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Wang W, Zhang J, Lu J, Wei X. Patient views of the good doctor in primary care: a qualitative study in six provinces in China. Glob Health Res Policy 2023; 8:24. [PMID: 37434267 DOI: 10.1186/s41256-023-00309-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 06/07/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND China has been striving to train primary care doctors capable of delivering high-quality service through general practitioner training programs and family doctor team reforms, but these initiatives have not adequately met patient needs and expectations. In order to guide further reform efforts to better meet patient expectations, this study generates a profile of the good doctor in primary care from the patient perspective. METHODS Semi-structured interviews were conducted in six provinces (Shandong, Zhejiang, Henan, Shaanxi, Shanxi, Heilongjiang) in China. A total of 58 interviewees completed the recorded interviews. Tape-based analysis was used to produce narrative summaries. Trained research assistants listened to the recordings of the interviews and summarized them by 30-s segments. Thematic analysis was performed on narrative summaries to identify thematic families. RESULTS Five domains and 18 attributes were generated from the analysis of the interview data. The domains of the good doctor in primary care from the patient perspective were: strong Clinical Competency (mentioned by 97% of participants) and Professionalism & Humanism (mentioned by 93% of participants) during service delivery, followed by Service Provision and Information Communication (mentioned by 74% and 62% of participants, respectively). Moreover, Chinese patients expect that primary care doctors have high educational attainment and a good personality (mentioned by 41% of participants). CONCLUSIONS This five-domain profile of the good doctor in primary care constitutes a foundation for further primary care workforce capacity building. Further primary care reform efforts should reflect the patient views and expectations, especially in the family physician competency framework and primary care performance assessment system development. Meanwhile, frontline primary care organizations also need to create supportive environments to assist competent doctors practice in primary care, especially through facilitating the learning of primary care doctors and improving their well-being.
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Affiliation(s)
- Wenhua Wang
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 West Xianning Road, Xi'an, People's Republic of China
| | - Jinnan Zhang
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 West Xianning Road, Xi'an, People's Republic of China
| | - Jiao Lu
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 West Xianning Road, Xi'an, People's Republic of China
| | - Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
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2
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Pratiwi AB, Padmawati RS, Mulyanto J, Willems DL. Patients values regarding primary health care: a systematic review of qualitative and quantitative evidence. BMC Health Serv Res 2023; 23:400. [PMID: 37098522 PMCID: PMC10131468 DOI: 10.1186/s12913-023-09394-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 09/15/2022] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Accessible and high-quality primary health care (PHC) is fundamental to countries moving towards universal health coverage. In order to improve the quality of patient-centered care provided in PHC, a comprehensive understanding of patients' values is crucial to address any gaps in the health care system. This systematic review aimed to identify patients' values relevant to PHC. METHODS We searched primary qualitative and quantitative studies about patients' values related to primary care in PubMed and EMBASE (Ovid) from 2009 to 2020. The studies' quality was assessed using Joanna Briggs Institute (JBI) Critical Appraisal Checklist for both quantitative and qualitative studies and Consolidated Criteria for Reporting Qualitative Studies (COREQ) for qualitative studies. A thematic approach was used in the data synthesis. OUTCOME The database search resulted in 1,817 articles. A total of 68 articles were full-text screened. Data were extracted from nine quantitative and nine qualitative studies that met the inclusion criteria. The participants of the studies were mainly the general population in high-income countries. Four themes emerged from the analysis: patients' values related to privacy and autonomy; values associated with the general practitioners including virtuous characteristics, knowledge and competence; values involving patient-doctor interactions such as shared decision-making and empowerment; and core values related to the primary care system such as continuity, referral, and accessibility. CONCLUSIONS This review reveals that the doctor's personal characteristics and their interactions with the patients are critical considerations concerning the primary care services from the patients' point of view. The inclusion of these values is essential to improve the quality of primary care.
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Affiliation(s)
- Agnes Bhakti Pratiwi
- Department of Ethics, Law, and Humanities, Faculty of Medicine, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands.
