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Schwenker R, Deutsch T, Unverzagt S, Frese T. Identifying patients with psychosocial problems in general practice: A scoping review. Front Med (Lausanne) 2023; 9:1010001. [PMID: 36844957 PMCID: PMC9945547 DOI: 10.3389/fmed.2022.1010001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 12/21/2022] [Indexed: 02/10/2023] Open
Abstract
Objective We conducted a scoping review with the aim of comprehensively investigating what tools or methods have been examined in general practice research that capture a wide range of psychosocial problems (PSPs) and serve to identify patients and highlight their characteristics. Methods We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews and the Joanna Briggs Institute Reviewer's Manual on scoping reviews. A systematic search was conducted in four electronic databases (Medline [Ovid], Web of Science Core Collection, PsycInfo, Cochrane Library) for quantitative and qualitative studies in English, Spanish, French, and German with no time limit. The protocol was registered with Open Science Framework and published in BMJ Open. Results Of the 839 articles identified, 66 met the criteria for study eligibility, from which 61 instruments were identified. The publications were from 18 different countries, with most studies employing an observational design and including mostly adult patients. Among all instruments, 22 were reported as validated, which we present in this paper. Overall, quality criteria were reported differently, with studies generally providing little detail. Most of the instruments were used as paper and pencil questionnaires. We found considerable heterogeneity in the theoretical conceptualisation, definition, and measurement of PSPs, ranging from psychiatric case findings to specific social problems. Discussion and conclusion This review presents a number of tools and methods that have been studied and used in general practice research. Adapted and tailored to local circumstances, practice populations, and needs, they could be useful for identifying patients with PSPs in daily GP practice; however, this requires further research. Given the heterogeneity of studies and instruments, future research efforts should include both a more structured evaluation of instruments and the incorporation of consensus methods to move forward from instrument research to actual use in daily practice.
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Affiliation(s)
- Rosemarie Schwenker
- Center for Health Sciences, Institute of General Practice, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Tobias Deutsch
- Department of General Practice, University of Leipzig, Leipzig, Germany
| | - Susanne Unverzagt
- Center for Health Sciences, Institute of General Practice, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Thomas Frese
- Center for Health Sciences, Institute of General Practice, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
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Libbis E, Sweeny AL, Holmes T, Aggarwal N, Snelling PJ, Slaughter E, Poncia H, Watkins SC. Forearmed is forewarned: A prospective intervention observational time-series study of patient empowerment for ultrasound-guided peripheral intravenous access. Emerg Med Australas 2022; 34:779-785. [PMID: 35578995 PMCID: PMC9790456 DOI: 10.1111/1742-6723.13981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 02/28/2022] [Accepted: 03/18/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Ultrasound (US) is a valuable adjunct to improve the success rates of difficult peripheral intravenous cannula (PIVC) insertions but is usually clinician initiated. The present study assessed for any change in clinician practice resulting from interventions aimed at empowering patients to advocate for early use of US if they self-identified as having difficult PIVC access. METHODS This was a prospective observational time-series study using a rapid quality improvement (RQI) framework. Three ED waiting room intervention strategies (printed media, video and wristband) were tested over three 2-week periods at a large teaching hospital. The impact of each intervention was assessed at eight time points during each intervention and compared to a pre-intervention baseline period using trend and time-series analysis. RESULTS A total of 1611 PIVC insertions were surveyed over 42 time points. The proportion of US-guided PIVC insertions was highest during Intervention 3 (wristbands; 5.5%) but all proportions remained below baseline (6.5%). Trend analysis identified an increasing frequency of US use during Intervention 1 (printed media, P = 0.01). However, no statistically significant trends were observed within the periods. CONCLUSIONS This is the first prospective study to assess the effect of various interventions to empower patients to self-identify as having difficult PIVC access and advocate for the use of US-guidance. The present study was indeterminate: no intervention tested in the present study noticeably influenced clinical practice, potentially attributable to the study design and confounding factors. This innovative study serves as a pilot for future research into patient empowerment, which is currently lacking in the literature.
