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Jayanti S, Rangan GK. Advances in Human-Centered Care to Address Contemporary Unmet Needs in Chronic Dialysis. Int J Nephrol Renovasc Dis 2024; 17:91-104. [PMID: 38525412 PMCID: PMC10961023 DOI: 10.2147/ijnrd.s387598] [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: 12/23/2023] [Accepted: 03/12/2024] [Indexed: 03/26/2024] Open
Abstract
Advances in the treatment of kidney failure with chronic dialysis have stagnated over the past three decades, with over 50% of patients still managed by conventional in-hospital haemodialysis. In parallel, the demands of chronic dialysis medical care have changed and evolved due to a growing population that has higher frailty and multimorbidity. Thus, the gap between the needs of kidney failure patients and the healthcare capability to provide effective overall management has widened. To address this problem, healthcare policy has increasingly aligned towards a human-centred approach. The paradigm shift of human-centred approach places patients at the forefront of decision-making processes, ensuring that specific needs are understood and prioritised. Integration of human-centred approaches with patient care has been shown to improve satisfaction and quality of life. The aim of this narrative is to evaluate the current clinical challenges for managing kidney failure for dialysis providers; summarise current experiences and unmet needs of chronic dialysis patients; and finally emphasise how human-centred care has advanced chronic dialysis care. Specific incremental advances include implementation of renal supportive care; home-assisted dialysis; hybrid dialysis; refinements to dialysis methods; whereas emerging advances include portable and wearable dialysis devices and the potential for the integration of artificial intelligence in clinical practice.
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Affiliation(s)
- Sumedh Jayanti
- Department of Renal Medicine, Westmead Hospital, Sydney, NSW, Australia
- Michael Stern Laboratory for Polycystic Kidney Disease, Centre for Transplant and Renal Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Gopala K Rangan
- Department of Renal Medicine, Westmead Hospital, Sydney, NSW, Australia
- Michael Stern Laboratory for Polycystic Kidney Disease, Centre for Transplant and Renal Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
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de Oliveira MAC, Miles A, Asbridge JE. Modern medical schools curricula: Necessary innovations and priorities for change. J Eval Clin Pract 2024; 30:162-173. [PMID: 37656633 DOI: 10.1111/jep.13916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 08/02/2023] [Indexed: 09/03/2023]
Abstract
Medical schools' curricula have expanded over the decades to incorporate important new medical breakthroughs and discoveries. Their current focus and overall structures remain, however, stubbornly captive of early 20th-century thinking, with changes having been undertaken in a piecemeal fashion. Indeed, since the notable Flexner reform in 1910, medical schools' study plans have suffered successive and typically always partial adjustments which have failed to keep up with scientific, technological and sociological change. This difficulty may be attributable to the well-known conservatism of medical schools, where updating study plans is a process that invariably encounters numerous barriers to change. These observations were afforded detailed attention some 15 years ago when de Oliveira wrote: 'it is now perfectly demonstrated that public medical schools have not been able to adapt their operation in depth and in due time to the new demands of teaching dictated by an explosive scientific and technological development'. Recent advances in communication and information technologies, as well as the introduction of new pedagogical techniques, have the potential to bring significant benefits to medical practice and healthcare systems, but these have not in the main become properly taught and utilized. The proposition that healthcare is evolving from reactive disease care to care that is predictive, preventive, personalized and participatory was initially regarded as highly speculative, yet systems approaches to biology and medicine are now beginning to provide experience of both health and disease at the molecular, cellular and organ levels. Medicine is a broad scientific field. In contrast to the 19th century, current medical 'sectarianism' is a positive by-product of rapid and gratifying medical progress, and the multiplicity of new models means that the lines of evidence legitimately bearing on practice and health policymaking are already highly diverse and likely to become ever more variegated over time. Put simply, most sound decisions, by definition, will be evidence-informed and not evidence-based, where divergence may be as informative as convergence. Here, the most enduring lesson of history is, perhaps, that clinical medicine is constantly rediscovering its humanistic core. Complexities create opportunities for innovation. In innovative environments, high-performing organizations are finding ways to create a culture that supports a diverse workforce preparing to deliver different models of care, with direct implications for excellence of patient experience and strong repercussions for medical education. The COVID-19 crisis saw major increases in the use of telemedicine, virtual office visits and other forms of online contact, and these are likely to increase considerably. This particular transformation will not be easy or comfortable to make. But reconfiguration of medical education seems inevitable, fuelled by online educational technology and the need to transform clinical training to more outpatient settings with promotion based on competency and person-centeredness, not simply time. As we prepare to enter 2024, this is an exciting time to be working in healthcare. We have more evidence than ever about how to provide high quality, person-centered care, and to keep patients safe. Shame on us if there is any hesitation about applying this knowledge to make the healthcare experience better for patients and providers. Embracing change and making continuous improvements are essential and urgent priorities for medicine and healthcare and, as we describe in the current article, will become more and more indispensably important in our rapidly changing world.
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Affiliation(s)
| | - Andrew Miles
- European Society for Person Centered Healthcare, London, UK
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Wang D, Hu Y, Liu K, Liu Z, Chen X, Cao L, Zhang W, Li K, Hu J. Issues in patients' experiences of enhanced recovery after surgery (ERAS) : a systematic review of qualitative evidence. BMJ Open 2023; 13:e068910. [PMID: 36810180 PMCID: PMC9945048 DOI: 10.1136/bmjopen-2022-068910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
OBJECTIVE To explore patients' experiences of enhanced recovery after surgery (ERAS) and to identify issues in the implementation of ERAS from the patient's perspective. DESIGN The systematic review and qualitative analysis were based on the Joanna Briggs Institute's methodology for conducting synthesis. DATA SOURCES Relevant studies published in four databases, that is, Web of Science, PubMed, Ovid Embase and the Cochrane Library, were systematically searched, and some studies were supplemented by key authors and reference lists. STUDY SELECTION Thirty-one studies were identified, involving 1069 surgical patients enrolled in the ERAS programme. The inclusion and exclusion criteria were formulated based on the Population, Interest of phenomena, Context, Study design criteria recommended by the Joanna Briggs Institute to determine the scope of article retrieval. The inclusion criteria were as follows: ERAS patients' experiences; qualitative data; English language and published from January 1990 to August 2021. DATA EXTRACTION Data were extracted from relevant studies using the standardised data extraction tool from Joanna Briggs Institute Qualitative Assessment and Review Instrument for qualitative research. DATA SYNTHESIS The themes in the structure dimension are as follows: (1) patients cared about the timeliness of healthcare professionals' help; (2) patients cared about the professionalism of family care; and (3) patients misunderstood and worried about the safety of ERAS. The themes in the process dimension are as follows: (1) patients needed adequate and accurate information from healthcare professionals; (2) patients needed to communicate adequately with healthcare professionals; (3) patients hoped to develop a personalised treatment plan and (4) patients required ongoing follow-up services. The theme in the outcome dimension is as follows: patients wanted to effectively improve severe postoperative symptoms. CONCLUSIONS Evaluating ERAS from the patient's perspective can reveal the omissions and deficiencies of healthcare professionals in clinical care so that problems in patients' recovery process can be solved in a timely manner, reducing potential barriers to the implementation of ERAS. PROSPERO REGISTRATION NUMBER CRD42021278631.
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Affiliation(s)
- Dan Wang
- Post-doctoral Mobile Research Station of Public Health and Preventive Medicine, School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, China
- School of Nursing, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Yanjie Hu
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, China
| | - Kai Liu
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhenmi Liu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xinrong Chen
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, China
| | - Liujiao Cao
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, China
| | - Weihan Zhang
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ka Li
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, China
| | - Jiankun Hu
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Wallace SJ, Barnett A, Cheng BB, Lowe J, Campbell KL, Young AM. What is 'successful rehabilitation'? A multi-stakeholder nominal group technique study to inform rehabilitation outcome measurement. Clin Rehabil 2023:2692155231157181. [PMID: 36785902 PMCID: PMC10387716 DOI: 10.1177/02692155231157181] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
OBJECTIVE To explore how stakeholders in rehabilitation conceptualise 'successful rehabilitation', to inform the development of a minimum dataset and core outcomes for sub-acute rehabilitation. DESIGN Qualitative consensus study using the nominal group technique. SETTING Online focus groups. PARTICIPANTS Consumer representatives (n = 7), clinicians (n = 15), and health service managers (n = 9) from Australia. INTERVENTION Participants responded to the question, 'What does successful rehabilitation look like?'. Following item generation, they prioritised their top five responses, allocating 100 points across items to denote relative importance. MAIN MEASURES Prioritised responses were analysed across stakeholder groups using qualitative content analysis. RESULTS Ten themes were identified. 'Successful rehabilitation' is: (1) person and family centred; (2) effective; (3) inter-professional; (4) accessible; (5) goal oriented with meaningful outcomes; (6) connected to the continuum of care; (7) evidence-based and supportive of innovation and research; (8) appropriately funded and skilled; (9) satisfying and engaging; and (10) safe. CONCLUSIONS Stakeholder-defined 'successful rehabilitation' aligned with principles of value-based care and evidence-based rehabilitation. Provision and receipt of person and family centred care was the most important indicator of successful rehabilitation. Measures of success should include indicators of structure, process, outcome, and experience, and be conducted at multiple time-points.
