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The Impact of Patient-Centered Care on Outcomes

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Abstract

We designed this observational cohort study to assess the association between patient-centered communication in primary care visits and subsequent health and medical care utilization. We selected 39 family physicians at random, and 315 of their patients participated. Office visits were audiotaped and scored for patient-centered communication. In addition, patients were asked for their perceptions of the patient-centeredness of the visit. The outcomes were: (1) patients' health, assessed by a visual analogue scale on symptom discomfort and concern; (2) self-report of health, using the Medical Outcomes Study Short Form-36; and (3) medical care utilization variables of diagnostic tests, referrals, and visits to the family physician, assessed by chart review. The 2 measures of patient-centeredness were correlated with the outcomes of visits, adjusting for the clustering of patients by physician and controlling for confounding variables. Patient-centered communication was correlated with the patients' perceptions of finding common ground. In addition, positive perceptions (both the total score and the subscore on finding common ground) were associated with better recovery from their discomfort and concern, better emotional health 2 months later, and fewer diagnostic tests and referrals. Patient-centered communication influences patients' health through perceptions that their visit was patient centered, and especially through perceptions that common ground was achieved with the physician. Patient-centered practice improved health status and increased the efficiency of care by reducing diagnostic tests and referrals.
The Journal of Family Practice
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September 2000 · Vol. 49, No. 9
Original Research
The Impact of Patient-Centered Care
on Outcomes
Moira Stewart, PhD; Judith Belle Brown, PhD; Allan Donner, PhD; Ian R. McWhinney, OC, MD;
Julian Oates, MD; W. Wayne Weston, MD;
John Jordan, MD
London, Ontario, Canada
Submitted, revised, July 4, 2000.
From the Centre for Studies in Family Medicine (M.S., J.B.B., I.R.M.), the Department of
Epidemiology and Biostatistics (A.D.), and the Department of Family Medicine (W.W.W., J.J.), The
University of Western Ontario. Dr Oates is a family physician. This paper was presented at the North
American Primary Care Research Group Meeting, Vancouver, British Columbia, November 1996.
Reprint requests should be addressed to Moira Stewart, PhD, Centre for Studies in Family Medicine,
Department of Family Medicine, Mogensen Building, 100 Collip Circle, Suite 245, The University of
Western Ontario, London, Ontario, Canada, N6G 4X8. E-mail: moira@julian.uwo.ca.
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BACKGROUND: We designed this observational cohort study to assess the association between
patient-centered communication in primary care visits and subsequent health and medical care
utilization.
METHODS: We selected 39 family physicians at random, and 315 of their patients participated.
Office visits were audiotaped and scored for patient-centered communication. In addition, patients
were asked for their perceptions of the patient-centeredness of the visit. The outcomes were: (1)
patients’ health, assessed by a visual analogue scale on symptom discomfort and concern; (2)
self-report of health, using the Medical Outcomes Study Short Form-36; and (3) medical care
utilization variables of diagnostic tests, referrals, and visits to the family physician, assessed by
chart review. The 2 measures of patient-centeredness were correlated with the outcomes of
visits, adjusting for the clustering of patients by physician and controlling for confounding
variables.
RESULTS: Patient-centered communication was correlated with the patients’ perceptions of
finding common ground. In addition, positive perceptions (both the total score and the subscore
on finding common ground) were associated with better recovery from their discomfort and
concern, better emotional health 2 months later, and fewer diagnostic tests and referrals.
CONCLUSIONS: Patient-centered communication influences patients’ health through perceptions
that their visit was patient centered, and especially through perceptions that common ground was
achieved with the physician. Patient-centered practice improved health status and increased the
efficiency of care by reducing diagnostic tests and referrals.
key words Physician-patient relations; family practice; patient-centered care. (J
Fam Pract 2000; 49:796-804)
See commentary about this article by Ronald M. Epstein, MD The Science of Patient-Centered Care
Being patient centered is a core value of medicine for many physicians. The principles of patient-centered
medicine date back to the ancient Greek school of Cos, which was interested in the particulars of each
patient.
1
More recently similar concepts have arisen in a variety of fields of human endeavor: the concept of
physical diagnosis and deeper diagnosis of Balint,
2
the client-centered therapy of Rogers,
3
the total-person
approach to patient problems in nursing of Neuman and Young,
4
the biopsychosocial model of Engel,
5
and
the disease- versus patient-centered medical practice of Byrne and Long.
