Biomedical subjects

Michel Wensing

Publications and source records attributed to Michel Wensing.

46 records · Page 3Linked to original sources

PubMed2003

Feedback based on patient evaluations: a tool for quality improvement?

Feedback regarding patient evaluations of health care is expected to be a tool for quality improvement. This study examined the response of general practitioners to such feedback in a randomised trial. Practitioners in the intervention group read and discussed the feedback report and then reported on a range of actions that can be undertaken to improve the quality of care. Their communication behaviour was not found to change. All of the practitioners were highly motivated to learn from patient views, both at baseline and after the intervention period. Compared to the control group, the practitioners in the intervention group had less favourable views of the relevance of patient feedback for their practice after the receipt of such feedback. Furthermore, these practitioners felt that a patient survey required considerable time and energy and saw little reason for change. Although patient feedback can help identify areas for improvement, specific barriers must be addressed before such feedback can be put to more widespread use.

Adult↗

PubMed2003

Patient characteristics as predictors of primary health care preferences: a systematic literature analysis.

OBJECTIVE: To identify associations between various cultural and demographic factors and patients' primary health care preferences. SEARCH STRATEGY: Searches were performed in MEDLINE (1966-December 2000), PsycINFO (1977-May 2001) and Sociological Abstracts (1963-December 2000). Identified papers were checked for more papers. INCLUSION CRITERIA: Studies with a focus on primary health care or health care in general, asking patients about preferences with regard to health care, reporting quantitative results and examining the relations between specific patient characteristics and patient preferences. DATA EXTRACTION AND SYNTHESIS: Data were extracted from studies using a scoring form to register what methods were used, which patient characteristics were analysed and which patient characteristics significantly influenced patients' preferences with regard to different aspects of health care (P < 0.05). MAIN RESULTS: A total of 145 studies were included with 2276 comparisons between subgroups of patients. Of all the comparisons, 607 (27%) showed a significant association between patient characteristics and preferences with regard to primary health care. Age and economic status significantly related to patient preferences in 38 and 33% of the comparisons, respectively. Education, health status, family situation, sex, and utilization of health care related significantly to patient preferences in less than 25% of the comparisons. CONCLUSIONS: This review of the literature showed patient characteristics to be an important determinant of preferences regarding many aspects of primary health care defined as general practice care or health care, in general. All of the patient characteristics examined here showed at least some significant associations with preferences for primary health care.

Age Factors↗

PubMed2003

Interventions to improve medication compliance in older patients living in the community: a systematic review of the literature.

Noncompliance affects all age groups, but older patients have specific barriers against effective medication use and can be more vulnerable to the incorrect use of medication. Some age-related barriers are vision loss and cognitive impairment. In people aged 60 years or older, noncompliance with medication regimens varies from 26-59%. In this article we review randomised controlled trials (RCTs) on interventions aimed to improve compliance with medication regimens in older patients living in the community. It is known from other reviews that multifaceted interventions, a combination of interventions, are more often effective than single-focus interventions, probably because these address a wider range of barriers. Also, an individual approach with specifically tailored interventions is effective at improving compliance. In this review the following two hypotheses are evaluated: i) multifaceted interventions improve compliance more successfully than single interventions; and ii) interventions that are tailored to patients improve compliance more successfully than generalised interventions. A systematic literature search in four databases produced 14 suitable RCTs with 23 interventions that we categorised as single or multifaceted, and generalised or tailored. Differences in medication compliance between the intervention group and the control group were in less than half of the comparisons in favour of the intervention group. Telephone-linked reminder systems achieved the most striking effect, looking at differences between the intervention and control group, and deserve further attention. Overall, multifaceted interventions and tailored interventions seemed to result more often in differences in compliance rates in older adults in favour of the intervention group compared with a control group than single and generalised interventions.

Aged↗

PubMed2003

Patient involvement in general practice care: a pragmatic framework.

