Comprehensive Patient Education Research Articles

The Long-Acting Cabotegravir Tail as an Implementation Challenge: Planning for Safe Discontinuation.

The long-acting feature of cabotegravir, an integrase-inhibitor highly effective in preventing acquisition of HIV in adolescents and adults, is both its greatest strength and a challenge to its implementation. Cab-LA is administered at 8-week intervals (after an initial loading dose) but has a long, variable drug "tail" that may leave users vulnerable to future drug resistance if they contract HIV during this critical period. The potential for cab-LA to meaningfully contribute to ending the HIV Epidemic is hindered by, among other factors, limited resources to guide patients and providers on how to safely discontinue injections. We suggest three key strategies to overcome this specific challenge: (1) Comprehensive patient education and counseling about the drug tail; (2) Training and coaching PrEP care teams, including clinical and non-clinical staff, on communication around the tail; (3) Adherence support strategies, including monitoring of cabotegravir drug levels after discontinuation, for a personalized medicine approach to safe discontinuation.

A Comprehensive Therapeutic Patient Education May Improve Wound Healing and Reduce Ulcer Recurrence and Mortality in Persons With Type 2 Diabetes

ObjectivesThe impact of a comprehensive therapeutic patient education (TPE) on the prognosis of diabetic foot ulcer (DFU) has not yet been evaluated in the literature. The purpose of this study was to determine whether TPE is a predictor of outcome in type 2 diabetes patients with DFU. MethodsWe evaluated 583 consecutive individuals with a recent and single DFU. They were treated and followed for 42.8±23.3 months. Patients were divided into 2 groups. The TPE group included subjects who had been receiving regular sessions of a comprehensive TPE, including a specific foot care education (FCE), for at least 12 months before DFU occurred (n=129). The non-TPE group comprised the remaining subjects (n=454). All 583 patients received intensive FCE during the treatment period. ResultsWe identified a significantly higher percentage of healed DFUs (96.0% vs 74.9%; p<0.0001) and a lower percentage of major amputations (0.8% vs 4.4%; p=0.0511), minor amputations (1.6% vs 12.3%; p=0.0003), DFU persistence (1.6% vs 8.4%; p=0.0069) and deaths (1.6% vs 21.4%; p<0.0001) in the TPE group than in the non-TPE group. Among 464 patients with healed ulcers, the proportion of subjects with re-ulceration was greater in the non-TPE group than in the TPE group (48.8% vs 6.5%; p<0.0001). Multivariate analysis showed that TPE can predict healing (odds ratio [OR], 4.202; 95% confidence interval [CI], 1.604 to 11.004; p=0.0035) and may significantly reduce DFU recurrence (OR, 0.093; 95% CI, 0.043 to 0.201; p<0.0001) and mortality (OR, 0.096; 95% CI, 0.022 to 0.410; p=0.0016). ConclusionA comprehensive TPE may have a positive impact on wound healing, ulcer recurrence and mortality in people with DFU.

Optimizing Perioperative Care in Transsphenoidal Pituitary Surgery: Considerations for Enhanced Recovery After Surgery.

To identify key recommendations for maximizing the efficiency and efficacy of perioperative care in transsphenoidal pituitary surgery. The authors performed a comprehensive literature search of Enhanced Recovery After Surgery protocols implemented for patients undergoing transsphenoidal adenomectomy (TSA); individual recommendations were abstracted, and the evidence base thoroughly reviewed. The authors identified 19 individual recommendations pertinent to the care of patients undergoing TSA, which were subdivided into preoperative (n=6), intraoperative (n=6), and postoperative (n=7) interventions. Key factors recommended for minimizing length of stay, preventing readmission, and improving patient outcomes included comprehensive patient education, multidisciplinary evaluation, avoidance of routine lumbar drain placement and nasal packing, and rigorous postoperative monitoring of pituitary function and salt-water imbalances. The overall level of evidence for 7/19 (37%) implemented recommendations was found to be low, suggesting a need for continued research in this patient population. Several key interventions should be considered in the development of Enhanced Recovery After Surgery protocols for TSA, which may aid in further decreasing length of stay and promoting positive patient outcomes.

