1
|
Khosravi M, Azar G, Izadi R. Principles and elements of patient-centredness in mental health services: a thematic analysis of a systematic review of reviews. BMJ Open Qual 2024; 13:e002719. [PMID: 38960446 PMCID: PMC11227821 DOI: 10.1136/bmjoq-2023-002719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 06/23/2024] [Indexed: 07/05/2024] Open
Abstract
INTRODUCTION Mental health disorders, particularly depression and anxiety, are widespread globally and necessitate effective solutions. The patient-centred approach has been identified as a viable and effective method for addressing these challenges. This paper synthesised the principles of patient-centred mental health services and provides a comprehensive review of the existing literature. MATERIALS AND METHODS This is a qualitative content analysis study conducted in a systematic review framework in 2022. PubMed, Scopus, ProQuest and Cochrane databases were systematically searched, and by screening the titles, abstracts, and the texts of studies related to the purpose of the research, the data were extracted. Evaluation of the quality of the studies was done using the CASP checklist for qualitative studies. After selecting the final studies based on the entry and exit criteria, subsequently, a thematic analysis of findings was conducted on the data obtained from the systematic review. RESULTS The database search produced 6649 references. After screening, 11 studies met the inclusion criteria. The quality scores indicated the studies were of high level of quality with acceptable risk of bias. The thematic analysis identified six major principles of patient-centredness in mental health services: education, involvement and cooperation, access, effectiveness and safety, health and well-being, and ethics. CONCLUSIONS Patient-centredness is a complex approach in mental health services. The principles and elements of patient-centredness foster positive patient outcomes, enhance healthcare quality and ensure compassionate and effective care. Upholding these principles is crucial for delivering patient-centred, ethical and effective mental health services. Furthermore, the study found that patient education can boost adherence and satisfaction, and decrease unnecessary hospitalisations. Patient involvement in decision-making is influenced by their age and the relationship with their psychologists. And, effective leadership and resource management can enhance clinical processes and patient-centredness in mental health services.
Collapse
Affiliation(s)
- Mohsen Khosravi
- Department of Healthcare Management, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ghazaleh Azar
- Department of Consultation and Mental Health, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Reyhane Izadi
- Department of Healthcare Management, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
2
|
Hoffmann K, Wojczewski S, Rumpler N, George A, de Boeckxstaens P. Giving patients a voice for healthcare reform in Austria: the qualitative voice-study. Fam Pract 2024:cmae031. [PMID: 38795059 DOI: 10.1093/fampra/cmae031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2024] Open
Abstract
BACKGROUND Inclusion of patients in healthcare service and system planning is an increasingly important tool to improve healthcare systems worldwide. In 2012, a focused healthcare reform was initiated in Austria to strengthen the primary care sector which is still underway in 2023. OBJECTIVE The aim of this study was to assess the perceptions, desires, and needs of patients in terms of primary care as a necessary building block of the Austrian healthcare reform. METHODS This study was designed as an exploratory qualitative study using semi-structured interviews between the years 2013 and 2018. Interviews with patients focused on positive and negative experiences with regard to general practice (GP) consultations and perceptions of the primary care system in general, as well as desires for improvement. Qualitative content analysis was used to analyse the material using the software atlas.ti. RESULTS Altogether, 41 interviews were conducted with seven categories identified. These categories include organization and time management around consultation, access, and availability including opening hours, human and professional aspects of consultation, infrastructure and hygiene of the waiting room, healthcare system factors, as well as non-clinical/administrative staff. CONCLUSIONS Appreciating and responding to patients' perceptions and needs, healthcare reform in Austria should include improvements regarding consultation/waiting time, coordination, and navigation in Primary Care. Successful healthcare reform has to include the patient voice.
Collapse
Affiliation(s)
- Kathryn Hoffmann
- Department for Primary Care Medicine, Center for Public Health, Medical University of Vienna, Vienna 1090, Austria
| | - Silvia Wojczewski
- Department for Primary Care Medicine, Center for Public Health, Medical University of Vienna, Vienna 1090, Austria
| | - Nicole Rumpler
- Department for Primary Care Medicine, Center for Public Health, Medical University of Vienna, Vienna 1090, Austria
| | - Aaron George
- Meritus Health, Hagerstown, MD 21742, United States
| | - Pauline de Boeckxstaens
- Department of Public Health and Primary Care, Ghent University Faculty of Medicine and Health Sciences, Ghent, 9000, Belgium
| |
Collapse
|
3
|
Majid U, Steele Gray C, Saragosa M, Kontos P, Kuluski K. Understanding the connection between hospital goals and patient and family engagement: A scoping review. PLoS One 2023; 18:e0293013. [PMID: 37883366 PMCID: PMC10602333 DOI: 10.1371/journal.pone.0293013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 10/03/2023] [Indexed: 10/28/2023] Open
Abstract
The person-centered care movement has influenced hospitals to make patient and family engagement (PE) an explicit commitment in their strategic plans. This is often reflected in mission, vision, and value (MVV) statements, which are organizational artifacts intended to influence the attitudes, beliefs, and actions of hospital teams and employees because of their saliency in organizational documents and communications. Previous research has found that organizational goals for PE, like those articulated in MVV statements, can lead to effective and meaningful PE. However, a deeper understanding of how and under which circumstances MVV statements encourage and promote PE practices is needed. A scoping review was conducted to understand the connection between hospital PE goals (such as MVV statements) and PE processes and practices. The research question was: what is known about how hospital MVV statements relate to PE processes and activities? Following Arksey and O'Malley's scoping review approach, 27 articles were identified as relevant to the research question. These articles revealed five strategies that help realize hospital PE goals: communicating organizational goals; aligning documents that convey organizational goals; aligning organizational processes to support PE; providing employees with resources and support; and motivating and empowering employees to integrate PE into their work. We discuss the implications of misalignment between hospital goals and practices, which reduce team and individual motivation toward hospital PE goals.
Collapse
Affiliation(s)
- Umair Majid
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Carolyn Steele Gray
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada
| | - Marianne Saragosa
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada
| | - Pia Kontos
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Kerry Kuluski
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| |
Collapse
|
4
|
Sagen JS, Smedslund G, Simonsen AE, Habberstad A, Kjeken I, Dagfinrud H, Moe RH. Patient engagement in the development and delivery of healthcare services: a systematic scoping review. BMJ Open Qual 2023; 12:e002309. [PMID: 37369560 PMCID: PMC10577732 DOI: 10.1136/bmjoq-2023-002309] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/26/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Patient engagement (PE) is required to improve future healthcare services. PE in the development and delivery of healthcare services is likely to be complex but is scarcely described. OBJECTIVES The objective of this scoping review was to summarise primary studies on mesolevel PE regarding structure, process and outcomes. More specifically, the aim was to explore barriers and facilitators to successful PE, how persons are engaged in the process and summarise reported consequences. METHOD A systematic scoping review was conducted, searching the MEDLINE, EMBASE, Cochrane and PsycINFO databases. Primary studies, published between 7 July 2005 and 4 October 2022, were considered for inclusion. Two reviewers extracted data about PE (eg, attributes of PE settings, facilitators and barriers, and outcomes to PE) and the first author coded the extracted data into structural, processual and outcome themes. RESULTS Of 8588 identified records, 37 studies were eligible. Most of the included studies were conducted in Europe (n=19; 51%) and North America (n=13; 35%). Structures that ensure sufficient stakeholder representativeness and PE knowledge through education may facilitate the PE process further, regardless of the environmental setting. Interpersonal relationships with uneven power dynamics were reported as noteworthy processual barriers to meaningful PE, while clearly described roles and tasks were reported as important facilitators. In contrast to hard outcomes with operationalised PE effects, the most noteworthy outcomes of PE were reported as soft processual consequences such as patient representatives improving their self-esteem and feeling valued. CONCLUSIONS Unfortunately, there is a dearth of studies exploring hard and operationalised PE outcomes on healthcare services and patients receiving healthcare. The PE process may be facilitated by dedicated finances to PE education and by ensuring sufficient stakeholder representativeness.
Collapse
Affiliation(s)
- Joachim Støren Sagen
- NKRR, Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Oslo Metropolitan University, Faculty of Health Sciences, Oslo, Norway
| | - Geir Smedslund
- NKRR, Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Norwegian Institute of Public Health, Oslo, Norway
| | | | - Andreas Habberstad
- The Norwegian Federation of Organisations of Disabled People, Oslo, Norway
| | - Ingvild Kjeken
- NKRR, Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Oslo Metropolitan University, Faculty of Health Sciences, Oslo, Norway
| | - Hanne Dagfinrud
- NKRR, Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- University of Oslo, Faculty of Medicine, Oslo, Norway
| | - Rikke Helene Moe
- NKRR, Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| |
Collapse
|
5
|
Dworetzky B, Hoover CG, Walker DK. Family Engagement at the Systems Level: A Framework for Action. Matern Child Health J 2023; 27:969-977. [PMID: 36913032 PMCID: PMC10160175 DOI: 10.1007/s10995-023-03619-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2022] [Indexed: 03/14/2023]
Abstract
While family engagement at the individual level of health care, such as families partnering with providers in decision-making about health care for an individual child has been well studied, family engagement in systems-level activities (e.g., participation in advisory and other decision-making groups, or creation and revision of policies) that impact the health services families and children receive has not. This note from the field presents a framework that describes the information and supports that help families partner with professionals and contribute to systems-level activities. Without attention to these components of family engagement, family presence and participation may be only token. We engaged an expert Family/Professional Workgroup whose members represented key constituencies and diverse geography, race/ethnicity, and areas of expertise; conducted a review of peer-reviewed publications and grey literature; and conducted a series of key informant interviews to identify best practices for supporting meaningful family engagement at the systems level. Based on an analysis of the findings, the authors identified four action-oriented domains of family engagement and key criteria that support and strengthen meaningful family engagement in systems-level initiatives. Child- and family-serving serving organizations can use this Family Engagement in Systems framework to support meaningful family engagement in the design of policies, practices, services, supports, quality improvement projects, research, and other systems-level activities.
Collapse
Affiliation(s)
- Beth Dworetzky
- Family Voices, 561 Virginia Rd, Bldg. 4, Suite 300, 01742, Concord, MA, USA.
| | - Clarissa G Hoover
- Family Voices, 561 Virginia Rd, Bldg. 4, Suite 300, 01742, Concord, MA, USA
| | | |
Collapse
|
6
|
Achstetter K, Köppen J, Hengel P, Blümel M, Busse R. Drivers of patient perceptions of health system responsiveness in Germany. Int J Health Plann Manage 2022; 37 Suppl 1:166-186. [PMID: 36184993 DOI: 10.1002/hpm.3570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 08/24/2022] [Accepted: 08/31/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Health system responsiveness (HSR)-the ability of a health system to meet the non-medical legitimate expectations of patients-is a key to patient-centred health systems. Although responsiveness is essential to provide equitable and accountable health care, little is known about patient-side drivers of HSR. This study aims to narrow this gap. METHODS A survey among 20,000 Germans with substitutive private health insurance included questions on HSR and patient characteristics such as health literacy (HL), experienced discrimination, and sociodemographic information. Survey data were linked to patient-level claims data. Logistic regression was applied to assess the association between HSR and patient characteristics. RESULTS The sample (age 54.0 ± 16.1; 60.5% male) contains 2951 respondents with outpatient physician care in the past year. Of the nine HSR items, eight are rated as (very) good (74.4%-94.3%), except for coordination between providers (60.2%). Patient characteristics highly influence HSR: patients with high HL, for instance, are more likely to assess responsiveness as (very) good (e.g., clear explanations from physicians: OR 4.17). Poor assessment of responsiveness is seen among users who experienced discrimination. CONCLUSION This study revealed new associations between HSR and patient characteristics. Incorporating this knowledge in practice would help strengthen patient-centred health services by considering patient experiences and expectations. This highlights that HSR can be used as a tool to evaluate and promote patient-centred health services. Future research should investigate additional drivers of HSR, both on the patient and the provider sides.
