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Inchingolo F, Inchingolo AM, Fatone MC, Avantario P, Del Vecchio G, Pezzolla C, Mancini A, Galante F, Palermo A, Inchingolo AD, Dipalma G. Management of Rheumatoid Arthritis in Primary Care: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:662. [PMID: 38928909 PMCID: PMC11203333 DOI: 10.3390/ijerph21060662] [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: 02/29/2024] [Revised: 05/13/2024] [Accepted: 05/16/2024] [Indexed: 06/28/2024]
Abstract
Rheumatoid arthritis (RA) can lead to severe joint impairment and chronic disability. Primary care (PC), provided by general practitioners (GPs), is the first level of contact for the population with the healthcare system. The aim of this scoping review was to analyze the approach to RA in the PC setting. PubMed, Scopus, and Web of Science were searched using the MESH terms "rheumatoid arthritis" and "primary care" from 2013 to 2023. The search strategy followed the PRISMA-ScR guidelines. The 61 articles selected were analyzed qualitatively in a table and discussed in two sections, namely criticisms and strategies for the management of RA in PC. The main critical issues in the management of RA in PC are the following: difficulty and delay in diagnosis, in accessing rheumatological care, and in using DMARDs by GPs; ineffective communication between GPs and specialists; poor patient education; lack of cardiovascular prevention; and increase in healthcare costs. To overcome these criticisms, several management strategies have been identified, namely early diagnosis of RA, quick access to rheumatology care, effective communication between GPs and specialists, active patient involvement, screening for risk factors and comorbidities, clinical audit, interdisciplinary patient management, digital health, and cost analysis. PC appears to be the ideal healthcare setting to reduce the morbidity and mortality of chronic disease, including RA, if a widespread change in GPs' approach to the disease and patients is mandatory.
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Affiliation(s)
- Francesco Inchingolo
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (P.A.); (G.D.V.); (C.P.); (A.M.); (A.D.I.); (G.D.)
| | - Angelo Michele Inchingolo
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (P.A.); (G.D.V.); (C.P.); (A.M.); (A.D.I.); (G.D.)
| | | | - Pasquale Avantario
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (P.A.); (G.D.V.); (C.P.); (A.M.); (A.D.I.); (G.D.)
| | - Gaetano Del Vecchio
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (P.A.); (G.D.V.); (C.P.); (A.M.); (A.D.I.); (G.D.)
| | - Carmela Pezzolla
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (P.A.); (G.D.V.); (C.P.); (A.M.); (A.D.I.); (G.D.)
| | - Antonio Mancini
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (P.A.); (G.D.V.); (C.P.); (A.M.); (A.D.I.); (G.D.)
| | | | - Andrea Palermo
- College of Medicine and Dentistry, Birmingham B4 6BN, UK
| | - Alessio Danilo Inchingolo
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (P.A.); (G.D.V.); (C.P.); (A.M.); (A.D.I.); (G.D.)
| | - Gianna Dipalma
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (P.A.); (G.D.V.); (C.P.); (A.M.); (A.D.I.); (G.D.)
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Woodward EN, Castillo AIM, True G, Willging C, Kirchner JE. Challenges and promising solutions to engaging patients in healthcare implementation in the United States: an environmental scan. BMC Health Serv Res 2024; 24:29. [PMID: 38178131 PMCID: PMC10768202 DOI: 10.1186/s12913-023-10315-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 11/13/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND One practice in healthcare implementation is patient engagement in quality improvement and systems redesign. Implementers in healthcare systems include clinical leadership, middle managers, quality improvement personnel, and others facilitating changes or adoption of new interventions. Patients provide input into different aspects of health research. However, there is little attention to involve patients in implementing interventions, especially in the United States (U.S.), and this might be essential to reduce inequities. Implementers need clear strategies to overcome challenges, and might be able to learn from countries outside the U.S. METHODS We wanted to understand existing work about how patients are being included in implementation activities in real world U.S. healthcare settings. We conducted an environmental scan of three data sources: webinars, published articles, and interviews with implementers who engaged patients in implementation activities in U.S. healthcare settings. We extracted, categorized, and triangulated from data sources the key activities, recurring challenges, and promising solutions using a coding template. RESULTS We found 27 examples of patient engagement in U.S. healthcare implementation across four webinars, 11 published articles, and seven interviews, mostly arranging patient engagement through groups and arranging processes for patients that changed how engaged they were able to be. Participants rarely specified if they were engaging a population experiencing healthcare inequities. Participants described eight recurring challenges; the two most frequently identified were: (1) recruiting patients representative of those served in the healthcare system; and (2) ensuring processes for equitable communication among all. We matched recurring challenges to promising solutions, such as logistic solutions on how to arrange meetings to enhance engagement or training in inclusivity and power-sharing. CONCLUSION We clarified how some U.S. implementers are engaging patients in healthcare implementation activities using less and more intensive engagement. It was unclear whether reducing inequities was a goal. Patient engagement in redesigning U.S. healthcare service delivery appears similar to or less intense than in countries with more robust infrastructure for this, such as Canada and the United Kingdom. Challenges were common across jurisdictions, including retaining patients in the design/delivery of implementation activities. Implementers in any region can learn from those in other places.
