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Patel KH, Chrisinger B. Effectiveness of primary care interventions in conjointly treating comorbid chronic pain and depression: a systematic review and meta-analysis. Fam Pract 2024; 41:234-245. [PMID: 37530738 DOI: 10.1093/fampra/cmad061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Chronic pain and depression are highly comorbid, but the lack of consensus on the best treatment strategies puts patients at high risk of suboptimal care-coordination as well as health and social complications. Therefore, this study aims to quantitatively assesses how effective different primary care interventions have been in treating the comorbid state of chronic pain and depression. In particular, this study evaluates both short-term outcomes-based specifically on measures of chronic pain and depression during an intervention itself-and long-term outcomes or measures of pain and depression in the months after conclusion of the formal study intervention. METHODS This study is a systematic review and meta-analysis of randomised-controlled trials (RCTs) enrolling patients with concurrent chronic pain and depression. Intensity and severity of pain and depression symptoms were the primary outcomes. The main inclusion criteria were RCTs that: (i) enrolled patients diagnosed with depression and chronic pain, (ii) occurred in primary care settings, (iii) reported baseline and post-intervention outcomes for chronic pain and depression, (iv) lasted at least 8 weeks, and (v) used clinically validated outcome measures. Risk of bias was appraised with the Risk of Bias 2 tool, and GRADE guidelines were used to evaluate the quality of evidence. RESULTS Of 692 screened citations, 7 multicomponent primary care interventions tested across 891 patients were included. Meta-analyses revealed significant improvements in depression at post-intervention (SMD = 0.44, 95% CI [0.17, 0.71], P = 0.0014) and follow-up (SMD = 0.41, 95% CI [0.01, 0.81], P = 0.0448). Non-significant effects were observed for chronic pain at post-intervention (SMD = 0.27, 95% CI [-0.08, 0.61], P = 0.1287) and follow-up (SMD = 0.13, 95% CI [-0.3, 0.56], P = 0.5432). CONCLUSIONS Based on the results of the meta-analysis, primary care interventions largely yielded small to moderate positive effects for depressive symptoms and no significant effects on pain. In one study, stepped-care to be more effective in treatment of comorbid chronic pain and depression than other interventions both during the intervention and upon post-intervention follow-up. As such, depression appears more amenable to treatment than pain, but the number of published RCTs assessing both conditions is limited. More research is needed to further develop optimal treatment strategies.
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Affiliation(s)
- Krishna H Patel
- Department of Social Policy Intervention, University of Oxford, Oxford, United Kingdom
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Benjamin Chrisinger
- Department of Social Policy Intervention, University of Oxford, Oxford, United Kingdom
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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.
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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
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Graves JM, Abshire DA, Alejandro AG. System- and Individual-Level Barriers to Accessing Medical Care Services Across the Rural-Urban Spectrum, Washington State. Health Serv Insights 2022; 15:11786329221104667. [PMID: 35706424 PMCID: PMC9189527 DOI: 10.1177/11786329221104667] [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: 01/20/2022] [Accepted: 05/08/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Residents of rural areas face barriers beyond geography and distance when accessing medical care services. The purpose of this study was to characterize medical care access barriers across several commonly used classifications of rurality. Methods: Washington State household residents completed a mixed-mode (paper/online) health care access survey between June 2018 and December 2019 administered to a stratified random sample of ZIP codes classified as urban, suburban, large rural, and small rural (4-tier scheme). For analyses, rurality was also classified into 2-tier schemes (rural/urban) based on ZIP code and county. Respondents reported availability of medical care services and system- and individual-level barriers to accessing services. Logistic regression models estimated the odds of reporting system- or individual-level barriers in accessing medical care services across rurality (4- and 2-tier schemes), adjusting for respondent characteristics, and weighted to account for survey design. Results: About 617 households completed the survey (25.7% response rate). Compared to urban residents (across all 3 schemes), more rural residents reported traveling to a distant city or town for medical care (P < .001). Rurality was significantly associated with increased odds of facing system-level barriers. Respondents from small rural areas had greater odds access barriers for primary care (OR 7.31, 95% CI 1.84-29.09) and having no primary care provider (OR 11.37, 95% CI 3.03-42.75) compared to urban respondents. Individual-level barriers were not associated with rurality. Conclusions: To improve healthcare access across the rural-urban spectrum, policymakers must consider system-level barriers facing rural populations.
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Affiliation(s)
- Janessa M Graves
- College of Nursing, Washington State University, Spokane, WA, USA
| | | | - Art G Alejandro
- College of Nursing, Washington State University, Spokane, WA, USA
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Yen K, Miyasaki JM, Waldron M, Yu L, Sankar T, Ba F. DBS-Edmonton App, a Tool to Manage Patient Expectations of DBS in Parkinson Disease. Neurol Clin Pract 2021; 11:e308-e316. [PMID: 34484906 DOI: 10.1212/cpj.0000000000000962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/14/2020] [Indexed: 12/20/2022]
Abstract
Objective After deep brain stimulation (DBS) for Parkinson disease (PD), patients often do not report the level of satisfaction anticipated. This misalignment can relate to patients' expectations for an invasive treatment and insufficient knowledge of DBS's effectiveness in relieving motor and nonmotor symptoms (NMS). Patient satisfaction depends on expectations and goals for treatment. We hypothesized that improving patient education with a patient-centered shared decision-making tool emphasizing autonomy would improve patient satisfaction and clinical outcome. Methods We developed a computer application (DBS-Edmonton app), allowing patients with PD to input their symptoms and to learn how effective DBS addresses their prioritized symptoms. Sixty-two volunteers referred for DBS used the DBS-Edmonton app. DBS-related knowledge and patient perceptions of the DBS-Edmonton app were assessed with pre- and post-use questionnaires. Fourteen of 24 patients who proceeded to DBS achieved optimization at 6 months. Perceived functional improvement was assessed and compared with 12 control patients with DBS who did not use the DBS-Edmonton app. Results All 62 volunteers considered the DBS-Edmonton app helpful and would recommend it to others. There was improved knowledge about how NMS and axial symptoms respond to DBS. Postoperatively, there was no significant difference in symptoms improvement assessed by standard scales between the groups. Volunteers who used the DBS-Edmonton app had greater satisfaction (p = 0.014). Conclusion This interventional study showed that the DBS-Edmonton app improved DBS-related knowledge and patient satisfaction, independent of the objective motor outcome. It may assist patients in deciding to proceed to DBS and can be easily incorporated into practice to improve patient satisfaction post-DBS.
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Affiliation(s)
- Kevin Yen
- Parkinson and Movement Disorders Program (KY, JMM, MW, FB), Division of Neurology, Department of Medicine, Faculty of Medicine and Dentistry, School of Public Health (LY), and Division of Neurosurgery (TS), Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Janis M Miyasaki
- Parkinson and Movement Disorders Program (KY, JMM, MW, FB), Division of Neurology, Department of Medicine, Faculty of Medicine and Dentistry, School of Public Health (LY), and Division of Neurosurgery (TS), Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Michelle Waldron
- Parkinson and Movement Disorders Program (KY, JMM, MW, FB), Division of Neurology, Department of Medicine, Faculty of Medicine and Dentistry, School of Public Health (LY), and Division of Neurosurgery (TS), Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Lin Yu
- Parkinson and Movement Disorders Program (KY, JMM, MW, FB), Division of Neurology, Department of Medicine, Faculty of Medicine and Dentistry, School of Public Health (LY), and Division of Neurosurgery (TS), Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Tejas Sankar
- Parkinson and Movement Disorders Program (KY, JMM, MW, FB), Division of Neurology, Department of Medicine, Faculty of Medicine and Dentistry, School of Public Health (LY), and Division of Neurosurgery (TS), Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Fang Ba
- Parkinson and Movement Disorders Program (KY, JMM, MW, FB), Division of Neurology, Department of Medicine, Faculty of Medicine and Dentistry, School of Public Health (LY), and Division of Neurosurgery (TS), Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
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Lenz B, Katsarava Z, Gil-Gouveia R, Karelis G, Kaynarkaya B, Meksa L, Oliveira E, Palavra F, Rosendo I, Sahin M, Silva B, Uludüz D, Ural YZ, Varsberga-Apsite I, Zengin ST, Zvaune L, Steiner TJ. Headache service quality evaluation: implementation of quality indicators in primary care in Europe. J Headache Pain 2021; 22:33. [PMID: 33910500 PMCID: PMC8080333 DOI: 10.1186/s10194-021-01236-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/31/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Lifting The Burden (LTB) and European Headache Federation (EHF) have developed a set of headache service quality indicators, successfully tested in specialist headache centres. Their intended application includes all levels of care. Here we assess their implementation in primary care. METHODS We included 28 primary-care clinics in Germany (4), Turkey (4), Latvia (5) and Portugal (15). To implement the indicators, we interviewed 111 doctors, 92 nurses and medical assistants, 70 secretaries, 27 service managers and 493 patients, using the questionnaires developed by LTB and EHF. In addition, we evaluated 675 patients' records. Enquiries were in nine domains: diagnosis, individualized management, referral pathways, patient education and reassurance, convenience and comfort, patient satisfaction, equity and efficiency of headache care, outcome assessment and safety. RESULTS The principal finding was that Implementation proved feasible and practical in primary care. In the process, we identified significant quality deficits. Almost everywhere, histories of headache, especially temporal profiles, were captured and/or assessed inaccurately. A substantial proportion (20%) of patients received non-specific ICD codes such as R51 ("headache") rather than specific headache diagnoses. Headache-related disability and quality of life were not part of routine clinical enquiry. Headache diaries and calendars were not in use. Waiting times were long (e.g., about 60 min in Germany). Nevertheless, most patients (> 85%) expressed satisfaction with their care. Almost all the participating clinics provided equitable and easy access to treatment, and follow-up for most headache patients, without unnecessary barriers. CONCLUSIONS The study demonstrated that headache service quality indicators can be used in primary care, proving both practical and fit for purpose. It also uncovered quality deficits leading to suboptimal treatment, often due to a lack of knowledge among the general practitioners. There were failures of process also. These findings signal the need for additional training in headache diagnosis and management in primary care, where most headache patients are necessarily treated. More generally, they underline the importance of headache service quality evaluation in primary care, not only to identify-quality failings but also to guide improvements. This study also demonstrated that patients' satisfaction is not, on its own, a good indicator of service quality.
