Responding to discriminatory requests for a different healthcare provider

2013 ◽  
Vol 21 (1) ◽  
pp. 86-96 ◽  
Author(s):  
Kyle Anstey ◽  
Linda Wright
Keyword(s):  
Healthcare Provider ◽  
Healthcare Providers ◽  
Workplace Discrimination ◽  
The Other ◽  
Care Providers ◽  
Patient Centered ◽  
Respect For Autonomy ◽  
Centered Care ◽  
Caregiver Preference ◽  
The One

Patient requests for a healthcare provider of a particular race or sexual orientation create a conflict of obligations. On the one hand, providers have a duty to deliver clinically indicated care consistent with patient preferences. On the other hand, providers have legal, professional, and organizational assurances that they should not suffer workplace discrimination. Protecting healthcare providers from harm while maintaining obligations to patients requires unambiguous messaging to both parties. Providers need to be clear that their organization will not be complicit in discrimination against them, instead supporting their needs and preferences for management of the situation. In a context of patient-centered care, harm principle-based boundaries of respect for autonomy must be defined. A Caregiver preference guideline developed and used at University Health Network, Toronto provides a standardized way for the organization to decide when it will honor patient requests for providers of a particular background. This process stresses dialogue, assessment of clinical feasibility, and empowerment and support for affected care providers.

Het medisch aansprakelijkheidssysteem en defensief gedrag in België

2021 ◽  
Author(s):  
K. DANIELS ◽  
T. VANDERSTEEGEN ◽  
W. MARNEFFE ◽  
L. DE WILDE
Keyword(s):  
Health Care Providers ◽  
Healthcare Providers ◽  
Defensive Medicine ◽  
The Other ◽  
Medical Liability ◽  
Care Providers ◽  
Defensive Behaviour ◽  
Risk Patients ◽  
Malpractice Liability ◽  
The One

The medical liability system and defensive behaviour in Belgium The aim of the medical liability system is, on the one hand, providing adequate compensation to victims of medical incidents and, on the other hand, incentivising health care providers to adopt sufficient care. However, the fear of healthcare providers for being involved in a liability procedure in case of a medical incident may cause them to practice defensive medicine. Defensive medicine is defined as the ordering of more tests, procedures and visits (assurance behaviour) or the avoidance of high-risk patients or procedures (avoidance behaviour), primarily (but not necessarily solely) to reduce the exposure to malpractice liability. Although various foreign studies assess the prevalence of defensive medicine, it is not yet sufficiently clear to what extent Belgian physicians act defensively in practice. A survey conducted in 2015 among 90 specialist physicians indicates that the medical liability system in Belgium may have an influence on their clinical practice and decision-making. However, additional research is necessary to inform policymakers about the real prevalence of defensive behaviour and its potential drivers and consequences.

Abstract 002: Patient Provider Communication and Patient-centered Outcomes Among Patients With Atherosclerotic Cardiovascular Disease in United States: Medical Expenditure Panel Survey 2010-2013

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Victor Okunrintemi ◽  
Erica Spatz ◽  
Joseph Salami ◽  
Haider Warraich ◽  
Salim Virani ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Medical Expenditure Panel Survey ◽  
Medical Expenditure ◽  
Atherosclerotic Cardiovascular Disease ◽  
Care Providers ◽  
Patient Centered ◽  
Patient Reported ◽  
Centered Care ◽  
Nationally Representative

