scholarly journals Patient-centered care, advance care planning, and treatment preferences among home medical care patients in Japan: The ZEVIOUS study

2021 ◽  
Author(s):  
Shinu Hayashi ◽  
Yutaka Shirahige ◽  
Yukio Tsugihashi ◽  
Hidekazu Iida ◽  
Misaki Hirose ◽  
...  
Keyword(s):  
Primary Care ◽  
Medical Care ◽  
Treatment Preferences ◽  
Patient Centeredness ◽  
Patient Centered ◽  
Quality Of Primary Care ◽  
Centered Care ◽  
Advance Care ◽  
Home Medical Care

AbstractBackgroundIt remains unclear how both the quality of patient-centered care and the patient’s illness affect advance care planning (ACP) in primary care settings. Identifying the facilitators and barriers to ACP in primary care settings has become a growing scientific and clinical challenge.ObjectiveTo examine the association between the quality of primary care and ACP preparedness among patients. Additionally, to investigate whether ACP preparedness and the patient’s illness are associated with the expression of future treatment preferences.DesignMulticenter cross-sectional study.ParticipantsAdult Japanese patients receiving home medical care.Main MeasuresA survey was run to assess consideration of ACP by patients and expression of future treatment preferences. The quality of primary care, which reflects patient centeredness, was assessed with the Japanese version of the Primary Care Assessment Tool– Short Form. Information on the clinical conditions that required home medical care was collected from physicians.Key ResultsOf 194 patients using 29 home medical services, 62 patients (32%) showed signs of ACP preparedness, and 153 patients (78%) expressed their treatment preferences. In a multivariable-adjusted generalized estimating equation, primary care quality was associated with ACP preparedness (per 10-point increase, adjusted OR: 1.96, 95% CI: 1.51–2.56). However, we found insufficient evidence to support that ACP preparedness was associated with a lower incidence of non-expression of treatment preferences (adjusted OR: 1.02, 95% CI 0.49–2.12). In contrast, having cancer was associated with a lower incidence of non-expression of treatment preferences (adjusted OR: 0.12, 95% CI: 0.01–0.995).ConclusionsAt a minimum, patient centeredness in home medical care facilitates must ensure the initiation of ACP preparedness. To understand the association between ACP preparedness and expression of treatment preferences, further efforts are warranted to clarify the quality and content of ACP preparedness simultaneously with the patient’s illness.

scholarly journals Relationship Between Adolescent Report of Patient-Centered Care and of Quality of Primary Care

2016 ◽  
Vol 16 (8) ◽  
pp. 770-776 ◽  
Author(s):  
Sara L. Toomey ◽  
Marc N. Elliott ◽  
David C. Schwebel ◽  
Susan R. Tortolero ◽  
Paula M. Cuccaro ◽  
...  
Keyword(s):  
Primary Care ◽  
Patient Centered Care ◽  
Patient Centered ◽  
Adolescent Report ◽  
Quality Of Primary Care ◽  
Centered Care

scholarly journals �A Phenomenal Person and Doctor�: Thank You Letters to Medical Care Providers (Preprint)

2016 ◽  
Author(s):  
Talya Miron-Shatz ◽  
Stefan Becker ◽  
Franklin Zaromb ◽  
Alexander Mertens ◽  
Avi Tsafrir
Keyword(s):  
Medical Care ◽  
The United States ◽  
Care Providers ◽  
Good Care ◽  
Patient Centered ◽  
Medical Facilities ◽  
Centered Care ◽  
Quality Of Medical Care ◽  
The Web

BACKGROUND Thank you letters to physicians and medical facilities are an untapped resource, providing an invaluable glimpse into what patients notice and appreciate in their care. OBJECTIVE The aim of this study was to analyze such thank you letters as posted on the Web by medical institutions to find what patients and families consider to be good care. In an age of patient-centered care, it is pivotal to see what metrics patients and families apply when assessing their care and whether they grasp specific versus general qualities in their care. METHODS Our exploratory inquiry covered 100 thank you letters posted on the Web by 26 medical facilities in the United States and the United Kingdom. We systematically coded and descriptively presented the aspects of care that patients and their families thanked doctors and medical facilities for. We relied on previous work outlining patient priorities and satisfaction (Anderson et al, 2007), to which we added a distinction between global and specific evaluations for each of the already existing categories with two additional categories: general praise and other, and several subcategories, such as treatment outcome, to the category of medical care. RESULTS In 73% of the letters (73/100), physicians were primarily thanked for their medical treatment. In 71% (71/100) of the letters, they were thanked for their personality and demeanor. In 52% cases (52/100), these two aspects were mentioned together, suggesting that from the perspective of patient as well as the family member, both are deemed necessary in positive evaluation of medical care. Only 8% (8/100) of the letters lacked reference to medical care, personality or demeanor, or communication. No statistically significant differences were observed in the number of letters that expressed gratitude for the personality or demeanor of medical care providers versus the quality of medical care (χ21, N=200=0.1, not statistically significant). Letters tended to express more specific praise for personality or demeanor, such as being supportive, understanding, humane and caring (48/71, 68%) but more general praise for medical care (χ21, N=424=63.9, P<.01). The most often mentioned specific quality of medical care were treatment outcomes (30/73, 41%), followed by technical competence (15/73, 21%) and treatment approach (14/73, 19%). A limitation of this inquiry is that we analyzed the letters that medical centers chose to post on the Web. These are not necessarily a representative sample of all thank you letters as are sent to health care institutions but are still indicative of what centers choose to showcase on the Web. CONCLUSIONS Physician demeanor and quality of interaction with patients are pivotal in how laymen perceive good care, no less so than medical care per se. This inquiry can inform care providers and medical curricula, leading to an improvement in the perceived quality of care.

