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Rudilla D, Alonso T, García E, Pérez P, Valenzuela C, Girón R, Zamora E, Soriano J, Landete P, Ancochea J. Psychometric Validation of the Patient-Reported Experience Measure (PREM) Questionnaire "HowRwe" in Patients With Respiratory Disease Receiving Home Respiratory Therapies. OPEN RESPIRATORY ARCHIVES 2024; 6:100304. [PMID: 38496265 PMCID: PMC10943053 DOI: 10.1016/j.opresp.2024.100304] [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: 12/27/2023] [Accepted: 01/28/2024] [Indexed: 03/19/2024] Open
Abstract
Introduction The patient experience is defined as all the interactions that occur between patients and the healthcare system. The experience of patients with respiratory disease with home respiratory treatments (HRT) is not captured in currently available Patient-Reported Outcome Measures (PROM). We present the psychometric validation of the Patient-Reported Experience Measure (PREM) 'HowRwe' in Spanish and for respiratory patients with HRT. Methods After translation following ISPOR guidelines (International Society for Pharmacoeconomics and Outcomes Research), the questionnaire was administered to adult respiratory patients who were receiving treatment at Hospital Universitario de La Princesa. The administration was done in two stages with 6 months of difference between the pre- and post-test. Results We studied 228 respiratory patients, with a mean (SD) age of 64.1 (13.2) years, 52.2% were men, 68.0% were married or coupled, and 56.6% were retired. Reliability coefficients of the scale were adequate, with α = .921 and Ω = .929 for pre-test, and α = .940 and Ω = .958 for post. The confirmatory factor analysis tested for pre- and post-intervention, showed an excellent overall fit: χ2(2) = 49.380 (p < .001), CFI = .941 and SRMR = .072; and χ2(2) = 37.579 (p < .001), CFI = .982 and SRMR = .046, respectively. No statistically significant associations were observed for neither age, adherence nor quality of life, except between HowRwe post-test and quality of life pre-test (r = .14 [.01,.26]; p = .035). No significant differences were found in sociodemographic variables. No differences in pre-test or post-test were found in effect of HRT. 85.6% of patients found the content of HowRwe "Useful", and the preferred channel to respond it were paper, app and email. Conclusions The Spanish version of the 'HowRwe' questionnaire to measure the experience in respiratory patients with home respiratory treatments (HRT), has adequate psychometric properties and conceptual and semantic equivalence with the original English version.
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Affiliation(s)
- David Rudilla
- Air Liquide Healthcare, Spain
- Hospital Universitario de La Princesa, Spain
| | | | | | | | | | - Rosa Girón
- Hospital Universitario de La Princesa, Spain
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Valadares Tavares L, Arruda P. Public contracting of home respiratory care services through an electronic quasi-market model. Int J Health Plann Manage 2022; 37:3344-3356. [PMID: 36002931 DOI: 10.1002/hpm.3561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/14/2022] [Accepted: 08/02/2022] [Indexed: 11/10/2022] Open
Abstract
Respiratory diseases are becoming a major challenge in health systems as they cover expanding and diversified pathologies such as chronic obstructive pulmonary disease, chronic bronchitis, emphysema and other types increasing at a fast rate as it is the case of sleep apnoea. Nowadays, most of these pathologies can be treated by home respiratory care services using advanced medical equipment as well as efficient assistance and monitoring services supported by digital technologies. However, the implementation of home respiratory care services implies flexible public contracting of such services to achieve equity conditions of access and to cope with their technological nature, their continuous processes of innovation and their time dependent demand. Unfortunately, traditional procurement processes are not able to meet these challenges explaining their frequent low rates of success and so an alternative procurement approach is proposed in this paper based on an electronic quasi-market model. This new model was successfully applied in Portugal and the evaluated results are also discussed herein.
