Exam 3: Patient care and healing Flashcards
why do people seek treatment? (4)
- Fear of symptoms
- Number and severity of symptoms
- Symptoms effects on work, recreational activities, plans and goals, and relationships
- Social sanctioning by employer or family and friends ⇒you may want to ignore it but others won’t
how is treatment delayed? (3)
- appraisal
- illness
- utilization
appraisal delay
occurs when we are slow to recognize we are having symptoms
- fatigue due to late nights instead of an infection
illness delay
recognize we are ill but haven’t decided we are ill enough to go to the clinic
utilization delay
when we know we should see a doctor and plan to go but havent taken steps to make it happen
reasons for delay (7)
- Misinterpretation of symptoms
- Fear of false alarms
- Concerns of being a burden to someone
- Interruption of plans ⇒ inconvenient
- Many things to be done and arranged before a hospital stay
- Financial concerns
- Insurance concerns
patient provider relationship components (7)
- Communication
- Evaluation
- Diagnosis
- Education ⇒ you to provider about symptoms and provider to you about condition and treatment options
- Decision making ⇒ based on evaluation, diagnosis, and education
- Treatment
- Feedback and reevaluation
interaction styles
- active provider and passive patient
- guidance based provider and cooperative patient
- mutual cooperation (most used)
medical communication categories (3)
- content
- process
- emotion
content in medical communication
related to the medical condition or about the patient more broadly
- When pain begins, are there family members who are around, information like medication specifics, etc.
process in medical communication
used to facilitate a better exchange
- Ask the patient if they understand, use encouraging phrases, etc. to orient patient about medical visit and appointment
emotion in medical communication
provider shows warmth, concern, empathy, etc. difficulties created by diagnosis or illnesses
relationship obstacles for the patient (6)
- Visit length ⇒ 15-20 minutes
- Doctor interruption, inattentiveness, and depersonalization
- Use of jargon and terminology
- Patient anxiety, pain, and embarrassment
- Literacy issues
- Cultural differences/stereotypes
relationship obstacles for the provider (6)
- Tight schedule and waiting patients
- Patient limited or biased disclosure
- Patient beliefs and self treatment
- Lack of feedback
- Literacy issues ⇒ what patients need to do for testing and treatment
- Cultural differences ⇒ different illness beliefs, uncomfortable, disclosure rules, etc.
What is the overall rate of non adherence for patients?
15-93% => average is 26%
non adherence across healthcare for patients (5)
- Antibiotic use ⇒ ⅓
- Missed health behavior appointments ⇒ 50-60%
- Cardiac patient ⇒ 25-34%
- Behavior change ⇒ 80%+
- Medication ⇒ 85%
creative nonadherence
when patients change their dosages or intake of medications
what makes nonadherence worse? (4)
- Treatment is long, complex, or frequent
- Treatment interferes with life activities
- Family is in distress or disorganized ⇒ unpredictable schedules
- Patient has lower literacy, or income, or is depressed
what are patient complaint domains? (3)
- Clinical ⇒ quality and safety
- Management ⇒ institution and timing/access (how care is manages and treatment availability)
- Relationships ⇒ communication and humaneness and patient rights
→ more financial and billing complains in the US where 39% were about communication
medical malpractice study
Levinson et al. 1997
- 59 primary care (family or internal medicine), mid to late career doctors ⇒ categorized by lawsuit history of >2 or 0
- Audio recordings, 10 visits per doctor
- Blind coded for content, process, and emotional content
6 features of national academy of medicine quality care?
- safe
- effective
- timely
- efficient
- equitable
- patient centered
safety according to NAM
avoiding harm to patients from the care intended to help them
effectiveness according to NAM
providing services based on scientific knowledge and refraining from providing service to those not likely to benefit ⇒ underuse and misuse avoidance
timeliness according to NAM
reducing waits and harmful delays for those receiving and giving care
efficiency according to NAM
avoiding waste of equipment, supplies, ideas, energy
equitability according to NAM
care that does not vary in quality because of personal characteristics like gender, ethnicity, geography, SES
patient centeredness according to NAM
respectful of and responsive to individual patient preferences, needs, and values ⇒ ensuring patient values guide all decisions
patient and family centered care (PFCC)
based on deep respect for patients as unique living beings and the obligation to care for them on their own terms
- Patients are known as persons in context of their own social world, listened to, informated, respected, and involved in their care ⇒ their wishes are honored during their healthcare journey (but not mindlessly enacted)
patient and family centered care principles (5)
- Listening to patients and families
- Establishing relationships with patients and families
- Sharing information
- Facilitating choice
- Patient involvement in decisions and treatment
components for patient centered medical home (PCMH) (5)
- Comprehensive care
- Patient centered care
- Coordinated care
- Accessible services
- Quality and safety
→ transform primary care ⇒ guidelines and tools
comprehensive care
physicians, advanced nurses, social workers, educators, care coordinators, nutritionists, etc. ⇒ may be virtual teams too
patient centered care
healthcare that is relationship based oriented toward the whole person ⇒ understanding and respecting each patients unique needs, culture, and practices
coordinated care
primary care coordinates across broader elements like specialty, hospital, home health care, and community care
- Discharged patients need this
accessible services
shorter waiting times for urgent needs, enhanced in person hours, telephone, electronic access, alternative methods of communication like calls or emails
quality and safety
commitment to quality and quality improvement such as evidence based medicine and clinical decision support tools
- Health management, satisfaction, data, improvement activities, etc.
