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Yan L, Wu X, Liu L, Wang F, Hu X. A balance of unsafe care incidents and interactive cooperative care: A constructivist grounded theory study of safe care ecosystem for older inpatients. J Clin Nurs 2024. [PMID: 38764238 DOI: 10.1111/jocn.17183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 03/21/2024] [Accepted: 04/07/2024] [Indexed: 05/21/2024]
Abstract
AIMS To explore older inpatients and their caregivers' care experience and how this relates to the gerontology care practice. BACKGROUND Research interest in the conceptualization of safe care for older inpatients was growing, and these studies were predominantly reported from a single or healthcare perspective. There is a shortage of literature on how patients and their caregivers conceptualise safe care. DESIGN Constructivist grounded theory. METHODS Stage 1 included semi-structured interviews with inpatients. Stage 2 included semi-structured interviews with caregivers and six field notes. Purposive and theoretical sampling were used to recruit 61 participants across six healthcare institutions. Data analysis included initial coding, focused coding, and theoretical coding using constant comparative, field notes and memo writing. RESULTS The substantive theory to emerge from the data was A balance of unsafe care incidents and interactive cooperative care. This core concept was informed by four categories: unsafe care incidents, interactive cooperative care, person-centred care, contextual conditions, and one care outcome. The relationships between these categories constituted a balance in which patient-centred care was the core, unsafe care incidents were the barriers, interactive cooperative care was the facilitator, and the result of the balance was the care outcome. The balance constituted a safe care ecosystem under the interaction of contextual conditions. CONCLUSIONS Interactive cooperative care is vital in enabling care stakeholders to reduce unsafe care incidents, which facilitates them in achieving safe care and further constructing a healthy care ecosystem. RELEVANCE TO CLINICAL PRACTICE This theory identifies barriers and facilitators encountered by care stakeholders to cope with everyday problems and guides them in developing personalised care plans to ensure patient safety.
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Affiliation(s)
- Lupei Yan
- Innovation Center of Nursing Research and Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Xiaorong Wu
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li Liu
- Innovation Center of Nursing Research and Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Fang Wang
- Innovation Center of Nursing Research and Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Xiuying Hu
- Innovation Center of Nursing Research and Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
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Ching SM, Cheong AT, Yee A, Thurasamy R, Lim PY, Zarina II, Lee KW, Taher SW, Ramachandran V. Prevalence and factors associated with burnout among healthcare providers in Malaysia: a web-based cross-sectional study. Ir J Med Sci 2024; 193:851-863. [PMID: 37556104 DOI: 10.1007/s11845-023-03483-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/26/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND This study aimed to assess the determinants of burnout among healthcare providers in the primary care setting. METHODS A web-based cross-sectional study was conducted among 1280 healthcare providers aged 18 years and older from 30 primary care clinics in Selangor, Malaysia. In this study, the Copenhagen Burnout Inventory was used to assess burnout. The results were analyzed using multiple logistic regression. RESULTS The prevalence of personal burnout was 41.7%, followed by work-related burnout (32.2%) and client-related burnout (14.5%). The determinants for personal burnout in this study were younger age, being a doctor, higher COVID-19 exposure risk, do not know where to seek help, inability to handle stress, poorer sleep quality score, higher total COVID-19 fear score, higher total stress score, and lower total BRS score. The determinants of work-related burnout were younger age, being a doctor, longer years of working, higher COVID-19 exposure risk, do not know where to seek help, lower altruistic score, poorer sleep quality score, higher total stress score, and lower total brief resilience score (BRS) score. The determinants of client-related burnout were doctor, single/divorced, more than one attachment site, and higher satisfaction toward the infection control, inability to handle stress, higher total depression score, and lower total BRS score. CONCLUSION Every fourth out of ten suffered from personal burnout, one-third from work-related burnout, and one-seventh from client-related burnout among healthcare providers during the COVID-19 pandemic. Healthcare systems must take care of healthcare workers' physical and emotional depletion, reducing the risk of burnout.
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Affiliation(s)
- Siew-Mooi Ching
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Selangor, Serdang, Malaysia.
| | - Ai Theng Cheong
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Selangor, Serdang, Malaysia
| | - Anne Yee
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Ramayah Thurasamy
- School of Management, Universiti Sains Malaysia, 11800, Penang, Minden, Malaysia
| | - Poh Ying Lim
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Selangor, Serdang, Malaysia
| | - Irmi Ismail Zarina
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Selangor, Serdang, Malaysia
| | - Kai Wei Lee
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Selangor, Serdang, Malaysia
| | - Sri Wahyu Taher
- Klinik Kesihatan Simpang Kuala, Ministry of Health Malaysia, Alor Setar Kedah, Malaysia
| | - Vasudevan Ramachandran
- Department of Medical Science, Faculty of Health Sciences, University College of MAIWP International, Taman Batu Muda, 68100, Kuala Lumpur, Batu Caves, Malaysia
- Department of Conservative Dentistry and Endodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
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Madruga Dias J. Ethics and non-evidence based therapies: Portuguese perspective in a global setting. Monash Bioeth Rev 2023; 41:174-180. [PMID: 36586073 PMCID: PMC10654189 DOI: 10.1007/s40592-022-00172-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2022] [Indexed: 01/01/2023]
Abstract
A contemporary serious lack of scientific knowledge by the general public and many decision-makers is now quite perceptible, both globally and in Portugal. Living in a science-driven technological world filled with scientific illiteracy is dangerous and a path toward disaster. Recent years brought a fairly strong global movement promoting the so-called "alternative therapy" that also affected Portugal. I propose an evidence-based ethics reflection and argumentation, both encompassing the global and the specific Portuguese reality. I debate the specific arguments used in favour of alternative therapies, demonstrating the inherent fallacies of thought, deliberate manipulation of words and concepts, and the dire consequences for global and local health politics by following this line of biased reasoning.
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Affiliation(s)
- João Madruga Dias
- Rheumatology Department, Unidade de Torres Novas, Centro Hospitalar do Médio Tejo EPE, R. Xanana Gusmão 45, 2350-754, Torres Novas, Portugal.
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa (NOVA Medical School), Campo Mártires da Pátria 130, 1169-056, Lisbon, Portugal.