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Affiliation(s)
- Eng Libbis
- Emergency DepartmentGold Coast Hospital and Health ServiceGold CoastQueenslandAustralia,School of Medicine and DentistryGriffith UniversityGold CoastQueenslandAustralia
| | - Amy L Sweeny
- Emergency DepartmentGold Coast Hospital and Health ServiceGold CoastQueenslandAustralia,Alliance for Vascular Access Teaching and ResearchSchools of Nursing and Midwifery, and Pharmacy and Medical Sciences, Griffith UniversityGold CoastQueenslandAustralia,Faculty of Health Sciences and MedicineBond UniversityGold CoastQueenslandAustralia
| | - Travis Holmes
- Faculty of Health Sciences and MedicineBond UniversityGold CoastQueenslandAustralia
| | - Nisha Aggarwal
- Faculty of Health Sciences and MedicineBond UniversityGold CoastQueenslandAustralia
| | - Peter J Snelling
- Emergency DepartmentGold Coast Hospital and Health ServiceGold CoastQueenslandAustralia,School of Medicine and DentistryGriffith UniversityGold CoastQueenslandAustralia,Child Health Research CentreThe University of QueenslandBrisbaneQueenslandAustralia
| | - Eugene Slaughter
- Alliance for Vascular Access Teaching and ResearchSchools of Nursing and Midwifery, and Pharmacy and Medical Sciences, Griffith UniversityGold CoastQueenslandAustralia,School of NursingMidwifery and Social Work, The University of QueenslandBrisbaneQueenslandAustralia
| | - Hugo Poncia
- Faculty of Health Sciences and MedicineBond UniversityGold CoastQueenslandAustralia,Emergency DepartmentThe Tweed HospitalTweed HeadsNew South WalesAustralia
| | - Stuart C Watkins
- Emergency DepartmentGold Coast Hospital and Health ServiceGold CoastQueenslandAustralia,School of Medicine and DentistryGriffith UniversityGold CoastQueenslandAustralia,Alliance for Vascular Access Teaching and ResearchSchools of Nursing and Midwifery, and Pharmacy and Medical Sciences, Griffith UniversityGold CoastQueenslandAustralia,Faculty of Health Sciences and MedicineBond UniversityGold CoastQueenslandAustralia
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Schwenker R, Kroeber ES, Deutsch T, Frese T, Unverzagt S. Identifying patients with psychosocial problems in general practice: a scoping review protocol. BMJ Open 2021; 11:e051383. [PMID: 34930731 PMCID: PMC8689158 DOI: 10.1136/bmjopen-2021-051383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 11/05/2021] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Psychosocial problems (PSPs) are common issues associated with negative health outcomes. Since general practitioners are the first point of contact for any health-related concern, understanding their options to recognise patients with PSPs plays an important role as it is essential for early intervention and can prevent serious conditions. The objective of our scoping review is to map published evidence on the usage of instruments to identify patients with PSPs in general practice. METHODS AND ANALYSIS We will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist and the Joanna Briggs Institute Reviewer's Manual on scoping reviews. A systematic search of four electronic databases (Medline (Ovid), Web of Science Core Collection, PsycInfo, Cochrane Library) will be conducted for quantitative and qualitative studies published in English, Spanish, French and German. Main study characteristics as well as information on identification instruments will be extracted and visualised in structured tables to map the available evidence. The protocol has been registered with Open Science Framework, https://osfio/c2m6z. ETHICS AND DISSEMINATION This study does not require ethical approval as we will not collect personal data. Dissemination will consist of publications, presentations and other knowledge translation activities.
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Affiliation(s)
- Rosemarie Schwenker
- Faculty of Medicine, Institute of General Practice and Family Medicine, Center of Health Sciences, Martin Luther University of Halle Wittenberg, Halle (Saale), Germany
| | - Eric Sven Kroeber
- Faculty of Medicine, Institute of General Practice and Family Medicine, Center of Health Sciences, Martin Luther University of Halle Wittenberg, Halle (Saale), Germany
| | - Tobias Deutsch
- Department of General Practice, Faculty of Medicine, University of Leipzig, Leipzig, Germany
| | - Thomas Frese
- Faculty of Medicine, Institute of General Practice and Family Medicine, Center of Health Sciences, Martin Luther University of Halle Wittenberg, Halle (Saale), Germany
| | - Susanne Unverzagt
- Faculty of Medicine, Institute of General Practice and Family Medicine, Center of Health Sciences, Martin Luther University of Halle Wittenberg, Halle (Saale), Germany
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Solis EC, Carlier IVE, van der Wee NJA, van Hemert AM. The clinical and cost-effectiveness of a self-management intervention for patients with persistent depressive disorder and their partners/caregivers: study protocol of a multicenter pragmatic randomized controlled trial. Trials 2021; 22:731. [PMID: 34688307 PMCID: PMC8542316 DOI: 10.1186/s13063-021-05666-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 09/28/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND After regular treatment, patients with persistent depressive disorder (PDD) may remain in specialized psychiatric outpatient care without achieving remission. Lacking other options, these patients often receive long-term, non-protocolized care as usual (CAU) that does not involve the partner/caregiver of the patient. Although the revised depression treatment guidelines suggest focusing on psychiatric rehabilitation and self-management as the next treatment step for PDD, an evidence-based cost-effective self-management protocol for PDD is lacking. This study investigates the "Patient and Partner Education Program for All Chronic Illnesses" (PPEP4All) as a brief self-management protocol that could lead to lower costs, higher quality of life, and less disease burden in PDD patients and their partners/caregivers. METHODS Presented is the rationale and methods of a multicenter pragmatic randomized controlled trial to evaluate the clinical efficacy and cost-effectiveness of PPEP4All for patients with PDD and their partners/caregivers. In accordance with current recommendations, a mixed methods research approach is used with both quantitative and qualitative data. A total of 178 eligible outpatients with PDD and their partners/caregivers are recruited and randomized to either PPEP4All or CAU. Those assigned to PPEP4All receive nine weekly self-management sessions with a trained PPEP4All therapist. Primary and secondary outcome measurements are at 0, 3, 6, and 12 months. DISCUSSION This project will result in the implementation of a self-management intervention for patients with PDD, meeting an urgent need in mental healthcare. Using PPEP4All can optimize the quality and efficiency of care for both patients with PDD and their partners/caregivers. TRIAL REGISTRATION Netherlands Trial Register Identifier NTR5973 . Registered on 20 July 2016.
