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Ames SG, Delaney RK, Delgado-Corcoran C, Houtrow AJ, Alvey J, Watt MH, Murphy N. Impact of disability-based discrimination in healthcare on parents of children with medical complexity. Dev Med Child Neurol 2024; 66:1226-1233. [PMID: 38327250 DOI: 10.1111/dmcn.15870] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 12/26/2023] [Accepted: 01/05/2024] [Indexed: 02/09/2024]
Abstract
AIM To qualitatively assess the impact of disability-based discrimination in healthcare on the parents of children with medical complexity (CMC). METHOD In this qualitative study, we conducted in-depth, semi-structured interviews with the parents of CMC. Data collection and analysis occurred iteratively; constant comparison methods were used to identify themes describing the impact of disability-based discrimination in pediatric healthcare on the parents of CMC. RESULTS Thirty participants from 15 US states were interviewed. Four themes were developed regarding the impact of disability-based discrimination in healthcare on parents. The themes were: (1) discrimination leads to a loss of trust in healthcare providers; (2) discrimination increases the burden of caregiving; (3) discrimination impacts parental well-being; and (4) racism and poverty-based discrimination amplifies disability-based discrimination. INTERPRETATION The experience of discrimination toward their child results in loss of trust and therapeutic relationship between provider and parent, causes increased burden to the family, and contributes to decreased parental well-being. These experiences are magnified in minoritized families and in families perceived to have a lower socioeconomic status based on insurance type.
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Affiliation(s)
- Stefanie G Ames
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Rebecca K Delaney
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | - Amy J Houtrow
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Justin Alvey
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Melissa H Watt
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Nancy Murphy
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
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2
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Williamson FA, Lester JN, Woods C, Kaye EC. Questions to promote child-centered care in racially discordant interactions in pediatric oncology. PATIENT EDUCATION AND COUNSELING 2024; 121:108106. [PMID: 38123375 DOI: 10.1016/j.pec.2023.108106] [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: 12/01/2023] [Accepted: 12/09/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE To examine questioning practices in racially discordant interactions and describe how these practices engendered child-centered care. METHODS We used applied conversation analysis to analyze a collection of 300 questions directed to children across 10 cases involving children of color and their families in disease reevaluation appointments in pediatric oncology. RESULTS Our analysis generated two patterns: 1) both the pediatric oncologists' and caregivers built upon one another's talk to enable the child's conversational turn, and 2) the oncologists' reformulated requests as questions to invite the child's permission and cooperation for completing exams and understanding symptoms. CONCLUSION Children, pediatric oncologists, and caregivers coordinated their actions to enable children to participate as recipients of and respondents to questions. The analysis of real-time interactions illuminates practices for centering children in clinical encounters and the benefits of doing so. PRACTICAL IMPLICATIONS This study's findings have implications for defining competencies and practices for fostering child-centered communication, creating training materials based on real-time encounters, and identifying strategies for humanizing pediatric patient experiences.
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Affiliation(s)
| | - Jessica Nina Lester
- Department of Counseling Education and Psychology, Indiana University, Bloomington, USA
| | - Cameka Woods
- St. Jude's Children's Research Hospital, Memphis, USA
| | - Erica C Kaye
- St. Jude's Children's Research Hospital, Memphis, USA
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3
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Cuneo AA, Sifflet C, Bardach N, Ly N, von Scheven E, Perito ER. Pediatric Medical Traumatic Stress and Trauma-Informed Care in Pediatric Chronic Illness: A Healthcare Provider Survey. J Pediatr 2023; 261:113580. [PMID: 37353148 DOI: 10.1016/j.jpeds.2023.113580] [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: 11/03/2022] [Revised: 06/06/2023] [Accepted: 06/16/2023] [Indexed: 06/25/2023]
Abstract
OBJECTIVE To inform approaches to pediatric medical traumatic stress (PMTS) by exploring providers' (1) perception of the impact of PMTS on the medical care of patients with pediatric-onset chronic illnesses, (2) self-reported competencies and practices of PMTS prevention, treatment, and counseling, and (3) perception of the barriers influencing the adoption of these practices. STUDY DESIGN A convenience sample of multidisciplinary healthcare providers was recruited through a multimodal recruitment strategy to participate in an electronic survey adapted from the Trauma-Informed Care Provider Survey. RESULTS Among participants (n = 304), 99% agreed that PMTS impacts patient health. Participants report altering medical care plans due to PMTS, including deferring or stopping treatments (n = 98 [32%]) and changing medication regimens (n = 88 [29%]). Sixty-eight percent (n = 208) report negative impact of PMTS on patient implementation of medical care plans, including medication nonadherence (n = 153 [50%]) and missed appointments (n = 119 [39%]). Although participants agreed it is their job to decrease patient stress (n = 292 [96%]) and perform PMTS assessments (n = 268 [88%]), few practiced PMTS-focused trauma informed care. Systems-level barriers to practice included insufficient training, absent clinical workflows, and lack of access to mental health experts. CONCLUSIONS Our findings have helped inform a conceptual framework for understanding the relationship between PMTS and health outcomes. Systems-level opportunities to optimize PMTS-focused trauma-informed care include (1) dissemination of provider training, (2) integrated workflows for PMTS mitigation, and (3) enhanced accessibility to mental health providers. Further work is required to determine if these interventions can improve health outcomes in patients with pediatric-onset chronic illnesses.
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Affiliation(s)
- Addison A Cuneo
- Department of Pediatrics, University of California San Francisco, San Francisco, CA.
| | - Christopher Sifflet
- School of Public Health, University of California, Berkeley, Berkeley, CA; School of Medicine, University of California, San Francisco, San Francisco, CA
| | - Naomi Bardach
- Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | - Ngoc Ly
- Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | - Emily von Scheven
- Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | - Emily R Perito
- Department of Pediatrics, University of California San Francisco, San Francisco, CA
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Grossoehme DH, Sellers J, Accordino S, Smith SM, Jenkins R, Richner G, Moore-Forbes Y, Friebert S. "It's a Different Conversation": Qualitative Analysis of Pediatric Home-based Hospice/Palliative Care Visits' Perceived Value. Pediatr Qual Saf 2023; 8:e663. [PMID: 37434594 PMCID: PMC10332824 DOI: 10.1097/pq9.0000000000000663] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 05/25/2023] [Indexed: 07/13/2023] Open
Abstract
Home-based hospice and/or palliative care (HBHPC) is an important and increasingly utilized aspect of care for children with serious conditions-those with high mortality risk, which either impacts their quality of life or carries a significant caregiver burden. Provider home visits are a core feature; however, the travel time and human resource allocation are significant challenges. Balancing the appropriateness of this allocation requires further characterization of the value of home visits to families and identification of the value domains of HBHPC for caregivers. For study purposes, we defined a "home visit" as an in-person visit by a physician or advanced practice provider to a child's residence. Methods The methods include a qualitative study using semistructured interviews and a grounded theory analytic framework enrolled caregivers of children aged 1 month to 26 years receiving HBHPC from either of 2 U.S. pediatric quaternary institutions between 2016 and 2021. Results Twenty-two participants were interviewed; the mean (SD) interview duration was 52.9 (22.6) minutes. The final conceptual model has 6 major themes: communicating effectively, fostering emotional and physical safety, building and maintaining relationships, empowering the family, seeing the bigger picture, and sharing burdens. Conclusions Caregiver-identified themes demonstrated improved communication, empowerment, and support from receiving HBHPC, which can facilitate enhanced family-centered, goal-concordant care.
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Affiliation(s)
- Daniel H. Grossoehme
- From the Department of Pediatrics, Akron Children’s Hospital, Akron, Ohio
- Rebecca D. Considine Research Institute, Akron Children’s Hospital, Akron, Ohio
| | - Jaime Sellers
- From the Department of Pediatrics, Akron Children’s Hospital, Akron, Ohio
| | - Samuel Accordino
- Rebecca D. Considine Research Institute, Akron Children’s Hospital, Akron, Ohio
| | - Steven M. Smith
- Department of Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio
| | - Rachel Jenkins
- From the Department of Pediatrics, Akron Children’s Hospital, Akron, Ohio
| | - Gwendolyn Richner
- From the Department of Pediatrics, Akron Children’s Hospital, Akron, Ohio
| | | | - Sarah Friebert
- From the Department of Pediatrics, Akron Children’s Hospital, Akron, Ohio
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Kenyon CC, Flaherty C, Floyd GC, Jenssen BP, Miller VA. Promoting Healthy Childhood Behaviors With Financial Incentives: A Narrative Review of Key Considerations and Design Features for Future Research. Acad Pediatr 2022; 22:203-209. [PMID: 34403802 PMCID: PMC8844312 DOI: 10.1016/j.acap.2021.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 07/15/2021] [Accepted: 08/10/2021] [Indexed: 11/24/2022]
Abstract
In the last decade, there has been a robust increase in research using financial incentives to promote healthy behaviors as behavioral economics and new monitoring technologies have been applied to health behaviors. Most studies of financial incentives on health behaviors have focused on adults, yet many unhealthy adult behaviors have roots in childhood and adolescence. The use of financial incentives is an attractive but controversial strategy in childhood. In this review, we first propose 5 general considerations in designing and applying incentive interventions to children. These include: 1) the potential impact of incentives on intrinsic motivation, 2) ethical concerns about incentives promoting undue influence, 3) the importance of child neurodevelopmental stage, 4) how incentive interventions may influence health disparities, and 5) how to finance effective programs. We then highlight empirical findings from randomized trials investigating key design features of financial incentive interventions, including framing (loss vs gain), timing (immediate vs delayed), and magnitude (incentive size) effects on a range of childhood behaviors from healthy eating to adherence to glycemic control in type 1 diabetes. Though the current research base on these subjects in children is limited, we found no evidence suggesting that loss-framed incentives perform better than gain-framed incentives in children and isolated studies from healthy food choice experiments support the use of immediate, small incentives versus delayed, larger incentives. Future research on childhood incentives should compare the effectiveness of gain versus loss-framing and focus on which intervention characteristics lead to sustained behavior change and habit formation.
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Affiliation(s)
- Chén C. Kenyon
- PolicyLab and Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia,Division of General Pediatrics, Children’s Hospital of Philadelphia,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania
| | - Carina Flaherty
- PolicyLab and Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia
| | - G. Chandler Floyd
- PolicyLab and Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia
| | - Brian P. Jenssen
- PolicyLab and Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia,Division of General Pediatrics, Children’s Hospital of Philadelphia,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania
| | - Victoria A. Miller
- Division of Adolescent Medicine, Children’s Hospital of Philadelphia,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania
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Venkatraman K, Vijayalakshmi V, Sudarsanam N, Manoharan A. Designing Dynamic Interventions to Improve Adherence in Pediatric Long-Term Treatment - The Role of Perceived Value of the Physician by Primary Caregivers. HEALTH COMMUNICATION 2021; 36:1825-1840. [PMID: 32731759 DOI: 10.1080/10410236.2020.1796284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Primary Caregivers are the fulcrum in the physician-caregiver-child triad. Existing literature discusses static multi-component interventions in detail. In long-term treatments, dynamic intervention design is needed as the environment and situations of the families are dynamic. The objectives of this study are (a) to identify the components of the primary caregiver's perception of the physician's value with reference to the effectiveness of consultation and relationships with the former and with the child; (b) to establish the role of this perception in designing dynamic interventions, and (c) to describe the perception's potential influence on adherence. A PRISMA, chronological, and morphological analysis of the literature is carried out about caregivers' adherence in the pediatric long-term treatment context. We define communication and consultation as the functional, whereas relationship as the emotional component of the caregiver's perception of the physician. We propose a theoretical model that incorporates intervention as an integral component of care. Adherence happens as a response to changing situations and hence fluctuates. Hence, a dynamic intervention design to benefit the child should be incorporated into care through the caregiver-physician bridge. Future research should explore how intervention needs change and the driving reasons for understanding the static and dynamic components of interventions.
