Healthcare professionals' perceptions and management of obesity & knowledge of glucagon, GLP-1, GIP receptor agonists, and dual agonists

Background

Anti-obesity medications (AOMs) have historically had limited weight-loss efficacy. However, newer glucagon-like peptide-1 receptor agonist (GLP-1 RA)-based therapies seem to be more effective, including dual agonists of GLP-1R and the glucagon receptor (GCGR) or glucose-dependent insulinotropic polypeptide receptor.

Objective

To explore healthcare professionals' (HCPs) experience in obesity treatment and their understanding of agonists of GCGR, glucose-dependent insulinotropic polypeptide (GIP) RA, and GLP-1 RA.

Methods

This cross-sectional online survey of HCPs prescribing AOMs was conducted in the United States in 2023 with a questionnaire designed to evaluate prescribing behavior and understanding of GCGR, GIP RA, and GLP-1 RA.

Results

The 785 respondents (251 primary-care physicians [PCPs], 263 endocrinologists, and 271 advanced practice providers [APPs]) reported 55% of their patients had obesity (body mass index ≥30 kg/m2 or ≥27 with weight-related complications) and recommended AOMs to 49% overall, significantly more endocrinologists (57% of patients, p < 0.0005) than PCPs (43%) or APPs (46%). The greatest barriers to treatment were medication cost/lack of insurance (mean 4.2 on 1-5 scale [no barrier-extreme barrier]), low patient engagement/adherence (3.3), and inadequate time/staff (3.1). Metformin was the type 2 diabetes (T2D) medication most commonly prescribed to treat obesity in T2D patients (92.5% of respondents). Most HCPs (65%) were very/extremely familiar with GLP-1 RA, but only 30% with GIP RA and 16% with GCGR. Most HCPs expected dual GCGR/GLP-1 RA to benefit many obesity-related conditions; however, only a minority of HCPs perceived that they would benefit non-cardiometabolic complications of obesity.

Conclusions

Among HCPs prescribing AOMs, gaps exist in the management of people living with obesity as <50% are prescribed AOMs. Barriers to treatment indicate a need to improve access to AOMs. HCPs were less familiar with GCGR or GIP RA than GLP-1 RA but expect dual GCGR/GLP-1 RA may offer additional benefits, potentially addressing treatment barriers and access. Thus, there is a need for greater education among HCPs regarding the mechanism of action and therapeutic effects of GCGR agonists, and dual GCGR/GLP-1 RA, so that the full range of obesity-related complications can be effectively treated.

Interventions and Hospital Characteristics Associated With Patient Experience: An Update of the Evidence

Patient experience is a key hospital quality measure. We review and characterize the literature on interventions, care and management processes, and structural characteristics associated with better inpatient experiences as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Prior reviews identified several promising interventions. We update these previous efforts by including more recent peer-reviewed literature and expanding the review's scope to include observational studies of HCAHPS measures with process measures and structural characteristics. We used PubMed to identify U.S. English-language peer-reviewed articles published in 2017 to 2020 and focused on hospital patient experience. The two HCAHPS domains for which we found the fewest potential quality improvement interventions were Communication with Doctors and Quietness. We identified several modifiable processes that could be rigorously evaluated in the future, including electronic health record patient engagement functionality, care management processes, and nurse-to-patient ratios. We describe implications for future policy, practice, and research.

Awareness of people using municipal swimming pools about the prevention, symptoms, and treatment of athlete's foot and onychomycosis before COVID-19

Introduction

Superficial mycosis is one of the most common diseases worldwide; however, its epidemiology is changing over time.

Aim

To present the awareness of people using swimming pools about athlete's foot and onychomycosis.

Material and methods

A total of 690 participants were subjected to an extensive survey administered via Google Documents. The questionnaire consisted of 30 online polling items and aimed to evaluate respondents' knowledge pertaining to fungal infections, encompassing aspects such as prevention strategies, disease trajectory, and therapeutic modalities. The survey sample specifically encompassed students and sports enthusiasts associated with 33 Internet groups, and data collection transpired during the period spanning 12 January to 15 March, 2018, predating the advent of the COVID-19 pandemic.

Results

In the study, 85.2% of participants regularly inspected their feet, with 4.8% seeking podiatric services. While 75.2% demonstrated hygienic behaviour by changing towels after each pool visit, 41.4% acknowledged sharing nail tools. Notably, 75.7% preferred professional assistance for symptoms, with 24.3% opting for home remedies. Gender disparities were evident, with women showing significantly better hygiene practices and pool usage than men (p < 0.001). Women also exhibited a stronger tendency to disinfect grooming tools and prioritise sterility during beautician services (p < 0.001). These findings emphasise the importance of gender-specific health behaviour analysis in promoting preventive measures.

Conclusions

The study highlights onychomycosis as a significant societal concern. Pre-COVID-19, awareness among municipal swimming pool users regarding prevention, symptoms, and treatment of athlete's foot and onychomycosis was insufficient.

Accessibility of Pelvic Floor Physiotherapy for Treating Urinary Incontinence in Older Women in Quebec: An Online Survey

Purpose

This cross-sectional descriptive study describes available pelvic floor physiotherapy (PT) services for older women with urinary incontinence (UI) in Quebec, Canada, and identifies possible affordability barriers.

Methods

From September to December 2019, Quebec physiotherapists practising pelvic floor PT were invited to complete a survey on their clinical practice and perceptions of the affordability of UI treatment for older women.

Results

Eighty-four of the 225 registered pelvic floor physiotherapists (37.3%) filled out the online survey. They worked a median of 32 hours/week in PT, with 15 of those hours (46.9%) in pelvic floor PT and three hours (9.8%) treating UI in older women. Only 13.0% of them offered group treatment, while 84.3% were interested in it. Most of the physiotherapists (92.2%) had met older women in their practice who had reported financial barriers to completing their pelvic floor PT treatment.

Conclusions

The accessibility of UI care in Quebec appears hampered by the limited availability of pelvic floor PT treatments, mainly in public settings, and potential financial constraints. Providing pelvic floor PT to groups could constitute a promising avenue to tackle both issues. Future studies should look at ways of implementing this option.

Correlation of morning dry mouth with clinical features of OSA in a community population: a cross-sectional study

OBJECTIVES

Morning dry mouth, commonly seen in Obstructive Sleep Apnea (OSA) patients, is absent in current OSA screening tools. This study evaluated the link between morning dry mouth and OSA's clinical symptoms and complications, aiming to determine its viability as a screening indicator.

METHODS

This research analyses baseline data from a prospective cohort study (the PIFCOPD study). Demographic information, medical history, and the presence of morning dry mouth symptoms were collected. The STOP-Bang questionnaire was performed for OSA screening. Logistic regression analyses were employed to establish the correlations between morning dry mouth and the clinical symptoms and comorbidities of OSA.

RESULT

1291 participants (62.1±7.5 years; 501 males, 790 females) were included, of which 416 reported morning dry mouth (32.2%). 42.6% in the high-risk OSA group and 22.1% in the low-risk group reported morning dry mouth. Individuals with morning dry mouth also showed higher STOP-Bang scores (3.3±1.6 vs. 2.3±1.4, P<0.01). Significant associations were found between morning dry mouth and loud snoring, observed sleep apnea, daytime fatigue, and hyperlipidemia (P<0.01), but not with alcohol consumption, tea consumption, diabetes, or hypertension.

CONCLUSION

Morning dry mouth is associated with increased OSA risk and its clinical signs, suggesting its potential as an OSA screening symptom.

CLINICAL TRIAL REGISTRATION

This study has been registered at www.ClinicalTrials.gov (registration identifier: NCT03532893) on 21 May 2018.

Feedback reports to the general practitioner (GP) on the patients' experiences: are GPs interested, and is this interest associated with GP factors and patient experience scores?

BACKGROUND

Patient experience feedback is key in patient centred health systems, but empirical evidence of general practitioner (GP) interest in it is sparse. We aimed to: (i) quantitatively estimate the level of GP interest for feedback reports on patient experience; (ii) explore determinants of such interest; and (iii) examine potential association between a priori interest and patient experience.

METHODS

The patient experience survey included maximum 300 randomly selected patients for each of 50 randomly selected GPs (response rate 41.4%, n = 5,623). GPs were sent a postal letter offering feedback reports and were grouped according to their replies: (i) interested in the report; (ii) not interested. Associations between interest and GP variables were assessed with Chi-square tests and multivariate logistic regression, while associations between interest and scores for 5 patient experiences scales were assessed with multilevel regression models.

RESULTS

About half (n = 21; 45.7%) of the GPs showed interest in the report by asking to receive the report. The only GP variable associated with a priori interest was being a specialist in general practice (58.6% vs. 23.5% for those without) (P = 0.021). Interest was significantly associated with the practice patient experience scale (4.1 higher score compared with those not interested, P = 0.048). Interest in the report had small and nonsignificant associations with the remaining patient experience scales.

CONCLUSIONS

Almost half of the GPs, and almost 3 in 5 of specialists in general practice, were interested in receiving a GP-specific feedback report on patient experiences. Interest in the report was generally not related to patient experience scores.