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Affiliation(s)
- Luís Valadares Tavares
- Centro de Investigação em Organizações, Mercados e Gestão Industrial, University Lusiada, Lisbon, Portugal
| | - Pedro Arruda
- Instituto Superior Técnico, University of Lisbon, Lisbon, Portugal
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Caneiras C, Jácome C, Oliveira D, Moreira E, Dias CC, Mendonça L, Mayoralas-Alises S, Fonseca JA, Diaz-Lobato S, Escarrabill J, Winck JC. The Portuguese Model of Home Respiratory Care: Healthcare Professionals' Perspective. Healthcare (Basel) 2021; 9:1523. [PMID: 34828569 PMCID: PMC8623333 DOI: 10.3390/healthcare9111523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 11/07/2021] [Accepted: 11/08/2021] [Indexed: 11/16/2022] Open
Abstract
Patients' and carers' views regarding the Portuguese model of home respiratory care were recently described, yet the complementary perspective of healthcare professionals (HCPs) is still to be investigated. Thus, this study explored HCPs experience in the management of patients needing home respiratory therapies (HRT), and their perspective about the Portuguese model. A phenomenological descriptive study, using focus groups, was carried out with 28 HCPs (median 42 y, 68% female) with distinct backgrounds (57% pulmonologists, 29% clinical physiologists, 7% physiotherapists, 7% nurses). Three focus groups were conducted in three regions of Portugal. Thematic analysis was performed by two independent researchers. HCPs have in general a positive view about the organization of the Portuguese model of home respiratory care, which was revealed in four major topics: Prescription (number of references, n = 171), Implementation and maintenance (n = 162), Carer involvement (n = 65) and Quality of healthcare (n = 247). Improvements needed were related to patients' late referral, HRT prescription (usability of the medical electronic prescription system and renewals burden), patients' education, access to hospital care team, lack of multidisciplinary work and articulation between hospital, primary and home care teams. This study describes the perspective of HCPs about the Portuguese model of home respiratory care and identifies specific points where improvements and reflections are needed. This knowledge may be useful to decision makers improve the current healthcare model.
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Affiliation(s)
- Cátia Caneiras
- Microbiology Research Laboratory on Environmental Health (EnviHealthMicro Lab), Institute of Environmental Health (ISAMB), Faculty of Medicine, University of Lisbon, 1649-028 Lisbon, Portugal
- Institute for Preventive Medicine and Public Health, Faculty of Medicine, University of Lisbon, 1649-028 Lisbon, Portugal
- Healthcare Department, Nippon Gases Portugal, 2600-242 Vila Franca de Xira, Portugal
| | - Cristina Jácome
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; (C.J.); (D.O.); (E.M.); (C.C.D.); (L.M.); (J.A.F.)
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
| | - Daniela Oliveira
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; (C.J.); (D.O.); (E.M.); (C.C.D.); (L.M.); (J.A.F.)
- Department of Medicine, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
- Rheumatology Department, Centro Hospitalar Universitário São João (CHUSJ), 4200-319 Porto, Portugal
| | - Emília Moreira
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; (C.J.); (D.O.); (E.M.); (C.C.D.); (L.M.); (J.A.F.)
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
| | - Cláudia Camila Dias
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; (C.J.); (D.O.); (E.M.); (C.C.D.); (L.M.); (J.A.F.)
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
| | - Liliane Mendonça
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; (C.J.); (D.O.); (E.M.); (C.C.D.); (L.M.); (J.A.F.)
| | | | - João Almeida Fonseca
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; (C.J.); (D.O.); (E.M.); (C.C.D.); (L.M.); (J.A.F.)
