Mature Adults at the GP : Length of Visit and Patient Satisfaction—Associations with Patient, Doctor, and Facility Characteristics

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Mature Adults at the GP: Length of Visit and Patient Satisfaction—Associations with Patient, Doctor, and Facility Characteristics

Background and objectives: The consultation time for more mature adults is often perceived as longer, increasing with the patient’s age and boosting their satisfaction with the visit. However, factors determining patient satisfaction (PS) or the consultation time (CT) in the population aged 50+ are not clearly identified. A cross-sectional design was used to identify factors specific to the facility (e.g., size, staff turnover), doctor (e.g., seniority, workload), and patient (e.g., self-rated health, impairment of activities) that are related to PS and the CT. Our secondary focus was on the relation of PS to the CT along with the role of the patient’s age and gender for both. Materials and Methods: Doctors (n = 178) and their 1708 patients (aged 50–97) from 77 primary care facilities participated in the study. The Patient Satisfaction with Visit Scale score and the CT were the outcome measures. Results: We identified associations with the CT in terms of the facility-related factors (number of GPs, time scheduling); doctors’ workload and health; and patients’ education, time attending GP, and impairments. PS was additionally governed by doctors’ perceived rate of patients aged 65+, as well as the patients’ hospitalization in the prior year, frequency of visits, and impairments. For adults aged 50+ the CT was unrelated to PS and both remained independent of patients’ age. Conclusions: Specific factors in terms of the facility, GP, and patient were identified as related to PS and the CT for participating adults in primary care. During visits of patients aged 50+ at their GP, there is scope for both time-savings and patient satisfaction improvements, when paying attention, e.g., to the time scheduled per visit, the number of doctors employed, and the patients’ impairments

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The Brave Patient after 80—Satisfaction with Visit and Individual Determinants of Proactive Patient Attitude among the Oldest General Practice Users

Background. A patient’s adherence to a course of treatment depends on the individual’s activation, the quality of patient–clinician relations, attitudes, self-efficacy, or positive emotions. Patient proactive attitude (PAA) is seldom researched among the oldest healthcare users. This study was designed to identify predictors of PAA toward health and treatment among community-dwelling general practice patients aged 80+, and was based on a PRACTA (PRomoting ACTive Aging) project. Methods. Patients (n = 658), aged 80+ visiting a general practitioner (GP) filled in the PRACTA attitude toward treatment and health scale and the PRACTA self-efficacy scale questionnaires. Sociodemographic factors, self-reported health status, and satisfaction with the visit were analyzed as independent factors. Results. Attitudes toward treatment and health scores were predicted by marital status, living alone or not alone, hospitalization the prior year, level of impairment, and satisfaction with visit. However, some differences were observed depending on the device’s subscale. Self-efficacy score was determined by marital status, living alone or not alone, prior hospitalization, and satisfaction with visit. We did not find an effect of age or gender on PAA. Patient satisfaction with visit was the strongest predictor of all PAA dimensions. Conclusion. Higher visit satisfaction helps to retain a PAA among seniors 80+. Screening questions about living situation, marital and functional status, emotional state, and recent history of hospitalization might help GPs additionally anticipate PAA level and adjust their actions accordingly

What else should we know about experiencing COPD? A narrative review in search of patients’ psychological burden alleviation

The present paper is a narrative review focusing on the psychological impact, identification of protective factors, and interventions minimizing the psychological burdens of chronic obstructive pulmonary disease (COPD). The research reviews studies on neurocognitive functions, personality, emotional problems, and health-related quality of life. This is done with regard to resources as well as activities enabling or enhancing a patient’s adaptation. PubMed and PsychArticles databases were searched for relevant medical (eg, CODP, emphysema), psychopathology (eg, depression), and psychological (eg, personality) keywords, followed by hand search. After application of the inclusion and exclusion criteria, the search resulted in 82 articles and book chapters. The choice was based on evidence accepted by evidence-based medicine, although at different levels of strength. Psychological experiencing of COPD appears to be very unequally represented with scientific research on emotional problems and functioning decrease significantly outnumbering those addressing resources or effective interventions. As our initial literature search called for an urgent need for further exploration, we have carefully pointed out numerous areas where the knowledge on how to protect or restore psychological well-being among COPD patients should be broadened

