Healthcare Experiences Of Patients Research Articles

Patient healthcare experiences in the Northwest Territories, Canada: an analysis of news media articles

ABSTRACT The factors that influence patient healthcare experiences are complex and connected to place. In northern Canada, the socio-historical context and the inequitable distribution of health services are unique influences on patients. The objective of this study was to examine the characteristics of patient healthcare experiences as reported through news media in the Northwest Territories. We used a case series design to examine patient healthcare experiences reported in news media articles. We conducted a systematic search for articles published between 2008 and 2017 in the online database of a media outlet in the Northwest Territories. We used descriptive statistics to summarise the article characteristics and thematic analysis to understand patient experiences in 128 articles related to 71 cases. Most often, cases involved women, concerned mental health, suicidality, or chronic diseases, and were predominantly negative. Patient experiences included problems associated with medical travel, communication difficulties with providers, lack of cultural safety, and barriers in accessing care resulting in poor-quality care, particularly for Indigenous patients. Broadly, these experiences are rooted in the colonial history in the North. Understanding patient experiences and including Indigenous patients in health system decision-making can help focus policies and clinical care on cultural safety and equity.

Child Life Services.

Child life programs are an important component of pediatric hospital-based care; they address the psychosocial concerns that accompany hospitalization and other health care experiences. Child life specialists focus on the optimal development and well-being of infants, children, adolescents, and young adults while promoting coping skills and minimizing the adverse effects of hospitalization, health care encounters, and/or other potentially stressful experiences. In collaboration with the entire health care team and family, child life specialists provide interventions that include therapeutic play, expressive modalities, and psychological preparation to facilitate coping and normalization at times and under circumstances that might otherwise prove overwhelming for the child. Play and developmentally appropriate communication are used to (1) promote optimal development, (2) educate children and families about health conditions, (3) prepare children and partner with families for medical events or procedures, (4) plan and rehearse useful coping and pain-management strategies with patients and families, (5) help children work through feelings about past or impending experiences, and (6) partner with families to establish therapeutic relationships between patients, siblings, and caregivers. Child life specialists collaborate with the entire interdisciplinary team to promote coping and enhance the overall health care experience for patients and families.

Patients With Health-Related Social Needs More Likely to Report Poor Clinic Experiences.

Measuring patients’ care experience is necessary to understanding and improving health care quality and is a core component of patient-centered care. In this study, we test whether patient health care experiences differed between patients with and without health-related social needs, above and beyond demographic differences previously studied. This study relies on survey data from 2341 patients who visited 1 of 7 primary care clinics in Portland, Oregon, and surrounding communities during the latter half of 2018. Survey analysis reveal that patients with at least 1 health-related social need had greater odds of reporting staff not always answering questions, not getting all the care they need, not getting the information to manage care, not being treated with respect by their provider, and getting care being a hassle. The findings from this study suggest that patients with health-related social needs are not getting the holistic care they expect in their primary care clinics and find it a hassle to get care regardless of their demographic characteristics and insurance status. This study may help to inform how health care systems and clinics can best serve patients with health-related social needs.

Healthcare practitioner views and experiences of patients self-monitoring blood pressure: a vignette study.

BackgroundHome self-monitoring of blood pressure is widely used in primary care to assist in the diagnosis of hypertension, as well as to improve clinical outcomes and support adherence to medication. The National Institute for Health and Care Excellence (NICE) care pathways for hypertension recommend specific guidelines, although they lack detail on supporting patients to self-monitor.AimTo elicit primary care practitioners’ experiences of managing patients’ home blood pressure self-monitoring, across surgeries located in different socioeconomic areas.Design & settingA qualitative focus group study was conducted with a total of 21 primary care professionals.MethodParticipants were GPs and practice nurses (PNs), purposively recruited from surgeries in areas of low and high deprivation, according to the English indices of multiple deprivation. Six vignettes were developed featuring data from interviews with people who self-monitor and these were used in five focus groups. Results were thematically analysed.ResultsThemes derived in the thematic analysis largely reflected topics covered by the vignettes. These included: advice on purchase of a device; supporting home monitoring; mitigating patient anxiety experienced as a result of home monitoring; valuing patients’ data; and effect of socioeconomic factors.ConclusionThe work provides an account of methods used by primary care practitioners in the management of home blood pressure self-monitoring, where guidance may be lacking and primary care practitioners act on their own judgement. Findings complement recent policy documentation, which recognises the need to adopt new ways of working to empower patients (for example, additional support from healthcare assistants), but lacks detail on how this should be done.

