence in Women's Health (CoE) provided evidence that women receive higher-quality primary health care, as indicated by receipt of recommended preventive care and patient satisfaction, when they receive their care in comprehensive women's health centers. A potential rival explanation for the CoE evaluation findings, however, is that the higher quality of care in the CoE may be attributable to a predominance of female physicians in CoE settings. More women who receive health care in a CoE have a female regular physician and female physicians may provide more preventive health services. Additionally, women may self-select into the CoE because of their preference for female providers. This paper presents results of an analysis examining the role of physician gender in the CoE evaluation. Women seen in three CoE clinics and women seen in other settings in the same communities who had a female physician are compared to assess the CoE effect while controlled for physician gender. The findings confirm a positive CoE effect for many of the quality of care indicators that were observed in the original evaluation. Women seen in CoEs are more likely to receive physical breast examinations and mammograms (ages > or =50). In addition, positive CoE findings for counseling on domestic violence, sexually transmitted diseases, family or relationship concerns, and sexual function or concerns were upheld. The CoE model of care delivers advantages to women that are not explained by the greater number of female physicians in these settings.
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Affiliation(s)
- Jillian T Henderson
- Center for Reproductive Health Research and Policy, University of California-San Francisco, San Francisco, CA 94118, USA.
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Abstract
This study was designed to explore the effects that training had on older adults' willingness to use the Internet to manage their health care. The most interesting result was that out of 70 self-volunteers, 58 were women. Results show that highly educated women who either own a computer or have access to one, and have low levels of anxiety toward computers, with strong feelings of self-efficacy toward computers and the Internet, and an internal locus of control, are more willing than men to use the Internet to find medical information to manage a chronic health problem.
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Affiliation(s)
- Robert Campbell
- Duquesne University, 433 Fisher Hall, Pittsburgh, PA, 15282, USA.
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Maly RC, Umezawa Y, Leake B, Silliman RA. Determinants of participation in treatment decision-making by older breast cancer patients. Breast Cancer Res Treat 2004; 85:201-9. [PMID: 15111757 DOI: 10.1023/b:brea.0000025408.46234.66] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE To identify the impact of patient age and patient-physician communication on older breast cancer patients' participation in treatment decision-making. METHODS We conducted a cross-sectional survey of breast cancer patients aged 55 years or older (n = 222) in Los Angeles County. Patients received a breast cancer diagnosis between 1998 and 2000, and were interviewed on average 7.1 months (SD = 2.9) from diagnosis. All patient-physician communication variables were measured by patient self-report. Patient participation in treatment decision-making was defined by (1) questioning the surgeon about treatment, and (2) perception of self as the final decision-maker. RESULTS In multiple logistic regression analyses, surgeons' specific solicitation of patients' input about treatment preferences had positive relationships with both dimensions of patient participation in decision-making, that is, questioning the surgeon (adjusted odds ratio [OR] = 2.09, 95% confidence interval [CI] = 1.05-4.16) and perceiving oneself to be the final decision-maker (OR = 2.38, CI = 1.08-5.28), controlling for patients' sociodemographic and case-mix characteristics and social support. Greater emotional support from surgeons was negatively associated with patient perception of being the final decision-maker. Physicians' information-giving and patient age were not associated with the participation measures. However, greater patient-perceived self-efficacy in patient-physician interactions was related to participation. CONCLUSION In breast cancer patients aged 55 years and older, surgeons' solicitation of patients' treatment preferences was a powerful independent predictor of patient participation in treatment decision-making, as was patient's self-efficacy in interacting with physicians. Increasing both physicians' and patients' partnership-building skills might enhance the quality of treatment decision-making and treatment outcomes in this burgeoning patient population.
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Affiliation(s)
- Rose C Maly
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024-2933, USA.
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270
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Marincowitz GJO. Putting Participation into Practice. S Afr Fam Pract (2004) 2004. [DOI: 10.1080/20786204.2004.10873084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Tai-Seale M. Voting with their feet: patient exit and intergroup differences in propensity for switching usual source of care. JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2004; 29:491-514. [PMID: 15328875 DOI: 10.1215/03616878-29-3-491] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Many analysts advocate patient exit as a strategy for consumers who experience poor-quality care. Exit is believed to have the potential to improve patient welfare by having patients leave (or "exit") poor-performing health care providers, thus signaling their dissatisfaction with the quality of care they have received and thereby admonishing those providers to improve. However, the validity of exit as a signal of consumer dissatisfaction hinges on how closely it reflects dissatisfaction. Intergroup differences in the propensity to exit could also result in unintended consequences. This article examines the association between consumer experience and the decision to change one's usual care providers. It also investigates if there are any intergroup differences in the propensity for changing providers according to insurance status, gender, and race or ethnicity. Data come from household surveys conducted by the Center for Studying Health System Change. Results show significant intergroup differences in propensity for switching usual source of care for voluntary or involuntary reasons related to insurance, rural residency, age, income, race, and ethnicity. Policy implications of the empirical results on exit, voice, and consumerism are discussed.
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272
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Kinchen KS, Cooper LA, Levine D, Wang NY, Powe NR. Referral of patients to specialists: factors affecting choice of specialist by primary care physicians. Ann Fam Med 2004; 2:245-52. [PMID: 15209202 PMCID: PMC1466676 DOI: 10.1370/afm.68] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2003] [Revised: 04/29/2003] [Accepted: 06/09/2003] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND We wanted to determine the importance of factors in primary care physicians' choice of specialist when referring patients and to compare importance ratings by physicians' race and sex. METHODS Using a cross-sectional study design, we surveyed a stratified national sample of 1,252 primary care physicians serving adults to include equal numbers of black women, white women, black men, and white men. We assessed the percentage of physicians rating each of 17 items to be of major importance in choosing a specialist and compared importance ratings by physicians' race and sex. RESULTS The response rate was 59.1%. Medical skill, appointment timeliness, insurance coverage, previous experience with the specialist, quality of specialist communication, specialist efforts to return patient to primary physician for care, and the likelihood of good patient-specialist rapport were of major importance to most respondents. Compared with black physicians, white physicians were more likely to rate previous experience with the specialist (65% vs 55%, P = .05) and board certification (41% vs 29%, P < .05) to be of major importance. White physicians were somewhat less likely than black physicians (17% vs 26%, P = .06) to rate patient convenience to be of major importance. Compared with male physicians, female physicians were more likely to rate the patient's insurance status to be of major importance (60% vs 44%, P < .01). CONCLUSIONS Primary care physicians serving adults consider several factors to be of major importance when choosing a specialist. The importance of patient convenience, previous experience with the specialist, specialist board certification, and insurance coverage accepted by specialist varied by physicians' race and sex. A better understanding of factors important to a diverse physician workforce may help to improve the referral process.
