scholarly journals Patient-Centred Multidisciplinary Inpatient Care-Have Diagnosis-Related Groups an Effect on the Doctor-Patient Relationship and Patients’ Motivation for Behavioural Change?

2016 ◽  
Vol 8 (10) ◽  
pp. 100 ◽  
Author(s):  
Tobias Romeyke ◽  
Elisabeth Noehammer ◽  
Hans Ch.Scheuer ◽  
Harald Stummer

<p><strong>Introduction: </strong>The aim of this, the largest survey of patients performed to date, is to analyse the effects of diagnosis related groups (DRGs) on the doctor-patient relationship in the context of interdisciplinary patient-centered care. In addition, it is intended to investigate the possibility of motivating patients to change their behavioural patterns and lifestyle in the context of holistic therapy.</p><p><strong>Methods: </strong>Over a period of five years, a continuous survey was performed of hospitalised patients who were exercising their entitlement to interdisciplinary therapy in an acute, inpatient setting.</p><p><strong>Results: </strong>The therapy was evaluated as good to very good both with and without the conditions of the case tariff fee system. Effects of the diagnosis related groups on the quality of the doctor-patient relationship could not be demonstrated (Mann-Whitney U test, p&gt;0,05). A clear trend was evident in the influence on motivation to change behavioural patterns and lifestyle (Fisher's exact test, p=0,000).</p><p><strong>Conclusions: </strong>Studies of the effects of reimbursement systems in the context of interdisciplinary care are still in their infancy, despite the widespread use of diagnosis related groups. The mandatory character implicit in the case tariff fee system, which requires minimum qualitative standards for structural and procedural parameters in the context of providing interdisciplinary patient-centered care, can influence patients' behavioural patterns and lifestyle.<strong></strong></p>

2014 ◽  
Author(s):  
Waqas Ahmad ◽  
Edward Krupat ◽  
Yumna Asmaa ◽  
Noor-E- Fatima ◽  
Rayan Attique ◽  
...  

Background. We initiated this study with the aim to assess the leaning of medical students towards either a doctor-centered or a patient-centered care and explore the effects of personal attributes on it like gender, academic year etc. of the students. Methods. A cross-sectional study was conducted between July-Sep 2013. The study population consisted of 1274 medical students in years 1-5 from two medical colleges. English version of PPOS was used to assess attitudes of medical students towards doctor-patient relationship. The relationship between PPOS scores and individual characteristics like gender, academic year etc. were examined by using Independent t-test and one way ANOVA. Results. A total of 792 students formed the final sample. Characteristics associated with most patient-centered attitudes were being in 4th academic year, married, being a foreigner and belonging to a Private college (p<0.05). Characteristics associated with most doctor-centered attitudes were being in 2nd academic year, divorced, having a local origin and belonging to a Govt. college (p<0.05). Gender and having doctor parents had no bearing, statistically, on the attitudes. Conclusion. Despite ongoing debate and emphasis on a patient-centered curriculum, our study suggests that current curriculum and its teachings are not producing the results they are designed to achieve. Students should be adequately exposed to the patients from the beginning of their medical education in clinical settings which are more sympathetic to a patient-centered care.


2014 ◽  
Author(s):  
Waqas Ahmad ◽  
Edward Krupat ◽  
Yumna Asmaa ◽  
Noor-E- Fatima ◽  
Rayan Attique ◽  
...  

Background. We initiated this study with the aim to assess the leaning of medical students towards either a doctor-centered or a patient-centered care and explore the effects of personal attributes on it like gender, academic year etc. of the students. Methods. A cross-sectional study was conducted between July-Sep 2013. The study population consisted of 1274 medical students in years 1-5 from two medical colleges. English version of PPOS was used to assess attitudes of medical students towards doctor-patient relationship. The relationship between PPOS scores and individual characteristics like gender, academic year etc. were examined by using Independent t-test and one way ANOVA. Results. A total of 792 students formed the final sample. Characteristics associated with most patient-centered attitudes were being in 4th academic year, married, being a foreigner and belonging to a Private college (p<0.05). Characteristics associated with most doctor-centered attitudes were being in 2nd academic year, divorced, having a local origin and belonging to a Govt. college (p<0.05). Gender and having doctor parents had no bearing, statistically, on the attitudes. Conclusion. Despite ongoing debate and emphasis on a patient-centered curriculum, our study suggests that current curriculum and its teachings are not producing the results they are designed to achieve. Students should be adequately exposed to the patients from the beginning of their medical education in clinical settings which are more sympathetic to a patient-centered care.


