The biopsychosocial model 25 years later: principles, practice, and scientific inquiry.
(25/50)
The biopsychosocial model is both a philosophy of clinical care and a practical clinical guide. Philosophically, it is a way of understanding how suffering, disease, and illness are affected by multiple levels of organization, from the societal to the molecular. At the practical level, it is a way of understanding the patient's subjective experience as an essential contributor to accurate diagnosis, health outcomes, and humane care. In this article, we defend the biopsychosocial model as a necessary contribution to the scientific clinical method, while suggesting 3 clarifications: (1) the relationship between mental and physical aspects of health is complex--subjective experience depends on but is not reducible to laws of physiology; (2) models of circular causality must be tempered by linear approximations when considering treatment options; and (3) promoting a more participatory clinician-patient relationship is in keeping with current Western cultural tendencies, but may not be universally accepted. We propose a biopsychosocial-oriented clinical practice whose pillars include (1) self-awareness; (2) active cultivation of trust; (3) an emotional style characterized by empathic curiosity; (4) self-calibration as a way to reduce bias; (5) educating the emotions to assist with diagnosis and forming therapeutic relationships; (6) using informed intuition; and (7) communicating clinical evidence to foster dialogue, not just the mechanical application of protocol. In conclusion, the value of the biopsychosocial model has not been in the discovery of new scientific laws, as the term "new paradigm" would suggest, but rather in guiding parsimonious application of medical knowledge to the needs of each patient. (+info)
Understanding non-compliance to colorectal cancer screening: a case control study, nested in a randomised trial [ISRCTN83029072].
(26/50)
BACKGROUND: The major limit to colorectal cancer screening effectiveness is often low compliance. We studied the reasons for non compliance and determinants of compliance to faecal occult blood tests in Lazio, Italy. METHODS: This is a case-control study nested within a trial that tested the effect of type of test and provider on colorectal cancer screening compliance. Non compliant trial subjects were classified as cases, and compliant subjects were classified as controls. We sampled 600 cases and 600 controls matched by their general practitioner, half were invited for screening at the hospital, and the other half directly at their general practitioner's office. Cases and controls answered questions on: distance from test provider, logistical problems, perception of colorectal cancer risk, confidence in screening efficacy, fear of results, presence of colorectal cancer in the family, and gastrointestinal symptoms. RESULTS: About 31% of cases never received the letter offering free screening, and 17% of the sampled population had already been screened. The first reported reason for non-compliance was "lack of time" (30%); the major determinant of compliance was the distance from the test provider: odds ratio > 30 minutes vs < 15 minutes 0.3 (95% CI = 0.2-0.7). The odds ratio for lack of time was 0.16 (95% IC 0.1-0.26). The effect was stronger if the hospital (0.03 95% CI = 0.01-0.1) rather than the general practitioner (0.3 95% CI = 0.2-0.6) was the provider. Twenty-two percent of controls were accompanied by someone to the test. CONCLUSION: To increase compliance, screening programmes must involve test providers who are geographically close to the target population. (+info)
Patient assessments of a hypothetical medical error: effects of health outcome, disclosure, and staff responsiveness.
(27/50)
OBJECTIVE: To assess whether patients' perceptions of a hypothetical medical error are influenced by staff responsiveness, disclosure of error, and health consequences of the error. DESIGN: Hypothetical scenario describing a medication error submitted by mail. Three factors were manipulated at random: rapid v slow staff responsiveness to error; disclosure v non-disclosure of the error; and occurrence of serious v minor health consequences. PARTICIPANTS: Patients discharged from hospital. MEASURES: Assessment of care described in the scenario as bad or very bad, rating of care as unsafe, and intent to not recommend the hospital. RESULTS: Of 1274 participants who evaluated the scenario, 71.4% rated health care as bad or very bad, 60.2% rated healthcare conditions as unsafe, and 25.5% stated that they would not recommend the hospital. Rating health care as bad or very bad was associated with slow reaction to error (odds ratio (OR) 2.8, 95% CI 2.1 to 3.6), non-disclosure of error (OR 2.0, 95% CI 1.5 to 2.6), and serious health consequences (OR 3.4, 95% CI 2.6 to 4.5). Similar associations were observed for rating healthcare conditions as unsafe and the intent to not recommend the hospital. Younger patients were more sensitive to non-disclosure than older patients. CONCLUSIONS: Former patients view medical errors less favorably when hospital staff react slowly, when the error is not disclosed to the patient, and when the patient suffers serious health consequences. (+info)
Patient expectations of fair complaint handling in hospitals: empirical data.