Hastalık Yönetiminde Dijital Sağlık Okuryazarlığı

Dünya, teknolojiye ve dijitalleşmeye doğru hızlı bir eğilim halindedir. Teknolojik gelişmelerle birlikte sağlık okuryazarlığı ilerlemiş ve hastalık yönetiminde dijital sağlık okuryazarlığının önemi fark edilmiştir. Bir hastanın, belirli bir teşhisle ilgili olarak iyileşmenin risk düzeyini ve öngörülen sonucunu anlaması için, sağlık okuryazarlığını kolaylaştıran kapsamlı hasta eğitim kaynaklarına erişebilmesi önemlidir. Topluma daha iyi sağlık hizmeti ve sağlık eğitimi verebilmek için hemşirelerin iyi düzeyde dijital sağlık okuryazarlığına sahip olmaları gerekmektedir. Hemşirelerin teknolojiyi etkin kullanabilmeleri dijital okuryazarlığı ile ilgili yeterli bilgi ve beceri kazanmalarına bağlıdır. Bu derlemenin amacı teknolojiyle birlikte gelişen dijital sağlık okuryazarlığının önemini vurgulamak ve hastalık yönetiminde dijital sağlık okuryazarlığı bakış açısını geliştirmektir.

Sports activity and quality of life improve after isolated ACL, isolated PCL, and combined ACL/PCL reconstruction

PurposeTo compare patient-reported outcomes following isolated anterior cruciate ligament reconstruction (ACL-R), isolated posterior cruciate ligament reconstruction (PCL-R), and combined ACL-R and PCL-R (ACL/PCL-R), at a minimum follow-up of 2 years.MethodsThis was a prospective observational registry cohort study based on the Swedish National Knee Ligament Registry. Patients undergoing isolated ACL-R, isolated PCL-R, and combined ACL/PCL-R between 2005 and 2019 were eligible for inclusion. Demographic characteristics as well as injury- and surgery-related data were queried from the SNKLR. To evaluate functional outcomes, the Knee Injury and Osteoarthritis Outcome Score (KOOS) was collected preoperatively and at 1- and 2-year follow-ups and compared between the treatment groups.ResultsIn total, 45,169 patients underwent isolated ACL-R, 192 patients isolated PCL-R, and 203 patients combined ACL/PCL-R. Preoperatively, and at the 1- and 2-year follow-ups, KOOS subscales were highest for the isolated ACL-R group, followed by the isolated PCL-R, and lowest for the combined ACL/PCL-R groups. Significant improvements were observed across all treatment groups in the majority of KOOS subscales between the preoperative, and 1- and 2-year follow-ups. All treatment groups showed the greatest improvements between the preoperative and 2-year follow-ups in the knee-related quality of life (mean improvement: isolated ACL-R, + 28 points; isolated PCL-R, + 23 points; combined ACL/PCL-R, + 21 points) and the function in sport and recreation (mean improvement: isolated ACL-R, + 26 points; isolated PCL-R, + 20 points; combined ACL/PCL-R, + 19 points) subscales.ConclusionClinically relevant improvements in knee function can be expected after isolated ACL-R, isolated PCL-R, and combined ACL/PCL-R. Functional improvements were particularly pronounced in the KOOS function in sport and recreation subscale, indicating the importance of knee stability for sports activity. This study facilitates more comprehensive patient education about functional expectations after surgical treatment of isolated and combined ACL and PCL injuries.Level of evidenceLevel 2.

The role of nursing in the hepatic rehabilitation of patients with liver cirrhosis

Liver cirrhosis is an important health problem that leads to morbidity and mortality. Severe complications are seen due to its ineffective management. Failure to meet the educational needs of patients with liver cirrhosis, inadequate self-care practices in disease management and frequent recurrence of life-threatening complications indicate the need for sustainable hepatic rehabilitation programmes. To provide hepatic rehabilitation, it is necessary to prepare comprehensive, accessible and sustainable patient education programmes, increase the patients' activation in self-care practices and interpret the results of self-care practices, as well as practice and manage complications accordingly. Using accessible and sustainable technology tools may help to provide hepatic rehabilitation and increase patients' activation in their disease management. This review paper was conducted to explain the nursing roles in the hepatic rehabilitation of patients with liver cirrhosis. It is recommended that the hepatic rehabilitation programme should be developed by nurses to maintain the care of patients with liver cirrhosis.