- Department of Medical Education and Bioethics, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
| | - Retna Siwi Padmawati
- Department of Health Behavior, Environment, and Social Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Center for Bioethics and Medical Humanities, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Joko Mulyanto
- Department of Public Health and Community Medicine, Faculty of Medicine, Universitas Jenderal Soedirman, Purwokerto, Indonesia
- Department of Public and Occupational Health, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Dick L Willems
- Department of Ethics, Law, and Humanities, Faculty of Medicine, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
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Escourrou E, Joyeux T, Guilhem M, Oustric S, Gardette V. How general practitioners perceive the aging trajectory of oldest-old - A qualitative study. BMC PRIMARY CARE 2023; 24:5. [PMID: 36624382 PMCID: PMC9829226 DOI: 10.1186/s12875-023-01964-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 01/02/2023] [Indexed: 01/11/2023]
Abstract
BACKGROUND A new population of older people is growing: the oldest-old. The care of the oldest-old (individuals aged 90 and over) is a new challenge in primary care. This study aimed to analyze the perception of General Practitioners (GP) on (1) the aging process of their patients up to a very advanced age, (2) how to adapt their practice to the care of these patients. METHODS We conducted a qualitative study using focus group (face to face) and individual (video call) interviews of GPs in southwest France. The sampling was purposive. We analyzed the interviews using an inductive approach based on the phases of thematic analysis. We used researchers' triangulation during the process. Collection was concluded when saturation was reached. RESULTS Three focus groups and one individual interview were conducted with a total of seventeen general practitioners. GP perception concerning aging and very advanced age were based on their personal experience and their daily clinical practice. Aging was perceived as an individual, unconscious, unpredictable and irreversible phenomenon. The shift towards "very old age" appeared inevitable. It could be a physical or psychological shift, or patients neglecting themselves or lacking a project. The care of the oldest-old became more specific and individual, adapted to the wishes of the patient. Those adaptations involve medical disengagement to focus on the most essential outcomes. The objectives of health care needed to be less strict with limited invasive practices. Prevention needed to focus mainly on prevention of falls and limitation of functional decline. CONCLUSION GPs identified an inevitable and unpredictable shift from old age to very old age. The adaption of the theory of disengagement allowed us to identify a medical disengagement of the GPs in the care of their oldest patients.
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Affiliation(s)
- Emile Escourrou
- grid.15781.3a0000 0001 0723 035XDépartement Universitaire de Médecine Générale, Faculté de Médecine Rangueil, Université Paul Sabatier Toulouse III, 133 route de Narbonne, 31400 Toulouse, France ,grid.15781.3a0000 0001 0723 035XMaintain Aging Research team, CERPOP, Université de Toulouse, Université Paul Sabatier, Inserm, Toulouse, France ,Maison de Santé Pluriprofessionnelle Universitaire La Providence, Toulouse, France
| | - Thomas Joyeux
- grid.15781.3a0000 0001 0723 035XDépartement Universitaire de Médecine Générale, Faculté de Médecine Rangueil, Université Paul Sabatier Toulouse III, 133 route de Narbonne, 31400 Toulouse, France
| | - Matthieu Guilhem
- grid.15781.3a0000 0001 0723 035XDépartement Universitaire de Médecine Générale, Faculté de Médecine Rangueil, Université Paul Sabatier Toulouse III, 133 route de Narbonne, 31400 Toulouse, France
| | - Stéphane Oustric
- grid.15781.3a0000 0001 0723 035XDépartement Universitaire de Médecine Générale, Faculté de Médecine Rangueil, Université Paul Sabatier Toulouse III, 133 route de Narbonne, 31400 Toulouse, France ,grid.15781.3a0000 0001 0723 035XMaintain Aging Research team, CERPOP, Université de Toulouse, Université Paul Sabatier, Inserm, Toulouse, France ,Maison de Santé Pluriprofessionnelle Universitaire La Providence, Toulouse, France
| | - Virginie Gardette
- grid.15781.3a0000 0001 0723 035XMaintain Aging Research team, CERPOP, Université de Toulouse, Université Paul Sabatier, Inserm, Toulouse, France ,grid.411175.70000 0001 1457 2980Centre Hospitalier Universitaire de Toulouse, Toulouse, France
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Touhami D, Brach M, Essig S, Ronca E, Debecker I, Eriks-Hoogland I, Scheel-Sailer A, Münzel N, Gemperli A. First contact of care for persons with spinal cord injury: a general practitioner or a spinal cord injury specialist? BMC FAMILY PRACTICE 2021; 22:195. [PMID: 34598672 PMCID: PMC8487149 DOI: 10.1186/s12875-021-01547-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 09/22/2021] [Indexed: 11/26/2022]
Abstract
Background Although general practitioners (GPs) are generally considered as the first point of contact for care, this may be different for persons with complex conditions, such as those with spinal cord injury (SCI). The objective of this study is to understand the differences in long-term care provision by GPs and SCI-specialists, by examining (1) the first contact of care for SCI health problems, (2) the morbidity profile and use of health-care services in relation to first contact, and (3) the factors associated with the choice of first contact. Methods In this cross-sectional study based on data derived from the Swiss Spinal Cord Injury Cohort Study Community Survey 2017, the main outcome measure was the reported first contact for SCI-specific care. This information was analysed using the chi-square test and logistic regression analysis of groups based on patient characteristics, use of health-care services and secondary health conditions assessed using the Spinal Cord Injury Secondary Conditions Scale (SCI-SCS). Results Out of 1294 respondents, 1095 reported their first contact for SCI-specific care; 56% indicated SCI-specialists and 44% specified GPs. On average, participants who first contacted a GP reported higher number of GP consultations (5.1 ± 5.2 vs. 3.9 ± 7.2), planned visits to ambulatory clinics (3.7 ± 7.3 vs. 3.6 ± 6.7) and hospital admissions (GP, 1.9 ± 1.7 vs. 1.5 ± 1.3), but lower number of visits to SCI-specialists (1.7 ± 1.8 vs. 2.6 ± 1.7) and of hospital days (22.8 ± 43.2 vs. 31.0 ± 42.8). The likelihood to contact a GP first was significantly higher in persons ≥75 years old (OR = 4.44, 95% CI = 1.85–10.69), Italian speakers (OR = 5.06, 95% CI = 2.44–10.47), had incomplete lesions (OR = 2.39, 95% CI = 1.71–3.35), experiencing pain (OR = 1.47, 95% CI = 1.04–2.09) or diabetes mellitus (OR = 1.85, 95% CI = 1.05–3.27), but lower for those situated closer to SCI centres (OR = 0.69, 95% CI = 0.51–0.93) or had higher SCI-SCS scores (OR = 0.92, 95% CI = 0.86–0.99). Conclusion Age, language region, travel distance to SCI centres, lesion completeness, and occurrence of secondary conditions play a significant role in determining the choice of first contact of care, however there is still some unwarranted variation that remains unclear and requires further research.
