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Laddu D, Neeland IJ, Carnethon M, Stanford FC, Mongraw-Chaffin M, Barone Gibbs B, Ndumele CE, Longenecker CT, Chung ML, Rao G. Implementation of Obesity Science Into Clinical Practice: A Scientific Statement From the American Heart Association. Circulation 2024; 150:e7-e19. [PMID: 38766861 DOI: 10.1161/cir.0000000000001221] [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] [Indexed: 05/22/2024]
Abstract
Obesity is a recognized public health epidemic with a prevalence that continues to increase dramatically in nearly all populations, impeding progress in reducing incidence rates of cardiovascular disease. Over the past decade, obesity science has evolved to improve knowledge of its multifactorial causes, identifying important biological causes and sociological determinants of obesity. Treatments for obesity have also continued to develop, with more evidence-based programs for lifestyle modification, new pharmacotherapies, and robust data to support bariatric surgery. Despite these advancements, there continues to be a substantial gap between the scientific evidence and the implementation of research into clinical practice for effective obesity management. Addressing barriers to obesity science implementation requires adopting feasible methodologies and targeting multiple levels (eg, clinician, community, system, policy) to facilitate the delivery of obesity-targeted therapies and maximize the effectiveness of guideline-driven care to at-need patient populations. This scientific statement (1) describes strategies shown to be effective or promising for enhancing translation and clinical application of obesity-based research; (2) identifies key gaps in the implementation of obesity science into clinical practice; and (3) provides guidance and resources for health care professionals, health care systems, and other stakeholders to promote broader implementation and uptake of obesity science for improved population-level obesity management. In addition, advances in implementation science that hold promise to bridge the know-do gap in obesity prevention and treatment are discussed. Last, this scientific statement highlights implications for health research policy and future research to improve patient care models and optimize the delivery and sustainability of equitable obesity-related care.
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Hehmeyer KN, Zierhut H, Dedrick R, Dean M, Schwarting K, Bellia KS, Cragun D. The development and preliminary evaluation of the Genetic Counseling Skills Checklist. J Genet Couns 2024; 33:578-591. [PMID: 37529972 DOI: 10.1002/jgc4.1758] [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: 07/07/2021] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 08/03/2023]
Abstract
Genetic counseling (GC) relies on communication to help people understand and adapt to genetic contributions of disease, and there is need for a practical and reliable method of comprehensively documenting GC communication skills without intensive coding. To this end, we created a novel process measure called the Genetic Counseling Skills Checklist (GCSC), utilizing previously validated measures, communication/counseling frameworks, and prior research findings. A multistage iterative process was used to develop, evaluate, and modify the GCSC to improve its clarity, usability, and content validity. To assess interrater reliability, randomly assigned, untrained individuals (i.e., coders) used the GCSC version 3 to code multiple simulated GC sessions. Average measures intraclass correlation coefficients (ICCs) were calculated for each of the 8 GCSC process categories using one-way, random effects models. After relatively minor modifications to the GCSC, two pairs of experienced coders used GCSC version 4 to independently code additional GC sessions and Cohen's Kappa coefficients (κ) were calculated to assess interrater reliability for each process category. The GCSC contains five to eight items within each category and demonstrates good content validity given its ability to capture nearly all GC skills that genetic counselors reported using in a prior qualitative study. Interrater reliability of GCSC version 3 among coders with limited experience was moderate or good for 6 out of the 8 process categories as evidenced by ICCs ranging from 0.55 to 0.86. Average interrater reliability of GCSC version 4 among one pair of experienced coders was strong for all eight process categories (κ ranging from 0.82 to 0.94); among the second pair of experienced coders scores were strong for six categories (κ ranging from 0.80 to 0.87) and moderate for two categories (κ of 0.77 and 0.78). The results suggest the need for training and experience to assure adequate interrater reliability across GCSC coders. Future work is needed to create a formalized training program for coders, complete a larger study to further validate the measure, and use the GCSC to document variability in skills used across providers and sessions.
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Affiliation(s)
| | - Heather Zierhut
- Department of Genetics, Cell Biology, and Development, University of Minnesota - Twin Cities, Minneapolis, Minnesota, USA
| | - Robert Dedrick
- Department of Educational and Psychological Studies, College of Education, University of South Florida, Tampa, Florida, USA
| | - Marleah Dean
- Department of Communication, University of South Florida, Tampa, Florida, USA
- Health Outcomes & Behavior Program, Moffitt Cancer Center, Tampa, Florida, USA
| | | | - Katie Sullivan Bellia
- Orlando Health Winnie Palmer Hospital Center for Maternal Fetal Medicine, Orlando, Florida, USA
| | - Deborah Cragun
- College of Public Health, University of South Florida, Tampa, Florida, USA
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Ng QX, Liau MYQ, Tan YY, Tang ASP, Ong C, Thumboo J, Lee CE. A Systematic Review of the Reliability and Validity of the Patient Activation Measure Tool. Healthcare (Basel) 2024; 12:1079. [PMID: 38891154 PMCID: PMC11171848 DOI: 10.3390/healthcare12111079] [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: 03/29/2024] [Revised: 05/20/2024] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
Patient activation, broadly defined as the ability of individuals to manage their health and navigate the healthcare system effectively, is crucial for achieving positive health outcomes. The Patient Activation Measure (PAM), a popularly used tool, was developed to assess this vital component of health care. This review is the first to systematically examine the validity of the PAM, as well as study its reliability, factor structure, and validity across various populations. Following the PRISMA and COSMIN guidelines, a search was conducted in MEDLINE, EMBASE, and Cochrane Library, from inception to 1 October 2023, using combinations of keywords related to patient activation and the PAM. The inclusion criteria were original quantitative or mixed methods studies focusing on PAM-13 or its translated versions and containing data on psychometric properties. Out of 3007 abstracts retrieved, 39 studies were included in the final review. The PAM has been extensively studied across diverse populations and geographical regions, including the United States, Europe, Asia, and Australia. Most studies looked at populations with chronic conditions. Only two studies applied the PAM to community-dwelling individuals and found support for its use. Studies predominantly showed a high internal consistency (Cronbach's alpha > 0.80) for the PAM. Most studies supported a unidimensional construct of patient activation, although cultural differences influenced the factor structure in some cases. Construct validity was established through correlations with health behaviors and outcomes. Despite its strengths, there is a need for further research, particularly in exploring content validity and differential item functioning. Expanding the PAM's application to more diverse demographic groups and community-dwelling individuals could enhance our understanding of patient activation and its impact on health outcomes.
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Affiliation(s)
- Qin Xiang Ng
- Health Services Research Unit, Singapore General Hospital, Singapore 169608, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore
| | - Matthias Yi Quan Liau
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
| | - Yong Yi Tan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
| | - Ansel Shao Pin Tang
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Clarence Ong
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore
| | - Julian Thumboo
- Health Services Research Unit, Singapore General Hospital, Singapore 169608, Singapore
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
- SingHealth Duke-NUS Medicine Academic Clinical Programme, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Chien Earn Lee
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore
- SingHealth Duke-NUS Medicine Academic Clinical Programme, Duke-NUS Medical School, Singapore 169857, Singapore
- SingHealth Office of Regional Health, Singapore 911532, Singapore
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Weiner DE, Delgado C, Flythe JE, Forfang DL, Manley T, McGonigal LJ, McNamara E, Murphy H, Roach JL, Watnick SG, Weinhandl E, Willis K, Berns JS. Patient-Centered Quality Measures for Dialysis Care: A Report of a Kidney Disease Outcomes Quality Initiative (KDOQI) Scientific Workshop Sponsored by the National Kidney Foundation. Am J Kidney Dis 2024; 83:636-647. [PMID: 37972814 DOI: 10.1053/j.ajkd.2023.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 09/08/2023] [Accepted: 09/15/2023] [Indexed: 11/19/2023]
Abstract
Providing high-quality patient-centered care is the central mission of dialysis facilities. Assessing quality and patient-centeredness of dialysis care is necessary for continuous dialysis facility improvement. Based predominantly on readily measured items, current quality measures in dialysis care emphasize biochemical and utilization outcomes, with very few patient-reported items. Additionally, current metrics often do not account for patient preferences and may compromise patient-centered care by limiting the ability of providers to individualize care targets, such as dialysis adequacy, based on patient priorities rather than a fixed numerical target. Developing, implementing, and maintaining a quality program using readily quantifiable data while also allowing for individualization of care targets that emphasize the goals of patients and their care partners provided the motivation for a September 2022 Kidney Disease Outcomes Quality Initiative (KDOQI) Workshop on Patient-Centered Quality Measures for Dialysis Care. Workshop participants focused on 4 questions: (1) What are the outcomes that are most important to patients and their care partners? (2) How can social determinants of health be accounted for in quality measures? (3) How can individualized care be effectively addressed in population-level quality programs? (4) What are the optimal means for collecting valid and robust patient-reported outcome data? Workshop participants identified numerous gaps within the current quality system and favored a conceptually broader, but not larger, quality system that stresses highly meaningful and adaptive measures that incorporate patient-centered principles, individual life goals, and social risk factors. Workshop participants also identified a need for new, low-burden tools to assess patient goals and priorities.
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Affiliation(s)
| | - Cynthia Delgado
- San Francisco Veterans Affairs Health Care System and the University of California, San Francisco, CA
| | | | | | | | | | | | | | | | - Suzanne G Watnick
- Northwest Kidney Centers, Seattle, WA; University of Washington, Seattle, WA; Puget Sound VA, Seattle, WA
| | - Eric Weinhandl
- University of Minnesota, Minneapolis, MN; Satellite Healthcare, San Jose, CA
| | | | - Jeffrey S Berns
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Banks LC, Kapphahn K, Das M, Patel MI. Randomized Trial of a Volunteer-Led Symptom Assessment Intervention on Documentation, Patient-Reported Outcomes, and Health Care Use Among Veterans With Lung Cancer. JCO Oncol Pract 2024; 20:419-428. [PMID: 38207246 DOI: 10.1200/op.23.00557] [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: 08/31/2023] [Revised: 11/03/2023] [Accepted: 11/27/2023] [Indexed: 01/13/2024] Open
Abstract
PURPOSE Identification and documentation of Veterans' symptoms are crucial for optimal lung cancer care delivery. The objective of this study was to determine whether a volunteer-led proactive telephone symptom assessment intervention could improve comprehensive symptom documentation. METHODS Veterans with lung cancer were randomly assigned to usual care (control group) or usual care with proactive symptom assessment in which a peer volunteer made weekly phone calls to assess patient symptoms under nurse practitioner supervision. The primary outcome was oncologist documentation of symptoms in the electronic health record at all clinical visits within 6 months after enrollment. Secondary outcomes included patient satisfaction with decision, patient activation, health-related quality of life (HRQOL), and symptom burden, measured at baseline, and 3, 6, and 9 months after enrollment, and acute care use within 9 months after enrollment. RESULTS Among 60 Veterans randomly assigned, median (range) age was 70.2 (50-86) years; 57 (95.0%) were male. More intervention participants had oncologist documentation of symptoms than control group participants (24 [77.4%] v seven [24.1%], respectively; odds ratio, 16.46 [95% CI, 4.58 to 59.16]). Intervention group participants had greater improvements over time in HRQOL (expected mean difference, 25.3 [95% CI, 15.00 to 35.70]) and patient activation (expected mean difference, 13.6 [95% CI, 3.79 to 23.39]), lower symptom burden (expected mean difference, -6.39 [95% CI, -15.21 to -2.46]), lower rates of emergency room visits (incidence rate ratio, 0.48 [95% CI, 0.30 to 0.75]), and hospitalizations (incidence rate ratio, 0.47 [95% CI, 0.28 to 0.77]) than control group participants. CONCLUSION This symptom assessment intervention is an effective strategy for Veterans with lung cancer.
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Affiliation(s)
| | - Kris Kapphahn
- Quantitative Sciences Unit, Stanford School of Medicine, Stanford, CA
| | - Millie Das
- Department of Medicine, VA Palo Alto Health Care System, Palo Alto, CA
- Division of Oncology, Stanford School of Medicine, Stanford, CA
| | - Manali I Patel
- Department of Medicine, VA Palo Alto Health Care System, Palo Alto, CA
- Division of Oncology, Stanford School of Medicine, Stanford, CA
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Yayan J, Franke KJ, Berger M, Windisch W, Rasche K. Adhesion, metastasis, and inhibition of cancer cells: a comprehensive review. Mol Biol Rep 2024; 51:165. [PMID: 38252369 PMCID: PMC10803487 DOI: 10.1007/s11033-023-08920-5] [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: 08/25/2023] [Accepted: 10/23/2023] [Indexed: 01/23/2024]
Abstract
This comprehensive review delves into cancer's complexity, focusing on adhesion, metastasis, and inhibition. It explores the pivotal role of these factors in disease progression and therapeutic strategies. This review covers cancer cell migration, invasion, and colonization of distant organs, emphasizing the significance of cell adhesion and the intricate metastasis process. Inhibition approaches targeting adhesion molecules, such as integrins and cadherins, are discussed. Overall, this review contributes significantly to advancing cancer research and developing targeted therapies, holding promise for improving patient outcomes worldwide. Exploring different inhibition strategies revealed promising therapeutic targets to alleviate adhesion and metastasis of cancer cells. The effectiveness of integrin-blocking antibodies, small molecule inhibitors targeting Focal adhesion kinase (FAK) and the Transforming Growth Factor β (TGF-β) pathway, and combination therapies underscores their potential to disrupt focal adhesions and control epithelial-mesenchymal transition processes. The identification of as FAK, Src, β-catenin and SMAD4 offers valuable starting points for further research and the development of targeted therapies. The complex interrelationships between adhesion and metastatic signaling networks will be relevant to the development of new treatment approaches.
