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Warner JO, Spitters SJIM. Integrating Patients Into Programmes to Address the Allergy Knowledge Practice Gap. Clin Exp Allergy 2024. [PMID: 39317386 DOI: 10.1111/cea.14563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/05/2024] [Accepted: 08/21/2024] [Indexed: 09/26/2024]
Abstract
There is a wide gap between the first publication of new treatments with efficacy and their successful application in clinical practice. In many respects, the management of allergic diseases is a good exemplar of the knowledge/practice gap. It was assumed that systematic reviews and publication of guidelines would ensure timely delivery of effective care, but this has not proved to be the case. While there are many reasons to explain shortcomings in healthcare delivery, the lack of patient and carer involvement in the planning of research, evidence review, guideline development and guideline implementation is most compelling. To achieve adherence to evidence-based guidelines consistently across all levels of the health service requires the implementation of integrated care with clear pathways through which patients can navigate. Quality improvement methodology could be employed to plan and implement integrated care pathways (ICPs). There is evidence that ICPs achieve improved outcomes for acute hospital-based interventions, but less work has focussed on long-term conditions where more diverse agencies are involved. At all stages, stakeholder representation from the full range of healthcare professionals, patients, their families, social services, education, local government and employers must be involved. In this article we review the step-wise and iterative process by which knowledge is implemented into practice to improve patient experience and outcomes We argue how this process can benefit from the involvement of patients and their carers as equal partners, and we discuss how different initiatives have involved patients with allergic diseases. There currently is a gap in evidence that links patient involvement to improved outcomes. We recommend the use of the Core Outcome Sets (COS) and Patient Reported Experience Measures (PREMS) which have been developed for allergic diseases to monitor the effects of implementation research and the impact of patient and carer involvement on outcomes.
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Affiliation(s)
- John O Warner
- National Health and Lung Institute, Imperial College, London, UK
| | - Sophie Jacoba Irma Maria Spitters
- National Health and Lung Institute, Imperial College, London, UK
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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Nordlind A, Anderzén‐Carlsson A, Sundqvist A, Ängeby K, Wray J, Oldham G, Almblad A. Translation, cultural adaptation and validation of a patient-reported experience measure for children. Health Expect 2024; 27:e13924. [PMID: 38062673 PMCID: PMC10768864 DOI: 10.1111/hex.13924] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/19/2023] [Accepted: 11/14/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND There is no national, validated, generic patient-reported experience measure (PREM) for children under 15 years of age in Sweden. A recent cross-sectional study found no consensus in how children's voices are heard in paediatric health care, as well as a lack of validated questionnaires. AIM The aim of this study is to translate, adapt and validate the six versions of the Children's and Young People's PREM for use in a Swedish health care context. DESIGN An exploratory sequential mixed-method design including cognitive interviews and content validity index (CVI) was used. The interviews focused on evaluating children's understanding of the questionnaire, and the CVI was used to further adjust the relevance of the questionnaire. PARTICIPANTS A convenience sample of 62 children participated in the cognitive interviews and an additional convenience sample of 42 children was included in the CVI testing. The children, aged 8-16 years, were attending routine visits at paediatric departments in a county hospital and a children's hospital in the mid-Sweden region between October 2020 and June 2022. RESULTS The translation, adaptation and validation process identified several issues regarding the understanding of the questionnaire in a Swedish context. Adaptations were made based on issues related to context, wording and the structure of the questions. CVI testing resulted in the removal of 3-10 questions in each of the different versions of the questionnaire. CONCLUSION The study has resulted in six face- and content-validated Swedish versions of the questionnaire ready for pilot testing. Although the versions of the original questionnaire were developed in collaboration with children in the United Kingdom, this did not mean that they could automatically be used in a Swedish health care context. This study confirms the importance of a rigorous process of adaptation and validation to ensure quality and applicability to children accessing health care in different countries. PATIENT OR PUBLIC CONTRIBUTION Children's views have guided the development of the original instrument and its adaptation to the Swedish health care context. Due to the strong patient involvement in the process of developing the Swedish versions of the questionnaire, the research group made a pragmatic decision to have no other patient contribution in the study.
