The Nature of Communication throughout Diagnosis and Management Planning in Initial Audiologic Rehabilitation Consultations

2015 ◽  
Vol 26 (01) ◽  
pp. 036-050 ◽  
Author(s):  
Caitlin Grenness ◽  
Louise Hickson ◽  
Ariane Laplante-Lévesque ◽  
Carly Meyer ◽  
Bronwyn Davidson
Keyword(s):  
Patient Outcomes ◽  
Hearing Aids ◽  
Patient Involvement ◽  
Interaction Analysis ◽  
Patient Centered ◽  
Management Planning ◽  
Diagnosis And Management ◽  
Analysis System ◽  
Communication Dynamics ◽  
Communication Control

Background: Effective practitioner-patient communication throughout diagnosis and management planning positively influences patient outcomes. A patient-centered approach whereby patient involvement in decision making is facilitated, a therapeutic relationship is developed, and information is bilaterally exchanged in an appropriate manner, leads to improved patient satisfaction, adherence to treatment, and self-management. Despite this knowledge, little is known about the nature of audiologist-patient communication throughout diagnosis and management planning. Purpose: This research aimed to explore verbal communication between audiologists and patients/companions throughout diagnosis and management planning in initial audiology consultations. Specifically, this study aimed to describe the nature and dynamics of communication by examining the number, proportion, and type of verbal utterances by all speakers (audiologist, patient, and companion when present). In addition, this study aimed to investigate the influence of audiologist, patient, and consultation factors, such as verbal dominance, content balance, and communication control, on the dynamics of communication. Study Sample: A total of 62 initial audiological rehabilitation consultations (involving 26 different audiologists) were filmed and analyzed using the Roter Interaction Analysis System. All patients were older than 55 yr, and a companion was present in 17 consultations. Data Collection and Analysis: This study focused solely on the communication relating to diagnosis and management planning (referred to as the “counseling phase”). Diagnosis, recommendations, rehabilitation options, and patient decisions were recorded along with the communication profiles and communication dynamics measured using the Roter Interaction Analysis System. Associations between communication dynamics (content balance, communication control, and verbal dominance) and eight variables were evaluated with Linear Mixed Model methods. Results: The mean length of time for diagnosis and management planning was 29.0 min (range, 2.2–78.5 min). Communication profiles revealed that patient-centered communication was infrequently observed. First, opportunities to build a relationship were missed, such that patients’ psychosocial concerns were rarely addressed and patients/companions showed little involvement in management planning. Second, the amount of talk was asymmetrical and the majority of audiologists’ education and counseling utterances related to hearing aids; yet, only 56% of patients decided to obtain hearing aids at the conclusion of the consultation. Hearing aids were recommended in 83% of consultations where a hearing loss was diagnosed and alternative options were rarely provided. Thus, shared decision making rarely occurred, and audiologists often diagnosed a hearing loss and recommended hearing aids without patient involvement. In addition, when a greater proportion of time was dedicated to diagnosis and management planning, patients had greater input and control by asking more questions and requesting further information. Conclusions: Patient-centered communication was rarely observed in the 62 consultations. Thus, although not measured in this study, patient outcomes are likely to be affected. Future research should examine the influence of audiologist communication on outcomes and encourage a shift toward patient-centered audiological rehabilitation.

scholarly journals Communication between Audiologist, Patient, and Patient’s Family Members during Initial Audiology Consultation and Rehabilitation Planning Sessions: A Descriptive Review

2019 ◽  
Vol 30 (09) ◽  
pp. 810-819 ◽  
Author(s):  
Vinaya Manchaiah ◽  
Monica L. Bellon-Harn ◽  
Ashley L. Dockens ◽  
Jamie H. Azios ◽  
William E. Harn
Keyword(s):  
Decision Making ◽  
Literature Review ◽  
Hearing Aids ◽  
Empirical Studies ◽  
Family Members ◽  
Patient Centered ◽  
Missed Opportunities ◽  
Management Planning ◽  
Rehabilitation Planning ◽  
The Mean

