Does improving patient-practitioner communication improve clinical outcomes in patients with cardiovascular diseases? A systematic review of the evidence

The Associations Between Physician-Patient Communication and Adjustment Outcomes of Patients and Physicians: A Systematic Review and Meta-Analysis of Correlations

Physician-Patient communication (PPC) has been linked to patient adjustment outcomes. However, conflicting results have been reported and previous systematic reviews showed some methodological weaknesses. It has also been suggested that PPC is related to physicians' own adjustment outcomes. This systematic review aims to explore and synthesize the associations between PPC and both patient and physician adjustment outcomes. A systematic search was conducted primarily in five databases and 11.488 non-duplicated articles were identified. Forty-five studies met the eligibility criteria and data extraction was performed for sample characteristics, PPC measurement, adjustment outcomes under examination and main outcomes. The observed results showed that the majority of the included studies were cross-sectional, assessed PPC by proxy-report and reported an overall positive association with patients' adjustment outcomes. None of the studies examined the association between PPC and physicians' adjustment outcomes. Thirty-three studies were meta-analyzed and showed a positive and significant association between PPC and patients' adjustment outcomes (r = .16). Due to the small number of studies included in the meta-analysis, the heterogeneity was high. Subgroup analysis could not identify sources for heterogeneity. Research on the associations between PPC and physicians' own adjustment outcomes is warranted. Future studies should be rigorous in defining clear PPC definitions, directionality of communication processes, and study design.

Are primary care consultations in Trinidad patient-centered? A cross-sectional study of patients with non-communicable diseases

BACKGROUND

The aim of this study was to measure the patient's perception of patient centeredness in their consultations for non-communicable diseases (NCDs). We also measured consultation length and patient enablement.

METHOD

A cross-sectional study was conducted over 2 months at four primary care clinics at the St. Joseph cluster of the North Central Regional Health Authority (NCRHA) in Trinidad and Tobago. Interviewers timed the consultation and completed post-consultation questionnaires using the Patient Perception of Patient-Centeredness (PPPC) questionnaire and the Patient Enablement Index (PEI). The PPPC is a 14-item (each scored 1-4) Likert-scaled instrument. The total score is averaged and a PPPC score of 4 is the maximum. The PEI measures the ability of the patient to cope with life and their disease. The PEI consists of 6 questions scored 0-2, with a maximum score of 12.

RESULTS

There were 180 respondents (response rate = 82.5%). Participants were female (75.6%), aged over 65 years (50.6%), married (51.1%), Indo-Trinidadian (52.2%), and Christian (60.6%). Half achieved a primary school education, and 37.2% secondary. The consultation length ranged between 1.32 and 31.22 min. The average, median and mode of the consultation length were 8.5, 7.74 and 10 min, respectively. The average, median and mode of the measures of patient-centeredness were PPPC (3.67, 3.86 and 4) and PEI score (5.93, 6 and 6). The PPPC average was lower in patients with a stroke (p = 0.022), and higher among those with more than 2 consultation interruptions (p = 0.015) and those who knew the doctor very well (p = 0.015). The PEI score was lower in patients with heart disease (p = 0.022). The consultation length was longer in those with tertiary education (p = 0.044) and those with two consultation interruptions (p = 0.032). PPPC Average and PEI Score correlated well (ρ = 0.408, p < 0.001). The consultation length correlated with the PPPC Average (ρ = 0.168,p = 0.025).

CONCLUSION

Primary Care consultations in this cluster of health centres in NCRHA in Trinidad were often patient centered. The consultation length, patient-centeredness, measured with the PPPC instrument, and patient enablement scores, measured with the PEI instrument, in consultations for NCDs in Trinidad compare favourably with international reports.

Current Situations and Challenges in the Development of Health Information Literacy

Health information literacy (HIL) is a significant concept that has gradually become known to the broader public in recent years. Although the definitions of HIL and health literacy seem to overlap, as an independent subconcept, HIL still shows a unique influence on improvements in people's health and health education. Remarkable evidence indicates that online health information (OHI) can effectively enrich people's knowledge and encourage patients to actively join the medical process, which is also accompanied by the emergence of various assessment tools. Although the current assessment tools, to a certain extent, can help people identify their shortcomings and improve their HIL, many studies have indicated that the deficiencies of the scales induce incomplete or unreal results of their HIL. In addition, continuing research has revealed an increasing number of influencing factors that have great effects on HIL and even regulate the different trends in doctor-patient relationships. Simultaneously, most of the uncensored OHI broadcasts have also affected the improvement in HIL in various ways. Thus, this review aims to summarize the assessment tools, influencing factors and current situations and challenges related to HIL. Further studies are required to provide more trusted and deeper references for the development of HIL.

