Abstract:
OBJECTIVES:To examine how practice constraints contribute to barriers in the health care of persons with dementia and their families, particularly with respect to behavioral aspects of care. DESIGN:Cross-sectional qualitative interview study of primary care physicians. SETTING:Physicians' offices. PARTICIPANTS:Forty primary care physicians in Northern California. MEASUREMENTS:Open-ended interviews lasted 30-60 minutes and were structured by an interview guide covering clinician background and practice setting, clinical care of a particular patient, and general approach to managing patients with AD or dementia. Interviews were transcribed and themes reflecting constraints of practice were identified through a systematic coding process. RESULTS:Recurring themes (i.e., those present in > or = 25% of physician interviews) included insufficient time, difficulty in accessing and communicating with specialists, low reimbursement, poor connections with community social service agencies, and lack of interdisciplinary teams. Physician narratives suggest that these constraints may lead to delayed detection of behavior problems, "reactive" as opposed to proactive management of dementia, and increased reliance on pharmacological rather than psychosocial approaches. CONCLUSION:Physicians often feel challenged in caring for dementia patients, particularly those who are more behaviorally complex, because of time and reimbursement constraints as well as other perceived barriers. Our results suggest that more effective educational interventions (for families and physicians) and broader structural changes are needed to better meet the needs of the elderly with dementia and their families now and in the future. Without these changes, dementia care is likely to continue to fall short.
journal_name
J Gen Intern Medjournal_title
Journal of general internal medicineauthors
Hinton L,Franz CE,Reddy G,Flores Y,Kravitz RL,Barker JCdoi
10.1007/s11606-007-0317-ysubject
Has Abstractpub_date
2007-11-01 00:00:00pages
1487-92issue
11eissn
0884-8734issn
1525-1497journal_volume
22pub_type
杂志文章abstract:BACKGROUND:Patients and healthcare stakeholders are increasingly becoming engaged in the planning and conduct of biomedical research. However, limited research characterizes this process or its impact. OBJECTIVE:We aimed to characterize patient and stakeholder engagement in the 50 Pilot Projects funded by the Patient-...
journal_title:Journal of general internal medicine
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更新日期:2013-07-01 00:00:00
abstract::Twenty-five to sixty percent of physicians report burnout across all specialties. Changes in the healthcare environment have created marked and growing external pressures. In addition, physicians are predisposed to burnout due to internal traits such as compulsiveness, guilt, and self-denial, and a medical culture tha...
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pub_type: 杂志文章,多中心研究
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更新日期:2016-02-01 00:00:00
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更新日期:2012-06-01 00:00:00
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更新日期:2013-01-01 00:00:00
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更新日期:1991-01-01 00:00:00
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更新日期:1991-07-01 00:00:00
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pub_type: 杂志文章
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更新日期:2004-03-01 00:00:00
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doi:10.1007/s11606-011-1788-4
更新日期:2011-11-01 00:00:00
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更新日期:2019-10-01 00:00:00
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更新日期:2002-07-01 00:00:00
abstract:BACKGROUND AND OBJECTIVE:Affect and how it is regulated plays a role in pain perception, maintenance of pain, and its resolution. This randomized, controlled trial evaluated an innovative affective self-awareness (ASA) intervention, which was designed to reduce pain and improve functioning in individuals with fibromyal...
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doi:10.1007/s11606-010-1418-6
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更新日期:2002-04-01 00:00:00
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更新日期:2016-02-01 00:00:00
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更新日期:2018-05-01 00:00:00
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更新日期:2020-01-01 00:00:00
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更新日期:2010-12-01 00:00:00
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更新日期:2019-01-01 00:00:00
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pub_type: 杂志文章,多中心研究
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更新日期:2014-04-01 00:00:00
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更新日期:2006-10-01 00:00:00
abstract:OBJECTIVES:The telephone can facilitate medical care but also result in adverse outcomes leading to telephone-related malpractice suits. Analyzing claims might identify errors amenable to prevention. The objective of the study was to describe medical errors involving the telephone in patient-clinician encounters that s...
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更新日期:2008-05-01 00:00:00