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Zhu J, Carr F, Sun M, Tian P, McLeod M, De Coutere S. A Pilot Study to Evaluate a New Hep-GRP Care Pathway to Improve Outcomes Among Canadian Older Adults with Liver Cirrhosis. Can Geriatr J 2024; 27:1-19. [PMID: 38433879 PMCID: PMC10896207 DOI: 10.5770/cgj.27.725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
Background Older adults with cirrhosis have complex medical needs that are not satisfied by organ specific management. Interdisciplinary approach may mitigate comorbidity and improve patient satisfaction. Methods A pilot study consisted of dual specialist interdisciplinary referral pathway and mixed virtual care delivery model are prospectively evaluated in older adults (65 years and older) with cirrhosis during the COVID-19 pandemic between September and December 2022. Participant attitudes towards telemedicine were surveyed. Results 68 participants with cirrhosis were consecutively assessed by hepatology. The mean age was 73 years. 39 (57%) screened positive for one or more geriatric syndrome(s). Comprehensive geriatric assessments were conducted via telemedicine in 18 participants, with additional referrals to physiotherapy and nutritional education. Compared to a historic cohort matched for age, sex, and Child-Pugh class, acute health service utilization measured by ER visits among those received dual specialist interdisciplinary consultation were lowered by 1.11 per patient at three-month follow up period (p = .0006, 95% CI 0.47-1.74). Majority participants (87.6%) preferred telemedicine or mixed method visits. Conclusion An interdisciplinary approach to older adults with cirrhosis will likely be beneficial, and routine screening for geriatric syndrome may lead to reduced acute health-care utilization in the short term. Telemedicine and virtual screening tools in seniors should be fully explored to improve access to care.
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Affiliation(s)
- Julie Zhu
- Digestive Care and Endoscopy, Dalhousie University, Halifax, NS
| | | | - Michael Sun
- Geriatrics, Dalhousie University, Halifax, NS
| | - Peter Tian
- Family Medicine, University of Alberta, Edmonton, AB
| | - Magnus McLeod
- General Internal Medicine, Dalhousie University, Halifax, NS
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Modica C, Lewis JH, Bay RC. Advancing Virtual at-Home Care for Community Health Center Patients Using Patient Self-Care Tools, Technology, and Education. J Multidiscip Healthc 2024; 17:521-531. [PMID: 38328633 PMCID: PMC10849139 DOI: 10.2147/jmdh.s443973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 01/22/2024] [Indexed: 02/09/2024] Open
Abstract
Introduction Health centers are community-based, patient directed primary care providers that offer accessible, high-quality primary care within medically underserved communities. Screening for cancer and managing complex chronic conditions such as diabetes, hypertension, obesity, and depression are vital services for the vulnerable populations seen by community health centers. Delivering care for complex chronic conditions and preventive services using virtual models that integrate self-care tools and technology is an important approach to increasing access for hard-to-reach patients served by health centers. Objective This study aimed to explore the use of a virtual care model, applied using a systems approach and patient-driven tools and technology, on the performance of clinical and patient experience measures. Methods A virtual care model, applied using a systems approach offered by the Value Transformation Framework (VTF), was combined with self-care tools and technology in twenty health centers across 17 states to drive improvement efforts. Changes in clinical measures and patient experience were compared. Results A total of 385 patients were enrolled and 270 (70.1%) completed a baseline visit and at least four virtual visits during the six-month intervention period. Statistically significant improvements were seen in measures for HbA1c, systolic and diastolic blood pressure, and bodyweight. Among the 270 who completed the baseline and at least 4 virtual visits, the percentage up-to-date for colorectal cancer screening increased from 113/270 (41.9%) to 169/270 (62.6%) after six months, p<0.001, a 20.7% increase. Patients completing the baseline visit and at least 4 virtual visits reported a 10.7% decrease in depression and increased satisfaction with virtual care visits compared to in-person visits (p<0.001). Conclusion Health centers applying the Value Transformation Framework's organizing framework to the use of virtual care models together with patient self-care tools, technology, and education, had improvements in measures for chronic and preventive conditions and patient experience.