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Affiliation(s)
| | - V Vijayalakshmi
- Department of Management Studies, Indian Institute of Technology, Madras
| | - Nandan Sudarsanam
- Department of Management Studies, Indian Institute of Technology, Madras
| | - Anand Manoharan
- Department of Clinical Research, Kanchi Kamakoti CHILDS Trust Hospital
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7
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Feldman ECH, Durkin LK, Bugno L, Balistreri KA, Davies WH, Miller SA, Greenley RN. Communication About Medication by Providers-Adolescent and Young Adult Version: Confirmatory Factor Analyses. J Pediatr Psychol 2021; 46:599-608. [PMID: 33706372 DOI: 10.1093/jpepsy/jsab009] [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] [Received: 07/03/2020] [Revised: 01/07/2021] [Accepted: 01/19/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To replicate the factor structure of a patient-report measure of provider communication about key medication prescription information, the Communication about Medication by Providers-Adolescent and Young Adult (CAMP-AYA) Version. We evaluated whether the 15-item, two-factor structure identified previously could be replicated via confirmatory factor analysis, and we also examined fit of unidimensional and bifactor models. Associations of CAMP-AYA Total and Factor Scores with provider satisfaction and select patient and medication characteristics were also examined. METHODS Participants were 739 AYA (ages 18-25) who completed the CAMP-AYA, a provider satisfaction rating, and provided demographic and medication information. RESULTS The bifactor model was best fitting (χ2 [75] = 689.60, p < .0001; root mean squared error of approximation = 0.11, 90% CI [0.10, 0.11]; Comparative Fit Index = 0.98; Tucker-Lewis Index = 0.98; Standardized Root Mean Square Residual Index = 0.02). Internal consistency reliabilities for Total and Factor Scores were high (αs > .89) and Total and Factor Scores were associated with provider satisfaction (ps < .001). CAMP-AYA scores varied as a function of type of prescription (short vs. long term; new vs. refill), with higher scores reported in the context of long term (>30-day course) or refilled prescriptions (ps < .007) in most cases. CONCLUSIONS This study provides additional support for the reliability of the CAMP-AYA as a tool to assess AYA perceptions of provider key information coverage about medication prescriptions.
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Affiliation(s)
- Estée C H Feldman
- Department of Psychology, Rosalind Franklin University of Medicine and Science
| | - Lindsay K Durkin
- Department of Psychology, Rosalind Franklin University of Medicine and Science
| | - Lindsey Bugno
- Department of Psychology, Rosalind Franklin University of Medicine and Science
| | | | | | - Steven A Miller
- Department of Psychology, Rosalind Franklin University of Medicine and Science
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8
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Glenn TW, Riekert KA, Roter D, Eakin MN, Pruette CS, Brady TM, Mendley SR, Tuchman S, Fivush BA, Eaton CK. Engagement and Affective Communication During Pediatric Nephrology Clinic Visits: Associations with Medication Adherence. PATIENT EDUCATION AND COUNSELING 2021; 104:578-584. [PMID: 32948401 PMCID: PMC7933303 DOI: 10.1016/j.pec.2020.08.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 08/24/2020] [Accepted: 08/26/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To evaluate whether engagement and affective communication among adolescents and young adults (AYAs) with chronic kidney disease (CKD), caregivers, and pediatric nephrology providers during outpatient clinic visits predicts antihypertensive medication adherence. METHODS AYAs (n = 60, M age = 15.4 years, SD = 2.7, 40% female, 43% African American/Black) and caregivers (n = 60, 73% female) attended audio-recorded clinic visits with pediatric nephrologists (n = 12, 75% female). Recordings were analyzed using global affect ratings of the Roter Interactional Analysis System. Antihypertensive medication adherence was monitored electronically before and after clinic visits. A linear regression model evaluated associations between affect ratings and post-visit adherence. RESULTS AYAs took 84% of doses (SD = 20%) pre-visit and 82% of doses (SD = 24%) post-visit. Higher AYA engagement (β = 0.03, p = .01) and the absence of provider negative affect (β=-0.15, p = .04) were associated with higher post-visit adherence, controlling for pre-visit adherence, AYA sex, age, and race, and clustered by provider. CONCLUSIONS Post-visit adherence was higher when AYAs were rated as more engaged and providers as less negative. PRACTICE IMPLICATIONS AYAs with lower engagement may benefit from further adherence assessment. Communication strategies designed to more actively engage AYAs in their care and diminish provider conveyance of negative affect during clinic visits may positively influence adherence among AYAs with CKD.
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Affiliation(s)
- Trevor W Glenn
- Johns Hopkins University School of Medicine, Baltimore MD - 733 N Broadway, Baltimore, MD, 21205, USA.
| | - Kristin A Riekert
- Johns Hopkins University School of Medicine, Baltimore MD - 733 N Broadway, Baltimore, MD, 21205, USA.
| | - Debra Roter
- Johns Hopkins University School of Medicine, Baltimore MD - 733 N Broadway, Baltimore, MD, 21205, USA.
| | - Michelle N Eakin
- Johns Hopkins University School of Medicine, Baltimore MD - 733 N Broadway, Baltimore, MD, 21205, USA.
| | - Cozumel S Pruette
- Johns Hopkins University School of Medicine, Baltimore MD - 733 N Broadway, Baltimore, MD, 21205, USA.
| | - Tammy M Brady
- Johns Hopkins University School of Medicine, Baltimore MD - 733 N Broadway, Baltimore, MD, 21205, USA.
| | - Susan R Mendley
- University of Maryland School of Medicine, Baltimore MD - 655 W Baltimore St S, Baltimore, MD, 21201, USA.
| | - Shamir Tuchman
- Children's National Medical Center, Washington DC - 110 Irving St NW, Washington, DC, 20010, USA.
| | - Barbara A Fivush
- Johns Hopkins University School of Medicine, Baltimore MD - 733 N Broadway, Baltimore, MD, 21205, USA.
| | - Cyd K Eaton
- Johns Hopkins University School of Medicine, Baltimore MD - 733 N Broadway, Baltimore, MD, 21205, USA.
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9
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Kaneko M, Aoki T, Goto R, Ozone S, Haruta J. Better Patient Experience is Associated with Better Vaccine Uptake in Older Adults: Multicentered Cross-sectional Study. J Gen Intern Med 2020; 35:3485-3491. [PMID: 32939665 PMCID: PMC7728885 DOI: 10.1007/s11606-020-06187-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 08/26/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Older adults' uptake of influenza and pneumococcus vaccines is insufficient worldwide. Although patient experience of primary care is associated with vaccine uptake in children, this relationship remains unclear for older adults. OBJECTIVE This study examined the association between patient experience of primary care and influenza/pneumococcal vaccine uptake in older adults. DESIGN AND METHODS We conducted a multicentered cross-sectional survey involving 25 primary care institutions in urban and rural areas in Japan. Participants were outpatients aged ≥ 65 years who visited one of the participating institutions within the 1-week study period. We assessed patient experience of primary care using the Japanese version of the Primary Care Assessment Tool (JPCAT), which includes six domains: first contact (accessibility), longitudinality (continuity of care), coordination, comprehensiveness (services available), comprehensiveness (services provided), and community orientation. We used a generalized linear mixed-effects model to adjust for clustering within institutions and individual covariates. KEY RESULTS One thousand participants were included in the analysis. After adjusting for clustering within institutions and other possible confounders, influenza and pneumococcal vaccine uptake was positively associated with JPCAT total scores (odds ratio per 1 standard deviation increase: 1.19, 95% confidence interval: 1.01-1.40 and odds ratio: 1.26, 95% confidence interval: 1.08-1.46, respectively). Of the JPCAT domains, coordination and community orientation were associated with influenza vaccine uptake and longitudinality, coordination, and comprehensiveness were associated with pneumococcal vaccine uptake. CONCLUSIONS Influenza and pneumococcal vaccine uptake were positively associated with patient experience of primary care in older adults. Consideration of patient experience, particularly longitudinality, coordination, comprehensiveness, and community orientation, could improve vaccine uptake.
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Affiliation(s)
- Makoto Kaneko
- Department of Family and Community Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan.
- Shizuoka Family Medicine Program, Shizuoka, Japan.
- Primary Care Research Unit, Graduate School of Health Data Science, Yokohama City University, Yokohama, Kanagawa, Japan.
| | - Takuya Aoki
- Division of Clinical Epidemiology, Jikei University School of Medicine, Tokyo, Japan
- Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ryohei Goto
- Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Sachiko Ozone
- Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Junji Haruta
- Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
- Medical Education Center, School of Medicine, Keio University, Tokyo, Japan
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10
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Skeens MA, Gerhardt CA, Bajwa R, Akard TF. Toward a better understanding: An exploration of provider perceptions in pediatric hematopoietic stem cell transplant adherence. Pediatr Transplant 2020; 24:e13786. [PMID: 32678483 DOI: 10.1111/petr.13786] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 05/20/2020] [Accepted: 06/15/2020] [Indexed: 12/23/2022]
Abstract
Pediatric HSCT patients endure complicated treatment regimens, lifestyle modifications, and a lifetime of long-term follow-up. Treatment adherence in this population is understudied and prevalence unknown. Providers (physicians and advanced practice nurses) in this study completed an online-structured questionnaire about definition, assessment, and perceived rates of adherence. Researchers' extracted 187 statements from participants' responses. The majority (n = 12, 71%) of providers reported adherence as a primary concern in outpatient HSCT. The major concern for providers was the potential of non-adherence to negatively affect outcomes. Providers also shared clinical examples of non-adherence. This study contributes to a better understanding of providers' perceptions of adherence within pediatric HSCT. Additional research is needed to describe, define, and improve adherence in pediatric HSCT to ultimately improve outcomes and quality of life for this vulnerable population.
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Affiliation(s)
- Micah A Skeens
- Pediatric Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, OH, USA.,The Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, OH, USA
| | - Cynthia A Gerhardt
- The Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, OH, USA.,Departments of Pediatrics and Psychology, The Ohio State University, Columbus, OH, USA
| | - Rajinder Bajwa
- Pediatric Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, OH, USA
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Lanyon C, Seeley J, Namukwaya S, Musiime V, Paparini S, Nakyambadde H, Matama C, Turkova A, Bernays S. "Because we all have to grow up": supporting adolescents in Uganda to develop core competencies to transition towards managing their HIV more independently. J Int AIDS Soc 2020; 23 Suppl 5:e25552. [PMID: 32869514 PMCID: PMC7459166 DOI: 10.1002/jia2.25552] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/04/2020] [Accepted: 05/29/2020] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Sustaining optimal adherence is the major challenge facing adolescents living with HIV (ALHIV), particularly in low-resource settings, where "second-line" is often the last accessible treatment option. We explored the knowledge and skills adolescents need in order to maintain improved adherence behaviours, and the specific ways clinicians and caregivers may support young people to do so more independently. METHODS We conducted individual, in-depth interviews with 20 ALHIV aged 10 to 18 years in Uganda in 2017 to 2018. All participants had recently commenced second-line treatment as part of a clinical trial. We used thematic qualitative analysis to examine adherence experiences and challenges while on first-line therapy, as well as specific supports necessary to optimise treatment-taking longer-term. RESULTS Adherence difficulties are exacerbated by relatively rapid shifts from caregiver-led approaches during childhood, to an expectation of autonomous treatment-taking with onset of adolescence. For many participants this shift compounded their ongoing struggles managing physical side effects and poor treatment literacy. Switching to second-line typically prompted reversion back to supervised adherence, with positive impacts on self-reported adherence in the immediate term. However, this measure is unlikely to be sustainable for caregivers due to significant caregiver burden (as on first line), and provided little opportunity for clinicians to guide and develop young people's capacity to successfully adopt responsibility for their own treatment-taking. CONCLUSIONS As ALHIV in sub-Saharan Africa are attributed increasing responsibility for treatment adherence and HIV management, they must be equipped with the core knowledge and skills required for successful, self-directed care. Young people need to be relationally supported to develop necessary "adherence competencies" within the supportive framework of a gradual "transition" period. Clinic conversations during this period should be adolescent-focussed and collaborative, and treatment-taking strategies situated within the context of their lived environments and support networks, to facilitate sustained adherence. The disclosure of adherence difficulties must be encouraged so that issues can be identified and addressed prior to treatment failure.
