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PubMed1994

Why aren't more pharmacists counseling?

Clearly, the answers to the question "Why aren't more pharmacists counseling patients?" are complex. Factors affecting counseling vary by practice site, geographical region, and pharmacists' attitudes. Advocates of patient counseling may label many factors mentioned by workshop participants as "just excuses not to change" or may question their validity. However, our experiences have shown that these are real problems with logical explanations and relatively simple solutions. By focusing this column on the steps for overcoming these common barriers to counseling, we hope to help pharmacists expand their role in patient care.

Communication Barriers↗
PubMed1992

Balancing relevance and excellence: organizational responses to link research with decision making.

Research faces the challenge of balancing relevance to decision making and excellence in the strict adherence to the norms of scientific inquiry. This paper examines the organizational responses that can be undertaken to promote integration of these potentially conflicting goals. We posit that there seem to be structural barriers to effective communication between researchers and decision makers, such as differences in priorities, time management, language, means of communication, integration of findings and definition of the final product of research. These barriers must be overcome through solutions aimed at the organization of research. In this respect, there are three possible models to approach the tension between excellence and relevance: academic subordination, segregation and integration. Only the latter makes it possible to reconcile the advantages of proximity to decision making with the procedures to assure academic quality. In addition to organizational design and institutional development, a strategy to promote research must include a set of incentives to prevent the 'internal brain drain', that is, the tendency of researchers to move to managerial positions. There are four guiding principles to address this problem: parallel careers, academic autonomy, administrative sacrifice and inverted incentives. The complexities of health problems demand that we create new organizational formulas to finally balance relevance and excellence in research.

Communication↗
PubMed2006

Language barriers surrounding medication use among older Latinos.

Limited English language proficiency forms a significant challenge for many Latinos in clinical settings. Although medications are commonly used by older individuals as a means of maintaining good health and managing health problems, the extent to which English proficiency is related to medication use among older Latinos is not known. Focus groups were conducted with Latino, community-residing individuals aged 50 and over in eastern Massachusetts. Qualitative evaluation of the group interviews suggests that language is a barrier in dealing with medication for these individuals. Limited English proficiency appears to be related to feelings of being discriminated against in clinical and pharmacy settings. As well, communicating directly with health professionals in a common language is associated with level of trust and confidence in medical settings. Use of formal and informal interpreters, as well as seeking Spanish-speaking physicians and pharmacies with Spanish-speaking staff, are identified as strategies for overcoming health-related obstacles surrounding language.

Age Distribution↗
PubMed2002

Improving knowledge and communication through an advance directives objective structured clinical examination.

Many physicians and patients do not discuss care at the end of life and most practicing physicians have had little formal education concerning end-of-life discussions. To address this deficiency, our internal medicine residency faculty participated in the National End of Life Residency Education Project and implemented a series of educational initiatives including an advance directives Objective Structured Clinical Examination (OSCE). The 20-minute station assessed knowledge about the key issues that differentiate types of advance directives; and communication issues that arise when discussing advance directives. OSCE results revealed that most residents readily learned to differentiate types of advance directives, appreciated fear and psychosocial factors as barriers to communication, and emphasized that do-not-resuscitate (DNR) orders did not mean a lack of treatment. Residents had difficulty discussing the influence of coping style and psychological defensiveness on behavior, and recognizing that patient's thoughts and concerns about dying or DNR orders might influence end of life wishes and behavior. The Advance Directives OSCE is a useful initial assessment of knowledge and ability to address basic end of life issues.

Advance Directives↗
PubMed2003

Notifying emergency department patients of negative test results: pitfalls of passive communication.

