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Newton-Levinson A, Griffin K, Blake SC, Swartzendruber A, Kramer M, Sales JM. "I probably have access, but I can't afford it": expanding definitions of affordability in access to contraceptive services among people with low income in Georgia, USA. BMC Health Serv Res 2024; 24:709. [PMID: 38849826 PMCID: PMC11157915 DOI: 10.1186/s12913-024-11133-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 05/21/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Disparities in rates of contraceptive use are frequently attributed to unequal access to and affordability of care. There is a need to better understand whether common definitions of affordability that solely relate to cost or to insurance status capture the reality of individuals' lived experiences. We sought to better understand how individuals with low incomes and the capacity for pregnancy conceptualized one domain of contraceptive access-affordability --in terms of health system and individual access and how both shaped contraceptive care-seeking in the US South. METHOD Between January 2019 to February 2020, we conducted twenty-five life-history interviews with low-income individuals who may become pregnant living in suburban counties in Georgia, USA. Interviews covered the ways individual and health system access factors influenced care-seeking for family planning over the life course. Interview transcripts were analyzed using a thematic analysis approach to identify experiences associated with individual and health system access. RESULTS Affordability was identified as a major determinant of access, one tied to unique combinations of individual factors (e.g., financial status) and health system characteristics (e.g., cost of methods) that fluctuated over time. Navigating the process to attain affordable care was unpredictable and had important implications for care-seeking. A "poor fit" between individual and health system factors could lead to inequities in access and gaps in, or non-use of contraception. Participants also reported high levels of shame and stigma associated with being uninsured or on publicly funded insurance. CONCLUSIONS Affordability is one domain of contraceptive access that is shaped by the interplay between individual factors and health system characteristics as well as by larger structural factors such as health and economic policies that influence both. Assessments of the affordability of contraceptive care must account for the dynamic interplay among multilevel influences. Despite the expansion of contraceptive coverage through the Affordable Care Act, low-income individuals still struggle with affordability and disparities persist.
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Affiliation(s)
- Anna Newton-Levinson
- Department of Behavioral, Social and Health Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, USA.
- Department of Gynecology and Obstetrics, Emory School of Medicine, 201 Dowman Dr, Atlanta, GA, 30307, USA.
| | - Kelsey Griffin
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, USA
| | - Sarah C- Blake
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, USA
| | - Andrea Swartzendruber
- Department of Epidemiology and Biostatistics, College of Public Health, The University of Georgia, 101 Buck Rd, Athens, GA, 30606, USA
| | - Michael Kramer
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, USA
| | - Jessica M- Sales
- Department of Behavioral, Social and Health Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, USA
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Hoehns JD, Witry M, McDonald M, Kadura S, O'Brien E, Nichols R, Greenwood J, Snyder J, Chavez R, Froyum-Roise A. Community Pharmacist and Family Medicine Collaboration for Pre-Visit Planning for Shared Patients Receiving Chronic Care Management Services. J Pharm Pract 2024; 37:571-577. [PMID: 36592033 DOI: 10.1177/08971900221148042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: Pre-visit planning entails completing necessary tasks prior to clinic appointments. Community pharmacists (CPs) have unique knowledge about patients' medication use but do not routinely provide drug therapy reviews before clinic visits. Objectives: (1) Create and implement a business partnership between a CP and family medicine clinic (FMC) for CP provision of pre-visit medication reviews, and (2) describe the billing experience for shared patients in the FMC chronic care management (CCM) program. Methods: A prospective 8-month study in one community pharmacy and FMC in Iowa. Eligible patients were enrolled in the clinic CCM program and received their prescriptions at the CP. CPs were granted access to the clinic electronic health record (EHR), performed medication reviews, and recorded drug therapy recommendations (DTRs) in the clinic EHR. FMC physicians reviewed CP DTRs before the patient encounter. Time tracking software in the EHR recorded CP and FMC time performing CCM services. CCM revenue was prorated between parties. FMC physicians completed a survey about their experience. Results: Overall, there were 129 CP reviews performed for 95 patients. These reviews resulted in 169 DTRs and 76% were accepted by the physician. There were 71 CCM claims billed and CCM revenue was $3596 ($1796 FMC, $1800 CP). More than 90% of physicians (N = 11) indicated they reviewed CP DTRs before the patient encounter and agreed they were helpful to their practice. Conclusion: CPs completed pre-visit medication reviews and made accepted medication therapy recommendations. CCM billing provided a mechanism for CPs to receive revenue for their services.
