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Patient and Physician Perceptions of their Relationship and Patient Satisfaction: A Study of Chronic Disease Management
Abstract
This study investigated patient and physician perceptions of their relationship and examined how their perceptions related to patient satisfaction. Data are based on 134 patient-physician interactions. Study participants included 12 physicians (five women and seven men) and 134 male patients with a diagnosis of diabetes mellitus being seen on an outpatient basis. Information on patient and physician demographics, patient's metabolic control and functional status and time spent in the interaction were also collected. Results revealed that patients with lower levels of education were most satisfied and that physicians who viewed the relationship as a patient-physician partnership had more satisfied patients than those who viewed the relationship as physician controlled. Findings also indicated that physicians' gender and number of years in practice were not related to patient satisfaction. Practical implications include: (1) increasing attention to physician's perceptions of his or her relationship with individual patients and (2) exposing newly trained physicians to partnership types of relationships, if future research confirms these findings in chronic disease management.
... As descobertas de pesquisas recentes têm implicações para a educação do paciente e o manejo da doença. Os prestadores de cuidados de saúde devem explicar aos doentes as definições dos parâmetros clínicos de uma forma que seja amiga do doente [26]. Isso pode ajudá-los a entender as informações de tratamento e tomar decisões informadas [26]. ...
... Os prestadores de cuidados de saúde devem explicar aos doentes as definições dos parâmetros clínicos de uma forma que seja amiga do doente [26]. Isso pode ajudá-los a entender as informações de tratamento e tomar decisões informadas [26]. Além disso, é importante que os pacientes entendam os desfechos clínicos em ensaios clínicos oncológicos para facilitar um melhor gerenciamento da doença [26]. ...
... Isso pode ajudá-los a entender as informações de tratamento e tomar decisões informadas [26]. Além disso, é importante que os pacientes entendam os desfechos clínicos em ensaios clínicos oncológicos para facilitar um melhor gerenciamento da doença [26]. Pesquisas são necessárias para determinar as formas mais eficazes de discutir esses desfechos com os pacientes [26]. ...
Introdução: A avaliação da hemodinâmica em pacientes com cardiopatia persistente é um tópico complexo e multifacetado que requer uma compreensão abrangente da fisiopatologia subjacente e dos fatores de risco associados. Esta revisão bibliográfica fornece um resumo valioso da pesquisa atual no campo e destaca vários temas-chave que surgiram de estudos recentes. Metodologia: foi realizada uma revisão de literatura conduzida para investigar os aspectos clínicos, fisiológicos, patológicos e hemodinâmicos em pacientes com cardiopatia persistente. Foram realizadas buscas em várias bases de dados entre 2010 e 2022, utilizando termos específicos. Os critérios de inclusão foram estudos de coorte, estudos de caso-controle e revisões sistemáticas com amostras maiores que 10 indivíduos. Após uma triagem inicial, 33 artigos foram selecionados para análise. Os artigos foram avaliados quanto à qualidade metodológica e os dados foram agrupados e analisados qualitativamente. Os resultados foram apresentados de forma descritiva, destacando as principais informações encontradas sobre os aspectos clínicos, fisiológicos, patológicos e hemodinâmicos em pacientes cardiopatas resistentes. Discussão: Uma descoberta notável é que a insuficiência cardíaca crônica continua sendo um grande problema de saúde pública, com quase 5 milhões de casos relatados apenas nos EUA. Apesar dos avanços no tratamento, a taxa de mortalidade dessa condição permanece alta, enfatizando a necessidade de pesquisas contínuas sobre os mecanismos subjacentes e intervenções mais eficazes. Além disso, a revisão identifica vários fatores de risco potenciais para doença cardíaca persistente, incluindo doença renal crônica, obesidade e inflamação. Esses achados sugerem que uma abordagem multidisciplinar para o manejo da doença, incorporando intervenções médicas e de estilo de vida, pode ser mais eficaz para melhorar os resultados dos pacientes. Conclusão: No geral, esta revisão ressalta a necessidade crítica de pesquisas contínuas sobre a fisiopatologia, fatores de risco e tratamento de doenças cardíacas persistentes e fornece informações valiosas sobre possíveis caminhos para futuras investigações.
... There is evidence that gendered communication styles may contribute to perceptions of patient satisfaction. Existing literature suggests that patient satisfaction is positively associated with affiliative communication styles (Anderson & Zimmerman, 1993Cousin & Schmid Mast, 2013;Hausman, 2004;Ong et al. 2000;Pieterse, Street & Buller, 1987;Van Dulmen, Beemer, Bensing, & Ausems, 2007) that exhibit more patient-centered behaviors such as, showing concerns, agreeableness, empathy, friendliness (Boer, Delnoij, & Rademakers, 2013;Carrard, Schmid Mast, Jaunin-Stalder, Perron, & Sommer, 2018). The use of controlling behaviors by doctors has similarly been found to have negative impacts on patient satisfaction (Anderson & Zimmerman, 1993;Bradley, Sparks & Nesdale, 2001;. ...
... Existing literature suggests that patient satisfaction is positively associated with affiliative communication styles (Anderson & Zimmerman, 1993Cousin & Schmid Mast, 2013;Hausman, 2004;Ong et al. 2000;Pieterse, Street & Buller, 1987;Van Dulmen, Beemer, Bensing, & Ausems, 2007) that exhibit more patient-centered behaviors such as, showing concerns, agreeableness, empathy, friendliness (Boer, Delnoij, & Rademakers, 2013;Carrard, Schmid Mast, Jaunin-Stalder, Perron, & Sommer, 2018). The use of controlling behaviors by doctors has similarly been found to have negative impacts on patient satisfaction (Anderson & Zimmerman, 1993;Bradley, Sparks & Nesdale, 2001;. Moreover, research suggests that male doctors commonly use the controlling style to communicate, where the affiliative style is more common among female doctors (Aruguete & Roberts, 2000;Buller & Street, 1992). ...
... In terms of doctor-patient interaction, research has found that male and female doctors adopt different communication styles where authoritative communication styles were mostly seen among male doctors, and affiliative communication styles were seen among female doctors. Research has also found that affiliative communication styles are positively connected to patient satisfaction because they exhibit more patient-centered behaviors (Anderson & Zimmerman, 1993;Buller & Buller,1987;Street & Buller,1987, Cousin & Schmid Mast, 2013. Therefore, the previous research has concluded patients tend to be more satisfied with female doctors as they use affiliative communication styles. ...
It has been well established that the doctor-patient relationship is integral for providing quality health care and sustaining patient satisfaction. Additionally, research has indicated that doctors' self-disclosure is considered as an essential interpersonal component of relational development. In terms of the doctor-patient interaction, previous research has produced numerous studies investigating the relationship between doctors' communication behaviors and patient satisfaction. Scholars have also explored how communication styles are associated with doctors' gender, and patient satisfaction. However, there is still a gap in the existing research concerning the connections between doctors' self-disclosure, gender, and patient satisfaction in doctor-patient interactions. My qualitative study sought to examine how doctors' self-disclosure impacts patient satisfaction and how doctors' gendered performances of self-disclosure were perceived by patients. I conducted an in-depth focus group interview with a total of eight volunteer participants (five females, three males). My findings indicated that doctors' self-disclosure positively impacts the patient satisfaction regardless of their gender. Additionally, participants indicated that self-disclosure from both male and female doctors was viewed as helpful when it was relevant and not excessive.
... In individuals with chronic diseases however, this number increases substantially and the relationship with their primary care physician and the experiences in the healthcare system become all the more relevant [2]. The relationships between patients and their physicians have the potential to determine and affect the way patients decide [3][4][5], e.g., with regard to a recommended usage of assisting technologies in older age [6][7][8]. These relationships and interactions with physicians and other entities within the healthcare systems are based on patients' trust in specific stakeholders but also in the healthcare system itself. ...
... Bell et al. [2] found that when patient's expectations about their primary care physician, such as medical information, new medications, medical tests, or a specialist referral, were not met, adherence to treatment plans was significantly lower than for patients whose expectation were met in the long run. Specifically in patients with chronic illnesses, patient-physician relationships are predictive of treatment adherence, patient activation, and overall satisfaction with their health plan [3][4][5]. ...
Health changes in general, but especially in older age, inevitably lead interactions with different people and entities in the health care system. Particularly in the case of severe health decisions, trust in the healthcare system and the people involved is essential. This raises the question of which factors can promote or impede trust and how these can be influenced by individual or circumstantial parameters. Therefore, the current study aims to investigate how trust in healthcare systems is built and maintained in severe health decisions. Understanding trust-relevant factors in severe health decisions provides the basis for further investigations of trust in assistive technologies for people of older age and in need of care. Two semi-structured focus groups with each five participants were carried out and recorded (N = 10). The results showed that severe health decisions represent situations in which fundamental aspects of life change so that life is no longer comparable to what it was before. The analyses also identified multiple factors relevant in trust building and maintenance, e.g., competence, empathy, transparency, communication, and financing. By contributing to a greater understanding of the patients’ needs, with the results of this study, recommendations for a more targeted and demand-oriented communication between the various stakeholders in health care systems can be derived.KeywordsTrustHealthcare SystemsSevere Health Decisions
... Patients with lower levels of education were on average more satisfied with their medical care and providers than patients with higher levels of education. [24][25][26] In the context of exploring the effects of length of waiting time on dental patients' satisfaction, these earlier findings might not only result in the prediction that less educated patients would be more satisfied than better educated patients, but there might be a differential effect of waiting time length in these groups. The second objective is to explore whether a patient's level of formal education (more precisely, the years of schooling they had received) will differentially affect their satisfaction as a function of the length of their waiting time. ...