6
In the past decade the patient-
centered concepts of Gerteis and colleagues
7
have been applied to the hospital setting.
In the setting of primary care, and specifically family practice, patient-centered concepts incorporate 6
interactive components. The first component is the physician’s exploration of both the patients’ disease and
4 dimensions of the illness experience including: their feelings about being ill, their ideas about what is wrong
with them, the impact of the problem on their daily functioning, and their expectations of what should be
done. The second component is the physician’s understanding of the whole person. The third component is
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the patient and physician finding common ground regarding management. In the fourth component the
physician incorporates prevention and health promotion into the visit. The fifth component is the
enhancement of the patient-physician relationship. Finally, the sixth component requires that patient-
centered practice be realistic. Our study addresses the first 3 of these components. Being patient centered
does not mean that physicians abdicate control to the patient
8
but rather that they find common ground in
understanding the patients and more fully respond to their unique needs.
9
What are the benefits of being patient centered? Previous research of specific communication variables
indicates that patient-centered encounters result in: (1) the duration of the office visit remaining the
same
10
,
11
(2) better patient satisfaction,
12
(3) higher physician satisfaction,
10
and (4) fewer malpractice
complaints.
13
We focus on 2 other outcomes: patients’ health and efficiency of care.
Methods
Our study was designed to test the hypothesis that adult patients whose first visit in an episode of illness is
patient centered will, by 2 months after the first visit: (1) more frequently demonstrate recovery from the
symptom (and recovery from the concern about the symptom); (2) demonstrate better self-reported health;
and (3) experience less subsequent medical care (ie, fewer visits, diagnostic tests, and referrals), compared
with patients whose visit is not patient centered.
Data Collection and Participants
For our observational cohort study data were collected at 5 points: (1) the research assistant identified
eligible patients in the physician’s office before the visit; (2) the office encounter was audiotaped and scored
for patient-centered communication; (3) the research assistant held a postencounter interview with the
patient; (4) we assessed, by chart review, the use of medical care during the 2-month follow-up; and (5) we
conducted a follow up telephone interview with patients 2-months after the encounter.
Physician Selection. Physicians were recruited from the 250 family physicians practicing in London,
Ontario, Canada, and the surrounding area. They were randomized within strata to ensure a representative
sample in terms of year of graduation and geographic location and were selected using a modified version of
the method of Borgiel and colleagues.
14
Patients. We approached patients who were older than 18 years and had 1 or more recurring problems who
presented to their physician’s office. Patients were excluded if they were too ill or disabled to answer
questions, had no presenting problem, were in the office for counseling, were accompanied by another
person, were not fluent in English, were hard of hearing, or were cognitively impaired. They were
approached before they saw the physician and were blind to the study hypotheses.
Sample Size Estimation. The sample size required for correlations of 0.20 to be detected with an a set at
0.05 (2 tailed) and a b set at 0.10 was 259
15
patients. Further inflation by 10% to account for the effect of
clustering on multiple regression
16
was thought to be reasonable (259÷0.9=288). Expecting 75% to
cooperate, we aimed to approach 384 patients (288÷0.75).
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Measures*
Measure of Patient-Centered Communication Score. The patient-centered communication score is based
on 3 of the 6 components of the model of patient-centered medicine.
17
-
20
The first component (exploring the
disease and the illness experience) received a high score when the physician explored the patients’
symptoms, prompts, feelings, ideas, function, and expectations. The second component (understanding the
whole person) received a high score when the physician elicited and explored issues relating to life cycle,
personality, or life context, including family. The third component (finding common ground) received a high
score when the physician clearly described the problem and the management plan, answered questions
about them, and discussed and agreed on them with the patient. Scoring sheets and procedures are
described in detail elsewhere.
21
Scores could range from 0 (not at all patient centered) to 100 (very patient
centered).
Interrater reliability has been established in earlier versions of the measure and for the current version
(r=0.69, 0.84, and 0.80 among 3 raters,
22
0.91 among 2 raters,
23
and 0.83 for n=19 for our study). Intrarater
reliability was 0.73 (n=20).
Correlations with global scores encompassing the 3 components supported the validity of the score (0.63 in
an earlier study
23
and 0.85 for our study, n=46).