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Khatri RB, Wolka E, Nigatu F, Zewdie A, Erku D, Endalamaw A, Assefa Y. People-centred primary health care: a scoping review. BMC PRIMARY CARE 2023; 24:236. [PMID: 37946115 PMCID: PMC10633931 DOI: 10.1186/s12875-023-02194-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/27/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Integrated people-centred health services (IPCHS) are vital for ensuring comprehensive care towards achieving universal health coverage (UHC). The World Health Organisation (WHO) envisions IPCHS in delivery and access to health services. This scoping review aimed to synthesize available evidence on people-centred primary health care (PHC) and primary care. METHODS We conducted a scoping review of published literature on people-centred PHC. We searched eight databases (PubMed, Scopus, Embase, CINAHL, Cochrane, PsycINFO, Web of Science, and Google Scholar) using search terms related to people-centred and integrated PHC/primary care services. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist to select studies. We analyzed data and generated themes using Gale's framework thematic analysis method. Themes were explained under five components of the WHO IPCHS framework. RESULTS A total of fifty-two studies were included in the review; most were from high-income countries (HICs), primarily focusing on patient-centred primary care. Themes under each component of the framework included: engaging and empowering people and communities (engagement of community, empowerment and empathy); strengthening governance and accountability (organizational leadership, and mutual accountability); reorienting the model of care (residential care, care for multimorbidity, participatory care); coordinating services within and across sectors (partnership with stakeholders and sectors, and coordination of care); creating an enabling environment and funding support (flexible management for change; and enabling environment). CONCLUSIONS Several people-centred PHC and primary care approaches are implemented in HICs but have little priority in low-income countries. Potential strategies for people-centred PHC could be engaging end users in delivering integrated care, ensuring accountability, and implementing a residential model of care in coordination with communities. Flexible management options could create an enabling environment for strengthening health systems to deliver people-centred PHC services.
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Affiliation(s)
- Resham B Khatri
- School of Public Health, Faculty of Medicine, the University of Queensland, Brisbane, QLD, Australia.
- Health Social Science and Development Research Institute, Kathmandu, Nepal.
| | - Eskinder Wolka
- International Institute for Primary Health Care-Ethiopia, Addis Ababa, Ethiopia
| | - Frehiwot Nigatu
- International Institute for Primary Health Care-Ethiopia, Addis Ababa, Ethiopia
| | - Anteneh Zewdie
- International Institute for Primary Health Care-Ethiopia, Addis Ababa, Ethiopia
| | - Daniel Erku
- Centre for Applied Health Economics, School of Medicine, Griffith University, Southport, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
| | - Aklilu Endalamaw
- School of Public Health, Faculty of Medicine, the University of Queensland, Brisbane, QLD, Australia
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Yibeltal Assefa
- School of Public Health, Faculty of Medicine, the University of Queensland, Brisbane, QLD, Australia
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Yu C, Xian Y, Jing T, Bai M, Li X, Li J, Liang H, Yu G, Zhang Z. More patient-centered care, better healthcare: the association between patient-centered care and healthcare outcomes in inpatients. Front Public Health 2023; 11:1148277. [PMID: 37927879 PMCID: PMC10620693 DOI: 10.3389/fpubh.2023.1148277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 09/19/2023] [Indexed: 11/07/2023] Open
Abstract
Objective The objective of this study is to explore the association between patient-centered care (PCC) and inpatient healthcare outcomes, including self-reported physical and mental health status, subjective necessity of hospitalization, and physician-induced demand behaviors. Methods A cross-sectional survey was conducted to assess patient-centered care among inpatients in comprehensive hospitals through QR codes after discharge from September 2021 to December 2021 and had 5,222 respondents in Jiayuguan, Gansu. The questionnaire included a translated 6-item version of the PCC questionnaire, physician-induced behaviors, and patients' sociodemographic characteristics including gender, household registration, age, and income. Logistic regression analyses were conducted to assess whether PCC promoted self-reported health, the subjective necessity of hospitalization, and decreased physician-induced demand. The interactions between PCC and household registration were implemented to assess the effect of the difference between adequate and inadequate healthcare resources. Results PCC promoted the patient's self-reported physical (OR = 4.154, p < 0.001) and mental health (OR = 5.642, p < 0.001) and subjective necessity of hospitalization (OR = 6.160, p < 0.001). Meanwhile, PCC reduced physician-induced demand in advising to buy medicines outside (OR = 0.415, p < 0.001), paying at the outpatient clinic (OR =0.349, p < 0.001), issuing unnecessary or repeated prescriptions and medical tests (OR = 0.320, p < 0.001), and requiring discharge and readmitting (OR = 0.389, p < 0.001). Conclusion By improving health outcomes for inpatients and reducing the risk of physician-induced demand, PCC can benefit both patients and health insurance systems. Therefore, PCC should be implemented in healthcare settings.