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Affiliation(s)
- Sarah J Wallace
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, 1974The University of Queensland, Brisbane, Australia
| | - Amandine Barnett
- Centre for Applied Health Economics, Menzies Health Institute Queensland, 5723Griffith University, Brisbane, Australia
| | - Bonnie By Cheng
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, 1974The University of Queensland, Brisbane, Australia
| | - Joshua Lowe
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, 1974The University of Queensland, Brisbane, Australia
| | - Katrina L Campbell
- Centre for Applied Health Economics, Menzies Health Institute Queensland, 5723Griffith University, Brisbane, Australia.,Healthcare Excellence and Innovation, Metro North Hospital and Health Service, Brisbane, Australia
| | - Adrienne M Young
- Department of Nutrition and Dietetics, 3883Royal Brisbane and Women's Hospital, Brisbane, Australia
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[Measurable: positive effects of patient-centered care]. UROLOGIE (HEIDELBERG, GERMANY) 2023; 62:77-80. [PMID: 36583747 DOI: 10.1007/s00120-022-02006-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/09/2022] [Indexed: 12/31/2022]
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Nadia S, Rivai F, Sidin I, Pasinringi SA. What is known about patient-centered care application in post-surgical breast cancer patients? Breast Dis 2023; 42:233-243. [PMID: 37522192 DOI: 10.3233/bd-239004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
BACKGROUND Over the past two decades, patient-centered care has become internationally recognized as a dimension of high-quality health care. Recent research has shown that patient-centered care has many benefits, which are broadly categorized as patient experience and clinical and operational benefits. OBJECTIVE The study aimed at analyzing the correlation between the application of patient-centered care (PCC) and length of stay, patient satisfaction, and clinical outcome of post-surgical breast cancer patients. METHODS The study design was cross-sectional. A sample of 100 patients was determined and selected with the inclusion criteria. Data were collected using measuring tools comprising patient-centered care and patient satisfaction questionnaires as well as medical records to evaluate the length of stay and clinical outcomes. Bivariate analysis was conducted to analyze the correlation between patient-centered-care and length of stay (LOS), patient satisfaction, and the clinical outcomes of inpatients. RESULTS A correlation was found between patient-centered care (PCC) application and patient satisfaction (p = 0.005), but no correlation was observed between PCC application and length of stay (LOS) (p = 0.176) as well as clinical outcome (p = 0.128). CONCLUSIONS The application of patient-centered care can be attributed to patient satisfaction but is not correlated to length of stay and clinical outcome of post-surgical breast cancer patients. The hospital should create an accepted definition and commonly agreed set of dimensions used for the concept of operationalization and its measurement to implement PCC and improve overall patient satisfaction and clinical outcome and reduce the length of stay as expected.
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Affiliation(s)
- Shafa Nadia
- Faculty of Public Health, Hasanuddin University, Makassar, Indonesia
| | - Fridawaty Rivai
- Faculty of Public Health, Hasanuddin University, Makassar, Indonesia
- Hasanuddin University Hospital, Makassar, South Sulawesi, Indonesia
| | - Indahwaty Sidin
- Faculty of Public Health, Hasanuddin University, Makassar, Indonesia
- Hasanuddin University Hospital, Makassar, South Sulawesi, Indonesia
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Zhou Y, Sun Y, Xu Y, Yuan H. Study on value-based design of healthcare facilities: Based on review of the literature in the USA and Japan. Front Public Health 2022; 10:883241. [PMID: 36159251 PMCID: PMC9500362 DOI: 10.3389/fpubh.2022.883241] [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: 02/24/2022] [Accepted: 08/15/2022] [Indexed: 01/21/2023] Open
Abstract
With limited medical resources, it is of great significance for countries all over the world to explore architectural design methods to enhance the value of medical facilities. Therefore, it is very necessary to carry out an extensive international comparison. In order to grasp the research trend of healthcare facilities in the world, this paper conducts co-occurrence analysis, cluster analysis, and trend analysis of the keywords of 334 English articles and 153 Japanese articles related to healthcare facilities published in important academic journals in the USA and Japan in the past 15 years. We not only compare the similarities and differences in healthcare facility research between the USA and Japan, but also explore the reasons for these differences. It is found that by introducing three kinds of value variables, such as time, space, and behavior, we can not only well explain the difference in the solution of healthcare facilities in the USA and Japan to reduce medical costs but also provide new ideas for architectural design to enhance the value of hospitals. Based on the above analysis, a conceptual framework of value-based design of healthcare facilities that combines the advantages of the USA and Japan is proposed in this paper.
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Affiliation(s)
- Ying Zhou
- Department of Architecture, School of Architecture, Southeast University, Nanjing, China,*Correspondence: Ying Zhou
| | - Yaonan Sun
- Department of Civil Engineering, School of Science, Nanjing University of Science and Technology, Nanjing, China
| | - Yi Xu
- Department of Architecture, School of Architecture, Southeast University, Nanjing, China
| | - Hao Yuan
- Department of Architecture, School of Architecture, Southeast University, Nanjing, China
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Rose SJ, Waggener L, Kiely SC, Hedge A. Postoccupancy Evaluation of a Neighborhood Concept Redesign of an Acute Care Nursing Unit in a Planetree Hospital. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2022; 15:171-192. [PMID: 35389291 DOI: 10.1177/19375867221091318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE A comparative study was undertaken to survey nurses working in an acute care nursing unit before and after moving to a new hospital to investigate the impact of a nursing unit designed utilizing Planetree build criteria. BACKGROUND The physical and emotional demands of frontline practitioners is a serious concern for patient safety and staff retention as the environmental design of nursing units can influence human errors from fatigue and interruption. METHOD A pre-move survey was conducted with acute care nurses in a conventional design nursing unit who were moving to a new facility. After the move to the new hospital design, the same survey was readministered to obtain comparative performance information. Qualitative responses were analyzed for triangulation with survey responses. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) and Press Ganey scores were collected over a 5-year period. RESULTS There were statistically significant improvements for most of the survey questions, especially for work efficiency and productivity, the design of the patient room and of support spaces, the information systems, and the environmental conditions. There were statistically significant improvements in the HCHAPS and Press Ganey survey questions. CONCLUSIONS The postoccupancy survey showed statistically significant improvements in most of the concerns highlighted in the pre-move survey and significant improvements in the workflow and overall satisfaction of nurses. Press Ganey results revealed all but five domains fell in the significantly improved category.
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Affiliation(s)
| | | | | | - Alan Hedge
- Human Factors and Ergonomics Laboratory, Department of Design and Environmental Analysis, College of Human Ecology, Cornell University, Ithaca, NY, USA
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Bogaert B. Moving Toward Person-Centered Care: Valuing Emotions in Hospital Design and Architecture. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2021; 15:355-364. [PMID: 34879737 DOI: 10.1177/19375867211062101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The intangible value of emotions is often neglected in healthcare evaluations; however, it forms an important part of the hospital experience that needs to be taken into consideration to move toward person-centered care. This article conceptualizes how space and architecture may influence patient, family, and healthcare provider emotions. Building upon Gaston Bachelard's Poetics of Space, theories on emotional design and architecture, as well as research in environmental design, we suggest several ways to value emotions in hospital design and architecture. The first theme explores several hospital spaces (the waiting room, the hospital room, the treatment room) using Bachelard's phenomenology in order to show how to facilitate emotional security by catering to the individual needs of the user. The second discusses the overall hospital room environment, notably the influence of light, color, and sound on the patient's emotional experience. The third explores architectural theorist Giuliana Bruno's theory of e(motion) to explore the hospital space as vissuto, a space of lived experiences, that invites us to rethink the design and architecture of hospital spaces to allow for patient participation. The article also gives suggestions of qualitative, person-centered methodologies that can be used to move forward this debate.