Educational and Personal Opportunity Costs of Medical Student Preparation for the United States Medical Licensing Examination Step 1 Exam: A Single-Center Study.

PurposeTo assess the degree to which medical students choose to disengage from their regular preclinical curriculum and extracurricular activities in order to focus on United States Medical Licensing Examination (USMLE) Step 1 exam preparation, as well as learner-perceived effects of Step 1 preparation on their physical, social, and mental health.MethodOnline survey of medical students who have taken the USMLE Step 1 exam at a single large Midwestern academic medical center.ResultsThe response rate was 54%. Students often reported absenteeism from a variety of preclinical curricular activities, including lectures (44%) and didactics focusing on medical ethics (37%), clinical skills (28%), and encounters with actual and standardized patients (9%) in order to study for USMLE Step 1. Many students also forewent extracurricular opportunities including research (53%), elective patient care opportunities (45%), community service (39%), and healthcare advocacy experiences (38%) in order to study for USMLE Step 1. Majorities of students identified Step 1 preparation as a cause of burnout (79%) or significant anxiety or depression (61%), for which nearly a third sought mental healthcare; students also reported Step 1 preparation as a cause of engaging in dangerous behaviors such as illicit prescription stimulant use as well as driving or providing patient care while impaired by fatigue. In narrative comments, students frequently described Step 1 to be a barrier to their development into effective clinicians, the traditional medical school curriculum to be a barrier to performance on Step 1, or both.ConclusionsMedical students often prioritize Step 1 exam preparation over engaging with the standard preclinical curriculum, extracurricular opportunities, and activities to promote wellbeing. These findings have implications for the emphasis residency program directors place on single high-stakes standardized exams in the resident recruitment process.

Podoconiosis in Rwanda: Knowledge, attitudes and practices among health professionals and environmental officers.

BackgroundPodoconiosis is a neglected tropical disease commonly found in volcanic regions, where soil is rich in silica. It usually manifests as bilateral lower limb edema. The majority of people affected by podoconiosis are farmers who do not wear shoes. The condition was recently documented in all 30 districts in Rwanda but knowledge, attitudes and practices (KAP) of Rwandan health professionals and environmental officers towards podoconiosis are unknown.Methodology/FindingsThe objective of this study was to assess the knowledge, attitudes and practices (KAP) of Rwandan health providers and environmental officers towards podoconiosis in order to improve patient healthcare experiences and health outcomes, and to reduce stigma against affected individuals. To achieve this goal, we administered a KAP assessment to physicians (N = 13), nurses/midwives (N = 59), community health workers (N = 226), and environmental officers (N = 38) in the third highest podoconiosis prevalence district in Rwanda (Musanze).All 336 respondents had heard of podoconiosis, but 147 (44%) respondents correctly identified soil as the only direct cause of podoconiosis. The awareness of signs and symptoms and risk groups was lower than any other category (31.5% and 47.5%, respectively). The overall attitude toward podoconiosis was positive (86.1%), with CHWs least likely to harbor negative beliefs against podoconiosis patients. One particular area where most respondents (76%) expressed negative attitude was that they saw people with podoconiosis as a threat to their own health and their family’s health. Prescription of antibiotics and use of ointments/soap to manage wounds was low (5% and 32.2%, respectively), in part due to supply shortages at health facilities.ConclusionsThis study identified clear gaps in health provider knowledge and practices that affect patient care for those with podoconiosis. Improved access to essential medicines at health facilities and podoconiosis-focused training sessions for practicing health providers are necessary to minimize the burden and stigma of affected individuals.

Healthcare experiences of patients with chronic heart failure in Germany: a scoping review

ObjectivesTo review systematically the past 10 years of research activity into the healthcare experiences (HCX) of patients with chronic heart failure (CHF) in Germany, in order to identify research foci...

