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Chen TT, Su WC, Liu MI. Patient-centered care in diabetes care-concepts, relationships and practice. World J Diabetes 2024; 15:1417-1429. [DOI: 10.4239/wjd.v15.i7.1417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/11/2024] [Accepted: 05/13/2024] [Indexed: 07/08/2024] Open
Abstract
We still do not have comprehensive knowledge of which framework of patient-centered care (PCC) is appropriate for diabetes care, which elements of PCC are evidence-based, and the mechanism by which PCC elements are associated with outcomes through mediators. In this review, we elaborate on these issues. We found that for diabetes care, PCC elements such as autonomy support (patient individuality), cooperation and collaboration (system-level approach), com-munication and education (behavior change techniques), emotional support (biopsychosocial approach), and family/other involvement and support are critically important. All of these factors are directly associated with different patient outcomes and indirectly associated with outcomes through patient activation. We present the practical implications of these PCC elements.
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Affiliation(s)
- Tsung-Tai Chen
- Department of Public Health, College of Medicine, Fu Jen Catholic University, New Taipei 24205, Taiwan
| | - Wei-Chih Su
- Department of Gastroenterology, Taipei Tzu-Chi Hospital, New Taipei 23142, Taiwan
| | - Mei-I Liu
- Department of Pediatric Endocrinology, Mackay Children's Hospital, Taipei 10449, Taiwan
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Brown TT, Lee J, Markarian S. The causal impact of shared decision making on pain outcomes: Gender matters. Soc Sci Med 2024; 355:117132. [PMID: 39029441 DOI: 10.1016/j.socscimed.2024.117132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 07/09/2024] [Accepted: 07/11/2024] [Indexed: 07/21/2024]
Abstract
This national US study determined the causal impact of shared decision making (SDM) on pain outcomes, including any overall pain and the subcategories of any acute pain and any chronic pain. We additionally examined whether the causal impact of SDM on overall pain is moderated by gender, race-ethnicity, clinician-patient racial-ethnic concordance, and clinician-patient gender concordance. We used national US data from the 2003-2017 Medical Expenditure Panel Survey, which were externally valid to the US national non-institutionalized population, employed a standard measure of shared decision making, and applied an internally-valid two-stage least squares approach that used the peer SDM behavior of similar clinicians as an instrument. The instrument was sufficiently strong and statistically uncorrelated with patient characteristics. We found a large impact of SDM on both female and male chronic pain outcomes, where the effect for females was approximately 50% larger than for males, with a 10 percentage point increase in SDM quality resulted fewer females experiencing chronic pain that interfered with everyday activities (-24.8 percentage points; 95% confidence interval [CI]: 43.3, -6.4) than males (-16.5 percentage points; 95% CI: 32.9, -1.0). We estimated that a 10 percentage point national increase in the SDM index would thus result in 10.1 million fewer females and 5.7 million fewer males in the US experiencing chronic pain that interfered with their daily activities. Policy implications include both increasing the quality of SDM for all patients and educating male patients on the value of SDM.
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Affiliation(s)
- Timothy T Brown
- University of California, 2121 Berkeley Way #5439, Berkeley, CA, 94720, USA.
| | - Jadyn Lee
- University of California, 2121 Berkeley Way #5439, Berkeley, CA, 94720, USA
| | - Sione Markarian
- University of California, 2121 Berkeley Way #5439, Berkeley, CA, 94720, USA
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Freeman-Hildreth Y, Aron D, Cola PA, Jr RB, Wang Y. Empowering diabetes management: The impact of patient-provider collaboration on type 2 diabetes outcomes through autonomy support and shared decision-making. PATIENT EDUCATION AND COUNSELING 2024; 127:108348. [PMID: 38870706 DOI: 10.1016/j.pec.2024.108348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 05/18/2024] [Accepted: 06/06/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVES Through the lens of self-determination theory, this quantitative study investigates how patient-provider collaboration through perceived shared decision-making (SDM) and autonomy support impact type 2 diabetes (T2D) outcomes. METHODS We sampled 474 individuals over 18 years old who self-identified as having T2D. Completed and valid responses were received from 378 participants from two separate groups in an online survey. Data was analyzed using the IBM Statistical Package for Social Sciences (SPSS), AMOS package, version 28, and Mplus, version 8.8. RESULTS Patient-provider collaboration through autonomy support improved treatment satisfaction (β = .16, ρ < .05) and self-management adherence (β = .43, ρ < .001). While collaboration through SDM improved treatment satisfaction (β = .25, ρ < .01), it worsened SM adherence (β = -.31, ρ < .001). The negative impact of SDM on self-management adherence was mitigated by our moderator, coping ability. However, coping ability minimally impacted treatment satisfaction and SM adherence when autonomous support was provided. CONCLUSIONS Autonomy support increases treatment satisfaction and self-management adherence. SDM enhances treatment satisfaction but may adversely affect self-management adherence. The study also suggests that coping ability can mitigate the negative effect of SDM on self-management adherence, although its influence is limited when autonomy support is provided by the provider. PRACTICAL IMPLICATIONS For providers, SDM and autonomy support permits shared power over treatment decisions while fostering independence over self-management tasks. Providers should evaluate patients' coping ability and adapt their approach to care based on the patient's coping capacity.
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Affiliation(s)
| | - David Aron
- Department of Medicine, Case Western Reserve University, Louis Stokes VA Medical Center, Cleveland, OH, USA
| | - Philip A Cola
- Weatherhead Department of Management, Design and Innovation, Case Western Reserve University, Cleveland, OH, USA
| | - Richard Boland Jr
- Weatherhead Department of Management, Design and Innovation, Case Western Reserve University, Cleveland, OH, USA
| | - Yunmei Wang
- Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
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Mattisson M, Börjeson S, Årestedt K, Lindberg M. Interaction between telenurses and callers - A deductive analysis of content and timing in telephone nursing calls. PATIENT EDUCATION AND COUNSELING 2024; 123:108178. [PMID: 38387390 DOI: 10.1016/j.pec.2024.108178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/15/2023] [Accepted: 01/26/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVES To explore the content and timing of verbal interaction between telephone nurses and callers, and to suggest areas for improvement. METHODS Transcribed telephone conversations (n = 30) to a national nurse-led advisory service were analyzed using deductive content analysis. Categorization of data was based on components of interaction in the Interaction Model of Client Heath Behavior (IMCHB): health information, affective support, decisional control, and professional-technical competencies. The content was described both quantitatively, based on word count, and qualitatively, using descriptions and exemplars. Transcripts were also coded according to five phases in the conversation process: opening, listening, analyzing, motivating, and ending. The distribution of interaction components among phases was explored. RESULTS Interaction primarily focused on health information, particularly during the listening and analyzing phases. Telenurses based their advice on medical facts and guided callers through the conversation process. Callers' emotions and reflections on advice were rarely discussed. CONCLUSIONS Health information dominate conversations. Interaction can be further developed, particularly with respect to acknowledging callers' emotional responses, their reactions to advice, and ensuring clarity in exchange of health information. PRACTICE IMPLICATIONS Findings offer valuable guidance for future development of interaction in telenursing.
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Affiliation(s)
- Marie Mattisson
- Department of Health, Medicine and Caring Sciences (HMV), Linköping University, Linköping, Sweden.
| | - Sussanne Börjeson
- Department of Health, Medicine and Caring Sciences (HMV), Linköping University, Linköping, Sweden
| | - Kristofer Årestedt
- Department of Research, Region Kalmar County, Kalmar, Sweden; Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden, Region Kalmar County, Kalmar, Sweden
| | - Malou Lindberg
- Department of Health, Medicine and Caring Sciences (HMV), Linköping University, Linköping, Sweden
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Kikuchi R, Kingston P, Hao A, Sadrolashrafi K, Yamamoto RK, Tolson H, Bilimoria SN, Guo L, Yee D, Ochoa MT, Armstrong AW. Shared decision-making in psoriasis care: Evaluation of how patients' perception of clinicians' delivery of care changes by age and sex. PLoS One 2024; 19:e0303058. [PMID: 38728289 PMCID: PMC11086864 DOI: 10.1371/journal.pone.0303058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 04/19/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Shared decision-making (SDM) refers to a collaborative process in which clinicians assist patients in making medically informed, evidence-based decisions that align with their values and preferences. There is a paucity of literature on SDM in dermatology. OBJECTIVE We aim to assess whether male and female psoriasis patients evaluate their clinicians' engagement in SDM differently across different age groups. METHODS Cross-sectional study using data from the 2014-2017 and 2019 Medical Expenditure Panel Surveys (MEPS). RESULTS A weighted total of 7,795,608 psoriasis patients were identified. SDM Scores ranged from 1 to 4, with 4 representing the most favorable patient evaluation of their clinicians' engagement in SDM. We conducted multivariate linear regression to compare mean SDM Scores in male psoriasis patients versus female psoriasis patients across different patient age groups. Female patients ages 60-69 perceived significantly greater clinician engagement in SDM compared to age-matched male patients (female patient perception of SDM 3.65 [95%CI:3.61-3.69] vs. male patient perception of SDM 3.50 [95%CI:3.43-3.58], p<0.005). The same trend of older female patients evaluating their clinicians' engagement in SDM significantly higher than their age-matched male counterparts exists for the age group >70 (p<0.005). No significant differences between male and female patients' evaluations of their clinicians' engagement in SDM were demonstrated in subjects younger than 60. All calculations were adjusted for demographic and clinical factors. CONCLUSIONS Compared to older male psoriasis patients, older female psoriasis patients evaluated their clinicians to be more engaged in shared decision-making.
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Affiliation(s)
- Robin Kikuchi
- Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Paige Kingston
- Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Audrey Hao
- Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Kaviyon Sadrolashrafi
- Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada, United States of America
| | - Rebecca K. Yamamoto
- Georgetown University School of Medicine, Washington, DC, United States of America
| | - Hannah Tolson
- University of Arizona College of Medicine, Phoenix, Arizona, United States of America
| | - Sara N. Bilimoria
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Lily Guo
- Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Danielle Yee
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Maria T. Ochoa
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - April W. Armstrong
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
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Bayrami S, Chamani M, JamaliMoghadamSiahkali S, SeyedAlinaghi S, Shirmard LR, Bayrami S, Javar HA, Ghahremani MH, Amini M, Tehrani MR, Shahsavari S, Dorkoosh FA. Preparation, Characterization and In vitro Evaluation of Insulin-PHBV Nanoparticles / Alginate Hydrogel Composite System for Prolonged Delivery of Insulin. J Pharm Sci 2024:S0022-3549(24)00094-7. [PMID: 38508339 DOI: 10.1016/j.xphs.2024.03.010] [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: 11/21/2023] [Revised: 03/14/2024] [Accepted: 03/14/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE In the present study, biodegradable poly (3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV) nanoparticles (NPs) containing insulin were loaded in sodium alginate/jeffamine (ALG/jeff) hydrogel for prolonged delivery of insulin. The main aim of this work was to fabricate an efficient insulin delivery system to improve patient adherence by decreasing the repetition of injections. METHODS Swelling and morphological properties and crosslinking efficiency of ALG/jeff hydrogel were assessed. The composite hydrogel was prepared by adding PHBV NPs to ALG/jeff hydrogel concurrently with crosslinking process. The morphology and loading capacity of composite hydrogel were analyzed. RESULTS Circular dichroism measurement demonstrated that insulin remains stable following fabrication process. The release profile exhibited 54.6 % insulin release from composite hydrogel within 31 days with minor initial burst release equated to nanoparticles and hydrogels. MTT cell viability analysis was performed by applying L-929 cell line and no cytotoxic effect was observed. CONCLUSIONS Favorable results clearly introduced fabricated composite hydrogel as an excellent candidate for drug delivery systems and also paves the route for prolonged delivery systems of other proteins.
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Affiliation(s)
- Samane Bayrami
- Department of Pharmaceutics, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Chamani
- Department of Pharmaceutics, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | | | - SeyedAhmad SeyedAlinaghi
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Rezaie Shirmard
- Department of Pharmaceutics, School of Pharmacy, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Sepide Bayrami
- Islamic Azad University, North Tehran Branch, Faculty of Bioscience, Tehran, Iran
| | - Hamid Akbari Javar
- Department of Pharmaceutics, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hossein Ghahremani
- Department of Toxicology-Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Amini
- Department of Medicinal Chemistry, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; Drug Design and Development Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Morteza Rafiee Tehrani
- Department of Pharmaceutics, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Shadab Shahsavari
- Chemical Engineering Department, Varamin-Pishva Branch, Islamic Azad University, Varamin, Iran
| | - Farid Abedin Dorkoosh
- Department of Pharmaceutics, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; Medical Biomaterial Research Centre (MBRC), Tehran University of Medical Sciences, Tehran 14399-56131, Iran.
