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Sideman AB, Razon N. Extra/ordinary medicine: Toward an anthropology of primary care. Soc Sci Med 2024; 346:116707. [PMID: 38430873 PMCID: PMC10978222 DOI: 10.1016/j.socscimed.2024.116707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 02/07/2024] [Accepted: 02/19/2024] [Indexed: 03/05/2024]
Abstract
Primary care is at the forefront of healthcare delivery. It is the site of disease prevention and health management and serves as the bridge between communities and the health care system As ethnographers of primary care, in this article we discuss what is gained by situating anthropological inquiry within primary care. We articulate how anthropologists can contribute to a better understanding of the issues that emerge in primary care. We provide a review of anthropological work in primary care and offer empirical data from two ethnographic case studies based in the United States, one focused on social risk screening in primary care and the other examining the diagnosis and care of people with dementia in primary care. Through these cases, we demonstrate how research of and within primary care can open important avenues for the study of the multidimensionality of primary care. This multidimensionality is apparent in the ways the medical field addresses the social and structural experiences of patients, scope of practice and disciplinary boundaries, and the intersection of ordinary and extraordinary medicine that emerge in the care of patients in primary care.
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Affiliation(s)
- Alissa Bernstein Sideman
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, USA; Global Brain Health Institute, Department of Neurology, University of California, San Francisco, USA; Department of Humanities & Social Sciences, University of California, San Francisco, USA.
| | - Na'amah Razon
- Department of Family and Community Medicine, University of California, Davis, USA
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Takada S, Shen Z, Bourgois P, Duru OK, Gelberg L, Han M, Javanbakht M, Shoptaw S, Wells K, Ryan G. A Qualitative Study of Perceptions and Preferences Regarding Social and Behavioral Risk Screening Among Primary Care Patients. J Gen Intern Med 2023; 38:3171-3179. [PMID: 37578623 PMCID: PMC10651619 DOI: 10.1007/s11606-023-08344-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 07/18/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Despite its relevance for healthcare settings, social and behavioral risk screening is not systematically performed by clinicians or healthcare systems. OBJECTIVE To address clinician concerns, such as social and behavioral risk screening disrupting the clinician-patient relationship and lack of resources to respond, we interviewed primary care patients at an academic medical center regarding their perceptions and preferences on social and behavioral risk screening. PARTICIPANTS Between September and December 2020, we recruited a convenience sample of 14 English-speaking primary care patients 18 years + from three clinics affiliated with an academic medical center. APPROACH Using a semi-structured interview guide, we asked about the importance of social and behavioral risk screening, whether or not and how to share social and behavioral risk factors, and how social and behavioral risk factors are addressed. We used a multi-step analytic process to identify the range and commonality of participants' responses thematically. KEY RESULTS Participants recognized that social and behavioral risk factor domains were relevant to primary care and important for treating the patient as a whole person. Participants preferred a conversation regarding social and behavioral risk factor with their primary care providers (PCPs), and suggested that, if surveys are used, they be followed with an open-ended, in-person discussion. Participants also suggested framing the discussion as something that is done routinely with all patients so that patients do not feel judged. Participants felt comfortable sharing social and behavioral risk factors when they trusted their PCPs, and felt that discussing social and behavioral risk factors with their PCPs built trust. Participants recognized that resources exist outside of the clinic, and suggested that PCPs distribute lists of relevant community resources to patients. CONCLUSION In our study of primary care patients on perceptions and preferences about screening and addressing social and behavioral risk factors, we found that patients were willing to share social and behavioral risk factors with their PCP, preferred an in-person discussions with or without a survey, and wanted a list of community resources to address their needs.
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Affiliation(s)
- Sae Takada
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
- VA Greater Los Angeles Health System, Los Angeles, CA, USA.
| | - Zewei Shen
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Philippe Bourgois
- Center for Social Medicine and Humanities, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Anthropology, University of California, Los Angeles, CA, USA
| | - O Kenrik Duru
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Lillian Gelberg
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Office of Health Care Transformation and Innovation, VA Greater Los Angeles Health System, Los Angeles, CA, USA
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Maria Han
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Marjan Javanbakht
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Steve Shoptaw
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Kenneth Wells
- VA Greater Los Angeles Health System, Los Angeles, CA, USA
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Gery Ryan
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
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Borowska M, Augustynowicz A, Olszewski P, Religioni U. Respecting the Patient's Right to Information in Hospital Wards in Poland - Socio-Economic Determinants of Patients' Opinions. Patient Prefer Adherence 2023; 17:2311-2323. [PMID: 37745630 PMCID: PMC10516204 DOI: 10.2147/ppa.s421336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/18/2023] [Indexed: 09/26/2023] Open
Abstract
Background Implementation of the patient's statutory right to information is one of determinants the quality and safety of medical services. The patients' opinions survey is an element of patient-centric care, which is now one of the most important things in modern healthcare. The main aim of the work is to examine patients' opinions on the observance of patients' right to information in the hospital and quality of healthcare in the hospital. A secondary objective was to examine the impact of socioeconomic variables on patients' opinions. Materials and Methods The study was based on the Computer-Assisted Web Interview (CAWI) questionnaire, carried out in March 2022. The sample included 801 persons. Respondents were patients hospitalized within a maximum of 12 months. The questionnaire contained closed questions about the quality of medical care, observance of the patient's right to information. Results Probability of referral was measured using the Net Promoter Score (NPS). Respondents answered the question about the recommendation on a scale from 0 to 10. People who rated the hospital ward at 10 and 9 are promoters, people who rated the hospital ward at 8 and 7 are neutral people. In turn, people who rated the hospital ward at 6, 5, 4, 3, 2, 1 or 0 are critics, ie people who will not recommend the hospital to their relatives. Most patients in hospital wards were the detractors (37%). The percentage of promoters was only 1% lower (36%) than that of the detractors. Patients was rated medical and nursing staff at a similar level with regard to the observance of the patient's right to information. Conclusion Most statistically significant differences in the assessment of medical care in the hospital ward were associated with such sociodemographic variables as age and income. People aged 55-64 and 65+ rated most of the analyzed aspects better.
