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1.
Farm. hosp ; 46(2): 1-8, Mar-Abr 2022. tab
Article in Spanish | IBECS | ID: ibc-VR-272

ABSTRACT

Los medicamentos de terapia avanzada han emergido en los últimosaños como nuevas estrategias farmacoterapéuticas. En este contexto, los serviciosde farmacia hospitalaria nos hemos tenido que adaptar al nuevo retoque ha supuesto su inclusión en nuestra cartera de servicios dentro del complejoproceso farmacoterapéutico en el que están inmersos los pacientes.Todas las actividades que se desarrollan en los servicios de farmaciahospitalaria cumplen con una base legal establecida en nuestra legislacióny garantizan la calidad y seguridad tanto de los pacientes atendidos comode todos y cada uno de los medicamentos que se gestionan.Los medicamentos de terapia avanzada tienen unas característicasespeciales a considerar que van desde las fases iniciales de seleccióny evaluación de los pacientes candidatos y su modelo de financiación,basado en riesgo compartido, hasta una fragilidad en su manipulación querequiere de una adecuada y adaptada formación del personal implicadoen la logística para mantener su viabilidad, al necesitar unas condicionesde conservación, en ocasiones, a temperaturas de menos 180 ºC, en elcaso de las células T con receptores quiméricos de antígenos.Además, la utilización clínica de los medicamentos de terapia avanzadaha necesitado de documentos de consenso de las sociedades científicas utiliquepongan en valor el posicionamiento del farmacéutico hospitalario, comomiembro indispensable dentro del equipo multidisciplinar asistencial, y quegaranticen, como en cualquier otro medicamento, la trazabilidad, la correctaconservación y custodia y el seguimiento farmacoterapéutico asociado auna adecuada atención farmacéutica de nuestros pacientes, sin olvidar laimportancia de la creciente investigación clínica, necesaria e imprescindiblepara una incorporación segura de nuevas dianas terapéuticas.


Advanced therapy medicinal products have emerged in recentyears as new pharmacotherapeutic strategies. In this context, hospitalpharmacy services have had to adapt to the new challenges posed bythe inclusion of advanced therapies in their roster of services againstthe background of the complex pharmacotherapeutic process patientstypically go through.All the activities carried out in the hospital pharmacy services mustabide by the rules established in the Spanish legislation and ensure boththe quality of the different drugs they manage and the safety of every singlepatient.Advanced therapy medicinal products are associated certain peculiarities,including the need to select and evaluate potential candidates toreceive them; recourse to financing mechanisms based on risk sharing; andtheir extreme fragility, which means that the personnel in charge of handlingthem must be properly trained to maintain their viability and that specialstorage conditions, involving temperatures below 180 ºC in the case ofchimeric antigen receptor T cell therapies, must be maintained.In addition, use of advanced therapy medicinal products in the clinicalsetting has made it necessary for scientific societies to produce consensus documents recognizing the pivotal role of hospital pharmacists as indispensablemembers of the multidisciplinary healthcare team and ensuringthe same traceability, conservation, custody and pharmacotherapeuticalmonitoring standards imposed on other drugs to provide for adequate pharmaceuticalcare. Scientific societies have also highlighted the importance ofintensifying clinical research, an essential requirement for the safe incorporationof new therapeutic targets.The present document is intended to describe the challenges pharmacistsmay face when using advanced therapy medicinal products at thedifferent stages or processes in the patient’s clinical journey.


Subject(s)
Humans , Male , Female , Pharmacy Administration , Immunotherapy, Adoptive , Genetic Therapy , Cryopreservation , Quality of Health Care , Patient Outcome Assessment , Pharmacy Service, Hospital , Epidemiology, Descriptive
2.
BMC Psychiatry ; 22(1): 408, 2022 Jun 18.
Article in English | MEDLINE | ID: mdl-35717161

ABSTRACT

INTRODUCTION: Resource-oriented interventions can be a low-cost option to improve care for patients with severe mental illnesses in low-resource settings. From 2018 to 2021 we conducted three randomized controlled trials testing resource-oriented interventions in Bosnia and Herzegovina (B&H), i.e. befriending through volunteers, multi-family groups, and improving patient-clinician meetings using the DIALOG+ intervention. All interventions were applied over 6 months and showed significant benefits for patients' quality of life, social functioning, and symptom levels. In this study, we explore whether patient experiences point to common processes in these interventions. METHODS: In-depth semi-structured interviews were conducted with 15 patients from each intervention, resulting in a total sample of 45 patients. Patients were purposively selected at the end of the interventions including patients with different levels of engagement and different outcomes. Interviews explored the experiences of patients and were audio-recorded, transcribed, and analysed using the thematic analysis framework proposed by Braun and Clark. RESULTS: Three broad themes captured the overall experiences of patients receiving resource-oriented interventions: An increased confidence and agency in the treatment process; A new and unexpected experience in treatment; Concerns about the sustainability of the interventions. CONCLUSIONS: The findings suggest that the three interventions - although focusing on different relationships of the patients - lead to similar beneficial experiences. In addition to being novel in the context of the mental health care system in B&H, they empower patients to take a more active and confident role in treatment. Whilst strengthening patients' agency in their treatment may be seen as a value in itself, it may also help to achieve significantly improved treatment outcomes. This shows promise for the implementation of these interventions in other low-resource countries with similar settings.