Evaluating the Implementation of the GREAT4Diabetes WhatsApp Chatbot to Educate People With Type 2 Diabetes During the COVID-19 Pandemic: Convergent Mixed Methods Study.

BackgroundIn South Africa, diabetes is a leading cause of morbidity and mortality, which was exacerbated during the COVID-19 pandemic. Most education and counseling activities were stopped during the lockdown, and the GREAT4Diabetes WhatsApp Chatbot was innovated to fill this gap.ObjectiveThis study aimed to evaluate the implementation of the chatbot in Cape Town, South Africa, between May and October 2021.MethodsConvergent mixed methods were used to evaluate the implementation outcomes: acceptability, adoption, appropriateness, feasibility, fidelity, cost, coverage, effects, and sustainability. Quantitative data were derived from the chatbot and analyzed using the SPSS. Qualitative data were collected from key informants and analyzed using the framework method assisted by Atlas-ti. The chatbot provided users with 16 voice messages and graphics in English, Afrikaans, or Xhosa. Messages focused on COVID-19 infection and self-management of type 2 diabetes.ResultsThe chatbot was adopted by the Metro Health Services to assist people with diabetes who had restricted health care during the lockdown and were at a higher risk of hospitalization and death from COVID-19 infection. The chatbot was disseminated via health care workers in primary care facilities and local nonprofit organizations and via local media and television. Two technical glitches interrupted the dissemination but did not substantially affect user behavior. Minor changes were made to the chatbot to improve its utility. Many patients had access to smartphones and were able to use the chatbot via WhatsApp. Overall, 8158 people connected with the chatbot and 4577 (56.1%) proceeded to listen to the messages, with 12.56% (575/4577) of them listening to all 16 messages, mostly within 32 days. The incremental setup costs were ZAR 255,000 (US $16,876) and operational costs over 6 months were ZAR 462,473 (US $30,607). More than 90% of the users who listened to each message found them useful. Of the 533 who completed the whole program, 351 (71.1%) said they changed their self-management a lot and 87.6% (369/421) were more confident. Most users changed their lifestyles in terms of diet (315/414, 76.1%) and physical activity (222/414, 53.6%). Health care workers also saw benefits to patients and recommended that the service continues. Sustainability of the chatbot will depend on the future policy of the provincial Department of Health toward mobile health and the willingness to contract with Aviro Health. There is the potential to go to scale and include other languages and chronic conditions.ConclusionsThe chatbot shows great potential to complement traditional health care approaches for people with diabetes and assist with more comprehensive patient education. Further research is needed to fully explore the patient’s experience of the chatbot and evaluate its effectiveness in our context.

Evaluating the effectiveness of a comprehensive patient education intervention in a hybrid model of cardiac rehabilitation: A pilot study.

ObjectiveTo evaluate the effectiveness of a comprehensive educational intervention in a hybrid model of cardiac rehabilitation in Spain during the COVID-19 pandemic.MethodsIn a prospective pretest-posttest pilot study a pooled sample of patients attending hybrid cardiac rehabilitation in Spain received a culturally-adapted education intervention for 6 weeks. Participants completed surveys at pre- and post-rehabilitation assessing disease-related knowledge, health literacy, adherence to the Mediterranean Diet and self-efficacy. Physical activity was measured by number of steps per day using wearable activity tracking devices. Satisfaction with the educational materials was also evaluated by a survey with a 10 point Likert-type scale and yes/no and open-ended questions.ResultsEighty-one(99%) participants completed both assessments. There was significant improvement in disease-related knowledge(p < 0.001), physical activity(p < 0.001), and adherence to the diet(p = 0.005) post-rehabilitation. The number of participants that were classified as having “high health literacy skills” increased by 17%. Post-rehabilitation knowledge was associated with education level (ß = 0.430; p = 0.001),pre-rehabilitation knowledge (ß = 0.510; p = 0.002), and high health literacy skills (ß = 0.489; p = 0.01). Educational materials were highly satisfactory to participants.ConclusionSignificant increases in disease-related knowledge and health behaviors in patients attending hybrid models of cardiac rehabilitation are encouraging results that support the value of implementing comprehensive educational initiatives to programs in Spain.InnovationThis work presents preliminary evidence of the effectiveness of the first comprehensive education intervention that is open access and culturally adapted to people living with cardiovascular disease in Spain.

