Patient Experience and Expression of Unpleasant Emotions During Health Care Encounters.
Ontology highlight
ABSTRACT:
SUBMITTER: Heyman RE
PROVIDER: S-EPMC7786783 | biostudies-literature |
REPOSITORIES: biostudies-literature
Similar Datasets
Project description:OBJECTIVE:Patient- and family-centered care (PFCC), which recognizes the family as an integral partner in high-quality clinical decision-making, is important to improving children's health care. Studies examining PFCC disparities in the general US pediatric population, however, are sparse, and use methodology that might mislead readers to overestimate effect sizes because of the high prevalence of high-quality PFCC. We address these issues using improved statistical modeling of conceptually-grounded disparity domains on more recent data. METHODS:This study examined 22,942 children in the 2011 to 2013 Medical Expenditure Panel Surveys (pooled cross-section) with at least 1 health care visit in the previous year (eligible for PFCC questions). We used robust-adjusted multivariable Poisson regression to estimate prevalence rate ratios-closer estimates of true risk ratios of highly prevalent outcomes-of 4 measures of high-quality PFCC and a composite measure. RESULTS:Overall, PFCC quality prevalences were high, ranging from 95% to 97% across the 4 PFCC measures with 92% of parents reporting the composite measure. In multivariable analyses, lower prevalence of high-quality PFCC was consistently observed among publicly insured children (relative to the privately insured, prevalence rate ratios ranging from 0.978 to 0.984 across the PFCC measures; 0.962 in the composite) and children living in families below the poverty line (children at ≥400% of the poverty line had 1.018-1.045 times the prevalence of high-quality PFCC across the PFCC measures; 1.056 in the composite). CONCLUSIONS:Although prevalence rate ratio methodology revealed smaller and perhaps clinically insignificant disparities in US children's PFCC quality than previously portrayed, nonetheless, several statistically significant disparities remain. The most consistent disparities identify those most vulnerable to PFCC quality: publicly insured and impoverished children.
| S-EPMC6333206 | biostudies-other
Project description:Although previous studies suggest an association between provider burnout and suboptimal self-reported communication, no studies relate physician burnout to observed patient-physician communication behaviors.To investigate the relationship between physician burnout and observed patient-physician communication outcomes in patient-physician encounters.Longitudinal study of enrollment data from a trial of interventions to improve patient adherence to hypertension treatment.Fifteen urban community-based clinics in Baltimore, MD.Forty physicians and 235 of their adult hypertensive patients, with oversampling of ethnic minorities and poor persons. Fifty-three percent of physicians were women, and the average practice experience was 11.2 years. Among the 235 patients, 66% were women, 60% were African-American, and 90% were insured.Audiotape analysis of communication during outpatient encounters (one per patient) using the Roter Interaction Analysis System and patients' ratings of satisfaction with and trust and confidence in the physician.The median time between the physician burnout assessment and the patient encounter was 15.1 months (range 5.6-30). Multivariate analyses revealed no significant differences in physician communication based on physician burnout. However, compared with patients of low-burnout physicians, patients of high-burnout physicians gave twice as many negative rapport-building statements (incident risk ratio 2.06, 95% CI 1.58-2.86, p < 0.001). Physician burnout was not significantly associated with physician or patient affect, patient-centeredness, verbal dominance, or length of the encounter. Physician burnout was also not significantly associated with patients' ratings of their satisfaction, confidence, or trust.Physician burnout was not associated with physician communication behaviors nor with most measures of patient-centered communication. However, patients engaged in more rapport-building behaviors. These findings suggest a complex relationship between physician burnout and patient-physician communication, which should be investigated and linked to patient outcomes in future research.