What Advice Is Currently Given to Patients with Age-Related Macular Degeneration (AMD) by Eyecare Practitioners, and How Effective Is It at Bringing about a Change in Lifestyle? A Systematic Review

There is currently no treatment for early/intermediate Age-related Macular Degeneration (AMD) but Eye Care Professionals (ECPs) are recommended to advise patients about modifiable lifestyle factors, including dietary changes, that can slow disease progression. The aim of this review was to understand advice currently given to patients with AMD by ECPs and to evaluate evidence regarding patient compliance. A systematic review was conducted of literature published in electronic databases: CINAHL, MEDLINE, PsycINFO, PyscARTICLES, EMBASE, AMED. Methods followed PRISMA guidelines (PROSPERO registration number: CRD42020223724). Twenty-four reports were eligible for inclusion, 12 focused on ECP experience, 7 on patient experience, and 6 on impact of advice (one paper reported on the ECP and patient experience). Studies reported that a substantial proportion of patients did not recall receiving lifestyle modification advice from their ECP (57.95%, range 2-95% across patient based studies). Practitioners were most likely to provide advice about nutritional supplements (80%, range 67-93% across ECP studies), and least likely about smoking (44%, range 28-71% across ECP studies), however supplements advised did not always comply with evidence-based guidelines. The main reason for patients not following lifestyle advice was lack of provision by the ECP (54.5%, range 21-94% across studies on the impact of advice). The review highlighted a need for more studies to understand patient preferences for receiving advice and research on ECP perceived barriers to advice provision.

Experiences of athletes with arrhythmogenic cardiac conditions in returning to play

Background

Recommendations for return to play (RTP) for athletes with genetic (or congenital) heart diseases (GHD) predisposing to sudden cardiac death (SCD) have evolved from an initially paternalistic and conservative approach, to supporting a more flexible approach to decision-making. The experiences of athletes and their families during the RTP process are unknown.

Objective

To understand current RTP processes.

Methods

We administered a mixed-methods telephone interview combining quantitative and qualitative components to 30 athletes with a GHD who had RTP, and 23 parents. Participants were identified from the Yale ICD Sports registry and Mayo Clinic's Windland Smith Rice Genetic Heart Rhythm Clinic. Qualitative data were analyzed using a grounded theory approach to identify common themes.

Results

Most common diagnoses were long QT syndrome and hypertrophic cardiomyopathy and most common sports, soccer, basketball, and football. Twenty-three athletes encountered ≥1 perceived barrier(s) to RTP: 17 were restricted by their first cardiologist; 6 were required to meet with school administrators, 4 signed waivers, and 3 hired lawyers. Common themes expressed by athletes and their parents were frustration with poor communication, perceived lack of physician knowledge of their diagnosis, and unilateral, paternalistic decision-making, as well as cynicism that physicians and schools were primarily concerned with liability. After RTP, 26 athletes had some form of emergency action plan, although responsibility was often left to the family.

Conclusion

Many perceived barriers exist for athletes with GHD who wish to RTP after their diagnoses. Shared decision-making from the onset is critical for RTP.

The Effect of Online Health Information Seeking on Physician-Patient Relationships: Systematic Review

BACKGROUND

The internet has now become part of human life and is constantly changing people's way of life. With the increasing popularity of online health information (OHI), it has been found that OHI can affect the physician-patient relationship by influencing patient behaviors.

OBJECTIVE

This study aims to systematically investigate the impact of OHI-seeking behavior on the physician-patient relationship.

METHODS

Literature retrieval was conducted on 4 databases (Web of Science, PubMed, China National Knowledge Infrastructure, SinoMed), and the time limit for literature publication was before August 1, 2021.

RESULTS

We selected 53 target papers (42 [79%] English papers and 11 [21%] Chinese papers) that met the inclusion criteria. Of these, 31 (58%) papers believe that patients' OHI behavior can enable them to participate in their own medical care, improve patient compliance, and improve the physician-patient relationship. In addition, 14 (26%) papers maintain a neutral attitude, some believing that OHI behavior has no significant effect on doctors and patients and others believing that due to changes in the factors affecting OHI behavior, they will have a negative or a positive impact. Furthermore, 8 (15%) papers believe that OHI search behavior has a negative impact on doctors and patients, while 6 (11%) papers show that OHI reduces Chinese patients' trust in doctors.

CONCLUSIONS

Our main findings showed that (1) OHI-seeking behavior has an impact on patients' psychology, behavior, and evaluation of doctors; (2) whether patients choose to discuss OHI with doctors has different effects on the physician-patient relationship; and (3) the negative impact of OHI on China's internet users is worthy of attention. Due to the low quality of OHI, poor health information literacy, short physician-patient communication time, and various types of negative news, patients' trust in doctors has declined, thus affecting the physician-patient relationship. Improvement of people's health information literacy and the quality of OHI are important factors that promote the positive impact of OHI on the physician-patient relationship.