Management of post-stroke fatigue: an Australian health professional survey

PURPOSE

Evidence for post-stroke fatigue management is limited. We aimed to explore how Australian health professionals assess and assist fatigue management. Our objectives were to identify fatigue assessment tools and interventions used, explore clinician's confidence managing fatigue and explore whether management of post-stroke fatigue differs from management of fatigue related to other conditions.

MATERIALS AND METHODS

An online cross-sectional survey was completed by Australian health professionals (n = 60) providing services to people with fatigue. Analysis of open-ended questions identified common interventions and descriptive statistics were calculated for closed and dichotomized questions.

RESULTS

Routine use of formal fatigue assessment tools was low (17%, n = 10). Most respondents reporting use of the Fatigue Impact Scale, Fatigue Assessment Scale and Fatigue Severity Scale. To address fatigue, respondents reported providing energy optimization strategies, education, and exercise interventions in clinical practice. Less frequently reported interventions were strategies to adapt tasks, sleep hygiene, psychology, nutrition, and pharmacology interventions. Respondents were "moderately" confident managing post-stroke fatigue. Respondents did not report differences between how they manage post-stroke fatigue and fatigue present in other conditions.

CONCLUSIONS

Few Australian health professionals formally assess post-stroke fatigue. Management is multidisciplinary and based on evidence from fatigue management in other conditions.Implications for rehabilitationMost health professionals are not routinely using formal assessment tools for fatigue, possibly due to a lack of consensus on best practice in research.Common strategies recommended by health professionals include energy optimisation strategies, education and exercise.Comprehensive guidelines for post-stroke fatigue management are yet to be established.Health professionals should assess post-stroke fatigue using a validated tool to ensure an individualised approach to management based on the current available clinical guidelines.

Venous thromboembolism prophylaxis for hospitalized adult patients: a survey of US health care providers on attitudes and practices

Background

Venous thromboembolism (VTE) is a leading cause of preventable mortality among hospitalized patients, but appropriate risk assessment and thromboprophylaxis remain underutilized or misapplied.

Objectives

We conducted an electronic survey of US health care providers to explore attitudes, practices, and barriers related to thromboprophylaxis in adult hospitalized patients and at discharge.

Results

A total of 607 US respondents completed the survey: 63.1% reported working in an academic hospital, 70.7% identified as physicians, and hospital medicine was the most frequent specialty (52.1%). The majority of respondents agreed that VTE prophylaxis is important (98.8%; 95% CI: 97.6%-99.5%) and that current measures are safe (92.6%; 95% CI: 90.2%-94.5%) and effective (93.8%; 95% CI: 91.6%-95.6%), but only half (52.0%; 95% CI: 47.9%-56.0%) believed that hospitalized patients at their institution are on appropriate VTE prophylaxis almost all the time. One-third (35.4%) reported using a risk assessment model (RAM) to determine VTE prophylaxis need; 44.9% reported unfamiliarity with RAMs. The most common recommendation for improving rates of appropriate thromboprophylaxis was to leverage technology. A majority of respondents (84.5%) do not reassess a patient's need for VTE prophylaxis at discharge, and a minority educates patients about the risk (16.2%) or symptoms (18.9%) of VTE at discharge.

Conclusion

Despite guideline recommendations to use RAMs, the majority of providers in our survey do not use them. A majority of respondents believed that technology could help improve VTE prophylaxis rates. A majority of respondents do not reassess the risk of VTE at discharge or educate patients about this risk of VTE at discharge.

Health care needs and health services utilization of people with spinal cord injury living in Jiangsu and Sichuan provinces of China: a cross-sectional community survey

PURPOSE

We aimed to investigate health care needs, health service utilization, and their socio-economic and health-related determinants in people with spinal cord injury (SCI) living in Jiangsu and Sichuan Provinces of China.

MATERIALS AND METHODS

A total of 1355 participants with SCI living in the community were recruited using a multi-stage stratified random sample and surveyed by telephone or online. Outcomes evaluated included the presence of health care needs, mode of health service utilization, and specific provider types seen within 12 months preceding the survey.

RESULTS

The prevalence of healthcare needs was 92%. Needs were higher in Sichuan (98%) as compared to Jiangsu (80%). Of those in need of health care, 38% reported not having utilized care, more in Sichuan (39%) than in Jiangsu (37%). In Jiangsu, inpatient care was more often used than in Sichuan (46% vs. 27%), while in Sichuan outpatient services were utilized more often (33% vs. 17%). On average, 1.6 provider types were seen, with Sichuan reporting fewer different provider types.

CONCLUSIONS

Considerable differences in the prevalence of health care needs and service utilization patterns were found between provinces, mostly in favour of the economically more developed Jiangsu Province.Implications for RehabilitationPeople with low income, particularly those below the World Bank poverty line for middle-income countries, had increased health care needs but utilized health care less often.Moreover, environmental barriers contributed significantly to unmet health care needs.This implies the necessity to provide better accessible and more affordable rehabilitation services for people with spinal cord injury (SCI) in China such as community-based rehabilitation programming.Policies for alleviation of poverty in the case of SCI including insurance for catastrophic health expenditure should also be reviewed and adapted where applicable.

Patient interpretations vary for questions in the Patient-Reported Outcomes Measurement Information System Upper Extremity

The Patient-Reported Outcomes Measurement Information System Upper Extremity (PROMIS-UE) is frequently used in research/clinical care, but how it is understood by patients is unknown. We conducted a qualitative study including 12 cognitive interviews with patients with hand/upper extremity conditions and those purposively sampled for mixed literacy. Using framework analysis, we identified six themes total: difficulty answering questions due to insufficient information; uncertainty about whether to respond with the ability to perform the task with the injured extremity alone, either the injured or healthy extremity, or both; lack of experience doing certain tasks; uncertainty about whether to answer questions based on ability to perform the task with or without adaptive techniques; answering questions based on limitations not related to upper extremity function; and uncertainty regarding whether to answer questions on the basis of ability or pain. This study demonstrates the challenges in completing questionnaires and that variability may limit the reliability, validity and responsiveness of the PROMIS-UE.

Teleneuropsychology during the COVID-19 pandemic in Mexico: the perspective from a middle-income country

INTRODUCTION

The use of teleneuropsychology (TeleNP) increased as a result of the COVID-19 pandemic; however, there have been no studies of the benefits and difficulties with this modality in middle-income countries. This study aimed to assess the current use of TeleNP in Mexico.

METHOD

Mexican neuropsychologists were invited to participate in an online survey regarding the use of TeleNP during the COVID-19 pandemic. The survey was based on issues from a literature review and consisted of 36 questions requiring yes/no, multiple choice, or ordinal answers. The survey was created using Google Forms and asked respondents to provide informed consent. A total of 107 clinical neuropsychologists completed the survey.

RESULTS

82% of participants currently use TeleNP, and most reported learning about TeleNP through personal experience, literature research, and colleagues. Brief evaluations, delivery of results, and intervention were the principal services provided, most frequently on a home-to-home basis. Almost 30% of clinicians reported not requiring informed consent for use of the modality. Consultations included children, adolescents, and adults in similar numbers; older adults were less frequent. Technological limitations were the most frequent reason for ruling out the modality with particular patients. Perceived benefits included the ability to continue consultations despite social distancing measures, lesser risk of COVID-19 infection, and the possibility of seeing patients with limited access to neuropsychological services. Reasons for not using TeleNP included a lack of standardized instruments, not feeling comfortable with the modality, and lack of technological resources and skills.

CONCLUSIONS

Despite the socioeconomic differences between Mexico and high-income countries, most of our findings were similar to reports from those countries. However, technological limitations were common, and smartphones were commonly used, contrary to recommendations in the literature. The future use of TeleNP in Mexico should include formal training and ethical guidelines.

Leveraging Free-Form Comments to Assess and Improve Patient Satisfaction

This study employed a text-analysis methodology to identify themes within patient comments and measure the relationship of those themes to patient satisfaction. Using these findings, a spreadsheet tool was created to allow a large sample of comments to be readily analyzed. The tool was validated using patient comment data provided by the Family Medicine Residency of Idaho. The tool gives clinicians the ability to easily analyze patient comments and identify actionable measures of patient satisfaction. Additionally, this tool will allow researchers to reduce vast sets of comment text into numerical data suited for quantitative analyses.

Effect of inpatient experiences on patient satisfaction and the willingness to recommend a hospital: The mediating role of patient satisfaction: A cross-sectional study

BACKGROUND AND AIMS

As high-quality health care encompasses patient-centered care, this study used the perceived quality-satisfaction-behavioral intention and structure-process-outcome models to (1) investigate the relationships among patient experience, patient satisfaction, and the willingness to recommend a hospital and (2) estimate the indirect effects of patient satisfaction on the relationship between patient experience and the willingness to recommend a hospital.

METHODS

A cross-sectional survey design was adopted to investigate data obtained from the Seoul National University Hospital Patient Experience survey administered in 2020. Responses were analyzed from 1555 patients, who had been admitted to the inpatient ward of a tertiary hospital for a period lasting more than 1 day.