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Islam MM, Oyarzun-Gonzalez X, Bose-Brill S, Donneyong MM. Supplemental Nutrition Assistance Program and Adherence to Antihypertensive Medications. JAMA Netw Open 2024; 7:e2356619. [PMID: 38393731 PMCID: PMC10891466 DOI: 10.1001/jamanetworkopen.2023.56619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 12/22/2023] [Indexed: 02/25/2024] Open
Abstract
Importance Nonadherence to antihypertensive medications is associated with uncontrolled blood pressure, higher mortality rates, and increased health care costs, and food insecurity is one of the modifiable medication nonadherence risk factors. The Supplemental Nutrition Assistance Program (SNAP), a social intervention program for addressing food insecurity, may help improve adherence to antihypertensive medications. Objective To evaluate whether receipt of SNAP benefits can modify the consequences of food insecurity on nonadherence to antihypertensive medications. Design, Setting, and Participants A retrospective cohort study design was used to assemble a cohort of antihypertensive medication users from the linked Medical Expenditure Panel Survey (MEPS)-National Health Interview Survey (NHIS) dataset for 2016 to 2017. The MEPS is a national longitudinal survey on verified self-reported prescribed medication use and health care access measures, and the NHIS is an annual cross-sectional survey of US households that collects comprehensive health information, health behavior, and sociodemographic data, including receipt of SNAP benefits. Receipt of SNAP benefits in the past 12 months and food insecurity status in the past 30 days were assessed through standard questionnaires during the study period. Data analysis was performed from March to December 2021. Exposure Status of SNAP benefit receipt. Main Outcomes and Measures The main outcome, nonadherence to antihypertensive medication refill adherence (MRA), was defined using the MEPS data as the total days' supply divided by 365 days for each antihypertensive medication class. Patients were considered nonadherent if their overall MRA was less than 80%. Food insecurity status in the 30 days prior to the survey was modeled as the effect modifier. Inverse probability of treatment (IPT) weighting was used to control for measured confounding effects of baseline covariates. A probit model was used, weighted by the product of the computed IPT weights and MEPS weights, to estimate the population average treatment effects (PATEs) of SNAP benefit receipt on nonadherence. A stratified analysis approach was used to assess for potential effect modification by food insecurity status. Results This analysis involved 6692 antihypertensive medication users, of whom 1203 (12.8%) reported receiving SNAP benefits and 1338 (14.8%) were considered as food insecure. The mean (SD) age was 63.0 (13.3) years; 3632 (51.3%) of the participants were women and 3060 (45.7%) were men. Although SNAP was not associated with nonadherence to antihypertensive medications in the overall population, it was associated with a 13.6-percentage point reduction in nonadherence (PATE, -13.6 [95% CI, -25.0 to -2.3]) among the food-insecure subgroup but not among their food-secure counterparts. Conclusions and Relevance This analysis of a national observational dataset suggests that patients with hypertension who receive SNAP benefits may be less likely to become nonadherent to antihypertensive medication, especially if they are experiencing food insecurity. Further examination of the role of SNAP as a potential intervention for preventing nonadherence to antihypertensive medications through prospectively designed interventional studies or natural experiment study designs is needed.
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Affiliation(s)
- Md. Mohaimenul Islam
- Outcomes and Translational Sciences, College of Pharmacy, The Ohio State University, Columbus
| | - Ximena Oyarzun-Gonzalez
- Outcomes and Translational Sciences, College of Pharmacy, The Ohio State University, Columbus
| | - Seuli Bose-Brill
- Division of General Internal Medicine, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus
| | - Macarius M. Donneyong
- Outcomes and Translational Sciences, College of Pharmacy, The Ohio State University, Columbus
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Yang Q, He J, Yuan F. Improvement of proportion of days covered for denosumab under implementation of clinical pharmacist adherence management system: normal and COVID-19 period. Osteoporos Int 2024; 35:309-316. [PMID: 37801081 PMCID: PMC10837216 DOI: 10.1007/s00198-023-06933-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/27/2023] [Indexed: 10/07/2023]
Abstract
We established a clinical pharmacist adherence management system (CPAMS) led by clinical pharmacists to examine whether denosumab adherence could be improved. The results showed that CPAMS could effectively improve adherence to denosumab and the treatment of osteoporosis. However, this effect weakened during the spread of infectious diseases such as COVID-19. PURPOSE Denosumab is currently one of the drugs that can effectively reduce the risk of clinical fracture. However, as a drug requiring long-term subcutaneous injection, patient adherence to denosumab is the most important factor affecting its therapeutic efficacy. Therefore, we established a clinical pharmacist adherence management system (CPAMS) led by clinical pharmacists and examined whether denosumab adherence could be improved. METHODS Data were collected from patients receiving denosumab in our hospital between March 2021 and May 2022. The patients who participated in the CPAMS were in the intervention group, and the rest were in the control group. We analysed the proportion of days covered (PDC) value of denosumab, distribution of subsequent visits, and proportion of patients who continued participating during the normal and coronavirus (COVID-19) periods. RESULTS Eighty-five patients were enrolled in this retrospective study: 32 in the intervention group and 53 in the control group. The PDC values were significantly higher in the intervention group (0.9875, 0.9025-1) than in the control group (0.5, 0.5-0.5) after 1 year. The subsequent visit rate in the intervention group was 93.80%. However, none of the patients in the control group returned. In the intervention group, the ratio of timely to delayed subsequent visits was 11:19. After the COVID-19 pandemic, the PDC value of the intervention group (0.957, 0.5-1) was lower than that before COVID-19, and the ratio of timely to delayed subsequent visits was 9:13. CONCLUSIONS Clinical pharmacist-led CPAMS could effectively improve adherence to denosumab and the treatment of osteoporosis.
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Affiliation(s)
- Qiong Yang
- Department of Pharmacy, Ningbo No. 6 Hospital, Ningbo, China
| | - Junhong He
- Department of Pharmacy, Ningbo No. 6 Hospital, Ningbo, China
| | - Fangfang Yuan
- Department of Rheumatism and Immunology, Ningbo No. 6 Hospital, Ningbo, China.
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Edlund MJ, Thomas SM, Wagner LK, Thompson JE, Wu LT, Dolor RJ, Chelminski PR, Ives TJ, Archer KR, Dewey CM, Sullivan MD, McCormack LA. Design of a Multicenter Randomized Controlled Trial comparing the effectiveness of shared decision making versus motivational interviewing plus cognitive behavioral therapy for voluntary opioid tapering: The INSPIRE study protocol. Contemp Clin Trials 2024; 137:107410. [PMID: 38092285 DOI: 10.1016/j.cct.2023.107410] [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: 09/19/2023] [Revised: 11/29/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND This paper describes the design and protocol of a pragmatic, randomized trial to evaluate the comparative effectiveness of shared decision making versus motivational interviewing plus cognitive behavioral therapy for chronic pain for the voluntary tapering of opioid dose in adults with chronic noncancer pain. Integrated Services for Pain: Interventions to Reduce Pain Effectively (INSPIRE) is a multicenter, randomized trial conducted at three academic health centers in the southeastern United States. Participants are adults receiving long-term opioid therapy of at least 20 morphine milligram equivalents daily for chronic noncancer pain. METHODS Participants were randomized to either the shared decision-making intervention or the motivational interviewing session and cognitive behavioral therapy for chronic pain intervention. All participants also received guideline-concordant care supporting opioid pharmacotherapy. The primary outcome was change from baseline in average daily prescribed opioid dose at 12 months, using prescribing data from electronic health records. Secondary outcomes were Patient-Reported Outcomes Measurement Information System Pain Interference and Physical Function at 12 months. CONCLUSION This trial evaluates the comparative effectiveness of shared decision making versus motivational interviewing plus cognitive behavioral therapy for chronic pain for the voluntary tapering of opioid dose in adults with chronic noncancer pain. Results from this study can guide clinicians, researchers, and policymakers as they seek to reduce opioid prescribing and improve management of chronic pain. CLINICAL TRIALS REGISTRATION ClinicalTrials.gov Identifier: NCT03454555 (https://clinicaltrials.gov/ct2/show/record/NCT03454555). Participant enrollment began on June 26, 2019.
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Affiliation(s)
- Mark J Edlund
- RTI International, Research Triangle Park, NC, United States.
| | - Sonia M Thomas
- RTI International, Research Triangle Park, NC, United States.
| | - Laura K Wagner
- RTI International, Research Triangle Park, NC, United States.
| | | | - Li-Tzy Wu
- Duke University, Durham, NC, United States.
| | | | - Paul R Chelminski
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
| | - Timothy J Ives
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
| | - Kristin R Archer
- Vanderbilt University Medical Center, Nashville, TN, United States.
| | - Charlene M Dewey
- Vanderbilt University Medical Center, Nashville, TN, United States.
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Wu S, Yang C, He L, Hu Z, Yao J. Meta-synthesis of qualitative studies on patient perceptions and requirements during the perioperative period of robotic surgery. J Robot Surg 2024; 18:44. [PMID: 38240864 DOI: 10.1007/s11701-023-01791-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/02/2023] [Indexed: 01/23/2024]
Abstract
This research undertakes a comprehensive evaluation and amalgamation of patient experiences and requirements during the perioperative period of robot-assisted surgery (RS), with the goal of enriching clinical practice with patient-centered insights. A meta-synthesis was performed and reported according to the preferred reporting Items for systematic reviews and meta-analyses and the enhancing transparency in reporting the synthesis of qualitative research statement. A rigorous literature search was conducted across multiple Chinese and English databases, namely PubMed, CINAHL (EBSCO), Embase, Web of Science, Scopus, China Biomedical Literature Database (CBLD), China National Knowledge Infrastructure (CNKI), Wanfang Data, and VIP Information. This study incorporated ten qualitative studies, the outcomes were classified into three overarching themes: personalized patient requirements related to RS; the psychological and physiological experiences of patients; and the divergent perceptions of male and female patients regarding RS. Greater emphasis needs to be placed on patient comprehension of RS, augmenting focus on patient psychological experiences, recognizing unique patient needs at various stages of RS, and providing patients with specialized knowledge and technical support.
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Affiliation(s)
- Shuang Wu
- School of Nursing, Shaanxi University of Chinese Medicine, Century Avenue, Chenyangzhai, Qindu District, Xianyang, 712046, Shaanxi, China
| | - Chunzhi Yang
- School of Nursing, Shaanxi University of Chinese Medicine, Century Avenue, Chenyangzhai, Qindu District, Xianyang, 712046, Shaanxi, China
| | - Liu He
- School of Nursing, Shaanxi University of Chinese Medicine, Century Avenue, Chenyangzhai, Qindu District, Xianyang, 712046, Shaanxi, China
| | - Zhixuan Hu
- School of Nursing, Shaanxi University of Chinese Medicine, Century Avenue, Chenyangzhai, Qindu District, Xianyang, 712046, Shaanxi, China
| | - Jie Yao
- School of Nursing, Shaanxi University of Chinese Medicine, Century Avenue, Chenyangzhai, Qindu District, Xianyang, 712046, Shaanxi, China.
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11
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Donneyong MM, Bynum M, Kemavor A, Crossnohere NL, Schuster A, Bridges J. Patient satisfaction with the quality of care received is associated with adherence to antidepressant medications. PLoS One 2024; 19:e0296062. [PMID: 38180988 PMCID: PMC10769059 DOI: 10.1371/journal.pone.0296062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 12/05/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND There is a paucity of evidence on the association between satisfaction with quality of care and adherence to antidepressants. OBJECTIVES To examine the association between patient satisfaction with healthcare and adherence to antidepressants. METHODS A cohort study design was used to identify antidepressant users from the 2010-2016Medical Expenditure Panel Survey data, a national longitudinal complex survey study design on the cost and healthcare utilization of the noninstitutionalized population in the United States. The Consumer Assessment of Healthcare Providers and Systems were used to measure participants' satisfaction with access and quality of care, patient-provider communication and shared decision-making (SDM). Patients were considered satisfied if they ranked the quality of care at ≥9 (range: 0[worst]- 10[best]). Antidepressant adherence was measured based on medication refill and complete discontinuation. MEPS sampling survey-weighted multivariable-adjusted logistic regression models were used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between satisfaction and adherence to antidepressants. We tested for the potential presence of reverse associations by restricting the analysis to new users of antidepressants. The roles of patient-provider communication and SDM on the satisfaction-adherence association were examined through structural equation models (SEM). RESULTS Among 4,990 (weighted counts = 8,661,953) antidepressant users, 36% were adherent while 39% discontinued antidepressants therapy. Half of antidepressant users were satisfied with the healthcare received. Satisfied patients were 26% (OR = 1.26, 95%CI: 1.08, 1.47) more likely to adhere and 17% (OR = 0.83, 95%CI: 0.71, 0.96) less likely to discontinue, compared to unsatisfied antidepressant users. Patient satisfaction was also associated with higher odds (OR = 1.41, 95%CI: 1.06, 1.88) of adherence among a subgroup of new users of antidepressants. The SEM analysis revealed that satisfaction was a manifestation of patient-provider communication (β = 2.03, P-value<0.001) and SDM (β = 1.14, P-value<0.001). CONCLUSIONS Patient satisfaction is a potential predictor of antidepressant adherence. If our findings are confirmed through intervention studies, improving patient-provider communication and SDM could likely drive both patient satisfaction and adherence to antidepressants.