Associations Between Patient-Provider Secure Message Content and Patients' Health Care Visits

Background: Between-visit communications can play a vital role in improving intermediate patient outcomes such as access to care and satisfaction. Secure messaging is a growing modality for these communications, but research is limited about the influence of message content on those intermediate outcomes. We examined associations between secure message content and patients' number of health care visits. Methods: Our study included 2,111 adult patients with hypertension and/or diabetes and 18,309 patient- and staff-generated messages. We estimated incident rate ratios (IRRs) for associations between taxonomic codes assigned to message content, and the number of office, emergency department, and inpatient visits. Results: Patients who initiated message threads in 2017 had higher numbers of outpatient visits (p < 0.001) compared with patients who did not initiate threads. Among patients who initiated threads, we identified an inverse relationship between outpatient visits and preventive care scheduling requests (IRR = 0.92; 95% confidence interval [CI]: 0.86-0.98) and requests for appointments for new conditions (IRR = 0.95; 95% CI: 0.92-0.99). Patients with higher proportions of request denials or more follow-up appointment requests had more emergency department visits compared with patients who received or sent other content (IRR = 1.18; 95% CI: 1.03-1.34 and IRR = 1.14; 95% CI: 1.07-1.23, respectively). We identified a positive association between outpatient visits and the proportion of threads that lacked a clinic response (IRR = 1.02; 95% CI: 1.00-1.03). Discussion: We report on the first analyses to examine associations between message content and health care visits. Conclusions: Our findings are relevant to understanding how to better use secure messaging to support patients and their care.

Patient-centered communication and emotional well-being in the era of medical violence in China

The past decade has witnessed an increasing number of patient assaults on doctors in China. Patient-centered communication (PCC) may be one way to mitigate this problem. This study examined the effects of PCC and patient trust on emotional health outcome, especially how patients' attitude toward medical violence affected this relationship. Data were drawn from the China Governance and Public Policy Survey administered in 2017 with a sample size of 3784. The results showed that PCC had no direct effect on emotional well-being. Instead, patient trust completely mediated this path. Also, patients' attitude toward medical violence increased the indirect effect of PCC on emotional well-being, suggesting a moderated mediation model. We call for education programs to promote PCC for both providers and patients, mass media campaigns to condemn violence against doctors and stricter law enforcement to stop medical violence.

Concepts for the Development of a Customizable Checklist for Use by Patients

OBJECTIVES

Checklists are tools that are developed to complete tasks by drawing on specific and relevant knowledge and supporting communication at critical times. If checklists were designed specifically for patient use, they could promote patient engagement, potentially leading to improved quality of care. Physicians of all specialties, nurses, patients, patient advocates, and administrators can take an active role in checklist development and dissemination.

METHODS

Our method to investigate concepts in developing a customizable patient checklist included a literature search concerning existing checklists and resources currently available to patients. Literature containing expert opinion regarding checklists, professional organization statements, and patients and providers were consulted.

RESULTS

A template for designing a patient checklist was developed incorporating methods from previous literature and resources regarding checklists. This template includes a development, drafting, and validation phase. Sample content for inclusion in potential checklists for patients with diabetes and patients undergoing anesthesia was devised.

CONCLUSIONS

Developed by physicians with input from patients and other involved health-care providers such as nurses, this relatively novel concept of a patient's checklist creates a role for the patient to ensure their own safety. With increasing attention to high-quality and cost-effective health care, patient satisfaction surveys will be assessed to rate overall health care. Further development of checklists will need to be guided by specific medical conditions and acceptance by patients and providers. Providers can use these checklists as a method to gauge a patient's understanding of an intervention, solidify the patient-doctor relationship, and improve patient safety.

Assessing the training needs of medical students in patient information gathering

BACKGROUND

Effective communication is at the heart of good medical practice but rates of error, patient complaints, and poor clinician job satisfaction are suggestive of room for improvement in this component of medical practice and education.

METHODS

We conducted semi-structured interviews with experienced clinicians (n = 19) and medical students (n = 20) to explore their experiences associated with teaching and learning clinical communication skills and identify targets for improvements to addressing these skills in medical curricula.

RESULTS

Interviews were thematically analysed and four key themes emerged; the importance of experience, the value of role-models, the structure of a consultation, and confidence.

CONCLUSIONS

The findings reinforce the need for improvement in teaching and learning communication skills in medicine, with particular opportunity to target approaches to teaching foundational skills which can establish a strong grounding before moving into more complex situations, thus preparing students for the flexibility required in medical interviewing. A second area of opportunity and need is in the engagement and training of clinicians as mentors and teachers, with the findings from both groups indicating that preparation for teaching and feedback is lacking. Medical programs can improve their teaching of communication skills and could learn from other fields s to identify applicable innovative approaches.

Prompting Patients with Poorly Controlled Diabetes to Identify Visit Priorities Before Primary Care Visits: a Pragmatic Cluster Randomized Trial

BACKGROUND

Most patients with diabetes do not meet all evidence-based goals of care, and many patients report poor communication and lack of involvement in decision-making during primary care visits.

