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BMJ Open Jun 2017This study reviews the current state of the published peer-reviewed literature related to physician burnout and two quality of care dimensions. The purpose of this... (Review)
Review
OBJECTIVES
This study reviews the current state of the published peer-reviewed literature related to physician burnout and two quality of care dimensions. The purpose of this systematic literature review is to address the question, 'How does physician burnout affect the quality of healthcare related to the dimensions of acceptability and safety?'
DESIGN
Using a multiphase screening process, this systematic literature review is based on publically available peer-reviewed studies published between 2002 and 2017. Six electronic databases were searched: (1) , (2) , (3) , (4) , (5) and (6) .
SETTING
Physicians practicing in civilian settings.
PARTICIPANTS
Practicing physicians who have completed training.
PRIMARY AND SECONDARY OUTCOME MEASURES
Quality of healthcare related to acceptability (ie, patient satisfaction, physician communication and physician attitudes) and safety (ie, minimising risks or harm to patients).
RESULTS
4114 unique citations were identified. Of these, 12 articles were included in the review. Two studies were rated as having high risk of bias and 10 as having moderate risk. Four studies were conducted in North America, four in Europe, one in the Middle East and three in East Asia. Results of this systematic literature review suggest there is moderate evidence that burnout is associated with safety-related quality of care. Because of the variability in the way patient acceptability-related quality of care was measured and the inconsistency in study findings, the evidence supporting the relationship between burnout and patient acceptability-related quality of care is less strong.
CONCLUSIONS
The focus on direct care-related quality highlights additional ways that physician burnout affects the healthcare system. These studies can help to inform decisions about how to improve patient care by addressing physician burnout. Continued work looking at the relationship between dimensions of acceptability-related quality of care measures and burnout is needed to advance the field.
Topics: Attitude of Health Personnel; Burnout, Professional; Communication; Humans; Medical Errors; Patient Safety; Patient Satisfaction; Physicians; Quality of Health Care
PubMed: 28637730
DOI: 10.1136/bmjopen-2016-015141 -
BMC Medical Education Mar 2021The demographic profile of practicing physicians is changing as more female medical students are graduating and practicing in the field. While the education received may... (Review)
Review
BACKGROUND
The demographic profile of practicing physicians is changing as more female medical students are graduating and practicing in the field. While the education received may not differ by gender, studies have shown that physician practice outcomes vary by provider gender. Various factors could contribute to these differences, including culture and explicit biases which may lead to implicit bias. This study aims to identify the available evidence of gender-based implicit bias throughout the delivery process of medicine.
METHODS
This scoping review evaluated published literature within the PubMed, Ovid MEDLINE, PsychINFO, Web of Science, and BioMed Central databases pertaining to physician's gender as a factor in the delivery of medicine. Arksey and O'Malley's six-stage methodology was used as a framework and reported using the updated Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Searches occurred between May 2020 and June 2020, and the timeframe was not limited. Included articles had gender as a factor in the delivery of medicine and implicit bias. Articles were excluded if they did not include the gender of the physician. After screening by reviewers and a medical librarian, study characteristics were charted and analyzed.
RESULTS
The initial search resulted in 2420 records. After screening, 162 of the records were selected based on title and keyword relevance. After additional screening, 15 records were ultimately included in the review based on full-text evaluation. Records were organized into sub-topics post hoc focused on clinical qualities, diagnostics, treatment, and outcomes.
CONCLUSION
This scoping review found that gender-based implicit bias may be inadvertently acquired from culture and education. Although implicit bias is highly researched, much of the current literature focuses on the gender of the patient. This study found important gaps in the available literature regarding race and gender of the physician. Further studies could explore outcome differences between recent graduates and career physicians, for both female and male physicians.
Topics: Clinical Decision-Making; Female; Humans; Male; Physicians; Prejudice; Students, Medical
PubMed: 33740973
DOI: 10.1186/s12909-021-02601-2 -
Critical Care (London, England) Jan 2016Evidence suggests that EMS-physician-guided cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrest (OOHCA) may be associated with improved outcomes, yet... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Evidence suggests that EMS-physician-guided cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrest (OOHCA) may be associated with improved outcomes, yet randomized controlled trials are not available. The goal of this meta-analysis was to determine the association between EMS-physician- versus paramedic-guided CPR and survival after OOHCA.
