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Krieger T, Jozwiak L, Ebersbach G, Suess T, Falkenburger B, Feige T, Eggers C, Warnecke T, Scholl W, Schmidt-Heisch C, Folkerts AK, Kalbe E, Seven ÜS. Exploring the lived experiences of individuals with Parkinson's disease and their relatives: insights into care provision experiences, disease management support, self-management strategies, and future needs in Germany (qualitative study). BMC Neurol 2024; 24:208. [PMID: 38890614 PMCID: PMC11184701 DOI: 10.1186/s12883-024-03696-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 05/29/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Parkinson's disease (PD) significantly impacts the health-related quality of life of affected individuals and their relatives. In order to support the affected individuals and their families in coping with PD, it is essential to offer comprehensive information about their experiences. A comprehensive understanding of their lived experiences with the disease, the healthcare system, applied self-management strategies and their needs is considered crucial for developing a PD support program. Therefore, we aimed to explore the lived experiences and support needs of individuals with PD and their relatives in Germany. METHODS This non-interventional, qualitative study conducted an explorative status quo and needs assessment. It generated knowledge through semi-structured focus groups and interviews with individuals with PD at various disease stages and their relatives. The interviews were digitally recorded, transcribed verbatim, and analysed using content analysis. RESULTS Fifty-two individuals with PD and 29 relatives participated in eight focus groups and 13 paired and 13 individual interviews. Four themes with corresponding subthemes emerged: (1) experiences, revealing individuals' experiences around their diagnosis and with disease-specific care provision; (2) management support offers, clarifying who provides support and the type of support offered; (3) self-management, including comprehensibility, meaningfulness and manageability; and (4) future needs, differentiating between deficits and needs. Most participants expressed a sense of abandonment when obtaining self-management strategies and mastering their lives with PD, often referred to as 'life 2.0'. They identified the lack of structured and adequate provision of information, system orientation and social awareness. CONCLUSIONS In Germany, there is an urgent need for a comprehensive PD care program that addresses the needs of individuals with PD and their relatives from the start of their care trajectory. It could assist individuals in gaining a comprehensive understanding of the disease, obtaining self-management strategies, building a support network, and becoming experts in self-managing their disease. Moreover, it may positively influence their care trajectory and reduce burdens, such as overburdening, fear of progression, and health anxiety. TRIAL REGISTRATION German Clinical Studies Register ( https://www.drks.de/DRKS00030090 , No. DRKS00030090, Date of registration: 15.12.2022).
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Affiliation(s)
- Theresia Krieger
- Medical Psychology | Neuropsychology and Gender Studies, Centre for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany.
| | - Leonie Jozwiak
- Medical Psychology | Neuropsychology and Gender Studies, Centre for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Georg Ebersbach
- Movement Disorder Clinic, Kliniken Beelitz, Beelitz-Heilstätten, Germany
| | - Thorsten Suess
- Movement Disorder Clinic, Kliniken Beelitz, Beelitz-Heilstätten, Germany
| | - Björn Falkenburger
- Department of Neurology, University of Technology Dresden, Dresden, Germany
| | - Tim Feige
- Department of Neurology, University of Technology Dresden, Dresden, Germany
| | - Carsten Eggers
- Knappschaftskrankenhaus Bottrop, Department of Neurology, Bottrop, Germany
| | - Tobias Warnecke
- Department of Neurology, University Hospital Munster, Munster, Germany
| | | | | | - Ann-Kristin Folkerts
- Medical Psychology | Neuropsychology and Gender Studies, Centre for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Elke Kalbe
- Medical Psychology | Neuropsychology and Gender Studies, Centre for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ümran Sema Seven
- Medical Psychology | Neuropsychology and Gender Studies, Centre for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
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Stoycheva T, Jameel A, Bain P, Nandi D, Jones B, Honeyfield L, Gedroyc W, Moore J. 'Am I fixed, am I better now?': undergoing MR-guided focused ultrasound for essential tremor: an interpretative phenomenological analysis. Front Neurol 2024; 15:1352581. [PMID: 38390595 PMCID: PMC10882628 DOI: 10.3389/fneur.2024.1352581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 01/12/2024] [Indexed: 02/24/2024] Open
Abstract
Introduction Essential tremor (ET) is characterised by postural and intentional tremor typically affecting the upper limbs, which can negatively impact functionality and quality of life. Magnetic Resonance-guided Focused Ultrasound (MRgFUS) is a novel and promising non-invasive treatment for ET which offers instantaneous results. Methods Using interpretative phenomenological analysis we explored the experience of undergoing MRgFUS in six ET patients as well as their experiences pre- and post-procedure. Results One-time, retrospective semi-structured interviews were conducted and six themes emerged: Life pre-treatment: "It's everyday tasks that get you down" and "Most people who understand, they are okay. Some people aren't"; MRgFUS: Treatment day: "Going into the unknown" and "There's no way I was going to press that button"; and Life post-treatment: "One is good. Two is better" and "Am I fixed, am I better now?." Discussion The findings point to a significant period of adjustment associated with living with ET and the effects of undergoing ET MRgFUS treatment. As ET progressed, participants struggled to cope with increasing symptoms and had to develop coping strategies to manage life with ET. The procedure itself was perceived as strange and extraordinary and despite some immediate adverse effects participants were determined to go through with it. Post procedure, all participants reported tremor suppression which was life changing. While some participants still felt burdened by ET, others expressed it took them a while to psychologically adjust to what essentially was their new body. This study has highlighted the need for patients to be supported at all stages of their ET journey.
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Affiliation(s)
- Tsvetina Stoycheva
- Imperial College Healthcare NHS Trust, London, United Kingdom
- King's College London, London, England, United Kingdom
| | - Ayesha Jameel
- Imperial College Healthcare NHS Trust, London, United Kingdom
- Imperial College London, London, England, United Kingdom
| | - Peter Bain
- Imperial College Healthcare NHS Trust, London, United Kingdom
- Imperial College London, London, England, United Kingdom
| | - Dipankar Nandi
- Imperial College Healthcare NHS Trust, London, United Kingdom
- Imperial College London, London, England, United Kingdom
| | - Brynmor Jones
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | | | - Wladyslaw Gedroyc
- Imperial College Healthcare NHS Trust, London, United Kingdom
- Imperial College London, London, England, United Kingdom
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Jackson K, Newbury-Birch D. Patient reported experiences of community rehabilitation and/or support services for people with long term neurological conditions: a narrative review of quantitative studies. Disabil Rehabil 2023:1-18. [PMID: 37905706 DOI: 10.1080/09638288.2023.2266369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 09/24/2023] [Indexed: 11/02/2023]
Abstract
Objectives: 1. To identify validated quantitative Patient Reported Experience Measures (PREM's) being used in Community Rehabilitation and/or Support services for people with long term neurological conditions (PwLTNC). 2. To explore how data from quantitative PREM's adds to research on patient experiences of Community Rehabilitation and Support for PwLTNC.Method: Eight data bases were searched for peer reviewed studies (2005-2021) which met inclusion criteria. Data extraction and quality assessment for sixteen studies was performed by two reviewers. Narrative synthesis was conducted.Results: Eleven validated PREM's were identified which captured data for 15,831 PwLTNC. PREM scores indicated positive and negative experiences for people with Multiple Sclerosis (n = 13,123), Parkinson's Disease (n = 2215) and Acquired Brain Injury (n = 493). Negative experiences related to Picker Institute Principles: 1 (accessibility); 3 (coordination/continuity); 4 (involvement/support for family and carers); 5 (information provision), 6 (Involvement in decision making) and 7 (empathy and emotional support).Conclusion: Quantitative PREM's provide evidence of process quality and person-centred care within community rehabilitation and support services across large data sets of heterogeneous neurological conditions and geographical locations. Quality improvement initiatives for people with MS, PD and ABI should target processes relating to Picker Institute Principles 1,3,4,5,6, and 7.Implications for RehabilitationQuantitative validated Patient Reported Experience Measures can be used to evaluate process quality and person- centred care within community rehabilitation and support services for people with long term neurological conditions.Experiences of people with Multiple Sclerosis, Parkinson's Disease and Acquired Brain Injury indicate the need for quality improvement in community rehabilitation.Training in communication skills and person-centred care may enhance information provision and support for self-management for people with long term neurological conditions.
