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Astaire E, Jennings L, Khundakar M, Silverio SA, Flynn AC. General practitioners' experiences of providing lifestyle advice to patients with depression: A qualitative focus group study. PLoS One 2024; 19:e0299934. [PMID: 38466705 PMCID: PMC10927082 DOI: 10.1371/journal.pone.0299934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 02/17/2024] [Indexed: 03/13/2024] Open
Abstract
OBJECTIVE Depression is an increasingly common mental health disorder in the UK, managed predominantly in the community by GPs. Emerging evidence suggests lifestyle medicine is a key component in the management of depression. We aimed to explore GPs' experiences, attitudes, and challenges to providing lifestyle advice to patients with depression. METHOD Focus groups were conducted virtually with UK GPs (May-July 2022). A topic guide facilitated the discussion and included questions on experiences, current practices, competence, challenges, and service provision. Data were analysed using template analysis. RESULTS 'Supporting Effective Conversations'; 'Willing, but Blocked from Establishing Relational Care'; 'Working Towards Patient Empowerment'; and 'Control Over the Prognosis' were all elements of how individualised lifestyle advice was key to the management of depression. Establishing a doctor-patient relationship by building trust and rapport was fundamental to having effective conversations about lifestyle behaviours. Empowering patients to make positive lifestyle changes required tailoring advice using a patient-centred approach. Confidence varied across participants, depending on education, experience, type of patient, and severity of depression. CONCLUSIONS GPs play an important role in managing depression using lifestyle medicine and a patient-centred approach. Organisational and educational changes are necessary to facilitate GPs in providing optimal care to patients with depression.
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Affiliation(s)
- Emma Astaire
- School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - Laura Jennings
- School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - Martina Khundakar
- Pharmacy Department, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle-upon-Tyne, United Kingdom
- School of Pharmacy, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Sergio A. Silverio
- School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, United Kingdom
| | - Angela C. Flynn
- School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
- School of Population Health, Royal College of Surgeons in Ireland, Dublin, Ireland
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Piccinini-Vallis H, Zed J, Easley J. Comparison of patients' perceptions of family physicians' patient-centeredness between virtual and in-person clinical encounters: A cross-sectional study. J Family Med Prim Care 2023; 12:517-522. [PMID: 37122655 PMCID: PMC10131964 DOI: 10.4103/jfmpc.jfmpc_1511_22] [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: 07/28/2022] [Revised: 10/31/2022] [Accepted: 11/29/2022] [Indexed: 05/02/2023] Open
Abstract
Introduction A clinician's patient-centeredness is a core construct of quality healthcare and is associated with several positive patient outcomes. This study aimed to compare patient-perceived patient centeredness between in-person and virtual clinical encounters during the coronavirus pandemic. Materials and Methods Participants completed an online anonymous questionnaire pertaining to a recent clinical encounter. Patients of an academic family medicine teaching clinic scheduled for either an in-person or a virtual clinical encounter were recruited by phone over a two-month period. Using the patient-centered clinical method as a conceptual framework, patient-perceived patient centeredness was measured by the Patient-Perceived Patient-Centeredness Questionnaire-Revised (PPPC-R), consisting of 18 items that reflect three factors (healthcare process, context and relationship, and roles). Results The sample consisted of 72 participants. There was no difference in the PPPC-R scores between participants who received in-person and those who received virtual care. However, the mean ranks for the PPPC-R total score and for all three factors were higher for participants who saw a family physician compared to participants who saw a family medicine learner. Conclusion Family physicians provided similar quality healthcare, measured through a patient-perceived patient-centeredness lens, via both virtual and in-person appointments. These results support sustaining virtual care when deemed appropriate by both patient and clinician.
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Affiliation(s)
- Helena Piccinini-Vallis
- Department of Family Medicine, Dalhousie University, Halifax, Canada
- Address for correspondence: Dr. Helena Piccinini-Vallis, Department of Family Medicine, Dalhousie University, 6960 Mumford Road, Suite 0265, Halifax, Nova Scotia, Canada B3L4P1. E-mail:
| | - Joanna Zed
- Department of Family Medicine, Dalhousie University, Halifax, Canada
| | - Julie Easley
- Department of Family Medicine, Dalhousie University, Fredericton, Canada
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3
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Grung I, Anderssen N, Haukenes I, Ruths S, Smith-Sivertsen T, Hetlevik Ø, Hjørleifsson S. Patient experiences with depression care in general practice: a qualitative questionnaire study. Scand J Prim Health Care 2022; 40:253-260. [PMID: 35603990 PMCID: PMC9397414 DOI: 10.1080/02813432.2022.2074069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To investigate patient experiences and preferences regarding depression care in general practice. DESIGN AND SETTING A qualitative study based on free-text responses in a web-based survey in 2017. Participants were recruited by open invitation on the web page of a Norwegian patient organization for mental health. The survey consisted of four open-ended questions concerning depression care provided by general practitioners (GPs), including positive and negative experiences, and suggestions for improvement. The responses were analysed by Template Analysis. SUBJECTS 250 persons completed the web-based survey, 86% were women. RESULTS The analysis revealed five themes: The informants appreciated help from their GP; they wanted to be met by the GP with a listening, accepting, understanding and respectful attitude; they wanted to be involved in decisions regarding their treatment, including antidepressants which they thought should not be prescribed without follow-up; when referred to secondary mental care they found it wrong to have to find and contact a caregiver themselves; and they thought sickness certification should be individualised to be helpful. CONCLUSIONS Patients in Norway appreciate the depression care they receive from their GP. It is important for patients to be involved in decision-making regarding their treatment.KEY POINTSDepression is common, and GPs are often patients' first point of contact when they seek help. • Patients who feel depressed appreciate help from their GP. • Patients prefer an empathetic GP who listens attentively and acknowledges their problems. • Individualised follow-up is essential when prescribing antidepressants, making a referral, or issuing a sickness absence certificate.
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Affiliation(s)
- Ina Grung
- Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- CONTACT Ina Grung Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
| | - Norman Anderssen
- Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Inger Haukenes
- Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Sabine Ruths
- Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Tone Smith-Sivertsen
- Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Øystein Hetlevik
- Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Stefan Hjørleifsson
- Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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MacKean P. Le potentiel d’une approche cognitivo-comportementale pour améliorer les symptômes des patients en soins primaires. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2022; 68:e22-e25. [PMID: 35177510 PMCID: PMC9842160 DOI: 10.46747/cfp.6802e22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Peter MacKean
- Médecin de famille à la retraite à Baltic (Î.-P.-É.), professeur adjoint au Département de médecine familiale à l’Université Dalhousie et ancien président du Collège des médecins de famille du Canada.,Correspondance D Peter MacKean; courriel
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5
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MacKean P. Potential of a cognitive-behavioural approach to improve patient symptoms in a primary care setting. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2022; 68:93-96. [PMID: 35177495 PMCID: PMC9842171 DOI: 10.46747/cfp.680293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Peter MacKean
- Retired family physician in Baltic, PEI; Assistant Professor in the Department of Family Medicine at Dalhousie University; and Past President of the College of Family Physicians of Canada.,Correspondence Dr Peter MacKean; e-mail
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6
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Roberts BW, Puri NK, Trzeciak CJ, Mazzarelli AJ, Trzeciak S. Socioeconomic, racial and ethnic differences in patient experience of clinician empathy: Results of a systematic review and meta-analysis. PLoS One 2021; 16:e0247259. [PMID: 33657153 PMCID: PMC7928470 DOI: 10.1371/journal.pone.0247259] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 02/03/2021] [Indexed: 12/30/2022] Open
Abstract
Introduction Empathy is essential for high quality health care. Health care disparities may reflect a systemic lack of empathy for disadvantaged people; however, few data exist on disparities in patient experience of empathy during face-to-face health care encounters with individual clinicians. We systematically analyzed the literature to test if socioeconomic status (SES) and race/ethnicity disparities exist in patient-reported experience of clinician empathy. Methods Using a published protocol, we searched Ovid MEDLINE, PubMed, CINAHL, EMBASE, CENTRAL and PsychINFO for studies using the Consultation and Relational Empathy (CARE) Measure, which to date is the most commonly used and well-validated methodology for measuring clinician empathy from the patient perspective. We included studies containing CARE Measure data stratified by SES and/or race/ethnicity. We contacted authors to request stratified data, when necessary. We performed quantitative meta-analyses using random effects models to test for empathy differences by SES and race/ethnicity. Results Eighteen studies (n = 9,708 patients) were included. We found that, compared to patients whose SES was not low, low SES patients experienced lower empathy from clinicians (mean difference = -0.87 [95% confidence interval -1.72 to -0.02]). Compared to white patients, empathy scores were numerically lower for patients of multiple race/ethnicity groups (Black/African American, Asian, Native American, and all non-whites combined) but none of these differences reached statistical significance. Conclusion These data suggest an empathy gap may exist for patients with low SES. More research is needed to further test for SES and race/ethnicity disparities in clinician empathy and help promote health care equity. Trial registration Registration (PROSPERO): CRD42019142809.
