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Wright B, Aylward J, Allsop S, Lennox A, Faulkner N, Bragge P. Patient Power: A feasibility study on the impact of providing a bedside notepad to encourage patients to ask questions following surgery. PEC Innov 2024; 4:100257. [PMID: 38318535 PMCID: PMC10839754 DOI: 10.1016/j.pecinn.2024.100257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 01/15/2024] [Accepted: 01/21/2024] [Indexed: 02/07/2024]
Abstract
Objective This study aimed to evaluate a behaviour change strategy to enhance the patient voice in the early post-operative setting. Methods The Patient Power notepad was evaluated in an uncontrolled, single-group, mixed-methods trial including a patient evaluation survey and staff phone interviews. Results Patients thought that the notepad was well-designed and prompted them to think of and ask questions. They strongly agreed that healthcare practitioners answered health-related questions fully and carefully. Staff reported that the notepad not only provided an easy mechanism through which patients and their families could communicate with their healthcare team, but it also created a permissive environment where questions were encouraged. Conclusion The Patient Power notepad provided an easy, acceptable and scalable intervention to encourage patients to engage more in their healthcare and specifically to ask questions about their care. By providing a structured tool for capturing patient concerns, symptoms, and questions, this innovation holds the potential to enhance patient satisfaction, treatment adherence, and overall healthcare outcomes. Innovation By facilitating comprehensive information exchange and the potential to promote shared decision-making, this innovation has the potential to improve patient satisfaction, treatment adherence, and overall healthcare outcomes.
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Affiliation(s)
| | | | | | - Alyse Lennox
- BehaviourWorks Australia, Monash University, Australia
| | | | - Peter Bragge
- BehaviourWorks Australia, Monash University, Australia
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Totzkay D. The potential influence of patient-centered communication, online provider communication, and social determinants of health on cancer screening. Patient Educ Couns 2024; 123:108238. [PMID: 38452686 DOI: 10.1016/j.pec.2024.108238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 02/19/2024] [Accepted: 02/29/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVE To understand how breast and cervical cancer screening are influenced by communicating with a healthcare provider, patient activation, and social determinants of health. METHOD Data were from the National Cancer Institute's Health Information National Trends Survey, focusing on women with no history of cancer at least 21 years old (N = 1466) to study cervical cancer screening and those at least 40 years old (N = 1114) to study breast cancer screening. Variables included patient-centered communication, electronic healthcare communication, patient activation, race/ethnicity, education, health insurance status, Appalachian residence, and financial insecurity. RESULTS Electronic communication predicted both cancer screens, but especially for White women. Patient-centered communication influenced cervical cancer screening only for women with insurance. It only influenced mammography for those without insurance. Patient activation did not influence either cancer screen behavior. CONCLUSION These data demonstrate more nuance is needed to parse potential effects of advocated-for healthcare behaviors. Use of publicly available datasets from can be informative but are limited methodologically. PRACTICE IMPLICATIONS Healthcare providers and systems should promote use of patient portals and other electronic means of interaction outside regular clinical visits for all patients. However, attention needs to be paid to the unequal benefits they afford to patients.
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Affiliation(s)
- Dan Totzkay
- Department of Communication Studies, West Virginia University, Morgantown, WV, USA.
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Provenzano M, Cillara N, Podda M, Cicalò E, Sotgiu G, Fransvea P, Poillucci G, Sechi R, Deserra A, Jiménez-Herrera M. Association between patient activation and delayed discharge in elective laparoscopic cholecystectomy: A prospective cohort analysis. Int J Nurs Stud 2024; 154:104751. [PMID: 38642474 DOI: 10.1016/j.ijnurstu.2024.104751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 02/24/2024] [Accepted: 03/02/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Improving patient activation may be an effective way to reduce healthcare costs and improve patient outcomes after surgery. OBJECTIVE To determine whether preoperative patient activation is associated with delayed discharge (i.e., length of stay >24 h) after elective laparoscopic cholecystectomy. Postoperative symptoms, unscheduled access to healthcare facilities within seven days of surgery, unplanned hospital readmissions, and postoperative complications were analyzed as secondary outcomes. DESIGN This cohort study was a secondary analysis of the DeDiLaCo study (Delayed Discharge after day-surgery Laparoscopic Cholecystectomy) collecting data of patients undergoing elective laparoscopic cholecystectomy during 2021 in Italy. Data was analyzed from June 2022 to April 2023. SETTING 90 Italian surgical centers participating in the study. PARTICIPANTS 4708 adult patients with an instrumental diagnosis of gallbladder disease and undergoing laparoscopic cholecystectomy. Patient activation was assessed using the Italian translation of Patient Activation Measure in the preoperative setting. RESULTS Of 4532 cases analyzed the median (IQR) Patient Activation Measure score was 80.3 (71.2-92.3). Participants were on average 55.5 years of age and 58.1 % were female. Two groups based on the activation level were created: 270 (6 %) had low activation, and 4262 had high activation. The low activation level was associated with the likelihood of delayed discharge (odds ratio [OR] 1.47, 95 % CI, 1.11-1.95; P = .008), higher symptom burden (OR 1.99, 95 % CI 1.49-2.66, P < .0001), and unplanned healthcare utilization within seven days after hospital discharge (OR 1.85, 95 % CI, 1.29-2.63; P = .001). There was no difference between the high and low activation groups in the incidence of postoperative complications (OR 1.28, 95 % CI, 0.95-1.73; P = .10) and hospital readmission after discharge (OR 0.95, 95 % CI, 0.30-3.05; P = .93). CONCLUSIONS Our results suggest that patients with low activation have 1.47 times the risk of delayed discharge compared with patients with higher activation, almost twice the risk of the onset of postoperative symptoms, and 1.85 times the risk of unscheduled use of hospital services. Screening for patient activation in the preoperative setting could not only identify patients not suitable for early discharge, but more importantly, help physicians and nurses develop tailored interventions.
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Affiliation(s)
- Maria Provenzano
- Department of Surgery, Santissima Trinità Hospital, Cagliari, Italy; Universitat Rovira i Virgili, Tarragona, Spain.
| | - Nicola Cillara
- Department of Surgery, Santissima Trinità Hospital, Cagliari, Italy
| | - Mauro Podda
- Department of Surgical Science, University of Cagliari, Italy
| | - Enrico Cicalò
- Department of Architecture, Design and Urban Planning, University of Sassari, Italy
| | - Giovanni Sotgiu
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Italy
| | - Pietro Fransvea
- Emergency Surgery and Trauma, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | | | - Raffaele Sechi
- Department of Surgery, Santissima Trinità Hospital, Cagliari, Italy
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Lightfoot CJ, Wilkinson TJ, Patel NA, Jones CR, Smith AC. Patient activation and psychological coping strategies to manage challenging circumstances during the COVID-19 pandemic in people with kidney disease. J Nephrol 2024; 37:353-364. [PMID: 38236468 PMCID: PMC11043035 DOI: 10.1007/s40620-023-01851-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/23/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND Coping with health problems requires some degree of self-management; however, an individual's ability to self-manage can be threatened during challenging times, such as the COVID-19 pandemic. Exploring differences and changes in psychological well-being and coping strategies between those with low and high patient activation may inform appropriate interventions to support psychological coping. METHODS People with chronic kidney disease (CKD) (non-dialysis and transplant) were recruited from 11 hospital sites across England between August and December 2020. Participants responded to an online survey study, including the Brief Coping Orientation to Problem Experienced (COPE) Inventory, Depression, Anxiety and Stress Scale (DASS-21), Short Health Anxiety Index (SHAI), and Patient Activation Measure (PAM-13). A follow-up survey was conducted 6-9 months later. Paired t tests assessed within-group changes, and chi-squared tests compared coping strategies utilised by low- and high-activated participants. General linear modelling was performed to determine the relationship between patient activation and coping strategies, and covariates. RESULTS Two hundred and fourteen participants were recruited (mean age: 60.7, 51% male, mean eGFR: 38.9 ml/min/1.73 m2). Low-activated participants were significantly more anxious than high-activated participants (P = 0.045). Health anxiety significantly decreased (i.e., got better) for high-activated participants (P = 0.016). Higher patient activation scores were associated with greater use of problem-focused strategies (β = 0.288, P < 0.001). Age (β = - 0.174, P = 0.012), sex (β = 0.188, P = 0.004), and education level (β = 0.159, P = 0.019) significantly predicted use of problem-focused strategies. DISCUSSION Those with higher activation had lower levels of anxiety, and more frequently used adaptive coping strategies during the pandemic. Targeted support and interventions may be required for people with CKD to enhance patient activation, encourage more positive adaptive coping strategies, and mitigate maladaptive coping strategies.
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Affiliation(s)
- Courtney Jane Lightfoot
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, LE1 7RH, UK.
- Leicester NIHR Biomedical Research Centre, Leicester, UK.
| | - Thomas James Wilkinson
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, LE1 7RH, UK
- Leicester NIHR Biomedical Research Centre, Leicester, UK
| | - Naeema Aiyub Patel
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, LE1 7RH, UK
- Leicester NIHR Biomedical Research Centre, Leicester, UK
| | - Ceri Rhiannon Jones
- Department of Neuroscience Psychology and Behaviour, University of Leicester, Leicester, UK
| | - Alice Caroline Smith
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, LE1 7RH, UK
- Leicester NIHR Biomedical Research Centre, Leicester, UK
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Paradis T, Robitaille S, Dumitra T, Liberman AS, Charlebois P, Stein BL, Fiore JF, Feldman LS, Lee L. The impact of patient activation on the effectiveness of digital health remote post-discharge follow-up and same-day-discharge after elective colorectal surgery. Surg Endosc 2024; 38:1548-1555. [PMID: 38114879 DOI: 10.1007/s00464-023-10597-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 11/14/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Low patient activation (PA) is associated with worse postoperative outcomes, however, its impact on the effectiveness of digital health interventions is unknown. We sought to determine the impact of PA on the effectiveness of digital health application for remote post-discharge follow-up for patients undergoing elective colectomy. METHODS Data analysis included a control cohort (CC) of patients undergoing elective colorectal surgery from 10/2017 to 04/2018 without the digital health intervention and a digital application cohort (DAC) that received a smart phone application for remote post-discharge follow-up from 03/2021 to 08/2022, including a subset of same-day discharge (SDD) patients. PA was measured using the Patient Activation Measure (PAM; score 0-100) and categorized into low (< 55.1) and high (≥ 55.1). The PAM was administered 4-6 weeks before surgery in the DAC group and on postoperative day (POD) 1 in the CC group. The main outcome measure was 30-day emergency department (ED) visits. RESULTS A total of 164 patients were included (89DAC with 50 SDD, 75CC), with no differences in patient characteristics other than more stoma closures in the DAC group. Overall, 77% of patients had high PA level, with no difference between CC and DAC (77% vs. 81%, p = 0.25). There was no difference in ED visits between CC and DAC (19% vs. 18%, p = 0.90). Overall, low PA was associated more ED visits (29% vs 14%, p = 0.04). In the SDD subgroup, low PA patients had more ED visits (38% vs. 7%, p = 0.015). PA level did not affect app usage metrics. On multiple regression, only low PA remained independently associated with ED visits (OR 3.42, 95%CI 1.27, 9.24). CONCLUSION Low PA remains an important predictor of surgical outcomes after elective colorectal surgery regardless of the use of a digital health application for remote post-discharge follow-up. This suggests that improving PA levels may improve postoperative outcomes.
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Affiliation(s)
- Tiffany Paradis
- Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Stephan Robitaille
- Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Teodora Dumitra
- Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - A Sender Liberman
- Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
- Colon & Rectal Surgery, McGill University Health Centre, Glen Campus - DS1.3310, 1001 Decarie Boulevard, Montreal, QC, H3G 1A4, Canada
| | - Patrick Charlebois
- Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
- Colon & Rectal Surgery, McGill University Health Centre, Glen Campus - DS1.3310, 1001 Decarie Boulevard, Montreal, QC, H3G 1A4, Canada
| | - Barry L Stein
- Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
- Colon & Rectal Surgery, McGill University Health Centre, Glen Campus - DS1.3310, 1001 Decarie Boulevard, Montreal, QC, H3G 1A4, Canada
| | - Julio F Fiore
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
| | - Liane S Feldman
- Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
| | - Lawrence Lee
- Department of Surgery, McGill University Health Centre, Montreal, QC, Canada.
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.
- Colon & Rectal Surgery, McGill University Health Centre, Glen Campus - DS1.3310, 1001 Decarie Boulevard, Montreal, QC, H3G 1A4, Canada.
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Lunardi LE, K Le Leu R, Matricciani LA, Xu Q, Britton A, Jesudason S, Bennett PN. Patient activation in advanced chronic kidney disease: a cross-sectional study. J Nephrol 2024; 37:343-352. [PMID: 38345687 PMCID: PMC11043190 DOI: 10.1007/s40620-023-01847-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/23/2023] [Indexed: 04/26/2024]
Abstract
BACKGROUND Patient activation refers to the knowledge, confidence and skills required for the management of chronic disease and is antecedent to self-management. Greater self-management in chronic kidney disease (CKD) results in improved patient experience and patient outcomes. AIM To examine patient activation levels in people with CKD stage 5 pre-dialysis and determine associations with sociodemographic characteristics, treatment adherence and healthcare utilisation. METHODS/DESIGN People with CKD stage 5 not receiving dialysis from one Australian kidney care service. Patient activation was measured using the 13-item Patient Activation Measure (PAM-13). Sociodemographic and clinical outcome data (emergency department visits, admissions) were collected from medical records. Morisky Medication Adherence Scale was used to determine self-report medication adherence. RESULTS Two hundred and four participants completed the study. The mean PAM-13 score was 53.4 (SD 13.8), with 73% reporting low activation levels (1 and 2). Patient activation scores significantly decreased with increased age (P < 0.001) and significantly increased with higher educational levels (P < 0.001). Higher patient activation level was associated with fewer hospital emergency department visits (P = 0.03) and increased medication adherence (P < 0.001). CONCLUSION Patient activation levels are low in people with CKD stage 5 not receiving dialysis suggesting limited ability for self-management and capacity for optimally informed decisions about their healthcare. Efforts to improve patient activation need to consider age and education level.
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Affiliation(s)
- Laura E Lunardi
- Central Northern Adelaide Renal and Transplantation Service, South Australia, Australia.
