A nationwide study of the processes of care undertaken in Rheumatology clinics throughout the UK

• Main Author: Vinall-Collier, Karen Annette
• Published: University of Leeds 2013
• Subjects: 616.723
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.616474

Rheumatology Out-patient clinics throughout the UK. A particular aim was to identify the contribution of Consultant Rheumatologist, Clinical Nurse Specialist and patient by comparing and contrasting physician-led and nurse-led clinics. A total of 107 direct observations from audio recordings of clinic consultations were analysed with the Roter's Interactional Analysis System (RIAS). This produced a patient centeredness score for each consultation as well as classification of interaction as either task focussed or socio-emotional. 'Patient initiated question asking' (not prompted.by the practitioner through questions) was of particular interest but is not distinguished under the RIAS. Hence, 10 cases (patient and practitioner matched consultation transcripts and interviews) were selected for further exploration of patient initiations to offer greater insight into the patients' meaning making. Thirty semi-structured interviews were undertaken with practitioners (N::;16) and patients (N=15) within 24hrs following their consultation and analysed using thematic analysis. The purpose of the analysis was to explore both practitioner and patient perceptions of the clinic visit to inform the interaction analysis undertaken using the RIAS. This research has enhanced understanding of Clinical Nurse Specialist consultations in Rheumatology, in particular the role of communication in the interaction and potential means to enhance patient participation as a precursor to shared clinical decision making. It is concluded that identifying processes of care and communication behaviours that are patient-centred help to activate patients. The contribution of a theoretical framework of Context-Mechanism-Outcome illuminates that processes do not occur in a vacuum and that contextual characteristics are especially important when comparing across practitioner groups .