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Safstrom E, Arestedt K, Hadjistavropoulos HD, Liljeroos M, Nordgren L, Jaarsma T, Stromberg A. Development and psychometric properties of a short version of the Patient Continuity of Care Questionnaire. Health Expect 2023; 26:1137-1148. [PMID: 36797976 PMCID: PMC10154813 DOI: 10.1111/hex.13728] [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: 03/29/2022] [Revised: 11/24/2022] [Accepted: 02/01/2023] [Indexed: 02/18/2023] Open
Abstract
INTRODUCTION Hospitalization due to cardiac conditions is increasing worldwide, and follow-up after hospitalization usually occurs in a different healthcare setting than the one providing treatment during hospitalization. This leads to a risk of fragmented care and increases the need for coordination and continuity of care after hospitalization. Furthermore, international reports highlight the importance of improving continuity of care and state that it is an essential indicator of the quality of care. Patients' perceptions of continuity of care can be evaluated using the Patient Continuity of Care Questionnaire (PCCQ). However, the original version is extensive and may prove burdensome to complete; therefore, we aimed to develop and evaluate a short version of the PCCQ. METHODS This was a psychometric validation study. Content validity was evaluated among user groups, including patients (n = 7), healthcare personnel (n = 15), and researchers (n = 7). Based on the results of the content validity and conceptual discussions among the authors, 12 items were included in the short version. Data from patients were collected using a consecutive sampling procedure involving patients 6 weeks after hospitalization due to cardiac conditions. Rasch analysis was used to evaluate the psychometric properties of the short version of the PCCQ. RESULTS A total of 1000 patients were included [mean age 72 (SD = 10), 66% males]. The PCCQ-12 presented a satisfactory overall model fit and a person separation index of 0.79 (Cronbach's α: .91, ordinal α: .94). However, three items presented individual item misfits. No evidence of multidimensionality was found, meaning that a total score can be calculated. A total of four items presented evidence of response dependence but, according to the analysis, this did not seem to affect the measurement properties or reliability of the PCCQ-12. We found that the first two response options were disordered in all items. However, the reliability remained the same when these response options were amended. In future research, the benefits of the four response options could be evaluated. CONCLUSION The PCCQ-12 has sound psychometric properties and is ready to be used in clinical and research settings to measure patients' perceptions of continuity of care after hospitalization. PATIENT OR PUBLIC CONTRIBUTION Patients, healthcare personnel and researchers were involved in the study because they were invited to select items relevant to the short version of the questionnaire.
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Affiliation(s)
- Emma Safstrom
- Nyköping Hospital, Sörmland County Council, Nyköping, Sweden.,Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Center for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Kristofer Arestedt
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.,Department of Research, Region Kalmar County, Kalmar, Sweden
| | | | - Maria Liljeroos
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Center for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Lena Nordgren
- Center for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Nursing Science, Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anna Stromberg
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Cardiology, Linköping University, Linköping, Sweden
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Dostálová V, Bártová A, Bláhová H, Holmerová I. The experiences and needs of frail older people receiving home health care: A qualitative study. Int J Older People Nurs 2021; 17:e12418. [PMID: 34418315 PMCID: PMC9285561 DOI: 10.1111/opn.12418] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 08/04/2021] [Accepted: 08/09/2021] [Indexed: 01/26/2023]
Abstract
Background Due to the rapid ageing of the population, there is increasing demand for long‐term care in the people's home environment. Such care aims to allow the people to stay at home and avoid hospitalisation or other institutional care. In home health care, care must be provided at the highest possible quality, with the focus on the people's needs and experiences. Objectives This study explores the experiences and needs of frail older people receiving home health care. Design and methods An exploratory descriptive qualitative approach was chosen. Audio‐taped semi‐structured interviews were conducted with fifteen older people receiving home health care. A content analysis was used to analyse the data collected. Results The content analysis identified one main theme, three categories and seven subcategories related to frail older people's needs and experiences of home health care. The main theme was quality of care. The first category, Safe and Secure Care, consisted of three subcategories: Education and Experience of Nurses, Information, and Continuity of Care in terms of personnel continuity and regular care. The second category, Autonomy, contained two subcategories: Decision‐making and Self‐sufficiency. The last category, Relationship with Professionals, consisted of two subcategories: Personality of Nurse and Partnerships. Conclusion Older people are able to express their satisfaction or dissatisfaction with home health care. The results of this study revealed that the quality of care is crucial for frail older people. Implication for practice The provision of home health care is inherently highly specific; home care nurses should work to provide the highest possible quality of care. In particular, nurses should focus on ensuring that the care they provide is safe, effective, timely, efficient and person‐centred.