| S-EPMC2533387 | biostudies-other
Project description:BackgroundDespite several countrywide attempts to strengthen and standardise the primary healthcare (PHC) system, Greece is still lacking a sustainable, policy-based model of integrated services. The aim of our study was to identify operational integration levels through existing patient care pathways and to recommend an alternative PHC model for optimum integration.MethodsThe study was part of a large state-funded project, which included 22 randomly selected PHC units located across two health regions of Greece. Dimensions of operational integration in PHC were selected based on the work of Kringos and colleagues. A five-point Likert-type scale, coupled with an algorithm, was used to capture and transform theoretical framework features into measurable attributes. PHC services were grouped under the main categories of chronic care, urgent/acute care, preventive care, and home care. A web-based platform was used to assess patient pathways, evaluate integration levels and propose improvement actions. Analysis relied on a comparison of actual pathways versus optimal, the latter ones having been identified through literature review.ResultsOverall integration varied among units. The majority (57%) of units corresponded to a basic level. Integration by type of PHC service ranged as follows: basic (86%) or poor (14%) for chronic care units, poor (78%) or basic (22%) for urgent/acute care units, basic (50%) for preventive care units, and partial or basic (50%) for home care units. The actual pathways across all four categories of PHC services differed from those captured in the optimum integration model. Certain similarities were observed in the operational flows between chronic care management and urgent/acute care management. Such similarities were present at the highest level of abstraction, but also in common steps along the operational flows.ConclusionsExisting patient care pathways were mapped and analysed, and recommendations for an optimum integration PHC model were made. The developed web platform, based on a strong theoretical framework, can serve as a robust integration evaluation tool. This could be a first step towards restructuring and improving PHC services within a financially restrained environment.
| S-EPMC5706391 | biostudies-literature
Project description:This study aims to investigate the role of emotions and beliefs of perceived severity about cyberbullying behavior in the relationship between bystanders' personal moral beliefs and their behavioral intentions in cyberbullying. A group of 402 fifth to twelfth graders (M age = 13.12; SD = 2.19; 55.7% were girls) participated and we ran exploratory factorial analyses of the instruments. A group of 676 fifth to twelfth grade students (M age = 14.10; SD = 2.74; 55.5% were boys) participated and we performed confirmatory factor analyses. A group of middle school students (N = 397; Mage = 13.88 years; SD = 1.45; 55.5% girls) participated and we ran the final analyses aimed to test the research hypotheses. Results from self-report measures showed that unpleasant emotions mediated personal moral beliefs and adolescent bystanders' intentions to help cybervictims. Normative beliefs of severity mediated the relation between personal moral beliefs and intentions to cyberbully others.
| S-EPMC9758407 | biostudies-literature
Project description:BACKGROUND:In order to play an active role in their health care, patients need information and motivation. Current delivery systems limit patients' involvement because they do not routinely provide them with enough details of their own clinical results, conditions and other important clinical data. The purpose of this study was to identify, from the perspective of patients, which topics matter the most, who should be communicating them, and when and how should they be provided. METHODS:We conducted a qualitative, phenomenological study analysing the content of subjective experiences, feelings and behaviours. We organized two focus groups with 13 participants and 15 in-depth interviews. Transcripts of the focus groups and interviews were checked for accuracy and then entered into Atlas ti™ v7.5.13 qualitative software. Two independent researchers performed a qualitative inductive content analysis to classify the data in two levels: themes and categories. RESULTS:The qualitative analysis provided 377 units of meaning synthesized into 22 categories and six themes: hospitalization procedure, Health Literacy relating to the patient's condition, information content, satisfaction, professional-patient relationship, and patient proactivity. Patients described which information they wished for, when they needed it, and who would provide it, usually related to actions such as admission, discharge or diagnostic tests. Oral information was more difficult to comprehend than the written kind, as patients can check written information several times if needed. Nurses were the most available professionals, and patients found easier to relate to them and ask them questions. Moreover, patients identified physicians as those professionals responsible for providing clinical information. CONCLUSIONS:Our results showed that patients suffered from poor Health Literacy regarding their personal condition, as they were unable to describe the symptoms, the type of tests being performed or their results, and some of them also had difficulties in naming the specific disease or comorbidities they had. During the hospitalization process, patients were in good shape to come with doubts and actively asked for more information. Healthcare organizations and professionals were offered the chance to ensure the correct communication and comprehension to their patients.
