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Chantaphakul H, Wang DY, Hang TTT, Kadir KA, Lam HT, Navarro-Locsin CG, Nanthapisal S, Poblete D, Tantilipikorn P, Tong WH, Nagrale D, Lucas M. Promoting patient-centred care in the management of allergic rhinitis in Asia-Pacific countries. World Allergy Organ J 2024; 17:100952. [PMID: 39262901 PMCID: PMC11388691 DOI: 10.1016/j.waojou.2024.100952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 07/17/2024] [Accepted: 07/30/2024] [Indexed: 09/13/2024] Open
Abstract
Background Allergic rhinitis (AR) has a high burden of disease in the Asia-Pacific region (APAC). Although guidelines provide recommendations regarding the diagnosis and treatment of AR, it is increasingly being recognised that there are gaps in their implementation. Patient-centred care involves accounting for the specific needs and desires of patients as well as including the patient in the decision-making process, and this may provide a means to reduce these gaps and consequently the burden of AR. Methods A group of 11 experts in immunology and otorhinolaryngology from APAC provided information regarding their practices and experiences in the management of AR through an online survey. The group then discussed the barriers and solutions for the implementation of patient-centred care across the patient journey in a face-to-face meeting. Results Key barriers to the implementation of patient-centred care for AR in APAC included a lack of patient awareness of the condition and treatment options, low adherence to treatments, financial constraints for patients, and time constraints for physicians. The solutions proposed include improving the knowledge of the patients about their conditions, the use of shared decision-making, the consideration of patient characteristics when choosing treatments, and the use of outcome measures to aid the optimisation of patient care. We provide specific recommendations for clinical practice. Conclusion A greater focus on patient-centred approaches has the potential to improve the management of AR in APAC. More emphasis should be placed on each patient's specific health needs and desired outcomes.
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Affiliation(s)
- Hiroshi Chantaphakul
- Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - De Yun Wang
- Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | | | - Hoang Thi Lam
- Unit of Allergy and Clinical Immunology, University Medical Center, Ho Chi Minh City, Viet Nam
| | | | - Sira Nanthapisal
- Division of Allergy, Immunology, and Rheumatology, Thammasat University, Pathumthani, Thailand
| | | | - Pongsakorn Tantilipikorn
- Center of Research Excellence in Allergy & Immunology, Faculty of Medicine, Siriraj Hospital, Thailand
| | | | | | - Michaela Lucas
- Department of Immunology, QE Medical Centre, Sir Charles Gairdner Hospital, Perth Children's Hospital, University of Western Australia, Perth, Australia
- Medical School, University of Western Australia, Perth, Australia
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2
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Liptzin DR, Neemann K, McCulloh R, Singleton R, Smith P, Carlson JC. Controversies in Antibiotic Use for Chronic Wet Cough in Children. J Pediatr 2024; 264:113762. [PMID: 37778412 PMCID: PMC11216076 DOI: 10.1016/j.jpeds.2023.113762] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/31/2023] [Accepted: 09/25/2023] [Indexed: 10/03/2023]
Affiliation(s)
- Deborah R Liptzin
- University of Montana School of Public and Community Health Sciences, Missoula, MT; Department of Pediatrics, University of Washington School of Medicine, Seattle, WA.
| | - Kari Neemann
- Department of Pediatrics, University of Nebraska Medical Center College of Medicine, Omaha, NE
| | - Russell McCulloh
- Department of Pediatrics, University of Nebraska Medical Center College of Medicine, Omaha, NE
| | | | - Paul Smith
- University of Montana School of Public and Community Health Sciences, Missoula, MT
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3
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Böhme Kristensen C, Asimakopoulou K, Scambler S. Enhancing patient-centred care in dentistry: a narrative review. Br Med Bull 2023; 148:79-88. [PMID: 37838360 PMCID: PMC10724466 DOI: 10.1093/bmb/ldad026] [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: 06/22/2023] [Revised: 09/07/2023] [Accepted: 09/19/2023] [Indexed: 10/16/2023]
Abstract
INTRODUCTION Patient-centred care (PCC) is widely used within the medical setting, but there is a need for more research on PCC implementation in dentistry. SOURCES OF DATA A narrative review was conducted with literature identified from the Ovid Interface, including several databases such as Embase and Medline. AREAS OF AGREEMENT PCC is associated with better health outcomes for patients, and greater work satisfaction among healthcare professionals. AREAS OF CONTROVERSY Efforts to implement PCC in dentistry are lacking due to several issues including non-consensus about PCC definition and lack of explicit guidelines on how to implement PCC in dentistry. GROWING POINTS AND AREAS TIMELY FOR DEVELOPING RESEARCH A theory-derived model of PCC explicitly designed for the dental setting was identified. This serves as a starting point to enhance PCC in dentistry, though further research is needed to empirically test the implementation of this model.
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Affiliation(s)
- Camilla Böhme Kristensen
- Faculty of Dentistry Oral & Craniofacial Sciences, Centre for Host-Microbiome Interactions, King’s College London, London SE1 9RW, UK
| | - Koula Asimakopoulou
- Visiting Professor of Health Psychology, Faculty of Dentistry Oral & Craniofacial Sciences, Centre for Host-Microbiome Interactions, King's College London, London SE1 9RW, UK
| | - Sasha Scambler
- Faculty of Dentistry Oral & Craniofacial Sciences, Centre for Host-Microbiome Interactions, King’s College London, London SE1 9RW, UK
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4
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He YZ, Liao PC, Chang YT. Enhancing patient-centred care in Taiwan's dental education system: Exploring the feasibility of doctor-patient communication education and training. J Dent Sci 2023; 18:1830-1837. [PMID: 37799875 PMCID: PMC10548035 DOI: 10.1016/j.jds.2023.07.006] [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: 05/27/2023] [Revised: 07/02/2023] [Indexed: 10/07/2023] Open
Abstract
Background/purpose Improved communication can optimize treatment outcomes and patient satisfaction. Findings emphasize the need for tailored communication strategies based on patient characteristics. Implementing communication courses can enhance patient-centered care and reduce conflicts. Therefore, this study examined the feasibility of integrating doctor-patient communication education in Taiwan's dental education system. Materials and methods Using interviews and questionnaires, we conducted descriptive statistics and generalized linear mixed-effects model analysis on the importance of doctor-patient communication from the dentist and patient perspectives. Results More than 600 patient surveys and four interviewed dentists with 20+ years of experience stressed doctor-patient communication in dentistry. Patients' age and income were positively related to the emphasis on physician-patient communication but negatively associated with dental assistants' communication. Dentists valued communication education but differed in its execution and importance. Conclusion It is recommended to initiate dentist-patient communication education during university studies and continue its practice to adapt to the changing societal dynamics. Individuals with higher socioeconomic status and older age show a greater appreciation for dentist-patient communication, potentially driven by self-promotion, thereby highlighting the diverse nature of doctor-patient relationships. Based on our findings, we suggest to implement the doctor-patient communication courses in Taiwan.
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Affiliation(s)
- Yi-Zhou He
- School of Life Science, National Taiwan Normal University, Taipei, Taiwan
| | - Pei-Chun Liao
- School of Life Science, National Taiwan Normal University, Taipei, Taiwan
| | - Yung-Ta Chang
- School of Life Science, National Taiwan Normal University, Taipei, Taiwan
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5
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Bosnic-Anticevich S, Bender BG, Shuler MT, Hess M, Kocks JWH. Recognizing and Tackling Inhaler Technique Decay in Asthma and Chronic Obstructive Pulmonary Disesase (COPD) Clinical Practice. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:2355-2364.e5. [PMID: 37146881 DOI: 10.1016/j.jaip.2023.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 02/22/2023] [Accepted: 04/11/2023] [Indexed: 05/07/2023]
Abstract
A poor inhaler technique continues to represent a substantial barrier to effective asthma and chronic obstructive pulmonary disease management. It can result in perceived lack of treatment effectiveness even with apparent adherence to a prescribed regimen of inhaled maintenance therapies, potentially resulting in an unnecessary change or escalation of treatment. Many patients are not trained to inhaler mastery in real-world practice; furthermore, even where mastery is initially achieved, an ongoing assessment and education are seldom maintained. In this review, we present an overview of the evidence for deterioration of the inhaler technique over time after training, investigate the factors that contribute to this deterioration, and explore innovative approaches to addressing the problem. We also propose steps forward drawn from the literature and our clinical insights.
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Affiliation(s)
| | - Bruce G Bender
- Department of Pediatrics, National Jewish Health, Denver, Colo
| | - Melinda T Shuler
- Quality Mangement, Eastern Band of Cherokee Indian, Tribal Option, Cherokee, NC
| | - Mike Hess
- Patient Outreach and Education, COPD Foundation, Miami, Fla
| | - Janwillem W H Kocks
- General Practitioners Research Institute, Groningen, the Netherlands; Observational and Pragmatic Research Institute, Singapore; Groningen Research Institute Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Department of Pulmonology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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6
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Mills I, Scambler S, Neville P, Asimakopoulou K. Developing a person-centred approach in dentistry beyond NHS recall intervals: a commentary. Br Dent J 2023; 235:24-28. [PMID: 37443223 DOI: 10.1038/s41415-023-6009-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 02/12/2023] [Accepted: 02/23/2023] [Indexed: 07/15/2023]
Abstract
Person-centred care (PCC) is acknowledged as a fundamental dimension of quality within health care and provides significant benefits for patients and clinicians. Models of PCC have primarily been developed from the medical literature, with limited consideration of their application within dentistry. The Personalised Care Institute was established to deliver education and training on PCC and is working with the Office of the Chief Dental Officer for England to develop resources on shared decision-making (SDM) to promote tailored recall intervals.This paper seeks to promote the value of PCC and SDM in delivering high-quality care but cautions against the use of generic models or training in view of the potential differences which may exist within dentistry, particularly general dental practice. The authors highlight the need to develop materials and training which are appropriate, contextualised and relevant to dentistry. The capacity and desire to deliver PCC is strongly influenced by the healthcare system which is in operation. The current units of dental activity (UDA) system operating in England would appear to act as a barrier to the delivery of PCC. Unless significant and rapid changes are introduced to the NHS Contract, UDA targets will continue to take precedence over PCC, SDM and tailored recall intervals.
