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Gołębiowska J, Szymala-Pędzik M, Żórawska J, Sobieszczańska M, Agrawal S. Identification of Factors Affecting the Increased Percentage of CGA Recommendations among Patients on Geriatric Ward. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2065. [PMID: 36767432 PMCID: PMC9915924 DOI: 10.3390/ijerph20032065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 06/18/2023]
Abstract
In Poland, the elderly population is noticeably increasing every year. Therefore, the current healthcare system has to rise to the challenge of treatment and prevention strategies targeting elderly persons. Based on the Vulnerable Elders Survey (VES-13 scale), consisting of international and validated scales, we put effort into identifying the factors affecting the increased percentage of CGA (Comprehensive Geriatric Assessment) recommendations by healthcare system physicians. The study group involved 78 patients from the Department of Geriatrics, Wroclaw Medical University, Poland, aged 60-91 (median Me = 81 years old). Of the studied patients, 51 were recommended for CGA (51/78; 64.6%). A statistically significant association was observed between CGA recommendation and age (p < 0.001); the likelihood of a CGA recommendation increased with age. Furthermore, the increased CGA recommendation was observed among geriatric patients with: (a) frailty syndrome (OR = 11.2, CI95% 2.88-43.5, p < 0.001), (b) high risk of malnutrition or malnutrition (OR = 3.87; CI95%, 1.00-14.9, p = 0.04), (c) low mental status (OR = 3.32, CI95% 1.22-9.09, p = 0.029), (d) low ability to perform basic daily duties (according to ADL scale-OR = 12.6, CI95% 1.57-101, p = 0.004 and IADL scale-OR = 4.71, CI95% 1.72-12.9, p = 0.003), and (e) fall risk (OR = 15.0, CI95% 4.67-48.3, p < 0.001). Moreover, homocysteine levels increased with age (p = 0.003) and decreased with sleep duration (p = 0.043). Taken together, all these factors seem to be important when implementing treatment programs adjusted to the individual geriatric patient.
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Affiliation(s)
- Justyna Gołębiowska
- Department and Clinic of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Małgorzata Szymala-Pędzik
- Clinical Department of Geriatrics, Wroclaw Medical University, Pasteur 4 Street, 50-367 Wroclaw, Poland
| | - Joanna Żórawska
- Clinical Department of Geriatrics, Wroclaw Medical University, Pasteur 4 Street, 50-367 Wroclaw, Poland
| | - Małgorzata Sobieszczańska
- Clinical Department of Geriatrics, Wroclaw Medical University, Pasteur 4 Street, 50-367 Wroclaw, Poland
| | - Siddarth Agrawal
- Department and Clinic of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 50-556 Wroclaw, Poland
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Smallwood AJ, Neuner JM, Fletcher KE, Walker CM, Schapira MM. Patient-Physician Concordance for Quantitative Formats and Treatment Options and the Relationship with State Anxiety. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1684-1690. [PMID: 33904119 DOI: 10.1007/s13187-021-02013-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/13/2021] [Indexed: 06/12/2023]
Abstract
Patient-physician concordance about topics discussed in a clinic visit is essential for effective communication but may be difficult to achieve in cancer care. We conducted a multicenter, observational study at two Midwestern oncology clinics. A sample of 48 English-speaking or Spanish-speaking women with newly diagnosed stage 0-3 breast cancer completed surveys before and after a visit with an oncologist. Patient-physician dyads were coded as concordant if both patient and physician follow-up self-reports agreed whether (or not) specific treatments were discussed (i.e., treatment option concordance; mastectomy, lumpectomy, hormone therapy, neoadjuvant, and adjuvant chemotherapy) and whether risk was described using certain quantitative formats (i.e., quantitative format concordance; percentages, proportions out of 100 and 1000, graphs, pictures, evidence from clinical studies, cancer stage). Agreement was determined using percent agreement and prevalence-adjusted bias-adjusted kappa (PABAK). Pearson's correlations were used to determine relationships between anxiety and each measure concordance. Percent concordance was higher for treatment concordance (73.3%) compared to quantitative format concordance (64.5%), and PABAK scores tended to be higher for treatment options (PABAK = .21-.78). Both treatment and quantitative format concordance were negatively associated with pre-visit state anxiety, but only treatment concordance was statistically significant (treatment: r = - .504, p = .001; quantitative format: r = - .096, p = .523). Our study indicates moderate patient-physician concordance in early breast cancer care communication and that patient anxiety may impact the ability for patients and physicians to agree on the content communicated in a clinic visit.
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Affiliation(s)
- Alicia J Smallwood
- Center for Patient Care and Outcomes Research, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
| | - Joan M Neuner
- Center for Patient Care and Outcomes Research, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
- Division of General Internal Medicine, Department of Medicine, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA
| | - Kathlyn E Fletcher
- Center for Patient Care and Outcomes Research, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
- Clement J. Zablocki VA Medical Center, 5000 W National Ave, Milwaukee, WI, 53295, USA
| | - Cindy M Walker
- School of Education, Office of the Dean, Duquesne University, 600 Forbes Ave, Pittsburgh, PA, 15282, USA
| | - Marilyn M Schapira
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
- Center for Health Equity Research and Promotion, Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA, 19104, USA
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Jensen-Battaglia M, Lei L, Xu H, Loh KP, Wells M, Tylock R, Ramsdale E, Kleckner AS, Mustian KM, Dunne RF, Kehoe L, Bearden J, Burnette BL, Whitehead M, Mohile SG, Wildes TM. Communication About Fall Risk in Community Oncology Practice: The Role of Geriatric Assessment. JCO Oncol Pract 2022; 18:e1630-e1640. [PMID: 35984998 PMCID: PMC9835996 DOI: 10.1200/op.22.00173] [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: 03/10/2022] [Revised: 05/12/2022] [Accepted: 07/06/2022] [Indexed: 01/16/2023] Open
Abstract
PURPOSE Falls are a modifiable source of morbidity for older adults with cancer, yet are underassessed in oncology practice. In this secondary analysis of a nationwide cluster-randomized controlled trial, we examined characteristics associated with patient-oncologist conversations about falls, and whether oncologist knowledge of geriatric assessment (GA) resulted in more conversations. METHODS Eligible patients (ClinicalTrials.gov identifier: NCT02107443) were age ≥ 70 years, had stage III/IV solid tumor or lymphoma, were being treated with noncurative treatment intent, and ≥ 1 GA domain impairment. Patients in both arms underwent GA. At practices randomly assigned to the intervention arm, oncologists were provided a GA summary with management recommendations. In both arms, patients had one clinical encounter audio-recorded, transcribed, and coded to categorize whether a conversation about falls occurred. Generalized linear mixed models adjusted for arm, practice site, and other important covariates were used to generate proportions and odds ratios (ORs) from the full sample. RESULTS Of 541 patients (intervention N = 293 and usual care N = 248, mean age: 77 years, standard deviation: 5.3), 528 had evaluable audio recordings. More patients had conversations about falls in the intervention versus usual care arm (61.3% v 10.3%, P < .001). Controlling for the intervention and practice site, history of falls (OR, 2.1; 95% CI, 1.3 to 3.6; P = .005) and impaired physical performance (OR, 4.7; 95% CI, 1.7 to 12.8; P = .002) were significantly associated with patient-oncologist conversations about falls. CONCLUSION GA intervention increased conversations about falls. History of falls and impaired physical performance were associated with patient-oncologist conversations about falls in community oncology practice.
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Affiliation(s)
- Marielle Jensen-Battaglia
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | | | - Huiwen Xu
- Department of Preventive Medicine and Population Health and Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX
| | - Kah Poh Loh
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY
| | - Megan Wells
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY
| | - Rachael Tylock
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY
| | - Erika Ramsdale
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY
| | - Amber S. Kleckner
- Department of Pain and Translational Symptom Science, School of Nursing, University of Maryland Baltimore, Baltimore, MD
| | - Karen M. Mustian
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY
| | - Richard F. Dunne
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY
| | - Lee Kehoe
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY
| | | | - Brian L. Burnette
- Cancer Research of Wisconsin and Northern Michigan (CROWN) NCORP, Green Bay, WI
| | - Mary Whitehead
- SCOREboard Advisory Group, University of Rochester Medical Center, Rochester, NY
| | - Supriya G. Mohile
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY
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Jensen-Battaglia M, Lei L, Xu H, Kehoe L, Patil A, Loh KP, Ramsdale E, Magnuson A, Kleckner AS, Wildes TM, Lin PJ, Mustian KM, Giri G, Whitehead M, Bearden J, Burnette BL, Geer J, Mohile SG, Dunne RF. Association of Oncologist-Patient Communication With Functional Status and Physical Performance in Older Adults: A Secondary Analysis of a Cluster Randomized Clinical Trial. JAMA Netw Open 2022; 5:e223039. [PMID: 35302628 PMCID: PMC8933739 DOI: 10.1001/jamanetworkopen.2022.3039] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
IMPORTANCE The functional status and physical performance of older adults with cancer are underassessed and undertreated despite the high prevalence of impaired functional status and physical performance in this population and their associations with chemotherapy-induced toxic effects and mortality. OBJECTIVE To examine the association between providing oncologists with a geriatric assessment (GA) summary with recommendations and having oncologist-patient conversations about functional and physical performance. DESIGN, SETTING, AND PARTICIPANTS Data for this secondary analysis were collected from October 29, 2014, to April 28, 2017, for a national cluster randomized clinical trial conducted by the University of Rochester Cancer Center National Cancer Institute Community Oncology Research Program evaluating the effect of a GA intervention on patient satisfaction with communication about aging-related concerns. There were 17 practice clusters in the intervention group and 14 in the usual care group. All 541 participants underwent a GA including standardized functional and physical performance measures and had 1 clinical encounter audio-recorded, transcribed, and blindly coded to categorize conversations by GA domain. Participants were aged 70 years or older, with a stage III or IV solid tumor or lymphoma with palliative treatment intent, and impairment in 1 or more GA domain. Statistical analysis was performed from August 18, 2020, to January 10, 2022. INTERVENTIONS Oncologist practices randomized to the intervention received a GA summary and validated recommendations for each patient prior to the audio-recorded clinical encounter. MAIN OUTCOMES AND MEASURES The primary analysis of this clinical trial assessed the effect of the intervention on patient satisfaction with oncologist communication about aging-related concerns. This secondary analysis assessed the post hoc hypothesis that the intervention would be associated with an increase in the proportion of patients having conversations with their oncologists and receiving oncologist recommendations specific to functional and physical performance concerns. RESULTS A total of 541 patients (276 men [51%]; mean [SD] age, 77.5 [5.2] years [range, 70-96 years]) were analyzed at baseline. Excluding 13 patients without audio recordings, 86% of patients (95% CI, 78%-91%) in the intervention group vs 59% of patients (95% CI, 47%-69%; P < .001) receiving usual care had conversations about functional or physical performance. Conversations were more frequently initiated by oncologists in the intervention group (84%; 95% CI, 77%-90%) than oncologists in the usual care group (58%; 95% CI, 45%-70%; P < .001). Oncologists in the intervention group were more likely to address patients' concerns (43%; 95% CI, 33%-53%) than oncologists in the usual care group (17%; 95% CI, 10%-26%; P < .001). CONCLUSIONS AND RELEVANCE In this secondary analysis of a cluster randomized clinical trial, providing oncologists with a GA summary was associated with an increase in the number of oncologist-patient conversations about functional and physical performance-related concerns with recommendations to address these concerns. These findings support the use of the GA summary and recommendations as important tools in caring for older adults with advanced cancer and functional or physical impairments. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02107443.