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Affiliation(s)
- Brenda Bogaert
- Healthcare Values Chair, Institut de Recherches Philosophiques de Lyon. Université Jean Moulin 3, Lyon, France
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Schouten B, Driesen BEJM, Merten H, Burger BHCM, Hartjes MG, Nanayakkara PWB, Wagner C. Experiences and perspectives of older patients with a return visit to the emergency department within 30 days: patient journey mapping. Eur Geriatr Med 2021; 13:339-350. [PMID: 34761369 PMCID: PMC9018642 DOI: 10.1007/s41999-021-00581-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/26/2021] [Indexed: 12/30/2022]
Abstract
Aim To achieve patient-centered care for older patients at the emergency department (ED) it is important to include their perspective and experience, and this can be done through the patient journey method. Findings By mapping the patient journey, we found that waiting times and suboptimal discharge communication are almost always related to a negative experience for older patients. Message The novelty of this study lies within the qualitative patient journey method, which allowed us to include the voice of the patient in issues that have been previously described (i.e. waiting times and discharge communication). We believe this can guide towards patient-centered improvement initiatives that can contribute to a positive ED experience in the future, for example a time-out at the ED and a discharge check list Supplementary Information The online version contains supplementary material available at 10.1007/s41999-021-00581-6. Purpose Up to 22% of older patients who visit the emergency department (ED) have a return visit within 30 days. To achieve patient-centered care for this group at the ED it is important to involve the patient perspective and strive to provide the best possible experience. The aim of this study was to gain insight into the experiences and perspectives of older patients from initial to return ED visit by mapping their patient journey. Methods We performed a qualitative patient journey study with 13 patients of 70 years and older with a return ED visit within 30 days who presented at the Amsterdam UMC, a Dutch academic hospital. We used semi-structured interviews focusing on the patient experience during their journey and developed a conceptual framework for coding. Results Our sample consisted of 13 older patients with an average age of 80 years, and 62% of them were males. The framework contained a timeline of the patient journey with five chronological main themes, complemented with an ‘experience’ theme, these were divided into 34 subthemes. Health status, social system, contact with the general practitioner, aftercare, discharge and expectations were the five main themes. The experiences regarding these themes differed greatly between patients. The two most prominent subthemes were waiting time and discharge communication, which were mostly related to a negative experience. Conclusions This study provides insight into the experiences and perspectives of older patients from initial to return ED visit. The two major findings were that lack of clarity regarding waiting times and suboptimal discharge communication contributed to negative experiences. Recommendations regarding waiting time (i.e. a two-hour time out at the ED), and discharge communication (i.e. checklist for discharge) could contribute to a positive ED experience and thereby potentially improve patient-centered care. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-021-00581-6.
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Affiliation(s)
- Bo Schouten
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1117, P/O Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - Babiche E J M Driesen
- Department of Emergency Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Hanneke Merten
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1117, P/O Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Brigitte H C M Burger
- Section General and Acute Internal Medicine, Department of Internal Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Mariëlle G Hartjes
- Section General and Acute Internal Medicine, Department of Internal Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Prabath W B Nanayakkara
- Section General and Acute Internal Medicine, Department of Internal Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Cordula Wagner
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1117, P/O Box 7057, 1007 MB, Amsterdam, The Netherlands.,Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
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Lowe D, Ryan R, Schonfeld L, Merner B, Walsh L, Graham-Wisener L, Hill S. Effects of consumers and health providers working in partnership on health services planning, delivery and evaluation. Cochrane Database Syst Rev 2021; 9:CD013373. [PMID: 34523117 PMCID: PMC8440158 DOI: 10.1002/14651858.cd013373.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Health services have traditionally been developed to focus on specific diseases or medical specialties. Involving consumers as partners in planning, delivering and evaluating health services may lead to services that are person-centred and so better able to meet the needs of and provide care for individuals. Globally, governments recommend consumer involvement in healthcare decision-making at the systems level, as a strategy for promoting person-centred health services. However, the effects of this 'working in partnership' approach to healthcare decision-making are unclear. Working in partnership is defined here as collaborative relationships between at least one consumer and health provider, meeting jointly and regularly in formal group formats, to equally contribute to and collaborate on health service-related decision-making in real time. In this review, the terms 'consumer' and 'health provider' refer to partnership participants, and 'health service user' and 'health service provider' refer to trial participants. This review of effects of partnership interventions was undertaken concurrently with a Cochrane Qualitative Evidence Synthesis (QES) entitled Consumers and health providers working in partnership for the promotion of person-centred health services: a co-produced qualitative evidence synthesis. OBJECTIVES To assess the effects of consumers and health providers working in partnership, as an intervention to promote person-centred health services. SEARCH METHODS We searched the CENTRAL, MEDLINE, Embase, PsycINFO and CINAHL databases from 2000 to April 2019; PROQUEST Dissertations and Theses Global from 2016 to April 2019; and grey literature and online trial registries from 2000 until September 2019. SELECTION CRITERIA We included randomised controlled trials (RCTs), quasi-RCTs, and cluster-RCTs of 'working in partnership' interventions meeting these three criteria: both consumer and provider participants meet; they meet jointly and regularly in formal group formats; and they make actual decisions that relate to the person-centredness of health service(s). DATA COLLECTION AND ANALYSIS Two review authors independently screened most titles and abstracts. One review author screened a subset of titles and abstracts (i.e. those identified through clinical trials registries searches, those classified by the Cochrane RCT Classifier as unlikely to be an RCT, and those identified through other sources). Two review authors independently screened all full texts of potentially eligible articles for inclusion. In case of disagreement, they consulted a third review author to reach consensus. One review author extracted data and assessed risk of bias for all included studies and a second review author independently cross-checked all data and assessments. Any discrepancies were resolved by discussion, or by consulting a third review author to reach consensus. Meta-analysis was not possible due to the small number of included trials and their heterogeneity; we synthesised results descriptively by comparison and outcome. We reported the following outcomes in GRADE 'Summary of findings' tables: health service alterations; the degree to which changed service reflects health service user priorities; health service users' ratings of health service performance; health service users' health service utilisation patterns; resources associated with the decision-making process; resources associated with implementing decisions; and adverse events. MAIN RESULTS We included five trials (one RCT and four cluster-RCTs), with 16,257 health service users and more than 469 health service providers as trial participants. For two trials, the aims of the partnerships were to directly improve the person-centredness of health services (via health service planning, and discharge co-ordination). In the remaining trials, the aims were indirect (training first-year medical doctors on patient safety) or broader in focus (which could include person-centredness of health services that targeted the public/community, households or health service delivery to improve maternal and neonatal mortality). Three trials were conducted in high income-countries, one was in a middle-income country and one was in a low-income country. Two studies evaluated working in partnership interventions, compared to usual practice without partnership (Comparison 1); and three studies evaluated working in partnership as part of a multi-component intervention, compared to the same intervention without partnership (Comparison 2). No studies evaluated one form of working in partnership compared to another (Comparison 3). The effects of consumers and health providers working in partnership compared to usual practice without partnership are uncertain: only one of the two studies that assessed this comparison measured health service alteration outcomes, and data were not usable, as only intervention group data were reported. Additionally, none of the included studies evaluating this comparison measured the other primary or secondary outcomes we sought for the 'Summary of findings' table. We are also unsure about the effects of consumers and health providers working in partnership as part of a multi-component intervention compared to the same intervention without partnership. Very low-certainty evidence indicated there may be little or no difference on health service alterations or health service user health service performance ratings (two studies); or on health service user health service utilisation patterns and adverse events (one study each). No studies evaluating this comparison reported the degree to which health service alterations reflect health service user priorities, or resource use. Overall, our confidence in the findings about the effects of working in partnership interventions was very low due to indirectness, imprecision and publication bias, and serious concerns about risk of selection bias; performance bias, detection bias and reporting bias in most studies. AUTHORS' CONCLUSIONS The effects of consumers and providers working in partnership as an intervention, or as part of a multi-component intervention, are uncertain, due to a lack of high-quality evidence and/or due to a lack of studies. Further well-designed RCTs with a clear focus on assessing outcomes directly related to partnerships for patient-centred health services are needed in this area, which may also benefit from mixed-methods and qualitative research to build the evidence base.
