Involvement In Disease Management Research Articles

Patients and Health Professionals' Perceptions of Primary Health Care Services in Saudi Arabia: A Scoping Review.

This scoping review aims to identify and summarize existing evidence concerning the quality and capacity of PHC services in the Kingdom of Saudi Arabia (KSA) with a focus on the patients and healthcare professionals' perceptions of PHC. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The digital library, PubMed, and the search engine Google Scholar were searched to broaden our results for primary research involving patient and/or health professionals' perspectives on Primary Healthcare in KSA. A total of 38 publications were selected for the scoping review. Several studies examined patients' overall satisfaction with PHC services (n=14) while others focused their investigation on specific services provided by PHC (n=3). Several studies assessed the perceptions of certain groups of patients (n=5). Several studies examined health professionals' perceptions of the use of electronic health records (n=3), the safety culture (n=2), communicable disease management (n=1), emergency services (n=1), laboratory services (n=1), cost-effectiveness (n=1), and leadership (n=1). This review also included studies that assessed the health professionals' job satisfaction and burnout (n=6). Patients were satisfied with some aspects of PHC services while recognizing that improvements in some areas were needed. These included waiting time, physician-patient communication, access to the services in rural areas, patient involvement in disease management, and oral health. Health workers were positive about certain quality aspects and services provided by PHC such as EHRs, safety culture, communicable disease management, emergency services, and laboratory services. Health workers demonstrated a low level of job satisfaction due to several reasons, including, working conditions, financial incentives, and burnout.

The Psoriatic Arthritis Experience in Saudi Arabia from the Rheumatolo-gist and Patient Perspectives.

Psoriatic arthritis (PsA) is a musculoskeletal disease that adversely affects physical mobility and quality of life. It is challenging to manage because of the heterogeneous na-ture of the symptoms and the current treatment options. To explore the patient and rheumatologist perspectives of PsA to help improve understanding of the disease experience and improve disease management. A descriptive, observational cross-sectional study of Saudi Arabian dermatologists and rheumatologists and patients with psoriasis or PsA was conducted. Questionnaire data were collect-ed from 31 dermatologists, 34 rheumatologists, 90 patients with psoriasis, and 98 patients with PsA and analysed using descriptive statistics. Here, data from rheumatologists and patients with PsA are presented. The results revealed similarities and differences in the rheumatologist and patient perspec-tives of PsA. Rheumatologists and patients agreed on the impact that PsA had on patients' quality of life and that more education was needed. However, they differed on several aspects of disease man-agement. Rheumatologists estimated the time to diagnosis as four times shorter than what patients experienced. Patients accepted their diagnosis more than rheumatologists perceived them to; rheu-matologists perceived patients to be worried or fearful. Patients perceived joint pain as their most severe symptom, in contrast to rheumatologists, who presumed skin appearance was the most severe symptom. Reported input into PsA treatment goals differed significantly. More than half of the rheumatologists reported equal patient-physician input into goal development as opposed to <10% of patients reporting the same. Almost half of patients reported no input into the development of their treatment goals. The management of PsA could benefit from enhanced screening and re-evaluation of what PsA outcomes have the most value to patients and rheumatologists. A multidisciplinary ap-proach is recommended with increased patient involvement in disease management and individual-ized treatment options.

Experiences and Satisfaction of Patients with Non-Communicable Diseases with Current Care in Primary Health Care Centres in Saudi Arabia.

Primary healthcare centres (PHCs) play a pivotal role in chronic disease care and prevention and therefore in the experience and satisfaction of patients with non-communicable diseases (NCDs). This survey examined the experiences and satisfaction of 315 Patients with NCDs receiving care from PHCs. Participants were from attendees at Ministry of Health PHCs in Riyadh, Saudi Arabia. Findings indicate that most patients were satisfied with the care they received and confirmed the importance of providers' and physicians' communication skills in this. There was a lack of evidence of managed care, including patient involvement in disease management suggesting that steps are needed to empower patients to take a greater role in disease management. This study emphasises the important role of physicians in providing patients with information and empowering them to access community health facilities for self-managed care. This study also indicates a need to strengthen the primary health care system's focus on care beyond PHCs.

