Tag Archives: evidence-based research

If Evidence Really Mattered, Physicians Would Be More Empathetic With Patients

[tweetmeme source=”Healthmessaging” only_single=false]Is anyone else tired of hearing about how important empathy is in the physician-patient relationship?  Every other day it seems a new study is talking about the therapeutic value of empathy.  Enough already!

It’s not that I don’t believe that empathy is important, I do.  I also believe the data that links physician empathy with improved patient outcomes, increased satisfaction, and better patient experiences.

A recent study released in Academic Medicine reported that “patients of physicians with high empathy scores were significantly more likely to have good control over their blood sugar as well as cholesterol, while the inverse was true for patients of physicians with low scores.”

Finding findings from this study by Hojat et al are consistent with a 2009 study by Rakel et al which found that among patients with the common cold those with physicians displaying high empathy had a significantly shorter duration of illness and trend toward lesser severity of illness and higher levels of immune response, compared to those patient whose physician displayed less empathy.

Going back further, in a 2001 review of 25 randomly controlled studies that looked at the influence of the practitioner-patient interac­tions outcomes , Di Blasi et al concluded that:

One relatively consistent finding is that physicians who adopt a warm, friendly, and reassuring manner are more effective than those who keep consul­tations formal and do not offer reassurance.

The problem with empathy research is that no one, including doctors, seems to be any paying attention as attested to the fact that nothing has changed.  Research documenting the therapeutic value of empathy goes back at least 20 years.  Despite the evidence, it seems that physicians are no more empathetic today than when people first started researching empathy.

Today we are told the health care is supposed to be evidence –based.   I wish that was the case when it came to empathy and the physician-patient relationship.  If it were we would have a lot more empathetic physicians, healthier patients, and much more satisfying patient experiences.

What do you think?

Sources:

Hojat, M. et al. Physicians’ Empathy and Clinical Outcomes for Diabetic Patients. Academic Medicine March 2011 – Volume 86 – Issue 3 – pp 359-364.

Rakel, D. et al. Practitioner Empathy and the Duration of the Common Cold.  Family Medicine, 2009;41(7):494-501.

Di Blasi, Z. et al. Influence of context effects on health outcomes: a systematic review. Lancet 2001;357(9258):757-62.

Social media advocates now have something to cheer about… sort of

[tweetmeme source=”Healthmessaging” only_single=false]Over the last year or two, lots of people have been jumping on the social media bandwagon, i.e., Twitter, Facebook, and so on. There has been a lot of talk about how social media and social networking will revolutionize health care…but little evidence to back this talk up.   Until now that is.
 
Before I get to the evidence that I referred to, I need to clarify something. The goal of social media as I understand it is to get people talking, sharing information and creating new ideas.   As applied to health care, one of the goals of social media is to get people/patients with like medical conditions taking, sharing and supporting one another.  Health care researchers refer to this phenomenon as peer support.   Peer support is not new to health care. Disease specific support groups (Breast Cancer, Diabetes, etc.) have been around for years. “Group” physician office visits comprised of patients with the same diagnosis have been around for years as well.
 
The Study
 
Now to the evidence. As anyone with a chronic condition or who treats patient with chronic conditions knows, patient self care is critical. Knowledge, skills and confidence are prerequisites for effective self care management.
 
A random controlled study recently published in the Annals of Internal Medicine looked at the efficacy of two alternative approaches helping patients with diabetes develop self care management efficacy:

  • one-on-one telephone conversations between two patients (of similar age)with diabetes
  • telephonic nurse care management

Male diabetes VA patients were randomly assigned to one of these two groups.  The HbA1c levels and blood pressures of patients assigned to both of the above intervention groups was measured at the start of the study and again at 6 months.  Patients in the peer support reviewed their test results, talked about care plans and received brief training in peer communication skills.  Peer partners were encouraged to call each other at least once a week.

Patients in the nurse care management group reviewed their test results, receive information about diabetes self care management and available care management services, and were encouraged to schedule follow-up telephone calls or face-to-face visits with that nurse care manager.

The Results

The study found that:

  1. patients in the peer support intervention achieved HbA1c levels that were 0.58% lower on average than those of patients who received nurse care management.
  2. patients in the RPS group with baseline HbA1c levels greater than 8.0% achieved a mean decrease of 0.88%, compared with a 0.07% decrease among those in the NCM group.
  3. patients on insulin in the peer support intervention with HbA1c level >8% were more likely to have their treatment intensified.
  4. patients in the peer support intervention reported a higher level of “diabetes-specific social support.”

These differences are both statistically and clinically significant.

Significance

The peer support intervention (like the nurse care management intervention) involved older males (average age of 62 years).  Older men are the last group I would have expected to pick up the phone and call another older male for information and support.  Presumably if peer support is well received by this group one can expect a broader adoption among other segments of the population.

The study provides hard evidence that peer support provided over the telephone can improve HbA1c levels among diabetic males.

The study presumes some level of knowledge and training in peer support communication skills among participants.

Take Aways

This study is one of the first randomly controlled studies to document the efficacy of a peer support intervention for a chronic condition.

This study did not look at web-based peer support. More research is needed to document efficacy of peer support delivered via the Internet, including e-mail and text.

Sources:

Heisler, et al.  Diabetes Control With Reciprocal Peer Support Versus Nurse Care Management – A Randomized Trial. Annals of Internal Medicine. 2010;153:507-515.

