Patients Healthcare Professionals Research Articles

Assessment of Alternative Medicine Use, Costs, and Predictors of Medication Adherence among Diabetes Mellitus Patients in Palestine.

Diabetes Mellitus (DM) is considered the fourth leading cause of death in Palestine, with a prevalence of 9.1% in patients aged 20-79 years, and has increased to 20.6% in 2020. This study aims to estimate DM costs, compare DM total health care cost among patient characteristics and DM management (e.g. anti-diabetic medications and alternative medicine), as well as assess MA and its predictors including patient characteristics, DM management, alternative medicine use, and DM costs. A cross-sectional study was conducted for the past one year among 479 diabetic patients, selected by convenience sampling and snowball sampling methods via electronic post of an online questionnaire, including a web link to the questionnaire page in a Google Form via email or public social media pages and applications. Data on patients' socio-demographic and clinical characteristics, medication profile, use of medicinal plants as alternative medicine, costs, and Medication Adherence (MA) were collected. The Statistical Package for Social Sciences (SPSS v. 25) was used to perform a descriptive, Kolmogorov-Smirnov test, univariate analysis, Mann-Whitney or Kruskal- Wallis test, multiple linear regression, binary logistic regression, and multiple logistic regression analysis. A p-value < 0.05 was considered statistically significant. More than half of the participants were male and living in villages (50.7%, 59.1%, respectively). Approximately 51.4% received Oral Hypoglycemic Drugs (OHDs) and only 16.1% received insulin. The participants receiving ≤3 medications daily acquired the highest percentage (55.7%), and less than half received medicinal plants as an alternative medicine for the management of DM. The estimated total DM health care cost per year incurred by patients and family members was Israeli Shekel 988,276 (US Dollar 307,590). More than half of the participants were considered adherent with the Eight-Item Morisky Medication Adherence Scale (MMAS-8) score ≥6. It is noteworthy that the use of alternative medicine was significantly associated with total health care cost and MA. Furthermore, DM duration was significantly associated with MA. These results are worth taking into consideration. This study reflects the need for strengthening the patient-health care professionals' relationship, and to enhance the role of preventive education, and the importance of awareness about MA, DSCMBs, and the use of alternative medicine based on evidence-based strategies to improve MA, glycemic control, meanwhile reducing the costs incurred by patients and family members.

Distilling lessons from home hospital implementation: a narrative scoping review.

Multiple Cochrane Reviews have demonstrated 'hospital at home' (HaH) as a promising healthcare model to be explored, with benefits such as higher care quality, reduced readmissions, shorter lengths of stay, lower cost and greater patient satisfaction. While there have been many reviews focusing on the quantitative clinical outcomes of HaH, there is generally a lack of collation of qualitative insights from stakeholders and lessons learnt from past HaH implementation. We performed a systematic literature search on four databases and included 17 papers involving the provision of acute and/or subacute care by healthcare professionals in patients' homes. Review characteristics and relevant outcomes were extracted from the reported findings and tables in the reviews, and these included stakeholder attitudes and factors contributing to the success of HaH implementation. Factors relating to patients and caregivers included home setup, preference for care and death settings, and support for caregiver. Factors involving the healthcare professionals and intervention included a multidisciplinary care team, accessibility to emergency care and support, training of providers and patients, adequate manpower allocation, robust eligibility and referral criteria, sufficient awareness of the HaH referral pathway, communication and medication management. HaH presents a promising alternative care model, and many of the success factors identified, including the strong push for multidisciplinary single care teams, existing frameworks for data sharing and strong community network, are already present today. As such, Singapore appears to be well positioned to adopt a new care model like HaH.

