ABSTRACT
Innovation in primary care has increased interest in patient self-management techniques; little is known about the methods practices use to support self-management. This study is a survey of small practices, fewer than 5 physicians, with NCQA (National Committee for Quality Assurance) recognition (response rate 59.1%). Main measures include the number and delegation of self-management support activities. Practices reported a high proportion of self-management support activities. Physicians perform most of these activities. Practices that reported receiving training in self-management were more likely to have high self-management support to delegate. Self-management support activities are performed mainly by physicians. Practices that perform more of these activities have more nonindependent health care providers.
Subject(s)
Patient-Centered Care , Primary Health Care , Self Care , Decision Making , Diffusion of Innovation , Health Services Research , Humans , Practice Management, Medical/organization & administration , Quality Assurance, Health Care , United StatesSubject(s)
Antibodies, Fungal/blood , Coccidioides/isolation & purification , Coccidioidomycosis/diagnosis , Skin/pathology , Coccidioides/immunology , Coccidioidomycosis/complications , Cough/etiology , Diagnosis, Differential , Exanthema/etiology , Humans , Hypoxia/etiology , Lung Diseases/diagnosis , Male , Middle Aged , Skin/microbiologyABSTRACT
BACKGROUND: Advance care directives (ACD) are not used equally by different ethnic groups in the United States. Theories regarding this difference include lack of access to health care, mistrust of the health care system, absence of surrogate decision makers, and universal lack of knowledge on this topic. Few studies have investigated attitudes toward advance care planning for future end-of-life decision-making in the Latino and Cambodian communities. METHODS: Six focus groups were conducted, including a total of 20 Latino and 19 Cambodian patients of two community health centers. Focus groups were audiotaped, transcribed, and qualitatively analyzed to identify major themes regarding attitudes toward advance directives and engaging in discussion about advance care planning. RESULTS: Most patients did not have a health care proxy nor had discussed this topic with their doctor. Two broad themes were identified: integration of belief systems (including religion, suffering/destiny, and importance of quality of life) as well as process/preferences regarding decision-making (including family roles, provider roles, confusion/uncertainty regarding ACD, and openness to learning about ACD). CONCLUSIONS: In focus groups discussing end-of-life decision making among Latino and Cambodian patients, two main themes emerged: integration of belief systems and process/preferences regarding end-of-life care. In particular, efforts to improve completion of advance care directives in diverse populations should consider patients' emphasis on quality of life and destiny in end-of-life planning as well as the role of family consensus in decision-making.