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Rieffestahl AM, Mogensen HO, Morcke AM, Risør T. 'If you had taken the lead…' - a qualitative study of patients with chronic conditions and their perspective in clinical encounters with medical students. Chronic Illn 2023; 19:692-703. [PMID: 35918800 DOI: 10.1177/17423953221115437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To explore what patients with chronic conditions emphasize as important in the patient-medical student conversation, and how the patients' experiences relate to trust. METHODS Twenty-one video-recorded sessions of patients' feedback in simulation-based communication courses for medical students were observed, transcribed, analyzed inductively and organized into three themes. RESULTS In the patients' feedback, three aspects were emphasized as important relating to trust: a) when the medical student relates medical information to the patient's lifeworld, b) when the student leads the patient throughout the conversation, and c) when the patient gets emotional support from the student. The patients felt that being met this way by the students grows trust and allows them to lean into the uncertainties they experience while still feeling safe. DISCUSSION The patients emphasize three aspects of importance in conversations with the medical students that grow trust. We argue that these aspects cannot be found in the traditional authority-led practice but can be found in leadership, which imply empathy and willingness to learn from patients. We suggest that students should learn that to effectively communicate with patients infers such leadership. By doing so, medical students can walk alongside their patients to build a relationship and nurture trust.
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Affiliation(s)
- Anne Marie Rieffestahl
- Capital Region of Denmark, Copenhagen Academy for Medical Education and Simulation, Copenhagen, Denmark
- Section of General Practice and The Research Unit for general Practice, Department of Public Health, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
| | - Hanne O Mogensen
- Department of Anthropology, Faculty of Social Science, University of Copenhagen, Copenhagen, Denmark
| | - Anne Mette Morcke
- Centre for Educational Development, Aarhus University, Aarhus, Denmark
| | - Torsten Risør
- Section of General Practice and The Research Unit for general Practice, Department of Public Health, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromso, Norway
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Muñoz Sastre MT, Kpanake L, Sorum PC, Mullet E. Patients' Positions on the Degree of Trust to be Placed in Physicians. Psychol Rep 2023:332941231197610. [PMID: 37607509 DOI: 10.1177/00332941231197610] [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: 08/24/2023]
Abstract
Patient-physician relationship is ideally based on mutual trust. Trust usually takes times to build but can quite instantaneously be destroyed as a result of a single action or a single misperception. This study examined the way patients conceptualize the relationship between trust in a physician and perceived competency, honesty and openness, and personal involvement in care. One hundred sixty-seven patients aged 18-85 years were presented with a set of 27 three-item realistic vignettes that described situations in which participants could find themselves if hospitalized because of illness or accident. These scenarios resulted from the complete crossing of the three factors mentioned above. Participants were asked to assess the level of trust they would feel in each case. Through cluster analysis, three positions were found. For a minority of participants, trust was either unconditionally high (4%) or always quite low (8%). For a majority (75%), however, trust depended interactively on competency and honesty, on the one hand, and involvement, on the other hand; that is, the impact of competency and honesty on trust always depended on the level of involvement in care. In particular, when involvement had a low level, trust was always quite low, irrespective of the levels of both other factors. These findings are fully consistent with the view that, for a majority of patients, trust is inherently brittle: A breach in any one of participants' expectations regarding physicians' professionalism is enough to result in a more than proportional reduction in trust level.
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Affiliation(s)
| | - Lonzozou Kpanake
- Department of Social Sciences and Communication, University of Québec - TELUQ, Montréal, QC, Canada
| | - Paul Clay Sorum
- Department of Pediatrics, Albany Medical College, Albany, NY, USA
| | - Etienne Mullet
- Department of Ethics, Institute of Advanced Studies (EPHE), Paris, France
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Graham B, Smith JE, Nelmes P, Squire R, Latour JM. Initial Development of a Patient Reported Experience Measure for Older Adults Attending the Emergency Department: Part I-Interviews with Service Users. Healthcare (Basel) 2023; 11:healthcare11050717. [PMID: 36900722 PMCID: PMC10000837 DOI: 10.3390/healthcare11050717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/22/2023] [Accepted: 02/25/2023] [Indexed: 03/06/2023] Open
Abstract
Older adults are a major Emergency Department (ED) user group who may be especially vulnerable to the consequences of crowding and sub-optimal care. Patient experience is a critical component of high-quality ED care and has previously been conceptualised using a framework focusing on patients' needs. This study aimed to explore the experiences of older adults attending the ED in relation to the existing needs-based framework. Semi-structured interviews were conducted during an emergency care episode with 24 participants aged over 65 years in a United Kingdom ED with an annual census ~100,000. Questions exploring patient experiences of care confirmed that meeting the communication, care, waiting, physical, and environmental needs were prominent determinants of experience for older adults. A further analytical theme emerged which did not align to the existing framework, focused on 'team attitudes and values'. This study builds on existing knowledge relating to the experience of older adults in the ED. In addition, data will also contribute to the generation of candidate items for the development of a patient reported experience measure for older adults attending the ED.
