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Saturday, November 20, 2021

The Change of Perception Towards our Healthcare Journey:

 


 

The Change of Perception Towards our Healthcare Journey:

TakeCharge Campaign

27th August 2021.

Ngadiuba, Alina

Pulse Center for Patient Safety Education and Advocacy in partnership with Health Strategies Reform

 

MEDICAL ERROR IN THE HEALTHCARE SYSTEM- “TAKE CHARGE CAMPAIGN”.

Communication between a healthcare physician and their respective patients plays a significant role in developing trust in a doctor-patient relationship. This is considered a leading factor in delivering proper healthcare services to patients. Communication involves the exchange of information and negotiation of mutual expectations between the doctor and the patient; a positive approach from a healthcare practitioner can increase the adherence of a patient. The outcome of a patient’s care is strongly associated with the communication during discussion or taking notes of medical history in consideration of a management plan. Furthermore, good communication behavior among doctors and their patients is related with the decrease in malpractice claims, and the patterns of communication between patient and physician has been associated with the satisfaction of medical visits. The explanations doctors provide to patients and the patient’s understanding to those explanations have shown to have an impact on the patient’s satisfaction and adherence to medical administrations (Zolaly, 2012).

Patient satisfaction has gained relevance in the healthcare system across the world. Studies have indicated that patient’s perception towards the healthcare system has been accepted as valid, significant, and standard indicators for improving the quality of healthcare services. Nonetheless, patients often fail to discuss their respective issues and anxieties with their healthcare practitioners when they are dissatisfied with the attitude of a doctor; hence, doctors lack awareness on the state of satisfaction of a patient with the healthcare consultation (Covinsky, Bates, Davis, & Delbanco, 1996).

Research studies have shown that lack of communication between doctors and their patients have are long existed problems in the medical subculture within the healthcare system (André Busato, Andreas Dönges, Sylvia Herren, Marcel Widmer, & Florica Marian, 2006). For instance, in the current healthcare practice environment, doctors are faced with several demands that are require time resources; increase in administrative requirements for the delivery of healthcare services such as service and authorizing requests and utilizing the process of reviews which affects the time allocated to patients. In 1995, the Commonwealth Fund Survey indicated that 41% of physicians reported a decline in the time spent with patients, while 43% stated that there is a decrease on the amount of time spent with their respective colleagues. Due to the changes in social and demographics of the healthcare workforce, most physicians have other responsibilities that reduce the time spent on patients. These factors have been considered as a crucial issue in establishing a firm doctor-patient relationship (Dugdale, Epstein, & Pantilat, 1999). 

In several scientific concepts, participation has different terms; In sociology, participation is defined as the means of sharing a beneficial mutual interest or participating in a group, while in political sciences, participation refers to: people facing the same problem with similar feelings, they careless about the problems and may consider their actions irrelevant, and/or due to lack of knowledge or awareness, people may consider their participation inadequate and may restrain from participating. Several studies illustrate that the “focus of interest has been on participation of patients in care and treatment decision making process, using such terminologies as involvement, collaboration and partnership of patients, clients, consumers and users”. There are different concepts on patient participation; one view considers the participation of  a patient in the decision making of treatment for their respect health issues, while other view indicates that patient participation means the “involvement of patient in disclosing relevant information, feelings and accepting the provided instructions of doctors and nurses”(Vahdat, Hamzehgardeshi, Hessam, & Hamzehgardeshi, 2014).

The participation of patients in the decision making of healthcare delivery and treatment is not a new area of focus; however, it has currently become a political necessity in different countries and healthcare management worldwide (Vahdat et al., 2014). It is known that the essential factor to improve the quality of healthcare services for patients around the world is to encourage patients to actively participate in their healthcare. According to the UK’s National Patient Safety Agency (NPSA), patients can play a significant role in reducing the incident rate of unintended injuries within the healthcare system. For instance, patients can contribute to preventing medication error and monitoring any cases of adverse events within the healthcare system (Davis, Jacklin, Sevdalis, & Vincent, 2007).

