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Kashani F, Abazari P, Haghani F. The components of diabetes educator's competence in diabetes self-management education in Iran: A qualitative study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2021; 10:111. [PMID: 34084858 PMCID: PMC8150089 DOI: 10.4103/jehp.jehp_912_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 08/18/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Limited research has been conducted in the field of diabetes educator's competency. However, no comprehensive and integrated explanations of educator's competence requirements in treatment centers exist in Iran. The aim of this study is to explain the components of diabetes educator's competence in diabetes self-management education in Iran. MATERIALS AND METHODS This was a qualitative descriptive-exploratory study. The data were collected through semi-structured and in-depth interviews and using purposeful sampling method in Isfahan University of medical science from April to October 2018. Sampling continued until data saturation. Participants included 20 people who were selected by purposive and snowball sampling method. The interviews were analyzed using content analysis method of Graneheim, Lundman. RESULTS Data analysis resulted in the emergence of three main categories including (1) Patient and family centered education, (2) process-based education, and (3) continuous progress in profession and also seven subcategories (patient and family activation, empower), facilitating educational process, comprehensive education assessment, development, implementation and evaluation of educational plans, developing educators' educational knowledge and skills, development of creativity and innovation, promote inter-professional cooperation in education. CONCLUSION The evaluation of facilitation factors for participation and empowerment patient and family along with creativity and interprofessional collaboration for comprehensive evaluation of patients in designing, implementation of educational programs were mentioned as important competencies of diabetes educators, which can have a significant impact on patients' recovery, treatment, and the promotion of society's health.
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Affiliation(s)
- Fahimeh Kashani
- Department of Adult Health Nursing, Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
- Community Health Research Center, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran
| | - Parvaneh Abazari
- Department of Adult Health Nursing, Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
- Nursing and Midwifery Sciences Development Research Center, Najafabad Branch Islamic Azad University, Najafabad, Iran
| | - Fariba Haghani
- Medical Education Research Center, Department of Medical Education, Isfahan University of Medical Sciences, Isfahan, Iran
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McBride K, Bacong AM, Reynoso A, Benjamin AE, Wallace SP, Kietzman KG. Healthcare Decision-Making Among Dual-Eligible Immigrants: Implications from a Study of an Integrated Medicare-Medicaid Demonstration Program in California. J Immigr Minor Health 2021; 22:494-502. [PMID: 31350680 DOI: 10.1007/s10903-019-00922-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
To improve the coordination of long-term services and supports for dual-eligibles (those with both Medicare and Medicaid), California created Cal MediConnect (CMC), an Affordable Care Act-authorized managed care demonstration program. Beneficiaries were "passively enrolled" into CMC, meaning they were automatically enrolled unless they actively opted out. The aim of this study was to examine differences in factors influencing the enrollment decisions of U.S. born and immigrant dual-eligible beneficiaries. To explore differences in decision-making processes, we conducted in-depth interviews with dual-eligible consumers (39 native and 14 immigrant) in Los Angeles County. Interviews were analyzed using a constructivist grounded theory approach. Our findings illustrate a heightened sense of vulnerability and disempowerment experienced by immigrant participants. Immigrant participants also faced greater challenges in accessing healthcare and eliciting healthcare information compared to U.S.-born participants. Understanding the diverse perspectives of dual-eligible immigrant healthcare decision-making has implications for health care reform strategies aimed at ameliorating disparities for vulnerable immigrant populations.
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Affiliation(s)
- Kaitlyn McBride
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Campus Box 951772, Los Angeles, CA, 90095-1772, USA. .,UCLA Center for Health Policy Research, Los Angeles, CA, USA.
| | - Adrian M Bacong
- UCLA Center for Health Policy Research, Los Angeles, CA, USA.,Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Ana Reynoso
- UCLA Center for Health Policy Research, Los Angeles, CA, USA
| | - A E Benjamin
- Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, CA, USA
| | - Steven P Wallace
- UCLA Center for Health Policy Research, Los Angeles, CA, USA.,Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Kathryn G Kietzman
- UCLA Center for Health Policy Research, Los Angeles, CA, USA.,Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA
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Cuevas H, Carter S. Nurse-Talk Ratios as a Measure of Participation in a Cognitive Rehabilitation Intervention for People With Type 2 Diabetes. Res Theory Nurs Pract 2021; 35:67-81. [PMID: 33632923 DOI: 10.1891/rtnp-d-19-00130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Comprehensive cognitive rehabilitation teaches strategies to enhance strengths and has been used by nurses to target cognitive problems in chronic conditions. However, to date, no evaluations of web-based cognitive rehabilitation, based in empowerment theory, specifically for people with type 2 diabetes (T2DM), have been done. PURPOSE The purpose of this study was to analyze a cognitive rehabilitation intervention for people with T2DM, using qualitative content analysis and 10-second event coding to determine to what extent the classes reflected empowerment theory. METHODS Nineteen adults with T2DM and two nurses participated in an 8-week intervention that combined webinar classes with online home-based computer training. Classes were audio recorded and 10-second event coding was used to calculate nurse-talk ratios. Transcripts were examined using content analysis and compared with the talk ratios. RESULTS Talk ratios ranged from 40% to 74% for each class. Qualitative themes included (a) importance of goal setting; (b) pairing cognitive strategies with diabetes self-management; (c) experience and information sharing; and (d) validation by healthcare providers. Positive participant outcomes related to empowerment were associated with low nurse-talk ratios in some classes. However, high nurse-talk ratios were associated with factual content that participants also considered valuable. IMPLICATIONS FOR PRACTICE Talk ratios did not completely reflect the communication skills of the nurse. The 10-second method should be applied to other educational interventions in combination with qualitative analysis. Future interventions should include components of discourse evaluation and examinations of relationships to adherence and clinical outcomes.
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Affiliation(s)
- Heather Cuevas
- School of Nursing, The University of Texas at Austin, Austin, TX
| | - Sharon Carter
- School of Nursing, The University of Texas at Austin, Austin, TX
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Schaefer I, Heneka N, Luckett T, Agar MR, Chambers SK, Currow DC, Halkett G, Disalvo D, Amgarth-Duff I, Anderiesz C, Phillips JL. Quality of online self-management resources for adults living with primary brain cancer, and their carers: a systematic environmental scan. BMC Palliat Care 2021; 20:22. [PMID: 33485331 PMCID: PMC7827995 DOI: 10.1186/s12904-021-00715-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 01/13/2021] [Indexed: 12/24/2022] Open
Abstract
Background A primary brain cancer diagnosis is a distressing, life changing event. It adversely affects the quality of life for the person living with brain cancer and their families (‘carers’). Timely access to evidence-based information is critical to enabling people living with brain cancer, and their carers, to self-manage the devastating impacts of this disease. Method A systematic environmental scan of web-based resources. A depersonalised search for online English-language resources published from 2009 to December 2019 and designed for adults (> 25 years of age), living with primary brain cancer, was undertaken using the Google search engine. The online information was classified according to: 1) the step on the cancer care continuum; 2) self-management domains (PRISMS taxonomy); 3) basic information disclosure (Silberg criteria); 4) independent quality verification (HonCode); 5) reliability of disease and treatment information (DISCERN Sections 1 and 2); and readability (Flesch-Kincaid reading grade). Results A total of 119 online resources were identified, most originating in England (n = 49); Australia (n = 27); or the USA (n = 27). The majority of resources related to active treatment (n = 76), without addressing recurrence (n = 3), survivorship (n = 1) or palliative care needs (n = 13). Few online resources directly provided self-management advice for adults living with brain cancer or their carers. Just over a fifth (n = 26, 22%) were underpinned by verifiable evidence. Only one quarter of organisations producing resources were HonCode certified (n = 9, 24%). The median resource reliability as measured by Section 1, DISCERN tool, was 56%. A median of 8.8 years of education was required to understand these online resources. Conclusions More targeted online information is needed to provide people affected by brain cancer with practical self-management advice. Resources need to better address patient and carer needs related to: rehabilitation, managing behavioural changes, survivorship and living with uncertainty; recurrence; and transition to palliative care. Developing online resources that don’t require a high level of literacy and/or cognition are also required. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00715-4.
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Affiliation(s)
- Isabelle Schaefer
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Nicole Heneka
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Tim Luckett
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Meera R Agar
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Suzanne K Chambers
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - David C Currow
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Georgia Halkett
- School of Nursing, Midwifery and Paramedicine, Psychology Building, Curtin University, Perth, Western Australia, Australia
| | - Domenica Disalvo
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Ingrid Amgarth-Duff
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Cleola Anderiesz
- Australian Brain Cancer Mission, Cancer Australia, Sydney, New South Wales, Australia
| | - Jane L Phillips
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia.
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Chen J, Amaize A, Barath D. Evaluating Telehealth Adoption and Related Barriers Among Hospitals Located in Rural and Urban Areas. J Rural Health 2020; 37:801-811. [PMID: 33180363 PMCID: PMC8202816 DOI: 10.1111/jrh.12534] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Purpose To assess telehealth adoption among hospitals located in rural and urban areas, and identify barriers related to enhanced telehealth capabilities in the areas of patient engagement and health information exchange (HIE) capacity with external providers and community partners. Methods We used the 2018 American Hospital Association (AHA) Annual Survey and IT Supplement Survey. We applied state fixed effects multivariate analyses and Oaxaca decomposition to estimate the variation of outcomes of interest by hospital geographies. Findings Our research showed substantial differences in telehealth adoption among hospitals located in rural, micropolitan, and metropolitan areas, where adoption rates increase with urbanicity. Rural hospitals were least likely to have telehealth systems with patient engagement capabilities such as the ability to view their health information online and electronically transmit medical information to a third party. They were also the least likely to report that clinical information was available electronically from outside providers. Our model explained 65% of the rural/urban difference in telehealth adoption, 55% of the number of telehealth services adopted, and 43%‐49% of the rural/urban difference in telehealth barriers. Conclusion Findings demonstrated significant barriers to telehealth use among hospitals located in rural and urban areas. For rural hospitals, barriers include lack of HIE capacity among health care providers in the community, and lack of patient engagement capability.
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Affiliation(s)
- Jie Chen
- Department of Health Policy and Management, School of Public Health, University of Maryland, College Park, Maryland
| | - Aitalohi Amaize
- Department of Health Policy and Management, School of Public Health, University of Maryland, College Park, Maryland
| | - Deanna Barath
- Department of Health Policy and Management, School of Public Health, University of Maryland, College Park, Maryland
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Johnson R, Scott J, Randolph SD. COVID-19 and Black America: The intersection of health equity and the NP workforce. Nurse Pract 2020; 45:11-14. [PMID: 32956193 DOI: 10.1097/01.npr.0000696932.97210.37] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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Comparison of Disease-related Knowledge of Patients With Inflammatory Bowel Disease Between the West and the East Using an Updated Questionnaire (IBD-KNOW). J Clin Gastroenterol 2020; 54:720-724. [PMID: 31764490 DOI: 10.1097/mcg.0000000000001283] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
GOALS The study aimed to compare the level and characteristics of disease-related knowledge of patients with inflammatory bowel disease (IBD) between the West and the East using an international version of a questionnaire regarding knowledge of inflammatory bowel disease (IBD-KNOW). BACKGROUND The authors recently developed a new questionnaire regarding IBD-KNOW, which showed excellent test characteristics in Korea. STUDY The IBD-KNOW questionnaire was administered to 100 patients with IBD from tertiary referral hospitals in the United States and Korea. Scores were calculated and compared between US and Korean patients, and factors associated with high scores were analyzed. RESULTS A total of 196 (100 US and 96 Korean) patients with IBD completed the questionnaires. Analysis of the baseline characteristics revealed that male sex, smoking status, disease duration, history of IBD-related operations, family history of IBD, and use of corticosteroids or biologics were significantly different between US and Korean patients. The mean IBD-KNOW score was higher in US patients than in Korean patients (14.8 vs. 11.3; P<0.001). Multivariate analyses showed that a high IBD-KNOW score (top 25%) was associated with a positive family history of IBD (odds ratio, 2.90; P=0.025) in US patients with IBD and with the use of biologics (odds ratio, 3.65; P=0.008) in Korean patients with IBD. CONCLUSIONS The IBD-KNOW questionnaire, an updated assessment tool of IBD-related knowledge, is simple, reliable, and available in various patient populations. IBD-KNOW can be used to identify the factors affecting the level of IBD-related knowledge to improve the quality of care in patients with IBD through a personalized approach.