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Affiliation(s)
- Blair Graham
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth PL4 8AA, UK
- Correspondence:
| | - Jason E. Smith
- Department of Emergency Medicine, University Hospitals Plymouth NHS Trust, Plymouth PL6 8DH, UK
| | - Pam Nelmes
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth PL4 8AA, UK
| | - Rosalyn Squire
- Department of Emergency Medicine, University Hospitals Plymouth NHS Trust, Plymouth PL6 8DH, UK
| | - Jos M. Latour
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth PL4 8AA, UK
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Perth 6102, Australia
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Foo CD, Surendran S, Jimenez G, Ansah JP, Matchar DB, Koh GCH. Primary Care Networks and Starfield's 4Cs: A Case for Enhanced Chronic Disease Management. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2926. [PMID: 33809295 PMCID: PMC8001119 DOI: 10.3390/ijerph18062926] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/04/2021] [Accepted: 03/08/2021] [Indexed: 11/16/2022]
Abstract
The primary care network (PCN) was implemented as a healthcare delivery model which organises private general practitioners (GPs) into groups and furnished with a certain level of resources for chronic disease management. A secondary qualitative analysis was conducted with data from an earlier study exploring facilitators and barriers GPs enrolled in PCN's face in chronic disease management. The objective of this study is to map features of PCN to Starfield's "4Cs" framework. The "4Cs" of primary care-comprehensiveness, first contact access, coordination and continuity-offer high-quality design options for chronic disease management. Interview transcripts of GPs (n = 30) from the original study were purposefully selected. Provision of ancillary services, manpower, a chronic disease registry and extended operating hours of GP practices demonstrated PCN's empowering features that fulfil the "4Cs". On the contrary, operational challenges such as the lack of an integrated electronic medical record and disproportionate GP payment structures limit PCNs from maximising the "4Cs". However, the enabling features mentioned above outweighs the shortfalls in all important aspects of delivering optimal chronic disease care. Therefore, even though PCN is in its early stage of development, it has shown to be well poised to steer GPs towards enhanced chronic disease management.
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Affiliation(s)
- Chuan De Foo
- Department of Health Systems and Behavioural Sciences, Saw Swee Hock School of Public Health, National University Singapore, Singapore 117549, Singapore; (S.S.); (G.C.H.K.)
| | - Shilpa Surendran
- Department of Health Systems and Behavioural Sciences, Saw Swee Hock School of Public Health, National University Singapore, Singapore 117549, Singapore; (S.S.); (G.C.H.K.)
| | - Geronimo Jimenez
- Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore;
- Department of Public Health and Primary Care, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - John Pastor Ansah
- Health Services and Systems Research, Duke-National University of Singapore Graduate Medical School, Singapore 169857, Singapore; (J.P.A.); (D.B.M.)
| | - David Bruce Matchar
- Health Services and Systems Research, Duke-National University of Singapore Graduate Medical School, Singapore 169857, Singapore; (J.P.A.); (D.B.M.)
- Department of Medicine, Division of General Internal Medicine, Duke University School of Medicine, Durham, NC 27710, USA
| | - Gerald Choon Huat Koh
- Department of Health Systems and Behavioural Sciences, Saw Swee Hock School of Public Health, National University Singapore, Singapore 117549, Singapore; (S.S.); (G.C.H.K.)
