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Introduction: The COVID-19 pandemic has negatively impacted clinical experience and case volumes. Surgical simulation is now an even more powerful training tool and, to maximize potential, we must ensure learner engagement. Our aim was to identify barriers to surgical simulation engagement and strategies to mitigate these. Method(s): Scoping search was performed with a trained librarian of PubMed, EMBASE and Web of Science. Title and screening were completed with inclusion criteria: articles describing barriers to engagement with surgical simulation. After full text screening, data was extracted from included articles: type of study, MERSQI score, type/number of participants, barriers to engagement and strategies to mitigate these. Result(s): Twenty-nine manuscripts were included with 951 faculty and 2,467 residents. The majority (86%) were in high income countries (HIC) and four in LMICs. Most were surveys (22/29), and five involved semi-structured interviews/focus groups. Mean adjusted MERSQI score was 8. Commonest barriers to HIC engagement were learner clinical duties (9/25), lack of learner time (13/25), lack of learner interest/motivation (9/25) and lack of faculty time or interest to participate (12/25). In LMIC, commonest barriers were lack of simulation lab/equipment (4/4), cost (3/4) and inadequate supervision (3/4). Strategies to improve HIC engagement were mandatory/protected resident simulation training (9/25) and, in LMIC, low cost simulators (4/4) and sharing resources (2/4). Conclusion(s): Identification of barriers to simulation engagement is crucial for successful learning. Given the increased importance of simulation education due to the COVID-19 pandemic, surgical educators should strategize to maximize engagement.
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Background It is a challenge for pharmacy courses worldwide to combine theoretical knowledge with practical skills to equip students for their future practice. Computer-based simulation offers a way of building a bridge between theory and practice. In recent years, digital simulation has expanded rapidly as a new technique of virtual learning. The digital platform ''Pharmacy Simulator'' proposes computer-based encounters with virtual patients to train clinical and communication skills in a community pharmacy setting. However, during the COVID-19 pandemic, while students were digitally resilient and endured the endless challenges of online lectures, many were dealing with Zoom and screen fatigue. Purpose To investigate pharmacy students' acceptance of Pharmacy Simulator before and during a pandemic situation. This focuses on students' self-assessment and confidence in counselling after playing the scenarios on Pharmacy Simulator. Method Two cohorts of Master of Pharmacy students at The University of Western Australia played two scenarios on Pharmacy Simulator in 2019 (anaphylaxis and salbutamol) and 2021 (anaphylaxis and vaccination). A mixed-method analysis was performed with data from (i) qualitative semi-structured interviews carried out in 2019 pertaining to participants' acceptance of Pharmacy Simulator and in 2021 (ii) a questionnaire with 25 items derived from the interviews. The interviews were transcribed verbatim into electronic format with the data management assistance MAXQDA and analyzed inductively using the Framework Method. Questionnaire responses were analyzed in Microsoft Excel using descriptive statistics. Openended questions were evaluated inductively. Findings Data were collected from 20 interviews and 31 answered questionnaires. In 2019, participants reported that Pharmacy Simulator was a fun, engaging, and straightforward learning tool and, therefore, user-friendly. They reported the feedback at the end of the session to be most valuable. The platform was perceived to fill the gap between the theory from lectures and community pharmacy practice. In 2021, participants ''agreed'' (median: 4, on a 5-point Likert scale) with seven statements about Pharmacy Simulator's usability, such as it being a helpful tool for acquiring new knowledge. Participants' confidence in counselling regarding the scenario topics improved. One participant stated, ''It taught me more through trial and error''. Conclusion Pharmacy students reported similar acceptance levels of Pharmacy Simulator before and during the COVID-19 pandemic. The use of simulation during virtual patient encounters seems to facilitate the transfer from theory to practice, independently of learning conditions that were predominantly screen-based.
