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MacPherson N, Ta B, Ball L, Gunatillaka N, Sturgiss EA. What makes a good general practice consultation? An exploratory pilot study with people from a low socioeconomic background. BJGP Open 2024; 8:BJGPO.2023.0160. [PMID: 38331468 PMCID: PMC11300992 DOI: 10.3399/bjgpo.2023.0160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/31/2023] [Accepted: 11/24/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND While patients from low socioeconomic (SES) backgrounds are at increased risk of developing chronic health conditions, typically managed within general practice, they report fewer positive consultation experiences with GPs than patients from higher SES groups. To our knowledge, existing research does not provide an in-depth understanding of the GP conducts that contribute to positive consultations. AIM To identify the factors that patients from low SES backgrounds perceive as essential for creating good consultation experiences. DESIGN & SETTING This exploratory pilot study was performed in GP clinics in Melbourne, Australia. METHOD We used an appreciative inquiry approach, focused on positive consultation experiences, previously shown to be helpful for researching sensitive topics. Nine patients from low SES backgrounds, who reported positive consultation experiences, undertook a semi-structured qualitative interview while watching the video recording of their GP consultation. Four different GPs were captured in the recordings. Inductive thematic coding was performed by two researchers. RESULTS The following four categories were developed: 1) the doctor's demeanour and how the patient was made to feel during the consultation drove their engagement; 2) an established and collaborative therapeutic relationship was of high importance to patients; 3) a doctor's therapeutic skillset was integral to patient confidence and comfort; and 4) patients appreciated verbal and non-verbal communication techniques. In each interview, the discussion about the video-recorded consultation often triggered reflections about previous consultations with the respective GP. CONCLUSION For patients from low SES groups, positive consultation experiences were underpinned by perceived continuity of care with a specific GP who consistently showed good communication skills and key interpersonal characteristics. This research is a small step towards increasing our understanding of the experience of individuals from low SES backgrounds in primary care and the existing health inequities within this area.
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Affiliation(s)
- Naomi MacPherson
- School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Binh Ta
- School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Lauren Ball
- Centre for Community Health and Wellbeing, School of Public Health and School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
| | - Nilakshi Gunatillaka
- School of Primary and Allied Health Care, Monash University, Melbourne, Australia
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Manoharan A, Siti Nur Farhana H, Manimaran K, Khoo EM, Koh WM. Facilitators and barriers for tuberculosis preventive treatment among patients with latent tuberculosis infection: a qualitative study. BMC Infect Dis 2023; 23:624. [PMID: 37740196 PMCID: PMC10517541 DOI: 10.1186/s12879-023-08612-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 09/14/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Various factors influence tuberculosis preventive treatment (TPT) decisions thus it is important to understand the health beliefs and concerns of patients before starting TPT to ensure treatment compliance. This study aims to explore facilitators and barriers for TPT among patients diagnosed with Latent Tuberculosis infection (LTBI) attending six primary healthcare clinics in Selangor, Malaysia. METHOD In-depth interviews were conducted face-to-face or via telephone among patients with a clinical diagnosis of LTBI using a semi-structured topic guide developed based on the common-sense model of self-regulation and literature review. Audio recordings of interviews were transcribed verbatim and analysed thematically. RESULTS We conducted 26 In-depth interviews; Good knowledge of active tuberculosis (TB) and its associated complications, including the perceived seriousness and transmissibility of active TB, facilitates treatment. LTBI is viewed as a concern when immune status is compromised, thus fostering TPT. However, optimal health is a barrier for TPT. Owing to the lack of knowledge, patients rely on healthcare practitioners (HCPs) to determine their treatment paths. HCPs possessing comprehensive knowledge play a role in facilitating TPT whereas barriers to TPT encompass misinterpretation of tuberculin skin test (TST), inadequate explanation of TST, and apprehensions about potential medication side effects. CONCLUSIONS Knowledge of LTBI can influence TPT uptake and patients often entrust their HCPs for treatment decisions. Improving knowledge of LTBI both among patients and HCPs can lead to more effective doctor-patient consultation and consequently boost the acceptance of TPT. Quality assurance should be enhanced to ensure the effective usage of TST as a screening tool.
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Affiliation(s)
- Anusha Manoharan
- Bandar Botanic Health Clinic, Bandar Botanic, Klang, Selangor, 42000, Malaysia
| | - H Siti Nur Farhana
- Institute for Health Behavioural Research, National Institutes of Health, Ministry of Health Malaysia, Block B3, Kompleks NIH, No 1, Jalan Setia Murni U13/52, Seksyen U13, Setia Alam, Shah Alam, Selangor, 40170, Malaysia
| | - K Manimaran
- Institute for Health Behavioural Research, National Institutes of Health, Ministry of Health Malaysia, Block B3, Kompleks NIH, No 1, Jalan Setia Murni U13/52, Seksyen U13, Setia Alam, Shah Alam, Selangor, 40170, Malaysia
| | - Ee Ming Khoo
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, 50603, Malaysia
| | - Wen Ming Koh
- Rawang Health Clinic, Jalan Rawang Perdana, Taman Rawang Perdana, Rawang, Selangor, 48000, Malaysia.