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Affiliation(s)
- B. Lenz
- Department of Neurology, Evangelical Hospital Unna, Unna, Germany
- Department of Neurology, Bundeswehr Central Hospital Koblenz, Koblenz, Germany
| | - Z. Katsarava
- Department of Neurology, Evangelical Hospital Unna, Unna, Germany
- Department of Neurology, University of Duisburg-Essen, Essen, Germany
- EVEX Medical Corporation, Tbilisi, Republic of Georgia
- IM Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | | | - G. Karelis
- Riga East Clinical University Hospital, Neurology and Neurosurgery Department, Headache Unit, Riga, Latvia
| | | | - L. Meksa
- Riga East Clinical University Hospital, Neurology and Neurosurgery Department, Headache Unit, Riga, Latvia
| | - E. Oliveira
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - F. Palavra
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Centre for Child Development – Neuropediatrics Unit, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - I. Rosendo
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Family Health Unit “Coimbra Centro”, Coimbra, Portugal
| | - M. Sahin
- Kartal 10 Nolu ASM Istanbul, Istanbul, Turkey
| | - B. Silva
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Family Health Unit “Pulsar”, Coimbra, Portugal
| | - D. Uludüz
- Neurology Department, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey
| | | | - I. Varsberga-Apsite
- Riga East Clinical University Hospital, Neurology and Neurosurgery Department, Headache Unit, Riga, Latvia
| | | | - L. Zvaune
- Riga East Clinical University Hospital, Neurology and Neurosurgery Department, Headache Unit, Riga, Latvia
| | - T. J. Steiner
- Norwegian University of Science and Technology, Trondheim, Norway
- Division of Neuroscience, Imperial College London, London, UK
| | - on behalf of European Headache Federation and Lifting The Burden: the Global Campaign against Headache
- Department of Neurology, Evangelical Hospital Unna, Unna, Germany
- Department of Neurology, Bundeswehr Central Hospital Koblenz, Koblenz, Germany
- Department of Neurology, University of Duisburg-Essen, Essen, Germany
- EVEX Medical Corporation, Tbilisi, Republic of Georgia
- IM Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
- Hospital da Luz Headache Center, Lisbon, Portugal
- Riga East Clinical University Hospital, Neurology and Neurosurgery Department, Headache Unit, Riga, Latvia
- Kagıthane Yahya Kemal ASM, Istanbul, Turkey
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Centre for Child Development – Neuropediatrics Unit, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Family Health Unit “Coimbra Centro”, Coimbra, Portugal
- Kartal 10 Nolu ASM Istanbul, Istanbul, Turkey
- Family Health Unit “Pulsar”, Coimbra, Portugal
- Neurology Department, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey
- Esenler Havaalanı ASM, Istanbul, Turkey
- Bagcılar Yıldıztepe ASM, Istanbul, Turkey
- Norwegian University of Science and Technology, Trondheim, Norway
- Division of Neuroscience, Imperial College London, London, UK
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Murphy M, Salisbury C. Relational continuity and patients' perception of GP trust and respect: a qualitative study. Br J Gen Pract 2020; 70:e676-e683. [PMID: 32784221 PMCID: PMC7425201 DOI: 10.3399/bjgp20x712349] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 02/16/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Despite the benefits of relational continuity of care, particularly for patients with multimorbidity, the traditional model of continuity is changing. Revisiting what patients with ongoing problems want from relational continuity could encourage initiatives to achieve these within a modern healthcare system. AIM To examine the attributes of GPs that patients with long-term conditions value most, and which attributes patients believe are facilitated by relational continuity. DESIGN AND SETTING Qualitative study in UK general practice. METHOD A thematic analysis was carried out, based on secondary analysis of interviews with 25 patients with long-term conditions that were originally conducted to inform a patient-reported outcome measure for primary care. RESULTS Patients with long-term conditions wanted their GPs to be clinically competent, to examine, listen to, care for, and take time with them, irrespective of whether they have seen them before. They believed that relational continuity facilitates a GP knowing their history, giving consistent advice, taking responsibility and action, and trusting and respecting them. Patients acknowledged practical difficulties and safety issues in achieving the first three of these without relational continuity. However, patients felt that GPs should trust and respect them even when continuity was not possible. CONCLUSION Policy initiatives promoting continuity with a GP or healthcare team should continue. Many patients see continuity as a safety issue. When patients experience relationship discontinuity, they often feel that they are not taken seriously or believed by their GP. GPs should therefore consistently seek to visibly demonstrate trust in their patients, particularly when they have not seen them before.
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Affiliation(s)
- Mairead Murphy
- Centre for Academic Primary Care, University of Bristol, Bristol Medical School, Bristol
| | - Chris Salisbury
- Centre for Academic Primary Care, University of Bristol, Bristol Medical School, Bristol
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Informing the model of care for an academic integrative healthcare centre: a qualitative study exploring healthcare consumer perspectives. BMC Complement Med Ther 2020; 20:58. [PMID: 32070328 PMCID: PMC7076816 DOI: 10.1186/s12906-019-2801-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 12/17/2019] [Indexed: 01/24/2023] Open
Abstract
Background In response to high demand and the growing body of evidence for traditional and complementary therapies, the practice of integrative medicine and integrative healthcare has emerged where these therapies are blended with conventional healthcare. While there are a number of academic integrative healthcare centres worldwide, there are none in Australia. Western Sydney University will soon establish an academic integrative healthcare centre offering evidence-informed traditional and complementary therapies integrated with conventional healthcare in a research-based culture. The aim of this study was to explore healthcare consumers’ views about the perceived need, advantages, and disadvantages of the proposed centre and its relevance to community-defined problems and health and service needs. Methods Qualitative methods, informed by community-based participatory research, were used during 2017. Focus groups supplemented with semi-structured interviews were conducted with healthcare consumers. Participants were recruited through paid advertisements on Facebook. Thematic coding, informed by an integrative healthcare continuum, was used to analyse and organise the data. Analysis was augmented with descriptive statistics of participant demographic details. Results Three main themes emerged: (i) the integrative approach, (i) person-centred care, and (iii) safety and quality. Participants proposed a coordinated healthcare model, with perspectives falling along a continuum from parallel and consultative to fully integrative models of healthcare. The importance of multidisciplinary collaboration and culturally appropriate, team-based care within a supportive healing environment was emphasised. A priority of providing broad and holistic healthcare that was person centred and treated the whole person was valued. It was proposed that safety and quality standards be met by medical oversight, evidence-informed practice, practitioner competency, and interprofessional communication. Conclusions Our findings demonstrate that participants desired greater integration of conventional healthcare with traditional and complementary therapies within a team-based, person-centred environment with assurances of safety and quality. Findings will be used to refine the model of care for an academic integrative healthcare centre in Western Sydney.
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Abstract
Background: In 2005, the Portuguese government launched a primary care (PC) reform. After a promising start, the reform is still incomplete and has been compromised by low investment. The incomplete nature of the reforms has resulted in the coexistence of different models of care delivery and heterogeneity in resource allocation and performance. PC has been extensively evaluated, but little is known about the patients’ views and preferences regarding PC and the ongoing reform. Aim: This study aims to examine patients’ experiences of and preferences for PC in Portugal and to explore their experience of the recent reforms. Methods: A qualitative study was undertaken which collected data from eight focus groups in the city of Braga, Portugal. Participants were recruited with the collaboration of eight local institutions. Focus groups’ discussions focused on patients’ experiences of and preferences for PC as well as their views on the reforms. Audio recordings were transcribed and analysed using an inductive thematic content analysis. Findings: The majority of participants perceived that the reform was positive. However, the improvements achieved by the reform were insufficient to lead to most participants having a positive experience of PC delivery in Portugal. Participants’ satisfaction/dissatisfaction with primary care was strongly associated with interpersonal relations and communication with doctors. Participants valued continuity of care, but felt the levels of responsiveness, flexibility and coordination in the current system were still unsatisfactory. Access and waiting times were seen as challenging and led participants to seek PC from emergency departments and private doctors. Policy Implications: The perception of increased inequity and the lack of effective choice undermined the social acceptability of the reform. Policies aimed at improving doctor–patient communication and continuity of care, as well as choice, may therefore lead to better satisfaction and more efficient use of health care settings.
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Krinke KS, Tangermann U, Amelung VE, Krauth C. Public preferences for primary care provision in Germany - a discrete choice experiment. BMC FAMILY PRACTICE 2019; 20:80. [PMID: 31185940 PMCID: PMC6560870 DOI: 10.1186/s12875-019-0967-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 05/20/2019] [Indexed: 11/18/2022]
Abstract
Background Primary care is a central element of healthcare and addresses the main health problems of the population. While primary care gains in importance due to an aging population, there is an ongoing debate on physician shortages in German rural regions. The study aims on analyzing the population’s preferences on primary healthcare and, therefore, on helping policy makers to make care delivery more responsive to patients’ needs when planning political reforms of primary care. Methods A paper-based discrete choice experiment (DCE) was used to assess preferences of the population of eight rural regions in Germany. Based on literature search and qualitative research, six attributes were selected and included in the choice experiment. The survey presented participants with eight choice sets in which they had to choose between two possible scenarios of care. A conditional logistic regression as well as a latent class model (LCM) were used to analyze preferences for primary healthcare. Results Nine hundred four participants completed the survey (response rate 46.1%). The conditional logistic regression showed significant impact of the attributes “home visits”, “distance to practice”, “number of healthcare providers”, “opening hours of the practice”, and “diagnostic facilities” on the respondents’ choices of primary healthcare alternatives. Moreover, the LCM identified four classes that can be characterized by preference homogeneity within and heterogeneity between the classes. Conclusion Although the study revealed heterogeneous preferences among the latent classes, several similarities in preferences for primary care could be detected. The knowledge on these public preferences may help policy makers when implementing new models of primary care and, thus, raise the populations’ acceptance of future primary care provision and innovative care models. Electronic supplementary material The online version of this article (10.1186/s12875-019-0967-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kim-Sarah Krinke
- Hannover Medical School, Institute for Epidemiology, Social Medicine and Health Systems Research, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
| | - Ulla Tangermann
- Hannover Medical School, Institute for Epidemiology, Social Medicine and Health Systems Research, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Volker Eric Amelung
- Hannover Medical School, Institute for Epidemiology, Social Medicine and Health Systems Research, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Christian Krauth
- Hannover Medical School, Institute for Epidemiology, Social Medicine and Health Systems Research, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
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Mazzi MA, Rimondini M, van der Zee E, Boerma W, Zimmermann C, Bensing J. Which patient and doctor behaviours make a medical consultation more effective from a patient point of view. Results from a European multicentre study in 31 countries. PATIENT EDUCATION AND COUNSELING 2018; 101:1795-1803. [PMID: 29891103 DOI: 10.1016/j.pec.2018.05.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 05/07/2018] [Accepted: 05/25/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To assess European patients' preferences regarding seven aspects of doctor-patient communication. METHODS 6049 patients from 31 European countries evaluated 21 doctor and 12 patient behaviours, through a patient-generated questionnaire (PCVq). Multilevel models explored the effects of patient characteristics, contextual and cultural dimensions on preferences. RESULTS Patients attributed more responsibility to doctors, by giving greater importance to doctor than to patient factors, in particular to Treating the patient as a partner and as a person and Continuity of care. Gender, age, education, the presence of chronic illness and two of Hofstede's cultural dimensions, Individualism and Indulgence, showed differential evaluations among patients. Women gave greater importance to all seven communication aspects, older patients to being prepared for the consultation, lower educated patients to Treating patient as a person and Thoughtful planning. Patients from countries with an indulgent background rated all seven communication aspects of greater importance. A more individualistic orientation was related to lower importance regarding the four doctor's factors and the patient factor Open and Honest. CONCLUSIONS Treating the patient as a person and providing continuity of care emerged as universal values. PRACTICE IMPLICATIONS The findings should represent a landmark for the adaptation of patient-generated communication guidelines and programs in Europe.
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Affiliation(s)
- Maria Angela Mazzi
- University of Verona, Department of Neurosciences, Biomedicine and Movement Sciences, Italy.
| | - Michela Rimondini
- University of Verona, Department of Neurosciences, Biomedicine and Movement Sciences, Italy
| | | | - Wienke Boerma
- NIVEL, Netherlands Institute for Health Services Research, The Netherlands
| | - Christa Zimmermann
- University of Verona, Department of Neurosciences, Biomedicine and Movement Sciences, Italy
| | - Jozien Bensing
- NIVEL, Netherlands Institute for Health Services Research, The Netherlands
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Weinhold I, Gurtner S. Rural - urban differences in determinants of patient satisfaction with primary care. Soc Sci Med 2018; 212:76-85. [PMID: 30025382 DOI: 10.1016/j.socscimed.2018.06.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 04/03/2018] [Accepted: 06/19/2018] [Indexed: 11/28/2022]
Abstract
In light of the rising regional inequalities in primary care provider supply, to ensure equitable access is a pressing issue in health policy. Most policy approaches fall short in considering the patient perspective when defining shortage areas. As a consequence, implementations of new service delivery models might fail to be responsive to patients' expectations. To explore regional differences in the relative importance of structure and process attributes as drivers of patient satisfaction with local primary care, we collected data from residents of three objectively well-supplied urban and six objectively worse-supplied rural areas in Germany and tested a multi-group structural equation model. The results suggest that the relative importance of care attributes is different among the regional conditions rural and urban. Regardless of regional constraints, the strongest determinants of satisfaction are not related to structural aspects but are concerned with the quality of the doctor-patient relationship. A lack of available choices and a higher tolerance in terms of distances provide possible explanations for the results. The high importance rural residents attribute to the interpersonal relation should not be neglected in the re-organization of traditional service delivery in rural areas.