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Affiliation(s)
- Brian W. Roberts
- Cooper University Health Care, Camden, New Jersey, United States of America
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, New Jersey, United States of America
- Center for Humanism, Cooper Medical School of Rowan University, Camden, New Jersey, United States of America
| | - Nitin K. Puri
- Cooper University Health Care, Camden, New Jersey, United States of America
- Department of Medicine, Cooper Medical School of Rowan University, Camden, New Jersey, United States of America
| | | | - Anthony J. Mazzarelli
- Cooper University Health Care, Camden, New Jersey, United States of America
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, New Jersey, United States of America
- Center for Humanism, Cooper Medical School of Rowan University, Camden, New Jersey, United States of America
| | - Stephen Trzeciak
- Cooper University Health Care, Camden, New Jersey, United States of America
- Center for Humanism, Cooper Medical School of Rowan University, Camden, New Jersey, United States of America
- Department of Medicine, Cooper Medical School of Rowan University, Camden, New Jersey, United States of America
- * E-mail:
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7
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McKenzie KJ, Pierce D, Mercer SW, Gunn JM. Do GPs use motivational interviewing skills in routine consultations with patients living with mental-physical multimorbidity? An observational study of primary care in Scotland. Chronic Illn 2021; 17:29-40. [PMID: 30580557 DOI: 10.1177/1742395318815960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To examine whether motivational interviewing is used by GPs in consultations with patients living with mental-physical multimorbidity. METHODS Secondary analysis of selected videos from an existing database of routine general practice consultations with adult patients in Glasgow, Scotland. Consultations involving patients with mental-physical multimorbidity were selected and coded using the Motivational Interviewing Treatment Integrity (MITI) coding system. RESULTS Sixty consultations were coded involving 32 GPs across 16 practices. Mean consultation length was 9.9 min. On average GPs asked 1.7 questions per minute and offered 1.2 pieces of information per minute. Using the MITI, five GPs met beginner proficiency for the relational global qualities of partnership and empathy; however, none of the GPs met beginner proficiency for the technical global rating of efforts made to encourage patients to discuss behaviour change. Simple reflections were observed in 67% of consultations and complex reflections in 28% of consultations. Confrontation, a technique inconsistent with motivational interviewing, was observed in 18% of consultations. DISCUSSION MI was not evident in these consultations with patients living with mental-physical multimorbidity. This study provides information about the baseline motivational interviewing-consistent skills of GPs working with multimorbid patients and may be helpful in informing motivational interviewing training efforts and future research.
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Affiliation(s)
- Kylie J McKenzie
- Department of General Practice, University of Melbourne, Carlton, Australia
| | - David Pierce
- Department of Rural Health, University of Melbourne, Ballarat, Australia
| | - Stewart W Mercer
- Chair of Primary Care Research, General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Jane M Gunn
- Chair of Primary Care Research, University of Melbourne, Carlton, Australia
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8
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Allen S, Rogers SN, Brown S, Harris RV. What are the underlying reasons behind socioeconomic differences in doctor-patient communication in head and neck oncology review clinics? Health Expect 2021; 24:140-151. [PMID: 33227177 PMCID: PMC7879543 DOI: 10.1111/hex.13163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To explore socioeconomic status (SES) differences in patterns of doctor-patient communication within head and neck cancer clinics and why such differences exist. METHODS Thirty-six head and neck cancer review appointments with five Physicians were observed and audio-taped, along with follow-up interviews involving 32 patients. Data were analysed using Thematic Analysis, and compared by patient SES (education, occupation and Indices of Multiple Deprivation). RESULTS Three main themes were identified: (a) Physicians used more humour and small talk in their consultations with high SES patients; (b) Low SES patients were more passive in their participation, engaged in less agenda setting and information-seeking, and framed their clinical experience differently; (c) Low SES patients had different preferences for involvement, defining involvement differently to high SES patients and were seen to take a more stoical approach. CONCLUSION Low SES patients take a more passive role in medical consultations, engage in less relational talk and are less likely to raise concerns, but were satisfied with this. Physicians may adapt their communication behaviour in response to low SES patients' expectations and preferences. PRACTICE IMPLICATIONS A question prompt list may help low SES patients to raise concerns during their consultations. This may reduce inequalities in communication and health.
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Affiliation(s)
- Sarah Allen
- Department of Health Services ResearchInstitute of Population Health SciencesUniversity of LiverpoolLiverpoolUK
| | - Simon N. Rogers
- Evidence‐Based Practice Research Centre (EPRC)Faculty of Health and Social CareEdge Hill UniversityOrmskirkUK
- Consultant Regional Maxillofacial UnitUniversity Hospital AintreeLiverpoolUK
| | - Steven Brown
- Department of Psychological SciencesInstitute of Population Health SciencesLiverpoolUK
| | - Rebecca V. Harris
- Department of Health Services ResearchInstitute of Population Health SciencesLiverpoolUK
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Mueller EL, Cochrane AR, Moore CM, Miller AD, Wiehe SE. Title: The Children's Oncology Planning for Emergencies (COPE) Tool: Prototyping with Caregivers of Children with Cancer. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2021; 2020:896-905. [PMID: 33936465 PMCID: PMC8075434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
As part of a larger project to co-design and create a mHealth tool to support caregivers of children with cancer, we performed a pilot, qualitative study. For this portion of the project, we engaged with caregivers of children with cancer to co-create and refine a low-fidelity prototype of the Children's Oncology Planning for Emergencies mHealth tool. Testing was accomplished through recorded semi-structured interviews with each caregiver as they interacted with a low-fidelity wireframe using Adobe Xd. Through the engagement of our key stakeholders, we were able to refine the COPE tool to provide the key elements they desired including pertinent patient medical information, checklist for planning when seeking urgent care, and coordination of care with the medical team and other caregivers.
