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Rui JR, Guo J, Yang K. How do provider communication strategies predict online patient satisfaction? A content analysis of online patient-provider communication transcripts. Digit Health 2024; 10:20552076241255617. [PMID: 38778866 PMCID: PMC11110499 DOI: 10.1177/20552076241255617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2024] [Indexed: 05/25/2024] Open
Abstract
Objective As a result of the growing access to the Internet, online medical platforms have gained increased popularity in China. However, which strategies doctors should use to improve their online communication with patients remains understudied. Drawing upon the performance-evaluation-outcome (PEO) model, the present study seeks to develop a typology of patient-centered communication (PCC) strategies online and identify those strategies that can increase patient satisfaction. Methods We employed the data crawling technique to access text-based patient-provider transcripts through a large medical consultation platform in China and coded 9140 conversational turns of doctors. Results Our analysis revealed 15 PCC strategies that Chinese doctors often used online. In addition, several strategies were found to enhance patient satisfaction including information provision, making diagnosis, information appraisal, emotion expression, emotion recognition and support, in-depth discussion of medical treatments, providing coping strategies, and enabling self-management. Conclusion Chinese patients may have developed multiple needs, which they expect to fulfill through their interactions with doctors. Technological affordances of online medical platforms may pressure doctors to adapt their communication strategies to patients' needs. Our findings develop the PEO model from the perspective of patient-provider communication strategies and add a perspective centering on patients' needs to the scholarship on patient satisfaction. In addition, these results provide practical implications on how to improve patient-provider communication online.
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Affiliation(s)
- Jian Raymond Rui
- College of Journalism and Communication, South China University of Technology, Guangzhou, Guangdong Province, China
| | - Jieqiong Guo
- Chule Cootek Information Technology Limited Company, Shanghai, China
| | - Keqing Yang
- College of Journalism and Communication, South China University of Technology, Guangzhou, Guangdong Province, China
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2
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Spragg JCJ, Michael TJF, Aslani P, Coleshill MJ, Chan JS, Day RO, Stocker SL. Optimizing adherence to allopurinol for gout: patients' perspectives. Br J Clin Pharmacol 2023; 89:1978-1991. [PMID: 36607199 DOI: 10.1111/bcp.15657] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/15/2022] [Accepted: 12/22/2022] [Indexed: 01/07/2023] Open
Abstract
AIMS Poor adherence to allopurinol among people with gout contributes to suboptimal gout management. This study sought to understand the facilitators and barriers to allopurinol adherence across the three stages of medication adherence, and patient perspectives on strategies to improve adherence, including self-monitoring urate concentration. METHODS Semi-structured interviews were conducted with 26 people with gout, previously or currently taking allopurinol. De-identified verbatim transcripts were thematically analysed using an inductive and deductive approach. RESULTS Facilitators of adherence during allopurinol initiation were motivation to prevent gout flares and trust in the advice of their healthcare professionals (HCPs). Reluctance to commence long-term medication was a barrier to allopurinol initiation. Believing in the effectiveness and necessity of allopurinol and reminder systems were facilitators of implementation. Barriers to implementation included forgetfulness, gout flares and limited feedback on allopurinol's effectiveness. Patients discontinued therapy when allopurinol was perceived as ineffective or unnecessary. Discontinuation coincided with patients experiencing gout flares while adhering to allopurinol and receiving suboptimal advice about gout management. Patients identified receiving accurate advice from HCPs and regular urate monitoring for feedback on allopurinol's effectiveness as potential strategies to improve adherence. Perceived benefits of self-monitoring urate as a strategy to promote adherence included the ability to self-manage gout and make informed decisions about allopurinol therapy with their HCP. CONCLUSION Patient perceptions of the effectiveness and necessity of allopurinol influenced intentional adherence during medication initiation, implementation and discontinuation. Strategies that inform patients of their urate control and provide accurate medical advice have the potential to improve adherence to allopurinol.
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Affiliation(s)
- Jane C J Spragg
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Toni J F Michael
- School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Parisa Aslani
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Matthew J Coleshill
- Black Dog Institute, Faculty of Medicine, The University of New South Wales, Randwick, New South Wales, Australia
- Faculty of Medicine, The University of New South Wales, Kensington, New South Wales, Australia
| | - Jian S Chan
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- Faculty of Medicine, The University of New South Wales, Kensington, New South Wales, Australia
| | - Richard O Day
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Darlinghurst, New South Wales, Australia
- St Vincent's Clinical Campus, School of Clinical Medicine, The University of New South Wales, Kensington, New South Wales, Australia
| | - Sophie L Stocker
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Darlinghurst, New South Wales, Australia
- St Vincent's Clinical Campus, School of Clinical Medicine, The University of New South Wales, Kensington, New South Wales, Australia
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Ramkumar SP, Lal D, Miglani A. Considerations for shared decision-making in treatment of chronic rhinosinusitis with nasal polyps. FRONTIERS IN ALLERGY 2023; 4:1137907. [PMID: 36970067 PMCID: PMC10036764 DOI: 10.3389/falgy.2023.1137907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/13/2023] [Indexed: 03/12/2023] Open
Abstract
Shared decision-making is an approach where physicians and patients work together to determine a personalized treatment course. Such an approach is integral to patient-centered care in chronic rhinosinusitis with nasal polyps (CRSwNP). CRSwNP is a chronic inflammatory condition of the sinonasal cavity that can severely impact physical health, smell, and quality of life (QOL). Traditional standard-of-care treatment options include topical (i.e. sprays) and oral corticosteroids and endoscopic sinus surgery, but more recently, novel corticosteroid delivery methods (i.e. high volume irrigations, recently-approved exhalation breath-powered delivering devices, and drug-eluting steroid implants) and 3 new FDA approved biologics directed against type II immunomodulators have become available. The availability of these therapeutics offers exciting new opportunities in CRSwNP management but requires personalized and shared-decision making as each modality has variable impacts on CRSwNP and related comorbid conditions. Studies have published treatment algorithms, but the practical use of these lean guidelines is heavily influenced by the lens of the treating physician, the most common being otolaryngologists and allergy immunologists. Clinical equipoise occurs when there is no basis for one intervention to be regarded as “better” than another. While most guidelines, in general, support the use of topical corticosteroids with or without oral corticosteroids followed by ESS for the majority of unoperated CRSwNP patients, there are situations of clinical equipoise that arise particularly in CRSwNP who have failed surgery or those with severe comorbid conditions. In the shared decision-making process, clinicians and patients must consider symptomatology, goals, comfort, compliance, treatment efficacy, and treatment cost when determining the initial choice of therapy and escalation of therapy with the potential use of multiple modalities for recalcitrant CRSwNP. A summary of salient considerations that might constitute shared decision-making is presented in this summary.
