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Holt B, Mendoza J, Nguyen H, Doan D, Nguyen VH, Cabauatan DJ, Duy LD, Fernandez M, Gaspar M, Hamoy G, Manlutac JMD, Mehtsun S, Mercado TB, Neo BL, Le BN, Nguyen H, Nguyen HT, Nguyen Y, Pham T, Pollack T, Rombaoa MC, Thai P, Thu TK, Truong PX, Vu D, Ong J, Duong D. Barriers and enablers to people-centred viral hepatitis care in Vietnam and the Philippines: Results of a patient journey mapping study. J Viral Hepat 2024; 31:391-403. [PMID: 38654623 DOI: 10.1111/jvh.13944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 02/09/2024] [Accepted: 04/05/2024] [Indexed: 04/26/2024]
Abstract
In Vietnam and the Philippines, viral hepatitis is the leading cause of cirrhosis and liver cancer. This study aims to understand the barriers and enablers of people receiving care for hepatitis B and C to support both countries' efforts to eliminate viral hepatitis as a public health threat by 2030. Retrospective, semi-structured interviews were conducted with a purposive, quota-based sample of 63 people living with hepatitis B or C in one province of Vietnam and one region of the Philippines. A rapid deductive approach to thematic analysis produced key findings among the three phases of care: (1) pre-awareness and testing, (2) linkage and treatment initiation and (3) ongoing treatment and recovery. The research found that participants followed five typical journeys, from a variety of entry points. Barriers during the pre-awareness and testing phase included limited awareness about hepatitis and its management, stigma and psychological impacts. Enablers included being familiar with the health system and/or patients benefiting from social connections within the health systems. During the linkage and treatment initiation phase, barriers included difficult physical access, complex navigation and inadequate counselling. In this phase, family support emerged as a critical enabler. During the ongoing treatment and recovery phase, the cost of care and socially and culturally informed perceptions of the disease and medication use were both barriers and enablers. Exploring peoples' journeys with hepatitis B and C in Vietnam and the Philippines revealed many similarities despite the different cultural and health system contexts. Insights from this study may help generate a contextualized, people-centred evidence base to inform the design and improvement of primary care services for hepatitis in both research sites.
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Affiliation(s)
- Bethany Holt
- Program in Global Primary Care and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jhaki Mendoza
- National Institutes of Health, University of the Philippines, Manila, Philippines
| | - Hoang Nguyen
- The Partnership for Health Advancement in Vietnam (HAIVN), Hanoi, Vietnam
| | - Duong Doan
- Hanoi University of Public Health, Hanoi, Vietnam
| | - Vy H Nguyen
- Program in Global Primary Care and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel Joy Cabauatan
- National Institutes of Health, University of the Philippines, Manila, Philippines
| | - Lam Dam Duy
- The Partnership for Health Advancement in Vietnam (HAIVN), Hanoi, Vietnam
| | - Martin Fernandez
- National Institutes of Health, University of the Philippines, Manila, Philippines
| | - Manu Gaspar
- National Institutes of Health, University of the Philippines, Manila, Philippines
| | - Geohari Hamoy
- National Institutes of Health, University of the Philippines, Manila, Philippines
| | | | - Sinit Mehtsun
- Global Patient Solutions, Gilead Science, Washington, DC, USA
- Global Patient Solutions, Gilead Science, Singapore, Singapore
| | - Timothy Bill Mercado
- National Institutes of Health, University of the Philippines, Manila, Philippines
| | - Boon-Leong Neo
- Global Patient Solutions, Gilead Science, Washington, DC, USA
- Global Patient Solutions, Gilead Science, Singapore, Singapore
| | - Bao Ngoc Le
- The Partnership for Health Advancement in Vietnam (HAIVN), Hanoi, Vietnam
| | - Hoa Nguyen
- Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia
| | - Huyen Thu Nguyen
- The Partnership for Health Advancement in Vietnam (HAIVN), Hanoi, Vietnam
| | - Yen Nguyen
- Action to the Community Development Institute, Hanoi, Vietnam
| | - Thuy Pham
- The Partnership for Health Advancement in Vietnam (HAIVN), Hanoi, Vietnam
| | - Todd Pollack
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Mary Cris Rombaoa
- School of Health Sciences, University of the Philippines Manila, Tarlac, Philippines
| | - Pham Thai
- Department of Health, Thai Binh, Vietnam
| | - Tran Khanh Thu
- Department of Health, Thai Binh, Vietnam
- Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | | | - Dung Vu
- Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Janus Ong
- National Institutes of Health, University of the Philippines, Manila, Philippines
| | - David Duong
- Program in Global Primary Care and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Daddato AE, Gleason KS, Dollar BA, McPhail TE, Kraus CR, Boxer RS. Understanding Experiences of Caregivers of Spouses With Dementia During Caregiver Health Care Emergencies. THE GERONTOLOGIST 2024; 64:gnad165. [PMID: 38205833 PMCID: PMC11194629 DOI: 10.1093/geront/gnad165] [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: 05/18/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Caregivers of persons with dementia are frequently spouses. Caregiver hospitalization causes disruption to caregiving. The goal of this research was to understand the preparedness and stress trajectory of peri-caregiver hospitalization. RESEARCH DESIGN AND METHODS Mixed methods were used. Caregivers of spouses with dementia (n = 1,000) were surveyed to determine their perceived preparedness for their own hospitalization. Journey mapping interviews (n = 18) were used to map caregivers' experiences during 5 phases: (a) their spouse with dementia (SWD)'s dementia diagnosis; (b) their SWD's dementia progression; (c) their own health event; (d) their own hospitalization; and (e) their own return home from the hospital. RESULTS Among the 452 (45%) eligible caregiver survey respondents, 75 (17%) had experienced hospitalization in the previous 12 months and 51 (68%) hospitalizations were unexpected. Twenty-three (31%) of hospitalized caregivers indicated they did not have prior plans in place for the care of the SWD. When asked about an unexpected hospitalization in the future, 233 (52%) felt somewhat prepared and 133 (29%) felt not at all prepared. Journey mapping revealed 3 groups of caregivers: Group 1 (n = 7) rated their stress lower during their hospitalization, Group 2 (n = 7) rated their stress highest during their hospitalization, and Group 3 (n = 4) were at a sustained high-stress level. DISCUSSION AND IMPLICATIONS Many caregivers are not prepared for their own hospitalization. The stress trajectory through important phases of dementia caregiving and a caregiver's own hospitalization is not universal. Meeting the needs of caregivers' peri-hospitalization should be tailored to the individual caregiver.
