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Lorello GR, Flexman AM. A matter of life and death: physician gender and patient outcomes after surgery. Br J Anaesth 2024; 133:479-482. [PMID: 38965014 DOI: 10.1016/j.bja.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 05/31/2024] [Accepted: 06/04/2024] [Indexed: 07/06/2024] Open
Abstract
Accumulating evidence supports an effect of physician gender (or sex, a surrogate used in many studies) on important patient outcomes such as death, complications, and hospital length of stay. Recent studies suggest that these effects result from the gender diversity of the team rather than individual physician gender. Here, we reflect on the potential mechanisms of an effect of physician gender on patient outcomes.
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Affiliation(s)
- Gianni R Lorello
- Department of Anesthesia and Pain Management, University Health Network, Toronto Western Hospital, Toronto, ON, Canada; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada; The Wilson Centre, Toronto, ON, Canada; Women's College Research Institute, Toronto, ON, Canada
| | - Alana M Flexman
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada; Department of Anesthesia, Providence Health Care, St. Paul's Hospital, Vancouver, BC, Canada; Centre for Advancing Health Outcomes, St. Paul's Hospital, Vancouver, BC, Canada.
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Perrault EK, McCullock SP, Hildenbrand GM, Walter KJ. The Effects of Safe Zone Badges in Physicians' Online Biographies: Evidence from an Experimental Study. HEALTH COMMUNICATION 2024; 39:1955-1965. [PMID: 37620990 DOI: 10.1080/10410236.2023.2249625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
Earning digital badges to showcase a person's expertise or knowledge are becoming increasingly popular. A healthcare provider's displaying of a Safe Zone badge within their online profile may offer prospective patients a cue as to the kind of care they might receive if they selected that particular provider. Prior research indicates LGBTQ+ individuals are looking for these types of cues within providers' biographies to make their selections. A between subjects, 2 (Safe Zone badge present/absent) x 2 (male/female doctor) online experiment was conducted (n = 658). Results revealed a main effect for the presence of the Safe Zone badge. Participants had greater anticipated satisfaction, liking, were more likely to view the provider as approachable, and were more willing to schedule an appointment with the provider displaying a Safe Zone badge.
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Walsh JA, Pei S, Alexander S, Braaten T, Walker JH, Clewell J, Douglas KM, Penmetsa GK, Ye X, Breviu B, Cannon GW, Kunkel GA, Sauer BC. Missed opportunities for treatment of inflammatory arthritis and factors associated with non-treatment: An observational cohort study in United States Veterans with rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis. Semin Arthritis Rheum 2024; 66:152436. [PMID: 38714073 DOI: 10.1016/j.semarthrit.2024.152436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 03/08/2024] [Accepted: 03/11/2024] [Indexed: 05/09/2024]
Abstract
OBJECTIVE To identify factors associated with non-treatment with biologic and non-biologic disease modifying anti-rheumatic drugs (DMARDs) during the 12 months after initial inflammatory arthritis (IA) diagnosis. METHODS We identified Veterans with incident IA diagnosed in 2007-2019. We assessed time to treatment with Kaplan-Meier curves. We identified associations between non-treatment and factors relating to patients, providers, and the health system with multivariate Generalized Estimation Equation (GEE) log-Poisson. Subgroup analyses included IA subtypes (rheumatoid arthritis [RA], psoriatic arthritis [PsA], and ankylosing spondylitis [AS]) and timeframes of the initial IA diagnosis (2007-11, 2012-15, and 2016-19). RESULTS Of 18,318 study patients, 40.7 % did not receive treatment within 12 months after diagnosis. In all patients, factors associated with non-treatment included Black race (hazard ratio, 95 % confidence interval: 1.13, 1.08-1.19), Hispanic ethnicity (1.14, 1.07-1.22), Charlson Comorbidity Index ≥2, (1.15, 1.11-1.20), and opiate use (1.09, 1.05-1.13). Factors associated with higher frequency of DMARD treatment included married status (0.86, 0.81-0.91); erosion in joint imaging report (HR: 0.86, 0.81-0.91); female diagnosing provider (0.90, CI: 0.85-0.96), gender concordance between patient and provider (0.91, CI: 0.86-0.97), and diagnosing provider specialty of rheumatology (0.53, CI: 0.49-0.56). CONCLUSION A high proportion of Veterans with IA were not treated with a biologic or non-biologic DMARD within one year after their initial diagnosis. A wide range of factors were associated with non-treatment of IA that may represent missed opportunities for improving the quality of care through early initiation of DMARDs.
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Affiliation(s)
- Jessica A Walsh
- Division of Rheumatology, Salt Lake City Veterans Affairs Health, 500 Foothill Dr, Salt Lake City, UT 84148, United States.
| | - Shaobo Pei
- Division of Rheumatology, Salt Lake City Veterans Affairs Health, 500 Foothill Dr, Salt Lake City, UT 84148, United States
| | - Swetha Alexander
- Division of Rheumatology, Salt Lake City Veterans Affairs Health, 500 Foothill Dr, Salt Lake City, UT 84148, United States
| | - Tawnie Braaten
- Division of Rheumatology, Salt Lake City Veterans Affairs Health, 500 Foothill Dr, Salt Lake City, UT 84148, United States
| | - Jodi H Walker
- Division of Rheumatology, Salt Lake City Veterans Affairs Health, 500 Foothill Dr, Salt Lake City, UT 84148, United States
| | - Jerry Clewell
- Division of Rheumatology, Salt Lake City Veterans Affairs Health, 500 Foothill Dr, Salt Lake City, UT 84148, United States
| | - Kevin M Douglas
- Division of Rheumatology, Salt Lake City Veterans Affairs Health, 500 Foothill Dr, Salt Lake City, UT 84148, United States
| | - Gopi K Penmetsa
- Division of Rheumatology, Salt Lake City Veterans Affairs Health, 500 Foothill Dr, Salt Lake City, UT 84148, United States
| | - Xiangyang Ye
- Division of Rheumatology, Salt Lake City Veterans Affairs Health, 500 Foothill Dr, Salt Lake City, UT 84148, United States
| | - Brian Breviu
- Division of Rheumatology, Salt Lake City Veterans Affairs Health, 500 Foothill Dr, Salt Lake City, UT 84148, United States
| | - Grant W Cannon
- Division of Rheumatology, Salt Lake City Veterans Affairs Health, 500 Foothill Dr, Salt Lake City, UT 84148, United States
| | - Gary A Kunkel
- Division of Rheumatology, Salt Lake City Veterans Affairs Health, 500 Foothill Dr, Salt Lake City, UT 84148, United States
| | - Brian C Sauer
- Division of Rheumatology, Salt Lake City Veterans Affairs Health, 500 Foothill Dr, Salt Lake City, UT 84148, United States
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Tsukahara Y, Novak M, Takei S, Asif IM, Yamasawa F, Torii S, Akama T, Matsumoto H, Day C. International study of physicians' opinion on physician-patient sex concordance when treating athletes. PM R 2024; 16:331-338. [PMID: 37850371 DOI: 10.1002/pmrj.13086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 09/06/2023] [Accepted: 10/03/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND The effect of physician-patient sex concordance in medicine has been reported in many studies. Whether physicians believe that the sex concordance between physician and athlete influences treatment has not been investigated. OBJECTIVE To determine whether physicians believe that the sex concordance between physician and athlete influences treatment. DESIGN Cross-sectional study. SETTING Online survey. PARTICIPANTS One thousand one hundred ninety-three sports medicine physicians in 51 countries. Participants were sports medicine physicians trained in orthopedics (n = 443 [37.1%]) and nonorthopedics (n = 750 [62.9%]). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Participants were asked to decide whether sex of the physician made them better suited to care for athletes of concordant or different sexes along with their personal background. RESULTS Orthopedic sports medicine physicians agreed less than nonorthopedic sports medicine physicians regarding the statement "MALE sports medicine physicians are better suited than their female counterparts to care for MALE athletes" (odds ratio [OR] 0.56, 95% confidence interval [CI] 0.35-0.91, p = .02), and compared to sports medicine physicians based in Europe, those based in Asia agreed more to this statement (OR 7.91, 95% CI 4.60-13.60, p < .01). In addition, regarding the statement "FEMALE sports medicine physicians are better suited than their male counterparts to care for FEMALE athletes," compared to sports medicine physicians based in Europe, those based in Asia (OR 9.12, 95% CI 5.63-14.79, p < .01) and North America (OR 2.18, 95% CI 1.46-3.25, p < .01) agreed more and orthopedic sports medicine physicians agreed less than nonorthopedic sports medicine physicians (OR 0.61, 95% CI 0.39-0.93, p = .02) to this statement. CONCLUSIONS Sports medicine physicians trained in orthopedics felt sex concordance was less important than physicians trained in other specialties. Asian sports medicine physicians believed sex concordance was more important compared to physicians in other regions.
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Affiliation(s)
- Yuka Tsukahara
- Waseda Institute for Sport Sciences, Waseda University, Tokorozawa, Japan
- Faculty of Physical Education, Tokyo Women's College of Physical Education, Tokyo, Japan
| | - Melissa Novak
- Department of Family Medicine, Oregon Health and Science University, Portland, USA
| | - Seira Takei
- Waseda Institute of Human Growth and Development, Waseda University, Tokorozawa, Japan
| | - Irfan M Asif
- Department of Family and Community Medicine, The University of Alabama at Birmingham School of Medicine, Birmingham, USA
| | | | - Suguru Torii
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
| | - Takao Akama
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
| | - Hideo Matsumoto
- Public Interest Incorporated Foundation, Japan Sports Medicine Foundation, Tokyo, Japan
| | - Carly Day
- Department of Health and Kinesiology, Purdue University, West Lafayette, USA
- Franciscan Physician Network, West Lafayette, USA
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Glenn J, Kleinhenz G, Smith JMS, Chaney RA, Moxley VBA, Donoso Naranjo PG, Stone S, Hanson CL, Redelfs AH, Novilla MLB. Do healthcare providers consider the social determinants of health? Results from a nationwide cross-sectional study in the United States. BMC Health Serv Res 2024; 24:271. [PMID: 38438936 PMCID: PMC10910743 DOI: 10.1186/s12913-024-10656-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 01/29/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND While the social determinants of health (SDOH) have a greater impact on individual health outcomes than the healthcare services a person receives, healthcare providers face barriers to addressing these factors in clinical settings. Previous studies have shown that providers often lack the necessary knowledge and resources to adequately screen for and otherwise assist patients with unmet social needs. This study explores the perceptions and behaviors related to SDOH among healthcare providers in the United States (US). METHODS This cross-sectional study analyzed data from a 22-item online survey using Reaction Data's research platform of healthcare professionals in the US. Survey items included demographic questions as well as Likert scale questions about healthcare providers' perceptions and behaviors related to SDOH. Descriptive statistics were calculated, and further analyses were conducted using t-tests and analysis of variance. RESULTS A total of 563 respondents completed the survey, with the majority being male (72.6%), White (81%), and located in urban areas (82.2%). In terms of perceptions, most providers agreed or strongly agreed that SDOH affect the health outcomes of all patients (68.5%), while only 24.1% agreed or strongly agreed that their healthcare setting was set up to address SDOH. In terms of behavior, fewer than half currently screened for SDOH (48.6%) or addressed (42.7%) SDOH in other ways. Most providers (55.7%) wanted additional resources to focus on SDOH. Statistical analyses showed significant differences by gender, with females being more likely than males to prioritize SDOH, and by specialty, with psychiatrists, pediatricians, and family/general medicine practitioners being more likely to prioritize SDOH. CONCLUSION Most healthcare providers understand the connection between unmet social needs and their patients' health, but they also feel limited in their ability to address these issues. Ongoing efforts to improve medical education and shift the healthcare system to allow for payment and delivery of more holistic care that considers SDOH will likely provide new opportunities for healthcare providers. In addition to what they can do at the institutional and patient levels, providers have the potential to advocate for policy and system changes at the societal level that can better address the root causes of social issues.
