Patient enablement requires physician empathy: a cross-sectional study of general practice consultations in areas of high and low socioeconomic deprivation in Scotland

Mercer, Stewart W; Jani, Bhautesh; Maxwell, Margaret; Wong, Samuel Yeung Shan; Watt, Graham

doi:10.1186/1471-2296-13-6

Cited by 128 publications

(155 citation statements)

References 21 publications

Supporting

Mentioning

133

Contrasting

Unclassified

Order By: Relevance

“…22 The higher empathy and patient centeredness regarding disease and illness experience in the affluent multimorbid group is also an important finding, since GP empathy and patient-centered approaches have previously been shown to improve patient enablement and health outcomes. [13][14][15] GP empathy and patient centeredness are generally lower in deprived areas compared with affluent, 15,23 and a systematic review has recently indicated that this is true generally of doctors dealing with patients of low educational status.…”

Section: Comparison With Published Literaturementioning

confidence: 99%

“…12 Empathic, patient-centered care is a prerequisite for patient enablement and improves health outcomes in both affluent and deprived areas. [13][14][15] In the present study, we examined the influence of multimorbidity on general practice consultations, in areas of high and low socioeconomic deprivation. We hypothesized that in affluent areas, where workforce pressures are less severe, 11 the greater needs and complexity of patients with multimorbidity would result in longer consultations, and more empathic, patientcentered care than in less complex patients without multimorbidity, but that in deprived areas, due to the ongoing inverse care law, 11 these effects of multimorbidity on the consultation would not be possible.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Multimorbidity and Socioeconomic Deprivation in Primary Care Consultations

et al. 2018

View full text Add to dashboard Cite

PURPOSEThe influence of multimorbidity on the clinical encounter is poorly understood, especially in areas of high socioeconomic deprivation where burdensome multimorbidity is concentrated. The aim of the current study was to examine the effect of multimorbidity on general practice consultations, in areas of high and low deprivation. METHODSWe conducted secondary analyses of 659 video-recorded routine consultations involving 25 general practitioners (GPs) in deprived areas and 22 in affluent areas of Scotland. Patients rated the GP's empathy using the Consultation and Relational Empathy (CARE) measure immediately after the consultation. Videos were analyzed using the Measure of Patient-Centered Communication. Multilevel, multi-regression analysis identified differences between the groups. RESULTSIn affluent areas, patients with multimorbidity received longer consultations than patients without multimorbidity (mean 12.8 minutes vs 9.3, respectively; P = .015), but this was not so in deprived areas (mean 9.9 minutes vs 10.0 respectively; P = .774). In affluent areas, patients with multimorbidity perceived their GP as more empathic (P = .009) than patients without multimorbidity; this difference was not found in deprived areas (P = .344). Video analysis showed that GPs in affluent areas were more attentive to the disease and illness experience in patients with multimorbidity (P < .031) compared with patients without multimorbidity. This was not the case in deprived areas (P = .727). CONCLUSIONSIn deprived areas, the greater need of patients with multimorbidity is not reflected in the longer consultation length, higher GP patient centeredness, and higher perceived GP empathy found in affluent areas. Action is required to redress this mismatch of need and service provision for patients with multimorbidity if health inequalities are to be narrowed rather than widened by primary care.

show abstract

Section: Comparison With Published Literaturementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Multimorbidity and Socioeconomic Deprivation in Primary Care Consultations

et al. 2018

View full text Add to dashboard Cite

show abstract

“…8,9 Patient activation, which is defined as having the knowledge, confidence, and skills to take care of one's health and health care, has been shown to be associated with a broad range of health-related outcomes, including better self-management and clinical indicators, fewer hospitalizations, and lower health care costs. [10][11][12][13][14][15][16][17][18][19][20] [34][35][36] Also, patients' assessment of clinician support of the chronic care model has been associated with higher levels of self-management. [37][38][39] Research to date has not examined whether clinicians' behaviors influence patients' level of activation, however.…”