Dale, J. et al.  Peer support telephone calls for improving health. The Cochrane Library. 2009, Issue 3.

Patients Want This or That…Don’t Believe It

[tweetmeme http://www.healthecommunications.wordpress.com%5DAnytime you come across a health care article that implies that every patient wants this or that, i.e., electronic access to their medical record, patient centered care, etc.,  you can safely assume that the claim is wrong. Why?  Patients are not a monolithic group – they don’t all share the same motivations, preferences, beliefs or experiences when it comes to their health.

But let’s face. If you are trying to push an agenda, just saying some people want this or that is not the same as implying that everyone wants it.

Take the issue of patient access to physician notes in their medical record.
Robert Wood Johnson recently announced their OpenNotes study. The OpenNotes project will evaluate the impact on both patients and physicians of sharing, through online medical record portals, the comments and observations made by physicians after each patient encounter. OK…so far so good.

Things begin to fall apart however when RWJ cites “a recent study“ in the Journal of General Internal Medicine, as part of the basis for the OpenNotes research. According to the RWJ that study found that “most consumers want full access to their medical records.” Since when did six focus groups (64 people) constitute a representative sample, e.g. most people?

The authors of the Journal of General Internal Medicine make the following claims about what patients think and want:

  • Patients are very comfortable with the idea of computers playing a central role in their care.
  • Patients want computers to bring them customized medical information.
  • Patients expect that in the future they will be able to rely on electronic technology for many routine medical issues.

Oh…I should mention that recruitment for the focus groups was limited to people who:

  1. Were concerned about health matters
  2. Were less than completely satisfied with services and information currently available to manage their health
  3. Used the Internet at least once a week for at least four different transaction types (e.g., banking, e-mail, and travel reservations).

The focus group participants tended to be younger (average age of 39 years old), well educated (67% college educated) and presumably healthier participants than the typical primary care patient panel.

Given the recruitment criteria, the attitudes and opinions expressed by these groups might reflect about 1/3 of adult patients at best. They certainly don’t reflect the opinions of my 88 year old mother or a lot of others people I suspect.

Don’t get me wrong. I think anyone who wants access to their medical record or patient centered care should get it. What I object to is when researchers attempt to justify a position or agenda when the evidence clearly does not support it.

Source:

Delbanco, T., et al. Insights for Internists: “I Want the Computer to Know Who I Am.” Journal of General Internal Medicine 24(6):727–32.

Like It Or Not – Patients Have Their Own Expectations Regarding “Needed” Care

[tweetmeme http://www.healthecommunications.wordpress.com%5DIn Less is More, the editors of the Archives of Internal Medicine make the case that too much unneeded care is being delivered in physician’s offices these days.   According to the authors, “patient expectations” are a leading cause of this costly problem.

Their solution? Get physicians to share with patients the “evidence” for why their requests are crazy, wrong, ill informed or just plain stupid.  But getting patients to buy into the “Less is More” argument is a daunting task as most physicians already know.

The problem is complicated by the fact that patients have a lot good reasons for not buying into the “Less is More” message.

Here are some examples of those reasons and how people come by them:

Direct personal experiences with current or previous providers

  • Doesn’t seem to know who I am or what problems are from one visit to the next
  • Doesn’t have lab test results at time of visit
  • My doctor can’t know everything
  • Medications don’t work for me
  • Too busy – feel rushed
  • No time for questions/interrupted

Indirect health care experiences of family or friends

  • My aunt died from diabetes…insulin didn’t help
  • My friend with cancer received radiation and lived…that’s what I want

What people read/hear

  • 50% of US adults don’t get recommended care
  • Guideline always changing – example: mammography screening
  • Medical errors/quality problems
  • US health care system broken
  • Rationing of care and death panels
  • Doctors don’t have enough time and aren’t paid enough

In truth, before physicians can change a patient’s mind about what constitutes “needed care” they need to understand the patient’s health beliefs and expectations.   But that’s not something physicians are very good at.  Nor are they paid to do it.  So until we can create the right incentives for physicians and patients to talk about such things, patients are welcome to and entitled to their own expectations of needed care.

Source:

How Less Health Care Can Result in Better Health.  Archives of Internal Medicine.  May10, 2010.


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“What We Have Here Is Failure To Communicate”

[tweetmeme source=”Healthmessaging” only_single=false]Forget electronic medical records.  If there’s any truth to the last 30 years of research coming out of NIH and academia, what we need to do is figure out how to improve the way physicians and patients communicate with the data we have.   It’s a much cheaper fix than EMR and there’s lots of evidence of significant cost-saving from improved physician-patient communications.

Don’t take my word for it.  Just do a Google search.   There are literally hundreds of peer-reviewed studies documenting the impact of effective physician-patient communication.  Interested in increasing patient or physician adherence?  There’s a bunch of peer-reviewed studies on that.   Interested in the facts on patient-centered care?  There’s peer-reviewed research on when it works and when it doesn’t.  You get the idea.

This blog is intended to take these research findings, dust them off and bring them to light.  I will share my insights and “take aways” from the research, and hopefully those of others as well.  In so doing, you can begin adapting these findings in your own organization.

As this blog finds it “voice,” let me invite you to share your thoughts and comments below.  If you are interested in contributing to “Mind the Gap” please contact me.