Building from Patient Experiences to Deliver Patient-Focused Healthcare Systems in Collaboration with Patients: A Call to Action

Patients' Experience with Received Healthcare in Internal Medicine and Surgery Wards of Slovenian Hospitals-A Cross-Sectional Survey

Aim

The aim of the study was to explore the experiences of patients with delivered healthcare in selected Slovenian hospitals.

Methods

A cross-sectional study was employed. A total of 1,748 patients participated. A shortened version of the Consumer Assessment of Healthcare Providers and Systems survey was used. Permission to conduct the study was obtained from the Slovenian Medical Ethics Committee. Data were collected between February and March 2020. Univariate, bivariate and multivariate analyses were conducted.

Results

The average hospital rating was 8.86 (SD=1.47; p<0.001) out of 10. The hospital would be definitely recommended to others by 1,290 (75.7%) respondents. The regression model "patients' experience with care" was explained in 18%, mostly by "patients' general health status" (-0.267), "provision of written and oral information about symptoms or health problems post discharge" (-0.200), and "talking to patients about care post discharge" (-0.175). The model "hospital rate" was explained in 30.4% by "patients' experience with care" (0.576), "new medication was explained" (-0.242) and "patient age" (0.132).

Conclusion

The hospital rates are good and mostly explained by patient experience. The results revealed that tasks connected to comprehensive preparation of patients for healthcare treatment including communication, health education and appropriate discharge are only partially fulfilled. Improvements and holistic data capture are needed to make the measurement of patient experience a greater contribution to the improvement and efficiency of hospital care.

The power paradox of patient-centred care in Chinese community health: Towards a conceptualisation

Patient-centred care (PCC) is widely heralded as a transformative healthcare paradigm, designed to prioritise patients' unique needs, preferences, and values in clinical decision-making. By potentially shifting away from the historically provider-centric model, PCC aims to empower patients as autonomous, active participants. However, critical questions remain: Does PCC genuinely dismantle power asymmetries, or does it merely serve as rhetoric subtly reinforcing existing hierarchies under the guise of empowerment? This study examines this power paradox-the disconnect between PCC's rhetorical positioning and its superficial implementation-through Steven Lukes' three dimensions of power, focusing on China's community healthcare system, where patient-centred ideals are strongly advocated. A year-long non-participant observation at a major community health centre in Shenzhen, complemented by semi-structured interviews with 16 general practitioners (GPs) and 18 hypertensive patients (HPs), informed an iterative thematic analysis. The analysis identified three paradoxes that complicate PCC's vision of patient empowerment. First, protective authority demonstrates how GPs' protective intentions manifest as directive behaviours, fostering dependency and limiting patient agency. Second, framing authority reveals how organisational norms, policies, and clinical expectations constrain patient choice, prioritising compliance over autonomy. Lastly, internalised compliance highlights PCC's ideological power, where HPs internalise adherence as integral to their identity as 'good' patients, embedding deference to medical authority within their sense of well-being. These findings offer critical insights into PCC's power paradox, questioning its theoretical capacity to redress entrenched provider-patient power imbalances. Addressing these challenges necessitates systemic reforms and shifts in clinical practice to genuinely prioritise patient-centredness.

Inclusion in neurological research: empowering people living with neurological diseases

The value of involving people living with diseases in the research process is increasingly recognized by professional associations and regulatory agencies alike. Patient contributions range from disease prevention and diagnosis to medication planning, and from advocacy to guideline production and clinical trial design. Thanks to the efforts of activists and advocates, new models of patient inclusion in medical research are being developed to replace outdated non-participative and tokenistic paradigms. New modalities of patient participation in research - for example, the introduction of patient experts, who work closely with researchers and clinicians - have progressively empowered individuals who are living with diseases. In this Perspective, we provide an overview of the current status of patient involvement in medical research, with a specific focus on neurology. We also discuss the existing and future roles of patient experts in neurological research.