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Affiliation(s)
- Ines Weinhold
- Technische Universität Dresden, Centre for Health Economics c/o Center for Evidence-based Healthcare, Fetscherstraße 74, 01307, Dresden, Germany.
| | - Sebastian Gurtner
- Bern University of Applied Sciences, Institute for Corporate Development, Brückenstr. 73, 3005, Bern, Switzerland.
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Kleij KS, Tangermann U, Amelung VE, Krauth C. Patients' preferences for primary health care - a systematic literature review of discrete choice experiments. BMC Health Serv Res 2017; 17:476. [PMID: 28697796 PMCID: PMC5505038 DOI: 10.1186/s12913-017-2433-7] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 07/05/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Primary care is a key element of health care systems and addresses the main health problems of the population. Due to the demographic change, primary care even gains in importance. The knowledge of the patients' preferences can help policy makers as well as physicians to set priorities in their effort to make health care delivery more responsive to patients' needs. Our objective was to describe which aspects of primary care were included in preference studies and which of them were the most preferred aspects. METHODS In order to elicit the preferences for primary care, a systematic literature search was conducted. Two researchers searched three electronic databases (PubMed, Scopus, and PsycINFO) and conducted a narrative synthesis. Inclusion criteria were: focus on primary health care delivery, discrete choice experiment as elicitation method, and studies published between 2006 and 2015 in English language. RESULTS We identified 18 studies that elicited either the patients' or the population's preferences for primary care based on a discrete choice experiment. Altogether the studies used 16 structure attributes, ten process attributes and four outcome attributes. The most commonly applied structure attribute was "Waiting time till appointment", the most frequently used process attribute was "Shared decision making / professional's attention paid to your views". "Receiving the 'best' treatment" was the most commonly applied outcome attribute. Process attributes were most often the ones of highest importance for patients or the population. The attributes and attribute levels used in the discrete choice experiments were identified by literature research, qualitative research, expert interviews, or the analysis of policy documents. CONCLUSIONS The results of the DCE studies show different preferences for primary health care. The diversity of the results may have several reasons, such as the method of analysis, the selection procedure of the attributes and their levels or the specific research question of the study. As the results of discrete choice experiments depend on many different factors, it is important for a better comprehensibility of the studies to transparently report the steps undertaken in a study as well as the interim results regarding the identification of attributes and levels.
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Affiliation(s)
- Kim-Sarah Kleij
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hanover, Germany
| | - Ulla Tangermann
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hanover, Germany
| | - Volker E. Amelung
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hanover, Germany
| | - Christian Krauth
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hanover, Germany
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Engelhard EAN, Smit C, Kroon FP, Nieuwkerk PT, Reiss P, Brinkman K, Geerlings SE. A Survey of Patients' Perspectives on Outpatient HIV Care in the Netherlands. Infect Dis Ther 2017; 6:443-452. [PMID: 28677021 PMCID: PMC5595778 DOI: 10.1007/s40121-017-0164-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Indexed: 11/26/2022] Open
Abstract
Introduction Responding to patients’ needs and preferences is important in the delivery of outpatient care. Recent and systematically collected data reflecting human immunodeficiency virus (HIV)-infected patients’ opinions on how their outpatient care should be delivered are lacking. Our aim was to identify aspects of care that people with HIV in outpatient care in The Netherlands consider important and to evaluate the extent to which the received care meets their expectations. Methods We measured patient preferences and experiences in a nationwide sample of HIV-infected patients using a modified, previously validated questionnaire (QUOTE-HIV). Results The aspects of care that were considered most important were specific expertise of the care provider in HIV medicine, the care provider taking the patient seriously and receiving adequate information about treatment options. In addition, confidentiality of HIV status at the outpatient clinic was a major concern. Patient experiences were positive, with the majority of the respondents indicating that they always or usually received care in accordance with their preferences. Conclusion HIV-infected patients greatly value having care providers with HIV-specific expertise. Safeguarding the privacy of HIV status and the provision of information about treatment options are matters that deserve continuous attention in the delivery of outpatient HIV care. Electronic supplementary material The online version of this article (doi:10.1007/s40121-017-0164-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Esther A N Engelhard
- Division of Infectious Diseases, Department of Internal Medicine, Academic Medical Center of the University of Amsterdam, Amsterdam, The Netherlands.
- Stichting HIV Monitoring, Amsterdam, The Netherlands.
| | - Colette Smit
- Stichting HIV Monitoring, Amsterdam, The Netherlands
| | - Frank P Kroon
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - Pythia T Nieuwkerk
- Department of Medical Psychology, Academic Medical Center of the University of Amsterdam, Amsterdam, The Netherlands
| | - Peter Reiss
- Division of Infectious Diseases, Department of Internal Medicine, Academic Medical Center of the University of Amsterdam, Amsterdam, The Netherlands
- Stichting HIV Monitoring, Amsterdam, The Netherlands
- Department of Global Health, Academic Medical Center of the University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Kees Brinkman
- Department of Internal Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Suzanne E Geerlings
- Division of Infectious Diseases, Department of Internal Medicine, Academic Medical Center of the University of Amsterdam, Amsterdam, The Netherlands
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Burt J, Campbell J, Abel G, Aboulghate A, Ahmed F, Asprey A, Barry H, Beckwith J, Benson J, Boiko O, Bower P, Calitri R, Carter M, Davey A, Elliott MN, Elmore N, Farrington C, Haque HW, Henley W, Lattimer V, Llanwarne N, Lloyd C, Lyratzopoulos G, Maramba I, Mounce L, Newbould J, Paddison C, Parker R, Richards S, Roberts M, Setodji C, Silverman J, Warren F, Wilson E, Wright C, Roland M. Improving patient experience in primary care: a multimethod programme of research on the measurement and improvement of patient experience. PROGRAMME GRANTS FOR APPLIED RESEARCH 2017. [DOI: 10.3310/pgfar05090] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BackgroundThere has been an increased focus towards improving quality of care within the NHS in the last 15 years; as part of this, there has been an emphasis on the importance of patient feedback within policy, through National Service Frameworks and the Quality and Outcomes Framework. The development and administration of large-scale national patient surveys to gather representative data on patient experience, such as the national GP Patient Survey in primary care, has been one such initiative. However, it remains unclear how the survey is used by patients and what impact the data may have on practice.ObjectivesOur research aimed to gain insight into how different patients use surveys to record experiences of general practice; how primary care staff respond to feedback; and how to engage primary care staff in responding to feedback.MethodsWe used methods including quantitative survey analyses, focus groups, interviews, an exploratory trial and an experimental vignette study.Results(1)Understanding patient experience data. Patients readily criticised their care when reviewing consultations on video, although they were reluctant to be critical when completing questionnaires. When trained raters judged communication during a consultation to be poor, a substantial proportion of patients rated the doctor as ‘good’ or ‘very good’. Absolute scores on questionnaire surveys should be treated with caution; they may present an overoptimistic view of general practitioner (GP) care. However, relative rankings to identify GPs who are better or poorer at communicating may be acceptable, as long as statistically reliable figures are obtained. Most patients have a particular GP whom they prefer to see; however, up to 40% of people who have such a preference are unable regularly to see the doctor of their choice. Users of out-of-hours care reported worse experiences when the service was run by a commercial provider than when it was run by a not-for profit or NHS provider. (2)Understanding patient experience in minority ethnic groups. Asian respondents to the GP Patient Survey tend to be registered with practices with generally low scores, explaining about half of the difference in the poorer reported experiences of South Asian patients than white British patients. We found no evidence that South Asian patients used response scales differently. When viewing the same consultation in an experimental vignette study, South Asian respondents gave higher scores than white British respondents. This suggests that the low scores given by South Asian respondents in patient experience surveys reflect care that is genuinely worse than that experienced by their white British counterparts. We also found that service users of mixed or Asian ethnicity reported lower scores than white respondents when rating out-of-hours services. (3)Using patient experience data. We found that measuring GP–patient communication at practice level masks variation between how good individual doctors are within a practice. In general practices and in out-of-hours centres, staff were sceptical about the value of patient surveys and their ability to support service reconfiguration and quality improvement. In both settings, surveys were deemed necessary but not sufficient. Staff expressed a preference for free-text comments, as these provided more tangible, actionable data. An exploratory trial of real-time feedback (RTF) found that only 2.5% of consulting patients left feedback using touch screens in the waiting room, although more did so when reminded by staff. The representativeness of responding patients remains to be evaluated. Staff were broadly positive about using RTF, and practices valued the ability to include their own questions. Staff benefited from having a facilitated session and protected time to discuss patient feedback.ConclusionsOur findings demonstrate the importance of patient experience feedback as a means of informing NHS care, and confirm that surveys are a valuable resource for monitoring national trends in quality of care. However, surveys may be insufficient in themselves to fully capture patient feedback, and in practice GPs rarely used the results of surveys for quality improvement. The impact of patient surveys appears to be limited and effort should be invested in making the results of surveys more meaningful to practice staff. There were several limitations of this programme of research. Practice recruitment for our in-hours studies took place in two broad geographical areas, which may not be fully representative of practices nationally. Our focus was on patient experience in primary care; secondary care settings may face different challenges in implementing quality improvement initiatives driven by patient feedback. Recommendations for future research include consideration of alternative feedback methods to better support patients to identify poor care; investigation into the factors driving poorer experiences of communication in South Asian patient groups; further investigation of how best to deliver patient feedback to clinicians to engage them and to foster quality improvement; and further research to support the development and implementation of interventions aiming to improve care when deficiencies in patient experience of care are identified.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
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Affiliation(s)
- Jenni Burt
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | - Gary Abel
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
- University of Exeter Medical School, Exeter, UK
| | - Ahmed Aboulghate
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Faraz Ahmed
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | | | - Julia Beckwith
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - John Benson
- Primary Care Unit, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Olga Boiko
- University of Exeter Medical School, Exeter, UK
| | - Pete Bower
- National Institute for Health Research (NIHR) School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | | | - Mary Carter
- University of Exeter Medical School, Exeter, UK
| | | | | | - Natasha Elmore
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Conor Farrington
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Hena Wali Haque
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | - Val Lattimer
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Nadia Llanwarne
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Cathy Lloyd
- Faculty of Health & Social Care, The Open University, Milton Keynes, UK
| | - Georgios Lyratzopoulos
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | - Luke Mounce
- University of Exeter Medical School, Exeter, UK
| | - Jenny Newbould
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Charlotte Paddison
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Richard Parker
- Primary Care Unit, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | | | | | | | | | - Ed Wilson
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | - Martin Roland
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
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Herman PM, Ingram M, Cunningham CE, Rimas H, Murrieta L, Schachter K, de Zapien JG, Carvajal SC. A Comparison of Methods for Capturing Patient Preferences for Delivery of Mental Health Services to Low-Income Hispanics Engaged in Primary Care. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2017; 9:293-301. [PMID: 26689700 DOI: 10.1007/s40271-015-0155-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Consideration of patient preferences regarding delivery of mental health services within primary care may greatly improve access and quality of care for the many who could benefit from those services. OBJECTIVES This project evaluated the feasibility and usefulness of adding a consumer-products design method to qualitative methods implemented within a community-based participatory research (CBPR) framework. RESEARCH DESIGN Discrete-choice conjoint experiment (DCE) added to systematic focus group data collection and analysis. SUBJECTS Focus group data were collected from 64 patients of a Federally-Qualified Health Center (FQHC) serving a predominantly low-income Hispanic population. A total of 604 patients in the waiting rooms of the FQHC responded to the DCE. MEASURES The DCE contained 15 choice tasks that each asked respondents to choose between three mental health services options described by the levels of two (of eight) attributes based on themes that emerged from focus group data. RESULTS The addition of the DCE was found to be feasible and useful in providing distinct information on relative patient preferences compared with the focus group analyses alone. According to market simulations, the package of mental health services guided by the results of the DCE was preferred by patients. CONCLUSIONS Unique patterns of patient preferences were uncovered by the DCE and these findings were useful in identifying pragmatic solutions to better address the mental health service needs of this population. However, for this resource-intensive method to be adopted more broadly, the scale of the primary care setting and/or scope of the issue addressed have to be relatively large.