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Affiliation(s)
- Vladimíra Dostálová
- Department of Longevity Studies, Faculty of Humanities, Charles University, Prague, Czech Republic
| | - Alžběta Bártová
- Department of Longevity Studies, Faculty of Humanities, Charles University, Prague, Czech Republic
| | - Hana Bláhová
- Department of Longevity Studies, Faculty of Humanities, Charles University, Prague, Czech Republic
| | - Iva Holmerová
- Department of Longevity Studies, Faculty of Humanities, Charles University, Prague, Czech Republic
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Ljungholm L, Klinga C, Edin-Liljegren A, Ekstedt M. What matters in care continuity on the chronic care trajectory for patients and family carers?-A conceptual model. J Clin Nurs 2021; 31:1327-1338. [PMID: 34351651 DOI: 10.1111/jocn.15989] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/12/2021] [Accepted: 07/15/2021] [Indexed: 01/19/2023]
Abstract
AIMS AND OBJECTIVES To describe essential aspects of care continuity from the perspectives of persons with complex care needs and their family carers. BACKGROUND Continuity of care is an important aspect of quality, safety and efficiency. For people with multiple chronic diseases and complex care needs, care must be experienced as connected and coherent, and consistent with medical and individual needs. The more complex the need for care, the greater the need for continuity across different competencies, services and roles. DESIGN A constructivist grounded theory approach was applied. METHODS Sixteen patients with one or more chronic diseases needing both health care and social care, living in their private homes, and twelve family carers, were recruited. Semi-structured interviews were conducted and analysed with constructivist grounded theory. The COREQ checklist was followed. RESULTS A conceptual model of care continuity was constructed, consisting of five categories that were interconnected through the core category: time and space. Patients' and family carers' experiences of care continuity were closely related to timely personalised care delivery, where access to tailored information, regardless of who was performing a care task, was essential for mutual understanding. This required clarity in responsibilities and roles, interprofessional collaboration and achieving a trusting relationship between each link in the chain of care, over time and space. To achieve care continuity, all the identified categories were important, as they worked in synergy, not in isolation. CONCLUSION Care continuity for people with complex care needs and family carers is experienced as multidimensional, with several essential aspects that work in synergy, but varies over time and depends on each person's own resources and situational and contextual circumstances. RELEVANCE TO CLINICAL PRACTICE The findings promote understanding of patients' and family carers' experiences of care continuity and may guide the delivery of care to people with complex care needs.
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Affiliation(s)
- Linda Ljungholm
- Department of Health and Caring Sciences, Linnaeus University Kalmar, Kalmar, Sweden
| | - Charlotte Klinga
- Department of Health and Caring Sciences, Linnaeus University Kalmar, Kalmar, Sweden.,Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - Anette Edin-Liljegren
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden.,Department of Nursing, Umeå University, Umeå, Sweden
| | - Mirjam Ekstedt
- Department of Health and Caring Sciences, Linnaeus University Kalmar, Kalmar, Sweden.,Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
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Säfström E, Nasstrom L, Liljeroos M, Nordgren L, Årestedt K, Jaarsma T, Stromberg A. Patient Continuity of Care Questionnaire in a cardiac sample: A Confirmatory Factor Analysis. BMJ Open 2020; 10:e037129. [PMID: 32641363 PMCID: PMC7342470 DOI: 10.1136/bmjopen-2020-037129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Even though continuity is essential after discharge, there is a lack of reliable questionnaires to measure and assess patients' perceptions of continuity of care. The Patient Continuity of Care Questionnaire (PCCQ) addresses the period before and after discharge from hospital. However, previous studies show that the factor structure needs to be confirmed and validated in larger samples, and the aim of this study was to evaluate the psychometric properties of the PCCQ with focus on factor structure, internal consistency and stability. DESIGN A psychometric evaluation study. The questionnaire was translated into Swedish using a forward-backward technique and culturally adapted through cognitive interviews (n=12) and reviewed by researchers (n=8). SETTING Data were collected in four healthcare settings in two Swedish counties. PARTICIPANTS A consecutive sampling procedure included 725 patients discharged after hospitalisation due to angina, acute myocardial infarction, heart failure or atrial fibrillation. MEASUREMENT To evaluate the factor structure, confirmatory factor analyses based on polychoric correlations were performed (n=721). Internal consistency was evaluated by ordinal alpha. Test-retest reliability (n=289) was assessed with intraclass correlation coefficient (ICC). RESULTS The original six-factor structure was overall confirmed, but minor refinements were required to reach satisfactory model fit. The standardised factor loadings ranged between 0.68 and 0.94, and ordinal alpha ranged between 0.82 and 0.95. All subscales demonstrated satisfactory test-retest reliability (ICC=0.76-0.94). CONCLUSION The revised version of the PCCQ showed sound psychometric properties and is ready to be used to measure perceptions of continuity of care. High ordinal alpha in some subscales indicates that a shorter version of the questionnaire can be developed.
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Affiliation(s)
- Emma Säfström
- Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Lena Nasstrom
- Research and Development Unit, Department of Medical and Health Sciences, Linköping University, Linkoping, Sweden
| | - Maria Liljeroos
- Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Lena Nordgren
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
- Department of Public Health and Caring Sciences, Uppsala Universitet, Uppsala, Sweden
| | - Kristofer Årestedt
- Faculty of health and Life Sciences, Linnaeus University, Kalmar, Sweden
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Anna Stromberg
- Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
- Department of Cardiology, Linköping University Hospital, Linkoping, Sweden
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Shrivastava R, Couturier Y, Simard-Lebel S, Girard F, Aguirre NVB, Torrie J, Emami E. Relational continuity of oral health care in Indigenous communities: a qualitative study. BMC Oral Health 2019; 19:287. [PMID: 31865901 PMCID: PMC6927186 DOI: 10.1186/s12903-019-0986-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 12/11/2019] [Indexed: 11/23/2022] Open
Abstract
Background The relational continuity of care is an essential function of primary health care. This study reports on the perspectives of Cree communities and their primary health care providers regarding the barriers and enablers of relational continuity of oral health care integrated at a primary health care organization. Methods A multiple case study design within a qualitative approach and developmental evaluation methodology were used to conduct this research study in Cree communities of Northern Québec. Maximum variation sampling and snowball techniques were used to recruit the participants. Data collection consisted of individual interviews and focus group discussions. Thematic analysis was conducted which included transcription, debriefing, codification, data display, and interpretation. The consolidated criteria for reporting qualitative studies (COREQ) were used to guide the reporting of study findings. Results A total of six focus group discussions and 36 individual interviews were conducted. Five major themes emerged from the thematic analyses for barriers (two) and enablers (three). Themes for barriers included impermanence and lack of effective communication, whereas themes for enablers included culturally competent professionals, working across professional boundaries, and proactive organizational engagement. Conclusions Based on these findings, relational continuity can be empowered by effective strategies for overcoming barriers and encouraging enablers, such as recruitment of permanent professionals, organizing cultural competency training, development of a Cree language dental glossary, encouraging inter-professional collaboration, and promoting the organization’s efforts.
