Healthcare Professional Interactions Research Articles

P071 Exploring experiences and preferences of people with rheumatoid arthritis for digital interventions to promote physical activity (PA)

Abstract Background/Aims Physical activity (PA) is effective for managing symptoms of rheumatoid arthritis (RA) but people with RA are less active than their healthy counterparts. A digital intervention (DI) to promote PA, is a potential solution. There is a paucity of literature available exploring the requirements of people with RA for a digital intervention. It is important to explore experiences and preferences before developing such an intervention. Aims: 1. Identify digital technology currently used by people with RA to support PA. 2. Understand the preferences and acceptability of people with RA for potential DI delivery. Methods A survey was developed to address these aims. A patient research partner (CS) and ‘think aloud’ pilots contributed to development. The survey was circulated once to members of the National Rheumatoid Arthritis Society in November 2022. This study was approved by the National Health Service Research Ethics Committee (reference 22/NE/0158). Results 1178 people consented to take part (86% female, 64% aged 55-74). The majority used digital technology every day (97%). 84% anticipated using a potential DI to support PA, most preferably every day (48%) or 2-3 times a week (14%). 16% never anticipated using DI to support PA. 34% reported currently using technology to support PA; mostly an app without healthcare professional (HCP) interaction (42%) or internet videos (40%). A further 27% had tried technology to support PA but discontinued, and 39% had never tried. An app was the most preferable delivery platform (56%), followed by a website (43%) or internet videos (28%). 51% would prefer to be offered or signposted to digital technology to support PA by an exercise professional with specific rheumatology training or a healthcare professional (22%). Potential DI delivery methods were rated on a Likert scale of 1-5 for general acceptability, a score of five indicating highest acceptability: automated response mean[SD] 3.6[0.9], ad-hoc HCP interaction 3.5[0.8] pre-arranged HCP interaction 3.4[1] and no interaction 3.1[1]. Conclusion People with RA are using digital technology regularly and many anticipated using a DI to support PA. Despite this, only a third are currently using digital technology to support PA. An app or website platform was the preferred delivery method suggesting that an internet delivered intervention is acceptable. Acceptability ratings of DI delivery methods were similar. Further sub-group analysis and exploration of free text responses is planned to inform tailoring of DI delivery. Disclosure C. Gerlis: None. A. Berry: None. S. Halls: None. M. Loizou: None. C. Swales: None. F. Cramp: None.

Intensive Care Units Healthcare Professionals' Experiences and Negotiations at the Beginning of the COVID-19 Pandemic in Germany: A Grounded Theory Study.

Faced with the pandemic of the novel coronavirus (SARS-CoV-2), healthcare professionals (HCPs) in intensive care units (ICU) adjusted their organizational, operational, and personal procedures to ensure care for COVID-19 patients. We used grounded theory approach to explore ICU HCPs' perspectives on professional action at the beginning of the COVID-19 pandemic in Germany from March to July 2020. The study aimed to examine implicit principles on negotiating social practice and interaction of ICU HCPs in an exceptional situation, which was characterized by a high level of changes. We conducted theme-guided qualitative telephone/virtual interviews with 39 ICU HCPs from ten German federal states. The data collection followed the principles of theoretical sampling. We adpoted grounded theory approach proposed by Charmaz and discussed using Lüscher’s theoretical concept of ambivalence. The analysis revealed five interconnected categories about the ICU HCPs’ negotiation of social practice and interaction at the beginning of the COVID-19 pandemic in Germany. In this context, a complex field of ambivalence (key category) emerged between habits and routines of a pre-pandemic normality. Pragmatic restructuring processes were initiated, which quickly resulted in a new normality of a “daily routine of preparation”. Dealing with ambivalence offers the potential for change.

Effect of pregnancy prolongation in early-onset pre-eclampsia on postpartum maternal cardiovascular, renal and metabolic function in primiparous women: an observational study.

