1
|
Malbois E, Hurst-Majno S. Empathy is not so perfect! -For a descriptive and wide conception of empathy. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2023; 26:85-97. [PMID: 36380157 PMCID: PMC9984513 DOI: 10.1007/s11019-022-10124-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/21/2022] [Indexed: 06/16/2023]
Abstract
Physician empathy is considered essential for good clinical care. Empirical evidence shows that it correlates with better patient satisfaction, compliance, and clinical outcomes. These data have nevertheless been criticized because of a lack of consistency and reliability. In this paper, we claim that these issues partly stem from the widespread idealization of empathy: we mistakenly assume that physician empathy always contributes to good care. This has prevented us from agreeing on a definition of empathy, from understanding the effects of its different components and from exploring its limits. This is problematic because physicians' ignorance of the risks of empathy and of strategies to manage them can impact their work and wellbeing negatively. To address this problem, we explore the effects of the potential components of empathy and argue that it should be conceived as a purely descriptive and wide term. We end by discussing implications for medical education.
Collapse
Affiliation(s)
- Elodie Malbois
- Institute for Ethics, History, and the Humanities, University of Geneva, Geneva, Switzerland.
| | - S Hurst-Majno
- Institute for Ethics, History, and the Humanities, University of Geneva, Geneva, Switzerland
| |
Collapse
|
2
|
Improving the Quality of Patient Care and Healthcare Staff Well-Being through an Empathy Immersion Educational Programme in New Zealand: Protocol of a Feasibility and Pilot Study. Methods Protoc 2021; 4:mps4040089. [PMID: 34940400 PMCID: PMC8706397 DOI: 10.3390/mps4040089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/08/2021] [Accepted: 12/13/2021] [Indexed: 11/17/2022] Open
Abstract
Empathy is positively related to healthcare workers and patients’ wellbeing. There is, however, limited research on the effects of empathy education delivered in acute clinical settings and its impact on healthcare consumers. This research tests the feasibility and the potential efficacy outcomes of an immersive education programme developed by the research team in collaboration with clinical partners and a multidisciplinary advisory group. Healthcare worker participants in the intervention ward will receive an 8-week immersive empathy education. The primary outcome (feasibility) will be assessed by evaluating the acceptability of the intervention and the estimated resources. The secondary outcome (efficacy) will be assessed using a quasi-experimental study design. Non-parametric tests will be used to test healthcare worker participants’ empathy, burnout, and organisational satisfaction (within-group and across groups), and healthcare consumer participants’ satisfaction (between-group) over time. Despite growing interest in the importance of empathy in professional relationships, to our knowledge, the present pilot study is the first to explore the feasibility and efficacy of an immersive empathy education in New Zealand. Our findings will provide critical evidence to support the development of a randomised cluster trial and potentially provide preliminary evidence for the effectiveness of this type of empathy education.
Collapse
|
3
|
Malbois E, Clavien C. Overcoming the limits of empathic concern: the case for availability and its application to the medical domain. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2020; 23:191-203. [PMID: 31832827 DOI: 10.1007/s11019-019-09935-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Empathic concern is essential to our social lives because it motivates helping behavior. It has, however, well-known shortcomings such as its limitation in scope. Here, we highlight a further shortcoming of empathic concern: it contributes little to understanding the relevant features of complex social situations (e.g. the causes of somebody's distress), and unaided by further cognitive inputs, likely fails to produce effective helping. We then elaborate on the conditions needed for an accurate assessment of others' situations: the ability to pay attention and try to understand others for their own sake. We explain that when combining these abilities with the valuing aspect of empathic concern, we obtain "availability", an understudied mental state which plays a crucial role in helping motivation. We provide a detailed definition of that notion and show how availability can be trained and exercised by health professionals in order to improve their care and relationships with patients.
Collapse
Affiliation(s)
- Elodie Malbois
- Department of Philosophy, University of Fribourg, Fribourg, Switzerland.
- Département de Philosophie, Miséricorde, Université de Fribourg, Av. De l'Europe 20, 1700, Fribourg, Switzerland.
| | - Christine Clavien
- iEH2 - Institute Ethics History Humanities, University of Geneva, Geneva, Switzerland
| |
Collapse
|
4
|
Brickley B, Sladdin I, Williams LT, Morgan M, Ross A, Trigger K, Ball L. A new model of patient-centred care for general practitioners: results of an integrative review. Fam Pract 2020; 37:154-172. [PMID: 31670759 DOI: 10.1093/fampra/cmz063] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND GPs providing patient-centred care (PCC) is embedded in international health care policies due to its positive impact on patients and potential to lower health care costs. However, what is currently known about GP-delivered PCC is unknown. OBJECTIVE To synthesize literature investigating GP-delivered PCC and address 'what is currently known about GP-delivered PCC?' METHOD A systematic literature search was conducted between June and July 2018. Eligible articles were empirical, full-text studies published in English between January 2003 and July 2018, related to at least three of the four dimensions of PCC described by Hudon et al. (2011), and related to preventative, acute, and/or chronic care by GPs. Following screening, full-text articles were independently assessed for inclusion by two investigators. Data were extracted and quality assessed by two researchers. Findings on PCC were analysed thematically (meta-synthesis). RESULTS Thirty medium- to high-quality studies met the inclusions criteria. Included studies utilized varied designs, with the most frequent being quantitative, cross-sectional. A theoretical model of PCC was synthesized from included studies and contained four major components: (i) understanding the whole person, (ii) finding common ground, (iii) experiencing time and (iv) aiming for positive outcomes. Harms of PCC were rarely reported. CONCLUSIONS Four overarching theoretical components of PCC relate to elements of the consultation and experience of time. These components can be used to inform the development of toolkits to support GPs and general practice organizations in pursuit of PCC as well as tools to measure patient-centredness.