Subject(s)
Mental Disorders , Quality of Life , Humans , Mental Disorders/therapy , Patient Outcome Assessment , Qualitative Research , Volunteers
3.
JAMA Netw Open ; 5(6): e2218167, 2022 Jun 01.
Article in English | MEDLINE | ID: mdl-35713900

ABSTRACT

Importance: The Patient Protection and Affordable Care Act (ACA) expanded Medicaid eligibility at the discretion of states to US individuals earning up to 138% of the federal poverty level (FPL) and made private insurance subsidies available to most individuals earning up to 400% of the FPL. Its national impact remains debated. Objective: To determine the association of the ACA with ambulatory quality, patient experience, utilization, and cost. Design, Setting, and Participants: This cross-sectional study used difference-in-differences (DiD) analyses comparing outcomes before (2011-2013) and after (2014-2016) ACA implementation for US adults aged 18 to 64 years with income below and greater than or equal to 400% of the FPL. Participants were respondents to the Medical Expenditure Panel Survey, a nationally representative annual survey. Data analysis was performed from January 2021 to March 2022. Exposures: ACA implementation. Main Outcomes and Measures: For quality and experience, this study examined previously published composites based on individual measures, including high-value care composites (eg, preventive testing) and low-value care composites (eg, inappropriate imaging), an overall patient experience rating, a physician communication composite, and an access-to-care composite. For utilization, outpatient, emergency, and inpatient encounters and prescribed medicines were examined. Overall and out-of-pocket expenditures were analyzed for cost. Results: The total sample included 123 171 individuals (mean [SD] age, 39.9 [13.4] years; 65 034 women [52.8%]). After ACA implementation, adults with income less than 400% of the FPL received increased high-value care (diagnostic and preventive testing) compared with adults with income 400% or higher of the FPL (change from 70% to 72% vs change from 84% to 84%; adjusted DiD, 1.20%; 95% CI, 0.18% to 2.21%; P = .02) with no difference in any other quality composites. Individuals with income less than 400% of the FPL had larger improvements in experience, communication, and access composites compared with those with income greater than or equal to 400% of the FPL (global rating of health, change from 69% to 73% vs change from 79% to 81%; adjusted DiD, 2.12%; 95% CI, 0.18% to 4.05%; P = .03). There were no differences in utilization or cost, except that receipt of primary care increased for those with lower income vs those with higher income (change from 65% to 66% vs change from 80% to 77%; adjusted DiD, 2.97%; 95% CI, 1.18% to 4.77%; P = .001) and total out-of-pocket expenditures decreased for those with lower income vs those with higher income (change from $504 to $439 vs from $757 to $769; adjusted DiD, -$105.50; 95% CI, -$167.80 to -$43.20; P = .001). Conclusions and Relevance: In this cross-sectional national study, the ACA was associated with improved patient experience, communication, and access and decreased out-of-pocket expenditures, but little or no change in quality, utilization, and total cost.


Subject(s)
Insurance, Health , Patient Protection and Affordable Care Act , Adult , Cross-Sectional Studies , Female , Health Services Accessibility , Humans , Patient Outcome Assessment , United States
4.
S D Med ; 75(3): 109-113, 2022 Mar.
Article in English | MEDLINE | ID: mdl-35708575