RESULTS

The path model demonstrated a good fit to the relationships between patient experience, patient satisfaction, and the willingness to recommend the hospital. Patient experience directly influenced patient satisfaction (β = 0.659, p < 0.001) and the willingness to recommend the hospital (β = 0.168, p < 0.001), whereas patient satisfaction had an indirect effect (β = 0.418, p < 0.001) on the relationship between patient experience and the willingness to recommend the hospital.

CONCLUSION

Patient experience is a critical factor that health care systems need to consider for enhancing patient-centeredness, patient satisfaction, and the willingness to recommend a hospital.

A Linear Decomposition Approach to Explain Excess Direct Healthcare Expenditures Associated with Pain Among Adults with Osteoarthritis

Objective:

Many patients with osteoarthritis experience pain which can lead to higher healthcare expenditures. It is important to understand the factors that drive the excess expenditures associated with pain in osteoarthritis.

Design:

Cross-sectional.

Study sample:

Our study sample consisted of adults (age ⩾ 18 years) from the Medical Expenditure Panel Survey (MEPS, 2018).

Methods:

Adults who were alive during the calendar year and had pain status were included in this study (N = 2804 weighted N = 32.03 million). Osteoarthritis was identified from the medical conditions file and household file. We used multivariable ordinary least squares regression to identify the statistically significant association of pain with direct healthcare expenditures. The Blinder-Oaxaca post-linear decomposition on log-transformed total direct healthcare expenditures was used to estimate the extent to which differences in characteristics contribute to the excess expenditures associated with pain.

Results:

Adults with osteoarthritis and pain had higher average expenditures ($21 814 vs $10 827, P < .001; 9.318 vs 8.538 in logtransformed expenditures) compared to those without pain. Pooled regression weights explained 62.9% of excess expenditures differences in characteristics between the 2 groups. The 2 main drivers of excess healthcare expenditures among adults with osteoarthritis and pain were (i) comorbidities (diabetes, asthma, chronic obstructive pulmonary disease, depression, heart diseases, cancer, and non-cancer pain conditions and (ii) prescription medications (NSAIDs, opioids, and polypharmacy).

Conclusion:

Need factors such as comorbid conditions, and prescription treatment explained the excess healthcare expenditures among adults with osteoarthritis and pain. The study findings suggest that reducing polypharmacy and appropriate management of comorbid conditions may be a pathway to reduce excess expenditures among adults with osteoarthritis and pain.

Men prefer pre-vasectomy consultation by telephone: a survey of vasectomized men

INTRODUCTION

Due to the COVID-19 pandemic teleconsultation was allowed as an insured service in the province of Quebec, Canada. We assessed the preferences of vasectomized patients for a pre-vasectomy consultation conducted in-person or by telephone.

MATERIALS AND METHODS

In September 2021, we sought the participation of 214 men who had their pre-vasectomy consultation over the phone to complete an anonymous three-item survey on their preferred modality for pre-vasectomy consultation. They completed their questionnaire in the waiting room of the vasectomy clinic just after the surgical procedure. We calculated the proportion and 95% confidence interval [CI] of patients preferring each modality. We assessed the difference in preference according to the distance between hometown and vasectomy clinic (< 25 km, 25-50 km, and > 50 km) with Fisher's exact test.

RESULTS

Participation rate was 98% (n = 209/214). Most patients would have preferred telephone over in-person pre-vasectomy consultation if they had been given a choice (96%; 95% CI 92% to 98%), if they had had to recommend a modality to a friend (95%; 95% CI 91% to 98%), and if they had had to do a pre-vasectomy consultation again (prefer or no preference; total 97%; 95% CI 94% to 99%). Distance between hometown and vasectomy clinic did not significantly influence their preferences (p > 0.29 for each of the three items).

CONCLUSIONS

Vasectomized men preferred having pre-vasectomy consultation by telephone instead of in person. If maintained as an insured service after the COVID-19 pandemic, Canadian physicians offering vasectomy services should consider making this service available to their patients.

A survey on the attitudinal differences between acute and community settings

INTRODUCTION

While challenges facing community and acute care practitioners have been studied elsewhere, this is not the case for respiratory therapists (RTs). This study aimed to examine attitudinal differences amongst RTs in British Columbia regarding challenges faced by acute and community settings.

METHODS

A 40-item anonymous online survey was sent to members of the British Columbia Society or Respiratory Therapists. Of the 40 questions, 11 were relevant to the study's aim.

RESULTS

Of 1024 invitations, 197 (19.2%) responded. One-hundred and seventeen (59.4%) self-identified as working in acute care settings, 53 (26.9%) in community settings, and 27 (13.7%) as "other". Stress- and interpersonal-related challenges showed statistically significant differences (P ≤ 0.05) based on work setting. Acute care had the highest percentage of responses for challenges related to technology, stress, inter-professional collaboration, and training. Community settings had the highest percentage in challenges related to independence and education. Both being equal received the highest percentage in challenges related to problem-solving, interpersonal, communication, and resource management.

DISCUSSION

While attitudinal differences exist, they are not extreme. It did not appear that respondents' primary motivation was to vote along "party lines".

CONCLUSIONS

The setting an RT works in can influence attitudes related to stress and interpersonal challenges. Despite this, one setting is not universally more challenging. Acute care settings can have greater technological, inter-professional, and training-related challenges. Community settings can have greater independence and education-related challenges. Both settings can provide similar challenges with problem-solving, communication, and resource management.

Utilization and quality assessment of digestive endoscopy in China: results from 5-year consecutive nationwide surveys

BACKGROUND

Worldwide, the volume and availability of digestive endoscopy have undergone dramatic development in recent years, with increasing attention on quality assurance. We investigated the utilization and quality of digestive endoscopy in China from 2015 to 2019 and developed a quantitative quality evaluation tool for medical institutions.

METHODS

We invited all tertiary/secondary hospitals in Chinese mainland to participate in the survey annually. The questionnaires included the personnel, annual volume, and quality indicators of endoscopy. An endoscopy quality index (EQI) was developed based on recorded quality indicators using principal component analysis to determine the relative weight.

RESULTS

From 2015 to 2019, 806, 1412, 2644, 2468, and 2541 hospitals were respectively enrolled in this study. The average annual volume of endoscopy increased from 12,445 to 16,206 (1.30-fold) and from 2938 to 4255 (1.45-fold) in tertiary and secondary hospitals, respectively. The most obvious growth was observed in diagnostic colonoscopy (1.44-fold for all hospitals after standardization). The proportion of early cancer among all esophageal and gastric cancers during diagnostic esophagogastroduodenoscopy increased from 12.3% (55,210/448,861) to 17.7% (85,429/482,647) and from 11.4% (69,411/608,866) to 16.9% (107,192/634,235), respectively. The adenoma detection rate of diagnostic colonoscopy increased from 14.9% (2,118,123/14,215,592) to 19.3% (3,943,203/20,431,104). The EQI model included 12 quality indicators, incorporating 64.9% (7.792/12) of the total variance into one comprehensive index. According to the EQI measurements, the quality of endoscopy was higher in tertiary hospitals and hospitals in developed areas with higher volume or more endoscopists than that in other hospitals.

CONCLUSIONS

Digestive endoscopy in China has developed considerably in recent years in terms of both volume and quality. The EQI is a promising tool to quantify the quality of endoscopy at different hospitals.

Obstetric Provider Attitudes and Office Practices for Maternal Influenza and Tdap Vaccination

Background: Although maternal vaccination with influenza and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccines improve health outcomes for pregnant individuals and infants, maternal vaccination rates are low. This study assessed obstetric providers' attitudes and practices related to influenza and Tdap vaccination in four large health systems in New York (NY) and California (CA). Methods: We conducted a cross-sectional survey of all obstetric providers within four health systems (two in NY, two in CA) to evaluate provider attitudes and office systems used for Tdap and influenza vaccination. The survey assessed perceptions of influenza and Tdap vaccination based on the Health Belief Model, and assessed office systems (reminders, prompts, standing orders, and patient education) and communication with pregnant patients related to influenza and Tdap vaccines. Results: We had 112 responses (52% response rate) for analyses. Respondents strongly supported vaccination during pregnancy but viewed influenza disease as less of a concern for newborns than for pregnant individuals (40% vs. 67% considered influenza disease to be very significant, p < 0.001). Only 84% agreed that giving influenza vaccine in the first trimester is very safe. Patient vaccine refusal was the most commonly named barrier for both influenza and Tdap vaccination. Providers frequently used office system prompts, but did not frequently use standing orders, patient educational materials, vaccine champions, and feedback on vaccination rates. Conclusions: While most providers consider influenza and Tdap vaccination important during pregnancy, there is room for improvement in focusing on the importance of maternal vaccination to the health of the infant, and increasing the use of office systems to improve vaccination during pregnancy.

Diabetic patient satisfaction on the quality of outpatient health care services

AIM

To assess the degree of satisfaction of diabetic patients with health care services and to determine the factors that influence it.

