Nonadherence in diabetes care among US adults with diabetes by stroke status

Objective Effects of stroke (i.e., memory loss, paralysis) may make effective diabetes care difficult which can in turn contribute to additional diabetes related complications and hospitalization. However, little is known about US post-stroke diabetes care levels. This study sought to examine diabetes care levels among US adults with diabetes by stroke status. Methods Using 2015–2018 Behavioral Risk Factor Surveillance System surveys, the prevalence of nonadherence with the American Diabetes Association’s diabetes care measures (<1 eye exam annually, <1 foot exam annually, <1 blood glucose check daily, <2 A1C tests annually, no receipt of annual flu vaccination) was ascertained in people with diabetes by stroke status. A separate logistic regression model was run for each diabetes care measure to determine if nonadherence patterns differed by stroke status after adjustment for stroke and diabetes associated factors. Results Our study included 72,630 individuals, with 9.8% having had a stroke. Nonadherence levels varied for each diabetes care measure ranging from 20.4–42.2% for stroke survivors and 22.8–44.0% for those who had never had stroke. By stroke status, nonadherence with diabetes management measures was comparable except for stroke survivors having both a lower prevalence (30.2% versus 40.1%) and odds of nonadherence (OR: 0.73, 95% CI: 0.65, 0.82) with daily blood glucose check than those who had never had stroke. Conclusion While nonadherence with diabetes management does not vary by stroke status, considerable nonadherence still exists among stroke survivors with diabetes. Additional interventions to improve diabetes care may help to reduce risk of further diabetes complications in this population.

Exploration of the psychometric properties of the Person-Centred Primary Care Measure (PCPCM) in a Chinese primary care population in Hong Kong: a cross-sectional validation study

ObjectivesTo evaluate the validity and psychometric properties of the Chinese Person-Centred Primary Care Measure (PCPCM) in a Chinese-speaking population.DesignA cross-sectional study.SettingA primary care clinic in Hong Kong.Participants300 Chinese adult patients (150 males and 150 females) were recruited from a primary care clinic to complete a questionnaire containing the PCPCM, Consultation and Relational Empathy (CARE), Patient Enablement Index (PEI) and Adult (short version) Primary Care Assessment Tool (PCAT). The Chinese PCPCM was readministered to 118 participants after 14 days for test–retest reliability.Outcome measuresThe construct validity, reliability and sensitivity of the Chinese PCPCM.ResultsThe Chinese PCPCM was identified to have a one-factor construct, with good item fit and unidimensionality on Rasch analysis. Internal reliability was high (Cronbach’s alpha >0.8) with moderate test–retest reliability (intraclass correlation coefficient=0.622, p<0.001). Significant correlations (0.58, 0.42, 0.48) between the PCPCM and CARE, PEI and Adult (short version) PCAT scores supported good convergent construct validity. PCPCM scores were higher among patients who had known their doctors for a longer period or who were more likely to be able to see the same doctor at every visit, and among those who self-reported to have ‘better health’ rather than ‘worse health’.ConclusionThe Chinese PCPCM appears to be a valid, reliable and sensitive instrument for evaluating the quality of person-centred care among primary care patients in Hong Kong. Further studies are needed to confirm the utility of this instrument in other Chinese-speaking populations around the world.

Two-week virtual pre-medical program increases empathy, clinical and communication skills: a mixed methods evaluation study (Preprint)

BACKGROUND Expressing empathy builds trust with patients, increases patient satisfaction and is associated with better health outcomes. Research shows expressing empathy and compassion to patients improves patient adherence to medications, decreases patient anxiety and decreases the number of malpractice lawsuits. Yet, there is a dearth of research on teaching empathy to pre-medical students. Stanford Medicine’s Clinical Science, Technology and Medicine Summer Internship (also called SASI) is a two-week, collaborative medical internship for high school and undergraduate students that aims to inspire students to pursue careers in healthcare as compassionate providers. The summer 2020 program was adapted to accomplish these objectives in a fully remote environment due to the COVID-19 global pandemic. OBJECTIVE This study measured the change in participants’ empathy and competencies in clinical and communication skills before and after program participation. METHODS Forty-one participants completed the Core Track (CT) only and thirty-nine participants completed the Core + Research Track (RT) of this program. Participants in both tracks received instruction in selected clinical skills and interacted directly with patients to improve interviewing skills and gain empathy. RT participants received additional instruction in research methodology. All participants completed online pre-and post-surveys about knowledge and skills assessment (KSA). Participant empathy was assessed using the validated Consultation and Relational Empathy (CARE) measure. A subset of participants completed optional focus groups to discuss empathy. Pre-and post- KSA and CARE measure scores were compared using paired t-tests and a linear regression model. Open-ended focus group answers were thematically analyzed. RESULTS Participants in both tracks demonstrated significant improvement in empathy after the two-week virtual online course (p = 0.007 in CT; p < 0.001 in RT). These results remained significant when controlled for gender and age. Lower pre-test score was associated with a greater change in empathy. Participants in both tracks demonstrated significant improvement in KSA questions related to surgical skills (CT: p < 0.001; RT: p < 0.001), epinephrine pen usage (CT: p < 0.001; RT: p < 0.001), x-ray image interpretation (CT: p < 0.001; RT: p < 0.001), and synthesizing information to problem solve (CT: p < 0.001; RT: p = 0.051). CT participants also showed significant improvement in health communication skills (p = 0.001). Qualitative analysis yielded three themes: empathy as action, empathy as a mindset, and empathy in designing healthcare systems. CONCLUSIONS Summer internships that introduce high school and undergraduate students to the field of healthcare through hands-on interaction and patient involvement may be an effective way to develop measurable empathy skills when combined with clinical skills training and mentorship. Notably, these increases were measured in a program administered via a virtual learning environment.

