Social science & medicine
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Social science & medicine · Jan 1990
ReviewA model of empathic understanding and adherence to treatment regimens in practitioner-patient relationships.
Empathic understanding in practitioner relationships is postulated as necessary for adherence to therapeutic regimens. It is considered to be one of the most important practitioner relationship skills leading ultimately to patient health benefit. Research literature from a wide-range of health disciplines including personality theory, social psychology, psychotherapy, psycho-analysis, and practitioner-patient communication highlights the key role of empathic processes in personal health care. ⋯ The model addresses theoretical relationships between practitioners' empathic understanding, patients' knowledge of their illness and motivation to get better, adherence to treatment advice, and outcome. Recent work on the selection and training of medical and nursing staff in empathic skills is reviewed. A number of areas for future research are outlined including the effect of individual practitioner differences in the components of empathy, empathic compatibility in practitioner-patient dyads, fluctuations in levels of practitioner empathy during long-term care, specific practitioner behaviours which communicate empathy, and the relationship between factors of patient satisfaction and the perception of empathic understanding.
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Social science & medicine · Jan 1990
Comparative Study Clinical TrialApplication of the verbal autopsy during a clinical trial.
During a community-based treatment trial of onchocerciasis with ivermectin, verbal autopsies were employed as one method to assess the safety of the drug. The verbal autopsy questionnaire was designed to determine causes of death and mortality differentials in the treated population. During the 8 months of surveillance here reported, 25 individuals died, yet only 9 of these deaths were certified. ⋯ We found that in 80% of the adult deaths, the verbal autopsy and death certificate diagnoses of underlying cause of death agreed. The verbal autopsy was less accurate in diagnosing child deaths which we attribute to the design of the verbal autopsy (being to detect potential drug related deaths in adults) and to the delay between death and interview. We conclude that verbal autopsies are an important addition to surveillance systems in remote areas where the absence or inadequacy of health information systems does not allow a thorough follow-up of all subjects in drug studies.
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Social science & medicine · Jan 1990
Comparative StudyCollaborative practice and provider styles of delivering health care.
The delivery of primary health care involves complex interactive communication between the provider and patient. Describing the manner or style of this communication is important to more completely understand the delivery of primary health care. The purpose of this study was to examine provider's style of interaction with the patient and to compare the styles of nurse practitioners and physicians in joint practice. ⋯ Nurse practitioners, however, exhibited significantly more concern with psychosocial issues than physicians. Type of visit and visit history were also factors associated with provider style. Using the style dimension indices constructed for this study a typology of provider styles was developed.
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Social science & medicine · Jan 1990
Referrals to physiotherapy: the relation between the number of referrals, the indication for referral and the inclination to refer.
This article studies the relation between the referral rate and the type of patients general practitioners refer for physiotherapy. The study population consists of GPs participating in the Netherlands' Sentinel Stations Network, who recorded data on all referrals to physiotherapy during one year and filled in a questionnaire. ⋯ High referring GPs were no more inclined to give in to their patients demands, had busier practices, closer relations with physiotherapists and viewed their knowledge of physiotherapy as more satisfactory than low referring GPs. Some policy implications are discussed in respect to these results.
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Social science & medicine · Jan 1989
ReviewWar-related changes in health and health services in Nicaragua.
The low-intensity war against Nicaragua from 1983 to 1987 has had a wide reaching impact on health, health services, and health economics in that country. Beyond the death of individuals and destruction of facilities, economic embargo and contra destruction have cost the health system about 200 billion cordobas between 1981 and 1987. This is approximately equal to the value of 2 years of the entire health budget. ⋯ Nonetheless, the indirect effects of the war have been detrimental to the system. Negative effect include the loss to the system of health professionals and rampant inflation. These forces contribute to the weakening of primary health programs and the reorientation of the national system into hospital based, curative medical services.