ObjectiveTo evaluate the association between deferred delivery in early‐onset pre‐eclampsia and offspring outcome and maternal cardiovascular, renal and metabolic function in the postpartum period.DesignObservational study.SettingTertiary referral hospital.PopulationNulliparous women diagnosed with pre‐eclampsia before 34 weeks’ gestation who participated in a routine postpartum cardiovascular risk assessment programme. Women with hypertension, diabetes mellitus or renal disease prior to pregnancy were excluded.MethodsRegression analyses were performed to assess the association between pregnancy prolongation and outcome measures.Main outcome measuresOffspring outcome and prevalence of deviant maternal cardiovascular, renal and metabolic function.ResultsThe study population included 564 women with a median pregnancy prolongation of 10 days (interquartile range [IQR] 4–18) who were assessed at on average 8 months (IQR 6–12) postpartum. Pregnancy prolongation after diagnosis resulted in a decrease in infant mortality (adjusted odd ratio [aOR] 0.907, 95% CI 0.852–0.965 per day prolongation). This improvement in offspring outcome was associated with an elevated risk of moderately increased albuminuria (aOR 1.025, 95% CI 1.006–1.045 per day prolongation), but not with aberrant cardiac geometry, cardiac systolic or diastolic dysfunction, persistent hypertension or metabolic syndrome.ConclusionPregnancy prolongation in early‐onset pre‐eclampsia is associated with improved offspring outcome and survival. These effects do not appear to be deleterious to short‐term maternal cardiovascular and metabolic function but are associated with a modest increase in risk of residual albuminuria.Tweetable abstractPregnancy prolongation in pre‐eclampsia has only a limited effect on postpartum maternal cardiovascular function.

Relapse prevalence, symptoms, and health care engagement: patient insights from the Multiple Sclerosis in America 2017 survey

BackgroundUnderestimation of relapse in multiple sclerosis (MS) is detrimental to the patient as well as to their relationship with their MS healthcare professional (HCP). ObjectiveTo obtain direct insight into relapse prevalence, symptoms, and HCP engagement from patients with MS who responded to the Multiple Sclerosis in America (MSIA) 2017 survey. MethodsInformation on patient demographics, health insurance coverage, symptoms, disability, relapses, and related HCP interactions were captured. Descriptive analyses were conducted and relapses were annualized. Chi-square tests were used to evaluate frequency of patient engagement, i.e. speaking with or seeing their HCP during relapse with annualized relapse frequency and topics discussed. ResultsOf the 5,311 patient-respondents, the mean age was 51.2 years (84.3% female, 89.3% Caucasian); 40.1% were on disability, and 96.8% had health insurance coverage. A total of 72.2% of patients were diagnosed with relapsing-remitting MS (RRMS); 74.8% of patients not reporting a diagnosis of primary progressive MS (PPMS) (n = 4819) were using disease-modifying therapy. In the 2 years preceding the survey, 73.1% experienced a relapse for a median number of 2 relapses; this corresponded to an annualized relapse distribution among all patients of 44.1% with < 1 relapse, 35.5% with 1–2 relapses, and 20.2% with > 2 relapses. In patients reporting relapses, 62.5% cited an average relapse duration of < 1 month, 10.9% cited 1–2 months, and 13.6% cited > 2 months (12.9% were unsure/didn't recall). Leading symptoms experienced with MS relapse were fatigue (77.4%), numbness/tingling (70.0%), and walking or balance issues (68.8%). With respect to HCP engagement during relapse, 46.9% of patients reported doing so always/often, vs. sometimes (27.3%), rarely (18.5%), and never (7.3%). The most common reasons cited for not engaging an HCP were that the relapse was not severe enough (57.9%), the HCP was unhelpful or didn't specifically tell the patient to contact them (30.9%), the treatment didn't work well or wasn't tolerated (25.6%), or the preference to manage alone (24.4%). A higher percentage of patients with 1 relapse coincided with the highest frequency of HCP engagement during relapse, and the highest percentage of patients with ≥ 5 relapses coincided with the lowest frequency of HCP engagement during relapse. Key relapse-related and MS-related topics were discussed more by patients who always/often engage their HCP during relapse. HCP follow-up after relapse was variable, with 35.0% of patients reporting follow-up within 1 month of first contact, 50.3% reporting follow-up at the next office visit, and 14.7% reporting no follow-up. ConclusionMS relapse remains particularly challenging for certain patients; some experience > 2 relapses in 1 year, relapse durations > 1 month, and relapse symptoms that interfere with daily functioning (e.g. walking/balance by 68.8%). Approximately 25% of patients reported rarely or never engaging their HCP during relapse. Common reasons for not engaging, like HCP helpfulness and treatment effectiveness/tolerance, warrant further exploration. Results indicating the benefits of timely touchpoints on both the part of the patient and HCP during relapse include the relationship between higher frequency of engagement with lower relapse frequency and more discussion of both relapse-related and MS-related discussion topics. Survey limitations apply.