This paper presents a pragmatic framework to guide decisions on involving people in general practice care. Patient involvement may be defined as: enabling patients to take an active role in deciding about and planning their healthcare. It can be located at different levels of care, including the patient-clinician contact or episode of care, and the patient population served by a care provider, or the regional or national population. The involvement of patients depends on considerations that include the aim of patient involvement, the type of health decision, and the type of patient. With respect to the aims, the fundamental question is whether involvement is seen as desirable in itself, or whether it is expected to result in favourable consequences. We suggest that patients' ability and willingness to be involved should determine the level of involvement. The concept of involving patients is relatively new, and new approaches are required to overcome obstacles for its implementation in healthcare.

Family Practice↗

PubMed2002

Deconstructing patient centred communication and uncovering shared decision making: an observational study.

BACKGROUND: Patient centred communication (PCC) has been described as a method for doctor-patient communication. The principles of shared decision making (SDM) have been proposed more recently. AIMS: This study aimed to examine PCC and SDM empirically with respect to their mutual association, the variation in practitioners' working styles, and the associations with patient characteristics. METHODS: Sixty general practitioners recruited 596 adult patients who gave written consent to have their consultations videotaped. The tapes were assessed by two researchers, using a standardised instrument for global communication. For the purpose of this exploratory study, scales for PCC and SDM were based on subsamples of items in the MAAS. RESULTS: The scales for PCC and SDM were weakly associated (Pearson correlation: 0.25). Physicians varied more on SDM than on PCC. The intracluster correlation of the PCC and SDM scales were, respectively, 0.34 and 0.19. However, hypotheses regarding associations with patient characteristics were not confirmed. Neither PCC nor SDM scores were related to patient gender, education, age, functional health status or existence of chronic conditions. CONCLUSION: The study provides evidence that PCC and SDM can be differentiated and comprise approaches to communication between clinicians and patients which may be more clearly distinguished by further focused research and training developments.

Adult↗

PubMed2002

Effectiveness of physical activity interventions for older adults: a review.

OBJECTIVE: This review evaluates the effectiveness of physical activity interventions among older adults. METHODS: Computerized searches were performed to identify randomized controlled trials. Studies were included if: (1) the study population consisted of older adults (average sample population age of > or =50 years and minimum age of 40 years); (2) the intervention consisted of an exercise program or was aimed at promoting physical activity; and (3) reported on participation (i.e., adherence/compliance) or changes in level of physical activity (e.g., pre-post test measures and group comparisons). RESULTS: The 38 studies included 57 physical activity interventions. Three types of interventions were identified: home-based, group-based, and educational. In the short-term, both home-based interventions and group-based interventions achieved high rates of participation (means of 90% and 84%, respectively). Participation declined the longer the duration of the intervention. Participation in education interventions varied widely (range of 35% to 96%). Both group-based interventions and education interventions were effective in increasing physical activity levels in the short-term. Information on long-term effectiveness was either absent or showed no difference of physical activity level between the study groups. CONCLUSIONS: Home-based, group-based, and educational physical activity interventions can result in increased physical activity, but changes are small and short-lived. Participation rates of home-based and group-based interventions were comparable, and both seemed to be unrelated to type or frequency of physical activity. The beneficial effect of behavioral reinforcement strategies was not evident. Comparative studies evaluating the effectiveness of diverse interventions are needed to identify the interventions most likely to succeed in the initiation and maintenance of physical activity.

Aged↗

PubMed2002

Patient satisfaction with availability of general practice: an international comparison.

