Patient-centered Care Approach Research Articles

A perspective on nonadherence to drug therapy: psychological barriers and strategies to overcome nonadherence.

Medication adherence represents an inefficiency and ongoing challenge within medical care. The problem has been long-recognized – indeed, the research literature contains thousands of articles on the topic. Nonetheless, because of the complex nature of the problem, it still cannot be considered to be solved. Reasons for nonadherence are myriad but psychological barriers to adherence are most difficult to mitigate and, thus, are the focus of this paper. The present narrative review sketches a summary of theoretical models commonly utilized to understand and help address medication nonadherence; uses a patient-centered care approach to contextualize the problem of nonadherence to drug therapies; and then outlines a set of best-practice recommendations based on the extant data and framed from the perspective of the Information-Motivation-Strategy model.

Patient education and health literacy

IntroductionPatient education is a relatively new science within the field of health care. In the past it consisted mainly of the transfer of knowledge and mostly biomedically based advice. Research has shown this to not be effective and sometimes counterproductive. As health care has moved away from applying a traditional paternalistic approach of ‘doctor knows best’ to a patient-centred care approach, patient education must be tailored to meet persons' individual needs. PurposeThe purpose of this master paper is to increase awareness of patients' health literacy levels. Health literacy is linked to literacy and entails people's knowledge, motivation and competences to access, understand, appraise and apply health information in order to make judgements and take decisions in everyday life concerning health care, disease prevention and health promotion to maintain or improve quality of life during the life course. Many patients have low health literacy skills, and have difficulty with reading, writing, numeracy, communication, and, increasingly, the use of electronic technology, which impede access to and understanding of health care information. ImplicationsMultiple professional organizations recommend using universal health literacy precautions to provide understandable and accessible information to all patients, regardless of their literacy or education levels. This includes avoiding medical jargon, breaking down information or instructions into small concrete steps, limiting the focus of a visit to three key points or tasks, and assessing for comprehension by using the teach back cycle. Printed information should be written at or below sixth-grade reading level. Visual aids can enhance patient understanding.

What are the effective elements in patient-centered and multimorbidity care? A scoping review

BackgroundInterventions to improve patient-centered care for persons with multimorbidity are in constant growth. To date, the emphasis has been on two separate kinds of interventions, those based on a patient-centered care approach with persons with chronic disease and the other ones created specifically for persons with multimorbidity. Their effectiveness in primary healthcare is well documented. Currently, none of these interventions have synthesized a patient-centered care approach for care for multimorbidity. The objective of this project is to determine the particular elements of patient-centered interventions and interventions for persons with multimorbidity that are associated with positive health-related outcomes for patients.MethodA scoping review was conducted as the method supports the rapid mapping of the key concepts underpinning a research area and the main sources and types of evidence available. A five-stage approach was adopted: (1) identifying the research question; (2) identifying relevant studies; (3) selecting studies; (4) charting the data; and (5) collating, summarizing and reporting results. We searched for interventions for persons with multimorbidity or patient-centered care in primary care. Relevant studies were identified in four systematic reviews (Smith et al. (2012;2016), De Bruin et al. (2012), and Dwamena et al. (2012)). Inductive analysis was performed.ResultsFour systematic reviews and 98 original studies were reviewed and analysed. Elements of interventions can be grouped into three main types and clustered into seven categories of interventions: 1) Supporting decision process and evidence-based practice; 2) Providing patient-centered approaches; 3) Supporting patient self-management; 4) Providing case/care management; 5) Enhancing interdisciplinary team approach; 6) Developing training for healthcare providers; and 7) Integrating information technology. Providing patient-oriented approaches, self-management support interventions and developing training for healthcare providers were the most frequent categories of interventions with the potential to result in positive impact for patients with chronic diseases.ConclusionThis scoping review provides evidence for the adaption of patient-centered interventions for patients with multimorbidity. Findings from this scoping review will inform the development of a toolkit to assist chronic disease prevention and management programs in reorienting patient care.