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Affiliation(s)
- Katherine Jackson
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
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Danoudis M, Soh SE, Iansek R. Health care experiences of people with Parkinson's disease in Australia. BMC Geriatr 2023; 23:430. [PMID: 37438688 DOI: 10.1186/s12877-023-04142-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 06/28/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Little is known about the health care experiences of people with Parkinson's disease (PwP) living in Australia. Exploring health care experiences can provide insight into service gaps which can then help direct quality improvement, such as improving communication between patients and health professionals. METHODS This study aimed to examine the health care experiences of a sample of PwP living in Australia using the Patient-Centered Questionnaire for Parkinson's disease (PCQ-PD). Participants were recruited from four sources located in Victoria, Australia: (1) a metropolitan Movement Disorders Program (Group 1); (2) metropolitan based movement disorder neurologists working as sole practitioners and not within multidisciplinary teams (Group 2); (3) a regional based multidisciplinary PD program (Group 3); and (4) PD support groups in regional and rural Victorian towns without PD specialist programs (Group 4). Scores derived from the PCQ-PD included the overall patient-centered score (OPS), six sub-scale experience scores (SES) and the quality improvement scores (QIS). Health care experiences were compared between Groups 1, 2, 3 and 4 and multivariate linear regression models were used to explore factors contributing to patient-centeredness. RESULTS 227 participants reported a mean (SD) OPS score of 1.8 (SD 0.5) with no significant differences between groups. The rating for the Tailored Information subscale was low, (mean 1.3, SD 0.5), with Group 2 having a significantly lower score, 1.1 (SD 0.5), compared to Group 1, 1.4 (SD 0.5) (p = 0.048). Experiences of Continuity of Care and Collaboration of Professionals were rated significantly lower by Group 2, 1.3 (SD 1.0) compared to Groups 1, 1.8 (SD 0.9) (p = 0.018) and 3, 2.1 (SD 0.8) (p = 0.002). Care aspects related to the Tailored Information subscale were prioritised for improvement by all groups. The main predictors of positive health care experiences were disease duration (coeff 0.02; 95% CI 0.00, 0.04) and living with another person (coeff 0.27: 95% CI 0.03, 0.51). CONCLUSION This sample of participants with PD had poor experiences of several aspects of care known to be important in the provision of quality PD care. They prioritised the improvement of personalised health care information and better continuity of care and collaboration between health professionals.
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Affiliation(s)
- Mary Danoudis
- Clinical Research Centre for Movement Disorders and Gait, Kingston Centre, Parkinson's Foundation Centre of Excellence, Monash Health, Cheltenham, VIC, Australia.
- Faculty of Medicine, Nursing and Health Sciences, School of Clinical Sciences, Monash University, Clayton, VIC, Australia.
| | - Sze-Ee Soh
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, Australia
- School of Primary and Allied Health Care, Monash University, Frankston, VIC, Australia
| | - Robert Iansek
- Clinical Research Centre for Movement Disorders and Gait, Kingston Centre, Parkinson's Foundation Centre of Excellence, Monash Health, Cheltenham, VIC, Australia
- Faculty of Medicine, Nursing and Health Sciences, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
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Stefani A, Tessitore A, Tambasco N, Cossu G, Ceravolo MG, Defazio G, Morgante F, Ramat S, Melzi G, Gualberti G, Merolla R, Onuk K, Lopiano L. Criteria for identification of advanced Parkinson’s disease: the results of the Italian subgroup of OBSERVE-PD observational study. BMC Neurol 2022; 22:41. [PMID: 35090406 PMCID: PMC8796340 DOI: 10.1186/s12883-022-02554-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 11/09/2021] [Indexed: 02/05/2023] Open
Abstract
Background Frequency of Advanced Parkinson’s Disease (APD) and its clinical characteristics are still not well defined. Here, we aimed to assess APD prevalence in the Italian OBSERVE-PD cohort, as well as treatment eligibility to device-aided therapies (DAT), and to compare the APD clinical judgment with the established Delphi criteria. Methods This sub-group analysis of the OBSERVE-PD study was performed on patients enrolled by 9 Movement Disorders centers in Italy. Motor and non-motor symptoms, PD characteristics, activities of daily living, and quality of life were assessed. Patient eligibility for DAT, response to current PD treatments, referral process, and the concordance between APD physician’s judgment and Delphi criteria were also assessed. Results According to physician’s judgment, 60 out of 140 patients (43%) had APD. The correlation between physician’s judgment and the overall APD Delphi criteria was substantial (K = 0.743; 95%CI 0.633–0.853), mainly driven by a discrete concordance found for the presence of ≥ 2 h of daily OFF time, presence of troublesome dyskinesia, ≥ 5 times daily oral levodopa dosing, and activities of daily living limitation. Forty-four (73%) APD patients were considered eligible to DAT but only 18 of them (41%) used these therapies, while most patients, independently from their eligibility, continued to use 3–5 oral daily medications, due to fear of invasive solutions and need to have a longer time to decide. Conclusion APD was frequent in the Italian OBSERVE-PD population. DAT in the eligible APD population proved to be underused, in spite of unsatisfactory symptoms control with oral medications in 67% of patients.
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Connor KI, Siebens HC, Mittman BS, Ganz DA, Barry F, McNeese-Smith DK, Cheng EM, Vickrey BG. Implementation fidelity of a nurse-led RCT-tested complex intervention, care coordination for health promotion and activities in Parkinson's disease (CHAPS) in meeting challenges in care management. BMC Neurol 2022; 22:36. [PMID: 35073865 PMCID: PMC8785022 DOI: 10.1186/s12883-021-02481-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 10/19/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Parkinson's disease (PD) complexity poses challenges for individuals with Parkinson's, providers, and researchers. A recent multisite randomized trial of a proactive, telephone-based, nurse-led care management intervention - Care Coordination for Health Promotion and Activities in Parkinson's Disease (CHAPS) - demonstrated improved PD care quality. Implementation details and supportive stakeholder feedback were subsequently published. To inform decisions on dissemination, CHAPS Model components require evaluations of their fidelity to the Chronic Care Model and to their implementation. Additionally, assessment is needed on whether CHAPS addresses care challenges cited in recent literature. METHODS These analyses are based on data from a subset of 140 intervention arm participants and other CHAPS data. To examine CHAPS Model fidelity, we identified CHAPS components corresponding to the Chronic Care Model's six essential elements. To assess implementation fidelity of these components, we examined data corresponding to Hasson's modified implementation fidelity framework. Finally, we identified challenges cited in current Parkinson's care management literature, grouped these into themes using open card sorting techniques, and examined CHAPS data for evidence that CHAPS met these challenges. RESULTS All Chronic Care Model essential elements were addressed by 17 CHAPS components, thus achieving CHAPS Model fidelity. CHAPS implementation fidelity was demonstrated by adherence to content, frequency, and duration with partial fidelity to telephone encounter frequency. We identified potential fidelity moderators for all six of Hasson's moderator types. Through card sorting, four Parkinson's care management challenge themes emerged: unmet needs and suggestions for providers (by patient and/or care partner), patient characteristics needing consideration, and standardizing models for Parkinson's care management. CHAPS activities and stakeholder perceptions addressed all these themes. CONCLUSIONS CHAPS, a supportive nurse-led proactive Parkinson's care management program, improved care quality and is designed to be reproducible and supportive to clinicians. Findings indicated CHAPS Model fidelity occurred to the Chronic Care Model and fidelity to implementation of the CHAPS components was demonstrated. Current Parkinson's care management challenges were met through CHAPS activities. Thus, dissemination of CHAPS merits consideration by those responsible for implementing changes in clinical practice and reaching people in need. TRIAL REGISTRATION ClinicalTrials.gov as NCT01532986 , registered on January 13, 2012.
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Affiliation(s)
- Karen I Connor
- Veterans Affairs Parkinson's Disease Research, Education and Clinical Center, Los Angeles, CA, USA. .,UCLA David Geffen School of Medicine, Los Angeles, CA, USA. .,, Novato, CA, 94945, USA.
| | | | - Brian S Mittman
- Kaiser Permanente Department of Research and Evaluation, Pasadena, CA, USA
| | - David A Ganz
- UCLA David Geffen School of Medicine, Los Angeles, CA, USA.,Veterans Affairs Geriatric Research, Education and Clinical Center and Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, CA, USA
| | - Frances Barry
- UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | | | - Eric M Cheng
- UCLA David Geffen School of Medicine, Los Angeles, CA, USA
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Nixina I, Gatsios D, Paal P, Konitsiotis S, Fotiadis DI. Exploring the knowledge and views of Greek Neurologists regarding Palliative Care Topics. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:7617-7620. [PMID: 34892853 DOI: 10.1109/embc46164.2021.9629508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Palliative care for Parkinson's disease is characterized by inconsistency and varies from country to country. Although some countries have taken significant steps to include palliative care in their health programs, others, such as Greece, are still at an early stage. One step towards the widespread adoption of palliative care is the education of all stakeholders, especially clinicians. This paper presents a preliminary version of a curriculum toolkit for Palliative Care education in Parkinson's disease. Also, we explore Greek neurologists' knowledge of Palliative care based on a questionnaire and present their feedback on the topics included in this toolkit.Clinical Relevance-The toolkit aims to benefit patients in need of palliative care through promoting health literacy and further educating healthcare providers. The proposed toolkit provides all the necessary information to become sufficient knowledge and ultimately translate into clinical practice skills.
