Patient accounts for nonadherence: A critical window into the patient experience.

OBJECTIVES: This paper explores patient use of excuses to better understand the patient experience during clinical interactions. METHODS: A content analysis of 32 residents treating 99 different patients was used to reveal accounts of nonadherence. Using grounded theory, these accounts were coded into types and then reduced using a Q-sort. RESULTS: Analysis revealed 163 accounts of nonadherence. When questioned about their adherence to treatment, 68% of patients offered at least one account for nonadherence during the visit. These accounts were coded into fourteen types and then the Q-sort identified four types of accounts: healthcare system failures, treatment failure, situational exigencies, and self-directed. Of the accounts offered, 7% of the patients provided 6 or more accounts and 25% provided between 3 and 5 accounts. CONCLUSIONS: The examination of excuses provides a unique way to gain insight into how patients communicate with their physicians. Patient accounts ranged from those where patients indicated adherence was within their control (self-directed) and accounts outside their control (healthcare system failure, treatment failure, and situational exigency). PRACTICE IMPLICATIONS: The types of accounts of nonadherence patients could provide doctors insight into the patient experience. Recognizing these types could allow opportunities for doctors to develop communication strategies for encouraging patient adherence.

Resident reflections on resident-patient communication during family medicine clinic visits.

OBJECTIVE: Residency programs emphasize effective doctor and patient interaction. However, training can be time intensive and logistically challenging. This paper examines a blog providing resident peer feedback and an opportunity to explore how residents think about patient communication. METHODS: A grounded theory approach examined peer commenting on doctor patient interactions. Between 2012-2015, at a U.S. East Coast Family Medicine Clinic, 35 family medicine residents were recorded interacting with patients, producing a total of 84 videos which were posted to a blog. Residents reflected on these videos resulting in 356 responses, 3162 meaning units and 211 codes. Codes were grouped into 10 themes. Further analysis explored how residents signaled positive and negative doctor communications-related behavior. RESULTS: Most common themes identified were Rapport/Relationship building skills, Negotiating the appointment, and Peer interaction. Most common themes discussed in light of both positive and negative behavior were Education, Use of technology, and Negotiating the appointment. CONCLUSIONS: Residents view their communication with patients as more of a transmission of critical information than an opportunity for dialogue. PRACTICE IMPLICATIONS: Findings support how online tools can be used for resident reflections. These tools can reveal resident perceptions of salient communication information in a clinical encounter.

Developing a patient-centered ISHAPED handoff with patient/family and parent advisory councils.

Our hospital system used Lean strategies to develop a new process for the change-of-shift bedside handoff titled ISHAPED (I = Introduce, S = Story, H = History, A = Assessment, P = Plan, E = Error Prevention, and D = Dialogue). Several teams collaborated with a Parent Advisory Council and a Patient/Family Advisory Council to design a study to explore patient perceptions of the handoff. The findings from the study along with recommendations from the councils were used to develop education modules on implementing patient-centered handoffs.

Expanding the walls of the health care encounter: support and outcomes for patients online.

This paper assesses the relationship between patient-health care provider (HCP) interaction and health behaviors. In total, 109 Native American patients diagnosed with diabetes mellitus were enrolled in a Web-based diabetes monitoring system. The system tracks patient-HCP interaction, and in total 924 personal messages were exchanged. These 924 messages contained 6,411 message units that were content analyzed using a nine-category scheme. Patient blood glucose monitoring was found to be related to the frequency of phatic communication, informational social support, and tangible social support messages, as well as messages containing references to personal contact. Finally, person-centered messages proved to be the single best predictor of patient involvement with the telemedicine system (as measured by the number of times the patient logged into the system).

The courage of one's conviction: when do nurse practitioners report unsafe practices?

When and why do nurses report unsafe patient practices when they see them? This paper adds to our understanding of the characteristics of health care practitioners who report errors and their environment by introducing role identity as an important concept for understanding this communication behavior. We analyzed the results of a national survey of 330 nurses to address three questions: (1) What factors are associated with nurses stating that they have observed tolerance for unsafe practices; (2) what fosters reporting of unsafe practices; and (3) what is the impact on nurses' commitment to the organization and the profession as a result of observing unsafe practices? Results suggest that the probability of reporting unsafe practices increases as the frequency of unsafe practices increases; this relationship is moderated by nurse role identity and supervisory support for reporting. The probability of reporting of unsafe practices also increases when nurses have a strong role identity and strong organizational role identity. Surprisingly, the highest probability for reporting occurs when both organization and nurse role identities are low. Finally, we examine how risk propensity influences reporting and discuss potential strategies for improving reporting of unsafe practices.

Communication plays a critical role in web-based monitoring.

BACKGROUND: Patient-health care practitioner (HCP) interaction via a Web-based diabetes management system may increase patient monitoring of their blood glucose (BG) levels. METHODS: A three-center, nonrandomized, prospective feasibility study of 109 Native Americans with poorly controlled type 1 diabetes mellitus and type 2 diabetes mellitus were recruited from Alabama, Idaho, and Arizona. The study intervention included the use of a Web-based diabetes management application (MyCareTeam) that allowed timely interaction between patients and HCPs. Information about diabetes, nutrition, and exercise was also available. Finally, patients were able to provide BG readings to their HCP via the MyCareTeam system. RESULTS: As a result, 59.6% of the patients sent one or more messages to their HCP, 92.67% received one or more messages from their HCP, and 78.89% received one or more person-centered messages from their HCP. Additionally, the number of times a patient logged into the system and the frequency with which they tested their blood sugar were correlated with (a) the number of messages sent to their HCP, (b) the total number of messages received from their HCP, and (c) the number of person-centered messages received from their HCP. Thus patients who sent more messages also tested their BG more frequently, as measured by the number of BG readings uploaded from their meter to the MyCareTeam database. Person-centered messages seem to be particularly important to motivating the patient to monitor their BG levels and use the Web-based system. CONCLUSIONS: These results suggest that patient-HCP interaction and, in particular, more personalized interactions increases patient frequency of BG monitoring.

Media attitudes vs. use: the contribution of context to the communication environment in telemedicine.

Media attitudes and media use have been the focus of considerable academic research. This article uses this research to explore patient and health care practitioner attitudes toward telemedicine interactions via videoconferencing technology.