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1.
Stacey L. Sheridan Katrina E. Donahue Alison T. Brenner 《Patient education and counseling》2019,102(2):238-252
Objective
To create a shared vision for the content, delivery, measurement, and sustainment of patient-centered high value care.Methods
We performed a scoping review and translated findings into toolkit for system leaders. For our scoping review, we searched Medline, 2005-November 2015, for literature on patient-centered care (PCC) and its relationship to a high value care change model. We supplemented searches with key author, Google Scholar, and key website searches. One author reviewed all titles, abstracts, and articles for inclusion; another reviewed a random 20%. To develop our toolkit, we translated evidence into simple, actionable briefs on key topics and added resources. We then iteratively circulated briefs and the overall toolkit to potential users, making updates as needed.Results
In our scoping review, we found multiple interventions and measures to support the components of PCC and our change model. We found little on the overall effects of PCC or how PCC creates value. Potential users reported our toolkit was simple, understandable, thorough, timely, and likely to be globally useful.Conclusions
Considerable evidence supports patient-centered high value care and a toolkit garnered enthusiasm.Practice Implications
The toolkit is ready for use, but needs comparison to other approaches. 相似文献2.
Giulia Casu Paola Gremigni Marinella Sommaruga 《Patient education and counseling》2019,102(1):126-133
Objective
To investigate how patients evaluate the provision of patient-centered care (PCC) by healthcare professionals and psychometrically test a questionnaire to assess it. A tool previously developed for self-assessment of professionals’ provision of PCC was adapted into a patient-rated form, named Patient-Professional Interaction Questionnaire (PPIQ).Methods
A sample of 1139 patients from six hospitals completed the 16-item PPIQ and the questionnaire structure, reliability, susceptibility to social desirability, and associations with other variables were tested.Results
The PPIQ confirmed the original four-factor structure (effective communication, interest in the patient’s agenda, empathy, and patient involvement in care) and showed acceptable reliability and measurement invariance across both in-/out-patients and first/non-first encounter with the evaluated professional. Associations with patients’ social desirability were negligible and effective communication was rated the highest among the PPIQ dimensions. PPIQ scores varied according to patients’ educational level and type of professional evaluated, while associations between first/non-first encounter and PPIQ scores varied according to in-/out-patient.Conclusion
The PPIQ is a psychometrically sound patient-rated measure of the provision of PCC by healthcare professionals.Practice implications
The PPIQ has potential value in promoting quality patient-professional interactions in the hospital setting, as patients’ reported experience is an important dimension of the clinician’s performance. 相似文献3.
Emilio Márquez-Contreras Lourdes de López García-Ramos Nieves Martell-Claros Vicente F. Gil-Guillen Sara Márquez-Rivero Elena Pérez-López Maria Angeles Garrido-Lopez Celia Farauste Adriana López-Pineda José Joaquin Casado-Martinez Domingo Orozco-Beltran Jose A. Quesada Concepción Carratalá-Munuera 《Patient education and counseling》2018,101(9):1654-1660
4.
Özlem Örsal Pınar Duru Özgül Örsal Kazım Tırpan Abdullah Çulhacı 《Patient education and counseling》2019,102(2):376-382
Objective
The aim of the study was to examine the relationships between health literacy, primary care satisfaction levels and health awareness of the patients who were admitted to primary care centers (Family Health Centers).Methods
This is a cross-sectional study conducted on individuals who were admitted to Family Health Centers (n?=?1.055) in Eskisehir province. The study data were collected by using Turkish Health Literacy Scale, the European Patients Evaluate General/Family Practice Scale and Health Awareness Scale.Results
As health literacy of participants increases, health awareness and satisfaction with primary care also increases (for each, p?<?.001). Health awareness increases health literacy by 0.55 points, health literacy increases satisfaction in primary care by 0.26 points.Conclusion
In the province of Eskisehir, the health literacy level of 7 out of 10 patients, who admitted to the primary care institution, is inadequate or problematic. As health awareness of participants increases, their level of health literacy also increases. As health literacy of participants increases, their satisfaction with family physicians also increases.Practice implications
As an integral part of preventive health services, studies should be performed to increase and improve the level of health literacy of patients who are admitted to primary care services. 相似文献5.