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Affiliation(s)
- Cheryl Modica
- National Association of Community Health Centers, Bethesda, MD, USA
| | - Joy H Lewis
- Department of Medicine and Public Health, A.T. Still University, School of Osteopathic Medicine, Mesa, AZ, USA
| | - R Curtis Bay
- Department of Interdisciplinary Health Sciences, Arizona School of Health Sciences, A.T. Still University, Mesa, AZ, USA
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Hayes Bauer E, Schultz ANØ, Brandt F, Smith AC, Bollig G, Dieperink KB. Patient and families' perspectives on telepalliative care: A systematic integrative review. Palliat Med 2024; 38:42-56. [PMID: 38112009 PMCID: PMC10865769 DOI: 10.1177/02692163231217146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
BACKGROUND Telepalliative care is increasingly used in palliative care, but has yet to be examined from a patient and family perspective. A synthesis of evidence may provide knowledge on how to plan and provide telepalliative care that caters specifically to patients and families' needs. OBJECTIVE To synthesise evidence on patients and families' perspectives on telepalliative care. DESIGN A systematic integrative review (PROSPERO #CRD42022301206) reported in accordance with PRISMA 2020 guidelines. Inclusion criteria; primary peer-reviewed studies published 2011-2022, patient and family perspective, >18 years, telepalliative care and English/Danish language. Quality was appraised using the mixed-methods appraisal tool, version 2020. Guided by Toronto and Remington, data were extracted, thematically analysed and synthesised. DATA SOURCES MEDLINE, EMBASE, PsycINFO and CINAHL were searched in March 2022 and updated in February 2023. RESULTS Forty-four studies were included. Analysis revealed five themes; the effect of the Covid-19 pandemic on telepalliative care, adding value for patients and families, synchronous and asynchronous telepalliative care, the integration of telepalliative care with other services and the tailoring and timing of telepalliative care. CONCLUSION Enhanced access to care and convenience, as attributes of telepalliative care, are highly valued. Patients and families have varying needs during the illness trajectory that may be addressed by early integration of telepalliative care based on models of care that are flexible and combine synchronous and asynchronous solutions. Further research should examine telepalliative care in a post-pandemic context, use of models of care and identify meaningful outcome measures from patient and family perspectives for evaluation of telepalliative care.
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Affiliation(s)
- Eithne Hayes Bauer
- Institute of Regional Health Research, Hospital Soenderjylland, University of Southern Denmark, Odense, Denmark
- Department of Internal Medicine, Medical Research Unit, Hospital Soenderjylland, University Hospital of Southern Jutland, Aabenraa, Denmark
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
- Faculty of Health Sciences, Department of Clinical Research, Family Focused Healthcare Research Centre (FaCe), University of Southern Denmark, Odense, Denmark
| | - Anders Nikolai Ørsted Schultz
- Institute of Regional Health Research, Hospital Soenderjylland, University of Southern Denmark, Odense, Denmark
- Department of Internal Medicine, Medical Research Unit, Hospital Soenderjylland, University Hospital of Southern Jutland, Aabenraa, Denmark
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
| | - Frans Brandt
- Institute of Regional Health Research, Hospital Soenderjylland, University of Southern Denmark, Odense, Denmark
- Department of Internal Medicine, Medical Research Unit, Hospital Soenderjylland, University Hospital of Southern Jutland, Aabenraa, Denmark
| | - Anthony C Smith
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
- Faculty of Medicine, Centre for Online Health, The University of Queensland, Australia
| | - Georg Bollig
- HELIOS Klinikum Schleswig, Department of Anesthesiology, Intensive Care, Palliative Medicine and Pain Therapy, Schleswig, Schleswig-Holstein, Germany
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Karin Brochstedt Dieperink
- Faculty of Health Sciences, Department of Clinical Research, Family Focused Healthcare Research Centre (FaCe), University of Southern Denmark, Odense, Denmark
- Department of Oncology, Odense University Hospital, Odense, Denmark