Patient Perception of Patient-Centeredness. Based on the patient-centered model, a series of 14 items
developed and validated in previous studies
24
,
25
were used to assess the patients’ postencounter
perceptions of how patient centered the interaction with the physician had been.† Items were averaged into:
total score, a subscore on exploring the disease and illness experience, and finding common ground. Low
scores represented patient centeredness.
Patient Recovery from Discomfort and Concerns. The primary health outcome was the recovery measure
based on the patients’ self-administered report on visual analogue scales (VAS) of the severity of the
symptom they identified as the main presenting problem and their concern about that problem at 2 points:
the postencounter interview and the follow-up 2 months later.
26
,
27
VAS have been tested for reliability and
validity in studies of pain and nausea (correlation of 0.75 with an intensity score).
26
Each of the symptom
recovery variables was continuous.
Patient Health Status. The Medical Outcomes Study Short Form-36 (SF-36) was used to assess self-
reported secondary health outcomes. This valid and reliable measure
18
is a multidimensional assessment of:
physical health, mental health, perception of health, social health, pain, and role function. All were
continuous variables except role function, for which the distribution of scores necessitated dichotomizing.
Medical Care. The care provided during the 2 months following the audiotaped encounter was assessed by
chart review (adapted from Bass and coworkers
24
) by 3 medical doctors (I.R.M., J.O., J.J.) blind to the
identity of the family physician and the patient, and also to the patient-centered scores. Items abstracted
were: the total number of visits during the 2 months (continuous variable); the number and kind of diagnostic
tests ordered during the 2 months that were relevant to the problems presented at the audiotaped visit
(dichotomous); and the number and kinds of referrals made during the 2 months that were relevant to the
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problems presented at the audiotaped visit (dichotomous).
Analysis. The hypotheses were tested using multiple regression for continuous outcomes and multiple
logistic regression for dichotomous outcomes,
29
both adjusted for the effect of the clustering of patients by
physician using “procedure mixed” in SAS for continuous outcomes and using both “procedure logistic” and
“procedure IML” in SAS for dichotomous outcomes.
30
The unit of analysis was the patient.
The following confounding variables were included in preliminary multivariable analyses on the basis of their
univariable relationships with outcomes at the level of P <.10: age, sex, number of family members at home,
desire to share feelings, who initiated the visit, tense personality, coping skills, concomitant health problems,
social support, marital status (married vs other), concomitant life problems, number of visits to the physician
in the previous 12 months, and main problem (1 of 5 groups: digestive, musculoskeletal, respiratory, skin,
and other).
Because of substantial sample attrition with so many covariates, and because only 2 variables were
consistently associated with the outcome measures, each subsequent multivariable analysis was conducted
with each of the primary independent variables and the 2 covariates (patients’ main presenting problem and
marital status).
Results
Descriptive Results
Of the 102 randomly selected family physicians, 83 were eligible because they were still practicing in the
area and had adequate office space to accommodate the research assistant. Of these, 39 (47%) agreed to
participate and completed the data collection. The participants were similar to the refusers [Table 1] in year
of graduation, practice location (rural or urban; high or low socioeconomic status) and sex; however,
participants were significantly more likely to be certificants of the College of Family Physicians of Canada
than refusers (59% and 27%, respectively; P=.007).
Of 464 eligible patients, 334 (72%) agreed to participate. Nineteen (~6%) were lost to the study. The final
315 participants represented an overall participation rate of 68%; their age was representative of the eligible
patients, but there was a higher proportion of men than in the total group of eligible patients.
[Table 2] shows that the slim majority of final participants were women, and most were middle aged and
married. Typical of the city, approximately 4 in 10 had more than a high school education. The most common
presenting problems were respiratory in nature.
[Table 3] shows the descriptive results for key variables.
Hypothesis Testing Results
The patient-centered communication scores (based on the audiotape analysis) were not significantly related
to any of the health outcomes after adjusting for the clustering of patients within practices and after
controlling for the 2 confounding variables. Similarly, patient-centered communication scores were not
related to any of the 3 medical care outcomes.
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Patient-centered communication scores (based on the audiotape analysis) were significantly correlated in
the expected direction, with patient perceptions that the patient and physician found common ground (r =-
0.16; P=.01). High scores (indicating very patient-centered communication) were correlated with low patient
perception scores (indicating patient-centeredness). The 2 other patient perception scores (total patient
perception score and the subscore on patient perception that the illness experience was explored) were not
significantly associated with patient-centered communication scores.