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Affiliation(s)
- Shreya P. Ramkumar
- Department of Otolaryngology – Head and Neck Surgery, Mayo Clinic Hospital, Phoenix, AZ, United States
- Saint Louis University School of Medicine, Saint Louis, MO, United States
| | - Devyani Lal
- Department of Otolaryngology – Head and Neck Surgery, Mayo Clinic Hospital, Phoenix, AZ, United States
| | - Amar Miglani
- Department of Otolaryngology – Head and Neck Surgery, Mayo Clinic Hospital, Phoenix, AZ, United States
- Correspondence: Amar Miglani
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Tahghighi H, Mortazavi H, Manteghi AA, Armat MR. The effect of comprehensive individual motivational-educational program on medication adherence in elderly patients with bipolar disorders: An experimental study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:70. [PMID: 37113432 PMCID: PMC10127489 DOI: 10.4103/jehp.jehp_1109_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/02/2022] [Indexed: 06/19/2023]
Abstract
BACKGROUND The number of older adults with bipolar disorder is increasing and medication non-adherence is a major problem that negatively impacts the course of bipolar disorder. This study aimed to determine the effect of a comprehensive individual motivational-educational program on medication adherence in elderly patients with bipolar disorder. MATERIALS AND METHOD An experimental study with pretest-posttest repeated measures with a control group was conducted on two groups of 62 elderly people with bipolar disorders hospitalized at Ibn Sina Hospital in Mashhad, Northeast Iran, 2019. For the elderly in the intervention group, a comprehensive motivational-educational program was administered for one month (four 30-45 minute sessions), and for the elderly in the control group, routine clinical care was performed. Medication adherence in both elderly groups was measured before, immediately after, one and two months after the intervention. Data were analyzed by SPSS statistical software (version 16) using descriptive statistics and independent t-test, Mann-Whitney, paired t-test, repeated measures analysis of variance (ANOVA), and Chi-square tests. RESULTS The mean age of elderlies in the intervention and control groups were 69.03 ± 5.75 and 68.50 ± 6.73 years, respectively. Regardless of the groups to which the patients were assigned, a significant difference in medication adherence scores was observed during the study period (time effect; P < 0.001). Also, the medication adherence score was significantly lower in the intervention group, compared to the control group (group effect; P < 0.001). Also, there was a group time interaction between the medication adherence score and the time of evaluation (P < 0.001). CONCLUSION The results of the present study confirm the positive effect of a comprehensive educational-motivational program on improving medication adherence in elderly patients with bipolar disorder.
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Affiliation(s)
- Hossein Tahghighi
- Student Research Committee, School of Nursing, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Hamed Mortazavi
- Geriatric Care Research Center, Department of Geriatric Nursing, School of Nursing, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | | | - Mohammad Reza Armat
- Geriatric Care Research Center, Department of Medical-Surgical Nursing, School of Nursing, North Khorasan University of Medical Sciences, Bojnurd, Iran
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Pedersen CG, Nielsen CV, Lynggaard V, Zwisler AD, Maribo T. The patient education strategy "learning and coping" improves adherence to cardiac rehabilitation in primary healthcare settings: a pragmatic cluster-controlled trial. BMC Cardiovasc Disord 2022; 22:364. [PMID: 35941553 PMCID: PMC9361528 DOI: 10.1186/s12872-022-02774-8] [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: 11/10/2021] [Accepted: 07/06/2022] [Indexed: 11/29/2022] Open
Abstract
Background Adherence and completion of programmes in educational and physical exercise sessions is essential in cardiac rehabilitation (CR) to obtain the known benefits on morbidity, mortality, risk factors, lifestyle, and quality of life. The patient education strategy “Learning and Coping” (LC) has been reported to positively impact adherence and completion in a hospital setting. It is unknown if LC has impact on adherence in primary healthcare settings, and whether LC improves self-management. The aim of this pragmatic primary healthcare-based study was to examine whether patients attending CR based on LC had a better adherence to patient education and physical exercise, higher program completion rate, and better self-management compared to patients attending CR based on a consultation program Empowerment, Motivation and Medical Adherence (EMMA).