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Dao T, Long K, Maier AB. Characteristics and perceptions of utilising telehealth for predominantly middle-aged to older, metropolitan-based general medical patients. Intern Med J 2023; 53:2247-2256. [PMID: 36876960 DOI: 10.1111/imj.16047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 02/19/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Effective post-pandemic telehealth (TH) requires understanding patients' characteristics and perceptions, which have not been established in broader clinical services and are independent of TH appointments. AIMS To understand medical patients' characteristics and perspectives on using TH. METHODS General medical patients in a statewide tertiary hospital in Victoria, Australia received a de-identified survey independent of TH appointments during visits between July and November 2020. Patients' characteristics, access to devices enabling TH, knowledge of TH and willingness to use TH were analysed with descriptive statistics. RESULTS Of 1600 patients, 754 (46.4% female, aged 72.0 years [59.0-83.0]) were able to complete the survey. The majority lived in metropolitan areas (74.4%), owned at least one TH device (98.1%) and had internet access at home (55.6%). About 52.7% of patients were comfortable with their devices, and 43.5% had successfully used TH. Although patients preferred face-to-face appointments (80.8%) and 41.4% agreed TH would be as good as in-person appointments, 63.9% were interested in future TH appointments. Patients preferring face-to-face appointments were older (P = 0.008) and had lower education levels (P = 0.010), whereas patients preferring TH had video TH devices (P < 0.05), were comfortable with their devices (P = 0.002) and were willing to use TH (P < 0.05). TH cost saving was parking AU$10.0 [0.0-15.0], driving AU$5.8 [4.5-19.9], public transport AU$8.00 [5.0-10.0], taxis AU$30.00 [15.0-50.0] and time AU$153.2 [76.6-153.2]. CONCLUSION From predominantly middle-aged to older, metropolitan-based general medical patients completing the survey, most patienpreferred face-to-face appointments to TH. Health services should subsidise those in need of TH and target the patients' barriers to effective TH use.
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Affiliation(s)
- Thang Dao
- Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Karrie Long
- Nursing Research Hub, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Andrea B Maier
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
- Healthy Longevity Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Centre for Healthy Longevity, @AgeSingapore, National University Health System, Singapore
- Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
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Tacchini-Jacquier N, Monnay S, Bonvin E, Dubuis J, Verloo H. Relatives' experiences of visiting restrictions during the COVID-19 pandemic's first wave: a PREMs study in Valais Hospital, Switzerland. BMC Health Serv Res 2023; 23:1008. [PMID: 37726727 PMCID: PMC10510254 DOI: 10.1186/s12913-023-10013-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 09/08/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic, most countries introduced temporary visiting restrictions on the relatives of acute care hospital patients, whether or not they were infected with SARS-CoV-2. This affected relatives' psychological and emotional states and how closely they could be involved in their loved one's hospitalization. STUDY AIMS Investigate relatives' experiences of visiting restrictions during the COVID-19 pandemic's first wave and the support offered by Valais Hospital's healthcare staff. METHODS Relatives and patients who had been discharged between February 28 and May 13, 2020, were asked to complete a patient-reported experience measures (PREMs) questionnaire, whether or not they had been infected by SARS-CoV-2. Relatives were asked about how visiting restrictions had affected them, their perceptions of the severity of the COVID-19 pandemic, the quality of communication concerning their loved ones' health status during their hospitalization, and the information received from healthcare staff. Descriptive and inferential statistics were computed. RESULTS Of 866 PREMs questionnaires returned, 818 were analyzable, and 543 relatives had experienced visiting restrictions to their loved ones: 92 relatives (87%) of COVID-19 patients and 451 relatives (66%) of non-infected patients, with heterogenous effects on their psychological and affective status. Overall, whether or not relatives were subjected to visiting restrictions, they perceived themselves to be well treated, well informed, and that communication with hospital healthcare staff was satisfactory. However, relatives subjected to visiting restrictions reported significantly lower scores on the quality of communication than other relatives. The relatives of patients in gynecology/obstetrics and internal medicine wards were significantly more affected by visiting restrictions than were the relatives of patients in other wards. Numerous relatives subjected to visiting restrictions reported regular communication with their loved ones or with healthcare staff, at least once a day (n = 179), either via videoconferences using FaceTime®, WhatsApp®, Zoom®, or Skype® or via mobile phone text messages. CONCLUSION Visiting restrictions affected relatives differently depending on the wards their loved ones were hospitalized. Healthcare institutions should investigate the utility of visiting restrictions on patients, how they affect relatives, and how to improve personalized patient-relative communications. Future research should attempt to develop reliable, validated measurement instruments of relatives' experiences of acute-care visiting restrictions during pandemics.