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Affiliation(s)
- Jeffrey Glenn
- Department of Public Health, Brigham Young University, 84602, Provo, UT, USA.
| | - Gwen Kleinhenz
- Department of Public Health, Brigham Young University, 84602, Provo, UT, USA
| | - Jenna M S Smith
- Department of Public Health, Brigham Young University, 84602, Provo, UT, USA
| | - Robert A Chaney
- Department of Public Health, Brigham Young University, 84602, Provo, UT, USA
| | - Victor B A Moxley
- J. Reuben Clark Law School, Brigham Young University, 84602, Provo, UT, USA
| | | | - Sarah Stone
- Department of Public Health, Brigham Young University, 84602, Provo, UT, USA
| | - Carl L Hanson
- Department of Public Health, Brigham Young University, 84602, Provo, UT, USA
| | - Alisha H Redelfs
- Department of Public Health, Brigham Young University, 84602, Provo, UT, USA
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Rometsch C. The Role of Female Physicians in Psychosomatic Medicine: Opportunities and Challenges. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2024; 5:8-12. [PMID: 38249938 PMCID: PMC10797173 DOI: 10.1089/whr.2023.0070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 01/23/2024]
Abstract
Background Female physicians are in some cases preferred by patients due to their sex-related characteristics such as softness and empathy. Psychosomatic medicine presents a compelling working environment due to its holistic approach. Methods This brief review synthesizes the challenges encountered by female physicians in psychosomatic medicine and outlines potential strategies for overcoming these barriers. Results The presence of female role models may constitute a crucial advancement in this process. There exists a pressing demand for specialized clinical and scientific programs in psychosomatic medicine at both national and international levels. Such programs, offered by universities and ministries, as well as comprehensive training initiatives, are indispensable in fostering the next generation of females in psychosomatics. Leading journals can lend their support by publishing special issues dedicated to female physicians. Conclusion Strengthening female physicians throughout all positions in psychosomatic medicine can contribute ultimately to the improvement of patient care.
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Affiliation(s)
- Caroline Rometsch
- Department of Experimental and Clinical Medicine, University of Florence, Firenze, Italy
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Malinzak EB, Huffmyer JL. Leadership in Anesthesiology: Striving for Equity, Maintaining Momentum. Anesth Analg 2023; 137:1167-1170. [PMID: 37973131 DOI: 10.1213/ane.0000000000006576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Affiliation(s)
- Elizabeth B Malinzak
- From the Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina
| | - Julie L Huffmyer
- Department of Anesthesiology, West Virginia University School of Medicine, Morgantown, West Virginia
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Liu Y, Verdonk P, de Wit M, Nefs G, Dedding C. Observing, 'doing' and 'making' gender in Dutch paediatric type 1 diabetes care, at home and in the clinic: Multiple-stakeholder perspectives. J Adv Nurs 2023; 79:4697-4706. [PMID: 37377143 DOI: 10.1111/jan.15757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 05/27/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023]
Abstract
AIM To investigate the perspectives of Dutch care professionals, parents and experts by experience on gender dynamics in paediatric type 1 diabetes care. DESIGN Qualitative research design. METHODS Fifteen semi-structured interviews were held with care professionals, supplemented by two focus groups with parents of children with diabetes (n = 12 parents) and three semi-structured interviews with two experts by experience and a mother. Two respondent validation interviews were conducted, one with two care professionals and one with an expert by experience. Participant observations were conducted at three clinics, a diabetes sports day, weekend for young people and their families, and a high-school. An inductive framework analysis was done, informed by relational theory on gender. RESULTS Care professionals 'did' and 'made' gender differences together with young people, manifesting as communicative difficulties, in particular between female care professionals and young boys. Boys were considered less skilled in articulating their needs compared to girls. At home, care professionals and parents observed, 'did' and 'made' gender differences by perpetuating gendered divisions of labour. As traditional caretakers, mothers risk focusing excessively on the diabetes of their child whilst fathers remained more at a distance. CONCLUSION Gender patterns have negative implications on those involved in paediatric type 1 diabetes. Leaving tacit the gendered communicative issues across child-parent and child-care professional dyads, can sustain invisible friction in a care system that normatively expects verbal participation and increased self-management. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE Findings may encourage care professionals and parents to engage with the potential impact of gender dynamics on diabetes practices. Incorporating these dynamics as conversational tools would contribute to improving type 1 diabetes care for young people.
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Affiliation(s)
- Yosheng Liu
- Department of Ethics, Law and Humanities, Amsterdam University Medical Center, Location VUmc, Amsterdam, The Netherlands
| | - Petra Verdonk
- Department of Ethics, Law and Humanities, Amsterdam University Medical Center, Location VUmc, Amsterdam, The Netherlands
| | - Maartje de Wit
- Department of Medical Psychology, Amsterdam University Medical Center, Location VUmc, Vrije Universiteit, Amsterdam, The Netherlands
- Public Health Research Institute, Amsterdam, The Netherlands
| | - Giesje Nefs
- Department of Medical Psychology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
- Diabeter, Center for Type 1 Diabetes Care and Research, Rotterdam, The Netherlands
- Department of Medical and Clinical Psychology, CoRPS-Center of Research on Psychological Disorders and Somatic Diseases, Tilburg University, Tilburg, The Netherlands
| | - Christine Dedding
- Department of Ethics, Law and Humanities, Amsterdam University Medical Center, Location VUmc, Amsterdam, The Netherlands
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Liu L, Obuobi S, Gulati M. Redesigning the Future of Medicine. JAMA Netw Open 2023; 6:e2323831. [PMID: 37459104 DOI: 10.1001/jamanetworkopen.2023.23831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Affiliation(s)
- Linda Liu
- Division of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Shirlene Obuobi
- Division of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Martha Gulati
- Department of Cardiology, Cedars-Sinai Smidt Heart Institute, Los Angeles, California
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Soares A, Piçarra N, Giger JC, Oliveira R, Arriaga P. Ethics 4.0: Ethical Dilemmas in Healthcare Mediated by Social Robots. Int J Soc Robot 2023; 15:807-823. [PMID: 37251278 PMCID: PMC9989998 DOI: 10.1007/s12369-023-00983-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2023] [Indexed: 03/09/2023]
Abstract
This study examined people's moral judgments and trait perception toward a healthcare agent's response to a patient who refuses to take medication. A sample of 524 participants was randomly assigned to one of eight vignettes in which the type of healthcare agent (human vs. robot), the use of a health message framing (emphasizing health-losses for not taking vs. health-gains in taking the medication), and the ethical decision (respect the autonomy vs. beneficence/nonmaleficence) were manipulated to investigate their effects on moral judgments (acceptance and responsibility) and traits perception (warmth, competence, trustworthiness). The results indicated that moral acceptance was higher when the agents respected the patient's autonomy than when the agents prioritized beneficence/nonmaleficence. Moral responsibility and perceived warmth were higher for the human agent than for the robot, and the agent who respected the patient's autonomy was perceived as warmer, but less competent and trustworthy than the agent who decided for the patient's beneficence/nonmaleficence. Agents who prioritized beneficence/nonmaleficence and framed the health gains were also perceived as more trustworthy. Our findings contribute to the understanding of moral judgments in the healthcare domain mediated by both healthcare humans and artificial agents.
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Affiliation(s)
- Antonio Soares
- ISCTE-Instituto Universitário de Lisboa, CIS-IUL, Lisboa, Portugal
| | - Nuno Piçarra
- ISCTE-Instituto Universitário de Lisboa, CIS-IUL, Lisboa, Portugal
| | | | - Raquel Oliveira
- ISCTE-Instituto Universitário de Lisboa, CIS-IUL, Lisboa, Portugal
| | - Patrícia Arriaga
- ISCTE-Instituto Universitário de Lisboa, CIS-IUL, Lisboa, Portugal
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Kang WH, Mohamad Sithik MN, Khoo JK, Ooi YG, Lim QH, Lim LL. Gaps in the management of diabetes in Asia: A need for improved awareness and strategies in men's sexual health. J Diabetes Investig 2022; 13:1945-1957. [PMID: 36151988 DOI: 10.1111/jdi.13903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/22/2022] [Accepted: 08/17/2022] [Indexed: 11/28/2022] Open
Abstract
Sexual dysfunction, which is defined as 'difficulty during any stage of the sexual encounter that prevents or impairs the individual or couple from enjoying sexual activity', is globally prevalent in males with prediabetes and diabetes. It is an early harbinger of cardiovascular diseases and has a profound impact on one's physical, mental, and social health. Among patients with either prediabetes or diabetes, the most common male sexual dysfunctions are hypogonadism, erectile dysfunction, and premature ejaculation. In Asia, although sexual health is an important factor of men's health, it is rarely discussed freely in real-life practice. Addressing sexual health in Asian males has always been challenging with multiple barriers at the levels of patients and health care providers. Therefore, the assessment and management of sexual dysfunction in routine clinical practice should involve a holistic approach with effective patient-provider communication. In this review, we discuss the epidemiology, pathophysiology, and the management of hypogonadism, erectile dysfunction, and premature ejaculation among males with either prediabetes or diabetes (type 1 and type 2), as well as the evidence gaps across Asia.
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Affiliation(s)
- Waye-Hann Kang
- Department of Medicine, Faculty of Medicine and Health Sciences, University Tunku Abdul Rahman, Selangor, Malaysia
| | | | - Jun-Kit Khoo
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ying-Guat Ooi
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Quan-Hziung Lim
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Lee-Ling Lim
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.,Asia Diabetes Foundation, Hong Kong SAR, China
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Ansert E, Rushing CJ. The Financial Implications of Being a Female Fellow: Does Another Year Help Close the Gap? J Foot Ankle Surg 2022; 61:991-995. [PMID: 35039197 DOI: 10.1053/j.jfas.2021.12.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 09/29/2021] [Accepted: 12/08/2021] [Indexed: 02/03/2023]
Abstract
In 2018, the American College of Foot and Ankle Surgeons Compensation and Benefits Survey illustrated a wage gap between male and female doctors of podiatric medicine in the United States. The purpose of the present study was to assess if an additional year of fellowship training closes that gap. To calculate the net present value, weighted mean general income data from female doctors of podiatric medicine with and without fellowship training was obtained. Demographic and clinical income data (based on 2080 hours) for 17 female graduates from 14 American College of Foot and Ankle Surgeons recognized fellowship programs was collected using an anonymous online survey. Income from general payments was collected from manual searches of Open Source Payments. Socioeconomic data from the 2018 American College of Foot and Ankle Surgeons compensation and benefits survey was used to calculate the net present value of the nonfellowship trained doctors of podiatric medicine for comparison. Overall, the net present value of female doctors of podiatric medicine with and without fellowship training was $1.91 million and $2.4 million, respectively. The comparative net present value and cumulative net income difference over 30 years for female doctors of podiatric medicine with and without fellowships was -$492,159.00 and -$820,000.00, respectively. The mean comparative income difference for fellowship trained female doctors of podiatric medicine annually was as follows: clinical (-$26,082.00) and general (+$1101.54). Based on the data, with consideration to the limitations of the study, the financial implications of fellowship on the gender wage gap is currently unclear. Additional research is warranted.
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Affiliation(s)
- Elizabeth Ansert
- Resident, PGY-2, St. Vincent Hospital Podiatric Residency Program, Worcester, MA.
