textbook chapter 9

Who uses health services

young children, women, older adults from advantaged groups

Age and health services

• Children have more contact with physicians 

• Then in middle age and late adulthood they increase again

Gender and health services

• Women have higher rates 

  • Pregnancy childbirth

  • They experience more illnesses

  • Men are more hesitant to admit problems

Sociocultural factors and health services

• Indigenous people report fewer doctor visits 

• Recent immigrants report fewer doctor visits 

• Highest for immigrants who have been in canada for 10 years and more

• In america, black people use emergency rooms and outpatient clinics for medical care 

• People of low SES percieve themselves as being less susceptible to illness so they dont seek out preventive care

• Barriers to access exist

• Low income groups have less regular sources of health care

• Language can be a barrier for immigrants 

• Canadas healthcare system is poorly educated on indigenous health therefore they arent able to get adequate care

Ideas, beliefs and using health services

• Iatrogenic conditions: patients develop health problems due to practitioner errors

• Not trusting practitioners can stop people from seeking care

• Gay men and women avoid medical care because of confidentiality concerns

• Adolescents have conditions that they want to keep private 

• Marginalized groups can be stigmatized

Health belief model and seeking medical care

• People report that medical bills, transportation and other barriers have curbed their ability to get medical care

• Cancer patients who believe that cancer cant be treated effectively delay treatment

Social and emotional factors in seeking medical care

• Depressed people delay getting medical care

• If expect fear and pain from treatment they may delay care

• Dental care pain makes people avoid dental care

• Embarrassment makes people avoid medical care

• Men believe getting medical care is weak

Stages in delaying medical care

• Treatment delay: the time that elapses when a person first notices a symptom and when the person enters medical care

• 3 stages

1. Appraisal delay: time person takes to interpret symptom as an indication of illness

• Symptom has greatest impact on taking action

2. Illness delay: the time taken between recognizing one is ill and deciding to seek medical attention

• Thoughts about symptom had the greatest impact

3. Utilization delay: the time after seeking medical care until actually going to use that health service

• Perception of benefits and barriers were most important

Using complementary and alternative medicine

a method is complementary if used along with conventional treatments, and alternative if used in place of them

• Manipulative and body based methods: move parts of the body (physio)

• Natural products: materials found in nature

• Mind and interventions: enhance minds ability to manage body function (yoga)

• Other CAM practices: energy fields that are believed to exist around the body, homeopathy and traditional chinese medicine

  • Widely used in less developed nations 

  • Patients rarely tell their doctors they are using CAM treatments

Who uses CAM

• People who use in north america tend to be well educated and have symptoms that have not improved with standard medical care

• 70% of canadian adults use CAM

• Vitamins and minerals are most common 

• White, western provinces are most likely

CAM issues

• Little or no scientific evidence of their safety and effectiveness 

• Some methods have value but some clearly dont (smelling lavender)

Hyperchondriasis

the tendency of individuals to worry excessively about their health, monitor their bodily sensations closely, make infrequent unfounded medical complaints, believe they are ill when doctor tells them they arent 

• In the DSM

• Needs to last 6 months and cause emotional distress

• Linked with neurioticism 

Patient preferences for participation in medical care

• People differ in the amount of participation they want with their doctor

• Women want more info than men

• Younger adults want more info than older adults 

• When you get your desired participation, there is better adjustment and satisfaction

• Patients who want an active role in their treatment adjust to recovery periods better

• Practitioners also differ in the involvement they want to provide

• If there is a mismatch

  • Patient has more stress

  • Patient less likely to follow the doctors advice 

  • Leads to a switch in doctors

The practitioners behaviour and style

• Doctor centred: asking yes or no questions and focusing on the problem that the patient mentioned, ignoring discussion of other problems

  • Intent on a link between initial problem and organic disorder 

• Patient centred: open ended questions, avoid medical jargon

  • Female doctors do this more 

• People prefer to have sensitiv and warm practioner

The patients behaviour and style

• Sometimes doctors get pissed at patients

• Patients high in neuroticism impair communication

Extent of the nonadherance problem

• Doctors overestimate the patients adherance levels 

• Patients overrreport their adherence

• Overall rate of adherence is about 60%

Why do patients do not ahdere to medical advice

• Requires changing long standing habits 

• Some are complex

• The duration, expense and side effects of medical regimen

Age, gender and sociocultural factors

• Little to no association by themselves

• Stronger relation when theyare joined together

• Childhood cancer patients had more adherance problems than older 

• Adolescents are less adherent to special diets than cancer patients

• Womens concern about weight control conflicts with blood sugar medicine 

• Some cultural groups have things that conflict with adhernance 

• Some minotirty groups might have lower literacy and higher health risks

Psychosocial aspects of the patient

• Health belief model applies here

• Rational nonadhernance: not adhering based on valid reasons 

• Self efficacy matters because they think they can succeed

• Social support: can also sometimes lead to nonadherance by being a bad influence

Cognitive and emotional factors

• They have to be able to understand and remember what they are to do 

• Negative emotions are linked to low adherence

Communicating with patients

• Need to clarify details

• Persons adherence depends on communication from practitoner

Adherence and the patient practioner relationship

• People with good relationship with doctor are more likely to adhere 

• Cultural sensitivity is needed

Nonadherance and health outcomes

• Increase their illnesses

• More likely to die

Improving physicians communication skills

• Give a thorough explanation of the regimen and repeat it so the patient understands

• Simplifying verbal instructions

• Using written instructions

• Having patient repeat instructions

• Assessing patients self efficacy

• Having patient record aderhance instances

Interventions directed at patients

• Have patient explicitly say that they will comply 

• Have physician office send follow up letters

• Use motivational interviewing

• Use social support to promote adherence

Behavioural methods

• Tailor the regimen

• Provide prompts and reminders

• Self monitoring

• Behavioural contracting: reward if they do it

Chronic care model

The chronic care model is usually used to manage long-term illnesses, but researchers say it can also help prevent health problems before they start (primary prevention. To do this, health care organizations should:

1. Make prevention a priority – focus on things like helping smokers quit.

2. Use good record systems – keep updated info on patients’ preventive care.

3. Design the care team well – doctors start prevention plans, and other staff help carry them out.

4. Support staff decisions – give training and reminders to identify who needs help.

5. Help patients manage themselves – provide info and resources for healthy changes.

6. Work with the community – connect with local programs and laws that support healthy living.