Vulnerable Populations & Global Public Health Presentation Oct 31/08

Time sensitive

Vulnerable populations and global public health

UBC-School of Population and Public Health (SPPH) Grand Rounds
Presentation for Friday, October 31, 2008

Presented by: Katia Mohindra, Post Doctoral Fellow, Global Health Research Program, SPPH, UBC

Topic: Vulnerable populations and global public health: perspectives from some 'egalitarian' societies***

Date: Friday October 31, 2008
Time: 9:00 AM TO 10:00 AM
James Mather Building
Room: #253 - 5804 Fairview Avenue
Vancouver, BC

Please join us for the Grand Rounds. If you are unable to attend in person, please join us remotely through our website www.spph.ubc.ca and simultaneously via conference call.

Dial in: 1-866-596-5278
Conference ID: 7347312#

If you do join us via conference call, it is very much appreciated if you put your phone on mute to enhance the listening ability of all remote listeners.

**Presentations are the property of the presenter(s) and permission must be obtained before copying or distribution of presentation occurs. Presentations for rounds from the website are for viewing purposes only.**

Should you have any questions, please contact Sylvia at sylvia.froese@ubc.ca or 604-822-7646

[Posted on: Women-Health eNews - an electronic mailing list for activists, researchers, and policy makers, both nationally and internationally, who are working to improve women's health. The list was created and is managed by the BC Centre of Excellence for Women's Health http://www.bccewh.bc.ca ]

Community Health Discusssions

CHNET-Works! a project from Community Health Research Unit, University of Ottawa is hosting a series of Fireside Chats (FREE pan-Canadian discussions for community health professionals - via telephone/internet conferences). October, November and December 'chats' are focusing on: Climate Change and Health, Healthy Aging and Food Insecurity. Discussions need to include perspectives re: social ceterminants of health.

Info and registration: www.chnet-works.ca and click on Fireside Chats

[posted on the Social Determinants of Health (SDOH) listserv October 29, 2008 by Dot Bonnenfant, CHNET-Works! Animateur]

Upcoming topics:
Climate Change and Health: shedding light November 20/08

Canadian Falls Prevention Curriculum - an UPdate February 5/09

Climate Change and Health: newHealth Canada Report November 13/08

Children Vulnerable to Environmental Contaminants December 10/08

Health Care: Preparation for Age of Scarce Oil October 30/08

Climate Change and Health: A Breath of Fresh Air November 7/08

Healthy Aging: Housing, Support Service and Health November 26/08

Food Insecurity: The Cost of Living - a tool December 5/08

Info Tech and Health Promotion.... December 4/08

Healthy Aging #2 - Aging with Dignity February 12/09

Skateboarding and Youth: What's working? December 3/08

Study Explores Value of Recording Medical Visits for Cancer Patients

Patients can find it hard to absorb what their doctors tell them during stressful moments. Recordings or transcripts of office visits could help people with cancer—or their family members—recall medical information they might otherwise have missed, a new review suggests.

“It is important to consider anything that can improve the cancer patient’s experience, especially interventions that can be easily accommodated within the normal office visit,” said lead author Marie Pitkethly, co-coordinator of the Scottish Primary Care Research Network in Dundee.

The review included 16 studies of 2,318 adults who either had cancer themselves or were dealing with a close relative with cancer. The researchers looked at the effects of providing recordings or summaries of doctor-patient interactions on information recall and understanding, participation in follow-up visits, satisfaction and other concerns.

The review appears in the latest issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews like this one draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

Richard Frankel Ph.D., a professor of medicine and geriatrics at the Indiana University School of Medicine, said many people who receive cancer information at the doctor’s office do not accurately remember what the physician said.

“Anything that can be done to increase their potential for retaining information is worth trying,” he said. “This review shows that the use of audio or videotapes can be very useful in some patients, but not all patients. The primary lesson this review teaches us that there needs to be an individualized approach to having difficult conversations with patients.”

For more on this study:
Pitkethly M, et al. Recordings or summaries of consultations for people with cancer. Cochrane Database of Systematic Reviews. Issue 3, 2008.