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
- Allergy Unit, Instituto and Hospital CUF Porto, 4460-188 Matosinhos, Portugal
| | - Salvador Diaz-Lobato
- Healthcare Department, Nippon Gases Spain, 28020 Madrid, Spain;
- Service of Pneumology, Hospital Universitario Moncloa, 28008 Madrid, Spain
| | - Joan Escarrabill
- Programa de Atención a la Cronicidad, Hospital Clínic de Barcelona, 08036 Barcelona, Spain;
- Master Plan for Respiratory Diseases (Ministry of Health) & Observatory of Home Respiratory Therapies (FORES), 08028 Barcelona, Spain
- REDISSEC Health Services Research on Chronic Patients Network, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - João Carlos Winck
- Department of Medicine, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
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Caneiras C, Jácome C, Moreira E, Oliveira D, Dias CC, Mendonça L, Mayoralas-Alises S, Fonseca JA, Diaz-Lobato S, Escarrabill J, Winck JC. A qualitative study of patient and carer experiences with home respiratory therapies: Long-term oxygen therapy and home mechanical ventilation. Pulmonology 2021; 28:268-275. [PMID: 34246616 DOI: 10.1016/j.pulmoe.2021.05.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/21/2021] [Accepted: 05/24/2021] [Indexed: 11/25/2022] Open
Abstract
Studies exploring the experience of patients receiving home respiratory therapies (HRT), such as long-term oxygen therapy (LTOT) and home mechanical ventilation (HMV), are still limited. This study focused on patients' and carers' experience with LTOT and HMV. An exploratory, cross-sectional qualitative study, using semi-structured focus groups, was carried out with 18 patients receiving HRT (median 71y, 78% male, 56% on both LTOT and HMV) and 6 carers (median age 67y, 67% female). Three focus groups were conducted in three regions of Portugal. Thematic analysis was performed by two independent researchers. Patients' and carers' experience was reflected in seven major topics, linked to specific time points and settings of the treatment: Initial symptoms/circumstances (n = 41), Prescription (n = 232), Implementation (n = 184), Carer involvement (n = 34), Quality of life impact (n = 301), Health care support/navigability (n = 173) and Suggestions (n = 14). Our findings demonstrate a general good perception of the HRT by patients and carers recognizing a significative quality of life impact improvement, while identifying specific points where improvements in healthcare are needed, particularly about navigability issues, articulation between the hospital, primary care and homecare teams, especially regardingprescriptionrenewal. This knowledge is crucial to promote a long-term HRT adherence and to optimize HRT delivery in line with patients' experience, needs, and values. Moreover, these key points can inform the development of a specific patient-reported experience measure (PREM) for patients on HRT, which is not currently available, and foster a more integrated respiratory care model.
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Affiliation(s)
- Cátia Caneiras
- Microbiology Research Laboratory on Environmental Health (EnviHealthMicroLab), Faculty of Medicine, Institute of Environmental Health (ISAMB), University of Lisbon, 1649-028 Lisbon, Portugal; Institute for Preventive Medicine and Public Health, Faculty of Medicine, University of Lisbon, 1649-028 Lisbon, Portugal; Healthcare Department, Nippon Gases Portugal, 2600-242 Vila Franca de Xira, Portugal.
| | - Cristina Jácome
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Emília Moreira
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Daniela Oliveira
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; Rheumatology Department, University Hospital Center of São João (CHUSJ), Porto, Portugal.
| | - Cláudia Camila Dias
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Liliane Mendonça
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
| | | | - João Almeida Fonseca
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal; Allergy Unit, CUF Institute and Hospital, 4460-188 Porto, Portugal
| | - Salvador Diaz-Lobato
- Healthcare Department, Nippon Gases Spain, 28020 Madrid, Spain; Service of Pneumology, University Hospital of Moncloa, 28008 Madrid, Spain
| | - Joan Escarrabill
- Hospital Clinic of Barcelona, 08036 Barcelona, Spain; Master Plan for Respiratory Diseases (Ministry of Health) & Observatory of Home Respiratory Therapies (FORES), 08028 Barcelona, Spain; REDISSEC Health Services Research on Chronic Patients Network, Instituto de Salud Carlos III, 28029 Madrid, Spain.