"Unidos Hablemos" - description of a virtual conference series to engage the Hispanic and Latino community in asthma and COVID-19 education and research

BACKGROUND

Inequity in asthma and COVID-19 outcomes and research among Hispanic or Latino individuals is well established. Patient centered outcomes research (PCOR) may help address these inequalities. This report describes the development, implementation, and evaluation of a virtual conference series program titled "Unidos Hablemos de/United, Let's Talk About" intended to address the health literacy of the Hispanic/Latino community regarding asthma and COVID-19 and to encourage involvement in PCOR.

METHODS

A Project Advisory Group consisting of Hispanic/Latino patient advisors who had been diagnosed with asthma and/or COVID-19, healthcare providers, researchers, a Hispanic faith-based leader, and a program evaluator designed and implemented a six-month series of monthly one-hour virtual sessions. Speakers and topics were selected that fit the Hispanic/Latino community and culture regarding asthma, COVID-19, and PCOR. Recruitment was through a multichannel digital promotion strategy, including social media. The virtual sessions were free on the ZOOM webinar platform and included interactive polling questions, live chat box, and Q&A. All audio and written materials from the sessions were translated into Spanish and English. Evaluations were used to rate the overall satisfaction with the program.

RESULTS

An average of 382 participants attended each of the six sessions, and participation generally increased with each session. The proportion of participants who considered themselves a Hispanic/Latino patient with asthma, caregiver, or clergy who served Hispanic/Latino communities increased by 100% from session one to session two. Preference for materials in Spanish ranged from 12 to 20% of participants over the six sessions. Among the sessions, 74-84% of polling question respondents indicated they would be willing to participate in research or a study, and 88% said they would be willing to serve as a patient partner/advocate. Program evaluations consistently indicated high satisfaction with the session content, session format, and feeling of inclusion.

CONCLUSIONS

Unidos Hablemos provided a voice to the Hispanic/Latino community that will inform future strategies to improve equity in asthma management, COVID-19, and PCOR. Patient speakers generated trust from the participants and "bridged the gap" between physicians, researchers, and the Hispanic/Latino community. Providing evidence-based, current information will empower patients and caregivers to make informed healthcare decisions.

The influence of patient experience and patient trust on willingness to see a doctor based on SOR theory

BACKGROUND

Improving patients' experience, enhancing patients' trust and improving the willingness to see a doctor are the key to the real implementation of the "gatekeeper" role of residents' health in township health centers. At present, in the field of health management, the research on the relationship between the three is relatively limited. The purpose of this study is to explore the current situation of patients' experience, patients' trust and willingness to see a doctor in township health centers, and further explore the relationship between the three, so as to provide a theoretical basis for improving the overall service and management quality of township health centers.

METHODS

In this study, a cross-sectional survey was conducted in Shandong Province, China from July to October 2020. We used a structured questionnaire to collect data, which included general information, medical information, patient experience, patient trust, and willingness to see a doctor. Patient experience, patient trust, and willingness to see a doctor were evaluated using the Likert 5-point scoring method, with a maximum score of 5. The higher the score, the better the patient experience, the greater the patient trust, and the stronger the willingness to see a doctor. SPSS21.0 was used to describe the current situation, test the reliability and validity, and analyze the Pearson correlation. AMOS23.0 was used for structural equation modeling.

RESULTS

The score of willingness to see a doctor was 3.84 ± 0.62. The score of patient experience was 3.81 ± 0.47, and the score of patient trust was 3.81 ± 0.60, which was a lower score compared to other studies in the same period. Both patient experience and patient trust both had a directly positive impact on the willingness to see a doctor, and the impact coefficients were 0.19 and 0.68, respectively. Patient experience has a direct positive impact on patient trust, with an impact coefficient of 0.74. Patient trust played a partial mediating role in the relationship between patient experience and willingness to see a doctor, and the impact coefficient was 0.50.

CONCLUSIONS

If the reform of China's healthcare system is to realize the goal of "not leaving the countryside for minor illnesses and not leaving the county for serious illnesses" increasing the willingness of patients to see a doctor at the grass-roots level primary hospitals is key. In addition, the government should vigorously promote the construction of township health centers and stimulate the vitality of grass-roots health institutions. If primary hospitals want to "catch" the demand of patients, they must improve patient experience and enhance patient trust.