Collapse
Affiliation(s)
- Bryce Brickley
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Ishtar Sladdin
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Lauren T Williams
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Mark Morgan
- Bond University, Gold Coast, Queensland, Australia
| | - Alyson Ross
- Gold Coast Primary Health Network, Gold Coast, Queensland, Australia
| | - Kellie Trigger
- Gold Coast Primary Health Network, Gold Coast, Queensland, Australia
| | - Lauren Ball
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| |
Collapse
|
5
|
Nørøxe KB, Vedsted P, Bro F, Carlsen AH, Pedersen AF. Mental well-being and job satisfaction in general practitioners in Denmark and their patients' change of general practitioner: a cohort study combining survey data and register data. BMJ Open 2019; 9:e030142. [PMID: 31694846 PMCID: PMC6858117 DOI: 10.1136/bmjopen-2019-030142] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 10/01/2019] [Accepted: 10/04/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Low job satisfaction and poor well-being (eg, stress and burnout) among physicians may have negative consequences for patient experienced healthcare quality. In primary care, this could manifest in patients choosing another general practitioner (GP). The objective of this study was to examine change of GP (COGP) (unrelated to change of address) among patients in relation to their GPs' job satisfaction, well-being and self-assessed work-ability. DESIGN AND SETTING Data from a nationwide questionnaire survey among Danish GPs in May 2016 was combined with register data on their listed patients. Associations between patients' COGP in the 6-month study period (from May 2016) and the job satisfaction/well-being of their GP were estimated as risk ratios (RRs) at the individual patient level using binomial regression analysis. Potential confounders were included for adjustment. PARTICIPANTS The study cohort included 569 776 patients aged ≥18 years listed with 409 GPs in single-handed practices. RESULTS COGP was significantly associated with occupational distress (burnout and low job satisfaction) in the GP. This association was seen in a dose-response like pattern. For burnout, associations were found for depersonalisation and reduced sense of personal accomplishment (but not for emotional exhaustion). The adjusted RR was 1.40 (1.10-1.72) for patients listed with a GP with the lowest level of job satisfaction and 1.24 (1.01-1.52) and 1.40 (1.14-1.72) for patients listed with a GP in the most unfavourable categories of depersonalisation and sense of personal accomplishment (the most favourable categories used as reference). COGP was not associated with self-assessed work-ability or domains of well-being related to life in general. CONCLUSIONS Patients' likelihood of changing GP increased with GP burnout and decreasing job satisfaction. These findings indicate that patients' evaluation of care as measured by COGP may be influenced by their GPs' work conditions and occupational well-being.
Collapse
Affiliation(s)
- Karen Busk Nørøxe
- Research Unit for General Practice, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | - Flemming Bro
- Research Unit for General Practice, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | - Anette Fischer Pedersen
- Research Unit for General Practice, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| |
Collapse
|
6
|
Acquati A, Uberti S, Aquino A, Cerasetti E, Castagna C, Rovere-Querini P, Pisa V. Do empathic osteopaths achieve better clinical results? An observational feasibility study. INT J OSTEOPATH MED 2019. [DOI: 10.1016/j.ijosm.2019.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
|
7
|
Self-management and patient activation in COPD patients: An evidence summary of randomized controlled trials. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2018. [DOI: 10.1016/j.cegh.2017.10.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
8
|
Abstract
Research has extensively identified empathic skills as essential in health trainings, policies, and recommendations. However, there have been conflicting views of the impact of empathy on burnout. Some studies contend that empathy serves a protective role, whereas other studies have shown that burnout leads to a diminished capacity to empathize. To date, studies have not yet explored whether defense styles mediate associations between empathy and burnout. A total of 442 nurses completed questionnaire measures of empathy, burnout, and defense mechanisms as part of a large-scale research study on nurse burnout. Findings reflected very high levels of emotional exhaustion and depersonalization among the nursing staff. The nurses in this study endorsed a predominantly immature defense style. In addition, immature defense styles mediated the association between empathy and emotional exhaustion and between empathy and depersonalization. The study provides further knowledge about the role of defense styles in nurse burnout and empathy.
Collapse
|
9
|
Derksen FAWM, Olde Hartman T, Bensing J, Lagro-Janssen A. Empathy in general practice-the gap between wishes and reality: comparing the views of patients and physicians. Fam Pract 2018; 35:203-208. [PMID: 28973531 DOI: 10.1093/fampra/cmx080] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Empathy is regarded by patients and general practitioners (GPs) as fundamental in patient-GP communication. Patients do not always experience empathy and GPs encounter circumstances which hamper applying it. OBJECTIVE To explore why receiving and offering empathy during the encounter in general practice does not always meet the wishes of both patients and GPs. METHOD A qualitative research method, based on focus group interviews with patients and in-depth interviews with GPs, was carried out. Within the research process, iterative data collection and analysis were applied. RESULTS Both patients and GPs perceive a gap between what they wish for with regard to empathy, and what they actually encounter in general practice. Patients report on circumstances which hamper receiving empathy and GPs on circumstances offering it. Various obstacles were mentioned: (i) circumstances related to practice organization, (ii) circumstances related to patient-GP communication or connectedness, (iii) differences between the patient's and the GP's expectations, (iv) time pressure and its causes and (v) the GP's individual capability to offer empathy. CONCLUSION When patients do not receive empathy from their GP or practice staff, they feel frustrated. This causes a gap between their expectations on the one hand and their actual experiences on the other. GPs generally want to incorporate empathy; the GP's private, professional and psychological well-being appears to be an important contributing factor in practicing empathy in daily practice. But they encounter various obstacles to offer this. It is up to GPs to take responsibility for showing practice members the importance of an appropriate empathical behaviour towards patients.
Collapse
Affiliation(s)
- F A W M Derksen
- Department Primary and Community Care, Gender and Women's Health, Radboudumc, Nijmegen, The Netherlands
| | - Tim Olde Hartman
- Department Primary and Community Care, Gender and Women's Health, Radboudumc, Nijmegen, The Netherlands
| | - Jozien Bensing
- Department of Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, NIVEL, Utrecht, The Netherlands
| | - Antoine Lagro-Janssen
- Department Primary and Community Care, Gender and Women's Health, Radboudumc, Nijmegen, The Netherlands
| |
Collapse
|
10
|
Ranstad K, Midlöv P, Halling A. Socioeconomic status and geographical factors associated with active listing in primary care: a cross-sectional population study accounting for multimorbidity, age, sex and primary care. BMJ Open 2017; 7:e014984. [PMID: 28601827 PMCID: PMC5734444 DOI: 10.1136/bmjopen-2016-014984] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Socioeconomic status and geographical factors are associated with health and use of healthcare. Well-performing primary care contributes to better health and more adequate healthcare. In a primary care system based on patient's choice of practice, this choice (listing) is a key to understand the system. OBJECTIVE To explore the relationship between population and practices in a primary care system based on listing. METHODS Cross-sectional population-based study. Logistic regressions of the associations between active listing in primary care, income, education, distances to healthcare and geographical location, adjusting for multimorbidity, age, sex and type of primary care practice. SETTING AND SUBJECTS Population over 15 years (n=123 168) in a Swedish county, Blekinge (151 731 inhabitants), in year 2007, actively or passively listed in primary care. The proportion of actively listed was 68%. MAIN OUTCOME MEASURE Actively listed in primary care on 31 December 2007. RESULTS Highest ORs for active listing in the model including all factors according to income had quartile two and three with OR 0.70 (95% CI 0.69 to 0.70), and those according to education less than 9 years of education had OR 0.70 (95% CI 0.68 to 0.70). Best odds for geographical factors in the same model had municipality C with OR 0.85 (95% CI 0.85 to 0.86) for active listing. Akaike's Information Criterion (AIC) was 124 801 for a model including municipality, multimorbidity, age, sex and type of practice and including all factors gave AIC 123 934. CONCLUSIONS Higher income, shorter education, shorter distance to primary care or longer distance to hospital is associated with active listing in primary care.Multimorbidity, age, geographical location and type of primary care practice are more important to active listing in primary care than socioeconomic status and distance to healthcare.
