Care-seeking In Patients Research Articles

P693 Care needs and reasons for (not) seeking care among fatigued patients with Inflammatory Bowel Disease: A qualitative study

Abstract Background Fatigue is one of the most prevalent and burdensome symptoms experienced by patients with inflammatory bowel disease (IBD), even when the disease is in remission. Many patients report dissatisfaction towards fatigue-related care and uptake of available interventions is often low. This study aims to explore reasons why IBD patients do or do not engage in professional fatigue-related care and their needs regarding type of care and how to offer care. Methods We conducted a qualitative study, taking a phenomenological methodological approach. Sixteen adult IBD patients with disease in remission and severe fatigue (i.e., Checklist Individual Strength – subjective fatigue ≥ 35) were recruited from an academic hospital. We performed semi-structured interviews. Data were analysed using template analyses. Results We identified six themes regarding reasons why to (not) seek care for fatigue: 1) cognitions about fatigue and coping (e.g., a need to deal with fatigue alone), 2) perceptions of fatigue-related care and previous care experiences (e.g., perceiving that nothing can be done about fatigue), 3) knowledge and behaviour of the healthcare provider (e.g., fatigue complaints are not taken seriously), 4) somatic factors (e.g., physical symptoms of IBD), 5) social factors (e.g., feeling misunderstood by others) and 6) practical factors (e.g., time and money). Furthermore, we identified needs regarding how to offer care, i.e., proactive screening and active offer of care by healthcare providers, a holistic and person-centred approach and practical needs taken into account. Finally, regarding what care to offer, patients suggested a broad range of options, including information provision on fatigue management, eliminating physical causes of fatigue, discussing medication options, lifestyle support, psychological support, peer support and practical support. Conclusion IBD patients’ perceptions, coping and knowledge, as well as healthcare professionals’ behaviours play a major role in seeking fatigue-related care. Findings emphasize the importance of discussing IBD-related fatigue actively and taking a holistic and patient-centred approach to treat fatigue, targeting a broad range of physical- and psychological factors. These findings yield a better understanding of factors that hinder and facilitate care seeking in fatigued IBD patients and hereby provide ways to optimize the uptake of care.

Mortality Risk in Irritable Bowel Syndrome: Results From a Nationwide Prospective Cohort Study.

Mortality concern is a frequent driver of care seeking in patients with irritable bowel syndrome (IBS). Data on mortality in IBS are scarce, and population-based studies have been limited in size. We examined mortality in IBS. A nationwide, matched, population-based cohort study was conducted in Sweden. We identified 45,524 patients undergoing a colorectal biopsy at any of Sweden's 28 pathology departments and with a diagnosis of IBS from 2002 to 2016 according to the National Patient Register, a nationwide registry of inpatient and outpatient specialty care. We compared the mortality risk between these individuals with IBS and age- and sex-matched reference individuals (n = 217,316) from the general population and siblings (n = 53,228). In separate analyses, we examined the role of mucosal appearance for mortality in IBS. Finally, we examined mortality in 41,427 patients with IBS not undergoing a colorectal biopsy. Cox regression estimated hazard ratios (HRs) for death. During follow-up, there were 3,290 deaths in individuals with IBS (9.4/1,000 person-years) compared with 13,255 deaths in reference individuals (7.9/1,000 person-years), resulting in an HR of 1.10 (95% confidence interval [CI] = 1.05-1.14). After adjustment for confounders, IBS was not linked to mortality (HR = 0.96; 95% CI = 0.92-1.00). The risk estimates were neutral when patients with IBS were compared with their siblings. The underlying mucosal appearance on biopsy had only a marginal impact on mortality, and patients with IBS not undergoing a colorectal biopsy were at no increased risk of death (HR = 1.02; 95% CI = 0.99-1.06). IBS does not seem to confer an increased risk of death.

