Navigating the health care system: perceptions of patients with chronic pain

2009 ◽  
Vol 29 (4) ◽  
pp. 162-168
Author(s):  
AL Dewar ◽  
K Gregg ◽  
MI White ◽  
J Lander
Keyword(s):  
Health Care ◽  
Chronic Pain ◽  
Health Care System ◽  
Health Care Professionals ◽  
Primary Care Physicians ◽  
Treatment Compliance ◽  
Care Utilization ◽  
Semistructured Interviews ◽  
The Individual ◽  
Care System

A new framework is needed for patients with chronic pain and their primary care physicians that acknowledges the individual’s experiences and provides evidence-informed education and better linkages to community-based resources. This study describes the experience of 19 chronic-pain sufferers who seek relief via the health care system. Their experiences were recorded through in-depth semistructured interviews and analyzed through qualitative methods. The participants reported early optimism, then disillusionment, and finally acceptance of living with chronic pain. Both individuals with chronic pain and their health care professionals need evidence-informed resources and information on best practices to assist them to manage pain. Empathetic communication between health care professionals and individuals with chronic pain is crucial because insensitive communication negatively affects the individual, reduces treatment compliance and increases health care utilization.

scholarly journals A meta-ethnography of health-care professionals’ experience of treating adults with chronic non-malignant pain to improve the experience and quality of health care

2018 ◽  
Vol 6 (17) ◽  
pp. 1-106 ◽  
Author(s):  
Fran Toye ◽  
Kate Seers ◽  
Karen Barker
Keyword(s):  
Health Care ◽  
Qualitative Research ◽  
Chronic Pain ◽  
Conceptual Model ◽  
Health Care System ◽  
Health Care Professionals ◽  
Short Film ◽  
Qualitative Evidence Synthesis ◽  
Future Work ◽  
Care System

BackgroundPeople with chronic pain do not always feel that they are being listened to or valued by health-care professionals (HCPs). We aimed to understand and improve this experience by finding out what HCPs feel about providing health care to people with chronic non-malignant pain. We did this by bringing together the published qualitative research.Objectives(1) To undertake a qualitative evidence synthesis (QES) to increase our understanding of what it is like for HCPs to provide health care to people with chronic non-malignant pain; (2) to make our findings easily available and accessible through a short film; and (3) to contribute to the development of methods for QESs.DesignWe used the methods of meta-ethnography, which involve identifying concepts and progressively abstracting these concepts into a line of argument.Data sourcesWe searched five electronic bibliographic databases (MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO and Allied and Complementary Medicine Database) from inception to November 2016. We included studies that explored HCPs’ experiences of providing health care to people with chronic non-malignant pain. We utilised the Grading of Recommendations Assessment, Development and Evaluation Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) framework to rate our confidence in the findings.ResultsWe screened 954 abstracts and 184 full texts and included 77 studies reporting the experiences of > 1551 HCPs. We identified six themes: (1) a sceptical cultural lens and the siren song of diagnosis; (2) navigating juxtaposed models of medicine; (3) navigating the patient–clinician borderland; (4) the challenge of dual advocacy; (5) personal costs; and (6) the craft of pain management. We produced a short film, ‘Struggling to support people to live a valued life with chronic pain’, which presents these themes (seeReport Supplementary Material 1; URL:www.journalslibrary.nihr.ac.uk/programmes/hsdr/1419807/#/documentation; accessed 24 July 2017). We rated our confidence in the review findings using the GRADE-CERQual domains. We developed a conceptual model to explain the complexity of providing health care to people with chronic non-malignant pain. The innovation of this model is to propose a series of tensions that are integral to the experience: a dualistic biomedical model compared with an embodied psychosocial model; professional distance compared with proximity; professional expertise compared with patient empowerment; the need to make concessions to maintain therapeutic relationships compared with the need for evidence-based utility; and patient advocacy compared with health-care system advocacy.LimitationsThere are no agreed methods for determining confidence in QESs.ConclusionsWe highlight areas that help us to understand why the experience of health care can be difficult for patients and HCPs. Importantly, HCPs can find it challenging if they are unable to find a diagnosis and at times this can make them feel sceptical. The findings suggest that HCPs find it difficult to balance their dual role of maintaining a good relationship with the patient and representing the health-care system. The ability to support patients to live a valued life with pain is described as a craft learnt through experience. Finally, like their patients, HCPs can experience a sense of loss because they cannot solve the problem of pain.Future workFuture work to explore the usefulness of the conceptual model and film in clinical education would add value to this study. There is limited primary research that explores HCPs’ experiences with chronic non-malignant pain in diverse ethnic groups, in gender-specific contexts and in older people living in the community.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

Stratification and “Universality”

2017 ◽  
Author(s):  
Tiffany D. Joseph
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Low Income ◽  
Health Care Professionals ◽  
State Level ◽  
Universal Health Care System ◽  
Documentation Status ◽  
Health Organization ◽  
Universal Health ◽  
Care System