Collapse
Affiliation(s)
- Katharina Achstetter
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany.,Berlin Centre for Health Economics Research, Technische Universität Berlin, Berlin, Germany
| | - Julia Köppen
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany.,Berlin Centre for Health Economics Research, Technische Universität Berlin, Berlin, Germany
| | - Philipp Hengel
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany.,Berlin Centre for Health Economics Research, Technische Universität Berlin, Berlin, Germany
| | - Miriam Blümel
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany.,Berlin Centre for Health Economics Research, Technische Universität Berlin, Berlin, Germany
| | - Reinhard Busse
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany.,Berlin Centre for Health Economics Research, Technische Universität Berlin, Berlin, Germany
| |
Collapse
|
7
|
Robin G, Brown E, Davis CA, Bird L, Wilson L, Halperin R, Brundage M, Croke J, Harper C, Giuliani M, Caissie A. Patient Engagement: an Assessment of Canadian Radiotherapy Programs' Current Practices, Perceived Barriers, and Facilitators. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1834-1841. [PMID: 34518991 DOI: 10.1007/s13187-021-02049-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/01/2021] [Indexed: 06/13/2023]
Abstract
Patient engagement and education have been mandated across Canadian radiation oncology programs (ROP). Guidance documents include the 2014 Canadian Association of Radiation Oncology (CARO) Radiation Therapy Patient Charter, the 2016 Canadian Partnership for Quality Radiotherapy (CPQR) Patient Engagement Guidelines (PEG) for Canadian Radiation Treatment Programs, and Accreditation Canada's 2017 refresh of Cancer Care Standards. Since little is known regarding uptake of these guidance statements, Canadian ROP were surveyed to assess current patient engagement and education practices. An e-survey was sent to Canadian ROP (n = 44). The survey focused on awareness and uptake of the CARO Patient Charter, CPQR PEG, and patient education practices. Survey development was guided by these documents and expert consensus, including CARO's Quality and Standards Patient Education/Engagement working group. Many (71%) responding ROP were familiar with the CARO Patient Charter, while 24% reported use. More than half (53%) of ROP were aware of the CPQR PEG, but approximately third (37%) had previously completed a self-audit. Most (88%) ROP view a pan-Canadian, evidence-based approach to educational materials beneficial and feasible (80%), with the majority (89%) willing to share their best practices across the radiotherapy community. Patient engagement and education are nationally mandated and supported by guidance documents. However, gaps have been identified across ROP for awareness and use of available tools, as well as uptake of their processes critical to quality of care. Understanding current practices will inform CPQR/CARO-supported pan-Canadian initiatives to optimize uptake, including development of CPQR Patient Education Guidance for Canadian Radiation Treatment Programs.
Collapse
Affiliation(s)
- Gabrielle Robin
- Dalhousie University, Halifax, NB & NS, Canada.
- CARO Quality and Standards Working Group, Markham, ON, Canada.
| | - Erika Brown
- CARO Quality and Standards Working Group, Markham, ON, Canada
- Canadian Partnership for Quality Radiotherapy, Halifax, Canada
| | - Carol-Anne Davis
- Dalhousie University, Halifax, NB & NS, Canada
- CARO Quality and Standards Working Group, Markham, ON, Canada
- Canadian Partnership for Quality Radiotherapy, Halifax, Canada
| | - Louise Bird
- CARO Quality and Standards Working Group, Markham, ON, Canada
- Canadian Partnership for Quality Radiotherapy, Halifax, Canada
| | - Lianne Wilson
- CARO Quality and Standards Working Group, Markham, ON, Canada
- Canadian Partnership for Quality Radiotherapy, Halifax, Canada
| | - Ross Halperin
- CARO Quality and Standards Working Group, Markham, ON, Canada
- BC Cancer Agency, Vancouver, BC, Canada
| | - Michael Brundage
- CARO Quality and Standards Working Group, Markham, ON, Canada
- Canadian Partnership for Quality Radiotherapy, Halifax, Canada
- Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, ON, Canada
| | - Jennifer Croke
- CARO Quality and Standards Working Group, Markham, ON, Canada
- Radiation Medicine Program, Princess Margaret Cancer Center, Toronto, ON, Canada
| | - Cody Harper
- Dalhousie University, Halifax, NB & NS, Canada
- CARO Quality and Standards Working Group, Markham, ON, Canada
| | - Meredith Giuliani
- CARO Quality and Standards Working Group, Markham, ON, Canada
- Radiation Medicine Program, Princess Margaret Cancer Center, Toronto, ON, Canada
| | - Amanda Caissie
- Dalhousie University, Halifax, NB & NS, Canada
- CARO Quality and Standards Working Group, Markham, ON, Canada
- Canadian Partnership for Quality Radiotherapy, Halifax, Canada
| |
Collapse
|
8
|
Olsson ABS, Haaland-Øverby M, Stenberg U, Slettebø T, Strøm A. Primary healthcare professionals' experience with patient participation in healthcare service development: A qualitative study. PEC INNOVATION 2022; 1:100068. [PMID: 37213719 PMCID: PMC10194342 DOI: 10.1016/j.pecinn.2022.100068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 07/11/2022] [Accepted: 07/23/2022] [Indexed: 05/23/2023]
Abstract
Objective How healthcare professionals experience patient participation in health service development impacts its use. This participatory study explores primary healthcare professionals' perceptions of developing health services with patient representatives. Methods Four focus group interviews with primary healthcare professionals (n = 26) were conducted. We analyzed data by applying Braun and Clarke's reflexive thematic analysis. Results The healthcare professionals perceived having a complementary interprofessional relationship with the patient representatives and regarded them as colleagues. However, the professionals navigated between a position of authority and collaboration, reconciling the need for participation with its challenges, e.g., to identify the representatives' collective representation among their personal experience, to ensure a more evidence-informed result that they and their colleagues would endorse. Conclusions Regarding patient representatives as colleagues can blur the line between professionals and representatives' positions and functions and further complicate health service development. Our results indicate a need for skilled facilitators to lead the process. Innovation This study identifies issues that professionals are uncertain about when collaborating with representatives to develop primary healthcare services; difficulties that professionals must overcome to collaborate constructively with representatives. Our findings can inform healthcare professionals' education about patient participation on all levels. We have suggested topics to address.
Collapse
Affiliation(s)
- Ann Britt Sandvin Olsson
- Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Postboks 4959 Nydalen, 0424 Oslo, Norway
- VID Specialized University, Faculty of Diakonia, Values and Professional Practice, Postboks 184 Vinderen, 0319 Oslo, Norway
- Corresponding author at: Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Postboks 4959 Nydalen, 0424 Oslo, Norway.
| | - Mette Haaland-Øverby
- Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Postboks 4959 Nydalen, 0424 Oslo, Norway
| | - Una Stenberg
- Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Postboks 4959 Nydalen, 0424 Oslo, Norway
- Frambu Resource Center for Rare Disorders, Sandbakkveien 18, 1404 Siggerud, Norway
| | - Tor Slettebø
- VID Specialized University, Faculty of Social Studies, Postboks 184 Vinderen, 0319 Oslo, Norway
| | - Anita Strøm
- VID Specialized University, Faculty of Health Studies, Postboks 184 Vinderen, 0319 Oslo, Norway
| |
Collapse
|
9
|
Jacob C, Bourke S, Heuss S. From testers to co-creators: the value and approaches to successful patient engagement in the development of eHealth solutions - Qualitative Expert Interviews Study. JMIR Hum Factors 2022; 9:e41481. [PMID: 36102548 PMCID: PMC9585443 DOI: 10.2196/41481] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/30/2022] [Accepted: 09/10/2022] [Indexed: 11/18/2022] Open
Abstract
Background Research has shown that patient engagement is most commonly done at the beginning of research or to test readily available prototypes and less commonly done in other phases such as the execution phases. Previous studies have reported that patients are usually assigned a consultative rather than a decision-making role in health service planning and evaluation. Objective This study had 2 objectives: to better understand the challenges and opportunities in the inclusion of patients in the development of eHealth technologies and ideas on how to overcome the identified gaps and to create a research-based end-to-end practical blueprint that can guide the relevant stakeholders to successfully engage patients as cocreators in all human-centered design phases rather than mere testers of preplanned prototypes. Methods Key informant interviews were conducted using in-depth semistructured interviews with 20 participants from 6 countries across Europe. This was followed by a focus group to validate the initial findings. Participants encompassed all the relevant stakeholder groups including patient experts, eHealth experts, health technology providers, clinicians, pharma executives, and health insurance experts. Results This study shows that engaging patients in eHealth development can help provide different types of value; namely, identifying unmet needs, better usability and desirability, better fit into the patient journey, better adoption and stickiness, better health outcomes, advocacy and trust, a sense of purpose, and better health equity and access. However, the participants agreed that patients are usually engaged too late in the development process, mostly assuming a sounding role in testing a ready-made prototype. The justification for these gaps in engagement is driven by some prominent barriers, notably compliance risks, patient-related factors, power dynamics, patient engagement as lip service, poor value perception, lack of resources, mistrust, and inflexibility. On the positive side, the participants also reflected on facilitators for better patient engagement; for instance, engaging through engagement partners, novel approaches such as the rise of professional patient experts, embedding patients in development teams, expectation management, and professional moderation services. Conclusions Overcoming the current gaps in patient engagement in eHealth development requires consolidated efforts from all stakeholders in a complex health care ecosystem. The shift toward more patient-driven eHealth development requires education and awareness; frameworks to monitor and evaluate the value of patient engagement; regulatory clarity and simplification; platforms to facilitate patient access and identification; patient incentivization, transparency, and trust; and a mindset shift toward value-based health care.
Collapse
Affiliation(s)
- Christine Jacob
- FHNW - University of Applied Sciences Northwestern Switzerland, Bahnhofstrasse 6, Windisch, CH
| | | | - Sabina Heuss
- FHNW - University of Applied Sciences Northwestern Switzerland, Olten, CH
| |
Collapse
|
10
|
How to Engage Health Care Workers in the Evaluation of Hospitals: Development and Validation of BSC-HCW1-A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159096. [PMID: 35897476 PMCID: PMC9367997 DOI: 10.3390/ijerph19159096] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/15/2022] [Accepted: 07/23/2022] [Indexed: 11/17/2022]
Abstract
Organizations worldwide utilize the balanced scorecard (BSC) for their performance evaluation (PE). This research aims to provide a tool that engages health care workers (HCWs) in BSC implementation (BSC-HCW1). Additionally, it seeks to translate and validate it at Palestinian hospitals. In a cross-sectional study, 454 questionnaires were retrieved from 14 hospitals. The composite reliability (CR), interitem correlation (IIC), and corrected item total correlation (CITC) were evaluated. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used. In both EFA and CFA, the scale demonstrated a good level of model fit. All the items had loadings greater than 0.50. All factors passed the discriminant validity. Although certain factors' convergent validity was less than 0.50, their CR, IIC, and CITC were adequate. The final best fit model had nine factors and 28 items in CFA. The BSC-HCW1 is the first self-administered questionnaire to engage HCWs in assessing the BSC dimensions following all applicable rules and regulations. The findings revealed that this instrument's psychometric characteristics were adequate. Therefore, the BSC-HCW1 can be utilized to evaluate BSC perspectives and dimensions. It will help managers highlight which BSC dimension predicts HCW satisfaction and loyalty and examine differences depending on HCWs' and hospital characteristics.
Collapse
|
11
|
Assessing Patient Experience and Attitude: BSC-PATIENT Development, Translation, and Psychometric Evaluation-A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127149. [PMID: 35742393 PMCID: PMC9223066 DOI: 10.3390/ijerph19127149] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/24/2022] [Accepted: 06/08/2022] [Indexed: 02/06/2023]
Abstract
Health care organizations (HCO) did not consider engaging patients in balanced scorecard (BSC) implementations to evaluate their performance. This paper aims to develop an instrument to engage patients in assessing BSC perspectives (BSC-PATIENT) and customize it for Palestinian hospitals. Two panels of experts participated in the item generation of BSC-PATIENT. Translation was performed based on guidelines. Pretesting was performed for 30 patients at one hospital. Then, 1000 patients were recruited at 14 hospitals between January and October 2021. Construct validity was tested through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Additionally, the composite reliability (CR), interitem correlation (IIC), and corrected item total correlation (CITC) were assessed to find redundant and low correlated items. As a result, the scales had a highly adequate model fit in the EFA and CFA. The final best fit model in CFA comprised ten constructs with 36 items. In conclusion, BSC-PATIENT is the first self-administered questionnaire specifically developed to engage patients in BSC and will allow future researchers to evaluate the impact of patient experience on attitudes toward BSC perspectives, as well as to compare the differences based on patient and hospital characteristics.