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Healthcare Professionals' Perspectives on the Cross-Sectoral Treatment Pathway for Women with Gestational Diabetes during and after Pregnancy-A Qualitative Study. J Clin Med 2021; 10:jcm10040843. [PMID: 33670723 PMCID: PMC7923110 DOI: 10.3390/jcm10040843] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 01/14/2023] Open
Abstract
Gestational diabetes mellitus (GDM) increases the risk of adverse outcomes during and after pregnancy, including a long-term risk of type 2 diabetes. Women with GDM are treated by numerous healthcare professionals during pregnancy and describe a lack of preventive care after pregnancy. We aim to investigate healthcare professionals’ perspectives on the cross-sectoral treatment pathway for women with GDM—during and after pregnancy. A qualitative study was conducted using systematic text condensation. Nine healthcare professionals (two general practitioners, four midwives, two obstetricians and one diabetes nurse) were interviewed and eight health visitors participated in two focus group discussions., Three major themes emerged: (1) “professional identities”, which were identified across healthcare professionals and shaped care practices; (2) ”unclear guidelines on type 2 diabetes prevention after GDM”, which contributed to uncertainty about tasks and responsibilities during and after pregnancy; and (3) “cross-sectoral collaboration”, which relied heavily on knowledge transfers between hospitals, general practice and the local municipality. The findings implicate that clear, transparent guidelines for all sectors should be prioritized to strengthen cross-sectoral care to women with GDM during and after pregnancy. As a result, strong cross-sectoral care throughout the GDM care pathway may improve maternal health by supporting healthy behaviors, facilitate weight loss and reduce the risk of subsequent GDM and early onset diabetes.
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Dahl M, Søndergaard SF, Diederichsen A, Pouwer F, Pedersen SS, Søndergaard J, Lindholt J. Facilitating participation in cardiovascular preventive initiatives among people with diabetes: a qualitative study. BMC Public Health 2021; 21:203. [PMID: 33482775 PMCID: PMC7824926 DOI: 10.1186/s12889-021-10172-6] [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: 07/08/2020] [Accepted: 01/05/2021] [Indexed: 11/24/2022] Open
Abstract
Background Type 2 diabetes (T2D) is associated with a significantly increased risk of cardiovascular disease (CVD). The DIAbetic CArdioVAscular Screening and intervention trial (DIACAVAS) was designed to clarify whether advanced imaging for subclinical atherosclerosis combined with medical treatment is an effective strategy to develop individualised treatment algorithms for Danish men and women with T2D aged 40–60. But in the DIACAVAS pilot study, the uptake was only 41%. Consequently, we explored how people experienced living with T2D to understand how to improve the uptake in initiatives targeting the prevention of CVD. Methods We used semi-structured interviews to obtain information on how the respondents experienced having T2D. For supplementary information, we used structured interviews on e.g. socioeconomic factors. From April to October 2019, 17 participants aged 40–60 years were recruited from general practices and diabetes outpatient clinics in Denmark. Several levels of analysis were involved consistent with inductive content analysis. Results The participants’ experiences of living with T2D fell along two continuums, from an emotional to a cognitive expression and from reactive to proactive disease management. This led to identification of four archetypal characteristics: (I) powerlessness, (II) empowerment, (III) health literacy, and (IV) self-efficacy. These characteristics indicated the importance of using different approaches to facilitate participation in cardiovascular preventive initiatives. Additionally, findings inspired us to develop a model for facilitating participation in future preventive initiatives. Conclusion Encouraging people with T2D to participate in cardiovascular preventive initiatives may necessitate a tailored invitation strategy. We propose a model for an invitational process that takes into consideration invitees’ characteristics, including powerlessness, empowerment, health literacy and self-efficacy. This model may enhance participation in such initiatives. However, participation is a general concern, not only in relation to cardiovascular prevention. Our proposed model may be applicable in preventive services for people with T2D in general. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10172-6.
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Affiliation(s)
- Marie Dahl
- Vascular Research Unit, Department of Surgery, Regional Hospital Central Denmark, Toldbodgade 12, DK-8800, Viborg, Denmark. .,Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Blvd. 82, DK-8200, Aarhus N, Denmark.
