51
|
Heneghan NR, Nazareth M, Johnson WJ, Tyros I, Sadi J, Gillis H, Rushton AB. Experiences of telehealth e-mentoring within postgraduate musculoskeletal physical therapy education in the UK and Canada: a protocol for parallel mixed-methods studies and cross-cultural comparison. BMJ Open 2021; 11:e042602. [PMID: 33550251 PMCID: PMC7925928 DOI: 10.1136/bmjopen-2020-042602] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Mentored clinical practice is central to demonstrating achievement of International Educational Standards in advanced musculoskeletal physical therapy. While traditionally delivered face-to-face, telehealth e-mentoring is a novel alternative to offering this unique pedagogy to facilitate mentee critical reflection, deeper learning and enhanced knowledge translation to optimise patient care. With COVID-19 resulting in widespread adoption of telehealth and access to mentors often limited by geography or cost, the potential value of telehealth e-mentoring needs investigating. To investigate the experiences and outcomes of multiple stakeholders (student mentees, mentors and patients) engaged in musculoskeletal physical therapy telehealth e-mentoring across two universities (UK and Canada). METHODS AND ANALYSIS Using case study design, we will use sequential mixed methods involving qualitative and quantitative components based on existing evidence. To examine the influence of telehealth e-mentoring on health outcomes in patients with musculoskeletal complaints, we will use patient-reported outcomes for satisfaction, patient empowerment and change in musculoskeletal health. We will conduct semistructured interviews to explore the development of critical thinking, clinical reasoning, communication skills and confidence of students engaged in telehealth e-mentoring. To explore the mentor acceptability and appropriateness of telehealth e-mentoring, we will conduct a focus group in each site. Finally, we will include a focus group of participants from each site to allow a cross-cultural comparison of findings to inform international stakeholders. Quantitative data will be analysed using descriptive statistics (median and IQR) to describe changes in outcome data and qualitative data will be analysed following the Framework Method. ETHICS AND DISSEMINATION This study has ethical approval from both institutions: the University of Birmingham (ERN_20-0695) and Western University (2020-116233-47832). Findings will be published in a peer-reviewed journal and disseminated to key stakeholders in musculoskeletal physical therapy education and practice.
Collapse
Affiliation(s)
- Nicola R Heneghan
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Madeleine Nazareth
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Wendy J Johnson
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
- Edinburgh Community Physiotherapy Service, NHS Lothian, Edinburgh, UK
| | - Isaak Tyros
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Jackie Sadi
- School of Physical Therapy, Western University, London, Ontario, Canada
| | - Heather Gillis
- School of Physical Therapy, Western University, London, Ontario, Canada
| | - Alison B Rushton
- School of Physical Therapy, Western University, London, Ontario, Canada
| |
Collapse
|
52
|
Muller I, Stuart B, Sach T, Hooper J, Wilczynska S, Steele M, Greenwell K, Sivyer K, Yardley L, Williams HC, Chalmers JR, Leighton P, Howells LM, Ridd MJ, Lawton S, Griffiths G, Nuttall J, Langan SM, Roberts A, Ahmed A, Kirk H, Becque T, Little P, Thomas KS, Santer M. Supporting self-care for eczema: protocol for two randomised controlled trials of ECO (Eczema Care Online) interventions for young people and parents/carers. BMJ Open 2021; 11:e045583. [PMID: 33550268 PMCID: PMC7925854 DOI: 10.1136/bmjopen-2020-045583] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/22/2020] [Accepted: 01/20/2021] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Eczema care requires management of triggers and various treatments. We developed two online behavioural interventions to support eczema care called ECO (Eczema Care Online) for young people and ECO for families. This protocol describes two randomised controlled trials (RCTs) aimed to evaluate clinical and cost-effectiveness of the two interventions. METHODS AND ANALYSIS: Design: Two independent, pragmatic, unmasked, parallel group RCTs with internal pilots and nested health economic and process evaluation studies. Setting: Participants will be recruited from general practitioner practices in England. Participants: Young people aged 13-25 years with eczema and parents and carers of children aged 0-12 years with eczema, excluding inactive or very mild eczema (five or less on Patient-Oriented Eczema Measure (POEM)). Interventions: Participants will be randomised to online intervention plus usual care or to usual eczema care alone. Outcome measures: Primary outcome is eczema severity over 24 weeks measured by POEM. Secondary outcomes include POEM 4-weekly for 52 weeks, quality of life, eczema control, itch intensity (young people only), patient enablement, health service and treatment use. Process measures include treatment adherence, barriers to adherence and intervention usage. Our sample sizes of 303 participants per trial are powered to detect a group difference of 2.5 (SD 6.5) in monthly POEM scores over 24 weeks (significance 0.05, power 0.9), allowing for 20% loss to follow-up. Cost-effectiveness analysis will be from a National Health Service and personal social service perspective. Qualitative and quantitative process evaluation will help understand the mechanisms of action and participant experiences and inform implementation. ETHICS AND DISSEMINATION The study has been approved by South Central Oxford A Research Ethics Committee (19/SC/0351). Recruitment is ongoing, and follow-up will be completed by mid-2022. Findings will be disseminated to participants, the public, dermatology and primary care journals, and policy makers. TRIAL REGISTRATION NUMBER ISRCTN79282252.
Collapse
Affiliation(s)
- Ingrid Muller
- School of Primary Care, Population Health and Medical Education, University of Southampton, Southampton, UK
| | - Beth Stuart
- School of Primary Care, Population Health and Medical Education, University of Southampton, Southampton, UK
| | - Tracey Sach
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Julie Hooper
- School of Primary Care, Population Health and Medical Education, University of Southampton, Southampton, UK
| | - Sylvia Wilczynska
- School of Primary Care, Population Health and Medical Education, University of Southampton, Southampton, UK
| | - Mary Steele
- Department of Psychology, University of Southampton, Southampton, UK
| | - Kate Greenwell
- Department of Psychology, University of Southampton, Southampton, UK
| | - Katy Sivyer
- Department of Psychology, University of Southampton, Southampton, UK
- Department of Psychology, University of Portsmouth, Portsmouth, UK
| | - Lucy Yardley
- Department of Psychology, University of Southampton, Southampton, UK
- School of Experimental Psychology, University of Bristol, Bristol, UK
| | - Hywel C Williams
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Joanne R Chalmers
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Paul Leighton
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Laura M Howells
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Matthew J Ridd
- Population Health Sciences, University of Bristol Faculty of Health Sciences, Bristol, UK
| | - Sandra Lawton
- Department of Dermatology, Rotherham NHS Foundation Trust, Rotherham, UK
| | - Gareth Griffiths
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Jacqui Nuttall
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Sinead M Langan
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Amanda Roberts
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Amina Ahmed
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Hayden Kirk
- Neurological Rehabilitation, Solent NHS Trust, Southampton, UK
| | - Taeko Becque
- School of Primary Care, Population Health and Medical Education, University of Southampton, Southampton, UK
| | - Paul Little
- School of Primary Care, Population Health and Medical Education, University of Southampton, Southampton, UK
| | - Kim S Thomas
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Miriam Santer
- School of Primary Care, Population Health and Medical Education, University of Southampton, Southampton, UK
| |
Collapse
|
53
|
McManus RJ, Little P, Stuart B, Morton K, Raftery J, Kelly J, Bradbury K, Zhang J, Zhu S, Murray E, May CR, Mair FS, Michie S, Smith P, Band R, Ogburn E, Allen J, Rice C, Nuttall J, Williams B, Yardley L. Home and Online Management and Evaluation of Blood Pressure (HOME BP) using a digital intervention in poorly controlled hypertension: randomised controlled trial. BMJ 2021; 372:m4858. [PMID: 33468518 PMCID: PMC7814507 DOI: 10.1136/bmj.m4858] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The HOME BP (Home and Online Management and Evaluation of Blood Pressure) trial aimed to test a digital intervention for hypertension management in primary care by combining self-monitoring of blood pressure with guided self-management. DESIGN Unmasked randomised controlled trial with automated ascertainment of primary endpoint. SETTING 76 general practices in the United Kingdom. PARTICIPANTS 622 people with treated but poorly controlled hypertension (>140/90 mm Hg) and access to the internet. INTERVENTIONS Participants were randomised by using a minimisation algorithm to self-monitoring of blood pressure with a digital intervention (305 participants) or usual care (routine hypertension care, with appointments and drug changes made at the discretion of the general practitioner; 317 participants). The digital intervention provided feedback of blood pressure results to patients and professionals with optional lifestyle advice and motivational support. Target blood pressure for hypertension, diabetes, and people aged 80 or older followed UK national guidelines. MAIN OUTCOME MEASURES The primary outcome was the difference in systolic blood pressure (mean of second and third readings) after one year, adjusted for baseline blood pressure, blood pressure target, age, and practice, with multiple imputation for missing values. RESULTS After one year, data were available from 552 participants (88.6%) with imputation for the remaining 70 participants (11.4%). Mean blood pressure dropped from 151.7/86.4 to 138.4/80.2 mm Hg in the intervention group and from 151.6/85.3 to 141.8/79.8 mm Hg in the usual care group, giving a mean difference in systolic blood pressure of -3.4 mm Hg (95% confidence interval -6.1 to -0.8 mm Hg) and a mean difference in diastolic blood pressure of -0.5 mm Hg (-1.9 to 0.9 mm Hg). Results were comparable in the complete case analysis and adverse effects were similar between groups. Within trial costs showed an incremental cost effectiveness ratio of £11 ($15, €12; 95% confidence interval £6 to £29) per mm Hg reduction. CONCLUSIONS The HOME BP digital intervention for the management of hypertension by using self-monitored blood pressure led to better control of systolic blood pressure after one year than usual care, with low incremental costs. Implementation in primary care will require integration into clinical workflows and consideration of people who are digitally excluded. TRIAL REGISTRATION ISRCTN13790648.
Collapse
Affiliation(s)
- Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Paul Little
- Primary Care and Population Sciences Unit, University of Southampton, Southampton, UK
| | - Beth Stuart
- Primary Care and Population Sciences Unit, University of Southampton, Southampton, UK
| | - Katherine Morton
- School of Psychology, University of Southampton, Southampton, UK
| | - James Raftery
- Primary Care and Population Sciences Unit, University of Southampton, Southampton, UK
| | - Jo Kelly
- Primary Care and Population Sciences Unit, University of Southampton, Southampton, UK
| | | | - Jin Zhang
- School of Psychology, University of Southampton, Southampton, UK
| | - Shihua Zhu
- Primary Care and Population Sciences Unit, University of Southampton, Southampton, UK
| | - Elizabeth Murray
- eHealth Unit, Research Department of Primary Care and Population Health Sciences, University College London, London, UK
| | - Carl R May
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Frances S Mair
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Susan Michie
- UCL Centre for Behaviour Change, University College London, London, UK
| | - Peter Smith
- Primary Care and Population Sciences Unit, University of Southampton, Southampton, UK
| | - Rebecca Band
- School of Psychology, University of Southampton, Southampton, UK
| | - Emma Ogburn
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Julie Allen
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Cathy Rice
- Patient and Public Contributor, Bristol, UK
| | - Jacqui Nuttall
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Bryan Williams
- Institute of Cardiovascular Sciences, NIHR UCL Hospitals Biomedical Research Centre, University College London, London, UK
| | - Lucy Yardley
- School of Psychology, University of Southampton, Southampton, UK
- School of Psychological Science, University of Bristol, UK
| |
Collapse
|
54
|
Nirmalan P. Design and development of objective questionnaires. KERALA JOURNAL OF OPHTHALMOLOGY 2021. [DOI: 10.4103/kjo.kjo_204_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
55
|
Bahrom NH, Ramli AS, Isa MR, Baharudin N, Badlishah-Sham SF, Mohamed-Yassin MS, Abdul-Hamid H. Validity and reliability of the Patient Activation Measure® (PAM®)-13 Malay version among patients with Metabolic Syndrome in primary care. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2020; 15:22-34. [PMID: 33329860 PMCID: PMC7735884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION The Patient Activation Measure (PAM) is one of the most extensively used, widely translated, and tested instruments worldwide in measuring patient activation levels in self-management. This study aimed to determine the validity and reliability of the PAM-13 Malay version among patients with Metabolic Syndrome (MetS) attending a primary care clinic. METHODS This work is a cross-sectional validation study among patients with MetS attending a university primary care clinic in Selangor. The PAM-13 Malay version underwent a validation process and field testing. Psychometric properties were examined using principal component analysis (PCA) with varimax rotation, scree plot, Monte Carlo simulation, internal consistency, and test-retest reliability analyses. RESULTS The content of the PAM-13 Malay version and the original version were conceptually equivalent. The questionnaire was refined after face validation by 10 patients with MetS. The refined version was then field-tested among 130 participants (response rate 89.7%). The Kaiser-Meyer-Olkin test was 0.767, and Bartlett's test of sphericity was ≤0.001, indicating sampling adequacy. Two factors were identified and labeled as (1) Passive and Building Knowledge, and (2) Taking Action and Maintaining Behavior. These labels were chosen as they were conceptually consistent with the items representing the levels of activation in PAM-13. The validated PAM-13 Malay version consisted of 13 items, framed into two domains. The overall Cronbach's α was 0.79, and the intraclass correlation coefficient was 0.45. CONCLUSIONS The PAM-13 Malay version is valid, reliable, and fairly stable over time. This questionnaire can be used to evaluate the levels of activation among patients with MetS in primary care in Malaysia.
Collapse
Affiliation(s)
- N H Bahrom
- MD (Calgary), Department of Primary Care, Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selayang Campus, Selangor, Malaysia
| | - A S Ramli
- MBBS (Newcastle, UK), MRCGP (UK), Deputy Director, Institute of Pathology Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor, Malaysia,
| | - M R Isa
- MBBS (UM), MPH (UM), Department of Population Health and Preventive Medicine, Faculty of Medicine, Universiti Teknologi MARA Sungai Buloh Campus, Selangor Malaysia
| | - N Baharudin
- MBBS (Monash), FRACGP (Australia), Department of Primary Care Medicine, Faculty of Medicine Universiti Teknologi MARA, Selayang Campus, Selangor, Malaysia
| | - S F Badlishah-Sham
- MBBCh BAO (Cork, Ireland), MFamMed (UiTM), Department of Primary Care Medicine, Faculty of Medicine Universiti Teknologi MARA, Selayang Campus, Selangor, Malaysia
| | - M S Mohamed-Yassin
- MBBS (Monash), FRACGP (Australia), Department of Primary Care Medicine, Faculty of Medicine Universiti Teknologi MARA, Selayang Campus, Selangor, Malaysia
| | - H Abdul-Hamid
- MB BCh (Cardiff), MRCGP (UK), Department of Primary Care Medicine, Faculty of Medicine Universiti Teknologi MARA, Selayang Campus, Selangor, Malaysia
| |
Collapse
|
56
|
Song HJ, Dennis S, Levesque JF, Harris M. How to implement patient experience surveys and use their findings for service improvement: a qualitative expert consultation study in Australian general practice. INTEGRATED HEALTHCARE JOURNAL 2020. [DOI: 10.1136/ihj-2019-000033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
ObjectiveTo identify barriers (patient, provider, practice and system levels) to consider when implementing patient experience surveys in Australian general practice and enablers of their systematic use to inform service improvement in clinical practice as well as the broader health system.Methods and analysisAn expert consultation and qualitative content analysis of cross-sectional, open-text survey data. Data were collected from key international and Australian experts in the areas of measurement and quality improvement in general practice.ResultsResponses from 20 participants from six countries were included in the study. Participants discussed the importance of ensuring value and relevance of surveys to stakeholders. Lack of resources, IT infrastructure, capacity building and sustained funding were identified as barriers to implementing surveys. Participants discussed the importance of clearly defining and communicating the purpose of surveys and agreed on the value of using patient experience to inform reflective, team-based learning at the practice level. Opinions differed on the use of patient experience data at the system level, with some questioning its utility or fairness for external performance reporting. Others recommended the aggregation and reporting of these data under certain conditions, including for the purpose of triangulation with other quality and outcome data. The study identified an evidence gap in the assessment and interpretation of patient experience data at the practice and system levels, including the analysis and contextualisation of survey findings at the system level.ConclusionPatient experience surveys have potential for guiding practice level quality improvement, but many barriers to their implementation remain. There is need for greater research and policy efforts to understand how this information can be used at the system level for improving Australian general practice.
Collapse
|
57
|
Buizza C, Cela H, Ferrari C, Goss C, Bottacini A, Mazzi MA, Del Piccolo L, Ghilardi A. Does being accompanied make a difference in communication during breast cancer consultations? Results from a multi-centered randomized controlled trial. J Psychosoc Oncol 2020; 39:189-203. [PMID: 33089767 DOI: 10.1080/07347332.2020.1829775] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES This study is based on a multi-centered RCT conducted on breast cancer patients during their first consultation with an oncologist. The main aim was to evaluate whether the introduction of a communication tool (i.e., the Question Prompt Sheet or Question Listing), with or without a companion, impacted the number of questions asked by patients during the consultation, and subsequent psychological and relational outcomes. METHODS The sample consisted of 324 breast cancer patients who were randomly placed into one of the two intervention groups: Question Prompt Sheet or Question Listing. Before and after the consultation, patients completed a set of standardized instruments: Satisfaction with decisions made during the consultation (SWD), Shared Decision Making Questionnaire (SDMQ-9), Patient Enablement Instrument (PEI), Patient Health Questionnaire Depression scale (PHQ-9), General Health Questionnaire (GHQ-12). RESULTS The results indicate that the number of questions asked during the consultation was higher when a Question Listing was provided and when the patient was unaccompanied. Unaccompanied patients asked more questions in both groups and had significantly lower scores than accompanied on the GHQ-12 and on the PHQ-9, indicating lower clinical symptomatology. CONCLUSIONS Results are in contrast with previous literature, indicating that being unaccompanied help patients to interact more with the oncologist. Further studies are needed to evaluate how the presence or not of a companion really impacts breast cancer patients during their first consultation with an oncologist. TRIAL REGISTRATION ClinicalTrials.gov NCT01510964.
