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Cunningham R, Imlach F, Lockett H, Lacey C, Haitana T, Every-Palmer S, Clark MTR, Peterson D. Do patients with mental health and substance use conditions experience discrimination and diagnostic overshadowing in primary care in Aotearoa New Zealand? Results from a national online survey. J Prim Health Care 2023; 15:112-121. [PMID: 37390032 DOI: 10.1071/hc23015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/28/2023] [Indexed: 07/02/2023] Open
Abstract
Introduction Quality of health care contributes to poor physical health outcomes for people with mental health and substance use conditions (MHSUC). AIM This study investigated experiences of people with MHSUC who sought help for a physical health condition in primary healthcare services, examining quality of care attributes. Methods An online survey of adults currently or recently accessing services for MHSUC was fielded in 2022. Respondents were recruited nationally through mental health, addiction and lived experience networks and social media. The attributes of service quality assessed were relationships (respect and being listened to), discrimination due to MHSUC, and diagnostic overshadowing (MHSUC diagnosis distracted from physical health care). Results Respondents who had used primary care services were included (n = 335). The majority of respondents reported both being treated with respect (81%) and being listened to (79%) always or most of the time. A minority of respondents reported diagnostic overshadowing (20%) or discrimination due to MHSUC (10%). People with four or more diagnoses or a diagnosis of bipolar disorder or schizophrenia had significantly worse experiences across all quality measures. Those with a diagnosis of substance use disorders had worse experiences for diagnostic overshadowing. Māori had worse experiences for respect and diagnostic overshadowing. Conclusions Although many respondents reported good experiences in primary care, this was not the case for everyone. Quality of care was affected by type and number of diagnoses and the person's ethnicity. Interventions to reduce stigma and diagnostic overshadowing for people with MHSUC are needed in primary care services in New Zealand.
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Affiliation(s)
- Ruth Cunningham
- Department of Public Health, University of Otago Wellington, PO Box 7343, Newtown, Wellington 6242, New Zealand
| | - Fiona Imlach
- Department of Public Health, University of Otago Wellington, PO Box 7343, Newtown, Wellington 6242, New Zealand
| | - Helen Lockett
- Department of Public Health, University of Otago Wellington, PO Box 7343, Newtown, Wellington 6242, New Zealand
| | - Cameron Lacey
- Maori/Indigenous Health Institute (MIHI), University of Otago Christchurch, Christchurch, New Zealand; and Department of Psychological Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Tracy Haitana
- Maori/Indigenous Health Institute (MIHI), University of Otago Christchurch, Christchurch, New Zealand
| | - Susanna Every-Palmer
- Department of Psychological Medicine, University of Otago Wellington, Wellington, New Zealand
| | - Mau Te Rangimarie Clark
- Maori/Indigenous Health Institute (MIHI), University of Otago Christchurch, Christchurch, New Zealand
| | - Debbie Peterson
- Department of Public Health, University of Otago Wellington, PO Box 7343, Newtown, Wellington 6242, New Zealand
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Ahmed A, van den Muijsenbergh METC, Vrijhoef HJM. Person-centred care in primary care: What works for whom, how and in what circumstances? HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e3328-e3341. [PMID: 35862510 PMCID: PMC10083933 DOI: 10.1111/hsc.13913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 04/29/2022] [Accepted: 07/04/2022] [Indexed: 06/10/2023]
Abstract
This rapid realist review aims to explain how and why person-centred care (PCC) in primary care works (or not) among others for people with low health literacy skills and for people with a diverse ethnic and socioeconomic background, and to construct a middle-range programme theory (PT). Peered reviewed- and non-peer-reviewed literature (Jan 2013-Feb 2021) reporting on PCC in primary care was included. Selection and appraisal of documents were based on relevance and rigour according to the Realist And Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) criteria. Data on context, mechanisms and outcomes (CMO) were extracted. Based on the extracted data, CMO configurations were identified per source publication. Configurations containing all three constructs (CMO) were included in the PT. The middle-range PT demonstrates that healthcare professionals (HCPs) should be trained and equipped with the knowledge and skills to communicate effectively (i.e. in easy-to-understand words, emphatically, checking whether the patient understands everything, listening attentively) tailored to the wishes, needs and possibilities of the patient, which may lead to higher satisfaction. This way the patient will be more involved in the care process and in the shared decision-making process, which may result in improved concordance, and an improved treatment approach. A respectful and empathic attitude of the HCP plays an important role in establishing a strong therapeutic relationship and improved health (system) outcomes. Together with a good accessibility of care for patients, setting up a personalised care plan with all involved parties may positively affect the self-management skills of patients. Good collaboration within the team and between different domains is desirable to ensure good care coordination. The coherence of items related to PCC in primary care should be considered to better understand its effectiveness.