Collapse
|
12
|
Amer F, Hammoud S, Khatatbeh H, Lohner S, Boncz I, Endrei D. A systematic review: the dimensions to evaluate health care performance and an implication during the pandemic. BMC Health Serv Res 2022; 22:621. [PMID: 35534850 PMCID: PMC9081670 DOI: 10.1186/s12913-022-07863-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/28/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The balanced scorecard (BSC) has been implemented to evaluate the performance of health care organizations (HCOs). BSC proved to be effective in improving financial performance and patient satisfaction. AIM This systematic review aims to identify all the perspectives, dimensions, and KPIs that are vital and most frequently used by health care managers in BSC implementations. METHODS This systematic review adheres to PRISMA guidelines. The PubMed, Embase, Cochrane, and Google Scholar databases and Google search engine were inspected to find all implementations of BSC at HCO. The risk of bias was assessed using the nonrandomized intervention studies (ROBINS-I) tool to evaluate the quality of observational and quasi-experimental studies and the Cochrane (RoB 2) tool for randomized controlled trials (RCTs). RESULTS There were 33 eligible studies, of which we identified 36 BSC implementations. The categorization and regrouping of the 797 KPIs resulted in 45 subdimensions. The reassembly of these subdimensions resulted in 13 major dimensions: financial, efficiency and effectiveness, availability and quality of supplies and services, managerial tasks, health care workers' (HCWs) scientific development error-free and safety, time, HCW-centeredness, patient-centeredness, technology, and information systems, community care and reputation, HCO building, and communication. On the other hand, this review detected that BSC design modification to include external and managerial perspectives was necessary for many BSC implementations. CONCLUSION This review solves the KPI categorization dilemma. It also guides researchers and health care managers in choosing dimensions for future BSC implementations and performance evaluations in general. Consequently, dimension uniformity will improve the data sharing and comparability among studies. Additionally, despite the pandemic negatively influencing many dimensions, the researchers observed a lack of comprehensive HCO performance evaluations. In the same vein, although some resulting dimensions were assessed separately during the pandemic, other dimensions still lack investigation. Last, BSC dimensions may play an essential role in tackling the COVID-19 pandemic. However, further research is required to investigate the BSC implementation effect in mitigating the pandemic consequences on HCO.
Collapse
Affiliation(s)
- Faten Amer
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, Pécs, Hungary.
- Faculty of Health Sciences, Institute for Health Insurance, University of Pécs, Pécs, Hungary.
| | - Sahar Hammoud
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
| | - Haitham Khatatbeh
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
| | - Szimonetta Lohner
- Clinical Center of the University of Pécs, Medical School, Cochrane Hungary, University of Pécs, Pécs, Hungary
| | - Imre Boncz
- Faculty of Health Sciences, Institute for Health Insurance, University of Pécs, Pécs, Hungary
| | - Dóra Endrei
- Faculty of Health Sciences, Institute for Health Insurance, University of Pécs, Pécs, Hungary
| |
Collapse
|
13
|
Ciasullo MV, Lim WM, Manesh MF, Palumbo R. The patient as a prosumer of healthcare: insights from a bibliometric-interpretive review. J Health Organ Manag 2022; 36:133-157. [PMID: 35383429 DOI: 10.1108/jhom-11-2021-0401] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE Healthcare policies around the globe are aimed at achieving patient-centeredness. The patient is understood as a prosumer of healthcare, wherein healthcare service co-production and value co-creation take center stage. The article endeavors to unpack the state of the literature on the innovations promoting the transition toward patient-centeredness, informing policy and management interventions fostering the reconceptualization of the patient as a prosumer of healthcare services. DESIGN/METHODOLOGY/APPROACH A hybrid review methodology consisting of a bibliometric-interpretive review following the Scientific Procedures and Rationales for Systematic Literature Reviews (SPAR-4-SLR) protocol is used. The bibliometric component enabled us to objectively map the extant scientific knowledge into research streams, whereas the interpretive component facilitated the critical analysis of research streams. FINDINGS Patient-centeredness relies on a bundle of innovations that are enacted through a cycle of patients' activation, empowerment, involvement and engagement, wherein the omission of any steps arrests the transition toward service co-production and value co-creation. Institutional, organizational and cognitive barriers should be overcome to boost the transition of patients from consumers to prosumers in a patient-centered model of healthcare. ORIGINALITY/VALUE The article delivers the state of the art of the scientific literature in the field of innovations aimed at sustaining the transition toward patient-centeredness and provides some food for thoughts to scholars and practitioners who wish to push forward service co-production and value co-creation in healthcare.
Collapse
Affiliation(s)
- Maria Vincenza Ciasullo
- Department of Management and Innovation Systems, University of Salerno, Salerno, Italy.,Faculty of Business, Design and Arts, Swinburne University of Technology, Kuching, Malaysia.,Department of Management, University of Isfahan, Isfahan, Iran
| | - Weng Marc Lim
- School of Business, Law and Entrepreneurship, Swinburne University of Technology, Melbourne, Australia.,Faculty of Business, Design and Arts, Swinburne University of Technology, Kuching, Malaysia
| | | | - Rocco Palumbo
- Department of Management and Law, University of Rome Tor Vergata, Roma, Italy
| |
Collapse
|
14
|
Schear RM, Hoyos JM, Davis AQ, Woods PL, Poblete S, Richardson RN, Finney Rutten LJ. Patient engagement and advocacy considerations in development and implementation of a multicancer early detection program. Cancer 2022; 128 Suppl 4:909-917. [PMID: 35133663 DOI: 10.1002/cncr.34047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 10/01/2021] [Accepted: 10/21/2021] [Indexed: 11/08/2022]
Affiliation(s)
- Rebekkah M Schear
- Livestrong Cancer Institutes, Dell Medical School, University of Texas at Austin, Austin, Texas
| | | | - Anjee Q Davis
- American Cancer Society Cancer Action Network, Inc, Washington, District of Columbia
| | - Phylicia L Woods
- American Cancer Society Cancer Action Network, Inc, Washington, District of Columbia.,Fight Colorectal Cancer, Springfield, Missouri
| | | | - Robin N Richardson
- Livestrong Cancer Institutes at the Dell Medical School, University of Texas at Austin, Austin, Texas
| | - Lila J Finney Rutten
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
15
|
Atkinson MK, Benneyan JC, Phillips RS, Schiff GD, Hunt LS, Singer SJ. Patient engagement in system redesign teams: a process of social identity. J Health Organ Manag 2021; ahead-of-print. [PMID: 34693670 DOI: 10.1108/jhom-02-2021-0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Studies demonstrate how patient roles in system redesign teams reflect a continuum of involvement and influence. This research shows the process by which patients move through this continuum and effectively engage within redesign projects. DESIGN/METHODOLOGY/APPROACH The authors studied members of redesign teams, consisting of 5-10 members: clinicians, systems engineers, health system staff and patient(s), from three health systems working on separate projects in a patient safety learning lab. Weekly team meetings were observed, January 2016-April 2018, 17 semi-structured interviews were conducted and findings through a patient focus group were refined. Grounded theory was used to analyze field notes and transcripts. FINDINGS Results show how the social identity process enables patients to move through stages in a patient engagement continuum (informant, partner and active change agent). Initially, patient and team member perceptions of the patient's role influence their respective behaviors (activating, directing, framing and sharing). Subsequently, patient and team member behaviors influence patient contributions on the team, which can redefine patient and team member perceptions of the patient's role. ORIGINALITY/VALUE As health systems grow increasingly complex and become more interested in responding to patient expectations, understanding how to effectively engage patients on redesign teams gains importance. This research investigates how and why patient engagement on redesign teams changes over time and what makes different types of patient roles valuable for team objectives. Findings have implications for how redesign teams can better prepare, anticipate and support the changing role of engaged patients.
Collapse
Affiliation(s)
- Mariam Krikorian Atkinson
- Health Policy and Management, T H Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | | | - Russell S Phillips
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Sara J Singer
- School of Medicine, Stanford University, Stanford, California, USA
| |
Collapse
|
16
|
Jabarulla MY, Lee HN. A Blockchain and Artificial Intelligence-Based, Patient-Centric Healthcare System for Combating the COVID-19 Pandemic: Opportunities and Applications. Healthcare (Basel) 2021; 9:1019. [PMID: 34442156 PMCID: PMC8391524 DOI: 10.3390/healthcare9081019] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/16/2021] [Accepted: 07/28/2021] [Indexed: 12/30/2022] Open
Abstract
The world is facing multiple healthcare challenges because of the emergence of the COVID-19 (coronavirus) pandemic. The pandemic has exposed the limitations of handling public healthcare emergencies using existing digital healthcare technologies. Thus, the COVID-19 situation has forced research institutes and countries to rethink healthcare delivery solutions to ensure continuity of services while people stay at home and practice social distancing. Recently, several researchers have focused on disruptive technologies, such as blockchain and artificial intelligence (AI), to improve the digital healthcare workflow during COVID-19. Blockchain could combat pandemics by enabling decentralized healthcare data sharing, protecting users' privacy, providing data empowerment, and ensuring reliable data management during outbreak tracking. In addition, AI provides intelligent computer-aided solutions by analyzing a patient's medical images and symptoms caused by coronavirus for efficient treatments, future outbreak prediction, and drug manufacturing. Integrating both blockchain and AI could transform the existing healthcare ecosystem by democratizing and optimizing clinical workflows. In this article, we begin with an overview of digital healthcare services and problems that have arisen during the COVID-19 pandemic. Next, we conceptually propose a decentralized, patient-centric healthcare framework based on blockchain and AI to mitigate COVID-19 challenges. Then, we explore the significant applications of integrated blockchain and AI technologies to augment existing public healthcare strategies for tackling COVID-19. Finally, we highlight the challenges and implications for future research within a patient-centric paradigm.
Collapse
Affiliation(s)
| | - Heung-No Lee
- School of Electrical Engineering and Computer Science, Gwangju Institute of Science and Technology, Gwangju 61005, Korea;
| |
Collapse
|
17
|
McKay GE, Zakas AL, Osman F, Lee-Miller C, Pophali P, Parkes A. Disparities Between Provider Assessment and Documentation of Care Needs in the Care of Adolescent and Young Adult Patients With Sarcoma. JCO Oncol Pract 2021; 17:e891-e900. [PMID: 33852368 DOI: 10.1200/op.20.00938] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Given the occurrence of cancer during a complex developmental time, adolescent and young adult (AYA) patients have unique psychosocial needs that necessitate supportive care, which is optimally provided using National Comprehensive Cancer Network (NCCN) AYA guidelines. We sought to explore compliance with NCCN AYA guidelines and compare with oncology providers' perceptions of AYA care needs. METHODS Retrospective chart reviews of AYA patients (15-39 years at time of cancer diagnosis) with sarcoma seen at least once in 2019 at the University of Wisconsin identified documentation of discussions deemed critical per NCCN AYA guidelines. As per the ASCO Quality Oncology Practice Initiative certification, we considered a threshold of these factors being discussed 75% of the time or higher to be compliant. Compliance was compared with an electronic survey of University of Wisconsin oncology providers regarding AYA patient needs, with items determined to have adequate resources if noted sufficient by at least 75% of providers. RESULTS We identified 43 AYA patients with sarcoma. Less than 75% of patients had documentation of discussion of contraception, sexual health, fertility, finances, genetics, social work referral, and clinical trials indicating noncompliance with NCCN guidelines. Surveys, completed by 38 oncology providers, showed significant discordance between providers' perceptions of AYAs' access to resources and providers' documented discussions of supportive care resources. CONCLUSION Disparities between oncology provider assessment of AYA care needs and documentation of critical components of AYA patient care demonstrate the need for novel tools to evaluate AYA care needs beyond provider assessments.