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Freitas C, Serino M, Araújo D, Pinto T, Van Zeller M, Gonçalves M, Drummond M. Long-term home non-invasive ventilation in chronic hypercapnic chronic obstructive pulmonary disease patients: Real-world impact on lung function, acute exacerbations and survival. CLINICAL RESPIRATORY JOURNAL 2021; 15:1130-1138. [PMID: 34224645 DOI: 10.1111/crj.13419] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/18/2021] [Accepted: 06/30/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Although long-term home non-invasive ventilation (H-NIV) has been used among chronic hypercapnic COPD patients, its clinical benefit is still on debate. We aim to assess the impact of H-NIV in chronic hypercapnic COPD patients. METHODS COPD patients who initiated H-NIV between January 2010 and December 2017 were included. Patients with concomitant respiratory disorders were excluded. Acute exacerbation (AE) before and 2 years after H-NIV initiation was assessed as main outcome. Secondary outcomes included lung function and gas exchange parameters. Survival since H-NIV initiation was determined, and factors related with survival were explored. RESULTS Seventy-two patients were enrolled. A decrease in partial pressure of carbon dioxide (PaCO2 ) in arterial blood (p < 0.001) and an improvement of partial pressure of oxygen (PaO2 ) (p < 0.001) were achieved using a high-intensity H-NIV. Regarding lung function, residual volume (RV) reduced (p = 0.010) and forced-expiratory volume in 1 s (FEV1 ) improved (p = 0.043) after H-NIV initiation. No significant differences in 6-min walking test (6MWT) were found. Compared with the year before H-NIV initiation, the number of AE diminished in the first and in the second years of follow-up (p < 0.001). The median survival was 79.0 months (95% confidence interval [CI], 52.9-105.1), and the covered distance in 6MWT predicted survival (hazard ratio [HR] = 0.026, p = 0.003) in the multivariate analysis. CONCLUSIONS High-intensity H-NIV significantly improved FEV1 and hyperinflation, decreased frequency of AEs and led to a remarkable median survival, which was independently predicted by the walking distance in 6MWT.
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Affiliation(s)
- Cláudia Freitas
- Pulmonology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal
| | - Mariana Serino
- Pulmonology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - David Araújo
- Pulmonology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Tiago Pinto
- Sleep and Non-invasive Ventilation Unit, Centro Hospitalar e Universitário de São João, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal
| | - Mafalda Van Zeller
- Sleep and Non-invasive Ventilation Unit, Centro Hospitalar e Universitário de São João, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal.,i3S - Institute for Research and Innovation in Health/Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Porto, Portugal
| | - Miguel Gonçalves
- Pulmonology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal.,Sleep and Non-invasive Ventilation Unit, Centro Hospitalar e Universitário de São João, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal.,i3S - Institute for Research and Innovation in Health/Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Porto, Portugal.,Intensive Care Medicine Department, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - Marta Drummond
- Sleep and Non-invasive Ventilation Unit, Centro Hospitalar e Universitário de São João, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal.,i3S - Institute for Research and Innovation in Health/Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Porto, Portugal
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Medical Electronic Prescription for Home Respiratory Care Services (PEM-CRD) at a Portuguese University Tertiary Care Centre (2014–2018): A Case Study. SUSTAINABILITY 2020. [DOI: 10.3390/su12239859] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Home respiratory care (HRC) is the provision of healthcare services at the place of residence of patients or their families, with the aim of meeting needs mainly resulting from chronic respiratory conditions, permanent disability, or terminal illness. In 2016, an innovative electronic prescription system, PEM-CRD, was fully implemented for HRC services in Portugal. To date, no study has addressed the impact of the execution of this digital innovation. For this purpose, we carried out an analysis of the prevalence and number of prescriptions for people with chronic respiratory diseases receiving HRC in the Lisbon metropolitan area, during 2014–2018, using the information obtained from the PEM-CRD database. The data analysis shows that while the number of patients receiving HRC treatment with a prescription has remained stable over the last four years, the number of prescriptions has significantly dropped since 2016 (2016–2018), with consequent paper and processes efficiency. The implementation of the digital Medical Electronic Prescription for Home Respiratory Care tool (PEM-CRD) and consequent dematerialization of these processes has increased the efficiency of prescribing in HRC. Additionally, the possibility of obtaining data through the PEM-CRD allows the monitoring of the evolving prevalence of therapies, improving the health services optimization and allowing reporting on data other than medicines.
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