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Aims: The DisCOVery study sought to better understand the experiences of young people with complex emerging mental health problems over the longer-term social restrictions related to the COVID-19 pandemic. A key focus investigated young people's attitudes and experiences of social connection, and how they perceived this to be related to their mental health and future recovery needs. Method(s): Semi-structured interviews were completed with 16 young people (aged 20 to 25) with pre-existing and complex mental health and social problems, between January to December 2021. N = 6 completed follow up interviews approximately 6 months after their initial interview. Interviews were analysed using thematic analysis. Results and Conclusion(s): Four themes were identified. These centred around a preference for balancing solitude and quality relationships within small social worlds, the complex role of in-person versus online connection and interaction, how the COVID-19 lockdowns were a facilitator of both social connection and disconnection, and the importance of relationships, talking and being listened to for well-being. The findings suggest that in-person, and to some extent online connection, is a key component of well-being, and is an active recovery goal that socially withdrawn young people with complex pre-existing mental health problems would like to work on.
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Aim and Objectives: 1. Knowledge of the COVID 19 vaccine among medical students in a tertiary care hospital. 2. Attitude towards the COVID 19 vaccine among medical students in a tertiary care hospital. Methodology: Study Location: Tertiary care hospital facility in Visakhapatnam. Study Period: From August to September 2022 will be the study period. Study Sample Size: 316. Statistics: Data are gathered using google forms, and the spread document is error-checked. Calculations are made for descriptive numbers like frequency and percentage. Result(s): Sociodemographic details about the participants-There were 316 competitors in total. Men make up about 34.5% (n=109) of the members. Approximately 65.5% of the members (n=207) are female. About 40.5% (n=128) of the participants are first-year students, 39.25% (n=124) are second-year students, 14.5% (n=46) are third-year students, and 5.7% (n=18) are fourth-year students. Conclusion(s): The majority of medical students' responses to this research show moderate knowledge of and a favorable outlook towards the COVID 19 vaccine. It also demonstrates that medical students are more knowledgeable and have more optimistic dispositions. Our findings can be applied to interventions that promote public health, particularly for medical students. To dispel the medical students' fears and misunderstandings regarding the COVID 19 vaccine, there should be seminars, lectures, and instructional videos that are specifically aimed at them.Copyright © 2023, Dr. Yashwant Research Labs Pvt. Ltd. All rights reserved.
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Introduction: de Quervain's syndrome is a painful condition commonly presented to hand therapists. Exercise is utilised as an intervention, but isometric exercise has not been investigated. We aimed to assess the feasibility and safety of isometric thumb extension exercise for de Quervain's syndrome and to explore differences between high-load and low-load isometric exercise. Method(s): This parallel-group randomised clinical feasibility trial included individuals with de Quervain's syndrome. All participants underwent a 2 week washout period where they received an orthosis, education, and range of motion exercises. Eligible participants were then randomised to receive high or low-load isometric thumb extension exercises, performed daily for 4 weeks. Feasibility and safety were assessed by recruitment and drop-out rates, adherence, adverse events, and participant feedback via semi-structured interviews. Secondary outcomes included patient-reported outcomes for pain and function, and blinded assessment of range of motion and strength. Result(s): Twenty-eight participants were randomised. There were no drop-outs after randomisation, and no serious adverse events. Adherence to exercise was 86.7%, with 84% of participants stating they would choose to participate again. There were clinically and statistically significant improvements in pain and function over time (p < 0.001) but not in range of motion or strength. There were no statistically significant between-group differences. Conclusion(s): Isometric thumb extension exercise within a multimodal approach appears a safe and feasible intervention for people with de Quervain's syndrome. A large multi-centre trial would be required to compare high- and low-load isometric exercises. Further research investigating exercise and multimodal interventions in this population is warranted.Copyright © The Author(s) 2023.
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A Conversation Partner Scheme (CPS) can provide an opportunity for students to learn about acquired communication disorders, develop skills to support adults in conversations and reflect on their personal attitudes about communication disability. It can also enhance communication, facilitate social inclusion and participation and increase well-being for CPS partners with acquired communication disabilities. The format of a CPS generally includes conversation-training workshops followed by face-to-face supported conversations. The COVID-19 pandemic and associated public health guidance necessitated the transition of all components of the scheme (training and conversations) to an online format. The aim of this case study was to investigate the feasibility of an online CPS and explore the participants' experience of this format. A case study design was undertaken with feasibility objectives examining Implementation, Practicality, Adaption, Integration and Acceptability of the online CPS. Data was gathered from students using questionnaires. Online semi-structured interviews were carried out with seven persons with aphasia (PwA) who participated as CPS partners. Technical challenges, duration of conversations and topics of conversations were also recorded. Twenty-seven speech and language therapy students and 14 CPS partners took part in the CPS. Eighty-five online conversation sessions were carried out. All seven PwA and many of the students (87.5%) perceived an online format as suitable for CPS conversations. However, many students highlighted the value of in-person contact and reported that the online format constrained the use of some communication ramps. The PwA repeatedly commended their student conversation partners and noted the CPS provided an opportunity for increased social interaction during the public health restrictions. The online CPS provided a timely opportunity for students to practice supported communication skills and was perceived to be important for student training and communication skills development.
