Biomedical subjects

Benjamin Crabtree

Publications and source records attributed to Benjamin Crabtree.

6 recordsLinked to original sources

PubMed2005

Patient-centered care and communication in primary care practice: what is involved?

OBJECTIVE: This secondary, qualitative analysis examined physician-patient interaction and patient-centered care in a random sample of encounters of 44 physicians in 18 family practices. METHODS: Fieldworkers were trained in qualitative and quantitative data collection strategies including participatory observation, narrative description, interviewing techniques and note-taking regarding practice observations, patient encounters and community assessment. Fieldworkers spent 4-8 weeks in each practice. Data included descriptions of practices, personnel, office systems, patient encounters, chart audits and physician, practice personnel and community informant interviews. Data analysis included comparison of results with Stewart et al. patient-centered model. RESULTS: Results support and extend the work of Stewart et al. The content and expression of clinical discourse in the exam room springs from complex sources, including physician and patient characteristics, practice and community cultures, and related medical care expectations. DISCUSSION: Patient-centered values often conflict with other competing values. Ideas drawn from complexity science helped make sense of how "attractors" identified in findings influenced outcomes of patient-centered care and communication. CONCLUSION: Physician, patient, practice and community characteristics, values and expectations impact the effectiveness of patient-centered care and communication. IMPLICATIONS: Medical students, residents and practicing physicians need opportunities to evaluate competing values affecting the delivery of patient care.

Communication↗

PubMed2004

Opportunistic approaches for delivering preventive care in illness visits.

OBJECTIVE: To describe how clinicians create opportunities to deliver preventive care in illness visits and assess the impact this has on preventive service delivery. METHOD: Detailed and descriptive fieldnotes were collected from 18 purposefully selected family practices, including direct observations of 53 primary care clinicians and 1620 patient encounters. Conversation analysis was used to examine the conversational techniques employed to deliver four preventive services (smoking counseling, immunization delivery, mammography, and cervical cancer screening) in illness visits. Qualitative data was coded and analyzed to assess impact on preventive service delivery rates. RESULTS: Two methods for opportunistic preventive service delivery were observed. In the first, clinicians used the close of the medical encounter to make arrangement for follow-up preventive care. In the second approach, clinicians use a stepwise conversational device to exit talk about the patient's presenting problem and enter into relevant health habit advice. Quantitative analyses show that opportunistic methods are rarely used to deliver preventive services in illness visits. The stepwise technique was the most frequently used method. Patients treated by clinicians who used opportunistic techniques to deliver preventive care in illness visits were more likely to be up-to-date on smoking counseling and cervical cancer screening than those patients who were treated by clinicians who did not use opportunistic approaches. CONCLUSIONS: Opportunistic preventive service delivery in illness visits can be an efficient and effective way to deliver preventive care. Although infrequently used, quantitative data suggest that the use of opportunistic approaches to deliver preventive services during illness visits can enhance preventive care rates. Interventions aimed at helping clinicians develop effective strategies for offering preventive care during illness visits may be an important complement to existing mechanical interventions that might, by themselves, be insufficient to improve preventive care.

Family Practice↗

PubMed2004

Speaking of weight: how patients and primary care clinicians initiate weight loss counseling.

BACKGROUND: Obesity is epidemic in the US and other industrialized countries and contributes significantly to population morbidity and mortality. Primary care physicians see a substantial portion of the obese population, yet rarely counsel patients to lose weight. METHODS: Descriptive field notes of outpatient visits collected as part of a multimethod comparative case study were used to study patterns of physician-patient communication around weight control in 633 encounters in family practices in a Midwestern state. RESULTS: Sixty-eight percent of adults and 35% of children were overweight. Excess weight was mentioned in 17% of encounters with overweight patients, while weight loss counseling occurred with 11% of overweight adults and 8% of overweight children. In weight loss counseling encounters, patients formulated weight as a problem by making it a reason for visit or explicitly or implicitly asking for help with weight loss. Clinicians did so by framing weight as a medical problem in itself or as an exacerbating factor for another medical problem. CONCLUSIONS: Strategies that increase the likelihood of patients identifying weight as a problem, or that provide clinicians with a way to "medicalize" the patient's obesity, are likely to increase the frequency of weight loss counseling in primary care visits.

Adult↗

PubMed2003

Using metaphor as a qualitative analytic approach to understand complexity in primary care research.

Metaphors offer exciting opportunities to identify and explore tacit knowledge and behavior that are embedded in complex organizations and shape health care practices. In this article, the authors explore the theoretical rationale, background, and advantages of using metaphor as an analytic strategy in qualitative health research. They used an analysis of 18 practices in a comparative case study designed to explore office practice strategies for delivering cancer prevention services for illustrations. During the individual and comparative stages of the analysis process, researchers heeded the metaphors that they used in their descriptive language of practices. The authors explore examples showing how metaphors clarify unwritten assumptions, values, and motivators that shape variations in practice behavior.

Family Practice↗

PubMedDate not supplied

Social network analysis as an analytic tool for interaction patterns in primary care practices.

PURPOSE: Social network analysis (SNA) provides a way of quantitatively analyzing relationships among people or other information-processing agents. Using 2 practices as illustrations, we describe how SNA can be used to characterize and compare communication patterns in primary care practices. METHODS: Based on data from ethnographic field notes, we constructed matrices identifying how practice members interact when practice-level decisions are made. SNA software (UCINet and KrackPlot) calculates quantitative measures of network structure including density, centralization, hierarchy and clustering coefficient. The software also generates a visual representation of networks through network diagrams. RESULTS: The 2 examples show clear distinctions between practices for all the SNA measures. Potential uses of these measures for analysis of primary care practices are described. CONCLUSIONS: SNA can be useful for quantitative analysis of interaction patterns that can distinguish differences among primary care practices.

Decision Making↗

PubMedDate not supplied

Creating innovative research designs: the 10-year Methodological Think Tank case study.

PURPOSE: Addressing important but complex research questions often necessitates the creation of innovative mixed methods designs. This report describes an approach to developing research designs for studying important but methodologically challenging research questions. METHODS: The Methodological Think Tank has been held annually in conjunction with the Primary Care Research Methods and Statistics Conference in San Antonio since 1994. A group of 3 to 4 methodologists with expertise balanced between quantitative and qualitative backgrounds is invited by the think tank coordinators to serve on a 2-day think tank to discuss a research question selected from those submitted in response to a call for proposals. During the first half-day, these experts explore the content area with the investigator, often challenging beliefs and assumptions. During the second half-day, the think tank participants systematically prune potential approaches until a desirable research method is identified. RESULTS: To date, the most recent 7 think tanks have produced fundable research designs, with 1 being funded by a K award and 4 by R01 grants. All participating investigators attributed much of their success to think tank participation. Lessons learned include (1) the importance of careful selection of participating methodologists, (2) all think tank communities of inquiry must go through 4 stages of development from pseudocommunity to community, and (3) the critical importance of listening by the investigator. CONCLUSION: Researchers and academic departments could use this process locally to develop innovative research designs.

Cooperative Behavior↗