OBJECTIVE

To test the hypothesis that a "Pre-Visit Prioritization" secure email message could improve visit communication and glycemic control among patients with type 2 diabetes.

DESIGN

We conducted a pragmatic, provider-randomized, multi-site clinical trial from March 2015 to October 2016 across 30 primary care practices within Kaiser Permanente Northern California (KPNC), a large integrated care delivery system.

PARTICIPANTS

Eligible patients had at least 1 year of KPNC membership, type 2 diabetes with most recently measured hemoglobin A1c (HbA1c) > = 8.0%, and were registered users of the KPNC online patient portal.

INTERVENTIONS

Patients in the intervention arm, upon booking an appointment, received a secure email through the KPNC online portal with a link to the EHR allowing them to submit their top one or two priorities prior to the visit. Control patients received usual care.

MAIN MEASURES

Glycemic control; change in HbA1c 6 and 12 months after the initial visit; patient-reported outcomes related to patient-provider communication and patient care experiences.

KEY RESULTS

During the study period, 1276 patients had at least one eligible visit. In post-visit surveys (n = 457), more intervention arm patients reported preparing questions for their visit (72% vs 63%, p = 0.048) and being given treatment choices to consider (81% vs 73%, p = 0.041). Patients in both arms had similar reductions in HbA1c over the 12-month study period (0.56% ± 1.45%), with no significant differences between arms.

CONCLUSIONS

A "light touch" email-based pre-visit intervention resulted in improved measures of visit interaction but did not significantly improve glycemic control relative to usual care. Improving diabetes clinical outcomes through more effective primary care visits may require more intensive approaches to patient visit preparation.

TRIAL REGISTRY

NCT02375932.

Perceptions of heart failure symptoms, disease severity, treatment decision-making, and side effects by patients and cardiologists: a multinational survey in a cardiology setting

Purpose

Explore the extent to which heart failure (HF) symptoms and side effects of HF treatment experienced by patients are recognized by cardiologists, and concordance between patient-cardiologist perceptions of HF severity and patients' contributions to treatment decision-making.

Methods

A multinational, cross-sectional survey of cardiologists and patients with HF was conducted. Patient-record forms (PRFs) were completed by cardiologists for consecutive consulting patients with HF, who completed a patient self-completion questionnaire (PSC). Responses from PRFs with an associated PSC were analyzed to compare patient- and cardiologist-reported occurrences of HF symptoms and treatment side effects, patient-perceived severity of HF and cardiologists' perceived risk of death within 12 months, and patient input into treatment decisions. Concordance was calculated as the number of response agreements between PSCs and PRFs for total number of matched pairs. Over- or underreporting of symptoms and side effects by cardiologists relative to patient-reported occurrences were calculated.

Results

Overall, 2,454 patient-cardiologist pairs were identified. High levels of concordance between matched pairs were observed for the occurrence of reported HF symptoms (93%), side effects (77%-98%) and degree of patient input into treatment decisions (74%); for perceived HF severity, concordance was 54%. Most symptoms (except dyspnea when active and fatigue/weakness, experienced by >50% of patients) were underreported by cardiologists. Of patients reporting to have been informed by their cardiologist that their HF was mild, 28% were perceived by their cardiologist to have a moderate-high/very high risk of death within 12 months. Treatment choice was not discussed with almost a third of patients. When discussed, 94% of patients (n=1,540) reported the cardiologist made the final decision. Cardiologists more often under- than overreported the occurrence of side effects reported by patients.

Conclusion

Improved patient-cardiologist dialogue and shared decision-making is required for optimizing patient care and outcomes in HF.

A longitudinal inquiry into directionality of effects between coping and information needs in hypertensive patients

PURPOSE

It is well recognized that effective health communication is associated with better adherence to medical prescriptions, behavioral changes, and enhanced perception of control over the disease. However, there is limited knowledge about the variables on which to tailor health messages. This study examined whether coping strategies were related to information needs over time in a sample of patients with hypertension.

PATIENTS AND METHODS

A three-wave longitudinal design was used to examine the potential reciprocal relationships among variables. The sample included 271 patients (43.5% women) affected by essential arterial hypertension with a mean age of 54.66 years (SD =10.74 years; range 30-78 years). Data on patients' demographic characteristics, coping strategies, and information needs were collected three times over 12 months. To test the directionality of the relationships linking coping to information needs, cross-lagged path analyses were applied in a structural equation modeling approach.

RESULTS

Active coping was related to a greater need for information regarding behavioral habits; avoidance coping was negatively associated with the need for information regarding daily life activities, while passive coping showed a positive relationship with this need. Moreover, results sustained the hypothesis that the relationship between coping and information needs was bi-directional. In fact, greater need for information about the disease and its pharmacological treatment was related to greater adoption of active coping strategies. The need for information about risk and complications was associated with the coping strategy related to alcohol use.