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Introduction: The use of telemedicine in surgical care quickly increased due to the COVID-19 pandemic. However, uptake among surgical specialties has not been consistent. We aimed to characterize surgical provider perceptions of barriers and facilitators to telemedicine use. Method(s): Surgeons and nurses within the gastrointestinal surgery division at a high-volume, tertiary care academic center were contacted for participation in this study. Individual semi-structured interviews explored barriers and facilitators to telemedicine use. Qualitative analysis was conducted by multiple coders using NVivo12 software. Result(s): Six surgeons and three nurses participated in this study. Among the 9 participants, 44% identified as female and 33% were over age 50. Three themes were identified as facilitators to provider utilization of telemedicine: increased accessibility for rural patients due to decreased travel time and cost, enhanced provider productivity from reduced transition time between visits, and the ability of video telemedicine to facilitate non-verbal communication and visual examination. Three themes were identified as barriers to provider utilization of telemedicine: unreliable broadband connection, negative impacts on workflow due to scheduling challenges and insufficient IT support, and the inability to conduct a physical exam and immediately manage certain complications. Conclusion(s): As telemedicine becomes highly integrated into routine care, best practice guidelines to surgeon-patient telemedicine encounters should be established. This will improve virtual communication and consistency across providers, as well as provider satisfaction with telemedicine. Future interventions should address concerns with workflow logistics and technical support by developing comprehensive training and troubleshooting strategies for healthcare providers.
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Objective: The radiation therapy technologist fundamentals training program (RFTP) facilitates knowledge and skills development of newly employed radiation therapy technologists (RTTs) within our China network. Since its initial implementation in 2019, the RFTP has evolved to address the diversity of RTTs' education and experience, as well as changing local clinical contexts. In particular, a shift to remote delivery and assessment has been required during the COVID-19 pandemic. This quality improvement initiative aimed to evaluate the impact of the RFTP on learning engagement and outcomes, from trainee perspectives. Method(s): Online pre-interview surveys and semi-structured interviews were conducted with 16 RTTs from five China sites in July and August 2022.1 Participants provided verbal informed consent regarding the survey and interview recordings for subsequent analysis. Surveys were reported with descriptive statistics, and interview themes were developed using direct content analysis.2 Results: 15/16 participants qualified in a non-RTT field of study, with most practiced in medical imaging (N = 7);12/12 participants with previous RTT experience reported differences in practice standards. All participants rated the RFTP highly (see Figure), with IGRT (13/16), ARIA (14/16), and SimCT (7/16) most frequently identified as new areas of learning;14 participants who completed the RFTP reported the preparation for IGRT standard workflow was most valuable. Discussion/Conclusion: Results show that the RFTP is an essential on-boarding program that advances RTTs' knowledge and reduces the skills gap to perform our network's established workflows. Additional feedback gained through this initiative will be considered for future development of the RFTP.
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Healthcare system is an essential system for any nation as it is responsible for maintaining the health of the individuals and public. However, the outbreak of different viral diseases such as influenza, covid-19 etc. has encouraged medical research in different developing and developed countries. Similarly, in Malaysia, different public and private research centers and biotechnology firms are being promoted to develop new and innovative medical drugs and equipment. However, different challenges are faced by the developers in promoting the development and innovations of medical commodities. Thus, this study was conducted to investigate different challenges in the development, funding, and reimbursement of medical innovations in Malaysia. For this purpose, semi-structured interviews were conducted with 7 developers from different public research and development (R&D) centers and biotechnology firms in Malaysia. After the interviews were conducted, their edited transcription was obtained, and thematic analysis was conducted, and different themes and sub-themes were formulated. The results obtained from this study showed that the lack of innovative environment, strategic compliances and effective funding structure negatively influences medical innovations in Malaysia. It has also been observed that poor reimbursement practices and policies and lack of pricing strategies by the Malaysian government impacts the ROI of the associated firms and developers. Thus, it has been recommended that mega-funds and reimbursement policies should be promoted to overcome these challenges in medical innovations.Copyright © 2023 ThinkBiotech LLC. All rights reserved.
