PubMed Health⌕ Search

Biomedical subjects

Timothy P Daaleman

Publications and source records attributed to Timothy P Daaleman.

11 recordsLinked to original sources
PubMed2006

A prevalence study of faith-based healing in the rural southeastern United States.

BACKGROUND: Although prayer and other spiritual practices are common among residents of the rural south, the use of faith-based healers (FBH), or healers who use prayer as their primary healing modality, has not been explored in this population. METHODS: Secondary data analysis from a random digit dialing telephone survey of rural adults in eight southern states. RESULTS: Our overall response rate was 51% and 193 subjects (4.1%) had seen an FBH practitioner within the previous year. FBH use was significantly more common among younger respondents (OR 7.21, 95% Ci 2.00, 25.94), women (OR 1.49, 95% CI 1.03, 2.14), those reporting poorer health (OR 1.83, 95% CI 1.19, 2.83), and those who believed in avoiding physicians (OR 1.82, 95% CI 1.24, 2.67). A relationship between FBH use and delayed or foregone medical care, and cost as a barrier to obtaining care was not statistically significant after controlling for other factors. CONCLUSIONS: Prevalence of FBH use is low, but is significantly related to younger age, female gender, poorer health status, barriers to medical care and devaluing medical care. Clinicians may consider exploring FBH usage with their younger, female patients, and those in poorer health. Policy makers should consider how FBH usage is related to various indicators of health care services demand, utilization and access.

Adult↗
PubMed2005

Processes for effective communication in primary care.

Communication in the delivery of health care services occurs along 2 axes: between providers and patients and among several providers. In primary care, a principle objective in the provider-patient relationship is facilitating whole-person care, which is care provided in the context of family and community. In addition, primary care emphasizes communication between the primary care physician and other providers with the goal of integrated care, or care provided in the context of a patient's overall health care needs. However, considering both the U.S. health care delivery system and medical education programs, several obstacles interfere with the necessary processes of communication. This paper addresses those obstacles with a conceptual framework for effective communication in primary care. Recommendations propose formalizing requirements for the exchange of information among providers, enhancing communication training, disseminating information technology, and mitigating external factors that disrupt communication in primary care.

Case Management↗
PubMed2004

Chatting behavior and patient satisfaction in the outpatient encounter.

Communication studies suggest that patient sociodemographic factors are embedded within medical encounters and impact patient expectations, judgments, and outcomes, such as satisfaction. Physician chatting has been suggested as one way to enhance patient satisfaction; however, little is known about chatting within the context of the clinical encounter or of the interaction of chatting with patient sociodemographic factors and patient satisfaction. The study's purpose was to determine the prevalence and patterns of chatting, and to examine the association of chatting with patient sociodemographic factors and patient satisfaction with their physician. A convenience sample of adult outpatients from an urban family practice underwent an exit interview. A total of 105 patients participated; 63 (61%) reported chatting from their recent encounter. No sociodemographic differences were observed between patients reporting chatting and those reporting no chatting. Chatting behavior pertaining to the patient's family or friends was the predominant topic, and more nonwhite (30%) than white (13%) patients reported this activity (p<0.001). There was no significant difference in satisfaction scores between patients that reported chatting behavior and those that did not (23.73 vs. 22.79, p=0.076). In addition, there was no difference in patient satisfaction scores for physician personal manner, technical skill, visit explanation, time spent with the physician, and overall visit between the chatting and nonchatting groups.

Adult↗
PubMed2002

Spirituality Index of Well-Being Scale: development and testing of a new measure.