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Affiliation(s)
- Anam Ahmed
- Panaxea b.vAmsterdamThe Netherlands
- Department of Primary and Community CareRadboud University Medical CentreNijmegenthe Netherlands
| | - Maria E. T. C. van den Muijsenbergh
- Department of Primary and Community CareRadboud University Medical CentreNijmegenthe Netherlands
- Department of Prevention and CarePharos: Dutch Centre of Expertise on Health Disparities, Program Prevention and CareUtrechtThe Netherlands
| | - Hubertus J. M. Vrijhoef
- Panaxea b.vAmsterdamThe Netherlands
- Department of Patient & CareMaastricht University Medical CenterMaastrichtThe Netherlands
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Mat Reffien MA, Aniza I, Sulong S, Tengku Bahanuddin TPZ, Mohd Salleh N, Nasir NH. Development, validity and reliability of instrument to evaluate implementation fidelity of the Family Doctor Concept (FDC) programme in public primary care clinics in Malaysia. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2022; 17:20-28. [PMID: 35440961 PMCID: PMC9004433 DOI: 10.51866/oa1197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The Family Doctor Concept (FDC) programme was introduced to public primary care clinics in late 2013 as part of the reform agenda in the primary healthcare delivery system. The study aimed to develop a validated and reliable instrument to evaluate the FDC implementation fidelity in primary care clinics. METHODS The instrument, which adapted the concept of patient-centred care (PCC), resulted from a series of expert discussions, a literature search, an FDC guideline, and a review of meeting minutes. A 2-step process was conducted with experts to achieve content and face validity. Consequently, the instrument was piloted in 5 public primary care clinics in Selangor involving 8 trained raters. Inter-rater reliability was estimated using intraclass correlation (ICC), while internal consistency was measured using Kuder-Richardson Formula 20 (KR-20). RESULTS The final instrument comprises 3 sections (instructions, clinic's characteristics and assessment items), with Section 3 containing 15 items divided into four components - population registration, formation of a primary care team, integrated treatment, and monitoring and evaluation. The ICC for total score was excellent, 0.981, while the ICCs of the individual component scores were good to excellent (population registration: 0.937, formation of primary care team: 0.742, integrated treatment: 0.996, and monitoring and evaluation: 0.996). The value of KR-20 was 0.615, which was considered adequate. CONCLUSION The instrument developed was found to be valid in terms of face and content validity and reliable in measuring the fidelity of FDC implementation with excellent inter-rater reliability.
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Affiliation(s)
- Muhammad Alimin Mat Reffien
- MBBS, MPH, MBA, Department of Community Health, Faculty of Medicine, Universiti, Kebangsaan Malaysia, Malaysia
| | - Ismail Aniza
- MD, MPH, PhD, Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Malaysia,
| | - Saperi Sulong
- MD, PhD, Department of Community Health, Faculty of Medicine, Universiti, Kebangsaan Malaysia, Malaysia
| | | | | | - Nazrila Hairizan Nasir
- MD, M. Family Medicine, Family Health Development Division, Ministry of Health, Malaysia
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Nystrøm V, Lurås H, Midlöv P, Leonardsen ACL. What if something happens tonight? A qualitative study of primary care physicians' perspectives on an alternative to hospital admittance. BMC Health Serv Res 2021; 21:447. [PMID: 33975573 PMCID: PMC8112060 DOI: 10.1186/s12913-021-06444-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 04/26/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Due to demographic changes, hospital emergency departments in many countries are overcrowded. Internationally, several primary healthcare models have been introduced as alternatives to hospitalisation. In Norway, municipal acute wards (MAWs) have been implemented as primary care wards that provide observation and medical treatment for 24 h. The intention is to replace hospitalisation for patients who require acute admission but not specialist healthcare services. The aim of this study was to explore primary care physicians' (PCPs') perspectives