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Abstract
Objectives: Patient trust in physicians is associated with patient satisfaction with healthcare, patients engaging in follow-up care, and positive health-related outcomes. The current study investigated whether age moderated the relation between trust in physicians and four health outcome variables, including patient satisfaction, doctor visits, emergency room visits, and hospital admissions. Methods: 398 English-speaking, community-dwelling adults completed measures of physician trust and important health outcome variables via Amazon Mechanical Turk. Results: Age significantly moderated relations between trust in physicians and hospital admissions, and trust in physicians and patient satisfaction, with both positive relations becoming stronger with increasing age. Discussion: The results highlight the need for a lifespan approach to the study of physician trust and related health outcomes. They offer an avenue for increasing physician trust, engagement with the healthcare system prior to the need for hospitalization, and the reduction of healthcare costs.
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Affiliation(s)
- Emma Katz
- Behavioral Medicine, VA Boston Healthcare System, Boston, MA, USA
| | - Barry Edelstein
- Department of Psychology, West Virginia University, Morgantown, WV, USA
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Artz N, Dalton J, Ramanathan R, Lin RT, Sadhwani S, Como CJ, Oyekan A, Tang YM, Li V, Nwankwo J, Lee JY, Shaw JD. Characterizing Negative Online Reviews of Spine Surgeons. Spine (Phila Pa 1976) 2024; 49:E154-E163. [PMID: 38351707 DOI: 10.1097/brs.0000000000004962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/05/2024] [Indexed: 05/09/2024]
Abstract
DESIGN Retrospective review. OBJECTIVE Characterize negative reviews of spine surgeons in the United States. SUMMARY Physician rating websites significantly influence the selection of doctors by other patients. Negative experiences are impacted by various factors, both clinical and nonclinical, geography, and practice structure. The purpose of this study was to evaluate and categorize negative reviews of spine surgeons in the United States, with a focus on surgical versus nonsurgical reviewers. METHODS Spine surgeons were selected from available online professional society membership directories. A search for reviews was performed on Healthgrades.com, Vitals.com, and RateMDs.com for the past 10 years. Free response reviews were coded by complaint, and qualitative analysis was performed. χ 2 and Fisher exact tests were used to compare categorical variables, and multiple comparisons were adjusted with Benjamini-Hochberg correction. A binary logistic regression model was performed for the top three most mentioned nonclinical and clinical complaint labels. A P -value <0.05 was considered statistically significant. RESULTS A total of 16,695 online reviews were evaluated, including 1690 one-star reviews (10.1%). Among one-star reviews, 64.7% were written by nonsurgical patients and 35.3% by surgical patients. Nonclinical and clinical comments constituted 54.9% and 45.1% of reviews, respectively. Surgeons in the South had more "bedside manner" comments (43.3%, P <0.0001), while Northeast surgeons had more "poor surgical outcome" remarks compared with all other geographic regions (14.4%, P <0.001). Practicing in the South and Northeast were independent predictors of having complaints about "bedside manner" and "poor surgical outcome," respectively. CONCLUSION Most one-star reviews of spine surgeons were attributed to nonsurgical patients, who tended to be unsatisfied with nonclinical factors, especially "bedside manner." However, there was substantial geographic variation. These results suggest that spine surgeons could benefit from focusing on nonclinical factors (bedside manner), especially among nonoperative patients, and that regional nuances should be considered in delivering spine care. LEVEL OF EVIDENCE Level- 5.
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Affiliation(s)
- Nicolas Artz
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
- Pittsburgh Orthopaedic Spine Research (POSR) Group, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Jonathan Dalton
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
- Pittsburgh Orthopaedic Spine Research (POSR) Group, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA
- Orland Bethel Family Musculoskeletal Research Center (BMRC), Pittsburgh, PA
| | - Rahul Ramanathan
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
- Pittsburgh Orthopaedic Spine Research (POSR) Group, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA
- Orland Bethel Family Musculoskeletal Research Center (BMRC), Pittsburgh, PA
| | - Ryan T Lin
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
- Pittsburgh Orthopaedic Spine Research (POSR) Group, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Shaan Sadhwani
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
- Pittsburgh Orthopaedic Spine Research (POSR) Group, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Christopher J Como
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
- Pittsburgh Orthopaedic Spine Research (POSR) Group, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA
- Orland Bethel Family Musculoskeletal Research Center (BMRC), Pittsburgh, PA
| | - Anthony Oyekan
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
- Pittsburgh Orthopaedic Spine Research (POSR) Group, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA
- Orland Bethel Family Musculoskeletal Research Center (BMRC), Pittsburgh, PA
| | - Yunting Melissa Tang
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
- Pittsburgh Orthopaedic Spine Research (POSR) Group, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA
- Orland Bethel Family Musculoskeletal Research Center (BMRC), Pittsburgh, PA
| | - Vivian Li
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
- Pittsburgh Orthopaedic Spine Research (POSR) Group, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Josephine Nwankwo
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
- Pittsburgh Orthopaedic Spine Research (POSR) Group, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Joon Y Lee
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
- Pittsburgh Orthopaedic Spine Research (POSR) Group, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA
- Orland Bethel Family Musculoskeletal Research Center (BMRC), Pittsburgh, PA
| | - Jeremy D Shaw
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
- Pittsburgh Orthopaedic Spine Research (POSR) Group, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA
- Orland Bethel Family Musculoskeletal Research Center (BMRC), Pittsburgh, PA
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Edelman DS, Palmer DM, Romero EK, Chang BP, Kronish IM. Impact of Native Language, English Proficiency, and Language Concordance on Interpersonal Care During Evaluation of Acute Coronary Syndrome. J Gen Intern Med 2023; 38:946-953. [PMID: 36127540 PMCID: PMC10039209 DOI: 10.1007/s11606-022-07794-w] [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] [Received: 03/23/2022] [Accepted: 09/07/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND High-quality interpersonal interactions between clinicians and patients can improve communication and reduce health disparities among patients with novice English proficiency (NEP). Yet, little is known about the impact of native language, NEP, and native language concordance on patient on perceptions of interpersonal care in the emergency department (ED). OBJECTIVE To determine the associations of native language, NEP, and native language concordance with patient perceptions of interpersonal care among patients undergoing evaluation for suspected acute coronary syndrome (ACS) in the ED. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study included 1000 patients undergoing evaluation for suspected ACS at an urban ED from 2013 to 2016. MAIN MEASURES English- and Spanish-speaking patients were surveyed to identify native language, English proficiency (classified as advanced, intermediate, or novice), and perceived language of the treating ED clinician. Patient perceptions of interpersonal care were assessed using the Interpersonal Processes of Care (IPC) survey, a validated 18-item tool for assessing social-psychological domains of patient-clinician interactions. IPC scores ≤ 4 were categorized as sub-optimal (range, 1-5). The associations between native language, English proficiency, and native language concordance with sub-optimal communication were assessed using hierarchical logistic regression adjusted for all three language variables, sociodemographic characteristics, and depression. KEY RESULTS Nine hundred thirty-three patients (48.0% native non-English-speaking, 55.7% Hispanic) completed the IPC; 522 (57.4%) perceived native language concordance. In unadjusted analyses, non-English native language (OR 1.38, 95% CI 1.04-1.82) and NEP (OR 1.45, 95% CI 1.06-1.98) were associated with sub-optimal communication, whereas language concordance was protective (OR 0.61, 95% CI 0.46-0.81). In fully adjusted analyses, only language concordance remained significantly associated with sub-optimal communication (AOR 0.62, 95% CI 0.42-0.93). CONCLUSIONS This study suggests that perceived native language concordance acts as a protective factor for patient-clinician interpersonal care in the acute setting, regardless of native language or English proficiency.
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Affiliation(s)
- David S Edelman
- Primary Care/Social Internal Medicine Residency Program, Department of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Dana M Palmer
- Department of Epidemiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Emily K Romero
- Teachers College, Columbia University, New York, NY, USA
| | - Bernard P Chang
- Department of Emergency Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Ian M Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 West 168th Street, PH9-311, New York, NY, 10032, USA.
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Everson J, Henderson SC, Cheng A, Senft N, Whitmore C, Dusetzina SB. Demand for and Occurrence of Medication Cost Conversations: A Narrative Review. Med Care Res Rev 2023; 80:16-29. [PMID: 35808853 DOI: 10.1177/10775587221108042] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
High medication prices can create a financial burden for patients and reduce medication initiation. To improve decision making, public policy is supporting development of tools to provide real-time prescription drug prices. We reviewed the literature on medication cost conversations to characterize the context in which these tools may be used. Our review included 42 articles: a median of 84% of patients across four clinical specialties reported a desire for cost conversations (n = 7 articles) but only 23% reported having held a cost conversation across six specialties (n = 16 articles). Non-White and older patients were less likely to report having held a cost conversation than White and younger patients in 9 of 13 and 5 of 9 articles, respectively, examining these associations. Our review indicates that tools providing price information may not result in improved decision making without complementary interventions that increase the frequency of cost conversations with a focus on protected groups.
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Affiliation(s)
- Jordan Everson
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | | | - Audrey Cheng
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | | | | | - Stacie B Dusetzina
- Vanderbilt University School of Medicine, Nashville, TN, USA.,Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
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Jentzsch A, Geier AK, Bleckwenn M, Schrimpf A. Differences in Demographics of Vaccinees, Access to, and Satisfaction with SARS-CoV-2 Vaccination Procedures between German General Practices and Mass Vaccination Centers. Vaccines (Basel) 2022; 10:1823. [PMID: 36366332 PMCID: PMC9696883 DOI: 10.3390/vaccines10111823] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/20/2022] [Accepted: 10/26/2022] [Indexed: 10/29/2023] Open
Abstract
In the European Union, SARS-CoV-2 vaccines became available in December 2020. The vaccination campaign in Germany was initially implemented through mass vaccination centers and later joined by general practitioners (GPs) in spring 2021. This study compared population characteristics, perceived access barriers, and satisfaction with the vaccination procedure between vaccination centers and GP practices. A paper-based survey was distributed (07/2021-10/2021) among newly vaccinated individuals in ten GP practices (n = 364) and two vaccine centers (n = 474). Participants in vaccine centers were younger compared to participants in GP practices. GP preference was higher in older participants and those with pre-existing illnesses. Wait time at vaccination site was longer in GP practices, whereas travel distance to site was longer for participants in vaccine centers. However, satisfaction with patient education and recommendation of site were more likely with increasing comprehensibility of the vaccination procedure and physicians' information as well as perceived sufficiency of patient education duration, factors that can be easily modified by all vaccination sites. Our results demonstrate that both types of vaccination sites complement each other in terms of accessibility and target population and that satisfaction with the vaccination procedure can be promoted at all sites by an easy-to-understand process.
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Affiliation(s)
- Anne Jentzsch
- Department of General Practice, Faculty of Medicine, Leipzig University, Philipp-Rosenthal-Str. 55, 04103 Leipzig, Germany
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Rzadkiewicz M, Haugan G, Włodarczyk D. Mature Adults at the GP: Length of Visit and Patient Satisfaction—Associations with Patient, Doctor, and Facility Characteristics. Medicina (B Aires) 2022; 58:medicina58020159. [PMID: 35208483 PMCID: PMC8874721 DOI: 10.3390/medicina58020159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 01/14/2022] [Accepted: 01/18/2022] [Indexed: 11/16/2022] Open
Abstract
Background and objectives: The consultation time for more mature adults is often perceived as longer, increasing with the patient’s age and boosting their satisfaction with the visit. However, factors determining patient satisfaction (PS) or the consultation time (CT) in the population aged 50+ are not clearly identified. A cross-sectional design was used to identify factors specific to the facility (e.g., size, staff turnover), doctor (e.g., seniority, workload), and patient (e.g., self-rated health, impairment of activities) that are related to PS and the CT. Our secondary focus was on the relation of PS to the CT along with the role of the patient’s age and gender for both. Materials and Methods: Doctors (n = 178) and their 1708 patients (aged 50–97) from 77 primary care facilities participated in the study. The Patient Satisfaction with Visit Scale score and the CT were the outcome measures. Results: We identified associations with the CT in terms of the facility-related factors (number of GPs, time scheduling); doctors’ workload and health; and patients’ education, time attending GP, and impairments. PS was additionally governed by doctors’ perceived rate of patients aged 65+, as well as the patients’ hospitalization in the prior year, frequency of visits, and impairments. For adults aged 50+ the CT was unrelated to PS and both remained independent of patients’ age. Conclusions: Specific factors in terms of the facility, GP, and patient were identified as related to PS and the CT for participating adults in primary care. During visits of patients aged 50+ at their GP, there is scope for both time-savings and patient satisfaction improvements, when paying attention, e.g., to the time scheduled per visit, the number of doctors employed, and the patients’ impairments.