Method A pragmatic cluster-controlled trial of two types of patient education LC and EMMA including ten primary healthcare settings and 514 patients (LC, n = 266; EMMA, n = 248) diagnosed with ischaemic heart disease discharged from hospital and referred to CR between August 1, 2018 and July 31, 2019. Adherence was defined as participation in ≥ 75% of provided sessions. Completion was defined as patients attended the final interview at the end of the 12-weeks programme. Patient Activation Measure (PAM) was used to obtain information on a person's knowledge, skills and confidence for self-management. PAM questionnaire was completed at baseline and 12-weeks follow-up. Multiple and Linear regression analyses adjusted for potential confounder variables and cluster effect were performed. Result Patients who followed CR based on LC had a higher adherence rate to educational and physical exercise sessions compared to patients who followed CR based on EMMA (p < 0.01). High-level of completion was found at the end of CR with no statistically significant between clusters (78.9% vs. 78.2%, p > 0.05). At 12-weeks, there was no statistical differences in PAM-score between clusters (p > 0.05). Conclusion This study indicates that the LC positively impacts adherence in CR compared to EMMA. We found non-significant difference in completing CR and in patient self-management between the two types of patient education. Future studies are needed to investigate if the higher adherence rate achieved by LC in primary healthcare settings translates into better health outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02774-8.
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Affiliation(s)
- Charlotte Gjørup Pedersen
- Department of Public Health, Aarhus University, Aarhus, Denmark. .,DEFACTUM, Central Denmark Region, Aarhus, Denmark. .,REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark. .,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Claus Vinther Nielsen
- Department of Public Health, Aarhus University, Aarhus, Denmark.,DEFACTUM, Central Denmark Region, Aarhus, Denmark.,Department of Clinical Social Medicine and Rehabilitation, Gødstrup Hospital, Herning, Denmark
| | - Vibeke Lynggaard
- Cardiovascular Research Unit, Department of Cardiology, Gødstrup Hospital, Herning, Denmark
| | - Ann Dorthe Zwisler
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Thomas Maribo
- Department of Public Health, Aarhus University, Aarhus, Denmark.,DEFACTUM, Central Denmark Region, Aarhus, Denmark
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Creagh NS, Zammit C, Brotherton JM, Saville M, McDermott T, Nightingale C, Kelaher M. The experience of under-screened and never-screened participants using clinician-supported self-collection cervical screening within the Australian National Cervical Screening Program. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455065221075905. [PMID: 35147064 PMCID: PMC8841921 DOI: 10.1177/17455065221075905] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Australia has had significant successes in the prevention of cervical cancer. However, there is considerable scope for improving screening participation. In December 2017, Australia shifted from cytology to a human papillomavirus–based screening program as part of the renewed National Cervical Screening Program. This provided the opportunity to introduce a clinician-supported self-collection cervical screening pathway, which allows screening participants aged 30 years or more and who are under-screened or never-screened to screen via a self-collected human papillomavirus test. Objective: This study aimed to explore screening participant experiences of a clinician-supported self-collection cervical screening pathway. Methods: Interviews (n = 45) were conducted with participants who had used the clinician-supported self-collection cervical screening pathway in the Australian National Cervical Screening Program between December 2017 and April 2019. Interviews were analyzed using template analysis. Results: Under-screened and never-screened participants reported a variety of interrelated barriers to cervical screening due to the nature of the test. For these participants, self-collection was a preferable way to perform screening as it overcame various barriers, was easy to use and promoted a sense of empowerment. Participants reported that the role of their practitioner was influential in their decision to undertake cervical screening, and that the support and information provided was a key factor in their experiences of the self-collection pathway. Conclusion: Findings support the use of a clinician-supported model of care, as an alternative screening modality in Australia’s National Cervical Screening Program. As more countries consider the move from a cytology to human papillomavirus–based cervical screening program, this model may assist in greater engagement of under-screened participants.
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Affiliation(s)
- Nicola S Creagh
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Claire Zammit
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Julia Ml Brotherton
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.,VCS Population Health, VCS Foundation, Carlton, VIC, Australia
| | - Marion Saville
- VCS Population Health, VCS Foundation, Carlton, VIC, Australia.,University Department of Obstetrics and Gynecology, The Royal Women's Hospital, University of Melbourne, Melbourne, VIC, Australia
| | | | - Claire Nightingale
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Margaret Kelaher
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
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Stenov V, Lindgreen P, Willaing I, Basballe HG, Joensen LE. Testing an analogue game to promote peer support and person-centredness in education for people with diabetes: A realist evaluation. Nurs Open 2021; 8:2536-2550. [PMID: 33650784 PMCID: PMC8363400 DOI: 10.1002/nop2.784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 12/10/2020] [Accepted: 01/29/2021] [Indexed: 12/21/2022] Open
Abstract
Aim To explore the outcomes of testing an analogue game to incorporate person‐centredness and peer dialogues in group‐based diabetes education targeting people with diabetes. Design Realist evaluation using quantitative and qualitative methods to explore context, mechanisms and outcomes of the intervention. Methods In March–July 2019, the game was tested among 76 people with type 2 diabetes and 17 professionals in 19 settings across nine Danish municipalities. Data consisted of game tests, interviews and questionnaires. Data were analysed using systematic text condensation and descriptive statistics. Results Outcomes of using the game were as follows: (a) a playful atmosphere; (b) active engagement; c) reflections on diabetes‐specific experiences; (d) focused dialogues; (e) professionals gaining insight into the needs of participants; and (f) professionals experiencing peer dialogue as important to incorporate into education. Questionnaire responses showed that 92% people with diabetes and 94% professionals found that the game incorporated person‐centredness and peer dialogues into education.