Health Care Experience of Young Adults Diagnosed With Type 1 Diabetes

Abstract Young adulthood, defined as 17 to 25 years, is a critical period of development. For young adults newly diagnosed with type 1 diabetes, effective communication from a health care provider is critical. This qualitative study used an electronic interview questionnaire focused on health care professional interactions and course of diagnosis for 12 young adults in college who were diagnosed between ages 17 and 25 years. Three themes emerged: 1) a lack of health information specific for the young adult with type 1 diabetes, 2.) emotional turbulence with forward thinking, and 3) needs/concerns of the group. Health care providers need to work to limit barriers in communication and provide a holistic plan of care.

The burden of chronic obstructive pulmonary disease associated with maintenance monotherapy in the UK.

BackgroundThis study characterized a cohort of chronic obstructive pulmonary disease (COPD) patients on maintenance bronchodilator monotherapy for ≥6 months to establish their disease burden, measured by health care utilization.MethodsData were extracted from the UK Clinical Practice Research Datalink and linked to Hospital Episode Statistics. The monotherapy period spanned the first prescription of a long-acting β2-adrenergic agonist or a long-acting muscarinic antagonist until the end of the study (December 31, 2013) or until step up to dual/triple therapy, for example, addition of another long-acting bronchodilator, an inhaled corticosteroid, or both. A minimum of four consecutive prescriptions and 6 months on continuous monotherapy were required. Patients <50 years old at first COPD diagnosis or with another significant respiratory disease before starting monotherapy were excluded. Disease burden was evaluated by measuring patients’ rate of face-to-face interactions with a health care professional (HCP), COPD-related exacerbations, hospitalizations, and referrals.ResultsA cohort of 8,811 COPD patients (95% Global initiative for chronic Obstructive Lung Disease stage A/B) on maintenance monotherapy was identified between 2002 and 2013; 45% of these patients were still on monotherapy by the end of the study. Median time from first COPD diagnosis to first monotherapy prescription was 56 days, while the median time on maintenance bronchodilator monotherapy was 2 years. The median number of prescriptions was 14. On average, patients had 15 HCP interactions per year, and one in ten patients experienced a COPD exacerbation (N=8,811). One in 50 patients were hospitalized for COPD per year (n=4,848).ConclusionThe average monotherapy-treated patient had a higher than average HCP interaction rate. We also identified a large cohort of patients who were stepped up to triple therapy despite a low rate of exacerbations. The use of the new class of long-acting muscarinic antagonist/long-acting β2-adrenergic agonist fixed-dose combinations may provide a useful step-up treatment option in such monotherapy patients, before the use of inhaled corticosteroids.

ORIGINAL RESEARCH—ED PHARMACOTHERAPY: Characteristics, Behaviors, and Attitudes of Men Bypassing the Healthcare System When Obtaining Phosphodiesterase Type 5 Inhibitors

