Identifying and managing ADRs: Qualitative analysis of patient reports to the UK Yellow Card Scheme

INTRODUCTION

Adverse drug reactions (ADRs) can have significant negative impact on peoples' daily lives, with physical, economic, social and/or psychological effects. Patient reporting of ADRs has been facilitated by pharmacovigilance systems across Europe. However, capturing data on patients' experiences of ADRs has proved challenging. Existing patient reports to the UK Yellow Card Scheme (YCS) contain free text comments which could be useful sources of information.

OBJECTIVES

To investigate patients' experiences of ADRs and their impact on patients as described in free-text data within patient Yellow Card (YC) reports submitted to the Medicines and Healthcare products Regulatory Agency (MHRA).

METHODS

A qualitative review of narrative texts was conducted on free text data from 2255 patient YC reports - July to December 2015.

RESULTS

Three key narrative themes emerged from analysis of the free text data in 2255 reports: (1) identification of ADRs, (2) severity and impact of ADRs and (3) management of ADRs. Temporal associations were the most common method of identification followed by differential diagnoses and confirmation with information sources such as healthcare professionals (HCPs). A combination of explicit and implicit impacts were described - physical, psychological, economic and social effects often persisted and caused serious disruption to many patients' lives. A range of strategies were used to manage ADRs including consultation with HCPs, stopping/reducing the medicine or taking medicines to alleviate symptoms.

CONCLUSION

Free text data from YC reports has been an underutilised resource to date, however this research has confirmed its potential value to pharmacovigilance and medication safety research.

Tick-Borne Surveillance Patterns in Perceived Non-Endemic Geographic Areas: Human Tick Encounters and Disease Outcomes

Recent scholarship supports the use of tick bite encounters as a proxy for human disease risk. Extending entomological monitoring, this study was designed to provide geographically salient information on self-reported tick bite encounters by survey respondents who concomitantly reported a Lyme disease (LD) diagnosis in a state perceived as non-endemic to tick-borne illness. Focusing on Texas, a mixed-methods approach was used to compare data on tick bite encounters from self-reported LD patients with county-level confirmed cases of LD from the U.S. Centers for Disease Control and Prevention (CDC), as well as serological canine reports. A greater proportion of respondents reported not recalling a tick bite in the study population, but a binomial test indicated that this difference was not statistically significant. A secondary analysis compared neighboring county-level data and ecological regions. Using multi-layer thematic mapping, our findings indicated that tick bite reports accurately overlapped with the geographic patterns of those patients previously known to be CDC-positive for serological LD and with canine-positive tests for Borrelia burgdorferi, anaplasmosis, and ehrlichiosis, as well as within neighboring counties and ecological regions. LD patient-reported tick bite encounters, corrected for population density, also accurately aligned with official CDC county hot-spots. Given the large number of counties in Texas, these findings are notable. Overall, the study demonstrates that direct, clinically diagnosed patient reports with county-level tick bite encounter data offer important public health surveillance measures, particularly as it pertains to difficult-to-diagnose diseases where testing protocols may not be well established. Further integration of geo-ecological and socio-demographic factors with existing national epidemiological data, as well as increasingly accessible self-report methods such as online surveys, will contribute to the contextual information needed to organize and implement a coordinated public health response to LD.

Disconnect in Assessments of Autosomal Dominant Polycystic Kidney Disease Burden Between Patients and Physicians: A Survey Study

Background

Autosomal dominant polycystic kidney disease (ADPKD) is a rare inherited kidney disorder with considerable symptom burden and negative effects even in early-stage disease. Patients' reporting of ADPKD symptom burden may differ from physicians' impressions. In this quantitative, cross-section survey study, we evaluated patient and physician assessments of symptom burden at early- and late-stage ADPKD.

Methods

In the United States, 300 patients with ADPKD and 155 physicians treating patients with ADPKD completed online surveys administered by Kantar. Disease stage was categorized as early (chronic kidney disease [CKD] stages 1-3) or late (stages 4-5). Patients completed the Work Productivity and Activity Impairment Questionnaire and reported current disease symptoms. Patients and physicians assessed impacts of ADPKD on daily life and burden of specific symptoms. Statistical analyses compared patient versus physician responses stratified by early- versus late-stage ADPKD.

Results

We found that impairment in work productivity was statistically greater in late- versus early-stage CKD. Compared with physicians' impressions, patients were more likely at early stages and less likely at later stages to report a moderate/strong impact of ADPKD on daily life. Among patients, 74% with early- and 88% with late-stage disease reported that ADPKD caused them to modify their daily lives. In early-stage disease, patients reported a statistically greater burden from feeling exhausted and less burden from dull kidney pain, cardiovascular problems, high blood pressure, and liver cysts than physicians assumed. At later stages, patients reported feeling exhausted and skeletal/joint pain as more burdensome, and frequent urination, high blood pressure, liver cysts, and hematuria as less burdensome, compared with physicians' impressions.