Sarina Fazio Jennifer Edwards Sheridan Miyamoto Stuart Henderson Madan Dharmar Heather M. Young 《Patient education and counseling》2019,102(1):106-112
Objective
Success in diabetes research and self-management is often defined as a significant decrease in glycated hemoglobin (A1C). The aim of this article is to explore different types of successes experienced by adults with type-2 diabetes participating in a health technology and nurse coaching clinical trial.Methods
A qualitative analysis was conducted using surveys and documentation from motivational interview-based coaching sessions between study nurses and intervention participants.Results
Of the 132 cases reviewed, types of success predominantly fell into five categories: 1) change in health behaviors; 2) change in mindset or awareness; 3) change in engagement with healthcare resources; 4) change in physical or emotional health; and 5) change in health indicators.Conclusion
Experiences of success in diabetes are more varied than traditional A1C-based outcome models. Our findings suggest coaching and technology can assist patients to achieve a range of successes in diabetes management through goal setting, health tracking, resolving barriers, and aligning goals with factors that impact change.Practice implications
While A1C reduction is a critical factor in decreasing risk of diabetes-related complications, when healthcare professionals focus on A1C as the main indicator of diabetes management success, important changes in individuals’ health and well-being may be overlooked or undervalued. 相似文献6.
Andrea S. Wallace Nicole L. Pierce Erica Davisson Kirstin Manges Toni Tripp-Reimer 《Patient education and counseling》2019,102(3):542-549
Objective
To evaluate an interactive tool designed to help patients communicate their social resources supportive of home recovery to health care providers.Methods
Seventy medical and surgical inpatients completed the D-CEGRM social resource interview, demographic queries, and discharge readiness surveys (RHDS) at discharge. Two weeks later, patients completed post-discharge coping difficulty surveys (PDCDS). Nurses unassociated with patients’ clinical care reviewed structured clinical notes created from the D-CEGRM and categorized patients as likely to have “inadequate” or “adequate” supportive resources for home self-management. Nurse decision making was tracked using an adjudication process, and post-hoc comparisons in patient characteristics, RHDS, and PDCDS were conducted.Results
Nurses categorized 36 patients (51%) as having inadequate resources. Number and accessibility of supports, presence of negative relationships, and previous struggles meeting health-related needs were important decision-making factors. Post-hoc comparisons revealed significant differences in demographic risk factors and discharge readiness ratings for those with inadequate vs. adequate resources.Conclusion
The D-CEGRM may be an efficient tool for patients to communicate access to social resources, and an effective facilitator of transitional care planning.Practice Implications: The D-CEGRM may provide a useful assessment of patients’ home context and guide for transitional care planning. 相似文献7.
Objective
Patient-clinician communication (PCC) may generate or reduce healthcare disparities. This paper is based on the 2017 International Conference on Communication in Healthcare keynote address and reviews PCC literature as a research area for the National Institute on Minority Health and Health Disparities (NIMHD).Methods
A narrative review of selected evidence on disparities in PCC experienced by race and ethnic minorities, associations between PCC and poor health outcomes, and patient and clinician factors related to PCC.Results
Factors associated with poor quality PCC on the patient level include being a member of racial/ethnic minority, having limited English proficiency, and low health and digital literacy; on the clinician level, being less culturally competent, lacking communication skills to facilitate shared decision-making, and holding unconscious biases. Recommendations include offering patient- and/or clinician-targeted interventions to guard against unconscious biases and improve PCC, screening patients for health literacy and English proficiency, integrating PCC in performance processes, and leveraging health information technologies to address unconscious biases.Conclusion
EffectivePCC is a pathway to decrease health disparities and promote health equity.Practice implications
Standardized collection of social determinants of health in the Electronic Health Record is an importantfirst step in promoting more effective PCC. 相似文献8.
