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Taiwong A, Uppor W, Vibulchai N. Concordance in the healthcare context: A concept analysis. BELITUNG NURSING JOURNAL 2024; 10:252-260. [PMID: 38947301 PMCID: PMC11211742 DOI: 10.33546/bnj.3343] [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: 03/17/2024] [Revised: 04/21/2024] [Accepted: 05/18/2024] [Indexed: 07/02/2024] Open
Abstract
Background The concept of concordance and its usage are indicative of patient-centered healthcare, which encourages an equitable collaboration between patients and clinicians. However, there is a lack of clarity in understanding concordance, and an analysis of this concept is warranted. Objective This paper seeks to explore the essence of the concordance concept in the healthcare context. Methods Walker and Avant's eight-step method of concept analysis was applied. A literature search was conducted using concordance AND concord as keywords on CINAHL, MEDLINE, PubMed, ProQuest, Cochrane database, and ScienceDirect databases, published between 2006 and 2022. Results The attributes of concordance include communication process, therapeutic partnership, and agreement on treatment regimens. Antecedents of concordance comprise provider-patient relationship, patients' beliefs, healthcare providers' characteristics, and complexity of treatment plans. Consequences are improved adherence and compliance, improved clinical outcomes, and better quality of life. Conclusion This paper offers clarification of concordance by presenting its antecedents, attributes, and consequences. The findings serve as a basis for developing assessments and nursing interventions to promote patient concordance. Nurses can use the findings to encourage concordance by establishing a trusty relationship during health encounters that respects patients' beliefs and effectively communicating to improve patients' understanding in dealing with complex treatment plans.
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Affiliation(s)
- Anucha Taiwong
- Srimahasarakham Nursing College, Faculty of Nursing, Praboromarajchanok Institute, Thailand
| | - Wassana Uppor
- Boromarajonani College of Nursing, Suphanburi, Faculty of Nursing, Praboromarajchanok Institute, Thailand
| | - Nisakorn Vibulchai
- Boromarajonani College of Nursing, Nakhon Ratchasima, Faculty of Nursing, Praboromarajchanok Institute, Thailand
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Heywood-Everett S, Henderson R, Webb C, Bland AR. Psychosocial factors impacting community-based pressure ulcer prevention: A systematic review. Int J Nurs Stud 2023; 146:104561. [PMID: 37542960 DOI: 10.1016/j.ijnurstu.2023.104561] [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: 11/07/2022] [Revised: 06/21/2023] [Accepted: 06/28/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND Pressure ulcers are a major health concern. They have a significant impact on the healthcare system and individuals, reducing quality of life across several domains. In community settings, self-management behaviours are central to their prevention. However, adherence with pressure ulcer prevention guidelines remains low, with little evidence guiding the relationship between patients and healthcare professionals to establish a concordant partnership. OBJECTIVE To synthesise evidence on factors contributing to community-based pressure ulcer prevention using the Theoretical Domains Framework and the Capability, Opportunity, Motivation, Behaviour (COM-B) model of behaviour. DESIGN Mixed methods systematic review and narrative synthesis. METHOD Systematic searches were conducted in the CINAHL, Cochrane, EMBASE, PsycINFO, PubMed, Scopus, and Web of Science databases on 14th December 2022. Studies were eligible if they contained data on the factors associated with adherence and concordance with pressure ulcer prevention guidelines in the community for patients, caregivers, and healthcare professionals. Methodological quality was assessed using the Hawker tool. Findings were synthesised using the Theoretical Domains Framework. The resulting themes were mapped onto the Capability, Opportunity, Motivation, Behaviour (COM-B) model. RESULTS Thirty studies were included in the review, including quantitative, qualitative, and mixed methods research. The synthesis identified 12 of the 14 Theoretical Domains Framework domains, with knowledge, social influences, beliefs about consequences, and beliefs about capabilities the most prevalent. Although knowledge appears to be an important contributor to adherence with prevention guidelines, knowledge alone does not appear sufficient to achieve concordance. A concordant relationship was facilitated by healthcare professionals' knowledge, motivation to work alongside patients and their priorities, and interpersonal skills to build rapport and trust, whilst barriers included lack of healthcare professional skills to navigate sensitive issues, paternalistic views of patient compliance and organisational processes that impact building rapport. CONCLUSIONS Several psychosocial factors may affect the ability to achieve concordance between individuals, caregivers and healthcare professionals with pressure ulcer prevention guidelines in the community. However, data regarding the efficacy of behaviour change interventions targeting these constructs is limited, with further research required to guide intervention development in this area.