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Affiliation(s)
- Patricia M Herman
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407-2138, USA.
| | - Maia Ingram
- University of Arizona, Zuckerman College of Public Health, 1295 N Martin Avenue, Tucson, AZ, 85724, USA
| | - Charles E Cunningham
- Department of Psychiatry and Behavioural Neurosciences, Jack Laidlaw Chair in Patient-Centered Health Care, Faculty of Health Sciences, Michael G. DeGroote School of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - Heather Rimas
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - Lucy Murrieta
- Sunset Community Health Center, 2060 W. 24th Street, Yuma, AZ, 85364, USA
| | - Kenneth Schachter
- University of Arizona, Zuckerman College of Public Health, 1295 N Martin Avenue, Tucson, AZ, 85724, USA
| | - Jill Guernsey de Zapien
- University of Arizona, Zuckerman College of Public Health, 1295 N Martin Avenue, Tucson, AZ, 85724, USA
| | - Scott C Carvajal
- Arizona Prevention Research Center, University of Arizona, Zuckerman College of Public Health, 1295 N Martin Avenue, Tucson, AZ, 85724, USA
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Weston C, Gilkes A, Durbaba S, Schofield P, White P, Ashworth M. Long term condition morbidity in English general practice: a cross-sectional study using three composite morbidity measures. BMC FAMILY PRACTICE 2016; 17:166. [PMID: 27894265 PMCID: PMC5127084 DOI: 10.1186/s12875-016-0563-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 11/14/2016] [Indexed: 11/10/2022]
Abstract
Background The burden of morbidity represented by patients with long term conditions (LTCs) varies substantially between general practices. This study aimed to determine the characteristics of general practices with high morbidity burden. Method Retrospective cross-sectional study; general practices in England, 2014/15. Three composite morbidity measures (MMs) were constructed to quantify LTC morbidity at practice level: a count of LTCs derived from the 20 LTCs included in the UK Quality and Outcomes Framework (QOF) disease registers, expressed as ‘number of QOF LTCs per 100 registered patients’; the % of patients with one or more QOF LTCs; the % of patients with one or more of 15 broadly defined LTCs included in the GP Patient Survey (GPPS). Determinants of MM scores were analysed using multi-level regression models. Analysis was based on a national dataset of English general practices (n = 7779 practices); GPPS responses (n = 903,357); general practice characteristics (e.g. list size, list size per full time GP); patient demographic characteristics (age, deprivation status); secondary care utilisation (out-patient, emergency department, emergency admission rates). Results Mean MM scores (95% CIs) were: 57.7 (±22.3) QOF LTCs per 100 registered patients; 22.8% (±8.2) patients with a QOF LTC; 63.5% (±11.7) patients with a GPPS LTC. The proportion of elderly patients and social deprivation scores were the strongest predictors of each MM score; scores were largely independent of practice characteristics. MM scores were positive predictors of secondary care utilization and negative predictors’ access, continuity of care and overall satisfaction. Conclusions Wide variation in LTC morbidity burden was observed across English general practice. Variation was determined by demographic factors rather than practice characteristics. Higher rates of secondary care utilisation in practices with higher morbidity burden have implications for resource allocation and commissioning budgets; lower reported satisfaction in these practices suggests that practices may struggle with increased workload. There is a need for a readily available metric to define the burden of morbidity and multimorbidity in general practice.
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Affiliation(s)
- Charlotte Weston
- Division of Health and Social Care Research, Department of Primary Care and Public Health Sciences, King's College London, Addison House, Guy's Campus, London, SE1 1UL, UK.
| | - Alexander Gilkes
- Division of Health and Social Care Research, Department of Primary Care and Public Health Sciences, King's College London, Addison House, Guy's Campus, London, SE1 1UL, UK
| | - Stevo Durbaba
- Division of Health and Social Care Research, Department of Primary Care and Public Health Sciences, King's College London, Addison House, Guy's Campus, London, SE1 1UL, UK
| | - Peter Schofield
- Division of Health and Social Care Research, Department of Primary Care and Public Health Sciences, King's College London, Addison House, Guy's Campus, London, SE1 1UL, UK
| | - Patrick White
- Division of Health and Social Care Research, Department of Primary Care and Public Health Sciences, King's College London, Addison House, Guy's Campus, London, SE1 1UL, UK
| | - Mark Ashworth
- Division of Health and Social Care Research, Department of Primary Care and Public Health Sciences, King's College London, Addison House, Guy's Campus, London, SE1 1UL, UK
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Desborough J, Bagheri N, Banfield M, Mills J, Phillips C, Korda R. The impact of general practice nursing care on patient satisfaction and enablement in Australia: A mixed methods study. Int J Nurs Stud 2016; 64:108-119. [PMID: 27768985 DOI: 10.1016/j.ijnurstu.2016.10.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 09/05/2016] [Accepted: 10/13/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND The numbers of nurses in general practice in Australia tripled between 2004 and 2012. However, evidence on whether nursing care in general practice improves patient outcomes is scarce. Although patient satisfaction and enablement have been examined extensively as outcomes of general practitioner care, there is little research into these outcomes from nursing care in general practice. The aim of this study was to examine the relationships between specific general practice characteristics and nurse consultation characteristics, and patient satisfaction and enablement METHODS: A mixed methods study examined a cross-section of patients from 21 general practices in the Australian Capital Territory. The Patient Enablement and Satisfaction Survey was distributed to 1665 patients who received nursing care between September 2013 and March 2014. Grounded theory methods were used to analyse interviews with staff and patients from these same practices. An integrated analysis of data from both components was conducted using multilevel mixed effect models. RESULTS Data from 678 completed patient surveys (response rate=42%) and 48 interviews with 16 nurses, 23 patients and 9 practice managers were analysed. Patients who had longer nurse consultations were more satisfied (OR=2.50, 95% CI: 1.43-4.35) and more enabled (OR=2.55, 95% CI: 1.45-4.50) than those who had shorter consultations. Patients who had continuity of care with the same general practice nurse were more satisfied (OR=2.31, 95% CI: 1.33-4.00) than those who consulted with a nurse they had never met before. Patients who attended practices where nurses worked with broad scopes of practice and high levels of autonomy were more satisfied (OR=1.76, 95% CI: 1.09-2.82) and more enabled (OR=2.56, 95% CI: 1.40-4.68) than patients who attended practices where nurses worked with narrow scopes of practice and low levels of autonomy. Patients who received nursing care for the management of chronic conditions (OR=2.64, 95% CI: 1.32-5.30) were more enabled than those receiving preventive health care. CONCLUSIONS This study provides the first evidence of the importance of continuity of general practice nurse care, adequate time in general practice nurse consultations, and broad scopes of nursing practice and autonomy for patient satisfaction and enablement. The findings of this study provide evidence of the true value of enhanced nursing roles in general practice. They demonstrate that when the vision for improved coordination and multidisciplinary primary health care, including expanded roles of nurses, is implemented, high quality patient outcomes can be achieved.
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Affiliation(s)
- Jane Desborough
- Department of Health Services Research and Policy, Research School of Population Health, Australian National University, Australia.
| | - Nasser Bagheri
- Department of Health Services Research and Policy, Research School of Population Health, Australian National University, Australia
| | - Michelle Banfield
- National Institute for Mental Health Research, Research School of Population Health, Australian National University, Australia
| | - Jane Mills
- Nursing, School of Health & Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Christine Phillips
- Social Foundations of Medicine, Australian National University Medical School, Australia
| | - Rosemary Korda
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Australia
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Desborough J, Phillips C, Banfield M, Bagheri N, Mills J. Impact of nursing care in Australian general practice on the quality of care: A pilot of the Patient Enablement and Satisfaction Survey (PESS). Collegian 2015; 22:207-14. [DOI: 10.1016/j.colegn.2014.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Wong MS, Gudzune KA, Bleich SN. Provider communication quality: influence of patients' weight and race. PATIENT EDUCATION AND COUNSELING 2015; 98:492-8. [PMID: 25617907 PMCID: PMC4379992 DOI: 10.1016/j.pec.2014.12.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 10/25/2014] [Accepted: 12/21/2014] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To examine the relationship between patient weight and provider communication quality and determine whether patient race/ethnicity modifies this association. METHODS We conducted a cross-sectional analysis with 2009-2010 medical expenditures panel survey-household component (N=25,971). Our dependent variables were patient report of providers explaining well, listening, showing respect, and spending time. Our independent variables were patient weight status and patient weight-race/ethnicity groups. Using survey weights, we performed multivariate logistic regression to examine the adjusted association between patient weight and patient-provider communication measures, and whether patient race/ethnicity modifies this relationship. RESULTS Compared to healthy weight whites, obese blacks were less likely to report that their providers explained things well (OR 0.78; p=0.02) or spent enough time with them (OR 0.81; p=0.04), and overweight blacks were also less likely to report that providers spent enough time with them (OR 0.78; p=0.02). Healthy weight Hispanics were also less likely to report adequate provider explanations (OR 0.74; p=0.04). CONCLUSION Our study provides preliminary evidence that overweight/obese black and healthy weight Hispanic patients experience disparities in provider communication quality. PRACTICE IMPLICATION Curricula on weight bias and cultural competency might improve communication between providers and their overweight/obese black and healthy weight Hispanic patients.
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Affiliation(s)
- Michelle S Wong
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, USA.
| | - Kimberly A Gudzune
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Sara N Bleich
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, USA
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Kenny P, De Abreu Lourenco R, Wong CY, Haas M, Goodall S. Community preferences in general practice: important factors for choosing a general practitioner. Health Expect 2015; 19:26-38. [PMID: 25565251 DOI: 10.1111/hex.12326] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Understanding the important factors for choosing a general practitioner (GP) can inform the provision of consumer information and contribute to the design of primary care services. OBJECTIVE To identify the factors considered important when choosing a GP and to explore subgroup differences. DESIGN An online survey asked about the respondent's experience of GP care and included 36 questions on characteristics important to the choice of GP. PARTICIPANTS An Australian population sample (n = 2481) of adults aged 16 or more. METHODS Principal components analysis identified dimensions for the creation of summated scales, and regression analysis was used to identify patient characteristics associated with each scale. RESULTS The 36 questions were combined into five scales (score range 1-5) labelled: care quality, types of services, availability, cost and practice characteristics. Care quality was the most important factor (mean = 4.4, SD = 0.6) which included questions about technical care, interpersonal care and continuity. Cost (including financial and time cost) was also important (mean = 4.1, SD = 0.6). The least important factor was types of services (mean = 3.3, SD = 0.9), which covered the range of different services provided by or co-located with the practice. Frequent GP users and females had higher scores across all 5 scales, while the importance of care quality increased with age. CONCLUSIONS When choosing a GP, information about the quality of care would be most useful to consumers. Respondents varied in the importance given to some factors including types of services, suggesting the need for a range of alternative primary care services.