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Affiliation(s)
- Marielle Jensen-Battaglia
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Lianlian Lei
- Department of Psychiatry, University of Michigan, Ann Arbor
| | - Huiwen Xu
- Sealy Center on Aging, Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston
| | - Lee Kehoe
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | - Amita Patil
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Kah Poh Loh
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | - Erika Ramsdale
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | - Allison Magnuson
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | - Amber S. Kleckner
- School of Nursing, Department of Pain and Translational Symptom Science, University of Maryland, Baltimore
| | | | - Po-Ju Lin
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Karen M. Mustian
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Gilbert Giri
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | - Mary Whitehead
- SCOREboard Advisory Group, University of Rochester Medical Center, Rochester, New York
| | - James Bearden
- Upstate Carolina National Cancer Institute Community Oncology Research Program, Spartanburg, South Carolina
| | - Brian L. Burnette
- Cancer Research of Wisconsin and Northern Michigan National Cancer Institute Community Oncology Research Program, Green Bay
| | - Jodi Geer
- Metro Minnesota Community Oncology Research Program National Cancer Institute Community Oncology Research Program, St Louis Park
| | - Supriya G. Mohile
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | - Richard F. Dunne
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
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5
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Bhamidipati VS, Hicks LS, Caplan R, Ingraham B, Rn PM, Robinson EJ. Predictors and Outcomes of Patient Knowledge of Plan of Care in Hospital Medicine: A Quality Improvement Study. Jt Comm J Qual Patient Saf 2021; 47:176-184. [PMID: 33454235 DOI: 10.1016/j.jcjq.2020.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 11/08/2020] [Accepted: 11/11/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Patient understanding of plan of care is associated with positive outcomes in ambulatory settings. In hospital medicine settings, patient-physician agreement on plan of care (concordance) has been limited and difficult to improve. This study examined the impact of adding a hospitalist to interdisciplinary rounds (IDR) on physician-patient-nurse concordance and the relationship between concordance and outcomes. METHODS IDR were conducted by core teams made up of unit-based nurses, a case manager, and a pharmacist. Over time, with cohorting, hospitalists were included in IDR (hospitalist IDR) for some patients assigned to unit-based hospitalists. In developing hospitalist IDR, the researchers emphasized using an IDR checklist, including a patient communication plan. Patient-nurse-physician interviews were used to assess concordance in the domains of diagnosis, tests and procedures, and expected discharge date. Using two-hospitalist review, agreement was rated as none, partial, or complete, and a total concordance score was calculated for each patient in both IDR groups. Multivariate analysis was used to examine the relationship between concordance, IDR type, patient factors, and utilization outcomes. RESULTS For 658 patients, the mean concordance score was 11.71 out of a possible 18. There was no difference in concordance between hospitalist and core IDR groups (11.68 vs. 11.84, p = 0.7). Higher total concordance score was associated with lower lengths of stay (p < 0.001) and readmission rates (p = 0.001). Total concordance had a negative association with patient age (p = 0.04). CONCLUSION Concordance did not change with IDR type. Higher concordance appears to be related to positive utilization outcomes. Future studies are needed to evaluate potential interventions to improve concordance.
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Greenbom M, Punchik B, Kagan E, Freud T, Press Y. Implementation of Geriatric Recommendations by Doctors: A Comparison of Models of Geriatric Assessment for Mobile and Home-Ridden Patients. Rejuvenation Res 2020; 23:377-386. [PMID: 31964225 DOI: 10.1089/rej.2019.2216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In the present study we assessed the rate of implementation of recommendations given following geriatric assessment for home-ridden patients; a retrospective review of medical records to evaluate the implementation of geriatric recommendations given to patients in the Home Geriatric Service (HGS) between 2015 and 2016. The patients were categorized into two groups: the HGS-clinic (HGS-C) group, in which the primary care physician was responsible for implementation of the recommendations, and the HGS-home care (HGS-H) group, in which the responsibility for implementation of the recommendations was on the geriatrician. The results were compared with the implementation of recommendations in other ambulatory models for mobile patients-Clinic-Based Geriatric Assessment Services (CBGAS). The study included 865 patients. The highest rate of implementation was in the HGS-H group (85.7%), compared with 66.6% in the HGS-C group and 52.7% in the CBGAS group (p < 0.0001). In the logistic regression model for prediction of patients with implementation rates above 75%, the only variable that entered the prediction model was affiliation with the HGS-H group (odds ratio [OR] = 4.8, 95% confidence interval [CI] 2.3-9.6, p < 0.0001) or the HGS-C group (OR = 1.7, 95% CI 1.0-2.9, p = 0.046). The implementation rate for geriatric recommendations is higher for home-ridden patients compared with mobile patients, with the maximum recommendation rate in the subgroup, where geriatricians implemented the recommendations themselves. These findings raise the possibility that the most successful model, in terms of the implementation of recommendations, is the model in which implementation is carried out by the same staff that conducted the assessment.
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Affiliation(s)
- Matan Greenbom
- Joyce & Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Boris Punchik
- Department of Family Medicine, Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Unit for Community Geriatrics, Division of Health in the Community, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Home Care Unit, Clalit Health Services, Beer-Sheva, Israel
| | - Ella Kagan
- Department of Family Medicine, Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Unit for Community Geriatrics, Division of Health in the Community, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Home Care Unit, Clalit Health Services, Beer-Sheva, Israel
| | - Tamar Freud
- Department of Family Medicine, Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yan Press
- Department of Family Medicine, Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Unit for Community Geriatrics, Division of Health in the Community, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Department of Geriatrics, Soroka Medical Center, Beer-Sheva, Israel
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Rietkerk W, Gerritsen DL, Kollen BJ, Hofman CS, Wynia K, Slaets JPJ, Zuidema SU. Effects Of Increasing The Involvement Of Community-Dwelling Frail Older Adults In A Proactive Assessment Service: A Pragmatic Trial. Clin Interv Aging 2019; 14:1985-1995. [PMID: 31814713 PMCID: PMC6858288 DOI: 10.2147/cia.s206100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 09/29/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Older adults and care professionals advocate a more integrated and proactive care approach. This can be achieved by proactive outpatient assessment services that offer comprehensive geriatric assessments to better understand the needs of older adults and deliver person-centered and preventive care. However, the effects of these services are inconsistent. Increased involvement of the older adult during the assessment service could increase the effects on older adult's well-being. METHODS We studied the effect of an assessment service (Sage-atAge) for community-dwelling frail adults aged ≥65 years. After studying the local experiences, this service was adapted with the aim to increase participant involvement through individual goal setting and using motivational interviewing techniques by health-care professionals (Sage-atAge+). Within Sage-atAge+, when finishing the assessment, a "goal card" was written together with the older adult: a summary of the assessment, including goals and recommendations. We measured well-being with a composite endpoint consisting of health, psychological, quality of life, and social components. With regression analysis, we compared the effects of the Sage-atAge and Sage-atAge+ services on the well-being of participants. RESULTS In total, 453 older adults were eligible for analysis with a mean age of 77 (± 7.0) years of whom 62% were women. We found no significant difference in the change in well-being scores between the Sage-atAge+ service and the original Sage-atAge service (B, 0.037; 95% CI, -0.188 to 0.263). Also, no change in well-being scores was found even when selecting only those participants for the Sage-atAge+ group who received a goal card. CONCLUSION Efforts to increase the involvement of older adults through motivational interviewing and goal setting showed no additional effect on well-being. Further research is needed to explore the relationship between increased participant involvement and well-being to further develop person-centered care for older adults.
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Affiliation(s)
- W Rietkerk
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - DL Gerritsen
- Department of Primary and Community Care and Radboud Alzheimer Centre, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - BJ Kollen
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - CS Hofman
- Department of Innovation and Research, Vilans, Centre of Expertise on Long-Term Care, Utrecht, the Netherlands
| | - K Wynia
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - JPJ Slaets
- Faculty of Medical Sciences, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
- Leyden Academy On Vitality And Ageing, Leiden, the Netherlands
| | - SU Zuidema
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Phillips LA, McAndrew LM. Empirical Evaluation of Veterans' Perceived Non-Concordance with Providers Regarding Medically Unexplained Symptoms. COUNSELING PSYCHOLOGIST 2019; 47:770-795. [PMID: 32015569 DOI: 10.1177/0011000019890317] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Medically unexplained symptoms (MUS) are common among veterans and are difficult to treat. Optimal treatment entails continued care from providers, including primary care and counseling psychologists. Non-concordance between veterans' and providers' views of MUS may contribute to poor veteran satisfaction with care and possibly disengagement with care (e.g., non-adherence to treatment recommendations, including counseling and graded exercise). The current study surveyed 243 veterans with MUS post-deployment and evaluated the degree of non-concordance perceived by veterans with their primary care providers regarding their MUS and the effect of perceived non-concordance on treatment behaviors and outcomes. Many veterans in the current sample perceived non-concordance with their provider regarding their MUS (19% reporting quite a bit or complete disagreement). Perceived non-concordance (regarding MUS overall and specific causal perceptions) predicted important outcomes of interest, particularly veterans' satisfaction with their provider. Perceived concordance with primary care doctors may be required for sufficient adherence to MUS treatment recommendations, such as seeking and maintaining psychological counseling. Research should evaluate the effect of perceived concordance with the counseling psychologist on adherence to and outcomes from counseling for MUS.
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Affiliation(s)
| | - Lisa M McAndrew
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs New Jersey Healthcare System, East Orange, USA.,Department of Educational and Counseling Psychology EDU220, University at Albany, Albany, USA
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Overcash J, Ford N, Kress E, Ubbing C, Williams N. Comprehensive Geriatric Assessment as a Versatile Tool to Enhance the Care of the Older Person Diagnosed with Cancer. Geriatrics (Basel) 2019; 4:geriatrics4020039. [PMID: 31238518 PMCID: PMC6630523 DOI: 10.3390/geriatrics4020039] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 06/14/2019] [Accepted: 06/20/2019] [Indexed: 12/27/2022] Open
Abstract
The comprehensive geriatric assessment (CGA) is a versatile tool for the care of the older person diagnosed with cancer. The purpose of this article is to detail how a CGA can be tailored to Ambulatory Geriatric Oncology Programs (AGOPs) in academic cancer centers and to community oncology practices with varying levels of resources. The Society for International Oncology in Geriatrics (SIOG) recommends CGA as a foundation for treatment planning and decision-making for the older person receiving care for a malignancy. A CGA is often administered by a multidisciplinary team (MDT) composed of professionals who provide geriatric-focused cancer care. CGA can be used as a one-time consult for surgery, chemotherapy, or radiation therapy providers to predict treatment tolerance or as an ongoing part of patient care to manage malignant and non-malignant issues. Administrative support and proactive infrastructure planning to address scheduling, referrals, and provider communication are critical to the effectiveness of the CGA.
