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Yi K, Kim S. Patient Perspectives of Chronic Disease Management and Unmet Care Needs in South Korea: A Qualitative Study. J Patient Exp 2023; 10:23743735231213766. [PMID: 38026059 PMCID: PMC10666679 DOI: 10.1177/23743735231213766] [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] [Indexed: 12/01/2023] Open
Abstract
Understanding and incorporating patients' perspectives are necessary to address the emerging challenge of chronic disease management. Our study examined patients' perceptions and experiences for the current chronic disease management system in South Korea. Focus group interviews were conducted on 23 patients and 11 themes emerged by qualitative content analysis. The participants experienced in terms of provider-patient interaction: doctors only prescribe medicine, doctors who provide conventional advice, doctors who do not respect the patients' opinion, long wait times and inadequate consultations, lack of personalized care, and freedom to select another doctor. They also experienced in their community and health system: struggling alone, commercial media and folk remedies, lack of IT technologies for care, demanding visiting services, and lack of collaboration in the community. We found that patients needed comprehensive and personalized care, respect from providers, and self-management support and collaborated care with the community using information technologies advancement. Our findings suggest that a fundamental change in the South Korean healthcare system paradigm is required for successful chronic care, including payment and healthcare delivery systems.
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Affiliation(s)
- Kyunghee Yi
- The University of Suwon, Gyeonggi, South Korea
| | - Sujin Kim
- Korea Institute for Health and Social Affairs, Sejong, South Korea
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Aghili R, Valojerdi AE, Farshchi A, Khamseh ME. Type 2 diabetes: patient assessment of chronic illness care. J Diabetes Metab Disord 2021; 20:7-13. [PMID: 34178820 DOI: 10.1007/s40200-020-00540-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 05/06/2020] [Indexed: 12/21/2022]
Abstract
Objective We tried to assess perception of chronic illness care in people with type 2 diabetes and to determine whether demographic variables, self-care behavior, as well as affective variables were related with perception of chronic illness care. Methods We conducted a secondary analysis of the previously published cross-sectional study in 441 Iranian people with type 2 diabetes. Chronic illness care was assessed with the validated tool of patient assessment of chronic illness care (PACIC). Different aspects of care according to the chronic care model are measured on a scale of 1-5, with 5 being highest perception of care. The association between perception of chronic illness care and measured variables were tested using spearman correlation test as well as univariate and multiple linear regression analysis. Results Finally, 380 filled out the PACIC questionnaire, completely (53.4% female, mean age: 54.73 ± 8.0 years, mean PACIC score: 2.52 ± 0.87). In spearman correlation test, considering PACIC score as the dependent variable, chronic illness care was inversely associated with level of education and distress, whereas, insulin treatment, wellbeing, family-social support and self-management were positively associated with chronic care (All p value<0.05). In the multiple linear regression analysis, family-social support was positively related to chronic care while level of education, marital status, diabetes-related distress, and high density lipoprotein had significant negative relationship with PACIC score (All p value<0.05). Conclusions Family-social support, level of education, marital status, and diabetes-related distress are the major determinants of patient experience of chronic illness care in people with type 2 diabetes.