Collapse
Affiliation(s)
- Karin Ranstad
- Department of Clinical Sciences in Malmö, Center for Primary Health Care Research, Lund University, Lund, Sweden
- Nättraby Primary Health Care Centre, Nättraby, Sweden
| | - Patrik Midlöv
- Department of Clinical Sciences in Malmö, Center for Primary Health Care Research, Lund University, Lund, Sweden
| | - Anders Halling
- Department of Clinical Sciences in Malmö, Center for Primary Health Care Research, Lund University, Lund, Sweden
| |
Collapse
|
11
|
Derksen F, Olde Hartman TC, van Dijk A, Plouvier A, Bensing J, Lagro-Janssen A. Consequences of the presence and absence of empathy during consultations in primary care: A focus group study with patients. PATIENT EDUCATION AND COUNSELING 2017; 100:987-993. [PMID: 27989493 DOI: 10.1016/j.pec.2016.12.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 11/25/2016] [Accepted: 12/10/2016] [Indexed: 05/14/2023]
Abstract
OBJECTIVE There is general consensus that explicit expression of empathy in patient-GP communication is highly valued. Yet, little is known so far about patients' personal experiences with and expectations of empathy. Insight into these experiences and expectations can help to achieve more person-centeredness in GP practice care. METHODS Participants were recruited by a press report in local newspapers. INCLUSION CRITERIA adults, a visit to the GP in the previous year. Exclusion criterion: a formal complaint procedure. Five focus groups were conducted. The discussions were analyzed using constant comparative analysis. RESULTS In total 28 participants took part in the focus group interviews. Three themes were identified: (1) Personalized care and enablement when empathy is present; (2) Frustrations when empathy is absent; (3) Potential pitfalls of empathy. Participants indicated that empathy helps build a more personal relationship and makes them feel welcome and at ease. Furthermore, empathy makes them feel supported and enabled. A lack of empathy can result in avoiding a visit to the GP. CONCLUSION Empathy is perceived as an important attribute of patient-GP communication. Its presence results in feelings of satisfaction, relief and trust. Furthermore, it supports patients, resulting in new coping strategies. A lack of empathy causes feelings of frustration and disappointment and can lead to patients avoiding visiting their GP. PRACTICE IMPLICATIONS More explicit attention should be given to empathy during medical education in general and during vocational GP-training.
Collapse
Affiliation(s)
- Frans Derksen
- Department Primary and Community Care, Gender & Women's Health, Radboudumc, Nijmegen, The Netherlands.
| | - Tim C Olde Hartman
- Department Primary and Community Care, Radboudumc, Nijmegen, The Netherlands
| | - Annelies van Dijk
- Department Primary and Community Care, Gender & Women's Health, Radboudumc, Nijmegen, The Netherlands
| | - Annette Plouvier
- Department Primary and Community Care, Gender & Women's Health, Radboudumc, Nijmegen, The Netherlands
| | - Jozien Bensing
- Department of Psychology, Faculty of Social and Behavioural Sciences, Utrecht University. NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - Antoine Lagro-Janssen
- Department Primary and Community Care, Gender & Women's Health, Radboudumc, Nijmegen, The Netherlands
| |
Collapse
|
12
|
Abstract
Background Stool specimen collection is challenging and informal feedback has indicated that participants find the process difficult. Increasing stool specimen returns would improve the investigation of outbreaks of diarrhoeal and food-borne disease. Aim To explore the barriers to stool sample collection and specimen return to ascertain which factors may help to improve the process. Design and setting Qualitative patient interview study in Gloucester, UK. Method A two-stage purposive sampling process was used to identify patients who had either previous experience or no experience of collecting a stool sample. The interview schedule, based on the theory of planned behaviour, was used to facilitate interviews with 26 patients. Interview transcripts were analysed using a modified framework analysis. Results Barriers to collection included embarrassment, fear of results, concerns around hygiene and contamination, discretion and privacy, and lack of information. Personal gain was identified as the main incentive to collecting and returning a stool sample. The need for an information leaflet on stool collection was emphasised by most patients. Conclusions GPs could make a number of small changes that could make a big difference for patients and potentially increase stool sample return. If they, rather than receptionists, distributed collection kits it may be easier for patients to ask any questions they had regarding collection. In addition, the provision of a stool-collection information leaflet could increase patients’ confidence regarding collecting the sample, and providing drop-off boxes for specimens could help prevent patients’ embarrassment regarding handing their stool over to a receptionist.
Collapse
|
13
|
Linqvist Leonardsen AC, Del Busso L, Abrahamsen Grøndahl V, Ghanima W, Barach P, Jelsness-Jørgensen LP. A qualitative study of patient experiences of decentralized acute healthcare services. Scand J Prim Health Care 2016; 34:317-24. [PMID: 27559763 PMCID: PMC5036023 DOI: 10.1080/02813432.2016.1222200] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Municipality acute wards (MAWs) have recently been launched in Norway as an alternative to hospitalizations, and are aimed at providing treatment for patients who otherwise would have been hospitalized. The objective of this study was to explore how patients normally admitted to hospitals perceived the quality and safety of treatment in MAWs. DESIGN The study had a qualitative design. Thematic analysis was used to analyze the data. SETTING The study was conducted in a county in south-eastern Norway and included five different MAWs. PATIENTS Semi-structured interviews were conducted with 27 participants who had required acute health care and who had been discharged from the five MAWs. RESULTS Three subthemes were identified that related to the overarching theme of hospital-like standards ("almost a hospital, but…"), namely (a) treatment and competence, (b) location and physical environment, and (c) adequate time for care. Participants reported the treatment to be comparable to hospital care, but they also experienced limitations. Participants spoke positively about MAW personnel and the advantages of having a single patient room, a calm environment, and proximity to home. CONCLUSIONS Participants felt safe when treated at MAWs, even though they realized that the diagnostic services were not similar to that in hospitals. Geographical proximity, treatment facilities and time for care positively distinguished MAWs from hospitals, while the lack of diagnostic resources was stressed as a limitation. Key points Municipality acute wards (MAWs) have been implemented across Norway. Research on patient perspectives on the decentralization of acute healthcare in MAWs is lacking. • Patients perceive decentralized acute healthcare and treatment as being comparable to the quality they would have expected in hospitals. • Geographical proximity, a home-like atmosphere and time for care were aspects stressed as positive features of the decentralized services. • Lack of diagnostic resources was seen as a limitation.