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Affiliation(s)
- Kraig S Kinchen
- Robert Wood Johnson Clinical Scholars Program, The Johns Hopkins University School of Medicine, Baltimore, MD 21205-2223, USA
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273
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Mangione-Smith R, Elliott MN, Stivers T, McDonald L, Heritage J, McGlynn EA. Racial/ethnic variation in parent expectations for antibiotics: implications for public health campaigns. Pediatrics 2004; 113:e385-94. [PMID: 15121979 DOI: 10.1542/peds.113.5.e385] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Widespread overuse and inappropriate use of antibiotics are a major public health concern. Little is known about racial/ethnic differences in parents seeking antibiotics for their children's upper respiratory illnesses. OBJECTIVE To examine racial/ethnic differences in parent expectations about the need for antibiotics and physician perceptions of those expectations. DESIGN We conducted a nested, cross-sectional survey of parents who were coming to see their child's pediatrician because of cold symptoms between October 2000 and June 2001. Parents completed a previsit survey that collected information on demographics, their child's illness, and a 15-item previsit expectations inventory that included an item asking how necessary it was for the physician to prescribe antibiotics. Physicians completed a postvisit survey that collected information on diagnosis, treatment, and whether the physician perceived the parent expected an antibiotic. The encounter was the unit of analysis. Multivariate logistic regression analyses were performed to evaluate predictors of dichotomized parental expectations for antibiotics, dichotomized physician perceptions of those expectations, diagnostic patterns, and antibiotic-prescribing patterns. SETTING Twenty-seven community pediatric practices in the Los Angeles, Calif, metropolitan area. PARTICIPANTS A volunteer sample of 38 pediatricians (participation rate: 64%) and a consecutive sample of 543 parents (participation rate: 83%; approximately 15 participating for each enrolled pediatrician) seeking care for their children's respiratory illnesses. Pediatricians were eligible to participate if they worked in a community-based managed care practice in the Los Angeles area. Parents were eligible to participate if they could speak and read English and presented to participating pediatricians with a child 6 months to 10 years old who had cold symptoms but had not received antibiotics within 2 weeks. MAIN OUTCOME MEASURES Parental beliefs about the necessity of antibiotics for their child's illness, physician perceptions of parental expectations for antibiotics, bacterial diagnosis rates, and antibiotic-prescribing rates. RESULTS Forty-three percent of parents believed that antibiotics were definitely necessary, and 27% believed that they were probably necessary for their child's illness. Latino and Asian parents were both 17% more likely to report that antibiotics were either definitely or probably necessary than non-Hispanic white parents. Physicians correctly perceived that Asian parents expected antibiotics more often than non-Hispanic white parents but underestimated the greater expectations of Latino parents for antibiotics. Physicians also correctly perceived that parents of children with ear pain or who were very worried about their child's condition were significantly more likely to expect antibiotics. Physicians were 7% more likely to make a bacterial diagnosis and 21% more likely to prescribe antibiotics when they perceived that antibiotics were expected. CONCLUSIONS Parent expectations for antibiotics remain high in Los Angeles County. With time, traditional public health messages related to antibiotic use may decrease expectations among non-Hispanic white parents. However, both public health campaigns and physician educational efforts may need to be designed differently to reach other racial/ethnic groups effectively. Despite public health campaigns to reduce antibiotic overprescribing in the pediatric outpatient setting, physicians continue to respond to parental pressure to prescribe them. To effectively intervene to decrease rates of inappropriate antibiotic prescribing further, physicians need culturally appropriate tools to better communicate and negotiate with parents when feeling pressured to prescribe antibiotics.
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Affiliation(s)
- Rita Mangione-Smith
- Department of Pediatrics, University of California, Los Angeles, California 90095-1752, USA.
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274
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Marincowitz GJO. Mutual Participation in the Health Worker-Patient Relationship. S Afr Fam Pract (2004) 2004. [DOI: 10.1080/20786204.2004.10873070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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275
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Wetzels R, Geest TA, Wensing M, Ferreira PL, Grol R, Baker R. GPs' views on involvement of older patients: an European qualitative study. PATIENT EDUCATION AND COUNSELING 2004; 53:183-188. [PMID: 15140458 DOI: 10.1016/s0738-3991(03)00145-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2003] [Revised: 03/21/2003] [Accepted: 04/07/2003] [Indexed: 05/24/2023]
Abstract
Involvement of older patients in general practice care is regarded as important, but is not widespread. To determine specific barriers to the involvement of older patients in general practice care and to identify variations between countries, we performed an international comparative study based on qualitative interviews with 233 general practitioners (GPs) in 11 countries. Most GPs thought that involving older patients had positive outcomes. GPs saw patient involvement as a process taking place solely during consultations. The main barrier for GPs was lack of time. Barriers related to older patients were their feelings of respect for doctors, their lack of experience in being involved and possible mental and physical impairments. To conclude, increasing involvement of older patients is not easy and will only be effective when GPs have adopted a more developed concept of patient involvement and are supported with the different methods for achieving this. The range of appropriate interventions may be similar in all countries.
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Affiliation(s)
- Raymond Wetzels
- Centre for Quality of Care Research, UMC St. Radboud, P.O. Box 9101, 229 KWAZO, 6500 HB, Nijmegen, The Netherlands.