... The way these situations are being managed seem to determine ultimately how much The results of this study also showed that patient characteristics might also affect the degree to which longer waiting times affect patients' satisfaction. While previous research clearly documented that patients' level of education was related to their treatment satisfaction, [24][25][26] this is the first study that documents that patients' level of education might moderate their responses to longer waiting times. In addition, there is some evidence that whether a dental visit is a new patient visit could further moderate patients' responses. ...
Purpose:
Spending time in waiting rooms prior to dental visits is not uncommon for dental hygiene patients. The objectives were to determine if the length of a patients' waiting time affected their satisfaction with the appointment and their evaluation of their provider. In addition, the patient's level of education and whether the dental visit is a first visit will be examined to determine if these affected the outcome.
Methods:
Survey data were collected from 399 adult patients who came for regularly scheduled visits to a dental school clinic. The patients ranged in age from 19 to 93 years (mean=52 years; SD=16.9). For 29% of the patients, this visit was the first visit with this provider.
Results:
The patients whose providers were early (n=65) were more satisfied, more likely to plan to follow their provider's recommendation and evaluated their relationship with their provider more positively than patients whose providers were on time (n=283), while the patients in the "late" group (n=32) showed the most negative responses to all questions. Patients from higher educational backgrounds were most negative in their responses when their providers were late. Patients with a first visit whose providers were late had the most negative evaluations of the patient-provider relationship.
Conclusion:
Long waiting times prior to a scheduled dental appointment have a negative effect on patients' satisfaction with their visit, the evaluations of the patient-provider relationship and the patients' intentions to return.
... According to Sanchez, one of the basic goals of marketing is to determine the values of the customer and to incorporate them into marketing programs to enhance customer loyalty (Sanchez, 2003). Good relationships between customers and service providers can lead to satisfied customers (Anderson & Zimmerman, 1993). Overall satisfaction is a significant and direct precursor to loyalty (Bodet, 2008). ...
... A good relationship between the customer and the service provider can lead to a satisfied customer. Anderson and Zimmerman (1993) found that a physician's perception of the relationship with his or her patients may be associated with patient satisfaction. In particular, physicians who characterized the patientphysician relationship as a partnership tended to have more satisfied patients than did those who view the relationship as controlled by the physician. ...
This study examined a model of patient loyalty from the perspectives of relationship marketing and patient satisfaction. Data were analyzed in two separate but sequentially related stages using structural equation modeling with partial least squares. Patient satisfaction directly affected loyalty, but it did not mediate the relationship between relationship marketing and loyalty. Although healthcare providers can increase patient satisfaction by demonstrating trustworthiness and commitment and by the use of good communication skills, these factors do not have a significant effect on loyalty despite their overall positive impact. JEL: I110, M310
... Except for 3 risk factors that had mixed association directionality, of the remaining 35 risk factors, 12 risk factors were always positively associated with patient satisfaction while 23 risk factors were always negatively associated with patient satisfaction (Table 1, S3 Table, and Fig 2). The most frequently identified negative risk factors, associated with more than half of all 18 questions, were as follows: poor self-evaluation of health (16/18, 89%), higher education level (15/18, 83%), and Asian ethnicity (12/18, 67%), which are all consistent with what has been reported in previous studies [25][26][27]. White individuals were overall less satisfied (8/18, 44%), and African American individuals were generally more satisfied (4/18, 22%) particularly in the questions related to communication with nurses (2/3, 67%). ...
... Our analysis identified several risk factors previously associated with patient satisfaction. For instance, patients who poorly evaluated their health, had a higher education level, or were Asian were more likely to be dissatisfied with their hospital experience [25][26][27]. Previous studies have demonstrated lower patient satisfaction scores in Asians without clearly identifying what underlying factors drive their tendency to respond less favorably as compared to patients of other races and ethnicities. ...
Background:
The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is the first publicly reported nationwide survey to evaluate and compare hospitals. Increasing patient satisfaction is an important goal as it aims to achieve a more effective and efficient healthcare delivery system. In this study, we develop and apply an integrative, data-driven approach to identify clinical risk factors that associate with patient satisfaction outcomes.
Methods:
We included 1,771 unique adult patients who completed the HCAHPS survey and were discharged from the inpatient Medicine service from 2010 to 2012. We collected 266 clinical features including patient demographics, lab measurements, medications, disease categories, and procedures. We developed and applied a data-driven approach to identify risk factors that associate with patient satisfaction outcomes.
Findings:
We identify 102 significant risk factors associating with 18 surveyed questions. The most significantly recurrent clinical risk factors were: self-evaluation of health, education level, Asian, White, treatment in BMT oncology division, being prescribed a new medication. Patients who were prescribed pregabalin were less satisfied particularly in relation to communication with nurses and pain management. Explanation of medication usage was associated with communication with nurses (q = 0.001); however, explanation of medication side effects was associated with communication with doctors (q = 0.003). Overall hospital rating was associated with hospital environment, communication with doctors, and communication about medicines. However, patient likelihood to recommend hospital was associated with hospital environment, communication about medicines, pain management, and communication with nurse.
Conclusions:
Our study identified a number of putatively novel clinical risk factors for patient satisfaction that suggest new opportunities to better understand and manage patient satisfaction. Hospitals can use a data-driven approach to identify clinical risk factors for poor patient satisfaction to support development of specific interventions to improve patients' experience of care.
... Education. There is evidence that people who are less educated tend to be more satisfied with primary care and general practice (Greenley et al., 1982), physician communication (Bartlett, 1984), ambulatory care (Anderson and Zimmerman, 1993) and hospital care (Linn, 1975). In contrast, people with more education were found to be more satisfied with ambulatory care (Linder-Pelz and Stewart, 1986) and hospital care (Kane, et al., 1997). ...
... Competency items were adjectives that reflected the skillfulness, efficiency, and accuracy of the physician. Finally, Anderson and Zimmerman (1993) found that patients were more satisfied when they felt like they controlled the patient-physician partnership. ...
... It therefore may be important that a relationship of trust and confidence with a GP and with a practice as a whole is formed to ensure attendance with a regular GP. Several studies have demonstrated that a positive relationship between a patient and their GP increases the patient's satisfaction and their compliance with treatment plans (Bertakis et al., 1991;Anderson & Zimmerman, 1992;Frank Small & Associates, 1995). ...
... This finding is significant, as under the Australian health care system there is no requirement for a patient to receive all their primary medical care from a particular GP or practice, unlike the United Kingdom and New Zealand (Harris & Frith, 1996). This finding indicates a relation of trust and confidence with the GP and the practice as a whole and is supported by several studies that have demonstrated a positive relationship between patients and their GPs increases patient satisfaction and their compliance with treatment plans (Bertakis et al., 1991;Anderson & Zimmerman, 1992;Frank Small & Associates, 1995). A regular GP promotes the uptake of health assessments, as GPs can undertake the assessments annually and therefore determine any changes in health status and prevention methods, which need to be implemented. ...
... At the origin of the innovative study protocol that is the main subject of this article, there is the strong conviction that the quality of communication should be pursued and always safeguarded: not only it strengthens a positive relationship between the speakers, but it is helpful in creating a solid therapeutic alliance between the patient and the physician [1][2][3][4]. Doctorpatient relationship is the core of the therapeutic journey and highly impacts its outcomes, such as the quality of care, patient's safety, autonomy [5,6], adherence, and compliance [7][8][9][10][11]. It has already been acknowledged to be a clinical tool [12][13][14][15]. ...
This paper explores a brand-new interdisciplinary approach applied to an enduring problem: the communication of severe diagnoses. The moment when physicians explain the diagnosis to patients and their relatives is sensitive, particularly for a disease that is rarely diagnosed early. The first part of the article is dedicated to the context of this delicate doctor-patient interaction. With this framework in mind, the paper delves into the innovative interdisciplinary methodology developed in the pilot study Communi.CARE, conducted in a hospital in Northern Italy, which focuses on the diagnosis of pancreatic ductal adenocarcinoma (PDAC). SARS-CoV-2 impact on the study development is highlighted. The study aims to explore the topic by combining different areas of expertise, including medicine, philosophy, sociology, and psychology. The contribution of philosophy is here presented as essential: it has a leading role in the conception of the study, its development, and the elaboration of results. It is shown throughout the study, from methodology to the analysis of results. Strengths and weaknesses of the methodology are discussed. In conclusion, further philosophical considerations on effective and ethical communication in this delicate context are recommended.
... All of these actions act to strengthen the medical relationship. Anderson and Zimmerman (1993) show patients are more satisfied with a partnership style relationship, rather than a physician controlled relationship. Communication clearly plays a significant role in patient satisfaction. ...
This study examined self-reports of engagement, confirmation, and satisfaction by Spanish-speaking physicians within the context of the relationship with Spanish-speaking patients. Previous research suggests the interaction is transactional and both physician and patient mutually contribute to the relationship. Results demonstrated engagement and confirmation positively influenced relational satisfaction of physicians (R 2 = .58, F(1,14) = 19.38, p < .01; R 2 = .29, F(1,14) = 5.84, p = .03, respectively). Additional results are reported. Implications and directions of future research are discussed within.
... In a recent study, Watson and Gallois (2002) argued that the key element in determining satisfaction in an interaction is the ability of the physician to treat his/her patient as an individual. In fact, Anderson and Zimmerman (1993) found that patient satisfaction was related to physician's tendency to view the physician-patient relationship as a partnership. ...
