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Wong TS, Chen Q, Liu T, Yu J, Gao Y, He Y, Zhong Q, Tan Z, Liu T, Lu J, Huang J, Zhang CJP, Yin L, Hu B, Ming WK. Patients, healthcare providers, and general population preferences for hemodialysis vascular access: a discrete choice experiment. Front Public Health 2024; 12:1047769. [PMID: 38784588 PMCID: PMC11112084 DOI: 10.3389/fpubh.2024.1047769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 04/16/2024] [Indexed: 05/25/2024] Open
Abstract
Background A patient-centered dialysis treatment option requires an understanding of patient preferences for alternative vascular accesses and nephrologists often face difficulties when recommending vascular access to end-stage kidney disease (ESKD) patients. We aimed to quantify the relative importance of various vascular access characteristics to patients, healthcare providers and general population, and how they affect acceptability for patients and healthcare providers. Methods In a discrete choice experiment, patients with maintenance hemodialysis (MHD), healthcare providers, and individuals from the general population were invited to respond to a series of hypothetical vascular access scenarios that differed in five attributes: cumulative patency, infection rate, thrombosis rate, cost, and time to maturation. We estimated the respondents' preference heterogeneity and relative importance of the attributes with a mixed logit model (MXL) and predicted the willingness to pay (WTP) of respondents via a multinomial logit model (MNL). Results Healthcare providers (n = 316) and the general population (n = 268) exhibited a favorable inclination toward longer cumulative patency, lower access infection rate and lower access thrombosis rate. In contrast, the patients (n = 253) showed a preference for a 3-year cumulative patency, 8% access infection rate, 35% access thrombosis rate and 1.5 access maturity time, with only the 3-year cumulative patency reaching statistical significance. Among the three respondent groups, the general population found cumulative patency less important than healthcare providers and patients did. Patients demonstrated the highest WTP for cumulative patency, indicating a willingness to pay an extra RMB$24,720(US$3,708) for each additional year of patency time. Conclusion Patients and healthcare providers had a strong preference for vascular access with superior patency. While the general population preferred vascular access with lower thrombosis rates. These results indicate that most patients prefer autogenous arteriovenous fistula (AVF) as an appropriate choice for vascular access due to its superior patency and lower complications than other vascular access types.
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Affiliation(s)
- Tak-Sui Wong
- Division of Nephrology, Department of Medicine, The First Affiliated Hospital, Jinan University, Guangzhou, China
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon, Hong Kong SAR, China
| | - Qian Chen
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Taoran Liu
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon, Hong Kong SAR, China
| | - Jing Yu
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon, Hong Kong SAR, China
| | - Yangyang Gao
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon, Hong Kong SAR, China
| | - Yan He
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon, Hong Kong SAR, China
| | - Qiongqiong Zhong
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Zijian Tan
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Tinlun Liu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
- International School, Jinan University, Guangzhou, China
| | - Jian Lu
- Division of Nephrology, Department of Medicine, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Jian Huang
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Bioinformatics Institute, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London, United Kingdom
| | - Casper J. P. Zhang
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Lianghong Yin
- Division of Nephrology, Department of Medicine, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Bo Hu
- Division of Nephrology, Department of Medicine, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Wai-Kit Ming
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon, Hong Kong SAR, China
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Al Hussein Al Awamlh B, Wallis CJD, Penson DF, Huang LC, Zhao Z, Conwill R, Talwar R, Morgans AK, Goodman M, Hamilton AS, Wu XC, Paddock LE, Stroup A, O’Neil BB, Koyama T, Hoffman KE, Barocas DA. Functional Outcomes After Localized Prostate Cancer Treatment. JAMA 2024; 331:302-317. [PMID: 38261043 PMCID: PMC10807259 DOI: 10.1001/jama.2023.26491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 12/04/2023] [Indexed: 01/24/2024]
Abstract
Importance Adverse outcomes associated with treatments for localized prostate cancer remain unclear. Objective To compare rates of adverse functional outcomes between specific treatments for localized prostate cancer. Design, Setting, and Participants An observational cohort study using data from 5 US Surveillance, Epidemiology, and End Results Program registries. Participants were treated for localized prostate cancer between 2011 and 2012. At baseline, 1877 had favorable-prognosis prostate cancer (defined as cT1-cT2bN0M0, prostate-specific antigen level <20 ng/mL, and grade group 1-2) and 568 had unfavorable-prognosis prostate cancer (defined as cT2cN0M0, prostate-specific antigen level of 20-50 ng/mL, or grade group 3-5). Follow-up data were collected by questionnaire through February 1, 2022. Exposures Radical prostatectomy (n = 1043), external beam radiotherapy (n = 359), brachytherapy (n = 96), or active surveillance (n = 379) for favorable-prognosis disease and radical prostatectomy (n = 362) or external beam radiotherapy with androgen deprivation therapy (n = 206) for unfavorable-prognosis disease. Main Outcomes and Measures Outcomes were patient-reported sexual, urinary, bowel, and hormone function measured using the 26-item Expanded Prostate Cancer Index Composite (range, 0-100; 100 = best). Associations of specific therapies with each outcome were estimated and compared at 10 years after treatment, adjusting for corresponding baseline scores, and patient and tumor characteristics. Minimum clinically important differences were 10 to 12 for sexual function, 6 to 9 for urinary incontinence, 5 to 7 for urinary irritation, and 4 to 6 for bowel and hormone function. Results A total of 2445 patients with localized prostate cancer (median age, 64 years; 14% Black, 8% Hispanic) were included and followed up for a median of 9.5 years. Among 1877 patients with favorable prognosis, radical prostatectomy was associated with worse urinary incontinence (adjusted mean difference, -12.1 [95% CI, -16.2 to -8.0]), but not worse sexual function (adjusted mean difference, -7.2 [95% CI, -12.3 to -2.0]), compared with active surveillance. Among 568 patients with unfavorable prognosis, radical prostatectomy was associated with worse urinary incontinence (adjusted mean difference, -26.6 [95% CI, -35.0 to -18.2]), but not worse sexual function (adjusted mean difference, -1.4 [95% CI, -11.1 to 8.3), compared with external beam radiotherapy with androgen deprivation therapy. Among patients with unfavorable prognosis, external beam radiotherapy with androgen deprivation therapy was associated with worse bowel (adjusted mean difference, -4.9 [95% CI, -9.2 to -0.7]) and hormone (adjusted mean difference, -4.9 [95% CI, -9.5 to -0.3]) function compared with radical prostatectomy. Conclusions and Relevance Among patients treated for localized prostate cancer, radical prostatectomy was associated with worse urinary incontinence but not worse sexual function at 10-year follow-up compared with radiotherapy or surveillance among people with more favorable prognosis and compared with radiotherapy for those with unfavorable prognosis. Among men with unfavorable-prognosis disease, external beam radiotherapy with androgen deprivation therapy was associated with worse bowel and hormone function at 10-year follow-up compared with radical prostatectomy.
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Affiliation(s)
| | - Christopher J. D. Wallis
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Urology, Department of Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - David F. Penson
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
- Veterans Affairs Tennessee Valley Geriatric Research Education and Clinical Center, Nashville
| | - Li-Ching Huang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Zhiguo Zhao
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ralph Conwill
- Office of Patient and Community Education, Patient Advocacy Program, Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ruchika Talwar
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Alicia K. Morgans
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Michael Goodman
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Ann S. Hamilton
- Department of Population and Public Health Sciences, Keck School of Medicine at the University of Southern California, Los Angeles
| | - Xiao-Cheng Wu
- Department of Epidemiology, Louisiana State University New Orleans School of Public Health, New Orleans
| | - Lisa E. Paddock
- Cancer Epidemiology Services, New Jersey Department of Health, Rutgers Cancer Institute of New Jersey, New Brunswick
- Rutgers School of Public Health, New Brunswick, New Jersey
| | - Antoinette Stroup
- Cancer Epidemiology Services, New Jersey Department of Health, Rutgers Cancer Institute of New Jersey, New Brunswick
- Rutgers School of Public Health, New Brunswick, New Jersey
| | - Brock B. O’Neil
- Department of Urology, University of Utah Health, Salt Lake City
| | - Tatsuki Koyama
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Karen E. Hoffman
- Department of Radiation Oncology, The University of Texas MD Anderson Center, Houston
| | - Daniel A. Barocas
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
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Gotfredsen K. Patient-reported outcomes for bone regenerative procedures. Periodontol 2000 2023; 93:270-276. [PMID: 37496403 DOI: 10.1111/prd.12500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/17/2023] [Accepted: 06/03/2023] [Indexed: 07/28/2023]
Abstract
Evidence-based dentistry used for decision-making and assessment of treatment includes three components: evidence from the literature, clinical expertise, and patient expectations. Patient satisfaction embraces affability, availability, and ability and can be examined using questionnaires or structured questions to the patient to evaluate patient perception of the treatment. The questions can be quantified using dichotomous, point, or visual analog scales. This would be a straightforward patient-reported outcome measure (PROM). Validated and specific oral health-related quality of life (OHRQoL) questionnaires such as the oral health impact profile (OHIP), oral impact on daily performance (OIDP), or the dental impact on daily living (DIDL) can be used as PROMs, and these measures are appropriate for population studies, where you can measure changes over time and differences between treatment groups. PROMs have shown to enhance patient engagement when integrated into clinical care. PROMs for bone regenerative procedures are mainly used as secondary outcome and are concentrating on the prosthetic outcome more than the pain, discomfort, anxiety, and cost of the surgical procedures. Surprisingly, most patients are satisfied and willing to have the procedures performed again. Whether this is recall bias or not and how the information's from the dentist and the team influence the patients answers to PROMs questionnaires are discussed. The importance of patient perspectives in bone regeneration procedures is obvious and combined with clinical outcome measures, it increases our ability to provide better care. Studies using PROMs as a primary outcome variable are required.
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Affiliation(s)
- Klaus Gotfredsen
- Section of Oral Rehabilitation, Department of Odontology, Faculty of Health Sciences, University of Copenhagen, København, Denmark
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Somohano VC, Smith CL, Saha S, McPherson S, Morasco BJ, Ono SS, Zaccari B, Lovejoy J, Lovejoy T. Patient-Provider Shared Decision-Making, Trust, and Opioid Misuse Among US Veterans Prescribed Long-Term Opioid Therapy for Chronic Pain. J Gen Intern Med 2023; 38:2755-2760. [PMID: 37118560 PMCID: PMC10506962 DOI: 10.1007/s11606-023-08212-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 04/12/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND Patient-provider shared decision-making is associated with better treatment adherence and pain outcomes in opioid-specific pain management. One possible mechanism through which shared decision-making may impact pain management outcomes is trust in one's prescribing provider. Elucidating relationships between factors that enhance the patient-provider relationship, such as shared decision-making and trust, may reduce risks associated with opioid treatment, such as opioid misuse. OBJECTIVE The purpose of this study was to investigate the mediating effect of trust in one's prescribing provider on the relationship between shared decision-making and current opioid misuse. DESIGN A secondary analysis of data from a prospective cohort study of US Veterans (N = 1273) prescribed long-term opioid therapy (LTOT) for chronic non-cancer pain. PARTICIPANTS Eligibility criteria included being prescribed LTOT, ability to speak and read English, and access to a telephone. Veterans were excluded if they had a cancer diagnosis, received opioid agonist therapy for opioid use disorder, or evidence of pending discontinuation of LTOT. Stratified random sampling was employed to oversample racial and ethnic minorities and women veterans. MAIN MEASURES Physician Participatory Decision-Making assessed level of patient involvement in medical decision-making, the Trust in Provider Scale assessed interpersonal trust in patient-provider relationships, and the Current Opioid Misuse Measure assessed opioid misuse. KEY RESULTS Patient-provider shared decision-making had a total significant effect on opioid misuse, in the absence of the mediator (c = - 0.243, p < 0.001), such that higher levels of shared decision-making were associated with lower levels of reported opioid misuse. When trust in provider was added to the mediation model, the indirect effect of shared decision-making on opioid misuse through trust in provider remained significant (c' = - 0.147, p = 0.007). CONCLUSIONS Shared decision-making is associated with less prescription opioid misuse through the trust that is fostered between patients and providers.
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Affiliation(s)
- Vanessa C Somohano
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
| | - Crystal L Smith
- Elson S. Floyd College of Medicine and the Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
| | - Somnath Saha
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
| | - Sterling McPherson
- Elson S. Floyd College of Medicine and the Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
| | - Benjamin J Morasco
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
- Department of Psychiatry, Oregon Health and Science University, Portland, OR, USA
| | - Sarah S Ono
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
- Department of Psychiatry, Oregon Health and Science University, Portland, OR, USA
| | - Belle Zaccari
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
- Department of Psychiatry, Oregon Health and Science University, Portland, OR, USA
| | - Jennette Lovejoy
- Department of Communication Studies, University of Portland, Portland, OR, USA
| | - Travis Lovejoy
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA.
- Department of Psychiatry, Oregon Health and Science University, Portland, OR, USA.
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Haskard-Zolnierek K, Martin LR, Bueno EH, Kruglikova-Sanchez Y. Physician-Patient Communication and Satisfaction in Spanish-Language Primary Care Visits. HEALTH COMMUNICATION 2023; 38:714-720. [PMID: 34482778 DOI: 10.1080/10410236.2021.1973176] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Language discordance poses a barrier to effective physician-patient communication, and health care outcomes, such as patient satisfaction, can be associated with language barriers experienced by Spanish-speaking patients. This exploratory study assessed specific aspects of communication between 128 Spanish-speaking primary care patients and their physicians (primary English speakers without an interpreter present). The rating scale developed for this study was used by five raters, who listened to audiotapes of each of these medical visits. Patients and physicians completed measures of visit satisfaction. Results indicated physicians with better Spanish-language skills were less frustrated with medical visit communication and more connected to their patients; patients whose physicians were rated as having better Spanish-speaking ability reported having greater choice in their medical care. Patients whose physicians spoke more Spanish were more satisfied with the information given by their physicians. Physicians rated as having better Spanish-speaking ability were more likely to say they could not understand all the patients wanted to tell them. These data support the importance of language concordance in physician-patient communication and awareness of potential communication barriers between physicians and patients.