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Affiliation(s)
- Chloe Lanyon
- School of Public HealthUniversity of SydneySydneyNSWAustralia
| | - Janet Seeley
- Department of Global Health and DevelopmentLondon School of Hygiene and Tropical MedicineLondonUnited Kingdom
- MRC/UVRI and LSHTM Uganda Research UnitEntebbeUganda
- Africa Health Research Institute (AHRI)DurbanSouth Africa
| | | | - Victor Musiime
- Department of Paediatrics and Child HealthMakerere UniversityKampalaUganda
- Research DepartmentJoint Clinical Research CentreKampalaUganda
| | - Sara Paparini
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUnited Kingdom
| | | | | | - Anna Turkova
- Clinical Trials UnitUniversity College LondonLondonUnited Kingdom
| | - Sarah Bernays
- School of Public HealthUniversity of SydneySydneyNSWAustralia
- Department of Global Health and DevelopmentLondon School of Hygiene and Tropical MedicineLondonUnited Kingdom
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12
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Shih S, Cohen LL. A Systematic Review of Medication Adherence Interventions in Pediatric Sickle Cell Disease. J Pediatr Psychol 2020; 45:593-606. [DOI: 10.1093/jpepsy/jsaa031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 04/11/2020] [Accepted: 04/14/2020] [Indexed: 12/20/2022] Open
Abstract
AbstractObjectiveAdherence to medication regimens is of critical importance in sickle cell disease (SCD). Most notably, data indicate that hydroxyurea, penicillin, and iron chelators increase life expectancy and decrease comorbid medical problems (e.g., strokes). However, average pediatric SCD adherence rates are only 55–74%. Studies have introduced interventions for pediatric SCD adherence, but no review has synthesized these data.MethodsWe conducted a systematic review of interventions for enhancing medication adherence in pediatric SCD. There were 9 studies that met inclusion and exclusion criteria. The Pediatric Self-Management Model provided a framework for organizing the modifiable factors targeted by existing interventions.ResultsThe 9 studies had high risk of bias levels and most targeted hydroxyurea. All studies used multiple measures of adherence, the interventions were multicomponent, and most included behavioral or technological interventions. There was variability in terms of whether the intervention targeted the individual, family, community, or healthcare system.ConclusionsConsistent with the broader adherence literature, targeting knowledge alone was insufficient in increasing adherence. Findings suggest that reminders and targeting self-efficacy were key to success. In addition, addressing multiple domains in an intervention yielded larger effects on adherence. Although these results are promising, this review highlights several limitations of the extant literature, including a paucity of intervention studies and several methodological weaknesses, such as small sample sizes, few randomized controlled trials, and variable measures of adherence. Recommendations for advancing scientific understanding of adherence promoting interventions in pediatric SCD are provided.
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Affiliation(s)
- Sharon Shih
- Department of Psychology, Georgia State University
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13
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Fernandez HGC, Moreira MCN, Gomes R. Making decisions on health care for children / adolescents with complex chronic conditions: a review of the literature. CIENCIA & SAUDE COLETIVA 2019; 24:2279-2292. [PMID: 31269185 DOI: 10.1590/1413-81232018246.19202017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 08/30/2017] [Indexed: 11/21/2022] Open
Abstract
The profile of pediatric care has gone through changes in Brazil and in the world. This process becomes more visible in surveys that deal with hospital admission or specialized outpatient care data. This fact leads us to the idea that it is in such spaces that these children and subjects who care for them are more visible and negotiate decisions. We aim to perform a state of the art literature review on decision making discussions and definitions, analyzing the current research in light of the theoretical Mol perspectives on the actors' logics of chronic diseases care; And the perspective of care goods exchanges in the dialogue between Martins and Moreira, triggering the Theory of Gift. The synthesis of the literature shows that decision making may be understood as a care planning process in which family, patients and health professionals are involved, and is linked to the family-centered care model. In terms of difficulties, we point out the prevalence of a dynamic that favors a criticizable choice because of the risks of inequality, such as the lack of discussion on the options and the actuation of the family mostly in times of difficult decisions.
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Affiliation(s)
| | | | - Romeu Gomes
- Instituto Fernandes Figueira, Fiocruz. Av. Rui Barbosa 716, Flamengo. 22250-020 Rio de Janeiro RJ Brasil.
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14
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Birand N, Boşnak AS, Diker Ö, Abdikarim A, Başgut B. The role of the pharmacist in improving medication beliefs and adherence in cancer patients. J Oncol Pharm Pract 2019; 25:1916-1926. [PMID: 30786821 DOI: 10.1177/1078155219831377] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Multiple factors have been reported to affect adherence to medication, including beliefs about medicines, while specifically tailored pharmaceutical care services for patients may improve adherence. The aim was to assess the impact of counselling by an oncology pharmacist on patients' medication adherence and beliefs. METHODS An interventional prospective study was performed in the oncology department at a tertiary hospital in Northern Cyprus from November 2017 to April 2018. The Beliefs about Medicines Questionnaire was used to evaluate the balance between beliefs about necessity and concerns and medication beliefs before and after an educational intervention. The Morisky Green Levine Test 2018 was used to evaluate adherence. RESULTS In total, 81 patients (65.4% females; mean age: 59.1 ± 11.34 years; 34.6% hypertensive; 19.8% with diabetes) were analysed before and after receiving counselling from an oncology pharmacist. Pharmacist education significantly enhanced the mean patient necessity-concern balance scores by two-fold (MT0(baseline) = -3.1 ± 8.6; MT1(posteducation) =3.0 ± 7.3; p < 0.0001), with patients who received counselling for the first time experiencing the greatest benefit. Multivariate analysis showed that patients who had a negative balance between their beliefs about the necessity of the medication and their concerns were less likely to adhere to the medication (0.138 (0.025-0.772)). CONCLUSION Counselling by an oncology pharmacist was effective in decreasing patient concerns and increasing their understanding of the necessity of the medication, thus enhancing their adherence and consequently improving the care they received.
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Affiliation(s)
- Nevzat Birand
- Department of Clinical Pharmacy, Faculty of Pharmacy, Near East University, North Cyprus, Turkey
| | | | - Ömer Diker
- Department of Medical Oncology, Near East Hospital, North Cyprus, Turkey
| | - Abdi Abdikarim
- Department of Clinical Pharmacy, Faculty of Pharmacy, Near East University, North Cyprus, Turkey
| | - Bilgen Başgut
- Department of Clinical Pharmacy, Faculty of Pharmacy, Near East University, North Cyprus, Turkey
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15
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Mayer-Brown S, Basch MC, Robinson ME, Janicke DM. Impact of Child and Maternal Weight on Healthcare Trainee Clinical Assessment Decision Making: A Virtual Human Study. Child Obes 2019; 15:63-70. [PMID: 30388042 DOI: 10.1089/chi.2018.0136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Adult literature documents that healthcare providers rely on patient characteristics, such as age, race, and weight, when making clinical decisions. However, little research has examined these biases among pediatric populations. This study aimed to examine the impact of child and maternal weight and race on clinical decision-making of healthcare trainees in the context of a pediatric pain assessment using standardized virtual pediatric patients and mothers. METHODS Ninety-two healthcare trainees read a standardized clinical vignette describing a child with chronic pain, which was accompanied by eight virtual human (VH) scenes-each with a child and mother. Scenes varied by the dyad's race, child's weight status, and mother's weight status. For each scene, participants were asked to make six healthcare assessment ratings. RESULTS Participants rated children (M = 42.44 vs. 48.69; p < 0.001) and mothers (M = 51.06 vs. 65.31; p < 0.001) with obesity as being less likely to adhere to physician recommendations compared with healthy weight children and mothers. Child patients with obesity (M = 38.88 vs. 30.08; p < 0.001) and mothers with obesity (M = 49.71 vs. 43.71; p < 0.001) were also rated as bearing more responsibility for the child's health status compared with healthy weight peers. CONCLUSIONS This study provides evidence that child and mother weight can impact clinical decision-making, as well as for the utility of VH technology in studying decision-making among healthcare trainees and providers.
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Affiliation(s)
- Sarah Mayer-Brown
- 1 Department of Child Psychiatry, Hasbro Children's Hospital, Providence, RI
| | - Molly C Basch
- 2 Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
| | - Michael E Robinson
- 2 Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
| | - David M Janicke
- 2 Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
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Kaneko M, Aoki T, Mori H, Ohta R, Matsuzawa H, Shimabukuro A, Motomura K, Inoue M. Associations of Patient Experience in Primary Care With Hospitalizations and Emergency Department Visits on Isolated Islands: A Prospective Cohort Study. J Rural Health 2018; 35:498-505. [PMID: 30550635 PMCID: PMC7380050 DOI: 10.1111/jrh.12342] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE In rural areas, the management of hospitalizations and emergency department (ED) visits is an important issue, and it is compounded by factors such as the long distance to secondary care facilities, funding difficulties in many rural medical institutions, and shortage of medical staff. While better patient experience (PX) has been shown to reduce hospitalizations and ED visits, previous studies have not considered the differences between urban and rural areas. In addressing this gap, this study examines the association between PX and hospitalizations/ED visits on isolated islands. METHODS This prospective cohort study was conducted on 5 isolated islands in Okinawa, Japan. We assessed the PX of primary care using the Japanese version of the Primary Care Assessment Tool (JPCAT), which comprises 6 domains: first contact, longitudinality, coordination, comprehensiveness (services available), comprehensiveness (services provided), and community orientation. The primary outcome was hospitalizations and ED visits in a year. We used a mixed effect model to adjust clustering within islands and individual covariates. FINDINGS Of 1,258 residents, 740 responded to a questionnaire for PX measurement. There were 73 hospitalizations and 62 ED visits. Adjusting for confounding and geographical clustering, hospitalizations had significant positive association with the PX score of each patient. ED visits were not associated with the total score of the JPCAT. CONCLUSION On the isolated islands, PX in primary care had positive correlation with hospitalizations. The contrast of our findings to those of previous studies may be due to the close patient-doctor relationship on isolated islands.