Collapse
Affiliation(s)
- Ann-Chatrin Linqvist Leonardsen
- Department of Research, Østfold Hospital Trust, Sarpsborg, Østfold, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- CONTACT Ann-Chatrin Linqvist Leonardsen Department of Research, Østfold Hospital Trust, Sarpsborg, Østfold, Norway/Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lilliana Del Busso
- Faculty of Health and Social Studies, Østfold University College, Sarpsborg, Østfold, Norway
| | | | - Waleed Ghanima
- Department of Research, Østfold Hospital Trust, Sarpsborg, Østfold, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Paul Barach
- Wayne University School of Medicine, Detriot, MI, USA
| | - Lars-Petter Jelsness-Jørgensen
- Department of Research, Østfold Hospital Trust, Sarpsborg, Østfold, Norway
- Faculty of Health and Social Studies, Østfold University College, Sarpsborg, Østfold, Norway
| |
Collapse
|
14
|
Thirioux B, Birault F, Jaafari N. Empathy Is a Protective Factor of Burnout in Physicians: New Neuro-Phenomenological Hypotheses Regarding Empathy and Sympathy in Care Relationship. Front Psychol 2016; 7:763. [PMID: 27303328 PMCID: PMC4880744 DOI: 10.3389/fpsyg.2016.00763] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 05/06/2016] [Indexed: 11/14/2022] Open
Abstract
Burnout is a multidimensional work-related syndrome that is characterized by emotional exhaustion, depersonalization-or cynicism-and diminution of personal accomplishment. Burnout particularly affects physicians. In medicine as well as other professions, burnout occurrence depends on personal, developmental-psychodynamic, professional, and environmental factors. Recently, it has been proposed to specifically define burnout in physicians as "pathology of care relationship." That is, burnout would arise, among the above-mentioned factors, from the specificity of the care relationship as it develops between the physician and the patient. Accordingly, experimental studies and theoretical approaches have suggested that burnout and empathy, which is one of the most important skills in physicians, are closely linked. However, the nature of the relation between burnout and empathy remains not yet understood, as reflected in the variety of theoretical and contradictory hypotheses attempting to causally relate these two phenomena. Firstly, we here question the epistemological problem concerning the modality of the burnout-empathy link. Secondly, we hypothesize that considering the multidimensional features of both burnout and empathy, on one hand, and on the other hand, the distinction between empathy and sympathy enables to overcome these contradictions and, consequently, gives a better understanding of the relationship between burnout and empathy in physicians. Thirdly, we propose that clarifying the link between burnout, empathy and sympathy would enable developing specific training in medical students and continuous professional formation in senior physicians and would potentially contribute to the prevention of burnout in medical care.
Collapse
Affiliation(s)
- Bérangère Thirioux
- Unité de Recherche Clinique Intersectorielle en Psychiatrie à Vocation Régionale Pierre Deniker, Centre Hospitalier Henri LaboritPoitiers, France
| | - François Birault
- Faculté de Médecine et de Pharmacie, Département de Médecine Générale, Université de PoitiersPoitiers, France
| | - Nematollah Jaafari
- Unité de Recherche Clinique Intersectorielle en Psychiatrie à Vocation Régionale Pierre Deniker, Centre Hospitalier Henri LaboritPoitiers, France
- Institut National de la Santé et de la Recherche Médicale CIC-P 1402 du Centre Hospitalo-Universitaire de Poitiers, Institut National de la Santé et de la Recherche Médicale U 1084, Experimental and Clinical Neuroscience Laboratory, Groupement de Recherche Centre National de la Recherche Scientifique 3557, Université de PoitiersPoitiers, France
| |
Collapse
|
15
|
Klement A, Oemler M, Wienke A, Richter M, Wolfradt U. [(Expected) Consultation length, mental (co-)morbidity and patient satisfaction in the family practice encounter]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2015; 109:560-9. [PMID: 26704817 DOI: 10.1016/j.zefq.2015.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 07/16/2015] [Accepted: 08/24/2015] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Mental disorders are common in family practice, but their meaning for variables of consultation is rarely considered. Thus, we examined the influence of mental disorders on patients' expectations regarding time, openness and seriousness as well as ratings of satisfaction with the consultation. METHODS Prior to consultation for 219 patients a screening for anxiety (GAD-7), depression (PHQ-9) and hypochondriasis (WI-7) was performed. Before and after the consultation patient expectations and ratings were recorded. Subgroup analysis was based on Mann-Whitney U tests. RESULTS Almost half of the sample were screen-positive. Prior the consultation, screen positive patients had higher ratings for expectations compared with screen negative patients, but did not differ in their experiences after the consultation. There was no association between consultation length and ratings for satisfaction. DISCUSSION Patients screened positive for mental disorders do not necessarily require longer consultation length, if their expectations regarding openness and seriousness are met. This is underlines the importance of communication skills in undergraduate medical education and specialist training for future GPs.
Collapse
Affiliation(s)
- Andreas Klement
- Sektion Allgemeinmedizin, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland; Profilzentrum für Gesundheitswissenschaften, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland.
| | - Matthias Oemler
- Sektion Allgemeinmedizin, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - Andreas Wienke
- Institut für Medizinische Epidemiologie, Biometrie und Informatik, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland; Profilzentrum für Gesundheitswissenschaften, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - Matthias Richter
- Institut für Medizinische Soziologie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland; Profilzentrum für Gesundheitswissenschaften, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - Uwe Wolfradt
- Institut für Psychologie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
| |
Collapse
|
16
|
Kurpas D, Bujnowska-Fedak MM, Athanasiadou A, Mroczek B. Factors Influencing Utilization of Primary Health Care Services in Patients with Chronic Respiratory Diseases. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 866:71-81. [PMID: 26022896 DOI: 10.1007/5584_2015_141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
The purpose of our study was to determine the factors affecting the level of services provided in primary health care among patients with chronic respiratory diseases. The study group consisted of 299 adults (median age: 65, min-max: 18-92 years) with mixed chronic respiratory diseases, recruited from patients of 135 general practitioners. In the analysis, in addition to the assessment of the provided medical services, the following were used: Patient Satisfaction Questionnaire, Camberwell Assessment of Needs Short Appraisal Schedule, Acceptance of Illness Scale, and WHO Quality of Life Instrument Short Form. Variables that determined the level of services were the following: age, place of residence, marital status, number of chronic diseases, and level of disease acceptance, quality of life, and health behaviors. The level of provided services correlated with variables such as gender, severity of somatic symptoms, level of satisfied needs, and satisfaction with health care. We concluded that in patients with mixed chronic respiratory diseases a higher level of health care utilization should be expected in younger patients, those living in the countryside, those having a partner, with multimorbidity, a low level of disease acceptance, those satisfied with their current quality of life, with positive mental attitudes, and maintaining health practices.