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Affiliation(s)
- Janine Overcash
- The College of Nursing, The Ohio State University, 1585 Neil Ave, Newton Hall, Columbus, OH 43201, USA.
| | - Nikki Ford
- Stephanie Spielman Comprehensive Breast Center, The Ohio State University, 1145 Olentangy River Road, Columbus, OH 43121, USA.
| | - Elizabeth Kress
- Stephanie Spielman Comprehensive Breast Center, The Ohio State University, 1145 Olentangy River Road, Columbus, OH 43121, USA.
| | - Caitlin Ubbing
- Stephanie Spielman Comprehensive Breast Center, The Ohio State University, 1145 Olentangy River Road, Columbus, OH 43121, USA.
| | - Nicole Williams
- Stephanie Spielman Comprehensive Breast Center, The Ohio State University, 1145 Olentangy River Road, Columbus, OH 43121, USA.
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10
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Overcash J. Comprehensive Geriatric Assessment: Interprofessional Team Recommendations for Older Adult Women With Breast Cancer. Clin J Oncol Nurs 2019; 22:304-315. [PMID: 29781467 DOI: 10.1188/18.cjon.304-315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Geriatric oncology incorporates comprehensive geriatric assessment (CGA) and traditional oncology care. OBJECTIVES The aims are to identify limitations reflected by mean scores on the CGA instruments and describe the CGA recommendations documented in the medical record. METHODS CGA was administered and consisted of the Timed Up and Go Test, the Activities of Daily Living Scale, the Instrumental Activities of Daily Living Scale, grip strength, falls, pain, the Brief Fatigue Inventory, the Pittsburgh Sleep Quality Index, the Geriatric Depression Scale, the Mini-Cog, and the Mini Nutritional Assessment. CGA recommendations were obtained from the medical record. Descriptive statistics were used to analyze the data. FINDINGS Most recommendations were for general cancer treatment, followed by fall referral/education.
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Kastner M, Hayden L, Wong G, Lai Y, Makarski J, Treister V, Chan J, Lee JH, Ivers NM, Holroyd-Leduc J, Straus SE. Underlying mechanisms of complex interventions addressing the care of older adults with multimorbidity: a realist review. BMJ Open 2019; 9:e025009. [PMID: 30948577 PMCID: PMC6500199 DOI: 10.1136/bmjopen-2018-025009] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To understand how and why effective multi-chronic disease management interventions influence health outcomes in older adults 65 years of age or older. DESIGN A realist review. DATA SOURCES Electronic databases including Medline and Embase (inception to December 2017); and the grey literature. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We considered any studies (ie, experimental quasi-experimental, observational, qualitative and mixed-methods studies) as long as they provided data to explain our programme theories and effectiveness review (published elsewhere) findings. The population of interest was older adults (age ≥65 years) with two or more chronic conditions. ANALYSIS We used the Realist And MEta-narrative Evidence Syntheses: Evolving Standards (RAMESES) quality and publication criteria for our synthesis aimed at refining our programme theories such that they contained multiple context-mechanism-outcome configurations describing the ways different mechanisms fire to generate outcomes. We created a 3-step synthesis process grounded in meta-ethnography to separate units of data from articles, and to derive explanatory statements across them. RESULTS 106 articles contributed to the analysis. We refined our programme theories to explain multimorbidity management in older adults: (1) care coordination interventions with the best potential for impact are team-based strategies, disease management programmes and case management; (2) optimised disease prioritisation involves ensuring that clinician work with patients to identify what symptoms are problematic and why, and to explore options that are acceptable to both clinicians and patients and (3) optimised patient self-management is dependent on patients' capacity for selfcare and to what extent, and establishing what patients need to enable selfcare. CONCLUSIONS To optimise care, both clinical management and patient self-management need to be considered from multiple perspectives (patient, provider and system). To mitigate the complexities of multimorbidity management, patients focus on reducing symptoms and preserving quality of life while providers focus on the condition that most threaten morbidity and mortality. PROSPERO REGISTRATION NUMBER CRD42014014489.
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Affiliation(s)
- Monika Kastner
- Knowledge Translation and Implementation, Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Leigh Hayden
- Knowledge Translation and Implementation, Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Yonda Lai
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Julie Makarski
- Knowledge Translation and Implementation, Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
| | - Victoria Treister
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Joyce Chan
- Knowledge Translation and Implementation, Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
| | - Julianne H Lee
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Noah M Ivers
- Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Family Medicine, Women’s College Hospital, Toronto, Ontario, Canada
| | - Jayna Holroyd-Leduc
- Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Medicine, University of Toronto, Toronto, Ontario, Canada
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Bouras AF, Ioos E, Aoudia A, Kaci H, Benaibouche D, Merad-Boudia F. The vision and role of geriatric oncology in surgical treatment of the elderly patient. J Visc Surg 2018; 156:37-44. [PMID: 30416005 DOI: 10.1016/j.jviscsurg.2018.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The phenomenon of population aging is constantly on the rise, as are the medical needs of elderly subjects. Oncological treatment concerns an ever larger number of elderly patients, raising a number of not only practical and medical questions, but also the ethical interrogations associated with therapeutic decision-making, quality of life and therapeutic obstinacy (futile medical care). Surgeons are increasingly preoccupied by elderly patients on account of the cancer rate among them, and they are compelled to cope with challenges such as morbimortality and prolonged hospitalization. Geriatric oncology is a discipline of increasing importance of which the goal consists in comprehensive care of the elderly cancer patient, care taking into full account his physical and psychological aging, his somatic and cognitive comorbidities, and, last but least, his life expectancy. The opinions and recommendations of geriatric oncologists provide increasingly more orientation for the oncological therapeutic decision-making processes. The objective of this attempt at clarification is to discuss the contributions of this discipline to everyday surgical activity, to provide surgeons with some tools facilitating initial evaluation of their patients, and to remind the reader of situations in which oncological assistance is of paramount importance.
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Affiliation(s)
- A F Bouras
- Faculté de médecine d'Alger, Université Benyoucef Benkhedda, Alger 1, Algeria; Chirurgie générale et digestive, CHU Lamine Debaghine, boulevard Saïd Touati, Bab El Oued, Alger, 16000, Algeria.
| | - E Ioos
- Médecine polyvalente et gériatrie, centre hospitalier Germon-et-Gauthier, 62408 Béthune, France
| | - A Aoudia
- Clinique de psychiatrie, hôpital Fontan II, CHRU Lille, 59000 Lille, France
| | - H Kaci
- Faculté de médecine d'Alger, Université Benyoucef Benkhedda, Alger 1, Algeria; Chirurgie générale et digestive, CHU Lamine Debaghine, boulevard Saïd Touati, Bab El Oued, Alger, 16000, Algeria
| | - D Benaibouche
- Faculté de médecine d'Alger, Université Benyoucef Benkhedda, Alger 1, Algeria; Chirurgie générale et digestive, CHU Lamine Debaghine, boulevard Saïd Touati, Bab El Oued, Alger, 16000, Algeria
| | - F Merad-Boudia
- Faculté de médecine d'Alger, Université Benyoucef Benkhedda, Alger 1, Algeria; Chirurgie générale et digestive, CHU Lamine Debaghine, boulevard Saïd Touati, Bab El Oued, Alger, 16000, Algeria
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13
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Kastner M, Cardoso R, Lai Y, Treister V, Hamid JS, Hayden L, Wong G, Ivers NM, Liu B, Marr S, Holroyd-Leduc J, Straus SE. Effectiveness of interventions for managing multiple high-burden chronic diseases in older adults: a systematic review and meta-analysis. CMAJ 2018; 190:E1004-E1012. [PMID: 30150242 PMCID: PMC6110649 DOI: 10.1503/cmaj.171391] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2018] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION More than half of older adults (age ≥ 65 yr) have 2 or more high-burden multimorbidity conditions (i.e., highly prevalent chronic diseases, which are associated with increased health care utilization; these include diabetes [DM], dementia, depression, chronic obstructive pulmonary disease [COPD], cardiovascular disease [CVD], arthritis, and heart failure [HF]), yet most existing interventions for managing chronic disease focus on a single disease or do not respond to the specialized needs of older adults. We conducted a systematic review and meta-analysis to identify effective multimorbidity interventions compared with a control or usual care strategy for older adults. METHODS We searched bibliometric databases for randomized controlled trials (RCTs) evaluating interventions for managing multiple chronic diseases in any language from 1990 to December 2017. The primary outcome was any outcome specific to managing multiple chronic diseases as reported by studies. Reviewer pairs independently screened citations and full-text articles, extracted data and assessed risk of bias. We assessed statistical and methodological heterogeneity and performed a meta-analysis of RCTs with similar interventions and components. RESULTS We included 25 studies (including 15 RCTs and 6 cluster RCTs) (12 579 older adults; mean age 67.3 yr). In patients with [depression + COPD] or [CVD + DM], care-coordination strategies significantly improved depressive symptoms (standardized mean difference -0.41; 95% confidence interval [CI] -0.59 to -0.22; I2 = 0%) and reduced glycosylated hemoglobin (HbA1c) levels (mean difference -0.51; 95% CI -0.90 to -0.11; I2 = 0%), but not mortality (relative risk [RR] 0.79; 95% CI 0.53 to 1.17; I2 = 0%). Among secondary outcomes, care-coordination strategies reduced functional impairment in patients with [arthritis + depression] (between-group difference -0.82; 95% CI -1.17 to -0.47) or [DM + depression] (between-group difference 3.21; 95% CI 1.78 to 4.63); improved cognitive functioning in patients with [DM + depression] (between-group difference 2.44; 95% CI 0.79 to 4.09) or [HF + COPD] (p = 0.006); and increased use of mental health services in those with [DM + (CVD or depression)] (RR 2.57; 95% CI 1.90 to 3.49; I2 = 0%). INTERPRETATION Subgroup analyses showed that older adults with diabetes and either depression or cardiovascular disease, or with coexistence of chronic obstructive pulmonary disease and heart failure, can benefit from care-coordination strategies with or without education to lower HbA1c, reduce depressive symptoms, improve health-related functional status, and increase the use of mental health services. PROTOCOL REGISTRATION PROSPERO-CRD42014014489.