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Affiliation(s)
- Richa Shrivastava
- Faculty of Dentistry, Université de Montréal, Montréal, Québec, H3C 3J7, Canada
| | - Yves Couturier
- School of Social Work, Université de Sherbrooke, Sherbrooke, J1H 4C4, Québec, Canada
| | | | - Felix Girard
- Faculty of Dentistry, Université de Montréal, Montréal, Québec, H3C 3J7, Canada
| | | | - Jill Torrie
- Director of Specialised Services, Cree Board of Health and Social Services of James Bay, Mistissini, Québec, G0W 1C0, Canada
| | - Elham Emami
- Faculty of Dentistry, McGill University, Montréal, Québec, H3A 1G1, Canada.
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Karam M, Lambert AS, Macq J. Patients' perceptions of continuity of care across primary care level and emergency departments in Belgium: cross-sectional survey. BMJ Open 2019; 9:e033188. [PMID: 31852708 PMCID: PMC6936975 DOI: 10.1136/bmjopen-2019-033188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To assess patients' perceptions of continuity of care (COC) across primary care level and emergency departments (EDs) and to identify contextual and individual factors that influence this perception. DESIGN Cross-sectional multicentre survey. SETTING Five EDs in Brussels and Wallonia. PARTICIPANTS 501 adult patients referred to the ED by their primary care physician (PCP). Patients with cognitive impairment or in critical condition were excluded. RESULTS Patients perceived high levels of the three types of COC. On an individual level, older patients showed a perception of higher levels of continuity. Lower levels of informational and management continuity were observed among patients suffering from chronic diseases and patients with a high level of education. Patients also perceived a redundancy of medical exams, in parallel to a high degree of accessibility between care levels. On an organisational level, three structural factors were identified as barriers to COC, namely, ED workload, suboptimal sharing information system and the current fee-for-service payment system that encourages competition and hinders coordination between actors. CONCLUSION Belgian healthcare services seem satisfying for patients and easily accessible. However, efforts need to be directed towards improving their efficiency. A stronger primary care level is also needed to benefit the healthcare system by reducing overuse of emergency services. On the individual level, a more enhanced patient-centred approach could be beneficial in improving patients experience of care.
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Affiliation(s)
- Marlene Karam
- Faculty of Public Health, Institute of Health and Society, Catholic University of Louvain Health Sciences Sector, Brussels, Belgium
| | - Anne-Sophie Lambert
- Faculty of Public Health, Institute of Health and Society, Catholic University of Louvain Health Sciences Sector, Brussels, Belgium
| | - Jean Macq
- Faculty of Public Health, Institute of Health and Society, Catholic University of Louvain Health Sciences Sector, Brussels, Belgium
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Gallacher KI, Quinn T, Kidd L, Eton D, Dillon M, Elliot J, Johnston N, Erwin PJ, Mair F. Systematic review of patient-reported measures of treatment burden in stroke. BMJ Open 2019; 9:e029258. [PMID: 31533946 PMCID: PMC6756342 DOI: 10.1136/bmjopen-2019-029258] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Treatment burden is the workload of healthcare for people with long-term conditions (LTC) and its impact on well-being. A method of measurement is required to identify those experiencing high burden and to measure intervention efficacy. Our aim was to identify, examine and appraise validated patient-reported measures (PRMs) of treatment burden in stroke. Here, stroke serves as an exemplar LTC of older adults. DESIGN A systematic review of published studies that describe the development and validation of PRMs measuring treatment burden in stroke survivors. DATA SOURCES We searched MEDLINE, Embase, CINAHL and PsycINFO electronic databases. ELIGIBILITY CRITERIA Studies published between January 2000 and 12 April 2019 inclusive, in English language. No restrictions were set based on clinical setting or geographical location. DATA EXTRACTION AND SYNTHESIS Screening, data extraction and quality appraisal were conducted by two independent reviewers. Content of the PRMs was compared with a published taxonomy of treatment burden. Quality appraisal was conducted using International Society for Quality of Life Research standards. RESULTS From 3993 articles, 6 relevant PRMs were identified: 3 were stroke specific: The Satisfaction with Stroke Care questionnaire; The Stroke Patient-Reported Outcome Measure and The Barriers to Physical Activity after Stroke scale. Three were generic but validated in stroke: The WHO Quality of Life-100; The Patient's Questionnaire on Participation in Discharge Planning and The Chao Perception of Continuity scale. None comprehensively measured treatment burden. Examples of omitted burdens included developing coping strategies, managing finances and returning to driving. The most notable issue regarding quality appraisal was that three PRMs lacked any underpinning qualitative research relevant to the sample. CONCLUSION There is a need to develop a comprehensive PRM of treatment burden for use in stroke, with potential for use in other older populations.