Factors Related to Delay in Seeking Medical Care Among Patients with Acute Myocardial Infarction in Dhaka

Background: Acute myocardial infarction (AMI) has been considered the leading cause of death and disability all over the globe where Bangladesh is not an exception. Early medical attention seeking behavior is decisive for saving valuable lives and reducing further complications. Objectives: Current research aimed to identify the factors related to delay in seeking medical care among AMI sufferers. Methods: This descriptive cross-sectional study was carried out by face-to-face interview from January 2017 to June 2018. A total of 120 patients were conveniently recruited from Ibrahim Cardiac Hospital and Research Institute, which is a tertiary level hospital in Dhaka. Delay in medical care seeking time was investigated using a pretested semi-structured questionnaire. Data were evaluated by Statistical Package for the Social Science version 20 and the relationship was assessed by using t-test. Results: Respondents who lived in the rural area (P = 0.01), whose pain duration less than 6 hours (P = 0.01) and radiation of pain (P = 0.02), took self-treatment (P = 0.04), misinterpretation of symptoms (P = 0.04), living long distance (P = 0.01), lack of suitable transport (P = 0.04), and faced traffic jam (P = 0.00) showed significantly higher delay in seeking medical care. Conclusions: It is necessary to develop a strategy for reducing delay in medical care seeking in patients with AMI to reduce cardiovascular mortality and morbidity. Proper education regarding major cardiovascular events could be an effective option.

Integrating Mobile-health, health coaching, and physical activity to reduce the burden of chronic low back pain trial (IMPACT): a pilot randomised controlled trial

BackgroundLow back pain is one of the most prevalent musculoskeletal conditions and the highest contributor to disability in the world. It is characterized by frequent relapses leading to additional care-seeking. Engagement in leisure physical activity is associated with lower recurrences and better prognosis and potentially reduced care-seeking. Our aim was to investigate the feasibility and preliminary efficacy of a patient-centred physical activity intervention, supported by health coaching and mobile health, to reduce care-seeking, pain and disability in patients with chronic low back pain after treatment discharge.MethodsWe conducted a pilot randomised controlled trial with blinded outcome assessment. Sixty-eight participants were recruited from four public outpatient physiotherapy departments and the general community in Sydney. The intervention group received a physical activity information booklet, plus one face-to-face and 12 telephone-based health coaching sessions. The intervention was supported by an internet-based application and an activity tracker (Fitbit). Control group (standard care) received the physical activity information booklet and advice to stay active. Feasibility measures included recruitment rate, intervention compliance, data completeness, and participant satisfaction. Primary outcomes were care-seeking, pain levels and activity limitation. Outcomes were assessed at baseline, 6-month follow-up and weekly for 6 months.ResultsNinety potential participants were invited over 15 months, with 68 agreeing to take part (75%). Overall, 903 weekly questionnaires were answered by participants from a total of 1107 sent (89%). Participants were largely satisfied with the intervention (mean = 8.7 out of 10 on satisfaction scale). Intervention group participants had a 38% reduced rate of care-seeking (Incidence Rate Ratio (IRR): 0.62, 95% CI: 0.32 to 1.18, p = 0.14, using multilevel mixed-effects Poisson regression analysis) compared to standard care, although none of the estimates was statistically significant. No between groups differences were found for pain levels or activity limitation.ConclusionThe health coaching physical activity approach trialed here is feasible and well accepted by participants and may reduce care-seeking in patients with low back pain after treatment discharge, although further evaluation with an adequately powered trial is needed.Trial registrationAustralian and New Zealand Trial Registry ACTRN12615000189527. Registered prospectively on 26–02–2015.

Symptom Perception, Evaluation, Response to Symptom, and Delayed Care Seeking in Patients With Acute Heart Failure

Exacerbation of heart failure (HF) requires early intervention to prevent hospital admission and to reduce mortality. Early care seeking requires that patients perceive symptoms, accurately evaluate perceived symptoms, and respond appropriately. How perception, evaluation, and response to symptoms are associated with delay in seeking care for worsening symptoms has rarely been studied. The aims of this study were to investigate the associations of perception of symptoms, evaluation of symptoms, and response to symptoms with delayed care seeking in patients with HF and to identify factors associated with delayed care seeking. Patients admitted for acute exacerbation of HF were enrolled in this cross-sectional observational study. We used structured interviews, questionnaires, and medical record review to collect data. Factors related to delayed care seeking were identified using nonlinear regression. Analysis was performed in 109 patients with HF. The median delay time was 124 hours. Delayed care seeking was associated with younger age and perception of fatigue, whereas evaluation of and response to symptoms were not associated with delay. Few characteristics of the symptom experience are associated with delayed care seeking among patients with HF who experience an exacerbation of symptoms. Further research is needed to determine why early care seeking is difficult among patients with HF.