METHODS AND RESULTS
Studies that compared EMS-physician- versus paramedic-guided CPR in OOHCA published until June 2014 were systematically searched in MEDLINE, EMBASE and Cochrane databases. All studies were required to contain survival data. Data on study characteristics, methods, and as well as survival outcomes were extracted. A random-effects model was used for the meta-analysis due to a high degree of heterogeneity among the studies (I(2) = 44%). Return of spontaneous circulation [ROSC], survival to hospital admission, and survival to hospital discharge were the outcome measures. Out of 3,385 potentially eligible studies, 14 met the inclusion criteria. In the pooled analysis (n = 126,829), EMS-physician-guided CPR was associated with significantly improved outcomes compared to paramedic-guided CPR: ROSC 36.2% (95% confidence interval [CI] 31.0 - 41.7%) vs. 23.4% (95% CI 18.5 - 29.2%) (pooled odds ratio [OR] 1.89, 95% CI 1.36 - 2.63, p < 0.001); survival to hospital admission 30.1 % (95% CI 24.2 - 36.7%) vs. 19.2% (95% CI 12.7 - 28.1%) (pooled OR 1.78, 95% CI 0.97 - 3.28, p = 0.06); and survival to discharge 15.1% (95% CI 14.6 - 15.7%) vs. 8.4% (95% CI 8.2 - 8.5%) (pooled OR 2.03, 95% CI 1.48 - 2.79, p < 0.001).
CONCLUSIONS
This systematic review suggests that EMS-physician-guided CPR in out-of-hospital cardiac arrest is associated with improved survival outcomes.
Topics: Cardiopulmonary Resuscitation; Emergency Medical Services; Humans; Out-of-Hospital Cardiac Arrest; Patient Discharge; Patient Outcome Assessment; Physicians; Survival Analysis; Time Factors
PubMed: 26747085
DOI: 10.1186/s13054-015-1156-6 -
Annals of Family Medicine May 2018Various models of care delivery have been investigated to meet the increasing demands in primary care. One proposed model is comanagement of patients by more than 1... (Review)
Review
PURPOSE
Various models of care delivery have been investigated to meet the increasing demands in primary care. One proposed model is comanagement of patients by more than 1 primary care clinician. Comanagement has been investigated in acute care with surgical teams and in outpatient settings with primary care physicians and specialists. Because nurse practitioners are increasingly managing patient care as independent clinicians, our study objective was to propose a model of nurse practitioner-physician comanagement.
METHODS
We conducted a literature search using the following key words: comanagement; primary care; nurse practitioner OR advanced practice nurse. From 156 studies, we extracted information about nurse practitioner-physician comanagement antecedents, attributes, and consequences. A systematic review of the findings helped determine effects of nurse practitioner-physician comanagement on patient care. Then, we performed 26 interviews with nurse practitioners and physicians to obtain their perspectives on nurse practitioner-physician comanagement. Results were compiled to create our conceptual nurse practitioner-physician comanagement model.
RESULTS
Our model of nurse practitioner-physician comanagement has 3 elements: effective communication; mutual respect and trust; and clinical alignment/shared philosophy of care. Interviews indicated that successful comanagement can alleviate individual workload, prevent burnout, improve patient care quality, and lead to increased patient access to care. Legal and organizational barriers, however, inhibit the ability of nurse practitioners to practice autonomously or with equal care management resources as primary care physicians.
CONCLUSIONS
Future research should focus on developing instruments to measure and further assess nurse practitioner-physician comanagement in the primary care practice setting.
Topics: Delivery of Health Care; Humans; Models, Theoretical; Nurse Practitioners; Organizational Culture; Physician-Nurse Relations; Physicians, Primary Care; Primary Health Care; Professional Role
PubMed: 29760030
DOI: 10.1370/afm.2230 -
The Journal of Medical Investigation :... 2023This study aimed to conduct a systematic review to clarify patient understanding, understanding of caring concepts, understanding of technology, competency to express...