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Affiliation(s)
- Chenhao Yu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yun Xian
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tiantian Jing
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mayangzong Bai
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xueyuan Li
- Health Commission of Shanghai Huangpu, Shanghai, China
| | - Jiahui Li
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Huigang Liang
- Department of Business and Information Technology, Fogelman College of Business and Economics, University of Memphis, Memphis, TN, United States
| | - Guangjun Yu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- School of Medicine, The Chinese University of Hong Kong, Shenzhen, Guangdong, China
| | - Zhiruo Zhang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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CORÔA ROBERTADECARVALHO, GOGOVOR AMÉDÉ, BEN CHARIF ALI, HASSINE ASMABEN, ZOMAHOUN HERVÉTCHALAVIGNON, MCLEAN ROBERTKD, MILAT ANDREW, PLOURDE KARINEV, RHEAULT NATHALIE, WOLFENDEN LUKE, LÉGARÉ FRANCE. Evidence on Scaling in Health and Social Care: An Umbrella Review. Milbank Q 2023; 101:881-921. [PMID: 37186312 PMCID: PMC10509507 DOI: 10.1111/1468-0009.12649] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 02/03/2023] [Accepted: 03/28/2023] [Indexed: 05/17/2023] Open
Abstract
Policy Points More rigorous methodologies and systematic approaches should be encouraged in the science of scaling. This will help researchers better determine the effectiveness of scaling, guide stakeholders in the scaling process, and ultimately increase the impacts of health innovations. The practice and the science of scaling need to expand worldwide to address complex health conditions such as noncommunicable and chronic diseases. Although most of the scaling experiences described in the literature are occurring in the Global South, most of the authors publishing on it are based in the Global North. As the science of scaling spreads across the world with the aim of reducing health inequities, it is also essential to address the power imbalance in how we do scaling research globally. CONTEXT Scaling of effective innovations in health and social care is essential to increase their impact. We aimed to synthesize the evidence base on scaling and identify current knowledge gaps. METHODS We conducted an umbrella review according to the Joanna Briggs Institute Reviewers' Manual. We included any type of review that 1) focused on scaling, 2) covered health or social care, and 3) presented a methods section. We searched MEDLINE (Ovid), Embase, PsycINFO (Ovid), CINAHL (EBSCO), Web of Science, The Cochrane Library, Sociological Abstracts (ProQuest), Academic Search Premier (EBSCO), and ProQuest Dissertations & Theses Global from their inception to August 6, 2020. We searched the gray literature using, e.g., Google and WHO-ExpandNet. We assessed methodological quality with AMSTAR2. Paired reviewers independently selected and extracted eligible reviews and assessed study quality. A narrative synthesis was performed. FINDINGS Of 24,269 records, 137 unique reviews were included. The quality of the 58 systematic reviews was critically low (n = 42). The most frequent review type was systematic review (n = 58). Most reported on scaling in low- and middle-income countries (n = 59), whereas most first authors were from high-income countries (n = 114). Most reviews concerned infectious diseases (n = 36) or maternal-child health (n = 28). They mainly focused on interventions (n = 37), barriers and facilitators (n = 29), frameworks (n = 24), scalability (n = 24), and costs (n = 14). The WHO/ExpandNet scaling definition was the definition most frequently used (n = 26). Domains most reported as influencing scaling success were building scaling infrastructure (e.g., creating new service sites) and human resources (e.g., training community health care providers). CONCLUSIONS The evidence base on scaling is evolving rapidly as reflected by publication trends, the range of focus areas, and diversity of scaling definitions. Our study highlights knowledge gaps around methodology and research infrastructures to facilitate equitable North-South research relationships. Common efforts are needed to ensure scaling expands the impacts of health and social innovations to broader populations.
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Affiliation(s)
- ROBERTA DE CARVALHO CORÔA
- VITAM ‐ Centre de recherche en santé durableCentre intégré universitaire de santé et services sociaux de la Capitale‐Nationale
- Unité de soutien au système de santé apprenant Québec
- Faculty of MedicineUniversité Laval
| | - AMÉDÉ GOGOVOR
- VITAM ‐ Centre de recherche en santé durableCentre intégré universitaire de santé et services sociaux de la Capitale‐Nationale
- Unité de soutien au système de santé apprenant Québec
- Faculty of MedicineUniversité Laval
| | | | - ASMA BEN HASSINE
- VITAM ‐ Centre de recherche en santé durableCentre intégré universitaire de santé et services sociaux de la Capitale‐Nationale
- Faculty of NursingUniversité Laval
| | - HERVÉ TCHALA VIGNON ZOMAHOUN
- Faculty of MedicineUniversité Laval
- School of Physical and Occupational TherapyFaculty of Medicine and Health Sciences, McGill University
| | - ROBERT K. D. MCLEAN
- International Development Research Centre
- Faculty of Medicine and Health SciencesStellenbosch University
| | - ANDREW MILAT
- School of Public HealthUniversity of Sydney
- Centre for Epidemiology and EvidenceNSW Ministry of Health
| | - KARINE V. PLOURDE
- VITAM ‐ Centre de recherche en santé durableCentre intégré universitaire de santé et services sociaux de la Capitale‐Nationale
| | - NATHALIE RHEAULT
- VITAM ‐ Centre de recherche en santé durableCentre intégré universitaire de santé et services sociaux de la Capitale‐Nationale
- Unité de soutien au système de santé apprenant Québec
| | - LUKE WOLFENDEN
- School of Medicine and Public HealthUniversity of Newcastle
- National Centre of Implementation ScienceUniversity of Newcastle
- Hunter New England Population Health
| | - FRANCE LÉGARÉ
- VITAM ‐ Centre de recherche en santé durableCentre intégré universitaire de santé et services sociaux de la Capitale‐Nationale
- Unité de soutien au système de santé apprenant Québec
- Faculty of MedicineUniversité Laval
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Abstract
Perioperative medicine remains an evolving, interdisciplinary subspecialty, which encompasses the unique perspectives and incorporates the respective vital expertise of numerous stakeholders. This integrated model of perioperative medicine and care has a wide-ranging set of clinical, strategic, and operational goals. Among these various programmatic goals, a subset of 4, specific, interdependent goals include (1) enhancing patient-centered care, (2) embracing shared decision-making, (3) optimizing health literacy, and (4) avoiding futile surgery. Achieving and sustaining this subset of 4 goals requires continued innovative approaches to perioperative care. The burgeoning field of narrative medicine represents 1 such innovative approach to perioperative care. Narrative medicine is considered the most prominent recent development in the medical humanities. Its central tenet is that attention to narrative-in the form of the patient's story, the clinician's story, or a story constructed together by the patient and clinician-is essential for optimal patient care. If we can view the health care experience through the patient's eyes, we will become more responsive to patients' needs and, thereby, better clinicians. There is a potential clinical nexus between the perioperative medicine practice and narrative medicine skills, which, if capitalized, can maximize perioperative patient care. There are a number of untapped educational and research opportunities in this fruitful nexus between perioperative medicine and narrative medicine.
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Affiliation(s)
- Thomas R Vetter
- From the Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, Texas
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Almunawar MN, Anshari M, Rosdi NBDM, Kisa A, Younis M. Reconsidering Patient Value to Create Better Healthcare. JOURNAL OF HEALTH MANAGEMENT 2023. [DOI: 10.1177/09720634231153721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
Healthcare can be seen as a value shop, in which solutions to health problems are offered in exchange for valuable contributions. However, the full value exchange between the healthcare provider and the patient is not always apparent. The value shop concept runs the risk of considering only what the patient pays (i.e., money, either paid by the patient or reimbursed by the government) while ignoring another important value, data. Yet without this data, the patient’s problem cannot be solved. This article offers a new paradigm in which a health provider can deliver better value by integrating all dimensions of the provider’s and patient’s value.