Patient involvement in disease management: A holistic approach in clinical pharmacy

Clinical pharmacy is one of the specialized areas of pharmacy profession which demands scientific and comprehensive therapeutic knowledge, extensive clinical experience and skills, and collaboration with other healthcare professionals as well as the patients in disease management. The concepts of patient involvement and patient empowerment, patient self-management and patient engagement in health care settings are explored in many studies. The PubMed search undertaken in March 2019 by using the keywords of ‘patient involvement,’ ‘disease management,’ and ‘clinical pharmacy’ revealed 581 publications, of those 268 were published in the last five years and 95 were review articles. Another search made by using the words of ‘patient empowerment’ and ‘clinical pharmacy,’ and the results were even increased to 735 articles. A patient-centered approach is the cornerstone of the provision of clinical pharmacy services in chronic disease management. The patient’s ability in problem-solving can be enhanced through teaching general skills and providing access to appropriate counseling or supervision. Therefore, patients become responsible for many issues, such as describing their symptoms and expressing their concerns properly, using specific self-management practices, and applying preventative approaches in their disease management. During the disease management process, roles and responsibilities of healthcare professionals and patients should be specified, and patients become less severely incapacitated by disease consequences, well-informed about their condition and medications, and have higher self-esteem to improve their condition or prevent their condition becoming worse.

PDB106 DOES MOBILE HEALTH LIVE UP TO EXPECTATIONS? EXPLORING REAL-WORLD EXPERIENCES IN PATIENTS WITH DIABETES

The mobile health (mHealth) market is expected to be worth over $150 billion by 2025. It is believed mHealth can improve clinical outcomes and patient involvement in disease management, and reduce risk of disease-related complications and associated cost. However, little information is available on patient perspectives on the use of mHealth products. Therefore, this study aimed to characterise real-world experiences of mHealth products for patients with diabetes, one of the largest populations of mHealth users. Publicly available posts from patients with diabetes (both types) and/or caregivers about continuous blood glucose monitoring were extracted from the Diabetes.co.uk forum, from 2016 to 2019, and subset to those containing names of select diabetes mHealth products. From these, a random sample of 80 users (153 posts) were qualitatively analysed using thematic analysis. Of 80 users, 73 had posts relevant to the study objectives, and 7 users were excluded as they did not provide an experience or perception of mHealth. Most common themes were satisfaction (32 users, 44% of users), accuracy (25 users, 34%) and cost (22 users, 30%). Of users mentioning satisfaction, 84% were happy with the product. However, where users discussed accuracy, 56% did not believe products to be accurate, and 32% discussed inconsistencies between outputs of different devices. Some users however, said accuracy did not matter as the value of mHealth is in tracking trends (32%). Cost was important for continued use of mHealth devices, and discussions regarding cost often related to NHS and insurance provision of mHealth products (11 users, 50%). mHealth is changing diabetes management, and whilst many users express positive attitudes there are key challenges for mHealth to overcome if its growth is to continue. This study can help researchers understand use-behaviours of mHealth products, in addition to areas for improvement to maximise benefit to patients with diabetes.

The Effect of a Tailored Patient Activation Intervention in Inflammatory Bowel Disease Patients

Purpose A pre-test, post-test, control group design was employed to investigate the impact of a tailored patient activation intervention (PAI) among inflammatory bowel disease (IBD) patients. Methods Patients who met the inclusion criteria were selected from medical records via convenience sampling, were consented, and completed a baseline survey. Based on responses to the baseline 13-item patient activation measure (PAM-13), they were categorized into one of four patient activation stages. During office visits, intervention patients (N=23) were given a tailored PAI based on their baseline stage, which consisted of an information booklet and focused discussion with the gastroenterologist, while the control group (N=27) received usual care. Baseline and 1-month post-intervention scores were compared between the intervention (N=20) and control (N=21) groups for changes in patient activation score, medication adherence, and satisfaction with care. Results Most participants were Caucasian (88%), female (64%), college graduates (56%), and had Crohn's disease (59.2%). Overall, females had a significantly higher (p=0.04) mean activation score (mean=70.9±15.4) than males (mean=60.9±10.7) at baseline. This trend was the same post-intervention (75.6 females vs 64.4 males; p=0.03). The difference in mean activation scores pre- vs post-intervention was not statistically significant between the intervention and control groups (mean=4.9±12.3, p=0.21). However, this difference could be considered to be clinically significant based on results from previous studies. There were no significant differences in medication adherence or satisfaction scores pre- vs post-intervention for either group. Conclusion Tailored PAIs have the potential to increase activation level of patients with inflammatory bowel disease. This customized medical interaction increased patient involvement in disease management and could potentially lead to improved health outcomes.

Connected drug delivery devices to complement drug treatments: potential to facilitate disease management in home setting.

