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Davis R, Parand A, Pinto A, Buetow S. Systematic review of the effectiveness of strategies to encourage patients to remind healthcare professionals about their hand hygiene. J Hosp Infect 2014; 89:141-62. [PMID: 25617088 DOI: 10.1016/j.jhin.2014.11.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 11/19/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Patients could help to improve the hand hygiene (HH) compliance of healthcare professionals (HCPs) by reminding them to sanitize their hands. AIM To review the effectiveness of strategies aimed at increasing patient involvement in reminding HCPs about their HH. METHODS A systematic review was conducted across Medline, EMBASE and PsycINFO between 1980 and 2013. FINDINGS Twenty-eight out of a possible 1956 articles were included. Of these, 23 articles evaluated the effectiveness of developed patient-focused strategies and five articles examined patients' attitudes towards hypothetical strategies. Sixteen articles evaluated single-component strategies (e.g. videos) and 12 articles evaluated multi-modal approaches (e.g. combination of video and leaflet). Overall, the strategies showed promise in helping to increase patients' intentions and/or involvement in reminding HCPs about their HH. HCP encouragement appeared to be the most effective strategy. However, the methodological quality of the articles in relation to addressing the specific aims of this review was generally weak. CONCLUSION A number of strategies are available to encourage patients to question HCPs about their HH. Better controlled studies with more robust outcome measures will enhance understanding about which strategies may be most successful and why.
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Affiliation(s)
- R Davis
- Centre for Patient Safety and Service Quality, Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK.
| | - A Parand
- Centre for Patient Safety and Service Quality, Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK
| | - A Pinto
- Centre for Patient Safety and Service Quality, Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK
| | - S Buetow
- Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, Auckland, New Zealand
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Abstract
AIMS To determine whether a diabetes annual review, independently of other care processes, is followed by improved patient clinical measurements. METHODS Audits conducted independently of the diabetes annual review were analysed for a time-trend in patient clinical measures. An interaction variable between the review and the year of audit was used to test for a change in gradient before and after a diabetes annual review. Each patient formed their own control. RESULTS The data included 9471 audits on 3397 patients from 92 practices, and diabetes annual reviews from 2003 to mid-2008. Percentages of patients with raised HbA(1c) , systolic blood pressure and lipids improved from first to last audit. Predicted means after a diabetes annual review for HbA(1c) decreased by 0.13% (1.0 mmol/mol), for HDL cholesterol increased by 0.04 mmol/L and for triglyceride decreased by 0.2 mmol/L. Predicted systolic and diastolic blood pressure, total cholesterol and urinary albumin:creatinine ratio did not change significantly. CONCLUSIONS Metabolic control improved over time but this was largely independently of the diabetes annual review, which appears to add little clinical value to existing New Zealand general practice care processes. Currently, general practitioners are paid to undertake a diabetes annual review and report the measurements collected. We would argue that payment needs to be directed to demonstrating appropriate changes in clinical management or achieving meaningful clinical goals, and that the annual review results should be part of systematic feedback to general practitioners, particularly directed at clinical inertia.
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Affiliation(s)
- T Kenealy
- University of Auckland, South Auckland Clinical School, Middlemore Hospital, Otahuhu, Auckland, New Zealand.
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Buetow S, Henshaw J, Cha R, O'Sullivan D. Distinguishing objective from subjective assessments of the severity of medication-related safety events among people with Parkinson's disease: a qualitative study. J Clin Pharm Ther 2011; 37:436-40. [PMID: 22129248 DOI: 10.1111/j.1365-2710.2011.01316.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Safety events indicating medication-related errors in Parkinson's disease (PD) are common but seldom studied, particularly from lay perspectives. Our objective was to study the meaning and significance to people living with PD of their experience of safety events. METHODS Twenty qualitative interviews were conducted by telephone with purposively sampled individuals with PD, a proxy, or both, throughout New Zealand. Themes identified from the data included joint assessments of the objective and subjective severity of the individual safety events. RESULTS AND DISCUSSION Most of the events indicated minor objective errors, whose severity was sometimes perceived as major, especially in the face of callous communication. WHAT IS NEW AND CONCLUSION Variation between objective and subjective assessments of the severity of possible errors indicated by safety events highlight the importance of distinguishing between, and using, both forms of assessment.
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Affiliation(s)
- S Buetow
- Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand.