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Rogalski D, Barnett N, Bueno de Mesquita A, Jubraj B. The Pharmacist Prescriber: A Psychological Perspective on Complex Conversations about Medicines: Introducing Relational Prescribing and Open Dialogue in Physical Health. PHARMACY 2023; 11:pharmacy11020062. [PMID: 36961040 PMCID: PMC10037595 DOI: 10.3390/pharmacy11020062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/09/2023] [Accepted: 03/15/2023] [Indexed: 03/25/2023] Open
Abstract
Pharmacists have traditionally supported the prescribing process, arguably in reactive or corrective roles. The advent of pharmacist prescribing in 2004 represented a major shift in practice, leading to greater responsibility for making clinical decisions with and for patients. Prescribing rights require pharmacists to take a more prescriptive role that will allow them to contribute to long-standing prescribing challenges such as poor medication adherence, overprescribing, and the need for shared decision-making and person-centered care. Central to these endeavors are the development and possession of effective consultation skills. University schools of pharmacists in the UK now routinely include consultation skills training, which is also provided by national education bodies. These challenges remain difficult to overcome, even though it is understood, for example, that increasing the effectiveness of adherence interventions may have a far greater impact on the health of the population than any improvement in specific medical treatments. More recently, a concerted effort has been made to tackle overprescribing and the harm that may occur through the inappropriate use of medication. In routine pharmacy work, these priorities may linger at the bottom of the list due to the busy and complex nature of the work. Solutions to these problems of adherence, optimizing benefits of medication, and overprescribing have typically been pragmatic and structured. However, an arguably reductionist approach to implementation fails to address the complex patient interactions around prescribing and taking medication, and the heterogeneity of the patient's experience, leaving the answers elusive. We suggest that it is essential to explore how person-centered care is perceived and to emphasize the relational aspects of clinical consultations. The development of routine pharmacist prescribing demands building on the core values of person-centered care and shared decision making by introducing the concepts of "relational prescribing" and "open dialogue" to cultivate an essential pharmacotherapeutic alliance to deliver concrete positive patient outcomes. We provide a vignette of how a clinical case can be approached using principles of relational prescribing and open dialogue. We believe these are solutions that are not additional tasks but must be embedded into pharmacy practice. This will improve professional satisfaction and resilience, and encourage curiosity and creativity, particularly with the advent of all pharmacists in Great Britain becoming prescribers at graduation from 2026.
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Affiliation(s)
- David Rogalski
- Camden and Islington NHS Foundation Trust, London RG24 9NA, UK
| | - Nina Barnett
- London North West University Healthcare NHS Trust, London HA1 3UJ, UK
- Medicines Use and Safety Division, NHS Specialist Pharmacy Service, London HA1 3UJ, UK
| | | | - Barry Jubraj
- Medicines Use and Safety Division, NHS Specialist Pharmacy Service, London HA1 3UJ, UK
- School of Pharmacy, University College London, London WC1E 6BT, UK
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Raji Y, Strony JT, Moon TJ, Smith KL, Sivasundaram L, Renko N, Victoroff BN, Gillespie RJ. Patients who have undergone total shoulder arthroplasty prefer greater surgeon involvement in shared decision making. J Shoulder Elbow Surg 2023; 32:645-652. [PMID: 36273791 DOI: 10.1016/j.jse.2022.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 09/11/2022] [Accepted: 09/28/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND There has been a shift in medical decision making from a paternalist model to a shared decision-making (SDM) approach, described as a patient-physician relationship where both parties collaborate to arrive on an evidence-based treatment regimen that best suits the patient's needs and values. However, there is a scarcity in evidence regarding SDM in shoulder arthroplasty. The purpose of this study was to evaluate overall patient preference for SDM and determine demographic and socioeconomic factors related to SDM preference in those undergoing shoulder arthroplasty. METHODS Patients aged 40-89 years who had undergone a total shoulder arthroplasty were enrolled. Two-part questionnaires were administered collecting patient demographic information and SDM subscale scores postoperatively. Bivariate and multivariate regression models were used to determine factors associated with SDM Total and subscale scores. RESULTS A total of 125 patients (53 male; mean age, 69.5 ± 10.4 years) who had undergone primary total shoulder arthroplasty were included. The mean Total SDM score was -2.24 ± 1.9 and the Preoperative, Operative, and Postoperative SDM subscale scores were -1.54 ± 2.0, -2.59 ± 2.2, and -2.48 ± 2.1, respectively, indicating a preference for SDM in the Preoperative subscale and surgeon-driven decision making in the total score and other 2 subscales. Multivariate regression models demonstrated a preference for surgeon decision making at both the 4-12-week postoperative period for the Preoperative subscale (odds ratio [OR] -1.03, 95% CI -2.0, -0.1, P = .039) and the 2-4-week postoperative period for the Operative subscale (OR -1.74, 95% CI -3.4, -0.1, P = .038) when compared to patients at the 2-week postoperative period. No other variables were significantly associated with any of the SDM subscale scores or Total SDM score. CONCLUSION Patients reported a more passive role in the decision-making process with an overall preference for a surgeon-led approach in primary total shoulder arthroplasty. Patients preferred a shared decision-making approach in regard to preoperative considerations but indicated a significant preference for surgeon-led decision making regarding day of surgery decisions. There were no correlations between SDM scores and age, sex, race, income, education level, insurance type, or treating surgeon. Overall, patients demonstrated a predilection for an SDM approach for preoperative considerations, contrary to those decisions associated with the day of surgery and postoperative care.
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Affiliation(s)
- Yazdan Raji
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
| | - John T Strony
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Tyler J Moon
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Kira L Smith
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Sports Medicine Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Lakshmanan Sivasundaram
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Nellie Renko
- Sports Medicine Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Brian N Victoroff
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Sports Medicine Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Robert J Gillespie
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Sports Medicine Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Tietbohl CK, Bergen C. "I was gonna ask you": How patients use agency framing to display engagement in primary care. Soc Sci Med 2022; 314:115496. [PMID: 36343460 DOI: 10.1016/j.socscimed.2022.115496] [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: 06/24/2022] [Revised: 09/22/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022]
Abstract
The message that patients should be responsible for their health is pervasive. Health promotion campaigns encourage patients to "ask your doctor" about potential illnesses and treatments, preventive medicine guidelines call for patients to self-monitor to avoid future health problems, and models like shared decision-making advocate for greater patient involvement in medical decisions. Research shows that patients can participate in medical dialogue by asking questions, but that doing so is difficult due to the structure and social norms of medical visits. In this article, we ask: how can patients participate more actively in medical care? Drawing on video recordings of older patients (aged 65 and older) and primary care physicians, we use conversation analysis to describe one practice that patients use to demonstrate personal responsibility for their health; agency framing. This involves prefacing questions to the doctor with phrases that project a prior intended action, such as "I was gonna ask you", "I was gonna tell you" or "I wanted to ask you". Patients use agency framing to cast their questions as 1) independently motivated, 2) well-informed, and 3) personally responsible. Consequently, patients exert agency within the confines of the medical visit structure to resist the potential interpretation that their question was responsive to the doctor or to the local interactional context. Rather, agency framing allows patients to show that their question was considered independently. Questions designed with agency framing work to portray the speaker as a responsible patient who is not only meeting the bare minimum of expected health maintenance, but is staying ahead of medical problems. This article discusses the particular importance of this practice among older patients, for whom demonstrating a willingness and ability to cope with medical problems may be significant for maintaining independence.
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Affiliation(s)
- Caroline K Tietbohl
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA; Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA.
| | - Clara Bergen
- Health & Innovations Division, Didi Hirsch Mental Health Services, Los Angeles, CA, USA; Division of Health Services Research and Management, City University of London School of Health Sciences, London, United Kingdom
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Patient activation reduces effects of implicit bias on doctor-patient interactions. Proc Natl Acad Sci U S A 2022; 119:e2203915119. [PMID: 35914161 PMCID: PMC9371681 DOI: 10.1073/pnas.2203915119] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Disparities between Black and White Americans persist in medical treatment and health outcomes. One reason is that physicians sometimes hold implicit racial biases that favor White (over Black) patients. Thus, disrupting the effects of physicians' implicit bias is one route to promoting equitable health outcomes. In the present research, we tested a potential mechanism to short-circuit the effects of doctors' implicit bias: patient activation, i.e., having patients ask questions and advocate for themselves. Specifically, we trained Black and White standardized patients (SPs) to be "activated" or "typical" during appointments with unsuspecting oncologists and primary care physicians in which SPs claimed to have stage IV lung cancer. Supporting the idea that patient activation can promote equitable doctor-patient interactions, results showed that physicians' implicit racial bias (as measured by an implicit association test) predicted racially biased interpersonal treatment among typical SPs (but not among activated SPs) across SP ratings of interaction quality and ratings from independent coders who read the interaction transcripts. This research supports prior work showing that implicit attitudes can undermine interpersonal treatment in medical settings and provides a strategy for ensuring equitable doctor-patient interactions.
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Sato A, Fujimori M, Shirai Y, Umezawa S, Mori M, Jinno S, Umehashi M, Okamura M, Okusaka T, Majima Y, Miyake S, Uchitomi Y. Assessing the need for a question prompt list that encourages end-of-life discussions between patients with advanced cancer and their physicians: A focus group interview study. Palliat Support Care 2022; 20:564-569. [PMID: 35876449 DOI: 10.1017/s1478951521001796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Early integration of palliative and cancer care improves the quality of life and is facilitated by discussions about the end of life after cessation of active cancer treatment between patients with advanced cancer and their physicians. However, both patients and physicians find end-of-life discussions challenging. The aim of this study was to assess the need for a question prompt list (QPL) that encourages end-of-life discussions between patients with advanced cancer and their physicians. METHODS Focus group interviews (FGIs) were conducted with 18 participants comprising 5 pancreatic cancer patients, 3 family caregivers, 4 bereaved family members, and 6 physicians. Three themes were discussed: question items that should be included in the QPL that encourages end-of-life discussions with patients, family caregivers, and physicians after cessation of active cancer treatment; when the QPL should be provided; and who should provide the QPL. Each interview was audio-recorded, and content analysis was performed. RESULTS The following 9 categories, with 57 question items, emerged from the FGIs: (1) preparing for the end of life, (2) treatment decision-making, (3) current and future quality of life, (4) current and future symptom management, (5) information on the transition to palliative care services, (6) coping with cancer, (7) caregivers' role, (8) psychological care, and (9) continuity of cancer care. Participants felt that the physician in charge of the patient's care and other medical staff should provide the QPL early during active cancer treatment. SIGNIFICANCE OF RESULTS Data were collected to develop a QPL that encourages end-of-life discussions between patients with advanced cancer and their physicians.
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Affiliation(s)
- Ayako Sato
- Division of Supportive Care and Translational Research Group, Institute for Cancer Control, National Cancer Center, Tokyo, Japan
- Tokyo Medical and Dental University, Tokyo, Japan
| | - Maiko Fujimori
- Division of Supportive Care and Translational Research Group, Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| | - Yuki Shirai
- Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | - Masanori Mori
- Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Sayaka Jinno
- Division of Supportive Care and Translational Research Group, Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| | - Mihoto Umehashi
- Division of Supportive Care and Translational Research Group, Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| | - Masako Okamura
- Division of Supportive Care and Translational Research Group, Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| | - Takuji Okusaka
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | | | | | - Yosuke Uchitomi
- Innovation Center for Supportive, Palliative and Psychosocial Care, National Cancer Center Hospital, Tokyo, Japan
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11
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Husted RS, Troelsen A, Husted H, Grønfeldt BM, Thorborg K, Kallemose T, Rathleff MS, Bandholm T. Knee-extensor strength, symptoms, and need for surgery after two, four, or six exercise sessions/week using a home-based one-exercise program: a randomized dose-response trial of knee-extensor resistance exercise in patients eligible for knee replacement (the QUADX-1 trial). Osteoarthritis Cartilage 2022; 30:973-986. [PMID: 35413476 DOI: 10.1016/j.joca.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/28/2022] [Accepted: 04/05/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate firstly the efficacy of three different dosages of one home-based, knee-extensor resistance exercise on knee-extensor strength in patients eligible for knee replacement, and secondly, the influence of exercise on symptoms, physical function and decision on surgery. METHOD One-hundred and forty patients eligible for knee replacement were randomized to three groups: 2, 4 or 6 home-based knee-extensor resistance exercise-sessions per week (group 2, 4 and 6 respectively) for 12 weeks. PRIMARY OUTCOME isometric knee-extensor strength. SECONDARY OUTCOMES Oxford Knee Score, Knee injury and Osteoarthritis Outcome Score, average knee pain last week (0-10 numeric rating scale), 6-min walk test, stair climbing test, exercise adherence and "need for surgery". RESULTS Primary analysis: Intention-to-treat analysis of 140 patients did not find statistically significant differences between the groups from baseline to after 12 weeks of exercise in isometric knee-extensor strength: Group 2 vs 4 (0.003 Nm/kg (0.2%) [95% CI -0.15 to 0.15], P = 0.965) and group 4 vs 6 (-0.04 Nm/kg (-2.7%) [95% CI -0.15 to 0.12], P = 0.628). Secondary analysis: Intention-to-treat analyses showed statistically significant differences between the two and six sessions/week groups in favor of the two sessions/week group for Oxford Knee Score: 4.8 OKS points (15.2%) [1.3 to 8.3], P = 0.008) and avg. knee pain last week (NRS 0-10): -1.3 NRS points (-19.5%) [-2.3 to -0.2], P = 0.018. After the 12-week exercise intervention, data were available for 117 patients (N = 39/group): 38 (32.5%) patients wanted surgery and 79 (67.5%) postponed surgery. This was independent of exercise dosage. CONCLUSION In patients eligible for knee-replacement we found no between-group differences in isometric knee extensor strength after 2, 4 and 6 knee-extensor resistance exercise sessions per week. We saw no indication of an exercise dose-response relationship for isometric knee-extensor strength and only clinically irrelevant within group changes. For some secondary outcome (e.g., KOOS subscales) we found clinically relevant within group changes, which could help explain why only one in three patients decided to have surgery after the simple home-based exercise intervention. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02931058. Preprint: https://doi.org/10.1101/2021.04.07.21254965.