Collapse
Affiliation(s)
- Chiara Buizza
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Herald Cela
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Clarissa Ferrari
- Service of Statistics, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Claudia Goss
- Department of Neurological, Biomedical and Movement Sciences, Section of Clinical Psychology, University of Verona, Italy
| | - Alessandro Bottacini
- Department of Neurological, Biomedical and Movement Sciences, Section of Clinical Psychology, University of Verona, Italy
| | - Maria Angela Mazzi
- Department of Neurological, Biomedical and Movement Sciences, Section of Clinical Psychology, University of Verona, Italy
| | - Lidia Del Piccolo
- Department of Neurological, Biomedical and Movement Sciences, Section of Clinical Psychology, University of Verona, Italy
| | - Alberto Ghilardi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| |
Collapse
|
58
|
Tolvanen E, Koskela TH, Helminen M, Kosunen E. The validity and reliability of the patient enablement instrument (PEI) after GP appointments in Finnish health care centres. J Patient Rep Outcomes 2020; 4:79. [PMID: 32936378 PMCID: PMC7494691 DOI: 10.1186/s41687-020-00243-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 08/25/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The aim of this study was to assess the validity and reliability of the Patient Enablement Instrument (PEI) in Finnish health care centre patients. A pilot study was conducted to assess the content validity of the PEI. A questionnaire study in three health care centres in Western Finland was performed in order to assess acceptability, construct validity, internal consistency, and measurement error of the instrument. A telephone interview 2 weeks after the appointment was performed to evaluate reproducibility. RESULTS The pilot study with 17 participants indicated good content validity of the PEI. In the questionnaire study, altogether 483 with a completed PEI score were included in the analyses. Factor analysis and item-scale correlations suggested high structural validity. The internal consistency of the instrument was high (Cronbach's α = 0.93). The PEI score diminished strongly over the two-week period. CONCLUSIONS The PEI has good content validity and acceptability, good construct validity, high internal consistency but low reproducibility. Thus, the PEI seems to be an applicable tool to measure patient enablement in Finnish primary health care.
Collapse
Affiliation(s)
- Elina Tolvanen
- Faculty of Medicine and Health Technology, Tampere University, c/o coordinator Leena Kiuru, Arvo Building B, 33014, Tampere, Finland. .,Pirkkala Municipal Health Centre, Pirkkala, Finland. .,Research, Development and Innovation Centre, Tampere University Hospital, Tampere, Finland.
| | - Tuomas H Koskela
- Faculty of Medicine and Health Technology, Tampere University, c/o coordinator Leena Kiuru, Arvo Building B, 33014, Tampere, Finland
| | - Mika Helminen
- Research, Development and Innovation Centre, Tampere University Hospital, Tampere, Finland.,Faculty of Social Sciences, Health Sciences, Tampere University, Tampere, Finland
| | - Elise Kosunen
- Faculty of Medicine and Health Technology, Tampere University, c/o coordinator Leena Kiuru, Arvo Building B, 33014, Tampere, Finland.,Centre for General Practice, Pirkanmaa Hospital District, Tampere, Finland
| |
Collapse
|
59
|
Van Wilder L, Clays E, Devleesschauwer B, Pype P, Boeckxstaens P, Schrans D, De Smedt D. Health-related quality of life in patients with non-communicable disease: study protocol of a cross-sectional survey. BMJ Open 2020; 10:e037131. [PMID: 32912984 PMCID: PMC7485234 DOI: 10.1136/bmjopen-2020-037131] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Non-communicable diseases (NCDs) are associated with lower health-related quality of life (HRQoL). However, knowledge about those diseases and predictors with a greater impact on patients' HRQoL as well as knowledge on the complex relationship between HRQoL and comorbidities is lacking. The aim of this study is to assess the impact of NCDs on patients' HRQoL, with a focus on multimorbidity and socioeconomic status. METHODS AND ANALYSIS A primary care-based cross-sectional study is conducted in Flanders (Belgium). Study participants (≥18 years) are medically diagnosed with at least one of the following diseases: cardiometabolic disorders, mental disorders and musculoskeletal disorders. A minimum of 50 general practitioners will participate to recruit participants (convenient sample) and a total of 531 patients will be enrolled (voluntary response sample). Each participant will complete a paper-based questionnaire to gather research outcomes. Statistical analyses will be performed using multiple linear regression models with HRQoL as main outcome parameter, adjusted for possible confounders. This study will generate new evidence on the key predictors of HRQoL in patients with NCDs, and particularly provide new insights in multimorbidity to improve the quality of care in primary care, to support patients' self-management and to allocate resources more effectively. ETHICS AND DISSEMINATION The study has been approved by the Ethical Committee of Ghent University Hospital, Ghent, Belgium (reference number: B670201939629) prior to the beginning of the recruitment. Study results will be disseminated through peer-reviewed publications and conference presentations.
Collapse
Affiliation(s)
- Lisa Van Wilder
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Els Clays
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | | | - Peter Pype
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | | | - Diego Schrans
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Delphine De Smedt
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| |
Collapse
|
60
|
Everitt H, Landau S, Little P, Bishop FL, O'Reilly G, Sibelli A, Holland R, Hughes S, Windgassen S, McCrone P, Goldsmith K, Coleman N, Logan R, Chalder T, Moss-Morris R. Therapist telephone-delivered CBT and web-based CBT compared with treatment as usual in refractory irritable bowel syndrome: the ACTIB three-arm RCT. Health Technol Assess 2020; 23:1-154. [PMID: 31042143 DOI: 10.3310/hta23170] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Irritable bowel syndrome (IBS) affects 10-22% of people in the UK. Abdominal pain, bloating and altered bowel habits affect quality of life and can lead to time off work. Current treatment relies on a positive diagnosis, reassurance, lifestyle advice and drug therapies, but many people suffer ongoing symptoms. Cognitive-behavioural therapy (CBT) is recommended in guidelines for patients with ongoing symptoms but its availability is limited. OBJECTIVES To determine the clinical effectiveness and cost-effectiveness of therapist telephone-delivered CBT (TCBT) and web-based CBT (WCBT) with minimal therapist support compared with treatment as usual (TAU) in refractory IBS. DESIGN This was a three-arm randomised controlled trial. SETTING This trial took place in UK primary and secondary care. PARTICIPANTS Adults with refractory IBS (clinically significant symptoms for 12 months despite first-line therapies) were recruited from 74 general practices and three gastroenterology centres from May 2014 to March 2016. INTERVENTIONS TCBT - patient CBT self-management manual, six 60-minute telephone sessions over 9 weeks and two 60-minute booster sessions at 4 and 8 months (8 hours' therapist time). WCBT - interactive, tailored web-based CBT, three 30-minute telephone sessions over 9 weeks and two 30-minute boosters at 4 and 8 months (2.5 hours' therapist time). MAIN OUTCOME MEASURES Primary outcomes - IBS symptom severity score (IBS SSS) and Work and Social Adjustment Scale (WSAS) at 12 months. Cost-effectiveness [quality-adjusted life-years (QALYs) and health-care costs]. RESULTS In total, 558 out of 1452 patients (38.4%) screened for eligibility were recruited - 186 were randomised to TCBT, 185 were randomised to WCBT and 187 were randomised to TAU. The mean baseline Irritable Bowel Syndrome Symptom Severity Score (IBS SSS) was 265.0. An intention-to-treat analysis with multiple imputation was carried out at 12 months; IBS SSS were 61.6 points lower in the TCBT arm [95% confidence interval (CI) 89.5 to 33.8; p < 0.001] and 35.2 points lower in the WCBT arm (95% CI 57.8 to 12.6; p = 0.002) than in the TAU arm (IBS SSS of 205.6). The mean WSAS score at 12 months was 10.8 in the TAU arm, 3.5 points lower in the TCBT arm (95% CI 5.1 to 1.9; p < 0.001) and 3.0 points lower in the WCBT arm (95% CI 4.6 to 1.3; p = 0.001). For the secondary outcomes, the Subject's Global Assessment showed an improvement in symptoms at 12 months (responders) in 84.8% of the TCBT arm compared with 41.7% of the TAU arm [odds ratio (OR) 6.1, 95% CI 2.5 to 15.0; p < 0.001] and 75.0% of the WCBT arm (OR 3.6, 95% CI 2.0 to 6.3; p < 0.001). Patient enablement was 78.3% (responders) for TCBT, 23.5% for TAU (OR 9.3, 95% CI 4.5 to 19.3; p < 0.001) and 54.8% for WCBT (OR 3.5, 95% CI 2.0 to 5.9; p < 0.001). Adverse events were similar between the trial arms. The incremental cost-effectiveness ratio (ICER) (QALY) for TCBT versus TAU was £22,284 and for WCBT versus TAU was £7724. Cost-effectiveness reduced after imputation for missing values. Qualitative findings highlighted that, in the CBT arms, there was increased capacity to cope with symptoms, negative emotions and challenges of daily life. Therapist input was important in supporting WCBT. CONCLUSIONS In this large, rigorously conducted RCT, both CBT arms showed significant improvements in IBS outcomes compared with TAU. WCBT had lower costs per QALY than TCBT. Sustained improvements in IBS symptoms are possible at an acceptable cost. Suggested future research work is longer-term follow-up and research to translate these findings into usual clinical practice. FUTURE WORK Longer-term follow-up and research to translate these findings into usual clinical practice is needed. TRIAL REGISTRATION Current Controlled Trials ISRCTN44427879. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme and will be published in full in Health Technology Assessment; Vol. 23, No. 17. See the NIHR Journals Library website for further project information. The University of Southampton sponsored this study. Funding was received from the NIHR HTA Board and the NIHR Clinical Research Network and support was received from the NIHR Clinical Research Network.
Collapse
Affiliation(s)
- Hazel Everitt
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Sabine Landau
- Biostatistics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Paul Little
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Felicity L Bishop
- Centre for Applications of Health Psychology, University of Southampton, Southampton, UK
| | - Gillian O'Reilly
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Alice Sibelli
- Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Rachel Holland
- Biostatistics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Stephanie Hughes
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Sula Windgassen
- Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Paul McCrone
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Kim Goldsmith
- Biostatistics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Nicholas Coleman
- Department of Gastroenterology, Southampton University Hospital, Southampton, UK
| | - Robert Logan
- Department of Gastroenterology, King's College Hospital, London, UK
| | - Trudie Chalder
- Academic Department of Psychological Medicine, King's College London, London, UK
| | - Rona Moss-Morris
- Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| |
Collapse
|
61
|
Geraghty AWA, Roberts L, Hill J, Foster NE, Yardley L, Hay E, Stuart B, Turner D, Griffiths G, Webley F, Durcan L, Morgan A, Hughes S, Bathers S, Butler-Walley S, Wathall S, Mansell G, Leigh L, Little P. Supporting self-management of low back pain with an internet intervention in primary care: a protocol for a randomised controlled trial of clinical and cost-effectiveness (SupportBack 2). BMJ Open 2020; 10:e040543. [PMID: 32819960 PMCID: PMC7440707 DOI: 10.1136/bmjopen-2020-040543] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Self-management and remaining physically active are first-line recommendations for the care of patients with low back pain (LBP). With a lifetime prevalence of up to 85%, novel approaches to support behavioural self-management are needed. Internet interventions may provide accessible support for self-management of LBP in primary care. The aim of this randomised controlled trial is to determine the clinical and cost-effectiveness of the 'SupportBack' internet intervention, with or without physiotherapist telephone support in reducing LBP-related disability in primary care patients. METHODS AND ANALYSIS A three-parallel arm, multicentre randomised controlled trial will compare three arms: (1) usual primary care for LBP; (2) usual primary care for LBP and an internet intervention; (3) usual primary care for LBP and an internet intervention with additional physiotherapist telephone support. Patients with current LBP and no indicators of serious spinal pathology are identified and invited via general practice list searches and mailouts or opportunistic recruitment following LBP consultations. Participants undergo a secondary screen for possible serious spinal pathology and are then asked to complete baseline measures online after which they are randomised to an intervention arm. Follow-ups occur at 6 weeks, 3, 6 and 12 months. The primary outcome is physical function (using the Roland and Morris Disability Questionnaire) over 12 months (repeated measures design). Secondary outcomes include pain intensity, troublesome days in pain over the last month, pain self-efficacy, catastrophising, kinesophobia, health-related quality of life and cost-related measures for a full health economic analysis. A full mixed-methods process evaluation will be conducted. ETHICS AND DISSEMINATION This trial has been approved by a National Health Service Research Ethics Committee (REC Ref: 18/SC/0388). Results will be disseminated through peer-reviewed journals, conferences, communication with practices and patient groups. Patient representatives will support the implementation of our full dissemination strategy. TRIAL REGISTRATION NUMBER ISRCTN14736486.
Collapse
Affiliation(s)
- Adam W A Geraghty
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, Hampshire, UK
| | - Lisa Roberts
- School of Health Sciences, University of Southampton & University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, UK
| | - Jonathan Hill
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, UK
| | - Nadine E Foster
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, UK
| | - Lucy Yardley
- Department of Psychology, University of Southampton, Southampton, Hampshire, UK
- School of Psychological Science, University of Bristol, Bristol, Bristol, UK
| | - Elaine Hay
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, UK
| | - Beth Stuart
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, Hampshire, UK
| | - David Turner
- Keele Clinical Trials Unit, School of Primary, Community and Social Care, Keele University, Keele, Newcastle, UK
| | - Gareth Griffiths
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Frances Webley
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Lorraine Durcan
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Alannah Morgan
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Stephanie Hughes
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, Hampshire, UK
| | - Sarah Bathers
- Keele Clinical Trials Unit, Keele University, Keele, Staffordshire, UK
| | | | - Simon Wathall
- Keele Clinical Trials Unit, Keele University, Keele, Staffordshire, UK
| | - Gemma Mansell
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Linda Leigh
- Patient and Public Involvement Representative, University of Southampton, Southampton, UK
| | - Paul Little
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, Hampshire, UK
| |
Collapse
|
62
|
Mangin D, Lamarche L, Oliver D, Bomze S, Borhan S, Browne T, Carr T, Datta J, Dolovich L, Howard M, Marentette-Brown S, Risdon C, Talat S, Tarride JE, Thabane L, Valaitis R, Price D. Health TAPESTRY Ontario: protocol for a randomized controlled trial to test reproducibility and implementation. Trials 2020; 21:714. [PMID: 32795381 PMCID: PMC7427958 DOI: 10.1186/s13063-020-04600-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 07/12/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Health TAPESTRY (Health Teams Advancing Patient Experience: STRengthening qualitY) aims to help people stay healthier for longer where they live by providing person-focused care through the integration of four key program components: (1) trained volunteers who visit clients in their homes, (2) an interprofessional primary health care team, (3) use of technology to collect and share information, and (4) improved connections to community health and social services. The initial randomized controlled trial of Health TAPESTRY found promising results in terms of health care use and patient outcomes, indicating a shift from reactive to preventive care. The trial was based on one clinical academic center, thus limiting generalizability. The study objectives are (1) to test reproducibility of the established effectiveness of Health TAPESTRY on physical activity and hospitalizations, (2) to test the feasibility of, and understand the contributing factors to, the implementation of Health TAPESTRY in six diverse communities across Ontario, Canada, and (3) to determine the value for money of implementing Health TAPESTRY. METHODS This planned study is a pragmatic parallel randomized controlled trial with a delayed intervention for control participants at 6 months. This trial will simultaneously assess effectiveness and implementation in a real-world setting (type II hybrid) in six diverse communities across Ontario. Participants 70 years of age and older will be randomized into the Health TAPESTRY intervention or the control group (usual care). Intervention clients will receive an individualized plan of care from an interprofessional care team. The plan will be based on a client's goals and current health risks identified through volunteer visits. The study's outcomes are mapped onto the RE-AIM framework, with levels of physical activity and number of hospitalizations as the co-primary outcomes. The main analysis will be a comparison at 6 months. DISCUSSION It is important to evaluate the effectiveness and implementation of Health TAPESTRY in multiple communities prior to scaling or widespread adoption. TRIAL REGISTRATION ClinicalTrials.gov NCT03397836 . Registered on 12 January 2018.