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Affiliation(s)
- Suzanne Heywood-Everett
- Primary Care Wellbeing Service, Bradford District Care NHS Foundation Trust, Shipley BD18 3LD, UK.
| | - Rebecca Henderson
- Department of Psychology, Manchester Metropolitan University, Manchester M15 6BH, UK
| | - Claire Webb
- Primary Care Wellbeing Service, Bradford District Care NHS Foundation Trust, Shipley BD18 3LD, UK
| | - Amy R Bland
- Department of Psychology, Manchester Metropolitan University, Manchester M15 6BH, UK
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Trimarco V, Izzo R, Mone P, Lembo M, Manzi MV, Pacella D, Falco A, Gallo P, Esposito G, Morisco C, Santulli G, Trimarco B. Therapeutic concordance improves blood pressure control in patients with resistant hypertension. Pharmacol Res 2023; 187:106557. [PMID: 36402254 PMCID: PMC9943685 DOI: 10.1016/j.phrs.2022.106557] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/10/2022] [Accepted: 11/15/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION An empathetic approach may be particularly useful in patients with therapy-resistant hypertension (TRH), defined as the failure to achieve target blood pressure (BP) despite a maximal doses of 3 antihypertensive drugs including a diuretic. However, the effects of therapeutic concordance have not been determined in hypertensive patients. METHODS We designed a study to explore the impact of therapeutic concordance in patients with TRH, who were included in an intervention arm based on a protocol in which trained personnel periodically verified the pharmacological regimen of these patients. RESULTS From a cohort of 5331 hypertensive patients followed-up for 77.64 ± 34.44 months, 886 subjects were found to have TRH; of these, 322 had apparent TRH (aTRH: uncontrolled office BP but optimal home BP) and 285 refused to participate in a second follow-up study, yielding a population of 279 patients with true TRH (tTRH). These tTRH patients were followed according to the therapeutic concordance protocol for 91.91 ± 54.7 months, revealing that 210 patients (75.27%) remained with uncontrolled BP (uncontrolled tTRH, Group I) while 69 patients (24.73%) reached an optimal BP control (average BP <140/90 mmHg in at least 50% of follow-up visits, Group II). Strikingly, at the end of the second follow-up, the percentage of patients displaying a decline in kidney function was significantly smaller in Group II than in Group I (8.5% vs 23.4%, p < 0.012). CONCLUSIONS Taken together, our findings indicate for the first time that therapeutic concordance significantly improves the outcome of antihypertensive treatment in a population of patients with TRH.
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Affiliation(s)
- Valentina Trimarco
- Department of Neuroscience, Reproductive Sciences and Dentistry, “Federico II” University, Naples, Italy
| | - Raffaele Izzo
- Department of Advanced Biomedical Sciences, “Federico II” University, Naples, Italy
| | - Pasquale Mone
- Department of Medicine, Division of Cardiology, Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, New York City, NY, USA
| | - Maria Lembo
- Department of Advanced Biomedical Sciences, “Federico II” University, Naples, Italy
| | - Maria Virginia Manzi
- Department of Advanced Biomedical Sciences, “Federico II” University, Naples, Italy
| | - Daniela Pacella
- Department of Public Health, “Federico II” University, Naples, Italy
| | - Angela Falco
- Department of Neuroscience, Reproductive Sciences and Dentistry, “Federico II” University, Naples, Italy
| | - Paola Gallo
- Department of Advanced Biomedical Sciences, “Federico II” University, Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, “Federico II” University, Naples, Italy
| | - Carmine Morisco
- Department of Advanced Biomedical Sciences, “Federico II” University, Naples, Italy,International Translational Research and Medical Education (ITME) Consortium, Naples, Italy
| | - Gaetano Santulli
- Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy; Department of Medicine, Division of Cardiology, Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, New York City, NY, USA; International Translational Research and Medical Education (ITME) Consortium, Naples, Italy; Department of Molecular Pharmacology, Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York City, NY, USA.