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13
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Plug I, van Dulmen S, Stommel W, Olde Hartman TC, Das E. Physicians' and Patients' Interruptions in Clinical Practice: A Quantitative Analysis. Ann Fam Med 2022; 20:423-429. [PMID: 36228066 PMCID: PMC9512556 DOI: 10.1370/afm.2846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/15/2022] [Accepted: 05/04/2022] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Physicians' interruptions have long been considered intrusive, masculine actions that inhibit patient participation, but a systematic analysis of interruptions in clinical interaction is lacking. This study aimed to examine when and how primary care physicians and patients interrupt each other during consultations. METHODS We coded and quantitatively analyzed interruption type (cooperative vs intrusive) in 84 natural interactions between 17 primary care physicians and 84 patients with common somatic symptoms. Data were analyzed using a mixed-effects logistic regression model, with role, gender, and consultation phase as predictors. RESULTS Of the 2,405 interruptions observed, 82.9% were cooperative. Among physicians, men were more likely to make an intrusive interruption than women (β = 0.43; SE, 0.21; odds ratio [OR] = 1.54; 95% CI, 1.03-2.31), whereas among patients, men were less likely to make an intrusive interruption than women (β = -0.35; SE, 0.17; OR = 0.70; 95% CI, 0.50-0.98). Patients' interruptions were more likely to be intrusive than physicians' interruptions in the phase of problem presentation (β = 0.71; SE, 0.23; OR = 2.03; 95% CI, 1.30-3.20), but not in the phase of diagnosis and/or treatment plan discussion (β = -0.17; SE, 0.15; OR = 0.85; 95% CI, 0.63-1.15). CONCLUSIONS Most interruptions in clinical interaction are cooperative and may enhance the interaction. The nature of physicians' and patients' interruptions is the result of an interplay between role, gender, and consultation phase.
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Affiliation(s)
- Ilona Plug
- Centre for Language Studies, Radboud University, Nijmegen, The Netherlands
| | - Sandra van Dulmen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, The Netherlands.,Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands.,Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Wyke Stommel
- Centre for Language Studies, Radboud University, Nijmegen, The Netherlands
| | - Tim C Olde Hartman
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, The Netherlands
| | - Enny Das
- Centre for Language Studies, Radboud University, Nijmegen, The Netherlands
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Saifee DH, Hudnall M, Raja U. Physician Gender, Patient Risk, and Web-Based Reviews: Longitudinal Study of the Relationship Between Physicians' Gender and Their Web-Based Reviews. J Med Internet Res 2022; 24:e31659. [PMID: 35394435 PMCID: PMC9034420 DOI: 10.2196/31659] [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: 06/29/2021] [Revised: 09/02/2021] [Accepted: 03/16/2022] [Indexed: 11/23/2022] Open
Abstract
Background Web-based reviews of physicians have become exceedingly popular among health care consumers since the early 2010s. A factor that can potentially influence these reviews is the gender of the physician, because the physician’s gender has been found to influence patient-physician communication. Our study is among the first to conduct a rigorous longitudinal analysis to study the effects of the gender of physicians on their reviews, after accounting for several important clinical factors, including patient risk, physician specialty, and temporal factors, using time fixed effects. In addition, this study is among the first to study the possible gender bias in web-based reviews using statewide data from Alabama, a predominantly rural state with high Medicaid and Medicare use. Objective This study conducts a longitudinal empirical investigation of the relationship between physician gender and their web-based reviews using data across the state of Alabama, after accounting for patient risk and temporal effects. Methods We created a unique data set by combining data from web-based physician reviews from the popular physician review website, RateMDs, and clinical data from the Center for Medicare and Medicaid Services for the state of Alabama. We used longitudinal econometric specifications to conduct an econometric analysis, while controlling for several important clinical and review characteristics across four rating dimensions (helpfulness, knowledge, staff, and punctuality). The overall rating and these four rating dimensions from RateMDs were used as the dependent variables, and physician gender was the key explanatory variable in our panel regression models. Results The panel used to conduct the main econometric analysis included 1093 physicians. After controlling for several clinical and review factors, the physician random effects specifications showed that male physicians receive better web-based ratings than female physicians. Coefficients and corresponding SEs and P values of the binary variable GenderFemale (1 for female physicians and 0 otherwise) with different rating variables as outcomes were as follows: OverallRating (coefficient –0.194, SE 0.060; P=.001), HelpfulnessRating (coefficient –0.221, SE 0.069; P=.001), KnowledgeRating (coefficient –0.230, SE 0.065; P<.001), StaffRating (coefficient –0.123, SE 0.062; P=.049), and PunctualityRating (coefficient –0.200, SE 0.067; P=.003). The negative coefficients indicate a bias toward male physicians versus female physicians for aforementioned rating variables. Conclusions This study found that female physicians receive lower web-based ratings than male physicians even after accounting for several clinical characteristics associated with the physicians and temporal effects. Although the magnitude of the coefficients of GenderFemale was relatively small, they were statistically significant. This study provides support to the findings on gender bias in the existing health care literature. We contribute to the existing literature by conducting a study using data across the state of Alabama and using a longitudinal econometric analysis, along with incorporating important clinical and review controls associated with the physicians.
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Affiliation(s)
- Danish Hasnain Saifee
- Department of Information Systems, Statistics, and Management Science, The University of Alabama, Tuscaloosa, AL, United States
| | - Matthew Hudnall
- Department of Information Systems, Statistics, and Management Science, The University of Alabama, Tuscaloosa, AL, United States
| | - Uzma Raja
- Department of Systems and Technology, Auburn University, Auburn, AL, United States
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15
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Bert F, Boietti E, Rousset S, Pompili E, Franzini Tibaldeo E, Gea M, Scaioli G, Siliquini R. Gender sensitivity and stereotypes in medical university students: An Italian cross-sectional study. PLoS One 2022; 17:e0262324. [PMID: 34990471 PMCID: PMC8735594 DOI: 10.1371/journal.pone.0262324] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 12/22/2021] [Indexed: 11/19/2022] Open
Abstract
Gender medicine is crucial to reduce health inequalities. Knowledge about students’ attitudes and beliefs regarding men, women and gender is important to improve gender medicine courses. The aim of this study is to evaluate gender stereotypes and its predictors in Italian medical students. We performed an online cross-sectional study among students from the University of Turin. We used the validated Nijmegen Gender Awareness Scale in Medicine scale to explore gender sensitivity and stereotypes. Multivariable logistic regression model was performed to explore potential predictors of gender awareness. We enrolled 430 students. Female sex, a better knowledge on gender medicine and having had a tutor aware of gender issues are associated with higher gender sensitivity. Older age, a better knowledge on gender medicine and having had a tutor sensitive to gender issues were predictors of more stereotyped opinions towards patients. Having had a tutor aware of gender medicine, male sex and older age were associated with more stereotypes towards doctors. Italian students have high gender sensitivity and low gender stereotypes. Age, higher knowledge of gender medicine and having had a tutor that considered gender were associated with higher gender stereotypes. Focusing on gender awareness in medical schools can contribute to a better care.
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Affiliation(s)
- Fabrizio Bert
- Department of Public Health Sciences, University of Turin, Turin, Italy
| | - Edoardo Boietti
- Department of Public Health Sciences, University of Turin, Turin, Italy
- * E-mail:
| | - Stefano Rousset
- Department of Public Health Sciences, University of Turin, Turin, Italy
| | - Erika Pompili
- Department of Public Health Sciences, University of Turin, Turin, Italy
| | | | - Marta Gea
- Department of Public Health Sciences, University of Turin, Turin, Italy
| | - Giacomo Scaioli
- Department of Public Health Sciences, University of Turin, Turin, Italy
| | - Roberta Siliquini
- Department of Public Health Sciences, University of Turin, Turin, Italy
- AOU City of Health and Science, University of Turin, Turin, Italy
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16
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Ayyash M, Ayyash M, Hassan Z, Farhat A, Rakine H, Blackwood RA. Factors and scenarios influencing Arab Americans’ preference for male versus female physicians. J Natl Med Assoc 2022; 114:199-206. [DOI: 10.1016/j.jnma.2021.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 12/27/2021] [Accepted: 12/31/2021] [Indexed: 11/27/2022]
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17
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Bratland SZ, Baste V, Steen K, Diaz E, Bondevik GT. Physician factors associated with medical errors in Norwegian primary care emergency services. Scand J Prim Health Care 2021; 39:429-437. [PMID: 34615440 PMCID: PMC8725954 DOI: 10.1080/02813432.2021.1973240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE The aim of this study was to examine the associations between characteristics of physicians working in primary care emergency units (PCEUs) and the outcome of assessments of the medical records. DESIGN Data from a previous case-control study was used to evaluate factors related to medical errors. SETTING Ten Norwegian PCEUs were included. SUBJECTS Physicians that had evoked a patient complaint, and a random sample of three physicians from the same PCEU and time period as the physician who had evoked a complaint. Recorded physician characteristics were: gender, seniority, citizenship at, and years after authorization as a physician, specialty in general practice, and workload at the PCEU. Main outcome measures: Assessments of the medical records: errors that may have led to harm, no medical error, or inconclusive. RESULTS In the complaint group 77 physicians were included, and in the random sample group 217. In the first group, 53.2% of the medical records were assessed as revealing medical errors. In the random sample group, this percentage was 3.2. In the complaint group the percentages for no-error and inconclusive for the female physicians were 30.8 and 15.4; and for the male physicians 9.8 and 27.3, p = 0.027. CONCLUSION In the group of complaints there was a higher percentage with no assessed medical error, and a lower percentage with inconclusive assessments of medical errors, among female physicians compared to their male colleagues. We found no other physician factors that were associated with assessed medical errors. Future research should focus on the underlying elements of these findings.Key pointsMedical errors are among the leading causes of death and they are essentially avoidable. Primary care emergency units are a vulnerable arena for committing medical errors.By assessing the medical records of a group of physicians who had evoked a complaint, no differences related to physician factors were revealed in the incidence of medical errors.In the group of female physicians, the proportion of no-errors, was higher, and the percentage of inconclusive medical records was lower than for their male colleagues.The Norwegian regulations on independent participation in PCEUs may have modulated these results.
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Affiliation(s)
- Svein Zander Bratland
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
- CONTACT Svein Zander Bratland National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
| | - Valborg Baste
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
| | - Knut Steen
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
| | - Esperanza Diaz
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Norway & Unit for Migration and Health, Norwegian Institute of Public Health Oslo, Bergen, Norway
| | - Gunnar Tschudi Bondevik
- Department of Global Public Health and Primary Care, University of Bergen & National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
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18
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Ballering AV, Muijres D, Uijen AA, Rosmalen JGM, Olde Hartman TC. Sex differences in the trajectories to diagnosis of patients presenting with common somatic symptoms in primary care: an observational cohort study. J Psychosom Res 2021; 149:110589. [PMID: 34385033 DOI: 10.1016/j.jpsychores.2021.110589] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Little insight exists into sex differences in diagnostic trajectories for common somatic symptoms. This study aims to quantify sex differences in the provided primary care diagnostic interventions for common somatic symptoms, as well as the consequences hereof for final diagnoses. METHODS In this observational cohort study, we used real-world clinical data from the Dutch Family Medicine Network (N = 34,268 episodes of care related to common somatic symptoms; 61,4% female). The association between patients' sex on the one hand, and diagnostic interventions and disease diagnoses on the other hand, were assessed using multilevel multiple logistic regression analyses. Structural equation modelling was used to estimate a mediation model with multiple parallel mediators to assess whether the fewer disease diagnoses given to female patients were mediated by the fewer diagnostic interventions female patients receive, compared to male patients. RESULTS Women received fewer physical examinations (OR = 0.84, 95%CI = 0.79-0.89), diagnostic imaging (OR = 0.92, 95%CI = 0.84-0.99) and specialist referrals (OR = 0.85, 95%CI = 0.79-0.91) than men, but more laboratory diagnostics (OR = 1.27, 95%CI = 1.19-1.35). Women received disease diagnoses less often than men for their common somatic symptoms (OR = 0.94, 95%CI = 0.89-0.98). Mediation analysis showed that the fewer disease diagnosis in female patients were mediated by the fewer diagnostic interventions conducted in women compared to men. CONCLUSION This study shows that sex inequalities are present in primary care diagnostic trajectories of patients with common somatic symptoms and that these lead to unequal health outcomes in terms of diagnoses between women and men. FPs have to be aware of these inequalities to ensure equal high-quality care for all patients.
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Affiliation(s)
- Aranka V Ballering
- University of Groningen, University Medical Center of Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Groningen, the Netherlands, P.O. Box 30.001, 9700, RB, Groningen, the Netherlands.
| | - Daan Muijres
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands. P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands.
| | - Annemarie A Uijen
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands. P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands.
| | - Judith G M Rosmalen
- University of Groningen, University Medical Center of Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Groningen, the Netherlands, P.O. Box 30.001, 9700, RB, Groningen, the Netherlands.
| | - Tim C Olde Hartman
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands. P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands.