Association of Receipt of Antibiotics with Patient Satisfaction for Caregivers of Children Presenting to Urgent-Care Settings

Background: The Press Ganey (PG) Medical Practice Survey is a commonly used questionnaire for measuring patient experience in healthcare. Our objective was to evaluate the PG surveys completed by caregivers of children presenting for urgent care evaluation of acute respiratory infections (ARIs) to determine any correlation with receipt of antibiotics during their visit. Methods: We evaluated responses to the PG urgent-care surveys for encounters of children <18 years presenting with ARIs (ie, sinusitis, bronchitis, pharyngitis, upper respiratory infection, acute otitis media, or serous otitis media with effusion) within 9 University of Utah urgent-care centers. Scores could range from 0 to 100. Because the distributions of scores followed right- skewed distribution with a high ceiling effect, we defined scores as dissatisfied with their care (≤25th percentile) and satisfied with their care (scores >25th percentile). Univariate and multivariable generalized mixed-effects logistic regression was used to assess correlates of patient dissatisfaction. Random intercepts were included for each provider to account for correlation within the same provider. Separate models were used for each PG component score. Multivariable models adjusted for receipt of antibiotics, age, gender, race, ethnicity, and provider type. Results: Overall, 388 of 520 responses (74.6%) indicated satisfaction and 132 responses (25.4%) indicated dissatisfaction. Among patients who did not receive antibiotics, 87 of 284 responses (30.6%) indicated dissatisfaction versus 45 of 236 (19.1%) who did receive antibiotics. Among patients who were dissatisfied with their clinician, raw clinician PG scores were higher among patients who received antibiotics (mean, 64.5; standard deviation [SD], 16.9) versus those who did not receive antibiotics (mean, 54.7; SD, 24.4; P = .015) (Table 1). In a multivariable analysis, receipt of antibiotics was associated with a reduction in patient dissatisfaction overall (odds ratio, 0.55; 95% CI, 0.36–0.85). Conclusions: Overall, most responses for patients seen for ARIs in pediatric urgent care were satisfied. However, a significantly higher proportion of responses for patients who did not receive antibiotics were dissatisfied than for those patients who received antibiotics. Antibiotic stewardship strategies to communicate appropriate prescribing while preserving patient satisfaction are needed in pediatric urgent-care settings.Funding: NoneDisclosures: None

The approach to improving patient experience at children's hospitals: a primer for pediatric radiologists.

Increasing attention is being given to improving patient experience in health care. Most children's hospitals have a patient experience office or team that champions and measures patient experience and partners with operations to optimize performance in this area. We outline the activities that our patient experience team undertakes at our pediatric health system to advocate for, measure and improve the experience of our patients and families. The framework we propose for such activities includes those that are proactive in improving patient experience as well as those that are reactive to when patients and families have had a poor experience. Those reactive practices are often centered on the management of patient complaints and grievances and early intervention into patient complaints so that they do not become grievances.

Impacto de los Centros Avanzados de Diabetes en la experiencia de los pacientes con diabetes tipo 2 con la atención sanitaria mediante la herramienta IEXPAC

AimsTo determine the experience with healthcare among patients with type 2 diabetes according to the assistance model provided in their primary care centers, and to determine factors related with their experience. MethodsThis was a cross-sectional study performed in patients with type 2 diabetes with cardiovascular or renal complications. The patients were divided in two groups according to whether they had been attended in Advanced Diabetes Centers (ADC) or the traditional assistance centers. Patient's healthcare experience was assessed with the «Instrument for Evaluation of the Experience of Chronic Patients» (IEXPAC) questionnaire, with possible scores ranging from 0 (worst experience) to 10 (best experience). ResultsA total of 451 patients (215 from ADC and 236 from traditional assistance centers) were included. The mean overall IEXPAC scores were 5.9 ± 1.7 (ADC) and 6.0 ± 1.9 (traditional assistance centers; p = 0.82). In the multivariant analyses, in ADC, the regular follow-up by the same physician (p = 0.01) and follow-up by a nurse (p = 0.01), were associated with a better patient experience, whereas receiving a higher number of medications was associated with a worse patient experience (p = 0.04). In the traditional assistance centers, only the regular follow-up by the same physician was associated with a better experience (p = 0.02). Patients from ADC centers reported a higher score in the quality of life scale (69.1 ± 16.5 vs. 64.6 ± 17.5; p = 0.008). ConclusionsIn general, the healthcare experience of type 2 diabetic patients with their sanitary assistance can be improved. Patients from ADC centers report a higher score in the quality of life scale than traditional assistance centers.