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Affiliation(s)
- Dima Touhami
- Department of Health Sciences and Medicine, University of Lucerne, 6002, Lucerne, Switzerland. .,Swiss Paraplegic Research, 6207, Nottwil, Switzerland.
| | - Mirjam Brach
- Department of Health Sciences and Medicine, University of Lucerne, 6002, Lucerne, Switzerland.,Swiss Paraplegic Research, 6207, Nottwil, Switzerland
| | - Stefan Essig
- Department of Health Sciences and Medicine, University of Lucerne, 6002, Lucerne, Switzerland.,Center of Primary and Community Care, University of Lucerne, 6002, Lucerne, Switzerland
| | - Elias Ronca
- Department of Health Sciences and Medicine, University of Lucerne, 6002, Lucerne, Switzerland.,Swiss Paraplegic Research, 6207, Nottwil, Switzerland
| | | | | | - Anke Scheel-Sailer
- Department of Health Sciences and Medicine, University of Lucerne, 6002, Lucerne, Switzerland.,Swiss Paraplegic Center, 6207, Nottwil, Switzerland
| | | | - Armin Gemperli
- Department of Health Sciences and Medicine, University of Lucerne, 6002, Lucerne, Switzerland.,Swiss Paraplegic Research, 6207, Nottwil, Switzerland.,Center of Primary and Community Care, University of Lucerne, 6002, Lucerne, Switzerland
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Manchaiah V, Swanepoel DW, Bennett RJ. Online Consumer Reviews on Hearing Health Care Services: A Textual Analysis Approach to Examine Psychologically Meaningful Language Dimensions. Am J Audiol 2021; 30:669-675. [PMID: 34297608 DOI: 10.1044/2021_aja-20-00223] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose The study examined psychologically meaningful language dimensions (i.e., social and emotional dimensions, health dimensions, and personal concerns) within online consumer reviews on hearing health care services using an automated textual analysis approach. Method Nine thousand six hundred twenty-two consumer reviews of hearing health care services, including an open-ended question (i.e., free text response to the prompt "share details of your own experience at this place") and an overall rating (on a 5-point scale ranging from "very good" to "very poor") were extracted from Google.com from 40 different cities across the United States. In addition, some metadata about the cities (i.e., region, population size, median age, percentage of older adults) were also recorded. Text responses were analyzed using the automated Linguistic Inquiry and Word Count software for selected language dimensions. The language dimensions of online hearing health care reviews were descriptively compared with language dimensions observed in the natural language of typical bloggers. Language dimensions from free text responses were correlated with quantitative overall experience ratings. Results Automated linguistic analysis showed that consumer reviews on hearing health care services had higher social processes, positive emotions, hearing, health, money, and work, and lower negative emotions and time-awareness when compared to typical bloggers. Examining the association between overall experience rating and the language dimensions revealed two broad findings. First, higher engagement of consumers in terms of social processes, positive emotions, hearing, and work dimensions was related to higher experience ratings. Second, higher engagement of consumers in terms of negative emotions, time awareness, and money was related to lower experience ratings. Conclusions Online reviews contain information about various dimensions (i.e., social and emotional dimensions as well as personal concerns) that have bearing toward the way in that they rate their health care experiences. Automated linguistic analysis of consumer reviews appears helpful in identifying gaps in service delivery that may influence consumer experience.
