Patient Provider Communication

Why your TeamSTEPPS program may not be working

by Timothy Clapper

Clapper, T. C., & Ng, G. M. (2012, in press). Why your TeamSTEPPS program may not be working. Clinical Simulation in Nursing. doi:10.1016/j.ecns.2012.03.007

Co-authored with Grace Ng

Team Strategies and Tools to Enhance Performance and Patient Safety ® (TeamSTEPPS) is a patient safety tool developed... more Team Strategies and Tools to Enhance Performance and Patient Safety ® (TeamSTEPPS) is a patient safety tool developed by the defense industry and based on four competencies: leadership, communication, situational monitoring, and mutual support. Unfortunately, there are barriers that prevent TeamSTEPPS from reaching its full potential, including: (a) lack of administrative support and resources, (b) lack of training focus to address hierarchal differences and incivility at all levels of health care practice and administration, (c) inadequate TeamSTEPPS instruction and simulation practices, and (d) educators’ resistance to change from crew resource management concepts. Suggestions for improvement include providing command and health care agency emphasis for the TeamSTEPPS program, providing adequate material and personnel resources, designing training that is geared to trainer implementation at the departmental level, prioritizing and saturating training, and striving toward a just culture.

Response to Consultation from European Medicines Agency: Good Pharmacovigilance Practice Module V – Risk management systems' (EMA/838713/2011)

by Theo Raynor

This consultation on Risk Management Systems is part of a wider consultation on Good Pharmacovigilance Practice. more This consultation on Risk Management Systems is part of a wider consultation on Good Pharmacovigilance Practice.

I focus my comments on risk minimisation materials and their need to be accessible, readable and understandable for the target readers (whether patients or professionals)

Health literacy: is it time to shift our focus from patient to provider?

by Theo Raynor

Commissioned editorial published in the British Medical Journal 22nd March 2012 (online)

Increasing people’s ability to understand and engage in their healthcare is an international priority. Research,... more Increasing people’s ability to understand and engage in their healthcare is an international priority. Research, particularly from the United States, has shown that people who lack such ability have poorer health outcomes and increased mortality.1 In the linked study (doi:10.1136/bmj.e1602), Bostock and colleagues show an adverse effect on mortality in patients in the United Kingdom too. The findings of this study are worrying, but not surprising. The study also suggests that a third of older people in the UK have difficulty reading and understanding basic health information. Considered alongside data from the US and
Australia, these findings suggest that between a third and half
of people in developed countries have difficulty understanding
and engaging in their healthcare and that this has important
consequences for health. In light of such findings it seems remarkable that the matter is not given higher priority.

The Missing Voice of the Critically Ill: A Medical Sociologist's First‐person Account

by David Rier

Sociology of Health and Illness 22:68-93; 2000


{Reprinted in Readings in Medical Sociology [2nd Ed.], William C. Cockerham (ed.), Englewood Cliffs, NJ: Prentice-Hall, 2000}.

{Reprinted in Case Study Research, Vol. II, Matthew David (ed.), London: Sage, 2005}.

Existing sociological studies of critical illness deal mainly with providers and families, but seldom with patients,... more Existing sociological studies of critical illness deal mainly with providers and families, but seldom with patients, themselves. Moreover, most of the literature on the patient's experience involves chronic illness. Based on the author's experience as an intensive care unit (ICU) patient, this paper demonstrates that certain concerns of the post-Parsonian literature, such as full disclosure of information to patients and patients' negotiation and collaboration with physicians, are of minimal relevance for critically ill patients. This paper also discusses the notebook the author used in the ICU to communicate while on a respirator, thus unintentionally leaving a concurrent record of his experience, in a form of "inadvertent ethnography.” This allowed him to reconstruct experiences rarely accessible to sociologists. Such notebooks can help us construct accounts of the ICU patient's experience, and move us towards a sociology of the critically ill patient. Potential topics for this new research area are suggested.