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Ebrahimi Z, Patel H, Wijk H, Ekman I, Olaya-Contreras P. A systematic review on implementation of person-centered care interventions for older people in out-of-hospital settings. Geriatr Nurs 2020; 42:213-224. [PMID: 32863037 DOI: 10.1016/j.gerinurse.2020.08.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 12/13/2022]
Abstract
THE PURPOSE of this study was to explore the content and essential components of implemented person-centered care in the out-of-hospital context for older people (65+). METHOD A systematic review was conducted, searching for published research in electronic databases: PubMed, CINAHL, Scopus, PsycInfo, Web of Science and Embase between 2017 and 2019. Original studies with both qualitative and quantitative methods were included and assessed according to the quality assessment tools EPHPP and CASP. The review was limited to studies published in English, Swedish, Danish, Norwegian and Spanish. RESULTS In total, 63 original articles were included from 1772 hits. The results of the final synthesis revealed the following four interrelated themes, which are crucial for implementing person-centered care: (1) Knowing and confirming the patient as a whole person; (2) Co-creating a tailored personal health plan; (3) Inter-professional teamwork and collaboration with and for the older person and his/her relatives; and (4) Building a person-centered foundation. CONCLUSION Approaching an interpersonal and inter-professional teamwork and consultation with focus on preventive and health promoting actions is a crucial prerequisite to co-create optimal health care practice with and for older people and their relatives in their unique context.
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Affiliation(s)
- Zahra Ebrahimi
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Centre for Person-Centred Care University of Gothenburg (GPCC), Gothenburg, Sweden.
| | - Harshida Patel
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Helle Wijk
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Chalmers University of Technology, Department of Architecture Sahlgrenska University Hospital Department of Quality Assurance and Patient Safety, Sweden
| | - Inger Ekman
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Centre for Person-Centred Care University of Gothenburg (GPCC), Gothenburg, Sweden
| | - Patricia Olaya-Contreras
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Godinho MA, Jonnagaddala J, Gudi N, Islam R, Narasimhan P, Liaw ST. mHealth for Integrated People-Centred Health Services in the Western Pacific: A Systematic Review. Int J Med Inform 2020; 142:104259. [PMID: 32858339 DOI: 10.1016/j.ijmedinf.2020.104259] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 07/16/2020] [Accepted: 08/18/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE This review aimed to examine how mobile health (mHealth) to support integrated people-centred health services has been implemented and evaluated in the World Health Organization (WHO) Western Pacific Region (WPR). METHODS Eight scientific databases were searched. Two independent reviewers screened the literature in title and abstract stages, followed by full-text appraisal, data extraction, and synthesis of eligible studies. Studies were extracted to capture details of the mhealth tools used, the service issues addressed, the study design, and the outcomes evaluated. We then mapped the included studies using the 20 sub-strategies of the WHO Framework on Integrated People-Centred Health Services (IPCHS); as well as with the RE-AIM (Reach, effectiveness, adoption, implementation and maintenance) framework, to understand how studies implemented and evaluated interventions. RESULTS We identified 39 studies, predominantly from Australia (n = 16), China (n = 7), Malaysia (n = 4) and New Zealand (n = 4), and little from low income countries. The mHealth modalities included text messaging, voice and video communication, mobile applications and devices (point-of-care, GPS, and Bluetooth). Health issues addressed included: medication adherence, smoking cessation, cardiovascular disease, heart failure, asthma, diabetes, and lifestyle activities respectively. Almost all were community-based and focused on service issues; only half were disease-specific. mHealth facilitated integrated IPCHS by: enabling citizens and communities to bypass gatekeepers and directly access services; increasing affordability and accessibility of services; strengthening governance over the access, use, safety and quality of clinical care; enabling scheduling and navigation of services; transitioning patients and caregivers between care sectors; and enabling the evaluation of safety and quality outcomes for systemic improvement. Evaluations of mHealth interventions did not always report the underlying theories. They predominantly reported cognitive/behavioural changes rather than patient outcomes. The utility of mHealth to support and improve IPCHS was evident. However, IPCHS strategy 2 (participatory governance and accountability) was addressed least frequently. Implementation was evaluated in regard to reach (n = 30), effectiveness (n = 24); adoption (n = 5), implementation (n = 9), and maintenance (n = 1). CONCLUSIONS mHealth can transition disease-centred services towards people-centred services. Critical appraisal of studies highlighted methodological issues, raising doubts about validity. The limited evidence for large-scale implementation and international variation in reporting of mHealth practice, modalities used, and health domains addressed requires capacity building. Information-enhanced implementation and evaluation of IPCHS, particularly for participatory governance and accountability, is also important.
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Affiliation(s)
- Myron Anthony Godinho
- WHO Collaborating Centre for eHealth, School of Public Health and Community Medicine, UNSW Sydney, Australia
| | - Jitendra Jonnagaddala
- WHO Collaborating Centre for eHealth, School of Public Health and Community Medicine, UNSW Sydney, Australia
| | - Nachiket Gudi
- Public Health Program, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Rubana Islam
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Padmanesan Narasimhan
- WHO Collaborating Centre for eHealth, School of Public Health and Community Medicine, UNSW Sydney, Australia
| | - Siaw-Teng Liaw
- WHO Collaborating Centre for eHealth, School of Public Health and Community Medicine, UNSW Sydney, Australia.
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Abstract
Heart failure is a chronic disease with a multitude of different clinical manifestations. Empowering people living with heart failure requires education, support structure, understanding the needs of patients, and reimaging the care delivery systems currently offered to patients. In this article, the authors discuss practical approaches to activate and empower people with heart failure and enable patient-provider dialogue and shared decision making.
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Affiliation(s)
- Peter Wohlfahrt
- Division of Cardiovascular Medicine, Department of Medicine, University of Utah, Salt Lake City, Utah, USA; Center for Cardiovascular Prevention, Charles University in Prague, First Faculty of Medicine and Thomayer Hospital, Prague, Czech Republic; Department of Preventive Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Josef Stehlik
- Division of Cardiovascular Medicine, Department of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Irene Z Pan
- Department of Pharmacy, University of Utah Health, Salt Lake City, Utah, USA; College of Pharmacy, University of Utah, Salt Lake City, Utah, USA
| | - John J Ryan
- Division of Cardiovascular Medicine, Department of Medicine, University of Utah, Salt Lake City, Utah, USA.
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Mead KH, Raskin S, Willis A, Arem H, Murtaza S, Charney L, Pratt-Chapman M. Identifying patients' priorities for quality survivorship: conceptualizing a patient-centered approach to survivorship care. J Cancer Surviv 2020; 14:939-958. [PMID: 32607715 DOI: 10.1007/s11764-020-00905-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 06/14/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE This study explored cancer survivors' experiences with and priorities for cancer survivorship care to describe a patient-centered approach to quality survivorship care. METHODS We conducted 22 focus groups with 170 adult survivors of breast, prostate, and colorectal cancer from six cities across the country and online. We used thematic analysis to identify participants' principles and priorities for quality survivorship care. RESULTS Based on our analysis of a limited group of cancer survivors, we identified two core principles that underlie participants' expectations for survivorship care and 11 practice priorities that reflect opportunities to improve patient-centeredness at the individual, interpersonal, and organizational levels. The principles reflect participants' desire to be better prepared for and equipped to accept and manage their chronic care needs post-cancer treatment. The priorities reflect practices that patients, providers, and cancer centers can engage in to ensure survivors' goals for post-treatment care are met. CONCLUSIONS Results from the study suggest the need to expand conceptualization of high-quality survivorship care. The survivor principles and practice priorities identified in this study challenge the field to organize a more patient-centered survivorship care system that empowers and respects patients and provides a holistic approach to survivors' chronic and long-term needs. IMPLICATIONS FOR CANCER SURVIVORS Quality cancer survivorship care must reflect patients' priorities. The findings from this study can be used to develop a patient-centered framework for survivorship care that can be used in conjunction with quality guidelines to ensure survivorship care is organized to achieve both clinical and patient-centered outcomes.
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Affiliation(s)
- K Holly Mead
- Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave., Washington, DC, 20052, USA.
| | - Sarah Raskin
- L. Douglas Wilder School of Government and Public Affairs, Virginia Commonwealth University, 1001 W. Franklin St., Richmond, VA, 23284, USA
| | - Anne Willis
- Cystic Fibrosis Foundation, 4550 Montgomery Ave., Bethesda, MD, 20814, USA
| | - Hannah Arem
- Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave., Washington, DC, 20052, USA
| | - Sarah Murtaza
- Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave., Washington, DC, 20052, USA
| | - Laura Charney
- Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave., Washington, DC, 20052, USA
| | - Mandi Pratt-Chapman
- George Washington University Cancer Center, George Washington University, 2600 Virginia Ave., NW, #300, Washington, DC, 20037, USA
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Novak P, Bloodworth R, Green K, Chen J. Local Health Department Activities to Reduce Emergency Department Visits for Substance Use Disorders. J Healthc Qual 2020; 41:134-145. [PMID: 31094946 PMCID: PMC6527127 DOI: 10.1097/jhq.0000000000000161] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The Affordable Care Act (ACA) provides financial incentives to prevent substance use disorders (SUDs). Local health departments (LHDs) can receive funds to establish care teams that partner with primary care providers and health systems. This study estimates the potential effect of LHDs on emergency visits for SUDs, using linked data sets from the Healthcare Cost and Utilization Project Emergency Department (ED) sample for the State of Maryland-2012, the National Association of County and City Health Officials Profiles Survey 2013, and Area Health Resource File 2013 to estimate potential effect of LHDs' provision of SUD preventive care and SUD-related policy implementation. Local health department involvement in SUD-related policy during the past 2 years and provision of preventive care for behavioral health in the past year significantly reduced the probability of having a SUD-related ED visit by 11% and 6%, respectively, after controlling for individual characteristics (odds ratio [OR] = 0.89, p < .001; OR = 0.93, p < .001). After adjusting for the individual and contextual factors, LHD involvement in policy was still associated with 14% reduction in SUD-related ED visits (OR = 0.86, p < .001). Results offer insights on the extent to which the LHD activities can possibly affect SUD-related ED visits and provide a foundation for future work to identify effective LHD interventions.
