Poor Doctor-patient Relationship Research Articles

Relationship between sexual dysfunction and burnout among physicians in primary hospital: a cross-sectional study.

The relationship between sexual dysfunction and burnout among physicians remains unclear. To investigate the frequency of sexual dysfunction among physicians in primary hospital and explore the association between sexual dysfunction and burnout. This study was a cross-sectional survey conducted through a questionnaire. We used the Arizona Sexual Experience Scale and the Chinese version of the Maslach Burnout Inventory-Human Service Survey to assess sexual function and burnout among physicians in primary hospital. Considering the working environment of physicians, we also evaluated the doctor-patient relationship and sleep quality. Over one-third of physicians experience sexual dysfunction. Burnout is a significant factor to sexual dysfunction among medical professionals. A total of 382 doctors participated in this survey, and the prevalence of sexual dysfunction was 33.51%. Sexual arousal and orgasm were the main sexual dysfunctions faced by male and female doctors, respectively. The prevalence of burnout among physicians was 43.72%. The prevalence of sexual dysfunction among physicians experiencing burnout (45.51%) was higher than that observed in physicians without burnout (24.19%). Physicians with burnout exhibited significantly higher total and individual scores on the Arizona Sexual Experience Scale as compared with physicians without burnout (all P values <.05). There was a significant positive correlation between depersonalization and sexual drive (r = 0.508, P < .001), sexual arousal (r = 0.521, P < .001), lubrication (r = 0.432, P < .001), orgasm/erection (r = 0.420, P < .001), and sexual satisfaction (r = 0.434, P < .001). Logistic regression analysis confirmed that-in addition to burnout-older age, dissatisfaction with income, a poor doctor-patient relationship, and poor sleep were significant contributors to sexual dysfunction among physicians in primary hospitals. Sexual health is an integral aspect of well-being. Prioritizing the sexual health of medical professionals can significantly contribute to improving their productivity. First, our sample size was small, and the impact of different specialties on sexual functioning was somewhat overlooked. Second, we lacked laboratory data (eg, testosterone and prolactin levels) that could provide substantial support to sexual identification. Finally, although we used logistic regression to establish causality, the relationship between sexual dysfunction and certain factors may be bidirectional. The issue of sexual dysfunction among doctors needs more attention. We should make targeted efforts to improve the quality of physicians' sexual lives.

Clinical relevance of nocebo effects in anesthesia practice: a narrative review

Background: Anesthesia practice has traditionally focused on technical skills and medical knowledge, but the importance of effective doctor-patient communication and patient-centered care is increasingly recognized. In this context, the nocebo effect is an important concept to be aware of as it can be associated with negative outcomes. Objective: This review summarizes the neurobiological and psychological factors underlying the formation of nocebo effects. Additionally, the implications of nocebo effects in clinical practice will be explored. Finally, we will provide a brief overview of communication concepts relevant to the physician-patient relationship that can help minimize nocebo effects and serve as a useful guide for anesthetists to improve their communication skills and provide better care to their patients. Methods: PubMed, Ovid and Cochrane library were searched using keywords related to “nocebo effect”, “anesthesia” and “communication”. In addition, we added articles found in references of identified articles relevant for our research. Results: Nocebo effects can arise from a variety of factors, including negative expectations, negative wording and suggestions, and a poor doctor-patient relationship. While nocebo effects can deteriorate health outcomes, appropriate verbal and non-verbal communication can improve patient satisfaction and subsequently health outcomes. Conclusion: In recent years, there has been an increasing recognition of the importance of doctor-patient communication in anesthesia practice. Communication strategies such as active listening, empathy, and positive language should be incorporated into anesthesia training programs. More research is needed to fully understand the impact of the nocebo effect on health outcomes and to develop effective strategies to mitigate its negative effects.

Exploring barriers and facilitators of primary care physicians towards optimising statin therapy in patients with hyperlipidaemia in the very high-risk group: a qualitative study in Singapore

ObjectivesTo explore the perspectives of primary care physicians with regard to the barriers and facilitators towards optimising statin therapy in patients with hyperlipidaemia in the very high-risk group.DesignQualitative descriptive study.SettingFour...