| | - Bruno Trimarco
- Department of Advanced Biomedical Sciences, “Federico II” University, Naples, Italy,International Translational Research and Medical Education (ITME) Consortium, Naples, Italy
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Understanding the impact and causes of 'failure to attend' on continuity of care for patients with chronic conditions. PLoS One 2021; 16:e0247914. [PMID: 33651826 PMCID: PMC7924779 DOI: 10.1371/journal.pone.0247914] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 02/16/2021] [Indexed: 11/20/2022] Open
Abstract
Aim To understand the impact and causes of ‘Failure to Attend’ (FTA) labelling, of patients with chronic conditions. Background Nurse navigators are registered nurses employed by public hospitals in Queensland, Australia, to coordinate the care of patients with multiple chronic conditions, who frequently miss hospital appointments. The role of the nurse navigator is to improve care management of these patients. Evidence for this is measured through improvement in patient self-management of their conditions, a reduction in preventable hospital admissions and compliance with attendance at outpatient clinics. Failure to attend (FTA) is one measure of hospital utilisation, identifying outpatient appointments that are cancelled or not attended. Method The cohort for this study was patients with multiple chronic conditions, and nurse navigators coordinating their care. Data describing the concept of FTA were thematically analysed twelve months into this three year evaluation. Results Although the patient is blamed for failing to attend appointments, the reasons appear to be a mixture of systems error/miscommunication between the patient and the health services or social reasons impacting on patient’s capacity to attend. Themes emerging from the data were: access barriers; failure to recognise personal stigma of FTA; and bridging the gap. Conclusion The nurse navigators demonstrate their pivotal role in engaging with outpatient services to reduce FTAs whilst helping patients to become confident in dealing with multiple appointments. There are many reasons why a patient is unable to attend a scheduled appointment. The phrase ‘Failure to Attend’ has distinctly negative connotations and can lead to a sense of blame and shame for those with complex chronic needs. We propose the use of the neutral phrase “appointment did not proceed” to replace FTA. Implications for Nursing management This article advocates for further consideration of collaborative models that engage the patient in their care journey and for consideration of the language used within the outpatient acute hospital setting, proposing the term ‘appointment did not proceed.’
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Foley L, Avramidis P, Randall S. New to the community setting: nurses' experiences and the importance of orientation. Aust J Prim Health 2021; 27:50-56. [PMID: 33352086 DOI: 10.1071/py20129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 10/12/2020] [Indexed: 11/23/2022]
Abstract
There has been little research about the experiences of nurses transitioning into community nursing (CN), despite the growing demand for nurses in this setting and impending shortfall in the nursing workforce in Australia. In this study, nurses from a busy metropolitan CN service were interviewed to explore how they experienced their first months in their new role. The interviews were analysed thematically, with three themes emerging: Adaptation, Focus of Care and Context. Participants detailed their experiences adjusting to new work practices and the community setting, and expanded on their enjoyment from increased autonomy, career goal recognition and rewarding patient relationships and outcomes. The findings of this study are aligned with previous literature about nurses entering the primary healthcare setting from acute care, and particularly highlight the need to individually tailor orientation, preceptorship and ongoing career development programs to each nurse.
