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Over the last few decades, information technology (IT) has significantly altered the nature of work and organizational structures in many industries, including health care. The purpose of this analysis is to compare how system-level differences affect IT implementation in health care (HIT) and the implications of these differences for health care equity.

We critically analyzed selected claims concerning the capacity of HIT to provide better care to more individuals at lower costs, thus contributing to health care equity, in the context of current health care reform efforts in the United States. We used the case of HIT implementation in Taiwan’s National Health Insurance system as a contrasting case.

We argue that however much HIT may yield in quality improvements or savings in the context of a universal and publicly financed single payer system, such savings simply cannot be accrued by a system of multiple health plans competing for better customers (i.e., less costly patients) and driven by profit.

It is important to define the level of analysis in debates about the potential of HIT to produce better health care at lower costs and the equity implications of this potential. In these debates, US policy makers should consider the commitment to health care equity that informed the design of Taiwan’s health care system and of HIT implementation in that country. HIT merely provides enabling tools that are of little value without major systemic changes

To our knowledge, the health IT expert literature has overlooked when not ignored the ethical principles informing health care systems, an omission which makes it difficult if not impossible to evaluate the potential of HIT to increase equity in health care.

The purpose of this paper is to provide a greater understanding of the general practitioner (GP)-patient relationship for academics and practitioners. A new model for dyadic professional relationships specifically designed for research into the doctor-patient relationship was developed and tested. Various conceptual models of trust and related constructs in the literature were considered and assessed for their relevance as were various related scales.

The model was designed and tested using purposefully designed scales measuring doctors’ trustworthiness, practice orientation performance and patient satisfaction. A quantitative survey used closed-ended questions and 372 patients responded from seven GP practices. The sample closely reflected the profile of the patients who responded to the DoH/NHS GP Patient Survey for England, 2010.

Hierarchical regression and partial least squares both accounted for 74 per cent of the variance in “overall patient satisfaction”, the dependent variable. Trust accounted for 39 per cent of the variance explained, with the other independent variables accounting for the other 35 per cent. ANOVA showed good model fit.

The findings on the factors which affect patient satisfaction and the doctor-patient relationship have direct implications for GPs and other health professionals. They are of particular relevance at a time of health reform and change.

The paper provides: a new model of the doctor-patient relationship and specifically designed scales to test it; a greater understanding of the effects of doctors’ trustworthiness, practice orientation and performance on patient satisfaction; and a new framework for examining the breadth and meaning of the doctor-patient relationship and the management of care from the patient’s viewpoint.

The purpose of this paper is to assess the nutritional status and quality of life in patients according to the clinical severity of liver cirrhosis.

A total of 151 cirrhotics were selected for study. Nutritional assessment was done by anthropometry, subjective global assessment, malnutrition universal screening tool, biochemical estimations and 72‐hour dietary recall. Quality of life was assessed by chronic liver disease questionnaire.

Child's status was A/B/C in 29/68/59, respectively. Muscle and fat depletion was significantly higher in grade C patients as compared to grade A and B patients. Incidence of malnutrition was lowest in grade A patients (72.4 percent) and highest in grade C patients (90.74 percent) (p = 0.00). Calorie and protein intake was significantly lower in grade C patients compared to grade A and B patients (p = 0.00). Child Pugh score was found to be an independent risk factor for various nutritional and clinical parameters.

The data presented reflect the assessment of a very small cohort of these patients and should be done on a larger scale.

Looking into the high prevalence of malnutrition and the negative impact of disease severity, nutritional assessment of these patients should be done on a regular basis and nutritional therapy planned accordingly.

Data on malnutrition from India are scarce. This study is a small attempt to throw light on the nutritional status and its variation according to clinical severity of liver cirrhosis.

We examine whether self-stigmatization may affect the everyday social interactions of individuals with a diagnosed, affective mental health disorder. Past research demonstrates self-stigmatization lowers self-esteem, efficacy, and personal agency, leading to the likely adoption of role-identities that are at the periphery of major social institutions. We advance research on self-stigma by examining the likely interactional and emotional consequences of enacting either a highly stigmatized self-identity or a weakly stigmatized self-identity.

Using affect control theory (ACT), we form predictions related to the interactional and emotional consequences of self-stigmatization. We use the Indianapolis Mental Health Study and Interact, a computerized instantiation of ACT, to generate empirically based simulation results for patients with an affective disorder (e.g., major depression and bipolar disorder), comparing simulations where the focal actor is a person with a mental illness who exhibits either high or low levels of self-stigma.

Self-stigma is predicted to negatively influence patients’ behavioral expression, leading the highly self-stigmatized to enact behaviors that are lower in goodness, power, and liveliness than the weakly self-stigmatized. Their corresponding emotional expressions during these types of interactions are similarly negatively impacted. Even though these likely interactions are the most confirmatory for people with high levels of self-stigma, they lead to interactions that are behaviorally and emotionally more negative than those who have been better able to resist internalizing stigmatizing beliefs.

This piece has implications for the literature on the interactional and life course challenges faced by psychiatric patients and contributes to the self-stigma literature more broadly. This work will hopefully inform future research involving the collection of non-simulation-based data on the everyday interactional experiences of people with mental health problems.

Recommending suitable doctors to patients on healthcare consultation platforms is important to both the patients and the platforms. Although doctor recommendation methods have been proposed, they failed to explain recommendations and address the data sparsity problem, i.e. most patients on the platforms are new and provide little information except disease descriptions. This research aims to develop an interpretable doctor recommendation method based on knowledge graph and interpretable deep learning techniques to fill the research gaps.