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Affiliation(s)
- Ericka C. Solis
- Department of Psychiatry, Leiden University Medical Center (LUMC), Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Ingrid V. E. Carlier
- Department of Psychiatry, Leiden University Medical Center (LUMC), Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Nic J. A. van der Wee
- Department of Psychiatry, Leiden University Medical Center (LUMC), Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Albert M. van Hemert
- Department of Psychiatry, Leiden University Medical Center (LUMC), Albinusdreef 2, 2333 ZA Leiden, The Netherlands
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Rosselli M, Salimbeni MV, Bessi C, Nesi E, Caruso S, Arboretti D, Migliorini E, Caterino E, Parentini E, Generini S, Zipoli M, Romanelli RG, Rosselli M, Marra F, Laffi G, Stasi C. Screening of distress among hospitalized patients in a department of internal medicine. Asian J Psychiatr 2015; 18:91-6. [PMID: 26470594 DOI: 10.1016/j.ajp.2015.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 07/30/2015] [Accepted: 08/09/2015] [Indexed: 01/23/2023]
Abstract
A psychosomatic approach to the basic screening of distress for patient care in hospitals and other health services is presented. The aims of this study were to verify association between: (1) medical illnesses and distress; (2) patients' needs and distress; (3) type of illness and patients' needs; (4) patients' needs and sense of coherence. One hundred and eighty-nine patients (78 F and 111 M, average age 65 years±8.43) were assessed by self-report questionnaires. We found that higher anxiety and/or depression levels were associated with urogenital (p=0.026), rheumatologic (p=0.006), oncological (p=0.011), neurological (p=0.026) and respiratory (p=0.013) illnesses. Higher distress scoring was associated with rheumatologic illnesses (p=0.024) and illnesses of the liver and digestive system (p=0.037) while a higher severity of distress was associated with oncological illnesses (p=0.011). Depression/anxiety were associated with the need to speak to a psychologist (p=0.050), to a spiritual advisor (p=0.009), to be more reassured by relatives (p=0.017), to feel less abandoned (p=0.036). Only low sense of coherence was associated with the need for greater dialogue with physicians (p=0.012), the need to participate less in treatment decisions (p=0.041), the need to feel less left to one's own devices (p=0.023). Several needs are associated with medical illnesses. In conclusion, these results indicate that early psychological screening could be important to avoid worse or chronic distress.
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Affiliation(s)
- Massimo Rosselli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Caterina Bessi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Elisa Nesi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Stefania Caruso
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Daria Arboretti
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Elodie Migliorini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Elvira Caterino
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Elisa Parentini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Sergio Generini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Massimo Zipoli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Matteo Rosselli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Fabio Marra
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Giacomo Laffi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Cristina Stasi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
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Abstract
One goal of genetic counseling is to facilitate client adaptation to a genetic condition or risk. Adaptation refers to both the process of coming to terms with the implications of the condition or risk and the observable outcomes of that process. This review summarizes existing studies on how well clients adapt to living with a common chronic disease, and more specifically, a genetic condition. Overall, it appears that about one-third of clients do not adjust well to the stress of living with a genetic condition or at risk. However, the data are limited by inconsistencies in the conceptualization of adaptation, a paucity of theoretical models, poor study design and inadequate outcome measures. Well-designed studies based upon multidimensional models are needed that focus on familial as well as individual adaptation. We conclude with a summary of studies that have explored the use of interventions to enhance adaptation and suggest improved client outcomes. Further research should result in evidence-based interventions to facilitate client adaptation that can be used effectively by genetic providers within the confines of their clinical work.