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Affiliation(s)
- Macarius M. Donneyong
- Division of Outcomes and Translational Sciences, College of Pharmacy, The Ohio State University, Columbus, OH, United States of America
| | - Mary Bynum
- Healthcare Management, Franklin University, Columbus, Ohio, United States of America
| | - Ameena Kemavor
- ADAMH Board of Franklin County, Columbus, OH, United States of America
| | - Norah L. Crossnohere
- Division of General Internal Medicine, The Ohio State College of Medicine, Columbus, Ohio, United States of America
| | - Anne Schuster
- Department of Biomedical Informatics, The Ohio State College of Medicine, Columbus, Ohio, United States of America
| | - John Bridges
- Department of Biomedical Informatics, The Ohio State College of Medicine, Columbus, Ohio, United States of America
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Zagt AC, Bos N, Bakker M, de Boer D, Friele RD, de Jong JD. A scoping review into the explanations for differences in the degrees of shared decision making experienced by patients. PATIENT EDUCATION AND COUNSELING 2024; 118:108030. [PMID: 37897867 DOI: 10.1016/j.pec.2023.108030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 09/29/2023] [Accepted: 10/16/2023] [Indexed: 10/30/2023]
Abstract
OBJECTIVES In order to improve the degree of shared decision making (SDM) experienced by patients, it is necessary to gain insight into the explanations for the differences in these degrees. METHODS A scoping review of the literature on the explanations for differences in the degree of SDM experienced by patients was conducted. We assessed 21,329 references. Ultimately, 308 studies were included. The explanations were divided into micro, meso, and macro levels. RESULTS The explanations are mainly related to the micro level. They include explanations related to the patient and healthcare professionals, the relationship between the patient and the physician, and the involvement of the patient's relatives. On the macro level, explanations are related to restrictions within the healthcare system such as time constraints, and adequate information about treatment options. On the meso level, explanations are related to the continuity of care and the involvement of other healthcare professionals. CONCLUSIONS SDM is not an isolated process between the physician and patient. Explanations are connected to the macro, meso, and micro levels. PRACTICE IMPLICATIONS This scoping review suggests that there could be more focus on explanations related to the macro and meso levels, and on how explanations at different levels are interrelated.
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Affiliation(s)
- Anne C Zagt
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands.
| | - Nanne Bos
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands
| | - Max Bakker
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands
| | - Dolf de Boer
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands
| | - Roland D Friele
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands; Tranzo Scientifc Center for Care and Wellbeing, Tilburg University, PO Box 90153, 5000 LE Tilburg, the Netherlands
| | - Judith D de Jong
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands; CAPHRI, Maastricht University, PO Box 616, 6200 MD Maastricht, the Netherlands
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Sweeney J, Tichnell C, Christian S, Pendelton C, Murray B, Roter DL, Jamal L, Calkins H, James CA. Characterizing Decision-Making Surrounding Exercise in ARVC: Analysis of Decisional Conflict, Decisional Regret, and Shared Decision-Making. CIRCULATION. GENOMIC AND PRECISION MEDICINE 2023; 16:e004133. [PMID: 38014565 PMCID: PMC10729899 DOI: 10.1161/circgen.123.004133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 10/25/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Limiting high-intensity exercise is recommended for patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) due to its association with penetrance, arrhythmias, and structural progression. Guidelines recommend shared decision-making (SDM) for exercise level, but there is little evidence regarding its impact. Therefore, we sought to evaluate the extent and implications of SDM for exercise, decisional conflict, and decisional regret in patients with ARVC and at-risk relatives. METHODS Adults diagnosed with ARVC or with positive genetic testing enrolled in the Johns Hopkins ARVC Registry were invited to complete a questionnaire that included exercise history and current exercise, SDM (SDM-Q-9), decisional conflict, and decisional regret. RESULTS The response rate was 64.8%. Two-thirds of participants (68.0%, n=121) reported clinically significant decisional conflict regarding exercise at diagnosis/genetic testing (DCS [decisional conflict scale]≥25), and half (55.1%, n=98) in the past year. Prevalence of decisional regret was also high with 55.3% (n=99) reporting moderate to severe decisional regret (DRS [decisional regret scale]≥25). The extent of SDM was highly variable ranging from no (0) to perfect (100) SDM (mean, 59.6±25.0). Those diagnosed in adolescence (≤age 21) reported significantly more SDM (P=0.013). Importantly, SDM was associated with less decisional conflict (ß=-0.66, R2=0.567, P<0.01) and decisional regret (ß=-0.37, R2=0.180, P<0.001) and no difference in vigorous intensity aerobic exercise in the 6 months after diagnosis/genetic testing or the past year (P=0.56; P=0.34, respectively). CONCLUSIONS SDM is associated with lower decisional conflict and decisional regret; and no difference in postdiagnosis exercise. Our data thus support SDM as the preferred model for exercise discussions for ARVC.
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Affiliation(s)
- Jessica Sweeney
- Johns Hopkins Bloomberg School of Public Health (J.S., D.L.R.), Johns Hopkins University, Baltimore
- National Human Genome Research Institute (J.S.), National Institutes of Health, Bethesda, MD
| | - Crystal Tichnell
- Division of Cardiology, Department of Medicine (C.T., C.P., B.M., H.C., C.A.J.), Johns Hopkins University, Baltimore
| | - Susan Christian
- Department of Medical Genetics, University of Alberta, Edmonton, Canada (S.C.)
| | - Catherine Pendelton
- Division of Cardiology, Department of Medicine (C.T., C.P., B.M., H.C., C.A.J.), Johns Hopkins University, Baltimore
| | - Brittney Murray
- Division of Cardiology, Department of Medicine (C.T., C.P., B.M., H.C., C.A.J.), Johns Hopkins University, Baltimore
| | - Debra L. Roter
- Johns Hopkins Bloomberg School of Public Health (J.S., D.L.R.), Johns Hopkins University, Baltimore
| | - Leila Jamal
- Center for Cancer Research, National Cancer Institute (L.J.), National Institutes of Health, Bethesda, MD
- Department of Bioethics, Clinical Center (L.J.), National Institutes of Health, Bethesda, MD
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine (C.T., C.P., B.M., H.C., C.A.J.), Johns Hopkins University, Baltimore
| | - Cynthia A. James
- Division of Cardiology, Department of Medicine (C.T., C.P., B.M., H.C., C.A.J.), Johns Hopkins University, Baltimore
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Raisa A, Alpert JM, Bylund CL, Jarad-Fodeh S. Identifying the mechanisms of patient-centred communication in secure messages between clinicians and cancer patients. PEC INNOVATION 2023; 2:100161. [PMID: 37384151 PMCID: PMC10294087 DOI: 10.1016/j.pecinn.2023.100161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/18/2023] [Accepted: 04/11/2023] [Indexed: 06/30/2023]
Abstract
Objective Identify how patients and clinicians incorporate patient-centered communication (PCC) within secure messaging. Methods A random sample of 199 secure messages from patient portal communication between patients and clinicians were collected and analyzed. Via manual annotation, the task of tagging target words/phrases in text, we identified five components of PCC: information giving, information seeking, emotional support, partnership, and shared decision-making. Textual analysis was also performed to understand the context of PCC expressions within messages. Results Information-giving was the predominant (n = 346, 68.1%) PCC category used in secure messaging, more than double of the other four PCC codes, information-seeking (n = 82, 16.1%), emotional support (n = 52, 10.2%), shared decision making (n = 5, 1.0%), combined. The textual analysis revealed that clinicians informed patients about appointment reminders and new protocols while patients reminded clinicians about upcoming procedures and outcomes of test results conducted by other clinicians. Although less common, patients expressed statements of concern, uncertainty, and fear; enabling clinicians to provide support. Conclusion Secure messaging is mainly used for exchanging information, but other aspects of PCC emerge using this channel of communication. Innovation Meaningful discussions can occur via secure messaging, and clinicians should be mindful of incorporating PCC when communicating with patients through secure messaging.
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Affiliation(s)
- Aantaki Raisa
- College of Journalism and Communications, University of Florida, Gainesville, FL, USA
| | - Jordan M. Alpert
- College of Journalism and Communications, University of Florida, Gainesville, FL, USA
| | - Carma L. Bylund
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Samah Jarad-Fodeh
- Department of Emergency Medicine, Yale School of Public Health – Biostatistics, Yale Center for Medical Informatics, Yale University, New Haven, CT, USA
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15
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Yee D, Kingston P, Lee K, Huang M, Peterson H, Korouri E, Armstrong AW. Shared decision-making and satisfaction with care in patients with psoriasis: A population-based study in the United States. J Am Acad Dermatol 2023; 89:920-926. [PMID: 37011814 DOI: 10.1016/j.jaad.2023.03.039] [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: 10/13/2022] [Revised: 02/19/2023] [Accepted: 03/12/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Shared decision-making (SDM) is a critical component of the patient-physician relationship. Although SDM has been reported to improve patient knowledge in other fields, it is still relatively unknown in dermatology. OBJECTIVE To determine the association between SDM and satisfaction with care among patients with psoriasis. METHODS Cross-sectional study using data from the 2014 to 2017 and 2019 Medical Expenditure Panel Survey. RESULTS A weighted total of 3,715,027 patients with psoriasis were identified. The average SDM score was 3.6 (of 4), and the average satisfaction with care score was 8.6 (of 10). Approximately 42% of the cohort reported having a high SDM (score, ≥3.9). Patients who had high SDM had, on average, 85% higher satisfaction with care (P < .001) after adjusting for covariates. LIMITATIONS The results of our study should be interpreted within the context of the Medical Expenditure Panel Survey database. The ability to measure SDM was limited by the 7 items from Medical Expenditure Panel Survey, which may not fully capture active participation in shared decision-making. CONCLUSION A majority of patients with psoriasis are not participating in highly SDM. It is important to construct a framework for carrying out SDM efficiently to enhance physician-patient communication and improve patient outcomes.
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Affiliation(s)
- Danielle Yee
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Paige Kingston
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Kathryn Lee
- Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Margaret Huang
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Hannah Peterson
- Loma Linda University School of Medicine, Loma Linda, California
| | | | - April W Armstrong
- Keck School of Medicine, University of Southern California, Los Angeles, California.
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Yakubu RA, Coleman A, Ainyette A, Katyayan A, Enard KR. Shared Decision-Making and Emergency Department Use Among People With High Blood Pressure. Prev Chronic Dis 2023; 20:E82. [PMID: 37733952 PMCID: PMC10516202 DOI: 10.5888/pcd20.230086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023] Open
Abstract
INTRODUCTION Forty-seven percent of all adults in the US have a diagnosis of high blood pressure. Among all US emergency department (ED) users, an estimated 45% have high blood pressure. The success of high blood pressure interventions in reducing ED visits is partially predicated on patients' adherence to treatment plans. One method for promoting adherence to treatment plans is shared decision-making between patients and medical providers. METHODS We conducted a cross-sectional observational study using 2015-2019 Medical Expenditure Panel Survey data. We used studies on shared decision-making as a guide to create a predictor variable for shared decision-making. We determined covariates according to the Andersen Behavioral Model of Health Services Use. ED use was the outcome variable. We used cross tabulation to compare covariates of ED use and multivariable logistical regression to assess the association between shared decision-making and ED use. Our sample size was 30,407 adults. RESULTS Less than half (39.3%) of respondents reported a high level of shared decision-making; 23.3% had 1 or more ED visits. In the unadjusted model, respondents who reported a high level of shared decision-making were 20% less likely than those with a low level of shared decision-making to report 1 or more ED visits (odds ratio [OR], 0.80; 95% CI, 0.75-0.86; P <.001). After adjusting for covariates, a high level of shared decision-making was still associated with lower odds of ED use (OR, 0.86; 95% CI, 0.76-0.97; P = .01). CONCLUSION Shared decision-making may be an effective method for reducing ED use among patients with high blood pressure.
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Affiliation(s)
- R Aver Yakubu
- Department of Health Management and Policy, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri
- Saint Louis University, Department of Health Management and Policy, 3545 Lafayette Ave, St Louis, MO 63104
| | - Alyssa Coleman
- Department of Health Management and Policy, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri
| | - Alina Ainyette
- Department of Health Management and Policy, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri
| | - Anisha Katyayan
- Department of Health Management and Policy, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri
| | - Kimberly R Enard
- Department of Health Management and Policy, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri
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Pereira F, Meyer-Massetti C, Del Río Carral M, von Gunten A, Wernli B, Verloo H. Development of a patient-centred medication management model for polymedicated home-dwelling older adults after hospital discharge: results of a mixed methods study. BMJ Open 2023; 13:e072738. [PMID: 37730411 PMCID: PMC10514617 DOI: 10.1136/bmjopen-2023-072738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 09/01/2023] [Indexed: 09/22/2023] Open
Abstract
OBJECTIVE This study aimed to investigate medication management among polymedicated, home-dwelling older adults after discharge from a hospital centre in French-speaking Switzerland and then develop a model to optimise medication management and prevent adverse health outcomes associated with medication-related problems (MRPs). DESIGN Explanatory, sequential, mixed methods study based on detailed quantitative and qualitative findings reported previously. SETTING Hospital and community healthcare in the French-speaking part of Switzerland. PARTICIPANTS The quantitative strand retrospectively examined 3 years of hospital electronic patient records (n=53 690 hospitalisations of inpatients aged 65 years or older) to identify the different profiles of those at risk of 30-day hospital readmission and unplanned nursing home admission. The qualitative strand explored the perspectives of older adults (n=28), their informal caregivers (n=17) and healthcare professionals (n=13) on medication management after hospital discharge. RESULTS Quantitative results from older adults' profiles, affected by similar patient-related, medication-related and environment-related factors, were enhanced and supported by qualitative findings. The combined findings enabled us to design an interprofessional, collaborative medication management model to prevent MRPs among home-dwelling older adults after hospital discharge. The model comprised four interactive fields of action: listening to polymedicated home-dwelling older adults and their informal caregivers; involving older adults and their informal caregivers in shared, medication-related decision-making; empowering older adults and their informal caregivers for safe medication self-management; optimising collaborative medication management practices. CONCLUSION By linking the retrospective and prospective findings from our explanatory sequential study involving multiple stakeholders' perspectives, we created a deeper comprehension of the complexities and challenges of safe medication management among polymedicated, home-dwelling older adults after their discharge from hospital. We subsequently designed an innovative, collaborative, patient-centred model for optimising medication management and preventing MRPs in this population.