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Affiliation(s)
- Josef Yayan
- Department of Internal Medicine, Division of Pulmonary, Allergy, and Sleep Medicine, Witten/Herdecke University, HELIOS Clinic Wuppertal, Heusnerstr. 40, 42283, Wuppertal, Germany.
| | - Karl-Josef Franke
- Department of Internal Medicine, Pulmonary Division, Internal Intensive Care Medicine, Infectiology, and Sleep Medicine, Märkische Clinics Health Holding Ltd, Clinic Lüdenscheid, Witten/Herdecke University, Lüdenscheid, Germany
| | - Melanie Berger
- Department of Pneumology, Cologne Merheim Hospital, Witten/Herdecke University, Cologne, Germany
| | - Wolfram Windisch
- Department of Pneumology, Cologne Merheim Hospital, Witten/Herdecke University, Cologne, Germany
| | - Kurt Rasche
- Department of Internal Medicine, Division of Pulmonary, Allergy, and Sleep Medicine, Witten/Herdecke University, HELIOS Clinic Wuppertal, Heusnerstr. 40, 42283, Wuppertal, Germany
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Urkande NK, Mankar N, Nikhade PP, Chandak M. Understanding the Complexities of Cast Post Retention: A Comprehensive Review of Influential Factors. Cureus 2023; 15:e51258. [PMID: 38288201 PMCID: PMC10823198 DOI: 10.7759/cureus.51258] [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: 11/18/2023] [Accepted: 12/27/2023] [Indexed: 01/31/2024] Open
Abstract
This comprehensive review delves into the intricate landscape of cast post retention in restorative dentistry, encompassing historical perspectives, contemporary techniques, and future directions. Examining factors ranging from tooth-related considerations to prosthesis-related dynamics, the review provides a detailed analysis of clinical techniques, including step-by-step procedures, common challenges, and innovative advancements. Technological breakthroughs, such as digital impressions, computer-aided design and computer-aided manufacturing (CAD/CAM) technology, three-dimensional (3D) printing, and finite element analysis, are explored for their transformative impact on precision and customization. The discussion extends to the promising future of cast post retention, emphasising emerging materials, the integration of artificial intelligence in treatment planning, and patient-specific approaches. Implications for clinical practice underscore the importance of individualised treatment planning and the adoption of advanced technologies. Recommendations for future research advocate for comprehensive long-term clinical studies, investigations into AI-driven treatment planning, and a focus on patient outcomes and satisfaction. This review consolidates existing knowledge and anticipates a future marked by enhanced precision, individualised care, and improved long-term success in cast post-retained restorations.
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Affiliation(s)
- Neha K Urkande
- Conservative Dentistry and Endodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Nikhil Mankar
- Conservative Dentistry and Endodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Pradnya P Nikhade
- Conservative Dentistry and Endodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Manoj Chandak
- Conservative Dentistry and Endodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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Castle EM, Billany RE, Lightfoot CJ, Annema C, De Smet S, Graham-Brown MP, Greenwood SA. Exercise as a therapeutic intervention in chronic kidney disease: are we nearly there yet? Curr Opin Nephrol Hypertens 2023; 32:502-508. [PMID: 37622530 PMCID: PMC10552838 DOI: 10.1097/mnh.0000000000000923] [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] [Indexed: 08/26/2023]
Abstract
PURPOSE OF REVIEW The opportunity to review the more recent evidence for prescribing exercise-based physical rehabilitation for people living with chronic kidney disease (CKD) is timely. There has been a recent global focus evaluating how physical activity interventions might improve health-related quality of life and outcomes for people living with chronic health conditions in a post-COVID era. There is finally a long overdue commitment from the kidney research and clinical community to deliver pragmatic interventions to help people living with CKD to be able to live well with their condition. RECENT FINDINGS This article reviews recent research, and discusses the challenges and potential solutions, for providing exercise-based therapeutic options for people living with CKD; including predialysis self-management interventions, options for both prehabilitation and posttransplant rehabilitation, pragmatic considerations for delivery of exercise therapy for people receiving haemodialysis treatment and the role of virtual kidney-specific rehabilitation. SUMMARY Whilst there remains a need for further research in this area of patient care, there is now a body of evidence and kidney-specific guidelines that firmly support a rollout of pragmatic and scalable exercise-based interventions for people living with CKD. We are indeed nearly there now.
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Affiliation(s)
- Ellen M. Castle
- Physiotherapy, Department of Health Sciences, College of Health, Medicine, and life Sciences, Brunel University, London, UK
| | - Roseanne E. Billany
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Courtney J. Lightfoot
- Leicester Kidney Lifestyle Team, Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Coby Annema
- Section of Nursing Science, Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Stefan De Smet
- Group Rehabilitation for Internal Disorders, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Nephrology and Renal Transplantation, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Laboratory of Abdominal Transplantation, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | | | - Sharlene A. Greenwood
- Renal Therapies, King's College Hospital NHS Trust, London, UK
- Faculty of Life Sciences & Medicine, King's College London, London, UK
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Bentlage E, Nyamadi JJ, Dubbeldam R. The Importance of Activating Factors in Physical Activity Interventions for Older Adults Using Information and Communication Technologies: Systematic Review. JMIR Mhealth Uhealth 2023; 11:e42968. [PMID: 37933182 PMCID: PMC10644949 DOI: 10.2196/42968] [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: 12/16/2022] [Revised: 06/14/2023] [Accepted: 08/04/2023] [Indexed: 11/08/2023] Open
Abstract
Background In an aging population, it is important to activate older adults in taking care of their own health. Increasing physical activity is one way to avoid or lessen age-related physical and mental impairments. Interest in the use of information and communication technology (ICT) tools to promote physical activity among older adults is growing considerably. Such tools are suitable for communicating activation factors-skills, knowledge, and motivation-by integrating a variety of behavior change techniques (BCTs) to enhance physical activity. Although activation factors have been incorporated into physical activity interventions using ICT, little is known about the actual integration methods used in such interventions or about the effects of activation factors on influencing behavior change. Objective The first aim of this study was to identify which of the activation factors were covered in physical activity-promoting ICT interventions for older adults and which BCTs were used to address them. The second objective was to classify the user interaction interfaces and delivery modes that were used to promote these activation factors. Methods The search engines of PubMed, Web of Science, and ScienceDirect were used to search for and identify articles examining the effectiveness of ICT interventions for promoting physical activity in older adults. References and related data were selected, extracted, and reviewed independently by 2 reviewers. The risk of bias was assessed, and any conflict was addressed by a third separate reviewer. Selected articles included older adults aged ≥55 years without pre-existing medical diseases and other physical or mental conditions that could hinder movement. Results In total, 368 records were retrieved, and 13 studies met all inclusion criteria. Articles differed in terms of themes, timescales, user interaction interfaces, and outcome measures; therefore, a quantitative data synthesis was not feasible. Motivation was the most promoted activation factor among all trials (33 times). An app and a smartwatch were used in the majority of intervention groups (7/20, 35%) for tracking physical activity and receiving personalized feedback based on the individual goals. Skills (25 times) and knowledge (17 times) were the next most commonly addressed activation factors. Face-to-face interaction was the most used approach to targeting users' skills, including providing instructions on how to perform a behavior and exchanging knowledge via education on the health consequences of insufficient physical activity. Overall, integrating all 3 activation factors and using multiple user interaction interfaces with a variety of delivery modes proved the most effective in improving physical activity. Conclusions This study highlights commonly used BCTs and preferred modes of their delivery. So far, only a limited number of available BCTs (21/99, 21%) have been integrated. Considering their effectiveness, a larger variety of BCTs that address skills, knowledge, and motivation should be exploited in future ICT interventions.
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Affiliation(s)
- Ellen Bentlage
- Department of Movement Science, Institute of Sport and Exercise Sciences, University of Münster, Münster, Germany
| | - John Jnr Nyamadi
- Department of Movement Science, Institute of Sport and Exercise Sciences, University of Münster, Münster, Germany
| | - Rosemary Dubbeldam
- Department of Movement Science, Institute of Sport and Exercise Sciences, University of Münster, Münster, Germany
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Gledhill K, Bucknall TK, Lannin NA, Hanna L. The role of collaborative decision-making in discharge planning: Perspectives from patients, family members and health professionals. J Clin Nurs 2023; 32:7519-7529. [PMID: 37403644 DOI: 10.1111/jocn.16820] [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: 12/23/2022] [Revised: 06/08/2023] [Accepted: 06/19/2023] [Indexed: 07/06/2023]
Abstract
AIM To explore discharge planning with a range of key stakeholders in subacute care, including consumers. DESIGN Qualitative descriptive study. METHODS Patients (n = 16), families (n = 16), clinicians (n = 17) and managers (n = 12) participated in semi-structured interviews or focus groups. Following transcription, data were analysed thematically. RESULTS The overarching facilitator of effective discharge planning was collaborative communication, leading to shared expectations by all stakeholders. Collaborative communication was underpinned by four key themes: patient- and family-centred decision-making, early goal setting, strong inter- and intra-disciplinary teamwork, and robust patient/family education. CONCLUSION Effective planning for discharge from subacute care is enabled by shared expectations and collaborative communication between key stakeholders. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Effective discharge planning processes are underpinned by effective inter- and intra-disciplinary teamwork. Healthcare networks should foster environments that promote effective communication between and within multidisciplinary team members as well as with patients and their families. Applying these principles to discharge planning may assist in reducing length of stays and rates of preventable readmissions post-discharge. IMPACT This study addressed a lack of knowledge about effective discharge planning in Australian subacute care. It found that collaborative communication between stakeholders was an overarching facilitator of effective discharge planning. This finding impacts subacute service design and professional education. REPORTING METHOD COREQ guidelines were followed in reporting this study. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution in the design, data analysis or preparation of the manuscript.
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Affiliation(s)
- Kate Gledhill
- School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
- School of Primary and Allied Healthcare, Monash University, Geelong, Victoria, Australia
| | - Tracey K Bucknall
- School of Nursing and Midwifery, Deakin University, Melbourne, Victoria, Australia
- Department of Occupational Therapy, Alfred Health, Melbourne, Victoria, Australia
- Department of Nursing, Alfred Health, Melbourne, Victoria, Australia
- Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Natasha A Lannin
- Department of Occupational Therapy, Alfred Health, Melbourne, Victoria, Australia
- Department of Nursing, Alfred Health, Melbourne, Victoria, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Lisa Hanna
- School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
- Institute of Health Transformation, Deakin University, Geelong, Victoria, Australia
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Ge L, Yip WF, Yan AHH, Seng ECS, Pei CCP, Onn ILY, Yiwen EC, Tham S, Moon-Ho RH, Tan WS. Perceived Roles and Barriers in Delivering Community-Based Care: A Qualitative Study of Health and Social Care Professionals. Int J Integr Care 2023; 23:5. [PMID: 37877112 PMCID: PMC10591202 DOI: 10.5334/ijic.7617] [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: 03/23/2023] [Accepted: 10/11/2023] [Indexed: 10/26/2023] Open
Abstract
Introduction As healthcare systems increasingly embrace population health management, the integration of health and social care to improve the health and well-being of individuals is crucial. Thus, we conducted a qualitative study in Singapore to understand health and social care professionals' (HCPs and SCPs) perception of the roles they played in delivering community-based care. Methods A descriptive phenomenological research design was adopted. HCPs and SCPs (n = 53) providing services in community settings were recruited purposefully and interviewed through eleven focus group discussions. Each session was recorded and transcribed. Thematic analysis was applied. Results Our results revealed eight themes in three main categories describing the roles played by HCPs and SCPs, including: (1) delivering needs-based care in community settings; (2) activating and empowering clients in health care, and (3) fostering community-based sustainable support networks. Six barriers encountered while performing these roles were also identified. Discussion and Conclusion Our results highlight that the roles of HCPs and SCPs go beyond the provision of direct medical and social care. They were involved in activating and empowering clients to take care of their health, and importantly, fostering community-based sustainable support networks to better empower individuals in coping with health challenges. The identified barriers shed light on areas for potential improvements for integrated community care.