Miriam Komaromy Erin Fanning Madden Andrea Zurawski Summers Kalishman Kristin Barker Patricia O’Sullivan Martin Jurado Sanjeev Arora 《Patient education and counseling》2018,101(3):524-531
Objective
Elicit patients’ perceptions of factors that facilitate their engagement in careMethods
In-depth interviews with 20 adult Medicaid patients who had complex health problems, frequent hospitalizations/emergency department use, and who were enrolled in an intensive, team-based care program designed to address medical, behavioral, and social needs.Results
Prior to engaging in the program, participants described weak relationships with primary care providers, frequent hospitalizations and emergency visits, poor adherence to medications and severe social barriers to care. After participating in the program, participants identified key factors that enabled them to develop trust and engage with care including: availability for extended intensive interactions, a non-judgmental approach, addressing patients' material needs, and providing social contact for isolated patients. After developing relationships with their care team, participants described changes such as sustained interactions with their primary care team and incremental improvements in health behaviors.Conclusion
These findings illuminate factors promoting “contingent engagement” for low socio-economic status patients with complex health problems, which allow them to become proactive in ways commensurate with their circumstances, and offers insights for designing interventions to improve patient outcomes.Practice implications
For these patients, engagement is contingent on healthcare providers’ efforts to develop trust and address patients’ material needs. 相似文献9.
Objective
Patient education on high-risk medications such as warfarin is important, and they require quick follow-up after initiation to maximize efficacy and safety. In our Anticoagulation Clinic, two 60-minute new patient appointments are available each day, contributing to prolonged lead-time. We instituted standardized warfarin video education to shorten in-clinic-room visit time, to potentially increase new patient appointments.Methods
Patients viewed the video in the waiting area with a goal to decrease visit times by 15?min (25%), before pharmacists completed their visit. Data collected included time spent in the clinic room, education comprehension, and patient feedback.Results
Ninety patient visits were evaluated in one pre-intervention and two post-intervention phases. Patients who received video education spent less time in the clinic room versus those who had not (52.4 vs 39.4?min, p?=?0.001), and two-thirds of all post-intervention visits achieved 25% reduction in visit time. There were no significant differences in education comprehension and patient satisfaction.Conclusion
Video education significantly decreased in-clinic-room visit time, and most patients achieved a goal of 25% reduction in time spent, without a change in comprehension or patient satisfaction.Practice implications
Implementation of video education can reduce clinic times in many patients without significantly impacting patient satisfaction. 相似文献10.
Katherine Treiman Lauren McCormack Laura Wagner Nancy Roach Rebecca Moultrie Hannah Sanoff Carla Bann Richard L. Street Mahima Ashok Bryce B. Reeve 《Patient education and counseling》2018,101(9):1585-1593
Objective
This study assessed patient-centered communication (PCC) among newly diagnosed colorectal cancer patients. PCC, a key part of patient-centered care, contributes directly and indirectly to health-related quality of life, satisfaction with care, and other outcomes.Methods
We conducted a survey of patients in North Carolina, using a theoretically-based and validated measure that provides an overall PCC score and subscale scores for six PCC functions.Results
A total of 501 patients participated. The highest scores were for the PCC functions of Fostering Healing Relationships, Exchanging Information, and Making Decisions. The lowest scores were for the functions of Managing Uncertainty and Enabling Self-Management, yet these were functions respondents rated as most important. Respondents who thought about more than one health professional (versus oncologist) reported better communication. PCC also varied by treatment type, mental and physical health status, age, race, and education.Conclusion
Most patients reported good communication overall, however patients in poor physical health and mental health reported worse communication. The quality of communication varied across the PCC functions.Practice implications
Health professionals need to use a PCC approach that builds trust, respects the patient, provides salient information that patients can understand, provides emotional support, and facilitates the patient’s engagement in care. 相似文献11.
Mary M. Step Gretchen A. Ferber Catherine Downs-Holmes Paula Silverman 《Patient education and counseling》2019,102(1):77-84
Objective
To assess the feasibility of a team-based prognosis and treatment goal discussion for women living with advanced breast cancer.Methods
Female patients diagnosed with advanced breast cancer (n?=?25) participated in a mixed methods study that evaluated the feasibility and effects of a planned and structured prognosis discussion. Audio analysis of the intervention appointments was conducted to assess intervention feasibility. Patient self-reports of prognosis related beliefs and treatment preferences were compared across intervention and usual care groups.Results
Most patients found the T-PAT appointment challenging but worthwhile. Intervention uptake by clinicians was good, but some fidelity disruptions were noted. T-PAT participants were more likely to hold realistic beliefs about disease curability after the appointment.Conclusion
Productive prognosis discussions can be delivered effectively by a practice-based clinical team within a semi-structured patient education appointment. It was perceived by patients with advanced breast cancer as both valuable and acceptable. T-PAT clinicians found the intervention easy to deliver.Practice implications
Regular implementation of T-PAT may help clinicians’ build prognosis discussion communication skills. T-PAT documentation provides valuable information that can be used to tailor ongoing care. 相似文献12.