Opinion of Patients and Healthcare Professionals on the Value of Integrating Emojis into Healthcare Communication

Introduction: Ability to discuss emotions can significantly strengthen the patient–Health Care Professional (HCP) relationship and improve outcomes. Communication barriers impede this relationship and limit the ability of HCPs to provide patient-centered care. Emojis are a universal language that has the potential to overcome these issues and are particularly suited for describing emotions.&#x0D; Aim: This 3-phase feasibility study aimed to collate current opinions around the utility of emojis in patient–HCP communication.&#x0D; Methods: In phase 1, a survey was conducted between September and October 2021 among members of the War On Cancer digital platform community (patients, friends, family, and others interested in the study) to determine how they used emojis in their personal and healthcare communications. In phase 2 (February 2022), selected patients were individually interviewed via zoom (9 questions; 30–60 minutes) to evaluate their current use of emojis in text-based communications, situations where emojis might and might not help them express themselves to HCPs, and emotions represented by different emojis. In phase 3 (February 2022), invited HCPs were individually interviewed face-to-face or via Zoom (6 open-ended questions; 30–45 minutes) to evaluate their current use of digital communications and emojis with patients, insights on the findings from phases 1 and 2, and overall thoughts on using emojis in patient communications.&#x0D; Results: The phase 1 survey had 290 respondents aged 15–84 years from 22 countries. The majority used emojis to express emotions in personal conversations and were positive about using them in HCP communications. In phase 2, 8 patients aged 30–70 years from the UK, US, and Sweden were interviewed. All used emojis in personal communications and a minority had used emojis to communicate with their HCP. Most interpreted emojis similarly, yet participants had varying views on when and how they should be used with HCPs, mainly because of the potential ambiguous interpretation. Some noted a lack of healthcare–adapted emojis. Participants identified 4 situations where emojis could be useful in HCP communication: emotional preparation before a visit, follow-up after a visit, situations with a language barrier, and to replace numeric scales for strength of emotion. Emojis were considered less useful as a substitute for face-to-face meetings, in serious situations, and when expressing serious emotions. In phase 3, 5 HCP volunteers (2 clinicians, 3 nurses) aged 30–45 years from the US and Sweden were interviewed. All communicated digitally with patients through electronic medical records or other platforms, sometimes only one-way (HCP to patient). No HCPs had used emojis directly with patients, noting that some platforms prohibit it. HCPs agreed with the scenarios identified in phase 2, further suggesting emojis may be most helpful for patients with poor literacy or who have difficulty expressing emotions.&#x0D; Conclusions: The findings of this survey and interviews demonstrated that both patients and HCPs recognize potential advantages in using emojis within healthcare conversations. Further research is required to determine the optimal settings in which emojis can be used to improve communications between patients and HCPs, and the associated clinical value.

Patients' experiences of primary healthcare and dermatology provision for alopecia.

Alopecia describes a group of dermatological conditions characterised by hair loss, which are either non-scarring or scarring in nature, and range from bald patches to complete body hair loss, to general thinning. In the UK, the General Practitioner (GP) is typically the first point of contact, and some patients are referred for specialist dermatology consultation. However, little is known about how individuals with alopecia in the UK experience the care provided by the National Health Service. We aimed to understand patients' perceptions of primary healthcare and dermatology provision. Further, we aimed to investigate how care provision and patients' overall patient journey might be improved in the UK, and how these lessons may apply internationally. An online mixed methods survey was distributed by Alopecia UK to UK-based individuals with alopecia. Open-ended text responses were analysed using qualitative content analysis. Quantitative data were analysed using descriptive analyses and dependent measures t-tests. A total of 291 participants completed the survey. They reported neutral-to-partial dissatisfaction with their GP appointments, with greater satisfaction in their most recent compared to their first appointment. Participants highlighted positive experiences with GPs and dermatologists as well as areas for improvement. Participants also expressed a desire for a greater degree of support and understanding about the psychological impact of alopecia. Results highlight the importance of being empathic and caring healthcare professionals for patients with alopecia, the need for training for GPs on alopecia, as well as a simplified and joined up pathway between primary and secondary healthcare.

The experiences and challenges of nurses who become patients in a hospital setting: A scoping review of the literature.