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Affiliation(s)
- Lixia Ge
- Health Services and Outcomes Research, National Healthcare Group Pte Ltd, SG
| | - Wan Fen Yip
- Health Services and Outcomes Research, National Healthcare Group Pte Ltd, SG
| | - Andy Ho Hau Yan
- School of Social Sciences, Nanyang Technological University, SG
- Lee Kong Chian School of Medicine, Nanyang Technological University, SG
| | | | | | | | - Evon Chua Yiwen
- Population Health & Community Transformation, Yishun Health, SG
| | - Sinma Tham
- Office of Community Integration, Woodlands Health Campus, SG
| | | | - Woan Shin Tan
- Health Services and Outcomes Research, National Healthcare Group Pte Ltd, SG
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Derricks V, Gainsburg I, Shields C, Fiscella K, Epstein R, Yu V, Griggs JJ. Examining the effects of physician burnout on pain management for patients with advanced lung cancer. Support Care Cancer 2023; 31:469. [PMID: 37458824 DOI: 10.1007/s00520-023-07899-w] [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: 01/11/2023] [Accepted: 06/21/2023] [Indexed: 07/20/2023]
Abstract
PURPOSE Physician burnout is generally associated with worse clinical outcomes. The purpose of this study is to examine the effects of physician burnout on the quality of physicians' pain assessment and opioid prescribing for patients with advanced lung cancer. Moreover, we test whether these relationships are moderated by patient-level factors, such as patient race and activation level, that have a demonstrated impact on clinical encounters. METHODS We conducted a secondary analysis of data from a multisite randomized field experiment. From 2012 to 2016, 96 primary care physicians and oncologists who treated solid tumors were recruited from hospitals and medical sites in three small metropolitan and rural areas in the USA. Physicians saw two unannounced standardized patients who presented with advanced lung cancer. Standardized patients varied across race (Black or White) and activation level (activated, typical). Visits were audio recorded and transcribed. Pain management was evaluated by the quality of pain assessment and opioid prescribing during these visits. RESULTS Mixed-effects linear regression and generalized mixed-effects modeling showed that higher levels of burnout were associated with a greater likelihood of prescribing an opioid and prescribing stronger opioid doses for patients. These effects were not moderated by patient race or activation level. CONCLUSION Findings from this work inform our understanding of physician-level factors that impact clinical decision-making in the context of cancer pain management. Specifically, this study identifies the role of physician burnout on the quality of prescribing for patients with advanced lung cancer.
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Affiliation(s)
- Veronica Derricks
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 N Blackford St., Indianapolis, IN, 46202, USA.
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA.
| | - Izzy Gainsburg
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
- Ross School of Business, University of Michigan, Ann Arbor, MI, USA
- John F. Kennedy School of Government, Harvard University, Cambridge, MA, USA
| | - Cleveland Shields
- Human Development & Family Studies, Purdue University, West Lafayette, IN, USA
| | - Kevin Fiscella
- Department of Family Medicine, University of Rochester School of Medicine, Rochester, NY, USA
| | - Ronald Epstein
- Department of Family Medicine, University of Rochester School of Medicine, Rochester, NY, USA
| | - Veronica Yu
- Department of Family Medicine, University of Rochester School of Medicine, Rochester, NY, USA
| | - Jennifer J Griggs
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, MI, USA
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
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Hollestelle MJ, van der Graaf R, Sturkenboom MC, van Delden JJ. Stimulating solidarity to improve knowledge on medications used during pregnancy : A contribution from the ConcePTION project. BMC Med Ethics 2023; 24:44. [PMID: 37370079 DOI: 10.1186/s12910-023-00924-x] [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: 01/21/2023] [Accepted: 06/20/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Pregnant people have been overlooked or excluded from clinical research, resulting in a lack of scientific knowledge on medication safety and efficacy during pregnancy. Thus far, both the opportunities to generate evidence-based knowledge beyond clinical trials and the role of pregnant people in changing their status quo have not been discussed. Some scholars have argued that for rare disease patients, for whom, just like pregnant people, a poor evidence base exists regarding treatments, solidarity has played an important role in addressing the evidence gap. This paper explores whether and how the enactment of solidarity among pregnant people can be stimulated to help address the poor evidence base on medications used during pregnancy. METHOD We use the concept of solidarity formulated by Prainsack and Buyx and enrich their concept by providing an account for stimulating the enactment of solidarity. Then we apply this account to the case of pregnant people who use medication. RESULTS Solidarity means enacted commitment on the part of an individual to assisting others with whom the person recognizes a similarity in a relevant respect. Although solidarity cannot be imposed, we argue that the empowerment of people is a crucial concept in understanding how solidarity can be stimulated. Empowerment in the context of pregnant people means creating awareness about their status quo, explaining how scientific research can help close the knowledge gap, and how pregnant people can themselves contribute. In particular, how pregnant people can contribute to the collection of health data to strengthen the evidence base for medications used during pregnancy. CONCLUSIONS We conclude that acting in solidarity can help change the status quo for pregnant people. Furthermore, we argue that the empowerment of pregnant people and other relevant stakeholders is a way to stimulate the enactment of solidarity. The process of empowerment starts by raising awareness about the lack of evidence on medications used during prengnacy and by explaining to pregnant people how they can contribute to changing the way knowledge is being generated by, for example, sharing data on the health effects of medications.
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Affiliation(s)
- Marieke J Hollestelle
- Department of Bioethics and Health Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Rieke van der Graaf
- Department of Bioethics and Health Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Miriam Cjm Sturkenboom
- Department Data science & Biostatistics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Johannes Jm van Delden
- Department of Bioethics and Health Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Liang R, Zhang H, Xie L, Sun A, Wang J, Chen J. Application of medical-nurse integration health education in aged patients undergoing percutaneous vertebroplasty. Medicine (Baltimore) 2023; 102:e33879. [PMID: 37335677 DOI: 10.1097/md.0000000000033879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
This study was designed to explore the effect of medical-nurse integration health education in aged patients undergoing percutaneous vertebroplasty. A total of 72 aged patients with osteoporotic vertebral compression fractures, who obtained percutaneous vertebroplasty from June 2019 to May 2022 were selected in this study. Patients were divided into control group (n = 36) and experimental group (n = 36) according to the time of hospitalization. The patients in control group received routine health education, while the patients in the experimental group received medical-nurse integration health education. We evaluated participants on 4 key aspects, their understanding of relevant knowledge, compliance with functional exercise, residual lower back pain rate, and satisfaction with the health education received. Our study found that patients in the experimental group had a significantly higher mastery rate of health education knowledge compared to those in the control group (88.89% vs 50.00%, P < .001). Additionally, compliance with the functional exercise program was higher in the experimental group, with over 80% of patients fully compliant, compared to only about 44.4% in the control group (P = .001). The average Japanese Orthopaedic Association score of the observation group 1 week after operation was higher than that of the control group (P < .05). Moreover, most patients in the experimental group were very satisfied with the medical-nurse integration health education, while most patients in the control group were only satisfied (P < .001). For aged patients with osteoporotic vertebral compression fractures treated by percutaneous vertebroplasty, medical-nurse integration health education could be an effective method to improve the ability of patients to obtain relevant education, enhance the compliance of patients for functional exercise and increase patient satisfaction to the education, and reduce residual low back pain in patients.
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Affiliation(s)
- Ruirui Liang
- School of Nursing, Anhui Medical University, Feicui Road, Hefei, Anhui, China
- Geriatrics Department, the Second People's Hospital of Hefei, Guangde Road, Hefei, Anhui, China
| | - Huimin Zhang
- Interventional Vascular Pain Department, The Second People's Hospital of Hefei, Guangde Road, Hefei, Anhui, China
| | - Lunfang Xie
- School of Nursing, Anhui Medical University, Feicui Road, Hefei, Anhui, China
| | - Aihua Sun
- Geriatrics Department, the Second People's Hospital of Hefei, Guangde Road, Hefei, Anhui, China
| | - Jing Wang
- Geriatrics Department, the Second People's Hospital of Hefei, Guangde Road, Hefei, Anhui, China
| | - Jun Chen
- Interventional Vascular Pain Department, The Second People's Hospital of Hefei, Guangde Road, Hefei, Anhui, China
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Hughes TD, Roller JS, Hahn F, Ferreri SP. Racial and Ethnic Disparities in Community-Based Pharmacies: A Scoping Review. PHARMACY 2023; 11:93. [PMID: 37368419 DOI: 10.3390/pharmacy11030093] [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: 01/16/2023] [Revised: 05/11/2023] [Accepted: 05/23/2023] [Indexed: 06/28/2023] Open
Abstract
As pharmacy practice shifts its focus toward population health care needs that serve public health, there is a need to understand community-based pharmacies' contributions to the reduction in health disparities. A scoping review was conducted to identify what community-based pharmacies in the United States are doing to target racial and ethnic disparities in community-based pharmacies. Forty-two articles revealed that community-based pharmacy services addressed racial and ethnic inequities in a variety of ways, including the types of interventions employed, as well as the ethnicities and conditions of the sample populations. Future work should focus on ensuring interventions are carried out throughout pharmacy practice and accessible to all racial and ethnic minoritized populations.
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Affiliation(s)
- Tamera D Hughes
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Jessica S Roller
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Faustina Hahn
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Stefanie P Ferreri
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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Mthembu Z, Chimbari M. Community engagement: health research through informing, consultation, involving and empowerment in Ingwavuma community. Front Public Health 2023; 11:1050589. [PMID: 37333558 PMCID: PMC10272796 DOI: 10.3389/fpubh.2023.1050589] [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] [Received: 09/21/2022] [Accepted: 05/16/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction The goal of community involvement in health research is to improve a community's ability to address its own health needs while ensuring that researchers understand and consider the community's priorities. Recent data show that socio-economic and environmental challenges continue to be a barrier to informing, consulting, involving and empowering communities in community-based health research beneficial to them. The aim of this study was to assess the extent to which the Ingwavuma community in KwaZulu-Natal Province, in rural South Africa, was informed, consulted, involved and empowered about two research projects conducted between 2014 and 2021. Methods The study used the modified random-route procedure to administer a standardized questionnaire to 339 household heads selected randomly. The questionnaires were administered face-to-face. The sample size was estimated using the Yamane sample size generating formula. Chi-square tests were performed to assess associations between demographic variables (age, gender, education, village) and respondents' knowledge and information of the projects, Malaria and Bilharzia in Southern Africa and Tackling Infections to Benefit Africa as well as their participation. Results The communities were generally well-informed about the health projects that were being carried out. Fewer than half of those who had heard about the projects had directly participated in them. The majority had been tested for one or more diseases and conditions, mostly high blood pressure, diabetes, and schistosomiasis, and had participated in a community feedback group; many had given their children's permission to be tested for schistosomiasis or to participate in project research activities. Others participated in public awareness campaigns and surveys. There was some evidence of a consultation process in the form of public consultation discussed in the projects, and not much discussion on empowerment. Discussion The findings demonstrate that researchers' CE approach was adaptable as communities were largely educated, involved, and subsequently empowered though without much consultation and that researchers had provided a space for sharing responsibilities in all engagement process decision-making. For the empowerment of the community, projects should take into account the intrapersonal and personal aspects affecting the community's capacity to effectively benefit from the information, consultation, involvement, and empowerment procedures.
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Affiliation(s)
- Zinhle Mthembu
- Department of Public Health Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- Department of Anthropology and Development Studies, Faculty of Humanities and Social Sciences, University of Zululand, KwaDlangezwa, South Africa
| | - Moses Chimbari
- Department of Public Health Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- Department of Anthropology and Development Studies, Faculty of Humanities and Social Sciences, University of Zululand, KwaDlangezwa, South Africa
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Gorecki MC, Piotrowski ME, Brown CM, Teli RR, Percy Z, Lane L, Bolling CF, Siegel RM, Copeland KA. STEP IN: Supporting Together Exercise and Play and Improving Nutrition; a Feasibility Study of Parent-Led Group Sessions and Fitness Trackers to Improve Family Healthy Lifestyle Behaviors in a Low-Income, Predominantly Black Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095686. [PMID: 37174204 PMCID: PMC10178511 DOI: 10.3390/ijerph20095686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/08/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Pediatric obesity is prevalent and challenging to treat. Although family-centered behavioral management is the gold standard, many families face structural inequities to its access and efficacy. Identifying ways to manage pediatric obesity within primary care is needed. METHODS This feasibility study included three sequential trials of peer-led group sessions occurring biweekly or monthly between 3/2016 and 2/2017. Parent-child dyads were recruited from a large academic primary care clinic via mailed invitations, prioritizing patients living in local zip codes of historical disinvestment. Eligible patients were 6 to 12 years with a body mass index ≥85th percentile, with parent and child interest in making healthy lifestyle changes, and English speaking. RESULTS 27 dyads participated, 77% were non-Hispanic Black. Retention and attendance rates were highest in the initial four-session biweekly pilot (100%, 0 dropouts), high in the full six-session biweekly cohort (83%, 1 dropout), and moderate in the monthly cohort (62.7%, 4 dropouts). Families reported high satisfaction with the sessions (4.75/5). Qualitative comments suggested social connections had motivated behavior change in some families. CONCLUSION Parent-led group sessions for pediatric weight management show promise in engaging families. A future large trial is needed to assess behavior change and anthropometric outcomes.
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Affiliation(s)
- Michelle C Gorecki
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7035, Cincinnati, OH 45229, USA
| | - Megan E Piotrowski
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7035, Cincinnati, OH 45229, USA
| | - Courtney M Brown
- Department of Pediatrics, Division of Primary Care Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH 43205, USA
| | - Radhika R Teli
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Zana Percy
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Laura Lane
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Christopher F Bolling
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Robert M Siegel
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Kristen A Copeland
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7035, Cincinnati, OH 45229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
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18
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Rohr J, Vahidy FS, Bartek N, Bourassa KA, Nanavaty NR, Antosh DD, Harms KP, Stanley JL, Madan A. Reducing psychiatric illness in the perinatal period: A review and commentary. World J Psychiatry 2023; 13:149-160. [PMID: 37123098 PMCID: PMC10130961 DOI: 10.5498/wjp.v13.i4.149] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/08/2023] [Accepted: 03/31/2023] [Indexed: 04/18/2023] Open
Abstract
This brief overview highlights the global crisis of perinatal psychiatric illness (PPI). PPI is a major contributor to many adverse pregnancy, childbirth, and childhood development outcomes. It contributes to billions of dollars in spending worldwide each year and has a significant impact on the individual, their family, and their community. It is also highly preventable. Current recommendations for intervention and management of PPI are limited and vary considerably from country to country. Furthermore, there are several significant challenges asso-ciated with implementation of these recommendations. These challenges are magnified in number and consequence among women of color and/or minority populations, who experience persistent and negative health disparities during pregnancy and the postpartum period. This paper aims to provide a broad overview of the current state of recommendations and implementation challenges for PPI and layout a framework for overcoming these challenges. An equity-informed model of care that provides universal intervention for pregnant women may be one solution to address the preventable consequences of PPI on child and maternal health. Uniquely, this model emphasizes the importance of managing and eliminating known barriers to traditional health care models. Culturally and contextually specific challenges must be overcome to fully realize the impact of improved management of PPI.
