Employers' efforts to measure and improve hospital quality: determinants of success.
(41/4025)
We examined eleven communities in which an employer coalition created a report card to compare the performance of the community's hospitals. After interviewing employer coalition and hospital representatives from each community, we found great variability in report cards' capacity to prompt quality improvement. Although some were successful, others had less impact because of conflicts between employer coalitions and hospitals. Areas of disagreement included selection of appropriate goals, methodology of quality measurement, whether report cards should be publicly released, and the use of economic incentives to improve quality. We describe these conflicts and offer recommendations for future hospital report cards. (+info)
The experience of native peer facilitators in the campaign against type 2 diabetes.
(42/4025)
CONTEXT: The use of peer facilitators in health programs has great potential. One important application is prevention and control of type 2 diabetes among American Indians. PURPOSE: To explore the experience of American Indian facilitators in a culturally appropriate intervention (Talking Circles) on 2 Northern Plains reservations. The Talking Circles offered a forum for educational dialogue on diabetes risk factors and the management of type 2 diabetes. METHODS: Phenomenology, a qualitative research approach, was used to answer the research question: "What did Native Talking Circle facilitators experience?" Participants were 4 lay health workers from the intervention reservations who had been trained to present a diabetes curriculum while coordinating and guiding the group discussion. During open-ended, taped interviews, the facilitators shared their experiences conducting the Talking Circles. Analysis categorized the experiences into common themes to explain the phenomena and cultural construction of oral discussions (Talking Circles) of diabetes. FINDINGS: Themes included the concept of "a calling" to do the work, which included a self-growth process, a blending of 2 worldviews as a diabetes intervention strategy, the importance of translating educational materials in a liaison role, and commitment to tribal people and communities. CONCLUSIONS: The experience of the facilitators was positive because they were knowledgeable about American Indian culture and worldview and were trained in both Talking Circle facilitation and type 2 diabetes. (+info)
Challenges to masculine transformation among urban low-income African American males.
(43/4025)
In this article we describe and analyze the challenges faced by an intervention program that addresses the fatherhood needs of low-income urban African American males. We used life history as the primary research strategy for a qualitative evaluation of a program we refer to as the Healthy Men in Healthy Families Program to better understand the circumstances and trajectory of men's lives, including how involvement in the program might have benefited them in the pursuit of their fatherhood goals. A model of masculine transformation, developed by Whitehead, was used to interpret changes in manhood/fatherhood attitudes and behaviors that might be associated with the intervention. We combined Whitehead's model with a social ecology framework to further interpret challenges at intrapersonal, interpersonal, community, and broader societal levels. (+info)
Socioeconomic status and dissatisfaction with health care among chronically ill African Americans.
(44/4025)
Addressing differences in social class is critical to an examination of racial disparities in health care. Low socioeconomic status is an important determinant of access to health care. Results from a qualitative, in-depth interview study of 60 African Americans who had one or more chronic illnesses found that low-income respondents expressed much greater dissatisfaction with health care than did middle-income respondents. Low socioeconomic status has potentially deadly consequences for several reasons: its associations with other determinants of health status, its relationship to health insurance or the absence thereof, and the constraints on care at sites serving people who have low incomes. (+info)
How are family physicians managing osteoporosis? Qualitative study of their experiences and educational needs.
(45/4025)
OBJECTIVE: To explore family physicians' experiences and perceptions of osteoporosis and to identify their educational needs in this area. DESIGN: Qualitative study using focus groups. SETTING: Four Ontario sites: one each in Thunder Bay and Timmins, and two in Toronto, chosen to represent a range of practice sizes, populations, locations, and use of bone densitometry. PARTICIPANTS: Thirty-two FPs participated in four focus groups. Physicians were identified by investigators or local contacts to provide maximum variation sampling. METHOD: Focus groups using a semistructured interview guide were audiotaped and transcribed. The constant comparative method of data analysis was used to identify key words and concepts until saturation of themes was reached. MAIN FINDINGS: Family physicians order bone densitometry and try to manage osteoporosis appropriately, but lack a rationale for testing and are confused about management. Participants' main concern was clinical management, followed by disease prevention and their educational needs. CONCLUSION: Family physicians are confused about how to manage osteoporosis. To reduce the burden of illness due to osteoporosis, educational interventions should be tailored to family physicians' needs. (+info)
Critical thinking in respiratory care practice: a qualitative research study.
