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The purpose of this chapter is to use sociological theory and research to develop an explanation for how chronic illnesses are managed at home and to thereby suggest some ways in which a sociological perspective can be applied to improve health care for persons with chronic illnesses. Self-care illness management is crucial to the prevention of and reduction of morbidity and mortality from chronic illness.

Review and synthesis of research literature.

Sociological research and theory suggest two important insights that should inform health care services aimed at improving self-care; chronic illness care occurs in the context of the household, neighborhood, and community and, therefore, the “patient” (i.e., the object of health services) is really the caregiving social network around the patient, and because the risk of chronic illness and the resources available to deal with it are socially (and unequally) distributed, “health care” interventions need to take account of disparities in risks and resources that will affect the patient’s ability to successfully comply with self-care regimens.

The review does not include an examination of the clinical research literature. It does, however, suggest that sociologists need to explicitly study chronic illness and health care related to it.

The chapter links the long history of research on family caregiving to the concern with the success of self-management of chronic illness. It also links concerns about that success to social disparities in the distribution of social resources and hence to morbidity and mortality disparities.

Describes a study designed to develop instruments for examining the quality of routine care of hypertension among the elderly and, using non‐medical predictors of quality ‐ such as elderly patient and doctor variables and doctor‐patient interaction variables ‐ to explain the variance in the quality of care. The study population comprised 352 elderly people (92 per cent) in one Jerusalem neighbourhood who were members of Israel’s largest sick fund. Interviews, screening, observation and examination of records were the sources of information. Multivariate analysis was performed. The findings indicated a plethora of deficiencies in the quality of routine care, mostly in the quality of surveillance and the control of hypertension. It was found that the outcome of care is primarily a result of the physician‐patient interaction, rather than of a lack of patient compliance. Proposes a national programme using the instruments developed.

This study formulates a new archetypical model that describes and re-interprets the patient–physician relationship from the perspective of two widespread phenomena in the healthcare delivery process: value co-creation (VCC) and defensive medicine (DM).

Grounded in the existing literature on VCC and DM, the authors designed and conducted 20 in-depth interviews with doctors (and patients) about their past relationships with patients (and doctors). After putting the recorded interviews through qualitative analysis with a three-level coding activity, the authors built an empirically informed model to classify patient–physician relationships.

The authors identified four archetypes of patient–physician relationships. Each archetype is described along with its representing characteristics and explained in terms of its consequences as they relate to VCC and DM.

This research contributes to the literature on both VCC in healthcare and DM, in addition to the patient–physician's relationship literature.

Being aware of patient–physician relationship mechanics, building long-term relations with patients and investing in service personalization and patient-centred care can effectively mitigate the risks of DM behaviours on one side while increasing the likelihood of VCC actualization on the other.

Although strictly linked to the interactions between patients and doctors, VCC and DM are typically considered disentangled. In this research paper, the authors identified four archetypes of patient–physician relationships in relation to these two phenomena.

The purpose of this paper is to examine the impact of consumer sociability and service provider perceived expertise on service relationship success.

A sample of 281 consumers in the USA, randomly selected with the assistance of a commercial list service, completed the survey. Structural equations modeling, was used to test the proposed model.

The findings show that customer sociability and service provider expertise are important to relationship success. In addition, the duration of the relationship was found to be a consequence of satisfaction and a driver of social benefits, which strengthens customer commitment.

Personality traits have been previously examined in a low involvement retail setting and not found to be a significant influence on commitment. This study finds that sociability does have a significant impact on service relationship success; thus, providing support for the importance of customer traits in relationship marketing in some contexts.

While provider characteristics are expected to influence customer commitment, this study provides evidence that at least one consumer personality trait (i.e. sociability) appears to impact commitment to a provider in high involvement services. Healthcare providers should be aware that the personality of the patient may be a driver of satisfaction with and commitment to the physician, despite the doctor's perceived level of expertise.

This research fills a gap in the literature on the link between customer traits and service relationships in a healthcare setting. Since consumers are co‐participants in service delivery, it is important to understand how their characteristics impact service relationship success.

The physician–patient relationship is the cornerstone of care quality. Unfortunately, it may be adversely affected by physician burnout, which is becoming more prevalent according to the literature. We present a model, based on the burnout and physician–patient communication literatures, which delineates the impact of physician burnout on the physician–patient interaction and ultimately on patient outcomes. In short, when physicians use depersonalization to cope with emotional exhaustion, their communication style becomes more biomedically oriented. Faced with this communication style when interacting with their physician, patients are less satisfied, trusting, and adherent. The implications of this model and directions for future research are presented.

As one of the five major dimensions of service quality, empathy has been and continues to be regarded as a requirement for a successful service encounter. This paper focuses on the highly customer-centric service industry of health care. The purpose of this paper is to shed light on the potential negative effects of empathy on both the physician and the patient.

Building on an in-depth review of literature and well-established service quality models, the authors propose a new model for understanding the complex role of physician empathy in the physician–patient encounter. The trait, emotional intelligence (EI), is presented as a moderator for physician empathy levels.

The Health Care Optimal Physician Empathy (HOPE) model enables further characterization and analysis of the tradeoffs between patient satisfaction and physician burnout and determining when empathy optimally works to the benefit of both the physician and the patient to maximize service quality. The HOPE model provides a systematic way to understand and determine the appropriate level of physician empathy that results in optimal outcomes for both physicians and their patients by demonstrating the tradeoffs between physician burnout and patient satisfaction.