Angela L. Palmer-Wackerly Heather L. Voorhees Sarah D’Souza Edward Weeks 《Patient education and counseling》2019,102(4):804-809
Objective
To identify how and why infertility patients’ communication with health care providers relates to their continuity of care within infertility treatment.Method
A grounded theory analysis was conducted for 25 in-depth interviews across three coding phases, where we remained open to all themes present in the data, narrowed to most prominent themes, and found the connections between the themes.Results
Based on our identified themes, we created a conceptual model that explains why infertility patients (dis)continued care with one or more clinician. Through this model, we describe two infertility identity transitions for patients: Transition 1: “Infertility as Temporary” to “Infertility as Enduring”; and Transition 2: “Infertility as Enduring” to “Infertility as Integrated.”Conclusion
The study explains how and why patients’ view of their infertility affects their communication, and thus their continuity of care, with clinicians.Practice implications
To provide patient-centered care within infertility treatment, providers can recognize how patients’ view of their infertility, and thus their needs, goals, and expectations, shift throughout their infertility experience. 相似文献13.
Meghana Yajnik Jonay N. Hill Oluwatobi O. Hunter Steven K. Howard T. Edward Kim T. Kyle Harrison Edward R. Mariano 《Patient education and counseling》2019,102(2):383-387
Objective
Effects of patient education on perioperative analgesic utilization are not well defined. We designed a simple pain management educational card for total knee arthroplasty (TKA) patients and retrospectively reviewed clinical data before and after implementation to test the hypothesis that more informed patients will use less opioid.Methods
With IRB approval, we analyzed clinical data collected perioperatively on all TKA patients one month before (PRE) and one month after (POST) card implementation. The card was designed using a modified Delphi method; the front explained all analgesic medications and the Defense and Veterans Pain Rating Scale was on the back. The primary outcome was total opioid dosage in morphine milligram equivalents (MME) for the first two postoperative days. Secondary outcomes included daily opioid usage, pain scores, ambulation distance, hospital length of stay and use of antiemetics.Results
There were 20 patients in each group with no differences in baseline characteristics. Total two-day MME [median (10th–90th percentiles)] was 71 (32–285) for PRE and 38 (1–117) for POST (p?=?0.001). There were no other differences.Conclusion
Educating TKA patients in multimodal pain management using a simple tool decreases opioid usage.Practice implications
Empowering TKA patients with education can reduce opioid use perioperatively. 相似文献14.
Marita S. Fønhus Therese K. Dalsbø Marit Johansen Atle Fretheim Helge Skirbekk Signe Flottorp 《Patient education and counseling》2019,102(3):474-485
Objective
To assess the effectiveness of patient-mediated interventions on healthcare professionals' performance.Methods
We conducted a systematic Cochrane review according to established guidelines. We searched predefined databases in 2016 and 2017. Two review authors independently assessed studies for inclusion, extracted data, assessed risk of bias, performed meta-analyses, and assessed the certainty of the evidence (GRADE).Results
We included 25 randomised studies with a total of 12 268 patients. We found that patient-reported health information interventions and patient education interventions probably improve healthcare professionals' adherence to recommended clinical practice (moderate certainty evidence). We also found that patient information interventions may improve healthcare professionals' adherence to recommended clinical practice (low certainty evidence). Patient decision aids may make little or no difference to the number of healthcare professionals’ adhering to recommended clinical practice (low-certainty evidence).Conclusion
Our findings strengthen the belief that patient-mediated interventions have the potential to improve professional practice, especially patient-reported health information interventions and patient education interventions.Practice implications
Our findings show that patient-reported health information interventions and patient education interventions are relevant approaches to improve professional practice. Thus, it seems reasonable to conclude that these types of patient-mediated interventions can contribute to improving the quality of healthcare services. 相似文献15.