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Affiliation(s)
| | - Muhammad Anshari
- UBD School of Business and Economics, Universiti Brunei Darussalam, Brunei
| | | | - Adnan Kisa
- School of Health Sciences, Kristiania University College, Oslo, Norway
| | - Mustafa Younis
- School of Public Health, Jackson State University, Jackson, MS, USA
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Gilkey MB, Cripps LA, Przywara KM, Batista MI, Galbraith AA. Strategies commercially-insured families use to manage the cost of asthma care: a qualitative interview study. J Asthma 2023; 60:96-104. [PMID: 35037558 DOI: 10.1080/02770903.2022.2030749] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Families affected by asthma report difficulty adhering to care regimens because of high medication costs, coupled with increased cost sharing required by some insurance plans. To inform efforts to support adherence, we conducted a qualitative study to explore how families manage asthma care costs. METHODS We conducted phone interviews with commercially-insured, US adults (n = 59) who had asthma and/or a child with asthma. Our purposive sample included participants with high- and low/no-deductible health plans. We analyzed data using thematic content analysis to identify strategies for managing asthma care costs and to assess strategies' implications for adherence. RESULTS Our analysis identified four overarching strategies for managing asthma care costs. First, participants used prevention strategies to avoid costly acute care by minimizing exposure to asthma triggers and adhering strictly to preventive medication regimens. Second, participants used shopping strategies to reduce costs, including by comparing medication prices across pharmacies, using medication coupons or free samples, and switching to lower-cost medications. Third, budgeting strategies involved putting aside funds, including in tax-exempt health savings accounts, or taking on debt to pay for care. Finally, some participants sought to reduce costs by forgoing recommended care, including by skipping medication doses or replacing prescribed medications with alternative therapies. CONCLUSION Commercially-insured families use a wide range of strategies to manage asthma care costs, with both positive and negative implications for adherence. Our typology of asthma cost management strategies can inform insurance redesign and other interventions to help families safely reduce costs and maximize adherence to recommended care.
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Affiliation(s)
- Melissa B Gilkey
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Lauren A Cripps
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA
| | | | - Mikaela I Batista
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA
| | - Alison A Galbraith
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA
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Giusti M, Cosma C, Simoni S, Persiani N. The Contribution of Cultural Heritage Owned by Local Health Authorities in the Humanization of Care: The Point of View of Top Management. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16632. [PMID: 36554513 PMCID: PMC9779731 DOI: 10.3390/ijerph192416632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/07/2022] [Accepted: 12/09/2022] [Indexed: 06/17/2023]
Abstract
After the COVID-19 pandemic, reforms in healthcare systems have the purpose to fully recover the relationship of healthcare organizations with their patients. For centuries, art was used throughout Europe in the healthcare context for its power to engage and support patients in their illnesses. This approach can be rediscovered by utilizing the cultural heritage owned by Local Health Authorities. In this context, tradition, art, innovation, and care coexist. This study aims to investigate the interest in developing projects for the humanization of care by the top management of Italian Local Health Authorities, in particular exploiting their cultural heritage. The evaluation of the proposal was conducted using semi-structured interviews with the top management of two Local Health Authorities, in which the Santa Maria Nuova hospital in Florence and the Santo Spirito in Sassia Hospital in Rome are located, as the two selected cases for this study. The interviewees welcomed the proposal to develop humanization of care projects involving the use of their cultural heritage. Moreover, they expressed their desire to invest human, economic, and structural resources in the development of these initiatives. The implementation of humanization of care projects using cultural heritage owned by Local Health Authorities is useful to apply specific policies to enhance the governance of the cultural heritage according to the health mission. On the other hand, it permits the search for additional or ad hoc resources. Finally, it is possible to humanize and improve patients' experience while increasing awareness among the health workforce and trainees.
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Affiliation(s)
- Martina Giusti
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
| | - Claudia Cosma
- Department of Health Science, University of Florence, 50134 Florence, Italy
| | - Stefania Simoni
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
| | - Niccolò Persiani
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
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Deveau N, Washington P, Leblanc E, Husic A, Dunlap K, Penev Y, Kline A, Mutlu OC, Wall DP. Machine learning models using mobile game play accurately classify children with autism. INTELLIGENCE-BASED MEDICINE 2022; 6:100057. [PMID: 36035501 PMCID: PMC9398788 DOI: 10.1016/j.ibmed.2022.100057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/10/2022] [Accepted: 03/29/2022] [Indexed: 11/23/2022]
Abstract
Digitally-delivered healthcare is well suited to address current inequities in the delivery of care due to barriers of access to healthcare facilities. As the COVID-19 pandemic phases out, we have a unique opportunity to capitalize on the current familiarity with telemedicine approaches and continue to advocate for mainstream adoption of remote care delivery. In this paper, we specifically focus on the ability of GuessWhat? a smartphone-based charades-style gamified therapeutic intervention for autism spectrum disorder (ASD) to generate a signal that distinguishes children with ASD from neurotypical (NT) children. We demonstrate the feasibility of using "in-the-wild", naturalistic gameplay data to distinguish between ASD and NT by children by training a random forest classifier to discern the two classes (AU-ROC = 0.745, recall = 0.769). This performance demonstrates the potential for GuessWhat? to facilitate screening for ASD in historically difficult-to-reach communities. To further examine this potential, future work should expand the size of the training sample and interrogate differences in predictive ability by demographic.