Collapse
Affiliation(s)
- D Kurpas
- Department of Family Medicine, Wroclaw Medical University, 1 Syrokomli St., 51-141, Wroclaw, Poland,
| | | | | | | |
Collapse
|
17
|
Abrahamsson B, Berg MLU, Jutengren G, Jonsson A. To recommend the local primary health-care centre or not: what importance do patients attach to initial contact quality, staff continuity and responsive staff encounters? Int J Qual Health Care 2015; 27:196-200. [PMID: 25855752 DOI: 10.1093/intqhc/mzv017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE This study aims to examine the circumstances associated with patients' tendencies to recommend a primary care centre, based on four hypotheses, the initial contact's quality, care relationship continuity, treatment encounter responsiveness and whether the significance of encounter responsiveness differs depending on whether the patient has been seeing a nurse or physician. DESIGN The study is based on the patient' self-reported responses, retrieved from the Swedish National Patient Survey. The design is cross-sectional, and data were analysed using a binary logistic regression. SETTING Data were collected from three primary healthcare centres in the region of Västra Götaland, Sweden. PARTICIPANTS A total of 362 patients (62% females) having visited any of three publicly run healthcare centres in September 2010 constitute the analytical sample. Participants were fairly evenly distributed across all age groups. MAIN OUTCOME MEASURES Recommendation was captured by patients' binary responses to the question: Would you recommend the visited primary healthcare centre? RESULTS The hypotheses involving initial contact quality, care relationship continuity and treatment encounter responsiveness were supported by the analyses. The latter was strongly associated with patient tendency to recommend the primary healthcare centre. However, the profession (nurse or physician) involved in the treatment encounter made no difference for the predictive significance of encounter responsiveness for a patient's tendency to recommend the healthcare centre. CONCLUSIONS Striving for stable and responsive patient/staff relationships and an open approach towards patients are potentially successful strategies for primary healthcare centres seeking to attract new patients and maintain current ones.
Collapse
|
18
|
Oglesby WH. Perceptions of and preferences for federally-funded family planning clinics. Reprod Health 2014; 11:50. [PMID: 24980897 PMCID: PMC4086278 DOI: 10.1186/1742-4755-11-50] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 06/24/2014] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The Title X family planning program provides affordable access to a range of sexual and reproductive health services, with a priority for low-income people. The disproportionate burden of unintended pregnancy, breast and cervical cancer, and sexually transmitted diseases among minority groups, teens, and young adults in the US underscore the need for affordable access to such services. However, increased access to sexual and reproductive health services, resulting from the Affordable Care Act (ACA) create questions regarding the continued need for this program. METHODS A study was conducted to assess clients' perceptions of Title X-funded family planning clinics and their preferences for these clinics for a range of sexual and reproductive health services. An anonymous, self-administered, paper-and-pencil survey was administered to 696 clients who received services from one of eight Title X-funded family planning clinics in Northeast Ohio. RESULTS The majority of participants stated very positive perceptions of the Title X-funded clinics; that they "Always" go to the Title X-funded clinic for birth control, STD/HIV testing, and pregnancy testing; and that the Title X-funded clinic was their regular source of health care. Females were more likely than males to prefer the Title X clinic for birth control, physical exams, pregnancy testing, and health information and more teens under the age of 18 preferred to use the Title X clinic for STD/HIV testing, physical exams, pregnancy testing, and health information. CONCLUSIONS Findings indicate that these Title X-funded family planning clinics successfully reached populations in need of sexual and reproductive health services and suggest that these facilities can help play an important role in reducing disparities even after full implementation of the Affordable Care Act. However, more research is needed to fully quantify the need and value of Title X-funded family planning clinics and its relation to the changing health care environment in the US.
Collapse
Affiliation(s)
- Willie H Oglesby
- Department of Health Policy & Management, College of Public Health, Kent State University, PO Box 5190, 800 Hilltop Drive, 212 Moulton Hall, Kent, Ohio 44242, USA.
| |
Collapse
|
19
|
Ranstad K, Midlöv P, Halling A. Importance of healthcare utilization and multimorbidity level in choosing a primary care provider in Sweden. Scand J Prim Health Care 2014; 32:99-105. [PMID: 24939741 PMCID: PMC4075024 DOI: 10.3109/02813432.2014.929819] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To study the associations between active choice of primary care provider and healthcare utilization, multimorbidity, age, and sex, comparing data from primary care and all healthcare in a Swedish population. DESIGN Descriptive cross-sectional study using descriptive analyses including t-test, correlations, and logistic regression modelling in four separate models. SETTING AND SUBJECTS The population (151 731) and all healthcare in Blekinge in 2007. MAIN OUTCOME MEASURE Actively or passively listed in primary care, registered on 31 December 2007. RESULTS Number of consultations (OR 1.31, 95% CI 1.30-1.32), multimorbidity level (OR 1.69, 95% CI 1.67-1.70), age (OR 1.03, 95% CI 1.03-1.03), and sex (OR for men 0.67, 95% CI 0.65-0.68) were all associated with registered active listing in primary care. Active listing was more strongly associated with number of consultations and multimorbidity level using primary care data (OR 2.11, 95% CI 2.08-2.15 and OR 2.14, 95% CI 2.11-2.17, respectively) than using data from all healthcare. Number of consultations and multimorbidity level were correlated and had similar associations with active listing in primary care. Modelling number of consultations, multimorbidity level, age, and sex gave four separate models with about 70% explanatory power for active listing in primary care. Combining number of consultations and multimorbidity did not improve the models. CONCLUSIONS Number of consultations and multimorbidity level were associated with active listing in primary care. These factors were also associated with each other differently in primary care than in all healthcare. More complex models including non-health-related individual characteristics and healthcare-related factors are needed to increase explanatory power.
Collapse
Affiliation(s)
- Karin Ranstad
- Department of Clinical Sciences in Malmö, Lund University, Sweden
- Nättraby Primary Health Care Centre, Nättraby, Sweden
| | - Patrik Midlöv
- Department of Clinical Sciences in Malmö, Lund University, Sweden
| | - Anders Halling
- Department of Clinical Sciences in Malmö, Lund University, Sweden
- Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
20
|
Abstract
BACKGROUND Empathy as a characteristic of patient-physician communication in both general practice and clinical care is considered to be the backbone of the patient-physician relationship. Although the value of empathy is seldom debated, its effectiveness is little discussed in general practice. This literature review explores the effectiveness of empathy in general practice. Effects that are discussed are: patient satisfaction and adherence, feelings of anxiety and stress, patient enablement, diagnostics related to information exchange, and clinical outcomes. AIM To review the existing literature concerning all studies published in the last 15 years on the effectiveness of physician empathy in general practice. DESIGN AND SETTING Systematic literature search. METHOD Searches of PubMed, EMBASE, and PsychINFO databases were undertaken, with citation searches of key studies and papers. Original studies published in English between July 1995 and July 2011, containing empirical data about patient experience of GPs' empathy, were included. Qualitative assessment was applied using Giacomini and Cook's criteria. RESULTS After screening the literature using specified selection criteria, 964 original studies were selected; of these, seven were included in this review after applying quality assessment. There is a good correlation between physician empathy and patient satisfaction and a direct positive relationship with strengthening patient enablement. Empathy lowers patients' anxiety and distress and delivers significantly better clinical outcomes. CONCLUSION Although only a small number of studies could be used in this search, the general outcome seems to be that empathy in the patient-physician communication in general practice is of unquestionable importance.
