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The Association of Types of Training and Practice Settings with Doctors' Empathy and Patient Enablement among Patients with Chronic Illness in Hong Kong.

ABSTRACT: The increase in non-communicable disease (NCD) is becoming a global health problem and there is an increasing need for primary care doctors to look after these patients although whether family doctors are adequately trained and prepared is unknown.This study aimed to determine if doctors with family medicine (FM) training are associated with enhanced empathy in consultation and enablement for patients with chronic illness as compared to doctors with internal medicine training or without any postgraduate training in different clinic settings.This was a cross-sectional questionnaire survey using the validated Chinese version of the Consultation and Relational Empathy (CARE) Measure as well as Patient Enablement Instrument (PEI) for evaluation of quality and outcome of care. 14 doctors from hospital specialist clinics (7 with family medicine training, and 7 with internal medicine training) and 13 doctors from primary care clinics (7 with family medicine training, and 6 without specialist training) were recruited. In total, they consulted 823 patients with chronic illness. The CARE Measure and PEI scores were compared amongst doctors in these clinics with different training background: family medicine training, internal medicine training and those without specialist training. Generalized estimation equation (GEE) was used to account for cluster effects of patients nested with doctors.Within similar clinic settings, FM trained doctors had higher CARE score than doctors with no FM training. In hospital clinics, the difference of the mean CARE score for doctors who had family medicine training (39.2, SD = 7.04) and internal medicine training (35.5, SD = 8.92) was statistically significant after adjusting for consultation time and gender of the patient. In the community care clinics, the mean CARE score for doctors with family medicine training and those without specialist training were 32.1 (SD = 7.95) and 29.2 (SD = 7.43) respectively, but the difference was not found to be significant. For PEI, patients receiving care from doctors in the hospital clinics scored significantly higher than those in the community clinics, but there was no significant difference in PEI between patients receiving care from doctors with different training backgrounds within similar clinic setting.Family medicine training was associated with higher patient perceived empathy for chronic illness patients in the hospital clinics. Patient enablement appeared to be associated with clinic settings but not doctors' training background. Training in family medicine and a clinic environment that enables more patient doctor time might help in enhancing doctors' empathy and enablement for chronic illness patients.

SUBMITTER: Yu FS

PROVIDER: S-EPMC4678047 | biostudies-other | 2015

REPOSITORIES: biostudies-other

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Project description:ObjectiveThere were studies evaluating advanced nursing practice independently in the mainland and Hong Kong Special Administrative Region of China, but there was no attempt to make a comparison of practice between them. This study employed a case study method to examine and compare advanced nursing practice in Hong Kong and Guangzhou.MethodPurposive sampling method was used to recruit 24 advanced practice nurses (APN) who came from the specialty of medical, surgical and pediatric in Hong Kong and Guangzhou. A questionnaire survey and semi-structured interview were conducted to solicit quantitative and qualitative data for exploring the structure-process-outcome of advanced nursing practice. The structure component explored the factors influencing advanced nursing practice. The process part examined APN role components and illustrations of exemplary advanced nursing practice. The outcomes described outcome indicators that best reflected advanced nursing practice.FindingsFindings revealed that in the structure domain, APN education and career development, team approach in healthcare, and support from management, physicians and professional associations were important contextual factors for APN development in both cities. For the process domain, participants had at least 80% of their time practicing independently/interdependently and were engaged in APN activities including direct/indirect patient care, research/project work, initiation of staff and patient protocols. All participants demonstrated competencies with impacts on patient, service and profession in their description of exemplary practice. Participants from both cities ranked patient-related outcomes as top indicators for their advanced nursing practice.ConclusionThis study has revealed that APNs in Guangzhou and Hong Kong shared similar work involvement and impacts and their demonstrated competencies were on par with international counterparts. Continued efforts need to be put in establishing formal APN education, clear clinical career pathway and title protection to empower nurses to provide optimal care to the fullest extent that they are prepared for.

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The Association of Types of Training and Practice Settings with Doctors' Empathy and Patient Enablement among Patients with Chronic Illness in Hong Kong.

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