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Affiliation(s)
- Eva N Woodward
- VA Center for Mental Healthcare and Outcomes Research, 2200 Fort Roots Drive, Building 11, North Little Rock, AR, 72114, USA.
- Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 W Markham St, Little Rock, AR, 72205, USA.
| | - Andrea Isabel Melgar Castillo
- VA Center for Mental Healthcare and Outcomes Research, 2200 Fort Roots Drive, Building 11, North Little Rock, AR, 72114, USA
- Graduate School, University of Arkansas for Medical Sciences, 4301 W Markham St, Little Rock, AR, 72205, USA
| | - Gala True
- South Central Mental Illness Research Education and Clinical Center, Southeast Louisiana Veterans Health Care System, 2400 Canal St, New Orleans, LA, 70119, USA
- Section on Community and Population Medicine, School of Medicine, Louisiana State University, 2400 Canal St (11F), New Orleans, LA, USA
| | - Cathleen Willging
- Pacific Institute for Research and Evaluation, 851 University Boulevard, Suite 101, Albuquerque, NM, 87106, USA
| | - JoAnn E Kirchner
- Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 W Markham St, Little Rock, AR, 72205, USA
- Behavioral Health Quality Enhancement Research Initiative (QUERI), Central Arkansas Veterans Healthcare System, 2200 Fort Roots Drive, Building 11, North Little Rock, AR, 72114, USA
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Vanstone M, Canfield C, Evans C, Leslie M, Levasseur MA, MacNeil M, Pahwa M, Panday J, Rowland P, Taneja S, Tripp L, You J, Abelson J. Towards conceptualizing patients as partners in health systems: a systematic review and descriptive synthesis. Health Res Policy Syst 2023; 21:12. [PMID: 36698200 PMCID: PMC9876419 DOI: 10.1186/s12961-022-00954-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 12/23/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND With the sharp increase in the involvement of patients (including family and informal caregivers) as active participants, collaborators, advisors and decision-makers in health systems, a new role has emerged: the patient partner. The role of patient partner differs from other forms of patient engagement in its longitudinal and bidirectional nature. This systematic review describes extant work on how patient partners are conceptualized and engaged in health systems. In doing so, it furthers the understanding of the role and activities of patient partners, and best practices for future patient partnership activities. METHODS A systematic review was conducted of peer-reviewed literature published in English or French that describes patient partner roles between 2000 and 2021 in any country or sector of the health system. We used a broad search strategy to capture descriptions of longitudinal patient engagement that may not have used words such as "partner" or "advisor". RESULTS A total of 506 eligible papers were identified, representing patient partnership activities in mostly high-income countries. These studies overwhelmingly described patient partnership in health research. We identified clusters of literature about patient partnership in cancer and mental health. The literature is saturated with single-site descriptive studies of patient partnership on individual projects or initiatives. There is a lack of work synthesizing impacts, facilitating factors and outcomes of patient partnership in healthcare. CONCLUSIONS There is not yet a consolidated understanding of the role, activities or impacts of patient partners. Advancement of the literature has been stymied by a lack of consistently used terminology. The literature is ready to move beyond single-site descriptions, and synthesis of existing pockets of high-quality theoretical work will be essential to this evolution.