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Affiliation(s)
- Marta Rzadkiewicz
- Department of Health Psychology, Medical University of Warsaw, Litewska 14/16, 00-575 Warsaw, Poland;
- Correspondence:
| | - Gorill Haugan
- Department of Public Health and Nursing, Norwegian University of Science and Technology, P.O. Box 8905, 7491 Trondheim, Norway;
- Faculty of Nursing and Health Science, Nord University, 7600 Levanger, Norway
| | - Dorota Włodarczyk
- Department of Health Psychology, Medical University of Warsaw, Litewska 14/16, 00-575 Warsaw, Poland;
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Patient Experience and Hospital Environment Measures at Military Treatment Facilities. J Healthc Manag 2022; 67:38-53. [PMID: 34982748 DOI: 10.1097/jhm-d-20-00316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
SUMMARY
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Alrasheed AA, Alharbi AH, Alotaibi AF, Alqarni AH, Alshahrani AM, Almigbal TH, Batais MA. Prevalence, Reasons and Determinants of Patients' Nondisclosure to Their Doctors in Saudi Arabia: A Community-Based Study. Patient Prefer Adherence 2022; 16:245-253. [PMID: 35125866 PMCID: PMC8811268 DOI: 10.2147/ppa.s347796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/15/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Patient-doctor communication is a fundamental component of patients' care. Withholding important information to the doctor can negatively affect the patients' health and patient-doctor communication. AIM This study aimed to explore the fundamental types of information that patients hide from doctors, eg, the use of medication, health-related lifestyle, or disagreement with the doctor's plan. In addition, this study examines the prevalence and reasons for this nondisclosure and factors associated with it. METHODOLOGY An online survey was conducted using a self-designed questionnaire, which was distributed to social media, targeting the residents of Saudi Arabia from February 1, 2021 to February 28, 2021. Respondents under 18 years of age and those who provided incomplete/incorrect data were excluded from the study. Types of nondisclosed information and their reasons were evaluated. RESULTS A total of 2725 participants completed the questionnaire, and 1392 (51.1%) were males. About 43.2% of the participants were 18-29 years. Most (82%) responded "yes" to the question "Have you ever withheld any information from your doctor?" Nondisclosed information commonly involved disagreements with the recommendation (44.7%), not taking prescription medication as instructed (40.6%), and not understanding the instructions (37.4%). The most frequent reasons (68.7%) for nondisclosure were that the participants wanted to undergo further tests, did not like the doctor's attitude (48.7%) and felt it did not matter to the doctor (43.2%). Those under 40 were more apt to withhold information (70.4%) than older participants (29.6%) p value = 0.0034. Other factors like gender, education level, and marital status were not associated with nondisclosure. CONCLUSION The prevalence of nondisclosure to doctors is high. Effective communication skills and sound doctor-patient relationships may reduce this risk and improve the care delivered to the patients.
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Affiliation(s)
- Abdullah A Alrasheed
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Family Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
- Correspondence: Abdullah A Alrasheed, Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia, Tel +966 55 644 0445, Email
| | | | | | | | - Abdullah M Alshahrani
- Department of Family Medicine, College of Medicine, University of Bisha, Bisha, Saudi Arabia
| | - Turky H Almigbal
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Family Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
- Vision College of Medicine, Vision Colleges in Riyadh, Riyadh, Saudi Arabia
| | - Mohammed A Batais
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Family Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
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Drossman DA, Chang L, Deutsch JK, Ford AC, Halpert A, Kroenke K, Nurko S, Ruddy J, Snyder J, Sperber A. A Review of the Evidence and Recommendations on Communication Skills and the Patient-Provider Relationship: A Rome Foundation Working Team Report. Gastroenterology 2021; 161:1670-1688.e7. [PMID: 34331912 DOI: 10.1053/j.gastro.2021.07.037] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/12/2021] [Accepted: 07/19/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND & AIMS Over several decades, changes in health care have negatively impacted meaningful communication between the patient and provider and adversely affected their relationship. Under increasing time pressure, physicians rely more on technology than face-to-face time gathering data to make clinical decisions. As a result, they find it more challenging to understand the illness context and fully address patient needs. Patients experience dissatisfaction and a diminution of their role in the care process. For patients with disorders of gut-brain interaction, stigma leads to greater care dissatisfaction, as there is no apparent structural basis to legitimize the symptoms. Recent evidence suggests that practical communication skills can improve the patient-provider relationship (PPR) and clinical outcomes, but these data are limited. METHODS The Rome Foundation convened a multidisciplinary working team to review the scientific evidence with the following aims: a) to study the effect of communication skills on patient satisfaction and outcomes by performing an evidence-based review; b) to characterize the influence of sociocultural factors, health care system constraints, patient perspective, and telehealth on the PPR; c) to review the measurement and impact of communication skills training on these outcomes; and d) to make recommendations to improve communication skills training and the PPR. RESULTS Evidence supports the fact that interventions targeting patient-provider interactions improve population health, patient and provider experience, and costs. Communication skills training leads to improved patient satisfaction and outcomes. The following are relevant factors to consider in establishing an effective PPR: addressing health care system constraints; incorporating sociocultural factors and the role of gender, age, and chronic illness; and considering the changing role of telehealth on the PPR. CONCLUSIONS We concluded that effective communication skills can improve the PPR and health outcomes. This is an achievable goal through training and system change. More research is needed to confirm these findings.
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Affiliation(s)
- Douglas A Drossman
- Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina, Center for Education and Practice of Biopsychosocial Care, Drossman Gastroenterology, and the Rome Foundation, Chapel Hill, North Carolina.
| | - Lin Chang
- Vatche and Tamar Manoukian Division of Digestive Diseases, G. Opopenbhemer Center for Neurobiology of Stress and Resilience, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, Calfornia
| | - Jill K Deutsch
- Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, Yale New Haven Hospital, New Haven, Connecticut
| | - Alexander C Ford
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK; Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK
| | - Albena Halpert
- Gastroenterology,Harvard University Health Services, Boston, Massachusetts
| | - Kurt Kroenke
- Regenstrief Institute, Indiana University School of Medicine, Indianapolis, Indiana
| | - Samuel Nurko
- Center for Motility and Functional Gastrointestinal Disorders, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts
| | - Johannah Ruddy
- Center for Education and Practice of Biopsychosocial Care and Rome Foundation, Raleigh, North Carolina
| | - Julie Snyder
- Gastrointetinal Psychology Service, Boston University, Harvard Medical School, Boston, Massachusetts
| | - Ami Sperber
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Huang SCC, Morgan A, Peck V, Khoury L. Improving Communications With Patients and Families in Geriatric Care. The How, When, and What. J Patient Exp 2021; 8:23743735211034047. [PMID: 34368432 PMCID: PMC8317236 DOI: 10.1177/23743735211034047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
There has been little published literature examining the unique communication challenges older adults pose for health care providers. Using an explanatory mixed-methods design, this study explored patients’ and their family/caregivers’ experiences communicating with health care providers on a Canadian tertiary care, inpatient Geriatric unit between March and September 2018. In part 1, the modified patient–health care provider communication scale was used and responses scored using a 5-point scale. In part 2, one-on-one telephone interviews were conducted and responses transcribed, coded, and thematically analyzed. Thirteen patients and 7 family/caregivers completed part 1. Both groups scored items pertaining to adequacy of information sharing and involvement in decision-making in the lowest 25th percentile. Two patients and 4 family/caregivers participated in telephone interviews in part 2. Interview transcript analysis resulted in key themes that fit into the “How, When, and What” framework outlining the aspects of communication most important to the participants. Patients and family/caregivers identified strategic use of written information and predischarge family meetings as potentially valuable tools to improve communication and shared decision-making.
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Affiliation(s)
- Shirley Chien-Chieh Huang
- Department of Medicine, Division of Geriatric Medicine, University of Ottawa, The Ottawa Hospital, and the Ottawa Hospital Research Institute, Ontario, Canada
| | - Alden Morgan
- Faculty of Medicine, University of Ottawa and The Ottawa Hospital, Ontario, Canada
| | | | - Lara Khoury
- Department of Medicine, Division of Geriatric Medicine, University of Ottawa, The Ottawa Hospital, and the Ottawa Hospital Research Institute, Ontario, Canada
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Palmer Kelly E, McGee J, Obeng-Gyasi S, Herbert C, Azap R, Abbas A, Pawlik TM. Marginalized patient identities and the patient-physician relationship in the cancer care context: a systematic scoping review. Support Care Cancer 2021; 29:7195-7207. [PMID: 34195857 DOI: 10.1007/s00520-021-06382-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/21/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE We sought to examine and categorize the current evidence on patient-physician relationships among marginalized patient populations within the context of cancer care using a systemic scoping review approach. METHODS Web-based discovery services (e.g., Google Scholar) and discipline-specific databases (e.g., PubMed) were queried for articles on the patient-physician relationship among marginalized cancer patients. The marginalized populations of interest included (1) race and ethnicity, (2) gender, (3) sexual orientation and gender identity, (4) age, (5) disability, (6) socioeconomic status, and (7) geography (rural/urban). Study screening and data extraction were facilitated through the Covidence software platform. RESULTS Of the 397 screened studies, 37 met study criteria-most articles utilized quantitative methodologies (n = 28). The majority of studies focused on racial and ethnic cancer disparities (n = 27) with breast cancer (n = 20) as the most common cancer site. Trust and satisfaction with the provider were the most prevalent issues cited in the patient-physician relationship. Differences in patient-physician communication practices and quality were also frequently discussed. Overall, studies highlighted the need for increased culturally congruent care among providers. CONCLUSION Results from this review suggest marginalized cancer patients face significant barriers in establishing culturally and linguistically congruent patient-physician relationships. Future studies should focus on the intersectionality of multiple marginalized identities and optimization of the patient-physician relationship.
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Affiliation(s)
| | - Julia McGee
- The Ohio State University, Columbus, OH, USA
| | - Samilia Obeng-Gyasi
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Chelsea Herbert
- Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA
| | - Rosevine Azap
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Alizeh Abbas
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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Welzel FD, Bär J, Stein J, Löbner M, Pabst A, Luppa M, Grochtdreis T, Kersting A, Blüher M, Luck-Sikorski C, König HH, Riedel-Heller SG. Using a brief web-based 5A intervention to improve weight management in primary care: results of a cluster-randomized controlled trial. BMC FAMILY PRACTICE 2021; 22:61. [PMID: 33794781 PMCID: PMC8017625 DOI: 10.1186/s12875-021-01404-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 02/25/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND The primary health care setting is considered a major starting point in successful obesity management. However, research indicates insufficient quality of weight counseling in primary care. Aim of the present study was to implement and evaluate a 5A online tutorial aimed at improving weight management and provider-patient-interaction in primary health care. The online tutorial is a stand-alone low-threshold minimal e-health intervention for general practitioners based on the 5As guidance for obesity management by the Canadian Obesity Network. METHODS In a cluster-randomized controlled trial, 50 primary care practices included 160 patients aged 18 to 60 years with obesity (BMI ≥ 30). The intervention practices had continuous access to the 5A online tutorial for the general practitioner. Patients of control practices were treated as usual. Primary outcome was the patients' perspective of the doctor-patient-interaction regarding obesity management, assessed with the Patient Assessment of Chronic Illness Care before and after (6/12 months) the training. Treatment effects over time (intention-to-treat) were evaluated using mixed-effects linear regression models. RESULTS More than half of the physicians (57%) wished for more training offers on obesity counseling. The 5A online tutorial was completed by 76% of the physicians in the intervention practices. Results of the mixed-effects regression analysis showed no treatment effect at 6 months and 12 months' follow-up for the PACIC 5A sum score. Patients with obesity in the intervention group scored lower on self-stigma and readiness for weight management compared to participants in the control group at 6 months' follow-up. However, there were no significant group differences for weight, quality of life, readiness to engage in weight management, self-stigma and depression at 12 months' follow-up. CONCLUSION To our knowledge, the present study provides the first long-term results for a 5A-based intervention in the context of the German primary care setting. The results suggest that a stand-alone low-threshold minimal e-health intervention for general practitioners does not improve weight management in the long term. To improve weight management in primary care, more comprehensive strategies are needed. However, due to recruitment difficulties the final sample was smaller than intended. This may have contributed to the null results. TRIAL REGISTRATION The study has been registered at the German Clinical Trials Register (Identifier: DRKS00009241 , Registered 3 February 2016).
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Affiliation(s)
- Franziska D Welzel
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany. .,Integrated Research and Treatment Centre (IFB) AdiposityDiseases, Leipzig University Medical Center, Leipzig, Germany.
| | - Jonathan Bär
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany
| | - Janine Stein
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany
| | - Margrit Löbner
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany.,Integrated Research and Treatment Centre (IFB) AdiposityDiseases, Leipzig University Medical Center, Leipzig, Germany
| | - Alexander Pabst
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany
| | - Melanie Luppa
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany
| | - Thomas Grochtdreis
- Department of Health Economics and Health Services Research, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Anette Kersting
- Integrated Research and Treatment Centre (IFB) AdiposityDiseases, Leipzig University Medical Center, Leipzig, Germany.,Clinic for Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Matthias Blüher
- Integrated Research and Treatment Centre (IFB) AdiposityDiseases, Leipzig University Medical Center, Leipzig, Germany.,Department of Endocrinology, Nephrology, Rheumatology, University Hospital Leipzig, Leipzig, Germany
| | - Claudia Luck-Sikorski
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany.,Integrated Research and Treatment Centre (IFB) AdiposityDiseases, Leipzig University Medical Center, Leipzig, Germany.,SRH University of Applied Sciences Gera, Gera, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany
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Qin S, Ding Y. Who Is More Satisfied with Health Services? A Cross-Sectional Study in China. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2021; 58:46958021999926. [PMID: 33645255 PMCID: PMC7923977 DOI: 10.1177/0046958021999926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This cross-sectional study aims to assess the Chinese population’s satisfaction with health service and identify 2 types of variables, Andersen’s behavioral model related variables and social environment variables associated with high satisfaction. Data were derived from the 2013 Chinese General Social Survey (CGSS). Using exploratory factor analysis, the original questionnaire’s 10 health services were grouped into 2 dimensions, including “health management service” and “public health service.” Then, the satisfaction was described. The associations between satisfaction and factors were assessed using a multivariable logistic regression model. As a result, a total of 5283 subjects were enrolled. The satisfaction was 56.74% for “health management service” and 54.48% for “public health service.” Those with older age, lower education level, positive social environment factors (ie, higher perceived social class, higher perceived social trust, and perceived social equity), and having pension were more likely to report high satisfaction. Moreover, compared to the east region (the most prosperous region), the individuals from the central region or the north-east region (both regional economic levels were medium) had lower odds of reporting high satisfaction. In comparison, those from the west region (the least developed region) had higher odds. In conclusion, actionable measures to increase satisfaction should be proposed by the Chinese government, including increasing pension insurance coverage, increasing investment in health services, creating an excellent social environment, etc.