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276
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Sciamanna CN, Clark MA, Diaz JA, Newton S. Filling the gaps in physician communication. The role of the Internet among primary care patients. Int J Med Inform 2004; 72:1-8. [PMID: 14644301 DOI: 10.1016/j.ijmedinf.2003.10.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Millions of people use the Internet as a source for health information yet little is understood about how the use of the Internet for health information is related to the doctor-patient relationship. OBJECTIVE We conducted the present study to understand the association between one's interest in using the Internet for general and quality-oriented health information and attitudes about one's communications with health care provider(s). DESIGN Cross-sectional survey. SETTING Four community-based primary care practices in Rhode Island. MEASUREMENTS A single self-administered survey included items to measure: interest in using the Internet to look for general and quality-oriented information and a patient's perceptions of the degree to which their doctors over the previous year have: (1) given them information and (2) engaged them in the decision-making process. RESULTS A total of 300 patients completed the survey. Among patients without Internet access, interest in using the Internet for health related activities was less among patients who felt that their doctor gave less information: Odds ratio 0.83 (95% CI, 0.70-0.98) and greater among patients who felt that their doctor engaged them more in decision making: Odds ratio 1.3 (95% CI, 1.1-1.6). Among patients with Internet access, we found no relationship between interest in using the Internet for health related activities and measures of patient-physician communication or patient-physician decision making. CONCLUSIONS Interest in using the Internet for health information is greater for those who (1) felt their doctors provided less information and (2) felt their doctors engaged them more in the decision-making process, but this is true only for those without access to the Internet.
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Affiliation(s)
- Christopher N Sciamanna
- Department of Community Health, Brown Medical School, The Miriam Hospital, Centers for Behavioral and Preventive Medicine, Coro Building, One Hoppin Street, Suite 500, Providence, RI 02903, USA.
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277
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Xu KT. The combined effects of participatory styles of elderly patients and their physicians on satisfaction. Health Serv Res 2004; 39:377-91. [PMID: 15032960 PMCID: PMC1361013 DOI: 10.1111/j.1475-6773.2004.00233.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To test whether concordance or discordance of patient participation between patients and physicians is associated with higher satisfaction, and to examine the effects of patients' and physicians' participatory styles on patients' satisfaction with their physicians. DATA Data collected in the Texas Tech 5000 Survey of elderly patients in West Texas were used. Patient satisfaction with their physicians was measured by a single item from the Consumer Assessment of Health Plans (CAHPS), representing patients' ratings of their physicians. Patient participation was measured by an index derived from a three-item instrument and physicians' participatory decision-making (PDM) style was measured by a three-item instrument developed by the Medical Outcomes Study. METHODS An ordered logit multivariate regression was used to investigate the effects of patients' and physicians' participatory styles on satisfaction with physicians. The interaction between patients' participation and physicians' participatory styles was also included to examine the dependency of the two variables. RESULTS Controlling for confounding factors, a higher PDM score was associated with a higher rating of patient satisfaction with physicians. A higher patient participation score was related to a lower physician satisfaction rating. The combined effect of patients' and physicians' participation styles indicated that for a low patient participation score, a high PDM score was not needed to produce high satisfaction. The greater the discordance in this direction, the higher the satisfaction. However, with a high patient participation score, only an extremely high PDM score would produce relatively high satisfaction. CONCLUSIONS The current study supports the discordance hypothesis. Participatory physicians and patient-physician communications concerning patient participation can promote higher satisfaction.
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Affiliation(s)
- K Tom Xu
- Division of Health Services Research, Department of Family and Community medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
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278
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Xu KT, Borders TF, Arif AA. Ethnic Differences in Parents’ Perception of Participatory Decision-Making Style of Their Children's Physicians. Med Care 2004; 42:328-35. [PMID: 15076809 DOI: 10.1097/01.mlr.0000118707.99818.cc] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The objectives of this study were to test whether there are ethnic differences in parents' perceptions of the participatory styles of their children's physicians, and to determine how Hispanic ethnicity influences the factors that are correlated with the perceptions of participatory styles. STUDY DESIGN We conducted a population-based cross-sectional telephone survey in 111 counties of West Texas. Parents of children and adolescents 3 to 18 years of age (n = 3876) were included in analyses. METHODS The participatory decision-making (PDM) style of physicians was measured by a 3-item instrument used in the Medical Outcomes Study. Multivariate analyses were performed to identify ethnic differences and whether the effect of independent variables on participatory style varied by ethnicity. RESULTS The t test showed that the mean participatory decision-making score for Hispanics was significantly lower than that for non-Hispanic whites (P <0.01). However, the variance of the PDM score among Hispanics was greater than that among non-Hispanic whites using an F test (P = 0.03). After controlling for other independent variables, the effect of ethnicity was still significant. The association between PDM scores and a child's insurance and the parent's age varied by ethnicity. Parents' age, education, self-employment status, and income were associated with non-Hispanic white parents' perceptions of physicians' PDM, whereas children's insurance, parents' education and income were associated with Hispanic parents' perceptions of physicians' PDM (P <0.05). CONCLUSIONS Because patient participation is closely related to health outcomes and patient satisfaction, improving Hispanic patients' participation can be 1 avenue for diminishing ethnic disparities in health. Further research is needed to establish whether ethnic differences in children's physicians' participation style exist from physicians' perspective and whether the differences are associated with physicians' characteristics.
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Affiliation(s)
- K Tom Xu
- Division of Health Services Research, Department of Family and Community Medicine, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas 79430, USA.
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279
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Takayama T, Yamazaki Y. How breast cancer outpatients perceive mutual participation in patient-physician interactions. PATIENT EDUCATION AND COUNSELING 2004; 52:279-289. [PMID: 14998598 DOI: 10.1016/s0738-3991(03)00092-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2002] [Revised: 01/03/2003] [Accepted: 01/17/2003] [Indexed: 05/24/2023]
Abstract
This study examines correlations between observable communicative behaviors and patient perceptions of patient-physician interaction in 86 breast cancer outpatient consultations from three patient-centered perspectives: patient participation, physician collaboration, and communicative success. Analysis relied on audio tape recordings and questionnaires, and incorporated non-behavioral factors particular to each physician, patient, and consultation. Results revealed that patient perceptions of self-participation depended on the length of consultation. Physician collaboration depended on the degree to which patients were given the opportunity to speak, while communicative success reflected a patient's level of anxiety at the time of the consultation. Yet patient perceptions of mutual participation reflected observable communicative behaviors only partially. This gap suggests that perceptual and behavioral measures reveal different aspects of participation and that the study of patient-physician interaction benefits from the inclusion of both kinds of measure.