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Ke C, Mohammad E, Chan JCN, Kong APS, Leung FH, Shah BR, Lee D, Luk AO, Ma RCW, Chow E, Wei X. Team-Based Diabetes Care in Ontario and Hong Kong: a Comparative Review. Curr Diab Rep 2023:10.1007/s11892-023-01508-0. [PMID: 37043089 PMCID: PMC10091345 DOI: 10.1007/s11892-023-01508-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/29/2023] [Indexed: 04/13/2023]
Abstract
PURPOSE OF REVIEW There are gaps in implementing and accessing team-based diabetes care. We reviewed and compared how team-based diabetes care was implemented in the primary care contexts of Ontario and Hong Kong. RECENT FINDINGS Ontario's Diabetes Education Programs (DEPs) were scaled-up incrementally. Hong Kong's Multidisciplinary Risk Assessment and Management Program for Diabetes Mellitus (RAMP-DM) evolved from a research-driven quality improvement program. Each jurisdiction had a mixture of non-team and team-based primary care with variable accessibility. Referral procedures, follow-up processes, and financing models varied. DEPs used a flexible approach, while the RAMP-DM used structured assessment for quality assurance. Each approach depended on adequate infrastructure, processes, and staff. Diabetes care is most accessible and functional when integrated team-based services are automatically initiated upon diabetes diagnosis within a strong primary care system, ideally linked to a register with supports including specialist care. Structured assessment and risk stratification are the basis of a well-studied, evidence-based approach for achieving the standards of team-based diabetes care, although flexibility in care delivery may be needed to meet the unique needs of some individuals. Policymakers and funders should ensure investment in skilled health professionals, infrastructure, and processes to improve care quality.
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Affiliation(s)
- Calvin Ke
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
- Department of Medicine, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
- ICES, Toronto, Ontario, Canada.
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China.
- , Toronto, Canada.
| | - Emaad Mohammad
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
- Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
- Asia Diabetes Foundation, Shatin, Hong Kong SAR, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Alice P S Kong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
- Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
- Asia Diabetes Foundation, Shatin, Hong Kong SAR, China
| | - Fok-Han Leung
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Community and Family Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Baiju R Shah
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Medicine, Sunnybrook Hospital, Toronto, Ontario, Canada
| | - Douglas Lee
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Andrea O Luk
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
- Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
- Asia Diabetes Foundation, Shatin, Hong Kong SAR, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Ronald C W Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
- Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
- Asia Diabetes Foundation, Shatin, Hong Kong SAR, China
| | - Elaine Chow
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
- Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
- Asia Diabetes Foundation, Shatin, Hong Kong SAR, China
| | - Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Gehenne L, Christophe V, Eveno C, Carnot A, Turpin A, Pannier D, Piessen G, Lelorain S. Creating scripted video-vignettes in an experimental study on two empathic processes in oncology: Reflections on our experience. PATIENT EDUCATION AND COUNSELING 2021; 104:654-662. [PMID: 32938562 DOI: 10.1016/j.pec.2020.08.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 08/10/2020] [Accepted: 08/29/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The aims were to: (1) apply the guidelines to develop and test the validity of video-vignettes manipulating empathy and context in oncology; (2) compare lay people's and patients' assessments of validity; (3) reflecting on our experiment METHODS: Guidelines were followed: (1) deciding whether video-vignettes were appropriate; (2) developing a valid script; (3) designing valid manipulations; (4) converting the scripted consultations into videos. One hundred sixteen lay people and 46 cancer patients filled in the Video Engagement Scale, the CARE, and ad hoc questionnaires on realism and emotions. RESULTS The video-vignettes are valid for experimental use. Differences appeared in the emotions participants reported. The empathic processes were successfully manipulated and perceived. Lay people's and patients' assessments were equivalent, except for video-vignettes in neutral consultations. Participants' comments on nonverbal behavior, camera perspective, scripts and empathy assessment were reported. CONCLUSION Patients' assessments are impacted by their personal experiences. Researchers should control for this in analogue patient studies. PRACTICE IMPLICATIONS Based on this experience, we reflect on: (1) adopting congruent nonverbal behavior throughout the video-vignettes; (2) alternating camera perspectives; (3) avoiding the sole use of written scripts; (4) using quantitative and qualitative analysis to validate scripts and video-vignettes.