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Affiliation(s)
- Shangren Qin
- Hangzhou Normal University, Hangzhou, China.,Hangzhou Medical College, Hangzhou, China
| | - Ye Ding
- Hangzhou Medical College, Hangzhou, China
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Al-Sahli B, Eldali A, Aljuaid M, Al-Surimi K. Person-Centered Care in a Tertiary Hospital Through Patient's Eyes: A Cross-Sectional Study. Patient Prefer Adherence 2021; 15:761-773. [PMID: 33883884 PMCID: PMC8055245 DOI: 10.2147/ppa.s286237] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 12/01/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The current trend in healthcare systems around the world is moving towards a person (or patient)-centered care (PCC) model. While some healthcare organizations have only recently embraced the PCC approach, there is no evidence of person-centered care in Saudi hospitals. This study aimed to assess patients' perspectives on the climate of person-centered care and its associated factors in a tertiary hospital in Saudi Arabia. METHODS A cross-sectional study design was conducted in 16 inpatient departments at a tertiary hospital in Riyadh, Saudi Arabia. The validated version of the Person-centered Climate Questionnaire-Patient (PCQ-P) was distributed to 300 adult patients admitted to the hospital for more than 48 hours. The patients were interviewed face-to-face, using the PCQ-P. Descriptive and inferential statistical analysis were performed using SPSS (version 22; IBM, NY, USA). RESULTS A total of 300 questionnaires were completed. More than half (53%) were females; 39.7% aged 21-40 years; 72.7% married; 49% hold a high school diploma; and 67.4% unemployed. For route of admission into hospital, 39.8% of the respondents were admitted as elective or outpatient appointments, and 45% had been admitted for less than a week. Most patients (84.3%) reported that they preferred to be treated in a governmental hospital. Inpatients' overall mean PCQ-P score was 73 ± 9.988 out of 85. Results suggested significant associations between patient characteristics and their perspectives on person-centered care, such as age (P=0.005), gender (P<0.001), nationality (P=0.026), area of residency (P=0.001), route to admission (P=0.002), length of stay (P=0.003), and hospital preference (P=0.010). CONCLUSION Overall, patients' perspective on person-centered care seems positive. Patient and hospital characteristics could play an important role in shaping patients' perceptions of the climate of person-centered care domains.
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Affiliation(s)
- Bashayer Al-Sahli
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- Department of Health System Management, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdelmoneim Eldali
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mohammed Aljuaid
- Department of Health Administration, King Saud University, Riyadh, Saudi Arabia
| | - Khaled Al-Surimi
- Department of Health System Management, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Community Medicine Department, Faculty of Medicine & Health Sciences, Thamar University, Dhamar, Yemen
- Correspondence: Khaled Al-Surimi Department of Health System Management, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, P.O. Box 3660, Riyadh, Saudi Arabia Email
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Mallat A, Vrontis D, Thrassou A. Patient satisfaction in the context of public–private partnerships. INTERNATIONAL JOURNAL OF ORGANIZATIONAL ANALYSIS 2020. [DOI: 10.1108/ijoa-03-2020-2066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose
This study aims to provide insights into the public–private partnerships (PPP) concept and its performance measurement in the health-care sector, identifying and refining critical success factors, including the perceived quality of health care, as evidenced by patient satisfaction and policy requirements for successful PPP implementation.
Design/methodology/approach
This theoretical study explores the existing literature on the relationship between service quality and patient satisfaction, to propose a culture-specific conceptual model interlinking the drivers of patient satisfaction with PPP. The in-depth theoretical research focuses on the qualitative performance indicators of PPPs, as well as their corresponding peripheral factors.
Findings
The research presents theoretical evidence that the concept of patient satisfaction can only be viewed through a multifactor perspective that incorporates demographics of patients, perceived service quality factors and emotions. It is found that significant improvements in service quality and patient satisfaction do, indeed, emphasize the effective role of PPP in hospitals.
Practical implications
The theoretical model is based on a comprehensive set of both cognitive and affective determinants. And considering these, as well as their causes, effects and interrelations, sets the foundations for testing and for further research to develop. Moreover, the outcomes of this study can be used as a theoretical base for the development of a PPP qualitative performance measurement framework.
Originality/value
This study attempts to fill the gap in knowledge on service quality and patient satisfaction as qualitative indicators for hospital performance after and toward PPP, while setting explicit factors and opening clear research avenues for further studies to follow.
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16
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Wang D, Liu C, Wang X, Zhang X. Association between Physicians' Perception of Shared Decision Making with Antibiotic Prescribing Behavior in Primary Care in Hubei, China: A Cross-Sectional Study. Antibiotics (Basel) 2020; 9:antibiotics9120876. [PMID: 33302365 PMCID: PMC7762535 DOI: 10.3390/antibiotics9120876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/04/2020] [Accepted: 12/05/2020] [Indexed: 01/21/2023] Open
Abstract
Shared decision-making (SDM) has been advocated as one effective strategy for improving physician–patient relationships and optimizing clinical outcomes. Our study aimed to measure physicians’ perception of SDM and establish the relationship between physicians’ perception of SDM and prescribing behavior in patients with upper respiratory tract infections. One cross-sectional study was conducted in Hubei Province from December 2019 to January 2020. The SDM questionnaire and prescription data of 2018 from electronic health records data were matched for each physician in this study. Multilevel modeling was applied to explore the relationship between physicians’ perception of SDM and antibiotic prescribing in primary care. Analyses were statistically controlled for demographic characteristics of the physicians and patients. Physicians’ positive perception of SDM had small but statistically significant effects on lower prescribing of antibiotics in the patient group aged over 40 years (odds ratio (OR) < 1; p < 0.05). Moreover, female physicians (OR = 0.71; p = 0.007) with higher educational levels (bachelor’s degree and above; OR = 0.71; p = 0.024) were significantly associated with the prescribing of less antibiotics (p < 0.05). A more positive perception of SDM was demonstrated as one significant predictor of less prescribing of antibiotics in the patient group over 40 years. There may be a promising focus of implementing SDM strategies targeting physician–patient communication in primary care.
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Nouri Y, Gholipour C, Aghazadeh J, Khanahmadi S, Beygzadeh T, Nouri D, Nahaei M, Karimi R, Hosseinalipour E. Evaluation of the risk factors associated with emergency department boarding: A retrospective cross-sectional study. Chin J Traumatol 2020; 23:346-350. [PMID: 33097392 PMCID: PMC7718523 DOI: 10.1016/j.cjtee.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 08/05/2020] [Accepted: 08/25/2020] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Boarding is a common problem in the emergency department (ED) and is associated with poor health care and outcome. Imam Khomeini Hospital is the main healthcare center in Urmia, a metropolis in the northwest of Iran. Due to the overcrowding and high patient load, we aim to characterize the rate, cause and consequence of boarding in the ED of this center. METHODS All medical records of patients who presented to the ED of Imam Khomeini Hospital from August 1, 2017 to August 1, 2018 were retrospectively analyzed. Patients with uncompleted records were excluded. Boarding was defined as the inability to transfer the admitted ED patients to a downstream ward in ≥2 h after the admission order. Demographic data, boarding rate, mortality and triage levels (1-5) assessed by emergency severity index were collected and analyzed. The first present time of patients was classified into 4 ranges as 0:00-5:59, 6:00-11:59, 12:00-17:59 and 18:00-23:59. Descriptive, parametric and non-parametric statistical tests were performed and the risk of boarding was determined by Pearson Chi-square test. RESULTS Demographic data analysis showed that 941 (58.5%) male and 667 (41.5%) female, altogether 1608 patients were included in this study. Five patients (0.3%) died. The distribution of patients with the triage levels 1-5 was respectively 79 (4.9%), 1150 (71.5%), 374 (23.3%), 4 (0.2%) and 0 (0%). Most patients were of level 2. Only 75 (4.7%) patients required intensive care. The majority of patients (84.2%) were presented at weekdays. The maximum patient load was observed between 12:00-17:59. Of the 1608 patients, 340 (21.1%) experienced boarding within a mean admission time of 13.70 h. Among the 340-boarded patients, 20.1% belonged to surgery, 12.1% to orthopedics, 10.9% to neurosurgery and 10.3% to neurology. The boarding rate was higher in females, patients requiring intensive care and those with low triage levels. Compared with the non-boarded, the boarded patients had a higher mean age. CONCLUSION The boarding rate is higher in the older and female patients. Moreover, boarding is dependent on the downstream ward sections: patients requiring surgical management experience the maximum boarding rate.
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Affiliation(s)
- Yousef Nouri
- Department of Emergency, Urmia University of Medical Sciences, Urmia, Iran,Corresponding author.
| | - Changiz Gholipour
- Department of General Surgery, Tabriz University of Medical Science, Tabriz, Iran
| | - Javad Aghazadeh
- Department of Neurosurgery, Urmia University of Medical Sciences, Urmia, Iran
| | - Shahriar Khanahmadi
- Student Research Committee, Urmia University of Medical Sciences, Urmia, Iran
| | - Talayeh Beygzadeh
- Student Research Committee, Urmia University of Medical Sciences, Urmia, Iran
| | - Danial Nouri
- National Organization for Development of Exceptional Talents, Urmia, Iran
| | - Mehryar Nahaei
- Department of General Surgery, Imam Khomeini Medical Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Reza Karimi
- Student Research Committee, Urmia University of Medical Sciences, Urmia, Iran
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Foo CD, Tan YL, Shrestha P, Eh KX, Ang IYH, Nurjono M, Toh SA, Shiraz F. Exploring the dimensions of patient experience for community-based care programmes in a multi-ethnic Asian context. PLoS One 2020; 15:e0242610. [PMID: 33237953 PMCID: PMC7688169 DOI: 10.1371/journal.pone.0242610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 11/06/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction The aim of this study is to explore patients’ experiences with community-based care programmes (CCPs) and develop dimensions of patient experience salient to community-based care in Singapore. Most countries like Singapore are transforming its healthcare system from a hospital-centric model to a person-centered community-based care model to better manage the increasing chronic disease burden resulting from an ageing population. It is thus critical to understand the impact of hospital to community transitions from the patients’ perspective. The exploration of patient experience will guide the development of an instrument for the evaluation of CCPs for quality improvement purposes. Methods A qualitative exploratory study was conducted where face-to-face in-depth interviews were conducted using a purposive sampling method with patients enrolled in CCPs. In total, 64 participants aged between 41 to 94 years were recruited. A deductive framework was developed using the Picker Patient Experience instrument to guide our analysis. Inductive coding was also conducted which resulted in emergence of new themes. Results Our findings highlighted eight key themes of patient experience: i) ensuring care continuity, ii) involvement of family, iii) access to emotional support, vi) ensuring physical comfort, v) coordination of services between providers, vi) providing patient education, vii) importance of respect for patients, and viii) healthcare financing. Conclusion Our results demonstrated that patient experience is multi-faceted, and dimensions of patient experience vary according to healthcare settings. As most patient experience frameworks were developed based on a single care setting in western populations, our findings can inform the development of a culturally relevant instrument to measure patient experience of community-based care for a multi-ethnic Asian context.
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Affiliation(s)
- Chuan De Foo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- * E-mail:
| | - Yan Lin Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Pami Shrestha
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Singapore Population Health Improvement Centre (SPHERiC), National University Health System, Singapore, Singapore
| | - Ke Xin Eh
- Singapore Population Health Improvement Centre (SPHERiC), National University Health System, Singapore, Singapore
- Regional Health System Office, National University Health System, Singapore, Singapore
| | - Ian Yi Han Ang
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Regional Health System Office, National University Health System, Singapore, Singapore
| | - Milawaty Nurjono
- Centre for Health Services and Policy Research (CHSPR), Saw Swee Hock School of Public Health National University of Singapore, Singapore, Singapore
- Health Services Research, Changi General Hospital, Singapore Health Services, Singapore, Singapore
| | - Sue-Anne Toh
- Singapore Population Health Improvement Centre (SPHERiC), National University Health System, Singapore, Singapore
- Regional Health System Office, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Farah Shiraz
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Singapore Population Health Improvement Centre (SPHERiC), National University Health System, Singapore, Singapore
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Looking for the "Little Things": A Multi-Disciplinary Approach to Medicines Monitoring for Older People Using the ADRe Resource. Geriatrics (Basel) 2020; 5:geriatrics5040079. [PMID: 33086499 PMCID: PMC7709700 DOI: 10.3390/geriatrics5040079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 01/29/2023] Open
Abstract
Advances in medicines have increased the effectiveness of treatments and the social and cultural authority of doctors. However, as prescribing has become the dominant modality of treatment, the “pharmaceuticalization” of medical practice has often resulted in treatment “at a distance”, with doctors having limited contact with patients. Older and poorer people, who are socially distanced from medical prescribers, suffer more adverse drug reactions (ADRs) than the general population. A team approach to checking patients systematically for ADRs, as detailed in manufacturers’ literature, can minimise medication errors, but regular review is rare. This paper explains the benefits of medicines monitoring to protect older patients from iatrogenic harm, such as over-sedation, falls, or drug-induced Parkinsonism. We show how multidisciplinary initiatives to optimise prescribing can be supported by using a recognised resource—the adverse drug reaction profile (ADRe). The profile identifies and documents patients’ signs and symptoms of putative ADRs. Better monitoring allows professionals to adjust prescribing and respond to identified problems with agility. Implementation of systematic monitoring will require changes to the regulatory regime and better inter-professional cooperation. Providing carers, nurses and pharmacists with a structured system to monitor patients would democratise relevant medical knowledge and help address ageism and the socio-economic health divide.