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Affiliation(s)
- Makoto Kaneko
- Department of Family and Community Medicine, Hamamatsu University School of Medicine, Higashi-ku, Hamamatsu, Shizuoka, Japan.,Shizuoka Family Medicine Program, Kikugawa, Shizuoka, Japan
| | - Takuya Aoki
- Department of Healthcare Epidemiology, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hideki Mori
- National Hospital Organization, Nagasaki Medical Center, Omura-shi, Nagasaki, Japan
| | | | | | | | | | - Machiko Inoue
- Department of Family and Community Medicine, Hamamatsu University School of Medicine, Higashi-ku, Hamamatsu, Shizuoka, Japan.,Shizuoka Family Medicine Program, Kikugawa, Shizuoka, Japan
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Jakubowska-Winecka A, Biernacka M. Parental Attitudes and Medication Adherence in Groups of Adolescents After Liver and Kidney Transplantations. Transplant Proc 2018; 50:2145-2149. [PMID: 30177127 DOI: 10.1016/j.transproceed.2018.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 04/13/2018] [Accepted: 05/07/2018] [Indexed: 11/18/2022]
Abstract
The objective of the study was to determine the connection between parental attitudes and medication adherence and the selected aspects of treatment in groups of adolescents after kidney and liver transplantations, in comparison with adolescents with diabetes and inflammatory bowel disease. Attitudes were assessed using M. Plopa's Parental Attitudes Scale, which distinguishes 5 types of attitudes. Medication adherence was evaluated on the basis of the Morisky Medication Adherence Scale (MMAS-8), used with the author's consent. With the 4-item scale developed by the authors, the following aspects of treatment were assessed: the patient's level of knowledge about the disease, treatment effects, and physician's satisfaction with patient cooperation. In both groups of adolescents after transplantation, 2 types of parental attitudes were found to correlate with medication adherence: the Accepting Attitude and the Overly Protective Attitude. The results of other studied aspects varied in terms of gender, age, and chronic disease type.
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Affiliation(s)
- A Jakubowska-Winecka
- Health Psychology Department, the Children's Memorial Health Institute, Warsaw, Poland.
| | - M Biernacka
- Health Psychology Department, the Children's Memorial Health Institute, Warsaw, Poland.
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Fuzzell LN, LaJoie AS, Smith KT, Philpott SE, Jones KM, Politi MC. Parents' adherence to pediatric health and safety guidelines: Importance of patient-provider relationships. PATIENT EDUCATION AND COUNSELING 2018; 101:1570-1576. [PMID: 29731179 PMCID: PMC6057837 DOI: 10.1016/j.pec.2018.05.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 04/27/2018] [Accepted: 05/01/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To examine 1) parent-provider communication about pediatric health/safety guidelines, 2) trust in child's provider, 3) comfort discussing guidelines, 4) agreement with guideline advice, 5) self-efficacy following guidelines, and their impact on guideline adherence. METHOD 256 parents of children ages 0-6 completed an online survey about sunscreen use, newborn Vitamin K injections, influenza vaccination, routine vaccination, car seats, infant safe sleep, furniture anchoring, large trampoline use, and firearm safety. Multivariable models regressed: 1) communication about each guideline on parents' corresponding guideline adherence; 2) trust, comfort discussing guidelines, agreement with guideline advice, self-efficacy, on parents' total guideline adherence. RESULTS Communication about furniture anchoring (OR = 2.26), sunscreen (OR = 5.28), Vitamin K injections (OR = 3.20), influenza vaccination (OR = 13.71), routine vaccination (OR = 6.43), car seats (OR = 6.15), and infant safe sleep (OR = 3.40) related to corresponding guideline adherence (ps < 0.05). Firearm safety communication was not related to adherence (OR = 1.11, n.s.). Trampoline communication related to lower likelihood of trampoline guideline adherence (OR = 0.24, p = 0.001). Agreement with guideline advice (β = 0.35), trust (β = 0.34), self-efficacy (β = 0.45), comfort discussing guidelines (β = 0.35) positively related to total guideline adherence (ps < 0.001). CONCLUSION Findings underscore the importance of provider communication about health/safety guidelines. PRACTICE IMPLICATIONS Providers should respectfully engage and build relationships with parents to support health/safety guideline adherence.
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Affiliation(s)
- Lindsay N Fuzzell
- Washington University in St. Louis, School of Medicine, Division of Public Health Sciences, St. Louis, MO, USA.
| | - A Scott LaJoie
- University of Louisville, Public Health and Information Sciences, Louisville, KY, USA
| | - Kyle T Smith
- Washington University in St. Louis, School of Medicine, Division of Public Health Sciences, St. Louis, MO, USA
| | - Sydney E Philpott
- Washington University in St. Louis, School of Medicine, Division of Public Health Sciences, St. Louis, MO, USA
| | - Katherine M Jones
- Washington University in St. Louis, School of Medicine, Department of Pediatrics, St. Louis, MO, USA
| | - Mary C Politi
- Washington University in St. Louis, School of Medicine, Division of Public Health Sciences, St. Louis, MO, USA
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Richardson KL, Weiss NS, Halbach S. Chronic School Absenteeism of Children with Chronic Kidney Disease. J Pediatr 2018; 199:267-271. [PMID: 29706492 PMCID: PMC6063782 DOI: 10.1016/j.jpeds.2018.03.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 03/03/2018] [Accepted: 03/14/2018] [Indexed: 12/18/2022]
Abstract
We evaluated the frequency of chronic school absenteeism (≥18 missed school days per year) among children with mild-to-moderate chronic kidney disease. Chronic absenteeism was present in 17.3% of children with chronic kidney disease, compared with 2.7% of children in the US National Health and Nutrition Examination Survey.
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Affiliation(s)
- Kelsey L Richardson
- Department of Pediatrics, Division of Pediatric Nephrology, Oregon Health & Science University, Portland, OR.
| | - Noel S Weiss
- Department of Epidemiology, University of Washington, Washington, DC
| | - Susan Halbach
- Department of Pediatrics, Division of Pediatric Nephrology, University of Washington, Seattle, WA
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Flott K, Darzi A, Mayer E. Care pathway and organisational features driving patient experience: statistical analysis of large NHS datasets. BMJ Open 2018; 8:e020411. [PMID: 29982201 PMCID: PMC6042542 DOI: 10.1136/bmjopen-2017-020411] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 05/21/2018] [Accepted: 05/24/2018] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE The aim of this study was to identify the care pathway and organisational factors that predict patient experience. DESIGN Statistical analysis of large National Health Service (NHS) datasets. SETTING ANDPARTICIPANTS England; acute NHS organisational-level data. PRIMARY AND SECONDARY OUTCOME MEASURES The relationship of care pathway and organisational variables to organisation-level patient experience. RESULTS A framework of 18 care pathway and organisational variables were created based on the existing literature. 11 of these correlated to patient experience in univariate analyses. Multicollinearity tests resulted in 1 of the 11 variables holding a correlation to another variable larger than r=0.70. A significant multilinear regression equation, including the final 10 variables, was found (F(10,108)=6.214, p<0.00), with an [Formula: see text] of 0.365. Two variables were significant in predicting better in patient experience: Amount of support to clinical staff (beta=0.2, p=0.02) and the proportion of staff who would recommend the trust as a place to work or receive treatment (beta=0.26, p=0.01). Two variables were significant in predicting a negative impact on the patient's rating of their experience: Number of patients spending over 4 hours from decision to admit to admission (beta=-1.99, p=0.03) and the percentage of estates and hotel services contracted out (beta=-0.23, p=0.01). CONCLUSIONS These results indicate that augmenting clinical support and investing in the mechanisms that facilitate positive staff experience is essential to delivering appropriate, informative and patient-centric care. Reducing wait times and the extent of external contracting within hospitals is also likely to improve patient ratings of experience. Understanding the relationship between patient experience and objective, measurable organisational features promote a more patient-centric interpretation of quality and compel a better use of patient experience feedback to drive improvement.
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Affiliation(s)
- Kelsey Flott
- NIHR Imperial Patient Safety Translational Research Centre (PSTRC), Imperial College London, London, UK
| | - Ara Darzi
- Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Erik Mayer
- Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, London, UK
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Patel NJ, Datye KA, Jaser SS. Importance of Patient-Provider Communication to Adherence in Adolescents with Type 1 Diabetes. Healthcare (Basel) 2018; 6:E30. [PMID: 29597246 PMCID: PMC6023481 DOI: 10.3390/healthcare6020030] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 03/19/2018] [Accepted: 03/26/2018] [Indexed: 01/15/2023] Open
Abstract
Effective communication between pediatric diabetes patients and their providers has the potential to enhance patient satisfaction and health outcomes, as well as improve diabetes-related self-management. In this review, we highlight the importance of communication between patients and providers, focusing on the effect of communication on adherence in the high-risk population of adolescents with type 1 diabetes. We synthesize the literature describing patient-provider communication in pediatric populations and provide implications for practice that focus on the most relevant, modifiable factors for improving self-management in adolescents with type 1 diabetes.
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Affiliation(s)
- Niral J Patel
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
| | - Karishma A Datye
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
| | - Sarah S Jaser
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
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Berg CA, Butner J, Wiebe DJ, Lansing AH, Osborn P, King PS, Palmer DL, Butler JM. Developmental model of parent-child coordination for self-regulation across childhood and into emerging adulthood: Type 1 diabetes management as an example. DEVELOPMENTAL REVIEW 2017; 46:1-26. [DOI: 10.1016/j.dr.2017.09.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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van Boven JFM, Ryan D, Eakin MN, Canonica GW, Barot A, Foster JM. Enhancing Respiratory Medication Adherence: The Role of Health Care Professionals and Cost-Effectiveness Considerations. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 4:835-46. [PMID: 27587317 DOI: 10.1016/j.jaip.2016.03.007] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 03/18/2016] [Accepted: 03/23/2016] [Indexed: 12/13/2022]
Abstract
Adherence to medication comprises a multiphased temporal process involving (1) initiation of prescribed therapy, (2) implementation as prescribed, and (3) subsequent persistence. Medication adherence remains suboptimal in most patients with long-term respiratory conditions such as asthma and chronic obstructive pulmonary disease (COPD). Interventions have been shown to effectively improve treatment initiation, implementation, and persistence when delivered at the health care professional level or the system level, but demonstration of the cost-effectiveness of these interventions is necessary to ensure their widespread use. This review summarizes how health care professionals can intervene to improve medication adherence in patients with asthma and COPD, provides some examples of effective primary care interventions, and illustrates some of the challenges to optimal implementation arising from cost-effectiveness modeling. Improving adherence is shown to be an economically viable treatment option for patients with asthma and COPD, but there are differences in the health economics pertaining to each condition and setting that can affect whether an intervention is considered cost-effective. Targeting adherence interventions at patients with the greatest to gain, and tailoring them to individual patient needs, may help to optimize cost-effectiveness ratios and improve the probability of positive reimbursement decisions, systemwide implementation, and resultant health benefits.