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Affiliation(s)
- Filipa Pereira
- Abel Salazar Institute of Biomedical Sciences, University of Porto, Porto, Portugal
- School of Health Sciences, HES-SO Valais/ Wallis, Sion, Switzerland
| | - Carla Meyer-Massetti
- Clinical Pharmacology and Toxicology, Clinical of General Internal Medicine, Inselspital, University Hospital of Bern, Bern, Switzerland
- Institute for Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - María Del Río Carral
- Institute of Psychology, Research Center for the Psychology of Health, Aging and Sports Examination (PHASE), University of Lausanne, Lausanne, Switzerland
| | - Armin von Gunten
- Service of Old Age Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Boris Wernli
- Swiss Centre of Expertise in the Social Sciences (FORS), University of Lausanne, Lausanne, Switzerland
| | - Henk Verloo
- School of Health Sciences, HES-SO Valais/ Wallis, Sion, Switzerland
- Service of Old Age Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
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Dehmer GJ, Grines CL, Bakaeen FG, Beasley DL, Beckie TM, Boyd J, Cigarroa JE, Das SR, Diekemper RL, Frampton J, Hess CN, Ijioma N, Lawton JS, Shah B, Sutton NR. 2023 AHA/ACC Clinical Performance and Quality Measures for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Performance Measures. J Am Coll Cardiol 2023; 82:1131-1174. [PMID: 37516946 DOI: 10.1016/j.jacc.2023.03.409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/31/2023]
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Wood H, Brand G, Clifford R, Kado S, Lee K, Seubert L. What Do Students' Questionnaire Responses Tell Us about Their Language around Person-Centred Care? An Exploratory Sentiment Analysis. Healthcare (Basel) 2023; 11:2458. [PMID: 37685492 PMCID: PMC10487836 DOI: 10.3390/healthcare11172458] [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: 06/30/2023] [Revised: 08/02/2023] [Accepted: 09/01/2023] [Indexed: 09/10/2023] Open
Abstract
There is a global movement for health and social care to be person-centred: supporting people's active participation when making health decisions and considering their opinions, beliefs, and needs. The World Health Organization recommend the inclusion of person-centred care in health and social care provision. This research aimed to explore Australian health and social care profession students' language around person-centred care. Final-year health and social care professions students, attending one of two Australian universities, participated in an online questionnaire. Responses were analysed and themed to an existing person-centred care framework, then a sentiment analysis was applied to each response. Of the responses collected from 90 students, 235 statements were linked to the four core values of the person-centred care framework: cultivating communication (44%); respectful and compassionate care (35%); engaging patients in managing their care (20%); and integration of care (<1%). Within these, 24 statements were positively aligned (10%); 100 statements were neutral (43%); and 111 statements contained negative sentiments (47%). Almost half of the responses were not aligned with the core values of person-centred care. This suggests that many of the final-year students are not yet conceptualizing care using a person-centred approach.
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Affiliation(s)
- Helen Wood
- School of Allied Health, The University of Western Australia, Perth 6009, Australia; (R.C.); (S.K.); (K.L.); (L.S.)
| | - Gabrielle Brand
- School of Nursing & Midwifery, Monash University, Melbourne 3004, Australia;
| | - Rhonda Clifford
- School of Allied Health, The University of Western Australia, Perth 6009, Australia; (R.C.); (S.K.); (K.L.); (L.S.)
| | - Sinead Kado
- School of Allied Health, The University of Western Australia, Perth 6009, Australia; (R.C.); (S.K.); (K.L.); (L.S.)
| | - Kenneth Lee
- School of Allied Health, The University of Western Australia, Perth 6009, Australia; (R.C.); (S.K.); (K.L.); (L.S.)
| | - Liza Seubert
- School of Allied Health, The University of Western Australia, Perth 6009, Australia; (R.C.); (S.K.); (K.L.); (L.S.)
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Carrozzi S, Schulz W, Beckwitt CH, Wera J, Wasil K, Fowler JR. Patients Prefer Ultrasound to Nerve Conduction Studies for the Diagnosis of Carpal Tunnel Syndrome. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5279. [PMID: 37744777 PMCID: PMC10513182 DOI: 10.1097/gox.0000000000005279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 08/02/2023] [Indexed: 09/26/2023]
Abstract
Background The net promoter score (NPS) allows analysis of patient satisfaction and preference between treatment and/or diagnostic testing. Electrodiagnostic testing (EDX) and ultrasound (US) are commonly used diagnostic tests for carpal tunnel syndrome. Although EDX is reliable for diagnosing carpal tunnel syndrome (CTS), it can be uncomfortable and inconvenient for patients. We aimed to determine whether patients preferred US or EDX studies for the diagnosis of CTS, using the NPS. Methods Seventy-five patients presenting to the clinic for evaluation of CTS complaints who had EDX were prospectively studied. US evaluation of the median nerve was then completed at time of evaluation. Patient satisfaction was determined by asking, "how likely are you to recommend this procedure to a friend or relative?" for both EDX and US. Patient demographics, comorbidities, CTS-6 questionnaire (CTS-6), and functionality assessed through patient-reported qDASH were also recorded. Results Sixty-five patients were included in the study. Most patients did not have any comorbidities and were nonsmokers. The gender composition was similar, and the average age of the enrolled patients was 58. The NPS for US was significantly higher than EDX (P < 0.0001). Patients with diabetes mellitus rated their EDX experience significantly lower than those without diabetes mellitus. Conclusions Patients are more likely to recommend US instead of EDX in the evaluation of CTS complaints. This allows for shared decision-making between the patient and provider if ordering diagnostic testing for CTS.
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Affiliation(s)
- Sabrina Carrozzi
- From the School of Medicine, University of Pittsburgh, Pittsburgh, Pa
| | - William Schulz
- From the School of Medicine, University of Pittsburgh, Pittsburgh, Pa
| | - Colin H. Beckwitt
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pa
| | - Jeffrey Wera
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pa
| | - Karen Wasil
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pa
| | - John R. Fowler
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pa
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Dehmer GJ, Grines CL, Bakaeen FG, Beasley DL, Beckie TM, Boyd J, Cigarroa JE, Das SR, Diekemper RL, Frampton J, Hess CN, Ijioma N, Lawton JS, Shah B, Sutton NR. 2023 AHA/ACC Clinical Performance and Quality Measures for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Performance Measures. Circ Cardiovasc Qual Outcomes 2023; 16:e00121. [PMID: 37499042 DOI: 10.1161/hcq.0000000000000121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Affiliation(s)
| | | | | | | | | | | | | | - Sandeep R Das
- ACC/AHA Joint Committee on Performance Measures liaison
| | | | | | | | | | | | - Binita Shah
- Society for Cardiovascular Angiography and Interventions representative
| | - Nadia R Sutton
- AHA/ACC Joint Committee on Clinical Data Standards liaison
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Kingston P, Yee D, Huang MY, Korouri E, Peterson H, Lee K, Agüero R, Armstrong AW. Shared decision-making and satisfaction with care: a population-based study in patients with acne with skin of colour in the USA. Clin Exp Dermatol 2023; 48:1032-1035. [PMID: 37098265 DOI: 10.1093/ced/llad151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/20/2023] [Indexed: 04/27/2023]
Abstract
Little is known about differences in shared decision-making and patient satisfaction with acne care among different ethnicities and races. We conducted a cross-sectional study to determine differences between patients with acne who are White and those with skin of colour (SOC), i.e. (i) engagement in shared decision-making, and (ii) patient satisfaction with care, using the 2009-2017 and 2019 Medical Panel Expenditure Survey. Patients with acne with SOC were nearly two times more likely to engage in high shared decision-making compared with White patients [adjusted odds ratio 1.80, 95% confidence interval (CI) 1.30-2.51, P < 0.001]. Patients with SOC with acne reported lower satisfaction with care compared with White patients (β = -0.38, 95% CI -0.69 to -0.06, P = 0.02). Patients with SOC who had acne reported higher levels of shared decision-making than White patients. However, compared with the White patients, patients with SOC report lower satisfaction with their care. There may be other factors contributing to lower satisfaction with care in patients with SOC who have acne.
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Affiliation(s)
| | - Danielle Yee
- Keck School of Medicine of USC, Los Angeles, CA, USA
| | | | - Edwin Korouri
- Rosalind Franklin University of Medicine and Science, Chicago Medical School, Chicago, IL, USA
| | - Hannah Peterson
- Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Kathryn Lee
- Saint Louis University School of Medicine, St Louis, MO, USA
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Hack V, Josfeld L, Hübner J, Keinki C, Büntzel J. Decision-making by cancer patients and the role of a counselling facility for complementary and alternative medicine: a cohort study. J Cancer Res Clin Oncol 2023; 149:2903-2913. [PMID: 35819526 PMCID: PMC10314849 DOI: 10.1007/s00432-022-04178-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/27/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this cohort study was to gain insight on influencing factors on the decision-making process in conventional medicine compared to complementary and alternative medicine (CAM). METHODS A standardized questionnaire was distributed among cancer patients who attended the counselling facility for CAM of a German university hospital in 2020. RESULTS Fifty patients (30.3%) returned the questionnaire. After counselling on CAM, most patients made a decision in CAM but also in conventional medicine. Thus, the focus on informed decision-making during counselling on CAM had a strong effect on the decision-making process in conventional medicine. Patients reporting good support also reported making decisions together with physicians and relatives. Moreover, after counselling on CAM, patients reported being more satisfied with their decision in both settings afterwards. CONCLUSION Information on CAM which focuses on informed decision-making, supports patient's ability to understand and weigh risks and benefits of treatments, supports shared decision-making and enables patients to transfer these competences also to decisions on conventional medicine. So counselling on CAM may further decision-making competences in cancer patients. This encourages patients to engage in shared decision-making and increases patient's satisfaction with decisions.
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Affiliation(s)
- Vanessa Hack
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany.
- , Christeserstraße, 98547, Kühndorf, Germany.
| | - Lena Josfeld
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | - Jutta Hübner
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | - Christian Keinki
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | - Jens Büntzel
- Klinik für HNO-Erkrankungen, Südharzklinikum, Nordhausen, Germany
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Kelepouris E, St Peter W, Neumiller JJ, Wright EE. Optimizing Multidisciplinary Care of Patients with Chronic Kidney Disease and Type 2 Diabetes Mellitus. Diabetes Ther 2023:10.1007/s13300-023-01416-2. [PMID: 37209236 DOI: 10.1007/s13300-023-01416-2] [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] [Received: 03/27/2023] [Accepted: 04/19/2023] [Indexed: 05/22/2023] Open
Abstract
Diabetes is the leading cause of chronic kidney disease (CKD), a condition associated with significant morbidity and mortality. As these patients have a high risk of developing cardiovascular disease and end-stage kidney disease, there is a need for early detection and early initiation of appropriate therapeutic interventions that slow disease progression and prevent adverse outcomes. Due to the complex nature of diabetes and CKD management, a holistic, patient-centered, collaborative care approach delivered by a coordinated multidisciplinary team (ideally including a clinical pharmacist as part of a comprehensive medication management program) is needed. In this review, we discuss the barriers to effective care, the current multidisciplinary approach used for CKD prevention and treatment, and the potential ways that the multidisciplinary management of CKD associated with type 2 diabetes mellitus can be refined to improve patient outcomes.
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Affiliation(s)
- Ellie Kelepouris
- Division of Renal Electrolyte and Hypertension, University of Pennsylvania, Philadelphia, PA, USA.
| | - Wendy St Peter
- University of Minnesota, Minneapolis, MN, USA
- Hennepin Healthcare Research Institute, Minneapolis, MN, USA
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Vu PD, Malik A, Cohen AS, Bansal V, Cowan MR, Blazek GM, Champagne-Langabeer T. Shared Decision Making in Acute Pain Management in Patients with Opioid Use Disorder: A Scoping Review. J Clin Med 2023; 12:jcm12103555. [PMID: 37240661 DOI: 10.3390/jcm12103555] [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: 02/22/2023] [Revised: 05/11/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023] Open
Abstract
The treatment of acute pain over the years has changed with increasing alternative therapies and increased scrutiny of opioid prescriptions. Shared Decision Making (SDM) has become a vital tool in increasing patient engagement and satisfaction in treatment decisions. SDM has been successfully implemented in the management of pain in a variety of settings; however, information regarding the use of SDM for treating acute pain in patients with a history of opioid use disorder (OUD) remains scarce. Following the Preferred Reporting Items for Systematic Reviews and Meta-analysis Extension for Scoping Reviews (PRISMA-ScR), we conducted a review to understand how SDM is used in acute pain management in patients with OUD. We searched Medline, Embase, CINAHL, and PsychInfo databases for relevant articles. Articles were screened and SDM outcomes of eligible articles were charted. The results were grouped by sub-theme based on a 1997 SDM model. There were three original research studies and one quality improvement study. The remaining articles were split evenly between reviews and reviews of clinical guidelines. Four themes emerged from the review: prior judgment and stigma related to OUD, trust and sharing of information, clinical tools, and interprofessional teams. This scoping review consolidated and expounded the current literature on SDM in the management of acute pain in patients with OUD. More work is needed to address prior judgments by both providers and patients and to build greater dialogue. Clinical tools may aid this process as well as the involvement of a multidisciplinary team.