on admission to a MAW as an alternative to hospitalisation. METHODS The study had a qualitative design, including interviews with 21 PCPs in a county in southeastern Norway. Data were analysed with a thematic approach. RESULTS The PCPs described uncertainty when referring patients to the MAW because of the fewer diagnostic opportunities there than in the hospital. Admission of patients to the MAW was assumed to be unsafe for both PCPs, MAW nurses and physicians. The PCPs assumed that medical competence was lower at the MAW than in the hospital, which led to scepticism about whether their tentative diagnoses would be reconsidered if needed and whether a deterioration of the patients' condition would be detected. When referring patients to a MAW, the PCPs experienced disagreements with MAW personnel about the suitability of the patient. The PCPs emphasised the importance of patients' and relatives' participation in decisions about the level of treatment. Nevertheless, such participation was not always possible, especially when patients' wishes conflicted with what PCPs considered professionally sound. CONCLUSIONS The PCPs reported concerns regarding the use of MAWs as an alternative to hospitalisation. These concerns were related to fewer diagnostic opportunities, lower medical expertise throughout the day, uncertainty about the selection of patients and challenges with user participation. Consequently, these concerns had an impact on how the PCPs utilised MAW services.
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Affiliation(s)
- Vivian Nystrøm
- Department of Health and Welfare, Østfold University College, (PB) 700, 1757 Halden, Norway
| | - Hilde Lurås
- Health Services Research Unit, Akershus University Hospital, (PB) 1000, 1478 Lørenskog, Norway
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog, Norway
| | - Patrik Midlöv
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, (PB) 50332, 202 13 Malmö, Sweden
| | - Ann-Chatrin Linqvist Leonardsen
- Department of Health and Welfare, Østfold University College, (PB) 700, 1757 Halden, Norway
- Østfold Hospital Trust, Halden, Norway
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Brickley B, Williams LT, Morgan M, Ross A, Trigger K, Ball L. Putting patients first: development of a patient advocate and general practitioner-informed model of patient-centred care. BMC Health Serv Res 2021; 21:261. [PMID: 33743709 PMCID: PMC7981870 DOI: 10.1186/s12913-021-06273-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 03/12/2021] [Indexed: 11/18/2022] Open
Abstract
Background Patients, providers and health care organisations benefit from an increased understanding and implementation of patient-centred care (PCC) by general practitioners (GPs). This study aimed to evaluate and advance a theoretical model of PCC developed in consultation with practising GPs and patient advocates. Methods Qualitative description in a social constructivist/interpretivist paradigm. Participants were purposively sampled from six primary care organisations in south east Queensland/northern New South Wales, Australia. Participants engaged in focus group discussions where they expressed their perceptions, views and feelings of an existing PCC model. Data was analysed thematically using a constant-comparison approach. Results Three focus groups with 15 patient advocates and three focus groups with 12 GPs were conducted before thematic saturation was obtained. Three themes emerged: i) the model represents the ideal, ii) considering the system and collaborating in care and iii) optimising the general practice environment. The themes related to participants’ impression of the model and new components of PCC perceived to be experienced in the ‘real world’. The data was synthesised to produce an advanced model of PCC named, “Putting Patients First: A Map for PCC”. Conclusions Our revised PCC model represents an enhanced understanding of PCC in the ‘real world’ and can be used to inform patients, providers and health organisations striving for PCC. Qualitative testing advanced and supported the credibility of the model and expanded its application beyond the doctor-patient encounter. Future work could incorporate our map for PCC in tool/tool kits designed to support GPs and general practice with PCC. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06273-y.