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Affiliation(s)
- Andrea E Daddato
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA
| | - Kathy S Gleason
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA
| | - Blythe A Dollar
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA
| | - Tobie E McPhail
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA
| | - Courtney R Kraus
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA
| | - Rebecca S Boxer
- Department of Internal Medicine, University of California Davis, Sacramento, California, USA
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Bulto LN, Davies E, Kelly J, Hendriks JM. Patient journey mapping: emerging methods for understanding and improving patient experiences of health systems and services. Eur J Cardiovasc Nurs 2024; 23:429-433. [PMID: 38306596 DOI: 10.1093/eurjcn/zvae012] [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: 01/27/2024] [Accepted: 01/29/2024] [Indexed: 02/04/2024]
Abstract
Patient journey mapping is an emerging field of research that uses various methods to map and report evidence relating to patient experiences and interactions with healthcare providers, services, and systems. This research often involves the development of visual, narrative, and descriptive maps or tables, which describe patient journeys and transitions into, through, and out of health services. This methods corner paper presents an overview of how patient journey mapping has been conducted within the health sector, providing cardiovascular examples. It introduces six key steps for conducting patient journey mapping and describes the opportunities and benefits of using patient journey mapping and future implications of using this approach.
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Affiliation(s)
- Lemma N Bulto
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, GPO Box 2100, Adelaide, SA 5042, Australia
| | - Ellen Davies
- Adelaide Health Simulation, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5001, Australia
| | - Janet Kelly
- Adelaide Nursing School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5001, Australia
| | - Jeroen M Hendriks
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, GPO Box 2100, Adelaide, SA 5042, Australia
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, SA 5001, Australia
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Solh Dost L, Gastaldi G, Dos Santos Mamed M, Schneider MP. Navigating outpatient care of patients with type 2 diabetes after hospital discharge - a qualitative longitudinal study. BMC Health Serv Res 2024; 24:476. [PMID: 38632612 PMCID: PMC11022398 DOI: 10.1186/s12913-024-10959-4] [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: 01/17/2024] [Accepted: 04/07/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND The transition from hospital to outpatient care is a particularly vulnerable period for patients as they move from regular health monitoring to self-management. This study aimed to map and investigate the journey of patients with polymorbidities, including type 2 diabetes (T2D), in the 2 months following hospital discharge and examine patients' encounters with healthcare professionals (HCPs). METHODS Patients discharged with T2D and at least two other comorbidities were recruited during hospitalization. This qualitative longitudinal study consisted of four semi-structured interviews per participant conducted from discharge up to 2 months after discharge. The interviews were based on a guide, transcribed verbatim, and thematically analyzed. Patient journeys through the healthcare system were represented using the patient journey mapping methodology. RESULTS Seventy-five interviews with 21 participants were conducted from October 2020 to July 2021. The participants had a median of 11 encounters (min-max: 6-28) with HCPs. The patient journey was categorized into six key steps: hospitalization, discharge, dispensing prescribed medications by the community pharmacist, follow-up calls, the first medical appointment, and outpatient care. CONCLUSIONS The outpatient journey in the 2 months following discharge is a complex and adaptive process. Despite the active role of numerous HCPs, navigation in outpatient care after discharge relies heavily on the involvement and responsibilities of patients. Preparation for discharge, post-hospitalization follow-up, and the first visit to the pharmacy and general practitioner are key moments for carefully considering patient care. Our findings underline the need for clarified roles and a standardized approach to discharge planning and post-discharge care in partnership with patients, family caregivers, and all stakeholders involved.
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Affiliation(s)
- Léa Solh Dost
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland.
| | - Giacomo Gastaldi
- Division of Endocrinology, Diabetes, Hypertension and Nutrition, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Marcelo Dos Santos Mamed
- Institute of Psychology and Education, University of Neuchatel, Neuchâtel, Switzerland
- Institute of Psychology, University of Lausanne, Lausanne, Switzerland
| | - Marie P Schneider
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland.
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Schäfer WLA, Johnson JK, Ager MS, Iroz CB, Huang R, Balbale SN, Stulberg JJ. Learning from the implementation of a surgical opioid reduction initiative in an integrated health system: a qualitative study among providers and patients. Implement Sci Commun 2024; 5:22. [PMID: 38468284 PMCID: PMC10926556 DOI: 10.1186/s43058-024-00561-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 02/23/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Surgical opioid overprescribing can result in long-term use or misuse. Between July 2018 and March 2019, the multicomponent intervention, Minimizing Opioid Prescribing in Surgery (MOPiS) was implemented in the general surgery clinics of five hospitals and successfully reduced opioid prescribing. To date, various studies have shown a positive outcome of similar reduction initiatives. However, in addition to evaluating the impact on clinical outcomes, it is important to understand the implementation process of an intervention to extend sustainability of interventions and allow for dissemination of the intervention into other contexts. This study aims to evaluate the contextual factors impacting intervention implementation. METHODS We conducted a qualitative study with semi-structured interviews held with providers and patients of the general surgery clinics of five hospitals of a single health system between March and November of 2019. Interview questions focused on how contextual factors affected implementation of the intervention. We coded interview transcripts deductively, using the Consolidated Framework for Implementation Research (CFIR) to identify the relevant contextual factors. Content analyses were conducted using a constant comparative approach to identify overarching themes. RESULTS We interviewed 15 clinicians (e.g., surgeons, nurses), 1 quality representative, 1 scheduler, and 28 adult patients and identified 3 key themes. First, we found high variability in the responses of clinicians and patients to the intervention. There was a strong need for intervention components to be locally adaptable, particularly for the format and content of the patient and clinician education materials. Second, surgical pain management should be recognized as a team effort. We identified specific gaps in the engagement of team members, including nurses. We also found that the hierarchical relationships between surgical residents and attendings impacted implementation. Finally, we found that established patient and clinician views on opioid prescribing were an important facilitator to effective implementation. CONCLUSION Successful implementation of a complex set of opioid reduction interventions in surgery requires locally adaptable elements of the intervention, a team-centric approach, and an understanding of patient and clinician views regarding changes being proposed.