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Affiliation(s)
- Emily L Mueller
- Indiana University, Indianapolis, IN
- Riley Hospital for Children, Indianapolis, IN
| | - Anneli R Cochrane
- Indiana University, Indianapolis, IN
- Riley Hospital for Children, Indianapolis, IN
| | | | | | - Sarah E Wiehe
- Indiana University, Indianapolis, IN
- Riley Hospital for Children, Indianapolis, IN
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10
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Libby G, Barnett KN, Fraser CG, Steele RJC. Association between faecal occult bleeding and medicines prescribed for chronic disease: a data linkage study. J Clin Pathol 2020; 74:664-667. [PMID: 33051288 DOI: 10.1136/jclinpath-2020-206986] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 09/21/2020] [Accepted: 09/27/2020] [Indexed: 12/29/2022]
Abstract
AIMS The presence of detectable faecal haemoglobin (f-Hb) has been shown to be associated with all-cause mortality and with death from a number of chronic diseases not known to cause gastrointestinal blood loss. This effect is independent of taking medicines that increase the risk of bleeding. To further investigate the association of f-Hb with chronic disease, the relationship between f-Hb and prescription of medicines for a variety of conditions was studied. METHODS All subjects (134 192) who participated in guaiac faecal occult blood test (gFOBT) screening in Tayside, Scotland, between March 2000 and March 2016, were studied in a cross-sectional manner by linking their gFOBT result (abnormal or normal) with prescribing data at the time of the test. RESULTS The screening participants with an abnormal gFOBT result were more likely to have been being prescribed medicines for heart disease, hypertension, diabetes and depression than those with a normal test result. This association persisted after adjustment for sex, age and deprivation (OR 1.35 (95%CI 1.23 to 1.48), 1.39 (1.27 to 1.52), 1.35 (1.15 to 1.58), 1.36 (1.16 to 1.59), all p<0.0001, for the four medicine categories, respectively). CONCLUSIONS The results of this study confer further substantial weight to the concept that detectable f-Hb is associated with a range of common chronic conditions that have a systemic inflammatory component; we speculate that f-Hb might have potential in identifying individuals who are high risk of developing chronic conditions or are at an early stage of disease.
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Affiliation(s)
- Gillian Libby
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds Faculty of Medicine and Health, Leeds, West Yorkshire, UK
| | - Karen N Barnett
- Division of Public Health and Genomics, University of Dundee School of Medicine, Dundee, Scotland, UK
| | - Callum G Fraser
- Centre for Research into Cancer Prevention & Screening, University of Dundee School of Medicine, Dundee, Scotland, UK
| | - Robert J C Steele
- Centre for Research into Cancer Prevention & Screening, University of Dundee School of Medicine, Dundee, Scotland, UK
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Brickley B, Sladdin I, Williams LT, Morgan M, Ross A, Trigger K, Ball L. A new model of patient-centred care for general practitioners: results of an integrative review. Fam Pract 2020; 37:154-172. [PMID: 31670759 DOI: 10.1093/fampra/cmz063] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND GPs providing patient-centred care (PCC) is embedded in international health care policies due to its positive impact on patients and potential to lower health care costs. However, what is currently known about GP-delivered PCC is unknown. OBJECTIVE To synthesize literature investigating GP-delivered PCC and address 'what is currently known about GP-delivered PCC?' METHOD A systematic literature search was conducted between June and July 2018. Eligible articles were empirical, full-text studies published in English between January 2003 and July 2018, related to at least three of the four dimensions of PCC described by Hudon et al. (2011), and related to preventative, acute, and/or chronic care by GPs. Following screening, full-text articles were independently assessed for inclusion by two investigators. Data were extracted and quality assessed by two researchers. Findings on PCC were analysed thematically (meta-synthesis). RESULTS Thirty medium- to high-quality studies met the inclusions criteria. Included studies utilized varied designs, with the most frequent being quantitative, cross-sectional. A theoretical model of PCC was synthesized from included studies and contained four major components: (i) understanding the whole person, (ii) finding common ground, (iii) experiencing time and (iv) aiming for positive outcomes. Harms of PCC were rarely reported. CONCLUSIONS Four overarching theoretical components of PCC relate to elements of the consultation and experience of time. These components can be used to inform the development of toolkits to support GPs and general practice organizations in pursuit of PCC as well as tools to measure patient-centredness.
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Affiliation(s)
- Bryce Brickley
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Ishtar Sladdin
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Lauren T Williams
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Mark Morgan
- Bond University, Gold Coast, Queensland, Australia
| | - Alyson Ross
- Gold Coast Primary Health Network, Gold Coast, Queensland, Australia
| | - Kellie Trigger
- Gold Coast Primary Health Network, Gold Coast, Queensland, Australia
| | - Lauren Ball
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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12
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Parker D, Byng R, Dickens C, McCabe R. Patients' experiences of seeking help for emotional concerns in primary care: doctor as drug, detective and collaborator. BMC FAMILY PRACTICE 2020; 21:35. [PMID: 32059636 PMCID: PMC7020382 DOI: 10.1186/s12875-020-01106-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 02/05/2020] [Indexed: 11/24/2022]
Abstract
Background NICE guidelines for the management of emotional concerns in primary care emphasise the importance of communication and a trusting relationship, which is difficult to operationalise in practice. Current pressures in the NHS mean that it is important to understand care from a patient perspective. This study aimed to explore patients’ experiences of primary care consultations for emotional concerns and what patients valued when seeking care from their GP. Methods Eighteen adults with experience of consulting a GP for emotional concerns participated in 4 focus groups. Data were analysed thematically. Results (1) Doctor as Drug: Patients’ relationship with their GP was considered therapeutic with continuity particularly valued. (2) Doctor as Detective and Validator: Patients were often puzzled by their symptoms, not recognising their emotional concerns. GPs needed to play the role of detective by exploring not just symptoms, but the person and their life circumstances. GPs were crucial in helping patients understand and validate their emotional concerns. (3) Doctor as Collaborator: Patients prefer a collaborative partnership, but often need to relinquish involvement because they are too unwell, or take a more active role because they feel GPs are ill-equipped or under too much pressure to help. Patients valued: GPs booking their follow up appointments; acknowledgement of stressful life circumstances; not relying solely on medication. Conclusions Seeking help for emotional concerns is challenging due to stigma and unfamiliar symptoms. GPs can support disclosure and understanding of emotional concerns by fully exploring and validating patients’ concerns, taking into account patients’ life contexts. This process of exploration and validation forms the foundation of a curative, trusting GP-patient relationship. A trusting relationship, with an emphasis on empathy and understanding, can make patients more able to share involvement in their care with GPs. This process is cyclical, as patients feel that their GP is caring, interested, and treating them as a person, further strengthening their relationship. NICE guidance should acknowledge the importance of empathy and validation when building an effective GP-patient partnership, and the role this has in supporting patients’ involvement in their care.
