Epistemic tensions between people living with asthma and healthcare professionals in clinical encounters

Confidential health care for adolescents: position paper of the Society for Adolescent Medicine

Confidential health care for adolescents: position paper of the Society for Adolescent Medicine

Building the patient–clinician relationship through conversation based on narrative approaches

Background Mirikizumab (MIRI) is an anti-IL-p19 antibody approved for moderately-to-severely active ulcerative colitis (UC). The recommended dose regimen has 2 parts: MIRI administration begins with intravenous (IV) infusion every 4 weeks (Q4W; 3 total) followed by subcutaneous (SC) injections (2 injections per dose) Q4W (Figure 1). Self-injection of SC MIRI is allowed after patient training. This study explored differences between healthcare provider (HCP) perspectives of UC patients’ experiences and patients’ actual experiences regarding MIRI administration during the LUCENT program. It also assessed HCPs’ own experiences with MIRI administration. Methods The study involved two cross-sectional, 30-min, web-based surveys including one for patients and one for HCPs. Patients were eligible if they were enrolled in LUCENT-3 having entered from LUCENT-1 or -2 phase 3 studies or AMAC phase 2 study. HCPs from LUCENT-3 sites were eligible if they administered or oversaw MIRI IV infusions or SC injections during LUCENT-1, -2, -3, or AMAC. Survey questions had responses based on 5-point Likert scales. Outcomes included satisfaction with and acceptability of MIRI administration (Table 1). The survey was completed during LUCENT-3; MIRI SC injection experience at the time of survey varied from >2 to ≥3 yrs. Results The surveys were completed by 93 patients from 11 countries and 42 HCPs (gastroenterologist/physician 31.0%, nurse 40.5%, other [coordinator] 28.6%) from 9 countries. Most patients were satisfied or very satisfied with IV infusions (82.8%) and SC injections (91.4%), which was lower than HCPs’ perspectives of patients’ experiences (IV, 92.9%; SC, 100%), but generally similar to HCPs’ own experiences (IV, 81.0%; SC, 95.2%). Consistent with patients’ actual experiences (SC Q4W, 97.8%; two injections, 96.8%), most HCPs thought that patients felt that receiving SC injections Q4W (100%) and receiving 2 SC injections for each dose (92.9%) were somewhat or completely acceptable. Patients (97.8%) were satisfied or very satisfied with MIRI administration overall and 90.3% agreed or strongly agreed that treatment benefits outweighed any administration dissatisfaction. These patient perspectives were similar to both HCP perspectives of UC patients’ experiences (95.2%; 88.1%) and HCPs’ own experiences (97.6%; 95.2%). Conclusion Most patients and HCPs were satisfied or very satisfied and acceptable or completely acceptable of MIRI IV and SC administration. Patients’ experiences were similar to HCPs’ perspectives of patients’ experiences as well as HCPs’ own experiences, although there was a tendency for HCPs to perceive patients’ satisfaction to be very satisfied at a higher rate than patients’ actual responses.

Reducing Implicit Bias in Maternity Care: A Framework for Action

To explore quality in hospitals from the patients' and health care professionals' perspective in line with Act on the Protection of Patient Rights. A qualitative study using a focus group design and semi-structured interviews. Three focus groups among health care professionals were conducted with 51 participants: 24 nurses and medical technicians, 15 physicians, 12 residents, followed by additional interviews (20 nurses and medical technicians, 10 physicians, and 2 residents). Twenty patients were interviewed at the time of their discharge from the hospital. Collected data were analysed using thematic analysis. Patients identified waiting for medical treatments/procedures as the most concerning factor, followed by changes in administration procedures and admission in hospitals. From the physicians' and nurses' perspective, the main topics were inadequate resources to work with and inadequate working environment. Residents emphasized administration and lack of adequate equipment in contrast to other health care professionals. Both patients and health care professionals identified similar organizational and administrative issues impacting on service delivery. Health care providers and patients equally recognize the factors that impact upon quality of care. This problem is beyond the health care professionals' possibility to solve, which is the main source of stress and burnout that influence the quality of care. These factors cannot be overcome, by either health care professionals or patient organizations working alone. Greater partnership between health providers and patient associations is needed. What is already known on this subject? Healthcare providers and patients have the same goal: good quality of care and safety. Croatia has undergone significant socio-economic and political changes, which have affected the organization of the health care system. The patient experience is positively associated with clinical effectiveness and patient safety. What does this study add? From the perspective of patients and health professionals the main concern regarding quality of care is the organization of work in hospitals. Croatian patients and health professionals show considerable agreement with regard to the administrative problems in hospitals. Solutions that include only efforts on the part of the health care worker will fail.