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Gatsios D, Antonini A, Gentile G, Konitsiotis S, Fotiadis D, Nixina I, Taba P, Weck C, Lorenzl S, Lex KM, Paal P. Education on palliative care for Parkinson patients: development of the "Best care for people with late-stage Parkinson's disease" curriculum toolkit. BMC MEDICAL EDUCATION 2021; 21:538. [PMID: 34696752 PMCID: PMC8547059 DOI: 10.1186/s12909-021-02964-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 08/28/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Palliative care education among all stakeholders involved in the care of patients with late-stage Parkinson's disease is not adequate. In fact, there are many unmet educational and training needs as confirmed with a targeted, narrative literature review. METHODS To address these needs we have developed the "Best Care for People with Late-Stage Parkinson's Disease" curriculum toolkit. The toolkit is based on recommendations and guidelines for training clinicians and other healthcare professionals involved in palliative care, educational material developed in recent research efforts for patients and caregivers with PD and consensus meetings of leading experts in the field. The final version of the proposed toolkit was drafted after an evaluation by external experts with an online survey, the feedback of which was statistically analysed with the chi-square test of independence to assess experts' views on the relevance and importance of the topics. A sentiment analysis was also done to complement statistics and assess the experts positive and negative sentiments for the curriculum topics based on their free text feedback. RESULTS The toolkit is compliant with Kern's foundational framework for curriculum development, recently adapted to online learning. The statistical analysis of the online survey, aiming at toolkit evaluation from external experts (27 in total), confirms that all but one (nutrition in advanced Parkinson's disease) topics included, as well as their objectives and content, are highly relevant and useful. CONCLUSIONS In this paper, the methods for the development of the toolkit, its stepwise evolution, as well as the toolkit implementation as a Massive Open Online Course (MOOC), are presented. The "Best Care for People with Late-Stage Parkinson' s disease" curriculum toolkit can provide high-quality and equitable education, delivered by an interdisciplinary team of educators. The toolkit can improve communication about palliative care in neurological conditions at international and multidisciplinary level. It can also offer continuing medical education for healthcare providers.
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Affiliation(s)
- Dimitrios Gatsios
- Department of Neurology, Medical School, University of Ioannina, GR-45110, Ioannina, Greece.
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, Ioannina, Greece.
| | - Angelo Antonini
- Parkinson and Movement Disorders Unit, Study Center for Neurodegeneration, Department of Neuroscience, University of Padua, Padua, Italy
| | - Giovanni Gentile
- Parkinson and Movement Disorders Unit, Study Center for Neurodegeneration, Department of Neuroscience, University of Padua, Padua, Italy
| | - Spyridon Konitsiotis
- Department of Neurology, Medical School, University of Ioannina, GR-45110, Ioannina, Greece
| | - Dimitrios Fotiadis
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, Ioannina, Greece
- Department of Biomedical Research, Institute of Molecular Biology and Biotechnology, Foundation for Research and Technology-Hellas, Ioannina, Greece
| | - Irini Nixina
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, Ioannina, Greece
| | - Pille Taba
- Department of Neurology and Neurosurgery, Institute of Clinical Medicine|, University of Tartu, Tartu, Estonia
- Clinic of Neurology, Tartu University Hospital, Tartu, Estonia
| | - Christiane Weck
- University Hospital Agatharied, Hausham, Germany
- Palliative Care Research Hub, WHO Collaborating Centre at the Institute of Nursing Science and Practice, Paracelsus Medical University in Salzburg, Salzburg, Austria
| | - Stefan Lorenzl
- University Hospital Agatharied, Hausham, Germany
- Palliative Care Research Hub, WHO Collaborating Centre at the Institute of Nursing Science and Practice, Paracelsus Medical University in Salzburg, Salzburg, Austria
| | - Katharina Maria Lex
- Palliative Care Research Hub, WHO Collaborating Centre at the Institute of Nursing Science and Practice, Paracelsus Medical University in Salzburg, Salzburg, Austria
| | - Piret Paal
- Palliative Care Research Hub, WHO Collaborating Centre at the Institute of Nursing Science and Practice, Paracelsus Medical University in Salzburg, Salzburg, Austria
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Ypinga JHL, Van Halteren AD, Henderson EJ, Bloem BR, Smink AJ, Tenison E, Munneke M, Ben-Shlomo Y, Darweesh SKL. Rationale and design to evaluate the PRIME Parkinson care model: a prospective observational evaluation of proactive, integrated and patient-centred Parkinson care in The Netherlands (PRIME-NL). BMC Neurol 2021; 21:286. [PMID: 34294077 PMCID: PMC8298196 DOI: 10.1186/s12883-021-02308-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 07/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Culminating evidence shows that current care does not optimally meet the needs of persons with parkinsonism, their carers and healthcare professionals. Recently, a new model of care was developed to address the limitations of usual care: Proactive and Integrated Management and Empowerment in Parkinson's Disease (PRIME Parkinson). From 2021 onwards, PRIME Parkinson care will replace usual care in a well-defined region in The Netherlands. The utility of PRIME Parkinson care will be evaluated on a single primary endpoint (parkinsonism-related complications), which reflects the health of people with parkinsonism. Furthermore, several secondary endpoints will be measured for four dimensions: health, patient and carer experience, healthcare professional experience, and cost of healthcare. The reference will be usual care, which will be continued in other regions in The Netherlands. METHODS This is a prospective observational study which will run from January 1, 2020 until December 31, 2023. Before the new model of care will replace the usual care in the PRIME Parkinson care region all baseline assessments will take place. Outcomes will be informed by two data sources. We will use healthcare claims-based data to evaluate the primary endpoint, and costs of healthcare, in all persons with parkinsonism receiving PRIME Parkinson care (estimated number: 2,000) and all persons with parkinsonism receiving usual care in the other parts of The Netherlands (estimated number: 48,000). We will also evaluate secondary endpoints by performing annual questionnaire-based assessments. These assessments will be administered to a subsample across both regions (estimated numbers: 1,200 persons with parkinsonism, 600 carers and 250 healthcare professionals). DISCUSSION This prospective cohort study will evaluate the utility of a novel integrated model of care for persons with parkinsonism in The Netherlands. We anticipate that the results of this study will also provide insight for the delivery of care to persons with parkinsonism in other regions and may inform the design of a similar model for other chronic health conditions.
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Affiliation(s)
- Jan H L Ypinga
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Angelika D Van Halteren
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Emily J Henderson
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU, UK
- Older People's Unit, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, UK
| | - Bastiaan R Bloem
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Agnes J Smink
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Emma Tenison
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU, UK
| | - Marten Munneke
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Yoav Ben-Shlomo
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU, UK
| | - Sirwan K L Darweesh
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
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Peláez Bejarano A, de las Aguas Robustillo Cortés M, Guzman Ramos MI. Patient experience in a rare disease: application of the IEXPAC questionnaire in hereditary transthyretin-mediated amyloidosis. Expert Opin Orphan Drugs 2021. [DOI: 10.1080/21678707.2021.1953468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Ana Peláez Bejarano
- Unidad de Gestión Clínica Farmacia, Hospital Juan Ramón Jiménez, Huelva, Spain
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Connor KI, Siebens HC, Mittman BS, McNeese-Smith DK, Ganz DA, Barry F, Edwards LK, McGowan MG, Cheng EM, Vickrey BG. Stakeholder perceptions of components of a Parkinson disease care management intervention, care coordination for health promotion and activities in Parkinson's disease (CHAPS). BMC Neurol 2020; 20:437. [PMID: 33267827 PMCID: PMC7708498 DOI: 10.1186/s12883-020-02011-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 11/23/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND A recent nurse-led proactive care management intervention, Care Coordination for Health Promotion and Activities in Parkinson Disease (CHAPS), improved care quality when compared to usual care in a randomized controlled trial. Therefore, stakeholder (patient participants, nurse care managers, and Parkinson disease (PD) specialists) perceptions of key intervention components merit evaluation to inform decisions about dissemination. METHODS This multi-site study occurred in five southwest United States Veterans Health Administration medical centers. Stakeholders were surveyed on their perceptions of CHAPS including the CHAPS Assessment, CHAPS nurse care managers, the Siebens Domain Management Model™ (a practical clinical model), and the Siebens Health Care Notebook (Notebook) (self-care tool). Participants' electronic medical records were abstracted for perceptions of the Notebook. Statistical analysis software was used to provide summary statistics; open card sorting methodology was used to identify themes and attributes in qualitative data including usability of some components. RESULTS Participants, overall, highly rated their medication self-management, acknowledged some challenges with the CHAPS self-care tools, reported knowledge of PD specialist follow-up and PD red flags, and rated CHAPS nurse care managers as helpful. Nurse care manager responses indicated the CHAPS Assessment and Program highly facilitated care of their patients. Most all PD specialists would refer other patients to CHAPS. Nurse care manager and PD specialist responses indicated improved participant management of their PD. Three themes emerged in participant perceptions of the Notebook: Notebook Assets (e.g., benefits and features-liked); Deferring Notebook Review (e.g., no time to review); and Reasons for Not Using (e.g., participant preference). Shared attributes regarding the Siebens Domain Management Model and Notebook usability, reported by nurse care managers, were user-friendly, person/patient-centered, and organized. Some challenges to their use were also reported. CONCLUSIONS Overall, stakeholder perceptions of the proactive nurse-led CHAPS intervention indicated its value in the care of individuals with PD. Responses about the CHAPS Assessment, Siebens Domain Management Model, and Notebook self-care tool signified their usefulness. Stakeholders' constructive suggestions indicated their engagement in CHAPS. These findings support CHAPS dissemination and contribute to research in care management. TRIAL REGISTRATION ClinicalTrials.gov as NCT01532986 , registered on January 13, 2012.