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Affiliation(s)
- R S Husted
- Department of Clinical Research, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark; Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Department of Physical and Occupational Therapy, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark; Clinical Orthopedic Research Hvidovre (CORH), Department of Orthopedic Surgery, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark.
| | - A Troelsen
- Clinical Orthopedic Research Hvidovre (CORH), Department of Orthopedic Surgery, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark.
| | - H Husted
- Clinical Orthopedic Research Hvidovre (CORH), Department of Orthopedic Surgery, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark.
| | - B M Grønfeldt
- Department of Clinical Research, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark; Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Department of Physical and Occupational Therapy, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark.
| | - K Thorborg
- Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Department of Physical and Occupational Therapy, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark; Sports Orthopaedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark.
| | - T Kallemose
- Department of Clinical Research, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark.
| | - M S Rathleff
- Center for General Practice at Aalborg University, Aalborg, Denmark; Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Aalborg, Denmark; Department of Health Science and Technology, Aalborg University, Denmark.
| | - T Bandholm
- Department of Clinical Research, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark; Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Department of Physical and Occupational Therapy, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark; Clinical Orthopedic Research Hvidovre (CORH), Department of Orthopedic Surgery, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark.
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12
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Mitchell KAR, Brassil KJ, Osborne ML, Lu Q, Brown RF. Understanding racial-ethnic differences in patient-centered care (PCC) in oncology through a critical race theory lens: A qualitative comparison of PCC among Black, Hispanic, and White cancer patients. PATIENT EDUCATION AND COUNSELING 2022; 105:2346-2354. [PMID: 34857428 PMCID: PMC9117574 DOI: 10.1016/j.pec.2021.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 11/02/2021] [Accepted: 11/12/2021] [Indexed: 05/30/2023]
Abstract
OBJECTIVES Patient-centered care (PCC) experiences can vary by race and ethnicity and likely contribute to cancer care disparities. We compared PCC concepts between Non-Hispanic White (White), Hispanic, and Non-Hispanic Black (Black) cancer patients utilizing Critical Race Theory (CRT) to understand the relationships between racial-ethnic identity and PCC. METHODS A thematic analysis and in-depth CRT-informed analysis of individual interviews exploring patient values, unmet needs, preferences, and priorities were performed. RESULTS Participants were aged> 25 yrs old, 53% male, and included 5 Hispanic, 4 Black and 6 White cancer patients. Unmet needs for time to make decisions, and provider interaction between visits and the value for finding meaning in the illness emerged among Blacks and Whites. The unmet need for a long-term treatment plan emerged among Blacks, and the preference of research participation among Whites. A value for optimism was observed among Hispanics and Whites. Racial-ethnic variations in patient descriptions and experiences of their values, unmet needs, preferences, and priorities were identified. CONCLUSIONS Underrepresented groups face subtle but significant challenges in feeling cared for and understood, voicing concerns, and obtaining quality care. PRACTICE IMPLICATIONS Increased mutual understanding and provider knowledge of unique PCC experiences among underrepresented cancer patients are needed.
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Affiliation(s)
| | | | | | - Qian Lu
- Department of Health Disparities Research, Division of OVP, Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Richard F Brown
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
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Wang Q, Adhikari SP, Wu Y, Sunil TS, Mao Y, Ye R, Sun C, Shi Y, Zhou C, Sylvia S, Rozelle S, Zhou H. Consultation length, process quality and diagnosis quality of primary care in rural China: A cross-sectional standardized patient study. PATIENT EDUCATION AND COUNSELING 2022; 105:902-908. [PMID: 34391601 DOI: 10.1016/j.pec.2021.08.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 08/01/2021] [Accepted: 08/04/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Consultation length, the time spent between patient and health care provider during a visit, is an essential element in measuring quality of health care patients receive from a primary care facility. However, the linkage between consultation length and process quality and diagnosis quality of primary care is still uncertain. This study aims to examine the role consultation length plays in delivering process quality and diagnosis quality, two central components of overall primary care quality, in rural China. METHODS We recruited unannounced standardized patients (SPs) to present classic symptoms of angina and tuberculosis in selected healthcare facilities in three provinces of China. The consultation length and primary care quality of SPs were measured and compared with both international and national standards of care. Ordinary Least Squares (OLS) regressions for process quality (continuous dependent variable) and Logistic regressions for diagnosis quality (binary dependent variable) were performed to investigate the relationship between consultation length and primary care quality. RESULTS The average consultation lengths among patients with classic symptoms of angina and those with symptoms of tuberculosis were approximately 4.33 min and 6.28 min, respectively. Providers who spent more time with patients were significantly more likely to complete higher percentage of recommended checklist items of both questions and examinations for angina (β = 1.39, 95%CI 1.01-1.78) and tuberculosis (β = 0.89, 95%CI 0.69-1.08). Further, providers who spent more time with patients were more likely to make correct diagnosis for angina (marginal effect = 0.014, 95%CI 0.002-0.026) and for tuberculosis (marginal effect = 0.013, 95%CI 0.005-0.021). CONCLUSIONS The average consultation length is extremely short among primary care providers in rural China. The longer consultation leads to both better process and diagnosis quality of primary care. PRACTICE IMPLICATIONS We recommend primary care providers to increase the length of their communication with patients. To do so, government should implement healthcare reforms to clarify the requirements of affordable and reliable consultation length in medical care services. Moreover, such an experience can also be extended to other developing countries.
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Affiliation(s)
- Qingzhi Wang
- Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Sasmita Poudel Adhikari
- Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Yuju Wu
- Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Thankam S Sunil
- Department of Public Health, University of Tennessee, TN, USA
| | - Yuping Mao
- Department of Communication Studies, California State University, California, USA
| | - Ruixue Ye
- Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Chang Sun
- Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Yaojiang Shi
- Center for Experimental Economics in Education, Shaanxi Normal University, Xi'an, China
| | - Chengchao Zhou
- Institute of Social Medicine and Health Administration, School of Public Health, Shandong University, Jinan, China
| | - Sean Sylvia
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
| | - Scott Rozelle
- Freeman Spogli Institute, Stanford University, California, USA
| | - Huan Zhou
- Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
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Wang D, Zhang X, Chen H, Liu C. Applying Theory of Planned Behavior to Understand Physicians' Shared Decision-Making With Patients With Acute Respiratory Infections in Primary Care: A Cross-Sectional Study. Front Pharmacol 2022; 12:785419. [PMID: 35153747 PMCID: PMC8828912 DOI: 10.3389/fphar.2021.785419] [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: 09/29/2021] [Accepted: 12/17/2021] [Indexed: 11/25/2022] Open
Abstract
Background: To understand the physicians’ shared decision-making behavior (SDM) with patients with acute respiratory infections (ARIs) based on the theory of planned behavior (TPB) and identify barriers to the implementation of SDM in primary care. Methods: A cross-sectional study of 617 primary care physicians was conducted in primary facilities in Hubei province, China from December 2019 to January 2020. A self-administered questionnaire based on TPB theory was applied for measuring the physicians’ SDM behavior with patients presenting with ARIs. Results: The proposed TPB model revealed that attitude and subjective norms predicted behavior intention, and behavior intention was one significant predictor of SDM behavior (p < 0.001). After controlling for physicians’ demographic characteristics, receiving training regarding antibiotics was significantly associated with physicians’ attitudes toward SDM, while educational level and gender were significantly associated with physicians’ intention of engaging in SDM (p < 0.05). Physicians’ perceptions of patients’ expectations and incapability of making decisions were the most frequently reported barriers to the implementation of SDM. Conclusion: The TPB theory provides insights for understanding physicians’ SDM behavior with patients with ARIs in primary care. Since attitudes, subjective norms, and behavior intention were demonstrated as significant predictors of SDM behavior, these may be a promising focus of SDM interventions based on TPB theory. The results of the TPB model and potential barriers of SDM behavior would help determine future directions for SDM training and educating the public.
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Affiliation(s)
- Dan Wang
- School of Management, Hubei University of Chinese Medicine, Wuhan, China
| | - Xinping Zhang
- School of Medical Management and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Haihong Chen
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China
| | - Chenxi Liu
- School of Medical Management and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
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15
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White AEC, Hood-Medland EA, Kravitz RL, Henry SG. Visit Linearity in Primary Care Visits for Patients with Chronic Pain on Long-term Opioid Therapy. J Gen Intern Med 2022; 37:78-86. [PMID: 34159543 PMCID: PMC8738805 DOI: 10.1007/s11606-021-06917-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 05/05/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Physicians and patients report frustration after primary care visits for chronic pain. The need to shift between multiple clinical topics to address competing demands during visits may contribute to this frustration. OBJECTIVE This study creates a novel measure, "visit linearity," to assess visit organization and examines whether visits that require less shifting back and forth between topics are associated with better patient and physician visit experiences. It also explores whether visit linearity differs depending on the following: (1) whether or not pain is a major topic of the visit and (2) whether or not pain is the first topic raised. DESIGN This study analyzed 41 video-recorded visits using inductive, qualitative analysis informed by conversation analysis. We used linear regression to evaluate associations between visit organization and post-visit measures of participant experience. PARTICIPANTS Patients were established adult patients planning to discuss pain management during routine primary care. Physicians were internal or family medicine residents. MAIN MEASURES Visit linearity, total topics, return topics, topic shifts, time per topic, visit duration, pain main topic, pain first topic, patient experience, and physician difficulty. KEY RESULTS Visits had a mean of 8.1 total topics (standard deviation (SD)=3.46), 14.5 topic shifts (SD=6.28), and 1.9 topic shifts per topic (SD=0.62). Less linear visits (higher topic shifts to topic ratio) were associated with greater physician visit difficulty (β=7.28, p<0.001) and worse patient experience (β= -0.62, p=0.03). Visit linearity was not significantly impacted by pain as a major or first topic raised. CONCLUSIONS In primary care visits for patients with chronic pain taking opioids, more linear visits were associated with better physician and patient experience. Frequent topic shifts may be disruptive. If confirmed in future research, this finding implies that reducing shifts between topics could help decrease mutual frustration related to discussions about pain.
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Affiliation(s)
- Anne Elizabeth Clark White
- Department of Internal Medicine, University of California Davis, Sacramento, CA USA
- University of California Davis Center for Healthcare Policy and Research, Sacramento, CA USA
| | - Eve Angeline Hood-Medland
- Department of Internal Medicine, University of California Davis, Sacramento, CA USA
- University of California Davis Center for Healthcare Policy and Research, Sacramento, CA USA
| | - Richard L. Kravitz
- Department of Internal Medicine, University of California Davis, Sacramento, CA USA
- University of California Davis Center for Healthcare Policy and Research, Sacramento, CA USA
| | - Stephen G. Henry
- Department of Internal Medicine, University of California Davis, Sacramento, CA USA
- University of California Davis Center for Healthcare Policy and Research, Sacramento, CA USA
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16
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Wallis CJD, Zhao Z, Huang LC, Penson DF, Koyama T, Kaplan SH, Greenfield S, Luckenbaugh AN, Klaassen Z, Conwill R, Goodman M, Hamilton AS, Wu XC, Paddock LE, Stroup A, Cooperberg MR, Hashibe M, O’Neil BB, Hoffman KE, Barocas DA. Association of Treatment Modality, Functional Outcomes, and Baseline Characteristics With Treatment-Related Regret Among Men With Localized Prostate Cancer. JAMA Oncol 2022; 8:50-59. [PMID: 34792527 PMCID: PMC8603232 DOI: 10.1001/jamaoncol.2021.5160] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
IMPORTANCE Treatment-related regret is an integrative, patient-centered measure that accounts for morbidity, oncologic outcomes, and anxiety associated with prostate cancer diagnosis and treatment. OBJECTIVE To assess the association between treatment approach, functional outcomes, and patient expectations and treatment-related regret among patients with localized prostate cancer. DESIGN, SETTING, AND PARTICIPANTS This population-based, prospective cohort study used 5 Surveillance, Epidemiology, and End Results (SEER)-based registries in the Comparative Effectiveness Analysis of Surgery and Radiation cohort. Participants included men with clinically localized prostate cancer from January 1, 2011, to December 31, 2012. Data were analyzed from August 2, 2020, to March 1, 2021. EXPOSURES Prostate cancer treatments included surgery, radiotherapy, and active surveillance. MAIN OUTCOMES AND MEASURES Patient-reported treatment-related regret using validated metrics. Regression models were adjusted for demographic and clinicopathologic characteristics, treatment approach, and patient-reported functional outcomes. RESULTS Among the 2072 men included in the analysis (median age, 64 [IQR, 59-69] years), treatment-related regret at 5 years after diagnosis was reported in 183 patients (16%) undergoing surgery, 76 (11%) undergoing radiotherapy, and 20 (7%) undergoing active surveillance. Compared with active surveillance and adjusting for baseline differences, active treatment was associated with an increased likelihood of regret for those undergoing surgery (adjusted odds ratio [aOR], 2.40 [95% CI, 1.44-4.01]) but not radiotherapy (aOR, 1.53 [95% CI, 0.88-2.66]). When mediation by patient-reported functional outcomes was considered, treatment modality was not independently associated with regret. Sexual dysfunction, but not other patient-reported functional outcomes, was significantly associated with regret (aOR for change in sexual function from baseline, 0.65 [95% CI, 0.52-0.81]). Subjective patient-perceived treatment efficacy (aOR, 5.40 [95% CI, 2.15-13.56]) and adverse effects (aOR, 5.83 [95% CI, 3.97-8.58]), compared with patient expectations before treatment, were associated with treatment-related regret. Other patient characteristics at the time of treatment decision-making, including participatory decision-making tool scores (aOR, 0.80 [95% CI, 0.69-0.92]), social support (aOR, 0.78 [95% CI, 0.67-0.90]), and age (aOR, 0.78 [95% CI, 0.62-0.97]), were significantly associated with regret. Results were comparable when assessing regret at 3 years rather than 5 years. CONCLUSIONS AND RELEVANCE The findings of this cohort study suggest that more than 1 in 10 patients with localized prostate cancer experience treatment-related regret. The rates of regret appear to differ between treatment approaches in a manner that is mediated by functional outcomes and patient expectations. Treatment preparedness that focuses on expectations and treatment toxicity and is delivered in the context of shared decision-making should be the subject of future research to examine whether it can reduce regret.