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Affiliation(s)
- James D Hoehns
- University of Iowa College of Pharmacy, Iowa City, IA, USA
- MercyOne Northeast Iowa Family Medicine Residency & Research, Waterloo, IA, USA
| | - Matthew Witry
- University of Iowa College of Pharmacy, Iowa City, IA, USA
| | - Madison McDonald
- AdventHealth East Orlando, Orlando, FL, USA
- Greenwood Pharmacy, Waterloo, IA, USA
| | - Sarah Kadura
- University of Iowa Hospital & Clinics, Iowa City, IA, USA
- Northeast Iowa Family Medicine Residency, Waterloo, IA, USA
| | - Emily O'Brien
- Northeast Iowa Family Medicine Residency, Waterloo, IA, USA
- UCHealth-Northern Colorado, Fort Collins, CO, USA
| | | | | | - Jamie Snyder
- Northeast Iowa Family Medicine Residency, Waterloo, IA, USA
- UnityPoint Central Iowa Residency Program-Waterloo Track, Prairie Parkway Residency Clinic, Cedar Falls, IA, USA
| | - Raemi Chavez
- University of Iowa College of Pharmacy, Iowa City, IA, USA
- Hy-Vee Pharmacy (1825), Vinton, IA, USA
| | - Adam Froyum-Roise
- Northeast Iowa Family Medicine Residency, Waterloo, IA, USA
- UnityPoint Central Iowa Residency Program-Waterloo Track, Prairie Parkway Residency Clinic, Cedar Falls, IA, USA
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Mann EA, Alexander K, Beaton W, Roe EB, Grant A, Shadman KA. Screening for Nephropathy in Pediatric Type 2 Diabetes: Quality Improvement to Increase Nephropathy Screening. Pediatr Qual Saf 2024; 9:e734. [PMID: 38807582 PMCID: PMC11132389 DOI: 10.1097/pq9.0000000000000734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 04/17/2024] [Indexed: 05/30/2024] Open
Abstract
Background Screening for early detection of microalbuminuria signaling kidney disease should begin as early as the time of diagnosis of youth-onset type 2 diabetes. This quality improvement initiative aimed to standardize urine nephropathy screening in pediatric patients with type 2 diabetes at a tertiary academic medical center and increase a baseline screening rate of 56%-75% over 6 months (September 2022-February 2023) and sustain that increase for 6 months (March through August 2023). Methods A multi-disciplinary team used quality improvement methods and iterative Plan-Do-Study-Act cycles. Targeted interventions included previsit planning workflow, education, and a new-onset triage protocol. The team collected data at baseline and prospectively by reviewing electronic medical records. The primary outcome measure was pediatric type 2 diabetes clinic visits in diabetes clinic with urine nephropathy screening before or on the visit date. Results A total of 121 youth were scheduled for T2D clinic visits between September 2021 and August 2023. The mean age was 14.5 years, and 60% were women, 40% were non-Hispanic Black, 28% were Hispanic/Latino, and 15% reported Spanish as their preferred language. Following the interventions of this project, urine nephropathy screening increased from 56% to 75%, and this change was sustained for 6 months. Conclusions Interventions focused on efficient recognition of the population needing screening, coordinated internal processes around screening, a shared understanding between all stakeholders, and practical support in the healthcare system increased urine nephropathy screening with sustained improvement.