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Introduction: Before spring 2020, many healthcare organisations did not possess detailed plans for the expansion and delivery of critical care during a pandemic. Furthermore, there was little directly-relevant individual or institutional experience to draw upon. Local, national and international guidance was drawn up rapidly and subject to frequent revision.1 Reflecting on these challenges, we designed a study to explore critical care and anaesthetic doctors' experiences of preparation for the provision of critical care services in the first wave of COVID-19. Objective(s): 1. To establish what factors facilitated and hindered the expansion and delivery of critical care services. 2. To identify important learning points for the provision of critical care during future pandemics. Method(s): We conducted semi-structured interviews with medical staff from the anaesthesia and critical care departments of our hospital, a tertiary centre with general and cardiothoracic intensive care units, including an ECMO service. We classified participants into two groups;1. Decision makers - individuals instrumental in shaping the critical care response, e.g., clinical directors and college tutors. 2. Staff members - clinicians working within the departments, including consultants and trainees. Thirteen interviews were conducted with 15 participants: eight decision makers and seven staff members. The interviews were recorded, transcribed and anonymised. We manually coded transcripts, and carried out an inductive thematic analysis.2 Results: Eight themes were generated from our analysis: * Problem solving with simulation: simulation exercises allowed experienced clinicians to troubleshoot practical issues and helped staff to prepare for unfamiliar tasks. * A sense of togetherness: staff reported that the "all hands-on deck" ethos was protective against fatigue, although this was short-lived. * Delayed and changing guidance: frequent guideline changes created confusion and anxiety. * Leading from the front: leaders with a clinical role were perceived more positively than those operating at a distance from the "shop-floor". * Coordination, collaboration and compromise: departments that accommodated each other's needs fostered productive inter-departmental relationships. * Insecure supply chains: staff took their own measures to ensure PPE availability, including acquisition of items outside NHS supply chains. * Constant communication: rapid methods of personal communication, e.g., WhatsApp were effective, although "WhatsApp fatigue" was endemic. * Balancing skill mix and fatigue: flux in workload required dynamic staff allocation. Underutilised staff groups created frustration and low morale in overworked colleagues. Conclusion(s): The threat to health and society from pandemic events is expected to increase over time.3 We should take this opportunity to gather experiences from those involved in the COVID-19 pandemic to guide future preparations. In early 2020, decision makes in local hospitals were operating with unclear guidance from external agencies. Our data, obtained in the summer of 2021 demonstrates that individual and departmental reflections had already resulted in processes being refined in later waves of COVID-19. Whilst the exact nature of future pandemics will vary, some elements of preparation will remain consistent. We recommend that plans for pandemic management should aim to reduce workload and target the most effective interventions, including by addressing the themes outlined above.
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Background: Stem cell transplantation is a potentially life-saving intervention for patients with blood cancer. Research suggests that there are existing disparities in access, care and treatment experiences, with patients identifying with a minority ethnic heritage reporting greater disadvantage compared to patients from white British, Irish or Northern European backgrounds. Although we know that the COVID-19 pandemic has been challenging for patients, less is known about the experiences of patients from specific ethnic communities. Method(s): In this research, we undertook 1-1, semi-structured interviews with eight patients within the stem cell transplant pathway who identify with a minority ethnic background. Interviews took place online, between May and November 2021. The interview questions explored views on aspects of the pandemic, including access and experience of care delivery, intervention, mental health and financial impact. Interviews were transcribed verbatim and analysed using reflexive thematic analysis. Result(s): The majority of patient participants were female (75%), and identified with a Black African or Caribbean heritage (75%). Four themes were identified from the data: (1) 'Lack of suitable donors' described the challenges of finding a stem cell donor and the importance of raising awareness of stem cell donation specifically within minority ethnic communities;(2) 'Experiences of care' explored patients' experiences of the healthcare system from pre-diagnosis to post-treatment, including how the COVID-19 pandemic had made some aspects of care easier but acted to disrupt others;(3) 'Intense and unpredictable process' described the nature of living with blood cancer and how this has impacted upon patients' lives including the extent to which they had been able to access and make use of advice to help keep them safe during the pandemic;and (4) 'Coping mechanisms' identified the factors which helped patients' to understand and adjust to living with their diagnosis and the treatment process. Conclusion(s): Patients in the stem cell transplant pathway often experience intense treatment regimens, debilitating symptoms and long hospital stays, which has a significant impact on their lives. Minority ethnic patients describe facing additional challenges in relation to health inequalities both within and outside of the pandemic. Seeking support from family, peers or community organisations can help buffer the negative impacts of living with blood cancer and multiple disadvantages, but such support was more difficult to access during the pandemic. This had psychological consequences for patients who are already within an intense emotional journey. Pandemic recovery plans should address mental health support as a priority.
