Are patients with chronic diseases a new challenge to general practice?

Organizing preventive health services to patient with chronic diseases

Why do clinics not follow the same code of practice?

Loni Ledderer

Research Unit of General Practice, Institute of Public Health,

University of Southern Denmarklledderer@health.sdu.dk.

Loni Ledderer 1

Are patients with chronic diseases a new challenge to general practice?

Organizing preventive health services to patient with chronic diseases

Existing Interventions focus on– Medical treatment– New technology– Clinical procedures

Existing Interventions neglect– Cultural rules– Collective meaning

Loni Ledderer 2

Are patients with chronic diseases a new challenge to general practice?

Organizing preventive health services to patient with chronic diseases

Rules and interaction about– Receptionist’s duties– The consultation routine– Blood tests

Give collective meaning to medical practice

Loni Ledderer 3

Are patients with chronic diseases a new challenge to general practice?

Organizing preventive health services to patient with chronic diseases

4

Motivational Interviewing (MI)

Organizing MI into patient care

Preventive Health Project2005-2006

10 general practicesVoluntary participation

Are patients with chronic diseases a new challenge to general practice?

Organizing preventive health services to patient with chronic diseases

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The resources in the clinic.• Consultation room• Appointment system• Trained staff

Are patients with chronic diseases a new challenge to general practice?

Organizing preventive health services to patient with chronic diseases

Loni Ledderer 6

Medical assessment

We have to be physicians; we form an estimate of biochemical profile from patients’ blood test….. We shall devote our time to the sick people. (clinic 4, GP)

Talk

I ask patients about their motives, what is valuable to them, try to figure out, what they think is most important. I also inquire about the reason for the decision they have made to visit the clinic, what kind of behavior change they expect to obtain... (Clinic 10, nurse)

Are patients with chronic diseases a new challenge to general practice?

Organizing preventive health services to patient with chronic diseases

Loni Ledderer 7

Biomedical approach Psychological approach

Producing variation in medical practices

Are patients with chronic diseases a new challenge to general practice?

Organizing preventive health services to patient with chronic diseases

Conclusion

Variation in clinics’ understanding of new interventions produces substantial variation in the form of health service offered to patients.

Loni Ledderer 8

Are patients with chronic diseases a new challenge to general practice?

Organizing preventive health services to patient with chronic diseases

Implication

Change in medical practice depends on healthcare organizations’ ability to put forward a new collective meaning to what is considered an appropriate health service.– No intervention fits equally into every clinic– Purely technical, instrumental and practical issues are inadequate

Loni Ledderer 9