The Andersen–Newman Behavioral Model of Health Service Use as a conceptual basis for understanding patient behavior within the patient–physician dyad: The influence of trust on adherence to statins in older people living with HIV and cardiovascular disease

Trust in healthcare professionals of people with chronic cardiovascular disease

BACKGROUND

Trust is an essential phenomenon of relationship between patients and healthcare professionals and can be described as an accepted vulnerability to the power of another person over something that one cares about in virtue of goodwill toward the trustor. This characterization of interpersonal trust appears to be adequate for patients suffering from chronic illness. Trust is especially important in the context of chronic cardiovascular diseases as one of the main global health problems.

RESEARCH AIM

The purpose of the qualitative study was to gain a deeper understanding of how people with chronic cardiovascular disease experience and make sense of trust in healthcare professionals.

RESEARCH DESIGN

Eleven semi-structured interviews with participants analysed using interpretative phenomenological analysis to explore in detail their lived experience of trust as a relational phenomenon.

PARTICIPANTS AND RESEARCH CONTEXT

Participants with chronic cardiovascular disease were purposively recruited from inpatients on the cardiology ward of the university hospital located in central Slovakia.

ETHICAL CONSIDERATIONS

The study was approved by the faculty ethics committee. Participants gave their written informed consent.

FINDINGS FOUR INTERRELATED GROUP EXPERIENTIAL THEMES

Sense of co-existence; Belief in competence; Will to help; Ontological security with eight subthemes were identified. The findings describe the participants' experience with trust in healthcare professionals as a phenomenon of close co-existence, which is rooted in the participants' vulnerability and dependence on the goodwill and competence of health professionals to help with the consequence of (re)establishing a sense of ontological security in the situation of chronic illness.

CONCLUSION

Findings will contribute to an in-depth understanding of trust as an existential dimension of human co-existence and an ethical requirement of healthcare practice, inspire patient empowerment interventions, support adherence to treatment, and person-centred care.

Primary healthcare service delivery for older people with progressive multimorbidity in low- and middle-income countries: a systematic review

Ensuring primary healthcare (PHC) accessibility to older people with multimorbidity is vital in preventing unnecessary health deterioration. However, older people ≥50 y of age in low- and middle-income countries (LMICs) face challenges in effectively accessing and utilizing PHC. A systematic review was conducted adopting the Andersen-Newman theoretical framework for health services utilization to assess evidence on factors that affect access to PHC by older people. This framework predicts that a series of factors (predisposing, enabling and need factors) influence the utilization of health services by people in general. Seven publications were identified and a narrative analytical method revealed limited research in this area. Facilitating factors included family support, closeness to the PHC facility, friendly service providers and improved functional status of the older people. Barriers included long distance and disjointed PHC services, fewer health professionals and a lack of person-centred care. The following needs were identified: increasing the number of health professionals, provision of PHC services under one roof and regular screening services. There is a need for more investment in infrastructure development, coordination of service delivery and capacity building of service providers in LMICs to improve access and utilization of PHC services for older people.

Patient initiated radiology requests: proof of wellness through images

BACKGROUND

Traditionally, general practitioners (GPs) have initiated the need for, and ordered, radiological tests. With the emergence of consumer-centred care, patients have started to request scans from doctors on their own initiative. Consumeristic health care has shifted the patient-doctor dyadic relationship, with GPs trending towards accommodating patients' requests.

METHODS

A mixed method analysis was conducted using a survey instrument with open ended questions and concurrent interviews to explore participants' responses from their requests for radiological studies from GPs. Themes emerging from both qualitative and quantitative methodologies were mapped onto the Andersen Newman Model (ANM).