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Affiliation(s)
- Jessica Rohr
- Department of Psychiatry and Behavioral Health, Houston Methodist, Houston, TX 77030, United States
| | - Farhaan S Vahidy
- Department of Neurosurgery, Houston Methodist, Houston, TX 77030, United States
| | - Nicole Bartek
- Department of Psychiatry and Behavioral Health, Houston Methodist, Houston, TX 77030, United States
| | - Katelynn A Bourassa
- Department of Psychiatry and Behavioral Health, Houston Methodist, Houston, TX 77030, United States
| | - Namrata R Nanavaty
- Department of Psychiatry and Behavioral Health, Houston Methodist, Houston, TX 77030, United States
| | - Danielle D Antosh
- Department of Obstetrics and Gynecology, Houston Methodist, Houston, TX 77030, United States
| | - Konrad P Harms
- Department of Obstetrics and Gynecology, Houston Methodist, Houston, TX 77030, United States
| | - Jennifer L Stanley
- Department of Obstetrics and Gynecology, Houston Methodist, Houston, TX 77030, United States
| | - Alok Madan
- Department of Psychiatry and Behavioral Health, Houston Methodist, Houston, TX 77030, United States
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Avery J, Thomas R, Howell D, Dubouloz Wilner CJ. Empowering Cancer Survivors in Managing Their Own Health: A Paradoxical Dynamic Process of Taking and Letting Go of Control. QUALITATIVE HEALTH RESEARCH 2023; 33:412-425. [PMID: 36825869 PMCID: PMC10126457 DOI: 10.1177/10497323231158629] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
In cancer care, gaps in support to help patients manage and live with the side-effects from cancer treatments have increased the emphasis on empowering patients to be more active and involved in managing their own health. However, empowerment in relation to promoting self-management behaviors is not well understood. Using the social constructivist grounded theory approach, our goal was to develop a theoretical understanding of this phenomenon in relation to the self-management behaviors of post-treatment cancer patients. Twenty-two post-treatment cancer patients participated in a semi-structured focused interview to co-construct with us how empowerment is defined, described, and experienced in relation to their capacity to self-manage. Through this co-construction, we defined empowerment as a process of personal growth, a display of fortitude and strength when participants confronted the impact of their illness that emerged in two dynamic and paradoxical ways: 1) establishing control over the impact of the illness as a means to maintain normalcy and to circumvent change over an eroding and changing sense of self and 2) relinquishing control over aspects of the illness deemed irrepressible and acknowledging and accepting change. When successful at establishing and/or relinquishing control, participants no longer viewed cancer as a threat, but re-interpreted their illness as also having a beneficial "empowering" experience and more capable of managing. Findings will guide the development of self-management interventions that use empowerment as a core construct.
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Affiliation(s)
- Jonathan Avery
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Roanne Thomas
- Department of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Doris Howell
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
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Hudon É, Chouinard MC, Ellefsen É, Beaudin J, Hudon C. The experience of pregnant women in contexts of vulnerability of prenatal primary nursing care: a descriptive interpretative qualitative study. BMC Pregnancy Childbirth 2023; 23:187. [PMID: 36932398 PMCID: PMC10023312 DOI: 10.1186/s12884-023-05474-z] [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: 09/16/2022] [Accepted: 02/27/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Prenatal primary nursing care contributes to improving the health outcomes of mothers and unborn babies. Some pregnant women in contexts of vulnerability experience prenatal nursing care in a positive way, while some do not. A better understanding of factors influencing this experience could help improve prenatal nursing care. The aim of this study was to describe factors influencing the prenatal primary nursing care experience of pregnant women in contexts of vulnerability. METHODS Thorne's qualitative interpretative descriptive approach was used. Twenty-four pregnant women in contexts of vulnerability were recruited in local community service centers in Quebec, Canada, using purposive and snowball samplings, to carry out a semi-structured interview. Participants were 16 years old and over, in their second or third trimester, or had given birth in the previous year, and received prenatal nursing care through community health services. Data collection methods included a logbook, sociodemographic questionnaire and semi-structured interview on vulnerable pregnant women's experience with prenatal primary nursing care. The Qualitative Analysis Guide of Leuven guided the inductive thematic analysis, following a constant comparative iterative process. RESULTS The women's experience was initially influenced by the fulfillment of their needs and expectations. These stem from their previous or current pregnancy experiences, their motivation to receive prenatal care, their family concerns as well as their contexts of vulnerability. From the pregnant women's perspective, the main factors that influenced their experience were the nurse's approach, characteristics and interventions that all impact on their relationship with nurses, as well as the prenatal primary care organization, including the modalities of prenatal care (i.e. schedule, setting, duration, number and frequency of meetings), the continuity and the program's prenatal care services, such as referral to a nutritionist, social worker or other services. CONCLUSIONS A conceptual framework is proposed to describe relationships among the factors distributed in three dimensions that influence the experience of pregnant women in contexts of vulnerability and to guide nurses in the improvement of prenatal primary care. Considering the complexity of this experience, a person-centered approach is mandatory to promote a positive experience, equity and a better use of services.
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Affiliation(s)
- Émilie Hudon
- grid.86715.3d0000 0000 9064 6198Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, 3001 12e avenue Nord, Sherbrooke, Québec J1H 5N4 Canada
- grid.265696.80000 0001 2162 9981Département des sciences de la santé, Université du Québec à Chicoutimi, 555 boul. de l’Université Chicoutimi, Chicoutimi, Québec G7H 2B1 Canada
| | - Maud-Christine Chouinard
- grid.14848.310000 0001 2292 3357Faculté des sciences infirmières, Université de Montréal, C.P. 6128, succ. Centre-ville, Montréal, Québec H3C 3J7 Canada
- Centre de recherche du Centre intégré universitaire de santé et de services sociaux du Nord-de-l’Île-de-Montréal, 5400 boulevard Gouin Ouest, Montréal, Québec H4J 1C4 Canada
| | - Édith Ellefsen
- grid.86715.3d0000 0000 9064 6198École des sciences infirmières, Université de Sherbrooke campus Longueuil, 150 Place Charles-Le Moyne, Longueuil, Québec J4K 0A8 Canada
| | - Jérémie Beaudin
- grid.86715.3d0000 0000 9064 6198Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, 3001 12e avenue Nord, Sherbrooke, Québec J1H 5N4 Canada
| | - Catherine Hudon
- grid.86715.3d0000 0000 9064 6198Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, 3001 12e avenue Nord, Sherbrooke, Québec J1H 5N4 Canada
- grid.86715.3d0000 0000 9064 6198Département de médecine de famille et de médecine d’urgence, Université de Sherbrooke, 3001 12e avenue Nord, Sherbrooke, Québec J1H 5N4 Canada
- grid.411172.00000 0001 0081 2808Centre de recherche du Centre hospitalier de l’Université de Sherbrooke, 3001 12e Avenue Nord, Sherbrooke, Québec J1H 5N4 Canada
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Quimby D, Conn BM, Ellis TT, Iverson E. The process of capacity-building for pediatric subspecialty providers to address the needs of adolescents and young adults with chronic illness. Int J Adolesc Med Health 2023; 35:89-99. [PMID: 33161385 DOI: 10.1515/ijamh-2020-0216] [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: 08/25/2020] [Accepted: 10/18/2020] [Indexed: 11/15/2022]
Abstract
Approximately 12% of adolescents in the USA live with a chronic health condition. Although youth with chronic illness visit healthcare providers more than healthy peers, pediatric subspecialty providers are less likely to address developmentally relevant concerns (e.g., reproductive health) with adolescents and young adults (AYA), particularly youth of color and/or youth in low-income communities. Despite the documented need for increased training, there remains a general lack of knowledge about pediatric subspecialty providers' training needs related to building their capacity to provide developmentally appropriate care to their adolescent and young adult patients. The present study describes an overall process for capacity-building to address the needs of diverse AYA patients with chronic medical conditions, built upon data representing key stakeholders and staff from 14 specialty care departments collected via quantitative surveys and focus groups. We describe the development of trainings for pediatric subspecialty providers from a large, urban, pediatric tertiary care center to address the health and psychosocial-related concerns of AYA living with chronic illness. We highlight valuable lessons from the capacity-building process in terms of increasing the ability of providers in a major pediatric healthcare center to provide developmentally appropriate care for AYA living with chronic illness. Finally, based on the results of our study, we provide recommendations on how to employ such a process in similar pediatric hospital settings.
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Affiliation(s)
- Dakari Quimby
- Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Bridgid M Conn
- Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Tierra T Ellis
- Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Ellen Iverson
- Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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22
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Spencer MRT, Chen J. Revisiting Patient Engagement and Empowerment Within the NIMHD Health Disparity Framework. Am J Public Health 2023; 113:141-143. [PMID: 36480774 PMCID: PMC9850631 DOI: 10.2105/ajph.2022.307170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Merianne Rose T Spencer
- Merianne Rose T. Spencer and Jie Chen are with the Department of Health Policy and Management and the Hospital And Public Health InterdisciPlinarY Research (HAPPY) Laboratory, School of Public Health, University of Maryland, College Park
| | - Jie Chen
- Merianne Rose T. Spencer and Jie Chen are with the Department of Health Policy and Management and the Hospital And Public Health InterdisciPlinarY Research (HAPPY) Laboratory, School of Public Health, University of Maryland, College Park
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van Zyl S, Kruger WH, Walsh CM. Chronic diseases of lifestyle curriculum: Students' perceptions in primary health care settings. Afr J Prim Health Care Fam Med 2023; 15:e1-e10. [PMID: 36744458 PMCID: PMC9900301 DOI: 10.4102/phcfm.v15i1.3775] [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: 08/04/2022] [Revised: 10/07/2022] [Accepted: 10/15/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Community-based primary health care (PHC) forms the foundation of healthcare in South Africa. Medical programmes need to equip future health practitioners to face the challenges of the rising burden of chronic diseases of lifestyle (CDL) in different communities. Community-based education (CBE) contributes to developing knowledge, skills and attitudes appropriate to the challenges experienced in the PHC context. AIM To explore medical students' perceptions of the current CDL curriculum and related programmes during CBE rotations. SETTING The study was conducted among fourth- and fifth-year medical students at the University of the Free State, South Africa. METHODS Focus group discussions were conducted and data were analysed thematically. RESULTS Themes included perceptions of the CDL curriculum, relevance thereof for the PHC setting and barriers and challenges to implementing PHC programmes. This study identified foundational CDL content that needs to be incorporated or revisited at strategic points. Participants identified the need to contextualise educational programmes and focus on affordable, culturally acceptable and holistic healthcare prevention strategies. Barriers and challenges included high patient load, resource constraints, the lack of continuous care and focus on communicable diseases. Community-based education rotations were described as meaningful opportunities to develop professional attributes, competencies and skills. CONCLUSION This study identified foundational concepts to consider at key points throughout the curriculum. Incorporating creative and reflective learning activities in CDL modules can prepare students for the realities of PHC settings.Contribution: This study provides insight into medical students' perceptions of the CDL curriculum and informs future curriculum content for CDL modules.
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Affiliation(s)
- Sanet van Zyl
- Department of Basic Medical Sciences, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Willem H. Kruger
- Department of Community Health, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Corinna M. Walsh
- Department of Nutrition and Dietetics, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
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Brady B, Sidhu B, Jennings M, Boland R, Hassett G, Chipchase L, Tang C, Yaacoub S, Pavlovic N, Sayad S, Andary T, Ogul S, Naylor J. The feasibility of implementing a cultural mentoring program alongside pain management and physical rehabilitation for chronic musculoskeletal conditions: results of a controlled before-and-after pilot study. BMC Musculoskelet Disord 2023; 24:47. [PMID: 36658511 PMCID: PMC9850562 DOI: 10.1186/s12891-022-06122-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 12/28/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Culturally diverse communities face barriers managing chronic musculoskeletal pain conditions including navigation challenges, sub-optimal healthcare provider engagement and difficulty adopting self-management behaviours. OBJECTIVES To explore the feasibility and trends of effectiveness of implementing a cultural mentoring program alongside clinical service delivery. METHODS This quasi-experimental controlled before-and-after multiple case study was conducted in three hospital-based services that provide treatment for patients with musculoskeletal pain. Two prospective cohorts, a pre-implementation and a post-implementation cohort, of adults with chronic musculoskeletal pain who attended during the 6-month recruitment phase, were eligible if they self-identified with one of the cultures prioritised for mentoring by the clinic. The pre-implementation cohort received routine care for up to 3-months, while the post-implementation cohort received up to 3-months of cultural mentoring integrated into routine care (3 to 10 sessions), provided by a consumer (n = 6) with lived experience. Feasibility measures (recruitment and completion rates, attendance, satisfaction), and trends of effectiveness (Patient Activation Measure and Health Literacy Questionnaire items one and six) were collated over 3-months for both cohorts. Outcomes were presented descriptively and analysed using Mann-Whitney U-tests for between-group comparisons. Translation and transcription of post-treatment semi-structured interviews allowed both cohorts' perspectives of treatment to be analysed using a Rapid Assessment Process. RESULTS The cultural mentor program was feasible to implement in clinical services with comparable recruitment rates (66% pre-implementation; 61% post-implementation), adequate treatment attendance (75% pre-implementation; 89% post-implementation), high treatment satisfaction (97% pre-implementation; 96% post-implementation), and minimal participant drop-out (< 5%). Compared to routine care (n = 71), patients receiving mentoring (n = 55) achieved significantly higher Patient Activation Measure scores (median change 0 vs 10.3 points, p < 0.01) at 3-months, while Health Literacy Questionnaire items did not change for either cohort over time. Three themes underpinned participant experiences and acceptability of the mentoring intervention: 'expectational priming', 'lived expertise' and 'collectivist orientation' to understand shared participant experiences and explore the potential differential effect of the mentoring intervention. CONCLUSION Participant experiences and observations of improved patient activation provide support for the acceptability of the mentoring intervention integrated into routine care. These results support the feasibility of conducting a definitive trial, while also exploring issues of scalability and sustainability.