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Affiliation(s)
- Karen I. Connor
- Veterans Affairs Parkinson’s Disease Research, Education and Clinical Center, Los Angeles, CA USA
- UCLA David Geffen School of Medicine, Los Angeles, CA USA
- Novato, CA USA
| | | | | | | | - David A. Ganz
- UCLA David Geffen School of Medicine, Los Angeles, CA USA
- Veterans Affairs Geriatric Research, Education and Clinical Center and Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, CA USA
| | - Frances Barry
- UCLA David Geffen School of Medicine, Los Angeles, CA USA
| | - Lisa K. Edwards
- Veterans Affairs Parkinson’s Disease Research, Education and Clinical Center, Los Angeles, CA USA
| | - Michael G. McGowan
- Veterans Affairs Parkinson’s Disease Research, Education and Clinical Center, Los Angeles, CA USA
| | - Eric M. Cheng
- UCLA David Geffen School of Medicine, Los Angeles, CA USA
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12
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Radder DLM, Nonnekes J, van Nimwegen M, Eggers C, Abbruzzese G, Alves G, Browner N, Chaudhuri KR, Ebersbach G, Ferreira JJ, Fleisher JE, Fletcher P, Frazzitta G, Giladi N, Guttman M, Iansek R, Khandhar S, Klucken J, Lafontaine AL, Marras C, Nutt J, Okun MS, Parashos SA, Munneke M, Bloem BR. Recommendations for the Organization of Multidisciplinary Clinical Care Teams in Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2020; 10:1087-1098. [PMID: 32444563 PMCID: PMC7415700 DOI: 10.3233/jpd-202078] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background: Optimal management in expert centers for Parkinson’s disease (PD) usually involves pharmacological and non-pharmacological interventions, delivered by a multidisciplinary approach. However, there is no guideline specifying how this model should be organized. Consequently, the nature of multidisciplinary care varies widely. Objective: To optimize care delivery, we aimed to provide recommendations for the organization of multidisciplinary care in PD. Methods: Twenty expert centers in the field of multidisciplinary PD care participated. Their leading neurologists completed a survey covering eight themes: elements for optimal multidisciplinary care; team members; role of patients and care partners; team coordination; team meetings; inpatient versus outpatient care; telehealth; and challenges towards multidisciplinary care. During a consensus meeting, outcomes were incorporated into concept recommendations that were reviewed by each center’s multidisciplinary team. Three patient organizations rated the recommendations according to patient priorities. Based on this feedback, a final set of recommendations (essential elements for delivery of multidisciplinary care) and considerations (desirable elements) was developed. Results: We developed 30 recommendations and 10 considerations. The patient organizations rated the following recommendations as most important: care is organized in a patient-centered way; every newly diagnosed patient has access to a core multidisciplinary team; and each team has a coordinator. A checklist was created to further facilitate its implementation. Conclusion: We provide a practical tool to improve multidisciplinary care for persons with PD at the organizational level. Future studies should focus on implementing these recommendations in clinical practice, evaluating their potential applicability and effectiveness, and comparing alternative models of PD care.
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Affiliation(s)
- Danique L M Radder
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour; Department of Neurology, Nijmegen, The Netherlands
| | - Jorik Nonnekes
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation; Nijmegen, The Netherlands
| | - Marlies van Nimwegen
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour; Department of Neurology, Nijmegen, The Netherlands
| | - Carsten Eggers
- Department of Neurology, University Hospital of Marburg, Marburg, Germany
| | - Giovanni Abbruzzese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa - IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Guido Alves
- The Norwegian Center for Movement Disorders, Department of Neurology, Stavanger University Hospital, Stavanger, Norway
| | - Nina Browner
- University of North Carolina, Movement Disorders Center, Chapel Hill, NC, USA
| | - K Ray Chaudhuri
- Institute of Psychiatry, Psychology & Neuroscience, Parkinson Foundation International Center of Excellence, King's College Hospital, Denmark Hill, London, UK
| | - Georg Ebersbach
- Movement Disorder Clinic Beelitz-Heilstaetten, Beelitz, Germany
| | - Joaquim J Ferreira
- Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.,CNS - Campus Neurológico Sénior, Torres Vedras, Portugal
| | | | | | | | - Nir Giladi
- Neurological Institute, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Sagol School of Neuroscience, Tel-Aviv University, Tel Aviv, Israel
| | | | | | - Suketu Khandhar
- Kaiser Permanente Sacramento Medical Center, Sacramento, CA, USA
| | - Jochen Klucken
- Department of Molecular Neurology, University Hospital Erlangen, Erlangen, Germany.,Research Group Digital Health Pathways, Fraunhofer IIS, Erlangen, Germany
| | - Anne-Louise Lafontaine
- Department of Neurology and Neurosurgery, McGill Movement Disorders Clinic, McGill University, Montreal, Canada
| | - Connie Marras
- The Edmond J Safra Program in Parkinson's disease and the Morton and Gloria Shulman Movement Disorders Center, Toronto Western Hospital, Toronto, Canada
| | - John Nutt
- Oregon & Health Science University Hospital, Portland, OR, USA
| | - Michael S Okun
- University of Florida Department of Neurology, Fixel Center for Neurological Diseases, Program for Movement Disorders and Neurorestoration, Gainesville, FL, USA
| | | | - Marten Munneke
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour; Department of Neurology, Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour; Department of Neurology, Nijmegen, The Netherlands
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Forner D, Ungar G, Chorney J, Meier J, Hong P. Turn analysis and patient-centredness in paediatric otolaryngology surgical consultations. Clin Otolaryngol 2020; 45:725-731. [PMID: 32368851 DOI: 10.1111/coa.13564] [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] [Received: 11/05/2019] [Revised: 04/13/2020] [Accepted: 04/26/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Physician and patient/parent communication is of utmost importance in consultations to improve the shared decision-making (SDM) processes. This study investigated SDM-related outcomes through turn analysis and an assessment of patient-centred dialogue. DESIGN Multi-centre prospective cohort study analysing audio- and video-recorded patient/parent-physician interactions. SETTING Two tertiary paediatric hospitals in Halifax, Nova Scotia and Salt Lake City, Utah. PARTICIPANTS Paediatric otolaryngologists, patients and parents during consultation for adenotonsillectomy. MAIN OUTCOME MEASURES Medical dialogue measures (turn analysis, patient-centredness scores via the Roter Interaction Analysis System) and SDM questionnaires (SDM-Q-9). RESULTS Turn density was significantly higher for physicians than patients/parents (P < .001), as were total statements (P < .001), and total time talking (P < .001). The opening statement was completed by the physician in 91.5% of interactions and was significantly longer than family opening statements (P = .003). The mean number of informed consent elements addressed per interaction was 4.5 out of 6. The mean patient-centredness score was 0.2 (range 0-0.56). Significant negative correlations between patient-centredness score and physician turn density (r = -.390, P = .002), physician mean turn time (r = -.406, P = .001), total physician statements (r = -.426, P = .001) and total physician speaking time (r = -.313, P = .016) were noted. There were no correlations in SDM questionnaire scores with turn analysis variables, informed consent elements or patient-centredness scores. CONCLUSIONS Surgeons dominated the consultation in terms of talking, mostly in a unidirectional manner. Neither patient-centredness nor turn analysis correlated with perceptions of SDM from the parents' perspective.
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Affiliation(s)
- David Forner
- IWK Health Centre, Halifax, NS, Canada.,Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - Gilanders Ungar
- IWK Health Centre, Halifax, NS, Canada.,Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada.,Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada
| | - Jill Chorney
- IWK Health Centre, Halifax, NS, Canada.,Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada
| | - Jeremy Meier
- Primary Children's Hospital, Salt Lake City, UT, USA.,Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Paul Hong
- IWK Health Centre, Halifax, NS, Canada.,Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada
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Patients' Perspective of Comprehensive Parkinson Care in Rural Victoria. PARKINSONS DISEASE 2020; 2020:2679501. [PMID: 32318258 PMCID: PMC7150699 DOI: 10.1155/2020/2679501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 03/06/2020] [Indexed: 11/17/2022]
Abstract
Methods This descriptive study used a survey to explore health-care experiences. Questionnaires were mailed to participants living in rural Victoria. Eligibility criteria included having a diagnosis of PD or Parkinsonism and sufficient English to respond to the survey. The validated Patient-Centred Questionnaire for PD was used to measure health-care experiences. The questions are grouped accordingly under one of the 6 subscales or domains. Outcomes from the questionnaire included summary experience scores (SES) for 6 subscales; overall patient-centeredness score (OPS); and quality improvement scores (QIS). Secondary outcomes included health-related quality of life using the disease-specific questionnaire PDQ39; disease severity using the Hoehn and Yahr staging tool; and disability using the Movement Disorders Society-Unified Parkinson's Disease Rating Scale, part II. Results Thirty-nine surveys were returned from the East Gippsland group and 68 from the rural group. The East Gippsland group rated significantly more positive the subscales “empathy and PD expertise,” P=0.02, and “continuity and collaboration of professionals,” P=0.01. The groups did not differ significantly for the remaining 4 subscales (P > 0.05) nor for the OPS (P=0.17). The QIS showed both groups prioritised the health-care aspect “provision of tailored information” for improvement. Quality of life was greater (P < 0.05) and impairment (P=0.012) and disability were less (P=0.002) in the East Gippsland group. Conclusion Participants who received health care from the East Gippsland program had better key health-care experiences along with better QOL and less impairment and disability. Participants prioritised provision of information as needing further improvement.