Sociotechnical Factors Affecting Patients' Adoption of Mobile Health Tools: Systematic Literature Review and Narrative Synthesis.

BackgroundMobile health (mHealth) tools have emerged as a promising health care technology that may contribute to cost savings, better access to care, and enhanced clinical outcomes; however, it is important to ensure their acceptance and adoption to harness this potential. Patient adoption has been recognized as a key challenge that requires further exploration.ObjectiveThe aim of this review was to systematically investigate the literature to understand the factors affecting patients’ adoption of mHealth tools by considering sociotechnical factors (from technical, social, and health perspectives).MethodsA structured search was completed following the participants, intervention, comparators, and outcomes framework. We searched the MEDLINE, PubMed, Cochrane Library, and SAGE databases for studies published between January 2011 and July 2021 in the English language, yielding 5873 results, of which 147 studies met the inclusion criteria. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and the Cochrane Handbook were followed to ensure a systematic process. Extracted data were analyzed using NVivo (QSR International), with thematic analysis and narrative synthesis of emergent themes.ResultsThe technical factors affecting patients’ adoption of mHealth tools were categorized into six key themes, which in turn were divided into 20 subthemes: usefulness, ease of use, data-related, monetary factors, technical issues, and user experience. Health-related factors were categorized into six key themes: the disease or health condition, the care team’s role, health consciousness and literacy, health behavior, relation to other therapies, integration into patient journey, and the patients’ insurance status. Social and personal factors were divided into three key clusters: demographic factors, personal characteristics, and social and cultural aspects; these were divided into 19 subthemes, highlighting the importance of considering these factors when addressing potential barriers to mHealth adoption and how to overcome them.ConclusionsThis review builds on the growing body of research that investigates patients’ adoption of mHealth services and highlights the complexity of the factors affecting adoption, including personal, social, technical, organizational, and health care aspects. We recommend a more patient-centered approach by ensuring the tools’ fit into the overall patient journey and treatment plan, emphasizing inclusive design, and warranting comprehensive patient education and support. Moreover, empowering and mobilizing clinicians and care teams, addressing ethical data management issues, and focusing on health care policies may facilitate adoption.

Cancer-Related Lymphedema Management: Development of Patient Education Resources.

Lymphedema education following cancer surgery helps patients feel more empowered to perform their own self-care. This may lead to fewer lymphedema symptoms postoperatively resulting in an overall improvement in the patient's quality of life. We identified a need for written comprehensive postoperative lymphedema patient education at our institution. We created the educational resources with the help of a multidisciplinary team and these resources are currently being provided to the patients during their visit to our lymphedema clinic. Plastic and breast oncology nurses, a plastic surgeon specializing in lymphedema management, physical therapists, occupational therapists, dietitians, a patient education specialist, two affiliated medical artists, and marketing and language services personnel engaged in an 18-month collaborative effort to create a variety of patient education resources. The created resources included surgical and therapeutic information, nutrition and dietary guidelines, postoperative exercises, diagnostic testing and imaging information, facility services, glossary of terms, web resources, and a personalized treatment guide for the patient.

A web-based comprehensive head and neck cancer patient education and support needs program: Usability testing.

Background: With increasing accessibility of the World Wide Web, patients are using it to obtain patient education materials (PEM). With this in mind, our group (surgeons, radiation oncologists, medical oncologists, nursing, allied health professionals and academic researchers) developed a comprehensive information resource for patients with head and neck cancer (HNC), the Head and Neck Cancer Australia, formerly Beyond Five website. The aim of this study was to determine patient usability of the Head and Neck Cancer Australia website. Methods: Usability testing (Cognitive walkthrough & Think-Aloud) in 18 patients treated for HNC was undertaken at a Cancer centre (anonymous for reviewers). Results: The tasks rated easiest by patients were finding information on psychological well-being (mean time spent: 66s, range: 10-565), health and well-being effecting quality of life (mean time spent: 36s, range 9-117) and carer information (mean time spent: 10s, range 3-35). Patients indicated the website contained a lot of information, covers most topics, was a trusted source of information and a springboard to other information. Conclusions: The Head and Neck Cancer Australia website provides a wide range of information and support in multiple formats available to HNC patients. Further refinements in design, navigation and website instructions are needed to allow effective patient interaction.

