Barriers to Patient-Centered Care for Dementia Clients in the Long-Term Living Setting

This study aimed to describe the nurse practitioners’ self-reported implementation of patient-centered care (PCC) and factors that influence their delivery of PCC. It was guided by a conceptualization of PCC that identified three components that distinguish PCC (i.e. holistic, collaborative, and responsive care) and respective activities that operationalize them. A sample of 149 nurse practitioners employed in acute and long term care settings, in Ontario Canada, completed a valid and reliable measure of the extent to which they implemented the three PCC components. The results indicated that the majority of respondents reported engagement in most activities reflective of the PCC components, most of the time, and that experienced nurse practitioners performed a large number of these activities. Further research should examine the contribution of each PCC component, as implemented by nurse practitioners and other members of the healthcare team, to patient-oriented outcomes.

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Quality conceptualization in the era of measurement: A qualitative study of primary care physicians in Medicare’s Merit-Based Incentive Payment System

10.21203/rs.3.rs-26478/v1 ◽

2020 ◽

Author(s):

Carl Thomas Berdahl ◽

Molly C Easterlin ◽

Gery Ryan ◽

Jack Needleman ◽

Teryl K Nuckols

Keyword(s):

Primary Care ◽

Primary Care Physicians ◽

Pay For Performance ◽

Patient Centered Care ◽

Payment System ◽

Incentive Payment ◽

Patient Centered ◽

Centered Care ◽

Quality In Healthcare

Abstract Background: While governmental programs seeking to improve the quality and value of healthcare through pay-for-performance initiatives have good intentions, participating physicians may be reluctant to participate for various reasons, including poor program alignment with considerations relevant to daily clinical practice. In this study, we sought to characterize how primary care physicians (PCPs) participating in Medicare’s Merit-Based Incentive Payment System (MIPS) conceptualize the quality of healthcare to help inform future measurement strategies that physicians would understand and appreciate.Methods: We performed semi-structured qualitative interviews with a nationwide sample of 20 PCPs participating in MIPS who were trained in internal medicine or family medicine. We asked PCPs how they would characterize quality in healthcare and what distinguished exceptional, good, and poor quality from one another. Interviews were transcribed and two coders independently read transcripts, allowing data to emerge from the interviews and developing theories about the data. The coders met intermittently to discuss findings, harmonize the coding scheme, develop a final list of themes and sub-themes, and aggregate a list of representative quotations.Results: Participants described quality in healthcare as consisting of two components: (1) evidence-based care that is safe, which included appropriate health maintenance and chronic disease control, accurate diagnoses, and adherence to guidelines and (2) patient-centered care, which included spending enough time with patients, responding to patient concerns, and establishing long-term patient-physician relationships that were founded upon trust. Conclusions: PCPs consider patient-centered care to be necessary for the provision of exceptional quality in healthcare. Program administrators for quality measurement and pay-for-performance programs should explore new ways to reward PCPs for providing outstanding patient-centered care. Future research should be undertaken to determine whether patient-centered activities such as forging long-term, favorable patient-physician relationships, are associated with improved health outcomes.

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Patient-centered care interventions to reduce the inappropriate prescription and use of benzodiazepines and z-drugs: a systematic review

PeerJ ◽

10.7717/peerj.5535 ◽

2018 ◽

Vol 6 ◽

pp. e5535 ◽

Cited By ~ 1

Author(s):

Aliaksandra Mokhar ◽

Janine Topp ◽

Martin Härter ◽

Holger Schulz ◽

Silke Kuhn ◽

...

Keyword(s):

Systematic Review ◽

Drug Use ◽

Patient Information ◽

Health Care Professionals ◽

Patient Centered Care ◽

Cochrane Library ◽

Inappropriate Prescription ◽

Patient Centered ◽

Centered Care

BackgroundBenzodiazepines (BZDs) and z-drugs are effective drugs, but they are prescribed excessively worldwide. International guidelines recommend a maximum treatment duration of 4 weeks. Although these drugs are effective in the short-term, long-term BZD therapy is associated with considerable adverse effects, the development of tolerance and, finally, addiction. However, there are different interventions in terms of patient-centered care that aim to reduce the use of BZDs and z-drugs as well as assist health care professionals (HCPs) in preventing the inappropriate prescription of BZDs.AimThe aim of this systematic review was to identify interventions that promote patient-centered treatments for inappropriate BZD and z-drug use and to analyze their effectiveness in reducing the inappropriate use of these drugs.MethodsTo identify relevant studies, the PubMed, EMBASE, PsycINFO, Psyndex, and Cochrane Library databases were searched. Studies with controlled designs focusing on adult patients were included. Trials with chronically or mentally ill patients were excluded if long-term BZD and z-drug use was indicated. Study extraction was performed based on the Cochrane Form for study extraction. To assess the quality of the studies, we used a tool based on the Cochrane Collaboration’s tool for assessing the risk of bias in randomized trials.ResultsWe identified 7,068 studies and selected 20 for systematic review. Nine interventions focused on patients, nine on HCPs, and two on both patients and HCPs. Intervention types ranged from simple to multifaceted. Patient-centered interventions that provided patient information effectively increased the appropriate use of BZDs. The educational approaches for HCPs that aimed to achieve appropriate prescription reported inconsistent results. The methods that combined informing patients and HCPs led to a significant reduction in BZD use.ConclusionsThis is the first review of studies focused on patient-centered approaches to reducing the inappropriate prescription and use of BZDs and z-drugs. The patient-centered dimension of patient information was responsible for a decrease in BZD and z-drug consumption. Further, in some studies, the patient-centered dimensions responsible for reducing the prescription and use of BZDs and z-drugs were the clinician’s essential characteristics and clinician-patient communication.

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