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Affiliation(s)
- Anna Nordlind
- School of Health Sciences, Faculty of Medicine and HealthÖrebro UniversityÖrebroSweden
- Department of Paediatric MedicineCounty Hospital KarlstadKarlstadSweden
| | - Agneta Anderzén‐Carlsson
- University Health Care Research Centre, Faculty of Medicine and HealthÖrebro UniversityÖrebroSweden
| | - Ann‐Sofie Sundqvist
- University Health Care Research Centre, Faculty of Medicine and HealthÖrebro UniversityÖrebroSweden
| | - Karin Ängeby
- Centre for Clinical Research and EducationRegion VärmlandKarlstadSweden
- School of Education, Health and Social StudiesDalarna UniversityFalunSweden
| | - Jo Wray
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID)Great Ormond Street Hospital for Children NHS Foundation TrustLondonUK
| | - Geralyn Oldham
- Data Research, Innovation and Virtual Environments (DRIVE) UnitGreat Ormond Street Hospital for Children NHS Foundation TrustLondonUK
| | - Ann‐Charlotte Almblad
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
- Children Hospital and EmergencyRegion UppsalaUppsalaSweden
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Yeung M, Hagel BE, Bobrovitz N, Stelfox TH, Elliot A, MacPherson A, McBeth P, Schuurmann N, Yanchar NL. Between paradigms: Comparing experiences for adolescents treated at pediatric and adult trauma centres. Injury 2023:S0020-1383(23)00363-7. [PMID: 37147145 DOI: 10.1016/j.injury.2023.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 03/31/2023] [Accepted: 04/12/2023] [Indexed: 05/07/2023]
Abstract
INTRODUCTION Injured adolescents may be treated at pediatric trauma centres (PTCs) or adult trauma centres (ATCs). Patient and parent experiences are an integral component of high-quality health care and can influence patient clinical trajectory. Despite this knowledge, there is little research on differences between PTCs and ATCs with respect to patient and caregiver-reported experience. We sought to identify differences in patient and parent-reported experiences between the regional PTC and ATC using a recently developed Patient and Parent-Reported Experience Measure. METHODS We prospectively enrolled patients (caregivers) aged 15-17 (inclusive), admitted to the local PTC and ATC for injury management (01/01/2020 - 31/05/2021) We provided a survey 8-weeks post-discharge to query acute care and follow-up experience. Patient and parent experiences were compared between the PTC and ATC using descriptive statistics, chi-square tests for categorical and independent t-tests for continuous variables. RESULTS We identified 90 patients for inclusion (51 PTC, and 39 ATC). From this population, we had 77 surveys (32 patient and 35 caregiver) completed at the PTC, and 41 (20 patient and 21 caregiver) at the ATC. ATC patients tended to be more severely injured. We identified few differences in reported experience on the patient measure but identified lower ratings from caregivers of adolescents treated in ATCs for the domains of information and communication, follow-up care, and overall hospital scores. Patients and parents reported poorer family accommodation at the ATC. CONCLUSION Patient experiences were similar between centres. However, caregivers report poorer experiences at the ATC in several domains. These differences are multifaceted, and may reflect differing patient volumes, effects of COVID-19, and healthcare paradigms. However, further work should target information and communication improvement in adult paradigms given its impact on other domains of care.
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Affiliation(s)
- Matthew Yeung
- Cumming School of Medicine, University of Calgary; Health Sciences Centre, Foothills campus, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
| | - Brent E Hagel
- Alberta Children's Hospital Research Institute, University of Calgary, Room 293, Heritage Medical Research Building, 3330 Hospital Dr. NW, Calgary, AB T2N 4N1, Canada
| | - Niklas Bobrovitz
- Temerty Faculty of Medicine, University of Toronto, Temerty Faculty of Medicine, 1 King's College Circle Medical Sciences Building, Room 2109, Toronto, ON M5S 1A8, Canada
| | - Thomas H Stelfox
- Department of Critical Care, University of Calgary, Foothills Medical Centre, 1403 29St NW, Calgary, AB T2N 2T9, Canada
| | - April Elliot
- Department of Pediatrics, Alberta Children's Hospital, 29 Oki Drive, Calgary, AB T2B 6A8, Canada
| | - Alison MacPherson
- Faculty of Health, York University, 337 Norman Bethune College, 170 Campus Walk, North York, ON M3J 1P3, Canada
| | - Paul McBeth
- Department of Surgery, University of Calgary, North Tower, Foothills Medical Centre, 1403 29St NW, Calgary, AB T2N 2T9, Canada
| | - Nadine Schuurmann
- Department of Geography, RCB 6119/7134, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | - Natalie L Yanchar
- Natalie L Yanchar: Department of Surgery, University of Calgary, Alberta Children's Hospital, 28 Oki Drive NW, Calgary, AB T3B 6A8, Canada.