Men may choose to bypass the healthcare system to obtain a phosphodiesterase type 5 inhibitor (PDE5i). Evaluate the characteristics and purchasing patterns of men obtaining a PDE5i without prior healthcare professional (HCP) interaction. Prior HCP interaction, defined as having a prescription for any PDE5i, having a PDE5i sample from a physician, or buying the PDE5i in a retail pharmacy; and erectile dysfunction (ED, the Massachusetts Male Aging Study single-item question) were assessed. A multivariate regression analysis determined predictive factors for PDE5i purchase without prior HCP interaction. Methods. A Web-based observational study was conducted in the United Kingdom, Germany, and Italy. Of the 11,899 participants, 1,252 (10.5% [95% CI, 10.0-11.1%]) reported PDE5i use in the last 6 months. PDE5is were obtained without prior HCP interaction by 403 users (32.3% [95% CI, 29.6-34.8%]); 65.5% of them had ED. Overall prevalence of men using PDE5is without HCP interaction was 3.0% (95% CI, 2.6-3.5%), 4.1% (95% CI, 3.5-4.6%), and 2.8% (95% CI, 2.1-3.5%) for men aged 18-34, 35-50, and >50 years, respectively (P = 0.0045). Predictive factors for obtaining a PDE5i without prior HCP interaction were embarrassment to speak to a physician (P = 0.0009) and the perception that this would be the cheapest way to get the medicine (P = 0.03). Based on these findings, it can be estimated that approximately 6 million men in Europe might currently bypass the healthcare system to obtain a PDE5i. In addition to the risks associated with use of PDE5is from uncontrolled sources, because most of these men have ED, they also miss the opportunity for important health information or medical follow-up. HCPs should actively address ED and offer treatment to discourage men from seeking uncontrolled sources of ED medicines.

Patterns of natural herb use by Asian and Pacific Islanders

Objective. Previous studies have noted the role of race/ethnicity in use of complementary and alternative medicine (CAM). Asian and Pacific Islanders (APIs) in particular have been found to use herbs more frequently, although the patterns of use among this population have not been described. The goal of this study was to characterize the rates and patterns of herb use among the API population of the United States. Design. Data from the 2002 US National Health Interview Survey, including the supplement on CAM, were analyzed using SAS. Cross-tabulation and logistical regression were used to determine the association between herb use and race/ethnicity, while adjusting for demographic factors. Results. After adjusting for age, gender and educational attainment, we found that APIs were more likely to use herbs than non-Hispanic Whites (OR=1.3; 95% CI: 1.1, 1.5; p=0.013), with the difference being most prominent in those 60 years old or older (OR=2.9; 95% CI: 1.8, 4.5; p<0.0001). Herb use among APIs was more common among women, those with higher education and income, and those in older age groups. Patterns of use also varied among API subgroups, with Chinese Americans reporting the highest rates of herb use in their lifetimes (44%) and in the previous 12 months (33%). Conclusion. Considerable diversity exists within API subgroups with regard to the prevalence and demographic and health correlates of natural herb use. Herb use is more common among APIs than non-Hispanic Whites, particularly among the elderly. The disaggregation of APIs by racial/ethnic subgroups may be important for patient–health care professional interactions, and when designing studies of racial/ethnic minority populations.

Childhood chronic pain and health care professional interactions: shaping the chronic pain experiences of children

Children with chronic pain meet numerous healthcare professionals during their search to understand their pain. Through semi-structured interviews, this qualitative study sought to understand the experiences of five children with chronic pain as they encountered healthcare professionals. In the majority of these interactions, children reported feeling misunderstood, disbelieved and abandoned. The findings of this study demonstrate that children's experiences with professionals influence their approach towards current and future healthcare encounters. All children discussed their guarded relationships with healthcare providers. Children also developed negative perceptions about their pain, in particular believing that their experience with chronic pain was life-threatening, and demanded major life adjustments. Interactions with healthcare professionals have a tremendous influence on children's perceptions and chronic pain experiences. In order to better understand and care for children with chronic pain, it is essential that healthcare professionals provide children with the opporunity to communicate their unique experiences with pain.

Communication and control: parent, child, and health care professional interactions during painful procedures.

Through use of a qualitative ethological approach, observations of 17 children who were undergoing 44 painful procedures during cancer diagnosis or treatment were videotaped and analyzed. The children, aged 4 to 18 years, were part of a larger study testing the effectiveness of nonpharmacologic pain management techniques. Analysis of the videotaped observations revealed that several distinct patterns of conversation between caregivers, parents, and children varied greatly among situations. Both child-centered and nonchild-centered communications were demonstrated. During periods of quiet, nonchild-centered behaviors increased. As a child's distress increased, parents actively changed behaviors to redirect verbal support back to the child and to the pain control interventions. Nurses' encouraging parents to be actively involved and physically close during painful treatments may results in less distress and discomfort for the child. In addition, health care professionals need to be aware of the various patterns of child-parent-caregiver interactions and the need to stay focused on the child during painful procedures to enhance the child's ability to cope.