Pediatric Atopic Dermatitis

ABSTRACT Background Atopic dermatitis is the most common pediatric skin disorder in the United States. Literature consensus designates patient education as crucial in atopic dermatitis management. Local problem Representing Alabama's only pediatric dermatology clinic, the clinic at Children's of Alabama receives a disproportionate number of referrals. The volume impedes on the clinician's ability to provide comprehensive patient education for new referrals. Methods All new atopic dermatitis referrals, newborn to 5 years old, are scheduled between August 2, 2019, and October 25, 2019, for the pediatric dermatology nurse practitioner's weekly clinic. To complete the visit, the nurse practitioner customizes an eczema action plan to be individually reviewed by the dermatology nurse with the patient. Interventions Before the visit, caregivers complete the Patient-Oriented Eczema Measure questionnaire to quantify eczema symptoms. They repeat this by phone 4–6 weeks later along with another Likert questionnaire measuring caregiver treatment confidence. Results Using SPSS Statistics 25 to analyze descriptive statistics, there was a statistically significant change in scores. Caregiver treatment confidence was uniformly high. Conclusion Improved atopic dermatitis symptoms and increased caregiver treatment confidence were observed after implementing nurse-led education with customized eczema action plans in new visits.

Knowledge and Perception Regarding the Development and Acceptability of Male Contraceptives Among Pharmacists: A Mixed Sequential Method.

Community pharmacists play a crucial role in providing comprehensive patient education regarding contraception methods. This study aims to investigate Jordanian pharmacists’ knowledge and perceptions toward male oral contraceptive pills (OCPs). A mixed-explanatory sequential method was divided into two phases. The first was a self-administered electronic survey that was distributed to community pharmacists/trainees in Jordan. The second phase was carried out through online semi-structured in-depth interviews targeting the maximum variation purposive sample of community pharmacists. A total of 158 (response rate 98%) questionnaires were included in the analysis. The majority of the participants were female (n = 118, 74.2%). In terms of knowledge, only 25% of participants acknowledged the presence of male OCPs and almost half were uncertain about the mechanism of action and the possible uses. The findings of the interviews confirmed a relatively negative perception toward male OCPs and the identified barriers to male OCPs were cultural norms, side effects, and poor compliance. It is argued that there is a negative perception toward male OCPs due to the majority of pharmacists not believing such products will be successful in Jordan. Once these pills are approved for their effectiveness and safety, men may need further education and encouragement to take an active role in family planning along with their partners.

Tools, Time, Training, and Team-Military Primary Care Providers' Perspectives on Improving Chronic Pain Assessment and Management.

Primary care providers are on the front lines of chronic pain management, with many reporting frustration, low confidence, and dissatisfaction in handling the complex issues associated with chronic pain care. Given the importance of their role and reported inadequacies and dissatisfaction in managing this challenging population, it is important to understand the perspectives of primary care providers when considering approaches to chronic pain management. This qualitative descriptive study aimed to comprehensively summarize the provider challenges and suggestions to improve chronic pain care in military primary care settings. Semi-structured interviews with 12 military primary care providers were conducted in a single U.S. Army medical center. All interviews were audio-recorded and lasted between 30 and 60 minutes. Interview transcripts were analyzed using ATLAS 9.0 software. Narratives were analyzed using a general inductive approach to content analysis. The Framework Method was used to organize the codes and emergent categories. All study procedures were approved by the Institutional Review Board of the University of Washington. Four categories captured providers' challenges and suggestions for improving chronic pain care: (1) tools for comprehensive pain assessment and patient education, (2) time available for each chronic pain appointment, (3) provider training and education, and (4) team-based approach to chronic pain management. Providers suggested use of the Pain Assessment Screening Tool and Outcomes Registry, more time per visit, incorporation of chronic pain care in health sciences curriculum, consistent provider training across the board, insurance coverage for complementary and integrative therapies, patient education, and improved access to interdisciplinary chronic pain care. Lack of standardized multifaceted tools, time constraints on chronic pain appointments, inadequate provider education, and limited access to complementary and integrative health therapies are significant provider challenges. Insurance coverage for complementary and integrative health therapies needs to be expanded. The Stepped Care Model of Pain Management is a positive and definite stride toward addressing many of these challenges. Future studies should examine the extent of improvement in guidelines-concordant chronic pain care, patient outcomes, and provider satisfaction following the implementation of the Stepped Care Model of Pain Management in military health settings.