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Ziabakhsh S, Albert A, Houlihan E. Development and Validation of a Brief Hospital-Based Ambulatory Patient Experience Survey Tool. HEALTHCARE POLICY = POLITIQUES DE SANTE 2020; 15:100-114. [PMID: 32077848 DOI: 10.12927/hcpol.2019.25968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
Recognition of the value of the patient perspective on services has led healthcare organizations to measure patient care experiences. A brief, generic and psychometrically sound scale to measure patient experiences in ambulatory/outpatient settings in Canada would be useful and is currently lacking. The purpose of this study was to develop and validate an English-language hospital-based ambulatory patient experience survey tool in a Canadian context. Based on a review of more than 20 instruments measuring experiences predominately in non-acute care settings, we initially selected 27 items to be included in the questionnaire, addressing quality dimensions of access, communication, continuity and coordination, shared decision making, emotional support, trust/confidence, privacy, patient-reported impact and physical environment. The survey instrument was subsequently tested among 1,219 ambulatory patients, and its psychometric properties were assessed. A final questionnaire was produced with 14 items and two emerging subscales: Patient-Provider Communication and Overall Quality of Experience, as determined by a factor analysis. The items within the scale showed high construct validity. Reliability was also excellent for the instrument. The applicability of this tool in supporting quality improvement initiatives is discussed.
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Affiliation(s)
- Shabnam Ziabakhsh
- Evaluation Specialist, BC Women's Hospital + Health Centre, Vancouver, BC
| | - Arianne Albert
- Biostatistician, Women's Health Research Institute, Vancouver, BC, Adjunct Associate Professor, University of British Columbia, Vancouver, BC
| | - Edwina Houlihan
- Senior Director, Patient Care Services, BC Women's Hospital + Health Centre, Vancouver, BC
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16
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Bull C, Byrnes J, Hettiarachchi R, Downes M. A systematic review of the validity and reliability of patient-reported experience measures. Health Serv Res 2019; 54:1023-1035. [PMID: 31218671 PMCID: PMC6736915 DOI: 10.1111/1475-6773.13187] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To identify patient-reported experience measures (PREMs), assess their validity and reliability, and assess any bias in the study design of PREM validity and reliability testing. DATA SOURCES/STUDY SETTING Articles reporting on PREM development and testing sourced from MEDLINE, CINAHL and Scopus databases up to March 13, 2018. STUDY DESIGN Systematic review. DATA COLLECTION/EXTRACTION METHODS Critical appraisal of PREM study design was undertaken using the Appraisal tool for Cross-Sectional Studies (AXIS). Critical appraisal of PREM validity and reliability was undertaken using a revised version of the COSMIN checklist. PRINCIPAL FINDINGS Eighty-eight PREMs were identified, spanning across four main health care contexts. PREM validity and reliability was supported by appropriate study designs. Internal consistency (n = 58, 65.2 percent), structural validity (n = 49, 55.1 percent), and content validity (n = 34, 38.2 percent) were the most frequently reported validity and reliability tests. CONCLUSIONS Careful consideration should be given when selecting PREMs, particularly as seven of the 10 validity and reliability criteria were not undertaken in ≥50 percent of the PREMs. Testing PREM responsiveness should be prioritized for the application of PREMs where the end user is measuring change over time. Assessing measurement error/agreement of PREMs is important to understand the clinical relevancy of PREM scores used in a health care evaluation capacity.
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Affiliation(s)
- Claudia Bull
- Centre for Applied Health Economics (CAHE)Griffith UniversityBrisbaneQueenslandAustralia
- Menzies Health Institute Queensland (MHIQ)BrisbaneQueenslandAustralia
| | - Joshua Byrnes
- Centre for Applied Health Economics (CAHE)Griffith UniversityBrisbaneQueenslandAustralia
- Menzies Health Institute Queensland (MHIQ)BrisbaneQueenslandAustralia
| | - Ruvini Hettiarachchi
- Centre for Applied Health Economics (CAHE)Griffith UniversityBrisbaneQueenslandAustralia
- Menzies Health Institute Queensland (MHIQ)BrisbaneQueenslandAustralia
| | - Martin Downes
- Centre for Applied Health Economics (CAHE)Griffith UniversityBrisbaneQueenslandAustralia
- Menzies Health Institute Queensland (MHIQ)BrisbaneQueenslandAustralia
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17
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Beaton NR, Watson S, Browne P, Sharma H, Mai GT, Harvey J, Bernard A, Brown E, Hargrave C, Lehman M. Deep inspiration breath hold in breast cancer: Development and analysis of a patient experience questionnaire. J Med Imaging Radiat Oncol 2018; 62:854-860. [PMID: 30175890 DOI: 10.1111/1754-9485.12795] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 07/26/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Evidence that Deep Inspiration Breath Hold (DIBH) can reduce cardiac dose during left-sided breast radiation therapy (RT) has led to widespread uptake of this technology. There is a paucity of published information documenting the impact of this technique on the patient's treatment experience. The aim of this study was to develop a tool to assess the patient's experience with the introduction of DIBH using the Elekta® Active Breathing Coordinator (ABC) in a single institution. METHODS A patient experience questionnaire was developed and was completed at three different stages of the patient's treatment; at planning, during the second week of treatment (day 6-10) and during the final week of treatment. RESULTS Questionnaire data were collected from 30 patients, who underwent DIBH breast treatment during the period March 2016 to May 2017. Patients were very happy with their use of the ABC equipment and most felt they were well supported and informed during their treatment. Levels of general fatigue and personal anxiety were identified to significantly increase from planning to the conclusion of treatment (P = 0.002 and P < 0.001 respectively). CONCLUSIONS This study produced a useful tool to measure patient experience during DIBH treatment. It demonstrated that the use of the technique was acceptable to patients and did not increase their distress. It provided a compelling case for the provision of tailored, well-communicated information, consistent routine and emotional support for patients throughout their entire treatment. The tool could be employed to assess the patient experience as new technologies are introduced into RT.
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Affiliation(s)
- Nakia-Rae Beaton
- Radiation Oncology Department, Cancer Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Sharon Watson
- Radiation Oncology Department, Cancer Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Patricia Browne
- Radiation Oncology Department, Cancer Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Harish Sharma
- Radiation Oncology Department, Cancer Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Gang Tao Mai
- Radiation Oncology Department, Cancer Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Jennifer Harvey
- Radiation Oncology Department, Cancer Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Anne Bernard
- QFAB Bioinformatics, Institute for Molecular Bioscience, University of Queensland, Brisbane, Queensland, Australia
| | - Elizabeth Brown
- Radiation Oncology Department, Cancer Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Catriona Hargrave
- Radiation Oncology Department, Cancer Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Margot Lehman
- Radiation Oncology Department, Cancer Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
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Schrag A, Khan K, Hotham S, Merritt R, Rascol O, Graham L. Experience of care for Parkinson's disease in European countries: a survey by the European Parkinson's Disease Association. Eur J Neurol 2018; 25:1410-e120. [DOI: 10.1111/ene.13738] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 06/21/2018] [Indexed: 12/01/2022]
Affiliation(s)
- A. Schrag
- Department of Clinical Neurosciences; Institute of Neurology; University College London; London UK
| | - K. Khan
- Department of Clinical Neurosciences; Institute of Neurology; University College London; London UK
| | - S. Hotham
- Centre for Health Services Studies; University of Kent; Canterbury UK
| | - R. Merritt
- Centre for Health Services Studies; University of Kent; Canterbury UK
- University of Surrey; Guildford UK
| | - O. Rascol
- Départements de Pharmacologie Clinique et de Neurosciences; Centre Hospitalo-Universitaire de Toulouse and INSERM; Centre d'Investigation Clinique CIC1436; Centre Expert Parkinson, NeuroToul COEN Centre of Excellence in Neurodegeneration; Université de Toulouse; Toulouse France
| | - L. Graham
- European Parkinson's Disease Association; Sevenoaks UK
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Benge JF, Heemsbergen T, Nelson RA, Konesheck DO, Konesheck B, Aaron CS. Toward patient-centered outcomes for cognitive evaluations: the perspective of those affected by Parkinson's disease. Clin Neuropsychol 2017; 32:1303-1318. [PMID: 29261024 DOI: 10.1080/13854046.2017.1414884] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Patient-centered outcomes research is predicated on the idea that the opinions, attitudes, and preferences of patients should help inform study design and interpretation. To date, little is known about what defines patient-centered outcomes from cognitive evaluations. The current evaluation sought to explore this issue in persons with Parkinson's disease (PwPD) and their care partners (CP). METHOD Focus groups of 22 PwPD/CP dyads were conducted to identify potential consumer oriented endpoints from cognitive evaluations. These endpoints were utilized to create a Patient-Centered Cognitive Assessment Outcomes Scale, which was administered to a different group of 50 PwPD/CP dyads who rated the importance of each outcome and identified their top three priority outcomes. RESULTS Three themes emerged from the focus groups: improved knowledge, advice, and planning. Both PwPD and CP rated items in all three domains as being very important outcomes. Priorities for outcomes in both groups favored treatment planning information slightly above knowledge based outcomes. CONCLUSIONS The PwPD and CP identified improved knowledge, advice for daily activities, and knowledge they could use to plan for future eventualities as very important. This information can be used as a framework for future studies aimed at demonstrating patient-centered outcomes from neuropsychological evaluations. Implications for future research are discussed.
