Exploring the therapeutic alliance in Belgian family medicine and its association with doctor–patient characteristics: a cross-sectional survey study

Abstract

ObjectivesPatient-centred care is related to better health outcomes, greater patient satisfaction and reduced healthcare costs. One of the core components of patient-centred care, defined in the patient-centred clinical method, is enhancing the patient–doctor relationship. In this study, we aim to measure the therapeutic alliance in consultations between patients and family doctors in Belgium, and explore which patient, provider and practice characteristics are associated with the strength of the therapeutic alliance.DesignCross-sectional cohort study using the Working Alliance Inventory for General Practice (WAI-GP). The patients and family doctors completed a survey after the consultation. The survey consisted of the WAI-GP, demographics, consultation characteristics and variables related to the patient–doctor relationship.SettingBelgian primary care.ParticipantsEvery third patient (both practice and house call visits) was invited to participate. 170 patient–doctor dyads from four practices were included. Total of 10 doctors (30% men, age range 24–63 years) and 170 patients (35.9% men, age range 18–92 years).Primary and secondary outcome measuresPrimary outcome was the WAI-GP score and its correlations with characteristics of the doctor (gender, age) and patients (gender, age, chronic disease, number of annual consultations).ResultsThe median WAI-GP score reported after these consultations was 4.5±0.62. Higher WAI-GP scores were reported for consultations with male doctors and by older patients. In the subsample of patients with a chronic illness, higher WAI-GP scores were reported by patients who had more than 10 follow-up consultations per year.ConclusionsConsultation quality is an important aspect of healthcare, but attention is needed to understand how the WAI-GP performs in relation to variables that are beyond control, such as gender of the physician, age of the patient and variables related to building continuity of care. This has implications for the measurement of quality of healthcare.

Patient, Caregiver, and Provider Perceptions of Transition Readiness and Therapeutic Alliance during Transition from Pediatric to Adult Care in Epilepsy

“…As noted, previous literature has suggested that strong patient-alliance can positively impact treatment outcomes in other clinical contexts. [29][30][31][32] Our data suggest that despite high-bond scores between patients and providers, it may not necessarily be associated with greater transition readiness nor does it negatively impact the willingness to transition as suggested in a prior study. 11 Descriptive data regarding implementation of discussion regarding transition readiness indicated that there is a higher likelihood of provider discussing transition specific items when they feel the patient is ready and likely to transition.…”

“…For example, strong patient-provider bonds can positively impact mental health and physical out-comes. [29][30][31] A strong working alliance between patient and provider has also been shown to predict patient adherence, satisfaction, and quality of life. 32 In contrast, a strong patientprovider bond may also hinder transition.…”

Evaluating the Effectiveness of Nutritional Therapy in the McClelland Teaching Clinic at the University of Worcester

“…Completion of the paperwork was very poor which affected the sample size for analysis, and consequently power resulting in the chance of Type 2 errors, where a difference may not have been detected when there was one, therefore a larger sample size for more robust statistical analysis would be recommended for future research [61]. In addition, it may be beneficial to compare MYMOP effectiveness and the working alliance relationship in gender and age categories, as well as morbidity characteristics [62]. Further research may help identify other skills necessary to build on the therapeutic alliance for more effective health behavior change [41].…”

Exploring the psychometric properties of the Working Alliance Inventory in general practice: a cross-sectional study

“…In primary care, much research has been conducted on the doctor-patient relationship (5)(6)(7)(8)(9), and results support that positive therapeutic relationships improve health and symptom outcomes for patients (10). Our international team is working towards a measure for the doctor-patient relationship that can be used in different healthcare settings to improve primary care interventions (11). This paper describes the next step in our journey.…”

“…The doctor–patient relationship depends on a variety of components, including trust, 12 , 13 empathy, 14 shared decision making, 15 and patient-centredness. 10 Multiple instruments have been developed to measure the different components of the doctor–patient relationship; for example, the CARE measure and the PPPC measure. The CARE is a widely used validated questionnaire for measuring the empathy of the doctor as experienced by the patient.…”