METHODS

It was a cross sectional study conducted in 2018 among diabetic outpatients of the department of endocrinology of the university hospital La Rabta. Patients general characteristics were noted. Each patient responded to a questionnaire, asked orally, in Tunisian dialect, by two physicians, about health care services including 20 questions grouped into three items. Each question was scored from 1 to 4 according to the degree of satisfaction. The global score as well as the scores of the items were calculated by adding the scores of the corresponding questions.

RESULTS

150 diabetic patients responded to the questionnaire; mean age: 58.9±12.2 years [18-88], sex-ratio: 0.51. Cronbach coefficient was 0.78. The overall score was 62.2±6.5 [46-80]. Ninety-seven patients (64.7%) had a score ≥60. The item concerning 'human contact and communication' was considered good in 98% of cases. The item concerning 'premises, cleanliness, comfort and safety' was considered intermediate in 64% of cases. Patients were very satisfied with the accessibility of the department inside the hospital (76.7%), the attitude of the agents during the administrative formalities (74%) and particularly the behaviour of the doctor (96%). However, they were dissatisfied with the noise (72%) and overcrowding (67.4%) of the waiting room. There were no statistically significant associations between the overall score and the studied data.

CONCLUSION

The diabetic patients were overall satisfied with the provided services. Actions must be taken to reduce overcrowding and long waiting times.

System- and Individual-Level Barriers to Accessing Medical Care Services Across the Rural-Urban Spectrum, Washington State

Background:

Residents of rural areas face barriers beyond geography and distance when accessing medical care services. The purpose of this study was to characterize medical care access barriers across several commonly used classifications of rurality.

Methods:

Washington State household residents completed a mixed-mode (paper/online) health care access survey between June 2018 and December 2019 administered to a stratified random sample of ZIP codes classified as urban, suburban, large rural, and small rural (4-tier scheme). For analyses, rurality was also classified into 2-tier schemes (rural/urban) based on ZIP code and county. Respondents reported availability of medical care services and system- and individual-level barriers to accessing services. Logistic regression models estimated the odds of reporting system- or individual-level barriers in accessing medical care services across rurality (4- and 2-tier schemes), adjusting for respondent characteristics, and weighted to account for survey design.

Results:

About 617 households completed the survey (25.7% response rate). Compared to urban residents (across all 3 schemes), more rural residents reported traveling to a distant city or town for medical care (P < .001). Rurality was significantly associated with increased odds of facing system-level barriers. Respondents from small rural areas had greater odds access barriers for primary care (OR 7.31, 95% CI 1.84-29.09) and having no primary care provider (OR 11.37, 95% CI 3.03-42.75) compared to urban respondents. Individual-level barriers were not associated with rurality.

Conclusions:

To improve healthcare access across the rural-urban spectrum, policymakers must consider system-level barriers facing rural populations.

Social, behavioural, and functional characteristics of community-dwelling South Korean adults with moderate and severe cognitive impairment

OBJECTIVES

This study used the 2016 Korean Longitudinal Study on Aging to investigate the social, behavioural, and functional characteristics of community-dwelling South Korean adults with cognitive impairment.

METHODS

Participants were classified as normal, moderate impairment, and severe impairment according to an algorithm that combined the Korean Mini-Mental State Examination score and the number of difficulties in performing instrumental activities of daily living. Selected characteristics included grip strength, depression, participation in exercise and social activities, and living in a rural, urban, or suburban community.

RESULTS

Most (72.7%) participants were classified as having normal cognition, 20.1% were classified as moderate impairment, and 7.2% were classified as severe impairment. Regardless of sex, the differences in grip strength across the cognitive status classifications were statistically significant, except for the difference between moderate and severe cognitive impairment in males (p = 0.8477). Greater number of depressive symptoms and living in rural areas were associated with significantly higher odds for severe cognitive impairment. Participants with moderate (OR = 0.51) and severe (OR = 0.33) cognitive impairment were less likely to participate in social activities than those with normal cognition.

CONCLUSIONS

The study findings revealed that social, behavioural, and functional characteristics are closely related to the cognitive status of community-dwelling adults in South Korea.

Patient experiences with general practitioners: psychometric performance of the generic PEQ-GP instrument among patients with chronic conditions

BACKGROUND

Most generic patient experience instruments have not been validated specifically for persons with chronic health problems, even though they are the dominant user of GPs/family physicians.

OBJECTIVES

To assess the psychometric properties of the generic Patient Experiences with GP Questionnaire (PEQ-GP) instrument (five scales: assessment of GP, coordination, patient enablement, accessibility, and practice) in persons with chronic conditions, and to develop a short version to maximize response rates and minimize respondent fatigue in future applications.

METHODS

Secondary analysis of data from a national survey of patient experiences with general practitioners in 2018-2019 (response rate: 42.6%). The psychometric properties of PEQ-GP were assessed with exploratory factor analysis and Cronbach's alpha, supplemented with confirmatory factor analysis (CFA) and item response theory (IRT). A short version was constructed and evaluated based on item performance.

RESULTS

Nine hundred and seventy persons reported a chronic condition(s), the most frequent being "musculoskeletal, arthritis, other back and joints" (n = 473, 48.8%). Factor analysis identified three scales with adequate psychometric results: GP (15 items; Cronbach's alpha: 0.96), practice (3 items; Cronbach's alpha: 0.87), and accessibility (2 items; Cronbach's alpha: 0.77). Evaluation of item performance identified a 7-item short version, including a 5-item GP scale with scores with strong concordance with the 15-item scale (Intraclass Correlation Coefficient: 0.97, P < 0.001).

CONCLUSIONS

The generic PEQ-GP exhibits adequate psychometric performance for persons with chronic conditions. Three empirically derived PEQ-GP scales cover evaluation of the GP, accessibility, and practice. The 7-item short form minimize respondent burden, but further validation work is warranted before large-scale use.

Use of preventive cardiovascular health care among Asian American individuals: A National Health Interview Survey Study

The risk of atherosclerotic cardiovascular disease (ASCVD) varies across Asian Americans. Heterogeneity in preventive health care use may have a role in health disparity across Asian American populations. We included 318,069 White, Chinese, Asian Indian, Filipino, and 'other Asian' (Japanese, Korean, and Vietnamese) participants with and without self-reported history of ASCVD or ASCVD risk factors (including hypertension, hypercholesterolemia, and diabetes) from 2006-2018 National Health Interview Survey (NHIS). We used multivariable logistic regression models adjusted for age, sex, US birth, education, insurance coverage, and a comorbidity score to assess the association between Asian American race/ethnicity and annual health care use. Adjusted odds ratios (aOR) with 95% confidence intervals were reported. Of the total, 187,093 participants did not report ASCVD or ASCVD risk factors (mean age, 40.2 ± 0.1 y; 52% women), and 130,976 participants reported ASCVD or ASCVD risk factors (mean age, 58.3 ± 0.9 y; 49.5% women). Compared with White individuals, among the group without ASCVD or ASCVD risk factors (N=187,093), 'other Asian' adults were less likely to visit general practitioner (aOR=0.80, 0.72-0.89), or check blood pressure (aOR=0.77, 0.66-0.89), blood cholesterol (aOR=0.80, 0.70-0.92), and fasting blood sugar (aOR=0.73, 0.63-0.84). Among participants with ASCVD or ASCVD risk factors (N=130,976), Asian Indian adults were more likely to visit general practitioner (aOR=1.29, 1.01-1.66), or check blood pressure (aOR=1.27, 0.83-1.96), blood cholesterol (aOR=1.46, 1.00-2.15), and fasting blood sugar (aOR=1.49, 1.11-1.99). Annual preventive health care use is heterogenous across the Asian American populations.

Overall patient experience with a virtual hybrid hospital at home program

Objectives:

Traditional hospital at home models often have high patient experience scores. The purpose of this study is to look at the patient experience of a new virtual hybrid model of hospital at home called Advanced Care at Home.

Methods:

Patients in Mayo Clinic’s Advanced Care at Home program received a survey via email from 1 January–31 May 2021. Each survey consisted of 20 questions divided into 18 multiple-choice and two open-ended questions.

Results:

Ninety-nine surveys were sent and 41 partially or completely finished surveys were returned for a response rate of 41.4%. Patients responded positively, denoted by answering “strongly agree or somewhat agree,” with regard to the ability to reach the team right away 100% of the time, being kept informed 92% of the time, the command center responding promptly to their needs 95% of the time, the team providing comfort and support 98% of the time, feeling comfortable with interacting with their provider by phone or tablet 95% of the time, the ease of use from the equipment 97% of the time, the virtual and in-person staff working well together 98% of the time, the staff treating patients with courtesy and respect 100% of the time, and the ease of understanding the discharge process and feeling ready to leave the program 100% of the time. All providers received positive responses on listening ⩾88% of the time. Patients gave a top rating in likelihood to recommend the program 100% of the time.

Conclusion:

Overall, the Advanced Care at Home model of hospital at home was highly recommended by patients. Patients scored the program high on responsiveness, staff engagement and communication, ease of equipment use, and readiness for discharge, strengthening the overall confidence in this novel program.