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Affiliation(s)
- Jared F Benge
- a Division of Neuropsychology, Department of Neurology , Baylor Scott and White Health , Temple , TX , USA.,b Plummer Movement Disorders Center , Baylor Scott & White Health , Temple , TX , USA.,c Department of Internal Medicine , Texas A&M Health Science Center , Temple , TX , USA
| | - Teresa Heemsbergen
- d Parkinson's Foundation - Parkinson's Advocates in Research (PAIR) , New York , NY , USA
| | - Ronald A Nelson
- d Parkinson's Foundation - Parkinson's Advocates in Research (PAIR) , New York , NY , USA
| | - David O Konesheck
- d Parkinson's Foundation - Parkinson's Advocates in Research (PAIR) , New York , NY , USA
| | - Bonny Konesheck
- d Parkinson's Foundation - Parkinson's Advocates in Research (PAIR) , New York , NY , USA
| | - Charles S Aaron
- e Georgetown Area Parkinson's Support Group , Georgetown , TX , USA.,f Independent Consultant
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Parkinson's disease patient preference and experience with various methods of DBS lead placement. Parkinsonism Relat Disord 2017; 41:25-30. [PMID: 28615151 DOI: 10.1016/j.parkreldis.2017.04.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 04/08/2017] [Accepted: 04/16/2017] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Physiology-guided deep brain stimulation (DBS) surgery requires patients to be awake during a portion of the procedure, which may be poorly tolerated. Interventional MRI-guided (iMRI) DBS surgery was developed to use real-time image guidance, obviating the need for patients to be awake during lead placement. METHODS All English-speaking adults with PD who underwent iMRI DBS between 2010 and 2014 at our Center were invited to participate. Subjects completed a structured interview that explored perioperative preferences and experiences. We compared these responses to patients who underwent the physiology-guided method, matched for age and gender. RESULTS Eighty-nine people with PD completed the study. Of those, 40 underwent iMRI, 44 underwent physiology-guided implantation, and five underwent both methods. There were no significant differences in baseline characteristics between groups. The primary reason for choosing iMRI DBS was a preference to be asleep during implantation due to: 1) a history of claustrophobia; 2) concerns about the potential for discomfort during the awake physiology-guided procedure in those with an underlying pain syndrome or severe off-medication symptoms; or 3) non-specific fear about being awake during neurosurgery. CONCLUSION Participants were satisfied with both DBS surgery methods. However, identification of the factors associated with a preference for iMRI DBS may allow for optimization of patient experience and satisfaction when choices of surgical methods for DBS implantation are available.
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Bouça-Machado R, Titova N, Chaudhuri KR, Bloem BR, Ferreira JJ. Palliative Care for Patients and Families With Parkinson's Disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 132:475-509. [PMID: 28554419 DOI: 10.1016/bs.irn.2017.02.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Parkinson's disease is the second most common neurodegenerative disease worldwide. There is widespread consensus that Parkinson patients, their carers, and clinicians involved in their care would benefit from a fully integrated, need-based provision of palliative care. However, the concept of palliative care in Parkinson's disease is still poorly defined and, consequently, poorly implemented into daily clinical practice. A particular challenge is the gradually progressive nature of Parkinson's disease-with insidiously increasing disability-making it challenging to clearly define the onset of palliative care needs for Parkinson patients. As people with Parkinson's disease are now living longer than in the past, future research needs to develop a more robust evidence-based approach to clarify the disease events associated with increased palliative care needs, and to examine these, prospectively, in an integrated palliative care service. The modern palliative care outlook, termed "simultaneous care,",is no longer restricted to the final stage of disease. It involves incorporating a continuity of care, effective management of the chronic-palliative interface, and a multidisciplinary network of professionals working both in the community and in specialized clinics, with active involvement of caregivers. Although promising, there is still a need to demonstrate the effectiveness of palliative care for patients with Parkinson's disease.
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Affiliation(s)
- Raquel Bouça-Machado
- Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal; CNS-Campus Neurológico Sénior, Torres Vedras, Portugal
| | - Nataliya Titova
- Federal State Budgetary Educational Institution of Higher Education "N.I. Pirogov Russian National Research Medical University" of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - K Ray Chaudhuri
- National Parkinson Foundation International Centre of Excellence, Kings College and Kings College Hospital, London, United Kingdom; Maurice Wohl Clinical Neuroscience Institute, Kings College, London, United Kingdom; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre (BRC) and Dementia Unit at South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Bas R Bloem
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Joaquim J Ferreira
- Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal; CNS-Campus Neurológico Sénior, Torres Vedras, Portugal; Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.
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Using a smartphone-based self-management platform to support medication adherence and clinical consultation in Parkinson's disease. NPJ PARKINSONS DISEASE 2017. [PMID: 28649602 PMCID: PMC5460235 DOI: 10.1038/s41531-016-0003-z] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The progressive nature of Parkinson’s disease, its complex treatment regimens and the high rates of comorbid conditions make self-management and treatment adherence a challenge. Clinicians have limited face-to-face consultation time with Parkinson’s disease patients, making it difficult to comprehensively address non-adherence. Here we share the results from a multi-centre (seven centres) randomised controlled trial conducted in England and Scotland to assess the impact of using a smartphone-based Parkinson’s tracker app to promote patient self-management, enhance treatment adherence and quality of clinical consultation. Eligible Parkinson’s disease patients were randomised using a 1:1 ratio according to a computer-generated random sequence, stratified by centre and using blocks of variable size, to intervention Parkinson’s Tracker App or control (Treatment as Usual). Primary outcome was the self-reported score of adherence to treatment (Morisky medication adherence scale −8) at 16 weeks. Secondary outcomes were Quality of Life (Parkinson’s disease questionnaire −39), quality of consultation for Parkinson’s disease patients (Patient-centred questionnaire for Parkinson’s disease), impact on non-motor symptoms (Non-motor symptoms questionnaire), depression and anxiety (Hospital anxiety and depression scale) and beliefs about medication (Beliefs about Medication Questionnaire) at 16 weeks. Primary and secondary endpoints were analysed using a generalised linear model with treatment as the fixed effect and baseline measurement as the covariate. 158 patients completed the study (Parkinson’s tracker app = 68 and TAU = 90). At 16 weeks Parkinson’s tracker app significantly improved adherence, compared to treatment as usual (mean difference: 0.39, 95%CI 0.04–0.74; p = 0.0304) with no confounding effects of gender, number of comorbidities and age. Among secondary outcomes, Parkinson’s tracker app significantly improved patients’ perception of quality of consultation (0.15, 95% CI 0.03 to 0.27; p = 0.0110). The change in non-motor symptoms was −0.82 (95% CI −1.75 to 0.10; p = 0.0822). 72% of participants in the Parkinson’s tracker app group continued to use and engage with the application throughout the 16-week trial period. The Parkinson’s tracker app can be an effective and novel way of enhancing self-reported medication adherence and quality of clinical consultation by supporting self-management in Parkinson’s disease in patients owning smartphones. Further work is recommended to determine whether the benefits of the intervention are maintained beyond the 16 week study period. A smartphone-based application improves treatment adherence of patients with Parkinson’s disease (PD). Rashmi Lakshminarayana, from uMotif Ltd, and researchers from the UK and The Netherlands describe the results of a 16 week trial of a Parkinson’s tracker app (PTA) that randomised 215 patients from seven different health centres. Patients using the app reported significantly better adherence to their medication plan compared with control patients who continued their treatment as usual. Interestingly, using the PTA also improved the patients’ perception of the quality of their clinical care, possibly as a result of feeling more involved and in control of their care. These findings suggest that by sending medication reminders and tracking symptoms, the app can help patients with Parkinson’s self-manage their increasingly complex treatment regimen as the disease progresses.