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Abstract
Abstract
This review examines two methodologies that are being increasingly used in health services research (HSR): the Delphi and nominal group techniques. The Delphi is a survey technique for decision making among isolated respondents while the nominal group technique (NGT) is a highly controlled small group process for the generation of ideas. Typical applications of the techniques are for the development of consensus guidelines or standards in areas where research based evidence is absent or inconclusive. We discuss methodological issues associated with these techniques, namely, sample size and composition, response rates, anonymity, feedback and consensus, and reliability and validity. We also illustrate the range of applications of the techniques in HSR, including pharmacy practice. Although not widely used to date, both methodologies are potentially valuable additions to the practice researcher's toolbox.
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Affiliation(s)
- J A Cantrill
- Department of Pharmacy and National Primary Care Research and Development Centre, University of Manchester, Manchester, England M13 9PL
| | - B Sibbald
- National Primary Care Research and Development Centre, University of Manchester
| | - S Buetow
- National Primary Care Research and Development Centre, University of Manchester
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Abstract
Amid neglect of patients' contribution to error has been a failure to ask whether patients are morally responsible for their errors. This paper aims to help answer this question and so define a worthy response to the errors. Recent work on medical errors has emphasised system deficiencies and discouraged finding people to blame. We scrutinize this approach from an incompatibilist, agent causation position and draw on Hart's taxonomy of four senses of moral responsibility: role responsibility; capacity responsibility; causal responsibility; and liability responsibility. Each sense is shown to contribute to an overall theoretical judgment as to whether patients are morally responsible for their errors (and success in avoiding them). Though how to weight the senses is unclear, patients appear to be morally responsible for the avoidable errors they make, contribute to or can influence.
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Affiliation(s)
- S Buetow
- Department of General Practice and Primary Health Care, University of Auckland, Private Bag 92019, Auckland, New Zealand.
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Abstract
Patient responsibilities in primary health care are controversial and, by comparison, the responsibilities of high need patients are less clear. This paper aims to suggest why high need patients receiving targeted entitlements in primary health care are free to have prima facie special responsibilities; why, given this freedom, these patients morally have special responsibilities; what these responsibilities are, and how publicly funded health systems ought to be able to respond when these remain unmet. It is suggested that the special responsibilities and their place in public policy acquire moral significance as a means to discharge a moral debt, share special knowledge, and produce desirable consequences in regard to personal and collective interests. Special responsibilities magnify ordinary patient responsibilities and require patients not to hesitate regarding attendance for primary health care. Persistent patient disregard of special responsibilities may necessitate limiting the scope of these responsibilities, removing system barriers, or respecifying special rights.
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Affiliation(s)
- S Buetow
- Department of General Practice and Primary Health Care, University of Auckland, Private Bag 92019, Auckland, New Zealand.
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Buetow S, Adair V, Coster G, Hight M, Gribben B, Mitchell E. Qualitative insights into practice time management: does 'patient-centred time' in practice management offer a portal to improved access? Br J Gen Pract 2002; 52:981-7. [PMID: 12528583 PMCID: PMC1314467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023] Open
Abstract
BACKGROUND Different sets of literature suggest how aspects of practice time management can limit access to general practitioner (GP) care. Researchers have not organised this knowledge into a unified framework that can enhance understanding of barriers to, and opportunities for, improved access. AIM To suggest a framework conceptualising how differences in professional and cultural understanding of practice time management in Auckland, New Zealand, influence access to GP care for children with chronic asthma. DESIGN OF STUDY A qualitative study involving selective sampling, semi-structured interviews on barriers to access, and a general inductive approach. SETTING Twenty-nine key informants and ten mothers of children with chronic, moderate to severe asthma and poor access to GP care in Auckland. METHOD Development of a framework from themes describing barriers associated with, and needs for, practice time management. The themes were independently identified by two authors from transcribed interviews and confirmed through informant checking. Themes from key informant and patient interviews were triangulated with each other and with published literature. RESULTS The framework distinguishes 'practice-centred time' from 'patient-centred time.' A predominance of 'practice-centred time' and an unmet opportunity for 'patient-centred time' are suggested by the persistence of five barriers to accessing GP care: limited hours of opening; traditional appointment systems; practice intolerance of missed appointments; long waiting times in the practice; and inadequate consultation lengths. None of the barriers is specific to asthmatic children. CONCLUSION A unified framework was suggested for understanding how the organisation of practice work time can influence access to GP care by groups including asthmatic children.
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Affiliation(s)
- S Buetow
- Department of General Practice and Primary Health Care, University of Auckland, Private Bag 92019, Auckland, New Zealand.
