Client-Centred Rehabilitation - Arthritis Community Research ...

1990), checklists of physician=s and patient=s
behavior (Bryne and Long, 1976), and
interviewing of patients after their
consultation with physicians (Henbest,
1985). Mead and Bower (2000) offer an
extensive review of the studies evaluating
the reliability and validity of various
measures of patient-centred care (please
refer to Mead and Bower for more details).
In an empirical study, Mead and Bower
(2000) compared the reliability and validity
of three observation-based measures of
patient-centred care. Their study evaluated
Henbest and Stewart=s (1989) scoring of
physicians responses to patient=s
requests/offers, the Roter method of coding
verbal statements of doctors and their
patients which was derived from the Roter
Interaction Analysis System (Roter, 1993),
and the rating scale (Mead and Bower,
2000).
In terms of reliability, interrater reliability
was highest for the Roter-based method
(.71) and lowest for the rating scale (.34). In
terms of validity, the three measures did not
correlate highly with one another indicating
that they did not measure the same
construct. Also, the rater scale and the
Roter-based method correlated highly with
psychosocial aspects of physician
consultation; the Henbest and Stewart
(1989) method did not (Mead and Bower,
2000).
Qualitative Analysis
Just as there is a tradition of quantitative
analysis of patient-centred care in general
practice, there is also a qualitative analytic
approach. While this approach to evaluating
patient-centred care advocates
understanding the experience and context of
the patient, the field research focuses more
on the role of the physician. Future research
needs to focus equal attention to both the
14
patient and the physician to reflect reality
(McWilliam, 1995).
2.3.2.5 Patient-Centred Care Outcomes
in Medicine
There were number of articles in the general
practice literature focused on the outcomes
of patient-centred care (Anderson, DeVellis
and DeVellis, 1987; Brody, Miller, Lerman,
Smith, and Caputo, 1989; Greenfield et al
1988; Kaplan et al., 1989; Kinmonth, et al.,
1998). The majority of such studies have
focused on patients suffering from chronic
illnesses such as diabetes, ulcers, breast
cancer and high blood pressure (Greenfield
et al., 1988; Kaplan et al. 1989; Kinmonth,
et al., 1998) Outcomes of patient-centred
care can be divided into subjective and
physical health outcomes. Common
subjective outcomes of patient-centred care
include higher levels of patient-practitioner
communication, greater patient satisfaction,
comfort and control (Anderson et al., 1987;
Brody et al., 1989; Kinmonth et al., 1998).
Common physical health outcomes of using
a patient-centred approach include
improvement in blood sugar levels, blood
pressure and overall health status (Brody et
al., 1989; Greenfield et al., 1988; Kaplan et
al., 1989).
2.3.2.6 Barriers To Patient-Centred Care
in General Practice
There was not much focus on the barriers to
patient-centred care in the general practice
literature. One barrier that was discussed
was the challenge of communication (Brown
et al., 1989; Harrison, 1982;Brown et al.,
1995). Common problems of
communication included misdiagnosis, and
patients and physicians disagreeing as to
what is the patient=s main problem (Brown
et al., 1989; Brown et al.,1995). A second
barrier to patient-centred care is its tendency