scholarly journals Perceptions, practice, and “ownership:” experiences in continuity of the patient-doctor relationship in a family medicine residency

2017 ◽  
Vol 8 (4) ◽  
pp. e74-85 ◽  
Author(s):  
Ann Lee ◽  
Sandra Kennett ◽  
Sheny Khera ◽  
Shelley Ross
Keyword(s):  
Health Care ◽  
Family Medicine ◽  
Health Care Delivery ◽  
Care Delivery ◽  
Structured Interviews ◽  
Descriptive Research ◽  
Provider Experiences ◽  
Significant Barrier ◽  
Qualitative Descriptive ◽  
Constant Comparative Analysis

Background: The objective of this mixed-methods study was to determine interpersonal continuity (the ongoing therapeutic relationship between patient and health care provider) experiences of family medicine residents and preceptors, and explore their perceptions of interpersonal continuity.Methods: Quantitative data on resident and preceptor encounters were extracted from the electronic medical record (EMR). Opportunities for developing interpersonal continuity were determined using the Usual Provider Continuity (UPC) Index. A qualitative descriptive research method was used for the qualitative portion. Semi-structured interviews were conducted and constant comparative analysis was used to determine emerging themes.Results: Residents were found to have low UPC rates; preceptor rates were higher. Qualitative findings showed variable experiences with interpersonal continuity not apparent from UPC rates. Both preceptors and residents expressed perception of “ownership” of patients as a significant barrier to interpersonal continuity. Conclusion: This study suggests that a perceived lack of individual “ownership” of a patient panel was a significant barrier to developing interpersonal continuity. This might conflict with current changes towards team-based health care delivery. Understanding perceptions and changing them through a multi-faceted approach including resident teaching and faculty development might help improve interpersonal continuity which are core to both family medicine curricula and current models of health care delivery.

scholarly journals User-provider relations pertaining to health care delivery in Jumla district

2014 ◽  
Vol 12 (2) ◽  
pp. 31-36
Author(s):  
Ashok Bhurtyal ◽  
Dushala Adhikari
Keyword(s):  
Health Care ◽  
Health Care Delivery ◽  
Care Delivery ◽  
International Health ◽  
Community Setting ◽  
Primary Health Care Centre ◽  
Structured Interviews ◽  
Health Care Centre ◽  
North West ◽  
Rural Villages

Background Nepal’s health policy making and programming shifted over the past six decades in tune with international milieu. After 2006 revolution, radical new leadership of health ministry wrote health as a fundamental right in the interim constitution and scrapped hitherto existing user fees in peripheral health facilities. This work aimed to understand user-provider interaction at facility and community setting while people attempt utilising fee-less health care.Methods We used key informant interviews to explore the mechanism of health care delivery and general reality of Jumla districtin north-west Nepal. We used semi-structured interviews with respondents at both the providing and receiving sides. We asked open ended questions and used answers to preceding questions to generate new questions around the area of discussion.Results Health care machinery in Jumla struggled between constrained supply and elevating demand side factors. District hospital endured this challenge more than primary health care centre and health posts studied. User-provider relations were more turbulent in the hospital where targeted approach to fee removal was effected, than other facilities where charges were abolished altogether. Users and providers had their own side of the story, exemplified by experiences in accessing and delivering fee-removed health care.Conclusion We conclude that user-provider dynamics manifest in Jumla originate elsewhere. Health care programmes are crafted without people’s meaningful participation. Prescriptions trickle down all the way from international health rings to rural villages like that of Jumla – through national systems – founded on economic and political interests as contrasted to citizen’s legitimate needs. We recommend further ethnographic work to fully explore and address factors that determine user-provider relations at point of health care use.DOI: http://dx.doi.org/10.3126/hprospect.v12i2.9870 Health Prospect Vol.12(2) 2013: 31-36

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