ABSTRACT

INTRODUCTION: The use of minimal and moderate sedation in the pediatric population allows for the successful completion of many procedures in both hospital and outpatient settings without the risks involved with general anesthesia. Sanford Children's outpatient sedation clinic had been using oral midazolam for minimal sedation but began using inhaled nitrous oxide in January 2019. The current study examines patient experience and parent/guardian satisfaction with use of inhaled nitrous oxide for minimal sedation. DESIGN/METHODS: A survey was designed to evaluate parent/guardian satisfaction with nitrous oxide for pediatric sedation in various outpatient procedures. Parents'/ guardians' understanding of the sedation and procedural logistics were surveyed as well as their satisfaction with the child's comfort, recovery time, and overall satisfaction were assessed. RESULTS: Thirty-seven surveys completed by parents/guardians of patients ages 1-16 years were collected. Average age of the patient was 6 years old, with 22 female and 15 male patients. Outpatient procedures for which the nitrous oxide sedation was used included 30 botulinum toxin injections, 5 VCUG, 1 vaccine administration, and 1 IV placement. Mean survey results were 9.6 (95 percent CI, 9.3-9.9) for satisfaction of recovery time, 8.5 (95 percent CI, 7.7-9.3) for control of discomfort, and 9.1 (95 percent CI, 8.5-9.7) for overall satisfaction. CONCLUSIONS: When evaluating nitrous oxide as an agent for minimal sedation in pediatric procedures, parents/guardians were most satisfied with the recovery time and least satisfied with its ability to control discomfort. Overall, we concluded that nitrous oxide is a moderately good agent for pediatric patients receiving minimal sedation.


Subject(s)
Anesthetics, Inhalation , Nitrous Oxide , Adolescent , Child , Child, Preschool , Female , Humans , Infant , Male , Outpatients , Parents , Patient Outcome Assessment , Patient Satisfaction , Personal Satisfaction
5.
BMC Complement Med Ther ; 22(1): 155, 2022 Jun 13.
Article in English | MEDLINE | ID: mdl-35698124

ABSTRACT

BACKGROUND: Individual acupuncture (AP) is a safe and effective treatment for cancer-related pain and other symptoms in cancer survivors. However, access to individual AP is limited, and costs can be prohibitive. Group AP could be a more cost-effective alternative as it is less expensive and non-inferior to individual AP for pain relief. Despite growing evidence in favour of group AP, patient acceptability and experience of group AP in cancer patients is relatively unknown. This exploratory study sought to compare patient experiences and acceptability of group versus individual AP in cancer patients. METHODS: Semi-structured, open-ended, in-depth interviews were conducted in a subset of 11 cancer patients enrolled in a randomized non-inferiority trial of group vs. individual AP for cancer pain. Participants for this study were recruited via purposive sampling, aiming for diversity in age, sex, education, employment, cancer types, and treatment arms. Data was analyzed using inductive thematic analysis. RESULTS: Two major themes were identified: a) overall experience of AP treatment b) value of AP. Participants across both treatment arms acknowledged improvement in pain, quality of sleep, mood and fatigue. Participants in the group AP arm reported a significant increase in perceived social support, while participants in the individual arm valued privacy and one-on-one interaction with the acupuncturist. Although some participants in the group arm had privacy-related concerns before the commencement of the program, these concerns waned after a few AP sessions. Participants across both the treatment arms reported cordial clinician-patient relationship with the acupuncturist. Willingness to pursue AP treatment in the future was comparable across both the treatment arms and was limited by out-of-pocket costs. CONCLUSION: Patient acceptability and experience of treatment in group AP was on par with individual AP. Group AP may further augment perceived social support among patients and privacy concerns, if any, subside after a few sessions. TRIAL REGISTRATION: ClinicalTrials.gov ( NCT03641222 ). Registered 10 July 2018 - Retrospectively registered.


Subject(s)
Acupuncture Therapy , Cancer Pain , Neoplasms , Cancer Pain/therapy , Humans , Neoplasms/complications , Neoplasms/therapy , Pain , Pain Management , Patient Outcome Assessment
6.
Fam Med Community Health ; 10(2)2022 Jun.
Article in English | MEDLINE | ID: mdl-35688482

ABSTRACT

OBJECTIVES: To evaluate primary care access for COVID-19 consultation among residents who have a usual source of care (USC) and to examine their associations with patient experience during the pandemic in Japan. DESIGN: Nationwide cross-sectional study. SETTING: Japanese general adult population. PARTICIPANTS: 1004 adult residents who have a USC. MAIN OUTCOME MEASURES: Patient experience assessed by the Japanese version of Primary Care Assessment Tool Short Form (JPCAT-SF). RESULTS: A total of 198 (19.7%) reported restricted primary care access for COVID-19 consultation despite having a USC. After adjustment for possible confounders, restricted primary care access for COVID-19 consultation was negatively associated with the JPCAT-SF total score (adjusted mean difference = -8.61, 95% CI -11.11 to -6.10). In addition, restricted primary care access was significantly associated with a decrease in all JPCAT-SF domain scores. CONCLUSIONS: Approximately one-fifth of adult residents who had a USC reported restricted primary care access for COVID-19 consultation during the pandemic in Japan. Our study also found that restricted primary care access for COVID-19 consultation was negatively associated with a wide range of patient experience including first contact. Material, financial and educational support to primary care facilities, the spread of telemedicine and the application of a patient registration system might be necessary to improve access to primary care during a pandemic.


