Objective To describe communication between pharmacy staff and patients at the counter in outpatient pharmacies. Both content and communication style were investigated. Methods Pharmaceutical encounters in three outpatient pharmacies in the Netherlands were video-recorded. Videos were analyzed based on an observation protocol for the following information: content of encounter, initiator of a theme and pharmacy staff's communication style. Results In total, 119 encounters were recorded which concerned 42 first prescriptions, 16 first refill prescriptions and 61 follow-up refill prescriptions. During all encounters, discussion was mostly initiated by pharmacy staff (85%). In first prescription encounters topics most frequently discussed included instructions for use (83%) and dosage instructions (95%). In first refill encounters, patient experiences such as adverse effects (44%) and beneficial effects (38%) were regularly discussed in contrast to follow-up refills (7% and 5%). Patients’ opinion on medication was hardly discussed. Conclusion Pharmacy staff in outpatient pharmacies generally provide practical information, less frequently they discuss patients’ experiences and seldom discuss patients’ perceptions and preferences about prescribed medication. Practice implications This study shows there is room for improvement, as communication is still not according to professional guidelines. To implement professional guidelines successfully, it is necessary to identify underlying reasons for not following the guidelines.
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Objective: To gain insight into how communication vulnerable people and health-care professionals experience the communication in dialogue conversations, and how they adjust their conversation using augmentative and alternative communication (AAC) or other communication strategies. Methods: Communication vulnerable clients and health-care professionals in a long-term care institution were observed during a dialogue conversation (n = 11) and subsequently interviewed (n = 22) about their experiences with the conversation. The clients had various communication difficulties due to different underlying aetiologies, such as acquired brain injury or learning disorder. Results from the observations and interviews were analysed using conventional content analysis. Results: Seven key themes emerged regarding the experiences of clients and professionals: clients blame themselves for miscommunications; the relevance of both parties preparing the conversation; a quiet and familiar environment benefitting communication; giving clients enough time; the importance and complexity of nonverbal communication; the need to tailor communication to the client; prejudices and inexperience regarding AAC. The observations showed that some professionals had difficulties using appropriate communication strategies and all professionals relied mostly on verbal or nonverbal communication strategies. Conclusion: Professionals were aware of the importance of preparation, sufficient time, a suitable environment and considering nonverbal communication in dialogue conversations. However, they struggled with adequate use of communication strategies, such as verbal communication and AAC. There is a lack of knowledge about AAC, and professionals and clients need to be informed about the potential of AAC and how this can help them achieve equal participation in dialogue conversations in addition to other communication strategies.
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This dissertation describes a research project about the communication between communication vulnerable people and health care professionals in long-term care settings. Communication vulnerable people experience functional communication difficulties in particular situations, due to medical conditions. They experience difficulties expressing themselves or understanding professionals, and/or professionals experience difficulties understanding these clients. Dialogue conversations between clients and professionals in healthcare, which for example concern health-related goals, activity and participation choices, diagnostics, treatment options, and treatment evaluation, are, however, crucial for successful client-centred care and shared decision making. Dialogue conversations facilitate essential exchanges between clients and healthcare professionals, and both clients and professionals should play a significant role in the conversation. It is unknown how communication vulnerable people and their healthcare professionals experience dialogue conversations and what can be done to support successful communication in these conversations. The aim of this research is to explore how communication vulnerable clients and professionals experience their communication in dialogue conversations in long-term care and how they can best be supported in improving their communication in these conversations.
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Abstract Background: Many countries in Europe have implemented managed competition and patient choice during the last decade. With the introduction of managed competition, health insurers also became an important stakeholder. They purchase services on behalf of their customers and are allowed to contract healthcare providers selectively. It has, therefore, become increasingly important to take one's insurance into account when choosing a provider. There is little evidence that patients make active choices in the way that policymakers assume they do. This research aims to investigate, firstly, the role of patients in choosing a healthcare provider at the point of referral, then the role of the GP and, finally, the influence of the health insurer/insurance policies within this process. Methods: We videotaped a series of everyday consultations between Dutch GPs and their patients during 2015 and 2016. In 117 of these consultations, with 28 GPs, the patient was referred to another healthcare provider. These consultations were coded by three observers using an observation protocol which assessed the role of the patient, GP, and the influence of the health insurer during the referral. Results: Patients were divided into three groups: patients with little or no input, patients with some input, and those with a lot of input. Just over half of the patients (56%) seemed to have some, or a lot of, input into the choice of a healthcare provider at the point of referral by their GP. In addition, in almost half of the consultations (47%), GPs inquired about their patients' preferences regarding a healthcare provider. Topics regarding the health insurance or insurance policy of a patient were rarely (14%) discussed at the point of referral. Conclusions: Just over half of the patients appear to have some, or a lot of, input into their choice of a healthcare provider at the point of referral by their GP. However, the remainder of the patients had little or no input. If more patient choice continues to be an important aim for policy makers, patients should be encouraged to actively choose the healthcare provider who best fits their needs and preferences.
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Background: Talking Mats is a framework developed to support communication with communication vulnerable people. Objective: The objective was twofold: to provide an overview of the objectives, target groups and settings for which Talking Mats has been used (Part 1), and an overview of empirical scientific knowledge on the use of Talking Mats (Part 2). Methods: In this scoping review scientific and grey literature was searched in PubMed, Cinahl, Psycinfo, Google, and Google Scholar. Articles that described characteristics of Talking Mats or its use were included. For Part 2, additional selection criteria were applied to focus on empirical scientific knowledge. Results: The search yielded 73 publications in Part 1, 12 of which were included in Part 2. Talking Mats was used for functional objectives (e.g. goal setting) and to improve communication and involvement. Part 2 showed that Talking Mats had positive influences on technical communication, effectiveness of conversations, and involvement and decision making in conversations. However, the level of research evidence is limited. Conclusions: Talking Mats can be used to support conversations between professionals and communication vulnerable people. More research is needed to study the views of people who are communication vulnerable and to study the effects of Talking Mats.
