|Year : 2020 | Volume
| Issue : 5 | Page : 2480-2486
“Patient centered care in medical disinformation era” among patients attending tertiary care hospital: A cross sectional study
Ravi Kant1, Poonam Yadav2, Surekha Kishore3, Rajesh Kumar2, Neetu Kataria2
1 Division of Diabetes and Metabolism, General Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
2 Centre of Excellence in Nursing Education and Research, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
3 Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
|Date of Submission||17-Mar-2020|
|Date of Decision||28-Mar-2020|
|Date of Acceptance||08-Apr-2020|
|Date of Web Publication||31-May-2020|
Dr. Poonam Yadav
Centre of Excellence in Nursing Education and Research, All India Institute of Medical Sciences, Virbhadra Road Shivaji Nagar, Near Barrage, Sturida Colony, Rishikesh - 249 203, Uttarakhand
Source of Support: None, Conflict of Interest: None
Background and Objectives: Patient-centered care refers to the provision of care for patients' comprehensive needs, perspectives, and preferences. In health security, communication between patient and physician is the main key through which we plan and implement to threats that can affect huge population. Aim: The aim of this study was to assess the patient-centered care in medical disinformation era among patients attending tertiary care teaching hospital, Rishikesh. Materials and Methods: A descriptive cross-sectional study was planned by enrolling 240 patients attending tertiary care teaching hospital. Total consecutive sampling technique was chosen to recruit the patients for the study. Tools: Tools used were case reporting form and components of primary care index (CPCI). Results: The results show statistically significant association between chronic history of illness of patient (P = 0.02), education of patient (P = 0.008), and habitat of patient (P = 0.05) with interpersonal communication between patient and physician, and the results also show statistically significant association between accumulated knowledge (P = 0.000), coordination of care (P = 0.001), continuity belief (P = 0.000), comprehensiveness of care (P = 0.001), and first contact (P = 0.001) with interpersonal communication between patient and physician. The lowest mean percentage of patient-centered care score was observed for accumulated knowledge (65.70%) and the highest mean percentage (85.15%) score of patient-centered care was observed for interpersonal communication. Conclusions: This study concluded that patient-centered care improves interpersonal communication between patient and physician. Threats arising due to present medical disinformation era can be combat by patient-centered care.
Keywords: Comprehensive care, continuity, interpersonal communication, medical disinformation, patient-centered care
|How to cite this article:|
Kant R, Yadav P, Kishore S, Kumar R, Kataria N. “Patient centered care in medical disinformation era” among patients attending tertiary care hospital: A cross sectional study. J Family Med Prim Care 2020;9:2480-6
|How to cite this URL:|
Kant R, Yadav P, Kishore S, Kumar R, Kataria N. “Patient centered care in medical disinformation era” among patients attending tertiary care hospital: A cross sectional study. J Family Med Prim Care [serial online] 2020 [cited 2020 Sep 19];9:2480-6. Available from: http://www.jfmpc.com/text.asp?2020/9/5/2480/285124
| Introduction|| |
Patient-centered care refers to the provision of care for patients' comprehensive needs, perspectives, and preferences. Definition of patient-centered care by the Institute of Medicine as follows: “Providing care that is respectful of, and responsive to, individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions.” American College of Physician has described principles that are necessary for patients for fulfilling health care and give significant track for implementing these ideas. The term “patient-centered care” was first created by the Institute of Medicine in 2001 and characterized as guaranteeing patients manage their very own clinical decisions, and has turned out to be normal place in human care. It incorporates guaranteeing patients access to services, care is composed and patients are given educating materials and resources. The principles of patient-centered care explains that patients and patient's families should be treated with respect and dignity along with that they should be active partners in all aspects of health care, which may contribute to the improvement of health-care systems. Patient and family should be partners in the education of health-care personnels. In this disinformation era, health-related misinterpretations spread over online networking, representing a risk to general wellbeing. Most of patients and caregivers searched for information sources other than health-care system. The most frequently checked source was Internet; patients and caregivers understand what they want to know and this source forces them to make precise decision. Health professionals should be aware and help patients and caregivers to better sort out and interpret the news they found. In the broadest origination, communication is a system that enables health professionals to impart information to patient and care givers. In health security, communication between patient and physician is the main key through which we plan and implement to threats that can affect huge population. Primary care focuses on communication between the primary care physician and other health-care providers with the aim of comprehensive care of all patients because primary care physician is first contact of patient and has the opportunity to take care of patient's health for long-term, through multiple visits at different stages of the patient's life.
Need and scope of the study
This study assesses the need of patient-centered care among patients attending tertiary care hospital in the medical disinformation era. Hence, it highlights the importance of implications of patient-centered care guidelines among the patients and health-care practioners globally.