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Affiliation(s)
- Katie I Gallacher
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Terry Quinn
- Department of Academic Geriatric Medicine, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Lisa Kidd
- Nursing & Healthcare School, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - David Eton
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Jennifer Elliot
- Stroke and Brain Imaging, Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK
| | - Natalie Johnston
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Patricia J Erwin
- Mayo Medical Libraries, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Frances Mair
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Effect of Retail Clinic Use on Continuity of Care Among Medicare Beneficiaries. J Am Board Fam Med 2019; 32:531-538. [PMID: 31300573 PMCID: PMC9296059 DOI: 10.3122/jabfm.2019.04.180349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 02/10/2019] [Accepted: 02/11/2019] [Indexed: 11/08/2022] Open
Abstract
PURPOSE We examined the relationship between retail clinic use and primary care physician (PCP) continuity among Medicare enrollees in the Houston metropolitan area. METHODS We identified retail clinic providers in the study area using a 2015 health care provider database. Medicare claims data from enrollees who received care from retail clinics in 2015 were compared with propensity score-matched sample of enrollees who received no care from retail clinics. RESULTS There were 2.32 retail clinic visits per 1000 beneficiaries in a month. Approximately 1.3% of Medicare beneficiaries used retail clinics. Retail clinic users were more likely to be aged 65 to 74 years, female, White, and Medicaid ineligible. In multivariable analyses with adjustments for covariates, significant predictors of retail clinic use included having ≥3 chronic conditions (Odds Ratio [OR], 1.53 vs no condition), living within 1 mile of a retail clinic (OR, 2.44 vs living ≥5 miles), and having no PCP (OR, 1.11 vs having PCP). Compared with propensity-matched controls, among enrollees with an identified PCP, likelihood of seeing their PCP (OR, 0.82; 95% CI, 0.73 to 0.93) and continuity of care was lower (0.75 ± 0.33 vs 0.80 ± 0.31) if they had retail clinic visits. CONCLUSIONS Retail clinic use was lower in the elderly population compared with the previously published rate in the younger populations. The lower rate of continuity of care observed among retail clinic users is concerning, especially for those with chronic medical conditions.
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Nilsen ER, Söderhamn U, Dale B. Facilitating holistic continuity of care for older patients: Home care nurses’ experiences using checklists. J Clin Nurs 2019; 28:3478-3491. [DOI: 10.1111/jocn.14940] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/16/2019] [Accepted: 05/29/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Elin R. Nilsen
- Faculty of Health and Sport Sciences, Centre for Caring Research University of Agder Grimstad Norway
| | - Ulrika Söderhamn
- Faculty of Health and Sport Sciences, Centre for Caring Research University of Agder Grimstad Norway
| | - Bjørg Dale
- Faculty of Health and Sport Sciences, Centre for Caring Research University of Agder Grimstad Norway
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Valaker I, Fridlund B, Wentzel-Larsen T, Hadjistavropoulos H, Nordrehaug JE, Rotevatn S, Råholm MB, Norekvål TM. Adaptation and psychometric properties of the Norwegian version of the heart continuity of care questionnaire (HCCQ). BMC Med Res Methodol 2019; 19:62. [PMID: 30885143 PMCID: PMC6423885 DOI: 10.1186/s12874-019-0706-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 03/11/2019] [Indexed: 11/17/2022] Open
Abstract
Background Continuity of cardiac care after hospital discharge is a priority, especially as healthcare systems become increasingly complex and fragmented. There are few available instruments to measure continuity of cardiac care, especially from the patient perspective. The aim of this study was (1) to translate and adapt the Heart Continuity of Care Questionnaire (HCCQ) to conditions in Norway, and (2) to determine its psychometric properties in self-report format administered to patients after percutaneous coronary intervention (PCI). Methods The HCCQ was first translated into Norwegian from the original English version, following a widely used cross-cultural adaptation process. Data were collected before hospital discharge and in a follow-up after 2 months. To assess psychometric properties, a confirmatory factor analysis (CFA) was performed and three aspects of construct validity were evaluated: structural validity, hypotheses testing and cross-cultural validation. Internal consistency of the HCCQ subscales was calculated using Cronbach’s alpha, while intra-class correlation (ICC) was used to assess test-retest reliability. Additionally, socio-demographic and patient-reported data were collected to correlate with HCCQ scores. Results Of those included at baseline, 436 (76%) completed the questionnaires after 2 months. CFA suggested that the fit of the HCCQ data to a 3-factor model was modest (RMSEA = 0.11, CFI = 0.90, TLI = 0.90). However, convergent validity was satisfactory, based on existing research. Internal consistency was good, as indicated by its Cronbach’s alphas: total continuity of care (0.95); informational (0.93), relational (0.87), and management (0.89) continuity. The ICC for the total HCCQ score was 0.80 (95% CI [0.71, 0.87] p < 0.001). As indicated by negative care experiences (rated as 1 or 2 on the five-point scale), patients seemed to have limited knowledge about medical treatment, lifestyle modification and follow-up after PCI. Participation in cardiac rehabilitation and longer consultations with the general practitioner after hospital discharge were positively correlated with better continuity of care. Conclusions Implementation of the HCCQ will likely support healthcare providers and researchers in identifying problem areas of continuity of cardiac care and in evaluating interventions aimed at improving continuity of care.