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Affiliation(s)
- Willemijn L A Schäfer
- Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Department of Surgery, Northwestern University Feinberg School of Medicine, 633 North Saint Clair Street, 20th Floor, Chicago, IL, USA.
| | - Julie K Johnson
- Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Department of Surgery, Northwestern University Feinberg School of Medicine, 633 North Saint Clair Street, 20th Floor, Chicago, IL, USA
| | | | - Cassandra B Iroz
- Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Department of Surgery, Northwestern University Feinberg School of Medicine, 633 North Saint Clair Street, 20th Floor, Chicago, IL, USA
| | - Reiping Huang
- Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Department of Surgery, Northwestern University Feinberg School of Medicine, 633 North Saint Clair Street, 20th Floor, Chicago, IL, USA
- American College of Surgeons, Chicago, IL, USA
| | - Salva N Balbale
- Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Department of Surgery, Northwestern University Feinberg School of Medicine, 633 North Saint Clair Street, 20th Floor, Chicago, IL, USA
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jonah J Stulberg
- Department of Surgery, University of Texas Health Science Center at Houston, Houston, TX, USA
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Thøgersen D, Krag MS, Johansen JS, Jørgensen A. Experiencing the unreal. Mapping patient journeys from injury towards rehabilitation for a life with tetraplegia. Soc Sci Med 2024; 344:116630. [PMID: 38310730 DOI: 10.1016/j.socscimed.2024.116630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/16/2023] [Accepted: 01/22/2024] [Indexed: 02/06/2024]
Abstract
When patients are brought to the emergency room with a traumatic injury to the spinal cord, the road to recovery is long and uncertain. In minutes, their lives have been irreversibly altered. Time will tell if the paralysis to the limbs is permanent or if some degree of mobility or sensation can be reacquired. To many patients, the first weeks feel almost unreal. They find themselves in a state of shock, and feelings of uncertainty and loss of control are dominating. Spinal cord injuries are treated in multiple specialized hospital units. Each unit is accountable for providing the best possible treatment within their area of expertise. While continuity in care has been a hot research topic for the past 20 years, few studies provide empirical data on patients' perspectives on long-term hospital treatments. This study examines how patients with tetraplegia experience continuity in care when they journey across multiple hospital units over the course of several months. This paper is based on a study of patient pathways for patients with tetraplegia caused by high spinal cord injuries. Semi-structured interviews were conducted with nine patients, seven next of kin and thirteen healthcare professionals in Copenhagen University Hospital. Data from the interviews were analyzed using patient journey mapping, to uncover variations in patients' experience during various stages of their admission. The study finds that patients are struggling to maintain a sense of control over their life as they continuously engage in negotiations of perceptions of their body, of the physical surroundings and of their perception of time and the future. The study concludes that health care professionals should be mindful of these key themes to support the patients' empowerment and active participation during recovery.
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Affiliation(s)
- Ditte Thøgersen
- Copenhagen University Hospital, Inge Lehmanns Vej 6, 2100, København Ø, Denmark.
| | | | | | - Anette Jørgensen
- Copenhagen University Hospital, Inge Lehmanns Vej 6, 2100, København Ø, Denmark
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He T, Cui W, Feng Y, Li X, Yu G. Digital health integration for noncommunicable diseases: Comprehensive process mapping for full-life-cycle management. J Evid Based Med 2024; 17:26-36. [PMID: 38361398 DOI: 10.1111/jebm.12583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/05/2024] [Indexed: 02/17/2024]
Abstract
AIM To create a systematic digital health process mapping framework for full-life-cycle noncommunicable disease management grounded in key stakeholder engagement. METHODS A triphasic, qualitative methodology was employed to construct a process mapping framework for digital noncommunicable disease management in Shanghai, China. The first phase involved desk research to examine current guidance and practices. In the second phase, pivotal stakeholders participated in focus group discussions to identify prevalent digital touchpoints across lifetime noncommunicable disease management. In the final phase, the Delphi technique was used to refine the framework based on expert insights and obtain consensus. RESULTS We identified 60 digital touchpoints across five essential stages of full-life-cycle noncommunicable disease management. Most experts acknowledged the rationality and feasibility of these touchpoints. CONCLUSIONS This study led to the creation of a comprehensive digital health process mapping framework that encompasses the entire life cycle of noncommunicable disease management. The insights gained emphasize the importance of a systemic strategic, person-centered approach over a fragmented, purely technocentric approach. We recommend that healthcare professionals use this framework as a linchpin for efficient disease management and seamless technology incorporation in clinical practice.
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Affiliation(s)
- Tianrui He
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenbin Cui
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuxuan Feng
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xingyi Li
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guangjun Yu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Sturmberg JP, Martin CM. From theory to practice: The pragmatic value of applying systems thinking and complexity sciences in healthcare. J Eval Clin Pract 2024; 30:149-152. [PMID: 38462994 DOI: 10.1111/jep.13979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 03/12/2024]
Affiliation(s)
- Joachim P Sturmberg
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- International Society for Systems and Complexity Sciences for Health, Waitsfield, Vermont, US
| | - Carmel M Martin
- Department of Medicine, Nursing and Allied Health Monash University, Clayton, Victoria, Australia
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Liyana Arachige M, Tse WC, Zhang R, Ma H, Singhal S, Phan T. Estimating the cost of visiting hospital outpatient. BMJ Neurol Open 2024; 6:e000576. [PMID: 38375528 PMCID: PMC10875508 DOI: 10.1136/bmjno-2023-000576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/18/2024] [Indexed: 02/21/2024] Open
Abstract
Objectives This study aims to investigate the cost incurred by people travelling to the neurology outpatient clinic of a large metropolitan hospital. As outpatients are a substantial portion of a hospital's demographic, we aimed to understand the patient experience of various commuters. Methods We conducted an observational study collecting demographic details and travel information for how people attended the neurology clinic of Monash Medical Centre. Statistical analysis was performed using R. 165 participants were randomly selected and interviewed in-person. Data were collected via an anonymous questionnaire. The study was approved by the Monash Health Human Ethics Research Committee. Results 155 responses were included in the analysis. Patients paid an average of $A16.64 to travel to Monash Medical Centre. Drivers paid on average $A16.70 and those taking public transport paid on average $A9.64, with the maximum cost overall being $A120.00. For patients driving to hospital, parking accounted for 60% of their travel costs. The average to Monash Medical centre was 20.82 km with the maximum being 190.88 km. Distance from hospital was correlated with a higher cost of travel (p<0.001, Spearman's rank correlation coefficient=0.48). There was also an inverse association between distance from hospital and socioeconomic status (p<0.001, Spearman's rank correlation coefficient=-0.26). Conclusion Travelling to hospital can be a costly endeavour. Driving is the most popular form of transport, but a large portion of the cost involved is hospital parking. Further research should be conducted at other tertiary centres with larger samples.
