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1.
Perm J ; 21: 16-101, 2017.
Article in English | MEDLINE | ID: mdl-28406791

ABSTRACT

BACKGROUND: Supporting day-to-day self-care activities has emerged as a best practice when caring for patients with chronic pain, yet providing this support may introduce challenges for both patients and primary care physicians. It is essential to develop tools that help patients identify the issues and outcomes that are most important to them and to communicate this information to primary care physicians at the point of care. OBJECTIVE: We describe our process to engage patients, primary care physicians, and other stakeholders in the context of a pilot randomized controlled trial of a patient-centered assessment process implemented in an everyday practice setting. We identify lessons on how to engage stakeholders and improve patient-centered care for those with chronic conditions within the primary care setting. METHODS: A qualitative analysis of project minutes, interviews, and focus groups was conducted to evaluate stakeholder experiences. Stakeholders included patients, caregivers, clinicians, medical office support staff, health plan administrators, an information technology consultant, and a patient advocate. RESULTS: Our stakeholders included many patients with no prior experience with research. This approach enriched the applicability of feedback but necessitated extra time for stakeholder training and meeting preparation. Types of stakeholders varied over the course of the project, and more involvement of medical assistants and Information Technology staff was required than originally anticipated. CONCLUSION: Meaningful engagement of patient and physician stakeholders must be solicited in a well-coordinated manner with broad health care system supports in place to ensure full execution of patient-centered processes.


Subject(s)
Chronic Pain/therapy , Delivery of Health Care , Pain Management , Patient-Centered Care , Physician-Patient Relations , Primary Health Care , Self Care , Allied Health Personnel , Caregivers , Communication , Delivery of Health Care/organization & administration , Humans , Patient Satisfaction , Physicians, Primary Care , Pilot Projects , Qualitative Research
2.
J Gen Intern Med ; 32(1): 93-100, 2017 01.
Article in English | MEDLINE | ID: mdl-27599489

ABSTRACT

Medication non-adherence is a significant clinical challenge that adversely affects psychosocial factors, costs, and outcomes that are shared by patients, family members, providers, healthcare systems, payers, and society. Patient-centered care (i.e., involving patients and their families in planning their health care) is increasingly emphasized as a promising approach for improving medication adherence, but clinician education around what this might look like in a busy primary care environment is lacking. We use a case study to demonstrate key skills such as motivational interviewing, counseling, and shared decision-making for clinicians interested in providing patient-centered care in efforts to improve medication adherence. Such patient-centered approaches hold considerable promise for addressing the high rates of non-adherence to medications for chronic conditions.


Subject(s)
Medication Adherence/psychology , Patient-Centered Care/methods , Physician-Patient Relations , Chronic Disease/therapy , Decision Making , Female , Humans , Hypertension/drug therapy , Middle Aged , Motivational Interviewing/methods , Outcome and Process Assessment, Health Care , Practice Patterns, Physicians' , Primary Health Care
3.
Patient Educ Couns ; 98(1): 102-10, 2015 Jan.
Article in English | MEDLINE | ID: mdl-25448313

ABSTRACT

OBJECTIVE: The Centers for Education and Research on Therapeutics convened a workshop to examine the scientific evidence on medication adherence interventions from the patient-centered perspective and to explore the potential of patient-centered medication management to improve chronic disease treatment. METHODS: Patients, providers, researchers, and other stakeholders (N = 28) identified and prioritized ideas for future research and practice. We analyzed stakeholder voting on priorities and reviewed themes in workshop discussions. RESULTS: Ten priority areas emerged. Three areas were highly rated by all stakeholder groups: creating tools and systems to facilitate and evaluate patient-centered medication management plans; developing training on patient-centered prescribing for providers; and increasing patients' knowledge about medication management. However, priorities differed across stakeholder groups. Notably, patients prioritized using peer support to improve medication management while researchers did not. CONCLUSION: Engaging multiple stakeholders in setting a patient-centered research agenda and broadening the scope of adherence interventions to include other aspects of medication management resulted in priorities outside the traditional scope of adherence research. PRACTICE IMPLICATIONS: Workshop participants recognized the potential benefits of patient-centered medication management but also identified many challenges to implementation that require additional research and innovation.


Subject(s)
Medication Adherence , Patient-Centered Care/methods , Research , Aged , Chronic Disease/drug therapy , Community Participation , Congresses as Topic , Female , Humans , Male , Patient Care Planning
4.
Patient Educ Couns ; 97(3): 310-26, 2014 Dec.
Article in English | MEDLINE | ID: mdl-25264309

ABSTRACT

OBJECTIVE: Patient-centered approaches to improving medication adherence hold promise, but evidence of their effectiveness is unclear. This review reports the current state of scientific research around interventions to improve medication management through four patient-centered domains: shared decision-making, methods to enhance effective prescribing, systems for eliciting and acting on patient feedback about medication use and treatment goals, and medication-taking behavior. METHODS: We reviewed literature on interventions that fell into these domains and were published between January 2007 and May 2013. Two reviewers abstracted information and categorized studies by intervention type. RESULTS: We identified 60 studies, of which 40% focused on patient education. Other intervention types included augmented pharmacy services, decision aids, shared decision-making, and clinical review of patient adherence. Medication adherence was an outcome in most (70%) of the studies, although 50% also examined patient-centered outcomes. CONCLUSIONS: We identified a large number of medication management interventions that incorporated patient-centered care and improved patient outcomes. We were unable to determine whether these interventions are more effective than traditional medication adherence interventions. PRACTICE IMPLICATIONS: Additional research is needed to identify effective and feasible approaches to incorporate patient-centeredness into the medication management processes of the current health care system, if appropriate.