- Patient needs patient-centered care for comprehensive management of disease
- Medical disinformation affects the health of the patients and health resources
- The subjects were honest in giving answer to each item in tool.
| Aim|| |
The aim of this study was to assess the patient-centered care in medical disinformation era among patients attending tertiary care hospital, Rishikesh.
This was a quantitative research approach.
This was a descriptive cross sectional study.
Sample of the study will be the patients attending selected outpatient departments (OPDs) at tertiary care hospital.
240 sample size calculated with the following formula:
n = N/1 + Nd2,
Where N is the total population (600) attending the selected OPDs at tertiary care hospital.
Total consecutive sampling technique has been adopted to recruit the sample in the study.
Gynecology, medicine, surgery, and orthopedic OPDs of tertiary care hospital.
The inclusion criteria of the study included the following:
- Patients aged above 18 years
- Patients attending tertiary care hospital.
The exclusion criteria of the study included the following:
- Those who are not willing to participate/providing informed written consent in the study
- Patients in need of emergency treatment
- Those who are attending the OPD at first time.
Data were collected in the month of January 2020.
- Case reporting form
- Component of primary care (CPCI).
After obtaining informed consent from the participants, data were collected through case reporting form and CPCI tool from patients attending selected OPDs at tertiary care hospital.
- Case reporting form: It consists of demographic characteristics and clinical variables of the participants
- Component of primary care (CPCI): This tool has been developed by Susan A Flocke, Ph D, Cleaveland, Oregon Health and Science University in 2016. This is the Likert scale to measure the key aspects of delivery of care based on definition of institute of medicine from perspective of patients visiting to physician. The components of primary care are associated with patient satisfaction with visits to family physicians
The factors were named as follows:
Interpersonal communication: It reports whether a physician listens and explains during interaction with patient.
Accumulated knowledge: Patient's perception that physician knows his or her medical issues and physician has accumulated knowledge of the patient.
Coordination of care: Patient's perception of physician knowledge of other visits, follow-up, and visit to specialists.
First contact: It measures as patient's perspective of seeking care from first contact. Continuity of belief: It measures as continuous care by physician or team.
Longitudinality: It measures as length of relationship between patient and physician. The response format of tool is Likert scale varying from 1 strongly disagree to 5 strongly agree and 0 at center option. Negatively worded items have been reverse scored.
Validity and reliability of tools
A panel of skilled experts was involved to evaluate the content validity of this tool. The panel evaluated the relevance of item to the component they proposed to measure. Internal consistency of each scale score was measured by Cronbach α internal consistency reliability of tool was 0.68–0.79. This level of internal consistency is considered good.
The data were collected, coded, and summarized from 240 patients with the help of subject data sheet and CPCI tool in MS Excel datasheet 2013 window and analyzed on the basis of objectives of the study using Statistical Package for the Social Sciences (SPSS) software program, version 23.0, IBM 1911, Armonk, New York. Appropriate descriptive and inferential statistics was applied to analyze the data considering P value significant as <0.05.
| Results|| |
Mean age of patients was 46.58 ± 1.47 [Table 1]. Among the participants, 134 (54%) were female [Figure 1]. In total, 158 (66%) participants were from rural background and 82 (34%) were from urban region [Figure 2]. 41 (17%), 41 (17%), and 53 (22%) of participants were consuming tobacco, smoking, and alcohol, respectively [Figure 3]. 163 (68%) were suffering from chronic illness [Figure 4]. 120 (50%) had family income less than Rs. 20,000 and only 10% of the participants had income more than Rs. 60,000.
[Table 2] shows mean with standard deviation and median of components of CPCI tool. [Table 3] shows statistically significant association between chronic history of illness of patient (P = 0.02), education of patient (P = 0.008), and habitat of patient (P = 0.05) with interpersonal communication between patient and physician. [Table 4] shows statistically significant association between accumulated knowledge (P = 0.000), coordination of care (P = 0.001), continuity belief (P = 0.000), comprehensiveness of care (P = 0.001), and first contact (P = 0.001) with interpersonal communication between patient and physician. [Figure 5] shows frequency % of patients who were strongly agree (score = 5) for accumulated knowledge. [Figure 6] shows frequency % of patients who were strongly agree (score = 5) for interpersonal communication. [Figure 7] shows frequency % of patients who were strongly agree (score = 5) for coordination of care. [Figure 8] shows frequency % of patients who were strongly agree (score = 5) for continuity belief. [Figure 9] shows mean frequency % of all domain of CPCI scale. The lowest mean percentage of patient-centered care score was observed for accumulated knowledge (65.70%) followed by coordination of care (77.32%), first contact (80.04%), comprehensiveness of care (80.06%) and continuity belief (80.66%). The highest mean percentage (85.15%) score of patient-centered care was observed for interpersonal communication.