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Affiliation(s)
- Peter D Vu
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, UTHealth Houston, 6431 Fannin, Houston, TX 77030, USA
| | - Aila Malik
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, UTHealth Houston, 6431 Fannin, Houston, TX 77030, USA
| | - A Sarah Cohen
- Houston ER Opioid System (HEROES), School of Biomedical Informatics, UTHealth Houston, 7000 Fannin, Houston, TX 77030, USA
| | - Vishal Bansal
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, UTHealth Houston, 6431 Fannin, Houston, TX 77030, USA
| | - Morgan R Cowan
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, UTHealth Houston, 6431 Fannin, Houston, TX 77030, USA
| | - Gregory M Blazek
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, UTHealth Houston, 6431 Fannin, Houston, TX 77030, USA
| | - Tiffany Champagne-Langabeer
- Houston ER Opioid System (HEROES), School of Biomedical Informatics, UTHealth Houston, 7000 Fannin, Houston, TX 77030, USA
- Tiffany Champagne-Langabeer, UTHealth Houston, 7000 Fannin St., Suite 600, Houston, TX 77030, USA
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26
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Dilles T, Mortelmans L, Loots E, Sabbe K, Feyen H, Wauters M, Haegdorens F, De Baetselier E. People-centered care and patients' beliefs about medicines and adherence: A cross-sectional study. Heliyon 2023; 9:e15795. [PMID: 37251820 PMCID: PMC10208933 DOI: 10.1016/j.heliyon.2023.e15795] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/21/2023] [Accepted: 04/21/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction People-centered care (PCC) strategies are believed to improve overall health outcomes. Medicines use is essential for the treatment of many patients with chronic conditions. Non-adherence rates are high and result in poor health outcomes, and increased healthcare utilization and costs. This study aimed to explore the relationship between PCC and adherence to medicines for persons with chronic medicines use, as well as the extent to which patients' beliefs about medicines are influenced by their level of perceived PCC. Methods A cross-sectional survey design was performed with adults using at least 3 chronic medicines per day. To measure the degree of medicines adherence, patients' ideas about medication, and PCC, four validated questionnaires were used: The Medication Adherence Report Scale (MARS-5), Beliefs about medicines questionnaire (BMQ), Client-Centered Care Questionnaire (CCCQ) and the Shared Decision Making Questionnaire (SDM-Q-9). Socio-demographics, health status, and drug-related burden were questioned as potential factors to impact the relationship between PCC and adherence. Results A sample of 459 persons participated. The mean score on the CCCQ (adjusted to pharmacotherapy) was 52.7 on 75 (sd = 8.83, range [18-70]). The top 20% scored 60 or more, the 20% lowest scores were 46 or less. Adherence levels were high, with a mean score of 22.6 on 25 on the MARS-5, and 88% scoring 20 or more. An increase in PCC corresponded to a higher chance of medicines adherence (OR 1.07, 95%CI [1.02-1.12]), corrected for age, the burden due to chronic diseases, the impact of side effects on daily life, and participants' beliefs about medicines. PCC showed positive correlations with the necessity of medicines use (r = 0.1, p = 0.016) and the balance between necessity and concerns (r = 0.3, p < 0.001); and negative correlations with levels of concerns (r = -0.3, p < 0.001) and scores on harmfulness (r = -0.3, p < 0.001) and overuse of medicines (r = -0.4, p < 0.001). Conclusion Patients with chronic medicine use perceived an average high level of people-centeredness in the pharmaceutical care they received. This PCC was weakly positively associated with adherence to their medicines. The higher PCC was evaluated, the more patients believed in the necessity of the medicines use and the better the balance between necessity and concerns. The people-centeredness of pharmaceutical care showed several shortcomings and can still be improved. As such, healthcare providers are advised to actively engage in PCC, and not to wait passively for information provided by the patient.
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27
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Miller T, Reihlen M. Assessing the impact of patient-involvement healthcare strategies on patients, providers, and the healthcare system: A systematic review. PATIENT EDUCATION AND COUNSELING 2023; 110:107652. [PMID: 36804578 DOI: 10.1016/j.pec.2023.107652] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Patient involvement has become an important and lively field of research, yet existing findings are fragmented and often contested. Without a synthesis of the research field, these findings are of limited use to scholars, healthcare providers, or policy-makers. OBJECTIVE Examine the body of knowledge on patient involvement to determine what is known, contested, and unknown about benefits, risks, and effective implementation strategies. PATIENT INVOLVEMENT Patients were not involved. METHODS Systematic literature review of 99 journal articles using a conceptual model integrating three levels: health systems, health providers, and patients. We extracted individual research findings and organized them into the structure of our model to provide a holistic picture of patient involvement. RESULTS The review highlights overlaps and conflicts between various patient involvement approaches. Our results show benefits for individual patients and the health system as a whole. At the provider level, however, we identified clear barriers to patient involvement. DISCUSSION Patient involvement requires collaboration among health systems, healthcare providers, and patients. We showed that increasing patient responsibility and health literacy requires policy-maker interventions. This includes incentives for patient education by providers, adapting medical education curricula, and building a database of reliable health information and decision support for patients. Furthermore, policies supporting a common infrastructure for digital health data and managed patient data exchange will foster provider collaboration. PRACTICAL VALUE Our review shows how an approach integrating health systems, healthcare providers, and patients can make patient involvement more effective than isolated interventions. Such systematic patient involvement is likely to improve population health literacy and healthcare quality.
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Affiliation(s)
- Thomas Miller
- Institute of Management and Organization, Leuphana University Lüneburg, Lüneburg, Germany.
| | - Markus Reihlen
- Institute of Management and Organization, Leuphana University Lüneburg, Lüneburg, Germany.
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Kee K, Gerrits RG, de Meij N, Boonen LHHM, Willems P. 'What you suggest is not what I expected': How pre-consultation expectations affect shared decision-making in patients with low back pain. PATIENT EDUCATION AND COUNSELING 2023; 106:85-91. [PMID: 36243600 DOI: 10.1016/j.pec.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 09/29/2022] [Accepted: 10/04/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Existing studies on shared decision-making (SDM) have hardly taken into consideration that patients could have independently developed expectations prior to their consultation with a healthcare provider, nor have studies explored how such expectations affect SDM. Therefore, we explore how pre-consultation expectations affect SDM in patients with low back pain. METHODS We performed a qualitative study through telephone interviews with 10 patients and seven care professionals (physicians, nurse, physician assistants) and 63 in-person observations of patient-physician consultations in an outpatient clinic in the Netherlands. Transcripts were analyzed through an open coding process. RESULTS A discrepancy existed between what patients expected and what care professionals could offer. Professionals perceived they had to undertake additional efforts to address patients' 'unrealistic' expectations while attempting SDM. Patients, in turn, were often dissatisfied with the outcomes of the SDM encounter, as they believed their own expectations were not reflected in the final decision. CONCLUSION Unaddressed pre-consultation expectations form a barrier to constructive SDM encounters. PRACTICAL IMPLICATIONS Patients' pre-consultation expectations need to be explored during the SDM encounter. To achieve decisions that are truly shared by care professionals and patients, patients' pre-consultation expectations should be better incorporated into SDM models and education.
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Affiliation(s)
- Karin Kee
- Department of Organization Sciences, Vrije Universiteit, Amsterdam, the Netherlands.
| | | | - Nelleke de Meij
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
| | | | - Paul Willems
- Department of Orthopedic Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
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29
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Corral-Partearroyo C, Sánchez-Viñas A, Gil-Girbau M, Peñarrubia-María MT, Aznar-Lou I, Serrano-Blanco A, Carbonell-Duacastella C, Gallardo-González C, Olmos-Palenzuela MDC, Rubio-Valera M. Improving Initial Medication Adherence to cardiovascular disease and diabetes treatments in primary care: Pilot trial of a complex intervention. Front Public Health 2022; 10:1038138. [PMID: 36561857 PMCID: PMC9764337 DOI: 10.3389/fpubh.2022.1038138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/10/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction The Initial Medication Adherence (IMA) intervention is a multidisciplinary and shared decision-making intervention to improve initial medication adherence addressed to patients in need of new treatments for cardiovascular diseases and diabetes in primary care (PC). This pilot study aims to evaluate the feasibility and acceptability of the IMA intervention and the feasibility of a cluster-RCT to assess the effectiveness and cost-effectiveness of the intervention. Methods A 3-month pilot trial with an embedded process evaluation was conducted in five PC centers in Catalonia (Spain). Electronic health data were descriptively analyzed to test the availability and quality of records of the trial outcomes (initiation, implementation, clinical parameters and use of services). Recruitment and retention rates of professionals were analyzed. Twenty-nine semi-structured interviews with professionals (general practitioners, nurses, and community pharmacists) and patients were conducted to assess the feasibility and acceptability of the intervention. Three discussion groups with a total of fifteen patients were performed to review and redesign the intervention decision aids. Qualitative data were thematically analyzed. Results A total of 901 new treatments were prescribed to 604 patients. The proportion of missing data in the electronic health records was up to 30% for use of services and around 70% for clinical parameters 5 months before and after a new prescription. Primary and secondary outcomes were within plausible ranges and outliers were barely detected. The IMA intervention and its implementation strategy were considered feasible and acceptable by pilot-study participants. Low recruitment and retention rates, understanding of shared decision-making by professionals, and format and content of decision aids were the main barriers to the feasibility of the IMA intervention. Discussion Involving patients in the decision-making process is crucial to achieving better clinical outcomes. The IMA intervention is feasible and showed good acceptability among professionals and patients. However, we identified barriers and facilitators to implementing the intervention and adapting it to a context affected by the COVID-19 pandemic that should be considered before launching a cluster-RCT. This pilot study identified opportunities for refining the intervention and improving the design of the definitive cluster-RCT to evaluate its effectiveness and cost-effectiveness. Clinical trial registration ClinicalTrials.gov, identifier NCT05094986.
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Affiliation(s)
- Carmen Corral-Partearroyo
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain,Department of Paediatrics, Obstetrics, Gynaecology and Preventive Medicine, Univ Autonoma de Barcelona, Bellaterra, Spain,Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública), Madrid, Spain
| | - Alba Sánchez-Viñas
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain,Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública), Madrid, Spain,Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
| | - Montserrat Gil-Girbau
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain,Parc Sanitari Sant Joan de Déu,Sant Boi de Llobregat, Spain,Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Barcelona, Spain
| | - María Teresa Peñarrubia-María
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain,Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública), Madrid, Spain,Primary Care Centre Bartomeu Fabrés Anglada, Direcció D'Atenció Primària Regió Metropolitana Sud, Institut Català de la Salut, Barcelona, Spain,Unitat de Suport a la Recerca Regió Metropolitana Sud, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Ignacio Aznar-Lou
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain,Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública), Madrid, Spain
| | - Antoni Serrano-Blanco
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain,Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública), Madrid, Spain,Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain,Parc Sanitari Sant Joan de Déu,Sant Boi de Llobregat, Spain
| | - Cristina Carbonell-Duacastella
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain,Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública), Madrid, Spain,Facultat de Farmàcia, Universitat de Barcelona, Barcelona, Spain
| | - Carmen Gallardo-González
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain,Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Barcelona, Spain,Primary Care Centre Bartomeu Fabrés Anglada, Direcció D'Atenció Primària Regió Metropolitana Sud, Institut Català de la Salut, Barcelona, Spain,Unitat de Suport a la Recerca Regió Metropolitana Sud, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Maria del Carmen Olmos-Palenzuela
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Barcelona, Spain,Primary Care Centre Bartomeu Fabrés Anglada, Direcció D'Atenció Primària Regió Metropolitana Sud, Institut Català de la Salut, Barcelona, Spain
| | - Maria Rubio-Valera
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain,Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública), Madrid, Spain,Parc Sanitari Sant Joan de Déu,Sant Boi de Llobregat, Spain,*Correspondence: Maria Rubio-Valera
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Leblang C, Taylor S, Brown A, Knapp J, Jindal M. A structured approach to Shared Decision Making training and assessment of knowledge, attitudes and perception of second year medical students. MEDICAL EDUCATION ONLINE 2022; 27:2044279. [PMID: 35262472 PMCID: PMC8920383 DOI: 10.1080/10872981.2022.2044279] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/31/2022] [Accepted: 02/16/2022] [Indexed: 06/14/2023]
Abstract
Shared decision making (SDM) has been acknowledged in the last decade. Literature has shown that when physicians are engaged in SDM and form a relationship with their patients, there is higher patient satisfaction of care. Moreover, SDM has been reported to improve patient outcomes and clinical measures. Despite this clear benefit of implementing SDM into clinical practice, there is little evidence for including SDM learning into preclinical medical education. We integrated an exercise for second year medical students to practice the steps of shared decision making. In this paper, the quantitative and qualitative results from a survey of medical students following the SDM learning exercise will be discussed. Students were more educated regarding SDM after this exercise and were motivated to use it in their future clinical careers. They also expressed overall positive attitudes towards SDM tools such as decision aids. Feedback to improve this SDM learning experience included the use of standardized patients, and to expand such education to the clinical environment training. This research provides a model of SDM practice integration into medical education. Similar programs can be beneficial for the development of SDM and other interpersonal skills.