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Affiliation(s)
- N Tacchini-Jacquier
- Development of Nursing Practices Unit, Valais Hospital, 86, Avenue du Grand-Champsec, CH-1951, Sion, Switzerland
| | - S Monnay
- Social Affairs and Human Resources Specialist, Valais Hospital, 86, Avenue du Grand-Champsec, CH-1951, Sion, Switzerland
| | - E Bonvin
- Valais Hospital, 86, Avenue Grand-Champsec, CH-1951, Sion, Switzerland
| | - J Dubuis
- Valais Family Caregivers' Association, 19, Avenue de Tourbillon, CH-1950, Sion, Switzerland
| | - H Verloo
- Valais Hospital, HES-SO Valais/Wallis, 5, Chemin de L'Agasse, CH-1950, Sion, Valais, Switzerland.
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Spiess ST, Gardner E, Turner C, Galt A, Fortenberry K, Ho T, Knox J, Ose D. We Cannot Put This Genie Back in the Bottle: Qualitative Interview Study Among Family Medicine Providers About Their Experiences With Virtual Visits During the COVID-19 Pandemic. J Med Internet Res 2023; 25:e43877. [PMID: 37651162 PMCID: PMC10502598 DOI: 10.2196/43877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 05/09/2023] [Accepted: 05/31/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND When a genie is freed from its bottle, things cannot be restored to the way they were before. At the beginning of the global COVID-19 pandemic, health care systems adjusted how they delivered care overnight. Primary care practices switched from seeing patients in person to virtual care applications, including video and phone visits, e-visits, e-consults, and messaging with clinicians. Prior to the pandemic, these applications were not as widely used, but discussions around their advantages and disadvantages in some settings were being explored. Emergency regulatory changes spurred by the pandemic freed this virtual care "genie" from its bottle. Wide-scale adoption of virtual care in family medicine has much potential, as primary care services are often a patient's first point of contact with the health care system. OBJECTIVE This study aims to analyze family medicine providers' experiences using virtual visits during the pandemic, perceived outcomes of the shift to virtual visits, and discusses its implications for the future of family medicine. METHODS This qualitative study took place at 3 academic primary care clinics between June and December 2020. Data were collected through one-on-one Zoom (version 5.2.1) interviews with family medicine clinical faculty who experienced the rapid transition of in-person visits to mostly "virtual" visits. The interviews were recorded, deidentified, and transcribed. We adopted a constructivist approach to qualitative content analysis to evaluate the results. RESULTS In total, 25 participants were eligible, and 20 individuals participated in this study (80% participation rate). The mean age was 43.4 years, and 85% (17/20) of the participants were female. We identified 3 main themes: the care process, patient engagement, and team-based care. CONCLUSIONS This study highlights the transition from in-person to virtual visits during the pandemic from the perspective of family medicine providers. Generally, family medicine providers' perceptions of the shift to virtual visits were positive, especially regarding team-based care. Challenges involved virtual inhibition, particularly for providers. Providers described ways they integrated virtual care with aspects of in-person care, creating a hybrid environment. The genie is out of the bottle-things will not be the same-but family medicine now has the opportunity to evolve.
