The Role of the Psychosocial Dimension in the Improvement of Quality of Care: A Systematic Review
, and | Mar 10, 2016
Article Category: Review article
Published Online: Mar 10, 2016
Page range: 86 - 95
Received: Feb 23, 2015
Accepted: Jul 02, 2015
DOI: https://doi.org/10.1515/sjph-2016-0004
Keywords
© National Institute of Public Health, Slovenia
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.
Figure 1.
Findings.
| Paper | Topic, study question | Sample size | Methods | Main results | Rating of the results Rating scale 1-3; |
|---|---|---|---|---|---|
| 26 | Measuring the quality of 2 motivation for physical activity from the health worker and whole professional team (pilot study) | N=424 (both sexes, over age 18, with a low level physical activity) | Systematic random sampling; intervention (professional health worker and team support physical activity) or control group | Motivational intervention by a physician and primary care team increased physical support | 2 |
| 27 | Differences in health care costs, doctor’s visits, quality of well-being according to wellness intervention | N=33, N= 28 (23 finished the first and 15 the last study) | Intervention (1: relaxation and problem-solving practice; 2: psychoeducational and skill oriented: nutrition, relaxation, exercise, etc.) or control group; pre- and post-test values | Short wellness program in family medicine improved quality of life | 3 |
| 49 | Testing what influences adherence to medication | N=236 (mean 41 years, male majority, mostly African-Americans) | To test a model of medication adherence among individuals taking anti-retroviral medication | Taking of medication was affected by different psychosocial variables (selfefficacy, depression, and social support) and provided directions for adherence intervention | 1 |
| 28 | Measuring depression outcomes, satisfaction and functioning in women | N=123 (women with depression) | 2 interventions (social intervention and antidepressants) and control group (only antidepressants); tested after 3 and 9 months | Social treatment improved social functioning and satisfaction | 3 |
| 50 | Measuring the quality of promotion of physical activity | N= 38 patients (out of 55) over 65 years visiting a medical practice by appointment N=12 physicians for 2 focus groups | Activity counselling in primary care: written assessment and personal counselling evaluated by focus group with primary care physicians, second mailing to inactive patients, evaluated by questionnaire | Physical activity promotion must be included in multidimensional health promotion; promotion through primary care has high potential (healthy aging) | 3 |
| 29 | Measuring the association between health beliefs and negative health outcomes | Sample 1 N=202, Sample 2 N= 209 | Prospective 2-panel design; psychosocial model of behaviours: social cognitive theory and theory of planned behavior | Perceptions of the efficacy of treatment predicted outcomes of treatment and prevention | 2 |
| 30 | Measuring the influence of physical activity on drug prescribing in PC on physical activity levels, stages of change and quality of life | N=481 (both sexes, 12 to 81 years) | Uncontrolled clinical study; individualized physical activity on prescription (follow up at 6 months) | Increased self-reported physical activity level, stages of action and maintenance of physical activity; quality of life increased | 3 |
| 36 | Measuring satisfaction which can influence health care outcomes | N=702 patients (from 38 resident doctors) | Expectations before visit, measures after visit, telephone interview about fulfilled expectations | The fulfilment of patient expectations influenced satisfaction and consultation outcomes | 2 |
| 35 | Measuring how practice style influences outcomes | N=509 (adult patients) | Care by family physicians or general internist | More frequent patientcentred care offered by a family physician reduced annual medical care charges | 1 |
| 31 | Measuring clinical effectiveness of primary care model for diabetic patients | N=335 (experimental group N=185, control N=145) | Model of diabetes care provided by primary care service in comparison to care provided at specialist diabetes clinic | Model of diabetes care provided by primary care service combined patient focus and holistic care well | 2 |
| 32 | Effects of psychosocial intervention on substance reduction in people with mental illness | N=25 RCTs | Meta-analysis | No compelling evidence that supports any one psychosocial treatment over another was found | 1 |
| 37 | Impact of physical limitations on perceived quality of care | N=674 (adult family medicine patients) | Telephone survey of family patients | People with physical limitations experienced a disparity in perceived quality of care | 3 |
| 38 | Model with accessibility of services and professional-patient relationship, coordination within health care team and scientific-technical quality of the service | N=213 (primary health care teams) | Descriptive study | Identified model with three dimensions: inter-personal relationships (physician’s information, attention to user’s needs, time dedicated to the user, etc.), team organisation (support from colleagues, work feedback, etc.) and scientifictechnical quality (quality of prescription standard, medications, etc.) | 2 |
| 39 | Association between social factors and depression | N=122 (residents in family medicine and psychiatry) | Survey at intervals | Parenting was found to be a protective factor from burnout; women not as vulnerable as previously reported | 1 |
| 40 | Assessing patientcentred decision making, interpersonal style and communication | N=1664 (adult general medicine patients) | Telephone interview | Better interpersonal process of care may predict more favourable patient outcomes and present one of the efforts to reduce health care disparities in our patients | 1 |