patient centered care outcomes (5)
- Symptoms improvement
- Health status
- Patient satisfaction
- Patient self management
- Medical adherence
health outcome assesments
self report and objective assessment ⇒ assessed by clinicians or found in medical records
what did the systematic review of patient experience ratings find after communication training? (3)
⅔ of the associations are positive:
- Adherence ⇒ 1.6 x higher with communication training
- Preventive service use ⇒ screening services and immunizations
- Safety ⇒ reductions in bed sores and infections
Note: especially strong for medical adherence
what were components of the systematic review of randomized control trials for communication training?
provider focused intervention ⇒ communication training
- Motivation, empathy, and communications
- Printed materials as well as feedback to providers and communication coaching to patients ⇒ objectively measured
outcomes of the systematic review for provider focused interventions (6)
- HRQOL
- Pain relief
- Anxiety and depression
- Weight loss
- Blood pressure
- Smoking cessation
→ small, but significant effects ⇒ there are rarely 1 completely determining factor
how are care and outcomes related? Directly and indirectly?
- May directly affect health outcomes or may have an indirect influence on psychological changes or influence the way a patient uses resources
- Differs on context and outcome of interest
components of communication between patients and providers (3)
- Information exchange
- Relationship development
- Support for self management
why is PFCC right regardless of medical outcome due to ethics
- This care should be the goal because it is ethically right
- It would be difficult to get all practices to invest time and resources without incentive
- Medicare payments are now linked to patient and caregiving experiences for health professionals
what can providers do for patients? (12)
- Show warmth ⇒ greet with a smile, address by name and say goodbye with their name
- Give process and orientation info ⇒ what happens during the visit and instructions you need from them (surgery buddy)
- Slow down and use simple language ⇒ no jargon but no baby talk
- Limit info and repeat it, use teach/show back ⇒ just give essentials and repeat them, have them repeat back (teach back) which helps with memory and check for misunderstanding
- Show or draw pictures ⇒ helps with understanding and memory
- Listen and show empathy ⇒ eye contact, repeating back, expressing concern/understanding
- Provide a shame free environment ⇒ keep judgement out of the encounter which blocks empathy and understanding as well as prevents patients from sharing information
- Encourage questions
- Support patient participation and self management ⇒ give symptom lists and goal setting with patient
- Engage family members ⇒ provide, gather, and be part of the treatment plan when appropriate
- Engage the community ⇒ host/participate in community health events, info booths, etc.
- Consider using technology for support and follow up
what are the 4 questions providers should ask?
- What is the worst thing about your health situation
- What in your life helps to make the situation better
- What does medical care do that helps make the situation better
- What does medical care do that doesn’t help your situation or makes it worse
what is the STEPS program?
free online training module for medical practices
- 49 modules for making improvement
- CME credit for providers
- Developed by stanford university school of medicine
what are the 3 target domains for medical practice transformation
- interpersonal
- clinical
- structural
→ useful for identifying domains of change for patients ⇒ these are not exclusive and can overlap with one another
interpersonal
affect the relationship between the providers and patients
- Listening, creating an atmosphere of trust, welcoming participation of family and friends, etc.
clinical
affect the provision of care
- Shared decision making, supporting self management, coordinating community resources-
structural
aspects of the clinical environment
- Providing a calm and welcoming space, making an easy appointment process, supporting the patient and clinician before, during, and after encounters with information technology
cultural competency
greater cultural competency leads to better patient care based on physicians understanding of various cultures and extending their knowledge during treatments
what did Truong, Pradies, and Priest do?