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Affiliation(s)
- Patricia Kenny
- Centre for Health Economics Research & Evaluation, University of Technology Sydney, Sydney, NSW, Australia
| | - Richard De Abreu Lourenco
- Centre for Health Economics Research & Evaluation, University of Technology Sydney, Sydney, NSW, Australia
| | - Chun Yee Wong
- Centre for Health Economics Research & Evaluation, University of Technology Sydney, Sydney, NSW, Australia
| | - Marion Haas
- Centre for Health Economics Research & Evaluation, University of Technology Sydney, Sydney, NSW, Australia
| | - Stephen Goodall
- Centre for Health Economics Research & Evaluation, University of Technology Sydney, Sydney, NSW, Australia
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Halcomb E, Davies D, Salamonson Y. Consumer satisfaction with practice nursing: a cross-sectional survey in New Zealand general practice. Aust J Prim Health 2015; 21:347-53. [DOI: 10.1071/py13176] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Accepted: 03/25/2014] [Indexed: 11/23/2022]
Abstract
An important consideration in health service delivery is ensuring that services meet consumer needs. Whilst nursing services in primary care have grown internationally, there has been limited exploration of consumer satisfaction with these services. This paper reports a descriptive survey that sought to evaluate consumers’ perceptions of New Zealand practice nurses (PNs). One thousand, five hundred and five patients who received nursing services at one of 20 participating New Zealand general practices completed a survey tool between December 2010 and December 2011. The 64-item self-report survey tool contained the 21-item General Practice Nurse Satisfaction (GPNS) scale. Data were analysed using both descriptive and inferential statistics. Internal consistency of the GPNS scale was high (Cronbach’s α 0.97). Participants aged over 60 years and those of European descent were significantly less satisfied with the PN (P = 0.001). Controlling for these characteristics, participants who had visited the PN more than four times previously were 1.34 times (adjusted odds ratio 1.34 (95% CI: 1.06–1.70) more satisfied than the comparison group (up to 4 previous visits to PN). In addition to the further validation of the psychometric properties of the GPNS scale in a different setting, the study also revealed a high level of satisfaction with PNs, with increased satisfaction with an increased number of visits. Nevertheless, the lower levels of satisfaction with PNs in the older age group as well as those of European descent, warrants further examination. The study also highlights the need for PNs and consumers to discuss consumer’s expectations of services and create a shared understanding of treatment goals.
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Ledford CJW, Childress MA, Ledford CC, Mundy HD. Refining the Practice of Prescribing: Teaching Physician Learners How to Talk to Patients About a New Prescription. J Grad Med Educ 2014; 6:726-32. [PMID: 26140126 PMCID: PMC4477570 DOI: 10.4300/jgme-d-14-00126.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 06/18/2014] [Accepted: 08/05/2014] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Clinician counseling about medication can improve patient understanding and adherence. This study developed a teaching session for physician learners about medication prescribing and communication, with evaluation at the physician and patient levels. OBJECTIVE We analyzed whether patients would perceive and report more comprehensive clinician presentation of medication information when receiving prescriptions from their physician in the intervention clinic. METHODS We conducted a single site, prospective intervention study that included lectures, role play, an objective standardized clinical examination (OSCE), and reminders displayed in patient care areas. For physician-level assessment, pretests and posttests included a written case presentation and a OSCE. For patient-level assessment, we used a cross-sectional observational design that included study of patient recall information, and assessment of patient satisfaction before and after intervention. RESULTS Twenty-seven family medicine residents and sports medicine fellows participated in the teaching session, focused on presenting patients the reasons, risks, and regimen of prescribed medication. In written testing, learners presented significantly more comprehensive information in posttests. In the OSCE (n = 14), all learners presented risks and regimen information. However, patient-level assessment showed no significant difference between before and after intervention. Notably, the covariates patient activation and satisfaction with communication both had a significant association with patient recall information. CONCLUSIONS Our intervention improved learner presentation of medication information. However, patient recall of the information conveyed did not change. Although physician training did not have a positive effect on patient recall, patient activation emerged as a critical influence of patients' perceptions of medication discussions.
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Tarrant C, Angell E, Baker R, Boulton M, Freeman G, Wilkie P, Jackson P, Wobi F, Ketley D. Responsiveness of primary care services: development of a patient-report measure – qualitative study and initial quantitative pilot testing. HEALTH SERVICES AND DELIVERY RESEARCH 2014. [DOI: 10.3310/hsdr02460] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundPrimary care service providers do not always respond to the needs of diverse groups of patients, and so certain patients groups are disadvantaged. General practitioner (GP) practices are increasingly encouraged to be more responsive to patients’ needs in order to address inequalities.Objectives(1) Explore the meaning of responsiveness in primary care. (2) Develop a patient-report questionnaire for use as a measure of patient experience of responsiveness by a range of primary care organisations (PCOs). (3) Investigate methods of population mapping available to GP practices.Design settingPCOs, including GP practices, walk-in centres and community pharmacies.ParticipantsPatients and staff from 12 PCOs in the East Midlands in the development stage, and 15 PCOs across three different regions of England in stage 3.InterventionsTo investigate what responsiveness means, we conducted a literature review and interviews with patients and staff in 12 PCOs. We developed, tested and piloted the use of a questionnaire. We explored approaches for GP practices to understand the diversity of their populations.Main outcome measures(1) Definition of primary care responsiveness. (2) Three patient-report questionnaires to provide an assessment of patient experience of GP, pharmacy and walk-in centre responsiveness. (3) Insight into challenges in collecting diversity data in primary care.ResultsThe literature covers three overlapping themes of service quality, inequalities and patient involvement. We suggest that responsiveness is achieved through alignment between service delivery and patient needs, involving strategies to improve responsive service delivery, and efforts to manage patient expectations. We identified three components of responsive service delivery: proactive population orientation, reactive population orientation and individual patient orientation. PCOs tend to utilise reactive strategies rather than proactive approaches. Questionnaire development involved efforts to include patients who are ‘seldom heard’. The questionnaire was checked for validity and consistency and is available in three versions (GP, pharmacy, and walk-in centre), and in Easy Read format. We found the questionnaires to be acceptable to patients, and to have content validity. We produced some preliminary evidence of reliability and construct validity. Measuring and improving responsiveness requires PCOs to understand the characteristics of their patient population, but we identified significant barriers and challenges to this.ConclusionsResponsiveness is a complex concept. It involves alignment between service delivery and the needs of diverse patient groups. Reactive and proactive strategies at individual and population level are required, but PCOs mainly rely on reactive approaches. Being responsive means giving good care equally to all, and some groups may require extra support. What this extra support is will differ in different patient populations, and so knowledge of the practice population is essential. Practices need to be motivated to collect and use diversity data. Future work needed includes further evaluation of the patient-report questionnaires, including Easy Read versions, to provide further evidence of their quality and acceptability; research into how to facilitative the use of patient experience data in primary care; and implementation of strategies to improve responsiveness, and evaluation of effectiveness.FundingThe National Institute for Health Research Service Delivery and Organisation programme.
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Affiliation(s)
- Carolyn Tarrant
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Emma Angell
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Richard Baker
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Mary Boulton
- Department of Clinical Health Care, Oxford Brookes University, Oxford, UK
| | - George Freeman
- School of Public Health, Imperial College London, London, UK
| | - Patricia Wilkie
- National Association for Patient Participation, Walton-on-Thames, UK
| | - Peter Jackson
- School of Management, University of Leicester, Leicester, UK
| | - Fatimah Wobi
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Diane Ketley
- Department of Health Sciences, University of Leicester, Leicester, UK
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Ingram M, Schachter KA, Guernsey de Zapien J, Herman PM, Carvajal SC. Using participatory methods to enhance patient-centred mental health care in a federally qualified community health center serving a Mexican American farmworker community. Health Expect 2014; 18:3007-18. [PMID: 25306904 DOI: 10.1111/hex.12284] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2014] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Mexican American farmworkers experience high rates of mental health conditions; however, it is difficult for them to access care. Patient-centred care is a systems-wide approach to improving the delivery of services for diverse populations in the primary care setting. AIM We describe the application of community-based participatory research methods to assess and address gaps in perceptions of mental health care between providers and migrant workers living in a US-Mexico Border community. SETTING A federally qualified health centre (FQHC) serving a community of approximately 60 000 agricultural workers who live in Yuma County and harvest vegetables during the winter season. DESIGN We conducted patient focus groups (n = 64) and FQHC staff interviews (n = 16) to explore attributes and dimensions of patient-centred mental health care. RESULTS Patients and staff both prioritized increased access to mental health care and patient-centred care, while patients were more concerned with interpersonal care and providers with coordination of care. All participants stressed the relationship between life events and mental health and the centrality of family in care. Patients also emphasized the importance of a good attitude, the ability to solve problems, positive family relationships and reliance on faith. Patients suggested that the FQHC inform patients about mental health resources, provide community informational talks to address stigma, and offer support groups. DISCUSSION The participatory approach of this qualitative study resulted in a wealth of data regarding patient preferences that will enable the FQHC to develop protocols and training to provide patient-centred mental health-care services for their community.
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Affiliation(s)
- Maia Ingram
- University of Arizona College of Public Health, Tucson, AZ, USA
| | - Ken A Schachter
- University of Arizona College of Public Health, Tucson, AZ, USA
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Abstract
BACKGROUND Recent changes in health care delivery may reduce continuity with the patient's primary care provider (PCP). Little is known about the association between continuity and quality of communication during ongoing efforts to redesign primary care in the Veterans Administration (VA). OBJECTIVE To evaluate the association between longitudinal continuity of care (COC) with the same PCP and ratings of patient-provider communication during the Patient Aligned Care Team (PACT) initiative. DESIGN Cross-sectional survey. PARTICIPANTS Four thousand three hundred ninety-three VA outpatients who were assigned to a PCP, had at least three primary care visits to physicians or physician extenders during Fiscal Years 2009 and 2010 (combined), and who completed the Survey of Healthcare Experiences of Patients (SHEP) following a primary care visit in Fiscal Year (FY)2011. MAIN MEASURES Usual Provider of Continuity (UPC), Modified Modified Continuity Index (MMCI), and duration of PCP care were calculated for each primary care patient. UPC and MMCI values were categorized as follows: 1.0 (perfect), 0.75-0.99 (high), 0.50-0.74 (intermediate), and < 0.50 (low). Quality of communication was measured using the four-item Consumer Assessment of Healthcare Providers and Systems-Health Plan program (CAHPS-HP) communication subscale and a two-item measure of shared decision-making (SDM). Excellent care was defined using an "all-or-none" scoring strategy (i.e., when all items within a scale were rated "always"). KEY RESULTS UPC and MMCI continuity remained high (0.81) during the early phase of PACT implementation. In multivariable models, low MMCI continuity was associated with decreased odds of excellent communication (OR = 0.74, 95 % CI = 0.58-0.95) and SDM (OR = 0.70, 95 % CI = 0.49, 0.99). Abbreviated duration of PCP care (< 1 year) was also associated with decreased odds of excellent communication (OR = 0.35, 95 % CI = 0.18, 0.71). CONCLUSIONS Reduced PCP continuity may significantly decrease the quality of patient-provider communication in VA primary care. By improving longitudinal continuity with the assigned PCP, while redesigning team-based roles, the PACT initiative has the potential to improve patient-provider communication.