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Affiliation(s)
- Vibeke Stenov
- Diabetes Management Research, Health Promotion Research Unit, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Pil Lindgreen
- Diabetes Management Research, Health Promotion Research Unit, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Ingrid Willaing
- Diabetes Management Research, Health Promotion Research Unit, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | | | - Lene Eide Joensen
- Diabetes Management Research, Health Promotion Research Unit, Steno Diabetes Center Copenhagen, Gentofte, Denmark
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8
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Stapleton A. Choosing not to follow rules that will reduce the spread of COVID-19. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2020; 17:73-78. [PMID: 32834967 PMCID: PMC7351050 DOI: 10.1016/j.jcbs.2020.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/01/2020] [Accepted: 07/03/2020] [Indexed: 12/27/2022]
Abstract
In response to the COVID-19 pandemic, many authorities have implemented public health measures that place restrictions on individuals. Understanding how individuals respond to these new rules, particularly whether they are likely to follow or break them, is extremely important. Relational frame theory offers unique insights into rule-governed behavior, allowing researchers to develop functional-analytic interpretations of why a listener may understand a rule, have the required response established in their behavioral repertoire, and still choose not to follow the rule. Drawing from research on rule-following in accordance with relational frame theory and cognitive neuroscience, social psychology, and health literature, this paper presents reasons why a rule may be understood but not followed, identifying important considerations for implementing public health measures to reduce the spread of COVID-19. Specifically, rule-givers should attend to their credibility, authority and ability to mediate consequences, rule plausibility, establishing adequate motivative augmental control, whether the behavior specified in the rule opposes habits, and whether the message incites counterpliance.
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Affiliation(s)
- Alison Stapleton
- School of Psychology, University College Dublin, Belfield, Dublin 4, Ireland
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9
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Safi Z, Abd-alrazaq A, Khalifa M, Househ M. Technical Aspects of Developing Chatbots for Medical Applications: Scoping Review (Preprint).. [DOI: 10.2196/preprints.19127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
BACKGROUND
Chatbots are applications that can conduct natural language conversations with users. In the medical field, chatbots have been developed and used to serve different purposes. They provide patients with timely information that can be critical in some scenarios, such as access to mental health resources. Since the development of the first chatbot, ELIZA, in the late 1960s, much effort has followed to produce chatbots for various health purposes developed in different ways.
OBJECTIVE
This study aimed to explore the technical aspects and development methodologies associated with chatbots used in the medical field to explain the best methods of development and support chatbot development researchers on their future work.
METHODS
We searched for relevant articles in 8 literature databases (IEEE, ACM, Springer, ScienceDirect, Embase, MEDLINE, PsycINFO, and Google Scholar). We also performed forward and backward reference checking of the selected articles. Study selection was performed by one reviewer, and 50% of the selected studies were randomly checked by a second reviewer. A narrative approach was used for result synthesis. Chatbots were classified based on the different technical aspects of their development. The main chatbot components were identified in addition to the different techniques for implementing each module.
RESULTS
The original search returned 2481 publications, of which we identified 45 studies that matched our inclusion and exclusion criteria. The most common language of communication between users and chatbots was English (n=23). We identified 4 main modules: text understanding module, dialog management module, database layer, and text generation module. The most common technique for developing text understanding and dialogue management is the pattern matching method (n=18 and n=25, respectively). The most common text generation is fixed output (n=36). Very few studies relied on generating original output. Most studies kept a medical knowledge base to be used by the chatbot for different purposes throughout the conversations. A few studies kept conversation scripts and collected user data and previous conversations.
CONCLUSIONS
Many chatbots have been developed for medical use, at an increasing rate. There is a recent, apparent shift in adopting machine learning–based approaches for developing chatbot systems. Further research can be conducted to link clinical outcomes to different chatbot development techniques and technical characteristics.
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Ellegaard MBB, Jensen AB, Lomborg K. Development of a Cancer Self-management Education Programme for Women with Breast Cancer at the End of Primary Treatment. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2019; 34:882-889. [PMID: 30014171 DOI: 10.1007/s13187-018-1390-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Breast cancer survivors have specific healthcare needs. As a result of their disease and treatment, they have to adapt to different physical and psychosocial late effects. Unfortunately, several studies have documented insufficiency in the survivorship healthcare system. The aim of this paper was to describe the process of development and testing of a novel Cancer Self-management Education programme (CSME programme) to improve patient-reported self-management and self-efficacy for patients with breast cancer who were at the end of primary treatment. The development of the educational programme was inspired by the Plan-Do-Study-Act (PDSA) circle and based on person-centred principles. It was conducted at a Danish university hospital. Nine oncology healthcare providers, two external experts in patient education and five patients were involved in the development and testing of the education programme. Implementation of dialogue-based tools was used as an educational learning instrument in the SCME programme. The PDSA approach to the development of the CSME programme resulted in a person-centred programme that could improve self-management and self-efficacy in the survivorship phase of patients with breast cancer.
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Affiliation(s)
| | - Anders Bonde Jensen
- Department of Oncology, Aarhus University Hospital, Nørrebrogade 44 - Building 5, 8000, Aarhus C, Denmark
| | - Kirsten Lomborg
- Department of Clinical Medicine, Aarhus University and the Research Program in Patient Involvement, Aarhus University Hospital, Aarhus, Denmark
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Abstract
The word ‘compliance' comes from the Latin word complire, meaning to fill up and hence to complete an action, transaction, or process and to fulfil a promise. In the Oxford English Dictionary, the relevant definition is ‘The acting in accordance with, or the yielding to a desire, request, condition, direction, etc.; a consenting to act in conformity with; an acceding to; practical assent”. Compliance with therapy is simply patients understanding of medication, motivation toward having this medication is a prescribed manner with the belief that the prescriber and prescribed medicine will be beneficial for his well-being. Although this is often the case, in a number of situations, the physician and pharmacist have not provided the patient with adequate instructions or have not presented the instructions in such a manner that the patient understands them. Nothing should be taken for granted regarding the patient's understanding of how to use medication, and appropriate steps must be taken to provide patients with the information and counseling necessary to use their medications as effectively and as safely as possible. 20% to 30% of new prescriptions are never filled at the pharmacy. Medication is not taken as prescribed 50% of the time. For patients prescribed medications for chronic diseases, after six months, the majority take less medication than prescribed or stop the medication altogether. There are both federal and state laws that make using or sharing prescription drugs illegal. If someone take a pill that was prescribed to someone else or give that pill to another person, not only is it against the law, it's extremely dangerous.