Exploring Quality of Primary Care for Patients Who Experience Homelessness and the Clinicians Who Serve Them: What Are Their Aspirations?

2020 ◽  
Vol 30 (6) ◽  
pp. 865-879 ◽  
Author(s):  
Allyson L. Varley ◽  
Ann Elizabeth Montgomery ◽  
Jocelyn Steward ◽  
Erin Stringfellow ◽  
Erika L. Austin ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care Professionals ◽  
Care Setting ◽  
Medical Decision ◽  
Institute Of Medicine ◽  
Patient Centered ◽  
Quality Of Primary Care ◽  
Template Analysis ◽  
Semistructured Interviews

To develop and evaluate an effective model of patient-centered, high-quality, homeless-focused primary care, our team explored key domains of primary care that may be important to patients. We anchored our conceptual framework in two reports from the Institute of Medicine (IOM) that defined components of primary care and quality of care. Using questions developed from this framework, we conducted semistructured interviews with 36 homeless-experienced individuals with past-year primary care engagement and 24 health care professionals (clinicians and researchers) who serve homeless-experienced patients in the primary care setting. Template analysis revealed factors important to this population. These included stigma, respect, and perspectives on patient control of medical decision-making in regard to both pain and addiction. For patients experiencing homelessness, the results suggest that quality primary care may have different meanings for patients and professionals, and that services should be tailored to meet homeless-specific needs.

scholarly journals Optimization of medical care for patients with ectopic pregnancy at the prehospital stage

2018 ◽  
pp. 202-208
Author(s):  
S. S. Ramazanova ◽  
I. B. Manukhin ◽  
A. L. Tikhomirov ◽  
S. V. Firichenko
Keyword(s):  
Primary Care ◽  
Medical Care ◽  
Ectopic Pregnancy ◽  
Medical Records ◽  
Early Stage ◽  
Diagnostic Errors ◽  
Quality Of Primary Care ◽  
Gynecological Diseases ◽  
Β Hcg

To date, throughout the world, a gold standard for the diagnosis of ectopic pregnancy has been recognized as a study of serum at β-hCG in combination with transvaginal echography. Ectopic pregnancy takes the first place among gynecological diseases in terms of the number of diagnostic errors, especially at an early stage. Purpose of the study. Analyze the defects in the provision of medical care to patients with ectopic pregnancy at an outpatient and outpatient stage and develop an optimized approach for providing primary care to patients with ectopic pregnancy. Material and methods. A retrospective analysis of 194 patients with confirmed ectopic pregnancy according to medical records and a prospective analysis of the quality of care in 332 patients with suspected ectopic pregnancy, taking into account the identified defects according to the optimized approach. Results. Using an optimized approach in the diagnosis of ectopic pregnancy, it is possible to increase the efficiency of diagnosis on the first visit from 27,1% to 76,1%, and significantly improves the quality of primary care.

scholarly journals Patient centeredness: The perspectives of uninsured primary care patients in the United States

2019 ◽  
Vol 22 (1) ◽  
pp. 19-26 ◽  
Author(s):  
Akiko Kamimura ◽  
Shannon Weaver ◽  
Bianca Armenta ◽  
Bethany Gull ◽  
Jeanie Ashby
Keyword(s):  
United States ◽  
Primary Care ◽  
Health Outcomes ◽  
Patient Involvement ◽  
The United States ◽  
Patient Centered Care ◽  
Patient Centeredness ◽  
Patient Centered ◽  
Centered Care ◽  
Primary Care Patients

