Dataset Information

Keeping the Patient at the Center: Teaching About Elements of Patient-Centered Care.

ABSTRACT:

Introduction

There is growing interest in delivering patient-centered care in all areas of medical practice, yet acquiring the requisite attitudes, skills, and behaviors simply by observing or participating in current systems of care that employ a medical or physician-centric model is challenging. Patient centeredness involves an understanding of patients' perspectives on their illness and treatment, the impact that health and illness have on the lives of patients, and the values and goals patients have for themselves, while also encouraging patients and health care professionals to engage in a shared decision-making model of health care. That model aspires to result in increased trust between providers and patients, as well as better patient outcomes.

Methods

This 90-minute workshop utilizes three different approaches to help the learner develop patient-centered care and communication skills in a mental health setting: a video of a patient sharing her experience with the mental health system, a narrative model of appreciating patient experience (first-person memoir), and an exercise using patient-centered language in a medical record documentation.

Results

This workshop was presented at the American Association of Psychiatric Directors of Residency Training (AADPRT) Annual Meeting in March 2016. Approximately 21 people attended. Feedback was received from 11 participants and demonstrated a high degree of agreement (4.5 out of 5) with the following statements: the speakers met the stated educational objectives; the content was educationally useful; the information in this presentation will inform my educational practices; the presentation advanced my knowledge of the subject.

Discussion

While these three pedagogical exercises do not cover the entirety of the skills required for patient-centered care and communication, they do provide a useful starting point for hearing and appreciating the experience of the patient. Despite the focus on mental health settings and treatment, other medical specialties could derive useful ideas from this workshop format or adapt the materials to their own needs.

SUBMITTER: Stagno S

PROVIDER: S-EPMC6440496 | biostudies-literature | 2016 Nov

REPOSITORIES: biostudies-literature

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Publications

Keeping the Patient at the Center: Teaching About Elements of Patient-Centered Care.

Stagno Susan S Crapanzano Kathleen K Schwartz Ann A

MedEdPORTAL : the journal of teaching and learning resources 20161111

<h4>Introduction</h4>There is growing interest in delivering patient-centered care in all areas of medical practice, yet acquiring the requisite attitudes, skills, and behaviors simply by observing or participating in current systems of care that employ a medical or physician-centric model is challenging. Patient centeredness involves an understanding of patients' perspectives on their illness and treatment, the impact that health and illness have on the lives of patients, and the values and goa ...[more]

PMID: 30984842

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Project description:IntroductionPatient-centered discharge care is critical to teach in clerkships: Studies have shown that patient-centered discharge care may reduce rehospitalization rates as well as ensure patient understanding after discharge. While these skills are necessary to be a successful intern, this is infrequently taught formally in clerkships. This session introduces medical students to challenges patients and providers face during care transitions, specifically, the transition after discharge from an inpatient hospital stay.MethodsThis workshop experience fosters the use of best communication-skills practices and team collaboration in discharge education and planning through reflective observation and role-play. Learners first identify common challenges faced when providing effective care transitions and then identify solutions to encourage patient-centered discharge care practices. Students also have the opportunity to be directly observed providing discharge care and to receive feedback using an observation tool. The materials associated with this publication include guidelines for workshop facilitators, blank video worksheet, completed video worksheet, teaching video, role-play exercise instructions and answer sheet for facilitators, direct observation tool, and workshop evaluation form.ResultsThe majority of students agreed the workshop would be helpful in practicing effective discharge education (69/75, 92%) and in providing patient-centered care during care transitions (72/75, 96%). Observers and students using the discharge education card reported an average score of 4.3 out of 5 that the observation was a helpful educational experience, and 84% of the completed discharge education tools included comments on areas of improvement or an action plan.DiscussionThe tool is brief and user friendly, allowing for this exercise to be completed without difficulty during busy ward days. It also can be completed by residents or attendings depending on time constraints.

Project description:BACKGROUND:Interventions to improve patient-centered care for persons with multimorbidity are in constant growth. To date, the emphasis has been on two separate kinds of interventions, those based on a patient-centered care approach with persons with chronic disease and the other ones created specifically for persons with multimorbidity. Their effectiveness in primary healthcare is well documented. Currently, none of these interventions have synthesized a patient-centered care approach for care for multimorbidity. The objective of this project is to determine the particular elements of patient-centered interventions and interventions for persons with multimorbidity that are associated with positive health-related outcomes for patients. METHOD:A scoping review was conducted as the method supports the rapid mapping of the key concepts underpinning a research area and the main sources and types of evidence available. A five-stage approach was adopted: (1) identifying the research question; (2) identifying relevant studies; (3) selecting studies; (4) charting the data; and (5) collating, summarizing and reporting results. We searched for interventions for persons with multimorbidity or patient-centered care in primary care. Relevant studies were identified in four systematic reviews (Smith et al. (2012;2016), De Bruin et al. (2012), and Dwamena et al. (2012)). Inductive analysis was performed. RESULTS:Four systematic reviews and 98 original studies were reviewed and analysed. Elements of interventions can be grouped into three main types and clustered into seven categories of interventions: 1) Supporting decision process and evidence-based practice; 2) Providing patient-centered approaches; 3) Supporting patient self-management; 4) Providing case/care management; 5) Enhancing interdisciplinary team approach; 6) Developing training for healthcare providers; and 7) Integrating information technology. Providing patient-oriented approaches, self-management support interventions and developing training for healthcare providers were the most frequent categories of interventions with the potential to result in positive impact for patients with chronic diseases. CONCLUSION:This scoping review provides evidence for the adaption of patient-centered interventions for patients with multimorbidity. Findings from this scoping review will inform the development of a toolkit to assist chronic disease prevention and management programs in reorienting patient care.