Connected drug delivery devices are increasingly being developed to support patient supervision and counseling in home setting. Features may include dosing reminders, adherence trackers, tools for patient education, and patient diaries to collect patient-reported outcomes, as well as monitoring tools with interfaces between patients and health care professionals (HCPs). Five connected devices have been selected as the basis for a review of the clinical evidence concerning the impact of electronic tools on treatment adherence and efficacy outcomes. Disease areas covered include multiple sclerosis, diabetes, hypertension, liver and renal transplant recipients, tuberculosis, hepatitis C, clinically isolated syndrome, asthma, and COPD. From studies comparing the use of electronic feedback tools to standard of care, there is an initial evidence for a higher adherence to treatment and better outcomes among patients who use the electronic tools. To substantiate the assumption that connected devices can improve adherence in an outpatient setting over a prolonged period of time, further data from controlled randomized studies are required. Key barriers to the broader adoption of connected devices include data privacy laws that may prevent data sharing with HCPs in some countries, as well as the need to demonstrate that the tools are consistently used and generate a high-quality and reproducible database. If these challenges can be addressed in a way that is agreeable to all stakeholders, it is expected that the future value of connected devices will be to 1) facilitate and improve patient involvement in disease management in a flexible care setting, 2) enable early treatment decisions, and 3) complement value-based reimbursement models.

Filial piety and parental responsibility: an interpretive phenomenological study of family caregiving for a person with mental illness among Korean immigrants

BackgroundDespite the strong influence of culture on family involvement in disease management, few studies have examined how immigrant families care for persons with mental illness. The purpose of this study was to examine how immigrant families organize their world to care for a mentally ill person in the United States. The current analysis focused on how Confucian notions of filial piety and parental obligation shape caregiving in Korean immigrant families.MethodsParticipants in this interpretive phenomenological study were comprised of six Korean immigrant women caring for a family member with mental illness. Participants provided narratives that illustrate challenges and opportunities in caring for their mentally ill family member.ResultsThree family caregiving patterns were discerned. Insulating from the outside world describes a family’s effort to accept a member's illness and to manage it within the family. Prioritizing education over well-being concerns parental commitment to the Confucian priority of educating one’s children. Reciprocating the sacrifice describes how a family adapts and enacts filial piety.ConclusionThe findings of this study warrant further study to examine the influence of Confucianism among Korean American families. The three patterns of caregiving are strongly aligned with Confucian notion of family and family engagement. These patterns may help health providers to anticipate the needs of and provide individualized, culturally appropriate mental health care for patients with mental illness and their families of Korean origin.

Patient perceptions of multiple sclerosis and its treatment.

BackgroundIn order to improve the treatment outcome in multiple sclerosis, it is important to document the factors that influence adherence to therapy. The purpose of this study was to determine patient perceptions and awareness of multiple sclerosis and its treatment, treatment adherence, and impact on quality of life and daily living.MethodsThis was a cross-sectional observational study performed in France. Each participating neurologist included the first three patients with relapsing-remitting multiple sclerosis who consulted after the start of the study. Data on clinical features were collected from a physician questionnaire and on disease and treatment perception and on quality of life from a patient autoquestionnaire.ResultsA total of 175 neurologists entered 202 patients in the study. The mean duration of disease was 8.0 ± 7.0 years, and immunomodulatory treatment had been administered for a mean duration of 3.0 ± 2.0 years. A total of 166 patients (82.2%) were treated with interferon-β preparations and 36 patients (17.8%) with glatiramer acetate. Eighty-five patients (42.1%) reported missing their injections from time to time and 36 patients (17.8%) reported “drug holidays”. The most frequently given reason for nonadherence was forgetfulness (38.7% of cases). Eighty-six patients (42.6%) and 70 patients (34.7%) claimed to be well informed about their disease and treatment, respectively. Adherence was significantly higher in well informed patients (P = 0.035). The majority of patients (176 patients, 87.1%) intended continuing their current treatment and 49.5% considered that their current treatment might reduce relapses. The most frequently reported side effect was muscle pain (124 patients, 61.4%).ConclusionPatient understanding of treatment for disease enhances treatment adherence. Greater patient involvement in disease management requires better communication between physicians and their patients.