|Table 2: Mean, median, and standard deviation score for the component of CPCI scale|
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|Table 3: Association between demographic variables and interpersonal communication|
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|Table 4: Association between accumulated knowledge, coordination of care, continuity belief, comprehensiveness of care, and interpersonal communication|
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| Discussion|| |
Patient-centered care involves interpersonal communication between patient and physician. Biglu et al. explained a significant association between communication skills of physicians and patients' satisfaction. Ha and Longnecker also supported that communication skill is the main consideration of clinical field and establishment of therapeutic interpersonal relationship with patient. Suh and Lee also supported that interpersonal communication has significant impact on patient care. Tanveer et al. also supported that interpersonal communication skills has significant association with patient level of satisfaction. This study reported that higher prevalence of coordination of care and continuity of care among patients which is a desirable feature of cost-effective healthcare systems. Baker et al. also reported that higher continuity of care is associated with a higher level of belief between patient and physician it further improve relationship between patients and physicians and quality and outcomes of care. In another study, preference for a with physician was associated with all aspects of continuity of care in this study more than 80% of respondents preferred a continuing relationship with doctors. Droz et al. also reported that items related to “communication and patient-centeredness care“, “coordination and continuity of care” are the most recurrently mentioned as “very important” in patient care. In a cross-sectional analytical study, conducted among 133 general practitioners and results of the study also reported association between longitudinal care and accumulated knowledge. Parchman et al. also reported that continuity of care improved communication, length of relationship, accumulated knowledge of the patient by the physician, and continuity belief. In another study, conducted among 5507 adults, reported continuity with a usual primary care physician. Pandhi et al. also reported that experiencing more first-contact access components was significantly associated with a higher rate of receiving patient care. Newell and Jordan reported that patient-centered communication improve health care and quality. Paiva et al. conducted a qualitative study and reported that patient-centered care improve communication and relationship between patient health-care providers through patients' and family participation. Nkrumah and Abekah-Nkrumah conducted an exploratory research and data were collected using qualitative methods, reported that communication related challenges are one of main constraints of patient-centered care. Cruz et al. also reported that coordination of care is associated with patient-centered care for both in women's health and children's health. This study also reported that all items of CPCI scale are quietly prevalent in tertiary care hospital and also reported statistically significant association between accumulated knowledge (P = 0.000), coordination of care (P = 0.001), continuity belief (P = 0.000), comprehensiveness of care (P = 0.001), and first contact (P = 0.001) with interpersonal communication between patient and physician. Aelbrecht et al. supported that patient's education had association with interaction between patient and physician. Another previous cross-sectional study observed association of race, ethnicity, age, frequent visits, and gender with interpersonal communication. The results of this study suggested statistically significant association between chronic history of illness of patient (P = 0.02), education of patient (P = 0.008) and habitat of patient (P = 0.05) with interpersonal communication between patient and physician. In this medical disinformation era, interpersonal communication between patient and physician plays significant role to improve the patient-centered care at tertiary care hospital.
It was a cross-sectional study and sample size was also limited and it was relatively small, and recruited from a single population.
Interpretations and implications
Development of coordination between different clinical departments will be helpful for the implication of patients centered approach to reduce the burden of patients at super specialty departments of tertiary care hospital as well as use of health-care resources and health-care costs. Health-care administers should emphasize on training and promoting the communication skills of physicians.
Each and every department may use patient-centered care approach to continuously enhance quality of nursing care and patient's satisfaction.
Patient-centered education may help to deliver effective patient-centered care which committed to improve quality and safety as well as life-long learning and professional formation.
Future research direction
Further, research on patient-centered care may overcome the challenges of medical disinformation era through interpersonal communication. It requires development of tool to measure medical disinformation and further in-depth study with larger sample size at various levels of clinical practices.
| Conclusions|| |
The interpersonal communication skills of health professionals play very important role in patient-centered care. It enhances continuity belief and first contact of patients with physician. Patient-centered care improves comprehensiveness and coordination of care among patients. Interpersonal communication can combat threats arises due to present medical disinformation era. This study suggests further improvement in the implementation of patient-centered care to continuously enhance quality of life, quality of health care, and hospital experience of patients with readiness for discharge.
Ethical policy and institutional review board statement
Ethical approval for this study was obtained from the Institutional Ethics Committee (IEC), All India Institute of Medical Sciences (AIIMS), Rishikesh (Protocol number AIIMS/IEC/19/1272).
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Boyd C, Fortin M. Future of multimorbidity research: How should understanding of multimorbidity inform health system design? Public Health Rev 2010;32:451-74.
