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BMC Health Services Research
Published in: BMC Health Services Research 1/2016

Open Access 01-12-2016 | Research article

‘It just has to click’: Internists’ views of: what constitutes productive interactions with chronically ill patients

Authors: N. M. H. Kromme, C. T. B. Ahaus, R. O. B. Gans, H. B. M. van de Wiel

Published in: BMC Health Services Research | Issue 1/2016

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Abstract

Background

According to the Chronic Care Model, productive interactions are crucial to patient outcomes. Despite productive interactions being at the heart of the Model, however, it is unclear what constitutes such an interaction. The aim of this study was to gain a better understanding of physician views of productive interactions with the chronically ill.

Method

We conducted a qualitative study and interviewed 20 internists working in an academic hospital. The data were analyzed using a constructivist approach of grounded theory. To categorize the data, a coding process within which a code list was developed and tested with two other coders was conducted.

Results

The participants engaged in goal-directed reasoning when reflecting on productive interactions. This resulted in the identification of four goal orientations: (a) health outcome; (b) satisfaction; (c) medical process; and (d) collaboration. Collaboration appeared to be conditional for reaching medical process goals and ultimately health outcome and satisfaction goals. Achieving rapport with the patient (‘clicking,’ in the term of the participants) was found to be a key condition that catalyzed collaboration goals. Clicking appeared to be seen as a somewhat unpredictable phenomenon that might or might not emerge, which one had to accept and work with. Goal orientations were found to be related to the specific medical context (i.e., a participant’s subspecialty and the nature of a patient’s complaint).