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Affiliation(s)
- Irene Valaker
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Førde, Norway.
| | - Bengt Fridlund
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.,Centre of Interprofessional Collaboration within Emergency care (CICE), Linnaeus University, Växjö, Sweden
| | - Tore Wentzel-Larsen
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway.,Centre for Child and Adolescent Mental Health, Eastern and Southern, Oslo, Norway.,Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | | | - Jan Erik Nordrehaug
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway.,Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | - Svein Rotevatn
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.,Norwegian Registry for Invasive Cardiology, Bergen, Norway
| | - Maj-Britt Råholm
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Førde, Norway
| | - Tone M Norekvål
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Førde, Norway.,Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
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Qiu C, Chen S, Yao Y, Zhao Y, Xin Y, Zang X. Adaption and validation of Nijmegen continuity questionnaire to recognize the influencing factors of continuity of care for hypertensive patients in China. BMC Health Serv Res 2019; 19:79. [PMID: 30696430 PMCID: PMC6352379 DOI: 10.1186/s12913-019-3915-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 01/17/2019] [Indexed: 12/05/2022] Open
Abstract
Background Continuity of care (COC) has become a primary point of concern for care providers in both developed and developing countries, which is regarded as the “cornerstone of care” and an “essential element” of good health care. A robust and proper instrument is of necessity to identify problems and evaluate intervention aimed at improving continuity of care. This study aimed to adapt Nijmegen continuity questionnaire (NCQ) into a Chinese version (NCQ-C) and to delineate the status of COC as well as explore its influencing factors for hypertensive patients in China. Methods A forward-back-translation procedure was adopted for the determination of the adaption of NCQ. Then a total of 448 patients completed questionnaires and 24-h ambulatory blood pressure monitoring (ABPM). Proper indexes were calculated to test the reliability and validity of NCQ-C. Logistic analysis were used to detect the influencing factors of COC. Results The NCQ-C had excellent intraclass correlation coefficient of 0.855 and internal consistency of seven dimensions varied from 0.907 to 0.944. The item-content validity index ranged from 0.71 to 1.00. For construct validity, seven-factor structure was confirmed as original questionnaire and all the fit indices indicated acceptable levels. Gender, education level, medical insurance and frequency of family visits, blood pressure level, depression status as well as general health perception were demonstrated to be statistically related to COC. Conclusions In addition, all the parameters of ABPM were negatively significant with COC. The NCQ-C has shown acceptable level of reliability and validity. The related factors of COC should arouse care providers’ attention.
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Affiliation(s)
- Chen Qiu
- School of Nursing, Tianjin Medical University, Qixiangtai Road, Heping District, Tianjin, China
| | - Shixiang Chen
- School of Nursing, Tianjin Medical University, Qixiangtai Road, Heping District, Tianjin, China
| | - Ying Yao
- Department of Emergency, Tianjin Medical University General Hospital, Tianjin, China
| | - Yue Zhao
- School of Nursing, Tianjin Medical University, Qixiangtai Road, Heping District, Tianjin, China
| | - Yi Xin
- Department of Cardiology, Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xiaoying Zang
- School of Nursing, Tianjin Medical University, Qixiangtai Road, Heping District, Tianjin, China.
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Ball LE, Barnes KA, Crossland L, Nicholson C, Jackson C. Questionnaires that measure the quality of relationships between patients and primary care providers: a systematic review. BMC Health Serv Res 2018; 18:866. [PMID: 30453957 PMCID: PMC6245854 DOI: 10.1186/s12913-018-3687-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 11/05/2018] [Indexed: 11/10/2022] Open
Abstract
Background International guidance on models of care stress the importance of good quality, continuous patient-provider relationships to support high quality and efficient care and hospital avoidance. However, assessing the quality of patient-provider relationships is challenging due to its experiential nature. The aim of this study was to undertake a systematic review to identify questionnaires previously developed or used to assess the quality of continuous relationships between patients and their provider in primary care. Methods MEDLINE, PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL) and SCOPUS databases were searched for English language studies published between 2009 and 2017. Key terms used identified studies conducted in the primary care setting examining relationships between patients and providers. Studies that focused on the conceptualisation, development, testing or review of a questionnaire, or studies that used a questionnaire for assessing the quality of continuous relationships between patients and providers were eligible. Studies that did not assess quality via a questionnaire, only assessed single aspects of relationships, only assessed single encounters, assessed transitions between settings or assessed relationships using an index were excluded. Information on validity testing of each relevant questionnaire identified from articles was reviewed to inform recommendations for future research and evaluation. Results Twenty-seven studies met the eligibility criteria, including 14 unique questionnaires. The questionnaires were diverse in length, scope, focus and level of validity testing. Five questionnaires were considered not feasible for future use due to size and lack of development work. Three questionnaires were considered strongest candidates for use in future work based on being relevant to the topic and primary care setting, freely available in English and not needing additional pilot work prior to use. These three questionnaires were the Care Continuity Across Levels of Care Scale, the Nijmegan Continuity Questionnaire and the Patient-Doctor Depth of Relationship Tool. Conclusions This study provides an overview of 14 unique questionnaires that have been used to assess the quality of continuous relationships between patients and primary care providers. The decision to use one of the questionnaires in future work requires careful consideration, including the scope, length, validation testing, accessibility of the questionnaires and their alignment with the initiative being evaluated.
