‘It just has to click’: Internists’ views of: what constitutes productive interactions with chronically ill patients
| Autor: | N. M. H. Kromme, Rijk O. B. Gans, H.B.M. van de Wiel, C. T. B. Ahaus |
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| Přispěvatelé: | Research programme OPERA, Lifestyle Medicine (LM), Groningen Kidney Center (GKC), Value, Affordability and Sustainability (VALUE), Lifelong Learning, Education & Assessment Research Network (LEARN) |
| Rok vydání: | 2016 |
| Předmět: |
Adult
Male medicine.medical_specialty Attitude of Health Personnel Goal orientations Subspecialty Health informatics Health administration 03 medical and health sciences 0302 clinical medicine Nursing Physicians Humans Medicine Chronic Care Model 030212 general & internal medicine Qualitative Research Chronic care Physician-Patient Relations business.industry Productive patient–physician interaction 030503 health policy & services Health Policy Public health Nursing research Internship and Residency Medical context Rapport Chronic disease Family medicine Chronic Disease Female 0305 other medical science business Research Article Qualitative research |
| Zdroj: | BMC Health Services Research, 16(1):191. BioMed Central Ltd. BMC Health Services Research |
| ISSN: | 1472-6963 |
| DOI: | 10.1186/s12913-016-1430-6 |
| Popis: | Background According to the Chronic Care Model, productive interactions are crucial to patient outcomes. Despite productive interactions being at the heart of the Model, however, it is unclear what constitutes such an interaction. The aim of this study was to gain a better understanding of physician views of productive interactions with the chronically ill. Method We conducted a qualitative study and interviewed 20 internists working in an academic hospital. The data were analyzed using a constructivist approach of grounded theory. To categorize the data, a coding process within which a code list was developed and tested with two other coders was conducted. Results The participants engaged in goal-directed reasoning when reflecting on productive interactions. This resulted in the identification of four goal orientations: (a) health outcome; (b) satisfaction; (c) medical process; and (d) collaboration. Collaboration appeared to be conditional for reaching medical process goals and ultimately health outcome and satisfaction goals. Achieving rapport with the patient (‘clicking,’ in the term of the participants) was found to be a key condition that catalyzed collaboration goals. Clicking appeared to be seen as a somewhat unpredictable phenomenon that might or might not emerge, which one had to accept and work with. Goal orientations were found to be related to the specific medical context (i.e., a participant’s subspecialty and the nature of a patient’s complaint). Conclusions The participants viewed a productive interaction as essentially goal-directed, catalyzed by the two parties clicking, and dependent on the nature of a patient’s complaint. Using the findings, we developed a conceptual process model with the four goal orientations as wheels and with clicking in the center as a flywheel. Because clicking was viewed as important, but somewhat unpredictable, teaching physicians how to click, while taking account of the medical context, may warrant greater attention. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1430-6) contains supplementary material, which is available to authorized users. |
| Databáze: | OpenAIRE |
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