Heart-focused anxiety and health care seeking in patients with non-cardiac chest pain: A prospective study.

This study aimed to estimate the incidence of medical consultations six months after an emergency department (ED) consultation for non-cardiac chest pain (NCCP). It also investigated the role of heart-focused anxiety (HFA) and other factors in predicting an increased healthcare utilization in these patients. This was a prospective study of 428 patients who came to an ED with NCCP. Patients completed an interview and questionnaires assessing HFA, psychological distress, the characteristics of NCCP, and comorbidities. Their medical consultations were assessed by telephone interview six months later. The contribution of each factor was assessed using a binomial negative regression. Eighty-three percent of patients reported at least one medical consultation (mean=3.1, standard deviation=3.9). HFA (incident rate ratio 1.01; 95% CI, 1.00-1.02), the presence of a medical condition (2.14; 1.51-3.03), NCCP frequency (1.49; 1.16-1.91) and NCCP-related interference (1.08; 1.04-1.13) were predictive of further medical consultations. A significant proportion of patients with NCCP are at risk of multiple medical consultations following discharge from the ED. HFA appears as a determinant of medical consultations after controlling for multiple confounding factors.

Durations and Delays in Care Seeking, Diagnosis and Treatment Initiation in Uncomplicated Pulmonary Tuberculosis Patients in Mumbai, India.

BackgroundTimely diagnosis and treatment initiation are critical to reduce the chain of transmission of Tuberculosis (TB) in places like Mumbai, where almost 60% of the inhabitants reside in overcrowded slums. This study documents the pathway from the onset of symptoms suggestive of TB to initiation of TB treatment and examines factors responsible for delay among uncomplicated pulmonary TB patients in Mumbai.MethodsA population-based retrospective survey was conducted in the slums of 15 high TB burden administrative wards to identify 153 self-reported TB patients. Subsequently in-depth interviews of 76 consenting patients that fit the inclusion criteria were undertaken using an open-ended interview schedule. Mean total, first care seeking, diagnosis and treatment initiation duration and delays were computed for new and retreatment patients. Patients showing defined delays were divided into outliers and non-outliers for all three delays using the median values.ResultsThe mean duration for the total pathway was 65 days with 29% of patients being outliers. Importantly the mean duration of first care seeking was similar in new (24 days) and retreatment patients (25 days). Diagnostic duration contributed to 55% of the total pathway largely in new patients. Treatment initiation was noted to be the least among the three durations with mean duration in retreatment patients twice that of new patients. Significantly more female patients experienced diagnostic delay. Major shift of patients from the private to public sector and non-allopaths to allopaths was observed, particularly for treatment initiation.ConclusionAchieving positive behavioural changes in providers (especially non-allopaths) and patients needs to be considered in TB control strategies. Specific attention is required in counselling of TB patients so that timely care seeking is effected at the time of relapse. Prioritizing improvement of environmental health in vulnerable locations and provision of point of care diagnostics would be singularly effective in curbing pathway delays.

Care-seeking decisions for worsening symptoms in heart failure: a qualitative metasynthesis

Over 50 % of heart failure (HF) patients delay seeking help for worsening symptoms until these reach acute levels and require emergency hospitalisation. This metasynthesis aimed to identify and explore factors influencing timely care-seeking in patients with HF. Electronic databases searched were MEDLINE, Embase, and CINAHL. Studies were included if they were peer-reviewed journal articles, written in English, and reported perspectives of HF patients following qualitative data collection and analysis. Forty articles underwent analysis following the approach of Thomas and Harden. Leventhal's self-regulatory model (SRM) was used to organise the literature. Much of the literature fits within the SRM; however, this model did not account for all factors that influence patients' care-seeking for worsening symptoms. Factors not accounted for included patients' appraisals of previous care-seeking experiences, perceived system and provider barriers to accessing care, and the influence of external appraisals. When added to factors already represented in the model, such as misattribution of symptoms, not identifying with HF diagnosis, cognitive status, lack of understanding information provided, adaptation to symptoms, and emotional responses, a more comprehensive account of patients' decision-making was revealed. This metasynthesis identified factors, as yet unaccounted for, in a prominent model, and has suggested a more comprehensive framework for addressing care-seeking in HF patients. This information can be used to tailor education, communication, and service initiatives to improve HF patients' responses to worsening symptoms and target those most at risk of delay.