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Affiliation(s)
- Elizabeth A. Mann
- From the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisc
| | - Kelsi Alexander
- From the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisc
| | | | | | - Amy Grant
- Cincinnati Children’s Hospital Medical Center, James M. Anderson Center for Health Systems Excellence
| | - Kristin A. Shadman
- From the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisc
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Abtahi H, Khoshnam-Rad N, Gholamzadeh M, Daraie M, Sabouri F. Conceptual framework for establishing twins prevention and continuous health promotion programme: a qualitative study. BMJ Open 2024; 14:e080443. [PMID: 38604635 PMCID: PMC11015185 DOI: 10.1136/bmjopen-2023-080443] [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: 10/02/2023] [Accepted: 04/02/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Twin registries and cohorts face numerous challenges, including significant resource allocation, twins' recruitment and retention. This study aimed to assess expert feedback on a proposed pragmatic idea for launching a continuous health promotion and prevention programme (HPPP) to establish and maintain twin cohorts. DESIGN A qualitative study incorporating an inductive thematic analysis. SETTING Tehran University of Medical Sciences. PARTICIPANTS Researchers with expertise in twin studies participated in our study. ANALYSIS AND DESIGN Expert opinions were gathered through focus group discussions (FGDs). Thematic analysis was employed to analyse the findings and develop a model for designing a comprehensive, long-term health promotion programme using ATLAS.ti software. Additionally, a standardised framework was developed to represent the conceptual model of the twin HPPP. RESULTS Eight FGDs were conducted, involving 16 experts. Thematic analysis identified eight themes and seven subthemes that encompassed the critical aspects of a continuous monitoring programme for twin health. Based on these identified themes, a conceptual framework was developed for the implementation of an HPPP tailored for twins. CONCLUSION This study presented the initial endeavour to establish a comprehensive and practical solution in the form of a continuous HPPP designed to tackle the obstacles of twins' cohorts.
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Affiliation(s)
- Hamidreza Abtahi
- Pulmonary and Critical Care Medicine Department, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
- Thoracic Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Tehran, Iran (the Islamic Republic of)
| | - Niloofar Khoshnam-Rad
- Thoracic Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Tehran, Iran (the Islamic Republic of)
| | - Marsa Gholamzadeh
- Health Information Management and Medical Informatics Department, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Morteza Daraie
- Department of Internal Medicine, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Fatemeh Sabouri
- Thoracic Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Tehran, Iran (the Islamic Republic of)
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Montejano RD, Chattopadhyay A, Woodruff CM, Botto N. Patient-Centered Communication Tools for the Patch Test Clinic. Dermatitis 2023; 34:392-398. [PMID: 36917543 DOI: 10.1089/derm.2022.0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Patient-centered communication positively impacts the clinical encounter. Multiple strategies exist to improve communication between providers and their patients; the application and impact of these strategies have been studied in multiple specialties, though little exists regarding communication best practices in the patch test clinic. Because the procedural components of patch testing often span the course of an entire week, effective communication with patients during the patch testing visit is important for not only technical success, but also patient understanding and experience. In this study, we highlight the value of beginning the patch testing visit with clear introductions and agenda setting, improving patient understanding and engagement through methods such as teach backs and cycles of questions and answers that create patient-provider dialogue, and using communication techniques to make expressions of empathy. We provide detailed examples regarding the application of these techniques to the patch testing process, aimed at enhancing the patch testing experience and improving clinical outcomes. Our review exemplifies how dermatologists can leverage communication tools to improve patient satisfaction and outcomes during patch testing.