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Affiliation(s)
- Meredith Vanstone
- grid.25073.330000 0004 1936 8227Department of Family Medicine, McMaster University, 1280 Main St W, Hamilton, ON L8S 4K1 Canada ,grid.25073.330000 0004 1936 8227Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, 1280 Main St W, Hamilton, ON L8S 4K1 Canada
| | - Carolyn Canfield
- Patient Advisors Network (PAN), Toronto, ON Canada ,grid.17091.3e0000 0001 2288 9830Department of Family Practice, University of British Columbia, 5950 University Boulevard, Vancouver, BC V6T 1Z3 Canada
| | - Cara Evans
- grid.25073.330000 0004 1936 8227Health Policy PhD Program, McMaster University, 1280 Main St W, Hamilton, ON L8S 4K1 Canada
| | - Myles Leslie
- grid.22072.350000 0004 1936 7697School of Public Policy, University of Calgary, 906 8Th Avenue S.W., Calgary, AB T2P1H9 Canada
| | | | - Maggie MacNeil
- grid.25073.330000 0004 1936 8227Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, 1280 Main St W, Hamilton, ON L8S 4K1 Canada
| | - Manisha Pahwa
- grid.25073.330000 0004 1936 8227Health Policy PhD Program, McMaster University, 1280 Main St W, Hamilton, ON L8S 4K1 Canada ,grid.419887.b0000 0001 0747 0732Occupational Cancer Research Centre, Cancer Care Ontario, Ontario Health, 505 University Avenue, Toronto, ON Canada
| | - Janelle Panday
- grid.25073.330000 0004 1936 8227Department of Family Medicine, McMaster University, 1280 Main St W, Hamilton, ON L8S 4K1 Canada
| | - Paula Rowland
- grid.17063.330000 0001 2157 2938Wilson Centre and Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Canada 1 King’s College Circle, Toronto, ON M5S 1A8 Canada
| | - Shipra Taneja
- grid.25073.330000 0004 1936 8227Department of Family Medicine, McMaster University, 1280 Main St W, Hamilton, ON L8S 4K1 Canada
| | - Laura Tripp
- grid.25073.330000 0004 1936 8227Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4K1 Canada
| | - Jeonghwa You
- grid.25073.330000 0004 1936 8227Health Policy PhD Program, McMaster University, 1280 Main St W, Hamilton, ON L8S 4K1 Canada
| | - Julia Abelson
- grid.25073.330000 0004 1936 8227Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, 1280 Main St W, Hamilton, ON L8S 4K1 Canada ,grid.25073.330000 0004 1936 8227Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4K1 Canada
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de Souza S, Johansson EC, Karlfeldt S, Raza K, Williams R. Patient and public involvement in an international rheumatology translational research project: an evaluation. BMC Rheumatol 2022; 6:83. [PMID: 36273206 PMCID: PMC9588249 DOI: 10.1186/s41927-022-00311-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 10/05/2022] [Indexed: 11/22/2022] Open
Abstract
Background Rheuma Tolerance for Cure (RTCure) is a five-year international collaboration between academia, industry and patients/members of the public. It focuses on developing approaches to predict the onset of rheumatoid arthritis (RA) and designing clinical trials to reduce the risk of disease development through immune-tolerising and other treatments. We conducted a mid-term evaluation of patient and public involvement (PPI) within the project.
