Patient-Focused Care: Medical Care

Patient-Focused Care: Medical CareThere 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.

When considering patients with pulmonary disease specifically, there is evidence that their information needs are not being adequately met by their primary care or specialist physicians. Koning et al surveyed 121 patients with asthma or COPD as to the medical care provided by either their primary care practitioner or their specialist. Although 90% of patients were satisfied with their treatment, the main area expressed by patients as an unfulfilled need was information. A need for more written information about pulmonary illness in general was expressed by 52% of patients. In addition, many patients required more information (verbal or written) regarding diagnostic tests (48%), the causes of their illness (44%), prognosis (34%), and long-term medication use (31%) [Table 2].

In general, with regard to information, more patients had unmet needs under specialists’ care than for primary care physicians, with a particular discrepancy between the two groups for information on long-term medication. Approximately one third of patients would have liked more participation in decisions about their treatment.
Koning et al also found that > 40% of patients expressed a need for greater continuity of care between their physicians [Table 2]. The importance of continuity of care in the physician/patient relationship for patients with asthma is illustrated in a study by Love et al, which included 1,726 patients (404 with asthma) who had two or more visits to a physician’s office, clinic, or emergency department in the previous 12 months. Respondents completed a five-item scale based on validated survey instruments.

Table 2—Pulmonary Patients With Unmet Needs From Either a Primary Care or Specialist Physician and Overall

Need Clusters/Items Patients With Unmet Needs, %
Primary Practitioner (n = 121) Specialist (n = 72) Overall (n = 193)
More information
About written information about asthma/COPD 50 57 52
About results from diagnostic tests 47 50 48
About causes 43 45 44
About prognosis 31 39 34
About long-term use of medication 25 41 31
Treatment 31 32 31
More patient participation in treatment decisions
More frequent physical examination 30 28 29
Organization 44 42 43
More continuity of care provider
Less waiting time 25 21 24
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