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Affiliation(s)
- B B Biesecker
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892-2073, USA.
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7
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Williams N, Wilkinson C, Stott N, Menkes DB. Functional illness in primary care: dysfunction versus disease. BMC FAMILY PRACTICE 2008; 9:30. [PMID: 18482442 PMCID: PMC2396161 DOI: 10.1186/1471-2296-9-30] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2007] [Accepted: 05/15/2008] [Indexed: 12/28/2022]
Abstract
BACKGROUND The Biopsychosocial Model aims to integrate the biological, psychological and social components of illness, but integration is difficult in practice, particularly when patients consult with medically unexplained physical symptoms or functional illness. DISCUSSION This Biopsychosocial Model was developed from General Systems Theory, which describes nature as a dynamic order of interacting parts and processes, from molecular to societal. Despite such conceptual progress, the biological, psychological, social and spiritual components of illness are seldom managed as an integrated whole in conventional medical practice. This is because the biomedical model can be easier to use, clinicians often have difficulty relinquishing a disease-centred approach to diagnosis, and either dismiss illness when pathology has been excluded, or explain all undifferentiated illness in terms of psychosocial factors. By contrast, traditional and complementary treatment systems describe reversible functional disturbances, and appear better at integrating the different components of illness. Conventional medicine retains the advantage of scientific method and an expanding evidence base, but needs to more effectively integrate psychosocial factors into assessment and management, notably of 'functional' illness. As an aid to integration, pathology characterised by structural change in tissues and organs is contrasted with dysfunction arising from disordered physiology or psychology that may occur independent of pathological change. SUMMARY We propose a classification of illness that includes orthogonal dimensions of pathology and dysfunction to support a broadly based clinical approach to patients; adoption of which may lead to fewer inappropriate investigations and secondary care referrals and greater use of cognitive behavioural techniques, particularly when managing functional illness.
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Affiliation(s)
- Nefyn Williams
- Department of Primary Care and Public Health, Cardiff University, North Wales Clinical School, Wrecsam, UK
| | - Clare Wilkinson
- Department of Primary Care and Public Health, Cardiff University, North Wales Clinical School, Wrecsam, UK
| | - Nigel Stott
- Department of Primary Care and Public Health, Cardiff University, UK
| | - David B Menkes
- Department of Psychological Medicine, Waikato Clinical School, University of Auckland, New Zealand
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Conceptualizing a quality plan for healthcare. A philosophical reflection on the relevance of the health profession to society. HEALTH CARE ANALYSIS 2007; 15:337-61. [PMID: 17943450 DOI: 10.1007/s10728-007-0071-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Today, health systems around the world are under pressure to create greater value for patients and society; increasing access, improving client orientation and responsiveness, reducing medical errors and safety, restraining utilization via managed care, and implementing priority allocation of resources for high-burden health problems are examples of strategies towards this end. The quality paradigm by virtue of its strategic consumer focus and its methods for achieving operational excellence has proved an effective approach for creating higher value in many sectors. If applied in a deliberate and holistic manner, the quality paradigm can bring about a more cost-effective organization of the health systems. In this article, we apply quality concepts to healthcare in a conceptual format; we characterize the health system's customers and outputs with their quality dimensions. The product of this effort is a blueprint for a customer-driven health system which identifies six types of customers, nine types of outputs and the associated operations. As a preliminary step, a new analysis and definition of health and disease is provided. Rethinking the structure of health system in this manner and the related conceptual model can guide medical research, health sciences education, and health services policy, and help the practitioner to integrate all modern trends in healthcare delivery.
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Walker JG, Jackson HJ, Littlejohn GO. Models of adjustment to chronic illness: Using the example of rheumatoid arthritis. Clin Psychol Rev 2004; 24:461-88. [PMID: 15245831 DOI: 10.1016/j.cpr.2004.03.001] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2003] [Revised: 01/23/2004] [Accepted: 03/10/2004] [Indexed: 11/16/2022]
Abstract
There are a number of theoretical frameworks that attempt to explain how individuals may adjust to threats to health and serious physical illness. The three major paradigms that attempt to organize key components of health and adaptation to illness include the following: the biomedical model which emphasizes disease; psychological models of adaptation to illness; and biopsychosocial models with the latter two emphasizing health, functioning, and well-being. Each of these three major paradigms, including biomedical, psychosocial, and biopsychosocial frameworks, is discussed and critiqued in turn, and contributions and theoretical issues in terms of adjustment to chronic illness, particularly rheumatoid arthritis (RA), are highlighted. Furthermore, a biopsychosocial framework for conceptualizing adjustment to physical illness is proposed that incorporates elements from key existing biomedical and psychosocial models of adaptation to chronic physical health issues.