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Affiliation(s)
- Bernadette Brady
- grid.410692.80000 0001 2105 7653Liverpool Hospital, South Western Sydney Local Health District, Locked Bag 7103 Liverpool, BC, Sydney, NSW 1871 Australia ,grid.1029.a0000 0000 9939 5719School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia ,grid.1013.30000 0004 1936 834XSydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006 Australia
| | - Balwinder Sidhu
- grid.410692.80000 0001 2105 7653Multicultural Health Unit, South Western Sydney Local Health District, 5/39 Stanley Street, Bankstown, NSW 2200 Australia
| | - Matthew Jennings
- grid.410692.80000 0001 2105 7653Liverpool Hospital, South Western Sydney Local Health District, Locked Bag 7103 Liverpool, BC, Sydney, NSW 1871 Australia
| | - Robert Boland
- grid.1013.30000 0004 1936 834XSydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006 Australia ,grid.410692.80000 0001 2105 7653Fairfield Hospital, South Western Sydney Local Health District, PO Box 5, Fairfield, Sydney, NSW 1851 Australia
| | - Geraldine Hassett
- grid.410692.80000 0001 2105 7653Liverpool Hospital, South Western Sydney Local Health District, Locked Bag 7103 Liverpool, BC, Sydney, NSW 1871 Australia
| | - Lucy Chipchase
- grid.1014.40000 0004 0367 2697Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Rd, Bedford Park, SA 5042 Australia
| | - Clarice Tang
- grid.1029.a0000 0000 9939 5719School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia ,grid.410692.80000 0001 2105 7653South Western Sydney Local Health District, Locked Bag 7103, Liverpool BC, Sydney, NSW Australia
| | - Sylvia Yaacoub
- grid.410692.80000 0001 2105 7653Fairfield Hospital, South Western Sydney Local Health District, PO Box 5, Fairfield, Sydney, NSW 1851 Australia
| | - Natalie Pavlovic
- grid.410692.80000 0001 2105 7653Fairfield Hospital, South Western Sydney Local Health District, PO Box 5, Fairfield, Sydney, NSW 1851 Australia
| | - Samia Sayad
- grid.410692.80000 0001 2105 7653Fairfield Hospital, South Western Sydney Local Health District, PO Box 5, Fairfield, Sydney, NSW 1851 Australia ,grid.410692.80000 0001 2105 7653South Western Sydney Local Health District, Locked Bag 7103, Liverpool BC, Sydney, NSW Australia
| | - Toni Andary
- grid.410692.80000 0001 2105 7653Fairfield Hospital, South Western Sydney Local Health District, PO Box 5, Fairfield, Sydney, NSW 1851 Australia
| | - Shaniya Ogul
- grid.410692.80000 0001 2105 7653Fairfield Hospital, South Western Sydney Local Health District, PO Box 5, Fairfield, Sydney, NSW 1851 Australia
| | - Justine Naylor
- grid.410692.80000 0001 2105 7653South Western Sydney Local Health District, Locked Bag 7103, Liverpool BC, Sydney, NSW Australia ,grid.1005.40000 0004 4902 0432SWS Clinical School UNSW, Locked Bag 7103, Liverpool BC, Sydney, NSW 1871 Australia ,grid.429098.eIngham Institute Applied Medical Research, 1 Campbell St, Liverpool, Liverpool, NSW 2170 Australia
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Pierce P, Whitten M, Hillman S. The impact of digital healthcare on vulnerable pregnant women: A review of the use of the MyCare app in the maternity department at a central London tertiary unit. Front Digit Health 2023; 5:1155708. [PMID: 37153515 PMCID: PMC10161794 DOI: 10.3389/fdgth.2023.1155708] [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: 01/31/2023] [Accepted: 03/30/2023] [Indexed: 05/09/2023] Open
Abstract
Introduction Digitalisation offers innovative solutions within maternity services; however, vulnerable groups risk being overlooked. University College London Hospital's (UCLH) successful implementation of a digital maternity app, MyCare, gives women access to test results, information about appointments, and enables communication with healthcare professionals (HCPs). Yet, little is known about access and engagement among vulnerable pregnant women. Methodology Research was conducted over a 3-month period (April-June 2022) in the Maternity Department at UCLH, UK. MyCare datasets were analysed, and anonymised surveys completed by vulnerable pregnant women and HCPs. Results Lower rates of utilisation and engagement with MyCare were seen in vulnerable pregnant women especially among refugee/asylum seekers, those with mental health issues, and those facing domestic violence. Non-users were also more likely to be individuals from ethnic minority backgrounds, with a lower average social-deprivation-index decile, whose first language was not English, and with a significant history of non-attendance to appointments. Patient and HCP surveys highlighted various barriers to MyCare engagement, including a lack of motivation, limited language options, low e-literacy levels, and complex app interfaces. Conclusion The use of a single digital tool, without a formulated pathway to identify and assist those not accessing or engaging with it, risks unequal care provision which may exacerbate health inequalities. This research advances the idea that digital exclusion is not necessarily a matter of access to technology, but an issue of a lack of engagement with these tools. Therefore, vulnerable women and HCPs must be integral to the implementation of digital strategies, to ensure no one is left behind.
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Affiliation(s)
- Poppy Pierce
- Medical School, Faculty of Medical Sciences, University College London, London, United Kingdom
- Correspondence: Poppy Pierce
| | - Melissa Whitten
- Women’s Health Division, Elizabeth Garrett Anderson Wing, University College London Hospital NHS Foundation Trust, London, United Kingdom
- Department of Maternal and Fetal Medicine, EGA Institute for Women’s Health, University College London, London, United Kingdom
| | - Sara Hillman
- Women’s Health Division, Elizabeth Garrett Anderson Wing, University College London Hospital NHS Foundation Trust, London, United Kingdom
- Department of Maternal and Fetal Medicine, EGA Institute for Women’s Health, University College London, London, United Kingdom
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McKeirnan KC, Anderson CB, Powell AJ, Gilbert R, Undeberg MR. The Role of the Pharmacist in Patient Self-Advocacy for Osteoporosis Screening. Sr Care Pharm 2022; 37:612-622. [DOI: 10.4140/tcp.n.2022.612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
Background Osteoporosis is a common bone disease affecting more than 200 million people worldwide. Commonly prescribed medications have the potential to contribute to bone loss and fracture risk. Providers may be unaware of effects of other commonly used medication classes,
which can lead to inadequate prevention or a lack of screening. Objective To describe a case of drug-induced bone density loss, characterized by long-term use of proton pump inhibitors (PPIs) in a postmenopausal woman; to describe the pharmacist’s role in encouraging
patient self-advocacy. Setting A rural and medically underserved area in eastern Washington State. Practice Description This patient case was part of a grant-funded project to identify and intervene with complex and high-risk patients from local rural
and underserved populations. Practice Innovation A pharmacist met with a 61-year-old female patient to complete a comprehensive medication review and subsequently identified a risk of osteoporosis secondary to long-term PPI and hormone replacement therapy use. Empowered
by the knowledge of risk of development of low bone density, the patient approached her provider twice with a request for bone density measurement. Results Despite initial hesitancy from her physician, the patient advocated for herself with concerns about developing osteoporosis.
Following obtaining a dual energy X-ray absorptiometry scan, the patient received a diagnosis of osteoporosis. Discussion Education from the pharmacist prompted the patient to advocate for osteoporosis screening and ultimately led to a diagnosis. Conclusion
Pharmacists play a critical role in identifying medication-induced conditions in patients with complex medications and multiple chronic disease states.
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Affiliation(s)
- Kimberly C. McKeirnan
- 1 Washington State University College of Pharmacy and Pharmaceutical Sciences, Pharmacotherapy Department, Spokane, Washington
| | | | - Alexa J. Powell
- 1 Washington State University College of Pharmacy and Pharmaceutical Sciences, Pharmacotherapy Department, Spokane, Washington
| | - Rubi Gilbert
- 3 Aging and Long-Term Care of Eastern Washington, Spokane, Washington
| | - Megan R. Undeberg
- 1 Washington State University College of Pharmacy and Pharmaceutical Sciences, Pharmacotherapy Department, Spokane, Washington
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Chen J, Buchongo P, Spencer MRT, Reynolds CF. An HIT-Supported Care Coordination Framework for Reducing Structural Racism and Discrimination for Patients With ADRD. Am J Geriatr Psychiatry 2022; 30:1171-1179. [PMID: 35659469 DOI: 10.1016/j.jagp.2022.04.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/16/2022] [Accepted: 04/13/2022] [Indexed: 01/25/2023]
Abstract
Black and Latinx Americans are disproportionately at greater risk for having Alzheimer's disease and related dementias (ADRD) than White Americans. Such differences in risk for ADRD are arguably explained through health disparities, social inequities, and historical policies. Structural racism and discrimination (SRD), defined as "macro-level conditions that limit opportunities, resources, and well-being of less privileged groups," have been linked with common comorbidities of ADRD, including hypertension, obesity, diabetes, depression. Given the historical impact of SRD-including discriminatory housing policies resulting in racial residential segregation that has been shown to limit access to education, employment, and healthcare-Black and Latinx populations with ADRD are directly or indirectly negatively affected by SRD in terms of access, quality and cost for healthcare. Emerging studies have brought to light the value of structural-level hospital and public health collaboration on care coordination for improving healthcare quality and access, and thus could serve as a macro-level mechanism for addressing disparities for minoritized racial and ethnic populations with ADRD. This paper presents a conceptual framework delineating how care coordination can successfully be achieved through health information technology (HIT) systems and ultimately address SRD. To address health inequities, it is therefore critical that policy initiatives invest in HIT capacities and infrastructures to promote care coordination, identify patient needs and preferences, and promote engagement of patients with ADRD and their caregivers.
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Affiliation(s)
- Jie Chen
- Department of Health Policy and Management, School of Public Health, University of Maryland, College Park (JC, PB, MRTS), MD; The Hospital and Public Health InterdisciPlinarY Research (HAPPY) Lab, School of Public Health, University of Maryland, College Park (JC, PB, MRTS), MD.
| | - Portia Buchongo
- Department of Health Policy and Management, School of Public Health, University of Maryland, College Park (JC, PB, MRTS), MD; The Hospital and Public Health InterdisciPlinarY Research (HAPPY) Lab, School of Public Health, University of Maryland, College Park (JC, PB, MRTS), MD
| | - Merianne Rose T Spencer
- Department of Health Policy and Management, School of Public Health, University of Maryland, College Park (JC, PB, MRTS), MD; The Hospital and Public Health InterdisciPlinarY Research (HAPPY) Lab, School of Public Health, University of Maryland, College Park (JC, PB, MRTS), MD
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Sirari T, Suthar R, Singh A, Prinja S, Gupta V, Malviya M, Chauhan AS, Sankhyan N. Development and economic evaluation of a patient-centered care model for children with Duchenne’s Muscular Dystrophy: A quasi-experimental study protocol (Preprint). JMIR Res Protoc 2022; 12:e42491. [PMID: 37115592 PMCID: PMC10182458 DOI: 10.2196/42491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 01/30/2023] [Accepted: 01/30/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Duchenne muscular dystrophy (DMD) is a rare progressive muscular disease that primarily affects boys. A lack of comprehensive care for patients living with DMD is directly associated with a compromised quality of life (QoL) for those affected and their caregivers. This disease also has a huge economic impact on families as its treatment requires substantial direct, indirect, and informal care costs. OBJECTIVE This study presents a protocol developed to evaluate the feasibility and efficacy of a patient-centered care (PCC) model for children with DMD. The care model was designed with the aim to empower families, improve QoL, and reduce economic burden on their families. METHODS This study is planned as a quasi-experimental study that will enroll 70 consecutive families with boys (aged 5-15 years) with DMD visiting a tertiary care center. The study is being conducted in 2 phases (preintervention and postintervention phases, referred to as phase 1 and phase 2, respectively). During phase 1, the patients received routine care. The study is now in phase 2, with the intervention currently being administered. The intervention is based on the PCC model individualized by the intervention team. The model has a comprehensive DMD telecare component that includes teleconsultation as one of its key components to reduce in-person physician visits at the health facility. Teleconsultation is especially beneficial for late-ambulatory and nonambulatory patients. Data on economic burden are being collected for out-of-pocket expenses for both phases during in-person visits via telephone or messaging apps on a monthly basis. QoL data for patients and their primary caregivers are being collected at 3 time points (ie, time of enrollment, end of phase 1, and end of phase 2). Outcome measures are being assessed as changes in economic burden on families and changes in QoL scores. RESULTS Participant recruitment began in July 2021. The study is ongoing and expected to be completed by March 2023. The findings based on baseline data are expected to be submitted for publication in 2023. CONCLUSIONS This paper outlines a research proposal developed to study the impact of a PCC model for patients with DMD in low- and middle-income countries (LMICs). This study is expected to provide evidence of whether a multicomponent, patient-centric intervention could reduce economic burdens on families and improve their QoL. The results of this study could guide policy makers and health professionals in India and other LMICs to facilitate a comprehensive care program for patients living with DMD. The economic impact of a rare disease is an important consideration to formulate or evaluate any health policy or intervention related to new treatments and financial support schemes. TRIAL REGISTRATION Clinical Trials Registry India (ICMR-NIMS) CTRI/2021/06/034274; https://www.ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=56650. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/42491.
