Patient nonadherence to medication in inflammatory bowel disease.

Background. The Ottawa Decision Support Framework (ODSF) provides a process that facilitates shared decision making. Objective. To assess the impact of implementing the ODSF on the agreement and th...

Impact of the Ottawa Decision Support Framework on the Agreement and the Difference between Patients' and Physicians' Decisional Conflict:

The current state of knowledge concerning relationships between elderly patients and their health care providers is reviewed in this article, chiefly in terms of physicians as providers. Characteristics of physicians, including age, gender, practice styles, and psychological attitudes, are shown to be relevant to the course and content of interactions. Equally critical are characteristics of the elderly patients, such as cohort membership, health status, gender, race, and health-related attitudes and beliefs. Also significant are the organizational settings in which interactions occur. Implications for elderly patient compliance and satisfaction, as well as health services utilization, are discussed in light of communication issues. The need for according elderly patients respect and dignity is stressed, particularly in light of ageist attitudes still prevalent among health practitioners and the society at large.

Issues in elderly patient-provider interactions.

Continuity of care is central to the philosophy and teaching of family medicine. Studies of continuity have yielded conflicting results with regard to outcomes. Reasons for this include a failure to agree upon a theoretical definition of continuity as well as failure to account for a number of influential determinants of the continuity process. It is suggested that continuity is an attitude based upon prior knowledge of and for each participant in the medical encounter. This attitude is made operational in a process consisting of five continuity dimensions: chronological, geographical, interdisciplinary, interpersonal, and informational. A working model of analysis is proposed, and the results of various studies are critically assessed. Future research in the area of continuity of care must provide reliable measures of the different continuity dimensions followed by well-controlled trials assessing the impact of these dimensions on the satisfaction, comfort, and health status of patients.

Continuity of care and family medicine: definition, determinants, and relationship to outcome.

Early in the history of medicine, Hippocrates (On Decorum, 1923 translation) cautioned against relying on patient’s self-reports of their compliance with medical regimens because he believed that patients typically do not tell the truth He suggested that patients try to avoid recriminations, embarrassment, or rejection by the practitioner by responding in a socially desirable manner

Adherence to Self-Care Regimens

This study concerned two questions: Why does the patient come to the physician? And, how does patient-physician agreement as to the primary purpose affect the process and outcome of the medical encounter? Separate interviews of patients and physicians following 200 medical encounters revealed a preponderance of visits for continuing care, a paucity of visits for social and emotional problems, and a number of visits in which "concern" as the patient's primary purpose was misperceived by the physician There was no statistically significant relationship when agreement (or lack of agreement) between patient and physician as to the purpose of the encounter was compared with patient age and sex, number of previous visits of the patient to the physician, and subsequent patient-physician agreement as to the diagnosis, prognosis, therapy, and satisfaction There was also no statistically significant relationship when patient-physician concordance as to visit purpose was compared with education level of the patient or with physician perception of the patient's intended compliance In both concordance and non-concordance groups, physicians underestimated both patient satisfaction with the encounters and intended compliance

Purpose of the medical encounter: identification and influence on process and outcome in 200 encounters in a model family practice center.

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Purpose of the medical encounter: identification and influence on process and outcome in 200 encounters in a model family practice center.