This scoping review aimed to identify and describe evidence regarding the experiences of nurses when they become patients or when nurses care for other health professional-patients in a hospital setting. A scoping review of internationally published peer-reviewed literature. A systematic search of peer-reviewed evidence was conducted in electronic databases: CINAHL, Medline, Scopus, ProQuest and PsycINFO. Critical appraisal, data extraction and summary were performed independently by two reviewers according to the scoping review framework developed by Arksey and O'Malley. Twenty-three publications from 1999 to 2021 were included in this scoping review. This scoping review highlighted seven key themes as follows: (1) the challenges for nurse-patients and caregivers; (2) role ambiguity when a nurse becomes a patient; (3) the need for personalized care to consider the nurse's professional experience; (4) the requirement to not make assumptions about the registered nurse's knowledge; (5) loss of control and vulnerabilities of being a patient; (6) the impact of the valuable small things that carers did and (7) the impact of being a nurse-patient on their future practice. While some aspects of nurse-patients' experiences are common to non-healthcare professional-patients, this review highlights there are unique challenges when nurses become patients themselves. Future research should focus on exploring nurses' experience of caring for other healthcare professional-patients and strive to better understand how to meet nurses' unique needs when they become patients themselves. This review advances knowledge on an under-explored topic, highlighting the unique and challenging experience when nurses become patients in a hospital setting. Nurses should be aware of the unique needs of nurse-patients to provide person-centred quality care. There was no direct patient or public contribution to this scoping review, although one of the authors did have experience as a nurse-patient in the last 3 years.

IoT framework of telerehabilitation system with wearable sensors for diabetes mellitus patients

Physical activity is commonly used as a treatment for diabetes patients, although its effectiveness in improving cognitive functions such as learning, thinking, remembering, and decision making is not clear. Regular exercise can gradually improve metabolic abnormalities associated with pre-diabetes and assist patients with type-2 diabetes (T2D) in managing their pharmacological treatment. The usage of mobile health (mHealth) as a tool to help diabetes patients with their diabetes self-management have been demonstrated in previous studies and it can lead to reductions in glycosylated hemoglobin (HbA1c) levels. Heart rate readings during physical activity is beneficial for healthcare professionals (HCP) to ensure appropriate intensity levels for their patients is achieved. Additionally, the list of the tailored physical activities is long, and it is quite challenging for the T2D patients to remember. Therefore, Tele-DM is proposed, consisting of a smartwatch and mobile application that enable remote physiotherapy sessions for T2D patients. The smartwatch transfers the heart rate data to Tele-DM through Google Fit database. The system provides tailored exercise programs to help patients reduce their weight and HbA1c levels. With the ability to facilitate two-way communication between HCP and T2D patients, the Tele-DM system is designed to enable an effective remote rehabilitation process.

Levothyroxine absorption test followed by directly observed treatment on an outpatient basis to address long-term high thyrotropin levels in a hypothyroid patient: a case report

BackgroundFor the treatment of hypothyroidism, patients are usually placed on lifelong levothyroxine replacement therapy. Achieving clinical and biochemical euthyroid status is sometimes difficult because of several factors, including poor compliance or poor absorption of levothyroxine in the gut mucosa.Case presentationWe present the case of a 45-year-old South Asian female with hypothyroidism on lifelong levothyroxine replacement. However, on her multiple follow-up visits over the past 2 years, it was noted that her thyrotropin level was never controlled and was not in range. A thorough history was unyielding in terms of compliance regarding levothyroxine medication and use of over-the-counter pills or mineral supplements that may interfere with the absorption of levothyroxine. Hence, we performed levothyroxine absorption test to rule out any malabsorption as well as document pseudo-malabsorption favoring drug nonadherence. Levothyroxine absorption test resulted in more than 56% absorption of levothyroxine; therefore, the patient was put on weekly directly observed treatment strategy resulting in normalization of thyrotropin levels on successive follow-ups.ConclusionDirectly observed treatment to replace levothyroxine once a week can be used as an alternative by health care professionals in patients in whom compliance to daily levothyroxine is the hidden cause of persistently raised thyrotropin. This strategy can reduce undue health burden on the patient and improve adherence to self-medication under confident supervision of the treating physician.