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Affiliation(s)
- Tomoko Takayama
- Department of Health Sociology, School of Health Science and Nursing, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
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280
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Schillinger D, Bindman A, Wang F, Stewart A, Piette J. Functional health literacy and the quality of physician-patient communication among diabetes patients. PATIENT EDUCATION AND COUNSELING 2004; 52:315-323. [PMID: 14998602 DOI: 10.1016/s0738-3991(03)00107-1] [Citation(s) in RCA: 286] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2002] [Revised: 02/24/2003] [Accepted: 03/06/2003] [Indexed: 05/24/2023]
Abstract
While patients with poor functional health literacy (FHL) have difficulties reading and comprehending written medical instructions, it is not known whether these patients also experience problems with other modes of communication, such as face-to-face encounters with primary care physicians. We enrolled 408 English- and Spanish-speaking diabetes patients to examine whether patients with inadequate FHL report worse communication than patients with adequate FHL. We assessed patients' experiences of communication using sub-scales from the Interpersonal Processes of Care in Diverse Populations instrument. In multivariate models, patients with inadequate FHL, compared to patients with adequate FHL, were more likely to report worse communication in the domains of general clarity (adjusted odds ratio [AOR] 6.29, P<0.01), explanation of condition (AOR 4.85, P=0.03), and explanation of processes of care (AOR 2.70, p=0.03). Poor FHL appears to be a marker for oral communication problems, particularly in the technical, explanatory domains of clinician-patient dialogue. Research is needed to identify strategies to improve communication for this group of patients.
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Affiliation(s)
- Dean Schillinger
- Primary Care Research Center, Department of Medicine, San Francisco General Hospital, University of California San Francisco, 995 Potrero Avenue, San Francisco, CA 94110, USA.
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281
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Steinhauser KE, Clipp EC, Bosworth HB, McNeilly M, Christakis NA, Voils CI, Tulsky JA. Measuring quality of life at the end of life: Validation of the QUAL-E. Palliat Support Care 2004; 2:3-14. [PMID: 16594230 DOI: 10.1017/s1478951504040027] [Citation(s) in RCA: 133] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives:To validate the QUAL-E, a new measure of quality of life at the end of life.Methods:We conducted a cross-sectional study to assess the instrument's psychometric properties, including the QUAL-E's associations with existing measures, evaluation of robustness across diverse sample groups, and stability over time. The study was conducted at the VA and Duke University Medical Centers, Durham, North Carolina, in 248 patients with stage IV cancer, congestive heart failure with ejection fraction ≤20%, chronic obstructive pulmonary disease with FEV1≤ 1.0 l, or dialysis-dependent end stage renal disease. The main outcome measures included QUAL-E and five comparison measures: FACIT quality of life measure, Missoula-VITAS Quality of Life Index, FACIT-SP spirituality measures, Participatory Decision Making Scale (MOS), and Duke EPESE social support scales.Results:QUAL-E analyses confirmed a four-domain structure (25 items):life completion(α = 0.80),symptoms impact(α = 0.87),relationship with health care provider(α = 0.71), andpreparation for end of life(α = 0.68). Convergent and discriminant validity were demonstrated with multiple comparison measures. Test–retest reliability assessment showed stable scores over a 1-week period.Significance of results:The QUAL-E, a brief measure of quality of life at the end of life, demonstrates acceptable validity and reliability, is easy to administer, performs consistently across diverse demographic and disease groups, and is acceptable to seriously ill patients. It is offered as a new instrument to assist in the evaluation of the quality and effectiveness of interventions targeting improved care at the end of life.
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Affiliation(s)
- Karen E Steinhauser
- Program on the Medical Encounter and Palliative Care, Durham VA Medical Center, Durham, North Carolina 27705, USA.
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282
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Trewin VF, Veitch GB. Patient sources of drug information and attitudes to their provision: a corticosteroid model. ACTA ACUST UNITED AC 2004; 25:191-6. [PMID: 14584224 DOI: 10.1023/a:1025810603241] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIM To determine patient's preferred sources of drug information and their attitudes to how this is provided. DESIGN A quantitative evaluation via personal interviews using a formal questionnaire. SUBJECT AND SETTINGS: A group of 101 in-patients in a chest ward at the Royal Devon & Exeter Healthcare NHS Trust. OUTCOME MEASURES Preferred sources for medication advice; personal involvement in own treatment; adequacy of consultation period; medication compliance; post discharge sources of drug information; recalled benefits and side effects of corticosteroids. RESULTS Preferred source of drug information was: doctor (35%), pharmacist (11%) and nurse 4%. Sixty percent of patients wanted to be involved in the choice of their medication, thirty-nine percent leaving it totally to the doctor and one patient who wanted the final word in what was prescribed. Sufficient discussion time with GPs was reported by 66% of patients (12%, insufficient) and 53% with hospital doctors (19%, insufficient). Non-compliance with medication was reported by 66% and compliance by 24%. Medication advice sources used when at home were; community pharmacists (22%), GPs/books & magazines/specialist societies (all 18%), nurses (10%) and others less than 8%. Benefits of corticosteroids recalled by patients were: 'improving breathing' (14), 'general improvement' (9) and 'improved mobility'/'greater appetite' (both 5)' with little change' reported by 13. Knowledge of side effects was much more comprehensive with; oedema/weight gain (50), skin/hair problems (33), osteoporosis (33), bruising (12) and mood changes (10) most commonly featured in responses. Almost all patients confirmed they liked to be given printed information about their medication. CONCLUSION Patients sought their medication advice from a variety of sources and armed with this almost two thirds of patients wished to exercise their rights to be involved with their treatment planning. Sufficient discussion time appeared to be available to about half of the interviewees though only a few understood the intended benefits of prescribed corticosteroids used as an example in this work. A much better knowledge of drug side effects might have partly explained the high level of declared non-compliance. Although pharmacists featured as the preferred source of drug information for some patients, a much more detailed investigation is needed of patients' attitudes to the profession and to individuals' consultation and communication skills.
