Minimum basic data set in general practice: definitions and coding.

A minimum basic data set (MBDS) was designed and used in general practice. The most important purpose and need for establishing such a data set is to assist in the provision of patient care. MBDS is designed to meet common needs for many general practitioners. Minimum means that individual programmes or the GP are free to collect as much additional data as they may wish. The MBDS includes two kinds of data: permanent and dynamic/encounter items. Permanent items are: patient data (identification, problem list, chronic treatments, source of payment) and GP data (professional characteristics). Dynamic/encounter items are: date, place, reasons for encounter, problems, process and prior encounter status.     

Psychosocial problems presented by patients with somatic reasons for encounter: tip of the iceberg?

BACKGROUND: Health-affecting psychosocial problems are inherent in general practice, present among one-third of the patients and constituting between 3 and 13% of reasons for encounter. Such problems are not always presented, and often overlooked by the doctors. OBJECTIVES: We aimed to describe the frequency of psychosocial problems presented to the doctor by patients with somatic reasons for encounter, as a proportion of the patients' existing health-affecting problems, and to explore whether characteristics of the doctor, the patient, their relationship or reason for encounter influence the presentation of problems. METHODS: A questionnaire survey of 1401 consecutive patients visiting 89 Norwegian GPs mapped the prevalence of nine commonly occurring psychosocial problems and the frequency by which they were disclosed during the consultation. RESULTS: From 21% (loneliness) to 59% (occupational stress) of problems were disclosed to the doctors. Reason for encounter was the only factor to influence the disclosure from male patients, while reason for encounter, educational level and income source of the patient, gender of the doctor, and the doctor's previous general knowledge of the patient influenced the disclosure from female patients. CONCLUSIONS: Less than half of health- affecting psychosocial problems are disclosed to GPs by patients with somatic reasons for encounter. Occupational stress is disclosed more often than other psychosocial problems. Female patients disclose non- occupational problems more often than male patients, especially if they know the doctor or if the doctor is a woman. Symptoms from the musculoskeletal system are the reasons for encounter most often preceding the disclosure of psychosocial problems.      

Patient satisfaction with the clinical encounter: social psychological determinants

Patient-practitioner transactions in the ambulatory setting have become an increasingly important focus for research in recent years. In particular, there is growing interest in providing empirical support for our anecdotal, 'common-sense' notions that clinical encounter experiences are a major determinant of outcomes such as the patient's satisfaction with the encounter. The present study was designed to look at this issue and addressed the following two research questions: Is there a relationship between fulfillment of patient requests for services and patient satisfaction with the clinical encounter? and What degree of satisfaction is explained by the qualities of the encounter as compared to the characteristics of the patient, physician, and system of health care? Four newly-developed instruments were administered to a convenience sample of 144 adult patients and their physicians prior to and following actual visits to a University Family Practice Center. Meeting patients' requests increased their satisfaction with the encounter. At least 19% of the variance in patient satisfaction could be attributed to request fulfillment. The implications of these findings for future research into the doctor-patient relationship are discussed.     

Getting comfortable with disability: The short- and long-term effects of a clinical encounter

BackgroundPhysicians report discomfort when interacting with patients with disabilities, which can negatively impact the quality of healthcare they provide.Objective/HypothesisAn intervention structured around a formative clinical encounter was assessed for its effectiveness in changing comfort towards treating patients with disabilities. It was predicted that this encounter would have a positive short- and long-term impact on medical students.MethodDuring the 2017–2018 academic year, 169 third-year medical students conducted a patient encounter with a person who had a disability. Students met individually with the “patient” and completed a brief social and medical history as if they were meeting a new patient to establish care. A measure of perceived comfort caring for patients with disabilities was administered to students before and after the encounter. One year after the patient encounter, 59 students were surveyed about their satisfaction and the impact of the patient encounter.ResultsThe impact of encountering people with disabilities in a clinical setting was positive, with statistically significant improvements across all items on the measure of perceived comfort. Students were highly satisfied with the experience and anticipated feeling more confident, more comfortable, less awkward, and more skilled and efficacious when encountering a person with a disability in their future practice. A thematic analysis of the one year follow-up data suggest that students valued the encounter and desired more content on disability throughout their education.ConclusionsMedical education should include dedicated exposure to persons with disabilities and a simulated patient experience allowing for a safe environment to gain skills and confidence.     