CONCLUSION

These results provide important suggestions for implementing more effective intervention programs aimed at fostering patients' self-care abilities. As it was possible to modify coping strategies, health care providers may consider measuring patients' strategies before the medical examination so they have time to refine the information they give to patients.

Online health information seeking by adults hospitalized for acute coronary syndromes: Who looks for information, and who discusses it with healthcare providers?

OBJECTIVE

To describe characteristics associated with online health information-seeking and discussing resulting information with healthcare providers among adults with acute coronary syndromes (ACS).

METHODS

Consecutive patients hospitalized with ACS in 6 hospitals in Massachusetts and Georgia who reported Internet use in the past 4 weeks (online patients) were asked about online health information-seeking and whether they discussed information with healthcare providers. Participants reported demographic and psychosocial characteristics; clinical characteristics were abstracted from medical records. Logistic regression models estimated associations with information-seeking and provider communication.

RESULTS

Online patients (N = 1142) were on average aged 58.8 (SD: 10.6) years, 30.3% female, and 82.8% non-Hispanic white; 56.7% reported online health information-seeking. Patients with higher education and difficulty accessing medical care were more likely to report information-seeking; patients hospitalized with myocardial infarction, and those with impaired health numeracy and limited social networks were less likely. Among information-seekers, 33.9% discussed information with healthcare providers. More education and more frequent online information-seeking were associated with provider discussions.

CONCLUSION

Over half of online patients with ACS seek health information online, but only 1 in 3 of these discuss information with healthcare providers.

PRACTICE IMPLICATIONS

Clinician awareness of patient information-seeking may enhance communication including referral to evidence-based online resources.

Factors Affecting Patient Portal Use Among Low-Income Pregnant Women: Mixed-Methods Pilot Study

Background

Patient portals offer patients personalized and secure Web access to their medical information and enable patients to manage their health care online. However, there is a lack of information about patient acceptance and use of patient portals among low-income pregnant women.

Objective

This formative research aims to assess the potential of a patient portal, MyChart, for improving prenatal health care and pregnancy outcomes, and identify the barriers and facilitators of MyChart use among low-income pregnant women.

Methods

A mixed-methods study was conducted with a convenience sample of 18 low-income pregnant women comprising low- and high-risk patients enrolled in a prenatal clinic in eastern North Carolina. MyChart use, patient demographics, and pregnancy information were collected by reviewing electronic medical charts. Health literacy was measured. Reported use and attitudes toward MyChart were collected using a semi-structured interview.

Results

Although 39% (7/18) of participants interviewed signed up for MyChart, only 22% (4/18) of them became active users. Another 33% (6/18) had never heard of MyChart or was unsure of how to access it. Users primarily accessed test results and appointment schedules. The main facilitating factors for patient portal use were information and motivation from health care providers and concerns about pregnancy due to a history of miscarriage. Reported barriers were lack of educational resources, lack of care provider encouragement, and technical difficulties possibly exacerbated by low health literacy. Participants also suggested improvements for MyChart, especially the provision of discussion-based support for pregnant women.

Conclusions

The one-time verbal introduction of MyChart does not meet current patients’ needs. Data reveal the need for more consistent patient education and support programs, tailored to patients’ previous pregnancy histories. The clinic also needs to facilitate better provider-patient communication about the importance of MyChart use.

True communication skills assessment in interdepartmental OSCE stations: Standard setting using the MAAS-Global and EduG

BACKGROUND

Comparing outcome of clinical skills assessment is challenging. This study proposes reliable and valid comparison of communication skills (1) assessment as practiced in Objective Structured Clinical Examinations (2). The aim of the present study is to compare CS assessment, as standardized according to the MAAS Global, between stations in a single undergraduate medical year.

METHODS

An OSCE delivered in an Irish undergraduate curriculum was studied. We chose the MAAS-Global as an internationally recognized and validated instrument to calibrate the OSCE station items. The MAAS-Global proportion is the percentage of station checklist items that can be considered as 'true' CS. The reliability of the OSCE was calculated with G-Theory analysis and nested ANOVA was used to compare mean scores of all years.

RESULTS

MAAS-Global scores in psychiatry stations were significantly higher than those in other disciplines (p<0.03) and above the initial pass mark of 50%. The higher students' scores in psychiatry stations were related to higher MAAS-Global proportions when compared to the general practice stations.

CONCLUSION

Comparison of outcome measurements, using the MAAS Global as a standardization instrument, between interdisciplinary station checklists was valid and reliable.

PRACTICE IMPLICATIONS

The MAAS-Global was used as a single validated instrument and is suggested as gold standard.