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Affiliation(s)
- Linda Foley
- Sydney Local Health District, 155-157 Livingstone Road, Marrickville, NSW 2204, Australia
| | - Panagiota Avramidis
- Sydney Local Health District, 155-157 Livingstone Road, Marrickville, NSW 2204, Australia
| | - Sue Randall
- The University of Sydney Susan Wakil School of Nursing and Midwifery, M03, 88 Mallett Street, Camperdown, NSW 2050, Australia; and Corresponding author.
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Richmond RS, Connolly M. A delineation of self-management and associated concepts. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2020. [DOI: 10.1080/20479700.2020.1810963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Zhang J, Yin C, Li H, Wei W, Gong Y, Tang F. Application of Once-Monthly Self-Reported ACT Questionnaire in Management of Adherence to Inhalers in Outpatients with Asthma. Patient Prefer Adherence 2020; 14:1027-1036. [PMID: 32606619 PMCID: PMC7311206 DOI: 10.2147/ppa.s176683] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 05/26/2020] [Indexed: 01/22/2023] Open
Abstract
PURPOSE Poor medication adherence can negatively affect health outcomes of patients with asthma from medication and significantly increase the healthcare costs. Management of adherence to inhalers remains a challenging topic in the long-term management of patients with asthma. We aim to evaluate the role of asthma control test (ACT) in the management of adherence to inhalers in outpatients with asthma. PATIENTS AND METHODS Six hundred twenty-seven outpatients with asthma admitted to the clinic of respiratory medicine in a tertiary hospital in northwestern China during 2016 to 2019 were randomly divided into observation group (n= 315) and control (n= 312) and received standard inhalant therapy for 6 months and lung function test before and after treatment. The patients in the observation group took ACT questionnaires at the end of each month, while the patients in control only took an ACT at the end of the last month. The 'Test of Adherence to Inhalers' (TAI) questionnaire was used to evaluate the patients' adherence to inhalant therapy. RESULTS All patients completed the study. The ACT scores in the observation group showed a gradual increase month by month. The TAI results indicated that adherence to inhalers of patients in the observation group was significantly better than that in control and the patients' non-adherence pattern in the observation group, with significantly lower erratic non-adherence, was also different from that in control. After 6 months of treatment, the lung function indexes and their relative improvement and the ACT scores in the observation group were significantly better or higher than those in control. CONCLUSION The once-monthly self-reported ACT can effectively improve the adherence to inhalers of outpatients with asthma mainly by addressing erratic non-adherence and improve the treatment effects, and thus deserves widespread use in the treatment adherence management in patients with asthma.
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Affiliation(s)
- Jing Zhang
- Department of Clinical Pharmacy, School of Pharmacy, Zunyi Medical University, Zunyi563006, People’s Republic of China
- Department of Respiratory Medicine, Central Hospital in Jinchang City (Worker’s Hospital of Jinchuan Group), Jinchang737102, People’s Republic of China
| | - Chengchen Yin
- Department of Clinical Pharmacy, School of Pharmacy, Zunyi Medical University, Zunyi563006, People’s Republic of China
- The Key Laboratory of Clinical Pharmacy in Zunyi City, Zunyi Medical University, Zunyi563006, People’s Republic of China
- Key Laboratory of Basic Pharmacology of Ministry of Education and Joint International Research Laboratory of Ethnomedicine of Ministry of Education, Zunyi Medical University, Zunyi563006, People’s Republic of China
| | - Hongfang Li
- Department of Clinical Pharmacy, School of Pharmacy, Zunyi Medical University, Zunyi563006, People’s Republic of China
- The Key Laboratory of Clinical Pharmacy in Zunyi City, Zunyi Medical University, Zunyi563006, People’s Republic of China
- Key Laboratory of Basic Pharmacology of Ministry of Education and Joint International Research Laboratory of Ethnomedicine of Ministry of Education, Zunyi Medical University, Zunyi563006, People’s Republic of China
| | - Weipeng Wei
- Department of Clinical Pharmacy, School of Pharmacy, Zunyi Medical University, Zunyi563006, People’s Republic of China
