Patients’ ideas,concerns, expectations and satisfaction in primary health care – a questionnaire study of patients and health care professionals’ perspectives

Abstract

Objective: Explore the perceptions of patients and health care professionals about patients’ ideas, concerns, expectations (ICE), and satisfaction in consultations with general practitioners (GPs), district nurses (DNs) and physiotherapists (PTs).

Design: Cross-sectional questionnaire study of participants in planned consultations.

Setting: Five primary health care centers and two rehabilitation centers in Stockholm, Sweden.

Subjects: Pairs of patients and GPs (n?=?156), patients and DNs (n?=?73), and patients and PTs (n?=?69).

Main outcome measures: Multiple-choice questions about patients’ ICE and satisfaction.

Results: Approximately 75% of patients and GPs reported that patients’ thoughts and explanations about their symptoms emerged during the consultation. For patient-DN pairs, the figure was 60%, and for patient-PT pairs, 80%. A majority of patients reported not having concerns and anxiety about the investigation/treatment, whereas health care professionals thought patients were more concerned. One-third of patients consulting GPs and PTs expected to receive a reason/explanation for their symptoms. Figures were lower for the DNs. About 70% of patients were satisfied with the consultation.

Conclusions: Most patients expressed their ideas, a minority had concerns, and a minority expected an explanation of their illness. Patients and health care professionals rated patient satisfaction high, but health care professionals tended to believe patients were less satisfied than patients reported they were.

• Key points

• Patient surveys show that important aspects of patient-centeredness remain weak in Swedish primary health care; for example, shared decision-making.

• In this study of planned consultations, few patients expected to receive an explanation of their symptoms, but most were satisfied with the consultation.

• Health care professionals thought patients’ experiences were more negative than they were.

• This discrepancy was observed in responses to questions about patients’ concerns, expectations and satisfaction.

     

Do characteristics of practices and general practitioners influence the yield of diabetes screening in primary care? The ADDITION Netherlands study

Objective

To investigate whether the yield of population-based diabetes screening is influenced by characteristics of the general practitioner (GP) and the practice.

Design

Cross-sectional study.

Setting

Seventy-nine general practices in the south-western region of the Netherlands.

Subjects

From 2002 to 2004, 56 978 people were screened for diabetes. GPs completed a questionnaire containing items on the GP (age, gender, employment, special interest in diabetes, providing insulin therapy) and the practice (setting, location, number of patients from ethnic minority groups, specific diabetes clinic, involvement of practice assistant, practice nurse or diabetes nurse in diabetes care).

Main outcome measures

The ratio screen-detected diabetic patients/known diabetic patients per practice (SDM/KDM) and the number of detected diabetic patients per practice adjusted for practice size and age distribution (SDM per standardized practice).

Results

The yield of screening per practice varied widely. Higher age of the GP (regression coefficient 0.20; 95% confidence interval, CI 0.07–0.34), urban location (−4.60; 95% CI −6.41 to −2.78) and involvement of the practice assistant (2.27; 95% CI 0.49–4.06) were independently associated with SDM/KDM. Using the other outcome variable, results were similar. Additionally, cooperation with a diabetes nurse was associated with a lower yield.

Conclusion

A lower yield of screening, reflecting a lower prevalence of undiagnosed diabetes, was found in practices of younger GPs and in urban practices. A lower yield was not associated with an appropriate practice organization regarding diabetes care nor with a specialty of the GP in diabetes. The wide variation in the yield of screening stresses the importance of a screening programme in each general practice.     

Variation in general practitioners’ information-seeking behaviour – a cross-sectional study on the influence of gender,age and practice form

Objective: To assess general practitioners’ (GPs’) information-seeking behaviour and perceived importance of sources of scientific medical information and to investigate associations with GP characteristics.

Design: A national cross-sectional survey was distributed electronically in December 2013.

Setting: Danish general practice.