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Affiliation(s)
- A K Mohiuddin
- Department of Pharmacy, World University of Bangladesh
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12
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Zhang Z, Monro J, Venn BJ. Carbohydrate Knowledge and Expectations of Nutritional Support among Five Ethnic Groups Living in New Zealand with Pre- and Type 2 Diabetes: A Qualitative Study. Nutrients 2018; 10:nu10091225. [PMID: 30181471 PMCID: PMC6163622 DOI: 10.3390/nu10091225] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 09/03/2018] [Accepted: 09/03/2018] [Indexed: 01/29/2023] Open
Abstract
Despite availability of diabetes and nutrition information for people with pre- and type 2 diabetes, the uptake and understanding of these resources may differ among ethnic groups. Our objective was to explore dietary knowledge and diabetes experiences amongst Māori, European, Pacific Island, Indian and East Asian people living in New Zealand with a focus on carbohydrate-containing foods. A registered diabetes dietitian led ethnic-specific discussions in groups involving 29 people with pre- or type 2 diabetes. Discussions were audio-recorded, fully transcribed and coded independently by two investigators. Themes were developed using deductive and inductive techniques. Five themes emerged: knowledge, concerns, achievements, simplicity and self-determination. Nutritional knowledge was lacking and a greater awareness of trustworthy dietary resources was needed. There were concerns about diabetes complications and appropriate carbohydrate-containing foods and portions. Contrary to this, people felt proud when achieving dietary goals and grateful for support from health care providers and family. Participants were willing to engage in self-care if advice from health professionals was given in plain language, and in a culturally appropriate manner. Given the desire to take an active role in diabetes self-management and willingness to use electronic devices, an ethnic-specific nutrition education resource could be a valuable tool.
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Affiliation(s)
- Zhuoshi Zhang
- Department of Human Nutrition, University of Otago, PO Box 56, Dunedin 9054, New Zealand.
| | - John Monro
- New Zealand Institute for Plant & Food Research Ltd., Private Bag 11600, Palmerston North 4442, New Zealand.
| | - Bernard J Venn
- Department of Human Nutrition, University of Otago, PO Box 56, Dunedin 9054, New Zealand.
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Garattini L, Padula A. Patient empowerment in Europe: is no further research needed? THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2018; 19:637-640. [PMID: 29520521 DOI: 10.1007/s10198-018-0965-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Affiliation(s)
- Livio Garattini
- CESAV, Centre for Health Economics, IRCCS Institute for Pharmacological Research "Mario Negri", 24020, Ranica, Italy.
| | - Anna Padula
- CESAV, Centre for Health Economics, IRCCS Institute for Pharmacological Research "Mario Negri", 24020, Ranica, Italy
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Blanco-Cornejo M, Riva-Palacio-Chiang-Sam IL, Sánchez-Díaz I, Cerritos A, Tena-Tamayo C, López-Hernández D. New model for diabetes primary health care based on patient empowerment and the right to preventive health: the MIDE program. Rev Panam Salud Publica 2017; 41:e128. [PMID: 31384261 PMCID: PMC6645172 DOI: 10.26633/rpsp.2017.128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 02/02/2017] [Indexed: 12/29/2022] Open
Abstract
Objective. To evaluate Mexico’s national Integrated Management of Diabetes in Stages (Manejo Integral de la Diabetes por Etapas, MIDE) program using three types of indicators: process, structure, and impact. Methods. A cross-sectional study was conducted using data for 97 452 people with diabetes (PWD) who participated in the MIDE patient empowerment program (PEP) at “MIDE modules” (standardized diabetes health care units) at Mexico’s Institute for Social Security and Services for State Workers (Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, ISSSTE) hospital clinics and family medical clinics nationwide between 2007 and 2014. The program promotes diabetes patient empowerment and self-care through outpatient consultations with a multidisciplinary health care team supported by continuous training. Baseline data were compared with results post-program for the following indicators: process (metabolic control (MetC), based on glycated hemoglobin (HbA1c), triglyceride (TG), and total cholesterol (TC) levels); structure (number of MIDE modules installed at ISSSTE clinics and number of patients/health personnel accredited as diabetes experts/awarded diplomas); and impact (average number of patient illness days (IDs) and hospitalization episodes (HEs) per PWD over a 12-month period). Results. Over the seven-year study period, the proportion of patients with MetC (HbA1c < 7.0%, TG < 150 mg/dL, and TC < 200 mg/dL) increased significantly (from 35.4% to 60% (with a peak level of 62% in 2013); P < 0.001); average HbA1c, triglycerides, and total cholesterol per PWD dropped by 25%, 31%, and 11% respectively; average number of IDs and HEs per PWD over a 12-month period dropped by 38% and 41% respectively; a total of 140 MIDE modules were installed at ISSSTE clinics; and a total of 1 117 diplomas were awarded to 826 health professionals, and 2 613 PWD were accredited as “patient experts in diabetes.” Conclusions. The MIDE PEP is feasible, usable, and acceptable to PWD. The program improves MetC; reduces the frequency of IDs and HEs; and facilitates patient participation, the involvement of health personnel, and shared decision-making.