Background: With recent enactment of Accountable Care Act, consumer reported patient-provider communication (PPC) assessed by Consumer Assessment of Health Plans Survey (CAHPS) in ambulatory settings is incorporated as a complementary value metric for patient-centered care of chronic conditions in pay-for-performance programs. In this study, we examine the relationship of PPC with select indicators of patient-centered care in a nationally representative adult US population with established atherosclerotic cardiovascular disease (ASCVD). Methods: The study population consisted of a nationally representative sample of 8223 individuals (age ≥ 18 years) representing 21.6 million with established ASCVD (self-reported or ICD-9 diagnosis) reporting a usual source of care in the 2010-2013 pooled Medical Expenditure Panel Survey (MEPS) cohort. Participants responded to questions from CAHPS that assess satisfaction with PPC (four-point response scale: never, sometimes, usually, always ) :(1) “How often providers show respect for what you had to say” (2) “How often health care providers listened carefully to you” (3) “How often health care providers explained things so you understood” (4) “How often health providers spent enough time with you” We developed a weighted PPC composite score, categorized as 1 ( never / sometimes ), 2 ( usually ), and 3 ( always ). Outcomes of interest were 1) patient reported outcomes (PRO): SF-12 physical/mental health status, 2) quality of care measures: statin and ASA use, 3) health-care resource utilization (HRU): Emergency room visits & hospital stays, 4) total annual and out of pocket healthcare expenditures (HCE). Results: As shown in the table, those with ASCVD reporting ineffective (never/sometimes) vs. effective PCC (always) were over 2-fold more likely to report poor PRO, 34% & 22% less likely to report statin and ASA use respectively, had a significantly greater HRU (OR≥ 2 ER visit: 1.40 [95% CI:1.09-1.80], OR≥ 2 hospitalization: 1.35 [95% CI:1.02-1.77], as well as an estimated $1,294 ($121-2468) higher annual HCE. Conclusion: This study reveals a strong relationship between patient-physician communication among those with established ASCVD with patient-reported outcomes, utilization of evidence based therapies, healthcare resource utilization and expenditures.

Healthcare Providers’ Attitudes, Knowledge, and Practice Behaviors for Educating Patients About Advance Directives: A National Survey

2018 ◽  
Vol 36 (5) ◽  
pp. 387-395 ◽  
Author(s):  
Frances R. Nedjat-Haiem ◽  
Tamara J. Cadet ◽  
Anup Amatya ◽  
Shiraz I. Mishra
Keyword(s):  
Online Survey ◽  
Survey Design ◽  
Healthcare Providers ◽  
Medical Decision ◽  
Cross Sectional Survey ◽  
Patient Centered ◽  
Cross Sectional ◽  
Practice Behaviors ◽  
Centered Care ◽  
Seriously Ill Patients

Background: Advance care planning for end-of-life care emerged in the mid-1970’s to address the need for tools, such as the advance directive (AD) legal document, to guide medical decision-making among seriously ill patients, their families, and healthcare providers. Objective: Study aims examine providers’ perspectives on AD education that involve examining (1) a range of attitudes about educating patients, (2) whether prior knowledge was associated with practice behaviors in educating patients, and (3) specific factors among healthcare providers such as characteristics of work setting, knowledge, attitudes, and behaviors that may influence AD education and documentation. Design: To examine providers’ views, we conducted a cross-sectional, online survey questionnaire of healthcare providers using social media outreach methods for recruitment. Methods: This study used a cross-sectional survey design to examine the proposed aims. Healthcare providers, recruited through a broad approach using snowball methods, were invited to participate in an online survey. Logistic regression analyses were used to examine providers’ views toward AD education. Results: Of 520 participants, findings indicate that most healthcare providers said that they were knowledgeable about AD education. They also viewed providing education as beneficial to their practice. These findings suggest that having a positive attitude toward AD education and experiencing less organizational barriers indicate a higher likelihood that providers will educate patients regarding ADs. Conclusion: Various disciplines are represented in this study, which indicates that attitudes and knowledge influence AD discussions. The importance of AD discussions initiated by healthcare providers is critical to providing optimal patient-centered care.

scholarly journals Instilling the core concept of inter professional education

1970 ◽  
Vol 9 (3) ◽  
pp. 201-206
Author(s):  
S Bhattacharya ◽  
SK Bhattacharya ◽  
AP Gautam
Keyword(s):  
Health Care ◽  
Health Professional ◽  
Health Care Providers ◽  
Professional Education ◽  
Care Delivery ◽  
Care Providers ◽  
Patient Centered ◽  
Innovative Teaching ◽  
Centered Care ◽  
Teaching Learning