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Affiliation(s)
- Rubi Danielle Montejano
- From the *Department of Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Aheli Chattopadhyay
- Department of Dermatology, University of San Francisco, San Francisco, California, USA
| | | | - Nina Botto
- Department of Dermatology, University of San Francisco, San Francisco, California, USA
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Dhanani S, Ramlakhan JU, Berta WB, Gagliardi AR. Optimizing the design and implementation of question prompt lists to support person-centred care: A scoping review. Health Expect 2023; 26:1404-1417. [PMID: 37227115 PMCID: PMC10349246 DOI: 10.1111/hex.13783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/13/2023] [Accepted: 05/15/2023] [Indexed: 05/26/2023] Open
Abstract
INTRODUCTION Question prompt lists (QPLs) are lists of questions that patients may want to discuss with clinicians. QPLs support person-centred care and have been associated with many beneficial outcomes including improved patient question-asking, and the amount and quality of the information provided by clinicians. The purpose of this study was to review published research on QPLs to explore how QPL design and implementation can be optimized. METHODS We performed a scoping review by searching MEDLINE, EMBASE, Scopus, CINAHL, Cochrane Library and Joanna Briggs Database from inception to 8 May 2022, for English language studies of any design that evaluated QPLs. We used summary statistics and text to report study characteristics, and QPL design and implementation. RESULTS We included 57 studies published from 1988 to 2022 by authors in 12 countries on a range of clinical topics. Of those, 56% provided the QPL, but few described how QPLs were developed. The number of questions varied widely (range 9-191). Most QPLs were single-page handouts (44%) but others ranged from 2 to 33 pages. Most studies implemented a QPL alone with no other accompanying strategy; most often in a print format before consultations by mail (18%) or in the waiting room (66%). Both patients and clinicians identified numerous benefits to patients of QPLs (e.g., increased patient confidence to ask questions, and patient satisfaction with communication or care received; and reduced anxiety about health status or treatment). To support use, patients desired access to QPLs in advance of clinician visits, and clinicians desired information/training on how to use the QPL and answer questions. Most (88%) studies reported at least one beneficial impact of QPLs. This was true even for single-page QPLs with few questions unaccompanied by other implementation strategies. Despite favourable views of QPLs, few studies assessed outcomes amongst clinicians. CONCLUSION This review identified QPL characteristics and implementation strategies that may be associated with beneficial outcomes. Future research should confirm these findings via systematic review and explore the benefits of QPLs from the clinician's perspective. PATIENT/PUBLIC CONTRIBUTION Following this review, we used the findings to develop a QPL on hypertensive disorders of pregnancy and interviewed women and clinicians about QPL design including content, format, enablers and barriers of use, and potential outcomes including beneficial impacts and possible harms (will be published elsewhere).
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Affiliation(s)
- Shazia Dhanani
- Toronto General Hospital Research InstituteUniversity Health NetworkTorontoCanada
| | - Jessica U. Ramlakhan
- Toronto General Hospital Research InstituteUniversity Health NetworkTorontoCanada
| | - Whitney B. Berta
- Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoCanada
| | - Anna R. Gagliardi
- Toronto General Hospital Research InstituteUniversity Health NetworkTorontoCanada
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Gholamzadeh M, Safdari R, Amini S, Abtahi H. Feasibility study and determination of prerequisites of telecare programme to enhance patient management in lung transplantation: a qualitative study from the perspective of Iranian healthcare providers. BMJ Open 2023; 13:e073370. [PMID: 37349094 PMCID: PMC10314650 DOI: 10.1136/bmjopen-2023-073370] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 06/02/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Non-adherence to treatment plans, follow-up visits and healthcare advice is a common obstacle in the management of lung transplant patients. This study aims to investigate experts' views on the needs and main aspects of telecare programmes for lung transplantation. DESIGN A qualitative study incorporating an inductive thematic analysis. SETTING Lung transplant clinic and thoracic research centre. PARTICIPANTS Clinicians: four pulmonologists, two cardiothoracic surgeons, two general physicians, two pharmacotherapists, one cardiologist, one nurse and one medical informatician. METHOD This study adopted a focus group discussion technique to gather experts' opinions on the prerequisites and features of a telecare programme in lung transplantation. All interviews were coded and combined into main categories and themes. Thematic analysis was performed to extract the key concepts using ATLAS.Ti. Ultimately, all extracted themes were integrated to devise a conceptual model. RESULTS Ten focus groups with 13 participants were conducted. Forty-six themes and subthemes were extracted through the thematic analysis. The main features of the final programme were extracted from expert opinions through thematic analysis, such as continuous monitoring of symptoms, drug management, providing a specific care plan for each patient, educating patients module, creating an electronic medical record to collect patient information, equipping the system with decision support tools, smart electronic prescription and the ability to send messages to the care team. The prerequisites of the system were summarised in self-care activities, clinician's tasks and required technologies. In addition, the barriers and benefits of using a telecare system to enhance the quality of care were determined. CONCLUSION Our investigation recognised the main factors that must be considered to design a telecare programme to provide ideal continuous care for lung transplant patients. Users should further explore the proposed model to support the development of telecare interventions at the point of care.
