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Mosteiro Miguéns DG, Rodríguez Fernández A, Zapata Cachafeiro M, Vieito Pérez N, Represas Carrera FJ, Novío Mallón S. Community Activities in Primary Care: A Literature Review. J Prim Care Community Health 2024; 15:21501319231223362. [PMID: 38197384 PMCID: PMC10785739 DOI: 10.1177/21501319231223362] [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: 10/29/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 01/11/2024] Open
Abstract
Community health promotion activities are a useful tool for a proactive approach to healthy lifestyles. However, the implementation of these types of activities at health centers is not standardized. The aim of this review was to analyse the characteristics of community activities undertaken in the primary care setting and substantiate available evidence on their health impact. We conducted a bibliographic review until November 15th, 2023 in the TRIPDATABASE, MEDLINE, EMBASE, and DIALNET databases. We included original papers on interventions, community activities, and actions and/or social prescriptions which had been implemented in a Primary Care setting, included a group approach in at least one session, and described some type of evaluation of the intervention applied. Studies targeted at professionals and those without involvement of the primary care team were excluded. The search identified 1912 potential studies. We included a total of 30 studies, comprising 11 randomized clinical trials, 14 quasi-experimental studies, 1 cohort study, and 4 qualitative studies. The issues most frequently addressed in community activities were healthy habits, physical activity, cardiovascular diseases and diabetes. Community activities can improve the physical and psychological environment of their participants, as well as their level of knowledge about the issues addressed. That said, however, implementation of these types of interventions is not uniform. The existence of a professional community-activity liaison officer at health centers, who would help integrate the health system with the community sector, could serve to standardize implementation and maximize the health impact of these types of interventions.
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Affiliation(s)
| | - Almudena Rodríguez Fernández
- University of Santiago de Compostela, Santiago de Compostela, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER of Epidemiology and Public Health, CIBERESP) Instituto de Salud Carlos III, Madrid, Spain
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Maruxa Zapata Cachafeiro
- University of Santiago de Compostela, Santiago de Compostela, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER of Epidemiology and Public Health, CIBERESP) Instituto de Salud Carlos III, Madrid, Spain
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Natalia Vieito Pérez
- University Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
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Najafi M, Gholipour K, Amerzadeh M, Kiaei MZ, Kalhor R. A framework for elderly participation in Primary Health Care in Tabriz Health complexes. BMC Geriatr 2023; 23:499. [PMID: 37605154 PMCID: PMC10441748 DOI: 10.1186/s12877-023-04217-1] [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: 07/27/2022] [Accepted: 08/04/2023] [Indexed: 08/23/2023] Open
Abstract
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.
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Affiliation(s)
- Mahdieh Najafi
- Student Research Committee, School of Public Health, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Kamal Gholipour
- Tabriz Health Services Management Research Center, Department of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Amerzadeh
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Mohammad Zakaria Kiaei
- Health Services Management, School of Public Health, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Rohollah Kalhor
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.
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Haihong C, Rong S, Yuqi X, Zhiyi W, Dan W, Xueyi L, Fan Y. Participation of pharmacists and patients in web-based pharmaceutical care consultation based on MEDICODE. Int J Med Inform 2023; 175:105074. [PMID: 37137216 DOI: 10.1016/j.ijmedinf.2023.105074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 04/03/2023] [Accepted: 04/16/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND The participation of providers and patients in medical communication is the core element of shared decision making. Furthermore, web-based pharmaceutical care consultation is increasingly necessary, welcomed and popular. OBJECTIVE This study aimed to analyze the participation of pharmacists and patients in web-based pharmaceutical care consultation, so as to form the promotion strategy for both parties' participation. METHODS Data of pharmacist-patient encounters was obtained from the online platform 'Good Doctor Website' from March 31, 2012 to June 22, 2019. MEDICODE was employed to analyze the participation of pharmacists and patients in web-based pharmaceutical care consultation using dialogue ratio, the preponderance of initiative, and dialogical roles (information provider, listener, instigator and participant). RESULTS This study included 121 pharmacist-patient encounters which discussed 382 specifically named medications. On average, 3.75 specific themes were discussed per medication. Among the 29 specific themes observed, 16 were initiated primarily by patients and 13 by pharmacists, 22 were primarily monologue, 6 were primarily dialogue, and 1 was a combination of the two. Pharmacists and patients were information providers or listeners in most content theme categories, such as possible main effect, possible adverse effect, instructions, warnings, adherence, designation, and observed adverse effect. CONCLUSIONS Pharmacists and patients exchanged less drug-related information in web-based pharmaceutical care consultation. The exchange had more patient-dominated behaviors and more of a monologue. Furthermore, pharmacists and patients were mainly information providers or listeners in communication. The participation of both parties was insufficient.