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Affiliation(s)
- Vivian F Trewin
- Pharmacy Department, Royal Devon, Exeter Healthcare NHS Trust, Barrack Road, EX2 SDW Exeter, UK
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283
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Zaharias G, Piterman L, Liddell M. Doctors and patients: gender interaction in the consultation. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2004; 79:148-155. [PMID: 14744716 DOI: 10.1097/00001888-200402000-00011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND Much research on gender differences in medicine has centered on women as better communicators, more egalitarian, more patient-centered, and more involved with psychosocial problems, preventive care, and female-specific problems. Hardly any research has examined the interaction between the doctor's gender and the patient's gender. The authors examined students' perceptions and comfort levels regarding patients' gender during consultation. METHOD This cross-sectional study used a questionnaire to survey final-year medical students at one school in 1999. It tested students' patient-centeredness, "patient-care" values, and degree of comfort in performing certain intimate physical examinations. RESULTS Women students were more patient-centered than were men students. Both genders were more attuned to the concerns of patients of their own gender, were more comfortable with personal rather than sexual issues, and were more uncomfortable with performing more intimate examinations upon the opposite gender. Using comparable case studies, it was also shown that the female student-female patient dyad had significantly greater "patient-care" values than did the male student-male patient dyad. CONCLUSION Medical students did not behave in a gender-neutral way in the consultation. There is a powerful interaction between a student's gender and a patient's gender. This warrants further investigation in the real clinical situation because it has implications on the outcomes of the consultation.
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Affiliation(s)
- George Zaharias
- Department of General Practice, Faculty of Medicine, Nursing and Health Sciences and head, School of Primary Health Care, Monash University, Victoria, Australia. .au
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284
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Ward MM, Sundaramurthy S, Lotstein D, Bush TM, Neuwelt CM, Street RL. Participatory patient-physician communication and morbidity in patients with systemic lupus erythematosus. ACTA ACUST UNITED AC 2003; 49:810-8. [PMID: 14673968 DOI: 10.1002/art.11467] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To examine associations between active patient-physician communication and measures of morbidity in patients with systemic lupus erythematosus (SLE). METHODS Audiotapes of routine visits between 79 women with SLE and their rheumatologists were coded for active patient participation and the degree of patient-centered communication of the physician, using a validated coding scheme. Measures of SLE activity, functional disability, and permanent organ damage were recorded at the same visit. Permanent organ damage was reassessed in 68 patients after a median of 4.7 years. RESULTS Patients who participated more actively in their visits had less permanent organ damage, as measured by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index, and tended to accrue less organ damage over time. There were no associations between either active patient participation or physicians' patient-centered communication scores and measures of SLE activity or functional disability. CONCLUSIONS Patients with SLE who participated more actively in their visits had less permanent organ damage, suggesting that involving patients more in their care may decrease morbidity.
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Affiliation(s)
- Michael M Ward
- Veterans Affairs Palo Alto Health Care System and Stanford University School of Medicine, Stanford, CA, USA.
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285
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Kiesler DJ, Auerbach SM. Integrating measurement of control and affiliation in studies of physician-patient interaction: the interpersonal circumplex. Soc Sci Med 2003; 57:1707-22. [PMID: 12948579 DOI: 10.1016/s0277-9536(02)00558-0] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Following a brief overview and commentary on the physician-patient communication literature, this article summarizes and evaluates research on the relationship between physician-patient control (dominant-submissive) and affiliation (friendly hostile) behaviors as they relate to medical outcomes. Findings for both verbal and nonverbal control and affiliation measures are included. The interpersonal circumplex (together with the important interactional principles that it incorporates) is then introduced as an heuristic guide for future medical interaction research. The circumplex was constructed as a conceptual and empirical model to integrate the numerous studies that have established control and affiliation as universal dimensions of human interpersonal behavior and relationships. Next, the small group of studies that have applied circumplex inventories to analyses of practitioner-patient transactions are reviewed with emphasis on their strengths and unique aspects of their findings. The concluding section enumerates advantages and innovations that the interpersonal circumplex and its measures can provide to facilitate more heuristic studies of physician-patient interactions.
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Affiliation(s)
- Donald J Kiesler
- Department of Psychology, Virginia Commonwealth University, 808 W. Franklin Street, Richmond, VA 23284-2018, USA
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286
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Kim C, Hofer TP, Kerr EA. Review of evidence and explanations for suboptimal screening and treatment of dyslipidemia in women. A conceptual model. J Gen Intern Med 2003; 18:854-63. [PMID: 14521649 PMCID: PMC1494935 DOI: 10.1046/j.1525-1497.2003.20910.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Screening and treatment rates for dyslipidemia in populations at high risk for cardiovascular disease (CVD) are inappropriately low and rates among women may be lower than among men. We conducted a review of the literature for possible explanations of these observed gender differences and categorized the evidence in terms of a conceptual model that we describe. Factors related to physicians' attitudes and knowledge, the patient's priorities and characteristics, and the health care systems in which they interact are all likely to play important roles in determining screening rates, but are not well understood. Research and interventions that simultaneously consider the influence of patient, clinician, and health system factors, and particularly research that focuses on modifiable mechanisms, will help us understand the causes of the observed gender differences and lead to improvements in cholesterol screening and management in high-risk women. For example, patient and physician preferences for lipid and other CVD risk factor management have not been well studied, particularly in relation to other gender-specific screening issues, costs of therapy, and by degree of CVD risk; better understanding of how available health plan benefits interact with these preferences could lead to structural changes in benefits that might improve screening and treatment.