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Affiliation(s)
- Priscilla Novak
- Department of Health Services Administration , School of Public Health, University of Maryland, College Park, MD, Also Agency for Healthcare Research and Quality (employee), , Cell: (571) 201-5165
| | - Robin Bloodworth
- Department of Health Services Administration , School of Public Health, University of Maryland College Park, MD Also Patient Centered Outcomes Research Institute (employee)
| | - Kerry Green
- Department of Behavioral and Community Health , School of Public Health, University of Maryland, College Park, MD
| | - Jie Chen
- Department of Health Services Administration , School of Public Health, University of Maryland, College Park, MD
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Kamoen O, Maqueda V, Yperzeele L, Pottel H, Cras P, Vanhooren G, Vanacker P. Stroke coach: a pilot study of a personal digital coaching program for patients after ischemic stroke. Acta Neurol Belg 2020; 120:91-97. [PMID: 31701472 DOI: 10.1007/s13760-019-01218-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 10/09/2019] [Indexed: 12/22/2022]
Abstract
Despite recent advances in acute stroke care, the risk of recurrent stroke remains high. On behalf of the Belgian Stroke Council (BSC), a nurse-led self-management program was developed, using a personal coach and digital platform with the aim of improving cardiovascular risk factor control in patients after ischemic stroke. The program was implemented in four Belgian hospitals. The stroke coach provided one educational session during hospitalization. After discharge, the patient received tips and tricks concerning a healthy lifestyle through the customized platform. The stroke coach set up video appointments through the platform at regular intervals. Primary endpoint of our study was the change in SCORE (Systematic COronary Risk Evaluation: High and Low cardiovascular Risk Charts) risk at baseline and 6 months compared with a historical control group who received standard care. A total of 147 patients were included for a follow-up period of 6 months. The mean SCORE in the intervention group showed a statistically significant reduction of 3.2 (p < 0.001) at 6 months. However, comparison between control and intervention groups was non-significant (p = 0.55). Secondary endpoints are promising with a medication adherence of 96%. Reported quality of life also improved (p < 0.001). No significant improvement in the modified Rankin scale (mRS) was observed (p = 0.720). Five percent of patients suffered a recurrent stroke. Our project consisting of a coached lifestyle intervention and digital platform shows promise in improving stroke recurrence rates, therapeutic adherence and quality of life in a Belgian healthcare setting.
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Affiliation(s)
- Olivia Kamoen
- Department of Neurology, Antwerp University Hospital, Edegem, Antwerp, Belgium.
| | - V Maqueda
- Department of Neurology, Sint-Lucas Hospital, Brugge, Belgium
| | - L Yperzeele
- Department of Neurology, Antwerp University Hospital, Edegem, Antwerp, Belgium
- Department of Neurology, Neurovascular Reference Center, Antwerp University Hospital, Edegem, Antwerp, Belgium
- Born Bunge Institute, Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - H Pottel
- Public Health and Primary Care, KU Leuven Kulak, Kortrijk, Belgium
| | - P Cras
- Department of Neurology, Antwerp University Hospital, Edegem, Antwerp, Belgium
- Department of Neurology, Neurovascular Reference Center, Antwerp University Hospital, Edegem, Antwerp, Belgium
- Born Bunge Institute, Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - G Vanhooren
- Department of Neurology, Sint-Jan Hospital, Brugge, Belgium
| | - P Vanacker
- Department of Neurology, Antwerp University Hospital, Edegem, Antwerp, Belgium
- Department of Neurology, Neurovascular Reference Center, Antwerp University Hospital, Edegem, Antwerp, Belgium
- Department of Neurology, Groeninge Hospital, Kortrijk, Belgium
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Trankle SA, Usherwood T, Abbott P, Roberts M, Crampton M, Girgis CM, Riskallah J, Chang Y, Saini J, Reath J. Integrating health care in Australia: a qualitative evaluation. BMC Health Serv Res 2019; 19:954. [PMID: 31829215 PMCID: PMC6907151 DOI: 10.1186/s12913-019-4780-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 11/26/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With aging populations, a growing prevalence of chronic illnesses, higher expectations for quality care and rising costs within limited health budgets, integration of healthcare is seen as a solution to these challenges. Integrated healthcare aims to overcome barriers between primary and secondary care and other disconnected patient services to improve access, continuity and quality of care. Many people in Australia are admitted to hospital for chronic illnesses that could be prevented or managed in the community. Western Sydney has high rates of diabetes, heart and respiratory diseases and the NSW State Ministry of Health has implemented key strategies through the Western Sydney Integrated Care Program (WSICP) to enhance primary care and the outcomes and experiences of patients with these illnesses. METHODS We aimed to investigate the WSICP's effectiveness through a qualitative evaluation focused on the 10 WSICP strategies using a framework analysis. We administered 125 in-depth interviews in two rounds over 12 months with 83 participants including patients and their carers, care facilitators, hospital specialists and nurses, allied health professionals, general practitioners (GPs) and primary care nurses, and program managers. Most participants (71%) were interviewed twice. We analysed data within a framework describing how strategies were implemented and used, the experiences around these, their perceived value, facilitators and barriers, and participant-identified suggestions for improvement. RESULTS Care facilitators helped patients access services within the hospital and in primary care and connected general practices with hospital specialists and services. Rapid access and stabilisation clinics with their patient hotlines assisted patients and carers to self-manage chronic illness while connecting GPs to specialists through the GP support-line. Action plans from the hospital informed GPs and their shared care plans which could be accessed by other community health professionals and patients. HealthPathways provided GPs with local, evidence-based guidelines for managing patients. Difficulties persisted in effective widespread access to shared records and electronic communication across sectors. CONCLUSIONS The combined WSICP strategies improved patient and carer experience of healthcare and capacity of GPs to provide care in the community. Information sharing required longer-term investment and support, though benefits were evident by the end of our research.
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Affiliation(s)
- Steven A. Trankle
- School of Medicine, Department General Practice, Western Sydney University, Building 30.3.18 Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2751 Australia
| | - Tim Usherwood
- School of Medicine, Sydney University, Sydney, Australia
- George Institute for Global Health, Sydney, Australia
| | - Penny Abbott
- School of Medicine, Department General Practice, Western Sydney University, Building 30.3.18 Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2751 Australia
| | - Mary Roberts
- Western Sydney Local Health District (Westmead Hospital), North Parramatta, Australia
| | | | - Christian M. Girgis
- School of Medicine, Sydney University, Sydney, Australia
- Western Sydney Local Health District (Westmead Hospital), North Parramatta, Australia
- Royal North Shore Hospital, Leonards, Australia
| | - John Riskallah
- Western Sydney Local Health District (Blacktown Hospital), Parramatta, Australia
| | - Yashu Chang
- School of Medicine, Department General Practice, Western Sydney University, Building 30.3.18 Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2751 Australia
- Western Sydney Local Health District (Blacktown Hospital), Parramatta, Australia
| | - Jaspreet Saini
- Western Sydney Primary Health Network, Blacktown, Australia
| | - Jennifer Reath
- School of Medicine, Department General Practice, Western Sydney University, Building 30.3.18 Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2751 Australia
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65
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What Does the Average Person Know About Endocrine and Vascular Surgeons? J Surg Res 2019; 244:348-351. [DOI: 10.1016/j.jss.2019.06.056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 05/13/2019] [Accepted: 06/14/2019] [Indexed: 12/21/2022]
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Parish CL, Feaster DJ, Pereyra MR, Alcaide M, Cohen M, Levin S, Gustafson D, Merenstein D, Aouizerat B, Donohue J, Webster-Cyriaque J, Wingood G, Kempf M, Metsch LR. Dental insurance, dental care utilization, and perceived unmet dental needs in women living with HIV: Results from the Women's Interagency HIV Study. J Public Health Dent 2019; 79:343-351. [PMID: 31418877 PMCID: PMC10876047 DOI: 10.1111/jphd.12336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 04/16/2019] [Accepted: 07/22/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Dental care is the most commonly cited unmet health-care service due to cost. Previous research has highlighted the unmet dental needs of people living with HIV (PLWH). Understanding associations among dental insurance availability, dental care utilization, and the presence of unmet dental needs among PLWH is a public health priority. METHODS Oral health surveys were collected cross-sectionally (April-October 2016) among 1,442 women living with HIV (WLWH) in the Women's Interagency HIV Study. Logistic regression models were used to analyze the association between having versus not having dental insurance by type (Ryan White, private, Medicaid/Medicare) and two primary outcomes: a) typical frequency of dental visits (at least annually, less than annually) and b) reporting an unmet dental need in the past 6 months. RESULTS All dental insurance types were associated with higher odds of receiving annual dental care and, for those with either Medicare/Medicaid or private insurance, lower odds of having an unmet dental need. When WLWH were asked to describe their oral health, poor self-reported condition was associated with both an unmet dental need (odds ratio [OR]: 4.52, 95 percent Confidence Interval [CI] [3.29-6.20]) and lower odds of annual dental care utilization (OR: 0.44, 95 percent CI [0.34-0.57]). Self-reported depressive symptom burden was also linked to having an unmet dental need (OR: 2.10, 95 percent CI [1.46-3.01]). CONCLUSIONS Dental insurance coverage increases dental care utilization and is associated with better oral health among WLWH. In the era of health-care reform, dental insurance coverage may be instrumental for enhancing treatment outcomes.
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Affiliation(s)
- Carrigan Leigh Parish
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Daniel J. Feaster
- Public Health Sciences, University of Miami School of Medicine, Miami, FL, USA
| | | | - Maria Alcaide
- Medicine, University of Miami School of Medicine, Miami, FL, USA
- CORE Center, Cook County Health and Hospitals System, Chicago, IL, USA
| | - Mardge Cohen
- Stroger Hospital Cook County Bureau of Health Services Department of Medicine, Chicago, IL, USA
| | - Susanna Levin
- Montefiore Hospital and Medical Center, Bronx, NY, USA
| | - Deborah Gustafson
- Neurology, State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - Daniel Merenstein
- Family Medicine, Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Bradley Aouizerat
- Oral and Maxillofacial Surgery, New York University College of Dentistry, New York, NY, USA
| | - Jessica Donohue
- WIHS Data Management and Analysis Center, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jennifer Webster-Cyriaque
- Dental Ecology, University of North Carolina at Chapel Hill School of Dentistry, Chapel Hill, North Carolina, USA
| | - Gina Wingood
- Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Mirjam Kempf
- Health Behavior, School of Nursing, Birmingham, Alabama, USA
| | - Lisa R. Metsch
- School of General Studies, Columbia University, New York, NY, USA
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Drumond N. Future Perspectives for Patient-Centric Pharmaceutical Drug Product Design with Regard to Solid Oral Dosage Forms. J Pharm Innov 2019. [DOI: 10.1007/s12247-019-09407-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Abstract
Purpose
Additional costs for healthcare provision are expected for cases where the level of care provided is not according to the patient’s needs and demands. To address these issues and reduce costs, fundamental changes need to be made on how healthcare provision is administered to patients, which raises the opportunity for the implementation of patient-centric systems.
Methods
This review addresses the importance of implementing a patient-centric approach in current healthcare provision and emphasizes the need to adjust current development and business models for a successful application of patient-centric care.
Results
To increase awareness and avoid confusion, the purpose of patient-centric pharmaceutical drug product design is reviewed in detail and future market opportunities for patient-centric drug products are discussed.
Conclusions
With regard to solid oral dosage forms, the subject of patient-centric pharmaceutical drug product design will focus more on the customization of existing technologies (e.g., dosage form size reduction) to address the needs of specific patient populations such as pediatrics, geriatrics, dysphagia patients, or the cognitively impaired.
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Chiang M, Chang J, Nakash O, Cruz-Gonzalez M, Fillbrunn MK, Alegría M. Change in Patient Activation and Mental Illness Symptoms After Communication Training: A Multisite Study With a Diverse Patient Sample. Psychiatr Serv 2019; 70:696-702. [PMID: 31084292 PMCID: PMC6675648 DOI: 10.1176/appi.ps.201800216] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Patient activation involves patients' ability and motivation to communicate about their health and health care. Research has demonstrated that clinician or patient interventions may improve patient activation. This study explored the degree to which clinician and patient interventions affected both patient activation and symptoms of depression and anxiety in a racially and ethnically diverse clinical sample. METHODS Data were from a randomized clinical trial that included 312 patients and 74 clinicians from 13 Massachusetts community- and hospital-based outpatient behavioral health clinics. Patients completed measures of patient activation and depression and anxiety symptoms. Secondary data analyses were conducted to examine the effect of patient and clinician interventions (DECIDE-PA and DECIDE-PC, respectively) on depression and anxiety symptoms and patient activation. A multilevel, mixed-effects simultaneous-equation model was estimated to assess the relationship between the interventions, changes in patients' symptoms, and patient activation. RESULTS Clinicians' greater intervention dosage (i.e., more completed DECIDE-PC training sessions) was associated with patients' decreased anxiety symptoms, but associations with patient activation or depression symptoms were not significant. The effect of clinician training dosage on anxiety symptoms was stronger when patients and clinicians were not of the same race-ethnicity. The reduction in patients' anxiety symptoms appeared to increase patient activation. CONCLUSIONS Clinician interventions designed to boost patient-clinician communication and the therapeutic alliance may serve to lessen patients' anxiety and may ultimately improve patient activation.