The Non-Adherence To Iron Chelation Therapy (ICT) Among Transfusion Dependent Thalassemia (TDT) Patients In Pakistan.

Madam, Thalassemia is an inherited blood disorder caused by ineffective erythropoiesis. Worldwide, it is among the most common genetic disorders. In Pakistan, around 5000 babies are born with this deadly disease every year.¹ Besides stem cell transplant the regular blood transfusion is the only treatment for thalassemia major. As one pint of blood contains 200-250 mg of iron, these transfusions ultimately lead to iron overload in the body. Consequently, excessive iron deposits in the internal organs such as the liver, heart, and endocrine organs.2 To forestall iron overload in TDT patients, ICT is mandatory. Currently, three drugs are recommended, deferoxamine, deferiprone, and deferasirox.3 Although these drugs are vital for iron excretion, it has been reported that 3-8 people out of 10 are non-compliant with these drugs.4 Besides social, economic, and behavioral factors, patient-related, medication-related, and socio-cultural barriers play vital roles in management through ICT. According to a survey conducted in Malaysia by Chong CC et.al, patients reported several factors affecting their compliance with ICT. Nescience, among patients regarding the application of intravenous chelators makes them reliant on paramedics. Furthermore, emotional stress due to this everlasting disorder drains them. Medication-related barriers include adverse drug reactions such as vomiting, burning skin sensation, dizziness and fear and discomfort among pediatric patients owing to intravenous infusing chelator. The poor doctor-patient relationship results in patient's negligence towards treatment.5 Poverty beingis a significant issue in Pakistan, has many negative impacts on the health system of its population, limiting access to medications. Considering the hazardous situation, effective approaches should be made on the national and personal levels. Enlightening patients to understand the treatment regimen and its advantages could be an integral approach. workshops, counseling sessions, and awareness campaigns must be put into place to educate the population. A social media approach will help provide the basic knowledge and preventive measures to the public. Government must ensure that patients are provided with essential medication and proper treatment. Actions including cost reduction of the medications, counseling session arrangements, and funding of TDT patients are required to reduce the burden of these patients. By adopting a multidisciplinary approach NGOs can play a vital role in fundraising and awareness through their drives and campaigns.

Development and validation of a medication non-adherence scale for Malaysian hypertensive patients: a mixed-methods study.

Non-adherence to anti-hypertensive medications can lead to hypertension-related complications. One of the most effective preventive measures to mitigate these complications is to understand the underlying determinants of medication non-adherence using various scales. Unfortunately, existing scales for measuring non-adherence to anti-hypertensive medications have certain limitations, such as insufficient consideration of validity, dimensionality, and cultural adaptation. In response, the current study aimed to develop and validate a measure of non-adherence to anti-hypertensive medications-known as the Malaysian Anti-hypertensive Agent Non-Adherence Scale (MAANS)-for use in local hypertensive patients. A two-phase mixed-methods approach was used. Phase 1 involved qualitative interviews with hypertensive patients from two health clinics in Kuala Lumpur, Malaysia. The themes extracted from these interviews were used to generate items for the MAANS. In Phase 2, data from 213 participants were analysed using exploratory factor analysis (EFA) to establish the scale's factor structure, thereby created the modified version of the MAANS. Confirmatory factor analysis (CFA) was then conducted on a separate dataset of 205 participants to confirm the factor structure, resulted in the final version of the MAANS. The reliability of the final MAANS version was assessed using Cronbach's alpha coefficient. The MAANS scores were used to predict subscales of the Malay version of the WHO Quality-of-Life (QOL) BREF, demonstrating the scale's predictive validity. Ten qualitative interviews yielded 73 items. The EFA produced a modified MAANS with 21 items grouped into five factors. However, the CFA retained three factors in the final scale: Perceived Non-Susceptibility, Poor Doctor-Patient Relationship, and Unhealthy Lifestyle. The final 14-item, 3-factor MAANS demonstrated moderate reliability (Cronbach's alpha coefficient = 0.64) and exhibited partial predictive validity, with the Poor Doctor-Patient Relationship and Unhealthy Lifestyle subscales significantly predicting Social QOL and Environmental QOL. The MAANS is a reliable, valid, and multidimensional scale specifically developed to evaluate non-adherence to anti-hypertensive medications in local clinical settings with the potential to further the advancement of research and practice in sociomedical and preventive medicine.