KEY WORDS: critical illness; intensive care unit (ICU); Parsons; empowerment; disclosure

PILs Project Summary report: Ensuring the Readability, Understandability and Efficacy of Patient Information Leaflets

by Jill Clark

Co-authored with Rob Wilson, Tim Kenny, Dave Moseley,
Lynn Newton, Doug Newton and Ian Purves

This report has been produced in order to identify areas of relevance to the writing and editing of Patient... more This report has been produced in order to identify areas of relevance to the writing and editing of Patient Information Leaflets; specifically the PILs Compendium produced by Tim Kenny.
The report also includes a record of the process by which the Patient Information Leaflet editing software (Watchword) was validated. The report will also offer recommendations as
to future developments in the writing and evaluation of PILs, other patient information leaflets and patient education materials generally. The report is therefore split into a number of sections:
Executive Summary
Glossary of Terms
A PIL for every ill? - General Review of the Literature by Tim Kenny
Patient Information and Education - Review of the Literature on Patient Information Leaflet Readability and Understandability by Jill Clark
Preparing Palatable PILs - A report containing general advice regarding the production of Readable and Understandable text applied to Patient Information Leaflets and a report of the
NEAR testing (North East Age Research group) results aimed at validating the Watchword software and offering pointers to future developments in the presentation of PILs by Doug Newton, Lynn Newton and David Moseley. Appendices describing and reporting the consultation process with Patient organisations and the process of editing PILs through the use of the Watchword analysis software and WordWeb thesaurus software conducted by Tim Kenny.

Promoting participatory medicine with social media: new media applications on hospital websites that enhance health education and e-patients’ voice.

by Linda Gallant

http://bit.ly/vzJLZS

Background and Objective: The nature of health communication is changing as people increasingly seek health... more Background and Objective: The nature of health communication is changing as people increasingly seek health information on the internet. The objective of this study was to investigate how hospital websites utilize a variety of e-health tools; online communication technologies such as social media, video, podcasts, and interactive formats.

Methods: An inductive content analysis was performed on the websites of 14 top-ranked US hospitals from January 5, 2011 to February 28, 2011. A total of 1,330 web pages were analyzed to identify the types of online communication technologies utilized by hospitals to provide e-patients with health information.

Findings: The findings provided an exploratory look at how hospitals provide web-based health information to patients. All hospitals used social media platforms such as Facebook, Twitter, or YouTube. Most hospitals offered web-based broadcasting of health information. Online health tools such as body mass index (BMI) calculators and health dictionaries were also a common website feature. Less frequently employed were mobile applications, hospital-patient interaction tools and health blogs.

Implications: The convergence of interactive media formats with web-based communication tools will likely enhance e-patient education and promote patient involvement in ways that alter traditional health care interactions, and may lead to enhanced levels of participatory medicine.
http://bit.ly/vzJLZS

The patient's view

by David Armstrong

The emancipation of Biographical Medicine

by David Armstrong

Physicians’ Perceptions of Adult Patients’ History of Child Abuse in Family Medicine Settings

by Gonzalo Bacigalupe

The Journal of the American Board of Family Medicine 20 (4): 417-419 (2007)

Childhood abuse places adults at risk for adverse psychological and physical health sequelae.1 In the Adverse... more Childhood abuse places adults at risk for adverse psychological and physical health sequelae.1 In the Adverse Childhood Experiences (ACE) study, Felitti et al2 found a significant dose–response relationship between the number of childhood traumatic experiences and a variety of adverse outcomes: poor self-rated health, various chronic diseases, disability, and early death. The experience of childhood abuse is common: 44% of a sample of men and women patients in primary care reported a history of childhood physical, sexual, or emotional abuse.3 Estimates of the proportion of women in primary care with histories of child sexual abuse range from 18% to 23%,4,5 and of child physical abuse from 12% to 14%.4 Although in the last decade public health and medical organizations have endorsed guidelines for screening for adult interpersonal violence, physician inquiry into childhood physical or sexual abuse has received little attention.