Asian consensus on assessment and management of mild to moderate plaque psoriasis with topical therapy.

A working group of dermatologists in Asian countries assessed the current status of psoriatic management in the region to prepare a consensus report on topical treatment in mild to moderate plaque psoriasis. Even though the association of psoriasis with systemic comorbidities is increasingly acknowledged, psoriasis is still lower in health‐care priority lists in the region. The psychosocial impact of psoriasis may be greater in Asian countries due to cultural norms and social discrimination. Non‐adherence to treatment is also common among Asians. The current care given to patients with mild to moderate psoriasis needs to be streamlined, enhanced and organized with a patient‐centered care approach to achieve better outcomes. A comprehensive assessment of the disease severity and its impact on a patient's life is required before initiating treatment. Education and active involvement of the patient in the treatment plan is an important part of psoriatic management. It is recommended to personalize topical treatment to meet the needs of the patient, depending on disease severity, psychosocial impact, the patient's expectations and, more importantly, the patient's willingness and ability to actively follow the treatment procedure. Fixed‐dose combination of corticosteroid and vitamin D analogs is the preferred topical medication for both initial and maintenance phases of treatment. The fast containment of the disease is the goal of the initial phase of 4–8 weeks and it demands a potent fast‐acting topical therapy. Satisfactory control of the disease and prevention of relapses should be achieved during the maintenance phase with twice a week or weekend applications.

On caring and sharing–Addressing psychological, biographical, and spiritual aspects in integrative cancer care: A qualitative interview study on physicians’ perspectives

BackgroundPatients confronted with a cancer diagnosis experience a variety of existential needs encompassing emotional, psychological, and spiritual areas of being. A patient-centered care approach addressing such existential issues is recognized as an essential aspect of health care. The aim of this study is to explore what role psychological, biographical, and spiritual factors play for experienced doctors working in integrative cancer care. MethodThe qualitative study was based on in-depth interviews with 35 purposively sampled doctors, all practicing integrative oncology in the field of anthroposophic medicine in hospitals and/or office-based practices in Germany and other countries. Data were analyzed using structured content analysis. ResultsPsychological, biographical, and spiritual factors are important issues in integrative cancer care. Prevailing themes identified in this study were enabling patients to participate in life, promoting autonomy and coping, stabilizing patients emotionally and cognitively, overcoming the disease, and–primarily if addressed by patients–integrating spiritual issues. Doctors offered conversation, counseling, and time, but also referred to art, music, literature, and nature, so that patients’ ongoing emotional, psychological, and spiritual needs could be explored and addressed. Doctors’ attitudes with regard to existential issues were seen as important, as was maintaining an attitude of openness towards existential issues. ConclusionDoctors in integrative cancer care utilize different methods to explore the needs of patients and employ a variety of treatment methods that address not just patients’ medical issues but their existential concerns as well.

Patient centred medical home (PCMH) and patient-practitioner orientation: Is there a relationship?

The patient-centred medical home (PCMH) and utilisation of a patient-centred care approach have been promoted as opportunities to improve healthcare quality while controlling expenditures. To determine the penetration of PCMH within physician practices, and to evaluate physician attitudes towards patient-practitioner orientation. The ultimate objective was to explore relationships between the patient-practitioner orientation of respondents and the presence of PCMH elements within their practice. A survey instrument was developed following a comprehensive literature review. Lead physicians practicing in four states were surveyed. The adjusted response rate was 26.7%. Responses indicated increased utilisation of PCMH elements (electronic medical records, e-mail and telephone consultations, and physician performance monitoring and feedback) compared with previous research. Within a logistic regression model, medical school graduation year (1990 or later >prior to 1990), practice size (group >solo), and percentage of time allocated to patient care (less >more) were significant predictors of working in a high PCMH alignment setting. Physician and practice characteristics did not predict the level of patient-practitioner orientation, though rural physicians were more patient-centred than urban physicians. A non-linear correlation between patient-practitioner orientation and the likelihood of practicing in a low or high PCMH-aligned practice was observed. There is a non-linear correlation between patient-practitioner orientation and the likelihood of a physician practicing in a low or high PCMH-aligned practice. The ability of a physician to work in a PCMH setting or practicing patient-centred care can go beyond a physician's aspirations to work and practice in that manner.