A MODEL FOR PREDICTION OF DRUG RESISTANT TUBERCULOSIS USING DATA MINING TECHNIQUE

The rate of mortality in the recent time because of tuberculosis disease is so alarming. Drug-Resistant Tuberculosis is a communicable disease very dangerous that attack lungs, many victims were not identified due to weak health systems facilities, poor doctor-patient relationship, and inefficient mechanisms for predicting of the disease. Data mining can be applied on medical data to foresee novel, useful and potential knowledge that can save a life, reduce treatment cost, increases diagnostic and prediction accuracy as well as delay taking during prediction which reduce the treatment cost of a patience. Several data mining technique such as classification, clustering, regression, and association rule were used to enhance the prediction of tuberculosis. In this project I used Naïve Bayes Classifier to design a model for predicting tuberculosis. I considered the following parameters; Gender, Chills, Fever, Night sweat, Fatigue, Cough with Blood, Weight loss, and Loss of Appetite for classification phase 1. While Gender Chest Pain, Sputum, Contact DR, Weight Loss, In-adequate treatment for classification phase 2 as the clinical symptom. The Naïve Bayes Classifier has the advantage of attribute independency, it is easy in construction, can classify categorical data, and can work on high dimensional data effectively. The model designed using Naïve Bayes Classifier is divided o into classification phase 1 and classification phase 2 and implemented using Phython 3.2 Programing Language. The result shows that Naïve Bayes Classfier was suitable in predicting drug resistant tuberculosis with performance accuracy of 82%, 98% and area under curve (AUC) is 88%.&#x0D; Keywords: Model Prediction, Tuberculosis. Drug, Resistant, Data Mining.

Plastic surgery professional misconduct: a cross-sectional study on cases between 2008 and 2017, filed before the São Paulo State Medical Board.

In plastic surgery, a lack of ethical and moral behavior by professionals can result in unfortunate circumstances and can justify ethical-disciplinary procedures. To review 421 plastic surgery professional-misconduct cases filed before the São Paulo State Medical Board (CREMESP) between 2008 and 2017. Cross-sectional study conducted in a medical council. The cases were categorized according to sex, age, medical specialty (plastic surgery, other field or none), medical ethics code chapter(s) involved, ethics code articles violated and board ruling/outcome. Most of the defendants were men over 40 years of age who were experienced in their professional practice and who graduated from public and private universities all over Brazil; 47.74% had a specialist title in plastic surgery. Violation of professional responsibility (medical malpractice, recklessness or negligence) was the commonest complaint (28.43%), followed by medical advertising (24.19%) and poor doctor-patient relationship (10.39%), in violation of articles 18, 51, 75 and 1. Among the 233 cases adjudicated over this period, 133 resulted in disciplinary sanction, 80 were ruled in the physician's favor and 20 were dismissed. Classification of plastic surgery professional-misconduct cases creates possibilities for adopting preventive measures for good practice in this specialty, which would consequently reduce the number of complaints to the regional medical boards.

Cardiovascular Disease in the Peruvian Andes: Local Perceptions, Barriers, and Paths to Preventing Chronic Diseases in the Cajamarca Region.

Objectives: Public health interventions can be improved by understanding peoples’ explanatory models of disease. We explore awareness and perceptions of cardiovascular diseases (CVD) and options for preventative actions in young adults living in rural Andean communities. Methods: We used convenience sampling to select 46 men and women from communities in Cajamarca (Peru). Subjects participated in eight focus groups where they discussed their understanding and perceived causes of CVD as well as barriers and pathways to healthy lifestyles. Results: Fresh foods, physical activity, unpleasant emotions, and healthcare access were cited as important determinants of healthy lifestyles. Barriers to healthy diets included lacking nutritional knowledge, fluctuating food prices, and limited access to foodstuffs. Women felt particularly vulnerable to CVD and identified gendered barriers to manage stress and engage in sports. Low health literacy, poor doctor-patient relationships, and long distances prevented participants from fully accessing healthcare. Conclusion: CVD prevention interventions should consider local knowledge of these diseases and of healthy lifestyles, and harness ongoing programmes that have successfully promoted good nutrition in children and pregnant women. In concert with public-private parterships, governments should include disease prevention interventions for the entire family.