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Ferreira J, Patel P, Guadagno E, Ow N, Wray J, Emil S, Poenaru D. Patient experience or patient satisfaction? A systematic review of child- and family-reported experience measures in pediatric surgery. J Pediatr Surg 2023; 58:862-870. [PMID: 36797113 DOI: 10.1016/j.jpedsurg.2023.01.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 01/02/2023] [Indexed: 01/21/2023]
Abstract
PURPOSE Patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) are increasingly recognized as important health care quality indicators. PREMs measure patients' perception of the care they have received, differing from satisfaction ratings, which measure their expectations. The use of PREMs in pediatric surgery is limited, prompting this systematic review to assess their characteristics and identify areas for improvement. METHODS A search was conducted in eight databases from inception until January 12, 2022, to identify PREMs used with pediatric surgical patients, with no language restrictions. We focused on studies of patient experience but also included studies that assessed satisfaction and sampled experience domains. The quality of the included studies was appraised using the Mixed Methods Appraisal Tool. RESULTS Following title and abstract screening of 2633 studies, 51 were included for full-text review, of which 22 were subsequently excluded because they measured only patient satisfaction rather than experience, and 14 were excluded for a range of other reasons. Out of the 15 included studies, questionnaires used in 12 studies were proxy-reported by parents and in 3 by both parents and children; none focused only on the child. Most instruments were developed in-house for each specific study, without patients' involvement in the process, and were not validated. CONCLUSIONS Although PROMs are increasingly used in pediatric surgery, PREMs are not yet in use, being typically substituted by satisfaction surveys. Significant efforts are needed to develop and implement PREMs in pediatric surgical care, in order to effectively capture children's and families' voices. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Julia Ferreira
- McGill University Faculty of Medicine and Health Sciences, Montreal, Quebec, Canada; Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Prachikumari Patel
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Elena Guadagno
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Nikki Ow
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Jo Wray
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Sherif Emil
- McGill University Faculty of Medicine and Health Sciences, Montreal, Quebec, Canada; Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Dan Poenaru
- McGill University Faculty of Medicine and Health Sciences, Montreal, Quebec, Canada; Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada.
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Rahman S, Elliott SA, Scott SD, Hartling L. Children at risk of anaphylaxis: A mixed-studies systematic review of parents' experiences and information needs. PEC INNOVATION 2022; 1:100018. [PMID: 37213745 PMCID: PMC10194313 DOI: 10.1016/j.pecinn.2022.100018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 01/13/2022] [Accepted: 01/17/2022] [Indexed: 05/23/2023]
Abstract
Objective To explore parents' self-reported experiences and information needs regarding recognition and management of pediatric anaphylaxis. Methods We searched Ovid Medline, Ovid PsychInfo, CINAHL Plus, the Cochrane Library, and grey literature to identify primary studies in English or French published since 2000. We used a mixed-method appraisal tool and convergent integrated approach to assess quality and synthesize data, respectively. Results 43 studies were included (22 quantitative, 19 qualitative, and 2 mixed-method); 77% of studies had high methodological quality. Parents' experiences were categorized as: recognizing an anaphylactic reaction; managing and responding to a reaction; emotional impact of caring for a child at risk of anaphylaxis; and interaction with the health system and healthcare providers. Parents' information needs were categorized into themes relating to: gaps in knowledge and information; type of information desired; information sources; and information delivery format. Conclusion Negative emotional experiences and a general lack of information were commonly reported by parents of included studies. Provision of relevant and comprehensible information may help parents to make informed decisions and manage reactions promptly. Innovation The findings of this review are guiding the development of an innovative knowledge translation tool (KT) as part of a larger initiative of developing a suite of parent-focused KT tools for acute childhood conditions.
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Affiliation(s)
- Sholeh Rahman
- Alberta Research Centre for Health Evidence (ARCHE), Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Sarah A. Elliott
- Alberta Research Centre for Health Evidence (ARCHE), Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Shannon D. Scott
- Translating Evidence in Child Health to Enhance Outcomes (ECHO), Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Lisa Hartling
- Alberta Research Centre for Health Evidence (ARCHE), Department of Pediatrics, University of Alberta, Edmonton, Canada
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Li Z, Tian L, Liu H, Tang S, Chen Q. Factors associated with parental burden among parents of children with food allergies in China: a cross-sectional study. BMJ Open 2022; 12:e065772. [PMID: 36153013 PMCID: PMC9511557 DOI: 10.1136/bmjopen-2022-065772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE This study aimed to investigate the factors associated with parental burden among parents of children with food allergies (FA) in China. DESIGN Cross-sectional study. SETTING The participants were recruited through the internet and one child health centre of a tertiary hospital in Changsha, China. PARTICIPANTS A total of 346 parents of children with FA were recruited using a convenience sampling method. After excluding the invalid questionnaires, 330 questionnaires were included for the analysis. OUTCOME MEASURES The data of general and disease-specific information of children with FA and their parents, as well as parental burden, social support and coping style of parents, were collected using a self-developed questionnaire and standard measurement tools with good psychometric properties. Univariate analysis and multivariate stepwise regression analysis were used to analyse the data. RESULTS Financial affordability regarding their children's FA and parents' social support were key protective factors against parental burden (β=-0.224, p<0.001 and β=-0.226, p<0.001, respectively). This study also found that parents' working conditions, the number of highly suspected food allergens, the number of children's FA-affected systems and whether children took amino acid milk powder were the factors associated with parental burden. CONCLUSIONS Health professionals should pay more attention to parents who are not at work and whose children have more highly suspected food allergens and more FA-affected systems because these parents often have a higher parental burden. Furthermore, it is important to improve financial support for children's FA and social support for parents of children with FA to decrease their parental burden.