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Abstract
Background: Minimal research focuses on interactions between providers and new ostomy patients. Studies show that provider communication is important for patient health outcomes. Objective: The purpose of this study was to investigate ostomy patients’ perceptions of provider communication following surgery and whether interactions adequately prepare ostomy patients to care for their new appliance. Method: Using a nonprobability national sample of 381 ostomy patients, we conducted a retrospective quantitative study. We measured adequacy of provider communication from self-reports from ostomy patients. Results: The results show that almost half of the sample (49%) reported receiving inadequate communication from providers. We also found a relationship between ostomy patients’ educational level and their perceptions of receiving adequate communication. Notably, patients with lower educational attainment reported receiving adequate communication up to 4 times more than patients with higher educational attainment. Conclusion: Our results suggest that not only do ostomy patients need better communication from providers following their surgery but also patients with higher educational attainment appear to expect more information from providers than patients with lower educational attainment.
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Affiliation(s)
| | - B Mitchell Peck
- Department of Sociology, University of Oklahoma, Norman, OK, USA
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Jafari A, Panuganti BA, Crawford KL, Shen S, DeConde AS. Rate and Factors Associated With Change in Surgeon for Revision Endoscopic Sinus Surgery. Laryngoscope 2020; 131:E1049-E1053. [PMID: 32866287 DOI: 10.1002/lary.29012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/11/2020] [Accepted: 07/23/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS A subset of patients will undergo revision endoscopic sinus surgery (ESS) with a different otolaryngologist than the one who performed their primary surgery. The purpose of this study is to report the incidence of and clinicodemographic factors associated with a change in surgeon for revision ESS. STUDY DESIGN Retrospective cohort study. METHODS Adult patients who underwent at least two outpatient ESS procedures between 2009 and 2014 using the State Ambulatory Surgery Database for Florida were included in the study. Change in surgeon was defined by a change in a unique provider identifier for the revision procedure. Multivariable regression analysis was used to determine characteristics associated with a change in surgeon. RESULTS A total of 2,963 patients were included. For the revision procedure, 47.7% of patients changed their surgeon. On multivariable logistic regression, a medium- (odds ratio [OR]: 0.64; 95% confidence interval [CI]: 0.53-0.77) or high-volume (OR: 0.50; 95% CI: 0.42-0.61) surgeon performing the index surgery and advanced age (≥65 years) (OR: 0.79; 95% CI: 0.63-0.99) were associated with decreased odds of surgeon change for revision ESS. Longer time elapsed between index and revision surgery (OR: 1.15; 95% CI: 1.13-1.17) was associated with increased odds of surgeon change. CONCLUSIONS Nearly half of patients who undergo revision ESS select a surgeon other than the one who performed their primary procedure. Surgeon volume, age, and time between surgeries affect the likelihood of a change in surgeon for revision ESS. These findings may provide introductory insights into patient preferences and decision making in the surgical management of recalcitrant chronic rhinosinusitis. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E1049-E1053, 2021.
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Affiliation(s)
- Aria Jafari
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology and Endoscopic Skull Base Surgery, University of Washington, Seattle, Washington, U.S.A
| | - Bharat A Panuganti
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, California, U.S.A
| | - Kayva L Crawford
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, California, U.S.A
| | - Sarek Shen
- School of Medicine, University of California San Diego, La Jolla, California, U.S.A
| | - Adam S DeConde
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, California, U.S.A
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Patient-reported experience measures in patients undergoing navigated transcranial magnetic stimulation (nTMS): the introduction of nTMS-PREMs. Acta Neurochir (Wien) 2020; 162:1673-1681. [PMID: 32100110 PMCID: PMC7295840 DOI: 10.1007/s00701-020-04268-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 02/17/2020] [Indexed: 11/02/2022]
Abstract
BACKGROUND Patient-reported experience measures (PREMs) are a unique measure of experience of patients which can help address the quality of care of the patients. OBJECTIVE Our aim of the study is to collect quality of care outcomes with our newly navigated transcranial magnetic stimulation patient-reported experience measure (nTMS-PREMs) questionnaire among neurosurgical patients undergoing nTMS. METHODS A single-centre prospective nTMS-PREMs 19-item questionnaire study was performed between February 2018 and December 2018 on patient referred for nTMS at our hospital. The Data was analysed using Likert scale, linear and logistic regression using statistical software (STATA 13.0®). RESULTS Fifty patient questionnaires were collected (30 males, 20 females, mean age of 47.6 ± 2.1 years) among which 74% of patients underwent both motor and language mapping with a mean duration of 103.3 ± 5.1 min. An overall positive response was noted from the results of the questionnaire, tiredness and anxiety being the common effects noted. Patients with the left-sided disease appreciated more the conditions provided in our laboratory (Q4, p = 0.040) and increasing age was related to less confidence and trust (Q6, p = 0.038) in the staff performing the exam. Younger patients tolerated nTMS better than older patients (> 65 years). PubMed literature search resulted in no relevant articles on the use of PREMs in nTMS patients. CONCLUSION nTMS is a well-tolerated non-invasive tool and nTMS-PREMS provides a promising role in identifying the unmet needs of the patients and improving the quality of their care.
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Dijkstra HP, Ergen E, Holtzhausen L, Beasley I, Alonso JM, Geertsema L, Geertsema C, Nelis S, Ngai ASH, Stankovic I, Targett S, Andersen TE. Remote assessment in sport and exercise medicine (SEM): a narrative review and teleSEM solutions for and beyond the COVID-19 pandemic. Br J Sports Med 2020; 54:1162-1167. [PMID: 32605933 PMCID: PMC7513251 DOI: 10.1136/bjsports-2020-102650] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2020] [Indexed: 12/12/2022]
Abstract
Background The COVID-19 pandemic forces sport and exercise medicine (SEM) physicians to think differently about the clinical care of patients. Many rapidly implement eHealth and telemedicine solutions specific to SEM without guidance on how best to provide these services. Aim The aim of this paper is to present some guiding principles on how to plan for and perform an SEM consultation remotely (teleSEM) based on a narrative review of the literature. A secondary aim is to develop a generic teleSEM injury template. Results eHealth and telemedicine are essential solutions to effective remote patient care, also in SEM. This paper provides guidance for wise planning and delivery of teleSEM. It is crucial for SEM physicians, technology providers and organisations to codesign teleSEM services, ideally involving athletes, coaches and other clinicians involved in the clinical care of athletes, and to gradually implement these services with appropriate support and education. Conclusion teleSEM provides solutions for remote athlete clinical care during and after the COVID-19 pandemic. We define two new terms—eSEM and teleSEM and discuss guiding principles on how to plan for and perform SEM consultations remotely (teleSEM). We provide an example of a generic teleSEM injury assessment guide.
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Affiliation(s)
- H Paul Dijkstra
- Department of Medical Education, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar .,Department for Continuing Education, University of Oxford, Oxford, UK
| | - Emin Ergen
- Sports Medicine Department, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar
| | - Louis Holtzhausen
- Sports Medicine Department, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar.,Section Sports Medicine, University of Pretoria Faculty of Health Sciences, Pretoria, South Africa
| | - Ian Beasley
- Sports Medicine Department, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar.,The Royal Ballet, London, UK
| | - Juan Manuel Alonso
- Sports Medicine Department, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar
| | - Liesel Geertsema
- Sports Medicine Department, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar
| | - Celeste Geertsema
- Sports Medicine Department, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar
| | - Sofie Nelis
- Department of Medical Education, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar
| | - Aston Seng Huey Ngai
- Sports Medicine Department, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar
| | - Ivan Stankovic
- Department of Medical Education, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar
| | - Stephen Targett
- Sports Medicine Department, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar
| | - Thor Einar Andersen
- Sports Medicine Department, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar.,Department of Sports Medicine, Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
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Pompeo-Fargnoli A, Fargnoli AS. Mental health treatment to assist in heart disease improved outcomes. J Health Psychol 2019; 26:1119-1125. [PMID: 31311333 DOI: 10.1177/1359105319864643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In this commentary, we highlight key scientific advancements in the area of depression and heart disease dual diagnosis, to explore how new approaches can be integrated from a mental health counseling perspective. The incorporation of mental health counseling is suggested as an aid in the treatment of patients with a cardiac disease diagnosis. However, there is no structured awareness or training program for mental health counselors to associate depression with heart disease since this involves both a high level of interdisciplinary research and collaboration with existing healthcare providers. Alongside rampant calls for changes in our modern healthcare system, new holistic practices may emerge, placing mental health services at the forefront to assist in improving cardiac disease patient outcomes.
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25
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Bodegård H, Helgesson G, Juth N, Olsson D, Lynøe N. Challenges to patient centredness - a comparison of patient and doctor experiences from primary care. BMC FAMILY PRACTICE 2019; 20:83. [PMID: 31202259 PMCID: PMC6570949 DOI: 10.1186/s12875-019-0959-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 04/30/2019] [Indexed: 12/02/2022]
Abstract
Background We designed this observational study to investigate the level of patients’ and doctors’ ratings of patient-centred aspects of the primary care consultation. Methods Questionnaire study with patients and doctors. Consecutive patients in a primary care setting and 16 doctors responding post visit. Results are presented as proportions with 95% confidence intervals. Results 411 questionnaires, 223 from patients and 188 from doctors, covered 251 consultations. Both patients and doctors gave the highest possible estimations on the aspects of patient-centred communication and satisfaction less frequently when the patient had other reasons for visit than purely somatic. Unlike the doctors’ estimations, the frequency of highest possible estimations in patient responses dropped if the patients had two to six reasons for visit rather than one. Among the six patient-centred aspects, both patients and doctors gave the highest possible estimation least frequently on the aspect of shared decision-making. Conclusion The results suggest that the nature of the reason, as well as the number of reasons for visit, interferes with the doctors’ level of patient-centred communication. Our results furthermore confirm the findings of previous studies that doctors insufficiently involve patients in their care. Electronic supplementary material The online version of this article (10.1186/s12875-019-0959-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Helene Bodegård
- Stockholm Centre for Healthcare Ethics, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Tomtebodavägen 18 A, 171 77, Stockholm, Sweden.
| | - Gert Helgesson
- Stockholm Centre for Healthcare Ethics, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Tomtebodavägen 18 A, 171 77, Stockholm, Sweden
| | - Niklas Juth
- Stockholm Centre for Healthcare Ethics, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Tomtebodavägen 18 A, 171 77, Stockholm, Sweden
| | - Daniel Olsson
- Unit of Medical Statistics, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden
| | - Niels Lynøe
- Stockholm Centre for Healthcare Ethics, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Tomtebodavägen 18 A, 171 77, Stockholm, Sweden
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26
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Brito Fernandes Ó, Baji P, Kringos D, Klazinga N, Gulácsi L, Lucevic A, Boncz I, Péntek M. Patient experiences with outpatient care in Hungary: results of an online population survey. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:79-90. [PMID: 31098884 PMCID: PMC6544599 DOI: 10.1007/s10198-019-01064-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 04/13/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Health systems are undertaking efforts to make health care more patient centered and value based. To achieve this goal, the use of patient-reported experience measures (PREMs) is increasing, especially across OECD countries. However, in Hungary, data on patients' experiences are still lacking. Thus, our aim was twofold: first, to collect data on outpatient experience in Hungary on patient-doctor communication and patient involvement in decision making and compare it with that of other OECD countries; second, to assess associations of outpatient experience with patients' socioeconomic characteristics. METHODS In early 2019, we conducted a cross-sectional, online, self-administered survey in a national representative sample of Hungary's population (n = 1000). The sample was weighted considering gender, age, highest education level attained, type of settlement, and region of residence. The survey questions were based on a set of recommended questions by the OECD. RESULTS Our findings show that the proportion of reported positive experiences is as follows: doctors providing easy-to-understand explanations (93.1%) followed by time spent on the consultation (87.5%), opportunities to raise questions (85.8%), and doctors involving patients in decision making about care and treatment (80.1%). The share of positive experiences falls behind OECD's average regarding patient-doctor communication and patient involvement in decision making, which signals room for improvement in these areas. CONCLUSIONS Women, younger people, people with a paid job, and patients with consultations with allied health professionals reported significant lesser positive care experiences and, hence, more targeted policies can be initiated based on our findings.