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Affiliation(s)
- Vinaya Manchaiah
- Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX
- Department of Speech and Hearing, School of Allied Health Sciences, Manipal University, Manipal, India
| | - De Wet Swanepoel
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Gauteng, South Africa
- Ear Science Institute Australia, Subiaco, Western Australia
- Ear Sciences Centre, School of Surgery, The University of Western Australia, Nedlands, Australia
| | - Rebecca J. Bennett
- Ear Science Institute Australia, Subiaco, Western Australia
- Ear Sciences Centre, School of Surgery, The University of Western Australia, Nedlands, Australia
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6
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De Freitas L, Goodacre S, O'Hara R, Thokala P, Hariharan S. A qualitative exploration of value and waste in a Trinidadian emergency department patient flow process: perspectives of patients and clinicians. J Health Organ Manag 2021; ahead-of-print. [PMID: 33619923 DOI: 10.1108/jhom-03-2020-0073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE A process that does not include the customer's value may not be effective in providing care. This study aimed to identify value and waste in an emergency department (ED) patient flow process from a patient and clinician perspective. DESIGN/METHODOLOGY/APPROACH A qualitative case study was conducted in an ED in Trinidad and Tobago. Observations and informal conversational interviews with clinicians (n = 33) and patients (n = 50) explored patient flow, value and waste. Thematic analysis was used to create a framework on valuable and wasteful aspects in the ED patient flow process. FINDINGS Valuable aspects led to direct improvements in the patient's health or an exchange of information in the process. Wasteful aspects were those with no patient activity, no direct ED clinical involvement, or resulted in a perceived inappropriate use of ED resources. However, there was a disparity in responses between clinicians and patients with clinicians identifying more features in the process. RESEARCH LIMITATIONS/IMPLICATIONS The single case study design limits the generalizability of findings to other settings. This study did not specifically explore the influence of age and gender on what mattered to patients in ED services. Future studies would benefit from exploring whether there are any age and gender differences in patient perspectives of value and waste. Further research is needed to validate the usefulness of the framework in a wider range of settings and consider demographic factors such as age and gender. PRACTICAL IMPLICATIONS The study has produced a framework which may be used to improve patient flow in a way that maximized value to its users. A collaborative approach, with active patient involvement, is needed to develop a process that is valuable to all. The single case study design limits the generalizability of findings to other settings. ORIGINALITY/VALUE Qualitative methods were used to explicitly explore both value and waste in emergency department patient flow, incorporating the patient perspective. This paper provides an approach that decision makers may use to refine the ED patient flow process into one that flows well, improves quality and maximizes value to its users.
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Affiliation(s)
- Loren De Freitas
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Steve Goodacre
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Rachel O'Hara
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Praveen Thokala
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Seetharaman Hariharan
- The University of the West Indies Saint Augustine Campus, Saint Augustine, Trinidad And Tobago
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Mackenzie L, Beavis AM, Tan ACW, Clemson L. Systematic Review and Meta-Analysis of Intervention Studies with General Practitioner Involvement Focused on Falls Prevention for Community-Dwelling Older People. J Aging Health 2020; 32:1562-1578. [PMID: 32912102 DOI: 10.1177/0898264320945168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Objectives: Falls are a significant health problem for the ageing population. This review aimed to identify effective falls prevention interventions with involvement of general practitioners (GPs). Methods: Systematic review of randomised controlled trials conducted from 1999-2019, with meta-analysis. Searches located 2736 articles. A quality assessment was conducted of all included studies. Results: 21 randomised controlled trials met the inclusion criteria and 19 studies could be included in a meta-analysis. Overall, studies were not effective for reducing multiple falls (Relative Risk (RR) 1.16, 95% CI .97-1.39 and p = .10) or reducing one or more falls (RR .91, 95% CI: .82-1.01 and p = .08), but were effective for reducing injurious falls (RR .76, 95% CI: .66-.87 and p = .001). Discussion: Studies involving the GP in an active role and aligned with the primary care context were effective. The fidelity of interventions was limited by independent GP decisions and older participants being required to initiate the intervention.
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Affiliation(s)
- Lynette Mackenzie
- Discipline of Occupational Therapy, School of Health Sciences, 4334The University of Sydney, Australia
| | - Ann-Marie Beavis
- Discipline of Occupational Therapy, School of Health Sciences, 4334The University of Sydney, Australia
| | - Amy C W Tan
- Ageing Work and Health Research Unit, School of Health Sciences, 4334The University of Sydney, Australia
| | - Lindy Clemson
- Ageing Work and Health Research Unit, School of Health Sciences, 4334The University of Sydney, Australia
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Marcinowicz L, Taranta E. Perspectives of older patients on the qualities which define a "good family nurse": A qualitative study. Nurs Open 2020; 7:814-821. [PMID: 32257269 PMCID: PMC7113527 DOI: 10.1002/nop2.456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/13/2020] [Accepted: 01/20/2020] [Indexed: 11/06/2022] Open
Abstract
Aim To explore what the term "good family nurse" means to older patients. Design A descriptive qualitative study design was used, and a purposive sampling method was adopted. Methods Semi-structured interviews were conducted with 21 patients aged 65 years and older who were receiving primary care in Bialystok (Poland). The interviews were recorded and then transcribed in verbatim. The data were analysed using content analysis. Data were collected between February 2017 and December 2018. Results We identified six main categories of qualities that define a "good family nurse". These are as follows: (a) personal traits and attributes (sex and individual characteristics and behaviours not directly related to nursing); (b) providing care (caring attitude and patient support); (c) communicating with the patient (the ability to listen and inform the patient); (d) professional competence (knowledge, professional experience and good technical skills); (e) ethical attitude (respect, patience and vocation); and (f) availability (the frequency and duration of home visits, organization of the doctor's appointments).