Collapse
Affiliation(s)
- Grace E McKay
- Division of Hematology, Medical Oncology, and Palliative Care, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Anna L Zakas
- Division of Oncology Genetics, Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Fauzia Osman
- Division of Hematology, Medical Oncology, and Palliative Care, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Cathy Lee-Miller
- Division of Hematology, Oncology and Bone Marrow Transplant, Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Priyanka Pophali
- Division of Hematology, Medical Oncology, and Palliative Care, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Amanda Parkes
- Division of Hematology, Medical Oncology, and Palliative Care, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| |
Collapse
|
18
|
Picklyk D, Volk S, Burns KK. The Provincial Patient and Family Group (PFG) for Alberta Health Services Transforms How Care is Planned and Delivered: A Decade of Experience. J Patient Exp 2021; 8:2374373521989245. [PMID: 34179362 PMCID: PMC8205415 DOI: 10.1177/2374373521989245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Although many health care organizations made significant headway in building relationships with patients and families at the point of care, there continues to be opportunities to partner with them at the system level. One such opportunity is the Patient and Family Advisory Group (PFG) at Alberta Health Services (AHS). Developed 10 years ago as a formal group of patient and family volunteers, PFG has provided advice on over 350 key organization initiatives, including the Patient First Strategy and the Family Visitation policies and guidelines. Through the formal partnership with PFG and its members who bring their lived experiences with the health system and its services, AHS has demonstrated its commitment to designing and improving services with the user in mind. Now entering its second decade, PFG, supported by AHS leadership, continues to explore new strategic approaches with internal and external stakeholders to reinforce the importance of Patient and Family-Centered Care.
Collapse
Affiliation(s)
- Deanna Picklyk
- Engagement and Patient Experience, Alberta Health Services, Edmonton, Alberta, Canada
| | - Shawn Volk
- Engagement and Patient Experience, Alberta Health Services, Edmonton, Alberta, Canada
| | | |
Collapse
|
19
|
Thomsen TG, Hølge-Hazelton B. Involvement of Patient and Family Representatives in Health-Care Job Interview Panels. J Patient Exp 2021; 7:1294-1302. [PMID: 33457578 PMCID: PMC7786726 DOI: 10.1177/2374373519826118] [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] [Indexed: 11/18/2022] Open
Abstract
Objectives: The involvement of patient and family representatives in job interview panels is sparsely documented. This study was conducted at a newly established university hospital in Denmark. The aim was to identify different perspectives on attitudes and experiences associated with involving patient and family representatives in the recruitment process for senior staff. Furthermore, the aim was to highlight considerations and reservations related to the subsequent implementation process. Methods: Inspiration was drawn from formative evaluation research. Data Sources: Seventeen telephone interviews with applicants, 49 e-mail responses from staff, and unsolicited e-mails to the researcher. Analysis Strategy: Interpretive description. Results: Learnings from the study showed among other things that the participating staff experienced widespread skepticism before participation in the job interview panels, but their experience in the panels led them to consider the patients’ and families’ input to be beneficial to the entire recruitment process. The considerations and reservations raised were divided into 5 themes. Conclusions: The results provide a relevant starting point to negotiate and refine the aims of collective patient involvement related to a given situation—such as health-care recruitment processes.
Collapse
Affiliation(s)
- Thora Grothe Thomsen
- Research Unit, Zealand University Hospital, Roskilde, Denmark.,Department of Regional Health Services Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Bibi Hølge-Hazelton
- Research Unit, Zealand University Hospital, Roskilde, Denmark.,Department of Regional Health Services Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
20
|
Greenwood D, Steinke D, Martin S, Tully MP. Meeting patient expectations: Development of an Emergency Department Pharmacist Practitioner service specification. Res Social Adm Pharm 2020; 17:S1551-7411(19)30564-9. [PMID: 34756404 DOI: 10.1016/j.sapharm.2020.08.016] [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: 05/31/2019] [Revised: 08/18/2020] [Accepted: 08/23/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Emergency Department Pharmacist Practitioners (EDPPs) undertake both 'traditional' clinical pharmacy work, e.g. check prescriptions, and 'practitioner' work, e.g. perform clinical examinations. A recent study found a large variation in the extent and type of care provided. Whilst variation allows services to be tailored to local needs, it is important that care meets the minimum standards that are safe, effective, patient-centred, timely, efficient, and equitable. OBJECTIVE(S) To develop an EDPP service specification based on views of professional and patient stakeholders, primarily to support providers with delivery of high quality services. METHODS Patients, ED pharmacists and other ED healthcare professionals developed standards guided by the Institute of Medicine's quality domains. A panel of six ED pharmacists suggested and agreed on themes that should be included in the service specification. Additional themes were identified through interviews with eight patients who had been cared for by EDPPs as to their expectations of the service. Finally, a multidisciplinary expert panel of healthcare professionals and researchers reviewed and refined the service specification. RESULTS ED pharmacists developed 36 themes with consensus achieved for 25. Additional themes from the patient interviews concerned the communication and behaviour of EDPPs rather than specific clinical activities undertaken. Whilst patients were happy to be cared for by an EDPP working within their competence, for certain conditions (e.g. major trauma) they wanted a doctor as their main care provider. An evidence-based EDPP service specification of 52 criteria grouped into 4 categories was produced: direct patient care (29); other activities (10); general approach (10); and service structures (3). CONCLUSIONS As the product of both patient and expert input, EDs could align existing or newly developed services to the specification. Whether or not the specification actually improves the quality of EDPP services requires investigation, as does the absolute quality impact of services.
Collapse
Affiliation(s)
- Daniel Greenwood
- Division of Pharmacy and Optometry, University of Manchester, Oxford Road, Manchester, M13 9PT, UK.
| | - Douglas Steinke
- Division of Pharmacy and Optometry, University of Manchester, Oxford Road, Manchester, M13 9PT, UK
| | - Sandra Martin
- Division of Pharmacy and Optometry, University of Manchester, Oxford Road, Manchester, M13 9PT, UK
| | - Mary P Tully
- Division of Pharmacy and Optometry, University of Manchester, Oxford Road, Manchester, M13 9PT, UK
| |
Collapse
|
21
|
Harrington RL, Hanna ML, Oehrlein EM, Camp R, Wheeler R, Cooblall C, Tesoro T, Scott AM, von Gizycki R, Nguyen F, Hareendran A, Patrick DL, Perfetto EM. Defining Patient Engagement in Research: Results of a Systematic Review and Analysis: Report of the ISPOR Patient-Centered Special Interest Group. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:677-688. [PMID: 32540224 DOI: 10.1016/j.jval.2020.01.019] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 01/17/2020] [Accepted: 01/30/2020] [Indexed: 05/13/2023]
Abstract
OBJECTIVES Lack of clarity on the definition of "patient engagement" has been highlighted as a barrier to fully implementing patient engagement in research. This study identified themes within existing definitions related to patient engagement and proposes a consensus definition of "patient engagement in research." METHODS A systematic review was conducted to identify definitions of patient engagement and related terms in published literature (2006-2018). Definitions were extracted and qualitatively analyzed to identify themes and characteristics. A multistakeholder approach, including academia, industry, and patient representation, was taken at all stages. A proposed definition is offered based on a synthesis of the findings. RESULTS Of 1821 abstracts identified and screened for eligibility, 317 were selected for full-text review. Of these, 169 articles met inclusion criteria, from which 244 distinct definitions were extracted for analysis. The most frequently defined terms were: "patient-centered" (30.5%), "patient engagement" (15.5%), and "patient participation" (13.4%). The majority of definitions were specific to the healthcare delivery setting (70.5%); 11.9% were specific to research. Among the definitions of "patient engagement," the most common themes were "active process," "patient involvement," and "patient as participant." In the research setting, the top themes were "patient as partner," "patient involvement," and "active process"; these did not appear in the top 3 themes of nonresearch definitions. CONCLUSION Distinct themes are associated with the term "patient engagement" and with engagement in the "research" setting. Based on an analysis of existing literature and review by patient, industry, and academic stakeholders, we propose a scalable consensus definition of "patient engagement in research."
Collapse
Affiliation(s)
| | - Maya L Hanna
- Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT USA
| | | | - Rob Camp
- Community Advisory Board Programme, EURORDIS, Barcelona, Spain
| | | | - Clarissa Cooblall
- Scientific & Health Policy Initiatives, ISPOR, Lawrenceville, NJ, USA
| | - Theresa Tesoro
- Scientific & Health Policy Initiatives, ISPOR, Lawrenceville, NJ, USA
| | | | | | | | | | | | | |
Collapse
|
22
|
Hurtubise K, Brousselle A, Camden C. Using collaborative logic analysis evaluation to test the program theory of an intensive interdisciplinary pain treatment for youth with pain‐related disability. PAEDIATRIC AND NEONATAL PAIN 2020; 2:113-130. [PMID: 35548259 PMCID: PMC8975192 DOI: 10.1002/pne2.12018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/09/2020] [Accepted: 03/27/2020] [Indexed: 12/26/2022]
Abstract
Intensive interdisciplinary pain treatment (IIPT) involves multiple stakeholders. Mapping the program components to its anticipated outcomes (ie, its theory) can be difficult and requires stakeholder engagement. Evidence is lacking, however, on how best to engage them. Logic analysis, a theory‐based evaluation, that tests the coherence of a program theory using scientific evidence and experiential knowledge may hold some promise. Its use is rare in pediatric pain interventions, and few methodological details are available. This article provides a description of a collaborative logic analysis methodology used to test the theoretical plausibility of an IIPT designed for youth with pain‐related disability. A 3‐step direct logic analysis process was used. A 13‐member expert panel, composed of clinicians, teachers, managers, youth with pain‐related disability, and their parents, were engaged in each step. First, a logic model was constructed through document analysis, expert panel surveys, and focus‐group discussions. Then, a scoping review, focused on pediatric self‐management, building self‐efficacy, and fostering participation, helped create a conceptual framework. An examination of the logic model against the conceptual framework by the expert panel followed, and recommendations were formulated. Overall, the collaborative logic analysis process helped raiseawareness of clinicians’ assumptions about the program causal mechanisms, identified program components most valued by youth and their parents, recognized the program features supported by scientific and experiential knowledge, detected gaps, and highlighted emerging trends. In addition to providing a consumer‐focused program evaluation option, collaborative logic analysis methodology holds promise as a strategy to engage stakeholders and to translate pediatric pain rehabilitation evaluation research knowledge to key stakeholders.
Collapse
Affiliation(s)
- Karen Hurtubise
- Faculté de Médecine et Sciences de la Santé Université de Sherbrooke Sherbrooke QC Canada
| | - Astrid Brousselle
- Faculté de Médecine et Sciences de la Santé Université de Sherbrooke Sherbrooke QC Canada
- School of Public Administration University of Victoria Victoria BC Canada
| | - Chantal Camden
- Faculté de Médecine et Sciences de la Santé Université de Sherbrooke Sherbrooke QC Canada
- CanChild Centre for Childhood Disability Research McMaster University Hamilton ON Canada
| |
Collapse
|
23
|
Chiu C, Bishop M, McDaniels B, Kim BJ, Tiro L. A Population-Based Investigation of Health-Care Needs and Preferences in American Adults With Multiple Sclerosis. J Patient Exp 2020; 7:34-41. [PMID: 32128369 PMCID: PMC7036688 DOI: 10.1177/2374373518812078] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Comprehensive and effective multiple sclerosis (MS) health care requires understanding of patients' needs, preferences, and priorities. OBJECTIVE To evaluate priorities of patients with MS for their MS care. METHODS Participants included 3003 Americans with MS recruited through the National MS Society and the North American Research Committee on Multiple Sclerosis patient registry. Participants completed a comprehensive questionnaire on aspects of their health-care experiences. RESULTS Participants identified the top 3 health-care priorities as (1) the affordability of MS health care, (2) ensuring that non-MS health-care providers have more education about MS and how it can interact with other conditions, and (3) access to an MS center or specialized MS clinic with MS health-care professionals together in one place. Participants receiving care in an MS center rated the quality and their satisfaction with care higher than those receiving care in other settings. Although having the opportunity to evaluate their health-care quality was important to the participants, only 36.4% had been provided the opportunity in the past year. CONCLUSIONS This study identifies health-care priorities and concerns for Americans with MS.
