Preferences Of Healthcare Professionals Research Articles

Exploring the barriers and facilitators for the use of digital health technologies for the management of COPD: a qualitative study of clinician perceptions.

Digital health technology (DHT) promises to support patients and healthcare professionals (HCPs) to optimize the management of chronic obstructive pulmonary disease (COPD). However, there is a lack of evidence demonstrating the effectiveness of DHT for the management of COPD. One reason for this is the lack of user-involvement in the development of DHT interventions in COPD meaning their needs and preferences are rarely accounted for in the design phase. Although HCP adoption issues have been identified in relation to DHT, little is known about the challenges perceived by HCPs providing care to COPD patients. Therefore, this study aims to qualitatively explore the barriers and facilitators HCPs perceive for the use of DHT in the management of COPD. Participants (n = 32) were recruited using snowball sampling from two university hospitals and several general practitioner clinics. A semi-structured interview was conducted with each participant. NVivo 12 software was used to complete thematic analysis on the data. Themes identified include: data quality; evidence-based care; resource constraints; and digital literacy presented as barriers; and facilitators include the following themes: digital health training and education; improving HCP digital literacy; and Personalized prescribing. Patient-centered approaches, such as pulmonary rehabilitation and shared decision-making were suggested as implementation strategies to ease the adoption of digital health for the management of COPD. These findings contribute new insights about the needs and preferences of HCPs working in COPD regarding DHT. The findings can be used to help mitigate user-experience issues by informing the design of person-centered implementation and adoption strategies for future digital health interventions in COPD.

Implications of Direct Healthcare Professional Communication in Egypt: barriers and preferences of Health Care Professionals

Direct Healthcare Professional Communication (DHPC) is essentially distributed for fast communication of new serious drug safety information to healthcare professionals (HCPs). However, the use of this tool concerning the knowledge and preferences of HCPs has never been evaluated in Egypt. This study aimed to evaluate the HCPs' knowledge, preferences, and barriers to the use of DHPC in Egypt. A cross-sectional study of a random sample of 254 HCPs surveyed via face-to-face interviews to assess the Egyptian HCPs' awareness of DHPC, the preferences, and barriers that affect its use. Among the 297 approached HCPs, only 254 accepted to participate with a response rate of 85.5%, including (50% internists, 22.83% cardiologists, 11.02% neurologists, 11.02% pediatricians, and 5.12% from other specialties). Most HCPs were not familiar with DHPC (N= 254, 61.8%). One-third of the visited HCPs who were aware of concerned drugs' risk(s) got their information from DHPC (N= 149, 36.9%). HCPs preference for communication channel was highest for meetings (N= 254, 65.7%) and least for newsletters (N= 254, 28%). HCPs reported barriers to reading DHPC included; busy schedule (N= 254, 47.6%), mistrusted source (N= 254, 24.4%), view as a marketing tool (N= 254, 21.7%), invaluable information (N= 254, 9.8%) and disbelief (N= 254, 7.5%). The DHPC did not reach the target HCPs most of the time, but when received, it was successful in conveying the required message to the target HCPs. Multiple barriers were identified that negatively impacted the success of DHPC. It is recommended to use other electronic communication methods to enhance the reachability of the current method (DHPC).

Preventing rheumatoid arthritis: Preferences for and predicted uptake of preventive treatments among high risk individuals.

ObjectiveTo understand preferences for and estimate the likely uptake of preventive treatments currently being evaluated in randomized controlled trials with individuals at increased risk of developing rheumatoid arthritis (RA).MethodsFocus groups were used to identify key attributes of potential preventive treatment for RA (reduction in risk of RA, how treatment is taken, chance of side effects, certainty in estimates, health care providers opinion). A web-based discrete choice experiment (DCE) was administered to people at-risk of developing RA, asking them to first choose their preferred of two hypothetical preventive RA treatments, and then between their preferred treatment and ‘no treatment for now.’ DCE data was analyzed using conditional logit regression to estimate the significance and relative importance of attributes in influencing preferences.ResultsTwo-hundred and eighty-eight first-degree relatives (60% female; 66% aged 18–39 years) completed all tasks in the survey. Fourteen out of fifteen attribute levels significantly influenced preferences for treatments. How treatment is taken (oral vs. infusion β0.983, p<0.001), increasing reduction in risk of RA (β0.922, p<0.001), health care professional preference (β0.900, p<0.001), and avoiding irreversible (β0.839, p<0.001) or reversible serious side effects (β0.799, p<0.001) were most influential. Predicted uptake was high for non-biologic drugs (e.g. 84% hydroxycholoroquine), but very low for atorvastatin (8%) and biologics (<6%).ConclusionDecisions to take preventative treatments are complex, and uptake depends on how treatments can compromise on convenience, potential risks and benefits, and recommendations/preferences of health care professionals. This evidence contributes to understanding whether different preventative treatment strategies are likely to be acceptable to target populations.