Patient-physician Communication: Research

With their waiting rooms crowded and exam rooms full, many physicians say they are too busy to be good communicators. Those who study physician time-management think otherwise. Certain communication skills can foster efficiency and effectiveness during an office visit without sacrificing rapport with patients, according to researchers at the University of Washington (UW) and the University of Rochester.

Their guide to a smoother flow of communication between doctors and patients appears in the July 14, 2008 issue of the Archives of Internal Medicine. Their model is based on the authors' observation: "Effective communication in primary care must include skills that enhance the quality of care while helping patients and physicians use time wisely… Making the best use of available time is important for visits of any duration."

A few of the lessons the researchers presented in the resulting article, "Relationship, Communication, and Efficiency in the Medical Encounter: Creating a Clinical Model from a Literature Review" include:

• focus the purpose of the visit with the patient: Instead of addressing each issue as it surfaces, creating a list at the start enables the doctor to confirm which problem is most medically urgent or most important to the patient. This approach also reduces the "Oh, by the way" issues brought up at the end of the visit.
• understand the patient's perspective: Exploring the patient's viewpoint is useful for promoting self-management, suggesting healthy changes, assessing motivation, learning the patient's family and cultural beliefs, understanding the social and psychological problems that are diminishing the patient's ability to function, or getting to the root of medically unexplained symptoms.
• reach a mutual agreement on a plan: The physician and patient decide on approaches the patient is willing to follow to manage or prevent the health concerns explored during the visit.

Throughout the office visit, it's helpful for physicians to:

• establish rapport and maintain the relationship: Some ways doctors do this are by eye contact, recognizing others in the room, or a brief warm greeting, such as, "Nice to see you." On the other hand, too much small talk steals away time from considering the patient's problems.
• practice mindfully: This occurs when physicians pay close attention to their own beliefs and reduce distractions in order to observe their patients' response to what is being said and done, and adjust accordingly. For example, a doctor lecturing on excess weight might notice the patient withdrawing. The doctor stops and asks about the patient's views. A physician who doesn't continuously monitor the interaction or doesn't check in with the patient may cover areas of little interest to the patient, and miss significant issues.
• track topics: Sometimes an interview veers off course, particularly when there are multiple topics and no clear agenda. Unless the conversation is redirected, it's likely that no clear decisions will be made on some problems before the end of the visit. Sharing an impression of what has and hasn't been covered and realigning by agreeing on what to talk about next can keep the discussion organized.
• acknowledge cues: When a physician responds with empathy to a patient's cues, a patient may reveal beliefs and preferences that can shape a successful treatment plan. Also, once their concerns are taken into account, most patients don't keep restating them. This saves time.
  

Researcher Larry Mauksch said, "Visits with the doctor that contain these fundamental elements lead to greater patient satisfaction, better adherence to medical regimes, increased self-management, better health outcomes, lower costs, and fewer malpractice claims. These skills enable physicians to do it right the first time, so they don't have to do it over."

The researchers are Larry Mauksch, a UW behavioral scientist in family medicine who studies and teaches doctor/patient communications; David C. Dugdale, an internal medicine physician and director of the UW Hall Health Primary Care Center; Sherry Dodson, UW clinical medical librarian; and Ronald Epstein, professor of family medicine, psychiatry, and oncology at the University of Rochester School of Medicine and Dentistry and its Center to Improve Communication and Health Care.

To read more about the project: http://uwnews.org/article.asp?articleID=42811

Health & Literacy: Constructing Curriculum for Health Care Providers--A Learning Institute

Health & Literacy: Constructing Curriculum for Health Care Providers
A Learning Institute
October 16-18, 2008
Calgary, AB

"This Institute will invite health-care providers from every branch of health-care service, curriculum developers in health-care and adult basic education and literacy, ESL providers, administrators, policy makers and anyone with an interest or expertise. You will share promising practices, models, consider the challenges and propose new directions for grounded curriculum in health literacy for health-care providers."

See brochure for details.