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Affiliation(s)
- Christopher J. D. Wallis
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee,Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada,Division of Urology, Department of Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Zhiguo Zhao
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Li-Ching Huang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David F. Penson
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Tatsuki Koyama
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | - Amy N. Luckenbaugh
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Ralph Conwill
- Office of Patient and Community Education, Patient Advocacy Program, Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Franklin, Tennessee
| | - Michael Goodman
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Ann S. Hamilton
- Department of Preventative Medicine, Keck School of Medicine at the University of Southern California, Los Angeles
| | - Xiao-Cheng Wu
- Department of Epidemiology, Louisiana State University New Orleans School of Public Health, New Orleans
| | - Lisa E. Paddock
- Department of Epidemiology, Cancer Institute of New Jersey, Rutgers Health, New Brunswick
| | - Antoinette Stroup
- Department of Epidemiology, Cancer Institute of New Jersey, Rutgers Health, New Brunswick
| | | | - Mia Hashibe
- Department of Family and Preventative Medicine, University of Utah School of Medicine, Salt Lake City
| | - Brock B. O’Neil
- Department of Urology, University of Utah Health, Salt Lake City
| | - Karen E. Hoffman
- Department of Radiation Oncology, The University of Texas MD Anderson Center, Houston
| | - Daniel A. Barocas
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
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Morelli E, Mulas O, Caocci G. Patient-Physician Communication in Acute Myeloid Leukemia and Myelodysplastic Syndrome. Clin Pract Epidemiol Ment Health 2021; 17:264-270. [PMID: 35444710 PMCID: PMC8985469 DOI: 10.2174/1745017902117010264] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 08/09/2021] [Accepted: 08/17/2021] [Indexed: 11/22/2022]
Abstract
Introduction An effective communication is an integral part of the patient-physician relationship. Lack of a healthy patient-physician relationship leads to a lower level of patient satisfaction, scarce understanding of interventions and poor adherence to treatment regimes. Patients need to be involved in the therapeutic process and the assessment of risks and perspectives of the illness in order to better evaluate their options. Physicians, in turn, must convey and communicate information clearly in order to avoid misunderstandings and consequently poor medical care. The patient-physician relationship in cancer care is extremely delicate due to the complexity of the disease. In cancer diagnosis, the physician must adopt a communicative approach that considers the psychosocial factors, needs and patient's preferences for information,which in turn all contribute to affect clinical outcomes. Search Strategy and Methods This review was conducted using the Preferred Reporting Items for Systematic and Meta-analyses (PRISMA) statement. We included studies on the importance of physician-patient communication in Acute Myeloid Leukaemia and Myelodysplastic Syndrome care. We searched PubMed, Web of Sciences, Scopus, Google scholar for studies published from December 1 st , 2020 up to March 1 st , 2021. Using MeSH headings, we search for the terms "Physician and patient communication AND Acute Myeloid leukemia" or "Myelodysplastic syndrome" or "Doctor" or "Clinician", as well as variations thereof . Purpose of the Review This review examines the progress in communication research between patient and physician and focuses on the impact of communication styles on patient-physician relationshipin hematologic cancers, including Acute Myeloid Leukaemia and Myelodysplastic Syndromes.
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Affiliation(s)
- Emanuela Morelli
- Hematology and CTMO, Businco Hospital, ARNAS “G. Brotzu”, Cagliari, Italy
| | - Olga Mulas
- Hematology and CTMO, Businco Hospital, ARNAS “G. Brotzu”, Cagliari, Italy
| | - Giovanni Caocci
- Hematology and CTMO, Businco Hospital, ARNAS “G. Brotzu”, Cagliari, Italy
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Engaging Patients with Late-Stage Non-Small Cell Lung Cancer in Shared Decision Making about Treatment. J Pers Med 2021; 11:jpm11100998. [PMID: 34683140 PMCID: PMC8539978 DOI: 10.3390/jpm11100998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/28/2021] [Accepted: 09/30/2021] [Indexed: 11/16/2022] Open
Abstract
Few treatment decision support interventions (DSIs) are available to engage patients diagnosed with late-stage non-small cell lung cancer (NSCLC) in treatment shared decision making (SDM). We designed a novel DSI that includes care plan cards and a companion patient preference clarification tool to assist in shared decision making. The cards answer common patient questions about treatment options (chemotherapy, chemotherapy plus immunotherapy, targeted therapy, immunotherapy, clinical trial participation, and supportive care). The form elicits patient treatment preference. We then conducted interviews with clinicians and patients to obtain feedback on the DSI. We also trained oncology nurse educators to implement the prototype. Finally, we pilot tested the DSI among five patients with NSCLC at the beginning of an office visit scheduled to discuss treatment with an oncologist. Analyses of pilot study baseline and exit survey data showed that DSI use was associated with increased patient awareness of the alternatives' treatment options and benefits/risks. In contrast, patient concern about treatment costs and uncertainty in treatment decision making decreased. All patients expressed a treatment preference. Future randomized controlled trials are needed to assess DSI implementation feasibility and efficacy in clinical care.
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Expectations and behaviour of older adults with neurological disorders regarding general practitioner consultations: an observational study. BMC Geriatr 2021; 21:512. [PMID: 34563125 PMCID: PMC8466933 DOI: 10.1186/s12877-021-02469-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 09/10/2021] [Indexed: 12/30/2022] Open
Abstract
Background Patients’ relationship with their GPs is linked to adherence, patient behaviour and satisfaction with healthcare. Several factors pertaining to this relationship have already been identified, however expectations and preferences vary depending on age and diagnosis. Chronically ill elderly patients constitute a group of patients with specific needs that are not yet understood. Methods For this observational study, 100 (44 female, mean age 72.72 + − 8.28 years) patients were interviewed. Multiple linear or binary logistic regression as well as analysis of variance was used to understand the link between factors pertaining to GP relationship and patient behaviour, and principal component analysis was performed to understand the underlying structure of patients’ needs. Results Patients attribute high importance to their GP’s opinion of them. On average, what the GP thinks about the patients is almost as important as what their partners think. Patients primarily want to be perceived as engaged, friendly and respected individuals, and it is important for patients to be liked by their GP. This importance is linked to active preparation; 65% of the patients prepared actively for GP consultations. Expectations regarding GP consultations can be split into two components: a medical aspect with a subfactor concerning emotional support, and a social component. Prominent factors influencing the relationship are the possibility to talk about emotions and mental well-being, trust, and GP competency. Satisfaction and trust were mainly linked to medical competency. Being able to show emotions or talk about mental well-being enhances perceived GP competence, satisfaction, and active patient preparation. However, a focus on the social component such as frequent talking about private topics reduces both perceived GP competency as well as active patient preparation. Conclusion Older patients take GP consultations seriously, and their expectations regarding GP consultations focus on medical competence and care as well as empathetic listening and understanding. Older persons seek a deeper connection to their GPs and are willing to be active and cooperative. As the patient–GP relationship influences health outcomes, treatment of older patients should be adjusted to enable this active participation. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02469-3.
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20
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Tait RC, Chibnall JT, Kalauokalani D. Patient Perceptions of Physician Burden in the Treatment of Chronic Pain. THE JOURNAL OF PAIN 2021; 22:1060-1071. [PMID: 33727158 DOI: 10.1016/j.jpain.2021.03.140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/22/2021] [Accepted: 03/01/2021] [Indexed: 12/30/2022]
Abstract
While patient perceptions of burden to caregivers is of recognized clinical significance among people with chronic pain, perceived burden to treating physicians has not been studied. This study examined how people with chronic pain perceived levels of medical evidence (low vs high) and pain severity (4,6,8/10) to influence physician burden and how burden then mediated expected clinical judgments. 476 people with chronic pain read vignettes describing a hypothetical patient with varying levels of medical evidence and pain severity from the perspective of a treating physician, rated the burden that patient care would pose, and made a range of clinical judgments. The effect of pain severity on clinical judgments was expected to interact with medical evidence and be conditionally mediated by burden. Although no associations with burden were found for the pain severity x medical evidence interaction or for pain severity alone, low levels of supporting medical evidence yielded higher burden ratings. Burden significantly mediated medical evidence effects on judgments of symptom credibility, clinical improvement, and psychosocial dysfunction. Results indicate that perceived physician burden negatively influenced judgments of patients with chronic pain, beyond the direct effects of medical evidence. Implications are discussed for clinical practice, as well as future research. PERSPECTIVE: : People with chronic pain expect physicians to view the care of patients without supporting medical evidence as burdensome. Higher burden is associated with less symptom credibility, more psychosocial dysfunction, and less treatment benefit. Perceived physician burden appears to impact how patients approach treatment, with potentially adverse implications for clinical practice.
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Affiliation(s)
- Raymond C Tait
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University, St. Louis, Missouri.
| | - John T Chibnall
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University, St. Louis, Missouri
| | - Donna Kalauokalani
- Chairman of the Board, American Chronic Pain Association, Rocklin, California
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21
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Lee T, Rosario H, Cifuentes E, Cui J, Lin EC, Miller VA, Lin HC. Review of interruptions in a pediatric subspecialty outpatient clinic. PLoS One 2021; 16:e0254528. [PMID: 34324552 PMCID: PMC8320932 DOI: 10.1371/journal.pone.0254528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 06/29/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The objective of this study was to describe interruptions in the pediatric ambulatory setting and to assess their impact on perceived physician communication, patient satisfaction and recall of provided physician instructions. METHODS An observational study was performed at the Children's Hospital of Philadelphia, Pediatric Gastroenterology clinic. Participation consisted of video recording the clinic visit and the caregiver completed post-visit surveys on communication and satisfaction. Video recordings were coded for interruptions, which were divided into 3 main categories: Visit Associated, Pediatric Associated, and Unanticipated. An interruption rate was calculated and correlated with the following outcome variables to assess the impact of interruptions: caregiver satisfaction, caregiver perception on the quality of physician communication, and caregiver instruction recall. RESULTS There were 675 interruptions noted in the 81 clinic visits, with an average of 7.96 (σ = 7.68) interruptions per visit. Six visits had no interruptions. The Patient was the most frequent interrupter. Significantly higher interruption rates occurred in clinic visits with younger patients (<7 years old) with most of the interruptions being Pediatric Associated interruptions. There was minimal correlation between the clinic visit interruption rate and caregiver satisfaction with the communication, caregiver perception of quality of communication, or caregiver instruction recall rate. CONCLUSION The effect of interruptions on the pediatric visit remains unclear. Interruptions may be part of the communication process to ensure alignment of the patient's agenda. Additional studies are needed to help determine the impact of interruptions and guide medical education on patient communication.
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Affiliation(s)
- Tyler Lee
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA, Division of Gastroenterology, Hepatology, and Nutrition, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Hinette Rosario
- Division of Gastroenterology, Hepatology, and Nutrition, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Elizabeth Cifuentes
- Division of Gastroenterology, Hepatology, and Nutrition, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Jiawei Cui
- Division of Gastroenterology, Hepatology, and Nutrition, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Emery C. Lin
- Department of Medicine, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Victoria A. Miller
- Division of Adolescent Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Henry C. Lin
- Division of Pediatric Gastroenterology, Doernbecher Children’s Hospital, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, United States of America
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Crocker JB, Lynch SH, Guarino AJ, Lewandrowski K. The Impact of Point-of-Care Hemoglobin A1c Testing on Population Health-Based Onsite Testing Adherence: A Primary-Care Quality Improvement Study. J Diabetes Sci Technol 2021; 15:561-567. [PMID: 33233954 PMCID: PMC8120050 DOI: 10.1177/1932296820972751] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The hemoglobin A1c (HbA1c) is a gold-standard test to diagnose and monitor diabetes mellitus and has been incorporated into population health performance metrics for quality care. However, patients and practices remain challenged in completing timely HbA1c tests. Point-of-care testing (POCT) for HbA1c provides a quick, easy, reliable method for monitoring diabetes in the primary care office setting. The objectives of this quality improvement study were to evaluate the impact of HbA1c POCT on onsite HbA1c testing frequency as a component of population health performance, as well as to measure the utility of HbA1c POCT in identifying clinically meaningful change in disease. METHOD Prospective quality improvement cohort study among sequentially scheduled adult patients with diabetes due for HbA1c testing across three primary care practices. RESULTS Practices with HbA1c POCT were 3.7 times less likely to miss HbA1c testing at the time of the visit compared with practices in which HbA1c POCT was not available (P < .001). Nearly one in four patients in each group were found to have clinically worsening diabetes (defined by an increase in HbA1c of ≥0.5% or 5.5 mmol/mol). Nearly half of those patients in the intervention group were identified by POCT. CONCLUSIONS HbA1c POCT can improve population health-driven HbA1c testing adherence at office visits in primary care and may enable more timely intervention of diabetes management for patients with worsening disease.
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Affiliation(s)
- Joseph Benjamin Crocker
- Department of Medicine, Division of
General Internal Medicine, Massachusetts General Hospital/Ambulatory Practice of the
Future, Harvard Medical School, Boston, MA, USA
- Joseph Benjamin Crocker, MD, Massachusetts
General Hospital/Ambulatory Practice of the Future, 101 Merrimac St, Suite 1000,
Boston, MA 02114, USA.
| | - Stephen H. Lynch
- Department of Medicine, Division of
General Internal Medicine, Massachusetts General Hospital/Ambulatory Practice of the
Future, Boston, MA, USA
| | - Anthony J. Guarino
- Fulbright Specialist Program, U.S.
Department of State, Washington, DC, USA
| | - Kent Lewandrowski
- Department of Pathology, Division of
Medicine, Massachusetts General Hospital, Boston, MA, USA
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23
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Glinert LH. Communicative and Discursive Perspectives on the Medication Experience. PHARMACY 2021; 9:pharmacy9010042. [PMID: 33671135 PMCID: PMC8006053 DOI: 10.3390/pharmacy9010042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/01/2021] [Accepted: 02/11/2021] [Indexed: 11/29/2022] Open
Abstract
Taking the ‘medication experience’ in the broad sense of what individuals hear and say about their medication, as well as how they experience it, this paper explores diverse research on medication information available to patients and their modes and capacities for interaction, including personal circles, doctors and pharmacists, labeling and promotion, websites, and the patient’s own inner conversations and self-expression. The goal is to illustrate, for nonspecialists in communication, how the actors, messages, mediums, genres, and contextual factors within a standard ethnographic and social semiotic model of discourse and communication are operating, not always effectively or beneficially, to mediate or construct a patient’s medication experience. We also suggest how disparate insights can be integrated through such a model and might generate new research questions.