| | - Susanne Friis Søndergaard
- Centre for Research in Clinical Nursing, Regional Hospital Central Denmark/VIA University College, School of Nursing, Viborg, Toldbodgade 12, DK-8800, Viborg, Denmark.,Department of Public Health, Nursing, Aarhus University, Bartholins Allé 2, DK-8000, Aarhus C, Denmark
| | - Axel Diederichsen
- Department of Cardiology, Odense University Hospital, J.B Winsløws vej 4, DK-5000, Odense C, Denmark
| | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Campusvej 55, DK-5230, Odense M, Denmark.,STENO Diabetes Centre Odense, Kløvervænget 112, DK-5000, Odense C, Denmark.,School of Psychology, Deakin University, Geelong Waterfront Campus, 1 Gheringhap Street, Geelong, Victoria, 3220, Australia
| | - Susanne S Pedersen
- Department of Cardiology, Odense University Hospital, J.B Winsløws vej 4, DK-5000, Odense C, Denmark.,Department of Psychology, University of Southern Denmark, Campusvej 55, DK-5230, Odense M, Denmark
| | - Jens Søndergaard
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, DK-5000, Odense C, Denmark
| | - Jes Lindholt
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, J.B. Winsløv Vej 4, DK-5000, Odense C, Denmark.,Elitary Research Centre of Individualised Medicine in Arterial Disease (CIMA), J.B. Winsløv Vej 4, DK-5000, Odense C, Denmark.,Cardiovascular Centre of Excellence in Southern Denmark (CAVAC), J.B. Winsløv Vej 4, DK-5000, Odense C, Denmark
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7
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Broholm-Jørgensen M, Langkilde SM, Tjørnhøj-Thomsen T, Pedersen PV. 'Motivational work': a qualitative study of preventive health dialogues in general practice. BMC FAMILY PRACTICE 2020; 21:185. [PMID: 32900366 PMCID: PMC7487907 DOI: 10.1186/s12875-020-01249-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 08/17/2020] [Indexed: 11/10/2022]
Abstract
Background The aim of this article is to explore preventive health dialogues in general practice in the context of a pilot study of a Danish primary preventive intervention ‘TOF’ (a Danish acronym for ‘Early Detection and Prevention’) carried out in 2016. The intervention consisted of 1) a stratification of patients into one of four groups, 2) a digital support system for both general practitioners and patients, 3) an individual digital health profile for each patient, and 4) targeted preventive services in either general practice or a municipal health center. Methods The empirical material in this study was obtained through 10 observations of preventive health dialogues conducted in general practices and 18 semi-structured interviews with patients and general practitioners. We used the concept of ‘motivational work’ as an analytical lens for understanding preventive health dialogues in general practice from the perspectives of both general practitioners and patients. Results While the health dialogues in TOF sought to reveal patients’ motivations, understandings, and priorities related to health behavior, we find that the dialogues were treatment-oriented and structured around biomedical facts, numeric standards, and risk factor guidance. Overall, we find that numeric standards and quantification of motivation lessens the dialogue and interaction between General Practitioner and patient and that contextual factors relating to the intervention framework, such as a digital support system, the general practitioners’ perceptions of their professional position as well as the patients’ understanding of prevention —in an interplay—diminished the motivational work carried out in the health dialogues. Conclusion The findings show that the influence of different kinds of context adds to the complexity of prevention in the clinical encounter which help to explain why motivational work is difficult in general practice.
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Affiliation(s)
- Marie Broholm-Jørgensen
- National Institute of Public Health, Research Program on Health and Social Conditions, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen K, Denmark.
| | - Siff Monrad Langkilde
- The Danish Centre for Urban Regeneration and Community Development, Hvidovre, Denmark
| | - Tine Tjørnhøj-Thomsen
- National Institute of Public Health, Research Program on Health and Social Conditions, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen K, Denmark
| | - Pia Vivian Pedersen
- National Institute of Public Health, Research Program on Health and Social Conditions, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen K, Denmark
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Joensson ABR, Guassora AD, Freil M, Reventlow S. What the doctor doesn't know: Discarded patient knowledge of older adults with multimorbidity. Chronic Illn 2020; 16:212-225. [PMID: 30213205 DOI: 10.1177/1742395318796173] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Adherence to treatment has proven to require the involvement of patients in treatment and care planning. This process involves incorporating patient knowledge, or knowledge about the patients' everyday life, into the clinical encounter. This article explores the disclosure practices of such knowledge from older adults with multimorbidity. METHODS This was an 18-month qualitative study among 14 older adults with multimorbidity living in Denmark. A thematic analysis was applied, focusing on perceptions of patient knowledge and disclosure practices among the participating patients. RESULTS Older adults with multimorbidity have various reasons for not disclosing personal knowledge. The results present three different domains of what we termed discarded patient knowledge: (1) knowledge that had no direct biomedical relevance from participants' perspective; (2) knowledge considered too private; and (3) knowledge assumed to position one as inferior. DISCUSSION The participants made judgments on what they believed was welcome in the clinical encounter, framing their knowledge within the purview of biomedicine. Participants' disclosure practices showed that personal knowledge is sometimes not recognized as important for health and care by participants themselves. Knowledge that could have influenced practitioners' understanding of the problem and provided different solutions, is argued to be discarded patient knowledge.