Collapse
|
21
|
Williams B, Sadasivan S, Kadirvelu A, Olaussen A. Empathy levels among first year Malaysian medical students: an observational study. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2014; 5:149-56. [PMID: 24876799 PMCID: PMC4035026 DOI: 10.2147/amep.s58094] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND The literature indicates that medical practitioners experience declining empathy levels in clinical practice. This highlights the need to educate medical students about empathy as an attribute early in the academic curriculum. The objective of this study was to evaluate year one students' self-reported empathy levels following a 2-hour empathy workshop at a large medical school in Malaysia. METHODS Changes in empathy scores were examined using a paired repeated-measures t-test in this prospective before and after study. RESULTS Analyzing the matched data, there was a statistically significant difference and moderate effect size between mean empathy scores before and 5 weeks after the workshop (112.08±10.67 versus 117.93±13.13, P<0.0001, d=0.48) using the Jefferson Scale Physician Empathy (Student Version). CONCLUSION The results of this observational study indicate improved mean self-reported empathy scores following an empathy workshop.
Collapse
Affiliation(s)
- Brett Williams
- Department of Community Emergency Health and Paramedic Practice, Melbourne, Australia
- Correspondence: Brett Williams, Department of Community Emergency Health and Paramedic Practice, Faculty of Medicine, Nursing and Health Sciences, Monash University Peninsula Campus, PO Box 527, McMahons Road, Frankston, Melbourne, Victoria 3199, Australia, Tel +613 9904 4283, Fax +613 9904 4168, Email
| | - Sivalal Sadasivan
- Jeffrey Cheah School of Medicine and Health Sciences, Sunway Campus, Selangor, Malaysia
| | - Amudha Kadirvelu
- Jeffrey Cheah School of Medicine and Health Sciences, Sunway Campus, Selangor, Malaysia
| | - Alexander Olaussen
- Department of Community Emergency Health and Paramedic Practice, Melbourne, Australia
| |
Collapse
|
22
|
Hojat M, Axelrod D, Spandorfer J, Mangione S. Enhancing and sustaining empathy in medical students. MEDICAL TEACHER 2013; 35:996-1001. [PMID: 23758178 DOI: 10.3109/0142159x.2013.802300] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND Empathy is an important component of physician competence that needs to be enhanced. AIM To test the hypotheses that medical students' empathy can be enhanced and sustained by targeted activities. METHODS This was a two-phase study in which 248 medical students participated. In Phase 1, students in the experimental group watched and discussed video clips of patient encounters meant to enhance empathic understanding; those in the control group watched a documentary film. Ten weeks later in Phase 2 of the study, students who were in the experimental group were divided into two groups. One group attended a lecture on empathy in patient care, and the other plus the control group watched a movie about racism. The Jefferson Scale of Empathy (JSE) was administered pre-post in Phase 1 and posttest in Phase 2. RESULTS In Phase 1, the JSE mean score for the experimental group improved significantly (p < 0.01); no change in the JSE scores was observed in the control group. In Phase 2, the JSE mean score improvement was sustained in the group that attended the lecture, but not in the other group. No change in empathy was noticed in the control group. CONCLUSION Research hypotheses were confirmed.
Collapse
|
23
|
Smidth M, Olesen F, Fenger-Grøn M, Vedsted P. Patient-experienced effect of an active implementation of a disease management programme for COPD - a randomised trial. BMC FAMILY PRACTICE 2013; 14:147. [PMID: 24088417 PMCID: PMC3850694 DOI: 10.1186/1471-2296-14-147] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 09/19/2013] [Indexed: 12/04/2022]
Abstract
BACKGROUND People living with chronic disease currently account for the majority of the total healthcare costs. The Central Denmark Region implemented a disease management programme (DMP) for chronic obstructive pulmonary disease (COPD) in 2008. This presented an opportunity to examine the effect of an evidence-based, planned and proactive implementation of a DMP compared to the usual implementation strategy. METHODS We performed a block- and cluster-randomised controlled trial with two groups and an extra external control group. The primary outcome was patients' assessment of their care after using an active implementation model for a DMP for COPD measured with the Patient-Assessment-of-Chronic-Illness-Care (PACIC) instrument. At baseline, questionnaires were sent to 2,895 patients identified by an algorithm based on health registry data on lung-related contacts to the healthcare system. Patients were asked to confirm or refute their diagnosis of COPD. Of those who responded, 1,445 (72.8%) confirmed their diagnosis. PACIC data were collected at baseline and at a 12-month follow-up for 744 (51.1%) patients. RESULTS Comparing the three groups after the implementation of the DMP, we found a statistically significantly higher change in the PACIC score in the intervention group than in the control groups. No statistically significant differences were found between the control and the external control groups in any of the dimensions. CONCLUSIONS Reinforcing the role of general practice as coordinator for care-and self-management-support with an active implementation of a DMP for COPD made patients score higher on the PACIC instrument, which indicates a better experience of the received healthcare. TRIAL REGISTRATION NCT01228708.
Collapse
Affiliation(s)
- Margrethe Smidth
- The Research Unit for General Practice Aarhus, Aarhus University, Aarhus C 8000, Denmark
- The Section for General Medicine, Aarhus University, Aarhus C 8000, Denmark
| | - Frede Olesen
- The Research Unit for General Practice Aarhus, Aarhus University, Aarhus C 8000, Denmark
| | - Morten Fenger-Grøn
- The Research Unit for General Practice Aarhus, Aarhus University, Aarhus C 8000, Denmark
| | - Peter Vedsted
- The Research Unit for General Practice Aarhus, Aarhus University, Aarhus C 8000, Denmark
| |
Collapse
|
24
|
Deledda G, Moretti F, Rimondini M, Zimmermann C. How patients want their doctor to communicate. A literature review on primary care patients' perspective. PATIENT EDUCATION AND COUNSELING 2013; 90:297-306. [PMID: 22709720 DOI: 10.1016/j.pec.2012.05.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 05/03/2012] [Accepted: 05/05/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To review the literature on the communicative behaviours primary care patients want from a "good" physician. METHODS An electronic search used the key words doctor-patient relation AND patient desires OR patient expectations OR patient preferences (from now on referred to as expectations). The qualitative and quantitative articles meeting the selection criteria were analysed separately, comparing methods, definitions, measures and outcomes. The physician behaviours desirable from a patient perspective were grouped by linking them to the communicative functions of an effective medical encounter as defined from a professional perspective. RESULTS Twenty-seven studies were included. Critical issues were the heterogeneity of definitions and measures and the lack of integration between quantitative and qualitative findings. Most of the expectations in qualitative studies were related to the function "Fostering the relationship". Similar expectations arose less often in quantitative studies. CONCLUSIONS Patients do have concrete expectations regarding each of the functions to be met in the medical encounters. The research approach tends to bias the results. PRACTICE IMPLICATIONS The collected expectations suggest how physicians may perform each of their tasks according to the patient perspective. Future research on patients' communicative expectations needs to overcome the gap between qualitative and quantitative findings.