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Affiliation(s)
- Charlotte Leblang
- University of South Carolina School of Medicine Greenville, Greenville, SC, USA
| | - Shannon Taylor
- University of South Carolina School of Medicine Greenville, Greenville, SC, USA
- Prisma Health Upstate, Greenville, SC, USA
| | | | - Jess Knapp
- Prisma Health Upstate, Greenville, SC, USA
| | - Meenu Jindal
- University of South Carolina School of Medicine Greenville, Greenville, SC, USA
- Prisma Health Upstate, Greenville, SC, USA
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31
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Lee S, Lee IS, Chae Y. Similarities between Ashi acupoints and myofascial trigger points: Exploring the relationship between body surface treatment points. Front Neurosci 2022; 16:947884. [PMID: 36408408 PMCID: PMC9671147 DOI: 10.3389/fnins.2022.947884] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 10/12/2022] [Indexed: 06/10/2024] Open
Abstract
Although acupuncture points and myofascial trigger points (TPs) are based in different medical fields, the two points share important attributes. We explored the relationship between acupuncture points and TPs based on their characteristics and the results of previous studies. We outlined the relationship between acupuncture points and TPs by examining their similarities and differences. Among the acupuncture point subgroups, TPs mostly corresponded to Ashi points. Based on the common features of TPs and Ashi points, we suggest that TPs are more closely related to Ashi points than to other acupoints. However, TPs also share some features, such as pain indication and location, with classical acupuncture points (CA) and extra acupuncture points (EA), which makes it difficult to elucidate their relationship with other subgroups. Therefore, we suggest to understand the relationship of CAs, EAs, Ashi points, and TPs. In this report, we concluded that concerning muscular pain symptoms Ashi points and TPs are indistinguishable.
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Affiliation(s)
- Seoyoung Lee
- Department of Science in Korean Medicine, Graduate School, Kyung Hee University, Seoul, South Korea
- Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, South Korea
| | - In-Seon Lee
- Department of Science in Korean Medicine, Graduate School, Kyung Hee University, Seoul, South Korea
- Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, South Korea
| | - Younbyoung Chae
- Department of Science in Korean Medicine, Graduate School, Kyung Hee University, Seoul, South Korea
- Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, South Korea
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32
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Corral-Partearroyo C, Sánchez-Viñas A, Gil-Girbau M, Peñarrubia-María MT, Aznar-Lou I, Gallardo-González C, Olmos-Palenzuela MDC, Rubio-Valera M. Complex multidisciplinary intervention to improve Initial Medication Adherence to cardiovascular disease and diabetes treatments in primary care (the IMA-cRCT study): mixed-methods process evaluation protocol. BMJ Open 2022; 12:e067468. [PMID: 36316078 PMCID: PMC9628671 DOI: 10.1136/bmjopen-2022-067468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Medication non-initiation, or primary non-adherence, is a persistent public health problem that increases the risk of adverse clinical outcomes. The initial medication adherence (IMA) intervention is a complex multidisciplinary intervention to improve adherence to cardiovascular and diabetes treatments in primary care by empowering the patient and promoting informed prescriptions based on shared decision-making. This paper presents the development and implementation strategy of the IMA intervention and the process evaluation protocol embedded in a cluster randomised controlled trial (the IMA-cRCT) to understand and interpret the outcomes of the trial and comprehend the extent of implementation and fidelity, the active mechanisms of the IMA intervention and in what context the intervention is implemented and works. METHODS AND ANALYSIS We present the protocol for a mixed-methods process evaluation including quantitative and qualitative methods to measure implementation and fidelity and to explore the active mechanisms and the interactions between the intervention, participants and its context. The process evaluation will be conducted in primary care centres and community pharmacies from the IMA-cRCT, and participants include healthcare professionals (general practitioners, nurses and community pharmacists) as well as patients. Quantitative data collection methods include data extraction from the intervention operative records, patient clinical records and participant feedback questionnaires, whereas qualitative data collection involves semistructured interviews, focus groups and field diaries. Quantitative and qualitative data will be analysed separately and triangulated to produce deeper insights and robust results. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Research Ethics Comittee (CEIm) at IDIAP Jordi Gol (codeCEIm 21/051 P). Findings will be disseminated through publications and conferences, as well as presentations to healthcare professionals and stakeholders from healthcare organisations. TRIAL REGISTRATION NUMBER NCT05026775.
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Affiliation(s)
- Carmen Corral-Partearroyo
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Parc Sanitari Sant Joan de Deu, Institut de Recerca Sant Joan de Deu, St Boi de Llobregat, Catalunya, Spain
- Department of Paediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universitat Autonoma de Barcelona, Bellaterra, Catalunya, Spain
| | - Alba Sánchez-Viñas
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Parc Sanitari Sant Joan de Deu, Institut de Recerca Sant Joan de Deu, St Boi de Llobregat, Catalunya, Spain
- Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Catalunya, Spain
| | - Montserrat Gil-Girbau
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Parc Sanitari Sant Joan de Deu, Institut de Recerca Sant Joan de Deu, St Boi de Llobregat, Catalunya, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Barcelona, Spain
| | - Maria Teresa Peñarrubia-María
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Parc Sanitari Sant Joan de Deu, Institut de Recerca Sant Joan de Deu, St Boi de Llobregat, Catalunya, Spain
- Unitat de Suport a la Recerca Regió Metropolitana Sud, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Catalunya, Spain
| | - Ignacio Aznar-Lou
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Parc Sanitari Sant Joan de Deu, Institut de Recerca Sant Joan de Deu, St Boi de Llobregat, Catalunya, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Comunidad de Madrid, Spain
| | - Carmen Gallardo-González
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Parc Sanitari Sant Joan de Deu, Institut de Recerca Sant Joan de Deu, St Boi de Llobregat, Catalunya, Spain
- Unitat de Suport a la Recerca Regió Metropolitana Sud, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Catalunya, Spain
| | - María Del Carmen Olmos-Palenzuela
- Primary Care Centre Bartomeu Fabrés Anglada, Institut Català de la Salut Gerència Territorial Metropolitana Sud, Barcelona, Catalunya, Spain
| | - Maria Rubio-Valera
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Parc Sanitari Sant Joan de Deu, Institut de Recerca Sant Joan de Deu, St Boi de Llobregat, Catalunya, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Comunidad de Madrid, Spain
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Hazazi A, Wilson A. Experiences and Satisfaction of Patients with Non-Communicable Diseases with Current Care in Primary Health Care Centres in Saudi Arabia. J Patient Exp 2022; 9:23743735221134734. [PMID: 36330229 PMCID: PMC9623365 DOI: 10.1177/23743735221134734] [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: 11/05/2022] Open
Abstract
Primary healthcare centres (PHCs) play a pivotal role in chronic disease care and prevention and therefore in the experience and satisfaction of patients with non-communicable diseases (NCDs). This survey examined the experiences and satisfaction of 315 Patients with NCDs receiving care from PHCs. Participants were from attendees at Ministry of Health PHCs in Riyadh, Saudi Arabia. Findings indicate that most patients were satisfied with the care they received and confirmed the importance of providers' and physicians' communication skills in this. There was a lack of evidence of managed care, including patient involvement in disease management suggesting that steps are needed to empower patients to take a greater role in disease management. This study emphasises the important role of physicians in providing patients with information and empowering them to access community health facilities for self-managed care. This study also indicates a need to strengthen the primary health care system's focus on care beyond PHCs.
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Affiliation(s)
- Ahmed Hazazi
- Menzies Centre for Health Policy and Economics, Sydney School of
Public Health, University of Sydney, Sydney, New South Wales, Australia,Department of Public Health, Faculty of Health Sciences, Saudi Electronic University, Riyadh, Saudi Arabia,Ahmed Hazazi, Menzies Centre for Health
Policy and Economics, Sydney School of Public Health, The University of Sydney,
No. 2W21/Level 2, Charles Perkins Centre D17, Sydney, NSW 2006, Australia.
E-mails: or
| | - Andrew Wilson
- Menzies Centre for Health Policy and Economics, Sydney School of
Public Health, University of Sydney, Sydney, New South Wales, Australia
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Yang Y, Qu T, Yang J, Ma B, Leng A. Confucian Familism and Shared Decision Making in End-of-Life Care for Patients with Advanced Cancers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191610071. [PMID: 36011706 PMCID: PMC9408283 DOI: 10.3390/ijerph191610071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 05/27/2023]
Abstract
Shared decision-making (SDM) has been institutionally recognized as clinically effective by many Western healthcare systems. Nevertheless, it appears culturally unattractive in China, a country that adheres to Confucian familism which strongly prefers collective family decisions. This study examined this conflict and assessed the influence of Confucian familism on SDM in end-of-life (EOL) care for advanced cancer patients. Between August and November 2018, 188 EOL advanced-cancer patients were randomly recruited from 640 cancer hospital medical records at a Tertiary A-level hospital in Shandong province. Eventually, 164 (87.23%) sample patients were included in the statistical analysis after the non-responsive cases (4.79%) and missing value (7.98%) were removed. SDM was measured through SDM-Q-9, and the patient's siblings were used as indicators of Confucian Familism. Of the 164 patients, the mean SDM score was 38/100; 47.6% were thoroughly unfamiliar with their treatment plans and fell outside the decision-making procedure. Each patient had four siblings on average. Ceteris paribus, more siblings led to lower SDM. Moreover, being 56-65 years old and open-minded were associated with higher SDM, while higher satisfaction of the quality of EOL care yielded lower SDM. In conclusion, Confucian familism weakened patient-clinician SDM in EOL care for advanced cancer patients.
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Affiliation(s)
- Yuexi Yang
- School of Political Science and Public Administration, Shandong University, Qingdao 266237, China
| | | | - Jinyue Yang
- Qingdao Center for Women and Children’s Health and Family Planning Service, Qingdao 266034, China
| | - Ben Ma
- School of Political Science and Public Administration, Shandong University, Qingdao 266237, China
| | - Anli Leng
- School of Political Science and Public Administration, Shandong University, Qingdao 266237, China
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Ballengee LA, Bosworth HB, Zullig LL. The role of accountability in adherence programs. PATIENT EDUCATION AND COUNSELING 2022; 105:2635-2636. [PMID: 35667936 DOI: 10.1016/j.pec.2022.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- L A Ballengee
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
| | - H B Bosworth
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA; Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - L L Zullig
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA; Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
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Goldberg EM, Bountogo M, Harling G, Baernighausen T, Davies JI, Hirschhorn LR. Older persons experiences of healthcare in rural Burkina Faso: Results of a cross sectional household survey. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000193. [PMID: 36962344 PMCID: PMC10021992 DOI: 10.1371/journal.pgph.0000193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 04/18/2022] [Indexed: 11/19/2022]
Abstract
Ensuring responsive healthcare which meets patient expectations and generates trust is important to increase rates of access and retention. This need is important for aging populations where non-communicable diseases (NCDs) are a growing cause of morbidity and mortality. We performed a cross-sectional household survey including socio-demographic; morbidities; and patient-reported health system utilization, responsiveness, and quality outcomes in individuals 40 and older in northwestern Burkina Faso. We describe results and use exploratory factor analysis to derive a contextually appropriate grouping of health system responsiveness (HSR) variables. We used linear or logistic regression to explore associations between socio-demographics, morbidities, and the grouped-variable, then between these variables and health system quality outcomes. Of 2,639 eligible respondents, 26.8% had least one NCD, 56.3% were frail or pre-frail and 23.9% had a recent healthcare visit, including only 1/3 of those with an NCD. Highest ratings of care experience (excellent/very good) included ease of following instructions (86.1%) and trust in provider skills (81.1%). The HSR grouping with the greatest factor loading included involvement in decision-making, clarity in communication, trust in the provider, and confidence in providers' skills, labelled Shared Understanding and Decision Making (SUDM). In multivariable analysis, higher quality of life (OR 1.02,95%CI 1.01-1.04), frailty (OR 1.47,95%CI 1.00-2.16), and SUDM (OR 1.06,95%CI 1.05-1.09) were associated with greater health system trust and confidence. SUDM was associated with overall positive assessment of the healthcare system (OR 1.02,95%CI 1.01-1.03) and met healthcare needs (OR 1.09,95%CI 1.08-1.11). Younger age and highest wealth quintile were also associated with higher met needs. Recent healthcare access was low for people with existing NCDs, and SUDM was the most consistent factor associated with higher health system quality outcomes. Results highlight the need to increase continuity of care for aging populations with NCDs and explore strengthening SUDM to achieve this goal.