OBJECTIVE: To identify associations between the characteristics of general practitioners and practices, and patients' evaluations of the availability of general practice. DESIGN: Written surveys completed by patients. SETTING: General practice care in nine European countries: Denmark, Germany, The Netherlands, Norway, UK, Belgium (Flanders and Wallonia), Switzerland, Slovenia and Spain. STUDY PARTICIPANTS: 15996 adult patients consecutively visiting the general practitioner (response rates per country varied between 47 and 89%). MAIN MEASURES: The Europep instrument to assess patients' evaluations of five aspects of the availability of general practice care: (1) getting an appointment, (2) getting through on the phone, (3) being able to speak to the practitioner on the telephone, (4) waiting time in the waiting room, and (5) providing quick services for urgent health problems. Each general practitioner recorded age, sex, number of years in the practice, number of practitioners and other care providers in the practice, and urbanization level of the practice. RESULTS: Patients' more positive evaluations were associated with fewer general practitioners in the practice, except for quick services for urgent health problems (range of conditional overall odds ratios, 1.69-2.02). In addition, a number of significant unconditional overall odds ratios were found, particularly those related to the number of general practitioners' working hours and the number of care providers in the practice. None of the associations was found consistently in all countries. CONCLUSION: Patients favour small practices and full-time general practitioners, which contradicts developments in general practice in many countries. Policy makers should consider how the tensions between patients' views and organizational developments can be solved.

Adult↗

PubMed1998

What can patients do to improve health care?

OBJECTIVE: To give an overview of the value of different interventions for increasing the role of individual patients in improving the quality of care provision. SEARCH strategy: Medline searches and manual searches in medical journals covering the period from 1980 until June 1997. INCLUSION CRITERIA: Studies reporting descriptions and evaluations of seven types of interventions that aim to help integrate the needs and preferences of individual patients into health care provision. DATA EXTRACTION: The following information was extracted: assumptions underlying the interventions; resources needed for development and implementation; and acceptability to clinicians. MAIN RESULTS: Several interventions for increasing patients' roles in health care could be successful in clinical practice, such as feeding forward patient data to clinicians, interactive patient education and feedback to health care providers about patients' evaluations of care. The available research focuses on feedback methods. Insights into the benefits and limitations of the use of the different interventions for improving care are limited. CONCLUSION: The active role that patients' views play in the contact with a care provider is often neglected. Promising interventions for the empowerment of individual patients require further development and evaluation.

Journal Article↗

PubMedDate not supplied

Attitudes and management of alcohol problems in general practice: descriptive analysis based on findings of a World Health Organization international collaborative survey.

AIMS: To determine if general practitioners' (GPs) experience of education on alcohol, support in their working environment for intervening with alcohol problems, and their attitudes have an impact on the number of patients they manage with alcohol problems. METHODS: 1300 GPs from nine countries were surveyed with a postal questionnaire as part of a World Health Organization (WHO) collaborative study. RESULTS: GPs who received more education on alcohol (OR = 1.5; 95% CI, 1.3-1.7), who perceived that they were working in a supportive environment (OR = 1.6; 95% CI, 1.4-1.9), who expressed higher role security in working with alcohol problems (OR = 2.0; 95% CI, 1.5-2.5) and who reported greater therapeutic commitment to working with alcohol problems (OR = 1.4; 95% CI, 1.1-1.7) were more likely to manage patients with alcohol-related harm. CONCLUSION: Both education and support in the working environment need to be provided to enhance the involvement of GPs in the management of alcohol problems.

Alcohol-Related Disorders↗

PubMedDate not supplied

Attitudes and managing alcohol problems in general practice: an interaction analysis based on findings from a WHO collaborative study.

AIMS: To determine if GPs' attitudes towards working with drinkers moderated the impact that training and support had on screening and brief intervention activity in routine practice. METHODS: Subjects were 340 GPs from four countries who were part of a World Health Organization randomized controlled trial to evaluate the effectiveness of training and support in increasing screening and brief alcohol intervention. GPs' self-reported attitudes towards working with drinkers were measured with the Shortened Alcohol and Alcohol Problems Perception Questionnaire. RESULTS: Whereas training and support increased GPs' screening and brief intervention rates, it did so only for practitioners who already felt secure and committed in working with drinkers. Training and support did not improve attitudes towards working with drinkers and, moreover, worsened the attitudes of those who were already insecure and uncommitted. CONCLUSIONS: To enhance the involvement of GPs in the management of alcohol problems, interventions that increase both actual experience and address practitioners' attitudes is required. Such support could take the form of on-site support agents and facilitators.

Alcoholism↗