Subject(s)
COVID-19 , Adult , Cross-Sectional Studies , Humans , Pandemics , Patient Outcome Assessment , Primary Health Care
7.
Stud Health Technol Inform ; 290: 350-353, 2022 Jun 06.
Article in English | MEDLINE | ID: mdl-35673033

ABSTRACT

Patient Centered Outcomes Research (PCOR) and health care delivery system transformation require investments in development of tools and techniques for rapid dissemination of clinical and operational best practices. This paper explores the current technology landscape for patient-centered clinical decision support (PC CDS) and what is needed to make it more shareable, standards-based, and publicly available with the goal of improving patient care and clinical outcomes. The landscape assessment used three sources of information: (1) a 22-member technical expert panel; (2) a literature review of peer-reviewed and grey literature; and (3) key informant interviews with PC CDS stakeholders. We identified ten salient technical considerations that span all phases of PC CDS development; our findings suggest there has been significant progress in the development and implementation of PC CDS but challenges remain.


Subject(s)
Decision Support Systems, Clinical , Delivery of Health Care , Humans , Patient Outcome Assessment , Patient-Centered Care , Technology
8.
Stud Health Technol Inform ; 290: 410-413, 2022 Jun 06.
Article in English | MEDLINE | ID: mdl-35673046

ABSTRACT

Patient experience while using telehealth services impacts patient care, and health system incentives and reimbursement. Therefore, the patient experience should be continuously improved, which requires evaluation. Surveying patients is integral to this process. Ideally, patient experience surveys used to evaluate telehealth services should cover patient experience sub-themes, be validated, and minimize bias. This paper evaluates how current validated patient experience surveys cover patient experience sub-themes, and how many are telehealth-specific. We collected 11 validated patient experience surveys. We then extracted five themes and 114 sub-themes of the patient experience. We evaluated survey questions against patient experience sub-themes. We found that current validated patient experience surveys cover, at most, 20.2% of patient experience sub-themes, with the most common sub-themes being "Psychosocial Needs" (81.8%) and "Information: Treatment" (72.7%). We cross-referenced validated patient experience surveys against validated telehealth-specific surveys. Only one validated patient experience survey (PEQ) was also telehealth-specific.


Subject(s)
Telemedicine , Humans , Patient Outcome Assessment , Patient Satisfaction , Surveys and Questionnaires , Telemedicine/methods
9.
Stud Health Technol Inform ; 290: 789-793, 2022 Jun 06.
Article in English | MEDLINE | ID: mdl-35673126

ABSTRACT

Our understanding of the impact of interventions in critical care is limited by the lack of techniques that represent and analyze complex intervention spaces applied across heterogeneous patient populations. Existing work has mainly focused on selecting a few interventions and representing them as binary variables, resulting in oversimplification of intervention representation. The goal of this study is to find effective representations of sequential interventions to support intervention effect analysis. To this end, we have developed Hi-RISE (Hierarchical Representation of Intervention Sequences), an approach that transforms and clusters sequential interventions into a latent space, with the resulting clusters used for heterogeneous treatment effect analysis. We apply this approach to the MIMIC III dataset and identified intervention clusters and corresponding subpopulations with peculiar odds of 28-day mortality. Our approach may lead to a better understanding of the subgroup-level effects of sequential interventions and improve targeted intervention planning in critical care settings.


Subject(s)
Critical Care , Patient Outcome Assessment , Humans
10.
Stud Health Technol Inform ; 290: 862-866, 2022 Jun 06.
Article in English | MEDLINE | ID: mdl-35673141

ABSTRACT

Since Covid-19, digital health interventions (DHIs) have been embraced as never before. The pandemic led to many new challenges, including the patient experience in digital health care delivery. In this literature study, we identified and synthesized factors that impact patient experience in digital health (dPEx), and reviewed the methods and strategies relevant to its design and implementation. We conducted an umbrella review including 15 reviews representing 543 studies. Four themes were identified that describe design-relevant factors that impact dPEx: individual context, content, technical issues, and design features. We propose a preliminary framework to explain the relationship between each factor and support user-centered design efforts. Further research is needed to identify which factors have the most impact.


