Effectiveness of patient-centered intervention in post-stroke patients in the family and community practice setting: A meta-analysis

Background@#According to the American Heart Association, post- stroke patients often have neurologic deficits which can lead to a variety of complications. Patient-centered approach to care promotes shared decision-making between physicians and patients regarding treatment plan and may lead to better health outcomes for these post-stroke patients@*Objective@#The effectiveness of patient-centered intervention in improving physical functioning among adult post-stroke patients with residual neurologic deficit was determined. Secondary outcomes such as improvement in social functioning, activities of daily living, quality of life and prevention of negative events such as death, re-hospitalization and depression were also evaluated@*Method@#This systematic review included comparative randomized clinical trials involving humans as the clinical subjects, diagnosed to have had a stroke and appropriately evaluated to be in recovery with residual neurologic deficit, with the intervention described labeled as ‘patient-centered care’, and reporting an outcome on the improvement of physical functioning. Online search was done in Pubmed, CENTRAL, NICE, and the grey literature. Three reviewers independently conducted the search, appraisal and data extraction@*Results@#Results varied depending on the outcome measurement tool utilized by the included studies. There was no difference between groups in terms of overall physical functioning and ADL as measured by SIS 16 and SIS 3.0. However, significant improvement was noted in the following subscales of SIS 3.0: hand movement (0.45,3.18, p=0.009, I2=0%), communication (0.86,2.16, p<0.00001, I2= 0%), and memory and thinking (0.13, 1.74, p=.02, I2= 33%). Physical function, ADL and social functioning using RNLI as an outcome (1.44-3.70] p<0.00001, I2= 0%), and physical functioning, social functioning, ADL and QOL as measured by participation (1.48, 3.74, p<0.00001, I2= 0%) and perception of recovery (2.22, 4.00, p<0.00001, I2=0%) also showed significant improvement@*Conclusion@#Patient-centered approaches have potential benefit in improving specific components of physical and social functioning, ADL and quality of life. However, differences in the type of patient-centered intervention and outcome measurement tools warrant further investigation into the specific interventions which will provide the most benefit to post-stroke patients

Effectiveness of patient-centered interventions in pulmonary tuberculosis: Family and community practice setting

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> Patient participation greatly influences success in the treatment of pulmonary tuberculosis. Patient centered approach is among the collaborative models of intervention that can be used as a holistic approach in treatment of any disease. Patient centered approach to care recognizes the rights and values of patients and appreciates them as valuable partners who actively participate in managing public health crisis like pulmonary tuberculosis.<br /></p><p style="text-align: justify;"><strong>OBJECTIVE:</strong> To determine the effectiveness of patient centered interventions in improving treatment adherence among patients with pulmonary tuberculosis as the primary objective. The secondary objective of this review was to determine acceptability of the patient centered intervention in terms of satisfaction, confidentiality, and cost of the intervention.<br /></p><p style="text-align: justify;"><strong>METHODS:</strong> A systematic review and meta-analysis of cohort studies done on adult patients diagnosed with pulmonary tuberculosis undergoing treatment supervised by either the usual directly-observed therapy or using a newly introduced intervention by video directly-observed therapy. Studies including patients with latent tuberculosis or extra pulmonary tuberculosis were excluded. Treatment adherence was measured as fraction of expected doses observed.<br /></p><p style="text-align: justify;"><strong>RESULTS:</strong> Both studies explored vDOT as an alternative to the usual DOT in monitoring adherence of patients in their treatment. In the studies reviewed, they observed higher fraction of expected doses observed on vDOTs compared to the group supervised under DOT. Consequently, there was significantly less missed observed doses and discontinuations in the vDOT group as compared<br />to the DOT group.<br /></p><p style="text-align: justify;"><strong>CONCLUSION:</strong> Patient-Centered Intervention is effective in improving adherence to treatment of pulmonary tuberculosis. This study was able to determine that patient centered intervention through Video Observed Therapy is acceptable in terms satisfaction, confidentiality, and cost.</p>