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McBride H, Evans S, Pinto A, Daly A, Ashmore C, Ilgaz F, Ford S, Buckley S, MacDonald A. Patient and carer perceptions of video, telephone and in-person clinics for Phenylketonuria (PKU). Orphanet J Rare Dis 2024; 19:303. [PMID: 39164733 PMCID: PMC11337755 DOI: 10.1186/s13023-024-03295-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 07/24/2024] [Indexed: 08/22/2024] Open
Abstract
BACKGROUND In phenylketonuria (PKU), attending multidisciplinary clinic reviews is an important aspect of life-long care. Since the COVID-19 pandemic, video and telephone clinics are used as alternative methods for people with PKU to have contact with their care team. There is limited research concerning patient preference, experience and perceptions of alternative types of clinic review. Individuals from the UK with PKU and their caregivers were invited to complete an online questionnaire, hosted on the National Society for PKU (NSPKU) website and social media platform. RESULTS Data was available from 203 respondents. Forty one per cent of respondents (n = 49/119) preferred in-person clinics; 41% (n = 49) a hybrid of in-person, video and telephone clinics; 9% (n = 11) video clinics only, 6% (n = 7) telephone only and 3% (n = 3) were unsure. The main respondent obstacles to in-person clinics were costs, travel and time, but this was balanced by the benefits of a physical examination and better patient engagement/motivation. Twenty one per cent (n = 36/169) of respondents were uncomfortable with the number of healthcare professionals (HCPs) in a clinic room. Patients were less likely to consult with a doctor on video (64%, n = 91/143) or phone (50%, n = 59/119) reviews compared to in-person (80%, n = 146/183). Issues with video and telephone reviews included the shorter time length of review, distractions, technical issues and poor patient engagement. CONCLUSIONS Online video and telephone clinic platforms were effective in overcoming the challenging circumstances in management, monitoring and treatment of patients with PKU during the COVID-19 pandemic. However, in-person clinics remain the preferred respondent option. It is important that HCPs are flexible, enabling people with PKU a choice of clinic options according to their individual clinical need and circumstances.
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Affiliation(s)
| | - Sharon Evans
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Alex Pinto
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Anne Daly
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Catherine Ashmore
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Fatma Ilgaz
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Hacettepe University, Ankara, 06100, Turkey
| | - Suzanne Ford
- NSPKU National Society for Phenylketonuria, London, UK
- North Bristol NHS Trust, Bristol, UK
| | - Sharon Buckley
- Department of Psychology, Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, 53 Bonsall Street, Manchester, M15 6GX, UK
| | - Anita MacDonald
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.
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Mathews M. Care-seeking experiences of unattached patients in the Canadian health care system: Qualitative study. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2024; 70:396-403. [PMID: 38886083 PMCID: PMC11280697 DOI: 10.46747/cfp.7006396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
OBJECTIVE To understand how lack of attachment to a regular primary care provider influences patients' outlooks on primary care, ability to address their health care needs, and confidence in the health care system. DESIGN Qualitative descriptive study using semistructured interviews. SETTING Canadian provinces of Nova Scotia, Ontario, and Quebec. PARTICIPANTS Patients aged 18 years or older who were unattached or had become attached within 1 year of being interviewed and who resided in the province in which they were interviewed. METHODS Forty-one semistructured interviews were conducted, during which participants were asked to describe how they had become unattached, their searches to find new primary care providers, their perceptions of and experiences with the centralized waiting list in their province, their experiences seeking care while unattached, and the impact of being unattached on their health and on their perceptions of the health care system. Interviews were transcribed and analyzed using a thematic approach. MAIN FINDINGS Two main themes were identified in interviews with unattached or recently attached patients: unmet needs of unattached patients and the impact of being unattached. Patients' perceived benefits of attachment included access to care, longitudinal relationships with health care providers, health history familiarity, and follow-up monitoring and care coordination. Being unattached was associated with negative effects on mental health, poor health outcomes, decreased confidence in the health care system, and greater pre-existing health inequities. CONCLUSION Having a regular primary care provider is essential to having access to high-quality care and other health care services. Attachment also promotes health equity and confidence in the public health care system and has broader system-level, social, and policy implications.