Healthcare professionals’ pharmacovigilance knowledge and adverse drug reaction reporting behavior and factors determining the reporting rates

Background: Spontaneous adverse drug reaction (ADR) reports prepared by healthcare professionals (HCPs) are the backbone of collecting post-marketing safety data. However, underreporting is a global problem creating health, economic, and ethical burden.Objectives: To determine the factors limiting ADR reporting rates from the HCPs’ point of view.Methods: A questionnaire containing 43 questions evaluating sociodemographic characteristics, pharmacovigilance knowledge and activities, and prescription behaviors was prepared on “surveymonkey.com.” The link was distributed mainly by professional organizations.Results: Although this survey aimed to reach all HCPs, most of the respondents were physicians and nurses. Of the 259 (69.6%) participants who encountered ADR at least once, only 105 (40.5%) reported ADR. The term “pharmacovigilance” was heard for the first time in this survey by 35.5% (n = 132) of the participants. Only 34.7% (n = 129) of the participants knew where to find the ADR reporting form, and 25.5% (n = 95) had previously filled the form and/or read it. Only 28.5% (n = 106) of the participants were aware of the ADR reporting and monitoring system of their institutions and related professionals. Almost all the participants agreed that pharmacovigilance and ADR reporting training are necessary.Conclusion: The main reason for underreporting is limited pharmacovigilance knowledge of HCPs. Training activities based on the needs and preferences of HCPs and close follow-up by authorities are the main steps to improve pharmacovigilance activities.

Overview on Patient Centricity in Cancer Care.

Successful implementation of treatment in cancer care partially depends on how patients' perspectives are taken into account, as preferences of health care professionals and patients may differ. Objectives of this exploratory research were (I) to identify patient preferences and values (PPVs) in cancer care as indicated by patient organizations (POs), (II) to determine how these PPVs are captured in cancer care guidelines and (III) to review how guidelines take into account these PPVs. Based on a survey developed and completed by 19 POs, a literature review was conducted to analyse how patient perspectives are incorporated in oncology treatment guidelines. Based on survey results traditional health technology assessment value propositions of oncology care, such as extended life, treatment-free remission and pain reduction, were also highly rated by POs. However, the heterogeneity of cancer PPVs were clearly reflected in the survey results. PPVs in cancer care guidelines were mostly limited to those micro-level aspects that are strictly related to health care provision, such as side-effects and comorbidities. Patient experience, emotional support and convenience of care were relatively neglected fields in the reviewed guidelines. Patient engagement was rarely presented in the guideline development phase. POs believe that patients should be encouraged to take an active role in their own care due to the heterogeneity of cancer patients and PPVs. Even if patient-centricity is a leading paradigm in cancer policy, based on our research it is not yet standard practice to include patients or POs at all appropriate levels of decision-making processes that are related to their health and well-being. Patient engagement should be an integral part of cancer care decision-making. This complexity must be reflected throughout policy making, avoiding a population level “one-size-fits-all” solution.

Pediatric information seeking behaviour, information needs, and information preferences of health care professionals in general emergency departments: Results from the Translating Emergency Knowledge for Kids (TREKK) Needs Assessment.

To determine national pediatric information needs, seeking behaviours, and preferences of health care professionals working in general EDs. An electronic cross-sectional survey was conducted with health care professionals in 32 Canadian general EDs. Data were collected in the EDs using the iPad and in-person data collectors. Total of 1,471 surveys were completed (57.1% response rate). Health care professionals sought information on children's health care by talking to colleagues (n=1,208, 82.1%), visiting specific medical/health websites (n=994, 67.7%), and professional development opportunities (n=941, 64.4%). Preferred child health resources included protocols and accepted treatments for common conditions (n=969, 68%), clinical pathways and practice guidelines (n=951, 66%), and evidence-based information on new diagnoses and treatments (n=866, 61%). Additional pediatric clinical information is needed about multisystem trauma (n=693, 49%), severe head injury (n=615, 43%), and meningitis (n=559, 39%). Health care professionals preferred to receive child health information through professional development opportunities (n=1,131, 80%) and printed summaries (n=885, 63%). By understanding health care professionals' information seeking behaviour, information needs, and information preferences, knowledge synthesis and knowledge translation initiatives can be targeted to improve pediatric emergency care. The findings from this study will inform the following two phases of the TREKK initiative to bridge the research-practice gap in Canadian general EDs.