Subjects: A population of 3440 GPs (corresponding to approximately 96% of all Danish GPs).

Main outcome measures: GPs’ use and perceived importance of information sources. Multilevel mixed-effects logit models were used to investigate associations with GP characteristics after adjusting for relevant covariates.

Results: A total of 1580 GPs (46.4%) responded to the questionnaire. GPs’ information-seeking behaviour is associated with gender, age and practice form. Single-handed GPs use their colleagues as an information source significantly less than GPs working in partnership practices and they do not use other sources more frequently. Compared with their younger colleagues, GPs aged above 44 years are less likely to seek information from colleagues, guidelines and websites, but more likely to seek information from medical journals. Male and female GPs seek information equally frequently. However, whereas male GPs are more likely than female GPs to find that pharmaceutical sales representative and non-refundable CME meetings are important, they are less likely to find that colleagues, refundable CME meetings, guidelines and websites are important.

Conclusion: Results from this study indicate that GP characteristics should be taken into consideration when disseminating scientific medical information, to ensure that patients receive medically updated, high-quality care.

• KEY POINTS

• Research indicates that information-seeking behaviour is associated with GP characteristics. Further insights could provide opportunities for targeting information dissemination strategies.

• Single-handed GPs seek information from colleagues less frequently than GPs in partnerships and do not use other sources more frequently.

• GPs aged above 44 years do not seek information as frequently as their younger colleagues and prefer other information sources.

• Male and female GPs seek information equally frequently, but do not consider information sources equally important in keeping medically updated.

     

Are men shortchanged on health? Perspective on health care utilization and health risk behavior in men and women in the United States

Background: Significant gender disparities exist in life expectancy and major disease morbidity. There is a need to understand the major issues related to men’s health that contributes to these significant disparities. It is hypothesized that, high‐risk behaviors and low utilization of all and preventive health services contribute to the higher mortality and the higher and earlier morbidity in men. Methods: Data was collected from CDC: Health United States, 2007; Health Behavior of Adults: United States 2002–04; and National Ambulatory Medical Care Survey: 2005 Summary. Results: In United States, men are more likely to be regular and heavy alcohol drinkers, heavier smokers who are less likely to quit, non‐medical illicit drug users, and are more overweight compared to women. Men are less likely to utilize health care visits to doctor’s offices, emergency departments (ED), and physician home visits than women. They are also less likely to make preventive care, hospice care, dental care visits, and have fewer hospital discharges and shorter hospital stays than women. Conclusions: High‐risk behaviors and low utilization of health services may contribute to the lower life expectancy in men. In the context of public health, behavioral and preventive interventions are needed to reduce the gender disparity.     

Midwives' group supervision and the influence of their continuity of care model – a pilot study

severinsson e., haruna m. & friberg f. (2010) Journal of Nursing Management 18, 400–408
Midwives' group supervision and the influence of their continuity of care model – a pilot study Background Midwives’ different leadership and supervisory styles influence women’s experiences of childbirth in various ways. Aim The aim of this study was to evaluate midwives’ experiences of group supervision and the influence of the continuity of care model, with particular focus on childbearing women’s need for emotional support. An additional aim was to evaluate the development of the midwives’ professional competence. Methods Qualitative thematic analysis was used to analyse the notes made during the supervision sessions and focus group discussion. Results The significance of the midwives’ continuity of care model was: assessment of the women’s individual needs, enabling strategies to create a deeper relationship and acknowledging the vulnerability in the relationship with the women. The outcome of the midwives’ group supervision was increased professional competence. Three themes emerged: Integrating science into midwifery practice, Awareness of one’s professional role and Sensitivity in one’s professional role. Conclusions These findings provide a clear indication that the women’s need for emotional support can be fulfilled by the midwives’ leadership. Implication for nursing management The development of the midwife’s role as a leader in maternity care is closely related to the opportunities for the provision of supervision aimed at increasing her professional competence.     