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Affiliation(s)
- Chen Haihong
- School of Health Policy & Management, Nanjing Medical University, Nanjing, China; Jiangsu Provincial Institute of Health, Nanjing Medical University, Nanjing, China
| | - Shao Rong
- Institute of Regulatory Science, China Pharmaceutical University, Nanjing, China; NMPA Key Laboratory for Drug Regulatory Innovation and Evaluation, Nanjing, China
| | - Xiong Yuqi
- Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Wen Zhiyi
- College of Humanities, Hubei University of Chinese Medicine, Wuhan, China
| | - Wang Dan
- School of Management, Hubei University of Chinese Medicine, Wuhan, China
| | - Liu Xueyi
- School of Health Policy & Management, Nanjing Medical University, Nanjing, China; Jiangsu Provincial Institute of Health, Nanjing Medical University, Nanjing, China
| | - Yang Fan
- School of Health Policy & Management, Nanjing Medical University, Nanjing, China; Jiangsu Provincial Institute of Health, Nanjing Medical University, Nanjing, China.
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Tobiano G, Manias E, Thalib L, Dornan G, Teasdale T, Wellwood J, Chaboyer W. Older patient participation in discharge medication communication: an observational study. BMJ Open 2023; 13:e064750. [PMID: 36958781 PMCID: PMC10040044 DOI: 10.1136/bmjopen-2022-064750] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/25/2023] Open
Abstract
OBJECTIVE To describe the extent to which older patients participate in discharge medication communication, and identify factors that predict patient participation in discharge medication communication. DESIGN Observational study. SETTING An Australian metropolitan tertiary hospital. PARTICIPANTS 173 older patients were observed undertaking one medication communication encounter prior to hospital discharge. OUTCOME Patient participation measured with MEDICODE, a valid and reliable coding framework used to analyse medication communication. MEDICODE provides two measures for patient participation: (1) Preponderance of Initiative and (2) Dialogue Ratio. RESULTS The median for Preponderance of Initiative was 0.7 (IQR=0.5-1.0) and Dialogue Ratio was 0.3 (IQR=0.2-0.4), indicating healthcare professionals took more initiative and medication encounters were mostly monologue rather than a dialogue or dyad. Logistic regression revealed that patients had 30% less chance of having dialogue or dyads with every increase in one medication discussed (OR 0.7, 95% CI 0.5 to 0.9, p=0.01). Additionally, the higher the patient's risk of a medication-related problem, the more initiative the healthcare professionals took in the conversation (OR 1.5, 95% CI 1.0 to 2.1, p=0.04). CONCLUSION Older patients are passive during hospital discharge medication conversations. Discussing less medications over several medication conversations spread throughout patient hospitalisation and targeting patients at high risk of medication-related problems may promote more active patient participation, and in turn medication safety outcomes.
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Affiliation(s)
- Georgia Tobiano
- NHMRC CRE in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
- Gold Coast University Hospital, Southport, Queensland, Australia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
- School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia
- Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia
| | - Lukman Thalib
- Department of Biostatistics, Istanbul Aydin University, Istanbul, Turkey
| | - Gemma Dornan
- Gold Coast University Hospital, Southport, Queensland, Australia
| | - Trudy Teasdale
- Gold Coast University Hospital, Southport, Queensland, Australia
| | - Jeremy Wellwood
- Gold Coast University Hospital, Southport, Queensland, Australia
| | - Wendy Chaboyer
- NHMRC CRE in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Southport, Queensland, Australia
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Hellmers N, Barkan S, Auerbach G, Hanineva A, Popa P, Sarva H, Henchcliffe C. Tablet-based patient educational interventions in care and management of complex movement disorders. Disabil Rehabil Assist Technol 2021:1-8. [PMID: 33784918 DOI: 10.1080/17483107.2021.1900934] [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: 10/21/2022]
Abstract
BACKGROUND Patient education is an essential part of management of complex, disabling neurological disorders. Mobile web-based educational materials provide a novel and potentially valuable means to communicate clinical information that can aid in both medical management and rehabilitation. AIMS We, therefore, evaluated an educational tablet-based intervention in three patient cohorts regarding the following topics: Parkinson's disease (PD) medications, dystonia and botulinum toxin treatment. METHODS A total of 50 subjects with PD, 32 with dystonia and 61 receiving botulinum toxin treatment for movement disorders or sialorrhoea were enrolled. Participants in each cohort completed a specific educational module at the time of their regularly scheduled clinic visit, comprising slides, in addition to pre- and post-module quizzes and a satisfaction survey. Additionally, participants in the dystonia and botulinum toxin modules were given a follow-up test at their 3- or 6-month clinical treatment visit. RESULTS There were 143 participants with 50 completing the PD module, 32 completing the dystonia module and 61 completing the botulinum toxin module. All three groups demonstrated significant improvement in knowledge of module content between their pre- and post-module test scores (PD: p=.0001, dystonia: p<.0001 and botulinum toxin: p=.008), and those who took the dystonia module maintained significant improvement at either a 3- or 6-month follow up compared to pre-module (p <.0001). CONCLUSIONS Tablet-based teaching modules are an effective means of communicating key concepts to patients. This study supports their use for improving patient understanding that can support lifelong approaches to managing disabling, neurological conditions.Implication for RehabilitationTablet-based modules are relatively easy to use for enhancing education during clinic visits and can possibly help reduce and maintain disability with chronic conditions like Parkinson's disease and dystonia.Improvements in post-test scores suggested that patient participants were able to retain information from the tablets about their complex and challenging conditions and treatments.Adding patients who are fluent in another language would have made this study more generalizable and future studies exploring educational interventions are warranted to help better tailor interventions to patients with chronic neurologic illnesses to help understand the complex aspects of their medical and rehabilitation therapy.The effect of cognitive changes in neurological conditions and understanding of educational information needs to be further tested.This positive result is especially meaningful during the COVID-19 pandemic when in-person access to both medical and rehabilitative care has been curtailed.