Parenting goals: Predictors of parent involvement in disease management of children with type 1 diabetes

The purpose of this study was to develop a measure of diabetes-specific parenting goals for parents of children with type 1 diabetes and to examine whether parenting goals predict a change in parenting involvement in disease management. An independent sample of primary caretakers of 87 children aged 10 to 16 years with type 1 diabetes completed the measure of parenting goals (diabetes-specific and general goals); both parent and child completed measures of parent responsibility for diabetes management at baseline and 6 months. Parents ranked diabetes-specific parenting goals as more important than general parenting goals, and rankings were moderately stable over time. Parenting goals were related to parent responsibility for diabetes management. The relative ranking of diabetes-specific parenting goals predicted changes in parent involvement over 6 months, with baseline ranking of goals predicting more parental involvement at follow-up. Parenting goals may play an important role in family management of type 1 diabetes.

‘It’s like taking poison to kill poison but I have to get better’: A qualitative study of beliefs about medicines in Rheumatoid arthritis and Systemic lupus erythematosus patients of South Asian origin

To investigate factors that influence beliefs about medicines in patients of South Asian origin with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). Qualitative methodology was used to explore the health beliefs of South Asian patients and in particular the factors that influenced their beliefs about medicines and disease modifying anti-rheumatic drugs (DMARDs). Thirty two patients with RA and SLE took part in focus group discussions. Patients who chose to participate in focus groups conducted in English were compared with those who chose to participate groups conducted in Punjabi or Urdu. Three main themes emerged to explain patients beliefs about medicines: (1) Beliefs about the necessity of DMARDs; (2) Concerns about DMARDs and other prescribed medicines including: (a) long-term side-effects; (b) the apparent lack of efficacy of some therapies; (c) concerns about changing from one drug to another and the large numbers of different medicines being taken; (3) Contextual factors which informed the patient's view on the necessity for particular medicines and concerns about them including: (a) beliefs about the causes of disease and the influence of religious beliefs on this; (b) barriers to communication with health care professionals about the medications being prescribed in clinic. In addition, our data revealed that these beliefs about DMARDs had important consequences for patient behaviour, including the use of traditional dietary and other non-pharmacological approaches. There were differences in views expressed between those who chose to speak in English and those who did not. This study has identified themes that explain previous findings of negative beliefs about medicines in patients of South Asian origin. Beliefs about the causes of disease had an important impact on the way some patients viewed medicines for RA and SLE. This will have implications for educational programmes designed to promote patient involvement in disease management.

Pulmonary Rehabilitation: A Focus on COPD in Primary Care

In 2007, the American College of Chest Physicians (ACCP) and the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) published updated guidelines on pulmonary rehabilitation (PR). For patients with chronic obstructive pulmonary disease (COPD), PR is now considered to be the standard of care for those with at least moderately severe COPD as well as those patients with COPD of mild severity (as determined by spirometry) who, following maximal medical care, remain symptom-limited in exercise capacity or functional status. The goal of PR is for the patient to become more physically active and maintain independence longer. The benefits of PR extend far beyond physical endurance and reduced dyspnea, and include improved adherence, reduced health care utilization and costs, more patient involvement in disease management, and improved patient outlook. Pulmonary rehabilitation is more than “just an exercise program;” it is a multidisciplinary, comprehensive intervention that is ideally performed in formal programs by a team of health care professionals, in partnership with the primary care physician. In reality, primary care physicians perform most of the long-term management of COPD patients and thus are left to create ad hoc PR programs in their own communities. This article outlines each of the ACCP/AACVPR recommendations for PR and provides commentary on how these recommendations apply to COPD management in primary care. A discussion of reimbursement issues and future directions for PR guidelines is also provided.

The Impact of Managing School-aged Children’s Diabetes: The Role of Child Behavior Problems and Parental Discipline Strategies

Models of diabetes management in children emphasize family relationships, particularly parent-child interactions. In adolescents, parental involvement in disease-specific management relates to better health and adherence. However, information about parental involvement in disease management for young children is limited and mixed. This study investigated behavior problems of school-aged children with Type 1 Diabetes Mellitus (T1DM) in association with parent discipline strategies and parents' perceptions of (1) time spent managing diabetes and (2) the impact their child's diabetes has on their discipline strategies. Parents of children ages 5-12 with T1DM completed standardized measures of child misbehavior, parent discipline strategies, and responded to questions regarding perceived time spent managing diabetes, and perceived impact of diabetes on ability to discipline. Results showed child mealtime misbehavior was common and associated with overreactive parental discipline. Further, overreactive discipline was also associated with reports of less time spent managing child's illness. Child misbehavior was positively associated with parents' perceived amount of time spent managing diabetes and with the impact of child diabetes on discipline. Findings suggest the importance of considering parent discipline strategies and child misbehavior when working with young children with diabetes.