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Affiliation(s)
- Dianne Lowe
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Rebecca Ryan
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Lina Schonfeld
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Bronwen Merner
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Louisa Walsh
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | | | - Sophie Hill
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
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Leidner C, Vennedey V, Hillen H, Ansmann L, Stock S, Kuntz L, Pfaff H, Hower KI. Implementation of patient-centred care: which system-level determinants matter from a decision maker's perspective? Results from a qualitative interview study across various health and social care organisations. BMJ Open 2021; 11:e050054. [PMID: 34489287 PMCID: PMC8422499 DOI: 10.1136/bmjopen-2021-050054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES The healthcare system is characterised by a high degree of complexity and involves various actors at different institutional levels and in different care contexts. To implement patient-centred care (PCC) successfully, a multidimensional consideration of influencing factors is required. Our qualitative study aims to identify system-level determinants of PCC implementation from the perspective of different health and social care organisations (HSCOs). DESIGN A qualitative study using n=20 semistructured face-to-face interviews with n=24 participants was carried out between August 2017 and May 2018. Interview data were analysed based on concepts of qualitative content analysis using an inductive and deductive approach. SETTING AND PARTICIPANTS Interviews were conducted with clinical and managerial decision makers from multiple HSCOs in the model region of Cologne, Germany. Participants were recruited via networks of practice partners and cold calling. RESULTS This study identified various determinants on the system level that are associated with PCC implementation. Decision makers described external regulations as generating an economically controlled alignment of the healthcare system. The availability and qualification of staff resources and patient-related incentives of financial resources were identified as an eminent requirement for providers to deliver PCC. Participants considered the strict separation of financing and delivery of healthcare into inpatient and outpatient sectors to be a barrier to PCC. Interorganisational collaboration and information exchange were identified as facilitators of PCC, as they enable continuous patient care cycles. CONCLUSION The results showed the necessity of enforcing paradigm changes at the system level from disease-centredness to patient-centredness while aligning policy and reimbursement decisions directly with patient needs and values. A systematic, long-term planned strategy that extends across all organisations is lacking, rather each organisation seeks its own possibilities to implement PCC activities under external restrictions.Trial registration numberDRKS00011925.
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Affiliation(s)
| | - Vera Vennedey
- Institute for Health Economics and Clinical Epidemiology, University Hospital Cologne, Cologne, Germany
| | - Hendrik Hillen
- Department of Business Administration and Health Care Management, University of Cologne, Cologne, Germany
| | - Lena Ansmann
- Department of Health Services Research, School of Medicine and Health Sciences, University of Oldenburg, Oldenburg, Germany, University of Oldenburg, Oldenburg, Germany
| | - Stephanie Stock
- Institute for Health Economics and Clinical Epidemiology, University Hospital Cologne, Cologne, Germany
| | - Ludwig Kuntz
- Department of Business Administration and Health Care Management, University of Cologne, Cologne, Germany
| | - Holger Pfaff
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), Faculties of Human Sciences and Medicine, University of Cologne, Cologne, Germany
| | - Kira Isabel Hower
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), Faculties of Human Sciences and Medicine, University of Cologne, Cologne, Germany
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From the Other Side of the Bed: Lived Experiences of Registered Nurses as Family Caregivers. J Nurs Care Qual 2021; 36:279-284. [PMID: 32956139 DOI: 10.1097/ncq.0000000000000516] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND To provide patient- and family-centered care, health care providers must understand the caregiver experience. Evidence suggests that registered nurses functioning as family caregivers (RNFCs) may have unique experiences and challenges. PURPOSE The purpose of this study was to explore the lived experiences of RNFCs during an adult family member's episode of care in the southern United States. METHODS A descriptive phenomenological approach was used to describe the essence of the RNFC experience throughout an episode of care. Twenty-five participants were recruited for semistructured, audio-recorded interviews. Data were analyzed using descriptive data analysis and constant comparison techniques. RESULTS Participants were predominantly female (88%). The essence of the phenomenon was dual roles. Five themes emerged: (1) blurring the boundaries, (2) revealing my identity, (3) having insider knowledge, (4) managing expectations, and (5) learning from my experience. CONCLUSIONS While caregiver experiences may be similar, RNFCs struggle with dual roles of registered nurse and caregiver, occasionally blurring boundaries of care.
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Olufson HT, Young AM, Green TL. The delivery of patient centred dietetic care in subacute rehabilitation units: A scoping review. J Hum Nutr Diet 2021; 35:134-144. [PMID: 34370342 DOI: 10.1111/jhn.12940] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 07/28/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patient centred care (PCC) positively influences individual and organisational outcomes. It is important that dietitians working in rehabilitation units are supported to deliver PCC, as effective rehabilitation is a collaborative and patient centred process. The objective of this scoping review was to explore the literature available regarding the delivery of dietetic PCC, with patients undergoing rehabilitation in subacute inpatient units. METHODOLOGY PubMed, MEDLINE, CINAHL, Embase and Scopus were searched for relevant published literature. Searches for grey and unpublished literature were also completed. Studies were eligible for inclusion and data extraction if they demonstrated the delivery of PCC by qualified dietitians, through individual consultations with adult patients undertaking subacute rehabilitation. RESULTS Overall, 675 studies were identified and six were included in the review. From the literature available, documentation was lacking regarding conceptualisation and delivery of patient centred nutrition care, with only one study providing quality indicators for patient centred dietetic services. Elements of PCC cited were mostly limited to phrases such as, 'individualised care', 'tailored advice', 'follow-up', and 'team collaboration'. CONCLUSION This scoping review identified a considerable gap in the literature regarding the delivery of dietetic PCC in subacute rehabilitation units. Contemporary descriptions of PCC show that delivery of care which is truly patient centred is far more comprehensive than individualising interventions or organising ongoing services. This raises the question, is the delivery of nutrition care in subacute rehabilitation unit's patient centred? This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Hannah T Olufson
- Faculty of Health & Behavioural Sciences, School of Nursing, Midwifery & Social Work, University of Queensland, Brisbane, QLD, Australia.,Dietetics & Food Services, Surgical, Treatment & Rehabilitation Service (STARS), Metro North Hospital & Health Service, Herston, QLD, Australia
| | - Adrienne M Young
- Nutrition & Dietetics, Royal Brisbane & Women's Hospital, Metro North Hospital & Health Service, Herston, QLD, Australia.,Faculty of Health & Behavioural Sciences, School of Human Movement & Nutrition Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Theresa L Green
- Faculty of Health & Behavioural Sciences, School of Nursing, Midwifery & Social Work, University of Queensland, Brisbane, QLD, Australia.,STARS Research & Education, Surgical, Treatment & Rehabilitation Service (STARS), Metro North Hospital & Health Service, Herston, QLD, Australia
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15
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Frakking T, Michaels S, Orbell-Smith J, Le Ray L. Framework for patient, family-centred care within an Australian Community Hospital: development and description. BMJ Open Qual 2021; 9:bmjoq-2019-000823. [PMID: 32354755 PMCID: PMC7213886 DOI: 10.1136/bmjoq-2019-000823] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 03/31/2020] [Accepted: 04/18/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To describe the development of a patient and family-centred care (PFCC) conceptual framework within a small community Australian Hospital. METHODS A scoping review of scientific and grey literature and community hospital stakeholder discussions were used to identify and design a conceptual framework for PFCC across five core pillars of leadership, engagement, service delivery, learning and environment. RESULTS 107 publications were identified and 76 were included for data extraction. A draft framework was constructed and modified following consultation with hospital stakeholders across a small Australian Community Hospital. The 'Caring Together' framework outlines three core layers: (1) the focus of our care is the experiences of our consumers and staff; (2) concepts of leadership, environment, service delivery, engagement and learning; and (3) the overarching fundamental values of being heard, respected, valued and supported by staff and consumers at all levels in an organisation. CONCLUSIONS The conceptual Caring Together framework structures key PFCC concepts across organisational priority areas within an Australian healthcare setting and can be used to guide implementation of PFCC at other small hospital facilities. Changes to national and state healthcare funding may help facilitate improved hospital facility implementation of PFCC, and ultimately improve consumer healthcare satisfaction and clinical outcomes.
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Affiliation(s)
- Thuy Frakking
- Research Development Unit, Metro North Hospital and Health Service, Herston, Queensland, Australia .,School of Health and Rehabilitation Sciences, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Suzanne Michaels
- Engagement & Integration, Caboolture Hospital, Metro North Hospital and Health Service, Caboolture, Queensland, Australia
| | - Jane Orbell-Smith
- Education & Training, Caboolture Hospital, Metro North Hospital and Health Service, Caboolture, Queensland, Australia
| | - Lance Le Ray
- Executive Management, Caboolture Hospital, Metro North Hospital and Health Service, Caboolture, Queensland, Australia
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Kamity R, Grella M, Kim ML, Akerman M, Quintos-Alagheband ML. From kamishibai card to key card: a family-targeted quality improvement initiative to reduce paediatric central line-associated bloodstream infections. BMJ Qual Saf 2020; 30:72-81. [DOI: 10.1136/bmjqs-2019-010666] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 05/10/2020] [Accepted: 06/08/2020] [Indexed: 12/13/2022]
Abstract
BackgroundCentral line-associated bloodstream infections (CLABSIs) are major contributors to preventable harm in the inpatient paediatric setting. Despite multiple guidelines to reduce CLABSI, sustaining reliable central line maintenance bundle compliance remains elusive. We identified frontline and family engagement as key drivers for this initiative. The baseline CLABSI rate for all our paediatric inpatient units (January 2016–January 2017) was 1.71/1000 central line days with maintenance bundle compliance at 87.9% (monthly range 44%–100%).ObjectiveTo reduce CLABSI by increasing central line maintenance bundle compliance to greater than 90% using kamishibai card (K-card) audits and family ‘key card’ education.MethodsWe transitioned our central line maintenance bundle audits from checklists to directly observed K-card audits. K-cards list the central line maintenance bundle elements to be reviewed with frontline staff. Key cards are cue cards developed using a plain-language summary of CLABSI K-cards and used by frontline staff to educate families. Key cards were distributed to families of children with central lines to simultaneously engage patients, families and frontline staff after a successful implementation of the K-card audit process. A survey was used to obtain feedback from families.ResultsIn the postintervention period (February 2017–December 2019), our CLABSI rate was 0.63/1000 central line days, and maintenance bundle compliance improved to 97.1% (monthly range 86%–100%, p<0.001). Of the 45 family surveys distributed, 20 (44%) were returned. Nineteen respondents (95%) reported being extremely satisfied with the key card programme and provided positive comments.ConclusionCombining the key card programme with K-card audits was associated with improved maintenance bundle compliance and a reduction in CLABSI. This programme has the potential for use in multiple healthcare improvement initiatives.