Subject(s)
COVID-19 , Telemedicine , Humans , Patient Outcome Assessment
11.
Aten. prim. (Barc., Ed. impr.) ; 54(1): 102232, ene.,2022. graf, tab
Article in Spanish | IBECS | ID: ibc-203174

ABSTRACT

Objetivos: Conocer la perspectiva de profesionales sobre aspectos y dimensiones que deberían formar parte indispensable de la Atención Centrada en la Persona (ACP).DiseñoTécnica Delphi.EmplazamientoAtención Primaria.ParticipantesSetenta y cuatro expertos médicos especialistas en medicina familiar y comunitaria (MF), tutores docentes, psicólogos y sociólogos distribuidos por todo el territorio nacional (enero-junio 2015).MétodosRespondieron a tres cuestionarios: primero sobre aspectos que debería tener en cuenta un MF para realizar ACP en todas sus dimensiones. En el segundo se preguntó sobre el grado de acuerdo con cada ítem y dimensión en que lo clasificaba. Las respuestas se priorizaron en un tercer cuestionario (escala Likert, rango de puntuación 1-10).ResultadosLa tasa de respuesta (TR) al primer cuestionario fue de 54,05%, obteniéndose 84 ítems, los más frecuentes Respeto y Atención Integral. El 2.° cuestionario con TR=48,6%, obtuvo 52 ítems con acuerdo superior al 75%. La TR del tercer cuestionario fue de 52,7%, obteniendo 21 ítems con puntuación >9. Los valores más altos correspondieron a aspectos esenciales de la ACP: respeto, atención integral, enfoque biopsicosocial, autonomía del paciente y participación en la toma de decisiones.ConclusionesSe identificaron nuevas dimensiones: Prevención y promoción de la salud, Gestión de Recursos y Competencia Clínica; añadidas a las previamente descritas: Perspectiva biopsicosocial, Médico como persona, Paciente como persona, Relación médico-paciente y Poder y Responsabilidad compartidas.El respeto, la atención integral, el enfoque biopsicosocial, la autonomía del paciente y su participación en la toma de decisiones, son los aspectos más valorados entre los seleccionados por los profesionales participantes.


Objectives: To know the perspective of professionals on aspects and dimensions that should be an indispensable part of Person-Centered Care (PCA).DesignDelphi Technique.LocationPrimary Care.Participants74 medical experts specializing in family and community medicine (FM), teaching tutors, psychologists and sociologists distributed throughout the national territory (January-June 2015).MethodsThey responded to three questionnaires: first, on aspects that a FP should take into account to carry out PCA in all its dimensions. In the second, they asked about the degree of agreement with each item and dimension in which it was classified. The responses were prioritized in a third questionnaire (Likert scale, score range 1-10).ResultsThe response rate (RR) to the 1st questionnaire was 54.05%, obtaining 84 items, the most frequent Respect and Comprehensive Attention. The 2nd questionnaire with RR = 48.6%, obtained 52 items with a degree of agreement greater than 75%. The RR of the 3rd questionnaire was 52.7%, obtaining 21 items with a score> 9. The highest values corresponded to essential aspects of PCA: respect, comprehensive care, biopsychosocial approach, patient autonomy, and participation in decision-making.


Subject(s)
Humans , Health Sciences , Primary Health Care/trends , Patient-Centered Care , Interviews as Topic/methods , Physicians, Family/trends , Patient Outcome Assessment
12.
BMC Health Serv Res ; 22(1): 755, 2022 Jun 07.
Article in English | MEDLINE | ID: mdl-35672727

ABSTRACT

BACKGROUND: Persons with spinal cord injury frequently visit numerous clinical settings. Such all-around experience of the system may serve as a comprehensive experience indicator. This study compared the patient experience of persons with chronic SCI in relation to healthcare service utilization patterns in 22 countries, hypothesizing that primary-care oriented patterns would offer a better experience. METHODS: This study was based on International Spinal Cord Injury Survey with 12,588 participants across 22 countries worldwide. Utilization patterns/clusters were identified by cluster analysis and experience score - by the partial credit model. The association between healthcare utilization and experience at the provider and cluster level was explored by regression analysis. RESULTS: The highest share of visits was to primary care physicians (18%) and rehabilitation physicians (16%). Utilization patterns had diverse orientations: from primary care to specialized and from inpatient to outpatient. The experience was reported as very good and good across different dimensions: 84% reported respectful treatment; 81% - clear explanations; 77% - involvement in decision making; 65% - satisfaction with care. The average experience score (0-100) was 64, highest - 74 (Brazil) and the lowest - 52 (Japan, South Korea). Service utilization at provider and at cluster levels were associated with patient experience, but no utilization pattern resulted in uniformly better patient experience. CONCLUSION: While there are distinct patterns between countries on how persons with chronic SCI navigate the healthcare system, we found that different utilization patterns led to similar patient experience. The observed difference in patient experience is likely determined by other contextual factors than service utilization.


