Effects of improved patient participation in primary care on health-related outcomes: a systematic review.

BACKGROUND: In primary care, many consultations address symptom-based complaints. Recovery from these complaints seldom exceeds placebo effects. Patient participation, because of its supposed effects on trust and patient expectancies, is assumed to benefit patients' recovery. While the idea is theoretically promising, it is still unclear what the effects of increased patient participation are on patient outcomes. Aim. To review the effects of controlled intervention studies aiming to improve patient participation in face-to-face primary care consultations on patient-oriented and/or disease-oriented outcomes. METHODS: This study is a systematic review. A systematic search was undertaken for randomized controlled trials designed to measure the effects of interventions that aimed to improve adult patients' participation in primary care visits. The CINAHL, Cochrane, EMBASE, PsycINFO and PubMed databases were searched. RESULTS: Seven different trials fulfilled the inclusion criteria. Three of the studies were related to symptom-based complaints. Five studies measured patient-oriented outcomes, the primary outcome of interest for this review. All studies suffered from substantial bias. Studies varied widely in their aims, types of complaints/diseases, strength of the interventions and their outcomes. The effects on patient-oriented outcomes and disease-oriented outcomes were ambiguous. CONCLUSION: Little research has been performed on health outcomes of interventions aiming to increase patient participation in general practice visits among patients suffering from symptom-based complaints. The results still are non-conclusive. The quality of the trials has been weak, possibly due to the complexity of the concept. This weak quality may explain the lack of conclusive results. Proposals for future research designs are offered.

Odour annoyance in the neighbourhood of livestock farming - perceived health and health care seeking behaviour.

INTRODUCTION AND OBJECTIVES: Odour annoyance forms the main source of environmental stress in residents living in the proximity of animal feeding operations (AFOs) and it has been associated with reduced health. This study aims to gain more insight into the association between AFOs in the neighbourhood, odour annoyance, other environmental stressors, and health, and incorporates health care seeking behaviour for reported symptoms. MATERIALS AND METHODS: Cross-sectional data from 753 people living in an area in the Netherlands with a high density of AFOs was evaluated. Odour and other environmental annoyances in the neighbourhood, general health and symptom reporting were obtained by questionnaire. Health care utilisation was obtained from electronic medical records of general practices. The number of pigs, poultry and cattle within a 500 m radius from homes was computed using Geographic Information System data. Mutually adjusted multiple Poisson and (ordinal) logistic regression analyses were performed. RESULTS: The number of pigs, poultry and cattle was equally associated with odour annoyance. This annoyance was associated with reduced general health and increased reporting of respiratory, gastrointestinal, neurological and stress-related symptoms. Participants rarely consulted their general practitioner for reported symptoms. Environmental stressors were weakly associated. CONCLUSIONS: The number of animals around the homes was associated with odour annoyance. Odour annoyance was associated with reduced health, which could be a reason for caution with the construction of new AFOs.