“It's Really Overwhelming”: Patient Perspectives on Care Coordination

Chang, Lawrence; Wanner, Kathryn J.; Kovalsky, Danielle; Smith, Kristofer L.; Rhodes, Karin V.

doi:10.3122/jabfm.2018.05.180034

Cited by 27 publications

(22 citation statements)

References 25 publications

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“…As for coordination and integration of care, as necessitated when patients encounter long waiting times in hospitals or disorganized operations, previous studies have focused on hospital-level care coordination strategies associated with better patient experience [77]. Besides, it is envisaged that information technologies can reduce the need to craft laborious, case-by-case strategies for coordinating patient care [30,78,79].…”

Section: Discussionmentioning

confidence: 99%

What Do Patients Complain About Online: A Systematic Review and Taxonomy Framework Based on Patient Centeredness

et al. 2019

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Background Complaints made online by patients about their health care experiences are becoming prevalent because of widespread worldwide internet connectivity. An a priori framework, based on patient centeredness, may be useful in identifying the types of issues patients complain about online across multiple settings. It may also assist in examining whether the determinants of patient-centered care (PCC) mirror the determinants of patient experiences. Objective The objective of our study was to develop a taxonomy framework for patient complaints online based on patient centeredness and to examine whether the determinants of PCC mirror the determinants of patient experiences. Methods First, the best fit framework synthesis technique was applied to develop the proposed a priori framework. Second, electronic databases, including Web of Science, Scopus, and PubMed, were searched for articles published between 2000 and June 2018. Studies were only included if they collected primary quantitative data on patients’ online complaints. Third, a deductive and inductive thematic analysis approach was adopted to code the themes of recognized complaints into the framework. Results In total, 17 studies from 5 countries were included in this study. Patient complaint online taxonomies and theme terms varied. According to our framework, patients expressed most dissatisfaction with patient-centered processes (101,586/204,363, 49.71%), followed by prerequisites (appropriate skills and knowledge of physicians; 50,563, 24.74%) and the care environment (48,563/204,363, 23.76%). The least dissatisfied theme was expected outcomes (3651/204,363, 1.79%). People expressed little dissatisfaction with expanded PCC dimensions, such as involvement of family and friends (591/204,363, 0.29%). Variation in the concerns across different countries’ patients were also observed. Conclusions Online complaints made by patients are of major value to health care providers, regulatory bodies, and patients themselves. Our PCC framework can be applied to analyze them under a wide range of conditions, treatments, and countries. This review has shown significant heterogeneity of patients’ online complaints across different countries.

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Section: Discussionmentioning

confidence: 99%

What Do Patients Complain About Online: A Systematic Review and Taxonomy Framework Based on Patient Centeredness

et al. 2019

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“…44 In fact, our study and prior studies show that patients often want their PCPs to be the coordinators of other services and specialty care. 45…”

Section: Iscussionmentioning

confidence: 99%

Importance of Communication and Relationships: Addressing Disparities in Hospitalizations for African-American Patients in Academic Primary Care

et al. 2019

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BACKGROUND: There are many interventions to facilitate seamless continuity of care for patients in transition from hospital back to primary care; however, disparities remain in readmission rates for vulnerable populations, especially African-Americans. OBJECTIVES: We set out to investigate the association of race and ethnicity with 30-day readmission in our urban academic setting and to identify factors that could be leveraged in primary care to address disparities in hospitalizations. METHODS/APPROACH: Using data originally collected for quality improvement purposes, we evaluated 30-day readmission rates for our primary care patients (January 1, 2013-September 30, 2014) by race and ethnicity, adjusting for demographic and clinical characteristics. Then, using inductive and deductive methods, we coded semi-structured interviews with 24 African-American primary care patients who were discharged from the Medicine or Cardiology service at our tertiary care hospital during the study period. KEY RESULTS: African-Americans had the highest readmission rate (21.7%) and a higher adjusted odds of readmission (1.37; 95% CI 1.04-1.81) compared to Whites. Five major themes emerged as having potential to be leveraged in primary care to help prevent multiple hospitalizations: (1) dependable patient-physician relationships, (2) healthcare coordination across settings, (3) continuity with one primary care provider (PCP), (4) disease selfmanagement, and (5) trust in resident physicians. Participants also made several recommendations to keep patients like themselves from returning to the hospital: increased time to tell their story during their primary care visit, more direct patient-physician communication during the visit, and improved access between visits. CONCLUSIONS: While African-American patients in our practice experience higher rates of hospital readmissions than their White counterparts, they emphasize the significance of their PCP relationship and communication to enhance disease management and prevent hospitalizations. Ongoing efforts are needed to establish and implement best practice communication trainings for patients at increased risk of hospitalization, particularly for resident physicians.

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“…However, for the patients and their families, it may be even more challenging. 1 Patients with multiple providers and/or emergency department visits, or providers in different health care systems often find care coordination quite difficult, and confusing. "It is really overwhelming" is quite descriptive of the experiences some patients report.…”

Section: Care Coordination and Integration With An Emphasis On Behavmentioning

confidence: 99%

“…Interestingly, "superusers" of the emergency department were excluded from this study. Importantly, Chang et al 1 report that patients expected their family physicians to undertake the coordination.…”

Section: Care Coordination and Integration With An Emphasis On Behavmentioning

confidence: 99%

Health Care Integration and Coordination with Emphasis on Mental Health, but Not for Medical Marijuana

Bowman¹,

Seehusen²,

Neale³

2018

J Am Board Fam Med

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Care coordination and behavioral health care integration are the subject of 4 of this month's articles. Patients with significant illness report that care coordination provides great challenges to them, and they expect family physicians to assist with the referrals and communication between the doctors. Patients' primary care providers were usually not the prescribers of patients' medical marijuana and were often unaware of its use, indicating lack of health care integration and coordination. Two articles provide insight into medication adherence. Also, how are family physicians addressing patient engagement at the practice level? Clinical topics in this issue include the following: specific exercises were not the answer to restless legs; epidural anesthesia may be associated with fewer, not more, vaginal lacerations; and fecal incontinence is less discussed but not necessarily less problematic than urinary incontinence. On the popular culture front, opioid mentions in top 100 songs are increasing. Lastly, what does it mean for the field of family medicine that some of us choose to become hospitalists?

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“It's Really Overwhelming”: Patient Perspectives on Care Coordination

Cited by 27 publications

References 25 publications

What Do Patients Complain About Online: A Systematic Review and Taxonomy Framework Based on Patient Centeredness

What Do Patients Complain About Online: A Systematic Review and Taxonomy Framework Based on Patient Centeredness

Importance of Communication and Relationships: Addressing Disparities in Hospitalizations for African-American Patients in Academic Primary Care

Health Care Integration and Coordination with Emphasis on Mental Health, but Not for Medical Marijuana

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