Patient-provider relationship as mediator between adult attachment and self-management in primary care patients with multiple chronic conditions

Brenk-Franz, Katja; Strauß, Bernhard; Tiesler, Fabian; Fleischhauer, Christian; Schneider, Nico; Gensichen, Jochen

doi:10.1016/j.jpsychores.2017.04.007

Cited by 21 publications

(23 citation statements)

References 31 publications

(43 reference statements)

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“…Along with current study’s finding, dealing with stressors such as illness, individuals with a secure attachment style fill more security, show better cognitive abilities and are more successful in educational, occupational and interpersonal functions 5 . In another study comparing children with secure and unsecure attachment style, secure children showed higher self-esteem in stressful situations, insist on solving the problem, have initiative and perseverance, use more efficient strategies and thus have better physical and mental health 23 .…”

Section: Discussionsupporting

confidence: 78%

Measurement of heart rate variability and cognitive abilities based on attachment styles in children with chronic medical conditions

Ghafarimoghadam

Dehghani-Arani

2019

Sci Rep

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Recognizing the biopsychosocial dimensions of chronic medical conditions in children and preparing them to adapt to medical processes is one of the most significant issues in the field of health psychology. The aim of this study was to measure heart rate variability and cognitive abilities based on attachment style in children with chronic medical conditions. To this end, 45 children aged 12–15 years who had received a diagnosis of a chronic medical disease and were matched with the inclusion/exclusion criteria, were entered the study using available sampling method. These children were assigned to three groups of secure, avoidance and anxiety attachment style based on the Collins and Reid Attachment Scale. These groups had been demographically homogeneous. Then heart rate variability and cognitive abilities were measured. One-way ANOVA results showed a significant difference between the three groups in the heart rate variability and cognitive abilities. Post hoc test showed that children with secure attachment style had higher efficiency in heart rate variability and cognitive abilities. These results indicate that attachment style is one of the factors influencing the health status of children with chronic medical illness. These findings highlight the importance of paying attention to psychological factors, especially attachment and its role in the health status of children with chronic medical conditions.

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Section: Discussionsupporting

confidence: 78%

Measurement of heart rate variability and cognitive abilities based on attachment styles in children with chronic medical conditions

Ghafarimoghadam

Dehghani-Arani

2019

Sci Rep

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“…The therapeutic relationship is likely a key factor guiding when and how providers adapt a treatment protocol to make it “work.” Providers described the challenge of teaching patients tangible skills to promote mental and physical health when faced with a myriad of significant life issues impacting patients’ well-being. Financial struggles, as one of our providers pointed out, is one example of the numerous life issues that may have an impact on patients’ physical and mental health (e.g., Brenk-Franz et al [ 39 ]). The impact of these issues was conceptualized in the development of this brief CBT [ 18 ] and cannot be disentangled from treating depression and anxiety.…”

Section: Discussionmentioning

confidence: 99%

“I had to somehow still be flexible”: exploring adaptations during implementation of brief cognitive behavioral therapy in primary care