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Affiliation(s)
- Natalie Hellmers
- Department of Neurology, Weill Cornell Medicine, Parkinson's Disease and Movement Disorders Institute, New York, NY, USA
| | - Samantha Barkan
- Department of Neurology, Weill Cornell Medicine, Parkinson's Disease and Movement Disorders Institute, New York, NY, USA
| | - Gabrielle Auerbach
- Department of Neurology, Weill Cornell Medicine, Parkinson's Disease and Movement Disorders Institute, New York, NY, USA
| | - Aneliya Hanineva
- Department of Neurology, Weill Cornell Medicine, Parkinson's Disease and Movement Disorders Institute, New York, NY, USA
| | - Paul Popa
- Department of Neurology, Weill Cornell Medicine, Parkinson's Disease and Movement Disorders Institute, New York, NY, USA
| | - Harini Sarva
- Department of Neurology, Weill Cornell Medicine, Parkinson's Disease and Movement Disorders Institute, New York, NY, USA
| | - Claire Henchcliffe
- Department of Neurology, Weill Cornell Medicine, Parkinson's Disease and Movement Disorders Institute, New York, NY, USA
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Baderol Allam FN, Ab Hamid MR, Buhari SS, Md Noor H. Web-Based Dietary and Physical Activity Intervention Programs for Patients With Hypertension: Scoping Review. J Med Internet Res 2021; 23:e22465. [PMID: 33720036 PMCID: PMC8074856 DOI: 10.2196/22465] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 11/13/2020] [Accepted: 01/16/2021] [Indexed: 01/23/2023] Open
Abstract
Background Hypertension is the root cause of many chronic diseases. Lifestyle changes (ie, dietary alterations and physical activity) are seen to be an important step in the prevention and treatment of hypertension. Educating people through web-based interventional programs could offer an effective solution and help these patients with hypertension in the existing health care scenario. Objective In this study, the researchers conducted a scoping literature review of the web-based dietary changes and physical activity–related intervention programs designed for the patients with hypertension and identified the methodologies, effectiveness, protocols, and theories, which could affect and improve existing clinical activities. Methods This review followed the scoping review methodology to identify and process the peer-reviewed studies published between 2010 and 2020. The literature searches were conducted on the following electronic databases: PubMed, Web of Science, MEDLINE (Medical Literature Analysis and Retrieval System Online), ScienceDirect, Scopus, and Google Scholar. By using relevant search terms, studies were included if they offered information related to the web-based intervention tools, specifically dietary and physical activity intervention for patients with hypertension. Studies written or translated in English language and published within the date range (January 2010 to March 2020) were included. Results Overall, 1441 articles were initially identified. The reviewers included 35 articles after removing duplicates and screening titles. Only 21 articles were assessed for full review, and 15 were kept for analysis. The researchers selected 15 web-based intervention articles published on the topic of hypertension from 7 countries. A few of these 15 web-based tools (4, 27%) included more than 3 functions and provided a lot of important information (such as appointments, health records, or viewable care). Several tools were standalone tools (11, 73%), while most of the tools supported communication intervention–related lifestyle or behavioral changes (13, 87%) and medication adherence (6, 40%). It was found that physicians (9, 60%), allied health professionals (5, 33%), and nurses (5, 33%) were the health care providers who generally used these tools for communicating with their patients. More than half of the above tools (10, 67%) were assessed by different researchers in randomized controlled trials, while 5 tools (33%) were investigated in nonrandomized studies. Conclusions We identified many web-based intervention programs for patients with hypertension from the literature databases. The findings indicate that numerous benefits can be derived after using a web-based dietary and physical activity intervention program for hypertension focusing on lifestyle changes. However, developers need to consider the preferences of the patients with regard to the information or the design features while developing or modifying web-based educational websites. These tools could be used for designing a patient-tailored website intervention program that is based on diet and physical activities for patients with hypertension.
