asthma patients and the patient-practitioner relationship: a qualitative study of continuity of care...
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Asthma Patients and the Asthma Patients and the Patient-Practitioner Patient-Practitioner
Relationship: A Qualitative Relationship: A Qualitative Study of Continuity of CareStudy of Continuity of Care
Margaret M. Love, PhD
Family Practice and Community Medicine
University of Kentucky (UK)
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Co-investigatorsCo-investigators
Sarah B. Wackerbarth, PhD, University of Kentucky
Arch G. Mainous, III, PhD, Medical University of South Carolina
Renee V. Girdler, MD, University of Louisville
Dennis E. Doherty, MD, University of Kentucky
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FundingFunding
UK NIH K30 Therapeutics and Translational Research Training Program
Agency for Healthcare Research and Quality (AHRQ)
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BackgroundBackground
Asthma
– Chronic respiratory disease characterized by episodes or attacks of inflammation and narrowing of small airways in response to asthma ‘triggers.’
NCHS www.cdc.gov/nchs
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BackgroundBackground
U.S. asthma statistics 2002
– 14 million (6.8%) noninstitutionalized adults diagnosed and still have asthma
– 12.6 million asthma-related visits to office-based physicians
– 1.9 million hospital emergency dept visits
NCHS www.cdc.gov/nchs
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BackgroundBackground
Continuity of care
– Ongoing relationship with the same health care practitioner over time
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BackgroundBackground
Continuity of care is associated with positive health-related outcomes
– Higher patient satisfaction
– Greater medication adherence
– Reduced health services utilization
– Decreased likelihood of emergency dept (ED) use and future hospitalization
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BackgroundBackground
An ongoing relationship with the same physician is highly valued by patients… especially by asthma patients.– Love & Mainous. J Fam Pract; 1999.
– Love, Mainous, Talbert, & Hager. J Fam Pract; 2000.
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Research ObjectiveResearch Objective
To better understand the physician-patient relationship from the perspective of persons with asthma, through the application of qualitative research methods
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Study DesignStudy Design
Qualitative, focus group study
– Six focus groups held in 2004
– 3 - 7 patients per group
– Audiotaped, prompted discussion
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Study DesignStudy Design
Adult asthma patients (age>18 years)
– UK Family Medical Center
– UK Pulmonary & Critical Care Medicine
– Lexington community
– Word of mouth
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Study DesignStudy Design
Examples of focus group prompts:
– Why would a relationship over time with the same health care professional be especially important to people who have asthma?
– What if you can’t see your regular doctor…?
– What else is important in your relationships with health care professionals?
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AnalysisAnalysis
Thematic analysis of transcripts
– What do patients like about their health care professional or their care?
– 2 investigators reviewed independently, identified themes, discussed, combined
– “Open” coding
– Saturation reached after 6 focus groups
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ParticipantsParticipants
26 participants– 20 female– 22 white– 20 aged 41-60 years– 18 group or private insurance– 14 college educated– 15 from UK Family Medical Center
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ResultsResults
Quality / healthcare outcomes
Interpersonal process / interaction
Relationship qualities / shared history
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Quality / OutcomesQuality / Outcomes
Discovered diagnosis
– Figured it out
– Finally one day a doctor told me, ‘No, you have mild asthma.’
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Quality / OutcomesQuality / Outcomes
Successful treatment
– Finally got help.
– They’ve tried something new on me and it’s worked for me.
– I appreciate my doctor helping me get to the point that we handled the balance of medications.
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Quality / OutcomesQuality / Outcomes
Reliable / assumes responsibility for care
– There constantly.
– Will take care of me.
– I pick up the telephone and call my doctor and he’ll meet me at the hospital.
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Quality / OutcomesQuality / Outcomes
Tailors care
– I feel like I just have to stand up and say, ‘Look. That just doesn’t go for me. This is what works.’ (-)
– He came in and treated me with a preconceived notion. (-)
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Interpersonal InteractionInterpersonal Interaction
Straightforward communication
– I appreciate the doctor being up front with me.
Explains
– He explains things in a way that even I can understand.
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Interpersonal InteractionInterpersonal Interaction
Talking and listening
– He would sit there and talk to me, ask me what was going on.
– And I don’t know that I feel that I’ve been heard yet. (-)
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Interpersonal InteractionInterpersonal Interaction
Respect and responsiveness
– Condescending. (-)
– And it’s real dismissive. (-)
– …respect my pain, treat me as an adult…
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Interpersonal InteractionInterpersonal Interaction
Comfortable
– Feel at ease with him
– Concerned
– Caring
– Compassionate
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Relationship / HistoryRelationship / History
“Knows” patient
– ... knows my history… knows what things trigger with me and what doesn’t trigger.
– … knows me… knows how to handle me.
– They know I don’t call unless I’m pretty well down.
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Relationship / HistoryRelationship / History
Mutual trust
– I trust her.
– If Doctor X tells me something, or advises me, I’ve taken that to heart.
– Mutual trust that I am not going to bother them just for the little bitty things.
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Relationship / HistoryRelationship / History
Continuity avoids starting over
– It takes time away from your visit… (-)
– … and you know what does work, and they want to try something new… (-)
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LimitationsLimitations
Small number of participants
Kentucky only
Self-reported outcomes
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Implications and Next StepsImplications and Next Steps
How to meet asthma patients’ concerns?
– When patients seek care at multiple locations (PCP, specialists, UTCs, EDs)
– When continuity of care with individual clinicians difficult to maintain
Future research…
– Does addressing their concerns improve health outcomes?