以服务接触理论的理念构建患者满意评价体系的探索性研究

目的 尝试运用服务接触理论思想探索构建患者满意评价体系内容与结构的方法.方法 通过叙事研究方法采集三甲医院门诊患者就医经历,采用服务接触理论对影响患者满意度的因素进行分析、归纳,在此基础上确定患者满意的各类触点,这些触点是构建评价体系内容与结构的依据.结果 在医疗服务各环节存在的服务触点有结果、过程、交流与互动3个维度,又再分为人的触点、设施的触点、信息的触点3个方面.这些触点都可成为影响满意度的因素,是构成患者满意评价体系的基本内容:如候诊环节座椅不够属于就医过程维度的设施触点,就诊环节医生态度冷淡属于交流与互动维度的人的触点,检查环节不能当天取结果属于结果维度的设施触点等.及时找出弱项服务触点并加以整改,将有效提升患者满意度.结论 根据服务接触理论整理出的各类服务触点能为构建合理有效的患者满意评价体系的具体内容和结构提供依据,叙事研究方法作为一种质性研究方法,可作为有效的患者满意度评价工具进行探索性研究阶段的信息收集.     

Effect of first-encounter pretest on pass/fail rates of a clinical skills medical licensure examination

Due to the high-stakes nature of medical exams it is prudent for test agencies to critically evaluate test data and control for potential threats to validity. For the typical multiple station performance assessments used in medicine, it may take time for examinees to become comfortable with the test format and administrative protocol. Since each examinee in the rotational sequence starts with a different task (e.g., simulated clinical encounter), those who are administered non-scored pretest material on their first station may have an advantage compared to those who are not. The purpose of this study is to investigate whether pass/fail rates are different across the sequence of pretest encounters administered during the testing day. First-time takers were grouped by the sequential order in which they were administered the pretest encounter. No statistically significant difference in fail rates was found between examinees who started with the pretest encounter and those who encountered the pretest encounter later in the sequence. Results indicate that current examination administration protocols do not present a threat to the validity of test score interpretations.     

Making your encounter form work for you

Practices depend on proper coding of procedures and diagnoses to obtain maximal reimbursement. Proficient coding by both educated physicians and staff is dependent on transmission of correct information. A well-designed encounter form is one key to enhance the process. This article provides some practical guidelines for making the encounter form more effective.     

基于消费情感的医院顾客满意形成机理研究

根据格式塔心理学的"认知-情感-行为"理论框架,建立了整合服务接触质量、顾客消费情感和顾客满意的概念模型,提出相应假设,并以医疗服务业为背景对该模型进行了验证.实证结果表明:医院服务接触质量包括环境主导、医生主导及护理人员主导的服务接触质量3个因子;在医院服务消费过程中,患者会同时经历积极消费情感和消极消费情感,且消极消费情感对积极消费情感有反向的影响;医院服务接触质量对患者消费情感和患者满意度都有显著的影响;积极消费情感和消极消费情感也对患者满意度有显著的影响.     

Emotions in Pediatric Emergencies: What We Know, What We Can Do

Emotional reactions are an important, but often ignored aspect of the pediatric emergency medical encounter The importance of the family s definition of emergency is discussed along with literature on reaction to trauma, developmental issues, and needs in the emergency encounter Specific actions are discussed in four categories (a) recognizing and legitimizing emotions, (b) assessing emotional aspects (c) responding to emotional needs and (d) following up with all involved.     