This study analyzed physicians' self-reported measures of engagement, confirmation and relational satisfaction in their communication with their patients (N = 218). Results indicated that communication engagement and confirmation significantly influence reported satisfaction (R 2 = .20, F(1,216) = 55.24, p < .01; R 2 = .14, F(1,216) = 35.87, p < .01, respectively). Additional results are reported. Implications for these results and directions for future study are discussed. I. INTRODUCTION The past three decades has seen an increased interest in the interpersonal communication skills of physicians in reference to their patients. In fact, Epstein and Hundert (2002) included the application of appropriate communication skills as an important component of physician competency. Moore, Adler, and Robertson (2000) found that physician communication behaviors increased patients' positive perceptions of physician-patient relations and decreased malpractice claim intentions. These relational outcomes may be a function of specific communication behaviors. To investigate this relationship, the present study will examine physicians' perceptions regarding specific core communication competencies in physician-patient interaction. In particular, this study examines the influence that physicians' interaction engagement and confirmation have on their reports of satisfaction in their relationship with their patients.
... Communication facilitates effective physician-patient interactions, enhances patient empowerment, improves patient understanding of health conditions, and enriches the therapeutic alliance between patients and practitioners. Effective communication has been linked to positive physical and mental health outcomes [2,5], thus making it a component of health care for all patients and is especially critical among those with chronic diseases because of the frequency of interaction between physicians and patients [6]. ...
Background:
Effective physician-patient communication is crucial for positive health outcomes for patients with chronic diseases. However, current methods of physician education in communication are often insufficient to help physicians understand how patients' actions are influenced by the contexts within which they live. An arts-based participatory theater approach can provide the necessary health equity framing to address this deficiency.
Objective:
The aim of this study was to develop, pilot, and conduct a formative evaluation of an interactive arts-based communication skills intervention for graduate-level medical trainees grounded in a narrative representative of the experience of patients with systemic lupus erythematosus.
Methods:
We hypothesized that the delivery of interactive communication modules through a participatory theater approach would lead to changes in both attitudes and the capacity to act on those attitudes among participants in 4 conceptual categories related to patient communication (understanding social determinants of health, expressing empathy, shared decision-making, and concordance). We developed a participatory, arts-based intervention to pilot this conceptual framework with the intended audience (rheumatology trainees). The intervention was delivered through routine educational conferences at a single institution. We conducted a formative evaluation by collecting qualitative focus group feedback to evaluate the implementation of the modules.
Results:
Our formative data suggest that the participatory theater approach and the design of the modules added value to the participants' learning experience by facilitating interconnection of the 4 communication concepts (eg, participants were able to gain insight into both what physicians and patients were thinking about on the same topic). Participants also provided several suggestions for improving the intervention such as ensuring that the didactic material had more active engagement and considering additional ways to acknowledge real-world constraints (eg, limited time with patients) in implementing communication strategies.
Conclusions:
Our findings from this formative evaluation of communication modules suggest that participatory theater is an effective method for framing physician education with a health equity lens, although considerations in the realms of functional demands of health care providers and use of structural competency as a framing concept are needed. The integration of social and structural contexts into the delivery of this communication skills intervention may be important for the uptake of these skills by intervention participants. Participatory theater provided an opportunity for dynamic interactivity among participants and facilitated greater engagement with the communication module content.
... It has been seen from a large portion of the reviews that more noteworthy fulfilment is related with lower level of training. As indicated by Anderson and Zimmerman (1993) who completed reviews in two facilities of Michigan, patients with lower level of instructions are generally fulfilled. Correspondingly, Schutz et al (1994) found that higher instructive fulfillment was firmly connected with disappointment among the patient's experiencing colonoscopy. ...
Introduction: Healthcare scenario is fast changing all over the world. Health as a fundamental right, is gaining popularity over the last few decades and it has become a social goal. Patient satisfaction is one of the established parameters to measure success of the healthcare services that are provided in the hospitals. There are high expectations and demands from consumers because of improved socio-economic status and easy accessibility to healthcare. Successful monitoring of customer’s perception has become a simple but important strategy. The measurement of patient satisfaction is an important tool for research, administration, and planning. Objective of the study: · To study the level of satisfaction among OPD Patients · To find out the level of satisfaction among the patients regarding the behaviour of the hospital staff · To analyse the perception of patients about cleanliness in the OPD of the hospital · To find out the perception of patients about diagnostic services in the OPD of the hospital. Methodology · Study design- Cross-sectional study · Study population- The target population of this study included patients who had utilized health services at the OPD of a secondary care public hospital in Month of July 2021. · Sample size- A sample of 100 out-door patients had been taken on random basis. · Study Settings- Study had been conducted in a secondary care public hospital, Bhojpuri, Bihar,India. · Tools of Data Collection- The data had been collected by interviewing patients who had utilized health services in out-patient services (OPD). Conclusion: The study concludes the overall patient satisfaction of government hospital. The results depicted in the study are highly alarming. A government hospital with such potential cannot sustain with such dissatisfying patients. The management needs to take necessary steps in order to repair its deteriorating image in the public domain.
... A survey study of 500 people discharged from a military teaching hospital also found that lower education correlated with higher satisfaction [32]. A crosssectional study measuring patients and clinicians' perceptions and patient satisfaction of 134 male patients and 12 physicians receiving care at a diabetes outpatient clinic found that patients with lower education were most satisfied [33]. Another cross-sectional study addressing colonoscopy patients' satisfaction 72 hours after the procedure found that higher education was associated with dissatisfaction with care [34]. ...
Objective
Patients might exaggerate their symptoms in an attempt to align the clinician’s views with their own. A person who sees potential benefit in symptom exaggeration might also experience less trust, more difficulty communicating, and lower satisfaction with their clinician. We asked if there was an association between patient rating of communication effectiveness, patient satisfaction, and patient trust with symptom exaggeration?
Methods
One hundred and thirty-two patients in four orthopaedic offices completed surveys including demographics, Communication-Effectiveness-Questionnaire (CEQ-6), Negative-Pain-Thoughts-Questionnaire (NPTQ-4), a Guttman-style satisfaction question, PROMIS Depression, and Stanford Trust in Physician. Patients were randomly assigned to answer three questions about symptom exaggeration for two scenarios: 1) their own exaggeration during the just-completed visit or 2) the average person’s tendency to exaggerate.
Results
In multivariable analysis, lower ratings of communication effectiveness were associated with greater symptom exaggeration (p=0.002), while an annual household income>$100,000 (p=0.033) was associated with higher ratings. Higher rating of satisfaction was associated with lower education attained (p=0.004). Greater trust was associated with lower personal exaggeration (p=0.002).
Conclusion
The relationship between greater exaggeration and lower ratings of communication effectiveness and trust suggests that symptom descriptions that seem more intense or diffuse than expected may indicate opportunities for more effective communication and trust.
Innovation
Patient experience can be improved by training clinicians to identify symptom exaggeration as a signal that the patient does not feel heard and understood and a cue to return to communication strategies that build trust.
... In part, our p value is being slightly lower contributed to this lack of significance. While it is not unusual for patient accounts and provider accounts to not be highly correlated (Anderson & Zimmerman, 1993;Hall et al., 1999), the virtual absence here suggests that the provider and patients do not view themselves in similar ways. These findings may suggest a lack of awareness on the part of the patients or providers such that perceptions do not align, or that the provider simply did not have enough experiences with these patients to form a perception that could better align with that of the patient. ...
Integrative approaches in the primary care setting have grown in favor over the past few decades, with many interesting findings about the influence of personality disorders on physical health and functioning; however, less is known about how specific pathological personality traits impact patient–provider assessments of physical and mental health. Using the DSM-5 Levels of Personality Functioning Questionnaire-Short Form (DLOPFQ-SF) and Personality Inventory for DSM-5-Brief Form, these relationships were evaluated in a sample of 50 inner-city, low-income patients in a primary care clinic. Point- biserial correlations revealed significant correlations between physical and mental health morbidities, as well as personal- ity pathology and patient response to treatment. Our findings lend further support to describing the relationships between personality pathology, medical comorbidities, and patient response to treatment.
... Since patients started reporting higher levels of satisfaction in cases of partnership or, more generally, when their needs and preferences were taken into consideration (Anderson and Zimmerman, 1993), a new medical practice called patient-centred care was conceptualized. Epstein et al. (2005) identified three core values of patient-centeredness: (1) considering patients' needs, wants, perspectives and individual experiences; (2) offering patients opportunities to provide inputs and participate in their care and (3) enhancing partnerships and understanding in the patient-physician relationship. ...
Purpose
This study formulates a new archetypical model that describes and re-interprets the patient–physician relationship from the perspective of two widespread phenomena in the healthcare delivery process: value co-creation (VCC) and defensive medicine (DM).
Design/methodology/approach
Grounded in the existing literature on VCC and DM, the authors designed and conducted 20 in-depth interviews with doctors (and patients) about their past relationships with patients (and doctors). After putting the recorded interviews through qualitative analysis with a three-level coding activity, the authors built an empirically informed model to classify patient–physician relationships.
Findings
The authors identified four archetypes of patient–physician relationships. Each archetype is described along with its representing characteristics and explained in terms of its consequences as they relate to VCC and DM.
Research limitations/implications
This research contributes to the literature on both VCC in healthcare and DM, in addition to the patient–physician's relationship literature.
Practical implications
Being aware of patient–physician relationship mechanics, building long-term relations with patients and investing in service personalization and patient-centred care can effectively mitigate the risks of DM behaviours on one side while increasing the likelihood of VCC actualization on the other.
Originality/value
Although strictly linked to the interactions between patients and doctors, VCC and DM are typically considered disentangled. In this research paper, the authors identified four archetypes of patient–physician relationships in relation to these two phenomena.
... Since patients started reporting higher levels of satisfaction in cases of partnership or, more generally, when their needs and preferences were taken into consideration (Anderson and Zimmerman, 1993), a new medical practice called patient-centred care was conceptualized. Epstein et al. (2005) identified three core values of patient-centeredness: (1) considering patients' needs, wants, perspectives and individual experiences; (2) offering patients opportunities to provide inputs and participate in their care and (3) enhancing partnerships and understanding in the patient-physician relationship. ...