AbstractCommunication during clinical consultations is an important factor that facilitates decision-making by patients and family members. For clinicians, these interactions are opportunities to build rapport and to facilitate appropriate decision-making.This article presents the literature review of studies focusing on communication between audiologist, patients, and their family members during initial audiology consultations and rehabilitation planning sessions.A literature review was conducted.The review included eight empirical studies.A systematic search of the CINAHL Complete, MEDLINE, and PsychInfo databases was used to identify relevant articles for review. Quality of the included studies was assessed using the Rating of Qualitative Research (RQR) scale.The average consultation length was 57.4 min (ranged 27.3–111 min), in which the mean length of case history discussion was 8.8 min (ranged 1.7–22.6 min) and the mean length of diagnosis and management planning was 29 min (ranged 2.2–78.5 min). Utterances spoken by audiologists were greater (about 51%) than patients (37%), whereas family members spoke the fewest utterances (12%) during interactions. Patients raised concerns (typically psychological in nature with negative emotional stance) about hearing aids in half of the appointments where hearing aids were recommended as the rehabilitation option. However, audiologists missed opportunities to build relationships as these concerns of patients were not typically addressed. Also, audiologists’ language was associated with hearing aid uptake (i.e., patients were less likely to uptake hearing aids when audiologists used complex language).The review highlights that audiologists dominate the conversation during audiology consultations and rehabilitation planning sessions. Audiologists did not take advantage of the opportunity to develop patient-centered communication and shared decision-making. Implications of these findings to both clinical practice and to audiology education and training are discussed.

scholarly journals A novel digital approach to describe real world outcomes among patients with constipation

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Allison Shapiro ◽  
Benjamin Bradshaw ◽  
Sabine Landes ◽  
Petra Kammann ◽  
Beatrice Bois De Fer ◽  
...  
Keyword(s):  
Heart Rate ◽  
Prospective Study ◽  
Real World ◽  
Symptom Severity ◽  
Interaction Analysis ◽  
Behavioral Activity ◽  
Patient Centered ◽  
Small Magnitude ◽  
Digital Devices ◽  
Bowel Movements

AbstractUnderstanding day-to-day variations in symptoms and medication management can be important in describing patient centered outcomes for people with constipation. Patient Generated Health Data (PGHD) from digital devices is a potential solution, but its utility as a tool for describing experiences of people with frequent constipation is unknown. We conducted a virtual, 16-week prospective study of individuals with frequent constipation from an online wellness platform that connects mobile consumer digital devices including wearable monitors capable of passively collecting steps, sleep, and heart rate data. Participants wore a Fitbit monitoring device for the study duration and were administered daily and monthly surveys assessing constipation symptom severity and medication usage. A set of 38 predetermined day-level behavioral activity metrics were computed from minute-level data streams for steps, sleep and heart rate. Mixed effects regression models were used to compare activity metrics between constipation status (irregular or constipated vs. regular day), medication use (medication day vs. non-medication day) and the interaction of medication day with irregular or constipation days, as well as to model likelihood to treat with constipation medications based on daily self-reported symptom severity. Correction for multiple comparisons was performed with the Benjamini–Hochberg procedure for false discovery rate. This study analyzed 1540 enrolled participants with completed daily surveys (mean age 36.6 sd 10.0, 72.8% female, 88.8% Caucasian). Of those, 1293 completed all monthly surveys and 756 had sufficient Fitbit data density for analysis of activity metrics. At a daily-level, 22 of the 38 activity metrics were significantly associated with bowel movement or medication treatment patterns for constipation. Participants were measured to have fewer steps on irregular days compared to regular days (−200 steps, 95% CI [−280, −120]), longer periods of inactivity on constipated days (9.1 min, 95% CI [5.2, 12.9]), reduced total sleep time on irregular and constipated days (−2.4 min, 95% CI [−4.3, −0.4] and −4.0 min, 95% CI [−6.5, −1.4], respectively). Participants reported greater severity of symptoms for bloating, hard stool, difficulty passing, and painful bowel movements on irregular, constipation and medication days compared to regular days with no medication. Interaction analysis of medication days with irregular or constipation days observed small increases in severity compared to non-medication days. Participants were 4.3% (95% CI 3.2, 5.3) more likely to treat with medication on constipated days versus regular. No significant increase in likelihood was observed for irregular days. Daily likelihood to treat increased for each 1-point change in symptom severity of bloating (2.4%, 95% CI [2.0, 2.7]), inability to pass (2.2%, 95% CI [1.4, 3.0]) and incomplete bowel movements (1.3%, 95% CI [0.9, 1.7]). This is the first large scale virtual prospective study describing the association between passively collected PGHD and constipation symptoms and severity at a day-to-day granularity level. Constipation status, irregular or constipated, was associated with a number of activity metrics in steps and sleep, and likelihood to treat with medication increased with increasing severity for a number of constipation symptoms. Given the small magnitude of effect, further research is needed to understand the clinical relevance of these results. PGHD may be useful as a tool for describing real world patient centered experiences for people with constipation.