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Affiliation(s)
- Ludmila Marcinowicz
- Department of Primary Health CareMedical University of BialystokBialystokPoland
| | - Ewa Taranta
- Department of Primary Health CareMedical University of BialystokBialystokPoland
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Jack K, Ridley C, Turner S. Effective communication with older people. Nurs Older People 2019; 31:e1126. [PMID: 31468756 DOI: 10.7748/nop.2019.e1126] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2018] [Indexed: 11/09/2022]
Abstract
Effective communication with older people is an important aspect of nursing practice. Ineffective communication can lead to older people feeling inadequate, disempowered and helpless. Nurses have a duty to ensure that older people think they are being listened to and that their concerns are being validated in a non-judgemental way. Central to effective communication is the ability of nurses to be self-aware, and monitor their thoughts and feelings about, for example, negative stereotypes associated with the ageing process. Effective communication can sometimes be difficult to achieve due to the effects of ageing, but nurses can overcome some barriers through thoughtful interventions. It is important to treat older people as individuals, and to monitor and adapt communication accordingly. By doing so, nurses can ensure older people feel empowered, respected and able to maintain their independence.
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Affiliation(s)
- Kirsten Jack
- Manchester Metropolitan University, Manchester, England
| | | | - Samuel Turner
- Manchester Metropolitan University, Manchester, England
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10
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Sheridan NF, Kenealy TW, Fitzgerald AC, Kuluski K, Dunham A, McKillop AM, Peckham A, Gill A. How does it feel to be a problem? Patients' experiences of self-management support in New Zealand and Canada. Health Expect 2018; 22:34-45. [PMID: 30244514 PMCID: PMC6351408 DOI: 10.1111/hex.12823] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 06/24/2018] [Accepted: 07/13/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The impact of long-term conditions is the "healthcare equivalent to climate change." People with long-term conditions often feel they are a problem, a burden to themselves, their family and friends. Providers struggle to support patients to self-manage. The Practical Reviews in Self-Management Support (PRISMS) taxonomy lists what provider actions might support patient self-management. OBJECTIVE To offer providers advice on how to support patient self-management. DESIGN Semi-structured interviews with 40 patient-participants. SETTING AND PARTICIPANTS Three case studies of primary health-care organizations in New Zealand and Canada serving diverse populations. Participants were older adults with long-term conditions who needed support to live in the community. MAIN OUTCOME MEASURES Qualitative description to classify patient narratives of self-management support according to the PRISMS taxonomy with thematic analysis to explore how support was acceptable and effective. RESULTS Patients identified a relationship-in-action as the mechanism, the how by which providers supported them to self-manage. When providers acted upon knowledge of patient lives and priorities, these patients were often willing to try activities or medications they had resisted in the past. Effective self-management support saw PRISMS components delivered in patient-specific combinations by individual providers or teams. DISCUSSION AND CONCLUSIONS Providers who establish relationships with patients can support them to self-manage and improve health outcomes. Delivery of taxonomy components, in the absence of a relationship, is unlikely to be either acceptable or effective. Providers need to be aware that social determinants of health can constrain patients' options to self-manage.
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Affiliation(s)
| | | | | | - Kerry Kuluski
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Allie Peckham
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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11
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Soares CC, Marques AM, Clarke P, Klein R, Koskinen L, Krasuckiene D, Lamsodiene E, Piscalkiene V, Küçükgüçlü Ö. Older people's views and expectations about the competences of health and social care professionals: a European qualitative study. Eur J Ageing 2018; 16:53-62. [PMID: 30886560 DOI: 10.1007/s10433-018-0466-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Adapting and providing quality services for people as they age is a common challenge across Europe. The perspective of older people is fundamental in a person-centred care approach. Expanding research at the European level that explicitly includes their views can offer a relevant contribution to the development of evidence-based guidelines that can be shared in education and training across health and social care professions. This study aimed to identify common meaningful dimensions of professional competence in health and social care emphasised by older people from six countries in different regions of Europe according to their experiences. A qualitative approach was chosen with a total of 95 semi-structured interviews conducted in Austria, Finland, Lithuania, Portugal, Turkey and UK, following a common topic guide. Participants in this study were aged 60 and above, and recruitment considered age, gender, level of education and living arrangements. Results identified a set of universal skills and practices that according to older people, health and social care professionals should meet. Competences at the interpersonal level were central in older people's discourses, and its core dimensions are anchored in relational, communication and socio-emotional skills of professionals. These findings reinforce the aspiration of establishing best practices in care that relies on the harmonisation of a competence framework that can be shared in the training and education of health and social care professionals across Europe and that voices older people's preferences, expectations and needs.