Evaluation of a Trauma Service: Patient and Family Perspectives.

Patient satisfaction is an indicator of the quality of care that underpins a patient's health care experience. A focus on both the patient and the family is important when evaluating satisfaction from the perspective of patients with trauma and is consistent with delivery of patient- and family-centered care. Using the literature to guide development, we designed and implemented a questionnaire to evaluate attitudes and experiences of patients and families case managed by the trauma service. This article reports the findings of this quality improvement project. A cross-sectional cohort pragmatic design was used. The questionnaire was conducted with 142 trauma patients and 49 family members. Data included hospital admission data, application of a satisfaction tool, and free text comments. Both patients and their family members rated the trauma service highly in the satisfaction scoring. Differences in the communication practices encountered by patients and families were identified. Strategies to involve family members and promote family-centered care are required in the context of trauma patients to improve the safety, quality, and satisfaction of the care they receive while being managed by the trauma service.

Prepregnancy Counseling for People of All Genders: Enhancing Safe and Accessible Family Building for Transgender, Gender Diverse, and Non-binary Individuals

The purpose of this narrative review is to expand routine prepregnancy counseling and anticipatory guidance to include people of all genders. Transgender, gender diverse, and non-binary (TGNB) individuals who were assigned female at birth may wish to parent, conceive, and carry a pregnancy, but are not included in guidelines for routine prepregnancy counseling. In addition to the topics covered in routine prepregnancy counseling, there are several unique considerations for prepregnancy care for TGNB individuals including perinatal testosterone use, gender dysphoria and distress, chest/breastfeeding, and navigation of clinical environments. Research in the area of TGNB medical care continues to grow as the visibility of these communities increases. However, data are limited surrounding pregnancy and prepregnancy-related care. Therefore, we present prepregnancy medical, surgical, social, and practice of care considerations for TGNB populations in light of other known health and healthcare experiences of TGNB patients. We outline several clinical recommendations to support clinicians in providing inclusive prepregnancy care. These recommendations aim to highlight the unique needs of TGNB individuals while recognizing that each patient’s experience and goals must be individualized to them.

Evaluating the effect of healthcare providers on the clinical path of heart failure patients through a semi-Markov, multi-state model

BackgroundInvestigating similarities and differences among healthcare providers, on the basis of patient healthcare experience, is of interest for policy making. Availability of high quality, routine health databases allows a more detailed analysis of performance across multiple outcomes, but requires appropriate statistical methodology.MethodsMotivated by analysis of a clinical administrative database of 42,871 Heart Failure patients, we develop a semi-Markov, illness-death, multi-state model of repeated admissions to hospital, subsequent discharge and death. Transition times between these health states each have a flexible baseline hazard, with proportional hazards for patient characteristics (case-mix adjustment) and a discrete distribution for frailty terms representing clusters of providers. Models were estimated using an Expectation-Maximization algorithm and the number of clusters was based on the Bayesian Information Criterion.ResultsWe are able to identify clusters of providers for each transition, via the inclusion of a nonparametric discrete frailty. Specifically, we detect 5 latent populations (clusters of providers) for the discharge transition, 3 for the in-hospital to death transition and 4 for the readmission transition. Out of hospital death rates are similar across all providers in this dataset. Adjusting for case-mix, we could detect those providers that show extreme behaviour patterns across different transitions (readmission, discharge and death).ConclusionsThe proposed statistical method incorporates both multiple time-to-event outcomes and identification of clusters of providers with extreme behaviour simultaneously. In this way, the whole patient pathway can be considered, which should help healthcare managers to make a more comprehensive assessment of performance.