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Affiliation(s)
- Bryce Brickley
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia.
| | - Lauren T Williams
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | | | - Alyson Ross
- Gold Coast Primary Health Network, Gold Coast, QLD, Australia
| | - Kellie Trigger
- Gold Coast Primary Health Network, Gold Coast, QLD, Australia
| | - Lauren Ball
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
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Romli MH, Mackenzie L, Tan PJ, Chiew RO, Tan SH, Tan MP. Comparison of Retrospective and Prospective Falls Reporting Among Community-Dwelling Older People: Findings From Two Cohort Studies. Front Public Health 2021; 9:612663. [PMID: 33777881 PMCID: PMC7994342 DOI: 10.3389/fpubh.2021.612663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 01/26/2021] [Indexed: 11/13/2022] Open
Abstract
Background: While prospective recording is considered as the gold standard, retrospective recall is widely utilized for falls outcomes due to its convenience. This brings about the concern on the validity of falls reporting in Southeast Asian countries, as the reliability of falls recall has not previously been studied. This study aimed to evaluate the reliability of retrospective falls recall compared to prospective falls recording. Methods: A secondary analysis of data from two prospective recording methods, falls diary and falls calendar, from two different research projects were obtained and analyzed. Retrospective falls recall was collected either through phone interview or follow-up clinic by asking the participants if they had fallen in the past 12 months. Results: Two-hundred-sixty-eight and 280 elderly participated in the diary and calendar groups, respectively. Moderate (46%) and poor (11%) return rates were found on completed diary and calendar recording. Under-(32%) and overreporting (24%) of falls were found in diary compared to only 4% of overreporting for the calendar. Retrospective recall method achieved 57% response rate for the diary group (followed up at clinic) and 89% for the calendar group (followed up via telephone interview). Agreement between retrospective and prospective reporting was moderate for the diary (kappa =0.44; p < 0.001) and strong for the calendar (kappa = 0.89; p < 0.001). Conclusion: Retrospective recall is reliable and acceptable in an observation study within healthy community older adults, while the combination of retrospective and prospective falls recording is the best for an intervention study with frailer older population. Telephone interview is convenient, low cost, and yielded a high response rate.
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Affiliation(s)
- Muhammad Hibatullah Romli
- Department of Rehabilitation Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia.,Malaysian Research Institute on Ageing (MyAgeingTM), Universiti Putra Malaysia, Serdang, Malaysia
| | - Lynette Mackenzie
- Discipline of Occupational Therapy, Faculty of Health Sciences, University of Sydney, Camperdown, NSW, Australia
| | - Pey June Tan
- Health Services and Policy Research Division, Geriatric Education and Research Institute, Singapore, Singapore
| | - Re On Chiew
- Faculty of Medicine, University of Malaya, Kuala Lampur, Malaysia
| | - Shun Herng Tan
- Faculty of Medicine, University of Malaya, Kuala Lampur, Malaysia
| | - Maw Pin Tan
- Faculty of Medicine, University of Malaya, Kuala Lampur, Malaysia
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Zhou LM, Xu RH, Xu YH, Chang JH, Wang D. Inpatients' Perception of Patient-Centered Care in Guangdong Province, China: A Cross-Sectional Study. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2021; 58:469580211059482. [PMID: 34872361 PMCID: PMC8655447 DOI: 10.1177/00469580211059482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study aimed to investigate the perceptions of patient-centered care (PCC) among inpatients in Guangdong Province (GD), China. Based on these perspectives, we sought to understand existing PCC practices in medical institutions and identify the impacts of inpatients’ sociodemographic status on their perceived PCC. A self-developed PCC questionnaire was used to investigate inpatients’ perceptions of PCC. A cross-sectional survey was conducted in nine tertiary-level hospitals across five cities in GD. Descriptive statistics was used to describe the levels of PCC in GD. The differences in PCC levels across different sociodemographic groups were assessed using analysis of variance and multivariate linear regression. Valid responses were provided by 1863 inpatients. The mean overall PCC score was 8.58 (standard deviation [SD] = 1.36); inpatients from the Pearl River Delta and eastern GD area reported significantly higher scores than those from western and northern GD area (P<.01). Inpatients from rural areas tended to report lower PCC scores than their urban counterparts. Among the PCC questionnaire sub-domains, inpatients scored highest and lowest in “patient experience” (mean = 8.96, SD = 1.34) and “medical insurance” (mean = 7.93, SD = 2.05), respectively. This study provided a comprehensive overview of inpatients’ perceptions of PCC in the public healthcare system in GD, China. Our findings highlighted that a majority of inpatients were satisfied with the PCC in public healthcare system; however, a significant discrepancy between inpatients with different sociodemographic status remained.