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Affiliation(s)
- Óscar Brito Fernandes
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8., Budapest, 1093, Hungary
- Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Petra Baji
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8., Budapest, 1093, Hungary
| | - Dionne Kringos
- Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Niek Klazinga
- Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - László Gulácsi
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8., Budapest, 1093, Hungary
| | - Armin Lucevic
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8., Budapest, 1093, Hungary
- Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Imre Boncz
- Institute for Health Insurance, Faculty of Health Sciences, University of Pécs, Mária u. 5-7, Pécs, 7621, Hungary
| | - Márta Péntek
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8., Budapest, 1093, Hungary.
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Lawford BJ, Bennell KL, Campbell PK, Kasza J, Hinman RS. Therapeutic Alliance Between Physical Therapists and Patients With Knee Osteoarthritis Consulting Via Telephone: A Longitudinal Study. Arthritis Care Res (Hoboken) 2019; 72:652-660. [PMID: 30927509 DOI: 10.1002/acr.23890] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 03/26/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To explore therapeutic alliance between physical therapists and patients with knee osteoarthritis during telephone consultations. Specifically, to describe and compare physical therapist and patient ratings, to determine whether alliance changes over time, and to evaluate whether individual characteristics are associated with alliance. METHODS We performed a secondary analysis of 84 patients in the intervention arm of a randomized controlled trial who completed 5-10 consultations with 1 of 8 physical therapists via telephone over 26 weeks, involving education, advice, and prescription of a strengthening and physical activity program. Therapeutic alliance was measured after the second (week 4) and final consultations (week 26), using the Working Alliance Inventory-Short Form. RESULTS Patient and physical therapist ratings of the alliance were high. At week 4, patients rated the overall alliance, and all 3 subscales, higher than therapists. At 26 weeks, patients rated the Task subscale higher than therapists. Patient ratings for the Goal subscale decreased over time, while physical therapist ratings for total alliance and the Bond subscale increased. For patients, the variables of living with others, consulting with a therapist with no previous experience delivering care remotely, having more telephone consultations, and having a higher self-efficacy were associated with greater alliance ratings. Therapists were more likely to perceive a stronger alliance if they had less clinical experience and when treating patients who were younger and had higher self-efficacy. CONCLUSION Physical therapist perceptions of the therapeutic alliance tended to be lower than those of patients early in treatment, but differences were small and of unclear clinical significance. Some subgroups of patients rated the alliance more strongly than others.
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Affiliation(s)
| | - Kim L Bennell
- University of Melbourne, Parkville, Victoria, Australia
| | | | | | - Rana S Hinman
- University of Melbourne, Parkville, Victoria, Australia
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28
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Klewitz F, Nöhre M, Bauer-Hohmann M, Tegtbur U, Schiffer L, Pape L, Schiffer M, de Zwaan M. Information Needs of Patients About Immunosuppressive Medication in a German Kidney Transplant Sample: Prevalence and Correlates. Front Psychiatry 2019; 10:444. [PMID: 31316406 PMCID: PMC6609567 DOI: 10.3389/fpsyt.2019.00444] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 06/04/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Worldwide clinical guidelines for the care of kidney transplant (KT) recipients recognize the importance of health care providers imparting appropriate immunosuppressive medication (ISM) information for the facilitation of safe medication self-management. The extent of medication information made available is, however, not necessarily what patients require to know about their prescribed medicines. A useful indicator for determining the quality of prescription practice is to what degree the provided information meets the personal needs of patients. No previous studies have focused on the ISM information needs of KT patients. This study aims to investigate how satisfied KT patients are with the provided ISM information and to examine the association between satisfaction levels and socio-demographic, psychosocial, and transplant-related variables. Materials and Methods: KT patients (n = 440) were asked to complete a series of self-report questionnaires to evaluate the variables adherence, ISM experience, perceived social support, symptoms of anxiety, and depression, and transplant-related information (e.g., donation type). ISM information needs were assessed with the Satisfaction with Information about Medicines Scale (SIMS-D). Results: On average, 35.9% of the answers to the SIMS-D items indicated dissatisfaction with the received information; dissatisfaction was more prevalent for the SIMS-D subscale "potential problems" (46.1%) than the SIMS-D subscale "action and usage" (26.7%). On an individual item level, the dissatisfaction with information concerning ISM side effects on drowsiness (57.1%) and sex life (56.3%) was most notable. Higher satisfaction with ISM information was correlated with higher age, better adherence, higher perceived social support, and lower anxiety levels. Multiple linear regression analyses revealed that adherence, perceived social support, and age were independently associated with ISM information satisfaction. No associations were found with sex, educational level, partnership status, symptoms of depression, experience of side effects, and transplant-related variables. Discussion: The data indicate that a substantial proportion of KT patients have unmet ISM information needs, especially with regard to potential problems of ISM. Dissatisfaction with ISM information is a potential amendable risk factor for KT patients engaging in non-adherent behavior, thus justifying further research in this area. ISM information should be tailored to meet the individual needs of KT patients in order to promote optimal medication self-management and adherence behavior.
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Affiliation(s)
- Felix Klewitz
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany.,Project Kidney Transplantation 360° (NTX 360°), Hannover Medical School, Hannover, Germany
| | - Mariel Nöhre
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany.,Project Kidney Transplantation 360° (NTX 360°), Hannover Medical School, Hannover, Germany
| | - Maximilian Bauer-Hohmann
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany.,Project Kidney Transplantation 360° (NTX 360°), Hannover Medical School, Hannover, Germany
| | - Uwe Tegtbur
- Project Kidney Transplantation 360° (NTX 360°), Hannover Medical School, Hannover, Germany.,Department of Sports Medicine, Hannover Medical School, Hannover, Germany
| | - Lena Schiffer
- Project Kidney Transplantation 360° (NTX 360°), Hannover Medical School, Hannover, Germany.,Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Lars Pape
- Project Kidney Transplantation 360° (NTX 360°), Hannover Medical School, Hannover, Germany.,Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Mario Schiffer
- Project Kidney Transplantation 360° (NTX 360°), Hannover Medical School, Hannover, Germany.,Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany.,Project Kidney Transplantation 360° (NTX 360°), Hannover Medical School, Hannover, Germany
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Aziz MM, Ji W, Masood I, Farooq M, Malik MZ, Chang J, Jiang M, Atif N, Fang Y. Patient Satisfaction with Community Pharmacies Services: A Cross-Sectional Survey from Punjab; Pakistan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15122914. [PMID: 30572667 PMCID: PMC6313509 DOI: 10.3390/ijerph15122914] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 12/02/2018] [Accepted: 12/03/2018] [Indexed: 01/28/2023]
Abstract
Purpose: Patient satisfaction can identify specific areas of improvement in community pharmacy services. Currently in Pakistan, no evidence exists in this regard. This study was conducted to determine the needs of patients and the current standards of pharmacies. Methods: A cross-sectional study was conducted between October 2016 and June 2017. A pilot tested questionnaire was used to collected the data from 1088 patients of 544 community pharmacies. Likert scale and one way ANOVA was used to analyze the data. Results: The response rate of community pharmacies was 80% and that of purchasers was 68.1%. The mean age of participants was 35.2 years. The mean overall satisfaction score of participants was 2.78/5.00. Many patients were dissatisfied (1.65/5.00) with parking facilities provided by pharmacies. Pharmacy service time fulfilled the requirements of most patients (4.16/5.00). The counseling person’s good attitude (3.99/5.00) was credited by purchasers. Level of patient satisfaction with the availability of medicines (3.19/5.00), safe storage of medicines in pharmacy stores (3.66/5.00), and quality of medicines (3.41/5.00) were almost moderate. Many patients were very satisfied (4.35/5.00) with readable instructions for their medications. Approximately half of the patients were dissatisfied with the waiting time. Many patients were also dissatisfied (2.28/5.00) with the knowledge of the counseling person. Patients perceived that staff interest in patient recovery (2.24/5.00) was low. No significant difference in level of satisfaction with regard to participant’s characteristics was found. Conclusions: The current study demonstrated a low level of patient satisfaction with regard to community pharmacy services in Pakistan. These services need improvement.
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Affiliation(s)
- Muhammad Majid Aziz
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an 710061, China.
- The Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an 710061, China.
- Global Health Institute, Xi'an Jiaotong University, Xi'an 710061, China.
- Shaanxi Center for Health Reform and Development Research, Xi'an 710061, China.
| | - Wenjing Ji
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an 710061, China.
- The Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an 710061, China.
- Global Health Institute, Xi'an Jiaotong University, Xi'an 710061, China.
- Shaanxi Center for Health Reform and Development Research, Xi'an 710061, China.
| | - Imran Masood
- Department of Pharmacy, Faculty of Pharmacy and Alternative Medicine, Railway Road Campus, Islamia University, Bahawalpur 63100, Pakistan.
| | - Muhammad Farooq
- Faculty of pharmacy, University of Lahore, Lahore 54000, Pakistan.
| | - Muhammad Zubair Malik
- Department of Pharmacy, University of Sargodha, University Road Sargodha, Punjab 40100, Pakistan.
| | - Jie Chang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an 710061, China.
- The Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an 710061, China.
- Global Health Institute, Xi'an Jiaotong University, Xi'an 710061, China.
- Shaanxi Center for Health Reform and Development Research, Xi'an 710061, China.
| | - Minghuan Jiang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an 710061, China.
- The Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an 710061, China.
- Global Health Institute, Xi'an Jiaotong University, Xi'an 710061, China.
- Shaanxi Center for Health Reform and Development Research, Xi'an 710061, China.
| | - Naveel Atif
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an 710061, China.
- The Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an 710061, China.
- Global Health Institute, Xi'an Jiaotong University, Xi'an 710061, China.
- Shaanxi Center for Health Reform and Development Research, Xi'an 710061, China.
- University College of Pharmacy, University of the Punjab, Shahra-i-Quaid-e-Azam, Lahore 54000, Pakistan.
| | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an 710061, China.
- The Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an 710061, China.
- Global Health Institute, Xi'an Jiaotong University, Xi'an 710061, China.
- Shaanxi Center for Health Reform and Development Research, Xi'an 710061, China.
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30
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Ke P, Jiang F, Wu D, Ke L, Lin Z, Jia J, Ye B, Liu B. A third-party investigation of inpatient satisfaction with a tertiary hospital in People's Republic of China. Patient Prefer Adherence 2018; 12:2027-2037. [PMID: 30349199 PMCID: PMC6188104 DOI: 10.2147/ppa.s176471] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Conflicts between doctors and patients occur in People's Republic of China each year. Serious negative relationships between doctors and patients are a significant social problem. This study aims to evaluate the satisfaction of inpatients in a tertiary hospital through a third party and analyze the relationship between sociodemographic characteristics and overall satisfaction. PATIENTS AND METHODS A cross-sectional investigation was conducted to obtain the demographic information and results for 20 items in an inpatient satisfaction questionnaire. A total of 872 inpatients were studied. Descriptive analysis was conducted using SPSS version 22.0 software. Independent sample t-tests and one-way ANOVA were used to compare the mean differences between groups. Multiple linear regression analysis was conducted to study the relationship between different demographic characteristics and overall satisfaction. P-values of <0.05 were considered significant. Matrix analysis was used to predict which of the 20 items had a higher priority for patient satisfaction. RESULTS Among the respondents, valid questionnaires were completed by 872 patients, with a response rate of 94.47% (872/923). The hospital inpatient satisfaction score was 84.92±10.34. Among the sociodemographic characteristics, education status, occupation, annual income, residence and frequency of visits were related to inpatient satisfaction and were statistically significant (P<0.05). However, sex, age and marital status were not significantly different in terms of the inpatient satisfaction score (P>0.05). Multiple linear regression analysis results showed that residence, age, occupation and education status were the factors affecting inpatient satisfaction. In further analyses, diet management, medical expenses, complaint management and hospital environment were in urgent need of improvement. CONCLUSION The overall level of inpatient satisfaction with this hospital seems to be acceptable, although areas for improvement remain.
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Affiliation(s)
- Pan Ke
- Health Management and Health Development Research Center of Hubei University of Medicine, Shiyan, People's Republic of China,
| | - Fengbo Jiang
- Postgraduate Training Base of Hubei University of Medicine, Jinzhou Medical University, Jinzhou, People's Republic of China
| | - Dongmei Wu
- Department of Cardiology Three Wards, Shiyan Taihe Hospital (The Affiliated Hospital of Hubei University of Medicine), Shiyan, People's Republic of China
| | - Li Ke
- Postgraduate Training Base of Hubei University of Medicine, Jinzhou Medical University, Jinzhou, People's Republic of China
| | - Zi Lin
- Postgraduate Training Base of Hubei University of Medicine, Jinzhou Medical University, Jinzhou, People's Republic of China
| | - Jia Jia
- Postgraduate Training Base of Hubei University of Medicine, Jinzhou Medical University, Jinzhou, People's Republic of China
| | - Baoxia Ye
- Department of Cardiology Three Wards, Shiyan Taihe Hospital (The Affiliated Hospital of Hubei University of Medicine), Shiyan, People's Republic of China
| | - Bing Liu
- Health Management and Health Development Research Center of Hubei University of Medicine, Shiyan, People's Republic of China,
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Xiong C, Chen X, Zhao X, Liu C. Patient satisfaction and gender composition of physicians - a cross-sectional study of community health services in Hubei, China. BMC Health Serv Res 2018; 18:217. [PMID: 29587723 PMCID: PMC5870243 DOI: 10.1186/s12913-018-3011-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Accepted: 03/15/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient satisfaction is associated with both individual (patients and health workers) and organizational (health facilities) characteristics. This study aimed to establish a link between patient satisfaction and gender composition of physicians in community health service (CHS) organizations. METHODS Participants were selected through multistage stratified random sampling: 36 CHS centers were selected from six municipalities in Hubei, China. All physicians on duty and patients visiting the CHS during the study period (from April to October in 2015) were invited to participate in this study: 324 physicians and 865 patients completed a questionnaire survey. Multilevel linear regression analyses were performed to determine the associations of patient satisfaction (scored from 1 to 5) with patient characteristics (gender, age, education, income, medical expense, frequency of visits to the CHS) and organizational features of the CHS (sex ratio of physicians, and gender differences of physicians in education and job satisfaction). RESULTS Older patients and those with a higher medical bill had a lower degree of satisfaction (p < 0.05). At the organizational level: a higher proportion of male physicians weakened the negative association between patient age and patient satisfaction (p < 0.05); a larger gap in university qualifications between male and female physicians exacerbated the negative association between patient age and patient satisfaction (p < 0.05). CONCLUSIONS The gender composition of physicians in CHSs is associated with patient satisfaction in the Chinese context: a larger gap (in number and qualifications) between male and female physicians is associated with higher patient satisfaction. Further studies are needed to explore the cultural roots of such an association.