Studies show that “the causes of diagnostic misadventures include problems that patients could potentially mitigate under some circumstances”.. In a retrospective study that involved patients who experienced diagnostics delay for colorectal cancer in America, an estimate of one-third had an average of 5.3 diagnostic process breakdown which includes lack of notifying the possibility of missing a diagnostic test appointment. From 587 patients who were diagnosed with lung cancer, about 44% of patients missed their appointments for diagnosis. While each patient is faced with their respective unique health challenge, patients are most likely to find barriers to participate in the journey of their diagnosis, especially when there is a feasible opportunity. Patients persistently find it challenging to communicate with their physicians; hence, creating an imbalance of power between the healthcare practitioner and patient (McDonald, Bryce, & Graber, 2013). Even though there has been an emphasis on the importance of patient’s involvement in their healthcare, evidence show that there are specific impediment that result to lack of effort to improve doctor-patient relationship. In a qualitative research study, a focus group of primary care patients indicated a hierarchical association with their respective doctors, defined by less than honest discussions and poor exchange of information. Furthermore, patients restrained from asking their physicians questions during their visits due to the fear of “second guessing” or the fear of being wrongly perceived by their physicians although they had an above average educational level and sought for external sources, either to clarify or make sense of their conversation with their doctors. In other cases, patients and their families are faced with several options without sufficient supervision from their doctor or coordination (Frosch, May, Rendle, Tietbohl, & Elwyn, 2012).

“The consumer model” and the “metaphor of the marketplace” are currently are applied in everyday life activities. They provide information on the different fields of the healthcare such as the opportunity to develop new and various relationship between the physician and the patient. Patients have technical competence expectations in their doctors, the availability, and the accessibility to healthcare (Lings et al., 2003).

Over the last decades, the occurrence of Healthcare Associated Infections (HAIs) has been acknowledged in the literature; it continues to increase in an alarming rate across the world. HAIs was originally referred to the infections that are related with the hospital admission in an acute-care unit (previously known as Nosocomial Infection), but recently, the term is applied to infections contracted during a continuous healthcare delivery (such as long-term care, home care and ambulatory care) among patients. These unforeseen infections can occur during the course of a patient’s healthcare treatment that results in to a significant increase in patient illness and deaths (morbidity and mortality rate); prolonged hospitalization; and increase of diagnostic procedures and therapeutic interventions, which incurs additional cost to patients with chronic diseases or upon the healthcare system. HAIs are considered preventable scenarios with undesirable impact on the healthcare deliver; quality of care indicator; an adverse event; and patient safety problems (Collins, 1991).

Healthcare Associated Infections (HAIs) is proven to be the most common cause of morbidity and mortality rate in the United States; they are considered the most frequent adverse events that occurs within the healthcare system. There is current emphasis on the HAIs as a patient safety hazard in the healthcare system and a public health issue that is in need for “Systematic HAI Surveillance”. Research studies have shown that in March 2006, 7 states in the United States have implemented an obligated reporting for HAIs in hospitals, while other states are in consideration of mandating similar legislative. According to the Centers for Disease Control and Prevention (CDC), National Nosocomial Infections Surveillance (NNIS) system, a study conducted in 1970 involved 62 participating hospitals, which eventually extended to over 300 acute care hospitals in 42 states by 2000 (Klevens et al., 2007). A survey which was carried out in 183 US hospitals of 11,282 patients had reported that approximately 4% of patients had at least 1 HAI with the often occurrence of microorganism called Clostridium Difficile. Other related infections include Surgical Site Infection (SSI), Pneumonia, and Gastrointestinal Infections. Another study which was conducted 2 years earlier by the same group discovered that 6% (51) of patients had experienced HAI with the top 75.8% of obtaining SSIs, Urinary Tract Infection (UTI), Pneumonia, and Blood Stream Infection (Haque, Sartelli, McKimm, & Bakar, 2018).

Medical error is defined as a preventable, yet an adverse effect of medical care provided to patients even though it may or may not be evident. Adverse drug events; improper transfusion; misdiagnosis; under/over treatment; surgical injuries; wrong site surgery; suicides; restraint-related injuries or death; falls; burns; pressure ulcers and mistaken patient identities are the most common medical error in the healthcare system. The increase of error rates that have adverse health outcomes normally occur in Intensive Care Units (ICU), Operating Rooms (OR), and Emergency Departments (ER). Medical errors can also be related to aging, new procedures, healthcare urgency and the severity of the medical condition. However, according to the 1999 IOM Report, most of the medical errors are results of faulty healthcare system; processes and conditions that could result to preventable mistakes, and not merely the carelessness of a person or the actions taken by a particular group (Niki Carver; Vikas Gupta; John E. Hipskind., 2020).

