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Marrie RA, Lancia S, Cutter GR, Fox RJ, Salter A. Access to Care and Health-Related Quality of Life in Multiple Sclerosis. Neurol Clin Pract 2024; 14:e200338. [PMID: 39185096 PMCID: PMC11341006 DOI: 10.1212/cpj.0000000000200338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 04/12/2024] [Indexed: 08/27/2024]
Abstract
Background and Objectives Despite their high health care use, it is unclear whether the health care needs of people with MS are being met and what their priorities are. We assessed priorities for access to, and affordability of care, by people living with MS in the United States. We also tested the association between perceived inadequate access to care and health-related quality of life (HRQoL). Methods In Fall 2022, we conducted a cross-sectional survey of participants in the North American Research Committee on Multiple Sclerosis Registry about access to care and HRQoL (Health Utilities Index Mark III). We used multivariable polytomous logistic regression to test sociodemographic and clinical factors associated with access to care. We used multivariable linear regression analysis to test the association between access to care and HRQoL. Results We included 4,914 respondents in the analysis, of whom 3,974 (80.9%) were women, with a mean (SD) age 64.4 (9.9) years. The providers who were most reported as needed but inaccessible were complementary providers (35.5%), followed by allied health providers (24.2%), occupational therapists (22.7%), and mental health providers (20.7%). Over 80% of participants reported that it was important or very important to be able to get an appointment with their primary MS health care provider when needed, to have sufficient time in their appointments to explain their concerns, to see their neurologist if their status changed, and that their health care providers communicated to coordinate their care. Participants who reported needing to see the provider but not having access or seeing the provider but would like to see them more often had lower HRQOL (ranging from -0.059 to -0.176) than participants who saw the provider as much as needed. Discussion Gaps in access to care persist for people with MS in the United States and substantially affect HRQoL. Improving access to care for people with MS should be a health system priority.
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Affiliation(s)
- Ruth Ann Marrie
- Department of Internal Medicine (RAM); Department of Community Health Sciences (RAM), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Neurology (SL, AS), Section on Statistical Planning and Analysis, UT Southwestern, Dallas, TX; Department of Biostatistics (GRC), University of Alabama in Birmingham, AB; and Mellen Center for Multiple Sclerosis (RJF), Neurological Institute, Cleveland Clinic, OH
| | - Samantha Lancia
- Department of Internal Medicine (RAM); Department of Community Health Sciences (RAM), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Neurology (SL, AS), Section on Statistical Planning and Analysis, UT Southwestern, Dallas, TX; Department of Biostatistics (GRC), University of Alabama in Birmingham, AB; and Mellen Center for Multiple Sclerosis (RJF), Neurological Institute, Cleveland Clinic, OH
| | - Gary R Cutter
- Department of Internal Medicine (RAM); Department of Community Health Sciences (RAM), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Neurology (SL, AS), Section on Statistical Planning and Analysis, UT Southwestern, Dallas, TX; Department of Biostatistics (GRC), University of Alabama in Birmingham, AB; and Mellen Center for Multiple Sclerosis (RJF), Neurological Institute, Cleveland Clinic, OH
| | - Robert J Fox
- Department of Internal Medicine (RAM); Department of Community Health Sciences (RAM), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Neurology (SL, AS), Section on Statistical Planning and Analysis, UT Southwestern, Dallas, TX; Department of Biostatistics (GRC), University of Alabama in Birmingham, AB; and Mellen Center for Multiple Sclerosis (RJF), Neurological Institute, Cleveland Clinic, OH