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Affiliation(s)
- Margarita Blanco-Cornejo
- Health Protection and Prevention Sub-Directorate Medical Directorate, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado Mexico City Mexico Health Protection and Prevention Sub-Directorate, Medical Directorate, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mexico City, Mexico
| | - Irma Luz Riva-Palacio-Chiang-Sam
- Health Protection and Prevention Sub-Directorate Medical Directorate, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado Mexico City Mexico Health Protection and Prevention Sub-Directorate, Medical Directorate, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mexico City, Mexico
| | - Iyari Sánchez-Díaz
- Health Protection and Prevention Sub-Directorate Medical Directorate, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado Mexico City Mexico Health Protection and Prevention Sub-Directorate, Medical Directorate, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mexico City, Mexico
| | - Antonio Cerritos
- Health Protection and Prevention Sub-Directorate Medical Directorate, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado Mexico City Mexico Health Protection and Prevention Sub-Directorate, Medical Directorate, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mexico City, Mexico
| | - Carlos Tena-Tamayo
- Hospital Regional de Alta Especialidad del Bajío Ministry of Health León, GJ Mexico Hospital Regional de Alta Especialidad del Bajío, Ministry of Health, León, GJ, Mexico
| | - Daniel López-Hernández
- Health Protection and Prevention Sub-Directorate Medical Directorate, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado Mexico City Mexico Health Protection and Prevention Sub-Directorate, Medical Directorate, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mexico City, Mexico
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Alpert JM, Dyer KE, Lafata JE. Patient-centered communication in digital medical encounters. PATIENT EDUCATION AND COUNSELING 2017; 100:1852-1858. [PMID: 28522229 PMCID: PMC5573682 DOI: 10.1016/j.pec.2017.04.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 03/13/2017] [Accepted: 04/28/2017] [Indexed: 05/09/2023]
Abstract
OBJECTIVE Patients are increasingly using the secure messaging function available through online patient portals to communicate with their health care providers, yet little is known about the characteristics of conversations that occur. The goal of this study is to describe the types of messages initiated by patients communicating via patient portals and to assess whether providers employ patient-centered strategies in their electronic responses. DESIGN A total of 193 messages from 58 message threads between patients and providers were collected during a one-week period in a large health care system. METHODS Content analysis of patient messages was conducted and deductive analysis of provider responses was employed for two types of patient-centered communication, provider use of supportive talk and partnership building. RESULTS Patients sent nearly double the number of messages compared to providers (65% versus 35%). Patient messages expressed concern, sought medical solutions and requested assistance with administrative tasks. Over half (53.4%) of provider replies did not contain language reflective of either partnership building or supportive talk. CONCLUSION Partnership building language and supportive talk occurred at lower rates than documented in the literature on in-person encounters. This may represent a lost opportunity to strengthen the patient-provider relationship. PRACTICE IMPLICATIONS As secure messaging is increasingly utilized as a form of patient-provider communication, it is important to understand how aspects of this communication channel, including the patient-centeredness of the language used by providers, impact patient-provider relationships and patient outcomes.
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Affiliation(s)
- Jordan M Alpert
- Department of Advertising, College of Journalism and Communications, University of Florida, United States.
| | - Karen E Dyer
- Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System,United States
| | - Jennifer Elston Lafata
- UNC Lineberger Comprehensive Cancer Center and UNC Eshelman School of Pharmacy, The University of North Carolina-Chapel Hill, United States
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16
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Bunn F, Goodman C, Reece Jones P, Russell B, Trivedi D, Sinclair A, Bayer A, Rait G, Rycroft-Malone J, Burton C. What works for whom in the management of diabetes in people living with dementia: a realist review. BMC Med 2017; 15:141. [PMID: 28750628 PMCID: PMC5532771 DOI: 10.1186/s12916-017-0909-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 07/04/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Dementia and diabetes mellitus are common long-term conditions and co-exist in a large number of older people. People living with dementia (PLWD) may be less able to manage their diabetes, putting them at increased risk of complications such as hypoglycaemia. The aim of this review was to identify key mechanisms within different interventions that are likely to improve diabetes outcomes in PLWD. METHODS This is a realist review involving scoping of the literature and stakeholder interviews to develop theoretical explanations of how interventions might work, systematic searches of the evidence to test and develop the theories and their validation with a purposive sample of stakeholders. Twenty-six stakeholders - user/patient representatives, dementia care providers, clinicians specialising in diabetes or dementia and researchers - took part in interviews, and 24 participated in a consensus conference. RESULTS We included 89 papers. Ten focused on PLWD and diabetes, and the remainder related to people with either dementia, diabetes or other long-term conditions. We identified six context-mechanism-outcome configurations which provide an explanatory account of how interventions might work to improve the management of diabetes in PLWD. This includes embedding positive attitudes towards PLWD, person-centred approaches to care planning, developing skills to provide tailored and flexible care, regular contact, family engagement and usability of assistive devices. An overarching contingency emerged concerning the synergy between an intervention strategy, the dementia trajectory and social and environmental factors, especially family involvement. CONCLUSIONS Evidence highlighted the need for personalised care, continuity and family-centred approaches, although there was limited evidence that this happens routinely. This review suggests there is a need for a flexible service model that prioritises quality of life, independence and patient and carer priorities. Future research on the management of diabetes in older people with complex health needs, including those with dementia, needs to look at how organisational structures and workforce development can be better aligned to their needs. TRIAL REGISTRATION PROSPERO, CRD42015020625. Registered on 18 May 2015.