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Affiliation(s)
- Ian Mills
- Peninsula Dental School, University of Plymouth, United Kingdom.
| | - Sasha Scambler
- Faculty of Dentistry, Oral and Craniofacial Sciences, King´s College London, United Kingdom
| | | | - Koula Asimakopoulou
- Faculty of Dentistry, Oral and Craniofacial Sciences, King´s College London, United Kingdom
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7
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Markazi-Moghaddam N, Balaye Jame SZ, Nikoomanesh M, Rezapour R. A Systematic Review and Meta-Analysis of Health Care Quality in Iran Based on the Comprehensive Quality Measurement in Health Care Model. Int J Prev Med 2023; 14:10. [PMID: 36942033 PMCID: PMC10023840 DOI: 10.4103/ijpvm.ijpvm_238_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/15/2021] [Indexed: 01/26/2023] Open
Abstract
Background Comprehensive assessment of health care quality is the first step in improving care and achieving health service goals. Therefore, this study aimed to conduct a systematic review and meta-analysis of health care quality in Iran based on the Comprehensive Quality Measurement in Health Care model. Methods In this study, the databases of PubMed, Scopus, Web of Science, Iranian Scientific Information Database (SID), MagIran, and Google Scholar were searched using English and Iran keywords without time limit. STATA 16 software and a random effect model were used for conducting meta-analysis. Results Of the 750 articles found, 20 were finally included; 13 of which were related to service quality, five to customer quality, and four to technical quality. Overall mean score of service quality was 7.79 [95% CI 7.43-8.15, df = 12, I2 = 98.48, P value < 0.000] out of 10, and overall mean score of customer quality was 73.20 ± 4.56 [95% CI 65.18-81.22, df = 5, I2 = 99.34, P value < 0.001] out of 100. Among the 12 dimensions of service quality, the confidentiality dimension (9.55 ± 0.12) had the highest mean score and the group support dimension (5.92 ± 0.901) had the lowest score. In general, from the viewpoint of service receivers, the technical quality is relatively favorable. Conclusions According to the results of this study, the quality of health care in Iran is significantly far from ideal. Therefore, planning to improve providing health care is essential.
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Affiliation(s)
- Nader Markazi-Moghaddam
- Critical Care Quality Improvement Research Center, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Health Management and Economics, School of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Sanaz Zargar Balaye Jame
- Department of Health Management and Economics, School of Medicine, AJA University of Medical Sciences, Tehran, Iran
- Address for correspondence: Dr. Sanaz Z. B. Jame, Department of Health Management and Economics, Faculty of Medicine, Aja University of Medical Sciences, Tehran, Iran. E-mail:
| | - Mahdi Nikoomanesh
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Ramin Rezapour
- Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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8
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Rigo L, Basso K, Pauli J, Portilio M. Affect and cognition as antecedents of patients’ trust in the dentist. BRAZILIAN JOURNAL OF ORAL SCIENCES 2022. [DOI: 10.20396/bjos.v21i00.8667228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Aim: to evaluate the association of the patients’ perception about dentist’s affect and cognition on trust and, consequently, on intention to return and patient satisfaction with life. Methods: Analytical cross-sectional study conducted in patients’ adults and elderly at of two dentistry clinics in the south of Brazil. Patients had to have a previous relationship with the dentist (at least one previous consult) and 18 years of age or older. The data were collected through self-administrated questionnaire using measures adapted from other research, using structural equation modeling. We test using a chi-square difference test (p-value<0,05). Results: The mean age of the 197 patients was 37.0 years (σ = 15.5). The affect perceived by the patient at the dentist had a positive effect (β = .53) on the trust that the patient develops in relation to the dentist. The same is true for the effect of the rational or cognitive aspects perceived by the patient at the dentist (β = .41). The trust positively influences the patient’s intention to return to that dentist (β = .82). In addition, the intention to return to the dentist positively influences the patient’s satisfaction with life (β = .49). Conclusions: Affective and cognitive aspects positively influenced the patient’s trust in the dentist. The greater the patient’s trust in the dentist, the greater the intention to return to that dentist. Furthermore, a good relationship with the dentist improve the patient’s satisfaction with life.
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9
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Law S, Antonacci R, Ormel I, Hidalgo M, Ma J, Dyachenko A, Laframboise D, Doucette E. Engaging patients, families and professionals at the bedside using whiteboards. J Interprof Care 2022; 37:400-409. [PMID: 35880772 DOI: 10.1080/13561820.2022.2074379] [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: 10/16/2022]
Abstract
Health-care systems around the world are striving to be patient-centered, and there is growing evidence that engaging patients and families in their care, as well as in efforts to redesign services, contributes to improved outcomes and experiences for patients and providers. This patient-oriented care movement includes efforts to improve the quality of information and communication between health-care professionals and patients as well as families and caregivers. Whiteboards have emerged as a best practice in hospitals to promote engagement and improve information and communication, yet with limited empirical evidence regarding their value to patients, families, or interprofessional teams. We introduced whiteboards on an acute medical unit at a community hospital and conducted an evaluation using a pre-post design collecting both qualitative and quantitative data. Baseline and post-implementation data were collected via qualitative interviews with patients/family and providers and using the Canadian Patient Experience Survey; focus groups were held with staff and members of the care team. Qualitative results highlighted improvements in communication between the care team and patients as well as family members. Implications for practice include attention to patient/family empowerment and safety, adherence to guidance for good communication, and support for regular training and education in the use of communication tools for members of the interprofessional team.
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Affiliation(s)
- Susan Law
- Mary's Research Centre, Department of Family Medicine, McGill UniversitySt. , Montreal, QC, Canada.,Institute for Better Health, University of Toronto & Senior Scientist, Toronto, ON, Canada
| | - Rosetta Antonacci
- Teaching Unit, St. Mary's HospitalNurse Manager - Medical-Clinical, Montreal, QC, Canada.,Ingram School of Nursing & Clinical Associate, Department of Academic and University Affairs, CIUSSS ODIM, Ingram School of Nursing, McGill University, Montreal, QC, Canada
| | - Ilja Ormel
- St. Mary's Research Centre, Montreal, QC, Canada
| | - Marcela Hidalgo
- Patient Engagement, St. Mary's Research Centre, Montreal, QC, Canada
| | - Julia Ma
- Biostatistician - Institute for Better Health, Trillium Health Partners.,Data Scientist, Precision Analytics, Montreal, QC, Canada
| | | | | | - Elaine Doucette
- Ingram School of Nursing, McGill University, Montreal, QC, Canada
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10
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Lafontaine S, Bourgault P, Ellefsen E. Acceptability of a self-management support intervention for people living with type 2 diabetes to promote a person-centered approach by nurses: A qualitative study. Collegian 2022. [DOI: 10.1016/j.colegn.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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11
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Madison JM, French CL. Giants in Chest Medicine: Richard S. Irwin, MD, Master FCCP. Chest 2021; 157:1423-1425. [PMID: 32505310 DOI: 10.1016/j.chest.2020.01.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 01/24/2020] [Indexed: 11/26/2022] Open
Affiliation(s)
- J Mark Madison
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA.
| | - Cynthia L French
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA
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12
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Sico IP, Oberle A, Thomas SM, Barsanti T, Egbuonu-Davis L, Kennedy DT, Zullig LL, Bosworth HB. Therapeutic Inertia in Prescribing Biologics for Patients with Moderate-to-Severe Asthma: Workshop Summary. Patient Prefer Adherence 2021; 15:705-712. [PMID: 33854304 PMCID: PMC8039536 DOI: 10.2147/ppa.s303841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/19/2021] [Indexed: 01/22/2023] Open
Abstract
Moderate-to-severe asthma represents about a quarter of the nearly 10% of Americans diagnosed with asthma. Many patients with moderate-to-severe asthma have uncontrolled symptoms that lead to exacerbations requiring oral corticosteroids. There are many factors contributing to poor asthma control, including poor adherence to prescribed therapies, the under-prescribing of biologics and therapeutic inertia. We convened an eight-member panel from fields of primary care, pulmonology, immunology, health services and clinical research, behavioral science and pharmaceutical medical affairs, with the goal of identifying contributing factors and solutions to therapeutic inertia with asthma biologics. We used the Capability, Opportunity, and Motivation (COM-B) model to classify patient and provider behavior towards therapeutic inertia. The model incorporates existing behavior theories and is driven by the interaction of capability, opportunity, and motivation. We used a Delphi method to identify and develop six primary solutions: 1) integration of patient-centered outcomes into asthma management practice; 2) provider education about asthma treatment; 3) moderate-to-severe asthma care delivery redesign; 4) harmonized, evidence-based protocol for the management of moderate-to-severe asthma; 5) designated coordinator approach for optimal asthma management; and 6) a case coordination digital support tool. Integration of patient-centered outcomes into asthma management practice and provider education were identified as having the highest potential to impact therapeutic and clinical inertia. The COM-B model is effective in identifying improvement within therapeutic inertia targeting the capabilities, opportunities, and motivations of patients, providers, and payer systems.