Theoretical and Pragmatic Adaptation of the 5As Model to Patient-Centered Hypertension Counselling

Patient-centered communication is a means for engaging patients in partnership. However, patient centered communication has not always been grounded in theory or in clinicians' pragmatic needs. The objective of this report is to present a practical approach to hypertension counselling that uses the 5As framework and is grounded in theory and best communication practices.

Arab-migrant Cancer Survivors' Experiences of Using Health-care Interpreters: A Qualitative Study

Objective:

This paper is drawn from a larger mixed-method study that sought to explore the cancer experiences of Jordanian and Australian Arab cancer survivors and their family caregivers. This paper specifically focuses on the experiences of the Australian cancer survivors and their use of interpreter services to communicate with health-care providers (HCPs).

Methods:

Individual face-to-face interviews were conducted using a semi-structured interview guide. Data were manually thematically analyzed using an inductive approach.

Results:

Three key themes were identified which highlighted the communication issues the Arab-migrant cancer survivors experienced when using health-care interpreters: (1) “My language is weak” – needing someone to help them when communicating with their HCPs; (2) “I had a problem in the dialect” – the need to understand and to be understood by the interpreters; and (3) “I felt all the time that there is something missing” – not being heard by the interpreter. Low confidence in engaging and using the English language meant many cancer survivors were reluctant to seek support from cancer services or to attend workshops conducted in the English language. Despite the presence of professionally trained health-care interpreters in health-care communications, cancer survivors were frustrated when provided with interpreters who did not speak the same dialect, causing linguistic and cultural discord. This created confusion as information was often misinterpreted, resulting in the delivery and receipt of mixed messages.

Conclusions:

Despite the availability of professionally trained health-care interpreters, our findings identified the need for HCPs to ascertain linguistic and cultural congruence when arranging interpreter services.

Residents' responsibilities: Adopting a wider view

Current ACGME regulations have limited residents' weekly hours and continuous working hours, a marked change, despite its uncertain effects on physician well-being and quality of care. Although residency programs in internal medicine and family medicine have adapted schedules to conform to these regulations, increasing evidence is accumulating to suggest that these training experiences are not adequately preparing the next generation of practicing primary care and hospital-based physicians. Data from an array of sources continue to demonstrate significant deficiencies in six areas of residents' responsibilities towards their patients: diminished patient "face time" and direct patient care; focus on patients' "reason for hospitalization" or "reason for visit" at the expense of possible neglect of patients' "secondary" medical problems; limited attention to patients' emotional or contextual problems and limited empathy; deficient implementation of the essential constituents of patient-centered care; neglect of habitual "reflective practice"; and excessive distinction between inpatient and outpatient responsibilities, leading to missed opportunities for inpatient residents to be aware of and attend to patients' post-discharge course although new information and readmissions related to the index hospitalization are prevalent. Thus, redesigning residency programs to widen residents' outlook and cover these inseparable components of high-quality care, may infuse the often fatigued and burnt-out residents with purpose and fulfillment, finally incorporating the missing elements of patient-centered care as integral parts of patients' admissions and therefore, of physicians' future careers.

The impact of a patient web communication intervention on reaching treatment suggested guidelines for chronic diseases: A randomized controlled trial

OBJECTIVE

Examine the impact of a PACE (Prepare, Ask, Check, Express) inspired web-based communication intervention alone or combined with a workshop on reaching treatment goals for patients suffering from chronic diseases (CDs), compared to usual care.

METHODS

Three arm single-blind RCT in community primary care (PC) practices. PC practitioners (n=18) had a CD patient caseload, and practicing >5 years. Patients >40 years old, English speaking, computer literate, not reaching treatment goals for hypertension, type II diabetes, and/or dyslipidemia.

INTERVENTIONS

(1) web-intervention and (2) web intervention and nurse facilitated workshop and (3) usual care.

OUTCOME

Proportion of patients meeting all treatment suggested guidelines for the diagnoses they were enrolled for.

RESULTS

Patients (n=322) were randomized, and of these 221 returned for follow up. Patients in the web group were 1.42 times more likely to meet targets compared to usual care [95% CI: 1.00-2.00], a statistical difference not seen in the combined group. Sensitivity analyses were performed to mitigate bias due to loss to follow up.

CONCLUSIONS

Training patients in communication skills using a website positively affects reaching treatment goals for hypertensive, diabetic and dyslipidemic patients.

PRACTICE IMPLICATIONS

Web communication interventions are an effective tool that can be used in primary care.

Patient-perceived health service needs in inflammatory arthritis: A systematic scoping review

BACKGROUND

Care that is patient-centred is more likely to be sustainable and associated with improved health outcomes. This approach to care requires an understanding of patients' health service needs, yet few studies have directly investigated the perceived health service needs of people with inflammatory arthritis.

OBJECTIVES

To systematically identify the existing literature relating to patient perceived health service needs for inflammatory arthritis.