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Background/Objectives: The changes and restrictions precipitated by the COVID-19 pandemic have led to innovation in Clinical Genetics service delivery worldwide. At the Guy's and St Thomas' (GSTT) Clinical Genetics Service, telegenetics was implemented at the beginning of the pandemic using the AttendAnywhere videoconferencing platform. We subsequently designed a qualitative study to capture experiences and preferences of Healthcare Professional's (HCP) using this service delivery model. Method(s): We conducted semi-structured interviews with seven HCPs working at the GSTT Clinical Genetics Service, including Genetic Counsellors, Clinical Geneticists and a Clinical Psychologist. Interview content was analysed using a thematic analysis approach. Result(s): We present HCPs' experiences of transitioning between virtual and in-person appointments and their appraisal of the technical and practical aspects of telegenetics. We also present themes that emerged about how HCPs' clinical practice has changed to adapt to telegenetics, as well as differences in both patients' and HCPs' attitudes towards virtual appointments when compared to in-person encounters. Future considerations will be shared regarding the suitability of telegenetics for Clinical Genetics appointments. Conclusion(s): Based on their experience at GSTT, HCPs interviewed would welcome the addition of telegenetics to the Clinical Genetics toolkit beyond the COVID-19 pandemic, and we will provide considerations for future guidelines.
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Co-creation places key stakeholders at the centre of development processes for quality improvement projects to reduce gaps between research and practice. We describe an Amplify OnTrackNY project that used principles of community-based participatory research to meaningfully partner with individuals with lived experience and describe lessons learned. Method(s): Two individuals with lived experience were hired and coled decision-making about project selection and design. The project examined OnTrackNY provider, participant, and family perspectives on the impact of COVID-19 on service delivery. To enhance the lived experience perspective, we hired two OnTrackNY graduates and a family member, and created mechanisms for team building and integration, and co-planning sessions. All team members contributed to the development of research questions, co-facilitated interviews/ focus groups, and participated in data analysis and dissemination. Result(s): Team members conducted focus groups and semi-structured interviews with 13 participants and five family members, presented results to various stakeholder groups, and are contributing to scientific publications. To ensure participation, our flexible working structure focused on promoting equity and building trust. Dedicated time ensured opportunities for meetings focused on mutual support, sharing, capacity building, and training in qualitative methods. Individuals with lived experience were in decision-making roles, created content, and led project activities embodying principles of power-sharing, reciprocity, and mutual learning. Orienting new team members to the office culture required extra effort. Conclusion(s): Provided sufficient time and infrastructure, it is feasible to meaningfully involve individuals with lived experience in quality improvement projects. Co-creation ensures that important perspectives are incorporated from the outset and procedures improve the relevance and uptake of research findings in the real world.
