-
[show abstract]
[hide abstract]
ABSTRACT: Past work suggests that the degree of similarity between patient and physician attitudes may be an important predictor of patient-centered outcomes.
To examine the extent to which patient and provider symmetry in health locus of control (HLOC) beliefs was associated with objectively derived medication refill adherence in patients with co-morbid diabetes mellitus (DM) and hypertension (HTN).
Eighteen primary care physicians at the VA Iowa City Medical Center and affiliated clinics; 246 patients of consented providers with co-morbid DM and HTN.
Established patient-physician dyads were classified into three groups according to the similarity of their HLOC scores (assessed in parallel). Data analysis utilized hierarchical linear modeling (HLM) to account for clustering of patients within physicians.
Objectively derived medication refill adherence was computed using data from the VA electronic pharmacy record; blood pressure and HgA1c values were considered as secondary outcomes.
Physician-patient dyads holding highly similar beliefs regarding the degree of personal control that individual patients have over health outcomes showed significantly higher overall and cardiovascular medication regimen adherence (p = 0.03) and lower diastolic blood pressure (p = 0.02) than in dyads in which the patient held a stronger belief in their own personal control than did their treating physician. Dyads in which patients held a weaker belief in their own personal control than did their treating physician did not differ significantly from symmetrical dyads. The same pattern was observed after adjustment for age, physician sex, and physician years of practice.
These data are the first to demonstrate the importance of attitudinal symmetry on an objective measure of medication adherence and suggest that a brief assessment of patient HLOC may be useful for tailoring the provider's approach in the clinical encounter or for matching patients to physicians with similar attitudes towards care.
Journal of General Internal Medicine 02/2010; 25(5):397-402. · 2.83 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Research has suggested that congruence between patient characteristics and contextual characteristics is a more robust predictor of outcomes than either patient or context characteristics alone. The goal of the present study was to examine the degree of congruence between patient preferences for the clinical encounter and reports of analogous dimensions of provider behavior and the effects of this congruence on patient outcomes.
Two hundred eighteen patients with diabetes (predominately Type II) completed measures of preference for and ratings of perceived provider behavior in three domains (1) information sharing, (2) behavioral involvement, and (3) socioemotional support.
Patient satisfaction, self-reported adherence, and a clinical marker of diabetic control (hemoglobin A1c) were the outcomes of interest.
Congruence in information sharing and congruence in behavioral involvement were predictive of glycemic control and self-reported adherence, respectively. Congruence in behavioral involvement and congruence in socioemotional support were predictive of greater patient satisfaction.
These findings provide further support for the importance of congruence between patient characteristics and contextual characteristics in predicting patient outcomes.
Health Psychology 11/2009; 28(6):660-7. · 3.87 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND: Congruence between patients' and providers' preferred healthcare role orientations has been shown to be important for improved clinical outcomes and patient satisfaction. Thus, it is important to know how different patient and provider populations might vary in preferred role orientations. OBJECTIVE: To measure the range of role orientation preferences among patients and providers in two different general medicine clinic populations. METHODS: Role orientation preferences of patients (n = 319) and providers (n = 151) in six Veterans Administration (VA) primary care clinics and two university-based primary care clinics were measured in a cross sectional survey using the 9-item Patient-Practitioner Orientation Scale (PPOS) sharing subscale among patients and providers. RESULTS: VA patients had lower mean PPOS scores (i.e. more provider-centered role preference) than the university clinic patients (31.2 vs 39.7, respectively; p < 0.001). The difference remained significant even after adjusting for age, sex, and education. VA and university clinic providers had similar mean PPOS scores (41.5 vs 42.6, respectively; p = 0.27). Greater differences were found in mean PPOS scores between VA patients and their providers (31.2 vs 41.5, respectively; p < 0.001) than university clinic patients and their providers (39.7 vs 42.6, respectively; p = 0.12). CONCLUSIONS: VA patients reported preferences for a more provider-centered role than university clinic patients and there was greater mean difference in preferred role orientations between VA patients and their providers than between university clinic patients and their providers. Differences in preferred role orientations by patients and providers should be considered when designing clinical initiatives and research to improve patient care.
The patient 03/2009; 2(1):33-38. · 0.57 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Few data exist examining how patients' preferred role orientation (patient-centered or provider-centered) is associated with "patient-centered" behavior and clinical markers of health.
The purpose of the study is to investigate how patients' preferred role orientation is associated with information-seeking behavior and clinical markers of health in a chronically ill population.
Participants were 189 hypertensive patients, at two VA Medical Centers and four community-based clinics, who completed measures of preferred role orientation and medication information seeking. Lab values of patients' blood pressure, LDL cholesterol, and glycosylated hemoglobin A1c were used as clinical markers.
Preference for a patient-centered role was associated with seeking medication information from various sources (e.g., the internet [OR = 1.14, 95% CI = 1.05-1.23]) and with the number of sources from which patients obtained information (beta = .21, p = 0.005). However, patient-centered preferences were also associated with higher systolic blood pressure (beta = 0.16, p = 0.04), higher diastolic blood pressure (beta = .15, p = 0.04), and higher LDL cholesterol (beta = 0.17, p = 0.04). There was no association with glycosylated hemoglobin A1c (beta = -0.10, p = 0.36).