reviewed 19 different reviews for interventions designed to increase access and effectiveness of healthcare service to people of various cultural and ethnic backgrounds
- used provider training for cultural knowledge, attitude awareness and change, skills to increase trust and disclosure of symptoms, beliefs, explanations, and behaviors
what was the results of Truong, prides, and priest studies? Most effective method?
provider behavior improved from the interventions => more modest changes in patient outcomes
- most effective method to change patient behaviors were culturally specific patient navigators and community health workers was the most effective for changing behaviors and access utilization ⇒ people who can provide translation and guidance during medical visits
Mobile health (mHealth)
technology used to support patient health ⇒ most common is SMS aka text messaging to patients
- Second most common is specialized applications like symptom checks, food diaries, and patient education ⇒ some added BPM’s, glucometers, and others
what does review of mHealth show for patient inprovement? (3)
- 27 RCTs for patient care, 56% improved
- 41 RCTs disease specific outcome, 39% improved ⇒ diabetes, chronic lung disease, CVD
- 40% used SMS, 23% used specialized apps
what is mHealth usability like? (3)
- Diverse populations, including low income, elderly, and bilingual
- Reported good comprehension and satisfaction
- Some did have difficulty with technology or device
what is patient care and participation like for mHealth? (4)
- Led to increased self management awareness and disease knowledge
- Increased patient confidence and sense of control
- Decreased anxiety because of feeling monitored
- Less burdened and evaluated than by a clinical visit
what social media apps are most frequently used for healthcare information?
Facebook, blogs, Twitter, and YouTube
what is the biggest benefit of social media healthcare information?
increased accessibility ⇒ information, symptoms regardless of geography
what is the biggest limitation of social media healthcare information?
information quality and consistency ⇒ sources differ and so does information
what are benefits and limitations of social media use?
Social media use data is important to reduce stigmas and provide consultations
- Benefits include accessibility, social support, and social interaction
- Limitations differ across groups but all users have concerns about information quality, reliability, and privacy ⇒ risk inadequate diagnosis and treatment
recommendations to help patients improve their medical care (8)
- Tell your story well ⇒ clear, complete, and accurate
- Be a good historian ⇒ when your symptoms started, treatments tried, progression of illness, medical history in the family, etc.
- Be a good record keeper ⇒ test results, referrals, admissions, medications, etc.
- Be an informed consumer ⇒ illness (read about it), procedures, medications (generic and brand names, time to take, amount to take, side effects, food/drug interactions)
- Take charge of managing your health ⇒ use the ask me 3 questions recommended to ask when you have an appointment (make sure all doctors know what others are planning)
- Know the test results ⇒ don’t assume no news is good news, find out what to do next
- Follow up ⇒ see when you should follow up, what to expect of treatment, what to do with new symptoms or feeling worse
- Make sure it is the right diagnosis ⇒ ask what else it could be not just the most likely thing
what 3 questions should you ask when taking charge of maintaining your health?
- What is my main problem
- What do I need to do
- Why is it important to do so
what is the power of place?
Can inspire, motivate, encourage, relax, and restore patients/families
what was the first research done on place in medical facilities?
Ulrich 1980’s
- patients were assigned to 2 types where 1 had trees and others had a brick wall
Nature view had shorter hospital stays, less medication, fewer post op complications
what did we have in ancient modern medicine?
appreciation in environment for aiding healing
- There is acknowledgement into the 19th century in healing resorts by lakes or seasides where fresh air is encouraged
what are evidence based design (EBD) components? (6)
Environmental features that benefit patients
- Identical rooms ⇒ routine tasks are easier and reduce medical errors
- Single bed rooms ⇒ less infection
- Easy clean furniture ⇒ less infection
- Lighting ⇒ medicine dispensing errors
- Automated sinks ⇒ increase time staff spend washing their hands but with limitations
- Non slip floors and support rails ⇒ reduce patient falls and injuries on the way to bathrooms where most injuries take place
what are 2 levels of EBD control?
- patient control
- noise control
patient control
patient uses a tablet to control beds, lights, window shades, room temp, television, and access to medical records
noise control
noise from staff, other patients talking, medical equipment are associated with slower recovery and less comfort and reduced sleep
- Also reverberated sounds which bounce off of smooth surfaces ⇒ Wall covering and carpets reduce this
how do we connect EBD and nature?
- Visual distraction
- Natural art ⇒ most helpful
- Real nature
what happens when patients see real nature from their hospital room?
patients prefer windows that look at nature and human activity
- Less delusions and hallucinations
- Everyone prefers to be surrounded by a natural setting ⇒ gardens help with pain, satisfaction, and navigation through healthcare environment
