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Salandi J, Vu-Eickmann P, Apfelbacher C, Sheikh A, Loerbroks A. Implementing the Patient Needs in Asthma Treatment (NEAT) questionnaire in routine care: a qualitative study among patients and health professionals. BMC Pulm Med 2023; 23:21. [PMID: 36650461 PMCID: PMC9843883 DOI: 10.1186/s12890-022-02293-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 12/20/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Many patients with asthma report unmet health care needs. The Patient Needs in Asthma Treatment (NEAT) questionnaire is a validated instrument to quantify these unmet needs. We explored how health professionals evaluated the instrument's utility as well as patients' and professionals' perspectives of how NEAT could be incorporated into routine clinical practice. METHODS Qualitative interviews were conducted by telephone between February and September 2021 with 19 patients with asthma and 21 health professionals (i.e., general practitioners, pneumologists, health professionals in pulmonary rehabilitation, and medical assistants). Interview recordings were transcribed verbatim and content-analyzed using both deductive and inductive approaches using MAXQDA. RESULTS Health professionals could see the potential value of using NEAT to inform clinical decisions. However, health professionals tended to be skeptical towards the routine use of NEAT in outpatient settings, mainly due to a lack of time. Implementation of NEAT was seen as more valuable in the context of patient education (i.e., in Disease Management Programs [DMPs] or pulmonary rehabilitation) by patients and health professionals alike, because it offered greater opportunities to address any unmet needs identified. Both patients and health professionals considered it more useful to use the questionnaire for the first time some time after the initial diagnosis has been made (e.g., when the treatment regime is found rather than at time of initial diagnosis). In the context of DMPs and pulmonary rehabilitation, NEAT could be used twice, i.e., before and after patient education to support patient-centered planning and evaluation. CONCLUSION Both patients and health professionals consider the use of the NEAT, in particular in educational programs (i.e., during DMPs or pulmonary rehabilitation), as feasible and useful. There is now a need to undertake a feasibility trial in routine care.
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Affiliation(s)
- Julia Salandi
- grid.411327.20000 0001 2176 9917Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany
| | - Patricia Vu-Eickmann
- grid.411327.20000 0001 2176 9917Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany
| | - Christian Apfelbacher
- grid.5807.a0000 0001 1018 4307Institute of Social Medicine and Health Systems Research (ISMHSR), Medical Faculty, Otto von Guericke University Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Aziz Sheikh
- grid.4305.20000 0004 1936 7988Asthma UK Centre for Applied Research, Usher Institute, Old Medical School, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG UK
| | - Adrian Loerbroks
- grid.411327.20000 0001 2176 9917Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany
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Salandi J, Icks A, Gholami J, Hummel S, Schultz K, Apfelbacher C, Sheikh A, Loerbroks A. Impact of pulmonary rehabilitation on patients' health care needs and asthma control: a quasi-experimental study. BMC Pulm Med 2020; 20:267. [PMID: 33059650 PMCID: PMC7559596 DOI: 10.1186/s12890-020-01301-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 09/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pulmonary rehabilitation offers potential benefits to people with asthma. It is however unknown if rehabilitation favourably affects patients' health care needs. We therefore examined if rehabilitation reduced needs and, in addition, if it improved asthma control. METHODS One hundred fifty patients with asthma were surveyed in three rehabilitation clinics at admission and at discharge. Additionally, we surveyed 78 participants with asthma twice 4 weeks apart. The latter sample (i.e. the control group) was recruited through other pathways than rehabilitation clinics. The Patient Needs in Asthma Treatment (NEAT) questionnaire and the Asthma Control Test (ACT) were completed at baseline and follow-up. Differences between baseline and follow-up and between rehabilitation and control group were examined by t-tests and chi-squared-tests. Univariate ANCOVAS were used to examine if NEAT and ACT follow-up scores differed significantly between groups. Within the rehabilitation group, linear regressions were used to examine if self-reported utilization of more interventions that addressed needs were associated with NEAT scores at follow-up. RESULTS At baseline, there were no differences between the rehabilitation and the control group regarding needs and asthma control. At follow-up, the rehabilitation group showed reduced needs (t(149) = 10.33, p < 0.01) and increased asthma control (t(130) = -6.67, p < 0.01), whereas members of the control group exhibited no changes. Univariate ANCOVAS showed that unmet follow-up needs (F(1, 212) = 36.46, p < 0.001) and follow-up asthma control (F(1, 195) = 6.97, p = 0.009) differed significantly between groups. In the rehabilitation group, self-reported utilization of more interventions was associated with reduced needs (β = 0.21; p = 0.03). CONCLUSIONS This study provides preliminary evidence suggestion that pulmonary rehabilitation in adults with asthma may reduce asthma-related needs and confirms previous findings that rehabilitation may improve asthma control.