An integrative review exploring the perceptions of patients and healthcare professionals towards patient involvement in promoting hand hygiene compliance in the hospital setting.

To review patients' and healthcare professionals' perceptions of patient involvement in promoting hand hygiene compliance in the hospital setting. Initiatives continue to emphasise the importance of involving patients in their safety at the point of care. A patient-centred care approach aimed to empower patients to become active members of the healthcare team. However, understanding the perceptions of patients and healthcare professionals of patient involvement in promoting hand hygiene compliance among healthcare professionals has yet to be fully explored. Integrative literature review. A five-stage review process informed by Whittemore and Knafl's methodology was conducted. MEDLINE and CINAHL were searched for papers published between January 2009-July 2017. Data were extracted manually, organised using NVivo 11 and analysed using thematic analysis. From an identified 240 papers, 19 papers were included in this review. Thematic analysis revealed two main themes with three related subthemes. Patients were willing to remind healthcare professionals (especially nurses) to wash their hands, healthcare professionals perception towards patients' involvement varied from one study to another. However, an overall positive attitude towards patient involvement was related to how patients asked and how healthcare professionals responded to being asked. There is limited evidence regarding patients' actual intention to ask healthcare professionals to wash their hands, and some evidence that patients are reluctant to do so. Further research is required to understand this area thoroughly, including which situations patients would feel more empowered to speak up. Simple messages promoting patient involvement may lead to complex reactions in both patients and healthcare professionals. It is unclear, yet how patients and staff react to such messages in clinical practice. There is a need for a deeper understanding of how they can work together to support harm free care.

Development of an Epilepsy Nursing Communication Tool: Improving the Quality of Interactions Between Nurses and Patients With Seizures.

ABSTRACTBackground: Nurses have become increasingly involved in overseeing the management of patients with complex medical conditions, including those with epilepsy. Nurses who are not specialists in epilepsy can play a central role in providing optimal care, education, and support to their patients with epilepsy, given the proper tools. Objective: Our objective was to create a tool that can be used by nurses in the clinic setting to help facilitate discussion of topics relevant to enhancing medical care and management of patients with epilepsy. To address this need, a panel of epilepsy nursing experts used a patient-centered care approach to develop an Epilepsy Nursing Communication Tool (ENCT). Methods: An initial set of topics and questions was created based on findings from a literature review. Eight nurse experts reviewed and revised the ENCT using focus groups and discussion forums. The revised ENCT was provided to nurses who care for patients with epilepsy but had not been involved in ENCT development. Nurses were asked to rate the usability and feasibility on a 5-point scale to assess whether the tool captured important topics and was easy to use. Results: Ten nurses provided usability and feasibility assessments. Results indicated strong tool utility, with median scores of 4.5, 4, and 4 for usefulness, ease of use, and acceptability, respectively. Conclusions: The preliminary ENCT shows promise in providing a tool that nurses can use in their interactions with patients with epilepsy to help address the complexity of disease management, which may help improve overall patient care.

British Columbia Ministry of Health Patients as Partners: A transformational approach.

Patients as Partners is a quality improvement initiative of the British Columbia Ministry of Health (the Ministry) that aims to bring patient voice, choice, and representation to the forefront of healthcare through collaboration with patients, families, non-governmental organizations, funded partners, regional health authorities, and healthcare providers. A spectrum of patient engagement activities, including capacity building and self-management support, occur through partnerships at the individual patient and provider, community, and system levels. These activities ensure patient priorities are identified and embed a patient-centred care approach into provincial policies and projects. Multi-/interdisciplinary collaborations in the healthcare sector occur through participation in working groups, advisory committees, and engagement events. Ongoing improvements include enhancing measurement strategies and leveraging opportunities around gaps. The Ministry was honoured with the International Association of Public Participation Award as the 2016 Canadian Organization of the Year in recognition of improving healthcare through patient and public education.

