Exploring Differences in Patient-Centered Practices among Healthcare Professionals in Acute Care Settings

There is limited evidence of the extent to which Healthcare professionals implement patient-centered care (PCC) and of the factors influencing their PCC practices in acute care organizations. This study aimed to (1) examine the practices reported by health professionals (physicians, nurses, social workers, other healthcare providers) in relation to three PCC components (holistic, collaborative, and responsive care), and (2) explore the association of professionals’ characteristics (gender, work experience) and a contextual factor (caseload), with the professionals’ PCC practices. Data were obtained from a large scale cross-sectional study, conducted in 18 hospitals in Ontario, Canada. Consenting professionals (n = 382) completed a self-report instrument assessing the three PCC components and responded to standard questions inquiring about their characteristics and workload. Small differences were found in the PCC practices across professional groups: (1) physicians reported higher levels of enacting the holistic care component; (2) physicians, other healthcare providers, and social workers reported implementing higher levels of the collaborative care component; and (3) physicians, nurses, and other healthcare providers reported higher levels of providing responsive care. Caseload influenced holistic care practices. Interprofessional education and training strategies are needed to clarify and address professional differences in valuing and practicing PCC components. Clinical guidelines can be revised to enable professionals to engage patients in care-related decisions, customize patient care, and promote interprofessional collaboration in planning and implementing PCC. Additional research is warranted to determine the influence of professional, patient, and other contextual factors on professionals’ PCC practices in acute care hospitals.     

Serious Mental Illness and Smoking Cessation Treatment Utilization: the Role of Healthcare Providers

The Journal of Behavioral Health Services & Research - Healthcare provider barriers to cessation resources may be undercutting quit rates for smokers with serious mental illness (SMI). The...     

Exploring the Phenomenon of Spiritual Care Between Hospital Chaplains and Hospital Based Healthcare Providers

Hospital chaplaincy and spiritual care services are important to patients’ medical care and well-being; however, little is known about healthcare providers’ experiences receiving spiritual support. A phenomenological study examined the shared experience of spiritual care between hospital chaplains and hospital-based healthcare providers (HBHPs). Six distinct themes emerged from the in-depth interviews: Awareness of chaplain availability, chaplains focus on building relationships with providers and staff, chaplains are integrated in varying degrees on certain hospital units, chaplains meet providers’ personal and professional needs, providers appreciate chaplains, and barriers to expanding hospital chaplains’ services. While HBHPs appreciated the care received and were able to provide better patient care as a result, participants reported that administrators may not recognize the true value of the care provided. Implications from this study are applied to hospital chaplaincy clinical, research, and training opportunities.     

Communication and Control: Hearing the Voices of Low-Income African American Adults to Improve Relationships with Healthcare Providers

ABSTRACT

Patient-provider relationships can either impede or encourage patient utilization of healthcare services and adherence to treatment. Given the significant health disparities found among low-income African Americans, it is imperative to understand this population’s experiences with healthcare providers and how to improve their patient-provider relationships in order to increase successful treatment outcomes. Relationship management is a well-tested theory that examines factors that improve outcomes between organizations and their publics. This exploratory study uses relationship management theory to understand how African Americans who are medically underserved perceive the quality of their relationships with healthcare providers. Focus groups were held with low-income African American adults. Findings reveal that communication is key to improving trust, but other characteristics needed for a quality relationship were lacking, particularly perceived commitment, which impedes better healthcare. The low-income, medically underserved context influenced participant perceptions of factors such as commitment, but participants also expressed efficacy in feeling in control of healthcare situations, which may help them maintain quality relationships. This study offers theoretical elaboration as well as practical suggestions for how providers may wish to address an important population of patients through communication.     

Quality Improvement in Healthcare Delivery Utilizing the Patient-Centered Medical Home Model

Despite the fact that the United States dedicates so much of its resources to healthcare, the current healthcare delivery system still faces significant quality challenges. The lack of effective communication and coordination of care services across the continuum of care poses disadvantages for those requiring long-term management of their chronic conditions. This is why the new transformation in healthcare known as the patient-centered medical home (PCMH) can help restore confidence in our population that the healthcare services they receive is of the utmost quality and will effectively enhance their quality of life. Healthcare using the PCMH model is delivered with the patient at the center of the transformation and by reinvigorating primary care. The PCMH model strives to deliver effective quality care while attempting to reduce costs. In order to relieve some of our healthcare system distresses, organizations can modify their delivery of care to be patient centered. Enhanced coordination of services, better provider access, self-management, and a team-based approach to care represent some of the key principles of the PCMH model. Patients that can most benefit are those that require long-term management of their conditions such as chronic disease and behavioral health patient populations. The PCMH is a feasible option for delivery reform as pilot studies have documented successful outcomes. Controversy about the lack of a medical neighborhood has created concern about the overall sustainability of the medical home. The medical home can stand independently and continuously provide enhanced care services as a movement toward higher quality care while organizations and government policy assess what types of incentives to put into place for the full collaboration and coordination of care in the healthcare system.     

