Patients’ engagement in primary care: powerlessness and compounding jeopardy. A qualitative study

Abstract

Background Primary health care does not adequately respond to populations known to have high needs such as those with compounding jeopardy from chronic conditions, poverty, minority status and age; as such populations report powerlessness.

Shared Decision Making and Motivational Interviewing: Achieving Patient-Centered Care Across the Spectrum of Health Care Problems

“…2,3 Data from surveys and qualitative and observational research indicate that clinicians often do not take patients' perspectives into account; rather, clinicians often promote or recommend specific treatments rather than consider patients' preferences during the decision-making process. [4][5][6][7] Clinicians are commonly challenged by the diversity of situations that arise in practice when they attempt to implement patient-centered care. For example, providing patient-centered care for a patient at the end of life is very different from counseling a patient with a long-term health condition or providing advice about preventative care.…”

A Longitudinal Study of Interactions Between Health Professionals and People With Newly Diagnosed Diabetes

“…These findings affirm other work identifying a relative absence of a patient-centered perspective. 6,20 In some consultations, the focus was on simply providing information, 40 with relatively little emphasis on the structured negotiation techniques noted previously to effect lifestyle change. 29 Furthermore, the requirement to use a structured checklist approach can lead to loss of more engaged communication technique, as was seen in the interaction of NS13 and PT03.…”

“…3 Although the impact of diabetes is largely a function of both social determinants of health and genetic predisposition, 3,4 an important determinant of outcome in primary care settings is the effectiveness of the consultation between patients and health care professionals. 5,6 Diabetes management is now focused on primary care settings 7 and multidisciplinary team care. 8 Multidisciplinary care presents challenges related to the consultation styles 9 of different health professionals, 10 and the different relationships patients develop by engaging in a linked sequence of consultations with professionals from both primary and secondary care.…”

“…time, building an effective nurse-patient 6 or physicianpatient relationship in early consultations, progressing to discussing treatment matters, and then addressing psychosocial issues. 23,24 Audio-taping and videotaping of consultations 25,26 are being increasingly used to explore the management of diabetes [27][28][29][30][31] and antecedents such as overweight and obesity.…”

Racial Inequities in Cardiovascular Disease in New Zealand

“…They suggested that clinicians must Adapted from [46,52] be willing to be guided by their patients' perceptions of need, not by their own assumptions of similarity and beliefs about illness and clinical management. As chronic conditions such as CVD are increasingly managed within the primary healthcare sector, Government policy must advocate greater engagement with vulnerable populations that emphasize health equity and provide incentives to general practitioners to adopt new approaches [58].…”