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Affiliation(s)
- Frances Bunn
- Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, UK.
| | - Claire Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, UK
| | | | - Bridget Russell
- Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, UK
| | - Daksha Trivedi
- Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, UK
| | - Alan Sinclair
- Foundation for Diabetes Research in Older People, Diabetes Frail Ltd, Luton, LU1 3UA, UK
| | - Antony Bayer
- Division of Population Medicine, Cardiff University, Cardiff, Wales, CF10 3AT, LL57 2EF, UK
| | - Greta Rait
- Research Department of Primary Care and Population Health, UCL Medical School (Royal Free Campus), Rowland Hill Street, London, NW3 2PF, UK
| | | | - Christopher Burton
- Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, UK
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Kambhampati S, Ashvetiya T, Stone NJ, Blumenthal RS, Martin SS. Shared Decision-Making and Patient Empowerment in Preventive Cardiology. Curr Cardiol Rep 2017; 18:49. [PMID: 27098670 DOI: 10.1007/s11886-016-0729-6] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Shared decision-making, central to evidence-based medicine and good patient care, begins and ends with the patient. It is the process by which a clinician and a patient jointly make a health decision after discussing options, potential benefits and harms, and considering the patient's values and preferences. Patient empowerment is crucial to shared decision-making and occurs when a patient accepts responsibility for his or her health. They can then learn to solve their own problems with information and support from professionals. Patient empowerment begins with the provider acknowledging that patients are ultimately in control of their care and aims to increase a patient's capacity to think critically and make autonomous, informed decisions about their health. This article explores the various components of shared decision-making in scenarios such as hypertension and hyperlipidemia, heart failure, and diabetes. It explores barriers and the potential for improving medication adherence, disease awareness, and self-management of chronic disease.
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Affiliation(s)
- Swetha Kambhampati
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, 600 N. Wolfe Street, Carnegie 591, Baltimore, MD, 21287, USA.
| | - Tamara Ashvetiya
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, 600 N. Wolfe Street, Carnegie 591, Baltimore, MD, 21287, USA
| | - Neil J Stone
- McGaw Medical Center, Northwestern University, Chicago, IL, USA
| | - Roger S Blumenthal
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, 600 N. Wolfe Street, Carnegie 591, Baltimore, MD, 21287, USA
| | - Seth S Martin
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, 600 N. Wolfe Street, Carnegie 591, Baltimore, MD, 21287, USA
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18
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Munsell M, Frean M, Menzin J, Phillips AL. An evaluation of adherence in patients with multiple sclerosis newly initiating treatment with a self-injectable or an oral disease-modifying drug. Patient Prefer Adherence 2017; 11:55-62. [PMID: 28115831 PMCID: PMC5221550 DOI: 10.2147/ppa.s118107] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE As the multiple sclerosis (MS) disease-modifying drug (DMD) treatment options have expanded to include oral therapies, it is important to understand whether route of administration is associated with DMD adherence. The objective of this study was to compare adherence to DMDs in patients with MS newly initiating treatment with a self-injectable versus an oral DMD. METHODS This retrospective database study used IMS Health Real World Data Adjudicated Claims - US data between July 1, 2010 and June 30, 2014. Adherence was measured by medication possession ratio (MPR), calculated as the total number of treated days divided by the total number of days from the first treated day until the end of 12-month follow-up. A binary measure representing adherence (MPR ≥0.8) versus nonadherence (MPR <0.8) to therapy was used. Logistic regression evaluated the likelihood of adherence to index DMD type (self-injectable vs oral). Covariates included patient baseline characteristics (ie, age, sex, comorbidities) and index DMD type. RESULTS The analysis included 7,207 self-injectable and 1,175 oral DMD-treated patients with MS. In unadjusted analyses, the proportion of patients adherent to therapy (MPR ≥0.8) did not differ significantly between the self-injectable (54.1%) and the oral DMD cohorts (53.0%; P=0.5075). After controlling for covariates, index DMD type was not a significant predictor of adherence (odds ratio [OR] 1.062; 95% confidence interval [CI]: 0.937-1.202; P=0.3473). Higher likelihood of adherence was associated with male sex (OR 1.20; 95% CI: 1.085-1.335; P=0.0005) and age groups older than 18-34 years (ORs 1.220-1.331; P<0.01). Depression was associated with a lower likelihood of adherence (OR 0.618; 95% CI: 0.511-0.747; P<0.0001). CONCLUSION Male sex and age older than 18-34 years were significantly associated with a higher likelihood of adherence, while depression was associated with a lower likelihood of adherence. Index DMD type, stratified by the route of administration (self-injectable vs oral DMD), was not a significant predictor of DMD adherence.
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Affiliation(s)
| | - Molly Frean
- Boston Health Economics, Inc., Waltham, MA, USA
| | - Joseph Menzin
- Boston Health Economics, Inc., Waltham, MA, USA
- Correspondence: Joseph Menzin, Boston Health Economics, Inc., 20 Fox Road, Waltham, MA 02451, USA, Tel +1 781 290 0808, Fax +1 781 290 0029, Email
| | - Amy L Phillips
- Health Economics & Outcomes Research, EMD Serono Inc., Rockland, MA, USA
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Łuczyński W, Głowińska-Olszewska B, Bossowski A. Empowerment in the Treatment of Diabetes and Obesity. J Diabetes Res 2016; 2016:5671492. [PMID: 28090541 PMCID: PMC5206444 DOI: 10.1155/2016/5671492] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 11/30/2016] [Indexed: 12/26/2022] Open
Abstract
As the available therapies for diabetes and obesity are not effective enough, diabetologists and educators search for new methods to collaborate with patients in order to support their health behaviors. The aim of this review is to discuss perspectives for the development of new empowerment-type therapies in the treatment of diabetes/obesity. Empowerment is a process whereby patients gain the necessary knowledge to influence their own behavior to improve the quality of their lives. It is carried out in five stages: (1) identify the problem, (2) explain the feelings and meanings, (3) build a plan, (4) act, and (5) experience and assess the execution. Although many years have passed since the advent and popularization of the concept of empowerment, the area remains controversial, mainly with regard to the methodology of therapy. Some previous studies have confirmed the positive effect of empowerment on body weight, metabolic control, and quality of life of patients with type 2 diabetes; however, few studies have been conducted in patients with type 1 diabetes. There is still a need to confirm the effectiveness of empowerment in accordance with Evidence Based Medicine by performing long-term observational studies in a large group of patients. In future, empowerment may become part of the standard of care for patients with diabetes and/or obesity.