Orthognathic surgery

Orthodontic treatment goals can be divided into five categories: facial esthetics, dental esthetics, functional occlusion, periodontal health, and stability.Orthognathic surgery is a unique endeavor in facial surgery: a patient's appearance and occlusal function can be improved significantly, impacting the patient's sense of self and well-being. Successful outcomes in modern orthognathic surgery rely on close collaboration between the surgeon and the orthodontist across all stages of treatment, from preoperative planning to finalization of occlusion. Virtual computer planning promotes a more accurate analysis of dentofacial deformity and preoperative planning. It is also an invaluable aid in providing comprehensive patient education.

Sociodemographics, lifestyle determinants, and viral infections in patients with head and neck cancer undergoing radiotherapy in Taiwan: A prospective cohort study.

10553 Background: Human papillomavirus (HPV) screening has been implemented to monitor both cervical cancer and head and neck cancer. In this prospective cohort study, we determined sociodemographic, behavioral, and infectious etiology for head and neck squamous cell carcinoma (HNSCC) in Taiwan using data collected from an anonymous sexually transmitted infections screening program. Methods: An anonymous sexually transmitted infections screening program was conducted at a medical center during 2016, in which sociodemographic characteristics including gender, age, marital status, education level, and occupation; medical history regarding underlying comorbidities and history of receiving HPV and other vaccines; lifestyle determinants including betel quid chewing, drug using, and sexual behaviors, were inquired. Blood, anal swab, and penile swab samples were collected to determine viral infections using polymerase chain reaction (PCR). With PCR, 37 HPV genotypes were detected. Regular follow-ups were made for patients enrolled in the screening program until end of 2020, during which all suspected malignancies were recorded upon referrals to oncologists. From this prospective cohort, odds ratios (ORs) of HNSCC for sociodemographic, lifestyle, and infectious variables were derived with logistic regression (R version 4.0.1). P &lt; 0.05 was considered statistically significant. Results: A total of 376 patients were enrolled. Most patients were men (n = 372), with a median age of 27 years. There were 124 (32.98%) HPV-positive patients and 78 (20.74%) HIV-positive patients. Among HPV-positive patients, 20 (25.64%) were of high-risk genotypes. During the follow-up, 44 patients developed HNSCC and all received radiotherapy. Multivariate analysis revealed that patients who were single (OR = 1.43, 95% CI = 1.12-1.83, P = 0.01) or widowed (OR = 2.47, 95% CI = 1.88-3.25, P &lt; 0.001) had higher risk of HNSCC than patients who were married. Patients aged 51-60 (OR = 2.93, 95% CI = 2.10-4.09, P &lt; 0.001) and over 60 (OR = 1.89, 95% CI = 1.45-2.47, P &lt; 0.001) presented higher risks of HNSCC, compared with those aged below 20. Patients addicted to betel quid chewing had high HNSCC risk (OR = 1.29, 95% CI = 1.11 – 1.50, P &lt; 0.001). However, patients with HPV infections did not present with higher HNSCC risks (OR = 0.925, 95% CI = 0.852 – 1.003, P = 0.058). Conclusions: In this prospective cohort study, the elderly, unmarried patients, and patients addicted to betel quid chewing, presented with high HNSCC incidence. On the contrary, the association between HPV infection and HNSCC was insignificant. As both betel nut-chewing and HPV infection could be prevented, we advocate for comprehensive screening and patient education for HNSCC prevention.