Collapse
Affiliation(s)
- Giuseppe Deledda
- Department of Public Health and Community Medicine, University of Verona, Verona, Italy
| | | | | | | |
Collapse
|
25
|
Hetlevik Ø, Gjesdal S. Personal continuity of care in Norwegian general practice: a national cross-sectional study. Scand J Prim Health Care 2012; 30:214-21. [PMID: 23113798 PMCID: PMC3520415 DOI: 10.3109/02813432.2012.735554] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Personal continuity is regarded as a core value in general practice. The aim of this study was to determine the level of personal continuity in Norwegian general practice. An investigation was made of the associations between high levels of personal continuity and patient, general practitioner (GP), and list characteristics. DESIGN Cross-sectional register-based study. SETTING Norwegian general practice in 2009. SUBJECTS 3220 GPs and 3 725 998 patients on the GP lists. MAIN OUTCOME MEASURES The Usual Provider Continuity Index (UPC), which measures the proportion of consultations made by the usual GP, was estimated for patients and aggregated to the GP list level. GPs were grouped into quartiles based on the UPC. Being a GP with a UPC in the two highest quartiles (UPC ≥ 0.80) was the outcome in the statistical analyses. STATISTICS Poisson regression models were used to estimate relative risks (RR). RESULTS The overall UPC was 0.78, increasing gradually from 0.68 in patients < 15 years of age to 0.86 for patients ≥ 60 years of age, and from 0.75 to 0.83 for patients with < 3 annual consultations compared with patients with > 10 consultations. A UPC > 0.80 was associated with longer patient lists and high GP consultation rates. Working in municipalities with < 10 000 residents was negatively associated with a high UPC. The UPC level for GPs was associated with total utilization of GP consultations in the list populations. CONCLUSION Overall, the Norwegian goal of a personal GP has been achieved; however, there are substantial variations between GPs and lower UPCs among young patients and in smaller municipalities.
Collapse
Affiliation(s)
- Øystein Hetlevik
- Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway.
| | | |
Collapse
|
26
|
|
27
|
Del Canale S, Louis DZ, Maio V, Wang X, Rossi G, Hojat M, Gonnella JS. The relationship between physician empathy and disease complications: an empirical study of primary care physicians and their diabetic patients in Parma, Italy. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2012; 87:1243-9. [PMID: 22836852 DOI: 10.1097/acm.0b013e3182628fbf] [Citation(s) in RCA: 293] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
PURPOSE To test the hypothesis that scores of a validated measure of physician empathy are associated with clinical outcomes for patients with diabetes mellitus. METHOD This retrospective correlational study included 20,961 patients with type 1 or type 2 diabetes mellitus from a population of 284,298 adult patients in the Local Health Authority, Parma, Italy, enrolled with one of 242 primary care physicians for the entire year of 2009. Participating physicians' Jefferson Scale of Empathy scores were compared with occurrence of acute metabolic complications (hyperosmolar state, diabetic ketoacidosis, coma) in diabetes patients hospitalized in 2009. RESULTS Patients of physicians with high empathy scores, compared with patients of physicians with moderate and low empathy scores, had a significantly lower rate of acute metabolic complications (4.0, 7.1, and 6.5 per 1,000 patients, respectively, P < .05). Logistic regression analysis showed physicians' empathy scores were associated with acute metabolic complications: odds ratio (OR) = 0.59 (95% confidence interval [CI], 0.37-0.95, contrasting physicians with high and low empathy scores). Patients' age (≥69 years) also contributed to the prediction of acute metabolic complications: OR = 1.7 (95% CI, 1.2-1.4). Physicians' gender and age, patients' gender, type of practice (solo, association), geographical location of practice (mountain, hills, plain), and length of time the patient had been enrolled with the physician were not associated with acute metabolic complications. CONCLUSIONS These results suggest that physician empathy is significantly associated with clinical outcome for patients with diabetes mellitus and should be considered an important component of clinical competence.
Collapse
|
28
|
Heje HN, Vedsted P, Olesen F. General practitioners' experience and benefits from patient evaluations. BMC FAMILY PRACTICE 2011; 12:116. [PMID: 22040039 PMCID: PMC3217866 DOI: 10.1186/1471-2296-12-116] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Accepted: 10/31/2011] [Indexed: 11/11/2022]
Abstract
Background It has now for many years been recognised that patient evaluations should be undertaken as an integral part of the complex task of improving the quality of general practice care. Yet little is known about the general practitioners' (GPs') benefit from patient evaluations. Aim 1 was to study the impact on the GPs of a patient evaluation and subsequent feedback of results presented at a plenary session comprising a study guide for the results and group discussions. Aim 2 was to study possible facilitators and barriers to the implementations of the results raised by the patient evaluation process. Methods A patient evaluation survey of 597 voluntarily participating GPs was performed by means of the EUROPEP questionnaire. Evaluation results were fed back to the GPs as written reports at a single feedback meeting with group discussions of the results. Between 3 and 17 months after the feedback, the 597 GPs received a questionnaire with items addressing their experience with and perceived benefit from the evaluations. Results 79.4% of the GPs responded. 33% of the responding GPs reported that the patient evaluation had raised their attention to the patient perspective on the quality of general practice care. Job satisfaction had improved among 26%, and 21% had developed a more positive attitude to patient evaluations. 77% of the GPs reported having learnt from the evaluation. 54% had made changes to improve practice, 82% would recommend a patient evaluation to a colleague and 75% would do another patient evaluation if invited. 14% of the GPs had become less positive towards patient evaluations, and job satisfaction had decreased among 3%. Conclusions We found a significant impact on the GPs regarding satisfaction with the process and attitude towards patient evaluations, GPs' attention to the patients' perspective on care quality and their job satisfaction. Being benchmarked against the average seemed to raise barriers to the concept of patient evaluations and difficulties interpreting the results may have formed a barrier to their implementation which was partly overcome by adding qualitative data to the quantitative results. The GPs' significant willingness to share and discuss the results with others may have served as a facilitator.
Collapse
Affiliation(s)
- Hanne N Heje
- The Research Unit, Department of General Practice, University of Aarhus, Denmark.
| | | | | |
Collapse
|
29
|
Grøndahl VA, Karlsson I, Hall-Lord ML, Appelgren J, Wilde-Larsson B. Quality of care from patients' perspective: impact of the combination of person-related and external objective care conditions. J Clin Nurs 2011; 20:2540-51. [PMID: 21749512 DOI: 10.1111/j.1365-2702.2011.03810.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIMS AND OBJECTIVES To describe patients' perceptions of quality of care and to explore combinations of person-related and external objective care conditions as potential predictors of these perceptions. BACKGROUND Several studies have examined various single factors of person-related and external objective care conditions in relation to quality of care. None of these has included the effect of over-occupancy on patients' perception of quality of care. Furthermore, little is known about how combinations of different factors are related to each other and to the perception of quality of care using multivariate analysis. DESIGN A cross-sectional design. METHOD A total of 528 patients (83·7%) from 12 medical, surgical or medical-surgical wards in five hospitals in Norway participated. Perceptions of quality of care and person-related conditions were measured with the 'Quality from Patient's Perspective' instrument. Data on external objective care conditions was collected from ward statistics provided by head nurses. Multivariate general linear modelling was used (p < 0·05). RESULTS The combination of person-related and external objective care conditions revealed five factors that predict patients' perception of quality of care. Three of these are person-related conditions: sex, age and self-reported psychological well-being and two of them are external objective care conditions: RNs (headcount) on the wards and frequency of over-occupancy. These five factors explained 55% of the model. Patients rated the quality of care high. CONCLUSIONS Sex, age, psychological well-being, frequency of over-occupancy and the number of RNs are important factors that must be emphasised if patients are to perceive the quality of care as high. Relevance to clinical practice. Head nurses and healthcare authorities must continually prepare the wards for over-occupancy and they must consider the number of RNs working on the wards.