Implementing Recommendations for Depression Screening of Adults

TheUSPreventiveServicesTaskForce (USPSTF)hasoffered its updated recommendations for the screening for depression in adults. The document, published thisweek in JAMA,1 updates a 2009 review of the evidence as to the net benefit of accurate diagnosis,effectivetreatment, andappropriate follow-upafter depression screening for adults older than 18 years, including pregnant and postpartum women, complementing previousrecommendationsfordepressionscreening inchildren and adolescents (http://www.uspreventiveservicetaskforce .org). There is no question that primary care screening offers a first-line medical opportunity to identify patients with an undiagnosed major depressive episode. Use of standardized screening instruments and evidence-based treatments are a critical first step. That said, anunsettling reality remains: how, even with improved efficiency of screening and more timely diagnoses,dowesecure thenecessary resources toensure that depressed patients not only receive treatment and follow-up, but that the treatment selected is both appropriate and optimized for the individual. Compounding these challenges, neurological patients with depression, even when identified, maybereticenttoacceptpsychiatrictreatment,2andlikeinternal medicine and primary care, the time and resources needed to address the behavioral “symptoms” are often eclipsed by core demands of the principal neurological or medical condition. For apatientpresentingwithmajordepressiveepisode, an antidepressant medication or evidence-based psychotherapy is currently recommendedas first-line treatment,with remission rates to these 2options roughly equivalent in all patients except themost severely ill.3With thisperceivedequivalency, treatment selection is oftenbasedon factors suchaspatient and health care professional preference, cost and accessibility, andpotential adverse effects.However, theodds are actually against remission in patients currently treated using this approach. At best, 40% of patients achieve remission with a first treatment, and the “wrong” first choice has significant individual and societal costs due to continueddistress, risk of suicide, loss of productivity, and wasted resources associated with 2 to 3 months of an ineffective treatment.Moreover, among the roughly60%to70%ofdepressed patientswho do not remitwith their first treatment,many do not return to explore other options, with potential lethal consequences.4These sameconcernshold fordepressionpresenting inpatientswithneurological diseases andothermedical illnesses where the combined presence of a mood disorder has a magnified effect on disability.5 Clearly, treatments are highly effective in some individuals, but there is no reliableway tomatch patients to their best treatment option or to avoid those that are unlikely to be effective, even in the setting of equal access. Developing reliable biomarkers that can stratify individual patients to specific treatments is essential to achieve the goal of a more personalized level of care for patientswith depression and all neuropsychiatric disorders.6Manymedical specialties suchas those treating heart disease and cancer now routinely use patient-level biological measures to subtype and stratify patients to treatments, andtoguide treatmentmodificationswith disease progression or categories of disease risk, substantially improving patient outcomes. Toward a “precision medicine” approach for depression, various strategies have been tested, including clinical, imaging, genetic, electroencephalographic, and immunological metrics, but with limited clinical impact thus far. Motivated to translate ongoing advances in functional and structural neuroimaging methods and mounting evidence of (1) distinct patterns of brain dysfunction across clinically defined depression subgroups, (2) regional correlates of specific mood, motor, and cognitive syndrome dimensions, and (3) differential change patterns with mechanistically distinct treatments,7 investigations of brain-based biomarkers that predict treatment outcomes to standard first-line treatments have been initiated. Recent studies have identified some initial promising imaging biomarker candidates that predict remission and nonresponse to cognitive behavioral therapy or a standard selective serotonin reuptake inhibitor Related article at jama.com Opinion Editorial

What are the preferences of health care professionals in Germany regarding fully liquid, ready-to-use hexavalent pediatric vaccine versus hexavalent pediatric vaccine that needs reconstitution?