General Perception of Doctor-Patient Relationship From Patients During the COVID-19 Pandemic in China: A Cross-Sectional Study.

The doctor–patient relationship (DPR) is essential in the process of medical consultations and treatments. Poor DPR may lead to poor medical outcomes, medical violence against doctors, and a negative perception of the healthcare system. Little is known about how DPR is affected during this novel coronavirus disease 2019 (COVID-19) pandemic. This cross-sectional study aimed to explore the DPR during the COVID-19 pandemic. There were 1,903 participants in China (95% response rate) who were recruited during the pandemic online via convenience and snowball sampling. Several questionnaires were used to evaluate participants' attitudes toward DPR, including the Patient–Doctor Relationship Questionnaire (PDRQ-9), Chinese Wake Forest Physician Trust Scale (C-WFPTS), a survey on medical violence against doctors, factors that affect and improve DPR, and general trust in medical services. Results revealed that DPR improved, and doctor–patient trust increased compared to participants' retrospective attitude before the pandemic. In addition, patients' violence against doctors decreased during the pandemic. Better doctor–patient trust and lower violence toward doctors are related to better DPR. Furthermore, we found that the main factors that could improve DPR include communication between doctors and patients, medical technology and services, and medical knowledge for patients. This study helped to better understand DPR in China, which may contribute to future health policies and medical practices in order to improve DPR and doctor–patient trust.

Medication adherence: a qualitative exploration of the experiences of adolescents with systemic lupus erythematosus.

There are increasing numbers of children diagnosed with systemic lupus erythematosus (SLE). Given the chronicity of the disease, individuals are confronted with cocktails of medications for an extended period. The present study explores experiences in medication adherence among adolescents with SLE in an acute care hospital. A descriptive qualitative design was employed. Fourteen adolescents with SLE were purposively selected. Face-to-face audio-recorded semi-structured interviews were conducted. Field notes and reflexive journals were maintained, and frequent debriefing sessions were performed to ensure the study's methodological rigour. Interviews were transcribed verbatim and thematic analyses were used. Constant comparative analysis was used to identify similarities and differences among the participants. Four themes emerged from interviews: (1) making sense of the treatment; (2) contending with side effects of medications; (3) maintaining networks of support; and (4) creating a new normal. The participants were motivated to adhere to medications when they developed awareness, received social support from family and friends and created routines for new normal when confronted with their diseases. However, some attributed a lack of parental support, poor doctor-patient relationships and the large numbers of medications as deterrence to medication adherence. This study highlights various medication-taking motivators and deterrents. Interdependent relationships between motivators and deterrents determine medication-taking behaviours. Findings from this multi-ethnic group of individuals of various ages and religious faith across the disease trajectory provide a deep insight into adolescents' experiences of medication adherence. This can contribute to the development of unique interventions for such individuals. Key points • Adolescents with systemic lupus erythematosus struggle with conforming to cocktails of medications. • A variety of factors either facilitate or impede their decisions to adhere to medication regimes. • Results suggest that tackling medication adherence among adolescents requires a multi-pronged approach from individual, familial and medical perspectives.

Influential Factors of Burnout among Village Doctors in China: A Cross-Sectional Study.

(1) Background: The heavy workload and understaffed personnel of village doctors is a challenge to the rural healthcare system in China. Previous studies have documented the predictors of doctors’ burnout; however, little attention has been paid to village doctors. This study aims to investigate the prevalence and influential factors of burnout among village doctors. (2) Methods: Data was collected by a self-administered questionnaire from 1248 village doctors who had worked at rural clinics for more than a year. Burnout was measured using the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) with three dimensions—emotional exhaustion (EE), depersonalization (DP), and reduced personal accomplishment (PA). A logistic regression model was applied to estimate the influential factors of burnout. (3) Results: The prevalence of overall burnout was 23.6%. Being male (OR = 0.58, 95%CI: 0.41–0.82), poor health status (OR = 0.80, 95%CI: 0.67–0.94), low income (OR = 0.62, 95%CI: 0.40–0.95), and a poor doctor–patient relationship (OR = 0.57, 95%CI: 0.48–0.67) were significantly related to burnout. Conclusion: Burnout is prevalent among Chinese village doctors. Policies such as increasing village doctors’ income and investing more resources in rural healthcare system should be carried out to mitigate and prevent burnout.