It Is Time to Take Complaints Seriously? An Exploratory Analysis of Communications Sent by Users to a Public Healthcare Agency before, during and after the COVID-19 Pandemic

Taking due account of users' perspectives is crucial for improving the quality of healthcare services. This study aimed to analyse the representations and evaluation criteria that users of a public health agency express towards care and treatment services and to explore whether and how the content and meaning of their communications varied according to pre-pandemic, pandemic or post-pandemic periods. A total of 501 communications sent to the public relations office of an Italian health agency were collected. An automatic content analysis procedure was applied to the textual corpus. Four main thematic cores were identified concerning the request for care and respect, the value of the doctor-patient relationship and the difficulties in contacting services and accessing care. Two main latent dimensions of meaning were identified, which capture the dialectic between the demand for relationships and the demand for access to care, and between attention to the relational competence of health workers and attention to the needs and rights of users. Communications collected during the pre-pandemic and post-pandemic periods mainly concern the difficulty of access to care; those collected during the pandemic period mainly concern the doctor-patient relationship. Interpersonal aspects and timely access to care appear to be crucial in users' assessment of the quality of care.

Leveraging patient experience data to guide medicines development, regulation, access decisions and clinical care in the EU

Patient experience data (PED), provided by patients/their carers without interpretation by clinicians, directly capture what matters more to patients on their medical condition, treatment and impact of healthcare. PED can be collected through different methodologies and these need to be robust and validated for its intended use. Medicine regulators are increasingly encouraging stakeholders to generate, collect and submit PED to support both scientific advice in development programs and regulatory decisions on the approval and use of these medicines. This article reviews the existing definitions and types of PED and demonstrate the potential for use in different settings of medicines' life cycle, focusing on Patient-Reported Outcomes (PRO) and Patient Preferences (PP). Furthermore, it addresses some challenges and opportunities, alluding to important regulatory guidance that has been published, methodological aspects and digitalization, highlighting the lack of guidance as a key hurdle to achieve more systematic inclusion of PED in regulatory submissions. In addition, the article discusses opportunities at European and global level that could be implemented to leverage PED use. New digital tools that allow patients to collect PED in real time could also contribute to these advances, but it is equally important not to overlook the challenges they entail. The numerous and relevant initiatives being developed by various stakeholders in this field, including regulators, show their confidence in PED's value and create an ideal moment to address challenges and consolidate PED use across medicines' life cycle.

Stakeholder Engagement in Type 1 Diabetes Research, Quality Improvement, and Clinical Care

The integration of stakeholder engagement (SE) in research, quality improvement (QI), and clinical care has gained significant traction. Type 1 diabetes is a chronic disease that requires complex daily management and care from a multidisciplinary team across the lifespan. Inclusion of key stakeholder voices, including patients, caregivers, health care providers and community advocates, in the research process and implementation of clinical care is critical to ensure representation of perspectives that match the values and goals of the patient population. This review describes the current framework for SE and its application to research, QI, and clinical care across the lifespan.

Patient Engagement and Patient Experience Data in Regulatory Review and Health Technology Assessment: A Global Landscape Review

BACKGROUND

Working with patients through meaningful patient engagement (PE) and incorporating patient experience data (PXD) is increasingly important in medicines and medical device development. However, PE in the planning, organization, generation, and interpretation of PXD within regulatory and health technology assessment (HTA) decision-making processes remains challenging. We conducted a global review of the PE and PXD landscape to identify evolving resources by geography to support and highlight the potential of integration of PE and PXD in regulatory assessment and HTA.

METHODS

A review of literature/public information was conducted (August 2021-January 2023), led by a multistakeholder group comprising those with lived or professional experience of PE and PXD, to identify relevant regulatory and HTA initiatives and resources reviewed and categorized by geography and focus area.