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Affiliation(s)
- Mengchun Chiang
- Counseling and Psychological Services, Carnegie Mellon University, Pittsburgh (Chiang); Department of Psychology, West Chester University, West Chester, Pennsylvania (Chang); School for Social Work, Smith College, Northampton, Massachusetts (Nakash); Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston (Cruz-Gonzalez, Fillbrunn, Alegría); Department of Medicine and Psychiatry, Harvard Medical School, Boston (Alegría)
| | - Janet Chang
- Counseling and Psychological Services, Carnegie Mellon University, Pittsburgh (Chiang); Department of Psychology, West Chester University, West Chester, Pennsylvania (Chang); School for Social Work, Smith College, Northampton, Massachusetts (Nakash); Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston (Cruz-Gonzalez, Fillbrunn, Alegría); Department of Medicine and Psychiatry, Harvard Medical School, Boston (Alegría)
| | - Ora Nakash
- Counseling and Psychological Services, Carnegie Mellon University, Pittsburgh (Chiang); Department of Psychology, West Chester University, West Chester, Pennsylvania (Chang); School for Social Work, Smith College, Northampton, Massachusetts (Nakash); Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston (Cruz-Gonzalez, Fillbrunn, Alegría); Department of Medicine and Psychiatry, Harvard Medical School, Boston (Alegría)
| | - Mario Cruz-Gonzalez
- Counseling and Psychological Services, Carnegie Mellon University, Pittsburgh (Chiang); Department of Psychology, West Chester University, West Chester, Pennsylvania (Chang); School for Social Work, Smith College, Northampton, Massachusetts (Nakash); Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston (Cruz-Gonzalez, Fillbrunn, Alegría); Department of Medicine and Psychiatry, Harvard Medical School, Boston (Alegría)
| | - Mirko K Fillbrunn
- Counseling and Psychological Services, Carnegie Mellon University, Pittsburgh (Chiang); Department of Psychology, West Chester University, West Chester, Pennsylvania (Chang); School for Social Work, Smith College, Northampton, Massachusetts (Nakash); Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston (Cruz-Gonzalez, Fillbrunn, Alegría); Department of Medicine and Psychiatry, Harvard Medical School, Boston (Alegría)
| | - Margarita Alegría
- Counseling and Psychological Services, Carnegie Mellon University, Pittsburgh (Chiang); Department of Psychology, West Chester University, West Chester, Pennsylvania (Chang); School for Social Work, Smith College, Northampton, Massachusetts (Nakash); Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston (Cruz-Gonzalez, Fillbrunn, Alegría); Department of Medicine and Psychiatry, Harvard Medical School, Boston (Alegría)
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Jull J, Köpke S, Boland L, Coulter A, Dunn S, Graham ID, Hutton B, Kasper J, Kienlin SM, Légaré F, Lewis KB, Lyddiatt A, Osaka W, Rader T, Rahn AC, Rutherford C, Smith M, Stacey D. Decision coaching for people making healthcare decisions. Hippokratia 2019. [DOI: 10.1002/14651858.cd013385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Janet Jull
- Queen's University; School of Rehabilitation Therapy, Faculty of Health Sciences; Kingston ON Canada
| | - Sascha Köpke
- University of Lübeck; Nursing Research Group, Institute of Social Medicine and Epidemiology; Ratzeburger Allee 160 Lübeck Germany D-23538
| | - Laura Boland
- The Ottawa Hospital Research Institute; Integrated Knowledge Translation Research Network; Ottawa Canada
| | | | - Sandra Dunn
- CHEO Research Institute, Centre for Practice-Changing Research Building; BORN Ontario; Ottawa Canada
| | - Ian D Graham
- University of Ottawa; School of Epidemiology, Public Health and Preventative Medicine; 600 Peter Morand Crescent Ottawa ON Canada
| | - Brian Hutton
- Ottawa Hospital Research Institute; Knowledge Synthesis Group; 501 Smyth Road Ottawa ON Canada K1H 8L6
| | - Jürgen Kasper
- Oslo Metropolitan University; Department of Nursing and Health Promotion, Faculty of Health Sciences; Oslo Norway
| | - Simone Maria Kienlin
- University of Tromsø; Faculty of Health Sciences, Department of Health and Caring Sciences; Tromsø Norway
- The South-Eastern Norway Regional Health Authority, Department of Medicine and Healthcare; Hamar Norway
| | - France Légaré
- Université Laval; Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL); 2525, Chemin de la Canardière Quebec Québec Canada G1J 0A4
| | | | - Anne Lyddiatt
- No affiliation; 28 Greenwood Road Ingersoll ON Canada N5C 3N1
| | - Wakako Osaka
- Keio University; Faculty of Nursing and Medical Care; Tokyo Japan
| | - Tamara Rader
- Canadian Agency for Drugs and Technologies in Health (CADTH); 600-865 Carling Avenue Ottawa ON Canada
| | - Anne C Rahn
- University Medical Center Hamburg-Eppendorf; Institute of Neuroimmunology and Multiple Sclerosis; Martinistr 52 Hamburg Germany 20246
| | - Claudia Rutherford
- University of Sydney; School of Psychology, Quality of Life Office; Camperdown Australia
- The University of Sydney; Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health; Camperdown Australia
| | - Maureen Smith
- Canadian Organization for Rare Disorders; 402-20 Driveway Ottawa ON Canada K2P1C8
| | - Dawn Stacey
- University of Ottawa; School of Nursing; Ottawa ON Canada
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Thorsen R, Bortot F, Caracciolo A. From patient to maker - a case study of co-designing an assistive device using 3D printing. Assist Technol 2019; 33:306-312. [DOI: 10.1080/10400435.2019.1634660] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- Rune Thorsen
- Fondazione Don Carlo Gnocchi IRCCS ONLUS, Milan, Italy
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Anderson AC, Akre E, Chen J. Exploring national trends of patient- and family-centered care among US children. J Child Health Care 2019; 23:200-212. [PMID: 30016885 DOI: 10.1177/1367493518786015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We explored national trends in the receipt of high-quality patient-physician communication and patient empowerment through behavioral health counseling among children in the United States. We used data from the Medical Expenditure Panel Survey from 2010 to 2014. We employed two measures of patient- and family-centered care (PFCC): (1) a composite measure of high-quality patient-physician communication ( n = 34,629) and (2) patient empowerment through behavioral health counseling about healthy eating ( n = 36,527) and exercise ( n = 38,318). We used multivariate logistic regression models to estimate the variation of receiving PFCC by social determinants of health over time. Rates of receiving behavioral health counseling about healthy eating (53-60%) and exercise (37-42%) were lower than the rate of receiving high-quality physician-patient communication (92-93%). Parents were significantly more likely to report receiving high-quality physician-patient communication in 2014 than in 2010 (odds ratio 1.37, confidence interval 1.08-1.67); however, no association was found for empowerment through behavioral health counseling. Low income and parental educational attainment, and lack of insurance were associated with lower odds of receiving behavioral health counseling. Results showed significant variation of physician-patient communication and empowerment by social and demographic factors. The results suggest more providers need to empower parents and their children to self-care through behavioral health counseling.
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Affiliation(s)
- Andrew C Anderson
- Department of Health Services Administration, School of Public Health, University of Maryland, College Park, MD, USA
| | - Ellesse Akre
- Department of Health Services Administration, School of Public Health, University of Maryland, College Park, MD, USA
| | - Jie Chen
- Department of Health Services Administration, School of Public Health, University of Maryland, College Park, MD, USA
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Alzubaidi H, Hussein A, Mc Namara K, Scholl I. Psychometric properties of the Arabic version of the 9-item Shared Decision-Making Questionnaire: the entire process from translation to validation. BMJ Open 2019; 9:e026672. [PMID: 30948608 PMCID: PMC6500381 DOI: 10.1136/bmjopen-2018-026672] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 02/04/2019] [Accepted: 02/05/2019] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To translate the German 9-item Shared Decision-Making Questionnaire (SDM-Q-9) to Arabic and assess its psychometric properties for measuring Arabic-speaking patients' perceptions of the shared decision-making (SDM) process. DESIGN Multicentre cross-sectional study. SETTING Secondary healthcare settings; outpatient clinics of 10 major hospitals were selected in four emirates in the United Arab Emirates (Abu Dhabi, Dubai, Sharjah and Umm Al Quwain). PARTICIPANTS Patients with chronic diseases who attended outpatient clinics of participating hospitals. MEASUREMENTS The original German SDM-Q-9 was translated to Arabic. International multiphase translation guidelines and the process of cross-cultural adaptation of self-reported measures were used. Various psychometric properties were assessed, including reliability (internal consistency), and construct validity (exploratory factor analysis [EFA] and confirmatory factor analysis [CFA]). RESULTS The final Arabic version of the SDM-Q-9 was tested among 516 secondary care patients. Internal consistency yielded a Cronbach's alpha of 0.929 for the whole scale. EFA showed a one-factorial solution, Kaiser-Meyer-Olkin measure of sampling adequacy was 0.907 and Bartlett's test of sphericity was significant (χ2=3413.69, df=36, p<0.0005). For the CFA, two different models were tested; Model 1 included the nine items and Model 2 was monofactorial that included items 2-9 and thus excluded item 1. Both models were adequate as they produced similar indices. CONCLUSIONS The Arabic version of SDM-Q-9 showed excellent reliability and acceptable validity parameters among secondary care patients. The newly translated Arabic questionnaire is the first psychometrically tested tool that can be used in the 22 member states of the Arab league to assess patients' perspectives on the SDM process.
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Affiliation(s)
- Hamzah Alzubaidi
- College of Pharmacy, Sharjah Institute for Medical Research, University of Sharjah, Sharjah, United Arab Emirates
| | - Amal Hussein
- Family and Community Medicine & Behavioral Sciences, University of Sharjah, College of Medicine, Sharjah, United Arab Emirates
| | | | - Isabelle Scholl
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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McCusker J, Lambert SD, Haggerty J, Yaffe MJ, Belzile E, Ciampi A. Self-management support in primary care is associated with improvement in patient activation. PATIENT EDUCATION AND COUNSELING 2019; 102:571-577. [PMID: 30497799 DOI: 10.1016/j.pec.2018.10.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 10/11/2018] [Accepted: 10/13/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To examine: 1) whether patient characteristics predict perceived self-management support (usefulness of information and collaborative care planning) by primary care providers after six months, and 2) the association between perceived self-management support and patient activation at 6 months METHODS: We conducted a secondary analysis among 120 primary care patients aged 40 and over with a chronic physical condition and comorbid depressive symptoms who participated in a randomized controlled trial of a coaching intervention for depression self-management. Activation was measured at baseline (T0) and 6 months (T1). Self-management support was captured at T1 for physical and mood problems. RESULTS The sample of analysis was 120 patients who completed all relevant measures. At T1, the perceived usefulness of information for mood self-management was independently associated with activation. More severe depressive symptoms at T0 predicted lower perceived usefulness of chronic condition self-management information at T1. Lower T0 mental health-related quality of life predicted lower perceived usefulness of mood self-management information at T1. CONCLUSIONS Perceived informational support for mood self-management may contribute to increased activation. Patients with more severe mental health symptoms or impairment perceive that they receive less useful self-management information from their care team. PRACTICE IMPLICATIONS Care teams should determine whether patients with mood problems need greater self-management support.