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Affiliation(s)
- Monika Kastner
- Knowledge Translation and Implementation unit (Kastner, Hayden), North York General Hospital, Li Ka Shing Knowledge Institute of St. Michael's Hospital (Kastner, Cardoso, Lai, Treister, Hamid, Straus); Institute of Health Policy, Management and Evaluation (Kastner), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Clinical Epidemiology and Biostatistics (Hamid), McMaster University, Hamilton, Ont.; Nuffield Department of Primary Care Health Sciences (Wong), University of Oxford, Oxford, UK; Family Practice Health Centre (Ivers), Women's College Research Institute, and Institute for Health System Solutions and Virtual Care, Women's College Hospital; Department of Family and Community Medicine and Institute of Health Policy (Ivers), Management and Evaluation, University of Toronto, Toronto; Regional Geriatric Program of Toronto (Liu), Sunnybrook Health Sciences, Geriatric Medicine, Toronto, Ont.; St. Peter's Hospital, Hamilton Health Sciences (Marr), Division of Geriatric Medicine (Marr), McMaster University, Hamilton, Ont.; Departments of Medicine and Community Health Sciences (Holroyd-Leduc), University of Calgary, Foothills Hospital, Calgary, Alta.; Department of Medicine (Straus), University of Toronto, Toronto, Ont.
| | - Roberta Cardoso
- Knowledge Translation and Implementation unit (Kastner, Hayden), North York General Hospital, Li Ka Shing Knowledge Institute of St. Michael's Hospital (Kastner, Cardoso, Lai, Treister, Hamid, Straus); Institute of Health Policy, Management and Evaluation (Kastner), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Clinical Epidemiology and Biostatistics (Hamid), McMaster University, Hamilton, Ont.; Nuffield Department of Primary Care Health Sciences (Wong), University of Oxford, Oxford, UK; Family Practice Health Centre (Ivers), Women's College Research Institute, and Institute for Health System Solutions and Virtual Care, Women's College Hospital; Department of Family and Community Medicine and Institute of Health Policy (Ivers), Management and Evaluation, University of Toronto, Toronto; Regional Geriatric Program of Toronto (Liu), Sunnybrook Health Sciences, Geriatric Medicine, Toronto, Ont.; St. Peter's Hospital, Hamilton Health Sciences (Marr), Division of Geriatric Medicine (Marr), McMaster University, Hamilton, Ont.; Departments of Medicine and Community Health Sciences (Holroyd-Leduc), University of Calgary, Foothills Hospital, Calgary, Alta.; Department of Medicine (Straus), University of Toronto, Toronto, Ont
| | - Yonda Lai
- Knowledge Translation and Implementation unit (Kastner, Hayden), North York General Hospital, Li Ka Shing Knowledge Institute of St. Michael's Hospital (Kastner, Cardoso, Lai, Treister, Hamid, Straus); Institute of Health Policy, Management and Evaluation (Kastner), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Clinical Epidemiology and Biostatistics (Hamid), McMaster University, Hamilton, Ont.; Nuffield Department of Primary Care Health Sciences (Wong), University of Oxford, Oxford, UK; Family Practice Health Centre (Ivers), Women's College Research Institute, and Institute for Health System Solutions and Virtual Care, Women's College Hospital; Department of Family and Community Medicine and Institute of Health Policy (Ivers), Management and Evaluation, University of Toronto, Toronto; Regional Geriatric Program of Toronto (Liu), Sunnybrook Health Sciences, Geriatric Medicine, Toronto, Ont.; St. Peter's Hospital, Hamilton Health Sciences (Marr), Division of Geriatric Medicine (Marr), McMaster University, Hamilton, Ont.; Departments of Medicine and Community Health Sciences (Holroyd-Leduc), University of Calgary, Foothills Hospital, Calgary, Alta.; Department of Medicine (Straus), University of Toronto, Toronto, Ont
| | - Victoria Treister
- Knowledge Translation and Implementation unit (Kastner, Hayden), North York General Hospital, Li Ka Shing Knowledge Institute of St. Michael's Hospital (Kastner, Cardoso, Lai, Treister, Hamid, Straus); Institute of Health Policy, Management and Evaluation (Kastner), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Clinical Epidemiology and Biostatistics (Hamid), McMaster University, Hamilton, Ont.; Nuffield Department of Primary Care Health Sciences (Wong), University of Oxford, Oxford, UK; Family Practice Health Centre (Ivers), Women's College Research Institute, and Institute for Health System Solutions and Virtual Care, Women's College Hospital; Department of Family and Community Medicine and Institute of Health Policy (Ivers), Management and Evaluation, University of Toronto, Toronto; Regional Geriatric Program of Toronto (Liu), Sunnybrook Health Sciences, Geriatric Medicine, Toronto, Ont.; St. Peter's Hospital, Hamilton Health Sciences (Marr), Division of Geriatric Medicine (Marr), McMaster University, Hamilton, Ont.; Departments of Medicine and Community Health Sciences (Holroyd-Leduc), University of Calgary, Foothills Hospital, Calgary, Alta.; Department of Medicine (Straus), University of Toronto, Toronto, Ont
| | - Jemila S Hamid
- Knowledge Translation and Implementation unit (Kastner, Hayden), North York General Hospital, Li Ka Shing Knowledge Institute of St. Michael's Hospital (Kastner, Cardoso, Lai, Treister, Hamid, Straus); Institute of Health Policy, Management and Evaluation (Kastner), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Clinical Epidemiology and Biostatistics (Hamid), McMaster University, Hamilton, Ont.; Nuffield Department of Primary Care Health Sciences (Wong), University of Oxford, Oxford, UK; Family Practice Health Centre (Ivers), Women's College Research Institute, and Institute for Health System Solutions and Virtual Care, Women's College Hospital; Department of Family and Community Medicine and Institute of Health Policy (Ivers), Management and Evaluation, University of Toronto, Toronto; Regional Geriatric Program of Toronto (Liu), Sunnybrook Health Sciences, Geriatric Medicine, Toronto, Ont.; St. Peter's Hospital, Hamilton Health Sciences (Marr), Division of Geriatric Medicine (Marr), McMaster University, Hamilton, Ont.; Departments of Medicine and Community Health Sciences (Holroyd-Leduc), University of Calgary, Foothills Hospital, Calgary, Alta.; Department of Medicine (Straus), University of Toronto, Toronto, Ont
| | - Leigh Hayden
- Knowledge Translation and Implementation unit (Kastner, Hayden), North York General Hospital, Li Ka Shing Knowledge Institute of St. Michael's Hospital (Kastner, Cardoso, Lai, Treister, Hamid, Straus); Institute of Health Policy, Management and Evaluation (Kastner), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Clinical Epidemiology and Biostatistics (Hamid), McMaster University, Hamilton, Ont.; Nuffield Department of Primary Care Health Sciences (Wong), University of Oxford, Oxford, UK; Family Practice Health Centre (Ivers), Women's College Research Institute, and Institute for Health System Solutions and Virtual Care, Women's College Hospital; Department of Family and Community Medicine and Institute of Health Policy (Ivers), Management and Evaluation, University of Toronto, Toronto; Regional Geriatric Program of Toronto (Liu), Sunnybrook Health Sciences, Geriatric Medicine, Toronto, Ont.; St. Peter's Hospital, Hamilton Health Sciences (Marr), Division of Geriatric Medicine (Marr), McMaster University, Hamilton, Ont.; Departments of Medicine and Community Health Sciences (Holroyd-Leduc), University of Calgary, Foothills Hospital, Calgary, Alta.; Department of Medicine (Straus), University of Toronto, Toronto, Ont
| | - Geoff Wong
- Knowledge Translation and Implementation unit (Kastner, Hayden), North York General Hospital, Li Ka Shing Knowledge Institute of St. Michael's Hospital (Kastner, Cardoso, Lai, Treister, Hamid, Straus); Institute of Health Policy, Management and Evaluation (Kastner), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Clinical Epidemiology and Biostatistics (Hamid), McMaster University, Hamilton, Ont.; Nuffield Department of Primary Care Health Sciences (Wong), University of Oxford, Oxford, UK; Family Practice Health Centre (Ivers), Women's College Research Institute, and Institute for Health System Solutions and Virtual Care, Women's College Hospital; Department of Family and Community Medicine and Institute of Health Policy (Ivers), Management and Evaluation, University of Toronto, Toronto; Regional Geriatric Program of Toronto (Liu), Sunnybrook Health Sciences, Geriatric Medicine, Toronto, Ont.; St. Peter's Hospital, Hamilton Health Sciences (Marr), Division of Geriatric Medicine (Marr), McMaster University, Hamilton, Ont.; Departments of Medicine and Community Health Sciences (Holroyd-Leduc), University of Calgary, Foothills Hospital, Calgary, Alta.; Department of Medicine (Straus), University of Toronto, Toronto, Ont
| | - Noah M Ivers
- Knowledge Translation and Implementation unit (Kastner, Hayden), North York General Hospital, Li Ka Shing Knowledge Institute of St. Michael's Hospital (Kastner, Cardoso, Lai, Treister, Hamid, Straus); Institute of Health Policy, Management and Evaluation (Kastner), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Clinical Epidemiology and Biostatistics (Hamid), McMaster University, Hamilton, Ont.; Nuffield Department of Primary Care Health Sciences (Wong), University of Oxford, Oxford, UK; Family Practice Health Centre (Ivers), Women's College Research Institute, and Institute for Health System Solutions and Virtual Care, Women's College Hospital; Department of Family and Community Medicine and Institute of Health Policy (Ivers), Management and Evaluation, University of Toronto, Toronto; Regional Geriatric Program of Toronto (Liu), Sunnybrook Health Sciences, Geriatric Medicine, Toronto, Ont.; St. Peter's Hospital, Hamilton Health Sciences (Marr), Division of Geriatric Medicine (Marr), McMaster University, Hamilton, Ont.; Departments of Medicine and Community Health Sciences (Holroyd-Leduc), University of Calgary, Foothills Hospital, Calgary, Alta.; Department of Medicine (Straus), University of Toronto, Toronto, Ont
| | - Barbara Liu
- Knowledge Translation and Implementation unit (Kastner, Hayden), North York General Hospital, Li Ka Shing Knowledge Institute of St. Michael's Hospital (Kastner, Cardoso, Lai, Treister, Hamid, Straus); Institute of Health Policy, Management and Evaluation (Kastner), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Clinical Epidemiology and Biostatistics (Hamid), McMaster University, Hamilton, Ont.; Nuffield Department of Primary Care Health Sciences (Wong), University of Oxford, Oxford, UK; Family Practice Health Centre (Ivers), Women's College Research Institute, and Institute for Health System Solutions and Virtual Care, Women's College Hospital; Department of Family and Community Medicine and Institute of Health Policy (Ivers), Management and Evaluation, University of Toronto, Toronto; Regional Geriatric Program of Toronto (Liu), Sunnybrook Health Sciences, Geriatric Medicine, Toronto, Ont.; St. Peter's Hospital, Hamilton Health Sciences (Marr), Division of Geriatric Medicine (Marr), McMaster University, Hamilton, Ont.; Departments of Medicine and Community Health Sciences (Holroyd-Leduc), University of Calgary, Foothills Hospital, Calgary, Alta.; Department of Medicine (Straus), University of Toronto, Toronto, Ont
| | - Sharon Marr