- The Key Laboratory of Clinical Pharmacy in Zunyi City, Zunyi Medical University, Zunyi563006, People’s Republic of China
- Key Laboratory of Basic Pharmacology of Ministry of Education and Joint International Research Laboratory of Ethnomedicine of Ministry of Education, Zunyi Medical University, Zunyi563006, People’s Republic of China
| | - Yuansha Gong
- School of Nursing, Zunyi Medical University, Zunyi563006, People’s Republic of China
| | - Fushan Tang
- Department of Clinical Pharmacy, School of Pharmacy, Zunyi Medical University, Zunyi563006, People’s Republic of China
- The Key Laboratory of Clinical Pharmacy in Zunyi City, Zunyi Medical University, Zunyi563006, People’s Republic of China
- Key Laboratory of Basic Pharmacology of Ministry of Education and Joint International Research Laboratory of Ethnomedicine of Ministry of Education, Zunyi Medical University, Zunyi563006, People’s Republic of China
- Correspondence: Fushan Tang Department of Clinical Pharmacy School of Pharmacy, Zunyi Medical University, Zunyi563006, People’s Republic of ChinaTel +86 851 2864 2337Fax +86 851 2864 2334 Email
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Becker RM, Heidemann ITSB. HEALTH PROMOTION IN CARE FOR PEOPLE WITH CHRONIC NON-TRANSMITABLE DISEASE: INTEGRATIVE REVIEW. TEXTO & CONTEXTO ENFERMAGEM 2020. [DOI: 10.1590/1980-265x-tce-2018-0250] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: to analyze the health promotion practices developed by nurses in the care of people with non-transmittable chronic disease in primary health care, in scientific publications, between 2007 and 2017. Method: an integrative literature review of a qualitative approach, conducted in five databases, in which was read and critical analysis of the studies in order to know the practices of health promotion. Results: 40 articles were selected and organized according to the fields of the Ottawa Charter: public policies, reorientation of health services, creation of personal skills, reinforcement of community action and favorable environments. Thus, most of the experiments were mainly related to two fields of action: development of personal skills and reorientation of the health system. There is a movement towards the development of a health promotion in which the collective, the social determinants of health and multidisciplinarity are advocated. Conclusion: some limits were identified that need to be overcome, among which stands out the inter-sectoral work that needs to grow beyond the health sector.
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Fu Y, McNichol E, Marczewski K, José Closs S. The Management of Chronic Back Pain in Primary Care Settings: Exploring Perceived Facilitators and Barriers to the Development of Patient-Professional Partnerships. QUALITATIVE HEALTH RESEARCH 2018; 28:1462-1473. [PMID: 29683041 DOI: 10.1177/1049732318768229] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Supporting patients in forming partnerships with health professionals is the key of effective self-management. This study aimed to explore the nature of patient-professional partnerships and its related factors that create facilitators and barriers to patients' self-management ability. A constructivist grounded theory approach was undertaken. Three main themes emerged: interaction and communication, integrated care, and service and system. A theoretical model was generated that posits effective communication, individualized integrated care, and high-quality service as key influences on the successful development of patient-professional partnerships and patients' ability to self-manage. Giving attention to these factors helps understand the development, implementation, mechanisms, and evaluation of building a patient-professional partnership and maximizes the opportunities for patient self-management of chronic pain. Future research and practice are needed to move beyond a simplistic focus on health outcomes to address the complex links between partnerships and treatment delivery processes, and interventions, effects, and patients' context.
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Affiliation(s)
- Y Fu
- 1 University of Leeds, Leeds, United Kingdom
| | - E McNichol
- 1 University of Leeds, Leeds, United Kingdom
| | - K Marczewski
- 2 Leeds Community Healthcare NHS Trust, Leeds, United Kingdom
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