The total score of patients’ perceptions that the visit was patient centered was associated with positive health
outcomes after adjusting for the clustering of patients within practices and after controlling for the 2
confounding variables [Table 4]. Patients’ postencounter levels of discomfort were lower when they
perceived the visit to have been patient centered than not.
A similar result occurred for 2 other patient health outcomes: the patients’ postencounter level of concern
(P=.02), and the mental health dimension of the SF-36 measure assessed 2 months after the study visit
(P=.05). The subscore of patient perceptions that the patient and physician found common ground was
associated with one of the health outcomes, the patients’ postencounter level of concern (P=.04). There
were no significant associations of the subscore on patients’ perceptions that the illness experience had
been explored with any of the patient health outcome measures.
Patients who perceived that their visit had been patient centered received fewer diagnostic tests [Table 5]
and referrals [Table 6] in the subsequent 2 months. The proportion receiving diagnostic tests rose from
14.6% in the group who perceived that the visit had been patient centered (total score), to 24.3% in the
group who perceived the visit was not. The proportion who were referred doubled from approximately 8% to
16%. These relationships were found even more strongly for the subscore on patient perceptions that the
patient and the physician found common ground, but were not found for the subscore on patient perceptions
that their illness experience had been explored. The proportion receiving diagnostic tests quadrupled from
4.1% in the group who perceived that the patient and the physician found common ground, to 25.4% in the
group who perceived that common ground had not been attained. The proportion who were referred doubled
from 6.1% to 14.9%. The number of visits by the patient to the family physician during the subsequent 2
months was not significantly related to the patient perceptions of patient centeredness, although there was a
trend (P=.11) with the average number of visits in 2 months in the 4 quartiles of patient perceptions as
follows: 1.0, 0.8, 1.2, and 1.3.
Discussion
Pathway to Improved Patient Outcomes
Patient-centered practice was associated with improved patients’ health status and increased efficiency of
care (reduced diagnostic tests and referrals). However, only 1 of the 2 measures of patient-centered practice
showed this result, the measure of patients’ perceptions of the patient centeredness of the visit. The
measure that was based on ratings of audiotaped physician-patient interactions, while related to the patients’
perception, was not directly related to health status or efficiency.
The relationship of patients’ perceptions of patient centeredness with their health and efficiency of care was
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both statistically and clinically significant. Specifically, recovery was improved by 6 points on a 100-point
scale; diagnostic tests and referrals were half as frequent if the visit was perceived to be patient centered.
The associations we found may imply a potentially important pathway (which could be tested in future trials),
such as the one shown in the [Figure]. The pathway suggests a process through which patient-physician
communication influences patients’ health, by first influencing the patients’ perceptions of being a full
participant in the discussions during the encounter. Such a pathway has been noted by Sobel, whose review
suggested a pathway to explain the lack of a direct relationship between patient education programs and
patient health where there was a relationship between patient perceptions about their health and health
outcomes. Sobel called this pathway “a biology of self-confidence.”
31
He and others
32
stress the critical role
of patient perceptions in the healing process, which highlight that a person’s subjective experience
influences biology.
How do we understand the results that show the ratings of the audiotape were not directly related to the
outcomes, but the patient-centered perception measure was related to outcomes? One interpretation is that
observable skills are not as important as patient perceptions. Although there is some evidence that skills
training can improve both physicians’ behavior and patients’ health,
33
our findings and those of Bensing and
Sluijs
34
indicate that differences in interviewing skills may not be associated with patient responses.
Physicians may learn to go through the motions of patient-centered interviewing without understanding what
it means to be a truly attentive and responsive listener. The implications of the current findings for educators
are that education about communication should go well beyond skills training to a deeper understanding of
what it means to be a responsive partner for the patient, during both that phase of the visit in which the
problem is discussed and when the discussion of treatment options occurs. Two examples of such education
approaches are: small group discussions between patients and physicians to illustrate the patients’
experiences and needs, and reviews of videotaped interviews with standardized patients participating in the
review. Placing prime importance on the patients’ perceptions recognizes the influence of these perceptions
on the patients’ subsequent health and epitomizes being truly patient centered.