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Aim: The objective of this conceptual study was to know the effects of COVID-19 on mental health of older adults. Study design: This qualitative study was conducted in October-December 2022 in District Sargodha. Twenty (20) older adults who have been suffered from COVID-19 were taken as respondents selected through snowball-purposive sampling technique. A semi-structured interview protocol was used to collect data through in-depth interviews from the respondents. Thematic analysis method of qualitative methodology of research was used to analyze the data to find the results. Result(s): The study found that older adults experienced severe mental health issues during COVID-19 period due to loneliness, isolation, anxiety and fear of disease and death. During the quarantine period and hospitalization, loneliness and social isolation affected the mental health of the older adults. Fear of disease & death and losing the loved ones negatively affected the older adults psychologically to great extent. However, respondents who were educated and well aware of causes and consequences of the disease;used this information and awareness as coping strategy and such respondents had less adverse affects on their mental health. Conclusion(s): COVID-19 virus affected the well-being of older people with regard to mental and emotional. Social isolation and loneliness have been observed as main factors affecting the mental condition of older adults during the pandemic. They experienced grave psychological issues due to loneliness and fear of disease & death during the quarantine/ hospitalization period.Copyright © 2023 Lahore Medical And Dental College. All rights reserved.
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Introduction: Adopting diabetes self-care behaviors to control blood glucose is essential, but adherence to them has been challenged due to restrictions related to Covid-19. These restrictions have negatively impacted the psychosocial condition of individuals with diabetes, which could lead to poor self-care. Accordingly, this study aimed to explore the experiences of individuals with type 2 diabetes regarding self-care behaviors and diabetes management during the COVID-19 pandemic. Material(s) and Method(s): This qualitative study was conducted using conventional content analysis, the data of which were collected through interviews with people over 18 years of age with type 2 diabetes who were selected from the Endocrinology Clinic of Erfan Hospital in Tehran. Using telephone and WhatsApp, semi-structured interviews were conducted with 20 participants (15 women). Content analysis was done using the constant comparative method, and the open and axial coding method was applied. The data were manually coded, and the main themes and categories emerged from data. Result(s): Two main themes emerged from the data: 1) challenges and limitations toward diabetes self-care and 2) facilitators of efficient self-care. Challenges and limitations included 4 sub-themes: Inevitable lifestyle changes, psychosocial problems, limited/lack of access to health care services and medication, and adverse physical effects. Facilitators had 2 sub-themes: improved individual capability and maintaining social interaction. Conclusion(s): Our findings indicated that inevitable lifestyle changes, limited access to health care, and adverse psychosocial consequences were the most critical challenges for diabetes management during the COVID-19 pandemic. Improving stress management skills and effective coping strategies can facilitate the adoption of self-care behaviors.Copyright © 2022, Research Institute for Endocrine Sciences. All rights reserved.
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Background: The Voluntary and Community Sector (VCS) is a vital partner in delivering care and support needs: enabling vulnerable people to live fulfilling, independent lives;helping them maintain good health and wellbeing. People living with HIV are disproportionately impacted by poverty, financial instability, stigma and discrimination, all of which were exacerbated during the COVID-19 pandemic. Pre-pandemic, this small HIV support organisation (part of the VCS) provided community, food, friendship and peer-support for people living with or affected by HIV, primarily via a weekly lunch club and monthly supper. This qualitative impact study explored clients' experiences of the change in service provision (eg food collection, doorstep food delivery, and companionship telephone calls) as the organisation adapted to members' needs during lockdowns and as restrictions altered. Method(s): Nineteen clients gave informed consent and participated in a facilitated in-person focus group. Two groups (n=10 and n=9) were held concurrently in June 2021 (after the second lockdown, but before all COVID restrictions were lifted). Focus groups lasted 60-90 minutes, with semi-structured interview question guides to structure discussions;they were recorded and transcribed verbatim. Deductive thematic analysis was conducted using a coding procedure to identify patterns between the groups and emerging themes. Result(s): The following themes relating to clients' experiences of the pandemic and their engagement with the organisation emerged from the focus groups: * Pre-lockdown services * Loneliness * Regular food parcels * Telephone companionship calls * Value of non-judgemental space Pre-lockdown, participants valued peer support and sharing meals together. During the pandemic, some clients experienced food insecurities;some felt disconnected and socially isolated;some lost their jobs or retired. Clients trusted the organisation to keep them safe (eg social distancing), and the volunteers delivering food made them feel valued and connected to their peers. Telephone check-ins helped tackle loneliness and reassured those who were anxious or afraid. Conclusion(s): During the pandemic this organisation helped address stigma, food insecurities and social isolation experienced by people living with HIV. Participants appreciated the organisation's mission and commitment to people living with HIV, and how welcoming and supportive the service is.
