Low value clinical practices from the citizenry’s perspective

13 Oct

During the fifth edition of the international Preventing Overdiagnosis Congress, strategies for implementing solutions to avoid overdiagnosis and overuse were addressed based on the available scientific evidence.

In this year’s edition, which was held in Barcelona last year, apart from the involvement of professionals and organisations, patients had the opportunity to actively participate.

Experiences in different healthcare areas were shown in the use of best practices to communicate and to empower patients to achieve a better understanding of shared decisions.

Different world initiatives addressed the best practices to empower citizens in subjects related to low value practices, overdiagnosis and overtreatment. Experiences were shared and a debate was initiated on fundamental subjects such as the communication and participation of patients.

In recent years, the Essencial Project has studied the perspective of health professionals on low value practices, their causes and possible solutions so as to avoid them.

Essencial Project team: Cari Almazán, Johanna Caro, Liliana Arroyo and Hortènsia Aguado

For example, in a previous post, we explained the results of a survey we carried out with professionals in the field of primary care. The results of this survey highlighted the need to involve and empower the population more. Patients are also important decision makers in relation to their needs and in the demand for certain health services. Hence, the project must be accompanied by a communications strategy aimed not only at patients but also at citizens in general.

That is why we, from the Essencial Project, have been interested in finding out the opinion of patients in addition to the perspective of professionals. In the international Preventing Overdiagnosis 2017 Congress we participated explaining how an exploratory first approach was made to identify the beliefs, attitudes and perceptions of patients regarding the most important elements in consultations, low value practices and the essential components of an effective dialogue between professionals and patients. The end purpose of this was to understand the position of people before initiating possible interventions in the citizenry and to determine the most effective communicative tools and channels.

In Catalonia, AQuAS carried out the first exploratory qualitative study at the end of 2016 using a focus group of parents and children assigned to a primary care team. Low value practices in paediatrics are frequently associated with an over-diagnosis regarding antibiotics, bronchodilatadors, antipyretics or imaging tests, among others. These scenarios have been transferred to the debate with patients themselves. In total, seven women, mothers and grandmother of 14 children participated.

The first point of discussion was the most important elements in a consultation with health professionals and it was found that the treatment (29%) and information received (28%) are the most important elements received by professionals (representing approximately 60% of those mentioned). The relationship with the professional comes next (15%, often related to the degree of trust), followed by the feeling that their wishes or needs are met (12%), information requested (9%) and the diagnosis (5%).

The participants did not know the concept of low value practice but did recognise situations of an excessive prescription of medication or the request of unnecessary tests, especially in emergency services and private consultations.

Regarding communication, the participants said they appreciated that professionals communicate in a simple and direct manner, explaining the reasons for decisions. Similarly, that they felt it was important to receive printed information from professionals which they could peruse later at home. They also said they would like more informative sessions or community groups where these types of subjects could be explained to them and so gain more knowledge about these types of practices.

In our context, this is the first exploratory study done to identify low value practices and the communicative strategies of the citizenry, being the start of a series of studies on the population. Nonetheless, one of the limitations with which we find ourselves was that the participation was lower than expected. Although the term ‘low value practices’ is not known, participants identify situations in which they have experienced them.

Similarly, it is important to underline how patients value the treatment and information received as well as the professional-patient relationship. In the same way, patients recognise the need for a professional’s communication skills and the need for tools to support an effective communicative exchange.

Post written by Johanna Caro Mendivelso (@jmcaro103).

Communicate what?? Communication skills for health care professionals

30 Jun

Carme CarrionGood morning Doctor”, “I have a headache”, “Can you give something to help me sleep”, “Take these and come back to see me in a few days” …. exchanges like these are common in the day-to-day between health professionals and patients. The words are often spoken in a distant and stressful setting, in which the computer far too often takes centre stage.

In a modern world where technology has come to play a significant role, the patient may sometimes be relegated to the back seat.

It seems a contradiction to say that in the age of communication, everybody seems to communicate less and even communicate worse, but unfortunately this is a reality and in by no means is this exclusive to the relationship between professional and patient.

When we refer to communicating “less” here, we do not mean in terms of quantity but mostly in terms of the quality of communication. There are very few practices in the world of health that do not involve communication, as such a good bedside manner is an essential part of patient-professional communication, between health professionals or with the general public.

For over 30 years, the Toronto Consensus Report has been highlighting the need for greater efforts to improve clinical communication. They often refer to the importance of emotion-based medicine, which states that the doctor-patient relationship should be based on the assumption that patients are sufficiently mature and aware of their health status. We come from an authoritarian society and a medical practice based on paternalistic models.

The democratic values ​​of our society may never have been all that sound and we’re still learning. Society itself has often bestowed on doctors a privileged social position that tends not to facilitate a suitable flow of communication with patients.

Obviously, there are other factors which do not help or make life easy for professionals, such as their heavy workload or the design of physicians’ facilities which clearly have not been fashioned with the patient in mind.

The training of health professionals is probably a key tool in ensuring that our physicians, and nurses are people with a close connection to their patients, interested in and capable of listening, interpreting, understanding non-verbal communication, are compassionate and assertive. In addition to addressing technical and technological aspects of the sector, medical and nursing faculties must also make room for the ethical and humanistic aspect of the studies.

There are plenty of initiatives becoming available to assist healthcare students in developing communication skills with the capacity to ensure that the relationship between professionals and patients is much more effective and affective.

However, once we have established the importance of these skills in the future professional’s curriculum, their acquisition becomes compulsory and their assessment critical. Recently, a set of recommended modifications to student curricula were published, regarding both content and teaching strategies to be used in different countries and settings (Kiessling, Bachmann, García de Leonardo).

It seems that consensus is not far off and therefore, all that remains is to implement these proposals in our universities and medical centres. When this takes place, it will most likely mean a win-win situation for all those involved.

Surely if we can manage to train our professional staff to be compassionate, assertive, practice active listening and empower patients in decision making, then we will achieve better health outcomes and greater wellbeing for both patients and their families, not to mention for the health professionals themselves.

Post written by Carme Carrion (@CarmeCarrion), Professor of Healthcare Studies at the Universitat Oberta de Catalunya (UOC) and Associate Professor at the Universitat de Girona (UdG).