Diphtheria, tetanus and acellular pertussis (DTaP) based combined vaccines have led to significant reduction in incidence of several serious pediatric infectious diseases. A new, fully liquid combined hexavalent vaccine has been introduced and has been shown to reduce administration time. This fully liquid vaccine may also be simpler to administer and could reduce handling errors. The present study was designed to understand the value that health care providers (HCPs) place on aspects of injection devices for combined hexavalent vaccine programs in Germany. A discrete choice experiment (DCE) was designed to elicit the views of HCPs regarding hexavalent vaccines. The key attributes of injection devices were identified through a focused literature search and interviews with HCPs. Five key attributes, each with two or three levels were described which included: type of device, experience of this hexavalent vaccine on the German market, preparation time, probability of handling errors, and dosage errors. Physicians (n=150) and nurses (n=150) who administered hexavalent vaccines in Germany completed the survey. Choice data were analyzed using the conditional logit procedure. All attributes were significant and important independent influences on physicians’ and nurses’ choices. Reducing any “probability of dosage errors” was the most important attribute. Both physicians and nurses had a strong preference to reduce preparation time. All other things equal both groups also significantly preferred a fully liquid hexavalent vaccine. They also preferred vaccines that had been on the market for a few years compared to ones that had not (especially the physicians). Additional analyses explored participants’ preferences in more detail through interaction terms. The DCE choice data provide useful insights into how HCPs view each aspect of the vaccination device. Overall, the HCPs preferred fully liquid vaccines. The survey also highlighted the importance of handling and dosage errors, reducing preparation time, and also experience of the HCPs with the use of a vaccine. The survey work included physicians and nurses and explored their views separately.

The Role of Mobile Applications in Improving Alcohol Health Literacy in Young Adults With Type 1 Diabetes: Help or Hindrance?

Mobile health (mHealth) is an expanding field which includes the use of social media and mobile applications (apps). Apps are used in diabetes self-management but it is unclear whether these are being used to support safe drinking of alcohol by people with type 1 diabetes (T1DM). Alcohol health literacy is poor among young adults with T1DM despite specific associated risks. Systematic literature review followed by critical appraisal of commercially available apps. An eSurvey investigating access to mHealth technology, attitudes toward apps for diabetes management and their use to improve alcohol health literacy was completed by participants. Of 315 articles identified in the literature search, 7 met the inclusion criteria. Ten diabetes apps were available, most of which lacked the educational features recommended by clinical guidelines. In all, 27 women and 8 men with T1DM, aged 19-31 years were surveyed. Of them, 32 had access to a smartphone/tablet; 29 used apps; 20 used/had used diabetes apps; 3 had used apps related to alcohol and diabetes; 11 had discussed apps with their health care team; 22 felt more communication with their health care team would increase awareness of alcohol-associated risks. Use of mobile apps is commonplace but the use of apps to support safe drinking in this population was rare. Most participants expressed a preference for direct communication with their health care teams about this subject. Further research is needed to determine the preferences of health care professionals and how they can best support young adults in safe drinking.

Primary care providers as partners in long-term follow-up of pediatric cancer survivors

To develop a model of shared healthcare delivery that includes primary care providers (PCP) and ensures best practice in follow-up of pediatric cancer survivors. Structured interviews with healthcare professionals (HCPs) were used to ascertain familiarity and confidence in providing care to survivors. Partnerships were made with HCP societies, and survivor care lectures were given at HCP meetings. HCP's preferences for ongoing continuing education (CE) opportunities were ascertained. Cancer SurvivorLink(TM), a web-based tool, was developed to allow patients to securely store their healthcare documents and share them electronically with registered HCPs. Educational material developed for Cancer SurvivorLink(TM) includes CE modules and QuickFacts--concise summaries of late effects. Website utilization was monitored utilizing Google Analytics. HCPs described moderate to very low familiarity with survivor care, but high interest in online CE learning. Thirty-one lectures were given to HCP groups to increase awareness. Preferred types of ongoing CE were: lectures, online text, and video modules. CE material was developed based on feedback from HCPs and website utilizations and includes 19 QuickFacts and 5 CE modules. During the first year, the website had 471 unique visitors and 1,129 total visits. QuickFacts received 345 views with Neurocognitive, Survivor Care 101, and Endocrine being most visited, and 49 CME modules have been completed. PCPs are interested in partnering in models of shared care for pediatric cancer survivors. Effective educational initiatives include lectures within HCP's professional education constructs and web-based CE opportunities. PCP involvement in survivor care alleviates some barriers to care such as geographic distance to the the cancer center and ensures that more pediatric cancer survivors receive recommended coordinated surveillance for late effects of cancer therapy.

The Hamilton Inventory for Complex Regional Pain Syndrome: A Cognitive Debriefing Study of the Clinician-based Component

Study Design Descriptive. Introduction The Hamilton Inventory for Complex Regional Pain Syndrome (HI-CRPS) is a multidisciplinary assessment tool under development. Purpose of the Study This study examined the assessment practices, beliefs and preferences of health care professionals working with CRPS to inform the content and structure of the clinician-based portion of the HI-CRPS (CB-HI-CRPS), as well as refine the user manual. Methods Semi-structured cognitive interviews were conducted with health care professionals from a spectrum of disciplines working with CRPS. Assessment practices and scaling preferences for 15 assessment concepts were collected, relating directly to items on the CB-HI-CRPS. Interviews were transcribed and coded with emergent themes. Results Participants reported using the concepts from the CB-HI-CRPS 85.2% of the time. Physicians and nurses preferred present/absent judgements, while therapists used none/mild/moderate/severe scaling. Emerging themes highlighted assessment values, beliefs about CRPS, professional roles, and knowledge translation. Conclusions Lack of uniformity in terminology and assessment behaviours underscores the need for clear scoring frameworks and standardized assessment instructions to improve reliability across the proposed users of the HI-CRPS. Level of Evidence Level 4.