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Affiliation(s)
- Daisy Parker
- College of Medicine and Health, University of Exeter, Exeter, UK.
| | | | - Chris Dickens
- College of Medicine and Health, University of Exeter, Exeter, UK
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13
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Christensen MC, Wong CMJ, Baune BT. Symptoms of Major Depressive Disorder and Their Impact on Psychosocial Functioning in the Different Phases of the Disease: Do the Perspectives of Patients and Healthcare Providers Differ? Front Psychiatry 2020; 11:280. [PMID: 32390877 PMCID: PMC7193105 DOI: 10.3389/fpsyt.2020.00280] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/23/2020] [Indexed: 12/12/2022] Open
Abstract
This analysis was undertaken to examine the relationship between different symptoms of major depressive disorder (MDD) and psychosocial functioning from the perspectives of patients and healthcare providers (HCPs) across the different phases of the disease (acute, post-acute, and remission). Data regarding symptoms of MDD and psychosocial functioning, assessed by an adapted version of the Functioning Assessment Short Test (FAST) scale, were elicited via an online survey from 2,008 patients diagnosed with MDD (based on their personal experience of the disease) and 3,138 patients observed by 1,046 HCPs (based on individual patient records). Correlations between patient-reported and HCP-reported MDD symptoms and impairment of psychosocial functioning were assessed by multivariate regression analysis. The population comprised 1,946 patient respondents and 3,042 HCP-reported patients. Patients reported experiencing a wider range of symptoms and greater impairment of functioning than reported by HCPs across all phases of the disease. At the domain level, only cognitive symptoms were found to be significantly associated with functioning during the acute phase from the perspective of patients, while from the HCPs' perspective both mood and cognitive symptoms significantly impacted functioning in this phase. Significant associations were seen between mood, physical, and cognitive symptom domains and functioning in both cohorts during the post-acute and remission phases. Differences in associations between individual MDD symptoms and functioning were also observed between the two cohorts across all disease phases; in particular, HCPs found that more physical symptoms impacted functioning during remission than did patients. In summary, the results suggest that perceptions of MDD symptoms and the associations between these symptoms and functioning differ significantly between patients and HCPs across all phases of the disease. These findings further highlight the need for improved communication between patients and HCPs in order to set appropriate treatment goals and promote symptomatic and functional recovery in MDD.
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Affiliation(s)
| | | | - Bernhard T Baune
- Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany.,Department of Psychiatry, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia.,The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia
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14
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Hetlevik Ø, Garre-Fivelsdal G, Bjorvatn B, Hjørleifsson S, Ruths S. Patient-reported depression treatment and future treatment preferences: an observational study in general practice. Fam Pract 2019; 36:771-777. [PMID: 31215999 DOI: 10.1093/fampra/cmz026] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Depression is prevalent in general practice, but few studies have explored patient-reported depression care. AIM To investigate patient-reported treatment received for depression and future treatment preferences among adult patients visiting their GP, and to evaluate the associations with sex, age and educational level. DESIGN AND SETTING A cross-sectional survey was conducted in general practices in Norway from 2016 to 2017. METHODS Altogether, 2335 consecutive patients (response rate, 89.2%) in the GPs' waiting rooms answered a questionnaire about their received depression treatment and treatment preferences in case of future depression. RESULTS The study population (N = 2239) had a mean age of 48.6 ± 17.7 years (range 18-91), 60.1% were women. Of the 770 patients reporting to have received depression treatment, 39.1% were treated exclusively by their GP while 52.5% also were referred to a psychologist/psychiatrist. Older age was positively associated with medication and negatively associated with referrals to psychologist/psychiatrist. People with high education had lower odds for receiving medication (odds ratios [OR], 0.49; 95% confidence intervals [CI]: 0.30-0.80) compared to those with low education. If future depression, 81.6% of the respondents would discuss this with their GP, 60.9% would prefer talking therapy with their GP, 22.5% medication, and 52.9% referral to psychologist or psychiatrist. CONCLUSION One-third of the patients attending their GPs had consulted with them at some time concerning depression the case of future depression, most patients preferred talking therapy with the GP. This finding warrants increased research focus on the GP's role in depression care.
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Affiliation(s)
- Øystein Hetlevik
- Department of Global Public Health and Primary Care, University of Bergen, Bergen
| | - Gina Garre-Fivelsdal
- Department of Global Public Health and Primary Care, University of Bergen, Bergen
| | - Bjørn Bjorvatn
- Department of Global Public Health and Primary Care, University of Bergen, Bergen.,Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen
| | - Stefan Hjørleifsson
- Department of Global Public Health and Primary Care, University of Bergen, Bergen.,Research Group for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
| | - Sabine Ruths
- Department of Global Public Health and Primary Care, University of Bergen, Bergen.,Research Group for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
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15
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Ryan BL, Brown JB, Tremblay PF, Stewart M. Measuring Patients' Perceptions of Health Care Encounters: Examining the Factor Structure of the Revised Patient Perception of Patient-Centeredness (PPPC-R) Questionnaire. J Patient Cent Res Rev 2019; 6:192-202. [PMID: 31414031 DOI: 10.17294/2330-0698.1696] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Given the ongoing desire to make health care more patient-centered and growing evidence supporting the provision of patient-centered care, it is important to have valid tools for measuring patient-centered care. The patient-centered clinical method (PCCM) is a conceptual framework for providing patient-centered care. A revision to the PCCM framework led to a corresponding need to enhance the Patient Perception of Patient-Centeredness (PPPC) questionnaire. The original PPPC was aligned with the components of the PCCM conceptual framework and developed to measure patient-centeredness from the patient's perspective. The purpose of this study was to examine the factor structure of a revised version of the PPPC (ie, PPPC-R). METHODS Eleven new items were added to the original 14 items. The modified questionnaire was administered to patients in primary health care teams in Ontario, Canada. The confirmatory factor analysis was conducted on a subset of 381 patients who had seen a family physician. RESULTS The initial proposed 4-factor model first tested with a confirmatory factor analysis (CFA) did not fit adequately. Exploratory factor analysis was therefore used as a second step to modify the model and to identify weak items. A 3-factor exploratory model with 18 of the original 25 items was converted into a final hypothetical CFA model that had a good fit (χ2 (132)=176.795, P<0.01; CFI=0.991; RMSEA=0.030). The third factor contained only 2 items and so is interpreted with caution. CONCLUSIONS The validity of the PPPC-R is supported by some congruence between the conceptual framework (the PCCM) and the statistical analysis (CFA), but there is not a 1:1 correspondence. The components of the PCCM represent conceptually what is important when teaching, researching, and providing patient-centered care, whereas the PPPC-R represents patient-centered care as it is experienced by the patient.
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16
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Gagliardi AR, Dunn S, Foster A, Grace SL, Green CR, Khanlou N, Miller FA, Stewart DE, Vigod S, Wright FC. How is patient-centred care addressed in women's health? A theoretical rapid review. BMJ Open 2019; 9:e026121. [PMID: 30765411 PMCID: PMC6398665 DOI: 10.1136/bmjopen-2018-026121] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Efforts are needed to reduce gendered inequities and improve health and well-being for women. Patient-centred care (PCC), an approach that informs and engages patients in their own health, is positively associated with improved care delivery, experiences and outcomes. This study aimed to describe how PCC for women (PCCW) has been conceptualised in research. METHODS We conducted a theoretical rapid review of PCCW in four health conditions. We searched MEDLINE, EMBASE, CINAHL, SCOPUS, Cochrane Library and Joanna Briggs index for English-language articles published from January 2008 to February 2018 inclusive that investigated PCC and involved at least 50% women aged 18 or older. We analysed findings using a six-domain PCC framework, and reported findings with summary statistics and narrative descriptions. RESULTS After screening 2872 unique search results, we reviewed 51 full-text articles, and included 14 (five family planning, three preventive care, four depression, one cardiovascular disease and one rehabilitation). Studies varied in how they assessed PCC. None examined all six PCC framework domains; least evaluated domains were addressing emotions, managing uncertainty and enabling self-management. Seven studies that investigated PCC outcomes found a positive association with appropriate health service use, disease remission, health self-efficacy and satisfaction with care. Differing views about PCC between patients and physicians, physician PCC attitudes and geographic affluence influenced PCC. No studies evaluated the influence of patient characteristics or tested interventions to support PCCW. CONCLUSION There is a paucity of research that has explored or evaluated PCCW in the conditions of interest. We excluded many studies because they arbitrarily labelled many topics as PCC, or simply concluded that PCC was needed. More research is needed to fully conceptualise and describe PCCW across different characteristics and conditions, and to test interventions that improve PCCW. Policies and incentives may also be needed to stimulate greater awareness and delivery of PCCW.