Views that the visit was patient centered included perceptions about the discussion of the problem (exploring
the illness experience) as well as discussion and agreement about treatment options (finding common
ground). There is a substantial body of research supporting the importance of these discussions. The
Headache Study found that patients’ perceptions that a full discussion of the problem had taken place
predicted resolution of headaches after 1 year.
34
In keeping with our results, which found that finding
common ground was more strongly associated with outcomes than exploring the illness experience, Riccardi
and Kurtz
36
stressed that the physicians’ explanation to the patients was the crucial phase of the visit. Also,
a key outcome study has found that patient agreement with the physician about the nature of the treatment
and the need for follow-up were strongly associated with their recovery.
37
Efficiency of Medical Care
We found that patient-centered practice (assessed by patients’ perceptions) was associated with the
efficiency of care by reducing subsequent diagnostic tests and referrals by half, after controlling for key
confounding variables. These results were both statistically significant and clinically significant. Also, the
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number of subsequent visits to the family physician was lower (although not significantly) when the patient
perceived the study visit to be patient centered. Efficiency in health service delivery was also found in a
randomized trial of compassionate care in the emergency department setting with homeless patients.
38
In
their study of continuity of care in Norwegian general practice, Hjortdahl and Borchgrevink
39
found that
diagnostic tests were 10 times more likely to be ordered for patients about whom physicians reported the
least previous knowledge compared with patients in whom they had reported fullest knowledge. Also,
patients had only half the chance of being referred if their physicians knew them and their history.
38
One possible interpretation of the results of our study is that patient-centered physicians order fewer tests
and refer less often. However, countering this interpretation is the fact that individual physicians in our study
showed a range of patient-centered scores, as well as a range in test ordering and referral. In addition, the
statistical analysis took account of the clustering of patients within a physician’s practice.
An alternative interpretation is that patients’ perceptions may influence resource use in several ways. For
example, increased participation during the visit may reduce patients’ anxiety and their perceived need for
investigations and referrals. Alternatively, patients’ perception that the physician has not understood their
problem may provoke insecurities resulting in a request for further medical interventions. Also, if patients
openly express their discontent with the encounter there may be an increase in physicians’ anxiety and a
lowering of their threshold for diagnostic uncertainty, resulting in further investigations and referrals.
Certainly the finding that the failure to be patient centered (as perceived by the patient) was related to higher
rates of referral and diagnostic tests should be a concern for medical education and health care policy.
Perhaps of most importance is that the patients’ experience of being a participating member in the
discussion of the problem and the treatment process may translate into the patients’ reduced need for further
investigation or referral—simultaneously reducing the physicians’ need as well.
These findings counter a common misconception: that being patient centered means responding to every
whim of the patient, thereby increasing expenses to the health care system.
Limitations
Approximately 30% of the patients refused to participate, and although the participants represented the age
distribution of eligible patients, men were overrepresented in the study. Nonetheless, sex was not identified
as a confounding variable for the associations studied.
Although no measure of severity was possible, the variables representing concurrent health problems and
concurrent life problems were considered in the analysis strategy. They were not related to the outcome
variables and were therefore not entered into the multivariable analyses.
One interpretation of the lack of association between patient-centered scores on the audiotaped interviews
and subsequent health outcomes may be that the audiotape measure has failed to capture the important
essence of the dynamic interaction between physicians and patients. The measure had a number of
strengths, however; it had been tested for reliability and validity (compared with a global rating), and it was
based on a theoretical framework. Also, it was correlated with one component of the patient perception
measure of a patient-centered interview, a finding which indicates that future research should be directed
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toward determining physicians’ skills and behaviors that correlate with the patients’ positive perceptions,
especially the perception that common ground has been reached. Such behaviors could then be emphasized
in clinical teaching.
It should be noted that the utilization data were available only from the participating practices and not from
care received elsewhere. Although this is a limitation, it would be expected that this lack of data would
minimize the current relationship between patient-centered practice and utilization, because patients with
less favorable perceptions would be potentially more likely to seek care elsewhere. Also, drug costs and
hospital costs were not included and require further study. Future research could also build on these results
about resource utilization and assess the specific kinds and actual costs of the diagnostic tests and referrals.