After the 2016 BMJ publication that “claims medical error should be considered the third leading cause of death in the USA”, there have been an increase of debate on the true incidence of death rate due to medical error. Studies indicate an annual estimate of 25, 0000 deaths due to medical error. An investigation carried out in the United Kingdom looked at 70 different studies which included 337,025 patients from general hospital, 47,148 of the patients suffered from injuries with 25,977 (55%) reported preventable injuries (SKEPTICAL SCALPEL, 2020). There has been a recent rise of medical errors in the USA; over 400,000 deaths have occurred within the last years which differs by states. The United States of America has the highest record of medical errors as compared to other developed countries. The most common medical error in USA is “surgical error”, which has been attributed as most preventable because surgical error is directly associated with patient safety(Canalichio, Berrondo, & Lendvay, 2020) . 

TAKE CHARGE CAMPAIGN:

The “Take Charge” Campaign aims at preparing people to become better prepared as patients by changing their perspection towards the involvement of their healthcare using 5 steps.

 

STEP 1: Understand & Complete Your Advance Directives 

OBJECTIVES
To create awareness among patients of the Advance Directive. 

STEP 2:Keep a Record of Your Medical History & Current Medications 

OBJECTIVES
To educate people on how to create and sustain their individual medical journal

STEP 3:
Prepare for Doctor Visits / Make A List of Questions

OBJECTIVES: 

To educate people on the importance of asking their healthcare practitioner relevant questions.


STEP 4:Prevent Infections / Ask Caregivers to Wash Their Hands 

OBJECTIVES: 
To educate people on the importance of asking a healthcare practitioner to wash their hands.


STEP 5:Use an Advocate / Be an Advocate for Others

OBJECTIVES: 
To provide guidelines on becoming an advocate. 

 

The TakeCharge campaign is a health campaign that focuses on helping patients and their families to understand their responsibilities in managing their healthcare as patients (if that should ever be the case). The campaign begun in the year of 2019, on the month of September. The campaign is non-funded campaign that involves 5 steps to “Safer Healthcare” to educate patients and their families to become active members of their healthcare team; to inform them on how to take charge of their healthcare decisions before the strike of any crisis.

The TakeCharge Campaign offers a different approach to reach the general public on the various ways of improving their healthcare before they become actual patients within the healthcare system. “This is not about HEALTH, but HEALTHCARE, the journey to better health”.

 

The 5 Steps to Safer Health Care! 

1.   Understand & Complete Your Advance Directives
 

Specifically, the healthcare proxy form or choosing a surrogate decision maker. According to the Mayo Clinic, “Advance directives guide choices for doctors and caregivers if you're terminally ill, seriously injured, in a coma, in the late stages of dementia or near the end of life.” Even temporarily as we have seen in recent months that people with COVID on a ventilator can not speak for themselves.  Children leaving for college, at 18 years old may need a parent or other person.  By choosing early to have a surrogate decisions maker, and the conversation about their preferred care wishes, people who cannot speak for themselves can be assured the care they wish for will be carried out.

 

2.    Keep a Record of Your Medical History & Current Medications 

Just as a resumé helps an employer understand your suitability for a job, a personal medical history helps a clinician understand the whole picture of you as a patient. That is especially true when you are seeing a healthcare provider for the first time, or when you see multiple providers. Updated lists by the patient can help to ensure information is correct.


3.    Prepare for Doctor Visits / Make A List of Questions 

 Hospitals and other therapy centers can present a whole galaxy of unknown situations and unfamiliar demands. Make a list, ask family to add questions, and bring it with you to the hospital intake, along with pen and paper to note down the answers. Included should be any new symptoms, new medications and clinicians.  Being prepared can help ensure questions are answered and time is used appropriately.

Before your next medical appointment, prepare your questions


4.    Prevent Infections / Ask Caregivers to Wash Their Hands 

One of the most basic yet most effective ways to prevent infections is for everyone — doctors, therapists, nurses, friends, and family — to wash their hands before touching the patient. But medical staff are busy and under pressure: sometimes they forget.


5.    Use an Advocate / Be an Advocate for Others

Everyone getting medical treatment should have someone to support them, to help raise questions, take notes, enhance communication with medical staff and make sure they are receiving patient-centered care.

This person is called a “patient advocate”. Such an advocate can help organize support from others, help review treatment options, and generally support a patient’s needs throughout their care and treatment. And the sicker, less “on top of things” the patient is, the more that advocate is needed. The advocate can help focus on the 5 Steps for the patient.