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Affiliation(s)
| | - Mohd Ramadan Ab Hamid
- Centre for Dietetics Studies, Faculty of Health Sciences, Universiti Teknologi MARA, Puncak Alam, Malaysia
| | - Siti Sabariah Buhari
- Centre for Dietetics Studies, Faculty of Health Sciences, Universiti Teknologi MARA, Puncak Alam, Malaysia
| | - Harrinni Md Noor
- Faculty of Education, Universiti Teknologi MARA, Puncak Alam, Malaysia
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Lussier MT, Richard C, Binta Diallo F, Boivin N, Hudon C, Boustani É, Witteman H, Jbilou J. I am ready to see you now, Doctor! A mixed-method study of the Let's Discuss Health website implementation in Primary Care. Health Expect 2020; 24:243-256. [PMID: 33285012 PMCID: PMC8077096 DOI: 10.1111/hex.13158] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 10/05/2020] [Accepted: 10/26/2020] [Indexed: 11/30/2022] Open
Abstract
Background Let's Discuss Health (LDH) is a website that encourages patients to prepare their health‐care encounters by providing communication training, review of topics and questions that are important to them. Objective To describe LDH implementation during primary care (PC) visits for chronic illnesses. Methods Design: Descriptive mixed‐method study. Setting: 6 PC clinics. Participants: 156 patients and 51 health‐care providers (HCP). Intervention: LDH website implementation. Outcome Measures: Perceived quality and usefulness of LDH; perceived quality of HCP‐patient communication; patient activation; LDH integration in routine PC practices and barriers to its use. Results Patients reported a positive perception of the website in that it helped them to adopt an active role in the encounters; recall their visit agenda and reduce encounter‐related stress; feel more confident to ask questions, feel more motivated to prepare their future medical visits and improve their chronic illness management. However, a certain disconnect emerged between HCP and patient perceptions as to the value of LDH in promoting a sense of partnership and collaboration. The main barriers to the use of LDH are HCP lack of interest, limited access to technology, lack of time and language barriers. Conclusion Our findings indicate that it is advantageous for patients to prepare their medical encounters. However, the study needs to be replicated in other medical environments using larger and more diverse samples. Patient and Public Contribution Patient partners were involved in the conduct of this study.
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Affiliation(s)
- Marie-Thérèse Lussier
- Department of Family Medicine and Emergency Medicine, University of Montreal, Montreal, QC, Canada.,Laval Integrated Health and Social Services Centre (Centre de santé et des services sociaux de Laval), Groupe de recherche sur les transformations des pratiques cliniques et organisationnelles, Laval, QC, Canada
| | - Claude Richard
- Laval Integrated Health and Social Services Centre (Centre de santé et des services sociaux de Laval), Groupe de recherche sur les transformations des pratiques cliniques et organisationnelles, Laval, QC, Canada
| | - Fatoumata Binta Diallo
- Laval Integrated Health and Social Services Centre (Centre de santé et des services sociaux de Laval), Groupe de recherche sur les transformations des pratiques cliniques et organisationnelles, Laval, QC, Canada
| | - Nathalie Boivin
- École réseau de Science infirmière (ÉRSI), University of Moncton, Moncton, NB, Canada
| | - Catherine Hudon
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Élie Boustani
- Department of Family Medicine and Emergency Medicine, University of Montreal, Montreal, QC, Canada
| | - Holly Witteman
- Department of Family Medicine and Emergency Medicine, Laval University, Laval, QC, Canada
| | - Jalila Jbilou
- Centre de formation médicale du Nouveau Brunswick, Université de Sherbrooke, École de psychologie, University of Moncton, Moncton, NB, Canada
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Treskes R, van Winden L, van Keulen N, van der Velde E, Beeres S, Atsma D, Schalij MJ. E-health bij poliklinische follow-up van myocardinfarctpatiënten. HUISARTS EN WETENSCHAP 2020; 63:27-32. [PMID: 33132407 PMCID: PMC7586365 DOI: 10.1007/s12445-020-0900-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
E-health maakt het mogelijk om goede poliklinische zorg aan hartinfarctpatiënten te leveren, zelfs gedurende de huidige COVID-19-pandemie. We deden een haalbaarheidsonderzoek om te kijken of e-health kan worden ingezet als een bruikbaar alternatief voor fysieke polikliniekbezoeken bij het leveren van poliklinische zorg. We verdeelden 200 hartinfarctpatiënten at random over een e-health-interventie of standaard follow-up. De primaire uitkomst was bloeddrukregulatie, secundaire uitkomsten waren patiënttevredenheid en klinische opnamen. Tussen beide groepen waren er geen significante verschillen in uitkomsten. E-health produceert daarmee gelijke uitkomsten.