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Affiliation(s)
- Marsa Gholamzadeh
- Health Information Management and Medical Informatics Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Safdari
- Health Information Management and Medical Informatics Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahideh Amini
- Clinical Pharmacy Department, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Abtahi
- Pulmonary and Critical Care Medicine Department, Tehran University of Medical Sciences, Tehran, Iran
- Thoracic Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
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Wiener AA, Neuman HB. Improving shared decision making in virtual breast cancer surgery consultations. Am J Surg 2023; 225:645-649. [PMID: 38577977 PMCID: PMC9579141 DOI: 10.1016/j.amjsurg.2022.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/06/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022]
Abstract
With the COVID19 pandemic, use of telehealth has expanded rapidly in subspecialties with limited prior telehealth experience. While telehealth offers many opportunities to improve patient convenience, access, and comfort, the virtual platform poses unique challenges for shared decision making. In this review article, we describe what occurs within a standard in-person breast surgery consult and propose a model for an ideal virtual breast surgery consult, including strategies to foster patient engagement and shared decision making. Our model incorporates pre-visit preparation, deliberate pauses, and targeted engagement as ways to encourage patients to integrate information and actively participate in treatment decisions. Intentional strategies such as these must be adopted to improve shared decision making on the virtual platform.
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Affiliation(s)
- Alyssa A Wiener
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Heather B Neuman
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; University of Wisconsin Carbone Cancer Center, Madison, WI, USA.
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Abtahi H, Safdari R, Gholamzadeh M. Pragmatic solutions to enhance self-management skills in solid organ transplant patients: systematic review and thematic analysis. BMC PRIMARY CARE 2022; 23:166. [PMID: 35773642 PMCID: PMC9247970 DOI: 10.1186/s12875-022-01766-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 06/06/2022] [Indexed: 02/07/2023]
Abstract
Background In organ transplantation, all patients must follow a complex treatment regimen for the rest of their lives. Hence, patients play an active role in the continuity of the care process in the form of self-management tasks. Thus, the main objective of our study was to investigate the pragmatic solutions applied by different studies to enhance adherence to self-management behaviors. Method A systematic review was conducted in five databases from 2010 to August 2021 using keywords. Eligible studies were all English papers that developed self-management programs to enhance patient care in solid organ transplantation. The interventions were analyzed using thematic analysis to determine the main descriptive areas. The quality of the included articles was evaluated using the research critical appraisal program (CASP) tool. Results Of the 691 retrieved articles, 40 met our inclusion criteria. Of these, 32 studies were devoted to the post-transplantation phase. Five main areas were determined (e-health programs for telemonitoring, non-electronic educational programs, non-electronic home-based symptom-monitoring programs, electronic educational plans for self-monitoring, and Telerehabilitation) according to thematic analysis. Most studies (72.5%) declared that developed programs and applied solutions had a statistically significant positive impact on self-management behavior enhancement in transplant patients. Conclusion The results showed that an effective solution for improving organ transplantation needs patient collaboration to address psychological, social, and clinical aspects of patient care. Such programs can be applied during candidate selection, waiting list, and after transplantation by putting the patient at the center of care. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01766-z.
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Affiliation(s)
- Hamidreza Abtahi
- Pulmonary and Critical care Medicine Department, Thoracic Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Safdari
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Marsa Gholamzadeh
- Ph.D. Candidate in Medical Informatics, Health Information Management Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, Fardanesh Alley, 5th FloorQods Ave, Tehran, Iran.
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