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Affiliation(s)
- Mariola Borowska
- Department of Economics of Health and Medical Law, Medical University of Warsaw, Warsaw, Poland
| | - Anna Augustynowicz
- Department of Economics of Health and Medical Law, Medical University of Warsaw, Warsaw, Poland
- School of Public Health Centre of Postgraduate Medical Education of Warsaw, Warsaw, Poland
| | | | - Urszula Religioni
- School of Public Health Centre of Postgraduate Medical Education of Warsaw, Warsaw, Poland
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Borowska M, Religioni U, Augustynowicz A. Patients' Opinions on the Quality of Services in Hospital Wards in Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:412. [PMID: 36612739 PMCID: PMC9819877 DOI: 10.3390/ijerph20010412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/13/2022] [Accepted: 12/21/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Patient opinion surveys have become a widely used method for assessing key aspects of the functioning of medical facilities and, thus, of the functioning of the entire health care system. They are a prerequisite for developing patient-centered care and an essential component of quality improvement programs. In many countries, including Poland, patient opinion surveys are written into the accreditation standards of medical institutions. Patient's readiness to recommend a hospital is a recognized indicator of the quality of patient-centered care. In a report on strategies for improving the quality of health care in Europe published in 2019 by WHO and the OECD (Organisation for Economic Cooperation and Development), patient's readiness to recommend a hospital was cited as one of the basic indicators of 'patient centeredness' along with patient satisfaction. Therefore, as well consideration of the quality of medical care, a patient recommendation index was also used in the study presented in this paper. The index was based on the answers to questions about the patient's readiness to recommend a hospital ward to family and friends. AIM The aim of the study was to investigate patients' opinions on the quality of services in particular hospital wards. A patient opinion survey can be used to improve the quality of services and monitor the effects of health-related activities, identify areas that need improvement, motivate medical staff and prevent their burnout, build a trusting relationship with patients, and compare the quality of health care in various facilities. MATERIAL AND METHODS The study was carried out in March 2022. The patient opinion survey was conducted using the CAWI (Computer-Assisted Web Interview). The sample selection was purposive. The respondents were patients with a history of hospitalization. The sample selection used an algorithm for the random selection of patients who met the criteria for the sample. The inclusion criterion was hospitalization in the 12 months prior to the study. A standardized questionnaire was used that was aimed at the assessment of the quality of medical care and the patient's rights to information. Additionally, the survey contained questions about the demographic characteristics of the respondents. RESULTS A total of 38% of patients with a history of hospitalization expressed criticisms. The majority of statistically significant differences were observed when differentiating respondents according to age. Elderly persons significantly more often declared having been treated with respect and interest. They also rated more highly the meals served in the hospital, effective pain treatment, and respect for the patient's dignity and intimacy during diagnosis and treatment. Younger persons assessed all these aspects of hospitalization less favorably. CONCLUSIONS Variables including age and the level of income had a statistically significant influence on the opinion of the respondents. Elderly persons assessed most aspects of the quality of care in a hospital ward more favorably. There were a similar number of "promoters" (36%) and "detractors" (38%) of the quality of hospital services. Detractors mainly pointed to long waiting times for hospital admission, the poor quality of medical and nursing care, and unappealing meals. The promoters emphasized the high quality of medical and nursing care and the favorable conditions of the accommodation. Regular patient satisfaction surveys are helpful in identifying areas in which the functioning of a medical entity requires changes.
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Affiliation(s)
- Mariola Borowska
- Department of Economics of Health and Medical Law, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Urszula Religioni
- School of Public Health, Centre of Postgraduate Medical Education of Warsaw, 01-813 Warsaw, Poland
| | - Anna Augustynowicz
- Department of Economics of Health and Medical Law, Medical University of Warsaw, 02-091 Warsaw, Poland
- School of Public Health, Centre of Postgraduate Medical Education of Warsaw, 01-813 Warsaw, Poland
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Closser S, Mendenhall E, Brown P, Neill R, Justice J. The anthropology of health systems: A history and review. Soc Sci Med 2021; 300:114314. [PMID: 34400012 DOI: 10.1016/j.socscimed.2021.114314] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 08/04/2021] [Accepted: 08/11/2021] [Indexed: 12/17/2022]
Abstract
Ethnographies of health systems are a theoretically rich and rapidly growing area within medical anthropology. Critical ethnographic work dating back to the 1950s has taken policymakers and health staff as points of entry into the power structures that run through the global health enterprise. In the last decade, there has been a surge of ethnographic work on health systems. We conceptualize the anthropology of health systems as a field; review the history of this body of knowledge; and outline emergent literatures on policymaking, HIV, hospitals, Community Health Workers, health markets, pharmaceuticals, and metrics. High-quality ethnographic work is an excellent way to understand the complex systems that shape health outcomes, and provides a critical vantage point for thinking about global health policy and systems. As theory in this space develops and deepens, we argue that anthropologists should look beyond the discipline to think through what their work does and why it matters.
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Affiliation(s)
- Svea Closser
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Rm E5545, Baltimore, MD, 21205, USA.
| | - Emily Mendenhall
- Science, Technology and International Affairs Program, Edmund A. Walsh School of Foreign Service, Georgetown University, USA
| | - Peter Brown
- Department of Anthropology, Emory University, USA
| | - Rachel Neill
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, USA
| | - Judith Justice
- Institute for Health and Aging, School of Nursing, University of California, San Francisco, USA
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