Purpose
The study focuses on the value co-creation processes in humanitarian professional services provision, analysing the key enabling factors of beneficiaries' participation, involved in long-term integration programmes (L-TIPs).
Design/methodology/approach
Through an in-depth case study, the research looks at the practices of value co-creation in humanitarian professional services, considering both the perspectives of the professional service provider and beneficiary.
Findings
In professional services beneficiary's participation affects the success of the L-TIPs outcomes. Participation's enablers can be classified into four different spheres, each belonging to different elements of professional service: the beneficiary, the professionals, the service design and the external environment.
Research limitations/implications
This paper contributes to the literature on humanitarian operations & supply chain management. By focussing on an understudied phase of the disaster life-cycle management, it contributes to the theory of value co-creation by exploring new issues and drivers of beneficiary's participation.
Practical implications
This research has interesting implications for policymakers and humanitarian practitioners. First, guidelines for professionals' behaviours and interventions should be designed as well as new practices and strategies should be adopted. Second, governments should avoid concentrating L-TIPs in few big humanitarian centres.
Originality/value
The study focuses on an understudied stage of humanitarian operations, namely the L-TIPs, and uses this setting to build on the theory of value co-creation in professional services by identifying its enabling factors, clustered into four spheres, namely beneficiary, professional, service design and environmental.
... In the health care context, patient satisfactions are regarded as a common evaluation in achieving the quality service and the goal of chronic treatment (Aliman & Mohamad, 2013;Anderson & Zimmerman, 1993;Porter, 2010) because it is related to patients' acceptance of treatment continuation, relationship with physician, patient adherence, and subsequent desired outcomes. Empirical evidence suggested that perceived value is a contributory factor to satisfaction (Yang & Peterson, 2004), and that service providers can expend their effort to improve value perceived by customers in order to increase customer satisfaction. ...
This research aims to explore the role of service encounter behaviors and customers’ participation in the interaction process to co-create value, leading to customer satisfaction. A model is developed and tested in the health care context. Based on the data of 320 paired patient–physician cases, the analysis reveals that physician’s interactions are critical customer-oriented behaviors, which directly affect customer value. More importantly, it plays a key role in activating the customer participation in a service creation. From the customer view, although actively engaging in a service requires more resources, it is worthy because it creates much more value-in-use.
... According to Sanchez, one of the basic objectives of marketing is to determine customer values and to include them in marketing programs to increase customer loyalty [3]. A good relationship between customers and service providers can lead to satisfied customers [4]. Based on Sari's findings [5], relationship marketing does not affect customer satisfaction. ...
... [8][9][10]19 However, the lack of association of clinicians' self-perceived empathy with affective patient outcomes is in contrast with some previous literature demonstrating that clinicians' perceptions can play a role in patients' emotional wellbeing, satisfaction, and quality of life. 21,22,45 Previous studies were, however, mostly conducted with patients suffering from nonlife-threatening illness and may, therefore, have yielded different results. It is arguable that in the setting of advanced cancer, the importance of patient-perceived empathy grows due to the high stakes involved 6 and the great amounts of distress and uncertainty experienced 46 and, therefore, may exceed the importance of clinicians' perceptions. ...
Background: Empathy is a cornerstone of effective communication. However, clinicians' and patients' perceptions of clinician-expressed empathy might differ. The independent perceptions of patients and clinicians on clinician-expressed empathy in advanced cancer consultations and the associations of these perceptions with patient outcomes are unknown.
Objective: We assessed (1) patients' and clinicians' independent perceptions of clinician-(self-)expressed empathy in advanced cancer consultations and (2) the associations between these perceptions and affective patient outcomes.
Methods: This observational study included data from 41 consultations in the advanced breast cancer setting. Postconsultation, patients' and clinicians' perceptions of clinician-expressed empathy were assessed, as well as patients' (1) pre–post anxiety, (2) post-anxiety, (3) emotional well-being, and (4) satisfaction. Multilevel regression analyses were run to draw conclusions.
Results: Patients perceived higher levels of empathy than clinicians, without a significant relationship between the two (mean [M] = 85.47, standard deviation [SD] = 14.00 vs. M = 61.88, SD = 15.30, 0–100 scale; β = 0.14, p < 0.138, 95% confidence interval [CI] = −0.04 to 0.32). Higher patient-perceived empathy was associated with decreased anxiety [(1) β = −0.67, p = 0.039, 95% CI = −1.30 to −0.03; (2) β = −0.15, p = 0.042, 95% CI = −0.30 to −0.01], higher satisfaction (β = 0.05, p < 0.001, 95% CI = 0.03 to 0.08), and lower emotional distress (β = −0.32, p < 0.001, 95% CI = −0.48 to −0.16). There were no associations with clinicians' perceptions [(1) β = −0.34, p = 0.307, 95% CI = −1.00 to 0.31; (2) β = −0.02, p = 0.824, 95% CI = −0.17 to 0.14; (3) β < 0.01, p = 0.918, 95% CI = −0.03 to 0.02; (4) β = 0.08, p = 0.335, 95% CI = −0.08 to 0.25].
Conclusions: Patients' and clinicians' empathy perceptions differed. In improving patient outcomes, the focus should be on patients' perceptions of clinician-expressed empathy. Future research could focus on ways to elicit patients' perceptions of empathy with the higher aim of improving patient outcomes.
... The satisfaction rate and the voluntary participation rate of farmers eventually decide whether the NRCMS can continue to reduce the farmers' financial burden caused by catastrophic illnesses healthcare costs. Existing studies paid more attention to the demographic information of the program's endusers, such as age, gender, education background, household economic status, recent health status, current health status, insurance enrollment, and so on [13][14][15][16][17]. This survey not only investigated what the satisfaction rate contributed to the participation will, but also focused on what different factors determined participants' satisfaction rate, such as outpatient and inpatient reimbursement, the methods of raising funds, the quality of health services and facilities provided, and discussed in view of participants. ...
Background:China launched New Rural Cooperative Medical System (NRCMS) in 2003. However, satisfaction and voluntary participation in NRCMS of Liaoning province was unknown after ten years launching of NRCMS.
Methods: In 2014, a total of 1500 individuals from 12 general hospitals in Liaoyang City, Dalian City, Panjin City and Tieling City of Liaoning Province were investigated using self-administered questionnaire by trained staff. Univariate and multivariate logistic regression analyses were applied to find out the satisfaction with NRCMS and its influencing factors among population from Liaoning province.
Results: Of all respondents, 180 individuals (13.8%) were highly or relatively satisfied with the program. Moreover, 1092 individuals (84.0%) were fairly satisfied with the program, whereas 29 individuals (2.2%) were not. Multivariate analysis showed the price and range of drug, reimbursement ratio, simplicity of reimbursement procedures and medical technology level of hospitals were the main factors influencing the satisfaction.
Conclusion: The overall satisfaction degree of Liaoning province's participating in NRCMS participant is at the middle level. In the process of seeking medical treatment, efforts are made to improve the reimbursement level, simplify the reimbursement procedures, increase the types of drugs in the reimbursement catalogue, and simultaneously take effective measures to control drug prices.
... As is evident, a patient's perspective is very different from that of doctors as his/her focus is on establishing an emotional bond with the doctor. [6][7][8][9][10] This theory was strengthened in a study done in Denmark [11] which showed that the patient develops an emotional relationship with the doctor, and he/she feel a certain sense of vulnerability in their relationship. ...
Context:
Doctor-patient relationship has gone through some troubled times in the recent past. Quality data regarding this is lacking in the Indian setting.
Aims:
The study aim was to find the perception of doctors regarding doctor-patient relationship.
Settings and design:
The study was conducted at a tertiary health-care center in West Bengal. It was a qualitative study including in-depth interviews and focus group discussions (FGDs).
Subjects and methods:
The study comprised of in-depth interviews (IDI) of thirty residents and three FGDs, involving 33 residents.
Statistical analysis used:
Data analysis was performed manually by deductive approach. Descriptive "codes" of the text information were done. The consolidated criteria for reporting qualitative research guidelines were followed.
Results:
Doctor-patient relationship was perceived as of mutual trust and respect. Overburdened doctors, impatient patients, unrealistic expectations from the treatment, and lack of infrastructure were some of the agreed-upon factors for the strained relationship. A combined corrective effort is needed to salvage the current situation.
Conclusions:
A healthy doctor-patient relationship is instrumental in the holistic picture of health care. Doctors, patients, administration, and media have shared causation to the problem and have equal responsibility for its amendment.
... Previous research across multiple studies has found that medical providers often overestimate patient compliance (Caron & Roth, 1971;Norell, 1981). In addition, several students have noted that provider and patient reports of the relationship are often not correlated (Anderson & Zimmerman, 1993;Hall, Stein, Roter, & Rieser, 1999). Also, for the internal medicine clinic, providers did not know the patients quite as well as the nurse practitioner in the psychiatry clinic, so ratings might have been attenuated. ...
The ability to evaluate patients’ level of personality functioning in assessing personality disorders has become increasingly important since the DSM–5 Section III hybrid system of personality disorder assessment was released. One measure developed to assess this criterion is the DSM–5 Levels of Personality Functioning Questionnaire (DLOPFQ; Huprich et al., 2017 Huprich, S. K. (2017). Personality pathology in primary care: Ongoing needs for detection and intervention. Journal of Clinical Psychology in Medical Settings[Web of Science ®] , [Google Scholar]), which assesses individuals’ self and other representations in four domains—self-direction, identity, empathy, and intimacy—across two contexts—work or school and relationships. A sample of 140 psychiatric and internal medicine outpatients were administered several questionnaires, including the DLOPFQ. Provider ratings also were obtained for level of functioning and DSM–5 pathological personality traits. Several of the DLOPFQ scales were significantly correlated with self-reported and provider-reported measures of DSM–5 trait domains and levels of functioning, along with self-reported measures of effortful control, overall physical and mental health, and well-being. Certain DLOPFQ scales and subscales were associated with provider ratings of likeability and patient contact with the providers. However, relatively modest validity coefficients, as well as poor discriminant validity of domain scales, indicate further research and measure refinement might be needed. It is concluded that, although further research is necessary, the DLOPFQ could be useful for understanding patients’ personality pathology in clinical settings.
