Application of the plurigaussian simulation technique in reproducing lithofacies with double anisotropy

Abstract

A number of trends, pressures and policy shifts can be identified thatare promoting greater patient involvement in health care deliverythrough consultations, treatments and continuing care. However, whilethe literature is growing fast on different methods of involvement,little attention has been given so far to the role which patientsthemselves wish to play, nor even of the conceptual meanings behindinvolvement or participation. This article reviews the current models ofinvolvement in health care delivery as derived from studies ofprofessional views of current and potential practice, prior to examiningthe empirical evidence from a large-scale qualitative study of the viewsand preferences of citizens, as patients, members of voluntary groups,or neither. Individual domiciliary interviews were carried out with 44people recruited from GP practices in northern England. Theserespondents were then included in a second phase of 34 focus groups in 6different localities in northern and southern England, of which 22 werewith individuals unaffiliated to any voluntary/community groups, 6related to local voluntary/community groups with specific interests inhealth or health care, and 6 related to groups without such specificinterests. A final set of 12 workshops with the same samples helped toconfirm emergent themes.The qualitative data enabled a taxonomy of patient-desired involvementto be derived, which is contrasted with professional-determined levelsof involvement identified from the literature. Participation is seen asbeing co-determined by patients and professionals, and occurring onlythrough the reciprocal relationships of dialogue and shareddecision-making. Not everyone wanted to be involved and the extent towhich involvement was desired depended on the contexts of type andseriousness of illness, various personal characteristics and patients'relationships with professionals. These levels are seen to provide basicbuilding blocks for a more sophisticated understanding of involvementwithin and between these contexts for use by professionals, managers,policy-makers and researchers. (c) 2006 Elsevier Ltd. All rightsreserved.