The authors highlight the potential detrimental effects on physicians themselves, and, in turn, on service quality. The theoretical and practical implications in this paper provide insights into the development and implementation of empathy-focused interventions and best practices to optimize service quality in the physician–patient interaction. The HOPE model is the first of its kind in shedding light on the manifestation of physician empathy.

Health service quality is an important determinant for health service satisfaction and behavioral intentions. The purpose of this paper is to investigate requirements of e‐health services and to develop a measurement model to analyze the construct of “perceived e‐health service quality.”

The paper adapts the C‐OAR‐SE procedure for scale development by Rossiter. The focal aspect is the “physician‐patient relationship” which forms the core dyad in the healthcare service provision. Several in‐depth interviews were conducted in Switzerland; first with six patients (as raters), followed by two experts of the healthcare system (as judges). Based on the results and an extensive literature research, the classification of object and attributes is developed for this model.

The construct e‐health service quality can be described as an abstract formative object and is operationalized with 13 items: accessibility, competence, information, usability/user friendliness, security, system integration, trust, individualization, empathy, ethical conduct, degree of performance, reliability, and ability to respond.

Limitations include the number of interviews with patients and experts as well as critical issues associated with C‐OAR‐SE. More empirical research is needed to confirm the quality indicators of e‐health services.

Health care providers can utilize the results for the evaluation of their service quality. Practitioners can use the hierarchical structure to measure service quality at different levels. The model provides a diagnostic tool to identify poor and/or excellent performance with regard to the e‐service delivery.

The paper contributes to knowledge with regard to the measurement of e‐health quality and improves the understanding of how customers evaluate the quality of e‐health services.

The purpose of this paper is to study the US-based (American) physiotherapy customers’ goals to engage in value cocreation activities during their well-being experience.

The authors perform Smart PLS-SEM analysis of the primary data of physiotherapy service customers in the USA.

The findings show that the US well-being customer engages in physiotherapy for individualizing, empowering, development, concerted and ethical motives but not for relating motives. These findings are contrasted with previous research to show that the service-dominant logic is not sufficient to account for the contextual complexity of the well-being experience and to explain the identified differences across culturally different customer segments.

By integrating insights from health-care and cross-cultural literature, the authors highlight the importance of relationship dynamics, culture and institutional context in well-being sector and develop a more comprehensive understanding of the cocreation behaviors in this industry. This helps advance the value cocreation research in well-being sector and promote the well-being experiences such as physiotherapy.

The authors draw from a variety of disciplinary perspectives and challenge the service-dominant (S-D) logic as insufficient in explaining the value cocreation between the customer and expert in the well-being sector. The authors adapt physician–patient relationship model from health-care literature and cultural values of power distance from cross-cultural literature to complement the S-D logic to account for the complexity and nuanced context of the well-being cocreation experience.

The purpose of this paper is to examine how patient assessment of primary care physician (PCP) communication is related to patient satisfaction with the PCP, patient perception of PCP professional competence, patient assessment of the relationship with the doctor and patient demographic characteristics using a segmentation approach.

The authors surveyed 514 adult patients waiting for appointments with their PCPs in two US primary care clinics. A latent class analysis was used to identify mutually exclusive unobserved homogeneous classes of patients.

The authors identified three distinct classes/groups with regard to patient assessment of physician communication and the physician-patient relationship. The largest group (53 percent of the sample) assessed their PCP communication and other doctor-patient relationship aspects as excellent. However, 37 percent provided mostly negative assessments, expressed high general dissatisfaction with the physician and disagreed with the statement that their PCP was well qualified to manage their health problems. These patients were on average more educated and affluent and the group included more males. About 10 percent of patients expressed generally lower satisfaction with the PCP, though their dissatisfaction was not as extreme as in the highly dissatisfied group.

Further studies are needed to help physicians develop skills to communicate with different patients.

Patient segmentation can be an important tool for healthcare quality improvement particularly for emerging approaches to primary care such as patient-centered care.

Measurements of the quality of physician‐patient communication are important in assessing patient outcomes, but the quality of communication is difficult to quantify. The aim of this paper is to develop a computer analysis system for the physician‐patient consultation process (CASC), which will use a quantitative method to quantify and analyze communication exchanges between physicians and patients during the consultation process.

CASC is based on the concept of narrative‐based medicine using a computer‐mediated communication (CMC) technique from a cognitive dialog processing system. Effective and ineffective consultation samples from the works of Saito and Kleinman were tested with CASC in order to establish the validity of CASC for use in clinical practice. After validity was confirmed, three researchers compared their assessments of consultation processes in a physician's office with CASCs. Consultations of 56 migraine patients were recorded with permission, and for this study consultations of 29 patients that included more than 50 words were used.

Transcribed data from the 29 consultations input into CASC resulted in two diagrams of concept structure and concept space to assess the quality of consultation. The concordance rate between the assessments by CASC and the researchers was 75 percent.

In this study, a computer‐based communication analysis system was established that efficiently quantifies the quality of the physician‐patient consultation process. The system is promising as an effective tool for evaluating the quality of physician‐patient communication in clinical and educational settings.