Social science & medicine
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Social science & medicine · Feb 2003
What are the ingredients for a successful evidence-based patient choice consultation?: A qualitative study.
The evidence-based patient choice (EBPC) approach is one of a number of newly emerging templates for medical encounters that advocate evidence-informed choice and shared decision-making. These models emphasise respect for patient preferences for involvement in health care decisions and advocate the sharing of good quality evidence-based information. In the medical consultation EBPC involves providing patients with evidence-based information in a way that facilitates their ability to make choices or decisions about their health care. ⋯ However, there were no suggestions as to how this might be achieved in practice. Participants' opinions relating to which model of decision-making should be adopted ranged from favouring an informed choice model, to the view that decision-making should be shared equally. Similarly, there was no clear view on how much guidance a doctor should offer a patient during decision-making concerning the most appropriate treatment option for that patient.
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Social science & medicine · Feb 2003
Eliciting preferences of the community for out of hours care provided by general practitioners: a stated preference discrete choice experiment.
Access to primary care services is a major issue as new models of delivering primary care continue develop in many countries. Major changes to out of hours care provided by general practitioners (GPs) were made in the UK in 1995. These were designed in response to low morale and job dissatisfaction of GPs, rather than in response to patients' preferences. ⋯ Preferences also differed across sub-groups of patients. Those who had never used out of hours care before had stronger preferences for waiting time and the doctor listening, suggesting higher expectations of non-users. Further research is required into the demand for out of hours care as new models of care become established.
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Social science & medicine · Jan 2003
Online commentary during the physical examination: a communication tool for avoiding inappropriate antibiotic prescribing?
A previously identified communication behavior, online commentary, is physician talk that describes what he/she is seeing, feeling, or hearing during the physical examination of the patient. The investigators who identified this communication behavior hypothesized that its use may be associated with successful physician resistance to perceived or actual patient expectations for inappropriate antibiotic medication. This paper examines the relationship between actual and perceived parental expectations for antibiotics and physician use of online commentary as well as the relationship between online commentary use and the physician's prescribing decision. ⋯ For presumed viral cases where the physician thought the parent expected to receive antibiotics, if the physician used at least some 'problem' online commentary, he/she prescribed antibiotics in 91% (10/11) of cases. Conversely, when the physician exclusively employed 'no problem' online commentary, antibiotics were prescribed 27% (4/15) of the time (p = 0.07). Use of 'no problem' online commentary did not add significantly to visit length. 'No problem' online commentary is a communication technique that may provide an effective and efficient method for resisting perceived expectations to prescribe antibiotics.
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Adolescents who reported to have given sexual favors for payment were investigated. The sample consisted of all adolescents in the public and private school systems in Oslo, the capital in Norway (age group 14-17, response rate 94.3%, N=10,828). Adolescents who had sold sex form 1.4%, three times as many boys as girls. ⋯ However, sex sale was associated with low intercourse debut age, conduct problems, alcohol problems, use of drugs (including heroin) and violent victimization. The conclusion is that a small group in the general adolescent population sells sex, and many of the clients are assumed to be homosexual or bisexual men. Adolescents who take part in these activities are often heavily involved in delinquent behaviors and use of drugs, and many probably are in a risk zone for sexually transmitted diseases (including HIV), drug abuse and a delinquent and criminal development.
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Social science & medicine · Jan 2003
How can we learn to live with pain? A Q-methodological analysis of the diverse understandings of acceptance of chronic pain.
An analysis is reported of the variety of understandings available in British culture to understand acceptance of chronic pain. Q-factor analysis is used within a critical framework as Q-methodology. Thirty participants completed the procedure. ⋯ Where accounts of chronic pain differ is in the extent to which acceptance of pain means a change in core aspects of self. Implications of this study for the study of chronic pain are discussed. In particular, how identity is managed in the context of threatening chronic pain is suggested as a fruitful area of future investigation.