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19
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Kadji K, Schmid Mast M. The effect of physician self-disclosure on patient self-disclosure and patient perceptions of the physician. PATIENT EDUCATION AND COUNSELING 2021; 104:2224-2231. [PMID: 33775499 DOI: 10.1016/j.pec.2021.02.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 02/01/2021] [Accepted: 02/08/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Physician self-disclosure is typically seen as patient-centered communication because it creates rapport and is seen as an expression of empathy. Given that many physician behaviors affect patients differently depending on whether they are shown by a female or male physician, we set out to test whether physician self-disclosure affects patients' intentions to self-disclose and patients' perceptions of their physicians depending on physicians' gender. METHOD Two hundred and forty-four participants were recruited and randomly assigned to read one of 4 vignettes as if they were the patient in the dialogue (analogue patient design). They were then asked to report how they would react to the physician and how they perceived the him or her. RESULTS Physicians who self-disclosed were perceived as more empathic than physicians who did not, regardless of physician and patient gender. Physician self-disclosure had an effect on the behavioral intentions of the analogue patients, and this was moderated by physician gender. Analogue patients indicated to be more willing to self-disclose to female than to male physicians who self-disclosed. CONCLUSION It is important to consider physician gender when training physicians in patient-centered communication because the same behavior can have different effects on patients depending on whether it originates from a female or a male physician. PRACTICAL IMPLICATIONS Physicians can use self-disclosure to express empathy. When female physicians do so, they might obtain more personal information from patients, which can positively affect diagnosis and treatment.
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Affiliation(s)
- Keou Kadji
- Department of Organizational Behavior, University of Lausanne, HEC, Switzerland.
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20
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Sergeant A, Saha S, Shin S, Weinerman A, Kwan JL, Lapointe-Shaw L, Tang T, Hawker G, Rochon PA, Verma AA, Razak F. Variations in Processes of Care and Outcomes for Hospitalized General Medicine Patients Treated by Female vs Male Physicians. JAMA HEALTH FORUM 2021; 2:e211615. [PMID: 35977207 PMCID: PMC8796959 DOI: 10.1001/jamahealthforum.2021.1615] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 05/22/2021] [Indexed: 12/17/2022] Open
Affiliation(s)
| | | | - Saeha Shin
- Unity Health Toronto, Toronto, Ontario, Canada
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21
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Lazcano-Ponce E, Angeles-Llerenas A, Rodríguez-Valentín R, Salvador-Carulla L, Domínguez-Esponda R, Astudillo-García CI, Madrigal-de León E, Katz G. Communication patterns in the doctor-patient relationship: evaluating determinants associated with low paternalism in Mexico. BMC Med Ethics 2020; 21:125. [PMID: 33302932 PMCID: PMC7731770 DOI: 10.1186/s12910-020-00566-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 12/01/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Paternalism/overprotection limits communication between healthcare professionals and patients and does not promote shared therapeutic decision-making. In the global north, communication patterns have been regulated to promote autonomy, whereas in the global south, they reflect the physician's personal choices. The goal of this study was to contribute to knowledge on the communication patterns used in clinical practice in Mexico and to identify the determinants that favour a doctor-patient relationship characterized by low paternalism/autonomy. METHODS A self-report study on communication patterns in a sample of 761 mental healthcare professionals in Central and Western Mexico was conducted. Multiple ordinal logistic regression models were used to analyse paternalism and associated factors. RESULTS A high prevalence (68.7% [95% CI 60.0-70.5]) of paternalism was observed among mental health professionals in Mexico. The main determinants of low paternalism/autonomy were medical specialty (OR 1.67 [95% CI 1.16-2.40]) and gender, with female physicians being more likely to explicitly share diagnoses and therapeutic strategies with patients and their families (OR 1.57 [95% CI 1.11-2.22]). A pattern of highly explicit communication was strongly associated with low paternalism/autonomy (OR 12.13 [95% CI 7.71-19.05]). Finally, a modifying effect of age strata on the association between communication pattern or specialty and low paternalism/autonomy was observed. CONCLUSIONS Among mental health professionals in Mexico, high paternalism prevailed. Gender, specialty, and a pattern of open communication were closely associated with low paternalism/autonomy. Strengthening health professionals' competencies and promoting explicit communication could contribute to the transition towards more autonomist communication in clinical practice in Mexico. The ethical implications will need to be resolved in the near future.
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Affiliation(s)
- Eduardo Lazcano-Ponce
- Population Health Research Centre, National Institute of Public Health, Cuernavaca, Morelos, Mexico.,Centre for Mental Health Research, Australian National University, Canberra, Australia
| | - Angelica Angeles-Llerenas
- Population Health Research Centre, National Institute of Public Health, Cuernavaca, Morelos, Mexico. .,Research Ethics Committee, National Institute of Public Health, Cuernavaca, Morelos, Mexico.
| | - Rocío Rodríguez-Valentín
- Population Health Research Centre, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Luis Salvador-Carulla
- Centre for Mental Health Research, Australian National University, Canberra, Australia
| | | | | | - Eduardo Madrigal-de León
- Hospital Director at the National Institute of Psychiatry Ramón de La Fuente Muñiz, Mexico City, Mexico
| | - Gregorio Katz
- Department of Mental Health, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
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Chandra S, Mohammadnezhad M. Investigating factors influencing patient trust in a developing Pacific Island Country, Fiji, 2018. Heliyon 2020; 6:e05680. [PMID: 33319117 PMCID: PMC7723801 DOI: 10.1016/j.heliyon.2020.e05680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 10/08/2020] [Accepted: 12/03/2020] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION In spite of the current evidence on positive impacts of patient trust on health outcomes, there are limited studies carried out in Pacific Island countries. This qualitative study aimed to explore the factors associated with patient trust in their doctors in Fiji. MATERIALS AND METHODS With use of grounded theory research design, twenty participants attending the outpatient department of the health centers in the Suva Sub-division, Fiji were recruited. Audio-recorded in-depth interview was conducted using a semi-structured questionnaire. Transcribed data were analyzed using manual thematic analysis. RESULT This study showed that interpersonal skills, communication skills, overall attitude and approach (customer care), clinical skills, improving health literacy and patient centred care were some of the factors influencing the level of trust patients had in their doctors. Though, together with communication and explanation, performing physical examination seemed to be bigger influencer of patient trust. CONCLUSION It can be concluded that developing policies to improve doctors' communication skills, clinical skills, patients' health literacy and customer care in Fiji can lead to better patient trust in their doctors.
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Affiliation(s)
- Swastika Chandra
- School of Public Health and Primary Care, Fiji National University, Suva, Fiji
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23
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Ünsal Adaca A, Başağaç Gül RT. First Experimental Study in Turkey Teaches Veterinary Students How to Break Bad News. JOURNAL OF VETERINARY MEDICAL EDUCATION 2020; 47:720-727. [PMID: 32053055 DOI: 10.3138/jvme.2019-0030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The importance of communication skills in veterinary medicine has been increasing for a long time. The aim of this article is to investigate how theoretical training, role-playing, and standardized/simulated client (SC) methods improve senior (fifth-year) veterinary students' skills in breaking bad news. The study was carried out with 67 volunteer senior students. The research was designed from a pre-test and post-test control group pattern. All students encountered the SC. After pre-tests, theoretical training was given to Experimental Group A (EGA) and Experimental Group B (EGB). Then, only the students in EGA role-played together. Each student completed a checklist consisting of 10 basic items after pre-tests and post-tests. After post-tests, focus group interviews with open-ended questions were conducted. In the pairwise comparisons, EGA's and EGB's adjusted post-test mean scores were significantly higher than the control group's (p < .001). EGA's and EGB's post-test scores were found to be significantly higher than their pre-test scores. Women's empathy and eye contact scores were found to be statistically higher than men's scores. This study is the first of its kind in Turkey to use SCs and peer-to-peer learning with role-play simulations in training students about breaking bad news in veterinary medicine. These findings show that theoretical training and role-playing has an impact on senior veterinary students' skills in breaking bad news.
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Chandra S, Ward P, Mohammadnezhad M. Investigating Patient Trust in Doctors: A Cross-Sectional Survey of Out-Patient Departments in Fiji. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2020; 41:369-377. [PMID: 33086937 DOI: 10.1177/0272684x20967602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Despite evidence on the positive impact of trust in a doctor-patient relationship on health outcomes, there are limited studies conducted in Pacific Island Countries including Fiji. This study was conducted to assess the current level of patient trust in doctors and investigate its determinants in Fiji. Method: A random sample of 410 participants attending the outpatient services completed the self-administered structured questionnaire. The response rate was 91% (N=375) and data was analyzed using descriptive statistics and analytic analysis using logistic regression. Result: Mean age of participants was 38years (±15yrs). The majority of patients had partial trust in their doctors compared to full trust (61.6% vs 38.4%). More than half of the participants perceived doctor's communication behavior as fair rather than good (53.6% vs 45.6%). Those over 50 years (OR 1.96; p=0.007, 95% CI: 1.198-3.226) and those who perceived doctors' communication behavior as good (OR 8.48; p=0.0001, 95% CI: 5.257-13.709) were significantly more likely to have full trust in the doctors. Conclusion: This study reveals that age and communication are determinants of trust in Fiji. In view of the current perception of the doctors' communication behavior, Fiji's Ministry of Health and Medical Services should implement policies to give equal importance to the communication skills of the doctors together with their clinical skills and enforce it in the medical schools.
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Affiliation(s)
- Swastika Chandra
- School of Public Health and Primary Care, Fiji National University, Suva, Fiji Island
| | - Paul Ward
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Masoud Mohammadnezhad
- School of Public Health and Primary Care, Fiji National University, Suva, Fiji Island
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25
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Świątoniowska-Lonc N, Białoszewski A, Makoul G, Jankowska-Polańska B. Translation and Cultural Adaptation of the Polish Version of the Communication Assessment Tool (CAT). Risk Manag Healthc Policy 2020; 13:1533-1542. [PMID: 32982511 PMCID: PMC7501465 DOI: 10.2147/rmhp.s261710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/22/2020] [Indexed: 11/23/2022] Open
Abstract
Background and Objective Adequate communication skills are the core competency of healthcare providers for optimal patient interaction and relationships based on mutual trust. Unfortunately, there are still few publications assessing the type and effectiveness of therapeutic communication, and there are no tools to facilitate the standard, regular evaluation of the process. The objective of this study was the translation and cultural adaptation of a Polish version of the 14-item Communication Assessment Tool (CAT) to assess the interpersonal and communication skills of physicians and to identify determinants influencing the quality of communication. Design It is an exploratory and cross-sectional survey design. The patients completed a survey consisted of the CAT. Socio-demographic data were obtained from the hospital register. Setting Hypertension clinic at the clinical hospital in Wrocław. Participants A total of 300 patients with diagnosed hypertension were selected. Of these, 50 patients were excluded (mental illness, cognitive impairment, resignation). A total of 250 people (61.23±14.34 years) participated in the study. Qualification for the study was carried out by a trained doctor, who is an internal medicine specialist. Main Measure Outcome Translation and cultural adaptation of Polish CAT. Results Cronbach’s alpha for the CAT is 0.96 and does not require the exclusion of any items to increase its value. The loadings of the individual items ranged from 0.725 to 0.894. At the item level, results ranged from 28.4% to 50.4% “excellent”, the highest scores were given to “let me talk without interruptions” (50.4%) and “talked in terms I could understand” (47.6%). The correlation analysis showed a modestly positive statistical effect of the duration of a medical visit (r=0.225) and the time spent on talking about patient’s problems (r=0.23) with the general result of the CAT questionnaire (p<0.001). Conclusion The CAT is a very good tool for assessing the quality of communication in Polish-speaking settings and can be recommended for use in everyday practice.