Contemporary Management of Male Anterior Urethral Strictures by Reconstructive Urology Experts-Results from an International Survey among ESGURS Members

Assessment of anterior urethral stricture (US) management of European urology experts is relevant to evaluate the quality of care given to the patients and plan future educational interventions. We assessed the practice patterns of the management of adult male anterior US among reconstructive urology experts from European countries. A 23-question online survey was conducted among European Association of Urology Section of Genito-Urinary Reconstructive Surgeons (ESGURS) members. A total of 88 invitations were sent by email at two different times (May and October 2019). Data were prospectively collected from May 2019 to December 2019. The response rate was 55.6%. Most of the responders were between 50 and 59 y.o. and mainly from University Public Teaching/Academic Hospitals. A total of 73.5% treated ≥20 patients/year with US. Retrograde urethrogram (RUG) was the commonest diagnostic tool, followed by uroflowmetry (UF) +/− post-void residual (PVR). Urethroplasty using grafts was the most frequent treatment (91.8%). Of responders, 55.3% performed >20 urethroplasties/year. Anastomotic urethroplasties were performed by 83.7%, skin flap repairs by 61.2%, perineal urethrostomy by 77.6% and non-transecting techniques by 63.3%. UF was the most common follow-up tool. Most of the responders considered urethroplasty as the primary option when indicated. Male anterior US among ESGURS members are treated mainly using urethroplasty graft procedures. RUG is preferred for diagnosis, and UF for follow-up.

[Knowledge and perceptions of the population on services in case of need for long-term care: A standardized telephone survey]

Knowledge and perceptions of the population on services in case of need for long-term care: A standardized telephone survey Abstract. Background: In the absence of professional support, family caregivers rarely recognize their own overload situations and therefore make inadequate use of support services in the event of a need for care. Aim: The study investigates the care of people in need for care, the level of knowledge about and stress factors in the assumption of care from the point of view of informal caregivers and non-caregivers. Methods: A cross-sectional study was conducted using standardized Computer Assisted Telephone Interviews (CATI) with persons aged 18 and older in Saxony. Descriptive and bivariate statistics were calculated. Results: Care provided by an outpatient care service or by family caregivers was rated significantly better by 259 informal caregivers compared with 342 non-caregivers among 601 participants (N = 601). Further, informal caregivers and non-caregivers had different knowledge about the closest place for long-term care counseling and about compensation payments from the pension insurance. Conclusions: In individual areas of the queried counseling services and relief options, the response behavior of family caregivers differed significantly from the other participants. It can be assumed that family caregivers have a slight information advantage of family caregivers in the use of support services.

Real-World Journey of Unresectable Stage III NSCLC Patients: Current Dilemmas for Disease Staging and Treatment

Daily-practice challenges in oncology have been intensified by the approval of immune checkpoint inhibitors (ICI). We aimed to outline current therapy policies and management of locally advanced unresectable stage III non-small-cell lung cancer (NSCLC) in different countries. One thoracic oncologist from each of the following countries—Belgium, Croatia, Greece, Israel, the Netherlands, Norway, Poland, Portugal, Romania, Slovenia, and Switzerland—participated in an electronic survey. Descriptive statistics were conducted with categorical variables reported as frequencies and continuous variables as median and interquartile range (IQR) (StataSE-v15). EBUS (endobronchial ultrasound bronchoscopy) was used either upfront or for N2 confirmation. Resectability is still a source of disagreement; thus, decisions vary within each multidisciplinary team. Overall, 66% of stage III patients [IQR 60–75] undergo chemoradiation therapy (CRT); concurrent CRT (cCRT) accounts for most cases (~70%). Performance status is universally used for cCRT eligibility. Induction chemotherapy is fairly weighted based on radiotherapy (RT) availability. Mean time to evaluation after RT completion is less than a month; ICI consolidation is started within six weeks. Durvamulab expenditures are reimbursed in all countries, yet some limiting criteria exist (PD-L1 ≥ 1%, cCRT). No clear guidance on therapies at Durvamulab progression exist; experts agree that it depends on progression timing. Given the high heterogeneity in real-world practices, standardized evidence-based decisions and healthcare provision in NSCLC are needed.

Treatment Satisfaction With Current Medications for Chronic Constipation: An Internet Survey of Japanese Patients

GOALS

This survey aims to determine relevant patient characteristics, treatment satisfaction, and bothersome symptoms in Japanese patients with chronic constipation (CC) treated at medical institutions.

BACKGROUND

Epidemiological surveys of Japanese patients with CC are limited.

STUDY

This internet survey, conducted in 2017, included 500 adults (selected from 589 respondents to match age composition ratio in Japan) who experienced constipation-like symptoms for ≥6 months, were treated at medical institutions for symptoms, and were taking any prescribed medication.

RESULTS

Of 500 patients, 65.6% were female and 62.6% had experienced constipation for >10 years. Abdominal bloating, infrequent bowel movement, hard consistency of stool, and difficulty of defecation were the most frequently reported and most bothersome symptoms in males and females. Overall, 29% of patients were satisfied with treatment (36% of males, 26% of females); the individual major CC symptom with the highest level of treatment satisfaction was infrequent bowel movement (31% of total, 45% of males, 26% of females). The level of treatment satisfaction for most individual major CC symptoms was lower in females than in males, and overall treatment satisfaction by therapeutic categories ranged from 16% to 46%. Mean overall treatment satisfaction, as well as mean treatment satisfaction for each major symptom, decreased with increasing number of treatments.

CONCLUSIONS

The survey results suggest that conventional treatment options were not effective enough to improve bothersome symptoms or treatment satisfaction. Treatment selection that is tailored to individual symptoms and takes patient characteristics into consideration may be key to improving patients' treatment satisfaction.

Comparison of Health Care Expenditures Among U.S. Older Adults With Pain Who Reported Frequent Exercise Versus Nonfrequent Exercise

This cross-sectional study included a nationally representative sample of U.S. adults aged ≥50 years with self-reported pain in the past 4 weeks from the 2018 Medical Expenditure Panel Survey. Adjusted linear regression analyses accounted for the complex survey design and assessed differences in several types of annual health care expenditures between individuals who reported frequent exercise (≥30 min of moderate-vigorous intensity physical activity ≥5 times per week) and those who did not. Approximately 23,940,144 of 56,979,267 older U.S. adults with pain reported frequent exercise. In adjusted analyses, individuals who reported frequent exercise had 15% lower annual prescription medication expenditures compared with those who did not report frequent exercise (p = .007). There were no statistical differences between frequent exercise status for other health care expenditure types (p > .05). In conclusion, adjusted annual prescription medication expenditures were 15% lower among older U.S. adults with pain who reported frequent exercise versus those who did not.

Comparison of Treatment Goals between Users of Biological and Non-Biological Therapies for Treatment of Psoriasis in Japan

Background: Previously, our cross-sectional observational study in Japan revealed high (68%) discordance within treatment goals between psoriasis patients and their physicians. Objective: This secondary analysis aimed to determine whether patient and physician users of biologics have higher treatment goals than users of non-biologics. Methods: A survey for both patients and physicians on background characteristics, disease severity, treatment goals, treatment satisfaction, and health-related quality of life was conducted at 54 sites. Association between treatment goals and biologic/non-biologic users was assessed using ordinal logistic regression models. Results: In total, 449 patient-physician pairs agreed to participate; 425 completed the survey and were analyzed. More biologic users than non-biologic users reported complete clearance (Psoriasis Area and Severity Index 100) as a treatment goal (patient-reported: 23.6% vs. 16.1%; physician-reported: 26.9% vs. 2.2%). Biologic users were significantly associated with higher treatment goals than non-biologic users (patient-reported: 1.8 (1.15–2.87) (odds ratio (9 5% CI)), p = 0.01; physician-reported: 11.0 (5.72–21.01), p < 0.01). Among biologic users, higher treatment goals were associated with higher treatment satisfaction (patient- and physician-rated); lower treatment goals were associated with back lesions and increasing patient age (patient-rated) and higher disease severity (physician-rated). Conclusion: Use of biologics among patients with psoriasis was associated with higher treatment goals. Further use of biologics contributed to treatment satisfaction. Appropriate treatment goals that are shared among patients and their physicians may improve treatment outcomes.

Dental access and expenditures for adults with intellectual and other disabilities

OBJECTIVES

Individuals with disabilities experience greater barriers accessing health care services and have poorer oral health outcomes than those without disabilities. The aims of this study were to examine dental access, utilization, expenditures, and sources of payment between adults with intellectual disabilities (ID), other types of disabilities, and without disabilities.

METHODS

Secondary analyses of data from the 2017 Medical Expenditure Panel Survey (MEPS) allowed examination of dental access (being able to get dental care and receiving necessary dental care without delay), dental utilization (having a dental visit in the past year), total dental expenditures, and associated sources of payment between three groups of adults based on disability status using descriptive, bivariate, and multivariable statistics.