This study aimed to conduct a systematic review to clarify patient understanding, understanding of caring concepts, understanding of technology, competency to express compassion, appropriate involvement in caring, and ethical and moral attitudes and responses toward patients. This systematic review was conducted through an electronic search across PubMed, Google Scholar, MEDLINE, and Science Direct. Authors independently appraised the methodological quality of the studies using the Mixed Method Appraisal Tool. A narrative synthesis approach was used to present these findings. Nine studies met the inclusion criteria and quality appraisal guidelines. Through thematic analysis, four major themes were identified:Technology and caring competency, Technology and patient-centered care, Empathetic skills, and Caring competency. This review has shown that patients choose physicians considering their emotions and communicate well with them, empowering them to take responsibility of their own or their loved ones' healthcare. In the age of technological advancement and availability of vast sources of information, it is expected of physicians to adapt to these character priorities while maintaining their sense of humanness, not only focusing on healing modalities, but also to guide, educate, and appropriately empower their patients toward achieving their healthcare goals. J. Med. Invest. 70 : 307-316, August, 2023.
Topics: Humans; Technology; Empathy; Physicians; Patient-Centered Care; Health Facilities
PubMed: 37940512
DOI: 10.2152/jmi.70.307 -
BMC Primary Care Dec 2023Although previous studies have reported general inexperience with the Epley manoeuvre (EM) among general physicians, no report has evaluated the effect of EM on benign... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Although previous studies have reported general inexperience with the Epley manoeuvre (EM) among general physicians, no report has evaluated the effect of EM on benign paroxysmal positional vertigo (BPPV) in primary care by using point estimates or certainty of evidence. We conducted this systematic review and meta-analysis and clarified the efficacy of EM for BPPV, regardless of primary-care and subspecialty settings.
METHODS
Systematic review and meta-analysis of randomised sham-controlled trials of EM for the treatment of posterior canal BPPV in primary-care and subspecialty settings. A primary-care setting was defined as a practice setting by general practitioners, primary-care doctors, or family doctors. A systematic search was conducted in January 2022 across databases, including Cochrane Central Resister of Controlled Trial, MEDLINE, Embase, Cumulative Index of Nursing and Allied Health Literature, World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov. Primary outcomes were the disappearance of subjective symptoms (vertigo), negative findings (Dix-Hallpike test), and all adverse events. We evaluated the certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluation approach.
RESULTS
Twenty-seven randomised controlled trials were identified. In primary-care settings, EM reduced the subjective symptoms [risk ratio (RR), 3.14; 95% confidence interval (CI), 1.96-5.02]; however, there was no applicable article for all adverse events. In the subspeciality setting, EM reduced the subjective symptoms (RR, 2.42; 95% CI, 1.64-3.56), resulting in an increase in negative findings (RR, 1.81; 95% CI, 1.40-2.34). The evidence exhibited uncertainty about the effect of EM on negative findings in primary-care settings and all adverse events in subspecialty settings.
CONCLUSIONS
Regardless of primary-care and subspecialty settings, EM for BPPV was effective. This study has shown the significance of performing EM for BPPV in primary-care settings. EM for BPPV in a primary-care setting may aid in preventing referrals to higher tertiary care facilities and hospitalisation for follow-up.
TRIAL REGISTRATION
The study was registered in protocols.io (PROTOCOL INTEGER ID: 51,464) on July 11, 2021.
Topics: Humans; Benign Paroxysmal Positional Vertigo; General Practitioners; Hospitalization; Language; MEDLINE
PubMed: 38042776
DOI: 10.1186/s12875-023-02217-z -
JAMA Oncology Jun 2019Significant controversy exists regarding whether physicians factor personal financial considerations into their clinical decision making. Within oncology, several...
IMPORTANCE
Significant controversy exists regarding whether physicians factor personal financial considerations into their clinical decision making. Within oncology, several reimbursement policies may incentivize physicians to increase health care use.