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Affiliation(s)
- Catherine Kim
- Division of General Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
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287
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Xu KT, Irons BK. Communication of Drug Affordability between Physicians and Elderly Patients. J Pharm Technol 2003. [DOI: 10.1177/875512250301900503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To identify characteristics among elderly patients associated with patient–provider communications regarding affordability of medications in prescribing and dispensing. Methods: Telephone survey data from consumers ≥65 years old collected in the Texas Tech 5000 Survey were used. The sample size for the analyses was 2,360. Demographics, insurance, financial factors, nonfinancial factors, prescription drug use, and health status were used to identify which subgroup of elderly patients recalled communication with their providers regarding the affordability of prescriptions. Statistical analyses included bivariate analyses and a multivariate logistic regression. Results: Eleven percent of the respondents reported being asked by their physicians whether they could afford prescription drugs. In the multivariate analysis, gender, race, insurance coverage for prescriptions, income, number of physician visits, out-of-pocket expenditure for prescriptions, health, and physicians' participatory decision-making score were found to be associated with patient–provider communications regarding affordability of medications. Conclusions: Further research needs to be conducted to identify ways to improve patient–provider relationships to facilitate communication regarding affordability of medications among elderly patients. Improved communication or sensitivity to prescription affordability has the potential to increase patient medication adherence and improve clinical outcomes.
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Affiliation(s)
- K Tom Xu
- K TOM XU PhD, Assistant Professor, School of Medicine, Department of Health Services Research and Management, Texas Tech University Health Sciences Center, Lubbock, TX
| | - Brian K Irons
- BRIAN K IRONS PharmD BCPS, Assistant Professor, School of Pharmacy, Department of Pharmacy Practice, Texas Tech University Health Sciences Center
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288
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Green CR, Anderson KO, Baker TA, Campbell LC, Decker S, Fillingim RB, Kalauokalani DA, Kaloukalani DA, Lasch KE, Myers C, Tait RC, Todd KH, Vallerand AH. The unequal burden of pain: confronting racial and ethnic disparities in pain. PAIN MEDICINE 2003; 4:277-94. [PMID: 12974827 DOI: 10.1046/j.1526-4637.2003.03034.x] [Citation(s) in RCA: 797] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CONTEXT Pain has significant socioeconomic, health, and quality-of-life implications. Racial- and ethnic-based differences in the pain care experience have been described. Racial and ethnic minorities tend to be undertreated for pain when compared with non-Hispanic Whites. OBJECTIVES To provide health care providers, researchers, health care policy analysts, government officials, patients, and the general public with pertinent evidence regarding differences in pain perception, assessment, and treatment for racial and ethnic minorities. Evidence is provided for racial- and ethnic-based differences in pain care across different types of pain (i.e., experimental pain, acute postoperative pain, cancer pain, chronic non-malignant pain) and settings (i.e., emergency department). Pertinent literature on patient, health care provider, and health care system factors that contribute to racial and ethnic disparities in pain treatment are provided. EVIDENCE A selective literature review was performed by experts in pain. The experts developed abstracts with relevant citations on racial and ethnic disparities within their specific areas of expertise. Scientific evidence was given precedence over anecdotal experience. The abstracts were compiled for this manuscript. The draft manuscript was made available to the experts for comment and review prior to submission for publication. CONCLUSIONS Consistent with the Institute of Medicine's report on health care disparities, racial and ethnic disparities in pain perception, assessment, and treatment were found in all settings (i.e., postoperative, emergency room) and across all types of pain (i.e., acute, cancer, chronic nonmalignant, and experimental). The literature suggests that the sources of pain disparities among racial and ethnic minorities are complex, involving patient (e.g., patient/health care provider communication, attitudes), health care provider (e.g., decision making), and health care system (e.g., access to pain medication) factors. There is a need for improved training for health care providers and educational interventions for patients. A comprehensive pain research agenda is necessary to address pain disparities among racial and ethnic minorities.
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Affiliation(s)
- Carmen R Green
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan 48109, USA.
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289
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Wills CE, Holmes-Rovner M. Preliminary validation of the Satisfaction With Decision scale with depressed primary care patients. Health Expect 2003; 6:149-59. [PMID: 12752743 PMCID: PMC5060180 DOI: 10.1046/j.1369-6513.2003.00220.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To conduct a preliminary validation of the Satisfaction With Decision (SWD) scale with depressed primary care patients. DESIGN Cross-sectional observational pilot study using a postal survey. SETTING AND PARTICIPANTS Depressed primary care patients (n = 97) who recently had made a new decision about antidepressant medication use completed surveys regarding their treatment decisions. MAIN VARIABLES Measures included patient-reported satisfaction with decision, decisional conflict, knowledge about depression and treatment, decision involvement, pain and health status, antidepressant medication efficacy, and satisfaction with health services. RESULTS The SWD scale had good internal consistency reliability (alpha = 0.85). Evidence for construct validity was confirmed via a hypothesized pattern of relationships between the SWD scale and other measures. Decision satisfaction was associated with several issues of relevance for designing patient-centred decision support interventions: (1) knowledge about depression and treatment; (2) involvement in health-related decisions; and (3) aiding evaluation of trade-offs among pros and cons of treatment. CONCLUSIONS The results of this pilot study show that the SWD scale appears to be a psychometrically sound and practical measure for research with this population. Additional research is needed on the theoretical nature of decision satisfaction and developing and testing patient-centred decision support interventions for depression treatment.
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Affiliation(s)
- Celia E Wills
- Michigan State University, College of Nursing and Professor, Michigan State University, College of Human Medicine, East Lansing, MI 48825, USA.