Employing the patient-centered collaborative care approach: a case study of complex geriatric patient with psychopathalogy of treatment resistant depression and primary hyperparathyroidism.

Introduction: Primary hyperparathyroidism is a relatively common endocrine disease with many nonspecific physical symptoms as well as potentially serious psychiatric effects. The incidence of the illness, severity of symptoms, and poorer outcomes are all positively correlated with increasing patient age. The Patient Centered Collaborative Care Approach is a demonstrable method of coordinating patient care, reducing the burden on patient advocates, and improving patient outcomes. The use of the Patient Centered Collaborative Care Approach has not previously been well described in treatment of psychiatric manifestations of primary hyperparathyroidism. Methods: Using the example of an elderly woman admitted with complex psychopathology and a diagnosis of primary hyperparathyroidism, this case will illustrate the value of the Patient-Centered Collaborative Care Approach in (1) establishing accurate diagnoses, (2) reducing harm from comorbidities, (3) improving patient outcomes, (4) potentially reducing overall hospital costs. Results: The case exemplifies the potential benefits of implementing the Patient-Centered Collaborative Care Approach in the treatment of a medically complex patient hospitalized for psychiatric complaints. Conclusion: A diagnosis of Primary hyperparathyroidism (PHPT) was not immediately made due to variables confounding initial lab values to include significant dehydration and malnourishment prior to admission. A multidisciplinary team was employed in the treatment for this patient utilizing the Patient centered Collaborative Care Approach. This included the psychiatric treatment team, internal medicine, endocrine surgery, as well as significant family involvement. Parathyroid adenoma was confirmed mass was successfully removed surgically. The patient made a rapid and dramatic improvement and her depressive symptoms remitted. The critical importance of clinical flexibility, questioning available data, and a collaborative team approach to the evolution of a diagnosis is discussed.

The Good and the Bad About the 2017 American College of Physicians Osteoporosis Guidelines

PurposeThe American College of Physicians (ACP) published a set of guidelines on how to prevent fractures in men and women with low bone density or osteoporosis. As the population ages, the overall risk of fractures increases, thus burdening the health care system. These guidelines review current evidence for osteoporosis management, providing an update to the previous 2008 ACP’s guidelines. MethodsThe ACP put forth 6 recommendations addressing the complexities in osteoporosis management based on evidence available through October 2016 with a focus on bisphosphonates, calcium, vitamin D, and estrogen. Evidence was graded according to recommended strength by using the ACP standard methods. FindingsThe ACP recommends anti-osteoporosis therapy with 1 of 3 bisphosphonates (alendronate, risedronate, or zoledronic acid) or denosumab in patients with osteoporosis, while excluding anabolic therapies, and recommends against raloxifene. Although bisphosphonates are the mainstay of treatment, anabolic therapy and raloxifene may be used in specific situations. Pharmacologic therapy is recommended for 5 years, oversimplifying length of therapy and failing to promote an individualized patient-centered care approach. Moreover, abrupt discontinuation of denosumab is associated with a decline in bone mineral density (BMD), which must be addressed. Routine monitoring of BMD by dual x-ray absorptiometry is not endorsed during treatment, which leads to underrecognition of management issues. Pharmacologic treatment with bisphosphonates for male osteoporosis is recommended, although therapies such as denosumab and teriparatide are excluded. Finally, the ACP recommends treatment for women aged ≥65 years at high risk for fracture with osteopenia after a discussion of patient preferences, fracture risk profile, and medications. ImplicationsOsteoporosis management is complex. The 2017 ACP guidelines address challenges faced by clinicians but oversimplify more complex issues. These are among a number of guidelines that are available for osteoporosis management, which may be used in combination with other sources to assist clinicians with diagnostic and management strategies.

