Patient experience of an integrated care model in a family practice clinic & FQHC

In order to investigate the patient experience of integrated behavioral health care in primary care settings, we implemented a patient cohort model from a combined site sample (N = 727) consisting of a family practice clinic and a Federally Qualified Health Center. Patient experience was measured using 12 questions from a validated measure, the Agency for Healthcare Research and Quality’s Consumer Assessment of Health Care Providers and Systems (CAHPS®), Home and Community Based Services version, and six additional questions about interactions with an integrated behavioral health care team. We assessed bivariate relationships between satisfaction with integration and the clinic practice and self-reported physical health or self-reported mental/emotional health. We also utilized multiple regression to evaluate this relationship. Our analyses showed a statistically significant and small to moderate direct correlation between patients’ self-reported health (both physical and mental/emotional health) and their ratings of the practice as a whole (p = .0003), such that patients who rated their physical and/or mental/emotional health as better were more likely to rate their overall satisfaction with the practice higher. The results of this study suggest that primary care patients with only mild to moderate health conditions (physical and/or mental/emotional) may experience greater satisfaction with integrated behavioral health care than patients with multiple and/or severe health conditions. In contrast, patients with multiple and/or severe health conditions may experience lower satisfaction with integrated behavioral health care and may be better served through higher levels of care.

Improving Vaccination Rates in Adults With Type 2 Diabetes in a Family Practice Setting Through the Use of Evidence-Based Interventions

Background: Adults with diabetes are at increased susceptibility to infectious disease because of hyperglycemia, poor glucose control, and decreased immunity. Diabetes is the seventh leading cause of death in Texas and the United States. Objective: The purpose of this evidence-based quality improvement project was to implement processes to facilitate providers’ adherence to immunization guidelines for adults with type 2 diabetes mellitus. Method: A protocol was created for a family practice clinic using the Four Pillars Transformation Program. Interventions included immunization standing orders, vaccine needs screening, patient education, electronic medical record alerts, an appointed immunization champion, and quality improvement meetings. Results: Ten weeks post project implementation, the increased screening and education resulted in 64% of the eligible patients being vaccinated with pneumococcal polysaccharide vaccine 23, 86% pneumococcal conjugate vaccine, 89% tetanus, and 54% herpes zoster. Conclusions: The results indicate that formal printed education on diabetes and vaccines increased vaccine uptake in eligible patients by 76%. Implications for Nursing: The Four Pillars Transformation Program allows each practice the ability to modify and select interventions best suited to the practice needs, making it a feasible tool for any clinic.

Verbal compliance-gaining strategies used by male physicians and patient healthcare experience

This study explores male physicians’ use of verbal compliance gaining strategies to encourage patients to adhere to medication regimens, lifestyle changes, or future appointments, and assesses which strategies are associated with patients’ reported healthcare experiences. Five physicians from a family practice clinic in northern British Columbia, Canada, were audio-recorded while interacting with 31 patients during actual consultations. Compliance-gaining utterances were coded into five categories of strategies, while patient experience with care was assessed using a questionnaire. A number of intriguing findings emerged: direct orders were related to a more negative experience with interpersonal aspects of care, but were fairly frequently used, especially with female patients. Persuasion was the only strategy that promoted a positive patient experience, but was rarely used. However, the effect of persuasion on patient experience was no longer significant when adjusting for patients’ health status. Physicians relied mostly on motivation strategies to encourage adherence, but these strategies were not related to patients’ assessment of their healthcare experiences. These results suggest that the most frequently used verbal compliance gaining strategies by physicians are not always appreciated by patients. To be more effective, it is necessary to inform physicians about which compliance-gaining strategies promote a positive patient healthcare experience.