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Affiliation(s)
- Job F M van Boven
- Department of Primary Care, Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Unit of Pharmacoepidemiology & Pharmacoeconomics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands.
| | - Dermot Ryan
- Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Michelle N Eakin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Md
| | - Giorgio W Canonica
- Allergy and Respiratory Diseases Clinica, DIMI Department of Internal Medicine, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - Aji Barot
- Patient Connect Service, Surrey, United Kingdom
| | - Juliet M Foster
- Clinical Management Group, Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia
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Coburn SS, Eakin MN, Roter D, Pruette C, Brady T, Mendley S, Tuchman S, Fivush B, Riekert KA. Patient-provider communication in nephrology care for adolescents and young adults. PATIENT EDUCATION AND COUNSELING 2017; 100:1680-1687. [PMID: 28433407 PMCID: PMC6476325 DOI: 10.1016/j.pec.2017.03.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 03/17/2017] [Accepted: 03/22/2017] [Indexed: 05/19/2023]
Abstract
OBJECTIVE To compare the relative quantity of talk between providers, caregivers, and adolescents and young adults (AYAs) with chronic kidney disease (CKD) and how communication differs by age. METHODS During nephrology clinic visits, conversations between AYAs with CKD (N=99, ages 11-20, median=15), their caregivers, and providers (N=19) were audiotaped and coded using the Roter Interaction Analysis System. Linear mixed models tested AYA age differences in talk frequency by AYAs, caregivers, and providers. Post-hoc analyses tested differences in talk using AYA age groups. RESULTS During clinic visits, providers spoke the most (63.7%), and caregivers spoke more (22.6%) than AYAs (13.7%). Overall talk differed by AYA age in AYAs (p<0.001) and caregivers (p<0.05), but not providers. Higher AYA age was associated with more AYA talk (biomedical information-giving, partnering, rapport-oriented) and less caregiver biomedical information-giving (ps<0.001-0.05). In post-hoc analyses, young adults talked more than adolescents; caregiver talk decreased in the middle-adolescent group. CONCLUSIONS Increases in AYA talk occur primarily in young adulthood, whereas caregiver talk decreases in middle adolescence. This may indicate an appropriate developmental shift but raises concerns about conversational gaps during middle-adolescence. PRACTICE IMPLICATIONS During transition-oriented treatment planning, providers should engage both AYAs and caregivers to avoid potential gaps in communication.
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Affiliation(s)
- S S Coburn
- The Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - M N Eakin
- The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - D Roter
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - C Pruette
- The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - T Brady
- The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - S Mendley
- The University of Maryland School of Medicine, Baltimore, MD, USA
| | - S Tuchman
- Children's National Health System, Washington, D.C., USA
| | - B Fivush
- The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - K A Riekert
- The Johns Hopkins School of Medicine, Baltimore, MD, USA
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Lockyer J, Bursey F, Richardson D, Frank JR, Snell L, Campbell C. Competency-based medical education and continuing professional development: A conceptualization for change. MEDICAL TEACHER 2017; 39:617-622. [PMID: 28598738 DOI: 10.1080/0142159x.2017.1315064] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Competency-based medical education (CBME) is as important in continuing professional development (CPD) as at any other stage of a physician's career. Principles of CBME have the potential to revolutionize CPD. Transitioning to CBME-based CPD will require a cultural change to gain commitment from physicians, their employers and institutions, CPD providers, professional organizations, and medical regulators. It will require learning to be aligned with professional and workplace standards. Practitioners will need to develop the expertise to systematically examine their own clinical performance data, identify performance improvement opportunities and possibilities, and develop a plan to address areas of concern. Health care facilities and systems will need to produce data on a regular basis and to develop and train CPD educators who can work with physician groups. Stakeholders, such as medical regulatory authorities who are responsible for licensing physicians and other standard-setting bodies that credential and develop maintenance-of-certification systems, will need to change their paradigm of competency enhancement through CPD.
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Affiliation(s)
- Jocelyn Lockyer
- a Cumming School of Medicine, University of Calgary , Calgary , Canada
| | - Ford Bursey
- b Faculty of Medicine, Memorial University of Newfoundland , St John's , Canada
| | - Denyse Richardson
- c Department of Medicine , University of Toronto , Toronto , Canada
- d Royal College of Physicians and Surgeons of Canada , Ottawa , Canada
| | - Jason R Frank
- d Royal College of Physicians and Surgeons of Canada , Ottawa , Canada
- f Department of Emergency Medicine , University of Ottawa , Ottawa , Canada
| | - Linda Snell
- d Royal College of Physicians and Surgeons of Canada , Ottawa , Canada
- e Centre for Medical and Department of General Internal Medicine , McGill University , Montreal , Canada
| | - Craig Campbell
- d Royal College of Physicians and Surgeons of Canada , Ottawa , Canada
- g Department of Medicine , University of Ottawa , Ottawa , Canada
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De Nadai AS, Karver MS, Murphy TK, Cavitt MA, Alvaro JL, Bengtson M, Stock S, Rakhshani AC, Storch EA. Common Factors in Pediatric Psychiatry: A Review of Essential and Adjunctive Mechanisms of Treatment Outcome. J Child Adolesc Psychopharmacol 2017; 27:10-18. [PMID: 27128785 PMCID: PMC5326981 DOI: 10.1089/cap.2015.0263] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The purpose of this article is to review the literature on hypothesized behavioral correlates of pharmacotherapy treatment response. A particular focus is placed on what have been referred to as "common factors" across mental health treatments, including medication adherence, therapeutic alliance, motivation for behavior change, and expectancies for positive treatment outcomes. These understudied factors may provide unique explanations for mechanisms of symptom change, patient risk as a result of protocol deviation, and attenuated treatment outcomes. METHOD A literature search was conducted to evaluate the relationship between treatment processes in pediatric psychiatry and medication adherence, therapeutic alliance, motivation for behavior change, and expectancies for positive treatment outcomes. RESULTS Substantial variability and room for improvement was identified for each common factor. Behavioral protocols have already been developed to address many aspects of common factors in pediatric psychiatric treatment, but are not yet a part of many practice parameters. CONCLUSION Interventions to improve common factors can be used immediately in tandem with psychopharmacological interventions to provide increased symptom relief and reduce patient risk. Furthermore, incorporating instruction in common factors interventions can positively affect training of future providers and enhance understanding of the mechanisms of effect of medications. An increased focus on common factors, with a particular emphasis on quantifying the magnitude and mechanisms of their effects on psychopharmacological interventions stand to benefit child patients, their families, treatment providers, training facilities, and pharmaceutical manufacturers.
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Affiliation(s)
- Alessandro S. De Nadai
- Department of Pediatrics, Rothman Center for Pediatric Neuropsychiatry, University of South Florida Morsani College of Medicine, Tampa, Florida
- Department of Psychiatry, University of South Florida, Tampa, Florida
- Department of Psychology, University of South Florida, Tampa, Florida
| | - Marc S. Karver
- Department of Psychology, University of South Florida, Tampa, Florida
| | - Tanya K. Murphy
- Department of Pediatrics, Rothman Center for Pediatric Neuropsychiatry, University of South Florida Morsani College of Medicine, Tampa, Florida
- Department of Psychiatry, University of South Florida, Tampa, Florida
| | - Mark A. Cavitt
- Department of Psychiatry, University of South Florida, Tampa, Florida
- All Children's Hospital—Johns Hopkins Medicine, St. Petersburg, Florida
| | - Jeffrey L. Alvaro
- Department of Psychiatry, University of South Florida, Tampa, Florida
- All Children's Hospital—Johns Hopkins Medicine, St. Petersburg, Florida
| | | | - Saundra Stock
- Department of Psychiatry, University of South Florida, Tampa, Florida
| | | | - Eric A. Storch
- Department of Pediatrics, Rothman Center for Pediatric Neuropsychiatry, University of South Florida Morsani College of Medicine, Tampa, Florida
- Department of Psychiatry, University of South Florida, Tampa, Florida
- Department of Psychology, University of South Florida, Tampa, Florida
- All Children's Hospital—Johns Hopkins Medicine, St. Petersburg, Florida
- Rogers Behavioral Health—Tampa Bay, Tampa, Florida
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Cox ED, Swedlund MP, Young HN, Moreno MA, Schopp JM, Rajamanickam V, Panepinto JA. Family Engagement in Pediatric Sickle Cell Disease Visits. HEALTH COMMUNICATION 2017; 32:51-59. [PMID: 27159356 PMCID: PMC5551046 DOI: 10.1080/10410236.2015.1099503] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Adults with sickle cell disease (SCD) report problems in relationship building and information exchange during clinic visits. To explore the origin of these communication challenges, we compare communication in pediatric SCD, diabetes, and asthma visits. We collected visit videos and parent surveys from 78 children ages 9-16 years with SCD, asthma, or diabetes. Coders assessed child, parent, and physician utterances reflecting relationship building, information giving, and information gathering. Associations of engagement with type of chronic disease visit were performed with negative binomial regression. Compared to SCD visits, children in diabetes visits spoke 53% more relationship-building utterances (p < .05) and physicians in asthma visits spoke 48% fewer relationship building utterances to the child (p < .01). In diabetes visits, physicians gave almost twice as much information to children and gave 48% less information to parents (both p < .01) compared to SCD visits. Compared to SCD visits, physicians spoke fewer information-gathering utterances to parents in diabetes and asthma visits (85% and 72% respectively, both p < .001). SCD visits reflect less engagement of the children and greater physician effort to gather information from parents. These differences highlight opportunities to enhance engagement as a mechanism for ultimately improving SCD care.
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Affiliation(s)
- Elizabeth D. Cox
- Department of Pediatrics, University of Wisconsin School of Medicine
and Public Health
| | - Matthew P. Swedlund
- Department of Family Medicine, University of Wisconsin School of
Medicine and Public Health
| | - Henry N. Young
- Department of Clinical and Administrative Pharmacy, University of
Georgia
| | - Megan A. Moreno
- Department of Pediatrics, University of Wisconsin School of Medicine
and Public Health
| | - Jennifer M. Schopp
- Department of Pediatrics, University of Wisconsin School of Medicine
and Public Health
| | - Victoria Rajamanickam
- Department of Biostatistics and Medical Informatics, University of
Wisconsin School of Medicine and Public Health
| | - Julie A. Panepinto
- Department of Pediatrics, Hematology/Oncology/Bone Marrow
Transplant, Medical College of Wisconsin, Children's Hospital of
Wisconsin
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KOHLSDORF M, COSTA JUNIOR ÁL, MARQUES FD. Effects of pre-consultation lists on the communicative behavior of children with cancer and their caregivers. ESTUDOS DE PSICOLOGIA (CAMPINAS) 2016. [DOI: 10.1590/1982-02752016000400006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract This cross-sectional study present effects of pre-consultation lists on caregivers' and children's communicative behavior. Thirty-two dyads caregiver-child took part in this research, divided in three groups concerning the study design: Baseline 1, Intervention phase, and Baseline 2. Children and caregivers were individually interviewed before consultations on pediatric cancer treatment, in order to list doubts, expectations, and estimated issues to the medical visit. These themes were written down on a sheet of paper, attached to the child´s medical record cover, and would then be used as a memo in the following consultation. Results show that pre-consultation lists produced no effects on children's behavior, however the procedure was associated to specific doubts discussed by caregivers regarding dietary recommendations, coping with side effects, child development, biological aspects of cancer, and school activities. This study presents a low cost procedure that may contribute to tailor communication in pediatric settings.
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Brouwer ML, Wijngaart LSVD, Hugen CAC, Gerrits GPJM, Roukema J, Merkus PJFM. Evaluation of monitoring strategies for childhood asthma. Expert Rev Respir Med 2016; 10:1199-1209. [PMID: 27666112 DOI: 10.1080/17476348.2016.1240034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The goal of monitoring pediatric asthma is to obtain and maintain asthma control, which is defined as minimizing asthma symptoms, restrictions to daily activities and the use of rescue medication. Long term goals include reducing the risk of fixed airflow limitation, and preventing asthma exacerbations and side effects of treatment. Several monitoring tools are available but no consensus exists on how to monitor patients in the most optimal way. Areas covered: In this review, we provide an overview of different tools and address general considerations on monitoring childhood asthma. Asthma care should be tailored to the individual patient. The health care professional should decide which monitoring strategy and frequency is optimal for the individual patient. Expert commentary: Personalized medicine should be the key issue in monitoring asthma in children. It is crucial to monitor disease activity and deterioration but there is no monitoring strategy that is clearly superior compared to others: The optimal strategy and frequency will vary between patients. Actually, both treatment and monitoring of pediatric asthma probably benefit from a personalized approach.