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Problems with communication and collaboration among perinatal caregivers threaten the quality and safety of care given to mothers and babies. Good communication and collaboration are critical to safe care for mothers and babies. In this study the researchers focused on studies examining the factors associated with good communication and collaboration as they occur in working routines in maternity care practice. Their study is part of a growing trend of identifying the positive aspects of communication and collaboration in maternity care.
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Background: Research on maternity care often focuses on factors that prevent good communication and collaboration and rarely includes important stakeholders – parents – as co-researchers. To understand how professionals and parents in Dutch maternity care accomplish constructive communication and collaboration, we examined their interactions in the clinic, looking for “good practice”. Methods: We used the video-reflexive ethnographic method in 9 midwifery practices and 2 obstetric units. Findings: We conducted 16 meetings where participants reflected on video recordings of their clinical interactions. We found that informal strategies facilitate communication and collaboration: “talk work” – small talk and humour – and “work beyond words” – familiarity, use of sight, touch, sound, and non-verbal gestures. When using these strategies, participants noted that it is important to be sensitive to context, to the values and feelings of others, and to the timing of care. Our analysis of their ways of being sensitive shows that good communication and collaboration involves “paradoxical care”, e.g., concurrent acts of “regulated spontaneity” and “informal formalities”. Discussion: Acknowledging and reinforcing paradoxical care skills will help caregivers develop the competencies needed to address the changing demands of health care. The video-reflexive ethnographic method offers an innovative approach to studying everyday work, focusing on informal and implicit aspects of practice and providing a bottom up approach, integrating researchers, professionals and parents. Conclusion: Good communication and collaboration in maternity care involves “paradoxical care” requiring social sensitivity and self-reflection, skills that should be included as part of professional training.
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Many healthcare professionals experience difficulties in discussing sexual health with their patients. The aim of this review was to synthesize results of studies on communication practices in interactions about sexual health in medical settings, to offer healthcare professionals suggestions on how to communicate about this topic. Veel zorgprofessionals ervaren problemen bij het bespreken van seksuele gezondheid met hun patiënten. Het doel van deze review was een synthese te presenteren van studies naar communicatiepraktijken in interactie over seksuele gezondheid in medische settings, om zorgprofessionals handreikingen te bieden voor communicatie over dit thema.
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The traditional paternalistic approach in health care is increasingly developing towards a patient-centered care (PCC) approach. However, not all patients are able to take advantage of the positive effects of PCC. Inadequate health literacy (HL) is an important limiting factor in the ability of patients to take on an active role and exchange information with their health care provider effectively. A provenly effective approach to improvement of provider-patient interaction and health outcomes is the use of health-related questionnaires. The aim of the research project described within this thesis was to adapt the most frequently-used questionnaire in Dutch physical therapy practice and add information and communication technology to it. A Dutch and Turkish version of the tool called Talking Touch Screen Questionnaire (TTSQ) was developed and evaluated on both usability and validity aspects. The current prototype of the tool does not yet fully solve the problems native and minority patients with low (health) literacy have with completing the adapted questionnaire. Big challenges in future development and testing the TTSQ are the recruitment of vulnerable members of the hard-to-reach native and minority target populations and finding research methods that suit the abilities and needs of these participants. This is expected to be a very challenging, labor- and time-consuming process. On the other hand, having a usable, valid and reliable TTSQ may well save a lot of time and money in both research and clinical practice in the future.
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Background: Research within the framework of Self-Determination Theory (SDT) indicates that patients' autonomy is to be considered a critical health care outcome in its own right since it promotes improved mental and physical health.This paper presents an analysis of studies addressing communication and interaction interventions in health literacy curricula for medical and health care practitioners, focusing on patient-oriented skills in “making sense” and “to adapt and self-manage”. For evaluating interventions, underlying communication models were traced. The criteria for good practice are “making sense” and “supporting autonomy in making choices”. For the search of interventions, keywords from both the framework of the EU-project, Intervention Research on Health Literacy among Ageing population (IROHLA), as well as the SDT (Self Determination Theory) were applied.The research question of this paper is to what degree are both aspects (making sense and making choices) of HL-definitions implemented in curricula on health literacy (HL) for medical and health care practitioners and providers? A Pubmed search revealed: a) that “making sense” is clearly represented in HL interventions in curricula; however, b) very few interventions teach medical and health care practitioners how to give autonomy support in the interaction with their (future) patients.Four promising, beneficial practices were identified. Several recommendations were presented encouraging curriculum developers to adapt skills of supporting autonomy into their programs.Methods: a qualitative content analysis of interventions in the curricula of communication and interaction skills for medical students and practitioners.Results: a review of literature indicates: a) most interventions in curricula for medical students and practitioners are focusing on skills in adequately providing information to patients by using an underlying (advanced) Sender-Message-Receiver Model; and b) only a few interventions in curricula are available for providing the acquisition of interaction skills in supporting autonomy.Conclusions: The proposal of Huber and others to change the emphasis in the definition of the WHO definition on health towards “to adapt and self manage” has impact on the training of medical students and practioners in dealing with patients with low levels of health literacy. From the present study it can be concluded that a dynamic approach to communication can be linked to theoretical constructs on self-management. In such an approach interaction techniques like scaffolding can increase the level of HL of the patient.
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