Anthroposophic medical therapy in chronic disease: a four-year prospective cohort study

Background  

The short consultation length in primary care is a source of concern, and the wish for more consultation time is a common reason for patients to seek complementary medicine. Physicians practicing anthroposophic medicine have prolonged consultations with their patients, taking an extended history, addressing constitutional, psychosocial, and biographic aspect of patients' illness, and selecting optimal therapy. In Germany, health benefit programs have included the reimbursement of this additional physician time. The purpose of this study was to describe clinical outcomes in patients with chronic diseases treated by anthroposophic physicians after an initial prolonged consultation.     

Development and evaluation of a cultural competency training curriculum

Background  

Increasing the cultural competence of physicians and other health care providers has been suggested as one mechanism for reducing health disparities by improving the quality of care across racial/ethnic groups. While cultural competency training for physicians is increasingly promoted, relatively few studies evaluating the impact of training have been published.     

Self-rated health of primary care house officers and its relationship to psychological and spiritual well-being

Background  

The stress associated with residency training may place house officers at risk for poorer health. We sought to determine the level of self-reported health among resident physicians and to ascertain factors that are associated with their reported health.     

The experience of palliative patients and their families of a family meeting utilised as an instrument for spiritual and psychosocial care: A qualitative study

Background  

This study explores the experience of palliative patients and their family members of a family meeting model, utilised as an instrument for the provision of spiritual and psychosocial care. In doing so the study embraces a broad understanding of spirituality which may or may not include formal religious practice and a concept of psychosocial care that includes: social and emotional well-being, communication, self esteem, mental health and adaptation to illness. The meeting of spiritual and psychosocial needs is considered to be an important aspect of palliative care.     

Planning training seminars in palliative care: a cross-sectional survey on the preferences of general practitioners and nurses in Austria

Background  

Training in palliative care is frequently requested by health care professionals. However, little is known in detail about the subject matters and the educational preferences of physicians and staff or assistant nurses in this field.     

Dealing with suicidal patients – a challenging task: a qualitative study of young physicians' experiences

Background  

Suicide is a major public health problem and treating suicidal patients represents one of the most challenging and complex clinical situations for young physicians. Education of physicians is considered an important strategy in suicide prevention. Young physicians often meet suicidal patients early in their career. Limited information is available about how newly educated physicians experience treating suicidal patients. The aim of the study was to shed light on the meaning of newly educated physicians' lived experiences in treating patients at risk of committing suicide.     

Subjective Social Status: Construct Validity and Associations with Psychosocial Vulnerability and Self-Rated Health

Background

Subjective social status (SSS) predicts health outcomes independently of traditional, objective indicators of socioeconomic status (SES). However, the potential confounding and mediating effects of negative affect and similar psychosocial risk and resilience factors have not been adequately addressed through formal studies of convergent and discriminant validity of SSS measures.

Purpose

The current study provides such a test of construct validity and subsequently examines whether psychosocial factors mediate the relationship between SSS and self-rated health.

Methods

We examined the convergent and discriminant validity of the MacArthur scales of SSS relative to measures of psychosocial risk and resilience (i.e., neuroticism, depressive symptoms, optimism, and marital quality) as well as SES (i.e., income) in 300 middle-aged and older married US couples. We also tested a factor of psychosocial vulnerability as a mediator of the relationship between SSS and self-rated health.

Results

Findings indicated clear convergent and discriminant validity of the MacArthur scales. Further, controlling age and income, both the US and community measures of SSS predicted psychosocial factors for men, however, only the community measure was independently predictive for women. Psychosocial vulnerability significantly mediated the pathway between SSS and self-rated health for men and women after controlling age and income.

Conclusions

These results provide strong support for the construct validity of the MacArthur scales and provide additional evidence of the role of psychosocial risk and resilience factors as mediators of the effects of SSS on health.     

A curriculum to teach medical students to care for people with disabilities: development and initial implementation

Background  

Effective communication skills and professionalism are critical for physicians in order to provide optimum care and achieve better health outcomes. The aims of this study were to evaluate residents' self-assessment of their communication skills and professionalism in dealing with patients, and to evaluate the psychometric properties of a self-assessment questionnaire.     