Quantifying Patient Engagement in Total Joint Arthroplasty Using Digital Application-Based Technology

BackgroundDigital patient engagement has been suggested as a mean to increase patient activation and patient satisfaction after total joint arthroplasty. The purpose of this study was to assess patient engagement with application-based educational tools and to explore what content was most useful to patients in the perioperative period surrounding total hip arthroplasty (THA) and total knee arthroplasty (TKA), respectively. MethodsPatients undergoing THA and TKA between October 2017 and January 2020 were enrolled to use an application-based digital technology. The App provides comprehensive patient education using a series of modules delivered at set intervals preoperatively and postoperatively. Patient engagement was defined as patients viewing at least one time the modules that were sent, or marking them as completed. Patient satisfaction was assessed using an in-application survey. ResultsComplete data were available on 207 patients of which 95 (46%) underwent THA and 112 (54%) underwent TKA. The average age was 60 years. 54% with patients invited to the program completed registration. An average compliance rate of 48% (41 modules engaged out of 83) was observed. Of all modules completed, the top three most popular categories included physical therapy/exercise videos, health literacy, and anxiety/stress/pain management. The least viewed category was nutrition planning and education. ConclusionWhen presented educational material related to THA and TKA, patients had a high rate of compliance. Digital technology platforms provide a scalable, meaningful approach to engaging patients throughout the continuum of joint replacement care and may serve as a cost-effective adjunct to traditional methods.

Reorganisation of obstetric services during the COVID pandemic - Experience from National Maternity Hospital Dublin Ireland.

The 2020 SARS-CoV-2 pandemic posed significant challenges to the health service. Many services cancelled all routine appointments and surgery, which allowed them to redirect care towards large numbers of infected patients requiring respiratory and other support. Maternity services are relatively unique in that most of the care is time sensitive and cannot be rescheduled. Assessment such as routine bloods need to be taken in early pregnancy, anatomic surveys are best conducted at 20–22 weeks' gestation, and births continue regardless of a pandemic. In this paper we describe how National Maternity Hospital Dublin, with an annual delivery rate of 8000 births, reorganised services to continue to care for our mothers and babies. This included the development of a ‘hospital within a hospital’ approach, and separate physical and care pathways for positive cases. The delivery of virtual outpatient appointments and a comprehensive online patient education portal have proved successful.

Analysis of prior authorization success and timeliness at a community-based specialty care pharmacy

BackgroundSpecialty medications may require a prior authorization (PA) before a patient can access the medication. Providers often identify PA approval as a burden for the practice. Pharmacists can facilitate the completion of the PA process. ObjectiveThe primary objective was to evaluate the time to first PA decision (approval or denial) for dermatologic medications dispensed by a community-based specialty pharmacy. A secondary objective was to compare PA timeliness (time to PA approval and time to first medication fill) between a community-based specialty pharmacy and a dermatology provider office.Practice description: Realo Specialty Care is a community-based independent specialty pharmacy that provides comprehensive care to patients with complex and chronic conditions such as plaque psoriasis, hidradenitis suppurativa, and atopic dermatitis. Pharmacy services include PA assistance, comprehensive medication management, patient education, and adherence monitoring. Practice innovationPharmacy dispensing system data were used to conduct a retrospective analysis of the effectiveness at resolving PA requests. PAs are traditionally completed by a provider’s practice, and data are documented within the pharmacy system as a PA task. Evaluation methodsData included PA tasks for dermatology prescriptions for patients aged 18 years or older between January 1, 2017, and June 30, 2019. Initial receipt of the prescription, PA decision, and PA decision date were noted in the PA task and confirmed via fax documentation. The date of first fill was confirmed by prescription data. ResultsThe pharmacy completed 677 PA tasks with a mean time to PA decision of 1.9 days, whereas the provider’s office averaged 20.9 days (P < 0.001). The pharmacy demonstrated a mean time to first fill of 6.6 days, whereas the provider’s office averaged 16.2 days (P < 0.001). ConclusionPharmacies can effectively complete PAs to expedite the filling process for patients and increase medication access. Provider practices could benefit from delegating these tasks to a partnered pharmacy.

A Randomized Controlled Trial of an Educational Handbook for Caregivers of Children with Atopic Dermatitis

Comprehensive patient education is critical to families’ ability to manage and cope with pediatric atopic dermatitis (AD). We evaluated whether an educational handbook could improve AD symptoms, caregiver confidence in AD management skills, and patient and family AD-related quality of life.