49 research outputs found
General practitioner empathy, patient enablement, and patient-reported outcomes in primary care in an area of high socio-economic deprivation in Scotland - a pilot prospective study using structural equation modelling
No full text<b>Objective</b> The aim of this pilot prospective study was to investigate the relationships between general practitioners (GPs) empathy, patient enablement, and patient-assessed outcomes in primary care consultations in an area of high socio-economic deprivation in Scotland.<p></p>
<b>Methods</b> This prospective study was carried out in a five-doctor practice in an area of high socio-economic deprivation in Scotland. Patients’ views on the consultation were gathered using the Consultation and Relational Empathy (CARE) Measure and the Patient Enablement Instrument (PEI). Changes in main complaint and well-being 1 month after the contact consultation were gathered from patients by postal questionnaire. The effect of GP empathy on patient enablement and prospective change in outcome was investigated using structural equation modelling.<p></p>
<b>Results</b> 323 patients completed the initial questionnaire at the contact consultation and of these 136 (42%) completed and returned the follow-up questionnaire at 1 month. Confirmatory factor analysis confirmed the construct validity of the CARE Measure, though omission of two of the six PEI items was required in order to reach an acceptable global data fit. The structural equation model revealed a direct positive relationship between GP empathy and patient enablement at contact consultation and a prospective relationship between patient enablement and changes in main complaint and well-being at 1 month.<p></p>
<b>Conclusion</b> In a high deprivation setting, GP empathy is associated with patient enablement at consultation, and enablement predicts patient-rated changes 1 month later. Further larger studies are desirable to confirm or refute these findings.<p></p>
<b>Practice implications</b> Ways of increasing GP empathy and patient enablement need to be established in order to maximise patient outcomes. Consultation length and relational continuity of care are known factors; the benefit of training and support for GPs needs to be further investigate
sj-docx-1-scm-10.1177_00369330221132156 - Supplemental material for Half a century of the inverse care law: A comparison of general practitioner job satisfaction and patient satisfaction in deprived and affluent areas of Scotland
No full textSupplemental material, sj-docx-1-scm-10.1177_00369330221132156 for Half a century of the inverse care law: A comparison of general practitioner job satisfaction and patient satisfaction in deprived and affluent areas of Scotland by Stewart W Mercer, Carey J Lunan, Clare MacRae, David AG Henderson, Bridie Fitzpatrick, John Gillies, Bruce Guthrie and Johanna Reilly in Scottish Medical Journal</p
More time for complex consultations in a high deprivation practice is associated with increased patient enablement
No full textBackgroundEvidence of the beneficial effects of longer consultations in general practice is limited.AimTo evaluate the effect of increasing consultation length on patient enablement in general practice in an area of extreme socioeconomic deprivation.Design of studyLongitudinal study using a ‘before and after’ design.SettingKeppoch Medical Centre in Glasgow, which serves the most deprived practice area in Scotland.MethodParticipants were 300 adult patients at baseline, before the introduction of longer consultations, and 324 at follow-up, more than 1 year after the introduction of longer consultations. The intervention studied was more time in complex consultations. Patient satisfaction, perceptions of the GPs’ empathy, GP stress, and patient enablement were collected by faceto-face interview. Additional qualitative data were obtained by individual interviews with the GPs, relating to their perceptions of the impact of the longer consultations.ResultsResponse rates of 70% were obtained. Overall, 53% of consultations were complex. GP stress was higher in complex consultations. Patient satisfaction and perception of the GPs’ empathy were consistently high. Average consultation length in complex consultations was increased by 2.5 minutes by the intervention. GP stress in consultations was decreased after the introduction of longer consultations, and patient enablement was increased. GPs’ views endorsed these findings, with more anticipatory and coordinated care being possible in the longer consultations.ConclusionMore resource to provide more time in complex consultations in an area of extreme deprivation is associated with an increase in patient enablement
Patient-centredness and the outcome of consultations with depressed patients in areas of high and low socioeconomic deprivation
No full text<b>Background</b> Most patients with depression are managed in general practice. In deprived areas, depression is more common and poorer outcomes have been reported.<p></p><b>Aim</b> To compare general practice consultations and early outcomes for patients with depression living in areas of high or low socioeconomic deprivation.<p></p>
<b>Design and setting</b> Secondary data analysis of a prospective observational study involving 25 GPs and 356 consultations in deprived areas, and 20 GPs and 303 consultations in more affluent areas, with follow-up at 1 month.<p></p>
<b>Method</b> Validated measures were used to (a) objectively assess the patient centredness of consultations, and (b) record patient perceptions of GP empathy.<p></p>
<b>Results</b> PHQ-9 scores >10 (suggestive of caseness for moderate to severe depression) were significantly more common in deprived than in affluent areas (30.1% versus 18.5%, P<0.001). Patients with depression in deprived areas had more multimorbidity (65.4% versus 48.2%, P<0.05). Perceived GP empathy and observer-rated patient-centred communication were significantly lower in consultations in deprived areas. Outcomes at 1 month were significantly worse (persistent caseness 71.4% deprived, 43.2% affluent, P = 0.01). After multilevel multiregression modelling, observer-rated patient centredness in the consultation was predictive of improvement in PHQ-9 score in both affluent and deprived areas.<p></p>
<b>Conclusion</b> In deprived areas, patients with depression are more common and early outcomes are poorer compared with affluent areas. Patient-centred consulting appears to improve early outcome but may be difficult to achieve in deprived areas because of the inverse care law and the burden of multimorbidity
Multimorbidity and socioeconomic deprivation in primary care consultations
No full textPurpose: The influence of multimorbidity on the clinical encounter is poorly understood, especially in areas of high socioeconomic deprivation where burdensome multimorbidity is concentrated. The aim of the current study was to examine the effect of multimorbidity on general practice consultations, in areas of high and low deprivation.