How does the general population treat their pain? A survey in Catalonia, Spain

Several epidemiological studies have shown that pain is a very common complaint in patients who seek medical care. However, the characteristics of how pain is treated in the general population have been studied less. The present survey was conducted to describe and analyze how the general population of Catalonia (Spain) approaches the treatment of their pain complaints. The study was carried out in 1964 adults who were surveyed by phone about the presence of painful events in the last six months, the intensity and location of their pain, what they did to treat their pain, and their resulting level of relief. Data were compared by age and gender. Pain prevalence was high (78.6%) and more frequent in women. The therapeutic strategy most commonly used was a visit to the physician (66.3%), followed by self-medication (27.6%) and alternative medicines (20.5%). Drugs were the primary treatment used by physicians (86.5%), followed by physical therapy (18.1%). Pain in the extremities, back and neck pain were often unsuccessfully treated. Self-medication was often performed with acetylsalicylic acid and paracetamol (acetaminophen), and was commonly used in conjunction with other therapeutic approaches (51.9%). Age (low use of paracetamol in the elderly) and gender (low use of paracetamol in men) were related to the type of drug used in self-medication. Older men, and those with severe pain located in the chest, required hospital admission more commonly. In conclusion, pain is a common reason for seeking medical care and using drugs. Therapeutic approaches are often related to the type of pain, but also to age or gender. Knowledge of these characteristics may allow for a more efficient use of available resources.     

Are men shortchanged on health? Perspective on life expectancy,morbidity, and mortality in men and women in the United States

Background: Significant gender disparities exist in life expectancy and major disease morbidity. There is an urgent need to understand the major issues related to men’s health that contributes to these significant disparities. It is hypothesized that men have higher and earlier morbidities, in addition to behavioral factors that contribute to their lower life expectancy. Methods: Data was collected from CDC: Health United States, 2007; American Heart Association, American Obesity Association, and American Cancer Society. Results: Men have lower life expectancy than women in most countries around the world including United States. This gender disparity is consistent regardless of geography, race and ethnicity. More men die of 12 out of the 15 leading causes of death than women. In addition, men have higher morbidity and mortality in coronary heart disease (CHD), hypertension, diabetes, and cancer. Conclusions: Men’s lower life expectancy may be explained by biological and clinical factors such as the higher incidence of cardiovascular metabolic disease and cancer. In the context of public health, raising awareness of cardiovascular and metabolic health is needed to reduce the gender disparity. In addition, consideration of preventive and early detection/intervention programs may improve men’s health.     

Research in public health and end-of-life care – Building on the past and developing the new

Introduction: Public health approaches offer the opportunity to move beyond clinical and health services approaches to end-of-life (EoL) care, to focus on whole populations, individuals and communities rather than patients and carers. They also allow concepts such as capacity, resilience, and wellbeing to come to the fore.

Methods: This paper, drawing on the experience of a diverse group of academics and practitioners from three countries in Europe, considers the research challenges related to examining new public health approaches to EoL care and how learning from more traditional or classic public health research can influence a future research agenda. Additional opportunities provided by the new public health approach to broaden learning and participation in research are considered.

Results: By bringing together strong traditional methods such as analysis of longitudinal population-level data with participatory approaches that draw on communities' experience and aspirations for care, the authors suggest that new and improved opportunities exist to evaluate the impact of participatory approaches.

Discussion: In conclusion, the paper urges researchers from classic and new public health to work in partnership to generate and respond to the emerging research agenda around new public health initiatives. There is much to be learned from both.     