| | - Amber Salter
- Department of Internal Medicine (RAM); Department of Community Health Sciences (RAM), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Neurology (SL, AS), Section on Statistical Planning and Analysis, UT Southwestern, Dallas, TX; Department of Biostatistics (GRC), University of Alabama in Birmingham, AB; and Mellen Center for Multiple Sclerosis (RJF), Neurological Institute, Cleveland Clinic, OH
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Dasso N, Catania G, Zanini M, Rossi S, Aleo G, Signori A, Scelsi S, Petralia P, Watson R, Hayter M, Sasso L, Bagnasco A. Informal carers' experiences with their children's care during hospitalization in Italy: Child HCAHPS results from RN4CAST@IT-Ped cross-sectional study. J Pediatr Nurs 2024; 74:10-16. [PMID: 37980795 DOI: 10.1016/j.pedn.2023.11.003] [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: 12/13/2022] [Revised: 11/01/2023] [Accepted: 11/04/2023] [Indexed: 11/21/2023]
Abstract
PURPOSE To examine informal carers' experiences during their child's hospitalization and evaluate the associations with care received and care context. DESIGN AND METHODS What is described in this article is only a part of the larger study, RN4CAST@IT-Ped, a multicenter cross-sectional study, with multi-level data collection through convenience sampling, the Child Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey was used to collect data from informal carers of pediatric patients, applying the "top box" approach. RESULTS Nine hospitals, 1472 nurses, and 635 children's parents were involved. A correlation was found between patient safety and satisfaction outcomes and nursing staff characteristics. Adequate workloads for nurses improved carers' assessment of their experience in the hospital. CONCLUSION Adequate staffing management could significantly improve informal carers' satisfaction with the care provided to their children during hospitalization. PRACTICE IMPLICATIONS Children's informal carers greatly value the care they receive in pediatric hospitals. Adequate workloads for nurses improve carers' overall evaluation of the care their children receive during hospitalization. Nursing management should consider improving these aspects to ensure high-quality care in children's hospitals.
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Affiliation(s)
- Nicoletta Dasso
- Health Professional Direction, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini 5, 16147 Genoa, Italy.
| | - Gianluca Catania
- Department of Health Sciences, University of Genoa, Via Pastore, 1, 16132 Genoa, Italy.
| | - Milko Zanini
- Department of Health Sciences, University of Genoa, Via Pastore, 1, 16132 Genoa, Italy.
| | - Silvia Rossi
- Health Professional Direction, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini 5, 16147 Genoa, Italy.
| | - Giuseppe Aleo
- Department of Health Sciences, University of Genoa, Via A. Pastore, 1, 16132 Genoa, Italy; Faculty of Nursing and Midwifery, Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin, Ireland..
| | - Alessio Signori
- Department of Health Sciences, Biostatistics, Via A. Pastore 1, I-16132 Genoa, Italy.
| | - Silvia Scelsi
- Health Professional Direction, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini 5, 16147 Genoa, Italy.
| | - Paolo Petralia
- Italian Association of Paediatric Hospitals (AOPI), General Director, ASL 4 S.S.R. Ligure, Via G. Gaslini 5, 16147 Genoa, Italy
| | | | - Mark Hayter
- Faculty of Health and Education, Manchester Metropolitan University, Manchester, United Kingdom.
| | - Loredana Sasso
- Department of Health Sciences, University of Genoa, Via Pastore, 1, 16132 Genoa, Italy.
| | - Annamaria Bagnasco
- Department of Health Sciences, University of Genoa, Via Pastore, 1, 16132 Genoa, Italy.