Perceptions of Health Care Providers' Communication: Relationships Between Patient-Centered Communication and Satisfaction

Specific communication practices of multiple professionals in health care settings can impact patient outcomes. This study, conducted at a large Children's Hospital, sought to determine the extent to which patient-centered communication (PCC) affected satisfaction with communication and with care itself. Parents of child patients (N = 195) reported on the communication practices of physicians, nurses, and hospital staff members during their most recent stay in the hospital. Surveys were completed on site. Health care providers' use of PCC behaviors, especially immediacy and perceived listening, was positively associated with satisfaction with care and with communication. In addition, PCC behaviors were perceived to be used more frequently with children in better health than with children with poorer health status.     

Patient-Centered Prenatal Counseling: Aligning Obstetric Healthcare Professionals With Needs of Pregnant Women

The first trimester aneuploidy screen (FTS) continues to be a leading approach to identify the risk of fetal aneuploidy. This study evaluated how obstetric (OB) professionals counsel women about FTS as one of a growing number of options to assess fetal health. A survey was completed by OB professionals (board-certified obstetrician/gynecologists and certified nurse midwives) between February and March 2011: (1) to identify knowledge and practice patterns with regard to FTS, and (2) to compare pregnant women’s educational needs and decision-making preferences with clinicians’ perceptions of these factors. A total of 216 surveys (11 percent) were completed by OB professionals and analyzed. Several barriers to effective patient counseling were identified, including gaps in obstetric professionals’ mastery of the screening test characteristics and variable approaches to discuss concepts of aneuploidy risk. OB participants reported limited confidence in discussing patient-valued topics, specifically post-screen options and pregnancy termination. Discordance was identified between OB professionals’ perceptions of pregnant women’s educational needs and decision-making preferences specific to FTS and historical data recently collected from 139 pregnant women who underwent the FTS. Study findings illustrate the need for clinician-targeted strategies to support pregnant women as they formulate informed decisions about the tests that may have a salient impact on their prenatal care decisions.     

The Role of the Healthcare Chaplain: A Literature Review

Healthcare chaplains operate in many healthcare sites internationally and yet their contribution is not always clearly understood by medical and healthcare staff. This review aims to explore the chaplains’ role in healthcare, with a view to informing best practice in future healthcare chaplaincy. Overall the extent of the provision and staffing of chaplaincy service internationally is unclear. From this review, several key spiritual and pastoral roles in healthcare emerge including a potential contribution to ethical decision making at the end of life. Healthcare chaplains are key personnel, already employed in many healthcare organizations, who are in a pivotal position to contribute to future developments of faith-based care, faith-sensitive pastoral, and spiritual care provision. They also have a new and evolving role in ethical support of patient, families and healthcare teams.     

Asthma Friendly Pharmacies: A Model to Improve Communication and Collaboration among Pharmacists,Patients, and Healthcare Providers

Pharmacists, with expertise in optimizing drug therapy outcomes, are valuable components of the healthcare team and are becoming increasingly involved in public health efforts. Pharmacists and pharmacy technicians in diverse community pharmacy settings can implement a variety of asthma interventions when they are brief, supported by appropriate tools, and integrated into the workflow. The Asthma Friendly Pharmacy (AFP) model addresses the challenges of providing patient-focused care in a community pharmacy setting by offering education to pharmacists and pharmacy technicians on asthma-related pharmaceutical care services, such as identifying or resolving medication-related problems; educating patients about asthma and medication-related concepts; improving communication and strengthening relationships between pharmacists, patients, and other healthcare providers; and establishing higher expectations for the pharmacist’s role in patient care and public health efforts. This article describes the feasibility of the model in an urban community pharmacy setting and documents the interventions and communication activities promoted through the AFP model.     

Mediating Role of Social Competence: Family Communication and Body Satisfaction among Male College Students

This study examined whether social competence mediates the association between family communication and undergraduate males’ body satisfaction. Male undergraduate students (N = 442) completed an online survey assessing their perceptions of mothers’ as well as fathers’ family communication patterns (FCPs), social competence, and body satisfaction. Results generally supported the hypothesized model. Conversation orientation, regardless of whether mothers’ or fathers’, was positively associated with social competence, which, in turn, was positively related to body satisfaction. On the other hand, the role of conformity orientation in predicting males’ body satisfaction varied by parental sex (mothers or fathers): Mothers’ conformity orientation was associated with body satisfaction through social competence in an expected manner, whereas fathers’ conformity orientation was related to none of the endogenous variables. However, once mothers’ FCPs were eliminated from the model, fathers’ conformity orientation became a direct as well as indirect predictor of sons’ body satisfaction through social competence. Interpretations of the findings, practical implications, and a future direction are discussed.     