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Affiliation(s)
- Isabelle P Sico
- Department of Population Health Science, Duke University School of Medicine, Durham, NC, USA
| | - Amber Oberle
- Division of Pulmonary, Allergy and Critical Care, Duke University, Durham, NC, USA
| | | | | | | | | | - Leah L Zullig
- Department of Population Health Science, Duke University School of Medicine, Durham, NC, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, NC, USA
- Division of General Internal Medicine, Duke University, Durham, NC, USA
| | - Hayden B Bosworth
- Department of Population Health Science, Duke University School of Medicine, Durham, NC, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, NC, USA
- Division of General Internal Medicine, Duke University, Durham, NC, USA
- School of Nursing, Duke University, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
- Correspondence: Hayden B Bosworth Duke University School of Medicine, 411 West Chapel Hill Street, Suite 600, Durham, NC, 27701, USATel +1 919-286-6936 Email
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13
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Knox BL, Luyet FM, Esernio-Jenssen D. Medical Neglect as a Contributor to Poorly Controlled Asthma in Childhood. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2020; 13:327-334. [PMID: 33088390 PMCID: PMC7561643 DOI: 10.1007/s40653-019-00290-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Child maltreatment, including medical neglect, is a frequent contributor to the development of asthma as well as a barrier to its proper management. This article aims to review the role of medical neglect as a contributor to poor asthma control. Medical neglect can present as failure of the caretaker to recognize severe asthma symptoms in a child, non-adherence to medical management, failure to prevent chronic exposure to allergens or tobacco smoke, poor child nutrition leading to obesity, and allowing a young child to manage his/her illness without supervision. This article will explore the different factors leading to medical neglect (as illustrated by two cases) and suggest possible interventions aiming to prevent emergency department visits, hospitalizations, and asthma-related deaths.
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Affiliation(s)
- Barbara L. Knox
- University of Wisconsin American Family Children’s Hospital, Madison, WI USA
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI USA
- University of Wisconsin Department of Pediatrics, 600 Highland Avenue, H4-428 CSC, Madison, WI 53792-4108 USA
| | - Francois M. Luyet
- University of Wisconsin American Family Children’s Hospital, Madison, WI USA
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI USA
| | - Debra Esernio-Jenssen
- Lehigh Valley Reilly Children’s Hospital, Allentown, PA USA
- Morsani College of Medicine USF Health, Tampa, FL USA
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14
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Abdul Aziz AF, Tan CE, Ali MF, Aljunid SM. The adaptation and validation of the satisfaction with stroke care questionnaire (Homesat) (SASC10-My™) for use in public primary healthcare facilities caring for long- term stroke survivors residing at home in the community. Health Qual Life Outcomes 2020; 18:193. [PMID: 32563246 PMCID: PMC7305597 DOI: 10.1186/s12955-020-01450-9] [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: 01/28/2020] [Accepted: 06/11/2020] [Indexed: 11/25/2022] Open
Abstract
Background Satisfaction with post stroke services would assist stakeholders in addressing gaps in service delivery. Tools used to evaluate satisfaction with stroke care services need to be validated to match healthcare services provided in each country. Studies on satisfaction with post discharge stroke care delivery in low- and middle-income countries (LMIC) are scarce, despite knowledge that post stroke care delivery is fragmented and poorly coordinated. This study aims to modify and validate the HomeSat subscale of the Dutch Satisfaction with Stroke Care-19 (SASC-19) questionnaire for use in Malaysia and in countries with similar public healthcare services in the region. Methods The HomeSat subscale of the Dutch SASC-19 questionnaire (11 items) underwent back-to-back translation to produce a Malay language version. Content validation was done by Family Medicine Specialists involved in community post-stroke care. Community social support services in the original questionnaire were substituted with equivalent local services to ensure contextual relevance. Internal consistency reliability was determined using Cronbach alpha. Exploratory factor analysis was done to validate the factor structure of the Malay version of the questionnaire (SASC10-My™). The SASC10-My™ was then tested on 175 post-stroke patients who were recruited at ten public primary care healthcentres across Peninsular Malaysia, in a trial-within a trial study. Results One item from the original Dutch SASC19 (HomeSat) was dropped. Internal consistency for remaining 10 items was high (Cronbach alpha 0.830). Exploratory factor analysis showed the SASC10-My™ had 2 factors: discharge transition and social support services after discharge. The mean total score for SASC10-My™ was 10.74 (SD 7.33). Overall, only 18.2% were satisfied with outpatient stroke care services (SASC10-My™ score ≥ 20). Detailed analysis revealed only 10.9% of respondents were satisfied with discharge transition services, while only 40.9% were satisfied with support services after discharge. Conclusions The SASC10-My™ questionnaire is a reliable and valid tool to measure caregiver or patient satisfaction with outpatient stroke care services in the Malaysian healthcare setting. Studies linking discharge protocol patterns and satisfaction with outpatient stroke care services should be conducted to improve care delivery and longer-term outcomes. Trial registration No.: ACTRN12616001322426 (Registration Date: 21st September 2016.
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Affiliation(s)
- Aznida Firzah Abdul Aziz
- Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
| | - Chai-Eng Tan
- Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Mohd Fairuz Ali
- Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Syed Mohamed Aljunid
- Community Health Department, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.,Department of Health Policy and Management, Faculty of Public Health, Kuwait University, Kuwait City, Kuwait
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Harrington RL, Hanna ML, Oehrlein EM, Camp R, Wheeler R, Cooblall C, Tesoro T, Scott AM, von Gizycki R, Nguyen F, Hareendran A, Patrick DL, Perfetto EM. Defining Patient Engagement in Research: Results of a Systematic Review and Analysis: Report of the ISPOR Patient-Centered Special Interest Group. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:677-688. [PMID: 32540224 DOI: 10.1016/j.jval.2020.01.019] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 01/17/2020] [Accepted: 01/30/2020] [Indexed: 05/13/2023]
Abstract
OBJECTIVES Lack of clarity on the definition of "patient engagement" has been highlighted as a barrier to fully implementing patient engagement in research. This study identified themes within existing definitions related to patient engagement and proposes a consensus definition of "patient engagement in research." METHODS A systematic review was conducted to identify definitions of patient engagement and related terms in published literature (2006-2018). Definitions were extracted and qualitatively analyzed to identify themes and characteristics. A multistakeholder approach, including academia, industry, and patient representation, was taken at all stages. A proposed definition is offered based on a synthesis of the findings. RESULTS Of 1821 abstracts identified and screened for eligibility, 317 were selected for full-text review. Of these, 169 articles met inclusion criteria, from which 244 distinct definitions were extracted for analysis. The most frequently defined terms were: "patient-centered" (30.5%), "patient engagement" (15.5%), and "patient participation" (13.4%). The majority of definitions were specific to the healthcare delivery setting (70.5%); 11.9% were specific to research. Among the definitions of "patient engagement," the most common themes were "active process," "patient involvement," and "patient as participant." In the research setting, the top themes were "patient as partner," "patient involvement," and "active process"; these did not appear in the top 3 themes of nonresearch definitions. CONCLUSION Distinct themes are associated with the term "patient engagement" and with engagement in the "research" setting. Based on an analysis of existing literature and review by patient, industry, and academic stakeholders, we propose a scalable consensus definition of "patient engagement in research."
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Affiliation(s)
| | - Maya L Hanna
- Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT USA
| | | | - Rob Camp
- Community Advisory Board Programme, EURORDIS, Barcelona, Spain
| | | | - Clarissa Cooblall
- Scientific & Health Policy Initiatives, ISPOR, Lawrenceville, NJ, USA
| | - Theresa Tesoro
- Scientific & Health Policy Initiatives, ISPOR, Lawrenceville, NJ, USA
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Jadun S, Syed N, Drabu T, Yates J. Patient awareness and quality of oral surgery referrals to specialist practice. ACTA ACUST UNITED AC 2020. [DOI: 10.1111/ors.12467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- S. Jadun
- University Dental Hospital of Manchester Manchester UK
| | - N. Syed
- SimplyOne Dental Droylsden Lancashire UK
| | - T. Drabu
- Langley Dental Practice Middleton Manchester UK
| | - J. Yates
- University Dental Hospital of Manchester Manchester UK
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Langberg EM, Dyhr L, Davidsen AS. Development of the concept of patient-centredness - A systematic review. PATIENT EDUCATION AND COUNSELING 2019; 102:1228-1236. [PMID: 30846206 DOI: 10.1016/j.pec.2019.02.023] [Citation(s) in RCA: 114] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 02/21/2019] [Accepted: 02/22/2019] [Indexed: 05/10/2023]
Abstract
OBJECTIVE Patient-centredness is often linked to high-quality patient care, but the concept is not well-defined. This study aims to provide an overview of how patient-centredness has been defined in the literature since Mead and Bower's review in 2000, and to provide an updated definition of the concept. METHOD & DESIGN We performed a systematic literature search in PubMed to identify original articles with a sufficient definition of patient-centredness. We analysed extracted data defining patient-centredness. RESULTS Eighty articles were included. The dimensions "biopsychosocial", "patient-as-person", "sharing power and responsibility" and "therapeutic alliance" corresponded to four of five dimensions described by Mead and Bower. "Coordinated care" was a new dimension. CONCLUSION The identified dimensions are encompassed by three elements: the patient, the doctor-patient relationship and the framework of care i.e. the health care system. The additional focus on coordinated care could reflect increasing complexity of the health care system. PRACTICE IMPLICATIONS Narrowing down the understanding of patient-centredness to these three focus areas, viz. 1) understanding of the patients' experience of the illness in their life situation, 2) the professional's relationship with the patient, and 3) coordination of care in the system, could make the operationalisation and implementation of a patient-centred approach more manageable.
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Affiliation(s)
- Emil Mørup Langberg
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen K, Denmark.
| | - Lise Dyhr
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen K, Denmark.
| | - Annette Sofie Davidsen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen K, Denmark.