Subject(s)
Decision Making , Medication Adherence , Patient Education as Topic , Patient-Centered Care , Humans , Outcome Assessment, Health Care , Self Administration
7.
J Health Commun ; 13(3): 287-302, 2008.
Article in English | MEDLINE | ID: mdl-18569359

ABSTRACT

This article examines health literacy among a group a HIV-positive persons at risk for receiving suboptimal health care due to histories of substance abuse, mental illness, incarceration, and unstable housing or homelessness. Participants receiving services from three outreach programs funded as part of a multisite demonstration project were screened for health literacy using the Test of Functional Health Literacy in Adults (TOFHLA) at program enrollment. The goal of this analysis was to identify demographics, risk factors, and health indicators associated with different levels of health literacy. Results indicated that although fewer than 30% of the sample scored in the marginal or inadequate range for health literacy, participants with these lower levels of health literacy were more likely to be African American or Latino/a, heterosexual, speak Spanish as their primary language, and have less than a high school education. The disparities in health literacy found in this study point to a need to assess level of health literacy and provide culturally sensitive health literacy interventions for persons with chronic diseases such as HIV. In addition to offering these services within HIV health care settings, health professionals can use other potential venues for health literacy assessment and intervention including substance abuse treatment and community-based social service, education, and training programs. Health care and support service providers also must become aware of the importance of health literacy when caring for all patients with HIV, particularly those most likely to have low health literacy.


Subject(s)
HIV Infections/psychology , Health Knowledge, Attitudes, Practice , Adolescent , Adult , Aged , Cross-Sectional Studies , Female , HIV Infections/epidemiology , Healthcare Disparities , Humans , Male , Middle Aged , Risk Factors , United States/epidemiology
8.
Ethn Dis ; 18(4): 403-8, 2008.
Article in English | MEDLINE | ID: mdl-19157242

ABSTRACT

US Latino adults are disproportionately affected by the HIV epidemic and experience disparities in access to HIV care. However, relatively little is known about how acculturation affects perceived barriers to engagement in care among Latinos. This article examines factors that may be associated with engaging HIV-infected persons in primary care by using interview data from 651 Latino and non-Latino adults presenting for services at five agencies that participated in a multisite demonstration project Latinos (n=219) were more likely than non-Latino Whites (n=117) to be male, recently diagnosed with HIV, less educated, without health insurance, not on Medicaid, taking HIV medications, and in better physical health. In addition, Latinos were more likely to report facing numerous structural barriers, stigma-related worries/concerns, and belief barriers than were non-Latino Whites. Upon closer examination of the Latino subsample, acculturation (based on language) was associated with reported structural barriers, worry/concern barriers, and belief barriers. In the final multivariate model that controlled for site, Spanish language was significantly associated with experiencing stigma-related worries/concerns that impact HIV status.


Subject(s)
Acculturation , Attitude/ethnology , HIV Infections/ethnology , Health Services Accessibility , Hispanic or Latino/psychology , Primary Health Care , Female , HIV Infections/psychology , Humans , Male , Socioeconomic Factors , White People/ethnology , White People/psychology
9.
AIDS Patient Care STDS ; 21 Suppl 1: S30-9, 2007.
Article in English | MEDLINE | ID: mdl-17563288

ABSTRACT

This paper examines factors associated with engaging socially marginalized HIV-positive persons in primary care using interview and chart review data from 984 clients presenting for services at 10 agencies participating in a multisite demonstration project. The sample was predominantly minority, and many reported drug and mental health problems as well as housing instability. At baseline, roughly half of the participants were engaged in HIV primary care; the other participants were either not at all engaged in HIV primary care or somewhat engaged in care. Those who were somewhat engaged in care were very similar to those who were not at all engaged in care, and significantly different than those who were fully engaged in care across a number of demographic, health status/utilization, and barriers to care items and fared equally poorly with regard to engagement in care at 12-month follow-up. In 12-month longitudinal analyses, 58% of those not engaged at baseline ( n = 517) became more fully engaged in care. In the final multivariate model that controlled for disease stage, decreases in drug use, structural barriers, and unmet needs were associated with engagement in care. Interventions that focus on decreasing structural barriers and unmet support services needs, addressing negative health beliefs and attending to drug use are promising public health strategies to engage marginalized HIV-positive persons in HIV primary care.


Subject(s)
Community-Institutional Relations , HIV Infections/therapy , Health Services Needs and Demand , Primary Health Care/statistics & numerical data , Adult , Demography , Female , HIV Infections/complications , Health Services Accessibility , Health Status , Humans , Interviews as Topic , Male , Middle Aged , Patient Acceptance of Health Care , Substance Abuse, Intravenous/complications , United States , United States Health Resources and Services Administration/organization & administration
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