It could be argued that the results of our study demonstrated simply that people with positive perceptions
and less severe problems achieved better health and more efficient services. We counter this interpretation
with 2 thoughts. First, the preliminary step in our analysis included confounding variables to control for a
variety of relevant variables (ie, personality and concomitant health problems). Only 2 confounding variables
were influential enough to remain in the final analysis: marital status and diagnostic code of the main
presenting problem. Second, patient perceptions were not independent of the physician-patient visit. They
were influenced significantly by the communication score based on the audiotaped encounter, implying that
the measure of perceptions was tapping not merely the patients’ general outlook on life, but also an
important interactive component of visits between patients and physicians.
Conclusions
Patient-centered practice was associated with improved health status (less discomfort, less concern, and
better mental health) and increased efficiency of care (fewer diagnostic tests and referrals).
Patients’ perceptions of the patient centeredness of the visit, but not the measure of audiotaped interactions,
were directly associated with the positive outcomes. The subscore on patients’ perception of finding common
ground was more strongly associated with the positive outcomes than the subscore on patients’ perception
about exploring the illness experience.
Medical education should go beyond skills training to encourage physicians’ responsiveness to the patients’
unique experience. Therefore, involving real patients and standardized patients in teaching programs is
recommended.
Health service organizations must recognize that efficiencies accrue from patient-centered practice and
encourage such practice through structures that enhance continuity of the patient-physician relationship and
through meaningful education programs.
· Acknowledgments ·
Our project was supported by a grant from the Health Care Systems Research Program of the Ministry of
Health of Ontario. The setting of the project was the Thames Valley Family Practice Research Unit
(TVFPRU), a health system-linked research unit funded by the Ministry of Health of Ontario. The opinions
contained are those of the authors, and no official endorsement by the Ministry is intended or should be
inferred. The TVFPRU is part of the Centre for Studies in Family Medicine, Department of Family Medicine,
The University of Western Ontario, London, Canada.
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... 1,2 This approach can be applied to all healthcare workers and all medical specialties. 1,3 Eight elements of patient-centered care were identified, including respect for the patient's values, preferences, and expressed needs; information and education; access to care; emotional support to reduce fear and anxiety; family and friend involvement; continuity and secure transition between health care settings; physical comfort; and coordination of care. 4 Patient-centered care allows patients to actively participate in all areas of their care, including treatment decisions and self-management. ...
... 5 Lack of patient-centered care results in poor health outcomes, decreased patient and family satisfaction, high readmission rates, increased average length of stay, higher mortality, poor management of chronic conditions, and additional costs. 3 The "quality chasm" report from the US Institute of Medicine characterized patient-centered care as respecting and responding to individual patient choices, needs, values and emphasizing that patient values lead all medical decisions. 6 New models of care that include patient preferences, care coordination, empowerment, and physical environment aspects are thought to be the most crucial contributors to quality improvement. ...
... By eliminating diagnostic tests and referrals, patient-centered practice enhanced health and boosted care efficiency. 3 Several studies have looked into patient care quality in Saudi Arabia. Wahabi et al 11 conducted a study to determine healthcare providers' attitudes toward clinical practice guidelines (CPGs). ...
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Objective: The interaction between physicians and patients is essential in clinical practice. Patient-centered care (PCC) is becoming popular in healthcare and provides an approach to deliver high-quality healthcare to yield positive clinical outcomes. This study explores family medicine residents' attitudes toward the physician-patient relationship and patient-centered care and the possible influence of demographic characteristics, level of training, school of graduation, and previous training. Methods: A cross-sectional study was conducted among family medicine residents in Riyadh. They were invited to enroll in a web-based survey that includes demographic data, training details, and the "Patient Practitioner Orientation Scale (PPOS).". Results: A total of 114 family medicine residents completed the survey. There were 68 (59.6%) males and 46 (40.4%) female residents. The overall PPOS was 4.23 ± 0.53. The mean score for sharing domain was 3.97 ± 0.66. The caring domain scored 4.49 ± 0.57. No correlations were found between the residents' demographic data and other included variables, and the means of sharing domain, caring domain, and overall score. Conclusion: Family medicine residents were found to have positive attitudes toward patient-centeredness. Integrating patient-centered training early in the curriculum can improve healthcare students' and trainees' attitudes toward patient-centered care. Future research can explore the possible interventions in systematic assessment and training programs that can improve PCP.