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Makhinova T, Barner JC, Brown CM, Richards KM, Rascati KL, Rush S, Nag A. Examination of Barriers to Medication Adherence, Asthma Management, and Control Among Community Pharmacy Patients With Asthma. J Pharm Pract 2019; 34:515-522. [PMID: 30947599 DOI: 10.1177/0897190019840117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe the prevalence of common barriers to asthma medication adherence and examine associations between patient-reported asthma controller adherence and asthma control, therapy adherence barriers, and asthma management characteristics. METHODS Previously developed asthma-specific tool was pilot tested on a convenience sample of adult patients with persistent asthma. The following data were collected via patient survey: demographic characteristics and comorbidities, adherence, asthma control, and asthma management characteristics. Descriptive and inferential statistics were used to address the study objective. RESULTS The patients (N = 93) were 45.4 (17.2) years of age, and 66.7% were female. The majority had poor (68.8%) adherence, with 61.3% of patients having controlled asthma. There was no significant association between adherence and asthma control. The mean number of barriers for good and poor adherence groups differed significantly: 2.0 ± 1.1 and 5.4 ± 2.4, respectively (P < .0001). Having an asthma action plan (AAP) was the only asthma management characteristic significantly related to adherence. The majority of patients with poor adherence did not have an AAP (76.6%), whereas 81.5% of patients with good adherence did have an AAP (P < 0.0001). CONCLUSIONS The use of this survey tool confirmed presence of asthma-specific barriers, thus using this specialized approach may lead to more effective, targeted counseling in community pharmacy settings.
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Affiliation(s)
- Tatiana Makhinova
- Faculty of Pharmacy and Pharmaceutical Sciences, 3158University of Alberta, Edmonton, Alberta, Canada
| | - Jamie C Barner
- College of Pharmacy, 441903The University of Texas at Austin, Austin, TX, USA
| | - Carolyn M Brown
- College of Pharmacy, 441903The University of Texas at Austin, Austin, TX, USA
| | - Kristin M Richards
- College of Pharmacy, 441903The University of Texas at Austin, Austin, TX, USA
| | - Karen L Rascati
- College of Pharmacy, 441903The University of Texas at Austin, Austin, TX, USA
| | - Sharon Rush
- College of Pharmacy, 441903The University of Texas at Austin, Austin, TX, USA
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Bender BG. Revisiting What We Need to Do to Help Urban Minority Children with Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 5:519-520. [PMID: 28283166 DOI: 10.1016/j.jaip.2016.11.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 11/09/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Bruce G Bender
- Division of Pediatric Behavioral Health, Department of Pediatrics, National Jewish Health, Denver, Colo.
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Mills IJ. Through the patient's eyes – the importance of person-centred care in oral cancer. Br Dent J 2018; 225:889-891. [DOI: 10.1038/sj.bdj.2018.923] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2018] [Indexed: 11/10/2022]
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Green J, Jester R, McKinley R, Pooler A. Chronic venous leg ulcer care: Putting the patient at the heart of leg ulcer care Part 2: Development and evaluation of the consultation template. Br J Community Nurs 2018; 23:S20-S30. [PMID: 29799794 DOI: 10.12968/bjcn.2018.23.sup6.s20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Part 2 in this article series summarises the final two phases of a study which explored the experiences of patients with leg ulcers and the impact of this condition on their quality of life. Early phases of the study revealed a mismatch between issues that affected a patient's quality of life and what they discussed during subsequent health care consultations. In light of this, a nominal group technique was employed to facilitate the development of a new leg ulcer consultation template with patient partners. The aim of this was to include many of the issues raised in phases 1. The new template was evaluated in terms of its utility, significance and clinical potential. The application of this template during routine consultations appears to encourage the patient to disclose issues that are important to them and may have otherwise been overlooked.
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Affiliation(s)
- Julie Green
- Queen's Nurse, Royal College of Nursing Professional Nursing Committee member, Royal College of Nursing District Nurse Forum Chair and member of the Association of District Nurse Educators Director of Postgraduate Studies and Senior Lecturer, Keele University School of Nursing and Midwifery, Clinical Education Centre, University Hospitals of North Midlands NHS Trust, Royal Stoke University Hospital, Newcastle Road, Stoke-on-Trent ST4 6QG
| | - Rebecca Jester
- Professor of Nursing, Faculty of Education, Health and Wellbeing, Institute of Health, University of Wolverhampton, WV1 1LY
| | - Robert McKinley
- Professor of Nursing, Faculty of Education, Health and Wellbeing, Institute of Health, University of Wolverhampton, WV1 1LY
| | - Alison Pooler
- Lecturer, Director of Learning and Teaching, School of Nursing and Midwifery, Keele University, Staffordshire, ST4 6QG
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Where does health communication technology fit into allergy practice? Ann Allergy Asthma Immunol 2018; 121:24-30. [PMID: 29852292 DOI: 10.1016/j.anai.2018.05.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 05/07/2018] [Accepted: 05/16/2018] [Indexed: 01/12/2023]
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Floch J, Zettl A, Fricke L, Weisser T, Grut L, Vilarinho T, Stav E, Ascolese A, Schauber C. User Needs in the Development of a Health App Ecosystem for Self-Management of Cystic Fibrosis: User-Centered Development Approach. JMIR Mhealth Uhealth 2018; 6:e113. [PMID: 29739742 PMCID: PMC5964302 DOI: 10.2196/mhealth.8236] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 11/29/2017] [Accepted: 12/21/2017] [Indexed: 11/16/2022] Open
Abstract
Background Digital self-management in cystic fibrosis (CF) is foreseen as a means toward better understanding of the disease and its treatment and better adherence to the treatment. Mobile apps hold the potential to provide access to information, motivate, and strengthen compliance. However, to deliver high-quality apps, the development should be based on thorough knowledge about user needs. Empirical research on the user-centered development of mobile apps for health care is, however, still limited. Objective The aim of this research is to develop and evaluate an app ecosystem for self-management in CF. It targets not only those directly affected by CF but also parents and health care professionals involved in the treatment. This paper covers the first step of the design process that aims to analyze the context and the user requirements. The primary research question is as follows: what digital support has the potential to usefully support persons with CF and their caregivers in the CF care? To answer this question, we address two preliminary questions: what important factors in everyday life affect the care of persons with CF? and how is the CF care delivered today and what are the limitations of CF care services? Methods The overall research adopts a user-centered design approach in which future users are involved in the development process from the very beginning to ensure that the apps developed best suit the potential users. The research presented in the paper follows an interpretative case study research strategy seeking to understand the concerns and needs of persons with CF and their caregivers. Data were collected through semistructured qualitative interviews involving 74 participants in seven European countries and from internet forums. Results The results of the analysis phase show a strong need for individuality of the digital support, as well as for its adaptability to different contexts. The paper presents the concerns and needs of the participants in the study and extracts a set of relevant features for a self-management app ecosystem. Education, enzyme dosage calculation, nutrition management, treatment organization, health diary, treatment follow-up, practical guidelines for treatment, communication with doctors, and communication with peers are foreseen as useful features. Conclusions The results indicate the readiness for self-management in the CF care even in countries that provide well-functioning health care services for CF care. The large diversity of user requirements identified reflects the crucial role user integration plays in developing apps for a chronic condition such as CF. The need for personalization stemming from the individuality of the patients and the need for communication with health care professionals support the idea of an app ecosystem for the self-management of CF.
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Irwin RS, Manaker S, Metersky ML, Baughman RP, Otulana T, Weinberger SE, Sussman AJ, McGrath NA. Higher Priced Older Pharmaceuticals: How Should We Respond? Chest 2017; 153:23-33. [PMID: 29017958 DOI: 10.1016/j.chest.2017.09.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 09/13/2017] [Accepted: 09/22/2017] [Indexed: 02/08/2023] Open
Abstract
We and our patients have been aware of the high cost of medications in the United States for decades; however, we are now witnessing a relatively new phenomenon: exponential price increases for some older pharmaceuticals that have been available for years. To assist practitioners in how to respond to the issue of higher priced pharmaceuticals, an interprofessional session was developed and held at CHEST 2016 in Los Angeles. The session proceedings and a few updates are presented here to summarize what pulmonologists; a sarcoidosis expert; a retired executive of a medical society, an executive of a pharmaceutical company and of a pharmacy; and an ethicist advise that we do about the problem. Because the comments presented at the session and in this manuscript represent the opinions of each author, this commentary in essence is a compilation of nine editorials. It does not represent a comprehensive discussion of the field of pricing of drugs. In reflecting upon the answers to the questions posed, and regardless of their sector of health care, all participants stated that they focused on the patient. However, actually providing patient-focused care (ie, the care defined from the patient's perspective) is another matter. To significantly improve patient satisfaction and health-care outcomes, patient-focused care needs to embody the 3 Cs of (1) communication, (2) continuity of care, and (3) concordance of expectations (ie, finding the common ground). Therefore, we discuss how the 3 Cs apply to responses to higher priced pharmaceuticals.
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Affiliation(s)
| | - Scott Manaker
- The Perelman School of Medicine and University of Pennsylvania, Philadelphia, PA
| | - Mark L Metersky
- University of Connecticut School of Medicine, Farmington, CT
| | - Robert P Baughman
- Department of Internal Medicine, University of Cincinnati Medical Center, Cincinnati, OH
| | | | - Steven E Weinberger
- The Perelman School of Medicine and University of Pennsylvania, Philadelphia, PA; Medical Education and Publishing Division, American College of Physicians, Philadelphia, PA
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Hladunewich MA, Beanlands H, Herreshoff E, Troost JP, Maione M, Trachtman H, Poulton C, Nachman P, Modes MM, Hailperin M, Pitter R, Gipson DS. Provider perspectives on treatment decision-making in nephrotic syndrome. Nephrol Dial Transplant 2017; 32:i106-i114. [PMID: 28391336 DOI: 10.1093/ndt/gfw309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 07/16/2016] [Indexed: 11/14/2022] Open
Abstract
Background Managing patients with nephrotic syndrome (NS) remains difficult for the practicing nephrologist. This often young patient population is faced with a debilitating, relapsing and remitting disease with non-specific treatment options that are often poorly tolerated. Clinicians managing these complex patients must attempt to apply disease-specific evidence while considering the individual patient's clinical and personal situation. Methods We conducted qualitative interviews to ascertain the provider perspectives of NS, treatment options and factors that influence recommendations for disease management, and administered a survey to assess both facilitators and barriers to the implementation of the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. Results When making treatment recommendations, providers considered characteristics of various treatments such as efficacy, side effects and evaluation of risk versus benefit, taking into account how the specific treatment fit with the individual patient. Time constraints and the complexity of explaining the intricacies of NS were noted as significant barriers to care. Although the availability of guidelines was deemed a facilitator to care, the value of the KDIGO guidelines was limited by the perception of poor quality of evidence. Conclusions The complexity of NS and the scarcity of robust evidence to support treatment recommendations are common challenges reported by nephrologists. Future development and use of shared learning platforms may support the integration of best available evidence, patient/family preferences and exchange of information at a pace that is unconstrained by the outpatient clinic schedule.