- Clinical & Health Sciences, University of South Australia, South Australia, Australia.
| | - Richard K Le Leu
- Central Northern Adelaide Renal and Transplantation Service, South Australia, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, South Australia, Australia
| | - Lisa A Matricciani
- Clinical & Health Sciences, University of South Australia, South Australia, Australia
| | - Qunyan Xu
- Clinical & Health Sciences, University of South Australia, South Australia, Australia
| | - Anne Britton
- Central Northern Adelaide Renal and Transplantation Service, South Australia, Australia
| | - Shilpanjali Jesudason
- Central Northern Adelaide Renal and Transplantation Service, South Australia, Australia
| | - Paul N Bennett
- School of Nursing and Midwifery, Griffith University, Queensland, Australia
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Morse AR, Hark LA, Gorroochurn P, Rojas R, Seiple WH, Shukla AG, Wang Y, Maruri SC, Henriquez DR, Harizman N, Wang Q, Liebmann JM, Cioffi GA. Association of Psychosocial Factors with Activation Among Patients with Glaucoma. Ophthalmol Glaucoma 2024:S2589-4196(24)00027-9. [PMID: 38320666 DOI: 10.1016/j.ogla.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/25/2024] [Accepted: 01/30/2024] [Indexed: 02/08/2024]
Abstract
OBJECTIVE To investigate the association of psychosocial factors with health self-management behaviors and beliefs among patients with primary open-angle glaucoma (POAG). DESIGN Prospective cross-sectional cohort study. PARTICIPANTS Patients (n = 202) with mild, moderate, or advanced bilateral POAG. METHODS Patients (N = 1164) were identified from electronic medical records at a single academic medical center. Letters soliciting participation were mailed to 591 randomly selected potential participants. Psychometric measures and a social determinants of health questionnaire were administered by phone to 202 study participants. MAIN OUTCOME MEASURES The National Eye Institute Visual Function Questionnaire-8 (NEI-VFQ), the Multidimensional Health Locus of Control (MHLC), the Perceived Medical Condition Self-Management Scale-4, the Patient Health Questionnaire-9 (PHQ), the Patient Activation Measure-13 (PAM), a health literacy question, and a social determinants of health questionnaire. RESULTS For each increase in level of POAG severity, there was a decrease in mean NEI-VFQ score (P < 0.001). For each unit increase in NEI-VFQ item 1, self-rated vision, mean PAM score increased (R2 = 5.3%; P = 0.001; 95% confidence interval [CI], 0.077-0.276). For each unit increase in "Internal" on the MHLC, mean PAM score increased (R2 = 19.3%; 95% CI, 0.649-1.166; P < 0.001). For each unit increase in "Doctors" on the MHLC, mean PAM score increased (R2 = 11.0%; 95% CI, 1.555-3.606; P < 0.001). For each unit increase in "Chance" on the MHLC, mean PAM score decreased (R2 = 2.6%; 95% CI, -0.664 to -0.051; P = 0.023). On multivariate analysis, adjusting for age, sex and race, for each unit increase in PHQ, mean PAM score decreased (95% CI, 0.061-1.35; P = 0.032); for each unit increase in MHLC "Doctors", mean PAM score increased (95% CI, -1.448 to 3.453; P < 0.001); for each unit increase in MHLC "Internal", mean PAM score increased (95% CI, 0.639-1.137; P < 0.001); for each unit increase in MHLC "Chance", mean PAM score decreased (95% CI, -0.685 to -0.098; P = 0.009). CONCLUSIONS We identified modifiable behavioral factors that could increase patients' self-perceived ability and confidence to manage their own eye care. Locus of control (MHLC), level of depression (PHQ), and self-rated functional vision (NEI-VFQ) were each associated with patient behaviors, attitudes, and beliefs needed for health self-management (activation, assessed by the PAM) and may be important determinants of adherence behaviors. Targeting change in patients' care beliefs and behaviors may improve activation and treatment outcomes. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Alan R Morse
- Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Irving Medical Center, New York, New York.
| | - Lisa A Hark
- Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Irving Medical Center, New York, New York; Department of Ophthalmology, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York
| | - Prakash Gorroochurn
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York
| | - Rebecca Rojas
- Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Irving Medical Center, New York, New York; Department of Ophthalmology, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York
| | - William H Seiple
- Department of Ophthalmology, New York University Grossman School of Medicine, New York, New York; Lighthouse Guild, New York, New York
| | - Aakriti G Shukla
- Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Irving Medical Center, New York, New York; Department of Ophthalmology, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York
| | - Yujia Wang
- Department of Ophthalmology, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York; Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York
| | - Stefania C Maruri
- Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Irving Medical Center, New York, New York
| | - Desiree R Henriquez
- Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Irving Medical Center, New York, New York
| | - Noga Harizman
- Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Irving Medical Center, New York, New York; Department of Ophthalmology, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York
| | - Qing Wang
- Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Irving Medical Center, New York, New York; Department of Ophthalmology, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York
| | - Jeffrey M Liebmann
- Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Irving Medical Center, New York, New York; Department of Ophthalmology, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York
| | - George A Cioffi
- Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Irving Medical Center, New York, New York; Department of Ophthalmology, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York
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Does MB, Adams SR, Kline-Simon AH, Marino C, Charvat-Aguilar N, Weisner CM, Rubinstein AL, Ghadiali M, Cowan P, Young-Wolff KC, Campbell CI. A patient activation intervention in primary care for patients with chronic pain on long term opioid therapy: results from a randomized control trial. BMC Health Serv Res 2024; 24:112. [PMID: 38254073 PMCID: PMC10802020 DOI: 10.1186/s12913-024-10558-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Given significant risks associated with long-term prescription opioid use, there is a need for non-pharmacological interventions for treating chronic pain. Activating patients to manage chronic pain has the potential to improve health outcomes. The ACTIVATE study was designed to evaluate the effectiveness of a 4-session patient activation intervention in primary care for patients on long-term opioid therapy. METHODS The two-arm, pragmatic, randomized trial was conducted in two primary care clinics in an integrated health system from June 2015-August 2018. Consenting participants were randomized to the intervention (n = 189) or usual care (n = 187). Participants completed online and interviewer-administered surveys at baseline, 6- and 12- months follow-up. Prescription opioid use was extracted from the EHR. The primary outcome was patient activation assessed by the Patient Activation Measure (PAM). Secondary outcomes included mood, function, overall health, non-pharmacologic pain management strategies, and patient portal use. We conducted a repeated measure analysis and reported between-group differences at 12 months. RESULTS At 12 months, the intervention and usual care arms had similar PAM scores. However, compared to usual care at 12 months, the intervention arm demonstrated: less moderate/severe depression (odds ratio [OR] = 0.40, 95%CI 0.18-0.87); higher overall health (OR = 3.14, 95%CI 1.64-6.01); greater use of the patient portal's health/wellness resources (OR = 2.50, 95%CI 1.42-4.40) and lab/immunization history (OR = 2.70, 95%CI 1.29-5.65); and greater use of meditation (OR = 2.72; 95%CI 1.61-4.58) and exercise/physical therapy (OR = 2.24, 95%CI 1.29-3.88). At 12 months, the intervention arm had a higher physical health measure (mean difference 1.63; 95%CI: 0.27-2.98). CONCLUSION This trial evaluated the effectiveness of a primary care intervention in improving patient activation and patient-reported outcomes among adults with chronic pain on long-term opioid therapy. Despite a lack of improvement in patient activation, a brief intervention in primary care can improve outcomes such as depression, overall health, non-pharmacologic pain management, and engagement with the health system. TRIAL REGISTRATION The study was registered on 10/27/14 on ClinicalTrials.gov (NCT02290223).
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Affiliation(s)
- Monique B Does
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612-2403, USA.
| | - Sara R Adams
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612-2403, USA
| | - Andrea H Kline-Simon
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612-2403, USA
| | - Catherine Marino
- Physical Medicine and Rehabilitation, Kaiser Permanente Northern California, Santa Clara, CA, USA
| | - Nancy Charvat-Aguilar
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612-2403, USA
| | - Constance M Weisner
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612-2403, USA
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Andrea L Rubinstein
- Department of Pain Medicine, The Permanente Medical Group, Santa Rosa, CA, USA
| | - Murtuza Ghadiali
- Addiction Medicine and Recovery Services, The Permanente Medical Group, San Francisco, CA, USA
| | - Penney Cowan
- American Chronic Pain Association, Rocklin, CA, USA
| | - Kelly C Young-Wolff
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612-2403, USA
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Cynthia I Campbell
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612-2403, USA
- Department of Psychiatry, University of California, San Francisco, CA, USA
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Duvdevani M, Yogev-Seligmann G, Schlesinger I, Nassar M, Erich I, Hadad R, Kafri M. Association of health behaviors with function and health-related quality of life among patients with Parkinson's disease. Isr J Health Policy Res 2024; 13:2. [PMID: 38173041 PMCID: PMC10763356 DOI: 10.1186/s13584-023-00588-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 12/28/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Current evidence on chronic conditions favors promotion of health behaviors as a mean to positively impact health outcomes. In Parkinson's disease, performing health behaviors is indicated as a means to fight the long-lasting burden of the disease. Understanding actual engagement in health behaviors and patient activation and their association to function and health-related quality of life is therefore important. Our objectives were, among people with Parkinson's disease: (1) to characterize health behaviors including utilization of rehabilitative treatments, physical activity, and patient activation levels, and (2) to test the associations between these health behaviors and health outcomes. METHODS A cross-sectional study of 88 people with Parkinson's disease (age 66.84 ± 8.8) was conducted. Participants answered questionnaires measuring health behaviors including utilization of health professions treatments, physical activity, patient activation, and health outcomes consisting of function and health-related quality of life. Linear regression models were conducted to test associations between measured health behaviors, function and health-related quality of life. RESULTS Participants rarely engage in rehabilitative treatments, but showed high levels of patient activation. Controlled by demographics and disease severity, physical activity and patient activation were associated with function (b = 0.41, p < .001; b = 0.2, p = .02, respectively) and physical activity but not patient activation, which was associated with health-related quality of life (b = 0.19, p = .03). There was also interaction effects of physical activity and non-motor symptoms, and physical activity and motor symptoms on health-related quality of life (b = 0.19, p = .02 and b = - 0.22, p = .01, respectively). CONCLUSIONS In respect to their potential health-related benefits for people with Parkinson's disease, health professionals' treatments are underutilized. Findings supported the importance of health behaviors for maintaining function and health-related quality of life among people with Parkinson's disease. They also show a differential contribution of motor and non-motor symptoms to the association between physical activity and quality of life. It is suggested that policy makers encourage opportunities for physical activity tailored for people with Parkinson's disease and adopt a proactive stance towards enhancing awareness and use of rehabilitation services. Trial registration NCT05211700, ClinicalTrials.gov ID: NCT05211700 first release 12/30/2021, https://classic. CLINICALTRIALS gov/ct2/show/NCT05211700.
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Affiliation(s)
- Michal Duvdevani
- Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Mount Carmel, POB 3338, 3103301, Haifa, Israel
| | - Galit Yogev-Seligmann
- Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Mount Carmel, POB 3338, 3103301, Haifa, Israel.
| | - Ilana Schlesinger
- Movement Disorders Institute, Department of Neurology, Rambam Health Care Campus, Haifa, Israel
- Technion Faculty of Medicine, Haifa, Israel
| | - Maria Nassar
- Movement Disorders Institute, Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Ilana Erich
- Movement Disorders Institute, Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Rafi Hadad
- Movement Disorders Institute, Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Michal Kafri
- Department of Physical Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa, Israel
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10
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House TR, Helm K, Wightman A. Building Partnerships to Improve Health Outcomes: Pediatric Patient and Family Engagement in Nephrology Practice. Adv Kidney Dis Health 2024; 31:37-45. [PMID: 38403392 DOI: 10.1053/j.akdh.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 09/28/2023] [Accepted: 10/11/2023] [Indexed: 02/27/2024]
Abstract
As health care practices have evolved from a disease-oriented to patient-focused paradigm, patient and family engagement (PFE) has been recognized as an important aspect of health care delivery and outcomes. While pediatricians have long approached care delivery with a family-centered lens, PFE may be a less familiar concept to situate among related concepts such as shared decision-making, self-efficacy, patient activation, and family-centered care. Children with CKD and their families indicate a need and desire for enhanced PFE efforts in pediatric nephrology. Improving PFE offers the opportunity to provide our patients and families with skills that will positively impact their health and wellness throughout their lives. In this review, we define PFE, describe the components of and levels at which PFE occurs across the health care system, examine PFE interventions of promise, and finally suggest future directions to support PFE in pediatric nephrology.
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Affiliation(s)
- Taylor R House
- Division of Pediatric Nephrology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI.
| | - Kelly Helm
- NephCure for Rare Kidney Disease, King of Prussia, PA
| | - Aaron Wightman
- Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
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11
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Goevaerts WF, Tenbült-van Limpt NCCW, Lu Y, Kop WJ, Kemps HMC, Brouwers RWM. Evaluation of an application for the self-assessment of lifestyle behaviour in cardiac patients. Neth Heart J 2024; 32:55-62. [PMID: 38060138 PMCID: PMC10781924 DOI: 10.1007/s12471-023-01835-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Currently, no uniform, well-validated and comprehensive lifestyle behaviour self-assessment instrument exists for patients with cardiovascular disease. PURPOSE To evaluate the usability of a novel mobile application (LifeStyleScore) based on validated instruments for the assessment of cardiovascular risk behaviours. Secondly, the application's acceptance by healthcare professionals (HCPs) and its association with improved patient activation and lifestyle behaviour was evaluated. METHODS In this single-centre, non-randomised observational pilot study, patients with coronary artery disease or atrial fibrillation entering cardiac rehabilitation (CR) completed the LifeStyleScore application, the Patient Activation Measure (PAM-13®), and the System Usability Scale (SUS) during the CR intake and after CR completion. A focus group interview was performed with the HCPs involved. RESULTS We analysed 20 participants, 3 of whom were women, with a mean age of 61.9 ± 6.7 years. The LifeStyleScore application was rated with a SUS score above average (> 68) before (69.6 ± 13.4) and after CR (68.6 ± 15.1). All HCPs (n = 8) found the application usable. Patient activation did not increase significantly after CR compared with baseline (62.0 ± 8.6 versus 59.2 ± 9.5, respectively, p = 0.28) and only physical activity levels improved significantly (2.4 ± 0.7 (standardised score) at baseline, 2.8 ± 0.4 after CR, p = 0.04). CONCLUSION The LifeStyleScore application was found to be usable for patients receiving CR. Its use did not result in increased patient activation, and of the lifestyle behaviours only physical activity levels improved. Further research is needed to evaluate how such applications can be optimally incorporated in CR programmes.
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Affiliation(s)
- Wilhelmina F Goevaerts
- Department of Cardiology, Máxima Medical Centre, Eindhoven/Veldhoven, The Netherlands.
- Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands.
| | - Nicole C C W Tenbült-van Limpt
- Department of Cardiology, Máxima Medical Centre, Eindhoven/Veldhoven, The Netherlands
- Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Yuan Lu
- Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Willem J Kop
- Center of Research on Psychological Disorders and Somatic Diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Hareld M C Kemps
- Department of Cardiology, Máxima Medical Centre, Eindhoven/Veldhoven, The Netherlands
- Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Rutger W M Brouwers
- Department of Cardiology, Máxima Medical Centre, Eindhoven/Veldhoven, The Netherlands
- Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands
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12
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Pellet J, Weiss M, Zúñiga F, Mabire C. Improving patient activation with a tailored nursing discharge teaching intervention for multimorbid inpatients: A quasi-experimental study. Patient Educ Couns 2024; 118:108024. [PMID: 37862876 DOI: 10.1016/j.pec.2023.108024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 10/05/2023] [Accepted: 10/11/2023] [Indexed: 10/22/2023]
Abstract
OBJECTIVE Preliminary effectiveness test of a novel structured personalized discharge teaching intervention for multimorbid inpatients. METHODS Using a 2-group sequential pre/post-intervention design, the sample comprised 68 pre-intervention control group and 70 post- intervention group participants. The discharge teaching intervention by trained clinical nurses used structured tools to engage patients and individualize discharge teaching. Outcomes measures included Patient Activation Measure, Readiness for Hospital Discharge Scale, Discharge Care Experiences Survey, and readmission with 10 days post-discharge. RESULTS The intervention had a statistically significant positive effect on improving patient activation (M=4.8; p = 0.05) from admission to post-discharge. The participation subscale of the Discharge Care Experiences Survey was higher in the intervention (M=4.1, SD=0.7) than the control group (M=3.8, SD=0.7; t (127)= -2.79, p = .01, effect size= .34). There were no significant between-group differences in Readiness for Hospital Discharge Scale and readmission. CONCLUSIONS Our results suggest that a structured personalized discharge teaching intervention can improve patient activation and participation in discharge care. Further refinement of the intervention is needed to evaluate and improve specific components of the intervention. PRACTICE IMPLICATIONS Structured personalized discharge teaching should include patient engagement strategies in the teaching-learning process.
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Affiliation(s)
- Joanie Pellet
- Institute of Higher Education and Research in Healthcare - IUFRS, University of Lausanne (UNIL), Lausanne University Hospital (CHUV), Lausanne, Switzerland.
| | - Marianne Weiss
- College of Nursing, Marquette University, Milwaukee, Wisconsin, USA
| | - Franziska Zúñiga
- Institute of Nursing Science (INS), Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Cedric Mabire
- Institute of Higher Education and Research in Healthcare - IUFRS, University of Lausanne (UNIL), Lausanne University Hospital (CHUV), Lausanne, Switzerland
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13
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Naamneh-Abuelhija B, Yogev-Seligmann G, Kafri M. Does affiliation with a minority group affect patient activation? Patient Educ Couns 2024; 118:108011. [PMID: 37866072 DOI: 10.1016/j.pec.2023.108011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 09/04/2023] [Accepted: 10/05/2023] [Indexed: 10/24/2023]
Abstract
OBJECTIVE To systematically review published studies assessing associations between ethnicity and patient activation (PA) among people with chronic conditions. METHODS A systematic review (PROSPERO-CRD42022320793) was performed by searching in PubMed, CINAHL, Scopus, and Google Scholar. Studies were included according to the following criteria: age > 18, diagnosis of at least one chronic condition, assessment of PA, report of ethnic minority group, and statistical analyses of PA scores include between-group comparisons or correlation or regression with ethnic group affiliation. Two reviewers conducted independent screening of records and full-text articles published until July 2021. Quality was evaluated using the National Institutes of Health study quality assessment tool. RESULTS From 197 records identified, 12 studies were included. The majority of studies focused on participants of White, Black and Hispanic ethnicity. Seven studies establish a significant association between ethnicity and PA, while the remainder of the studies found no association or inconclusive results. CONCLUSIONS The findings indicate that ethnicity is related to PA although additional, multiple explanatory variables other than ethnicity to PA were identified. Practice implications Programs to promote PA should be adjusted to participants' ethnic affiliation but consider differences in the barriers to PA and their magnitude that may differ across different ethnicities.