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Affiliation(s)
- Janine G Walker
- Centre for Mental Health Research, Australian National University, Canberra.
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Tansella M, Burti L. Integrating evaluative research and community-based mental health care in Verona, Italy. Br J Psychiatry 2003; 183:167-9. [PMID: 12893671 DOI: 10.1192/bjp.183.2.167] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Verona is a city of about 260 000 inhabitants, located in northern Italy, half way between Milan and Venice and on the route from Italy to central Europe. It is a historical city with impressive Roman and medieval monuments. Verona is also a modern and affluent city, with a commercial and industrial centre and a university that includes a school of medicine with a good reputation.
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Affiliation(s)
- Michele Tansella
- Department of Medicine and Public Health, Section of Psychiatry, University of Verona, Verona, Italy
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McKague M, Verhoef M. Understandings of health and its determinants among clients and providers at an urban community health center. QUALITATIVE HEALTH RESEARCH 2003; 13:703-717. [PMID: 12756689 DOI: 10.1177/1049732303013005008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The authors' aim was to explore clients' and health care providers' perceptions of health and its determinants in preparation for the development of a screening tool to assess client health determinants at a community health center through template and editing analyses of interviews with 6 health care providers and 7 clients. Participants defined health as a multidimensional state, with common themes including the ability to cope and to function according to expectations. They identified multiple interrelated factors that affect health. The findings support existing health determinant frameworks but provide greater detail about specific determinants within broad categories presented in these frameworks. The results create a foundation for the development of a screening tool to assess client health determinants.
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Zimmermann C, del Piccolo L, Mazzi MA. Patient cues and medical interviewing in general practice: examples of the application of sequential analysis. EPIDEMIOLOGIA E PSICHIATRIA SOCIALE 2003; 12:115-23. [PMID: 12916453 DOI: 10.1017/s1121189x00006187] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AIMS To illustrate how sequence analysis may be applied to the medical interview to: 1. explore how physicians without formal training in communication skills elicit and respond to patient cues and expression of expectations and opinions; and 2. test the hypothesis that physicians' closed ended questions determine the use of subsequent closed ended questions. METHODS 238 consultations in primary care, coded with the Verona Medical Interview Classification System, were analysed. Lag 1 analysis was applied to study which physician behaviour precedes and follows patient cues. Pattern recognition analysis for five lag sequences was performed to test the occurrence of predefined specific code chains, where a closed and an open ended question were followed either by two closed-ended questions or by two patient facilitating interventions RESULTS Patients' cue offers were most likely after facilitative interventions, but not after open-ended questions; physicians were most likely to respond to these expressions with facilitation. Physicians' tendency to use closed ended questions increased after previous closed questions and decreased after an open-ended question. CONCLUSIONS Lag sequential analysis and pattern recognition analysis are useful methods to study exploratory and theory driven hypotheses and allow an initial approach to validate the supposed appropriateness of specific physician interventions.
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Affiliation(s)
- Christa Zimmermann
- Department of Medicine and Public Health, Section of Psychiatry, Service of Medical Psychology, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134 Verona, Italy.
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Del Piccolo L. [Psychosocial problem disclosure during primary care consultations]. EPIDEMIOLOGIA E PSICHIATRIA SOCIALE 2000; 9:257-71. [PMID: 11256058 DOI: 10.1017/s1121189x00008393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To examine how primary care patients with psychosocial problems actually introduce and present these topics. To examine the influence of some personality traits (emotional dependency and health locus of control) on psychosocial problem disclosure. DESIGN "Case control". Cases had a GHQ-12 score equal or higher than three. Controls were matched with cases according to GP, GPs' attribution of absence or presence of emotional distress sex, age and presence of chronic illness. SETTING Six single handed primary care practices. MEASURES Clinical and Socio-demographic data, Social Problems List, List of 12 Threatening Life Events, GHQ-12, Multidimensional Health Locus of Control, Interpersonal Dependency Inventory and a Social Support Index. RESULTS The introduction of psychosocial topics by patients is related to the attribution of emotional distress by GP. Patients identified correctly as not distressed present less often psychosocial topics compared to patients recognised as distressed. Distressed patients not recognised as such more often than the others did not offer any psychosocial cue. The personality measures did not influence the presentation of psychosocial problems. CONCLUSIONS The lack of psycho-social cues from patients and of patient-centred skills contributed to the non recognition of emotional distressed patients. GPs' active facilitation of the presentation of psychosocial topics in such patients would improve the recognition of emotional distress.
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Affiliation(s)
- L Del Piccolo
- Dipartimento di Medicina e Sanità Pubblica, Servizio di Psicologia Medica, Università di Verona, Verona.