Practical Approaches to Diagnosing, Treating and Preventing Hypoglycemia in Diabetes.

Hypoglycemia in individuals with diabetes can increase the risk of morbidity and all-cause mortality in this patient group, particularly in the context of cardiovascular impairment, and can significantly decrease the quality of life. Hypoglycemia can present one of the most difficult aspects of diabetes management from both a patient and healthcare provider perspective. Strategies used to reduce the risk of hypoglycemia include individualizing glucose targets, selecting the appropriate medication, modifying diet and lifestyle and applying diabetes technology. Using a patient-centered care approach, the provider should work in partnership with the patient and family to prevent hypoglycemia through evidence-based management of the disease and appropriate education.

Perspectives of patients, close relatives, nurses, and physicians on end-of-life medication management

We conducted an empirical multicenter study with a qualitative approach, including in-depth interviews with patients, relatives, nurses, specialists, and general practitioners (GPs). We used the constant comparative method and ATLAS.ti (v. 7.1) software for our analysis. Saturation occurred after 18 patient cases (76 interviews). Some 5 themes covering 18 categories were identified: (1) priorities in end-of-life care, such as symptom management and maintaining hope; (2) appropriate medication use, with attention to unnecessary medication and deprescription barriers; (3) roles in decision making, including physicians in the lead, relatives' advocacy, and pharmacists as suppliers; (4) organization and communication (e.g., transparency of tasks and end-of-life conversations); and (5) prerequisites about professional competence, accessibility and quality of medical records, and financial awareness. Patients, relatives, nurses, specialists, and GPs varied in their opinions about these themes. This study adds to our in-depth understanding of the complex practice of end-of-life medication management. It provides knowledge about the diversity of the perspectives of patients, close relatives, nurses, and physicians regarding beliefs, attitudes, knowledge, skills, behavior, work setting, the health system, and cultural factors related to the matter. Our results might help to draw an interdisciplinary end-of-life medication management guide aimed at stimulating a multidisciplinary and patient-centered pharmacotherapeutic care approach.

Racial centrality may be linked to mistrust in healthcare institutions for African Americans.

Evidence suggests that racial identity is an important component to African Americans' self-concepts and therefore may be relevant to patients' trust in healthcare, yet little is known as to how racial identity may influence trust or mistrust. African American adults (N = 220) in the greater Portland, Oregon, area provided survey reports of healthcare-related attitudes and experiences. Those who reported higher racial centrality had lower trust in healthcare institutions. Based on these findings, clinicians employing patient-centered care approaches should recognize racial identity as an important component to patients' experiences when they seek to deliver equitable care to African American patients.

Modelo de prescripción centrado en la persona para mejorar la adecuación y adherencia terapéutica en los pacientes con multimorbilidad

Patients with multiple disorders and on multiple medication are often associated with clinical complexity, defined as a situation of uncertainty conditioned by difficulties in establishing a situational diagnosis and decision-making.The patient-centred care approach in this population group seems to be one of the best therapeutic options. In this context, the preparation of an individualised therapeutic plan is the most relevant practical element, where the pharmacological plan maintains an important role.There has recently been a significant increase in knowledge in the area of adequacy of prescription and adherence. In this context, we must find a model must be found that incorporates this knowledge into clinical practice by the professionals.Person-centred prescription is a medication review model that includes different strategies in a single intervention. It is performed by a multidisciplinary team, and allows them to adapt the pharmacological plan of patients with clinical complexity.

Improving Patient Engagement and Satisfaction: Lessons from a Patient-Driven Care Initiative in a Community-Based Hospital.