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Affiliation(s)
- Nicholas Deveau
- Biomedical Data Science, Stanford University, Stanford, 94305, California, United States
| | - Peter Washington
- Bioengineering, Stanford University, Stanford, 94305, California, United States
| | - Emilie Leblanc
- Pediatrics, Stanford University, Stanford, 94305, California, United States
| | - Arman Husic
- Pediatrics, Stanford University, Stanford, 94305, California, United States
| | - Kaitlyn Dunlap
- Pediatrics, Stanford University, Stanford, 94305, California, United States
| | - Yordan Penev
- Pediatrics, Stanford University, Stanford, 94305, California, United States
| | - Aaron Kline
- Pediatrics, Stanford University, Stanford, 94305, California, United States
| | - Onur Cezmi Mutlu
- Electrical Engineering, Stanford University, Stanford, 94305, California, United States
| | - Dennis P Wall
- Biomedical Data Science, Stanford University, Stanford, 94305, California, United States
- Pediatrics, Stanford University, Stanford, 94305, California, United States
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Kwakkenbos L, Carrier ME, Welling J, Turner KA, Cumin J, Pépin M, van den Ende C, Schouffoer AA, Hudson M, van Breda W, Sauve M, Mayes MD, Malcarne VL, Nielson WR, Nguyen C, Boutron I, Rannou F, Thombs BD, Mouthon L. Randomized feasibility trial of the Scleroderma Patient-centered Intervention Network hand exercise program (SPIN-HAND). PeerJ 2022; 10:e13471. [PMID: 35945943 PMCID: PMC9357372 DOI: 10.7717/peerj.13471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 04/29/2022] [Indexed: 01/20/2023] Open
Abstract
Purpose The Scleroderma Patient-centered Intervention Network (SPIN) online hand exercise program (SPIN-HAND), is an online self-help program of hand exercises designed to improve hand function for people with scleroderma. The objective of this feasibility trial was to evaluate aspects of feasibility for conducting a full-scale randomized controlled trial of the SPIN-HAND program. Materials and Methods The feasibility trial was embedded in the SPIN cohort and utilized the cohort multiple randomized controlled trial (cmRCT) design. In the cmRCT design, at the time of cohort enrollment, cohort participants consent to be assessed for trial eligibility and randomized prior to being informed about trials conducted using the cohort. When trials were conducted in the cohort, participants randomized to the intervention were informed and consented to access the intervention. Participants randomized to control were not informed that they have not received an intervention. All participants eligible and randomized to participate in the trial were included in analyses on an intent-to-treat basis. Cohort participants with a Cochin Hand Function Scale score ≥ 3/90 and an interest in using an online hand-exercise intervention were randomized (1:1 ratio) to be offered as usual care plus the SPIN-HAND Program or usual care for 3 months. User satisfaction was assessed with semi-structured interviews. Results Of the 40 randomized participants, 24 were allocated to SPIN-HAND and 16 to usual care. Of 24 participants randomized to be offered SPIN-HAND, 15 (63%) consented to use the program. Usage of SPIN-HAND content among the 15 participants who consented to use the program was low; only five (33%) logged in more than twice. Participants found the content relevant and easy to understand (satisfaction rating 8.5/10, N = 6). Automated eligibility and randomization procedures via the SPIN Cohort platform functioned properly. The required technical support was minimal. Conclusions Trial methodology functioned as designed, and the SPIN-HAND Program was feasibly delivered; however, the acceptance of the offer and use of program content among accepters were low. Adjustments to information provided to potential participants will be implemented in the full-scale SPIN-HAND trial to attempt to increase offer acceptance.
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Affiliation(s)
| | - Marie-Eve Carrier
- Lady Davis Institute of the Jewish General Hospital, Montreal, Canada
| | - Joep Welling
- NVLE Dutch patient organization for systemic autoimmune diseases, Utrecht, The Netherlands
| | | | - Julie Cumin
- Lady Davis Institute of the Jewish General Hospital, Montreal, Canada
| | - Mia Pépin
- Lady Davis Institute of the Jewish General Hospital, Montreal, Canada
| | | | - Anne A. Schouffoer
- Leiden University Medical Center, Leiden, The Netherlands,Haga Teaching Hospital, The Hague, The Netherlands
| | - Marie Hudson
- Lady Davis Institute of the Jewish General Hospital, Montreal, Canada,Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Ward van Breda
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands
| | - Maureen Sauve
- Scleroderma Society of Ontario, Hamilton, Ontario, Canada,Scleroderma Canada, Ottawa, Ontario, Canada
| | - Maureen D. Mayes
- University of Texas McGovern School of Medicine, Houston, Texas, United States of America
| | | | | | | | - Isabelle Boutron
- Centre d’Épidémiologie Clinique, Assistance Publique–Hôpitaux de Paris (AP-HP), Hôpital Hôtel Dieu, Paris, France,Centre of Research Epidemiology and Statistics (CRESS), Inserm, INRA, Université de Paris, Paris, France
| | - François Rannou
- Université de Paris, Paris, France,Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Brett D. Thombs
- Lady Davis Institute of the Jewish General Hospital, Montreal, Canada,Department of Medicine, McGill University, Montreal, Quebec, Canada,Department of Psychiatry, McGill University, Montreal, Quebec, Canada,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada,Department of Psychology, McGill University, Montreal, Quebec, Canada,Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada
| | - Luc Mouthon
- Service de Médecine Interne, Centre de Référence Maladies Autoimmunes Systémiques Rares d’Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France,APHP-CUP, Hôpital Cochin, Paris, France
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13
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Towle S. 'Poorly relaxed women': A situational analysis of pelvic examination learning materials for medical students. MEDICAL EDUCATION 2022; 56:716-723. [PMID: 35086164 DOI: 10.1111/medu.14737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 01/04/2022] [Accepted: 01/17/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Certain clinical pelvic examination (PE) teaching methods have been critiqued for prioritising student learning over patient autonomy and for not accurately representing diverse patient communities. As such, patient-centred and culturally competent approaches to the PE may need further emphasis in the medical curriculum-in particular, in content delivered to students before patient interaction. Classroom materials serve as students' first exposure to the sensitive procedure. This research explores how patients are represented in these materials. METHODS A situational analysis was conducted on 10 purposively sampled PE learning materials for the 2019/20 academic year from five undergraduate medical schools in Canada. Situational analysis focuses on analysing discourse but is epistemically aligned with post-structuralism (most notably Foucault's theories involving discursive power) and allows for specific consideration of 'silences' in the data. Collected data were analysed using cartographic approaches according to this methodology, with particular attention paid to the tenets and frameworks of patient-centred and culturally competent care. RESULTS Overall, content in these materials misrepresented and under-represented patients. Materials contained both outdated and unnecessarily sexualised language, in addition to a lack of patient diversity. Clinical authority was often centred over patient agency, and several updated PE techniques known to improve patient experience were absent. Patient-centred and culturally competent approaches were therefore inadequately highlighted in most of the materials. CONCLUSIONS Depictions contained in these materials may be perpetuating stereotypes and biases in medicine and may be working to maintain teaching practices that cause harm to patients (standardised and regular) who students interact with in both clinical and educational settings. Efforts may be needed to improve classroom materials on the PE so that they more adequately centre patients and provide opportunities to discuss culturally competent approaches to the procedure that (i) may not be covered in other parts of the PE curriculum and (ii) can reduce known health disparities.