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Background/Aims First Contact Physiotherapists (FCPs) assess, diagnose and manage patients presenting with musculoskeletal disorders in primary care, without the need for prior GP consultation. Prior to COVID-19 almost every consultation was conducted in-person. Since the pandemic, many consultations are now undertaken remotely, a trend that is set to continue in line with the 'Digital first' strategy which seeks to enhance patient access to appointments. This aim of this study was to explore FCP views of remote consultations and how this impacted their role satisfaction and wellbeing. Methods This mixed methods two phase study consisted of an online survey investigating distributed via professional networks and through social media. The phase one survey explored consultation methods;levels of training;challenges and benefits;and a stress appraisal. Data were analysed descriptively. Respondents were invited to take part in phase two which included a semi-structured interview to gain an in-depth understanding of FCPs lived experience of remote consultation ways of working. Transcripts were thematically analysed. Results The online survey received n=109 responses from UK-based FCPs. Data revealed that despite the 'Digital First' push for continued remote consultations, the majority of FCPs (62%) used them for less than a quarter of their appointment slots. Whilst recognising that many patients found this format convenient, FCPs highlighted their own stress levels, citing poor efficacy, anxiety of misdiagnosis, feelings of isolation and increased administrative workload. Nearly two thirds (66%) of respondents had not received any training in how to conduct effective remote consultations. Follow-up interviews with n=16 FCPs highlighted coping strategies including following up with an in-person consultation and directing patients to other community health and wellbeing resources. In areas of high socioeconomic deprivation and poor health literacy additional problems associated with communication difficulties, poor IT access and capability, and digital poverty were all cited. Conclusion Remote consultations may offer a convenient alternative for some patients. FCP responses suggest that the continued offer of remote consultation is decreasing now pandemic restrictions have been lifted, despite the push for continued digital working practices. The perceived lack of efficacy, and fear of missing important diagnostic information means that many FCPs are either returning to in-person consultation or following up with a second face-to-face assessment resulting in potential service inefficiencies. Additional challenges were identified in areas of high deprivation and low health literacy, and the value of this consultation format needs to be considered in this context. Future work should focus on the training and support needs of FCP staff who are engaging with remote working to ensure clinical effectiveness and staff wellbeing.
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Introduction: One in six adults are affected by hearing loss, and this number increases with age.(1) Inadequate communication is a barrier to the delivery of effective care for people with hearing loss.(2) Communication regarding medicines is particularly relevant to the pharmaceutical care of older people who are more likely to be living with hearing loss, have multiple comorbidities and experience polypharmacy, a risk factor for adverse drug events. This study sought to explore factors that facilitate and impede communication with people with age-related hearing loss (presbycusis) in the community pharmacy, to provide a base upon which to identify solutions/ interventions to improve these interactions. Aim(s): To explore the barriers and facilitators to effective communication with people with age-related hearing loss in the community pharmacy setting. Method(s): This qualitative study consisted of semistructured interviews with people with age-related hearing loss (presbycusis), older people (>50 years old) without hearing loss, and focus groups and interviews with community pharmacists, conducted between March - June 2022. Participants were recruited purposively via advert and snowballing. Interviews and focus groups were conducted using Microsoft Teams or Zoom;two interviews were held by telephone. Data was analysed using the framework method. Result(s): Sixteen people with age-related hearing loss and three older people without hearing loss took part. Eight community pharmacists took part across two focus groups and one interview. Four main themes were identified. The first was 'grappling with the environment'. This theme reflects the multitude of environmental barriers to communication and person-centred pharmaceutical care such as heavy workload, time constraints, lack of privacy, noise levels and Covid-19 safety measures on communication. The second was 'promoting acknowledgment and inclusion of hearing loss in the pharmacy'. This theme captures the perception among patients that their hearing loss is not relevant to the community pharmacy setting and that more could be done to signify that a pharmacy recognises the needs of those with hearing loss. Third, 'patient perceptions and use of community pharmacy services'. This theme highlights the awareness and perceptions of the role of the pharmacy that is, primarily or exclusively as a place to collect prescriptions and the limited interaction with pharmacy personnel. The final theme was 'differing perceptions of patients and pharmacists about communication'. This theme articulates the varying patient-provider perceptions about communication and levels of awareness among pharmacists about the key facilitators to communication. Conclusion(s): This study garnered rich insights about the experiences of accessing and providing pharmaceutical care for people with age-related hearing loss within the community pharmacy setting. However, due to the Covid- 19 pandemic, data collection was chiefly conducted online and the findings cannot be considered reflective of the experiences of older people facing digital exclusion. There is clearly a need to improve pharmacists' awareness of, access to and implementation of strategies, adaptations, and assistive technologies to facilitate communication with people with hearing loss. Future research should identify interventions to support the implementation of strategies/adaptations that are tailored to the needs of people with hearing loss and pharmacists in order to engender hearing-friendly community pharmacies.