scholarly journals Current Evidence and Future Perspectives on the Effective Practice of Patient-Centered Laboratory Medicine

2015 ◽  
Vol 61 (4) ◽  
pp. 589-599 ◽  
Author(s):  
Mike J Hallworth ◽  
Paul L Epner ◽  
Christoph Ebert ◽  
Corinne R Fantz ◽  
Sherry A Faye ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Clinical Effectiveness ◽  
Laboratory Medicine ◽  
Current Evidence ◽  
Patient Centered ◽  
Definition Of ◽  
Current Utilization ◽  
Measures Of Effectiveness ◽  
The Impact ◽  
Primary Measure

AbstractBACKGROUNDSystematic evidence of the contribution made by laboratory medicine to patient outcomes and the overall process of healthcare is difficult to find. An understanding of the value of laboratory medicine, how it can be determined, and the various factors that influence it is vital to ensuring that the service is provided and used optimally.CONTENTThis review summarizes existing evidence supporting the impact of laboratory medicine in healthcare and indicates the gaps in our understanding. It also identifies deficiencies in current utilization, suggests potential solutions, and offers a vision of a future in which laboratory medicine is used optimally to support patient care.SUMMARYTo maximize the value of laboratory medicine, work is required in 5 areas: (a) improved utilization of existing and new tests; (b) definition of new roles for laboratory professionals that are focused on optimizing patient outcomes by adding value at all points of the diagnostic brain-to-brain cycle; (c) development of standardized protocols for prospective patient-centered studies of biomarker clinical effectiveness or extraanalytical process effectiveness; (d) benchmarking of existing and new tests in specified situations with commonly accepted measures of effectiveness; (e) agreed definition and validation of effectiveness measures and use of checklists for articles submitted for publication. Progress in these areas is essential if we are to demonstrate and enhance the value of laboratory medicine and prevent valuable information being lost in meaningless data. This requires effective collaboration with clinicians, and a determination to accept patient outcome and patient experience as the primary measure of laboratory effectiveness.

scholarly journals Patient Centered Medical Home transformation at an academic medical center

2015 ◽  
Vol 5 (1) ◽  
pp. 34
Author(s):  
Randy Wexler ◽  
Jennifer Lehman ◽  
Mary Jo Welker
Keyword(s):  
Family Medicine ◽  
Patient Outcomes ◽  
Medical Home ◽  
Medical Center ◽  
Academic Medical Center ◽  
Lessons Learned ◽  
Patient Centered Medical Home ◽  
Model Of Care ◽  
Patient Centered ◽  
Academic Medical

Background: Primary care is playing an ever increasing role in the design and implementation of new models of healthcare focused on achieving policy ends as put forth by government at both the state and federal level. The Patient Centered Medical Home (PCMH) model is a leading design in this endeavor.Objective: We sought to transform family medicine offices at an academic medical center into the PCMH model of care with improvements in patient outcomes as the end result.Results: Transformation to the PCMH model of care resulted in improved rates of control of diabetes and hypertension and improved prevention measures such as smoking cessation, mammograms, Pneumovax administration, and Tdap vaccination. Readmission rates also improved using a care coordination model.Conclusions: It is possible to transform family medicine offices at academic medical centers in methods consistent with newer models of care such as the PCMH model and to improve patient outcomes. Lessons learned along the way are useful to any practice or system seeking to undertake such transformation.