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Affiliation(s)
- Rokhsareh Aghili
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, No. 10, Firoozeh St., South Vali-asr Ave., Vali-asr Sq., Tehran, 15937-16615 Iran
| | - Ameneh Ebrahim Valojerdi
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, No. 10, Firoozeh St., South Vali-asr Ave., Vali-asr Sq., Tehran, 15937-16615 Iran
| | - Amir Farshchi
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, No. 10, Firoozeh St., South Vali-asr Ave., Vali-asr Sq., Tehran, 15937-16615 Iran.,Department of Pharmacoeconomics and Pharmaceutical Administration, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ebrahim Khamseh
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, No. 10, Firoozeh St., South Vali-asr Ave., Vali-asr Sq., Tehran, 15937-16615 Iran
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Burt J, Campbell J, Abel G, Aboulghate A, Ahmed F, Asprey A, Barry H, Beckwith J, Benson J, Boiko O, Bower P, Calitri R, Carter M, Davey A, Elliott MN, Elmore N, Farrington C, Haque HW, Henley W, Lattimer V, Llanwarne N, Lloyd C, Lyratzopoulos G, Maramba I, Mounce L, Newbould J, Paddison C, Parker R, Richards S, Roberts M, Setodji C, Silverman J, Warren F, Wilson E, Wright C, Roland M. Improving patient experience in primary care: a multimethod programme of research on the measurement and improvement of patient experience. PROGRAMME GRANTS FOR APPLIED RESEARCH 2017. [DOI: 10.3310/pgfar05090] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BackgroundThere has been an increased focus towards improving quality of care within the NHS in the last 15 years; as part of this, there has been an emphasis on the importance of patient feedback within policy, through National Service Frameworks and the Quality and Outcomes Framework. The development and administration of large-scale national patient surveys to gather representative data on patient experience, such as the national GP Patient Survey in primary care, has been one such initiative. However, it remains unclear how the survey is used by patients and what impact the data may have on practice.ObjectivesOur research aimed to gain insight into how different patients use surveys to record experiences of general practice; how primary care staff respond to feedback; and how to engage primary care staff in responding to feedback.MethodsWe used methods including quantitative survey analyses, focus groups, interviews, an exploratory trial and an experimental vignette study.Results(1)Understanding patient experience data. Patients readily criticised their care when reviewing consultations on video, although they were reluctant to be critical when completing questionnaires. When trained raters judged communication during a consultation to be poor, a substantial proportion of patients rated the doctor as ‘good’ or ‘very good’. Absolute scores on questionnaire surveys should be treated with caution; they may present an overoptimistic view of general practitioner (GP) care. However, relative rankings to identify GPs who are better or poorer at communicating may be acceptable, as long as statistically reliable figures are obtained. Most patients have a particular GP whom they prefer to see; however, up to 40% of people who have such a preference are unable regularly to see the doctor of their choice. Users of out-of-hours care reported worse experiences when the service was run by a commercial provider than when it was run by a not-for profit or NHS provider. (2)Understanding patient experience in minority ethnic groups. Asian respondents to the GP Patient Survey tend to be registered with practices with generally low scores, explaining about half of the difference in the poorer reported experiences of South Asian patients than white British patients. We found no evidence that South Asian patients used response scales differently. When viewing the same consultation in an experimental vignette study, South Asian respondents gave higher scores than white British respondents. This suggests that the low scores given by South Asian respondents in patient experience surveys reflect care that is genuinely worse than that experienced by their white British counterparts. We also found that service users of mixed or Asian ethnicity reported lower scores than white respondents when rating out-of-hours services. (3)Using patient experience data. We found that measuring GP–patient communication at practice level masks variation between how good individual doctors are within a practice. In general practices and in out-of-hours centres, staff were sceptical about the value of patient surveys and their ability to support service reconfiguration and quality improvement. In both settings, surveys were deemed necessary but not sufficient. Staff expressed a preference for free-text comments, as these provided more tangible, actionable data. An exploratory trial of real-time feedback (RTF) found that only 2.5% of consulting patients left feedback using touch screens in the waiting room, although more did so when reminded by staff. The representativeness of responding patients remains to be evaluated. Staff were broadly positive about using RTF, and practices valued the ability to include their own questions. Staff benefited from having a facilitated session and