Partner violence and medical encounters: African-American women's perspectives

OBJECTIVE: To examine the relationship between intimate partner violence (IPV) victimization and patient satisfaction with medical encounters among an African-American population. DESIGN: Cross-sectional, self-administered, anonymous survey. SETTING: Community-based, primary care center. PATIENTS: Consecutive African-American women recruited from an urban health center. A total of 102 women provided sufficient information to reveal whether they were currently experiencing IPV and to allow us to assess their experiences in their most recent primary care encounter. MEASUREMENTS: Patients' perceptions of their most recent encounter using questions adopted from the Medical Interview Satisfaction Scale and Consultation Satisfaction Questionnaire. We used the Conflicts Tactics Scale, supplemented with questions measuring sexual violence and emotional abuse, to assess IPV "in the past year." RESULTS: Women who reported current IPV rated several aspects of the encounter more negatively than did women who did not report current abuse. The IPV victims were less likely to report that they felt respected and accepted during the encounter, and they provided lower ratings of the quality of communication with their providers. CONCLUSIONS: It is unclear why victims of partner violence experience medical encounters as less satisfactory. Researchers need to expand studies of medical encounters as experienced by abused women to determine whether IPV status adversely affects general medical care.     

Anomalous patients: the experiences of doctors with an illness

Variations in the distribution of power have been used to account for and to advocate different types of doctor-patient relationship. It might be expected that doctors who become patients would have a ‘mutual’ relationship with their treating doctor. Data from interviews with doctors with a recent illness show that this is not necessarily the case and may not even be doctors’ preferred model of doctor-patient relationship for themselves when they become ill. Doctors constitute anomalous patients since they confound two categories generally held to be separate, ‘doctor’ and ‘patient’. This affects the type of medical encounter they have, raising issues of identity and role performance for both patient and treating doctor. Doctor/patients may be in control of the encounter (through choice or default); they may consciously choose or have explicitly ascribed to them the status of ‘ordinary patient’; some believe that doctors should be treated as extraordinary patients with particular needs dependent on their insider status as much as their pathology. The negotiation of power in the encounter between doctors and medically qualified patients is problematic but the existence of the power differential in the medical encounter emerges as ‘natural’ and largely as desirable, since it is linked to the ability and authority to take charge of the disorder which illness represents.     

Routine, ceremony, or drama: an exploratory field study of the primary care clinical encounter.

BACKGROUND. Practicing family physicians often find family systems theory and the biopsychosocial model attractive, but have difficulties applying them in a busy office practice. METHODS. Two family physicians in a four-person group practice were identified as "exemplars" at managing daily office practice. A collaborative, qualitative methodology was used to explore their strategy. A series of semistructured key informant interviews with the two physicians and the head nurse identified themes later clarified using ethnoscience interviewing techniques. The resultant clinical encounter typology and decision-making taxonomy were evaluated using participant observation and key informant review. The final results were compared with the literature on physician-patient relationships. RESULTS. Three clinical encounter types were identified. "Routines" were simple, single, and brief visits in which a contractual style and the biomedical model were used. "Ceremonies" were linked rituals that invoked a covenantal style. "Dramas" were a series of visits concerning situations of conflict and emotion and included psychosocial problems. The family was often convened for dramas. Determination of the presenting concern, the trigger for coming, the patient request, the illness prototype, and the type of communication allowed recognition of the clinical encounter type. CONCLUSIONS. Identifying a clinical encounter as a routine, ceremony, or drama may help family physicians integrate family systems concepts into their busy office practices. These findings have numerous implications for future research, clinical practice, and teaching.     

Human factors in primary care telemedicine encounters

Traditional delivery of primary care takes place in a face-to-face transaction between provider and patient. In telemedicine, however, the transaction is 'filtered' by the distance and technology. The potential problem of filtered communication in a telemedicine encounter was examined from a human factors perspective. Patients with and without experience of telemedicine, and providers who had experience of telemedicine, were asked about patient-provider relationships in interviews and focus groups. Seven themes emerged: initial impressions, style of questions, field of view, physical interaction, social talk, control of encounter and ancillary services. This suggests that communication can be improved and better patient-provider relationships can be developed in a primary care telemedicine encounter if attention is paid to four areas of the interaction: verbal, non-verbal, relational and actions/transactional. The human factors dimension of telemedicine is an important element in delivery of health care at a distance - and is one of few factors over which the provider has direct control.     