Personal health promotion at US medical schools: a quantitative study and qualitative description of deans' and students' perceptions

Background  

Prior literature has shown that physicians with healthy personal habits are more likely to encourage patients to adopt similar habits. However, despite the possibility that promoting medical student health might therefore efficiently improve patient outcomes, no one has studied whether such promotion happens in medical school. We therefore wished to describe both typical and outstanding personal health promotion environments experienced by students in U.S. medical schools.     

Unhealthy Behaviors in Adolescents: Multibehavioral Associations with Psychosocial Problems

Background

Several unhealthy behaviors are associated with psychosocial health in adolescents. Previous studies have shown that different adolescent health behaviors cluster, and, in order to understand these associations, it is important to investigate the relations between individual behaviors and psychosocial problems.

Purpose

This study addressed the research question “Are adolescent health behaviors associated with psychosocial problems, and to what extent do certain health behaviors confound the relations between other health behaviors and psychosocial problems in adolescents?”

Methods

Self-reported questionnaire data on a broad range of health behaviors and demographics were collected from 2,690 high school students in the Netherlands in September 2012.

Results

After adjustment for demographic characteristics, nearly all unhealthy behaviors were found to be significantly associated with psychosocial problems. However, after correction for confounding by other behaviors, psychosocial problems were associated with fewer behaviors, namely compulsive internet use and videogame playing, smoking, cannabis use, and being bullied. These associations differed in boys and girls.

Conclusions

In multibehavioral analyses adjusted for behavioral clustering, which can cause considerable interbehavioral confounding, several behaviors were associated with psychosocial problems in adolescents. This approach to behavior analysis provides a better insight into behaviors and psychosocial health, and the specific associations identified can be utilized when designing effective prevention programs, such as health-promoting school interventions.     

Evaluation of an inter-professional workshop to develop a psychosocial assessment and child-centred communication training programme for paediatricians in training

Background  

The quality of psychosocial assessment of children in consultations varies widely. One reason for this difference is the variability in effective mental health and communication training at undergraduate and post-qualification levels. In recognition of this problem, the Royal College of Paediatrics and Child Health in the United Kingdom have developed the Child in Mind Project that aims to meet this deficit in medical training. This paper describes the evaluation of a workshop that explored the experiences and expectations of health care professionals in the development of a training programme for doctors.     

Validation of a theory-based instrument measuring patient-reported psychosocial care by physicians using a multiple indicators and multiple causes model

Objective

The purpose of this study is the further validation of an existing instrument for measuring patient-reported psychosocial care by physicians using a multiple indicators and multiple causes model, to estimate the association of construct values with its antecedent causes as well as consequences simultaneously.

Methods

A written questionnaire was answered by 2470 patients (response rate, 52.9%) who were treated in the year 2000 in six hospitals in Germany.

Results

Estimation of the multiple indicators and multiple causes model produced an acceptable model fit (Tucker–Lewis index = .940, comparative fit index = .943 and root mean square error of approximation = .060). The latent construct of psychosocial care by physicians predicted the construct of patient satisfaction by 83% (beta = 0.91), trust in physicians by 85% (beta = .92), and image of the hospital by 69% (beta = .83).

Conclusion

Based on our multiple indicators and multiple causes model instrument's reported psychometric characteristics and on initial validity indicators, psychosocial care by physicians can be regarded as an adequate measure for further use in outcome research.

Practice Implications

The scale psychosocial care by physicians can be used as a valid instrument in regard to quality assessment and assurance.     

Parental Overprotection and Heart-Focused Anxiety in Adults with Congenital Heart Disease

Background  

The care of adult patients with congenital heart disease (CHD) is challenging from a mental health perspective, as these patients continue to face a variety of biopsychosocial issues that may impact emotional functioning. Despite these issues, there are limited data on the psychosocial functioning of adults with CHD, and there are no data on the impact of parental overprotection on heart-focused anxiety in this patient population.     

Perspectives of Family Physicians on Computer-assisted Health-risk Assessments

Background

The firsthand experience of physicians using computer-assisted health-risk assessment is salient for designing practical eHealth solutions.

Objective

The aim of this study was to enhance understanding about computer-assisted health-risk assessments from physicians’ perspectives after completion of a trial at a Canadian, urban, multi-doctor, hospital-affiliated family practice clinic.