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Dos Santos Marques IC, Herbey II, Theiss LM, Hollis RH, Knight SJ, Davis TC, Fouad M, Chu DI. Understanding the Surgical Experience for African-Americans and Caucasians With Enhanced Recovery. J Surg Res 2020; 250:12-22. [PMID: 32014697 DOI: 10.1016/j.jss.2019.12.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 11/18/2019] [Accepted: 12/27/2019] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Racial/ethnic disparities in surgical outcomes exist. Enhanced recovery programs (ERPs) have reduced some racial/ethnic disparities, but it remains unclear if disparities in experiences are also reduced. The purpose of this study was to use qualitative methods to better understand the surgical experience for African-American and Caucasian patients in the setting of an ERP. METHODS Using purposeful sampling at a minority-serving institution, we recruited African-American and Caucasian patients who had undergone colorectal surgery under an ERP to six focus groups. Participants identified barriers and facilitators to a positive, or negative, surgical experience. Audio recordings were transcribed and analyzed using an indicative thematic approach with NVivo 10 software (QSR International). RESULTS Forty-three patients (15 African-Americans and 28 Caucasians) participated in six focus groups. Six themes were identified by patients to be important in surgery: 1) knowledge about colorectal surgery, 2) obtaining information, 3) quality of information, 4) setting expectations about surgery, 5) following preoperative and postoperative instructions, and 6) confidence in surgery outcomes. For both racial/ethnic groups, patients felt that more information could have been provided, information should be given at their level of understanding, and trust in the physician made them feel confident in a positive outcome. African-American patients described experiences of having incorrect or no expectations on surgical outcomes, being provided inconsistent information, and feeling misled. African-Americans also described following instructions from family members and valued the importance of diet and exercise in recovery. CONCLUSIONS African-American and Caucasian surgical patients have varied surgical experiences even under an ERP. All patients, however, valued the ability to obtain, process, and understand health information during the surgical process. These elements define "health literacy" and suggest the importance of providing health literacy-sensitive care in surgery.
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Affiliation(s)
| | - Ivan I Herbey
- Division of Gastrointestinal Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Lauren M Theiss
- Division of Gastrointestinal Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Robert H Hollis
- Division of Gastrointestinal Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Sara J Knight
- Division of Preventative Medicine, University of Utah, Salt Lake City, Utah
| | - Terry C Davis
- Departments of Medicine and Pediatrics, Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - Mona Fouad
- Division of Preventative Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Daniel I Chu
- Division of Gastrointestinal Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
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Huelat B, Pochron ST. Stress in the Volunteer Caregiver: Human-Centric Technology Can Support Both Caregivers and People with Dementia. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:E257. [PMID: 32466618 PMCID: PMC7353905 DOI: 10.3390/medicina56060257] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/22/2020] [Accepted: 05/22/2020] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Currently, one in eight people over the age of 65 have dementia, and approximately 75% of caregiving is provided by volunteer family members with little or no training. This study aimed to quantify points of stress for home-based caregivers with the aim of reducing stress for them while concurrently supporting quality of life for the people with dementia whom they cared for. The overreaching purpose was to increase our knowledge of the caregiver stress burden and explore potential technologies and behaviors to ease it. Materials and Methods: We interviewed home-based and professional caregivers regarding causes of emotional and physical stress and methods they used to alleviate it. Results: This study found that: (1) dementia symptoms created a burden of stress for home-based caregivers primarily in the areas of medication management, memory loss, hygiene care and disruptive behaviors; (2) home-based caregivers identified "finding available resources" as the most important source of stress relief; (3) a minority of home-based caregivers possessed a resource network and knew how to find resources but all professional caregivers were able to find resources and support; (4) home-based caregivers combated dementia symptoms with positive distractions and human touch with little use of technology, since it was mostly unknown; and 5) facility-based caregivers were knowledgeable and readily used dementia-based technology. Conclusion: Since professional caregivers have access to technological resources that our home-based caregivers lack, one might logically conclude that we should transfer technology used by professionals to those with dementia. However, great caution needs to be in place before we take that step. Successful technology should address the human experience as home-based caregivers try to use new technologies. Human-centric technology addresses the needs of both people with dementia and the home-based caregiver.
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Affiliation(s)
| | - Sharon T. Pochron
- Sustainability Studies Program, School of Marine and Atmospheric Sciences, Stony Brook University, Stony Brook, NY 11794-3352, USA;
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Ahmed S, Djurkovic A, Manalili K, Sahota B, Santana MJ. A qualitative study on measuring patient-centered care: Perspectives from clinician-scientists and quality improvement experts. Health Sci Rep 2019; 2:e140. [PMID: 31890898 PMCID: PMC6920695 DOI: 10.1002/hsr2.140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 09/18/2019] [Accepted: 09/27/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND AND AIMS Patient-centered care (PCC) benefits patients, health-care providers, and health-care systems by providing delivery of care that addresses patient values and needs while improving provider experiences, and by decreasing health-care expenditure. To improve PCC, health-care systems need to measure it. Recently, we developed a PCC framework that is evidence based and patient informed. The purpose of this study was to gather the perspective of clinician-scientists and quality improvement experts regarding the PCC domains included in the framework. Their perspectives were used to refine these domains, which ultimately will inform the development of PCC quality indicators. METHODS Participants were recruited via expert and snowball sampling. Semi-structured interviews were conducted with clinician-scientists and quality improvement experts from Canada, the United States, and the United Kingdom from October 2017 to January 2018. With the use of an interview guide developed using the PCC framework, interviews were audio recorded and transcribed for a thematic analysis using NVivo qualitative data analysis software. Inductive thematic analysis was used to identify themes and subthemes. RESULTS Sixteen semi-structured interviews were conducted, which included four clinician-scientists and 12 quality improvement experts. Twelve of the participants were from Canada, three from the United Kingdom, and one from the United States. From the thematic analysis, three major themes were identified: (a) measurability of PCC, (b) practical considerations for implementing measurement, and (c) policy and practice implications. Participants discussed barriers and recommendations to improve and increase the clarity of the PCC domains in health system reporting, resulting in several future directions to refine and target specific PCC domains. CONCLUSION Clinician-scientists and quality improvement experts provided key recommendations for the measurement of PCC. The perspectives of key stakeholders in PCC measurement will inform strategies for the implementation and uptake of patient-centered quality indicators in health-care systems. The views of these key experts can lay the foundation for the development of standardized measures of PCC, to ensure monitoring and improvement of PCC.