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Affiliation(s)
- Zeen Li
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Lang Tian
- Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Haiyan Liu
- Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Siyuan Tang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Qirong Chen
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
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Yeung M, Hagel BE, Bobrovitz N, Stelfox TH, Yanchar NL. Development of the quality of teen trauma acute care patient and parent-reported experience measure. BMC Res Notes 2022; 15:304. [PMID: 36138467 PMCID: PMC9503226 DOI: 10.1186/s13104-022-06194-x] [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: 11/05/2021] [Accepted: 09/07/2022] [Indexed: 11/10/2022] Open
Abstract
Objective Patient-Reported Experience Measures (PREMs) provide valuable patient feedback on quality of care and have been associated with clinical outcomes. We aimed to test the reliability of a modified adult trauma care PREM instrument delivered to adolescents admitted to hospital for traumatic injuries, and their parents. Modifications included addition of questions reflecting teen-focused constructs on education supports, social network maintenance and family accommodation. Results Forty adolescent patients and 40 parents participated. Test-retest reliability was assessed using Cohen’s kappa, weighted kappa, and percent agreement between responses. Directionality of changed responses was noted. Most of the study ran during the COVID-19 pandemic. We established good reliability of questions related to in-hospital and post-discharge communication, clinical and ancillary care and family accommodation. We identified poorer reliability among constructs reflecting experiences that varied from the norm during the pandemic, which included “maintenance of social networks”, “education supports”, “scheduling clinical follow-ups” and “post-discharge supports”. Parents, but not patients, demonstrated more directionality of change of responses by responding with more negative in-hospital and more positive post-discharge experiences over time between the test and retest periods, suggesting risk of recall bias. Situational factors due to the COVID-19 pandemic and potential risks of recall bias may have limited the reliability of some parts of the survey. Supplementary Information The online version contains supplementary material available at 10.1186/s13104-022-06194-x.
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Affiliation(s)
- Matthew Yeung
- Department of Surgery, University of Calgary, Calgary, Canada
| | - Brent E Hagel
- Department of Pediatrics, University of Calgary, Calgary, Canada
| | - Niklas Bobrovitz
- Department of Critical Care, University of Calgary, Calgary, Canada.,Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Thomas H Stelfox
- Department of Critical Care, University of Calgary, Calgary, Canada
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Warner JO. Translating results from research into clinical practice. Arch Dis Child 2022; 107:505-506. [PMID: 34426408 DOI: 10.1136/archdischild-2021-321887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 08/05/2021] [Indexed: 11/03/2022]
Affiliation(s)
- John O Warner
- Inflammation, Repair and Development Section, Imperial College London National Heart and Lung Institute, London, UK
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Nordlind A, Sundqvist A, Anderzén‐Carlsson A, Almblad A, Ängeby K. How paediatric departments in Sweden facilitate giving children a voice on their experiences of healthcare: A cross-sectional study. Health Expect 2022; 25:384-393. [PMID: 34856647 PMCID: PMC8849245 DOI: 10.1111/hex.13396] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 09/17/2021] [Accepted: 11/07/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND In January 2020, the United Nations Convention on the Rights of the Child was incorporated into Swedish law. According to Swedish regulations, patients are to be given the opportunity to participate in quality improvement. Sometimes, the patients are children who have the right to be heard on matters concerning them, such as their experience of a hospital visit. OBJECTIVE This study aimed to describe how Swedish paediatric departments facilitate children's voices on their healthcare experiences and how their perspectives are taken into account in quality improvement work. METHODS This study has a descriptive cross-sectional design. Data were collected using a study-specific survey sent by e-mail to all the heads of the paediatric departments in Sweden, with both inpatient and outpatient care. The response rate was 74% (28 of 38 departments). RESULTS The results demonstrated a variation in questionnaires used and to whom they were targeted; less than half of the participating departments reported having had questionnaires aimed at children. The results also indicated a major variation in other working methods used to allow children to voice their experiences in Swedish paediatric departments. The results indicate that the national co-ordination in facilitating the children's rights to be heard on their experiences in healthcare organisations can be improved. CONCLUSION Further research is required to ascertain which method is the most practically effective in paediatric departments, in what way children prefer to be heard regarding their experience of and perspectives on healthcare, and what questions need to be asked. A validated national patient-reported experience measure developed with and aimed at children could provide them with equal opportunities to voice their experiences in healthcare, regardless of their diagnoses or which paediatric department they visit.