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Affiliation(s)
- Jane McCusker
- St. Mary's Research Centre, Hayes Pavilion, 3830 Avenue Lacombe, Suite 4720, H3T 1M5, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Purvis Hall, 1020 Pin. Avenue, H3A 1A2, Montreal, Quebec, Canada.
| | - Sylvie D Lambert
- St. Mary's Research Centre, Hayes Pavilion, 3830 Avenue Lacombe, Suite 4720, H3T 1M5, Montreal, Quebec, Canada; Ingram School of Nursing, McGill University, McGill University, 680 Sherbrooke Street West, Suite 1800, H3A 2M7, Montreal, Quebec, Canada.
| | - Jeannie Haggerty
- St. Mary's Research Centre, Hayes Pavilion, 3830 Avenue Lacombe, Suite 4720, H3T 1M5, Montreal, Quebec, Canada; Department of Family Medicine, McGill University, 5858 Chemin de la Côte-des-Neiges, 3rd Floor, H3S 1Z1, Montreal, Quebec, Canada.
| | - Mark J Yaffe
- St. Mary's Research Centre, Hayes Pavilion, 3830 Avenue Lacombe, Suite 4720, H3T 1M5, Montreal, Quebec, Canada; Family Medicine Centre, St. Mary's Hospital Center, 3830, H3T 1M5, Montreal, Quebec, Canada; Department of Family Medicine, McGill University, 5858 Chemin de la Côte-des-Neiges, 3rd Floor, H3S 1Z1, Montreal, Quebec, Canada.
| | - Eric Belzile
- St. Mary's Research Centre, Hayes Pavilion, 3830 Avenue Lacombe, Suite 4720, H3T 1M5, Montreal, Quebec, Canada.
| | - Antonio Ciampi
- St. Mary's Research Centre, Hayes Pavilion, 3830 Avenue Lacombe, Suite 4720, H3T 1M5, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Purvis Hall, 1020 Pin. Avenue, H3A 1A2, Montreal, Quebec, Canada.
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Service-Learning and Professional Values Development of Baccalaureate Nursing Students. Nurs Educ Perspect 2019; 41:E47-E49. [PMID: 30807505 DOI: 10.1097/01.nep.0000000000000484] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Service-learning has been linked to attributes of professionalism such as integrity, altruism, and social justice in nursing literature. The purpose of this literature review was to determine how local service-learning experiences with vulnerable populations affect the development of professionalism and professional values in baccalaureate nursing students. A summary of the themes, Professionalism and Leadership and Critical Stance on Social Justice, is presented.
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Malembaka EB, Karemere H, Balaluka GB, Lambert AS, Muneza F, Deconinck H, Macq J. A new look at population health through the lenses of cognitive, functional and social disability clustering in eastern DR Congo: a community-based cross-sectional study. BMC Public Health 2019; 19:93. [PMID: 30665386 PMCID: PMC6341676 DOI: 10.1186/s12889-019-6431-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 01/11/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The importance of viewing health from a broader perspective than the mere presence or absence of disease is critical at primary healthcare level. However, there is scanty evidence-based stratification of population health using other criteria than morbidity-related indicators in developing countries. We propose a novel stratification of population health based on cognitive, functional and social disability and its covariates at primary healthcare level in DR Congo. METHOD We conducted a community-based cross-sectional study in adults with diabetes or hypertension, mother-infant pairs with child malnutrition, their informal caregivers and randomly selected neighbours in rural and sub-urban health zones in South-Kivu Province, DR Congo. We used the WHO Disability Assessment Schedule 2.0 (WHODAS) to measure functional, cognitive and social disability. The study outcome was health status clustering derived from a principal component analysis with hierarchical clustering around the WHODAS domains scores. We calculated adjusted odds ratios (AOR) using mixed-effects ordinal logistic regression. RESULTS Of the 1609 respondents, 1266 had WHODAS data and an average age of 48.3 (SD: 18.7) years. Three hierarchical clusters were identified: 9.2% of the respondents were in cluster 3 of high dependency, 21.1% in cluster 2 of moderate dependency and 69.7% in cluster 1 of minor dependency. Associated factors with higher disability clustering were being a patient compared to being a neighbour (AOR: 3.44; 95% CI: 1.93-6.15), residency in rural Walungu health zone compared to semi-urban Bagira health zone (4.67; 2.07-10.58), female (2.1; 1.25-2.94), older (1.05; 1.04-1.07), poorest (2.60; 1.22-5.56), having had an acute illness 30 days prior to the interview (2.11; 1.24-3.58), and presenting with either diabetes or hypertension (2.73; 1.64-4.53) or both (6.37; 2.67-15.17). Factors associated with lower disability clustering were being informally employed (0.36; 0.17-0.78) or a petty trader/farmer (0.44; 0.22-0.85). CONCLUSION Health clustering derived from WHODAS domains has the potential to suitably classify individuals based on the level of health needs and dependency. It may be a powerful lever for targeting appropriate healthcare service provision and setting priorities based on vulnerability rather than solely presence of disease.
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Affiliation(s)
- Espoir Bwenge Malembaka
- Ecole Régionale de Santé Publique, ERSP, Faculté de Médecine, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
- Institute of Health and Society, IRSS, Université Catholique de Louvain, Brussels, Belgium
| | - Hermès Karemere
- Ecole Régionale de Santé Publique, ERSP, Faculté de Médecine, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
| | - Ghislain Bisimwa Balaluka
- Ecole Régionale de Santé Publique, ERSP, Faculté de Médecine, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
| | - Anne-Sophie Lambert
- Institute of Health and Society, IRSS, Université Catholique de Louvain, Brussels, Belgium
| | - Fiston Muneza
- Department of Epidemiology and Biostatics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Hedwig Deconinck
- Institute of Health and Society, IRSS, Université Catholique de Louvain, Brussels, Belgium
| | - Jean Macq
- Institute of Health and Society, IRSS, Université Catholique de Louvain, Brussels, Belgium
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Gómez-Velasco DV, Almeda-Valdes P, Martagón AJ, Galán-Ramírez GA, Aguilar-Salinas CA. Empowerment of patients with type 2 diabetes: current perspectives. Diabetes Metab Syndr Obes 2019; 12:1311-1321. [PMID: 31496769 PMCID: PMC6689555 DOI: 10.2147/dmso.s174910] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 06/25/2019] [Indexed: 01/18/2023] Open
Abstract
Patient empowerment is a continuous process in which knowledge, motivation, and capacity to take control of their disease are built within a person. This concept is not always well understood and applied. This review describes the strategies to induce empowerment in patients with diabetes. In addition, the most common scales used to evaluate empowerment in diabetes is described. Furthermore, the effectiveness of the empowerment-based interventions for improving metabolic control and diabetes knowledge are described. Finally, we discuss opportunities for empowerment implementation in clinical practice and current needs on research that can be translated into public policies.
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Affiliation(s)
- Donají V Gómez-Velasco
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Paloma Almeda-Valdes
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Alexandro J Martagón
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Mexico City, Mexico
| | - Gabriela A Galán-Ramírez
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Carlos A Aguilar-Salinas
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Mexico City, Mexico
- Correspondence: Carlos A Aguilar-SalinasUnidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Avenida Vasco de Quiroga No. 15 Colonia Belisario Domínguez Sección XVI. Delegación Tlalpan, Mexico City14080, MexicoTel +52 555 487 0900 ext 6319 Email
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Hossain MM, Tasnim S, Sharma R, Sultana A, Shaik AF, Faizah F, Kaur R, Uppuluri M, Sribhashyam M, Bhattacharya S. Digital interventions for people living with non-communicable diseases in India: A systematic review of intervention studies and recommendations for future research and development. Digit Health 2019; 5:2055207619896153. [PMID: 31897307 PMCID: PMC6920343 DOI: 10.1177/2055207619896153] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 11/29/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND A high burden of non-communicable diseases (NCDs) is contributing to high mortality and morbidity in India. Recent advancements in digital health interventions, including mHealth, eHealth, and telemedicine, have facilitated patient-centered care for NCDs. OBJECTIVE This systematic review aims to evaluate the current evidence on digital interventions for people living with NCDs in India and the outcomes of those interventions. METHODS We adopted PRISMA guidelines and systematically reviewed articles from MEDLINE, CINAHL, PsycINFO, ERIC, and Scopus databases with following criteria: journal articles presenting digital intervention(s) used by people with at least one of the NCDs, reporting health outcomes following the intervention, studies conducted in India among Indian population. RESULTS Among 1669 articles retrieved from multiple sources, only 13 articles met our criteria. Most (n = 7) studies were conducted in southern states of India; eight studies included patients with diabetes, followed by neuropsychiatric disorders and other NCDs. Five studies recruited participants from tertiary hospitals; six interventions used text-messaging for delivering health services, and 10 studies reported randomized controlled trials. All the studies reported positive health outcomes following the intervention, including better self-management, increased patient-provider communication, improved medication adherence, and reduced disease symptoms. Most studies scored moderate to high in quality assessment checklist of Downs and Black. CONCLUSION Current evidence suggests a low number of interventions with positive outcomes. Future research should explore avenues of advanced technologies ensuring equitable and sustainable development of digital health interventions for people living with NCDs in India.
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Affiliation(s)
- Md Mahbub Hossain
- School of Public Health, Texas A&M University, College
Station, TX, USA
| | - Samia Tasnim
- School of Public Health, Texas A&M University, College
Station, TX, USA
| | | | - Abida Sultana
- Gazi Medical College, Mojid Sarani, Sonadanga, Khulna,
Bangladesh
| | | | - Farah Faizah
- The United Nations Population Fund (UNFPA), Dhaka,
Bangladesh
| | - Ravneet Kaur
- School of Public Health, Texas A&M University, College
Station, TX, USA
| | - Madhuri Uppuluri
- School of Public Health, Texas A&M University, College
Station, TX, USA
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Daly JM, Calderon R, Hoffman-Zinnel DJ, Wynohrad LA, Powers BN, Mohr TL, Levy BT. Strategies used and lessons learned by community assistants in organising regional forums for cancer education in Iowa, USA. Eur J Cancer Care (Engl) 2018; 27:e12868. [PMID: 29873862 PMCID: PMC6310140 DOI: 10.1111/ecc.12868] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 03/07/2018] [Accepted: 04/25/2018] [Indexed: 11/28/2022]
Abstract
Cancer prevention efforts at the community level are essential in the fight against cancer. Understanding community dynamics provides insights into building meaningful relationships between researchers and community organizations. In this study, community assistants were hired to organize and host forums to encourage interdisciplinary collaboration, with the goal of strengthening and transforming relationships between a university academic health center and communities. A 19-item questionnaire was developed to determine the strategies community assistants used to schedule and host community forums. Community assistants completed the questionnaire and were interviewed. Community assistants successfully scheduled and hosted 113 forums in 49 cities throughout the state of Iowa, with 2,209 persons attending. Strategies used included cold calls, using contact lists from the Iowa Cancer Consortium membership list, and contacts from business associates. Additionally, electronic and social media were used to arrange and advertise scheduled forums. The various strategies used and lessons learned by the community assistants proved successful in organizing and hosting forums throughout the state of Iowa, which reached 40 of Iowa's 99 counties. The efforts of the community assistants, the Iowa Cancer Consortium, and the Iowa Research Network, laid the foundation for continued cancer research and education collaboration between researchers and community organizations.
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Affiliation(s)
- Jeanette M. Daly
- Department of Family Medicine Carver College of Medicine, University of Iowa, Iowa City, IA. , Telephone: 319-384-8995
| | - Raul Calderon
- Faculty of Sport Science, Kasetsart University, Kamphaeng Saen, Thailand
| | | | | | | | | | - Barcey T. Levy
- Department of Family Medicine, Carver College of Medicine and the Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA.