| 41 | Influence of work and living conditions on health | N=5666 | Cross-sectional study | The greater the financial distress and shame, the greater risk of psychosocial ill health | 1 |
| 42 | Nine quality indicators in 4 countries | N=4 (countries) | Data from health statistics agencies | Socioeconomic disparities in health care quality and health status were found | 3 |
| 43 | Patient-centred medical home and preventive services | N=24 (primary care settings) | Cross-sectional analysis | Patient-centred medical home highly correlated with preventive services delivery | 2 |
| 48 | Lowering hospitalizations in association with check-ups | N=660 (hospitalized patients) | Random sample | Regular health checkups outside of the Family Health Strategy doubled the likelihood of hospitalization | 1 |
| 44 | Quality of life (health, independence, psychological and emotional well-being) affected by frailty status (reduced energy levels, depressive status, etc.) | N=239 (community dwelling outpatients aged 65+) | Cross-sectional survey | Quality of life was negatively affected by frailty status | 3 |
| 45 | Diabetes management and quality of life | N=400 (primary care patients with diabetes) | Cross-sectional survey | Diabetes-related complications, worse subjective health and dissatisfaction with medical care influenced worsening of QoL | 3 |
| 46 | Bio-psycho-social view associated with medical prescription | N=8430 (all general practices in England) | Ecological study | Socio-economic status, ethnic density, chronic disease explained 44% of the variance in the volume of antidepressants prescribed | 1 |
| 47 | Status of behavioural medicine in psychiatric and medical illness | N=9 (family medicine residency programs) | Survey | Behavioural medicine was found to be useful in the prevention and treatment of physical and psychiatric illness | 1 |
| 33 | Intervention (quality improvement program; patient-oriented medical model) led to reduction in hospitalization and more optimal allocation of healthcare resources | N=808 (elderly 65+ in single clinic) | Evaluation of intervention program for reduction in the hospitalization of elderly people | Allocation of resources in primary care brought about a decrease in hospitalization figures | 1 |
| 34 | Prevention and chronic disease management as main points in primary health care | N=30 (primary care practices) | Before and after study; intervention first 12 months; preventive care, and after this another 3-9 months, chronic illness management | Intervention (preventive manoeuvres according to Canadian Task Force on Preventive Health Care recommendations) was effective in producing improvements in preventive care performance also beyond the intervention period | 1 |
| 54 | Therapeutic model that has influence on quality of life | N=15 (gastroenterological patients) | Semi-structured interviews | The sample was too small for conclusions about the psychosocial treatment on quality of life of patients | 3 |
| 19 | Holistic work (stated as) especially important in preventive work and palliative care | N=7 (focus groups with 22 GPs and 30 DNs) | Focus groups | The possibility to use (w) holistic model in their work gave family physicians and district nurses a strong motivation; organisation of primary care was shown to be a barrier or facilitator | 1 |
| 51 | Quality of consultation composed of: family physicians’ competence and their empathy/caring | N=11 (72 patients) | Focus groups with local community groups (n=8) and other local residents (n=3) | Patients from deprived areas expected a holistic family physician | 3 |
| 52 | Impact of evidence-based and patient-centred care on quality of care | N=5 (45 members) | Focus groups | Evidence-based and patientcentred care may influence the quality of care | 1 |
| 53 | Patients’ perceptions of development of quality indicators for chronic disease | N=6 (focus groups for adults with epilepsy); N=15 (experts) | Focus groups; Delphi study; 10 patient-generated quality indicators; 5 rated by experts | Patients’ perceptions of quality may be incorporated into future development of quality indicators for chronic disease | 3 |
| 55 | Model with influence on health outcomes | N=35 (married or previously married women with depressive disorder) | Qualitative investigation – interviews | Recommendation of using the psychosocial model for public health interventions and mental health promotion (in Indian context) | 1 |
| 56 | Bio-psychosocial model in chronic pain management strategy | N=25 (members of pain management teams) | Semi-structured interviews | Little impact of social factors in managing chronic pain, so the model may not achieve its full potential | 1 |
| 57 | Meeting patient needs to improve quality of care | N=13 (senior citizens, 65-91 years) | Semi-structured interviews | For older people with growing health problems, continuity of care, trust, free choice of family physician and an open attitude are highly valued | 3 |
| 58 | Effect of interpersonal process quality of medical consultations | N=21 (adult patients from 3 primary care clinics) | Semi-structured interviews | Patients with lower socioeconomic status are least likely to expect holistic care or empowerment, judging the quality of the treatment outcomes according to human skills and attitudes (empathic and engaged family physicians) and perceived outcomes of treatment | 2 |
| 59 | Importance of holistic approach to treatment and support in methadone | N=159 (opiate-dependent individuals 5 years after start of methadone treatment) | Interviews | QoL defined by psychological well-being and other psychosocial variables | 3 |
| 60 | maintenance treatment How the patient’s and physician’s sociocultural influences shape health and health care | N=22 (family physicians) | Semi-structured in-depth interviews | Medicine and physicians should be socially and culturally neutral; by seeking to avoid bias, physicians might be denying the role of sociocultural influences in patients’ health (access, treatment, outcomes) | 1 |