scholarly journals Patient Centeredness from a Perspective of History of the Present: A Genealogical Analysis

2020 ◽  
Vol 7 ◽  
pp. 233339362095024
Author(s):  
Eleni Siouta ◽  
Ulf Olsson
Keyword(s):  
Health Care ◽  
Health Policy ◽  
Patient Centeredness ◽  
Patient Centered ◽  
Policy Documents ◽  
Policy Issues ◽  
History Of ◽  
Transnational Discourse ◽  
Historical Discourses ◽  
Historical Periods

The overall aim of this study, performed in Sweden, was to problematize the contemporary national and transnational discourse on patient centeredness, which during recent decades has become a given, having become established as a dogma in conversations, writing, and thinking about patients and health care. We did that by showing that ideas such as patient centeredness can be seen differently from the way they are depicted in contemporary discourses about health care. In the presented analysis, we drew on Foucault’s concepts of governmentality, ‘history of the present’ and genealogy. This means that we reflected on contemporary conceptions of how phenomena, such as the care seeker, have been constructed within other discourses about health care. Empirically, we used different health policy documents—government reports from three different historical periods. The analysis showed that contemporary narratives about centeredness are neither more, nor less, care seeker-centered than the narratives of yesteryear. Rather, the phenomenon of the care seeker is given different frames and meanings within the framework of different economic and historical discourses about health care. Our analysis raised questions about the contemporary construction of patient centeredness. In a world with such huge economic differences between nations, as well as between citizens within most nations, the contemporary discourse may be limited as it does not problematize structural issues in the same way as previous discourses had done. Perhaps what is needed today are national and international patient-centered or person-centered discourses which also discuss policies and practices that are population- and social group-centered. In the final discussion of the analysis, we identified a new patient-centered discourse, which views the patient as a resource among other resources. The most important limitation of this type of study is that it is only about discourses and policy issues and not about daily practical activities.

scholarly journals What Do Patients Complain About Online: A Systematic Review and Taxonomy Framework Based on Patient Centeredness (Preprint)

2019 ◽  
Author(s):  
Jing Liu ◽  
Shengchao Hou ◽  
Richard Evans ◽  
Chenxi Xia ◽  
Weidong Xia ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
A Priori ◽  
Patient Experiences ◽  
Study Patient ◽  
Significant Heterogeneity ◽  
Care Providers ◽  
Patient Centeredness ◽  
Patient Centered ◽  
Wide Range

BACKGROUND Complaints made online by patients about their health care experiences are becoming prevalent because of widespread worldwide internet connectivity. An a priori framework, based on patient centeredness, may be useful in identifying the types of issues patients complain about online across multiple settings. It may also assist in examining whether the determinants of patient-centered care (PCC) mirror the determinants of patient experiences. OBJECTIVE The objective of our study was to develop a taxonomy framework for patient complaints online based on patient centeredness and to examine whether the determinants of PCC mirror the determinants of patient experiences. METHODS First, the best fit framework synthesis technique was applied to develop the proposed a priori framework. Second, electronic databases, including Web of Science, Scopus, and PubMed, were searched for articles published between 2000 and June 2018. Studies were only included if they collected primary quantitative data on patients’ online complaints. Third, a deductive and inductive thematic analysis approach was adopted to code the themes of recognized complaints into the framework. RESULTS In total, 17 studies from 5 countries were included in this study. Patient complaint online taxonomies and theme terms varied. According to our framework, patients expressed most dissatisfaction with patient-centered processes (101,586/204,363, 49.71%), followed by prerequisites (appropriate skills and knowledge of physicians; 50,563, 24.74%) and the care environment (48,563/204,363, 23.76%). The least dissatisfied theme was expected outcomes (3651/204,363, 1.79%). People expressed little dissatisfaction with expanded PCC dimensions, such as involvement of family and friends (591/204,363, 0.29%). Variation in the concerns across different countries’ patients were also observed. CONCLUSIONS Online complaints made by patients are of major value to health care providers, regulatory bodies, and patients themselves. Our PCC framework can be applied to analyze them under a wide range of conditions, treatments, and countries. This review has shown significant heterogeneity of patients’ online complaints across different countries.

scholarly journals An implementation history of primary health care transformation: Alberta’s primary care networks and the people, time and culture of change