This research proposes an advanced doctor recommendation method that leverages a health knowledge graph to overcome the data sparsity problem and uses deep learning techniques to generate accurate and interpretable recommendations. The proposed method extracts interactive features from the knowledge graph to indicate implicit interactions between patients and doctors and identifies individual features that signal the doctors' service quality. Then, the authors feed the features into a deep neural network with layer-wise relevance propagation to generate readily usable and interpretable recommendation results.

The proposed method produces more accurate recommendations than diverse baseline methods and can provide interpretations for the recommendations.

This study proposes a novel doctor recommendation method. Experimental results demonstrate the effectiveness and robustness of the method in generating accurate and interpretable recommendations. The research provides a practical solution and some managerial implications to online platforms that confront information overload and transparency issues.

The purpose of this paper is to examine the relationship between patients’ provider communication effectiveness and courteousness with patients’ satisfaction and trust at free clinics.

This cross-sectional survey (n=507), based on the Consumer Assessment of Healthcare Providers and Systems instrument, was conducted in two Southeastern US free clinics. Latent class analysis (LCA) was used to identify patient subgroups (clusters) with similar but not immediately visible characteristics.

Across the items assessing provider communication effectiveness and courteousness, five distinct clusters based on patient satisfaction, trust and socio-demographics were identified. In clusters where communication and courteousness ratings were consistent, trust and satisfaction ratings were aligned with these domains, e.g., 54 percent rated communication and courteousness highly, which was associated with high patient satisfaction and trust. When communication effectiveness and courteousness ratings diverged (e.g., low communication effectiveness but high courteousness), patient trust and satisfaction ratings aligned with communication effectiveness ratings. In all clusters, the association was greater for communication effectiveness than for provider courteousness. Thus, provider courteousness was important but secondary to communication effectiveness.

Investment in patient-centered communication training for providers will improve patient satisfaction and trust.

The study is the first to examine individual provider communication components and how they relate to patient satisfaction and trust in free clinics. LCA helped to more fully examine communication constructs, which may be beneficial for more nuanced quality improvement efforts.

This study aims to describe patients presented in an interprofessional, virtual education program focused on the mental health of adults with intellectual and developmental disabilities (IDD), as well as present interprofessional recommendations for care.

In this retrospective chart review, descriptive statistics were used to describe patients. Content analysis was used to analyze interprofessional recommendations. The authors used the H.E.L.P. (health, environment, lived experience and psychiatric disorder) framework to conceptualize and analyze the interprofessional recommendations.

Themes related to the needs of adults with IDD are presented according to the H.E.L.P. framework. Taking a team-based approach to care, as well as ensuring care provider knowledge of health and social histories, may help better tailor care.

This project draws on knowledge presented in a national interprofessional and intersectoral educational initiative, the first in Canada to focus on this population.

Patient safety programmes aim to make healthcare safe for both patients and health professionals. The purpose of this paper is to explore the UK’s patient safety improvement programmes over the past 15 years and explore what lessons can be learnt to improve Libyan healthcare patient safety.

Publications focusing on UK patient safety were searched in academic databases and content analysed.

Several initiatives have been undertaken over the past 15 years to improve British healthcare patient safety. Many stakeholders are involved, including regulatory and professional bodies, educational providers and non-governmental organisations. Lessons can be learnt from the British journey.

Developing a national patient safety strategy for Libya, which reflects context and needs is paramount. Above all, Libyan patient safety programmes should reference internationally approved guidelines, evidence, policy and learning from Britain’s unique experience.

This review examines patient safety improvement strategies adopted in Britain to help developing country managers to progress local strategies based on lessons learnt from Britain’s unique experience.

Internationally, healthcare systems are moving towards delivering care in an integrated manner which advocates a multi-disciplinary approach to decision making. Such an approach is formally encouraged in the management of Atrial Fibrillation patients through the European Society of Cardiology guidelines. Since the emergence of new oral anticoagulants switching between oral anticoagulants (OACs) has become prevalent. This case study considers the role of multi-disciplinary decision making, given the complex nature of the agents. The purpose of this paper is to explore Irish General Practitioners’ (GPs) experience of switching between all OACs for Arial Fibrillation (AF) patients; prevalence of multi-disciplinary decision making in OAC switching decisions and seeks to determine the GP characteristics that appear to influence the likelihood of multi-disciplinary decision making.

A probit model is used to determine the factors influencing multi-disciplinary decision making and a multinomial logit is used to examine the factors influencing who is involved in the multi-disciplinary decisions.

Results reveal that while some multi-disciplinary decision-making is occurring (64 per cent), it is not standard practice despite international guidelines on integrated care. Moreover, there is a lack of patient participation in the decision-making process. Female GPs and GPs who have initiated prescriptions for OACs are more likely to engage in multi-disciplinary decision-making surrounding switching OACs amongst AF patients. GPs with training practices were less likely to engage with cardiac consultants and those in urban areas were more likely to engage with other (non-cardiac) consultants.

For optimal decision making under uncertainty multi-disciplinary decision-making is needed to make a more informed judgement and to improve treatment decisions and reduce the opportunity cost of making the wrong decision.

The purpose of this paper is to study the profiles of adults with autism spectrum disorder (ASD) requiring an inpatient psychiatric admission.

This paper examines profiles of 27 inpatients with intellectual disability (ID) and ASD who were admitted to a specialized inpatient unit in two time periods (January 2005 to June 2009 and July 2009 to December 2013) to explore changes over time in patient profiles.

Findings suggest that individuals who were admitted more recently between July 2009 and December 2013, were younger and more likely to come from other ethnic backgrounds than those admitted between January 2005 and June 2009. There was a trend for recent admissions to come from family homes, have moderate to profound ID and have longer hospital stay.

This is the first study to compare profiles of adults with ASD receiving inpatient services over time. The value of the study lies in illustrating that the needs of this growing patient group are changing which has implications for the treatment provision including specialized inpatient treatment.