OBJECTIVE
To evaluate whether the financial incentives presented by oncology reimbursement policies affect physician practice patterns.
EVIDENCE REVIEW
Studies evaluating an association between reimbursement incentives and changes in reimbursement policy on oncology care delivery were reviewed. Articles were identified systematically by searching PubMed/MEDLINE, Web of Science, Proquest Health Management, Econlit, and Business Source Premier. English-language articles focused on the US health care system that made empirical estimates of the association between a measurement of physician reimbursement/compensation and a measurement of delivery of cancer treatment services were included. The Risk of Bias in Non-Randomized Studies of Interventions tool was used to assess risk of bias. There were no date restrictions on the publications, and literature searches were finalized on February 14, 2018.
FINDINGS
Eighteen studies were included. All were observational cohort studies, and most had a moderate risk of bias. Heterogeneity of reimbursement policies and outcomes precluded meta-analysis; therefore, a qualitative synthesis was performed. Most studies (15 of 18 [83%]) reported an association between reimbursement and care delivery consistent with physician responsiveness to financial incentives, although such an association was not identified in all studies. Findings consistently suggested that self-referral arrangements may increase use of radiotherapy and that profitability of systemic anticancer agents may affect physicians' choice of drug. Findings were less conclusive as to whether profitability of systemic anticancer therapy affects the decision of whether to use any systemic therapy.
CONCLUSIONS AND RELEVANCE
To date, this study is the first systematic review of reimbursement policy and clinical care delivery in oncology. The findings suggest that some oncologists may, in certain circumstances, alter treatment recommendations based on personal revenue considerations. An implication of this finding is that value-based reimbursement policies may be a useful tool to better align physician incentives with patient need and increase the value of oncology care.
Topics: Humans; Observational Studies as Topic; Oncologists; Physician Self-Referral; Practice Patterns, Physicians'; Reimbursement, Incentive
PubMed: 30605222
DOI: 10.1001/jamaoncol.2018.6196 -
BMC Medical Education Apr 2022Recognizing that physicians may struggle to achieve knowledge, skills, attitudes and or conduct at one or more stages during their training has highlighted the...
BACKGROUND
Recognizing that physicians may struggle to achieve knowledge, skills, attitudes and or conduct at one or more stages during their training has highlighted the importance of the 'deliberate practice of improving performance through practising beyond one's comfort level under guidance'. However, variations in physician, program, contextual and healthcare and educational systems complicate efforts to create a consistent approach to remediation. Balancing the inevitable disparities in approaches and settings with the need for continuity and effective oversight of the remediation process, as well as the context and population specific nature of remediation, this review will scrutinise the remediation of physicians in training to better guide the design, structuring and oversight of new remediation programs.
METHODS
Krishna's Systematic Evidence Based Approach is adopted to guide this Systematic Scoping Review (SSR in SEBA) to enhance the transparency and reproducibility of this review. A structured search for articles on remediation programs for licenced physicians who have completed their pre-registration postings and who are in training positions published between 1st January 1990 and 31st December 2021 in PubMed, Scopus, ERIC, Google Scholar, PsycINFO, ASSIA, HMIC, DARE and Web of Science databases was carried out. The included articles were concurrently thematically and content analysed using SEBA's Split Approach. Similarities in the identified themes and categories were combined in the Jigsaw Perspective and compared with the tabulated summaries of included articles in the Funnelling Process to create the domains that will guide discussions.
RESULTS
The research team retrieved 5512 abstracts, reviewed 304 full-text articles and included 101 articles. The domains identified were characteristics, indications, frameworks, domains, enablers and barriers and unique features of remediation in licenced physicians in training programs.
CONCLUSION
Building upon our findings and guided by Hauer et al. approach to remediation and Taylor and Hamdy's Multi-theories Model, we proffer a theoretically grounded 7-stage evidence-based remediation framework to enhance understanding of remediation in licenced physicians in training programs. We believe this framework can guide program design and reframe remediation's role as an integral part of training programs and a source of support and professional, academic, research, interprofessional and personal development.