Collapse
Affiliation(s)
- Chungyi Chiu
- Department of Kinesiology and Community Health, University of Illinois at
Urbana–Champaign, Champaign, IL, USA
| | - Malachy Bishop
- Department of Early Childhood, Special Education, and Rehabilitation
Counseling, University of Kentucky, Lexington, KY, USA
| | - Bradley McDaniels
- Department of Early Childhood, Special Education, and Rehabilitation
Counseling, University of Kentucky, Lexington, KY, USA
| | - Byung-Jin Kim
- Department of Early Childhood, Special Education, and Rehabilitation
Counseling, University of Kentucky, Lexington, KY, USA
| | - Lebogang Tiro
- Department of Early Childhood, Special Education, and Rehabilitation
Counseling, University of Kentucky, Lexington, KY, USA
| |
Collapse
|
24
|
Hertel E, Cheadle A, Matthys J, Coleman K, Gray M, Robbins M, Tufte J, Hsu C. Engaging patients in primary care design: An evaluation of a novel approach to codesigning care. Health Expect 2019; 22:609-616. [PMID: 31134725 PMCID: PMC6737754 DOI: 10.1111/hex.12909] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 04/18/2019] [Accepted: 04/22/2019] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Recognition is growing that to create truly patient-centred care, health-care organizations need to partner with patients around care design. More research into the benefits of engaging patients and the most effective ways of partnering with them is needed. METHODS This study assessed the process and impact of a collaborative effort to design a new clinic service that balanced the number of patient and clinical provider/staff codesigners involved and recruited patients to represent diverse perspectives. Data sources included interviews with participants, event observation and participant surveys. RESULTS Our evaluation found that including patients as equal partners improved the design process by infusing a real-world, patient perspective. The pre-event orientation and interactive methods used in the event fostered positive collaboration, as well as personal growth for the patient codesigners. CONCLUSION This study demonstrated the feasibility and benefits of including a roughly equal number of patients and clinical providers/staff in design events and ensuring that the patients represent diverse perspectives.
Collapse
Affiliation(s)
- Erin Hertel
- Center for Community Health & EvaluationKaiser Permanente Washington Health Research Institute (formerly known as Group Health Research Institute)SeattleWashington
| | - Allen Cheadle
- Center for Community Health & EvaluationKaiser Permanente Washington Health Research Institute (formerly known as Group Health Research Institute)SeattleWashington
| | - Juno Matthys
- Center for Community Health & EvaluationKaiser Permanente Washington Health Research Institute (formerly known as Group Health Research Institute)SeattleWashington
| | - Katie Coleman
- MacColl Center for Healthcare InnovationKaiser Permanente Washington Health Research Institute (formerly known as Group Health Research Institute)SeattleWashington
| | - Marlaine Gray
- Center for Community Health & EvaluationKaiser Permanente Washington Health Research Institute (formerly known as Group Health Research Institute)SeattleWashington
| | - Michele Robbins
- Kaiser Permanente Washington Health Research Institute (formerly known as Group Health Research Institute)SeattleWashington
| | - Janice Tufte
- Kaiser Permanente Washington Health Research Institute (formerly known as Group Health Research Institute)SeattleWashington
| | - Clarissa Hsu
- Center for Community Health & EvaluationKaiser Permanente Washington Health Research Institute (formerly known as Group Health Research Institute)SeattleWashington
| |
Collapse
|
25
|
Haesebaert J, Samson I, Lee-Gosselin H, Guay-Bélanger S, Proteau JF, Drouin G, Guimont C, Vigneault L, Poirier A, Sanon PN, Roch G, Poitras MÈ, LeBlanc A, Légaré F. How to engage patients in research and quality improvement in community-based primary care settings: protocol for a participatory action research pilot study. RESEARCH INVOLVEMENT AND ENGAGEMENT 2018; 4:30. [PMID: 30288298 PMCID: PMC6166288 DOI: 10.1186/s40900-018-0113-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 08/15/2018] [Indexed: 06/08/2023]
Abstract
PLAIN ENGLISH SUMMARY Making primary care clinics more patient-centered is key to improving patients' experience of care. If patients themselves were engaged in helping define priorities and suggesting quality improvements in the clinic, care would respond better to their needs. However, patient engagement is a new phenomenon, particularly in community based primary care clinics. How to engage patients in quality improvement in these clinics, or what effect this might have, is not well known. The involvement of patients needs to be adapted to the way these clinics function. The aim of this study is to create and evaluate a new model of patient engagement for quality improvement in community based primary care clinics. Patients, primary care professionals and researchers will create advisory councils in two primary care clinics in Quebec City (Canada). In each clinic, the advisory council will include 12 patients or caregivers registered at the clinic, a clinician and a clinic manager. The advisory council will meet every 6 weeks for a total of six meetings. Two patient-experts will facilitate meetings. During meetings, members of the council will list their needs in order of importance. Then they will suggest improvements in line with these needs. We will study if our advisory council model is well adapted to community based primary care settings and meets participants' expectations. At the end of the study we will be able to offer guidance about engaging patients with health professionals in quality improvement in primary care clinics. ABSTRACT Background Involvement of end-users, including patients, managers and clinicians, in identifying quality improvement and research priorities might improve the relevance of projects and increase their impact. Few patient engagement initiatives have taken place in community based primary care practices (CBPCPs) and best practices for engaging patients in such settings are not well defined. The aim of this pilot study is to develop and assess the feasibility of a new collaborative model of advisory council involving clinicians, managers, patients and caregivers in CBPCP to strengthen their capacity to conduct quality improvement and patient-oriented research projects. Methods We will conduct a participatory action research project in two non-academic CBPCPs in Quebec City (Canada). In each CBPCP, the advisory council will include 12 patients or caregivers, a clinician and a clinic manager. Patients or their caregivers will be identified by clinicians and contacted by patient-experts. They will be eligible if they are registered at the practice, motivated, and available to attend meetings. The council will meet every 6 weeks for a total of six meetings. Two patient-experts will guide council members to identify quality improvement priorities and patient-oriented research questions based on their experience in the clinic. They will then be supported to plan actions to target these priorities. Analysis of meetings will be based on feasibility criteria, notes by non-participant observers in log books, audio-recording of the meetings and questionnaires to evaluate council members' perceptions and the likelihood they would engage in such councils. Discussion The results of this study will be a model of patient engagement and a discussion of factors to improve the model to fit the needs of primary care patients and professionals. This will lay the foundation for a sustainable structure for long-term patient engagement and contribute to the development of a patient-centered and quality-improvement culture in CBPCPs.
Collapse
Affiliation(s)
- Julie Haesebaert
- Centre de recherche sur les soins et services de première ligne de l’Université Laval, CIUSSS de la Capitale-Nationale, Pavillon Landry-Poulin, 2525, chemin de la Canardière, Quebec City, Quebec G1J 0A4 Canada
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC Canada
| | - Isabelle Samson
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec City, Quebec Canada
| | - Hélène Lee-Gosselin
- Department of Management, Faculty of Business Administration, Université Laval, Quebec City, Quebec Canada
| | - Sabrina Guay-Bélanger
- Centre de recherche sur les soins et services de première ligne de l’Université Laval, CIUSSS de la Capitale-Nationale, Pavillon Landry-Poulin, 2525, chemin de la Canardière, Quebec City, Quebec G1J 0A4 Canada
| | | | | | | | | | | | | | - Geneviève Roch
- Centre Hospitalier Universitaire de Québec – Université Laval Research Centre, Hôpital Saint-François d’Assise, Quebec City, Quebec Canada
- Faculty of Nursing, Université Laval, Quebec City, Quebec Canada
| | - Marie-Ève Poitras
- Department of Health Sciences, Université du Québec à Chicoutimi, Chicoutimi, Quebec Canada
| | - Annie LeBlanc
- Centre de recherche sur les soins et services de première ligne de l’Université Laval, CIUSSS de la Capitale-Nationale, Pavillon Landry-Poulin, 2525, chemin de la Canardière, Quebec City, Quebec G1J 0A4 Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec City, Quebec Canada
| | - France Légaré
- Centre de recherche sur les soins et services de première ligne de l’Université Laval, CIUSSS de la Capitale-Nationale, Pavillon Landry-Poulin, 2525, chemin de la Canardière, Quebec City, Quebec G1J 0A4 Canada
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec City, Quebec Canada
| |
Collapse
|
26
|
Goodridge D, Henry C, Watson E, McDonald M, New L, Harrison EL, Scharf M, Penz E, Campbell S, Rotter T. Structured approaches to promote patient and family engagement in treatment in acute care hospital settings: protocol for a systematic scoping review. Syst Rev 2018; 7:35. [PMID: 29482622 PMCID: PMC5827976 DOI: 10.1186/s13643-018-0694-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 02/06/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While effective engagement of patients and families in treatment is increasingly viewed as a priority for many healthcare systems, much remains to be learned about the nature and outcomes of approaches that seek to accomplish this goal in the acute care hospital setting. Wide variability in the implementation of practices designed to promote patient and family engagement in hospitals has been noted. Approaches aimed at promoting patient and family engagement in treatment share the over-arching goal of changing behaviors of patients, families, and healthcare providers and possibly administrators. Behavior change techniques (BCTs) can be a key element of patient and family engagement approaches. This scoping review will contribute to the development of an evidence base detailing that the BCTs have potential to be effective in patient and family engagement interventions. The specific objectives of this review are to (a) identify and classify approaches used in acute care hospitals to engage patient and families in treatment according to the behavior change technique taxonomy; and (b) evaluate and synthesize the outcomes for these approaches for patients and families, healthcare providers, and health administrators/funders. METHODS This systematic scoping review will allow us to determine the extent, range, and nature of research activity related to initiatives designed to promote patient and family engagement in care. A comprehensive electronic literature search will be conducted in MEDLINE, EMBASE, and CINAHL. Studies will be included if they report on outcomes of a structured or systematic approach to the promotion of adult inpatient and family engagement in treatment in acute care settings. Studies will be selected in a two-stage screening process (title and abstract; full text) and quality will be assessed using the mixed methods assessment tool. Data extraction will include narrative descriptions of the intervention and classification of the behavior change techniques employed. DISCUSSION This review aims to identify and classify the specific behavior change techniques underpinning patient and family engagement interventions used in acute care hospital settings. By identifying the "active ingredients" in these interventions, our findings will be transferable to a wide range of acute care hospital contexts and populations.
Collapse
Affiliation(s)
- Donna Goodridge
- College of Medicine, University of Saskatchewan, Saskatoon, Canada.
| | - Chrysanthus Henry
- Department of Community and Population Health Studies, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Erin Watson
- Leslie and Irene Dube Health Sciences Library, University of Saskatchewan, Saskatoon, Canada
| | - Meghan McDonald
- College of Medicine, Health Sciences Graduate Program, University of Saskatchewan and Saskatchewan Collaborative Bachelor of Science in Nursing Program, Saskatchewan Polytechnic, Saskatoon, Canada
| | - Lucia New
- College of Medicine, Health Sciences Graduate Program, University of Saskatchewan and Saskatchewan Collaborative Bachelor of Science in Nursing Program, Saskatchewan Polytechnic, Saskatoon, Canada
| | - Elizabeth L Harrison
- School of Physical Therapy, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Murray Scharf
- College of Education, University of Saskatchewan, Saskatoon, Canada
| | - Erika Penz
- College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Steve Campbell
- Faculty of Health, University of Tasmania, Hobart, Australia
| | - Thomas Rotter
- Healthcare Quality Programs, Queen's University, Kingston, Canada
| |
Collapse
|
27
|
Halperin IJ, Mukerji G, Maione M, Segal P, Wolfs M, Goguen J, Jeffs L. Adult Patient Perspectives on Care for Type 1 and Type 2 Diabetes Across the Institute of Medicine's 6 Domains of Quality. Can J Diabetes 2018; 42:36-43. [DOI: 10.1016/j.jcjd.2017.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 03/16/2017] [Accepted: 03/16/2017] [Indexed: 11/30/2022]
|
28
|
Goodridge D, Isinger T, Rotter T. Patient family advisors' perspectives on engagement in health-care quality improvement initiatives: Power and partnership. Health Expect 2018; 21:379-386. [PMID: 28960630 PMCID: PMC5750697 DOI: 10.1111/hex.12633] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Engagement of the public in defining and shaping the organization and delivery of health care is increasingly viewed as integral to improving quality and promoting transparent decision making. Meaningful engagement of the public in health-care reform is predicated on shifting entrenched power imbalances between health-care systems and those it claims to serve. OBJECTIVES To describe the expressions, forms and spaces of power from the perspectives of persons who participated as Patient/Family Advisors (PFAs) in Rapid Process Improvement Workshops (RPIWs) within Saskatchewan, Canada. METHODS Using a qualitative, interpretive approach, in-depth interviews were conducted with a purposive sample of 18 PFAs who had participated in at least one RPIW over the past year. Deductive thematic analysis was informed by Gaventa's model of power. RESULTS Motivations for serving as a PFA included a sense of obligation to contribute to the improvement of a public system, recognition of their rights as citizens within a publicly funded system and an opportunity to openly express their concerns where previous encounters had been very negative. The invited spaces of the RPIWs were created by policymakers to accord visible power to PFAs. Participation resulted in PFAs gaining new insights into the structure and operations of the system, affirmation of their right to advocate and recognition of the potential to claim spaces of power as consumers. Advisement on specific health-care initiatives using the vehicle of PFAs shaped and promoted new forms and spaces of power, representing one step in a very long road to full engagement of consumers in health care.