... Patients were also unhappy about their lack of involvement in the decision-making process after discontinuation. While some patients prefer to participate in developing medical plans for their illnesses and others adopt a more passive attitude [27,31], it has been shown that physicians who involve their patients in treatment decision-making report more satisfied patients than more authoritarian physicians [32]. ...
OxyContin, formerly one of the most commonly prescribed medications for chronic pain in Canada, was discontinued, delisted from the Ontario Drug Formulary, and replaced by a tamper-resistant formulation in 2012. The impact of discontinuing OxyContin on patients formerly prescribed it to treat chronic pain was unreported. Patients with chronic pain aged 45 years and over ( n=13 ) were recruited from two primary care and one specialty practice sites and interviewed using a semistructured guide to capture their experiences with discontinuing OxyContin, the efficacy of alternate medications, and relationships with physicians. Additional interviews were conducted with their physicians ( n=7 ) to obtain physician perceptions on discontinuation and to expand understanding of the patients’ experiences. Aspects of patients’ pain and medical care through the discontinuation process revealed emergent themes that both converge and diverge from that of treating physicians. Areas of divergence include the motive for discontinuation, which was condemned by most patients but supported by all physicians, and the perceived impact of discontinuance on pain control, with the majority of patients experiencing a negative impact and most physicians describing it as insignificant. Perceptions of patients and physicians coincided on the need to optimize pain management practices.
... 22 Doctors who view patient physician relationships as partnerships have a higher level of satisfaction among their patients. 23 According to a multivariate analysis, spending more time with patients was significantly associated with patient satisfaction. 24 Based on the foregoing, the following hypothesis was proposed: ...
This paper develops a framework with which to conceptualize loyalty to healthcare organizations in terms of relationship marketing, patient satisfaction, provider switching, and retention programs. This conceptual framework can be viewed from the perspective of hospitals and clinics using structural equation modeling with a partial least squares approach (Smart PLS 2.0). Respondents received healthcare services, funded by the government and a university health insurance plan, from both types of organizations. The concept of loyalty differed slightly depended on whether data from the hospital and the clinic were analyzed together or separately. Indeed, hospitals and clinics differ with regard to several factors that can affect loyalty.
... both groups reported high satisfaction with care, Spanish- speaking caregivers were more satisfied despite the fact that two- thirds of them reported waiting more than 90 min for an outpa- tient chemotherapy. Multiple studies have reported greater satisfac- tion with cancer care associated with low levels of education and acculturation.[27][28][29][30][31]Acculturation was not measured, but Spanish- speaking caregivers had low educational attainment. Future research could explore the relationship between acculturation and satisfac- tion with care among Spanish-speaking caregivers of pediatric can- cer patients. ...
... Client satisfaction, a core element of quality of care has been associated with sev eral patient aspects, namely therapy adherence and continuity of care [6] also with loyalty [7] of provider. Assessments of satisfac tion allow the integration of the patients' view into the operational activities, identification of gaps, and adjustment of imperfections in health services [8][9][10]. ...
The study explored both users and non-users' perspective on accessibility, availability and perceived quality of reproductive health services, and challenges for non-availing services offered from selected urban primary health care facilities. A cross sectional study having both quantitative and qualitative components was conducted in 14 facilities in Sylhet city corporation area of Bangladesh. In general respondents were satisfied with the services they received from the clinics. The main reasons of satisfaction were: low cost services, good behavior of provider, and waiting time. Users in both types of urban healthcare facilities expressed needs for additional services: provision of additional laboratory tests and medicine supplies with low costs and introducing male providers for serving males. The non-users were unaware about the range of services offered by the facilities. Community health promoters can introduce awareness building at the community on availability of existing services and enhancing utilization of healthcare.
... This is in contrast to the bulk of previous studies [60,61]. There may be two explanations for this finding: (1) the measurement method, asking for direct experiences instead of standardised questionnaires and (2) the close relationship of our physicians with their patients as a result of regular follow-up, which might have been intensified by the randomised trial [62]. Physicians realised the affective dimension of the worst experience by choosing cancer diagnosis first (60 %) and psychological distress third (16 %). ...
Little is known about the subjective experience of breast cancer survivors after primary treatment. However, these experiences are important because they shape their communication about their illness in everyday life, usage and acceptance of healthcare, and expectations of new generations of patients. The present study investigated this topic by combining qualitative and quantitative methods.
Breast cancer survivors in Bavaria, Germany were mailed a questionnaire up to seven years after enrolment into a randomised controlled clinical trial and start of their therapy. This enquired about their worst experiences during the breast cancer episode, positive aspects of the illness and any advice they would give to newly diagnosed patients. A category system for themes was systematically created and answers were categorised by two independent raters. Frequencies of key categories were then quantitatively analysed using descriptive statistics. In addition, local treating physicians gave their opinion on the response categories chosen by their patients.
133 (80 %) of 166 eligible patients who survived up to seven years returned the questionnaire. The most prominent worst experience reported by survivors was psychological distress (i.e. anxiety, uncertainty; prevalence 38 %) followed by chemotherapy (25 %), and cancer diagnosis (18 %). Positive aspects of the illness were reported by 48 % with the most frequent including change in life priorities (50 %) and social support (22 %). The most frequent advice survivors gave was fighting spirit (i.e. think positive, never give up; prevalence 42 %). Overall, physicians' estimates of the frequency of these responses corresponded well with survivors' answers.
Although physicians' understanding of breast cancer patients was good, psychological distress and chemotherapy-related side effects were remembered as particularly burdensome by a substantial part of survivors. On the one hand, patients' quality of life needs to be assessed repeatedly during medical follow-up to identify such specific complaints also including specific recommendations to the physician for targeted psychosocial and medical support. On the other hand the advices and positive aspects of the disease, reported by the survivors, can be used to promote positive ways of coping with the illness.
... The PCAS allows judges to choose among 35 operationally defined complaint categories drawn from patient satisfaction studies. 24 Consistent with previous research, each complaint is assigned to one of thirty-five specific categories subsumed under six general types, including physician communication, humaneness, care and treatment, access and availability, environment, or billing problems. (See Tables 1 & 2) Inter-rater reliabilities in initial norming studies ranged from 0.78 to 0.93, reflecting good agreement among judges responsible for assigning complaints to categories. ...
... Finally, the current participants were of relatively high socioeconomic status. Medical patients with higher levels of education have reported less satisfaction than patients with lower levels of education, 28 and wealthier patients are more likely to file malpractice claims than those with lower incomes. 29 Thus, although these participants may not be representative of patient populations at large, higher socioeconomic status may be particularly relevant to medical malpractice claims. ...
Objective To examine the causal effects of doctor-patient relations and the severity of a medical outcome on medical patient perceptions and malpractice intentions in the event of an adverse medical outcome. Design Randomized between-subjects experimental design. Patients were given scenarios depicting interactions between an obstetric patient and her physician throughout the patient's pregnancy, labor, and delivery. Participants One hundred twenty-eight postpartum obstetric patients were approached for participation, of whom 104 completed the study. Main outcome measures Patients' perceptions of physician competence and intentions to file a malpractice claim. Results Positive physician communication behaviors increased patients' perceptions of physician competence and decreased malpractice claim intentions toward both the physician and the hospital. A more severe outcome increased only patients' intentions to sue the hospital. Conclusion These results provide empiric evidence for a direct, causal effect of the doctor-patient relationship on medical patients' treatment perceptions and malpractice claim intentions in the event of an adverse medical outcome.
... Within the last decade, however, there has been a shift from this type of treatment paradigm to a more collaborative one where patients are highly engaged (patient centeredness). Physicians who see their relationship with patients as a partnership or a collaboration, have more satisfied patients compared to those who have a more authoritarian relationship (Anderson & Zimmerman 1993). Despite a shift towards patient centeredness, our data suggest that patients are still reluctant to question the physician authority. ...
... Research has shown that physician attitudes about diabetes and diabetes management are associated with patient selfcare behaviors. For instance, patient self-care behaviors are positively associated with physicians' beliefs about how serious diabetes is and how important glucose control is, physicians' expertise in diabetes, and the way physicians communicate with patients (Anderson & Zimmerman, 1993;Ho, Marger, Beart, Yip, & Shekelle, 1997;Johnson, 1992). However, much less attention has been devoted to the issue of social support among adults with type 2 diabetes (Trief, Grant, Elbert, & Weinstock, 1998). ...
In today’s scenario Patients are not cost conscious but they have become quality conscious and this is due to the growth in disposable income and increase in the health consciousness of the patients’. Thus, hospital is a major social institution for delivering healthcare, offering considerable advantages to both patient and society. Hospitals are classified into two ways firstly it is classified according to the objective of the hospital or service offered to the patient and secondly according to the ownership or control.