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Affiliation(s)
- Sarah Towle
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
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14
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Ghosh K, Dohan MS, Veldandi H, Garfield M. Digital Transformation in Healthcare: Insights on Value Creation. JOURNAL OF COMPUTER INFORMATION SYSTEMS 2022. [DOI: 10.1080/08874417.2022.2070798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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15
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Patient-provider therapeutic connections to improve health care: Conceptual development and systematic review of patient measures. Health Care Manage Rev 2022; 47:317-329. [PMID: 35170483 DOI: 10.1097/hmr.0000000000000339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Triple Aim (improved population health, improved patient experiences, and lower costs) has influenced U.S. health care since it was introduced in 2008. With it, value-based purchasing has brought unprecedented focus on patient experience measurement. Despite having devoted extensive resources toward improving patient experiences, inconsistent improvements suggest there are some dimensions not yet being widely measured or addressed. Furthermore, a renewed focus on health disparities calls for stronger patient-provider connections in order to reduce health care inequities. PURPOSE The aim of this study was to articulate the concept of therapeutic connections (TCs) in health care and examine existing survey measures, from the patient perspective, to learn whether they capture the TC construct. METHOD We interviewed subject matter experts (n = 24) and patients (n = 22) about measuring TCs and then conducted a systematic review of quantitative measures from three databases using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) criteria. RESULTS Of 31 unique measures, none captured all of the theorized TC dimensions. Most were measures of collaboration and shared decision-making or caring. DISCUSSION Focusing on the nature of patient-provider connections is vital because they are the backbone of most delivery models seeking to achieve the Triple Aim. Further development of the TC concept and measures is warranted to facilitate organizational and financing policies that meaningfully support widespread improvement. PRACTICE IMPLICATIONS A focus on barriers and facilitators of TCs is needed. Without advancing our understanding of the role TCs play in care, policymakers and practitioners will be limited in their ability to make impactful changes.
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Soon YE, Murray CM, Aguilar A, Boshoff K. Describing consumer involvement, recruitment, retention in Australian occupational therapy university education: A cross sectional survey. Br J Occup Ther 2022. [DOI: 10.1177/03080226211064475] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Consumer involvement in occupational therapy programmes is one of the accreditation requirements of the Occupational Therapy Council in Australia. Consumers are direct recipients of occupational therapy services. Current knowledge about consumer involvement within occupational therapy education is minimal and mostly in mental health. This study identifies the trends for involvement and methods for recruitment and retention of consumers in Australian occupational therapy university education programmes. Methods Twenty-one occupational therapy programme directors in Australian universities were directly invited by email to participate in an online questionnaire. Prior to distribution, the questionnaire was piloted and the content validity tested. Analysis of closed-ended questions occurred using frequencies and percentages and content analysis occurred with open-text responses. Results Nine programme directors completed the questionnaire. Consumers were mainly involved in delivering lectures, sharing stories and having discussions in small groups. Consumers were recruited to programmes through collaboration with organisations and/or by direct approach. The main retention strategies included employing consumers as university educators and providing support before/during involvement. Conclusion Consumer involvement in curricula addresses university programme requirements and aims to prepare students for consumer-focussed practice. The findings inform educators about diverse ways of recruiting, retaining and involving consumers in their programmes.
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Affiliation(s)
| | - Carolyn M Murray
- Allied Health and Human Performance Academic Unit, International Centre for Allied Health Evidence, University of South Australia, Adelaide, SA, Australia
| | - Alejandra Aguilar
- Allied Health and Human Performance Academic Unit, International Centre for Allied Health Evidence, University of South Australia, Adelaide, SA, Australia
| | - Kobie Boshoff
- Allied Health and Human Performance Academic Unit, International Centre for Allied Health Evidence, University of South Australia, Adelaide, SA, Australia
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Abujaber AA, Nashwan AJ, Fadlalla A. Enabling the adoption of machine learning in clinical decision support: A Total Interpretive Structural Modeling Approach. INFORMATICS IN MEDICINE UNLOCKED 2022. [DOI: 10.1016/j.imu.2022.101090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Patel KN, Mazurenko O, Ford E. Analysis of Hospital Quality Measures and Web-Based Chargemasters, 2019: Cross-sectional Study. JMIR Form Res 2021; 5:e26887. [PMID: 34420914 PMCID: PMC8414290 DOI: 10.2196/26887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 04/21/2021] [Accepted: 05/31/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The federal health care price transparency regulation from 2019 is aimed at bending the health care cost curve by increasing the availability of hospital pricing information for the public. OBJECTIVE This study aims to examine the associations between publicly reported diagnosis-related group chargemaster prices on the internet and quality measures, process indicators, and patient-reported experience measures. METHODS In this cross-sectional study, we collected and analyzed a random 5.02% (212/4221) stratified sample of US hospital prices in 2019 using descriptive statistics and multivariate analysis. RESULTS We found extreme price variation in shoppable services and significantly greater price variation for medical versus surgical services (P=.006). In addition, we found that quality indicators were positively associated with standard charges, such as mortality (β=.929; P<.001) and readmissions (β=.514; P<.001). Other quality indicators, such as the effectiveness of care (β=-.919; P<.001), efficient use of medical imaging (β=-.458; P=.001), and patient recommendation scores (β=-.414; P<.001), were negatively associated with standard charges. CONCLUSIONS We found that hospital chargemasters display wide variations in prices for medical services and procedures and match variations in quality measures. Further work is required to investigate 100% of US hospital prices posted publicly on the internet and their relationship with quality measures.