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Affiliation(s)
- Anna Nordlind
- Faculty of Medicine and HealthÖrebro UniversityÖrebroSweden
- Department of Paediatric MedicineCounty Hospital KarlstadKarlstadSweden
| | - Ann‐Sofie Sundqvist
- Faculty of Medicine and HealthUniversity Health Care Research Centre, Örebro UniversityÖrebroSweden
- Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and HealthÖrebro UniversityÖrebroSweden
| | - Agneta Anderzén‐Carlsson
- Faculty of Medicine and HealthUniversity Health Care Research Centre, Örebro UniversityÖrebroSweden
| | - Ann‐Charlotte Almblad
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
- Children Hospital and EmergencyRegion Uppsala, UppsalaSweden
| | - Karin Ängeby
- Centre for Clinical ResearchRegion Värmland, KarlstadSweden
- School of Education, Health and Social StudiesDalarna UniversityFalunSweden
- Department of Health Sciences, Faculty of MedicineLund UniversityLundSweden
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Daniels L, Barker S, Chang YS, Chikovani T, DunnGalvin A, Gerdts JD, Gerth Van Wijk R, Gibbs T, Villarreal-Gonzalez RV, Guzman-Avilan RI, Hanna H, Hossny E, Kolotilina A, Ortega Martell JA, Pacharn P, de Lira Quezada CE, Sibanda E, Stukus D, Tham EH, Venter C, Gonzalez-Diaz SN, Levin ME, Martin B, Munblit D, Warner JO. Harmonizing allergy care-integrated care pathways and multidisciplinary approaches. World Allergy Organ J 2021; 14:100584. [PMID: 34820045 PMCID: PMC8591185 DOI: 10.1016/j.waojou.2021.100584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 08/08/2021] [Accepted: 08/26/2021] [Indexed: 01/14/2023] Open
Abstract
There is a wide time gap between the publication of evidence and the application of new knowledge into routine clinical practice. The consequence is sub-optimal outcomes, particularly concerning for long-term relapsing/remitting conditions such as allergic diseases. In response, there has been a proliferation of published guidelines which systematically review evidence for the gold-standard management of most allergic disorders. However, this has not necessarily been followed by improved outcomes, partly due to a lack of coordination across the patient pathway. This has become known as the "second translational gap". A proposed solution is the development and implementation of integrated care pathways (ICPs) to optimize patient outcomes, with the notion that evidence-based medicine requires evidence-based implementation. ICP implementation is shown to improve short-term outcomes for acute conditions and routine surgery, including reduced length of hospital stay, improved documentation and improved patient safety. However, this improvement is not reflected in patient experience or patient-centered functional outcomes. The implementation of life-long, cost-effective interventions within comprehensive pathways requires a deep appreciation for complexity within allergy care. We promote an evidence-based methodology for the implementation of ICPs for allergic disorders in which all stakeholders in allergy care are positioned equally and encouraged to contribute, particularly patients and their caregivers. This evidence-based process commences with scoping the unmet needs, followed by stakeholder mapping. All stakeholders are invited to meetings to develop a common vision and mission through the generation of action/effect diagrams which helps build concordance across the agencies. Dividing the interventions into achievable steps and reviewing with plan/do/study/act cycles will gradually modify the pathway to achieve the best outcomes. While the management guidelines provide the core knowledge, the key component of implementation involves education, training, and support of all healthcare professionals (HCPs), patients and their caregivers. The pathways should define the level of competence required for each clinical task. It may be useful to leave the setting of care delivery or the specific HCP involved undefined to account for variable patterns of health service delivery as well as local socioeconomic, ethnic, environmental, and political imperatives. In all cases, where competence is exceeded, it is necessary to refer to the next stage in the pathway. The success and sustainability of ICPs would ideally be judged by patient experience, health outcomes, and health economics. We provide examples of successful programs, most notably from Finland, but recommend that further research is required in diverse settings to optimize outcomes worldwide.
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Affiliation(s)
- Lydia Daniels
- Faculty of Medicine, Imperial College London, London, UK
| | - Sally Barker
- Faculty of Medicine, Imperial College London, London, UK
| | - Yoon-Seok Chang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Tinatin Chikovani
- Department of Immunology, Tbilisi State Medical University, Tbilisi, Georgia
| | - Audrey DunnGalvin
- Applied Psychology and Paediatrics and Child Health, University College Cork, Cork, Ireland
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | | | - Roy Gerth Van Wijk
- Section of Allergology, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Trevor Gibbs
- Association for Medical Education in Europe (AMEE), Dundee, Scotland, UK
- Independant Consultant in Primary Care and Medical Education, UK
| | - Rosalaura V. Villarreal-Gonzalez
- Regional Center of Allergy and Clinical Immunology, University Hospital “Dr. Jose Eleuterio Gonzalez”, Faculty of Medicine, Autonomous University of Nuevo León, Monterrey, Mexico
| | - Rosa I. Guzman-Avilan
- Regional Center of Allergy and Clinical Immunology, University Hospital “Dr. Jose Eleuterio Gonzalez”, Faculty of Medicine, Autonomous University of Nuevo León, Monterrey, Mexico
| | | | - Elham Hossny
- Pediatric Allergy and Immunology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | - Anastasia Kolotilina
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | | | - Punchama Pacharn
- Department of Pediatrics, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Cindy E. de Lira Quezada