RESULTS

Overall, 53 relevant initiatives/resources were identified (global, 14; North America, 11; Europe, 11; Asia, nine; UK, six; Latin America, one; Africa, one). Most focused either on PE (49%) or PXD (28%); few (11%) mentioned both PE and PXD (as largely separate activities) or demonstrated an integration of PE and PXD (11%).

CONCLUSIONS

Our analysis demonstrates increasing interest in PE, PXD, and guidance on their use individually in decision-making. However, more work is needed to offer guidance on maximizing the value of patient input into decisions by combining both PE and PXD into regulatory and HTA processes; the necessity of integrating PE in the design and interpretation of PXD programs should be highlighted. A co-created framework to achieve this integration is part of a future project.

Perspectives of People At-Risk on Parkinson's Prevention Research

The movement toward prevention trials in people at-risk for Parkinson's disease (PD) is rapidly becoming a reality. The authors of this article include a genetically at-risk advocate with the LRRK2 G2019 S variant and two patients with rapid eye movement sleep behavior disorder (RBD), one of whom has now been diagnosed with PD. These authors participated as speakers, panelists, and moderators in the "Planning for Prevention of Parkinson's: A Trial Design Forum" hosted by Massachusetts General Hospital in 2021 and 2022. Other authors include a young onset person with Parkinson's (PwP) and retired family physician, an expert in patient engagement in Parkinson's, and early career and veteran movement disorders clinician researchers. Several themes emerged from the at-risk participant voice concerning the importance of early intervention, the legitimacy of their input in decision-making, and the desire for transparent communication and feedback throughout the entire research study process. Challenges and opportunities in the current environment include lack of awareness among primary care physicians and general neurologists about PD risk, legal and psychological implications of risk disclosure, limited return of individual research study results, and undefined engagement and integration of individuals at-risk into the broader Parkinson's community. Incorporating the perspectives of individuals at-risk as well as those living with PD at this early stage of prevention trial development is crucial to success.

Co-creation of the Global Patient Experience Data Navigator: a multi-stakeholder initiative to ensure the patient voice is represented in health decision-making

BACKGROUND

Putting patients' needs and priorities at the forefront of healthcare initiatives and medical product development is critical to achieve outcomes that matter most to patients. This relies on the integration of early, meaningful patient engagement (PE) to learn what is important to patients, and collection of representative patient experience data (PXD). The increased number of PE/PXD efforts across global regulatory, health technology assessment, and healthcare systems is an important step forward to deliver improved health outcomes for patients. However, these initiatives are fragmented and lack integration, which is necessary to maximize efforts and reduce burden on patients. To overcome these challenges, the Global Patient Experience Data Navigator has been co-created by Patient Focused Medicines Development to provide practical resources that can facilitate and optimize PXD generation, collection, analysis, and dissemination for patient benefit and aims to be applicable across all therapeutic areas for all stakeholders.

METHODS

Co-creation of the Navigator took place through an iterative process of validation and formalization driven by a diverse, multi-stakeholder working group with individuals who have varying knowledge/experience in PE/PXD.

RESULTS

A series of workshops took place to conduct a gap analysis, develop a taxonomy model, and integrate existing frameworks. The collective insights led to the development of the Navigator consisting of four specific tools in the form of downloadable templates, which can be used to: (1) prioritize outcomes that matter most to patients and their caregivers; (2) select appropriate measurement methods for these outcomes; (3) identify when and why PXD is used throughout the product development cycle for each stakeholder; (4) identify when and why PXD is used throughout the healthcare process for each stakeholder. A public consultation was carried out to collect user feedback before the Navigator was made publicly available in December 2022.

CONCLUSION

To our knowledge, the Global Patient Experience Data Navigator is the only publicly available toolkit developed with a multi-stakeholder and disease-agnostic approach providing taxonomically grouped resources to optimize the collection and collation of PXD for patient benefit. Future work will aim to further engage patients by adding a PE dimension to the Navigator.