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Wakefield D, Bayly J, Selman LE, Firth AM, Higginson IJ, Murtagh FE. Patient empowerment, what does it mean for adults in the advanced stages of a life-limiting illness: A systematic review using critical interpretive synthesis. Palliat Med 2018; 32:1288-1304. [PMID: 29956568 PMCID: PMC6088522 DOI: 10.1177/0269216318783919] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Patient empowerment, defined as 'a process through which people gain greater control over decisions and actions affecting their health' (World Health Organization) is a key theme within global health and social care strategies. The benefits of incorporating empowerment strategies in care are well documented, but little is known about their application or impact for patients with advanced, life-limiting illness(s). AIM To identify and synthesise the international evidence on patient empowerment for adults with advanced, life-limiting illness(s). DESIGN Systematic review (PROSPERO no. 46113) with critical interpretive synthesis methodology. DATA SOURCES Five databases (MEDLINE, Embase, CINHAL, PsycINFO and Cochrane) were searched from inception to March 2018. Grey literature and reference list/citation searches of included papers were undertaken. INCLUSION CRITERIA empirical research involving patients with advanced life-limiting illness including descriptions of, or references to, patient empowerment within the study results. RESULTS In all, 13 papers met inclusion criteria. Two qualitative studies explored patient empowerment as a study objective. Six papers evaluated interventions, referencing patient empowerment as an incidental outcome. The following themes were identified from the interpretive synthesis: self-identity, personalised knowledge in theory and practice, negotiating personal and healthcare relationships, acknowledgement of terminal illness, and navigating continued losses. CONCLUSION There are features of empowerment, for patients with advanced life-limiting illness distinct to those of other patient groups. Greater efforts should be made to progress the empowerment of patients nearing the end of their lives. We propose that the identified themes may provide a useful starting point to guide the assessment of existing or planned services and inform future research.
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Affiliation(s)
- Dominique Wakefield
- 1 Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
| | - Jo Bayly
- 1 Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
| | - Lucy Ellen Selman
- 2 Bristol Randomised Trials Collaboration (BRTC), School of Social and Community Medicine, Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Alice M Firth
- 1 Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
| | - Irene J Higginson
- 1 Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
| | - Fliss Em Murtagh
- 3 Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
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Brady B, Veljanova I, Schabrun S, Chipchase L. Integrating culturally informed approaches into physiotherapy assessment and treatment of chronic pain: a pilot randomised controlled trial. BMJ Open 2018; 8:e021999. [PMID: 29980547 PMCID: PMC6042550 DOI: 10.1136/bmjopen-2018-021999] [Citation(s) in RCA: 12] [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] [Received: 01/29/2018] [Revised: 04/17/2018] [Accepted: 05/31/2018] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To evaluate patient engagement with, and the feasibility of, a novel, culturally adapted physiotherapy pain management approach. DESIGN A participant-blinded and assessor-blinded pilot randomised controlled trial. SETTING Outpatient physiotherapy departments at two public hospitals and one district pain clinic. PARTICIPANTS Adults (n=48) with chronic musculoskeletal pain (daily pain >3 months), who self-identified as Mandaean, Assyrian or Vietnamese, were randomised to one of two physiotherapy treatment conditions. INTERVENTIONS 24 participants underwent combined group and individualised treatment described as 'culturally adapted physiotherapy', while 24 underwent evidence-informed 'usual physiotherapy care'. Both treatment arms consisted of up to 10 sessions over a 3-month period. OUTCOME MEASURES Patient engagement was measured via participant attendance, adherence and satisfaction data. Secondary outcomes included clinical measures of pain severity, interference and suffering, physical function and negative emotional state. RESULTS 96% of participants undergoing culturally adapted physiotherapy completed treatment, compared with 58% of the usual physiotherapy group. For the culturally adapted group attendance (87%±18%) and adherence (68%±32%) were higher relative to usual care (68%±32% and 55%±43%). Satisfaction was similar for the culturally adapted (82.7%±13.4%) and usual care (79.3±17.3) groups. For secondary outcomes, a significant between-group effect for pain-related suffering in favour of the culturally adapted group was observed with a medium effect size (partial η2 0.086, mean 3.56, 95% CI 0.11 to 7), while results for pain severity, interference, physical function and negative emotional state were similar. CONCLUSIONS Aligning treatment with the beliefs and values of culturally and linguistically diverse communities enhances patient engagement with physiotherapy. These results support the feasibility of a larger, multisite trial to determine if improved engagement with culturally adapted physiotherapy translates to improved clinical outcomes. TRIAL REGISTRATION NUMBER ACTRN12616000857404; Pre-results.
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Affiliation(s)
- Bernadette Brady
- School of Science and Health, Western Sydney University, Sydney, New South Wales, Australia
- Departments of Pain Medicine and Physiotherapy, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Irena Veljanova
- School of Social Science and Psychology, Western Sydney University, Sydney, New South Wales, Australia
| | - Siobhan Schabrun
- School of Science and Health, Western Sydney University, Sydney, New South Wales, Australia
| | - Lucinda Chipchase
- School of Science and Health, Western Sydney University, Sydney, New South Wales, Australia
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Rovini E, Maremmani C, Cavallo F. Automated Systems Based on Wearable Sensors for the Management of Parkinson's Disease at Home: A Systematic Review. Telemed J E Health 2018; 25:167-183. [PMID: 29969384 DOI: 10.1089/tmj.2018.0035] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Parkinson's disease is a common neurodegenerative pathology that significantly influences quality of life (QoL) of people affected. The increasing interest and development in telemedicine services and internet of things technologies aim to implement automated smart systems for remote assistance of patients. The wide variability of Parkinson's disease in the clinical expression, as well as in the symptom progression, seems to address the patients' care toward a personalized therapy. OBJECTIVES This review addresses automated systems based on wearable/portable devices for the remote treatment and management of Parkinson's disease. The idea is to obtain an overview of the telehealth and automated systems currently developed to address the impairments due to the pathology to allow clinicians to improve the quality of care for Parkinson's disease with benefits for patients in QoL. DATA SOURCES The research was conducted within three databases: IEEE Xplore®, Web of Science®, and PubMed Central®, between January 2008 and September 2017. STUDY ELIGIBILITY CRITERIA Accurate exclusion criteria and selection strategy were applied to screen the 173 articles found. RESULTS Ultimately, 55 articles were fully evaluated and included in this review. Divided into three categories, they were automated systems actually tested at home, implemented mobile applications for Parkinson's disease assessment, or described a telehealth system architecture. CONCLUSION This review would provide an exhaustive overview of wearable systems for the remote management and automated assessment of Parkinson's disease, taking into account the reliability and acceptability of the implemented technologies.
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Affiliation(s)
- Erika Rovini
- 1 The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera (PI), Italy
| | - Carlo Maremmani
- 2 U.O. Neurologia, Ospedale delle Apuane (AUSL Toscana Nord Ovest), Massa (MS), Italy
| | - Filippo Cavallo
- 1 The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera (PI), Italy
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Lambert K, Mansfield K, Mullan J. Qualitative exploration of the experiences of renal dietitians and how they help patients with end stage kidney disease to understand the renal diet. Nutr Diet 2018; 76:126-134. [PMID: 29968271 DOI: 10.1111/1747-0080.12443] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 05/17/2018] [Accepted: 05/21/2018] [Indexed: 10/28/2022]
Abstract
AIM Dietary modification is integral to the management of end stage kidney disease. However, adherence to the renal diet is poor. Few studies have explored the perspectives of renal dietitians and how they work with patients to facilitate dietary change. The objectives of this study were to explore the experiences of renal dietitians about educating patients with end stage kidney disease; and to describe the strategies perceived to help patients understand the renal diet. METHODS Semi-structured interviews based on Sensemaking theory were conducted with renal dietitians (n = 27) working in Australia and New Zealand from a range of metropolitan, regional and remote areas. RESULTS Five major themes across two categories were derived from the data. The renal dietitians in this study experienced feelings of frustration, frequently worked in practice environments with limited or inadequate resources and perceived that establishing trust and demonstrating empathy were important to sense making. Renal dietitians helped patients make sense of and understand the diet by clarifying ambiguities and conflicting information; and simplifying complexity by using simple explanations, individualised advice and practical support. These strategies were considered critical to the renal diet sense making process. CONCLUSIONS The experience of providing renal diet advice to adults with end stage kidney disease was emotionally and professionally challenging. Alternative approaches to patient education may help dietitians to empower patients to better understand the renal diet. Further research exploring the experiences of learning about the renal diet from the patient and carer perspective would also help to inform future alternative approaches.
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Affiliation(s)
- Kelly Lambert
- Department of Clinical Nutrition, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Kylie Mansfield
- Faculty of Science, Medicine and Health, School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Judy Mullan
- Faculty of Science, Medicine and Health, School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia.,Centre for Health Research Illawarra Shoalhaven Population (CHRISP), Australian Health Services Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
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De Marchis EH, Doekhie K, Willard-Grace R, Olayiwola JN. The Impact of the Patient-Centered Medical Home on Health Care Disparities: Exploring Stakeholder Perspectives on Current Standards and Future Directions. Popul Health Manag 2018; 22:99-107. [PMID: 29920148 DOI: 10.1089/pop.2018.0055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Over the past decade, the Patient-Centered Medical Home (PCMH) has become a preeminent model for primary care delivery. Simultaneously, health care disparities have gained increasing attention. There has been limited research on whether and how the PCMH can or should affect health care disparities. The authors conducted qualitative interviews with key stakeholders and experts on the PCMH model and health care disparities, including grant and policy makers, accreditors, researchers, patient advocates, primary care practices, practice transformation organizations, and payers, to assess perspectives on the role of the PCMH in addressing health care disparities. The application of grounded theory and thematic analysis elucidated best practice recommendations for the PCMH model's role in addressing health care disparities. Although the majority of stakeholders support greater integration of efforts to reduce health care disparities into the PCMH model, most stakeholders view the current PCMH model as having minimal or indirect influence on health care disparities. The majority supported greater integration of efforts to reduce health care disparities into the PCMH model. As the PCMH model continues to be refined, and as the health care system strives toward improving population health, there must be reflection on the policies and delivery systems that impact health care disparities.
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Affiliation(s)
| | - Kirti Doekhie
- 2 Institute of Health Policy and Management (iBMG), Erasmus University Rotterdam , the Netherlands
| | | | - J Nwando Olayiwola
- 1 University of California , San Francisco, San Francisco, California.,3 RubiconMD , New York, New York
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Wilson TE, Kay ES, Turan B, Johnson MO, Kempf MC, Turan JM, Cohen MH, Adimora AA, Pereyra M, Golub ET, Goparaju L, Murchison L, Wingood GM, Metsch LR. Healthcare Empowerment and HIV Viral Control: Mediating Roles of Adherence and Retention in Care. Am J Prev Med 2018; 54:756-764. [PMID: 29656911 PMCID: PMC5962433 DOI: 10.1016/j.amepre.2018.02.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 02/13/2018] [Accepted: 02/13/2018] [Indexed: 01/17/2023]
Abstract
INTRODUCTION This study assessed longitudinal relationships between patient healthcare empowerment, engagement in care, and viral control in the Women's Interagency HIV Study, a prospective cohort study of U.S. women living with HIV. METHODS From April 2014 to March 2016, four consecutive 6-month visits were analyzed among 973 women to assess the impact of Time 1 healthcare empowerment variables (Tolerance for Uncertainty and the state of Informed Collaboration Committed Engagement) on Time 2 reports of ≥95% HIV medication adherence and not missing an HIV primary care appointment since last visit; and on HIV RNA viral control across Times 3 and 4, controlling for illicit drug use, heavy drinking, depression symptoms, age, and income. Data were analyzed in 2017. RESULTS Adherence of ≥95% was reported by 83% of women, 90% reported not missing an appointment since the last study visit, and 80% were categorized as having viral control. Logistic regression analyses revealed a significant association between the Informed Collaboration Committed Engagement subscale and viral control, controlling for model covariates (AOR=1.08, p=0.04), but not for the Tolerance for Uncertainty subscale and viral control (AOR=0.99, p=0.68). In separate mediation analyses, the indirect effect of Informed Collaboration Committed Engagement on viral control through adherence (β=0.04, SE=0.02, 95% CI=0.02, 0.08), and the indirect effect of Informed Collaboration Committed Engagement on viral control through retention (β=0.01, SE=0.008, 95% CI=0.001, 0.030) were significant. Mediation analyses with Tolerance for Uncertainty as the predictor did not yield significant indirect effects. CONCLUSIONS The Informed Collaboration Committed Engagement healthcare empowerment component is a promising pathway through which to promote engagement in care among women living with HIV.