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290
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Jung HP, Baerveldt C, Olesen F, Grol R, Wensing M. Patient characteristics as predictors of primary health care preferences: a systematic literature analysis. Health Expect 2003; 6:160-81. [PMID: 12752744 PMCID: PMC5060177 DOI: 10.1046/j.1369-6513.2003.00221.x] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To identify associations between various cultural and demographic factors and patients' primary health care preferences. SEARCH STRATEGY Searches were performed in MEDLINE (1966-December 2000), PsycINFO (1977-May 2001) and Sociological Abstracts (1963-December 2000). Identified papers were checked for more papers. INCLUSION CRITERIA Studies with a focus on primary health care or health care in general, asking patients about preferences with regard to health care, reporting quantitative results and examining the relations between specific patient characteristics and patient preferences. DATA EXTRACTION AND SYNTHESIS Data were extracted from studies using a scoring form to register what methods were used, which patient characteristics were analysed and which patient characteristics significantly influenced patients' preferences with regard to different aspects of health care (P < 0.05). MAIN RESULTS A total of 145 studies were included with 2276 comparisons between subgroups of patients. Of all the comparisons, 607 (27%) showed a significant association between patient characteristics and preferences with regard to primary health care. Age and economic status significantly related to patient preferences in 38 and 33% of the comparisons, respectively. Education, health status, family situation, sex, and utilization of health care related significantly to patient preferences in less than 25% of the comparisons. CONCLUSIONS This review of the literature showed patient characteristics to be an important determinant of preferences regarding many aspects of primary health care defined as general practice care or health care, in general. All of the patient characteristics examined here showed at least some significant associations with preferences for primary health care.
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Affiliation(s)
- Hans Peter Jung
- Centre for Quality of Care Research, Universities of Nijmegen and Maastricht, Nijmegen and Maastricht, The Netherlands.
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291
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Kerr EA, Smith DM, Kaplan SH, Hayward RA. The association between three different measures of health status and satisfaction among patients with diabetes. Med Care Res Rev 2003; 60:158-77. [PMID: 12800682 DOI: 10.1177/1077558703060002002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Studies suggest that health status influences patient satisfaction, but little work has examined the influence of different measures of health status on satisfaction. The authors examined whether the association between health status and satisfaction varied for different measures of health status among 2000 diabetic patients receiving care across 25 Veterans Affairs facilities. Health status was measured using (1) the diabetes-related components of the Total Illness Burden Index (DM TIBI), a measure of diabetes severity and comorbidities; (2) the Short Form 36 (SF-36) Physical Function Index (PFI10); and (3) the SF-36 general health perceptions question (SF-1). Satisfaction was measured both by a 5-item scale on satisfaction with patient-provider communication and by a single item on overall diabetes care satisfaction. In adjusted models, worse health on all three health status measures correlated with lower satisfaction, but the DM TIBI explained more of the variation in satisfaction than either the PFI10 or SF-1. Moreover, when the DM TIBI was added to the model containing PFI10, PFI10 was no longer significantly associated with satisfaction. In this diabetes population, health status appears to have a substantial impact on patient satisfaction, and this effect is considerably greater for diabetes severity than for physical functioning.
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Affiliation(s)
- Eve A Kerr
- VA Center for Practice Management and Outcomes Research and University of Michigan School of Medicine, USA
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292
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Greene MG, Adelman RD. Physician-older patient communication about cancer. PATIENT EDUCATION AND COUNSELING 2003; 50:55-60. [PMID: 12767586 DOI: 10.1016/s0738-3991(03)00081-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Cancer is frequently a disease of older individuals. Communication between physicians and older patients about cancer prevention, screening, diagnosis, treatment and care is complicated by a variety of factors including patients' beliefs, perceptions, and knowledge about cancer. In addition, other older patient factors such as possible sensory deficits, cognitive impairment, functional limitations and accompaniment by significant others to the medical encounter influence communication. Physicians' attitudes about aging may also affect recommendations for cancer screening, treatment regiments and care of older cancer patients. To understand communication as a complex, multidimensional human enterprise requires knowledge of older patients' lived experience of cancer and their need for honest and compassionate care. Research findings on physician-older patient communication about cancer need to be translated into medical education, training and practice to improve the care of the older cancer patient.
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Affiliation(s)
- Michele G Greene
- Department of Health and Nutrition Sciences, Brooklyn College, 2900 Bedford Avenue, Brooklyn, NY 11210, USA.
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293
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Ashton CM, Haidet P, Paterniti DA, Collins TC, Gordon HS, O'Malley K, Petersen LA, Sharf BF, Suarez-Almazor ME, Wray NP, Street RL. Racial and ethnic disparities in the use of health services: bias, preferences, or poor communication? J Gen Intern Med 2003; 18:146-52. [PMID: 12542590 PMCID: PMC1494820 DOI: 10.1046/j.1525-1497.2003.20532.x] [Citation(s) in RCA: 336] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
African Americans and Latinos use services that require a doctor's order at lower rates than do whites. Racial bias and patient preferences contribute to disparities, but their effects appear small. Communication during the medical interaction plays a central role in decision making about subsequent interventions and health behaviors. Research has shown that doctors have poorer communication with minority patients than with others, but problems in doctor-patient communication have received little attention as a potential cause, a remediable one, of health disparities. We evaluate the evidence that poor communication is a cause of disparities and propose some remedies drawn from the communication sciences.
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294
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van Ryn M, Fu SS. Paved with good intentions: do public health and human service providers contribute to racial/ethnic disparities in health? Am J Public Health 2003; 93:248-55. [PMID: 12554578 PMCID: PMC1447725 DOI: 10.2105/ajph.93.2.248] [Citation(s) in RCA: 373] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
There is extensive evidence of racial/ethnic disparities in receipt of health care. The potential contribution of provider behavior to such disparities has remained largely unexplored. Do health and human service providers behave in ways that contribute to systematic inequities in care and outcomes? If so, why does this occur? The authors build on existing evidence to provide an integrated, coherent, and sound approach to research on providers' contributions to racial/ethnic disparities. They review the evidence regarding provider contributions to disparities in outcomes and describe a causal model representing an integrated set of hypothesized mechanisms through which health care providers' behaviors may contribute to these disparities.
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Affiliation(s)
- Michelle van Ryn
- Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Medical Center, MN 55417, USA.