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14
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Grassi L, Rasconi G, Pedriali A, Corridoni A, Bevilacqua M. Social support and psychological distress in primary care attenders. Ferrara SIMG Group. PSYCHOTHERAPY AND PSYCHOSOMATICS 2000; 69:95-100. [PMID: 10671830 DOI: 10.1159/000012372] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Growing evidence has been collected about the high prevalence of psychological distress in primary care. The role of psychosocial variables, namely the role of support from the patients' interpersonal ties, has not been extensively explored. METHODS The study investigated the relationship between perceived social support, as evaluated by the Multidimensional Scale of Perceived Social Support, and psychological distress, as measured by the Brief Symptom Inventory, in 1,341 primary care attenders. RESULTS In comparison with highly supported patients, lowly supported subjects showed higher scores on distress dimensions (e.g. depression, anxiety, phobia) and a higher prevalence of psychological morbidity ('caseness' = 37.3 vs. 11%). CONCLUSION The findings suggest that, in the setting of primary care, the GPs' assessment of their patients' social support system may be useful in identifying those more vulnerable to psychological stress.
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Affiliation(s)
- L Grassi
- Department of Medical Sciences of Communication and Behavior, Section of Psychiatry, the Consultation-Liaison Psychiatric Service, University of Ferrara, Italy.
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15
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Gagnayre R, Traynard PY, d'Ivernois JF, Slama G. An analysis of the teaching techniques used in diabetic specialist consultations. PATIENT EDUCATION AND COUNSELING 2000; 39:163-167. [PMID: 11040715 DOI: 10.1016/s0738-3991(99)00018-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
We attempted to explore the teaching practices of 11 senior diabetic specialists consulting in a out-patient hospital setting and known to have a strong commitment to patient education. The survey consisted of a questionnaire dealing with the duration and distribution of speaking time, the classification of questions, the type of oral questions asked of patients, written materials, teaching aids, demonstrations, if any, care techniques used, and whether or not information was summarized. Our study of 44 consultations showed an average consultation time of 26 +/- 10 min and a balanced sharing of speaking time. The percentage of consultations during which no questions were asked depended on the type and classification of test questions, i.e. oral questions to check knowledge (13.6%), open-ended problem-solving questions (27.3%) or problems involving written materials (54.5%). One to two problems involving open-ended questions were set during 36.4% of the consultations and one to two problems involving written materials were set in 20.5% of the cases; visual aids prepared in advance took a back seat to sketches made during the consultation itself. Information was summed up by the caregiver 75% of the time, and 50% with the patient's help. Our results indicate a patient education orientation during consultations and help to design a standard model formation combined teaching/treatment consultations.
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Affiliation(s)
- R Gagnayre
- Health Sciences Education Department, WHO Associate Centre for the Development of Human Resources in Healthcare, UFR SMBH Léonard de Vinci, Université Paris 13, France.
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Gala C, Rigatelli M, De Bertolini C, Rupolo G, Gabrielli F, Grassi L. A multicenter investigation of consultation-liaison psychiatry in Italy. Italian C-L Group. Gen Hosp Psychiatry 1999; 21:310-7. [PMID: 10514955 DOI: 10.1016/s0163-8343(99)00015-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In order to evaluate the extent and quality of consultation-liaison (C-L) activity in Italy, a multicenter investigation was conducted in 17 general hospitals. All of the hospitalized patients referred to C-L psychiatry during a 1-year period were assessed by means of a specific instrument (Patient Registration Form, PRF-SF). Of 518,212 patients, 4182 were referred to C-L services (referral rate = 0.72%). Typical consultations were for female patients (60.1%), admitted to medical wards (71.5%), aged 55-75 years. Most interventions were carried out within 2 days; a minority (22%) were urgent requests. Gastrointestinal and cardiovascular disorders, and unexplained medical symptoms were the most frequent ICD-9 somatic diagnoses at admission. One-third of the patients were not informed of having been referred to C-L and half of them had a lifetime history of psychiatric disturbances. Most frequent ICD-10 psychiatric diagnoses were neurotic, stress-related, and somatoform syndromes (33.1%), affective syndromes (19.4%), and organic mental syndromes (10.7%). Two-thirds of the patients were given only one consultation whereas the reminder received two to four follow-up visits. The rate of transfer to psychiatric wards was low (2.1%). Psychopharmacological treatment was suggested in 65% of cases, and 75.5% of the patients were referred to community psychiatric care at discharge. The implications of the findings are discussed.