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Affiliation(s)
- Lucie Gehenne
- Univ. Lille, CNRS, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, F-59000 Lille, France.
| | - Véronique Christophe
- Univ. Lille, CNRS, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, F-59000 Lille, France; Department of Human and Social Sciences, Centre Léon Bérard, Lyon, France
| | - Clarisse Eveno
- Department of Digestive and Oncological Surgery, University of Lille, Claude Huriez University Hospital, Lille, France
| | - Aurélien Carnot
- Department of General Oncology, Centre Oscar Lambret, Lille, France
| | - Anthony Turpin
- Department of Medical Oncology, University of Lille, Claude Huriez University Hospital, Lille, France; University of Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, UMR9020 - UMR-S 1277 - Canther - Cancer Heterogeneity, Plasticity and Resistance to Therapies, F-59000, Lille, France
| | - Diane Pannier
- Department of General Oncology, Centre Oscar Lambret, Lille, France
| | - Guillaume Piessen
- Department of Digestive and Oncological Surgery, University of Lille, Claude Huriez University Hospital, Lille, France; Jean-Pierre Aubert Research Center, Neurosciences and Cancer, University of Lille, IMR-S 1172-JPArc, Lille, France
| | - Sophie Lelorain
- Univ. Lille, CNRS, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, F-59000 Lille, France.
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He AJ, Tang VFY. Integration of health services for the elderly in Asia: A scoping review of Hong Kong, Singapore, Malaysia, Indonesia. Health Policy 2021; 125:351-362. [PMID: 33422336 DOI: 10.1016/j.healthpol.2020.12.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 12/23/2020] [Accepted: 12/29/2020] [Indexed: 12/14/2022]
Abstract
Against the backdrop of rapid ageing populations, there is an increasing recognition of the need to integrate various health services for the elderly, not only to provide more coordinated care, but also to contain the rapid cost inflation driven primarily by the curative sector. Funded by the Asia-Pacific Observatory on Health Systems and Policies, this scoping review seeks to synthesize the received knowledge on care integration for the elderly in four Asian societies representing varying socioeconomic and health-system characteristics: Singapore, Hong Kong, Malaysia, and Indonesia. The search for English-language literature published between 2009 and 2019 yielded 67 publications in the final sample. The review finds that both research and practice regarding health service integration are at a preliminary stage of development. It notes a marked trend in seeking to integrate long-term elderly care with curative and preventive care, especially in community settings. Many distinctive models proliferated. Integration is demonstrated not only horizontally but also vertically, transcending public-private boundaries. The central role of primary care is highly prominent in almost all the integration models. However, these models are associated with a variety of drawbacks in relation to capacity, perception, and operation that necessitate further scholarly and policy scrutiny, indicating the robustness and persistence of siloed healthcare practices.
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Affiliation(s)
- Alex Jingwei He
- Department of Asian and Policy Studies, The Education University of Hong Kong, 10 Lo Ping Road, Tai Po, New Territories, Hong Kong Special Administrative Region.
| | - Vivien F Y Tang
- Department of Asian and Policy Studies, The Education University of Hong Kong, 10 Lo Ping Road, Tai Po, New Territories, Hong Kong Special Administrative Region
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Gehenne L, Lelorain S, Anota A, Brédart A, Dolbeault S, Sultan S, Piessen G, Grynberg D, Baudry A, Christophe V. Testing two competitive models of empathic communication in cancer care encounters: A factorial analysis of the CARE measure. Eur J Cancer Care (Engl) 2020; 29:e13306. [DOI: 10.1111/ecc.13306] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 04/12/2020] [Accepted: 08/07/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Lucie Gehenne
- CNRS, UMR 9193 ‐ SCALab ‐ Sciences Cognitives et Sciences Affectives Univ. Lille Lille France
| | - Sophie Lelorain
- CNRS, UMR 9193 ‐ SCALab ‐ Sciences Cognitives et Sciences Affectives Univ. Lille Lille France
| | - Amélie Anota
- Methodology and Quality of Life in Oncology Unit (IMSER UMR 1098) University of Besançon Besançon France
| | - Anne Brédart
- Psycho‐oncology and Social Service Institut Curie Paris France
- Psychopathology and Health Process Laboratory (LPPS UR 4057) Psychology Institute University Paris Descartes France
| | - Sylvie Dolbeault
- Psycho‐oncology and Social Service Institut Curie Paris France
- University Paris SudUniversity PSL Paris France
| | - Serge Sultan
- Sainte Justine University Health Center Montréal QC Canada
- Departments of Pediatrics and Psychology University of Montreal Montréal QC Canada
| | - Guillaume Piessen
- Department of Digestive and Oncological Surgery Claude Huriez University Hospital University of Lille Lille France
- Jean‐Pierre Aubert Research Center – Neurosciences and Cancer University of Lille (IMR‐S 1172‐JPArc) Lille France
| | - Delphine Grynberg
- CNRS, UMR 9193 ‐ SCALab ‐ Sciences Cognitives et Sciences Affectives Univ. Lille Lille France
- Institut Universitaire de France Paris France
| | - Anne‐Sophie Baudry
- CNRS, UMR 9193 ‐ SCALab ‐ Sciences Cognitives et Sciences Affectives Univ. Lille Lille France
- Oncology and Medical Specialties Department Valenciennes Hospital Valenciennes France
| | - Véronique Christophe
- CNRS, UMR 9193 ‐ SCALab ‐ Sciences Cognitives et Sciences Affectives Univ. Lille Lille France
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Lelorain S, Cortot A, Christophe V, Pinçon C, Gidron Y. Physician Empathy Interacts with Breaking Bad News in Predicting Lung Cancer and Pleural Mesothelioma Patient Survival: Timing May Be Crucial. J Clin Med 2018; 7:jcm7100364. [PMID: 30336582 PMCID: PMC6210310 DOI: 10.3390/jcm7100364] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 10/03/2018] [Accepted: 10/15/2018] [Indexed: 12/15/2022] Open
Abstract
This study is the first to examine the prognostic role of physician empathy in interaction with the type of consultation (TC) (TC, bad news versus follow-up consultations) in cancer patient survival. Between January 2015 and March 2016, 179 outpatients with thoracic cancer and a Karnofsky performance status ≥60 assessed their oncologist’s empathy using the CARE questionnaire, which provides a general score and two sub-dimensions: listening/compassion and active/positive empathy. Survival was recorded until April 2018. Usual medical, social and psychological confounders were included in the Cox regression. The median follow-up time was 3.1 years. There was a statistical interaction between listening/compassion empathy and TC (p = 0.016) such that in bad news consultations, higher listening/compassion predicted a higher risk of death (hazard ratio (HR) = 1.13; 95% confidence interval (CI): 1.03–1.23; p = 0.008). In follow-up consultations, listening/compassion did not predict survival (HR = 0.94; 95% CI: 0.85–1.05; p = 0.30). The same results were found with the general score of empathy, but not with active/positive empathy. In bad news consultations, high patient-perceived physician compassion could worry patients by conveying the idea that there is no longer any hope, which could hasten death. Further studies are warranted to confirm these results and find out the determinants of patient perception of physician empathy.