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Benson T. Why it is hard to use PROMs and PREMs in routine health and care. BMJ Open Qual 2023; 12:e002516. [PMID: 38135303 DOI: 10.1136/bmjoq-2023-002516] [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: 07/26/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
Patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) show the results of healthcare activities as rated by patients and others. Patients or their proxies record feedback using questionnaires. These can enhance quality for all and tailored care for individuals. This paper describes obstacles that inhibit widespread use of PROMs and PREMs and some potential solutions.Implementation is a prerequisite for any innovation to succeed. Health and care services are complex and people need to be engaged at every level. Most people are cautious about proven innovations such as PROMs and PREMs but champions and leaders can help them engage. The NASSS framework (reasons for Non-adoption, Abandonment and failure to Scale up, Spread or Sustain digital health innovations) helps indicate that implementation is complex why it may be resisted.The Plan-Do-Study-Act (PDSA) approach aids implementation and helps ensure that everyone knows who should do what, when, where, how and why. Noise is an under-appreciated problem, especially when tracking patients over time such as before and after treatment. Interoperability of PROMs and PREMs with electronic health records should use Fast Health Interoperability Resources and internationally accepted coding schemes such as SNOMED CT and LOINC.Most projects need multiple measures to meet the needs of everyone involved. Measure selection should focus on their relevance, ease of use, and response rates.If these problems are avoided or mitigated, PROMs and PREMs can help deliver better patient outcomes, patient experience, staff satisfaction and health equity.
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Affiliation(s)
- Tim Benson
- R-Outcomes Ltd, Newbury, UK
- Institute of Health Informatics, UCL, London, UK
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Davis C, Noblet T, Mistry J, Kowalski K, Rushton A. Patient satisfaction with advanced physiotherapy practice internationally: Protocol for a systematic mixed studies review. PLoS One 2023; 18:e0293170. [PMID: 37862302 PMCID: PMC10588830 DOI: 10.1371/journal.pone.0293170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 10/06/2023] [Indexed: 10/22/2023] Open
Abstract
RATIONALE Patient satisfaction is a complex construct consisting of human and system attributes. Patient satisfaction can afford insight into patient experience, itself a key component of evaluating healthcare quality. Internationally, advanced physiotherapy practice (APP) extends across clinical fields and is characterised as a higher level of practice with a high degree of autonomy and complex decision making. Patient satisfaction with APP appears positive. While evidence synthesis of patient satisfaction with APP exists, no systematic review has synthesised evidence across clinical fields. Therefore, the objectives of this systematic review are 1) to evaluate patient satisfaction with APP internationally, and 2) to evaluate human and system attributes of patient satisfaction with APP. MATERIALS AND METHODS A systematic mixed studies review using a parallel-results convergent synthesis design will be conducted. Searches of Medline, Embase, Web of Science, CINAHL, Cochrane, PEDro and grey literature databases will be conducted from inception to 18/7/2023. Studies of APP (World Physiotherapy definition) whereby practitioners a) have advanced clinical and analytical skills that influence service improvement and provide clinical leadership, b) have post-registration masters level specialisation (or equivalence), c) deliver safe, competent care to patients with complex needs and d) may use particular occupational titles; that measure patient satisfaction across all clinical fields and countries will be included. Two reviewers will screen studies, extract data, assess methodological quality of included studies (mixed methods appraisal tool), and contribute to data synthesis. Quantitative data will undergo narrative synthesis (textual descriptions) and qualitative data thematic synthesis (analytical themes). Integration of data syntheses will inform discussion. IMPLICATIONS This systematic review will provide insight into patient satisfaction with APP internationally, exploring attributes that influence satisfaction. This will aid design, implementation, or improvement of APP and facilitate the delivery of patient-centred, high-quality healthcare. Lastly, this review will inform future methodologically robust research investigating APP patient satisfaction and experience.
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Affiliation(s)
- Chris Davis
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
- Nuffield Health Learning Foundation, Nuffield Health, Surrey, England
| | - Tim Noblet
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
- Therapies Department, St Georges University Hospitals NHS Foundation Trust, London, England
| | - Jai Mistry
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
- Therapies Department, St Georges University Hospitals NHS Foundation Trust, London, England
| | - Katie Kowalski
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Alison Rushton
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
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Lampridis S. Raising the bar, lowering the diaphragm: a new era in diaphragmatic plication. J Thorac Dis 2023; 15:3529-3532. [PMID: 37559649 PMCID: PMC10407503 DOI: 10.21037/jtd-23-716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 06/02/2023] [Indexed: 08/11/2023]
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