RESULTS

Data were analysed for 'predisposing,' 'need' and 'enabling' elements of the ANM model and were correspondingly mapped to patient's requests for radiological referrals according to the elements of the ANM. Participants expressed anxiety about their health, were confident in the types of radiological scans they desired and typically indicated the need for evidence of good health. Their desire for such requested scans was often enabled through prior exposure to health information and the experience of specific symptoms. Requests came with the expectation of validation, and if these requests were denied, participants indicated that they would seek another doctor who would oblige.

CONCLUSIONS

In our modest study of Australian patients, participants were well informed about their health. Exposure to information seems to create a sense of anxiousness prior to visiting the doctor. Individuals sought visual proof of wellness through imaging, and doctors in return often accommodated patient requests for radiological studies to appease patients' needs and to maintain workflow.

Role of Health Literacy, Social Support, Patient-Physician Relationship, and Health-Related Quality of Life in Predicting Medication Adherence in Cardiovascular Diseases in Oman

Purpose

Cardiovascular diseases (CVDs) remain a global health threat, and medication adherence remains low. Medication adherence is a complex phenomenon and is affected by many factors that require investigation. Oman has limited literature examining medication adherence and influencing factors among patients with CVDs. This study examined the influence of health literacy, social support, the patient-physician relationship, and health-related quality of life on medication adherence among patients with cardiovascular diseases.

Patients and Methods

This cross-sectional study used a correlation design. The study included 360 participants with CVDs. Descriptive statistics, independent t-test, one-way ANOVA, and multiple regression analysis were utilized for data analyses.

Results

Findings revealed that higher social support (B=0.117; p=0.033), good patient-physician relationship (B=0.124; p < 0.01), better mental health (B=0.045; p < 0.01), more bodily pain (B=0.030; p < 0.01), and unemployment (B=1.297; p < 0.01) were predictors of higher adherence. High school education and above predicted lower medication adherence (B= -1.255; p= 0.019), while health literacy was not a significant predictor of medication adherence (B= 0.061; p= 0.289).

Conclusion

To improve medication adherence, healthcare providers and researchers should consider improving patients' social support, mental health, and the patient-physician relationship. In addition, patients' socioeconomic status should always be considered and examined as an influencing factor of medication adherence.

Factors associated with the utilization of community-based health services among older adults in China-an empirical study based on Anderson's health behavior model

Taking the modified Anderson health behavior model as the analysis framework and relying on 1136 empirical research data of S District in Foshan City, Guangdong Province of China, this study explores the influence of predisposing factors, enabling factors and need factors on the utilization of community-based health services among older adults in China. The results show that three variables have a significant impact on the use of family health services, which are whether the pension is the main source of living, income surplus, and major expenditure items. Seven variables have a significant impact on the use of preventive health services, which are household registration type, the basic endowment insurance coverage, the nature of the working unit before retirement, the self-rated health status, chronic diseases, self-care ability in daily life, and preventive health care needs.

Examining the Impact of the Golden Compass Clinical Care Program for Older People with HIV: A Qualitative Study

The combined burden of geriatric conditions, comorbidities, and HIV requires a model of HIV care that offers a comprehensive clinical approach with people 50 years or older with HIV. Golden Compass is an outpatient, multidisciplinary HIV-geriatrics program with an onsite HIV geriatrician, cardiologist, pharmacist, and social worker, offering specialist referrals, care navigation, and classes on improving functional status and cognition. Participants (13 patients and 11 primary care providers) were recruited using a non-probability sampling method to participate in semi-structured interviews on the perceived impact of Golden Compass on care delivered to older people with HIV. Interviews were transcribed verbatim and framework analysis used to analyze the transcripts. The perceived impacts of Golden Compass by patients and providers were organized by the Compass points (Northern: Heart and Mind, Eastern: Bones and Strength, Southern: Navigation and Network, Western: Dental, Hearing, and Vision). Overall, patients valued the focus on functional health and whole-person care, leading to greater trust in the ability of providers. Providers gained new skills through the geriatrics, cardiology and/or pharmacist consultations. The HIV-geriatrics specialty approach of Golden Compass improved functional ability and quality of life for older adults with HIV. Few integrated care programs for older people with HIV have been evaluated. This study adds to the limited literature demonstrating high patient and provider satisfaction with a HIV-care model that incorporated principles of geriatric medicine emphasizing a comprehensive approach to sustaining functional ability and improving quality of life.