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Affiliation(s)
- Sophie Lelorain
- University of Lille, CNRS, CHU Lille, UMR 9193-SCALab-Cognitive and Affective Sciences, F-59000 Lille, France.
| | - Alexis Cortot
- University of Lille, Department of Thoracic Oncology, Albert Calmette University Hospital, F-59000 Lille, France.
| | - Véronique Christophe
- University of Lille, CNRS, CHU Lille, UMR 9193-SCALab-Cognitive and Affective Sciences, F-59000 Lille, France.
| | - Claire Pinçon
- University of Lille, CHU Lille, EA 2694, Public Health: Epidemiology and Quality of Care, F-59000 Lille, France.
| | - Yori Gidron
- University of Lille, CNRS, CHU Lille, UMR 9193-SCALab-Cognitive and Affective Sciences, F-59000 Lille, France.
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Bikker AP, Fitzpatrick B, Murphy D, Forster L, Mercer SW. Assessing the Consultation and Relational Empathy (CARE) Measure in sexual health nurses' consultations. BMC Nurs 2017; 16:71. [PMID: 29204104 PMCID: PMC5702142 DOI: 10.1186/s12912-017-0265-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 11/13/2017] [Indexed: 12/30/2022] Open
Abstract
Background Increasingly healthcare policies emphasise the importance of person-centred, empathic care. Consequently, healthcare professionals are expected to demonstrate the ‘human’ aspects of care in training and in practice. The Consultation and Relational Empathy (CARE) Measure is a patient-rated measure of the interpersonal skills of healthcare practitioners. It has been widely validated for use by healthcare professionals in both primary and secondary care. This paper reports on the validity and reliability of the CARE Measure with sexual health nurses. Methods Patient questionnaires were collected for 943 consultations with 20 sexual health nurses. Participating patients self-completed the questionnaire immediately after the encounter with the nurse. The questionnaire included the ten item CARE Measure, the Patient Enablement Index, and overall satisfaction instruments. Construct validity was assessed through Spearman’s correlation and principal component analysis. Internal consistence was assessed through Cronbach’s alpha and the inter-rater reliability through Generalisability Theory. Data were collected in 2013 in Scotland. Results Female patients completed 68% of the questionnaires. The mean patient age was 28.8 years (standard deviation 9.8 years). Two of the 20 participating nurses withdrew from the study. Most patients (71.7%) regarded the CARE Measure items as very important to their consultation and the number of ‘not applicable’ and missing responses’ were low (2.6% and 0.1% respectively). The participating nurses had high CARE Measure scores; out of a maximum possible score of 50, the overall mean CARE measure score was 47.8 (standard deviation 4.4). The scores were moderately correlated with patient enablement (rho = 0.232, p = 0.001) and overall satisfaction (rho = 0.377, p = 0.001. Cronbach’s alpha showed the measure’s high internal consistency (Cronbach’s alpha coefficient = 0.95), but the inter-rater reliability could not be calculated due to the high achieved CARE Measure scores that varied little between nurses. Conclusions Within this clinical context the CARE Measure has high perceived relevance and face validity. The findings support construct validity and some evidence of reliability. The high CARE Measure scores may have been due to sample bias. A future study which ensures a representative sample of patients on a larger group of nurses is required to determine whether the measure can discriminate between nurses.