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Affiliation(s)
- Michelle A Hladunewich
- Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Heather Beanlands
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON, Canada
| | - Emily Herreshoff
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Jonathan P Troost
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Maria Maione
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON, Canada
| | - Howard Trachtman
- Department of Pediatrics, New York University, New York, NY, USA
| | - Caroline Poulton
- Division of Nephrology, Department of Medicine, University of North Carolina Kidney Center, Chapel Hill, NC, USA
| | - Patrick Nachman
- Division of Nephrology, Department of Medicine, University of North Carolina Kidney Center, Chapel Hill, NC, USA
| | | | | | - Renee Pitter
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Debbie S Gipson
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
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Crespo-Lessmann A, Plaza V, González-Barcala FJ, Fernández-Sánchez T, Sastre J. Concordance of opinions between patients and physicians and their relationship with symptomatic control and future risk in patients with moderate-severe asthma. BMJ Open Respir Res 2017; 4:e000189. [PMID: 29018525 PMCID: PMC5604707 DOI: 10.1136/bmjresp-2017-000189] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 07/26/2017] [Accepted: 08/09/2017] [Indexed: 11/23/2022] Open
Abstract
Introduction Differences between the opinions of patients and physicians on the impact of asthma are common. We hypothesised that patient–physician discordance may negatively affect asthma outcome. Methods A total of 2902 patients (61% women, mean age 47 years) with moderate–severe asthma and 231 physicians participated in a prospective study. At the baseline visit, data on demographics, clinical variables, degree of asthma control according to the Asthma Control Test (ACT), basic spirometry and the Hospital Anxiety and Depression Scale (HADS) were collected and an ad hoc questionnaire was completed that allowed the degree of concordance between doctors and patients to be assessed. A scheduled telephone call after 3 months was used to elicit the ACT score and the future risk of asthma. At the final visit at 6 months, the following data were recorded: ACT score, spirometry, HADS score and an ad hoc questionnaire to assess the agreement between the doctor and the patient. Changes in study variables according to patient–physician concordance or discordance were analysed. Results The rate of patient–physician discordance was 27.2%, with overestimation of disease impact by the physician in 12.3% and underestimation in 14.9%. Patient–physician opinion discordance, particularly in the case of physicians underestimating the impact of asthma, showed worse results with statistically significant differences in ACT score, a higher percentage of patients with poor asthma control and lower HADS scores. The need for hospital and emergency department admissions was also higher. Conclusion Patient–physician opinion discordance may be contributing to lower symptomatic control and increased future risk, with a higher impact when physicians underestimate the impact of asthma on their patients.
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Affiliation(s)
- Astrid Crespo-Lessmann
- Service of Pneumology, Hospital de la Santa Ceu i Sant Pau, Institute of Sant Pau & Biomedical Research (IBB Sant Pau), Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Vicente Plaza
- Service of Pneumology, Hospital de la Santa Ceu i Sant Pau, Institute of Sant Pau & Biomedical Research (IBB Sant Pau), Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Francisco-Javier González-Barcala
- Service of Pneumology, Complejo Hospitalario Universitario de Santiago de Compostela. Department of Medicine, University of Santiago de Compostela. Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, Spain
| | | | - Joaquín Sastre
- Department of Allergy, Hospital Universitario Fundación Jiménez Díaz. Centro deInvestigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
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The Impact of Patient Demographics on the Selection of Breast Imaging Centers. AJR Am J Roentgenol 2017; 209:W184-W193. [DOI: 10.2214/ajr.16.17305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Román-Rodríguez M, Ibarrola-Ruiz L, Mora F, Plaza V, Sastre J, Torrego A, Vega JM, Sánchez-Herrero G. Motivational interviewing for adherence: post-training attitudes and perceptions of physicians who treat asthma patients. Patient Prefer Adherence 2017; 11:811-820. [PMID: 28461743 PMCID: PMC5407448 DOI: 10.2147/ppa.s127645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the attitudes and perceptions of health care professionals (HCPs) who have been trained in motivational interviewing (MI) to improve adherence. Another objective of this study was to compare groups of HCPs with different levels of training in adherence (trained vs untrained; previous training in adherence education [AdhE] vs specific training in MI). METHODS For this study, a national questionnaire-based survey was conducted among HCPs treating asthma. A total of 360 HCPs were surveyed (allergists: n=110; pulmonologists: n=120; general practitioners: n=130). Of them, 180 physicians had received a training intervention (training in AdhE: n=90; training in MI to promote adherence: n=90). RESULTS Of the total surveyed HCPs, 92.8% reported adherence is highly important in asthma control. More professionals trained in MI compared to those trained in AdhE considered that "simplifying treatment as far as possible" (85.6% vs 68.9%, P=0.0077), "involving the patient in treatment plans" (85.6% vs 71.1%, P=0.0187), "giving the patient self-care patterns" (52.2% vs 36.7%, P=0.0357) and "performing MI" (42.2% vs 15.6%, P<0.0001) were the most important interventions to promote adherence. "Empathy between doctor and patient" (93.3% vs 77.8%, P=0.0036) and "concordance of medical and patient treatment goals" (96.7% vs 72.2%, P<0.0001) were the factors perceived as having the greatest influence in improving adherence to asthma treatment by the physicians in the MI group as opposed to those in the AdhE group. The use of MI in asthma consultation was the most highly valued resource to promote adherence to treatment among all the professionals, particularly those who had received specific MI training compared to those who had received any kind of previous training in AdhE (96.7% vs 66.7%, P<0.0001). CONCLUSION MI is considered an important tool to promote adherence to asthma treatment among HCPs, especially among those specifically trained in that aspect. MI training interventions seem to influence HCPs' approaches to improve self-care and to engage patients in treatment plans rather than approaches solely centered on AdhE.
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Affiliation(s)
- Miguel Román-Rodríguez
- Centro de Salud Son Pisà, IB-Salut, Balearic Health Service, Unidad de investigación en enfermedades crónicas respiratorias en atención primaria, Instituto de Investigación Sanitaria de Baleares (IdISBa), Palma de Mallorca
- Correspondence: Miguel Román-Rodríguez, Centro de Salud Son Pisà, C/De Vicenç Joan Rossello Ribas, No 65, 07011 Palma de Mallorca, Spain, Tel +34 97 163 4115, Email
| | | | - Fernando Mora
- Department of Psychiatry, Hospital Infanta Leonor, Madrid
| | - Vicente Plaza
- Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Institut d’Investigació Biomédica Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona
| | - Joaquín Sastre
- Department of Allergology, Fundación Jimenez Díaz y Universidad Autónoma de Madrid, CIBER de Enfermedades Respiratorias, Ministerio de Economía y Competitividad, Madrid
| | - Alfonso Torrego
- Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Institut d’Investigació Biomédica Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona
| | - José María Vega
- Unidad de Gestión Clínica de Alergología, Hospital Regional Universitario de Málaga, Málaga, Spain
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Jutterström L, Hörnsten Å, Sandström H, Stenlund H, Isaksson U. Nurse-led patient-centered self-management support improves HbA1c in patients with type 2 diabetes-A randomized study. PATIENT EDUCATION AND COUNSELING 2016; 99:1821-1829. [PMID: 27372525 DOI: 10.1016/j.pec.2016.06.016] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 05/11/2016] [Accepted: 06/16/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the effect of a patient-centered self-management support, in type 2 diabetes (T2D) with regard to metabolic changes. METHODS 182 patients were randomized into group intervention (GI), individual intervention (II) or internal controls (IC). An external control (EC) group was recruited from another county council. The intervention consisted of six sessions that featured themes, which regarded different views of their illness experiences. Data were collected in 2010 and 2011. RESULTS HbA1c was significantly decreased at 12-month follow-up with 5mmol/mol in the GI and 4mmol/mol in the II. In the IC group, the HbA1c was close to baseline. The EC group had increased HbA1c, though not significantly. When the HbA1c difference at baseline was adjusted, there was a significant difference between intervention groups and the EC-group. CONCLUSION Patient-centered self-management support, led by nurses, can lower HbA1c among patients with type 2 diabetes. PRACTICE IMPLICATIONS It is possible to train diabetes specialist nurses in clinical patient-centered care, and simultaneously influence patients' metabolic balance positively.
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Affiliation(s)
- L Jutterström
- Department of Nursing, Umeå University, Umeå, Sweden.
| | - Å Hörnsten
- Department of Nursing, Umeå University, Umeå, Sweden.
| | - H Sandström
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden.
| | - H Stenlund
- Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences, Umeå University, Umeå, Sweden.
| | - U Isaksson
- Department of Nursing, Umeå University, Umeå, Sweden.