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Affiliation(s)
- Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Sheila Dunn
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Angel Foster
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Sherry L Grace
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Courtney R Green
- Society of Obstetricians and Gynecologists of Canada, Ottawa, Ontario, Canada
| | - Nazilla Khanlou
- Society of Obstetricians and Gynecologists of Canada, Ottawa, Ontario, Canada
- Faculty of Health/School of Nursing, York University, Toronto, Ontario, Canada
| | - Fiona A Miller
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Donna E Stewart
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Simone Vigod
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Frances C Wright
- Louise Temerty Breast Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Baune BT, Christensen MC. Differences in Perceptions of Major Depressive Disorder Symptoms and Treatment Priorities Between Patients and Health Care Providers Across the Acute, Post-Acute, and Remission Phases of Depression. Front Psychiatry 2019; 10:335. [PMID: 31178765 PMCID: PMC6537882 DOI: 10.3389/fpsyt.2019.00335] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 04/29/2019] [Indexed: 11/15/2022] Open
Abstract
Limited data exist on concordance between patients' and health care providers' (HCPs) perceptions regarding symptoms of major depressive disorder (MDD) and treatment priorities, particularly across disease phases. This study examined concordance during the acute, post-acute, and remission phases of MDD. In an online survey, 2,008 patients responded based on their experience with MDD, and 1,046 HCPs responded based on their clinical experience treating patients with MDD. Questions included symptom frequency and severity, treatment priorities, and impact on psychosocial functioning. Patients reported more frequently mood, physical, and cognitive symptoms than HCPs in the post-acute and remission phases and greater impact on psychosocial functioning. Patients reported that all these symptoms require high treatment priority across the phases of MDD, generally to a greater extent than HCPs. Patients also gave high emphasis to addressing impairment in psychosocial functioning early in the treatment course. A substantial difference in the effectiveness of treating symptoms of MDD between patients and HCPs was observed. This is the first study to quantify, broadly, differences in perceptions of MDD symptom prevalence, severity, and treatment priorities across MDD phases, and the study findings highlight a need for improved communication between patients and HCPs about symptoms, their impact on psychosocial functioning, and treatment priorities across phases.
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Affiliation(s)
- Bernhard T Baune
- Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany.,Department of Psychiatry, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia.,Discipline of Psychiatry, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
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18
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Briones-Vozmediano E, Maquibar A, Vives-Cases C, Öhman A, Hurtig AK, Goicolea I. Health-Sector Responses to Intimate Partner Violence: Fitting the Response Into the Biomedical Health System or Adapting the System to Meet the Response? JOURNAL OF INTERPERSONAL VIOLENCE 2018; 33:1653-1678. [PMID: 26691205 DOI: 10.1177/0886260515619170] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This study aims to analyze how middle-level health systems' managers understand the integration of a health care response to intimate partner violence (IPV) within the Spanish health system. Data were obtained through 26 individual interviews with professionals in charge of coordinating the health care response to IPV within the 17 regional health systems in Spain. The transcripts were analyzed following grounded theory in accordance with the constructivist approach described by Charmaz. Three categories emerged, showing the efforts and challenges to integrate a health care response to IPV within the Spanish health system: "IPV is a complex issue that generates activism and/or resistance," "The mandate to integrate a health sector response to IPV: a priority not always prioritized," and "The Spanish health system: respectful with professionals' autonomy and firmly biomedical." The core category, "Developing diverse responses to IPV integration," crosscut the three categories and encompassed the range of different responses that emerge when a strong mandate to integrate a health care response to IPV is enacted. Such responses ranged from refraining to deal with the issue to offering a women-centered response. Attempting to integrate a response to nonbiomedical health problems as IPV into health systems that remain strongly biomedicalized is challenging and strongly dependent both on the motivation of professionals and on organizational factors. Implementing and sustaining changes in the structure and culture of the health care system are needed if a health care response to IPV that fulfills the World Health Organization guidelines is to be ensured.
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Affiliation(s)
- Erica Briones-Vozmediano
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, Spain
- Public Health Research Group of the University of Alicante, Spain
- Interuniversity Institute for Social Development and Peace, World Health Organization Collaborating Centre for Health and Social Inclusion of the University of Alicante, Spain
| | - Amaia Maquibar
- Department of Nursing I, University of the Basque Country, Leioa, Bizkaia, Spain
| | - Carmen Vives-Cases
- Public Health Research Group of the University of Alicante, Spain
- Interuniversity Institute for Social Development and Peace, World Health Organization Collaborating Centre for Health and Social Inclusion of the University of Alicante, Spain
- Epidemiology and Public Health CIBER, Madrid, Spain
| | - Ann Öhman
- Umeå Centre for Gender Studies, Umeå University, Sweden
- Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Anna-Karin Hurtig
- Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Isabel Goicolea
- Public Health Research Group of the University of Alicante, Spain
- Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Sweden
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19
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Detollenaere J, Boeckxstaens P, Willems S. Association between person-centredness and financially driven postponement of care in European primary care: a cross-sectional multicountry study. CMAJ Open 2018; 6:E176-E183. [PMID: 29669737 PMCID: PMC7869660 DOI: 10.9778/cmajo.20170082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Previous research has shown that person-centred care has beneficial effects on several health-related outcomes. We investigated the association between a general practitioner's person-centred attitude and financially driven postponement of care in European countries. METHODS In this cross-sectional study, data were collected within the Quality and Costs of Primary Care in Europe study, which included 69 201 patients and 7183 general practitioners from 31 European countries (all 27 European Union member states, 2 candidate states [former Yugoslav Republic of Macedonia and Turkey], Norway and Switzerland). Financially driven postponement of care was measured by asking patients whether they had postponed care for financial reasons in the previous 12 months. We constructed a variable for person-centredness using a previously published conceptual framework: 1) exploring both the disease and the illness experience, 2) understanding the whole person, 3) finding common ground and 4) enhancing the patient-physician relationship. We analyzed the data using multilevel logistic regression modelling, adjusting for the strength of a country's primary care system. RESULTS Having a low income was associated with higher financially driven postponement of care. General practitioners with a person-centred attitude were associated with lower rates of financially driven postponement among their patients. An increase in general practitioners' person-centredness with 1 standard deviation was associated with a decreased likelihood of postponement of care for financial reasons (odds ratio 0.923, 95% confidence interval 0.869-0.981). INTERPRETATION Person-centred care by general practitioners in Europe was associated with lower financially driven postponement of care, irrespective of the strength of a country's primary care system.
