Multilinear regression models were used to assess the impact of age, sex, race, education, number of physician visits, health improvement and life satisfaction, and continuity of care on provider communication (“The doctor or provider listened to you and talked with you about your care”) and level of patient influence (“Your ability to influence the treatment you received from a doctor or provider for your health problems”). For asthmatic patients, the quality of provider communication was only dependent on continuity of care (p = 0.01). Continuity of care (p = 0.02) and life satisfaction (p = 0.04) were the only variables contributing to the level of patient influence for asthmatic patients. For nonasthmatic patients, continuity of care, age, number of physician visits, general health, health improvement, and life satisfaction all contributed to patients’ perceptions of quality for provider communication (p < 0.01); these variables also contributed significantly to patient influence (p < 0.008). read only
Category Archives: Asthma : Part 2
There was a high level of agreement between mothers and fathers on the number of needs for all of the subgroups, although there was a significant difference for contact needs, where only mothers, not fathers, perceived a higher need to be in contact with parents of children in a similar situation to themselves (p < 0.01). Physicians’ ratings of information needs showed very poor correlation with either mothers’ (r = 0.7) or fathers’ (r = — 0.01) ratings, with physicians significantly underestimating the number of information needs (p < 0.05). Physicians also noted significantly fewer needs for specific help than either mothers (p < 0.01) or fathers (p < 0.001) and fewer contact needs than mothers (p < 0.01). Overall, both mothers and fathers endorsed a greater total number of needs than physicians (p < 0.001). Thus, there was a disconnect between the parents’ perception of their needs and the physicians’ perception. mycanadianfamilypharmacy.net
Patient-focused care, however, is not necessarily the same as physician/patient shared decision mak-ing. Patient preferences for a shared decisionmaking approach or physician-directed consultations were evaluated using patient responses to videos of acted consultations of these two different approach-es. Preference for a directed approach was seen when the illness involved physical rather than psychological symptoms and in subjects > 61 years of age. Preference for a shared approach was associated with higher social class (professional and managerial/ technical) and with subjects who smoked. There were, however, large minorities in these groups favoring the opposite approach. It appears that shared decision making is a distinct entity from patient-focused care, and physicians need to understand their patients’ level of need to be involved in decision making vs being directed and guided at a time when they may feel vulnerable.
If patient-focused care is preferred by most patients, why is it not universally adopted? In clinical practice, there are significant barriers to patient-focused care that need to be overcome.
Biomedical physicians were more focused on the patients’ disease but were unlikely to elicit psychosocial information. High-control physicians dominated the encounter and disregarded the patients’ agenda. These physician styles were compared with patient-evaluated quality attributes in primary care using the Components of Primary Care Instrument and patient satisfaction. Table 1 shows the rankings for the different physician styles against these outcomes and length of visit. There was a significant difference between the different styles for communication, accumulated knowledge, coordination of care, patient satisfaction with physician, and patient expectations met. The person-focused style was ranked first for all of these factors; biopsychosocial was ranked second for four of the five factors, followed by biomedical; and high physician control was the least effective style, ranked last for four of these five elements. The person-focused style was the style most likely to be associated with a positive assessment of patient-determined quality in primary care and patient satisfaction. However, consultations with the person-focused style were longer than with the other styles, which can be a challenge to disseminate widely in primary care. read
Patient-focused care aims to bring more equality into the physician/patient relationship as well as an understanding of the patient, not just their illness. However, models of medical management are generally conceived, tested, and disseminated by medical professionals.
Do patients want patient-focused care? Little et al investigated patients’ preferences for a patient-focused approach in the primary care consultation. These investigators administered a preconsultation questionnaire to 824 patients, 661 of whom also completed a postconsultation questionnaire. Factor analysis identified three groupings of patient preferences: communication (including listening, exploration of concerns, and requirements for information, doctor-patient relationship and a clear explanation); partnership (including specific aspects of communication related to finding common ground, such as exploration, discussion, and mutual agreement about patients’ ideas, the problem, and treatment); and health promotion (including how to stay healthy and reduce the risk of future illness). ventolin inhalers
Patient-focused or patient-centered care is not a new concept, but its value has been overlooked in preference to the physician-led, technology-based, disease-centered model that has prevailed in medicine for the last 50 years. Stewart suggests that patient-focused care is often defined by what it is not: technology centered, doctor centered, hospital centered, and disease centered. Today, patient-focused care can be thought of as a merging of the patient education, self-care, and evidence-based models of medical practice. Patient-focused care takes the best points from each of these models and distills them into four broad areas of intervention: communication with patients, partnerships, health promotion, and physical care (medications and treatments). Patient-focused care, therefore, requires an appreciation of a variety of issues: patients’ expectations, beliefs, and concerns regarding their disease and an understanding of their personal circumstances; the motivation to provide information regarding diagnosis, pathology, treatments, and prognosis; the ability to find a common ground on what the problem is and agreeing on management; and the knowledge to utilize the best medical evidence to inform treatment decisions. cfm-online-shop.com
Finally, a distinctive barrier was the parental perception on differences in quality of care, due to the use of Medicaid insurance. In some cases, parents believed that certain limitations (ie, the prescription of generic vs brand name medications, poor access to administrative assistance, limits on refills) were due to the fact that they had Medicaid insurance, as opposed to limitations imposed on both Medicaid-insured and non-Medicaid-insured patients. Asthma self-management education should be targeted to improve control among high-risk popula-tions. Medicaid-insured families face unique barriers related to income and insurance limitations as well as other issues faced by non-Medicaid-insured children with asthma.
If this is an unstated concern of parents, it may be important for physicians to specifically state that their decisions for care are not based on the type of patient insurance. One technique to improve this would be to focus on communication, reassuring patients about any concerns or fears. read
Many specific asthma and management challenges faced by Medicaid caregivers are not fundamentally different than those of other parents; however, they often have less social support to aid them in dealing with their child’s medical needs and face greater financial barriers compared to other parents. Our participants reported similar issues related to school, family quality of life, and financial issues as reported by Mansour et al in a study of urban, low-income families; however, they appeared to have greater asthma knowledge and voiced understanding that children with persistent disease required chronic anti-inflammatory therapy.
In order for families to be compliant with antiinflammatory care, they need to understand proper use of such medications, have their questions regarding potential undesirable side effects addressed, and believe (outcome expectancy) that administering this chronic medication to their child will decrease asthma symptoms and improve health. When providers communicate this information well, patients use fewer acute care services and miss less school. More info
Like all children, these Medicaid-insured patients spend at least 6 to 8 h/d at school. The children are dependent on the school system to provide supervision and care for their asthma, which is a reasonable point of concern for parents. Many states including Michigan have policies that allow students to carry their own medication and self-medicate as necessary. A lack of awareness by teachers and school personnel of asthma was frustrating for the focus group caregivers. To tailor asthma care for children, physicians need to be knowledgeable of school-related care issues and assist families with school advocacy and asthma education.
The management of asthma requires coordination and awareness of multiple tasks. This may impact the caregiver’s self-efficacy at both behavior specific and situational (environment)-specific levels. In other words, a parent with lower self-efficacy may not be able to act or trust their capability for dealing with and caring for their child’s asthma in the Medicaid or medical systems. Our findings suggest that the caregivers require and desire ongoing education with an emphasis to support development of parental confidence regarding asthma self-management skills; feedback and communication may be able to address this.