protected time to discuss patient feedback.ConclusionsOur findings demonstrate the importance of patient experience feedback as a means of informing NHS care, and confirm that surveys are a valuable resource for monitoring national trends in quality of care. However, surveys may be insufficient in themselves to fully capture patient feedback, and in practice GPs rarely used the results of surveys for quality improvement. The impact of patient surveys appears to be limited and effort should be invested in making the results of surveys more meaningful to practice staff. There were several limitations of this programme of research. Practice recruitment for our in-hours studies took place in two broad geographical areas, which may not be fully representative of practices nationally. Our focus was on patient experience in primary care; secondary care settings may face different challenges in implementing quality improvement initiatives driven by patient feedback. Recommendations for future research include consideration of alternative feedback methods to better support patients to identify poor care; investigation into the factors driving poorer experiences of communication in South Asian patient groups; further investigation of how best to deliver patient feedback to clinicians to engage them and to foster quality improvement; and further research to support the development and implementation of interventions aiming to improve care when deficiencies in patient experience of care are identified.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
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Affiliation(s)
- Jenni Burt
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | - Gary Abel
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
- University of Exeter Medical School, Exeter, UK
| | - Ahmed Aboulghate
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Faraz Ahmed
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | | | - Julia Beckwith
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - John Benson
- Primary Care Unit, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Olga Boiko
- University of Exeter Medical School, Exeter, UK
| | - Pete Bower
- National Institute for Health Research (NIHR) School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | | | - Mary Carter
- University of Exeter Medical School, Exeter, UK
| | | | | | - Natasha Elmore
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Conor Farrington
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Hena Wali Haque
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | - Val Lattimer
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Nadia Llanwarne
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Cathy Lloyd
- Faculty of Health & Social Care, The Open University, Milton Keynes, UK
| | - Georgios Lyratzopoulos
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | - Luke Mounce
- University of Exeter Medical School, Exeter, UK
| | - Jenny Newbould
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Charlotte Paddison
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Richard Parker
- Primary Care Unit, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | | | | | | | | | - Ed Wilson
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | - Martin Roland
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
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Fontanelli MDM, Teixeira JA, Sales CH, de Castro MA, Cesar CLG, Alves MCGP, Goldbaum M, Marchioni DM, Fisberg RM. Validation of self-reported diabetes in a representative sample of São Paulo city. Rev Saude Publica 2017; 51:20. [PMID: 28355348 PMCID: PMC5344074 DOI: 10.1590/s1518-8787.2017051006378] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 02/14/2016] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To validate the self-reported diabetes mellitus in adults and older adults living in the city of São Paulo, Brazil. METHODS We have used data of 569 subjects (284 adults and 285 older adults), participants of the population-based cross-sectional study Inquérito de Saúde do Município de São Paulo (Health Survey of São Paulo). Fasting glucose ≥ 7.0 mmol/L (126 mg/dL) and/or use of drugs (oral hypoglycemic and/or insulin) defined the diagnosis of diabetes mellitus. We have validated the self-reported diabetes mellitus by calculating the sensitivity, specificity, positive predictive values, and negative predictive values. We have used Poisson regression with robust variance to verify the factors associated with the sensitivity of the self-reported datum. For all analyses, we have considered the sample design of the study. RESULTS The sensitivity of self-reported diabetes mellitus was 63.8% (95%CI 49.2-76.3), specificity was 99.7% (95%CI 99.1-99.9), positive predictive value was 95.5% (95%CI 84.4-98.8), and negative predictive value was 96.9% (95%CI 94.9-98.2). The correct reporting of diabetes mellitus was more prevalent among older adults (PR = 2.0; 95%CI 1.2-3.5) than among adults. CONCLUSIONS The use of the datum of self-reported diabetes mellitus is valid, especially among older adults living in the city of São Paulo. The results highlight the need to track diabetes mellitus in asymptomatic subjects who have one or more risk factors for it, mainly in the adult population of this city.