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Affiliation(s)
- Annemieke P Bikker
- Usher Institute for Population Sciences and Informatics, The University of Edinburgh, 9 BioQuarter, Little France Road, Edinburgh, EH16 4UX UK
| | - Bridie Fitzpatrick
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, 1 Horselethill Road, Glasgow, G12 9LX UK
| | - Douglas Murphy
- School of Medicine, University of Dundee, Mackenzie Building, Kirsty Semple Way, Dundee, DD2 4BF UK
| | - Lorraine Forster
- Sandyford Sexual Health Services, 2-6 Sandyford Place, Glasgow, G3 7NB UK
| | - Stewart W Mercer
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, 1 Horselethill Road, Glasgow, G12 9LX UK
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Crosta Ahlforn K, Bojner Horwitz E, Osika W. A Swedish version of the Consultation and Relational Empathy (CARE) measure. Scand J Prim Health Care 2017; 35:286-292. [PMID: 28768444 PMCID: PMC5592356 DOI: 10.1080/02813432.2017.1358853] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE A validated measure to gather patient feedback on physicians' empathy is not available in Swedish. The objective for this study was to examine the psychometric characteristics of a Swedish version of the Consultation and Relational Empathy (CARE) measure (widely used in English). DESIGN, SETTING AND PATIENTS The CARE measure was translated into Swedish and tested on 554 unselected patients visiting physicians in two primary care clinics in northwestern Stockholm, Sweden. MAIN OUTCOME MEASURES Adequate translation, as well as reliability and validity of the Swedish CARE measure. RESULTS The Swedish CARE measure seemed to demonstrate high acceptability and face validity when consulting a physician. The mean CARE score 41.5 (SD 8.9) over all 10 item was not significantly influenced by seasonality, age or gender. Scores were somewhat negatively distributed, but corrected item-total correlations were high (0.86-0.91) suggesting homogeneity. Internal reliability was very high (Cronbach's alpha 0.975). Factor analysis implied a one-dimensional structure with factor loadings between 0.89 and 0.93. CONCLUSIONS The Swedish CARE measure appears to be psychometrically valid and reliable enough in physicians.
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Affiliation(s)
- K. Crosta Ahlforn
- Center for Social Sustainability, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - E. Bojner Horwitz
- Center for Social Sustainability, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - W. Osika
- Center for Social Sustainability, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stress Clinic Foundation, Stockholm, Sweden
- CONTACT W. Osika Center for Social Sustainability, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 171 77 Stockholm, Sweden
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10
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Adams SM, Case TI, Fitness J, Stevenson RJ. Dehumanizing but competent: The impact of gender, illness type, and emotional expressiveness on patient perceptions of doctors. JOURNAL OF APPLIED SOCIAL PSYCHOLOGY 2017. [DOI: 10.1111/jasp.12433] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Samantha M. Adams
- Department of Psychology; Macquarie University; Sydney New South Wales 2109 Australia
| | - Trevor I. Case
- Department of Psychology; Macquarie University; Sydney New South Wales 2109 Australia
| | - Julie Fitness
- Department of Psychology; Macquarie University; Sydney New South Wales 2109 Australia
| | - Richard J. Stevenson
- Department of Psychology; Macquarie University; Sydney New South Wales 2109 Australia
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MAKIVIĆ I, KERSNIK J, KLEMENC-KETIŠ Z. The Role of the Psychosocial Dimension in the Improvement of Quality of Care: A Systematic Review. Zdr Varst 2016; 55:86-95. [PMID: 27647093 PMCID: PMC4820186 DOI: 10.1515/sjph-2016-0004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 07/02/2015] [Indexed: 01/11/2023] Open
Abstract
The aim of our systematic review was to analyse the published literature on the psychosocial dimension of care in family medicine and its relationship with quality of care. We wanted to find out whether there is any evidence on the psychosocial approach in (family) medicine. The recommended bio-psycho-social approach, besides the biomedical model of illness, takes into account several co-influencing psychological, sociological and existential factors. An online search of nine different databases used Boolean operators and the following selection criteria: the paper contained information on the holistic approach, quality indicators, family medicine, patient-centred care and/or the bio-psycho-social model of treatment. We retrieved 743 papers, of which 36 fulfilled our inclusion criteria. Including the psychosocial dimension in patient management has been found to be useful in the prevention and treatment of physical and psychiatric illness, resulting in improved social functioning and patient satisfaction, reduced health care disparities, and reduced annual medical care charges. The themes of patient-centred, behavioural or psychosocial medicine were quite well presented in several papers. We could not find any conclusive evidence of the impact of a holistic bio-psycho-social-approach. Weak and variable definitions of psychosocial dimensions, a low number of well-designed intervention studies, and low numbers of included patients limited our conclusions.