Conclusions

The participants viewed a productive interaction as essentially goal-directed, catalyzed by the two parties clicking, and dependent on the nature of a patient’s complaint. Using the findings, we developed a conceptual process model with the four goal orientations as wheels and with clicking in the center as a flywheel. Because clicking was viewed as important, but somewhat unpredictable, teaching physicians how to click, while taking account of the medical context, may warrant greater attention.
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Literature
1.
Wagner EH. Chronic disease management: what will it take to improve care for chronic illness? Eff Clin Pract. 1998;1(1):2–4.PubMed
2.
Wagner EH, Austin BT, Davis C, Hindmarsh M, Schaefer J, Bonomi A. Improving chronic illness care: translating evidence into action. Health Aff (Millwood). 2001;20(6):64–78.CrossRef
3.
Cramm JM, Nieboer AP. A longitudinal study to identify the influence of quality of chronic care delivery on productive interactions between patients and (teams of) healthcare professionals within disease management programmes. BMJ Open. 2014;4(9): e005914-2014-005914.
4.
Oprea L, Braunack-Mayer A, Rogers WA, Stocks N. An ethical justification for the Chronic Care Model (CCM). Health Expect. 2010;13(1):55–64.CrossRefPubMed
5.
Davy C, Bleasel J, Liu H, Tchan M, Ponniah S, Brown A. Effectiveness of chronic care models: opportunities for improving healthcare practice and health outcomes: a systematic review. BMC Health Serv Res. 2015;15:194-015-0854-8.
6.
Kiesler DJ, Auerbach SM. Optimal matches of patient preferences for information, decision-making and interpersonal behavior: Evidence, models and interventions. Patient Educ Couns. 2006;61(3):319–41.CrossRefPubMed
7.
8.
Bastiaens H, Van Royen P, Pavlic DR, Raposo V, Baker R. Older people’s preferences for involvement in their own care: A qualitative study in primary health care in 11 European countries. Patient Educ Couns. 2007;68(1):33–42.CrossRefPubMed
9.
Mirzaei M, Aspin C, Essue B, Jeon YH, Dugdale P, Usherwood T, Leeder S. A patient-centred approach to health service delivery: improving health outcomes for people with chronic illness. BMC Health Serv Res. 2013;13:251-6963-13-251.
10.
11.
12.
Becker G, Kaufman SR. Managing an uncertain illness trajectory in old age: patients’ and physicians’ views of stroke. Med Anthropol Q. 1995;9(2):165–87.CrossRefPubMed
13.
Loewe R, Schwartzman J, Freeman J, Quinn L, Zuckerman S. Doctor talk and diabetes: Towards an analysis of the clinical construction of chronic illness. Soc Sci Med. 1998;47(9):1267–76.CrossRefPubMed
14.
Asbring P, Narvanen AL. Ideal versus reality: physicians perspectives on patients with chronic fatigue syndrome (CFS) and fibromyalgia. Soc Sci Med. 2003;57(4):711–20.CrossRefPubMed
15.
Hinchey SA, Jackson JL. A cohort study assessing difficult patient encounters in a walk-in primary care clinic, predictors and outcomes. J Gen Intern Med. 2011;26(6):588–94.CrossRefPubMedPubMedCentral
16.
Frank J. The CanMEDS 2005 physician competence framework. 2005.
17.
Wouda JC, van de Wiel HB. Education in patient-physician communication: how to improve effectiveness? Patient Educ Couns. 2013;90(1):46–53.CrossRefPubMed
18.
Molleman E, Broekhuis M, Stoffels R, Jaspers F. How health care complexity leads to cooperation and affects the autonomy of health care professionals. Health Care Anal. 2008;16(4):329–41.CrossRefPubMed
19.
Glaser BG, Strauss AL. Purpose and credibility of qualitative research. Nurs Res. 1966;15(1):56–61.CrossRefPubMed
20.
Charmaz K. Constructing Grounded Theory. A Practical Guide Through Qualitative Analysis. London: Sage Publications; 2006.
21.
Strauss C, Quinn N. A Cognitive Theory of Cultural Meaning. New York: Cambridge University Press; 1997.
22.
Francis JJ, Johnston M, Robertson C, Glidewell L, Entwistle V, Eccles MP, Grimshaw JM. What is an adequate sample size? Operationalising data saturation for theory-based interview studies. Psychol Health. 2010;25(10):1229–45.CrossRefPubMed
23.
D’Andrade RG. Some methods for studying cultural cognitive structures. In: Quinn N, editor. Finding culture in talk: a selection of methods. New York: Palgrave Macmillan; 2005. p. 83–104.CrossRef
24.
Hennink M, Hutter I, Bailey A. Qualitative Research Methods. London: SAGE Publications; 2011. p. 201–32.
25.
Miles MB, Huberman AM. Qualitative Data Analysis: An Expanded Sourcebook. 2nd ed. London: SAGE Publications; 1994. p. 143–70.
26.
Bird J, Cohen-Cole SA. The three-function model of the medical interview. An educational device. Adv Psychosom Med. 1990;20:65–88.CrossRefPubMed
27.
Lipkin JM, Putnam SM, Lazare A. The Medical Interview. Clinical care, Education and Research. New York: Springer–Verlag; 1995.
28.