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Affiliation(s)
- Titiksha Sirari
- Lovely Professional University, Phagwara, India
- Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Renu Suthar
- Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amarjeet Singh
- Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
- Community Medicine, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India
| | - Shankar Prinja
- Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishwas Gupta
- Lovely Professional University, Phagwara, India
- Symbiosis Centre for Management Studies, Noida, Uttar Pradesh, India
| | - Manisha Malviya
- Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Naveen Sankhyan
- Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Albaroudi A, Chen J. Consumer Assessment of Healthcare Providers and Systems Among Racial and Ethnic Minority Patients With Alzheimer Disease and Related Dementias. JAMA Netw Open 2022; 5:e2233436. [PMID: 36166229 PMCID: PMC9516284 DOI: 10.1001/jamanetworkopen.2022.33436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
IMPORTANCE Consumer Assessment of Healthcare Providers and Systems (CAHPS) measures have been used widely to measure patient-centered care. Evidence is needed to understand CAHPS measures among racial and ethnic minority patients with Alzheimer disease and related dementias (ADRD). OBJECTIVE To examine racial and ethnic disparities in CAHPS among patients with ADRD and to examine the association between social determinants of health and CAHPS disparities. DESIGN, SETTING, AND PARTICIPANTS This study focused on patients with ADRD who were enrolled in Medicare Shared Savings Program Accountable Care Organizations (ACOs). The primary data sets were the 2017 Medicare Beneficiary Summary File and the beneficiary-level ACO data. The study population was limited to community-based beneficiaries who had a diagnosis of ADRD and were aged 65 years and older. Cross-sectional analyses and the decomposition approach were implemented. Data were analyzed from November 2021 to July 2022. EXPOSURE Enrollment in a Medicare Shared Savings Program ACO. MAIN OUTCOMES AND MEASURES Six ACO CAHPS measures were included: getting timely care, appointments, and information; how well providers communicate; patients' rating of provider; access to specialists; health promotion and education; and shared decision-making. ACO CAHPS were continuous measures with possible ranges from 0 to 100. The summation of these 6 measures as an overall index was also created. In CAHPS measures, the term provider can include hospitals, home health care agencies, and doctors, among others. RESULTS The final sample included 568 368 beneficiaries (347 783 female patients [61.2%]; 38 030 African American patients [6.69%], 6258 Asian patients [1.10%], 18 231 Hispanic patients [3.21%], and 505 849 White patients [89.0%]; mean [SD] age, 82.17 [7.95] years). Significant racial and ethnic disparities in CAHPS scores were observed. After controlling for beneficiary, hospital, and area characteristics, compared with their White counterparts, African American or Black (coefficient = -1.05; 95% CI, -1.15 to -0.95; P < .001), Asian (coefficient = -0.414; 95% CI, -0.623 to -0.205; P < .001), and Hispanic (coefficient = -0.099; 95% CI, -0.229 to 0.032; P = .14) patients with ADRD reported lower total CAHPS scores. Disparities were also observed among individual ACO CAHPS. Decomposition results showed that a proxy for social determinants of health explained 10% to 13% of disparities of ACO CAHPS between African American or Black vs White and Hispanic vs White patients with ADRD. Most of the racial and ethnic disparities, especially those between White and Asian individuals, could not be explained by the models used to analyze data. CONCLUSIONS AND RELEVANCE These results demonstrated significant variations in CAHPS by race and ethnicity among patients with ADRD enrolled in ACOs. Social determinants of health are critical in explaining racial and ethnic disparities. More research is needed to explain disparities in CAHPS.
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Affiliation(s)
- Asmaa Albaroudi
- Department of Health Policy and Management, School of Public Health, University of Maryland, College Park
- The Hospital And Public Health Interdisciplinary Research Lab, School of Public Health, University of Maryland, College Park
| | - Jie Chen
- Department of Health Policy and Management, School of Public Health, University of Maryland, College Park
- The Hospital And Public Health Interdisciplinary Research Lab, School of Public Health, University of Maryland, College Park
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Collet R, Major M, van Egmond M, van der Leeden M, Maccow R, Eskes A, Stuiver M. Experiences of interaction between people with cancer and their healthcare professionals: A systematic review and meta-synthesis of qualitative studies. Eur J Oncol Nurs 2022; 60:102198. [DOI: 10.1016/j.ejon.2022.102198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/16/2022] [Accepted: 08/25/2022] [Indexed: 11/29/2022]
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Bhattad PB, Pacifico L. Empowering Patients: Promoting Patient Education and Health Literacy. Cureus 2022; 14:e27336. [PMID: 36043002 PMCID: PMC9411825 DOI: 10.7759/cureus.27336] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 11/05/2022] Open
Abstract
Patients are generally keen to understand and obtain more information about their medical conditions. There exists a need to develop updated and thorough yet concise patient education handouts and to encourage healthcare providers (HCPs) to use uniform patient education methods. A thorough review of literature on patient education material was performed prior to starting the study. A comparison with different resources regarding the appropriateness of patient education was done. Educating HCPs to effectively use patient educational materials incorporated into the electronic health record system, including electronic methods, such as the use of a patient portal, to help educate patients. Strategies were formulated to reduce the amount of processing and attending time required for fetching appropriate materials and lead to fast, efficient, and effective patient education. To improve the physical and psychosocial wellbeing of a patient, personalized patient education handouts, in addition to verbal education by the HCPs, augment the betterment of patient care via shared decision making and by improving patient satisfaction and health literacy.
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Behera NS, Bunzli S. Towards a Communication Framework for Empowerment in Osteoarthritis Care. Clin Geriatr Med 2022; 38:323-343. [DOI: 10.1016/j.cger.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Nursing interventions that humanise care for patients affected by COVID-19 in isolation units: An integrative review. Infect Dis Health 2022; 27:163-174. [PMID: 35459625 PMCID: PMC8971055 DOI: 10.1016/j.idh.2022.03.001] [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: 11/24/2021] [Revised: 02/25/2022] [Accepted: 03/06/2022] [Indexed: 11/20/2022]
Abstract
Background During the global pandemic, the increasing number of hospitalised patients affected by COVID-19 led to a shortage of nurses. This situation can cause nurses to focus their care on managing the acute aspects of the disease, neglecting interventions that can humanise their practices and improve quality of care. This review aims to identify nurses' interventions that can humanise care for patients affected by COVID-19 in isolation units. Methods Whittemore and Knafl's integrative review methodology was used to structure and conduct the review. The literature search was conducted using CINAHL, MEDLINE, Nursing & Allied Health, MedicLatina, Sciencedirect, LILACS, and PubMed databases. Researchers performed the final search in January 2021. Results A total of seven articles were included in this review. Interventions by nursing staff that may humanise care for patients affected by COVID-19 in isolation units fall within two themes: “expressive dimension interventions”, related to the establishment of communication with patients and their families, providing psychological comfort, shared decision-making and patient education; and “instrumental dimension interventions”, associated with providing patients physical comfort, and symptom management. Conclusion This review provides insight into both “expressive dimension” and “instrumental dimension” of nursing interventions that may humanise care to patients affected by COVID-19 in isolation units. This knowledge will allow nurses to improve their care practices, providing more holistic, humanised care for these patients.
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Puccinelli-Ortega N, Cromo M, Foley KL, Dignan MB, Dharod A, Snavely AC, Miller DP. Facilitators and Barriers to Implementing a Digital Informed Decision Making Tool in Primary Care: A Qualitative Study. Appl Clin Inform 2022; 13:1-9. [PMID: 34986491 PMCID: PMC8731240 DOI: 10.1055/s-0041-1740481] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Informed decision aids provide information in the context of the patient's values and improve informed decision making (IDM). To overcome barriers that interfere with IDM, our team developed an innovative iPad-based application (aka "app") to help patients make informed decisions about colorectal cancer screening. The app assesses patients' eligibility for screening, educates them about their options, and empowers them to request a test via the interactive decision aid. OBJECTIVE The aim of the study is to explore how informed decision aids can be implemented successfully in primary care clinics, including the facilitators and barriers to implementation; strategies for minimizing barriers; adequacy of draft training materials; and any additional support or training desired by clinics. DESIGN This work deals with a multicenter qualitative study in rural and urban settings. PARTICIPANTS A total of 48 individuals participated including primary care practice managers, clinicians, nurses, and front desk staff. APPROACH Focus groups and semi-structured interviews, with data analysis were guided by thematic analysis. KEY RESULTS Salient emergent themes were time, workflow, patient age, literacy, and electronic health record (EHR) integration. Saving time was important to most participants. Patient flow was a concern for all clinic staff, and they expressed that any slowdown due to patients using the iPad module or perceived additional work to clinic staff would make staff less motivated to use the program. Participants voiced concern about older patients being unwilling or unable to utilize the iPad and patients with low literacy ability being able to read or comprehend the information. CONCLUSION Integrating new IDM apps into the current clinic workflow with minimal disruptions would increase the probability of long-term adoption and ultimate sustainability. NIH TRIAL REGISTRY NUMBER R01CA218416-A1.
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Affiliation(s)
- Nicole Puccinelli-Ortega
- Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina, United States,Address for correspondence Nicole Puccinelli-Ortega, MS Department of Internal Medicine, Medical Center BoulevardWinston-Salem, NC 27157-1063United States
| | - Mark Cromo
- Department of Internal Medicine, University of Kentucky, Lexington, Kentucky, United States
| | - Kristie L. Foley
- Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina, United States
| | - Mark B. Dignan
- Department of Internal Medicine, University of Kentucky, Lexington, Kentucky, United States
| | - Ajay Dharod
- Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina, United States
| | - Anna C. Snavely
- Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina, United States
| | - David P. Miller
- Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina, United States
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Perez Jolles M, Rivera D, Jacobs G, Thomas KC, Schneiderman JU, Wenzel S. Views on health activation and support services among formerly homeless adults living in Permanent Supportive Housing in the United States. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:154-164. [PMID: 33894078 DOI: 10.1111/hsc.13384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 03/01/2021] [Accepted: 03/11/2021] [Indexed: 06/12/2023]
Abstract
Individuals who have experienced chronic homelessness often have unmet physical and mental health needs and experiences of trauma and stigma. This study aimed to measure, for the first time, health activation (self-advocacy and empowerment) levels among formerly homeless adults living in Permanent Supportive Housing or PSH (referred to hereafter as residents). In addition, residents' experiences accessing health services, and their sense of health activation and efforts to manage their health within PSH settings, were explored. A mixed-methods study was conducted in Southern California (October 2018-June 2019) using a validated survey and interviews with a randomly selected group of residents (n = 61) from three PSH agencies. Activation levels were measured using the Patient Activation Measure. Descriptive and univariate survey analyses were conducted. Interview data was analysed using NVivo. Two coders coded all transcripts, and team meetings were held to reach consensus. Results showed most residents were female (64%), racial and ethnic minorities (66%), on average 54-year-olds, with 37 months of PSH residency, and 43% were taking some action to manage their health (intermediate activation level). Challenges accessing care were due to breakdowns in care, unpleasant experiences with providers, low health literacy and feeling overwhelmed by co-occurring chronic conditions. Health activation related to knowing when to take care of their health on their own and when to seek care. Unique challenges emerged related to PSH, such as lack of resident control within the housing setting and limited personnel responding to health emergencies. These challenges were magnified because residents live alone, per PSH requirements.