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Affiliation(s)
- Julia Salandi
- Institute of Occupational, Social, and Environmental Medicine, Centre for Health and Society, Medical Faculty, University of Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
| | - Andrea Icks
- Institute of Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty, University of Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
- Institute of Health Services Research and Health Economics, German Diabetes Center, Medical Faculty, University of Düsseldorf, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany
| | - Jalal Gholami
- Nordseeklinik Borkum der DRV Rheinland, Bubertstraße 4, 26757, Borkum, Germany
| | - Stefan Hummel
- MEDIAN Klinik Heiligendamm, Kinderstrand 1, 18209, Bad Doberan, Germany
| | - Konrad Schultz
- Klinik Bad Reichenhall der DRV Bayern Süd, Salzburger Str. 8-11, 83435, Bad Reichenhall, Germany
| | - Christian Apfelbacher
- Institute of Social Medicine and Health Systems Research (ISMHSR), Otto von Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Adrian Loerbroks
- Institute of Occupational, Social, and Environmental Medicine, Centre for Health and Society, Medical Faculty, University of Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
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Farzandipour M, Nabovati E, Heidarzadeh Arani M, Akbari H, Sharif R, Anvari S. Enhancing Asthma Patients' Self-Management through Smartphone-Based Application: Design, Usability Evaluation, and Educational Intervention. Appl Clin Inform 2019; 10:870-878. [PMID: 31724144 DOI: 10.1055/s-0039-1700866] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE The aim of this study was to design and evaluate a smartphone-based application for improving self-management in patients with asthma and evaluate its effects on their knowledge. METHODS In this applied research, based on the Clinical Practice Guideline and a systematic review, a questionnaire was designed to determine the application information content and functionality requirements by 15 pediatric and adult asthma and allergy specialist. Then the application was designed and developed using Adobe Air software on the Android operating system. Usability evaluation of the mobile application was performed using the standard questionnaire for user interaction satisfaction (QUIS), which completed by 30 patients with asthma, 8 information technology (IT) specialists, and 2 asthma and allergy specialists. Self-management knowledge of 30 asthma patients was measured using a researcher-made questionnaire before and after using the application. RESULTS The number of specialists in the both Delphi rounds was 15 and the mean work experiences were 17.6 years. The most important elements for asthma self-management were avoiding exposure to allergen and triggers (96%), drug treatment (94.6%), and how to use the therapeutic tools (92.4%), and the most important functionalities were alerting the patients when they did not control asthma (92%), setting reminders for timely drug use (85.4%) and therapeutic tools (82.6%), recording prescription drugs (82.6%), and peak flow meter values (82%). Usability evaluation showed that 30 patients with asthma, 8 IT specialists, and 2 physicians evaluated the application at a "good" level. The mean score of the patients' knowledge before intervention was 2.43 ± 0.95 which after intervention was significantly increased to 4.3 ± 0.56 (p < 0.001). CONCLUSION Considering the desirable outcomes of application evaluation and a positive impact of this educational intervention on asthma patients' knowledge, it is possible to use mobile-based self-management programs to help these patients to manage illness and gain knowledge and self-management skills.
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Affiliation(s)
- Mehrdad Farzandipour
- Health Information Management Research Center, Department of Health Information Management and Technology, School of Allied Health Professions, Kashan University of Medical Sciences, Kashan, Iran
| | - Ehsan Nabovati
- Health Information Management Research Center, Department of Health Information Management and Technology, School of Allied Health Professions, Kashan University of Medical Sciences, Kashan, Iran
| | | | - Hossein Akbari
- Department of Biostatistics and Epidemiology, School of Health, Kashan University of Medical Sciences, Kashan, Iran
| | - Reihane Sharif
- Department of Health Information Management and Technology, School of Allied Health Professions, Kashan University of Medical Sciences, Kashan, Iran
| | - Shima Anvari
- Department of Health Information Management and Technology, School of Allied Health Professions, Kashan University of Medical Sciences, Kashan, Iran
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Schreitmüller J, Apfelbacher C, Sheikh A, Loerbroks A. The Patient Needs in Asthma Treatment (NEAT) questionnaire: Further evidence on its psychometric properties. Allergy 2019; 74:1511-1521. [PMID: 30985936 DOI: 10.1111/all.13782] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/04/2019] [Accepted: 02/19/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Building on previous psychometric work, we sought to assess the Patient Needs in Asthma Treatment (NEAT) questionnaire's validity, responsiveness to change, and the minimal important change (MIC) over a 3-year period (Study 1) and its reliability and the smallest detectable change (SDC) in a test-retest study (Study 2) among patients self-reporting physician-diagnosed asthma. METHODS In Study 1, a total of 207 patients completed a survey which included the NEAT, the Asthma Control Test (ACT), the Asthma Quality of Life Questionnaire-Sydney (AQLQ-S), and a question on treatment satisfaction in 2014 and 2017. In Study 2, a total of 78 patients completed NEAT twice on average four weeks apart in 2018. RESULTS Concurrent validity: In linear regressions, unmet patient needs were cross-sectionally associated with poorer asthma control (β = -0.21; P = 0.01), asthma-related quality of life (QoL) (β = 0.31; P < 0.01), and treatment satisfaction (β = -0.59; P < 0.01). Predictive Validity: Higher unmet needs at baseline predicted worse treatment satisfaction at follow-up (β = -0.28; P < 0.01), but neither asthma control nor asthma-related QoL. Responsiveness to change was demonstrated by linear regressions of changes in the total NEAT score and changes in AQLQ-S (β = 0.21; P < 0.01) and treatment satisfaction (β = -0.36; P < 0.01). MIC: Patients whose NEAT score increased between baseline and follow-up by the identified MIC (0.301) reported lower treatment satisfaction at follow-up (β = -0.17; P = 0.01). Test-retest reliability was demonstrated by correlations between NEAT baseline and follow-up scores (eg, intra-class correlation coefficients for total score = 0.78). The SDC (0.384) was slightly larger than MIC. CONCLUSION NEAT is a promising tool for assessing asthma treatment needs.