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Johnson Girard V, Hill A, Glaser E, Lussier MT. Optimizing Communication About Topical Corticosteroids: A Quality Improvement Study. J Cutan Med Surg 2020; 24:240-248. [DOI: 10.1177/1203475420908250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Patients are often non-adherent to topical corticosteroids (TCS). This may be in part due to poor communication between patients and dermatologists. Objectives This quality improvement (QI) study aims to describe dermatologist–patient communication about TCS treatments and to compare communication before and after the implementation of an educational intervention. Methods This QI study assesses the communication between dermatologists and new dermatology outpatients receiving a TCS prescription in a tertiary care center. The QI intervention is 2-pronged, consisting of an educational pamphlet for patients and a communication workshop for the dermatology team. Encounters were audiotaped, and communication was analyzed using a coding system (MEDICODE). Phase 1 recordings happened preintervention and reflect the usual dermatologist–patient communication in this practice setting and phase 2 recordings were postintervention. Results Phase 1 reveals that dermatologists frequently address informational medication themes, such as naming the medications and informing patients about their proper use. They less frequently discuss patient experience themes, such as goals of treatment, adverse effects of treatments, and exploring patients’ emotions about medications (such as anxiety, fears, etc.). After the intervention, there was more frequent discussion of patient experience themes without increasing consultation length. But, in both phases, physicians address most themes as a monolog with little verbal input from patients. Conclusions Our study raises awareness regarding dermatologists’ communication patterns about TCS, identifying specific areas for improvement, such as discussions of adverse effects, and explicitly addressing patients’ attitudes and emotions. This is an essential step to foster a sense-making of TCS for patients.
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Affiliation(s)
- Valérie Johnson Girard
- Department of Medicine (Dermatology), Hôpital de la Cité-de-la-Santé, Laval, Centre intégré de santé et des services sociaux de Laval, Quebec, Canada
| | - Ashley Hill
- Department of Medicine (Dermatology), Centre Hospitalier de l’Université de Montréal, Quebec, Canada
| | - Emma Glaser
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Marie-Thérèse Lussier
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, University of Montreal, Quebec, Canada
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Treskes RW, van Winden LAM, van Keulen N, van der Velde ET, Beeres SLMA, Atsma DE, Schalij MJ. Effect of Smartphone-Enabled Health Monitoring Devices vs Regular Follow-up on Blood Pressure Control Among Patients After Myocardial Infarction: A Randomized Clinical Trial. JAMA Netw Open 2020; 3:e202165. [PMID: 32297946 PMCID: PMC7163406 DOI: 10.1001/jamanetworkopen.2020.2165] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
IMPORTANCE Smart technology via smartphone-compatible devices might improve blood pressure (BP) regulation in patients after myocardial infarction. OBJECTIVES To investigate whether smart technology in clinical practice can improve BP regulation and to evaluate the feasibility of such an intervention. DESIGN, SETTING, AND PARTICIPANTS This study was an investigator-initiated, single-center, nonblinded, feasibility, randomized clinical trial conducted at the Department of Cardiology of the Leiden University Medical Center between May 2016 and December 2018. Two hundred patients, who were admitted with either ST-segment elevation myocardial infarction or non-ST-segment acute coronary syndrome, were randomized in a 1:1 fashion between follow-up groups using smart technology and regular care. Statistical analysis was performed from January 2019 to March 2019. INTERVENTIONS For patients randomized to regular care, 4 physical outpatient clinic visits were scheduled in the year following the initial event. In the intervention group, patients were given 4 smartphone-compatible devices (weight scale, BP monitor, rhythm monitor, and step counter). In addition, 2 in-person outpatient clinic visits were replaced by electronic visits. MAIN OUTCOMES AND MEASURES The primary outcome was BP control. Secondary outcomes, as a parameter of feasibility, included patient satisfaction (general questionnaire and smart technology-specific questionnaire), measurement adherence, all-cause mortality, and hospitalizations for nonfatal adverse cardiac events. RESULTS In total, 200 patients (median age, 59.7 years [interquartile range, 52.9-65.6 years]; 156 men [78%]) were included, of whom 100 were randomized to the intervention group and 100 to the control group. After 1 year, 79% of patients in the intervention group had controlled BP vs 76% of patients in the control group (P = .64). General satisfaction with care was the same between groups (mean [SD] scores, 82.6 [14.1] vs 82.0 [15.1]; P = .88). The all-cause mortality rate was 2% in both groups (P > .99). A total of 20 hospitalizations for nonfatal adverse cardiac events occurred (8 in the intervention group and 12 in the control group). Of all patients, 32% sent in measurements each week, with 63% sending data for more than 80% of the weeks they participated in the trial. In the intervention group only, 90.3% of patients were satisfied with the smart technology intervention. CONCLUSIONS AND RELEVANCE These findings suggest that smart technology yields similar percentages of patients with regulated BP compared with the standard of care. Such an intervention is feasible in clinical practice and is accepted by patients. More research is mandatory to improve patient selection of such an intervention. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02976376.