- Regional Center of Allergy and Clinical Immunology, University Hospital “Dr. Jose Eleuterio Gonzalez”, Faculty of Medicine, Autonomous University of Nuevo León, Monterrey, Mexico
| | - Elopy Sibanda
- Asthma, Allergy and Immune Dysfunction Clinic, Twin Palms Medical Centre, Harare, Zimbabwe
- Department of Pathology, Medical School, National University of Science and Technology, Bulawayo, Zimbabwe
| | - David Stukus
- Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Elizabeth Huiwen Tham
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, Singapore
- Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Carina Venter
- Section of Allergy and Immunology, University of Colorado Denver School of Medicine, Children's Hospital Colorado, Colorado, USA
| | - Sandra N. Gonzalez-Diaz
- Regional Center of Allergy and Clinical Immunology, University Hospital “Dr. Jose Eleuterio Gonzalez”, Faculty of Medicine, Autonomous University of Nuevo León, Monterrey, Mexico
| | - Michael E. Levin
- Division of Paediatric Allergy, Department of Paediatrics, University of Cape Town, Cape Town, South Africa
| | - Bryan Martin
- Division of Allergy and Immunology, Department of Otolaryngology, The Ohio State University, Columbus, OH, USA
| | - Daniel Munblit
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
- Solov'ev Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - John O. Warner
- Inflammation, Repair and Development Section, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
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11
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Lacomba-Trejo L, Valero-Moreno S, Montoya-Castilla I, Pérez Marín M. Predicting health-related quality of life in Spanish adolescents with allergic rhinoconjunctivitis and bronchial asthma. PSYCHOL HEALTH MED 2021; 27:613-625. [PMID: 33759655 DOI: 10.1080/13548506.2021.1904514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study analyzed the predictive power of sociodemographic (age, sex) and medical variables (months since diagnosis and in treatment, immunotherapy, number of environmental allergens, food allergies or atopic dermatitistypes) on the quality of life of patients with rhinoconjunctivitis and bronchial asthma, using models based on comparative qualitative fuzzy analysis to compare them according to the pathology(s).Retrospective cross-sectional design.Sixty-four adolescents (65.60% boys) diagnosed with rhinoconjunctivitis and/or bronchial asthma aged between 12 and 16 years old (M= 14.02; SD = 1.45).The data were collected between February 2019 and January 2020 using the Brief Disease Perception Questionnaire (B-IPQ), the Adolescent Rhinoconjunctivitis Quality of Life Questionnaire (AdolRQoLQ) and the Respiratory Disease Questionnaire Self-administered and Standardized Chronicle (CRQ-SAS). Qualitative comparative analysis models (QCA) were used.In the QCA models, the various combinations indicated that the variables that predicted a higher quality of life for both rhinocojuntivitis symptoms and respiratory symptoms were receiving longer-term immunotherapy and a perceived lower threat of the disease. The consistencies of the models vary between 23-29%. In conclusion, the patients' QoL was explained by the presence of longer-term immunotherapy and a less threatening perception of the disease.Therefore, early multidisciplinary diagnosis and treatment is important.
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Affiliation(s)
- Laura Lacomba-Trejo
- Department of Personality, Assessment and Psychological Treatments, University of Valencia, Valencia, Spain
| | - Selene Valero-Moreno
- Department of Personality, Assessment and Psychological Treatments, University of Valencia, Valencia, Spain
| | | | - Marian Pérez Marín
- Department of Personality, Assessment and Psychological Treatments, University of Valencia, Valencia, Spain
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Assessing the engagement of children and families in selecting patient-reported outcomes (PROs) and developing their measures: a systematic review. Qual Life Res 2020; 30:983-995. [DOI: 10.1007/s11136-020-02690-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2020] [Indexed: 01/14/2023]
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13
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Hodnekvam K, Iversen HH, Brunborg C, Skrivarhaug T. Development and validation of a questionnaire to assess young patients' experiences with diabetes care and transition. Acta Paediatr 2020; 109:2057-2066. [PMID: 31998990 DOI: 10.1111/apa.15205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 01/05/2020] [Accepted: 01/28/2020] [Indexed: 11/27/2022]
Abstract
AIM To describe the development and validation of a questionnaire in a national Norwegian population-based cohort study designed to assess the experiences of young people with type 1 diabetes who had made the transition from paediatric to adult diabetes care. METHODS The questionnaire was developed by the authors based on literature searches, focus group interviews, discussions with experts and cognitive interviews. We included 776 individuals with type 1 diabetes who were last registered in the Norwegian Childhood Diabetes Registry between 2009 and 2012 and had been receiving adult health care for at least 2 years. The data quality was analysed, factor analysis was performed, and the internal reliability, test-retest reliability and construct validity were determined. RESULTS The response rate was 321 patients (41.4%); 57.6% were female, and the average age at recruitment was 22.9 ± 1.2 years. Seven factors were identified. Satisfactory evidence was provided for the internal consistency, reliability and construct validity of the questionnaire. All scales met the criterion of Cronbach's alpha above 0.4. The test-retest correlations ranged from 0.64 to 0.92. CONCLUSION The thorough validation of the questionnaire proved satisfactory and indicated that it may be of value for further studies measuring patients' experiences with diabetes care and transition.