Methods

A qualitative approach of face-to-face, in-depth, semi-structured interviews was used. All interviews were audio recorded and field notes taken. Analytic induction and constant comparative techniques were used for coding and analyses. Interpretation was facilitated by peer audit and insights gained from the social exchange theoretical perspective.

Results

Ten physicians (seven female and three male) participated in the interviews. Three overarching themes emerged in relation to computer-assisted health-risk assessments: (1) perceived benefits, (2) perceived concerns or challenges, and (3) feasibility. Physicians unanimously acknowledged the potential of computer-assisted health-risk assessments to open dialogue on psychosocial health risks. They also appreciated the general facilitative roles of the tool, such as improving time-efficiency by asking questions on health risks prior to the consultation and triggering patients’ self-reflections on the risks. However, in the context of ongoing physician-patient relationships, physicians expressed concerns about the impact of the computer-assisted health-risk assessment tool on visit time, patient readiness to talk about psychosocial issues when the purpose of the visit was different, and the suitability of such risk assessment for all visits to detect new risk information. In terms of feasibility, physicians displayed general acceptance of the risk assessment tool but considered it most feasible for periodic health exams and follow-up visits based on their perceived concerns or challenges and the resources needed to implement such programs. These included clinic level (staff training, space, confidentiality) and organizational level (time, commitment and finances) support.

Conclusions

Participants perceived computer-assisted health-risk assessment as a useful tool in family practice, particularly for identifying psychosocial issues. Physicians displayed a general acceptance of the computer tool and indicated its greater feasibility for periodic health exams and follow-up visits than all visits. Future physician training on psychosocial issues should address physicians’ concerns by emphasizing the varying forms of “clinical success” for the management of chronic psychosocial issues. Future research is needed to examine the best ways to implement this program in diverse clinical settings and patient populations.

Trial Registration

ClinicalTrials.gov {"type":"clinical-trial","attrs":{"text":"NCT00385034","term_id":"NCT00385034"}}NCT00385034; http://clinicaltrials.gov/ct2/show/{"type":"clinical-trial","attrs":{"text":"NCT00385034","term_id":"NCT00385034"}}NCT00385034 (Archived by WebCite at http://www.webcitation.org/5pV8AGRgt)     

Peer assessment of outpatient consultation letters – feasibility and satisfaction

Background  

Written correspondence is one of the most important forms of communication between health care providers, yet there is little feedback provided to specialists. The objective of this study was to determine the feasibility and satisfaction of a peer assessment program on consultation letters and to determine inter-rater reliability between family physicians and specialists.     

Well-being in residency training: a survey examining resident physician satisfaction both within and outside of residency training and mental health in Alberta

Background  

Despite the critical importance of well-being during residency training, only a few Canadian studies have examined stress in residency and none have examined well-being resources. No recent studies have reported any significant concerns with respect to perceived stress levels in residency. We investigated the level of perceived stress, mental health and understanding and need for well-being resources among resident physicians in training programs in Alberta, Canada.     

Psychosocial and demographic characteristics relating to vaccine attitudes in Australia

Objective

Distrust in vaccination is a public health concern. In responding to vaccination distrust, the psychosocial context it occurs in needs to be accounted for. But this psychosocial context is insufficiently understood. We examined how Australians’ attitudes to childhood vaccination relate to broader psychosocial characteristics pertaining to two key areas: health and government.

‘Adaptive’ Psychosocial Factors in Relation to Home Blood Pressure: A Study in the General Population of Southern Netherlands

Background  

Evidence is accumulating for an association between psychosocial stress and elevated blood pressure. However, studies focusing on adaptive psychosocial factors are scarce.     

Relationships Between Cardiorespiratory Fitness,Physical Activity,and Psychosocial Variables in Overweight and Obese Breast Cancer Survivors

Background  

Breast cancer survivors not only experience distressing physical symptoms associated with treatments, but also are faced with psychosocial challenges. Despite growing scientific evidence that physical activity (PA) may mitigate psychosocial distress experienced by women treated for breast cancer, the literature is equivocal.     

Speech recognition software and electronic psychiatric progress notes: physicians' ratings and preferences

Background  

The context of the current study was mandatory adoption of electronic clinical documentation within a large mental health care organization. Psychiatric electronic documentation has unique needs by the nature of dense narrative content. Our goal was to determine if speech recognition (SR) would ease the creation of electronic progress note (ePN) documents by physicians at our institution.