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Douglas J, Delpachitra P, Paul E, McGain F, Pilcher D. Non-English speaking is a predictor of survival after admission to intensive care. J Crit Care 2014; 29:769-74. [PMID: 24852085 DOI: 10.1016/j.jcrc.2014.03.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Revised: 02/16/2014] [Accepted: 03/25/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The relationship between English proficiency and health care outcomes in intensive care has rarely been examined. This study aimed to determine whether being a non-English speaker would predict mortality in a critical care setting. Secondary end points were intensive care unit (ICU) and hospital length of stay. MATERIALS AND METHODS This is a single-center, retrospective, cohort study of admissions from January 1, 2000 until December 31, 2011 in a tertiary level intensive care setting in Melbourne, Australia. All admissions during the study period were included. Patients without language data were excluded. Of those with multiple admissions, only the first was included. Analysis of 20082 ICU admissions was undertaken, of which 19059 (94.9%) were English speakers. RESULTS After adjusting for confounding variables (age, severity of illness, diagnostic group, year of admission, and socioeconomic status), English-speaking status was independently associated with an increased risk of death (odds ratio, 1.91; 95% confidence interval 1.46-2.49; P < .001). There was no difference in ICU length of stay between groups. Hospital length of stay was shorter for English speakers. CONCLUSION Contrary to expectations, this large single-center study shows a consistent relationship between non-English-speaking status and increased survival after admission to ICU.
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Affiliation(s)
- James Douglas
- The Department of Intensive Care Medicine, The Alfred Hospital, Prahran, Victoria, 3181, Australia.
| | - Pavitra Delpachitra
- The Department of Intensive Care Medicine, The Alfred Hospital, Prahran, Victoria, 3181, Australia
| | - Eldho Paul
- The Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, 3004, Australia
| | - Forbes McGain
- The Department of Intensive Care Medicine, The Western Hospital, Footscray, Victoria, 3001, Australia
| | - David Pilcher
- The Department of Intensive Care Medicine, The Alfred Hospital, Prahran, Victoria, 3181, Australia; The Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, 3004, Australia
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Hepworth J, Askew D, Jackson C, Russell A. 'Working with the team': an exploratory study of improved type 2 diabetes management in a new model of integrated primary/secondary care. Aust J Prim Health 2014; 19:207-12. [PMID: 22951067 DOI: 10.1071/py12087] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 07/24/2012] [Indexed: 01/30/2023]
Abstract
This study aimed to explore how a new model of integrated primary/secondary care for type 2 diabetes management, the Brisbane South Complex Diabetes Service (BSCDS), related to improved diabetes management in a selected group of patients. We used a qualitative research design to obtain detailed accounts from the BSCDS via semi-structured interviews with 10 patients. The interviews were fully transcribed and systematically coded using a form of thematic analysis. Participants' responses were grouped in relation to: (1) Patient-centred care; (2) Effective multiprofessional teamwork; and (3) Empowering patients. The key features of this integrated primary/secondary care model were accessibility and its delivery within a positive health care environment, clear and supportive interpersonal communication between patients and health care providers, and patients seeing themselves as being part of the team-based care. The BSCDS delivered patient-centred care and achieved patient engagement in ways that may have contributed to improved type 2 diabetes management in these participants.
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Affiliation(s)
- Julie Hepworth
- Centre for Primary Health Care Research, School of Medicine, The University of Queensland, Herston, Qld 4006, Australia
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McFall SL, Mullen PD, Byrd TL, Cantor SB, Le YC, Torres-Vigil I, Pettaway C, Volk RJ. Treatment decisions for localized prostate cancer: a concept mapping approach. Health Expect 2014; 18:2079-90. [PMID: 24506829 DOI: 10.1111/hex.12175] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2014] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Few decision aids emphasize active surveillance (AS) for localized prostate cancer. Concept mapping was used to produce a conceptual framework incorporating AS and treatment. METHODS Fifty-four statements about what men need to make a decision for localized prostate cancer were derived from focus groups with African American, Latino and white men previously screened for prostate cancer and partners (n = 80). In the second phase, 89 participants sorted and rated the importance of statements. RESULTS An eight cluster map was produced for the overall sample. Clusters were labelled Doctor-patient exchange, Big picture comparisons, Weighing the options, Seeking and using information, Spirituality and inner strength, Related to active treatment, Side-effects and Family concerns. A major division was between medical and home-based clusters. Ethnic groups and genders had similar sorting, but some variation in importance. Latinos rated Big picture comparisons as less important. African Americans saw Spirituality and inner strength most important, followed by Latinos, then whites. Ethnic- and gender-specific concept maps were not analysed because of high similarity in their sorting patterns. CONCLUSIONS We identified a conceptual framework for management of early-stage prostate cancer that included coverage of AS. Eliciting the conceptual framework is an important step in constructing decision aids which will address gaps related to AS.
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Affiliation(s)
- Stephanie L McFall
- Institute for Social and Economic Research University of Essex, Colchester, UK
| | - Patricia D Mullen
- School of Public Health, The University of Texas Health Sciences Center, Houston, TX, USA
| | - Theresa L Byrd
- Department of Family and Community Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Scott B Cantor
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yen-Chi Le
- School of Public Health, The University of Texas Health Sciences Center, Houston, TX, USA
| | | | - Curtis Pettaway
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Robert J Volk
- Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Ledford CJW, Childress MA, Ledford CC, Mundy HD. The practice of prescribing: discovering differences in what we tell patients about prescription medications. PATIENT EDUCATION AND COUNSELING 2014; 94:255-260. [PMID: 24183710 DOI: 10.1016/j.pec.2013.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 08/26/2013] [Accepted: 10/05/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE This study explored patient recall of clinician presentation of information about prescription medication, looking specifically for communication patterns and differences by patient individual characteristics and by medication availability type. METHODS A cross sectional survey collected information about 216 patients' perceptions of clinician presentations of medication information. RESULTS Demographically, males recalled receiving more information about reasons, risks, and regimen in medication discussions. By medication type, patients reported receiving more medication information when the clinician presented a prescription-only medication as opposed to a medication that was also available over the counter. CONCLUSION Given the broad and unmonitored use of over-the-counter products, coupled with the increasing awareness of risks associated with many of these medications, it is concerning that patients report receiving less information about these products. PRACTICE IMPLICATIONS The emphasis on appropriate medication counseling should not be limited to medications available only by prescription. Prescribers should be mindful of these potential tendencies when discussing medications.
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Affiliation(s)
- Christy J W Ledford
- Department of Biomedical Informatics, Uniformed Services University of the Health Sciences, Bethesda, USA.
| | - Marc A Childress
- Department of Family Medicine, Fort Belvoir Community Hospital, Fort Belvoir, USA
| | | | - Heather D Mundy
- Department of Family Medicine, Fort Belvoir Community Hospital, Fort Belvoir, USA
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Danyliv A, Pavlova M, Gryga I, Groot W. Preferences for physician services in Ukraine: a discrete choice experiment. Int J Health Plann Manage 2014; 30:346-65. [PMID: 24399636 DOI: 10.1002/hpm.2239] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 11/14/2013] [Accepted: 11/18/2013] [Indexed: 11/09/2022] Open
Abstract
Evidence on preferences of Ukrainian consumers for healthcare improvements can help to design reforms that correspond to societal priorities. This study aims to elicit and to place monetary values on public preferences for out-patient physician services in Ukraine. The method of discrete choice experiment is used on a sample of 303 respondents, representative of the adult Ukrainian population. The random effect logit model with interactions provides the best fit for the data and is used to calculate the marginal willingness to pay (MWTP) for quality and access improvements. At a sample level, there is no clear preference to pay formally rather than informally or vice versa. We also do not find that visiting a general practitioner is preferred over direct access to a medical specialist. However, there are differences between population groups. Quality-related attributes of physician services appear important to respondents, especially the attitude of medical staff. Thus, interpersonal aspects of out-patient care should be given priority in decisions about investments in quality improvements. Other aspects, that is social quality and access, are important as well but their improvement brings fewer social gains. Measures should be taken to eradicate the informal payment channels and to strengthen the gate-keeping role of primary care.
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Affiliation(s)
- Andriy Danyliv
- School of Public Health, National University of Kyiv-Mohyla Academy, Kyiv, Ukraine.,Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Maastricht University, Maastricht, Netherlands
| | - Milena Pavlova
- Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Maastricht University, Maastricht, Netherlands
| | - Irena Gryga
- School of Public Health, National University of Kyiv-Mohyla Academy, Kyiv, Ukraine
| | - Wim Groot
- Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Maastricht University, Maastricht, Netherlands.,Top Institute Evidence-Based Education Research (TIER), Maastricht, Netherlands
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Roland M, Roberts M, Rhenius V, Campbell J. GPAQ-R: development and psychometric properties of a version of the general practice assessment questionnaire for use for revalidation by general practitioners in the UK. BMC FAMILY PRACTICE 2013; 14:160. [PMID: 24138508 PMCID: PMC3819733 DOI: 10.1186/1471-2296-14-160] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 10/16/2013] [Indexed: 11/21/2022]
Abstract
Background The General Practice Assessment Questionnaire (GPAQ) has been widely used to assess patient experience in general practice in the UK since 2004. In 2013, new regulations were introduced by the General Medical Council (GMC) requiring UK doctors to undertake periodic revalidation, which includes assessment of patient experience for individual doctors. We describe the development of a new version of GPAQ – GPAQ-R which addresses the GMC’s requirements for revalidation as well as additional NHS requirements for surveys that GPs may need to carry out in their own practices. Methods Questionnaires were given out by doctors or practice staff after routine consultations in line with the guidance given by the General Medical Council for surveys to be used for revalidation. Data analysis and practice reports were provided independently. Results Data were analysed for questionnaires from 7258 patients relating to 164 GPs in 29 general practices. Levels of missing data were generally low (typically 4.5-6%). The number of returned questionnaires required to achieve reliability of 0.7 were around 35 for individual doctor communication items and 29 for a composite score based on doctor communication items. This suggests that the responses to GPAQ-R had similar reliability to the GMC’s own questionnaire and we recommend 30 completed GPAQ-R questionnaires are sufficient for revalidation purposes. However, where an initial screen raises concern, the survey might be repeated with 50 completed questionnaires in order to increase reliability. Conclusions GPAQ-R is a development of a well-established patient experience questionnaire used in general practice in the UK since 2004. This new version can be recommended for use in order to meet the UK General Medical Council’s requirements for surveys to be used in revalidation of doctors. It also meets the needs of GPs to ask about patient experience relating to aspects of practice care that are not specific to individual general practitioners (e.g. receptionists, telephone access) which meet other survey requirements of the National Health Service in England. Use of GPAQ-R has the potential to reduce the number of surveys that GPs need to carry out in their practices to meet the various regulatory requirements which they face.
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Affiliation(s)
- Martin Roland
- Cambridge Centre for Health Services Research, University of Cambridge, Cambridge, UK.