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Myles Leslie ◽  
Akram Khayatzadeh-Mahani ◽  
Judy Birdsell ◽  
P. G. Forest ◽  
Rita Henderson ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Quality Improvement ◽  
Primary Health Care ◽  
Fee For Service ◽  
Structured Interviews ◽  
Policy Documents ◽  
Incremental Change ◽  
Primary Health ◽  
History Of

Abstract Background Primary care, and its transformation into Primary Health Care (PHC), has become an area of intense policy interest around the world. As part of this trend Alberta, Canada, has implemented Primary Care Networks (PCNs). These are decentralized organizations, mandated with supporting the delivery of PHC, funded through capitation, and operating as partnerships between the province’s healthcare administration system and family physicians. This paper provides an implementation history of the PCNs, giving a detailed account of how people, time, and culture have interacted to implement bottom up, incremental change in a predominantly Fee-For-Service (FFS) environment. Methods Our implementation history is built out of an analysis of policy documents and qualitative interviews. We conducted an interpretive analysis of relevant policy documents (n = 20) published since the first PCN was established. We then grounded 12 semi-structured interviews in that initial policy analysis. These interviews explored 11 key stakeholders’ perceptions of PHC transformation in Alberta generally, and the formation and evolution of the PCNs specifically. The data from the policy review and the interviews were coded inductively, with participants checking our emerging analyses. Results Over time, the PCNs have shifted from an initial Frontier Era that emphasized local solutions to local problems and featured few rules, to a present Era of Accountability that features central demands for standardized measures, governance, and co-planning with other elements of the health system. Across both eras, the PCNs have been first and foremost instruments and supporters of family physician authority and autonomy. A core group of people emerged to create the PCNs and, over time, to develop a long-term Quality Improvement (QI) vision and governance plan for them as organizations. The continuing willingness of both these groups to work at understanding and aligning one another’s cultures to achieve the transformation towards PHC has been central to the PCNs’ survival and success. Conclusions Generalizable lessons from the implementation history of this emerging policy experiment include: The need for flexibility within a broad commitment to improving quality. The importance of time for individuals and organizations to learn about: quality improvement; one another’s cultures; and how best to support the transformation of a system while delivering care locally.

Cultural Health Capital

2016 ◽  
Author(s):  
Janet K. Shim ◽  
Jamie Suki Chang ◽  
Leslie A. Dubbin
Keyword(s):  
Health Care ◽  
Underserved Populations ◽  
Primary Source ◽  
The United States ◽  
Cultural Resources ◽  
Health Capital ◽  
Patient Centeredness ◽  
Patient Centered ◽  
Patient Protection ◽  
Centered Care

The 2010 Patient Protection and Affordable Care Act promulgated a number of fundamental changes to the United States health-care system. Less visible and controversial aspects included the creation of institutions and strategies to reduce health disparities and enhance the quality and patient-centeredness of health care. In this chapter, we offer the concept of cultural health capital (CHC) as a sociological intervention for analyzing these changes aimed at making health care more patient-centered, particularly for historically underserved populations. In particular, we use the notion of CHC to illustrate how patient-centered care is accomplished or undone through complex interpersonal and interactional work that is highly dependent on access to stratified cultural resources that both patients and providers bring to health-care interactions. In so doing, we aim to contest that racism in health care is the primary source of health inequalities. Instead we argue that patients’ and providers’ cultural assets and interactional styles—themselves the product of complex social, cultural, historical, political, and economic contexts—influence their abilities to communicate with and understand one another.

Research and Design Trends for Exam Room Computing to Enhance Patient Centeredness

2021 ◽  
Vol 65 (1) ◽  
pp. 196-200
Author(s):  
Jason J. Saleem ◽  
Laura G. Militello ◽  
Onur Asan ◽  
Jacob M. Read ◽  
Enid Montague
Keyword(s):  
Patient Communication ◽  
Patient Centeredness ◽  
Patient Centered ◽  
History Of Research ◽  
Room Design ◽  
Exam Room ◽  
History Of ◽  
Recent Trends ◽  
Research And Design ◽  
Improve Patient

While there is an extensive and established history of research that demonstrates the unfortunate capacity of exam room computing and electronic health records (EHRs) to negatively impact provider-patient communication and interaction, recent trends in exam room computing are promising in that there may be an opportunity for the EHR to improve patient engagement. The logical evolution of this research is to flip the narrative to understand strategies for using exam room computing as a mediator or facilitator of provider-patient communication and interaction, rather than simply establishing ways to mitigate the documented barriers. Panelists will present and discuss their latest research and experiences that may contribute to the evolution of using exam room computing as a tool to enhance provider-patient communication and interaction. We will also discuss how a thoughtful exam room design with patient-centered exam room computing technologies and practices may positively impact specific human factors, safety, and bias outcomes.

