Social science & medicine
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Social science & medicine · Jan 2004
What is important to continuity in home care?. Perspectives of key stakeholders.
In Canada, home care is growing rapidly. Each province takes a somewhat different approach to its delivery. Ontario uses a competitive bidding model to award contracts to community agencies that bid for service delivery rights. ⋯ Clients included consistency of timing of service delivery while rarely mentioning care management issues. They emphasized the importance of consistent knowledge and skills in the workers and trusting relationships as important to experiencing care continuity. The description of attributes of continuity of home care that emerged from this study is compared to definitions found in the nursing, mental health and primary care literature.
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Social science & medicine · Dec 2003
Randomized Controlled Trial Clinical TrialThe continuum of patient satisfaction--from satisfied to very satisfied.
In a move towards a more informed understanding of the concept of satisfaction, this paper aims to explore how 30 dermatology patients describe what it meant to them to be either satisfied or very satisfied with their healthcare. This was undertaken using in-depth interviews and the findings suggest that participants clearly differentiated between being satisfied or very satisfied with healthcare. ⋯ This observation of a 'continuum of satisfaction' has specific and important implications for the future analysis and presentation of patient satisfaction surveys. It is suggested that attention to the differences between the two constructs provides a useful means to highlighting areas of patient concern and that researchers reporting the results of patient satisfaction surveys should cease to collapse them.
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Social science & medicine · Nov 2003
Pain management and symptoms of substance dependence among patients with sickle cell disease.
Concerns about dependence on prescribed analgesia may compromise pain management, but there was previously little reliable evidence about substance dependence among patients with sickle cell disease (SCD). We conducted in-depth, semi-structured interviews with SCD patients in London, UK, to assess DSM-IV symptoms of substance dependence and abuse. Criteria were applied to differentiate between pain-related symptoms, which corresponded to the DSM-IV symptoms but involved analgesics used to control pain, and non-pain-related symptoms, which involved analgesic use beyond pain management. ⋯ Psychological disturbance was a theme associated with non-pain-related symptoms. The implications are for more responsive treatment of pain in SCD and greater awareness of how patients' pain coping may be perceived as analgesic dependence. Further research could examine ways that pain-related and non-pain-related symptoms of dependence may be associated with other pain coping strategies and with the outcomes of treatment for painful episodes in hospital.
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Social science & medicine · Nov 2003
Comparative StudySomatization and mental health: a comparative study of the idiom of distress hypothesis.
Somatization is the expression of physical symptoms in the absence of medically explained physical illness. As a disproportionate response to psychosocial distress, somatization is usually correlated with depression. According to the idiom of distress hypothesis, the association of somatization and mental health is mitigated when somatizing indirectly expresses, and is understood by others as, emotional distress. ⋯ Bivariate and multivariate analyses revealed that the relationship of somatization with mental health depends on culture. Also, the disparity in mental health was greatest and favored the U. S. adults at low levels of somatization, but the disparity in mental health between countries disappeared as somatization increased.
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Social science & medicine · Nov 2003
Physicians' experiences of caring for late-stage HIV patients in the post-HAART era: challenges and adaptations.
As medical treatment for AIDS has become more complex, the need for good palliative and end-of-life care has also increased for patients with advanced disease. Such care is often inadequate, especially among low-income, ethnic minority patients. The current study investigated physicians' experiences with caring for dying HIV patients in an underserved, inner city community in the Bronx, NY. ⋯ Working with dying HIV patients in the post-HAART era of efficacious treatment challenges physician's cherished roles and values. Physicians adapt to the challenge through a variety of cognitive and behavioral strategies. The failure to adapt successfully has psychological consequences for providers that may impact patient care.