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Balqis-Ali NZ, Saw PS, Anis-Syakira J, Fun WH, Sararaks S, Lee SWH, Abdullah M. Healthcare provider person-centred practice: relationships between prerequisites, care environment and care processes using structural equation modelling. BMC Health Serv Res 2022; 22:576. [PMID: 35488228 PMCID: PMC9052661 DOI: 10.1186/s12913-022-07917-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 04/04/2022] [Indexed: 11/20/2022] Open
Abstract
Background The translation of person-centred care concepts into practice requires fulfilment of necessary components, including person-centred values and practice held by the employees and having a supportive system. The objectives of this study were multifold: firstly, to evaluate the measurement model, secondly, to examine the roles of prerequisite or attributes of healthcare providers and care environment and how they affect delivery of person-centred processes; and finally, to examine the mediating effect of care environment towards the relationship between prerequisite and care processes. Methods A cross sectional study was conducted among healthcare providers working in primary care facilities in a state in Malaysia. The Person-centred Practice Inventory-Staff instrument (PCPI-S) was distributed and completed by respondents. The instrument structure, reliability and validity were assessed through confirmatory factor analysis, while the framework’s unidirectional hypothesis and the mediation path hypothesis were analysed using structural equation modelling. Results The overall goodness of fit verifies the original Person-centred Practice Framework, allowing some correlation errors. There were significant relationships between prerequisites of healthcare providers and care environment (β = 0.826, p < 0.001), as well as between care environment and care processes (β = 0.785, p < 0.001). This analysis also proved that care environment plays a partial mediating role in the relationship between prerequisites and care processes. Conclusions In order to successfully move towards delivering person-centred practice, it is imperative to equip healthcare providers with person-centred values and beliefs, while at the same time transform current work culture to align with person-centred care. This will allow successful delivery of person-centred processes. Trial registration NMRR-18-309-40,447. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07917-3.
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Affiliation(s)
- Nur Zahirah Balqis-Ali
- Centre for Health Outcomes Research, Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Block B2, No. 1, Jalan Setia Murni U13/52, Seksyen U13 Bandar Setia Alam, 40170, Shah Alam, Selangor, Malaysia.
| | - Pui San Saw
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, 47500, Bandar Sunway, Selangor, Malaysia.,Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, 47500, Bandar Sunway, Selangor, Malaysia
| | - Jailani Anis-Syakira
- Centre for Health Outcomes Research, Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Block B2, No. 1, Jalan Setia Murni U13/52, Seksyen U13 Bandar Setia Alam, 40170, Shah Alam, Selangor, Malaysia
| | - Weng Hong Fun
- Centre for Health Outcomes Research, Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Block B2, No. 1, Jalan Setia Murni U13/52, Seksyen U13 Bandar Setia Alam, 40170, Shah Alam, Selangor, Malaysia
| | - Sondi Sararaks
- Centre for Health Outcomes Research, Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Block B2, No. 1, Jalan Setia Murni U13/52, Seksyen U13 Bandar Setia Alam, 40170, Shah Alam, Selangor, Malaysia
| | - Shaun Wen Huey Lee
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, 47500, Bandar Sunway, Selangor, Malaysia.,School of Pharmacy, Taylor's University Lakeside Campus, Jalan Taylors, 47500, Subang Jaya, Selangor, Malaysia
| | - Mokhtar Abdullah
- MERITUS University, 49, The Boulevard, Mid Valley City, Lingkaran Syed Putra, 59200, Kuala Lumpur, Malaysia