Partner violence and medical encounters: African-American women’s perspectives

Objective: To examine the relationship between intimate partner violence (IPV) victimization and patient satisfaction with medical encounters among an African-American population.Design: Cross-sectional, self-administered, anonymous survey.Setting: Community-based, primary care center.Patients: Consecutive African-American women recruited from an urban health center. A total of 102 women provided sufficient information to reveal whether they were currently experiencing IPV and to allow us to assess their experiences in their most recent primary care encounter.Measurements: Patients’ perceptions of their most recent encounter using questions adopted from the Medical Interview Satisfaction Scale and Consultation Satisfaction Questionnaire. We used the Conflicts Tactics Scale, supplemented with questions measuring sexual violence and emotional abuse, to assess IPV “in the past year.”Results: Women who reported current IPV rated several aspects of the encounter more negatively than did women who did not report current abuse. The IPV victims were less likely to report that they felt respected and accepted during the encounter, and they provided lower ratings of the quality of communication with their providers.Conclusions: It is unclear why victims of partner violence experience medical encounters as less satisfactory. Researchers need to expand studies of medical encounters as experienced by abused women to determine whether IPV status adversely affects general medical care.     

Making use of contrasting participant views of the same encounter

Medical Education 2010: 44: 953–961 Context The practice of medicine involves many stakeholders (or participant groups such as patients, doctors and trainees). Based on their respective goals, perceptions and understandings, and on what is being measured, these stakeholders may have dramatically different viewpoints of the same event. There are many ways to characterise what occurred in a clinical encounter; these include an oral presentation (faculty perspective), a written note (trainee perspective), and the patient’s perspective. In the present study, we employed two established theories as frameworks with the purpose of assessing the extent to which different views of the same clinical encounter (a three‐component, Year 2 medical student objective structured clinical examination [OSCE] station) are similar to or differ from one another. Methods We performed univariate comparisons between the individual items on each of the three components of the OSCE: the standardised patient (SP) checklist (patient perspective); the post‐encounter form (trainee perspective), and the oral presentation rating form (faculty perspective). Confirmatory factor analysis (CFA) of the three‐component station was used to assess the fit of the three‐factor (three‐viewpoint) model. We also compared tercile performance across these three views as a form of extreme groups analysis. Results Results from the CFA yielded a measurement model with reasonable fit. Moderate correlations between the three components of the station were observed. Individual trainee performance, as measured by tercile score, varied across components of the station. Conclusions Our work builds on research in fields outside medicine, with results yielding small to moderate correlations between different perspectives (and measurements) of the same event (SP checklist, post‐encounter form and oral presentation rating form). We believe obtaining multiple perspectives of the same encounter provides a more valid measure of a student’s clinical performance.     

Patient satisfaction with outpatient primary health care in a metropolitan medical center

This paper presents rates and correlates of patient satisfaction with primary care in a New York medical center. Over an eight-week period, we studied only first-time, "workup" encounters. Patient satisfaction was measured with three scales and one single-item measure. The highest rates of satisfaction were registered in relation to (1) the encounter in general, followed by (2) doctor conduct and (3) convenience. Four sets of independent variables were studied: sociodemographic variables, social psychological antecedent variables, other patient characteristics, and physician characteristics. Age was found to be the most important sociodemographic characteristic of patients affecting their satisfaction with the encounter; having positive expectations of the encounter had more effect on subsequent satisfaction ratings than other social psychological variables studied here. When each of the satisfaction measures was regressed on the sets of independent variables, the proportion of variance explained changed, as did the relative contribution of the different independent variables. We discuss the importance of studying patient satisfaction with specific medical encounters, along with the findings of our study.     

Decision-making in the physician-patient encounter: revisiting the shared treatment decision-making model.

In this paper we revisit and add elements to our earlier conceptual framework on shared treatment decision-making within the context of different decision-making approaches in the medical encounter (Charles, C., Gafni, A., Whelan, T., 1997. Shared decision-making in the medical encounter: what does it mean? (or, it takes at least two to tango). Social Science & Medicine 44, 681 692.). This revised framework (1) explicitly identifies different analytic steps in the treatment decision-making process; (2) provides a dynamic view of treatment decision-making by recognizing that the approach adopted at the outset of a medical encounter may change as the interaction evolves; (3) identifies decision-making approaches which lie between the three predominant models (paternalistic, shared and informed) and (4) has practical applications for clinical practice, research and medical education. Rather than advocating a particular approach, we emphasize the importance of flexibility in the way that physicians structure the decision-making process so that individual differences in patient preferences can be respected.