Care-seeking decisions for worsening symptoms in Heart Failure: a qualitative metasynthesis

Over 50 % of heart failure (HF) patients delay seeking help for worsening symptoms until these reach acute levels and require emergency hospitalisation. This metasynthesis aimed to identify and explore factors influencing timely care-seeking in patients with HF. Electronic databases searched were MEDLINE, Embase, and CINAHL. Studies were included if they were peer-reviewed journal articles, written in English, and reported perspectives of HF patients following qualitative data collection and analysis. Forty articles underwent analysis following the approach of Thomas and Harden. Leventhal’s self-regulatory model (SRM) was used to organise the literature. Much of the literature fits within the SRM; however, this model did not account for all factors that influence patients’ care-seeking for worsening symptoms. Factors not accounted for included patients’ appraisals of previous care-seeking experiences, perceived system and provider barriers to accessing care, and the influence of external appraisals. When added to factors already represented in the model, such as misattribution of symptoms, not identifying with HF diagnosis, cognitive status, lack of understanding information provided, adaptation to symptoms, and emotional responses, a more comprehensive account of patients’ decision-making was revealed. This metasynthesis identified factors, as yet unaccounted for, in a prominent model, and has suggested a more comprehensive framework for addressing care-seeking in HF patients. This information can be used to tailor education, communication, and service initiatives to improve HF patients’ responses to worsening symptoms and target those most at risk of delay.

Inappropriate use of continuous cardiac telemetry and its potential adverse impact on human resources management and financial burdens

Purpose: Over 50% of heart failure (HF) patients delay seeking help for worsening symptoms until these reach acute levels and require emergency hospitalisation. This metasynthesis aimed to identify andexplore factors influencing timely care-seeking in patients with HF. Methods: Electronic databases searched were Medline, EMBASE and CINAHL. Studies were included if they were peer reviewed journal articles written in English, and reported perspectives of HF patients following qualitative data collection and analysis. Forty articles underwent analysis following the approach of Thomas andHarden. Leventhal’s self-regulatory model (SRM) was used to organise the literature. Results: Much of the literature fit within the SRM, however this model did not account for all factors that influence patients’ care-seeking for worsening symptoms. Factors not accounted for included patients’ appraisals of previous careseeking experiences, perceived system and provider barriers to accessing care, and the influence of external appraisals. When added to factors already represented in themodel, such asmisattribution of symptoms, not identifyingwithHF diagnosis, cognitive status, lack of understanding information provided, adaptation to symptoms, and emotional responses, a more comprehensive account of patients’ decision-making was revealed. Implications: This metasynthesis identified factors, as yet unaccounted for, in a prominent model, and has suggested a more comprehensive framework for addressing care-seeking in HF patients. This information can be used to tailor education, communication, and service initiatives to improve HF patients’ responses to worsening symptoms.

Emotions delay care-seeking in patients with an acute myocardial infarction

In acute myocardial infarction the risk of death and loss of myocardial tissue is at its highest during the first few hours. However, the process from symptom onset to the decision to seek medical care can take time. To comprehend patients' pre-hospital delay, attention must be focused on the circumstances preceding the decision to seek medical care. To add a deeper understanding of patients' thoughts, feelings and actions that preceded the decision to seek medical care when afflicted by an acute myocardial infarction. Fourteen men and women with a first or second acute myocardial infarction were interviewed individually in semi-structured interviews. Data were analysed by qualitative content analysis. Four themes were conceptualized: 'being incapacitated by fear, anguish and powerlessness', 'being ashamed of oneself', 'fear of losing a healthy identity' and 'striving to avoid fear by not interacting with others'. Patients were torn between feelings such as anguish, fear, shame and powerlessness. They made an effort to uphold their self-image as being a healthy person thus affected by an unrecognized discomfort. This combined with a struggle to protect others from involvement, strengthened the barriers to seeking care. The present study indicates that emotional reactions are important and influence patients' pre-hospital behaviour. Being ashamed of oneself stood out as a novel finding. Emotions might be an important explanation of undesired and persisting patient delays. However, our findings have to and should be evaluated quantitatively. Such a study is in progress.