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Affiliation(s)
- Badera Naamneh-Abuelhija
- Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Mount Carmel, Haifa 3498838, Israel
| | - Galit Yogev-Seligmann
- Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Mount Carmel, Haifa 3498838, Israel
| | - Michal Kafri
- Department of Physical Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Mount Carmel, Haifa 3498838, Israel.
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14
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Demiray O, Gunes ED, Kulak E, Dogan E, Karaketir SG, Cifcili S, Akman M, Sakarya S. Classification of patients with chronic disease by activation level using machine learning methods. Health Care Manag Sci 2023; 26:626-650. [PMID: 37824033 DOI: 10.1007/s10729-023-09653-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 09/04/2023] [Indexed: 10/13/2023]
Abstract
Patient Activation Measure (PAM) measures the activation level of patients with chronic conditions and correlates well with patient adherence behavior, health outcomes, and healthcare costs. PAM is increasingly used in practice to identify patients needing more support from the care team. We define PAM levels 1 and 2 as low PAM and investigate the performance of eight machine learning methods (Logistic Regression, Lasso Regression, Ridge Regression, Random Forest, Gradient Boosted Trees, Support Vector Machines, Decision Trees, Neural Networks) to classify patients. Primary data collected from adult patients (n=431) with Diabetes Mellitus (DM) or Hypertension (HT) attending Family Health Centers in Istanbul, Turkey, is used to test the methods. [Formula: see text] of patients in the dataset have a low PAM level. Classification performance with several feature sets was analyzed to understand the relative importance of different types of information and provide insights. The most important features are found as whether the patient performs self-monitoring, smoking and exercise habits, education, and socio-economic status. The best performance was achieved with the Logistic Regression algorithm, with Area Under the Curve (AUC)=0.72 with the best performing feature set. Alternative feature sets with similar prediction performance are also presented. The prediction performance was inferior with an automated feature selection method, supporting the importance of using domain knowledge in machine learning.
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Affiliation(s)
- Onur Demiray
- Department of Computing, Imperial College London, London, SW7 2AZ, UK
| | - Evrim D Gunes
- College of Administrative Sciences and Economics, Koç University, Rumeli Feneri Yolu, Sariyer-Istanbul, Turkey.
| | - Ercan Kulak
- Ministry of Health Caycuma District Health Directorate, Zonguldak, Turkey
| | - Emrah Dogan
- Ministry of Health, Zonguldak Community Health Center, Zonguldak, Turkey
| | | | - Serap Cifcili
- Department of Family Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Mehmet Akman
- Department of Family Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Sibel Sakarya
- MPH, MHPE, School of Medicine, Department of Public Health, Koç University, Rumeli Feneri Yolu, Sariyer-Istanbul, Turkey
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15
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Kato A, Yoshiuchi K, Hashimoto H, Suzuki R, Yamauchi T, Kadowaki T. Feasibility, acceptability, and effects of a self-stigma reduction pilot program for Japanese individuals with type 2 diabetes. PEC Innov 2023; 2:100112. [PMID: 37214517 PMCID: PMC10194166 DOI: 10.1016/j.pecinn.2022.100112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 10/02/2022] [Accepted: 11/27/2022] [Indexed: 05/24/2023]
Abstract
Objective To examine the feasibility, acceptability, and effects of a self-stigma reduction program for patients with type 2 diabetes mellitus (T2DM). Methods We adopted a within-subjects pre-post study design, measuring self-stigma among T2DM patients who received treatment at a tertiary-level hospital. Results Of the 17 participants, 11 participants completed the program (mean age: 54.36 ± 8.58 years; women: 63.6%; mean T2DM duration: 12.09 ± 10.41 years). Participants experienced reduced levels of self-stigma between the pre- and post-study time points (mean pre-study score: 35.82 ± 16.26; mean post-study score: 25.55 ± 16.91). The difference in self-stigma was not significant (effect size: d = 0.8, χ2 = 3.6, p = 0.057). Overall, participants who completed the program were satisfied except for the duration of each session. Conclusion The self-stigma reduction program was relatively feasible and acceptable. Although due to the small sample size our results were not statistically significant, a large reduction of self-stigma was found in those who completed the program, which is promising. Future studies with larger sample sizes are needed to measure the program's long-term effects on the reduction of self-stigma. Innovation This program is innovative as the researchers and healthcare professionals collaborated with patients who contributed their narratives.
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Affiliation(s)
- Asuka Kato
- Department of Health and Social Behavior, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kazuhiro Yoshiuchi
- Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hideki Hashimoto
- Department of Health and Social Behavior, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Ryo Suzuki
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Diabetes, Metabolism and Endocrinology, Tokyo Medical University, Tokyo, Japan
| | - Toshimasa Yamauchi
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takashi Kadowaki
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Toranomon Hospital, Tokyo, Japan
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Serrano-Pérez P, Rivero-Santana A, Daigre-Blanco C, Palma-Álvarez RF, Nistal-Franco I, Antoni Ramos-Quiroga J, Grau-López L. Shared decision making in patients with substance use disorders: A one-year follow-up study. Psychiatry Res 2023; 329:115540. [PMID: 37857131 DOI: 10.1016/j.psychres.2023.115540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 10/07/2023] [Accepted: 10/09/2023] [Indexed: 10/21/2023]
Abstract
Patient-centered care in therapeutic processes has been associated with better clinical outcomes, however, it remains a poorly studied aspect in Substance Use Disorder (SUD). The study aimed to evaluate patient's preferences, perceived participation in treatment decisions and activation level; and how they predict retention, pharmacological adherence and substance use during one-year follow-up. Logistic regression models were used to analyze the association between independent variables, along with a wide number of sociodemographic and clinical covariates, and outcomes. Most patients prefer a shared or passive role when making decisions about their treatment, and showed concordance between their preferred and perceived roles. In the univariate models, perceiving more involvement than desired showed a higher likelihood of treatment discontinuation at 12 months, and substance use at 6 and 12 months. No significant associations were found between the remaining decisional variables or the degree of activation with the assessed outcomes. A majority of SUD patients prefer and perceive to be involved in the decision-making process about their treatment. Patients perceiving more involvement than desired might experience an excess of responsibility that could negatively influence treatment continuation and substance use. Limitations of the study preclude any definitive conclusion, and more research is needed to confirm these results.
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Affiliation(s)
- Pedro Serrano-Pérez
- Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain; Department of Psychiatry, Hospital Álvaro Cunqueiro, SERGAS, Vigo, Spain; Translational Neuroscience Research Group, Galicia Sur Health Research Institute (IIS-Galicia Sur), SERGAS-UVIGO, CIBERSAM, Vigo, Spain.
| | - Amado Rivero-Santana
- Canary Islands Health Research Institute Foundation (FIISC); Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS) Spain
| | - Constanza Daigre-Blanco
- Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain; Department of Psychiatry, Addiction and Dual Diagnosis Section, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Psychiatry Group, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Madrid, Spain
| | - Raúl Felipe Palma-Álvarez
- Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain; Department of Psychiatry, Addiction and Dual Diagnosis Section, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Psychiatry Group, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Madrid, Spain
| | - Icía Nistal-Franco
- Department of Psychiatry, Hospital Álvaro Cunqueiro, SERGAS, Vigo, Spain
| | - Josep Antoni Ramos-Quiroga
- Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain; Department of Psychiatry, Addiction and Dual Diagnosis Section, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Psychiatry Group, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Madrid, Spain
| | - Lara Grau-López
- Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain; Department of Psychiatry, Addiction and Dual Diagnosis Section, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Psychiatry Group, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Madrid, Spain
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17
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Ljungberg Persson C, Al-Nuaimi A, Esmaeili N, Svensberg K. Patients' attitudes towards using a question prompt list in community pharmacies. Patient Educ Couns 2023; 115:107862. [PMID: 37422951 DOI: 10.1016/j.pec.2023.107862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 05/28/2023] [Accepted: 06/17/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVE To explore patients' usage rate and perceived usefulness and benefits of a question prompt list (QPL) when collecting prescribed medication in community pharmacies. METHODS Data were collected in Swedish pharmacies using questionnaires and semi-structured interviews with patients. The Technology Acceptance Model (TAM) was used, and the outcomes were usage rate, factors impacting on use, and perceived ease of use, usefulness, and benefits of self-reported question-asking and self-perceived medication knowledge. Descriptive statistics and group comparisons were performed, and qualitative data were analyzed thematically with the TAM. RESULTS Out of 145 patients filling out the questionnaire, 72 (50.0%) reported they had used the QPL. Patients with new prescriptions and non-native Swedish speakers used the QPL more often (p = 0.03; p = 0.009, respectively). The QPL was quick to read (86.3%) and easy to understand (91.4%). Forty percent stated that they asked more questions, and self-reported users scored higher on self-perceived medication knowledge. In the interviews (n = 14), the QPL was described as an eye-opener as to what one could ask the pharmacist. CONCLUSIONS Patients were willing to use a QPL in community pharmacies. PRACTICE IMPLICATIONS A QPL in pharmacies might improve patients' engagement medication knowledge, as well as showcase the expertise of pharmacists.
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Affiliation(s)
- C Ljungberg Persson
- School of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden.
| | - A Al-Nuaimi
- Department of Pharmacy, University of Uppsala, Box 580, 751 23 Uppsala, Sweden
| | - N Esmaeili
- School of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
| | - K Svensberg
- Department of Pharmacy, University of Uppsala, Box 580, 751 23 Uppsala, Sweden
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Janelle Cambron-Mellott M, Way N, Pesa J, Adigun M, Jean Wright II H. Factors associated with patient activation among individuals with depression within racial/ethnic groups in the United States. Prev Med Rep 2023; 35:102299. [PMID: 37519446 PMCID: PMC10372381 DOI: 10.1016/j.pmedr.2023.102299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 05/19/2023] [Accepted: 06/21/2023] [Indexed: 08/01/2023] Open
Abstract
Increasing patient activation may be vital for improving quality of care for individuals with depression. Among adults with depression who reside in the United States, we sought to examine the association of depression severity, race/ethnicity, and household income with patient activation and within identify factors associated with patient activation within race/ethnicity groups. Data from the 2020 US National Health and Wellness Survey, a cross-sectional, general population survey, were used to identify White, Black/African American, Asian, and Hispanic respondents with self-reported physician-diagnosed depression. Generalized linear models were used to identify factors associated with patient activation. Analyses included 8,216 respondents (mean age = 44 years, 68.0% female). Depression severity was negatively associated with patient activation (β = -0.29, p < 0.001). Patient activation was significantly higher in Black vs. White respondents (β = 1.50, p = 0.001) and in respondents with a household income of $25,000-$49,999 (β = 0.96, p = 0.015), $50,000-$99,000 (β = 0.88, p = 0.031), and ≥$100,000 (β = 1.78, p < 0.001) vs. <$25,000. Adjusted mean patient activation scores were highest among Black respondents (61.1), followed by Hispanic (60.2), White (59.6), and Asian (59.0) respondents. Neither race/ethnicity nor household income moderated the relationship between depression severity and patient activation; however, the factors most strongly associated with patient activation differed by race/ethnicity. These results indicate that the pathway to improving patient activation in individuals with depression may vary by race/ethnicity. Understanding factors associated with patient activation can help inform the design of interventions to increase patient activation in individuals with depression.
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Affiliation(s)
| | - Nate Way
- Cerner Enviza, an Oracle Company, 2800 Rock Creek Parkway, Kansas City, MO 64117, USA
| | - Jacqueline Pesa
- Janssen Scientific Affairs, LLC, 1125 Trenton Harbourton Road, Titusville, NJ 08560, USA
| | - Muideen Adigun
- Janssen Scientific Affairs, LLC, 1125 Trenton Harbourton Road, Titusville, NJ 08560, USA
| | - H. Jean Wright II
- Behavioral Health and Justice Division, Department of Behavioral Health and Intellectual disAbility Services, City of Philadelphia, 1601 Market Street, Five Penn Center, 7th Floor, Philadelphia, PA 19103, USA
- Temple University, Psychology Department, Weiss Hall, 6th Floor, 1701 N 13th St, Philadelphia, PA 19122, USA
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Nielsen MS, Steinsbekk A, Nøst TH. Interest in using patient portals among adolescents in mental health care - a cross-sectional study. BMC Health Serv Res 2023; 23:841. [PMID: 37559093 PMCID: PMC10410786 DOI: 10.1186/s12913-023-09823-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/17/2023] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION Adolescents in mental health care may benefit from using patient portals to access personalised information about their health and treatment. While no studies have considered the interest in using patient portals among adolescents in mental health care, factors such as patient activation, self-reported health, depressive symptoms, diagnosis, healthcare utilisation, and eHealth literacy have been found to be associated with interest in and use of patient portals in other patient groups. Therefore, the aim was to explore the associations between interest in using patient portals and patient activation, self-reported health, depressive symptoms, diagnosis, healthcare utilisation and eHealth literacy among adolescents in specialist mental health care. METHODS A cross-sectional study among adolescents between 12 and 18 years of age receiving or having received treatment at four different specialist child and adolescent mental healthcare services across Norway. The adolescents´ answers to the questionnaire were linked to data on their healthcare utilisation and ICD-10 diagnoses from the Norwegian Patient Registry. The data were analysed using descriptive statistics and bivariate tests. RESULTS The 53 adolescents who participated, had a mean age of 15 years and 68% of them identified as female. Two out of three (64%) were interested in using patient portals. Most of the factors were not associated with interest in using patient portals. However, adolescents with mental and behavioural disorders (F diagnoses, 75% interested) were more interested in using patient portals compared to those with symptoms and signs involving cognition, perception, emotional state, and behaviour (R diagnoses, 31% interested). CONCLUSION Except for mental health diagnosis, this study did not identify any specific factors likely to impact patient portal interest among adolescents in specialist mental health care.
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Affiliation(s)
- Martine Stecher Nielsen
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, 7491, Norway.
| | - Aslak Steinsbekk
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Norwegian Centre for E-health Research, Tromsø, Norway
| | - Torunn Hatlen Nøst
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, 7491, Norway
- Norwegian Advisory Unit on Complex Symptom Disorders, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
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Nielsen BK, Nielsen PB, Mejdahl CT, Nielsen LA, Nielsen CP, Maindal HT, Wolf M. Mental well-being and patient activation during the first eight months of the COVID-19 pandemic in Denmark - a cohort study among 710 Danish adults with chronic conditions. BMC Public Health 2023; 23:1472. [PMID: 37532983 PMCID: PMC10394778 DOI: 10.1186/s12889-023-16316-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 07/14/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND COVID-19 has highlighted the importance of patient activation in managing chronic conditions and promoting resilience during times of crisis. Patient activation refers to an individual's knowledge, skills, and confidence in managing their own health and healthcare. Previous research has shown that people with higher levels of patient activation are better prepared to navigate the challenges of chronic illness and are more likely to engage in healthy behaviors. However, the impact of patient activation on COVID-19-related concerns and mental well-being among people with chronic conditions during the pandemic remains unclear. This study aims to investigate the possible role of patient activation in shaping COVID-19-related concerns and to describe changes in mental well-being among Danish adults with one or more chronic conditions during the early months of the pandemic. METHODS Danish adults with chronic conditions (e.g. diabetes, coronary heart disease, obstructive pulmonary lung disease, cancer) who had participated in a municipal health education program prior to the COVID-19 outbreak were asked to participate in this prospective questionnaire study in May 2020 and November 2020. Sociodemographic (sex, age, living status, educational attainment, employment status) and disease-related information (diagnosis, one or more chronic conditions) along with the Patient Activation Measure were collected before the outbreak and were obtained from a clinical database used for monitoring and evaluation of municipal health education programs. In contrast, the two questionnaires collected six months apart consisted of single items related to concerns about COVID-19 and the WHO-5 well-being index. RESULTS A total of 710 people with chronic conditions (mean age 60.9 years; 55.8% female) participated at both time points. In bivariate analyses, patient activation was associated with COVID-19-related concern and well-being. At follow-up, participants experienced a significant decrease in well-being. The decrease was associated with poorer well-being measured six months earlier, a greater perception that it had become more challenging to take care of one's health due to the pandemic, and finally, feeling lonely. The association between patient activation and well-being ceased to be significant in the multivariate regression model. CONCLUSIONS A considerable proportion of people with chronic conditions participating in this study have been mentally burdened during COVID-19. Although lower levels of patient activation were associated with greater COVID-19-related concerns, it did not have a significant impact on mental well-being over time.