Mindfulness and compassion training for health professionals: A qualitative study.

Compassion is a key component of quality care. Encouraging Health Care Professionals (HCPs) to develop a patient-centered care relationship through mindfulness and compassion training may be beneficial for both patients and HCPs. We assessed the impact of a compassion-centered mindfulness program [i.e., the Mindfulness Based (MB) CARE program] on healthcare practice conducting 10 phone interviews with HCPs who experienced the program. The training had an overall positive impact on the HCPs ability to feel compassion toward their patients and themselves, helped them develop kindness toward themselves and their patients, and enhanced their attention to their patient's needs and theirs. Participants were better able to accept the difficult work experiences or those their patients experienced, with more perceived equanimity and less reactivity. Professional mindfulness and compassion training programs could be operational levers for institutions aiming at fostering more compassionate HCPs-patients relationships.

An analysis of the experiences of bereaved relatives and health care providers following palliative sedation: a study protocol for a qualitative international multicenter case study

BackgroundPatients at the end-of-life may experience refractory symptoms of which pain, delirium, vomiting and dyspnea are the most frequent. Palliative sedation can be considered a last resort option to alleviate one or more refractory symptoms. There are only a limited number of (qualitative) studies exploring the experiences of relatives of sedated patients and their health care professionals (HCPs). The aims of this study protocol are: 1) to elicit the experiences of bereaved relatives and health care professionals of patients treated with palliative sedation and 2) to explore the understanding of the decision-making process to start palliative sedation across care settings in 5 European countries.MethodsThis study protocol is part of the larger HORIZON 2020 Palliative Sedation project. Organisational case study methodology will be used to guide the study design. In total, 50 cases will be conducted in five European countries (10 per country). A case involves a semi-structured interview with a relative and an HCP closely involved in the care of a deceased patient who received some type of palliative sedation at the end-of-life. Relatives and health care professionals of deceased patients participating in a linked observational cohort study of sedated patients cared for in hospital wards, palliative care units and hospices will be recruited. The data will be analyzed using a framework analysis approach. The first full case will be analyzed by all researchers after being translated into English using a pre-prepared code book. Afterwards, bimonthly meetings will be organized to coordinate the data analysis.DiscussionThe study aims to have a better understanding of the experiences of relatives and professional caregivers regarding palliative sedation and this within different settings and countries. Some limitations are: 1) the sensitivity of the topic may deter some relatives from participation, 2) since the data collection and analysis will be performed by at least 5 different researchers in 5 countries, some differences may occur which possibly makes it difficult to compare cases, but using a rigorous methodology will minimize this risk.

Psychosocial and emotional morbidities after a diagnosis of cancer: Qualitative evidence from healthcare professional cancer patients.

This inquiry aimed to; (1) examine the psychosocial and emotional sequelae associated with cancer patient-hood experience in healthcare professionals (HCPs) in Uganda, (2) generate evidence to inform clinical and nursing practice about the needs of HCP patients with cancer. This was a qualitative phenomenological study. The study was conducted among HCP cancer patients and survivors recruited from oncology and palliative care settings in Uganda. Data were collected via audio-taped, face-to-face or telephone open-ended interviews. Interviews were transcribed verbatim. Thematic analysis was used. Eight HCP cancer patients and survivors participated in the study. Their mean age was 56 years, range 29-85 years. Three major themes emerged: (1) From a healthcare provider to a patient, (2) Socioeconomic challenges, and (3) Coping and support strategies.

Prehospital Administration of Aspirin and Nitroglycerin for Patients With Suspected Acute Coronary Syndrome - A Systematic Review.