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Abstract
Contesting that a debate on evidence-based health care has taken place, this article charts three paths to the future: continuing avoidance of debate by proponents of evidence-based medicine (EBM); conflict, which the EBM movement courts and critics have espoused, and dialogue. The last portal allows for integration, which would end the disagreement between EBM and its critics and make a debate unnecessary. In search of integration, I sketch a bridge whose construction requires not compromise but a win- win approach. The bridge is a medicine of meaning (MOM). Consolidating multiple pillars of evidence to unify questions that are not necessarily the same for protagonists and critics of EBM, a MOM contends that the purpose or meaning of medicine is always healing and helping, and each party finds meaning in medicine by contributing to this common purpose in its own distinctive way.
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Affiliation(s)
- S Buetow
- Division of General Practice and Primary Health Care, Faculty of Medical and Health Sciences, University of Auckland, New Zealand.
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Abstract
Power is an inescapable aspect of all social relationships, and inherently is neither good nor evil. Doctors need power to fulfil their professional obligations to multiple constituencies including patients, the community and themselves. Patients need power to formulate their values, articulate and achieve health needs, and fulfil their responsibilities. However, both parties can use or misuse power. The ethical effectiveness of a health system is maximised by empowering doctors and patients to develop 'adult-adult' rather than 'adult-child' relationships that respect and enable autonomy, accountability, fidelity and humanity. Even in adult-adult relationships, conflicts and complexities arise. Lack of concordance between doctors and patients can encourage paternalism but may be best resolved through negotiated care. A further area of conflict involves the 'double agency' of doctors for both patients and the community. Empowerment of all players is not always possible but is most likely where each party considers and acknowledges power issues.
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Affiliation(s)
- F Goodyear-Smith
- Division of General Practice & Primary, Health Care, Faculty of Medical & Health Sciences, University of Auckland, New Zealand.
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Abstract
BACKGROUND A patient's psychological adaptation to heart failure can influence its impact on his or her life. However, attempts to understand how patients cope mentally with severe emotional strain have led to inconsistent use of a plethora of concepts, making communication and clinical care difficult. OBJECTIVES The aim of the present study was to develop a framework for conceptualizing how patients with chronic heart failure cope mentally with their illness, and then use the framework to suggest how GPs can facilitate patient self-care. METHODS We systematically reduced and reassembled the narrative texts of personal, semi-structured interviews until their interpretation was complete. The interviews were conducted during late 1999 with 62 heart failure patients under GP care in 30 practices across central Auckland, New Zealand. RESULTS Our framework describes four coping strategies: avoidance, disavowal, denial and acceptance. Disavowal provides a distinct coping strategy through which patients, who basically understand the threat to their life situations, seek hope through positively reconstructing this threat. Use of this strategy was highly salient regardless of patients' age, the length of time since their recorded diagnosis or the degree of self-reported limitation of recent physical function due to heart failure. Only over age 70 were avoidance and acceptance also highly salient among patients whose heart failure was diagnosed at least 3 years previously and had mildly limited their recent physical function. CONCLUSION Many different heart failure patients use disavowal to palliate the emotional strain and find hope. Disavowal is not a problem to deal with but a process GPs can facilitate by implementing a range of suggested strategies through methods such as story telling.
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Affiliation(s)
- S Buetow
- Department of General Practice and Primary Health Care, University of Auckland, PO Box 92 019, Auckland, New Zealand
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Buetow S, Coster G, Gurr E. Looking forward to health needs assessments: a new perspective on 'need'. N Z Med J 2001; 114:92-4. [PMID: 11297145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Affiliation(s)
- S Buetow
- Health Research Council of New Zealand.
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Abstract
Evidence is defined by its ability to establish or support conclusions. Evidence-based medicine (EBM) equates evidence with scientific evidence and views factors such as clinical expertise as important in moving from evidence to action. In contrast, we suggest that EBM should acknowledge multiple dimensions of evidence including scientific evidence, theoretic evidence, practical evidence, expert evidence, judicial evidence and ethics-based evidence. What EBM loses by not acknowledging these dimensions as evidence is the ability, among other things, to make and defend judgements based on understandings that complement science and are no less important than those science can offer. We argue for a new definition of EBM that, without forced accommodation or unacceptable compromise, acknowledges dimensions of evidence produced within and outside science.
