Solving the puzzle of posthospital recovery: What is the role of the individual physician?

Recognition of schizophrenia and quality of treatment during the COVID-19 pandemic: A Danish nationwide study

BACKGROUND

The COVID-19 pandemic may have exacerbated the state of ill-health among patients with schizophrenia. We examined the number of patients diagnosed with schizophrenia, the number of hospital admissions and outpatient contacts and the quality of treatment during the pandemic in comparison with the previous years.

METHODS

We identified patients ≥18 years old registered in the Danish Schizophrenia Registry from 2016 to 2022. Using a generalized linear model, we estimated prevalence ratios (PR) and 95 % confidence intervals (CI) for each variable of interest.

RESULTS

A minor reduction in the number of new cases, admissions and outpatient contacts was seen during the first lockdown; however, there was no overall change across the pandemic period compared with the pre-pandemic period. We found no change in the proportion of patients who were interviewed using a diagnostic tool (37.0 % during pandemic vs 37.9 % pre-pandemic; PR = 0.87; 95 % CI 0.68-1.12) or received family intervention (57.7 % vs 57.1 %; PR = 0.97; 95 % CI 0.81-1.15), and no decrease was observed in the proportion of patients assessed for social support. Furthermore, no change in the proportion of patients re-admitted within 30 days (35.9 % vs 35.0 %; PR = 0.96; 95 % CI 0.88-1.07) or screened for suicide risk in relation to discharge (55.2 % vs 56.8 %; PR = 0.96; 95 % CI 0.97-1.09) was observed.

CONCLUSIONS

Recognition and treatment of schizophrenia was minimally affected during the first lockdown, but across the pandemic period no overall change was observed. The quality of treatment of schizophrenia was unchanged.

Exploring physician engagement in health care organizations: a scoping review

RATIONALE

Enhancing health system effectiveness, efficiency, and appropriateness is a management priority in most world countries. Scholars and practitioners have focused on physician engagement to facilitate such outcomes.

OBJECTIVES

Our research was intended to: 1) unravel the definition of physician engagement; 2) understand the factors that promote or impede it; 3) shed light on the implications of physician engagement on organizational performance, quality, and safety; and 4) discuss the tools to measure physician engagement.

METHOD

A scoping review was undertaken. Items were collected through electronic databases search and snowball technique. The PRISMA extension for Scoping Reviews (PRISMA-ScR) statement and checklist was followed to enhance the study replicability.

RESULTS

The search yielded 16,062 records. After an initial screening, 300 were selected for potential inclusion in this literature review. After removing duplicates and records not meeting the inclusion criteria, full-text analysis of 261 records was performed, yielding a total of 174 records.

DISCUSSION

Agreement on the conceptualization of physician engagement is thin; furthermore, scholars disagree on the techniques and approaches used to assess its implementation and implications. Proposals have been made to overcome the barriers to its adoption, but empirical evidence about implementing physician engagement is still scarce.

CONCLUSIONS

Our scoping review highlights the limitations of the extant literature about physician engagement. Physician engagement is a relatively ill-defined concept: developing an evidence base for its actual implementation is necessitated to provide reliable guidance on how the governance of health care organizations could be improved. Although we did not assess the quality or the robustness of current empirical research, our findings call for further research to: 1) identify potential drivers of physician engagement, 2) develop dependable assessment tools providing health care organizations with guidance on how to foster physician engagement, and 3) evaluate engagement's actual impact on health care organizations' performance.

Physician engagement: a concept analysis

The term "physician engagement" is used quite frequently, yet it remains poorly defined and measured. The aim of this study is to clarify the term "physician engagement." This study used an eight step-method for conducting concept analyses created by Walker and Avant. MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched on February 14, 2019. No limitations were put on the searches with regard to year or language. Results identify that the term "physician engagement" is regular participation of physicians in (1) deciding how their work is done, (2) making suggestions for improvement, (3) goal setting, (4) planning, and (5) monitoring of their performance in activities targeted at the micro (patient), meso (organization), and/or macro (health system) levels. The antecedents of "physician engagement" include accountability, communication, incentives, interpersonal relations, and opportunity. The results include improved outcomes such as data quality, efficiency, innovation, job satisfaction, patient satisfaction, and performance. Defining physician engagement enables physicians and health care administrators to better appreciate and more accurately measure engagement and understand how to better engage physicians.

Understanding patient-centred readmission factors: a multi-site, mixed-methods study

IMPORTANCE

Patient concerns at or before discharge inform many transitional care interventions; few studies examine patients' perceptions of self-care and other factors related to readmission.

OBJECTIVES

To characterise patient-reported or caregiver-reported factors contributing to readmission.

DESIGN, SETTING AND PARTICIPANTS

Cross-sectional, national study of general medicine patients readmitted within 30 days at 12 US hospitals. Interviews included multiple-choice survey and open-ended survey questions of patients or their caregivers.

MEASUREMENTS

Multiple-choice survey quantified post-discharge difficulty in seven domains of self-care: medication use, contacting providers, transportation, basic needs (eg, food and shelter), diet, social support and substance abuse. Open-ended responses were coded into themes that added depth to the domains above or captured additional patient-centred concerns.

RESULTS

We interviewed 1066 readmitted patients. 91% reported understanding their discharge plan; however, only 37% reported that providers asked about barriers to carrying out the plan. 52% reported experiencing difficulty in ≥1 self-care domains ranging in frequency from 22% (diet) to 7% (substance use); 26% experienced difficulty in two or more domains. Among 508 patients (48% overall) who reported no difficulties in these domains, two-thirds either could not attribute their readmission to any specific difficulty (34%) or attributed their readmission to progression or persistence of their disease despite following their discharge plan (31%). Only 20% attributed their readmission to early discharge (8%), poor-quality hospital care (6%) or issues such as inadequate discharge instructions or follow-up care (6%).

LIMITATIONS

The study population included only patients readmitted at academic medical centres and may not be representative of community-based care.

CONCLUSION

Patients readmitted within 30 days reported understanding their discharge plans, but frequent difficulties in self-care and low anticipatory guidance for resolving these issues after discharge.