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Affiliation(s)
- Roderick W. Treskes
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Nicole van Keulen
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | | | - Douwe E. Atsma
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Martin Jan Schalij
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
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Buller-Taylor T, McGuinness L, Yan M, Janjua NZ. Reducing patient and provider knowledge gaps: An evaluation of a community informed hepatitis C online course. PATIENT EDUCATION AND COUNSELING 2018; 101:1095-1102. [PMID: 29370951 DOI: 10.1016/j.pec.2018.01.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/20/2017] [Accepted: 01/09/2018] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Hepatitis C (HCV) knowledge gaps are associated with lower levels of engagement in (HCV) care which contributes to HCV-related morbidity and mortality. Knowledge gaps may be exacerbated by rapid changes in HCV care/treatment. Cost-effective, timely and easy-to-implement education is needed to address knowledge gaps and foster HCV engagement. METHODS We developed a free, one-hour, online course for patients and providers. Online and facilitated course events were evaluated. Outcome measures included: pre/post-scores, perceived knowledge gains and increased capacity to educate/encourage engagement in HCV care. RESULTS Total pre-post-test gains were significant (p < .001) across groups. Over 50% of participants reported: perceived knowledge gains of "A lot" or higher; the course increased their capacity to educate and encourage client engagement in care by "A lot" or higher. CONCLUSIONS The evaluation confirmed ongoing patient and provider HCV knowledge gaps, significantly reduced those gaps, and increased provider's capacity to educate and encourage client engagement in HCV care. PRACTICE IMPLICATIONS The course is an effective tool to address knowledge gaps that might lower engagement in care. It is available to patients to use in the privacy of their own home or for providers for their personal use, to use with individuals or patient groups.
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Affiliation(s)
- Terri Buller-Taylor
- British Columbia Centre for Disease Control (BCCDC); School of Nursing, University of British Columbia (UBC), Vancouver, Canada.
| | - Liza McGuinness
- British Columbia Centre for Disease Control (BCCDC); School of Nursing, University of British Columbia (UBC), Vancouver, Canada
| | - Melissa Yan
- School of Population and Public Health, UBC, Vancouver, Canada
| | - Naveed Z Janjua
- British Columbia Centre for Disease Control (BCCDC); School of Population and Public Health, UBC, Vancouver, Canada
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Armas A, Meyer SB, Corbett KK, Pearce AR. Face-to-face communication between patients and family physicians in Canada: A scoping review. PATIENT EDUCATION AND COUNSELING 2018; 101:789-803. [PMID: 29173960 DOI: 10.1016/j.pec.2017.11.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 11/07/2017] [Accepted: 11/16/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Patient-provider communication is critical in primary care. Canada's unique health system, population distribution, and cultural context suggest there is value in addressing the topic in the Canadian context. We conducted a scoping review to synthesize recent Canadian literature to inform practice in primary care settings and identify research agendas for patient-provider communication in Canada. METHODS Using Arksey and O'Malley's framework we searched four literature databases: Medline, Web of Science, CINAHL and EMBASE. We extracted 21,932 articles published between 2010 and 2017. A total of 108 articles met the inclusion criteria. The articles were analyzed qualitatively using thematic analysis to identify major themes. RESULTS Four major themes were identified: information sharing, relationships, health system challenges, and development and use of communication tools. CONCLUSION Our review identified a need for Canadian research regarding: communication in primary care with Aboriginal, immigrant, and rural populations; the impact of medical tourism on primary care; and how to improve communication to facilitate continuity of care. PRACTICE IMPLICATIONS Challenges providers face in primary care in Canada include: communicating with linguistically and culturally diverse populations; addressing issues that emerge with the rise of medical tourism; a need for decision aids to improve communication with patients.