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Affiliation(s)
- Berit Kjærside Nielsen
- DEFACTUM - Public Health Research, Central Denmark Region, Olof Palmes Allé 15, Aarhus N, DK-8200, Denmark.
| | - Pernille Bjørnholt Nielsen
- DEFACTUM - Public Health Research, Central Denmark Region, Olof Palmes Allé 15, Aarhus N, DK-8200, Denmark
| | | | - Lise Arnth Nielsen
- DEFACTUM - Public Health Research, Central Denmark Region, Olof Palmes Allé 15, Aarhus N, DK-8200, Denmark
| | - Camilla Palmhøj Nielsen
- DEFACTUM - Public Health Research, Central Denmark Region, Olof Palmes Allé 15, Aarhus N, DK-8200, Denmark
- Department of Public Health - Department of Health Services Research, Aarhus University, Aarhus C, Denmark
| | - Helle Terkildsen Maindal
- Department of Public Health - Department of Health Services Research, Aarhus University, Aarhus C, Denmark
| | - Michael Wolf
- Institute for Public Health and Medicine (IPHAM) - Center for Applied Health Research on Aging, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Hernar I, Graue M, Igland J, Richards DA, Riise HKR, Haugstvedt A, Kolltveit BCH. Patient activation in adults attending appointments in general practice: a cross-sectional study. BMC Prim Care 2023; 24:144. [PMID: 37430197 DOI: 10.1186/s12875-023-02102-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 07/03/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Patient activation refers to patients' knowledge, confidence, skills, ability, beliefs, and willingness to manage their health and healthcare. Patient activation is an essential component of self-management and identifying patient activation levels will identify people at risk for health decline at an earlier stage. We aimed to explore patient activation in among adults attending general practice by (1) investigating differences in patient activation according to characteristics and markers of health-related behaviour; (2) examining the associations of quality of life and satisfaction with health with patient activation; and (3) comparing patient activation between persons with or without type 2 diabetes (T2D) and with or without elevated T2D risk. METHODS We performed a cross-sectional study and recruited 1,173 adult patients from four Norwegian general practices between May to December 2019. The participants completed a questionnaire containing sociodemographic and clinical variables, the Patient Activation Measure (PAM-13), the quality of life and satisfaction with health items from the WHO Quality of Life-BREF, three questions about exercise (regularity, intensity and exercise time), the Finnish Diabetes Risk Score (FINDRISC) and Body Mass Index. We tested differences between groups and associations using Chi-squared tests, Fisher's exact tests, t-tests, one-way ANOVAs and Spearman's rho tests. RESULTS The sample's mean PAM-13 score was 69.8 (0-100) (SD 14.8). In the total population, we found that participants reporting higher patient activation scores also reported more favourable health-related behaviours (exercise and healthy eating). We found positive correlations between the PAM-13 scores and, respectively, the quality of life score and the satisfaction with health score. We found no differences in patient activation between people with or without T2D and those with or without elevated T2D risk. CONCLUSIONS We found that higher patient activation was associated with favourable health-related behaviours, a better quality of life and better satisfaction with health among adults attending four general practices in Norway. Assessing patient activation has the potential to help general practitioners identify patients who might benefit from closer follow-up in advance of negative health outcomes.
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Affiliation(s)
- Ingvild Hernar
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, P.O. Box 7030, N-5020, Bergen, Norway.
- Department of Internal Medicine, Haukeland University Hospital, Bergen, Norway.
| | - Marit Graue
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, P.O. Box 7030, N-5020, Bergen, Norway
| | - Jannicke Igland
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, P.O. Box 7030, N-5020, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - David A Richards
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, P.O. Box 7030, N-5020, Bergen, Norway
- Institute for Health Research, College of Medicine and Health,, University of Exeter, Exeter, UK
| | - Hilde Kristin Refvik Riise
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, P.O. Box 7030, N-5020, Bergen, Norway
| | - Anne Haugstvedt
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, P.O. Box 7030, N-5020, Bergen, Norway
| | - Beate-Christin Hope Kolltveit
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, P.O. Box 7030, N-5020, Bergen, Norway
- Vossevangen Medical Centre, Voss, Norway
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Tardy AL, Marguet S, Costantino H, Stewart A, Mackie D, Saba G, Amand C. Profile and quality of life of the adult population in good health according to the level of vitality: European NHWS cross sectional analysis. BMC Public Health 2023; 23:1061. [PMID: 37277779 DOI: 10.1186/s12889-023-15754-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 04/13/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND The World Health Organization's definition of health highlights the importance of mental and physical wellbeing and not only disease state. However, lack of awareness on the burden of impaired vitality and its impact on the quality of life of the general healthy population prevents healthcare providers from delivering appropriate solutions and advice. This study aims to better characterize this population in Europe and identify the profile and the health reported outcomes associated with impaired vitality. METHODS This retrospective observational study included National Health and Wellness Survey (NHWS) data collected in healthy participants aged 18-65 years from five European Union countries in 2018. Socio-demographic and lifestyle characteristics, comorbidities, attitudes towards healthcare systems, Patient Activation Measure, health-related quality of life outcomes (EQ-5D), and work productivity and activity impairment were analysed according to SF-12 vitality score subgroups (≥ 60, 50- < 60, 40- < 50, < 40). RESULTS A total of 24,295 participants were enrolled in the main analysis. Being a female, younger, having a lower income and being obese or having sleep and mental disorders was associated with an increased risk of impaired vitality. This was associated with a higher consumption of healthcare resources along with having a weak patient-physician relationship. Participants who were disengaged in the self-management of their health were 2.6 times more likely to have a low level of vitality. For participants in the lowest vitality group, odds of mobility problems increased by 3.4, impairment of usual activity by 5.8, increased of pain and discomfort by 5.6 and depression and anxiety by 10.3, compared with participants in the highest vitality group. Also, odds of presenteeism increased by 3.7, overall work impairment by 3.4 and daily activity losses by 7.1. CONCLUSION Evidence-based trends facilitate the identification of a healthy population with impaired vitality in real-world practice. This study highlights the actual burden of low vitality on daily life activities, particularly on mental health and reduced work productivity. Additionally, our results underline the importance of self-engagement in the management of vitality impairment and highlights the need to implement strategies to address this public health concern in the affected population (HCP-patient communication, supplements, meditation).
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Affiliation(s)
| | | | | | - Andrew Stewart
- Science Hub, Sanofi Consumer Healthcare Cambridge, Cambridge, MA, USA
| | | | | | - Caroline Amand
- Science Hub, Sanofi Consumer Healthcare, Gentilly, France.
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23
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Ilie G, Rendon R, Mason R, MacDonald C, Kucharczyk MJ, Patil N, Bowes D, Bailly G, Bell D, Lawen J, Ha M, Wilke D, Massaro P, Zahavich J, Kephart G, Rutledge RDH. A Comprehensive 6-mo Prostate Cancer Patient Empowerment Program Decreases Psychological Distress Among Men Undergoing Curative Prostate Cancer Treatment: A Randomized Clinical Trial. Eur Urol 2023; 83:561-570. [PMID: 36822969 DOI: 10.1016/j.eururo.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 12/30/2022] [Accepted: 02/03/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND Although survival rates for newly diagnosed prostate cancer patients are very high, most of them will likely suffer significant treatment-related side effects, depression, or anxiety, affecting their quality of life. OBJECTIVE The aim of this study was to examine the effects of a 6-mo online home-based physical, mental, and social support intervention, the Prostate Cancer Patient Empowerment Program (PC-PEP), on preventing psychological distress among men undergoing curative prostate cancer treatment. DESIGN, SETTING, AND PARTICIPANTS In a crossover randomized clinical trial of 128 men aged 50-82 yr scheduled for curative prostate cancer surgery or radiotherapy (± hormone treatment), 66 received the 6-mo PC-PEP intervention and 62 were randomized to a waitlist-control arm and received the standard of care for 6 mo, and then PC-PEP to the end of the year. The PC-PEP intervention consisted of daily e-mails with video instructions providing education, patient activation, and empowerment on healthy living including physical and mental health, dietary recommendations, social support, physical and pelvic floor fitness, stress reduction using a biofeedback device, social connection and intimacy, and social support. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary outcome was nonspecific psychological distress (clinical cutoff ≥20) measured at baseline, and at 6 and 12 mo using the Kessler Psychological Distress Scale (K10). RESULTS AND LIMITATIONS At 6 mo, patients in the waitlist-control group had 3.59 (95% confidence interval: 1.12-11.51) times higher odds for nonspecific psychological distress and need for psychological treatment than men who received the PC-PEP intervention. At 12 mo, the wait-list control group that received the intervention at 6 mo had higher psychological distress than the early group. CONCLUSIONS PC-PEP delivered early following diagnosis significantly prevented the burden of psychological distress in men undergoing curative prostate cancer treatment compared with standard of care, or late (6 mo later) intervention. PATIENT SUMMARY In this report, we looked at the effectiveness of a program (Prostate Cancer Patient Empowerment Program: PC-PEP) developed with patients' engagement on the mental distress of patients awaiting curative treatment for their prostate cancer. The PC-PEP program lasted for 6 mo, and it prescribed, described, and demonstrated daily aerobic and strength training, kegels (pelvic floor training to help with urinary and sexual function), dietary changes that have been shown to be helpful in the prevention of prostate cancer and prostate cancer progression, stress reduction using a biofeedback device, as well as social and emotional support. All patients in the PC-PEP program were invited to a monthly video conference with the leads of the program who appeared in the 6 mo of daily videos prescribing the activities the patients were asked to watch and follow. The leads were a prostate cancer oncologist and a scientist in prostate cancer quality of life research. Half of the patients in this study received PC-PEP daily for the first 6 mo and were re-assessed at the end of the year. The other half received standard of care for 6 month and then received the intervention to the end of the year. The results of the study show that, at 6 mo, this intervention was effective at reducing the mental distress that accompanies a prostate cancer diagnosis and treatment compared with the standard of care. Mental distress was significantly reduced when the intervention was received early, compared with that received late (6 mo after scheduled curative treatment). We conclude that multi-faceted patient education and empowerment programming of this kind that is developed with patient engagement from the start is crucial to the care of patients diagnosed with prostate cancer and should be implemented in the standard of care. While treatment for prostate cancer is highly successful, side effects that accompany most treatments significantly affect the quality of life of patients. Here, we describe PC-PEP, a patient education and activation program that is cost effective, highly enforced by patients, and successful at reducing the impact of prostate cancer active treatment-related side effects on their psychological state. To learn more about this project, please visit www.pcpep.org. The program is now being tested in a phase 4 implementation trial throughout Canada and internationally (New Zealand), and is being expanded and tested for other types of cancer.
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Affiliation(s)
- Gabriela Ilie
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Ricardo Rendon
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ross Mason
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Cody MacDonald
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Michael J Kucharczyk
- Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Nikhilesh Patil
- Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - David Bowes
- Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Greg Bailly
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - David Bell
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Joseph Lawen
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Michael Ha
- Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Derek Wilke
- Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Peter Massaro
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jeffery Zahavich
- Department of Kinesiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - George Kephart
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
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Müller K, Schuster F, Rodolico A, Siafis S, Leucht S, Hamann J. How should patient decision aids for schizophrenia treatment be designed? - A scoping review. Schizophr Res 2023; 255:261-273. [PMID: 37062107 DOI: 10.1016/j.schres.2023.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 02/14/2023] [Accepted: 03/12/2023] [Indexed: 04/18/2023]
Abstract
Despite the clear rationale for applying shared decision-making in the context of the preference sensitive decision for or against antipsychotics and the upswing of patient decision aids (pDAs) to support this process, there is still a lack of knowledge regarding which key features are crucial for pDAs in schizophrenia treatment. A scoping review according to the PRISMA-SRc was conducted to inform on crucial key features and quality indicators. The review focussed on the following seven aspects for investigating pDAs: (1) Types of decision aids, (2) Values, (3) Decision Guidance, (4) Output of the decision aid, (5) Target group, (6) Effectiveness according to publication and (7) Decision aid evaluation. Eleven studies which addressed six unique decision aids met the eligibility criteria. There were major differences in the design as well as in the development of the decision aids. Three aspects emerged that should be given special consideration in the design of such tools for antipsychotics: the evidence used by the decision aid, the algorithm for translating evidence into a decision aid and finally the presentation of the evidence. We recommend the use of data with a high level of evidence and to combine it with individualized treatment by taking into account patient preferences and previous experiences as well as comparing them with clinical assessments. Fully computerized decision aids that use complicated algorithms, for example, by merging treatment effects with patient characteristics to suggest an appropriate treatment at the end, tend to be paternalistic and thus not appropriate for SDM, in our view. In addition, possible cognitive deficits need to be considered when presenting the output of decision aids for antipsychotics.
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Affiliation(s)
- Katharina Müller
- kbo-Isar-Amper-Klinikum München, Munich, Germany; Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Florian Schuster
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany; Schön Klinik Bad Aibling Harthausen, Bad Aibling, Germany
| | - Alessandro Rodolico
- Department of Clinical and Experimental Medicine, Institute of Psychiatry, University of Catania, Catania, Italy
| | - Spyridon Siafis
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany.
| | - Johannes Hamann
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany; Bezirkskrankenhaus Mainkofen, Deggendorf, Germany
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Zhang A, Wang J, Wan X, Guo Z, Zhang Z, Zhao S, Bai S, Miao Y, Zhang J. The mediating effect of self-efficacy on the relationship between diabetes self-management ability and patient activation in older adults with type 2 diabetes. Geriatr Nurs 2023; 51:136-142. [PMID: 36940508 DOI: 10.1016/j.gerinurse.2023.02.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 02/13/2023] [Accepted: 02/13/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the level of diabetes self-management ability in older patients with type 2 diabetes and analyse its relationship with patient activation. Besides, the mediating effect of self-efficacy on the relationship between the two was assessed in the study. METHODS Using a cross-sectional design, 200 elderly patients with type 2 diabetes were recruited from the community of Yangzhou, China. The Patient Activation Measure (PAM), The Self-efficacy for Diabetes (SED), and The Summary of Diabetes Self-Care Activities Measure (SDSCA) were used in the questionnaires. Data analysis was performed using SPSS 27.0 and PROCESS macro. RESULTS Pearson correlation analysis revealed a significant positive correlation (p< 0.01) between diabetes self-management ability and patient activation (r=0.312) and self-efficacy (r=0.367). Self-efficacy partially mediated the effect between patient activation and self-management ability in older patients with type 2 diabetes, and the mediating effect accounted for 49.33% of the total effect (p< 0.001). CONCLUSIONS Older patients with type 2 diabetes in the community have a moderate level of self-management ability. Patient activation can improve patients' self-management ability through self-efficacy.