Conclusion

The results of this survey study demonstrate a disconnect between patients' experiences and physicians' awareness of the burden of ADPKD and highlight the need for more patient/physician discussion of symptoms and disease management.

The added value of geriatric assessment in evaluating a patient's Health-Related Quality-of-Life: A study in ≥70-year-old early-stage invasive breast cancer patients

OBJECTIVE

The objective of this study was to assess the relationship between geriatric assessment (GA) and health-related Quality-of-Life (HRQOL) in older patients with breast cancer.

METHODS

Patients were assigned either to adjuvant chemotherapy (CTG) or to a control group (CG). Spearman rank coefficients (ρ) calculated correlations between HRQOL and GA at baseline, 3 months and 1 year. Multivariate regressions modelled the prognostic value of GA in evaluating of a patient's HRQOL and the accuracy of baseline GA in predicting HRQOL decline (change of ≥10 points).

RESULTS

The analysis included 57 patients in the CTG and 52 in the CG. Strong correlations (ρ ≥ 0.5) were reported between the EORTC QLQ-C30 Physical Functioning Scale and Activities of Daily Living (ADL), Instrumental ADL (iADL) and Leuven Oncogeriatric Frailty Score Scale (LOFS). Multivariate models demonstrated that poor iADL, ADL and LOFS (CG) and ADL and iADL (CTG) contributed to a statistically (all p < .05) worse HRQOL. The relative gain in predicting 3-month and 1-year HRQOL decline was 24.1% and 4.7% (CG) and 6.1% and 18.3% (CTG).

CONCLUSION

Our results show that the functional measures in the GA are strongly correlated with patient self-reported functioning. Poor baseline GA has a modest probability of predicting HRQOL deterioration.

Early Sport Specialization and Subjective Hip and Groin Dysfunction in Collegiate Ice Hockey Athletes

CONTEXT

Sport specialization is a popular trend among youth athletes that has been associated with an increased risk for developing lower extremity overuse injuries. Early ice hockey specialization may contribute to the high rates of noncontact and overuse hip and groin injuries in collegiate ice hockey athletes.

OBJECTIVE

To examine the effects of high, moderate, and low levels of sport specialization on subjective hip and groin dysfunction in collegiate ice hockey athletes.

DESIGN

Retrospective cohort study.

SETTING

Data were collected during the midseason of the 2018-2019 hockey season at a local ice hockey arena.

PATIENTS OR OTHER PARTICIPANTS

National Collegiate Athletic Association Division III and club ice hockey players from Midwestern college programs (n = 187; 81 women, 106 men).

MAIN OUTCOME MEASURE(S)

Participants were stratified into high-, moderate-, and low-specialization groups based on ice hockey participation before grade 9 of high school. The 6 subscales of the Hip and Groin Outcome Score questionnaire were used to assess current subjective hip and groin dysfunction.

RESULTS

The high-specialization group had lower scores than the low-specialization group on the Symptoms (P = .001), Pain (P = .003), Activities of Daily Living (P = .001), Sport and Recreation (P = .014), and Quality of Life (P = .002) subscales. The moderate-specialization group had lower scores than the low-specialization group on the Symptoms (P = .015) and Activities of Daily Living (P = .006) subscales.

CONCLUSIONS

Collegiate ice hockey athletes who were highly specialized before high school reported greater current hip and groin pain, symptoms, and dysfunction during activities of daily living and sport and recreation and lower current hip- and groin-related quality of life compared with low-specialization ice hockey athletes. Early ice hockey specialization may be detrimental to hip and groin function in collegiate ice hockey athletes.

Health Care Applicability of a Patient-Centric Web Portal for Patients' Medication Experience

Background

With the advent of the patient-centered care paradigm, it is important to examine what patients’ reports of medication experience (PROME) mean to patient care. PROME available through a Web portal provide information on medication treatment options and outcomes from the patient’s perspective. Patients who find certain PROME compelling are likely to mention them at their physician visit, triggering a discussion between the patient and the physician. However, no studies have examined PROME’s potential applicability to patient care.

Objective

This study aimed to examine older (≥50 years) adults’ perceptions of the health care applicability of a hypothetical PROME Web portal. Specifically, this study investigated whether PROME would facilitate patient-physician communication, and identified the preferred reporting items and the trusted sponsors of such a PROME Web portal.

Methods

We used a cross-sectional, self-administered, 5-point Likert scale survey to examine participants’ perceptions of a hypothetical PROME Web portal that compared PROME for 5 common antihypertensive medications. Between August and December 2013, we recruited 300 members of 7 seniors’ centers in a metropolitan area of a southeastern state of the United States to participate in the survey.