RESULTS

Adults with ID have 2.70 (95% CI: 2.03, 3.61) times the odds of being unable to get dental care and 2.88 (95% CI: 2.11, 3.94) times the odds of having to delay necessary dental care compared with adults without disabilities. No significant differences were observed in dental utilization or mean total dental expenditure between the three groups after adjusting for demographic and socioeconomic variables. Among adults who incurred a dental expenditure, adults with ID had a greater share of dental care paid for by Medicaid, and adults without disabilities had a greater share of dental care paid for by private insurance.

CONCLUSIONS

Despite similar mean total dental expenditures, reduced dental access reported by adults with ID suggests that this population experiences significantly greater challenges obtaining dental care. Adults with ID rely more heavily on Medicaid to finance dental care.

Associations of multiple (≥5) chronic conditions among a nationally representative sample of older United States adults with self-reported pain

OBJECTIVES

The association between an individuals' demographic and health characteristics and the presence of multiple chronic conditions is not well known among older United States (US) adults. This study aimed to identify the prevalence and associations of having multiple chronic conditions among older US adults with self-reported pain.

METHODS

This retrospective, cross-sectional study used data from the 2017 Medical Expenditure Panel Survey. Study subjects were aged ≥50 years and had self-reported pain in the past four weeks. The outcome variable was multiple (≥5) chronic conditions (vs. <5 chronic conditions). Hierarchical logistic regression models were used to identify significant associations between demographic and health characteristics and multiple chronic conditions with significance indicated at an a priori alpha level of 0.05. The complex survey design was accounted for when obtaining nationally-representative estimates.

RESULTS

The weighted population was 57,074,842 US older adults with pain, of which, 66.1% had ≥5 chronic conditions. In fully-adjusted analyses, significant associations of ≥5 comorbid chronic conditions included: age 50-64 vs. ≥65 years (adjusted odds ratio [AOR]=0.478, 95% confidence interval [CI]=0.391, 0.584); male vs. female gender (AOR=1.271, 95% CI=1.063, 1.519); white vs. other race (AOR=1.220, 95% CI=1.016, 1.465); Hispanic vs. non-Hispanic ethnicity (AOR=0.614, 95% CI=0.475, 0.793); employed vs. unemployed (AOR=0.591, 95% CI=0.476, 0.733); functional limitations vs. no functional limitations (AOR=1.862, 95% CI=1.510, 2.298); work limitations vs. no work limitations (AOR=1.588, 95% CI=1.275, 1.976); little/moderate vs. quite a bit/extreme pain (AOR=0.732, 95% CI=0.599, 0.893); and excellent/very good (AOR=0.375, 95% CI=0.294, 0.480) or good (AOR=0.661, 95% CI=0.540, 0.810) vs. fair/poor physical health.

CONCLUSIONS

Approximately 38 million of the 57 million US older adults with pain in this study had ≥5 chronic conditions in 2017. Several characteristics were associated with multiple chronic conditions, which may be important for health care professionals to consider when working with patients to manage their pain. This study was approved by The University of Arizona Institutional Review Board (2006721124, June 12, 2020).

Administration and Therapeutic Drug Monitoring of β-lactams and Vancomycin in Critical Care Units in Colombia: The ANTIBIOCOL Study

Therapeutic drug monitoring (TDM) and continuous infusion strategies are effective interventions in clinical practice, but these practices are still largely unknown in Colombia, especially in the critical care setting. This study aims to describe the practices involved in the administration and TDM of β-lactams and vancomycin reported by specialists in critical care in Colombia and to explore the factors that are related to the use of extended infusion. An online nationwide survey was applied to 153 specialists, who were selected randomly. A descriptive, bivariate analysis and a logistic regression model were undertaken. In total, 88.9% of the specialists reported TDM availability and 21.57% reported access to results within 6 h. TDM was available mainly for vancomycin. We found that 85.62% of the intensivists had some type of institutional protocol; however, only 39.22% had a complete and socialized protocol. The odds of preferring extended infusions among those who did not have institutional protocols were 80% lower than those with complete protocols, OR 0.2 (95% CI: 0.06−0.61). The most important perceived barriers to performing continuous infusions and TDM were the lack of training and technologies. This pioneering study in Colombia could impact the quality of care and outcomes of critically ill patients in relation to the threat of antimicrobial resistance.

Safety attitudes build safety culture: Nurse/midwife leaders improving health care using quantitative data

AIM

We aim to determine safety attitudes of nurses and midwives across a Local Health District in Australia and compare results 1 year later following facilitated feedback of results.

BACKGROUND

Positive safety cultures are imperative for positive patient and staff outcomes. Staff member's attitude contribute to an organisations safety culture but can differ between health professional groups and across different subcultures.

METHOD

The Safety Attitudes Questionnaire (SAQ-Short version) was administered to all nurses and midwives within a Local Health District in NSW, Australia in 2019 and 2020. Results were facilitated back to nursing/midwifery leadership teams with an expectation of developing and enacting an action plan, based on results.

RESULTS

Of the six domains in the SAQ-Short version, five domains scores increased significantly (p < .001) over the time period.

CONCLUSIONS

Measures over time are important to establish differences in perceptions and feedback on impact of actions. Facilitated feedback of results shows meaning when nursing/midwifery leadership staff have data explained and an opportunity to discuss and plan.

IMPLICATIONS FOR NURSING MANAGEMENT

This study shows that facilitated feedback of quantitative survey results brings improved results when a survey is replicated. Nurse managers should enact a contextualized action plan with teams based on survey results to influence improvement in safety attitudes of staff.

Characteristics of the Measurement Tools for Assessing Health Information-Seeking Behaviors in Nationally Representative Surveys: Systematic Review

BACKGROUND

The coronavirus pandemic (COVID-19) has also emerged as an infodemic, thereby worsening the harm of the pandemic. This situation has highlighted the need for a deeply rooted understanding of the health information-seeking behaviors (HISBs) of people.

OBJECTIVE

The aim of this paper was to review and provide insight regarding methodologies and the construct of content in HISB surveys by answering the following research question: what are the characteristics of the measurement tools for assessing HISBs in nationally representative surveys around the world?

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses was used as the framework for this study. A data search was performed through 5 international and 2 Korean databases covering the years between 2008 and 2020. Initially, studies performed among nationally representative samples were included to discover HISB survey instruments. The methodologies of the studies using HISB surveys were analyzed. For content analysis, 2 researchers reached a consensus through discussion by scrutinizing the contents of each survey questionnaire.

RESULTS

A total of 13 survey tools from 8 countries were identified after a review of 2333 records from the search results. Five survey tools (Health Information National Trends Survey, Health Tracking Survey, Annenberg National Health Communication Survey, National Health Interview Survey, and Health Tracking Household Survey) from the United States, 2 instruments from Germany, and 1 tool from each of the countries of the European Union, France, Israel, Poland, South Korea, and Taiwan were identified. Telephone or web-based surveys were commonly used targeting the adult population (≥15 years of age). From the content analysis, the domains of the survey items were categorized as follows: information (information about health and patient medical records), channel (offline and online), and health (overall health, lifestyle, and cancer). All categories encompassed behavioral and attitude dimensions. A theoretical framework, that is, an information-channel-health structure for HISBs was proposed.

CONCLUSIONS

The results of our study can contribute to the development and implementation of the survey tools for HISB with integrated questionnaire items. This will help in understanding HISB trends in national health care.

Adjusting for Pubertal Status Reduces Overweight and Obesity Prevalence in the United States

OBJECTIVE

To compare pediatric overweight and obesity prevalence among non-Hispanic white, Mexican American, and non-Hispanic black US youths before and after adjusting body mass index (BMI) for pubertal status, as assessed by Tanner stage.

STUDY DESIGN

We analyzed cross-sectional anthropometric and pubertal data from non-Hispanic white, Mexican American, and non-Hispanic black youths in the National Health and Nutrition Examination Survey (NHANES) III. We developed specialized Tanner stage and chronological age-adjusted models to establish Tanner-stage adjusted BMI z-scores, which were then used to determine adjusted overweight/obesity prevalence. We compared pediatric overweight/obesity prevalence before and after pubertal status adjustment.

RESULTS

Among 3206 youths aged 8-18 years (50% male; 26% non-Hispanic white, 35% Mexican American, 39% non-Hispanic black), adjusting BMI for Tanner stage significantly reduced overweight (males, from 29% to 21%; females, from 29% to 17%) and obesity (males, from 14% to 7%; females, from 11% to 5%) prevalence across all races/ethnicities. The obesity prevalence reduction was more pronounced in Mexican Americans (males, 11% reduction; females, 9% reduction) and non-Hispanic blacks (males and females, 10% reduction) compared with non-Hispanic whites (males, 6% reduction; females, 5% reduction). Similar patterns were seen in overweight prevalence.

CONCLUSIONS

Adjusting for pubertal status reduced the prevalence of overweight/obesity in non-Hispanic white, Mexican American, and non-Hispanic black youth. This suggests that adjusting for puberty incorporates changes otherwise not captured when only considering the age of a child. Adjusting BMI for pubertal status may be important when interpreting a youth's weight status and consideration for obesity management, as well as when interpreting pediatric overweight/obesity prevalence data.