Application of the Spanish-Language Consultation and Relational Empathy (CARE) Measure to Assess Patient-Centered Care Among Latino Populations

Introduction: Reliable and valid measures are needed to assess the patient-centeredness of clinical care among Latino populations. Methods: We translated the Consultation and Relational Empathy (CARE) measure from English to Spanish and assessed its psychometric properties using data from 349 Latino parents/guardians visiting a pediatric clinic. Using confirmatory factor analysis, we examined the psychometric properties of the Spanish CARE measure. Results: Internal reliability of the Spanish CARE measure was high (Omega coefficient = 0.95). Similar to the English-language CARE measure, factor analysis of the Spanish CARE measure yielded a single domain of patient-centeredness with high item loadings (factor loadings range from 0.79 to 0.96). Conclusion: This preliminary analysis supports the reliability and validity of the Spanish version of the CARE measure among Latinos in pediatric care settings. With further testing, the Spanish CARE measure may be a useful tool for tracking and improving the health care delivered to Latino populations.

Effect of physician attire on patient perceptions of empathy in Japan: a quasi-randomized controlled trial in primary care

Background There is limited quantitative research on the effect of physician attire on patient–physician relationships. This study aimed to measure the influence of Japanese family physicians’ attire on the “human” aspects of medical care in terms of patient-perceived relational empathy. Methods This was a multicenter, prospective, controlled trial conducted in primary clinics in Japan. We explored the effects of family physician attire (white coat vs. casual attire) on patient-perceived empathy. Family physicians were allocated to alternate weeks of wearing a white coat or casual attire during consultations. Patients’ perceptions of physician empathy were evaluated using the self-rated Japanese Consultation and Relational Empathy (CARE) Measure. We used a linear mixed model to analyze the CARE Measure scores, adjusting for cluster effects of patients nested within doctor, age, and sex of patients, and doctors’ sex and years of clinical experience. We used the same method with Bonferroni adjustment to analyze patient sex differences in perceived empathy. Results A total of 632 patients of seven family physicians were allocated to white coat-wearing consultations (n = 328), and casual attire-wearing consultations (n = 304). There was no difference in CARE Measure scores between white coat and casual primary care consultations overall (p = 0.162). Subgroup analysis of patient sex showed that CARE Measure scores of male patients were significantly higher in the Casual group than in the White coat group (adjusted p-value = 0.044). There was no difference in female patient scores between White coat and Casual groups (adjusted p-value = 1.000). Conclusions This study demonstrated that physician attire (white coat or casual attire) in a primary care setting did not affect patient-perceived relational empathy overall. However, male patients of physicians wearing casual attire reported higher physician empathy. Although empathy cannot be reduced to simple variables such as attire, white coats may have a negative effect on patients, depending on the context. Family physicians should choose their attire carefully. Trial registration Japanese University Hospital Medical Information Network (UMIN-ICDR). Clinical Trial identifier number UMIN000037687 (Registered August 14, 2019, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000042749). The study was prospectively registered.

Socioeconomic, racial and ethnic differences in patient experience of clinician empathy: Results of a systematic review and meta-analysis

Introduction Empathy is essential for high quality health care. Health care disparities may reflect a systemic lack of empathy for disadvantaged people; however, few data exist on disparities in patient experience of empathy during face-to-face health care encounters with individual clinicians. We systematically analyzed the literature to test if socioeconomic status (SES) and race/ethnicity disparities exist in patient-reported experience of clinician empathy. Methods Using a published protocol, we searched Ovid MEDLINE, PubMed, CINAHL, EMBASE, CENTRAL and PsychINFO for studies using the Consultation and Relational Empathy (CARE) Measure, which to date is the most commonly used and well-validated methodology for measuring clinician empathy from the patient perspective. We included studies containing CARE Measure data stratified by SES and/or race/ethnicity. We contacted authors to request stratified data, when necessary. We performed quantitative meta-analyses using random effects models to test for empathy differences by SES and race/ethnicity. Results Eighteen studies (n = 9,708 patients) were included. We found that, compared to patients whose SES was not low, low SES patients experienced lower empathy from clinicians (mean difference = -0.87 [95% confidence interval -1.72 to -0.02]). Compared to white patients, empathy scores were numerically lower for patients of multiple race/ethnicity groups (Black/African American, Asian, Native American, and all non-whites combined) but none of these differences reached statistical significance. Conclusion These data suggest an empathy gap may exist for patients with low SES. More research is needed to further test for SES and race/ethnicity disparities in clinician empathy and help promote health care equity. Trial registration Registration (PROSPERO): CRD42019142809.