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Affiliation(s)
- Anqi Zhang
- The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou 225003, Jiangsu, China; School of Nursing and Public Health, Yangzhou University, Yangzhou 225009, Jiangsu, China
| | - Jinsong Wang
- The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou 225003, Jiangsu, China; School of Nursing and Public Health, Yangzhou University, Yangzhou 225009, Jiangsu, China; Yangzhou Commission of Health, Yangzhou 225012, Jiangsu, China.
| | - Xiaojuan Wan
- School of Nursing and Public Health, Yangzhou University, Yangzhou 225009, Jiangsu, China
| | - Zihe Guo
- Yangzhou Commission of Health, Yangzhou 225012, Jiangsu, China
| | - Ziyi Zhang
- School of Nursing and Public Health, Yangzhou University, Yangzhou 225009, Jiangsu, China
| | - Shuhan Zhao
- School of Nursing and Public Health, Yangzhou University, Yangzhou 225009, Jiangsu, China
| | - Shuo Bai
- School of Nursing and Public Health, Yangzhou University, Yangzhou 225009, Jiangsu, China
| | - Yamin Miao
- School of Nursing and Public Health, Yangzhou University, Yangzhou 225009, Jiangsu, China
| | - Jing Zhang
- Yangzhou Commission of Health, Yangzhou 225012, Jiangsu, China
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Imeri H, Holmes E, Desselle S, Rosenthal M, Barnard M. A survey study of adults with chronic conditions: Examining the correlation between patient activation and health locus of control. Chronic Illn 2023; 19:118-131. [PMID: 36638782 DOI: 10.1177/17423953211067431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES This study aimed to examine (1) the association between patient activation (PA), health locus of control (HLOC), sociodemographic and clinical factors, and (2) the effect of HLOC dimensions, sociodemographic and clinical factors on PA. METHODS Three hundred U.S. adults, with at least one chronic condition (CC) were recruited through Amazon Mechanical Turk and completed an online survey which included sociodemographic questions, the Patient Activation Measure® - 10, and the Multidimensional Locus of Control (MHLC) - Form B. Statistical analyses, including descriptive, correlation, and multiple linear regression, were conducted using IBM SPSS v25. RESULTS Of the 300 participants, more than half were male (66.3%), White (70.7%), with at least a college degree (76.0%), and employed full-time (79.0%). The average PA score was 68.8 ± 14.5. Multiple linear regression indicated that participants who reported they were Black, retired, with a greater number of CCs, and with higher scores in Chance MHLC had higher PA, while participants with higher scores in Internal MHLC, were unemployed and reported to have been affected by COVID-19-related worry or fear to manage their CC, had lower PA. DISCUSSION HLOC dimensions should be addressed concurrently with PA for patients with CCs, thus adding to a more patient-centered clinical approach.
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Affiliation(s)
- Hyllore Imeri
- 8083University of Mississippi, Department of Pharmacy Administration, University, MS, United States
| | - Erin Holmes
- 8083University of Mississippi, Department of Pharmacy Administration, University, MS, United States
| | - Shane Desselle
- 59431Touro University California, Department of Pharmacy, Vallejo, CA, United States
| | - Meagen Rosenthal
- 8083University of Mississippi, Department of Pharmacy Administration, University, MS, United States
| | - Marie Barnard
- 8083University of Mississippi, Department of Pharmacy Administration, University, MS, United States
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Vohra Y, Brown CM, Moczygemba LR, Wilfong L. Evaluating the relationship between patient activation and health-related quality of life (HRQOL) in patients with pancreatic cancer (PwPC). Support Care Cancer 2023; 31:191. [PMID: 36847972 DOI: 10.1007/s00520-023-07632-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 02/06/2023] [Indexed: 02/28/2023]
Abstract
PURPOSE Advanced pancreatic cancer is synonymous with a high mortality rate, debilitating symptom profile, and minimal prolongation in overall survival. Therefore, health-related quality of life (HRQOL) is important in patients with pancreatic cancer (PwPC). In chronic conditions, patient activation is positively associated and higher HRQOL. However, no known study has evaluated patient activation, HRQOL, and their association in PwPC. METHODS A 43-item cross-sectional survey assessed patient activation and HRQOL of patients with locally advanced and metastatic pancreatic cancer undergoing chemotherapy. Variables were analyzed descriptively, and relationships were assessed using bivariate statistics (sig p < 0.05). RESULTS Fifty-six patients participating in the study had an average age of 69.5 ± 11.1 years, and the majority were females (51.8%), Caucasians (61.8%), married/partnered (64.3%), and had at least a college degree (59%). Almost half were at stage 4 (48.2%), and most were newly diagnosed (66.1%). Mean patient activation score was 63.5 ± 17.2 (scale range: 0-100), with most at higher activation levels of 3 or 4 (66.7%). Mean HRQOL score of 41.0 ± 12.7 (scale range: 0-72) was low. Patient activation levels, age, education level, and gender explained 21% of variation in overall HRQOL scores. Patients at activation level 4 had significantly higher overall HRQOL versus those at lower activation (level 1 or 2). Higher patient activation was significantly associated with having either private insurance only or multiple insurances and being partnered. CONCLUSION Patient activation significantly predicted HRQOL in PwPC despite the low sample size. Initiatives to increase patient activation should focus on patients of low socioeconomic status and those without partner support.
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Affiliation(s)
- Yogesh Vohra
- College of Pharmacy, University of Texas at Austin, Austin, TX, USA.
| | - Carolyn M Brown
- College of Pharmacy, University of Texas at Austin, Austin, TX, USA
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Page-Reeves J, Murray-Krezan C, Burge MR, Mishra SI, Regino L, Bleecker M, Perez D, McGrew HC, Bearer EL, Erhardt E. A patient-centered comparative effectiveness research study of culturally appropriate options for diabetes self-management. medRxiv 2023:2023.01.31.23285236. [PMID: 36778329 PMCID: PMC9915824 DOI: 10.1101/2023.01.31.23285236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This project compared the effectiveness of two evidence-based models of culturally competent diabetes health promotion: The Diabetes Self-Management Support Empowerment Model (DSMS), and The Chronic Care Model (CCM). Our primary outcome was improvement in patient capacity for diabetes self-management as measured by the Diabetes Knowledge Questionnaire (DKQ) and the Patient Activation Measure (PAM). Our secondary outcome was patient success at diabetes self-management as measured by improvement in A1c, depression sores using the PHQ-9, and Body Mass Index (BMI). We also gathered data on the cultural competence of the program using the Consumer Assessment of Healthcare Providers and Systems Cultural Competence Set (CAHPS-CC). We compared patient outcomes in two existing sites in Albuquerque, New Mexico that serve a large population of Latino diabetes patients from low-income households. Participants were enrolled as dyads-a patient participant (n=226) and a social support participant (n=226). Outcomes over time and by program were analyzed using longitudinal linear mixed modeling, adjusted for patient participant demographic characteristics and other potential confounding covariates. Secondary outcomes were also adjusted for potential confounders. Interactions with both time and program helped to assess outcomes. This study did not find a difference between the two sites with respect to the primary outcome measures and only one of the three secondary outcomes showed differential results. The main difference between programs was that depression decreased more for CCM than for DSMS. An exploratory, subgroup analysis revealed that at CCM, patient participants with a very high A1c (>10) demonstrated a clinically meaningful decrease. However, given the higher cultural competence rating for the CCM, statistically significant improvement in depression, and the importance of social support to the patients, results suggest that a culturally and contextually situated diabetes self-management and education program design may deliver benefit for patients, especially for patients with higher A1c levels.
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Affiliation(s)
- Janet Page-Reeves
- Department of Family & Community Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
- Office for Community Health, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Cristina Murray-Krezan
- Department of Medicine, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Shiraz I. Mishra
- Department of Family & Community Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
- Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Lidia Regino
- Office for Community Health, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Molly Bleecker
- Office for Community Health, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Daniel Perez
- Office for Community Health, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | | | - Elaine L. Bearer
- Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Erik Erhardt
- Department of Mathematics and Statistics, University of New Mexico, Albuquerque, New Mexico, USA
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Brady B, Sidhu B, Jennings M, Boland R, Hassett G, Chipchase L, Tang C, Yaacoub S, Pavlovic N, Sayad S, Andary T, Ogul S, Naylor J. The feasibility of implementing a cultural mentoring program alongside pain management and physical rehabilitation for chronic musculoskeletal conditions: results of a controlled before-and-after pilot study. BMC Musculoskelet Disord 2023; 24:47. [PMID: 36658511 PMCID: PMC9850562 DOI: 10.1186/s12891-022-06122-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 12/28/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Culturally diverse communities face barriers managing chronic musculoskeletal pain conditions including navigation challenges, sub-optimal healthcare provider engagement and difficulty adopting self-management behaviours. OBJECTIVES To explore the feasibility and trends of effectiveness of implementing a cultural mentoring program alongside clinical service delivery. METHODS This quasi-experimental controlled before-and-after multiple case study was conducted in three hospital-based services that provide treatment for patients with musculoskeletal pain. Two prospective cohorts, a pre-implementation and a post-implementation cohort, of adults with chronic musculoskeletal pain who attended during the 6-month recruitment phase, were eligible if they self-identified with one of the cultures prioritised for mentoring by the clinic. The pre-implementation cohort received routine care for up to 3-months, while the post-implementation cohort received up to 3-months of cultural mentoring integrated into routine care (3 to 10 sessions), provided by a consumer (n = 6) with lived experience. Feasibility measures (recruitment and completion rates, attendance, satisfaction), and trends of effectiveness (Patient Activation Measure and Health Literacy Questionnaire items one and six) were collated over 3-months for both cohorts. Outcomes were presented descriptively and analysed using Mann-Whitney U-tests for between-group comparisons. Translation and transcription of post-treatment semi-structured interviews allowed both cohorts' perspectives of treatment to be analysed using a Rapid Assessment Process. RESULTS The cultural mentor program was feasible to implement in clinical services with comparable recruitment rates (66% pre-implementation; 61% post-implementation), adequate treatment attendance (75% pre-implementation; 89% post-implementation), high treatment satisfaction (97% pre-implementation; 96% post-implementation), and minimal participant drop-out (< 5%). Compared to routine care (n = 71), patients receiving mentoring (n = 55) achieved significantly higher Patient Activation Measure scores (median change 0 vs 10.3 points, p < 0.01) at 3-months, while Health Literacy Questionnaire items did not change for either cohort over time. Three themes underpinned participant experiences and acceptability of the mentoring intervention: 'expectational priming', 'lived expertise' and 'collectivist orientation' to understand shared participant experiences and explore the potential differential effect of the mentoring intervention. CONCLUSION Participant experiences and observations of improved patient activation provide support for the acceptability of the mentoring intervention integrated into routine care. These results support the feasibility of conducting a definitive trial, while also exploring issues of scalability and sustainability.
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Affiliation(s)
- Bernadette Brady
- grid.410692.80000 0001 2105 7653Liverpool Hospital, South Western Sydney Local Health District, Locked Bag 7103 Liverpool, BC, Sydney, NSW 1871 Australia ,grid.1029.a0000 0000 9939 5719School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia ,grid.1013.30000 0004 1936 834XSydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006 Australia
| | - Balwinder Sidhu
- grid.410692.80000 0001 2105 7653Multicultural Health Unit, South Western Sydney Local Health District, 5/39 Stanley Street, Bankstown, NSW 2200 Australia
| | - Matthew Jennings
- grid.410692.80000 0001 2105 7653Liverpool Hospital, South Western Sydney Local Health District, Locked Bag 7103 Liverpool, BC, Sydney, NSW 1871 Australia
| | - Robert Boland
- grid.1013.30000 0004 1936 834XSydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006 Australia ,grid.410692.80000 0001 2105 7653Fairfield Hospital, South Western Sydney Local Health District, PO Box 5, Fairfield, Sydney, NSW 1851 Australia
| | - Geraldine Hassett
- grid.410692.80000 0001 2105 7653Liverpool Hospital, South Western Sydney Local Health District, Locked Bag 7103 Liverpool, BC, Sydney, NSW 1871 Australia
| | - Lucy Chipchase
- grid.1014.40000 0004 0367 2697Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Rd, Bedford Park, SA 5042 Australia
| | - Clarice Tang
- grid.1029.a0000 0000 9939 5719School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia ,grid.410692.80000 0001 2105 7653South Western Sydney Local Health District, Locked Bag 7103, Liverpool BC, Sydney, NSW Australia
| | - Sylvia Yaacoub
- grid.410692.80000 0001 2105 7653Fairfield Hospital, South Western Sydney Local Health District, PO Box 5, Fairfield, Sydney, NSW 1851 Australia
| | - Natalie Pavlovic
- grid.410692.80000 0001 2105 7653Fairfield Hospital, South Western Sydney Local Health District, PO Box 5, Fairfield, Sydney, NSW 1851 Australia
| | - Samia Sayad
- grid.410692.80000 0001 2105 7653Fairfield Hospital, South Western Sydney Local Health District, PO Box 5, Fairfield, Sydney, NSW 1851 Australia ,grid.410692.80000 0001 2105 7653South Western Sydney Local Health District, Locked Bag 7103, Liverpool BC, Sydney, NSW Australia
| | - Toni Andary
- grid.410692.80000 0001 2105 7653Fairfield Hospital, South Western Sydney Local Health District, PO Box 5, Fairfield, Sydney, NSW 1851 Australia
| | - Shaniya Ogul
- grid.410692.80000 0001 2105 7653Fairfield Hospital, South Western Sydney Local Health District, PO Box 5, Fairfield, Sydney, NSW 1851 Australia
| | - Justine Naylor
- grid.410692.80000 0001 2105 7653South Western Sydney Local Health District, Locked Bag 7103, Liverpool BC, Sydney, NSW Australia ,grid.1005.40000 0004 4902 0432SWS Clinical School UNSW, Locked Bag 7103, Liverpool BC, Sydney, NSW 1871 Australia ,grid.429098.eIngham Institute Applied Medical Research, 1 Campbell St, Liverpool, Liverpool, NSW 2170 Australia
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Bennett-Brown M, Gesselman AN, Miller WR. Constructive communication patterns as related to relationship satisfaction, seizure severity, and patient activation among people with epilepsy. Epilepsy Behav 2023; 138:108957. [PMID: 36379164 DOI: 10.1016/j.yebeh.2022.108957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 10/11/2022] [Accepted: 10/12/2022] [Indexed: 11/13/2022]
Abstract
PURPOSE People with epilepsy (PWE) must manage their condition properly for both quality and longevity of life. Effective self-management is critical and can be monitored via levels of patient activation (i.e., a continuum of taking a passive vs active role in personal healthcare) and the presence/severity of seizures. One known influencer of self-management is the quality of one's intimate relationship, a documented area of major concern for PWE. Here we examined a critical facet of PWEs' intimate relationships-(un)constructive communication with their partner. METHODS Using data from a web-based survey of 89 PWE, and regression-based mediation analyses, we examined associations with patient activation and seizure severity. We added further explanatory utility by examining relationship satisfaction as a mediator of those links. RESULTS There were positive links between more constructive communication, more patient activation, and less severe seizures. The explanatory path of constructive communication to better relationship satisfaction to lower seizure severity emerged as a significant partial mediation (i.e., direct effect remained significant), while relationship satisfaction fully mediated (i.e., direct effect became non-significant) the link between constructive communication and greater patient activation. CONCLUSION Our results provide insight into how relationship processes may impact the experience of epilepsy, including seizure severity and patient activation. Future research is needed.
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Affiliation(s)
- Margaret Bennett-Brown
- The Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, IN, United States; Department of Communication Studies, Texas Tech University, Lubbock, TX, United States.
| | - Amanda N Gesselman
- The Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, IN, United States
| | - Wendy R Miller
- School of Nursing, Indiana University, Bloomington, IN, United States
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31
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Sachdev R, Mo K, Wang KY, Zhang B, Musharbash FN, Vadhera A, Ochuba AJ, Kebaish KM, Skolasky RL, Neuman BJ. Preoperative patient activation predicts minimum clinically important difference for PROMIS pain and physical function in patients undergoing elective spine surgery. Spine J 2023; 23:85-91. [PMID: 36029964 DOI: 10.1016/j.spinee.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 07/21/2022] [Accepted: 08/17/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Patient activation is a patient's willingness to take independent actions to manage their own health care. PURPOSE The goal of this study is to determine whether preoperative patient activation measure (PAM) predicts minimum clinically important difference (MCID) for Patient-Reported Outcomes Measurement Information System (PROMIS) pain, physical function, depression, and anxiety for patients undergoing elective spine surgery. STUDY DESIGN/SETTING Retrospective review. PATIENT SAMPLE A single-institution, academic database of patients undergoing elective spine surgery. OUTCOME MEASURE MCID at 1-year follow-up for PROMIS pain, physical function, depression and anxiety. METHODS We retrospectively reviewed a single-institution, academic database of patients undergoing elective spine surgery. Preoperative patient activation was evaluated using the PAM-13 survey, which was used to stratify patients into four activation stages. Primary outcome variable was achieving MCID at 1-year follow-up for PROMIS pain and physical function. Multivariable logistic regression analysis was used to determine impact of patient activation on PROMIS pain and the physical function. RESULTS Of the 430 patients, 220 (51%) were female with a mean age of 58.2±16.8. Preoperatively, 34 (8%) were in activation stage 1, 45 (10%) in stage 2, 98 (23%) in stage 3, and 253 (59%) in stage 4. At 1-year follow up, 248 (58%) achieved MCID for PROMIS physical function, 256 (60%) achieved MCID for PROMIS pain, 151 (35.28%) achieved MCID for PROMIS depression, and 197 (46%) achieved MCID for PROMIS anxiety. For PROMIS physical function, when compared to patients at stage 1 activation, patients at stage 2 (aOR:3.49, 95% CI:1.27, 9.59), stage 3 (aOR:3.54, 95% CI:1.40, 8.98) and stage 4 (aOR:7.88, 95% CI:3.29, 18.9) were more likely to achieve MCID. For PROMIS pain, when compared against patients at stage 1, patients at stage 3 (aOR:2.82, 95% CI:1.18, 6.76) and stage 4 (aOR:5.44, 95% CI:2.41, 12.3) were more likely to achieve MCID. For PROMIS depression, when compared against patients at stage 1, patients at stage 4 were more likely to achieve MCID (Adjusted Odds Ratio (aOR):2.59, 95% CI:1.08-6.19). For PROMIS anxiety, when compared against patients at stage 1, stage 3 (Adjusted Odds Ratio (aOR):3.21, 95% CI:1.20-8.57), and stage 4 (aOR:5.56, 95% CI:2.20-14.01) were more likely to achieve MCID. CONCLUSION Patients at higher stages of activation were more likely to achieve MCID for PROMIS pain, physical function, depression, and anxiety at 1-year follow-up. Routine preoperative assessment of patient activation may help identify patients at risk of poor outcomes.