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Affiliation(s)
- Lauren E Ball
- Centre for Health System Reform and Integration, UQ-Mater Research Institute, Brisbane, Australia. .,Menzies Health Institute Queensland, Griffith University, Parklands Drive, Southport, Gold Coast, QLD, 4222, Australia.
| | - Katelyn A Barnes
- Menzies Health Institute Queensland, Griffith University, Parklands Drive, Southport, Gold Coast, QLD, 4222, Australia
| | - Lisa Crossland
- Centre for Health System Reform and Integration, UQ-Mater Research Institute, Brisbane, Australia
| | - Caroline Nicholson
- Centre for Health System Reform and Integration, UQ-Mater Research Institute, Brisbane, Australia
| | - Claire Jackson
- Centre for Health System Reform and Integration, UQ-Mater Research Institute, Brisbane, Australia
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Rucci P, Foglino S, Bravi F, D'Avenia R, Altini M, Carradori T, Angelastro A, Fantini MP. Validation of the OPportunity for Treatment In ONcology (OPTION) questionnaire measuring continuity of care. Eur J Cancer Care (Engl) 2017; 27. [PMID: 28895233 DOI: 10.1111/ecc.12765] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2017] [Indexed: 11/29/2022]
Abstract
Increasing efforts are ongoing to deliver effective cancer care through integrated networks of services. Measuring patients' experience of care is essential to identify problematic areas that require organisational adjustments. The aim of the present study was to examine the validity of OPTION questionnaire, designed to measure patient's perceived continuity of care across different phases of their care pathway. The study was carried at the Institute for Cancer Treatment and Research, Meldola and the oncology departments of the Local Health Authority of Romagna, Italy. Principal component analysis (PCA) was performed to identify factors underlying patients' perception of continuity of care. Factor scores were compared between patients with or without a care coordinator using Mann-Whitney test. The study sample consisted of 214 patients with breast or colorectal cancer, with a mean age of 62.3 years. Most patients identified the oncologist as their care coordinator. Five factors were extracted using PCA: (1) "trustful relationship with health care staff," (2) "information on care pathway," (3) "information on changes related to the illness," (4) "feelings of abandonment" and (5) "collaboration among health care professionals." The scores of factors 2 and 3 were significantly higher among those with a care coordinator. The OPTION questionnaire is a reliable instrument that can help clinicians and administrative stakeholder target efforts and resources in the pursuit of quality of care.
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Affiliation(s)
- Paola Rucci
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | | | | | - Rossella D'Avenia
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | | | | | - Angela Angelastro
- Area Qualità e Accreditamento, Agenzia nazionale per i servizi sanitari, Roma, Italy
| | - Maria Pia Fantini
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
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Lees C, Hutchison T, O'Brien S. Introducing community integrated nursing teams: How one Clinical Commissioning Group applied an evidence-based approach. Br J Community Nurs 2017; 22:289-294. [PMID: 28570114 DOI: 10.12968/bjcn.2017.22.6.289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The present day collection of financial and demographic challenges confronted by health and social care mean that integrated services are undoubtedly essential to sustain adequate care. However, the impact of integrated care upon healthcare staff and patients as well as new ways of working will need to be demonstrated, with collaboration and engagement throughout any transition. This paper provides an overview of the evidence relating to the delivery of effective, integrated out-of-hospital care, with a discussion of the literature. It also considers how one Clinical Commissioning Group has begun the process of integration with the focus on community nursing services for the provision of better care for patients with an evidence-based approach.
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Affiliation(s)
- Carolyn Lees
- Senior Lecturer, Liverpool John Moores University
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Jiang L, Lofters A, Moineddin R, Decker K, Groome P, Kendell C, Krzyzanowska M, Li D, McBride ML, Mittmann N, Porter G, Turner D, Urquhart R, Winget M, Zhang Y, Grunfeld E. Primary care physician use across the breast cancer care continuum: CanIMPACT study using Canadian administrative data. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2016; 62:e589-e598. [PMID: 27737994 PMCID: PMC5063785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To describe primary care physician (PCP) use and continuity of PCP care across the breast cancer care continuum. DESIGN Population-based, retrospective cohort study using provincial cancer registries linked to health administrative databases. SETTING British Columbia, Manitoba, and Ontario. PARTICIPANTS All women with incident invasive breast cancer from 2007 to 2012 in Manitoba and Ontario and from 2007 to 2011 in British Columbia. MAIN OUTCOME MEASURES The number and proportions of visits to PCPs were determined. Continuity of care was measured using the Usual Provider of Care index calculated as the proportion of visits to the most-often-visited PCP in the 6 to 30 months before a breast cancer diagnosis (baseline) and from 1 to 3 years following a breast cancer diagnosis (survivorship). RESULTS More than three-quarters of patients visited their PCPs 2 or more times during the breast cancer diagnostic period, and more than 80% of patients had at least 1 PCP visit during breast cancer adjuvant treatment. Contact with the PCP decreased over time during breast cancer survivorship. Of the 3 phases, women appeared to be most likely to not have PCP contact during adjuvant treatment, with 10.7% (Ontario) to 18.7% (British Columbia) of women having no PCP visits during this phase. However, a sizable minority of women had at least monthly visits during the treatment phase, particularly in Manitoba and Ontario, where approximately a quarter of women saw a PCP at least monthly. We observed higher continuity of care with PCPs in survivorship (compared with baseline) in all provinces. CONCLUSION Primary care physicians were generally involved throughout the breast cancer care continuum, but the level of involvement varied across care phases and by province. Future interventions will aim to further integrate primary and oncology care.