Beyond Participation: Evaluating the Role of Patients in Designing Oncology Clinical Trials

Historically, subject matter experts and healthcare professionals have played a pivotal role in driving oncology clinical trials. Although patients have been key participants, their deliberate and active contribution to the design and decision-making process has been limited. This scoping review aimed to examine the existing literature to scope the extent of active patient engagement in the design of oncology clinical trials and its corresponding influence on trial outcomes. We conducted a systematic search using two databases, namely MEDLINE (Ovid) and EMBASE, to identify relevant studies exploring patient engagement in cancer-related clinical research design. We identified seven studies that met the eligibility criteria. The studies highlighted the benefits of active patient involvement, such as improved recruitment strategies, and the attainment of more patient-centered trial outcomes. The influence of patient involvement varied from tangible developments like patient-friendly resources to indirect impacts like improved patient experiences and potentially higher adherence to trial intervention. The future of clinical trials should prioritize patients' values and perspectives, with regulatory bodies fostering these practices through clear guidelines. As the concept of patient centricity takes root in oncology research, the involvement of patients should evolve beyond mere participation.

The impact on patients of the tertiary-primary healthcare interface in kidney failure: a qualitative study

BACKGROUND

Clinicians and patients have reported fragmentation in the primary and tertiary healthcare interface. However, perspectives of service navigation and the impacts of fragmentation are not well defined, particularly for patients transitioning to dialysis. This study aimed to define patient perspectives of the functioning of the health service interface and impacts on healthcare experiences and engagement, informing patient-centred and outcomes-focused service models.

METHODS

A qualitative study was conducted through semi-structured interviews with 25 dialysis patients (16 males) aged 34-78 receiving dialysis across a multi-site tertiary service. Transcripts were analysed thematically.

RESULTS

Three main themes were identified: (1) The Changing Nature of General Practitioner (GP) Patient Relationships; (2) Ownership and Leadership in Kidney Care; and (3) The Importance of Nephrologist-GP Communications. Patients perceived an unreliable primary-tertiary service interface which lacked coordinated care and created challenges for primary care continuity. These impacted perceptions of healthcare provider expertise and confidence in healthcare systems. Patients subsequently increased the healthcare sought from tertiary kidney clinicians. The fractured interface led some to coordinate communication between health sectors, to support care quality, but this caused additional stress.

CONCLUSIONS

A fragmented primary-tertiary healthcare interface creates challenges for patient service navigation and can negatively impact patient experiences, leading to primary care disengagement, reduced confidence in health care quality and increased stress. Future studies are imperative for assessing initiatives facilitating health system integration, including communication technologies, healthcare provider training, patient empowerment, and specific outcomes in health, economic and patient experience measures, for patients transitioning to dialysis.

Perceptions of the primary health care team about the implementation of integrated care of patients with type 2 diabetes and hypertension in Slovenia: qualitative study

BACKGROUND

Integrated care involves good coordination, networking, and communication within health care services and externally between providers and patients or informal caregivers. It affects the quality of services, is more cost-effective, and contributes to greater satisfaction among individuals and providers of integrated care. In our study, we examined the implementation and understanding of integrated care from the perspective of providers - the health care team - and gained insights into the current situation.

METHODS

Eight focus groups were conducted with health care teams, involving a total of 48 health care professionals, including family physicians, registered nurses, practice nurses, community nurses, and registered nurses working in a health education center. Prior to conducting the focus groups, a thematic guide was developed based on the literature and contextual knowledge with the main themes of the integrated care package. The analysis was conducted using the NVivo program.

RESULTS

We identified 12 main themes with 49 subthemes. Health care professionals highlighted good accessibility and the method of diagnostic screening integrated with preventive examinations as positive aspects of the current system of integrated care in Slovenia. They mentioned the good cooperation within the team, with the involvement of registered nurses and community nurses being a particular advantage. Complaints were made about the high workload and the lack of workforce. They feel that patients do not take the disease seriously enough and that patients as teachers could be useful.