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Affiliation(s)
- Change Xiong
- Change Xiong, Department of Social Medicine and Health Management, School of Basic Medical Science, Hubei University of Science and Technology, 88 Xianning Road, Xianning, 437100, People's Republic of China.
| | - Xiao Chen
- Xiao Chen, Institute of Medicine, Hubei University of Science and Technology, 88 Xianning Road, Xianning, 437100, People's Republic of China.
| | - Xinyuan Zhao
- Xinyuan Zhao, School of Clinic Medical Science, Hubei University of Science and Technology, Xianning, 437100, People's Republic of China
| | - Chaojie Liu
- Chaojie Liu, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, 3086, Australia
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32
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Soares CC, Marques AM, Clarke P, Klein R, Koskinen L, Krasuckiene D, Lamsodiene E, Piscalkiene V, Küçükgüçlü Ö. Older people's views and expectations about the competences of health and social care professionals: a European qualitative study. Eur J Ageing 2018; 16:53-62. [PMID: 30886560 DOI: 10.1007/s10433-018-0466-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Adapting and providing quality services for people as they age is a common challenge across Europe. The perspective of older people is fundamental in a person-centred care approach. Expanding research at the European level that explicitly includes their views can offer a relevant contribution to the development of evidence-based guidelines that can be shared in education and training across health and social care professions. This study aimed to identify common meaningful dimensions of professional competence in health and social care emphasised by older people from six countries in different regions of Europe according to their experiences. A qualitative approach was chosen with a total of 95 semi-structured interviews conducted in Austria, Finland, Lithuania, Portugal, Turkey and UK, following a common topic guide. Participants in this study were aged 60 and above, and recruitment considered age, gender, level of education and living arrangements. Results identified a set of universal skills and practices that according to older people, health and social care professionals should meet. Competences at the interpersonal level were central in older people's discourses, and its core dimensions are anchored in relational, communication and socio-emotional skills of professionals. These findings reinforce the aspiration of establishing best practices in care that relies on the harmonisation of a competence framework that can be shared in the training and education of health and social care professionals across Europe and that voices older people's preferences, expectations and needs.
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Affiliation(s)
- Célia Casaca Soares
- 1Department of Social Sciences and Humanities, School of Health, Centre for Interdisciplinary Applied Research in Health, Instituto Politecnico de Setúbal, Campus do IPS, Estefanilha, Setúbal, 2910-761 Portugal.,2Centro de Investigação e Intervenção Social (CIS-IUL), Instituto Universitário de Lisboa (ISCTE-IUL), Av. das Forças Armadas, Lisboa, 1649-026 Portugal
| | - António Manuel Marques
- 1Department of Social Sciences and Humanities, School of Health, Centre for Interdisciplinary Applied Research in Health, Instituto Politecnico de Setúbal, Campus do IPS, Estefanilha, Setúbal, 2910-761 Portugal.,2Centro de Investigação e Intervenção Social (CIS-IUL), Instituto Universitário de Lisboa (ISCTE-IUL), Av. das Forças Armadas, Lisboa, 1649-026 Portugal
| | - Pat Clarke
- 3School of Nursing and Allied Health, Liverpool John Moores University, Henry Cotton, 15/21 Webster St., Liverpool, L3 2ET UK
| | - Regina Klein
- 4Department Health + Social Care, Carinthia University of Applied Sciences, Hauptplatz 11, 9560 Feldkirchen, Austria
| | - Liisa Koskinen
- 5School of Health Care, Savonia University of Applied Sciences, PL 6 (Microkatu 1), 70201 Kuopio, Finland
| | - Daine Krasuckiene
- 6Faculty of Medicine, Kaunas University of Applied Sciences, Pramones pr. 20, 50468 Kaunas, Lithuania
| | - Evelina Lamsodiene
- 6Faculty of Medicine, Kaunas University of Applied Sciences, Pramones pr. 20, 50468 Kaunas, Lithuania
| | - Viktorija Piscalkiene
- 6Faculty of Medicine, Kaunas University of Applied Sciences, Pramones pr. 20, 50468 Kaunas, Lithuania
| | - Özlem Küçükgüçlü
- 7Department of Internal Medicine Nursing, Dokuz Eylul University, Inciralti İzmir, Turkey
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Ekerstad N, Östberg G, Johansson M, Karlson BW. Are frail elderly patients treated in a CGA unit more satisfied with their hospital care than those treated in conventional acute medical care? Patient Prefer Adherence 2018; 12:233-240. [PMID: 29445266 PMCID: PMC5808689 DOI: 10.2147/ppa.s154658] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Our aim was to study whether the acute care of frail elderly patients directly admitted to a comprehensive geriatric assessment (CGA) unit is superior to the care in a conventional acute medical care unit in terms of patient satisfaction. DESIGN TREEE (Is the TReatment of frail Elderly patients Effective in an Elderly care unit?) is a clinical, prospective, controlled, one-center intervention trial comparing acute treatment in CGA units and in conventional wards. SETTING This study was conducted in the NÄL-Uddevalla county hospital in western Sweden. PARTICIPANTS In this follow-up to the TREEE study, 229 frail patients, aged ≥75 years, in need of acute in-hospital treatment, were eligible. Of these patients, 139 patients were included in the analysis, 72 allocated to the CGA unit group and 67 to the conventional care group. Mean age was 85 years and 65% were female. INTERVENTION Direct admittance to an acute elderly care unit with structured, systematic interdisciplinary CGA-based care, compared to conventional acute medical care via the emergency room. MEASUREMENTS The primary outcome was the satisfaction reported by the patients shortly after discharge from hospital. A four-item confidential questionnaire was used. Responses were given on a 4-graded scale. RESULTS The response rate was 61%. In unadjusted analyses, significantly more patients in the intervention group responded positively to the following three questions about the hospitalization: "Did you get the nursing from the ward staff that you needed?" (p=0.003), "Are you satisfied with the information you received on your diseases and medication?" (p=0.016), and "Are you satisfied with the planning before discharge from the hospital?" (p=0.032). After adjusted analyses by multiple regression, a significant difference in favor of the intervention remained for the first question (p=0.027). CONCLUSION Acute care in a CGA unit with direct admission was associated with higher levels of patient satisfaction compared with conventional acute care via the emergency room.
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Affiliation(s)
- Niklas Ekerstad
- Department of Cardiology, NU (NÄL-Uddevalla) Hospital Group, Trollhättan-Uddevalla-Vänersborg
- Department of Medical and Health Sciences, Division of Health Care Analysis, Linköping University, Linköping
- Correspondence: Niklas Ekerstad, Department of Cardiology, NU (NAL-Uddevalla) Hospital Group, Lärketorpsvägen, 46100 Trollhättan, Sweden, Tel +46 736 249 652, Fax +46 104 357 129, Email
| | - Göran Östberg
- Division of Internal and Acute Medicine, NU Hospital Group, Trollhättan-Uddevalla-Vänersborg
| | - Maria Johansson
- Division of Internal and Acute Medicine, NU Hospital Group, Trollhättan-Uddevalla-Vänersborg
| | - Björn W Karlson
- Division of Internal and Acute Medicine, NU Hospital Group, Trollhättan-Uddevalla-Vänersborg
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Lafata JE, Shay LA, Winship JM. Understanding the influences and impact of patient-clinician communication in cancer care. Health Expect 2017; 20:1385-1392. [PMID: 28636108 PMCID: PMC5689225 DOI: 10.1111/hex.12579] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2017] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Patient-clinician communication is thought to be central to care outcomes, but when and how communication affects patient outcomes is not well understood. OBJECTIVE We propose a conceptual model and classification framework upon which the empirical evidence base for the impact of patient-clinician communication can be summarized and further built. DESIGN We use the proposed model and framework to summarize findings from two recent systematic reviews, one evaluating the use of shared decision making (SDM) on cancer care outcomes and the other evaluating the role of physician recommendation in cancer screening use. KEY RESULTS Using this approach, we identified clusters of studies with positive findings, including those relying on the measurement of SDM from the patients' perspective and affective-cognitive outcomes, particularly in the context of surgical treatment decision making. We also identify important gaps in the literature, including the role of SDM in post-surgical treatment and end-of-life care decisions, and those specifying particular physician communication strategies when recommending cancer screening. CONCLUSIONS Transparent linkages between key conceptual domains and the influence of methodological approaches on observed patient outcomes are needed to advance our understanding of how and when patient-clinician communication influences patient outcomes. The proposed conceptual model and classification framework can be used to facilitate the translation of empirical evidence into practice and to identify critical gaps in knowledge regarding how and when patient-clinician communication impacts care outcomes in the context of cancer and health care more broadly.
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Affiliation(s)
- Jennifer Elston Lafata
- UNC Lineberger Comprehensive Cancer Center and UNC Eshelman School of PharmacyThe University of North CarolinaChapel HillNCUSA
| | | | - Jodi M. Winship
- School of MedicineVirginia Commonwealth UniversityRichmondVAUSA
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Abstract
OBJECTIVE The goal of this study was to analyze the persistence with antiepileptic drugs (AED) and associated factors in patients followed in neurological practices in Germany. METHODS This study included patients aged 18years or over who received two initial diagnoses of epilepsy and a first prescription of AED between 2007 and 2015 in a neurological practice (index date). The main outcome measure was the rate of AED persistence within five years of the index date. Kaplan-Meier analyses were performed to study treatment persistence as a function of age. A Cox proportional hazards regression model was used to estimate the relationship between non-persistence and demographic/clinical variables. RESULTS A total of 8192 patients followed in neurological practices were included. After five years of follow-up, 41.1% (≤40years), 45.2%, (41-60years) and 50.1% (>60years) of patients followed in neurological practices were persistent (log-rank p-value<0.001). A negative association was found between discontinuation and age (≤40years vs. >60years: OR=1.19, 95% CI: 1.09-1.31; 41-60years vs. >60years: OR=1.10, 95% CI: 1.01-1.19). Furthermore, patients receiving old AED (OR=1.16, 95% CI: 1.01-1.34) or gabapentin (OR=1.46, 95% CI: 1.16-1.83) and those diagnosed with depression (OR=1.12, 95% CI: 1.03-1.21) were at a higher risk of non-persistence, whereas those receiving levetiracetam (OR=0.69, 95% CI: 0.60-0.80) or lamotrigine (OR=0.88, 95% CI: 0.79-0.97) and those with dementia (OR=0.74, 95% CI: 0.65-0.83) were at a lower risk. CONCLUSIONS The rate of epilepsy patients persistent with AED was low after five years of treatment. Age, gender, co-morbidities, and drug characteristics were associated with this persistence.
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Influences on patient satisfaction in healthcare centers: a semi-quantitative study over 5 years. BMC Health Serv Res 2017; 17:361. [PMID: 28526039 PMCID: PMC5438500 DOI: 10.1186/s12913-017-2307-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 05/11/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Knowledge of ambulatory patients' satisfaction with clinic visits help improve communication and delivery of healthcare. The goal was to examine patient satisfaction in a primary care setting, identify how selected patient and physician setting and characteristics affected satisfaction, and determine if feedback provided to medical directors over time impacted patient satisfaction. METHODS A three-phase, semi-quantitative analysis was performed using anonymous, validated patient satisfaction surveys collected from 889 ambulatory outpatients in 6 healthcare centers over 5-years. Patients' responses to 21 questions were analyzed by principal components varimax rotated factor analysis. Three classifiable components emerged: Satisfaction with Physician, Availability/Convenience, and Orderly/Time. To study the effects of several independent variables (location of clinics, patients' and physicians' age, education level and duration at the clinic), data were subjected to multivariate analysis of variance (MANOVA).. RESULTS Changes in the healthcare centers over time were not significantly related to patient satisfaction. However, location of the center did affect satisfaction. Urban patients were more satisfied with their physicians than rural, and inner city patients were less satisfied than urban or rural on Availability/Convenience and less satisfied than urban patients on Orderly/Time. How long a patient attended a center most affected satisfaction, with patients attending >10 years more satisfied in all three components than those attending <1-5 years. Level of education affected patients' satisfaction only in the component Orderly/Time; patients without a high school education were significantly less satisfied than those with more. Patients in their 40's were significantly less satisfied in Availability/Convenience than those >60 years old. Patients were significantly more satisfied with their 30-40 year-old physicians compared with those over 60. On Orderly/Time, patients were more satisfied with physicians who were in their 50's than physicians >60. CONCLUSIONS Improvement in patient satisfaction includes a need for immediate, specific feedback. Although Medical Directors received feedback yearly, we found no significant changes in patient satisfaction over time. Our results suggest that, to increase satisfaction, patients with lower education, those who are sicker, and those who are new to the center likely would benefit from additional high quality interactions with their physicians.