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Affiliation(s)
- Alana Armas
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.
| | - Samantha B Meyer
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Kitty K Corbett
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Alex R Pearce
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
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Treskes RW, Van der Velde ET, Schoones JW, Schalij MJ. Implementation of smart technology to improve medication adherence in patients with cardiovascular disease: is it effective? Expert Rev Med Devices 2018; 15:119-126. [PMID: 29271661 DOI: 10.1080/17434440.2018.1421456] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Medication adherence is of key importance in the treatment of cardiovascular disease. Studies consistently show that a substantial proportion of patients is non-adherent. AREAS COVERED For this review, telemedicine solutions that can potentially improve medication adherence in patients with cardiovascular disease were reviewed. A total of 475 PubMed papers were reviewed, of which 74 were assessed. EXPERT COMMENTARY Papers showed that evidence regarding telemedicine solutions is mostly conflictive. Simple SMS reminders might work for patients who do not take their medication because of forgetfulness. Educational interventions and coaching interventions, primarily delivered by telephone or via a web-based platform can be effective tools to enhance medication adherence. Finally, it should be noted that current developments in software engineering may dramatically change the way non-adherence is addressed in the nearby future.
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Affiliation(s)
- Roderick W Treskes
- a Department of Cardiology , Leiden University Medical Center , Leiden , The Netherlands
| | - Enno T Van der Velde
- a Department of Cardiology , Leiden University Medical Center , Leiden , The Netherlands
| | - Jan W Schoones
- b Walaeus Library , Leiden University Medical Center , Leiden , The Netherlands
| | - Martin J Schalij
- a Department of Cardiology , Leiden University Medical Center , Leiden , The Netherlands
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14
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Le Reste JY, Nabbe P, Billot Grasset A, Le Floch B, Grall P, Derriennic J, odorico M, Lalande S, le Goff D, Barais M, Chiron B, Lingner H, Guillou M, Barraine P. Multimorbid outpatients: A high frequency of FP appointments and/or family difficulties, should alert FPs to the possibility of death or acute hospitalization occurring within six months; A primary care feasibility study. PLoS One 2017; 12:e0186931. [PMID: 29095849 PMCID: PMC5667834 DOI: 10.1371/journal.pone.0186931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 10/10/2017] [Indexed: 11/24/2022] Open
Abstract
Background The European General Practitioners Research Network (EGPRN) designed and validated a comprehensive definition of multimorbidity using a systematic literature review and qualitative research throughout Europe. This definition was tested as a model to assess death or acute hospitalization in multimorbid outpatients. Objective To assess which criteria in the EGPRN concept of multimorbidity could detect outpatients at risk of death or acute hospitalization in a primary care cohort at a 6-month follow-up and to assess whether a large scale cohort with FPs would be feasible. Method Family Physicians included a random sample of multimorbid patients who attended appointments in their offices from July to December 2014. Inclusion criteria were those of the EGPRN definition of Multimorbidity. Exclusion criteria were patients under legal protection and those unable to complete the 2-year follow-up. Statistical analysis was undertaken with uni- and multivariate analysis at a 6-month follow-up using a combination of approaches including both automatic classification and expert decision making. A Multiple Correspondence Analysis (MCA) completed the process with a projection of illustrative variables. A logistic regression was finally performed in order to identify and quantify risk factors for decompensation. Results 19 FPs participated in the study. 96 patients were analyzed. 3 different clusters were identified. MCA showed the central function of psychosocial factors and peaceful versus conflictual relationships with relatives in all clusters. While taking into account the limit of a small cohort, age, frequency of family physician visits and extent of family difficulties were the factors which predicted death or acute hospitalization. Conclusion A large scale cohort seems feasible in primary care. A sense of alarm should be triggered to prevent death or acute hospitalization in multimorbid older outpatients who have frequent family physician visits and who experience family difficulties.