(28/50)
BACKGROUND: A common finding in several studies is patients' dissatisfaction with complaint handling in health care. The reasons why are for the greater part unknown. The key to an answer may be found in a better understanding of patients' expectations. We investigated patients' expectations of complaint handling in hospitals. METHODS: Subjects were patients who had lodged a complaint at the complaint committees of 74 hospitals in the Netherlands. A total of 424 patients (response 75%) completed a written questionnaire at the start of the complaint procedures. Derived from justice theory, we asked what they expected from fair procedures, fair communication and fair outcome of complaint handling. RESULTS: The predominant reason for complainants to lodge a complaint was to prevent the incident from happening again. Complainants expected fair procedures from the complaint committee, in particular an impartial position. This was most important to 87% of the complainants. They also expected to be treated respectfully. Furthermore, they expected the hospital and the professional involved to respond to their complaint. A change in hospital performances was the most wanted outcome of complaint handling, according to 79% of the complainants. They also expected disclosure from the professionals. Professionals should admit a mistake when it had occurred. More complainants (65%) considered it most important to get an explanation than an apology (41%). Only 32% of complainants expected the professional to make an effort to restore the doctor-patient relationship. A minority of complainants (7%) wanted financial compensation. CONCLUSION: Nearly all complainants want to prevent the incident from happening again, not out of pure altruism, but in order to restore their sense of justice. We conclude that complaint handling that does not allow for change is unlikely to meet patients' expectations. Secondly, complaint handling should not be left exclusively to complaint committees, the responses of hospital and professionals are indispensable. (+info)
Assessment of the impact of implementing the Baby-Friendly Hospital Initiative.
(29/50)
OBJECTIVE: To evaluate the impact of the Baby-Friendly Hospital Initiative on the breastfeeding practices of mothers from the urban area of Montes Claros, MG, Brazil. METHODS: A comparative analysis was performed of two cross-sectional breastfeeding indicator studies with randomized samples of children under 2 years of age. One study was carried out before and the other after the Baby-Friendly Hospital Initiative had been implemented throughout all public pregnancy and childbirth care services in the city. Kaplan-Meyer survival curves were constructed for different breastfeeding patterns. Log rank testing was used to calculate the level of significance of differences between curves for before and after the Initiative. RESULTS: The survival curves demonstrate that breastfeeding rates increased during the study period. The log rank test detected significance for increases in all patterns of breastfeeding (p < 0.000). Median overall breastfeeding duration increased from 8.9 to 11.6 months and median duration of exclusive breastfeeding rose from 27 days to 3.5 months. CONCLUSIONS: Implementation of the Baby-Friendly Hospital Initiative in all public maternity units in Montes Claros significantly increased breastfeeding rates in the city. Since the ideal state of affairs has not yet been reached, further strategies must be implemented to promote and support breastfeeding practices. (+info)
Patients' satisfaction and opinions of their experiences during admission in a tertiary care hospital in Pakistan - a cross sectional study.
(30/50)
BACKGROUND: It is often felt that developing countries need to improve their quality of healthcare provision. This study hopes to generate data that can help managers and doctors to improve the standard of care they provide in line with the wishes of the patients. METHODS: It was a cross sectional study carried out at a major tertiary care hospital of Karachi. Patients between the ages of 18 and 80 years admitted to the hospital for at least one day were included. Patients in the maternity, psychiatry and chemotherapy wards and those in the ICU/CCU were excluded. A pretested, peer reviewed translation of a validated patient satisfaction scale developed by the Picker Institute of Europe was administered. RESULTS: A total of 173 patients (response rate: 78.6 %) filled the questionnaire. Patient satisfaction was at levels comparable to European surveys for most aspects of hospital care. However, nearly half the patients (48%) felt they had to wait too long to get a bed in the hospital after presenting to the ER. 68.6% of the patients said that they were never asked for views on the quality of care provided. 20% of the patients did not find anyone in the staff to talk to about their worries and fears while 27.6% felt that they were given emotional support to only some extent. Up to one third of the patients said they were not provided enough information regarding their operative procedures beforehand. CONCLUSION: Although several components of patient care equal the quality levels of the west, many sections require considerable improvement in order to improve health care provision. The healthcare team needs to get more involved with the patients, providing them greater support and keeping them informed and involved with their medical treatment. Efforts should be made to get regular feedback from the patients. (+info)
Comparing patient reports about hospital care across a Canadian-US border.
(31/50)
OBJECTIVE: To compare patient reports about hospital care between western New York State and southern Ontario using a random intercept model. METHOD: Cross-sectional survey of 3923 patients who received medical or surgical care between August and October 2004 at 28 hospitals (14 hospitals per jurisdiction). Thirty-five questions were combined to calculate eight indicators with scores ranging from 0 to 100 (best care experience). For each indicator, a model was built where the region (western New York vs. southern Ontario) was included as a fixed effect with hospital as random within region. A number of patient characteristics were also included as fixed effects. RESULTS: The effect of the region was statistically significant (P < 0.05) only for the models predicting the 'continuity and transition', 'involvement of family' and 'physical comfort' indicator scores. The differences were 10.66, 4.05 and -3.23 points, respectively. In all three models, the random intercepts were not statistically significant, indicating that the differences above did not vary by hospitals. The model predicting 'overall impression' scores, however, showed a random intercept statistically significant (P = 0.026). The individual-level explained proportion of variance ranged from 5.68 to 11.22%, and the hospital-within-region-level explained proportion of variance ranged from 2.19 to 52.28%. CONCLUSION: The difference observed on the 'continuity and transition' indicator might be the only one somewhat meaningful, and might be explained by health maintenance organization reimbursements' mechanisms and hospital quality improvement initiatives available in western New York, as well as by the fact that occupancy rates in western New York border the 60% compared with the 95% in southern Ontario. (+info)
The importance of relationships in mental health care: a qualitative study of service users' experiences of psychiatric hospital admission in the UK.
(32/50)