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Affiliation(s)
- Włodzimierz Łuczyński
- Department of Pediatrics, Endocrinology, Diabetology with Cardiology Division, Medical University of Białystok, Waszyngtona 17, 15-274 Białystok, Poland
- *Włodzimierz Łuczyński:
| | - Barbara Głowińska-Olszewska
- Department of Pediatrics, Endocrinology, Diabetology with Cardiology Division, Medical University of Białystok, Waszyngtona 17, 15-274 Białystok, Poland
| | - Artur Bossowski
- Department of Pediatrics, Endocrinology, Diabetology with Cardiology Division, Medical University of Białystok, Waszyngtona 17, 15-274 Białystok, Poland
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20
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Lavalle-González FJ, Chiquete E. Patients' empowerment, physicians' perceptions, and achievement of therapeutic goals in patients with type 1 and type 2 diabetes mellitus in Mexico. Patient Prefer Adherence 2016; 10:1349-57. [PMID: 27555751 PMCID: PMC4968990 DOI: 10.2147/ppa.s107437] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Physicians' perception may not parallel objective measures of therapeutic targets in patients with diabetes. This is an issue rarely addressed in the medical literature. We aimed to analyze physicians' perception and characteristics of adequate control of patients with diabetes. PATIENTS AND METHODS We studied information on physicians and their patients who participated in the third wave of the International Diabetes Management Practices Study registry in Mexico. This analysis was performed on 2,642 patients, 203 with type 1 diabetes mellitus (T1DM) and 2,439 with type 2 diabetes mellitus (T2DM), treated by 200 physicians. RESULTS The patients perceived at target had lower hemoglobin A1c (HbA1c) and fasting blood glucose than those considered not at target. However, overestimation of the frequency of patients with HbA1c <7% was 41.5% in patients with T1DM and 31.7% in patients with T2DM (underestimation: 2.8% and 8.0%, respectively). The agreement between the physicians' perception and the class of HbA1c was suboptimal (κ: 0.612). Diabetologists and endocrinologists tested HbA1c more frequently than primary care practitioners, internists, or cardiologists; however, no differences were observed in mean HbA1c, for both T1DM (8.4% vs 7.2%, P=0.42) and T2DM (8.03% vs 8.01%, P=0.87) patients. Nevertheless, insulin users perceived at target, who practiced self-monitoring and self-adjustment of insulin, had a lower mean HbA1c than patients without these characteristics (mean HbA1c in T1DM: 6.8% vs 9.6%, respectively; mean HbA1c in T2DM: 7.0% vs 10.1%, respectively). CONCLUSION Although there is a significant physicians' overestimation about the optimal glycemic control, this global impression and characteristics of patients' empowerment, such as self-monitoring and self-adjustment of insulin, are associated with the achievement of targets.
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Affiliation(s)
| | - Erwin Chiquete
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Correspondence: Erwin Chiquete, Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Tlapan, Ciudad de México, Código Postal 14000, México, Tel +52 54 87 0900 ext 5052, Fax +52 56 55 1076, Email
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Graumlich JF, Wang H, Madison A, Wolf MS, Kaiser D, Dahal K, Morrow DG. Effects of a Patient-Provider, Collaborative, Medication-Planning Tool: A Randomized, Controlled Trial. J Diabetes Res 2016; 2016:2129838. [PMID: 27699179 PMCID: PMC5028848 DOI: 10.1155/2016/2129838] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 08/04/2016] [Indexed: 11/18/2022] Open
Abstract
Among patients with various levels of health literacy, the effects of collaborative, patient-provider, medication-planning tools on outcomes relevant to self-management are uncertain. Objective. Among adult patients with type II diabetes mellitus, we tested the effectiveness of a medication-planning tool (Medtable™) implemented via an electronic medical record to improve patients' medication knowledge, adherence, and glycemic control compared to usual care. Design. A multicenter, randomized controlled trial in outpatient primary care clinics. 674 patients received either the Medtable tool or usual care and were followed up for up to 12 months. Results. Patients who received Medtable had greater knowledge about indications for medications in their regimens and were more satisfied with the information about their medications. Patients' knowledge of drug indication improved with Medtable regardless of their literacy status. However, Medtable did not improve patients' demonstrated medication use, regimen adherence, or glycemic control (HbA1c). Conclusion. The Medtable tool supported provider/patient collaboration related to medication use, as reflected in patient satisfaction with communication, but had limited impact on patient medication knowledge, adherence, and HbA1c outcomes. This trial is registered with ClinicalTrials.gov NCT01296633.
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Affiliation(s)
- James F. Graumlich
- Department of Medicine, University of Illinois College of Medicine at Peoria, 530 Northeast Glen Oak Avenue, Peoria, IL 61637, USA
- *James F. Graumlich:
| | - Huaping Wang
- Department of Medicine, Division of Research Services, University of Illinois College of Medicine at Peoria, One Illini Drive, Peoria, IL 61605, USA
| | - Anna Madison
- Department of Psychology, University of Illinois at Urbana-Champaign, 603 E. Daniel, Champaign, IL 61820, USA
| | - Michael S. Wolf
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, 750 North Lake Shore Drive, 10th Floor, Chicago, IL 60611, USA
| | - Darren Kaiser
- Northwestern Medical Faculty Foundation, 675 North Saint Clair Street, Chicago, IL 60611, USA
| | - Kumud Dahal
- Department of Medicine, University of Illinois College of Medicine at Peoria, One Illini Drive, Peoria, IL 61605, USA
| | - Daniel G. Morrow
- Department of Educational Psychology, University of Illinois at Urbana-Champaign, Education Building, 1310 South 6th Street, Champaign, IL 61820, USA
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