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Affiliation(s)
| | - Wai Chung Tse
- Hudson Institute of Research, Monash Health, Clayton, Victoria, Australia
| | - Roland Zhang
- Hudson Institute of Research, Monash Health, Clayton, Victoria, Australia
| | - Henry Ma
- School of Clinical Sciences, Department of Medicine, Monash University, Clayton, Victoria, Australia
| | - Shaloo Singhal
- Department of Neurology and Clinical Trials Imaging and Infomatics division of Stroke and Aging Research Group, Monash University, Clayton, Victoria, Australia
| | - Thanh Phan
- Medicine, Monash University, Clayton, Victoria, Australia
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Suwedi-Kapesa LC, Nyondo-Mipando AL, Choko A, Obasi A, MacPherson P, Desmond N. Process Evaluation of Services for HIV-Infected Post-Partum Women and HIV-Exposed Infants in Primary Health Care Blantyre Malawi. Health Serv Insights 2024; 17:11786329231224623. [PMID: 38322594 PMCID: PMC10846036 DOI: 10.1177/11786329231224623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 11/28/2023] [Indexed: 02/08/2024] Open
Abstract
HIV testing among HIV-exposed infants (HEI) in Malawi is below global targets and, affected by low utilisation of health services after birth. We conducted a mixed methods evaluation of the implementation of services for early infant diagnosis (EID) of HIV against national guidelines in Blantyre, Malawi, to inform the development of strategies to improve EID services uptake. We estimated coverage of HEI enrolment in HIV care and HIV testing at 6 weeks through a retrospective data review. We qualitatively explored implementation gaps in EID services through process mapping of 8 mother-infant pairs (MIP); and investigated healthcare workers' (HCW) perspectives on the implementation gaps through group interviews with 16 HCWs. We analysed the quantitative data descriptively and conducted a thematic content analysis of qualitative data. Of 163 HEIs born at the study sites, 39 (24%) were enrolled in an HIV care clinic before post-natal discharge, and 85 (52%) received HIV testing by 6 weeks. The median time for MIP to receive EID services was 4 (1-8) hours. The implementation gaps observed during process mapping included: failure to identify and enrol HEI in HIV care clinic; lack of immunisation, counselling for HEI testing, HIV testing, drug refilling, and family planning; and different appointment dates for mother and infant. HCWs reported delays and gaps influencing optimal service provision including: lack of screening to identify MIP, limited supervision for student HCWs when providing services, inadequate capacity of point of care machines, challenges with integrating services, and role confusion. Use of unique identifiers for MIP and establishing a booking system to schedule appointments to suit point of care machine capacity were primary service improvement recommendations. This study identified suboptimal EID services in Malawi due to process, capacity, and system factors. Context-appropriate interventions accommodating systems thinking are needed to enhance service provision.
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Affiliation(s)
- Leticia Chimwemwe Suwedi-Kapesa
- Liverpool School of Tropical Medicine, Liverpool, England, UK
- Malawi-Liverpool-Welcome Trust Clinical Research Programme (MLWT), Blantyre, Malawi
| | - Alinane Linda Nyondo-Mipando
- Malawi-Liverpool-Welcome Trust Clinical Research Programme (MLWT), Blantyre, Malawi
- Department of Health Systems and Policy, School of Global and Public Health Kamuzu University of Health Sciences, Blantyre, Malawi
- Department of Women’s and Children’s Health, University of Liverpool, Liverpool, England, UK
| | - Augustine Choko
- Liverpool School of Tropical Medicine, Liverpool, England, UK
- Malawi-Liverpool-Welcome Trust Clinical Research Programme (MLWT), Blantyre, Malawi
| | - Angela Obasi
- Liverpool School of Tropical Medicine, Liverpool, England, UK
- Axess Sexual Health, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Peter MacPherson
- School of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Nicola Desmond
- Liverpool School of Tropical Medicine, Liverpool, England, UK
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Mendoza Martínez MG, Guadarrama Orozco J, Peláez Ballestas I. Pilgrimage in pediatric palliative care: The journey of caregivers. Soc Sci Med 2024; 343:116508. [PMID: 38242031 DOI: 10.1016/j.socscimed.2023.116508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/30/2023] [Accepted: 12/10/2023] [Indexed: 01/21/2024]
Abstract
Admission of terminally ill patients into pediatric palliative care remains a challenge in Mexico and Latin America, despite the multiple benefits of early transfer. In this context the trajectories in search of health care of patients and caregivers have not been documented. Therefore, the objective of this study was to describe and analyze the experiences of primary caregivers and family members of pediatric patients in the palliative care unit of a Children's Hospital in Mexico, between October 19, 2019, and January 19, 2022. We used the framework of health pilgrimage, which comprises the transformative search of healing for patients, focusing on health barriers and the necessary displacement in search of care. With information obtained through interviews, we reconstructed the pilgrimages in search of health care navigating the Mexican healthcare system. Furthermore, we describe the experience of the primary caregiver accompanying the sick child during their journey to palliative care. We recount the adverse factors associated with this pilgrimage, such as the emotional and socioeconomic impact on primary and secondary caregivers.
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Affiliation(s)
| | - Jessica Guadarrama Orozco
- Department of Palliative Care and Quality of Life. Hospital Infantil de México "Federico Gomez", Mexico City, Mexico.
| | - Ingris Peláez Ballestas
- Rheumatology Department. Hospital General de Mexico "Dr. Eduardo Liceaga", Mexico City, Mexico.