Assessment of anxiety and depression in IBD adolescents

Inflammatory Bowel Disease (IBD) is a chronic disease, with typical pediatric onset. Due to its unpredictable course and “embarrassing” symptoms, IBD can have a significant impact on cognitive and psychosocial development. Further, the majority of existing studies demonstrate that there are high rates of psychiatric disorders, most commonly anxiety and depression, among IBD youth (Burke, Meyer, Kocoshis et al., 1989; Engstrom, 1992; Engstrom & Lindquist, 1991; Szajnberg, Krall, Davis, Treem, & Hyams, 1993; Szigethy et al., 2004). Prevalence rates range from 25 to 60 percent, with majority of studies reporting near 50%, and these rates may be higher compared to other chronically ill adolescents. To complicate matters, anxiety and depression are associated with significant long-term disabilities (Ialongo, Edelsohn, Werthamer-Larsson, Crockett, & Kellam, 1994, 1995), and may impact disease management and healthcare utilization (Mittermaier et al., 2004). To date, scarce research has investigated these factors, and existing research has significant methodological limitations, making this a top 5 area for research according to Crohn's and Colitis Foundation of America (2006). The present study will provide information regarding the nature of anxiety and depression (i.e., disease specific and general) for youth, ages 12-17, with IBD, as well as describe disease management, healthcare utilization, and general and social functioning. Data collection has been initiated at two New York City pediatric gastroenterology medical clinics and will include information regarding demographics, IBD illness severity, disease management, medical usage, anxiety and depressive symptoms, and psychosocial functioning across multiple relevant functional domains. Measures were also included to assess parental anxiety and depression, physician ratings of family's use of services, and parent's involvement in disease management and the child's treatment. Analyses will examine the relationship of psychopathology (child and parent) with disease management, medical usage, and quality of life. Results will be discussed in terms of their implications for treating anxiety and depression in adolescents with this chronic illness and in designing and implementing interventions for this population.

Primary care in a post-communist country 10 years later: Comparison of service profiles of Lithuanian primary care physicians in 1994 and GPs in 2004

Objectives The study aimed, firstly, to assess changes in the service profile of primary care physicians between 1994, when features of the Soviet health system prevailed, and 2004, when retraining of GPs was completed. Secondly, to compare service profiles among current GPs, taking into account their positions before being retrained. Methods A cross-sectional repeated measures study was conducted among district therapists and district pediatricians in 1994 and GPs in 2004. A questionnaire was used containing identical items on the physicians’ involvement in curative and preventive services. The response rates in both years were 87% and 73%, respectively. Results In 2004, physicians had much more office contacts with patients than in 1994. Modest progress was made with the provision of technical procedures. Involvement in disease management was also stronger in 2004 than in 1994, particularly among former pediatricians. Involvement in screening activities remained stable among former therapists and increased among former pediatricians. At present, GPs who used to be therapists provide a broader range of services than ex pediatricians. GPs from the residency programme hold an intermediate position. Conclusions Lithuanian GPs have taken up new tasks but variation can be reduced. The health care system is still in the midst of transition.

Hepatology a Dynamic Discipline Says President-elect of AASLD

Dr. Henry J. Gores, MD, is President-elect of the American Association for the Study of Liver Diseases (AASLD). The Chief of Gastroenterology and Hepatology and Professor of Medicine at the Mayo Clinic College of Medicine in Rochester, Minnesota, says hepatology is a “dynamic health discipline” with expectations for increasing involvement in disease management.

Associations of Paternal Involvement in Disease Management with Maternal and Family Outcomes in Families with Children with Chronic Illness

The role of fathers in pediatric disease management and its associations with family functioning have rarely been the focus of empirical study. In this study, we used the Dads Active Disease Support scale (DADS), a measure of the amount and helpfulness of paternal involvement in pediatric disease management, to explore the association between father involvement and other aspects of family functioning. A sample of 190 heterosexual couples completed the DADS and measures of maternal, marital, and family functioning. Maternal report of higher ratings on DADS Helpfulness scale was associated with fewer self-reported maternal psychiatric symptoms and less perceived impact of the disease on family functioning. Both mothers' and fathers' reports indicated that more paternal involvement was related to more favorable outcomes in marital satisfaction and family functioning. More paternal involvement in disease management was associated with healthier maternal, marital, and family functioning. Longitudinal studies are needed to determine whether paternal involvement is likely to be a fruitful target for psychological intervention.