Collapse
|
30
|
Affiliation(s)
- Helena Liira
- Department of General Practice and Primary Care, University of Helsinki, Finland
| |
Collapse
|
31
|
Bjertnaes OA, Lyngstad I, Malterud K, Garratt A. The Norwegian EUROPEP questionnaire for patient evaluation of general practice: data quality, reliability and construct validity. Fam Pract 2011; 28:342-9. [PMID: 21078822 DOI: 10.1093/fampra/cmq098] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The EUROPEP is a widely used international instrument to evaluate general practice care from the perspective of patients, but measurement properties including reliability at the GP level are not sufficiently documented. OBJECTIVE The objectives of this study were to assess the psychometric properties of the Norwegian version of the EUROPEP and estimate GP-level reliability for scales and items. METHODS Nine hundred patients consulting nine GPs at a medical centre in Norway were invited to complete the Norwegian EUROPEP at home following a recent consultation. We assessed item missing and ceiling effects and used factor analysis to assess the structure of the 23 items of the EUROPEP. Scales were tested for reliability and construct validity, while reliability at the GP level was tested for items and scales. RESULTS Five hundred and fifty-seven patients (61.9%) returned the questionnaire. Seven of 23 items had missing responses >10% and 20% had high ceiling effects. Factor analysis identified two groups of questions that formed scales with satisfactory internal consistency reliability and validity. The clinical behaviour scale (12 items) and the organization of care scale (4 items) met the criterion of 0.7 for Cronbach's alpha. The GP-level reliability was >0.7 for both scales, but 9 of 23 items were below the criterion of 0.7. CONCLUSIONS The study identified two scales in the Norwegian EUROPEP instrument with satisfactory psychometric properties. However, high proportions of item non-response large ceiling effects and low GP-level reliability for several items indicate the need for further instrument refinement.
Collapse
Affiliation(s)
- Oyvind A Bjertnaes
- Department for Quality Measurement and Patient Safety, Norwegian Knowledge Centre for the Health Services, St Olavs plass, 0130 Oslo, Norway.
| | | | | | | |
Collapse
|
32
|
Wun YT, Lam TP, Lam KF, Goldberg D, Li DKT, Yip KC. How do patients choose their doctors for primary care in a free market? J Eval Clin Pract 2010; 16:1215-20. [PMID: 20695952 DOI: 10.1111/j.1365-2753.2009.01297.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS A recent trend in health care system is to provide more choices to the patients. This study surveyed the general public's choices for primary care in Hong Kong which has the setting of free choices for private or public service and also direct access to specialists. METHODS We used a combined qualitative and quantitative approach. We held five focus group interviews with participants of different socio-economic categories. Information from the focus groups helped to design a questionnaire for random telephone interviews with members of the public aged 18 or above. RESULTS There were 37 participants in the focus groups and 1647 respondents in the telephone survey. The most important factor for choosing a doctor was proximity to home or workplace, followed by quick relief from the illness. Once continuity of care had been established, distance was of less importance but comprehensive care was valued. Nearly 70% of the public had regular doctors. About 93% of the public would consult specialists directly when they thought they needed a specialist's opinion. Nearly 30% chose specialists for any medical care and 38% preferred specialists to also look after their primary care problems. CONCLUSION Convenient accessibility was the most important factor for the initial choice of primary care doctors by the general public. The perceived clinical proficiency of the doctor determined future continuity of care. Patients liked to have direct access to specialists. Though some chose to see the specialists even for primary care problems, most people had regular doctors who were likely to have the attributes of family doctors.
Collapse
Affiliation(s)
- Yuk Tsan Wun
- Family Medicine Unit, The University of Hong Kong, Hong Kong, China
| | | | | | | | | | | |
Collapse
|
33
|
Martín-Fernández J, del Cura-González MI, Gómez-Gascón T, Fernández-López E, Pajares-Carabajal G, Moreno-Jiménez B. [Patient satisfaction with the patient-doctor relationship measured using the questionnaire (PDRQ-9)]. Aten Primaria 2010; 42:196-203. [PMID: 20116893 DOI: 10.1016/j.aprim.2009.09.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2009] [Revised: 09/28/2009] [Accepted: 09/28/2009] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To describe patient satisfaction of their relationship with the family physician, using the PDRQ-9 questionnaire and assess its psychometric properties. DESIGN Cross-sectional study. SETTING Six Primary Care Health centres in the Community of Madrid, Spain. PARTICIPANTS Four hundred and fifty one patients randomly selected from those who had just visited their family physician. INTERVENTIONS Interviews were carried out to collect demographic characteristics, health needs, the accessibility to the service, and the socioeconomic situation of the subjects. MEASUREMENTS The PDRQ-9 responses were collected and a synthetic satisfaction index was constructed. A multivariable model was designed to explain differences in satisfaction. RESULTS The mean satisfaction index was 4.41 (95% CI: 4.33-4.48) on a scale of 1 (the worst) to 5 (the best satisfaction possible), with a median of 4.78 (interquartile range 4.00-5.00). Four of every 10 subjects expressed the maximum possible satisfaction ("ceiling effect"). A single factor explained 75.3% of the variance, with a Cronbach alpha value of 0.952. Age (OR 1.03, 95% CI: 1.02-1.05) and living in rural areas (OR 1.44, 95% CI: 0.94-2.20) were associated with above average satisfaction. CONCLUSIONS Primary care users feel their relationship with their family physicians are very satisfactory, particularly in those who are older and who live in rural areas. The PDRQ-9 questionnaire shows a high internal consistency, but it is not good enough to discriminate in the upper part of the scale.
Collapse
Affiliation(s)
- Jesús Martín-Fernández
- CS San Martín de Valdeiglesias, Area 8 de AP, Servicio Madrileño de Salud, Madrid, España.
| | | | | | | | | | | |
Collapse
|
34
|
Affiliation(s)
- Peter Vedsted
- The Research Unit for General Practice, Danish Research Centre for Cancer Diagnosis in Primary Care, Aarhus University, Denmark E-mail:
| | - Frede Olesen
- The Research Unit for General Practice, Danish Research Centre for Cancer Diagnosis in Primary Care, Aarhus University, Denmark E-mail:
| |
Collapse
|