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Affiliation(s)
| | - Artur Białoszewski
- Department of Prevention of Environmental Hazards and Allergology, Warsaw Medical University, Warsaw, Poland
| | - Gregory Makoul
- PatientWisdom, Inc., New Haven, CT, USA.,Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Beata Jankowska-Polańska
- Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
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Bratland SZ, Baste V, Steen K, Diaz E, Gjelstad S, Bondevik GT. Physician factors associated with increased risk for complaints in primary care emergency services: a case - control study. BMC FAMILY PRACTICE 2020; 21:201. [PMID: 32977768 PMCID: PMC7519491 DOI: 10.1186/s12875-020-01272-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 09/15/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Patient safety incidents defined as any unintended or unexpected incident that could have or were judged to have led to patient harm, are reported as relatively common. In this study patient complaints have been used as an indicator to uncover the occurrence of patient safety incidents in primary care emergency units (PCEUs) in Norway. METHODS Ten PCEUs in major cities and rural parts of Norway participated. These units cover one third of the Norwegian population. A case-control design was applied. The case was the physician that evoked a complaint. The controls were three randomly chosen physicians from the same PCEU as the physician having evoked the complaint. The following variables regarding the physicians were chosen: gender, citizenship at, and years after authorization as physician, and specialty in general practice. The magnitude of patient contact was defined as the workload at the PCEU. The physicians' characteristics and workload were extracted from the medical records from the fourteen-day period prior to the consultation that elicited the complaint. The rest of the variables were then obtained from the Norwegian physician position register. Logistic regression was used to estimate odds ratio for complaints both unadjusted and adjusted for the independent variables. The data were analyzed using SPSS (Version25) and STATA. RESULTS A total of 78 cases and 217 controls were included during 18 months (September 1st 2015 till March 1st 2017). The risk of evoking a complaint was significantly higher for physicians without specialty in general practice, and lower for those with medium low and medium high workload compared to physicians with no duty during the fourteen-day period prior to the index consultation. The limited strength of the study did not make it possible to assess any correlation between workload and the other variables (physician's gender, seniority and citizenship at time of authorization). CONCLUSIONS Continuous medical training and achieving the specialty in general practice were decisively associated with a reduced risk for complaints in primary care emergency services. Future research should focus on elements promoting quality of care such as continuing education, duty rosters and other structural and organizational factors.
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Affiliation(s)
- Svein Zander Bratland
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Kalfarveien 31, N-5018, Bergen, Norway.
| | - Valborg Baste
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Kalfarveien 31, N-5018, Bergen, Norway
| | - Knut Steen
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Kalfarveien 31, N-5018, Bergen, Norway
| | - Esperanza Diaz
- Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, N-5018, Bergen, Norway.,Unit for Migration and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Svein Gjelstad
- Department of General Practice, University of Oslo, Kirkeveien 166, Fredrik Holsts hus, N-0450, Oslo, Norway
| | - Gunnar Tschudi Bondevik
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Kalfarveien 31, N-5018, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, N-5018, Bergen, Norway
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THE EVALUATION OF BURNOUT AND COMMUNICATİON SKILLS IN PRIMARY CARE STAFF. INTERNATIONAL JOURNAL OF HEALTH SERVICES RESEARCH AND POLICY 2020. [DOI: 10.33457/ijhsrp.735875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Luna A, Price A, Srivastava U, Chu LF. Critical patient insights from the same-day feedback programme at Stanford Health Care. BMJ Open Qual 2020; 9:e000773. [PMID: 32816863 PMCID: PMC7430334 DOI: 10.1136/bmjoq-2019-000773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 05/29/2020] [Accepted: 06/09/2020] [Indexed: 11/28/2022] Open
Abstract
PATIENT-CENTERED ORGANISATIONS Healthcare organisations now integrate patient feedback into value-based compensation formulas. This research considered Stanford Healthcare's same-day feedback, a programme designed to evaluate the patient experience. Specifically, how did patients with cancer interviewed in the programme assess their physicians? Furthermore, how did assessments differ across emotional, physical, practical and informational needs when interviewed by volunteer patient and family partners (PAFPs) versus hospital staff? PATIENT-PHYSICIAN COMMUNICATION BARRIERS Integral to this research was Communication Accommodation Theory (CAT), which suggests individuals adjust interactions based on conversational roles, needs and understanding. Previous influential research was conducted by Frosch et al (2012) and Di Bartolo et al (2017), who revealed barriers to patient-physician communication, and Baker et al (2011) who associated CAT with these interactions. However, we still did not know if patients alter physician assessments between interviewers. VOLUNTEERS COLLECT PATIENT NEEDS This mixed methods study worked with 190 oncology unit patient interviews from 2009 to 2017. Open-ended interview responses underwent thematic analysis. When compared with hospital staff, PAFPs collected more practical and informational needs from patients. PAFPs also collected more verbose responses that resembled detailed narratives of the patients' hospital experiences. This study contributed insightful patient perspectives of physician care in a novel hospital programme.
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Affiliation(s)
- Alessandro Luna
- MD Program, Columbia University College of Physicians and Surgeons, New York, New York, USA
- Alumnus, Department of Human Biology, Stanford University, Stanford, California, USA
| | - Amy Price
- Senior Research Scientist, Stanford Anesthesia Informatics and Media Lab, Stanford University School of Medicine, Stanford, California, USA
| | - Ujwal Srivastava
- Undergraduate Student, Stanford University, Stanford, California, USA
- Research Assistant, Stanford Medicine X Program, Stanford University School of Medicine, Stanford, California, USA
| | - Larry F Chu
- Professor, Department of Anesthesiology, Perioperative and Pain Medicine; Executive Director, Stanford Medicine X Program; Director, Stanford Anesthesia Informatics and Media Lab, Stanford University School of Medicine, Stanford, California, USA
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Elsner S, Juergensen M, Faust E, Niesel A, Pedersen LS, Rudnicki PM, Waldmann A. Urinary incontinence in women: treatment barriers and significance for Danish and German GPs. Fam Pract 2020; 37:367-373. [PMID: 31758169 DOI: 10.1093/fampra/cmz077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Female urinary incontinence (UI) is common. Only scant information exists on the significance of UI for GPs' consultations. OBJECTIVES (i) To assess the significance of female UI for GPs and to look at barriers that could be detrimental to treatment by comparing GPs from Denmark and Germany, with different health systems and access to UI guidelines. (ii) To assess whether GPs' gender and age were relevant to the discussion of UI. METHODS We conducted a cross-sectional survey. In the Fehmarn belt-region, a Danish-German border region, a self-developed questionnaire was sent to all the GPs (n = 930). RESULTS In total, 407 GPs returned the questionnaire (43%); 403 questionnaires were analysed. Using a scale from 0 (never) to 10 (always), addressing UI was reported with an average score of 3.8 (SD: 2.1) among Danish and 3.5 (SD: 2.1) among German GPs. The topic was discussed more frequently with female (4.2; SD 2.2) than with male GPs (3.2; SD 2.0). Danish GPs estimated the prevalence among their female patients at 10% (SD: 8.0) and German GPs at 14% (SD: 11.2). 61% of the Danish and 19% of the German GPs used UI guidelines. German GPs significantly more often reported the barrier 'uncertainty of how to treat UI' [OR = 5.39 (95% CI: 2.8; 10.4)]. CONCLUSIONS In consultations with female GPs, UI was discussed significantly more frequently than with male GPs. Compared with the Danish GPs, German GPs stated significantly more uncertainties regarding UI treatment measures, and tended not to use UI guidelines.
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Affiliation(s)
- Susanne Elsner
- Institute for Social Medicine and Epidemiology, Lübeck, Germany
| | - Martina Juergensen
- Institute for the History of Medicine and Science Studies, University of Lübeck, Lübeck, Germany
| | - Elke Faust
- Gynäkologische Praxisklinik, Hamburg, Germany
| | | | | | | | - Annika Waldmann
- Institute for Social Medicine and Epidemiology, Lübeck, Germany.,Hamburg Cancer Registry, Hamburg, Germany
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Rugema L, Persson M, Mogren I, Ntaganira J, Krantz G. A qualitative study of healthcare professionals' perceptions of men and women's mental healthcare seeking in Rwanda. JOURNAL OF COMMUNITY PSYCHOLOGY 2020; 48:891-903. [PMID: 31944336 DOI: 10.1002/jcop.22308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/27/2019] [Accepted: 12/03/2019] [Indexed: 06/10/2023]
Abstract
This study aimed to explore health care professionals (HCP') perceptions about mental-health-seeking behaviours in men and women and its social and gender implications in Rwanda. Six focus group discussions including 43 HCPs working at mental health facilities and district hospitals in Rwanda were conducted. Data were analysed using qualitative content analysis. The emerging theme "Traditional gender role patterns and stigma are displayed in mental health care seeking, adherence to treatment and family effects" illustrated how HCPs perceived gender differences and outcomes in mental healthcare seeking. The theme was based on three categories: "Gender differences in health care seeking patterns," "Gender roles and stigma affect adherence to counselling and treatment," and "Gender roles exert an influence on family support" and related subcategories, with which each described various aspects contributing to the result. According to HCPs who regularly encountered people with mental health problems, neither men nor women with mental health problems could adequately benefit from the available mental health services because of the strong influence stigma and prevailing traditional gender roles had on men's and women's mental-healthcare-seeking behaviour. There is an urgent need for comprehensive societal interventions involving policy makers, HCPs, and the general population to diminish the stigma tied to mental illness and the traditional gender norms that negatively influence healthcare-seeking patterns; such actions can improve the health of many citizens.
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Affiliation(s)
- Lawrence Rugema
- Department of Community Health, School of Public health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Department of Public Health and Community Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Ingrid Mogren
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
| | - Joseph Ntaganira
- Department of Community Health, School of Public health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Gunilla Krantz
- Department of Public Health and Community Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Abstract
Objective: The recent rise in ADHD has prompted concerns about adolescents with ADHD diverting and/or misusing stimulants. This is the first study to assess physician perceptions of the pervasiveness of these issues. Method: Questionnaires were mailed to a national sample of pediatric subspecialists. Responses were analyzed (n = 826; 18% response rate) using descriptive statistics and regression analyses. Results: In the past year, 59% of physicians suspected ≥1 patient(s) with ADHD diverted stimulants. Seventy-four percent believed ≥1 patient(s) feigned symptoms to obtain an initial ADHD diagnosis; 66% believed ≥1 patient(s) wanted stimulants to improve academic performance. Child and adolescent psychiatrists were most likely to suspect diversion and feigning symptoms. Thirty-nine percent of physicians believed diversion was at least "common." Conclusion: Although many physicians suspected stimulant diversion and misuse, a substantial number were unaware of these issues, and subspecialist perceptions varied. These findings support the potential pervasiveness of these issues and the need for increased physician awareness.