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Affiliation(s)
- Irena MAKIVIĆ
- University of Ljubljana, Faculty of Medicine, Department of Family Medicine, Poljanski nasip 58, 1000 Ljubljana, Slovenia
- Corresponding author: Tel: +386 40 66 88 27; E-mail:
| | - Janko KERSNIK
- University of Ljubljana, Faculty of Medicine, Department of Family Medicine, Poljanski nasip 58, 1000 Ljubljana, Slovenia
| | - Zalika KLEMENC-KETIŠ
- University of Maribor, Faculty of Medicine, Department of Family Medicine, Taborska ul. 8, 2000 Maribor, Slovenia
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Chung VCH, Yip BHK, Yu ELM, Liu S, Ho RST, Sit RWS, Leung AWN, Wu JCY, Wong SYS. Patient Perceptions of Expression of Empathy From Chinese Medicine Clinicians in a Chinese Population: A Cross-Sectional Study. Medicine (Baltimore) 2016; 95:e3316. [PMID: 27124021 PMCID: PMC4998684 DOI: 10.1097/md.0000000000003316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
This study aims to examine the level of empathy perceived by patients receiving care from herbalists, acupuncturists and massage therapists and to investigate the factors that influence levels of perceived empathy.Participants who were 18 years or above; able to provide written informed consent; and able to read and write in Chinese without assistance were included. A total of 514 participants sampled from charity and semipublic Chinese medicine (CM) clinics in Hong Kong were recruited to assess levels of empathy perceived during various length of consultations (1-20 minutes) by the Chinese Consultation and Relational Empathy Measure (Chinese CARE). Multiple linear regressions were conducted to evaluate the associations between perceived levels of empathy and the type of CM practitioner consulted and participants' demographic and health characteristics.The average Chinese CARE total score for participants consulting CM practitioners was 34.3 of a maximum of 50. After adjusting for participants' health and demographic characteristics, acupuncturists received the highest ratings (P < 0.001), whereas massage therapists (P < 0.001) scored the lowest of the 3 modalities. Participants receiving social benefits (P = 0.013), those with longer waiting times (P = 0.002), and those with shorter consultation durations (P = 0.020) scored significantly lower on the Chinese CARE.The level of empathy perceived by participants using CM was similar to results found for those in conventional care, in contrast to findings in other geographical settings, where a high level of perceived empathy was a major motivator for participants to choose complementary medicine.
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Affiliation(s)
- Vincent C H Chung
- From the Jockey Club School of Public Health and Primary Care (VCHC, BHKY, ELMY, SL, RSTH, RWSS, SYSW), Hong Kong Institute of Integrative Medicine (VCHC, RWSS, JCYW, SYSW), and School of Chinese Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China (AWNL)
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Das SK, Samantaray D, Patra JK, Samanta L, Thatoi H. Antidiabetic potential of mangrove plants: a review. FRONTIERS IN LIFE SCIENCE 2015. [DOI: 10.1080/21553769.2015.1091386] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Bhattacharyya S, Issac A, Rajbangshi P, Srivastava A, Avan BI. "Neither we are satisfied nor they"-users and provider's perspective: a qualitative study of maternity care in secondary level public health facilities, Uttar Pradesh, India. BMC Health Serv Res 2015; 15:421. [PMID: 26409876 PMCID: PMC4584124 DOI: 10.1186/s12913-015-1077-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 09/18/2015] [Indexed: 11/29/2022] Open
Abstract
Background Quality of care provided during childbirth is a critical determinant of preventing maternal mortality and morbidity. In the studies available, quality has been assessed either from the users’ perspective or the providers’. The current study tries to bring both perspectives together to identify common key focus areas for quality improvement. This study aims to assess the users’ (recently delivered women) and care providers’ perceptions of care to understand the common challenges affecting provision of quality maternity care in public health facilities in India. Methods A qualitative design comprising of in-depth interviews of 24 recently delivered women from secondary care facilities and 16 health care providers in Uttar Pradesh, India. The data were analysed thematically to assess users’ and providers’ perspectives on the common themes. Results The common challenges experienced regarding provision of care were inadequate physical infrastructure, irregular supply of water, electricity, shortage of medicines, supplies, and gynaecologist and anaesthetist to manage complications, difficulty in maintaining privacy and lack of skill for post-delivery counselling. However, physical access, cleanliness, interpersonal behaviour, information sharing and out-of-pocket expenditure were concerns for only users. Similarly, providers raised poor management of referral cases, shortage of staff, non-functioning of blood bank, lack of incentives for work as their concerns. Discussion The study identified the common themes of care from both the perspectives, which have been foundrelevant in terms of challenges identified in many developing countries including India. The study framework identified new themes like management of emergencies in complicated cases, privacy and cost of care which both the group felt is relevant in the context of providing quality care during childbirth in low resource setting. The key challenges identified by both the groups can be prioritized, when developing quality improvement program in the health facilities. The identified components of care can match the supply with the demand for care and make the services truly responsive to user needs. Conclusion The study highlights infrastructure, human resources, supplies and medicine as priority areas of quality improvement in the facility as perceived by both users and providers, nevertheless the interpersonal aspect of care primarily reported by the users must also not be ignored. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-1077-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sanghita Bhattacharyya
- Public Health Foundation of India, Plot no. 47, Sector 44, Institutional Area, Gurgaon, Haryana, 122002, India.
| | - Anns Issac
- Public Health Foundation of India, Plot no. 47, Sector 44, Institutional Area, Gurgaon, Haryana, 122002, India.