- Knowledge Translation and Implementation unit (Kastner, Hayden), North York General Hospital, Li Ka Shing Knowledge Institute of St. Michael's Hospital (Kastner, Cardoso, Lai, Treister, Hamid, Straus); Institute of Health Policy, Management and Evaluation (Kastner), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Clinical Epidemiology and Biostatistics (Hamid), McMaster University, Hamilton, Ont.; Nuffield Department of Primary Care Health Sciences (Wong), University of Oxford, Oxford, UK; Family Practice Health Centre (Ivers), Women's College Research Institute, and Institute for Health System Solutions and Virtual Care, Women's College Hospital; Department of Family and Community Medicine and Institute of Health Policy (Ivers), Management and Evaluation, University of Toronto, Toronto; Regional Geriatric Program of Toronto (Liu), Sunnybrook Health Sciences, Geriatric Medicine, Toronto, Ont.; St. Peter's Hospital, Hamilton Health Sciences (Marr), Division of Geriatric Medicine (Marr), McMaster University, Hamilton, Ont.; Departments of Medicine and Community Health Sciences (Holroyd-Leduc), University of Calgary, Foothills Hospital, Calgary, Alta.; Department of Medicine (Straus), University of Toronto, Toronto, Ont
| | - Jayna Holroyd-Leduc
- Knowledge Translation and Implementation unit (Kastner, Hayden), North York General Hospital, Li Ka Shing Knowledge Institute of St. Michael's Hospital (Kastner, Cardoso, Lai, Treister, Hamid, Straus); Institute of Health Policy, Management and Evaluation (Kastner), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Clinical Epidemiology and Biostatistics (Hamid), McMaster University, Hamilton, Ont.; Nuffield Department of Primary Care Health Sciences (Wong), University of Oxford, Oxford, UK; Family Practice Health Centre (Ivers), Women's College Research Institute, and Institute for Health System Solutions and Virtual Care, Women's College Hospital; Department of Family and Community Medicine and Institute of Health Policy (Ivers), Management and Evaluation, University of Toronto, Toronto; Regional Geriatric Program of Toronto (Liu), Sunnybrook Health Sciences, Geriatric Medicine, Toronto, Ont.; St. Peter's Hospital, Hamilton Health Sciences (Marr), Division of Geriatric Medicine (Marr), McMaster University, Hamilton, Ont.; Departments of Medicine and Community Health Sciences (Holroyd-Leduc), University of Calgary, Foothills Hospital, Calgary, Alta.; Department of Medicine (Straus), University of Toronto, Toronto, Ont
| | - Sharon E Straus
- Knowledge Translation and Implementation unit (Kastner, Hayden), North York General Hospital, Li Ka Shing Knowledge Institute of St. Michael's Hospital (Kastner, Cardoso, Lai, Treister, Hamid, Straus); Institute of Health Policy, Management and Evaluation (Kastner), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Clinical Epidemiology and Biostatistics (Hamid), McMaster University, Hamilton, Ont.; Nuffield Department of Primary Care Health Sciences (Wong), University of Oxford, Oxford, UK; Family Practice Health Centre (Ivers), Women's College Research Institute, and Institute for Health System Solutions and Virtual Care, Women's College Hospital; Department of Family and Community Medicine and Institute of Health Policy (Ivers), Management and Evaluation, University of Toronto, Toronto; Regional Geriatric Program of Toronto (Liu), Sunnybrook Health Sciences, Geriatric Medicine, Toronto, Ont.; St. Peter's Hospital, Hamilton Health Sciences (Marr), Division of Geriatric Medicine (Marr), McMaster University, Hamilton, Ont.; Departments of Medicine and Community Health Sciences (Holroyd-Leduc), University of Calgary, Foothills Hospital, Calgary, Alta.; Department of Medicine (Straus), University of Toronto, Toronto, Ont
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Kagan E, Freud T, Punchik B, Barzak A, Peleg R, Press Y. A Comparative Study of Models of Geriatric Assessment and the Implementation of Recommendations by Primary Care Physicians. Rejuvenation Res 2017; 20:278-285. [DOI: 10.1089/rej.2016.1891] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ella Kagan
- Yasski Clinic, Comprehensive Geriatric Assessment Unit, Clalit Health Services, Beer-Sheva, Israel
| | - Tamar Freud
- Department of Family Medicine, Faculty of Health Sciences, Siaal Research Center for Family Medicine and Primary Care, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Boris Punchik
- Yasski Clinic, Comprehensive Geriatric Assessment Unit, Clalit Health Services, Beer-Sheva, Israel
- Department of Family Medicine, Faculty of Health Sciences, Siaal Research Center for Family Medicine and Primary Care, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Unit for Community Geriatrics, Division of Health in the Community, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Alex Barzak
- Yasski Clinic, Comprehensive Geriatric Assessment Unit, Clalit Health Services, Beer-Sheva, Israel
| | - Roni Peleg
- Department of Family Medicine, Faculty of Health Sciences, Siaal Research Center for Family Medicine and Primary Care, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Clalit Health Services, Beer-Sheva, Israel
| | - Yan Press
- Yasski Clinic, Comprehensive Geriatric Assessment Unit, Clalit Health Services, Beer-Sheva, Israel
- Department of Family Medicine, Faculty of Health Sciences, Siaal Research Center for Family Medicine and Primary Care, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Unit for Community Geriatrics, Division of Health in the Community, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Byerly LK, Harper GM. Is it time for comprehensive geriatric assessment to move beyond primary care? The case for targeting medical sub-specialty practice. Isr J Health Policy Res 2017; 6:33. [PMID: 28593039 PMCID: PMC5460411 DOI: 10.1186/s13584-017-0158-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 05/29/2017] [Indexed: 02/08/2023] Open
Abstract
Comprehensive geriatric assessment (CGA) as a consultative service for older adults with complex medical and psychosocial challenges has existed for decades. However, studies have often showed inconsistent acceptance and implementation of geriatric recommendations by primary care providers (PCPs) raising doubts about the overall benefits of CGA in this setting. Press and colleagues investigated the patient- and provider-related factors that affect recommendation implementation, and like previous studies, they too found similarly low rates of implementation. In this commentary, we acknowledge the perennial challenges that exist to improving the acceptance of CGA in primary care practice, and we suggest an alternative target: medical sub-specialty practice. By highlighting three medical sub-specialty fields (oncology, nephrology, and cardiology), which have demonstrated that CGA can be incorporated into their respective clinical practices, we argue that CGA may prove to have greater impact in these settings than in primary care. We also propose initial research steps that could further delineate the trends, outcomes, and next steps for such consultations.
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Affiliation(s)
- Laura K Byerly
- Division of Geriatrics, University of California, San Francisco and San Francisco VA Medical Center, 4150 Clement Street, 181G, San Francisco, CA 94121 USA
| | - G Michael Harper
- Division of Geriatrics, University of California, San Francisco and San Francisco VA Medical Center, 4150 Clement Street, 181G, San Francisco, CA 94121 USA
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Press Y, Punchik B, Kagan E, Barzak A, Freud T. Which factors affect the implementation of geriatric recommendations by primary care physicians? Isr J Health Policy Res 2017; 6:7. [PMID: 28451380 PMCID: PMC5404663 DOI: 10.1186/s13584-017-0134-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 02/06/2017] [Indexed: 11/10/2022] Open
Abstract
Background The overall implementation rate for outpatient comprehensive geriatric assessment (OCGAU) recommendations ranges from 48.6 to 71%. The purpose of the study was to identify factors that reduce the implementation rate of geriatric recommendations. Methods The medical records of patients who were assessed in the comprehensive geriatric assessment unit over an 8 year study period were surveyed. Data collected included patient's characteristics (socio-demographic, functional, cognitive, and affective condition, co-morbidity), number of recommendations, the identity of the geriatrician, and data related to the primary physician (age, sex, seniority, number of patients referred for geriatric assessment). Results Three thousand four hundred thirty-four recommendations were made for 488 patients (mean age 83.6 ± 0.6 years) of which 1,634 (47.6%) were implemented by their primary physician. In univariate analyses patients with an implementation rate < 25%, compared to patients with implementation rate ≥75%, had a higher Charlson Comorbidity Index Total Score (CCITS) (2.5 ± 1.9 vs. 1.8 ± 1.7, P < 0.05), a lower Barthel Index (82.8 ± 16.2 vs. 87.0 ± 15.3, P < 0.05), and a lower Instrumental Activity of Daily Living score (7.2 ± 3.5 vs. 8.2 ± 3.7, P < 0.05). There were no differences between these groups in other patient characteristics or the number of recommendations made during the assessment. Similarly, there were no differences in the identity of the geriatrician or the primary physician's characteristics. In the multivariate analysis only higher CCITS was associated with a lower rate of recommendation implementation by primary physicians. Conclusions There is a need to increase the implementation rate by primary physicians by increasing and strengthening the link with them and by further training in the field of geriatrics medicine. Trial registration The Helsinki committee of the Meir Medical Center approved the study (Approval #024/2015 [k]).
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Affiliation(s)
- Yan Press
- Department of Family Medicine, Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Yasski Clinic, Comprehensive Geriatric Assessment Unit, Clalit Health Services, Beer-Sheva, Israel.,Unit for Community Geriatrics, Division of Health in the Community, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Boris Punchik
- Department of Family Medicine, Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Yasski Clinic, Comprehensive Geriatric Assessment Unit, Clalit Health Services, Beer-Sheva, Israel.,Unit for Community Geriatrics, Division of Health in the Community, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ella Kagan
- Yasski Clinic, Comprehensive Geriatric Assessment Unit, Clalit Health Services, Beer-Sheva, Israel.,Unit for Community Geriatrics, Division of Health in the Community, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Alex Barzak
- Yasski Clinic, Comprehensive Geriatric Assessment Unit, Clalit Health Services, Beer-Sheva, Israel
| | - Tamar Freud
- Department of Family Medicine, Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Garroutte EM, Kunovich RM, Buchwald D, Goldberg J. Medical Communication in Older American Indians: Variations by Ethnic Identity. J Appl Gerontol 2016. [DOI: 10.1177/0733464805282725] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The authors analyzed audiotapes from 102 patients of American Indian race (≥50 years) to explore how ethnic identity influences medical communication. A standardized interaction analysis system was used to classify patient utterances into categories: information-giving, questions, social talk, positive talk, negative talk. The authors identified patient subgroups distinguished by level of identification with American Indian and White identity and explored whether some subgroups devoted more communication to certain categories of talk. Patients highly affiliated with American Indian identity devoted a significantly greater percentage of communication to “positive talk”—including statements of optimism, reassurance, and agreement—than patients identifying at lower levels (p > .05). They devoted less communication to “negative talk,” including corrections, disagreements, and anxiety statements (p < .05). Effects persisted after adjustment for confounders, including health status. Patterns may encourage providers to underestimate distress and overestimate satisfaction and comprehension in patients highly affiliated with American Indian identity.