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Affiliation(s)
| | - Sarah A Keim
- Nationwide Children's Hospital, Columbus, OH, USA
| | - Andrew Adesman
- Cohen Children's Medical Center of New York, New Hyde Park, NY, USA
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Chandra S, Ward P, Mohammadnezhad M. Factors Associated With Patient Satisfaction in Outpatient Department of Suva Sub-divisional Health Center, Fiji, 2018: A Mixed Method Study. Front Public Health 2019; 7:183. [PMID: 31312630 PMCID: PMC6614334 DOI: 10.3389/fpubh.2019.00183] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 06/17/2019] [Indexed: 02/05/2023] Open
Abstract
Background: With evolving health care industry toward patient centered orientation, inputs from the patients' perspective is valuable. Improved patient satisfaction is associated with increased levels of adherence to treatment processes and recommended prevention, and improved health outcomes. Hence, this study was conducted to assess the current level of patient satisfaction and explore its determinants in the Suva Subdivision health centers, Fiji, 2018. Methods: This was a mixed method cross-sectional study employing both quantitative and qualitative designs. A random sample of 410 participants attending the outpatient services completed the self-administered structured questionnaire. The questionnaire focused on socio-demographic features, waiting time, doctors' communication, and patient trust. Data from 375 questionnaires (response rate of 91%) was analyzed in SPSS where descriptive analysis and univariate and multivariate logistic regression was done at 0.05 level of significance and 95% confidence interval to find the determinants of patient satisfaction. From these 375 participants, 20 participants were purposefully selected for audio recorded interview guided by a semi-structured questionnaire and data was analyzed using thematic analysis. Results: The majority of the patients were generally fully satisfied with their consultation (69.3%). Univariate logistic regression showed that age, gender, education level, waiting time, doctors' communication behavior, and patient trust level were significantly associated with patient satisfaction independently. After controlling for all the variables, gender, number of visits, waiting time, and patient trust were significantly associated with trust. Those who had full trust in the doctors, were more likely to be fully satisfied with their consultation (aOR of 18; p = 0.0001) and those who got seen within 1 h, were more likely to be satisfied with their consultation (aOR of 3.3; p = 0.0001). Though, the patients voiced that getting a satisfying consultation was worth the wait. The doctors' attitude and way of communication also made a difference to the patient's level of satisfaction. Conclusions: This study showed that patient satisfaction is positively associated with patient trust, doctors' interpersonal skills and communication behavior and negatively associated with waiting time. Hence, doctors upgrading their communication skills and health service managers strategizing ways to improve waiting time can contribute to better patient trust and thus lead to better patient satisfaction and positively influence health outcomes.
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Affiliation(s)
- Swastika Chandra
- Department of Public Health, School of Public Health and Primary Care, Fiji National University, Suva, Fiji
| | - Paul Ward
- Department of Public Health, School of Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Masoud Mohammadnezhad
- Department of Public Health, School of Public Health and Primary Care, Fiji National University, Suva, Fiji
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Tzeng H, Okpalauwaekwe U, Feng C, Jansen SL, Barker A, Yin C. Exploring associations between older adults' demographic characteristics and their perceptions of self-care actions for communicating with healthcare professionals in southern United States. Nurs Open 2019; 6:1133-1142. [PMID: 31367439 PMCID: PMC6650656 DOI: 10.1002/nop2.315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 04/19/2019] [Accepted: 04/29/2019] [Indexed: 11/09/2022] Open
Abstract
AIMS This study examined associations between older adults' demographic factors and their perceived importance of, desire to and ability to perform seven self-care behaviours for communicating with healthcare professionals. DESIGN This cross-sectional survey study analysed subset data of 123 older adults 65 years and older, living in southern United States. METHODS The Patient Action Inventory for Self-Care (57 items, grouped into 11 categories) was used to collect self-reported self-care data. Demographic characteristics were also collected. Descriptive statistics and logistic regression analyses were used to tests for relationships between the variables relevant to the research objective. RESULTS Regression findings showed that separated older adults felt less able to share ideas about their healthcare experiences compared to married older adults. Male older adults reported less desire to list issues to discuss and less desire to share ideas about their care experience with their healthcare professionals compared to their female counterparts.
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Affiliation(s)
- Huey‐Ming Tzeng
- School of NursingThe University of Texas Medical BranchGalvestonTexas
| | | | - Cindy Feng
- School of Public HealthUniversity of SaskatchewanSaskatoonSaskatchewanCanada
| | | | - Anne Barker
- Whitson‐Hester School of NursingTennessee Technological UniversityCookevilleTennessee
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Clinical Approach in Youth Sports Medicine: Patients' and Guardians' Desired Characteristics in Sports Medicine Surgeons. J Am Acad Orthop Surg 2019; 27:479-485. [PMID: 31232794 DOI: 10.5435/jaaos-d-18-00263] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Adolescent athletes' and their guardians' preferences for sports medicine surgeon characteristics are unknown. METHODS Unique, anonymous surveys regarding preferences in characteristics of sports medicine surgeons were given to both patients (aged 10 to 18 years) and their guardians before being seen by a sports medicine surgeon. RESULTS Patients and their guardians reported shared decision making as the most important surgeon characteristic, followed by understanding patients' sports and goals. A higher percentage of male patients than female patients had a surgeon sex preference (P = 0.005); however, for both the groups, this ranked lower than other surgeon qualities. Nearly all respondents reported that the adolescent patient should be involved in medical decision making; yet, physician selection was determined by the guardian 65% of the time. CONCLUSIONS Both adolescent patients and their guardians reported shared decision making and understanding patients' sports and goals as surgeon qualities that were more important to them than surgeon sex. LEVEL OF EVIDENCE Level IV, cross-sectional study.
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AbuTaleb NI, Dashti TA, Alasfour SM, Elshazly M, Kamel MI. Knowledge and perception of domestic violence among primary care physicians and nurses: A comparative study. ALEXANDRIA JOURNAL OF MEDICINE 2019. [DOI: 10.1016/j.ajme.2011.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Affiliation(s)
| | | | | | - Medhat Elshazly
- Department of Health Information and Medical Records, Ministry of Health , Kuwait
| | - Mohamed I. Kamel
- Community Medicine Department, Faculty of Medicine , Alexandria University , Alexandria, Egypt
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Alsafy NN, Alhendal ES, Alhawaj SH, El-Shazly MK, Kamel MI. Knowledge of primary care nurses regarding domestic violence. ALEXANDRIA JOURNAL OF MEDICINE 2019. [DOI: 10.1016/j.ajme.2011.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Affiliation(s)
| | | | - Shurooq H. Alhawaj
- Head of East Sabahiya Clinic Al-Ahmadi Health Region Ministry of Health Kuwait
| | - Medhat K. El-Shazly
- Department of Medical Statistics Medical Research Institute Alexandria University Egypt
- Department of Health Information and Medical Records Ministry of Health Kuwait
| | - Mohamed I. Kamel
- Community Medicine Department Faculty of Medicine Alexandria University Egypt
- Department of Occupational Medicine Ministry of Health Kuwait
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Mainardi GM, Cassenote AJF, Guilloux AGA, Miotto BA, Scheffer MC. What explains wage differences between male and female Brazilian physicians? A cross-sectional nationwide study. BMJ Open 2019; 9:e023811. [PMID: 31048423 PMCID: PMC6502025 DOI: 10.1136/bmjopen-2018-023811] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE In many countries an increase in the number of women in medicine is accompanied by gender inequality in various aspects of professional practice. Women in medical workforce usually earn less than their male counterparts. The aim of this study was to describe the gender wage difference and analyse the associated factors in relation to Brazil's physicians. PARTICIPANTS 2400 physicians. SETTING Nationwide, cross-sectional study conducted in 2014. METHODS Data were collected via a telephone enquiry. Sociodemographic and work characteristics were considered factors, and monthly wages (only the monthly earnings based on a medical profession) were considered as the primary outcome. A hierarchical multiple regression model was used to study the factors related to wage differences between male and female physicians. The adjustment of different models was verified by indicators of residual deviance and the Akaike information criterion. Analysis of variance was used to verify the equality hypothesis subsequently among the different models. RESULTS The probability of men receiving the highest monthly wage range is higher than women for all factors. Almost 80% of women are concentrated in the three lowest wage categories, while 51% of men are in the three highest categories. Among physicians working between 20 and 40 hours a week, only 2.7% of women reported receiving >US$10 762 per month, compared with 13% of men. After adjustment for work characteristics in the hierarchical multiple regression model, the gender variable estimations (ß) remained, with no significant modifications. The final effect of this full model suggests that the probability of men receiving the highest salary level (≥US$10 762) is 17.1%, and for women it is 4.1%. Results indicate that a significant gender wage difference exists in Brazil. CONCLUSION The inequality between sexes persisted even after adjusting for working factors such as weekly workload, number of weekly on-call shifts, physician office work, length of practice and specialisation.
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Affiliation(s)
| | | | | | - Bruno A Miotto
- Medicina Preventiva, Universidade de Sao Paulo Faculdade de Medicina, Sao Paulo, Brazil
| | - Mario Cesar Scheffer
- Medicina Preventiva, Universidade de Sao Paulo Faculdade de Medicina, Sao Paulo, Brazil
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Ashton-James CE, Tybur JM, Grießer V, Costa D. Stereotypes about surgeon warmth and competence: The role of surgeon gender. PLoS One 2019; 14:e0211890. [PMID: 30811457 PMCID: PMC6392236 DOI: 10.1371/journal.pone.0211890] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 01/22/2019] [Indexed: 01/26/2023] Open
Abstract
Past research indicates that patient perceptions of surgeon warmth and competence influence treatment expectancies and satisfaction with treatment outcomes. Stereotypes have a powerful impact on impression formation. The present research explores stereotypes about surgeon warmth and competence and investigates the extent to which surgeon gender influences perceptions of female and male surgeons. A between-subjects experiment was conducted online using crowdsourcing technology to derive a representative sample from the general population. Four hundred and fifteen participants were randomly assigned to evaluate the warmth and competence of males, females, surgeons, male surgeons, or female surgeons, using validated measures. Planned contrasts revealed that as a group, surgeons received higher warmth and competence ratings than non-surgeons (p = .007). Consistent with gender stereotypes, female surgeons received higher warmth ratings (p < .001) and lower competence ratings (p = .001) than male surgeons. The stereotype of surgeons held by the general public is that they are high in warmth and competence relative to other occupational groups. Surgeon gender appears to influence general beliefs about the warmth and competence of female and male surgeons.
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Affiliation(s)
- Claire E. Ashton-James
- Pain Management Research Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Department of Experimental and Applied Psychology, VU University Amsterdam, Amsterdam, The Netherlands
| | - Joshua M. Tybur
- Department of Experimental and Applied Psychology, VU University Amsterdam, Amsterdam, The Netherlands
| | - Verena Grießer
- Department of Psychology, Ludwig Maximilian University Munich, Munich, Germany
| | - Daniel Costa
- Pain Management Research Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Sultan WIM, Sultan MIM, Crispim J. Palestinian doctors' views on patient-centered care in hospitals. BMC Health Serv Res 2018; 18:766. [PMID: 30305081 PMCID: PMC6180518 DOI: 10.1186/s12913-018-3573-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 09/27/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Understanding the perceived importance of Patient-Centered Care (PCC) among Palestinian doctors and how the provider and other clinical characteristics may impact their views on PCC is essential to determine the extent to which PCC can be implemented. This study investigates the provision of PCC among hospital doctors in a developing and unstable country, namely, Palestine. METHODS This descriptive, cross-sectional research employed self-report survey among 369 Palestinian doctors working in hospitals in 2016. Respondents completed the Provider-Patient Relationship Questionnaire (PPRQ) and were asked to rate the importance of 16 PCC subjects in a context-free manner. Then they scored the existence of eight contextual attributes in their workplace. RESULTS Although 71.4% of the participants got training in communication, only 45% of the participants knew about PCC. 48.8% of doctors considered the "exchange of information" with patients most important PCC component. Clustering identified three groups of doctors: 32.4% of doctors reported good perceptions of PCC, 47.5% moderate; and 20.1% poor. Older, married, and specialist doctors and those familiar with PCC are more likely classified in the "good" cluster. Results revealed a significant difference between doctors' views based on their gender, experience, marital status, previous knowledge about PCC, and type of hospital in favor of males, experienced, married, familiar with PCC, and doctors in private hospital respectively. The level of job interest, nurses' cooperation, the tendency of patients to hide information, and doctor's friendly style were positively related with more perceived importance of PCC. CONCLUSION We identified benchmark doctors who perceive the high relative importance of PCC. Our results highlighted knowledge gaps and training weaknesses among doctors in public and private hospitals in respect to their views on PCC. Decision makers may invest in the determined contextual predictors to enhance attitudes towards PCC. This work doesn't address patients' views on PCC.
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Affiliation(s)
- Wasim I M Sultan
- School of Administrative Sciences, PPU-Palestine & NIPE-Portugal, Hebron, Palestine.