Treat Me But Don't Judge Me: A Qualitative Examination of Health Care Experiences of Pregnant and Parenting Youth

PurposeTo examine whether experiences of positive respectful encounters and negative disrespectful encounters differ between sickness absentees with a cancer diagnosis and sickness absentees with other diagnoses, especially in relation to their ability to return to work (RTW).MethodsA total of 9032 long-term sickness absentees in Sweden responded to a questionnaire (response rate 52%) about experiences of positive and negative encounters with healthcare professionals. The association between different types of such encounters and participants feeling respected or disrespected were calculated with population attributable risk with 95% confidence intervals (CI). The perceived impact on ability to RTW was also examined.ResultsSignificantly, larger proportions among those who experienced a positive encounter and also felt respected stated that those encounters facilitated their ability to RTW, compared to those who experienced a positive encounter without feeling respected: among cancer absentees the difference in proportions were 21% (CI, 7–34) versus 50% (CI, 45–55); among absentees with other diagnoses 42% (CI, 37–47) versus 63% (CI, 61–64). Similar comparisons among sick-listed who experienced negative encounters indicated that also feeling disrespected impeded ability to RTW among a significantly larger proportion of those with other diagnoses [51% (CI, 48–54) versus 35% (CI, 31–39) of those not feeling disrespected]. Among cancer absentees, the corresponding proportions were 20% (CI, 9–30) versus 25% (CI, 9–41).ConclusionsCompared to sickness absentees with other diagnoses, a larger proportion of cancer sickness absentees stated that they were facilitated by respectful encounters and not impeded by disrespectful encounters, regarding self-estimated ability to RTW. More research is needed to examine whether these differences can be associated with use of a patient-centered encountering approach.

BackgroundDiabetes mellitus is highly prevalent and associated with huge economic burden globally. The conventional care and management of diabetes mellitus is highly fragmented and complex, warranting the need for a comprehensive Collaborative Care Model (CCM). Little is known about the perception of patients with diabetes and their healthcare providers about CCM, its barriers and facilitators. This study aimed to explore the value of CCM in diabetes care at a primary healthcare (PHC) setting from the perspective of patients with diabetes and healthcare professionals (HCPs), in an effort to expand our current knowledge on collaborative care in diabetes at primary care level for the purpose of quality improvement and service expansion.MethodsUsing an exploratory case study approach, semi-structured interviews were conducted among patients and HCPs who encountered CCM in Qatar during 2019 and 2020. The semi-structured interviews were transcribed verbatim and the data were analysed and interpreted using a deductive-inductive thematic analysis approach.ResultsTwelve patients and 12 HCPs at a diabetes clinic participated in one-to-one interviews. The interviews resulted in five different themes: the process and components of collaborative care model (four subthemes), current organizational support and resources (three subthemes), impact of collaborative care model on diabetes outcomes (three subthemes), enablers of collaborative care model (three subthemes), and barriers to collaborative care model (three subthemes). The participants indicated easy access to and communication with competent and pleasant HCPs. The patients appreciated the extra time spent with HCPs, frequent follow-up visits, and health education, which empowered them to self-manage diabetes. HCPs believed that successful CCM provision relied on their interest and commitment to care for patients with diabetes. Generally, participants identified barriers and facilitators that are related to patients, HCPs, and healthcare system.ConclusionsThe providers and users of CCM had an overall positive perception and appreciation of this model in PHC settings. Barriers to CCM such as undesirable attributes of HCPs and patients, unsupportive hospital system, and high workload must be addressed before implementing the model in other PHC settings.