Methods Two surveys on PPI were co-designed by the PPI Coordinator, Patient/Public Research Partners (PRPs) and a researcher. Both anonymous, electronic surveys were distributed to 61 researchers and 9 PRPs. Quantitative survey data were analysed using descriptive statistics and free text responses underwent inductive thematic analysis. Results Researcher and Patient response rates were 33% and 78%, respectively. Quantitative Researcher Survey data highlighted that (i) responding researchers represented all seven Work Packages (WPs), (ii) 40% thought PRPs had made a large or extremely large contribution to their own WPs, (iii) 55% thought PPI has had a moderate or large impact on RTCure, (iv) 75% worked with PRPs in RTCure, and (v) 60% said PRPs had affected their research thinking. Quantitative PRP Survey data highlighted that (i) PRPs were most involved in four WPs, (ii) 43% thought they had made a minor contribution to their main WP, (iii) 57% thought PPI has had a small impact on RTCure, and (iv) 57% thought they received too little feedback on the outcome of their contribution to different tasks. Four main themes were identified in both surveys: ‘PRP contributions’, ‘Experiences of PPI’, ‘Impact of PPI on RTCure’, and ‘How PPI can be improved’. Two additional themes from the Researcher Survey were ‘Impact of PPI on researchers’ and ‘Influence on Future Projects’, and from the PRP Survey were ‘Impact of PPI on PRPs’ and ‘Engagement with PRPs’. Conclusion PPI seemed to have a significant impact on RTCure, however, PRPs were less aware. A focus on improving communication between PRPs and researchers (facilitated by the PPI Coordinator), and providing PPI training for researchers is likely to improve involvement. Complex legal agreements for PRPs should be avoided and careful attention paid to appropriate PRP compensation. Supplementary Information The online version contains supplementary material available at 10.1186/s41927-022-00311-w.
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Affiliation(s)
- Savia de Souza
- Centre for Rheumatic Diseases, King's College London, London, SE5 9RJ, UK.
| | - Eva C Johansson
- Swedish Rheumatism Association (Reumatikerförbundet), Box 90337, 120 25, Stockholm, Sweden
| | - Susanne Karlfeldt
- Rheumatology Unit, Karolinska Institutet and Academic Specialist Center, Stockholm Health Services, 171 77, Stockholm, Sweden
| | - Karim Raza
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2WB, UK
| | - Ruth Williams
- Centre for Rheumatic Diseases, King's College London, London, SE5 9RJ, UK
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5
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Tvedten OG, Croker A, Lawrence M, Williams K, Perry N, Croker J. Personalised written consultation summaries for patients: An 'up-close, in-depth, inside-out' exploration of a rheumatologist's patient-centred strategy. PATIENT EDUCATION AND COUNSELING 2022; 105:2362-2370. [PMID: 34920911 DOI: 10.1016/j.pec.2021.11.026] [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: 08/27/2020] [Revised: 11/19/2021] [Accepted: 11/24/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The importance of ensuring that patients understand and remember information from rheumatology consultations is well recognised. However, literature focuses on 'one-size-fits-all' information resources. In this qualitative study our 'upclose, in-depth, inside-out' exploration sought to understand the personalised written consultation summary, a rheumatologist's patient-centred strategy developed through ongoing reflection. METHODS A research team of a rheumatologist, practice nurse, two patients, registrar and researcher used a participatory research approach, collaborative inquiry Semistructured interviews were undertaken with 29 patients. Data analysis was dialogical and iterative, moving from descriptive to conceptual. RESULTS Implicit within the personalised written consultation summary were domains and actions of: INVOLVEMENT in the process (contributing to the content, clarifying and negotiating the content, being present as it is written), CONTINUITY of information (taking the summary, sharing it with others, storing it at home) and SECURITY for ongoing management (owning the summary, being reminded about management plans, having a basis for re-checking). CONCLUSION Aligned with the findings are patient-centred intentions for health literacy, personal health information management and medication adherence. The second highlights an important theoretical basis for patient-centred rheumatology strategies beyond consultations. PRACTICE IMPLICATIONS A model and reflective questions are presented to inform ongoing reflections about patient-centred information strategies.
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Affiliation(s)
- Olav Gjønnes Tvedten
- University of Newcastle, Department of Rural Health, Tamworth, NSW 2340, Australia; Hunter New England Local Health District, Tamworth, NSW 2340, Australia
| | - Anne Croker
- University of Newcastle, Department of Rural Health, Tamworth, NSW 2340, Australia.