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Affiliation(s)
- Jens Detollenaere
- Affiliation: Faculty of Medicine and Health Sciences, Department of Family Medicine and Primary Health Care, Ghent University, Gent, Belgium
| | - Pauline Boeckxstaens
- Affiliation: Faculty of Medicine and Health Sciences, Department of Family Medicine and Primary Health Care, Ghent University, Gent, Belgium
| | - Sara Willems
- Affiliation: Faculty of Medicine and Health Sciences, Department of Family Medicine and Primary Health Care, Ghent University, Gent, Belgium
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20
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Mercer SW, Zhou Y, Humphris GM, McConnachie A, Bakhshi A, Bikker A, Higgins M, Little P, Fitzpatrick B, Watt GCM. Multimorbidity and Socioeconomic Deprivation in Primary Care Consultations. Ann Fam Med 2018; 16. [PMID: 29531103 PMCID: PMC5847350 DOI: 10.1370/afm.2202] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The influence of multimorbidity on the clinical encounter is poorly understood, especially in areas of high socioeconomic deprivation where burdensome multimorbidity is concentrated. The aim of the current study was to examine the effect of multimorbidity on general practice consultations, in areas of high and low deprivation. METHODS We conducted secondary analyses of 659 video-recorded routine consultations involving 25 general practitioners (GPs) in deprived areas and 22 in affluent areas of Scotland. Patients rated the GP's empathy using the Consultation and Relational Empathy (CARE) measure immediately after the consultation. Videos were analyzed using the Measure of Patient-Centered Communication. Multilevel, multi-regression analysis identified differences between the groups. RESULTS In affluent areas, patients with multimorbidity received longer consultations than patients without multimorbidity (mean 12.8 minutes vs 9.3, respectively; P = .015), but this was not so in deprived areas (mean 9.9 minutes vs 10.0 respectively; P = .774). In affluent areas, patients with multimorbidity perceived their GP as more empathic (P = .009) than patients without multimorbidity; this difference was not found in deprived areas (P = .344). Video analysis showed that GPs in affluent areas were more attentive to the disease and illness experience in patients with multimorbidity (P < .031) compared with patients without multimorbidity. This was not the case in deprived areas (P = .727). CONCLUSIONS In deprived areas, the greater need of patients with multimorbidity is not reflected in the longer consultation length, higher GP patient centeredness, and higher perceived GP empathy found in affluent areas. Action is required to redress this mismatch of need and service provision for patients with multimorbidity if health inequalities are to be narrowed rather than widened by primary care.
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Affiliation(s)
- Stewart W Mercer
- Academic Unit of General Practice and Primary Care, Institute of Health and Well-being, University of Glasgow, Scotland, United Kingdom
| | - Yuefang Zhou
- School of Medicine, University of St Andrews, Scotland, United Kingdom
| | - Gerry M Humphris
- School of Medicine, University of St Andrews, Scotland, United Kingdom
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Boyd Orr Building, University of Glasgow, Scotland, United Kingdom
| | - Andisheh Bakhshi
- Robertson Centre for Biostatistics, Boyd Orr Building, University of Glasgow, Scotland, United Kingdom
| | - Annemieke Bikker
- Academic Unit of General Practice and Primary Care, Institute of Health and Well-being, University of Glasgow, Scotland, United Kingdom
| | - Maria Higgins
- Academic Unit of General Practice and Primary Care, Institute of Health and Well-being, University of Glasgow, Scotland, United Kingdom
| | - Paul Little
- Primary Medical Care, Aldermoor Health Centre, Aldermoor close, University of Southampton, Southampton, United Kingdom
| | - Bridie Fitzpatrick
- Academic Unit of General Practice and Primary Care, Institute of Health and Well-being, University of Glasgow, Scotland, United Kingdom
| | - Graham C M Watt
- Academic Unit of General Practice and Primary Care, Institute of Health and Well-being, University of Glasgow, Scotland, United Kingdom
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21
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Prior A, Vestergaard M, Larsen KK, Fenger-Grøn M. Association between perceived stress, multimorbidity and primary care health services: a Danish population-based cohort study. BMJ Open 2018; 8:e018323. [PMID: 29478014 PMCID: PMC5855234 DOI: 10.1136/bmjopen-2017-018323] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Mental stress is common in the general population. Mounting evidence suggests that mental stress is associated with multimorbidity, suboptimal care and increased mortality. Delivering healthcare in a biopsychosocial context is key for general practitioners (GPs), but it remains unclear how persons with high levels of perceived stress are managed in primary care. We aimed to describe the association between perceived stress and primary care services by focusing on mental health-related activities and markers of elective/acute care while accounting for mental-physical multimorbidity. DESIGN Population-based cohort study. SETTING Primary healthcare in Denmark. PARTICIPANTS 118 410 participants from the Danish National Health Survey 2010 followed for 1 year. Information on perceived stress and lifestyle was obtained from a survey questionnaire. Information on multimorbidity was obtained from health registers. OUTCOME MEASURES General daytime consultations, out-of-hours services, mental health-related services and chronic care services in primary care obtained from health registers. RESULTS Perceived stress levels were associated with primary care activity in a dose-response relation when adjusted for underlying conditions, lifestyle and socioeconomic factors. In the highest stress quintile, 6.8% attended GP talk therapy (highest vs lowest quintile, adjusted incidence rate ratios (IRR): 4.96, 95% CI 4.20 to 5.86), 3.3% consulted a psychologist (IRR: 6.49, 95% CI 4.90 to 8.58), 21.5% redeemed an antidepressant prescription (IRR: 4.62, 95% CI 4.03 to 5.31), 23.8% attended annual chronic care consultations (IRR: 1.22, 95% CI 1.16 to 1.29) and 26.1% used out-of-hours services (IRR: 1.47, 95% CI 1.51 to 1.68). For those with multimorbidity, stress was associated with more out-of-hours services, but not with more chronic care services. CONCLUSION Persons with high stress levels generally had higher use of primary healthcare, 4-6 times higher use of mental health-related services (most often in the form of psychotropic drug prescriptions), but less timely use of chronic care services.
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Affiliation(s)
- Anders Prior
- Research Unit for General Practice and Section for General Medical Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Mogens Vestergaard
- Research Unit for General Practice and Section for General Medical Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Karen Kjær Larsen
- Research Unit for General Practice and Section for General Medical Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Morten Fenger-Grøn
- Research Unit for General Practice and Section for General Medical Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
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22
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Prescott SL, Logan AC. Transforming Life: A Broad View of the Developmental Origins of Health and Disease Concept from an Ecological Justice Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13111075. [PMID: 27827896 PMCID: PMC5129285 DOI: 10.3390/ijerph13111075] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 10/21/2016] [Accepted: 10/28/2016] [Indexed: 12/20/2022]
Abstract
The influential scientist Rene J. Dubos (1901–1982) conducted groundbreaking studies concerning early-life environmental exposures (e.g., diet, social interactions, commensal microbiota, housing conditions) and adult disease. However, Dubos looked beyond the scientific focus on disease, arguing that “mere survival is not enough”. He defined mental health as fulfilling human potential, and expressed concerns about urbanization occurring in tandem with disappearing access to natural environments (and elements found within them); thus modernity could interfere with health via “missing exposures”. With the advantage of emerging research involving green space, the microbiome, biodiversity and positive psychology, we discuss ecological justice in the dysbiosphere and the forces—financial inequity, voids in public policy, marketing and otherwise—that interfere with the fundamental rights of children to thrive in a healthy urban ecosystem and learn respect for the natural environment. We emphasize health within the developmental origins of health and disease (DOHaD) rubric and suggest that greater focus on positive exposures might uncover mechanisms of resiliency that contribute to maximizing human potential. We will entrain our perspective to socioeconomic disadvantage in developed nations and what we have described as “grey space”; this is a mental as much as a physical environment, a space that serves to insidiously reinforce unhealthy behavior, compromise positive psychological outlook and, ultimately, trans-generational health. It is a dwelling place that cannot be fixed with encephalobiotics or the drug-class known as psychobiotics.
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Affiliation(s)
- Susan L Prescott
- International Inflammation (in-FLAME) Network, Worldwide Universities Network (WUN), 35 Stirling Hwy, Crawley 6009, Australia.
- School of Paediatrics and Child Health Research, University of Western Australia, P.O. Box D184, Princess Margaret Hospital, Perth 6001, Australia.
| | - Alan C Logan
- International Inflammation (in-FLAME) Network, Worldwide Universities Network (WUN), 35 Stirling Hwy, Crawley 6009, Australia.
- PathLight Synergy, 23679 Calabassas Road, Suite 542, Calabassas, CA 91302, USA.