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Affiliation(s)
- Lewis H Glinert
- Middle Eastern Studies and Linguistics, Dartmouth College, NH 03755, USA
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24
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Mariano DJ, Liu A, Eppler SL, Gardner MJ, Hu S, Safran M, Chou L, Amanatullah DF, Kamal RN. Does a Question Prompt List Improve Perceived Involvement in Care in Orthopaedic Surgery Compared with the AskShareKnow Questions? A Pragmatic Randomized Controlled Trial. Clin Orthop Relat Res 2021; 479:225-232. [PMID: 33239521 PMCID: PMC7899535 DOI: 10.1097/corr.0000000000001582] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 10/30/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Most conditions in orthopaedic surgery are preference-sensitive, where treatment choices are based on the patient's values and preferences. One set of tools increasingly used to help align treatment choices with patient preferences are question prompt lists (QPLs), which are comprehensive lists of potential questions that patients can ask their physicians during their encounters. Whether or not a comprehensive orthopaedic-specific question prompt list would increase patient-perceived involvement in care more effectively than might three generic questions (the AskShareKnow questions) remains unknown; learning the answer would be useful, since a three-question list is easier to use compared with the much lengthier QPLs. QUESTION/PURPOSE Does an orthopaedic-specific question prompt list increase patient-perceived involvement in care compared with the three generic AskShareKnow questions? METHODS We performed a pragmatic randomized controlled trial of all new patients visiting a multispecialty orthopaedic clinic. A pragmatic design was used to mimic normal clinical care that compared two clinically acceptable interventions. New patients with common orthopaedic conditions were enrolled between August 2019 and November 2019 and were randomized to receive either the intervention QPL handout (orthopaedic-specific QPL with 45 total questions, developed with similar content and length to prior QPLs used in hand surgery, oncology, and palliative care) or a control handout (the AskShareKnow model questions, which are: "What are my options? What are the benefits and harms of those options? How likely are each of those benefits and harms to happen to me?") before their visits. A total of 156 patients were enrolled, with 78 in each group. There were no demographic differences between the study and control groups in terms of key variables. After the visit, patients completed the Perceived Involvement in Care Scale (PICS), a validated instrument designed to evaluate patient-perceived involvement in their care, which served as the primary outcome measure. This instrument is scored from 0 to 13, with higher scores indicating higher perceived involvement. RESULTS There was no difference in mean PICS scores between the intervention and control groups (QPL 8.3 ± 2.3, control 8.5 ± 2.3, mean difference 0.2 [95% CI -0.53 to 0.93 ]; p = 0.71. CONCLUSION In patients undergoing orthopaedic surgery, a QPL does not increase patient-perceived involvement in care compared with providing patients the three AskShareKnow questions. Implementation of the three AskShareKnow questions can be a more efficient way to improve patient-perceived involvement in their care compared with a lengthy QPL. LEVEL OF EVIDENCE Level II, therapeutic study.
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Affiliation(s)
- David J Mariano
- D. J. Mariano, A. Liu, S. L. Eppler, M. J. Gardner, S. Hu, M. Safran, L. Chou, D. F. Amanatullah, R. N. Kamal, VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, CA, USA
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25
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Wolfe C, Pestian T, Gecili E, Su W, Keogh RH, Pestian JP, Seid M, Diggle PJ, Ziady A, Clancy JP, Grossoehme DH, Szczesniak RD, Brokamp C. Cystic Fibrosis Point of Personalized Detection (CFPOPD): An Interactive Web Application. JMIR Med Inform 2020; 8:e23530. [PMID: 33325834 PMCID: PMC7773511 DOI: 10.2196/23530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/02/2020] [Accepted: 10/30/2020] [Indexed: 01/01/2023] Open
Abstract
Background Despite steady gains in life expectancy, individuals with cystic fibrosis (CF) lung disease still experience rapid pulmonary decline throughout their clinical course, which can ultimately end in respiratory failure. Point-of-care tools for accurate and timely information regarding the risk of rapid decline is essential for clinical decision support. Objective This study aims to translate a novel algorithm for earlier, more accurate prediction of rapid lung function decline in patients with CF into an interactive web-based application that can be integrated within electronic health record systems, via collaborative development with clinicians. Methods Longitudinal clinical history, lung function measurements, and time-invariant characteristics were obtained for 30,879 patients with CF who were followed in the US Cystic Fibrosis Foundation Patient Registry (2003-2015). We iteratively developed the application using the R Shiny framework and by conducting a qualitative study with care provider focus groups (N=17). Results A clinical conceptual model and 4 themes were identified through coded feedback from application users: (1) ambiguity in rapid decline, (2) clinical utility, (3) clinical significance, and (4) specific suggested revisions. These themes were used to revise our application to the currently released version, available online for exploration. This study has advanced the application’s potential prognostic utility for monitoring individuals with CF lung disease. Further application development will incorporate additional clinical characteristics requested by the users and also a more modular layout that can be useful for care provider and family interactions. Conclusions Our framework for creating an interactive and visual analytics platform enables generalized development of applications to synthesize, model, and translate electronic health data, thereby enhancing clinical decision support and improving care and health outcomes for chronic diseases and disorders. A prospective implementation study is necessary to evaluate this tool’s effectiveness regarding increased communication, enhanced shared decision-making, and improved clinical outcomes for patients with CF.
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Affiliation(s)
- Christopher Wolfe
- Division of Biostatistics & Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Teresa Pestian
- Division of Biostatistics & Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Emrah Gecili
- Division of Biostatistics & Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Weiji Su
- Division of Biostatistics & Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Department of Mathematical Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Ruth H Keogh
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - John P Pestian
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States.,Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Michael Seid
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States.,Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,James M Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Peter J Diggle
- Centre for Health Informatics, Computing, and Statistics, Lancaster Medical School, Lancaster University, Lancaster, United Kingdom.,Health Data Research UK, London, United Kingdom
| | - Assem Ziady
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States.,Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - John Paul Clancy
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States.,Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Cystic Fibrosis Foundation, Bethesda, MD, United States
| | - Daniel H Grossoehme
- Haslinger Family Pediatric Palliative Care Center, Akron Children's Hospital, Akron, OH, United States.,Rebecca D Considine Research Institute, Akron Children's Hospital, Akron, OH, United States.,Division of Family & Community Medicine, Akron Children's Hospital, Akron, OH, United States
| | - Rhonda D Szczesniak
- Division of Biostatistics & Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States.,Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Cole Brokamp
- Division of Biostatistics & Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States
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The Chinese Version of Rochester Participatory Decision-Making Scale (RPAD): Reliability and Validity. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:4343815. [PMID: 33381201 PMCID: PMC7749781 DOI: 10.1155/2020/4343815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/10/2020] [Accepted: 10/23/2020] [Indexed: 11/17/2022]
Abstract
Aim This study aims to translate the Rochester Participatory Decision-Making Scale (RPAD) into the Chinese language and to test the reliability and validity of the Chinese version of the scale in the gynecological clinic. Methods After obtaining the permission of the original author, the Brislin translation model was used to forward-translation and back-translation. Then, an expert group was set up to discuss this scale and result in cross-cultural adaptation. A convenient sampling method was used to select ten doctors working in the gynecological clinic of two top-three hospitals and 20 patients of each doctor. The Rochester Decision Participation Scale was used by the Chinese version for investigation. Results The Chinese version of the Rochester Participatory Decision-Making Scale has a Cronbach's α coefficient of 0.604 for the total content reliability, the Spearman–Brown coefficient of half-reliability is 0.646, and the Guttman coefficient of half-reliability is 0.612. The retest reliability is 0.922. By exploratory factor analysis, the scale extracted three common factors, and the standard factor load corresponding to each entry is higher than 0.4. Conclusion The reliability and validity of the Chinese version in the Rochester Participatory Decision-Making Scale are acceptable, which can be used to evaluate doctors “promotion of patients” participation in decision-making.
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Implementing a multilevel intervention to accelerate colorectal cancer screening and follow-up in federally qualified health centers using a stepped wedge design: a study protocol. Implement Sci 2020; 15:96. [PMID: 33121536 PMCID: PMC7599111 DOI: 10.1186/s13012-020-01045-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/10/2020] [Indexed: 12/31/2022] Open
Abstract
Background Screening for colorectal cancer (CRC) not only detects disease early when treatment is more effective but also prevents cancer by finding and removing precancerous polyps. Because many of our nation’s most disadvantaged and vulnerable individuals obtain health care at federally qualified health centers, these centers play a significant role in increasing CRC screening among the most vulnerable populations. Furthermore, the full benefits of cancer screenings must include timely and appropriate follow-up of abnormal results. Thus, the purpose of this study is to implement a multilevel intervention to increase rates of CRC screening, follow-up, and referral-to-care in federally qualified health centers, as well as simultaneously to observe and to gather information on the implementation process to improve the adoption, implementation, and sustainment of the intervention. The multilevel intervention will target three different levels of influences: organization, provider, and individual. It will have multiple components, including provider and staff education, provider reminder, provider assessment and feedback, patient reminder, and patient navigation. Methods This study is a multilevel, three-phase, stepped wedge cluster randomized trial with four clusters of clinics from four different FQHC systems. In the first phase, there will be a 3-month waiting period during which no intervention components will be implemented. After the 3-month waiting period, we will randomize two clusters to cross from the control to the intervention and the remaining two clusters to follow 3 months later. All clusters will stay at the same phase for 9 months, followed by a 3-month transition period, and then cross over to the next phase. Discussion There is a pressing need to reduce disparities in CRC outcomes, especially among racial/ethnic minority populations and among populations who live in poverty. Single-level interventions are often insufficient to lead to sustainable changes. Multilevel interventions, which target two or more levels of changes, are needed to address multilevel contextual influences simultaneously. Multilevel interventions with multiple components will affect not only the desired outcomes but also each other. How to take advantage of multilevel interventions and how to implement such interventions and evaluate their effectiveness are the ultimate goals of this study. Trial registration This protocol is registered at clinicaltrials.gov (NCT04514341) on 14 August 2020.
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Röttele N, Schöpf-Lazzarino AC, Becker S, Körner M, Boeker M, Wirtz MA. Agreement of physician and patient ratings of communication in medical encounters: A systematic review and meta-analysis of interrater agreement. PATIENT EDUCATION AND COUNSELING 2020; 103:1873-1882. [PMID: 32376141 DOI: 10.1016/j.pec.2020.04.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 03/29/2020] [Accepted: 04/03/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To determine the agreement of physician and patient ratings of communication in medical face-to-face consultations. METHODS A systematic search of twelve databases was conducted. Studies investigating agreement between physician and patient ratings of communication in medical face-to-face encounters and reporting interrater agreement were included. Methodological quality was assessed, and study characteristics and physician-patient agreement were narratively summarized. Meta-analysis was conducted for a subsample of the included studies investigating shared decision making. RESULTS Of the 17 included studies, ten studies did not demonstrate any correspondence between physician and patient ratings. The remaining seven studies revealed poor to fair absolute agreement (κ between .13 and .42; κw between .31 and .49; 95% CI 0.13 - 0.76) and poor to moderate consistency (r = .17 and .06; rpolyc between .39 and .63; p < .05). Meta-analysis of six studies yielded small association (rpolyc = .15). CONCLUSION Physicians and patients evaluate communication differently and at best, only slightly agree in their ratings, indicating that the construct of communication is not measurable in a stable manner. PRACTICE IMPLICATIONS Decision makers and researchers should be aware that they assess different aspects of communication, depending on the perspective examined. PROSPERO registration number: CRD42019120065.
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Affiliation(s)
- Nicole Röttele
- Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Andrea C Schöpf-Lazzarino
- Division of General Practice/Family Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Sonja Becker
- Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Mirjam Körner
- Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Martin Boeker
- Medical Data Science, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Markus A Wirtz
- Department of Research Methods, Freiburg University of Education, Freiburg, Germany
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Matthies N, Keshen S, Lewis S, Webster F, Perruccio AV, Rampersaud YR. An Exploratory Analysis of Spine Patients' Preoperative Concerns and Decision-making Process: Does What Surgeons Say Matter? Spine (Phila Pa 1976) 2020; 45:1067-1072. [PMID: 32675614 DOI: 10.1097/brs.0000000000003456] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cross-sectional, pre-post patient survey. OBJECTIVE The aim of this study was to determine what factors affect a patient's decision to undergo elective surgery following a surgical consultation. SUMMARY OF BACKGROUND DATA The surgical consultation is an important step in selecting and preparing patients for elective surgery. Despite the proven effectiveness and low risk of complications, many spine procedure candidates may still choose to forgo surgery after an appropriate discussion and clear surgical indications. METHODS Survey and open-response questions regarding pre- and post-consultation surgical concerns and overall willingness to undergo surgery were collected and analyzed from 124 patients deemed surgical candidates. Demographics, surgical willingness, and patient concerns were analyzed. Open-ended response data were tallied for surgical concerns and responses were analyzed line-by-line to assess for main themes. Sub-analysis was included on patients who reconsidered their willingness post-consultation. RESULTS Qualitative thematic analysis of patient's concerns regarding surgery uncovered six major themes: Interference on quality of life (QOL), fear, physical concerns, success, risk, and concerns regarding the surgeon (CS). Success and risk were most commonly mentioned pre-consultation (27%, 26%); risk and QOL were most commonly mentioned post-consultation (22%, 21%). Of 124 patients, 103 were willing to have surgery before consultation and remained willing post-consultation; six patients became unwilling. Twenty-one patients were unwilling to consider surgery before consultation; only five remained unwilling. No differences were found between degenerative and deformity patients regarding initial willingness or changes thereafter. CONCLUSION The decision to undergo surgery is a multifactorial and complex process with a variety of patient concerns. We grouped these concerns into six categories to aid in future discussion with patients. 87% of patients have made up their mind before attending their surgical consultation. Appropriate understanding of patient-specific willingness and concerns should help facilitate necessary discussion and aid in a more efficient and useful shared decision-making process. LEVEL OF EVIDENCE 4.