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Roustán G, Loro M, Rosell Á, Menchen B, Vicente O, Elosua-González M, Castaño JL, Peña C, Isidoro O. Development of a Patient Journey Map for Improving Patient Experience and Quality of Atopic Dermatitis Care. Dermatol Ther (Heidelb) 2024; 14:505-519. [PMID: 38334904 PMCID: PMC10891039 DOI: 10.1007/s13555-024-01100-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 01/14/2024] [Indexed: 02/10/2024] Open
Abstract
INTRODUCTION Atopic dermatitis (AD) is a chronic inflammatory skin condition that affects both children and adults. AD increases the risk of developing comorbidities like asthma, allergic rhinitis and food allergies. AD patients face difficulties, including itching, lack of effective treatments, lack of funding and discomfort in seeking a diagnosis or treatment. This study aims to identify the main barriers and opportunities to improve the experience of patients with AD and provide high-quality care. METHODS Patients, caregivers and healthcare professionals were recruited from the Dermatology Department at Puerta de Hierro Majadahonda University Hospital (Madrid, Spain). Interviews with patients, caregivers and professionals were performed. Participants used storyboards to depict their preferred scenarios for improving healthcare interactions and create a Patient Journey Map. RESULTS A total of 15 participants were included in the study. Early symptoms of AD were commonly described as undefined stages. As symptoms worsened, patients and caregivers expressed uncertainty and frustration. Patients became concerned about AD after their first serious flare and started experiencing intense itching, eczema, wounds, shedding or asthma. Topical corticosteroids were used to manage flares, but their effectiveness diminished over time, causing further frustration. Because of the ineffectiveness of their initial treatments, dermatologists observed that patients tended to downplay symptoms and how they affected their quality of life. The specialized treatment of severe AD significantly changed patients' emotional states. Despite AD's chronic nature, patients strived to enjoy remission periods and cope with flares. Psychological and emotional support was crucial for patients and caregivers, a need addressed by the Patients' School initiative at HUPHM hospital. CONCLUSION The severity of AD has a profound impact on patients' lives. Patient and caregiver emotional and social needs can be met by adequate communication, access to effective treatments and comprehensive psychological support.
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Affiliation(s)
- Gastón Roustán
- Department of Dermatology, Puerta de Hierro Majadahonda University (HUPHM) Hospital, Madrid, Spain.
| | - Marta Loro
- Department of Dermatology, Puerta de Hierro Majadahonda University (HUPHM) Hospital, Madrid, Spain
| | - Ángel Rosell
- Department of Dermatology, Puerta de Hierro Majadahonda University (HUPHM) Hospital, Madrid, Spain
| | - Belén Menchen
- Hospital Pharmacy, Puerta de Hierro Majadahonda University (HUPHM) Hospital, Madrid, Spain
| | | | - Marta Elosua-González
- Department of Dermatology, Puerta de Hierro Majadahonda University (HUPHM) Hospital, Madrid, Spain
| | - Juan L Castaño
- Department of Dermatology, Puerta de Hierro Majadahonda University (HUPHM) Hospital, Madrid, Spain
| | - Catalina Peña
- Instituto de Experiencia del Paciente, Madrid, Spain
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Härkönen H, Myllykangas K, Gomes J, Immonen M, Kärppä M, Hyvämäki P, Jansson M. Challenges and needs in cerebrovascular disease pathway: A qualitative descriptive study from the patients' and healthcare professionals' perspectives. J Adv Nurs 2024. [PMID: 38214101 DOI: 10.1111/jan.16055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/12/2023] [Accepted: 12/30/2023] [Indexed: 01/13/2024]
Abstract
AIM(S) To understand patients' and healthcare professionals' experiences to improve care in and across different domains of the cerebrovascular disease pathway. DESIGN A qualitative descriptive study. METHODS Semi-structured in-person interviews were conducted among 22 patients diagnosed with acute cerebrovascular disease and 26 healthcare professionals taking care of them in a single tertiary-level hospital from August 2021 to March 2022. Data were analysed using deductive and inductive content analysis. The consolidated criteria for reporting qualitative research was used to ensure reliable reporting. RESULTS Overall, 19 generic and 79 sub-categories describing perceived challenges with 17 generic and 62 sub-categories describing perceived needs were identified related to primary prevention, organization of stroke services, management of acute stroke, secondary prevention, rehabilitation, evaluation of stroke outcome and quality assessment, and life after stroke. CONCLUSION Several challenges and needs were identified in and across the different domains of the cerebrovascular disease pathway. There is a requirement for adequate resources, early initiation of treatment, early diagnostics and recanalization, dedicated rehabilitation services, long-term counselling and support, and impact evaluation of services to improve cerebrovascular disease care. Future research on caregivers', and clinical leadership experiences in and across the cerebrovascular disease pathway is needed to explore the provision of services. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE The results of this study can be applied by organizations, managers and research for developing and improving services in the cerebrovascular disease pathway. IMPACT This study identified several patient-related, organizational and logistical needs and challenges, with suggestions for required actions, that can benefit the provision of effective, high-quality cerebrovascular disease care. REPORTING METHOD We have adhered to relevant EQUATOR guidelines with the COREQ reporting method. PATIENT OR PUBLIC CONTRIBUTION No patient or public involvement.
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Affiliation(s)
- Henna Härkönen
- Research Unit of Health Sciences and Technology (HST), University of Oulu/Faculty of Medicine, Oulu, Finland
| | - Kirsi Myllykangas
- Research Unit of Health Sciences and Technology (HST), University of Oulu/Faculty of Medicine, Oulu, Finland
| | | | - Milla Immonen
- VTT Technical Research Centre of Finland, Oulu, Finland
| | - Mikko Kärppä
- Neurocenter, Neurology, Oulu University Hospital, Oulu, Finland
- Research Unit of Clinical Medicine, Neurology, University of Oulu/Faculty of Medicine, Oulu, Finland
| | - Piia Hyvämäki
- Research Unit of Health Sciences and Technology (HST), University of Oulu/Faculty of Medicine, Oulu, Finland
| | - Miia Jansson
- Research Unit of Health Sciences and Technology (HST), University of Oulu/Faculty of Medicine, Oulu, Finland
- RMIT University, Melbourne, Victoria, Australia
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14
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Onyango OO, Willows TM, McKnight J, Schell CO, Baker T, Mkumbo E, Maiba J, Khalid K, English M, Oliwa JN. Third delay in care of critically ill patients: a qualitative investigation of public hospitals in Kenya. BMJ Open 2024; 14:e072341. [PMID: 38176878 PMCID: PMC10773318 DOI: 10.1136/bmjopen-2023-072341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 12/12/2023] [Indexed: 01/06/2024] Open
Abstract
OBJECTIVES Third delay refers to delays in delivering requisite care to patients after they arrive at a health facility. In low-resource care settings, effective triage and flow of care are difficult to guarantee. In this study, we aimed to identify delays in the delivery of care to critically ill patients and possible ways to address these delays. DESIGN This was an exploratory qualitative study using in-depth interviews and patient journeys. The qualitative data were transcribed and aggregated into themes in NVivo V.12 Plus using inductive and deductive approaches. SETTING This study was conducted in four secondary-level public Kenyan hospitals across four counties between March and December 2021. The selected hospitals were part of the Clinical Information Network. PARTICIPANTS Purposive sampling method was used to identify administrative and front-line healthcare providers and patients. We conducted 12 in-depth interviews with 11 healthcare workers and patient journeys of 7 patients. Informed consent was sought from the participants and maintained throughout the study. RESULTS We identified a cycle of suboptimal systems for care with adaptive mechanisms that prevent quality care to critically ill patients. We identified suboptimal systems for identification of critical illness, inadequate resources for continuity care and disruption of the flow of care, as the major causes of delays in identification and the initiation of essential care to critically ill patients. Our study also illuminated the contribution of inflexible bureaucratic non-clinical business-related organisational processes to third delay. CONCLUSION Eliminating or reducing delays after patients arrive at the hospital is a time-sensitive measure that could improve the care outcomes of critically ill patients. This is achievable through an essential emergency and critical care package within the hospitals. Our findings can help emphasise the need for standardised effective and reliable care priorities to maintain of care of critically ill patients.