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Affiliation(s)
- C Gala
- Servizio di Psicologia Clinica, IRCSS, Ospedale Maggiore, Milano, Italy
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Pini S, Tansella M. Detection and management of mental distress and psychiatric disorders in primary care settings. EPIDEMIOLOGIA E PSICHIATRIA SOCIALE 1999; 8:92-104. [PMID: 10540512 DOI: 10.1017/s1121189x00007594] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Epidemiological and clinical studies indicate that 10-50% of primary care patients suffering from clinically relevant psychiatric distress are not diagnosed by their physician and only a minority of them receive an appropriate treatment. The improvement of physicians' ability to detect mental distress and psychiatric disorder, in their routine clinical activity, represents a crucial point to reduce the social impact of mental illnesses, prevent their worsening and chronicity and, eventually, relieve mental health services of an excessive burden of care and costs. The aim of this article is to examine a number of factors which intervene in the process of detection of mental distress by the physician. Then, we will examine factors related to the management of psychiatric disorders most commonly co-occurring with physical illness in general health care sector. METHOD The method used for this review was essentially a recension of the literature concerning detection and treatment of psychiatric disorders in primary care settings, having in view to see the factors connected with these processes. RESULTS Among factors intervening in the process of identification of mental distress in primary care settings, both the characteristics of the physician and the characteristics of the patient should be taken into account. Primary care physicians and psychiatrists are being asked to work together more frequently in this era of community care. The principal aim of such invoked collaboration is the amelioration of quality of care and reduction of costs for mentally ill patients. An important issue within this collaboration is the referral by primary care physicians to specialist services.
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Affiliation(s)
- S Pini
- Clinica Psichiatrica, Università di Pisa.
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Zimmermann C, Del Piccolo L, Saltini A. [Teaching biopsychosocial approach in the carrying out of clinical interviews before teaching to recognize emotional disturbances]. EPIDEMIOLOGIA E PSICHIATRIA SOCIALE 1999; 8:71-8. [PMID: 10540509 DOI: 10.1017/s1121189x00007569] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Del Piccolo L, Benpensanti MG, Bonini P, Cellerino P, Saltini A, Zimmermann C. [The Verona Medical Interview Classification System/Patient (VR-MICS/P): the tool and its reliability]. EPIDEMIOLOGIA E PSICHIATRIA SOCIALE 1999; 8:56-67. [PMID: 10504776 DOI: 10.1017/s1121189x00007521] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To assess the reliability and to describe the categories and the procedure to apply the VR-MICS/P (Verona-Medical Interview Classification System/Patient). SETTING The interviews used for the reliability study were audiotaped. Five general practitioners (GPs) working in two general practices in South-Verona recorded their consultations. SAMPLE 50 interviews selected randomly from 120, 10 for each GP. The selection criterion for the participating patients was a GHQ-12 score of 3 and the consultation for a new illness episode. MAIN OUTCOME MEASURES The VR-MICS/P classifies patients' verbal behaviours into 21 categories, 15 of them are defined by form (cue or statement) and content. PROCEDURE Two trained raters classified 50 interviews. Before applying the classification system each interview is divided into units which are numbered to define doctor's and patient's sequence of speech. RESULTS The reliability of VR-MICS/P was satisfactory (Kappa 0.85). Similarity Index (Dice, 1945) for categories varied between 0.71 and 0.94. Reliability for form and content classification was satisfactory too (Similarity Index between 0.81 and 0.89 and between 0.84 and 0.94, respectively). CONCLUSIONS The VR-MICS/P is a reliable measure for describing patients' verbal behaviours during medical interviews. It can be used together with the VR-MICS/D (Verona-Medical Interview Classification System/Doctor; Saltini et al., 1998) to describe the medical interview, the quality of doctor-patient interview and can be used as a measure of patient centredness.
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Affiliation(s)
- L Del Piccolo
- Dipartimento di Medicina e Sanità Pubblica, Università di Verona, Verona.
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Waxman R, Tennant A, Helliwell P. Community survey of factors associated with consultation for low back pain. BMJ (CLINICAL RESEARCH ED.) 1998; 317:1564-7. [PMID: 9836660 PMCID: PMC28737 DOI: 10.1136/bmj.317.7172.1564] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/18/1998] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To investigate the psychosocial factors associated with consultation for low back pain. DESIGN Two phase cross sectional postal survey. SETTING Bradford Metropolitan Health District. SUBJECTS 1813 adults responding to the phase 1 questionnaire. 540 of the 782 with an episode of low back pain in the past 12 months completed the second questionnaire. MAIN OUTCOME MEASURES Six psychosocial constructs. RESULTS 406 (52%) of the respondents reporting back pain in the past 12 months had not consulted a health professional. Logistic regression showed that consultation was associated with externalised beliefs regarding pain management (odds ratio 3.6; 95% confidence interval 2.1 to 6.0). Duration of pain affected the factors associated with consultation. Consultation for episodes lasting less than two weeks (n=290) was associated with greater than median pain (3.0; 1.7 to 5.5), consultation for episodes over two weeks (n=243) was associated with increased disability (3.7; 1.5 to 9.0), and consultation for episodes over three months (n=143) with increased depression (3.9; 1.3 to 11.8). CONCLUSIONS The results support a role for psychosocial factors in consultation for low back pain and suggest that the reasons for consultation vary with duration of pain. Duration of the episode may be a useful guide to management of non-specific low back pain.