Collapse
Affiliation(s)
- Dee Mangin
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 5th floor, Hamilton, ON, L8P 1H6, Canada.
| | - Larkin Lamarche
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 5th floor, Hamilton, ON, L8P 1H6, Canada
| | - Doug Oliver
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 3rd floor, Hamilton, ON, L8P 1H6, Canada
| | - Sivan Bomze
- Canadian Red Cross, 5700 Cancross Court, Mississauga, ON, L5R 3E9, Canada
| | - Sayem Borhan
- Department of Family Medicine, and Department of Health Research Methods, Evidence and Impact McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - Tracy Browne
- Canadian Red Cross, 1460 Fairburn Street, Sudbury, ON, P3A 1N7, Canada
| | - Tracey Carr
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 6th floor, Hamilton, ON, L8P 1H6, Canada
| | - Julie Datta
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 6th floor, Hamilton, ON, L8P 1H6, Canada
| | - Lisa Dolovich
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 5th floor, Hamilton, ON, L8P 1H6, Canada
| | - Michelle Howard
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 5th floor, Hamilton, ON, L8P 1H6, Canada
| | | | - Cathy Risdon
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 6th floor, Hamilton, ON, L8P 1H6, Canada
| | - Samina Talat
- Canadian Red Cross, 5700 Cancross Court, Mississauga, ON, L5R 3E9, Canada
| | - Jean-Eric Tarride
- Department of Health Research Methods, Evidence and Impact, McMaster University, Programs for Assessment of Technologies in Health and Center for Health Economics and Policy Analysis, CRL 227, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Programs for Assessment of Technologist in Health, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - Ruta Valaitis
- School of Nursing, McMaster University, Health Sciences Centre, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - David Price
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 6th floor, Hamilton, ON, L8P 1H6, Canada
| |
Collapse
|
63
|
Hansen CB, Pavlovic KMH, Sondergaard J, Thilsing T. Does GP empathy influence patient enablement and success in lifestyle change among high risk patients? BMC FAMILY PRACTICE 2020; 21:159. [PMID: 32770946 PMCID: PMC7415174 DOI: 10.1186/s12875-020-01232-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 07/22/2020] [Indexed: 11/17/2022]
Abstract
Background Chronic lifestyle-related-diseases can be prevented by healthy lifestyle. Patients at high risk of disease may benefit from targeted health checks in general practice. However, general-practice-based-studies have shown that patient outcome, enablement, and well-being may be influenced by general practitioner (GP) empathy. The aim of this study is to investigate 1) how high risk patients evaluate their GPs’ empathy during a health check consultation, 2) whether the perceived GP empathy is associated with the patient’s enablement in immediate continuation of the health check consultation and 3) the patient’s subsequent lifestyle changes. Methods This study is part of a population based non-randomized feasibility study testing a complex intervention that systematically identifies citizens at high risk of lifestyle-related disease and with health-risk behavior and offers targeted preventive services in the Danish primary care sector. The ultimate aim of the intervention is to improve lifestyle and thereby reduce the risk of lifestyle-related disease. In the feasibility study a random sample of patients aged 30 to 59 years were invited to participate, and to fill in a questionnaire on lifestyle-risk factors. Participants deemed to be at high risk of disease were offered a focused clinical examination and a subsequent health check consultation at the GP. Following each health check consultation GP empathy and patient enablement were assessed using The Care Measure (CARE) and Patient Enablement Instrument (PEI). Patient’s perceived healthy-lifestyle change (y/n) was assessed after three months. The study has been approved by the Danish Data Protection Agency (J.nr 2015–57-0008) and registered at ClinicalTrial. Gov on June 13, 2016. Results Twenty-six GP’s participated in the study. Among 93 patients receiving a health check consultation 60 rated the GPs empathy. The median CARE-score was 40. The PEI median was 5.5 and 44.9% achieved a healthier lifestyle. No association was observed between GP empathy and patient enablement or a perceived healthier lifestyle. Conclusion No statistical significant association between the CARE-score and patient enablement or a perceived healthier lifestyle was observed. Our results contrast previous findings and may to some extent be explained by a small sample size and the selected high-risk group. Trial registration number NCT02797392.
Collapse
Affiliation(s)
- Caroline Braad Hansen
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.
| | | | - Jens Sondergaard
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Trine Thilsing
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
64
|
Chan CHY, Lau BHP, Chan THY, Leung HT, So GYK, Chan CLW. Examining the Moderating Role of Patient Enablement on the Relationship Between Health Anxiety and Psychosomatic Distress: A Cross-Sectional Study at a Traditional Chinese Medicine Outpatient Clinic in Hong Kong. Front Psychol 2020; 11:1081. [PMID: 32655430 PMCID: PMC7325961 DOI: 10.3389/fpsyg.2020.01081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 04/28/2020] [Indexed: 11/13/2022] Open
Abstract
Background Little research effort has been devoted to examining the role of patient enablement in alleviating health anxiety in primary care. In this study, we examined the role of patient enablement as a moderator in the relationship between health anxiety, psychological distress, and treatment seeking in traditional Chinese medicine (TCM). Methods The participants were 634 patients of a government-subsidized Chinese medicine outpatient clinic in Hong Kong. They were asked to complete a series of questionnaires on patient enablement, health anxiety, anxiety, depression, physical distress, annual clinic visits, and service satisfaction and provided various demographic details. Descriptive statistics, correlations, and general linear models were used to analyze the data. Results We found that patient enablement correlated positively with service satisfaction. Patient enablement also interacted significantly with health anxiety in affecting indices of psychological distress (depression, anxiety) and treatment seeking (annual visits). Among highly enabled patients, the positive association between health anxiety and indices of psychological distress was weakened, and they also showed more health anxiety-driven treatment seeking as measured by annual clinic visits. Conclusion These findings suggest a moderating mechanism by which patient enablement weakens the relationship between health anxiety on psychological well-being and increases treatment-seeking behavior in TCM. Practitioners are encouraged to provide sufficient information to patients to foster self-care and disease self-management using complementary and alternative medicine (CAM).
Collapse
Affiliation(s)
- Celia H Y Chan
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| | - Bobo H P Lau
- Department of Counselling and Psychology, Hong Kong Shue Yan University, North Point, Hong Kong
| | - Timothy H Y Chan
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| | - H T Leung
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| | - Georgina Y K So
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| | - Cecilia L W Chan
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| |
Collapse
|
65
|
Tolvanen E, Groenewegen PP, Koskela TH, Bjerve Eide T, Cohidon C, Kosunen E. Patient enablement after a consultation with a general practitioner-Explaining variation between countries, practices and patients. Health Expect 2020; 23:1129-1143. [PMID: 32602205 PMCID: PMC7696125 DOI: 10.1111/hex.13091] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/08/2020] [Accepted: 05/22/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Patient enablement is a concept developed to measure quality in primary health care. The comparative analysis of patient enablement in an international context is lacking. OBJECTIVE To explain variation in patient enablement between patients, general practitioners (GPs) and countries. To find independent variables associated with enablement. DESIGN We constructed multi-level logistic regression models encompassing variables from patient, GP and country levels. The proportions of explained variances at each level and odds ratios for independent variables were calculated. SETTING AND PARTICIPANTS A total of 7210 GPs and 58 930 patients in 31 countries were recruited through the Quality and Costs of Primary Care in Europe (QUALICOPC) study framework. In addition, data from the Primary Health Care Activity Monitor for Europe (PHAMEU) study and Hofstede's national cultural dimensions were combined with QUALICOPC data. RESULTS In the final model, 50.6% of the country variance and 18.4% of the practice variance could be explained. Cultural dimensions explained a major part of the variation between countries. Several patient-level and only a few practice-level variables showed statistically significant associations with patient enablement. Structural elements of the relevant health-care system showed no associations. From the 20 study hypotheses, eight were supported and four were partly supported. DISCUSSION AND CONCLUSIONS There are large differences in patient enablement between GPs and countries. Patient characteristics and patients' perceptions of consultation seem to have the strongest associations with patient enablement. When comparing patient-reported measures as an indicator of health-care system performance, researchers should be aware of the influence of cultural elements.
Collapse
Affiliation(s)
- Elina Tolvanen
- Faculty of Medicine and Health Technology, c/o coordinator Leena Kiuru, Tampere University, Tampere, Finland.,Pirkkala Municipal Health Centre, Pirkkala, Finland.,Science Centre, Pirkanmaa Hospital District, Tampere, Finland
| | - Peter P Groenewegen
- Nivel-Netherlands Institute for Health Services Research, Utrecht, The Netherlands.,Department of Sociology, Utrecht University, Utrecht, The Netherlands.,Department of Human Geography, Utrecht University, Utrecht, The Netherlands
| | - Tuomas H Koskela
- Faculty of Medicine and Health Technology, c/o coordinator Leena Kiuru, Tampere University, Tampere, Finland
| | - Torunn Bjerve Eide
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Christine Cohidon
- Department of Family Medicine, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Elise Kosunen
- Faculty of Medicine and Health Technology, c/o coordinator Leena Kiuru, Tampere University, Tampere, Finland.,Centre for General Practice, Pirkanmaa Hospital District, Tampere, Finland
| |
Collapse
|
66
|
Grahn Kronhed AC, Enthoven P, Spångeus A, Willerton C. Mindfulness and Modified Medical Yoga as Intervention in Older Women with Osteoporotic Vertebral Fracture. J Altern Complement Med 2020; 26:610-619. [PMID: 32543212 DOI: 10.1089/acm.2019.0450] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: People with osteoporotic vertebral compression fractures (VCFs) have decreased health-related quality of life (HRQoL). Yoga and mindfulness are methods that can promote well-being. Objective: The aim of this article was to explore the effect of mindfulness and modified medical yoga on HRQoL, stress, sleep, and pain in people 60 years or older with a diagnosed osteoporotic VCF. Design: The School of Osteoporosis in Linköping (SOL) is a pilot study with randomized groups. Materials and Methods: The SOL-study was scheduled to once a week for 10 weeks. Ten people were randomized to a theory (T) group, and ten people were randomized to a theory and mindfulness/medical yoga (MMY) group. The educational sessions lasted 60 min and were similar for the groups, but they took place at different facilities. An experienced physiotherapist supervised the MMY sessions for 60 min. Sleep quality and present stress experience were measured on a symmetric Likert scale. The numeric rating scale was used for pain, and EQ-5D, RAND-36, and Qualeffo-41 were used for HRQoL. The patient enablement instrument (PEI) was used to reflect how the participants coped with their illness. Results: Eight women in the MMY-group and seven women in the T-group completed the SOL study interventions. The adherence to the intervention program was 89% in the MMY-group and 87% in the T-group. There was no adverse consequence of the MMY training. After the 10-week intervention period, sleep quality (p = 0.018) and present stress (p = 0.043), but not perceived pain were improved in the MMY-group. The social function (SF) domain was improved in the MMY-group that was measured by both RAND-36 (p = 0.028) and Qualeffo-41 (p = 0.012). There was a trend toward a better PEI-score in the MMY-group compared with the T-group postintervention (p = 0.089). Conclusion: This article suggests that mindfulness and modified medical yoga supervised by a skilled physiotherapist may be a feasible way to improve SF, sleep, and stress in older women with osteoporotic VCFs.
Collapse
Affiliation(s)
- Ann-Charlotte Grahn Kronhed
- Rehab Väst, Local Health Care Services in the West of Östergötland, Östergötland, Sweden.,Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Paul Enthoven
- Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.,Department of Medical and Health Sciences, Pain and Rehabilitation Centre, Linköping University, Linköping, Sweden
| | - Anna Spångeus
- Department of Acute Internal Medicine and Geriatrics and Linköping University, Linköping, Sweden.,Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Catrin Willerton
- Rehab Väst, Local Health Care Services in the West of Östergötland, Östergötland, Sweden
| |
Collapse
|
67
|
Graffigna G, Barello S, Riva G, Corbo M, Damiani G, Iannone P, Bosio AC, Ricciardi W. Italian Consensus Statement on Patient Engagement in Chronic Care: Process and Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17114167. [PMID: 32545278 PMCID: PMC7312656 DOI: 10.3390/ijerph17114167] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 12/15/2022]
Abstract
Patient engagement has been recognized as a key priority in chronic care. However, scholars agree that guidelines are needed to ensure effective patient engagement strategies. To this end, a Consensus Conference process was promoted with the following methodological steps: (1) extensive literature review about patient engagement initiatives in chronic care; (2) a stakeholders survey to collect best practices and (3) workshops with experts. On the basis of the information collected, a consensus statement was drafted, revised, and finalized by a panel of select renowned experts. These experts agreed in defining engagement as an eco-systemic concept involving multiple actors all of which contribute to influence patients’ willingness and ability to engage in chronic care. Moreover, experts recommended, whenever possible, to adopt standardized instruments to assess engagement levels and related unmet needs. Then, experts strongly advised appropriate trainings for healthcare professionals about patient engagement strategies. Furthermore, the importance of promoting healthcare professionals’ wellbeing has been advocated. Family caregivers, as well as patients’ organizations - should be trained and engaged to increase the effectiveness of interventions dedicated to patients. Finally, experts agreed that digital technologies should be considered as a crucial enhancer for patient engagement in chronic care.
Collapse
Affiliation(s)
- Guendalina Graffigna
- EngageMinds Hub – Consumer, Food and Health Engagement Research Center, Department of Psychology, Università Cattolica del Sacro Cuore, 20123 Milan, Italy; (G.R.); (A.C.B.)
- Department of Psychology, Catholic University of Milan, 20123 Milan, Italy
- Correspondence: (G.G.); (S.B.); Tel.: +39-0272343863 (S.B.)
| | - Serena Barello
- EngageMinds Hub – Consumer, Food and Health Engagement Research Center, Department of Psychology, Università Cattolica del Sacro Cuore, 20123 Milan, Italy; (G.R.); (A.C.B.)
- Department of Psychology, Catholic University of Milan, 20123 Milan, Italy
- Correspondence: (G.G.); (S.B.); Tel.: +39-0272343863 (S.B.)
| | - Giuseppe Riva
- EngageMinds Hub – Consumer, Food and Health Engagement Research Center, Department of Psychology, Università Cattolica del Sacro Cuore, 20123 Milan, Italy; (G.R.); (A.C.B.)
| | - Massimo Corbo
- Casa di Cura Privata del Policlinico, 20100 Milan, Italy;
| | - Gianfranco Damiani
- Fondazione Policlinico Universitario A., Gemelli IRCCS, 00168 Roma, Italy; (G.D.); (W.R.)
- Faculty of Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | | | - Albino Claudio Bosio
- EngageMinds Hub – Consumer, Food and Health Engagement Research Center, Department of Psychology, Università Cattolica del Sacro Cuore, 20123 Milan, Italy; (G.R.); (A.C.B.)
- Department of Psychology, Catholic University of Milan, 20123 Milan, Italy
| | - Walter Ricciardi
- Fondazione Policlinico Universitario A., Gemelli IRCCS, 00168 Roma, Italy; (G.D.); (W.R.)
- Faculty of Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| |
Collapse
|
68
|
Bahrom NH, Ramli AS, Isa MR, Abdul-Hamid H, Badlishah-Sham SF, Baharudin N, Mohamed-Yassin MS. Factors Associated with High Patient Activation Level among Individuals with Metabolic Syndrome at a Primary Care Teaching Clinic. J Prim Care Community Health 2020; 11:2150132720931301. [PMID: 32507012 PMCID: PMC7278304 DOI: 10.1177/2150132720931301] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: High activation level has been associated with higher education background, better self-rated health status, and having adequate health literacy. However, there is a gap in the literature regarding the level of activation and the factors associated with it among patients with metabolic syndrome (MetS) in the Malaysian primary care setting. Objectives: This study aims to determine activation levels and the factors associated with high activation among individuals with MetS in primary care. Methods: A cross-sectional study was conducted at a university primary care clinic. Patient activation was measured using the Patient Activation Measure®-13 Malay version. Activation levels were dichotomized into "low activation" (levels 1 and 2) and "high activation" (levels 3 and 4). To determine the factors associated with high activation, simple logistic regressions (SLogR) followed by multiple logistic regressions (MLogR) were performed. Results: Of 333 participants, 280 (84.1%) were included in the final analysis. The mean activation score was 59.4 (SD ±10.20) and 61.8% had high activation level. Two variables were found to be significant on MLogR. Those who were employed have the odds of 3.135 (95% CI 1.442-6.816) of having high activation compared with those who were unemployed. Those with good self-reported health status have the odds of 6.482 (95% CI 1.243-33.792) of having high activation compared to those with poor self-reported health status. Conclusions: The majority of participants had high activation levels. Those who were employed and those who had good self-reported health status were more likely to have high activation levels. Findings of this study could be used to develop patient activation interventions to improve self-management skills among individuals with MetS in primary care. These may include problem solving support, individualized care plans, peer or family support, and skill building. Those in high activation group can be trained to become mentors to support their peers who have low activation level.