This study aimed to assess patient’s satisfaction towards health services at the Out-Patient Department of Hospital National Guido Valadares (HNGV) Timor-Leste. The research design was a cross-sectional study. Collected data from 206 outpatient consuming the OPD services at Hospital National Guido Valadares (HNGV), Timor-Leste, using interview method with structured questionnaire. Descriptive statistics and Chi-square test were used to analyze general, enabling factors, the need factors and association between satisfaction levels. Overall patient’s satisfaction was 77%. Patients had high satisfaction and low satisfaction were 55.8% and 44.2% respectively. The four components; convenience (85.4%), courtesy (64.6%), quality of care (55.8%) and only physical environment (47.6%) was low satisfaction. Regarding patients’ attitude was associated with satisfaction level (p-value = 0.001), more than half of patients (50.5%) had good attitude while less than half of them (49.5%) had poor attitude. Overall expectation was associated with satisfaction level (p-value = 0.001), patients with high expectation had high satisfaction (81.9%) and only (28.7%) of patient had low expectation. The health care service is the important part which should be improved by the hospital because it is the basic of service. Good or bad of health care service can influence the level of satisfaction. The hospital should improve the physical environment including; the atmosphere of this OPD should be clean, sitting chairs should be available at the waiting area and if possible arrange the television program to give health information in the sitting area, sign and directions to indicate where to go in the service should be complete and clear.
Black individuals are underrepresented in randomized clinical trials (RCTs). Willingness to participate is a frequently cited explanation. However, the few studies that have investigated willingness to participate demonstrated no difference between Black individuals and other groups. We sought to measure willingness to participate by focusing on sickle cell disease (SCD), in which approximately 90% of affected individuals are Black. We conducted an analysis of 17 RCTs. A level of clarity was defined and correlated with each article's transparency in reporting patient enrollment data. Calculated measures of acceptance ranged from 32% to 93.5%. Calculated completion rates ranged from 58.8% to 100%. Weighted measures of acceptance and completion were 59.1% and 83.8%, respectively. Our study is limited by focusing solely on studies pertinent to SCD and only a minority of publications reviewed provided sufficient patient enrollment data. Yet, our results suggest that decreased willingness to participate does not account for underrepresentation of Black individuals.
Background:
Increasing incidence of coronavirus 2019 (COVID-19) infection has challenged healthcare systems to increase capacity while needing to conserve personal protective equipment (PPE) supplies and minimize nosocomial spread. Telemedicine shows promise to address these challenges but lacks comprehensive evaluation in the inpatient environment.
Objective:
To evaluate an intra-hospital telemedicine program (virtual care), along with its impact on exposure risk and communication.
Methods:
We conducted a natural experiment of virtual care on patients admitted for COVID-19. The primary exposure variable was documented use of virtual care. Patient characteristics, PPE use rates and their association with virtual care use were assessed. In parallel, we conducted surveys with patients and clinicians to capture satisfaction with virtual care along the domains of communication, medical treatment, and exposure risk.
Results:
Of 137 total patients in our primary analysis, 43 patients used virtual care. In total, there were 82 inpatient days of use and 401 inpatient days without use. Hospital utilization and illness severity was similar in patients who opted-in vs opted-out. Virtual care was associated with a significant reduction in PPE use and physical exam rate. Surveys of 41 patients and clinicians showed high rates of recommendation for further use, and subjective improvements in communication. However, providers and patients expressed limitations in usability, medical assessment and empathetic communication.
Conclusions:
In this pilot natural experiment, only a subset of patients used inpatient virtual care. When used, virtual care was associated with reductions in PPE use, reductions in exposure risk, and patient and provider satisfaction.
Clinicaltrial:
Purpose
This paper aims to examine the effect of customer relationship management (CRM) on patient satisfaction and patient loyalty, controlling for other socio-demographic characteristics.
Design/methodology/approach
The study used a two-stage sampling process and structured questionnaires to collect data from 788 patients from three health facilities (public, quasi-public and private) in Greater Accra, Ghana. The data collected was analyzed using descriptive statistics and regression via the partial least squares-based structural equation model.
Findings
The results suggest that CRM is significantly positively correlated with patient satisfaction and patient loyalty, with patient satisfaction also significantly correlated with patient loyalty. Additionally, the results suggest that the introduction of education, health facility ownership, health insurance status and gender, neither impact significantly on the relationship between CRM and patient satisfaction/patient loyalty nor influenced patient satisfaction and patient loyalty directly.
Research limitations/implications
The findings of the current paper can have substantial practice implications for operators in the health-care industry in Ghana. CRM components such as service quality, customer service, communication and the use of appropriate technology to deliver service will be fundamental if organizations operating in the health-care ecosystem in Ghana are to be able to compete effectively.
Originality/value
This is one of the very few papers on the relationship between CRM and patient satisfaction and patient loyalty in African health-care literature. Thus, the findings of the paper can constitute a great resource not only to academics but also to practitioners who are looking to be competitive in the health-care market.
Patient experience is emerging as a key differentiating factor in patients’ choice of healthcare system. Many healthcare organizations are attempting to improve their patient experience by data-driven, patient-centered initiatives. This involves engaging all staff along all the contact points of a patient’s journey in healthcare. Perhaps, the physicians or care providers are most important link in this chain but also the most challenging to engage in improvement efforts. Most healthcare organizations have some training or workshops to educate providers on communication skills and other tools to enhance patient experience. However, there seems to a paucity of a standardized approach or a roadmap to put together a robust physician or care provider coaching or improvement partnership program with patient experience (PX) staff. There seems to be several gaps in this process. The current article attempts to develop broad guidelines and suggest a roadmap to address these gaps. The article also suggests general templates for PX staff to use in conducting these improvement work with providers and suggestions for developing a standard physician observation or shadowing template for consistency. The article has woven several commonly used tools like motivational interviewing, change management (ADKAR model), and several communication tools to suggest a detailed blue print for provider patient experience improvement partnership.
Many professional people are most comfortable dealing with factual communication. When given bad news, however, patients or clients can be expected to exhibit emotions such as shock, disbelief, anxiety, anger, or distress. Faced with heightened emotion and fearing that the situation may escalate and get out of control, clinicians are likely to react too quickly in an attempt to shut it down or else to ignore it completely. The author considers ways to help role-players address emotional concerns in others, suggesting the concepts of a play within a play, and optimal moments of response. Role-play is a rehearsal process, and emotions may also arise in role-players. These responses are natural and beneficial in that future interactions are likely to be more empathic and authentic.
Chronic diseases have been the focus of qualitative researchers. However, few studies have explained in depth the methodological options chosed in the studies and their reasons. This paper presents some reflections on the methodological strategies and procedures used in a multisite, qualitative study whose focus are the individual's perspectives on chronic conditions and medical care. Such reflections are on the study's orientation, the selection of the area, the focus groups and the social relations among participants. We conclude stating that the methodological options and the strategies used, rather than being solely a technical issue, are deeply linked to the study's object, the social relations among participants and the context of research.
Objectives: To carry out a descriptive and critical review of the healthcare provider-patient relationship (PPR) research, including the main issues studied, the theoretical and methodological approaches used, the antecedents and the consequences considered, etc. Methods: A bibliographical research was performed in eight databases (n = 2714 results). After removal of duplicates, of articles neither in French nor in English, irrelevant or with missing information, 1416 articles were classed in different categories according to nine criteria (e.g. criterion: methodological approach used; categories: articles using a quantitative approach with questionnaires, a qualitative approach with interviews, etc.). The main representative trends of the literature were identified by ranking these categories according to the number of classed articles. The frequencies with which the variables associated with the PPR were studied in the same articles (co-occurrences) were also analyzed. Results: In addition to identify the most representative trends of the literature (e.g. studies mostly empirical and quantitative, focused on physicians), the results reveal the existence of nine relatively distinct research areas structured around three key cross-cutting variables: patient satisfaction, communication skills of the healthcare provider and treatment choice. Overall, few studies included at the same time the patient and the healthcare provider in the assessment of the quality and consequences of their relationship (asymmetrical focus). Conclusions: There is especially a need for promoting studies adopting a symmetrical focus, i.e. analyzing the process by which the protagonists adjust reciprocally (or not) their attitudes and behavior. Accordingly, the concept of relational fit is introduced, defined and discussed.
The relationship of the physician with an elderly patient involves more than simple application of the most current diagnostic and therapeutic information. Knowing this is necessary but not sufficient to ensure an optimum outcome. It also requires recognition of the differences and similarities between the patient and the physician. It requires sensitivity to age-related changes that may increase the anxiety associated with illness for the patient and that may increase the difficulty of obtaining accurate historical and physical information for the physician. It also involves appreciation of differences in the values among elderly patients and a willingness to negotiate what may be medically indicated or medically possible, with what is most desirable from the patient’s frame of reference. The goals of therapy for an elderly person may lie in relief of symptoms rather than a cure, preservation of independent living rather than returning to employment, and easing suffering at the end of life rather than fighting death.
Objectives: to identify the socio-demographic, clinical, psycho-behavioural and therapeutic factors explaining uncontrolled blood pressure in a population of hypertensives in ambulatory practice. Methods: the DUO-HTA survey is a national, cross-sectional, mirrored, observational study, from a representative sample of 347 general practitioners (MG) and 210 cardiologists, and a population of 2 022 hypertensive patients followed by these doctors. The data were collected by means of questionnaires completed by the hypertensives and their doctors. Results: the factors significantly discriminating patients for whom BP was controlled (C) from those patients whose BP was not controlled (NC) were an age less than 65 years, smoking, obesity, alcohol consumption, sedentary lifestyle and multiple anti-hypertensive treatment. On the psycho-behavioural front, the NC patients were more often anxious and irritable, claiming to lead a stressful life and for whom hypertension was often perceived as a "foreign entity" and a source of frustration and multiple deprivations. The factors discriminating the NC doctors from the C doctors were essentially psycho-behavioural, with the NC doctors considering the management of hypertension as being less gratifying, and hypertension as a condition with fluctuating progression, poorly understood and dramatised by patients. Conclusion: the DUO-HTA survey underlines the weight of reciprocal representation systems in hypertension for patients and their doctors, as well as the quality of the doctor-patient relationship in blood pressure control. It prompts the development of sensitisation actions for practitioners centered on improving the doctor-patient relationship.