Pre-hospital care-seeking in patients with acute myocardial infarction and subsequent quality of care in Beijing

Background Cumulative evidence demonstrates that primary percutaneous coronary intervention (PCI) is a reperfusion strategy for ST-elevation myocardial infarction (STEMI). This study was undertaken to evaluate the pre-hospital care-seeking pathway and subsequent care quality in patients with STEMI in the Beijing health care system, which offers patients a choice between seeking care in a small community hospital (SH group) or a large hospital (LH group). Methods Between January 1 and December 31, 2006, a cross-sectional and multicenter survey was conducted in 11 hospitals qualified as tertiary centers in Beijing and included consecutive patients with STEMI admitted within 24 hours after onset of symptoms. Results Among the 566 patients interviewed, 28.3% first arrived at a small community hospital and were transferred to large hospitals with the ability to perform primary PCI. The median total pre-hospital delay in the SH group (n=160) was significantly longer than in the LH group (n=406) (225 vs. 120 minutes, P <0.001). Multivariate analysis showed that interpreting symptoms to non-cardiac origin (OR, 1.996; 95% CI: 1.264-3.155), absence of history of myocardial infarction (OR, 1.595; 95% CI: 1.086-3.347), non-health insurance coverage (OR, 1.931; 95% CI: 1.079-3.012) and absence of sense of impending doom (OR, 4.367; 95% CI: 1.279-14.925) were independent predictors for choosing small hospitals. After adjusting for demographics and medical history, patients in the SH group were 1.698 times (95% CI: 1.182-3.661) less likely to receive primary PCI compared with those in the LH group. Conclusions Above one fourth of the STEMI patients in Beijing experienced inter-hospital transfer. Factors including symptoms interpretation, symptoms, history of myocardial infarction, and insurance coverage were associated with the patients’ pre-hospital care-seeking pathway. The patients who were transferred had longer pre-hospital delays and were less likely to receive primary PCI.

Medical care-seeking and health-risk behavior in patients with head and neck cancer: the role of health value, control beliefs and psychological distress

Health behavior plays an important role in the development, detection and course of cancer of the head and neck. Relevant health behavior includes prompt medical care seeking, and smoking and drinking cessation after diagnosis. This study examines the relationship between these health behaviors and health value and control beliefs, as well as psychological distress. Two hundred and sixty-four recently diagnosed head and neck cancer patients were interviewed about their health behavior, and they filled in a questionnaire on health beliefs and psychological distress. The results showed that one-quarter (25%) of the patients had waited more than 3 months before seeking medical care, 50% had continued to smoke and 80% had continued to drink after the diagnosis. The patients, particularly those who smoked and drank before diagnosis, reported lower levels of health value and perceived health competence than a general population sample with which they were compared. Patients who engaged in patient delay reported a lack of perceived health competence. Psychological distress and lack of perceived health competence were found to be more common among patients who continued to smoke. The implications of these findings are discussed with regard to interventions aimed at promoting these specific health behaviors.

Perceived inability to cope and care-seeking in patients with toothache: a qualitative study

Perceived inability to cope and care-seeking in patients with toothache: a qualitative study

Perceived inability to cope and care-seeking in patients with toothache: a qualitative study

To explore the subjective experience of a sample of patients attending a dental teaching hospital emergency clinic with toothache. Subjects 21 female and 14 male dental patients, of different ages, marital status, employment status and levels of education, presenting with toothache at a dental teaching hospital emergency clinic. Data collection Unstructured in-depth interviews, following a topic guide. Analysis Transcribing, sifting, indexing and charting data according to key issues and themes. A dimension of toothache pain that emerged was the perceived inability to cope. Patients reported a dependency on a dentist or other person to alleviate their pain, suggesting connotations of helplessness, disempowerment and incapacitation. The perceived inability to cope was also expressed in terms of loss of control, despair and isolation. A number of care-seeking patterns for toothache was identified: repeated visits to the same dentist for emergency care, repeated visits to different dentists, attendance at the dental hospital emergency clinic and consulting non-dental health workers such as doctors and pharmacists. The perceived inability to cope and care-seeking patterns are two unexplored dimensions of the toothache pain experience. Both dimensions may be associated with pain intensity, the clinical conditions that manifest as toothache, quality of treatment provided and management of demand for emergency dental care. A conceptual framework is proposed for future research to investigate these relationships.