Tiffany D. Joseph’s chapter examines how stratification of access by immigration status effectively undermined a “universal” health policy. While the ACA only extended coverage to U.S. citizens and eligible documented immigrants, Massachusetts pursued a universal health care system at the state level and offered coverage to all residents, regardless of documentation status. Despite this policy that aimed for inclusion, immigrants in Massachusetts were still more likely than non-immigrants to remain uninsured. Joseph interviewed Brazilian and Dominican immigrants, health care professionals, and immigrant/health organization employees to find out why immigrants remained uninsured. She identified immigration-related, health care system, and bureaucratic barriers that prevented individuals from effectively accessing care. Massachusetts serves as both a model and a cautionary tale for ACA implementation, with barriers exacerbated for immigrant, low-income, and minority populations.

scholarly journals Social and Health System Complexities Impacting on Decision-Making for Utilization of Oncology and Palliative Care in an African Context: A Qualitative Study

2019 ◽  
Vol 35 (3) ◽  
pp. 185-191 ◽  
Author(s):  
David A. Agom ◽  
Stuart Allen ◽  
Sarah Neill ◽  
Judith Sixsmith ◽  
Helen Poole ◽  
...  
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Palliative Care ◽  
Qualitative Study ◽  
Health Care System ◽  
Health Care Professionals ◽  
Care Delivery ◽  
Semistructured Interview ◽  
Design Data ◽  
Care System

Background: There is a dearth of research focusing on identifying the social complexities impacting on oncology and palliative care (PC), and no study has explored how the health-care system in Nigeria or other African contexts may be influencing utilization of these services. Aim: This study explored how social complexities and the organization of health-care influenced the decision-making process for the utilization of oncology and PC in a Nigerian hospital. Methods: This qualitative study used an interpretive descriptive design. Data were collected using semistructured interview guides with 40 participants, comprising health-care professionals, patients, and their families. Thematic analysis was conducted to generate and analyze patterns within the data. Findings: Three themes were identified: dysfunctional structural organization of the health-care delivery system, service-users’ economic status, and the influence of social networks. The interrelationship between the themes result in patients and their family members decisions either to present late to the hospital, miss their clinical appointments, or not to seek oncological health care and PC. Conclusion: This article offers insights into the role of the health-care system, as organized currently in Nigeria, as “autoinhibitory” and not adequately prepared to address the increasing burden of cancer. We therefore argue that there is a need to restructure the Nigerian health-care system to better meet the needs of patients with cancer and their families as failure to do so will strengthen the existing inequalities, discourage usage, and increase mortality.

Les motifs du suicide gériatrique: une étude exploratoire

2003 ◽  
Vol 22 (2) ◽  
pp. 197-205
Author(s):  
Luc Legris ◽  
Michel Préville
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Health Care Professionals ◽  
Basic Needs ◽  
The Elderly ◽  
Elderly Persons ◽  
Need To Belong ◽  
Psychological Autopsy ◽  
Structured Interviews ◽  
Care System

ABSTRACTFive semi-structured interviews were conducted, using the psychological autopsy method, in order to document the causes of geriatric suicide and to describe the interaction among suicidal elderly persons, their personal and social environments, and health care professionals. The results of this study support our hypothesis that elderly persons view suicide as a means of alleviating the psychological suffering associated with the frustration they experience on account of their inability to satisfy their basic needs. Three types of basic needs that affect the suicidal tendency of elderly persons were identified: the need to self-actualize, the need to belong, and the need to feel safe. The results also show that the people who make up the social and personal environment of elderly persons have a limited role in the prevention of suicide. This is due to their unfamiliarity with the problems surrounding the fulfilment of the basic needs of the suicidal elderly. Furthermore, as revealed in the cases studied here, the intervention of the health care system has centred mainly on the use of medication as a treatment for symptoms of psychological distress. The health care system pays little attention to the dissonance associated with the frustration suicidal elderly persons experience on account of their inability to satisfy their basic needs. Finally, the outcome of this qualitative study suggests that understanding the basic needs of the elderly can be very useful in understanding geriatric suicide.

Climate change and Australia's healthcare system - risks, research and responses

2010 ◽  
Vol 34 (4) ◽  
pp. 441 ◽  
Author(s):  
Haylee J. Weaver ◽  
Grant A. Blashki ◽  
Anthony G. Capon ◽  
Anthony J. McMichael
Keyword(s):  
Climate Change ◽  
Health Care ◽  
Health Care System ◽  
Health Care Professionals ◽  
Disaster Preparedness ◽  
Research Capacity ◽  
Service Planning ◽  
Ageing Population ◽  
Promotion Policy ◽  
Care System

Climate change will affect human health, mostly adversely, resulting in a greater burden on the health care system, in addition to any other coexistent increases in demand (e.g. from Australia’s increasingly ageing population). Understanding the extent to which health is likely to be affected by climate change will enable policy makers and practitioners to prepare for changing demands on the health care system. This will require prioritisation of key research questions and building research capacity in the field. There is an urgent need to better understand the implications of climate change for the distribution and prevalence of diseases, disaster preparedness and multidisciplinary service planning. Research is needed to understand the relationship of climate change to health promotion, policy evaluation and strategic financing of health services. Training of health care professionals about climate change and its effects will also be important in meeting long-term workforce demands.