scholarly journals The Discursive Turn in Policy Analysis and the Validation of Policy Stories

2012 ◽  
Vol 41 (2) ◽  
pp. 271-289 ◽  
Author(s):  
LINDSAY PRIOR ◽  
DAVID HUGHES ◽  
STEPHEN PECKHAM
Keyword(s):  
Health Care ◽  
Health Policy ◽  
Network Analysis ◽  
Northern Ireland ◽  
Narrative Analysis ◽  
Reliability And Validity ◽  
Narrative Structure ◽  
Relative Importance ◽  
Policy Documents ◽  
Key Characteristics

AbstractThis paper is concerned with the language of policy documents in the field of health care, and how ‘readings’ of such documents might be validated in the context of a narrative analysis. The substantive focus is on a comparative study of UK health policy documents (N = 20) as produced by the various assemblies, governments and executives of England, Scotland, Wales and Northern Ireland during the period 2000–09. Following the identification of some key characteristics of narrative structure the authors indicate how text-mining strategies allied with features of semantic and network analysis can be used to unravel the basic elements of policy stories and to facilitate the presentation of data in such a way that readers can verify the strengths (and weaknesses) of any given analysis – with regard to claims concerning, say, the presence, absence or relative importance of key ideas and concepts. Readers can also ‘see’ how the different components of any one story might fit together, and to get a sense of what has been excluded from the narrative as well as what has been included, and thereby assess the reliability and validity of interpretations that have been placed upon the data.

Old-aged patients’ experiences with patient-centered primary health care in Serbia

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
K Vojvodic ◽  
G W Wolf
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Healthcare Services ◽  
Patient Centeredness ◽  
Patient Centered ◽  
Aged Patients ◽  
Cross Sectional ◽  
Healthcare Needs ◽  
Primary Health ◽  
Positive Experiences

Abstract Objective The population in Serbia is getting older, with the population aged 65+ increasing from 17.2% to 19.6% (2007-2017). As people age, their health needs become more complex and health services must be adopted to their needs. Patient-centeredness is regarded as the basis for modern healthcare services. Patients' satisfaction surveys are widely used to identify experiences of patients, including old ones. The aim of this study was to assess old-patient centeredness of primary healthcare (PHC) in Serbia according to patients' experiences with healthcare workers. Methods Between 2009 and 2015 cross-sectional studies were conducted in 169 Serbian PHC centers (160.948 patients), thereby using a questionnaire referring to socio-demographic characteristics, preventive care counseling, experiences with general practitioners (GPs) (knowledge of patients' health status, listening, giving clear explanations concerning illness and medicines), nurses (friendliness and provision of information), co-payment for healthcare and the overall satisfaction with PHC. Non-parametric tests (Chi-square and Kruskal-Wallis) were used for statistical analyses. Results A large portion of the respondents asserted to be satisfied or very satisfied with the obtained PHC services, the majority had positive experiences with GPs and nurses. About one third (32.7%) of patients were 60 years or older. Significant differences concerning the number of positive experiences in contact with GPs and nurses were found between age groups. In both domains patients 60 years or older, had more positive experiences and were overall more satisfied with PHC services than younger (p < 0.001). Conclusions The results show that old aged patients have positive experiences with GPs and nurses in Serbian PHC. Primary health care meets their needs and can be regarded as patient-centered. The main limitation of the study was the lack of a questionnaire specific for old aged, which could better explore their needs and experiences. Key messages Patient-centeredness is regarded as the basis for modern healthcare services and doctors and nurses have leading role in providing patient-centered healthcare. Old aged patients have specific healthcare needs and health systems have big challenge in obtaining adequate health care with good health outcomes.

scholarly journals Independent and Web-Based Advice for Infertile Patients Using Fertility Consult: Pilot Study (Preprint)

2019 ◽  
Author(s):  
Aleida Gerarda Huppelschoten ◽  
Jan Peter de Bruin ◽  
Jan AM Kremer
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Pilot Study ◽  
Shared Decision Making ◽  
Shared Decision ◽  
Patient Centeredness ◽  
Patient Centered ◽  
Web Based ◽  
Online Platform ◽  
Centered Care