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Affiliation(s)
- Tracey E Wilson
- Department of Community Health Sciences, State University of New York, Downstate Medical Center School of Public Health, Brooklyn, New York.
| | - Emma Sophia Kay
- School of Social Work, University of Alabama, Tuscaloosa, Alabama
| | - Bulent Turan
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mallory O Johnson
- Department of Medicine, University of California, San Francisco, California
| | | | - Janet M Turan
- School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mardge H Cohen
- Department of Medicine, Stroger Hospital, Cook County Health and Hospital System, Chicago, Illinois
| | - Adaora A Adimora
- Department of Medicine, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Margaret Pereyra
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - Elizabeth T Golub
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Lakshmi Goparaju
- Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia
| | - Lynn Murchison
- Department of Medicine, Montefiore Medical Center, Bronx, New York
| | - Gina M Wingood
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York
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Affiliation(s)
- E Olayinka Ladeji
- Pharmaceutical Health Services Research Department, School of Pharmacy, University of Maryland, Baltimore 220 Arch St., Saratoga Building, Baltimore, MD 21201, USA
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Murphy KA, Ellison-Barnes A, Johnson EN, Cooper LA. The Clinical Examination and Socially At-Risk Populations: The Examination Matters for Health Disparities. Med Clin North Am 2018; 102:521-532. [PMID: 29650073 DOI: 10.1016/j.mcna.2017.12.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Data from the United States show that persons from low socioeconomic backgrounds, those who are socially isolated, belong to racial or ethnic minority groups, or identify as lesbian, gay, bisexual, or transgender experience health disparities at a higher rate. Clinicians must transition from a biomedical to a biopsychosocial framework within the clinical examination to better address social determinants of health that contribute to health disparities. We review the characteristics of successful patient-clinician interactions. We describe strategies for relationship-centered care within routine encounters. Our goal is to train clinicians to mitigate differences and reduce disparities in health care delivery.
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Affiliation(s)
- Karly A Murphy
- Department of Medicine, Johns Hopkins Hospital, 2024 East Monument Street, Suite 2-500, Baltimore, MD 21287, USA.
| | - Alejandra Ellison-Barnes
- Osler Medical Residency Training Program, Department of Medicine, Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD 21287, USA
| | - Erica N Johnson
- Johns Hopkins Bayview Internal Medicine Residency, Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, Mason F. Lord Building, Center Tower Suite 381, 5200 Eastern Avenue, Baltimore, MD 21224, USA
| | - Lisa A Cooper
- Department of Medicine, Johns Hopkins Center for Health Equity, Johns Hopkins University School, 2024 East Monument Street, Suite 2-500, Baltimore, MD 21287, USA; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Center for Health Equity, Johns Hopkins University, 2024 East Monument Street, Suite 2-500, Baltimore, MD 21287, USA
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87
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Chen J, Novak P, Goldman H. Public Health System-Delivered Mental Health Preventive Care Links to Significant Reduction of Health Care Costs. Popul Health Manag 2018; 21:462-468. [PMID: 29683382 DOI: 10.1089/pop.2018.0010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The objective was to estimate the association between health care expenditures and implementation of preventive mental health programs by local health departments (LHDs). Multilevel nationally representative data sets were linked to test the hypothesis that LHDs' provision of preventive mental health programs was associated with cost savings. A generalized linear model with log link and gamma distribution and state-fixed effects was used to estimate the association between LHDs' mental illness prevention services and total health care expenditures per person per year for adults aged 18 years and older. The main outcome measure was the annual total health care expenditure per person. The findings indicated that LHD provision of population-based prevention of mental illness was associated with an $824 reduction (95% confidence interval: -$1,562.94 to -$85.42, P < 0.05) in annual health care costs per person, after controlling for individual, LHD, community, and state characteristics. LHDs can play a critical role in establishing an integrated health care model. Their impact, however, has often been underestimated or neglected. Results showed that a small investment in LHDs may yield substantial cost savings at the societal level. The findings of this research are critical to inform policy decisions for the expansion of the Public Health 3.0 infrastructure.
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Affiliation(s)
- Jie Chen
- 1 Department of Health Services Administration, School of Public Health, University of Maryland , College Park, Maryland
| | - Priscilla Novak
- 1 Department of Health Services Administration, School of Public Health, University of Maryland , College Park, Maryland
| | - Howard Goldman
- 2 School of Medicine, University of Maryland , Baltimore, Maryland
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88
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Sin MK, Ha A, Taylor V. Sociocultural Barriers to Lung Cancer Screening Among Korean Immigrant Men. J Community Health 2018; 41:790-7. [PMID: 26846627 DOI: 10.1007/s10900-016-0154-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Lung cancer is a commonly occurring cancer among Korean American men. Korean Americans have lower rates of cancer screening participation than other Asian American sub-groups. However, little is known about factors that influence the cancer screening behavior of Korean immigrants. The purpose of this study was to explore facilitators of and barriers to lung cancer screening (i.e., low dose CT of the chest) among Korean immigrant men, using qualitative individual interviews and focus groups. A convenience sample of 24 Korean men who were immigrants, Washington State residents, able to speak Korean, aged 55-79, and eligible for lung cancer screening (based on current guidelines) were recruited from Korean churches and senior centers. Five focus groups (that included between two and five men) and nine individual interviews were conducted. Content analysis was used to analyze the qualitative data. Facilitators of lung cancer screening included perceptions about positive aspects of the health care system in South Korea, recommendations from others (physicians, family members, and community organizations), existing health problems and respiratory symptoms, interest in health, and the health consequences of aging. Barriers included costs of health care in the US, lack of time, lack of knowledge (about lung cancer and screening), attitudes about prevention, and lack of physician recommendation. This study adds new knowledge to a field where little information is available. It also lays the groundwork for developing culturally relevant lung cancer screening interventions for Korean Americans and the health care providers who serve them.
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Affiliation(s)
- Mo-Kyung Sin
- Seattle University College of Nursing, 901 12th Ave, P.O. Box 222000, Seattle, WA, 98122-1090, USA.
| | - Ara Ha
- Seattle University College of Nursing, 901 12th Ave, P.O. Box 222000, Seattle, WA, 98122-1090, USA
| | - Vicky Taylor
- Cancer Prevention Research Program, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N., P.O. Box 19204, Seattle, WA, 98109, USA
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89
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Turesson C, Kvist J, Krevers B. Patients’ needs during a surgical intervention process for Dupuytren’s disease. Disabil Rehabil 2017; 41:666-673. [DOI: 10.1080/09638288.2017.1402095] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Christina Turesson
- Department of Hand Surgery, Plastic Surgery and Burns, Linköping University, Linköping, Sweden
- Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden
| | - Joanna Kvist
- Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University, Linköping, Sweden
| | - Barbro Krevers
- Department of Medical and Health Sciences, Division of Health Care Analysis, Linköping University, Linköping, Sweden
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90
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Brooks Carthon JM, Rearden J, Pancir D, Gamble K, Rothwell H. "They're on the Fast Track": Older Blacks Describe Experiences of Nursing Care Quality During Hospitalization. Clin Nurs Res 2017; 26:557-575. [PMID: 27836934 PMCID: PMC5425319 DOI: 10.1177/1054773816674478] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Older Black patients are at increased risk for experiencing a hospital readmission. This disparity may be related to a variety of factors, including care received during hospitalization. The purpose of this study was to elicit the perceptions of older Black patients at high risk for readmission, and explore their nursing care needs and preferences during and following hospitalization. A qualitative descriptive design was used, including individual interviews with 19 Black members of a Program of All-Inclusive Care for the Elderly facility located in a northeastern urban setting. Four themes were captured encompassing characteristics of nursing care quality, unmet care needs, nurse-patient communication, and observations of competing nursing demands. Efforts to improve care transitions and prevent readmissions must address the needs and preferences of high-risk older Black patients while also attending to system-level inefficiencies that decrease the ability for nurses to complete all aspects of care.
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91
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Scales K, Lepore M, Anderson RA, McConnell ES, Song Y, Kang B, Porter K, Thach T, Corazzini KN. Person-Directed Care Planning in Nursing Homes: Resident, Family, and Staff Perspectives. J Appl Gerontol 2017; 38:183-206. [PMID: 29165004 DOI: 10.1177/0733464817732519] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Empowering individuals to direct their own care is central to person-centered care and health care policy. However, there is limited knowledge of how "person-directed care planning" (PDCP) can be achieved in particular settings. This study identifies key structures and processes for operationalizing and implementing PDCP in nursing homes. Using participatory inquiry, we convened "stakeholder engagement sessions" with residents, families, nursing staff, and managers/administrators in two North Carolina nursing homes ( N = 24 sessions; N = 67 unique participants). Stakeholders discussed current care-planning processes and provided feedback on an emergent conceptual framework of PDCP. Three themes emerged through directed-content analysis: strategies included providing formal and informal opportunities to engage in care planning and ensuring effective follow-through; different roles were required among leadership, staff, residents, and families to accomplish PDCP; and limits on achieving PDCP included competing priorities and perceived regulatory and resource constraints. Results are discussed in terms of the specific competencies required for accomplishing PDCP.
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Affiliation(s)
| | | | | | - Eleanor S McConnell
- 4 Duke University, Durham, NC, USA.,5 Geriatric Research, Education and Clinical Center, Department of Veterans Affairs Medical Center, Durham, NC, USA
| | - Yuting Song
- 6 University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Trini Thach
- 3 University of North Carolina at Chapel Hill, USA
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92
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Prabhu AV, Kim C, Crihalmeanu T, Hansberry DR, Agarwal N, DeFrances MC, Trejo Bittar HE. An online readability analysis of pathology-related patient education articles: an opportunity for pathologists to educate patients. Hum Pathol 2017; 65:15-20. [DOI: 10.1016/j.humpath.2017.04.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 04/05/2017] [Accepted: 04/19/2017] [Indexed: 02/06/2023]
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93
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Caufield-Noll C, Gorman L. Heart-Healthy Conversations: A Librarian-Physician Partnership to Promote Disease Management and Wellness Information to Cardiology Patients. JOURNAL OF CONSUMER HEALTH ON THE INTERNET 2017. [DOI: 10.1080/15398285.2017.1309169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - Linda Gorman
- Harrison Medical Library, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
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94
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Palumbo R, Annarumma C. Empowering organizations to empower patients: An organizational health literacy approach. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2016. [DOI: 10.1080/20479700.2016.1253254] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Rocco Palumbo
- Department of Management & Innovation Systems, University of Salerno, 84084, Via Giovanni Paolo II, nr. 132, Fisciano, Sa, Italy
| | - Carmela Annarumma
- Department of Management & Innovation Systems, University of Salerno, 84084, Via Giovanni Paolo II, nr. 132, Fisciano, Sa, Italy
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95
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Kane EP, Collinsworth AW, Schmidt KL, Brown RM, Snead CA, Barnes SA, Fleming NS, Walton JW. Improving diabetes care and outcomes with community health workers. Fam Pract 2016; 33:523-8. [PMID: 27418587 DOI: 10.1093/fampra/cmw055] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Type II diabetes continues to be a major health problem in USA, particularly in minority populations. The Diabetes Equity Project (DEP), a clinic-based diabetes self-management and education program led by community health workers (CHWs), was designed to reduce observed disparities in diabetes care and outcomes in medically underserved, predominantly Hispanic communities. OBJECTIVE The purpose of this study was to evaluate the impact of the DEP on patients' clinical outcomes, diabetes knowledge, self-management skills, and quality of life. METHODS The DEP was implemented in five community clinics from 2009 to 2013 and 885 patients completed at least two visits with the CHW. Student's paired t-tests were used to compare baseline clinical indicators with indicators obtained from patients' last recorded visit with the CHW and to assess differences in diabetes knowledge, perceived competence in managing diabetes, and quality of life. A mixed-effects model for repeated measures was used to examine the effect of DEP visits on blood glucose (HbA1c), controlling for patient demographics, clinic and enrolment date. RESULTS DEP patients experienced significant (P < 0.0001) improvements in HbA1c control, blood pressure, diabetes knowledge, perceived competence in managing diabetes, and quality of life. Mean HbA1c for all DEP patients decreased from 8.3% to 7.4%. CONCLUSION Given the increasing prevalence of diabetes in USA and documented disparities in diabetes care and outcomes for minorities, particularly Hispanic patients, new models of care such as the DEP are needed to expand access to and improve the delivery of diabetes care and help patients achieve improved outcomes.