Collapse
|
69
|
Kendrick T, Geraghty AWA, Bowers H, Stuart B, Leydon G, May C, Yao G, O’Brien W, Glowacka M, Holley S, Williams S, Zhu S, Dewar-Haggart R, Palmer B, Bell M, Collinson S, Fry I, Lewis G, Griffiths G, Gilbody S, Moncrieff J, Moore M, Macleod U, Little P, Dowrick C. REDUCE (Reviewing long-term antidepressant use by careful monitoring in everyday practice) internet and telephone support to people coming off long-term antidepressants: protocol for a randomised controlled trial. Trials 2020; 21:419. [PMID: 32448374 PMCID: PMC7245840 DOI: 10.1186/s13063-020-04338-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 04/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Around one in ten adults take antidepressants for depression in England, and their long-term use is increasing. Some need them to prevent relapse, but 30-50% could possibly stop them without relapsing and avoid adverse effects and complications of long-term use. However, stopping is not always easy due to withdrawal symptoms and a fear of relapse of depression. When general practitioners review patients on long-term antidepressants and recommend to those who are suitable to stop the medication, only 6-8% are able to stop. The Reviewing long-term antidepressant use by careful monitoring in everyday practice (REDUCE) research programme aims to identify safe and cost-effective ways of helping patients taking long-term antidepressants taper off treatment when appropriate. METHODS Design: REDUCE is a two-arm, 1:1 parallel group randomised controlled trial, with randomisation clustered by participating family practices. SETTING England and north Wales. POPULATION patients taking antidepressants for longer than 1 year for a first episode of depression or longer than 2 years for repeated episodes of depression who are no longer depressed and want to try to taper off their antidepressant use. INTERVENTION provision of 'ADvisor' internet programmes to general practitioners or nurse practitioners and to patients designed to support antidepressant withdrawal, plus three patient telephone calls from a psychological wellbeing practitioner. The control arm receives usual care. Blinding of patients, practitioners and researchers is not possible in an open pragmatic trial, but statistical and health economic data analysts will remain blind to allocation. OUTCOME MEASURES the primary outcome is self-reported nine-item Patient Health Questionnaire at 6 months for depressive symptoms. SECONDARY OUTCOMES depressive symptoms at other follow-up time points, anxiety, discontinuation of antidepressants, social functioning, wellbeing, enablement, quality of life, satisfaction, and use of health services for costs. SAMPLE SIZE 402 patients (201 intervention and 201 controls) from 134 general practices recruited over 15-18 months, and followed-up at 3, 6, 9 and 12 months. A qualitative process evaluation will be conducted through interviews with 15-20 patients and 15-20 practitioners in each arm to explore why the interventions were effective or not, depending on the results. DISCUSSION Helping patients reduce and stop antidepressants is often challenging for practitioners and time-consuming for very busy primary care practices. If REDUCE provides evidence showing that access to internet and telephone support enables more patients to stop treatment without increasing depression we will try to implement the intervention throughout the National Health Service, publishing practical guidance for professionals and advice for patients to follow, publicised through patient support groups. TRIAL REGISTRATION ISRCTN:12417565. Registered on 7 October 2019.
Collapse
Affiliation(s)
- Tony Kendrick
- Primary Care, Population Sciences, and Medical Education, University of Southampton, Aldermoor Health Centre, Southampton, UK
| | - Adam W. A. Geraghty
- Primary Care, Population Sciences, and Medical Education, University of Southampton, Aldermoor Health Centre, Southampton, UK
| | - Hannah Bowers
- Primary Care, Population Sciences, and Medical Education, University of Southampton, Aldermoor Health Centre, Southampton, UK
| | - Beth Stuart
- Primary Care, Population Sciences, and Medical Education, University of Southampton, Aldermoor Health Centre, Southampton, UK
| | - Geraldine Leydon
- Primary Care, Population Sciences, and Medical Education, University of Southampton, Aldermoor Health Centre, Southampton, UK
| | - Carl May
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Guiqing Yao
- Department of Health Sciences, University of Leicester, George Davies Centre, Leicester, UK
| | - Wendy O’Brien
- Primary Care, Population Sciences, and Medical Education, University of Southampton, Aldermoor Health Centre, Southampton, UK
| | - Marta Glowacka
- Department for Rehabilitation and Sport Sciences, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Simone Holley
- School of Psychology, Building 44 Highfield Campus, University of Southampton, Southampton, UK
| | - Samantha Williams
- Primary Care, Population Sciences, and Medical Education, University of Southampton, Aldermoor Health Centre, Southampton, UK
| | - Shihua Zhu
- Primary Care, Population Sciences, and Medical Education, University of Southampton, Aldermoor Health Centre, Southampton, UK
| | - Rachel Dewar-Haggart
- Primary Care, Population Sciences, and Medical Education, University of Southampton, Aldermoor Health Centre, Southampton, UK
| | - Bryan Palmer
- Primary Care, Population Sciences, and Medical Education, University of Southampton, Aldermoor Health Centre, Southampton, UK
| | - Margaret Bell
- Primary Care, Population Sciences, and Medical Education, University of Southampton, Aldermoor Health Centre, Southampton, UK
| | - Sue Collinson
- Primary Care, Population Sciences, and Medical Education, University of Southampton, Aldermoor Health Centre, Southampton, UK
| | - Imogen Fry
- School of Psychology, Building 44 Highfield Campus, University of Southampton, Southampton, UK
| | - Glyn Lewis
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Gareth Griffiths
- Southampton Clinical Trials Unit, University of Southampton and University Hospitals Southampton NHS Foundation Trust, Southampton General Hospital, Southampton, UK
| | - Simon Gilbody
- Department of Health Sciences, Seebohm Rowntree Building, University of York, York, UK
| | - Joanna Moncrieff
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Michael Moore
- Primary Care, Population Sciences, and Medical Education, University of Southampton, Aldermoor Health Centre, Southampton, UK
| | - Una Macleod
- Hull York Medical School, Allam Medical Building, University of Hull, Hull, UK
| | - Paul Little
- Primary Care, Population Sciences, and Medical Education, University of Southampton, Aldermoor Health Centre, Southampton, UK
| | - Christopher Dowrick
- Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
| |
Collapse
|
70
|
Pekonen A, Eloranta S, Stolt M, Virolainen P, Leino-Kilpi H. Measuring patient empowerment - A systematic review. PATIENT EDUCATION AND COUNSELING 2020; 103:777-787. [PMID: 31767243 DOI: 10.1016/j.pec.2019.10.019] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 10/21/2019] [Accepted: 10/23/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The purpose of this systematic review was to identify generic instruments measuring patient empowerment and related concepts and analyse the main content and psychometric properties of these instruments. METHODS A systematic search was conducted using empowerment and related concepts (enablement, activation, engagement, perceived control) as search terms. The main content of the instruments was analysed by classifying the subscales and items of the elements of empowerment into patient's capacities, patient's knowledge, patient's behaviour and support by others. Psychometric properties were analysed with the criteria of Terwee and colleagues (2007). RESULTS Thirteen instruments were identified; and out of them, five instruments covered all the four elements used to define of empowerment. Psychometric properties were variable; none of the instruments contained all the evaluated psychometric properties. CONCLUSION There are generic instruments measuring empowerment and its related concepts. The instruments were heterogeneous in structure and psychometric properties. Empowerment is more wide-ranging and multidimensional than its related concepts. PRACTICE IMPLICATIONS This review provides knowledge for healthcare professionals and researchers who want to support or evaluate patients' empowerment. With a generic instrument, it is possible to obtain comparable information from diverse patient groups. Further testing of psychometric properties of each instrument is recommended.
Collapse
Affiliation(s)
- Arja Pekonen
- University of Turku, Department of Nursing Science and Clinical Nurse Specialist, Turku University Hospital, Finland.
| | - Sini Eloranta
- University of Turku, Department of Nursing Science and Principal Lecturer, Turku University of Applied Sciences, Finland
| | - Minna Stolt
- University Lecturer, University of Turku, Department of Nursing Science, Finland
| | | | - Helena Leino-Kilpi
- University of Turku, Department of Nursing Science and Nurse director, Turku University Hospital, Finland
| |
Collapse
|
71
|
Williams B, Hibberd C, Baldie D, Duncan EAS, Elders A, Maxwell M, Rattray JE, Cowie J, Strachan H, Jones MC. Evaluation of the impact of an augmented model of The Productive Ward: Releasing Time to Care on staff and patient outcomes: a naturalistic stepped-wedge trial. BMJ Qual Saf 2020; 30:27-37. [PMID: 32217699 PMCID: PMC7788216 DOI: 10.1136/bmjqs-2019-009821] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 11/20/2019] [Accepted: 02/27/2020] [Indexed: 11/24/2022]
Abstract
Background Improving the quality and efficiency of healthcare is an international priority. A range of complex ward based quality initiatives have been developed over recent years, perhaps the most influential programme has been Productive Ward: Releasing Time to Care. The programme aims to improve work processes and team efficiency with the aim of ‘releasing time’, which would be used to increase time with patients ultimately improving patient care, although this does not form a specific part of the programme. This study aimed to address this and evaluate the impact using recent methodological advances in complex intervention evaluation design. Method The objective of this study was to assess the impact of an augmented version of The Productive Ward: Releasing Time to Care on staff and patient outcomes. The design was a naturalistic stepped-wedge trial. The setting included fifteen wards in two acute hospitals in a Scottish health board region. The intervention was the Productive Ward: Releasing Time to Care augmented with practice development transformational change methods that focused on staff caring behaviours, teamwork and patient feedback. The primary outcomes included nurses’ shared philosophy of care, nurse emotional exhaustion, and patient experience of nurse communication. Secondary outcomes covered additional key dimensions of staff and patient experience and outcomes and frequency of emergency admissions for same diagnosis within 6 months of discharge. Results We recruited 691 patients, 177 nurses and 14 senior charge nurses. We found statistically significant improvements in two of the study’s three primary outcomes: patients’ experiences of nurse communication (Effect size=0.15, 95% CI; 0.05 to 0.24), and nurses’ shared philosophy of care (Effect size =0.42, 95% CI; 0.14 to 0.70). There were also significant improvements in secondary outcomes: patients’ overall rating of ward quality; nurses’ positive affect; and items relating to nursing team climate. We found no change in frequency of emergency admissions within six months of discharge. Conclusions We found evidence that the augmented version of The Productive Ward: Releasing Time to Care Intervention was successful in improving a number of dimensions of nurse experience and ward culture, in addition to improved patient experience and evaluations of the quality of care received. Despite these positive summary findings across all wards, intervention implementation appeared to vary between wards. By addressing the contextual factors, which may influence these variations, and tailoring some elements of the intervention, it is likely that greater improvements could be achieved. Trial registration number UKCRN 14195.
Collapse
Affiliation(s)
- Brian Williams
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Carina Hibberd
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Deborah Baldie
- Division of Nursing, Queen Margaret University Edinburgh, Musselburgh, East Lothian, UK
| | - Edward A S Duncan
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | - Andrew Elders
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Margaret Maxwell
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | - Janice E Rattray
- School of Nursing and Health Sciences, University of Dundee, Dundee, UK
| | - Julie Cowie
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Heather Strachan
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | - Martyn C Jones
- School of Nursing and Health Sciences, University of Dundee, Dundee, UK
| |
Collapse
|
72
|
Brickley B, Sladdin I, Williams LT, Morgan M, Ross A, Trigger K, Ball L. A new model of patient-centred care for general practitioners: results of an integrative review. Fam Pract 2020; 37:154-172. [PMID: 31670759 DOI: 10.1093/fampra/cmz063] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND GPs providing patient-centred care (PCC) is embedded in international health care policies due to its positive impact on patients and potential to lower health care costs. However, what is currently known about GP-delivered PCC is unknown. OBJECTIVE To synthesize literature investigating GP-delivered PCC and address 'what is currently known about GP-delivered PCC?' METHOD A systematic literature search was conducted between June and July 2018. Eligible articles were empirical, full-text studies published in English between January 2003 and July 2018, related to at least three of the four dimensions of PCC described by Hudon et al. (2011), and related to preventative, acute, and/or chronic care by GPs. Following screening, full-text articles were independently assessed for inclusion by two investigators. Data were extracted and quality assessed by two researchers. Findings on PCC were analysed thematically (meta-synthesis). RESULTS Thirty medium- to high-quality studies met the inclusions criteria. Included studies utilized varied designs, with the most frequent being quantitative, cross-sectional. A theoretical model of PCC was synthesized from included studies and contained four major components: (i) understanding the whole person, (ii) finding common ground, (iii) experiencing time and (iv) aiming for positive outcomes. Harms of PCC were rarely reported. CONCLUSIONS Four overarching theoretical components of PCC relate to elements of the consultation and experience of time. These components can be used to inform the development of toolkits to support GPs and general practice organizations in pursuit of PCC as well as tools to measure patient-centredness.
Collapse
Affiliation(s)
- Bryce Brickley
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Ishtar Sladdin
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Lauren T Williams
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Mark Morgan
- Bond University, Gold Coast, Queensland, Australia
| | - Alyson Ross
- Gold Coast Primary Health Network, Gold Coast, Queensland, Australia
| | - Kellie Trigger
- Gold Coast Primary Health Network, Gold Coast, Queensland, Australia
| | - Lauren Ball
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| |
Collapse
|
73
|
Vaillancourt S, Cullen JD, Dainty KN, Inrig T, Laupacis A, Linton D, Malherbe S, Maybee A, Schull MJ, Seaton MB, Beaton DE. PROM-ED: Development and Testing of a Patient-Reported Outcome Measure for Emergency Department Patients Who Are Discharged Home. Ann Emerg Med 2020; 76:219-229. [PMID: 32173134 DOI: 10.1016/j.annemergmed.2019.12.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 12/16/2019] [Accepted: 12/20/2019] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE Common outcomes of care valued by emergency department (ED) patients who are not hospitalized have been characterized, but no measurement instrument has been developed to date. We developed and validated a patient-reported outcome measure for use with adult ED patients who are discharged home (PROM-ED). METHODS In previous research, 4 main outcomes of importance to ED patients were defined: symptom relief, understanding, reassurance, and having a plan. We developed a bank of potential questions (phase 1) that were first tested for suitability through cognitive debriefing with patients (phase 2). Revised questions were then tested quantitatively with a large panel of participants who had recently received ED care (phase 3). Informed by these results, a panel of experts used a modified Delphi process to make decisions on item reduction. The resulting instrument (PROM-ED 1.0) was then evaluated for its measurement properties (structural validity, hypothesis testing, and reliability). RESULTS Sixty-seven questions divided among 4 scales (1 for each outcome domain) were assembled. In accordance with cognitive debriefing with 8 patients (phase 2), 15 questions were modified and 13 removed. Testing of these questions with 444 participants (phase 3) identified problematic floor or ceiling effects (n=10), excessive correlations between items (n=11), and low item-total correlations (n=7). The expert panel (22 participants, phase 4) made decisions using this information on the exclusion of items, resulting in 22 questions across 4 scales that together constitute the PROM-ED 1.0. Testing provided good evidence of validity and test-retest reliability (n=200). CONCLUSION The PROM-ED enables the measurement of patient-centered outcomes of importance to patients receiving care in the ED who are not hospitalized. These data could have important applications in research and care improvement.
Collapse
Affiliation(s)
- Samuel Vaillancourt
- Department of Emergency Medicine, St. Michael's Hospital, Toronto, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada.
| | - John D Cullen
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Katie N Dainty
- Institute for Health Policy and Management, University of Toronto, Toronto, Canada; North York General Hospital, Toronto, Canada
| | - Taucha Inrig
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Andreas Laupacis
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada
| | - Denise Linton
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Stéphanie Malherbe
- Hôpital Montfort and Department of Emergency and Family Medicine, University of Ottawa, Ottawa, Canada
| | | | - Michael J Schull
- Department of Medicine, University of Toronto, Toronto, Canada; Institute for Health Policy and Management, University of Toronto, Toronto, Canada; Department of Emergency Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada; the Institute for Clinical Evaluative Sciences, Toronto, Canada
| | | | - Dorcas E Beaton
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| |
Collapse
|
74
|
Pascual López JA, Gil Pérez T, Sánchez Sánchez JA, Menárguez Puche JF. [Questionnaires of person centered care in primary care. A systematic review]. Aten Primaria 2019; 52:738-749. [PMID: 31883783 PMCID: PMC8054285 DOI: 10.1016/j.aprim.2019.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 10/11/2019] [Accepted: 11/18/2019] [Indexed: 12/30/2022] Open
Abstract
Objetivo Pese a la importancia de la «atención centrada en la persona» (ACP), hay evidentes limitaciones para valorarla y medirla, debidas probablemente a la dificultad para definirla. El objetivo del estudio fue identificar herramientas validadas que midiesen la ACP o algunos de sus aspectos en el ámbito de la atención primaria. Diseño Revisión sistemática. Fuentes de datos MEDLINE, Embase, Cochrane, PSYCinfo, IME-Biomedicina, LILACS y TESEO hasta del 31 de mayo de 2018. Selección de estudios Los criterios de inclusión fueron: a) estudios de validación de cuestionarios, revisiones sistemáticas sobre estudios de validación u otros estudios descriptivos, b) realizados todos ellos en el ámbito de la atención primaria y c) que midieran aspectos de la ACP en profesionales y/o pacientes. Dos investigadores revisaron de forma independiente los artículos y sus discrepancias fueron resueltas por un tercer investigador. Extracción de datos Se recogieron datos sobre los aspectos de la ACP medidos, población a la que se dirige, tipo de cuestionario, y datos sobre validez y fiabilidad. Resultados Se localizaron 1.415 artículos a los que se añadieron 54 referencias adicionales identificadas a través de referencias de los artículos de la revisión sistemática. Tras una depuración finalmente fueron 75 los artículos que cumplieron todos los criterios y 39 las herramientas identificadas y clasificadas según las dimensiones analizadas. Conclusiones Debido a la dificultad de medir la ACP en su conjunto, la mayor parte de los artículos hacen referencia solo a alguno de sus aspectos o dimensiones, predominando la perspectiva del paciente frente a la del profesional. Estas herramientas son, no obstante, un importante punto de partida para futuros cuestionarios que intenten valorar de forma integral la ACP.