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Affiliation(s)
- M L Brouwer
- a Department of pediatrics , Canisius Wilhelmina Hospital , Nijmegen , The Netherlands
| | - L S van den Wijngaart
- b Amalia children's hospital, department of pediatrics, division of respiratory medicine , Radboud University Medical Centre , Nijmegen , The Netherlands
| | - C A C Hugen
- c Department of pediatrics , University Centre for Chronic Diseases (Dekkerswald) , Nijmegen , The Netherlands
| | - G P J M Gerrits
- a Department of pediatrics , Canisius Wilhelmina Hospital , Nijmegen , The Netherlands
| | - J Roukema
- b Amalia children's hospital, department of pediatrics, division of respiratory medicine , Radboud University Medical Centre , Nijmegen , The Netherlands
| | - P J F M Merkus
- a Department of pediatrics , Canisius Wilhelmina Hospital , Nijmegen , The Netherlands.,b Amalia children's hospital, department of pediatrics, division of respiratory medicine , Radboud University Medical Centre , Nijmegen , The Netherlands
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Eneriz-Wiemer M, Saynina O, Sundaram V, Lee HC, Bhattacharya J, Sanders LM. Parent Language: A Predictor for Neurodevelopmental Follow-up Care Among Infants With Very Low Birth Weight. Acad Pediatr 2016; 16:645-52. [PMID: 27130810 DOI: 10.1016/j.acap.2016.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 04/05/2016] [Accepted: 04/19/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Preterm/very low birth weight infants may suffer neurodevelopmental delays. Pediatricians should monitor neurodevelopment and pursue timely referrals. Yet parents who speak non-English primary languages (NEPL) report worse health care communication and fewer appropriate specialty referrals for their children. We sought to determine whether infants of NEPL parents receive recommended outpatient follow-up care for neurodevelopment. We hypothesized that these infants received less care than infants of English speakers. METHODS We linked paid claims from California Children's Services to clinical data from California Perinatal Quality Care Collaborative (58% linkage rate, 1541 subjects) for publicly insured infants with birth weight <1500 g or gestational age ≤32 weeks. Our primary outcomes were completion of 1) preventive visits and 2) ophthalmology visits; and receipt of 3) influenza vaccination and 4) palivizumab. To compare group differences, we also assessed 5) hospital length of stay and 6) readmissions. Analyses were adjusted for medical severity and sociodemographic characteristics. RESULTS A total of 433 infants (28%) had NEPL parents. Infants of NEPL parents had 38% higher odds of receiving influenza vaccination (95% confidence interval 9-75, P = .008) and completed 8% more preventive visits (95% confidence interval 1-64, P = .019) than infants of English speakers. Infants of NEPL parents did not have longer lengths of stay or more readmissions. CONCLUSIONS Infants of NEPL parents were more likely than infants of English speakers to receive some aspects of recommended outpatient follow-up care. Regardless of language, all infants received far lower rates of follow-up care than recommended by national guidelines. Future study should address the causes of these gaps.
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Affiliation(s)
- Monica Eneriz-Wiemer
- Department of Pediatrics, Palo Alto Medical Foundation, Palo Alto, Calif; Division of General Pediatrics, Stanford University School of Medicine, Los Gatos, Calif.
| | - Olga Saynina
- Center for Policy, Outcomes, and Prevention, Stanford University, Stanford, Calif
| | - Vandana Sundaram
- Quantitative Services Unit, Stanford University School of Medicine, Palo Alto, Calif
| | - Henry C Lee
- Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, Calif; California Perinatal Quality Care Collaborative, Stanford, Calif
| | - Jay Bhattacharya
- Center for Health Policy/Center for Primary Care and Outcomes Research, Stanford, Calif
| | - Lee M Sanders
- Division of General Pediatrics, Stanford University School of Medicine, Los Gatos, Calif; Center for Policy, Outcomes, and Prevention, Stanford University, Stanford, Calif
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Kohlsdorf M, Costa Junior ÁL. Associations between clinical and sociodemographic data and patterns of communication in pediatric oncology. PSICOLOGIA-REFLEXAO E CRITICA 2016. [DOI: 10.1186/s41155-016-0028-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Abstract
OBJECTIVES Guidelines recommend close follow-up during the treatment of childhood functional constipation. Only sparse evidence exists on how follow-up is best implemented. Our aim was to evaluate whether follow-up by phone or self-management through Web-based information improved treatment outcomes. METHODS In this randomized controlled trial, conducted in secondary care, 235 children, ages 2 to 16 years, who fulfilled the Rome III criteria of childhood constipation, were assigned to 1 of the 3 follow-up regimens: control group (no scheduled contact), phone group (2 scheduled phone contacts), and Web group (access to Web-based information). PRIMARY OUTCOME number of successfully treated children after 3, 6, and 12 months. SECONDARY OUTCOMES phone contacts, relapse, fecal incontinence, and laxative use. RESULTS After 3 and 6 months, significantly more children in the Web group (79.7%/75.9%) were successfully treated compared with the control and phone groups (59.7%/63.6% and 63.3%/64.6%) (P = 0.007/P = 0.03). No difference was found after 12 months (control, 72.7%; phone, 68.4%; Web group, 78.5%; P = 0.40). Extra phone consultations were significantly more frequent in the Web group (44.3%) compared with the control group (28.6%) (P = 0.04). Before 3 months, 45.5% of phone consultations were completed in the Web group versus 28.8% and 25.8% in the control and phone groups (P = 0.05/P = 0.02). Relapses, fecal incontinence, and laxative use were not different between interventions. CONCLUSIONS Improved self-management behavior caused by access to self-motivated Web-based information induced faster short-term recovery during the treatment of functional constipation. Patient empowerment rather than health care-promoted follow-up may be a step toward more effective treatment for childhood constipation.
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Pai ALH, McGrady ME. Assessing Medication Adherence as a Standard of Care in Pediatric Oncology. Pediatr Blood Cancer 2015; 62 Suppl 5:S818-28. [PMID: 26700926 DOI: 10.1002/pbc.25795] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 09/08/2015] [Accepted: 09/10/2015] [Indexed: 11/08/2022]
Abstract
Poor adherence to pediatric cancer treatment protocols may prevent children and adolescents from realizing the potential benefits of therapy. This paper presents the evidence for a standard of care for supporting medication adherence. Databases were reviewed for articles examining adherence and including children and/or adolescents with cancer. Fourteen articles (i.e., qualitative, quantitative, review, and randomized clinical trials) were evaluated for rigor. There is moderate-quality evidence to support a strong recommendation for adherence to be assessed routinely and monitored throughout the treatment. Integrating the proposed clinical procedures into standard clinical care may improve outcomes for children and adolescents with cancer.
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Affiliation(s)
- Ahna L H Pai
- Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Division of Behavioral Medicine and Clinical Psychology, Center for Adherence and Self-Management, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Meghan E McGrady
- Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Division of Behavioral Medicine and Clinical Psychology, Center for Adherence and Self-Management, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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34
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Atasoy N, Şenormanci Ö, Saraçli Ö, Doğan V, Kaygisiz İ, Atik L, Örsel S. The Effect of Dressing Styles and Attitudes of Psychiatrists on Treatment Preferences: Comparison between Patients and Psychiatrists. Noro Psikiyatr Ars 2015; 52:380-385. [PMID: 28360744 DOI: 10.5152/npa.2015.8767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 06/20/2014] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Recently, different dressing styles and attitudes of psychiatrists have been proposed to enhance the interaction between patients and the physician. The aim of the present study was to investigate the preferences of dressing style and attitudes of a psychiatrist of the patients referred to an outpatient psychiatry clinic and the perception of psychiatrists regarding the preferences of the patients. METHODS One hundred and fifty-three patients referred to the outpatient psychiatry clinic of the Bülent Ecevit University School of Medicine, and 94 psychiatrists have been included in the present study. RESULTS When the images of psychiatrists were evaluated in terms of referral for treatment, trust in treatment, and willingness to share their confidential matters, both groups gave minimum scores to causal/sports dress style. While psychiatrists preferred to dress in a suit, casuals, and white coat, the preference order was white coat, casual dress, and suit in the patient group. There was a significant difference between the groups with respect to three dressing styles. CONCLUSION It can be suggested that psychiatrists assume that patients are traditional in terms of their preference of the dressing style of a doctor and doctor-patient relationship, and a white coat is important to enhance the treatment adherence of patients.
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Affiliation(s)
- Nuray Atasoy
- Department of Psychiatry, Bülent Ecevit University Faculty of Medicine, Zonguldak, Turkey
| | - Ömer Şenormanci
- Department of Psychiatry, Bülent Ecevit University Faculty of Medicine, Zonguldak, Turkey
| | - Özge Saraçli
- Department of Psychiatry, Bülent Ecevit University Faculty of Medicine, Zonguldak, Turkey
| | - Veysel Doğan
- Department of Psychiatry, Bülent Ecevit University Faculty of Medicine, Zonguldak, Turkey
| | - İsmet Kaygisiz
- Department of Psychiatry, Bülent Ecevit University Faculty of Medicine, Zonguldak, Turkey
| | - Levent Atik
- Department of Psychiatry, Bülent Ecevit University Faculty of Medicine, Zonguldak, Turkey
| | - Sibel Örsel
- Department of Psychiatry, Bülent Ecevit University Faculty of Medicine, Zonguldak, Turkey
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Ernst MM, O'Brien HL, Powers SW. Cognitive-Behavioral Therapy: How Medical Providers Can Increase Patient and Family Openness and Access to Evidence-Based Multimodal Therapy for Pediatric Migraine. Headache 2015; 55:1382-96. [PMID: 26198185 PMCID: PMC4715506 DOI: 10.1111/head.12605] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2015] [Indexed: 01/09/2023]
Abstract
Although evidence supports the recommendation for cognitive-behavioral therapy (CBT) for pediatric migraine, few children actually receive this evidence-based intervention. In this article, we briefly review the most recent empirical evidence supporting CBT. We then identify both provider- and system-related barriers as well as patient-related barriers. Finally, we provide practical solutions to addressing these barriers in the service of facilitating children receiving optimal comprehensive management of their headaches.
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Affiliation(s)
- Michelle M Ernst
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Hope L O'Brien
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
- Headache Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Scott W Powers
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
- Headache Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Kohlsdorf M, Costa Junior ÁL. A proposal for a behavioral pre-consultation: Analysis of the use of a protocol during consultations. ESTUDOS DE PSICOLOGIA (CAMPINAS) 2015. [DOI: 10.1590/0103-166x2015000200007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This study aimed to analyze how physicians, caregivers, and children use protocols regarding estimated issues to medical visits, procedure named pre-consultation lists, along treatment for childhood cancer. Three pediatricians and 24 dyads child-caregiver took part; each pair was interviewed before medical visits in order to report doubts, needs and issues estimated to the consultation. This list was attached to child's medical record as a memo of themes to discuss in the next medical visit. Results show that two physicians included effectively this file in their consultations and discussed a great amount of issues listed by caregivers and patients. Children did not refer to the listed issues, but parents, in smaller amounts, discussed the themes in the protocol. This procedure contributed to insert the child in consultations and it may facilitate the focus on specific themes, however the physician's main role in managing communication during pediatric medical visits is highlighted.