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Lee WW, Alkureishi MA, Ukabiala O, Venable LR, Ngooi SS, Staisiunas DD, Wroblewski KE, Arora VM. Patient Perceptions of Electronic Medical Record Use by Faculty and Resident Physicians: A Mixed Methods Study. J Gen Intern Med 2016; 31:1315-1322. [PMID: 27400921 PMCID: PMC5071284 DOI: 10.1007/s11606-016-3774-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 01/27/2016] [Accepted: 06/08/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND While concerns remain regarding Electronic Medical Records (EMR) use impeding doctor-patient communication, resident and faculty patient perspectives post-widespread EMR adoption remain largely unexplored. OBJECTIVE We aimed to describe patient perspectives of outpatient resident and faculty EMR use and identify positive and negative EMR use examples to promote optimal utilization. DESIGN This was a prospective mixed-methods study. PARTICIPANTS Internal medicine faculty and resident patients at the University of Chicago's primary care clinic participated in the study. APPROACH In 2013, one year after EMR implementation, telephone interviews were conducted with patients using open-ended and Likert style questions to elicit positive and negative perceptions of EMR use by physicians. Interview transcripts were analyzed qualitatively to develop a coding classification. Satisfaction with physician EMR use was examined using bivariate statistics. RESULTS In total, 108 interviews were completed and analyzed. Two major themes were noted: (1) Clinical Functions of EMR and (2) Communication Functions of EMR; as well as six subthemes: (1a) Clinical Care (i.e., clinical efficiency), (1b) Documentation (i.e., proper record keeping and access), (1c) Information Access, (1d) Educational Resource, (2a) Patient Engagement and (2b) Physical Focus (i.e., body positioning). Overall, 85 % (979/1154) of patient perceptions of EMR use were positive, with the majority within the "Clinical Care" subtheme (n = 218). Of negative perceptions, 66 % (115/175) related to the "Communication Functions" theme, and the majority of those related to the "Physical Focus" subtheme (n = 71). The majority of patients (90 %, 95/106) were satisfied with physician EMR use: 59 % (63/107) reported the computer had a positive effect on their relationship and only 7 % (8/108) reported the EMR made it harder to talk with their doctors. CONCLUSIONS Despite concerns regarding EMRs impeding doctor-patient communication, patients reported largely positive perceptions of the EMR with many patients reporting high levels of satisfaction. Future work should focus on improving doctors "physical focus" when using the EMR to redirect towards the patient.
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Affiliation(s)
- Wei Wei Lee
- Department of Medicine, University of Chicago, 5841 S. Maryland Avenue MC 3051, L325B, Chicago, IL, 60637, USA.
| | | | - Obioma Ukabiala
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Laura Ruth Venable
- Department of Medicine, University of Chicago, 5841 S. Maryland Avenue MC 3051, L325B, Chicago, IL, 60637, USA
| | - Samantha S Ngooi
- Department of Medicine, University of Chicago, 5841 S. Maryland Avenue MC 3051, L325B, Chicago, IL, 60637, USA
| | - Daina D Staisiunas
- Department of Medicine, University of Chicago, 5841 S. Maryland Avenue MC 3051, L325B, Chicago, IL, 60637, USA
| | | | - Vineet M Arora
- Department of Medicine, University of Chicago, 5841 S. Maryland Avenue MC 3051, L325B, Chicago, IL, 60637, USA
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Williams JS, Walker RJ, Smalls BL, Hill R, Egede LE. Patient-Centered Care, Glycemic Control, Diabetes Self-Care, and Quality of Life in Adults with Type 2 Diabetes. Diabetes Technol Ther 2016; 18:644-649. [PMID: 27541872 PMCID: PMC5069713 DOI: 10.1089/dia.2016.0079] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The Affordable Care Act places a newfound emphasis on patient-centered medical home and patient-centered care (PCC). The purpose of this study was to evaluate the relationship between PCC, diabetes self-care, glycemic control, and quality of life (QOL) in a sample of adults with type 2 diabetes. METHODS Six hundred fifteen patients were recruited from two adult primary care clinics in the southeastern United States. Primary outcome variables were self-care behaviors (medication adherence, diet, exercise, blood sugar testing, and foot care), glycemic control, and QOL (physical component summary [PCS] score and mental component summary [MCS] score of SF12). PCC was assessed using a modified 7-item Picker Patient Experience Questionnaire. Regression modeling was used to assess independent associations while adjusting for relevant covariates. RESULTS In adjusted analyses, PCC was significantly associated with PCS QOL (β = -0.03, 95% confidence interval [CI] -0.05 to -0.01), MCS QOL (β = 0.09, 95% CI 0.04-0.14), medication adherence (β = 0.12, 95% CI 0.08-0.17), general diet (β = 0.12, 95% CI 0.07-0.17), specific diet (β = 0.05, 95% CI 0.01-0.08), blood sugar testing (β = 0.09, 95% CI 0.04-0.15), and foot care (β = 0.12, 95% CI 0.07-0.18). CONCLUSION PCC is associated with diabetes self-management and QOL, but was not significantly associated with glycemic control in patients with diabetes. PCC may be an important factor in self-care behaviors, but the process of focusing care around the patient may need to expand throughout the healthcare system before changes in outcomes such as glycemic control are noted.
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Affiliation(s)
- Joni S. Williams
- Department of Medicine, Center for Health Disparities Research, Medical University of South Carolina, Charleston, South Carolina
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Rebekah J. Walker
- Department of Medicine, Center for Health Disparities Research, Medical University of South Carolina, Charleston, South Carolina
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
- Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina
| | - Brittany L. Smalls
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts
| | - Rachel Hill
- Department of Medicine, Center for Health Disparities Research, Medical University of South Carolina, Charleston, South Carolina
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Leonard E. Egede
- Department of Medicine, Center for Health Disparities Research, Medical University of South Carolina, Charleston, South Carolina
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
- Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina
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Brown CE, Jones CJ, Stuttaford L, Robertson A, Rashid RS, Smith HE. A qualitative study of the allergy testing experiences, views and preferences of adult patients. Clin Transl Allergy 2016; 6:34. [PMID: 27583128 PMCID: PMC5006618 DOI: 10.1186/s13601-016-0125-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 08/12/2016] [Indexed: 11/25/2022] Open
Abstract
Background Patients can be tested for IgE sensitivities with in vivo or in vitro testing, but patients’ experiences of different allergy test modalities have not been studied. The objective of this study was to investigate adult patients’ experiences, views and preferences for allergy testing, exploring skin prick testing and allergen-specific IgE testing. Methods A qualitative study of adults attending out-patients for investigation of a suspected allergy. A purposive, convenience sample identified participants and semi-structured interviews were conducted, face to face or by telephone. Interviews were recorded and transcribed verbatim. Thematic content analysis was used to explore patients’ experiences. Results 23 patients were interviewed. The characteristics of skin prick tests particularly valued were the immediacy and visibility of results, which enabled testing and interpretation to be achieved within a single clinic appointment. In vitro testing offered patients simplicity and procedural speed, necessitating only a single puncture site, and was perceived to be a superior test as it was conducted in a laboratory. Conclusions The patient preferred method of allergy testing was skin prick testing rather than in vitro allergen specific IgE testing. However, most patients were accepting of either testing modality because their desire to confirm or exclude an allergic trigger overrode any perceived disadvantages of the test method. Trial registration Not applicable as study descriptive and qualitative.
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Affiliation(s)
- Clare E Brown
- Division of Primary Care and Public Health Medicine, Brighton and Sussex Medical School, Room 319, Mayfield House, Village Way, Brighton, BN1 9PH UK
| | - Christina J Jones
- Division of Primary Care and Public Health Medicine, Brighton and Sussex Medical School, Room 319, Mayfield House, Village Way, Brighton, BN1 9PH UK
| | - Laura Stuttaford
- Division of Primary Care and Public Health Medicine, Brighton and Sussex Medical School, Room 319, Mayfield House, Village Way, Brighton, BN1 9PH UK
| | - Annalee Robertson
- Division of Primary Care and Public Health Medicine, Brighton and Sussex Medical School, Room 319, Mayfield House, Village Way, Brighton, BN1 9PH UK
| | - Rabia S Rashid
- Department of Respiratory Medicine, Royal Sussex County Hospital, Brighton, UK
| | - Helen E Smith
- Division of Primary Care and Public Health Medicine, Brighton and Sussex Medical School, Room 319, Mayfield House, Village Way, Brighton, BN1 9PH UK
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Hoxha J, Weng C. Leveraging dialog systems research to assist biomedical researchers' interrogation of Big Clinical Data. J Biomed Inform 2016; 61:176-84. [PMID: 27067901 PMCID: PMC5875984 DOI: 10.1016/j.jbi.2016.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 02/29/2016] [Accepted: 04/07/2016] [Indexed: 11/30/2022]
Abstract
The worldwide adoption of electronic health records (EHR) promises to accelerate clinical research, which lies at the heart of medical advances. However, the interrogation of such Big Data by clinical researchers can be laborious and error-prone, involving iterative and ineffective communication of data requests to data analysts. Research on this communication process is rare. There also exists no contemporary system that offers intelligent solutions to assist clinical researchers in their quest for clinical data. In this article, we first provide a detailed characterization of the challenges encountered in this communication space. Second, we identify promising synergies between fields studying human-to-human and human-machine communication that can shed light on biomedical data query mediation. We propose a mixed-initiative dialog-based approach to support autonomous clinical data access and recommend needed technology development and communication study for accelerating clinical research.
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Affiliation(s)
- Julia Hoxha
- Department of Biomedical Informatics, Columbia University, 622 W. 168th Street, New York, NY, USA.
| | - Chunhua Weng
- Department of Biomedical Informatics, Columbia University, 622 W. 168th Street, New York, NY, USA.