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Affiliation(s)
- Saskia T Spiess
- Department of Family and Preventative Medicine, School of Medicine, University of Utah Health, Salt Lake City, UT, United States
| | - Elena Gardner
- Department of Family and Preventative Medicine, School of Medicine, University of Utah Health, Salt Lake City, UT, United States
| | - Cindy Turner
- Department of Family and Preventative Medicine, School of Medicine, University of Utah Health, Salt Lake City, UT, United States
| | - Annie Galt
- Department of Family and Preventative Medicine, School of Medicine, University of Utah Health, Salt Lake City, UT, United States
| | - Katherine Fortenberry
- Department of Family and Preventative Medicine, School of Medicine, University of Utah Health, Salt Lake City, UT, United States
| | - Tiffany Ho
- Department of Family and Preventative Medicine, School of Medicine, University of Utah Health, Salt Lake City, UT, United States
| | - Jordan Knox
- Department of Family and Preventative Medicine, School of Medicine, University of Utah Health, Salt Lake City, UT, United States
| | - Dominik Ose
- Department of Family and Preventative Medicine, School of Medicine, University of Utah Health, Salt Lake City, UT, United States
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Mavragani A, Batterham PJ, Gulliver A, Morse A, Calear AL, McCallum S, Banfield M, Shou Y, Newman E, Dawel A. The Factors Associated With Telehealth Use and Avoidance During the COVID-19 Pandemic: Longitudinal Survey. J Med Internet Res 2023; 25:e43798. [PMID: 36649254 PMCID: PMC9947771 DOI: 10.2196/43798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/16/2022] [Accepted: 01/06/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Social distancing requirements due to the COVID-19 pandemic saw a rapid increase in the delivery of telehealth consultations as an alternative to face-to-face health care services. OBJECTIVE The aims of this study were to assess the use and acceptability of telehealth during the early stages of the pandemic and identify factors associated with telehealth avoidance during this period. METHODS Data were obtained from waves 4 and 7 of a longitudinal survey designed to assess the impact of the COVID-19 pandemic on the health and behavior of a representative sample of Australian adults. Participants reported on their use or avoidance of telehealth during the assessment period, as well as the mode of telehealth used and acceptability. RESULTS Approximately 30% of participants reported using telehealth during the assessment periods, with the most common telehealth modality being the telephone. Acceptance of telehealth was generally high and was higher among those who used telehealth compared with those who did not. Approximately 18% of participants reported avoiding health care due to telehealth. Across assessment waves, avoidance was associated with younger age, speaking a language other than or in addition to English, having a current medical diagnosis, and lower levels of telehealth acceptability. CONCLUSIONS While most participants in this study were accepting of telehealth services, there remain barriers to use, especially among those from particular sociodemographic groups. At a population level, avoidance of health services in nearly one in five adults may have considerable long-term impacts on morbidity and potentially mortality. Targeted efforts to promote engagement with telehealth services are critical if these adverse outcomes are to be avoided, particularly during periods when access to face-to-face services may be limited.
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Affiliation(s)
| | - Philip J Batterham
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
| | - Amelia Gulliver
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
| | - Alyssa Morse
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
| | - Alison L Calear
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
| | - Sonia McCallum
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
| | - Michelle Banfield
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
| | - Yiyun Shou
- Research School of Psychology, The Australian National University, Canberra, Australia.,Saw See Hock School of Public Health, National University of Singapore, Singapore, Singapore.,Lloyd's Register Foundation Institute for the Public Understanding of Risk, National University of Singapore, Singapore, Singapore
| | - Eryn Newman
- Research School of Psychology, The Australian National University, Canberra, Australia
| | - Amy Dawel
- Research School of Psychology, The Australian National University, Canberra, Australia
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Pakenham K, Martin CL. Psychosocial palliative care: Patients' preferred intervention medium, target domains, and well-being priorities. Palliat Support Care 2022:1-9. [PMID: 36377378 DOI: 10.1017/s1478951522001535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Although psychological distress in palliative patients has at least an equal or greater impact on the quality of life compared to physical or spiritual distress, there is limited research on contextual factors associated with psychosocial intervention accessibility and relevance. This is the first published study to explore patients' views on psychosocial intervention delivery medium preferences, key biopsychosocial target domains, and well-being priorities during the palliative and end-of-life (EOL) phases. METHODS Eighty-one palliative patients from a Specialist Palliative Care Service completed a questionnaire, which collected quantitative and qualitative data on preferred mediums for receiving psychosocial interventions, priority biopsychosocial target domains, and well-being priorities during the palliative and EOL phases. RESULTS Results showed that an individual in-person was the most preferred medium for receiving psychosocial interventions. Improving quality of life, distressing emotions, and adjusting to the palliative care context were the 3 most frequently endorsed biopsychosocial target domains. Valued living and comfortable living were the key priority well-being themes for the palliative phase, whereas being surrounded by loved ones and comfortable and dignified dying were the priority well-being themes for the EOL phase. SIGNIFICANCE OF RESULTS Findings highlight psychosocial interventions as an essential part of a holistic approach to patient-centered care throughout both the palliative and the EOL phases. Results can inform the refinement of existing and the development of new psychosocial interventions, particularly those that target emotional distress, adjustment, and quality of life. Furthermore, in-person treatment delivery remains essential in an evolving digital world.