 

 

 

 

 

 

 

 

 

REFERENCES:

  1. André Busato, Andreas Dönges, Sylvia Herren, Marcel Widmer, & Florica Marian. (2006). Health status and health care utilisation of patients in complementary and conventional primary care in Switzerland—an observational study. Family Practice, 23(1), 116–124. https://doi.org/10.1093/FAMPRA
  2. Canalichio, K. L., Berrondo, C., & Lendvay, T. S. (2020). Simulation Training in Urology: State of the Art and Future Directions. https://doi.org/10.2147/AMEP.S198941
  3. Collins, A. S. (1991). Chapter 41 . Preventing Health Care - Associated Infections Definitions of Health Care-Associated Infections. Preventing Health Care-Associated Infections, 1–29. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK2683/
  4. Covinsky, K. E., Bates, C. K., Davis, R. B., & Delbanco, T. L. (1996). Physicians’ attitudes toward using patient reports to assess quality of care. Academic Medicine, 71(12), 1353–1356. https://doi.org/10.1097/00001888-199612000-00020
  5. Davis, R. E., Jacklin, R., Sevdalis, N., & Vincent, C. A. (2007, September 1). Patient involvement in patient safety: What factors influence patient participation and engagement? Health Expectations, Vol. 10, pp. 259–267. https://doi.org/10.1111/j.1369-7625.2007.00450.x
  6. Dugdale, D. C., Epstein, R., & Pantilat, S. Z. (1999). Time and the patient-physician relationship. Journal of General Internal Medicine, Vol. 14, p. S34. https://doi.org/10.1046/j.1525-1497.1999.00263.x
  7. Frosch, D. L., May, S. G., Rendle, K. A. S., Tietbohl, C., & Elwyn, G. (2012). Authoritarian physicians and patients’ fear of being labeled “difficult” among key obstacles to shared decision making. Health Affairs, 31(5), 1030–1038. https://doi.org/10.1377/hlthaff.2011.0576
  8. Haque, M., Sartelli, M., McKimm, J., & Bakar, M. A. (2018). Health care-associated infections – An overview. Infection and Drug Resistance, Vol. 11, pp. 2321–2333. https://doi.org/10.2147/IDR.S177247
  9. Klevens, R. M., Edwards, J. R., Richards, C. L., Horan, T. C., Gaynes, R. P., Pollock, D. A., & Cardo, D. M. (2007). Estimating health care-associated infections and deaths in U.S. Hospitals, 2002. Public Health Reports, 122(2), 160–166. https://doi.org/10.1177/003335490712200205
  10. Lings, P., Evans, P., Seamark, D., Seamark, C., Sweeney, K., Dixon, M., & Pereira Gray, D. (2003). The doctor-patient relationship in US primary care. Journal of the Royal Society of Medicine, 96(4), 180–184. https://doi.org/10.1258/jrsm.96.4.180
  11. McDonald, K. M., Bryce, C. L., & Graber, M. L. (2013, October 1). The patient is in: Patient involvement strategies for diagnostic error mitigation. BMJ Quality and Safety, Vol. 22, pp. ii33–ii39. https://doi.org/10.1136/bmjqs-2012-001623
  12. Niki Carver; Vikas Gupta; John E. Hipskind. (2020, July 10). Medical Error - StatPearls - NCBI Bookshelf. Retrieved September 17, 2020, from Stat Pearls Publishing website: https://www.ncbi.nlm.nih.gov/books/NBK430763/
  13. SKEPTICAL SCALPEL, M. (2020). Medical error is not the third leading cause of death. Retrieved September 17, 2020, from KevinMD website: https://www.kevinmd.com/blog/2020/02/medical-error-is-not-the-third-leading-cause-of-death.html
  14. Vahdat, S., Hamzehgardeshi, L., Hessam, S., & Hamzehgardeshi, Z. (2014). Patient involvement in health care decision making: A review. Iranian Red Crescent Medical Journal, 16(1), 12454. https://doi.org/10.5812/ircmj.12454
  15. Zolaly, M. A. (2012). Satisfaction of parents of paediatric patients with physicians’ communication skills in Almadinah Almunawwarah, Kingdom of Saudi Arabia. Journal of Taibah University Medical Sciences, 7(1), 29–34. https://doi.org/10.1016/j.jtumed.2012.07.007

 

 

 

 

 

 

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