Development of the traumatic brain injury Rehabilitation Needs Survey: a Veterans Affairs TBI Model Systems study

PURPOSE

To describe the development of the Rehabilitation Needs Survey (RNS) for persons in the chronic phase of traumatic brain injury (TBI) recovery.

MATERIALS AND METHODS

RNS items were generated following a literature review (January - March 2015) on the topic of rehabilitation needs and revised via consensus from an expert panel of TBI clinicians and researchers. The RNS was added to the VA TBI Model Systems longitudinal study; data collection occurred between 2015-2019. Needs were classified as current (if endorsed) or absent; if current, needs were classified as unmet if no help was received. Need frequency and association with rehabilitation outcomes were presented.

RESULTS

Eight studies examined rehabilitation needs and formed the initial item pool of 42 needs. This was reduced to form the 21-item RNS which was administered at year 1 (n = 260) and year 2 (n = 297) post-TBI. Number of needs endorsed was 8-9, and number of unmet needs was 1-2, on average. Number of needs was correlated with functional status, neurobehavioral symptoms, and mental health symptoms (p < 0.05) suggesting support for convergent validity of the RNS.

CONCLUSION

The RNS is a new measure of rehabilitation needs following TBI. Further investigation into its psychometrics and clinical utility is recommended.Implications for rehabilitationVeterans and Service Members with traumatic brain injury across the severity spectrum have ongoing rehabilitation needs during the chronic phase of recovery.The Rehabilitation Needs Survey is a standardized measure of rehabilitation needs following traumatic brain injury.Identification of unmet rehabilitation needs is important for raising awareness of service gaps and providing justification for resource allocation.

Perceptions of Medical Providers on Morality and Decision-Making Capacity in Withholding and Withdrawing Life-Sustaining Treatment and Suicide

BACKGROUND

This study attempts to understand if medical providers beliefs about the moral permissibility of honoring patient-directed refusals of life-sustaining treatment (LST) are tied to their beliefs about the patient's decision-making capacity. The study aims to answer: 1) does concern about a patient's treatment decision-making capacity relate to beliefs about whether it is morally acceptable to honor a refusal of LST, 2) are there differences between provider types in assessments of decision-making capacity and the moral permissibility to refuse LST, and 3) do provider demographics impact beliefs about decision-making capacity and the moral permissibility to refuse LST. Methods: A mixed-methods survey using Likert assessment and vignette-based questions was administered to medical providers within a single health system in the upper Midwest (N = 714) to assess their perspectives on the moral acceptance and decision-making capacity in cases of withholding and withdrawing treatment and suicide. Results: Behavioral health providers report accepting of the moral permissibility of suicide (91.2%) more than either medical providers (77.2%) or surgeons (74.4%) (n = 283). Decision-making capacity was questioned more in the vignettes of the patients refusing life-saving surgery (36%) and voluntarily starvation (40.8%) than in the vignette of the patient requesting to deactivate a pacemaker (13%) (n = 283). Behavioral health providers were more concerned about the capacity to refuse life-saving surgery (55.9%) than medical providers (33.8%) or surgeons (23.1%) (n = 283). Conclusions: Respondents endorse the moral permissibility of persons to withhold or withdraw from treatment regardless of motive. Clinical concerns about a patient's treatment decision-making capacity do not strongly correlate to views about the moral permissibility of honoring refusals of LST. Different provider types appear to have different thresholds for when to question treatment decision-making capacity. Behavioral health providers tend to question treatment decision-making capacity to refuse LST more than non-behavioral health providers.

Association of Self-Reported Frequent Exercise Among a Nationally Representative Sample of Older People in the United States With Self-Reported Pain

This retrospective, cross-sectional database study aimed to identify characteristics associated with self-reported frequent exercise (defined as moderate- to vigorous-intensity exercise for ≥30 min five times a week) in older U.S. (≥50 years) adults with pain in the past 4 weeks, using 2017 Medical Expenditure Panel Survey data and hierarchical logistic regression models. The variables significantly associated with frequent exercise included being male (adjusted odds ratio [AOR] = 1.507, 95% confidence interval [CI] [1.318, 1.724]); non-Hispanic (AOR = 1.282, 95% CI [1.021, 1.608]); employed (AOR = 1.274, 95% CI [1.040, 1.560]); having no chronic conditions versus ≥5 conditions (AOR = 1.576, 95% CI [1.094, 2.268]); having two chronic conditions versus ≥5 conditions (AOR = 1.547, 95% CI [1.226, 1.952]); having no limitation versus having a limitation (AOR = 1.209, 95% CI [1.015, 1.441]); having little/moderate versus quite/extreme pain (AOR = 1.358, 95% CI [1.137, 1.621]); having excellent/very good versus fair/poor physical health (AOR = 2.408, 95% CI [1.875, 3.093]); and having good versus fair/poor physical health (AOR = 1.337, 95% CI [1.087, 1.646]). These characteristics may be useful to create personalized pain management protocols that include exercise for older adults with pain.

Impact of the COVID-19 Pandemic on the Hospital: Inpatient's Perceived Quality in Spain

Although the Coronavirus disease 2019 (COVID-19) pandemic has generated a large amount of studies, the patient-perceived quality of care (PQ) in this context is still not well known, so more studies intending to focus on this issue are strongly needed. This study assesses changes on PQ in patients hospitalized in Spain during the first month of the COVID-19 pandemic and investigates differences between those admitted for this cause and the rest a descriptive study using the “Net Promoters Score” and the hospital regular monitoring plan. Due to this point of view, ethical approval is not applicable. Four PQ dimensions (nurse, physician, and nurse assistant actions [NA], and discharge information [DI]) were measured in all COVID patients (57) and in a sample of non-COVID patients (60) discharged at home during the first month of the pandemic, and also compared with another sample (384) from an immediately previous period. The COVID patients scored worse (8.2) than non-COVID ones (9.0; P < .0001), especially in NA and DI, and were more likely to be detractors (odds ratio [OR]: 3.05, P < .0001) and less to be promoters (OR: 0.64, P < .05). Global and DI net promoters score values before the pandemic were higher than afterward. In conclusion, the COVID-19 pandemic negatively and significantly influenced the health care quality as perceived by inpatients, both in COVID and in non-COVID ones, but more intensely in the former. As a health care organization, this knowledge meant an opportunity from improvement and to be better qualified to face the pandemic.

Predictors of Mental Health Status among Older United States Adults with Pain

Poor mental health is common among older adults with pain, resulting in high economic burden and impaired quality of life. This retrospective, cross-sectional database study aimed to identify characteristics associated with good mental health status among United States (US) adults aged ≥50 years with self-reported pain in the last four weeks using a weighted sample of 2017 Medical Expenditure Panel Survey data. Hierarchical multivariable logistic regression models were used to identify statistically significant predictors of good (versus poor) perceived mental health status. From a weighted population of 57,074,842 individuals, 85.5% (95% confidence interval (CI) = 84.4%, 86.7%) had good perceived mental health. Good mental health was associated most strongly with physical health status (adjusted odds ratio (AOR) = 9.216, 95% CI = 7.044, 12.058). Employed individuals were 1.7 times more likely to report good mental health versus unemployed (AOR = 1.715, 95% CI = 1.199, 2.452). Individuals who had completed less than high school education (AOR = 0.750, 95% CI = 0.569, 0.987) or who reported having a limitation (AOR = 0.513, 95% CI = 0.384, 0.684) were less likely to report good mental health. These key characteristics can be utilized to predict mental health status, which may be investigated to better manage concurrent pain and poor mental health.

The Cure SMA Membership Surveys: Highlights of Key Demographic and Clinical Characteristics of Individuals with Spinal Muscular Atrophy

Background:

Cure SMA maintains the largest patient-reported database for people affected with spinal muscular atrophy (SMA). In 2017, Cure SMA initiated annual surveys with their membership to collect demographic and disease characteristics, healthcare, and burden of disease information from patients and caregivers.

Objective:

To summarize results from two large-scale Cure SMA surveys in 2017 and 2018.

Methods:

Cure SMA database members were invited to complete surveys; these were completed by caregivers for living or deceased individuals with SMA and/or affected adults.

Results:

In 2017, 726 surveys were completed for 695 individuals with SMA; in 2018, 796 surveys were completed for 760 individuals with SMA. Data from both survey years are available for 313 affected individuals. Age at symptom onset, distribution of SMN2 gene copy number, and representation of each SMA type in the surveys were consistent with that expected in the SMA population. In the 2018 survey, the average age at diagnosis was 5.2 months for SMA type I and the reported mean age at death for this subgroup was 27.8 months. Between survey years, there was consistency in responses for factors that should not change within individuals over time (e.g., reported age at diagnosis).

Conclusions:

Results from the Cure SMA surveys advance the understanding of SMA and facilitate advocacy efforts and healthcare services planning. Longitudinal surveys are important for evaluating the impact of effective treatments on changing phenotypes, and burden of disease and care in individuals with SMA.

