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Schmidt MM, Griffin JM, McCabe P, Stuart-Mullen L, Branda M, OByrne TJ, Bowers M, Trotter K, McLeod C. Shared medical appointments: Translating research into practice for patients treated with ablation therapy for atrial fibrillation. PLoS One 2021; 16:e0246861. [PMID: 33577612 PMCID: PMC7880477 DOI: 10.1371/journal.pone.0246861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 01/27/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND People with atrial fibrillation (AF) have lower reported quality of life and increased risk of heart attack, death, and stroke. Lifestyle modifications can improve arrhythmia-free survival/symptom severity. Shared medical appointments (SMAs) have been effective at targeting lifestyle change in other chronic diseases and may be beneficial for patients with AF. OBJECTIVE To determine if perceived self-management and satisfaction with provider communication differed between patients who participated in SMAs compared to patients in standard care. Secondary objectives were to examine differences between groups for knowledge about AF, symptom severity, and healthcare utilization. METHODS We conducted a retrospective analysis of data collected where patients were assigned to either standard care (n = 62) or a SMA (n = 59). Surveys were administered at pre-procedure, 3, and 6 months. RESULTS Perceived self-management was not significantly different at baseline (p = 0.95) or 6 months (p = 0.21). Patients in SMAs reported more knowledge gain at baseline (p = 0.01), and higher goal setting at 6 months (p = 0.0045). Symptom severity for both groups followed similar trends. CONCLUSION Patients with AF who participated in SMAs had similar perceived self-management, patient satisfaction with provider communication, symptom severity, and healthcare utilization with their counterparts, but had a statistically significant improvement in knowledge about their disease.
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Affiliation(s)
- Monika M. Schmidt
- U.S. Department of Veteran’s Affairs, Nashville, TN, United States of America
| | | | - Pamela McCabe
- Mayo Clinic, Rochester, MN, United States of America
| | | | - Megan Branda
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado-Denver Anschutz Medical Campus, Aurora, CO, United States of America
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Tsiamparlis-Wildeboer AHC, Feijen-De Jong EI, Scheele F. Factors influencing patient education in shared medical appointments: Integrative literature review. PATIENT EDUCATION AND COUNSELING 2020; 103:1667-1676. [PMID: 32376140 DOI: 10.1016/j.pec.2020.03.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 02/28/2020] [Accepted: 03/06/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE This integrative literature review investigates the factors influencing patient education in Shared Medical Appointments. METHODS Following template analysis method, we used key concepts of the Social Cognitive Theory (SCT) and Social Constructivism as a priori themes. After detailed analysis of the included studies, we deduced subthemes, forming a final template. Based on this final template, we analysed our data again as a final check. RESULTS We included 22 studies. We found that the factors feeling of bonding, humour, feeling of safety, access to information, time, relationship participants-staff, modelling and self-regulation influence the education of SMA participants. Furthermore, we found that health care providers function both as leaders and peers. CONCLUSION We found eight factors that influence the education of SMA participants. Health care providers exert influence on these factors, but in turn, they are also influenced by them in their transfer of knowledge. PRACTICE IMPLICATIONS In order to create a climate of learning and to promote transfer of knowledge, these eight factors should be considered. Health care providers should be aware of their roles and they might need some extra skills for their leadership roles. This can also lead to practical implications for the curriculum in medical schools.
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Affiliation(s)
- Anna H C Tsiamparlis-Wildeboer
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Midwifery Science, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands; University of Groningen, University Medical Center Groningen, Department of General Practice & Elderly Medicine, Groningen, The Netherlands; AVAG (Academy Midwifery Amsterdam and Groningen), Groningen, The Netherlands.
| | - Esther I Feijen-De Jong
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Midwifery Science, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands; University of Groningen, University Medical Center Groningen, Department of General Practice & Elderly Medicine, Groningen, The Netherlands; AVAG (Academy Midwifery Amsterdam and Groningen), Groningen, The Netherlands
| | - Fedde Scheele
- Vrije Universiteit Amsterdam, Athena Institute for Transdisciplinary Research, Amsterdam, The Netherlands; Amsterdam UMC, The Netherlands
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Parikh M, Rajendran I, D'Amico S, Luo M, Gardiner P. Characteristics and Components of Medical Group Visits for Chronic Health Conditions: A Systematic Scoping Review. J Altern Complement Med 2019; 25:683-698. [PMID: 30945935 DOI: 10.1089/acm.2018.0524] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objectives: Chronic health conditions are a major challenge to the health care system. Medical Group Visits (MGVs) are a valuable health care delivery model used in a variety of medical settings and patient populations. We conducted a systematic scoping review of MGV research literature for chronic health conditions to summarize the characteristics and individual components of MGVs in the United States of America and Canada. Design: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses scoping review methodology and searched five databases using nine widely used MGV-related terms. Subjects: We included studies conducted in the United States and Canada, whose participants were >18 years old and attended an MGV conducted in a medical setting by a billable health care provider. We excluded groups related to diabetes, pregnancy, and cancer. Results: Of 3777 studies identified, we found 55 eligible studies of which 9 are randomized controlled trials and 46 are observational studies. The majority of studies were conducted in academic medical centers, were observational in design, and recruited patients using physician referrals. The three most frequently studied groups include a combination of several chronic conditions (n = 12), chronic pain conditions (n = 10), and cardiovascular disease (n = 9). Curriculum components included didactics (n = 55), experiential activities (n = 27), and socializing components (n = 12). Didactic areas include (1) medical topics such as symptoms management (n = 27) of which 14 included pain management, and (2) lifestyle/educational component (n = 33) that comprised of talks on nutrition (n = 29), exercise (n = 20), stress (n = 16), and sleep (n = 10). The top integrative medicine (IM) modalities (n = 13) included: mindfulness techniques (n = 8), meditation (n = 6), and yoga (n = 5). Substantial heterogeneity was observed in the recruitment, implementation, curriculum components, and outcomes reported. Conclusion: The MGV is a model of patient-centered care that has captured the attention of researchers. IM modalities are well represented in the curriculum components of MGVs. Further investigation into the components identified by this study, may help in better targeting of group interventions to patients and contexts, where it is most likely to be effective.