... Currently, several studies have covered patient-centered care services and the impacts resulting from it on processes and outcomes of care by extensively emphasizing on the relationship between patient and care facilitators. Nevertheless, much of the patient's experiences result outside the office of a physician [6][7][8]. ...
... Developing good consultation technique lies at the heart of person-centred care and may lead to improved health outcomes for patients [21][22][23][24][25]. Historically the discipline of pharmacy has been taught as a scienti c subject, with pharmacists trained as the experts in medicines [26]. ...
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Background Demonstrating a person-centred approach in a consultation is a key component of delivering high-quality healthcare. To support development of such an approach requires training underpinned by valid assessment tools. Given the lack of a pharmacy-specific tool, a new global consultation skills assessment tool: the Medicines Related – Consultation Assessment Tool (MR-CAT) was designed and tested. Aim This study aimed to test the validity and reliability of the MR-CAT CAT using psychometric methods. Methods Psychometric testing involved analysis of participants’ (n = 13) assessment of fifteen pre-recorded simulated consultations using the MR-CAT. Analysis included discriminant validity testing, intrarater and interrater reliability testing, and internal consistency testing for each of the five sections of the MR-CAT. Results Internal consistency for the overall global assessment and each of the five sections of the MR-CAT was good (Cronbach’s alpha = 0.97). The MR-CAT discriminated well at the global level (p <0.001). Moderate to high intrarater reliability was observed at the global level and for all sections of the MR-CAT (rho = 0.64 – 0.84) in the test-retest analysis. Moderate to good interrater reliability (Kendall’s W = 0.68 – 0.90) was observed at the global level and for all sections of the MR-CAT. Conclusions The MR-CAT is a valid and reliable tool for assessing person-centred pharmacy consultations. Moreover, its unique design means that the MR-CAT can be used in both formative and summative assessment.
... Pharmacists' participative behavior, patients' participative behavior and interpersonal communication are components of the PCC (Pribadi et al., 2019;Wang et al., 2018). According to Stewart et al, Patient Centered Care is beneficial for reducing malpractice and increase of medication adherence (Stewart et al., 2000). Moreover, PCC can also increase satisfaction and reduce the severity of disease symptoms in patients (Hudon et al., 2011). ...
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Patient satisfaction and trust are the main focus in the context of health care. Patient satisfaction is influenced by medication service factors, handling patient complaints and listening to patient needs. Important to develop and test a patient-centered care model as a tool to monitor, measure, analyze, and increase patient satisfaction and trust among people with non-communicable diseases in Public Health Center service setting. This study attempts to ascertain the effect of care on patient satisfaction and trust in pharmacy staff at the Magelang City Public Health Center. Cross-sectional quantitative research is used in this field. 212 people participated as the sample. Non-probability sampling using a purposive sample strategy was used as the sampling technique in this investigation. Structural Equation Modeling-Partial Least Square (SEM-PLS) is used for hypothesis testing. According to the study's findings, patient satisfaction is positively impacted by pharmacy staffs’ participative behavior and interpersonal communication (p< 0.05). Interpersonal communication and pharmacy staff participation do not affect the trust in pharmacy staff (p> 0.05). Patient satisfaction plays a moderating role in the association between pharmacy staff participation and trust in pharmacy staff (p< 0.05). Likewise, the association between interpersonal communication and trust in pharmacy staff is mediated by patient satisfaction (p< 0.05).