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Mateo-Abad M, González N, Fullaondo A, Merino M, Azkargorta L, Giné A, Verdoy D, Vergara I, de Manuel Keenoy E. Impact of the CareWell integrated care model for older patients with multimorbidity: a quasi-experimental controlled study in the Basque Country. BMC Health Serv Res 2020; 20:613. [PMID: 32620116 PMCID: PMC7333301 DOI: 10.1186/s12913-020-05473-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 06/26/2020] [Indexed: 11/14/2022] Open
Abstract
Background Older patients with multimorbidity have complex health and social care needs, associated with elevated use of health care resources. The aim of this study is to evaluate the impact of CareWell integrated care model for older patients with multimorbidity in the Basque Country. Methods The CareWell program for older patients with multimorbidity, based on the coordination between health providers, home-based care and patient empowerment, supported by information and communication technology tools. The program was deployed in four healthcare areas in the Basque Country. The control group was formed by two organizations in which the program had not been deployed and regular care procedures were applied. Participants, older patients (aged ≥65) with two or more chronic conditions (at least one being chronic obstructive pulmonary disease, chronic heart failure, or diabetes mellitus), categorized as complex according to a risk stratification algorithm, were followed up to 12 months. The impact of the program on the use of health resources, clinical effectiveness, and satisfaction was evaluated using a mixed-method approach. Semi-structured interviews were performed to assess satisfaction with the newly deployed model and mixed regression models to measure the effect of the intervention throughout the follow-up period. Results Two hundred patients were recruited (101 intervention and 99 control), mostly males (63%) with a mean age of 79 years and age-adjusted Charlson Comorbidity Index of 9.7 on average. Relevant differences between the groups were observed for all dimensions. In the intervention group, the number of hospitalizations and visits to emergency centers was reduced, and the number of primary care contacts increased. Clinical changes were also observed, such as a decrease in the body mass index and blood glucose levels. The satisfaction level was high for all stakeholders. Conclusion The implementation of CareWell integrated care model changed the profile of health resource utilization, strengthening the key role of primary care and reducing the number of emergency visits and hospitalizations. The satisfaction with this model of care was high. Trial registration ClinicalTrials.gov, NCT03042039. Registered 3 February 2017 - Retrospectively registered.
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Affiliation(s)
- Maider Mateo-Abad
- Kronikgune Institute for Health Services Research, Barakaldo, Basque Country, Spain. .,Health Services Research on Chronic Patients Network (REDISSEC), Barakaldo, Basque Country, Spain.
| | - Nerea González
- Kronikgune Institute for Health Services Research, Barakaldo, Basque Country, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Barakaldo, Basque Country, Spain.,Osakidetza Basque Health Service, Hospital Galdakao-Usansolo, Galdakao, Basque Country, Spain
| | - Ane Fullaondo
- Kronikgune Institute for Health Services Research, Barakaldo, Basque Country, Spain
| | - Marisa Merino
- Osakidetza Basque Health Service, Tolosaldea Integrated Health Care Organization, Tolosa, Basque Country, Spain.,Biodonostia Health Research Institute, Economic Evaluation of Chronic Diseases Group, Donostia, Basque Country, Spain
| | - Lierni Azkargorta
- Osakidetza Basque Health Service, Tolosaldea Integrated Health Care Organization, Tolosa, Basque Country, Spain
| | - Anna Giné
- Kronikgune Institute for Health Services Research, Barakaldo, Basque Country, Spain
| | - Dolores Verdoy
- Kronikgune Institute for Health Services Research, Barakaldo, Basque Country, Spain
| | - Itziar Vergara
- Kronikgune Institute for Health Services Research, Barakaldo, Basque Country, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Barakaldo, Basque Country, Spain.,Biodonostia Health Research Institute, Primary Care Group, Donostia, Basque Country, Spain
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Cervantes-Ortega M, Du S, Biegler KA, Al-Majid S, Davis KC, Chen Y, Kobsa A, Mukamel DB, Sorkin DH. Participatory decision-making for cancer care in a high-risk sample of low income Mexican-American breast cancer survivors: The role of acculturation. ACTA ACUST UNITED AC 2020; 6:35-43. [PMID: 33898743 DOI: 10.5430/ijh.v6n2p35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Despite declining cancer incidence and mortality rates, Latina patients continue to have lower 5-year survival rates compared to their non-Hispanic white counterparts. Much of this difference has been attributed to lack of healthcare access and poorer quality of care. Research, however, has not considered the unique healthcare experiences of Latina patients. Methods Latina women with prior diagnoses of stage 0-III breast cancer were asked to complete a cross-sectional survey assessing several socio-demographic factors along with their experiences as cancer patients. Using a series of linear regression models in a sample of 68 Mexican-American breast cancer survivors, we examined the extent to which patients' ratings of provider interpersonal quality of care were associated with patients' overall healthcare quality, and how these associations varied by acculturation status. Results Findings for Latina women indicated that both participatory decision-making (PDM) (β = 0.62, p < .0001) and trust (β = 0.53, p = .02) were significantly associated with patients' ratings of healthcare quality. The interaction between acculturation and PDM further suggested that participating in the decision-making process mattered more for less acculturated than for more acculturated patients (β = -0.51, p ≤ .01). Conclusions The variation across low and high acculturated Latinas in their decision-making process introduces a unique challenge to health care providers. Further understanding the relationship between provider-patient experiences and ratings of overall healthcare quality is critical for ultimately improving health outcomes.
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Affiliation(s)
| | - Senxi Du
- Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - Kelly A Biegler
- Department of Medicine, University of California Irvine, Irvine, USA
| | - Sadeeka Al-Majid
- School of Nursing, California State University Fullerton, Fullerton, USA
| | - Katelyn C Davis
- Department of Medicine, University of California Irvine, Irvine, USA
| | - Yunan Chen
- Department of Informatics, University of California Irvine, Irvine, USA
| | - Alfred Kobsa
- Department of Informatics, University of California Irvine, Irvine, USA.,Department of Computer Science, University of California Irvine, Irvine, USA
| | - Dana B Mukamel
- Department of Medicine, University of California Irvine, Irvine, USA
| | - Dara H Sorkin
- Department of Medicine, University of California Irvine, Irvine, USA
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Huo N, Chen L, Ullah Mishuk A, Li C, Hansen RA, Harris I, Kiptanui Z, Wang Z, Dutcher SK, Qian J. Generic levothyroxine initiation and substitution among Medicare and Medicaid populations: a new user cohort study. Endocrine 2020; 68:336-348. [PMID: 31993992 DOI: 10.1007/s12020-020-02211-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/17/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE Generic levothyroxine has been approved and available since 2004 but its substitution remains controversial. Therefore, the objective was to examine patterns of and identify factors associated with initiation and substitution of generic levothyroxine treatment. METHODS This was a retrospective observational study, including new users of brand and generic levothyroxine in 2013-2015 Medicare (n = 15,877) or 2011-2012 Medicaid (n = 9390) administrative claim databases. The primary outcomes included (1) generic levothyroxine initiation, and (2) among brand-new users, generic levothyroxine substitution in 12 months. The factors associated with generic levothyroxine initiation and substitution were measured. RESULTS Among all levothyroxine new users, Medicare beneficiaries had a higher proportion of generic levothyroxine initiation than Medicaid beneficiaries (66.40% vs. 44.04%, respectively). Medicare beneficiaries' demographic factors, and health service utilizations were associated with generic levothyroxine initiation. Medicaid beneficiaries who were male and residing in the northeast region and rural areas were more likely to initiate generic levothyroxine. Among brand levothyroxine new users, the generic substitution rate was higher in the Medicare than the Medicaid cohort (18.26 vs. 3.88%). Medicare brand levothyroxine new users' demographic factors and health service utilizations were associated with generic levothyroxine substitution. Medicaid brand levothyroxine new users who were residing in the northeast region, with more prior hospitalization, and initiating a lower dosage of brand levothyroxine, had higher rates of generic substitution. CONCLUSION Patient demographic factors and health service utilizations are associated with generic levothyroxine initiation and substitution. Educational outreach programs targeted to increase generic levothyroxine use and prescription savings should be tailored based on different patient populations.
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Affiliation(s)
- Nan Huo
- Auburn University Harrison School of Pharmacy, Auburn, AL, USA
| | - Li Chen
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IL, USA
| | | | - Chao Li
- Auburn University Harrison School of Pharmacy, Auburn, AL, USA
| | | | | | | | - Zhong Wang
- Office of Research and Standards, Office of Generic Drugs, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Sarah K Dutcher
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Jingjing Qian
- Auburn University Harrison School of Pharmacy, Auburn, AL, USA.
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Schatman ME, Patterson E, Shapiro H. Patient Interviewing Strategies to Recognize Substance Use, Misuse, and Abuse in the Dental Setting. Dent Clin North Am 2020; 64:503-512. [PMID: 32448454 DOI: 10.1016/j.cden.2020.02.001] [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: 10/24/2022]
Abstract
Brief and effective clinical interviewing is critical for identifying patient risk factors, including those associated with substance use. Dental practitioners may perceive identifying patient substance misuse and abuse as a complex undertaking or may consider this clinical assessment beyond the scope of their training and practice. This article describes interviewing strategies that will help dental providers communicate effectively and empathically with their patients to collect relevant clinical information related to substance use, misuse, and abuse and provide better care for their patients.
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Affiliation(s)
- Michael E Schatman
- Department of Diagnostic Sciences, Tufts University School of Dental Medicine, 1 Kneeland Street, Boston, MA 02111, USA; Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, MA, USA.
| | - Ellen Patterson
- Department of Comprehensive Care, Tufts University School of Dental Medicine, 1 Kneeland Street, Boston, MA 02111, USA
| | - Hannah Shapiro
- Department of Biopsychology, Tufts University, Robinson Hall, 200 College Avenue, Medford, MA 02155, USA
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Perceived Patient Satisfaction and Associated Factors among Psychiatric Patients Who Attend Their Treatment at Outpatient Psychiatry Clinic, Jimma University Medical Center, Southwest Ethiopia, Jimma, 2019. PSYCHIATRY JOURNAL 2020; 2020:6153234. [PMID: 32206668 PMCID: PMC7077051 DOI: 10.1155/2020/6153234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 02/12/2020] [Indexed: 11/17/2022]
Abstract
Background In health care, patient satisfaction is an attitudinal response and a pillar for quality assurance, but there is reluctance to measure it among mentally ill patients. Satisfied patients become more compliant. However, no study was done in this study area before. Therefore, this study was conducted to determine the magnitude of perceived patient satisfaction and associated factor at Jimma University Medical Center, outpatient psychiatry clinic. Methods Cross-sectional study design was conducted, and systematic random sampling technique was used to get study participants. The 24-item Mental Health Service Satisfaction Scale (a validated tool in Ethiopia) was used to assess patient satisfaction. Data was entered using Epi-data 3.1 and exported to the Statistical Package for the Social Sciences 22.0 for analysis. Linear regression analysis (P < 0.05) was used to identify the association between the outcome and independent variable. Result 414 respondents participated in the study with response rate of 98%. The overall percentage of patient satisfaction was 50.3% (95% CI 48.4%-51.2%). Being male (β = -0.651, 95% CI (-0.969, -0.332)), having secondary and above educational status (β = -0.651, 95% CI (-0.969, -0.332)), having secondary and above educational status (β = -0.651, 95% CI (-0.969, -0.332)), having secondary and above educational status (β = -0.651, 95% CI (-0.969, -0.332)), having secondary and above educational status (β = -0.651, 95% CI (-0.969, -0.332)), having secondary and above educational status (β = -0.651, 95% CI (-0.969, -0.332)), having secondary and above educational status (β = -0.651, 95% CI (-0.969, -0.332)), having secondary and above educational status (β = -0.651, 95% CI (-0.969, -0.332)), having secondary and above educational status (β = -0.651, 95% CI (-0.969, -0.332)), having secondary and above educational status (Conclusion and Recommendation. This study found that half of the study participants are satisfied with the service. Distance from the hospital, current substance use, waiting time, and having good social support were identified as modifiable factors that can be improved through working with stakeholders to increase patient satisfaction.
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Misra AJ, Ong SY, Gokhale A, Khan S, Melnick ER. Opportunities for addressing gaps in primary care shared decision-making with technology: a mixed-methods needs assessment. JAMIA Open 2020; 2:447-455. [PMID: 32025641 PMCID: PMC6993997 DOI: 10.1093/jamiaopen/ooz027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/13/2019] [Accepted: 07/09/2019] [Indexed: 12/31/2022] Open
Abstract
Objectives To analyze current practices in shared decision-making (SDM) in primary care and perform a needs assessment for the role of information technology (IT) interventions. Materials and Methods A mixed-methods study was conducted in three phases: (1) ethnographic observation of clinical encounters, (2) patient interviews, and (3) physician interviews. SDM was measured using the validated OPTION scale. Semistructured interviews followed an interview guide (developed by our multidisciplinary team) informed by the Traditional Decision Conflict Scale and Shared Decision Making Questionnaire. Field notes were independently coded and analyzed by two reviewers in Dedoose. Results Twenty-four patient encounters were observed in 3 diverse practices with an average OPTION score of 57.2 (0-100 scale; 95% confidence interval [CI], 51.8-62.6). Twenty-two patient and 8 physician interviews were conducted until thematic saturation was achieved. Cohen's kappa, measuring coder agreement, was 0.42. Patient domains were: establishing trust, influence of others, flexibility, frustrations, values, and preferences. Physician domains included frustrations, technology (concerns, existing use, and desires), and decision making (current methods used, challenges, and patients' understanding). Discussion Given low SDM observed, multiple opportunities for technology to enhance SDM exist based on specific OPTION items that received lower scores, including: (1) checking the patient's preferred information format, (2) asking the patient's preferred level of involvement in decision making, and (3) providing an opportunity for deferring a decision. Based on data from interviews, patients and physicians value information exchange and are open to technologies that enhance communication of care options. Conclusion Future primary care IT platforms should prioritize the 3 quantitative gaps identified to improve physician-patient communication and relationships. Additionally, SDM tools should seek to standardize common workflow steps across decisions and focus on barriers to increasing adoption of effective SDM tools into routine primary care.