OBJECTIVE: Many emergency departments that perform a high volume of group A Streptococcus throat cultures inform patients or parents that unless they are notified of a positive result they can assume that their throat culture result is negative. Thus, positive throat culture results are communicated actively and negative results are communicated passively. We sought to determine the effectiveness and safety of such a system. METHODS: Prospective cohort study of 301 consecutive patients who had group A Streptococcus throat cultures obtained between March 28, 2000, and May 10, 2000, in the emergency department of an urban, academic, tertiary-care children's hospital. Outcomes were determined by telephone surveys of patients or their parents or guardians. The primary outcome was whether respondents had accurate knowledge of the throat culture result. Secondary outcomes included receipt of appropriate treatment instructions, need for another telephone call to the emergency department or primary-care provider to clarify the result or treatment instructions, satisfaction with the communication process, and preference to receive both positive and negative results or just positive results. RESULTS: Fifty-three percent of respondents did not have accurate knowledge of the throat culture result, 5% received inappropriate treatment instructions, 13% sought further clarification, 29% were dissatisfied with the communication process, and 85% preferred to receive both positive and negative results. Parents of patients with positive results were more likely to have accurate knowledge of the result (odds ratio 6.9, 95% confidence interval 1.4-65.7) and to be satisfied with the communication process. CONCLUSIONS: Passive communication of negative throat culture results to patients seen in the emergency department can be unreliable. Active communication of both positive and negative results may improve patient knowledge and satisfaction and ensure appropriate therapy, but in the absence of automated notification systems, would be resource intensive.

Adolescent↗
PubMed2004

Creating cross-racial primary care relationships in a nurse-managed center.

Culturally incompetent communication patterns with providers influence the health disparities of African Americans. Limited knowledge exists on cross-racial nurse practitioner nurse-patient relationships (NP-NPRs). The purpose of this paper is to describe how NPs and patients in cross-racial relationships developed primary care relationships in one nurse managed center (NMC). A qualitative design incorporated a social constructivist paradigm and the methodology of Interpretive Interactionism. Twenty cross-racial NP-patient dyads (White NPs and Black patients) participated in individual 1 to 3-hour audiotaped interviews regarding their ongoing relationships and the impact of the NMC. The analysis uncovered a rich description of the relationship processes from the initial meeting to its current state. Multiple themes for each phase, as well as, four typologies of primary care cross-racial NP-NPRs are described. Significant relationship work was needed by both partners to overcome communication misunderstandings, contextual aspects of cross-racial interactions and other overt and covert perceptions.

Adaptation, Psychological↗
PubMed2000

Knowledge and communication difficulties for patients with chronic heart failure: qualitative study.

OBJECTIVES: To explore patients' understanding of chronic heart failure; to investigate their need for information and issues concerning communication. DESIGN: Qualitative analysis of in-depth interviews by a constant comparative approach. PARTICIPANTS: 27 patients identified by cardiology and care of the elderly physicians as having symptomatic heart failure (New York Heart Association functional class of II, III, or IV) and who had been admitted to hospital with heart failure in the past 20 months. RESULTS: Participants were aged 38-94 (mean 69 years); 20 had a New York Heart Association classification of III or IV. All had at least one concurrent illness. Participants sought information from the research interviewer about their heart failure, their prognosis, and likely manner of death. They also described several factors that could inhibit successful communication with their doctors. These included difficulties in getting to hospital appointments, confusion, short term memory loss, and the belief that doctors did not want to provide patients with too much knowledge. CONCLUSIONS: Good communication requires the ability both to listen and to impart relevant information. Effective and better ways of communicating with patients with chronic heart failure need to be tested. Disease specific barriers to effective communication, such as short term memory loss, confusion, and fatigue should be addressed. Strategies to help patients ask questions, including those related to prognosis, should be developed.

Adult↗
PubMed2005

Barriers to the integration of mind-body medicine: perceptions of physicians, residents, and medical students.