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Affiliation(s)
- Rahul Sachdev
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline Street JHOC 5241, Baltimore, MD 21287, USA
| | - Kevin Mo
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline Street JHOC 5241, Baltimore, MD 21287, USA
| | - Kevin Y Wang
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline Street JHOC 5241, Baltimore, MD 21287, USA
| | - Bo Zhang
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline Street JHOC 5241, Baltimore, MD 21287, USA
| | - Farah N Musharbash
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline Street JHOC 5241, Baltimore, MD 21287, USA
| | - Amar Vadhera
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline Street JHOC 5241, Baltimore, MD 21287, USA
| | - Arinze J Ochuba
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline Street JHOC 5241, Baltimore, MD 21287, USA
| | - Khaled M Kebaish
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline Street JHOC 5241, Baltimore, MD 21287, USA
| | - Richard L Skolasky
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline Street JHOC 5241, Baltimore, MD 21287, USA
| | - Brian J Neuman
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline Street JHOC 5241, Baltimore, MD 21287, USA.
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Venechuk G, Allen LA, Thompson JS, Morris MA, Matlock DD, McIlvennan CK, Dickert NW, Tietbohl C. Trust and activation in defining patient-clinician interactions for chronic disease management. Patient Educ Couns 2023; 106:113-119. [PMID: 36167759 DOI: 10.1016/j.pec.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 08/26/2022] [Accepted: 09/20/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Patient-clinician relationship quality and patient activation can both improve patient health outcomes, but prior work has primarily examined these factors independently. We examine how these two factors shape patient behavior in the setting of ambulatory heart failure care, where serial intensification of multiple medications is central to chronic care delivery. METHODS We used content analysis to analyze 22 in-depth patient interviews and 32 audio-recorded clinic visits collected for the EPIC-HF Trial. This was a secondary analysis providing qualitative depth to the parent RCT. RESULTS We identified a typology of patient activation and patient-clinician relationship quality, with four types: Supported, Skeptical, Deferential, and Unempowered. Types were sensitive to time and context; a given patient might occupy multiple types throughout the course of a single clinic visit. The effects of patient-activation and the patient-clinician relationship appeared to be bidirectional, with each influencing the other. CONCLUSION Patient-clinician relationship quality and patient activation are dominant in shaping clinical interactions and disease management. This interaction is dynamic, and patients may change types depending on time, place, or context. PRACTICE IMPLICATIONS These findings suggest that both patient activation and high relationship quality work together to create a supportive environment for chronic care, where intermittent skepticism, deference or empowerment may be useful at particular times or in certain situations.
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Affiliation(s)
- Grace Venechuk
- Colorado Program for Patient Centered Decisions, Adult & Child Center for Outcomes Research & Delivery Science, University of Colorado School of Medicine, Aurora, CO 80045, USA; Department of Sociology, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Larry A Allen
- Colorado Program for Patient Centered Decisions, Adult & Child Center for Outcomes Research & Delivery Science, University of Colorado School of Medicine, Aurora, CO 80045, USA.
| | - Jocelyn S Thompson
- Colorado Program for Patient Centered Decisions, Adult & Child Center for Outcomes Research & Delivery Science, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Megan A Morris
- Colorado Program for Patient Centered Decisions, Adult & Child Center for Outcomes Research & Delivery Science, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Daniel D Matlock
- Colorado Program for Patient Centered Decisions, Adult & Child Center for Outcomes Research & Delivery Science, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Colleen K McIlvennan
- Colorado Program for Patient Centered Decisions, Adult & Child Center for Outcomes Research & Delivery Science, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Neal W Dickert
- Division Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Caroline Tietbohl
- Colorado Program for Patient Centered Decisions, Adult & Child Center for Outcomes Research & Delivery Science, University of Colorado School of Medicine, Aurora, CO 80045, USA
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Zhu Y, Song Y, Wang Y, Ji H, Wang D, Cai S, Wang A. Relationships among social support, self-efficacy, and patient activation in community-dwelling older adults living with coronary heart disease: A cross-sectional study. Geriatr Nurs 2022; 48:139-44. [PMID: 36219932 DOI: 10.1016/j.gerinurse.2022.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/14/2022] [Accepted: 09/15/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To explore whether social support indirectly influences patient activation through self-efficacy in older adults living with coronary heart disease. METHODS A cross-sectional study was conducted. Older patients (n=451) from four communities in the city of Qingdao completed a questionnaire survey. We conducted multiple linear regression models and bootstrap testing to assess the relationships among social support, self-efficacy, and patient activation. RESULTS Patient activation was positively correlated with social support (r = 0.524, P < 0.01) and with self-efficacy (r = 0.740, P < 0.01). The of social support had indirect positive effect on patient activation through self-efficacy and the effect was 58.8%. CONCLUSIONS We identified the critical role of social support and self-efficacy for the activation of community-dwelling older patients living with coronary heart disease. Our findings provide essential knowledge for developing and evaluating effective interventions to promote patient activation and enhance self-management of coronary heart disease.
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Zrubka Z, Vékás P, Németh P, Dobos Á, Hajdu O, Kovács L, Gulácsi L, Hibbard J, Péntek M. Validation of the PAM-13 instrument in the Hungarian general population 40 years old and above. Eur J Health Econ 2022; 23:1341-1355. [PMID: 35102464 PMCID: PMC9550701 DOI: 10.1007/s10198-022-01434-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 01/11/2022] [Indexed: 05/07/2023]
Abstract
BACKGROUND Patient activation comprises the skills, knowledge and motivation necessary for patients' effective contribution to their care. We adapted and validated the 13-item Patient Activation Measure (PAM-13) in the ≥ 40 years old Hungarian general population. METHODS A cross-sectional web survey was conducted among 900 respondents selected from an online panel via quota sampling. After 10 days, the survey was repeated on 100 respondents. The distribution, internal consistency, test-retest reliability, factor structure, convergent, discriminant and known-groups validity of PAM-13 were assessed according to the COSMIN guidelines. RESULTS The sample comprised 779 respondents. Mean (± SD) age was 60.4 ± 10.6 years, 54% were female and 67% had chronic illness. Mean (± SD) PAM-13 score was 60.6 ± 10.0. We found good internal consistency (Cronbach alpha: 0.77), moderate test-retest reliability (ICC: 0.62; n = 75), a single-factor structure and good content validity: PAM-13 showed moderate correlation with the eHealth Literacy Scale (r = 0.40), and no correlation with age (r = 0.02), education (r = 0.04) or income (ρ = 0.04). Higher PAM-13 scores were associated with fewer lifestyle risks (p < 0.001), more frequent health information seeking (p < 0.001), participation in patient education (p = 0.018) and various online health-related behaviours. When controlling for health literacy, sociodemographic factors and health status, the association of higher PAM-13 scores with overall fewer lifestyle risks, normal body mass index, physical activity and adequate diet remained significant. Similar properties were observed in the subgroup of participants with chronic morbidity, but not in the age group 65+. CONCLUSION PAM-13 demonstrated good validity in the general population. Its properties in clinical populations and the elderly as well as responsiveness to interventions warrant further research.
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Affiliation(s)
- Zsombor Zrubka
- University Research and Innovation Center, Óbuda University, Bécsi út 96/b, Budapest, 1034, Hungary.
- Corvinus Institute for Advanced Studies, Corvinus University of Budapest, Fővám tér 8, Budapest, 1093, Hungary.
| | - Péter Vékás
- Institute of Mathematical Statistics and Modelling, Corvinus University of Budapest, Fővám tér 8, Budapest, 1093, Hungary
| | - Péter Németh
- Doctoral School of Economics, Business and Informatics, Corvinus University of Budapest, Fővám tér 8, Budapest, 1093, Hungary
| | - Ágota Dobos
- Centre for Foreign Language Education and Research, Corvinus University of Budapest, Fővám tér 8, Budapest, 1093, Hungary
| | - Ottó Hajdu
- Institute of Business Economics, Eötvös Loránd University, Rákóczi út 7, Budapest, 1088, Hungary
| | - Levente Kovács
- University Research and Innovation Center, Óbuda University, Bécsi út 96/b, Budapest, 1034, Hungary
| | - László Gulácsi
- University Research and Innovation Center, Óbuda University, Bécsi út 96/b, Budapest, 1034, Hungary
- Corvinus Institute for Advanced Studies, Corvinus University of Budapest, Fővám tér 8, Budapest, 1093, Hungary
| | - Judith Hibbard
- Health Policy Research Group, University of Oregon, 1209 University of Oregon, Eugene, OR, 97403-1209, USA
| | - Márta Péntek
- University Research and Innovation Center, Óbuda University, Bécsi út 96/b, Budapest, 1034, Hungary
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Jerant A, Duberstein PR, Kravitz RL, Kleiman EM, Rizvi SL, Cipri C, Liu D, Scher L, Freitas M, Jones-Hill M, Oravetz A, Van Orden KA, Franks P. Ethical and methodological challenges slowing progress in primary care-based suicide prevention: Illustrations from a randomized controlled trial and guidance for future research. J Psychiatr Res 2022; 154:242-51. [PMID: 35961180 DOI: 10.1016/j.jpsychires.2022.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 06/26/2022] [Accepted: 07/20/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Despite the pressing need for primary care-based suicide prevention initiatives and growing acknowledgement of recruitment difficulties and Institutional Review Board (IRB) challenges in suicide research, we are aware of no illustrative examples describing how IRB decisions in the design of a primary care trial can compound recruitment challenges. METHODS The CDC-funded trial (NCT02986113) of Men and Providers Preventing Suicide aimed to examine the effects of a tailored computer program encourage men with suicidal thoughts (n = 304, ages 35-64) to discuss suicide with a primary care clinician and accept treatment. Before a visit, participants viewed MAPS or a non-tailored control video. Post-visit, both arms were offered telephone collaborative care, as mandated by the institutional review board (IRB). We previously showed that exposure to MAPs led to improvements in communication about suicide in a primary care visit. In this paper, we report data on the study's primary outcome, suicide preparatory behaviors. RESULTS After screening nearly 4100 men, 48 enrolled. Recruitment challenges, which were exacerabted by an IRB mandate narrowing post-intervention patient management differences between trial arms, limited detection of the effects of MAPS on suicide preparatory behaviors. CONCLUSIONS While primary care settings are key sites for suicide prevention trials, issues such as recruitment difficulties and overly restrictive IRB requirements may limit their utility. Methodological innovation to improve recruitment and ethical guidance to inform IRB decision-making are needed.
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Filippaios A, Tran KVT, Mehawej J, Ding E, Paul T, Lessard D, Barton B, Lin H, Naeem S, Otabil EM, Noorishirazi K, Dai Q, Sadiq H, Chon KH, Soni A, Saczynski J, McManus DD. Psychosocial measures in relation to smartwatch alerts for atrial fibrillation detection. Cardiovasc Digit Health J 2022; 3:198-200. [PMID: 36310684 PMCID: PMC9596300 DOI: 10.1016/j.cvdhj.2022.07.069] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Andreas Filippaios
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts.,Program in Digital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Khanh-Van T Tran
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Jordy Mehawej
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts.,Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Eric Ding
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Tenes Paul
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts.,Program in Digital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Darleen Lessard
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Bruce Barton
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Honghuang Lin
- Program in Digital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Syed Naeem
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Edith Mensah Otabil
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Kamran Noorishirazi
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Qiying Dai
- Division of Cardiovascular Medicine, Department of Medicine, Saint Vincent Hospital, Worcester, Massachusetts
| | - Hammad Sadiq
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Ki H Chon
- Department of Biomedical Engineering, University of Connecticut, Storrs, Connecticut
| | - Apurv Soni
- Program in Digital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts.,Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Jane Saczynski
- Department of Pharmacy and Health Systems Sciences, School of Pharmacy, Northeastern University, Boston, Massachusetts
| | - David D McManus
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts.,Program in Digital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts.,Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts
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Hübner J, Welter S, Ciarlo G, Käsmann L, Ahmadi E, Keinki C. Patient activation, self-efficacy and usage of complementary and alternative medicine in cancer patients. Med Oncol 2022; 39:192. [PMID: 36071252 DOI: 10.1007/s12032-022-01796-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/15/2022] [Indexed: 11/08/2022]
Abstract
Complementary and alternative medicine (CAM) is used by many cancer patients by themselves. Therefore, we conducted a survey regarding the association between CAM, self-efficacy, and patient activation in adult cancer patients. A standardized questionnaire, consisted of the ASKU, the PAM 13-D, and a structured questionnaire on CAM usage from our own working group, was distributed to 880 potential participants. Six hundred and thirty-nine (639) patients (male 32.9%, female 63.2%; gynecological cancer 41%, gastrointestinal 19.2%, urogenital 15.6%) took part. 60% of all patients used CAM in the last 3 months (biological 73%, holistic 63%, mind–body methods 62%). Higher self-efficacy was associated with higher interest in CAM (p = 0.03), but not usage of CAM, compared to patients with lower self-efficacy (p = 0.099). Higher patient activation was associated with higher interest in CAM (p = 0.004) and usage of CAM (p = 0.012). Patients with higher activation significantly more often used homeopathy (p = 0.007), prayer (p = 0.002), yoga, etc. (p = 0.032), meditation (p = 0.002), low carb or ketogenic diets (p < 0.001) (but not vegan or other cancer diets). Higher patient activation is associated with higher usage of CAM. Focusing on patient activation as a goal in patient–physician relationship will help patients to adhere to a healthy lifestyle and to actively participate in the whole treatment process.
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Anderson G, Rega ML, Casasanta D, Graffigna G, Damiani G, Barello S. The association between patient activation and healthcare resources utilization: a systematic review and meta-analysis. Public Health 2022; 210:134-141. [PMID: 35970015 DOI: 10.1016/j.puhe.2022.06.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 05/11/2022] [Accepted: 06/19/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To measure the association between patient activation and hospitalization or emergency department (ED) visits among adults with chronic diseases. STUDY DESIGN Systematic review and meta-analysis. METHODS A systematic review of English articles was performed using the following databases: PubMed, Cochrane Library, Web of Science, PsycINFO, and Embase. Articles were searched from 2005 until July 2021. Observational studies that measured the association between patient activation, measured by the Patient Activation Measure (PAM), and hospitalization or ED visits among adults with chronic or multichronic diseases were included. Pairs of reviewers independently screened the studies and extracted data for qualitative and quantitative synthesis. The methodological quality was assessed using the Quality in Prognostic Studies (QUIPS) tool. RESULTS A total of nine observational studies (153,121 participants) were included in the qualitative synthesis, whereas six were pooled in the quantitative synthesis (151,359 participants). High levels of patient activation were significantly associated with a reduced risk for both hospitalizations (RR [95% CI] = 0.69 [0.61; 0.77], I2 = 78%) and ED visits (RR [95% CI] = 0.76 [0.70; 0.84], I2 = 72%). CONCLUSIONS Our findings suggest the existence of an inverse association between patient activation and healthcare resources utilization. Further observational studies are needed to fully comprehend the magnitude of this association.