Lack of collaboration and alignment between members of the healthcare team interfere with the patient-centred care approach. The Patient-Driven Care Project was initiated in 2012. This model sought to advance a system of care that is patient-driven, family-centred and provider-guided to improve the value to patients and give them more control on their health journey. The evaluation revealed that the efforts should focus on sustainability and continuation of support and encouragement of hospital colleagues to ensure each patient and family experience is based on caring communication at every interaction with them.

The Columbia-Bronx VA amalgamative clerkship: an effective, 12-week, integrated, longitudinal clinical experience

ABSTRACTBackground: Many medical schools have adopted the longitudinal integrated clerkship (LIC) model in response to calls for increased continuity in clinical learning environments. However, because of implementation challenges, such programs are not feasible at some institutions or are limited to a small number of students.Objective: In January 2014, Columbia University College of Physicians and Surgeons (P&S) recognized the need to explore different LIC formats and began offering four, 12-week amalgamative clerkships (AC). Students within this curricular track experienced primary care, internal medicine ‘away’, orthopedic surgery, urology, and an elective in an integrated format.Design: P&S developed the AC in partnership with the James J. Peters VA Medical Center in Bronx, NY (BVA). All patient care and educational conferences took place at the BVA during the 12-week experience. The learning objectives of the AC were aligned to the learning objectives of a 52-week LIC also offered at Columbia. An evaluation process was developed to determine student learning experiences and preliminary outcomes, including how well the LIC-related objectives could be achieved in a shorter period of time.Results: In 2015, P&S collected AC evaluation data through three student feedback sessions. Students reported that the AC provided opportunity for patient continuity, patient-centered care approaches, meaningful roles for students, career development opportunities, and health systems awareness.Conclusions: Early outcomes indicate that the BVA AC provides a degree of longitudinality that can influence student perceptions of patient care, career development, and health systems, consistent with the larger LIC. The team continues to gather additional data on students’ experiences and investigate additional sites that have potential to serve as future AC learning environments.

Integrated and patient-centered care for people with multimorbidity: insights from European practices

Introduction: Integrated and patient-centered care is considered an effective response to the needs of people who suffer from multiple chronic conditions. People with multimorbidity often need care from multiple healthcare providers and various disciplines. A better coordination and integration of this care would improve its quality. Additionally, a patient-centered care approach would improve the quality of care for people with multimoribidty. Patient-centered care is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions. In practice this means that the patients’ personal health goals should be the starting point when deciding on care and treatment options. This is especially important for people who suffer from multiple chronic conditions, because outcomes of disease specific treatments might not always be feasible due to the many health problems. Besides patients’ personal health goals, their preferences for treatment options and their resources should be taken into account when deciding on the type(s) of treatment or care. However, providing patient-centered care may not be easily realized in daily practice, as it requires specific skills of healthcare providers, and characteristics of the delivery system may be hindering. In the project Innovating care for people with multiple chronic conditions in Europe (ICARE4EU), we explored how patient-centeredness is currently given shape in innovative European integrated care initiatives for people with multimorbidity.Methods: In 2014, the ICARE4EU project selected 101 innovative integrated care practices (referred to as programmes) in 31 European countries. These programmes were collected via country experts and the selection of programmes was based on pre-defined criteria. Via questionnaires, the programme managers provided details about the characteristics of the selected programmes, including characteristics related to patient-centeredness. Eight of the programmes were considered very innovative based on the questionnaire and were therefore visited by two ICARE4EU project partners.Results: Almost all managers of the 101 integrated care programmes reported that the programme improved patient-centeredness (92%), but there was a wide variety in the tools that were used for this purpose. For instance, motivational interviewing by care providers was applied in 52 practices. Furthermore, case managers were appointed in 41 practices. In 70 practices individual care plans were introduced, but implementation of such plans was often lower than intended. In almost half of the selected innovative care programmes, the involvement of informal carers was described as an objective. Informal carers are addressed by as co-client in 17 programmes and as co-care provider in 27 programmes. Reported barriers to provide more patient-centered care were e.g. inadequate knowledge of patients (61%), lack of time (56%), inadequate knowledge or skills of care providers (45%) and lack of a clear vision of managers (40%). To illustrate successful approaches as well as their barriers, specific programmes will be discussed in more detail, including the Finnish POTKU project.Discussion: A positive attitude of healthcare providers is key, but not sufficient to provide care that is really patient-centered. Structural changes are needed in all domains, e.g. training, care delivery, information systems and financing. The involvement of informal carers as co-client and co-carer seems not generally applied yet in current European integrated care programmes. A limitation of our study is that not all of the selected integrated care programmes were visited. Therefore, practices could deviate from what was described in the questionnaire. Furthermore, we found that the effects of the selected innovative programmes were often not evaluated. A suggestion for future research is therefore to evaluate the effects of current innovative practices on for instance quality and efficiency of care.Conclusion: Based on observations from the ICARE4EU project, it can be concluded that efforts are being undertaken in many European countries, directed at improving the quality of care for people with multimorbidity by incorporating elements of patient-centeredness. Certain elements of patient-centered care, such as the involvement of patients in shared-goal setting, the involvement of informal carers and the use of care plans are not generally applied yet.

