Evidence Based Practice and Patient Needs: Difference between revisions
No edit summary |
No edit summary |
||
Line 257: | Line 257: | ||
|} | |} | ||
You can read more about the PICOT Research question [[PICOT Research Question|here]] | |||
Revision as of 08:00, 6 November 2023
This article or area is currently under construction and may only be partially complete. Please come back soon to see the finished work! (6/11/2023)
Original Editor - User Name
Top Contributors - Wanda van Niekerk and Jess Bell
Introduction[edit | edit source]
Step one of the evidence based practice (EBP) model is to determine the needs of the patient to formulate a clinical question. This step involves assessing the patient and determining the extent of their condition, their values and beliefs, and their specific context and preferences. All of this information will be useful in formulating the clinical question. This step correlates with the Ask component of the 5 A’s of EBP.
Interview Principles[edit | edit source]
- Patient-centredness
- Patient-centredness is defined as: “Health care that establishes a partnership among practitioners, patients and their families… to ensure that decisions respect patients’ wants, needs, and preferences and that patients have the education and support they need to make decisions and participate in their own care.”[1]
- Patient-centredness is positively associated with[2]:
- patient satisfaction
- well-being
- adherence
- health behaviour
- knowledge about medical condition and recovery rate
- In an assessment of patient perspectives on patient-centredness the following aspects are noted as most important to patients[2]:
- being taken seriously
- receiving competent treatment with empathy
- being recognised as individuals in exceptional circumstances
- enough time during treatment sessions
- timely access to care
- Non-verbal communication
- This includes aspects such as[3]:
- eye contact
- posture
- tone of voice
- head nods
- gestures
- postural positions
- In cases where verbal and non-verbal messages contradict each other, non-verbal communication tends to outweigh the verbal message. Empathy and emotion are communicated more distinctively via non-verbal communication than verbally, making good non-verbal communication an integral, often overlooked part of the medical interview. Empathy is expressed by acting warm, friendly and reassuring, and has been linked with better patient satisfaction and recovery rates, and subsequently better health outcomes.[3]
- This includes aspects such as[3]:
- Amount of information
- Avoid information overload - more information is not always better as patients can forget between 40 – 80% of the medical information that they receive.
- Providing the patient with too little information will decrease patient satisfaction
- Adherence to advice/ treatment
- Adherence is defined as: “the extent to which a person conforms to the the agreed-upon recommendations of a health care provider.” [4]
- Factors that may influence patient adherence to treatment include[5]:
- level of motivation
- self-discipline
- acceptance of specific treatments
- perceived effectiveness of treatment
- beliefs and attitudes
- cultural background
- communicative aspects
- communication skills of healthcare professionals
- motivation of healthcare professional to enhance the self-efficacy of patients
- healthcare professional – patient relationship
- professional experience of healthcare professional
- Patient concerns
- Allowing patients to discuss their concerns about their health reduces emotional stress and increases symptom resolution. Patients who can share their concerns in a safe environment feels heard, valued and more hopeful. It also leads to the patient providing invaluable information on their experience of their illness, injury or condition.[6]
All these principles leads to building a better relationship with your patient. It also builds trust and this leads to a patient feeling safe and comfortable enough to volunteer information that you need to formulate an accurate clinical question. Healthcare providers can built patients’ trust by[7]:
- effective communication
- caring about their patients
- demonstrating competence
Subjective Interview[edit | edit source]
Ask an open question: “For which problem did you come to physiotherapy today?” or “Do you want to just tell me a little bit about your [problem presentation] first of all?"[8]
Table 1 provides an overview of some of the questions that can be asked as part of the patient interview.[9] Note that these can differ within different healthcare professions.
Patient context and their perspective |
|
---|---|
Symptoms |
|
Behaviour of symptoms |
|
History of present condition |
|
Family and socio-economic history |
|
Medical screening questions/ special questions | Red flags to consider:
Other medical conditions to ask about(DEARTH)
Yellow flags (Psychosocial factors that can increase the risk of developing chronic pain) to consider:
|
Patient expectations |
|
Physical Examination[edit | edit source]
A short overview of the physical examination is shown in Table 2. Note that this will differ across different healthcare professions.
Observation |
|
---|---|
Movement Tests |
|
Joint integrity tests | Ligament stress tests |
Muscle tests |
|
Nerve tests |
|
Special tests | Vascular |
Palpation |
|
Joint tests | Accessory movements to test joint glides/ movement in different directions |
Formulating the Clinical Question[edit | edit source]
Once you have gathered all the relevant information through the subjective and physical examination and applied clinical reasoning you can formulate a clinical question. The PICOT clinical question model is a useful tool to use. It helps with:
- formulating a question which focuses on an important issue for a patient or population
- identification of important terminology to used while searching for evidence
- filter and select results related to the topic of interest
The different components of this model are:
P | Patient, population, problem |
|
---|---|---|
I | Intervention |
|
C | Comparator |
|
O | Outcomes |
|
T | Type - type of intervention question; type of treatment; type of studies
Time |
|
You can read more about the PICOT Research question here
Sub Heading 2[edit | edit source]
Sub Heading 3[edit | edit source]
Resources[edit | edit source]
- bulleted list
- x
or
- numbered list
- x
References[edit | edit source]
- ↑ Edgman-Levitan S, Schoenbaum SC. Patient-centered care: achieving higher quality by designing care through the patient’s eyes. Israel Journal of Health Policy Research. 2021 Dec;10:1-5.
- ↑ 2.0 2.1 Zeh S, Christalle E, Zill JM, Härter M, Block A, Scholl I. What do patients expect? Assessing patient-centredness from the patients’ perspective: an interview study. BMJ open. 2021 Jul 1;11(7):e047810.
- ↑ 3.0 3.1 Vogel, D., Meyer, M., Harendza, S., 2018. Verbal and non-verbal communication skills including empathy during history taking of undergraduate medical students. BMC Med. Educ. 18, 157.
- ↑ WHO. World Health Organisation. Adherence to Long Term Therapies – Evidence for Action. WHO Library Cataloguing-in-Publication Data. 2003.
- ↑ Alt A, Luomajoki H, Luedtke K. Which aspects facilitate the adherence of patients with low back pain to physiotherapy? A Delphi study. BMC Musculoskeletal Disorders. 2023 Jul 27;24(1):615.
- ↑ Drossman DA, Chang L, Deutsch JK, Ford AC, Halpert A, Kroenke K, Nurko S, Ruddy J, Snyder J, Sperber A. A review of the evidence and recommendations on communication skills and the patient–provider relationship: a Rome foundation working team report. Gastroenterology. 2021 Nov 1;161(5):1670-88.
- ↑ Greene J, Ramos C. A mixed methods examination of health care provider behaviors that build patients’ trust. Patient Education and Counseling. 2021 May 1;104(5):1222-8.
- ↑ Chester EC, Robinson NC, Roberts LC. Opening clinical encounters in an adult musculoskeletal setting. Manual Therapy. 2014 Aug 1;19(4):306-10.
- ↑ 9.0 9.1 9.2 Ryder D, Barnard K, editors. Petty's Musculoskeletal Examination and Assessment, Edition 6: A Handbook for Therapists. Elsevier Health Sciences; 2023.