Persuading patients to take their prescribed medicines has long been regarded as problematic, and this non-compliance often has serious and wide reaching outcomes. Concordance is a new way of looking at the processes within the consultation, and allowing the patients agenda to be taken into account when coming to a management decision. This new book not only provides a concise overview of the area but describes its implications for practice. Written by a multidisciplinary team, no other publication on concordance has the depth and breadth of coverage. It will be of interest to all healthcare professionals, academics and students with an interest in this emerging area.
The capacity of professional medicine to resist change - and also concordance - is impressive, but perplexing. It is one of the issues I seek to address in this book. I suggest that a preoccupation with trying to change the relationship between the professional-patient dyad has deflected attention from the extent to which such relations are embedded in, and constrained by, wider administrative and organisational structures, especially as these relate to the operation of professional hierarchies and interprofessional deference and allegiances. Barriers to change also result from the inertia of a system which has evolved a highly stylised etiquette as an adaptive mechanism to contain the difficulties and tensions intrinsic to the medical consultation. Its therapeutic purpose and potential are often subordinate to the goal of achieving success as a social encounter. The principles of concordance are deeply challenging to traditional professional roles and status. However, medicine has always displayed an ability to block change through tactics of appropriation and incorporation. Professionals have often shown particular difficulty giving up their monopoly of 'expertise' and in acknowledging the legitimacy of the patient perspective. Although the term 'concordance' has become quite widely used, its meaning is usually subverted by its employment as a synonym for 'compliance', albeit 'informed' compliance. A slightly more sophisticated version values professional elicitation of the patient perspective in order to more accurately tailor information as a means of overcoming the unhelpful m/sconceptions that impede compliance. The original emphasis on the consultation as a negotiated exchange, in which the professional has something of value to learn from the patient, has largely been lost. The rhetoric of modernity and change provides an effective mask for inertia and conservatism. Preface.
Racial and ethnic disparities in health care are known to reflect access to care and other issues that arise from differing socioeconomic conditions. There is, however, increasing evidence that even after such differences are accounted for, race and ethnicity remain significant predictors of the quality of health care received. In Unequal Treatment, a panel of experts documents this evidence and explores how persons of color experience the health care environment. The book examines how disparities in treatment may arise in health care systems and looks at aspects of the clinical encounter that may contribute to such disparities. Patients' and providers' attitudes, expectations, and behavior are analyzed. How to intervene? Unequal Treatment offers recommendations for improvements in medical care financing, allocation of care, availability of language translation, community-based care, and other arenas. The committee highlights the potential of cross-cultural education to improve provider-patient communication and offers a detailed look at how to integrate cross-cultural learning within the health professions. The book concludes with recommendations for data collection and research initiatives. Unequal Treatment will be vitally important to health care policymakers, administrators, providers, educators, and students as well as advocates for people of color.
The book introduces the reader to one of the most provocative conceptual models in nursing today. It breaks new ground not only in its presentation of the Intersystem Model but also in its in-depth treatment of the spiritual subsytem as an intrinsic part of the biological-psychosocial-spiritual triad. The contributors provide case examples and concrete tools that will allow readers to apply the model and incorporate it into their personal and conceptual framework of practice.
For patients and their loved ones, no care decisions are more profound than those made near the end of life. Unfortunately, the experience of dying in the United States is often characterized by fragmented care, inadequate treatment of distressing symptoms, frequent transitions among care settings, and enormous care responsibilities for families. According to this report, the current health care system of rendering more intensive services than are necessary and desired by patients, and the lack of coordination among programs increases risks to patients and creates avoidable burdens on them and their families. Dying in America is a study of the current state of health care for persons of all ages who are nearing the end of life. Death is not a strictly medical event. Ideally, health care for those nearing the end of life harmonizes with social, psychological, and spiritual support. All people with advanced illnesses who may be approaching the end of life are entitled to access to high-quality, compassionate, evidence-based care, consistent with their wishes. Dying in America evaluates strategies to integrate care into a person- and family-centered, team-based framework, and makes recommendations to create a system that coordinates care and supports and respects the choices of patients and their families. The findings and recommendations of this report will address the needs of patients and their families and assist policy makers, clinicians and their educational and credentialing bodies, leaders of health care delivery and financing organizations, researchers, public and private funders, religious and community leaders, advocates of better care, journalists, and the public to provide the best care possible for people nearing the end of life.
Written by leading teledermatologists and telemedicine experts, this hands-on guide addresses the practical needs of the many emerging teledermatology services worldwide. It covers the medical and technical prerequisites for such services as well as the photographic imaging essentials. It also illustrates the performance of teledermatology by means of clinical examples, discusses teledermatology in underdeveloped countries, and presents specialized methods of teledermatology. The impact of telemedicine on the doctor-patient relationship is explored, and the advantages that accrue from improving access to expert knowledge are explained. In addition, quality assurance, legal assumptions, economic aspects, and the future horizons of such health care services are all considered. A comprehensive appendix provides information on training opportunities, sample protocols, consent forms, information sheets, references, and relevant web links.
Bringing together treatment and referral advice from existing guidelines, this text aims to improve access to services and recognition of common mental health disorders in adults and provide advice on the principles that need to be adopted to develop appropriate referral and local care pathways.
The Institute of Medicine study Crossing the Quality Chasm (2001) recommended that an interdisciplinary summit be held to further reform of health professions education in order to enhance quality and patient safety. Health Professions Education: A Bridge to Quality is the follow up to that summit, held in June 2002, where 150 participants across disciplines and occupations developed ideas about how to integrate a core set of competencies into health professions education. These core competencies include patient-centered care, interdisciplinary teams, evidence-based practice, quality improvement, and informatics. This book recommends a mix of approaches to health education improvement, including those related to oversight processes, the training environment, research, public reporting, and leadership. Educators, administrators, and health professionals can use this book to help achieve an approach to education that better prepares clinicians to meet both the needs of patients and the requirements of a changing health care system.