Characteristics of US Adults Delaying Dental Care Due to the COVID-19 Pandemic

Background:

Coronavirus disease 2019 (COVID-19) has disrupted the delivery of health care services, including dental care. The objective of this study was to quantify and describe US adults who delayed dental care due to the COVID-19 pandemic.

Methods:

We analyzed cross-sectional responses collected from a nationally representative and long-running panel survey of US adults conducted in late May and early June 2020 (response rate = 70%). The survey included questions about dental care delayed due to the COVID-19 pandemic, purpose of the delayed dental visits, timing of future dental visits, and demographic information. Pearson’s chi-square tests were used to determine if rates of delayed dental care varied by subgroup. A multivariable regression model, adjusted for age, race, Hispanic ethnicity, census division, and rurality, was estimated to predict the odds of reporting delayed dental care.

Results:

Nearly half of respondents (46.7%) reported delaying going to the dentist or receiving dental care due to the COVID-19 pandemic. Among adults who reported delaying dental care due to the pandemic, 74.7% reported delaying a checkup, 12.4% reported delaying care to address something that was bothering them, and 10.5% reported delaying care to get planned treatment. About 44.4% of adults reported that they planned to visit the dentist within the next 3 mo. In the multivariable regression model, only living in an urban (vs. rural) area was associated with significantly higher odds of delayed dental care due to the pandemic (odds ratio: 1.5; 95% confidence interval: 1.1, 2.1).

Conclusions:

Nearly half of US adults reported delaying dental care due to the COVID-19 pandemic during the spring of 2020. Our results offer insight into the experiences of patients seeking dental care this spring and the economic challenges faced by dental providers due to the pandemic.

Knowledge Transfer Statement:

This article describes US adults who delayed dental care due to the COVID-19 pandemic. Results can be used by clinicians and policymakers to understand delayed care during the pandemic.

Emergency admission risk stratification tools in UK primary care: a cross-sectional survey of availability and use

Background

Stratifying patient populations by risk of adverse events was believed to support preventive care for those identified, but recent evidence does not support this. Emergency admission risk stratification (EARS) tools have been widely promoted in UK policy and GP contracts.

Aim

To describe availability and use of EARS tools across the UK, and identify factors perceived to influence implementation.

Design and setting

Cross-sectional survey in UK.

Method

Online survey of 235 organisations responsible for UK primary care: 209 clinical commissioning groups (CCGs) in England; 14 health boards in Scotland; seven health boards in Wales; and five local commissioning groups (LCGs) in Northern Ireland. Analysis results are presented using descriptive statistics for closed questions and by theme for open questions.

Results

Responses were analysed from 171 (72.8%) organisations, of which 148 (86.5%) reported that risk tools were available in their areas. Organisations identified 39 different EARS tools in use. Promotion by NHS commissioners, involvement of clinical leaders, and engagement of practice managers were identified as the most important factors in encouraging use of tools by general practices. High staff workloads and information governance were identified as important barriers. Tools were most frequently used to identify individual patients, but also for service planning. Nearly 40% of areas using EARS tools reported introducing or realigning services as a result, but relatively few reported use for service evaluation.

Conclusion

EARS tools are widely available across the UK, although there is variation by region. There remains a need to align policy and practice with research evidence.

Hospital adoption of electronic health record functions to support age-friendly care: results from a national survey

OBJECTIVE

To measure US hospitals' adoption of electronic health record (EHR) functions that support care for older adults, focusing on structured documentation of the 4Ms (What Matters, Medication, Mentation, and Mobility) and electronic health information exchange/communication with patients, caregivers, and long-term care providers.

MATERIALS AND METHODS

In an online survey of a national, random sample of 797 US acute-care hospitals in 2018-2019, 479 (60.1%) responded. We calculated nationally representative measures of the percentages of hospitals with EHRs that include structured documentation of the 4Ms and exchange/communications functions.

RESULTS

Structured EHR documentation of the 4Ms was fully implemented in at least 1 unit in 64.0% of hospitals and across all units in 41.5% of hospitals. Of the 4Ms, structured documentation was the highest for medications (91.3% in at least 1 unit) and the lowest for mentation (70.3% in at least 1 unit). All exchange/communication functions had been implemented in at least 1 unit in 16.2% of facilities and across all units in 7.6% of hospitals. Less than half of the hospitals had an EHR portal for long-term care facilities to access hospital information (45.4% in at least 1 unit), sent information electronically to long-term care facilities (44.6%), and had training for adults/caregivers on the patient portal (32.1%).

DISCUSSION

Despite significant national investment in EHRs, hospital EHRs do not yet include key documentation, exchange, and communication functions needed to support evidence-based care for the older adults who comprise the majority of the inpatient population. Additional policy efforts are likely needed to promote the expansion of EHR capabilities into these high-value domains.

CONCLUSIONS

US acute-care hospital EHRs are lacking key functions that support care for older adults.

Beyond Access Block: Understanding the Role of Health Literacy and Self-Efficacy in Low-Acuity Emergency Department Patients

Background: Health literacy, self-efficacy, and patient satisfaction are factors associated with healthcare utilization. The relationships among these factors and their combined impact on patients’ self-rated health have historically been studied in chronic disease populations. This study assessed low-acuity emergency department (ED) patients’ ratings of these factors, the relationships among these factors, and their effect on re-presentation rates to the ED.

Methods: In this single-arm cohort survey, patients provided demographic data, completed health literacy and self-efficacy assessments prior to being seen by a physician, and completed a discharge perceptions questionnaire that included a global satisfaction question at the time of departure. Three months later, patients answered a telephone survey to measure post-ED visit health outcomes.

Results: Health literacy (r=0.114, P=0.023) and self-efficacy (r=0.469, P<0.001) were both independently and positively associated with self-rated health. Neither factor was associated with patient satisfaction. Self-rated health was negatively associated with return ED visits (r=–0.137, P=0.011).

Conclusion: Existing research shows that health literacy has a linear association with self-efficacy and self-rated health. The results of this study suggest that in the context of low-acuity ED patients, health literacy and self-efficacy affect patients’ understanding of their health status (self-rated health) but do not lead to better utilization of healthcare resources. Improvement of health literacy and self-efficacy, specifically to increase self-rated health, may provide a future avenue of intervention to reduce low-acuity ED patient re-presentation.

Response and role of palliative care during the COVID-19 pandemic: A national telephone survey of hospices in Italy

BACKGROUND

Palliative care is an important component of health care in pandemics, contributing to symptom control, psychological support, and supporting triage and complex decision making.

AIM

To examine preparedness for, and impact of, the COVID-19 pandemic on hospices in Italy to inform the response in other countries.

DESIGN

Cross-sectional telephone survey, in March 2020.

SETTING

Italian hospices, purposively sampled according to COVID-19 regional prevalence categorised as high (>25), medium (15-25) and low prevalence (<15) COVID-19 cases per 100,000 inhabitants. A brief questionnaire was developed to guide the interviews. Analysis was descriptive.

RESULTS

Seven high, five medium and four low prevalence hospices provided data. Two high prevalence hospices had experienced COVID-19 cases among both patients and staff. All hospices had implemented policy changes, and several had rapidly implemented changes in practice including transfer of staff from inpatient to community settings, change in admission criteria and daily telephone support for families. Concerns included scarcity of personal protective equipment, a lack of hospice-specific guidance on COVID-19, anxiety about needing to care for children and other relatives, and poor integration of palliative care in the acute planning response.

CONCLUSION

The hospice sector is capable of responding flexibly and rapidly to the COVID-19 pandemic. Governments must urgently recognise the essential contribution of hospice and palliative care to the COVID-19 pandemic and ensure these services are integrated into the health care system response. Availability of personal protective equipment and setting-specific guidance is essential. Hospices may also need to be proactive in connecting with the acute pandemic response.

Association between hospital admissions and healthcare provider communication for individuals with sickle cell disease

Objective: To test the hypothesis that caregivers' or adult participants' low ratings of provider communication are associated with more hospital admissions among adults and children with sickle cell disease (SCD), respectively. Secondarily, we determined whether there was an association between the caregivers' or participants' health literacy and rating of providers' communication. Methods: Primary data were collected from participants through surveys between 2014 and 2016, across six sickle cell centers throughout the U.S. In this cross-sectional cohort study, 211 adults with SCD and 331 caregivers of children with SCD completed surveys evaluating provider communication using the Consumer Assessment of Healthcare Providers and Systems (CAHPS), healthcare utilization, health literacy, and other sociodemographic and behavioral variables. Analyses included descriptive statistics, bivariate analyses, and logistic regression. Results: Participants with better ratings of provider communication were less likely to be hospitalized (odds ratio (OR) = 0.54, 95% confidence interval (CI) = [0.35, 0.83]). Positive ratings of provider communication were associated with fewer readmissions for children (OR = 0.23, 95% CI = [0.09, 0.57]). Participants with better ratings of provider communication were less likely to rate their health literacy as lower (regression coefficient (B) = -0.28, 95% CI = [-0.46, -0.10]). Conclusions: Low ratings of provider communication were associated with more hospitalizations and readmissions in SCD, suggesting the need for interventions targeted at improving patient-provider communication which could decrease hospitalizations for this population.