Introduction Patient-centered care has become increasingly important within the United States (US) healthcare system. Given that patient-centered care predicts patient satisfaction, health outcomes, and cost-effectiveness, it is of the utmost importance to study patient-centered care from the perspectives of marginalized populations including minorities, immigrants, and other underserved populations. The purpose of this study is to examine factors that affect underserved primary care patients’ perceptions of patient centeredness. Methods The data were cross-sectional and collected in Fall 2016. Free clinic patients (N = 723) completed a self-administered survey, which measures patient centeredness, patient involvement in care, and clinical empathy. Validated measures were part of the survey, and the internal consistency of scales was tested. The general linear model was performed to predict factors associated with patients’ perceptions of patient centeredness. Results Higher levels of perceived patient involvement in care and higher levels of perceived empathy in consultation are related to higher levels of patient centeredness. While better physical health is associated with higher levels of perceived empathy in consultation, high levels of emotional health and depression are not. Conclusions Patients’ perceptions of involvement and empathy are important factors for patient-centered care, although this study did not show causal directions among variables. Based on the findings of this study, it is recommended that future studies should focus on the following three points: (1) to develop and evaluate trainings for providers, (2) develop education classes for patients who utilize free clinics, (3) analyze how these programs affect patient-centered care and health outcomes.

scholarly journals Strategizing EHR use to achieve patient-centered care in exam rooms: a qualitative study on primary care providers

2015 ◽  
Vol 23 (1) ◽  
pp. 137-143 ◽  
Author(s):  
Jing Zhang ◽  
Yunan Chen ◽  
Shazia Ashfaq ◽  
Kristin Bell ◽  
Alan Calvitti ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Providers ◽  
Patient Centered Care ◽  
Theory Approach ◽  
Care Providers ◽  
Structured Interviews ◽  
Patient Centeredness ◽  
Patient Centered ◽  
Qualitative Interview Study ◽  
Centered Care

Abstract Objective Electronic health records (EHRs) have great potential to improve quality of care. However, their use may diminish “patient-centeredness” in exam rooms by distracting the healthcare provider from focusing on direct patient interaction. The authors conducted a qualitative interview study to understand the magnitude of this issue, and the strategies that primary care providers devised to mitigate the unintended adverse effect associated with EHR use. Methods and Materials Semi-structured interviews were conducted with 21 healthcare providers at 4 Veterans Affairs (VAs) outpatient primary care clinics in San Diego County. Data analysis was performed using the grounded theory approach. Results The results show that providers face demands from both patients and the EHR system. To cope with these demands, and to provide patient-centered care, providers attempt to perform EHR work outside of patient encounters and create templates to streamline documentation work. Providers also attempt to use the EHR to engage patients, establish patient buy-in for EHR use, and multitask between communicating with patients and using the EHR. Discussion and Conclusion This study has uncovered the challenges that primary care providers face in integrating the EHR into their work practice, and the strategies they use to overcome these challenges in order to maintain patient-centered care. These findings illuminate the importance of developing “best” practices to improve patient-centered care in today’s highly “wired” health environment. These findings also show that more user-centered EHR design is needed to improve system usability.

scholarly journals Comparing the Quality of Primary Care between Public and Private Providers in Urban China: A Standardized Patient Study

2021 ◽  
Vol 18 (10) ◽  
pp. 5060
Author(s):  
Min Su ◽  
Zhongliang Zhou ◽  
Yafei Si ◽  
Sean Sylvia ◽  
Gang Chen ◽  
...  
Keyword(s):  
Primary Care ◽  
Correct Diagnosis ◽  
Standardized Patients ◽  
Urban China ◽  
Standardized Patient ◽  
Patient Centered ◽  
Correct Treatment ◽  
Public And Private ◽  
Quality Of Primary Care

Previous studies have been limited by not directly comparing the quality of public and private CHCs using a standardized patient method (SP). This study aims to evaluate and compare the quality of the primary care provided by public and private CHCs using a standardized patient method in urban China. We recruited 12 standardized patients from the local community presenting fixed cases (unstable angina and asthma), including 492 interactions between physicians and standardized patients across 63 CHCs in Xi’an, China. We measured the quality of primary care on seven criteria: (1) adherence to checklists, (2) correct diagnosis, (3) correct treatment, (4) number of unnecessary exams and drugs, (5) diagnosis time, (6) expense of visit, (7) patient-centered communication. Significant quality differences were observed between public CHCs and private CHCs. Private CHC physicians performed 4.73 percentage points lower of recommended questions and exams in the checklist. Compared with private CHCs, public CHC providers were more likely to give a higher proportion of correct diagnosis and correct treatment. Private CHCs provided 1.42 fewer items of unnecessary exams and provided 0.32 more items of unnecessary drugs. Private CHC physicians received a 9.31 lower score in patient-centered communication. There is significant quality inequality in different primary care models. Public CHC physicians might provide a higher quality of service. Creating a comprehensive, flexible, and integrated health care system should be considered an effective approach towards optimizing the management of CHC models.

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