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Affiliation(s)
- Manasi Parikh
- 1Department of Family Medicine and Boston Medical Center, Boston, MA
| | - Iniya Rajendran
- 2Department of Internal Medicine, Boston Medical Center, Boston, MA
| | - Salvatore D'Amico
- 1Department of Family Medicine and Boston Medical Center, Boston, MA
| | - Man Luo
- 1Department of Family Medicine and Boston Medical Center, Boston, MA
| | - Paula Gardiner
- 3Department of Family Medicine and Community Health, UMass Memorial Health Care, University of Massachusetts Medical School, Worcester, MA
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Griffin JM, Stuart-Mullen LG, Schmidt MM, McCabe PJ, O'Byrne TJ, Branda ME, McLeod CJ. Preparation for and Implementation of Shared Medical Appointments to Improve Self-Management, Knowledge, and Care Quality Among Patients With Atrial Fibrillation. Mayo Clin Proc Innov Qual Outcomes 2018; 2:218-225. [PMID: 30225453 PMCID: PMC6132214 DOI: 10.1016/j.mayocpiqo.2018.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 06/08/2018] [Accepted: 06/15/2018] [Indexed: 06/08/2023] Open
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia in adults and is associated with an increased risk of stroke, heart failure, and death. Therapy for this pervasive arrhythmia is complex, involving multiple options that chiefly manage symptoms and prevent stroke. Current therapeutic strategies are also of limited efficacy, and can present potentially life-threatening side effects and/or complications. Emerging research suggests that the burden of AF can be reduced by improving patient understanding of the arrhythmia and teaching patients to adopt and maintain lifestyle and behavior changes. Shared medical appointments (SMAs) have been successfully used to deliver education and develop patient coping and disease management skills for patients with complex needs, but there is a paucity of studies examining the use of SMAs for managing AF. Moreover, few studies have examined strategies for implementing SMAs into routine clinical care. We detail our approach for (1) adapting a patient-centered SMA curriculum; (2) designing an evaluation comparing SMAs to routine care on patient outcomes; and (3) implementing SMAs into routine clinical practice. We conclude that evaluation and implementation of SMAs into routine clinical practice requires considerable planning and continuous engagement from committed key stakeholders, including patients, family members, schedulers, clinical staff, nurse educators, administrators, and billing specialists.
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Coates J, Gething F, Johnson MI. Shared medical appointments for managing pain in primary care settings? Pain Manag 2017; 7:223-227. [PMID: 28699374 DOI: 10.2217/pmt-2017-0016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Jonathan Coates
- St. Anthony's Health Centre, St. Anthony's Road, Walker, Newcastle NE6 2NN, UK
| | - Fraser Gething
- Pain Management Team, Newcastle upon Tyne Hospitals NHS Foundation Trust, Elswick Health Centre, Newcastle upon Tyne NE4 6SH, UK
| | - Mark I Johnson
- Centre for Pain Research, School of Clinical & Applied Sciences, Leeds Beckett University City Campus, Leeds LS1 3HE, UK
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Graarup J, Ferrari P, Howard LS. Patient engagement and self-management in pulmonary arterial hypertension. Eur Respir Rev 2017; 25:399-407. [PMID: 27903662 DOI: 10.1183/16000617.0078-2016] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 10/13/2016] [Indexed: 11/05/2022] Open
Abstract
Improved care in pulmonary arterial hypertension has led to increased longevity for patients, with a paralleled evolution in the nature of their needs. There is more focus on the impact of the disease on their day-to-day activities and quality of life, and a holistic approach is coming to the front of pulmonary arterial hypertension management, which places the patient at the centre of their own healthcare. Patients are thus becoming more proactive, involved and engaged in their self-care, and this engagement is an important factor if patient outcomes are to improve. In addition, involvement of the patient may improve their ability to cope with pulmonary arterial hypertension, as well as help them to become effective in the self-management of their disease. Successful patient engagement can be achieved through effective education and the delivery and communication of timely, high-quality information. A multidisciplinary approach involving healthcare professionals, carers, patient associations and expert patient programmes can also encourage patients to engage. Strategies that promote patient engagement can help to achieve the best possible care and support for the patient and also benefit healthcare providers.