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Affiliation(s)
- G Anderson
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1, Rome, 00133, Italy
| | - M L Rega
- School of Nursing, Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, Rome, 00168, Italy
| | - D Casasanta
- Children Hospital Bambino Gesù, Piazza di Sant'Onofrio, 4, 00165, Roma, Italy
| | - G Graffigna
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli 1, Milan, 20123, Italy; EngageMinds HUB - Consumer, Food & Health Engagement Research Center, Milan, 20123, Italy; Faculty of Agriculture, Food and Environmental Sciences, Università Cattolica del Sacro Cuore, via Milano 24, Cremona, 26100, Italy
| | - G Damiani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, Rome, 00168, Italy; Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, Rome, 00168, Italy
| | - S Barello
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli 1, Milan, 20123, Italy; EngageMinds HUB - Consumer, Food & Health Engagement Research Center, Milan, 20123, Italy.
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Watson DJ, Ducheine L. The Role of the Nurse in the Prehabilitation Unit. Semin Oncol Nurs 2022; 38:151332. [PMID: 36008199 DOI: 10.1016/j.soncn.2022.151332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To address some of the main nurse's role in facilitating patients' participation and engagement to prepare for the stress of surgery. DATA SOURCES These include published peer reviewed literature, web-based resources, and professional organizations' resources. CONCLUSION Psychological and physical optimization of surgical patients during the preoperative phase is a novel approach known as the prehabilitation program. A multidisciplinary team of health professionals work in synergy to prepare patients for the upcoming surgery. Different roles and responsibilities may be allotted to the nurse, whereas one of which may focus on patient education. Being cognizant of low health literacy rates while using various teaching strategies known to promote patient understanding may increase patient participation to prepare for surgery. IMPLICATIONS FOR NURSING PRACTICE This article may guide nurses who are new to the concept of health literacy and patient activation. We wish to sensitize nurses to a few strategies to support patient understanding and involvement. This overview can help others who are establishing a prehabilitation unit in their institution to highlight the important role a nurse can play toward patient education.
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Affiliation(s)
- Deborah J Watson
- Department of Nursing, McGill University Health Centre, Montreal, Quebec, Canada.
| | - Loïca Ducheine
- Department of Nursing, McGill University Health Centre, Montreal, Quebec, Canada
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Olomu A, Kelly-Blake K, Hart-Davidson W, Gardiner J, Luo Z, Heisler M, Holmes-Rovner M. Improving diabetic patients' adherence to treatment and prevention of cardiovascular disease (Office Guidelines Applied to Practice-IMPACT Study)-a cluster randomized controlled effectiveness trial. Trials 2022; 23:659. [PMID: 35971135 PMCID: PMC9376908 DOI: 10.1186/s13063-022-06581-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 07/20/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Despite nationwide improvements in cardiovascular disease (CVD) mortality and morbidity, CVD deaths in adults with type 2 diabetes (T2DM) are 2-4 times higher than among those without T2DM. A key contributor to these poor health outcomes is medication non-adherence. Twenty-one to 42% of T2DM patients do not take blood sugar, blood pressure (BP), or statin medications as prescribed. Interventions that foster and reinforce patient-centered communication show promise in improving health outcomes. However, they have not been widely implemented, in part due to a lack of compelling evidence for their effectiveness in real-life primary care settings. METHODS This pragmatic cluster-randomized trial randomizes 17 teams in 12 Federally Qualified Healthcare Centers (FQHCs) to two experimental groups: intervention (group 1): Office-Gap + Texting vs. control (group 2): Texting only. Office-GAP (Office-Guidelines Applied to Practice) is a patient activation intervention to improve communication and patient-provider partnerships through brief patient and provider training in shared decision-making (SDM) and use of a guideline-based checklist. The texting intervention (Way2Health) is a cell phone messaging service that informs and encourages patients to adhere to goals, adhere to medication use and improve communication. After recruitment, patients in groups 1 and 2 will both attend (1) one scheduled group visit, (90-120 min) conducted by trained research assistants, and (2) follow-up visits with their providers after group visit at 0-1, 3, 6, 9, and 12 months. Data will be collected over 12-month intervention period. Our primary outcome is medication adherence measured using eCAP electronic monitoring and self-report. Secondary outcomes are (a) diabetes-specific 5-year CVD risk as measured with the UK Prospective Diabetes Study (UKPDS) Engine score, (b) provider engagement as measured by the CollaboRATE Shared-Decision Making measure, and (c) patient activation measures (PAM). DISCUSSION This study will provide a rigorous pragmatic evaluation of the effectiveness of combined mHealth, and patient activation interventions compared to mHealth alone, targeting patients and healthcare providers in safety net health centers, in improving medication adherence and decreasing CVD risk. Given that 20-50% of adults with chronic illness demonstrate medication non-adherence, increasing adherence is essential to improve CVD outcomes as well as healthcare cost savings. TRIAL REGISTRATION The ClinicalTrials.gov registration number is NCT04874116.
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Affiliation(s)
- Adesuwa Olomu
- Division of General Internal Medicine, Department of Medicine, Michigan State University, East Lansing, MI, USA.
| | - Karen Kelly-Blake
- grid.17088.360000 0001 2150 1785Center for Bioethics and Social Justice & Department of Medicine, Michigan State University, East Lansing, MI USA
| | - William Hart-Davidson
- grid.17088.360000 0001 2150 1785Department of Writing, Rhetoric, and American Cultures, Michigan State University, East Lansing, MI USA
| | - Joseph Gardiner
- grid.17088.360000 0001 2150 1785Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI USA
| | - Zhehui Luo
- grid.17088.360000 0001 2150 1785Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI USA
| | - Michele Heisler
- grid.214458.e0000000086837370Department of Internal Medicine, University of Michigan, East Lansing, MI USA
| | - Margaret Holmes-Rovner
- grid.17088.360000 0001 2150 1785Center for Bioethics and Social Justice & Department of Medicine, Michigan State University, East Lansing, MI USA
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Mergelsberg ELP, Olson JL, Moore S, Jensen JF, Seivwright H, Norman R, Watson NA. Providing evidence from practice: Evaluating 4.5 years of implementing diabetes education support program in carbohydrate management. Patient Educ Couns 2022; 105:2225-2233. [PMID: 35221169 DOI: 10.1016/j.pec.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 02/01/2022] [Accepted: 02/01/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To evaluate personal and economical outcomes of CarbSmart, a 3-hour person-centered, theory-based program implemented throughout Australia, targeting optimal dietary carbohydrate management. METHODS More than 500 CarbSmart programs were implemented over 4.5 years. Pre-, post-, (N = 4656) and 3-month follow-up assessments (N = 188) of knowledge, empowerment, confidence, and patient activation were collected from people with diabetes. Participant satisfaction and potential annual cost-savings were calculated. FINDINGS Repeated measures ANCOVAs showed large improvements pre- to post-program in all outcome variables (d = 0.80-1.68), which were maintained at 3-month follow-up in a sub-sample. Participant satisfaction was high (Net Promoter Score = 72.3). Potential annual cost-savings nation-wide were estimated at US$512million. CONCLUSION This paper provides evidence that CarbSmart is effective in improving behavioral indicators of self-management outcomes in Australians living with diabetes. PRACTICE IMPLICATIONS CarbSmart has the potential to prevent diabetes-related complications. However, not engaging people living with diabetes with lower levels of patient activation at baseline was recognized as a future opportunity to improve the impact of our service. Strategies are needed to engage people with lower activation levels to improve outcomes in vulnerable and at-risk populations. FUNDING The development of CarbSmart was funded by Diabetes WA, the national implementation of CarbSmart by the National Diabetes Services Scheme, an initiative of the Australian Government.
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Affiliation(s)
- Enrique L P Mergelsberg
- National Evaluation Team, National Diabetes Services Scheme (NDSS), Diabetes Australia, 3/322 Hay Street Subiaco, Western Australia 6008, Australia; School of Population Health, Curtin University, Kent Street, Perth, Western Australia 6102, Australia.
| | - Jenny L Olson
- National Evaluation Team, National Diabetes Services Scheme (NDSS), Diabetes Australia, 3/322 Hay Street Subiaco, Western Australia 6008, Australia
| | - Sheryl Moore
- Diabetes Educator, Health Services, Diabetes WA, 3/322 Hay Street Subiaco, Western Australia 6008, Australia
| | - Jessica F Jensen
- Research and Evaluation Team, Diabetes WA, 3/322 Hay Street Subiaco, Western Australia 6008, Australia
| | - Hayley Seivwright
- Research and Evaluation Team, Diabetes WA, 3/322 Hay Street Subiaco, Western Australia 6008, Australia
| | - Richard Norman
- School of Population Health, Curtin University, Kent Street, Perth, Western Australia 6102, Australia
| | - Natasha A Watson
- National Evaluation Team, National Diabetes Services Scheme (NDSS), Diabetes Australia, 3/322 Hay Street Subiaco, Western Australia 6008, Australia; Research and Evaluation Team, Diabetes WA, 3/322 Hay Street Subiaco, Western Australia 6008, Australia
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Rodriguez LA, Thomas TW, Finertie H, Turner CD, Heisler M, Schmittdiel JA. Psychosocial and diabetes risk factors among racially/ethnically diverse adults with prediabetes. Prev Med Rep 2022; 27:101821. [PMID: 35656212 PMCID: PMC9152808 DOI: 10.1016/j.pmedr.2022.101821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 03/08/2022] [Accepted: 04/30/2022] [Indexed: 11/29/2022] Open
Abstract
Psychosocial factors such as self-efficacy may be important in helping high-risk adults prevent diabetes. We aimed to describe psychosocial and diabetes risk factors in adults with prediabetes and evaluate if these varied by demographic characteristics. Cross-sectional data came from baseline surveys and electronic health records (2018-2021) of adults with prediabetes enrolled in a randomized study of peer support for diabetes prevention at Kaiser Permanente Northern California and Michigan Medicine. Linear regression was used to compare differences between racial/ethnic groups, adjusting for age, sex, and clinic. Of 336 participants in the study, 62% were female; median age was 57; 41% were White, 35% African American, 9% Hispanic. Mean autonomous motivation was 6.6 and self-efficacy to prevent diabetes was 6.0 (1-7 scale); mean perceived social support was 47 (12-72 scale). Hispanic adults reported higher autonomous motivation and African American adults reported higher self-efficacy compared to White adults. Hispanic and African American adults had more diabetes risk factors than White adults, including greater family history of diabetes, hypertension, sugar-sweetened beverage consumption, physical inactivity and food insecurity. In conclusion, participants reported high levels of autonomous motivation and self-efficacy at baseline, with Hispanic and African American adults reporting higher levels of some psychosocial factors related to behavior change, suggesting a significant opportunity to engage a diverse population of adults with prediabetes in diabetes prevention strategies. However, Hispanic and African American participants showed greater diabetes risk factors levels. Diabetes prevention efforts should address both to reduce diabetes incidence.
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Affiliation(s)
- Luis A. Rodriguez
- Kaiser Permanente Northern California, Division of Research, 2000 Broadway Oakland, CA 94612, USA
| | - Tainayah W. Thomas
- Kaiser Permanente Northern California, Division of Research, 2000 Broadway Oakland, CA 94612, USA
| | - Holly Finertie
- Kaiser Permanente Northern California, Division of Research, 2000 Broadway Oakland, CA 94612, USA
| | - Cassie D. Turner
- University of Michigan Medical School, Department of Internal Medicine, 1301 Catherine St. Ann Arbor, MI, USA
- VA Ann Arbor Healthcare System, VA Center for Clinical Management Research, 2800 Plymouth Rd, Bld. 16/300N-07, Ann Arbor, MI 48109, USA
| | - Michele Heisler
- University of Michigan Medical School, Department of Internal Medicine, 1301 Catherine St. Ann Arbor, MI, USA
- VA Ann Arbor Healthcare System, VA Center for Clinical Management Research, 2800 Plymouth Rd, Bld. 16/300N-07, Ann Arbor, MI 48109, USA
| | - Julie A. Schmittdiel
- Kaiser Permanente Northern California, Division of Research, 2000 Broadway Oakland, CA 94612, USA
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Memory KE, Wilkinson TJ, Smith AC, Lightfoot CJ. A qualitative exploration of the facilitators and barriers to self-management in kidney transplant recipients. J Nephrol 2022; 35:1863-1872. [PMID: 35467326 PMCID: PMC9035973 DOI: 10.1007/s40620-022-01325-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 03/27/2022] [Indexed: 11/26/2022]
Abstract
Background Understanding the behaviours that facilitate or impede one’s ability to self-manage is important to improve health-related outcomes in kidney transplant recipients (KTRs). Previous studies exploring the self-management experiences of KTRs have focused on specific tasks (e.g., medication adherence), age groups (e.g., adolescent or older recipients), or have been conducted outside of the UK where transferability of findings is unknown. Our study aimed to explore the perceptions and experiences of self-management in UK KTRs to identify facilitators and barriers associated with self-management tasks. Methods Semi-structured interviews were conducted with eleven KTRs. Topics explored included experiences of self-management tasks (diet, exercise, medications, stress management), perceived healthcare role, and future interventional approaches. Thematic analysis was used to identify and report themes. Results Eight themes were identified which were mapped onto the three self-management tasks described by Corbin and Strauss: medical, role and emotional management. Perceived facilitators to self-management were: gathering health-related knowledge, building relationships with healthcare professionals, creating routines within daily life, setting goals and identifying motivators, establishing support networks, and support from family and friends. Complexity of required treatment and adjusting to a new health status were perceived barriers to self-management. Conclusions Participants described the importance of collaborative consultations and continuity of care. Tailored interventions should identify individualised goals and motivators for participating in self-management. Education on effective strategies to manage symptoms and comorbidities could help alleviate KTRs’ perceived treatment burden. Family and peer support could emotionally support KTRs; however, managing the emotional burden of transplantation warrants more attention. Graphic abstract ![]()
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Affiliation(s)
- Katherine E Memory
- Leicester Medical School, University of Leicester, Leicester, UK
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Thomas J Wilkinson
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Alice C Smith
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Courtney J Lightfoot
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK.
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van Deen WK, Khalil C, Dupuy TP, Bonthala NN, Spiegel BMR, Almario CV. Assessment of inflammatory bowel disease educational videos for increasing patient engagement and family and friends' levels of understanding. Patient Educ Couns 2022; 105:660-669. [PMID: 34154860 PMCID: PMC9910446 DOI: 10.1016/j.pec.2021.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 05/11/2021] [Accepted: 06/05/2021] [Indexed: 05/04/2023]
Abstract
OBJECTIVE We developed five educational videos through a user-centered approach for patients with inflammatory bowel diseases (IBD) and their families and friends. Here, we assessed if IBD patient activation and family and friends' abilities to understand IBD patients' thoughts, feelings, and behaviors (i.e., perspective taking) changed after watching the videos. METHODS Through a pre-post survey, we assessed patient activation and perspective taking levels in people with a self-reported IBD diagnosis and their family and friends, respectively, before and after watching one of the videos. RESULTS Among 767 participants with IBD, patient activation scores increased significantly after watching each video. In regression analyses, patient activation levels were less likely to increase in biologic-naïve participants after viewing the coping video. Among 232 people who knew someone with IBD, perspective taking scores increased significantly in 8/9 domains, which was more likely to occur among women. CONCLUSIONS Educational videos developed through a user-centered approach were associated with higher self-reported IBD patient activation scores and perspective taking levels among family and friends. PRACTICE IMPLICATIONS These videos, which are now widely disseminated on social media, serve as a model for how to create educational materials for improving patient activation and empathy in the social media era.
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Affiliation(s)
- Welmoed K van Deen
- Division of Health Services Research, Cedars-Sinai, Los Angeles, CA, United States; Department of Medicine, Cedars-Sinai, Los Angeles, CA, United States; Erasmus School of Health Policy and Management, Health Technology Assessment Section, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Carine Khalil
- Division of Health Services Research, Cedars-Sinai, Los Angeles, CA, United States; LIRAES, Paris Descartes University, Paris, France
| | - Taylor P Dupuy
- Division of Health Services Research, Cedars-Sinai, Los Angeles, CA, United States
| | - Nirupama N Bonthala
- Department of Medicine, Cedars-Sinai, Los Angeles, CA, United States; Inflammatory Bowel Disease Center, Cedars-Sinai, Los Angeles, CA, United States; Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai, Los Angeles, CA, United States
| | - Brennan M R Spiegel
- Division of Health Services Research, Cedars-Sinai, Los Angeles, CA, United States; Department of Medicine, Cedars-Sinai, Los Angeles, CA, United States; Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai, Los Angeles, CA, United States
| | - Christopher V Almario
- Division of Health Services Research, Cedars-Sinai, Los Angeles, CA, United States; Department of Medicine, Cedars-Sinai, Los Angeles, CA, United States; Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai, Los Angeles, CA, United States.