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Affiliation(s)
- Kunal N Patel
- Northern Illinois University, DeKalb, IL, United States
| | | | - Eric Ford
- University of Alabama at Birmingham, Birmingham, AL, United States
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19
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Andersen-Hollekim T, Melby L, Sand K, Gilstad H, Das A, Solbjør M. Shared decision-making in standardized cancer patient pathways in Norway-Narratives of patient experiences. Health Expect 2021; 24:1780-1789. [PMID: 34289215 PMCID: PMC8483187 DOI: 10.1111/hex.13317] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 06/07/2021] [Accepted: 07/01/2021] [Indexed: 11/29/2022] Open
Abstract
Background Cancer patient pathways (CPPs) were implemented in Norway in 2015–2017 to advance cancer diagnostics and treatment initiation. The aim of CPPs is to ensure standardized waiting times, but also to strengthen patient participation and shared decision‐making. This study investigates how patients enrolled in a CPP experienced shared decision‐making. Methods This study comprised of 19 individual semistructured interviews with patients who had been enrolled in a CPP at three hospitals in Norway. Twelve patients had breast cancer, four patients had prostate cancer and three patients had malignant melanoma. We analyzed their experiences using a narrative approach. Findings This study showed how participating in a standardized CPP provided different possibilities for shared decision‐making. The patients' narratives of shared decision‐making in CPPs included stories from the three cancer diagnoses through the following themes: (1) The predictable safeness of standardizations, (2) the ambivalence of making decisions and (3) opposing standardizations and pushing for action. Conclusion Standardized CPPs provided patients with predictability and safety. Shared decision‐making was possible when the cancer diagnoses supported preference‐sensitive treatment options. Balancing standardizations with individualized care is necessary to facilitate patient participation in CPPs, and the possibility of shared decision‐making needs to be discussed for each specific CPP. Patient or Public Contribution A service user representative from the Norwegian Cancer Society participated in designing this study.
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Affiliation(s)
- Tone Andersen-Hollekim
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway
| | - Line Melby
- Department of Health Research, SINTEF Digital, SINTEF, Trondheim, Norway
| | - Kari Sand
- Department of Health Research, SINTEF Digital, SINTEF, Trondheim, Norway
| | - Heidi Gilstad
- Centre for Academic and Professional Communication, Department of Language and Literature, NTNU, Trondheim, Norway
| | - Anita Das
- Department of Health Research, SINTEF Digital, SINTEF, Trondheim, Norway
| | - Marit Solbjør
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway
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Iliffe S, Manthorpe J. Medical consumerism in the UK, from 'citizen's challenge' to the 'managed consumer'-A symbol without meaning? Health Expect 2021; 24:182-187. [PMID: 33477206 PMCID: PMC8077128 DOI: 10.1111/hex.13197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/27/2020] [Accepted: 12/31/2020] [Indexed: 12/18/2022] Open
Abstract
Background In Britain's National Health Service (NHS), medical consumerism is disliked by many doctors but managed by NHS leaders. Managed consumers have choices about treatment options, but are expected to help contain costs, improve quality of care, take part in clinical research and advocacy, and increase productivity. There are so many meanings for medical consumerism that it can be categorized, in post‐structuralist terms, as a ‘symbol without meaning’, but meanings are plentiful in the NHS. Policy expectations Choices made by discriminating consumers were expected to improve the quality of medical care for all. Extending choice to the many, and not restricting options to the few, would allow gains from choices to accumulate, so that choice would sustain social solidarity. Managed consumerism would in theory, therefore, instil reasonable choices and responsible behaviours in a moralized citizenry, across the nation. The advocates of New Labour's espousal of medical consumerism expected the accumulative effects of customer choices to challenge professional and occupational power, erode the medical model of health and illness, constrain professional judgements, and open the NHS to new ways of working. Almost all their expectations have been thwarted, so far. Conclusions Managed consumerism is far from being a meaningless symbol. This discussion paper explores the territory of managed consumerism and suggests realistic ways to make it more effective in shaping the NHS. Patient & Public Contribution We developed the arguments in this discussion paper with insights provided by a lay expert (see Acknowledgements) with experience of consumerism in both public sector management and a disease‐related charity.
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Affiliation(s)
- Steve Iliffe
- Research Department of Primary Care & Population Health, University College London, London, UK
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Information or Habit: What Health Policy Makers Should Know about the Drivers of Self-Medication among Romanians. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020689. [PMID: 33466957 PMCID: PMC7830883 DOI: 10.3390/ijerph18020689] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/28/2020] [Accepted: 01/09/2021] [Indexed: 02/06/2023]
Abstract
We use the Knowledge, Perceptions and Practices framework to analyze determinants of three types of self-medication practices in Romania: (1) self-medication in the case of cold/flu/viral infections; (2) taking non-prescribed medicine in general; and (3) self-medication based on recommendations by others. We analyzed 706 responses to an online survey and used a factor-based Partial Least Squares algorithm (PLSF) to estimate the relationships between each type of self-medication and possible predictors. Our results show that self–medication is strongly predicted by non-cognitive behavioral factors such as habits and similarity of symptoms, while cognitive determinants such as knowledge and understanding of potential risks are not significantly associated with self-medication behaviors. This paper identifies nonlinear relationships among self-medication practices and its predictors and discusses how our results can help policymakers calibrate interventions with better accuracy.
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Tran BQ. Strategies for effective patient care: Integrating quality communication with the patient‐centered approach. SOCIAL AND PERSONALITY PSYCHOLOGY COMPASS 2020. [DOI: 10.1111/spc3.12574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Brandon Q. Tran
- Department of Psychology University of California Riverside California USA
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Iliffe S, Manthorpe J. Medical consumerism and the modern patient: successful ageing, self-management and the 'fantastic prosumer'. J R Soc Med 2020; 113:339-345. [PMID: 32910877 PMCID: PMC7488811 DOI: 10.1177/0141076820911574] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Steve Iliffe
- Research Department of Primary Care & Population Health, University College London, London NW3 2PF, UK
| | - Jill Manthorpe
- NIHR Policy Research Unit on Health & Social Care Workforce, King's College London, London WC2B 6LE, UK
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Whose experience is it anyway? Toward a constructive engagement of tensions in patient-centered health care. JOURNAL OF SERVICE MANAGEMENT 2020. [DOI: 10.1108/josm-04-2020-0095] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeHealthcare delivery faces increasing pressure to move from a provider-centered approach to become more consumer-driven and patient-centered. However, many of the actions taken by clinicians, patients and organizations fail to achieve that aim. This paper aims to take a paradox-based perspective to explore five specific tensions that emerge from this shift and provides implications for patient experience research and practice.Design/methodology/approachThis paper uses a conceptual approach that synthesizes literature in health services and administration, organizational behavior, services marketing and management and service operations to illuminate five patient experience tensions and explore mitigation strategies.FindingsThe paper makes three key contributions. First, it identifies five tensions that result from the shift to more patient-centered care: patient focus vs employee focus, provider incentives vs provider motivations, care customization vs standardization, patient workload vs organizational workload and service recovery vs organizational risk. Second, it highlights multiple theories that provide insight into the existence of the tensions and how they may be navigated. Third, specific organizational practices that engage the tensions and associated examples of leading organizations are identified. Relevant measures for research and practice are also suggested.Originality/valueThe authors develop a novel analysis of five persistent tensions facing healthcare organizations as a result of a shift to a more consumer-driven, patient-centered approach to care. The authors detail each tension, discuss an existing theory from organizational behavior or services marketing that helps make sense of the tension, suggest potential solutions for managing or resolving the tension and provide representative case illustrations and useful measures.