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Affiliation(s)
- Kenneth Pakenham
- School of Psychology, The University of Queensland Faculty of Health and Behavioural Sciences, St Lucia, QLD, Australia
| | - Christopher Lloyd Martin
- School of Psychology, The University of Queensland Faculty of Health and Behavioural Sciences, St Lucia, QLD, Australia
- Specialist Palliative Care Service, Sunshine Coast Hospital and Health Service, 2B West Terrace, Caloundra, QLD, Australia
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Gleeson LL, Ludlow A, Clyne B, Ryan B, Argent R, Barlow J, Mellon L, De Brún A, Pate M, Kirke C, Moriarty F, Flood M. Pharmacist and patient experiences of primary care during the COVID-19 pandemic: An interview study. Explor Res Clin Soc Pharm 2022; 8:100193. [PMID: 36268130 PMCID: PMC9557137 DOI: 10.1016/j.rcsop.2022.100193] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 09/18/2022] [Accepted: 10/10/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction A number of significant changes designed to reduce the spread of COVID-19 were introduced in primary care during the COVID-19 pandemic. In Ireland, these included fundamental legislative and practice changes such as permitting electronic transfer of prescriptions, extending duration of prescription validity, and encouraging virtual consultations. Although such interventions served an important role in preventing the spread of infection, their impact on practice and patient care is not yet clear. The aim of this study was to investigate patient and healthcare professional (pharmacist and general practitioner) experiences to understand the impact of COVID-19 on primary care and medication safety during the first two years of the COVID-19 pandemic in Ireland. Methods A qualitative study using semi-structured interviews was undertaken between October 2021 and January 2022. Participants included twelve patients, ten community pharmacists, and one general practitioner. Interviews were transcribed verbatim and analysed using thematic analysis. Only patient and pharmacist interviews were included. Findings Themes from the interviews included: 1) Access to care, 2) Technological changes, 3) Experiences of care, and 4) Patient safety. Particular challenges identified included the difficulty faced by patients when accessing care, impacts on experiences of patient care, and extensive changes to pharmacy practice during the pandemic. Conclusions This study found that COVID-19 countermeasures considerably impacted patient and pharmacist experiences of primary care in terms of care and medication safety. While many changes were welcomed, others such as virtual consultations were received more cautiously likely due to the rapid and unplanned nature of their introduction. Further research is needed to identify how to optimise these changes to improve pharmacist and patient experience, and to understand the impact on patient safety.
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Affiliation(s)
- Laura L. Gleeson
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
| | - Aoife Ludlow
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
| | - Barbara Clyne
- Department of General Practice, RCSI University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
| | - Ben Ryan
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
| | - Rob Argent
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
| | - James Barlow
- Department of Pharmaceutical and Medicinal Chemistry, RCSI University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
| | - Lisa Mellon
- Department of Health Psychology, School of Population Health, RCSI University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
| | - Aoife De Brún
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin 4, Ireland
| | - Muriel Pate
- National Quality and Patient Safety Directorate, Health Service Executive, Dr Steevens' Hospital, Dublin 8, Ireland
| | - Ciara Kirke
- National Quality and Patient Safety Directorate, Health Service Executive, Dr Steevens' Hospital, Dublin 8, Ireland
| | - Frank Moriarty
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
| | - Michelle Flood
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
- Corresponding author.
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