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Affiliation(s)
| | - Tamara M Willows
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Jacob McKnight
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Carl Otto Schell
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden
- Department of Medicine, Nyköping Hospital, Nyköping, Sweden
| | - Tim Baker
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Ifakara Health Institute, Dar es Salaam, Tanzania, United Republic of
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
- Department of Emergency Medicine, Muhimbili University of Health and Allied Sciences, Muhimbili, Tanzania, United Republic Of
| | - Elibariki Mkumbo
- Ifakara Health Institute, Dar es Salaam, Tanzania, United Republic of
| | - John Maiba
- Ifakara Health Institute, Dar es Salaam, Tanzania, United Republic of
| | - Karima Khalid
- Ifakara Health Institute, Dar es Salaam, Tanzania, United Republic of
- Department of Anaesthesia and Critical Care, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | - Mike English
- KEMRI-Wellcome Trust Research Programme Nairobi, Nairobi, Kenya
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Jacquie N Oliwa
- KEMRI-Wellcome Trust Research Programme Nairobi, Nairobi, Kenya
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Reynolds AC, Loffler KA, Grivell N, Brown BW, Adams RJ. Diagnosis and management of sleep disorders in shift workers, with patient informed solutions to improve health services research and practice. Sleep Med 2024; 113:131-141. [PMID: 38016359 DOI: 10.1016/j.sleep.2023.11.027] [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: 08/19/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND The combination of shift work and an unmanaged sleep disorder carries health and safety risks. Yet, diagnosis rates for sleep disorders are low in shift workers. The aim of this study was to understand the experience of sleep disorder diagnosis and treatment in shift workers, and consider patient informed solutions to improve access to health services. METHODS Semi-structured interviews were conducted with 16 Australian shift workers with a diagnosed sleep disorder. Patient journey mapping and reflexive thematic analysis were used to understand diagnosis and management experiences. RESULTS There were highly variable experiences with diagnosis and management, often taking >5 years to seek help from a health care provider (HCP) after noticing symptoms of a sleep disorder. Three themes were constructed, including 'the cause of the problem', 'prioritising work', and '(dis)satisfaction and (dis)connection'. Extent of patient and HCP awareness of sleep disorders, and a prevailing attitude of shift work being 'the problem' impacted diagnosis, as did organisational needs (including rostering, which had both positive and negative influences on help seeking). Relationships with HCPs were important, and living on non-standard time was both a barrier and an enabler to sleep disorder care. Participants identified the need for education and awareness, prompts and easy access to screening and referral pathways, and tailored models of care. CONCLUSION Education and awareness initiatives for shift workers, their employers and HCPs, together with development of a model of care for shift workers with sleep disorders may address some of the unique barriers to diagnosis and management.
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Affiliation(s)
- Amy C Reynolds
- Flinders Health and Medical Research Institute (Sleep Health) / Adelaide Institute for Sleep Health, Flinders University, Bedford Park, SA, Australia.
| | - Kelly A Loffler
- Flinders Health and Medical Research Institute (Sleep Health) / Adelaide Institute for Sleep Health, Flinders University, Bedford Park, SA, Australia; Health Data and Clinical Trials, Flinders University, Bedford Park, SA, Australia
| | - Nicole Grivell
- Flinders Health and Medical Research Institute (Sleep Health) / Adelaide Institute for Sleep Health, Flinders University, Bedford Park, SA, Australia
| | - Brandon Wj Brown
- Flinders Health and Medical Research Institute (Sleep Health) / Adelaide Institute for Sleep Health, Flinders University, Bedford Park, SA, Australia
| | - Robert J Adams
- Flinders Health and Medical Research Institute (Sleep Health) / Adelaide Institute for Sleep Health, Flinders University, Bedford Park, SA, Australia
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Parkin S, Neale J, Strang J. Conceptualising retention in treatment with long-acting injectable buprenorphine (for opioid use disorder) as a journey: Findings from a longitudinal qualitative study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 122:104221. [PMID: 37865052 DOI: 10.1016/j.drugpo.2023.104221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/22/2023] [Accepted: 09/27/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND Conceptualisations of the 'patient journey' are popular within health service research. Patient journeys provide a person-centred approach to health care that typically prioritise subjective patient experience with the aim of improving relevant forms of intervention. This article explores the conceptualisation of retention in treatment for opioid use disorder (OUD) using long-acting injectable buprenorphine (LAIB) as a journey. METHODS Data derive from a longitudinal qualitative study, involving semi-structured interviews (held at six time-points), with participants who each initiated LAIB for the first time. Data analysis for this article focuses exclusively upon the experiences of those who had continued with LAIB treatment throughout one year (11 participants). Framework and thematic narrative analyses of 64 interviews with 11 participants sought to identify 'retention-narratives' that would indicate a 'retention journey' associated with LAIB treatment. FINDINGS Shared treatment experiences consisted of three distinct phases (Withdrawal and Separation, Transformation, and Engagement) that progressed in a linear and intersecting manner through time. Each phase had features that defined treatment experiences at a given time but changed as treatment progressed. All 11 participants experienced multiple features within each of the three treatment phases and all participants reported separation from their respective service provider throughout the first 12 months of treatment. Although some valued the latter separation, most were dissatisfied by reduced levels of contact. CONCLUSION Retention in treatment for OUD with LAIB, for at least 12-months, can be conceptualised as a journey. This conceptualisation emphasises the benefits (and challenges) clinicians and patients may expect to encounter during the first year of a LAIB treatment programme. An added implication of conceptualising LAIB treatment in this manner is that optimal benefits of the medication (as observed by participants) began to emerge during 'months 7-12' of the retention journey.