Collapse
Affiliation(s)
| | - Trinidad Gil Pérez
- Centro de Salud docente Mariano Yago, Servicio Murciano de Salud, Yecla, Murcia, España
| | - Juan Antonio Sánchez Sánchez
- Grupo de Trabajo de Medicina Basada en la Evidencia, Sociedad Murciana de Medicina de Familia y Comunitaria (SMUMFyC), Murcia, España
| | - Juan Francisco Menárguez Puche
- Grupo de Trabajo de Medicina Basada en la Evidencia, Sociedad Murciana de Medicina de Familia y Comunitaria (SMUMFyC), Murcia, España; Centro de Salud docente Profesor Jesús Marín, Molina de Segura, Murcia, España
| |
Collapse
|
75
|
Siegel A, Ehmann AT, Meyer I, Gröne O, Niebling W, Martus P, Rieger MA. PEN-13: A New Generic 13-Item Questionnaire for Measuring Patient Enablement (German Version). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4867. [PMID: 31816911 PMCID: PMC6926737 DOI: 10.3390/ijerph16234867] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 11/28/2019] [Indexed: 11/16/2022]
Abstract
Background: The purpose of our study was to develop and psychometrically test a German-language survey instrument that measures patient enablement generically and in greater detail than previous instruments. Methods: A multidisciplinary team developed 13 items to capture individual aspects of patient enablement (PEN-13). A pre-test with 26 subjects was followed by a random sample survey of N = 1168 subjects. An exploratory factor analysis was conducted in a random split-half sample of the data to explore PEN-13's factor structure; a confirmatory factor analysis was conducted in the validation sample. The internal consistency of the factors was evaluated using Cronbach's alpha, PEN-13's construct validity was checked by means of additional hypothesis testing. Results: The two factors self-management and patient-practitioner interaction, detected in the exploratory analysis, were confirmed with a few modifications in the confirmatory factor analysis, with the comparative fit index (CFI) amounting to 0.903. The Cronbach's alpha values of those two factors amounted to α = 0.90 and α = 0.82, respectively. The correlations of the PEN-13 score with the 'general self-efficacy' and 'health literacy' (HLS-EU-Q16) scores further confirmed its construct validity; the respective correlation coefficients amounted to 0.57 and 0.60. Conclusion: The German version of the survey instrument Patient Enablement Scale-13 items (PEN-13) shows acceptable psychometric properties. Practical implications: PEN-13 seems particularly suitable for health services research purposes. We recommend checking the results in another sample as well as evaluating its responsiveness to enablement-enhancing interventions.
Collapse
Affiliation(s)
- Achim Siegel
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tübingen, Wilhelmstraße 27, 72074 Tübingen, Germany; (A.T.E.); (M.A.R.)
| | - Anna T. Ehmann
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tübingen, Wilhelmstraße 27, 72074 Tübingen, Germany; (A.T.E.); (M.A.R.)
| | - Ingo Meyer
- PMV forschungsgruppe, University of Cologne, Herderstraße 52, 50391 Cologne, Germany;
| | - Oliver Gröne
- OptiMedis AG, Burchardstraße 17, 20095 Hamburg, Germany;
- London School of Hygiene and Tropical Medicine, University of London, London WC1E 7HT, UK
| | - Wilhelm Niebling
- Division of General Practice, University Medical Center Freiburg, 79910 Freiburg, Germany;
| | - Peter Martus
- Institute for Clinical Epidemiology and Applied Biometry, University Hospital Tübingen, Silcherstr. 5, 72076 Tübingen, Germany;
| | - Monika A. Rieger
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tübingen, Wilhelmstraße 27, 72074 Tübingen, Germany; (A.T.E.); (M.A.R.)
| |
Collapse
|
76
|
Skarbalienė A, Jurgutis A, Strandberg EL, Pawlikowska T. Patient involvement in assessing consultation quality: validation of patient enablement instrument (PEI) in Lithuanian general practice. BMC FAMILY PRACTICE 2019; 20:167. [PMID: 31795934 PMCID: PMC6892019 DOI: 10.1186/s12875-019-1061-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 11/27/2019] [Indexed: 11/10/2022]
Abstract
Background The Patient Enablement Instrument (PEI) was designed to encapsulate consultation outcome from the perspective that increasing their understanding and coping ability would underpin a positive consultation outcome for patients. The objective of the study was the validation of the PEI in Lithuanian general practice and comparison of Lithuanian patients’ enablement with previous studies in Europe to see if factors associated with patient enablement in Lithuania were reflective of those in the previous studies. Methods The Patient Enablement Instrument was translated into Lithuanian and included in the questionnaire along with the questions about a person’s health, reasons for visiting the doctor and feeling about the consultation. Practices from 4 different municipalities that are situated in different geographical regions which have both town and rural areas were sampled randomly. Patients scheduled consecutively aged 18 years or more were the subjects of the study. The data analyses focused on internal reliability and concept validity. Results The overall mean patient enablement score was 6.43. Enablement scores declined with increasing patient age, and female patients were more enabled. Patients with biomedical problems had the highest enablement results, while patients with complex problems had the lower results. Enablement was positively related to receiving a prescription and knowing a doctor, and negatively related to wish having consultation with another doctor. Conclusions This study substantiates the rationality of using PEI in assessing primary care consultations in Lithuania. The correlations of enablement largely reflect the situation in Western and Central Europe: longer consultation and access to the same physician increases patient enablement.
Collapse
Affiliation(s)
- Aelita Skarbalienė
- Faculty of Health Sciences, Klaipeda University, H.Manto, 84, Klaipeda, Lithuania.
| | - Arnoldas Jurgutis
- Faculty of Health Sciences, Klaipeda University, H.Manto, 84, Klaipeda, Lithuania
| | - Eva Lena Strandberg
- Faculty of Medicine, Lund University, Jan Waldenströms gata, 35, Malmö, Sweden
| | - Teresa Pawlikowska
- Health Professions Education Centre, RCSI, 123 St. Stephen's Green, Dublin 2, Ireland
| |
Collapse
|
77
|
Lindfors O, Holmberg S, Rööst M. Informing patients on planned consultation time - a randomised controlled intervention study of consultation time in primary care. Scand J Prim Health Care 2019; 37:402-408. [PMID: 31496331 PMCID: PMC6883428 DOI: 10.1080/02813432.2019.1663581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Objective: To investigate whether patients' pre-consultation knowledge of the time frames for the consultation influences the actual consultation time and/or patient and physician related outcomes; satisfaction and enablement.Design: Randomised controlled blinded intervention study.Setting: Four strategically chosen Primary Health Care Centres (PHCC:s) in Kronoberg county in Sweden participated.Intervention: Pre-consultation information on planned consultation time. During one week in each PHCC consecutive patients were randomised to intervention group or control group, when booking an appointment with a physician.Subjects: Patients >18 years of age.Main outcome measures: Consultation time, patient satisfaction, patient enablement and physician satisfaction.Results: No significant difference in consultation time was found between the intervention group and control group. No differences were seen between intervention group and control group regarding any of the other measures. Stratified data showed significantly shorter consultation time for the intervention group in one of the PHCC:s and for employed physicians. Employed physicians also rated consultations as being easier and were more satisfied with their consultations compared to non-employed physicians.Conclusion: Information on the planned consultation time has a potential to decrease consultation time in certain settings. No negative side effects were found in this study. Key pointsPatients prepare before their consultation but to influence its contents and length is difficult.Informing patients on estimated consultation time can influence actual consultation time.Informing patients on planned consultation time has no adverse effects in this study.
Collapse
Affiliation(s)
- Oskar Lindfors
- AMK Kronoberg, Kronoberg County Centre for Competence in Primary Health Care, Kronoberg, Sweden;
- CONTACT Oskar Lindfors AMK Kronoberg, Kronoberg County Centre for Competence in Primary Health Care, Region Kronoberg, 351 88 Växjö, Sweden
| | - Sara Holmberg
- Department of Research and Development, Växjö, Sweden;
- Division of Occupational and Environmental Medicine, Institute of Laboratory Medicine, Lund University, Lund, Sweden;
| | - Mattias Rööst
- AMK Kronoberg, Kronoberg County Centre for Competence in Primary Health Care, Kronoberg, Sweden;
- Department of Clinical Sciences, General Practice/Family Medicine, Lund University, Malmö, Sweden
| |
Collapse
|
78
|
Freilich J, Wiking E, Nilsson GH, Olsson C. Patients' ideas, concerns, expectations and satisfaction in primary health care - a questionnaire study of patients and health care professionals' perspectives. Scand J Prim Health Care 2019; 37:468-475. [PMID: 31724460 PMCID: PMC6883420 DOI: 10.1080/02813432.2019.1684430] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective: Explore the perceptions of patients and health care professionals about patients' ideas, concerns, expectations (ICE), and satisfaction in consultations with general practitioners (GPs), district nurses (DNs) and physiotherapists (PTs).Design: Cross-sectional questionnaire study of participants in planned consultations.Setting: Five primary health care centers and two rehabilitation centers in Stockholm, Sweden.Subjects: Pairs of patients and GPs (n = 156), patients and DNs (n = 73), and patients and PTs (n = 69).Main outcome measures: Multiple-choice questions about patients' ICE and satisfaction.Results: Approximately 75% of patients and GPs reported that patients' thoughts and explanations about their symptoms emerged during the consultation. For patient-DN pairs, the figure was 60%, and for patient-PT pairs, 80%. A majority of patients reported not having concerns and anxiety about the investigation/treatment, whereas health care professionals thought patients were more concerned. One-third of patients consulting GPs and PTs expected to receive a reason/explanation for their symptoms. Figures were lower for the DNs. About 70% of patients were satisfied with the consultation.Conclusions: Most patients expressed their ideas, a minority had concerns, and a minority expected an explanation of their illness. Patients and health care professionals rated patient satisfaction high, but health care professionals tended to believe patients were less satisfied than patients reported they were.Key pointsPatient surveys show that important aspects of patient-centeredness remain weak in Swedish primary health care; for example, shared decision-making.In this study of planned consultations, few patients expected to receive an explanation of their symptoms, but most were satisfied with the consultation.Health care professionals thought patients' experiences were more negative than they were.This discrepancy was observed in responses to questions about patients' concerns, expectations and satisfaction.
Collapse
Affiliation(s)
- Joel Freilich
- Roslags Näsby Health Care Center, Stockholm County Council, Stockholm, Sweden;
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden;
- CONTACT Joel Freilich MMC/System Safety in Health Care, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm 17177, Sweden
| | - Eivor Wiking
- Mörby Academic Primary Health Care Center, Stockholm County Council, Stockholm, Sweden;
| | - Gunnar H Nilsson
- Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden
| | - Christina Olsson
- Mörby Academic Primary Health Care Center, Stockholm County Council, Stockholm, Sweden;
- Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
79
|
Grace R, Baird K, Elcombe E, Webster V, Barnes J, Kemp L. Effectiveness of the Volunteer Family Connect Program in Reducing Isolation of Vulnerable Families and Supporting Their Parenting: Randomized Controlled Trial With Intention-To-Treat Analysis of Primary Outcome Variables. JMIR Pediatr Parent 2019; 2:e13023. [PMID: 31750834 PMCID: PMC6895872 DOI: 10.2196/13023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 04/10/2019] [Accepted: 07/19/2019] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Volunteer home visiting is a widely adopted community-based approach to support families by linking isolated or vulnerable families with community volunteers who visit their homes weekly over approximately 12 months. This study seeks to robustly evaluate the effectiveness of this model of support for families with young children. OBJECTIVE This paper reports the intention-to-treat analysis of primary and secondary outcomes for a pragmatic randomized controlled trial (RCT) of the Volunteer Family Connect intervention, a volunteer home-visiting program designed to support families with young children who experience social isolation or a lack of parenting confidence and skills. METHODS The RCT was conducted across seven sites in Australia. Overall, 341 families were recruited: 169 intervention (services as usual+volunteer home visits) and 172 control (services as usual) families. Intervention families received the program for 3-12 months. Participants were invited to complete six data collection points over a 15-month period. Primary outcomes were community connectedness and parenting competence. Secondary outcomes included parent physical and mental health, general parent wellbeing, parent empowerment, the sustainability of family routines, and the parent-child relationship. According to the protocol, the program would be judged to be effective if at least one of the primary outcomes was significantly positive and the other was neutral (ie, intervention families did not demonstrate positive or negative outcomes compared to the control group). RESULTS The intervention group demonstrated significant improvement in the primary outcome variable parenting sense of competence as compared to the control group. Overall, there was no significant difference between the intervention and control groups with regard to the primary outcome variable community connectedness, other than on the "Guidance" subscale of the Social Provisions Scale. Because there were statistically significant findings for the total score of one primary outcome variable "parenting sense of competence" and largely neutral findings for the primary outcome variable "community connectedness," the program met the previously defined criteria for program effectiveness. In relation to secondary outcomes, intervention families reported significantly higher wellbeing and were significantly more likely to feel that life was improving. CONCLUSIONS The Volunteer Family Connect intervention was considered an effective intervention, with a role to play on the landscape of services available to support vulnerable families with young children. TRIAL REGISTRATION Australian New Zealand Clinical Trial Registry ACTRN12616000396426; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370304.
Collapse
Affiliation(s)
- Rebekah Grace
- Translational Research and Social Innovation, Western Sydney University, Liverpool, Australia
| | - Kelly Baird
- Translational Research and Social Innovation, Western Sydney University, Liverpool, Australia
| | - Emma Elcombe
- Translational Research and Social Innovation, Western Sydney University, Liverpool, Australia
| | - Vana Webster
- Translational Research and Social Innovation, Western Sydney University, Liverpool, Australia
| | - Jacqueline Barnes
- Institute for the Study of Children, Families and Social Issues, Birkbeck University of London, London, United Kingdom
| | - Lynn Kemp
- Translational Research and Social Innovation, Western Sydney University, Liverpool, Australia
| |
Collapse
|
80
|
Ainsworth B, Greenwell K, Stuart B, Raftery J, Mair F, Bruton A, Yardley L, Thomas M. Feasibility trial of a digital self-management intervention 'My Breathing Matters' to improve asthma-related quality of life for UK primary care patients with asthma. BMJ Open 2019; 9:e032465. [PMID: 31722952 PMCID: PMC6858238 DOI: 10.1136/bmjopen-2019-032465] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To assess the feasibility of a randomised controlled trial (RCT) and acceptability of an asthma self-management digital intervention to improve asthma-specific quality of life in comparison with usual care. DESIGN AND SETTING A two-arm feasibility RCT conducted across seven general practices in Wessex, UK. PARTICIPANTS Primary care patients with asthma aged 18 years and over, with impaired asthma-specific quality of life and access to the internet. INTERVENTIONS 'My Breathing Matters' (MBM) is a digital asthma self-management intervention designed using theory, evidence and person-based approaches to provide tailored support for both pharmacological and non-pharmacological management of asthma symptoms. OUTCOMES The primary outcome was the feasibility of the trial design, including recruitment, adherence and retention at follow-up (3 and 12 months). Secondary outcomes were the feasibility and effect sizes of specific trial measures including asthma-specific quality of life and asthma control. RESULTS Primary outcomes: 88 patients were recruited (target 80). At 3-month follow-up, two patients withdrew and six did not complete outcome measures. At 12 months, two withdrew and four did not complete outcome measures. 36/44 patients in the intervention group engaged with MBM (median of 4 logins, range 0-25, IQR 8). Consistent trends were observed to improvements in asthma-related patient-reported outcome measures. CONCLUSIONS This study demonstrated the feasibility and acceptability of a definitive RCT that is required to determine the clinical and cost-effectiveness of a digital asthma self-management intervention. TRIAL REGISTRATION NUMBER ISRCTN15698435.