The main objective of this research work was to explore the healthcare professionals’ perspectives of type 2 diabetes patients’ experiences of self-management of diabetes in the rural area of Pakistan. In this study, we have carried out a methodological approach to use a self-management framework to direct the interview guide for healthcare professionals to examine their perceptions and expectations of their diabetes patients’ adherence to the medications prescribed. Twenty healthcare professionals were recruited in this study consisting of ten general practitioners and ten nurses from various clinics (medical centres) of Al-Rehman Hospital at Abbottabad, Pakistan. This qualitative study explored the feelings and opinions of general practitioners on patients’ compliance and adherence by using the semi-structured interview guide using a methodological framework. All interviews of participants were audiotaped and transcribed for content analysis. Six major themes were identified: patient–doctor relationship; patient’s non-adherence to diet and exercise; conflicts with the patients; low self-efficacy and feeling of “resignation with poor care”; the influence of culture on patients’ self-management activities and lack of support for patients by health care providers, patients, and their families. We have derived relevant solutions from qualitative studies and considered that communication, tailored, and shared care is the best approach for patient adherence to treatment. GPs felt that a structured consultation and follow-up in a multidisciplinary team might help to increase adherence. The results of this qualitative health research highlighted the challenges healthcare professionals are facing in rural Pakistan in managing patients with type 2 diabetes and supporting their management activities. Healthcare professionals and patients may benefit by adopting a methodological framework approach to ensure meaningful participation and adjusting the patient–doctor relationship, and setting up achievable management and self-management goals.

Upmark M, Hagberg J, Alexanderson K. Negative encounters with social insurance officers – experiences of women and men on long‐term sick leaveInt J Soc Welfare 2011: 20: 309–317 © 2009 Karolinska Institutet. International Journal of Social Welfare © 2009 Blackwell Publishing Limited and the International Journal of Social WelfareThis study aimed to gain knowledge about long‐term sickness absentees' experiences of negative encounters with social insurance officers (SIOs). A questionnaire about encounters with SIOs and healthcare professionals was sent to 10,000 long‐term sickness absentees in Sweden (response rate 58 per cent, n= 5,802). Twenty per cent of the respondents had experienced negative encounters with SIOs compared with 27 per cent with healthcare professionals. Response patterns regarding the 23 different types of negative encounters with SIOs were similar for women and men. Slightly more women [odds ratio (OR) 1.2–1.5] agreed to most of the items. When adjusting for age, country of birth, education and self‐rated health gender differences, only two items remained. Foreign‐born had higher ORs even after adjustments. Experiencing negative encounters of different types with SIOs can hardly contribute to empowerment and return to work. Interventions, preferably in terms of randomised controlled studies, are warranted to improve the situation.

Community-based evaluation of 'Preferred Place of Care' in the North West of England

Research on patient-clinician relationships: celebrating success and identifying the next scope of work.

The COVID-19 pandemic acted as a catalyst for the use of information and communication technology (ICT) in inpatient and outpatient health care settings. Digital tools were used to connect patients, families, and providers amid visitor restrictions, while web-based platforms were used to continue care amid COVID-19 lockdowns. What we have yet to learn is the experiences of health care providers (HCPs) regarding the use of ICT that supported changes to clinical care during the COVID-19 pandemic. The aim of this paper was to describe the experiences of HCPs in using ICT to support clinical care changes during the COVID-19 pandemic. This paper is reporting on a subset of a larger body of data that examined changes to models of care during the pandemic. This study used a qualitative, descriptive study design. In total, 30 HCPs were recruited from 3 hospitals in Canada. One-on-one semistructured interviews were conducted between December 2022 and June 2023. Qualitative data were analyzed using an inductive thematic approach to identify themes across participants. A total of 30 interviews with HCPs revealed 3 themes related to their experiences using ICT to support changes to clinical care during the COVID-19 pandemic. These included the use of ICT (1) to support in-person communication with patients, (2) to facilitate connection between provider to patient and patient to family, and (3) to provide continuity of care. HCP narratives revealed the benefits of digital tools to support in-person communication between patient and provider, the need for thoughtful consideration for the use of ICT at end-of-life care, and the decision-making that is needed when choosing service delivery modality (eg, web based or in person). Moving forward, organizations are encouraged to provide education and training on how to support patient-provider communication, find ways to meet patient and family wishes at end-of-life care, and continue to give autonomy to HCPs in their clinical decision-making regarding service delivery modality.

Advancing racial justice in patient care encounters—yes, we can!