Action cameras and the Roter interaction analysis system to assess veterinarian-producer interactions in a dairy setting

2017 ◽  
Vol 182 (8) ◽  
pp. 227-227 ◽  
Author(s):  
Caroline Ritter ◽  
Herman W Barkema ◽  
Cindy L Adams
Keyword(s):  
Production Management ◽  
Interaction Analysis ◽  
Relationship Building ◽  
Herd Health ◽  
Veterinary Education ◽  
Clinical Communication ◽  
Roter Interaction Analysis System ◽  
Farmer Education ◽  
Analysis System ◽  
On Farm

Herd health and production management (HH&PM) are critical aspects of production animal veterinary practice; therefore, dairy veterinarians need to effectively deliver these services. However, limited research that can inform veterinary education has been conducted to characterise these farm visits. The aim of the present study was to assess the applicability of action cameras (eg, GoPro cameras) worn by veterinarians to provide on-farm recordings, and the suitability of these recordings for comprehensive communication analyses. Seven veterinarians each recorded three dairy HH&PM visits. Recordings were analysed using the Roter interaction analysis system (RIAS), which has been used to evaluate medical conversations in human and companion animal contexts, and provided insights regarding the importance of effective clinical communication. However, the RIAS has never been used in a production animal environment. Results of this pilot study indicate that on-farm recordings were suitable for RIAS coding. Dairy practitioners use a substantial amount of talk allocated to relationship-building and farmer education but that communication patterns of the same veterinarian vary considerably between farm visits. Consecutive studies using this method will provide observational data for research purposes and promise to aid in the improvement of veterinary education through identification of communication priorities and gaps in dairy advisory discussions.

scholarly journals An Overview on Patient-Centered Clinical Services

2021 ◽  
Vol 4 (2) ◽  
pp. 157-170
Author(s):  
Gaurav Joshi ◽  
Atul Kabra ◽  
Nishant Goutam ◽  
Alka Sharma
Keyword(s):  
Patient Outcomes ◽  
Clinical Pharmacist ◽  
Healthcare Systems ◽  
Clinical Services ◽  
Drug Related Problems ◽  
Patient Centered ◽  
Health Quality ◽  
Health Quality Of Life ◽  
The One

Drug-related problems (DRPs) had often been a concern in the system that needed to be detected, avoided, and addressed as soon as possible. The need for a clinical pharmacist becomes even more important. He is the one who can not only share the load but also be an important part of the system by providing required advice. They fill out the patient's pharmacotherapy reporting form and notify the medical team's head off any drug-related issues. General practitioners register severe adverse drug reactions (ADRs) yearly. As a result of all of this, a clinical pharmacist working in and around the healthcare system is expected to advance the pharmacy industry. Its therapy and drugs can improve one's health quality of life by curing, preventing, or diagnosing a disease, sign, or symptom. The sideshows, on the other hand, do much harm. Because of the services they offer, clinical pharmacy has grown in popularity. To determine the overall effect and benefits of the emergency department (ED) clinical pharmacist, a systematic review of clinical practice and patient outcomes will be needed. A clinical pharmacist's anatomy, toxicology, pharmacology, and medicinal chemistry expertise significantly improves a patient's therapy enforcement. It is now important to examine the failure points of healthcare systems as well as the individuals involved.

scholarly journals Teacher-Students Verbal Interaction At The Secondary Level

2008 ◽  
Vol 5 (9) ◽  
Author(s):  
Hafiz Muhammad Inamullah ◽  
Ishtiaq Hussain ◽  
M. Naseer Ud Din
Keyword(s):  
Interaction Analysis ◽  
Secondary Level ◽  
Verbal Interaction ◽  
Teacher Student ◽  
Teaching Behaviour ◽  
Teacher Students ◽  
Analysis System

The main purpose of this study was to explore teacher-student verbal interaction in the secondary level classes using the Flanders Interaction Analysis system (FIA).  Its findings and conclusions may stimulate teachers at the secondary level to improve their teaching behaviour in order to maximize students’ learning.

scholarly journals Patient Outcomes at 26 Months in the Patient-Centered Medical Home National Demonstration Project

2010 ◽  
Vol 8 (Suppl_1) ◽  
pp. S57-S67 ◽  
Author(s):  
C. R. Jaen ◽  
R. L. Ferrer ◽  
W. L. Miller ◽  
R. F. Palmer ◽  
R. Wood ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Medical Home ◽  
Demonstration Project ◽  
Patient Centered Medical Home ◽  
Patient Centered
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