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Affiliation(s)
- Li Jiang
- Epidemiologist with the Institute for Clinical Evaluative Sciences at Queen's University in Kingston, Ont.
| | - Aisha Lofters
- Assistant Professor and Clinician Scientist in the Department of Family and Community Medicine at the University of Toronto in Ontario
| | - Rahim Moineddin
- Professor and a senior biostatistician in the Department of Family and Community Medicine at the University of Toronto
| | - Kathleen Decker
- Senior epidemiologist in the Epidemiology and Cancer Registry Department at CancerCare Manitoba and Assistant Professor in the Department of Community Health Sciences at the University of Manitoba in Winnipeg
| | - Patti Groome
- Senior scientist in the Division of Cancer Care and Epidemiology at the Queen's Cancer Research Institute and Professor in the Department of Public Health Sciences at Queen's University
| | - Cynthia Kendell
- Doctoral candidate and Project Coordinator with the Cancer Outcomes Research Program at Dalhousie University in Halifax, NS
| | - Monika Krzyzanowska
- Researcher with the University Health Network and Clinical Lead of Quality Care and Access for the Systemic Treatment Program at Cancer Care Ontario in Toronto
| | - Dongdong Li
- Biostatistical research methodologist at the BC Cancer Agency in Vancouver
| | - Mary L McBride
- Distinguished Scientist in Cancer Control Research for the BC Cancer Agency and Clinical Professor in the School of Population and Public Health at the University of British Columbia
| | | | - Geoff Porter
- Professor and Ramia Chair in Surgical Oncology at Dalhousie University
| | - Donna Turner
- Epidemiologist and Provincial Director of the Population Oncology portfolio at CancerCare Manitoba, and Associate Professor in the Department of Community Health Sciences at the University of Manitoba
| | - Robin Urquhart
- Assistant Professor and Ramia Scientist in the Department of Surgery at Dalhousie University
| | - Marcy Winget
- Clinical Associate Professor in the School of Medicine at Stanford University in California
| | - Yang Zhang
- Biostatistical research methodologist at the BC Cancer Agency
| | - Eva Grunfeld
- Giblon Professor and Vice-Chair of Research in the Department of Family and Community Medicine at the University of Toronto and Director of Knowledge Translation Research in the Health Services Research Program at the Ontario Institute for Cancer Research
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Easley J, Miedema B, Carroll JC, O'Brien MA, Manca DP, Grunfeld E. Patients' experiences with continuity of cancer care in Canada: Results from the CanIMPACT study. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2016; 62:821-827. [PMID: 27737982 PMCID: PMC5063773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To explore patient perspectives on and experiences with the coordination and continuity of cancer care. DESIGN Qualitative study using semistructured telephone interviews. SETTING Canada. PARTICIPANTS Thirty-eight breast and colorectal cancer survivors 1 to 4 years after diagnosis. METHODS Using a constructivist grounded theory approach, semistructured telephone interviews were conducted with the participants. The interviews were digitally recorded, transcribed verbatim, and proofread. Transcripts were reviewed to create a focused coding scheme that was used to develop categories for participants' experiences. MAIN FINDINGS Although this study focused on the continuity of cancer care, patients described their experiences with cancer care in general, concentrating predominantly on their relationships with individual health care providers (HCPs). Based on patients' experiences, several themes were identified as the core components of providing good continuity and well coordinated care. The most important overarching theme was communication, which overlapped with 4 other themes: patient-HCP relationships, the role of HCPs, lack of access to care, and timely and tailored information. CONCLUSION Patients believed that good communication between HCPs and patients was key to improving the overall continuity of cancer care. Continuity of care is an important theoretical concept in cancer care, but it is not easily recognized by patients. They perceive the cancer care continuum and continuity of care as cancer care in general, which is typically framed by the individual relationships with their HCPs. Future research and interventions need to focus on finding and testing ways to improve communication to enhance continuity of cancer care.
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Affiliation(s)
- Julie Easley
- Research coordinator at the Dalhousie Family Medicine Teaching Unit in Fredericton, NB
| | - Baukje Miedema
- Professor and Director of Research at the Dalhousie Family Medicine Teaching Unit.