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Waibel S, Wong ST, Katz A, Levesque JF, Nibber R, Haggerty J. The influence of patient-clinician ethnocultural and language concordance on continuity and quality of care: a cross-sectional analysis. CMAJ Open 2018; 6:E276-E284. [PMID: 30026191 PMCID: PMC6182102 DOI: 10.9778/cmajo.20170160] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Concordance refers to shared characteristics between a clinician and patient, such as ethnicity or language. The purpose of this study was to examine whether patient-clinician concordance is associated with patient-reported continuity of care (relational, informational and management) and patient-reported impacts of care (quality and empowerment). METHODS This is a secondary analysis of cross-sectional patient surveys that were administered across British Columbia, Manitoba and Quebec using random digit dialling. Participants were adults who spoke English, French, Mandarin, Cantonese or Punjabi and who had visited a primary care clinician in the previous 12 months (n = 3156). Patients self-identified as being of European, Chinese, South Asian and Indigenous descent. Outcome measures included patients' perceptions of continuity, quality and empowerment. Adjusted logistic regression models and odds ratio were generated. RESULTS More than 64% of non-Indigenous respondents reported ethnocultural concordance. Ethnocultural concordance was associated with higher odds of relational and management continuity. This same pattern held when there was both ethnocultural and language concordance. No association was found between language concordance and any outcome measure. Chinese participants reported lower quality (odds ratio [OR] 0.24, 95% confidence interval [CI] 0.12-0.48), as did South Asian participants (OR 0.17, 95% CI 0.09-0.31) than did participants of European descent. INTERPRETATION Higher relational and management continuity is more likely with the presence of patient-clinician ethnocultural and language concordance. Lower continuity and quality reported by Chinese and South Asian particpants could indicate important health care disparities.
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Affiliation(s)
- Sina Waibel
- Centre for Health Services and Policy Research (Waibel, Wong), School of Population and Public Health, University of British Columbia; School of Nursing (Wong, Nibber), University of British Columbia, Vancouver, BC; Department of Family Medicine and Community Health Sciences (Katz), University of Manitoba, Winnipeg, Man.; Centre for Primary Health Care and Equity (Levesque), University of New South Wales; Agency for Clinical Innovation (Levesque), Sydney, Australia; Department of Family Medicine (Haggerty), McGill University, Montréal, Que
| | - Sabrina T Wong
- Centre for Health Services and Policy Research (Waibel, Wong), School of Population and Public Health, University of British Columbia; School of Nursing (Wong, Nibber), University of British Columbia, Vancouver, BC; Department of Family Medicine and Community Health Sciences (Katz), University of Manitoba, Winnipeg, Man.; Centre for Primary Health Care and Equity (Levesque), University of New South Wales; Agency for Clinical Innovation (Levesque), Sydney, Australia; Department of Family Medicine (Haggerty), McGill University, Montréal, Que.
| | - Alan Katz
- Centre for Health Services and Policy Research (Waibel, Wong), School of Population and Public Health, University of British Columbia; School of Nursing (Wong, Nibber), University of British Columbia, Vancouver, BC; Department of Family Medicine and Community Health Sciences (Katz), University of Manitoba, Winnipeg, Man.; Centre for Primary Health Care and Equity (Levesque), University of New South Wales; Agency for Clinical Innovation (Levesque), Sydney, Australia; Department of Family Medicine (Haggerty), McGill University, Montréal, Que
| | - Jean-Frederic Levesque
- Centre for Health Services and Policy Research (Waibel, Wong), School of Population and Public Health, University of British Columbia; School of Nursing (Wong, Nibber), University of British Columbia, Vancouver, BC; Department of Family Medicine and Community Health Sciences (Katz), University of Manitoba, Winnipeg, Man.; Centre for Primary Health Care and Equity (Levesque), University of New South Wales; Agency for Clinical Innovation (Levesque), Sydney, Australia; Department of Family Medicine (Haggerty), McGill University, Montréal, Que
| | - Raji Nibber
- Centre for Health Services and Policy Research (Waibel, Wong), School of Population and Public Health, University of British Columbia; School of Nursing (Wong, Nibber), University of British Columbia, Vancouver, BC; Department of Family Medicine and Community Health Sciences (Katz), University of Manitoba, Winnipeg, Man.; Centre for Primary Health Care and Equity (Levesque), University of New South Wales; Agency for Clinical Innovation (Levesque), Sydney, Australia; Department of Family Medicine (Haggerty), McGill University, Montréal, Que
| | - Jeannie Haggerty
- Centre for Health Services and Policy Research (Waibel, Wong), School of Population and Public Health, University of British Columbia; School of Nursing (Wong, Nibber), University of British Columbia, Vancouver, BC; Department of Family Medicine and Community Health Sciences (Katz), University of Manitoba, Winnipeg, Man.; Centre for Primary Health Care and Equity (Levesque), University of New South Wales; Agency for Clinical Innovation (Levesque), Sydney, Australia; Department of Family Medicine (Haggerty), McGill University, Montréal, Que
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Jenson A, Roter DL, Mkocha H, Munoz B, West S. Patient-centered communication of community treatment assistants in Tanzania predicts coverage of future mass drug administration for trachoma. PATIENT EDUCATION AND COUNSELING 2018; 101:1075-1081. [PMID: 29329726 DOI: 10.1016/j.pec.2018.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 12/27/2017] [Accepted: 01/05/2018] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Prevention of Trachoma, the leading cause of infectious blindness, requires community treatment assistants (CTAs) to perform mass drug administration (MDA) of azithromycin. Previous research has shown that female CTAs have higher MDA coverage, but no studies have focused on the content of conversation. We hypothesize that female CTAs had more patient-centered communication and higher MDA coverage. METHODS In 2011, CTAs from 23 distribution sites undergoing MDA as part of the Partnership for Rapid Elimination of Trachoma were selected. CTA - villager interactions were audio recorded. Audio was analyzed using an adaptation of the Roter Interaction Analysis System. The outcome of interest was the proportion of adults receiving MDA in 2011 who returned in 2012. RESULTS 58 CTAs and 3122 interactions were included. Sites with female CTAs had significantly higher patient-centeredness ratio (0.548 vs 0.400) when compared to sites with male CTAs. Sites with more patient-centered interactions had higher proportion of patients return (p = 0.009). CONCLUSION Female CTAs had higher proportion of patient-centered communication. Patient centered communication was associated with higher rates of return for MDA. PRACTICE IMPLICATIONS Greater patient-centered connection with health care providers affects participation in public health efforts, even when those providers are lay health workers.
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Affiliation(s)
- Alexander Jenson
- Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore MD, United States.
| | - Debra L Roter
- The Johns Hopkins Bloomberg School of Public Health, Baltimore MD, United States
| | | | - Beatriz Munoz
- Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore MD, United States
| | - Sheila West
- Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore MD, United States
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Xiong C, Chen X, Zhao X, Liu C. Patient satisfaction and gender composition of physicians - a cross-sectional study of community health services in Hubei, China. BMC Health Serv Res 2018; 18:217. [PMID: 29587723 PMCID: PMC5870243 DOI: 10.1186/s12913-018-3011-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Accepted: 03/15/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient satisfaction is associated with both individual (patients and health workers) and organizational (health facilities) characteristics. This study aimed to establish a link between patient satisfaction and gender composition of physicians in community health service (CHS) organizations. METHODS Participants were selected through multistage stratified random sampling: 36 CHS centers were selected from six municipalities in Hubei, China. All physicians on duty and patients visiting the CHS during the study period (from April to October in 2015) were invited to participate in this study: 324 physicians and 865 patients completed a questionnaire survey. Multilevel linear regression analyses were performed to determine the associations of patient satisfaction (scored from 1 to 5) with patient characteristics (gender, age, education, income, medical expense, frequency of visits to the CHS) and organizational features of the CHS (sex ratio of physicians, and gender differences of physicians in education and job satisfaction). RESULTS Older patients and those with a higher medical bill had a lower degree of satisfaction (p < 0.05). At the organizational level: a higher proportion of male physicians weakened the negative association between patient age and patient satisfaction (p < 0.05); a larger gap in university qualifications between male and female physicians exacerbated the negative association between patient age and patient satisfaction (p < 0.05). CONCLUSIONS The gender composition of physicians in CHSs is associated with patient satisfaction in the Chinese context: a larger gap (in number and qualifications) between male and female physicians is associated with higher patient satisfaction. Further studies are needed to explore the cultural roots of such an association.
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Affiliation(s)
- Change Xiong
- Change Xiong, Department of Social Medicine and Health Management, School of Basic Medical Science, Hubei University of Science and Technology, 88 Xianning Road, Xianning, 437100, People's Republic of China.
| | - Xiao Chen
- Xiao Chen, Institute of Medicine, Hubei University of Science and Technology, 88 Xianning Road, Xianning, 437100, People's Republic of China.
| | - Xinyuan Zhao
- Xinyuan Zhao, School of Clinic Medical Science, Hubei University of Science and Technology, Xianning, 437100, People's Republic of China
| | - Chaojie Liu
- Chaojie Liu, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, 3086, Australia
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Quercioli C, Nisticò F, Messina G, Maccari M, Barducci M, Carriero G, Nante N. Gender differences in health expenditure determinants: A follow-up study. Health Care Women Int 2018; 40:33-46. [PMID: 29494785 DOI: 10.1080/07399332.2018.1445252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Researchers' aim was to investigate if patients/physicians characteristics could differently affect males/females health care expenditure. In 2009/2010, a health-related-quality-of-life (HRQL) measure was distributed to 887 general practitioners' (GP) patients in Siena's province-Italy. Severity of diseases was calculated through Cumulative Illness Rating Scale Severity Index (CIRS-SI). Information about GPs' gender and age and patients' gender, age, and socio-economic variables were recorded. 2012 data about pharmaceutical, outpatient and hospital expenditure were obtained. Multivariate regression was carried out. In males, hospital expenditure increased with higher CIRS-SI and female GP whilst in females it was not influenced by any of the variables. Outpatient and pharmaceutical expenditure increased with aging, higher CIRS-SI, and lower HRQL and education, both in males and females. Gender differences in health expenditure determinants emerged for hospital expenditure.
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Affiliation(s)
- Cecilia Quercioli
- a Postgraduate School of Public Health , University of Siena , Siena , Italy.,b Healthcare Management - Local Health Unit 7 , Siena , Italy
| | - Francesca Nisticò
- a Postgraduate School of Public Health , University of Siena , Siena , Italy
| | - Gabriele Messina
- a Postgraduate School of Public Health , University of Siena , Siena , Italy.,c Department of Molecular and Developmental Medicine , University of Siena , Siena , Italy
| | - Mauro Maccari
- b Healthcare Management - Local Health Unit 7 , Siena , Italy
| | - Massimo Barducci
- a Postgraduate School of Public Health , University of Siena , Siena , Italy
| | | | - Nicola Nante
- a Postgraduate School of Public Health , University of Siena , Siena , Italy.,c Department of Molecular and Developmental Medicine , University of Siena , Siena , Italy
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Noro I, Roter DL, Kurosawa S, Miura Y, Ishizaki M. The impact of gender on medical visit communication and patient satisfaction within the Japanese primary care context. PATIENT EDUCATION AND COUNSELING 2018; 101:227-232. [PMID: 28823411 DOI: 10.1016/j.pec.2017.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 07/14/2017] [Accepted: 08/01/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE This study was designed to address significant gaps in the predominantly western-centric research literature by examining the influence of gender concordance in medical communication and patient satisfaction within the Japanese context. METHODS New primary care patients (54 male and 49 female) were randomly assigned to study internists (6 males and 5 females). Recorded visits were coded with the Roter Interaction Analysis System (RIAS). Post-visit, patients completed a Japanese version of the Medical Interview Satisfaction Scale (MISS). RESULTS: Female concordant visits showed higher levels of patient-centeredness than all other gender combinations. Female physicians substantially modified their communication based on patient gender while male physicians did not. Gender concordance was associated with higher female, but lower male patient satisfaction relative to gender discordant visits. CONCLUSION Contrary to normative experience of medicine as a male dominated profession in Japan, and gender-based power differentials, male-gendered clinical communication is less likely to satisfy male than female patients, while female-gendered communication is positively associated with female patient satisfaction. PRACTICE IMPLICATIONS Patient satisfaction ratings reflect greater gender flexibility in terms of acceptable physician behavior than Japanese norms would suggest.