| | | | | | - Narelle Perry
- Rheumatology Practice, Tamworth, NSW 2340, Australia
| | - Jim Croker
- University of Newcastle, Department of Rural Health, Tamworth, NSW 2340, Australia; Hunter New England Local Health District, Tamworth, NSW 2340, Australia; Rheumatology Practice, Tamworth, NSW 2340, Australia
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6
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Gukova X, Hazlewood GS, Arbillaga H, MacMullan P, Zimmermann GL, Barnabe C, Choi MY, Barber MRW, Charlton A, Job B, Osinski K, Hartfeld NMS, Knott MW, Pirani P, Barber CEH. Development of an interdisciplinary early rheumatoid arthritis care pathway. BMC Rheumatol 2022; 6:35. [PMID: 35751106 PMCID: PMC9233314 DOI: 10.1186/s41927-022-00267-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/29/2022] [Indexed: 11/28/2022] Open
Abstract
Background To develop an interdisciplinary care pathway for early rheumatoid arthritis (RA) including referral triage, diagnosis, and management. Methods Our process was a four-phase approach. In Phase 1, an anonymous survey was electronically distributed to division rheumatologists. This provided data to a small interprofessional working group of rheumatology team members who drafted an initial care pathway informed by evidence-based practice in Phase 2. In Phase 3, an education day was held with approximately 40 physicians (rheumatologists and rheumatology residents), members of our interprofessional team, and two clinic managers to review the proposed care elements through presentations and small group discussions. The care pathway was revised for content and implementation considerations based on feedback received. Implementation of the care pathway and development of strategies for evaluation is ongoing across multiple practice sites (Phase 4). Results Our care pathway promotes an approach to patient-centered early RA care using an interdisciplinary approach. Care pathway elements include triage processes, critical diagnostics, pre-treatment screening and vaccinations, and uptake of suggested RA pharmacologic treatment using shared decision-making strategies. Pathway implementation has been facilitated by nursing protocols and evaluation includes continuous monitoring of key indicators. Conclusion The ‘Calgary Early RA Care Pathway’ emphasizes a patient-centered and interdisciplinary approach to early RA identification and treatment. Implementation and evaluation of this care pathway is ongoing to support, highest quality care for patients. Supplementary Information The online version contains supplementary material available at 10.1186/s41927-022-00267-x.
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Affiliation(s)
- Xenia Gukova
- Department of Medicine, Cumming School of Medicine, Faculty of Medicine, University of Calgary, 3330 Hospital Drive, NW, Calgary, AB, T2N 4N1, Canada
| | - Glen S Hazlewood
- Department of Medicine, Cumming School of Medicine, Faculty of Medicine, University of Calgary, 3330 Hospital Drive, NW, Calgary, AB, T2N 4N1, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Arthritis Research Canada, Vancouver, Canada
| | - Hector Arbillaga
- Department of Medicine, Cumming School of Medicine, Faculty of Medicine, University of Calgary, 3330 Hospital Drive, NW, Calgary, AB, T2N 4N1, Canada
| | - Paul MacMullan
- Department of Medicine, Cumming School of Medicine, Faculty of Medicine, University of Calgary, 3330 Hospital Drive, NW, Calgary, AB, T2N 4N1, Canada
| | - Gabrielle L Zimmermann
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Learning Health System, Alberta SPOR SUPPORT Unit, Alberta, Canada
| | - Cheryl Barnabe
- Department of Medicine, Cumming School of Medicine, Faculty of Medicine, University of Calgary, 3330 Hospital Drive, NW, Calgary, AB, T2N 4N1, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Arthritis Research Canada, Vancouver, Canada
| | - May Y Choi
- Department of Medicine, Cumming School of Medicine, Faculty of Medicine, University of Calgary, 3330 Hospital Drive, NW, Calgary, AB, T2N 4N1, Canada.,Arthritis Research Canada, Vancouver, Canada
| | - Megan R W Barber
- Department of Medicine, Cumming School of Medicine, Faculty of Medicine, University of Calgary, 3330 Hospital Drive, NW, Calgary, AB, T2N 4N1, Canada
| | | | - Becky Job
- Alberta Health Services, Calgary, Canada
| | | | - Nicole M S Hartfeld
- Department of Medicine, Cumming School of Medicine, Faculty of Medicine, University of Calgary, 3330 Hospital Drive, NW, Calgary, AB, T2N 4N1, Canada
| | | | | | - Claire E H Barber
- Department of Medicine, Cumming School of Medicine, Faculty of Medicine, University of Calgary, 3330 Hospital Drive, NW, Calgary, AB, T2N 4N1, Canada. .,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. .,Arthritis Research Canada, Vancouver, Canada.