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Affiliation(s)
- Alexandra B Ryborg Joensson
- Department of Public Health, The Research Unit for General Practice and The Section of General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Ann Dorrit Guassora
- Department of Public Health, The Research Unit for General Practice and The Section of General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Morten Freil
- Knowledge Center for User Involvement in Healthcare, Danish Patients, Copenhagen, Denmark
| | - Susanne Reventlow
- Department of Public Health, The Research Unit for General Practice and The Section of General Practice, University of Copenhagen, Copenhagen, Denmark
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Ahmadian Yazdi N, Soltani Arabshahi K, Bigdeli S, Ghaffarifar S. Challenges in promoting clinical empathy skills in medical students: A content analysis study. Med J Islam Repub Iran 2020; 33:104. [PMID: 31934564 PMCID: PMC6946919 DOI: 10.34171/mjiri.33.104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Indexed: 12/30/2022] Open
Abstract
Background: Empathy is a key clinical skill in the medical profession, and many studies have reported a decline in it among medical students during their years of education; especially, in the clinical stage, and this affective decline persists in the physician-hood. This study aimed to explore the participants' perceptions about challenges for promoting clinical empathy in training stages. Methods: A qualitative design using content analysis was applied. Semi-structured interviews were applied to obtain data. Individual interviews were conducted with 14 interns and six clinical professors. The data were analyzed through conventional content analysis and the credibility, trustworthiness, and conformability of the data were confirmed. Results: Data analysis led to the extraction of two main categories, including overt and covert challenges, and also four categories and nine sub-categories. Conclusion: Resolving clinical empathy challenges in medical students requires financial and human resources, and training on the principles of effective doctor-patient interactions. Furthermore, professionalism should be strengthened in professors, and both official and hidden curricula should be revised accordingly.
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Affiliation(s)
- Nahid Ahmadian Yazdi
- Department of Medical Education, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Kamran Soltani Arabshahi
- Department of Medical Education, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.,Center for Educational Research in Medical Sciences (CERMS), Iran University of Medical Sciences, Tehran, Iran
| | - Shoaleh Bigdeli
- Center for Educational Research in Medical Sciences (CERMS), Iran University of Medical Sciences, Tehran, Iran
| | - Saeideh Ghaffarifar
- Medical Education Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
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Why do general practitioners not refer patients to behaviour-change programmes after preventive health checks? A mixed-method study. BMC FAMILY PRACTICE 2019; 20:135. [PMID: 31604416 PMCID: PMC6788028 DOI: 10.1186/s12875-019-1028-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 09/20/2019] [Indexed: 01/08/2023]
Abstract
Background This study was embedded in the Check-In randomised controlled trial that investigated the effectiveness of general practice-based preventive health checks on adverse health behaviour and early detection of non-communicable diseases offered to individuals with low socioeconomic positions. Despite successful recruitment of patients, the intervention had no effect. One reason for the lack of effectiveness could be low rates of referral to behaviour-change programmes in the municipality, resulting in a low dose of the intervention delivered. The aim of this study is to examine the referral pattern of the general practitioners and potential barriers to referring eligible patients to these behaviour-change programmes. Methods A mixed-method design was used, including patients’ questionnaires, recording sheet from the health checks and semi-structured qualitative interviews with general practitioners. All data used in the study were collected during the time of the intervention. Logistic regressions were used to estimate odds ratios for being eligible and for receiving referrals. The qualitative empirical material was analysed thematically. Emerging themes were grouped, discussed and the material was re-read. The themes were reviewed alongside the analysis of the quantitative material to refine and discuss the themes. Results Of the 364 patients, who attended the health check, 165 (45%) were marked as eligible for a referral to behaviour-change programme by their general practitioner and of these, 90 (55%) received referrals. Daily smoking (OR = 3.22; 95% CI:2.01–5.17), high-risk alcohol consumption (OR = 2.66; 95% CI:1.38–5.12), obesity (OR = 2.89; 95% CI:1.61–5.16) and poor lung function (OR = 2.05; 95% CI:1.14–3.70) were all significantly associated with being eligible, but not with receiving referral. Four themes emerged as the main barriers to referring patients to behaviour-change programmes: 1) general practitioners’ responsibility and ownership for their patients, 2) balancing information and accepting a rejection, 3) assessment of the right time for behavioural change and 4) general practitioners’ attitudes towards behaviour-change programmes in the municipality. Conclusion We identified important barriers among the general practitioners which influenced whether the patients received referrals to behaviour-change programmes in the municipality and thereby influenced the dose of intervention delivered in Check-In. The findings suggest that an effort is needed to assist the collaboration between general practices and the municipalities’ primary preventive services. Trial registration Clinical Trials NCT01979107; October 25, 2013.
