GHF2010 – PS23 – Improving Patient-Provider Communication in the Context of Chronic Disease

Session Outline

Parallel session PS23, Tuesday, April 20 2010, 14:00-15:30, Room 4
Chair(s): Beat Stoll, Senior Lecturer, Institute of Social and Preventive Medicine, University of Geneva, Switzerland, Johanna Sommer, Teaching and Research Unit of Primary Care, Faculty of Medicine, University of Geneva, Switzerland
Summary: The interaction between patient and healthcare provider is key for treatment seeking and eventually the health status of people. And yet, neither health research nor interventions in developing countries have focused much on it. Not only is an appropriate patient-provider communication a crucial cornerstone for patient adherence to treatment in the context of chronic diseases such as HIV/AIDS or depressive disorders. Next to questions of availability and affordability of health services and products, people's perceptions with regard to the interaction with different providers also determines where a patient seeks treatment, i.e. with a 'modern', biomedical healthcare service, a street vendor or 'traditional' healers. In other words, patients' acceptability of healthcare services depends mainly on issues such as friendliness of staff as well as adequate explanations of diagnosis and treatment procedures. The aim of this panel is to explore main elements of an adequate patient-provider communication from an expert's and patient's point of view; discuss empirical findings on patient-provider interaction and patients' satisfaction; and examine possible interventions to strengthen provider communication skills.
Communication: Access to the Patient 
Johanna Sommer, Teaching and Research Unit of Primary Care, Faculty of Medicine, University of Geneva, Switzerland
Relevance of Patient-Provider Communication for Access to Healthcare 
Alexander Schulze, Manager Health Projects, Novartis Foundation for Sustainable Development, Switzerland
Seeking Common Ground: How Traditional Healers Interact with Patients in Rural Cameroon 
Niklaus Labhardt, Swiss Tropical Institute, University of Basel, Switzerland
Who Understands Diagnosis and Treatment? Institutional Factors Prevail over Patient Characteristics 
Aly Barry, Project Manager, ACCESS Initiative, Novartis Foundation for Sustainable Development, Mali
Interpreter-Mediated Communication in HIV/AIDS Clinics in Western Cape, South Africa
Alexandre Bischoff, PhD in Epidemiology, Division of International and Humanitarian Medicine, Geneva University Hospitals, Switzerland

Session Documents

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Session Report

Submitted by: Laura Mathew (ICVolunteers); Contributors: Christoph Wirth (ICVolunteers)

Photo by John Brownlee, ICVolunteers.org

The importance of communication between patients and health care providers was the key topic of this session. As well as highlighting how communication can affect patients' adherence to treatment and influence where they are likely to seek medical treatment, the members of the panel spoke about barriers to communication in the developing world and discussed possible interventions to remedy this.

Johanna Sommer (Teaching and Research Unit of Primary Care, Faculty of Medicine, University of Geneva, Switzerland) began by contrasting the advances in medicine with the comparative lack of development in communications between medical professionals and patients. Medical jargon can make it difficult for patients to understand the benefits of treatment, sometimes resulting in non-compliance and, consequently, less effective courses of treatment.

Communication is a relatively young discipline that has not been seen as central to the study of medicine, but more as an ‘optional extra’. By working with other countries and organisations such as the European Association for Communication in Healthcare, the medical community can develop the necessary curricula of communication skills to enhance patient understanding, improve accessibility and adherence to treatment and achieve empowerment.

Alexander Schulze (Manager, Health Projects, Novartis Foundation for Sustainable Development) outlined the link between patient-provider communication and access to healthcare using empirical data from Tanzania.

The first phase of Project ACCESS in Tanzania between 2003 and 2007 focused on identifying the obstacles to access for patients, while the second phase concentrated on action that could be taken to improve patient-provider communication.

Evidence from Tanzania showed weak communication and mixed perceptions among patients in terms of satisfaction. Crucially, many use another provider for the same illness, especially when information has not been property communicated. A common consequence of poor instructions is that treatment is ineffective, causing the patient to turn to alternative treatments, such as traditional healers.

Niklaus Labhardt (Swiss Tropical Institute, University of Basel, Switzerland) highlighted a study in rural Cameroon, examining the differences between traditional healers and Western-style healthcare providers.

The outcome of the study showed that few differences were found between patients who sought treatment from a traditional healer and those who went to their nearest health centre. Commonly cited reasons for the prevalence of traditional healers are lack of education, distance and cost, yet none of these was shown to influence patients’ decisions to favour traditional methods over conventional medicine.

There was, however, a significant difference in verbal interaction between the two patient groups and their respective healthcare providers. In consultations with traditional healers, there were found to be considerably fewer utterances than in a conventional medical assessment. Moreover, the conversation tended towards lifestyle and psychosocial issues such as the concept of illness rather than concentrating on purely medical topics.

The government of Mali has been working with the Novartis Foundation since 2001 with the aim of improving primary healthcare. Aly Barry (Project Manager, ACCESS Initiative, Novartis Foundation for Sustainable Development, Mali) spoke about positive developments such as the increased use of healthcare services and the improved management of community health centres by community health associations. However, patients often complain about lack of empathy, discrimination, humiliation and difficulties in understanding medical explanations when visiting healthcare providers.

Research carried out by the ACCESS Initiative has shown that the health centre where a patient is treated is the most important factor in determining whether they will understand their diagnosis and treatment, rather than such characteristics as literacy, gender and age. This suggests that the communication skills of medical staff could play a key role and that communication training is an appropriate course of action.

Alexandre Bischoff (PhD in Epidemiology, Division of International and Humanitarian medicine, Geneva University Hospitals) spoke about interpreter-mediated communication in HIV/AIDS clinics in the Western Cape, South Africa.

Adherence to antiretroviral therapy is a hot topic and a key barrier to this is language, particularly in the Western Cape where 11 official languages are spoken. Although many people speak more than one language, proficiency in the second language is rarely adequate to discuss complex medical issues, so an assessment was carried out to determine how health professionals in ARV clinics deal with language issues and the use of interpreters.

The study found that doctors require training on how to work with interpreters and recognised that adherence counsellors play an important role in patients’ understanding of treatments. It is therefore vital to improve communications in ARV clinics.

The session concluded that communication should be seen as an essential part of teaching medicine rather than an extra; access to healthcare is driven by the quality of relationships between healthcare providers and patients; patients favour traditional healers’ methods of communication; healthcare providers are important to patients’ understanding of treatment, as seen in Mali; and language is a significant barrier to treatment in many African countries.

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