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      Managing multimorbidity: how can the patient experience be improved?

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          Abstract

          The patient’s experience of their own healthcare is an important aspect of care quality that has been shown to improve clinical and other outcomes. Very little is currently known about patient experience in the management of multimorbidity, although preliminary evidence suggests that it may be poor. Individuals with multimorbidity report better experiences of care when they are knowledgeable and involved in the decision-making, when their care is well coordinated, and communication is good. A greater focus on disease prevention, stronger collaboration between health and social care services, and the provision of more integrated care for people with mental and physical health problems would also help to improve the patient experience. Advocacy groups can amplify the patient voice and improve access to care, as well as provide information and support to patients and their families. Patients have an important role in preventing multimorbidity and improving its management, and should be involved in the development of health policies and the delivery of healthcare services. Inequalities in access to quality healthcare must also be addressed.

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          Is the quality of the patient-provider relationship associated with better adherence and health outcomes for patients with HIV?

          Mary Beach, Robert Moore, Jeanne Keruly (2006)
          Patient-centeredness, originally defined as understanding each patient as a unique person, is widely considered the standard for high-quality interpersonal care. The purpose of our study was to examine the association between patient perception of being "known as a person" and receipt of highly active antiretroviral therapy (HAART), adherence to HAART, and health outcomes among patients with HIV. Cross-sectional analysis. One thousand seven hundred and forty-three patients with HIV. Patient reports that their HIV provider "knows me as a person" and 3 outcomes: receipt of HAART, adherence to HAART, and undetectable serum HIV RNA. Patients who reported that their provider knows them "as a person" were more likely to receive HAART (60% vs 47%, P<.001), be adherent to HAART (76% vs 67%, P=.007), and have undetectable serum HIV RNA (49% vs 39%, P<.001). Patients who reported their provider knows them "as a person" were also older (mean 38.0 vs 36.6 years, P<.001), reported higher quality-of-life (mean LASA score 71.1 vs 64.8, P<.001), had been followed in clinic longer (mean 64.4 vs 61.7 months, P=.008), missed fewer appointments (mean proportion missed appointments 0.124 vs 0.144, P<.001), reported more positive beliefs about HAART therapy (39% vs 28% strongly believed HIV medications could help them live longer, P<.008), reported less social stress (50% vs 62% did not eat regular meals, P<.001) and were less likely to use illicit drugs or alcohol (22% vs 33% used drugs, P<.001; 42% vs 53% used alcohol, P<.001). Controlling for patient age, sex, race/ethnicity, quality-of-life, length of time in clinic, missed appointments, health beliefs, social stress, and illicit drug and alcohol use, patients who reported their provider knows them "as a person" had higher odds of receiving HAART (odds ratio [OR] 1.41, 95% confidence interval [CI] 1.19 to 1.65), adhering to HAART (OR 1.33, 95% CI 1.02 to 1.72), and having undetectable serum HIV RNA (1.20, 95% CI 1.02 to 1.41). We found that a single item measuring the essence of patient-centeredness-the patients' perception of being "known as a person"-is significantly and independently associated with receiving HAART, adhering to HAART, and having undetectable serum HIV RNA. These results support the hypothesis that the quality of patient-physician relationship is directly related to the health of patients.
          Article 0 comments Cited 114 times – based on 0 reviews     Review now
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            Expanding patient involvement in care. Effects on patient outcomes.

            S Greenfield, S. Kaplan, J E Ware (1985)
            An intervention was developed to increase patient involvement in care. Using a treatment algorithm as a guide, patients were helped to read their medical record and coached to ask questions and negotiate medical decisions with their physicians during a 20-minute session before their regularly scheduled visit. In a randomized controlled trial we compared this intervention with a standard educational session of equal length in a clinic for patients with ulcer disease. Six to eight weeks after the trial, patients in the experimental group reported fewer limitations in physical and role-related activities (p less than 0.05), preferred a more active role in medical decision-making, and were as satisfied with their care as the control group. Analysis of audiotapes of physician-patient interactions showed that patients in the experimental group were twice as effective as control patients in obtaining information from physicians (p less than 0.05). Results of the intervention included increased involvement in the interaction with the physician, fewer limitations imposed by the disease on patients' functional ability, and increased preference for active involvement in medical decision-making.
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              Quality monitoring of physicians: linking patients' experiences of care to clinical quality and outcomes.