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23
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Garg R, Shen C, Sambamoorthi N, Kelly K, Sambamoorthi U. Type of Multimorbidity and Patient-Doctor Communication and Trust among Elderly Medicare Beneficiaries. INTERNATIONAL JOURNAL OF FAMILY MEDICINE 2016; 2016:8747891. [PMID: 27800181 PMCID: PMC5069353 DOI: 10.1155/2016/8747891] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 09/01/2016] [Accepted: 09/15/2016] [Indexed: 06/06/2023]
Abstract
Background. Effective communication and high trust with doctor are important to reduce the burden of multimorbidity in the rapidly aging population of the US. However, the association of multimorbidity with patient-doctor communication and trust is unknown. Objective. We examined the relationship between multimorbidity and patient-doctor communication and trust among the elderly. Method. We used the Medicare Current Beneficiary Survey (2012) to analyze the association between multimorbidity and patient-doctor communication and trust with multivariable logistic regressions that controlled for patient's sociodemographic characteristics, health status, and satisfaction with care. Results. Most elderly beneficiaries reported effective communication (87.5-97.5%) and high trust (95.4-99.1%) with their doctors. The elderly with chronic physical and mental conditions were less likely than those with only physical conditions to report effective communication with their doctor (Adjusted Odds Ratio [95% Confidence Interval] = 0.80 [0.68, 0.96]). Multimorbidity did not have a significant association with patient-doctor trust. Conclusions. Elderly beneficiaries had high trust in their doctors, which was not affected by the presence of multimorbidity. Elderly individuals who had a mental condition in addition to physical conditions were more likely to report ineffective communication. Programs to improve patient-doctor communication with patients having cooccurring chronic physical and mental health conditions may be needed.
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Affiliation(s)
- Rahul Garg
- Department of Pharmaceutical Systems and Policy, West Virginia University, Morgantown, WV 26506, USA
| | - Chan Shen
- Department of Biostatistics and Health Services Research, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Nethra Sambamoorthi
- School of Continuing Education, Northwestern University, Evanston, IL 60208, USA
| | - Kimberly Kelly
- Department of Pharmaceutical Systems and Policy, West Virginia University, Morgantown, WV 26506, USA
| | - Usha Sambamoorthi
- Department of Pharmaceutical Systems and Policy, West Virginia University, Morgantown, WV 26506, USA
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24
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Mercer SW, O'Brien R, Fitzpatrick B, Higgins M, Guthrie B, Watt G, Wyke S. The development and optimisation of a primary care-based whole system complex intervention (CARE Plus) for patients with multimorbidity living in areas of high socioeconomic deprivation. Chronic Illn 2016; 12:165-81. [PMID: 27068113 PMCID: PMC4995497 DOI: 10.1177/1742395316644304] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 02/01/2016] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To develop and optimise a primary care-based complex intervention (CARE Plus) to enhance the quality of life of patients with multimorbidity in the deprived areas. METHODS Six co-design discussion groups involving 32 participants were held separately with multimorbid patients from the deprived areas, voluntary organisations, general practitioners and practice nurses working in the deprived areas. This was followed by piloting in two practices and further optimisation based on interviews with 11 general practitioners, 2 practice nurses and 6 participating multimorbid patients. RESULTS Participants endorsed the need for longer consultations, relational continuity and a holistic approach. All felt that training and support of the health care staff was important. Most participants welcomed the idea of additional self-management support, though some practitioners were dubious about whether patients would use it. The pilot study led to changes including a revised care plan, the inclusion of mindfulness-based stress reduction techniques in the support of practitioners and patients, and the stream-lining of the written self-management support material for patients. DISCUSSION We have co-designed and optimised an augmented primary care intervention involving a whole-system approach to enhance quality of life in multimorbid patients living in the deprived areas. CARE Plus will next be tested in a phase 2 cluster randomised controlled trial.
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Affiliation(s)
- Stewart William Mercer
- General Practice and Primary Care, University of Glasgow, United Kingdom of Great Britain and Northern Ireland
| | - Rosaleen O'Brien
- General Practice and Primary Care, University of Glasgow, United Kingdom of Great Britain and Northern Ireland
| | - Bridie Fitzpatrick
- General Practice and Primary Care, University of Glasgow, United Kingdom of Great Britain and Northern Ireland
| | - Maria Higgins
- General Practice and Primary Care, University of Glasgow, United Kingdom of Great Britain and Northern Ireland
| | - Bruce Guthrie
- General Practice and Primary Care, University of Glasgow, United Kingdom of Great Britain and Northern Ireland
| | - Graham Watt
- General Practice and Primary Care, University of Glasgow, United Kingdom of Great Britain and Northern Ireland
| | - Sally Wyke
- General Practice and Primary Care, University of Glasgow, United Kingdom of Great Britain and Northern Ireland
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Brown JB, Ryan BL, Thorpe C. Processes of patient-centred care in Family Health Teams: a qualitative study. CMAJ Open 2016; 4:E271-6. [PMID: 27398373 PMCID: PMC4933633 DOI: 10.9778/cmajo.20150128] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Patient-centred care, access to care, and continuity of and coordination of care are core processes in primary health care delivery. Our objective was to evaluate how these processes are enacted by 1 primary care model, Family Health Teams, in Ontario. METHODS Our study used grounded theory methodology to examine these 4 processes of care from the perspective of health care providers. Twenty Family Health Team practice sites in Ontario were selected to represent maximum variation (e.g., location, year of Family Health Team approval). Semi-structured interviews were conducted with each participant. A constant comparative approach was used to analyze the data. RESULTS Our final sample population involved 110 participants from 20 Family Health Teams. Participants described how their Family Health Team strived to provide patient-centred care, to ensure access, and to pursue continuity and coordination in their delivery of care. Patient-centred care was provided through a variety of means forging the links among the other processes of care. Participants from all teams articulated a commitment to timely access, spontaneously expressing the importance of access to mental health services. Continuity of care was linked to both access and patient-centred care. Coordination of care by the team was perceived to reduce unnecessary walk-in clinic and emergency department visits, and facilitated a smoother transition from hospital to home. INTERPRETATION These 4 processes of patient care were inextricably linked. Patient-centred care was the focal point, and these processes in turn served to enhance the delivery of patient-centred care.
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Affiliation(s)
- Judith Belle Brown
- Departments of Family Medicine (Brown, Ryan, Thorpe), and Epidemiology and Biostatistics (Ryan), Schulich School of Medicine and Dentistry, Western University; School of Social Work (Brown), King's University College, Western University, London, Ont
| | - Bridget L Ryan
- Departments of Family Medicine (Brown, Ryan, Thorpe), and Epidemiology and Biostatistics (Ryan), Schulich School of Medicine and Dentistry, Western University; School of Social Work (Brown), King's University College, Western University, London, Ont
| | - Cathy Thorpe
- Departments of Family Medicine (Brown, Ryan, Thorpe), and Epidemiology and Biostatistics (Ryan), Schulich School of Medicine and Dentistry, Western University; School of Social Work (Brown), King's University College, Western University, London, Ont
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The influence of socioeconomic deprivation on multimorbidity at different ages: a cross-sectional study. Br J Gen Pract 2015; 64:e440-7. [PMID: 24982497 PMCID: PMC4073730 DOI: 10.3399/bjgp14x680545] [Citation(s) in RCA: 131] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background Multimorbidity occurs at a younger age in individuals in areas of high socioeconomic deprivation but little is known about the ‘typology’ of multimorbidity in different age groups and its association with socioeconomic status. Aim To characterise multimorbidity type and most common conditions in a large nationally representative primary care dataset in terms of age and deprivation. Design and setting Cross-sectional analysis of 1 272 685 adults in Scotland. Method Multimorbidity type of participants (physical-only, mental-only, mixed physical, and mental) and most common conditions were analysed according to age and deprivation. Results Multimorbidity increased with age, ranging from 8.1% in those aged 25–34 to 76.1% for those aged ≥75 years. Physical-only (56% of all multimorbidity) was the most common type of multimorbidity in those aged ≥55 years, and did not vary substantially with deprivation. Mental-only was uncommon (4% of all multimorbidity), whereas mixed physical and mental (40% of all multimorbidity) was the most common type of multimorbidity in those aged <55 years and was two- to threefold more common in the most deprived compared with the least deprived in most age groups. Ten conditions (seven physical and three mental) accounted for the top five most common conditions in people with multimorbidity in all age groups. Depression and pain featured in the top five conditions across all age groups. Deprivation was associated with a higher prevalence of depression, drugs misuse, anxiety, dyspepsia, pain, coronary heart disease, and diabetes in multimorbid patients at different ages. Conclusion Mixed physical and mental multimorbidity is common across the life-span and is exacerbated by deprivation from early adulthood onwards.
