Interactions with the healthcare system influence advance care planning activities: results from a representative survey in 11 developed countries

Sable-Smith, Alex; Arnett, Kelly; Nowels, Molly; Colborn, Kathryn; Lum, Hillary D.; Nowels, David

doi:10.1093/fampra/cmx113

Cited by 13 publications

(22 citation statements)

References 23 publications

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“…In addition, the role of physician payment through capitation has not previously been described. Similar to previous findings that patients who complete any part of the ACP process are more likely to attend higher quality primary care practices, 20 we find here that physicians who work in practices that incorporate more processes and functions found in higher quality primary care also are more likely to engage patients in ACP conversations. The mechanism for this association between ACP conversations and higher quality primary care are unknown but may be related to enhanced use of team-based care models 26 -28 or use of electronic health records to support these discussions.…”

Section: Discussionsupporting

confidence: 89%

“…We hypothesized that physicians who work in APCP/PCMH practices would be more likely to routinely engage in ACP conversations with patients be-cause (1) practices using these advanced models have built-in features and processes known to facilitate more ACP conversations, (2) APCP/PCMH practices meet quality standards to gain certification, 24 and (3) previous research has shown that patients who obtain care from higher quality primary care practices are more likely to report having engaged in ACP conversations. 20 The results we report demonstrate that whether being an APCP/PCMH practice is associated with ACP conversations depends on how APCP/PCMH practices are identified.…”

Section: Discussionmentioning

confidence: 70%

“…19 There is some evidence that patients reporting higher quality primary care services are also more likely to engage in ACP activities. 20 In that report, the assessment of primary care services quality was derived from an index of activities in primary care practices associated with quality care. 21 We have found no other studies evaluating the association of quality primary care services with engaging patients in ACP activities.…”

mentioning

confidence: 99%

“…This study aims to describe the characteristics of a representative sample of US PCPs who routinely engage patients in ACP conversations and the associated features of the primary care settings in which they practice. Given the potential association between higher quality primary care practices with engaging patients in ACP conversations, 20 we also evaluated the research question of whether physicians who report working in APCP/PCMH are more likely to routinely engage patients in ACP.…”

mentioning

confidence: 99%

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Features of U.S. Primary Care Physicians and Their Practices Associated with Advance Care Planning Conversations

Nowels

Sheffler

et al. 2019

J Am Board Fam Med

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Introduction: Primary care practices are essential settings for Advance Care Planning (ACP) conversations with patients. We hypothesized that such conversations occur more routinely in Advanced Primary Care/Patient Centered Medical Home (APCP/PCMH) Practices using practice transformation strategies. Methods: We analyzed characteristics of physician respondents and their practices associated with ACP discussions in older and sicker patients using US data from the 2015 Commonwealth Fund International Survey of Primary Care Physicians in 10 Nations. The primary outcome was how routinely these ACP conversations are reported. We developed an index of APCP/PCMH features as a practice covariable. Results: Respondents (N ‫؍‬ 1001) were predominantly male (60%) and >45 years old (74%). Multivariable analyses showed that suburban practice location was associated with fewer ACP conversations; working in a practice commonly seeing patients with multiple chronic conditions or who have palliative care needs, and working in a practice from which home visits are made, were associated with more ACP conversations. Physicians compensated in part by capitation were more likely to report ACP conversations. No association was found between a single item asking if the practice was an APCP/PCMH and having ACP conversations. However, higher scores on an index of APCP/PCMH features were associated with more ACP conversations. Conclusions: In this sample of US primary care physicians, the types of patients seen, practice location, and physician compensation influenced whether physicians routinely discuss ACP with patients who are older and sicker. Practices demonstrating more features of APCP/PCMH models of primary care are also associated with ACP discussions.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 70%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Features of U.S. Primary Care Physicians and Their Practices Associated with Advance Care Planning Conversations