2018 ◽  
Vol 28 (2) ◽  
pp. 567-570
Author(s):  
Radost Assenova ◽  
Levena Kireva ◽  
Gergana Foreva

Introduction: The European definition of WONCA of general practice introduces the determinant elements of person-centered care regarding four important, interrelated characteristics: continuity of care, patient "empowerment", patient-centred approach, and doctor-patient relationship. The application of person-centred care in general practice refers to the GP's ability to master the patient-centered approach when working with patients and their problems in the respective context; use the general practice consultation to develop an effective doctor–patient relationship, with respect to patient’s autonomy; communicate, set priorities and establish a partnership when solving health problems; provide long-lasting care tailored to the needs of the patient and coordinate overall patient care. This means that GPs are expected to develop their knowledge and skills to use this key competence. Aim: The aim of this study is to make a preliminary assessment of the knowledge and attitudes of general practitioners regarding person-centered care. Material and methods: The opinion of 54 GPs was investigated through an original questionnaire, including closed questions, with more than one answer. The study involved each GP who has agreed to take part in organised training in person-centered care. The results were processed through the SPSS 17.0 version using descriptive statistics. Results: The distribution of respondents according to their sex is predominantly female - 34 (62.9%). It was found that GPs investigated by us highly appreciate the patient's ability to take responsibility, noting that it is important for them to communicate and establish a partnership with the patient - 37 (68.5%). One third of the respondents 34 (62.9%) stated the need to use the GP consultation to establish an effective doctor-patient relationship. The adoption of the patient-centered approach at work is important to 24 (44.4%) GPs. Provision of long-term care has been considered by 19 (35,2%). From the possible benefits of implementing person-centered care, GPs have indicated achieving more effective health outcomes in the first place - 46 (85.2%). Conclusion: Family doctors are aware of the elements of person-centered care, but in order to validate and fully implement this competence model, targeted GP training is required.


2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 50-50
Author(s):  
Manasi A. Tirodkar ◽  
Sarah Hudson Scholle

50 Background: The patient-centered medical home (PCMH) model of care is being widely adopted as a way to provide accessible, proactive, coordinated care and self-care through primary care practices. During active treatment for cancer, the oncology practice is often the primary setting supporting the patient and coordinating cancer treatment. For this project, we are implementing a Patient-centered Oncology Care model in five oncology practices and evaluating the impact on cost, quality, and patient experiences. Methods: To determine the structures and processes present in the practices at baseline, we conducted a self-assessment on the standards, followed with an on-site “audit” for compliance with the standards. To get a sense for organizational culture and motivation to change, we conducted site visits which included interviews with providers, staff and patients and observation of clinical encounters and workflow. Results: Among the highest priority structures and processes, the most common were telephone triage, symptom management, advance care planning, and the use of evidence-based guidelines. The least common were patient/family orientation, availability of same day appointments, discussion and documentation of goals of therapy, symptom assessment, and tracking of appointments. All of the practices had made patient-centered care a priority and staff were motivated to change. There was variation in the way providers and the care team used health information technology during clinical workflow. There was also variation in which staff coordinated care for patients and whether or not financial counseling was offered. All of the practices stated that they needed to work on implementing survivorship care planning, shared decision-making, and patient engagement in quality improvement and practice transformation Conclusions: The pilot oncology practices have many structures and processes in common. However, there is little standardization within practices in the way these processes are established and documented. Practices vary in how they are implementing patient-centered care processes. However, with motivation to change, staff and providers are actively engaged in the transformation process.


2019 ◽  
Vol 11 (3) ◽  
pp. 18-34
Author(s):  
Olga LIPOVETSKI ◽  
Daniela COJOCARU

The physician-patient interaction and relationship is the core element of the health-care system, which is developing towards greater patient's involvement in required medical decisions, regarding patient's medical condition. Sharing physicians-patient decisions issue is deepening on the medical discourse. It includes a sociological essence, which is considered in the current article, which tends to compare physician-patient relationship in Israel and worldwide. The current article presents a literary Review of academic articles, mainly from the past decade, inquiring searching databases, such as NCBI, Elsevier, JAMA and Research Gate, using keywords of Patient-Centered Care, professionalism, and human and sociological approaches of patients' medical care. Among dozens of found articles, 40 were assessed and selected for the review. Although, a recognition of the importance of using SDM and CCM can be found within healthcare teams, hardly no use of the models is actually in practice in healthcare systems in Israel. The CCM and the SDM models should be implied in Israel for the best of patients, physician and the healthcare system.