What is the impact of advanced primary care nursing roles on patients, nurses and their colleagues? A literature review

OBJECTIVES: To review and draw together the existing research evidence to assess the impact of advanced primary care nursing roles, particularly first contact nursing roles, for patients, nurses themselves and their colleagues in order to highlight salient issues for policy, practice and research. BACKGROUND: Internationally, nurses' roles continue to expand in response to doctor shortages and policy drives to provide effective and efficient health services. A body of research exists from which to evaluate the impact of advanced nursing roles on various dimensions of healthcare delivery and organisation. DESIGN AND DATA SOURCES: Medline, CINAHL, Applied Social Sciences Index and Abstracts, British Nursing Index, Cochrane Library, EMBASE, National Research Register, and PsycINFO databases were searched, including relevant websites. Studies were included if published in English and relevant to the primary/community care setting. Of a total of 211 papers identified, 88 were of relevance and included in the review. RESULTS: Nurses working in many advanced primary care roles such as acute/minor illness, minor injury and long-term conditions provide safe and effective care, and patient satisfaction is generally high. Many factors influence patient satisfaction with, and access to, such services but are little understood. Evidence on cost-effectiveness, efficiency and impact on other health care professionals is inconclusive though research suggests the introduction of extended roles can create uncertainty and intra-/inter-professional tensions. CONCLUSIONS: Evidence is of variable quality, often ignoring potentially important effect mediators such as the experience and educational level of advanced nurses, the effect of service 'maturation', organisational characteristics and differing patient preferences. The complex range of factors that influence patient satisfaction, access and outcomes of care need further investigation. Recent UK developments in nurse prescribing and the introduction of a national post-registration competency framework may improve working relations and patient understanding and experience of advanced nursing roles in primary care.     

The effectiveness of primary care streaming in emergency departments on decision-making and patient flow and safety – A realist evaluation

Primary care streaming was implemented in UK Emergency Departments (EDs) to manage an increasing demand for urgent care. We aimed to explore its effectiveness in EDs with different primary care models and identify contexts and mechanisms that influenced outcomes: streaming patients to the most appropriate clinician or service, ED flow and patient safety.MethodWe observed streaming and interviewed ED and primary care staff during case study visits to 10 EDs in England. We used realist methodology, synthesising a middle-range theory with our qualitative data to refine and create a set of theories that explain relationships between contexts, mechanisms and outcomes.ResultsMechanisms contributing to the effectiveness of primary care streaming were: quality of decision-making, patient flow, redeploying staff, managing patients across streams, the implementation of governance protocols, guidance, training, service evaluation and quality improvement efforts. Experienced nurses and good teamworking and strategic and operational management were key contextual factors.ConclusionWe recommend service improvement strategies, operational management, monitoring, evaluation and training to ensure that ED nurses stream patients presenting at an ED seeking urgent care to the most appropriate clinicians for their needs in a safe and efficient manner.     

Patients’ perspectives on care,communication, and teamwork in the emergency department

BackgroundThe work of healthcare professionals (HCPs) in the emergency department (ED) involves effective communication and efficient teamwork, which may be perceived differently by patients and HCPs. Therefore, it is important to explore patient perspectives of information exchange and clinical assessment.AimTo evaluate experiences of care, communication, and teamwork from ED patients’ perspectives.MethodsSemi-structured interviews were conducted with 17 patients who were assessed in a Swedish ED during Spring 2021. Thematic analysis was used.ResultsParticipants’ experiences reflected the complex environment of the ED. Findings emphasize the importance of information exchange in relation to a caring approach. Three themes emerged: the need for a caring approach by HCPs towards patients’; the need for dialogue between patient and HCPs; and the need for information on ED environment constraints.ConclusionsPatients felt comforted when they experienced a caring empathic approach from the HCPs. For example, patients valued an individual holistic approach rather than feeling that they were being objectified by their medical conditions. This was important in coping with the anxiety caused by a stressful ED environment. There is a critical need for effective exchange of information between patients and HCPs.     

Socioeconomic disparities in physical activity among Swedish women and trends over time – the population study of women in Gothenburg

Abstract

Objective: To explore secular trends in physical activity in relation to socioeconomic position in middle-aged women, with focus on whether the social gaps have become wider, narrower, or remain unchanged.