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Bhattacharya SB, Rossi MI, Mentz JM. Optimizing strategies to improve interprofessional practice for veterans, part 1. J Multidiscip Healthc 2014; 7:179-88. [PMID: 24790456 PMCID: PMC4000184 DOI: 10.2147/jmdh.s51010] [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] [Indexed: 11/23/2022] Open
Abstract
Introduction Interprofessional patient care is a well-recognized path that health care systems are striving toward. The Veteran’s Affairs (VA) system initiated interprofessional practice (IPP) models with their Geriatric Evaluation and Management (GEM) programs. GEM programs incorporate a range of specialties, including but not limited to, medicine, nursing, social work, physical therapy and pharmacy, to collaboratively evaluate veterans. Despite being a valuable resource, they are now faced with significant cut-backs, including closures. The primary goal of this project was to assess how the GEM model could be optimized at the Pittsburgh, Pennsylvania VA to allow for the sustainability of this important IPP assessment. Part 1 of the study evaluated the IPP process using program, patient, and family surveys. Part 2 examined how well the geriatrician matched patients to specialists in the GEM model. This paper describes Part 1 of our study. Methods Three strategies were used: 1) a national GEM program survey; 2) a veteran/family satisfaction survey; and 3) an absentee assessment. Results Twenty-six of 92 programs responded to the GEM IPP survey. Six strategies were shared to optimize IPP models throughout the country. Of the 34 satisfaction surveys, 80% stated the GEM clinic was beneficial, 79% stated their concerns were addressed, and 100% would recommend GEM to their friends. Of the 24 absentee assessments, the top three reasons for missing the appointments were transportation, medical illnesses, and not knowing/remembering about the appointment. Absentee rate diminished from 41% to 19% after instituting a reminder phone call policy. Discussion Maintaining the sustainability of IPP programs is crucial for the health of our veterans. This project uncovered tools to improve the GEM IPP model for our veterans that can be incorporated nationally. Despite the lengthy nature of IPP models, patients and families appreciated the thoroughness, requested transportation and food, and responded well to reminder phone calls. A keen eye on these issues and concomitant medical complexity needs to be observed when planning IPP models to ensure sustainability.
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Affiliation(s)
- Shelley B Bhattacharya
- Geriatric Research Education and Clinical Center (GRECC), Veteran's Affairs Pittsburgh Healthcare System ; University of Pittsburgh Medical Center, Pittsburgh, PA, USA ; Albert Schweitzer Fellowship Program, Pittsburgh, PA, USA
| | - Michelle I Rossi
- Geriatric Research Education and Clinical Center (GRECC), Veteran's Affairs Pittsburgh Healthcare System ; University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jennifer M Mentz
- Geriatric Research Education and Clinical Center (GRECC), Veteran's Affairs Pittsburgh Healthcare System
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Baron EP, Markowitz SY, Lettich A, Hastriter E, Lovell B, Kalidas K, Dodick DW, Schwedt TJ. Triptan education and improving knowledge for optimal migraine treatment: an observational study. Headache 2014; 54:686-97. [PMID: 24520930 DOI: 10.1111/head.12286] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND It is generally felt that patient education and patient knowledge regarding triptan use for acute migraine management are important for successful and safe treatment. It is unclear how knowledgeable triptan users are regarding their triptan, how much education occurs when triptans are prescribed, and the impact patient education has on actual patient knowledge regarding triptan use. OBJECTIVE The primary objective was to compare triptan users' self-perceived knowledge and actual knowledge about triptans in patients who report having received triptan education vs patients who report not having received triptan education. METHODS This was a multicenter prospective observational study of 207 migraine patients who were using triptans for abortive therapy and who were being evaluated as new patients at academic headache specialty clinics in the United States. Patients completed standardized questionnaires regarding their self-perceived knowledge about triptans, their actual knowledge regarding triptans, and the perceived education about the triptan that they had received at the time of prescription. RESULTS Although greater than 80% of the subjects reported receiving education about when to take the triptan and the number of doses they could take for headache, only 71.5% reported receiving education about triptan side effects, 64% for the number of triptan doses they could take each week/month, 64% for taking other medications with the triptan, and 49% for medical contraindications to triptan use. Compared with subjects who did not recall receiving education about when to take their triptan, subjects who recalled such education had a statistically significant greater actual knowledge for taking the triptan immediately after a headache begins (91% vs 77%, P = .049; confidence interval [CI]: 0.00-0.33), treating when pain is mild (75% vs 50%, P = .009; CI: 0.04-0.45), understanding that they do not need to fail treatment with over-the-counter medications before taking a triptan (74% vs 42%, P = .001; CI: 0.11-0.51), and recognizing that coronary artery disease is a contraindication to triptan use (40% vs 19%, P = .001; CI: 0.09-0.34). CONCLUSION This study provides evidence that patients who recall having received education at the time of triptan prescribing have greater knowledge regarding optimal triptan use. Triptan users who recalled having received this education had greater recognition of the importance of taking the triptan immediately at the onset of a headache, treating when pain is mild, not needing to fail treatment with over-the-counter medications before taking a triptan, and understanding that coronary artery disease is a contraindication to triptan use.
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Affiliation(s)
- Eric P Baron
- Cleveland Clinic Neurological Institute, Cleveland, OH, USA
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20
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Molfenter TD, Brown RL. Effects of Physician Communication and Family Hardiness on Patient Medication Regimen Beliefs and Adherence. ACTA ACUST UNITED AC 2014; 2. [PMID: 25593977 DOI: 10.4172/2327-5146.1000136] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This study aims to develop a model that describes how physician communication and family hardiness affect medication regimen beliefs and adherence for patients on regimens to control diabetes and hyperlipidemia (high cholesterol). Study participants (n=1356) completed self-report questionnaires on health beliefs. Pharmacy refill records from a health plan in the United States provided data on their medication adherence. Structural equation modeling was used to model variable relationships. A mediation analysis demonstrated that physician communication behaviors had a significant impact on the patients' behavioral intention to adhere to their regimen and medication adherence when they were mediated by the patient's medication taking health beliefs related to perceived benefit of the regimen, impact of side effects, and cost of regimen. Conversely, family hardiness had no effect on medication-taking behaviors. To improve patient medication-taking behaviors, physician communication behaviors should be targeted. The study suggests the physician's initial regimen discussion is important to both regimen initiation and long-term adherence, and should emphasize the regimen's benefits and how to avoid common side effects. Also, establishing a follow-up physician-patient relationship can enhance regimen adherence and reduce the likelihood that a patient will stop taking the medication due to cost concerns. The research supports the important role the physician plays in health behavior maintenance. Future research should study the effect physicians have on other recurring health behaviors.
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Georgy EE, Carr ECJ, Breen AC. Met or matched expectations: what accounts for a successful back pain consultation in primary care? Health Expect 2013; 16:143-54. [PMID: 21679288 PMCID: PMC5060651 DOI: 10.1111/j.1369-7625.2011.00706.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Patients' as well as doctors' expectations might be key elements for improving the quality of health care; however, previous conceptual and theoretical frameworks related to expectations often overlook such complex and complementary relationship between patients' and doctors' expectations. The concept of 'matched patient-doctor expectations' is not properly investigated, and there is lack of literature exploring such aspect of the consultation. AIM The paper presents a preliminary conceptual model for the relationship between patients' and doctors' expectations with specific reference to back pain management in primary care. METHODS The methods employed in this study are integrative literature review, examination of previous theoretical frameworks, identification of conceptual issues in existing literature, and synthesis and development of a preliminary pragmatic conceptual framework. OUTCOME A simple preliminary model explaining the formation of expectations in relation to specific antecedents and consequences was developed; the model incorporates several stages and filters (influencing factors, underlying reactions, judgement, formed reactions, outcome and significance) to explain the development and anticipated influence of expectations on the consultation outcome. CONCLUSION The newly developed model takes into account several important dynamics that might be key elements for more successful back pain consultation in primary care, mainly the importance of matching patients' and doctors' expectations as well as the importance of addressing unmet expectations.
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Affiliation(s)
- Ehab E Georgy
- School of Health and Social Care, Bournemouth University, Dorset, UK.
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22
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Attar HS, Chandramani S. Impact of physician empathy on migraine disability and migraineur compliance. Ann Indian Acad Neurol 2012; 15:S89-94. [PMID: 23024571 PMCID: PMC3444220 DOI: 10.4103/0972-2327.100025] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Revised: 04/12/2012] [Accepted: 04/18/2012] [Indexed: 01/01/2023] Open
Abstract
Aims: We aim to establish the role that perceived physician empathy plays in determining migraineurs’ outcomes and compliance with migraine management plans. We checked for associations between perceived physician empathy and clinical outcomes as well as compliance with management plans. Materials and Methods: 63 migraineurs were enrolled between July and September 2011. Questionnaire administered at the time of inclusion into the study included self-assessment of disability due to migraine (Migraine Disability Assessment Test) followed by migraineurs’ assessment of physician empathy (Consultation and Relational Empathy Measure). Three months later, a telephonic questionnaire ascertained changes in disability due to migraine and compliance with migraine treatment. Statistical Analysis: Data was entered in Microsoft Excel 2010 and analyzed using SPSS 17. Pearson's correlation was employed to analyze the significance of relationship between variables. P-value of less than 0.05 has been considered statistically significant. Results: Statistically significant positive Pearson's correlations are seen between perceived empathy and decrease in migraine disability and symptoms over three months (P < 0.05). Significant positive relationships are also seen between perceived empathy and compliance with diet/meal timings, exercising, de-stressing/sleep pattern modification and medications (P < 0.05). Self-reported compliance is significantly correlated with improved patient outcomes (P < 0.05). Conclusions: Substantial positive associations are found between perceived physician empathy and migraineurs’ outcomes and compliance with management plans. This emphasizes the importance of empathy in migraineur-physician communication.