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Cohen JM, Blustein J, Weinstein BE, Dischinger H, Sherman S, Grudzen C, Chodosh J. Studies of Physician-Patient Communication with Older Patients: How Often is Hearing Loss Considered? A Systematic Literature Review. J Am Geriatr Soc 2017; 65:1642-1649. [DOI: 10.1111/jgs.14860] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Jamie M. Cohen
- State University of New York Upstate Medical University; Syracuse New York
| | - Jan Blustein
- Wagner Graduate School of Public Service, New York University; New York New York
- Department of Population Health; New York University School of Medicine; New York New York
| | - Barbara E. Weinstein
- Doctor of Audiology Program; The Graduate Center, City University of New York; New York New York
| | - Hannah Dischinger
- Oregon Health & Science University School of Medicine; Portland Oregon
| | - Scott Sherman
- Department of Population Health; New York University School of Medicine; New York New York
- Division of Geriatric Medicine and Palliative Care, Department of Medicine; New York University School of Medicine; New York New York
| | - Corita Grudzen
- Department of Emergency Medicine; New York University School of Medicine; New York New York
| | - Joshua Chodosh
- Department of Population Health; New York University School of Medicine; New York New York
- Division of Geriatric Medicine and Palliative Care, Department of Medicine; New York University School of Medicine; New York New York
- VA New York Harbor Heathcare System; New York New York
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Wu J, Davis-Ajami ML, Noxon V, Lu ZK. Venue of receiving diabetes self-management education and training and its impact on oral diabetic medication adherence. Prim Care Diabetes 2017; 11:162-170. [PMID: 27840086 DOI: 10.1016/j.pcd.2016.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 09/22/2016] [Accepted: 10/16/2016] [Indexed: 10/20/2022]
Abstract
AIMS To determine predictors associated with the diabetes self-management education and training (DSME) venue and its impact on oral antidiabetic (OAD) medication adherence. METHODS The Medical Expenditure Panel Survey household component (MEPS-HC) data (2010-2012) identified adults with diabetes prescribed OAD medication(s) who completed a supplemental Diabetes Care Survey (DCS). Based on the DCS responses to questions about the number and type of DSME venue(s), two groups were created: (1) multiple venues (a physician or health professional plus internet and/or group classes) vs (2) single venue (physician or health professional only). The medication possession ratio (MPR) measured medication adherence, with 0.80 the cut-point defining adherent. Logistic regression examined factors associated with the DSME venue and its effect on OAD medication adherence. RESULTS Of the 2119 respondents, 41.6% received DSME from multiple venues. Age (<65years), education-level (college or higher), high-income, and diet modification were significantly more likely associated with receiving DSME from multiple venues. In single vs multiple venues, medication adherence was suboptimal (mean MPR 0.66 vs 0.64, p=0.245), and venue showed no influence on adherence (OR: 0.92, 95% CI, 0.73-1.16). CONCLUSION Sociodemographic characteristics influence where adults with diabetes receive DSME. Adding different DSME venues may not address suboptimal OAD medication adherence.
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Affiliation(s)
- Jun Wu
- Department of Pharmaceutical & Administrative Sciences, Presbyterian College School of Pharmacy, 307 N. Broad Street, Clinton, SC 29325, USA.
| | - Mary Lynn Davis-Ajami
- Adult Health and Nursing Systems, Virginia Commonwealth University School of Nursing, Richmond, USA
| | - Virginia Noxon
- Department of Clinical Pharmacy & Outcomes Sciences, University of South Carolina, Columbia, USA
| | - Zhiqiang Kevin Lu
- Department of Clinical Pharmacy & Outcomes Sciences, University of South Carolina, Columbia, USA
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Wlodarczyk D, Chylińska J, Lazarewicz M, Rzadkiewicz M, Jaworski M, Adamus M, Haugan G, Lillefjell M, Espnes GA. Enhancing Doctors' Competencies in Communication With and Activation of Older Patients: The Promoting Active Aging (PRACTA) Computer-Based Intervention Study. J Med Internet Res 2017; 19:e45. [PMID: 28228370 PMCID: PMC5343213 DOI: 10.2196/jmir.6948] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Revised: 01/07/2017] [Accepted: 01/29/2017] [Indexed: 01/27/2023] Open
Abstract
Background Demographic changes over the past decades call for the promotion of health and disease prevention for older patients, as well as strategies to enhance their independence, productivity, and quality of life. Objective Our objective was to examine the effects of a computer-based educational intervention designed for general practitioners (GPs) to promote active aging. Methods The Promoting Active Aging (PRACTA) study consisted of a baseline questionnaire, implementation of an intervention, and a follow-up questionnaire that was administered 1 month after the intervention. A total of 151 primary care facilities (response rate 151/767, 19.7%) and 503 GPs (response rate 503/996, 50.5%) agreed to participate in the baseline assessment. At the follow-up, 393 GPs filled in the questionnaires (response rate, 393/503, 78.1%), but not all of them took part in the intervention. The final study group of 225 GPs participated in 3 study conditions: e-learning (knowledge plus skills modelling, n=42), a pdf article (knowledge only, n=89), and control (no intervention, n=94). We measured the outcome as scores on the Patients Expectations Scale, Communication Scale, Attitude Toward Treatment and Health Scale, and Self-Efficacy Scale. Results GPs participating in e-learning demonstrated a significant rise in their perception of older patients’ expectations for disease explanation (Wald χ2=19.7, P<.001) and in perception of motivational aspect of older patients’ attitude toward treatment and health (Wald χ2=8.9, P=.03) in comparison with both the control and pdf article groups. We observed additional between-group differences at the level of statistical trend. GPs participating in the pdf article intervention demonstrated a decline in self-assessed communication, both at the level of global scoring (Wald χ2=34.5, P<.001) and at the level of 20 of 26 specific behaviors (all P<.05). Factors moderating the effects of the intervention were the number of patients per GP and the facility’s organizational structure. Conclusions Both methods were suitable, but in different areas and under different conditions. The key benefit of the pdf article intervention was raising doctors’ reflection on limitations in their communication skills, whereas e-learning was more effective in changing their perception of older patients’ proactive attitude, especially among GPs working in privately owned facilities and having a greater number of assigned patients. Although we did not achieve all expected effects of the PRACTA intervention, both its forms seem promising in terms of enhancing the competencies of doctors in communication with and activation of older patients.
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Affiliation(s)
- Dorota Wlodarczyk
- Second Faculty of Medicine, Department of Medical Psychology, Medical University of Warsaw, Warsaw, Poland
| | - Joanna Chylińska
- Second Faculty of Medicine, Department of Medical Psychology, Medical University of Warsaw, Warsaw, Poland
| | - Magdalena Lazarewicz
- Second Faculty of Medicine, Department of Medical Psychology, Medical University of Warsaw, Warsaw, Poland
| | - Marta Rzadkiewicz
- Second Faculty of Medicine, Department of Medical Psychology, Medical University of Warsaw, Warsaw, Poland
| | - Mariusz Jaworski
- Second Faculty of Medicine, Department of Medical Psychology, Medical University of Warsaw, Warsaw, Poland
| | - Miroslawa Adamus
- Second Faculty of Medicine, Department of Medical Psychology, Medical University of Warsaw, Warsaw, Poland
| | - Gørill Haugan
- NTNU Center for Health Promotion Research, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Monica Lillefjell
- NTNU Center for Health Promotion Research, Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Geir Arild Espnes
- NTNU Center for Health Promotion Research, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
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Johnson DM, Russell RS, White SW. Perceptions of care quality and the effect on patient satisfaction. INTERNATIONAL JOURNAL OF QUALITY & RELIABILITY MANAGEMENT 2016. [DOI: 10.1108/ijqrm-08-2015-0121] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This research models the impact of patient perceptions of care quality on overall patient satisfaction in a rural healthcare organization over a three-year time period. The purpose of this paper is to determine if the factors that influence perceptions of service quality change over time and if the change affects overall patient satisfaction.
Design/methodology/approach
Data were collected for three fiscal years (2012-2014) using a 36-question, Likert-scaled attitudinal survey. Multiple regression analysis was performed to identify which constructs of five different service quality dimensions were statistically significant in predicting overall patient satisfaction. Paired comparison of means and ANOVA F-tests highlighted significant differences across years and demographics.
Findings
Multiple regression models of overall patient satisfaction over a three-year time period had significant repeat variables, indicating salience of the dimensions and constructs of service quality that predict patient satisfaction. However, some dimensions of service quality did not remain significant from one year to another, indicating there may be a gap in the patient service cycle over an extended time frame.
Originality/value
This paper explored the sequential relationship between patient satisfaction survey data and perceptions of service quality over a multi-year time frame. The research focussed on outpatient medical clinics, while the majority of previous studies have focussed on acute care or inpatient stays. A longitudinal study is especially relevant for outpatient clinics where continuity of care is important.
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Haerizadeh M, Moise N, Chang BP, Edmondson D, Kronish IM. Depression and doctor-patient communication in the emergency department. Gen Hosp Psychiatry 2016; 42:49-53. [PMID: 27638972 PMCID: PMC5028124 DOI: 10.1016/j.genhosppsych.2016.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 06/08/2016] [Accepted: 06/09/2016] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Depression may adversely affect health outcomes by influencing doctor-patient communication. We aimed to determine the association between depressive symptoms and doctor-patient communication among patients presenting to the emergency department (ED) with a suspected acute coronary syndrome (ACS). METHOD We enrolled a consecutive sample of 500 patients evaluated for ACS symptoms from the ED of an urban medical center. Depressive symptoms (8-item Patient Health Questionnaire, PHQ-8) and doctor-patient communication in the ED (Interpersonal Processes of Care) were assessed during hospitalization. Logistic regression was used to determine the association between depressive symptoms and doctor-patient communication, adjusting for age, sex, race, ethnicity, education, language, health insurance status and comorbidities. RESULTS Compared to nondepressed patients, depressed patients (PHQ-8≥10) were more likely (P<.05) to report suboptimal communication on five of seven communication domains: clarity, elicitation of concerns, explanations, patient-centered decision making and discrimination. A greater proportion of depressed versus nondepressed patients reported suboptimal overall communication (39.8% versus 22.9%, P<.001). In adjusted analyses, depressed patients remained more likely to report suboptimal doctor-patient communication (adjusted odds ratio 2.42, 95% confidence interval 1.52-3.87; P<.001). CONCLUSIONS Depressed patients with ACS symptoms reported less optimal doctor-patient communication in the ED than nondepressed patients. Research is needed to determine whether subjectively rated differences in communication are accompanied by observable differences.
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Affiliation(s)
- Mytra Haerizadeh
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 W. 168th St., New York, NY 10032, USA
| | - Nathalie Moise
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 W. 168th St., New York, NY 10032, USA
| | - Bernard P Chang
- Department of Emergency Medicine, Columbia University Medical Center, 622 W. 168th St., New York, NY 10032, USA
| | - Donald Edmondson
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 W. 168th St., New York, NY 10032, USA
| | - Ian M Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 W. 168th St., New York, NY 10032, USA.
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Cox CL, Zhu L, Ojha RP, Li C, Srivastava DK, Riley BB, Hudson MM, Robison LL. The unmet emotional, care/support, and informational needs of adult survivors of pediatric malignancies. J Cancer Surviv 2016; 10:743-58. [PMID: 26897613 PMCID: PMC5341614 DOI: 10.1007/s11764-016-0520-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 01/29/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE This study describes the prevalence and predisposing factors for potentially modifiable unmet emotional, care/support, and information needs among adult survivors of childhood malignancies. METHODS A randomly selected/stratified sample of participants in the Childhood Cancer Survivor Study (CCSS) responded to the CCSS-Needs Assessment Questionnaire (CCSS-NAQ) (n = 1189; mean [SD] current age, 39.7 [7.7], range = 26-61 years; 60.9 % women; mean [SD] years since diagnosis, 31.6 [4.7]). Survivors self-reported demographic information, health concerns, and needs; diagnosis/treatment data were obtained from medical records. Adjusted proportional risk ratios (prevalence ratios, PRs) were used to evaluate 77 separate needs. RESULTS Fifty-four percent of survivors reported unmet psycho-emotional, 41 % coping, and 35 % care/support needs; 51, 35, and 33 %, respectively, reported unmet information needs related to cancer/treatment, the health care system, and surveillance. Female sex and annual income <$60K were associated with multiple needs; fewer needs were linked to diagnosis/years since/or age at diagnosis. Having moderate/extreme cancer-related anxiety/fear was associated with all needs, including a >6-fold increased prevalence for help dealing with "worry" (PR = 6.06; 95 % confidence interval [CI], 3.79-9.69) and anxiety (PR = 6.10; 95 % CI, 3.82-9.72) and a >5-fold increased prevalence for "needing to move on with life" (PR = 5.56; 95 % CI, 3.34-9.25) and dealing with "uncertainty about the future" (PR = 5.50; 95 % CI, 3.44-8.77). Radiation exposure and perceived health status were related to 42 and 29 needs, respectively. CONCLUSIONS Demographic factors, disease/treatment characteristics, and intrapersonal factors can be used to profile survivors' unmet emotional, care/support, and information needs. IMPLICATIONS FOR CANCER SURVIVORS These data can be used to enhance provider-survivor communication, identify at-risk subsamples, and appraise core intervention content.