METHODS

A systematic review of MEDLINE, EMBASE, CINAHL, and PsycINFO was conducted (1990-2016). Studies examining patients' perceived needs relating to health services for inflammatory arthritis were identified. Descriptive data regarding study design and methodology were extracted and risk of bias assessed. Findings were collated and categorized thematically.

RESULTS

In total, 27 of 1405 (16 qualitative, 9 quantitative, and 2 mixed-methods) studies were relevant. The main areas of perceived need related to (1) Communication: consumers wanted clear, empathic communication, and to be involved with decision-making. (2) Characteristics of ongoing care: adequate consultation length with continuity and timely care were valued. (3) Factors influencing care-seeking included individual attitudes, disease severity, finances and family expectations. (4) Allied health and complementary and alternative medicines (CAM) were perceived as useful by many. The reporting of CAM use to doctors was variable, with several factors contributing to under-reporting.

CONCLUSIONS

This review identified patients' perceived needs for better communication with their health providers, the heterogeneity of influences determining when care is sought and preferences regarding non-pharmacologic therapies. Aligning patients' perceived needs with evidence-based therapy for people with inflammatory arthritis will be important in optimizing patient outcomes.

Survey Analysis of an Ambulatory Surgical Checklist for Patient Use

Although checklists are used as tools for providers, they have not been adequately explored as tools for patients. The purpose of this study was to survey the stakeholders on the usefulness of an ambulatory surgical checklist for patients. We performed a cross-sectional study through a survey designed to include both patients and providers. Descriptive analysis of the data was performed based on responses from 35 patients and 52 providers. Overall, 94% of patients and 83% of providers thought the checklist would be beneficial for patients. In addition, 37% of providers indicated potential barriers to checklist implementation, including fear of confusing the patient, making patients doubt the care they were receiving, taking too much time, and lack of resources. Based on survey responses, the study suggests that the ambulatory surgical checklist can potentially facilitate patient education, enable more active patient participation, increase patient satisfaction, and decrease patient anxiety.

The impact of health literacy and life style risk factors on health-related quality of life of Australian patients

BACKGROUND

Limited evidence exists regarding the relationship between health literacy and health-related quality of life (HRQoL) in Australian patients from primary care. The objective of this study was to investigate the impact of health literacy on HRQoL in a large sample of patients without known vascular disease or diabetes and to examine whether the difference in HRQoL between low and high health literacy groups was clinically significant.

METHODS

This was a cross-sectional study of baseline data from a cluster randomised trial. The study included 739 patients from 30 general practices across four Australian states conducted in 2012 and 2013 using the standard Short Form Health Survey (SF-12) version 2. SF-12 physical component score (PCS-12) and mental component score (MCS-12) are derived using the standard US algorithm. Health literacy was measured using the Health Literacy Management Scale (HeLMS). Multilevel regression analysis (patients at level 1 and general practices at level 2) was applied to relate PCS-12 and MCS-12 to patient reported life style risk behaviours including health literacy and demographic factors.

RESULTS

Low health literacy patients were more likely to be smokers (12 % vs 6 %, P = 0.005), do insufficient physical activity (63 % vs 47 %, P < 0.001), be overweight (68 % vs 52 %, P < 0.001), and have lower physical health and lower mental health with large clinically significant effect sizes of 0.56 (B (regression coefficient) = -5.4, P < 0.001) and 0.78(B = -6.4, P < 0.001) respectively after adjustment for confounding factors. Patients with insufficient physical activity were likely to have a lower physical health score (effect size = 0.42, B = -3.1, P < 0.001) and lower mental health (effect size = 0.37, B = -2.6, P < 0.001). Being overweight tended to be related to a lower PCS-12 (effect size = 0.41, B = -1.8, P < 0.05). Less well-educated, unemployed and smoking patients with low health literacy reported worse physical health. Health literacy accounted for 45 and 70 % of the total between patient variance explained in PCS-12 and MCS-12 respectively.

CONCLUSIONS

Addressing health literacy related barriers to preventive care may help reduce some of the disparities in HRQoL. Recognising and tailoring health related communication to those with low health literacy may improve health outcomes including HRQoL in general practice.

Nursing Home Stakeholder Views of Resident Involvement in Medical Care Decisions

Demand by nursing home residents for involvement in their medical care, or, patient-centered care, is expected to increase as baby boomers begin seeking long-term care for their chronic illnesses. To explore the needs in meeting this proposed demand, we used a qualitative descriptive method with content analysis to obtain the joint perspective of key stakeholders on the current state of person-centered medical care in the nursing home. We interviewed 31 nursing home stakeholders: 5 residents, 7 family members, 8 advanced practice registered nurses, 5 physicians, and 6 administrators. Our findings revealed constraints placed by the long-term care system limited medical involvement opportunities and created conflicting goals for patient-centered medical care. Resident participation in medical care was perceived as low, but important. The creation of supportive educational programs for all stakeholders to facilitate a common goal for nursing home admission and to provide assistance through the long-term care system was encouraged.