Effects of Temporal Framing on Response to Antismoking Messages: The Mediating Role of Perceived Relevance

This study tested the effect of temporal framing on young adult smokers’ response to antismoking communication messages. In two studies using largely identical designs, young adult smokers recruited from a large university (n = 52) and Amazon Mechanical Turk (n = 210) were exposed to either no messages or messages featuring different temporal frames. Analysis of the combined data (N = 262) showed that framing the health consequences of smoking in a proximal (vs. distal) time frame led to greater perceived message relevance, less use of heuristic processing, greater use of systematic processing, greater positive affect, and more intense fear. Mediation analysis showed that perceived relevance was a significant mediator of the effect of temporal framing on message processing and emotional responses. In separate analysis of the Amazon Mechanical Turk data, the proximal frame also showed a consistent pattern of stronger impact on behavioral intentions compared to the distal frame, but the difference was only significant on the measure of intending to try to quit. Overall, findings of this study suggest that using proximal (vs. distal) frames may enhance receptivity to antismoking messages among young adult smokers, although the behavioral impact of this framing strategy still awaits further research.     

信息技术在医疗服务贸易中的作用

信息技术的应用，对医疗服务贸易的发展产生巨大的推动力。信息技术帮助完成不同形式的跨境合作，医疗服务贸易不仅在发达国家之间，而且在发达国家与发展中国家，以及发展中国家相互之间广泛开展。     

Exploring the Experiences of Child Welfare-Focused Therapeutic Service Providers

The Journal of Behavioral Health Services & Research - The importance of mental and behavioral health for child welfare clients is well-documented; yet, little is known about the challenges...     

Perspectives on the Role of Patient-Centered Medical Homes in HIV Care

To strengthen the quality of HIV care and achieve improved clinical outcomes, payers, providers, and policymakers should encourage the use of patient-centered medical homes (PCMHs), building on the Ryan White CARE Act Program established in the 1990s.The rationale for a PCMH with HIV-specific expertise is rooted in clinical complexity, HIV’s social context, and ongoing gaps in HIV care. Existing Ryan White HIV/AIDS Program clinicians are prime candidates to serve HIV PCMHs, and HIV-experienced community-based organizations can play an important role.Increasingly, state Medicaid programs are adopting a PCMH care model to improve access and quality to care. Stakeholders should consider several important areas for future action and research with regard to development of the HIV PCMH.Combination antiretroviral therapy (ART) is critical to the management of HIV/AIDS because it improves survival of HIV-infected persons1,2 and reduces rates of both sexual and mother-to-child transmission of disease.3,4 Adherence to ART decreases the average mortality rate in people living with HIV (PLWH) by one half,2 reduces sexual transmission of HIV-1 in serodiscordant couples by 96%,4 and reduces the frequency of mother-to-child transmission to below 2%.3 Because of these clinical and preventive benefits, increasing access to ART and retention in care remains an important public health strategy.Unfortunately, the Centers for Disease Control and Prevention estimates that of the 1.1 million people living with HIV disease in the United States in 2012, only 37.0% were retained in HIV care.5 Only 25.0% of PLWH have achieved viral suppression (defined as a sustained viral load of ≤ 50 copies per mL).5,6 The Centers for Disease Control and Prevention considers ART with durable viral suppression key to a comprehensive HIV prevention strategy.7,8 Recent estimates show that increasing the HIV diagnosis rate (i.e., the percentage of individuals aware of their infection) to 90.0%, achieving 80.7% viral suppression in care, and obtaining full funding of behavioral interventions for PLWH could avert nearly 180 000 new infections by 2020.9Difficulties in accessing ART and achieving viral suppression stem from delayed diagnosis and other challenges to engagement and retention in care, such as substance use, unstable housing or homelessness, psychiatric disorders, language barriers, and incarceration.10,11 Regular adherence is crucial for long-term viral suppression, and missed doses or significant variation in dosage timing can lead to viral resistance that may portend treatment failure.12,13Serving PLWH through a patient-centered medical home (PCMH) may be a successful strategy for increasing the number of people who remain in care and achieve viral control. PCMH models, which have evolved over decades, focus on whole person care coordinated across all the elements of the health care system and the patient’s community.14 Both the National HIV/AIDS Strategy and the Patient Protection and Affordable Care Act include the PCMH as a valued strategy for accomplishing key goals of improving quality of care and cost containment.15–17The national rate of 25% viral suppression reflects a need for development and refinement of the PCMH specifically designed for PLWH, or the HIV PCMH. Stakeholders across the health care system—including providers and payers—should ensure that a growing proportion of PLWH enroll in a PCMH with specific HIV expertise that comprehensively meets their needs. An alternative policy direction would be to enroll PLWH into traditional PCMHs that address the full spectrum of primary care, although that alternative is suboptimal.     

Exploring The Migration Profiles of Primary Healthcare Users in South Africa

South Africa’s public healthcare system responses seldom engage with migration. Our exploratory study investigates migration profiles and experiences of primary healthcare (PHC) users. A cross-sectional survey involving non-probability sampling was conducted with 229 PHC users at six purposively selected PHC clinics in three districts of SA. The survey captured socio-demographic information, migration histories, and PHC experiences. Chi square and Fischer’s exact tests were used to compare categorical variables, whilst Mann–Whitney U tests compared continuous variables between groups. Most PHC users were migrants (22% internal South African; 45% cross-border) who generally move for reasons other than healthcare seeking. Length of time accessing services at a specific clinic was shown to be key in describing experiences of PHC use. Understanding population movement is central to PHC strengthening in SA and requires improved understanding of mobility dynamics in regard to not just nationality, but also internal mobility and length of stay.