The Inter Professional Education (IPE) is an innovative teaching learning intervention in Health Professions’ Education during which members of more than one health profession learn interactively together to improve collaborative practice and/health of the patients. Thus this approach provides positive outcomes for students enhancing their awareness towards other professional groups, improving knowledge and understanding of how to work in an inter professional team and strengthening their communication and collaboration skills. Within the hierarchical nature of many clinical settings, the aims of IPE courses intersect with socialization of health professional (HP) students into roles of responsibility and authority. The IPE in HP courses emphasizes the practice of frequent high quality communication, strong relationships and partnerships among health care providers to maximize the quality of care thus improving the efficiency of care thereby improving clinical outcomes. Health Professional Schools are this motivated to opt for inter professional education to improve the learning of the students, health care delivery and patient outcomes. Keywords: Inter professional relations; patient centered care; education DOI: http://dx.doi.org/10.3126/hren.v9i3.5591   HR 2011; 9(3): 201-206

Caring for Patients with Service Dogs: Information for Healthcare Providers

2016 ◽  
Vol 22 (1) ◽  
Author(s):  
Michelle Krawczyk
Keyword(s):  
Emotional Support ◽  
Healthcare Providers ◽  
Background Information ◽  
Future Research ◽  
Service Dogs ◽  
Patient Centered ◽  
Service Dog ◽  
Healthcare Settings ◽  
Centered Care

People with disabilities use various assistance devices to improve their capacity to lead independent and fulfilling lives. Service dogs can be crucial lifesaving companions for their owners. As the use of service dogs increases, nurses are more likely to encounter them in healthcare settings. Service dogs are often confused with therapy or emotional support dogs. While some of their roles overlap, service dogs have distinct protection under the American Disabilities Act (ADA). Knowing the laws and proper procedures regarding service dogs strengthens the abilities of healthcare providers to deliver holistic, patient-centered care. This article provides background information about use of dogs, and discusses benefits to patients and access challenges for providers. The author reviews ADA laws applicable to service dog use and potential challenges and risks in acute care settings. The role of the healthcare professional is illustrated with an exemplar, along with recommendations for future research and nursing implications related to care of patients with service dogs.

Thoughts About Meanings of Compliance, Adherence, and Concordance

2020 ◽  
Vol 33 (4) ◽  
pp. 358-360
Author(s):  
Jacqueline Fawcett
Keyword(s):  
Conceptual Model ◽  
Patient Autonomy ◽  
Healthcare Providers ◽  
Patient Centered Care ◽  
Patient Centered ◽  
Or Groups ◽  
Health Related Behaviors ◽  
Centered Care ◽  
Health Related

The purpose of this essay is to explore the meanings of the widely used terms compliance and adherence and the less widely used term concordance and to raise questions about the appropriateness of these terms when used to describe individuals’ or groups’ health-related behaviors. Discussion focuses on how recognition of how the meanings of these terms has uncovered the failure to honor nursing’s emphasis on person/patient-centered care due to power imbalances between healthcare providers and patents and the subsequent lack of patient autonomy. Consideration of these problems with existing terms could facilitate identification of a potentially more appropriate term based on the language of a nursing conceptual model and/or theory.

scholarly journals Do patients and health care providers have discordant preferences about which aspects of treatments matter most? Evidence from a systematic review of discrete choice experiments

BMJ Open ◽  
2017 ◽  
Vol 7 (5) ◽  
pp. e014719 ◽  
Author(s):  
Mark Harrison ◽  
Katherine Milbers ◽  
Marie Hudson ◽  
Nick Bansback
Keyword(s):  
Systematic Review ◽  
Healthcare Provider ◽  
Discrete Choice ◽  
Health Care Providers ◽  
Healthcare Providers ◽  
Choice Experiments ◽  
Discrete Choice Experiments ◽  
Care Providers ◽  
Healthcare Interventions ◽  
Heterogeneity Of Preferences