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Affiliation(s)
- Kristin Hodnekvam
- Department of Paediatric and Adolescent Medicine Telemark Hospital Skien Norway
- Norwegian Childhood Diabetes Registry Oslo University Hospital Oslo Norway
| | | | - Cathrine Brunborg
- Oslo Centre for Biostatistics and Epidemiology Research Support Services Oslo Norway
| | - Torild Skrivarhaug
- Division of Paediatric and Adolescence Medicine Oslo University Hospital Oslo Norway
- Oslo Diabetes Research Centre Oslo University Hospital Oslo Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
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14
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Asthma/Rhinitis (The United Airway) and Allergy: Chicken or Egg; Which Comes First? J Clin Med 2020; 9:jcm9051483. [PMID: 32423152 PMCID: PMC7291147 DOI: 10.3390/jcm9051483] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/09/2020] [Accepted: 05/11/2020] [Indexed: 12/15/2022] Open
Abstract
While allergy, asthma and rhinitis do not inevitably co-exist, there are strong associations. Not all those with asthma are allergic, rhinitis may exist without asthma, and allergy commonly exists in the absence of asthma and/or rhinitis. This is likely due to the separate gene/environment interactions which influence susceptibility to allergic sensitization and allergic airway diseases. Allergic sensitization, particularly to foods, and eczema commonly manifest early in infancy, and not infrequently are followed by the development of allergic rhinitis and ultimately asthma. This has become known as the "allergic march". However, many infants with eczema never develop asthma or rhinitis, and both the latter conditions can evolve without prior eczema or food allergy. Understanding the mechanisms underlying the ontogeny of allergic sensitization and allergic disease will facilitate rational approaches to the prevention and management of asthma and allergic rhinitis. Furthermore, a range of new, so-called biological, therapeutic approaches, targeting specific allergy-promoting and pro-inflammatory molecules, are now in clinical trials or have been recently approved for use by regulatory authorities and could have a major impact on disease prevention and control in the future. Understanding basic mechanisms will be essential to the employment of such medications. This review will explain the concept of the united airway (rhinitis/asthma) and associations with allergy. It will incorporate understanding of the role of genes and environment in relation to the distinct but interacting origins of allergy and rhinitis/asthma. Understanding the patho-physiological differences and varying therapeutic requirements in patients with asthma, with or without rhinitis, and with or without associated allergy, will aid the planning of a personalized evidence-based management strategy.
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Moen ØL, Opheim E, Trollvik A. Parents Experiences Raising a Child with Food Allergy; A Qualitative Review. J Pediatr Nurs 2019; 46:e52-e63. [PMID: 30857930 DOI: 10.1016/j.pedn.2019.02.036] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 02/27/2019] [Accepted: 02/27/2019] [Indexed: 11/16/2022]
Abstract
PROBLEM Food allergies are one of the fastest growing public health concerns without a cure, affecting approximately 8% of the world's child population. Being the parent of a child with allergies may lead to concerns, and affect everyday life in the family. The aim was to synthesize and describe parents' experiences of living with food allergies in families when one of the children has a food allergy. ELIGIBILITY CRITERIA A systematic search using subject terms and text words was performed in Cinahl (Ebsco), Swemed+, Medline (OVID) and Scopus in October 2017. The search was limited to parents with children and adolescents, for the years from 2006 to October 2017. SAMPLE One hundred and forty articles were screened and 24 were included. RESULTS A meta-summery of the results from the included studies were conducted. The parents lived in fear, after their child had their first reaction and had become allergic, a life threatening experience. They tried to live an ordinary family life and parents had to learn how to be one-step ahead and understand early signs. The family's social life was also influenced. Parents asked for support and information from health professionals and more knowledge and skills increased parents' manageability. CONCLUSION Parents need support and a seamless encounter with health professionals, with multidisciplinary collaboration and knowledge sharing to develop the parents' self-efficacy. IMPLICATIONS Health professionals must provide information and support parents on their path through the health-care system in having a child with a food allergy.
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Affiliation(s)
- Øyfrid Larsen Moen
- Faculty of Medicine and Health Sciences, Department of Health sciences, Norwegian University of Science and Technology (NTNU), Norway.
| | - Elin Opheim
- Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Norway.
| | - Anne Trollvik
- Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Norway.