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Affiliation(s)
- R Waxman
- Rheumatology and Rehabilitation Research Unit, University of Leeds Research School of Medicine, Leeds, UK.
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Saltini A, Cappellari D, Cellerino P, Del Piccolo L, Zimmermann C. [An instrument for evaluating th medical interview in general practice: VR-MICS/D (Verona-Medical Interview Classification System/Doctor)]. EPIDEMIOLOGIA E PSICHIATRIA SOCIALE 1998; 7:210-23. [PMID: 10023185 DOI: 10.1017/s1121189x00007405] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To assess the reliability of the VR-MICS/D (Verona-Medical Interview Classification System/Doctor) and to identify the verbal behaviour by general practitioners in interviews conducted with primary care attenders with medical complaints and emotional distress. SETTING Two general practices in South-Verona. SAMPLE 100 primary care patients attending for a new illness episode with a GHQ-12 score > or = 3. The five participating GPs contributed each with 20 audiotaped interviews of 10 patients judged by GP as emotionally distressed and of 10 judged without emotional distress. MAIN OUTCOME MEASURES The VR-MICS/D classifies GPs' verbal behaviour during the medical interview into 16 categories in terms of form (question or statement) and content and allows to assess their interview skills. PROCEDURE Two raters classified 30 interviews (15 with patients judged by their GP as emotionally distressed and 15 with patients judged without emotional distress). Having established satisfactory reliability, the overall verbal performance, based on 100 interviews, was assessed and GPs' verbal behaviours with patients judged as emotionally distressed was compared with that adopted with patients judged without emotional distress. RESULTS The reliability was satisfactory (Kappa 0.93). Percentage agreements for categories varied between 78.2% and 96.4%. The most frequent verbal behaviours were closed ended questions and information giving (58% of a total of 5522 classified verbal units). Interviews with patients judged as emotional distressed contained a greater number of psychological and psychosocial contents, facilitating comments and clarifications. These differences, however, were small, despite their statistical significance. CONCLUSIONS The VR-MICS/D is a reliable measure for describing GPs' verbal behaviour during the interview with emotional distressed patients. The interview style of the GPs in this study was similar to that reported in the literature for GPs without formal training in communication skills and was characterised by a prevalently doctor-centred approach. This approach, particularly with emotional distressed patients, has severe limitations and underlines the necessity of the introduction of communication skills training.
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Affiliation(s)
- A Saltini
- Servizio di Psicologia Medica, Università di Verona
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Del Piccolo L. [Physician-patient interactions: a comparison of analysis systems]. EPIDEMIOLOGIA E PSICHIATRIA SOCIALE 1998; 7:52-67. [PMID: 9658682 DOI: 10.1017/s1121189x00007120] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The medical interview has important diagnostic and therapeutic functions and requires the integration of doctor-centred and patient-centred interviewing techniques to collect accurate and complete biopsychosocial data from the patient. Analysis of the interaction between patient and doctors which occur during the medical interview allow to evaluate physicians' interview techniques and to eventually improve them. OBJECTIVE 1. To review different Interaction Analysis Systems (IAS) used to describe doctor-patient communication in terms of clinical relevance, observational strategy, reliability and behavioural and verbal contents. 2. To critically evaluate these IASs on the basis of their relevant research outcomes. METHOD Previous reviews on interaction and keywords for Medline research (HealthGate) listed above were utilised to collect the relevant literature. RESULTS Seventeen classification systems were identified and ten were discussed in a chronological order. Starting from a general sociological or psycholinguistic approach, the IASs over the years have became more specific and detailed, focusing more on the medical interview and on specific topics, such as cancer or hospital medical consultations. CONCLUSIONS When studying interactions in general practice medicine, it is important to define the significant units of interaction which allow to identify a "patient-centred approach", since this is relevant not only for obtaining reliable and complete medical and social data, but also for the recognition of patients with emotional disorders and their correct diagnosis. Listening to the patient and facilitating the expression of emotions is an important aspect of patient education too, as patients learn that talking about psychological problems to their physician is appropriate and may be therapeutic.
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