Subject(s)
Spinal Cord Injuries , Delivery of Health Care , Humans , Inpatients , Patient Acceptance of Health Care , Patient Outcome Assessment , Spinal Cord Injuries/epidemiology , Spinal Cord Injuries/therapy
13.
BMC Prim Care ; 23(1): 139, 2022 Jun 02.
Article in English | MEDLINE | ID: mdl-35655143

ABSTRACT

BACKGROUND: Healthcare providers frequently struggle to provide effective care to patients with chronic Lyme-associated symptoms (chronic Lyme disease, CLD), potentially causing these patients to feel misunderstood or neglected by the healthcare system. This study is the first to use a combined medical and communication science approach, and aims to assess patients' experiences with CLD & CLD-related care, identify themes and repertories in these patients' narrations, and provide potential ways to improve communication with them. METHODS: Informed by the principles of 'clean language', we conducted focus groups with self-identified CLD patients (N = 15). We asked participants about their experiences with CLD and CLD-related healthcare. We performed thematic analyses using a bottom-up approach based in discourse analysis. We also sought to identify specific types of verbalizations (repertoires) across themes. RESULTS: Participants thematised a heterogeneous set of CLD-associated symptoms, which they frequently labelled as 'invisible' to others. Their illness significantly affected their daily lives, impacting their work, social activities, relationships with loved ones, hobbies and other means of participating in society. Negative experiences with healthcare providers were near-universal, also in patients with short-lived CLD-associated symptoms. Verbalizations were notable for frequent use of communicative modes that implicitly create common ground between participants and that give a certain validity to personal experiences (impersonal 'you' and other forms of presupposition). CONCLUSION: Central themes found in CLD patients' communication are 1. the experience of significant symptoms, 2. for which adequate relief is only rarely found from conventional medical practitioners, and 3. that are largely invisible to the outside world. Verbalizing these themes, patients use various repertoires for their shared experiences, such as a feeling of abandonment or not being heard by the medical system, feelings of loss with respect to their previous health, and the idea that they might have been better off had they been diagnosed sooner. Working with these repertoires will enable healthcare providers to establish a shared perspective with their CLD patients, thus engaging in more fruitful doctor-patient communication. We hypothesize that these findings are not unique to CLD, but may also be applicable to other conditions with an uncertain aetiology, such as Long COVID.


Subject(s)
COVID-19 , Post-Lyme Disease Syndrome , COVID-19/complications , Focus Groups , Humans , Patient Outcome Assessment
14.
BMJ Open ; 12(5): e057687, 2022 May 30.
Article in English | MEDLINE | ID: mdl-35636783

ABSTRACT

INTRODUCTION: Colorectal cancer (CRC) screening programmes can reduce incidence and mortality from this condition if adherence to them is high. As patient experience and satisfaction are key factors in determining adherence to screening programmes, they need to be measured. Furthermore, to promote highly patient-centred healthcare, the perception of patients regarding shared decision-making during CRC screening needs to be known. This study aims to assess the experience, satisfaction and participation in decision-making of participants in a CRC screening programme and of patients diagnosed with CRC through this programme in relation to the diagnostic and therapeutic processes of cancer. METHODS AND ANALYSIS: The CyDESA study is a mixed-methods study with a four phase sequential design. In phase 1, we will conduct a systematic review of patient-reported experience measures (PREMs) for patient experience or satisfaction with CRC screening. In case no located PREM can be applied, in phase 2, we will develop a new PREM. We will use the Delphi methodology to reach consensus among experts and patients and will conduct a pilot test of the developed PREM. Phase 3 is a multicentric cross-sectional study based on self-reported questionnaires that will be conducted at three Spanish hospitals (n=843). The objective is to find out about the experience, satisfaction and participation in decision-making of participants in the CRC screening programme who have had a positive screening test result according to their final screening diagnosis: false positives, colorectal polyps or CRC. Phase 4 is a qualitative phenomenological study based on individual interviews. It will explore the experiences of participants in the CRC screening programme and of those diagnosed with CRC. ETHICS AND DISSEMINATION: Ethics approval by the Ethics Committees of Corporació Sanitària Parc Taulí, Hospital de Sant Pau and Parc de Salut Mar. Findings will be published in peer-reviewed journals and presented at conferences. TRIAL REGISTRATION NUMBER: NCT04610086.