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Affiliation(s)
| | - Juliana Araújo Teixeira
- Programa de Pós-Graduação de Nutrição em Saúde Pública. Universidade de São Paulo. São Paulo, SP, Brasil
| | - Cristiane Hermes Sales
- Programa de Pós-Graduação de Nutrição em Saúde Pública. Universidade de São Paulo. São Paulo, SP, Brasil
| | | | - Chester Luiz Galvão Cesar
- Departamento do Epidemiologia. Faculdade de Saúde Pública. Universidade de São Paulo. São Paulo, SP, Brasil
| | | | - Moisés Goldbaum
- Departamento de Medicina Preventiva. Faculdade de Medicina. Universidade de São Paulo. São Paulo, SP, Brasil
| | - Dirce Maria Marchioni
- Departamento de Nutrição. Faculdade de Saúde Pública. Universidade de São Paulo. São Paulo, SP, Brasil
| | - Regina Mara Fisberg
- Departamento de Nutrição. Faculdade de Saúde Pública. Universidade de São Paulo. São Paulo, SP, Brasil
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Richardson LM, Hill JN, Smith BM, Bauer E, Weaver FM, Gordon HS, Stroupe KT, Hogan TP. Patient prioritization of comorbid chronic conditions in the Veteran population: Implications for patient-centered care. SAGE Open Med 2016; 4:2050312116680945. [PMID: 27928501 PMCID: PMC5131809 DOI: 10.1177/2050312116680945] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 10/17/2016] [Indexed: 12/14/2022] Open
Abstract
Objective: Patients with comorbid chronic conditions may prioritize some conditions over others; however, our understanding of factors influencing those prioritizations is limited. In this study, we sought to identify and elaborate a range of factors that influence how and why patients with comorbid chronic conditions prioritize their conditions. Methods: We conducted semi-structured, one-on-one interviews with 33 patients with comorbidities recruited from a single Veterans Health Administration Medical Center. Findings: The diverse factors influencing condition prioritization reflected three overarching themes: (1) the perceived role of a condition in the body, (2) self-management tasks, and (3) pain. In addition to these themes, participants described the rankings that they believed their healthcare providers would assign to their conditions as an influencing factor, although few reported having shared their priorities or explicitly talking with providers about the importance of their conditions. Conclusion: Studies that advance understanding of how and why patients prioritize their various conditions are essential to providing care that is patient-centered, reflecting what matters most to the individual while improving their health. This analysis informs guideline development efforts for the care of patients with comorbid chronic conditions as well as the creation of tools to promote patient–provider communication regarding the importance placed on different conditions.
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Affiliation(s)
- Lorilei M Richardson
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Veterans Health Administration, Bedford, MA, USA
| | - Jennifer N Hill
- Center of Innovation for Complex Chronic Health Care, Edward Hines Jr. VHA Hospital, Veterans Health Administration, Hines, IL, USA
| | - Bridget M Smith
- Center of Innovation for Complex Chronic Health Care, Edward Hines Jr. VHA Hospital, Veterans Health Administration, Hines, IL, USA; Department of Pediatrics, Northwestern University, Evanston, IL, USA
| | - Erica Bauer
- Center of Innovation for Complex Chronic Health Care, Edward Hines Jr. VHA Hospital, Veterans Health Administration, Hines, IL, USA
| | - Frances M Weaver
- Center of Innovation for Complex Chronic Health Care, Edward Hines Jr. VHA Hospital, Veterans Health Administration, Hines, IL, USA; Department of Public Health Sciences, Stritch School of Medicine, Loyola University Chicago, Chicago, IL, USA
| | - Howard S Gordon
- Center of Innovation for Complex Chronic Health Care, Jesse Brown VHA Medical Center, Veterans Health Administration, Chicago, IL, USA; Division of Academic Internal Medicine, Department of Medicine, University of Illinois Chicago at College of Medicine, Chicago, IL, USA
| | - Kevin T Stroupe
- Center of Innovation for Complex Chronic Health Care, Edward Hines Jr. VHA Hospital, Veterans Health Administration, Hines, IL, USA; Department of Public Health Sciences, Stritch School of Medicine, Loyola University Chicago, Chicago, IL, USA
| | - Timothy P Hogan
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Veterans Health Administration, Bedford, MA, USA; Division of Health Informatics and Implementation Science, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
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