Listening to patients: How understanding health information use can contribute to health literacy constructs

by Maria L. Souden

Information work in the chronic illness experience

by Maria L. Souden

Person Centred Care and Shared Decision Making: Implications for Ethics, Public Health and Research

by Christian Munthe

co-authored with Lars Sandman and Daniela Cutas. Published in Health Care Analysis, 2011, vol. 19, DOI: 10.1007/s10728-011-0183-y

This paper presents a systematic account of ethical issues actualised in different areas, as well as at different... more This paper presents a systematic account of ethical issues actualised in different areas, as well as at different levels and stages of health care, by introducing organisational and other procedures that embody a shift towards person centred care and shared decision-making (PCC/SDM). The analysis builds on general ethical theory and earlier work on aspects of PCC/SDM relevant from an ethics perspective. This account leads up to a number of theoretical as well as empirical and practice oriented issues that, in view of broad advancements towards PCC/SDM, need to be considered by health care ethics researchers. Given a PCC/SDM-based reorientation of health care practice, such ethics research is essential from a quality assurance perspective.

Buyer beware? Does the information provided with herbal products available over the counter enable safe use?

by Theo Raynor

BMC Medicine 2011, 9:94doi:10.1186/1741-7015-9-94

Authors: David K Raynor, Rebecca Dickinson, Peter Knapp, Andrew F Long, Donald Nicolson

Background
Herbal products obtained over the counter are commonly used in Europe, North America and Australia.... more Background
Herbal products obtained over the counter are commonly used in Europe, North America and Australia. Although there is concern about a lack of information provided to consumers to allow the safe use of these products, there has been no published research to confirm these fears. In this study, we evaluated written information provided with commonly used herbal products in the UK in advance of a European Union Directive issued in April 2011 that tightened regulations for some herbal products, including requirements to provide safety information.

Methods
Five commonly used herbal products were purchased from pharmacies, health food shops and supermarkets: St John's wort, Asian ginseng, echinacea, garlic and ginkgo. Written information provided with the products (on the package or on a leaflet contained in the package) was evaluated for inclusion of each of the key safety messages included in the monographs of the US National Center for Complementary and Alternative Medicine. Specifically, we looked for information on precautions (such as Asian ginseng not being suitable for people with diabetes), interactions with conventional medicines (such as St John's wort with the contraceptive pill and warfarin) and side effects (such as ginkgo and allergic reactions).

Results
Our analysis showed that, overall, 51 (75%) of 68 products contained none of the key safety messages. This included 4 of 12 St John's wort products, 12 of 12 ginkgo products, 6 of 7 Asian ginseng products, 20 of 21 garlic products and 9 of 13 echinacea products. The two products purchased that are registered under the new European Union regulations (for St John's wort) contained at least 85% of the safety messages.

Conclusions
Most of the herbal medicine products studied did not provide key safety information which consumers need for their safe use. The new European Union legislation should ensure that St John's wort and echinacea products will include the previously missing information in due course. The legislation does not apply to existing stock. Depending on therapeutic claims made by manufacturers, garlic, ginkgo and Asian ginseng products may not be covered by the legislation and can continue to be bought without the safety information. Also, consumers will still be able to buy products over the internet from locations outside European Union jurisdiction. Potential purchasers need to know, in both the short term and the long term, how to purchase herbal products which provide the information they need for the safe use of these products.

Ho, E. Y., & Bylund, C. L. (2008). Models of health and models of interaction in the practitioner-client relationship in acupuncture. Health Communication, 23(6), 506-515. doi: 10.1080/10410230802460234

by Evelyn Y. Ho

Delivering a patient-focused health service: the views of physicians in Barbados

by Clare Xanthos

'Health Sociology Review', 2007

The primary aim of this study is the exploration of the views of physicians in Barbados on the provision of a... more The primary aim of this study is the exploration of the views of physicians in Barbados on the provision of a patient-focused health service. Qualitative interviews were conducted with fifteen physicians based at a teaching hospital in Barbados. The data was analysed in relation to literature on the physician-patient relationship with particular reference to 'patient-focused' versus 'provider-focused' approaches to health care delivery.

