A method to determine the impact of patient-centered care interventions in primary care

A framework for elderly participation in Primary Health Care in Tabriz Health complexes

BACKGROUND

A framework for increasing elderly participation in Primary Health Care (PHC) is a vital issue considering the growing population. After examining the situation and elderly participation in the provision of PHC in the health complexes of Tabriz City, the present study presents the framework of elderly participation in PHC.

METHODS

This is a mixed-method study. First, we reviewed the models of elderly participation in PHC worldwide using a comprehensive search of literature. Then, we extracted the service providers' and the elderly's views regarding the obstacles and solutions for the elderly participation in PHC in Iran using the interviews and focus group discussions (FGD). We conducted three FGDs (8-10 people) and seven individual interviews. Data were analyzed using the content analysis method. We developed the proposed framework for the participation of the elderly in PHC using a panel of experts and checked and confirmed the framework's validity using the Delphi technique with 11 experts from the content validity index and modified kappa coefficient.

RESULTS

Based on the result of included studies in the systematic review, the characteristics of the participation models were classified into five areas: the characteristics of the service user, the main facilitator of the intervention, the type of ownership of the center, the subject and the method of participation. The solutions and obstacles, and problems presented by the service providers and users in different areas include 12 themes (elderly participation, home care, and self-care, respect for the elderly, cooperation of different organizations, service package for the elderly, referral system, planning for the elderly, considering insurance for the elderly, the role of informing the elderly, mental health of the elderly, physical space of centers and training of elderly caregivers) and 46 sub-themes. The final framework also includes five themes (approaches and strategies to attract participation, indicators, and consequences of participation of the elderly, implementation strategies of elderly care, implementation infrastructure and goals and areas of participation of the elderly) and sub-themes.

CONCLUSION

The results of the study indicate that the final framework obtained should be used based on a systematic model for elderly participation in PHC and should be implemented and followed up based on local strategies and specific indicators, considering all capacities.

Assessing Spiritual Well-Being in Residential Aged Care: An Exploratory Review

With the emerging incorporation of spiritual care into the allied health stream, there is a need for a clear and validated process of spiritual review that can be understood across multidisciplinary teams. The aim and purpose of this paper was to critically review the literature regarding spiritual screening, history-taking and assessment, and explore the merits of developing a brief instrument focussed on assessing and improving the spiritual well-being of consumers within residential aged care. Following an exploratory review of the literature, the results indicate that effective processes are noted regarding the triage and identification of the needs and spiritual assessment of consumers; however, many of these tools are overly religious in content, unwieldy in size, or not specifically aimed at identifying the immediate crisis confronting the consumer. It is recommended that an assessment instrument be developed which is communicable across all allied health practitioners (including spiritual carers), which may contribute towards a taxonomy of common consumer conditions, and which will enable the development and delivery of more targeted care plans.

Glaucoma patient-provider communication about vision quality-of-life

OBJECTIVE

The purpose of this study was to: (a) describe the extent to which ophthalmologists and glaucoma patients discuss vision quality-of-life during office visits, and (b) examine the association between patient and ophthalmologist characteristics and provider-patient communication about vision quality-of-life.

METHODS

Patients with glaucoma who were newly prescribed or on glaucoma medications were recruited at six ophthalmology clinics. Patients' visits were video-tape recorded and quality-of-life communication variables were coded. Generalized estimating equations were used to analyze the data.

RESULTS

Two hundred and seventy-nine patients participated. Specific glaucoma quality-of-life domains were discussed during only 13% of visits. Older patients were significantly more likely to discuss one or more vision quality-of-life domains than younger patients. African American patients were significantly less likely to make statements about their vision quality-of-life and providers were less likely to ask them one or more vision quality-of-life questions than non-African American patients.

CONCLUSION

Eye care providers and patients infrequently discussed the patient's vision quality-of-life during glaucoma visits. African American patients were less likely to communicate about vision quality-of-life than non-African American patients.

PRACTICE IMPLICATIONS

Eye care providers should make sure to discuss vision quality-of-life with glaucoma patients.

'Some patients are more equal than others': Patient-centred care differential in two-tier inpatient ward hospitals in Ghana

OBJECTIVE

To examine differences in patient-centred care among private and public inpatients in public hospitals and whether satisfaction with patient-centred care differ between the patient groups.

METHOD

Cross-sectional data collected from inpatients in private wards (n=300) and public wards (n=520) in Ghana, using a structured questionnaire modelled on four dimensions of patient-centred care: respect and dignity, emotional support, interpersonal relations and information sharing.

RESULTS

Patient-centred care differed significantly among private and public patients (p<0.001), with an effect size ranging from medium to large. Private patients rated patient-centred care higher than public patients in all the items of the four dimensions. Satisfaction with patient-centred care discriminated between the patient groups. Satisfaction was significantly high for private patients who are aged 50+ (p<0.001), had high education (p<0.05) and high income (p<0.001) compared to the same category of public patients.

CONCLUSION

Physicians behaviour is stereotyping and less favourable to public patients, suggesting inequitable access to patient-centred care for inpatients from high and low socioeconomic backgrounds.

PRACTICE IMPLICATIONS

Hospitals with private and public wards should be compelled to properly coordinate and regulate the activities of physicians to avoid fragmented care for inpatients.

An observational study of social and emotional support in smoking cessation Twitter accounts: content analysis of tweets

Background

Smoking continues to be the number one preventable cause of premature death in the United States. While evidence for the effectiveness of smoking cessation interventions has increased rapidly, questions remain on how to effectively disseminate these findings. Twitter, the second largest online social network, provides a natural way of disseminating information. Health communicators can use Twitter to inform smokers, provide social support, and attract them to other interventions. A key challenge for health researchers is how to frame their communications to maximize the engagement of smokers.

Objective

Our aim was to examine current Twitter activity for smoking cessation.

Methods

Active smoking cessation related Twitter accounts (N=18) were identified. Their 50 most recent tweets were content coded using a schema adapted from the Roter Interaction Analysis System (RIAS), a theory-based, validated coding method. Using negative binomial regression, the association of number of followers and frequency of individual tweet content at baseline was assessed. The difference in followership at 6 months (compared to baseline) to the frequency of tweet content was compared using linear regression. Both analyses were adjusted by account type (organizational or not organizational).

Results

The 18 accounts had 60,609 followers at baseline and 68,167 at 6 months. A total of 24% of tweets were socioemotional support (mean 11.8, SD 9.8), 14% (mean 7, SD 8.4) were encouraging/engagement, and 62% (mean 31.2, SD 15.2) were informational. At baseline, higher frequency of socioemotional support and encouraging/engaging tweets was significantly associated with higher number of followers (socioemotional: incident rate ratio [IRR] 1.09, 95% CI 1.02-1.20; encouraging/engaging: IRR 1.06, 95% CI 1.00-1.12). Conversely, higher frequency of informational tweets was significantly associated with lower number of followers (IRR 0.95, 95% CI 0.92-0.98). At 6 months, for every increase by 1 in socioemotional tweets, the change in followership significantly increased by 43.94 (P=.027); the association was slightly attenuated after adjusting by account type and was not significant (P=.064).

Conclusions

Smoking cessation activity does exist on Twitter. Preliminary findings suggest that certain content strategies can be used to encourage followership, and this needs to be further investigated.