This article reviews the theoretical background and empirical literature of the construct ,,patient satisfaction". Patient satisfaction is usually seen as a patient's subjective judgement on a medical or psychological treatment, which is based on a-priori-expectations. Typically the classification of Ware et al. (1983) ist used, however, the construct suffers from conceptual shortcomings. The ratings on satisfaction scales are regularly extremely high, correlations with characteristics of the patient, the treatment and a-priori-expectations are weak. Qualitative studies show, that commonly used models are too simplistic in nature and that patient satisfaction scales are often no valid measures of patient judgements.
Patient-centered care requires health care providers to recognize and act on patients' genuine needs and expectations. Fulfillment of patients' expectations influences health care utilization, patient satisfaction, and indicates overall quality of care. Most of the patients entering a tertiary care facility have set expectations regarding the nature of f treatment, tests, biberrals, medications and relevant health care facilities. The present clinical research work aimed at prospectively analyzing factors influencing patient satisfaction at four big teaching hospitals of Lahore, Pakistan. The 492 (82%) responded out of 600 inpatients approached.The patients were extensively interviewed regarding the perceived quality of tertiary care. Only 7.90% of the patients perceived the quality of facilities/information prior to admission as excellent. Quality of medicines and treatment was regarded as satisfactory by 26.29% of the patients. The overall follow up care was perceived as good by 45.63%of the randomly selected patients. Quality of medical treatment was graded excellent with biberence to doctoral care (7.88%), nursing care (12.00%) or pharmaceutical care (0%) respectively.Enhanced interaction between different health care providers and patients can significantly improve patient related specific health outcomes. Restructuring of pharmacy services is vital for best patient care based built upon the notion of patient satisfaction which has a single goal of meeting expectations and values of the patients.The time,access and behavior are three most important component in patient satisfaction.The implementation of swift growing patient centered pharmaceutical care definitely augment the patient satisfaction.
Conducted 3 known-groups studies with 418 Ss to obtain discriminant validity information among potential self-report measures (a health opinion survey, a situation-specific desire for control scale, and a generalized desire for control scale) of the construct desire for control over health care processes. In Study 1, types of preparation for childbirth were investigated, and in Studies 2 and 3, choice of a place to die and signing a living will were examined. Results indicate that none of the measures adequately distinguished Ss who had signed a living will (or intended to) from Ss who did not intend to sign one. The best discriminator of a choice of a place to die (hospital vs home or hospice) and of type of preparation for childbirth (Lamaze vs other types of classes vs no classes) was the Information subscale of the health opinion survey. The generalized and specific desire for control scales did not significantly help to discriminate among these groups. Correlations of these measures with demographic variables are discussed. (37 ref) (PsycINFO Database Record (c) 2006 APA, all rights reserved).
This article describes the development of a diabetes attitude scale (DAS) that was designed to measure the attitudes of health-care professionals (HCPs). The DAS was developed through the efforts of a national panel of diabetes experts. The panel developed a 60-item scale that was pilot tested and reduced to a 50-item scale. The 50-item scale was then mailed to a national sample of HCPs with an interest in diabetes. The surveys were returned by 633 nurses, 322 dietitians, 116 physicians, and 67 others totaling 1138 returns (a return rate of 54%). The returned surveys were analyzed, and a 31-item DAS composed of 8 subscales resulted. Evidence for the reliability and validity of the 31-item DAS along with the instrument itself are included in this study.
This paper presents a controlled, and situationally specific, test of a common assertion regarding alienation in modern society. The hypothesis is tested that differences in alienation (i.e., in powerlessness) are associated with differential learning of behavior-relevant information. Comparing patients who differ in their degree of alienation, but who are matched for socio-economic backgrounds and for health and hospital histories, it is shown that the more alienated patients score lower on an objective test of knowledge about tuberculosis. Furthermore, these differences in objective knowledge are reflected in both the staff's description of the patients, and in the patients' attitudes about the information process. In understanding the attitude data, it is shown that the social structure of the ward as well as individual alienation must be taken into account. The relevance of these findings for contemporary viewpoints concerning the significance of alienation is noted.
This paper summarizes the results of 61 independent studies containing descriptive variables from objectively measured medical encounters. Over 200 unique patient and provider variables were identified and grouped a priori, through a process of consensual validation, into six broad categories of communication process variables: information-giving, information-seeking, partnership-building, social conversation, positive talk and negative talk. Length of medical visit and proportionate contribution of each speaker were abstracted. In addition each study was coded for 47 study attributes including characteristics of the sample, study design and methodology. Study results fall in three broad areas: (1) characteristics of the studies are presented based on the coded attributes; (2) communication profiles of patient and physician interaction are constructed by averaging the data over studies; and (3) comparisons of communication behavior across studies are presented by common sample and setting characteristics.
Results of 40 experimental trials designed to enhance communication skills of patients or health-care providers are summarized. Calculation of effect sizes (ES) offered a method for comparing the impact of these interventions on communicative behaviors. Communicative behaviors were categorized into interpersonal processes and interviewing skills. For patient-targeted interventions that examined interpersonal process variables (n = 10), modeling and skill-practice interventions exhibited the largest ES values. For provider-targeted interventions (n = 30), 21 assessed interviewing skills, 5 examined interpersonal processes and 4 examined both categories. Effect sizes were moderate to large for interviewing skills interventions targeted at medical students. For other provider groups, the majority of studies failed to include the necessary data to calculate ES. The dearth of studies examining interpersonal processes prevented drawing any conclusive statements about their relative efficacy. On the basis of these findings, current methodological concerns are described, recommendations for future research presented and practical implications discussed.
This study examines whether the health status of patients with rheumatoid arthritis, and their satisfaction with their treatment, were more strongly associated with patient-physician agreement about the importance of various aspects of the treatment program, or with the extent to which patients' concerns about their care were reduced during a clinic visit.Questionnaire responses from 82 rheumatologist-patient dyads showed that patients whose concerns were reduced tended to be satisfied with the visit, and to exhibit good overall health status and low levels of psychological distress. In contrast, patient-physician agreement was not associated with general or psychological health status, and was negatively associated with patient satisfaction.Although this cross-sectional analysis does not prove causality, the results are consistent with the premise that reducing the concerns of patients has a beneficial impact on clinical outcomes. Mere concordance between the patient and physician regarding the importance of various aspects of the treatment program, however, may not produce these beneficial effects.
Interventions oriented toward enhancing patient-provider communication will benefit from having a satisfactory measure of patients’ desires for control in clinical interactions. Findings from two studies are reported describing the development and validation of the Multidimensional Desire for Control (MDC) Scales. A total of 160 patients with non-insulin-dependent diabetes (NIDDM) participated in the first study, which was designed to develop and validate a measure of patients‘ desires for control. Factor analysis yielded three subscales reflecting patients’ desires for: (i) personal, (ii) clinician, and (ii) shared control in the interaction. Alphas for the three subscales were high (α 0.75–0.86). Correlations with other measures of control were suggestive of good construct validity. The second investigation involves a replication study verifying the factorial composition and validity of the scales. An independent sample of 109 patients with NIDDM participated in this study. Findings support the reliability of the subscales (α0.75–0.81). Furthermore, patients‘ desires for control were significantly associated with patient satisfaction, with desire for personal control negatively related to patient satisfaction (r = –0.30, –0.41, affective and behavioural dimensions, respectively) and desire for clinician control positively related to satisfaction (r = 0.44, 0.28, 0.31, affective, behavioral, and cognitive dimensions, respectively).
A sample survey of the public in a midwestern state substantiates the existence of widespread challenges to the authority of physicians, a phenomenon previously reported only impressionistically in the media. Attitudes tending to reject physicians' right to direct their interaction with patients characterized more than half the sample and were related to younger age, higher educational level, and greater health knowledge, with a consumerist and anti-authority stance also explanatory. Actual challenging behavior occurred at least once for about half the group, but in this instance was related less to age and knowledge than to more extensive experience with the health care system, as well as a lack of trust in people in general and doctors' competence in particular. However, explained variance was modest, arguing that other variables, not identified in this study, are at work. Surprisingly, respondents' health status, race, sex, and pattern of insurance coverage had little impact on either attitude or behavior, while both knowledge and a general tendency to reject authority were influential factors. Implications for physician-patient relations in the future are discussed in light of a number of social changes, including the rising educational level of the American public.
In this study, Social Learning Theory was used to generate psychosocial predictors of regimen adherence among persons with insulin-dependent diabetes mellitus (IDDM). Four categories of predictors were formed: knowledge, expectancies, skills, and environmental support. Persons with IDDM (84 adults and 23 adolescents) completed measures within each predictor category on two occasions, separated by 6 months. Multimethod assessment procedures (self-monitoring, interviews, mechanical devices) were used to measure adherence to four aspects of the IDDM regimen: insulin injections, glucose testing, diet, and exercise. Bivariate analyses demonstrated that measures of expectancies and environmental support were reliably related to several adherence behaviours. In particular, self-efficacy expectations were related to adherence across almost all regimen areas for both adolescents and adults. Skills were also important, though only for adolescents, whereas regimen knowledge was unrelated to adherence for either adults or adolescents. Multivariate analyses showed that expectancies were consistently predictive of adherence and that, in general, psychosocial variables were better predictors of insulin administration and glucose testing than of diet or exercise. The implications of these findings for diabetes education programs are discussed.
A total of 69 clinical encounters between 15 internal medicine residents and 69 geriatric patients were examined to determine the residents' attitudes toward specific patients and to assess their mutual satisfaction with the clinical encounter. The residents rated their attitudes toward each patient and indicated their beliefs about the patients' health status, adjustment to medical care, and expected benefits of health education activities. In general, both the residents and the patients expressed satisfaction with their clinical encounters. Little similarity in the satisfaction ratings of the residents and patients was found. The patients tended to express higher levels of satisfaction than the residents. The residents' perceptions of the expected benefits of health education and attitudes toward the patient were found to be statistically significant predictors of the residents' satisfaction. These findings suggest that specific attitudes and beliefs of residents toward their geriatric patients are linked to the residents' satisfaction and hold important implications for medical training.