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Affiliation(s)
- Ling-Ming Zhou
- School of Health Management, 70570Southern Medical University, Guangdong, China.,The Second Affiliated Hospital of Guangzhou Medical University, Guangdong, China
| | - Richard Huan Xu
- Department of Rehabilitation Sciences, 26680The Hong Kong Polytechnic University, Hong Kong SAR, China.,Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yan-Hua Xu
- Hospital Office, Meizhou People's Hospital, Guangdong, China
| | - Jing-Hui Chang
- School of Health Management, 70570Southern Medical University, Guangdong, China
| | - Dong Wang
- School of Health Management, 70570Southern Medical University, Guangdong, China.,Institute of health management, Southern Medical University, Guangdong, China
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Brickley B, Williams LT, Morgan M, Ross A, Trigger K, Ball L. Patient-centred care delivered by general practitioners: a qualitative investigation of the experiences and perceptions of patients and providers. BMJ Qual Saf 2020; 31:191-198. [PMID: 33303622 DOI: 10.1136/bmjqs-2020-011236] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 11/12/2020] [Accepted: 11/26/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Patient-centred care (PCC) is care that is respectful and responsive to the wishes of patients. The body of literature on PCC delivered by general practitioners (GPs) has increased steadily over time. There is an opportunity to advance the work on GP-delivered PCC through qualitative research involving both patients and providers. AIM To explore the perceptions and experiences of PCC by patient advocates and GPs. DESIGN AND SETTING Qualitative description in a social constructivist paradigm. Participants were sampled from six primary care organisations in south east Queensland/northern New South Wales, Australia. METHOD Purposive sampling was used to recruit English-speaking adult participants who were either practising GPs or patient advocates. Focus group sessions explored participants' perceptions and experiences of PCC. Data were analysed thematically using a constant-comparative approach. RESULTS Three focus groups with 15 patient advocates and three focus groups with 12 practising GPs were conducted before thematic saturation was obtained. Five themes emerged: (1) understanding of PCC is varied and personal, (2) valuing humanistic care, (3) considering the system and collaborating in care, (4) optimising the general practice environment and (5) needing support for PCC that is embedded into training. CONCLUSION Patient advocates' and GPs' understanding of PCC are diverse, which can hinder strategies to implement and sustain PCC improvements. Future research should explore novel interventions that expose GPs to unique feedback from patients, assess the patient-centeredness of the environment and promote GP self-reflection on PCC.
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Affiliation(s)
- Bryce Brickley
- School of Allied Health Sciences, Griffith University Menzies Health Institute Queensland, Gold Coast, Queensland, Australia
| | - Lauren T Williams
- School of Allied Health Sciences, Griffith University Menzies Health Institute Queensland, Gold Coast, Queensland, Australia
| | - Mark Morgan
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Alyson Ross
- General Practice Support, Gold Coast Primary Health Network, Gold Coast, Queensland, Australia
| | - Kellie Trigger
- General Practice Support, Gold Coast Primary Health Network, Gold Coast, Queensland, Australia
| | - Lauren Ball
- School of Allied Health Sciences, Griffith University Menzies Health Institute Queensland, Gold Coast, Queensland, Australia
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Vennedey V, Dust G, Schippel N, Shukri A, Strupp J, Rietz C, Voltz R, Stock S. Patient-centered care during the last year of life: adaptation and validation of the German PACIC short form for bereaved persons as proxies (PACIC-S9-proxy). BMC Palliat Care 2020; 19:177. [PMID: 33234117 PMCID: PMC7687735 DOI: 10.1186/s12904-020-00687-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 11/18/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Providing patient-centered care (PCC) during the last year of life (LYOL) can be challenging due to the complexity of the patients' medical, social and psychological needs, especially in case of chronic illnesses. Assessing PCC can be helpful in identifying areas for improvements. Since not all patients can be surveyed, a questionnaire for proxy informants was developed in order to retrospectively assess patient-centeredness in care during the whole LYOL. This study aimed to evaluate the feasibility and validity of an adapted version of the German Patient Assessment of Chronic Illness Care (PACIC) for surveying bereaved persons in order to assess PCC during the decedents' LYOL. METHODS The German PACIC short form (11 items) was adapted to a nine-item version for surveying bereaved persons on the decedent's LYOL (PACIC-S9-Proxy). Items were rated on a five-point Likert scale. The PACIC adaptation and validation was part of a cross-sectional survey in the region of Cologne. Participants were recruited through self-selection and active recruitment by practice partners. Sociodemographic characteristics and missing data were analyzed using descriptive statistics. An exploratory factor analysis was conducted in order to assess the structure of the PACIC-S9-Proxy. Internal consistency was estimated using Cronbach's alpha. RESULTS Of the 351 informants who participated in the survey, 230 (65.52%) considered their decedent to have suffered from chronic illness prior to death. 