Collapse
|
29
|
Graffigna G, Barello S. Spotlight on the Patient Health Engagement model (PHE model): a psychosocial theory to understand people's meaningful engagement in their own health care. Patient Prefer Adherence 2018; 12:1261-1271. [PMID: 30050288 PMCID: PMC6056150 DOI: 10.2147/ppa.s145646] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The concept of patient engagement in health care is gaining more and more attention not only in the scientific literature, but also as a requirement in the everyday practices of health care organizations. In general terms, the growing body of literature devoted to patient engagement is mainly inspired by the sociological and public health perspectives, which have generated various theories and models trying to explain how people become active agents in their health and care management. However, theories focusing on the psychosocial dimensions intervening in the patient engagement experience are still limited. This paper proposes a psychosocial perspective on patient engagement and discusses the Patient Health Engagement model, which is an evidence-based psychological theory built on extensive qualitative narrative research and literature analysis aimed at explaining patient engagement and its development in the patients' perspective. The model has been applied to orient patient and professional educational interventions and has contributed to the generation of the first scientific measure of the psychological experience of patients' engagement in their own care (Patient Health Engagement scale). According to this theory, patient engagement is a developmental process that involves the recovered patients' ability to have a life projectuality and goal directedness - even if living with a disease. The paper will also discuss the theoretical origins of this model and will conduct a critical comparison of the theory with the Transtheoretical Model of Change developed by Prochaska and the five-stage grief theory by Kubler-Ross.
Collapse
Affiliation(s)
- Guendalina Graffigna
- Department of Psychology, EngageMinds HUB Research Center, Università Cattolica del Sacro Cuore, Milano, Italy,
| | - Serena Barello
- Department of Psychology, EngageMinds HUB Research Center, Università Cattolica del Sacro Cuore, Milano, Italy,
| |
Collapse
|
30
|
Baines RL, Regan de Bere S. Optimizing patient and public involvement (PPI): Identifying its "essential" and "desirable" principles using a systematic review and modified Delphi methodology. Health Expect 2017; 21:327-335. [PMID: 28929554 PMCID: PMC5750770 DOI: 10.1111/hex.12618] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2017] [Indexed: 11/29/2022] Open
Abstract
Background There is international interest in the active involvement of patients and the public. However, consensus on how best to optimize its application is currently unavailable. Objective To identify and assess the underlying principles of patient and public involvement (PPI) in health and social care services, research, education and regulation across medicine, dentistry and nursing. Design A four‐phase methodology: (i) an extensive systematic review of published and grey literature; (ii) inductive thematic analysis of review findings; (iii) development of best practice principles; and (iv) consensus testing of identified principles using a modified Delphi methodology. Setting and participants Twelve systematic reviews and 88 grey literature publications were reviewed leading to the unique identification of 13 principles later assessed by 18 PPI experts. Results Essential consensus (>75% agreement) was obtained for nine principles reviewed. Working in equal partnership and sharing information achieved the highest consensus rates: 16/17 essential 94.1%; 1/17 desirable 5.8%. The four remaining principles that failed to reach essential consensus were categorized as desirable by expert respondents. No principles were considered irrelevant. No alternatives were suggested. Discussion Expert respondents suggest essential principles must be achieved to optimize PPI best practice. To advance PPI practice, desirable principles should also be aspired to wherever possible. Conclusions This study's innovative approach advances existing knowledge by providing previously unavailable consensus about PPI best practice. Research findings hold important theoretical and practical implications for educators, regulators, researchers and practitioners looking to effectively work together.
Collapse
Affiliation(s)
- Rebecca L Baines
- Collaboration for the Advancement of Medical Education Research & Assessment, University of Plymouth, Plymouth, UK
| | - Sam Regan de Bere
- Collaboration for the Advancement of Medical Education Research & Assessment, University of Plymouth, Plymouth, UK
| |
Collapse
|
31
|
Whiston L, Barry JM, Darker CD. Participation of patients and family members in healthcare services at the service and national levels: A lesson learned in Dublin, Ireland. PATIENT EDUCATION AND COUNSELING 2017; 100:583-591. [PMID: 27816316 DOI: 10.1016/j.pec.2016.10.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 10/18/2016] [Accepted: 10/24/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Identify the current amount and intensity of patient and family participation at the patient, service and national levels from a diabetes and a psychiatric service perspective. Establish the current level of support for greater participation and related characteristics. METHOD Researcher-administered questionnaires were conducted with 738 patients and family members in an outpatient type 2 diabetes service and an outpatient psychiatric service, both in Dublin, Ireland. RESULTS Patient and family participation at the service and national levels are restricted to the provision of information. Typically no involvement in discussions or the decision -making process is reported. The majority of participants favour greater patient participation at the service level (537/669; 80.3%) and the national level (561/651; 86.2%). Greater support for patient and family member participation is significantly associated with participant's age, service satisfaction and level of education. CONCLUSION Patient and family participation is greatest at the patient level. The majority of patients and family members support greater participation at the service and national levels. PRACTICE IMPLICATIONS The best way to implement participation needs to be identified. There needs to be a greater focus on participation at the service level. The role of family members also needs to be investigated further.
Collapse
Affiliation(s)
- Lucy Whiston
- Department of Public Health and Primary Care, Institute of Population Health, Trinity College Dublin, Russell Centre, Tallaght Cross, Dublin 24, Ireland.
| | - Joe M Barry
- Department of Public Health and Primary Care, Institute of Population Health, Trinity College Dublin, Russell Centre, Tallaght Cross, Dublin 24, Ireland.
| | - Catherine D Darker
- Department of Public Health and Primary Care, Institute of Population Health, Trinity College Dublin, Russell Centre, Tallaght Cross, Dublin 24, Ireland.
| |
Collapse
|
32
|
Abstract
PURPOSE The spotlight has recently been placed on managers' responsibility for patient-centred care as a result of Mid Staffordshire NHS Foundation Trust failings. In previous research, clinicians reported that managers do not have an adequate structured plan for implementing patient-centred care. The purpose of this paper is to assess the perceptions of European hospital management with respect to factors affecting the implementation of a patient-centred approach. DESIGN/METHODOLOGY/APPROACH In total, 15 semi-structured interviews were conducted with hospital managers (n=10), expert country informants (n=2), patient organisations (n=2) and a user representative (n=1) from around Europe. Participants were purposively and snowball sampled. Interviews were analysed using framework analysis. FINDINGS Most participants felt that current levels of patient-centred care are inadequate, but accounted that there were a number of macro, meso and micro challenges they faced in implementing this approach. These included budget constraints, political and historical factors, the resistance of clinicians and other frontline staff. Organisational culture emerged as a central theme, shaped by these multi-level factors and influencing the way in which patient-centred care was borne out in the hospital. Participants proposed that the needs of patients might be better met through increasing advocacy by patient organisations and greater staff contact with patients. ORIGINALITY/VALUE This study is the first of its kind to obtain management views from around Europe. It offers an insight into different models of how patient-centred care is realised by management. It indicates that managers see the value of a patient-centred approach but that they feel restricted by a number of factors at multiple levels.
Collapse
Affiliation(s)
- Angelina Taylor
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
| | | |
Collapse
|
33
|
Cukor D, Cohen LM, Cope EL, Ghahramani N, Hedayati SS, Hynes DM, Shah VO, Tentori F, Unruh M, Bobelu J, Cohen S, Dember LM, Faber T, Fischer MJ, Gallardo R, Germain MJ, Ghahate D, Grote N, Hartwell L, Heagerty P, Kimmel PL, Kutner N, Lawson S, Marr L, Nelson RG, Porter AC, Sandy P, Struminger BB, Subramanian L, Weisbord S, Young B, Mehrotra R. Patient and Other Stakeholder Engagement in Patient-Centered Outcomes Research Institute Funded Studies of Patients with Kidney Diseases. Clin J Am Soc Nephrol 2016; 11:1703-1712. [PMID: 27197911 PMCID: PMC5012486 DOI: 10.2215/cjn.09780915] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Including target populations in the design and implementation of research trials has been one response to the growing health disparities endemic to our health care system, as well as an aid to study generalizability. One type of community-based participatory research is "Patient Centered-Research", in which patient perspectives on the germane research questions and methodologies are incorporated into the study. The Patient-Centered Outcomes Research Institute (PCORI) has mandated that meaningful patient and stakeholder engagement be incorporated into all applications. As of March 2015, PCORI funded seven clinically-focused studies of patients with kidney disease. The goal of this paper is to synthesize the experiences of these studies to gain an understanding of how meaningful patient and stakeholder engagement can occur in clinical research of kidney diseases, and what the key barriers are to its implementation. Our collective experience suggests that successful implementation of a patient- and stakeholder-engaged research paradigm involves: (1) defining the roles and process for the incorporation of input; (2) identifying the particular patients and other stakeholders; (3) engaging patients and other stakeholders so they appreciate the value of their own participation and have personal investment in the research process; and (4) overcoming barriers and challenges that arise and threaten the productivity of the collaboration. It is our hope that the experiences of these studies will further interest and capacity for incorporating patient and stakeholder perspectives in research of kidney diseases.
Collapse
Affiliation(s)
- Daniel Cukor
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Purificacion S, Brown E, Anne-Davis C, French J. Patient engagement in radiation therapy: The development of guidelines for current Canadian practices. Healthc Manage Forum 2016; 29:187-195. [PMID: 27576854 DOI: 10.1177/0840470416647159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Radiation therapy service quality is not only defined by the technical aspects of care-the patient's involvement and satisfaction also contribute largely to determining the quality of care received. Although there have been recent increases in support for the development of patient engagement activities throughout Canada, the lack of guidance and knowledge of patient engagement techniques within the radiotherapy context limits implementation. Without processes to obtain first-hand insight from patients, the need for these programs is overlooked. With a commitment to improving quality and consistency of care, the Canadian Partnership for Quality Radiotherapy recognized the need for a set of national guidelines on patient engagement in radiation therapy service delivery. Making use of the perspectives and first-hand experience of patient representatives, this initiative aims to develop a pan-Canadian guidance document that radiation therapy centres can adopt for successful integration of patient engagement through core activities of service delivery.