Design: Cohort comparisons between two representative samples of women, recruited in 1980–81 and 2004–05 as a part of the Population Study of Women in Gothenburg.

Setting: Gothenburg, the second largest city of Sweden, with ≈ 450?000 inhabitants.

Subjects: Population-based cohorts of 38- and 50-year-old women, invited in 1980–81 and 2004–05 to free health examinations. The study population in 1980 was n?=?477, 38- and 50-year-old women born in 1930 (n?=?355) and 1942 (n?=?122), and in 2004 n?=?500, 38- and 50-year- old women born in 1966 (n?=?207) and 1954 (n?=?293).

Main outcome measure: Physical activity at work and leisure time. Socioeconomic position was defined based on socio-occupational group and level of education. Physical activity during work and leisure time was based on questionnaires.

Results: On average 38- and 50-year-old women were more physically active at work and leisure time in 2004–05 compared to 1980–81; odds ratio (OR) for increase over time for physical activity at work for 38-year-olds: 2.59, (95% confidence interval (CI) 1.65–4.07), and for 50-year-olds: OR 2.09 (1.52–2.88); OR for increase physical activity leisure time in 38-year-olds: 1.93 (1.25–2.98), and in 50-year-olds 2.04 (1.49–2.79). There were no significant differences between socioeconomic groups in physical activity levels changes over time.

Conclusion: Women in different socioeconomic groups improved their physical activity at work and leisure time to the same extent from 1980 to 2004, indicating that the socioeconomic gap in physical activity is neither increasing nor decreasing.

• Key Points

• The gap in physical activity levels between socioeconomic groups seems to have remained stable for middle-aged women the last 25 years.

• ??However, women were more physically active in 2004 at work and during leisure time, independent of socioeconomic position, compared to 1980.

• ??It remains a great challenge to create structures that enable these behaviours for all social groups.

     

Effect of Covid-19 pandemic on mental health among Albanian people residing in the country and abroad – Implications for mental care

BackgroundCoronavirus disease caused by the novel coronavirus Covid-19 is a current worldwide outbreak. The use of quarantine and isolation proved effective in containing the spread of infection.ObjectivesThe purpose of this cross-sectional study was to assess the mental health of Albanian people residing in the country and abroad during the quarantine period for the Covid-19 pandemic.DesignThis study was carried out from 25th March – 20th April 2020 through a web survey shared on social networks. The goal was to reach at least the minimum sample size for cross-sectional studies. The Patient Health Questionnaire (PHQ-9) was used to assess mental health. Chi-square (χ²) and Fisher –Exact test were used to assess the statistical significance among variables. P values ≤0.05 were considered statistically significant.Results715 participants were included in the final analyses (78.41% females and 21.53% males). Most were residents in Albania (80.41%) and the others resided mainly in Italy (6.89%), Greece (3.51%), Germany (2.43%), Kosovo (1.62%) and the UK (1.69%). Statistical association was found between gender, country of residency and measures taken. Summary score of PHQ-9 items was 6.4662. The total score of depression classification shows that 31.82% and 12.90% of participants have respectively mild and moderate depression. Female participants showed the highest score for some items of PHQ-9, p≤0.05.ConclusionsFindings suggest that health care professionals should recognize and address mental health problems associated with Covid-19 especially in vulnerable groups. Acting in a timely and proper manner is essential in preventing these problems from becoming chronic.     