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Kamstrup-Larsen N, Dalton SO, Broholm-Jørgensen M, Larsen LB, Thomsen JL, Johansen C, Tolstrup JS. Using general practitioners to recruit individuals with low socioeconomic position to preventive health checks is feasible: a cross sectional study. Scand J Prim Health Care 2019; 37:294-301. [PMID: 31286817 PMCID: PMC6713093 DOI: 10.1080/02813432.2019.1639901] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 05/31/2019] [Indexed: 02/03/2023] Open
Abstract
Objective: To test whether demographic and health-related characteristics are associated with non-attendance of preventive health checks offered to individuals with low levels of education using proactive recruitment by the general practitioners. Design: A cross-sectional study. Setting: 32 general practice clinics in Copenhagen, Denmark. Subjects: A total of 549 individuals aged 45-64, with low levels of education, enrolled in the intervention group of a randomised controlled trial on preventive health checks offered by general practitioner. Main outcome measures: Non-attendance of the preventive health checks. Methods: (i) Descriptive characteristics of attendees and non-attendees and (ii) crude and adjusted multi-level logistic regression to examine associations of individual characteristics with non-attendance of preventive health checks. Results: Overall, 33% did not attend the prescheduled preventive health checks at their general practitioners. Non-attendees were more likely to live without a partner, be of non-Western origin, be daily smokers, have poor self-rated health, have higher pulmonary symptoms score, have increased level of stress, have low levels of self-efficacy, have metabolic risk factors or non-communicable diseases and have had no contact with their general practitioner within the past year. Conclusion: The findings suggest that, it is feasible to use general practitioners for recruiting individuals for preventive health checks. However, even in a trial targeting individuals with low levels of education, there are differences between attendees and non-attendees, with a more adverse health behaviour profile and worse health status observed among the non-attendees. KEY POINTS Current awareness • Non-attendance of preventive health checks offered to the general population is associated with low socioeconomic position and adverse health behaviours. Main statements • It is feasible to use general practitioners proactively in recruitment to preventive health checks offered to individuals with low socioeconomic positions. • In a trial targeting individuals with low levels of education, there were differences between attendees and non-attendees. • Non-attendance was associated with daily smoking, poor self-rated health, high stress and no contact with the general practitioner within the last year.
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Affiliation(s)
- Nina Kamstrup-Larsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Susanne Oksbjerg Dalton
- Survivorship Research Unit, the Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Naestved, Denmark
| | | | - Lars Bruun Larsen
- Research Unit of General Practice in Odense, University of Southern Denmark, Denmark
| | - Janus Laust Thomsen
- Research Unit for General Practice in Aalborg, Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Christoffer Johansen
- Survivorship Research Unit, the Danish Cancer Society Research Center, Copenhagen, Denmark
- Late Effect Research Unit CASTLE, Finsen Center, Rigshospitalet, Copenhagen, Denmark
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Hoeyer K. Data as promise: Reconfiguring Danish public health through personalized medicine. SOCIAL STUDIES OF SCIENCE 2019; 49:531-555. [PMID: 31272287 DOI: 10.1177/0306312719858697] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
'Personalized medicine' might sound like the very antithesis of population science and public health, with the individual taking the place of the population. However, in practice, personalized medicine generates heavy investments in the population sciences - particularly in data-sourcing initiatives. Intensified data sourcing implies new roles and responsibilities for patients and health professionals, who become responsible not only for data contributions, but also for responding to new uses of data in personalized prevention, drawing upon detailed mapping of risk distribution in the population. Although this population-based 'personalization' of prevention and treatment is said to be about making the health services 'data-driven', the policies and plans themselves use existing data and evidence in a very selective manner. It is as if data-driven decision-making is a promise for an unspecified future, not a demand on its planning in the present. I therefore suggest interrogating how 'promissory data' interact with ideas about accountability in public health policies, and also with the data initiatives that the promises bring about. Intensified data collection might not just be interesting for what it allows authorities to do and know, but also for how its promises of future evidence can be used to postpone action and sidestep uncomfortable knowledge in the present.