193 of these informants (83.91%) completed ≥5 items of the questionnaire and were included in the analysis. The least answered item was item (74.09%) was item 4 (encouragement to group & classes for coping). The most frequently answered item (96.89%) was item 2 (satisfaction with care organization). Informants rated the item" Given a copy of their treatment plan" highest (mean 3.96), whereas "encouragement to get to a specific group or class to cope with the condition" (mean 1.74) was rated lowest. Cronbach's alpha was 0.84. A unidimensional structure of the questionnaire was found (Kaiser-Meyer-Olkin 0.86, Bartlett's test for sphericity p < 0.001), with items' factor loadings ranging from 0.46 to 0.82. CONCLUSIONS The nine-item questionnaire can be used as efficient tool for assessing PCC during the LYOL retrospectively and by proxies. TRIAL REGISTRATION The study was registered in the German Clinical Trials Register ( DRKS00011925 ) on 13 June 2017.
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Affiliation(s)
- Vera Vennedey
- Institute for Health Economics and Clinical Epidemiology, Gleueler Straße 176-178, 50935 Cologne, Germany
| | - Gloria Dust
- Department of Palliative Medicine, Medical Faculty, University of Cologne, Cologne, Germany
| | - Nicolas Schippel
- Department of Palliative Medicine, Medical Faculty, University of Cologne, Cologne, Germany
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), University of Cologne, Cologne, Germany
| | - Arim Shukri
- Institute for Health Economics and Clinical Epidemiology, Gleueler Straße 176-178, 50935 Cologne, Germany
| | - Julia Strupp
- Department of Palliative Medicine, Medical Faculty, University of Cologne, Cologne, Germany
| | | | - Raymond Voltz
- Department of Palliative Medicine, Medical Faculty, University of Cologne, Cologne, Germany
- Center for Health Services Research Cologne (ZVFK), University of Cologne, Cologne, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), University of Cologne, Cologne, Germany
- Clinical Trials Center Cologne (ZKS), University of Cologne, Cologne, Germany
| | - Stephanie Stock
- Institute for Health Economics and Clinical Epidemiology, Gleueler Straße 176-178, 50935 Cologne, Germany
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10
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Vennedey V, Hower KI, Hillen H, Ansmann L, Kuntz L, Stock S. Patients' perspectives of facilitators and barriers to patient-centred care: insights from qualitative patient interviews. BMJ Open 2020; 10:e033449. [PMID: 32376748 PMCID: PMC7223019 DOI: 10.1136/bmjopen-2019-033449] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Previous studies on patient-centred care (PCC) and its facilitators and barriers usually considered specific patient groups, healthcare settings and aspects of PCC or focused on expert perspectives. The objective of this study was to analyse patients' perspectives of facilitators and barriers towards implementing PCC. DESIGN We conducted semistructured individual interviews with chronically ill patients. The interviewees were encouraged to share positive and negative experiences of care and the related facilitators and barriers in all settings including preventive, acute and chronic health issues. Interview data were analysed based on the concept of content analysis. SETTING Interviews took place at the University Hospital Cologne, nursing homes, at participants' homes or by telephone. PARTICIPANTS Any person with at least one chronic illness living in the region of Cologne was eligible for participation. 25 persons with an average age of 60 years participated in the interviews. The participants suffered from various chronic conditions including mental health problems, oncological, metabolic, neurological diseases, but also shared experiences related to acute health issues. RESULTS Participants described facilitators and barriers of PCC on the microlevel (eg, patient-provider interaction), mesolevel (eg, health and social care organisation, HSCO) and macrolevel (eg, laws, financing). In addition to previous concepts, interviewees illustrated the importance of being an active patient by taking individual responsibility for health. Interviewees considered functioning teams and healthy staff members a facilitator of PCC as this can compensate stressful situations or lack of staff to some degree. A lack of transparency in financing and reimbursement was identified as barrier to PCC. CONCLUSION Individual providers and HSCOs can address many facilitators and barriers of PCC as perceived by patients. Large-scale changes such as reduction of administrative barriers, the expansion of care networks or higher mandatory nurse to patient ratios require political action and incentives. TRIAL REGISTRATION NUMBER DRKS00011925.