Collapse
Affiliation(s)
- Ben Ainsworth
- Department of Psychology, University of Bath, Bath, UK
- NIHR Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Kate Greenwell
- Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Beth Stuart
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - James Raftery
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Frances Mair
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Anne Bruton
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Lucy Yardley
- Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- School of Psychological Sciences, University of Bristol, Bristol, UK
| | - Mike Thomas
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| |
Collapse
|
81
|
Butterworth JE, Hays R, McDonagh STJ, Richards SH, Bower P, Campbell J. Interventions for involving older patients with multi-morbidity in decision-making during primary care consultations. Cochrane Database Syst Rev 2019; 2019:CD013124. [PMID: 31684697 PMCID: PMC6815935 DOI: 10.1002/14651858.cd013124.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Older patients with multiple health problems (multi-morbidity) value being involved in decision-making about their health care. However, they are less frequently involved than younger patients. To maximise quality of life, day-to-day function, and patient safety, older patients require support to identify unmet healthcare needs and to prioritise treatment options. OBJECTIVES To assess the effects of interventions for older patients with multi-morbidity aiming to involve them in decision-making about their health care during primary care consultations. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; all years to August 2018), in the Cochrane Library; MEDLINE (OvidSP) (1966 to August 2018); Embase (OvidSP) (1988 to August 2018); PsycINFO (OvidSP) (1806 to August 2018); the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (Ovid) (1982 to September 2008), then in Ebsco (2009 to August 2018); Centre for Reviews and Dissemination Databases (Database of Abstracts and Reviews of Effects (DARE)) (all years to August 2018); the Health Technology Assessment (HTA) Database (all years to August 2018); the Ongoing Reviews Database (all years to August 2018); and Dissertation Abstracts International (1861 to August 2018). SELECTION CRITERIA We sought randomised controlled trials (RCTs), cluster-RCTs, and quasi-RCTs of interventions to involve patients in decision-making about their health care versus usual care/control/another intervention, for patients aged 65 years and older with multi-morbidity in primary care. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodological procedures. Meta-analysis was not possible; therefore we prepared a narrative synthesis. MAIN RESULTS We included three studies involving 1879 participants: two RCTs and one cluster-RCT. Interventions consisted of: · patient workshop and individual coaching using behaviour change techniques; · individual patient coaching utilising cognitive-behavioural therapy and motivational interviewing; and · holistic patient review, multi-disciplinary practitioner training, and organisational change. No studies reported the primary outcome 'patient involvement in decision-making' or the primary adverse outcome 'less patient involvement as a result of the intervention'. Comparing interventions (patient workshop and individual coaching, holistic patient review plus practitioner training, and organisational change) to usual care: we are uncertain whether interventions had any effect on patient reports of high self-rated health (risk ratio (RR) 1.40, 95% confidence interval (CI) 0.36 to 5.49; very low-certainty evidence) or on patient enablement (mean difference (MD) 0.60, 95% CI -9.23 to 10.43; very low-certainty evidence) compared with usual care. Interventions probably had no effect on health-related quality of life (adjusted difference in means 0.00, 95% CI -0.02 to 0.02; moderate-certainty evidence) or on medication adherence (MD 0.06, 95% CI -0.05 to 0.17; moderate-certainty evidence) but probably improved the number of patients discussing their priorities (adjusted odds ratio 1.85, 95% CI 1.44 to 2.38; moderate-certainty evidence) and probably increased the number of nurse consultations (incident rate ratio from adjusted multi-level Poisson model 1.37, 95% CI 1.17 to 1.61; moderate-certainty evidence) compared with usual care. Practitioner outcomes were not measured. Interventions were not reported to adversely affect rates of participant death or anxiety, emergency department attendance, or hospital admission compared with usual care. Comparing interventions (patient workshop and coaching, individual patient coaching) to attention-control conditions: we are uncertain whether interventions affect patient-reported high self-rated health (RR 0.38, 95% CI 0.15 to 1.00, favouring attention control, with very low-certainty evidence; RR 2.17, 95% CI 0.85 to 5.52, favouring the intervention, with very low-certainty evidence). We are uncertain whether interventions affect patient enablement and engagement by increasing either patient activation (MD 1.20, 95% CI -8.21 to 10.61; very low-certainty evidence) or self-efficacy (MD 0.29, 95% CI -0.21 to 0.79; very low-certainty evidence); or whether interventions affect the number of general practice visits (MD 0.51, 95% CI -0.34 to 1.36; very low-certainty evidence), compared to attention-control conditions. The intervention may however lead to more patient-reported changes in management of their health conditions (RR 1.82, 95% CI 1.35 to 2.44; low-certainty evidence). Practitioner outcomes were not measured. Interventions were not reported to adversely affect emergency department attendance nor hospital admission when compared with attention control. Comparing one form of intervention with another: not measured. There was 'unclear' risk across studies for performance bias, detection bias, and reporting bias; however, no aspects were 'high' risk. Evidence was downgraded via GRADE, most often because of 'small sample size' and 'evidence from a single study'. AUTHORS' CONCLUSIONS Limited available evidence does not allow a robust conclusion regarding the objectives of this review. Whilst patient involvement in decision-making is seen as a key mechanism for improving care, it is rarely examined as an intervention and was not measured by included studies. Consistency in design, analysis, and evaluation of interventions would enable a greater likelihood of robust conclusions in future reviews.
Collapse
Affiliation(s)
- Joanne E Butterworth
- University of Exeter Medical SchoolUniversity of Exeter Collaboration for Academic Primary Care (APEx)Smeall BuildingSt Luke's CampusExeterDevonUKEX1 2LU
| | - Rebecca Hays
- University of ManchesterNIHR School for Primary Care Research, Manchester Academic Health Science Centre, Division of Population Health, Health Services Research and Primary Care5th Floor, Williamson BuildingOxford RoadManchesterUKM13 9PL
| | - Sinead TJ McDonagh
- University of Exeter Medical SchoolUniversity of Exeter Collaboration for Academic Primary Care (APEx)Smeall BuildingSt Luke's CampusExeterDevonUKEX1 2LU
| | - Suzanne H Richards
- University of LeedsLeeds Institute of Health SciencesCharles Thackrah Building101 Clarendon RoadLeedsUKLS2 9LJ
| | - Peter Bower
- University of ManchesterNIHR School for Primary Care Research, Manchester Academic Health Science Centre, Division of Population Health, Health Services Research and Primary Care5th Floor, Williamson BuildingOxford RoadManchesterUKM13 9PL
| | - John Campbell
- University of Exeter Medical SchoolUniversity of Exeter Collaboration for Academic Primary Care (APEx)Smeall BuildingSt Luke's CampusExeterDevonUKEX1 2LU
| | | |
Collapse
|
82
|
Chan JMH, Fang AHS, Shah M. Factors affecting patient enablement in an Asian setting: a mixed methods study. Singapore Med J 2019; 61:647-660. [PMID: 31598731 DOI: 10.11622/smedj.2019125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Patient-centred medical care has been rising in importance since the turn of the century. It entails treating patients in relation to their biopsychosocial outlook so as to support the management of their conditions. The extent to which a patient is enabled to acquire skills and knowledge can be measured with the Patient Enablement Instrument (PEI) proposed by Howie and colleagues, and it has been noted to be more reflective of a good consultation compared to patient satisfaction scores. This study aimed to determine the level of patient enablement in the Singaporean context and the factors facilitating it. METHODS We conducted an embedded mixed method study with primary care patients in two phases: (a) a PEI questionnaire was completed by 150 patients; and (b) a qualitative approach using focused group discussions and individual interviews was used to explore factors associated with high enablement. RESULTS The mean PEI score was 4.5 ± 4.4, with significantly higher scores among patients attending specialised primary care clinics. Important physician factors were doctors' advice, attitude and relationship with the patient. Critical system factors included good continuity of care, workload and financial support, while patient factors included their beliefs, preparedness, inquisitiveness and trust, with considerable impact from the influence of community. CONCLUSION The PEI score in the Singaporean context is similar to that of other Asian contexts, but slightly higher than that reported in Western studies. Good doctor-patient relationships, efficient systems facilitating continuity of care, and motivated and informed patients all contribute to increased enablement.
Collapse
|
83
|
Everitt HA, Landau S, O'Reilly G, Sibelli A, Hughes S, Windgassen S, Holland R, Little P, McCrone P, Bishop FL, Goldsmith K, Coleman N, Logan R, Chalder T, Moss-Morris R. Cognitive behavioural therapy for irritable bowel syndrome: 24-month follow-up of participants in the ACTIB randomised trial. Lancet Gastroenterol Hepatol 2019; 4:863-872. [PMID: 31492643 PMCID: PMC7026694 DOI: 10.1016/s2468-1253(19)30243-2] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 07/10/2019] [Accepted: 07/18/2019] [Indexed: 12/22/2022]
Abstract
Background Irritable bowel syndrome (IBS) is common, affecting 10–20% of the adult population worldwide, with many people reporting ongoing symptoms despite first-line therapies. Cognitive behavioural therapy (CBT) is recommended in guidelines for refractory IBS but there is insufficient access to CBT for IBS and uncertainty about whether benefits last in the longer term. Assessing Cognitive behavioural Therapy for IBS (ACTIB) was a large, randomised, controlled trial of two forms of CBT for patients with refractory IBS. ACTIB results showed that, at 12 months, both forms of CBT for IBS were significantly more effective than treatment as usual at reducing IBS symptom severity in adults with refractory IBS. This follow-up study aimed to evaluate 24-month clinical outcomes of participants in the ACTIB trial. Methods In the ACTIB three-group, randomised, controlled trial, 558 adults with refractory IBS were randomly allocated to receive either therapist-delivered telephone CBT (telephone-CBT group), web-based CBT with minimal therapist support (web-CBT group), or treatment as usual (TAU group) and were followed up for 12 months. Participants were adults with refractory IBS (clinically significant symptoms for ≥12 months despite being offered first-line therapies), recruited by letter and opportunistically from 74 general practices and three gastroenterology centres in London and the south of England (UK) between May 1, 2014, and March 31, 2016. Primary outcome measures were IBS Symptom Severity Score (IBS-SSS) and Work and Social Adjustment Scale (WSAS), assessed in the intention-to-treat (ITT) population with multiple imputation. This study was a non-prespecified naturalistic follow-up and analysis of the participants of the ACTIB trial at 24 months assessing the same outcomes as the original trial. Outcome measures were completed online by participants or a paper questionnaire was posted, or telephone follow-up undertaken. The ACTIB trial is registered with the International Standard Randomised Controlled Trial Number registry, number ISRCTN44427879. Findings 24-month follow-up of outcomes was achieved for 323 (58%) of 558 participants: 119 (64%) of 186 in the telephone-CBT group, 99 (54%) of 185 in the web-CBT group, and 105 (56%) of 187 in the TAU group. At 24 months, mean IBS-SSS was 40·5 points (95% CI 15·0 to 66·0; p=0·002) lower in the telephone-CBT group and 12·9 points (−12·9 to 38·8; p=0·33) lower in the web-CBT group than in the TAU group. The mean WSAS score was 3·1 points (1·3 to 4·9; p<0·001) lower in the telephone-CBT group and 1·9 points (0·1 to 3·7; p=0·036) lower in the web-CBT group than in the TAU group. A clinically significant IBS-SSS change (≥50 points) from baseline to 24 months was found in 84 (71%) of 119 participants in the telephone-CBT group, in 62 (63%) of 99 in the web-CBT group, and in 48 (46%) of 105 in the TAU group. In total 41 adverse events were reported between 12 to 24 months: 11 in the telephone-CBT group, 15 in the web-CBT group, and 15 in the TAU group. Of these, eight were reported as gastrointestinal related, five as psychological, and six as musculoskeletal. There were no adverse events related to treatment. Interpretation At 24-month follow-up, sustained improvements in IBS were seen in both CBT groups compared with TAU, although some previous gains were reduced compared with the 12-month outcomes. IBS-specific CBT has the potential to provide long-term improvement in IBS, achievable within a usual clinical setting. Increasing access to CBT for IBS could achieve long-term patient benefit. Funding UK National Institute for Health Research.
Collapse
Affiliation(s)
- Hazel A Everitt
- School of Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, UK.
| | - Sabine Landau
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Gilly O'Reilly
- School of Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Alice Sibelli
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Stephanie Hughes
- School of Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Sula Windgassen
- Academic Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Rachel Holland
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Paul Little
- School of Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Paul McCrone
- King's Health Economics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Felicity L Bishop
- Centre for Applications of Health Psychology, University of Southampton, Southampton, UK
| | - Kim Goldsmith
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Nicholas Coleman
- Department of Gastroenterology, Southampton University Hospital, Southampton, UK
| | | | - Trudie Chalder
- Academic Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Rona Moss-Morris
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| |
Collapse
|
84
|
Everitt HA, Landau S, O’Reilly G, Sibelli A, Hughes S, Windgassen S, Holland R, Little P, McCrone P, Bishop F, Goldsmith K, Coleman N, Logan R, Chalder T, Moss-Morris R. Assessing telephone-delivered cognitive-behavioural therapy (CBT) and web-delivered CBT versus treatment as usual in irritable bowel syndrome (ACTIB): a multicentre randomised trial. Gut 2019; 68:1613-1623. [PMID: 30971419 PMCID: PMC6709776 DOI: 10.1136/gutjnl-2018-317805] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/31/2019] [Accepted: 02/22/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate the clinical effectiveness of two modes of cognitive-behavioural therapy (CBT) for IBS compared with treatment as usual (TAU) in refractory IBS. DESIGN A three-arm randomised controlled trial assessing telephone-delivered CBT (TCBT), web-based CBT (WCBT) with minimal therapist support, and TAU. Blinding participants and therapists was not possible. Chief investigator, assessors and statisticians were blinded. Participants were adults with refractory IBS (clinically significant symptoms for ≥12 months despite first-line therapies), recruited by letter and opportunistically from 74 general practices and three gastroenterology centres in London and South of England between May 2014 to March 2016. Co-primary outcomes were IBS Symptom Severity Score (IBS-SSS) and Work and Social Adjustment Scale (WSAS) at 12 months. RESULTS 558/1452 (38.4%) patients screened for eligibility were randomised: 76% female: 91% white: mean age 43 years. (391/558) 70.1% completed 12 months of follow-up. Primary outcomes: Compared with TAU (IBS-SSS 205.6 at 12 months), IBS-SSS was 61.6 (95% CI 33.8 to 89.5) points lower (p<0.001) in TCBT and 35.2 (95% CI 12.6 to 57.8) points lower (p=0.002) in WCBT at 12 months. Compared with TAU (WSAS score 10.8 at 12 months) WSAS was 3.5 (95% CI 1.9 to 5.1) points lower (p<0.001) in TCBT and 3.0 (95% CI 1.3 to 4.6) points lower (p=0.001) in WCBT. All secondary outcomes showed significantly greater improvement (p≤0.002) in CBT arms compared with TAU. There were no serious adverse reactions to treatment. CONCLUSION Both CBT interventions were superior to TAU up to 12 months of follow-up. TRIAL REGISTRATION NUMBER ISRCTN44427879.
Collapse
Affiliation(s)
- Hazel Anne Everitt
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Sabine Landau
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
| | - Gilly O’Reilly
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Alice Sibelli
- Department of Psychology, Institue of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
| | - Stephanie Hughes
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Sula Windgassen
- Department of Psychology, Institue of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
| | - Rachel Holland
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
| | - Paul Little
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Paul McCrone
- Department of Health Services and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
| | - Felicity Bishop
- Department of Psychology, University of Southampton, Southampton, UK
| | - Kimberley Goldsmith
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
| | - Nicholas Coleman
- Department of Gastroenterology, University Hospital Southampton, Southampton, UK
| | - Robert Logan
- Department of Gastroenterology, King’s College Hospital, London, UK
| | - Trudie Chalder
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
| | - Rona Moss-Morris
- Department of Psychology, Institue of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
| | | |
Collapse
|
85
|
Desborough J, Parkinson A, Korda R, Han J, McManus M, Aung E. The practical use of the Patient Enablement and Satisfaction Model in nurse-led outpatient cardiac clinics. Collegian 2019. [DOI: 10.1016/j.colegn.2018.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
86
|
Lai J, Klag M, Shikako‐Thomas K. Designing a program evaluation for a medical-dental service for adults with autism and intellectual disabilities using the RE-AIM framework. Learn Health Syst 2019; 3:e10192. [PMID: 31317073 PMCID: PMC6628980 DOI: 10.1002/lrh2.10192] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 12/27/2018] [Accepted: 03/10/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Robust evaluation of service models can improve the quality and efficiency of care while articulating the models for potential replication. Even though it is an essential part of learning health systems, evaluations that benchmark and sustain models serving adults with developmental disabilities are lacking, impeding pilot programs from becoming official care pathways. Here, we describe the development of a program evaluation for a specialized medical-dental community clinic serving adults with autism and intellectual disabilities in Montreal, Canada. METHOD Using a Participatory Action-oriented approach, researchers and staff co-designed an evaluation for a primary care service for this population. We performed an evaluability assessment to identify the processes and outcomes that were feasible to capture and elicited perspectives at both clinical and health system levels. The RE-AIM framework was used to categorize and select tools to capture data elements that would inform practice at the clinic. RESULTS We detail the process of conceptualizing the evaluation framework and operationalizing the domains using a mixed-methods approach. Our experience demonstrated (1) the utility of a comprehensive framework that captures contextual factors in addition to clinical outcomes, (2) the need for validated measures that are not cumbersome for everyday practice, (3) the importance of understanding the functional needs of the organization and building a sustainable data infrastructure that addresses those needs, and (4) the need to commit to an evolving, "living" evaluation in a dynamic health system. CONCLUSIONS Evaluation employing rigorous patient-centered and systems-relevant metrics can help organizations effectively implement and continuously improve service models. Using an established framework and a collaborative approach provides an important blueprint for a program evaluation in a learning health system. This work provides insight into the process of integrating care for vulnerable populations with chronic conditions in health care systems and integrated knowledge generation processes between research and health systems.