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7
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Manhas KP, Olson K, Churchill K, Miller J, Teare S, Vohra S, Wasylak T. Exploring patient centredness, communication and shared decision-making under a new model of care: Community rehabilitation in canada. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:1051-1063. [PMID: 33825236 DOI: 10.1111/hsc.13304] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 12/16/2020] [Accepted: 01/05/2021] [Indexed: 05/27/2023]
Abstract
Patient-centred care and patient engagement in healthcare and health research are widely mandated by funders, health systems and institutions. Increasingly, shared decision-making (SDM) is recognised as promoting patient-centred care. We explore this relationship by studying SDM in the context of integrating novel patient-centred policies in community rehabilitation. There is little research on SDM in rehabilitation, and less so in the critical community context. Patient co-investigators led study co-design. We aimed to describe how patients and providers experience SDM at community rehabilitation sites that adopted a novel, patient-centred Rehabilitation Model of Care (RMoC). Guided by focused ethnography, we conducted focus groups and interviews. Patient and professional participants were recruited from 10 RMoC early-adopter community rehabilitation sites. Sites varied in geography, patient population and provider disciplines. Patient and community engagement researchers used a set-collect-reflect method to document patient perspectives. Researchers captured provider perspectives using a semi-structured question guide. We completed 11 focus groups and 18 interviews (n = 45 providers, n = 17 patients). We found that most early-adopter providers spoke in a shared, patient-first language that focused on patient readiness, barriers and active listening. Congruent patient perceptions reflected inclusion in decision-making, goal setting and positive relationships. Many patients queried how care would become and remain accessible before and after community rehabilitation care respectively. Remaining connected while in the community was described as important to patients. Providers identified barriers like time, team dynamics and lack of clarity on the RMoC aims, which challenged the initiative's long-term sustainability. Policy innovations can promote SDM and communication through multiple strategies and training to facilitate candid, encouraging conversations. Sustainability of SDM gains is paramount. Most providers moved beyond tokenistic engagement, but competing responsibilities and team member resistance could thwart continuity. Further research is needed to empirically assess respectful and compassionate communication and SDM in community rehabilitation long term.
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Affiliation(s)
- Kiran Pohar Manhas
- Alberta Health Services, Calgary, Canada
- Integrative Health Institute, University of Alberta, Edmonton, Canada
| | - Karin Olson
- Integrative Health Institute, University of Alberta, Edmonton, Canada
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Katie Churchill
- Alberta Health Services, Calgary, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Occupational Therapy, University of Alberta, Edmonton, Canada
| | - Jean Miller
- Patient and Community Engagement Research Program, O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
| | - Sylvia Teare
- Patient and Community Engagement Research Program, O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
| | - Sunita Vohra
- Integrative Health Institute, University of Alberta, Edmonton, Canada
- Departments of Pediatrics and Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Tracy Wasylak
- Alberta Health Services, Calgary, Canada
- Faculty of Nursing, University of Calgary, Calgary, Canada
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8
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Lloyd N, Kenny A, Hyett N. Evaluating health service outcomes of public involvement in health service design in high-income countries: a systematic review. BMC Health Serv Res 2021; 21:364. [PMID: 33879149 PMCID: PMC8056601 DOI: 10.1186/s12913-021-06319-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 03/26/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Internationally, it is expected that health services will involve the public in health service design. Evaluation of public involvement has typically focused on the process and experiences for participants. Less is known about outcomes for health services. The aim of this systematic review was to a) identify and synthesise what is known about health service outcomes of public involvement and b) document how outcomes were evaluated. METHODS Searches were undertaken in MEDLINE, EMBASE, The Cochrane Library, PsycINFO, Web of Science, and CINAHL for studies that reported health service outcomes from public involvement in health service design. The review was limited to high-income countries and studies in English. Study quality was assessed using the Mixed Methods Appraisal Tool and critical appraisal guidelines for assessing the quality and impact of user involvement in health research. Content analysis was used to determine the outcomes of public involvement in health service design and how outcomes were evaluated. RESULTS A total of 93 articles were included. The majority were published in the last 5 years, were qualitative, and were located in the United Kingdom. A range of health service outcomes (discrete products, improvements to health services and system/policy level changes) were reported at various levels (service level, across services, and across organisations). However, evaluations of outcomes were reported in less than half of studies. In studies where outcomes were evaluated, a range of methods were used; most frequent were mixed methods. The quality of study design and reporting was inconsistent. CONCLUSION When reporting public involvement in health service design authors outline a range of outcomes for health services, but it is challenging to determine the extent of outcomes due to inadequate descriptions of study design and poor reporting. There is an urgent need for evaluations, including longitudinal study designs and cost-benefit analyses, to fully understand outcomes from public involvement in health service design.