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Affiliation(s)
- Stephen Parkin
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, SE5 8BB, UK.
| | - Joanne Neale
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, SE5 8BB, UK; Centre for Social Research in Health, University of New South Wales, NSW 2052, Australia
| | - John Strang
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, SE5 8BB, UK; South London & Maudsley (SLaM) NHS Foundation Trust, London SE5 8AZ, UK
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Benz C, Scott‐Jeffs W, Revitt J, Brabon C, Fermanis C, Hawkes M, Keane C, Dyke R, Cooper S, Locantro M, Welsh M, Norman R, Hendrie D, Robinson S. Co-designing a telepractice journey map with disability customers and clinicians: Partnering with users to understand challenges from their perspective. Health Expect 2023; 27:e13919. [PMID: 37990612 PMCID: PMC10726283 DOI: 10.1111/hex.13919] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/10/2023] [Accepted: 11/12/2023] [Indexed: 11/23/2023] Open
Abstract
INTRODUCTION Telepractice has the potential to align with the directive to reduce inequalities by United Nations Sustainable Development Goal 10. Telepractice additionally addresses a national digital health strategic plan for accessible digitally enabled models of care. To plan improvements, it is essential to understand the experience of telepractice for people with disability, which may be achieved through an approach such as journey mapping. The current article provides both a disability-specific case study and a methodological guide for the inclusion of customers and clinicians in the meaningful redevelopment of services. The Perth, Australia-based case study aimed to gain insights into the experience of telepractice for people with disability. The methodological aim describes using co-design to produce a journey map in collaboration with customers and clinicians, for potential replication in a wide range of health and social care contexts. METHOD Interview transcripts gathered from a cohort of customer participants (n = 17) were used to inform the journey map. A group of customers (n = 5) and clinicians plus one manager (n = 5) distributed the findings onto a customer experience journey map during a co-design workshop. The journey map describes the emotional experience and actions taken, along five phases of a timeline through telepractice service interactions: (1) before, (2) selecting telepractice, (3) telepractice preparation, (4) during telepractice sessions and (5) after. RESULTS A journey map visualisation of customer experiences was produced that identified strengths of telepractice service delivery (flexibility) while noting challenges (with technology) as opportunities for improvement. The consensus of participants was the desire to have access to telepractice currently and in the future, in addition to in-person delivery. CONCLUSION These findings are valuable in the context of advocating for the incorporation of customers and clinicians through co-design workshops in the content analysis and creation of a journey map that is representative of the lived experience of accessing telepractice services. PATIENT OR PUBLIC CONTRIBUTION The paper forms part of a larger co-design process that included customer participants throughout the design and planning of the project, inclusion of a peer researcher and the co-designers in the workshops, journey map and this article production.
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Affiliation(s)
- Cloe Benz
- School of Population HealthCurtin UniversityBentleyWestern AustraliaAustralia
| | | | | | | | | | | | | | - Robert Dyke
- Rocky BayMosman ParkWestern AustraliaAustralia
| | | | | | - Mai Welsh
- Rocky BayMosman ParkWestern AustraliaAustralia
| | - Richard Norman
- School of Population HealthCurtin UniversityBentleyWestern AustraliaAustralia
| | - Delia Hendrie
- School of Population HealthCurtin UniversityBentleyWestern AustraliaAustralia
| | - Suzanne Robinson
- School of Population HealthCurtin UniversityBentleyWestern AustraliaAustralia
- Deakin Health EconomicsInstitute for Health Transformation, Deakin UniversityBurwoodVictoriaAustralia
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Saragosa M, Nizzer S, McKay S, Kuluski K. The hospital-to-home care transition experience of home care clients: an exploratory study using patient journey mapping. BMC Health Serv Res 2023; 23:934. [PMID: 37653515 PMCID: PMC10469468 DOI: 10.1186/s12913-023-09899-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 08/10/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Care transitions have a significant impact on patient health outcomes and care experience. However, there is limited research on how clients receiving care in the home care sector experience the hospital-to-home transition. An essential strategy for improving client care and experience is through client engagement efforts. The study's aim was to provide insight into the care transition experiences and perspectives of home care clients and caregivers of those receiving home care who experienced a hospital admission and returned to home care services by thematically and illustratively mapping their collective journey. METHODS This study applied a qualitative descriptive exploratory design using a patient journey mapping approach. Home care clients and their caregivers with a recent experience of a hospital discharge back to the community were recruited. A conventional inductive approach to analysis enabled the identification of categories and a collective patient journey map. Follow-up interviews supported the validation of the map. RESULTS Seven participants (five clients and two caregivers) participated in 11 interviews. Participants contributed to the production of a collective journey map and the following four categories and themes: (1) Touchpoints as interactions with the health system; Life is changing; (2) Pain points as barriers in the health system: Sensing nobody is listening and Trying to find a good fit; (3) Facilitators to positive care transitions: Developing relationships and gaining some continuity and Trying to advocate, and (4) Emotional impact: Having only so much emotional capacity. CONCLUSIONS The patient journey map enabled a collective illustration of the care transition depicted in touchpoints, pain points, enablers, and feelings experienced by home care recipients and their caregivers. Patient journey mapping offers an opportunity to acknowledge home care clients and their caregivers as critical to quality care delivery across the continuum.
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Affiliation(s)
- Marianne Saragosa
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 1 Bridgepoint Drive, Toronto, ON, M4M 2B5, Canada.
