Journal of evaluation in clinical practice
-
As one of the factors related to doctor-shopping behaviour (i.e. consulting multiple doctors with regard to the same illness episode), very little has been revealed about the role of doctor explanation. We examined therefore the association between doctor explanation and doctor-shopping behaviour. ⋯ These results imply the following: (1) a patient's inability to understand a doctor's explanation about treatment, which results from a large gap between the perceptions of the patient and those of the doctor, is the most significant predictor of doctor-shopping behaviour, and (2) in the context of favourable patient-doctor interactions, when doctors feel their explanations are insufficient, they may be able to prevent doctor-shopping behaviour by providing relatively thorough explanations about treatment.
-
A clinical practice guideline for chronic obstructive pulmonary disease (COPD) was implemented in all Veterans Health Administration (VHA) hospitals in the US. The aim of the current analyses is to describe current adherence rates and the organizational factors related to provider adherence to the COPD guideline. ⋯ Organizations can play an important role in providing a supportive climate to facilitate their providers' adherence to guidelines by implementing processes and culture changes that involve these five measures.
-
To reduce health inequalities and improve quality in health care, health policy initiatives in countries including New Zealand and the United Kingdom are expecting general practice to share responsibilities for a population approach to health care. This is giving increased emphasis to preventative care, including health promotion. Reasoned debate on this policy is overdue, not least in New Zealand, where clinicians within general practice appear to have been seduced by the lack of clarity in health policy into accepting this policy without question. ⋯ This paper suggests that a population health approach is inappropriate in general practice when this approach weakens personal care and involves health promotion activity of unknown safety and effectiveness. The example of intentional weight loss to reduce overweight is used to illustrate these issues. We argue for a restricted range of general practice services.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Costs and effectiveness of pre- and post-operative home physiotherapy for total knee replacement: randomized controlled trial.
To assess the effectiveness of pre- and post-operative physiotherapy at home for unilateral total knee replacement (TKR). ⋯ Although home physiotherapy was as effective and as acceptable to patients as hospital outpatient physiotherapy for unilateral TKR, it was more expensive. Additional pre-operative home physiotherapy did not improve patient-perceived health outcomes.