Correlates of satisfaction for the relationship with their physician in type 2 diabetic patients

In the context of an Italian nation-wide outcomes research program on type 2 diabetes, we investigated the contribution of both patient and setting-related factors to patient satisfaction with their relationship with their physicians. The level of patient satisfaction was measured using the American Board of Internal Medicine (ABIM) 14 patient satisfaction questionnaire. The main results were obtained using multilevel analysis, a statistical technique that takes into account the clustered nature of our data. Overall, 3563 patients were recruited by 101 diabetologists and 103 general practitioners (GPs). Information on patients’ satisfaction was available for 2515 patients (71% of the whole sample). Patients’ satisfaction was related to patient characteristics and attitudes, but not with physician’s sex, age, speciality, and setting of care. In particular, patients who were less likely to delegate to physicians responsibility for diabetes management and those perceiving a lower degree of involvement in disease management showed lower levels of satisfaction. Lower satisfaction scores were also related to lower levels of school education, more severe clinical conditions, and lower psychological adaptation to diabetes. However, patients reporting higher levels of diabetes related worries and more frequent encounters with health care providers showed higher levels of satisfaction. In conclusion, patient satisfaction with physicians’ humanness and communication skills is strongly related to personal characteristics, attitudes, expectations, and perceived health. In deciding the best decision-making approach to adopt in individual patients, it is of primary importance to measure how the patient perceives and engages in relationships.

Psychometric properties of a new measure of fathers' involvement in the management of pediatric chronic diseases.

Despite theoretical and empirical reasons suggesting its potential importance, paternal involvement in the management of pediatric chronic diseases has rarely been a primary focus of research on family adaptation to pediatric disease. This may be due to a lack of appropriate tools to measure relevant behaviors. This study assessed the reliability and validity of the Dads' Active Disease Support scale (DADS), which was designed to measure male and female caregivers' estimates of the amount and helpfulness of paternal involvement in managing six pediatric chronic diseases. A sample of 224 heterosexual couples completed the DADS and measures of mother, child, and family functioning, yielding 190 who completed data sets. Of these, 91 mothers and 88 fathers completed the DADS again after a 1-month interval. Results confirmed DADS internal consistency, test-retest reliability, and interparent agreement. Confirmatory factor analysis supported its construct validity: A two-factor model (amount and helpfulness of fathers' involvement) best accounted for participants' responses. Significant correlations with scores on the Family Assessment Device supported DADS convergent validity. DADS scores of mothers and fathers suggest substantial room for improvement in both the amount and the helpfulness of paternal involvement in disease management. Mothers provided significantly higher ratings of the helpfulness of fathers' involvement than did fathers. The DADS appears to be a reliable and valid measure for studies of the associations between paternal involvement in disease management and child, maternal, and family adaptation to pediatric chronic medical conditions.

Attitudinal classification of patients receiving antibiotic treatment for mild respiratory tract infections

The aim of this study was to determine patients’ perceptions of antibiotic therapy and the doctor's skill in the management of ambulatory respiratory tract infections. Standardized face-to-face interviews were used with more than 3000 randomized patients or parents from four European countries. Attitudinal dimensions relating to their doctor identified four patient types: Involved (30%), Deferent (23%), Ignored (13%) and Critical (17%). Involved and Deferent patients were the most satisfied by the information received from their doctor (43%/39% compared with 17%/16% for Ignored/Critical, respectively, P<0.01). They also scored more highly on the accurate use of antibiotics, with 80%/80% vs. 38%/62%, respectively ( P<0.01), understanding dosing intervals and 77%/77% vs. 36%/60% ( P<0.01), understanding the course length. Involved and Deferent patients showed better compliant behaviour, with 91% of both groups vs. 86% of the Ignored and Critical claiming to have taken every dose ( P<0.001) and 92%/87% vs. 84%/85% claiming to have finished the course ( P<0.001 for Involved only). Involved and Deferent patients were less prone to save part of a course of antibiotics than the Ignored and Critical (46%/41% vs. 20%/31%, P<0.001), and they perceived the antibiotics prescribed to be more effective (36%/31% vs. 21%/15%, P<0.001). By analysing patient perceptions, this study identifies an important mirror effect, whereby a more sympathetic attitude from the doctor should increase the patient's involvement in disease management, for a more appropriate use of antibiotics in common infections.