(46/4025)
INTRODUCTION: Recent publications indicate that critical thinking should be an integral part of respiratory care education. However, we know very little about critical thinking in the context of respiratory care. The critical thinking abilities and decision-making characteristics of practicing respiratory therapists have not been studied. PURPOSE: Identify and describe the critical thinking skills and traits of respiratory therapists, using a qualitative, descriptive research methodology. METHODS: Critical thinking was defined as the combination of logical reasoning, problem-solving, and reflection. The sample was selected through nominations of experts, using reputational-case selection. The research involved observations of 18 registered respiratory therapists, followed by in-depth interviews. Data were collected over a 1-year period and there were 125 hours of observation and 36 hours of interview. The observations were the basis for identifying and describing context-bound situations that require critical thinking, as well as the essential skills and related traits. RESULTS: The data set consists of over 600 single-spaced pages of interview transcripts and participant-observation field notes, in addition to 36 audio tapes. Field notes and interview transcripts were continuously analyzed throughout the study, using the constant-comparative method described by Glaser and Strauss. CONCLUSIONS: The findings suggest that critical thinking in respiratory care practice involves the abilities to prioritize, anticipate, troubleshoot, communicate, negotiate, reflect, and make decisions. (+info)
"Fire away": the opening sequence in general practice consultations.
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BACKGROUND: Proponents of recent models of the doctor-patient relationship, such as concordance and shared decision making, have emphasized mutuality rather than paternalism or consumerism. However, little attention has been paid so far to the ways in which this might actually be achieved. OBJECTIVES: The aims of this study were to establish whether there are any rules governing the opening sequence in general practice consultations, and to analyse the ways in which the observing or breaking of such rules contributes to the development of mutuality between patients and GPs. METHODS: The paper is based on a qualitative study of 62 patients consulting 20 GPs in 20 practices in the Midlands and Southeast of England. Consultations were audio recorded and transcribed; patients were interviewed before and after each consultation, and doctors were interviewed afterwards. Data were analysed using the sociological method of Conversation Analysis. The outcomes were participants' own understandings as demonstrated in their speech. RESULTS: A selection rule was identified whereby doctors choose between the questions "How are you?" and "What can I do for you?" to elicit patients' concerns. Deviations from this selection rule may be either repairable or strategic. Repairable deviance is based on misunderstanding between participants, and is resolved interactionally, usually by patients. Strategic deviance is the attempt by doctors to emphasize or de-emphasize certain aspects of their relationships with particular patients. Deviations from the rule which are not repaired lead to misalignment between participants. CONCLUSION: In relation to concordance, or shared decision making more generally, this analysis demonstrates that alignment or misalignment between participants will occur before any discussion about treatment options occurs. In cases of misalignment, concordance will be much harder to achieve. Mutuality is an achievement of both patients and doctors, and requires the active participation of patients. (+info)
GPs' perspectives on managing time in consultations with patients suffering from depression: a qualitative study.
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BACKGROUND: Although there is widespread concern that general practice consultations are too short for doctors to provide a high quality of care for patients, the relationship between the length and outcome of these consultations remains unclear. Research to date has neglected the subjective experience of consultation time of both patients and GPs. OBJECTIVES: Our aim was to investigate GP perspectives on consultation time and the management of depression in general practice. METHOD: A qualitative interview-based study was carried out of 19 GPs from eight West Midlands general practices. RESULTS: The GPs in this study acknowledged the pressure of work and resource constraints in general practice. However, they did not feel these prevented them from providing good support and treatment for depression. They were confident in the effectiveness of antidepressants and their own skills in providing counselling support, and were able to utilize time flexibly in responding to patients' variable needs. Depression was viewed as a relatively straightforward problem that usually could be managed within the resources available to general practice. CONCLUSION: The doctors generally did not experience time to be a limiting factor in providing care for patients with depression. This is in contrast to the more acute sense of time pressure commonly reported by patients which they felt undermined their capacity to benefit from the consultation. GPs need to be more aware of patient anxieties about time, and to devise effective means of raising patients' sense of time entitlement in general practice consultations. (+info)