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Affiliation(s)
- Ellen M. Goldberg
- University of Chicago Pritzker School of Medicine, Chicago, Illinois, United States of America
| | | | - Guy Harling
- Institute for Global Health, University College London, London, United Kingdom
| | - Till Baernighausen
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Justine I. Davies
- Institute of Applied Health Research, Birmingham University, Birmingham, United Kingdom
| | - Lisa R. Hirschhorn
- Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
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Pereira F, Bieri M, Martins MM, del Río Carral M, Verloo H. Safe Medication Management for Polymedicated Home-Dwelling Older Adults after Hospital Discharge: A Qualitative Study of Older Adults, Informal Caregivers and Healthcare Professionals’ Perspectives. NURSING REPORTS 2022; 12:403-423. [PMID: 35736616 PMCID: PMC9230543 DOI: 10.3390/nursrep12020039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/20/2022] [Accepted: 05/26/2022] [Indexed: 11/18/2022] Open
Abstract
Safe medication management is particularly challenging among polymedicated home-dwelling older adults after hospital discharge. This study aimed to identify and categorise the stressors experienced and reconstitution strategies adopted by older adults, their informal caregivers, and healthcare professionals as they manage older adults’ medications after hospital discharge. A primary study collected the perspectives of 28 older adults, 17 informal caregivers, and 13 healthcare professionals using a qualitative descriptive design. The Neuman Systems Model was used as the basis for a secondary deductive content analysis. Findings revealed that post-discharge medication management at home involved numerous stressors, often including dysfunctions in communication, collaboration, and coordination between the multiple stakeholders involved. Reconstitution strategies for safe medication management were not always successful or satisfactory and were sometimes identified as stressors themselves. Older adults, informal caregivers, and healthcare professionals’ perspectives highlighted several potential opportunities for improving safe medication management through nurse-led, interprofessional, patient-centred practices.
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Affiliation(s)
- Filipa Pereira
- Institute of Biomedical Sciences Abel Salazar, University of Porto, 4050-313 Porto, Portugal
- School of Health Sciences, HES-SO Valais/Wallis, 1950 Sion, Switzerland; (M.B.); (H.V.)
- Correspondence:
| | - Marion Bieri
- School of Health Sciences, HES-SO Valais/Wallis, 1950 Sion, Switzerland; (M.B.); (H.V.)
| | | | - María del Río Carral
- Research Center for Psychology of Health, Aging and Sport Examination, Institute of Psychology, University of Lausanne, 1015 Lausanne, Switzerland;
| | - Henk Verloo
- School of Health Sciences, HES-SO Valais/Wallis, 1950 Sion, Switzerland; (M.B.); (H.V.)
- Service of Old Age Psychiatry, Lausanne University Hospital, 1008 Prilly, Switzerland
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Wang S, Lu Q, Ye Z, Liu F, Yang N, Pan Z, Li Y, Li L. Effects of a smartphone application named "Shared Decision Making Assistant" for informed patients with primary liver cancer in decision-making in China: a quasi-experimental study. BMC Med Inform Decis Mak 2022; 22:145. [PMID: 35641979 PMCID: PMC9152304 DOI: 10.1186/s12911-022-01883-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 05/16/2022] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND It is well known that decision aids can promote patients' participation in decision-making, increase patients' decision preparation and reduce decision conflict. The goal of this study is to explore the effects of a "Shared Decision Making Assistant" smartphone application on the decision-making of informed patients with Primary Liver Cancer (PLC) in China. METHODS In this quasi-experimental study , 180 PLC patients who knew their real diagnoses in the Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China, from April to December 2020 were randomly assigned to a control group and an intervention group. Patients in the intervention group had an access to the "Shared Decision Making Assistant" application in decision-making, which included primary liver cancer treatment knowledge, decision aids path, continuing nursing care video clips, latest information browsing and interactive platforms. The study used decision conflict scores to evaluate the primary outcome, and the data of decision preparation, decision self-efficacy, decision satisfaction and regret, and knowledge of PLC treatment for secondary outcomes. Then, the data were entered into the SPSS 22.0 software and were analyzed by descriptive statistics, Chi-square, independent t-test, paired t-test, and Mann-Whitney tests. RESULTS Informed PLC patients in the intervention group ("SDM Assistant" group) had significantly lower decision conflict scores than those in the control group. ("SDM Assistant" group: 16.89 ± 8.80 vs. control group: 26.75 ± 9.79, P < 0.05). Meanwhile, the decision preparation score (80.73 ± 8.16), decision self-efficacy score (87.75 ± 6.87), decision satisfaction score (25.68 ± 2.10) and knowledge of PLC treatment score (14.52 ± 1.91) of the intervention group were significantly higher than those of the control group patients (P < 0.05) at the end of the study. However, the scores of "regret of decision making" between the two groups had no statistical significance after 3 months (P > 0.05). CONCLUSIONS Access to the "Shared Decision Making Assistant" enhanced the PLC patients' performance and improved their quality of decision making in the areas of decision conflict, decision preparation, decision self-efficacy, knowledge of PLC treatment and satisfaction. Therefore, we recommend promoting and updating the "Shared Decision Making Assistant" in clinical employment and future studies.
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Affiliation(s)
- Sitong Wang
- Department of Nursing, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, No. 700 Moyu Road, Jiading District, Shanghai, 201805, People's Republic of China.,Officers' Ward, General Hospital of Northern Theater Command, Shenyang, 110016, Liaoning, People's Republic of China
| | - Qingwen Lu
- Department of Nursing, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, No. 700 Moyu Road, Jiading District, Shanghai, 201805, People's Republic of China
| | - Zhixia Ye
- Department of Nursing, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, No. 700 Moyu Road, Jiading District, Shanghai, 201805, People's Republic of China
| | - Fang Liu
- Department of Nursing, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, No. 700 Moyu Road, Jiading District, Shanghai, 201805, People's Republic of China
| | - Ning Yang
- Department of No. 5 Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, 201805, People's Republic of China
| | - Zeya Pan
- Department of No. 3 Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, 201805, People's Republic of China
| | - Yu Li
- Department of Organ Transplantation, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, 201805, People's Republic of China
| | - Li Li
- Department of Nursing, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, No. 700 Moyu Road, Jiading District, Shanghai, 201805, People's Republic of China.
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Quality Improvement Initiatives in Renal Biopsy for Patient-Centered Communication by Shared Decision Making. Diagnostics (Basel) 2022; 12:diagnostics12051227. [PMID: 35626381 PMCID: PMC9140834 DOI: 10.3390/diagnostics12051227] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/08/2022] [Accepted: 05/12/2022] [Indexed: 01/25/2023] Open
Abstract
Background: Renal biopsy is the gold standard for diagnosing renal disease. The major concern is bleeding. Shared decision making (SDM) has been reported to improve communication but has never been used regarding renal biopsy. Methods: We launched a 5-year project on SDM for renal biopsy. We collected cases of renal biopsy and bleeding, and cases of SDM. The process of quality improvement (QI) for SDM is also shared. Results: Taichung Veterans General Hospital has the largest number of renal biopsy cases, and the lowest bleeding rate in Taiwan. We enlisted a core team for this QI project and conducted stakeholder mapping. In 2017, we conducted a small pilot study for SDM based on printed material as a decision aid. The satisfaction rate was 95.5%. From 2018 to 2019, we improved SDM patients’ decision aid from printed material to four videos, designing questions to consolidate their understanding, and a unique information platform. The above improvements facilitated the utilization of SDM for renal biopsy (81.27% in 2020 and 100% in 2021). Even with higher bleeding complications in 2019 and 2020, patients remained satisfied when we launched SDM prior to renal biopsy. Conclusion: This is the first study regarding SDM on renal biopsy. Through SDM, patients had time to understand renal biopsy, including risk and benefit. We recommend SDM to elaborate renal biopsy in clinical practice.
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Górriz JL, Romera I, Cobo A, O'Brien PD, Merino-Torres JF. Glucagon-Like Peptide-1 Receptor Agonist Use in People Living with Type 2 Diabetes Mellitus and Chronic Kidney Disease: A Narrative Review of the Key Evidence with Practical Considerations. Diabetes Ther 2022; 13:389-421. [PMID: 35175551 PMCID: PMC8934828 DOI: 10.1007/s13300-021-01198-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/21/2021] [Indexed: 02/06/2023] Open
Abstract
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are incretin-mimetic agents that are effective adjuncts in the treatment of diabetes. This class of medications is also associated with promoting weight loss and a low risk of hypoglycemia, and some have been shown to be associated with a significant reduction of major cardiovascular events. Mounting evidence suggests that GLP-1 RAs have benefits beyond reducing blood glucose that include improving kidney function in people living with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD), a common microvascular complication of T2DM. Several large clinical studies, the majority of which are cardiovascular outcome trials, indicate that GLP-1 RA therapy is safe and tolerable for people living with T2DM and compromised renal function, and also suggest that GLP-1 RAs may have renoprotective properties. Although evidence from clinical trials has shown GLP-1 RAs to be safe and efficacious in people living with T2DM and renal impairment, their use is uncommon in this patient population. With continuing developments in the field of GLP-1 RA therapy, it is important for physicians to understand the benefits and practical use of GLP-1 RAs, as well as the clinical evidence, in order to achieve positive patient outcomes. Here, we review evidence on GLP-1 RA use in people living with T2DM and CKD and summarize renal outcomes from clinical studies. We provide practical considerations for GLP-1 RA use to provide an added benefit to guide treatment in this high-risk patient population.
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Affiliation(s)
- José L Górriz
- Department of Nephrology, Hospital Clínico Universitario de Valencia-INCLIVA, University of Valencia, Valencia, Spain
| | | | | | | | - Juan F Merino-Torres
- Endocrinology and Nutrition Department, Hospital Universitario y Politécnico de La Fe, University of Valencia, Valencia, Spain
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Spatial Healthcare Accessibility: A District-Level Analysis of Travel for Outpatient Diabetology in Czechia. Healthcare (Basel) 2022; 10:healthcare10020395. [PMID: 35207008 PMCID: PMC8871827 DOI: 10.3390/healthcare10020395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 11/16/2022] Open
Abstract
Assessments of regional differences in the accessibility and capacity of health services often rely on indicators based on data from the permanent residents of a given region. However, a patient does not always use health services in their place of residence. The objective of this article is to evaluate the influence of spatial healthcare accessibility on regional differences in the provision and take-up of health services, using outpatient diabetology in Czechia as a case study. The analysis is grounded in monitoring the differences in the patient’s place of residence and the location of the healthcare provided. Anonymized individual data of the largest Czech health insurance company for 2019 are used (366,537 patients, 2,481,129 medical procedures). The data are aggregated at the district level (LAU 1). It has been identified that regions where patients travel outside their area of residence to access more than half of their healthcare needs are mostly in local/regional centres. Moreover, these patients increase the number of medical services provided in local/regional centres, often by more than 20%, which has been reflected in greater healthcare capacity in these centres. To assess regional differences, it is important to take the spatial healthcare accessibility into account and also consider why patients travel for healthcare. Reasons could be the insufficient local capacity, varied quality of health services or individual factors. In such cases, healthcare actors (health insurance companies, local government etc.) should respond to the situation and take appropriate action to reduce these dissimilarities.
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Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM, Bischoff JM, Bittl JA, Cohen MG, DiMaio JM, Don CW, Fremes SE, Gaudino MF, Goldberger ZD, Grant MC, Jaswal JB, Kurlansky PA, Mehran R, Metkus TS, Nnacheta LC, Rao SV, Sellke FW, Sharma G, Yong CM, Zwischenberger BA. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021; 145:e18-e114. [PMID: 34882435 DOI: 10.1161/cir.0000000000001038] [Citation(s) in RCA: 139] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AIM The guideline for coronary artery revascularization replaces the 2011 coronary artery bypass graft surgery and the 2011 and 2015 percutaneous coronary intervention guidelines, providing a patient-centric approach to guide clinicians in the treatment of patients with significant coronary artery disease undergoing coronary revascularization as well as the supporting documentation to encourage their use. METHODS A comprehensive literature search was conducted from May 2019 to September 2019, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, CINHL Complete, and other relevant databases. Additional relevant studies, published through May 2021, were also considered. Structure: Coronary artery disease remains a leading cause of morbidity and mortality globally. Coronary revascularization is an important therapeutic option when managing patients with coronary artery disease. The 2021 coronary artery revascularization guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with coronary artery disease who are being considered for coronary revascularization, with the intent to improve quality of care and align with patients' interests.