CONCLUSION

Primary care teams described the importance of implementing integrated care for diabetes and hypertension patients at four levels: Patient, community, care providers, and state. Primary care teams also recognized the importance of including more professionals from different health care settings on their team.

Factors and Mechanism Influencing Client Experience of Residential Integrated Health and Social Care for Older People: A Qualitative Model in Chinese Institutional Settings

BACKGROUND

An emerging service delivery model of integrating health and social care for older people has been actively promoted by the Chinese government since 2016, but the client experience and influencing mechanism still remain unclear.

METHODS

this study adopts a qualitative methodology to delve deeper into the factors and mechanism shaping the client experience of residential integrated health and social care for older people in the Chinese context, so as to understand the experiences of older residents during the whole process of receiving integrated care services, and on this basis, put forward suggestions for the improvement of a high-quality aged care service system. We coded and analyzed the in-depth interview data of twenty older adults and six staff members from June 2019 to February 2020, recruited from six institutions in Changsha, one of the ninety pilot cities for integrated health and social care in China.

RESULTS

the findings showed that the client experience of older adults is mainly affected by factors in three dimensions (scene construction, individual minds, and interaction and communication), which are comprised of six sub-categories (social foundation, institutional functions, perception and emotion, cognition and understanding, intimacy and trust, and participation). Based on the factors and mechanism (consisting of six influencing paths), we constructed a model of the client experience of integrated health and social care for older people in the Chinese population.

CONCLUSIONS

the factors and mechanism influencing the client experience of integrated health and social care for older people are complex and multifaceted. Attention should be paid to the direct effects of perception and emotion, institutional functions, intimacy and trust in the client experience, and the indirect effects of social foundation and participation on the client experience.

Routine measurement of patient experience

Patient experience is a key pillar of healthcare quality. We describe a framework of three short generic measures covering Patient Experience, Result Satisfaction and Service Integration. The Result Satisfaction measure is described for the first time.These measures capture twelve aspects of patient experience covering the relationship between patients and clinicians (Patient Experience), the immediate results of the consultation or treatment as perceived by patients (Result Satisfaction) and collaboration between different healthcare services and silos (Service Integration). Each measure has four items.These measures are compared with three national measures: the Friends and Family Test and the General Practice Patient Survey used in England, and HCAHPS used in US hospitals. The expected benefits of national measures are not being achieved and we need to think again about how best to tailor health services to meet patients' expectations.The three measures described (Patient Experience, Result Satisfaction and Service Integration) are generic, short and have low reading ages. They share common forms and scoring schemes, which mean that they can be used individually or in combination at all levels of a healthcare provider.

Phenomenology as a resource for translational research in mental health: methodological trends, challenges and new directions

This editorial reflects on current methodological trends in translational research in mental health. It aims to build a bridge between two fields that are frequently siloed off from each other: interventional research and phenomenologically informed research. Recent years have witnessed a revival of phenomenological approaches in mental health, often - but not only - as a means of connecting the subjective character of experience with neurobiological explanatory accounts of illness. Rich phenomenological knowledge accrued in schizophrenia, and wider psychosis research, has opened up new opportunities for improving prediction, early detection, diagnosis, prognostic stratification, treatment and ethics of care. Novel qualitative studies of delusions and hallucinations have challenged longstanding assumptions about their nature and meaning, uncovering highly complex subjective dimensions that are not adequately captured by quantitative methodologies. Interdisciplinary and participatory research efforts, informed by phenomenological insights, have prompted revisions of pre-established narratives of mental disorder dominated by a dysfunction framework and by researcher-centric outcome measures. Despite these recent advances, there has been relatively little effort to integrate and translate phenomenological insights across applied clinical research, with the goal of producing more meaningful, patient-valued results. It is our contention that phenomenological psychopathology - as the basic science of psychiatry - represents an important methodology for advancing evidence-based practices in mental health, and ultimately improving real-world outcomes. Setting this project into motion requires a greater emphasis on subjectivity and the structures of experience, more attention to the quality and patient-centredness of outcome measures, and the identification of treatment targets that matter most to patients.