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Affiliation(s)
- Sadia Ahmed
- Department of Community Health Sciences, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Andrea Djurkovic
- Department of Community Health Sciences, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Kimberly Manalili
- Department of Community Health Sciences, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Balreen Sahota
- Department of Community Health Sciences, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Department of Student Accessibility Services, Student and Enrolment ServicesUniversity of CalgaryCalgaryAlbertaCanada
| | - Maria J. Santana
- Department of Community Health Sciences, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Department of Paediatrics, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
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20
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Pirhonen L, Bolin K, Olofsson EH, Fors A, Ekman I, Swedberg K, Gyllensten H. Person-Centred Care in Patients with Acute Coronary Syndrome: Cost-Effectiveness Analysis Alongside a Randomised Controlled Trial. PHARMACOECONOMICS - OPEN 2019; 3:495-504. [PMID: 30825129 PMCID: PMC6861393 DOI: 10.1007/s41669-019-0126-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND Costs associated with an ACS incident are most pronounced in the acute phase but are also considerably long after the initial hospitalisation, partly due to considerable productivity losses, which constitute a substantial part of the economic burden of the disease. Studies suggest that person-centred care may improve health-related quality of life and reduce the costs associated with the disease. OBJECTIVE The aim of this study was to calculate the cost-effectiveness of a person-centred care intervention compared with usual care in patients with acute coronary syndrome (ACS), in a Swedish setting. METHODS Primary data from a randomised controlled trial of a person-centred intervention in patients with ACS was used. The person-centred intervention involved co-creation of a health plan between the patient and healthcare professionals, based on the patient's narrative. Thereafter, goals for the recovery period were set and followed-up continuously throughout the intervention. The clinical data, collected during the randomised controlled trial, was complemented with data from national health registers and the Swedish Social Insurance Agency. The study was conducted at two hospitals situated in a Swedish municipality. Patients were enrolled between June 2011 and February 2014 (192 patients were included in this study; 89 in the intervention group and 103 in the control group). Incremental cost-effectiveness ratios were calculated separately for the age groups < 65 years and ≥ 65 years in order to account for the age of retirement in Sweden. The cost-effectiveness ratios were calculated using health-related quality of life (EQ-5D) and costs associated with healthcare and pharmaceutical utilisation, and productivity losses. RESULTS Treatment effects and costs differed between those below and those above the age of 65 years. The base-case calculations showed that person-centred care was more effective and less costly compared with usual care for patients under 65 years of age, while usual care was more effective and less costly in the older age group. Probabilistic sensitivity analyses resulted in a 90% likelihood that person-centred care is cost-effective compared with usual care for patients with ACS under the age of 65 years. CONCLUSIONS Person-centred care was found to be cost-effective compared with usual care for patients with acute coronary syndrome under the age of 65 years. This clinical trial is registered at Researchweb (ID 65791).
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Affiliation(s)
- Laura Pirhonen
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30, Göteborg, Sweden.
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Göteborg, Sweden.
- Department of Economics, Centre for Health Economics (CHEGU), University of Gothenburg, Göteborg, Sweden.
| | - Kristian Bolin
- Department of Economics, Centre for Health Economics (CHEGU), University of Gothenburg, Göteborg, Sweden
| | - Elisabeth Hansson Olofsson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30, Göteborg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Göteborg, Sweden
| | - Andreas Fors
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30, Göteborg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Göteborg, Sweden
- Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Göteborg, Sweden
| | - Inger Ekman
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30, Göteborg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Göteborg, Sweden
| | - Karl Swedberg
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Göteborg, Sweden
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
- National Heart and Lung Institute, Imperial College, London, UK
| | - Hanna Gyllensten
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30, Göteborg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Göteborg, Sweden
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Liu W, Hao Y, Zhao X, Peng T, Song W, Xue Y, Tao S, Kang Z, Ning N, Gao L, Cui Y, Liang L, Wu Q. Gender differences on medical students' attitudes toward patient-centred care: a cross-sectional survey conducted in Heilongjiang, China. PeerJ 2019; 7:e7896. [PMID: 31660273 PMCID: PMC6815647 DOI: 10.7717/peerj.7896] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 09/16/2019] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES Assessing medical students' attitudes toward patient-centred care is essential to bettering medical education. Based on doctor-patient relationships and the medical system in China, it is important to explore the impact of gender differences and other background factors on patient-centred attitudes and to provide references for medical education reform. METHODS A cross-sectional study was conducted on fourth-year medical undergraduate students from November 2017 to March 2018 in Heilongjiang Province, Northeast China. The Chinese-revised Patient-Practitioner Orientation Scale (CR-PPOS), which has been validated in previous research, was used to measure the medical students' attitudes. The medical students' demographic data was collected, including their gender, age, information on whether they have siblings, family residence location, doctor(s) for parents, year in which the student first experienced clinical practice, and student category. RESULTS A total of 513 students (91.12%) completed the survey. The Chinese medical students scored considerably higher for 'Caring' (including patients' preferences into the decision-making process) than for 'Sharing' (sharing information/responsibility with patients). These students tended to have patient-centred attitudes, as measured by an average overall CR-PPOS score of 3.63 (scores higher than 3.5 indicate patient-centred attitudes), which is higher than Malian (3.38) and Pakistani (3.40) medical students but lower than American (4.57) and Brazilian (4.66) students. Female students (P < 0.05) were significantly associated with more patient-centred attitudes and with higher 'Sharing' and 'Caring' subscale scores. Student category (P < 0.05) was associated with 'Sharing' and 'Caring' scores. Clinical hospital students (P < 0.05) were associated with more patient-centred attitudes and with higher 'Sharing' and 'Caring' subscale scores, Students without siblings (p < 0.07) were associated with the higher 'Sharing' subscale scores. CONCLUSIONS In China, gender has a significant impact on medical students' patient-centred attitudes, which is similar to findings from other countries. If medical schools want to raise patient-centred attitudes across the board and bridge the gap between male and female patient-centred attitudes, gender, student category, and other factors should be incorporated into medical education.
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Affiliation(s)
- Wei Liu
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, China
| | - Yanhua Hao
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, China
| | - Xiaowen Zhao
- Department of Health Economics, School of Health Management, Harbin Medical University, Harbin, China
| | - Tao Peng
- Department of Sexual Health Education, School of Health Management, Harbin Medical University, Harbin, China
| | - Weijian Song
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, China
- Department of Humanities and Social Sciences, Harbin Medical University, Daqing, China
| | - Yuxin Xue
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, China
- Chengyang People’s Hospital, Qingdao, China
| | - Siyi Tao
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, China
| | - Zheng Kang
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, China
| | - Ning Ning
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, China
| | - Lijun Gao
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, China
| | - Yu Cui
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, China
| | - Libo Liang
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, China
| | - Qunhong Wu
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, China
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Schults J, Cooke M, Richards J, Theodoros J, Andresen E, Paterson R, Alcock M. mHealth Applications for Children and Young People With Persistent Pain: A Scoping Review. Clin Nurs Res 2018; 28:779-794. [PMID: 30126292 DOI: 10.1177/1054773818795078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Persistent pain is a global health care issue affecting more than 30% of children and young people. mHealth applications delivered using smartphones, are an innovative method to engage children in pain self-management. This article outlines the evidence concerning the development, implementation, and evaluation of mHealth apps for these children in terms of feasibility, acceptability, and impact on important pain outcomes such as quality of life and health care utilization.
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Affiliation(s)
- Jessica Schults
- 1 Department of Anaesthesia and Pain Management, Lady Cilento Children's Hospital, Queensland, Australia
- 2 Menzies Health Queensland, Griffith University, Queensland, Australia
| | - Marie Cooke
- 2 Menzies Health Queensland, Griffith University, Queensland, Australia
| | - Julianne Richards
- 1 Department of Anaesthesia and Pain Management, Lady Cilento Children's Hospital, Queensland, Australia
| | - Joanne Theodoros
- 1 Department of Anaesthesia and Pain Management, Lady Cilento Children's Hospital, Queensland, Australia
| | - Elizabeth Andresen
- 1 Department of Anaesthesia and Pain Management, Lady Cilento Children's Hospital, Queensland, Australia
| | - Rebecca Paterson
- 2 Menzies Health Queensland, Griffith University, Queensland, Australia
| | - Mark Alcock
- 1 Department of Anaesthesia and Pain Management, Lady Cilento Children's Hospital, Queensland, Australia
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Bachnick S, Ausserhofer D, Baernholdt M, Simon M. Patient-centered care, nurse work environment and implicit rationing of nursing care in Swiss acute care hospitals: A cross-sectional multi-center study. Int J Nurs Stud 2018; 81:98-106. [DOI: 10.1016/j.ijnurstu.2017.11.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 10/19/2017] [Accepted: 11/21/2017] [Indexed: 02/05/2023]
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Santana MJ, Manalili K, Jolley RJ, Zelinsky S, Quan H, Lu M. How to practice person-centred care: A conceptual framework. Health Expect 2018; 21:429-440. [PMID: 29151269 PMCID: PMC5867327 DOI: 10.1111/hex.12640] [Citation(s) in RCA: 407] [Impact Index Per Article: 67.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Globally, health-care systems and organizations are looking to improve health system performance through the implementation of a person-centred care (PCC) model. While numerous conceptual frameworks for PCC exist, a gap remains in practical guidance on PCC implementation. METHODS Based on a narrative review of the PCC literature, a generic conceptual framework was developed in collaboration with a patient partner, which synthesizes evidence, recommendations and best practice from existing frameworks and implementation case studies. The Donabedian model for health-care improvement was used to classify PCC domains into the categories of "Structure," "Process" and "Outcome" for health-care quality improvement. DISCUSSION The framework emphasizes the structural domain, which relates to the health-care system or context in which care is delivered, providing the foundation for PCC, and influencing the processes and outcomes of care. Structural domains identified include: the creation of a PCC culture across the continuum of care; co-designing educational programs, as well as health promotion and prevention programs with patients; providing a supportive and accommodating environment; and developing and integrating structures to support health information technology and to measure and monitor PCC performance. Process domains describe the importance of cultivating communication and respectful and compassionate care; engaging patients in managing their care; and integration of care. Outcome domains identified include: access to care and Patient-Reported Outcomes. CONCLUSION This conceptual framework provides a step-wise roadmap to guide health-care systems and organizations in the provision PCC across various health-care sectors.