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Affiliation(s)
- Cheryl L Cox
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105-3678, USA.
| | - Liang Zhu
- Department of Biostatistics, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105-3678, USA
| | - Rohit P Ojha
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105-3678, USA
| | - Chenghong Li
- Department of Biostatistics, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105-3678, USA
| | - Deo Kumar Srivastava
- Department of Biostatistics, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105-3678, USA
| | - Barth B Riley
- Department of Health Systems Sciences, University of Illinois-Chicago, 845 S. Damen Avenue, Chicago, IL, 60612, USA
| | - Melissa M Hudson
- Department of Oncology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105-3678, USA
| | - Les L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105-3678, USA
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Baker TA, Roker R, Collins HR, Johnson-Lawrence V, Thorpe RJ, Mingo CA, Vasquez E. Beyond Race and Gender: Measuring Behavioral and Social Indicators of Pain Treatment Satisfaction in Older Black and White Cancer Patients. Gerontol Geriatr Med 2016; 2:2333721415625688. [PMID: 28138486 PMCID: PMC5119862 DOI: 10.1177/2333721415625688] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 12/10/2015] [Accepted: 12/14/2015] [Indexed: 11/16/2022] Open
Abstract
There are a number of factors that influence compliance with prescribed plans of care. However, there remains a need to identify the collective source health, behavioral, and social constructs have on treatment satisfaction. This study aimed to identify indicators of pain treatment satisfaction among older adults receiving outpatient treatment from a comprehensive cancer center in the southeast region of the United States. Data included a sample of 149 Black and White patients diagnosed with cancer, with the majority being White (85%) and female (57%). Patients were surveyed on questions assessing pain treatment satisfaction, pain severity, and additional social characteristics. A series of multivariate models were specified, whereby patients reporting multiple chronic conditions, poor communication, and perceived discrimination were less satisfied with treatment. Positive communication, higher self-efficacy, and fewer perceived discriminatory acts were significant among the female patients only. These findings suggest the need to develop clinical models that assess how these factors influence the degree of treatment satisfaction, while providing a comprehensive mechanism by which to service the long-term needs of older adults.
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Zucca A, Sanson-Fisher R, Waller A, Carey M, Boadle D. The first step in ensuring patient-centred quality of care: ask the patient. Eur J Cancer Care (Engl) 2016; 26. [DOI: 10.1111/ecc.12435] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2015] [Indexed: 11/28/2022]
Affiliation(s)
- A. Zucca
- Health Behaviour Research Group; Priority Research Centre for Health Behaviour; University of Newcastle & Hunter Medical Research Institute, Level 4; Hunter Medical Research Institute; Callaghan NSW Australia
| | - R. Sanson-Fisher
- Health Behaviour Research Group; Priority Research Centre for Health Behaviour; University of Newcastle & Hunter Medical Research Institute, Level 4; Hunter Medical Research Institute; Callaghan NSW Australia
| | - A. Waller
- Health Behaviour Research Group; Priority Research Centre for Health Behaviour; University of Newcastle & Hunter Medical Research Institute, Level 4; Hunter Medical Research Institute; Callaghan NSW Australia
| | - M. Carey
- Health Behaviour Research Group; Priority Research Centre for Health Behaviour; University of Newcastle & Hunter Medical Research Institute, Level 4; Hunter Medical Research Institute; Callaghan NSW Australia
| | - D. Boadle
- Department of Medical Oncology; Royal Hobart Hospital; Hobart TAS Australia
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Klement A, Oemler M, Wienke A, Richter M, Wolfradt U. [(Expected) Consultation length, mental (co-)morbidity and patient satisfaction in the family practice encounter]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2015; 109:560-9. [PMID: 26704817 DOI: 10.1016/j.zefq.2015.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 07/16/2015] [Accepted: 08/24/2015] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Mental disorders are common in family practice, but their meaning for variables of consultation is rarely considered. Thus, we examined the influence of mental disorders on patients' expectations regarding time, openness and seriousness as well as ratings of satisfaction with the consultation. METHODS Prior to consultation for 219 patients a screening for anxiety (GAD-7), depression (PHQ-9) and hypochondriasis (WI-7) was performed. Before and after the consultation patient expectations and ratings were recorded. Subgroup analysis was based on Mann-Whitney U tests. RESULTS Almost half of the sample were screen-positive. Prior the consultation, screen positive patients had higher ratings for expectations compared with screen negative patients, but did not differ in their experiences after the consultation. There was no association between consultation length and ratings for satisfaction. DISCUSSION Patients screened positive for mental disorders do not necessarily require longer consultation length, if their expectations regarding openness and seriousness are met. This is underlines the importance of communication skills in undergraduate medical education and specialist training for future GPs.
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Affiliation(s)
- Andreas Klement
- Sektion Allgemeinmedizin, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland; Profilzentrum für Gesundheitswissenschaften, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland.
| | - Matthias Oemler
- Sektion Allgemeinmedizin, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - Andreas Wienke
- Institut für Medizinische Epidemiologie, Biometrie und Informatik, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland; Profilzentrum für Gesundheitswissenschaften, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - Matthias Richter
- Institut für Medizinische Soziologie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland; Profilzentrum für Gesundheitswissenschaften, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - Uwe Wolfradt
- Institut für Psychologie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
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Russell RS, Johnson DM, White SW. Patient perceptions of quality: analyzing patient satisfaction surveys. INTERNATIONAL JOURNAL OF OPERATIONS & PRODUCTION MANAGEMENT 2015. [DOI: 10.1108/ijopm-02-2014-0074] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– Healthcare facilities are entering an era of increased oversight and heightened expectations concerning both reduced costs and measureable quality. The US Affordable Care Act requires healthcare organizations to collect certain metrics, including patient assessments of quality, in order to monitor and improve the quality of healthcare. These metrics are used as a basis for graduated insurance reimbursements, and are available to consumers as an aid in selecting healthcare providers and insurance plans. The purpose of this paper is to provide healthcare providers with the analytic capabilities to better understand quality of care from the patient’s point of view.
Design/methodology/approach
– This research examines patient satisfaction data from a multi-specialty Medical Practice Group, and uses regression analysis and paired comparisons to provide insight into patient perceptions of care quality.
Findings
– Results show that variables related to Access, Moving Through the Visit, Nurse/Assistant, Care Provider and Personal Issues significantly impact overall assessments of care quality. In addition, while gender and type of care provider do not appear to have an impact on overall patient satisfaction, significant differences do exist based on age group, specialty of the physician and clinic type.
Originality/value
– This study differs from most academic research as it focusses on medical practices, rather than hospitals, and includes multiple clinic types, medical specialties and physician types in the analysis. The study demonstrates how analytics and patient perceptions of quality can inform policy decisions.
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Smith LM, Anderson WL, Kenyon A, Kinyara E, With SK, Teichman L, Dean-Whittaker D, Goldstein E. Racial and Ethnic Disparities in Patients' Experience With Skilled Home Health Care Services. Med Care Res Rev 2015; 72:756-74. [PMID: 26238122 DOI: 10.1177/1077558715597398] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 06/13/2015] [Indexed: 11/16/2022]
Abstract
Racial and ethnic disparities are found in many health care settings; however, there is little prior research on such disparities among patients receiving home health care services. This study used 2012 Home Health Care CAHPS(®) data to identify any overall patient-level disparities in self-reported experience of care and to decompose these disparities according to whether they result from within-agency versus between-agency differences. Although patient experience of care ratings were high across all groups, the study identified consistently lower ratings for all minority groups on two of three Home Health Care CAHPS measures, with Asians reporting the greatest disparities. Three quarters of disparities were found to be within-agency disparities, which were primarily related to care processes and provider/patient communications rather than to specific health care services received. Despite high ratings in general, home health agencies may need to focus on cultural competency initiatives to address racial and ethnic disparities within their agencies.
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Affiliation(s)
| | | | - Anne Kenyon
- RTI International, Research Triangle Park, NC, USA
| | | | - Sarah K With
- RTI International, Research Triangle Park, NC, USA
| | - Lori Teichman
- Centers for Medicare & Medicaid Services, Baltimore, MD, USA
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Satisfaction with pain treatment in older cancer patients: Identifying variants of discrimination, trust, communication, and self-efficacy. J Hosp Palliat Nurs 2013; 15. [PMID: 24363611 DOI: 10.1097/njh.0b013e3182a12c24] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
How satisfied a patient is with their medical treatment may influence compliance and adherence to medical regimens. While a number of studies have examined patient satisfaction among younger populations, few have determined the impact social factors have on satisfaction with pain treatment among older adults. This study aimed to determine the influence discrimination, trust, communication, and other health characteristics have on satisfaction with pain treatment among older adults receiving outpatient services from a comprehensive cancer center. Participants were surveyed on questions assessing pain symptomatology, and identified social (discrimination, trust, and communication), physical (comorbidities, pain interference), behavioral (self-efficacy), and demographic characteristics. Analyses were calculated to determine the total and indirect effects of trust, communication, and self-efficacy as mediators on the perceived discrimination-patient satisfaction with pain treatment relationship. Data showed a significant relationship of communication and discrimination on patient satisfaction. However, none of the mediating effects were significant. It must be recognized that patient satisfaction is contingent upon a myriad of social factors that are not exclusive, but rather coexisting determinants of health. Particularly among the elderly, perceived discrimination and incidences of poor communication may be significant influences on health and the lived day-to-day experiences of this adult population.
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Negotiating Vulnerabilities: How Older Adults with Multiple Chronic Conditions Interact with Physicians. Can J Aging 2013; 33:26-37. [DOI: 10.1017/s0714980813000597] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
RÉSUMÉLa littérature concernant les interactions entre les patients et les médecins a largement ignoré les points de vue des personnes âgées souffrant de comorbidités multiples. Cette étude, avec des données recueillies à partir d’entretiens approfondis avec 16 hommes et 19 femmes qui ont eu une moyenne de six affections chroniques, a porté sur la façon dont les participants ont perçus et vécus les soins fournis par leurs médecins de soins primaires. Les participants ont suggéré que les médecins qui soignent les patients atteints de maladies chroniques multiples devraient être minutieux, prête à “gate-keeping,” fiables et ouvert à différents styles de prise de décision. Cependant, nombreux participants à l’étude ont perçu qu’ils recevaient des soins inadéquats en raison de faiblesses personnelles de leurs médecins, les contraintes de consultations médicales, et l’âgisme sociétal. Par conséquent, beaucoup de participants, surtout les femmes, ont utilisé des diverses stratégies pour maximiser les soins reçus et pour gérer les impressions des médecins à leur egard comme dignes patients. Nos résultats suggèrent que les patients âgés atteints de morbidités multiples perçoivent que leur besoins de santé ne sont pas suffisamment satisfaits.
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Clinician stress and patient-clinician communication in HIV care. J Gen Intern Med 2012; 27:1635-42. [PMID: 22821571 PMCID: PMC3509305 DOI: 10.1007/s11606-012-2157-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 06/11/2012] [Accepted: 06/20/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Clinician stress is common, but few studies have examined its relationship with communication behaviors. OBJECTIVE To investigate associations between clinician stress and patient-clinician communication in primary HIV care. DESIGN Observational study. PARTICIPANTS Thirty-three primary HIV clinicians and 350 HIV-infected adult, English-speaking patients at three U.S. HIV specialty clinic sites. MAIN MEASURES Clinicians completed the Perceived Stress Scale, and we categorized scores in tertiles. Audio-recordings of patient-clinician encounters were coded using the Roter Interaction Analysis System. Patients rated the quality of their clinician's communication and overall quality of medical care. We used regression with generalized estimating equations to examine associations between clinician stress and communication outcomes, controlling for clinician gender, clinic site, and visit length. KEY RESULTS Among the 33 clinicians, 70 % were physicians, 64 % were women, 67 % were non-Hispanic white, and the mean stress score was 3.9 (SD 2.4, range 0-8). Among the 350 patients, 34 % were women, 55 % were African American, 23 % were non-Hispanic white, 16 % were Hispanic, and 30 % had been with their clinicians >5 years. Verbal dominance was higher for moderate-stress clinicians (ratio=1.93, p<0.01) and high-stress clinicians (ratio=1.76, p=0.01), compared with low-stress clinicians (ratio 1.45). More medical information was offered by moderate-stress clinicians (145.5 statements, p <0.01) and high-stress clinicians (125.9 statements, p=0.02), compared with low-stress clinicians (97.8 statements). High-stress clinicians offered less psychosocial information (17.1 vs. 19.3, p=0.02), and patients of high-stress clinicians rated their quality of care as excellent less frequently than patients of low-stress clinicians (49.5 % vs. 66.9 %, p<0.01). However, moderate-stress clinicians offered more partnering statements (27.7 vs. 18.2, p=0.04) and positive affect (3.88 vs. 3.78 score, p=0.02) than low-stress clinicians, and their patients' ratings did not differ. CONCLUSIONS Although higher stress was associated with verbal dominance and lower patient ratings, moderate stress was associated with some positive communication behaviors. Prospective mixed methods studies should examine the complex relationships across the continuum of clinician well-being and health communication.
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