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Affiliation(s)
- Julia Schreitmüller
- Institute of Occupational, Social, and Environmental Medicine, Medical Faculty, Centre for Health and Society University of Düsseldorf Düsseldorf Germany
| | - Christian Apfelbacher
- Medical Sociology, Institute of Epidemiology and Preventive Medicine University of Regensburg Regensburg Germany
| | - Aziz Sheikh
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics University of Edinburgh Edinburgh UK
| | - Adrian Loerbroks
- Institute of Occupational, Social, and Environmental Medicine, Medical Faculty, Centre for Health and Society University of Düsseldorf Düsseldorf Germany
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Patient Perceptions of Living with Severe Asthma: Challenges to Effective Management. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:2613-2621.e1. [PMID: 31178414 DOI: 10.1016/j.jaip.2019.04.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 04/14/2019] [Accepted: 04/17/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND The management of severe asthma poses many challenges related to treatment, adherence, and psychosocial morbidity. There is little direct data from the patient perspective to understand and negotiate the complexities of managing severe asthma. OBJECTIVE To explore the patient perceptions of living with severe asthma and the experience of managing severe asthma, in order to better understand the support that might promote more effective self-management for severe asthma. METHODS Participants were recruited from a specialist Difficult Asthma Service. Semistructured interviews were conducted by researchers independent of the patient's care. Interviews were transcribed verbatim and inductive thematic analysis was performed. RESULTS Twenty-nine participants (13 male: mean [standard deviation] age, 49.5 [13.6] years: mean Asthma Control Questionnaire 2.2 [1.2]) participated in an interview. Analysis resulted in 4 major themes describing the experience and challenges to managing severe asthma: understanding of severe asthma, emotional impact of living with severe asthma (subtheme: fear of hospitalization), public perceptions of asthma, and concerns about medications. CONCLUSIONS Health care professionals need to consider and discuss with patients their perceptions of severe asthma and the relevant treatments; particular attention should focus around education of disease control and actively exploring thoughts around hospitalization. Our data highlight the potential for psychological and social support to enhance self-management by directly addressing the wide-ranging individual challenges patients face. There is also a need for greater public awareness and education about severe asthma to minimize patient distress particularly in the work environment.
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Schreitmüller J, Loerbroks A. The role of self-efficacy and locus of control in asthma-related needs and outcomes: a cross-sectional study. J Asthma 2019; 57:196-204. [PMID: 30634885 DOI: 10.1080/02770903.2018.1556687] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Objective: This study sought to identify psychological resources, which are associated with improved asthma outcomes. Methods: A total of 205 patients who reported physician-diagnosed asthma were surveyed between September 2017 and March 2018. Psychological resources included self-efficacy (i.e. the belief in one's capabilities to organize and execute required behavior [SE]; assessed by the Short Scale for Measuring General Self-Efficacy Beliefs), and internal and external locus of control (i.e. one's beliefs about whether a given event is the result of one's behavior or of forces outside one's control [LoC]; Scale for Internal External Locus of Control-4). Outcome variables included asthma control (Asthma Control Test), asthma-related quality of life (QoL; Asthma Quality of Life Questionnaire-Sydney) and patient needs (Patient Needs in Asthma Treatment Questionnaire). Associations were estimated by linear regressions. Results: We observed that higher self-efficacy and internal LoC scores, but lower scores on the external LoC subscale were associated with improved asthma control (SE: β = 0.19, p = 0.01; internal LoC: β = 0.17, p = 0.02; external LoC: β = -0.18, p = 0.01), better asthma-related QoL (SE: β = -0.38, p < 0.01; internal LoC: β = -0.40, p < 0.01; external LoC: β = 0.46, p < 0.01) and less unmet needs (SE: β = -0.16, p = 0.02; internal LoC: β = -0.18, p < .01; external LoC: β = 0.32, p < 0.01). Conclusions: Our study provides novel evidence on psychological resources among patients with asthma, which are associated with improved asthma outcomes.
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Affiliation(s)
- Julia Schreitmüller
- Institute of Occupational Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Düsseldorf, Germany
| | - Adrian Loerbroks
- Institute of Occupational Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Düsseldorf, Germany
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