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Klok T, Kaptein AA, Brand PLP. Non-adherence in children with asthma reviewed: The need for improvement of asthma care and medical education. Pediatr Allergy Immunol 2015; 26:197-205. [PMID: 25704083 DOI: 10.1111/pai.12362] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/18/2015] [Indexed: 12/31/2022]
Abstract
Adherence to daily inhaled corticosteroid therapy is a key determinant of asthma control. Therefore, improving adherence to inhaled corticosteroids is the most effective method through which healthcare providers can help children with uncontrolled asthma. However, identifying non-adherent patients is difficult, and electronic monitoring is the only reliable method to assess adherence. (Non-)adherence is a complex behavioural process influenced by many interacting factors. Intentional barriers to adherence are common; driven by illness perceptions and medication beliefs, patients and parents deliberately choose not to follow the doctor's recommendations. Common non-intentional barriers are related to family routines, child-raising issues, and to social issues such as poverty. Effective interventions improving adherence are complex, because they take intentional and non-intentional barriers to adherence into account. There is evidence that comprehensive, guideline-based asthma self-management programmes can be successful, with excellent adherence and good asthma control. Patient-centred care focused on healthcare provider-patient/parent collaboration is the key factor determining the success of guided self-management programmes. Such care should focus on shared decision-making as this has been shown to improve adherence and healthcare outcomes. Current asthma care falls short because many physicians fail to adhere to asthma guidelines in their diagnostic approach and therapeutic prescriptions, and because of the lack of application of patient-centred health care. Increased awareness of the importance of patient-centred communication and increased training in patient-centred communication skills of undergraduates and experienced attending physicians are needed to improve adherence to daily controller therapy and asthma control in children with asthma.
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Affiliation(s)
- Ted Klok
- Department of Paediatric Pulmonology and Allergology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands.,Princess Amalia Children's Center, Isala Hospital, Zwolle, the Netherlands
| | - Adrian A Kaptein
- Unit of Psychology, Leiden University Medical Center, Leiden, the Netherlands
| | - Paul L P Brand
- Princess Amalia Children's Center, Isala Hospital, Zwolle, the Netherlands.,UMCG Postgraduate School of Medicine, University Medical Center, University of Groningen, Groningen, the Netherlands
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Leader A, Raanani P. Adherence-related issues in adolescents and young adults with hematological disorders. Acta Haematol 2014; 132:348-62. [PMID: 25228561 DOI: 10.1159/000360197] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Nonadherence to medical recommendations is a widespread problem well documented in a multitude of clinical settings. Nonadherence may adversely affect clinical outcomes such as survival and quality of life and increase health-care-related costs. An understanding of the factors driving nonadherence is key to developing effective adherence-enhancing interventions (AEIs). There are ongoing attempts in contemporary adherence research to better define the various components of adherence, to find optimal measures of adherence and correlations with clinical outcomes, and to create a classification system for AEIs. Nonadherence is also widely prevalent among adolescents and young adults (AYAs) with chronic hematological diseases, affecting up to 50% of patients and increasing with age. Combined use of objective (i.e. electronic monitoring, EM) and subjective (i.e. self-report) measures of adherence may be the preferred approach to assess adherence. The unique physical, social and emotional aspects of the AYA life stage are closely related to intricate causes of nonadherence in AYAs such as problems in transition to adult care. Until proven otherwise, the empirical target in AYAs with hematological disorders should be perfect adherence. Multilevel AEIs, EM feedback and behavioral interventions are among the most effective types of AEIs. Despite the magnitude of the problem, only a handful of AEIs have been evaluated among AYAs with hematological disorders. Thus, this is a field with unmet needs warranting high-quality trials using standardized and well-specified assessment methods and interventions. This review discusses the prevalence, definition, causes and clinical implications of nonadherence among AYAs with hematological disorders, along with strategies to measure and improve adherence.
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Affiliation(s)
- Avi Leader
- Institute of Hematology, Davidoff Center, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
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Antal H, Hossain MJ, Hassink S, Henry S, Fuzzell L, Taylor A, Wysocki T. Audio-video recording of health care encounters for pediatric chronic conditions: observational reactivity and its correlates. J Pediatr Psychol 2014; 40:144-53. [PMID: 24974174 DOI: 10.1093/jpepsy/jsu046] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Audio-video recording of pediatric clinic visits could generate observational reactivity, affecting measures of communication among patients, parents, and clinicians. METHODS We measured observational reactivity in a direct observation study of communication during 155 pediatric visits for any of 5 chronic conditions by coding camcorder awareness behaviors and self-report questionnaires. We analyzed associations between observational reactivity and measures of communication behavior and visit quality. RESULTS Directly observed camcorder awareness behaviors (634 events) comprised 0.59% of all coded events (n = 107,668). Younger children displayed these behaviors more often than did older children (F = 6.47; p < .0001). Clinicians' camcorder awareness declined significantly over successive study visits (t = -2.096; p = .043). Associations of camcorder awareness with objectively scored communication behaviors or self-reported visit quality were negligible. CONCLUSIONS Most recordings included slight evidence of participant camcorder awareness. But there was negligible evidence that camcorder awareness influenced clinic visit communication.
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Affiliation(s)
- Holly Antal
- Nemours, A Children's Health System, Jacksonville, Florida, Nemours, A Children's Health System, Wilmington, Delaware, and Nemours, A Children's Health System, Orlando, Florida
| | - M Jobayer Hossain
- Nemours, A Children's Health System, Jacksonville, Florida, Nemours, A Children's Health System, Wilmington, Delaware, and Nemours, A Children's Health System, Orlando, Florida
| | - Sandra Hassink
- Nemours, A Children's Health System, Jacksonville, Florida, Nemours, A Children's Health System, Wilmington, Delaware, and Nemours, A Children's Health System, Orlando, Florida
| | - Shannon Henry
- Nemours, A Children's Health System, Jacksonville, Florida, Nemours, A Children's Health System, Wilmington, Delaware, and Nemours, A Children's Health System, Orlando, Florida
| | - Lindsay Fuzzell
- Nemours, A Children's Health System, Jacksonville, Florida, Nemours, A Children's Health System, Wilmington, Delaware, and Nemours, A Children's Health System, Orlando, Florida
| | - Alex Taylor
- Nemours, A Children's Health System, Jacksonville, Florida, Nemours, A Children's Health System, Wilmington, Delaware, and Nemours, A Children's Health System, Orlando, Florida
| | - Tim Wysocki
- Nemours, A Children's Health System, Jacksonville, Florida, Nemours, A Children's Health System, Wilmington, Delaware, and Nemours, A Children's Health System, Orlando, Florida
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40
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Abstract
BACKGROUND AND OBJECTIVE Improving medical regimen adherence is essential for maximizing the therapeutic potential of treatments for pediatric chronic illness. Health care providers are uniquely positioned to deliver adherence promotion interventions. However, no studies have summarized the effectiveness of health care provider-delivered adherence interventions. The objective of this study was to describe the effectiveness of health care provider-delivered adherence promotion interventions in improving adherence among children who have chronic illness. Data sources include PubMed, PsycINFO, CINAHL, and Scopus. Studies were included if they were randomized-controlled trials of pediatric interventions aiming to increase adherence to the primary regimen for a chronic illness and at least 1 health care provider delivered the intervention. RESULTS A total of 35 randomized-controlled studies including 4616 children were included. Greater improvements in adherence were observed immediately after health care provider-delivered interventions (d = 0.49; 95% confidence interval, 0.32 to 0.66) than at longer-term follow-up (d = 0.32; 95% confidence interval, 0.10 to 0.54). Treatment effect sizes differed across the adherence behaviors measured. There was significant heterogeneity in treatment effects; however, no moderators of treatment effectiveness were identified. This meta-analysis focused on the published literature. In addition, the majority of studies involved children who had asthma and younger children. CONCLUSIONS Health care provider-delivered interventions for children who have chronic illness can be effective in improving adherence. Gains in adherence are highest immediately after intervention. Future interventions and studies should include multiple methods of assessing adherence, include active comparators, and address long-term maintenance of adherence gains.
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Affiliation(s)
- Yelena P. Wu
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah; and
| | - Ahna L.H. Pai
- Center for Adherence and Self-Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
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Boogerd EA, Noordam C, Verhaak CM. The Sugarsquare study: protocol of a multicenter randomized controlled trial concerning a web-based patient portal for parents of a child with type 1 diabetes. BMC Pediatr 2014; 14:24. [PMID: 24472527 PMCID: PMC3909406 DOI: 10.1186/1471-2431-14-24] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 01/24/2014] [Indexed: 11/10/2022] Open
Abstract
Background Type 1 diabetes demands a complicated disease self-management by child and parents. The overwhelming task of combining every day parenting tasks with demands of taking care of a child with diabetes can have a profound impact on parents, often resulting in increased parenting stress. Tailored disease information, easy accessible communication with healthcare professionals and peer support are found to support parents to adequately cope with the disease and the disease self-management in everyday life. Internet can help facilitate these important factors in usual pediatric diabetes care. Therefore, we will develop a web-based patient portal in addition to usual pediatric diabetes care and subsequently evaluate its efficacy and feasibility. The web-based patient portal, called Sugarsquare, provides online disease information, and facilitates online parent-professional communication and online peer support. We hypothesize that parenting stress in parents of a child with type 1 diabetes will decrease by using Sugarsquare and that Sugarsquare will be feasible in this population. Methods/Design We will test the hypotheses using a multicenter randomized controlled trial. Eligible participants are parents of a child with type 1 diabetes under the age of 13. Parents are excluded when they have no access to the internet at home or limited comprehension of the Dutch language. Participants are recruited offline from seven clinics in the Netherlands. Participants are randomly allocated to an intervention and a control group. The intervention group will receive access to the intervention during the twelve-month study-period; the control group will receive access in the last six months of the study-period. Self-reported parenting stress is the primary outcome in the present study. Data will be gathered at baseline (T0) and at six (T1) and twelve (T2) months following baseline, using online questionnaires. User statistics will be gathered throughout the twelve-month study-period for feasibility. Discussion Dependent on its feasibility and efficacy, the intervention will be implemented into usual pediatric diabetes care. Strengths and limitations of the study are discussed. Trial registration NTR3643 (Dutch Trial Register)
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Affiliation(s)
- Emiel A Boogerd
- Department of Medical Psychology, Radboud university medical center, PO Box 9101, 6500 HB, Nijmegen, the Netherlands.
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Kohlsdorf M, Costa-Junior ÁL. Comunicação em pediatria: revisão sistemática de literatura. ESTUDOS DE PSICOLOGIA (CAMPINAS) 2013. [DOI: 10.1590/s0103-166x2013000400007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A qualidade da comunicação em Pediatria influencia diretamente o sucesso do tratamento, ao promover níveis satisfatórios de adesão, retenção de informações e acolhimento a demandas biopsicossociais. Constituiu objetivo deste trabalho realizar uma revisão sistemática da literatura referente à comunicação em pediatria publicada entre 2000 e 2010. Foram selecionados trabalhos incluídos nas bases de dados PubMed/MedLine, Bireme/BVS e ScienceDirect, Portal de Periódicos da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior e SciELO. Os 61 trabalhos selecionados indicam prevalência de delineamentos descritivos e técnicas de análise qualitativas e quantitativas, em detrimento de estudos experimentais e uso de técnicas mistas para análise de dados. A literatura indica a importância da inclusão do paciente pediátrico no processo de comunicação e do acolhimento a demandas psicossociais, destacando que programas para melhoria da comunicação têm obtido bons resultados. Destaca-se a importância de estudos sistemáticos que possibilitem compreender os fatores envolvidos na comunicação em pediatria e a inserção de programas psicossociais eficientes.
