ABSTRACT
[This corrects the article DOI: 10.1038/s41746-018-0073-x.].
ABSTRACT
OBJECTIVE: This study examined the perspectives of 18 health care providers (nurses, consultant doctors, residents, radiologists, and physiotherapists) and 18 patients regarding best practices for patient-centred care (PCC) in a free private hospital in Pakistan, studying the congruence between provider and patient perspectives. METHODS: Six focus group interviews (FGIs) were conducted from January to March 2017: three with providers and three with patients. Focus group interviews were audio-recorded and transcribed verbatim. A deductive approach was used to analyse the data using the key dimensions of Scholl's framework, which was then complemented with constant comparison analysis to explore variability and similarity among participants across the six focus groups. RESULTS: Findings indicated that providers and patients acknowledged maintaining a collaborative relationship with patients by using empathy. Patients and providers agreed that providers allocated time to counsel the patient and alleviated their fears. Family involvement was seen as a key indicator in decision making for patients. Some discrepancies were found between patient and provider perceptions of inhibitors to PCC, notably a lack of teamwork exhibited by providers and continuity of care offered postdischarge. CONCLUSIONS: We recommend practices of PCC that are congruent with non-Western settings where religion and family play a primary role in matters dealing with patients' illnesses. Our findings suggest the need for recurrent training to improve teamwork among providers; questioning the implicit agreement of patients who may be vulnerable to decision making of authoritarian figures in their family; and the inclusion of peer-support workers or community health workers to offer aftercare support to patients in their home.
Subject(s)
Attitude of Health Personnel , Health Personnel/psychology , Orthopedics/organization & administration , Patient-Centered Care/organization & administration , Patients/psychology , Cooperative Behavior , Empathy , Focus Groups , Health Knowledge, Attitudes, Practice , Humans , Orthopedics/standards , Patient Preference , Patient-Centered Care/standards , Physician-Patient Relations , Tertiary Care CentersABSTRACT
Peripheral artery disease (PAD) is a vascular disease that leads to reduced blood flow to the limbs, often causing claudication symptoms that impair patients' ability to walk. The distance walked during a 6-min walk test (6MWT) correlates well with patient claudication symptoms, so we developed the VascTrac iPhone app as a platform for monitoring PAD using a digital 6MWT. In this study, we evaluate the accuracy of the built-in iPhone distance and step-counting algorithms during 6MWTs. One hundred and fourteen (114) participants with PAD performed a supervised 6MWT using the VascTrac app while simultaneously wearing an ActiGraph GT9X Activity Monitor. Steps and distance-walked during the 6MWT were manually measured and used to assess the bias in the iPhone CMPedometer algorithms. The iPhone CMPedometer step algorithm underestimated steps with a bias of -7.2% ± 13.8% (mean ± SD) and had a mean percent difference with the Actigraph (Actigraph-iPhone) of 5.7% ± 20.5%. The iPhone CMPedometer distance algorithm overestimated distance with a bias of 43% ± 42% due to overestimation in stride length. Our correction factor improved distance estimation to 8% ± 32%. The Ankle-Brachial Index (ABI) correlated poorly with steps (R = 0.365) and distance (R = 0.413). Thus, in PAD patients, the iPhone's built-in distance algorithm is unable to accurately measure distance, suggesting that custom algorithms are necessary for using iPhones as a platform for monitoring distance walked in PAD patients. Although the iPhone accurately measured steps, more research is necessary to establish step counting as a clinically meaningful metric for PAD.
