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Characteristics of international primary care practices and physicians related to advance care planning: a cross-sectional survey study

BACKGROUND: Primary care providers (PCPs) are well-situated to delivery primary palliative care such as advance care planning (ACP). The aim of this work is to identify practice characteristics, including features found in advanced primary care models (APCMs), that predict PCP engagement of patients...

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Autores principales: Nowels, Molly A., Nowels, David, Sheffler, Julia, Lum, Hillary D.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10347754/
https://www.ncbi.nlm.nih.gov/pubmed/37452276
http://dx.doi.org/10.1186/s12875-023-02103-8
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author Nowels, Molly A.
Nowels, David
Sheffler, Julia
Lum, Hillary D.
author_facet Nowels, Molly A.
Nowels, David
Sheffler, Julia
Lum, Hillary D.
author_sort Nowels, Molly A.
collection PubMed
description BACKGROUND: Primary care providers (PCPs) are well-situated to delivery primary palliative care such as advance care planning (ACP). The aim of this work is to identify practice characteristics, including features found in advanced primary care models (APCMs), that predict PCP engagement of patients in ACP. METHODS: We analyzed characteristics of physician respondents and their practices associated with ACP conversations in older and sicker patients using data from 11 countries who participated in the 2015 Commonwealth Fund International Survey of Primary Care Physicians in 10 Nations. The primary outcome was how routinely these ACP conversations are reported. We used a validated measure to describe practice-level characteristics of advanced primary care models. We conducted bivariate and multivariable analyses to determine PCP and practice characteristics associated with routinely engaging patients in ACP and with documenting patient preferences in medical records. RESULTS: Respondents (N = 12,049) predominantly were older than 45 and did not view their jobs as high stress. PCPs reported routinely engaging patients in ACP work in practices with more APCM features. They are more likely to view their jobs as high stress, to work more hours, to practice in rural areas, and to work in smaller practices. Multivariable analyses showed that older PCP age, higher perceived stress of the job, practice location in rural areas, and increased number of APCM features were associated with more ACP conversations. Increased number of APCM features was also associated with higher odds of routinely recording patient preferences in their medical records. CONCLUSIONS: In this international survey, physician and practice characteristics, including having features associated with APCMs, were associated with whether physicians routinely discuss ACP with patients who are older and sicker. Many features of APCMs may facilitate ACP discussions between PCPs and patients. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12875-023-02103-8.
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spelling pubmed-103477542023-07-15 Characteristics of international primary care practices and physicians related to advance care planning: a cross-sectional survey study Nowels, Molly A. Nowels, David Sheffler, Julia Lum, Hillary D. BMC Prim Care Research BACKGROUND: Primary care providers (PCPs) are well-situated to delivery primary palliative care such as advance care planning (ACP). The aim of this work is to identify practice characteristics, including features found in advanced primary care models (APCMs), that predict PCP engagement of patients in ACP. METHODS: We analyzed characteristics of physician respondents and their practices associated with ACP conversations in older and sicker patients using data from 11 countries who participated in the 2015 Commonwealth Fund International Survey of Primary Care Physicians in 10 Nations. The primary outcome was how routinely these ACP conversations are reported. We used a validated measure to describe practice-level characteristics of advanced primary care models. We conducted bivariate and multivariable analyses to determine PCP and practice characteristics associated with routinely engaging patients in ACP and with documenting patient preferences in medical records. RESULTS: Respondents (N = 12,049) predominantly were older than 45 and did not view their jobs as high stress. PCPs reported routinely engaging patients in ACP work in practices with more APCM features. They are more likely to view their jobs as high stress, to work more hours, to practice in rural areas, and to work in smaller practices. Multivariable analyses showed that older PCP age, higher perceived stress of the job, practice location in rural areas, and increased number of APCM features were associated with more ACP conversations. Increased number of APCM features was also associated with higher odds of routinely recording patient preferences in their medical records. CONCLUSIONS: In this international survey, physician and practice characteristics, including having features associated with APCMs, were associated with whether physicians routinely discuss ACP with patients who are older and sicker. Many features of APCMs may facilitate ACP discussions between PCPs and patients. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12875-023-02103-8. BioMed Central 2023-07-14 /pmc/articles/PMC10347754/ /pubmed/37452276 http://dx.doi.org/10.1186/s12875-023-02103-8 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Nowels, Molly A.
Nowels, David
Sheffler, Julia
Lum, Hillary D.
Characteristics of international primary care practices and physicians related to advance care planning: a cross-sectional survey study
title Characteristics of international primary care practices and physicians related to advance care planning: a cross-sectional survey study
title_full Characteristics of international primary care practices and physicians related to advance care planning: a cross-sectional survey study
title_fullStr Characteristics of international primary care practices and physicians related to advance care planning: a cross-sectional survey study
title_full_unstemmed Characteristics of international primary care practices and physicians related to advance care planning: a cross-sectional survey study
title_short Characteristics of international primary care practices and physicians related to advance care planning: a cross-sectional survey study
title_sort characteristics of international primary care practices and physicians related to advance care planning: a cross-sectional survey study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10347754/
https://www.ncbi.nlm.nih.gov/pubmed/37452276
http://dx.doi.org/10.1186/s12875-023-02103-8
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