Implementation and Feasibility of the Re-Engineered Discharge for Surgery (RED-S) Intervention: A Pilot Study.

Adapting Project Re-Engineered Discharge (Project RED), an intervention for reducing internal medicine hospital readmissions, is a promising option for reducing colorectal surgery readmissions. We conducted a pilot study for the adaptation and implementation of Project RED with patients admitted for colectomy at a regional VA tertiary care center between July 2014 and January 2015. Implementation was evaluated using adherence to intervention components and results from the Survey of Healthcare Experiences of Patients. The adapted Project RED for Surgery has five components: surgical wound/ostomy-care education, scheduled follow-up appointments, medication reconciliation, an After Hospital Care Plan, and postdischarge phone calls. All (n = 21) participants received postoperative wound care education, and 77% of ostomy patients received education. Follow-up appointments were scheduled for 76% with surgery clinic and 67% with primary care. Half received pharmacist-led medication reconciliation. Seventy-five percent received a postdischarge phone call. Ninety five percent of participants reported positive or satisfactory care transitions versus less than 60% of a comparison group of surgery patients from the same institution. We summarized lessons learned from this intervention study to facilitate future dissemination efforts. The lessons learned from this pilot can guide quality improvement teams seeking to implement the Re-Engineered Discharge for Surgery intervention within their existing workflows.

Implementing Uberization in Malaysian Healthcare Services

Getting appropriate healthcare is a challenge to the citizens in Malaysia due to the limited facilities, healthcare providers, and cost of healthcare. Uberization of healthcare will help fill this gap. Uberization helps modify the market or economic model with the introduction of a cheaper and more effective alternative service by introducing a different way of buying or using it, with the use of mobile technology. With powerful artificial intelligence engines operating on cloud servers, mobile apps can provide a better healthcare experience for patients. With uberization application, the patient need not come to the hospital to see a doctor before a treatment can be planned. Once a request is made by the patient, the healthcare providers can come to see the patient at an agreed place. This article aims to explore the possible uberization of healthcare in Malaysia.

Patient satisfaction in Kazakhstan: Looking through the prism of patient healthcare experience

ObjectivesThis study aimed to explore the relationship between patient satisfaction and patient experience after exposure to inpatient hospitalization. MethodsA cross-sectional self-completed survey at the bedside in the Inpatient departments of the University Medical Center hospitals (UMC) in Nur-Sultan city, Kazakhstan was submitted. A total of 153 patients completed the survey from September 2017 to June 2018. The survey used the Picker Patient Experience questionnaire validated in Russian and Kazakh languages. ResultsThe majority of patients were satisfied with their hospital stay (90.8 %). Only self-rated health status was associated with overall satisfaction (OR 1.922, 95 % CI 1.09−3.37). Patient experience assessment revealed an association of physical comfort and respect for patient preferences with overall satisfaction (OR 0.101, 95 % CI 0.01−0.91 and OR 0.317, 95 % CI 0.11−0.92). ConclusionsStudy findings support that patient satisfaction is an exaggerated image of healthcare performance. Groups with negative experience have shown lower overall satisfaction in the dimensions ‘physical comfort’ and ‘respect for patient preferences’. Practice implicationsImproving patient centered communication and pain control in clinical practice may lead to the improvement in patient satisfaction.

Participatory decision-making for cancer care in a high-risk sample of low income Mexican-American breast cancer survivors: The role of acculturation.

Despite declining cancer incidence and mortality rates, Latina patients continue to have lower 5-year survival rates compared to their non-Hispanic white counterparts. Much of this difference has been attributed to lack of healthcare access and poorer quality of care. Research, however, has not considered the unique healthcare experiences of Latina patients. Latina women with prior diagnoses of stage 0-III breast cancer were asked to complete a cross-sectional survey assessing several socio-demographic factors along with their experiences as cancer patients. Using a series of linear regression models in a sample of 68 Mexican-American breast cancer survivors, we examined the extent to which patients' ratings of provider interpersonal quality of care were associated with patients' overall healthcare quality, and how these associations varied by acculturation status. Findings for Latina women indicated that both participatory decision-making (PDM) (β = 0.62, p < .0001) and trust (β = 0.53, p = .02) were significantly associated with patients' ratings of healthcare quality. The interaction between acculturation and PDM further suggested that participating in the decision-making process mattered more for less acculturated than for more acculturated patients (β = -0.51, p ≤ .01). The variation across low and high acculturated Latinas in their decision-making process introduces a unique challenge to health care providers. Further understanding the relationship between provider-patient experiences and ratings of overall healthcare quality is critical for ultimately improving health outcomes.