Grundmeijer HGLM, Reenders K, Rutten G. Het geneeskundig proces. Klinisch redeneren van klacht naar therapie (in Dutch). Maarssen: Elsevier Gezondheidszorg; 2009.
29.
Speckens AE, Van Hemert AM, Bolk JH, Rooijmans HG, Hengeveld MW. Unexplained physical symptoms: outcome, utilization of medical care and associated factors. Psychol Med. 1996;26(4):745–52.CrossRefPubMed
30.
Nimnuan C, Hotopf M, Wessely S. Medically unexplained symptoms: an epidemiological study in seven specialities. J Psychosom Res. 2001;51(1):361–7.CrossRefPubMed
31.
Salmon P. Conflict, collusion or collaboration in consultations about medically unexplained symptoms: The need for a curriculum of medical explanation. Patient Educ Couns. 2007;67(3):246–54.CrossRefPubMed
32.
Burton C. Beyond somatisation: a review of the understanding and treatment of medically unexplained physical symptoms (MUPS). Br J Gen Pract. 2003;53(488):231–9.PubMedPubMedCentral
33.
34.
Tickle-Degnen L, Rosenthal R. The nature of rapport and its nonverbal correlates. Psychological Inquiry. 1990;1(4):285–93.CrossRef
35.
Bernieri FJ. The Expression of Rapport. In: Manusov V, editor. Mahwah: Lawrence Erlbaum Associates Publishers; 2005 347–359
36.
Bernieri FJ, Gillis JS, Davis JM, Grahe JE. Dyad rapport and the accuracy of its judgment across situations: A lens model analysis. J Pers Soc Psychol. 1996;71(1):110–29.CrossRef
37.
Ramseyer F, Tschacher W. Nonverbal Synchrony in Psychotherapy: Coordinated Body Movement Reflects Relationship Quality and Outcome. J Consult Clin Psychol. 2011;79(3):284–95.CrossRefPubMed
38.
Martin DJ, Garske JP, Davis MK. Relation of the therapeutic alliance with outcome and other variables: a meta-analytic review. J Consult Clin Psychol. 2000;68(3):438–50.CrossRefPubMed
39.
Tickle-Degnen L, Gavett E. Changes in nonverbal behavior during the development of therapeutic relationships. In: Philippot P, Feldman RS, Coats EJ, editors. Nonverbal behavior in clinical settings. Oxford: Oxford University Press; 2003. p. 75–110.CrossRef
40.
Epstein RM. Whole mind and shared mind in clinical decision-making. Patient Educ Couns. 2013;90(2):200–6.CrossRefPubMed
41.
Zwar N, Harris M, Griffiths R. A Systematic Review of Chronic Disease management. Sydney: Australian Primary Health Care Institute; 2006.
42.
Wagner EH, Bennett SM, Austin BT, Greene SM, Schaefer JK, Vonkorff M. Finding common ground: patient-centeredness and evidence-based chronic illness care. J Altern Complement Med. 2005;11 Suppl 1:S7–15.PubMed
43.
Michie S, Miles J, Weinman J. Patient-centredness in chronic illness: what is it and does it matter? Patient Educ Couns. 2003;51(3):197–206.CrossRefPubMed
44.
Dwamena F, Holmes-Rovner M, Gaulden CM, Jorgenson S, Sadigh G, Sikorskii A, Lewin S, Smith RC, Coffey J, Olomu A. Interventions for providers to promote a patient-centred approach in clinical consultations. Cochrane Database Syst Rev. 2012;12:CD003267.PubMed
45.
Hibbard JH, Greene J. What the evidence shows about patient activation: better health outcomes and care experiences; fewer data on costs. Health Aff (Millwood). 2013;32(2):207–14.CrossRef
46.
47.
Suchman AL. A new theoretical foundation for relationship-centered care. Complex responsive processes of relating. J Gen Intern Med. 2006;21(Suppl 1(1525–1497; 0884–8734)):S40–4.CrossRefPubMedPubMedCentral
48.
Oprea L. An analytic review of the doctor-patient relationship (Part II). Revista Romana de Bioetica. 2009;7(3):142–53.
49.
50.
Hilderink PH, Collard R, Rosmalen JG, Oude Voshaar RC. How does ageing affect the impact of medically unexplained symptoms and medically explained symptoms on health-related quality of life? Int J Geriatr Psychiatry. 2015;30(7):737–43.CrossRefPubMed
51.
52.
van der Feltz-Cornelis CM, Hoedeman R, Keuter EJ, Swinkels JA. Presentation of the multidisciplinary guideline medically unexplained physical symptoms (MUPS) and somatoform disorder in the Netherlands: disease management according to risk profiles. J Psychosom Res. 2012;72(2):168–9.CrossRefPubMed
53.
Hull M. Building a rapport with patients. Foundation Years. 2007;3(3):103–4.CrossRef
54.
van den Eertwegh V, van Dulmen S, van Dalen J, Scherpbier AJ, van der Vleuten CP. Learning in context: Identifying gaps in research on the transfer of medical communication skills to the clinical workplace. Patient Educ Couns. 2013;90(2):184–92.CrossRefPubMed
55.
Silverman J. Clinical communication training in continuing medical education: possible, do-able and done? Patient Educ Couns. 2011;84(2):141–2.CrossRefPubMed
Metadata
Title
‘It just has to click’: Internists’ views of: what constitutes productive interactions with chronically ill patients
Authors
N. M. H. Kromme
C. T. B. Ahaus
R. O. B. Gans
H. B. M. van de Wiel
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2016
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-016-1430-6

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