Collapse
Affiliation(s)
- Jonathan Lai
- Centre for Innovation in Autism and Intellectual DisabilitiesMiriam FoundationMontrealCanada
- School of Physical and Occupational TherapyMcGill UniversityMontrealCanada
| | - Malvina Klag
- Centre for Innovation in Autism and Intellectual DisabilitiesMiriam FoundationMontrealCanada
| | | |
Collapse
|
87
|
Tolvanen E, Koskela TH, Kosunen E. Comparison of the Patient Enablement Instrument (PEI) with two single-item measures among Finnish Health care centre patients. BMC Health Serv Res 2019; 19:376. [PMID: 31196088 PMCID: PMC6567660 DOI: 10.1186/s12913-019-4182-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 05/27/2019] [Indexed: 11/29/2022] Open
Abstract
Background The Patient Enablement Instrument (PEI) is an established patient-reported outcome measure (PROM) that reflects the quality of appointments with general practitioners (GPs). It is a six-item questionnaire administered to the patient immediately after a consultation. The aim of this study was to evaluate whether a single-item measure could replace the PEI when measuring patient enablement among Finnish health care centre patients. Methods Two single-item measures, Q1 and Q2, were chosen for comparison with the PEI. Firstly, a pilot study with questionnaire testing and brief interviews with the respondents were performed in order to assess the content validity of the PEI and the single-item measures. Secondly, a questionnaire study after a single appointment with a GP was carried out in three health care centres in Western Finland in order to evaluate the construct and criterion validity of the single-item measures. A telephone interview was performed 2 weeks after the appointment in order to assess the test-retest reliability of the single-item measures. The sensitivity, specificity, and both positive and negative predictive values of Q1 and Q2 were calculated with different PEI score cut-off points. Results Altogether 483 patients with a completed PEI were included in the questionnaire study analyses. Altogether 149 and 175 patients had completed Q1 and Q2, respectively, both in the questionnaire and the telephone interview. The correlations between the PEI and Q1 and Q2 were 0.48 and 0.84, respectively. Both the single-item measures had a high sensitivity and a negative predictive value in relation to patients with lower PEI scores. The reliability coefficients were 0.24 for Q1 and 0.76 for Q2. The test-retest values of Q1, Q2, and the PEI were low. Conclusions Q2 seems to be a valid and reliable measure of patient enablement. Q1 seems to be less correlated with the PEI, but it also has a high negative predictive value in relation to low enablement scores.
Collapse
Affiliation(s)
- Elina Tolvanen
- Faculty of Medicine and Health Technology, Tampere University, c/o coordinator Leena Kiuru, Arvo Building B, 33014, Tampere, Finland. .,Pirkkala Municipal Health Centre, Pirkkala, Finland. .,Science Centre, Pirkanmaa Hospital District, Tampere, Finland.
| | - Tuomas H Koskela
- Faculty of Medicine and Health Technology, Tampere University, c/o coordinator Leena Kiuru, Arvo Building B, 33014, Tampere, Finland.,Centre for General Practice, Pirkanmaa Hospital District, Tampere, Finland
| | - Elise Kosunen
- Faculty of Medicine and Health Technology, Tampere University, c/o coordinator Leena Kiuru, Arvo Building B, 33014, Tampere, Finland.,Centre for General Practice, Pirkanmaa Hospital District, Tampere, Finland
| |
Collapse
|
88
|
Kongsted A, Hartvigsen J, Boyle E, Ris I, Kjaer P, Thomassen L, Vach W. GLA:D® Back: group-based patient education integrated with exercises to support self-management of persistent back pain - feasibility of implementing standardised care by a course for clinicians. Pilot Feasibility Stud 2019; 5:65. [PMID: 31086676 PMCID: PMC6507160 DOI: 10.1186/s40814-019-0448-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 04/12/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Clinical guidelines for management of low back pain (LBP) are not routinely implemented in practice, and guidelines rarely offer tools for implementation. Therefore, we developed GLA:D® Back, a standardised intervention of patient education and supervised exercises. This pilot study tested the feasibility of implementing GLA:D Back in clinical practice in Denmark by delivering a course for physiotherapists and chiropractors. It should further inform the planning of an implementation-effectiveness study using a pre-post group design alongside nation-wide implementation. METHODS Thirty-one clinicians from nine clinics participated. Feasibility of implementation was evaluated in terms of adoption and through focus group interviews and a feedback meeting. Patient-level data, including pain, disability, and pain enablement, were collected from (1) LBP patients visiting the clinics during a pre-specified 2-week period 2 months prior to clinicians attending the GLA:D Back course (n = 84), (2) LBP patients consulting during a 2-week period 2 months after the course (n = 77), and (3) those enrolled in GLA:D Back during 4 months after implementation (n = 89). Patient data were collected at baseline and at 4 months. RESULTS Clinicians' evaluations of the course were positive and resulted in several modifications. The clinical intervention was adopted by all test sites. Most patient characteristics were similar across groups. Patients mainly had persistent LBP (73% > 3 months) and most had been treated for more than 4 weeks at inclusion. Patients in GLA:D Back were more often retired (30% vs. 16% before implementation) and at high risk of poor prognosis (25% vs. 13%). Procedures for data collection were feasible, and outcomes after implementation, especially with GLA:D Back, were as good as or better than before implementation. Recruiting patients and achieving comparable pre- and post-groups was difficult. CONCLUSIONS Implementation of the GLA:D Back clinical intervention in Danish primary care physiotherapy and chiropractic clinics was feasible through a 2-day clinician course. Both clinicians and patients were satisfied with the programme, and patient-reported outcomes were slightly better than outcomes in patients registered before implementation. It was not deemed possible to conduct an implementation-effectiveness trial as part of a nation-wide implementation.
Collapse
Affiliation(s)
- Alice Kongsted
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark
| | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark
| | - Eleanor Boyle
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Inge Ris
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Per Kjaer
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Health Sciences Research Centre, University College Lillebaelt, Odense, Denmark
| | - Line Thomassen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Werner Vach
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| |
Collapse
|
89
|
Siu HYH, Delleman B, Langevin J, Mangin D, Howard M, Fang Q, Price D, Chan D. Demonstrating a Technology-Mediated Intervention to Support Medication Adherence in Community-Dwelling Older Adults in Primary Care: A Feasibility Study. Gerontol Geriatr Med 2019; 5:2333721419845179. [PMID: 31106241 PMCID: PMC6503597 DOI: 10.1177/2333721419845179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 03/27/2019] [Accepted: 03/28/2019] [Indexed: 12/05/2022] Open
Abstract
Background: Medication non-adherence can lead to significant
morbidity and mortality. This 4-week feasibility study aims to demonstrate that
the eDosette intervention can be implemented with older adults in primary care.
Method: Fifty-six older adults from four primary care sites in
Southwestern Ontario, Canada participated. The intervention involved generating,
for pharmacist review, weekly medication administration records based on
transmitted data captured by the eDosette. The primary outcome is implementation
feasibility defined by recruitment, adherence rates, frequency of captured
missed and late doses, descriptions of clinical work resulting from the
intervention, and participant feedback. Results: The recruitment
rate was 24% (57/240); one withdrew due to personal reasons. The mean observed
adherence rate was 82% (range 49%-100%). Overall, participants missed 505 and
took 2,105 doses late; 118 clinical decisions occurred with 72 unique medication
changes in 31 participants. Participants found the eDosette easy to use and did
not feel that they were viewed negatively because of their potential
non-adherence. Conclusion: The eDosette intervention could be
feasibly implemented in primary care with older adults. Providing information
about when an older adult takes their medications could play a role in
medication adherence by prompting more informed discussions between the older
adult and primary care clinicians.
Collapse
Affiliation(s)
- Henry Yu-Hin Siu
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Bethany Delleman
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Jessica Langevin
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Dee Mangin
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Michelle Howard
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Qiyin Fang
- Department of Engineering Physics, McMaster University, Hamilton, Ontario, Canada
| | - David Price
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - David Chan
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
90
|
Etz RS, Zyzanski SJ, Gonzalez MM, Reves SR, O'Neal JP, Stange KC. A New Comprehensive Measure of High-Value Aspects of Primary Care. Ann Fam Med 2019; 17:221-230. [PMID: 31085526 PMCID: PMC6827628 DOI: 10.1370/afm.2393] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 03/18/2019] [Accepted: 03/21/2019] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To develop and evaluate a concise measure of primary care that is grounded in the experience of patients, clinicians, and health care payers. METHODS We asked crowd-sourced samples of 412 patients, 525 primary care clinicians, and 85 health care payers to describe what provides value in primary care, then asked 70 primary care and health services experts in a 2½ day international conference to provide additional insights. A multidisciplinary team conducted a qualitative analysis of the combined data to develop a parsimonious set of patient-reported items. We evaluated items using factor analysis, Rasch modeling, and association analyses among 2 online samples and 4 clinical samples from diverse patient populations. RESULTS The resulting person-centered primary care measure parsimoniously represents the broad scope of primary care, with 11 domains each represented by a single item: accessibility, advocacy, community context, comprehensiveness, continuity, coordination, family context, goal-oriented care, health promotion, integration, and relationship. Principal axes factor analysis identified a single factor. Factor loadings and corrected item-total correlations were >0.6 in online samples (n = 2,229) and >0.5 in clinical samples (n = 323). Factor scores were fairly normally distributed in online patient samples, and skewed toward higher ratings in point-of-care patient samples. Rasch models showed a broad spread of person and item scores, acceptable item-fit statistics, and little item redundancy. Preliminary concurrent validity analyses supported hypothesized associations. CONCLUSIONS The person-centered primary care measure reliably, comprehensively, and parsimoniously assesses the aspects of care thought to represent high-value primary care by patients, clinicians, and payers. The measure is ready for further validation and outcome analyses, and for use in focusing attention on what matters about primary care, while reducing measurement burden.
Collapse
Affiliation(s)
- Rebecca S Etz
- Larry A. Green Center for the Advancement of Primary Health Care for the Public Good .,Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
| | - Stephen J Zyzanski
- Center for Community Health Integration, Departments of Family Medicine & Community Health, Population & Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Martha M Gonzalez
- Larry A. Green Center for the Advancement of Primary Health Care for the Public Good.,Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
| | - Sarah R Reves
- Larry A. Green Center for the Advancement of Primary Health Care for the Public Good.,Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
| | - Jonathan P O'Neal
- Larry A. Green Center for the Advancement of Primary Health Care for the Public Good.,Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
| | - Kurt C Stange
- Larry A. Green Center for the Advancement of Primary Health Care for the Public Good.,Center for Community Health Integration, Departments of Family Medicine & Community Health, Population & Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio.,Departments of General Medical Sciences and Sociology, and Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
| |
Collapse
|
91
|
Abstract
OBJECTIVE To develop and assess the reliability of a measure of primary care using items from the Medical Expenditure Panel Survey (MEPS), a US representative survey of community-dwelling persons. METHODS On the basis of the domains from the literature on primary care characteristics, we identified relevant items within the 2013-2014 MEPS family of surveys. In a sample of primary survey respondents with at least 1 office-based physician visit in the last 12 months, we conducted exploratory factor analysis, retaining items with a factor loading of 0.30 and factors ≥3 items. Using a hold-out sample, internal consistency, reproducibility, and confirmatory factor analyses were performed. RESULTS On the basis of 16 care domains, we found 32 candidate items in the MEPS. Factor analyses of data from 4549 persons meeting inclusion criteria (27.6% of the total sample), yielded 3 unique factors involving 24 items. We named these subscales Relationship, Comprehensiveness, and Health Promotion, displaying internal consistency reliability of 0.86, 0.78, and 0.69, respectively. Confirmatory factor analysis corroborated the stability of the exploratory findings in the hold out sample. Sensitivity analyses showed robustness to differences in underlying correlation structure, alternative approach to missing data, and extension to indirect survey respondents. CONCLUSIONS The MEPS Primary Care measure with 3 subscales is reliable and may be useful in conducting primary care health services and outcomes research in the rich MEPS dataset. Further validation is needed, and is described in a companion paper.
Collapse
|
92
|
Testing a Model of Consultation-based Reassurance and Back Pain Outcomes With Psychological Risk as Moderator: A Prospective Cohort Study. Clin J Pain 2019; 34:339-348. [PMID: 29509169 PMCID: PMC5844580 DOI: 10.1097/ajp.0000000000000541] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Reassurance is an essential part of treatment for low back pain (LBP), but evidence on effective methods to deliver reassurance remains scarce. The interaction between consultation-based reassurance and patients' psychological risk is unknown. Our objective was to investigate the relationship between consultation-based reassurance and clinical outcomes at follow-up, in people with and without psychological risk. METHODS We tested the associations between specific reassurance components (data gathering, relationship building, generic reassurance, and cognitive reassurance), patients' psychological risk (the presence of depression, anxiety, catastrophizing, or fear-avoidance), and postconsultation outcomes including, satisfaction and enablement, disability, pain, and mood at 3-month follow-up. RESULTS Adjusted linear regression models using data from patients who had recently consulted for LBP in primary care (n=142 in 43 practices) indicated that all reassurance components were strongly associated with increased satisfaction, whereas generic reassurance was significantly associated with postconsultation enablement. Generic reassurance was also associated with lower pain at 3 months, whereas cognitive reassurance was associated with increased pain. A significant interaction was observed between generic reassurance and psychological risk for depression at 3 months: high rates of generic reassurance were associated with lower depression in low-risk patients, but with higher rates of depression for high-risk groups. DISCUSSION The findings support the hypothesis that different components of reassurance are associated with specific outcomes, and that psychological risk moderates this relationship for depression. Clinicians reassuring behaviors might therefore have the potential to improve outcomes in people with LBP, especially for patients with higher psychological risk profiles.
Collapse
|
93
|
Peolsson A, Peterson G, Hermansen A, Ludvigsson ML, Dedering Å, Löfgren H. Physiotherapy after anterior cervical spine surgery for cervical disc disease: study protocol of a prospective randomised study to compare internet-based neck-specific exercise with prescribed physical activity. BMJ Open 2019; 9:e027387. [PMID: 30782952 PMCID: PMC6377535 DOI: 10.1136/bmjopen-2018-027387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 11/12/2018] [Accepted: 11/16/2018] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Patients suffering from remaining disability after anterior cervical decompression and fusion (ACDF) surgery for cervical disc disease may be prescribed physical activity (PPA) or neck-specific exercises (NSEs). Currently, we lack data for the success of either approach. There is also a knowledge gap concerning the use of internet-based care for cervical disc disease. The scarcity of these data, and the high proportion of patients with various degrees of incapacity following ACDF, warrant increased efforts to investigate and improve cost-effective rehabilitation. The objective is to compare the effectiveness of a structured, internet-based NSE programme, versus PPA following ACDF surgery. METHODS AND ANALYSIS This is a prospective, randomised, multicentre study that includes 140 patients with remaining disability (≥30% on the Neck Disability Index, NDI) following ACDF for radiculopathy due to cervical disc disease. Patient recruitment occurs following attendance at routine clinical appointments, scheduled at 3 months postsurgery. Patients are then randomised to one of two groups (70 patients/group) for a 3-month treatment programme/period of either internet-based NSE or PPA. Questionnaires on background data, pain and discomfort, physical and mental capacity, satisfaction with care, and health and workplace factors are completed, along with physical measures of neck-related function conducted by independent test leaders blinded to randomisation. Measures are collected at inclusion, after the 3-month treatments (end of treatment) and at a 2-year follow-up. Radiography will be completed at the 2-year follow-up. Preoperative data will be collected from the Swedish Spine Registry. Data on healthcare consumption, drug use and sick leave will be requested from the relevant national registers. ETHICAL CONSIDERATIONS This study was approved by the Regional Ethical Review Board in Linköping Ref. 2016/283-31 and 2017/91- 32. The scientists are independent with no commercial ties. Patients are recruited after providing written informed consent. Patient data are presented at group level such that no connection to any individual can be made. All data are anonymised when reported, and subject to the Swedish Official Secrets Health Acts. The test leaders are independent and blinded for randomisation. Exercises, both general and neck-specific, have been used extensively in clinical practice and we anticipate no harm from their implementation other than a risk of muscle soreness. Both randomisation groups will receive care that is expected to relieve pain, although the group receiving NSE is expected to demonstrate a greater and more cost-effective improvement versu s the PPA group. Any significant harm or unintended effects in each group will be collected by the test leaders. All questionnaires and test materials are coded by the research group, with code lists stored in locked, fireproof file cabinets, housed at the university in a room with controlled (card-based) access. Only individuals in receipt of a unique website address posted by the researchers can access the programme; patients can neither communicate with each other nor with caregivers via the programme.Study participation might lead to improved rehabilitation versus non-participation, and might therefore be of benefit. The results of this study should also contribute to more effective and flexible rehabilitation, shorter waiting times, lower costs and the possibility to implement our findings on a wider level. DISSEMINATION If effective, the protocols used in this study can be implemented in existing healthcare structures. The results of the study will be presented in scientific journals and popular science magazines of relevance to health. The findings will also be presented at local, regional, national and international conferences and meetings, as well as in the education of university students and at public lectures. Information about the results will be communicated to the general population in cooperation with patient organisations and the media. TRIAL REGISTRATION NCT03036007.
