Using Health Services

healthcare organized into

specialties

first line-family physician

• treat

• refer to specialist

inpatient

• serious illness

• requires special equipment

• continuous care

nursing homes

• long term medical and personal care

  • majority are disabled or frail elders

shift to outpatient or home healthcare

• cost

• improved technology

medical care

• seeking services

• patient-provider relationship

• hospitalization

• “healing” care

recognition of a symptom

intensity of physical symptoms and situational factors

people seem to have a uniform threshold at which heat becomes painful

but individuals differ in the degree of pain they will tolerate before doing something about it (like taking meds)

competing stimuli

extent to which people pay attention to internal stimuli at any given time depends partly on the nature or degree of environmental stimuli present at that time

interpretation of symptoms

subjective, psych process

• individual, historical, cultural, social, and psych factors

• prior experience

• expectations

• seriousness of symptoms

• somaticization

• hypocondriasis

cognitive representations of illness

• illness schemas/illness representations/commonsense models

  • illness identity

  • causes and underlying pathology

  • timeline

  • consequence

• prevalence

• self efficacy

• culture

illness identity

consists of the name and symptoms of the disease

causes and underlying pathology

ideas concerning how one gets the disease (“I got a cold because a girl sneezed her germs in my face.”) and what physiological events occur with it

timeline/prognosis ideas

how long the disease takes to appear and lasts.

• Ex: symptoms of salmonella take many hours to appear after eating tainted food; some people know this, and others think the symptoms occur immediately

consequence

involves ideas about the seriousness, effects, and outcomes of an illness.

• less prevalent seen as more severe

lay referral network

getting advice from friends, family, coworkers, non-practitioners who provide their own info and interpretations regarding person’s symptoms

internet as lay referral network

• more than 100k health related websites

• most physicians believe the internet affects healthcare positively

lay referral network factors

• help interpret symptom

• give advice about seeking med attention

• recommend remedy

• recommend consulting another lay referral person

complementary and alternative medicine (CAM)

• natural products

• mind and body practices

age

• utilization

• type of illness

• fear

gender

• biological (pregnancy)

• social norms

  • healthcare seeking/help seeking

  • lifestyle/profession/time

women may develop more illnesses that require medical attention

they show higher rates of medical drug use and illness from acute conditions, such as respiratory infections, and from nonfatal chronic diseases, such as arthritis and migraine headache

men are more hesitant

to admit having symptoms and to seek medical care

gender differences and reporting and perceiving symptoms

probably reflects sex‐role stereotypes—that is, societies often encourage men more than women to ignore pain and to be tough and independent

social class and culture

• financial

• culture/religion

• beliefs/tradition

social psychological factors

• attitudes/beliefs

  • latrogenic conditions

• HBM

Individuals who fail to get prescriptions filled or seek care at a doctors office

decrease with higher income

Iatrogenic conditions

results of medical care (sometimes due to errors)

Health Belief Model

decision making process about perceived seriousness and susceptibility also weighing the risk and benefits – will the treatment actually be beneficial

delay

many live with one or more serious symptoms for months without seeking care

who delays?

• perceive treatment as expensive

• perceive seeking care as too time consuming

• believe the symptoms are not serious

• elderly

• have no regular contact with a physician

• seek treatment primarily in response to pain and

• social pressure

• fearful

appraisal delay

the time a person takes to interpret a symptom as an indication of illness

illness delay

the time taken between recognizing one is ill and deciding to seek medical atention

utilization delay

the time after deciding to seek medical care until actually going in to use that health service

in illness delay stage

thoughts about the symptom had the greatest impact

• individuals decided to seek medical attention more quickly if the symptom was new rather than very familiar and if they didn't think much about the symptom and its implications

during utilization delay

perceptions of benefits and barriers were important—delay was shortest for those people who were less concerned about the cost of treatment, had severe pain, and felt that their symptoms could be cured

having a major nonillness problem or life event (such as marriage/divorce)

was an important factor that increased the total treatment delay

effective communication in a medical setting

physical setting

results of poor communication

• harm to patients (poor outcomes, nonadherence 15-93%)

• harm to providers (greater malpractice and suits)

patient involvement

• decision making

• cooperation

• expertise about their own health

patient centered provider communication

open ended questions

doctor centered provider communication

• not listening

• use of jargon

• depersonalization

• stereotypes of patients

patient behaviors

• knowledge

  • symptoms

  • healthcare system

  • prior experiences

• attitudes toward symptoms

• attitudes toward doctors/healthcare system

• deference, cooperation, openness

interpersonal factors

providers rarely receive feedback when a patient doesn’t return

patient not returning

• Tx led to cure

• patient got worse and went elsewhere

• Tx failed, patient got better anyway

• patient died

physical barriers

gloves

psychological barriers

• attempts at distance (detached)

  • decrease human connection with suffering patient

• objectivity and professionalism

adherence

the extent to which a patient’s behavior matches agreed recommendations from a healthcare

• crucial for effective management of chronic and acute illnesses

WHO estimates average adherence to long term therapies

around 50%

why patients don’t adhere

• complex treatment regimens or multiple medications

• side effects/cost concerns

• misunderstanding of instructions or low health literacy

• emotional distress, stigma, denial

• lack of motivation or perceived need

psychological predictors of adherence

• health beliefs and perceived control over illness

• self efficacy

• motivation and readiness to change

• personality traits

• quality of patient-provider communication and trust

strategies to improve adherence

• simplify medication schedules and routines

• provide clear, written, and verbal instructions

• use digital reminders or follow ups

• encourage social support and family involvement

• reinforce successes with positive feedback

behavioral techniques

• self monitoring and goal setting

• behavioral contracts or small rewards

• cognitive-behavioral approaches to overcome barriers

• tailor interventions to ind needs and motivations