The role of gender in the active attitude toward treatment and health among older patients in primary health care—self-assessed health status and sociodemographic factors as moderators

Abstract Background Active attitude toward treatment and health (ATH) leads to improved cooperation and better health outcomes in patients. Supporting it in the population of older adults is a growing need in primary care. Recognising the role of gender, health and other sociodemographic factors can help to distinguish patients who need the most assistance in activation from general practitioners (GPs). The objective of the study was to investigate gender differences in ATH as well as the moderating role of self-assessed health (SAH) and selected sociodemographic factors (age, education, financial status, marital status). Methods A cross-sectional, multicentre study among 4936 primary care older patients (aged 50+) was conducted. The PRACTA-Attitude toward Treatment and Health questionnaire (PRACTA-ATH) was used to measure the cognitive, emotional (positive and negative affect), and motivational dimensions of ATH. Patients were approached before and after their visits in the primary health-care facilities randomly selected in Central Poland. Results Generalised linear models (GENLIN) revealed the main effects of gender, SAH, and sociodemographic characteristics, such as financial status, marital status and education. Interaction effects of gender and age (Wald’s χ2 = 24.767, p < 0.001 for ATH Global), as well as gender and SAH (Wald’s χ2 = 16.712, p < 0.002 for ATH Global) on ATH were found. The most assistance in regard to ATH was required by men aged 50–74 and men declaring good self-assessed health. Generally, women declared a more active attitude than men, showing more knowledge (M = 5.40, SD = 0.07 and M = 5.21, SD = 0.07, for women and men, respectively, p = 0.046), positive emotion (M = 5.55, SD = 0.06 and M = 5.33, SD =0.06, for women and men, respectively, p = 0.015) and motivation to be involved in their health issues (M = 5.71, SD = 0.07 and M = 5.39, SD = 0.07, for women and men, respectively, p = 0.001). The level of negative emotions related to health was not significantly different between genders (p = 0.971). Conclusions The need to create health promoting programmes taking account of particular gender differences in older adults emerges. In regard to clinical practice, building a sense of efficacy and individual responsibility for health, providing information about the means of health promotion and prevention, and recognising health-related cognitions, is recommended especially for men who feel well and are less advanced in age (50–74)

Primary Care Patients’ Expectations Towards Medical Appointments and Their Experiences During the Visit: Does Age Matter?

Introduction: There is evidence that meeting patients’ expectations toward health care correlates with involvement in the treatment they receive. The most important patient expectations concern certain types of information: explanation of disease and treatment, health promotion, and improvement in quality of life. Other demands include proper rapport and emotional support. The aim of this paper was to examine different patient groups over the age of 50 years and their expectations toward medical visits, evaluated before a visit and after the visit. Patients and methods: The study group consisted of 4,921 primary health-care patients. The patients received self-administered questionnaires that they filled in before and after the appointment with the doctor. Interviews with patients were conducted individually by specially trained interviewers. The PRACTA Patient Expectations Scale was used to measure the appointment-related expectations of the patients. Results: We observed differences related to age in patients’ expectations before medical visits regarding the following factors: disease explanation, treatment explanation, quality of life, rapport, and emotional support. The same differences were not observed on health promotion. Evaluation of patients’ appointment-related experiences after the visit showed that there were significant differences between the age-groups regarding all types of expectations included in the study. Differences between previsit and postvisit measurements were statistically significant in all age-groups. Patients who received less than they expected from doctors outnumbered those who received what they expected or more in all the groups. Conclusion: Patients’ expectations toward medical visits are conditioned by age. Therefore, doctors should pay more attention to requirements related to age in their effort to identify and satisfy expectations. This is particularly important in light of the discrepancy between previsit expectations and the actual experiences of patients evaluated after the visit