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Shoesmith W, Chua SH, Giridharan B, Forman D, Fyfe S. Creation of consensus recommendations for collaborative practice in the Malaysian psychiatric system: a modified Delphi study. Int J Ment Health Syst 2020; 14:45. [PMID: 32577126 PMCID: PMC7304147 DOI: 10.1186/s13033-020-00374-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/30/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND There is strong evidence that collaborative practice in mental healthcare improves outcomes for patients. The concept of collaborative practice can include collaboration between healthcare workers of different professional backgrounds and collaboration with patients, families and communities. Most models of collaborative practice were developed in Western and high-income countries and are not easily translatable to settings which are culturally diverse and lower in resources. This project aimed to develop a set of recommendations to improve collaborative practice in Malaysia. METHODS In the first phase, qualitative research was conducted to better understand collaboration in a psychiatric hospital (previously published). In the second phase a local hospital level committee from the same hospital was created to act on the qualitative research and create a set of recommendations to improve collaborative practice at the hospital for the hospital. Some of these recommendations were implemented, where feasible and the outcomes discussed. These recommendations were then sent to a nationwide Delphi panel. These committees consisted of healthcare staff of various professions, patients and carers. RESULTS The Delphi panel reached consensus after three rounds. The recommendations include ways to improve collaborative problem solving and decision making in the hospital, ways to improve the autonomy and relatedness of patients, carers and staff and ways to improve the levels of resources (e.g. skills training in staff, allowing people with lived experience of mental disorder to contribute). CONCLUSIONS This study showed that the Delphi method is a feasible method of developing recommendations and guidelines in Malaysia and allowed a wider range of stakeholders to contribute than traditional methods of developing guidelines and recommendations.Trial registration Registered in the National Medical Research Register, Malaysia, NMRR-13-308-14792.
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Affiliation(s)
- Wendy Shoesmith
- Faculty of Medicine and Health Sciences, University Malaysia Sabah, Kota Kinabalu, Malaysia
- Curtin University, Miri, Sarawak Malaysia
| | - Sze Hung Chua
- Hospital Mesra Bukit Padang, Ministry of Health, Kota Kinabalu, Malaysia
| | | | - Dawn Forman
- School of Public Health, Curtin University, Perth, Australia
- University of Derby, Derby, UK
| | - Sue Fyfe
- School of Public Health, Curtin University, Perth, Australia
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Zakare-Fagbamila RT, Howell E, Choi AY, Cheng TZ, Clement M, Neely M, Gottfried ON. Clinic Satisfaction Tool Improves Communication and Provides Real-Time Feedback. Neurosurgery 2020; 84:908-918. [PMID: 29669027 DOI: 10.1093/neuros/nyy137] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 03/22/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patient-reported assessments of the clinic experience are increasingly important for improving the delivery of care. The Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) survey is the current standard for evaluating patients' clinic experience, but its format gives 2-mo delayed feedback on a small proportion of patients in clinic. Furthermore, it fails to give specific actionable results on individual encounters. OBJECTIVE To develop and assess the impact of a single-page Clinic Satisfaction Tool (CST) to demonstrate real-time feedback, individualized responses, interpretable and actionable feedback, improved patient satisfaction and communication scores, increased physician buy-in, and overall feasibility. METHODS We assessed CST use for 12 mo and compared patient-reported outcomes to the year prior. We assessed all clinic encounters for patient satisfaction, all physicians for CG-CAHPS global rating, and physician communication scores, and evaluated the physician experience 1 yr after implementation. RESULTS During implementation, 14 690 patients were seen by 12 physicians, with a 96% overall CST utilization rate. Physicians considered the CST superior to CG-CAHPS in providing immediate feedback. CG-CAHPS global scores trended toward improvement and were predicted by CST satisfaction scores (P < .05). CG-CAHPS physician communication scores were also predicted by CST satisfaction scores (P < .01). High CST satisfaction scores were predicted by high utilization (P < .05). Negative feedback dropped significantly over the course of the study (P < .05). CONCLUSION The CST is a low-cost, high-yield improvement to the current method of capturing the clinic experience, improves communication and satisfaction between physicians and patients, and provides real-time feedback to physicians.