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Affiliation(s)
- Monica Perez Jolles
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Dean Rivera
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Gabrielle Jacobs
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Kathleen C Thomas
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, Asheville, NC, USA
- Division of Research, UNC Health Sciences at MAHEC, Asheville, NC, USA
| | - Janet U Schneiderman
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Suzanne Wenzel
- Richard M. and Ann L. Thor Professor in Urban Social Development, USC Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
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Haydon-Greatting S. The era of telehealth pharmacy practice. J Am Pharm Assoc (2003) 2022. [PMCID: PMC8785964 DOI: 10.1016/j.japh.2021.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Reported Barriers to Hepatitis C Treatment among Pregnant and Early-Parenting Mothers Undergoing Substance Use Disorder Treatment in One U.S. State. Infect Dis Rep 2021; 14:1-11. [PMID: 35076528 PMCID: PMC8788261 DOI: 10.3390/idr14010001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/15/2021] [Accepted: 12/15/2021] [Indexed: 11/16/2022] Open
Abstract
Nationwide, the prevalence of the hepatitis C virus (HCV) has risen in recent years. At least 90% of infected persons must be treated to achieve global elimination targets. The current study aimed to explore barriers to, and facilitators of, direct-acting antiviral (DAA) HCV treatment uptake amongst pregnant and early-parenting women undergoing comprehensive substance use treatment. Twenty participants with documented HCV antibody positivity were recruited from two substance use treatment centers in central Kentucky. Semi-structured interviews were conducted to explore knowledge about HCV, previous experiences, and intentions to seek care. Themes were extracted using an inductive analytical approach. Most participants were aware of the dangers posed by HCV infection. However, there was a high degree of misinformation about transmission mechanisms and treatment eligibility requirements. Low priority for HCV treatment also surfaced as a barrier to treatment uptake. Participants reported being unable to seek care due to time and resource limitations in the presence of a highly demanding treatment process. Findings from the current study suggest that more work is needed to eliminate residual barriers that limit access to HCV treatment among pregnant and early-parenting women in treatment for substance use disorder.
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Jabour SM, Chander G, Riekert KA, Keruly JC, Herne K, Hutton H, Beach MC, Lau B, Moore RD, Monroe AK. The Patient Reported Outcomes as a Clinical Tool (PROACT) Pilot Study: What Can be Gained by Sharing Computerized Patient-Reported Mental Health and Substance Use Symptoms with Providers in HIV Care? AIDS Behav 2021; 25:2963-2972. [PMID: 33559775 DOI: 10.1007/s10461-021-03175-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
Substance use and mental health (SU/MH) disorders are insufficiently recognized in HIV care. We examined whether conveying SU/MH screening results to patients and providers increased SU/MH discussions and action plans. Intervention participants completed a computerized patient-reported questionnaire before their HIV visit; screened positive on ≥ 1 measure: depression, anxiety, PTSD symptoms, at-risk alcohol use, or drug use; and reviewed screening results to decide which to prioritize with their provider. Screening results and clinical recommendations were conveyed to providers via medical record. A historic control included patients with positive screens but no conveyance to patient or provider. The patient-provider encounter was audio-recorded, transcribed, and coded. For the overall sample (n = 70; 38 control, 32 intervention), mean age (SD) was 51.8 (10.3), 61.4% were male, and 82.9% were Black. Overall, 93.8% raised SU/MH in the intervention compared to 50.0% in the control (p < 0.001). Action plans were made for 40.0% of intervention and 10.5% of control encounters (p = 0.049). Conveying screening results with clinical recommendations increased SU/MH action plans, warranting further research on this intervention to address SU/MH needs.
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Seixas AA, Olaye IM, Wall SP, Dunn P. Optimizing Healthcare Through Digital Health and Wellness Solutions to Meet the Needs of Patients With Chronic Disease During the COVID-19 Era. Front Public Health 2021; 9:667654. [PMID: 34322469 PMCID: PMC8311288 DOI: 10.3389/fpubh.2021.667654] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 05/21/2021] [Indexed: 01/07/2023] Open
Abstract
The COVID-19 pandemic exposed and exacerbated longstanding inefficiencies and deficiencies in chronic disease management and treatment in the United States, such as a fragmented healthcare experience and system, narrowly focused services, limited resources beyond office visits, expensive yet low quality care, and poor access to comprehensive prevention and non-pharmacological resources. It is feared that the addition of COVID-19 survivors to the pool of chronic disease patients will burden an already precarious healthcare system struggling to meet the needs of chronic disease patients. Digital health and telemedicine solutions, which exploded during the pandemic, may address many inefficiencies and deficiencies in chronic disease management, such as increasing access to care. However, these solutions are not panaceas as they are replete with several limitations, such as low uptake, poor engagement, and low long-term use. To fully optimize digital health and telemedicine solutions, we argue for the gamification of digital health and telemedicine solutions through a pantheoretical framework-one that uses personalized, contextualized, and behavioral science algorithms, data, evidence, and theories to ground treatments.
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Affiliation(s)
- Azizi A. Seixas
- Department of Population Health, Department of Psychiatry, New York University (NYU) Grossman School of Medicine, New York, NY, United States
| | - Iredia M. Olaye
- Department of Medicine Division of Clinical Epidemiology and Evaluative Sciences Research, Weill Cornell Medical College, New York, NY, United States
| | - Stephen P. Wall
- Department of Emergency Medicine, Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Pat Dunn
- American Heart Association, Center for Health Technology and Innovation, New York, NY, United States
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Chang FH, Fields BE, Kersey JM, Wu CY, Shih M, Skidmore ER. How does culture influence the implementation of strategy training in stroke rehabilitation? A rapid ethnographic study of therapist perspectives in Taiwan and the United States. Disabil Rehabil 2021; 44:5612-5622. [DOI: 10.1080/09638288.2021.1946604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Feng-Hang Chang
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Beth E. Fields
- Occupational Therapy Program, Department of Kinesiology, University of Wisconsin–Madison, Madison, MI, USA
| | - Jessica M. Kersey
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Chao-Yi Wu
- Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, OR, USA
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, OR, USA
| | - Minmei Shih
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Elizabeth R. Skidmore
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Physical Medicine & Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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Poivret D, Goetz C, Zevering Y, Wilcke C, Noirez V. Effect of patient-led cooperative follow-up by general practitioners and community pharmacists on osteoporosis treatment persistence. Int J Rheum Dis 2021; 24:912-921. [PMID: 34058072 DOI: 10.1111/1756-185x.14146] [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: 03/29/2021] [Revised: 04/29/2021] [Accepted: 05/07/2021] [Indexed: 11/28/2022]
Abstract
AIM Osteoporosis is a major risk factor for fractures. Poor persistence with osteoporosis medication hampers outcomes. This study assessed whether encouraging the formation of patient-led follow-up cooperatives between general practitioners (GPs) and community pharmacists improved medication persistence. METHODS All consecutive patients who attended an osteoporosis patient education program were invited to participate. They were given a logbook containing questionnaires they would bring to 6-monthly visits to their GP and pharmacist. The effect of this 3-year cooperative follow-up on persistence with medication and lifestyle changes was assessed. RESULTS In total, 121 patients (average age, 67 years; 93% female) participated. Poor cooperation between GPs and pharmacists was noted. Nevertheless, medication persistence ranged from 83% to 91% over the 6 visits. However, since patient drop-out rates were high and questionnaire return rates were low, a post-study medical chart review was performed. This confirmed that persistence was high (74%-83%) at 3 years post-enrollment, even for oral bisphosphonate-treated patients (73%-76%). However, adoption of anti-osteoporosis lifestyle changes was poor throughout the study: one- to two-thirds of the patients did not alter their diet, physical activity, or surroundings to prevent falls. CONCLUSION One study goal, namely, to encourage GPs and pharmacists to cooperate in patient follow-up, was not achieved. However, high medication persistence was observed. This may reflect the education program, patient empowerment, personalized attention from study personnel, and being in a study. Patient-centered approaches can thus significantly increase medication persistence in osteoporosis. Ongoing education may be needed to improve patient adoption of and persistence with lifestyle changes.
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Affiliation(s)
- Didier Poivret
- Department of Rheumatology, Mercy Hospital (CHR Metz-Thionville), Metz, France
| | - Christophe Goetz
- Clinical Research Support Unit, Mercy Hospital (CHR Metz-Thionville), Metz, France
| | - Yinka Zevering
- SciMeditor Medical Writing and Editing Services, Metz, France
| | - Christophe Wilcke
- Regional Union for Health Professionals-Pharmacists, Lorraine, Nancy, France
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Pawlak M. Ways of walking, speaking and listening: Nursing practices and professional identities among Polish nurses in Norway. Nurs Inq 2021; 28:e12418. [PMID: 33961719 DOI: 10.1111/nin.12418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 04/02/2021] [Accepted: 04/05/2021] [Indexed: 11/29/2022]
Abstract
This article explores the lived experiences of Polish nurses' transition into the Norwegian healthcare system and analyses the emerging differences in nursing practices and professional identities between Poland and Norway. It draws on ethnographic findings and argues that nursing is a complex practice, which involves not only nursing knowledge, but also less obvious and often taken for granted nursing imaginaries and actions. In doing so, the article looks at different ways of walking, speaking and listening, which are not merely nurses' daily habits, but also the embodiments of hierarchical relations, agency and empowerment in healthcare settings. This kind of analytical perspective of the existing differences in nursing practices and professional identities between Poland and Norway raises crucial questions about transitional contexts of nurse migration and shows that nursing is not static, but rather a dynamic and processual way of conduct.
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Affiliation(s)
- Marek Pawlak
- Department of Ethnology and Cultural Anthropology, Jagiellonian University in Cracow, Cracow, Poland
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Hart DP, Branchford BR, Hendry S, Ledniczky R, Sidonio RF, Négrier C, Kim M, Rice M, Minshall M, Arcé C, Prince S, Kelleher M, Lee S. Optimizing language for effective communication of gene therapy concepts with hemophilia patients: a qualitative study. Orphanet J Rare Dis 2021; 16:189. [PMID: 33910590 PMCID: PMC8082836 DOI: 10.1186/s13023-020-01555-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 09/23/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND For communities of people living with hemophilia and other genetic conditions, gene therapy could represent a paradigm shift in treatment strategies. As investigational therapeutic modalities such as gene therapy become more widely used and discussed, there is a critical need for all stakeholders to communicate using a lexicon that is intelligible, accurate, consistent, and representative of novel treatments. In doing so, expectations can be more carefully managed and potential risks, benefits, and limitations better understood. In recognition of this need, a first-ever study of gene therapy lexicon was conducted using established methods of market research and linguistic analysis. METHODS Ninety-four participants representing hematologists, nurses, caregivers, and people with hemophilia A, in six countries (US, UK, Spain, Germany, France, Italy) took part in a series of in-depth interviews, face-to-face focus groups, an advisory board meeting, and online group interviews to develop, refine, and test verbal, written, and pictorial language concepts through a three-phase iterative process. Sessions were conducted in local languages using detailed discussion guides. Feedback from participants was captured using real-time instant-response dial testing to measure moment-by-moment emotional responses to language stimuli. Semiquantitative analysis of the responses informed selection of preferred language concepts for final testing, and qualitative discussion explored preference rationale. Participants also completed polling and forced rank and choice written exercises. RESULTS Study feedback showed that the hemophilia community has preferences around consistent lexicon to describe hemophilia and its management. Expert linguistic analysis of feedback from the three phases enabled agreement of a consensus lexicon of vocabulary and an optimized summary narrative for talking about gene therapy amongst people affected by hemophilia A. Preferences were largely consistent across audiences and countries, although some country-specific recommendations were made. A representative summary phrase was agreed: "Gene therapy is being studied in clinical trials with the aim to allow the body to produce factor VIII protein on its own". CONCLUSIONS The use of preferred language across different stakeholders increases understanding and comfort during discussions of novel and complex therapeutic modalities such as gene therapy. Consistent use of community-informed lexicon minimizes miscommunication and facilitates informed decision-making regarding potential future treatment opportunities.
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Affiliation(s)
- Daniel P Hart
- Royal London Haemophilia Centre, Barts and The London School of Medicine and Dentistry, Queen Mary University London, London, E1 1BB, UK.
| | - Brian R Branchford
- Hemophilia and Thrombosis Center, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
| | - Sarah Hendry
- Maslansky + Partners, 200 Varick Street, Suite 601, New York, NY, 10014, USA
| | - Robert Ledniczky
- Maslansky + Partners, 200 Varick Street, Suite 601, New York, NY, 10014, USA
| | | | - Claude Négrier
- Hemophilia and Thrombosis Center, Hôpital Cardiologique, Université Lyon 1, Lyon, France
| | - Michelle Kim
- Hemophilia Foundation of Southern California, Pasadena, CA, USA
| | | | | | - Claire Arcé
- Association française des hémophiles, Paris, France
| | | | | | - Sharon Lee
- BioMarin Pharmaceutical Inc., Novato, CA, USA
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Rajiah K, Sivarasa S, Maharajan MK. Impact of Pharmacists' Interventions and Patients' Decision on Health Outcomes in Terms of Medication Adherence and Quality Use of Medicines among Patients Attending Community Pharmacies: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4392. [PMID: 33918990 PMCID: PMC8122322 DOI: 10.3390/ijerph18094392] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/13/2021] [Accepted: 04/13/2021] [Indexed: 11/16/2022]
Abstract
Community pharmacists are responsible for providing the appropriate information on the use of medications to patients, which may enhance their medication adherence. The extent of control that patients have on their health care preferences creates many challenges for community pharmacists. This study aimed to determine the impact of pharmacist interventions and patient decisions on health outcomes concerning medication adherence and the quality use of medicines among patients attending community pharmacies. Appropriate studies were identified in a systematic search using the databases of Medline, Scopus, Google Scholar, and PubMed. The search included literature published between 2004 and 2019. The database searches yielded 683 titles, of which 19 studies were included after the full-text analysis with a total of 9313 participants. Metaprop command in Stata software version 14 was used for the analysis. This study was undertaken based on the general principles of the Cochrane Handbook for Systematic Reviews of Interventions and subsequently reported according to the Preferred Reporting Items for Systematic Reviews (PRISMA) extension. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach was directly used to rate the quality of evidence (high, moderate, low, or very low). The results revealed the effective interaction between patients and community pharmacists, the importance of pharmacist intervention on medication adherence and quality use of medicine, and the role of community pharmacists in counselling patients. Decision/choice of patients in self-care and self-medication is a factor contributing to health outcomes. Effective interaction of community pharmacists with patients in terms of medication adherence and quality use of medicines provided a better health outcome among patients. The community pharmacists influenced the decision/choice of patients in self-care and self-medications.