Nomophobia among medical residents

Objective To assess the prevalence and severity of nomophobia among medical residents in Menoufia University Hospitals and to assess its relation with anxiety, doctor–patient relationship, and residents' specialty/subspecialty. Background Nomophobia is an abbreviation for 'no-mobile-phone phobia,' which describes anxiety experienced by mobile phone users in its absence; it is the fear of becoming technologically incommunicable. This fear is characterized by physical, psychological, and cognitive symptoms in the context of stress or danger. Patients and methods A descriptive cross-sectional study was conducted on 221 medical residents in Menoufia University Hospitals in the frame of 13 months. They were assessed through predesigned questionnaires to determine the prevalence and severity of nomophobia and anxiety. Doctor–patient relationship was observed through Kalamazoo checklist. Results Prevalence of both nomophobia and anxiety was 100% among the studied group. More than half of the participants had moderate nomophobia and ~ 73% of the participants had mild anxiety. There was a positive moderate correlation between anxiety and nomophobia (r = 0.51), as increasing the severity of anxiety was associated with increasing in severity of nomophobia. Relation between nomophobia and anxiety was significant positive regarding doctor–patient relationship (P Conclusion Prevalence of nomophobia was 100% among medical residents in Menoufia University Hospitals. Approximately half of the studied residents who had a poor doctor–patient relationships had severe nomophobia. Specialty of medical residents had effect on nomophobia severity.

The Antecedents of Poor Doctor-Patient Relationship in Mobile Consultation: A Perspective from Computer-Mediated Communication.

This study aims to understand the underlying reasons for poor doctor-patient relationships (DPR). While extant studies on antecedents of poor DPR mainly focus on the offline context and often adopt the patients’ perspective, this work focuses on the mobile context and take both doctors’ and mobile consultation users’ perspectives into consideration. To fulfill this purpose, we first construct a theoretical framework based on the Computer-Mediated Communication (CMC) literature. Then we coded 592 doctor-user communication records to validate and elaborate the proposed theoretical model. This work reveals that characteristics of mobile technologies pose potential challenges on both doctors’ and patients’ information providing, informative interpreting, and relationship maintaining behaviors, resulting in 10 and 6 types of inappropriate behaviors of doctors and users, respectively, that trigger poor DPR in the mobile context. The findings enrich the research on online DPR and provide insights for improving DPR in the mobile context.

Classification of plastic surgery malpractice complaints brought before the São Paulo Medical Board that were treated as professional-misconduct cases: a cross-sectional study.

Nowadays, there is an ethical and moral necessity to establish rules that govern professional attitudes and conduct. In the medical field, these rules are multifaceted, given the health consequences inherent to medical procedures. Ethics is an even more delicate subject when it comes to plastic surgery, since one of the aims of this particular medical specialty is esthetic improvement of the body. To survey and classify São Paulo State Medical Board investigations of plastic-surgery complaints that were treated as professional-misconduct cases between 2007 and 2016. Cross-sectional study conducted in a medical council. A total of 360 cases were reviewed. Among these, 8 (2.23%) were dismissed, 1 (0.27%) became an administrative lawsuit and 351 (97.50%) were treated as professional-misconduct cases. A breakdown of the complaints filed over the nine-year period showed that complaints concerning malpractice were the most common (28.43%), followed by those regarding medical advertising (24.19%) and poor doctor-patient relationships (10.39%). Overall, the number of complaints lodged decreased over the last two years reviewed, although complaints regarding malpractice and poor doctor-patient relationships increased by 10% over the same period. In order to further reduce the number of medical board investigations, the medical establishment needs to carefully review the medical training of students and doctors at every stage of their careers.