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Affiliation(s)
| | - Pisana Ferrari
- PHA Europe, European Pulmonary Hypertension Association, Udine, Italy
| | - Luke S Howard
- National Pulmonary Hypertension Service, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
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Social and Support Services Offered by Cleft and Craniofacial Teams: A National Survey and Institutional Experience. J Craniofac Surg 2016; 27:356-60. [PMID: 26825746 DOI: 10.1097/scs.0000000000002385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND A multidisciplinary approach to patients with craniofacial abnormalities is the standard of care by the American Cleft Palate-Craniofacial Association (ACPA). The standards of team care, however, do not require provision of social support services beyond access to a social worker. The purpose of this investigation is to study social support services provided by ACPA teams, funding sources for services, and family interest in services. METHODS A survey was submitted to ACPA cleft and craniofacial team leaders (N = 161), which evaluated the provision of potentially beneficial social support services, and their funding sources. A second survey administered to patient families at our institution gauged their level of interest in these services. Statistical analysis evaluated the level of interest among services. RESULTS Seventy-five of 161 (47%) teams and 39 of 54 (72%) families responded to the surveys. Services provided included scholarships (4%), summer camp (25%), social media (32%), patient support groups (36%), parties (42%), parent support groups (46%), other opportunities (56%), and social workers (90%). The majority of funding for social workers was by the institution (61%) whereas funding for ancillary services varied (institution, team, fundraisers, grants, and other sources). Families indicated an average interest of 2.4 ± 1.41 for support groups, 2.5 ± 1.63 for summer camps, 2.92 ± 1.66 for parties, 3.16 ± 1.65 for social media, and 3.95 ± 1.60 for scholarships (P value <0.05). CONCLUSIONS The ACPA standards of team care do not require teams to provide social support services beyond access to a social worker. Among our survey respondents, the authors found that in addition to a social worker, teams offered social support services, which were not required. The social worker position is usually institutionally funded, whereas funding sources for additional services varied. Respondents at our center desired additional social support services. The authors recommend a hybrid model of hospital and nonhospital funding to provide social and support services to patients with craniofacial deformities.
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Meinema JG, van Dijk N, Beune EJAJ, Jaarsma DADC, van Weert HCPM, Haafkens JA. Determinants of adherence to treatment in hypertensive patients of African descent and the role of culturally appropriate education. PLoS One 2015; 10:e0133560. [PMID: 26267453 PMCID: PMC4534399 DOI: 10.1371/journal.pone.0133560] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 06/28/2015] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND In Western countries, better knowledge about patient-related determinants of treatment adherence (medication and lifestyle) is needed to improve treatment adherence and outcomes among hypertensive ethnic minority patients of African descent. OBJECTIVE To identify patient-related determinants of adherence to lifestyle and medication recommendations among hypertensive African Surinamese and Ghanaian patients with suboptimal treatment results (SBP≥140) living in the Netherlands and how culturally appropriate hypertension education (CAHE) influenced those determinants. METHODS This study analysed data of 139 patients who participated in the CAHE trial. Univariate logistic regression analysis was used to measure the association between patient-related determinants (medication self-efficacy, beliefs about medication and hypertension, social support, and satisfaction with care) and treatment adherence. We also tested whether CAHE influenced the determinants. RESULTS Medication self-efficacy and social support were associated with medication adherence at baseline. At six months, more medication self-efficacy and fewer concerns about medication use were associated with improved medication adherence. Self-efficacy was also associated with adherence to lifestyle recommendations at baseline. CAHE influenced patients' illness perceptions by creating more understanding of hypertension, its chronic character, and more concerns about the associated risks. CONCLUSION In this high-risk population, health care providers can support medication adherence by paying attention to patients' medication self-efficacy, the concerns they may have about medication use and patients' perceptions on hypertension. The CAHE intervention improved patients' perception on hypertension.
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Affiliation(s)
- Jennita G. Meinema
- Department of General Practice/Family Medicine, Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands
- * E-mail:
| | - Nynke van Dijk
- Department of General Practice/Family Medicine, Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands
| | - Erik J. A. J. Beune
- Department of Social Medicine, Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands
| | - Debbie A. D. C. Jaarsma
- Department of Evidence-based medical education, University Medical Center of Groningen, Groningen, the Netherlands
| | - Henk C. P. M. van Weert
- Department of General Practice/Family Medicine, Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands
| | - Joke A. Haafkens
- Department of General Practice/Family Medicine, Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands
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