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Ahmad A, Sorensen K. Enabling and hindering factors influencing adherence to asthma treatment among adolescents: A systematic literature review. J Asthma 2016; 53:862-78. [PMID: 27053332 DOI: 10.3109/02770903.2016.1155217] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The aim of this systematic literature review is to study the enabling and hindering factors influencing adherence to asthma treatment among adolescents. Furthermore, it explores the role of caregivers and the healthcare provider in terms of supporting adolescents to manage and live with asthma. DATA SOURCES The literature review was conducted using the MeSH terms asthma, adherence, health literacy, behavior, adolescents, tools, healthcare provider, caregiver, peer influence, self-management, quality of life, morbidity and mortality in PubMed, PsycInfo, MEDLINE and CINAHL. STUDY SELECTION The literature search resulted in 652 articles of which 304 were screened based on title and abstracts. Ninety-one of the screened articles were then selected for full-text assessment resulting in 42 articles for in-depth analysis. RESULTS The literature review identified nine enabling and hindering factors relevant for adherence to asthma treatment among adolescents: behavior, belief, self-management, health literacy, role of health provider, assessment of adherence, role of caregiver, role of peers and the national asthma guidelines. CONCLUSION Working with this particular age group is complex and further research in understanding adolescent's behavior, motives, beliefs and perceptions towards adherence to asthma treatment is required to guide them towards better self-management and acceptance of their condition.
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Affiliation(s)
- Anam Ahmad
- a Department of International Health , CAPHRI, Faculty of Health Medicine and Life Science, Maastricht University , Maastricht , The Netherlands
| | - Kristine Sorensen
- a Department of International Health , CAPHRI, Faculty of Health Medicine and Life Science, Maastricht University , Maastricht , The Netherlands
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Ratzon R, Reshef A, Efrati O, Deutch M, Forschmidt R, Cukierman-Yaffe T, Kenett R, Kidon MI. Impact of an extended challenge on the effectiveness of β-lactam hypersensitivity investigation. Ann Allergy Asthma Immunol 2016; 116:329-33. [PMID: 26922211 DOI: 10.1016/j.anai.2016.01.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 01/05/2016] [Accepted: 01/20/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Drug provocation tests (DPTs) are the gold standard in the diagnosis of β-lactam hypersensitivity. However, no consensus exists on the need for extended provocation tests, even though the effectiveness of the short DPT is relatively low and there has been an increase in the relative incidence of nonimmediate hypersensitivity reactions. OBJECTIVE To evaluate the effectiveness of a 7-day (extended) DPT compared with a 1-day-only (short) DPT in the management of hypersensitivity reactions to β-lactam antibiotics. METHODS Patients referred to the allergy clinic of the Sheba Medical Center for suspected β-lactam hypersensitivity from January 2008 to December 2012 underwent in vivo skin tests and an immediate short DPT with the culprit drug. Unless an immediate reaction was clearly documented, patients were offered a 7-day, extended DPT. Long-term effectiveness, calculated as the subsequent use of the tested antibiotic, and satisfaction levels were assessed with a telephone questionnaire. RESULTS Of 49 negative DPT results, 26 (53%) were long and 23 (47%) were short. A total of 78% of the patients who underwent the long DPT reported that they used the drug compared with 61% of those who underwent only the short DPT (P = .049). Most patients were very satisfied with the drug allergy evaluation process. CONCLUSIONS An extended DPT protocol increased the effectiveness of the allergy workup in our center without compromising patient satisfaction and safety, and it should be recommended to patients with a history of nonimmediate reaction to β-lactam.
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Affiliation(s)
- Roy Ratzon
- Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Avner Reshef
- Allergy and Immunology Unit, Sheba Medical Center, Tel Hashomer, Israel
| | - Ori Efrati
- Sackler Medical School, Tel Aviv University, Tel Aviv, Israel; Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel
| | - Michal Deutch
- Allergy and Immunology Unit, Sheba Medical Center, Tel Hashomer, Israel
| | - Rinat Forschmidt
- Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel
| | - Tali Cukierman-Yaffe
- Sackler Medical School, Tel Aviv University, Tel Aviv, Israel; Endocrinology Institute, Gertner Institute for Epidemiology and Health Policy Research, Endocrinology Institute, Sheba Medical Center, Ramat Gan, Israel
| | - Ron Kenett
- University of Turin, Turin, Italy; Center for Research in Risk Engineering, New York University School of Engineering, New York, New York
| | - Mona Iancovici Kidon
- Sackler Medical School, Tel Aviv University, Tel Aviv, Israel; Allergy and Immunology Unit, Sheba Medical Center, Tel Hashomer, Israel; Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel.
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Bridging Protocol for Surgical Patients: One Clinic's Experience Facilitating a Safe Anticoagulation Intervention. J Perianesth Nurs 2015; 30:476-486. [PMID: 26596383 DOI: 10.1016/j.jopan.2014.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 12/08/2013] [Accepted: 02/12/2014] [Indexed: 11/21/2022]
Abstract
Surgical candidates often present with complex medical histories that necessitate an individualized approach to care to minimize surgical and anesthetic risk. Patients on warfarin require exceptionally careful clinical assessment, consideration, and consistency to reduce the risk of perioperative thromboembolism and bleeding complications. In response to this need, Victoria General Hospital in Winnipeg, Manitoba, Canada developed a bridging protocol based on evidence-based guidelines and a checklist tool to incorporate and communicate the necessary tasks among the interprofessional team. The purpose of this initiative was to create a patient-focused process to assist those at risk for a thromboembolic event to navigate through a clear, consistent, and collaborative surgical experience whenever cessation and resumption of warfarin administration was required.
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Creasy KR, Lutz BJ, Young ME, Stacciarini JMR. Clinical Implications of Family-Centered Care in Stroke Rehabilitation. Rehabil Nurs 2015; 40:349-59. [PMID: 25648522 PMCID: PMC4544639 DOI: 10.1002/rnj.188] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2014] [Indexed: 12/30/2022]
Abstract
PURPOSE Most stroke survivors will be cared for at home by family caregivers with limited training. Families actively involved in rehabilitation feel more prepared for the new responsibilities of caring for the stroke survivor. The focus of this article is to highlight the relevant concepts of a family-centered model of care and provide general guidance on how integrating a family-centered mindset may be clinically applicable. DESIGN Concept Analysis. METHODS Synthesis of literature on family-centered care and its application in for rehabilitation nurses. FINDINGS Family-centered care is a model of collaborative healthcare that encourages collaboration and partnership among patients, families, and providers with respect to the planning, delivery, and evaluation of health care. Care provided within such a model can expand providers' knowledge of the impact of illness and any issues that may affect eventual transition back home. CONCLUSION Rehabilitation nurses should view stroke patients and family caregivers as a unit. Using family-centered strategies can help nurses provide appropriate, individualized care during rehabilitation.
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Affiliation(s)
| | - Barbara J. Lutz
- University of North Carolina Wilmington, School of Nursing, Wilmington, NC
| | - Mary Ellen Young
- University of Florida, College of Public Health and Health Professions, Gainesville, FL
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Abstract
Patient nonadherence significantly burdens the treatment of allergic rhinitis (AR). Fewer than half of prescribed doses of intranasal corticosteroid medication are taken. The challenges for immunotherapies are even greater. While sustained treatment for 3 to 5 years is required for full benefit, most patients receiving immunotherapy, either subcutaneous or sublingual, stop treatment within the first year. Although research into interventions to improve AR adherence is lacking, lessons learned from adherence interventions in other chronic health conditions can be applied to AR. Two well-established, overriding models of care-the chronic care model and patient-centered care-can improve adherence. The patient-centered care model includes important lessons for allergy providers in their daily practice, including understanding and targeting modifiable barriers to adherence. Additionally, recent studies have begun to leverage health information and communication technologies to reach out to patients and promote adherence, extending patient-centered interventions initiated by providers during office visits.
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Affiliation(s)
- Bruce G Bender
- Department of Pediatrics, National Jewish Health, 1400 Jackson Street, Denver, CO, 80206, USA,
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Kalaitzidis E. Patients' decision-making experiences in the acute healthcare setting--a case study. Scand J Caring Sci 2015; 30:83-90. [PMID: 25857486 DOI: 10.1111/scs.12224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 02/08/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND The transition from being an ordinary citizen to a hospitalised patient can be a daunting experience particularly for the uninitiated and inexperienced. Patients are likely to have questions such as 'where do I go?', 'what should I do?', 'when?' and 'who should I ask?' The process for making practical moment-to-moment decisions is often complex and fraught with difficulties. Identifying critical points in the hospitalisation experience may provide insights into the quality of hospital management systems and professional practices from a patient perspective. OBJECTIVE This study aimed to identify institutional practices and structures in the context of acute healthcare settings which impact on patient moment-to-moment decision-making experiences. METHOD A case study approach was used as the exploratory methodology, and interviews were conducted with three former adult inpatients. In order to gain an understanding of each participant's experiences, data collecting strategies used in this research were a semistructured interview and document analysis of information documents, such as hospital supplied pamphlets, provided to the researcher by the participants. RESULTS The study identified five major themes. Identified as being critical to the participants were information sharing by healthcare professionals, professional advice and professional role identification. Less so were environment and everyday life. Associated with these themes were the participant's common experience of being confined in unfamiliar surroundings, adjusting to institutional routines and of being heavily dependent on others. CONCLUSION Findings indicate that patient moment-to-moment decision-making may be informed and enhanced in several areas: relevant and timely information sharing, varying the dress code between the different professions, reducing conflicting professional advice, clear signage around the hospital, and flexible visiting hours, telephones and clocks in patient rooms.
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Affiliation(s)
- Evdokia Kalaitzidis
- School of Nursing and Midwifery, Flinders University, Bedford Park, Adelaide, SA, Australia
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Fromer L, Goodwin E, Walsh J. Customizing Inhaled Therapy to Meet the Needs of COPD Patients. Postgrad Med 2015; 122:83-93. [DOI: 10.3810/pgm.2010.03.2125] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Pijnenburg MW, Szefler S. Personalized medicine in children with asthma. Paediatr Respir Rev 2015; 16:101-7. [PMID: 25458797 DOI: 10.1016/j.prrv.2014.10.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 10/02/2014] [Indexed: 12/16/2022]
Abstract
Personalized medicine for children with asthma aims to provide a tailored management of asthma, which leads to faster and better asthma control, has less adverse events and may be cost saving. Several patient characteristics, lung function parameters and biomarkers have been shown useful in predicting treatment response or predicting successful reduction of asthma medication. As treatment response to the main asthma therapies is partly genetically determined, pharmacogenetics may open the way for personalized medicine in children with asthma. However, the number of genes identified for the various asthma drug response phenotypes remains small and randomized controlled trials are lacking. Biomarkers in exhaled breath or breath condensate remain promising but did not find their way from bench to bedside yet, except for the fraction of exhaled nitric oxide. E-health will most likely find its way to clinical practice and most interventions are at least non-inferior to usual care. More studies are needed on which interventions will benefit most individual children.