This experimental study investigated the efficacy of two modeling procedures on enhancing patient communication. A pretreatment interview assessed knowledge, assertiveness, and other concomitant variables. A total of 150 subjects were randomly assigned to one of three treatment conditions. The two modeling conditions were videotaped presentations of a health educator interacting with a patient (i.e., model) who either asked questions or revealed problems. The control videotape included only the educator's presentation; no patient was shown. A subsequent standardized face-to-face patient education session was used to assess the impact of the intervention on patient communicative behaviors. A posttreatment interview assessed knowledge and satisfaction. Subjects who viewed a modeling videotape spoke more than subjects who viewed a control videotape. The bulk of our findings indicated that a question-asking model was generally more effective than a disclosive model in eliciting communicative behaviors. Knowledge scores were found to increase after the intervention, regardless of subjects' verbal participation. Subjects in either of the modeling conditions who spoke more indicated higher affective satisfaction.
We conducted three known-groups studies to obtain discriminant validity information among potential self-report measures of the construct desire for control over health care processes. In the first study we looked at types of preparation for childbirth; in Studies 2 and 3 we investigated choice of a place in which to die and signing a Living Will. With none of the measures could we adequately distinguish those who had signed a Living Will (or intended to) from those who did not intend to sign one. The best discriminator of a choice of a place to die (hospital vs. home or hospice) and type of preparation for childbirth (Lamaze vs. other types of classes vs. no classes) was the Information subscale of Krantz's Health Opinion Survey (KHOS; Krantz, Baum, & Wideman, 1980). With the Behavioral Involvement subscale of the KHOS and our newly designed situation-specific measure of desire for control, we could only inconsistently discriminate among the groups. The generalized measure, Burger and Cooper's (1979) Desire for Control Scale, did not help us to discriminate among these groups. Correlations of these measures with demographic variables are provided and discussed.
An understanding of means to improve patient adherence to the therapeutic regimen is a subject of increasing concern in medical care. This study examined the effects of physician interpersonal skills and teaching on patient satisfaction, recall, and adherence to the regimen. We studied the ambulatory visits of 63 patients to five medical residents at a teaching hospital in Baltimore. It was found that quality of interpersonal skills influenced patient outcomes more than quantity of teaching and instruction. Secondary analyses found that all the effects of physician communication skills on patient adherence are mediated by patient satisfaction and recall. These findings indicate that the physician might pay particular attention to these two variables in trying to improve patient adherence, and that enhancing patient satisfaction may be pivotal to the care of patients with chronic illness.
Although shared decision making by patients and clinicians has been advocated, little is known about the degree of participation in decision making that patients actually prefer or about clinicians' appreciation of these preferences. We administered questionnaires about three aspects of decision making to 210 hypertensive outpatients and to their 50 clinicians, who represented three types of medical practices. We found that 41% of patients preferred more information about hypertension; clinicians underestimated patient preferences for discussion about therapy in 29% of cases and overestimated 11% (k = .22); and 53% of patients preferred to participate in making decisions, while clinicians believed that their patients desired to participate in 78% of cases. Many patients who preferred not to make initial therapeutic decisions did want to participate in ongoing evaluation of therapy. Thus, clinicians underestimate patients' desire for information and discussion but overestimate patients' desire to make decisions. Awareness of this discrepancy may facilitate communication and decision making.
KIE
A survey of hypertensive outpatients and their physicians in three different clinic settings revealed differences between patients and physicians in their perceptions of disclosure and decision making. Patients wanted more discussion of therapy and of decisions about treatment but preferred to leave decision making to their clinicians. Physicians underestimated both the amount of information patients received and the amount they desired, but overestimated both the amount of actual patient participation in decision making and their patients' desire to make decisions. The authors suggest that, in view of these discrepancies, physicians and patients should engage in direct discussion of their preferences.
The statistical methodology of health research experiments published in Lancet, the New England Journal of Medicine, and Medical Care between 1975 and 1980 for the presence or absence of an error of experimental design and analysis was examined. The error is the result of inappropriately using patient-related observations as the unit of analysis to form conclusions about provider behavior or outcomes determined jointly by patients and providers. The error was present in 20 of 28 (71%) health care experiments addressing an issue of health provider professional performance. Its usual effect is to increase erroneously the power of an experiment to detect differences between experimental and control groups. It is likely that this type of error could be avoided by the explicit and prospective definition of hypotheses and the populations to which they are intended to pertain.
The residency is examined from the point of view of adult developmental theory. Significant developmental tasks which face residents are described. Recommendations for management of common developmental conflicts occurring in residency are discussed.
Practicing physicians must frequently make decisions about how much they wish to encourage patient participation in clinical decision-making and how to respond to rational patient demands that do not coincide with their own decisions. These are difficult ethical dilemmas with no indisputable or universal solutions. The traditional concept of the doctor-patient relationship places the patient in a passive, compliant role. The patient's only obligation is to seek competent help and cooperate with the physician. A number of factors have contributed to the continued dominance of the traditional doctor-patient imbalance of power. Despite these factors, there seems to be a great deal of public dissatisfaction with health care delivery in the United States; demands for more patient autonomy are increasing. This paper discusses the concept of mutual participation, presents an approach to encouraging patient participation in clinical decision-making, and considers its theoretical advantages.
This paper explores health education's responsibility for advocacy of a client-provider model of relationship which emphasizes active partnership and participation. Arguments supporting the model are made on the basis of philosophical and theoretical concerns, its consistency with health education tenets, and national trends towards greater consumerism.
Multiple Regression in Behavioral Research Cramer EM: Significance tests and tests of models in multiple regression
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Pedhazur EJ: Multiple Regression in Behavioral Research, New York: CBS College Publishing, 1982. Cramer EM: Significance tests and tests of models in multiple regression. Am Stat 1972; 26: 26-32.
Interpreting multiple statistical tests
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Belyea M: Interpreting multiple statistical tests. Diabetes
Spectrum 1990; 3: 202.
Health and behavior: a research agenda
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Hamburg DA, Elliott GR, Parron DL: Health and
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Academy Press, 1982.
Anderson Division of Diabetes Translation (K-10) National Center for Chronic Disease Prevention Golden and Health Promotion A, Libber S: The effects of physician communications Centers for Disease Control skills on patient satisfaction; recall and adherence
- A Lynda
- Ee Bartlett
- M Grayson
- R Barker
- Dm Levine
Correspnndence to:
Lynda A. Anderson
Division of Diabetes Translation (K-10)
National Center for Chronic Disease Prevention
Bartlett EE, Grayson M, Barker R, Levine DM, Golden
and Health Promotion
A, Libber S: The effects of physician communications
Centers for Disease Control
skills on patient satisfaction; recall and adherence. J
1600 Clifton Road, N.E. Atlanta
Chron Dis 1984; 37: 755-764.
GA 30333, USA
Alienation and learning in a hospital setting Szasz TS, Hollender MH: A contribution to the philosophy of medicine: the basic models of the doctorpatient relationship
- M Seeman
- J Evans
Seeman M, Evans J: Alienation and learning in a hospital
setting. Am Sot Rev 1962; 21: 772-783.
Szasz TS, Hollender
MH: A contribution
to the
philosophy
of medicine: the basic models of the doctorpatient relationship.
Arch Intern Med 1956; 97: 585-592.
Diabetes regimen behavior: predicting adherence
- Kd Mccaul
- Re Glasgow
- Lc Schafer
McCaul KD, Glasgow RE, Schafer LC: Diabetes regimen
behavior: predicting adherence. Med Care 1987; 25:
868-881.
Szasz TS, Hollender MH: A contribution to the philosophy of medicine: the basic models of the doctorpatient relationship
- M Seeman
- J Evans
Seeman M, Evans J: Alienation and learning in a hospital
setting. Am Sot Rev 1962; 21: 772-783.
Szasz TS, Hollender
MH: A contribution
to the
philosophy
of medicine: the basic models of the doctorpatient relationship.
Arch Intern Med 1956; 97: 585-592.
Health and behavior: a research agenda
- D A Hamburg
- G R Elliott
- D L Parron
Hamburg DA, Elliott GR, Parron DL: Health and
behavior: a research agenda. Washington, DC: National
Academy Press, 1982.
Cramer EM: Significance tests and tests of models in multiple regression
- Q E Whiting-O'keefe
- C Henke
- D W Simborg
Whiting-O'Keefe QE, Henke C, Simborg DW: Choosing
the correct unit of analysis in medical care experiments.
Med Care 1984; 22: 1101-1114.
Pedhazur EJ: Multiple Regression in Behavioral
Research, New York: CBS College Publishing, 1982.
Cramer EM: Significance tests and tests of models in
multiple regression. Am Stat 1972; 26: 26-32.
The effects of physician communications Centers for Disease Control skills on patient satisfaction; recall and adherence
- Lynda A Bartlett
- E E Grayson
- M Barker
- R Levine
- Golden Health Promotion
- A Libber
Lynda A. Anderson
Division of Diabetes Translation (K-10)
National Center for Chronic Disease Prevention
Bartlett EE, Grayson M, Barker R, Levine DM, Golden
and Health Promotion
A, Libber S: The effects of physician communications
Centers for Disease Control
skills on patient satisfaction; recall and adherence. J
1600 Clifton Road, N.E. Atlanta
Chron Dis 1984; 37: 755-764.
GA 30333, USA
Diabetes regimen behavior: predicting adherence
- McCaul