Subject(s)
Colorectal Neoplasms , Early Detection of Cancer , Colorectal Neoplasms/diagnosis , Cross-Sectional Studies , Humans , Patient Outcome Assessment , Patient Satisfaction , Personal Satisfaction , Systematic Reviews as Topic
15.
Curr Oncol ; 29(5): 3565-3575, 2022 05 15.
Article in English | MEDLINE | ID: mdl-35621678

ABSTRACT

BACKGROUND: Up to 20% of women diagnosed with tubo-ovarian carcinoma carry a germline pathogenic variant in a cancer-predisposing gene (e.g., BRCA1/BRCA2). Identifying these variants can help to inform eligibility for therapies, guide surveillance and prevention of new primary cancers, and assess risk to family members. The Gynecologic Oncology-Initiated Genetic Testing Model (GOIGT) was initiated at the McGill University Health Centre (MUHC) to streamline universal germline genetic testing for this population, while addressing the limited resources in the public healthcare system. This study aimed to evaluate the patient experience of participating in this model. METHODS: Study participants were patients diagnosed with high-grade non-mucinous epithelial tubo-ovarian cancer who underwent genetic testing through the GOIGT model between 1 January 2017 and 31 December 2020. Eligible participants completed the retrospective questionnaires at least one month after result disclosure. RESULTS: A total of 126 patients were tested through the GOIGT model during the study period, of which 56 were invited to participate. Thirty-four participants returned the study questionnaire. Overall, participants did not report decision regret following the genetic testing and were satisfied with the GOIGT model. Participants reported low levels of uncertainty and distress related to the implications of their test results for themselves and their family members. CONCLUSIONS: The results of this study support the continued implementation of mainstreamed genetic testing models for women with high-grade non-mucinous tubo-ovarian cancer. Further studies are required to compare experiences for patients with different genetic test results.


Subject(s)
Ovarian Neoplasms , Female , Genes, BRCA2 , Genetic Testing/methods , Humans , Ovarian Neoplasms/genetics , Patient Outcome Assessment , Retrospective Studies
16.
J Ambul Care Manage ; 45(3): 182-190, 2022.
Article in English | MEDLINE | ID: mdl-35612389

ABSTRACT

This study highlights the key drivers that form particular patient impressions resulting in exemplary overall provider performance ratings across service lines in the ambulatory environment. Two national samples of CG-CAHPS data were analyzed. Results indicate variance of impact among all CG-CAHPS questions on "top-box" scores for overall rating of provider among specialties. Interestingly, the same 5 explanatory variables-provider listened carefully, provider spent enough time, provider showed respect, provider knew important information about medical history, and provider explained things clearly-had the greatest explanatory power across the primary and specialty care samples when analyzed via multiple logistic regression analysis.


Subject(s)
Medicine , Patient Satisfaction , Ambulatory Care Facilities , Humans , Patient Outcome Assessment
17.
Ann Fam Med ; 20(3): 266-272, 2022.
Article in English | MEDLINE | ID: mdl-35606138

ABSTRACT

PURPOSE: Access to health care is a long-standing concern for rural patients; however, administrative measures fail to capture the subjective patient experience of accessing health care. The purpose of this review was to synthesize the qualitative literature on patient and caregiver experiences of accessing health care services for chronic disease management among US residents of rural areas. METHODS: We searched Embase, MEDLINE, PsycInfo, CINAHL, and Scopus to identify qualitative studies published during 2010-2019. A thematic synthesis approach was used to analyze findings from included studies. RESULTS: A total of 62 studies involving 1,354 unique participants were included. The largest share of studies (24.2%) was focused on the experience of patients with cancer, followed by behavioral health (16.1%), HIV and AIDS (14.5%), and diabetes (12.9%). We identified 4 primary analytic themes of barriers and facilitators associated with the experience of accessing health care services for chronic disease management in rural areas: (1) navigating the rural environment, (2) navigating the health care system, (3) financing chronic disease management, and (4) rural life (ie, common elements of a distinct "rural" way of thinking and behaving). CONCLUSIONS: In this comprehensive review, we found that important cultural, structural, and individual factors influenced the rural patient's experience of health care access and use, including barriers and facilitators posed by geographic and built environments, and distinct rural mores. Our findings can inform policies and programs that both facilitate structural aspects of access and include culturally appropriate interventions.VISUAL ABSTRACT.