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Affiliation(s)
- Mariëlle W Pijnenburg
- Department of Paediatrics/ Paediatric Respiratory Medicine, Erasmus Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands.
| | - Stanley Szefler
- The Breathing Institute / Pulmonary Medicine, Department of Pediatrics, Children's Hospital Colorado; University of Colorado Denver School of Medicine, Aurora (CO), USA.
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Phillips RL, Short A, Kenning A, Dugdale P, Nugus P, McGowan R, Greenfield D. Achieving patient-centred care: the potential and challenge of the patient-as-professional role. Health Expect 2014; 18:2616-28. [PMID: 25040882 DOI: 10.1111/hex.12234] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2014] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The patient-as-professional concept acknowledges the expert participation of patients in interprofessional teams, including their contributions to managing and coordinating their care. However, little is known about experiences and perspectives of these teams. OBJECTIVE To investigate (i) patients' and carers' experiences of actively engaging in interprofessional care by enacting the patient-as-professional role and (ii) clinicians' perspectives of this involvement. DESIGN, SETTING AND PARTICIPANTS A two-phased qualitative study. In Phase 1, people with chronic disease (n = 50) and their carers (n = 5) participated in interviews and focus groups. Phase 2 involved interviews with clinicians (n = 14). Data were analysed thematically. FINDINGS Patients and carers described the characteristics of the role (knowing about the condition, questioning clinicians, coordinating care, using a support network, engaging an advocate and being proactive), as well as factors that influence its performance (the patient-clinician partnership, benefits, barriers and applicability). However, both patients and carers, and clinicians cautioned that not all patients might desire this level of involvement. Clinicians were also concerned that not all patients have the required knowledge for this role, and those who do are time-consuming. When describing the inclusion of the patient-as-professional, clinicians highlighted the patient and clinician's roles, the importance of the clinician-patient relationship and ramifications of the role. CONCLUSION Support exists for the patient-as-professional role. The characteristics and influencing factors identified in this study could guide patient engagement with the interprofessional team and support clinicians to provide patient-centred care. Recognition of the role has the potential to improve health-care delivery by promoting patient-centred care.
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Affiliation(s)
- Rebecca L Phillips
- Centre for Health Stewardship, The Australian National University, Canberra, ACT, Australia.,Institute for Governance and Policy Analysis, University of Canberra, Canberra, ACT, Australia
| | - Alison Short
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, The University of New South Wales, Sydney, NSW, Australia
| | - Annie Kenning
- Centre for Health Stewardship, The Australian National University, Canberra, ACT, Australia
| | - Paul Dugdale
- Centre for Health Stewardship, The Australian National University, Canberra, ACT, Australia.,Chronic Disease Management Unit, ACT Health, Canberra, ACT, Australia
| | - Peter Nugus
- Department of Family Medicine and Centre for Medical Education, McGill University, Montréal, QC, Canada
| | - Russell McGowan
- Health Care Consumers' Association of the Australian Capital Territory, Canberra, ACT, Australia
| | - David Greenfield
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, The University of New South Wales, Sydney, NSW, Australia
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Fage-Butler A. Improving patient information leaflets: developing and applying an evaluative model of patient-centredness for text. Commun Med 2014; 10:105-15. [PMID: 24851506 DOI: 10.1558/cam.v10i2.105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The purpose of this paper is to present an evaluative model of patient-centredness for text and to illustrate how this can be applied to patient information leaflets (PILs) that accompany medication in the European Union. Patients have criticized PILs for sidelining their experiences, knowledge and affective needs, and denying their individuality. The health communication paradigm of patient-centredness provides valuable purchase on these issues, taking its starting point in the dignity and integrity of the patient as a person. Employing this evaluative model involves two stages. First, a Foucauldian Discourse Analysis is performed of sender and receiver and of the main discourses in PILs. These aspects are then evaluated using the perspectives of patient-centredness theory relating to the medical practitioner, patient and content. The evaluative model is illustrated via a PIL for medication for depression and panic attacks. Evaluation reveals a preponderance of biomedical statements, with a cluster of patient-centred statements primarily relating to the construction of the patient. The paper contributes a new method and evaluative approach to PIL and qualitative health research, as well as outlining a method that facilitates the investigation of interdiscursivity, a recent focus of critical genre analysis.
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Mills I, Frost J, Cooper C, Moles DR, Kay E. Patient-centred care in general dental practice--a systematic review of the literature. BMC Oral Health 2014; 14:64. [PMID: 24902842 PMCID: PMC4054911 DOI: 10.1186/1472-6831-14-64] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Accepted: 05/21/2014] [Indexed: 12/30/2022] Open
Abstract
Background Delivering improvements in quality is a key objective within most healthcare systems, and a view which has been widely embraced within the NHS in the United Kingdom. Within the NHS, quality is evaluated across three key dimensions: clinical effectiveness, safety and patient experience, with the latter modelled on the Picker Principles of Patient-Centred Care (PCC). Quality improvement is an important feature of the current dental contract reforms in England, with “patient experience” likely to have a central role in the evaluation of quality. An understanding and appreciation of the evidence underpinning PCC within dentistry is highly relevant if we are to use this as a measure of quality in general dental practice. Methods A systematic review of the literature was undertaken to identify the features of PCC relevant to dentistry and ascertain the current research evidence base underpinning its use as a measure of quality within general dental practice. Results Three papers were identified which met the inclusion criteria and demonstrated the use of primary research to provide an understanding of the key features of PCC within dentistry. None of the papers identified were based in general dental practice and none of the three studies sought the views of patients. Some distinct differences were noted between the key features of PCC reported within the dental literature and those developed within the NHS Patient Experience Framework. Conclusions This systematic review reveals a lack of understanding of PCC within dentistry, and in particular general dental practice. There is currently a poor evidence base to support the use of the current patient reported outcome measures as indicators of patient-centredness. Further research is necessary to understand the important features of PCC in dentistry and patients’ views should be central to this research.
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Affiliation(s)
- Ian Mills
- NIHR Academic Clinical Fellow in General Dental Practice and Honorary Lecturer, Plymouth University Peninsula Schools of Medicine & Dentistry, Plymouth, UK.
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McDonald VM, Higgins I, Gibson PG. Managing older patients with coexistent asthma and chronic obstructive pulmonary disease: diagnostic and therapeutic challenges. Drugs Aging 2014; 30:1-17. [PMID: 23229768 DOI: 10.1007/s40266-012-0042-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Asthma and chronic obstructive pulmonary disease (COPD) are common obstructive airway diseases, especially among older people. These conditions are associated with a significant and increasing disease burden. The diagnosis and management of asthma and COPD in older populations are complex, and consequently clinicians are faced with many therapeutic and diagnostic challenges. Both aging and obstructive airway diseases are associated with complex co-morbidities and these coexisting illnesses confound management. Moreover, the age-related physiological changes that occur in the lungs may lead to airflow limitation, and this may be difficult to distinguish from an active disease state. In practice, management of asthma and COPD is informed by disease-specific clinical practice guidelines; however, most older people with these conditions are excluded from clinical trials that are designed to inform practice, creating major evidence gaps. Furthermore, seldom do clinical practice guidelines consider the complexities of management in older populations. The problems experienced by older people are complex and multifactorial and our approach to management must reflect these challenges. Opportunities exist to improve the management and outcomes for older people with obstructive airway disease and there is an urgent need for clinical trials to test management approaches in this population; current research must consider the challenges and evidence gaps that exist.
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Affiliation(s)
- Vanessa M McDonald
- Priority Research Centre for Asthma and Respiratory Diseases, University of Newcastle, Newcastle, NSW, Australia
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Bradley S, Mott S. Adopting a patient-centred approach: an investigation into the introduction of bedside handover to three rural hospitals. J Clin Nurs 2013; 23:1927-36. [DOI: 10.1111/jocn.12403] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Stacey Bradley
- Mount Gambier Regional Centre; University of South Australia; Mount Gambier SA Australia
| | - Sarah Mott
- Mount Gambier Regional Centre; University of South Australia; Mount Gambier SA Australia
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Urrutia I, Plaza V, Pascual S, Cisneros C, Entrenas LM, Luengo MT, Caballero F. Asthma control and concordance of opinions between patients and pulmonologists. J Asthma 2013; 50:877-83. [DOI: 10.3109/02770903.2013.819886] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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49
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Patient-centred care in general dental practice: sound sense or soundbite? Br Dent J 2013; 215:81-5. [DOI: 10.1038/sj.bdj.2013.684] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2013] [Indexed: 11/08/2022]
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50
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Sweeney LA, Warren O, Gardner L, Rojek A, Lindquist DG. A Simulation-Based Training Program Improves Emergency Department Staff Communication. Am J Med Qual 2013; 29:115-23. [DOI: 10.1177/1062860613491308] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Lynn A. Sweeney
- Brown University, Providence, RI
- The Miriam Hospital, Providence RI
- Rhode Island Hospital, Providence RI
| | - Otis Warren
- Brown University, Providence, RI
- The Miriam Hospital, Providence RI
- Rhode Island Hospital, Providence RI
| | | | | | - David G. Lindquist
- Brown University, Providence, RI
- The Miriam Hospital, Providence RI
- Rhode Island Hospital, Providence RI
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