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Abstract
Children and families often have difficulty following prescribed medical treatment for chronic pediatric conditions. Such nonadherence has a significant impact on children's health care outcomes and the costs of their care. This review describes a comprehensive approach to increase treatment adherence in chronic pediatric illnesses and lessen its impact. Key elements of this proposed model of adherence promotion include the following: (1) a core approach to adherence promotion to be implemented by pediatric health care providers; (2) follow-up and ongoing management; and (3) tailoring and targeting specific more intensive family-centered interventions to children and adolescents who demonstrate clinically significant treatment nonadherence or risk for nonadherence. Behavioral specialists have important roles in conducting research on adherence promotion, training health care providers, and delivering services to children and adolescents with clinically significant adherence problems.
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Carpenter DM, Ayala GX, Williams DM, Yeatts KB, Davis S, Sleath B. The relationship between patient-provider communication and quality of life for children with asthma and their caregivers. J Asthma 2013; 50:791-8. [PMID: 23730868 DOI: 10.3109/02770903.2013.808347] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE This study examined whether patient-provider communication is associated with asthma-related quality of life (QOL) and asthma outcomes among children with asthma and their caregivers. METHODS Children ages 8-16 years with asthma and their caregivers (n = 296) were recruited at five pediatric practices in North Carolina. Children and caregivers reported demographic and clinical characteristics immediately after an audio-taped medical visit with their health care provider. During a home visit that took place 1 month after the medical visit, children and caregivers reported asthma-related QOL, and caregivers reported child asthma outcomes, including asthma symptom days and missed school days. Generalized estimating equations were used to determine whether patient-provider communication during the medical visit was associated with child and caregiver QOL and child asthma outcomes 1 month later. RESULTS On average, providers asked caregivers 4.5 questions and asked children 3 questions per visit, whereas caregivers and children asked less than 1 question per visit. Providers asked children more asthma-related questions, caregivers reported better QOL and fewer asthma symptom days 1 month later. Children and caregivers with higher asthma-management self-efficacy at the office visit reported better QOL 1 month later. CONCLUSIONS Mirroring national guideline recommendations, our results suggest that providers should ask children about their asthma during medical visits. Future longitudinal studies should conduct mediation analyses to determine whether asking children asthma-related questions during medical visits increases children's asthma management self-efficacy and ultimately improve outcomes, such as QOL, health care utilization, symptom days and missed school days.
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Affiliation(s)
- Delesha M Carpenter
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
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Doyle C, Lennox L, Bell D. A systematic review of evidence on the links between patient experience and clinical safety and effectiveness. BMJ Open 2013; 3:e001570. [PMID: 23293244 PMCID: PMC3549241 DOI: 10.1136/bmjopen-2012-001570] [Citation(s) in RCA: 1247] [Impact Index Per Article: 113.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 11/02/2012] [Accepted: 11/12/2012] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To explore evidence on the links between patient experience and clinical safety and effectiveness outcomes. DESIGN Systematic review. SETTING A wide range of settings within primary and secondary care including hospitals and primary care centres. PARTICIPANTS A wide range of demographic groups and age groups. PRIMARY AND SECONDARY OUTCOME MEASURES A broad range of patient safety and clinical effectiveness outcomes including mortality, physical symptoms, length of stay and adherence to treatment. RESULTS This study, summarising evidence from 55 studies, indicates consistent positive associations between patient experience, patient safety and clinical effectiveness for a wide range of disease areas, settings, outcome measures and study designs. It demonstrates positive associations between patient experience and self-rated and objectively measured health outcomes; adherence to recommended clinical practice and medication; preventive care (such as health-promoting behaviour, use of screening services and immunisation); and resource use (such as hospitalisation, length of stay and primary-care visits). There is some evidence of positive associations between patient experience and measures of the technical quality of care and adverse events. Overall, it was more common to find positive associations between patient experience and patient safety and clinical effectiveness than no associations. CONCLUSIONS The data presented display that patient experience is positively associated with clinical effectiveness and patient safety, and support the case for the inclusion of patient experience as one of the central pillars of quality in healthcare. It supports the argument that the three dimensions of quality should be looked at as a group and not in isolation. Clinicians should resist sidelining patient experience as too subjective or mood-oriented, divorced from the 'real' clinical work of measuring safety and effectiveness.
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Affiliation(s)
- Cathal Doyle
- NIHR CLAHRC for North West London, Chelsea and Westminster Hospital, London, UK
| | - Laura Lennox
- NIHR CLAHRC for North West London, Chelsea and Westminster Hospital, London, UK
- Department of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, UK
| | - Derek Bell
- NIHR CLAHRC for North West London, Chelsea and Westminster Hospital, London, UK
- Department of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, UK
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Maruani A, Léger J, Giraudeau B, Naouri M, Le Bidre E, Samimi M, Delage M. Effect of physician dress style on patient confidence. J Eur Acad Dermatol Venereol 2012; 27:e333-7. [PMID: 22882283 DOI: 10.1111/j.1468-3083.2012.04665.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND We lack data on how physicians can instill confidence in patients. OBJECTIVES We aimed to determine whether dress style (professional white coat or formal, semiformal or casual attire) affects confidence in the physician by patients (children, teenagers, adults) with dermatology complaints consulting in the hospital or private practice. METHODS Design. Descriptive prospective cross sectional study carried out from July 1, 2008 to July 1, 2009. Setting. Outpatients in the department of dermatology of a French tertiary care hospital, and two dermatological private consulting rooms. Participants and design. Consulting patients were ≥ 7 years and classified as children 7-11 years old, accompanying parents, teenagers (12-17 years), and adults ≥ 18 years consulting alone. Subjects viewed two iconographic boards containing 4 photographs in a random order of a male physician on 1 board and a female physician on the other board in 4 different dress styles: professional (white coat and stethoscope), formal (shirt and tie for men), semiformal, and casual (T-shirt, jeans). Subjects then completed a questionnaire asking them to rate, on a scale of 0-10, their confidence in the physicians portrayed and answered whether they considered physician dress important. Main outcomes and measures. The main outcome was subjects' ranking of photos of physicians by dress style, according to the confidence they felt. For children 7-11 years old, we considered the frequency of the chosen dress style. The secondary outcome was whether physician dress was important to patients. RESULTS We included 329 patients. Children at the hospital most frequently chose the photo of the physician, both male (62%) and female (64%), with the white coat. Teenagers' choices were professional dress, then semiformal, formal, and casual attire. Accompanying adults and adults consulting alone had the same ranking. CONCLUSIONS In France, patients of all ages who consult for dermatology complaints in hospital and in private practice have the most confidence in a physician who wears a professional white coat.
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Affiliation(s)
- A Maruani
- University François Rabelais Tours CHRU Tours, Department of Dermatology CHRU Tours, Clinical Investigation Center, Inserm 202, Tours, France
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Hansson M. Where should we draw the line between quality of care and other ethical concerns related to medical registries and biobanks? THEORETICAL MEDICINE AND BIOETHICS 2012; 33:313-323. [PMID: 22810581 DOI: 10.1007/s11017-012-9229-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Together with large biobanks of human samples, medical registries with aggregated data from many clinical centers are vital parts of an infrastructure for maintaining high standards of quality with regard to medical diagnosis and treatment. The rapid development in personalized medicine and pharmaco-genomics only underscores the future need for these infrastructures. However, registries and biobanks have been criticized as constituting great risks to individual privacy. In this article, I suggest that quality with regard to diagnosis and treatment is an inherent, morally normative requirement of health care, and argue that quality concerns in this sense may be balanced with privacy concerns.
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Affiliation(s)
- Mats Hansson
- Department of Public Health and Caring Sciences, Centre for Research Ethics & Bioethics, Uppsala University, P.O. Box 564, 751 22, Uppsala, Sweden.
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Farnesi BC, Ball GDC, Newton AS. Family-health professional relations in pediatric weight management: an integrative review. Pediatr Obes 2012; 7:175-86. [PMID: 22492659 DOI: 10.1111/j.2047-6310.2012.00029.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Revised: 11/14/2011] [Accepted: 12/09/2011] [Indexed: 11/30/2022]
Abstract
In this integrative review, we examined contemporary literature in pediatric weight management to identify characteristics that contribute to the relationship between families and health professionals and describe how these qualities can inform healthcare practices for obese children and families receiving weight management care. We searched literature published from 1980 to 2010 in three electronic databases (MEDLINE, PsycINFO and CINAHL). Twenty-four articles identified family-health professional relationships were influenced by the following: health professionals' weight-related discussions and approaches to care; and parents' preferences regarding weight-related terminology and expectations of healthcare delivery. There was considerable methodological heterogeneity in the types of reports (i.e. qualitative studies, review articles, commentaries) included in this review. Overall, the findings have implications for establishing a positive clinical relationship between families and health professionals, which include being sensitive when discussing weight-related issues, using euphemisms when talking about obesity, demonstrating a non-judgmental and supportive attitude and including the family (children and parents) in healthcare interactions. Experimental research, clinical interventions and longitudinal studies are needed to build on the current evidence to determine how best to establish a collaborative partnership between families and health professionals and whether such a partnership improves treatment adherence, reduces intervention attrition and enhances pediatric weight management success.
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Affiliation(s)
- B C Farnesi
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
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Abstract
This article is intended to assist educators in the medical field in promoting competency among medical students and trainees on the key issues in child and adolescent depression, including approach, understanding, and management. Using clinical vignettes, up-to-date research, and expert opinion and referencing accessible guidelines, resources, and tools, the authors' goal is to create information that is engaging and useful. It is designed to reach a broad audience with emphasis on trainees who are early in their career path (eg, medical students or interns) and/or who are going into primary care.
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Affiliation(s)
- Robert Li Kitts
- Department of Psychiatry, Children's Hospital Boston and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
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Kit BK, Simon AE, Ogden CL, Akinbami LJ. Trends in preventive asthma medication use among children and adolescents, 1988-2008. Pediatrics 2012; 129:62-9. [PMID: 22144697 DOI: 10.1542/peds.2011-1513] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To examine trends in preventive asthma medication (PAM) use among children with current asthma in the United States from 1988 to 2008. METHODS We performed a cross-sectional analysis of PAM use among 2499 children aged 1 to 19 years with current asthma using nationally representative data from the National Health and Nutrition Examination Survey (NHANES) during 3 time periods: 1988-1994, 1999-2002, and 2005-2008. PAMs included inhaled corticosteroids, leukotriene receptor antagonists, long-acting β-agonists, mast-cell stabilizers, and methylxanthines. RESULTS Among children with current asthma, there was an increase in the use of PAMs from 17.8% (SE: 3.3) in 1988-1994 to 34.9% (SE: 3.3) in 2005-2008 (P < .001 for trend). Adjusting for age, gender, race/ethnicity, and health insurance status, the odds of PAM use were higher in 2005-2008 compared with 1988-1994 (adjusted odds ratio [aOR] = 2.6; 95% confidence interval [CI]: 1.5-4.5). A multivariate analysis, combining all 3 time periods, showed lower use of PAMs among non-Hispanic black (aOR = 0.5 [95% CI: 0.4-0.7]) and Mexican American (aOR = 0.6 [95% CI: 0.4-0.9]) children compared to non-Hispanic white children. PAM use was also lower in 12 to 19 year olds compared with 1 to 5 year olds and also in children who did not have health insurance compared with those who did. CONCLUSIONS Between 1988 and 2008, the use of PAM increased among children with current asthma. Non-Hispanic black and Mexican American children, adolescents aged 12 to 19 years, and uninsured children with current asthma had lower use of PAM.
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Affiliation(s)
- Brian K Kit
- Division of Health and Nutrition Examination Surveys, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland, USA.
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