Patients who preferred a patient-centered role engaged in behavior consistent with their preferences, but had higher blood pressure and less favorable lipid levels. These findings are discussed in terms of the nature and treatment of certain chronic conditions that may explain why a patient-centered role orientation is associated with a less favorable clinical profile in some contexts.
Annals of Behavioral Medicine 03/2008; 35(1):80-6. · 4.20 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The goal of this article is to provide a rational methodological review of studies addressing the treatment of childhood headache. In particular, the goal is to provide a review of process variables that may be associated with the efficacy of behavioral and psychological treatments for childhood headache. A search for studies that examined the efficacy of treatment for headache among children younger than 12 years of age was conducted using Medline from 1966 to 2005. A total of 9 studies were selected for the present systematic review. The findings from this study suggest that although research supports the use of behavioral treatments for headache among this patient population, process variables such as child demographics, as well as treatment characteristics such as time in treatment, may moderate treatment efficacy.
Journal of Child Neurology 11/2007; 22(10):1172-81. · 1.75 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: There is increasing interest in the role that patient and physician health-related attitudes may play in predicting patient outcomes.
This study examined the similarity of the attitudes held by patients and their physicians about the patient role in health care delivery and its relationship to patient outcomes.
Participants were 16 primary care physicians from a single academic medical center and 146 patients who had been seen by their respective physician at least twice during the prior 6 months. Physicians and patients completed two measures reflecting healthcare-related attitudes: the Multidimensional Health Locus of Control questionnaire and the Patient-Practitioner Orientation Scale (PPOS). Patients also completed measures of satisfaction and adherence.
Analyses were conducted using hierarchical linear modeling with patients clustered within physicians. Degree of symmetry on internal health locus of control was positively associated with both patient adherence, F(2, 131) = 3.75, p = .03, and satisfaction, F(2, 133) = 7.16, p = .01. Degree of similarity on the Information/Power Sharing subscale of the PPOS was not positively associated with adherence or satisfaction.
These data suggest that patients who are more similar in attitude to their physicians as indicated by internal health locus of control scores (but not PPOS scores) are more satisfied with their medical care and more adherent with treatment recommendations than patients who are less internally focused than their physicians.
Annals of Behavioral Medicine 07/2007; 33(3):262-8. · 4.20 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Among end-stage renal disease (ESRD) patients on hemodialysis, death from withdrawal from life-sustaining dialysis is increasingly common. The present study's objective was to examine depression as a potential risk factor for hemodialysis withdrawal. Two hundred forty ESRD hemodialysis (133 male and 107 female) patients were followed for an average of 4 years after depression symptom assessment. Of these, 18% withdrew from dialysis. Using multivariate survival analysis and after controlling for the effects of age (p < .001) and clinical variables, the authors found that level of depression symptoms was a unique and significant predictive risk factor for the subsequent decision to withdraw from dialysis (p < .05). The potential impact that depression may have on the decision to withdraw from hemodialysis should be considered by health care providers, patient families, and patients.
Health Psychology 03/2006; 25(2):198-204. · 3.87 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Participants in the present study were 207 patients with chronic kidney disease (CKD) who completed internal HLOC and depression measures at baseline and at an approximately 16-month follow-up period. Regression results indicated that after controlling for baseline level of depression, baseline internal HLOC was not a significant predictor of depression at follow-up. However, increases in internal HLOC over the 16-month follow-up were predictive of depression at follow-up. Furthermore, this relationship was qualified by an interaction between change in internal HLOC and disease progression. These results suggest that changes in internal HLOC over time may be a particularly important determinant of adjustment for individuals whose chronic illness progresses or becomes life threatening.
Journal of Health Psychology 10/2005; 10(5):677-86. · 1.22 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Poor patient adherence is a widespread problem among patients undergoing hemodialysis for end-stage renal disease.
The goal of this study was to examine the joint role of perceived restriction of control and individual differences in preference for control in predicting adherence to the hemodialysis regimen.
Participants were 49 patients recruited from five hemodialysis centers affiliated with the University of Iowa Hospitals and Clinics. Preference for control in the health care context was assessed using the Preference for Information and Preference for Behavioral Involvement subscales of the Krantz Health Opinion Survey, and perceived control was assessed using six items written for this study. Adherence was assessed by examining patients' interdialysis session weight gains (IWG).
Hierarchical regression analysis indicated that the interaction between preference for information and perceived control over dialysis context explained a significant proportion of variance in IWG values, change in R2 =.09, F(1, 43) = 5.26, p <.05, standardized beta = -.32. Among patients with lower levels of perceived control in the dialysis setting, a higher preference for information concerning one's own health care was associated with increasingly poorer adherence. IWG levels in these individuals reflected clinically problematic nonadherence with fluid-intake restrictions. Among patients with a higher level of perceived control, preference for information had little effect on adherence. No main or interactive effects were found involving differences in patients' preference for behavioral involvement in their own health care or for the items reflecting perceived control outside the dialysis treatment setting.
These data suggest that assessing and examining the interactive effects of patients' preferences for control and perceived control may, in some cases, be useful in identifying those individuals at risk for difficulty in adhering to the complex behavioral restrictions associated with chronic medical regimens.
Annals of Behavioral Medicine 06/2004; 27(3):155-61. · 4.20 Impact Factor