Limitations in Health-Care System Resources Affecting Adherence of Patient With Psoriasis to Topical Drugs: A Focus Group Study

2020 ◽  
Vol 5 (2) ◽  
pp. 54-60
Author(s):  
Mathias Tiedemann Svendsen ◽  
Steven R. Feldman ◽  
Sylvia Naiga Tiedemann ◽  
Anne Sofie Stochholm Sørensen ◽  
Cecilie Marie Ringgaard Rivas ◽  
...  
Keyword(s):  
Health Care ◽  
Focus Group ◽  
Health Care System ◽  
Continuity Of Care ◽  
Health Care Professionals ◽  
Topical Therapy ◽  
Focus Group Study ◽  
Topical Drugs ◽  
System Resources ◽  
Care System

Background: Topical therapy is first-line treatment for patients with mild-to-moderate psoriasis, but low adherence to topical drugs is a barrier to treatment success. Health-care system resources are considered to have an impact on adherence of patient with psoriasis to topical drugs. Objective: To investigate dermatology nurses’ perception of the impact of health-care system resources on topical therapy adherence in patients with psoriasis. Methods: A semistructured focus group study was performed with 6 dermatology nurses and 2 student nurses. Participants were recruited from a dermatology outpatient hospital clinic. The study focused on the dermatology nurses’ perception of the effect health-care system resources (including health-care services provided to patients, how clinics are organized, and how the health-care personnel communicate) have on adherence of patients with psoriasis to topical treatment. The focus group discussion was divided into 3 areas: communication with patients and intercollegial communication, follow-up visits and admissions to consultations by other health-care professions, and how to establish consultations to support adherence of patients with psoriasis to topical drugs. Data were analyzed by a systematic text condensation method based on a phenomenological–hermeneutic approach. Results: Nurses identified a number of health-care system resources that may affect adherence of patients with psoriasis, primarily professional collaboration and communication, continuity of care, and the establishment of nurse consultations. Conclusion: Adherence may by negatively affected by contradictory information about topical drugs due to inadequate interprofessional collaboration among health-care professionals. Improving communication between health-care professionals and patients, ensuring continuity of care, and establishing nurse consultations may improve topical therapy outcomes.

Utilisation of health care system by chronic pain patients who applied for disability pensions

Pain ◽  
1999 ◽  
Vol 82 (3) ◽  
pp. 275-282 ◽  
Author(s):  
Jette Højsted ◽  
Anita Alban ◽  
Karis Hagild ◽  
Jørgen Eriksen
Keyword(s):  
Health Care ◽  
Chronic Pain ◽  
Health Care System ◽  
Chronic Pain Patients ◽  
Pain Patients ◽  
Care System

scholarly journals Development by a Large Integrated Health Care System of an Objective Methodology for Evaluation of Medical Oncology Service Sites

2012 ◽  
Vol 8 (2) ◽  
pp. 70-70
Author(s):  
Marija Bjegovich-Weidman ◽  
Jill Kahabka ◽  
Amy Bock ◽  
Jacob Frick ◽  
Helga Kowalski ◽  
...  
Keyword(s):  
Health Care ◽  
Employee Engagement ◽  
Health Care System ◽  
Patient Experience ◽  
Primary Care Physicians ◽  
Medical Oncology ◽  
Cost Savings ◽  
Full Time ◽  
Medical Oncologists ◽  
Care System

Purpose: Aurora Health Care (AHC) is the largest health care system in Wisconsin, with 14 acute care hospitals. In early 2010, a group of 18 medical oncologists became affiliated with AHC. This affiliation added 13 medical oncology infusion clinics to our existing 12 sites. In the era of health care reform and declining reimbursement, we need an objective method and criteria to evaluate our 25 outpatient medical oncology sites. We developed financial, clinical, and strategic tools for the evaluation and management of our cancer subservice lines and outpatient sites. The key to our success has been the direct involvement of stakeholders with a vested interest in the services in the selection of the criteria and evaluation process. Methods: We developed our objective metrics for evaluation based on strategic, financial, operational, and patient experience criteria. Strategic criteria included: population trends, full-time equivalent (FTE) medical oncologists/primary care physicians, FTE radiation oncologists, FTE oncologic surgeons, new annual cases of patients with cancer, and market share trends. Financial criteria per site included: physician work relative value units, staff FTE by type, staff salaries, and profit and loss. Operational criteria included: facility by type (clinic v hospital based), hours of operation, and facility detail (eg, No. of chairs, No. of procedure and examination rooms, square footage). Patient experience criteria included: nursing model primary/nurse navigators, multidisciplinary support at site, Press Ganey (South Bend, IN; health care performance improvement company) results, and employee engagement score. Results: The outcome of our data analysis has resulted in the development of recommendations for AHC senior leadership and geographic market leadership to consider the consolidation of four sites (phase one, four sites; phase two, two sites) and priority strategic sites to address capacity issues that limit growth. The recommendations if implemented would result in significant cost savings, currently being quantified as a result of consolidation and improved efficiency. A reinvestment of these cost savings would be required to address facility expansion and program enhancement to maximize patient-centered expert care consistently across all of our remaining sites of service.

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