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Affiliation(s)
- Nicola Lloyd
- Violet Vines Marshman Centre for Rural Health Research, La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| | - Amanda Kenny
- Violet Vines Marshman Centre for Rural Health Research, La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| | - Nerida Hyett
- Violet Vines Marshman Centre for Rural Health Research, La Trobe Rural Health School, La Trobe University, Bendigo, Australia
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Haste A, Lambert M, Sharp L, Thomson R, Sowden S. Patient experiences of the urgent cancer referral pathway-Can the NHS do better? Semi-structured interviews with patients with upper gastrointestinal cancer. Health Expect 2020; 23:1512-1522. [PMID: 32989907 PMCID: PMC7752202 DOI: 10.1111/hex.13136] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 07/28/2020] [Accepted: 09/08/2020] [Indexed: 01/22/2023] Open
Abstract
Background Timeliness is viewed as a key feature of health‐care quality. Internationally, this is challenging. In England, cancer waiting time targets are currently not being met. For example, between 2015 and 2018 only 71% of patients with upper gastrointestinal (UGI) cancer started treatment within the recommended 62 days of referral. Objective We explored patients’ experiences to identify areas for service improvement. Design Semi‐structured interviews were conducted. Setting and participants Twenty patients who were referred through the urgent (two‐week) GP referral route and were within six months of receiving first treatment were recruited. Data analysis Data from the interviews were analysed thematically. Results Four themes were developed: organization of care; diagnosis; support; and views and expectations of the NHS. Patients described cross‐cutting issues such as complex and varied pathways and uncertainty about what would happen next. They felt daunted by the intensity and speed of investigations. They were presented with a recommended course of action rather than options and had little involvement in decision making. They were grateful for care, reluctant to complain and resigned to the status quo. Discussion and conclusions In order to meet patient needs, the NHS needs to improve communication and streamline pathways. Future cancer pathways also need to be designed to support shared decision making, be truly person‐centred and informed by patient experience.
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Affiliation(s)
- Anna Haste
- Department of Psychology, School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK
| | - Mark Lambert
- Public Health England, North East Centre, Newcastle, UK
| | - Linda Sharp
- Newcastle University Centre for Cancer, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Richard Thomson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sarah Sowden
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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10
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Carr ECJ, Patel JN, Ortiz MM, Miller JL, Teare SR, Barber CEH, Marshall DA. Co-design of a patient experience survey for arthritis central intake: an example of meaningful patient engagement in healthcare design. BMC Health Serv Res 2019; 19:355. [PMID: 31164176 PMCID: PMC6549374 DOI: 10.1186/s12913-019-4196-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 05/28/2019] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND To describe the process of patient engagement to co-design a patient experience survey for people with arthritis referred to central intake. METHODS We used a participatory design to engage with patients to co-design a patient experience survey that comprised three connected phases: 1) Identifying the needs of patients with arthritis, 2) Developing a set of key performance indicators, and 3) Determining the survey items for the patient experience survey. RESULTS Patient recommendations for high quality healthcare care means support to manage arthritis, to live a meaningful life by providing the right knowledge, professional support, and professional relationship. The concept of integrated care was a core requirement from the patients' perspective for the delivery of high quality arthritis care. Patients experience with care was ranked in the top 10 of 28 Key Performance Indicators for the evaluation of central intake, with 95% of stakeholders rating it as 9/10 for importance. A stakeholder team, including Patient and Community Engagement Researchers (PaCER), mapped and rated 41 survey items from four validated surveys. The final patient experience survey had 23 items. CONCLUSION The process of patient engagement to co-design a patient experience survey, for people with arthritis, identified aspects of care that had not been previously recognized. The linear organization of frameworks used to report patient engagement in research does not always capture the complexity of reality. Additional resources of cost, time and expertise for patient engagement in co-design activity are recognized and should be included, where possible, to ensure high quality data is captured.