OBJECTIVE: This study of medical students, residents, and physicians examined their responses to focus group questions in an effort to understand barriers to discussing psychosocial issues and using mind-body interventions to address health issues. METHODS: Four focus groups were conducted: two with medical students and residents, one with primary care doctors, and one with physicians representing different specialties. Responses were audio recorded and transcribed verbatim. RESULTS: Factors identified as possible barriers to recognizing the importance of psychosocial/mind-body factors included lack of knowledge of evidence base, inadequate attention paid to the mind-body area in training, perceived lack of competence to use mind-body methods, inadequate time, lack of economic incentive, perception that psychosocial factors are beyond their capacity to control, tendency to perceive conditions as either biological or psychosocial in nature, perception that patients do not want to address psychosocial/lifestyle issues, and cultural beliefs that addressing the psychosocial domain is not within the purview of physicians. CONCLUSIONS: Despite evidence that psychosocial issues play an important role in health outcomes, students, residents, and practicing physicians reported that methods to deal with these issues are frequently given inadequate attention in medical training, and many physicians feel ill equipped to deal with these issues. In addition, environmental factors, including lack of time, insufficient monetary incentives, and a larger cultural ethos that favors the "quick-fix" over the more difficult task of examining the role of psychosocial factors, appear to serve as significant barriers to medicine's more fully embracing the biopsychosocial model.

Adult↗
PubMed2003

Barriers to physicians' decisions to discuss hospice: insights gained from the United States hospice model.

Due to its comprehensive and cost-saving design, hospice has become a critical component of health care. Physicians have become the primary gatekeepers to information on hospice and sources of referral to hospice. However, many physicians do not discuss hospice options until late in the disease course, when patients and their families are no longer able to benefit from hospice services. Although physicians, as well as patients and hospice personnel, cite patient and hospice structure factors as barriers, the present article will focus on barriers physicians have more control over, such as their discomfort discussing terminality and fear of losing contact with patients. Focusing on the American hospice model, the present article will review past findings, examine gaps in the research, and propose systematic ways to discern whether the factors physicians claim are barriers actually affect their decision making about hospice referral.

Attitude of Health Personnel↗
PubMedDate not supplied

Conducting research with urban elders: issues of recruitment, data collection, and home visits.

The National Institutes of Health 1994 guidelines require inclusion of minorities in research. People seeking grants need to be aware of techniques for recruitment of minority populations. The Boston University Alzheimer's Disease Center addresses difficult recruitment issues that arise from a skeptical minority population. The approach uses home visits to circumvent many of the barriers to recruitment and retention of participants in research studies.

Aged↗
PubMedDate not supplied

Cultural barriers to health care for southeast Asian refugees.

Many Southeast Asians now living in the United States experience severe health problems, attributable to physical trauma and inadequate health care in Asia, and low socioeconomic status in this country. Evidence indicates that despite their health problems, Southeast Asian refugees underuse the American health care system. Cultural reasons for this underuse are examined. Southeast Asian cultural attitudes toward suffering, such as beliefs that suffering is inevitable or that one's life span is predetermined, can cause Southeast Asians not to seek health care. Cultural beliefs about the sources of illness and correspondingly appropriate forms of treatment can be a barrier to Western health care. Many lack familiarity with Western diagnostic techniques and treatments and thus are apprehensive. Health care providers' ignorance of Southeast Asian cultures can interfere with communication with patients, resulting in culturally irrelevant services or misinterpretation of side effects of Southeast Asian folk medicines. Southeast Asians' lack of familiarity with American culture can make health care services geographically and economically inaccessible and can cause Southeast Asians to be ignorant of available services or how to access them. An understanding of Southeast Asian cultures and additional outreach efforts by Western medical practitioners and health care providers are needed to improve the use of health care services by Southeast Asian refugees in this country.

Adult↗
PubMed2005

Barriers to community integration for participants in community-based psychiatric rehabilitation.

This pilot study examined barriers to community integration for adults with serious mental illness (SMI) enrolled in a community-based psychiatric rehabilitation program. Program staff administered a self-report scale to 135 adults (mean age = 43.3 years, 53% men, 65.1% White). Staff completed the same measure. Individuals with mental illness and staff differed significantly in their reports of the type, number, F (1, 73) = 29.25, P < .0001, and severity (F (1, 176) = 43.53, P < .0001) of barriers to community integration. Clinicians should assist adults with SMI to identify relevant barriers, and participate in treatment planning and outcome evaluation.

Adult↗
PubMed2001

Barriers to providing effective mental health services to Asian Americans.