OBJECTIVE: To evaluate the reliability and validity of the Spirituality Index of Well-Being (SIWB) Scale in a patient population. STUDY DESIGN: Cross-sectional survey. POPULATION: Community-dwelling elderly individuals (n = 277) recruited from primary care clinic sites in the Kansas City metropolitan area. OUTCOMES MEASURED: Internal consistency, concurrent construct validity, discriminant validity, and factor analysis with Varivax rotation. RESULTS: The initial version of the SIWB contained 40 items: 20 from a self-efficacy domain and 20 from a life scheme domain. Factor analysis yielded 6 items loaded most strongly on factor 1 (intrapersonal self-efficacy) and 6 other items loaded strongly on factor 2 (life scheme). The Self-efficacy subscale had an alpha of.83 and the Life Scheme subscale had an alpha of.80; the total 12-item SIWB Scale had an alpha of.87. The SIWB had significant and expected correlations with other quality-of-life measures related to subjective well-being: EuroQol (r =.18), Geriatric Depression Scale (r = -35), the Physical Functioning Index from the Short Form 36 (r =.28), and the Years of Healthy Life Scale (r = -.35). Religiosity did not correlated significantly with the SIWB (r =.12, P =.056). CONCLUSIONS: The 12-item SIWB Scale is a valid and reliable measure of subjective well-being in an older patient population.

Age Factors↗
PubMedDate not supplied

Religion, spirituality, and health status in geriatric outpatients.

BACKGROUND: Religion and spirituality remain important social and psychological factors in the lives of older adults, and there is continued interest in examining the effects of religion and spirituality on health status. The purpose of this study was to examine the interaction of religion and spirituality with self-reported health status in a community-dwelling geriatric population. METHODS: We performed a cross-sectional analysis of 277 geriatric outpatients participating in a cohort study in the Kansas City area. Patients underwent a home assessment of multiple health status and functional indicators by trained research assistants. A previously validated 5-item measure of religiosity and 12-item spirituality instrument were embedded during the final data collection. Univariate and multivariate analyses were performed to determine the relationship between each factor and self-reported health status. RESULTS: In univariate analyses, physical functioning (P < .01), quality of life (P < .01), race (P < .01), depression (P < .01), age (P = .01), and spirituality (P < .01) were all associated with self-reported health status, but religiosity was not (P = .12). In a model adjusted for all covariates, however, spirituality remained independently associated with self-appraised good health (P = .01). CONCLUSIONS: Geriatric outpatients who report greater spirituality, but not greater religiosity, are more likely to appraise their health as good. Spirituality may be an important explanatory factor of subjective health status in older adults.

Activities of Daily Living↗
PubMedDate not supplied

A cross-cultural study of physician treatment decisions for demented nursing home patients who develop pneumonia.

PURPOSE: We wanted to explore factors that influence Dutch and US physician treatment decisions when nursing home patients with dementia become acutely ill with pneumonia. METHODS: Using a qualitative semistructured interview study design, we collected data from 12 physicians in the Netherlands and 12 physicians in North Carolina who care for nursing home patients. Our main outcome measures were perceptions of influential factors that determine physician treatment decisions regarding care of demented patients who develop pneumonia. RESULTS: Several themes emerged from the study. First, physicians viewed their patient care roles differently. Dutch physicians assumed active, primary responsibility for treatment decisions, whereas US physicians were more passive and deferential to family preferences, even in cases when they considered families' wishes for care as inappropriate. These family wishes were a second theme. US physicians reported a perceived sense of threat from families as influencing the decision to treat more aggressively, whereas Dutch physicians revealed a predisposition to treat based on what they perceived was in the best interest of the patient. The third theme was the process of decision making whereby Dutch physicians based decisions on an intimate knowledge of the patient, and American physicians reported limited knowledge of their nursing home patients as a result of lack of contact time. CONCLUSION: Physician-perceived care roles regarding treatment decisions are influenced by contextual differences in physician training and health care delivery in the United States and the Netherlands. These results are relevant to the debate about optimal care for patients with poor quality of life who lack decision-making capacity.

Adult↗
PubMedDate not supplied

The Spirituality Index of Well-Being: a new instrument for health-related quality-of-life research.