Jane Gunn Jacqui Cameron Konstancja Densley Sandra Davidson Susie Fletcher Victoria Palmer Patty Chondros Christopher Dowrick Jane Pirkis 《Patient education and counseling》2018,101(1):105-112
Objective
To describe the characteristics of primary care attendees with depressive symptoms who use mental health websites.Methods
789 individuals with depressive symptoms recruited and followed up annually for nine years. Self-reported written surveys included mental health, professional and self-help use, e-mental health interventions or therapeutic websites. Marginal logistic regression examined association between mental health website (MHW) use and patient’s mental health, health services use, anti-depressant use and self-help strategies.Results
36% of participants used an MHW at least once. MHW users were more likely to be female, younger, highly educated and employed. MHW use increased with depressive symptom severity; reported in 16% of assessments when minimal symptoms were present and 28% when severe symptoms were present. MHW use was associated with: GP mental health visits, psychologist and psychiatrist visits and other self-help strategies including self-help books and telephone helplines.Conclusion(s)
Mental health websites were more likely to be used by those with severe depressive symptoms rather than those with mild depression as recommended in current guidelines.Practice implication(s)
Whilst mental health websites offer potential to support the high volume of people with mild depression new strategies may be required to ensure uptake. 相似文献16.
To support and to be supported. A qualitative study of peer support centres in cancer care in Norway
Objective
To explore what peer supporters, patients and their relatives want and gain from peer support in cancer care.Methods
Focus group interviews with peer supporters, and in-depth interviews with peer supporters, patients and relatives (N = 38) and observations of daily activities in a Vardesenter (“Cairn Centre”).Results
Peer supporters helped cancer patients and relatives with coping in and outside the hospital in several ways: (1) conveying hope and providing ways to cope in situations where despair would often be prevalent, thus protecting against unhealthy stress; (2) being someone who had the same experiences of disease and treatment, and thus providing a framework for positive social comparisons; and (3) to be an important supplement to family and health care providers. To be working as a peer supporter was also found to be positive and important for the peer supporters themselves.Conclusion
The peer support program represented a valuable supplement to informal support from family and friends and healthcare providers, and gave the peer supporters a new role as “professionally unprofessional”.Practice implications
Organised peer support represents a feasible intervention to promote coping for cancer survivors. 相似文献17.
Objective
Information overload can negatively impact positive health behaviors such as cancer screening. The 8-item Cancer Information Overload (CIO) scale appears to be the only validated measure of health-related information overload. The present study assesses the validity of the CIO scale when modified for use in patients with atrial fibrillation (AF) residing in Australia.Methods
We conducted a secondary analysis of data from a study of adult Australian patients with AF (N?=?386) in which a modified version of the CIO scale was used. In the present study, we examined the construct (convergent and divergent) validity and performed an exploratory factor analysis for the modified scale.Results
All items on the modified-CIO scale appear to load onto a single factor. As predicted, higher education levels (rs=-.24, p?<?.001) and higher oral anticoagulant knowledge (rs=-.17, p?=?.001) were significantly associated with lower modified-CIO scores; no other demographic characteristics were significantly associated with CIO scores.Conclusion
When adapted to the AF context, the modified-CIO scale appears to be a valid measure of information overload.Practice Implications
A valid scale is required to measure information overload accurately. Knowledge of the interplay between information overload and various health behaviors help focus future efforts to support patient empowerment. 相似文献18.
19.
Michael Anthony Fajardo Guy Balthazaar Alexandra Zalums Lyndal Trevena Carissa Bonner 《Patient education and counseling》2019,102(3):467-473
Objective
The study aim was to identify all freely available online diabetes risk calculators and to evaluate their suitability for patients with low health literacy.Methods
Online diabetes risk calculators were identified by an environmental scan. The Patient Education Material Assessment Tool for Printable Materials was used to determine understandability and actionability scores. A high-risk profile was used to compare the risk results obtained with each calculator.Results
Thirty-five risk calculators were identified; 51% had no described model, 23% reported absolute risk and 31% used visual aids. The estimated risk for the same profile ranged from low to very high. The mean understandability score was 79% (SD?=?19%) and the mean actionability score was 42% (SD?=?30%).Conclusions
Online diabetes risk calculators are generally understandable, but not very actionable, and may not be completely suitable for use by patients with low health literacy. The estimated risk is highly variable depending on the underlying model used for the calculation.Practice Implications
Patients and healthcare providers need to exercise caution when selecting a diabetes risk calculator. 相似文献20.
Kaitlyn Walsh Teaghan A.M. Pryor Kristin A. Reynolds John R. Walker 《Patient education and counseling》2019,102(1):99-105