ObjectivesTo review studies eliciting patient and healthcare provider preferences for healthcare interventions using discrete choice experiments (DCEs) to (1) review the methodology to evaluate similarities, differences, rigour of designs and whether comparisons are made at the aggregate level or account for individual heterogeneity; and (2) quantify the extent to which they demonstrate concordance of patient and healthcare provider preferences.MethodsA systematic review searching Medline, EMBASE, Econlit, PsycINFO and Web of Science for DCEs using patient and healthcare providers. Inclusion criteria: peer-reviewed; complete empiric text in English from 1995 to 31July 2015; discussing a healthcare-related topic; DCE methodology; comparing patients and healthcare providers.DesignSystematic review.ResultsWe identified 38 papers exploring 16 interventions in 26 diseases/indications. Methods to analyse results, determine concordance between patient and physician values, and explore heterogeneity varied considerably between studies. The majority of studies we reviewed found more evidence of mixed concordance and discordance (n=28) or discordance of patient and healthcare provider preferences (n=12) than of concordant preferences (n=4). A synthesis of concordance suggested that healthcare providers rank structure and outcome attributes more highly than patients, while patients rank process attributes more highly than healthcare providers.ConclusionsDiscordant patient and healthcare provider preferences for different attributes of healthcare interventions are common. Concordance varies according to whether attributes are processes, structures or outcomes, and therefore determining preference concordance should consider all aspects jointly and not a binary outcome. DCE studies provide excellent opportunities to assess value concordance between patients and providers, but assessment of concordance was limited by a lack of consistency in the approaches used and consideration of heterogeneity of preferences. Future DCEs assessing concordance should fully report the framing of the questions and investigate the heterogeneity of preferences within groups and how these compare.

scholarly journals Advancing Health Equity During the COVID-19 Pandemic through Digital Medical Interpretation Platforms

2021 ◽  
Author(s):  
Nazia Sharfuddin ◽  
Pamela Mathura ◽  
Emily Ling ◽  
Ellen Bruseker ◽  
Areej Rajeh ◽  
...  
Keyword(s):  
Health Equity ◽  
Clinical Assessment ◽  
Limited English Proficiency ◽  
Healthcare Providers ◽  
Accurate Information ◽  
Clinical Workflow ◽  
Patient Centered ◽  
Medical Interpretation ◽  
Centered Care ◽  
Improving Accuracy

Abstract Background: Medical Interpretation Services (MIS) is the gold-standard that should be used during clinical assessments with patients who have limited English proficiency (LEP) or have hearing loss. The COVID-19 pandemic has highlighted the urgent need for clear, concise medical communication between patients and clinicians to prevent the spread of COVID-19 and ensure public safety. Cost of MIS is covered by the provincial health authority in Alberta; however, it is not consistently utilized across the province.Aim: To implement digital MIS in the Emergency Department (ED) of one urban teaching hospital, improving accuracy of clinical assessment and to provide patient-centered communication. Methods: Applying quality improvement methodology, an intervention comprised of digital MIS technology and education was trialed for 6 months. To assess intervention effect, the number of MIS minutes and calls were measured monthly and a questionnaire was developed and administered to determine ED healthcare providers’ awareness, technology accessibility and perception of MIS integration into the clinical workflow. Results: Digital MIS was utilized consistently in the ED from the beginning of the COVID-19 pandemic (March 2020) and over the subsequent six months. The cost avoidance due to digital MIS usage was estimated to be $19,612.16. ED healthcare providers indicated that digital MIS helped smooth communication with patients and reduced the time it took to gather and provide accurate information. Conclusion: Providing digital MIS access, education and training is a means to advance health equity, by improving accuracy of clinical assessment and patient-centered care in the ED.

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