Using the research framework recommended by L. Rogler, R. Malgady, and D. Rodriguez (1989), the current paper examines the barriers to providing effective mental health services to Asian Americans. Beginning with the recognition that Asian Americans consists of numerous heterogeneous subgroups, the issue of the stereotype of Asian Americans as the "model minority" was also discussed. The primary focus of the paper is on Stages 2, 3, and 4 within the Rogler et al. (1989) model and the identification and discussion of cultural factors that hinder the delivery of mental health services to Asian Americans. The paper is therefore organized into these three sections: (a) help-seeking or mental health service utilization, (b) evaluation of mental health problems, and (c) psychotherapeutic services. In each of the sections, not only are the barriers to delivery of effective mental health services discussed but so are the research and methodological problems as well as some directions for future research. This critical review of the literature has been prepared with the goal of serving as a "blueprint" for us to pursue rigorous but relevant research to identify and reduce these cultural barriers to providing effective mental health services to Asian Americans.

Asian↗
PubMed2004

Facilitators and barriers to support group participation for family caregivers of adults with mental illness.

OBJECTIVE: Few low-income and minority caregivers of persons with serious mental illness participate in support groups. This study examined the facilitators and barriers to participation in support groups for families of persons with serious mental illness among lower socioeconomic African-American and Caucasian family caregivers. Three hypotheses were tested in a multivariate model which included need, enabling and predisposing variables utilizing a revised version of the Andersen model. Support group membership was hypothesized to be predicted by a higher perceived cost-benefit ratio (benefits minus costs) of group participation, fewer numbers of access barriers and higher levels of service use. METHODS: A non-experimental cross-sectional design was used. Subjects were 145 lower socioeconomic status African-American and Caucasian family caregivers, 65 of whom were current support group members and 80 of whom had never participated in support groups. RESULTS: Findings confirmed that support group members reported a more favorable cost-benefit ratio and fewer access barriers than did non-support group members, controlling for other variables. Level of non-support group service use was not significantly different for support and non-support group members. CONCLUSIONS: Non-members' assessments of support group participation may be based on inaccurate perceptions and/or incomplete knowledge. Educational campaigns, sponsored by support groups and mental health authorities focusing on both perceptions about support groups as well as structural impediments to participation, such as access barriers, should be undertaken.

Adult↗
PubMed2004

Communications with research participants and communities: foundations for best practices.

Communities and research participants increasingly feel that they have rights to be equal partners with researchers and to have access to the results of studies to which they have contributed. Concurrently, research sponsors have become aware of legal liabilities, societal repercussions, and credibility impacts of ignoring research communication responsibilities. However, issues related to research communications are rarely discussed at professional meetings or taught in academic programs. As a result, individual investigators may not be clear about their duties to communicate the results of their research. It is important to address this gap between expectations and abilities, because researchers' lack of communication fosters a climate of distrust in science and implies disinterest or disrespect for participants and communities. Ethical, legal, and professional frameworks and practices were reviewed to develop insights about principles, guidelines, and means that can be used to promote best practices. A review of general research guidance and specific requests for proposals revealed sponsors' communication priorities. While there are barriers to research communication, there is an increasing awareness among sponsors and investigators that effective and responsive communication is not a cheap or uniform add-on to a project or proposal. Communications must be tailored to the project considering all potential stakeholders, and resources need to be allocated specifically for communication activities within projects. Researchers, sponsors, professional societies and academia all have opportunities to improve principles, policies, frameworks, guidelines and strategies to foster "best practice" communication of research results.

Australia↗
PubMed2002

Communication skills: some problems in nursing education and practice.

This article is based on a literature review carried out as part of a study of communication skills training in pre-registration nursing education in England in 2000. A systematic literature search was conducted and 200 articles were found that were relevant to the study. Definitional problems were found, with terms such as communication skills and interpersonal skills being used interchangeably. The term communications strategies is suggested to overcome these problems, as it reflects the logical organization of a number of different communication skills within a theoretical or empirical framework. Problems in current communication skills teaching and social barriers to using communication skills in practice are discussed. It is concluded that problems continue to exist in these areas and that an emphasis on both aspects is needed if patient and staff satisfaction is to be improved.

Communication↗