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van der Eijk M, Bloem BR, Nijhuis FAP, Koetsenruijter J, Vrijhoef HJM, Munneke M, Wensing M, Faber MJ. Multidisciplinary Collaboration in Professional Networks for PD A Mixed-Method Analysis. JOURNAL OF PARKINSONS DISEASE 2016; 5:937-45. [PMID: 26444096 DOI: 10.3233/jpd-150673] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND ParkinsonNet, a nationwide organization with regionally oriented professional health networks in TheNetherlands, aims to improve the quality of Parkinson care. Facilitation of multidisciplinary collaboration is a key objective of ParkinsonNet. OBJECTIVES This study examined whether the concept enhances multidisciplinary collaboration between healthcare professionals involved in Parkinson care. METHODS A regional network involving 101 healthcare professionals was newly established. Participants received two questionnaires. One aimed at documenting direct working relationships ('connections') between professionals and the other aimed at evaluating multidisciplinary team performance. Additionally, thirteen healthcare professionals were interviewed to identify barriers and facilitators for multidisciplinary collaboration. 'Social network analysis' focused on sub-networks around three community hospitals at baseline and one year after the implementation. RESULTS The number of 'knowing each other' connections increased from 1431 to 2175 (52% , p < 0.001) and 'professional contact' connections increased from 664 to 891 (34% , p < 0.001). Large differences between sub-networks were found, positive changes being associated with a central role of neurologists and nurse specialists committed to multidisciplinary care. The perceived team performance did not change. Participants experienced problems with information exchange and interdisciplinary communication. Generally, participants were unaware of other healthcare professionals involved in individual patients and what treatments they provide simultaneously. CONCLUSIONS ParkinsonNet partially enhanced multidisciplinary collaboration between healthcare professionals involved in Parkinson care. Crucial facilitators of this were a central role of nurse specialists and the commitment to collaborate with and refer to expert therapists among neurologists. Additional measures are needed to further improve multidisciplinary care across different institutions and around individual patients.
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Affiliation(s)
- Martijn van der Eijk
- Department of Neurology, Radboud Institute of Health Sciences (RIHS), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frouke A P Nijhuis
- Department of Neurology, Radboud Institute of Health Sciences (RIHS), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan Koetsenruijter
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hubertus J M Vrijhoef
- Tilburg School of Social and Behavioral Sciences, Tranzo, Scientific center for care and welfare, The Netherlands.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Marten Munneke
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Michel Wensing
- Department of Neurology, Radboud Institute of Health Sciences (RIHS), Radboud University Medical Center, Nijmegen, The Netherlands.,Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marjan J Faber
- Department of Neurology, Radboud Institute of Health Sciences (RIHS), Radboud University Medical Center, Nijmegen, The Netherlands.,Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, Nijmegen, The Netherlands
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van der Eijk M, Faber MJ, Post B, Okun MS, Schmidt P, Munneke M, Bloem BR. Capturing patients' experiences to change Parkinson's disease care delivery: a multicenter study. J Neurol 2015; 262:2528-38. [PMID: 26292793 PMCID: PMC4639577 DOI: 10.1007/s00415-015-7877-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 07/31/2015] [Accepted: 08/01/2015] [Indexed: 11/30/2022]
Abstract
Capturing patients’ perspectives has become an essential part of a quality of care assessment. The patient centeredness questionnaire for PD (PCQ-PD) has been validated in The Netherlands as an instrument to measure patients’ experiences. This study aims to assess the level of patient centeredness in North American Parkinson centers and to demonstrate the PCQ-PD’s potential as a quality improvement instrument. 20 Parkinson Centers of Excellence participated in a multicenter study. Each center asked 50 consecutive patients to complete the questionnaire. Data analyses included calculating case mix-adjusted scores for overall patient centeredness (scoring range 0–3), six subscales (0–3), and quality improvement (0–9). Each center received a feedback report on their performance. The PCQ-PD was completed by 972 PD patients (median 50 per center, range 37–58). Significant differences between centers were found for all subscales, except for emotional support (p < 0.05). The information subscale (mean 1.62 SD 0.62) and collaboration subscale (mean 2.03 SD 0.58) received the lowest experience ratings. 14 centers (88 %) who returned the evaluation survey claimed that patient experience scores could help to improve the quality of care. Nine centers (56 %) utilized the feedback to change specific elements of their care delivery process. PD patients are under-informed about critical care issues and experience a lack of collaboration between healthcare professionals. Feedback on patients’ experiences facilitated Parkinson centers to improve their delivery of care. These findings create a basis for collecting patients’ experiences in a repetitive fashion, intertwined with existing quality of care registries.
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Affiliation(s)
- Martijn van der Eijk
- Department of Neurology, Radboud Institute of Health Sciences (RIHS), Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Marjan J Faber
- Department of Neurology, Radboud Institute of Health Sciences (RIHS), Radboud University Medical Center, Nijmegen, The Netherlands.,Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bart Post
- Department of Neurology (935), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Michael S Okun
- McKnight Brain Institute, UF Health College of Medicine, University of Florida Center for Movement Disorders and Neurorestoration, Gainesville, FL, USA
| | | | - Marten Munneke
- Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Neurology (935), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Department of Neurology (935), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.
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O’Brien C, Clemson L, Canning CG. Multiple factors, including non-motor impairments, influence decision making with regard to exercise participation in Parkinson’s disease: a qualitative enquiry. Disabil Rehabil 2015; 38:472-81. [DOI: 10.3109/09638288.2015.1055377] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Hommel I, van Gurp PJ, Tack CJ, Liefers J, Mulder J, Wollersheim H, Hulscher MEJL. Perioperative diabetes care: room for improving the person centredness. Diabet Med 2015; 32:561-8. [PMID: 25308875 DOI: 10.1111/dme.12600] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 08/07/2014] [Accepted: 10/06/2014] [Indexed: 01/26/2023]
Abstract
AIMS Person centredness is an important principle for delivering high-quality diabetes care. In this study, we assess the level of person centredness of current perioperative diabetes care. METHODS We conducted a survey in six Dutch hospitals, among 690 participants with diabetes who underwent major abdominal, cardiac or large-joint orthopaedic surgery. The survey included questions regarding seven dimensions of person-centred perioperative diabetes care. RESULTS Complete data were obtained from 298 participants. The survey scores were low for many of the dimensions of person centredness. The dimensions 'information', 'patient involvement' and 'coordination and integration of care' had the lowest scores. Only half the participants had received information about perioperative diabetes treatment, and approximately one-third had received information about the effect of surgery on blood glucose values, target glucose values and glucose measurement times. Similarly, half the participants had an opportunity to ask questions preoperatively, and only one-third of the participants felt involved in the decision-making regarding diabetes treatment. Most participants knew neither the caregiver in charge of perioperative diabetes treatment nor whom to contact in case of diabetes-related problems during their hospital stay. CONCLUSIONS Current perioperative diabetes care is characterized by a lack of patient information and limited patient involvement. These results indicate that there is ample room for improving the person centredness of perioperative diabetes care.
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Affiliation(s)
- I Hommel
- Department of IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
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Louis ED, Rohl B, Rice C. Defining the Treatment Gap: What Essential Tremor Patients Want That They Are Not Getting. Tremor Other Hyperkinet Mov (N Y) 2015; 5:331. [PMID: 26317044 PMCID: PMC4548969 DOI: 10.7916/d87080m9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Accepted: 07/08/2015] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND Patient-centeredness (i.e., providing care that is responsive to individual patient preferences) is increasingly recognized as a crucial element of quality of care. METHODS A six-item patient-centeredness questionnaire was devised to assess the self-perceived needs of essential tremor (ET) patients. A link to the questionnaire was included in the monthly e-newsletter of the International Essential Tremor Foundation. The questionnaires were completed online and data were available in electronic format. RESULTS There were 1,418 respondents. One in three respondents (i.e., 31.4%) indicated that the doctor was not even "moderately well-educated" about ET. Only 11.8% of respondents were satisfied with their care. Respondents raised a multiplicity of issues that were not being addressed in their current care. The top items were psychological services and support (33.9%), physical or occupational therapy (28.6%), handling embarrassment and social effects of tremor (15.8%), feelings of not being in control (13.7%), a detailed report and a more quantitative way of assessing tremor and tracking progression (12.7%), better counseling about current treatment and medications (11.9%), empathy, compassion and a feeling of being heard (11.6%), a treatment approach other than just medications and surgery (11.2%), and a discussion of all symptoms aside from tremor (e.g., cognition, balance). DISCUSSION Patients with ET identified a broad range of issues that they felt were not addressed in their treatment; indeed, only one in 10 patients reported that they were satisfied with their care. It is hoped that patient-centered approaches such as this will lead to improved models for the care of patients with this common chronic disease.
