Physician-patient partnership in managing chronic illness

Clark, Noreen M.; Nothwehr, Faryle; Gong, Molly; Evans, David; Maiman, Lois A.; Hurwitz, Martin E.; Roloff, Dietrich W.; Mellins, Robert B.

doi:10.1097/00001888-199511000-00008

Cited by 90 publications

(63 citation statements)

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“…Social cognitive theory (90)(91)(92) and the transtheoretical stages of change model (93)(94)(95) suggest the value of an individualized, stage-specific approach that sets manageable priorities, of providing clients with feedback on their implementation of action plans, and of CHES serving as role models who demonstrate actions to reduce exposures (e.g., vacuuming and cleaning mold). CHES used several techniques to encourage participant actions: simplification to adapt to the participant's lifestyle; monitoring and reinforcement; individualizing, reviewing, and adjusting plans as needed; encouraging family involvement; being attentive to client concerns and fears; and giving participants simple, brief, written materials that reinforced the actions recommended and skills taught (96)(97)(98)(99)(100)(101). The experience of implementing SKCHH and new findings in the research literature have shown us ways to improve our protocols.…”

Section: The Action Planmentioning

confidence: 99%

The Seattle-King County healthy homes project: implementation of a comprehensive approach to improving indoor environmental quality for low-income children with asthma.

Krieger

Takaro

Allen

et al. 2002

Environ Health Perspect

126

102

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Pediatric asthma is a growing public health issue, disproportionately affecting low-income people and people of color. Exposure to indoor asthma triggers plays an important role in the development and exacerbation of asthma. We describe the implementation of the Seattle-King County Healthy Homes Project, a randomized, controlled trial of an outreach/education intervention to improve asthma-related health status by reducing exposure to allergens and irritants in the home. We randomly assigned 274 low-income children with asthma ages 4-12 to either a high- or a low-intensity group. In the high-intensity group, community health workers called Community Home Environmental Specialists (CHES) conducted initial home environmental assessments, provided individualized action plans, and made additional visits over a 12-month period to provide education and social support, encouragement of participant actions, provision of materials to reduce exposures (including bedding encasements), assistance with roach and rodent eradication, and advocacy for improved housing conditions. Members of the low-intensity group received the initial assessment, home action plan, limited education during the assessment visit, and bedding encasements. We describe the recruitment and training of CHES and challenges they faced and explain the assessment and exposure reduction protocols addressing dust mites, mold, tobacco smoke, pets, cockroaches, rodents, dust, moisture, and toxic or hazardous chemicals. We also discuss the gap between the practices recommended in the literature and what is feasible in the home. We accomplished home interventions and participants found the project very useful. The project was limited in resolving structural housing quality issues that contributed to exposure to indoor triggers.

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Section: The Action Planmentioning

confidence: 99%

The Seattle-King County healthy homes project: implementation of a comprehensive approach to improving indoor environmental quality for low-income children with asthma.

Krieger

Takaro

Allen

et al. 2002

Environ Health Perspect

126

102

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“…The seminar organized patient teaching objectives and messages into a sequence that physicians could incorporate into one or more visits, depending on patients' needs and the time available. The premises underlying the programme are discussed elsewhere [8].…”

Section: The Interventionmentioning

confidence: 99%

Long-term effects of asthma education for physicians on patient satisfaction and use of health services

et al. 2000

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This randomized clinical trial evaluated the long-term impact of an interactive seminar for physicians based on principles of self-regulation on clinician behaviour, children's use of health services for asthma, and parent's views of physician performance.Seventy-four general practice paediatricians, and 637 of their asthma patients aged 1±12 yrs, were randomized to treatment or control. Children and parents were blind to physicians' participation. Data were collected at baseline and follow-up through self-administered surveys (paediatricians), telephone interviews (parents) and medical records. The seminar focused on development of communication and teaching skills and use of therapeutic medical regimens for asthma as outlined in the National Asthma Education and Prevention Program guidelines.Approximately 2 yrs postintervention, treatment group physicians were more likely than control physicians to: use protocols for delivering asthma education (odds ratio (OR) 4.9, p=0.2), write down for patients how to adjust medicines when symptoms change (OR 5.7, p=0.05), and provide more guidelines for modifying therapy (OR 3.8, p=0.06). Parents scored treatment group physicians higher than control physicians on five specific positive communication behaviours. Children seen by treatment group physicians had fewer hospitalizations (p=0.03) and those with higher levels of emergency department (ED) use at baseline had fewer subsequent ED visits (p=0.03). No differences regarding the number of office visits were noted. There were no significant differences found between treatment and control group physicians in the amount of time spent with patients during office visits (26 versus 29 min) or in the number of patients treated with anti-inflammatory medicine.It is concluded that interactive asthma seminars for paediatricians had significant long-term benefits for their asthma care. Annual expenditure by individuals, professional societies, and corporations on professional education are considerable as this form of learning is thought to be a major way in which physicians keep abreast of changes in clinical practice. Nonetheless, little information evaluated by randomized controlled study designs exists in the literature about the impact of education for practicing physicians on the health status of their patients. While studies of continuing medical education are rare [1±3], fewer still are available to assess the persistence or decline of effects over the longer term. Developing potent interventions for clinicians, that change their practices and result in desirable patient outcomes, is important for ultimately improving healthcare and reducing costs.There are at least three reasons for why providing effective continuing education is salient in asthma control. Firstly, a chronic disease like asthma requires an ongoing partnership between clinician and patient and the nature of that relationship has only recently received attention in research [4]. Not all physicians are aware of the elements of partnership (for exam...

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“…Research and clinical experience suggest that, with training, health professionals can improve their communication skills in such a way that patients experience measurably better outcomes, but few effective models have been tested [13]. Similarly, there are few validated tools with which to assess health professional communication [4,6].…”

Section: Improving Communication Between Health Professionals and Patmentioning

confidence: 99%

“…Detailed strategies may need to differ from culture to culture, but good general guidelines exist (table 2) [13].…”

Section: Improving Communication Between Health Professionals and Patmentioning

confidence: 99%

Enhancing care for people with asthma: the role of communication, education, training and self-management. 1998 World Asthma Meeting Education and Delivery of Care Working Group

Partridge

Hill²

2000

Eur Respir J

114

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Reduction in the morbidity associated with asthma requires attention to several aspects of the behaviour of health professionals and patients, and to the interactions between these two groups. In this review, what has been learnt about health professional/patient communication and patient education (skills, settings and materials), lay and health professional liaison (including telephone helplines), patient education in low-income countries, the integration of patient education into clinical practice, health professional training and the implementation of guidelines, and the role of national asthma campaigns is drawn together. What changes in public policy would enhance asthma care, and whether the promotion of asthma self-management skills is cost effective are also considered. It is concluded that, although further research is necessary in many areas, well-educated health professionals who recognize the person with asthma as an individual, and who give advice about self-management, can significantly reduce the suffering and costs associated with asthma. Eur Respir J 2000; 16: 333±348.

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Physician-patient partnership in managing chronic illness

Cited by 90 publications

References 0 publications

The Seattle-King County healthy homes project: implementation of a comprehensive approach to improving indoor environmental quality for low-income children with asthma.

The Seattle-King County healthy homes project: implementation of a comprehensive approach to improving indoor environmental quality for low-income children with asthma.

Long-term effects of asthma education for physicians on patient satisfaction and use of health services

Enhancing care for people with asthma: the role of communication, education, training and self-management. 1998 World Asthma Meeting Education and Delivery of Care Working Group

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