| | - Preety Rajbangshi
- Public Health Foundation of India, Plot no. 47, Sector 44, Institutional Area, Gurgaon, Haryana, 122002, India.
| | - Aradhana Srivastava
- Public Health Foundation of India, Plot no. 47, Sector 44, Institutional Area, Gurgaon, Haryana, 122002, India.
| | - Bilal I Avan
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
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Wee LE, Lim LY, Shen T, Lee EY, Chia YH, Tan AYS, Koh GCH. Choice of primary health care source in an urbanized low-income community in Singapore: a mixed-methods study. Fam Pract 2014; 31:81-91. [PMID: 24253204 DOI: 10.1093/fampra/cmt064] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Cost and misperceptions may discourage lower income Singaporeans from utilizing primary care. We investigated sources of primary care in a low-income Singaporean community in a mixed-methods study. METHODS Residents of a low-income public rental flat neighbourhood were asked for sociodemographic details and preferred source of primary care relative to their higher income neighbours. In the qualitative component, interviewers elicited, from patients and health care providers, barriers/enablers to seeking care from Western-trained doctors. Interviewees were selected via purposive sampling. Transcripts were analyzed thematically, and iterative analysis was carried out using established qualitative method. RESULTS Participation was 89.8% (359/400). Only 11.1% (40/359) preferred to approach Western-trained doctors, 29.5% (106/359) preferred alternative medicine, 6.7% (24/359) approached family/friends and 52.6% (189/359) preferred self-reliance. Comparing against higher income neighbours, rental flat residents were more likely to turn to alternative medicine and family members but less likely to turn to Western-trained doctors (P < 0.001). For the qualitative component, a total of 20 patients and 9 providers were interviewed before data saturation was reached. Patient and provider comments fell into the following content areas: primary care characteristics, knowledge, costs, priorities, attitudes and information sources. Self-reliance was perceived as acceptable for 'small' illnesses but not for 'big' ones, communal spirit was cited as a reason for consulting family/friends and social distance from primary care practitioners was highlighted as a reason for not consulting Western-trained doctors. CONCLUSION Western-trained physicians are not the first choice of lower income Singaporeans for seeking primary care. Knowledge, primary care characteristics and costs were identified as potential barriers/enablers.
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Albalushi RM, Sohrabi MR, Kolahi AA. Clients' satisfaction with primary health care in muscat. Int J Prev Med 2012; 3:713-7. [PMID: 23112898 PMCID: PMC3482999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Accepted: 04/03/2012] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND To measure clients' satisfaction with primary health care in the capital of Oman, Muscat, and also to identify the factors affecting their satisfaction. METHODS Through a cross-sectional study in health centers, 400 participants during the period from November 2009 to February 2010 were interviewed about their satisfaction degree with the primary health care services and setting. Four urban primary health care clinics from Muscat were selected randomly. Six domains of satisfaction including accessibility to services, continuity of care, humaneness of staff, comprehensiveness of care, provision of health education, and effectiveness of services were calculated from selected variables. The mean score of each area were calculated and then divided by the number of items in each area. Finally satisfaction areas were ranked based on recent criteria. RESULTS Mean age was 29.5 years (SD = 9.37) for male and 26.01 years (SD = 7.12) for female participants. All the areas were suitable and only continuity of care had negative score. The ranked areas of satisfaction were as humanness of staff, effectiveness of services, access to services, provision of health educational materials, comprehensiveness of care, continuity of care. CONCLUSIONS Primary health care were accepted as a suitable strategy for providing health care among clients of urban health centers of Muscat. It can be recommended to other countries to use this as a choice for health care provision.
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Affiliation(s)
- Rima M Albalushi
- General practitioner, Department of Radiology, khoula Hospital Ministery of health, Muscat, Oman
| | - Mohammad-Reza Sohrabi
- Department of Community Medicine, Faculty of Medicine and Social Determinants of Heallth Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Correspondence to: Dr. Mohammad-Reza Sohrabi, Department of Community Medicine, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Evin, Tehran, Iran. E-mail:
| | - Ali-Asghar Kolahi
- Department of Community Medicine, Faculty of Medicine and Social Determinants of Heallth Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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An overview of 19 instruments assessing the doctor-patient relationship: different models or concepts are used. J Clin Epidemiol 2012; 65:10-5. [PMID: 22118265 DOI: 10.1016/j.jclinepi.2011.05.011] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Revised: 05/17/2011] [Accepted: 05/25/2011] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The doctor-patient relationship has been linked to patient satisfaction, treatment adherence, and treatment outcome. Many different instruments have been developed to assess this relationship. The large variety makes it difficult to compare results of different studies and choose an instrument for future research. This review aims to provide an overview of the existing instruments assessing the doctor-patient relationship. STUDY DESIGN AND SETTING We performed a systematic search in PubMed, PsychInfo, EMBASE, and Web of Science for questionnaires measuring the doctor-patient relationship. We appraised each instrument ascertaining the questionnaires focused on the doctor-patient relationship. We compared the content and psychometric characteristics of the instruments. RESULTS We found 19 instruments assessing the doctor-patient relationship. The instruments assess a variety of dimensions and use diverse conceptual models for the doctor-patient relationship. The instruments found also vary in terms to which they have been psychometrically tested. CONCLUSION We have provided an overview of 19 instruments assessing the doctor-patient relationship. The selection of an instrument for future research should be based on the model or conceptual basis of the doctor-patient relationship that is most applicable to the study objectives and the health care field in which it will be applied.