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Affiliation(s)
- Célia Casaca Soares
- 1Department of Social Sciences and Humanities, School of Health, Centre for Interdisciplinary Applied Research in Health, Instituto Politecnico de Setúbal, Campus do IPS, Estefanilha, Setúbal, 2910-761 Portugal.,2Centro de Investigação e Intervenção Social (CIS-IUL), Instituto Universitário de Lisboa (ISCTE-IUL), Av. das Forças Armadas, Lisboa, 1649-026 Portugal
| | - António Manuel Marques
- 1Department of Social Sciences and Humanities, School of Health, Centre for Interdisciplinary Applied Research in Health, Instituto Politecnico de Setúbal, Campus do IPS, Estefanilha, Setúbal, 2910-761 Portugal.,2Centro de Investigação e Intervenção Social (CIS-IUL), Instituto Universitário de Lisboa (ISCTE-IUL), Av. das Forças Armadas, Lisboa, 1649-026 Portugal
| | - Pat Clarke
- 3School of Nursing and Allied Health, Liverpool John Moores University, Henry Cotton, 15/21 Webster St., Liverpool, L3 2ET UK
| | - Regina Klein
- 4Department Health + Social Care, Carinthia University of Applied Sciences, Hauptplatz 11, 9560 Feldkirchen, Austria
| | - Liisa Koskinen
- 5School of Health Care, Savonia University of Applied Sciences, PL 6 (Microkatu 1), 70201 Kuopio, Finland
| | - Daine Krasuckiene
- 6Faculty of Medicine, Kaunas University of Applied Sciences, Pramones pr. 20, 50468 Kaunas, Lithuania
| | - Evelina Lamsodiene
- 6Faculty of Medicine, Kaunas University of Applied Sciences, Pramones pr. 20, 50468 Kaunas, Lithuania
| | - Viktorija Piscalkiene
- 6Faculty of Medicine, Kaunas University of Applied Sciences, Pramones pr. 20, 50468 Kaunas, Lithuania
| | - Özlem Küçükgüçlü
- 7Department of Internal Medicine Nursing, Dokuz Eylul University, Inciralti İzmir, Turkey
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Jaworski M, Rzadkiewicz M, Adamus M, Chylinska J, Lazarewicz M, Haugan G, Lillefjell M, Espnes GA, Wlodarczyk D. Primary care patients' expectations regarding medical appointments and their experiences during a visit: does age matter? Patient Prefer Adherence 2017; 11:1221-1233. [PMID: 28761335 PMCID: PMC5522818 DOI: 10.2147/ppa.s133390] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION There is evidence that meeting patients' expectations toward health care correlates with involvement in the treatment they receive. The most important patient expectations concern certain types of information: explanation of disease and treatment, health promotion, and improvement in quality of life. Other demands include proper rapport and emotional support. The aim of this paper was to examine different patient groups over the age of 50 years and their expectations toward medical visits, evaluated before a visit and after the visit. PATIENTS AND METHODS The study group consisted of 4,921 primary health-care patients. The patients received self-administered questionnaires that they filled in before and after the appointment with the doctor. Interviews with patients were conducted individually by specially trained interviewers. The PRACTA Patient Expectations Scale was used to measure the appointment-related expectations of the patients. RESULTS We observed differences related to age in patients' expectations before medical visits regarding the following factors: disease explanation, treatment explanation, quality of life, rapport, and emotional support. The same differences were not observed on health promotion. Evaluation of patients' appointment-related experiences after the visit showed that there were significant differences between the age-groups regarding all types of expectations included in the study. Differences between previsit and postvisit measurements were statistically significant in all age-groups. Patients who received less than they expected from doctors outnumbered those who received what they expected or more in all the groups. CONCLUSION Patients' expectations toward medical visits are conditioned by age. Therefore, doctors should pay more attention to requirements related to age in their effort to identify and satisfy expectations. This is particularly important in light of the discrepancy between previsit expectations and the actual experiences of patients evaluated after the visit.