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Affiliation(s)
- Eloise C. J. Carr
- Faculty of Nursing, University of Calgary, PF2237, 2500 University Drive NW, Calgary, Alberta T2N 1N4 Canada
| | - Jatin N. Patel
- Pan-SCN Manager, Strategic Clinical Networks™, Alberta Health Services, 10030 – 107 Street NW, Edmonton, Alberta T5J 3E4 Canada
| | - Mia M. Ortiz
- Faculty of Nursing, University of Calgary, PF2237, 2500 University Drive NW, Calgary, Alberta T2N 1N4 Canada
| | - Jean L. Miller
- O’Brien Institute for Public Health, University of Calgary, 3280, Hospital Dr. NW, Calgary, Alberta T2N 4Z6 Canada
| | - Sylvia R. Teare
- O’Brien Institute for Public Health, University of Calgary, 3280, Hospital Dr. NW, Calgary, Alberta T2N 4Z6 Canada
| | - Claire E. H. Barber
- Arthritis Research Center, University of Calgary, HRIC 3AA20, 3280, Hospital Dr. NW, Calgary, Alberta T2N 4Z6 Canada
| | - Deborah A. Marshall
- Cumming School of Medicine, University of Calgary, Health Research Innovation Centre (HRIC) – 3C56, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6 Canada
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11
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Lopatina E, Miller JL, Teare SR, Marlett NJ, Patel J, Barber CEH, Mosher DP, Wasylak T, Woodhouse LJ, Marshall DA. The voice of patients in system redesign: A case study of redesigning a centralized system for intake of referrals from primary care to rheumatologists for patients with suspected rheumatoid arthritis. Health Expect 2018; 22:348-363. [PMID: 30520175 PMCID: PMC6543166 DOI: 10.1111/hex.12855] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 10/24/2018] [Accepted: 11/14/2018] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND The published literature demands examples of health-care systems designed with the active engagement of patients to explore the application of this complex phenomenon in practice. METHODS This case study explored how the voice of patients was incorporated into the process of redesigning an element of the health-care system, a centralized system for intake of referrals from primary care to rheumatologists for patients with suspected rheumatoid arthritis (RA)-centralized intake. The phenomenon of patient engagement using "patient and community engagement researchers" (PaCERs) in research and the process of redesigning centralized intake were selected as the case. In-depth evaluation of the case was undertaken through the triangulation of findings from the document review and participants' reflection on the case. RESULTS In this case, patients and PaCERs participated in multiple activities including an initial meeting of key stakeholders to develop the project vision; a patient-to-patient PaCERs study to gather perspectives of patients with RA on the challenges they face in accessing and navigating the health-care system, and what they see as key elements of an effective system that would be responsive to their needs; the development of an evaluation framework for future centralized intake; and the choice of candidate centralized intake strategies to be evaluated. CONCLUSIONS The described feasible multistep approach to active patient engagement in health-care system redesign contributes to an understanding of the application of this complex phenomenon in practice. Therefore, the manuscript serves as one more step towards a patient-centred health-care system that is redesigned with active patient engagement.
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Affiliation(s)
- Elena Lopatina
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Jean L Miller
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Sylvia R Teare
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Nancy J Marlett
- Community Rehabilitation and Disability Studies, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jatin Patel
- Strategic Clinical Networks™, Alberta Health Services, Edmonton, Alberta, Canada
| | - Claire E H Barber
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Dianne P Mosher
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tracy Wasylak
- Strategic Clinical Networks™, Alberta Health Services, Edmonton, Alberta, Canada.,Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Linda J Woodhouse
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada.,McCaig Institute for Bone and Joint Health, Calgary, Alberta, Canada
| | - Deborah A Marshall
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.,Strategic Clinical Networks™, Alberta Health Services, Edmonton, Alberta, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,McCaig Institute for Bone and Joint Health, Calgary, Alberta, Canada.,Alberta Bone and Joint Health Institute, Calgary, Alberta, Canada
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