2,790,112 research outputs found
Views of patients with multi-morbidity on what is important for patient-centered care in the primary care setting
__Background:__ Patient-centered care (PCC) has been proposed as the way forward in improving primary care for
patients with multi-morbidity. However, it is not clear what PCC exactly looks like in practice for patients with multimorbidity.
A better understanding of multi-morbid patientsâ views on what PCC should look like and which
elements are most important may help to improve care delivery for this vulnerable population. The present study
thus aimed to identify views of patients with multi-morbidity on the relative importance of PCC aspects in a Dutch
primary care setting.
__Methods:__ Interviews were conducted with 16 patients with multi-morbidity using Q-methodology, which
combines quantitative and qualitative analyses. The participants ranked 28 statements about the eight dimensions
of PCC (patientsâ preferences, information and education, access to care, emotional support, family and friends,
continuity and transition, physical comfort, and coordination of care) by relative importance. By-person factor
analysis using centroid factor extraction and varimax rotation were used to reveal factors that represent viewpoints.
Qualitative interview data were used to interpret the viewpoints.
__Results:__ The analyses revealed three factors representing three distinct viewpoints of patients with multi-morbidity
on what is important for patient-centered care in the primary care setting. Patients with viewpoint 1 are prepared
proactive patients who seem to be well-off and want to be in charge of their own care. To do so, they seek medical
information and prefer to be supported by a strongly coordinated multidisciplinary team of healthcare
professionals. Patients with viewpoint 2 are everyday patients who visit GPs and require well-coordinated, respectful,
and supportive care. Patients with viewpoint 3 are vulnerable patients who are less resourceful in terms of
communication skills and finances, and thus require accessible care and professionals taking the lead while treating
them with dignity and respect.
__Conclusion:__ The findings of this study suggest that not all patients with multi-morbidity require the same type of
care delivery, and that not all aspects of PCC delivery are equally important to all patients
Exploring patient and family satisfaction in pediatric neurological surgery
Introduction Patient and family satisfaction during outpatient visits is correlated with a continuance of care and likelihood to recommend the practice to others. Additionally, patient-family satisfaction can determine the success of the practice and influence medical outcomes. Utilizing a well-validated surveys instrument, patient and family satisfaction can be explored in the office setting. Methods During a consecutive 36 month period, a standardized and validated patient satisfaction survey instrument was provided to the family members of patients who presented to two pediatric neurosurgery clinics associated with Nemours Children\u27s Health System. The completed surveys were analyzed statistically to identify correlations between overall satisfaction, defined as âLikelihood to Recommend (LTR) the Practiceâ, and relevant practice and provider variables. Results The factors that exhibited the greatest correlation to LTR were: âCheerfulness of Practiceâ (r = 0.74), âAbility to Get Desired Appointmentâ (r = 0.70), âLikelihood of Recommending Care Providerâ (r = 0.65), âStaff Worked Togetherâ (r = 0.65), and âWaiting Area Comfort and Pleasantnessâ (r = 0.60). Discussion and conclusions Patient and family satisfaction surveys are useful for gaining insight into pediatric neurosurgical practices. Data from this cohort suggest that the environment in which patient care is delivered, timeliness of appointments and positive perceptions of the healthcare team correlate most strongly with overall satisfaction. © 201
Reviving Full-Service Family Practice in British Columbia
Describes innovative operational reforms made in the province's fee-for-service system to improve quality of care and reduce costs, including incentive payments for chronic disease management and enhanced training. Outlines lessons learned and challenges
Evidence-based rules from family practice to inform family practice; The learning healthcare system case study on urinary tract infections
Background: Analysis of encounter data relevant to the diagnostic process sourced from routine electronic medical record (EMR) databases represents a classic example of the concept of a learning healthcare system (LHS). By collecting International Classification of Primary Care (ICPC) coded EMR data as part of the Transition Project from Dutch and Maltese databases (using the EMR TransHIS), data mining algorithms can empirically quantify the relationships of all presenting reasons for encounter (RfEs) and recorded diagnostic outcomes. We have specifically looked at new episodes of care (EoC) for two urinary system infections: simple urinary tract infection (UTI, ICPC code: U71) and pyelonephritis (ICPC code: U70). Methods: Participating family doctors (FDs) recorded details of all their patient contacts in an EoC structure using the ICPC, including RfEs presented by the patient, and the FDs' diagnostic labels. The relationships between RfEs and episode titles were studied using probabilistic and data mining methods as part of the TRANSFoRm project. Results: The Dutch data indicated that the presence of RfE's "Cystitis/Urinary Tract Infection", "Dysuria", "Fear of UTI", "Urinary frequency/urgency", "Haematuria", "Urine symptom/complaint, other" are all strong, reliable, predictors for the diagnosis "Cystitis/Urinary Tract Infection". The Maltese data indicated that the presence of RfE's "Dysuria", "Urinary frequency/urgency", "Haematuria" are all strong, reliable, predictors for the diagnosis "Cystitis/Urinary Tract Infection". The Dutch data indicated that the presence of RfE's "Flank/axilla symptom/complaint", "Dysuria", "Fever", "Cystitis/Urinary Tract Infection", "Abdominal pain/cramps general" are all strong, reliable, predictors for the diagnosis "Pyelonephritis". The Maltese data set did not present any clinically and statistically significant predictors for pyelonephritis. Conclusions: We describe clinically and statistically significant diagnostic associations observed between UTIs and pyelonephritis presenting as a new problem in family practice, and all associated RfEs, and demonstrate that the significant diagnostic cues obtained are consistent with the literature. We conclude that it is possible to generate clinically meaningful diagnostic evidence from electronic sources of patient data
Training, status and migration of general practitioners / family physicians within Europe
The survey intended to explore and identify the
training background and status of general practitioners/
family physicians (GPs) in member countries within
EURACT (European Academy of Teachers in General
Practice/Family Medicine), and to gain an overview of
processes involved when GP-trained doctors migrate to
work in another member country. A questionnaire, with closed and open-ended
questions, was sent to representatives of all 39
EURACT-member countries in 2009. The main outcome
measures were the training background and status of
GPs in public/private settings in each country and the
requirements of additional training and testing when
migrating to another country. Forty-one completed questionnaires were received
from 31 (79%) of the EURACT countries. The data
indicate that specialist training for General Practice/
Family Medicine (GP/FM) is well established throughout
and generally required for appointment to public career
posts. The data also indicate that European Uniontrained
GPs can move freely to most countries with
usually no tests of medical knowledge or language
proficiency. Orientation to the healthcare system in the
destination country is usually not provided. work in public/private GP/FM posts in many European
countries, although new appointments to public posts
RESEARCH ARTICLE
Training, status and migration
of General Practitioners/Family
Physicians within Europe
in nearly all countries require specialist GP training.
It was not possible to identify a uniform or agreed
approach applied by employing agencies to confirm
the medical competence and language skills of migrant
doctors and to provide them with orientation to
healthcare systems. In the high-context dependent
discipline of GP/FM this is of concern.peer-reviewe
Commentary on Family-Directed Structural Therapy: Ten Years of Building on Family Strengths
This is an original and ground-breaking article because the authors have operationalized important concepts in family-centered thinking and practice, developed assessment tools that can be used for testing the validity of these concepts and then collected data from control and treatment groups of families in four very different service areas.
Nevertheless, the use of \u27structural family therapy\u27 in the title and design of instruments without grounding this research in the non-linear systems assumptions that are the hallmark of the literature on structural family therapy, obscures some of the theoretical and practice problems that are faced in family treatment today
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