The Relationship Between Follow-up Appointments and Access to Primary Care.

Health care operations managers need to balance scheduling frequent follow-ups for patients with chronic conditions and fitting in patients requiring care for new complaints. We quantify how frequency of follow-up visits corresponds with access to care for patients receiving care from the Department of Veterans Affairs (VA). We use patient data collected between October 2013 and June 2016 by the Survey of Healthcare Experiences of Patients (SHEP). Our sample is comprised of 94,496 patients. We estimate logistic models with 1-month lagged facility-level predictors. We calculate monthly measures characterizing facility-level service provision, including the average time between successive primary care visits, the average primary care visit length, the percentage of primary care appointments that are overbooked, the percent of visits that are unscheduled (i.e., walk-ins), and the ratio of patients to providers. We control for economic factors that are associated with health care supply and demand, including median household income, veteran priority status, the Zillow Housing Price Index, and veteran unemployment rates. We also control for patient demographics. We restrict the data to patients with at least one in-person primary care visit who have provided information on their ability to access urgent and routine care. We find that shorter average follow-up times are associated with better access for patients needing urgent or routine care. A 1-month increase in the average time between successive primary care visits is associated with 10% (p < 0.001) lower odds of reporting being able to access urgent care within 1day and 13% (p < 0.001) lower odds of reporting usually or always being able to access routine care when needed. Facilities with higher average follow-up times are more likely to have patients report that they are unable to quickly access urgent or routine primary care.

Primary care experiences of veterans with opioid use disorder in the Veterans Health Administration

BackgroundWhile patients with substance use disorders (SUDs) are thought to encounter poor primary care experiences, the perspectives of patients with opioid use disorder (OUD), specifically, are unknown. This study compares the primary care experiences of patients with OUD, other SUDs and no SUD in the Veterans Health Administration. MethodsThe sample included Veterans who responded to the national Patient-Centered Medical Home Survey of Healthcare Experiences of Patients, 2013–2015. Respondents included 3554 patients with OUD, 36,175 with other SUDs, and 756,386 with no SUD; 742 OUD-diagnosed patients received buprenorphine. Multivariable multinomial logistic regressions estimated differences in the probability of reporting positive and negative experiences (0–100 scale) for patients with OUD, compared to patients with other SUDs and no SUD, and for OUD-diagnosed patients treated versus not treated with buprenorphine. ResultsOf all domains, patients with OUD reported the least positive experiences with access (31%) and medication decision-making (35%), and the most negative experiences with self-management support (35%) and provider communication (23%). Compared to the other groups, patients diagnosed with OUD reported fewer positive and/or more negative experiences with access, communication, office staff, provider ratings, comprehensiveness, care coordination, and self-management support (adjusted risk differences[aRDs] range from |2.9| to |7.0|). Among OUD-diagnosed patients, buprenorphine was associated with more positive experiences with comprehensiveness (aRD = 8.3) and self-management support (aRD = 7.1), and less negative experiences with care coordination (aRD = −4.9) and medication shared decision-making (aRD = −5.4). ConclusionsIn a national sample, patients diagnosed with OUD encounter less positive and more negative experiences than other primary care patients, including those with other SUDs. Buprenorphine treatment relates positively to experiences with care comprehensiveness, medication decisions, and care coordination. As stakeholders encourage more primary care providers to manage OUD, it will be important for healthcare systems to attend to patient access and experiences with care in these settings.

Patients, clinicians and researchers working together to improve cardiovascular health: a qualitative study of barriers and priorities for patient-oriented research

ObjectivesThe overall goal of this study is to identify priorities for cardiovascular (CV) health research that are important to patients and clinician-researchers. We brought together a group of CV patients...