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Mercer SW, Fung CSC, Chan FWK, Wong FYY, Wong SYS, Murphy D. The Chinese-version of the CARE measure reliably differentiates between doctors in primary care: a cross-sectional study in Hong Kong. BMC FAMILY PRACTICE 2011; 12:43. [PMID: 21631927 PMCID: PMC3123195 DOI: 10.1186/1471-2296-12-43] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Accepted: 06/01/2011] [Indexed: 12/04/2022]
Abstract
BACKGROUND The Consultation and Relational Empathy (CARE) Measure is a widely used patient-rated experience measure which has recently been translated into Chinese and has undergone preliminary qualitative and quantitative validation. The objective of this study was to determine the reliability of the Chinese-version of the CARE Measure in reliably differentiating between doctors in a primary care setting in Hong Kong METHODS Data were collected from 984 primary care patients attending 20 doctors with differing levels of training in family medicine in 5 public clinics in Hong Kong. The acceptability of the Chinese-CARE measure to patients was assessed. The reliability of the measure in discriminating effectively between doctors was analysed by Generalisability-theory (G-Theory) RESULTS The items in the Chinese-CARE measure were regarded as important by patients and there were few 'not applicable' responses. The measure showed high internal reliability (coefficient 0.95) and effectively differentiated between doctors with only 15-20 patient ratings per doctor (inter-rater reliability > 0.8). Doctors' mean CARE measure scores varied widely, ranging from 24.1 to 45.9 (maximum possible score 50) with a mean of 34.6. CARE Measure scores were positively correlated with level of training in family medicine (Spearman's rho 0.493, p < 0.05). CONCLUSION These data demonstrate the acceptability, feasibility and reliability of using the Chinese-CARE Measure in primary care in Hong Kong to differentiate between doctors interpersonal competencies. Training in family medicine appears to enhance these key interpersonal skills.
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Affiliation(s)
- Stewart W Mercer
- Primary Care Research, General Practice and Primary Care, University of Glasgow, Glasgow, Scotland, UK
| | - Colman SC Fung
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T., Hong Kong
| | - Frank WK Chan
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T., Hong Kong
| | - Fiona YY Wong
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T., Hong Kong
| | - Samuel YS Wong
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T., Hong Kong
| | - Douglas Murphy
- Quality, Safety and Informatics Research Group, Division of Clinical and Population Sciences and Education, University of Dundee, Dundee, Scotland, UK
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Mercer SW, Siu JY, Hillier SM, Lam CLK, Lo YYC, Lam TP, Griffiths SM. A qualitative study of the views of patients with long-term conditions on family doctors in Hong Kong. BMC FAMILY PRACTICE 2010; 11:46. [PMID: 20525340 PMCID: PMC2889885 DOI: 10.1186/1471-2296-11-46] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Accepted: 06/04/2010] [Indexed: 11/10/2022]
Abstract
BACKGROUND Primary care based management of long-term conditions (LTCs) is high on the international healthcare agenda, including the Asia-Pacific region. Hong Kong has a 'mixed economy' healthcare system with both public and private sectors with a range of types of primary care doctors. Recent Hong Kong Government policy aims to enhance the management of LTCs in primary care possibly based on a 'family doctor' model. Patients' views on this are not well documented and the aim of the present study was to explore the views of patients with LTCs on family doctors in Hong Kong. METHODS The views of patients (with a variety of LTCs) on family doctors in Hong Kong were explored. Two groups of participants were interviewed; a) those who considered themselves as having a family doctor, b) those who considered themselves as not having a family doctor (either with a regular primary care doctor but not a family doctor or with no regular primary care doctor). In-depth individual semi-structured interviews were carried out with 28 participants (10 with a family doctor, 10 with a regular doctor, and 8 with no regular doctor) and analysed using the constant comparative method. RESULTS Participants who did not have a family doctor were familiar with the concept but regarded it as a 'luxury item' for the rich within the private healthcare system. Those with a regular family doctor (all private) regarded having one as important to their and their family's health. Participants in both groups felt that as well as the more usual family medicine specialist or general practitioner, traditional Chinese medicine practitioners also had the potential to be family doctors. However most participants attended the public healthcare system for management of their LTCs whether they had a family doctor or not. Cost, perceived need, quality, trust, and choice were all barriers to the use of family doctors for the management of their LTCs. CONCLUSIONS Important barriers to the adoption of a 'family doctor' model of management of LTCs exist in Hong Kong. Effective policy implementation seems unlikely unless these complex barriers are addressed.
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Affiliation(s)
- Stewart W Mercer
- Section of General Practice and Primary Care, Division of Community-based Sciences, Faculty of Medicine, University of Glasgow, UK.
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