Methods: We conducted secondary analyses of 659 video-recorded routine consultations involving 25 general practitioners (GPs) in deprived areas and 22 in affluent areas of Scotland. Patients rated the GP’s empathy using the Consultation and Relational Empathy (CARE) measure immediately after the consultation. Videos were analyzed using the Measure of Patient-Centered Communication. Multilevel, multi-regression analysis identified differences between the groups.
Results: In affluent areas, patients with multimorbidity received longer consultations than patients without multimorbidity (mean 12.8 minutes vs 9.3, respectively; P = .015), but this was not so in deprived areas (mean 9.9 minutes vs 10.0 respectively; P = .774). In affluent areas, patients with multimorbidity perceived their GP as more empathic (P = .009) than patients without multimorbidity; this difference was not found in deprived areas (P = .344). Video analysis showed that GPs in affluent areas were more attentive to the disease and illness experience in patients with multimorbidity (P < .031) compared with patients without multimorbidity. This was not the case in deprived areas (P = .727).
Conclusions: In deprived areas, the greater need of patients with multimorbidity is not reflected in the longer consultation length, higher GP patient centeredness, and higher perceived GP empathy found in affluent areas. Action is required to redress this mismatch of need and service provision for patients with multimorbidity if health inequalities are to be narrowed rather than widened by primary care
The consumer challenge in the NHS The development and application of new approaches to obtain and compare lay and professional views on the quality and need for services
No full textSIGLEAvailable from British Library Document Supply Centre-DSC:DXN049264 / BLDSC - British Library Document Supply CentreGBUnited Kingdo
An Investigation of the Processes of Confirmation and Certification of Coronary Heart Disease Deaths in Glasgow
No full textCoronary mortality rates for men and women in Glasgow are amongst the highest in the world. Recent studies have questioned the reliability of published mortality data. This study describes the process of death certification in Glasgow, indicating the diverse ways in which deaths occurring in a variety of circumstances are processed by a variety.of types of person so that a death certificate can be issued. The study uses this information to assess the reliability of the coronary mortality data in a manner similiar to "validity exercises" carried out elsewhere, except that the results are presented in an operational and social context. Finally, the study discusses possible measures which might be taken to improve the reliability of the coronary mortality data
The permanent deacon and minister - social intermediary of the threshold
No full textIn this article the author shares some reflections based on her doctoral research on the ancient ministry of the diaconate which was restored at the Second Vatican Council
The Asset-based Collaborative Working model (ACW model): pragmatic action research in healthcare service development
No full textEmbedding researchers in clinical practice may not be an obvious consideration in asset-constrained healthcare settings. However, with increasing calls for best practice and value-for-money, understanding what works, for whom and why, is of paramount importance. This article illustrates how a researcher embedded in a healthcare professional group not only facilitated a service development within existing resources, but also enabled the group to identify relevant theories, and their interrelationships, underpinning the group's actions during the developmental process. This resulted in the construction of a new theoretical model, the Asset-based Collaborative Working model. This research suggests that embedding research in service development is feasible and can result in substantive learning and an understanding of group working which is required in contemporary healthcare provision. While developed in the clinical field of lymphoedema, the Asset-based Collaborative-Working model may be applicable in other care settings
A neuro-fuzzy classification system model
No full textThis thesis was scanned from the print manuscript for digital preservation and is copyright the author.
Researchers can access this thesis by asking their local university, institution or public library to
make a request on their behalf. Monash staff and postgraduate students can use the link in the References field