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Affiliation(s)
- Anjali J Misra
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA.,School of Public Health, University College Cork, Cork, Ireland
| | - Shawn Y Ong
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Arjun Gokhale
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Sameer Khan
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Edward R Melnick
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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Hoffman KE, Penson DF, Zhao Z, Huang LC, Conwill R, Laviana AA, Joyce DD, Luckenbaugh AN, Goodman M, Hamilton AS, Wu XC, Paddock LE, Stroup A, Cooperberg MR, Hashibe M, O’Neil BB, Kaplan SH, Greenfield S, Koyama T, Barocas DA. Patient-Reported Outcomes Through 5 Years for Active Surveillance, Surgery, Brachytherapy, or External Beam Radiation With or Without Androgen Deprivation Therapy for Localized Prostate Cancer. JAMA 2020; 323:149-163. [PMID: 31935027 PMCID: PMC6990712 DOI: 10.1001/jama.2019.20675] [Citation(s) in RCA: 166] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 11/30/2019] [Indexed: 11/14/2022]
Abstract
Importance Understanding adverse effects of contemporary treatment approaches for men with favorable-risk and unfavorable-risk localized prostate cancer could inform treatment selection. Objective To compare functional outcomes associated with prostate cancer treatments over 5 years after treatment. Design, Setting, and Participants Prospective, population-based cohort study of 1386 men with favorable-risk (clinical stage cT1 to cT2bN0M0, prostate-specific antigen [PSA] ≤20 ng/mL, and Grade Group 1-2) prostate cancer and 619 men with unfavorable-risk (clinical stage cT2cN0M0, PSA of 20-50 ng/mL, or Grade Group 3-5) prostate cancer diagnosed in 2011 through 2012, accrued from 5 Surveillance, Epidemiology and End Results Program sites and a US prostate cancer registry, with surveys through September 2017. Exposures Treatment with active surveillance (n = 363), nerve-sparing prostatectomy (n = 675), external beam radiation therapy (EBRT; n = 261), or low-dose-rate brachytherapy (n = 87) for men with favorable-risk disease and treatment with prostatectomy (n = 402) or EBRT with androgen deprivation therapy (n = 217) for men with unfavorable-risk disease. Main Outcomes and Measures Patient-reported function, based on the 26-item Expanded Prostate Index Composite (range, 0-100), 5 years after treatment. Regression models were adjusted for baseline function and patient and tumor characteristics. Minimum clinically important difference was 10 to 12 for sexual function, 6 to 9 for urinary incontinence, 5 to 7 for urinary irritative symptoms, and 4 to 6 for bowel and hormonal function. Results A total of 2005 men met inclusion criteria and completed the baseline and at least 1 postbaseline survey (median [interquartile range] age, 64 [59-70] years; 1529 of 1993 participants [77%] were non-Hispanic white). For men with favorable-risk prostate cancer, nerve-sparing prostatectomy was associated with worse urinary incontinence at 5 years (adjusted mean difference, -10.9 [95% CI, -14.2 to -7.6]) and sexual function at 3 years (adjusted mean difference, -15.2 [95% CI, -18.8 to -11.5]) compared with active surveillance. Low-dose-rate brachytherapy was associated with worse urinary irritative (adjusted mean difference, -7.0 [95% CI, -10.1 to -3.9]), sexual (adjusted mean difference, -10.1 [95% CI, -14.6 to -5.7]), and bowel (adjusted mean difference, -5.0 [95% CI, -7.6 to -2.4]) function at 1 year compared with active surveillance. EBRT was associated with urinary, sexual, and bowel function changes not clinically different from active surveillance at any time point through 5 years. For men with unfavorable-risk disease, EBRT with ADT was associated with lower hormonal function at 6 months (adjusted mean difference, -5.3 [95% CI, -8.2 to -2.4]) and bowel function at 1 year (adjusted mean difference, -4.1 [95% CI, -6.3 to -1.9]), but better sexual function at 5 years (adjusted mean difference, 12.5 [95% CI, 6.2-18.7]) and incontinence at each time point through 5 years (adjusted mean difference, 23.2 [95% CI, 17.7-28.7]), than prostatectomy. Conclusions and Relevance In this cohort of men with localized prostate cancer, most functional differences associated with contemporary management options attenuated by 5 years. However, men undergoing prostatectomy reported clinically meaningful worse incontinence through 5 years compared with all other options, and men undergoing prostatectomy for unfavorable-risk disease reported worse sexual function at 5 years compared with men who underwent EBRT with ADT.
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Affiliation(s)
- Karen E. Hoffman
- Department of Radiation Oncology, The University of Texas MD Anderson Center, Houston
| | - David F. Penson
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Zhiguo Zhao
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Li-Ching Huang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ralph Conwill
- Office of Patient and Community Education, Patient Advocacy Program, Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Aaron A. Laviana
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Daniel D. Joyce
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Amy N. Luckenbaugh
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Michael Goodman
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Ann S. Hamilton
- Department of Preventative Medicine, Keck School of Medicine at the University of Southern California, Los Angeles
| | - Xiao-Cheng Wu
- Department of Epidemiology, Louisiana State University New Orleans School of Public Health, New Orleans
| | - Lisa E. Paddock
- Department of Epidemiology, Cancer Institute of New Jersey, Rutgers Health, New Brunswick
| | - Antoinette Stroup
- Department of Epidemiology, Cancer Institute of New Jersey, Rutgers Health, New Brunswick
| | | | - Mia Hashibe
- Department of Family and Preventative Medicine, University of Utah School of Medicine, Salt Lake City
| | - Brock B. O’Neil
- Department of Urology, University of Utah Health, Salt Lake City
| | | | | | - Tatsuki Koyama
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Daniel A. Barocas
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
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Kalsi D, Ward J, Lee R, Fulford K, Handa A. Shared decision-making across the specialties: Much potential but many challenges. J Eval Clin Pract 2019; 25:1050-1054. [PMID: 31502393 DOI: 10.1111/jep.13276] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 07/28/2019] [Accepted: 08/21/2019] [Indexed: 01/12/2023]
Abstract
Shared decision-making (SDM) is a collaborative process through which patients and clinicians work together to arrive at a mutually agreed-upon treatment plan. The use of SDM has gathered momentum, with it being legally mandated in some areas; however, despite being a ubiquitously applicable intervention, its maturity in use varies across the specialties and requires an appreciation of the nuanced and different challenges they each present. It is therefore our aim in this paper to review the current and potential use of SDM across a wide variety of specialties in order to understand its value and the challenges in its implementation. The specialties we consider are Primary Care, Mental Health, Paediatrics, Palliative Care, Medicine, and Surgery. SDM has been demonstrated to improve decision quality in many scenarios across all of these specialties. There are, however, many challenges to its successful implementation, including the need for high-quality decision aids, cultural shift, and adequate training. SDM represents a paradigm shift towards more patient-centred care but must be implemented with continued people centricity in order to realize its full potential.
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Affiliation(s)
- Dilraj Kalsi
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Oxford, UK.,Collaborating Centre for Values Based Practice, St Catherine's College, Oxford, UK
| | - Joel Ward
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Oxford, UK.,Collaborating Centre for Values Based Practice, St Catherine's College, Oxford, UK
| | - Regent Lee
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Oxford, UK
| | - Kenneth Fulford
- Collaborating Centre for Values Based Practice, St Catherine's College, Oxford, UK
| | - Ashok Handa
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Oxford, UK.,Collaborating Centre for Values Based Practice, St Catherine's College, Oxford, UK
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van Esch TEM, Brabers AEM, Hek K, van Dijk L, Verheij RA, de Jong JD. Does shared decision-making reduce antibiotic prescribing in primary care? J Antimicrob Chemother 2019; 73:3199-3205. [PMID: 30165644 DOI: 10.1093/jac/dky321] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 07/12/2018] [Indexed: 01/19/2023] Open
Abstract
Background Increasing antibiotic resistance is recognized as a major threat to global health and is related to antibiotic prescription rates in primary care. Shared decision-making (SDM), the process in which patients and doctors participate together in making decisions, is argued to possibly promote more appropriate use of antibiotics and reduce prescribing. However, it is unknown whether in practice fewer antibiotics are prescribed where more SDM takes place. Objectives To investigate whether more SDM is related to less antibiotic prescribing and whether this relationship differs between subgroups of patients (male/female and age groups). Patients and methods A questionnaire survey was conducted among 2670 members of the Dutch Health Care Consumer Panel to measure SDM (response rate 45%). Average practice-level SDM scores were calculated for 15 general practices. Data from routine electronic health records of 8192 adult patients of these general practices participating in the Nivel Primary Care Database were used to assess relevant illness episodes (acute cough, acute rhinosinusitis and urinary tract infection), the indication for antibiotics and antibiotic prescriptions. Logistic multilevel regression analyses were performed to investigate the relationship between practice-level SDM and patient-level antibiotic prescriptions. Results In practices where more SDM takes place, general practitioners prescribed fewer antibiotics for adult patients under the age of 40 years in preference-sensitive situations (i.e. situations in which antibiotics could be considered according to clinical guidelines). Conclusions SDM can be a framework to reduce the prescribing of antibiotics and thus to control antibiotic resistance.
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Affiliation(s)
- Thamar E M van Esch
- Nivel, the Netherlands Institute for Health Services Research, BN Utrecht, The Netherlands
| | - Anne E M Brabers
- Nivel, the Netherlands Institute for Health Services Research, BN Utrecht, The Netherlands
| | - Karin Hek
- Nivel, the Netherlands Institute for Health Services Research, BN Utrecht, The Netherlands
| | - Liset van Dijk
- Nivel, the Netherlands Institute for Health Services Research, BN Utrecht, The Netherlands
| | - Robert A Verheij
- Nivel, the Netherlands Institute for Health Services Research, BN Utrecht, The Netherlands
| | - Judith D de Jong
- Nivel, the Netherlands Institute for Health Services Research, BN Utrecht, The Netherlands.,Health Services Research Maastricht University, MD Maastricht, The Netherlands
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Dunne N. Development and validation of the Children's Competence in Decision-Making Scale. Nurs Child Young People 2019:e1170. [PMID: 31523940 DOI: 10.7748/ncyp.2019.e1170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Measuring competence in children's ability to make decisions about their care is laden with conceptual problems. Although there are a variety of tools to measure competence, no scales have been identified that measured competence in children. AIM To develop, test and validate a scale that measured competence in the decision-making process of children aged 8-12 years with long-term conditions, called the Children's Competence in Decision-Making (CCD-M) Scale. METHOD A convergent, sequential, mixed-methods validation design was used. Four stages of scale development were used following recommended procedures. The qualitative arm explored the experiences of being involved in decision-making and these insights were used to develop the scale which was then subject to psychometric testing. RESULTS Cronbach's α of the overall scale was 0.86, which shows good internal validity. Additionally, the α analysis when items were deleted showed no considerable variation and had no value below 0.7, showing excellent internal validity throughout. No substantial increase in α could be achieved. CONCLUSION The CCD-M Scale offers practitioners the ability to test the competence levels of children to decide the extent to which they may want to be involved in the decision-making process. This, in turn, may help to plan care in a more effective way and may have an effect on adherence levels in self-management of illness.
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Affiliation(s)
- Nina Dunne
- School of Health Sciences, University of Brighton, Brighton, England
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40
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Abstract
A well-functioning primary care system will have the capacity to provide timely, adequate, and effective care for patients to avoid nonurgent emergency department (ED) use. This study advances academic discussion by examining whether patient negative experiences during their encounter with a primary care physician (PCP) are associated with nonurgent ED use nationwide in the United States. This retrospective cohort study used data from the 2010-2011 Medical Expenditure Panel Survey. The independent measures were patient perceptions of PCPs' communication and care quality in 2010. The multivariate logit model was employed to analyze the nonurgent ED use as opposed to no ED use in 2011, after controlling for age, gender, race and ethnicity, rural/urban location, marital status, and education levels in 2010. All predictors were treated as dummy variables. We employed the lagged time effect and controlled health status to account for the endogeneity between outcomes and the main independent variables. The weights and variance were adjusted using the survey procedures to yield nationally representative results. The study sample consisted of 5242 adults, which represented 131 317 908 weighted people in the total population. While the measure of patient satisfaction with providers' communication was not associated with nonurgent ED use (P = .750), patient perceived poor and intermediary levels of primary care quality had higher odds of a nonurgent ED visit (OR = 1.75, P = .049, and OR = 1.48, P = .050, respectively) compared with high levels of care quality. For PCPs, endeavors may be considered in improving health care quality to reduce nonurgent ED use. Whenever possible, PCPs' efforts may want to be devoted to both communication and care quality to improve patients' health outcomes and satisfaction and to reduce nonurgent ED use.
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Yeo V, Dowsey M, Alguera-Lara V, Ride J, Lancsar E, Castle DJ. Antipsychotic choice: understanding shared decision-making among doctors and patients. J Ment Health 2019; 30:66-73. [DOI: 10.1080/09638237.2019.1630719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Vivien Yeo
- Department of Mental Health, St. Vincent’s Hospital, Melbourne, Australia
| | - Michelle Dowsey
- Department of Surgery, St. Vincent’s Hospital, Melbourne, Australia
| | | | - Jemimah Ride
- Health Economics Unit, Centre for Health Policy, Melbourne School of Global and Population Health, Carlton, Australia
| | - Emily Lancsar
- Department of Health Services Research & Policy, Research School of Population Health, College of Health & Medicine, The Australian National University, Canberra, Australia
| | - David J. Castle
- St. Vincent’s Hospital, Melbourne, Australia
- The University of Melbourne, Melbourne, Australia
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Faruquee CF, Khera AS, Guirguis LM. Family physicians' perceptions of pharmacists prescribing in Alberta. J Interprof Care 2019; 34:87-96. [PMID: 31043099 DOI: 10.1080/13561820.2019.1609432] [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: 10/26/2022]
Abstract
Canadian pharmacists now have prescribing authority and little is documented about the physicians' perception, experience and relational dynamics evolving around the pharmacists' prescribing practice. The objective of this study was to explore Albertan family physicians' perceptions and experiences of pharmacists' prescribing practice. We used purposeful and maximum variation sampling method and semi-structured face to face or telephone interviews to collect data. From October 2014 to February 2016, we interviewed 12 family physicians in Alberta, having experience with pharmacist prescribing. Interviews were audio recorded and transcribed verbatim for analysis using an interpretive description method, guided by "Relational Coordination" theory. NVivo software was used to manage the data. Three key beliefs (i.e., renewal versus initiate new prescription, community versus team pharmacists, and "I am responsible") about pharmacist prescribing were identified. Trust and communication were prominent themes which shaped participants' collaboration with pharmacist prescribers. Participants were classified as either "collaborative" or "consultative". Participants had greater collaboration with the team pharmacist prescribers compared to community pharmacists due to a higher level of trust and ease of communication. Renewal prescribing by any pharmacist was well accepted but participants showed hesitancy in accepting pharmacist-initiated prescriptions. Our findings provide insight into interprofessional collaboration and communication between physician and pharmacist prescribers.