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Affiliation(s)
- Kingston Rajiah
- Department of Pharmacy Practice, School of Pharmacy, International Medical University, Kuala Lumpur 57200, Malaysia;
| | - Shreeta Sivarasa
- Student, Master in Pharmacy Practice, School of Postgraduate Studies, International Medical University, Kuala Lumpur 57200, Malaysia;
| | - Mari Kannan Maharajan
- Department of Pharmacy Practice, School of Pharmacy, International Medical University, Kuala Lumpur 57200, Malaysia;
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Wu L, Liu J, Lai J, Meng L. Primary nursing intervention can improve the prognosis and postoperative quality of life of patients with hypertensive intracerebral hemorrhage undergoing minimally invasive surgery. Am J Transl Res 2021; 13:2955-2961. [PMID: 34017461 PMCID: PMC8129221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 11/22/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE This study aimed to explore the role of primary nursing in patients with hypertensive intracerebral hemorrhage (HICH) undergoing minimally invasive surgery. METHODS We randomly assigned 106 patients with HICH treated in our hospital to receive routine nursing (54 cases, group A) or primary nursing in addition to routine nursing (52 cases, group B). The scores of negative emotions, incidence of complications, quality of life, and prognosis of all patients were recorded. RESULTS The score of negative emotions and the incidence of complications were lower in group B than in group A (P < 0.05). The scores of quality of life and prognosis were higher in group B than in group A (P < 0.05). CONCLUSION Primary nursing intervention can improve the prognosis and postoperative quality of life of patients with HICH undergoing minimally invasive surgery.
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Affiliation(s)
- Liqian Wu
- Department of Nuclear Medicine, Tangshan Gongren HospitalTangshan 063000, Hebei Province, China
| | - Jing Liu
- Department of Neurosurgery, Tangshan Gongren HospitalTangshan 063000, Hebei Province, China
| | - Jing Lai
- Department of Nursing, The First People’s Hospital of Longquanyi DistrictChengdu 610010, Sichuan Province, China
| | - Libo Meng
- Second Intensive Care Unit, Fourth Affiliated Hospital of China Medical UniversityShenyang 110032, Liaoning Province, China
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Milo RB, Ramira A, Calero P, Georges JM, Pérez A, Connelly CD. Patient Activation and Glycemic Control Among Filipino Americans. Health Equity 2021; 5:151-159. [PMID: 33937600 PMCID: PMC8080926 DOI: 10.1089/heq.2020.0075] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose: Increasing patient activation facilitates self-management of health, improves health outcomes, and lowers health care expenditures. Extant research notes mixed findings in patient activation by race/ethnicity. The purpose of the study was to examine the relationships among patient activation, select patient characteristics, and glycemic control among Filipino Americans. Methods: A cross-sectional study was conducted with a convenience sample of Filipino Americans (n=191), with a diagnosis of diabetes mellitus type 1 or type 2, recruited from a southern California adult primary care clinic between December 2017 and March 2018. Patient activation, select characteristics, and hemoglobin A1c (HbA1c) levels were assessed. Bivariate and logistic regression analyses were used to identify correlates of glycemic control. The Strengthening the Reporting of Observational studies in Epidemiology (STROBE) checklist was used to develop the study. Results: Participants with HgbA1C≤7.0% reported statistically higher patient activation measure (13 items) (PAM-13) natural log score (mean [M]=60.32, standard deviation [SD]=13.50) compared to those with an HgbA1C>7.0%, M=52.58, SD=10.19, F(1)=11.05, p<0.001. Multivariate logistic regression using age, low-density lipoprotein, and PAM-13 natural log was statistically reliable distinguishing between A1C≤7.0 and A1C>7.0, −2 LogLikehood=1183.23, χ2(3)=15.44, p<0.001. Conclusions: Patient activation is an important factor in supporting glycemic control. Findings support interventions to target patient activation. Providers are encouraged to use racial/ethnic-centered engagement strategies in resolving health disparity with racial and ethnic minorities to facilitate patient activation and improve health outcomes in patients with diabetes.
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Affiliation(s)
- Razel B Milo
- Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, University of San Diego, San Diego, California, USA
| | - Arlin Ramira
- Department of Nursing and Health Occupations, Higher Education Center at Otay Mesa, Southwestern College, San Diego, California, USA
| | - Patricia Calero
- Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, University of San Diego, San Diego, California, USA
| | - Jane M Georges
- Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, University of San Diego, San Diego, California, USA
| | - Alexa Pérez
- Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, University of San Diego, San Diego, California, USA
| | - Cynthia D Connelly
- Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, University of San Diego, San Diego, California, USA
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Kashani F, Abazari P, Haghani F. The components of diabetes educator's competence in diabetes self-management education in Iran: A qualitative study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2021; 10:111. [PMID: 34084858 PMCID: PMC8150089 DOI: 10.4103/jehp.jehp_912_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 08/18/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Limited research has been conducted in the field of diabetes educator's competency. However, no comprehensive and integrated explanations of educator's competence requirements in treatment centers exist in Iran. The aim of this study is to explain the components of diabetes educator's competence in diabetes self-management education in Iran. MATERIALS AND METHODS This was a qualitative descriptive-exploratory study. The data were collected through semi-structured and in-depth interviews and using purposeful sampling method in Isfahan University of medical science from April to October 2018. Sampling continued until data saturation. Participants included 20 people who were selected by purposive and snowball sampling method. The interviews were analyzed using content analysis method of Graneheim, Lundman. RESULTS Data analysis resulted in the emergence of three main categories including (1) Patient and family centered education, (2) process-based education, and (3) continuous progress in profession and also seven subcategories (patient and family activation, empower), facilitating educational process, comprehensive education assessment, development, implementation and evaluation of educational plans, developing educators' educational knowledge and skills, development of creativity and innovation, promote inter-professional cooperation in education. CONCLUSION The evaluation of facilitation factors for participation and empowerment patient and family along with creativity and interprofessional collaboration for comprehensive evaluation of patients in designing, implementation of educational programs were mentioned as important competencies of diabetes educators, which can have a significant impact on patients' recovery, treatment, and the promotion of society's health.
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Affiliation(s)
- Fahimeh Kashani
- Department of Adult Health Nursing, Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
- Community Health Research Center, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran
| | - Parvaneh Abazari
- Department of Adult Health Nursing, Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
- Nursing and Midwifery Sciences Development Research Center, Najafabad Branch Islamic Azad University, Najafabad, Iran
| | - Fariba Haghani
- Medical Education Research Center, Department of Medical Education, Isfahan University of Medical Sciences, Isfahan, Iran
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McBride K, Bacong AM, Reynoso A, Benjamin AE, Wallace SP, Kietzman KG. Healthcare Decision-Making Among Dual-Eligible Immigrants: Implications from a Study of an Integrated Medicare-Medicaid Demonstration Program in California. J Immigr Minor Health 2021; 22:494-502. [PMID: 31350680 DOI: 10.1007/s10903-019-00922-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
To improve the coordination of long-term services and supports for dual-eligibles (those with both Medicare and Medicaid), California created Cal MediConnect (CMC), an Affordable Care Act-authorized managed care demonstration program. Beneficiaries were "passively enrolled" into CMC, meaning they were automatically enrolled unless they actively opted out. The aim of this study was to examine differences in factors influencing the enrollment decisions of U.S. born and immigrant dual-eligible beneficiaries. To explore differences in decision-making processes, we conducted in-depth interviews with dual-eligible consumers (39 native and 14 immigrant) in Los Angeles County. Interviews were analyzed using a constructivist grounded theory approach. Our findings illustrate a heightened sense of vulnerability and disempowerment experienced by immigrant participants. Immigrant participants also faced greater challenges in accessing healthcare and eliciting healthcare information compared to U.S.-born participants. Understanding the diverse perspectives of dual-eligible immigrant healthcare decision-making has implications for health care reform strategies aimed at ameliorating disparities for vulnerable immigrant populations.
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Affiliation(s)
- Kaitlyn McBride
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Campus Box 951772, Los Angeles, CA, 90095-1772, USA. .,UCLA Center for Health Policy Research, Los Angeles, CA, USA.
| | - Adrian M Bacong
- UCLA Center for Health Policy Research, Los Angeles, CA, USA.,Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Ana Reynoso
- UCLA Center for Health Policy Research, Los Angeles, CA, USA
| | - A E Benjamin
- Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, CA, USA
| | - Steven P Wallace
- UCLA Center for Health Policy Research, Los Angeles, CA, USA.,Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Kathryn G Kietzman
- UCLA Center for Health Policy Research, Los Angeles, CA, USA.,Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA
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Cuevas H, Carter S. Nurse-Talk Ratios as a Measure of Participation in a Cognitive Rehabilitation Intervention for People With Type 2 Diabetes. Res Theory Nurs Pract 2021; 35:67-81. [PMID: 33632923 DOI: 10.1891/rtnp-d-19-00130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Comprehensive cognitive rehabilitation teaches strategies to enhance strengths and has been used by nurses to target cognitive problems in chronic conditions. However, to date, no evaluations of web-based cognitive rehabilitation, based in empowerment theory, specifically for people with type 2 diabetes (T2DM), have been done. PURPOSE The purpose of this study was to analyze a cognitive rehabilitation intervention for people with T2DM, using qualitative content analysis and 10-second event coding to determine to what extent the classes reflected empowerment theory. METHODS Nineteen adults with T2DM and two nurses participated in an 8-week intervention that combined webinar classes with online home-based computer training. Classes were audio recorded and 10-second event coding was used to calculate nurse-talk ratios. Transcripts were examined using content analysis and compared with the talk ratios. RESULTS Talk ratios ranged from 40% to 74% for each class. Qualitative themes included (a) importance of goal setting; (b) pairing cognitive strategies with diabetes self-management; (c) experience and information sharing; and (d) validation by healthcare providers. Positive participant outcomes related to empowerment were associated with low nurse-talk ratios in some classes. However, high nurse-talk ratios were associated with factual content that participants also considered valuable. IMPLICATIONS FOR PRACTICE Talk ratios did not completely reflect the communication skills of the nurse. The 10-second method should be applied to other educational interventions in combination with qualitative analysis. Future interventions should include components of discourse evaluation and examinations of relationships to adherence and clinical outcomes.
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Affiliation(s)
- Heather Cuevas
- School of Nursing, The University of Texas at Austin, Austin, TX
| | - Sharon Carter
- School of Nursing, The University of Texas at Austin, Austin, TX
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Schaefer I, Heneka N, Luckett T, Agar MR, Chambers SK, Currow DC, Halkett G, Disalvo D, Amgarth-Duff I, Anderiesz C, Phillips JL. Quality of online self-management resources for adults living with primary brain cancer, and their carers: a systematic environmental scan. BMC Palliat Care 2021; 20:22. [PMID: 33485331 PMCID: PMC7827995 DOI: 10.1186/s12904-021-00715-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 01/13/2021] [Indexed: 12/24/2022] Open
Abstract
Background A primary brain cancer diagnosis is a distressing, life changing event. It adversely affects the quality of life for the person living with brain cancer and their families (‘carers’). Timely access to evidence-based information is critical to enabling people living with brain cancer, and their carers, to self-manage the devastating impacts of this disease. Method A systematic environmental scan of web-based resources. A depersonalised search for online English-language resources published from 2009 to December 2019 and designed for adults (> 25 years of age), living with primary brain cancer, was undertaken using the Google search engine. The online information was classified according to: 1) the step on the cancer care continuum; 2) self-management domains (PRISMS taxonomy); 3) basic information disclosure (Silberg criteria); 4) independent quality verification (HonCode); 5) reliability of disease and treatment information (DISCERN Sections 1 and 2); and readability (Flesch-Kincaid reading grade). Results A total of 119 online resources were identified, most originating in England (n = 49); Australia (n = 27); or the USA (n = 27). The majority of resources related to active treatment (n = 76), without addressing recurrence (n = 3), survivorship (n = 1) or palliative care needs (n = 13). Few online resources directly provided self-management advice for adults living with brain cancer or their carers. Just over a fifth (n = 26, 22%) were underpinned by verifiable evidence. Only one quarter of organisations producing resources were HonCode certified (n = 9, 24%). The median resource reliability as measured by Section 1, DISCERN tool, was 56%. A median of 8.8 years of education was required to understand these online resources. Conclusions More targeted online information is needed to provide people affected by brain cancer with practical self-management advice. Resources need to better address patient and carer needs related to: rehabilitation, managing behavioural changes, survivorship and living with uncertainty; recurrence; and transition to palliative care. Developing online resources that don’t require a high level of literacy and/or cognition are also required. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00715-4.
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Affiliation(s)
- Isabelle Schaefer
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Nicole Heneka
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Tim Luckett
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Meera R Agar
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Suzanne K Chambers
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - David C Currow
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Georgia Halkett
- School of Nursing, Midwifery and Paramedicine, Psychology Building, Curtin University, Perth, Western Australia, Australia
| | - Domenica Disalvo
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Ingrid Amgarth-Duff
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Cleola Anderiesz
- Australian Brain Cancer Mission, Cancer Australia, Sydney, New South Wales, Australia
| | - Jane L Phillips
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia.
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