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Affiliation(s)
- Erin P Kane
- Community Care, Baylor Scott and White Health, Dallas, TX, USA
| | | | | | - Rachel M Brown
- Center for Clinical Effectiveness, Baylor Scott and White Health, Dallas, TX, USA
| | | | - Sunni A Barnes
- STEEEP Analytics, Baylor Scott and White Health, Dallas, TX, USA
| | - Neil S Fleming
- Center for Clinical Effectiveness, Baylor Scott and White Health, Dallas, TX, USA, Robbins Institute for Health Policy & Leadership in the Hankamer School of Business, Baylor University, Waco, TX, USA and
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96
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Abildsnes E, Meland E, Samdal GB, Stea TH, Mildestvedt T. Stakeholders' expectations of Healthy Life Centers: A focus group study. Scand J Public Health 2016; 44:709-717. [PMID: 27340189 DOI: 10.1177/1403494816655946] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS The aims of this study were to explore stakeholders' expectations of municipal Healthy Life Centers (HLCs) in Norway, and to evaluate whether these expectations were compatible with current guidelines and recommendations. METHODS A multidisciplinary team of researchers arranged focus group sessions with Healthy Life Centre staff, municipality administration, county administration, general practitioners and representatives of three patient organizations. We audiotaped and transcribed the sessions verbatim. In analyses we used Systematic Text Condensation and an editing analysis style. RESULTS Expectations spanned from primary prevention among children to rehabilitation of adults with established disease, depending on the stakeholders' assumptions of the role of HLCs. Healthcare providers emphasized person-centered advice based on the participant's willingness to change, and their impressions of the participant's presenting condition and life circumstances. Many participants represented underprivileged groups, not reached by population-based information strategies. Consistent with self-determination theory, participants who contacted the HLCs themselves more often expressed a will for lifestyle change than those referred from general practitioners, and less often dropped out. Participants with complex challenges and insufficient coping strategies often strived with follow-up. Among these, many suffered from mental health problems. CONCLUSIONS The Norwegian HLC is still a concept in development and is trying to define its position in the public healthcare system. In accordance with national recommendations to reduce social health inequalities, the stakeholders emphasized providing effective, evidence-based HLC programs including underprivileged groups. They also expressed concern about prioritizing between an individual and population approach, and between different target groups and tasks.
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Affiliation(s)
- Eirik Abildsnes
- 1 Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Eivind Meland
- 1 Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Gro Beate Samdal
- 1 Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Tonje H Stea
- 2 Department of Public Health, Sport and Nutrition, University of Agder, Kristiansand, Norway
| | - Thomas Mildestvedt
- 1 Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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97
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McCusker J, Lambert SD, Cole MG, Ciampi A, Strumpf E, Freeman EE, Belzile E. Activation and Self-Efficacy in a Randomized Trial of a Depression Self-Care Intervention. HEALTH EDUCATION & BEHAVIOR 2016; 43:716-725. [PMID: 27179288 DOI: 10.1177/1090198116637601] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES In a sample of primary care participants with chronic physical conditions and comorbid depressive symptoms: to describe the cross-sectional and longitudinal associations of activation and self-efficacy with demographic, physical and mental health status, health behaviors, depression self-care, health care utilization, and use of self-care tools; and to examine the effects of a depression self-care coaching intervention on these two outcomes. Design/Study Setting. A secondary analysis of activation and self-efficacy data collected as part of a randomized trial to compare the effects of a telephone-based coached depression self-care intervention with a noncoached intervention. Activation (Patient Activation Measure) was measured at baseline and 6 months. Depression self-care self-efficacy was assessed at baseline, at 3 months, and at 6 months. PRINCIPAL FINDINGS In multivariable cross-sectional analyses (n = 215), activation and/or self-efficacy were associated with language, birthplace, better physical and mental health, individual exercise, specialist visits, and antidepressant nonuse. In longitudinal analyses (n = 158), an increase in activation was associated with increased medication adherence; an increase in self-efficacy was associated with use of cognitive self-care strategies and increases in social and solitary activities. There were significant improvements from baseline to 6 months in activation and self-efficacy scores both among coached and noncoached groups. The self-care coaching intervention did not affect 6-month activation or self-efficacy but was associated with quicker improvement in self-efficacy. CONCLUSIONS Overall, the results for activation and self-efficacy were similar, although self-efficacy correlated more consistently than activation with depression-specific behaviors and was responsive to a depression self-care coaching intervention.
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Affiliation(s)
- Jane McCusker
- McGill University, Montreal, Quebec, Canada .,St. Mary's Research Centre, Montreal, Quebec, Canada
| | - Sylvie D Lambert
- McGill University, Montreal, Quebec, Canada.,St. Mary's Research Centre, Montreal, Quebec, Canada
| | - Martin G Cole
- McGill University, Montreal, Quebec, Canada.,St. Mary's Hospital Center, Montreal, Quebec, Canada
| | | | | | - Ellen E Freeman
- Université de Montréal, Montreal, Quebec, Canada.,Maisonneuve-Rosemont Hospital Research Centre, Montreal, Quebec, Canada
| | - Eric Belzile
- St. Mary's Research Centre, Montreal, Quebec, Canada
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98
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Chen J, O'Brien MJ, Mennis J, Alos VA, Grande DT, Roby DH, Ortega AN. Latino Population Growth and Hospital Uncompensated Care in California. Am J Public Health 2015; 105:1710-7. [PMID: 26066960 DOI: 10.2105/ajph.2015.302583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the association between the size and growth of Latino populations and hospitals' uncompensated care in California. METHODS Our sample consisted of general acute care hospitals in California operating during 2000 and 2010 (n = 251). We merged California hospital data with US Census data for each hospital service area. We used spatial analysis, multivariate regression, and fixed-effect models. RESULTS We found a significant association between the growth of California's Latino population and hospitals' uncompensated care in the unadjusted regression. This association was still significant after we controlled for hospital and community population characteristics. After we added market characteristics into the final model, this relationship became nonsignificant. CONCLUSIONS Our findings suggest that systematic support is needed in areas with rapid Latino population growth to control hospitals' uncompensated care, especially if Latinos are excluded from or do not respond to the insurance options made available through the Affordable Care Act. Improving availability of resources for hospitals and providers in areas with high Latino population growth could help alleviate financial pressures.
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Affiliation(s)
- Jie Chen
- Jie Chen is with the Department of Health Services Administration, School of Public Health, University of Maryland, College Park. Matthew J. O'Brien is with the Division of General Internal Medicine and Geriatrics and the Center for Community Health, Feinberg School of Medicine, Northwestern University, Chicago, IL. Jeremy Mennis is with the Department of Geography and Urban Studies, Temple University, Philadelphia, PA. Victor A. Alos is with Puentes de Salud, Philadelphia, PA. David T. Grande is with the Department of Internal Medicine, Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Dylan H. Roby and Alexander N. Ortega are with the Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles
| | - Matthew J O'Brien
- Jie Chen is with the Department of Health Services Administration, School of Public Health, University of Maryland, College Park. Matthew J. O'Brien is with the Division of General Internal Medicine and Geriatrics and the Center for Community Health, Feinberg School of Medicine, Northwestern University, Chicago, IL. Jeremy Mennis is with the Department of Geography and Urban Studies, Temple University, Philadelphia, PA. Victor A. Alos is with Puentes de Salud, Philadelphia, PA. David T. Grande is with the Department of Internal Medicine, Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Dylan H. Roby and Alexander N. Ortega are with the Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles
| | - Jeremy Mennis
- Jie Chen is with the Department of Health Services Administration, School of Public Health, University of Maryland, College Park. Matthew J. O'Brien is with the Division of General Internal Medicine and Geriatrics and the Center for Community Health, Feinberg School of Medicine, Northwestern University, Chicago, IL. Jeremy Mennis is with the Department of Geography and Urban Studies, Temple University, Philadelphia, PA. Victor A. Alos is with Puentes de Salud, Philadelphia, PA. David T. Grande is with the Department of Internal Medicine, Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Dylan H. Roby and Alexander N. Ortega are with the Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles
| | - Victor A Alos
- Jie Chen is with the Department of Health Services Administration, School of Public Health, University of Maryland, College Park. Matthew J. O'Brien is with the Division of General Internal Medicine and Geriatrics and the Center for Community Health, Feinberg School of Medicine, Northwestern University, Chicago, IL. Jeremy Mennis is with the Department of Geography and Urban Studies, Temple University, Philadelphia, PA. Victor A. Alos is with Puentes de Salud, Philadelphia, PA. David T. Grande is with the Department of Internal Medicine, Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Dylan H. Roby and Alexander N. Ortega are with the Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles
| | - David T Grande
- Jie Chen is with the Department of Health Services Administration, School of Public Health, University of Maryland, College Park. Matthew J. O'Brien is with the Division of General Internal Medicine and Geriatrics and the Center for Community Health, Feinberg School of Medicine, Northwestern University, Chicago, IL. Jeremy Mennis is with the Department of Geography and Urban Studies, Temple University, Philadelphia, PA. Victor A. Alos is with Puentes de Salud, Philadelphia, PA. David T. Grande is with the Department of Internal Medicine, Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Dylan H. Roby and Alexander N. Ortega are with the Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles
| | - Dylan H Roby
- Jie Chen is with the Department of Health Services Administration, School of Public Health, University of Maryland, College Park. Matthew J. O'Brien is with the Division of General Internal Medicine and Geriatrics and the Center for Community Health, Feinberg School of Medicine, Northwestern University, Chicago, IL. Jeremy Mennis is with the Department of Geography and Urban Studies, Temple University, Philadelphia, PA. Victor A. Alos is with Puentes de Salud, Philadelphia, PA. David T. Grande is with the Department of Internal Medicine, Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Dylan H. Roby and Alexander N. Ortega are with the Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles
| | - Alexander N Ortega
- Jie Chen is with the Department of Health Services Administration, School of Public Health, University of Maryland, College Park. Matthew J. O'Brien is with the Division of General Internal Medicine and Geriatrics and the Center for Community Health, Feinberg School of Medicine, Northwestern University, Chicago, IL. Jeremy Mennis is with the Department of Geography and Urban Studies, Temple University, Philadelphia, PA. Victor A. Alos is with Puentes de Salud, Philadelphia, PA. David T. Grande is with the Department of Internal Medicine, Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Dylan H. Roby and Alexander N. Ortega are with the Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles
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