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Affiliation(s)
- Maria J. Santana
- Department of Community Health SciencesCumming School of MedicineUniversity of CalgaryCalgaryABCanada
| | - Kimberly Manalili
- Department of Community Health SciencesCumming School of MedicineUniversity of CalgaryCalgaryABCanada
| | - Rachel J. Jolley
- Department of Community Health SciencesCumming School of MedicineUniversity of CalgaryCalgaryABCanada
| | - Sandra Zelinsky
- Patient PartnerStrategy for Patient‐oriented Research, Methods and Development PlatformAlbertaABCanada
| | - Hude Quan
- Department of Community Health SciencesCumming School of MedicineUniversity of CalgaryCalgaryABCanada
| | - Mingshan Lu
- Department of Community Health SciencesCumming School of MedicineUniversity of CalgaryCalgaryABCanada
- Department of EconomicsUniversity of CalgaryCalgaryABCanada
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Fradgley EA, Paul CL, Bryant J, Zucca A, Oldmeadow C. System-Wide and Group-Specific Health Service Improvements: Cross-Sectional Survey of Outpatient Improvement Preferences and Associations with Demographic Characteristics. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15020179. [PMID: 29360743 PMCID: PMC5858254 DOI: 10.3390/ijerph15020179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 12/16/2017] [Accepted: 01/17/2018] [Indexed: 11/16/2022]
Abstract
Efficient patient-centred quality improvement requires an understanding of the system-wide areas of dissatisfaction along with evidence to identify the programs which can be strategically targeted according to specific patient characteristics and preferences. This cross-sectional study reports the proportion of chronic disease outpatients selecting 23 patient-centred improvement initiatives. Using univariate tests and multivariable logistic regressions, this multi-site study also identifies initiatives differentially selected by outpatients according to clinical and demographic characteristics. A total of 475 outpatients participated (49% response). Commonly selected initiatives included: reducing wait-times (22.3%); convenient appointment scheduling (16.0%); and receiving up-to-date treatment information (16.0%). Within univariate tests, preferences for information and service accessibility initiatives were not significantly associated with specific subgroups. However, seven initiatives were preferred according to age, gender, diagnosis status, and chronic disease type within multivariate models. For example, neurology outpatients were more likely to select assistance to manage psychological symptoms when compared to oncology outpatients (OR: 2.89). Study findings suggest that system-wide programs to enhance information provision are strategic approaches to improve experiences across patient characteristics. Furthermore, a few initiatives can be targeted to specific groups and emphasized the importance of detailed scoping analyses and tailored implementation plans when designing patient-centred quality improvement programs.
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Affiliation(s)
- Elizabeth A Fradgley
- Priority Research Centre for Cancer Research, Innovation and Translation, University of Newcastle, Callaghan, NSW 2308, Australia.
- Priority Research Centre for Health Behaviour, Hunter Medical Research Institute, University of Newcastle, Callaghan, NSW 2308, Australia.
| | - Christine L Paul
- Priority Research Centre for Cancer Research, Innovation and Translation, University of Newcastle, Callaghan, NSW 2308, Australia.
- Priority Research Centre for Health Behaviour, Hunter Medical Research Institute, University of Newcastle, Callaghan, NSW 2308, Australia.
| | - Jamie Bryant
- Priority Research Centre for Health Behaviour, Hunter Medical Research Institute, University of Newcastle, Callaghan, NSW 2308, Australia.
- Health Behaviour Research Group, University of Newcastle, Callaghan, NSW 2308, Australia.
| | - Alison Zucca
- Priority Research Centre for Health Behaviour, Hunter Medical Research Institute, University of Newcastle, Callaghan, NSW 2308, Australia.
- Health Behaviour Research Group, University of Newcastle, Callaghan, NSW 2308, Australia.
| | - Christopher Oldmeadow
- Hunter Medical Research Institute, HMRI Building, University of Newcastle, Callaghan, NSW 2308, Australia.
- School of Mathematical and Physical Sciences, Faculty of Science and Information Technology, University of Newcastle, Callaghan, NSW 2308, Australia.
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Segan JD, Briggs AM, Chou L, Connelly KL, Seneviwickrama M, Sullivan K, Cicuttini FM, Wluka AE. Patient-perceived health service needs in inflammatory arthritis: A systematic scoping review. Semin Arthritis Rheum 2017; 47:765-777. [PMID: 29174791 DOI: 10.1016/j.semarthrit.2017.10.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Revised: 09/04/2017] [Accepted: 10/27/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Care that is patient-centred is more likely to be sustainable and associated with improved health outcomes. This approach to care requires an understanding of patients' health service needs, yet few studies have directly investigated the perceived health service needs of people with inflammatory arthritis. OBJECTIVES To systematically identify the existing literature relating to patient perceived health service needs for inflammatory arthritis. METHODS A systematic review of MEDLINE, EMBASE, CINAHL, and PsycINFO was conducted (1990-2016). Studies examining patients' perceived needs relating to health services for inflammatory arthritis were identified. Descriptive data regarding study design and methodology were extracted and risk of bias assessed. Findings were collated and categorized thematically. RESULTS In total, 27 of 1405 (16 qualitative, 9 quantitative, and 2 mixed-methods) studies were relevant. The main areas of perceived need related to (1) Communication: consumers wanted clear, empathic communication, and to be involved with decision-making. (2) Characteristics of ongoing care: adequate consultation length with continuity and timely care were valued. (3) Factors influencing care-seeking included individual attitudes, disease severity, finances and family expectations. (4) Allied health and complementary and alternative medicines (CAM) were perceived as useful by many. The reporting of CAM use to doctors was variable, with several factors contributing to under-reporting. CONCLUSIONS This review identified patients' perceived needs for better communication with their health providers, the heterogeneity of influences determining when care is sought and preferences regarding non-pharmacologic therapies. Aligning patients' perceived needs with evidence-based therapy for people with inflammatory arthritis will be important in optimizing patient outcomes.
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Affiliation(s)
- Julian D Segan
- Department of Epidemiology and Preventative Medicine, School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, Commercial Rd, Victoria 3004, Melbourne, Australia
| | - Andrew M Briggs
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia; MOVE: Muscle, Bone & Joint Health, Victoria, Australia
| | - Louisa Chou
- Department of Epidemiology and Preventative Medicine, School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, Commercial Rd, Victoria 3004, Melbourne, Australia
| | - Kathryn L Connelly
- Department of Epidemiology and Preventative Medicine, School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, Commercial Rd, Victoria 3004, Melbourne, Australia
| | - Maheeka Seneviwickrama
- Department of Epidemiology and Preventative Medicine, School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, Commercial Rd, Victoria 3004, Melbourne, Australia
| | - Kaye Sullivan
- Monash University Library, Monash University, Melbourne, Victoria, Australia
| | - Flavia M Cicuttini
- Department of Epidemiology and Preventative Medicine, School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, Commercial Rd, Victoria 3004, Melbourne, Australia
| | - Anita E Wluka
- Department of Epidemiology and Preventative Medicine, School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, Commercial Rd, Victoria 3004, Melbourne, Australia.
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Fregene T, Wintle S, Venkat Raman V, Edmond H, Rizvi S. Making the experience of elective surgery better. BMJ Open Qual 2017; 6:e000079. [PMID: 28959782 PMCID: PMC5574259 DOI: 10.1136/bmjoq-2017-000079] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 06/22/2017] [Indexed: 11/03/2022] Open
Abstract
Objective Patient experience is one of the three pillars of quality in healthcare; improving it must be a key aim if we are to make the overall quality of the healthcare we provide better. Methods We devised a quality improvement project to improve the patient experience of elective surgery. We conducted surveys of patients and assessed their experience by using semistructured interviews and patient questionnaires. We gathered data about their overall satisfaction, fasting times and their communication with staff. We used this information to inform strategies aimed at improving patient experience. Results Our initial results showed that patients who had their operations later in the day were significantly less likely to report a positive experience. We found the main reasons for this were long waiting times, poor communication and prolonged fasting. We implemented changes over 'Plan, Do, Study, Act' cycles, including (1) staggering patient arrival times, (2) introducing the concept of the 'Golden Patient', (3) having a single point of contact on the day surgery unit to communicate between theatre staff and patients, (4) using the WHO checklist to finalise list order, and (5) altering patient information letters to include the possibility of a wait on the day of surgery. Conclusion This project increased the percentage of patients reporting an 'Excellent' or 'Good' experience from 65% to 96%. In addition to improving our patients' experience, our project has also delivered shorter waiting times, better dissemination of information and fewer patients reporting hunger or thirst.