Learning to plan? A critical fiction about the facilitation of professional and practice development plans in primary care

A shift from continuing medical education towards professional and organisational development policies, coupled with the introduction of accountability frameworks (clinical governance), has generated interest in professional and practice development plans (PPDPs) in general practice. The problems of implementing this change in an independent contractor-based service remain unexplored and the aims of this study were to focus on the facilitator's experience of the issues that hampered or fostered development in general practice. Facilitators of PPDPs were asked to document their experience of supporting 12 practices in an all Wales feasibility study. In order to maintain organisational anonymity while reporting accurate accounts of the obstacles encountered, a method known as critical fiction was employed. This method allowed the authors to write detailed reflective accounts that were then fictionalised. The culture of general practice reflects the development of an independent contractor service that has developed into partnerships that employ some professionals (practice nurses, managers and administrative staff) and collaborate with others in variable arrangements (community nurses, health visitors, midwives and others). Developing organisation-wide systems in so-called 'primary health care teams' is a difficult exercise, given the ethos of autonomous decision-making processes and the lack of experience of 'whole systems' approaches in primary care. The potential for multiprofessional synergy and the evidence that systematic changes lead to sustained health care improvements are well established. But the implementation issues of these concepts have not been addressed. Existing educational policies are based in uniprofessional paradigms and the protected time requirements and funding streams required for PPDPs have not been clarified.     

Insurance policies and perceived quality of primary care among privately insured patients: do features of managed care widen the racial, ethnic, and language-based gaps?

CONTEXT: Little is known about whether some features of managed care widen disparities in patients' evaluations of primary care. OBJECTIVES: We investigated whether the magnitudes of racial and ethnic/language-based differences in patients' evaluations of the quality of primary care vary by capitation and gatekeeping. DESIGN: We used a telephone survey of a representative sample of the US noninstitutionalized population, Community Tracking Study Household Survey 1998-1999, and Followback Survey of respondents' insurance administrators. SETTING AND PARTICIPANTS: Our sample was privately insured adults who saw a physician at least once during the year preceding the interview and whose last visit was to a primary care physician. MAIN OUTCOME MEASURES: We measured patients' evaluations of (1) how well the physician listened, (2) how well the physician explained, and (3) how thorough and careful the physician was during the last visit. RESULTS: Significant white-minority differences emerge more often in plans using capitation or gatekeeping than in other plans. The gaps in patients' evaluations of their primary care providers' (PCP) explanations and thoroughness between whites and Hispanics interviewed in English are larger when the PCP is capitated than when the PCP is not capitated. The gap in the evaluations of their PCP's explanations by whites and Hispanics interviewed in English is larger in plans that require referrals for specialist visits than in other plans. The magnitude of racial and ethnic/language-based gaps for Hispanics interviewed in Spanish, blacks, and Native American/Asian/Pacific Islanders do not differ by capitation and gatekeeping. CONCLUSION: English-speaking Hispanics' perceptions of the quality of primary care may be more dissimilar from whites' when capitation or gatekeeping are used than when these policies are not used.     

Justifications of physicians’ choice of action Attitudes among the general public,GPs, and oncologists in Sweden

Objective To compare choice of actions and justifying reasons among the general public, GPs and oncologists. Design A postal questionnaire using four vignettes: a healthy patient reluctant to quit smoking and one demanding an X-ray, a pulmonary cancer patient reluctant to quit smoking and one demanding immunotherapy. Subjects A random sample of the general public (n=1000), GPs (n=200), and oncologists (n=200). Main outcome measures The respondents’ choice of how the physician should act (general public)/would act (physicians), and, with reference to their choice of action, their justifying reasons. Results A majority answered that the physician should/would bring up the question about smoking cessation with the reluctant patient, justified by promotion of medical benefit and protection from harm. With reference to the reluctant cancer patient every second oncologist and every third GP would not mention smoking cessation, justified by respect for self-determination and enhancement of the relationship. Facing the patient demanding a new X-ray the general public was more in favour while the physicians rejected it. One-third of the general public answered that the seriously ill patient's demand for immunotherapy should be granted and referred to respect for self-determination and enhanced relationship. A majority of the physicians rejected such a demand, justified by promotion of a fair distribution of resources. Conclusion The fear of infringing the patient's right to self-determination and harming the relationship is exaggerated by physicians. They are mostly expected to bring up smoking cessation with a reluctant patient. How to manage demanding patients is more controversial.