Comparing patient talk to physician notes

From patient talk to physician notes—Comparing the content of medical interviews with medical records in a sample of outpatients in Internal Medicine Patient Education and Counseling Volume 76, Issue 3, Pages 336-340 (September 2009
An increasing number of consultations are delivered in group practices, where a stable 1:1 relationship between patient and physician cannot be guaranteed. Therefore, correct documentation of the content of a consultation is crucial to hand over information from one health care professional to the next.Methods: We randomly selected 20 interviews from a series of 56 videotaped consultations with patients requesting a general check-up exam in the outpatient department of Internal Medicine at the University Hospital Basel. All patients actively denied having any symptoms or specific health concerns at the time they made their appointment. Videotapes were analysed with the Roter Interaction Analysis System (RIAS). Corresponding physician notes were analysed with a category check-list that contained the information related items from RIAS.Results: Interviews contained a total of 9.002 utterances and lasted between 15 and 53min (mean duration: 37min). Patient-centred communication (Waiting, Echoing, Mirroring, Summarising) in the videos significantly correlated with the amount of information presented by patients: medical information (r=.57; p=.009), therapeutic information (r=.50; p=.03), psychosocial information (r=.41; p=.07), life style information (r=.52; p=.02), and with the sum of patient information (r=.64; p=.003). Even though there was a significant correlation between the amount of information from the video and information in physician's notes in some categories (patient gives medical information; Pearson's r=.45; p=.05, patient gives psychosocial information; Pearson's r=.49; p=.03), an inspection of the regression lines shows that a large extent of patient information is omitted from the charts. Physicians never discussed with patients whether information should be documented in the charts or omitted.Conclusions: The use of typical patient-centred techniques increases information gathered from patients. Physicians document only a small percentage of patient information in the charts, their ‘condensing heuristic’ is not shared with patients.Practice implications: Patient involvement should be advocated not only to medical decision making but also to the way physicians document the content of a consultation. It is a joint responsibility of patient and health care professional to decide, which information should be kept and thus be communicated to another health care professional in future consultations."

Your Doctor

Your Doctor’s Office or the Internet? Two Paths to Personal Health Records

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Diabetes 2.0 Resources at Webicina

More than 200 million people suffer from diabetes worldwide and it is one of those medical conditions that are covered in details online. The medical blogosphere and the community sites are very rich in diabetes-related content. From Bertalan Mesko's Webicina site (also Weight Loss 2.0, Depression 2.0, Cancer 2.0, Pregnancy 2.0)

* Diabetes News and Forums
* Diabetes in the medical blogosphere
* Diabetes Podcasts and Interviews
* Community Sites and FaceBook Groups
* Microblogging: Twitter and Friendfeed
* Diabetes Wikis
* Diabetes videos, animations and videocasts
* Diabetes On Mobile
* Second Life, the virtual world
* Social Bookmarking and Diabetes
* Medical Search Engines
* Diabetes Slideshows

Thinking Outside the Pillbox

In its new research brief, "Thinking Outside the Pillbox," NEHI addresses the root causes of poor patient medication adherence - a significant contributor to overall health care waste - and offers promising solutions to improve adherence, particularly among chronic disease patients

"Experts stress that patients not only vary across a continuum of knowledge (their health literacy, their understanding of their disease and so on), they vary across a continuum of willingness and ability to adhere as well. This variability among patients also extends to patients’ proclivity to persist in adherence over time – thus a successful adherence strategy must provide continuity of care and follow-up. The odds that an adherence strategy will be successful are related to how well the strategy can first identify the varying needs of individual patients, and then match services accordingly. An ideal adherence strategy should be patient-centered and holistic taking into account everything from lifestyle to cultural and belief systems."

Prescription Medication Adherence: Provider and Patient Perspective (Focus Group Report)

Ted Eytan on the National Consumers League/AHRQ Focus group report: Prescription Medication Adherence (pdf)

"there are actually a broad array of technology approaches to supporting adherence, including reminder systems (whose innovation should be incorporated into a comprehensive strategy to be sure). Those technology approaches may be most cost-effectively applied as close to the provider patient relationship as possible, to include things like:

* An after-visit summary after every encounter (whether on the phone, e-mail, or in person), with an accurate medication list that the patient + family + support can verify and ask questions about
* Education aids in every encounter to promote understanding of medication use to include the “why?” as well as the “what?”
* Accessible two-way communication (phone, e-mail) before, during, and after every encounter. "

The Pill Phone

Mobile medication reminder and guide

Doctor-Patient Communication Suboptimal

Doctor-Patient Communication Suboptimal

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Concordance 2.0....

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