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Kurlander JE, Helminski D, Lanham M, Henstock JL, Kidwell KM, Krein SL, Saini SD, Richardson CR, De Vries R, Resnicow K, Ruff AL, Wallace DM, Jones EK, Perry LK, Parsons J, Ha N, Alexandris-Souphis T, Dedrick D, Aldridge E, Barnes GD. Development of a multicomponent implementation strategy to reduce upper gastrointestinal bleeding risk in patients using warfarin and antiplatelet therapy, and protocol for a pragmatic multilevel randomized factorial pilot implementation trial. Implement Sci Commun 2022; 3:8. [PMID: 35090577 PMCID: PMC8796614 DOI: 10.1186/s43058-022-00256-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/09/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The concomitant use of anticoagulant and antiplatelet medications increases the risk of upper gastrointestinal (GI) bleeding. Two underused evidence-based practices (EBPs) can reduce the risk: de-prescribe unnecessary antiplatelet therapy or initiate a proton pump inhibitor. We describe the development of a multicomponent intervention to increase use of these EBPs in patients treated with warfarin and followed by an anticoagulation monitoring service (AMS), and the design of a pilot pragmatic implementation trial. METHODS A participatory planning group iteratively used Implementation Mapping and the Multiphase Optimization Strategy to develop implementation strategies and plan the trial. Informed by qualitative interviews with patients and clinicians, we drew on several implementation science theories, as well as self-determination theory, to design interventions. For patients, we developed an activation guide to help patients discuss the EBPs with their clinicians. For clinicians, we developed two electronic health record (EHR)-based interventions: (1) clinician notification (CN) consists of a templated message that identifies a patient as high risk, summarizes the EBPs, and links to a guidance statement on appropriate use of antiplatelet therapy. (2) Clinician notification with nurse facilitation (CN+NF) consists of a similar notification message but includes additional measures by nursing staff to support appropriate and timely decision-making: the nurse performs a chart review to identify any history of vascular disease, embeds indication-specific guidance on antiplatelet therapy in the message, and offers to assist with medication order entry and patient education. We will conduct a pilot factorial cluster- and individual-level randomized controlled trial with a primary objective of evaluating feasibility. Twelve clinicians will be randomized to receive either CN or CN+NF for all their patients managed by the AMS while 50 patients will be individually randomized to receive either the activation guide or usual care. We will explore implementation outcomes using patient and clinician interviews along with EHR review. DISCUSSION This pilot study will prepare us to conduct a larger optimization study to identify the most potent and resource conscious multicomponent implementation strategy to help AMSs increase the use of best practices for upper GI bleeding risk reduction. TRIAL REGISTRATION ClinicalTrials.gov NCT05085405 . Registered on October 19, 2021-retrospectively registered.
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Affiliation(s)
- Jacob E Kurlander
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
- Veterans Affairs (VA) Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, USA.
| | - Danielle Helminski
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Michael Lanham
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
- University of Michigan Office of Clinical Informatics, Ann Arbor, MI, USA
| | - Jennifer L Henstock
- Health Information Technology and Services, University of Michigan, Ann Arbor, MI, USA
| | - Kelley M Kidwell
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Sarah L Krein
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Veterans Affairs (VA) Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Sameer D Saini
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Veterans Affairs (VA) Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Caroline R Richardson
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Raymond De Vries
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Kenneth Resnicow
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
- University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA
| | | | - David M Wallace
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Elizabeth K Jones
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Linda K Perry
- Frankel Cardiovascular Center, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jacqueline Parsons
- Frankel Cardiovascular Center, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Nghi Ha
- Frankel Cardiovascular Center, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Tina Alexandris-Souphis
- Frankel Cardiovascular Center, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Dale Dedrick
- Frankel Cardiovascular Center, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Elizabeth Aldridge
- Frankel Cardiovascular Center, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Geoffrey D Barnes
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Frankel Cardiovascular Center, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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Magadi W, Lightfoot CJ, Memory KE, Santhakumaran S, van der Veer SN, Thomas N, Gair R, Smith AC. Patient activation and its association with symptom burden and quality of life across the spectrum of chronic kidney disease stages in England. BMC Nephrol 2022; 23:45. [PMID: 35081904 PMCID: PMC8793272 DOI: 10.1186/s12882-022-02679-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 01/13/2022] [Indexed: 12/11/2022] Open
Abstract
Background The knowledge, skills, and confidence to manage one’s own health is termed patient activation and can be assessed using the Patient Activation Measure (PAM). This measure is increasingly recommended for use in chronic kidney disease (CKD), but there is a need to better understand patient activation within this population. This work aimed to explore the association of PAM with patient-reported outcomes, namely symptom burden and health-related quality of life (HRQoL), to understand the relationship between patient activation and outcomes which are of importance to people with CKD. Methods Non-dialysis, dialysis, and kidney transplant patients from 14 renal units across England completed a survey comprising questionnaires assessing patient activation, symptom burden, and HRQoL. Latent class analysis (LCA) was used to determine HRQoL and symptom burden subgroups in the data. Multinomial logistic regression analyses were performed to investigate the associations between patient activation and symptom burden and HRQoL classes separately, adjusting for age, gender, ethnicity, deprivation and treatment modality. Results Three thousand thirteen participants (mean age 61.5 years, 61.8% males, and 47% haemodialysis) were included in the analysis. Patient activation was strongly associated with both the HRQoL and symptom burden classes identified, with highly activated patients more likely to report higher HRQoL (P = < 0.0001; OR 29.2, 95% CI 19.5–43.9) and fewer symptoms (P = < 0.0001; OR 25.9, 95% CI 16.8–40.2). Conclusion Lower activation levels are associated with a higher symptom burden and reduced HRQoL across the trajectory of CKD stages and treatment modalities. Therefore, targeted and holistic self-management support focussing on improving activation may have the potential to improve aspects of health experience which are valued by individuals living with kidney disease. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-022-02679-w.
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Affiliation(s)
- Winnie Magadi
- UK Renal Registry, Brandon House Building 20A1, Southmead Road, Bristol, BS34 7RR, UK.
| | - Courtney J Lightfoot
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Katherine E Memory
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Shalini Santhakumaran
- UK Renal Registry, Brandon House Building 20A1, Southmead Road, Bristol, BS34 7RR, UK
| | - Sabine N van der Veer
- Centre for Health Informatics, Division of Informatics, Imaging and Data Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Nicola Thomas
- School of Health and Social Care, London South Bank University, London, UK
| | - Rachel Gair
- UK Renal Registry, Brandon House Building 20A1, Southmead Road, Bristol, BS34 7RR, UK
| | - Alice C Smith
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK
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Fang A, Abdelgadir D, Gopalan A, Ross T, Uratsu CS, Sterling SA, Grant RW, Iturralde E. Engaging patients in population-based chronic disease management: A qualitative study of barriers and intervention opportunities. Patient Educ Couns 2022; 105:182-189. [PMID: 33975772 PMCID: PMC8566319 DOI: 10.1016/j.pec.2021.04.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/05/2021] [Accepted: 04/29/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Cardiovascular disease (CVD) continues to be a leading cause of morbidity in the U.S. Managing CVD risk factors, such as diabetes or hypertension, can be challenging for many individuals. We investigated the barriers experienced by patients who persistently struggled to reach their CVD risk factor control goals. METHODS This qualitative study examined patient, clinician, and researcher observations of individuals' experiences in a chronic disease management program. All participants (n = 332) were enrolled in a clinical trial testing a skills-based group intervention seeking to improve healthcare engagement. Data were analyzed through a general inductive approach and resulting themes were structured along the Capability-Opportunity-Motivation-Behavior framework. RESULTS Analyses identified care engagement barriers related to participants' communication skills and activation, care team relationship processes, and emotional factors. Although most participants reported benefitting from skills training, persistent barriers included distrust of their providers, shame about health challenges, and dissatisfaction with care team interactions that were described as impersonal or unresponsive. CONCLUSIONS AND PRACTICE IMPLICATIONS Efforts to support engagement in CVD risk factor management programs should address whether patients and their care team have the necessary skills, opportunities and confidence to proactively communicate health needs and engage in non-judgmental interactions for goal-setting, rapport-building, and shared decision-making.
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Affiliation(s)
- Anya Fang
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Dana Abdelgadir
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Anjali Gopalan
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Thekla Ross
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Connie S Uratsu
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Stacy A Sterling
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Richard W Grant
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA.
| | - Esti Iturralde
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
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48
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Munkhtogoo D, Nansalmaa E, Chung KP. The relationships of health literacy, preferred involvement, and patient activation with perceived involvement in care among Mongolian patients with breast and cervical cancer. Patient Educ Couns 2022; 105:158-165. [PMID: 34024671 DOI: 10.1016/j.pec.2021.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To explore the relationships of health literacy, preferred involvement, and patient activation with perceived involvement in care among patients with breast and cervical cancer. METHODS A cross-sectional survey was conducted with patients aged 20 years or older, aware of their cancer diagnosis, and currently receiving care at the National Cancer Center, Mongolia. Descriptive statistics and multivariate regression analysis were used to identify the relationships among study variables. RESULTS Two hundred twenty-five patients were included in the final analysis. Patients' perceived involvement was examined as two subdomains: patient information seeking (PIS) and patient decision-making (PDM). Patient health literacy was found to only significantly influence PIS, and patient preferred involvement demonstrated a significant influence only on PDM. However, patient activation predictor was found to significantly influence both PIS and PDM (PIS [β = 0.22, p = 0.00] and PDM [β = 0.14, p = 0.00]). CONCLUSION Health literacy, preferred involvement, and patient activation each demonstrated distinct influences on patients' perceived involvement subdomains, with patient activation being the most important predictor. PRACTICE IMPLICATIONS Comprehensive strategies at the healthcare organization, professional, and patient levels may help to facilitate and advance patient involvement in care, and ultimately improve the quality of healthcare services respective to domain of patient-centeredness.
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Affiliation(s)
- Dulmaa Munkhtogoo
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Erdenekhuu Nansalmaa
- National Cancer Center, Ulaanbaatar, Mongolia; Department of Pathophysiology, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Kuo-Piao Chung
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan.
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49
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Hack SM, Muralidharan A, Abraham CR. Between and within race differences in patient-centeredness and activation in mental health care. Patient Educ Couns 2022; 105:206-211. [PMID: 34045090 DOI: 10.1016/j.pec.2021.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/30/2021] [Accepted: 05/05/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES The aim of this study was to compare Black and White mental health care patients' perceptions of their providers' and their own participation in patient-centered mental health care. Perceptions of patient-centered care (PCC) in relation to the Multidimensional Model of Racial Identity were explored. METHODS Black and White veterans receiving mental health care (n = 82) completed surveys assessing patient activation, involvement in care, perceptions of PCC, and therapeutic alliance. Black participants (n = 40) also completed the Multidimensional Inventory of Black Identity. RESULTS There were no differences by race in perceived PCC, though Black participants had lower levels of therapeutic alliance with their mental health care provider and were less activated. Black identity centrality, private regard, and public regard were positively related to PCC and elements of PCC such as patient information seeking/sharing. CONCLUSIONS Intragroup identity variables such as racial centrality, regard, and ideology influenced perceived PCC among Black participants. Race identity variables should be explored in future research on racial disparities and PCC. PRACTICE IMPLICATIONS Mental health care providers serving Black patients should create opportunities to discuss racial identity and race-related experiences as part of their efforts to improve therapeutic alliance and increase the patient-centeredness of care.
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Affiliation(s)
- Samantha M Hack
- Veterans Affairs VISN 5 Mental Illness Research, Education, and Clinical Center, Baltimore, USA; School of Social Work, University of Maryland-Baltimore, Baltimore, USA.
| | - Anjana Muralidharan
- Veterans Affairs VISN 5 Mental Illness Research, Education, and Clinical Center, Baltimore, USA; Department of Psychiatry, University of Maryland-Baltimore, Baltimore, USA
| | - Carol R Abraham
- College of Arts and Sciences, University of Baltimore, Baltimore, USA
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50
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Frith G, Carver K, Curry S, Darby A, Sydes A, Symonds S, Wilson K, McGregor G, Auton K, Nichols S. Changes in patient activation following cardiac rehabilitation using the Active +me digital healthcare platform during the COVID-19 pandemic: a cohort evaluation. BMC Health Serv Res 2021; 21:1363. [PMID: 34952575 PMCID: PMC8703006 DOI: 10.1186/s12913-021-07363-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 11/24/2021] [Indexed: 12/29/2022] Open
Abstract
Background Restrictions on face-to-face contact, due to COVID-19, led to a rapid adoption of technology to remotely deliver cardiac rehabilitation (CR). Some technologies, including Active+me, were used without knowing their benefits. We assessed changes in patient activation measure (PAM) in patients participating in routine CR, using Active+me. We also investigated changes in PAM among low, moderate, and high risk patients, changes in cardiovascular risk factors, and explored patient and healthcare professional experiences of using Active+me. Methods Patients received standard CR education and an exercise prescription. Active+me was used to monitor patient health, progress towards goals, and provide additional lifestyle support. Patients accessed Active+me through a smart-device application which synchronised to telemetry enabled scales, blood pressure monitors, pulse oximeter, and activity trackers. Changes in PAM score following CR were calculated. Sub-group analysis was conducted on patients at high, moderate, and low risk of exercise induced cardiovascular events. Qualitative interviews explored the acceptability of Active+me. Results Forty-six patients were recruited (Age: 60.4 ± 10.9 years; BMI: 27.9 ± 5.0 kg.m2; 78.3% male). PAM scores increased from 65.5 (range: 51.0 to 100.0) to 70.2 (range: 40.7 to 100.0; P = 0.039). PAM scores of high risk patients increased from 61.9 (range: 53.0 to 91.0) to 75.0 (range: 58.1 to 100.0; P = 0.044). The PAM scores of moderate and low risk patients did not change. Resting systolic blood pressure decreased from 125 mmHg (95% CI: 120 to 130 mmHg) to 119 mmHg (95% CI: 115 to 122 mmHg; P = 0.023) and waist circumference measurements decreased from 92.8 cm (95% CI: 82.6 to 102.9 cm) to 85.3 cm (95% CI 79.1 to 96.2 cm; P = 0.026). Self-reported physical activity levels increased from 1557.5 MET-minutes (range: 245.0 to 5355.0 MET-minutes) to 3363.2 MET-minutes (range: 105.0 to 12,360.0 MET-minutes; P < 0.001). Active+me was acceptable to patients and healthcare professionals. Conclusion Participation in standard CR, with Active+me, is associated with increased patient skill, knowledge, and confidence to manage their condition. Active+me may be an appropriate platform to support CR delivery when patients cannot be seen face-to-face. Trial registration As this was not a clinical trial, the study was not registered in a trial registry. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07363-7.
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Affiliation(s)
- Gabbi Frith
- Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, S9 3TY, UK.,Sport and Physical Activity Research Centre, Sheffield Hallam University, Sheffield, S10 2BP, UK
| | - Kathryn Carver
- Cardiology Services, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
| | - Sarah Curry
- Eastern Academic Health Science Network, Magog Court, Cambridge, CB22 3AD, UK
| | - Alan Darby
- Cardiac Rehabilitation Service, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
| | - Anna Sydes
- Cardiac Rehabilitation Service, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
| | - Stephen Symonds
- And The Beat Goes On - Phase IV Cardiac Rehabilitation Programme, Cambridge, CB2 9BE, UK
| | - Katrina Wilson
- Eastern Academic Health Science Network, Magog Court, Cambridge, CB22 3AD, UK
| | - Gordon McGregor
- Department of Cardiopulmonary Rehabilitation, Centre for Exercise & Health, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, CV2 2DX, UK.,Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.,Centre for Sport, Exercise & Life Sciences, Coventry University, Coventry, CV1 5FB, UK
| | - Kevin Auton
- Aseptika Limited (Activ8rlives), St Ives Business Park, St Ives, Cambridgeshire, PE27 4AA, UK
| | - Simon Nichols
- Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, S9 3TY, UK. .,Sport and Physical Activity Research Centre, Sheffield Hallam University, Sheffield, S10 2BP, UK.
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