Effect of a Person‐Centered Course on the Empathic Ability of Dental Students

Person-centered or patient-centered care (PCC) focuses on the individual's needs and concerns. Although PCC is widely acknowledged as a core value of modern medicine, there has been a lack of research on how dental curricula could engage future dentists in PCC approaches. The aim of this study was to assess the impact of a PCC course on empathy in dental students. A controlled study was conducted with fourth-year dental students in four dental faculties in France in 2014-15. The test group (n=63) received 20 hours of PCC training including arts-based approaches, narrative dentistry activities, and workshops on communication based on the Calgary-Cambridge guide. There was no change in the curriculum of the control group (n=217). Pretest and posttest measures with the Toronto Empathy Questionnaire (TEQ) and Jefferson Scale of Physician Empathy (JSPE) were compared for the two groups. The comparisons showed no significant differences on the TEQ or JSPE (p=0.25 and p=0.08, respectively). However, there was a higher proportion of students with more than an eight-point decrease in TEQ values in the control group (p=0.02). The stabilization of empathic ability in the test group may have counteracted the tendency for natural erosion of empathy among students during their clinical activities. These results suggest that PCC training constitutes a promising approach to developing dental students' empathic ability, but there is a need to assess the effects of such training over longer periods.

Teamwork – a way to improve patient perceptions of the quality of care in an emergency department: an intervention study with follow-up

Rationale, aims and objectives: Targeted interventions are suggested for improving patient perceptions of the emergency care they have received. However, organizational changes are another way of addressing these issues. Structured evaluation of such changes is warranted. The overall aim was to investigate how organizational changes aimed to support multi-professional teamwork in the emergency department (ED) could affect patients’ perceptions of the quality of care.Method: The introduction of multi-professional teamwork in an emergency department at a Swedish university hospital was evaluated using an intervention study design. Weeks with standard procedure were interchanged with and compared to, intervention weeks over a 4-week period and follow-up after 1.5 years. In total, 203 patients completed the questionnaire “Quality from the Patient’s Perspective (QPP)”. Results: Of 4 dimensions, 3 (medical-technical, identity-oriented approach and socio-cultural atmosphere) showed increasing improvements from the control phase to follow-up. Seven of 22 items concerning quality of care in the emergency department improved significantly from baseline to intervention and to follow-up. The number of areas in need of improvement was dramatically reduced in the intervention phase compared to the control phase and overall the results were sustained 1.5 years later. Significant differences between the study phases in patient perceptions of waiting time were also noted.Conclusion: Multi-professional teamwork has previously been related to improved patient safety and lead time efficiency. Findings show that it may also be related to improvements in patients’ perceptions of quality of care in the emergency department. Emphasizing this relationship may enhance the patient-centered care approach of emergency departments.