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Affiliation(s)
- Vera Vennedey
- Institute for Health Economics and Clinical Epidemiology, University Hospital Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Kira Isabel Hower
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), Faculty of Human Sciences and Faculty of Medicine, University of Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Hendrik Hillen
- Department of Business Administration and Health Care Management, University of Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Lena Ansmann
- Department of Health Services Research, Division of Organizational Health Services Research, Faculty of Medicine and Health Sciences, University of Oldenburg, Oldenburg, Lower Saxony, Germany
| | - Ludwig Kuntz
- Department of Business Administration and Health Care Management, University of Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Stephanie Stock
- Institute for Health Economics and Clinical Epidemiology, University Hospital Cologne, Cologne, Nordrhein-Westfalen, Germany
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Vennedey V, Peltzer S, Shukri A, Müller H, Jessen F, Albus C, Stock S. Comparison of Patient and Proxy Assessment of Patient-Centeredness in the Care of Coronary Heart Disease: A Cross Sectional Survey Using the PACIC-S11.1. J Prim Care Community Health 2020; 11:2150132720976235. [PMID: 33225798 PMCID: PMC7686633 DOI: 10.1177/2150132720976235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/29/2020] [Accepted: 11/03/2020] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION When making medical care more patient-centered, surveys on patients' and their relatives' experiences can be helpful in identifying opportunities for improvement. In cases where the targeted patients are unable to express their own perspective, for example, due to them being too young or suffering from severe impairments, proxies can serve as substitutes. Proxies are frequently used in care planning and consent. Nevertheless, it is unclear whether patients' assessments of how patient-centered their medical care is are similar to those of their proxies. This study aims to assess the level of consistency between patients' and their proxies' assessments using an adapted version of the Patient Assessment of Chronic Illness Care (PACIC) short form questionnaire. METHODS In a cross-sectional study, patients with coronary heart disease were recruited at cardiologists' offices, rehabilitation clinics and hospitals. Participants were surveyed with regard to the perceived level of patient-centeredness during their care using an adapted version of the German PACIC short form (PACIC-S11.1). Correlations in the assessments made by each patient and their respective proxy were analyzed. On the level of the patients group and the relatives group differences between mean ratings for each item were compared using paired t-tests. RESULTS In total, 74 pairs of patients and proxies submitted the completed questionnaire. On the level of the individual patient/proxy pairs, no correlation, or significant but low correlation, was found between the ratings. On the group level, patients' and their proxies' item ratings were similar in the interpretation of averages, but still demonstrated statistically significant differences. Overall, patients rated their care as more patient-centered than their proxies did. CONCLUSION The study shows that, on the individual level, proxies' ratings do not necessarily reflect the patients' assessment of PCC. On the group level, the assessments of relatives regarding PCC are similar to those of the patients. TRIAL REGISTRATION German clinical trials register (Deutsches Register Klinischer Studien, DRKS) Registration Number: DRKS00012434 (URL: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00012434).
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Affiliation(s)
- Vera Vennedey
- University of Cologne, Faculty of
Medicine and University Hospital Cologne, Cologne, Germany
| | - Samia Peltzer
- University of Cologne, Faculty of
Medicine and University Hospital Cologne, Cologne, Germany
| | - Arim Shukri
- University of Cologne, Faculty of
Medicine and University Hospital Cologne, Cologne, Germany
| | - Hendrik Müller
- University of Cologne, Faculty of
Medicine and University Hospital Cologne, Cologne, Germany
| | - Frank Jessen
- University of Cologne, Faculty of
Medicine and University Hospital Cologne, Cologne, Germany
- German Center for Neurodegenerative
Diseases (DZNE), Bonn, Germany
| | - Christian Albus
- University of Cologne, Faculty of
Medicine and University Hospital Cologne, Cologne, Germany
| | - Stephanie Stock
- University of Cologne, Faculty of
Medicine and University Hospital Cologne, Cologne, Germany
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