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Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM, Bischoff JM, Bittl JA, Cohen MG, DiMaio JM, Don CW, Fremes SE, Gaudino MF, Goldberger ZD, Grant MC, Jaswal JB, Kurlansky PA, Mehran R, Metkus TS, Nnacheta LC, Rao SV, Sellke FW, Sharma G, Yong CM, Zwischenberger BA. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2021; 79:e21-e129. [PMID: 34895950 DOI: 10.1016/j.jacc.2021.09.006] [Citation(s) in RCA: 521] [Impact Index Per Article: 173.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM The guideline for coronary artery revascularization replaces the 2011 coronary artery bypass graft surgery and the 2011 and 2015 percutaneous coronary intervention guidelines, providing a patient-centric approach to guide clinicians in the treatment of patients with significant coronary artery disease undergoing coronary revascularization as well as the supporting documentation to encourage their use. METHODS A comprehensive literature search was conducted from May 2019 to September 2019, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, CINHL Complete, and other relevant databases. Additional relevant studies, published through May 2021, were also considered. STRUCTURE Coronary artery disease remains a leading cause of morbidity and mortality globally. Coronary revascularization is an important therapeutic option when managing patients with coronary artery disease. The 2021 coronary artery revascularization guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with coronary artery disease who are being considered for coronary revascularization, with the intent to improve quality of care and align with patients' interests.
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The Association of Mobile Health Applications with Self-Management Behaviors among Adults with Chronic Conditions in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910351. [PMID: 34639651 PMCID: PMC8507726 DOI: 10.3390/ijerph181910351] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/25/2021] [Accepted: 09/27/2021] [Indexed: 11/17/2022]
Abstract
Background: Mobile applications related to health and wellness (mHealth apps) are widely used to self-manage chronic conditions. However, research on whether mHealth apps facilitate self-management behaviors of individuals with chronic conditions is sparse. We aimed to evaluate the association of mHealth apps with different types of self-management behaviors among patients with chronic diseases in the United States. Methods: This is a cross-sectional observational study. We used data from adult participants (unweighted n = 2340) of the Health Information National Trends Survey in 2018 and 2019. We identified three self-management behaviors: (1) resource utilization using electronic personal health records; (2) treatment discussions with healthcare providers; and (3) making healthcare decisions. We analyzed the association of mHealth apps to self-management behaviors with multivariable logistic and ordinal regressions. Results: Overall, 59.8% of adults (unweighted number = 1327) used mHealth apps. Adults using mHealth apps were more likely to use personal health records (AOR = 3.11, 95% CI 2.26–4.28), contact healthcare providers using technology (AOR = 2.70, 95% CI 1.93–3.78), and make decisions on chronic disease management (AOR = 2.59, 95% CI 1.93–3.49). The mHealth apps were associated with higher levels of self-management involvement (AOR = 3.53, 95% CI 2.63–4.72). Conclusion: Among individuals with chronic conditions, having mHealth apps was associated with positive self-management behaviors.
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Kirsch V, Matthes J. A simulation-based module in pharmacology education reveals and addresses medical students' deficits in leading prescription talks. Naunyn Schmiedebergs Arch Pharmacol 2021; 394:2333-2341. [PMID: 34522985 PMCID: PMC8514349 DOI: 10.1007/s00210-021-02151-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/02/2021] [Indexed: 11/29/2022]
Abstract
Although doctor-patient communication is essential for drug prescription, the literature reveals deficits in this area. An educational approach at the Cologne medical faculty aims at identifying and addressing those deficits in medical students.Fifth-year medical students first conducted a simulated prescription talk spontaneously. Subsequently, the conversation was discussed with peer students. A pharmacist moderated the discussion based upon a previously developed conversation guide. Afterwards, the same student had the conversation again, but as if for the first time. Conversations were video-recorded, transcribed and subjected to quantitative content analysis. Four days after the simulation, the students who conducted the talk, those who observed and discussed it, and students who did neither, completed a written test that focused on the content of an effective prescription talk.Content analysis revealed clear deficits in spontaneously led prescription talks. Even essential information as on adverse drug reactions were often lacking. Prescription talks became clearly more informative and comprehensive after the short, guided peer discussion. With regard to a comprehensive, informative prescription talk, the written test showed that both the students who conducted the talk and those who only observed it performed clearly better than the students who did not participate in the educational approach.Deficits regarding prescription talks are present in 5th year medical students. We provide an approach to both identify and address these deficits. It thus may be an example for training medical students in simulated and clinical environments like the EACPT recommended to improve pharmacology education.
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Affiliation(s)
- Verena Kirsch
- Center of Pharmacology, Institute II, University of Cologne, Gleueler Strasse 24, 50931, Cologne, Germany
| | - Jan Matthes
- Center of Pharmacology, Institute II, University of Cologne, Gleueler Strasse 24, 50931, Cologne, Germany.
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Chang TJ, Bridges JFP, Bynum M, Jackson JW, Joseph JJ, Fischer MA, Lu B, Donneyong MM. Association Between Patient-Clinician Relationships and Adherence to Antihypertensive Medications Among Black Adults: An Observational Study Design. J Am Heart Assoc 2021; 10:e019943. [PMID: 34238022 PMCID: PMC8483480 DOI: 10.1161/jaha.120.019943] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background We assessed the associations between patient-clinician relationships (communication and involvement in shared decision-making [SDM]) and adherence to antihypertensive medications. Methods and Results The 2010 to 2017 Medical Expenditure Panel Survey (MEPS) data were analyzed. A retrospective cohort study design was used to create a cohort of prevalent and new users of antihypertensive medications. We defined constructs of patient-clinician communication and involvement in SDM from patient responses to the standard questionnaires about satisfaction and access to care during the first year of surveys. Verified self-reported medication refill information collected during the second year of surveys was used to calculate medication refill adherence; adherence was defined as medication refill adherence ≥80%. Survey-weighted multivariable-adjusted logistic regression models were used to measure the odds ratio (OR) and 95% CI for the association between both patient-clinician constructs and adherence. Our analysis involved 2571 Black adult patients with hypertension (mean age of 58 years; SD, 14 years) who were either persistent (n=1788) or new users (n=783) of antihypertensive medications. Forty-five percent (n=1145) and 43% (n=1016) of the sample reported having high levels of communication and involvement in SDM, respectively. High, versus low, patient-clinician communication (OR, 1.38; 95% CI, 1.14-1.67) and involvement in SDM (OR, 1.32; 95% CI, 1.08-1.61) were both associated with adherence to antihypertensives after adjusting for multiple covariates. These associations persisted among a subgroup of new users of antihypertensive medications. Conclusions Patient-clinician communication and involvement in SDM are important predictors of optimal adherence to antihypertensive medication and should be targeted for improving adherence among Black adults with hypertension.
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Affiliation(s)
| | - John F P Bridges
- Department of Biomedical Informatics Ohio State College of Medicine Columbus OH
| | - Mary Bynum
- Healthcare Management Franklin University Columbus OH
| | - John W Jackson
- Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Joshua J Joseph
- College of Medicine The Ohio State University Wexner Medical Center Columbus OH
| | - Michael A Fischer
- Division of Pharmacoepidemiology and Pharmacoeconomics Brigham & Women's Hospital Boston MA
| | - Bo Lu
- College of Public Health Ohio State University Columbus OH
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Hodgson JC, Bretherton R. Twelve tips for novice academic staff supporting medical students in distress. MEDICAL TEACHER 2021; 43:839-844. [PMID: 33073646 DOI: 10.1080/0142159x.2020.1831464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The importance of having university systems to support students' wellbeing and welfare needs has been well documented, with an increasing literature on best practice for structuring student support services from an institutional perspective. Nevertheless, individual members of academic staff are often required to deal with students who are experiencing challenging circumstances, and this is especially so in the pre-clinical phases of medical training. The prospect of advising and supporting students who are in difficulty and who may be distressed, can be daunting and can also negatively impact the wellbeing of the staff involved. These tips present the practical guidelines we have developed on how academic staff can best manage meetings with students in situations of crisis or high emotion.
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Affiliation(s)
- Jessica C Hodgson
- Lincoln Medical School, Universities of Nottingham and Lincoln, Lincoln, UK
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Atinga RA, Akosen G, Bawontuo V. Perceived characteristics of outpatient appointment scheduling association with patient satisfaction and treatment adherence: An innovation theory application. Hosp Pract (1995) 2021; 49:298-306. [PMID: 34121573 DOI: 10.1080/21548331.2021.1942878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Despite the growing interest in Appointment scheduling (APS) in hospitals of developing countries, empirical assessment of their effectiveness in improving patients' experiences and adherence to treatment remains limited. We drew on the attributes of an innovation theory to hypothesize and test the extent to which perceived attributes of APS: relative advantage, compatibility, and complexity influences patient satisfaction and treatment adherence in a neurology clinic of a large Teaching Hospital in Ghana. METHODS A structured questionnaire was used to collect cross-sectional data from a sample of 295 scheduled patients visiting the clinic for follow-up care. Partial Least Squares Structural Equation Modeling (PLS-SEM) was used to analyze the hypothesized direct relationships of the APS attributes with patient satisfaction and treatment adherence, and the moderating effect of cordial doctor-patient communication in the relationships. RESULTS While the compatibility of APS with patient preference was positively associated with patient satisfaction (p < 0.01) and adherence to treatment (p < 0.01), the reverse was observed for complexity of the APS system (p < 0.01). We also found statistically significant relationship of patient satisfaction with treatment adherence (p < 0.01) which was positively moderated by cordial doctor-patient communication. CONCLUSION Findings suggest that making the APS system more compatible with patient preference can greatly improve upon patient experience satisfaction and adherence to medical treatment for effective therapeutic outcomes. PRACTICE IMPLICATION In the light of its benefits to patient care and outcomes, APS should be given priority over walk-in services in specialty clinics of developing countries.
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Affiliation(s)
- Roger A Atinga
- Department of Public Administration and Health Services Management, University of Ghana Business School, Box Lg 78, University of Ghana Business School, Accra, Ghana
| | - Gifty Akosen
- Department of Public Administration and Health Services Management, University of Ghana Business School, Box Lg 78, University of Ghana Business School, Accra, Ghana
| | - Vitalis Bawontuo
- Faculty of Health and Allied Sciences, Catholic University College of Ghana, Sunyani, Ghana
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Aspects of Medication and Patient participation-an Easy guideLine (AMPEL). A conversation guide increases patients' and physicians' satisfaction with prescription talks. Naunyn Schmiedebergs Arch Pharmacol 2021; 394:1757-1767. [PMID: 34106304 PMCID: PMC8298249 DOI: 10.1007/s00210-021-02107-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 05/27/2021] [Indexed: 12/13/2022]
Abstract
Patients want more information and active participation in medical decisions. Information and active participation correlate with increased adherence. A conversation guide, combining patient-relevant drug information with steps of shared decision-making, was developed to support physicians in effective and efficient prescription talks. Six GP trainees in community-based primary care practices participated in a controlled pilot study in sequential pre-post design. Initially, they conducted 41 prescription talks as usual, i.e., without knowing the guide. Then, they conducted 23 talks considering the guide (post-intervention phase). Immediately after the respective talk, patients filled in a questionnaire on satisfaction with the information on medication and physician–patient interaction, and physicians about their satisfaction with the talk and the application of the guide. Patients felt better informed after guide-based prescription talks (e.g., SIMS-D in median 10 vs. 17, p < 0.05), more actively involved (KPF-A for patient activation 2.9 ± 0.8 vs. 3.6 ± 0.8, p < 0.05), and more satisfied with the physician–patient interaction. Physicians rated the guide helpful and feasible. Their satisfaction with the conversation was significantly enhanced during the post-intervention phase. The evaluation of the duration of the talk was not influenced. Enhanced patients’ and physicians’ satisfaction with prescription talks encourages further examinations of the conversation guide. We invite physicians to try our guide in everyday medical practice.
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Deniz S, Akbolat M, Çimen M, Ünal Ö. The Mediating Role of Shared Decision-Making in the Effect of the Patient-Physician Relationship on Compliance With Treatment. J Patient Exp 2021; 8:23743735211018066. [PMID: 34179444 PMCID: PMC8205395 DOI: 10.1177/23743735211018066] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: For a successful treatment outcome, the components of the treatment process are very important. The patient–physician relationship plays a key role in the successful therapeutic process and effective health service delivery. The patient’s compliance with the treatment directly affects the success of the treatment. Objective: This study aims to determine the effect of the patient–physician relationship on compliance with the treatment and to determine whether shared decision-making has an mediating role in this effect. Patient Involvement: Most of the study participants (55%) were younger than 35 and their average age was 30. The majority of the participants have an associate degree or higher education. Method: The study used a 4-part survey form as the data collection tool. The sample in this study consisted of 399 participants. To analyze the obtained data, Structural Equation Modeling was used by employing the Smart PLS3 software. Results: The results of the study show that the patient–physician relationship positively affects the patient’s compliance with the treatment and shared decision-making. In addition, shared decision-making positively affects the patient’s compliance with the treatment. The effect of the patient–physician relationship on compliance with treatment was strengthened through shared decision-making. Discussion: The results of the study revealed that patient–physician relationship and shared decision-making are two important factors in patients’ compliance with the treatment. Accordingly, the stronger the patient–physician relationship and the more patients participate in their treatment decisions, the higher their compliance with the treatment.
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Affiliation(s)
- Serkan Deniz
- Thermal Vocational School, Yalova University, Yalova, Turkey
| | - Mahmut Akbolat
- Business Faculty, Department of Healthcare Management, Sakarya University, Sakarya, Turkey
| | - Mesut Çimen
- Department of Healthcare Management, Acibadem Mehmet Ali Aydinlar University, İstanbul, Turkey
| | - Özgün Ünal
- Business Faculty, Department of Healthcare Management, Sakarya University, Sakarya, Turkey
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