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Affiliation(s)
- Chowdhury F Faruquee
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton Clinic Health Academy, Edmonton, Alberta, Canada
| | - Amandeep Sheny Khera
- Faculty of Medicine and Dentistry, Department of Family Medicine, University of Alberta, Alberta, Canada
| | - Lisa M Guirguis
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton Clinic Health Academy, Edmonton, Alberta, Canada
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43
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Structuring times and activities in the oncology visit. Soc Sci Med 2019; 228:211-222. [DOI: 10.1016/j.socscimed.2019.03.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 03/17/2019] [Accepted: 03/21/2019] [Indexed: 11/19/2022]
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Harrison-Blount M, Nester C, Williams A. The changing landscape of professional practice in podiatry, lessons to be learned from other professions about the barriers to change - a narrative review. J Foot Ankle Res 2019; 12:23. [PMID: 31015864 PMCID: PMC6469120 DOI: 10.1186/s13047-019-0333-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 04/04/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The delivery of healthcare is changing and aligned with this, the podiatry profession continues to change with evidence informed practice and extending roles. As change is now a constant, this gives clinicians the opportunity to take ownership to drive that change forward. In some cases, practitioners and their teams have done so, where others have been reluctant to embrace change. It is not clear to what extent good practice is being shared, whether interventions to bring about change have been successful, or what barriers exist that have prevented change from occurring. The aim of this article is to explore the barriers to changing professional practice and what lessons podiatry can learn from other health care professions. MAIN BODY A literature search was carried out which informed a narrative review of the findings. Eligible papers had to (1) examine the barriers to change strategies, (2) explore knowledge, attitudes and roles during change interventions, (3) explore how the patients/service users contribute to the change process (4) include studies from predominantly primary care in developed countries.Ninety-two papers were included in the final review. Four papers included change interventions involving podiatrists. The barriers influencing change were synthesised into three themes (1) the organisational context, (2) the awareness, knowledge and attitudes of the professional, (3) the patient as a service user and consumer. CONCLUSIONS Minimal evidence exists about the barriers to changing professional practice in podiatry. However, there is substantial literature on barriers and implementation strategies aimed at changing professional practices in other health professions. Change in practice is often resisted at an organisational, professional or service user level. The limited literature about change in podiatry, a rapidly changing healthcare workforce and the wide range of contexts that podiatrists work, highlights the need to improve the ways in which podiatrists can share successful attempts to change practice.
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Pereira J, Bruera E, Macmillan K, Kavanagh S. Palliative Cancer Patients and Their Families on the Internet: Motivation and Impact. J Palliat Care 2019. [DOI: 10.1177/082585970001600403] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Increasingly, palliative patients and their families are going online. A series of cases are presented to explore the reasons they go online and the effects of their online activity, both harmful and beneficial. This paper highlights the need to take this growing phenomenon and its effects on patient care seriously, and identifies key areas that need to be explored further.
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Affiliation(s)
- Jose Pereira
- Palliative Care Program, Grey Nuns Community Hospital & Health Centre, Edmonton, Alberta
| | - Eduardo Bruera
- University of Texas, M.D. Anderson Cancer Center, Houston, U.S.A
| | - Karen Macmillan
- Palliative Care Program, Grey Nuns Community Hospital and Health Centre, Edmonton, Alberta
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Shields CG, Griggs JJ, Fiscella K, Elias CM, Christ SL, Colbert J, Henry SG, Hoh BG, Hunte HER, Marshall M, Mohile SG, Plumb S, Tejani MA, Venuti A, Epstein RM. The Influence of Patient Race and Activation on Pain Management in Advanced Lung Cancer: a Randomized Field Experiment. J Gen Intern Med 2019; 34:435-442. [PMID: 30632104 PMCID: PMC6420510 DOI: 10.1007/s11606-018-4785-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 08/30/2018] [Accepted: 11/19/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pain management racial disparities exist, yet it is unclear whether disparities exist in pain management in advanced cancer. OBJECTIVE To examine the effect of race on physicians' pain assessment and treatment in advanced lung cancer and the moderating effect of patient activation. DESIGN Randomized field experiment. Physicians consented to see two unannounced standardized patients (SPs) over 18 months. SPs portrayed 4 identical roles-a 62-year-old man with advanced lung cancer and uncontrolled pain-differing by race (black or white) and role (activated or typical). Activated SPs asked questions, interrupted when necessary, made requests, and expressed opinions. PARTICIPANTS Ninety-six primary care physicians (PCPs) and oncologists from small cities, and suburban and rural areas of New York, Indiana, and Michigan. Physicians' mean age was 52 years (SD = 27.17), 59% male, and 64% white. MAIN MEASURES Opioids prescribed (or not), total daily opioid doses (in oral morphine equivalents), guideline-concordant pain management, and pain assessment. KEY RESULTS SPs completed 181 covertly audio-recorded visits that had complete data for the model covariates. Physicians detected SPs in 15% of visits. Physicians prescribed opioids in 71% of visits; 38% received guideline-concordant doses. Neither race nor activation was associated with total opioid dose or guideline-concordant pain management, and there were no interaction effects (p > 0.05). Activation, but not race, was associated with improved pain assessment (ẞ, 0.46, 95% CI 0.18, 0.74). In post hoc analyses, oncologists (but not PCPs) were less likely to prescribe opioids to black SPs (OR 0.24, 95% CI 0.07, 0.81). CONCLUSIONS Neither race nor activation was associated with opioid prescribing; activation was associated with better pain assessment. In post hoc analyses, oncologists were less likely to prescribe opioids to black male SPs than white male SPs; PCPs had no racial disparities. In general, physicians may be under-prescribing opioids for cancer pain. TRIAL REGISTRATION NCT01501006.
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Affiliation(s)
- Cleveland G Shields
- Center for Cancer Research, Purdue University, West Lafayette, IN, USA
- Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, IN, USA
- Human Development & Family Studies, Purdue University, West Lafayette, IN, USA
| | - Jennifer J Griggs
- Department of Internal Medicine, Hematology/ Oncology Division, and Health Management and Policy, University of Michigan School of Medicine, Ann Arbor, MI, USA
- Department of Health Management & Policy, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Kevin Fiscella
- Center for Communication and Disparities Research, University of Rochester School of Medicine, Rochester, NY, USA
- Department of Family Medicine, University of Rochester School of Medicine, Rochester, NY, USA
- Department of Public Health Sciences, University of Rochester School of Medicine, Rochester, NY, USA
| | - Cezanne M Elias
- Human Development & Family Studies, Purdue University, West Lafayette, IN, USA
| | - Sharon L Christ
- Human Development & Family Studies, Purdue University, West Lafayette, IN, USA
- Department of Statistics, Purdue University, West Lafayette, IN, USA
| | - Joseph Colbert
- Department of Biostatistics, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Stephen G Henry
- Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Beth G Hoh
- Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY, USA
| | - Haslyn E R Hunte
- School of Public Health, Department of Social and Behavioral Sciences, West Virginia University, Morgantown, WV, USA
| | - Mary Marshall
- Human Development & Family Studies, Purdue University, West Lafayette, IN, USA
| | - Supriya Gupta Mohile
- James P Wilmot Cancer Center, University of Rochester School of Medicine, Rochester, NY, USA
| | - Sandy Plumb
- Center for Communication and Disparities Research, University of Rochester School of Medicine, Rochester, NY, USA
- Department of Family Medicine, University of Rochester School of Medicine, Rochester, NY, USA
- James P Wilmot Cancer Center, University of Rochester School of Medicine, Rochester, NY, USA
| | - Mohamedtaki A Tejani
- James P Wilmot Cancer Center, University of Rochester School of Medicine, Rochester, NY, USA
| | - Alison Venuti
- Center for Communication and Disparities Research, University of Rochester School of Medicine, Rochester, NY, USA
| | - Ronald M Epstein
- Center for Communication and Disparities Research, University of Rochester School of Medicine, Rochester, NY, USA.
- Department of Family Medicine, University of Rochester School of Medicine, Rochester, NY, USA.
- Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY, USA.
- James P Wilmot Cancer Center, University of Rochester School of Medicine, Rochester, NY, USA.
- Department of Medicine, University of Rochester School of Medicine, Rochester, NY, USA.
- Family Medicine Research Programs, University of Rochester, Rochester, NY, USA.
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Heuser CC, Gibbins KJ, Herrera CA, Theilen LH, Holmgren CM. Moms in medicine: Job satisfaction among physician-mothers in obstetrics and gynecology. Work 2019; 60:201-207. [PMID: 29865100 DOI: 10.3233/wor-182734] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Physician satisfaction is linked to positive patient outcomes. Mothers form an increasing fraction of the obstetrics and gynecology (ob/gyn) workforce. OBJECTIVE Define factors that affect physician satisfaction among ob/gyn physicians who are also mothers. METHODS We constructed and validated a Redcap survey and invited members of online ob/gyn-mom groups to participate. Characteristics of participants' professional and personal lives were evaluated for possible association with the satisfaction outcomes. Comparison testing was performed using Chi-squared test or Fisher's exact test for categorical variables, Student's t-test for parametric variables, and Wilcoxon Rank-Sum test for non-parametric variables. RESULTS Responses were received from 232 participants. A majority reported being unsatisfied with their time to spend with children (66%), partner (70%), and on personal hobbies/activites (75%). Eighty-percent rate professional morale as very/somewhat positive. Women who rated their morale as very/somewhat positive worked fewer hours per week than women with neutral/negative responses (43.6 vs 49.7, p = 0.01). Women with positive morale were also less likely to work over 50 h/week (39.5% vs 56.8%, p = 0.04). CONCLUSIONS Ob/gyn physician-mothers have high professional morale but are dissatisfied with time for extra-professional activities. Longer clinical hours correlate with dissatisfaction based on several measurements.
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Affiliation(s)
- Cara C Heuser
- Department of Maternal-Fetal Medicine, Intermountain Healthcare, Murray, UT, USA.,University of Utah, Division of Maternal Fetal Medicine, Salt Lake City, UT, USA
| | - Karen J Gibbins
- University of Utah, Division of Maternal Fetal Medicine, Salt Lake City, UT, USA
| | - Christina A Herrera
- University of Utah, Division of Maternal Fetal Medicine, Salt Lake City, UT, USA
| | - Lauren H Theilen
- University of Utah, Division of Maternal Fetal Medicine, Salt Lake City, UT, USA
| | - Calla M Holmgren
- Department of Maternal-Fetal Medicine, Intermountain Healthcare, Murray, UT, USA.,University of Utah, Division of Maternal Fetal Medicine, Salt Lake City, UT, USA
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Schwartz J, Grimm J. Stigma Communication Surrounding PrEP: The Experiences of A Sample of Men Who Have Sex With Men. HEALTH COMMUNICATION 2019; 34:84-90. [PMID: 29048252 DOI: 10.1080/10410236.2017.1384430] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
HIV is a serious problem in the USA, particularly for men who have sex with men (MSM). A new means of HIV prevention, called pre-exposure prophylaxis (PrEP), has been shown to be highly effective. However, in spite of earning FDA approval, adoption of PrEP by MSM has been limited. The purpose of this study was to examine the experiences of a sample of 38 MSM who have adopted PrEP, focusing on communication with healthcare providers and social networks. In-depth interviews were used to collect data. Findings revealed that stigmatization by healthcare providers as well as stigmatization by other MSM was a relatively common experience for participants. Additionally, participants described that a high level of health literacy, health advocacy, and communication skill were necessary to adopt PrEP. Given these findings, strategies are suggested for improving MSM's healthcare and increasing rates of PrEP adoption.
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Affiliation(s)
- Joseph Schwartz
- a Department of Communication Studies , Northeastern University
| | - Josh Grimm
- b Manship School of Journalism , Louisiana State University
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Philpot LM, Khokhar BA, Roellinger DL, Ramar P, Ebbert JO. Time of Day is Associated with Opioid Prescribing for Low Back Pain in Primary Care. J Gen Intern Med 2018; 33:1828-1830. [PMID: 29968050 PMCID: PMC6206357 DOI: 10.1007/s11606-018-4521-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Lindsey M Philpot
- Robert D. and Patricia E. Kern Mayo Clinic Center for the Science of Health Care Delivery, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Bushra A Khokhar
- Robert D. and Patricia E. Kern Mayo Clinic Center for the Science of Health Care Delivery, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Daniel L Roellinger
- Robert D. and Patricia E. Kern Mayo Clinic Center for the Science of Health Care Delivery, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Priya Ramar
- Robert D. and Patricia E. Kern Mayo Clinic Center for the Science of Health Care Delivery, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Jon O Ebbert
- Robert D. and Patricia E. Kern Mayo Clinic Center for the Science of Health Care Delivery, Mayo Clinic College of Medicine, Rochester, MN, USA. .,Primary Care Internal Medicine , Mayo Clinic College of Medicine, Rochester, MN, USA.
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50
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Hospital Discharge and Selecting a Skilled Nursing Facility: A Comparison of Experiences and Perspectives of Patients and Their Families. Prof Case Manag 2018; 23:50-59. [PMID: 29381669 DOI: 10.1097/ncm.0000000000000252] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF STUDY A currently proposed rule by the Centers for Medicare & Medicaid Services would require providers to devote more resources to discharge planning from hospitals to ensure the prioritization of patient preferences and goals in the discharge planning process. Annually, more than 3 million persons enter a nursing home in the United States, with the vast majority of patients coming directly from hospitals. Although early evidence suggests more family involvement than patient involvement in the discharge process, most of this work has relied on retrospective reports of the decision-making process postplacement. This article seeks to examine and compare the experiences and perspectives of patients and others involved in the selection of the nursing home (predominately adult children and spouses). PRIMARY PRACTICE SETTING Large academic medical hospital with patients being discharged to a skilled nursing facility. METHODOLOGY AND SAMPLE A total of 225 patients or their family members and involved others who completed an exit survey assessing their experiences and perspectives in selecting a skilled nursing home and in experiencing the discharge process more generally. RESULTS Patients were the primary decision makers about 23% of the time but were often involved in the decision even when family members/involved others were primarily making decisions in the discharge process. Although patients were involved in the selection of the nursing home to a lesser degree than involved others, their level of satisfaction with the decision to be discharged to a skilled nursing home and their level of satisfaction with their personal level of involvement with the selection of the specific nursing home did not differ from the satisfaction ratings of the involved others. Furthermore, their confidence in the decision and their satisfaction with the decision did not differ from ratings provided by family members/involved others. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE Recommendations for case management practice include (1) encouraging patients and their families to take an active role in the discharge process; (2) incorporating technology into the discharge process that promotes this active level of engagement; and (3) facilitating access to data to promote discharge to the highest quality nursing homes available.
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