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Affiliation(s)
| | | | - Ashley Y Choi
- School of Medicine, Duke University, Durham, North Carolina
| | - Tracy Z Cheng
- School of Medicine, Duke University, Durham, North Carolina
| | - Mary Clement
- Department of Musculoskeletal and Spine Services, Duke University Medical Center, Durham, North Carolina
| | - Megan Neely
- Depart-ment of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | - Oren N Gottfried
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
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Zakare-Fagbamila RT, Seyferth E, Cheng TZ, Clement M, Stroup B, Gottfried ON. Chief complaints and feedback from clinic satisfaction tool: Thematic analysis of a new outpatient communication tool. Int J Clin Pract 2019; 73:e13318. [PMID: 30703294 DOI: 10.1111/ijcp.13318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 01/25/2019] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Up to half of all patients leave their outpatient clinic visit with an uncommunicated need. We designed the clinic satisfaction tool (CST) as a low-cost, highly utilised assessment of the spine clinic experience that improved communication in our multidisciplinary spine practice. The purpose of this study was to qualitatively analyse chief complaints and feedback from the CSTs to determine how spine clinic patients used the form, identify the most prevalent concerns and mark areas for improvement. METHODS Institutional retrospective review of CSTs. Chief complaints and feedback were inductively coded to create a framework for patient complaints. RESULTS 832 patients presented to clinic, and 100 sets of chief complaints coded before reaching thematic saturation. Patients used the chief complaint section of CST to canvas four themes: symptoms, questions about their disease, management and treatment. Twenty-nine patients left mostly positive feedback but also wrote additional concerns about care. CONCLUSION Spine patients have a predictable pattern of chief complaints and with the CST were able to have all these complaints addressed. The CST efficiently collects practice-specific chief complaints that can be used to guide physician behaviour and design educational clinical tools that are useful for patients.
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Affiliation(s)
| | | | - Tracy Z Cheng
- School of Medicine, Duke University, Durham, North Carolina
| | - Mary Clement
- Department of Musculoskeletal & Spine Services, Duke University, Durham, North Carolina
| | - Bethany Stroup
- Department of Musculoskeletal & Spine Services, Duke University, Durham, North Carolina
| | - Oren N Gottfried
- Department of Neurosurgery, Duke University, Durham, North Carolina
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Lim KK, Sivasampu S, Mahmud F. Equity in access to health care in a rural population in Malaysia: A cross-sectional study. Aust J Rural Health 2016; 25:102-109. [PMID: 27377781 DOI: 10.1111/ajr.12298] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2016] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To examine the extent of equity in access to health care, their determinants and reasons of unmet need of a rural population in Malaysia. DESIGN Exploratory cross-sectional survey administered by trained interviewers among participants of a health screening program. SETTING A rural plantation estate in the West Coast of Peninsular Malaysia. PARTICIPANTS One hundred and thirty out of 142 adults above 18 years old who attended the program. MAIN OUTCOME MEASURE Percentages of respondents reporting realised access and unmet need to health care, determinants of both access indicators and reasons for unmet need. Realised access associated with need but not predisposing or enabling factors and unmet need not associated with any variables were considered equitable. RESULTS A total of 88 (67.7%) respondents had visited a doctor (realised access) in the past 6 months and 24.8% (n = 31) experienced unmet need in the past 12 months. Using logistic regression, realised access was associated with presence of chronic disease (OR 6.97, P < 0.001), whereas unmet need was associated with low education level (OR 6.50, P < 0.05), 'poor' or 'fair' self-assessed health status (OR 6.03, P < 0.05) and highest income group (> RM 2000 per month) (OR 51.27, P < 0.05). Personal choice (67.7%) was more commonly expressed than barriers (54.8%) as reasons for unmet need. CONCLUSIONS The study found equity in realised access and inequity in unmet need among the rural population, the latter associated with education level, subjective health status and income. Despite not being generalisable, the findings highlight the need for a national level study on equity in access before the country reforms its health system.