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Introduction: Breathlessness is a common symptom in clinical practice and in many prevalent diseases including chronic obstructive lung disease (COPD), asthma, heart failure, lung cancers and post COVID-19 syndrome. Understanding patients' experience of living with breathlessness, their expectations of care and self-management needs is essential to support development of health services and resources that meet their needs. Aim(s): To explore the perspectives of patients and their careers, on living with chronic breathlessness, provision and quality of medical care, and accessing information and resources to assist self-management. The study also explored their views on three evidence-based breathlessness patient education materials (PEMs). Method(s): Qualitative study involving in-depth semi-structured interviews with 16 patients living with chronic breathlessness (>=2 weeks) and their careers. Topics explored included: (1) experience living with breathlessness;(2) current medical care experience and their expectations;and (3) self-management resources, needs and views on some current publicly available PEMs. Result(s): Fourteen patients (cardiac, respiratory, and non-cardiorespiratory) and two carers (50% female) were interviewed (mean age 57 years). Twelve main themes were identified - (1) Breathlessness controls their lives, (2) Breathlessness avoidance and the vicious cycle, (3) Coping vs Fatalism, (4) Feeling misunderstood by their surroundings and health providers, (5) Diagnostic delays, misdiagnosis, and knowledge gaps, (6) Discontinuity of care, (7) Focus on pharmacologic management of breathlessness, (8) Demand for choice, non-pharmacologic options and support, (9) Beyond curing disease: symptom relief and improving quality of life as a goal, (10) Being more aware and in control of their disease, (11) Self-management and limited support for it, and (12) Resources they would value. Conclusion(s): Breathlessness remains a neglected condition in Australia. Patients suffer from lack of clinician and community awareness, discontinuity of care, and too few clinical and self-management options.
ABSTRACT
INTRODUCTION AND OBJECTIVE: Overactive bladder (OAB) is highly prevalent, affecting millions of Americans, and poses a significant symptom burden. The purpose of this study was to understand patient experiences with OAB and the impact of these experiences on OAB treatment. METHOD(S): People with symptoms of OAB were recruited from a tertiary care clinic and from an online health research portal to complete semi-structured interviews regarding their OAB experiences. The interviews were recorded, transcribed, coded, and inductively analyzed to identify emerging themes. RESULT(S): We performed 19 interviews and identified several key themes central to the patient experience, including symptom impact and severity, knowledge, stigma, self-efficacy, and regret. We considered these themes along the following stages of the patient's OAB journey. Symptom Development and Awareness: The routine of self-care is insidious and normalized, making realization of a lifestyle that is centered around voiding less obvious to patients, leading to a delay of care-seeking. Participants noted restrictions on all aspects of life. Adjectives used to describe symptom impact included "annoyance, depression, humiliation and desperation." Care-Seeking: Participants expressed coping behaviors during onset and gradual worsening of symptoms, however many recounted a "sentinel event" that heightened their severity perception and served as a cue to action. Routine primary care visit screenings and friend recommendations were additional cues to action. Reasons for careseeking delay included lack of OAB knowledge, stigma, and embarrassment. Experiences with Therapy: Participants recognized that treatment outcomes depended on their engagement. Some individuals regretted their lack of self-advocacy and self-efficacy. Participants highlighted internal barriers (forgetfulness, doubting treatment effectiveness) and external barriers (comorbidities, COVID- 19) to therapy adherence. Among those with high self-efficacy, fear of treatment failure, calendar tools, and social support networks facilitated treatment compliance (Figure 1). CONCLUSION(S): Living with OAB affects patients physically, mentally, and socially. Gaining a better understanding of OAB experiences can help physicians tailor their practice to meet patients' needs.