Section: Introductionmentioning

confidence: 99%

Supporting Patient Behavior Change: Approaches Used by Primary Care Clinicians Whose Patients Have an Increase in Activation Levels

et al. 2016

View full text Add to dashboard Cite

PURPOSE We aimed to identify the strategies used to support patient behavior change by clinicians whose patients had an increase in patient activation.METHODS This mixed methods study was conducted in collaboration with Fairview Health Services, a Pioneer Accountable Care Organization. We aggregated data on the change in patient activation measure (PAM) score for 7,144 patients to the primary care clinician level. We conducted in-depth interviews with 10 clinicians whose patients' score increases were among the highest and 10 whose patients' score changes were among the lowest. Transcripts of the interviews were analyzed to identify key strategies that differentiated the clinicians whose patients had top PAM change scores. RESULTSClinicians whose patients had relatively large activation increases reported using 5 key strategies to support patient behavior change (mean = 3.9 strategies): emphasizing patient ownership; partnering with patients; identifying small steps; scheduling frequent follow-up visits to cheer successes, problem solve, or both; and showing caring and concern for patients. Clinicians whose patients had lesser change in activation were far less likely to describe using these approaches (mean = 1.3 strategies). Most clinicians, regardless of group, reported developing their own approach to support patient behavior change. Those whose patients showed high activation change reported spending more time with patients on counseling and education than did those whose patients showed less improvement in activation.CONCLUSIONS Clinicians vary in the strategies they use to promote behavior change and in the time spent with patients on such activities. The 5 key strategies used by clinicians with high patient activation change are promising approaches to supporting patient behavior change that should be tested in a larger sample of clinicians to validate their effectiveness. 2016;14:148-154. doi:10.1370/afm.1904. Ann Fam Med INTRODUCTIONT hrough policies such as pay for performance and public reporting of clinicians' quality of care, clinicians are increasingly responsible for their patients' care outcomes. [1][2][3][4] Yet, for health outcomes to improve, patients must do their part, following through on treatment regimens and making recommended lifestyle changes.5-7 Given the key role that patients play in determining health outcomes, policy makers have made patient engagement and patient activation a major focus, including embedding approaches for increasing engagement in the Patient Protection and Affordable Care Act. 8,9 Patient activation, which is defined as having the knowledge, confidence, and skills to take care of one's health and health care, has been shown to be associated with a broad range of health-related outcomes, including better self-management and clinical indicators, fewer hospitalizations, and lower health care costs. [10][11][12][13][14][15][16][17][18][19][20] [34][35][36] Also, patients' assessment of clinician support of the chronic care model has been associated with hig...

show abstract

“…The quantitative work of Stewart Mercer shows that only empathic consultations lead to more empowered patients. 7 We need to teach staff to listen and understand as well as perform technical information gathering. It is not the diabetic patient but the patient who suffers with diabetes.…”

Section: Q7 How Can We Recognise and Replicate Staff Members' Actionmentioning

confidence: 99%

Cultivating Compassionate Care: Why Does it Matter and What Can We Do to Promote It?

Ward

Gillies

Grant³

et al. 2018

Journal of the Royal College of Physicians of Edinburgh

View full text Add to dashboard Cite

How compassionate is our NHS?' was held on 13 March 2017 at the Royal College of Physicians of Edinburgh Declaration of interests No conflicts of interest declared 'You can't look at compassion in healthcare without looking at compassion in society.' John Carnochan Perhaps a good sign for an event designed to trigger debate is when, prior to it beginning, you need to change the title. 'How compassionate is our NHS?' Or the reformed title, 'How compassionate is our health and social care?' was jointly organised by Royal College of Physicians of Edinburgh, the University of Edinburgh's Global Compassion Initiative and the Scottish Public Services Ombudsman's Offi ce. Based on a fi ctional patient's tale, Mary, an elderly lady, falls at home and is admitted to hospital. The tale follows Mary's journey though initial consultations and ward moves towards discharge. It is added to by a fi ctional complaint, not dissimilar to those that occur in real life, from Mary's daughter regarding aspects of her care. The day itself allowed the audience, comprising people ranging from patients, nurses, managers, senior and junior doctors (in hospital and general practice), psychologists, social care and third sector representatives, in addition to representatives of the funding and organising bodies themselves, to discuss and comment on the case. It also invited perspectives from invited speakers from health, social care, academia and humanities to discuss compassion in our care systems.

show abstract

Patient enablement requires physician empathy: a cross-sectional study of general practice consultations in areas of high and low socioeconomic deprivation in Scotland

Cited by 128 publications

References 21 publications

Multimorbidity and Socioeconomic Deprivation in Primary Care Consultations

Multimorbidity and Socioeconomic Deprivation in Primary Care Consultations

Supporting Patient Behavior Change: Approaches Used by Primary Care Clinicians Whose Patients Have an Increase in Activation Levels

Cultivating Compassionate Care: Why Does it Matter and What Can We Do to Promote It?

Contact Info

Product

Resources

About