| S-EPMC7035644 | biostudies-literature
Project description:ImportancePatient reviews of health care experiences are increasingly used for public reporting and alternative payment models. Critics have argued that this incentivizes physicians to provide more care, including low-value care, undermining efforts to reduce wasteful practices.ObjectiveTo assess associations between rates of low-value service provision to a primary care professional (PCP) patient panel and patients' ratings of their health care experiences.Design, setting, and participantsThis quality improvement study used Medicare fee-for-service claims from January 1, 2007, to December 31, 2014, for a random 20% sample of beneficiaries to identify beneficiaries for whom each of 8 low-value services could be ordered but would be considered unnecessary. The study also used health care experience reports from independently sampled beneficiaries who responded to the 2010-2015 Consumer Assessment of Healthcare Providers and Systems (CAHPS) Medicare fee-for-service survey. Statistical analysis was performed from January 1, 2019, to December 9, 2020.Main outcomes and measuresThe main outcomes were health care experience ratings from Medicare beneficiaries who responded to the CAHPS survey from 2 domains, namely "Your Health Care in the Last 6 Months" (overall health care, office wait time, timely access to nonurgent care, and timely access to urgent care) and "Your Personal Doctor" (overall personal physician and a composite score for interactions with personal physician). Beneficiaries in both samples were attributed to the PCP with whom they had the most spending. For each PCP, a composite score of low-value service exposure was constructed using the 20% sample; this score represented the adjusted relative propensity of the PCP patient panel to receive low-value care. The association between low-value service exposure and health care experience ratings reported by the CAHPS respondents in the PCP patient panel was estimated using regression analysis.ResultsThe final sample had 100 743 PCPs, with a mean of approximately 258 patients per PCP. Only 1 notable association was found; more low-value care exposure was associated with more frequent reports of having to wait more than 15 minutes after the scheduled time of an appointment (a mean of 0.448 points lower CAHPS score on a 10-point scale for PCP patient panels who received the most low-value care vs the least low-value care). Although some other associations were statistically significant, their magnitudes were substantially smaller than those typically considered meaningful in other CAHPS literature and were inconsistent in direction across levels of low-value service exposure.Conclusions and relevanceThis quality improvement study found that more low-value care exposure for a PCP patient panel was not associated with more favorable patient ratings of their health care experiences.
| S-EPMC8261613 | biostudies-literature
Project description:BACKGROUND :Residencies have incorporated high-value care (HVC) training to contain health care expenditures. Assessment methods of HVC curricula are limited. OBJECTIVE :In our clinical skills laboratory, we evaluated the effectiveness of HVC curricula using standardized patients (SPs) to determine if there is a correlation with performance in counseling, history and physical, HVC knowledge, and demographics. METHODS :Through ambulatory cases, SPs evaluated postgraduate year 2 (PGY-2) residents using checklists to determine if they obtained the chief complaint, medical and social history, focused physical examination, and conveyed information regarding patient management. Investigators scored knowledge-based questions on the need for imaging in low back pain, annual stress testing in coronary artery disease, and chest x-ray for gastroesophageal reflux disease. Univariate analysis was used to calculate percentage distribution of residents' ordering of inappropriate tests. RESULTS :All 56 PGY-2 residents participated in the study and completed at least 2 of 3 HVC cases. Analysis showed that 48% (27 of 56) ordered at least 1 inappropriate test. Residents who ordered unnecessary testing had similar performance in history and physical as well as knowledge of HVC. Inappropriate ordering was significantly associated with poorer performance in counseling (mean percentage counseling score of 68% versus 56% for those who ordered inappropriately, P < .001) and communication skills (mean percentage communication score of 74% versus 71% for those who ordered inappropriately, P < .003). There were no patterns for ordering by demographics. CONCLUSIONS :Our evaluation of residents during SP encounters found a correlation between the use of inappropriate testing and lower counseling and communication skills.