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Affiliation(s)
- Ikuko Noro
- Department of Human Science, the Jikei University School of Medicine, 8-3-1 Kokuryocho, Chofu, Tokyo 182-8570, Japan.
| | - Debra L Roter
- Department of Health, Behavior and Society, Bloomberg School of Public Health,Johns Hopkins University 624 N. Broadway, Suite 750 Baltimore, MD 21205, USA.
| | - Satoko Kurosawa
- Department of Diabetes and Metabolism, Tohoku University Hospital, 1-1 Seiryocho, Aoba, Sendai, Miyagi 980-8574, Japan.
| | - Yasuhiko Miura
- Department of General Medicine, the Jikei University School of Medicine, 163-1 Kashiwashita, Kashiwa, Chiba 277-8567, Japan.
| | - Masato Ishizaki
- Graduate School of Interdisciplinary Information Studies, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo 113-0033, Japan.
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Abstract
Purpose
The patient healthcare experience is a complex phenomenon, as is encouraging patient compliance with medical advice. To address this multifaceted relationship, the purpose of this paper is to explore the ways resident physicians verbally encourage patient compliance and the relationship between these compliance-seeking strategies and patient satisfaction.
Design/methodology/approach
A total of 40 medical interviews between resident physicians and patients were audio-recorded, transcribed, coded, and analysed. Patient questionnaires were also administered and analysed.
Findings
It was found that resident physicians used indirect orders most frequently, followed by motivation, persuasion, scheduling, and direct orders. It was also found that female patients received (marginally) more messages than male patients; female residents used more messages with female patients than with male patients; female residents used more persuasion messages with female patients than with male patients; male residents were less likely than female residents to use motivational messages with female patients; and compliance was significantly correlated with expertise satisfaction, overall satisfaction, and communication satisfaction.
Originality/value
This study advances existing research by examining various ways in which residents verbally encourage patient compliance and the relationship between these messages and patient satisfaction. Findings can be used to inform physicians on strategies to encourage patient adherence to medication regimen, appointments, and lifestyle changes.
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Abstract
Though life expectancy sex differences are decreasing in many Western countries, men experience higher mortality rates at all ages. Men are often reluctant to seek medical care because health help-seeking is strongly linked to femininity, male weakness, and vulnerability. Many men are also more likely to access emergency care services in response to injury and/or severe pain instead of engaging primary health care (PHC) services. Nurse practitioners are well positioned to increase men's engagement with PHC to waylay the pressure on emergency services and advance the well-being of men. This article demonstrates how nurse practitioners can work with men in PHC settings to optimize men's self-health and illness prevention and management. Four recommendations are discussed: (1) leveling the hierarchies, (2) talking it through, (3) seeing diversity within patterns, and (4) augmenting face-to-face PHC services. In terms of leveling the hierarchies nurse practitioners can engage men in effectual health decision making. Within the interactions detailed in the talking it through section are strategies for connecting with male patients and mapping their progress. In terms of seeing diversity with in patterns and drawing on the plurality of masculinities, nurse practitioners are encouraged to adapt a variety of age sensitive assessment tools to better intervene and guide men's self-health efforts. Examples of community and web based men's health resources are shared in the augmenting face-to-face PHC services section to guide the work of nurse practitioners. Overall, the information and recommendations shared in this article can proactively direct the efforts of nurse practitioners working with men.
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Affiliation(s)
- Marina B. Rosu
- University of British Columbia, Vancouver, British Columbia, Canada
| | - John L. Oliffe
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Mary T. Kelly
- University of British Columbia, Vancouver, British Columbia, Canada
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Shiner B, Leonard Westgate C, Harik JM, Watts BV, Schnurr PP. Effect of Patient-Therapist Gender Match on Psychotherapy Retention Among United States Veterans with Posttraumatic Stress Disorder. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2017; 44:642-650. [PMID: 27530121 PMCID: PMC6149526 DOI: 10.1007/s10488-016-0761-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Extant literature suggests that patient-therapist gender matching may be associated with psychotherapy retention. We examined this relationship in a national cohort of Veterans (n = 506,471) initiating psychotherapy for posttraumatic stress disorder (PTSD) using multivariate logistic regression models. Overall, women were retained in psychotherapy at higher rates than men. When patient and therapist factors as well as practice patterns are considered, gender match between female patients with PTSD and female therapists was not a positive predictor of psychotherapy retention. Contrary to our expectations, gender match between male patients with PTSD and male therapist was a negative predictor of psychotherapy retention.
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Affiliation(s)
- Brian Shiner
- White River Junction VA Medical Center, 215 North Main Street, White River Junction, VT, 05009, USA.
- VA National Center for PTSD, 215 North Main Street, White River Junction, VT, 05009, USA.
- VA National Center for Patient Safety, Ann Arbor, MI, USA.
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
- VA National Center for Patient Safety, 215 North Main Street, White River Junction, VT, 05009, USA.
| | | | - Juliette M Harik
- White River Junction VA Medical Center, 215 North Main Street, White River Junction, VT, 05009, USA
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Bradley V Watts
- VA National Center for Patient Safety, Ann Arbor, MI, USA
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
- VA National Center for Patient Safety, 215 North Main Street, White River Junction, VT, 05009, USA
| | - Paula P Schnurr
- VA National Center for PTSD, 215 North Main Street, White River Junction, VT, 05009, USA
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
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Rey-Bellet S, Dubois J, Vannotti M, Zuercher M, Faouzi M, Devaud K, Rodondi N, Rodondi PY. Agenda Setting During Follow-Up Encounters in a University Primary Care Outpatient Clinic. HEALTH COMMUNICATION 2017; 32:714-720. [PMID: 27408954 DOI: 10.1080/10410236.2016.1168003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
At the beginning of the medical encounter, clinicians should elicit patients' agendas several times using open-ended questions. Little is known, however, about how many times physicians really solicit a patient's agenda during follow-up encounters. The objective was to analyze the number of agenda solicitations by physicians, of agendas initiated by physicians, and of patients' spontaneous agendas during the beginning and the entire encounter. We analyzed 68 videotaped follow-up encounters at a university primary care outpatient clinic. The number of different types of agenda setting was searched for and analyzed using negative binomial regression or logistic regression models. Physicians solicited agendas a mean ± SD of 0.8 ± 0.7 times/patient during the first 5 minutes and 1.7 ± 1.2 times/patient during the entire encounter. Physicians in 32.4% of encounters did not solicit the patient agenda, and there were never more than two physician's solicitations during the first 5 minutes. The mean number of physician's solicitations of the patients' agenda was 42% lower among female physicians during the first 5 minutes and 34% lower during the entire encounter. The number of agendas initiated by physicians was 1.2 ± 1.2/patient during the beginning and 3.2 ± 2.3/patient during the entire encounter. In 58.8% of the encounters, patients communicated their agendas spontaneously. There were twice as many patient spontaneous agendas (IRR = 2.12, p = .002) with female physicians than with males. This study showed that agenda solicitation with open-ended questions in follow-up encounters does not occur as often as recommended. There is thus a risk of missing new agendas or agendas that are important to the patient.
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Affiliation(s)
| | - Julie Dubois
- b Institute for Social and Preventive Medicine , Lausanne University Hospital
| | - Marco Vannotti
- c Department of Ambulatory Care and Community Medicine , University of Lausanne
| | - Marili Zuercher
- c Department of Ambulatory Care and Community Medicine , University of Lausanne
| | - Mohamed Faouzi
- b Institute for Social and Preventive Medicine , Lausanne University Hospital
| | - Karen Devaud
- b Institute for Social and Preventive Medicine , Lausanne University Hospital
| | - Nicolas Rodondi
- d Department of General Internal Medicine , University of Bern
- e Institute of Primary Health Care , University of Bern
| | - Pierre-Yves Rodondi
- b Institute for Social and Preventive Medicine , Lausanne University Hospital
- c Department of Ambulatory Care and Community Medicine , University of Lausanne
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Riese A, Rappaport L, Alverson B, Park S, Rockney RM. Clinical Performance Evaluations of Third-Year Medical Students and Association With Student and Evaluator Gender. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:835-840. [PMID: 28099178 DOI: 10.1097/acm.0000000000001565] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
PURPOSE Clinical performance evaluations are major components of medical school clerkship grades. But are they sufficiently objective? This study aimed to determine whether student and evaluator gender is associated with assessment of overall clinical performance. METHOD This was a retrospective analysis of 4,272 core clerkship clinical performance evaluations by 829 evaluators of 155 third-year students, within the Alpert Medical School grading database for the 2013-2014 academic year. Overall clinical performance, assessed on a three-point scale (meets expectations, above expectations, exceptional), was extracted from each evaluation, as well as evaluator gender, age, training level, department, student gender and age, and length of observation time. Hierarchical ordinal regression modeling was conducted to account for clustering of evaluations. RESULTS Female students were more likely to receive a better grade than males (adjusted odds ratio [AOR] 1.30, 95% confidence interval [CI] 1.13-1.50), and female evaluators awarded lower grades than males (AOR 0.72, 95% CI 0.55-0.93), adjusting for department, observation time, and student and evaluator age. The interaction between student and evaluator gender was significant (P = .03), with female evaluators assigning higher grades to female students, while male evaluators' grading did not differ by student gender. Students who spent a short time with evaluators were also more likely to get a lower grade. CONCLUSIONS A one-year examination of all third-year clerkship clinical performance evaluations at a single institution revealed that male and female evaluators rated male and female students differently, even when accounting for other measured variables.
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Affiliation(s)
- Alison Riese
- A. Riese is assistant professor, Department of Pediatrics and Medical Science, Section of Medical Education, Alpert Medical School of Brown University, Providence, Rhode Island.L. Rappaport is a first-year pediatrics resident, University of Michigan Medical School, Ann Arbor, Michigan.B. Alverson is associate professor, Department of Pediatrics and Medical Science, Section of Medical Education, Alpert Medical School of Brown University, Providence, Rhode Island.S. Park is postdoctoral research associate, Alpert Medical School of Brown University and Center for International Health Research at Rhode Island Hospital, Providence, Rhode Island.R.M. Rockney is professor, Department of Pediatrics, Family Medicine, and Medical Science, Section of Medical Education, Alpert Medical School of Brown University, Providence, Rhode Island
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Waylen A, Makoul G, Albeyatti Y. Patient-clinician communication in a dental setting: a pilot study. Br Dent J 2017; 218:585-8; discussion 588. [PMID: 25998352 DOI: 10.1038/sj.bdj.2015.389] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2015] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To undertake a pilot study and examine whether the communication assessment tool (CAT) is useful in assessing patient perceptions of dentists' interpersonal skills. DESIGN Cross-sectional questionnaire study. SETTING Three speciality dental clinics in a University teaching hospital in the United Kingdom. PARTICIPANTS, MATERIALS AND MEASURES: One hundred patients, seen by 20 dentists, were recruited to the study. Patients completed the CAT after their consultation. MAIN OUTCOME MEASURES Patient ratings of excellent interpersonal skills within a dental consultation according to dentists' experience, gender and speciality. RESULTS Complete data was received from 95 patients. On average, dentists' communication skills were rated as excellent 73% of the time. Patients were least satisfied with opportunities to ask questions within their consultation and with their level of involvement in decision-making. There were suggested differences in patients' perceived satisfaction with communication according to dentists' experience and gender. CONCLUSION Overall, patients are satisfied with the quality of communication with their dentist. Our findings are comparable to those from larger studies suggesting that the CAT is an effective tool to use in a dental context. The CAT would be useful in documenting the development of dentists' and students' interpersonal skills.
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Affiliation(s)
- A Waylen
- School of Oral and Dental Sciences, Lower Maudlin St, Bristol, BS1 2LY
| | - G Makoul
- Bristol Dental Hospital, University of Bristol, Lower Maudlin St, Bristol, BS1 2LY
| | - Y Albeyatti
- University of Connecticut School of Medicine, Farmington, Connecticut, USA
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