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Affiliation(s)
- Tajinere Fregene
- Royal Free Perioperative medicine and Anaesthesia Quality Group (RoFPAQ), Royal Free London NHS Foundation Trust, London, UK
| | - Sarah Wintle
- Anaesthesia, University College London Hospitals NHS Foundation Trust, London, UK
| | - Vishal Venkat Raman
- Royal Free Perioperative medicine and Anaesthesia Quality Group (RoFPAQ), Royal Free London NHS Foundation Trust, London, UK
| | - Holly Edmond
- Anaesthesia, Christchurch Hospital, Christchurch, New Zealand
| | - Shoaib Rizvi
- Royal Free Perioperative medicine and Anaesthesia Quality Group (RoFPAQ), Royal Free London NHS Foundation Trust, London, UK
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Dockens AL, Bellon-Harn ML, Manchaiah V. Preferences to Patient-Centeredness in Pre-Service Speech and Hearing Sciences Students: A Cross-Sectional Study. J Audiol Otol 2016; 20:73-9. [PMID: 27626079 PMCID: PMC5020576 DOI: 10.7874/jao.2016.20.2.73] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 04/04/2016] [Accepted: 05/04/2016] [Indexed: 12/14/2022] Open
Abstract
Background and Objectives Patient-centeredness is a critical approach to rehabilitation in allied health professions and is an imperative component of evidence-based practice. However, it is unknown if patient-centeredness is valued by students enrolled in allied health. This study was aimed at determining preferences to patient-centeredness in pre-service speech and hearing students in the field of speech and hearing sciences. Subjects and Methods Pre-service speech and hearing students (n=93) completed the Patient-Practitioner Orientation Scale (PPOS) and were grouped according to low, medium, or high exposure to curriculum content. Results Across exposure levels, students exhibited high preference to patient centeredness with a mean PPOS score of 4.13 (standard deviation–0.5). A pairedsample t-test revealed a significant difference (p≤0.0001) between the caring and sharing subscales of the PPOS with lower mean scores on the caring subscale. No significant differences were noted across levels of exposure for sharing subscale, caring subscale, or PPOS full-scale. Conclusions Results suggest a need for curriculum enhancement focused on improved caring and empathy.
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Affiliation(s)
- Ashley L Dockens
- Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX, USA
| | | | - Vinaya Manchaiah
- Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX, USA.; The Swedish Institute for Disability Research, Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.; Audiology India, Mysore, Karnataka, India
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Frampton SB, Guastello S, Lepore M. Compassion as the foundation of patient-centered care: the importance of compassion in action. J Comp Eff Res 2014; 2:443-55. [PMID: 24236742 DOI: 10.2217/cer.13.54] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The Institute of Medicine defines patient-centered care as "providing care that is respectful of, and responsive to, individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions." What is missing in this definition is an explicit emphasis on compassion. This perspective article draws on the experience of Planetree (CT, USA), a not-for-profit organization that partners with healthcare establishments to drive adoption of patient-centered care principles and practices by connecting healthcare professionals with the voices and perspectives of the patients and family members who utilize their services. Across hundreds of focus groups facilitated by Planetree, patients and their loved ones emphasize that paramount among their needs, preferences and values are compassionate human interactions. For care to be truly patient-centered, a foundation of compassion is essential. Reports from patients and the media, and research from healthcare systems around the world demonstrate the fallacy of assuming that compassion is a current or prevalent feature of the care experience. Concurrently, a growing evidence base highlights the supreme importance of compassion in driving high-quality, high-value care. However, good intentions are not sufficient for delivering compassionate care. Drawing on the experiences of exemplary patient-centered hospitals (recognized as such following a rigorous culture audit to determine fulfillment of the criteria for formal recognition as a Designated® Patient-Centered Hospital [Planetree]), this paper explores practical approaches for embedding compassion in healthcare delivery and organizational culture to meet patients' expressed desires for empathic and respectful human interactions.
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Time to embrace a new patient-centered care rallying cry: "why not?". PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2014; 7:231-3. [PMID: 24958465 DOI: 10.1007/s40271-014-0069-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Jonas WB, Chez RA, Smith K, Sakallaris B. Salutogenesis: the defining concept for a new healthcare system. Glob Adv Health Med 2014; 3:82-91. [PMID: 24944875 PMCID: PMC4045099 DOI: 10.7453/gahmj.2014.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Wayne B Jonas
- Samueli Institute, Alexandria, Virginia, United States
| | - Ronald A Chez
- Samueli Institute, Alexandria, Virginia, United States
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Abstract
The Culture of Caring model is an education-practice partnership built on a crosswalk of contemporary nursing concepts. It provides a framework and a bundle of strategies to create a transformed teaching-learning environment. Preliminary evaluation suggests that such a culture can strengthen student learning and support transition to practice for new graduate nurses.
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Lewis EH. A Culture Shift. Anesth Analg 2013; 116:1191-2. [DOI: 10.1213/ane.0b013e3182884484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Frintner MP, Mendoza FS, Dreyer BP, Cull WL, Laraque D. Resident cross-cultural training, satisfaction, and preparedness. Acad Pediatr 2013; 13:65-71. [PMID: 23312858 DOI: 10.1016/j.acap.2012.10.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2012] [Revised: 10/11/2012] [Accepted: 10/17/2012] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe the diversity of pediatric residents and examine relationships of cross-cultural training experiences with training satisfaction, perceived preparedness for providing culturally effective care, and attitudes surrounding care for underserved populations. METHODS A cross-sectional survey was conducted of a national random sample of graduating pediatric residents and an additional sample of minority residents. Using weighted analysis, we used multivariate regression to test for differences in satisfaction, preparedness, and attitudes between residents with more and less cross-cultural experiences during residency, controlling for residents' characteristics and experiences before training. RESULTS The survey response rate was 57%. Eleven percent were Hispanic, 61% white, 21% Asian, 9% African American, 9% other racial/ethnic groups; 34% grew up in a bi- or multilingual family. Ninety-three percent of residents were satisfied with their residency training, 81% with the instruction they received on health and health care disparities, and 54% on global health issues. Ninety-six percent of residents felt they were prepared to care for patients from diverse backgrounds, but fewer felt prepared to care for families with beliefs at odds with Western medicine (49%) and families who receive alternative or complementary care (37%). Residents with more cross-cultural experiences during residency reported being better prepared than those with less experience to care for families with limited English proficiency (adjusted odds ratio [aOR] 2.11; 95% confidence interval [CI] 1.40-3.17), new immigrants (aOR 1.91; 95% CI 1.32-2.75), and with religious beliefs that might affect clinical care (aOR 1.62; 95% CI 1.13-2.32). CONCLUSIONS Pediatric residents begin their training with diverse cross-cultural backgrounds and experiences. Residency experiences in cross-cultural care contribute to feelings of preparedness to care for diverse US children.
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Affiliation(s)
- Mary Pat Frintner
- Department of Research, American Academy of Pediatrics, Elk Grove Village, IL, USA
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Abstract
This article is a literature review of the definition, models and methods of implementation of patient-centred care (PCC). Modern healthcare systems are rapidly changing to adopt a more patient-centred approach to care. However, the implementation of PCC can be hampered by the lack of a clear definition and methods of measurement. It is increasingly important for healthcare providers to understand the core elements of PCC. This article examines the literature to carry out a concept analysis of PCC, including definition, concepts and theoretical perspectives.
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Affiliation(s)
- Rinchen Pelzang
- Jigme Dorji Wangchuk National Referral Hospital, Ministry of Health, Royal Government of Bhutan, Thimphu, Bhutan
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Abstract
The literature is replete with evidence about the effects of the work environment on nurses' stress levels, interdisciplinary collaboration, workload, job conflict, job satisfaction, and anticipated turnover. Healthcare leaders have been challenged by the American Association of Critical-Care Nurses (AACN), other professional organizations, and regulatory agencies to develop and sustain healthy work environments that support the professional practice of nursing. Magnet designation, the Beacon award, and other organizational structures and cultures led by authentic and transformational leaders have been the stimulus to ensure that workplaces are both healthy and healthful. The positive effect of healing environments on patient and provider outcomes has caused many healthcare leaders to strive to develop healing attributes within their philosophies of care and organizational cultural initiatives.
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