Students’ group discussion on violence against doctors during the foundation course in a medical college

Introduction: Doctors being exposed to violent incidents is a reflection of the issues troubling the healthcare system. Younger doctors are more likely to be victims of violence. There is a need to provide education on avoiding or handling situations of violence early in their careers. The Medical Council of India suggested guidelines for a one month “Foundation Course” at the beginning of MBBS course to be implemented by colleges. It aims at acquisition of skills in language, interpersonal relationships and communication. Methods: As part of the 1st MBBS foundation course of the NRI Medical College in Guntur district of Andhra Pradesh state during the month of August 2019, a three hour session on violence against doctors was planned and conducted. It was divided into an interactive lecture for 45 minutes followed by group discussions for one hour and final presentations. The 180 medical students admitted into first MBBS (till date) were divided into 6 equal groups according to their role numbers. Each group session was facilitated by one faculty member. Individual group ideas on the subject were compiled and categorised into themes. Possible remedies were also put forward. Results: The themes identified were policy concerns, professional factors, social factors, media factors and management/Govt. factors. The possible remedies discussed by the students were also classified as those involving doctors, management, media and people. Discussion: High expenditures of healthcare in private hospitals and lack of equipment, facilities and skilled professionals in Govt. and smaller hospitals are reasons for resentment. Lack of proper communication and empathy lead to poor doctor patient relationships and forms the basis of aggression. Long waiting times, unavailability of personnel etc. are inflammatory issues. The role of media in providing misinformation about medical events is a concern. Management's responsibility is seen in providing adequate protection to medical personnel, preventing violence and promptly handling imminent violent situations. Solutions look towards improving communication and empathy in doctors, ensuring proper personnel and equipment by management as well as effective policies in patient services. Responsible reporting of alleged medical mismanagement by the media can stem such incidents. Finally it is also important that people understand the role of doctors in their lives. Conclusion: There is an urgent need to re-establish trust in the healthcare system through moral, regulatory and legal responses. Planned activities such as reforming medical education, promoting care giving and ensuring quality of care are necessary. This example of student discussion on such a critical topic goes a long way in preparing a medical student in becoming a better doctor.

Burnout among obstetricians and paediatricians: a cross-sectional study from China

ObjectivesHospitals devoted to maternal and child health represent unique healthcare institutions in China. Healthcare professionals in these hospitals attend to health services for women and children, and also provide technical...

Adesão à terapêutica nos doentes com esquizofrenia: uma revisão da literatura

Resumo: Introdução: Avaliar a adesão ao tratamento com agentes antipsicóticos em doentes com esquizofrenia é um desafio para qualquer médico psiquiatra, dada a subjetividade inerente ao tema. Apesar disso, a falta de adesão à terapêutica é prejudicial para o curso clínico da doença, resultando num risco aumentado de agudizações da doença e de internamentos hospitalares. O objetivo do presente estudo é rever a literatura corrente relativa aos fatores que influenciam a adesão ao tratamento antipsicótico em doentes com esquizofrenia. Métodos: Foi revista a literatura escrita em inglês entre 2006 e 2016 integralmente disponível no PubMed/MEDLINE que avaliasse potenciais fatores de risco para a adesão ao tratamento em doentes adultos (com mais de 18 anos) com esquizofrenia, através das palavras-chave: adherence, nonadherence, compliance, noncompliance, schizophrenia, psychosis, antipsychotic, neuroleptic. Resultados: Foram incluídos 39 estudos na revisão final. A média dos níveis de adesão ao tratamento foi de 32%. Foram identificados os seguintes fatores de risco para a falta de adesão ao tratamento: idade jovem, abuso de substâncias, psicopatologia psicótica presente, ausência de insight sobre a doença e a necessidade de tratamento, atitudes negativas perante o tratamento, relação médico-doente de má qualidade ou falta de apoio social e familiar. Conclusões: As intervenções direcionadas para melhorar a adesão à terapêutica devem ser individualizadas para cada doente, baseadas numa história clínica completa, para que todos os aspetos individuais que contribuam para esta variável possam ser convenientemente avaliados.