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Paddison CAM, Abel GA, Roland MO, Elliott MN, Lyratzopoulos G, Campbell JL. Drivers of overall satisfaction with primary care: evidence from the English General Practice Patient Survey. Health Expect 2013; 18:1081-92. [PMID: 23721257 DOI: 10.1111/hex.12081] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2013] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/OBJECTIVES To determine which aspects of primary care matter most to patients, we aim to identify those aspects of patient experience that show the strongest relationship with overall satisfaction and examine the extent to which these relationships vary by socio-demographic and health characteristics. DESIGN/SETTING Data from the 2009/10 English General Practice Patient Survey including 2,169,718 respondents registered with 8362 primary care practices. MEASURES/ANALYSES Linear mixed-effects regression models (fixed effects adjusting for age, gender, ethnicity, deprivation, self-reported health, self-reported mental health condition and random practice effect) predicting overall satisfaction from six items covering four domains of care: access, helpfulness of receptionists, doctor communication and nurse communication. Additional models using interactions tested whether associations between patient experience and satisfaction varied by socio-demographic group. RESULTS Doctor communication showed the strongest relationship with overall satisfaction (standardized coefficient 0.48, 95% CI = 0.48, 0.48), followed by the helpfulness of reception staff (standardized coefficient 0.22, 95% CI = 0.22, 0.22). Among six measures of patient experience, obtaining appointments in advance showed the weakest relationship with overall satisfaction (standardized coefficient 0.06, 95% CI = 0.05, 0.06). Interactions showed statistically significant but small variation in the importance of drivers across different patient groups. CONCLUSIONS For all patient groups, communication with the doctor is the most important driver of overall satisfaction with primary care in England, along with the helpfulness of receptionists. In contrast, and despite being a policy priority for government, measures of access, including the ability to obtain appointments, were poorly related to overall satisfaction.
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Affiliation(s)
- Charlotte A M Paddison
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Gary A Abel
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Martin O Roland
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge, Cambridge, UK
| | | | - Georgios Lyratzopoulos
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - John L Campbell
- University of Exeter Medical School, Smeall Building, Exeter, UK
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Abstract
This article examines the multiple aspirations and practices subsumed under the rubric "patient-centered care." Clarifying the term's meaning is essential to understanding its impact on policy discourse and health care.
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Affiliation(s)
- Rachel Grob
- University of Wisconsin-Madison, Wisconsin, USA
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Abstract
BACKGROUND Many countries use pay-for-performance schemes to reward family practices financially for achieving quality indicators. The views of patients on pay for performance remain largely unexplored. AIM To gain the views of family practice patients on the United Kingdom pay-for-performance Quality and Outcomes Framework (QOF). DESIGN AND SETTING Interviews with 52 patients were conducted in 15 family practices across England. All patients had at least one long-term condition that had been diagnosed before the introduction of the QOF in 2004. METHOD Semi-structured interviews analysed using open explorative thematic coding. RESULTS Few patients had heard of the QOF or had noticed changes to the structure or process of their care. However, where they were noted, changes to consultations such as increased use of computers and health checks initiated by the GP or practice nurse were seen as good practice. The majority of patients were surprised to hear their practice received bonuses for doing 'simple things'. Some patients also raised concerns over potential unintended consequences of pay-for-performance frameworks, such as a reduced focus on non-incentivised areas. CONCLUSION This study adds a unique patient perspective to the debate around the impact of pay-for-performance schemes and consequences on patient care. Patients' views, experiences, and concerns about pay for performance mostly chime with previously described opinions of primary care staff. Patient surprise and concern around incentivising basic processes of care shows how patient views are vital when monitoring and evaluating a scheme that is designed to improve patient care.
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Gask L, Bower P, Lamb J, Burroughs H, Chew-Graham C, Edwards S, Hibbert D, Kovandžić M, Lovell K, Rogers A, Waheed W, Dowrick C, Group AMPR. Improving access to psychosocial interventions for common mental health problems in the United Kingdom: narrative review and development of a conceptual model for complex interventions. BMC Health Serv Res 2012; 12:249. [PMID: 22889290 PMCID: PMC3515797 DOI: 10.1186/1472-6963-12-249] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Accepted: 06/25/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the United Kingdom and worldwide, there is significant policy interest in improving the quality of care for patients with mental health disorders and distress. Improving quality of care means addressing not only the effectiveness of interventions but also the issue of limited access to care. Research to date into improving access to mental health care has not been strongly rooted within a conceptual model, nor has it systematically identified the different elements of the patient journey from identification of illness to receipt of care. This paper set out to review core concepts underlying patient access to mental health care, synthesise these to develop a conceptual model of access, and consider the implications of the model for the development and evaluation of interventions for groups with poor access to mental health care such as older people and ethnic minorities. METHODS Narrative review of the literature to identify concepts underlying patient access to mental health care, and synthesis into a conceptual model to support the delivery and evaluation of complex interventions to improve access to mental health care. RESULTS The narrative review adopted a process model of access to care, incorporating interventions at three levels. The levels comprise (a) community engagement (b) addressing the quality of interactions in primary care and (c) the development and delivery of tailored psychosocial interventions. CONCLUSIONS The model we propose can form the basis for the development and evaluation of complex interventions in access to mental health care. We highlight the key methodological challenges in evaluating the overall impact of access interventions, and assessing the relative contribution of the different elements of the model.
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Affiliation(s)
- Linda Gask
- Manchester Academic Health Science Centre, Health Sciences Research Group, University of Manchester, Manchester, 5th Floor Williamson Building, Oxford Road, M13 9PL, UK
| | - Peter Bower
- Manchester Academic Health Science Centre, Health Sciences Research Group, University of Manchester, Manchester, 5th Floor Williamson Building, Oxford Road, M13 9PL, UK
| | - Jonathan Lamb
- Manchester Academic Health Science Centre, Health Sciences Research Group, University of Manchester, Manchester, 5th Floor Williamson Building, Oxford Road, M13 9PL, UK
| | - Heather Burroughs
- Manchester Academic Health Science Centre, Health Sciences Research Group, University of Manchester, Manchester, 5th Floor Williamson Building, Oxford Road, M13 9PL, UK
| | - Carolyn Chew-Graham
- Manchester Academic Health Science Centre, Health Sciences Research Group, University of Manchester, Manchester, 5th Floor Williamson Building, Oxford Road, M13 9PL, UK
| | - Suzanne Edwards
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Derek Hibbert
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Marija Kovandžić
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Karina Lovell
- Manchester Academic Health Science Centre, School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, 5th Floor Williamson Building, Oxford Road, M13 9PL, UK
| | - Anne Rogers
- Manchester Academic Health Science Centre, Health Sciences Research Group, University of Manchester, Manchester, 5th Floor Williamson Building, Oxford Road, M13 9PL, UK
| | - Waquas Waheed
- Lancashire Care NHS Foundation Trust, Lancashire, UK
| | - Christopher Dowrick
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - AMP Research Group
- Manchester Academic Health Science Centre, Health Sciences Research Group, University of Manchester, Manchester, 5th Floor Williamson Building, Oxford Road, M13 9PL, UK
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
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Verlinde E, De Laender N, De Maesschalck S, Deveugele M, Willems S. The social gradient in doctor-patient communication. Int J Equity Health 2012; 11:12. [PMID: 22409902 PMCID: PMC3317830 DOI: 10.1186/1475-9276-11-12] [Citation(s) in RCA: 151] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Accepted: 03/12/2012] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE In recent years, the importance of social differences in the physician-patient relationship has frequently been the subject of research. A 2002 review synthesised the evidence on this topic. Considering the increasing importance of social inequalities in health care, an actualization of this review seemed appropriate. METHODS A systematic search of literature published between 1965 and 2011 on the social gradient in doctor-patient communication. In this review social class was determined by patient's income, education or occupation. RESULTS Twenty original research papers and meta-analyses were included. Social differences in doctor-patient communication were described according to the following classification: verbal behaviour including instrumental and affective behaviour, non-verbal behaviour and patient-centred behaviour. CONCLUSION This review indicates that the literature on the social gradient in doctor-patient communication that was published in the last decade, addresses new issues and themes. Firstly, most of the found studies emphasize the importance of the reciprocity of communication.Secondly, there seems to be a growing interest in patient's perception of doctor-patient communication. PRACTICE IMPLICATIONS By increasing the doctors' awareness of the communicative differences and by empowering patients to express concerns and preferences, a more effective communication could be established.
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Affiliation(s)
- Evelyn Verlinde
- Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium
- Verlinde Evelyn, Department of Family Medicine and Primary Health Care, Ghent University, UZ-1 K3, De Pintelaan 185, B-9000 Ghent, Belgium
| | - Nele De Laender
- Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium
| | | | - Myriam Deveugele
- Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium
| | - Sara Willems
- Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium
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Wendt C, Mischke M, Pfeifer M, Reibling N. Cost barriers reduce confidence in receiving medical care when seriously ill. Int J Clin Pract 2011; 65:1115-7. [PMID: 21995689 DOI: 10.1111/j.1742-1241.2011.02770.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
People need to trust that necessary care will be provided in the case of serious illness or injury, but negative experiences with the healthcare system reduce confidence. In this article, we discuss the effect of cost barriers on people's confidence in receiving safe and quality medical care when falling seriously ill in seven countries: Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom and the United States.
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Affiliation(s)
- C Wendt
- Department of Sociology, University of Siegen, Siegen, Germany MZES, University of Mannheim, Mannheim, Germany.
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Halcomb EJ, Caldwell B, Salamonson Y, Davidson PM. Development and psychometric validation of the general practice nurse satisfaction scale. J Nurs Scholarsh 2011; 43:318-27. [PMID: 21884378 DOI: 10.1111/j.1547-5069.2011.01408.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To develop an instrument to assess consumer satisfaction with nursing in general practice to provide feedback to nurses about consumers' perceptions of their performance. DESIGN Prospective psychometric instrument validation study. METHODS A literature review was conducted to generate items for an instrument to measure consumer satisfaction with nursing in general practice. Face and content validity were evaluated by an expert panel, which had extensive experience in general practice nursing and research. Included in the questionnaire battery was the 27-item General Practice Nurse Satisfaction (GPNS) scale, as well as demographic and health status items. This survey was distributed to 739 consumers following intervention administered by a practice nurse in 16 general practices across metropolitan, rural, and regional Australia. Participants had the option of completing the survey online or receiving a hard copy of the survey form at the time of their visit. These data were collected between June and August 2009. FINDINGS Satisfaction data from 739 consumers were collected following their consultation with a general practice nurse. From the initial 27-item GPNS scale, a 21-item instrument was developed. Two factors, "confidence and credibility" and "interpersonal and communication" were extracted using principal axis factoring and varimax rotation. These two factors explained 71.9% of the variance. Cronbach's α was 0.97. CONCLUSIONS The GPNS scale has demonstrated acceptable psychometric properties and can be used both in research and clinical practice for evaluating consumer satisfaction with general practice nurses. RELEVANCE TO CLINICAL PRACTICE Assessing consumer satisfaction is important for developing and evaluating nursing roles. The GPNS scale is a valid and reliable tool that can be utilized to assess consumer satisfaction with general practice nurses and can assist in performance management and improving the quality of nursing services.
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Affiliation(s)
- Elizabeth J Halcomb
- Family & Community Health Research Group (FaCH) & School of Nursing & Midwifery (SONM), College of Health and Science (CHS), University of Western Sydney, Sydney, Australia.
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Krucien N, Le Vaillant M, Pelletier-Fleury N. Do the organizational reforms of general practice care meet users' concerns? The contribution of the Delphi method. Health Expect 2011; 16:3-13. [PMID: 21679287 DOI: 10.1111/j.1369-7625.2011.00698.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
CONTEXT The debate over primary care reform in France, as in most OECD countries, centres on questions about efficacy and accessibility. Do these reforms actually respond to the users' concerns? OBJECTIVE The objective of this study was to identify the importance that users attribute to different aspects of general practice (GP) care. DESIGN The method used was a variant of the classical Delphi approach, called Delphi 'ranking-type'. Between May and September 2009, 74 experts aged over 18 were recruited by 'snowballing' sampling. Three iterative rounds were required to identify the core aspects through a consensus-building approach. RESULTS It is shown that users attribute a very high importance to the 'doctor-patient relationship' dimension. The following aspects 'GP patient information about his/her illness', 'Clarity of communication and explanation', and 'Whether the GP seemed listen to the patient' were evaluated by 96% of the experts as being of high importance. The coordination of GP was also considered as a very important aspect for 85% of the experts. In contrast, the aspects that belong to the organizational dimension appeared to be of relatively low importance for users. CONCLUSIONS Our results support a comprehensive approach of care and argue in favour of care reorganization following the patient-centred model. To promote organizational care reforms through the prism of the doctor-patient relationship could thus be a fruitful way to insure a better quality of care and the social acceptability of the reforms.