Eliciting Preferences for Reimbursed Drugs Selection Criteria in Côte dʼIvoire

Côte d'Ivoire, a West African country, has decided to set up a formulary as part of its universal health insurance (UHI) program. One of its goals will be to facilitate access to safe and efficacious drugs. To guarantee transparency throughout the formulary listing process, it is important to select and value relevant decision criteria for that purpose. To investigate the preferences of healthcare professionals (physicians) when selecting reimbursable drugs and to analyze trade-offs between criteria for formulary listing in Côte d'Ivoire. Choice sets based on four attributes (cost effectiveness of treatments, severity of the disease for which the treatments are indicated, age of the population affected by diseases considered, and social class affected by diseases considered [poor, rich]) were presented in a self-completion questionnaire. Analysis of questionnaire responses showed that 'cost effectiveness', 'severity of disease', and 'social class' were significant attributes in responder's preferences for reimbursable drugs. More specifically, respondents' choices were more sensitive to drugs that are very cost effective, that target very severe disease, and that target diseases in poor people. This explorative study enabled us to elicit the preferences of a sample of healthcare professionals (physicians) for reimbursed drug selection criteria in Côte d'Ivoire using the discrete-choice experiment method. Further work is required to achieve the ultimate objective of developing a formulary for Côte d'Ivoire.

Drug Information Availability and Preferences of Health Care Professionals in Illinois: A Pilot Survey Study

Purpose: The primary objective of the study was to determine differences in drug information availability and preferences among pharmacists, nurses, and physicians in Illinois. Methods: A survey was mailed to a random sample of Illinois pharmacists, nurses, and physicians. The survey listed 25 common drug information resources and asked respondents to indicate familiarity with, access to, and preference for each resource. Demographic information was also collected. Results: Of 1,900 deliverable surveys, there were 283 responses, which included 106 pharmacists, 81 nurses, and 96 physicians for a response rate of 15%. Statistical differences among the three groups regarding availability, preference, and familiarity of drug information resources were detected in 20/25, 23/25, and 22/25 of the resources, respectively. Conclusions: Pharmacists appear more familiar with and have wider access to drug information resources than nurses and physicians. Heath care professionals have varied preferences for drug information resources.

PERCEPTION OF HEALTH STATUS AND QUALITY OF LIFE OF EXTREMELY LOW–BIRTH WEIGHT SURVIVORS: The Consumer, The Provider, and the Child

In neonatal intensive care, parents make important clinical management decisions in conjunction with health professionals. Little information is available in the literature, however, on whether the preferences of health care professionals, parents, and children differ for the resulting health outcomes. This article compares the preferences of these stakeholders for four to five hypothetical health states that are common to extremely low-birth weight infants. The findings have conceptual and practical implications for decision making in the neonatal intensive care unit.

Representing Medical Protocols for Organizational Simulation: An Information-Processing Approach

Organizational simulations have been used in business, manufacturing, and engineering design tasks to gain insight into organizational process bottlenecks, and to improve the quality and efficiency of processes within these industries. As market pressures demand increased efficiencies within the health care industry, organizational simulation techniques could provide similar insight into the design of better medical care processes, or protocols, in medical organizations. To simulate the process of medical care within a specific organization however, requires models that can represent (1) unpredictable patient responses to care, (2) the flexibility needed to adapt to different patients, and (3) different preferences of health care professionals and the implicit preferences contained within the protocol. Using previous work on simulation in the Virtual Design Team (VDT), and an example protocol drawn from an existing protocol in bone marrow transplantation, we describe extensions to the VDT information-processing representation that will allow us to simulate the performance characteristics of a medical protocol used within a medical organization. Our representational extensions capture the uncertainty of medical care for patients, the activity flexibility within the organization, and the preferences of health care professionals that will make information-processing organizational simulations in the medical domain possible. We believe our representation will provide a robust simulation “tool box” that can be used to investigate the performance of specific medical protocols within different hospital settings, and explore organizational theory within the health care industry.