PRS83 - PATIENT PERSPECTIVE ON MEDICATION ADHERENCE IN ASTHMA: A SYSTEMATIC REVIEW OF THE LITERATURE

To conduct a targeted systematic review of the qualitative evidence underlying patients’ perspective on medication adherence with specific regard to short-acting β2-agonists (SABA) overreliance and inhaled corticosteroids (ICS) underuse in asthma patients. Peer-reviewed and published English language articles with observational and clinical trial data assessing adherence to licensed asthma medications (1 January 2012‒26 February 2018, inclusive) were identified using Medline and Embase. Results included articles with a population aged ≥12 years and qualitative data describing medication adherence (initiation/implementation/discontinuation). Of 254 citations identified, 43 were duplicates while 197 were ineligible. Examination of reference lists of the 14 eligible articles identified 3 additional eligible articles. Similarly, 4 additional articles were identified from reference lists of recent systematic reviews. Thus, 21 articles underwent full-text review and table abstractions. Seven major patient-centred drivers of SABA overreliance and ICS underuse were identified: treatment of asthma as an “as-needed” condition; consideration of asthma as a low-priority disease due to its episodic nature; doubts about diagnostic accuracy and lack of diagnostic consensus between physicians and specialists; poor patient-physician relationship due to a lack of written asthma action plans, a clear diagnosis, formal or objective assessment of disease severity, a patient-centred treatment approach and insufficient explanation of asthma management; suboptimal understanding of controller versus rescue medications; suboptimal inhaler techniques; and fear of short- and long-term side effects. Patients with asthma expressed a desire to be involved in selecting therapy options. Patient perception regarding asthma medications is related to symptoms and disease status, suboptimal knowledge of medication, poor doctor-patient relationship, and fear of side effects leading to SABA overreliance and ICS underuse. Patients with newly diagnosed asthma or known suboptimal medication understanding should receive targeted education and adherence interventions. Adherence interventions should also be directed toward changing provider behaviors and communication to promote optimal adherence.

Assessment of patient concerns: a review.

Patient-centred communication is the mainstay of the medical consultation. It includes the assessment of patient concerns and is important in building the doctor-patient therapeutic relationship. Our aim was to perform a literature review to identify relevance of patient concern assessment, to identify what concerns are encountered in various clinical settings and to explore the different methodologies used to obtain them. A narrative review was performed. Addressing patient concerns is associated with increased patient satisfaction. Unvoiced concerns are associated with unresolved health issues and poor doctor-patient relationships. Different specialities have focused on different aspects of concern assessment. Patient concern assessment studies are mostly qualitative in nature. Not all qualitative methods give similar results. Interviews are more reliable sources of information than questionnaires as no one questionnaire captures all patient concerns. The location where interviews take place is also relevant. Assessing patient concerns is associated with positive outcomes. Patient concerns are handled differently by different clinical specialties. Various methodologies have been used for concern assessment. Interviews and questionnaires can often yield different results.

Why rural diabetic patients do not attend for scheduled appointments: Results of a qualitative study

AimsDespite the need for timely return of patients for visit and blood sugar control, rate of attendance to health centers is low. This qualitative study was conducted to identify and explain the status of diabetics’ referral to rural health centers of Ahvaz from the patients and participants’ point of view. Materials and methodsThis research was performed with qualitative approach and phenomenological method in 2016. Using semi-structured interview with 14 diabetic patients, 6 health workers, 3 doctors and 3 members of the patient’s families the required data were collected. Data were analysis simultaneously using the software Max Q D12 and the main themes were identified. ResultsThe data analysis was performed and 5 main themes and 19 sub-themes were derived, including the following: 1. Personal Barriers 2. economic and social barriers 3. environmental barriers 4. Organizational barriers and 5. barriers related to service providers: lack of patients reverence, staff absenteeism at work, lack of patients follow-up, poor doctor-patient relationship. ConclusionThe main themes of this research were extracted including five main personal, economic, social, environmental, organizational causes and the causes related to service providers. It seems that knowledge and awareness can be promoted by educating patients and their families, service provider personnel; also cost and time taken for the patients can be decreased and index of blood sugar control percentage can be increased by providing special facilities near the patient’s location, setting up electronic referral system and sending feedback and cross-sector collaborations.