              Dana Gelb Safran, Jürgen E. Schneider, Richard Marshall … (2008)
              Physicians are increasingly asked to improve the delivery of clinical services and patient experiences of care. We evaluated the association between clinical performance and patient experiences in a statewide sample of physician practice sites and a sample of physicians within a large physician group. We separately identified 373 practice sites and 119 individual primary care physicians in Massachusetts. Using Health Plan Employer Data and Information Set data, we produced two composites addressing processes of care (prevention, disease management) and one composite addressing outcomes. Using Ambulatory Care Experiences Survey data, we produced seven composite measures summarizing the quality of clinical interactions and organizational features of care. For each sample (practice site and individual physician), we calculated adjusted Spearman correlation coefficients to assess the relationship between the composites summarizing patient experiences of care and those summarizing clinical performance. Among 42 possible correlations (21 correlations involving practice sites and 21 involving individual physicians), the majority were positive in site level (71%) and physician level (67%) analyses. For the 28 possible correlations involving patient experiences and clinical process composites, 8 (29%) were significant and positive, and only 2 (7%) were significant and negative. The magnitude of the significant positive correlations ranged from 0.13 to 0.19 at the site level and from 0.28 to 0.51 at the physician level. There were no significant correlations between patient experiences and the clinical outcome composite. The modest correlations suggest that clinical quality and patient experience are distinct, but related domains that may require separate measurement and improvement initiatives.
              Article 0 comments Cited 45 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Comorb
                Journal ID (iso-abbrev): J Comorb
                Journal ID (publisher-id): joc
                Title: Journal of Comorbidity
                Publisher: Swiss Medical Press GmbH (Hochwald, Switzerland )
                ISSN (Electronic): 2235-042X
                Publication date (Electronic): 17 February 2016
                Publication date Collection: 2016
                Volume: 6
                Issue: 1
                Pages: 28-32
                Affiliations
                [1] 1Bulgarian National Patients’ Organization, Sofia, Bulgaria
                [2] 2Patient Access Partnership, Brussels, Belgium
                [3] 3Group of Activists on Treatments (GAT), Lisbon, Portugal
                [4] 4EuropaColon, Germany
                [5] 5Lynch Syndrome International
                [6] 6Global Alliance of Mental Illness Advocacy Networks-Europe (GAMIAN-Europe)
                [7] 7Group of the Progressive Alliance of Socialists and Democrats, European Parliament, Brussels, Belgium
                Author notes
                Correspondence: Stanimir Hasardzhiev, National Patients’ Organization, 3 Lyuben Karavelov str. Office 5, Sofia 1142, Bulgaria. Tel.: +359 (0)2 958 9519; E-mail: stanimir.h@ 123456npo.bg
                Article
                Publisher ID: joc.2016.6.75
                DOI: 10.15256/joc.2016.6.75
                PMC ID: 5556465
                PubMed ID: 29090169
                SO-VID: 9f90b9dd-0de5-4acc-8fc1-cc5bf8d896a0
                Copyright © Copyright: © 2015 The Authors
                License:

                This is an open-access article distributed under the Creative Commons Attribution-NonCommercial License, which permits all noncommercial use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 4 January 2016
                Date accepted : 25 January 2016
                Categories
                Subject: Review

                Keywords: multimorbidity,multiple chronic conditions,comorbidity,patient experience,patient access partnership
                Data availability:
                Keywords: multimorbidity, multiple chronic conditions, comorbidity, patient experience, patient access partnership

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