PURPOSE: Despite considerable interest in examining spirituality in health-related quality-of-life studies, there is a paucity of instruments that measure this construct. The objective of this study was to test a valid and reliable measure of spirituality that would be useful in patient populations. METHODS: We conducted a multisite, cross-sectional survey using systematic sampling of adult outpatients at primary care clinic sites in the Kansas City metropolitan area (N = 523). We determined the instrument reliability (Cronbach's alpha, test-retest) and validity (confirmatory factor analysis, convergent and discriminant validation) of the Spirituality Index of Well-Being (SIWB). RESULTS: The SIWB contains 12 items: 6 from a self-efficacy domain and 6 from a life scheme domain. Confirmatory factor analysis found the following fit indices: chi2 (54, n = 508) = 508.35, P < .001; Comparative Fit Index = .98; Tucker-Lewis Index = .97; root mean square error of approximation = .13. The index had the following reliability results: for the self-efficacy subscale, alpha = .86 and test-retest r = 0.77; for the life scheme subscale, alpha = .89 and test-retest r = 0.86; and for the total scale alpha = .91 and test-retest r = 0.79, showing very good reliability. The SIWB had significant and expected correlations with other quality-of-life instruments that measure well-being or spirituality: Zung Depression Scale (r = 0-.42, P < .001), General Well-Being Scale (r = 0.64, P < .001), and Spiritual Well-Being Scale (SWB) (r = 0.62, P < .001). There was a modest correlation between the religious well-being subscale of the SWB and the SIWB (r = 0.35, P < .001). CONCLUSIONS: The Spirituality Index of Well-Being is a valid and reliable instrument that can be used in health-related quality-of-life studies.

Cross-Sectional Studies↗
PubMedDate not supplied

Religion, spirituality, and the practice of medicine.

Physicians are confronted with new information from the popular media, peer-reviewed journals, and their patients regarding the association of religious and spiritual factors with health outcomes. Although religion and spirituality have become more visible within health care, there are considerable ethical issues raised when physicians incorporate these dimensions into their care. Spiritualities are responsive to patient needs by offering beliefs, stories, and practices that facilitate the creation of a personally meaningful world, a constructed "reality" in the face of illness, disability, or death. It is largely through narrative that physicians incorporate into the health care encounter the spiritualities that are central to their patients' lived experience of illness and health.

Attitude to Death↗
PubMedDate not supplied

Reorganizing medicare for older adults with chronic illness.

A major challenge for the US health care system during coming years will be the financial viability and reorganization of Medicare--a program in which over 90% of family physicians participate. Although chronic illness constitutes a trajectory characterized by long-term patterns of health and functional states, fee-for-service Medicare is largely directed to the treatment of acute, episodic illness. Beyond the prescription drug benefit, there were several provisions in the Medicare Prescription Drug Improvement and Modernization Act of 2003 that were designed to improve the quality of care and reduce costs for chronically ill beneficiaries, an important first step in the reorientation of Medicare to chronic illness care. Quality is the foundation of Medicare's movement to a chronic care program and paying physicians for quality care is on the horizon. Family physicians will need to be actively engaged in Medicare's reorientation by articulating and promoting a quality of care that effectively integrates evidence-based medicine with a person-centered focus.

Aged↗
PubMedDate not supplied

Family medicine and the life course paradigm.

A unique characteristic of family physicians is that they seek to understand individual patients within the context of their families and larger social environments. Unfortunately, the intellectual development of family medicine is hampered by the reliance on epidemiologic, health service, and biomedical paradigms that are limited in their contextual perspectives on patients' lives. However, another paradigm, that of the life course, represents an interdisciplinary framework that views persons in context over time. It provides an ecological understanding of individual people by examining phenomena at the nexus of social pathways, developmental or health trajectories, and social change. A life course paradigm provides a way of thinking about patients in both proximal (eg, lived lives and family) and distal (eg, health care system) contexts over a life span. Five core principles define the life course as a paradigmatic framework: (1) human development and aging as lifelong processes, (2) human agency, (3) historical time and place, (4) the timing of events in a life, and (5) linked lives. At the individual level, the life course orients physicians to the opportunities and constraints that frame the health care choices, plans, and initiatives of people who maintain health and also face illness. At the organizational level, the life course offers an intellectual infrastructure for the New Model of Family Medicine by depicting an idealized delivery system that may be longitudinally integrated. It also emphasizes health and illness trajectories by linking health and other service organizations that assist individuals at different stages of their lives.

Family Practice↗