Perceiving one's heart condition to be cured following hospitalization for acute coronary syndromes: Implications for patient-provider communication

OBJECTIVE

We examined the proportion of patients perceiving their heart condition to be cured following hospitalization for ACS and identified characteristics associated with these perceptions.

METHODS

We conducted a prospective cohort study of adults hospitalized with ACS (N=396). Patient interviews during hospitalization and one week post-discharge provided demographic and psychosocial characteristics. Medical records provided clinical characteristics. At one week, patients who rated "My heart condition is cured" as "definitely true" or "mostly true" were considered to perceive their heart condition cured.

RESULTS

Participants were aged 60.7 (SD:11.0) years, 26.5% female, and 89.0% non-Hispanic white; 16.7% had unstable angina, 59.6% NSTEMI, and 23.7% STEMI. One week post-discharge, 30.3% perceived their heart condition to be cured. Characteristics associated with cure perceptions were older age (OR=2.2; 95% CI: 1.2-4.0 for ≥65 years vs <55 years), male sex (OR=2.4; 95%CI: 1.3-4.2), history of hypertension (OR=1.8; 95%CI: 1.1-3.1), history of stroke (OR=4.2; 95%CI: 1.1-16.7), no history of CHD (OR=2.8; 95%CI: 1.6-4.9), and receipt of CABG during hospitalization (OR=4.8, 95%CI: 1.9-12.0 vs medical management).

CONCLUSION

One week post-discharge, 3 in 10 patients perceived their heart condition to be cured.

PRACTICE IMPLICATIONS

Conversations with patients should frame ACS as a chronic disease and dispel cure perceptions.

Effects of a Patient-Provider, Collaborative, Medication-Planning Tool: A Randomized, Controlled Trial

Among patients with various levels of health literacy, the effects of collaborative, patient-provider, medication-planning tools on outcomes relevant to self-management are uncertain. Objective. Among adult patients with type II diabetes mellitus, we tested the effectiveness of a medication-planning tool (Medtable™) implemented via an electronic medical record to improve patients' medication knowledge, adherence, and glycemic control compared to usual care. Design. A multicenter, randomized controlled trial in outpatient primary care clinics. 674 patients received either the Medtable tool or usual care and were followed up for up to 12 months. Results. Patients who received Medtable had greater knowledge about indications for medications in their regimens and were more satisfied with the information about their medications. Patients' knowledge of drug indication improved with Medtable regardless of their literacy status. However, Medtable did not improve patients' demonstrated medication use, regimen adherence, or glycemic control (HbA1c). Conclusion. The Medtable tool supported provider/patient collaboration related to medication use, as reflected in patient satisfaction with communication, but had limited impact on patient medication knowledge, adherence, and HbA1c outcomes. This trial is registered with ClinicalTrials.gov NCT01296633.

Toward an evidence-based patient-provider communication in rehabilitation: linking communication elements to better rehabilitation outcomes

Background:

There is a growing interest in linking aspects of patient-provider communication to rehabilitation outcomes. However, the field lacks a conceptual understanding on: (a) ‘how’ rehabilitation outcomes can be improved by communication; and (b) through ‘which’ elements in particular. This article elaborates on the conceptual developments toward informing further practice and research.

Methods:

Existing models of communication in healthcare were adapted to rehabilitation, and its outcomes through a comprehensive literature review.

Results:

After depicting mediating mechanisms and variables (e.g. therapeutic engagement, adjustment toward disability), this article presents the ‘4 Rehab Communication Elements’ deemed likely to underpin rehabilitation outcomes. The four elements are: (a) knowing the person and building a supportive relationship; (b) effective information exchange and education; (c) shared goal-setting and action planning; and (d) fostering a more positive, yet realistic, cognitive and self-reframing.

Discussion:

This article describes an unprecedented, outcomes-oriented approach toward the design of rehabilitation communication, which has resulted in the development of a new intervention model: the ‘4 Rehab Communication Elements’. Further trials are needed to evaluate the impact of this whole intervention model on rehabilitation outcomes.

White coat hypertension: improving the patient-health care practitioner relationship

White coat hypertension is characterized by the variability of a patient’s blood pressure measurements between the physician’s office and the patient’s home environment. A patient with white coat hypertension has high blood pressure levels in the physician’s office and normal blood pressure levels in their typical environment. This condition is likely caused by the patient’s anxiety within the physician’s office and in the presence of the physician. Research has shown that improving the relationship between a patient and their health care provider can decrease the patient’s anxiety, with the implication of decreasing the patient’s likelihood of demonstrating white coat hypertension. This review provides an overview of the previous literature regarding white coat hypertension, its prevalence, and the consequences for those who develop persistent hypertension. Furthermore, this review discusses the implications of improving patient and health care provider interactions through effective communication, empathy, and trust, as well as the implications for future research studies in improving the patient and health care provider’s relationship.