Collapse
Affiliation(s)
| | - Erika Brown
- Canadian Partnership for Canadian Radiotherapy, Red Deer, Alberta, Canada
| | | | - John French
- British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| |
Collapse
|
35
|
Saunders C, Carter DJ. Is health systems integration being advanced through Local Health District planning? AUST HEALTH REV 2016; 41:154-161. [PMID: 27096436 DOI: 10.1071/ah15191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 03/08/2015] [Indexed: 11/23/2022]
Abstract
Objective Delivering genuine integrated health care is one of three strategic directions in the New South Wales (NSW) Government State Health Plan: Towards 2021. This study investigated the current key health service plan of each NSW Local Health District (LHD) to evaluate the extent and nature of health systems integration strategies that are currently planned. Methods A scoping review was conducted to identify common key principles and practices for successful health systems integration to enable the development of an appraisal tool to content assess LHD strategic health service plans. Results The strategies that are planned for health systems integration across LHDs focus most often on improvements in coordination, health care access and care delivery for complex at-risk patients across the care continuum by both state- and commonwealth-funded systems, providers and agencies. The most common reasons given for integrated activities were to reduce avoidable hospitalisation, avoid inappropriate emergency department attendance and improve patient care. Conclusions Despite the importance of health systems integration and finding that all NSW LHDs have made some commitment towards integration in their current strategic health plans, this analysis suggests that health systems integration is in relatively early development across NSW. What is known about the topic? Effective approaches to managing complex chronic diseases have been found to involve health systems integration, which necessitates sound communication and connection between healthcare providers across community and hospital settings. Planning based on current health systems integration knowledge to ensure the efficient use of scarce resources is a responsibility of all health systems. What does this paper add? Appropriate planning and implementation of health systems integration is becoming an increasingly important expectation and requirement of effective health systems. The present study is the first of its kind to assess the planned activity in health systems integration in the NSW public health system. NSW health districts play a central role in health systems integration; each health service plan outlines the strategic directions for the development and delivery of all state-funded services across each district for the coming years, equating to hundreds of millions of dollars in health sector funding. The inclusion of effective health systems integration strategies allows Local Health Districts to lay the foundation for quality patient outcomes and long-term financial sustainability despite projected increases in demand for health services. What are the implications for practice? Establishing robust ongoing mechanisms for effective health systems integration is now a necessary part of health planning. The present study identifies several key areas and strategies that are wide in scope and indicative of efforts towards health systems integration, which may support Local Health Districts and other organisations in systematic planning and implementation.
Collapse
Affiliation(s)
- Carla Saunders
- Centre for Health Services Management, Faculty of Health, University of Technology Sydney, Jones Street, Ultimo, NSW 2007(PO Box 222), Australia. Email
| | - David J Carter
- Centre for Health Services Management, Faculty of Health, University of Technology Sydney, Jones Street, Ultimo, NSW 2007(PO Box 222), Australia. Email
| |
Collapse
|
36
|
Long Term Effect on Professionals' Knowledge, Practice and Attitudes towards User Involvement Four Years after Implementing an Organisational Development Plan: A Controlled Study. PLoS One 2016; 11:e0150742. [PMID: 26974971 PMCID: PMC4790889 DOI: 10.1371/journal.pone.0150742] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 02/18/2016] [Indexed: 11/23/2022] Open
Abstract
Background Health service organisations are increasingly implementing user involvement initiatives according to requirements from governments, such as user representation in administrational boards, better information to users, and more involvement of the users during treatment. Professionals are vital in all initiatives to enhance user involvement, and initiatives to increase involvement should influence the professionals’ practice and attitudes. The implementation of a development plan intending to enhance user involvement in a mental health hospital in Central Norway had no effect on the professionals after 16 months. The objective was therefore to investigate the long term effect on the professionals’ knowledge, practice and attitudes towards user involvement after four years. Methods This was a non-randomized controlled study including professionals from three mental health hospitals in Central Norway. A development plan intended to enhance user participation was implemented in one of the hospitals, including establishing a patient education centre and a user office, purchasing of user expertise, appointing contact professionals for next of kin, and improving of the centre’s information and the professional culture. The professionals at two other hospitals constituted the control group. All professionals were invited to answer the Consumer Participation Questionnaire (CPQ) and additional questions, at a four year interval. Results A total of 399 professionals participated (43% response rate). Comparing the changes in the intervention group with the changes in the control group, the results showed that the plan had improved some aspects of the professionals’ knowledge about the user involvement taking place in the hospital. In addition, some parts of the professionals’ practice of providing information to the service users was improved, and the development plan might have raised their awareness about insufficient involvement of next of kin. Conclusions This is the first controlled study on the long term effect on professionals from implementing a development plan to enhance user participation in a mental health hospital. Since there was more effect after four years than after 16 months, this study indicates that it takes time before the effect of complex interventions to enhance patient participation in organisations can be detected among the professionals. More long-term studies are thus warranted.
Collapse
|
37
|
Snyder H, Engström J. The antecedents, forms and consequences of patient involvement: A narrative review of the literature. Int J Nurs Stud 2016; 53:351-78. [DOI: 10.1016/j.ijnurstu.2015.09.008] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 09/01/2015] [Accepted: 09/09/2015] [Indexed: 12/19/2022]
|
38
|
Locatelli SM, Hill JN, Bokhour BG, Krejci L, Fix GM, Nora Mueller, Solomon JL, Van Deusen Lukas C, LaVela SL. Provider perspectives on and experiences with engagement of patients and families in implementing patient-centered care. Healthcare (Basel) 2015; 3:209-14. [DOI: 10.1016/j.hjdsi.2015.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 03/11/2015] [Accepted: 04/29/2015] [Indexed: 11/27/2022] Open
|
39
|
Primary care-led commissioning and public involvement in the English National Health Service. Lessons from the past. Prim Health Care Res Dev 2014; 16:289-303. [DOI: 10.1017/s1463423614000486] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BackgroundPatient and Public involvement (PPI) in health care occupies a central place in Western democracies. In England, this theme has been continuously prominent since the introduction of market reforms in the early 1990s. The health care reforms implemented by the current Coalition Government are making primary care practitioners the main commissioners of health care services in the National Health Service, and a duty is placed on them to involve the public in commissioning decisions and strategies. Since implementation of PPI initiatives in primary care commissioning is not new, we asked how likely it is that the new reforms will make a difference. We scanned the main literature related to primary care-led commissioning and found little evidence of effective PPI thus far. We suggest that unless the scope and intended objectives of PPI are clarified and appropriate resources are devoted to it, PPI will continue to remain empty rhetoric and box ticking.AimTo examine the effect of previous PPI initiatives on health care commissioning and draw lessons for future development.MethodWe scanned the literature reporting on previous PPI initiatives in primary care-led commissioning since the introduction of the internal market in 1991. In particular, we looked for specific contexts, methods and outcomes of such initiatives.Findings1. PPI in commissioning has been constantly encouraged by policy makers in England. 2. Research shows limited evidence of effective methods and outcomes so far. 3. Constant reconfiguration of health care structures has had a negative impact on PPI. 4. The new structures look hardly better poised to bring about effective public and patient involvement.
Collapse
|
40
|
Petriwskyj A, Gibson A, Webby G. Participation and power in care: Exploring the “client” in client engagement. J Aging Stud 2014; 31:119-31. [DOI: 10.1016/j.jaging.2014.09.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 09/15/2014] [Accepted: 09/15/2014] [Indexed: 11/27/2022]
|
41
|
Establishing components of high-quality injury care: Focus groups with patients and patient families. J Trauma Acute Care Surg 2014; 77:749-756. [PMID: 25494428 DOI: 10.1097/ta.0000000000000432] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Each year, injuries affect 700 million people worldwide, more than 5 million people die of injuries, and 68,000 survivors remain permanently impaired. Half of all critically injured patients do not receive recommended care, and medical errors are common. Little is known about the aspects of injury care that are important to patients and their families. The purpose of this study was to explore the views of patients and families affected by injury on desired components of injury care in the hospital setting. METHODS With the use of a grounded theory approach, this qualitative study involved focus groups with injured patients, family members of survivors, and bereaved family members from four Canadian trauma (injury care) centers. RESULTS Thirty-eight participants included injured patients (n = 16), family members of survivors (n = 13), and bereaved family members (n = 9) across four trauma (injury care) centers in different jurisdictions. Participants articulated numerous themes reflecting important components of injury care organized across three domains as follows: clinical care (staff availability, professionalism, physical comfort, adverse events), holistic care (patient wellness, respect for patient and family, family access to patient, family wellness, hospital facilities, supportive care), and communication and information (among staff, with or from staff, content, delivery, and timing). Bereaved family members commented on decision making and end-of-life processes. Subthemes were revealed in most of these themes. Trends by site or type of participant were not identified. CONCLUSION The framework of patient- and family-derived components of quality injury care could be used by health care managers and policy makers to guide quality improvement efforts. Further research is needed to extend and validate these components among injured patients and families elsewhere. Translating these components into quality indicators and blending those with measures that reflect a provider perspective may offer a comprehensive means of assessing injury care.
Collapse
|
42
|
Omeni E, Barnes M, MacDonald D, Crawford M, Rose D. Service user involvement: impact and participation: a survey of service user and staff perspectives. BMC Health Serv Res 2014; 14:491. [PMID: 25344210 PMCID: PMC4212124 DOI: 10.1186/s12913-014-0491-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 10/06/2014] [Indexed: 11/17/2022] Open
Abstract
Background Over the last 20 years governments around the world have promoted user involvement in an effort to improve the quality of health services. Despite the growing emphasis placed on user involvement in England, there is a paucity of recent studies looking at how service users and professionals perceive the outcomes of user involvement policies. This study aimed to examine the overall levels of participation in service user involvement in mental health services among professionals and service users and ascertain their views on the impact of involvement activity on various areas of service delivery. Methods A cross-sectional survey of service users and providers within community mental health services. The sampling was carried out across three mental health Trusts, two serving people living in inner-city areas and a third covering a mixed rural/urban population. A questionnaire with closed and open ended questions was used to gather the responses of service users and frontline professionals. As a mixed methods study, the analysis consisted of both quantitative and qualitative approaches. Results Three hundred and two service users responded to the survey with a response rate of 48%. One hundred and forty three frontline mental health professionals, 26.8% of those approached submitted questionnaires. Almost half of service users (N=138, 45.7%,) and healthcare professionals (N=143, 55.9%) reported having been involved in some form of user involvement activity. Although there were some differences in the responses of service users and frontline professionals, both groups reported that service user involvement was having a positive impact. Conclusions The findings show that, within the three mental health trusts examined in this study, service user involvement has become widespread and is perceived by both staff and service users to be a good policy. The study had some important limitations. The questionnaire used was based on existing literature, however it was not subjected to psychometric testing. In addition, response rates were low, particularly among professionals. Despite the limitations, the findings are encouraging, offering important of insight into views and experiences of service users and healthcare staff. Further studies are needed to assess and investigate the topic on a national level.
Collapse
Affiliation(s)
- Edward Omeni
- Service User Research Enterprise (SURE), Institute of Psychiatry, Psychology and Neuroscience at King's College London, De Crespigny Park, London, SE5 8AF, UK.
| | - Marian Barnes
- School of Applied Social Science, University of Brighton, Mayfield House, Falmer, East Sussex, BN1 9PH, UK.
| | - Dee MacDonald
- School of Applied Social Science, University of Brighton, Mayfield House, Falmer, East Sussex, BN1 9PH, UK.
| | - Mike Crawford
- Department of Medicine, Imperial College, Claybrook Centre, Claybrook Road, , Hammersmith, London, W6 8LN, UK.
| | - Diana Rose
- Service User Research Enterprise (SURE), Institute of Psychiatry, Psychology and Neuroscience at King's College London, De Crespigny Park, London, SE5 8AF, UK.
| |
Collapse
|
43
|
Thomas N. Editorial. J Ren Care 2014; 40:149. [PMID: 25123324 DOI: 10.1111/jorc.12096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Nicola Thomas
- Principal Lecturer, London South Bank University, UK
| |
Collapse
|
44
|
Gagnon MP, Candas B, Desmartis M, Gagnon J, La Roche D, Rhainds M, Coulombe M, Dipankui MT, Légaré F. Involving patient in the early stages of health technology assessment (HTA): a study protocol. BMC Health Serv Res 2014; 14:273. [PMID: 24950739 PMCID: PMC4072844 DOI: 10.1186/1472-6963-14-273] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 06/16/2014] [Indexed: 11/19/2022] Open
Abstract
Background Public and patient involvement in the different stages of the health technology assessment (HTA) process is increasingly encouraged. The selection of topics for assessment, which includes identifying and prioritizing HTA questions, is a constant challenge for HTA agencies because the number of technologies requiring an assessment exceeds the resources available. Public and patient involvement in these early stages of HTA could make assessments more relevant and acceptable to them. Involving them in the development of the assessment plan is also crucial to optimize their influence and impact on HTA research. The project objectives are: 1) setting up interventions to promote patient participation in three stages of the HTA process: identification of HTA topics, prioritization, and development of the assessment plan of the topic prioritized; and 2) assessing the impact of patient participation on the relevance of the topics suggested, the prioritization process, and the assessment plan from the point of view of patients and other groups involved in HTA. Methods Patients and their representatives living in the catchment area of the HTA Roundtable of Université Laval’s Integrated University Health Network (covering six health regions of the Province of Quebec, Canada) will be involved in the following HTA activities: 1) identification of potential HTA topics in the field of cancer; 2) revision of vignettes developed to inform the prioritization of topics; 3) participation in deliberation sessions for prioritizing HTA topics; and 4) development of the assessment plan of the topic prioritized. The research team will coordinate the implementation of these activities and will evaluate the process and outcomes of patient involvement through semi-structured interviews with representatives of the different stakeholder groups, structured observations, and document analysis, mainly involving the comparison of votes and topics suggested by various stakeholder groups. Discussion This project is designed as an integrated approach to knowledge translation and will be conducted through a close collaboration between researchers and knowledge users at all stages of the project. In response to the needs expressed by HTA producers, the knowledge produced will be directly useful in guiding practices regarding patient involvement in the early phases of HTA.