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Affiliation(s)
- Ka Keat Lim
- National Clinical Research Centre, Kuala Lumpur, Malaysia
| | | | - Fatihah Mahmud
- National Clinical Research Centre, Kuala Lumpur, Malaysia
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Summers RH, Moore M, Ekberg S, Chew-Graham CA, Little P, Stevenson F, Brindle L, Leydon GM. Soliciting additional concerns in the primary care consultation and the utility of a brief communication intervention to aid solicitation: A qualitative study. PATIENT EDUCATION AND COUNSELING 2016; 99:724-732. [PMID: 26792390 DOI: 10.1016/j.pec.2015.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 12/07/2015] [Accepted: 12/10/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To investigate the perspectives of general practitioners (GPs) on the practice of soliciting additional concerns (ACs) and the acceptability and utility of two brief interventions (prompts) designed to aid the solicitation. METHODS Eighteen GPs participating in a feasibility randomised controlled trial were interviewed. Interviews were semi-structured and audio-recorded. Data were analysed using a Framework Approach. RESULTS Participants perceived eliciting ACs as important for: reducing the need for multiple visits, identifying serious illness early, and increasing patient and GP satisfaction. GPs found the prompts easy to use and some continued their use after the study had ended to aid time management. Others noted similarities between the intervention and their usual practice. Nevertheless, soliciting ACs in every consultation was not unanimously supported. CONCLUSION The prompts were acceptable to GPs within a trial context, but there was disagreement as to whether ACs should be solicited routinely. Some GPs considered the intervention to aid their prioritisation efficiency within consultations. PRACTICE IMPLICATIONS Some GPs will find prompts which encourage ACs to be solicited early in the consultation enable them to better organise priorities and manage time-limited consultations more effectively.
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Affiliation(s)
- Rachael H Summers
- Faculty of Health Sciences, University of Southampton, Southampton, UK.
| | - Michael Moore
- Primary Care and Population Sciences, University of Southampton, Southampton, UK.
| | - Stuart Ekberg
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia.
| | - Carolyn A Chew-Graham
- Research Institute, Primary Care and Health Sciences, and NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West Midlands, Research Institute, Keele University, Keele, UK.
| | - Paul Little
- Primary Care and Population Sciences, University of Southampton, Southampton, UK.
| | - Fiona Stevenson
- Research Department of Primary Care & Population Health, University College London, London, UK.
| | - Lucy Brindle
- Faculty of Health Sciences, University of Southampton, Southampton, UK.
| | - Geraldine M Leydon
- Primary Care and Population Sciences, University of Southampton, Southampton, UK.
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Low LL, Tong SF, Low WY. Social Influences of Help-Seeking Behaviour Among Patients With Type 2 Diabetes Mellitus in Malaysia. Asia Pac J Public Health 2015. [PMID: 26219560 DOI: 10.1177/1010539515596807] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This qualitative study aimed to explore the influence of social networks such as family members, friends, peers, and health care providers toward the help-seeking behaviour (HSB) of patients with type 2 diabetes mellitus in the public and private primary care settings. In-depth interviews of 12 patients, 9 family members, and 5 health care providers, as well as 3 focus groups among 13 health care providers were conducted. All interviews were audio-taped and transcribed verbatim for qualitative analysis. Social influences play a significant role in the help-seeking process; once diagnosed, patients source information from people around them to make decisions. This significant influence depends on the relationship between patients and social networks or the level of trust, support, and comforting feeling. Thus, the impacts on patients' help-seeking behavior are varied. However, the help-seeking process is not solely an individual's concern but a dynamic process interacting with the social networks within the health care system.
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Affiliation(s)
- Lee Lan Low
- University of Malaya, Kuala Lumpur, Malaysia Institute for Health Systems Research, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Seng Fah Tong
- Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Wah Yun Low
- University of Malaya, Kuala Lumpur, Malaysia
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