Collapse
Affiliation(s)
- Anneli Peolsson
- Department of Medical and Health Sciences, Physiotherapy, Linköping University, Linköping, Sweden
| | - Gunnel Peterson
- Department of Medical and Health Sciences, Physiotherapy, Linköping University, Linköping, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden
| | - Anna Hermansen
- Department of Medical and Health Sciences, Physiotherapy, Linköping University, Linköping, Sweden
| | - Maria Landén Ludvigsson
- Department of Medical and Health Sciences, Physiotherapy, Linköping University, Linköping, Sweden
- Department of Rehabilitation and Department of Medical and Health Sciences, Rehab Väst, Region Council of Östergötland, Linkoping, Sweden
| | - Åsa Dedering
- Allied Health Professionals Function, Occupational Therapy and Physiotherapy, University Hospital, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
| | - Håkan Löfgren
- Neuro-Orthopedic Center, Ryhov Hospital, Jönköping, Sweden
| |
Collapse
|
94
|
Murphy M, Hollinghurst S, Salisbury C. Patient understanding of two commonly used patient reported outcome measures for primary care: a cognitive interview study. BMC FAMILY PRACTICE 2018; 19:162. [PMID: 30261850 PMCID: PMC6161379 DOI: 10.1186/s12875-018-0850-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 09/17/2018] [Indexed: 01/25/2023]
Abstract
Background Standardised generic patient-reported outcome measures (PROMs) which measure health status are often unresponsive to change in primary care. Alternative formats, which have been used to increase responsiveness, include individualised PROMs (in which respondents specify the outcomes of interest in their own words) and transitional PROMs (in which respondents directly rate change over a period). The objective of this study was to test qualitatively, through cognitive interviews, two PROMs, one using each respective format. Methods The individualised PROM selected was the Measure Yourself Medical Outcomes Profile (MYMOP). The transitional PROM was the Patient Enablement Instrument (PEI). Twenty patients who had recently attended the GP were interviewed while completing the questionnaires. Interview data was analysed using a modification of Tourangeau’s model of cognitive processing: comprehension, response, recall and face validity. Results Patients found the PEI simple to complete, but for some it lacked face validity. The transitional scale was sometimes confused with a status scale and was problematic in situations when the relevant GP appointment was part of a longer episode of care. Some patients reported a high enablement score despite verbally reporting low enablement but high regard for their GP, which suggested hypothesis-guessing. The interpretation of the PEI items was inconsistent between patients. MYMOP was more difficult for patients to complete, but had greater face validity than the PEI. The scale used was open to response-shift: some patients suggested they would recalibrate their definition of the scale endpoints as their illness and expectations changed. Conclusions The study provides information for both users of PEI/MYMOP and developers of individualised and transitional questionnaires. Users should heed the recommendation that MYMOP should be interview-administered, and this is likely to apply to other individualised scales. The PEI is open to hypothesis-guessing and may lack face-validity for a longer episode of care (e.g. in patients with chronic conditions). Developers should be cognisant that transitional scales can be inconsistently completed: some patients forget during completion that they are measuring change from baseline. Although generic questionnaires require the content to be more general than do disease-specific questionnaires, developers should avoid questions which allow broad and varied interpretations. Electronic supplementary material The online version of this article (10.1186/s12875-018-0850-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Mairead Murphy
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - Sandra Hollinghurst
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Chris Salisbury
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| |
Collapse
|
95
|
Butterworth JE, Hays R, Richards SH, Bower P, Campbell J. Interventions for involving older patients with multimorbidity in decision-making during primary care consultations. Hippokratia 2018. [DOI: 10.1002/14651858.cd013124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Joanne E Butterworth
- University of Exeter Medical School; Primary Care Research Group; Smeall Building St Luke's Campus Exeter Devon UK EX1 2LU
| | - Rebecca Hays
- University of Manchester; NIHR School for Primary Care Research, Manchester Academic Health Science Centre, Division of Population Health, Health Services Research and Primary Care; 5th Floor, Williamson Building Oxford Road Manchester UK M13 9PL
| | - Suzanne H Richards
- University of Leeds; Leeds Institute of Health Sciences; Charles Thackrah Building 101 Clarendon Road Leeds UK LS2 9LJ
| | - Peter Bower
- University of Manchester; NIHR School for Primary Care Research, Manchester Academic Health Science Centre, Division of Population Health, Health Services Research and Primary Care; 5th Floor, Williamson Building Oxford Road Manchester UK M13 9PL
| | - John Campbell
- University of Exeter Medical School; Department of General Practice and Primary Care; Smeall Building St Luke's Campus Exeter UK EX1 2LU
| |
Collapse
|
96
|
Kemp L, Grace R, Comino E, Jackson Pulver L, McMahon C, Harris E, Harris M, George A, Mack HA. The effectiveness of a sustained nurse home visiting intervention for Aboriginal infants compared with non-Aboriginal infants and with Aboriginal infants receiving usual child health care: a quasi-experimental trial - the Bulundidi Gudaga study. BMC Health Serv Res 2018; 18:599. [PMID: 30075818 PMCID: PMC6091045 DOI: 10.1186/s12913-018-3394-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 07/15/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In Australia there is commitment to developing interventions that will 'Close the Gap' between the health and welfare of Indigenous and non-Indigenous Australians and recognition that early childhood interventions offer the greatest potential for long term change. Nurse led sustained home visiting programs are considered an effective way to deliver a health and parenting service, however there is little international or Australian evidence that demonstrates the effectiveness of these programs for Aboriginal infants. This protocol describes the Bulundidi Gudaga Study, a quasi-experimental design, comparing three cohorts of families from the Macarthur region in south western Sydney to explore the effectiveness of the Maternal Early Childhood Sustained Home-visiting (MECSH) program for Aboriginal families. METHODS Mothers were recruited when booking into the local hospital for perinatal care and families are followed up until child is age 4 years. Participants are from three distinct cohorts: Aboriginal MECSH intervention cohort (Group A), Non-Aboriginal MECSH intervention cohort (Group B) and Aboriginal non-intervention cohort (Group C). Eligible mothers were those identified as at risk during the Safe Start assessment conducted by antenatal clinic midwives. Mothers in Group A were eligible if they were pregnant with an Aboriginal infant. Mothers in Group B were eligible if they were pregnant with a non-Aboriginal infant. Mothers in Group C are part of the Gudaga descriptive cohort study and were recruited between October 2005 and May 2007. The difference in duration of breastfeeding, child body mass index, and child development outcomes at 18 months and 4 years of age will be measured as primary outcomes. We will also evaluate the intervention effect on secondary measures including: child dental health; the way the program is received; patterns of child health and illness; patterns of maternal health, health knowledge and behaviours; family and environmental conditions; and service usage for mothers and families. DISCUSSION Involving local Aboriginal research and intervention staff and investing in established relationships between the research team and the local Aboriginal community is enabling this study to generate evidence regarding the effectiveness of interventions that are feasible to implement and sustainable in the context of Aboriginal communities and local service systems. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12616001721493 Registered 14 Dec 2016. Retrospectively registered.
Collapse
Affiliation(s)
- Lynn Kemp
- Translational Research and Social Innovation (TReSI), School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
- Centre for Health Equity Training Research and Evaluation, part of the Centre for Primary Health Care and Equity, UNSW Australia, Sydney, NSW 2052 Australia
- Ingham Institute for Applied Medical Research , Liverpool Hospital Locked Bag 7103, Liverpool BC, NSW 1871 Australia
| | - Rebekah Grace
- Translational Research and Social Innovation (TReSI), School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
- Centre for Health Equity Training Research and Evaluation, part of the Centre for Primary Health Care and Equity, UNSW Australia, Sydney, NSW 2052 Australia
- Ingham Institute for Applied Medical Research , Liverpool Hospital Locked Bag 7103, Liverpool BC, NSW 1871 Australia
- Department of Educational Studies, Macquarie University, Room 234, X5B, Sydney, NSW 2109 Australia
| | - Elizabeth Comino
- Centre for Health Equity Training Research and Evaluation, part of the Centre for Primary Health Care and Equity, UNSW Australia, Sydney, NSW 2052 Australia
- Ingham Institute for Applied Medical Research , Liverpool Hospital Locked Bag 7103, Liverpool BC, NSW 1871 Australia
- Centre for Primary Health Care and Equity, UNSW Australia, Sydney, NSW 2052 Australia
| | - Lisa Jackson Pulver
- Office of the Pro Vice Chancellor, Engagement & Aboriginal & Torres Strait Islander Leadership, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
- School of Medicine, UNSW Australia, Sydney, NSW 2052 Australia
| | - Catherine McMahon
- Psychology Department, Centre for Emotional Health, Macquarie University, Level 7, Room 715, C3A Building, North Ryde, NSW 2109 Australia
| | - Elizabeth Harris
- Centre for Primary Health Care and Equity, UNSW Australia, Sydney, NSW 2052 Australia
| | - Mark Harris
- Centre for Primary Health Care and Equity, UNSW Australia, Sydney, NSW 2052 Australia
| | - Ajesh George
- Ingham Institute for Applied Medical Research , Liverpool Hospital Locked Bag 7103, Liverpool BC, NSW 1871 Australia
- Centre for Oral Health Outcomes & Research Translation (COHORT), Western Sydney University, South Western Sydney Local Health District, Locked Bag 7103, Liverpool BC, NSW 1871 Australia
- Faculty of Dentistry, University of Sydney, Sydney, NSW 2006 Australia
| | - Holly A. Mack
- Translational Research and Social Innovation (TReSI), School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
- Centre for Health Equity Training Research and Evaluation, part of the Centre for Primary Health Care and Equity, UNSW Australia, Sydney, NSW 2052 Australia
- Ingham Institute for Applied Medical Research , Liverpool Hospital Locked Bag 7103, Liverpool BC, NSW 1871 Australia
- Faculty of Health, University of Technology Sydney, Ultimo, NSW 2007 Australia
| |
Collapse
|
97
|
Nurse practitioner consultations in primary health care: a case study-based survey of patients' pre-consultation expectations, and post-consultation satisfaction and enablement. Prim Health Care Res Dev 2018; 20:e36. [PMID: 30012232 PMCID: PMC6536762 DOI: 10.1017/s1463423618000415] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background Research has not yet fully investigated links to consultation duration, patient expectations, satisfaction, and enablement in nurse practitioner consultations. This study was developed to address some of these research gaps in nurse practitioner consultations, particularly with a focus on expectations, satisfaction, and enablement. Aim To explore the influence of pre-consultation expectations, and consultation time length durations on patient satisfaction and enablement in nurse practitioner consultations in primary health care. Design Survey component of a larger convergent parallel mixed methods case study designed to conjointly investigate the communication processes, social interactions, and measured outcomes of nurse practitioner consultations. The survey element of the case study focusses on investigating patients’ pre-consultation expectations and post-consultation patient satisfaction and enablement. Methods A questionnaire measuring pre-consultation expectations, and post-consultation satisfaction and enablement, completed by a convenience sample of 71 adults consulting with nurse practitioners at a general practice clinic. Initial fieldwork took place in September 2011 to November 2012, with subsequent follow-up fieldwork in October 2016. Results Respondents were highly satisfied with their consultations and expressed significantly higher levels of enablement than have been seen in previous studies of enablement with other types of clinicians (P=0.003). A significant, small to moderate, positive correlation of 0.427 (P=0.005) between general satisfaction and enablement was noted. No significant correlation was seen between consultation time lengths and satisfaction or enablement. Conclusion Higher levels of patient enablement and satisfaction are not necessarily determined by the time lengths of consultations, and how consultations are conducted may be more important than their time lengths for optimising patient satisfaction and enablement.
Collapse
|
98
|
Grace R, Kemp L, Barnes J, Elcombe E, Knight J, Baird K, Webster V, Byrne F. Community Volunteer Support for Families With Young Children: Protocol for the Volunteer Family Connect Randomized Controlled Trial. JMIR Res Protoc 2018; 7:e10000. [PMID: 30012544 PMCID: PMC6066638 DOI: 10.2196/10000] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 05/16/2018] [Accepted: 05/29/2018] [Indexed: 01/27/2023] Open
Abstract
Background Use of community volunteers to support vulnerable families is a widely employed strategy with a long history. However, there has been minimal formal scientific investigation into the effectiveness of volunteer home visiting programs for families. There is also a need for research examining whether volunteer home visiting leads to improved outcomes for volunteers. Objective The objective of this paper is to describe the research protocol for a pragmatic randomized controlled trial (RCT) of the Volunteer Family Connect intervention, a volunteer home visiting program designed to support families of young children who experience social isolation or a lack of parenting confidence and skills. The project is being conducted in partnership with 3 leading not-for-profit organizations, designed to contribute to the body of evidence that informs decisions about appropriate family support services according to the level of need. It is the first study to examine outcomes for both the families and the volunteers who deliver the service. Methods The RCT is being conducted in 7 sites across Australia. We aim to recruit 300 families to the study: 150 control (services as usual) and 150 intervention (services as usual + volunteer home visiting) families. Intervention families will receive the service for 3-12 months according to their needs, and all participants will complete 6 data collection points over 15 months. A minimum of 80 volunteers will also be recruited, along with a matched community comparison group. The volunteers will complete 3 data collection points over 12 months. Primary outcomes include community connectedness and parenting competence. Secondary outcomes include parent physical and mental health; general parent well-being; parent empowerment; the child-parent relationship; sustainability of family routines; child immunization; child nutrition or breastfeeding; number of accidental injury reports; and volunteer health, well-being, and community connectedness. Results This effectiveness trial was funded in 2016, and we aim to complete data collection by the end of 2018. The first results are expected to be submitted early in 2019. Conclusions There is a need to rigorously assess volunteer home visiting and whether it has a unique and important role on the service landscape, complementary to professional services. This research is the first trial of a volunteer home visiting program to be conducted in Australia and one of the largest of its kind worldwide. Trial Registration Australian New Zealand Clinical Trial Registry ACTRN12616000396426; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370304 (Archived by WebCite athttp://www.webcitation.org/70q42fU7V) Registered Report Identifier RR1-10.2196/1000
Collapse
Affiliation(s)
- Rebekah Grace
- Department of Educational Studies, Faculty of Human Sciences, Macquarie University, North Ryde, Australia
| | - Lynn Kemp
- Translational Research and Social Innovation, School of Nursing and Midwifery, Western Sydney University, Liverpool, Australia
| | - Jacqueline Barnes
- Institute for the Study of Children, Families and Social Issues, Department of Psychological Sciences, Birkbeck, University of London, London, United Kingdom
| | - Emma Elcombe
- Translational Research and Social Innovation, School of Nursing and Midwifery, Western Sydney University, Liverpool, Australia
| | - Jennifer Knight
- Department of Educational Studies, Faculty of Human Sciences, Macquarie University, North Ryde, Australia
| | - Kelly Baird
- Department of Educational Studies, Faculty of Human Sciences, Macquarie University, North Ryde, Australia
| | - Vana Webster
- Department of Educational Studies, Faculty of Human Sciences, Macquarie University, North Ryde, Australia
| | - Fiona Byrne
- Translational Research and Social Innovation, School of Nursing and Midwifery, Western Sydney University, Liverpool, Australia
| |
Collapse
|
99
|
Nurse-led hypertension management was well accepted and non-inferior to physician consultation in a Chinese population: a randomized controlled trial. Sci Rep 2018; 8:10302. [PMID: 29985459 PMCID: PMC6037742 DOI: 10.1038/s41598-018-28721-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 06/28/2018] [Indexed: 11/29/2022] Open
Abstract
The objective of this study is to evaluate if nurse-led repeated prescription (NRP) could ensure non-inferior disease control and would be accepted in Chinese patients with controlled hypertension (HT) in primary care clinics. A 12-month follow-up non-inferiority randomized trial was conducted. The non-inferior margins for systolic and diastolic blood pressure were 6.6 mmHg and 3.7 mmHg, respectively. Eligible patients (>18 years of age) with HT were randomized to the NRP and usual care (UC) groups for their regular clinical follow-up. We used ANCOVA to study the difference-of-difference of the blood pressures between the two groups. The levels of patient acceptance and experience of NRP were assessed by the observed opt-out rate and a qualitative analysis. We found no statistically significant differences in BP blood pressure between the NRP (N = 194) and UC (N = 199) groups. Only 4 of the participants in the NRP group opted out due to a preference for assessment by a physician. The interviewed participants (N = 12) felt positive about NRP, because they experienced more relaxed communication with the nurse and believed that the eligibility to join the NRP program was an indication of optimal BP control. We observed no adverse events. The findings show that NRP was well accepted and found to be non-inferior to physician consultation for HT management.
Collapse
|
100
|
Barratt J, Thomas N. Nurse practitioner consultations in primary health care: an observational interaction analysis of social interactions and consultation outcomes. Prim Health Care Res Dev 2018; 20:e37. [PMID: 29979148 PMCID: PMC6536749 DOI: 10.1017/s1463423618000427] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 03/26/2018] [Accepted: 05/25/2018] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To determine the discrete nature of social interactions occurring in nurse practitioner consultations and investigate the relationship between consultation social interaction styles (biomedical and patient-centred) and the outcomes of patient satisfaction, patient enablement, and consultation time lengths. METHODS A case study-based observational interaction analysis of verbal social interactions, arising from 30 primary health care nurse practitioner consultations, linked with questionnaire measures of patient satisfaction and enablement. RESULTS A significant majority of observed social interactions used patient-centred communication styles (P=0.005), with neither nurse practitioners nor patients or carers being significantly more verbally dominant. Nurse practitioners guided the sequence of consultation interaction sequences, but patients actively participated through interactions such as asking questions. Usage of either patient-centred or biomedical interaction styles were not significantly associated with increased levels of patient satisfaction or patient enablement. The median consultation time length of 10.1 min (quartiles 8.2, 13.7) was not significantly extended by high levels of patient-centred interactions being used in the observed consultations. CONCLUSION High usage levels of patient-centred interaction styles are not necessarily contingent upon having longer consultation times available, and clinicians can encourage patients to use participatory interactions, whilst still then retaining overall guidance of the phased sequences of consultations, and not concurrently extending consultation time lengths. This study adds to the body of nurse practitioner consultation communication research by providing a more detailed understanding of the nature of social interactions occurring in nurse practitioner consultations, linked to the outcomes of patient satisfaction and enablement.
Collapse
Affiliation(s)
- Julian Barratt
- Head of Community Nursing and Workforce Development, Institute of Health, University of Wolverhampton, Wolverhampton, UK
| | - Nicola Thomas
- Professor of Kidney Care, School of Health and Social Care, London South Bank University, London, UK
| |
Collapse
|