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Romeyke T, Noehammer E, Stummer H. Patient-Reported Outcomes Following Inpatient Multimodal Treatment Approach in Chronic Pain-Related Rheumatic Diseases. Glob Adv Health Med 2020; 9:2164956120948811. [PMID: 32913669 PMCID: PMC7444101 DOI: 10.1177/2164956120948811] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 07/06/2020] [Accepted: 07/20/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction Musculoskeletal disorders may cause chronic pain, which is associated with deterioration in physical well-being, functions, and quality of life. There are worldwide shortfalls in the care that is provided to the affected patients. Holistic, interdisciplinary care is rare. Monomodal therapeutic approaches dominate when health-care resources are scarce. In this study, we test the patient-relevant outcomes of multimodal treatment for rheumatic diseases that are associated with pain and check for remuneration. Methods We performed a retrospective data analysis of an inpatient multimodal treatment. The target parameter was the patient perspective, which we assessed by means of Patient-Reported Outcomes (PRO). We applied the Visual Analogue Scale (mental and physical condition), the Heidelberg Short Early Risk Assessment Questionnaire, the Pain Disability Index, and the pain grading according to Kohlmann/Raspe (N = 375 patients). We also investigated compensation for inpatient treatments with and without multimodal treatments. Moreover, we compared Diagnosis-Related Group remuneration with and without complex treatment. Results After implementing a multimodal treatment, improved mental (mood) status was significantly better (Wilcoxon signed-rank test, P < . 001), despite high levels of pain (Kohlmann/Raspe) reported on admission. Apart from the underlying rheumatic disease, 111 patients also reported chronic back pain, which was improved following the treatment (t test, P < . 001). Subjective impairments associated with pain were significantly lower at the end of the hospital stay (Wilcoxon signed-rank test, P < . 001). Compensation for inpatient treatments with multimodal treatments increased noticeably in German hospitals in 2016 to 2019, while remunerations for monomodal treatments show mixed results. Conclusion PROs regarding mood, pain, and perceived impairments improved following the multimodal complex treatment. Compensation of hospitals should take into account additional performance requirements of holistic treatments, whereby the promotion and further studies of PROs are recommended.
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Affiliation(s)
- Tobias Romeyke
- Institute for Management and Economics in Health Care, UMIT-Private University of Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria.,Waldhausklinik, Acute Hospital for Internal Medicine, Pain Therapy, Complementary and Individualized Patient Centred Medicine, Deuringen, Germany
| | - Elisabeth Noehammer
- Institute for Management and Economics in Health Care, UMIT-Private University of Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Harald Stummer
- Institute for Management and Economics in Health Care, UMIT-Private University of Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
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Abstract
BACKGROUND Patient utilization of public reporting has been suboptimal despite attempts to encourage use. Lack of utilization may be due to discordance between reported metrics and what patients want to know when making health care choices. OBJECTIVE The objective of this study was to identify measures of quality that individuals want to be presented in public reporting and explore factors associated with researching health care. RESEARCH DESIGN Patient interviews and focus groups were conducted to develop a survey exploring the relative importance of various health care measures. SUBJECTS Interviews and focus groups conducted at local outpatient clinics. A survey administered nationally on an anonymous digital platform. MEASURES Likert scale responses were compared using tests of central tendency. Rank-order responses were compared using analysis of variance testing. Associations with binary outcomes were analyzed using multivariable logistic regression. RESULTS Overall, 4672 responses were received (42.0% response rate). Census balancing yielded 2004 surveys for analysis. Measures identified as most important were hospital reputation (considered important by 61.9%), physician experience (51.5%), and primary care recommendations (43.2%). Unimportant factors included guideline adherence (17.6%) and hospital academic affiliation (13.3%, P<0.001 for all compared with most important factors). Morbidity and mortality outcome measures were not among the most important factors. Patients were unlikely to rank outcome measures as the most important factors in choosing health care providers, irrespective of age, sex, educational status, or income. CONCLUSIONS Patients valued hospital reputation, physician experience, and primary care recommendations while publicly reported metrics like patient outcomes were less important. Public quality reports contain information that patients perceive to be of relatively low value, which may contribute to low utilization.
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Benatar S, Daneman D. Disconnections between medical education and medical practice: A neglected dilemma. Glob Public Health 2020; 15:1292-1307. [PMID: 32320350 DOI: 10.1080/17441692.2020.1756376] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Medical practice has changed profoundly over the past 60 years. Many changes have also been made in medical education, often with a view to countering adverse aspects of highly specialised, commercialised and bureaucratised modern medical practice. Regardless of the state of the world today and of the variety of changes that may occur in the years ahead, excellence in the application of bedside skills and technological advances, accompanied by excellence in humanistic aspects of caring for patients as people, will remain preeminent goals at the heart of medical practice. Powerful social forces that negatively influence practice cannot be counteracted through changes in medical education alone and need to be addressed directly within health systems. Shifting healthcare towards a valued social service is arguably essential for improving both public and individual health through more widespread universal access to high quality and effectively integrated health care.
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Affiliation(s)
- Solomon Benatar
- University of Cape Town, Cape Town, South Africa.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Denis Daneman
- Department of Paediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Canada
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Laviana AA, Luckenbaugh AN, Resnick MJ. Trends in the Cost of Cancer Care: Beyond Drugs. J Clin Oncol 2020; 38:316-322. [PMID: 31804864 PMCID: PMC6994251 DOI: 10.1200/jco.19.01963] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2019] [Indexed: 01/10/2023] Open
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From the ACA to Even Better Reform. J Ambul Care Manage 2019; 42:195-201. [DOI: 10.1097/jac.0000000000000286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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