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Affiliation(s)
- Mariusz Jaworski
- Department of Medical Psychology, Second Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
- Correspondence: Mariusz Jaworski, Department of Medical Psychology, Second Faculty of Medicine, Medical University of Warsaw, ZJAM Building–First Floor, 81 Zwirki i Wigury Street, Warsaw 02-091, Poland, Tel +48 22 572 0533, Fax +48 22 572 0542, Email
| | - Marta Rzadkiewicz
- Department of Medical Psychology, Second Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Miroslawa Adamus
- Department of Medical Psychology, Second Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Joanna Chylinska
- Department of Medical Psychology, Second Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Magdalena Lazarewicz
- Department of Medical Psychology, Second Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
| | | | - Monica Lillefjell
- Department of Neuromedicine and Movement Science, NTNU Center for Health Promotion Research, Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Dorota Wlodarczyk
- Department of Medical Psychology, Second Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
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13
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Sundling C, Nilsson ME, Hellqvist S, Pendrill LR, Emardson R, Berglund B. Travel behaviour change in old age: the role of critical incidents in public transport. Eur J Ageing 2016; 13:75-83. [PMID: 27034646 PMCID: PMC4769306 DOI: 10.1007/s10433-015-0358-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Older people’s travel behaviour is affected by negative or positive critical incidents in the public transport environment. With the objective of identifying such incidents during whole trips and examining how travel behaviour had changed, we have conducted in-depth interviews with 30 participants aged 65–91 years in the County of Stockholm, Sweden. Out of 469 incidents identified, 77 were reported to have resulted in travel behaviour change, 67 of them in a negative way. Most critical incidents were encountered in the physical environment on-board vehicles and at stations/stops as well as in pricing/ticketing. The findings show that more personal assistance, better driving behaviour, and swift maintenance of elevators and escalators are key facilitators that would improve predictability in travelling and enhance vulnerable older travellers’ feeling of security. The results demonstrate the benefit of involving different groups of end users in future planning and design, such that transport systems would meet the various needs of its end users.
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Affiliation(s)
- Catherine Sundling
- Gösta Ekman Laboratory, Department of Psychology, Stockholm University, 106 91 Stockholm, Sweden
| | - Mats E. Nilsson
- Gösta Ekman Laboratory, Department of Psychology, Stockholm University, 106 91 Stockholm, Sweden
| | - Sara Hellqvist
- Department of Psychology, Stockholm University, 106 91 Stockholm, Sweden
| | - Leslie R. Pendrill
- SP–Technical Research Institute of Sweden, P.O. Box 857, 501 15 Borås, Sweden
| | - Ragne Emardson
- SP–Technical Research Institute of Sweden, P.O. Box 857, 501 15 Borås, Sweden
| | - Birgitta Berglund
- Department of Psychology, Stockholm University, 106 91 Stockholm, Sweden
- Institute of Environmental Medicine, Karolinska Institutet, P.O. Box 210, 171 77 Stockholm, Sweden
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Shareef MA, AlAmodi AA, Al-Khateeb AA, Abudan Z, Alkhani MA, Zebian SI, Qannita AS, Tabrizi MJ. The interplay between academic performance and quality of life among preclinical students. BMC MEDICAL EDUCATION 2015; 15:193. [PMID: 26521026 PMCID: PMC4628381 DOI: 10.1186/s12909-015-0476-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 10/22/2015] [Indexed: 05/22/2023]
Abstract
BACKGROUND The high academic performance of medical students greatly influences their professional competence in long term career. Meanwhile, medical students greatly demand procuring a good quality of life that can help them sustain their medical career. This study examines validity and reliability of the tool among preclinical students and testifies the influence of their scholastic performance along with gender and academic year on their quality of life. METHODS A cross sectional study was conducted by distributing World Health Organization Quality of Life, WHOQOL-BREF, survey among medical students of year one to three at Alfaisal University. For validity, item discriminate validity(IDV) and confirmatory factor analysis were measured and for reliability, Cronbach's α test and internal item consistency(IIC) were examined. The association of GPA, gender and academic year with all major domains was drawn using Pearson's correlation, independent samples t-test and one-way ANOVA, respectively. RESULTS A total of 335 preclinical students have responded to this questionnaire. The construct has demonstrated an adequate validity and good reliability. The high academic performance of students positively correlated with physical (r = 0.23, p < 0.001), psychological health (r = 0.29, p < 0.001), social relations (r = 0.11, p = 0.03) and environment (r = 0.23, p < 0.001). Male student scored higher than female peers in physical and psychological health. DISCUSSION This study has identified a direct relationship between the academic performance of preclinical students and their quality of life. CONCLUSION The WHOQOL-BREF is a valid and reliable tool among preclinical students and the positive direction of high academic performance with greater QOL suggests that academic achievers procure higher satisfaction and poor achievers need a special attention for the improvement of their quality of life.