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Zhou Y, Lundy JM, Humphris G, Mercer SW. Do multimorbidity and deprivation influence patients' emotional expressions and doctors' responses in primary care consultations?--An exploratory study using multilevel analysis. PATIENT EDUCATION AND COUNSELING 2015; 98:1063-1070. [PMID: 26111501 DOI: 10.1016/j.pec.2015.05.026] [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: 11/27/2014] [Revised: 05/27/2015] [Accepted: 05/30/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To explore whether and how patient multimorbidity and socioeconomic deprivation might influence patients' emotional expression and doctors' responses in the general practice (GP) consultations. METHODS Video recordings of 107 consultations (eight GPs) were coded with the Verona Coding Definitions of Emotional Sequences (VR-CoDES). Multilevel logistic regressions modelled the probability of GP providing space response, considering patient multimorbidity, deprivation conditions and other contextual factors. Further multinomial regressions explored the possible impact of multimorbidity and deprivation on expression of and specific responses to patients' emotional distress. RESULTS It was less likely for GPs to provide space as the consultation proceeded, controlling for multimorbidity and deprivation variables. Patients with multimorbidity were less likely to express emotional distress in an explicit form. GPs were more likely to provide acknowledgement to emotions expressed by patients from more deprived areas. CONCLUSION Multimorbidity and deprivation may influence the dynamics of the GP consultations in specific ways. Rigorous methodologies using larger samples are required to explore further how these two variables relate to each other and influence cue expression, provider response and subsequent patient outcomes. PRACTICE IMPLICATIONS Understanding how multimorbidity and deprivation impact on GP consultations may help inform future service improvement programmes.
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Affiliation(s)
- Yuefang Zhou
- School of Medicine, University of St Andrews, St Andrews, UK.
| | - Jenna-Marie Lundy
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Gerry Humphris
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Stewart William Mercer
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Goicolea I, Hurtig AK, San Sebastian M, Vives-Cases C, Marchal B. Developing a programme theory to explain how primary health care teams learn to respond to intimate partner violence: a realist case-study. BMC Health Serv Res 2015; 15:228. [PMID: 26054758 PMCID: PMC4460973 DOI: 10.1186/s12913-015-0899-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 06/02/2015] [Indexed: 11/28/2022] Open
Abstract
Background Despite the progress made on policies and programmes to strengthen primary health care teams’ response to Intimate Partner Violence, the literature shows that encounters between women exposed to IPV and health-care providers are not always satisfactory, and a number of barriers that prevent individual health-care providers from responding to IPV have been identified. We carried out a realist case study, for which we developed and tested a programme theory that seeks to explain how, why and under which circumstances a primary health care team in Spain learned to respond to IPV. Methods A realist case study design was chosen to allow for an in-depth exploration of the linkages between context, intervention, mechanisms and outcomes as they happen in their natural setting. The first author collected data at the primary health care center La Virgen (pseudonym) through the review of documents, observation and interviews with health systems’ managers, team members, women patients, and members of external services. The quality of the IPV case management was assessed with the PREMIS tool. Results This study found that the health care team at La Virgen has managed 1) to engage a number of staff members in actively responding to IPV, 2) to establish good coordination, mutual support and continuous learning processes related to IPV, 3) to establish adequate internal referrals within La Virgen, and 4) to establish good coordination and referral systems with other services. Team and individual level factors have triggered the capacity and interest in creating spaces for team leaning, team work and therapeutic responses to IPV in La Virgen, although individual motivation strongly affected this mechanism. Regional interventions did not trigger individual and/ or team responses but legitimated the workings of motivated professionals. Conclusions The primary health care team of La Virgen is involved in a continuous learning process, even as participation in the process varies between professionals. This process has been supported, but not caused, by a favourable policy for integration of a health care response to IPV. Specific contextual factors of La Virgen facilitated the uptake of the policy. To some extent, the performance of La Virgen has the potential to shape the IPV learning processes of other primary health care teams in Murcia. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-0899-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Isabel Goicolea
- Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umea University, SE-90187, Umea, Sweden. .,Public Health Research Group, Department of Community Nursing, Preventive Medicine and Public Health and History of Science, Alicante University, Alicante, Spain.
| | - Anna-Karin Hurtig
- Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umea University, SE-90187, Umea, Sweden.
| | - Miguel San Sebastian
- Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umea University, SE-90187, Umea, Sweden.
| | - Carmen Vives-Cases
- Public Health Research Group, Department of Community Nursing, Preventive Medicine and Public Health and History of Science, Alicante University, Alicante, Spain. .,CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain.
| | - Bruno Marchal
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
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Lundy JM, Bikker A, Higgins M, Watt GC, Little P, Humphries GM, Mercer SW. General practitioners’ patient-centredness and responses to patients’ emotional cues and concerns: relationships with perceived empathy in areas of high and low socioeconomic deprivation. ACTA ACUST UNITED AC 2015. [DOI: 10.1186/s40639-015-0011-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Yélamos C, Sanz A, Marín R, Martínez-Ríos C. Experiencia del paciente: una nueva forma de entender la atención al paciente oncológico. PSICOONCOLOGIA 1970. [DOI: 10.5209/psic.59184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
En el presente trabajo se analiza el concepto de Experiencia del Paciente (PX) así como las variables que contribuyen a la mejora del mismo. El objetivo es explicar su utilidad clínica en el ámbito de la salud, en concreto sobre la población oncológica, además de demostrar el papel activo que la Psicooncología puede tener en la implementación de esta estrategia, en relación directa con la humanización de la asistencia sanitaria. Para ello, se ha revisado la literatura con evidencia empírica existente hasta el momento y que sitúa la experiencia del paciente como un pilar indispensable a la hora de mejorar la calidad de la atención clínica, junto con la efectividad del tratamiento y la seguridad del paciente. Estos elementos presentan una interacción positiva entre ellos y están moderados por la comunicación médico-paciente, lo que evidencia la necesidad de desarrollar habilidades de comunicación por los profesionales en la práctica clínica, la coordinación de la atención sanitaria, el acceso a los servicios y la percepción del paciente respecto a la atención recibida. La experiencia del paciente resulta clínicamente relevante e influyente en la recuperación del estado de salud del paciente, así como constituye un cambio en la cultura sanitaria, cuyo protagonista es el paciente y en torno a él debe girar dicho cambio de manera multidisciplinar e integral por parte de los profesionales sanitarios implicados en su cuidado. Se concluye con una nueva línea de actuación del psicooncólogo en la experiencia del paciente para promover un servicio oncológico de calidad.
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