et al. 2018

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BackgroundPrimary care clinics present challenges to implementing evidence-based psychotherapies (EBPs) for depression and anxiety, and frontline providers infrequently adopt these treatments. The current study explored providers’ perspectives on fidelity to a manualized brief cognitive behavioral therapy (CBT) as delivered in primary care clinics as part of a pragmatic randomized trial. Data from the primary study demonstrated the clinical effectiveness of the treatment and indicated that providers delivered brief CBT with high fidelity, as evaluated by experts using a standardized rating form. Data presented here explore challenges providers faced during implementation and how they adapted nonessential intervention components to make the protocol “fit” into their clinical practice.MethodsA multiprofessional group of providers (n = 18) completed a one-time semi-structured interview documenting their experiences using brief CBT in the primary care setting. Data were analyzed via directed content analysis, followed by inductive sorting of interview excerpts to identify key themes agreed upon by consensus. The Dynamic Adaptation Process model provided an overarching framework to allow better understanding and contextualization of emergent themes.ResultsProviders described a variety of adaptations to the brief CBT to better enable its implementation. Adaptations were driven by provider skills and abilities (i.e., using flexible content and delivery options to promote treatment engagement), patient-emergent issues (i.e., addressing patients’ broader life and clinical concerns), and system-level resources (i.e., maximizing the time available to provide treatment).ConclusionsThe therapeutic relationship, individual patient factors, and system-level factors were critical drivers guiding how providers adapted EBP delivery to improve the “fit” into their clinical practice. Adaptations were generally informed by tensions between the EBP protocol and patient and system needs and were largely not addressed in the EBP protocol itself. Adaptations were generally viewed as acceptable by study fidelity experts and helped to more clearly define delivery procedures to improve future implementation efforts. It is recommended that future EBP implementation efforts examine the concept of fidelity on a continuum rather than dichotomized as adherent/not adherent with focused efforts to understand the context of EBP delivery.Trial registrationClinicalTrials.gov, NCT01149772Electronic supplementary materialThe online version of this article (10.1186/s13012-018-0768-z) contains supplementary material, which is available to authorized users.

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“…Discussing the reasons for having multiple visits can be important for patients to have appropriate expectations. Previous research demonstrated that consistent high-quality patient–provider relationships are pivotal in optimizing health outcomes for people with chronic conditions such as diabetes ( 21 , 22 ).…”

Section: Discussionmentioning

confidence: 99%

Factors Associated With Avoiding Health Care Among Community-Dwelling Medicare Beneficiaries With Type 2 Diabetes

LaManna

Towne

et al. 2020

Prev. Chronic Dis.

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Introduction Health care avoidance by Medicare beneficiaries with chronic conditions such as type 2 diabetes can result in adverse health and economic outcomes. The objective of this study was to describe factors associated with choices to avoid health care among Medicare beneficiaries with type 2 diabetes. Methods We used a survey-weighted logistic model and the nationally representative 2016 Medicare Current Beneficiary Survey to analyze data on 1,782 Medicare beneficiaries aged ≥65 with type 2 diabetes, to examine associations between Medicare beneficiaries’ decisions to avoid health care and multiple factors (eg, dissatisfaction with information given by providers, health problems that should have been discussed with providers but were not, worry about health more than other people their age). Results Of our study sample, 26.1% reported they avoid health care. Five factors were associated with avoiding health care: delaying care (vs not) because of costs (adjusted odds ratio [aOR] = 2.06; P = .005); having health problems that should have been discussed with providers but were not (vs having discussions) (aOR = 1.50; P = .04); worrying (vs not) about health more than other people their age (aOR = 2.13; P < .001); self-reporting “other” minority race (vs non-Hispanic White) (aOR = 2.01; P = .006); and education levels. Participants with less than a high school diploma (aOR = 1.95; P = .001) and participants with a high school diploma only (aOR = 1.49; P = .049) were more likely than participants with an education beyond high school to report avoiding health care. Conclusion Approximately 1 in 4 Medicare beneficiaries with type 2 diabetes avoid health care. We found inequities in care-seeking behavior by race/ethnicity and education level. Health care perceptions and lack of appropriate discussion of health care concerns with health care providers are also associated with this behavior. Clinical interventions (eg, improved patient–provider communication) and educational outreach are needed to decrease the numbers of Medicare beneficiaries who avoid health care.

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Patient-provider relationship as mediator between adult attachment and self-management in primary care patients with multiple chronic conditions

Cited by 21 publications

References 31 publications

Measurement of heart rate variability and cognitive abilities based on attachment styles in children with chronic medical conditions

Measurement of heart rate variability and cognitive abilities based on attachment styles in children with chronic medical conditions

“I had to somehow still be flexible”: exploring adaptations during implementation of brief cognitive behavioral therapy in primary care

Factors Associated With Avoiding Health Care Among Community-Dwelling Medicare Beneficiaries With Type 2 Diabetes

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