“De perceptie van de arts-patiënt communicatie vanuit het standpunt ...


“De perceptie van de arts-patiënt communicatie vanuit het standpunt ...

Masterthesis 2010

“The perception of the doctor-patient

communication from the perspective of the

patient in a health care centre in Nicaragua”



Promotor: Prof. Dr. Myriam Deveugele

Co-promotor: Dr. Peter Decat


1. Background

2. Research setting and goals

3. Methodology

4. Results

5. Discussion


Modelo de Salud Familiar y Comunitario (MOSAFC)

A new health care model in Nicaragua


• Accessible care

• Integrated care

• Continuity of care

• Cooperation between different health care providers

Importance of an integrated primary health care system

Changing doctor-patient relationship

Central role of communication

BUT: problems with the implementation!


Evidence regarding doctor-patient communication

Adequate communication = benefits for the doctor ánd the patient


Western Countries:

Patient-Centred Care

Shared Decision Making

Developing countries:

Disease-oriented care, a more biomedical aproach

Medical paternalism


What? Cross-sectional study

Were? Semi-rural health centre Gaspar Garcia

Laviana, San Juan del Sur

Who? Patients older than 15 years old

When? July 16 th – August 12 th 2009

Why? Responding the questions:

- What is important regarding the doctor-patient communication

according to the patients?

- To what extent does the doctor currently meet the patient’s


- How can the doctor improve the communication to fit better with

these expectations?


Quantitative part

Questionnaire: QUOTE-Communication (NIVEL)

Data handling: Chi-square test

Bivariate Logististic Regression

Significance level: P < 0.05

Qualitative part

Semi-structured interviews with patients

4. RESULTS (1)

Quantitative part: 218 complete questionnaires

Important for the patient: - that they were listened to

- that a diagnosis was made

- that they were given explanation

Expectations least fulfilled regarding:

- taking part in the decision making process

- discussing the different treatment options

- receiving information about possible adverse effects

The mean waiting time: 2h36min

4. RESULTS (2)

Correlations between:

Continuity of care and

- Taking enough time for the consultation

- Giving more explanation

Taking enough time and

- Doctor: empathy, physical examination,

listening, shared decision making

- Patient: less concerns

Asking all questions and

- The doctor listening more and giving more


4. RESULTS (3)

Qualitative part: 6 interviews

Limited accessibility and availability of care

- long waiting time

- insufficient availability of (free) medication

- lack of a professional attitude of the secretary and nurses

About the medical care the patients were generally


Perception that care in private sector was better

Fear to speak (badly)


Doctor-patient communication in developing countries is (at least) as

important as in Western countries

The continuity of care already has a positive effect

Certain expectations towards the consultation were already met.

Active participation of the patient should be encouraged

- Shared Decision Making

- Patient empowerment

It is important to take enough time for the consultation

The long waiting time is a bottleneck

Limitations of the study

More research on doctor-patient communicaion in developping

countries is needed

Thank you!

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