2020 ◽  
Vol 21 (1) ◽  
pp. 28-33
Author(s):  
Beatriz Do Amaral Rezende Bento ◽  
Tânia Gisela Biberg-Salum ◽  
Mirella Ferreira da Cunha Santos ◽  
Rosilene Canavarros Monteiro

Este estudo foi conduzido junto aos professores de um curso médico que adota a metodologia de Aprendizagem Baseada em Problemas, em uma universidade pública, com o objetivo de avaliar os aspectos atitudinais no contexto da relação médico-paciente. Trata-se de um estudo do tipo observacional, descritivo-exploratório, transversal, realizado na cidade de Campo Grande- MS, na Universidade Estadual de Mato Grosso do Sul (UEMS). O instrumento utilizado para a avaliação da atitude dos professores a respeito da relação médico-paciente foi a escala PPOS (Patient-practitioner Orientation Scale), também foi utilizado um questionário sociodemográfico. Os docentes foram divididos em 3 grupos, de acordo com a média obtida das 18 questões da escala PPOS.  O primeiro, representado por uma média inferior a 4,57 define o grupo com atitudes centradas no médico, o segundo com valores que variam de 4,57 a 5,00 representa o grupo com atitudes relativamente centradas no paciente e o terceiro, com médias superiores a 5,00 estabelece o grupo com atitudes totalmente centradas no paciente. Quando se analisam os números obtidos, percebe-se que ainda há uma parcela de professores que possuem atitudes centradas nos médicos. Ainda há muito para ser feito no sentido de permitir ao paciente passar de objeto a sujeito na prática médica, e isto demanda mudanças significativas na maneira de se ensinar e praticar a medicina. Conclui-se que este estudo tem algumas limitações, uma delas é a amostra reduzida, outra limitação se refere ao uso da escala traduzida, o que pode ter interferido com algumas respostas, gerando uma interpretação errada.   Palavras-chave: Educação Médica. Docentes de Medicina. Relação Médico-Paciente. Assistência Centrada no Paciente.   Abstract This study was conducted with the professors of a medical course that adopts the Problem-Based Learning methodology, in a public university, with the objective of evaluating the attitudinal aspects in the context of the doctor-patient relationship. This is an observational descriptive-exploratory, cross-sectional study, carried out in the city of Campo Grande-MS, at the Universidade Estadual Mato Grosso do Sul (UEMS). The instrument used to evaluate the teachers' attitude towards the doctor-patient relationship was the PPOS scale (Patient-practitioner Orientation. Scale), a sociodemographic questionnaire was also used. The teachers were divided into 3 groups, according to the average obtained from the 18 questions on the PPOS scale. The first represented by an average of less than 4.57 defines the group with attitudes centered on the doctor, the second with values ranging from 4.57 to 5.00 represents the group with attitudes relatively centered on the patient and the third, with averages greater than 5.00 establishes the group with attitudes totally centered on the patient. When analyzing the numbers obtained, it is clear that there is still a portion of teachers who have attitudes centered on doctors. There is still much to be done in order to allow the patient to move from object to subject in medical practice, and this requires significant changes in the way of teaching and practicing medicine. It is concluded that this study has some limitations, one of which is the reduced sample, another limitation refers to the use of the translated scale, which may have interfered with some responses, generating a wrong interpretation.   Keywords: Education, Medical. Faculty, Medical. Physician-Patient Relation. Patient-Centered Care.  


2017 ◽  
Vol 14 (4) ◽  
pp. 256-270 ◽  
Author(s):  
Lilla Náfrádi ◽  
Zlatina Kostova ◽  
Kent Nakamoto ◽  
Peter J Schulz

Objectives To study patients’ perspectives about the role of the doctor–patient relationship in promoting the resilience process. Methods We conducted in-depth interviews with 20 chronic pain patients. Using open-ended questions, the interviews explored aspects of the doctor–patient relationship that impacted the patients’ perceptions of their resilience. Thematic analysis built on an inductive, adaptive approach to data coding was employed to organize a representation of key factors affecting resilience. Results The themes emerging from the interviews inform us about how the different aspects of the doctor–patient relationship can promote patient resilience in chronic pain. Three main themes emerged: the doctor providing psychological support, promoting patients’ health literacy related to chronic pain and its treatment, and empowering the patients to cooperate in finding the right treatment. This fosters patients’ direct outcomes (feeling validated, health literate, and empowered), which, in turn, lead to adaptive coping responses and day-to-day disease management. These direct outcomes are crucial for patients to maintain socially and personally meaningful activities and their functional (physical) capacity. Discussion A doctor–patient relationship following the precepts of the patient-centered care is a significant resource that can lead to increased patient resilience. Thus, future interventions promoting patient resilience might consider addressing the doctor–patient relationship.


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