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Affiliation(s)
- Hatim S Attar
- Department of Medicine, K. J. Somaiya Medical College and Research Center, Somaiya Ayurvihar Complex, Sion, Mumbai, Maharashtra, India
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Press Y, Biderman A, Peleg R, Tandeter H, Dwolatzky T. Benefits of active participation of family physicians in geriatric consultations. Geriatr Gerontol Int 2012; 12:725-32. [DOI: 10.1111/j.1447-0594.2012.00839.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Molfenter TD, Bhattacharya A, Gustafson DH. The roles of past behavior and health beliefs in predicting medication adherence to a statin regimen. Patient Prefer Adherence 2012; 6:643-51. [PMID: 23055697 PMCID: PMC3461604 DOI: 10.2147/ppa.s34711] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Current medication-adherence predictive tools are based on patient medication-taking beliefs, but studying past behavior may now be a more explanatory and accessible method. This study will evaluate if past medication-refill behavior for a statin regimen is more predictive of medication adherence than patient medication-taking health beliefs. PATIENTS AND METHODS This prospective longitudinal study was implemented in a national managed care plan in the United States. A group of 1433 statin patients were identified and followed for 6 months. Medication-taking health beliefs, collected from self-reported mail questionnaires, and past medication-refill behavior, using proportion of days covered (PDC), were collected prior to 6-month follow-up. Outcomes were measured using categorical PDC variable (of adherence, PDC ≥ 85%, versus nonadherence, PDC < 85%), with model fit estimated using receiver operator characteristic analysis. RESULTS The area under the receiver operator characteristic curve for past behavior (A(z) = 0.78) was significantly greater (P < 0.05) than for patient health beliefs (A(z) = 0.69), indicating that past prescription-refill behavior is a better predictor of medication adherence than prospective health beliefs. Among health beliefs, the factor most related to medication adherence was behavioral intent (odds ratio, 5.12; 95% confidence interval, 1.84 to 15.06). The factor most strongly related to behavioral intent was impact of regimen on daily routine (odds ratio, 3.3; 95% confidence interval, 1.41 to 7.74). CONCLUSION Electronic medical records and community health-information networks may make past prescription-refill rates more accessible and assist physicians with managing medication-regimen adherence. Health beliefs, however, may still play an important role in influencing medication-taking behaviors.
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Affiliation(s)
- Todd D Molfenter
- Center for Health Enhancement Systems Studies (CHESS), Madison, WI, USA
- Correspondence: Todd Molfenter, Center for Health Enhancement Systems, Studies (CHESS), 4103 Mechanical, Engineering Building, 1513 University Avenue, Madison, WI 53706, USA, Tel +1 608 262 1685, Fax +1 608 890 1438, Email
| | | | - David H Gustafson
- Center for Health Enhancement Systems Studies (CHESS), Madison, WI, USA
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Fairhall N, Langron C, Sherrington C, Lord SR, Kurrle SE, Lockwood K, Monaghan N, Aggar C, Gill L, Cameron ID. Treating frailty--a practical guide. BMC Med 2011; 9:83. [PMID: 21733149 PMCID: PMC3146844 DOI: 10.1186/1741-7015-9-83] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Accepted: 07/06/2011] [Indexed: 01/13/2023] Open
Abstract
Frailty is a common syndrome that is associated with vulnerability to poor health outcomes. Frail older people have increased risk of morbidity, institutionalization and death, resulting in burden to individuals, their families, health care services and society. Assessment and treatment of the frail individual provide many challenges to clinicians working with older people. Despite frailty being increasingly recognized in the literature, there is a paucity of direct evidence to guide interventions to reduce frailty. In this paper we review methods for identification of frailty in the clinical setting, propose a model for assessment of the frail older person and summarize the current best evidence for treating the frail older person. We provide an evidence-based framework that can be used to guide the diagnosis, assessment and treatment of frail older people.
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Affiliation(s)
- Nicola Fairhall
- Rehabilitation Studies Unit, Faculty of Medicine, The University of Sydney, Ryde, Sydney 2112, Australia
- The George Institute for Global Health, The University of Sydney, Sydney 2000, Australia
| | - Colleen Langron
- Rehabilitation and Aged Care Services, Hornsby Ku-ring-gai Hospital, Hornsby, Sydney 2077, Australia
| | - Catherine Sherrington
- The George Institute for Global Health, The University of Sydney, Sydney 2000, Australia
| | - Stephen R Lord
- Neuroscience Research Australia, University of New South Wales, Randwick, Sydney 2031, Australia
| | - Susan E Kurrle
- Rehabilitation and Aged Care Services, Hornsby Ku-ring-gai Hospital, Hornsby, Sydney 2077, Australia
| | - Keri Lockwood
- Rehabilitation and Aged Care Services, Hornsby Ku-ring-gai Hospital, Hornsby, Sydney 2077, Australia
| | - Noeline Monaghan
- Rehabilitation Studies Unit, Faculty of Medicine, The University of Sydney, Ryde, Sydney 2112, Australia
| | - Christina Aggar
- Faculty of Nursing and Midwifery, The University of Sydney, Sydney 2006, Australia
| | - Liz Gill
- Rehabilitation Studies Unit, Faculty of Medicine, The University of Sydney, Ryde, Sydney 2112, Australia
| | - Ian D Cameron
- Rehabilitation Studies Unit, Faculty of Medicine, The University of Sydney, Ryde, Sydney 2112, Australia
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Garrido MM, Kane RL, Kaas M, Kane RA. Use of mental health care by community-dwelling older adults. J Am Geriatr Soc 2011; 59:50-6. [PMID: 21198461 DOI: 10.1111/j.1532-5415.2010.03220.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To examine relationships between perceived need for care, illness characteristics, attitudes toward care, and probability that older adults will use mental health care (MHC). DESIGN Secondary data analysis. SETTING The Collaborative Psychiatric Epidemiology Surveys (2001-2003). PARTICIPANTS One thousand six hundred eighty-one community-dwelling adults aged 65 and older. MEASUREMENTS Self-reported MHC use and perceived need for care in the previous 12 months, previous year and history of mental illness, history of physical illness, attitudes toward care, and sociodemographic characteristics. RESULTS Of the entire sample, 6.5% had received some type of MHC in the previous year, although 65.9% of those with major depressive disorder (MDD) and 72.5% with anxiety did not receive MHC. In respondents with previous-year depression or anxiety, use was less likely for those with low World Health Organization Disability Assessment Scale (WHO-DAS) self-care ability. Use was more likely for those with more chronic physical conditions and worse WHO-DAS cognitive capacity. Seventeen percent of those with perceived need for MHC did not receive it. In respondents with perceived need, subthreshold generalized anxiety disorder was associated with lower likelihood of use. Use was more likely for older respondents and those with more household members, at least a high school education, and better self-care ability. Forty-one percent of those who perceived a need for care but did not use it met previous-year diagnostic criteria for anxiety, and 17% met criteria for MDD. CONCLUSION Understanding the perceptions that underlie individuals' health care-seeking behavior is an important step toward reducing underuse of MHC by older adults.
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Affiliation(s)
- Melissa M Garrido
- Research Enhancement Award Program and Geriatric Research, Education, and Clinical Center, James J Peters Veterans Affairs Medical Center, Bronx, New York, USA.
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Allegretti A, Borkan J, Reis S, Griffiths F. Paired interviews of shared experiences around chronic low back pain: classic mismatch between patients and their doctors. Fam Pract 2010; 27:676-83. [PMID: 20671000 DOI: 10.1093/fampra/cmq063] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND current treatments for chronic low back pain (LBP) appear to be inadequate and there are growing calls for new approaches. This study explores the paired interviews of shared experiences among chronic LBP patients and their physicians with the ultimate goal of improving doctor-patient communication and clinical outcomes. METHODS in-depth interviews of a purposeful sample of paired chronic LBP patients and their doctors were conducted, transcribed and analysed using a multistep iterative process. Interview pairs were examined for important themes and major areas of convergence and divergence/mismatch. RESULTS patients' stories focused on their suffering from severe and disabling LBP while conveying a high level of reliance on their family physicians. Physicians described many challenges in treating this patient population. Patient and doctor stories were convergent regarding the severity/seriousness of illness, the lack of effective treatments and the existence of many barriers to care. Notable areas of mismatch: biomedical/biomechanical versus biopsychosocial (BPS) models of illness, treatment expectations/goals of reducing pain versus improving function and the importance of a definitive diagnosis. DISCUSSION patient and physician stories revealed shared themes and convergences, as well as significant discordance and mismatch. Family physicians, trained in and adherent to the BPS model, may have great difficulty when matched with biomechanically oriented patients. Re-conceptualizing doctors and LBP patients as a single teachable dyad may be useful. Clinical application of paired interviews of shared experiences may be useful in bridging communication and paradigmatic gaps, reducing mismatch and developing shared treatment plans.
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Affiliation(s)
- Andrew Allegretti
- Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
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Martens MG, Shaw H. Maximizing Effectiveness of Bisphosphonate Therapy for Osteoporosis. South Med J 2008; 101:824-30. [DOI: 10.1097/smj.0b013e31817fd436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Curtin RB, Walters BA, Schatell D, Pennell P, Wise M, Klicko K. Self-efficacy and self-management behaviors in patients with chronic kidney disease. Adv Chronic Kidney Dis 2008; 15:191-205. [PMID: 18334246 DOI: 10.1053/j.ackd.2008.01.006] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Although past research has examined self-management among patients with end-stage renal disease (ESRD), little is known about self-management in patients with chronic kidney disease (CKD). In this cross-sectional survey (no intervention), 174 patients with CKD (serum creatinine > or =1.7 mg/dL) completed self-reported measures of self-efficacy, physical and mental functioning, and self-management. The purpose of the study was to explore the association between patients' perceived self-efficacy and their self-management behaviors. Five types of self-management behaviors were measured: communication with caregivers, partnership in care, self-care, self-advocacy, and medication adherence. Controlling for other relevant variables including age, education, diabetic status, hypertension, serum creatinine, physical functioning, and mental health functioning, higher perceived self-efficacy scores were associated with increased communication, partnership, self-care, and medication-adherence behaviors. In this study, patients' perceived self-efficacy was a more consistent correlate of self-management behavior than were demographic or health characteristics. Because self-management has been associated with positive patient outcomes, fostering self-management by supporting patient self-efficacy may have long-term benefits.
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Participation des médecins généralistes dans les réseaux de santé : expériences en Amérique du Nord. Rev Epidemiol Sante Publique 2007; 55:401-12. [DOI: 10.1016/j.respe.2007.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2007] [Accepted: 09/17/2007] [Indexed: 11/21/2022] Open
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Guzman-Clark JRS, Fang MA, Sehl ME, Traylor L, Hahn TJ. Barriers in the management of glucocorticoid-induced osteoporosis. ACTA ACUST UNITED AC 2007; 57:140-6. [PMID: 17266078 DOI: 10.1002/art.22462] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To determine present practice for the management of glucocorticoid-induced osteoporosis (GIOP) in veterans; to characterize provider knowledge, beliefs, and practice behaviors regarding management of GIOP; and to identify potential barriers and interventions in the management of GIOP. METHODS To characterize current management of GIOP in an academic veterans administration medical center, we conducted a retrospective chart review of 100 patients who were prescribed a 90-day supply of prednisone. To assess clinicians' knowledge of GIOP clinical guidelines and perceptions of GIOP management, primary care clinicians and subspecialists completed a questionnaire and participated in focus groups. RESULTS Chart review revealed that only 32 of 100 patients receiving long-term glucocorticoid treatment underwent bone mineral density testing, and only 32 patients were prescribed the recommended calcium supplements. Of the 23 providers who completed the questionnaire and participated in the focus groups, 4 correctly identified both the dose and duration of glucocorticoid use at which GIOP prevention measures should be instituted. Common GIOP management barriers cited by participants were lack of knowledge, having limited time during the clinic visit to address all problems, patient nonadherence, and system problems. The most commonly mentioned potential interventions were the use of computerized clinical reminders and patient education. CONCLUSION Clinicians frequently do not follow recommended guidelines for the management of GIOP. Improving the management of GIOP will likely require a fundamental redesigning of care processes for this disorder in order to overcome provider, patient-related, and system barriers.