BACKGROUND Patient-centered care—that is, care tailored to personal wishes and needs of patients—has become increasingly important. It is especially relevant in health care areas where patients suffer from a high burden of disease, such as fertility care. At present, both diagnosis and treatment for infertile couples is provided at a single hospital. As a consequence, patients are not likely to receive optimal, independent advice regarding their fertility problems. Internet-based, independent advice could be feasible for large groups of patients because it is not limited by travel distance and overhead costs. OBJECTIVE The aim of this study was to explore the experiences of both patients and professionals with an online platform using video consultations for patients with infertility seeking independent advice for their fertility problem. METHODS This pilot study evaluated an online platform, Fertility Consult, where patients with infertility can get independent advice by a gynecologist through a video consultation, thus eliminating the need of meeting the doctor physically. Semistructured interviews were performed with 2 gynecologists and the chairman of the Dutch patients association. This information was used for a patients’ questionnaire about their first experiences with Fertility Consult, including questions about the level of patient-centeredness and shared decision making, using the Patient-Centered Questionnaire-Infertility (PCQ-Infertility) and the CollaboRATE questionnaire, respectively. RESULTS Of the first 27 patients enrolled at Fertility Consult, 22 responded (82%). Most patients (82%) visited Fertility Consult for a second opinion, seeking more personal attention and independent advice. The mean level of patient-centeredness on the PCQ-Infertility questionnaire was 2.78 (SD 0.58) on a scale of 0 to 3. For the CollaboRATE questionnaire (scale 0-9), patients provided a median score of 8.0 (range 7-9) on all 3 questions about shared decision making. CONCLUSIONS Patients were satisfied with independent, well-prepared, Web-based advice; health care professionals felt they were able to provide patients with proper advice in a manner befitting patients’ needs, without any loss of quality. Future studies should focus more on the separation of advice and treatment and on Web-based consultations compared with face-to-face consultations to ascertain the possibility of increased patient involvement in the process to improve the level of patient-centered care.

To what Extent do Australian Health Policy Documents address Social Determinants of Health and Health Equity?

2016 ◽  
Vol 45 (3) ◽  
pp. 545-564 ◽  
Author(s):  
MATTHEW FISHER ◽  
FRANCES E. BAUM ◽  
COLIN MACDOUGALL ◽  
LAREEN NEWMAN ◽  
DENNIS MCDERMOTT
Keyword(s):  
Health Care ◽  
Health Policy ◽  
Social Determinants Of Health ◽  
Health Equity ◽  
Social Determinants ◽  
Access To Health Care ◽  
Determinants Of Health ◽  
Policy Action ◽  
Policy Documents ◽  
Australian Health

AbstractEvidence on social determinants of health and health equity (SDH/HE) is abundant but often not translated into effective policy action by governments. Governments’ health policies have continued to privilege medical care and individualised behaviour-change strategies. In the light of these limitations, the 2008 Commission on the Social Determinants of Health called on health agencies to adopt a stewardship role; to take action themselves and engage other government sectors in addressing SDH/HE. This article reports on research using analysis of health policy documents – published by nine Australian national or regional governments – to examine the extent to which the Australian health sector has taken up such a role.We found policies across all jurisdictions commonly recognised evidence on SDH/HE and expressed goals to improve health equity. However, these goals were predominantly operationalised in health care and other individualised strategies. Relatively few strategies addressed SDH/HE outside of access to health care, and often they were limited in scope. National policies on Aboriginal health did most to systemically address SDH/HE.We used Kingdon's (2011) multiple streams theory to examine how problems, policies and politics combine to enable, partially allow, or prevent action on SDH/HE in Australian health policy.

Recapturing Justice in the Managed Care Era

1996 ◽  
Vol 5 (4) ◽  
pp. 493-499
Author(s):  
Jonathan D. Moreno
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Health Policy ◽  
Care Delivery ◽  
Health Care Delivery System ◽  
Past Century ◽  
Policy Issues ◽  
The Past ◽  
Learning Options ◽  
Century Health

If economics has been the “dismal science” of the past century, health policy promises to be that of the next. Health policy issues evoke far less passion than the emotion-laden immediacies of bedside decision making. Nevertheless, it is patent that “macro” issues in all their obscurity and complexity are unavoidable if the health care delivery system of the future is to be fiscally sound and publicly acceptable. In addition, as Americans are now learning, options for care at the bedside are ineluctably constrained by seemingly distant societal choices.

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