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Patient-centered care is widely acknowledged as an important goal in healthcare delivery. Research has demonstrated that patient perceptions of patient-centred care can be linked to clinical and long-term outcomes in addition to being a useful metric for quality improvement efforts. Objectives: 1) To identify patients’ perspectives and experiences of patient-centerd care in some communes in Thua Thien Hue province; 2) To determine the association between the patients’ perspectives, experiences on patient-centered care and utilization of the health services. Methods: A cross sectional descriptive study was conducted in 313 patients living in Thua Thien Hue province. A structured questionnaire was use to investigate 4 main domains of patient-centered care: Information and Education, Relationships with doctors and other health professionals, making decisions, motivate patients about self-management. We used test ANOVA to analyze the association between patient-centered care and health care utilization among participants (p < 0.05). Results: The percentage of good patient-centered care (≥ 3.75 points) was 43.1% (Mean = 3.58 (0.57)). Patients using health services at the commune health centers had a higher experience in patient-centered care compared to district, province and central hospitals (p < 0.005). Domains “Encourage patients to take care of themselves” and “Relationship factor with doctors” were evaluated low. There were statistically significant associations between patient-centered care and primary health care facilities, quality of life utilization of periodic health checkup, and patient activation in health care (p <0.05). Conclusion: Out study illustrates that patients’ perspectives and experiences of patient-centered care are still low. There is a need to improve communication and counseling skills of health care providers and increase patient motivation for self-care Key words: patient-centered care, primary care, health care utilization
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Background: Despite high prevalence, emotional distress among primary care patients often goes unrecognized during routine medical encounters.Objective: To explore the effect of communication-skills training on the process and outcome of care associated with patients' emotional distress.Methods: A randomized, controlled field trial was conducted with 69 primary care physicians and 648 of their patients. Physicians were randomized to a no-training control group or one of two communication-skills training courses designed to help physicians address patients' emotional distress. The two training courses addressed communication through problem-defining skills or emotion-handling skills. All office visits of study physicians were audiotaped until five emotionally distressed and five nondistressed patients were enrolled based on patient response to the General Health Questionnaire. Physicians were also audiotaped interviewing a simulated patient to evaluate clinical proficiency. Telephone monitoring of distressed patients for utilization of medical services and General Health Questionnaire scores was conducted 2 weeks, 3 months, and 6 months after their audiotaped office visits.Results: Audiotape analysis of actual and simulated patients showed that trained physicians used significantly more problem-defining and emotion-handling skills than did untrained physicians, without increasing the length of the visit. Trained physicians also reported more psychosocial problems, engaged in more strategies for managing emotional problems with actual patients, and scored higher in clinical proficiency with simulated patients. Patients of trained physicians reported reduction in emotional distress for as long as 6 months.Conclusions: Important changes in physicians' communication skills were evident after an 8-hour program. The training improved the process and outcome of care without lengthening the visits.(Arch Intern Med. 1995;155:1877-1884)
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Objective. —To identify specific communication behaviors associated with malpractice history in primary care physicians and surgeons.Design. —Comparison of communication behaviors of "claims" vs "no-claims" physicians using audiotapes of 10 routine office visits per physician.Settings. —One hundred twenty-four physician offices in Oregon and Colorado.Participants. —Fifty-nine primary care physicians (general internists and family practitioners) and 65 general and orthopedic surgeons and their patients. Physicians were classified into no-claims or claims (≥2 lifetime claims) groups based on insurance company records and were stratified by years in practice and specialty.Main Outcome Measures. —Audiotape analysis using the Roter Interaction Analysis System.Results. —Significant differences in communication behaviors of no-claims and claims physicians were identified in primary care physicians but not in surgeons. Compared with claims primary care physicians, no-claims primary care physicians used more statements of orientation (educating patients about what to expect and the flow of a visit), laughed and used humor more, and tended to use more facilitation (soliciting patients' opinions, checking understanding, and encouraging patients to talk). No-claims primary care physicians spent longer in routine visits than claims primary care physicians (mean, 18.3 vs 15.0 minutes), and the length of the visit had an independent effect in predicting claims status. The multivariable model for primary care improved the prediction of claims status by 57% above chance (90% confidence interval, 33%-73%). Multivariable models did not significantly improve prediction of claims status for surgeons.Conclusions. —Routine physician-patient communication differs in primary care physicians with vs without prior malpractice claims. In contrast, the study did not find communication behaviors to distinguish between claims vs no-claims surgeons. The study identifies specific and teachable communication behaviors associated with fewer malpractice claims for primary care physicians. Physicians can use these findings as they seek to improve communication and decrease malpractice risk. Malpractice insurers can use this information to guide malpractice risk prevention and education for primary care physicians but should not assume that it is appropriate to teach similar behaviors to other specialty groups.
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In a 2 × 2 design, college student subjects described one of two levels of cold pressor pain (threshold or tolerance) with the McGill Pain Questionnaire administered via one of two modes (interview or paper-and-pencil). Interview administration was associated with higher scores on 5 of the 6 MPQ scores calculated. Data did not support the notion that this effect is entirely attributable to increased probability of interviewed subjects' endorsement of descriptors for which clarification of meaning was sought. Reliable effects of pain intensity were also found on 5 of the 6 measures, but in no case did pain intensity and mode of administration significantly interact.