Subject(s)
Health Services Accessibility , Rural Population , Chronic Disease , Humans , Patient Outcome Assessment , Qualitative Research
18.
Health Qual Life Outcomes ; 20(1): 82, 2022 May 21.
Article in English | MEDLINE | ID: mdl-35597948

ABSTRACT

In public health context, oncology is associated with severe negative impact on patients and on their relatives' quality of life. Over the last decades, survival has remained at 50% worldwide for some tumor locations. Patient reported outcomes (PROs) assessment and, the corresponding use in clinical practice, help establishing patient individualized profiling involving caregivers. The purpose of this systematic review was to examine critical success factors for PROs assessment in daily clinical oncology practice. Additionally, we investigated how PROs collection can change oncology perspectives for patients and caregivers. According to PRISMA guidelines, 83 studies were included in this systematic review, whether related with implementation in daily clinical practice or associated with its use in oncology. PROs assessment gathers multi-professional teams, biomedical and clinical expertise, patients, families and caregivers. Institutional involvement, first line for caregiver's adherence, team continuous formation, encompassing training and support, design of clear workflows, continuous monitoring, and data analysis are crucial for implementation. PROs measures are decisive in oncology. Several items were improved, including caregiver-patient-physician communication, patient risk groups identification, unmet problems and needs detection, disease course and treatment tracking, prognostic markers, cost-effectiveness measurement and comfort/support provision for both patients and caregivers. Routine assessment and implementation of PROs in clinical practice are a major challenge and a paradigm transformation for future.


Subject(s)
Patient Reported Outcome Measures , Quality of Life , Caregivers , Humans , Medical Oncology , Patient Outcome Assessment
19.
PLoS One ; 17(5): e0268656, 2022.
Article in English | MEDLINE | ID: mdl-35587506

ABSTRACT

BACKGROUND: The current quality of evidence supporting dry cupping for individuals with chronic low back pain (CLBP) is low and suggests that nonspecific factors impact experiences reported by patients. Therefore, this study assessed the impacts of social and professional support on the experience of individuals with CLBP treated with dry cupping or sham. METHOD: This is an observational study with qualitative approach. Twenty-four individuals with CLBP who received dry cupping or sham in a previous clinical trial were invited. Data was collected using a semi-structured interview conducted by a trained researcher. Content analysis was used to analyze experiences, systematic procedures, and description of the content of messages. The dimensions of "pain", "general perceptions", and "perceived social and professional support" guided the analysis. RESULTS: Answers of both groups converged on similar perceptions, especially regarding pain. Physical condition was the most fragile aspect. We also observed an influence of perceived social and professional support on painful symptoms. Thus, the experience of individuals with CLBP treated with dry cupping or sham indicated that factors related to social and professional support impacted results. CONCLUSIONS: We observed that individuals with CLBP reported similar perceptions of the effects of dry cupping or sham treatment, indicating that contextual factors may influence the perception of these individuals regarding the treatment received.


Subject(s)
Chronic Pain , Cupping Therapy , Low Back Pain , Chronic Pain/therapy , Humans , Low Back Pain/therapy , Pain Measurement , Patient Outcome Assessment , Qualitative Research
20.
Am J Otolaryngol ; 43(4): 103483, 2022.
Article in English | MEDLINE | ID: mdl-35580419

ABSTRACT

OBJECTIVE: To compare the experiences of patients who received sialendoscopy under general anesthesia (GA) with those who received monitored anesthesia care (MAC). METHODS: Patients who underwent sialendoscopy for sialadenitis or sialolithiasis from July 1, 2020, to July 31, 2021, were offered inclusion to this prospective observational study. A survey was sent to consenting patients on post-operative day 1 to record aspects of their pre-, intra-, and post-operative experience. The primary outcome was overall satisfaction. Secondary outcomes included pain tolerability and preference for similar anesthetic modality in the future. RESULTS: Seventy-five patients completed the post-operative survey (86% response rate), of which 39 patients received GA and 36 received MAC. Patient overall satisfaction was similar between groups (GA: "Poor/Average/Good" = 23%, "Excellent" = 77%; MAC: "Poor/Average/Good" = 25%, "Excellent" = 75%, p = 1.00). Tolerability of immediate post-operative pain was likewise similar between the GA (82%) and MAC (97%) groups (p = 0.058). Patients who received MAC reported intra-operative pain as "none/tolerable" 72% of the time and "uncomfortable" 28% of the time. Patients who received GA would prefer the same anesthetic in the future more often than in the MAC group (85% versus 61%, respectively, OR 3.50, 95% CI 1.17-10.50, p = 0.035). CONCLUSION: In regard to patient satisfaction, both MAC and GA are acceptable anesthetic choices in sialendoscopy for appropriate cases. Patients report similar overall satisfaction and post-operative pain tolerance under either anesthetic modality. Patients who undergo GA report higher rates of preference for similar anesthetic modality in the future. Further study is needed to determine the most appropriate criteria for anesthesia modality selection.


Subject(s)
Anesthesia, General , Salivary Gland Calculi , Humans , Pain, Postoperative , Patient Outcome Assessment , Retrospective Studies , Salivary Gland Calculi/surgery , Treatment Outcome
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