Results were first, that while the concept of patient-focused care has gained some recognition in Barbados over the last five years, several respondents considered health care delivery was in general not patient-focused. Secondly, with regard to the sample of physicians interviewed, there were different approaches to health care delivery and varying extents to which physicians were 'patient-focused' in relation to different issues.

Three broad approaches were identified: 'patient-focused', 'provider-focused' and 'intermediate'. Thirdly, physicians could also be grouped into three 'types' consistent with these three broad approaches; that is, patient-focused, provider-focused, and intermediate.

Living With Hepatitis C: The Medical Encounter

by Magdalena Harris

New Zealand Sociology, 2005.

This paper is based on interviews with twenty individuals with
hepatitis C living in the Auckland region. A... more This paper is based on interviews with twenty individuals with
hepatitis C living in the Auckland region. A primary theme that arose from these interviews was that of the participants’ interaction with medical professionals. The stigmatised and ambiguous nature of hepatitis C often made for an unsatisfactory and harrowing encounter. I argue that the biomedical model is flawed in its attitude towards chronic illness. Instead of a one‑dimensional focus on treatment and cure there needs to be renewed focus on helping patients “live a good life while being ill”. Necessary for the attainment of this goal are ongoing models of care that take into account the experiential nature of illness and the social context of the individual.

SMS text message healthcare appointment reminders in England

by Alan Card

Car J, Ng C, Atun R, Card A. SMS text message healthcare appointment reminders in England. 'J Ambul Care Manage. 2008 Jul-Sep;31(3):216-9. PMID: 18574379.

Missed appointments place a costly and disruptive strain on National Health Service resources in England. One major... more Missed appointments place a costly and disruptive strain on National Health Service resources in England. One major source of missed appointments appears to be insufficient communication between patients and providers. SMS text messaging shows promise as a simple, cost-effective means of bridging this communications gap. SMS provides an instant and asynchronous means of communication that protects patient privacy. The potential for this technology is balanced, however, by the lack of high-quality evidence to support its use. There is an urgent need for robust evaluation of critical quality, safety, cost implications, and acceptability before the large-scale rollout of SMS-based systems.

“They Don’t Want Anything to Do with You”: Patient Views of Primary Care Management of Chronic Pain

by Gonzalo Bacigalupe

Carole C. Upshur, Gonzalo Bacigalupe, & Roger Luckmann (2010). Pain Medicine

Objective. Chronic pain is one of the most frequent complaints of patients in primary care, yet both patients and... more Objective. Chronic pain is one of the most frequent complaints of patients in primary care, yet both patients and providers report low satisfaction with chronic pain care. This study was designed to explore the views held by a diverse sample of patients with chronic pain complaints about their care experiences to identify ways to improve care.
Design. Qualitative analysis of 17 patient focus groups (size 3–7 participants). Groups used struc- tured questions and were tape recorded, tran- scribed, and coded using qualitative software. Eleven groups were conducted in English, six groups in Spanish.
Patients. Convenience sample of 72 adult patients (68% female, 44% Latino, mean age = 48.1 years)
recruited from four diverse primary care practices in Central Massachusetts.
Results. Across all 17 groups, and all gender, ethnicity, and age groups, most patients reported suboptimal interactions with their providers when seeking care for chronic pain. Subjects acknowl- edged feeling disrespected and distrusted, sus- pected of drug-seeking, and having their symptoms dismissed as trivial and/or not warranting medical care. Patients reported more satisfaction when they felt a provider listened to them, trusted them, was accessible to address pain concerns between visits, and used patient-centered approaches to establish goals and treatment plans. Patients also recom- mended some management techniques related to the chronic disease management model to improve pain care.
Conclusions. Implementingpatient-centeredappro- aches in caring for individuals with chronic pain and using principles drawn from the chronic disease management model to improve care systems may improve both patient and provider satisfaction with chronic pain care.
Key Words. Chronic Pain; Patient Views; Primary Care; Pain Management; Qualitative Methods; Focus Groups