- VHA Home HealthCare, Toronto, ON, Canada.
| | | | - Sandra McKay
- VHA Home HealthCare, Toronto, ON, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
- Ted Rogers School of Management, Toronto Metropolitan University, Toronto, ON, Canada
- The Institute for Education Research, University Health Network, Toronto, ON, Canada
- Michael Garron Hospital, Toronto East Health Network, East York, Toronto, ON, Canada
| | - Kerry Kuluski
- Trillium Health Partners, Mississauga, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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Menear M, Duhoux A, Bédard M, Paquette JS, Baron M, Breton M, Courtemanche S, Dubé S, Dufour S, Fortin M, Girard A, Larouche-Côté É, L'Espérance A, LeBlanc A, Poitras ME, Rivet S, Sasseville M, Achim A, Archambault P, Bajurny V, Brown JB, Carrier JD, Côté N, Couturier Y, Dogba MJ, Gagnon MP, Ghio SC, Marshall EG, Kothari A, Lussier MT, Mair FS, Smith S, Vachon B, Wong S. Understanding the impacts of the COVID-19 pandemic on the care experiences of people with mental-physical multimorbidity: protocol for a mixed methods study. BMC PRIMARY CARE 2023; 24:154. [PMID: 37488515 PMCID: PMC10364355 DOI: 10.1186/s12875-023-02106-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 07/06/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Primary care and other health services have been disrupted during the COVID-19 pandemic, yet the consequences of these service disruptions on patients' care experiences remain largely unstudied. People with mental-physical multimorbidity are vulnerable to the effects of the pandemic, and to sudden service disruptions. It is thus essential to better understand how their care experiences have been impacted by the current pandemic. This study aims to improve understanding of the care experiences of people with mental-physical multimorbidity during the pandemic and identify strategies to enhance these experiences. METHODS We will conduct a mixed-methods study with multi-phase approach involving four distinct phases. Phase 1 will be a qualitative descriptive study in which we interview individuals with mental-physical multimorbidity and health professionals in order to explore the impacts of the pandemic on care experiences, as well as their perspectives on how care can be improved. The results of this phase will inform the design of study phases 2 and 3. Phase 2 will involve journey mapping exercises with a sub-group of participants with mental-physical multimorbidity to visually map out their care interactions and experiences over time and the critical moments that shaped their experiences. Phase 3 will involve an online, cross-sectional survey of care experiences administered to a larger group of people with mental disorders and/or chronic physical conditions. In phase 4, deliberative dialogues will be held with key partners to discuss and plan strategies for improving the delivery of care to people with mental-physical multimorbidity. Pre-dialogue workshops will enable us to synthesize an prepare the results from the previous three study phases. DISCUSSION Our study results will generate much needed evidence of the positive and negative impacts of the COVID-19 pandemic on the care experiences of people with mental-physical multimorbidity and shed light on strategies that could improve care quality and experiences.
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Affiliation(s)
- Matthew Menear
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada.
- VITAM Centre de recherche en santé durable, Quebec City, Canada.
| | - Arnaud Duhoux
- Faculty of Nursing, Université de Montréal, Montreal, Canada
- Centre de Recherche Charles-Le Moyne, Montreal, Canada
| | - Myreille Bédard
- Person With Lived Experience (Patient Partner), Montreal, Canada
| | - Jean-Sébastien Paquette
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada
- VITAM Centre de recherche en santé durable, Quebec City, Canada
| | - Marie Baron
- VITAM Centre de recherche en santé durable, Quebec City, Canada
| | - Mylaine Breton
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | | | - Savannah Dubé
- VITAM Centre de recherche en santé durable, Quebec City, Canada
| | - Stefany Dufour
- VITAM Centre de recherche en santé durable, Quebec City, Canada
| | - Martin Fortin
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Ariane Girard
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | | | | | - Annie LeBlanc
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada
- VITAM Centre de recherche en santé durable, Quebec City, Canada
| | - Marie-Eve Poitras
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Sophie Rivet
- VITAM Centre de recherche en santé durable, Quebec City, Canada
| | - Maxime Sasseville
- VITAM Centre de recherche en santé durable, Quebec City, Canada
- Faculty of Nursing, Université Laval, Quebec, Canada
| | - Amélie Achim
- VITAM Centre de recherche en santé durable, Quebec City, Canada
- Department of Psychiatry, Université Laval, Quebec, Canada
| | - Patrick Archambault
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada
- VITAM Centre de recherche en santé durable, Quebec City, Canada
| | - Virtue Bajurny
- Person with Lived Experience (Patient Partner), Toronto, Canada
| | | | - Jean-Daniel Carrier
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Nancy Côté
- VITAM Centre de recherche en santé durable, Quebec City, Canada
- Faculty of Social Sciences, Université Laval, Quebec, Canada
| | - Yves Couturier
- School of Social Work, Université de Sherbrooke, Sherbrooke, Canada
| | - Maman Joyce Dogba
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada
- VITAM Centre de recherche en santé durable, Quebec City, Canada
| | - Marie-Pierre Gagnon
- VITAM Centre de recherche en santé durable, Quebec City, Canada
- Faculty of Nursing, Université Laval, Quebec, Canada
| | | | | | - Anita Kothari
- Department of Health Studies, Western University, London, Canada
| | - Marie-Thérèse Lussier
- Department of Family Medicine and Emergency Medicine, Université de Montréal, Montreal, Canada
| | - Frances S Mair
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Susan Smith
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, UK
| | - Brigitte Vachon
- School of Rehabilitation, Université de Montréal, Montreal, Canada
| | - Sabrina Wong
- Faculty of Applied Science, University of British Colombia, Vancouver, Canada
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Lagura JA, Dordunoo D, Mallidou A, Carey J, Borycki EM, Kushniruk A. Patient Journey Map: Metal Hypersensitivity. J Patient Exp 2023; 10:23743735231183576. [PMID: 37362250 PMCID: PMC10286172 DOI: 10.1177/23743735231183576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Abstract
In this study, we highlight patients' experiences with metal hypersensitivity (MH) after receiving implantable medical devices (IMDs). We aim to identify gaps in clinical care and improve outcomes for individuals who have or may be sensitive to metals. Secondary data analysis from a previous interpretative phenomenological qualitative study was utilized. Using patient journey maps, we explored the experiences of 8 individuals from outpatient settings who received IMD and have first-hand experience with MH. We documented their journey from MH symptom recognition to diagnosis and subsequent IMD management. The results reveal that the time frames from device implantation to the treatment of MH varied from 17 to 228 months. The longest phase on the patient journey maps was the symptom recognition phase, which refers to the time between symptom emergence and MH diagnosis. Participants also required extensive healthcare utilization following their initial surgery. These findings emphasize that MH should be considered in differential diagnoses for patients with IMD. Early screening and detection of MH can enhance patient safety, alleviate distress, and reduce unnecessary healthcare utilization.
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Affiliation(s)
| | - Dzifa Dordunoo
- School of Nursing, University of Victoria, Victoria, Canada
| | | | - Jett Carey
- School of Nursing, University of Victoria, Victoria, Canada
| | - Elizabeth M. Borycki
- School of Health Information Science, University of Victoria, Victoria, BC, Canada
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