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295
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Duetz MS, Schneeweiss S, Maclure M, Abel T, Glynn RJ, Soumerai SB. Physician gender and changes in drug prescribing after the implementation of reference pricing in British Columbia. Clin Ther 2003; 25:273-84. [PMID: 12637126 DOI: 10.1016/s0149-2918(03)90037-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Gender-specific attitudes and communication styles are known to influence both the content and outcome of medical visits. Therefore, gender-specific differences in response to cost containment may also occur. OBJECTIVE The purpose of this study was to assess the effect of physician gender on changes in prescribing patterns of angiotensin-converting enzyme (ACE) inhibitors after the implementation of reference pricing for prescription drugs in British Columbia, Canada. METHODS Reference pricing is a cost-sharing policy by which use of high-priced medication requires out-of-pocket payment of the price difference between the cost-sharing drug and a lower-cost drug within the same class. In British Columbia, reference pricing for ACE inhibitors was introduced on January 1, 1997. Analysis was carried out on linked pharmacy and medical service claims data on 927 female and 2922 male physicians treating 47,680 Pharmacare Plan A enrollees who were aged >-65 years and were prescribed a high-priced ACE inhibitors before the implementation of reference pricing. RESULTS Female physicians (24.1% of all physicians) were younger, treated more female patients, had patients with fewer chronic illnesses, and worked more often as general practitioners than did male physicians. The patients of female physicians were more likely to receive a written physician-requested exemption from copayment, according to a multivariate logistic regression analysis (odds ratio [OR], 1.25; 95% CI, 1.04-1.50). Data suggested that patients of female physicians were more likely to stop antihypertensive drug therapy (OR, 1.43; 95% CI, 0.96-2.13); however, this was independent of the new copayment policy. CONCLUSIONS The results provide empirical evidence that physician gender is associated with slightly different patient management strategies regarding physician-requested exemptions after the start of a new drug cost-sharing policy. However, these differences are unlikely to have meaningful clinical or economic consequences.
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Affiliation(s)
- Margreet S Duetz
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA
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296
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Effects of a Depression Education Program on Residentsʼ Knowledge, Attitudes, and Clinical Skills. Obstet Gynecol 2003. [DOI: 10.1097/00006250-200301000-00031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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297
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Bolaños E, Sarría-Santamera A. [Perspective of patients on type-2 diabetes and their relationship with primary care health professionals: a qualitative study]. Aten Primaria 2003; 32:195-200. [PMID: 12975081 PMCID: PMC7669193 DOI: 10.1016/s0212-6567(03)79251-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
AIM The objective of this study is to investigate the perception that people with type 2 diabetes have about the disease and about their relationship with the primary healthcare professionals. DESIGN Qualitative research, carried out between September-November 2000. SETTING Primary healthcare center Barrio del Pilar from Madrid. PARTICIPANTS 15 persons with type 2 diabetes. Variables considered to design the profiles of the interviewed were: age, gender, educational level, and time since diagnosis. METHOD Structural sampling and open interviews. RESULTS Patients express having scarce information regarding the consequences of diabetes. As diabetes is symptom free represents a difficulty for being perceived as a severe disease. The most valued aspects of the relationship with health professionals are that they provide with clear and tailored information, build a trust context, support changes and take account their perspectives and living circumstances. CONCLUSIONS It is essential to recognize how patients understand and shape the disease. Information provided by professionals have to be tailored to patients necessities, and take place in a trusting environment. Decisions related with diabetes management have to be aligned with patients perspectives. Effective communication could be considered as a useful tool to encourage adherence and improve healthcare quality.
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Affiliation(s)
- E Bolaños
- Agencia de Evaluación de Tecnologías Sanitarias. Instituto de Salud Carlos III. Madrid. España.
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298
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Harwood J, Sparks L. Social identity and health: an intergroup communication approach to cancer. HEALTH COMMUNICATION 2003; 15:145-159. [PMID: 12742766 DOI: 10.1207/s15327027hc1502_3] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
This article describes the ways in which group identifications and stereotypes can inform our understanding of cancer prevention and treatment as well as more general social processes surrounding the experience of cancer. From a perspective grounded in social identity theory, we describe the ways in which understanding primary identities (i.e., those associated with large social collectives such as cultural groups), secondary identities (i.e., those associated with health behaviors), and tertiary identities (i.e., those associated with cancer) can help explain certain cancer-related social processes. We forward a series of propositions to stimulate further research on this topic.
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Affiliation(s)
- Jake Harwood
- Department of Communication, University of Arizona, Tucson, AZ 85721, USA.
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299
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Katz RV, Kegeles SS, Green BL, Kressin NR, James SA, Claudio C. The Tuskegee Legacy Project: history, preliminary scientific findings, and unanticipated societal benefits. Dent Clin North Am 2003; 47:1-19. [PMID: 12519002 PMCID: PMC1408070 DOI: 10.1016/s0011-8532(02)00049-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This article is intended to provide a relatively complete picture of how a pilot study--conceived and initiated within an NIDCR-funded RRCMOH--matured into a solid line of investigation within that center and "with legs" into a fully funded study within the next generation of NIDCR centers on this topic of health disparities, the Centers for Research to Reduce Oral Health Disparities. It highlights the natural opportunity that these centers provide for multicenter. cross-disciplinary research and for research career pipelining for college and dental school students; with a focus, in this case, on minority students. Futhermore, this series of events demonstrates the rich potential that these types of research centers have to contribute in ways that far exceed the scientific outcomes that form their core. In this instance, the NMOHRC played a central--and critical, if unanticipated--role in contributing to two events of national significance, namely the presidential apology to the African American community for the research abuses of the USPHS--Tuskegee syphilis study and the establishment of the National Center for Bioethics in Research and Health Care at Tuskegee University. Research Centers supported by the NIH are fully intended to create a vortex of scientific activity that goes well beyond the direct scientific aims of the studies initially funded within those centers. The maxim is that the whole should be greater than the sum of its initial constituent studies or parts. We believe that NMOHRC did indeed achieve that maxim--even extending "the whole" to include broad societal impact. well beyond the scope of important, but mere, scientific outcomes--all within the concept and appropriate functions of a scientific NIH-funded research center.
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Affiliation(s)
- Ralph V Katz
- Department of Epidemiology & Health Promotion, New York University College of Dentistry, 345 East 24th Street, New York, NY 10010, USA.
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300
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Braddock CH, Micek MA, Fryer-Edwards K, Levinson W. Factors that Predict Better Informed Consent. THE JOURNAL OF CLINICAL ETHICS 2002. [DOI: 10.1086/jce200213411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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