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Affiliation(s)
- Maria Mathews
- Professor in the Department of Family Medicine in the Schulich School of Medicine and Dentistry at Western University in London, Ont
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Carson SL, Hong C, Behforouz H, Chang E, Dixon LZ, Factor D, George SM, Lewis J, Majeno A, Morales M, Porter C, Shah A, Vassar S, Brown AF. Mechanisms for Community Health Worker Action on Patient-, Institutional-, and Community-Level Barriers to Primary Care in a Safety-Net Setting. J Ambul Care Manage 2022; 45:22-35. [PMID: 34812754 PMCID: PMC8622376 DOI: 10.1097/jac.0000000000000405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Medically and socially complex patients disproportionately face barriers to primary care, contributing to health inequities and higher health care costs. This study elicited perspectives on how community health workers (CHWs) act upon barriers to primary care in 5 patient (n = 25) and 3 CHW focus groups (n = 17). Participants described how CHWs acted on patient-level barriers through social support, empowerment, and linkages, and system-level barriers by enhancing care team awareness of patient circumstances, optimizing communication, and advocating for equitable treatment. Limitations existed for influencing entrenched community-level barriers. CHWs, focusing on patient preferences, motivators, and circumstances, intervened on multilevel barriers to primary care, including advocacy for equitable treatment. These mechanisms have implications for existing CHW conceptual models.
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Affiliation(s)
- Savanna L. Carson
- Division of General Internal Medicine & Health Services Research, Department of Medicine, University of California Los Angeles, 1100 Glendon Ave, Suite 1820, Los Angeles, CA, 90095
| | - Clemens Hong
- Los Angeles County, Department of Health Services, 241 N. Figueroa Street Los Angeles, CA 90012
| | - Heidi Behforouz
- Los Angeles County, Department of Health Services, 241 N. Figueroa Street Los Angeles, CA 90012
| | - Emily Chang
- Division of General Internal Medicine & Health Services Research, Department of Medicine, University of California Los Angeles, 1100 Glendon Ave, Suite 1820, Los Angeles, CA, 90095
| | - Lydia Z. Dixon
- Health Science Program, California State University, Channel Islands, 1 University Dr, Camarillo, CA 93012
| | - Diane Factor
- Worker Education & Resource Center, Inc, 1545 Wilshire Blvd #500, Los Angeles, CA 90017
| | - Sheba M. George
- Department of Urban Public Health, Charles R Drew University of Medicine and Science, College of Science and Health, 1731 E 120th St, Los Angeles, CA 90059
| | - Jenebah Lewis
- USC Suzanne Dworak-Peck School of Social Work, 669 W 34th St, Los Angeles, CA 90089
| | - Angelina Majeno
- Department of Psychological Science, University of California Irvine, 510 E Peltason Dr. Irvine, California 92697
| | - Maria Morales
- Division of General Internal Medicine & Health Services Research, Department of Medicine, University of California Los Angeles, 1100 Glendon Ave, Suite 1820, Los Angeles, CA, 90095
| | - Courtney Porter
- Division of General Internal Medicine & Health Services Research, Department of Medicine, University of California Los Angeles, 1100 Glendon Ave, Suite 1820, Los Angeles, CA, 90095
- Worker Education & Resource Center, Inc, 1545 Wilshire Blvd #500, Los Angeles, CA 90017
| | - Ami Shah
- Los Angeles County, Department of Health Services, 241 N. Figueroa Street Los Angeles, CA 90012
| | - Stefanie Vassar
- Division of General Internal Medicine & Health Services Research, Department of Medicine, University of California Los Angeles, 1100 Glendon Ave, Suite 1820, Los Angeles, CA, 90095
- Olive View-UCLA Medical Center, 14445 Olive View Dr, Sylmar, CA 91342
| | - Arleen F. Brown
- Division of General Internal Medicine & Health Services Research, Department of Medicine, University of California Los Angeles, 1100 Glendon Ave, Suite 1820, Los Angeles, CA, 90095
- Olive View-UCLA Medical Center, 14445 Olive View Dr, Sylmar, CA 91342
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