Utilization Rates of SGLT2 Inhibitors and GLP-1 Receptor Agonists and Their Facility-Level Variation Among Patients With Atherosclerotic Cardiovascular Disease and Type 2 Diabetes: Insights From the Department of Veterans Affairs

OBJECTIVE

There is mounting evidence regarding the cardiovascular benefits of sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1 RA) among patients with atherosclerotic cardiovascular disease (ASCVD) and type 2 diabetes mellitus (T2DM). There is paucity of data assessing real-world practice patterns for these drug classes. We aimed to assess utilization rates of these drug classes and facility-level variation in their use.

RESEARCH DESIGN AND METHODS

We used the nationwide Veterans Affairs (VA) health care system data set from 1 January 2020 to 31 December 2020 and included patients with established ASCVD and T2DM. Among these patients, we assessed the use of SGLT2i and GLP-1 RA and the facility-level variation in their use. Facility-level variation was computed using median rate ratios (MRR), a measure of likelihood that two random facilities differ in use of SGLT2i and GLP-1 RA in patients with ASCVD and T2DM.

RESULTS

Among 537,980 patients with ASCVD and T2DM across 130 VA facilities, 11.2% of patients received an SGLT2i while 8.0% of patients received a GLP-1 RA. Patients receiving these cardioprotective glucose-lowering drug classes were on average younger and had a higher proportion of non-Hispanic Whites. Overall, median (10th-90th percentile) facility-level rates were 14.92% (9.31-22.50) for SGLT2i and 10.88% (4.44-17.07) for GLP-1 RA. There was significant facility-level variation among SGLT2i use-MRRunadjusted: 1.41 (95% CI 1.35-1.47) and MRRadjusted: 1.55 (95% CI 1.46 -1.63). Similar facility-level variation was observed for use of GLP-1 RA-MRRunadjusted: 1.34 (95% CI 1.29-1.38) and MRRadjusted: 1.78 (95% CI 1.65-1.90).

CONCLUSIONS

Overall utilization rates of SGLT2i and GLP-1 RA among eligible patients are low, with significantly higher residual facility-level variation in the use of these drug classes. Our results suggest opportunities to optimize their use to prevent future adverse cardiovascular events among these patients.

An Adaptable Framework for Factors Contributing to Medication Adherence: Results from a Systematic Review of 102 Conceptual Frameworks

OBJECTIVE

To summarize the available conceptual models for factors contributing to medication adherence based on the World Health Organization (WHO)'s five dimensions of medication adherence via a systematic review, identify the patient groups described in available conceptual models, and present an adaptable conceptual model that describes the factors contributing to medication adherence in the identified patient groups.

METHODS

We searched PubMed®, Embase®, CINAHL®, and PsycINFO® for English language articles published from inception until 31 March 2020. Full-text original publications in English that presented theoretical or conceptual models for factors contributing to medication adherence were included. Studies that presented statistical models were excluded. Two authors independently extracted the data.

RESULTS

We identified 102 conceptual models, and classified the factors contributing to medication adherence using the WHO's five dimensions of medication adherence, namely patient-related, medication-related, condition-related, healthcare system/healthcare provider-related, and socioeconomic factors. Eight patient groups were identified based on age and disease condition. The most universally addressed factors were patient-related factors. Medication-related, condition-related, healthcare system-related, and socioeconomic factors were represented to various extents depending on the patient group. By systematically examining how the WHO's five dimensions of medication adherence were applied differently across the eight different patient groups, we present a conceptual model that can be adapted to summarize the common factors contributing to medication adherence in different patient groups.