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Affiliation(s)
- Jean Yves Le Reste
- EA 7479 SPURBO, Department of general practice, Université de Bretagne occidentale, Brest, France
- * E-mail: (JYLR); (PN)
| | - Patrice Nabbe
- EA 7479 SPURBO, Department of general practice, Université de Bretagne occidentale, Brest, France
- * E-mail: (JYLR); (PN)
| | - Alice Billot Grasset
- EA 7479 SPURBO, Department of general practice, Université de Bretagne occidentale, Brest, France
| | - Bernard Le Floch
- EA 7479 SPURBO, Department of general practice, Université de Bretagne occidentale, Brest, France
| | - Pauline Grall
- EA 7479 SPURBO, Department of general practice, Université de Bretagne occidentale, Brest, France
| | - Jeremy Derriennic
- EA 7479 SPURBO, Department of general practice, Université de Bretagne occidentale, Brest, France
| | - Michele odorico
- EA 7479 SPURBO, Department of general practice, Université de Bretagne occidentale, Brest, France
| | - Sophie Lalande
- EA 7479 SPURBO, Department of general practice, Université de Bretagne occidentale, Brest, France
| | - Delphine le Goff
- EA 7479 SPURBO, Department of general practice, Université de Bretagne occidentale, Brest, France
| | - Marie Barais
- EA 7479 SPURBO, Department of general practice, Université de Bretagne occidentale, Brest, France
| | - Benoit Chiron
- EA 7479 SPURBO, Department of general practice, Université de Bretagne occidentale, Brest, France
| | | | - Morgane Guillou
- EA 7479 SPURBO, Department of general practice, Université de Bretagne occidentale, Brest, France
| | - Pierre Barraine
- EA 7479 SPURBO, Department of general practice, Université de Bretagne occidentale, Brest, France
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Richard C, Glaser E, Lussier M. Communication and patient participation influencing patient recall of treatment discussions. Health Expect 2017; 20:760-770. [PMID: 27868327 PMCID: PMC5513012 DOI: 10.1111/hex.12515] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2016] [Indexed: 01/10/2023] Open
Abstract
CONTEXT Patient recall of treatment information is a key variable towards chronic disease (CD) management. It is unclear what communication and patient participation characteristics predict recall. OBJECTIVES To assess what aspects of doctor-patient communication predict patient recall of medication information. To describe lifestyle treatment recall, in CD primary care patients. DESIGN Observational study within a RCT. SETTING & PARTICIPANTS Community-based primary care (PC) practices. Family physicians (n=18): practicing >5 years, with a CD patient caseload. Patients (n=159): >40 years old, English speaking, computer literate, off-target hypertension, type II diabetes and/or dyslipidaemia. MAIN VARIABLES Patient characteristics: age, education, number of CDs. Information characteristics: length of encounter, medication status, medication class. Communication variables: socio-emotional utterances, physician dominance and communication control scores and PACE (ask, check and express) utterances, measured by RIAS. Number of medication themes, dialogue and initiative measured by MEDICODE. MAIN OUTCOME MEASURES Recall of CD, lifestyle treatment and medication information. RESULTS Frequency of lifestyle discussions varied by topic. Patients recalled 43% (alcohol), 52% (diet) to 70% (exercise) of discussions. Two and a half of six possible medication themes were broached per medication discussion. Less than one was recalled. Discussing more themes, greater dialogue and patient initiative were significant predictors of improved medication information recall. DISCUSSION Critical treatment information is infrequently exchanged. Active patient engagement and explicit conversations about medications are associated with improved treatment information recall in off-target CD patients followed in PC. CONCLUSION Providers cannot take for granted that long-term off-target CD patients recall information. They need to encourage patient participation to improve recall of treatment information.
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Affiliation(s)
- Claude Richard
- Primary Care Research TeamCentre intégré de santé et des services sociaux de LavalLavalQCCanada
| | - Emma Glaser
- Primary Care Research TeamCentre intégré de santé et des services sociaux de LavalLavalQCCanada
- Faculty of MedicineUniversité de MontréalMontréalQCCanada
| | - Marie‐Thérèse Lussier
- Primary Care Research TeamCentre intégré de santé et des services sociaux de LavalLavalQCCanada
- Family Medicine and Emergency Medicine DepartmentFaculty of MedicineUniversité de MontréalMontréalQCCanada
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De Pasquale C, Veroux M, Fornaro M, Sinagra N, Basile G, Gozzo C, Santini R, Costa A, Pistorio ML. Psychological perspective of medication adherence in transplantation. World J Transplant 2016; 6:736-742. [PMID: 28058225 PMCID: PMC5175233 DOI: 10.5500/wjt.v6.i4.736] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 08/25/2016] [Accepted: 10/27/2016] [Indexed: 02/05/2023] Open
Abstract
AIM To identify the risk factors and the post-transplant psychological symptoms that affect adherence to therapy in a population of kidney transplant recipients.
METHODS The study examined the psychological variables likely responsible for the non-adherent behavior using a psychological-psychiatric assessment, evaluation of the perception of patients’ health status, and an interview regarding the anti-rejection drug therapy assumption. The study included 74 kidney transplant recipients.
RESULTS Individuals with a higher level of education and more years since transplantation showed better mental balance. Regarding gender, women appeared to be less adherent to therapy. Further, the years since transplantation adversely affected the proper pharmacological assumption. Adherence to therapy did not significantly change with the mental health index.
CONCLUSION The biopsychosocial illness model provides a conceptual frame of reference in which biological, psychological, and social aspects take on the same importance in the adherence to treatment protocols. For effective management, it is necessary to understand the patients’ personal experiences, their assumptions about the disease, health status perception, and mood, and to identify any “barriers” that could cause them to become noncompliant.
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