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Chakravorty S, Tallett A, Witwicki C, Hay H, Mkandawire C, Ogundipe A, Ojeer P, Whitaker A, Thompson J, Sizmur S, Sathyamoorthy G, Warner JO. Patient-reported experience measure in sickle cell disease. Arch Dis Child 2018; 103:1104-1109. [PMID: 30077973 PMCID: PMC6287562 DOI: 10.1136/archdischild-2018-314955] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 04/25/2018] [Accepted: 04/28/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To develop patient-reported experience measure surveys for patients with sickle cell disease (SCD) to understand their healthcare and lived experience in the UK and for their use in future to inform healthcare service development. DESIGN Picker methodology was used as follows: (1) qualitative scoping by focus group discussions; (2) questionnaire development through stakeholder consultations; (3) construct validation of questionnaires through cognitive testing; and (4) further assessment of construct validity by a nationwide pilot survey. SETTING Patients with SCD and their carers were eligible. Focus group discussions took place in non-hospital settings, arranged out of hours. Cognitive testing took place in specialist sickle cell clinics. The pilot survey was available to UK participants only and was administered through web-based questionnaires, face-to face completion and in sickle cell community events. PARTICIPANTS Thirty-three patients and carers took part in the focus groups, 21 participants undertook cognitive testing and 722 respondents completed the pilot survey. RESULTS Findings highlighted a widespread prevalence of poor knowledge about SCD among healthcare providers and the public. Poorer experience of care was present in the emergency setting compared with planned care, of which lack of timely provision of pain relief was of concern. Adolescents and young people reported significantly poorer experience of care in several domains compared with children or adults. CONCLUSIONS The new surveys functioned well, with good evidence of validity, and were accessible to the SCD patient population, supporting their future use in assessing patient experience to inform service delivery and improvements in care quality.
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Affiliation(s)
- Subarna Chakravorty
- Paediatric Haematology, King’s College Hospital NHS Foundation Trust, London, UK,Imperial College London, London, UK
| | | | | | | | | | | | | | | | | | | | - Ganesh Sathyamoorthy
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) for North West London, London, UK
| | - John O Warner
- Imperial College London, London, UK,National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) for North West London, London, UK
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Urrutia-Pereira M, Mocellin L, de Oliveira R, Simon L, Lessa L, Solé D. Knowledge on asthma, food allergies, and anaphylaxis: Assessment of elementary school teachers, parents/caregivers of asthmatic children, and university students in Uruguaiana, in the state of Rio Grande do Sul, Brazil. Allergol Immunopathol (Madr) 2018; 46:421-430. [PMID: 29338962 DOI: 10.1016/j.aller.2017.09.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 09/14/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Allergic diseases have become an increasingly common reality in the last years, extending beyond the family context. OBJECTIVE Assessing the level of knowledge on asthma, food allergies and anaphylaxis of asthmatic children's parents/caregivers (PC), elementary school teachers (EST) and university students (US) in Uruguaiana, RS, Brazil. METHOD 577 individuals (PC - N=111; EST - N=177; US - N=299) took part in the study, answering the Newcastle Asthma Knowledge Questionnaire (validated for Portuguese) and another questionnaire on Food Allergy (FA) and anaphylaxis. RESULTS Although PC have asthmatic children, their asthma knowledge level was average, slightly above that of EST and EU. The lack of knowledge on passive smoking, use of medications and their side effects should be highlighted. US have shown to be better informed about FA and anaphylaxis. However, even though a significant proportion of respondents know the most common symptoms of FA and anaphylaxis, few named subcutaneous adrenaline as the drug of choice for treating anaphylaxis. Although a significant number of respondents know about the possibility of anaphylactic reactions happening at school or in activities outside the school, we were surprised by the absence of conditions in schools to provide emergency care to such students. CONCLUSION Despite the high prevalence of allergic diseases in childhood, asthmatic children's parents/caregivers, elementary school teachers and university students have inadequate levels of knowledge to monitor these patients.
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Wray J, Hobden S, Knibbs S, Oldham G. Hearing the voices of children and young people to develop and test a patient-reported experience measure in a specialist paediatric setting. Arch Dis Child 2018; 103:272-279. [PMID: 28903950 DOI: 10.1136/archdischild-2017-313032] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 07/11/2017] [Accepted: 08/08/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To develop and test patient-reported experience measures (PREMs) for children and young people in a specialist paediatric hospital setting. DESIGN Six PREMs were developed and tested by children and young people for children and young people aged 8-11, 12-13 and 14-16 years in inpatient and outpatient settings. A week-long pilot was implemented across inpatient wards and outpatient clinics to identify facilitators and barriers to the routine use of PREMs in a real-time setting across our organisation. SETTING Tertiary paediatric hospital. MAIN OUTCOME MEASURES Final PREMs; identified facilitators and barriers to implementation. PARTICIPANTS 543 children and young people aged 8-16 years attending outpatient clinics or inpatient wards across a range of specialties. RESULTS Three key themes about hospital experience were identified during focus groups: facilities, treatment and tests and people working at the hospital, and these provided the structure for the questionnaires. During cognitive testing the questionnaires were generally understood but some revisions to language and length of the questionnaires were required. Two designs were selected for the final PREMs. During acceptability and feasibility testing it was evident that children and young people liked the PREMs and wanted to give feedback on their hospital experience. Particular challenges for routine use of the PREMs focused on sustainability and resources. CONCLUSIONS The new PREMs will provide children and young people receiving care in specialist paediatric hospitals with the opportunity to provide feedback on their experience. Sustainability and ensuring that feedback results in improvements need to be addressed in future work.
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Affiliation(s)
- Jo Wray
- Charles West Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | - Sarah Knibbs
- Social Research Institute, Ipsos MORI, London, UK
| | - Geralyn Oldham
- Charles West Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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