| S-EPMC5646926 | biostudies-literature
Project description:ObjectiveTo investigate patient experience with probiotics and factors that influence probiotic use among adult patients.MethodPatients were invited to complete a questionnaire that assessed their experiences and opinions regarding probiotics. Questionnaires were distributed to patients seeking primary health care services at a family and community medicine practice site and a community pharmacy. Patients were invited to complete the questionnaire while awaiting the physician or waiting for prescriptions to be filled.ResultsOverall, 162 surveys were completed and returned (66% response rate) from patients aged 18 to 89 years of age (mean 49.5 years). Most patients (n=107; 65%) were familiar with the term "probiotic", and 49 patients (29.9%) had personally used the supplements in the past. Of those who had used probiotics, the majority (57%) had used the supplements to maintain "good gastrointestinal health" and most (59%) felt that the supplements had been beneficial. However, most (59%) had not informed their health care provider about their use of the supplements.ConclusionUse of probiotic supplements is common among consumers, but may not be reported to health care providers.
| S-EPMC4222242 | biostudies-literature
Project description:IntroductionCommunity health centers often screen for and address patients' unmet social needs. This study examines the degree to which community health center patients report receiving social needs assistance and compares measures of access and quality between patients who received assistance versus similar patients who did not.MethodsA nationally representative sample of 4,699 nonelderly adults receiving care at community health centers from the 2014-2015 Health Resources and Services Administration Health Center Patient Survey was used, representing 12.6 million patients. The exposure-having "received social needs assistance"-was based on whether a patient received any community health center assistance accessing social programs (e.g., applying for government benefits) or basic needs (e.g., obtaining transportation, housing, food). Using logistic regression models with inverse probability of treatment weights, outcomes for patients who received social needs assistance with similar patients who did not were compared. Study outcomes, reported as absolute adjusted differences, included reporting a community health center as a usual source of care, reporting the emergency department as a usual source of care, perceived quality of care, and willingness to recommend the community health center to others. Data were analyzed in 2020.ResultsOf the sample, 36% reported receiving social needs assistance, where the most common form of assistance was applying for government benefits. Relative to similar patients who did not receive social needs assistance, patients receiving assistance were significantly more likely to report a community health center as their usual source of care (adjusted difference=7.2 percentage points, 95% CI=2.2, 12.1) and to report perceived quality of care as "the best" (adjusted difference=11.1, 95% CI=5.4, 16.9). They were significantly less likely to report the emergency department as their usual source of care (adjusted difference= -4.2, 95% CI= -7.0, -1.3).ConclusionsAs community health centers and other providers consider providing social needs assistance to patients, these results suggest that doing so may be associated with improved access to and quality of care.
| S-EPMC7931986 | biostudies-literature
Project description:BackgroundTransitioning nonemergency, ambulatory medical care to virtual visits in light of the COVID-19 global pandemic has been a massive shift in philosophy and practice that naturally came with a steep learning curve for patients, physicians, and clinic administrators.ObjectiveWe undertook a multimethod study to understand the key factors associated with successful and less successful experiences of virtual specialist care, particularly as they relate to the patient experience of care.MethodsThis study was designed as a multimethod patient experience study using survey methods, descriptive qualitative interview methodology, and administrative virtual care data collected by the hospital decision support team. Six specialty departments participated in the study (endoscopy, orthopedics, neurology, hematology, rheumatology, and gastroenterology). All patients who could speak and read English and attended a virtual specialist appointment in a participating clinic at St. Michael's Hospital (Toronto, Ontario, Canada) between October 1, 2020, and January 30, 2021, were eligible to participate.ResultsDuring the study period, 51,702 virtual specialist visits were conducted in the departments that participated in the study. Of those, 96% were conducted by telephone and 4% by video. In both the survey and interview data, there was an overall consensus that virtual care is a satisfying alternative to in-person care, with benefits such as reduced travel, cost, time, and SARS-CoV-2 exposure, and increased convenience. Our analysis further revealed that the specific reason for the visit and the nature and status of the medical condition are important considerations in terms of guidance on where virtual care is most effective. Technology issues were not reported as a major challenge in our data, given that the majority of "virtual" visits reported by our participants were conducted by telephone, which is an important distinction. Despite the positive value of virtual care discussed by the majority of interview participants, 50% of the survey respondents still indicated they would prefer to see their physician in person.ConclusionsPatient experience data collected in this study indicate a high level of satisfaction with virtual specialty care, but also signal that there are nuances to be considered to ensure it is an appropriate and sustainable part of the standard of care.
| S-EPMC9239568 | biostudies-literature