CONCLUSION

Our conceptual models can be utilized as a guide for clinicians and researchers in identifying the facilitators and barriers to medication adherence and developing future interventions to improve medication adherence.

PROTOCOL REGISTRATION

PROSPERO Identifier: CRD42020181316.

Healthcare services utilisation among patients with hypertension and diabetes in rural Ghana

BACKGROUND

Non-communicable diseases (NCDs) remain a global burden and is projected to increase due to aging, rapid urbanization and unhealthy lifestyles. The study was conducted to determine the prevalence of hypertension and diabetes in rural districts in the Ashanti region of Ghana and to determine factors that influence utilization of health care services.

SETTING

Offinso North, Amansie West, Ahafo Ano South, and Asante Akim South.

METHODS

A population based prospective cross-sectional study comprising of adults aged 18 years and above was carried out from January 2016 to March 2016. A multistage sampling method was employed to select four rural districts in the Ashanti region of Ghana. A structured questionnaire was used to collect primary data from respondents.

RESULTS

A total of 684 participants were recruited in the study. The prevalence of hypertension and diabetes was found to be 16.23% and 5.41% respectively. The prevalence of diabetes and hypertension comorbidity was 1.61%. The public hospital was the most preferred choice of facility (52.56%) for patients with NCDs.Educational level significantly decreased the likelihood of seeking healthcare in OTCMS and Health Centre to Hospitals (RRR = 0.1, 95% CI = 0.011-0.917, p = 0.042) and (RRR = 0.4, 95% CI = 0.198-0.679, p = 0.001) respectively.

CONCLUSION

The prevalence of self -reported hypertension and diabetes observed in this study was relatively lower for hypertension and higher for diabetes as compared to other studies in Ghana. The public hospital is the most preferred choice of health facilities for patients with hypertension and diabetes in the rural districts.

A Qualitative Exploration of Facilitators for Health Service Use among Aging Gay Men Living with HIV

Using Anderson’s Health Behavioral Model of Health Service Use, this study explores factors facilitating health service use among aging gay men living with HIV. Qualitative data from 10 participants recruited from a federally qualified health center were analyzed using theoretical thematic analysis. Results shown to facilitate health service use include an existing need for services in the form of HIV management; predisposing factors of age and the development of resilience in the face of stigmatizing experiences related to their sexual identity and health status; and enabling influences including comfort with medical providers, providers knowledgeable in lesbian, gay, bisexual, transgender, and queer issues, and sexual concordant providers. Need for services, predisposing factors, and enabling factors are discussed in relation, as well as each factor’s unique implications for this population. Results from this study may be used to improve service use and provides tangible clinical recommendations.

Behavioural Economics and Human Decision Making: Instances from the Health Care System

Over the last two decades behavioural economics has gained much momentum among scholars because of its innovative and controversial ways of explaining processes and mechanisms underpinning individuals' judgements and decision making. Thanks to these features, behavioural economics has been applied to diversified domains, namely finance, public choice and marketing. Although the intrinsic characteristics of the health care sector, ranging from incomplete and asymmetrical information to high frequency of critical choices, make the sector a fertile ground for behavioural economics applications, research on the influences of behavioural economics on health care and clinical decision making are still rather fragmented. Therefore, through an interdisciplinary literature review integrating behavioural economics research with medical and behavioural decision-making studies, this article contributes to behavioural decision-making literature by providing a wide overview of how behavioural economics strategies may impact, and be implemented in, diverse health care circumstances. Examples of behavioural economics applications to health care circumstances include: organ donation and transplantation; habitual choices; individuals' loss aversion and trust; present-biased preference; decision fatigue and excessive choice. Hence, this article aims to promote the effective behaviour of both consumers and providers in health care.

Microfinance Interventions and HIV Treatment Outcomes: A Synthesizing Conceptual Framework and Systematic Review

BACKGROUND

Microfinance interventions have the potential to improve HIV treatment outcomes, but the mechanisms through which they operate are not entirely clear.