Teaching general practitioners to activate older patients: the intervening role of changes in perceived communication skills

Objective This report examined whether a change in the perceived communication behaviour (PeCoBe) of general practitioners (GPs) influenced the effect of the Promoting Active Aging (PRACTA) intervention on activation of older patients as perceived by GPs. Methods Pre- and post-intervention questionnaires were filled out by 225 GPs, who were assigned to three groups, e-learning, pdf-article, and control. GPs self-reported their communication behaviour and their perceptions of the attitudes of older patients toward treatment and health. Results Participation in the e-learning intervention showed an increase in the PeCoBe of GPs, while reading the pdf-article resulted in a decrease of such behaviours. An increase in the PeCoBe of GPs was positively related to an increase in their perception of an active attitude among older patients. The indirect effects observed for e-learning and pdf-article interventions had opposite directions. Conclusion Both types of PRACTA intervention exerted an impact on GPs’ perception of the attitudes of older patients, and change in PeCoBe of GPs could be considered as a mechanism driving this effect. Practical implications The methods based on a combination of knowledge delivery and modelling of communication skills are strongly recommended forms of teaching for GPs on how to communicate with and activate seniors

Enhancing GPs’ competencies in communication and activation of the elderly: results from the PRACTA computer-based intervention study

Background: Demographic changes over the past decades call for the promotion of health and disease prevention for older patients, as well as strategies to enhance their independence, productivity, and quality of life. Objective: Our objective was to examine the effects of a computer-based educational intervention designed for general practitioners (GPs) to promote active aging. Methods: The Promoting Active Aging (PRACTA) study consisted of a baseline questionnaire, implementation of an intervention, and a follow-up questionnaire that was administered 1 month after the intervention. A total of 151 primary care facilities (response rate 151/767, 19.7%) and 503 GPs (response rate 503/996, 50.5%) agreed to participate in the baseline assessment. At the follow-up, 393 GPs filled in the questionnaires (response rate, 393/503, 78.1%), but not all of them took part in the intervention. The final study group of 225 GPs participated in 3 study conditions: e-learning (knowledge plus skills modelling, n=42), a pdf article (knowledge only, n=89), and control (no intervention, n=94). We measured the outcome as scores on the Patients Expectations Scale, Communication Scale, Attitude Toward Treatment and Health Scale, and Self-Efficacy Scale. Results: GPs participating in e-learning demonstrated a significant rise in their perception of older patients’ expectations for disease explanation (Wald χ2=19.7, P<.001) and in perception of motivational aspect of older patients’ attitude toward treatment and health (Wald χ2=8.9, P=.03) in comparison with both the control and pdf article groups. We observed additional between-group differences at the level of statistical trend. GPs participating in the pdf article intervention demonstrated a decline in self-assessed communication, both at the level of global scoring (Wald χ2=34.5, P<.001) and at the level of 20 of 26 specific behaviors (all P<.05). Factors moderating the effects of the intervention were the number of patients per GP and the facility’s organizational structure. Conclusions: Both methods were suitable, but in different areas and under different conditions. The key benefit of the pdf article intervention was raising doctors’ reflection on limitations in their communication skills, whereas e-learning was more effective in changing their perception of older patients’ proactive attitude, especially among GPs working in privately owned facilities and having a greater number of assigned patients. Although we did not achieve all expected effects of the PRACTA intervention, both its forms seem promising in terms of enhancing the competencies of doctors in communication with and activation of older patients

Additional file 1: Table S1. of The role of gender in the active attitude toward treatment and health among older patients in primary health care—self-assessed health status and sociodemographic factors as moderators

Pairwise comparisons in significant interactions for ATH. The table presents results of pairwise comparisons for significant interactions of gender and investigated variables in all dimensions of ATH (DOCX 18 kb