Nowels

Sheffler

et al. 2019

J Am Board Fam Med

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“…Older patients with high SES (class 1) may be more quality-oriented and preferred the senior medical practitioners to provide PHCS. 55 In contrast, some patients often attach great importance to their own healthcare experience than comparative information. Since 2009, community health service centers have delivered health management services for the elderly, usually provided by the junior general practitioners.…”

Section: Discussionmentioning

confidence: 99%

<p>Preferences for Primary Healthcare Services Among Older Adults with Chronic Disease: A Discrete Choice Experiment</p>

Peng¹,

Jiang²,

Xiao³

et al. 2020

PPA

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Purpose The aim of this study was to quantify the relative importance of the preference heterogeneity of Chinese older adults with chronic disease for primary healthcare service (PHCS) in the hypothetical minor chronic disease scenario. Patients and Methods A discrete choice experiment (DCE) was administered to the patients aged 60 and above with at least one chronic disease in China. Five DCE attributes were considered, including types of service, treatment options, out-of-pocket (OOP) cost per visit, distance to practice, and the seniority of medical practitioners. DCE data were analysed taking into account of potential preference heterogeneity using both a mixed logit model (MLM) and a latent class logit model (LCLM). Results A total of 432 respondents consented to complete the questionnaires and 372 valid respondents were included in analysis. All attributes were significantly influencing respondents’ PHCS choice except for the types of service. Significant preference heterogeneity was observed among respondents. Based on the preferred LCLM estimates, four latent classes were identified. The first class (28.8%) valued modern medicine service the most, the second class (17.8%) was dominated by distance to practice, the third class (29%) preferred all the attributes except the types of services and valued TCM service most, the fourth class (24.4%) paid more attention to the types of service. Education, gender, age, income, regions of residence, and status of the chronic condition were found to be associated with latent class memberships. Conclusion A better understanding of the relative importance of PHCS characteristics is a crucial step for the future policy implementations. The significant preference heterogeneity identified in this study highlights that effective policy interventions should be tailored to different patients’ characteristics.

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Exploring the Uptake of Advance Care Planning in Older Adults: An Integrative Review

Frechman

Dietrich

Walden

et al. 2020

Journal of Pain and Symptom Management

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Context. Advance care planning (ACP) is essential to elicit goals, values, and preferences of care in older adults with serious illness and on trajectories of frailty. An exploration of ACP uptake in older adults may identify barriers and facilitators. Objective. To conduct an integrative review of research on the uptake of ACP in older adults and create a conceptual model of the findings. Methods. Using Whittemore and Knafl's methodology, we systematically searched four electronic databases of ACP literature in older adults from 1996 through December 2019. Critical appraisal tools were used to assess study quality, and articles were categorized according to level of evidence. Statistical and thematic analysis was then undertaken. Results. Among 1081 studies, 78 met inclusion criteria. Statistical analysis evaluated ACP and variables within the domains of demographics, psychosocial, disability and functioning, and miscellaneous. Thematic analysis identified a central category of enhanced communication, followed by categories of 1) provider role and preparation; 2) patient/family relationship patterns; 3) standardized processes and structured approaches; 4) contextual influences; and 5) missed opportunities. A conceptual model depicted categories and relationships. Conclusions. Enhanced communication and ACP facilitators improve uptake of ACP. Clinicians should be cognizant of these factors. This review provides a guide for clinicians who are considering implementation strategies to facilitate ACP in real-world settings.

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Interactions with the healthcare system influence advance care planning activities: results from a representative survey in 11 developed countries

Abstract: In this international study, individuals with greater interaction with the healthcare system through hospitalization, multimorbidity, access to quality primary care and informal caregiving reported more ACP activities.

Cited by 13 publications

References 23 publications

Features of U.S. Primary Care Physicians and Their Practices Associated with Advance Care Planning Conversations

Features of U.S. Primary Care Physicians and Their Practices Associated with Advance Care Planning Conversations

<p>Preferences for Primary Healthcare Services Among Older Adults with Chronic Disease: A Discrete Choice Experiment</p>

Exploring the Uptake of Advance Care Planning in Older Adults: An Integrative Review

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