Topics: Attitude; Humans; Medicine; Physicians; Reproducibility of Results
PubMed: 35443679
DOI: 10.1186/s12909-022-03278-x -
Journal of Medical Internet Research Feb 2022The internet has now become part of human life and is constantly changing people's way of life. With the increasing popularity of online health information (OHI), it has... (Review)
Review
BACKGROUND
The internet has now become part of human life and is constantly changing people's way of life. With the increasing popularity of online health information (OHI), it has been found that OHI can affect the physician-patient relationship by influencing patient behaviors.
OBJECTIVE
This study aims to systematically investigate the impact of OHI-seeking behavior on the physician-patient relationship.
METHODS
Literature retrieval was conducted on 4 databases (Web of Science, PubMed, China National Knowledge Infrastructure, SinoMed), and the time limit for literature publication was before August 1, 2021.
RESULTS
We selected 53 target papers (42 [79%] English papers and 11 [21%] Chinese papers) that met the inclusion criteria. Of these, 31 (58%) papers believe that patients' OHI behavior can enable them to participate in their own medical care, improve patient compliance, and improve the physician-patient relationship. In addition, 14 (26%) papers maintain a neutral attitude, some believing that OHI behavior has no significant effect on doctors and patients and others believing that due to changes in the factors affecting OHI behavior, they will have a negative or a positive impact. Furthermore, 8 (15%) papers believe that OHI search behavior has a negative impact on doctors and patients, while 6 (11%) papers show that OHI reduces Chinese patients' trust in doctors.
CONCLUSIONS
Our main findings showed that (1) OHI-seeking behavior has an impact on patients' psychology, behavior, and evaluation of doctors; (2) whether patients choose to discuss OHI with doctors has different effects on the physician-patient relationship; and (3) the negative impact of OHI on China's internet users is worthy of attention. Due to the low quality of OHI, poor health information literacy, short physician-patient communication time, and various types of negative news, patients' trust in doctors has declined, thus affecting the physician-patient relationship. Improvement of people's health information literacy and the quality of OHI are important factors that promote the positive impact of OHI on the physician-patient relationship.
Topics: Humans; Information Seeking Behavior; Internet; Physician-Patient Relations; Physicians; Surveys and Questionnaires; Trust
PubMed: 35142620
DOI: 10.2196/23354 -
International Journal For Equity in... Feb 2021Utilization of primary-care and specialist physicians seems to be associated differently with socioeconomic status (SES). This review aims to summarize and compare the... (Review)
Review
BACKGROUND
Utilization of primary-care and specialist physicians seems to be associated differently with socioeconomic status (SES). This review aims to summarize and compare the evidence on socioeconomic inequalities in consulting primary-care or specialist physicians in the general adult population in high-income countries.
METHODS
We carried out a systematic search across the most relevant databases (Web of Science, Medline) and included all studies, published since 2004, reporting associations between SES and utilization of primary-care and/or specialist physicians. In total, 57 studies fulfilled the eligibility criteria.
RESULTS
Many studies found socioeconomic inequalities in physician utilization, but inequalities were more pronounced in visiting specialists than primary-care physicians. The results of the studies varied strongly according to the operationalization of utilization, namely whether a physician was visited (probability) or how often a physician was visited (frequency). For probabilities of visiting primary-care physicians predominantly no association with SES was found, but frequencies of visits were higher in the most disadvantaged. The most disadvantaged often had lower probabilities of visiting specialists, but in many studies no link was found between the number of visits and SES.
CONCLUSION
This systematic review emphasizes that inequalities to the detriment of the most deprived is primarily a problem in the probability of visiting specialist physicians. Healthcare policy should focus first off on effective access to specialist physicians in order to tackle inequalities in healthcare.
PROSPERO REGISTRATION NUMBER
CRD42019123222 .
Topics: Adult; Health Services Accessibility; Healthcare Disparities; Humans; Income; Physicians; Primary Health Care; Social Class; Socioeconomic Factors; Specialization
PubMed: 33568126
DOI: 10.1186/s12939-020-01375-1