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Affiliation(s)
- Elan D. Louis
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, USA
- Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, CT, USA
- *To whom correspondence should be addressed. E-mail:
| | - Brittany Rohl
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Catherine Rice
- International Essential Tremor Foundation, Lenexa, KS, USA
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Lee JMZ, Shine JM, Lewis SJG. What matters to people with Parkinson's disease living in Australia? J Clin Neurosci 2014; 22:338-41. [PMID: 25308618 DOI: 10.1016/j.jocn.2014.06.097] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 06/23/2014] [Indexed: 10/24/2022]
Abstract
Patient-centred care is increasingly being recognised as an integral aspect of improving the quality of health care services. There has been a recent interest in taking a patient-centred approach to Parkinson's disease (PD) care by involving patients in shared decision making, as well as providing access to multidisciplinary teams of medical practitioners, PD nurse specialists, and allied health professionals. However, to our knowledge there are no data regarding patient preferences for interventions in PD management. The present study examined the relative importance of issues regarding quality of life for people living with PD in Australia using a self-administered survey. Overall, respondents ranked more research funding in PD (mean rank, 340.42) as the most important issue, access to PD nurses (285.50) in second place, followed by access to multidisciplinary facilities/clinics with allied health professionals (283.39) in third place, subsidised PD treatments (233.50) in fourth place, and better general practitioner education (184.69) as the least important issue of the options offered. There was a statistically significant difference between the five issues (H[4] = 65.38, p < 0.001). Within the framework of patient-centred care, public funding allocations perhaps should be based on what patients want. As such, these findings suggest that for people living with a chronic, progressive, incurable illness, research is highly valued.
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Affiliation(s)
- Joanna M Z Lee
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; Brain and Mind Research Institute, Parkinson's Disease Research Clinic, The University of Sydney, 94 Mallett Street, Camperdown, Sydney, NSW 2050, Australia
| | - James M Shine
- Brain and Mind Research Institute, Parkinson's Disease Research Clinic, The University of Sydney, 94 Mallett Street, Camperdown, Sydney, NSW 2050, Australia
| | - Simon J G Lewis
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; Brain and Mind Research Institute, Parkinson's Disease Research Clinic, The University of Sydney, 94 Mallett Street, Camperdown, Sydney, NSW 2050, Australia; Royal Prince Alfred Hospital, Department of Neurology, Camperdown, Sydney, NSW, Australia.
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Lakshminarayana R, Wang D, Burn D, Chaudhuri KR, Cummins G, Galtrey C, Hellman B, Pal S, Stamford J, Steiger M, Williams A. Smartphone- and internet-assisted self-management and adherence tools to manage Parkinson's disease (SMART-PD): study protocol for a randomised controlled trial (v7; 15 August 2014). Trials 2014; 15:374. [PMID: 25257518 PMCID: PMC4283131 DOI: 10.1186/1745-6215-15-374] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 08/18/2014] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Nonadherence to treatment leads to suboptimal treatment outcomes and enormous costs to the economy. This is especially important in Parkinson's disease (PD). The progressive nature of the degenerative process, the complex treatment regimens and the high rates of comorbid conditions make treatment adherence in PD a challenge. Clinicians have limited face-to-face consultation time with PD patients, making it difficult to comprehensively address non-adherence. The rapid growth of digital technologies provides an opportunity to improve adherence and the quality of decision-making during consultation. The aim of this randomised controlled trial (RCT) is to evaluate the impact of using a smartphone and web applications to promote patient self-management as a tool to increase treatment adherence and working with the data collected to enhance the quality of clinical consultation. METHODS/DESIGN A 4-month multicentre RCT with 222 patients will be conducted to compare use of a smartphone- and internet-enabled Parkinson's tracker smartphone app with treatment as usual for patients with PD and/or their carers. The study investigators will compare the two groups immediately after intervention. Seven centres across England (6) and Scotland (1) will be involved. The primary objective of this trial is to assess whether patients with PD who use the app show improved medication adherence compared to those receiving treatment as usual alone. The secondary objectives are to investigate whether patients who receive the app and those who receive treatment as usual differ in terms of quality of life, quality of clinical consultation, overall disease state and activities of daily living. We also aim to investigate the experience of those receiving the intervention by conducting qualitative interviews with a sample of participants and clinicians, which will be administered by independent researchers. TRIAL REGISTRATION ISRCTN45824264 (registered 5 November 2013).
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Affiliation(s)
| | - Duolao Wang
- />Liverpool School of Tropical Medicine, Liverpool, UK
| | - David Burn
- />Regional Neurosciences Centre, Newcastle General Hospital, Newcastle upon Tyne, UK
| | - K Ray Chaudhuri
- />Neurology/Movement Disorders, National Parkinson Foundation Centre of Excellence, King’s College Hospital, University Hospital Lewisham, Kings College and Institute of Psychiatry, London, UK
| | - Gemma Cummins
- />John van Geest Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Clare Galtrey
- />St George’s Healthcare NHS Foundation Trust, London, UK
| | | | - Suvankar Pal
- />NHS Forth Valley, Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, UK
| | | | - Malcolm Steiger
- />University of Liverpool and The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Adrian Williams
- />University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - The SMART-PD Investigators
- />uMotif Ltd, London, UK
- />Liverpool School of Tropical Medicine, Liverpool, UK
- />Regional Neurosciences Centre, Newcastle General Hospital, Newcastle upon Tyne, UK
- />Neurology/Movement Disorders, National Parkinson Foundation Centre of Excellence, King’s College Hospital, University Hospital Lewisham, Kings College and Institute of Psychiatry, London, UK
- />John van Geest Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- />St George’s Healthcare NHS Foundation Trust, London, UK
- />NHS Forth Valley, Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, UK
- />The Cure Parkinson’s Trust, London, UK
- />University of Liverpool and The Walton Centre NHS Foundation Trust, Liverpool, UK
- />University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Aarts JWM, Vennik F, Nelen WLDM, van der Eijk M, Bloem BR, Faber MJ, Kremer JAM. Personal health communities: a phenomenological study of a new health-care concept. Health Expect 2014; 18:2091-106. [PMID: 24646089 DOI: 10.1111/hex.12177] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2014] [Indexed: 01/24/2023] Open
Abstract
CONTEXT Fragmentation of care, complexity of diseases and the need to involve patients actively in their individual health care led to the development of the personal health community (PHC). In a PHC, patients can -regardless of the nature of their condition- invite all professionals that are involved in their health care process. Once gathered, the patient and health care team can exchange information about the patient's health and communicate through several functionalities, in a secured environment. OBJECTIVES Exploring the use, first experiences and potential consequences of using PHCs in health care. DESIGN Qualitative phenomenological study. PARTICIPANTS Eighteen respondents, consisting of women experiencing infertility (n = 5), persons with Parkinson's disease (n = 6), a gynaecologist, a fertility doctor, a fertility nurse, three Parkinson's specialist nurses and a neurologist. RESULTS First experiences with PHCs showed that patients use their PHC differently, dependending on their condition and people involved. Various (potential) advantages for future health care were mentioned relating to both organizational aspects of care (e.g. continuity of care) and the human side of care (e.g. personal care). Patient involvement in care was facilitated. Disadvantages were the amount of work that it took and technological issues. CONCLUSIONS Using PHCs leads to promising improvements in both the organization of care and care experience, according to the participants in this study. They indicate that patients with different diseases and in different circumstances can benefit from these improvements. The PHC seem to be an online tool that can be applied in a personalized way. When (technically) well facilitated, it could stimulate active involvement of patients in their own health and health care. It warrants further research to study its effect on concrete health outcomes.
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Affiliation(s)
| | - Femke Vennik
- Institute of Health Policy & Management (iBMG), Erasmus University Rotterdam, DR Rotterdam, the Netherlands
| | - Willianne L D M Nelen
- Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Martijn van der Eijk
- Department of Neurology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Bastiaan R Bloem
- Department of Neurology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Marjan J Faber
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Jan A M Kremer
- Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
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van der Eijk M, Nijhuis FAP, Faber MJ, Bloem BR. Moving from physician-centered care towards patient-centered care for Parkinson's disease patients. Parkinsonism Relat Disord 2013; 19:923-7. [PMID: 23742970 DOI: 10.1016/j.parkreldis.2013.04.022] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 04/19/2013] [Accepted: 04/25/2013] [Indexed: 11/28/2022]
Abstract
Today's society is changing rapidly and individuals increasingly favor an active role in designing their own lives. Contemporary patients are no exception, but the present health care system-which is organized primarily from the provider's perspective-is not yet prepared for this development. Here, we argue that an alternative way to organize health care, namely more from the patient's perspective, may help to contain costs, while improving the quality, safety and access to care. This involves a redefinition of the patient-doctor relationship, such that patients are no longer regarded as passive objects, but rather as active subjects who work as partners with health care professionals to optimize health ('participatory medicine'). The opportunities that come with such a collaborative and patient-centered care model are reviewed within the context of patients with Parkinson's disease. We also discuss societal and Parkinson-specific barriers that could impede implementation of this alternative care model to the management of Parkinson's disease and other chronic conditions.
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Affiliation(s)
- Martijn van der Eijk
- Department of Neurology, Nijmegen Centre for Evidence Based Practice, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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