OBJECTIVES

To construct a synthesizing conceptual framework for the impact of microfinance interventions on HIV treatment outcomes using evidence from our systematic review.

METHODS

We conducted a systematic review by searching electronic databases and journals from 1996 to 2018 to assess the effects of microfinance interventions on HIV treatment outcomes, including adherence, retention, viral suppression, and CD4 cell count.

RESULTS

All studies in the review showed improved adherence, retention, and viral suppression, but varied in CD4 cell count following participation in microfinance interventions-overall supporting microfinance's positive role in improving HIV treatment outcomes. Our synthesizing conceptual framework identifies potential mechanisms through which microfinance impacts HIV treatment outcomes through hypothesized intermediate outcomes.

CONCLUSION

Greater emphasis should be placed on assessing the effect mechanisms and intermediate behaviors to generate a sound theoretical basis for microfinance interventions.

Analyzing factors enabling colorectal cancer screening adherence in Korean Americans using the Andersen's Behavioral Model of Health Services Utilization

Purpose/objectives: Korean Americans (KAs) report suboptimal colorectal cancer (CRC) screening adherence. This study investigated factors that enable KAs to adhere to CRC screening guidelines using the Andersen's Behavioral Model of Health Services Utilization. Design: Cross-sectional survey using self-reported measures of CRC screening behaviors. Sample and methods: Purposive sampling was used to recruit 433 KAs aged 50-75 from the Atlanta metropolitan area who completed questionnaires measuring predisposing (i.e., gender, age, marital status, and educational attainment), enabling (income, health insurance, regular annual health checkups, doctor's recommendation English proficiency, CRC knowledge, self-efficacy for CRC screening, and decisional balance in CRC screening), and need (family cancer history and self-reported health status) factors associated with CRC screening. Findings: A multiple logistic regression model including all 14 predictor variables revealed that several enabling factors (i.e., income, regular annual health checkups, doctor's recommendation, self-efficacy, and decisional balance) independently predicted increased CRC screening adherence in KAs. No predisposing or need factors independently predicted CRC screening. Conclusions and implications for psychosocial providers or policy: To increase CRC screening adherence among KAs, psychosocial interventions should target on improving their self-efficacy and decisional balance regarding CRC screening, while policy interventions should focus on promoting health providers' CRC screening recommendations during routine health checkups.

Qualitative exploration of why people repeatedly attend emergency departments for alcohol-related reasons

Background

Understanding why people repeatedly attend Emergency Departments (EDs) for alcohol-related reasons is an important prerequisite to identifying ways of reducing any unnecessary demands on hospital resources. We use Andersen’s Behavioural Model of Health Services Use to explore factors that contributed to repeat ED attendances.

Methods

Qualitative interviews were conducted with 30 people who repeatedly attended EDs for alcohol-related reasons (≥10 attendances in the past 12 months). We recruited participants from 6 EDs in London, United Kingdom. Data on socio-demographic characteristics, substance use, contact with specialist addiction and other health services, most recent ED attendance, and previous ED attendances were analysed.

Results

Participants reported long-standing health problems, almost all were unemployed, and many had limited education and unstable housing. Most held positive health beliefs about EDs, despite some negative experiences. They reported limited community resources: poor social support, inaccessible primary care services, dislike or lack of information about specialist addiction services, and difficulties travelling to services. In contrast, EDs offered immediate, sympathetic care and free transport by ambulance. Participants’ perceived need for care was high, with physical injury and pain being the main reasons for ED attendance.

Conclusions

Push’ and ‘pull’ factors contributed to repeated ED use. ‘Push’ factors included individual-level problems and wider community service failings. ‘Pull’ factors included positive experiences of, and beliefs about, ED care. Community services need to better engage and support people with complex drinking problems, whilst ED staff can be more effective in referring patients to community-based services.