Baker A. Book: Crossing the quality chasm: A new health system for the 21st
century. BMJ 2001;323:1192.
Shrank W. Primary care practice transformation and the rise of consumerism. J Gen Intern Med 2017;32:387-91.
Greiner A, Knebel E. Health professions education: A bridge to quality. J Healthc Qual 2004;26:54.
Nickel W, Weinberger S, Guze P. Principles for patient and family partnership in care: An American college of physicians position paper. Ann Intern Med 2018;169:796-9.
Kata A. Anti-vaccine activists, Web 2.0, and the postmodern paradigm – An overview of tactics and tropes used online by the anti-vaccination movement. Vaccine 2012;30:3778-89.
Chiò A, Montuschi A, Cammarosano S, De Mercanti S, Cavallo E, Ilardi A, et al
. ALS patients and caregivers communication preferences and information seeking behaviour. Eur J Neurol. 2008;15(1):55-60. doi:10.1111/j.1468-1331.2007.02000.x.
Ventola CL. Social media and health care professionals: Benefits, risks, and best practices. - PubMed - NCBI [Internet]. Ncbi.nlm.nih.gov. 2020. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25083128
. [Last cited on 2020 Mar 08].
Aller M, Vargas I, Coderch J, Vázquez M. Doctors' opinion on the contribution of coordination mechanisms to improving clinical coordination between primary and outpatient secondary care in the Catalan national health system. BMC Health Serv Res 2017;17:842.
Flocke SA. Measuring attributes of primary care: Development of a new instrument. - PubMed - NCBI [Internet]. Ncbi.nlm.nih.gov. 2020. Available from: https://www.ncbi.nlm.nih.gov/pubmed/9228916
. [Last cited on 2020 Mar 09].
Biglu M, Nateqv F, Ghojazadeh M, Asgharzadeh A. Communication skills of physicians and patients' satisfaction. Materi Socmed 2017;29:192-5.
Suh W, Lee C. Impact of shared-decision making on patient satisfaction. J Prev Med Public Health 2010;43:26-34.
Tanveer F, Shahid S, Hafeez MM. Impact of doctor's interpersonal communication skill on patient's satisfaction level. Isra Med J 2018;10:306-9.
Baker R, Mainous Iii A, Gray D, Love M. Exploration of the relationship between continuity, trust in regular doctors and patient satisfaction with consultations with family doctors. Scand J Prim Health Care 2003;21:27-32.
Liu C, Wu Y, Chi X. Relationship preferences and experience of primary care patients in continuity of care: A case study in Beijing, China. BMC Health Serv Res 2017;17:585.
Droz M, Senn N, Cohidon C. Communication, continuity and coordination of care are the most important patients' values for family medicine in a fee-for-services health system. BMC Fam Pract 2019;20:19.
Hjortdahl P. Continuity of care: General practitioners' knowledge about, and sense of responsibility toward their patients. Fam Pract 1992;9:3-8.
Parchman M, Noël P, Lee S. Primary care attributes, health care system hassles, and chronic illness. Med Care 2005;43:1123-9.
Pandhi N, DeVoe J, Schumacher J, Bartels C, Thorpe C, Thorpe J, et al
. Number of first-contact access components required to improve preventive service receipt in primary care homes. J Gen Intern Med 2012;27:677-84.
Newell S, Jordan Z. The patient experience of patient-centered communication with nurses in the hospital setting: A qualitative systematic review protocol. JBI Database System Rev Implementat Rep 2015;13:76-87.
Paiva D, Abreu L, Azevedo A, Silva S. Patient-centered communication in type 2 diabetes: The facilitating and constraining factors in clinical encounters. Health Serv Res 2019;54:623-35.
Nkrumah J, Abekah-Nkrumah G. Facilitators and barriers of patient-centered care at the organizational-level: A study of three district hospitals in the central region of Ghana. BMC Health Serv Res 2019;19:900.
Cruz M, Santos A, Araújo L, Andrade E. A coordenação do cuidado na qualidade da assistência à saúde da mulher e da criança no PMAQ[Coordination of care and quality of healthcare for women and children in the PMAQ]. Cad Saúde Pública 2019;35:e00004019.
Aelbrecht K, Hanssens L, Detollenaere J, Willems S, Deveugele M, Pype P. Determinants of physician–patient communication: The role of language, education and ethnicity. Patient Educ Couns 2019;102:776-81.
Singh S, Evans N, Williams M, Sezginis N, Baryeh N. Influences of socio-demographic factors and health utilization factors on patient-centered provider communication. Health Commun 2017;33:917-23.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9]
[Table 1], [Table 2], [Table 3], [Table 4]