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Zou Y, Zhang X, Hao Y, Shi L, Hu R. General practitioners versus other physicians in the quality of primary care: a cross-sectional study in Guangdong Province, China. BMC FAMILY PRACTICE 2015; 16:134. [PMID: 26452648 PMCID: PMC4600296 DOI: 10.1186/s12875-015-0349-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 09/24/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND The primary care in China can be provided by general practitioners (GPs) and other physicians (non-GPs). However, China's general practice system has never been really established. Chinese patients tend to consider the quality of primary care provided by GPs much lower than that of non-GPs. Besides, many GPs presently prefer leaving their own positions and seeking better development in big hospitals, which has made the already weak GP system weaker. Yet, few studies have specially compared the quality of primary care provided by Chinese GPs and other physicians and no studies have explored the independent predictors of Chinese GPs' intentions to stay on their current job. In this study, we aimed to compare the quality of primary care offered by GPs with non-GPs and to explore the independent predictors of GPs' future work intentions. METHODS This cross-sectional study applied multi-stage random cluster sampling methodology. The data were collected from November 2013 to September 2014 in Guangdong Province. In total, 401 effective questionnaires were selected from the physicians. Quality of primary care was assessed using the Primary Care Assessment Tool (PCAT) Provider Part, representing six primary care domains: ongoing care, coordination (i.e., referrals and information systems), comprehensiveness (i.e., service available and service provided), family-centeredness, community orientation and cultural competence. RESULTS Of 401 participating physicians, 163 (40.6 %) were GPs. The total PCAT score was 26.32 ± 2.24 which was the sum score of the six domains and represent the quality of primary care. GPs achieved significantly different total scores and scores on three individual scales: comprehensiveness: service available, comprehensiveness: service provided and community orientation. Multiple linear regressions revealed GPs had a higher total score and scores for comprehensiveness: service provided and community orientation after adjusting for sociodemographic characteristics. In addition, GPs were more likely to intend to stay in their current job in the coming year, and this was associated with their educational level. CONCLUSIONS Our findings showed that GPs reported higher quality of primary care than other physicians, and were more inclined to stay in their current job. With more comprehensive care and community orientation provided by GPs, residents could reach basic medical cares and needn't to crowd into larger hospitals.
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Affiliation(s)
- Yaming Zou
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Road 2, Guangzhou, 510080, P.R China.
| | - Xiao Zhang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Road 2, Guangzhou, 510080, P.R China.
| | - Yuantao Hao
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Road 2, Guangzhou, 510080, P.R China.
| | - Leiyu Shi
- Department of Health Policy & Management, Bloomberg School of Public Health, Primary Care Policy Center, Johns Hopkins University, Baltimore, USA.
| | - Ruwei Hu
- Department of Health Management, School of Public Health, Sun Yat-sen University, 74 Zhongshan Road 2, Guangzhou, 510080, P.R China.
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Rocque R, Leanza Y. A Systematic Review of Patients' Experiences in Communicating with Primary Care Physicians: Intercultural Encounters and a Balance between Vulnerability and Integrity. PLoS One 2015; 10:e0139577. [PMID: 26440647 PMCID: PMC4594916 DOI: 10.1371/journal.pone.0139577] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 09/15/2015] [Indexed: 11/26/2022] Open
Abstract
Communication difficulties persist between patients and physicians. In order to improve care, patients’ experiences of this communication must be understood. The main objective of this study is to synthesize qualitative studies exploring patients’ experiences in communicating with a primary care physician. A secondary objective is to explore specific factors pertaining to ethnic minority or majority patients and their influence on patients’ experiences of communication. Pertinent health and social sciences electronic databases were searched systematically (PubMed, Cinahl, PsychNet, and IBSS). Fifty-seven articles were included in the review on the basis of being qualitative studies targeting patients’ experiences of communication with a primary care physician. The meta-ethnography method for qualitative studies was used to interpret data and the COREQ checklist was used to evaluate the quality of included studies. Three concepts emerged from analyses: negative experiences, positive experiences, and outcomes of communication. Negative experiences related to being treated with disrespect, experiencing pressure due to time constraints, and feeling helpless due to the dominance of biomedical culture in the medical encounter. Positive experiences are attributed to certain relational skills, technical skills, as well as certain approaches to care privileged by the physician. Outcomes of communication depend on patients’ evaluation of the consultation. Four categories of specific factors exerted mainly a negative influence on consultations for ethnic minorities: language barriers, discrimination, differing values, and acculturation. Ethnic majorities also raised specific factors influencing their experience: differing values and discrimination. Findings of this review are limited by the fact that more than half of the studies did not explore cultural aspects relating to this experience. Future research should address these aspects in more detail. In conclusion, all patients seemed to face additional cultural challenges. Findings provide a foundation for the development of tailored interventions to patients’ preferences, thus ensuring more satisfactory experiences. Health care providers should be sensitive to specific factors (cultural and micro-cultural) during all medical encounters.
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Affiliation(s)
- Rhea Rocque
- School of Psychology, Laval University, Quebec City, Quebec, Canada
- * E-mail:
| | - Yvan Leanza
- School of Psychology, Laval University, Quebec City, Quebec, Canada
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