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Ishikawa H, Hashimoto H, Yano E. Patients' preferences for decision making and the feeling of being understood in the medical encounter among patients with rheumatoid arthritis. ACTA ACUST UNITED AC 2007; 55:878-83. [PMID: 17139664 DOI: 10.1002/art.22355] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine how patients' preferences for decision making in the medical encounter affect the association between their participation style and the feeling of being understood by the physician. METHODS The study group comprised 115 patients with rheumatoid arthritis who were under continuous care by 8 rheumatologists at a university-affiliated rheumatology clinic in Tokyo, Japan. A questionnaire was distributed just after each encounter, in which patients' self-reported participation in communication during the visit, preference for decision making, and the feeling of being understood were measured. The feeling of being understood was regressed on the participation style and preference for decision making after controlling for demographic and functional variables. RESULTS Patient participation in visit communication was positively associated with the feeling of being understood. This relationship was moderated by patients' preference for decision making. Patients with higher preference for decision making were more likely to feel understood when they more actively participated in visit communication, whereas this relationship was weaker among those with lower preference for decision making. CONCLUSION Inviting patients to participate in visit communication may not always enhance the feeling of being understood by the physician when patients have less preference for autonomous decision making in the relationship with the physician. Exploring patients' preferences in the relationship would help physicians understand what the patient expects from visit communication and tailor their practice style to meet patients' needs.
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Affiliation(s)
- Hirono Ishikawa
- Department of Hygiene & Public Health, Teikyo University School of Medicine, Tokyo, Japan.
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Perreault K, Dionne CE. Does patient-physiotherapist agreement influence the outcome of low back pain? A prospective cohort study. BMC Musculoskelet Disord 2006; 7:76. [PMID: 16987418 PMCID: PMC1609117 DOI: 10.1186/1471-2474-7-76] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2006] [Accepted: 09/20/2006] [Indexed: 11/12/2022] Open
Abstract
Background Recent research suggests that agreement between patients' and health professionals' perceptions may influence the outcome of various painful conditions. This issue has received little attention in the context of low back pain and physiotherapy interventions. The current study aimed at exploring the relationship between patient-physiotherapist agreement on baseline low back pain intensity and related functional limitations, and changes in patient outcomes four weeks later. Methods Seventy-eight patient-physiotherapist dyads were included in the study. At baseline, patients and physiotherapists completed a Numerical Rating Scale and the Roland-Morris Disability Questionnaire. Patients' perceptions were reassessed over the phone at follow-up. Results Using multiple regression, baseline level of patient-physiotherapist agreement on pain intensity was associated with both outcome measures at follow-up. Agreement on functional limitations had no impact on outcomes. Conclusion The results of this study indicate that patient-physiotherapist agreement has some impacts on the short-term outcomes of low back pain. Further research is needed to confirm these findings.
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Affiliation(s)
- Kadija Perreault
- Department of Rehabilitation, Faculty of Medicine, Pavillon Ferdinand-Vandry, Laval University, Quebec, Quebec, G1K 7P4, Canada
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, 525, boulevard Wilfrid-Hamel, H-1412, Quebec, Quebec, G1M 2S8, Canada
| | - Clermont E Dionne
- Department of Rehabilitation, Faculty of Medicine, Pavillon Ferdinand-Vandry, Laval University, Quebec, Quebec, G1K 7P4, Canada
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, 525, boulevard Wilfrid-Hamel, H-1412, Quebec, Quebec, G1M 2S8, Canada
- Population Health Research Unit, Research Centre of the Laval University Affiliated Hospital, Hôpital du Saint-Sacrement, 1050 chemin Sainte-Foy Quebec, Quebec, G1S 4L8, Canada
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Dearborn JL, Panzer VP, Burleson JA, Hornung FE, Waite H, Into FH. Effect of Gender on Communication of Health Information to Older Adults. J Am Geriatr Soc 2006; 54:637-41. [PMID: 16686875 DOI: 10.1111/j.1532-5415.2006.00665.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To examine the effect of gender on three key elements of communication with elderly individuals: effectiveness of the communication, perceived relevance to the individual, and effect of gender-stereotyped content. DESIGN Survey. SETTING University of Connecticut Health Center. PARTICIPANTS Thirty-three subjects (17 female); aged 69 to 91 (mean+/-standard deviation 82+/-5.4). MEASUREMENTS Older adults listened to 16 brief narratives randomized in order and by the sex of the speaker (Narrator Voice). Effectiveness was measured according to ability to identify key features (Risks), and subjects were asked to rate the relevance (Plausibility). Number of Risks detected and determinations of plausibility were analyzed according to Subject Gender and Narrator Voice. Narratives were written for either sex or included male or female bias (Neutral or Stereotyped). RESULTS Female subjects identified a significantly higher number of Risks across all narratives (P=.01). Subjects perceived a significantly higher number of Risks with a female Narrator Voice (P=.03). A significant Voice-by-Stereotype interaction was present for female-stereotyped narratives (P=.009). In narratives rated as Plausible, subjects detected more Risks (P=.02). CONCLUSION Subject Gender influenced communication effectiveness. A female speaker resulted in identification of more Risks for subjects of both sexes, particularly for Stereotyped narratives. There was no significant effect of matching Subject Gender and Narrator Voice. This study suggests that the sex of the speaker influences the effectiveness of communication with older adults. These findings should motivate future research into the means by which medical providers can improve communication with their patients.
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Garroutte EM, Sarkisian N, Arguelles L, Goldberg J, Buchwald D. Cultural identities and perceptions of health among health care providers and older American Indians. J Gen Intern Med 2006; 21:111-6. [PMID: 16390503 PMCID: PMC1484651 DOI: 10.1111/j.1525-1497.2006.00321.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Differences in provider-patient health perceptions have been associated with poor patient outcomes, but little is known about how patients' cultural identities may be related to discordant perceptions. OBJECTIVE To examine whether health care providers and American-Indian patients disagreed on patient health status ratings, and how differences related to these patients' strength of affiliation with American-Indian and white-American cultural identities. DESIGN Survey of patients and providers following primary care office visits. PARTICIPANTS One hundred and fifteen patients > or =50 years and 7 health care providers at a Cherokee Nation clinic. All patients were of American-Indian race, but varied in strength of affiliation with separate measures of American-Indian and white-American cultural identities. MEASUREMENTS Self-reported sociodemographic and cultural characteristics, and a 5-point rating of patient's health completed by both patients and providers. Fixed-effects regression modeling examined the relationships of patients' cultural identities with differences in provider-patient health rating. RESULTS In 40% of medical visits, providers and patients rated health differently, with providers typically judging patients healthier than patients' self-rating. Provider-patient differences were greater for patients affiliating weakly with white cultural identity than for those affiliating strongly (adjusted mean difference=0.70 vs 0.12, P=.01). Differences in ratings were not associated with the separate measure of affiliation with American-Indian identity. CONCLUSIONS American-Indian patients, especially those who affiliate weakly with white-American cultural identity, often perceive health status differently from their providers. Future research should explore sources of discordant perceptions.
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Kerse N, Buetow S, Mainous AG, Young G, Coster G, Arroll B. Physician-patient relationship and medication compliance: a primary care investigation. Ann Fam Med 2004; 2:455-61. [PMID: 15506581 PMCID: PMC1466710 DOI: 10.1370/afm.139] [Citation(s) in RCA: 220] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE We assessed the relationship between 4 attributes of the physician-patient relationship and medication compliance. METHODS We conducted a waiting room survey of patients consulting 22 general practitioners in 14 randomly selected practices in Auckland, New Zealand (81% response rate). A total of 370 consecutive patients (75% response rate) completed survey instruments about 4 attributes of the physician-patient relationship. Continuity of care (assessed from use of a usual physician, length of continuity, and perceived importance of continuity) and trust in the physician were ascertained before the consultation. After the consultation the Patient Enablement Index measured the physician's ability to enable patients in self-care, and concordance between the patient and physician was measured by a 6-item inventory of perceived agreement about the presenting problem and management, were ascertained immediately after the consultation. Compliance with prescribed medication therapy was ascertained by telephone follow-up 4 days after the consultation. RESULTS Overall, 220 patients (61%) received a prescription, and 79% of these patients were taking the medication at follow-up. In a univariate analysis adjusted for clustering, only trust and physician-patient concordance were significantly related to compliance. In analysis further adjusted for health and demographic factors, physician-patient concordance was independently related to compliance (odds ratio = 1.34, 95% confidence interval, 1.04-1.72). CONCLUSIONS Primary care consultations with higher levels of patient-reported physician-patient concordance were associated with one-third greater medication compliance. An emphasis on understanding and facilitating agreement between physician and patient may benefit outcomes in primary care.
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Affiliation(s)
- Ngaire Kerse
- Department of General Practice and Primary Health Care, University of Auckland, New Zealand.
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Sewitch MJ, Abrahamowicz M, Dobkin PL, Tamblyn R. Measuring differences between patients' and physicians' health perceptions: the patient-physician discordance scale. J Behav Med 2003; 26:245-64. [PMID: 12845937 DOI: 10.1023/a:1023412604715] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We report on the development and validation of an instrument to assess discordance between physicians and their patients on evaluations of health-related information: the Patient-Physician Discordance Scale (PPDS). The 10-item questionnaire is designed to be employed across chronic diseases and can be used in clinical practice and research. It measures the extent of patient-physician discordance on five aspects of the patient's health status and five aspects of the office visit. A prospective study with 200 outpatients with inflammatory bowel disease and their treating physicians revealed that the 10-item discordance scores had good construct validity and satisfactory convergent validity. Overall discordance and the three subscales, discordance on symptoms and treatment, well-being, and communication and satisfaction, identified by factor analysis, had acceptable internal consistency. Patient and physician ratings demonstrated moderate-to-high concurrent validity. Study limitations and directions for future research with PPDS are discussed.
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Affiliation(s)
- Maida J Sewitch
- Faculté de médecine, Université de Montréal C.P. 6128, Succ. Centre-Ville, Montreal, Quebec, Canada H3C 3J7.
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