Collapse
Affiliation(s)
- Marie-Pierre Gagnon
- Research Centre of the CHU de Québec, Hôpital Saint-François d'Assise, 10 rue de l'Espinay, D6-726, Quebec City, QC G1L 3L5, Canada.
| | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Vahdat S, Hamzehgardeshi L, Hessam S, Hamzehgardeshi Z. Patient involvement in health care decision making: a review. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e12454. [PMID: 24719703 PMCID: PMC3964421 DOI: 10.5812/ircmj.12454] [Citation(s) in RCA: 296] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 08/01/2013] [Accepted: 09/01/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patient participation means involvement of the patient in decision making or expressing opinions about different treatment methods, which includes sharing information, feelings and signs and accepting health team instructions. OBJECTIVES Given the importance of patient participation in healthcare decision making which empowers patients and improves services and health outcomes, this study was performed to review previous studies on patient participation in healthcare decision making. MATERIALS AND METHODS To prepare this narrative review article, researchers used general and specific search engines, as well as textbooks addressing this subject for an in-depth study of patient involvement in healthcare decision-making. As a result, 35 (out of 100 relevant) articles and also two books were selected for writing this review article. RESULTS BASED ON THE REVIEW OF ARTICLES AND BOOKS, TOPICS WERE DIVIDED INTO SIX GENERAL CATEGORIES: definition of participation, importance of patient participation, factors influencing participation of patients in healthcare decisions, method of patient participation, tools for evaluating participation, and benefits and consequences of patient participation in health care decision-making. CONCLUSIONS IN MOST STUDIES, FACTORS INFLUENCING PATIENT PARTICIPATION CONSISTED OF: factors associated with health care professionals such as doctor-patient relationship, recognition of patient's knowledge, allocation of sufficient time for participation, and also factors related to patients such as having knowledge, physical and cognitive ability, and emotional connections, beliefs, values and their experiences in relation to health services.
Collapse
Affiliation(s)
- Shaghayegh Vahdat
- Department of Health Service Administration, Science and Research Branch, Islamic Azad University, Shiraz, IR Iran
| | - Leila Hamzehgardeshi
- Department of Health Service Administration, Science and Research Branch, Islamic Azad University, Shiraz, IR Iran
- Corresponding Author: Leila Hamzehgardeshi, Department of Health Service Administration, Science and Research Branch, Islamic Azad University, Shiraz, IR Iran. Tel: +98-7283113100, Fax: +98-7284692110, E-mail:
| | - Somayeh Hessam
- Department of Health Service Administration, Science and Research Branch, Islamic Azad University, Shiraz, IR Iran
| | | |
Collapse
|
46
|
Lawton J, Rankin D, Elliott J. Is consulting patients about their health service preferences a useful exercise? QUALITATIVE HEALTH RESEARCH 2013; 23:876-886. [PMID: 23618684 DOI: 10.1177/1049732313485161] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
As part of the shift toward patient-centered care, patients are increasingly being consulted about their preferences for health services and interventions, including those explored during randomized controlled trials (RCTs), to ensure that service recommendations are aligned to their own circumstances and needs. Hence, we interviewed patients (N = 40) who participated in a randomized control trial comparing diabetes education courses delivered using two different formats to establish whether, and why, they preferred one format to the other, to inform recommendations for future course delivery. Not only did patients report changing their preferences, and the reasons underlying these preferences, over time, but all patients also claimed to prefer the particular course they had attended. We use our findings and experiences to problematize the notion of a patient preference and to raise questions about what we can really learn from consulting patients about the care they receive within the context of an RCT.
Collapse
Affiliation(s)
- Julia Lawton
- University of Edinburgh, Edinburgh, United Kingdom.
| | | | | |
Collapse
|
47
|
Nathan S, Braithwaite J, Stephenson N. Facilitating the action of community representatives in a health service: the role of a community participation coordinator. BMC Health Serv Res 2013; 13:154. [PMID: 23627583 PMCID: PMC3646681 DOI: 10.1186/1472-6963-13-154] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 04/19/2013] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Commitments to community participation are common in health policy, yet ways to maximise the input and impact of community representatives in health service delivery and care remain elusive, lack empirical evidence and are under-theorised. METHODS The role of Community Participation (CP) Coordinators involved in an Australian health service were examined in a triangulated multi-method, multi-site ethnographically informed three year study. Formal fieldwork involved observation of just over 42 hours of meetings together with informal interactions in the field with staff and community members and in-depth interviews and discussions with 10 Community Representatives, 19 staff and the seven CP Coordinators employed during the study period. RESULTS Four key roles that Community Participation Coordinators undertake to support and facilitate the action of community representatives operating within a health service were identified in our analysis: 1) Building skills and confidence; 2) Engaging them in agendas for action: 3) Helping them navigate and understand the health system; and 4) Advocating to staff. A fifth role of advocating externally to outside groups and building coalitions is suggested as important, but was not strongly represented in our data. CONCLUSIONS This study offers a new model synthesising the key roles of coordinating and facilitating community participation in health services which may be transferable to other health service settings. Our findings call attention to the need for health services to employ a facilitator who can support, engage, navigate and advocate for community representative's participation and influence in health service policy and practice.
Collapse
Affiliation(s)
- Sally Nathan
- School of Public Health and Community Medicine, UNSW, Sydney, NSW, 2052, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Centre for Clinical Governance Research, UNSW Medicine, UNSW, Sydney, NSW, 2052, Australia
| | - Niamh Stephenson
- School of Public Health and Community Medicine, UNSW, Sydney, NSW, 2052, Australia
| |
Collapse
|
48
|
Developing a patient and family-centred approach for measuring the quality of injury care: a study protocol. BMC Health Serv Res 2013; 13:31. [PMID: 23351430 PMCID: PMC3570378 DOI: 10.1186/1472-6963-13-31] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 01/21/2013] [Indexed: 12/30/2022] Open
Abstract
Background Quality indicators (QI) are used in health care to measure quality of service and performance improvement. Health care professionals and organizations caring for patients with injuries need information regarding the quality of care provided and the outcomes experienced in order to target improvement efforts. However, very little is known about the quality of injury care provided to individual patients and populations and even less about patients’ perspectives on quality of care. The absence of QIs that incorporate patient or family preferences, needs or values has been identified as an important gap in the science and practice of injury quality improvement. The primary objective of this research protocol is to develop and evaluate the first set of patient and family-centred QIs of injury care for critically injured patients Methods/design This mixed methods study is comprised of three Sub-Studies. Sub-Study A will utilize focus group methodology to describe the preferences, needs and values of critically injured patients and their family members regarding the quality of health care delivered. Qualitative content analysis of the transcripts will begin after the first completed focus group and will draw on grounded theory using a process of open, axial and selective coding. A panel of stakeholders will be assembled during Sub-Study B to review the themes identified from the focus groups and develop a catalogue of potential patient and family-centred QIs of injury care using the RAND/UCLA Appropriateness Method (RAM). The QIs developed by the stakeholder panel will be pilot tested in Sub-Study C using surveys of patients and their family members to determine construct validity, intra-rater reliability and clinical sensibility. Discussion Measuring the quality of injury care is but a first step towards improving patient outcomes. This research will develop the first set of patient and family-centred QIs of injury care. To improve patient care, we need accessible, reliable indicators of quality that are important to patients, and that can then be used to establish quality of care benchmarks, to flag potential problems or successes, follow trends over time and identify disparities across organizations, communities, populations and regions.
Collapse
|
49
|
Kötter T, Schaefer FA, Scherer M, Blozik E. Involving patients in quality indicator development - a systematic review. Patient Prefer Adherence 2013; 7:259-68. [PMID: 23569365 PMCID: PMC3616132 DOI: 10.2147/ppa.s39803] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Quality indicators (QI) are used in many health care areas to measure, compare, and improve the quality of care. Ideas of quality differ between health care providers and patients, yet patients are not regularly involved in QI development nor does a methodological standard for patient involvement in QI development exist. In this study we systematically reviewed the medical journal articles and gray literature for published approaches for involving patients in QI development. METHODS We searched medical literature databases (Medline, Excerpta Medica database, and Cumulative Index to Nursing and Allied Health Literature), screened websites, and contacted experts in the field of QI development for publications on approaches to patient involvement in QI development. RESULTS Eleven relevant journal articles and four web-published documents were included. Four major approaches to patient involvement were extracted from the literature: (1) focus group interviews, (2) self-administered questionnaires, (3) individual interviews, and (4) participation in panels during systematic consensus processes. Patients' views were collected by involving patients, patient representatives, or family members. CONCLUSION Although there is a large body of literature on QI, publications that describe approaches to patient involvement in QI development are scarce. In principle, indirect and direct methods of patient involvement can be distinguished, and it seems most promising to combine different approaches. However, the limited number of publications identified clearly shows that further research in this field is overdue and that the quality of reporting found in studies within this field needs to be improved.
Collapse
Affiliation(s)
- Thomas Kötter
- Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Friederike Anna Schaefer
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Scherer
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Eva Blozik
- Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Correspondence: Eva Blozik Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Martinistraâe 52, D-20246 Hamburg, Germany Tel +49 40 7410 52400 Fax +49 40 7410 53681 Email
| |
Collapse
|
50
|
Bragazzi NL. From P0 to P6 medicine, a model of highly participatory, narrative, interactive, and "augmented" medicine: some considerations on Salvatore Iaconesi's clinical story. Patient Prefer Adherence 2013; 7:353-9. [PMID: 23650443 PMCID: PMC3640773 DOI: 10.2147/ppa.s38578] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Salvatore Iaconesi was recently diagnosed with a brain tumor. He decided to share his clinical records not only with doctors but with everybody who wishes to find him a cure. "Because cure is not unique," he emphasizes "there are cures for the body and cures for the soul, and everyone, from a painter to a musician, can find me a cure. Please, feel free to take my clinical history for example and let it become a game, a video, a music, a picture, whatever you like." The emblematic hallmark of the changing times, Salvatore Iaconesi's case is an example of how many profound revolutions and steps medicine has undertaken during the past few centuries. Stemming from a form of remote medical paternalism and arriving at the concept of a therapeutic alliance, medicine nowadays faces challenges and opportunities at a level before unforeseeable and unimaginable. The new concept of P6 medicine (personalized, predictive, preventive, participatory, psychocognitive, and public) is discussed, together with its profound implications.
Collapse
Affiliation(s)
- Nicola Luigi Bragazzi
- Correspondence: Nicola Luigi Bragazzi, School of Public Health, Department of Health Sciences (DISSAL), Via Antonio Pastore1, 16132, Genoa, Italy, Tel +39 010 353 7664, Fax +39 010 353 7669, Email ;
| |
Collapse
|