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Affiliation(s)
- Klaus Hoeyer
- Centre for Medical Science and Technology Studies, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Broholm-Jørgensen M, Kamstrup-Larsen N, Guassora AD, Reventlow S, Dalton SO, Tjørnhøj-Thomsen T. ‘It can’t do any harm’: A qualitative exploration of accounts of participation in preventive health checks. HEALTH RISK & SOCIETY 2019. [DOI: 10.1080/13698575.2019.1602251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Nina Kamstrup-Larsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Ann Dorrit Guassora
- The research Unit and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Reventlow
- The research Unit and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Oksbjerg Dalton
- Danish Cancer Society Research Center, Survivorship, Copenhagen, Denmark
- Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Næstved, Denmark
| | - Tine Tjørnhøj-Thomsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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14
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Hafting M, Gullbrå F, Anderssen N, Rørtveit G, Smith-Sivertsen T, van Doesum K. Overcoming Clinician and Parent Ambivalence: General Practitioners' Support of Children of Parents With Physical or Mental Illness and/or Substance Abuse. Front Psychiatry 2019; 9:724. [PMID: 30670986 PMCID: PMC6331400 DOI: 10.3389/fpsyt.2018.00724] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 12/07/2018] [Indexed: 12/03/2022] Open
Abstract
Children who are next of kin to parents with physical or mental illness and/or substance abuse need access to mental health support and several cost-effective interventions are available. Because most parents in the target group often consult general practitioners (GPs), GPs may have a crucial role in identifying burdened children and ensuring their follow-up. However, this important topic has received little attention in clinical discussions and research. In response to the knowledge gap, we conducted the research project Burdened Children as Next of Kin and the General Practitioner. Four sub-studies have been completed and published: a sub-study with qualitative analysis of focus group interviews with GPs (paper 1), a qualitative analysis of focus group interviews with adolescents as next of kin (paper 2), and a qualitative analysis of individual interviews with parents with illness and/or substance abuse (paper 3). The results from these sub-studies were incorporated in a survey sent to members of a nationwide GP organization (paper 4). The aim of the present sub-study was to gain further knowledge about conditions for the encounters between GPs and parents with impairments to be supportive for the children as next of kin. The material of the present sub-study derived from the project's four previous sub-studies and comprised a secondary analysis of the four prior sub-studies. We conducted an overarching thematic analysis of these sub-studies' results sections. We searched for statements from the GPs, the adolescents, and the parents on their experiences and evaluations of the needs of the children and their families, and the possible ways of accommodating these needs in general practice. The analysis shows that both GPs and parents were ambivalent about addressing the topic of the patients' children during consultations. This was the case although the GPs were in a good position to identify these vulnerable children, and the parents were worried about their children's situations. Possible strategies for GPs to overcome this ambivalence can be to (1) strengthen their competence in the topic, (2) gradually build trusting relationships with parents, and (3) gradually gain contextual knowledge about the families' situations. GPs can do this by performing ordinary GP tasks and acknowledging the parents' efforts to give their children good daily lives.
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Affiliation(s)
- Marit Hafting
- Regional Center for Child and Youth Mental Health and Child Welfare, Uni Research Health, Bergen, Norway
| | - Frøydis Gullbrå
- Research Unit for General Practice, Uni Research Health, Bergen, Norway
| | - Norman Anderssen
- Research Unit for General Practice, Uni Research Health, Bergen, Norway
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Guri Rørtveit
- Research Unit for General Practice, Uni Research Health, Bergen, Norway
- Research Group for General Practice, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | | | - Karin van Doesum
- Clinical Psychology, Radboud University Nijmegen, Nijmegen, Netherlands
- Impluz, Prevention Team Mental Health, Deventer, Netherlands
- Regional Center of Child and Youth Mental Health and Child Welfare, Artic University of Tromsø, Tromsø, Norway
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