Results

An overwhelming majority of study participants (243/300, 81.0%) had a favorable perception of PROME’s health care applicability. They were mostly positive that PROME would facilitate patient-physician communication, except for the perception that physicians would be upset by the mention of PROME (n=133, 44.3%). Further, 85.7% (n=257) of participants considered the PROME information trustworthy, and 72.0% (n=216) were willing to participate by reporting their own medication experiences. Study participants wanted the PROME Web portal to report the number of reviews, star ratings, and individual comments concerning different medication attributes such as side effects (224/809, 27.7%), cost (168/809, 20.8%), and effectiveness (153/809, 18.9%). Finally, the PROME Web portal sponsorship was important to participants, with the most trusted sponsor being academic institutions (120/400, 30.0%).

Conclusions

PROME, if well compiled through Web portals, have the potential to facilitate patient-physician communication.

Facilitating and securing offline e-medicine service through image steganography

E-medicine is a process to provide health care services to people using the Internet or any networking technology. In this Letter, a new idea is proposed to model the physical structure of the e-medicine system to better provide offline health care services. Smart cards are used to authenticate the user singly. A very unique technique is also suggested to verify the card owner's identity and to embed secret data to the card while providing patients' reports either at booths or at the e-medicine server system. The simulation results of card authentication and embedding procedure justify the proposed implementation.

The CARE Guidelines: Consensus-based Clinical Case Reporting Guideline Development

BACKGROUND

A case report is a narrative that describes, for medical, scientific, or educational purposes, a medical problem experienced by one or more patients. Case reports written without guidance from reporting standards are insufficiently rigorous to guide clinical practice or to inform clinical study design.

PRIMARY OBJECTIVE

Develop, disseminate, and implement systematic reporting guidelines for case reports.

METHODS

We used a three-phase consensus process consisting of (1) premeeting literature review and interviews to generate items for the reporting guidelines, (2) a face-to-face consensus meeting to draft the reporting guidelines, and (3) postmeeting feedback, review, and pilot testing, followed by finalization of the case report guidelines.

RESULTS

This consensus process involved 27 participants and resulted in a 13-item checklist-a reporting guideline for case reports. The primary items of the checklist are title, key words, abstract, introduction, patient information, clinical findings, timeline, diagnostic assessment, therapeutic interventions, follow-up and outcomes, discussion, patient perspective, and informed consent.

CONCLUSIONS

We believe the implementation of the CARE (CAse REport) guidelines by medical journals will improve the completeness and transparency of published case reports and that the systematic aggregation of information from case reports will inform clinical study design, provide early signals of effectiveness and harms, and improve healthcare delivery.

Do claims-based continuity of care measures reflect the patient perspective?

Continuity of care (CoC) is a cornerstone of the patient-centered medical home (PCMH) and one of the primary means for achieving health care quality. Despite decades of study, however, CoC remains difficult to define and quantify. To incorporate patient experiences into health reform evaluations, it is critical to determine if and how well CoC measures traditionally derived from administrative claims capture patient experiences. In this study, we used claims data and self-reported continuity experiences of 2,620 Medicare beneficiaries who completed the National Health and Health Services Use Questionnaire to compare 16 claims-based CoC indices to a multidimensional patient-reported CoC measure. Our results show that most claims-based CoC measures do not reflect older adults' perceptions of continuous patient-provider relationships, indicating that claims-based assessments should be used in tandem with patient reports for defining, quantifying, and evaluating CoC in health care delivery models.

Associations between technical quality of diabetes care and patient experience

AIMS

It has long been held that high-quality care has both technical and interpersonal aspects. The nature and strength of any association between both aspects remain poorly explored. This study investigated the associations between diabetes patients' reports of receiving recommended care (as measures of technical quality) and their experience and ratings (as measures of interpersonal care).

METHODS

Using data from a cross section of 3096 patients with diabetes nested within 24 diabetes-care-networks, we conducted multilevel regression analysis of the relationships between nine indicators of receiving care recommended in practice guidelines and: six scales of patient experience and global ratings of general practitioner, nurses, and overall diabetes care.

RESULTS

On average, reporting having received recommended care was associated with reporting better patient experience and ratings. The extent and frequencies of these associations varied across the different care processes. Receiving foot examination, physical activity advice, smoking status check, eye examination, and HbA1c testing, but not nutritional advice, urine, cholesterol or blood pressure checks, were statistically associated with better patient experience and global ratings. Those who received HbA1c testing rated their overall care 1.002 points higher (95% confidence interval: 0.726-1.278) on a scale of 0-10 than those who did not.

CONCLUSIONS

Higher self-reported technical quality of care in diabetes appears to be frequently but not always associated with better experiences and ratings. It is possible that the former leads to the latter and/or that both share a common cause within providers. Both care aspects do not seem interchangeable during performance assessment.