Project description:BackgroundA high proportion of the US primary care workforce reports burnout, which is associated with negative consequences for clinicians and patients. Many protective factors from burnout are characteristics of patient-centered medical home (PCMH) models, though even positive organizational transformation is often stressful. The existing literature on the effects of PCMH on burnout is limited, with most findings based on small-scale demonstration projects with data collected only among physicians, and the results are mixed.ObjectiveTo determine if components of PCMH related to team-based care were associated with lower burnout among primary care team members participating in a national medical home transformation, the VA Patient Aligned Care Team (PACT).DesignWeb-based, cross-sectional survey and administrative data from May 2012.ParticipantsA total of 4,539 VA primary care personnel from 588 VA primary care clinics.Main measuresThe dependent variable was burnout, and the independent variables were measures of team-based care: team functioning, time spent in huddles, team staffing, delegation of clinical responsibilities, working to top of competency, and collective self-efficacy. We also included administrative measures of workload and patient comorbidity.Key resultsOverall, 39 % of respondents reported burnout. Participatory decision making (OR 0.65, 95 % CI 0.57, 0.74) and having a fully staffed PACT (OR 0.79, 95 % CI 0.68, 0.93) were associated with lower burnout, while being assigned to a PACT (OR 1.46, 95 % CI 1.11, 1.93), spending time on work someone with less training could do (OR 1.29, 95 % CI 1.07, 1.57) and a stressful, fast-moving work environment (OR 4.33, 95 % CI 3.78, 4.96) were associated with higher burnout. Longer tenure and occupation were also correlated with burnout.ConclusionsLower burnout may be achieved by medical home models that are appropriately staffed, emphasize participatory decision making, and increase the proportion of time team members spend working to the top of their competency level.

Project description:BACKGROUND:In recent literature, patient portals are considered as important tools for the delivery of patient-centered care. To date, it is not clear how patients would conceptualize a patient portal and which health information needs they have when doing so. OBJECTIVE:This study aimed (1) to investigate health information needs, expectations, and attitudes toward a patient portal and (2) to assess whether determinants, such as patient characteristics, health literacy, and empowerment status, can predict two different variables, namely the importance people attribute to obtaining health information when using a patient portal and the expectations concerning personal health care when using a patient portal. METHODS:We conducted a cross-sectional survey of the Flemish population on what patients prefer to know about their digital health data and their expectations and attitudes toward using a patient portal to access their electronic health record. People were invited to participate in the survey through newsletters, social media, and magazines. We used a questionnaire including demographics, health characteristics, health literacy, patient empowerment, and patient portal characteristics. RESULTS:We received 433 completed surveys. The health information needs included features such as being notified when one's health changes (371/396, 93.7%), being notified when physical parameters increase to dangerous levels (370/395, 93.7%), observing connections between one's symptoms or diseases or biological parameters (339/398, 85.2%), viewing the evolution of one's health in function of time (333/394, 84.5%), and viewing information about the expected effect of treatment (349/395, 88.4%). Almost 90% (369/412) of respondents were interested in using a patient portal. Determinants of patients' attachment for obtaining health information on a patient portal were (1) age between 45 and 54 years (P=.05); (2) neutral (P=.03) or interested attitude (P=.008) toward shared decision making; and (3) commitment to question physicians' decisions (P=.03, R2=0.122). Determinants of patients' expectations on improved health care by accessing a patient portal were (1) lower education level (P=.04); (2) neutral (P=.03) or interested attitude (P=.008) toward shared decision making; and (3) problems in understanding health information (P=.04; R2=0.106). CONCLUSIONS:The interest in using a patient portal is considerable in Flanders. People would like to receive alerts or some form of communication from a patient portal in case they need to act to manage their health. Determinants such as education, attached importance to shared decision making, difficulties in finding relevant health information, and the attached importance in questioning the decisions of physicians need to be considered in the design of a patient portal.

Project description:BackgroundUnderstanding the perceived importance of Patient-Centered Care (PCC) among Palestinian doctors and how the provider and other clinical characteristics may impact their views on PCC is essential to determine the extent to which PCC can be implemented. This study investigates the provision of PCC among hospital doctors in a developing and unstable country, namely, Palestine.MethodsThis descriptive, cross-sectional research employed self-report survey among 369 Palestinian doctors working in hospitals in 2016. Respondents completed the Provider-Patient Relationship Questionnaire (PPRQ) and were asked to rate the importance of 16 PCC subjects in a context-free manner. Then they scored the existence of eight contextual attributes in their workplace.ResultsAlthough 71.4% of the participants got training in communication, only 45% of the participants knew about PCC. 48.8% of doctors considered the "exchange of information" with patients most important PCC component. Clustering identified three groups of doctors: 32.4% of doctors reported good perceptions of PCC, 47.5% moderate; and 20.1% poor. Older, married, and specialist doctors and those familiar with PCC are more likely classified in the "good" cluster. Results revealed a significant difference between doctors' views based on their gender, experience, marital status, previous knowledge about PCC, and type of hospital in favor of males, experienced, married, familiar with PCC, and doctors in private hospital respectively. The level of job interest, nurses' cooperation, the tendency of patients to hide information, and doctor's friendly style were positively related with more perceived importance of PCC.ConclusionWe identified benchmark doctors who perceive the high relative importance of PCC. Our results highlighted knowledge gaps and training weaknesses among doctors in public and private hospitals in respect to their views on PCC. Decision makers may invest in the determined contextual predictors to enhance attitudes towards PCC. This work doesn't address patients' views on PCC.

Dataset Information

Keeping the Patient at the Center: Teaching About Elements of Patient-Centered Care.

Introduction

Methods

Results

Discussion

Publications

Keeping the Patient at the Center: Teaching About Elements of Patient-Centered Care.

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