| | - June C Carroll
- Family physician in the Granovsky Gluskin Family Medicine Centre at Mount Sinai Hospital in Toronto, Ont, and Clinician Scientist and Associate Professor in the Department of Family and Community Medicine at the University of Toronto
| | - Mary Ann O'Brien
- Assistant Professor in the Department of Family and Community Medicine at the University of Toronto and Scientific Associate with the Knowledge Translation Research Network, Health Services Research Program, and Ontario Institute for Cancer Research
| | - Donna P Manca
- Clinical Director of the Alberta Family Practice Research Network, Director of the Northern Alberta Primary Care Research Network, and Director of Research in the Department of Family Medicine at the University of Alberta in Edmonton
| | - Eva Grunfeld
- Giblon Professor and Vice-Chair of Research in the Department of Family and Community Medicine at the University of Toronto and Director of Knowledge Translation Research in the Health Services Research Program at the Ontario Institute for Cancer Research
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Raji MY, Chen NW, Raji M, Kuo YF. Factors Associated With Seeking Physician Care by Medicare Beneficiaries Who Receive All Their Primary Care From Nurse Practitioners. J Prim Care Community Health 2016; 7:249-57. [PMID: 27456894 DOI: 10.1177/2150131916659674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND A shortage of primary care physicians has led to the alternative strategy of nurse practitioners (NPs) as primary care providers for the growing elderly population. Many states have implemented policies that allow NPs to practice independently with no physician oversight. Little is known about the continuity of primary care provided by NPs. OBJECTIVE To examine rate and correlates of switching from exclusive NP primary care to receiving some or all primary care from physicians. DESIGN A retrospective cohort study. PARTICIPANTS Medicare beneficiaries (n = 38 618) with diabetes, congestive heart failure, or chronic obstructive pulmonary disease who received all their primary care from NPs in 2007. MAIN MEASURES Multivariable logistic regression model was used to assess patient and disease characteristics associated with switching from sole NP primary care in 2007 to receiving some or all primary care from physicians between 2008 and 2010. RESULTS Of elderly patients receiving all their primary care from NPs in 2007, 53.8% switched to receiving some or all primary care from physicians in 2008-2010. The switching patients had less comorbidity before the switch and were more likely to reside in metropolitan areas, ZIP code areas with high education or states with the most restriction on NP scope of practice. In multivariable analyses, significant predictors of switching included one of the following within 30 days before the switch: emergency room visits (odds ratio [OR] = 1.55, 95% confidence interval [CI] = 1.44-1.68), hospitalization (OR = 1.13, 95% CI = 1.02-1.25), new diagnosis of heart attacks (OR = 5.52, 95% CI = 4.33-7.02), pneumonia (OR = 4.84, 95% CI = 3.71-6.32), atrial fibrillation (OR = 3.99, 95% CI = 2.93-5.44), stroke (OR = 2.94, 95% CI = 2.31-3.74), or cancer (OR = 2.65, 95% CI = 1.94-3.63). CONCLUSIONS About half of Medicare patients under exclusive NP primary care switched to physicians for some or all primary care over a 3-year period. Future study is needed to understand the reasons for switching.
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Affiliation(s)
| | - Nai-Wei Chen
- The University of Texas Medical Branch, Galveston, TX, USA
| | - Mukaila Raji
- The University of Texas Medical Branch, Galveston, TX, USA
| | - Yong-Fang Kuo
- The University of Texas Medical Branch, Galveston, TX, USA
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McCrorie C, Closs SJ, House A, Petty D, Ziegler L, Glidewell L, West R, Foy R. Understanding long-term opioid prescribing for non-cancer pain in primary care: a qualitative study. BMC FAMILY PRACTICE 2015; 16:121. [PMID: 26362559 PMCID: PMC4567803 DOI: 10.1186/s12875-015-0335-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 08/31/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND The place of opioids in the management of chronic, non-cancer pain is limited. Even so their use is escalating, leading to concerns that patients are prescribed strong opioids inappropriately and alternatives to medication are under-used. We aimed to understand the processes which bring about and perpetuate long-term prescribing of opioids for chronic, non-cancer pain. METHODS We held semi-structured interviews with patients and focus groups with general practitioners (GPs). Participants included 23 patients currently prescribed long-term opioids and 15 GPs from Leeds and Bradford, United Kingdom (UK). We used a grounded approach to the analysis of transcripts. RESULTS Patients are driven by the needs for pain relief, explanation, and improvement or maintenance of quality of life. GPs' responses are shaped by how UK general practice is organised, available therapeutic choices and their expertise in managing chronic pain, especially when facing diagnostic uncertainty or when their own approach is at odds with the patient's wishes. Four features of the resulting transaction between patients and doctors influence prescribing: lack of clarity of strategy, including the risk of any plans being subverted by urgent demands; lack of certainty about locus of control in decision-making, especially in relation to prescribing; continuity in the doctor-patient relationship; and mutuality and trust. CONCLUSIONS Problematic prescribing occurs when patients experience repeated consultations that do not meet their needs and GPs feel unable to negotiate alternative approaches to treatment. Therapeutic short-termism is perpetuated by inconsistent clinical encounters and the absence of mutually-agreed formulations of underlying problems and plans of action. Apart from commissioning improved access to appropriate specialist services, general practices should also consider how they manage problematic opioid prescribing and be prepared to set boundaries with patients.
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Affiliation(s)
- Carolyn McCrorie
- Leeds Institute of Health Sciences, Charles Thackrah Building, University of Leeds, 101 Clarendon Road, Leeds, LS2 9LJ, UK.
| | - S José Closs
- School of Healthcare, Baines Wing, University of Leeds, Leeds, LS2 9JT, UK
| | - Allan House
- Leeds Institute of Health Sciences, Charles Thackrah Building, University of Leeds, 101 Clarendon Road, Leeds, LS2 9LJ, UK
| | - Duncan Petty
- Bradford School of Pharmacy, University of Bradford, Richmond Rd, Bradford, Yorkshire, BD7 1DP, UK
| | - Lucy Ziegler
- Leeds Institute of Health Sciences, Charles Thackrah Building, University of Leeds, 101 Clarendon Road, Leeds, LS2 9LJ, UK
| | - Liz Glidewell
- Leeds Institute of Health Sciences, Charles Thackrah Building, University of Leeds, 101 Clarendon Road, Leeds, LS2 9LJ, UK
| | - Robert West
- Leeds Institute of Health Sciences, Charles Thackrah Building, University of Leeds, 101 Clarendon Road, Leeds, LS2 9LJ, UK
| | - Robbie Foy
- Leeds Institute of Health Sciences, Charles Thackrah Building, University of Leeds, 101 Clarendon Road, Leeds, LS2 9LJ, UK
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