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Wendt C, Mischke M, Pfeifer M, Reibling N. Confidence in receiving medical care when seriously ill: a seven-country comparison of the impact of cost barriers. Health Expect 2011; 15:212-24. [PMID: 21631654 DOI: 10.1111/j.1369-7625.2011.00677.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE This paper examines how negative experiences with the health-care system create a lack of confidence in receiving medical care in seven countries: Australia, Canada, Germany, The Netherlands, New Zealand, the United Kingdom, and the United States. METHODS The empirical analysis is based on data from the Commonwealth Fund International Health Policy Survey 2007, with nationally representative samples of adults aged 18 and over. For the analysis of the experience of cost barriers and confidence in receiving medical care, we conducted pairwise comparisons of group percentages as well as country-wise multivariate logistic regression models. RESULTS Individuals who have experienced cost barriers show a significantly lower level of confidence in receiving safe and quality medical care than those who have not. This effect is most pronounced in the United States, where people who have foregone necessary treatment because of costs are four times as likely to lack confidence as individuals without the experience of cost barriers (adjusted odds ratio 4.00). In New Zealand, Germany, and Canada, individuals with the experience of cost barriers are twice as likely to report low confidence compared with those without this experience (adjusted odds ratios of 1.95, 2.19 and 2.24, respectively). In The Netherlands and UK, cost barriers are only a marginal phenomenon. CONCLUSIONS The fact that the experience of financial barriers considerably lowers confidence indicates that financial incentives, such as private co-payments, have a negative effect on overall public support and therefore on the legitimacy of health-care systems.
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Affiliation(s)
- Claus Wendt
- Department of Sociology, University of Siegen, Siegen, Germany.
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Heinrich C, Karner K. Ways to Optimize Understanding Health Related Information: The Patients’ Perspective. Geriatr Nurs 2011; 32:29-38. [DOI: 10.1016/j.gerinurse.2010.09.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2009] [Revised: 08/30/2010] [Accepted: 09/08/2010] [Indexed: 10/18/2022]
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Eronen R, Calabretto H, Pincombe J. Improving the professional support for parents of young infants. Aust J Prim Health 2011; 17:186-94. [DOI: 10.1071/py10062] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Accepted: 12/10/2010] [Indexed: 11/23/2022]
Abstract
The objective of this study was to discuss ideas for improving child health services on the basis of findings of an observational study that was designed to explore the role of child health nurses in supporting parents during the first 6 months following the birth of an infant. As part of a larger study in a child health service in urban Australia, surveys were used to collect data from two independent samples of both parents and nurses at an 8-month interval. Data were condensed using factor analysis; regression analyses were used to determine which aspects of care were most important for the parents, and importance–performance analysis was used to determine which aspects of care needed improvement. While the majority of parents valued support from child health nurses, a need for improvement was identified in empowering parents to make their own decisions, discussing emotional issues with parents, providing continuity of care and giving consistent advice. Organisations should value and provide support for child health nurses in their invisible, non-quantifiable work of supporting families. The structure of child health services should also provide child health nurses continuity of care with the families they support.
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Lawton R, Gardner P, Plachcinski R. Using vignettes to explore judgements of patients about safety and quality of care: the role of outcome and relationship with the care provider. Health Expect 2010; 14:296-306. [PMID: 21029278 DOI: 10.1111/j.1369-7625.2010.00622.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND There is a growing body of evidence that safe outcomes and quality care are important to patients. For the patient, evaluations of safety and quality are made on the basis of the interpersonal interactions that they have with health professionals as well as the technical aspects of their care. OBJECTIVE In this study, we investigated the extent to which outcome of care (harm or not) and relationship (good or bad) with the care provider impact on the judgements of responsibility and blame as well as decisions about likelihood of making a complaint. METHOD Ninety-eight mothers made seven ratings of responsibility, blame and action in response to four hypothetical vignettes in a questionnaire. The vignettes described poor quality ante-natal care in which outcome and relationship with the health-care provider were systematically manipulated across different versions of the questionnaire. RESULTS Multivariate analyses showed that participants made significantly more negative ratings in response to vignettes describing a bad outcome and those that described a poor relationship with the health professional. However, whilst ratings of seriousness and likelihood of making a complaint were most influenced by the manipulation of outcome in the vignettes, judgements of blame and responsibility were most effected by the depiction of relationship with the health professional as good or bad. Moreover, for three of the four vignettes, relationship rather than outcome most strongly influenced overall ratings of care. DISCUSSION These findings are discussed in the context of theory and policy developments.
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Affiliation(s)
- Rebecca Lawton
- Institute of Psychological Sciences, University of Leeds, UK.
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Campbell J, Smith P, Nissen S, Bower P, Elliott M, Roland M. The GP Patient Survey for use in primary care in the National Health Service in the UK--development and psychometric characteristics. BMC FAMILY PRACTICE 2009; 10:57. [PMID: 19698140 PMCID: PMC2736918 DOI: 10.1186/1471-2296-10-57] [Citation(s) in RCA: 112] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2009] [Accepted: 08/22/2009] [Indexed: 11/17/2022]
Abstract
Background The UK National GP Patient Survey is one of the largest ever survey programmes of patients registered to receive primary health care, inviting five million respondents to report their experience of NHS primary healthcare. The third such annual survey (2008/9) involved the development of a new survey instrument. We describe the process of that development, and the findings of an extensive pilot survey in UK primary healthcare. Methods The survey was developed following recognised guidelines and involved expert and stakeholder advice, cognitive testing of early versions of the survey instrument, and piloting of the questionnaire in a cross sectional pilot survey of 1,500 randomly selected individuals from the UK electoral register with two reminders to non-respondents. Results The questionnaire comprises 66 items addressing a range of aspects of UK primary healthcare. A response rate of 590/1500 (39.3%) was obtained. Non response to individual items ranged from 0.8% to 15.3% (median 5.2%). Participants did not always follow internal branching instructions in the questionnaire although electronic controls allow for correction of this problem in analysis. There was marked skew in the distribution of responses to a number of items indicating an overall favourable impression of care. Principal components analysis of 23 items offering evaluation of various aspects of primary care identified three components (relating to doctor or nurse care, or addressing access to care) accounting for 68.3% of the variance in the sample. Conclusion The GP Patient Survey has been carefully developed and pilot-tested. Survey findings, aggregated at practice level, will be used to inform the distribution of £65 million ($107 million) of UK NHS resource in 2008/9 and this offers the opportunity for NHS service planners and providers to take account of users' experiences of health care in planning and delivering primary healthcare in the UK.
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Affiliation(s)
- John Campbell
- Peninsula Medical School, University of Exeter, Exeter, UK.
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DeVoe JE, Wallace LS, Fryer GE. Measuring patients' perceptions of communication with healthcare providers: do differences in demographic and socioeconomic characteristics matter? Health Expect 2009; 12:70-80. [PMID: 19250153 DOI: 10.1111/j.1369-7625.2008.00516.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND National governments across the globe have set goals to improve healthcare delivery. Understanding patient-provider communication is essential for the development of policies that measure how well a healthcare system delivers care. OBJECTIVES This study was designed to determine which, if any, demographic factors were independently associated with how US patients perceive various aspects of communication with their healthcare providers. DESIGN AND METHODS The study was a secondary, cross-sectional analysis of nationally representative data from the 2002 Medical Expenditure Panel Survey (MEPS). Among US adults with a healthcare visit in the past year (n = approximately 16,700), we assessed the association between several covariate demographic and socioeconomic factors and four dependent measures of patient perceptions of communication with their healthcare providers. RESULTS Across all four measures of communication, older patients were more likely to report positively. Having health insurance and a usual source of care were consistent predictors of positive perceptions of communication. Hispanic patients also reported better perceptions of communication across all four measures. The most economically disadvantaged patients were less likely to report that providers always explained things so that they understood. Male patients were more likely to report that providers always spent enough time with them. CONCLUSIONS This study suggests that patient perceptions of communication in healthcare settings vary widely by demographics and other individual patient characteristics. In this paper, we discuss the relevance of these communication disparities to design policies to improve healthcare systems, both at the individual practice level and the national level.
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Affiliation(s)
- Jennifer E DeVoe
- Department of Family Medicine, Oregon Health & Science University, Portland, OR 97239, USA.
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Entwistle VA. Hurtful comments are harmful comments: respectful communication is not just an optional extra in healthcare. Health Expect 2009; 11:319-20. [PMID: 19076661 DOI: 10.1111/j.1369-7625.2008.00527.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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DeVoe JE, Wallace LS, Fryer GE. Patient age influences perceptions about health care communication. Fam Med 2009; 41:126-133. [PMID: 19184691 PMCID: PMC4918755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE The study's objective was to determine if a patient's age is independently associated with how he/she perceives interactions with health care providers. METHODS We used a secondary, cross-sectional analysis of nationally representative data from the 2002 Medical Expenditure Panel Survey (MEPS). We measured the independent association between patient age and six outcomes pertaining to communication and decision-making autonomy, while simultaneously controlling for gender, race, ethnicity, family income, educational attainment, census region, rural residence, insurance status, and usual source of care. RESULTS Compared to patients>or=65 years, patients ages 18-64 were less likely to report that their provider "always" listened to them, "always" showed respect for what they had to say, and "always" spent enough time with them. DISCUSSION Patient perceptions of health care interactions vary by age. A better understanding of how and why age is associated with patient-provider communication could be useful to design practice-level interventions that enhance services and also to develop national policies that improve health care delivery and health outcomes.
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Affiliation(s)
- Jennifer E DeVoe
- Department of Family Medicine, Oregon Health and Science University, Portland, OR 97239, USA.
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Wallace LS, DeVoe JE, Heintzman JD, Fryer GE. Language preference and perceptions of healthcare providers' communication and autonomy making behaviors among Hispanics. J Immigr Minor Health 2008; 11:453-9. [PMID: 18814028 DOI: 10.1007/s10903-008-9192-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2008] [Accepted: 09/09/2008] [Indexed: 11/25/2022]
Abstract
BACKGROUND To examine influence of language preference-English versus Spanish-on Hispanics' perceptions of their healthcare providers' communication behaviors. METHODS Using the 2005 Medical Expenditure Panel Survey (MEPS), we observed non-institutionalized Hispanics (n = 5197; US population estimate = 27,070,906), aged >or=18 years, reporting visiting a healthcare provider within the past 12 months. RESULTS When compared to Spanish responders (reference group), English responders were more likely to report that their healthcare provider "always" listened to them carefully (adjusted odds ratio (OR) = 1.39, 95% confidence interval (CI) 1.09-1.78), "always" explained things so that they understood (adjusted OR 1.37, 95% CI 1.08-1.73), "always" spent enough time with them (adjusted OR = 1.62, 95% CI 1.24-2.11),"always" asked them to help make decisions (adjusted OR 1.37, 95% CI 1.03-1.82), and "always" showed respect for treatment decisions (adjusted OR = 1.66, 95% CI 1.27-2.19). DISCUSSION Healthcare providers should consider the complex needs of Hispanic patients whose language of choice is not English.
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Affiliation(s)
- Lorraine S Wallace
- Department of Family Medicine, University of Tennessee Graduate School of Medicine, Knoxville, TN 37920, USA.
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Incentives and control in primary health care: findings from English pay‐for‐performance case studies. J Health Organ Manag 2008; 22:48-62. [DOI: 10.1108/14777260810862407] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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