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Affiliation(s)
- S Buetow
- Department of General Practice and Primary Health Care, University of Auckland, New Zealand
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Buetow S. Patient enrollment with co-payments: implications for patient choice in general practice. N Z Med J 1999; 112:473-4. [PMID: 10678214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Affiliation(s)
- S Buetow
- Department of General Practice and Primary Health Care, University of Auckland
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14
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Affiliation(s)
- S Buetow
- School of Medicine and Health Science, University of Auckland, New Zealand
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Cantrill JA, Sibbald B, Buetow S. Indicators of the appropriateness of long-term prescribing in general practice in the United Kingdom: consensus development, face and content validity, feasibility, and reliability. Qual Health Care 1998; 7:130-5. [PMID: 10185138 PMCID: PMC2483608 DOI: 10.1136/qshc.7.3.130] [Citation(s) in RCA: 93] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To develop valid, reliable indicators of the appropriateness of long-term prescribing in general practice medical records in the United Kingdom. DESIGN A nominal group was used to identify potential indicators of appropriateness of prescribing. Their face and content validity were subsequently assessed in a two round Delphi exercise. Feasibility and reliability between raters were evaluated for the indicators for which consensus was reached and were suitable for application. PARTICIPANTS The nominal group comprised a disciplinary mix of nine opinion leaders and prominent academics in the field of prescribing. The Delphi panel was composed of 100 general practitioners and 100 community pharmacists. RESULTS The nominal group resulted in 20 items which were refined to produce 34 statements for the Delphi exercise. Consensus was reached on 30, from which 13 indicators suitable for application were produced. These were applied by two independent raters to the records of 49 purposively sampled patients in one general practice. Nine indicators showed acceptable reliability between raters. CONCLUSIONS 9 indicators of prescribing appropriateness were produced suitable for application to the medical record of any patient on long term medication in United Kingdom general practice. Although the use of the medical record has limitations, this is currently the only available method to assess a patient's drug regimen in its entirety.
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Affiliation(s)
- J A Cantrill
- National Primary Care Research and Development Centre, University of Manchester, UK
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Buetow S. The scope for the involvement of patients in their consultations with health professionals: rights, responsibilities and preferences of patients. J Med Ethics 1998; 24:243-247. [PMID: 9752626 PMCID: PMC1377673 DOI: 10.1136/jme.24.4.243] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The degree and nature of patient involvement in consultations with health professionals influences problem and needs recognition and management, and public accountability. This paper suggests a framework for understanding the scope for patient involvement in such consultations. Patients are defined as co-producers of formal health services, whose potential for involvement in consultations depends on their personal rights, responsibilities and preferences. Patients' rights in consultations are poorly defined and, in the National Health Service (NHS), not legally enforceable. The responsibilities of patients are also undefined. I suggest that these are not to deny, of their own volition, the rights of others, which in consultations necessitate mutuality of involvement through information-exchange and shared decision-making. Preferences should be met insofar as they do not militate against responsibilities and rights.
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Affiliation(s)
- S Buetow
- University of Manchester, England
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Affiliation(s)
- S Buetow
- National Primary Care Research and Development Centre, University of Manchester, UK
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Douglas RM, Woodward A, Miles H, Buetow S, Morris D. A prospective study of proneness to acute respiratory illness in the first two years of life. Int J Epidemiol 1994; 23:818-26. [PMID: 8002197 DOI: 10.1093/ije/23.4.818] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND This study sought explanations for the proneness to respiratory events in young Australian children. METHODS Prospective respiratory symptom diaries on 836 children collected data on respiratory symptoms and episodes. Questionnaires to mothers and birth and pregnancy records provided 56 known and possible predictors which were tested against two summary respiratory outcomes in each of the first and second years of life. RESULTS The two summary respiratory variables recorded for first and second year of life give four outcome variables. In fitting multivariate regression models to predict outcomes, use of child care in early childhood and mothers' experience of respiratory illness in the 12 months before birth were significant predictors for all four outcomes. Number of siblings was a predictor for three of the four outcomes. Sleep difficulty during pregnancy in the mother, and respiratory hospitalization of the infant in the first year, were significant predictors for both first-year outcomes. Unexpected and unexplained findings emerged for alcohol intake during pregnancy, passive smoking and breastfeeding in relation to the second year respiratory outcomes. Less than 9% of variance in outcome scores was explained in any of the four multiple regression models but this rose to between 24% and 31% when a corresponding score from the other year was added to the model. CONCLUSIONS Proneness to respiratory illness is an important entity; its determinants are largely unknown and events in pregnancy or the perinatal period explain only a small proportion of the between-infant variability.
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Affiliation(s)
- R M Douglas
- National Centre for Epidemiology and Population Health, Australian National University, Canberra
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