Background: Recent guidelines for acute coronary syndrome (ACS) recommend prehospital administration of aspirin and nitroglycerin for ACS patients. However, there is no clear evidence to support this. We investigated the benefits and harms of prehospital administration of aspirin and nitroglycerin by non-physician healthcare professionals in patients with suspected ACS.Methods and Results: We searched the PubMed database and used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach to assess the certainty of evidence. Three retrospective studies for aspirin and 1 for nitroglycerin administered in the prehospital setting to patients with acute myocardial infarction were included. Prehospital aspirin administration was associated with significantly lower 30-day and 1-year mortality compared with aspirin administration after arrival at hospital, with odds ratios (OR) of 0.59 (95% confidence interval [CI] 0.35–0.99) and 0.47 (95% CI 0.36–0.62), respectively. Prehospital nitroglycerin administration was also associated with significantly lower 30-day and 1-year mortality compared with no prehospital administration (OR 0.34 [95% CI 0.24–0.50] and 0.38 [95% CI 0.29–0.50], respectively). The certainty of evidence was very low in both systematic reviews.Conclusions: Our systematic reviews suggest that prehospital administration of aspirin and nitroglycerin by non-physician healthcare professionals is beneficial for patients with suspected ACS, although the certainty of evidence is very low. Further investigation is needed to determine the benefit of the prehospital administration of these agents.

Physical activity counseling during and following stem cell transplantation – patients' versus advisors' perspectives

ABSTRACT Background People receiving hematopoietic stem cell transplantation (HSCT) endure long phases of therapy and immobility, which diminish their physical activity (PA) level leading to physical deconditioning. One of the reasons is a lack of clarity on the part of those who work in oncology clinical settings of their role in assessing, advising, and referring patients to exercise. Therefore, our study investigates reported physical activity counseling behavior of health care professionals (HCPs) and the patient perspective on this topic. Methods Physicians (N = 52), nurses (N = 52) physical therapists (N = 26), and patients receiving HSCT (N = 62) participated in a nationwide cross-sectional online-survey. Patients‘ preferred source of information concerning PA was determined. We examined HCPs self-assessed PA counseling behavior and patients‘ PA recall by assessing the use of the 5As (Ask, Advice, Agree, Assist, Arrange). Analysis of survey responses was descriptive. Univariate multinomial logistic regression examined whether sociodemographic factors and patient characteristics influence the response behavior. Results Physicians and PA specialists were patients‘ preferred source of information regarding PA. A large discrepancy between HCPs’ perception and the degree to which HSCT patients recall advice became apparent; profound counseling steps like making referrals were less often recalled in our patient sample. Inactive patients reported to receive less basic PA counseling by physicians. Conclusion Future research should identify the requirements to increase patients’ recall concerning PA counseling in the setting of HSCT. Important messages about PA need to be made more salient to those who are less active and less engaged.

Oral health associated with incident diabetes but not other chronic diseases: A register-based cohort study.

IntroductionOral infectious diseases are common chronic oral diseases characterized by a chronic inflammatory condition. We investigated chronic oral diseases as potential risk factors for systemic chronic diseases, diabetes mellitus, connective tissue diseases, seropositive rheumatoid arthritis, ulcerative colitis, and Crohn's disease, as well as severe psychotic and other severe mental disorders.MethodsThe cohort comprised 68,273 patients aged ≥ 29 years with at least one dental visit to the Helsinki City Health Services between 2001 and 2002. The cohort was linked to the data on death (Statistics Finland), cancer (Finnish Cancer Registry), and drug reimbursement (Finnish Social Insurance Institution) and followed until death or the end of 2013. The outcomes of interest were the incidences of chronic diseases measured starting with special refund medication, which means Social Insurance Institution partly or fully reimburses medication costs. Outcomes of interest were diabetes mellitus, connective tissue diseases, seropositive rheumatoid arthritis, ulcerative colitis and Crohn's disease, and severe mental disorders.ResultsThe mean follow-up time was 9.8 years. About 25% of the study population had periodontitis, 17% caries, over 70% apical periodontitis, and 9% <24 teeth at the start of follow-up. Diabetes was the only chronic systemic condition associated with oral health variables. Having 24 to 27 teeth was associated with a higher incidence rate ratio (IRR) (1.21, 95% confidence interval 1.09–1.33) compared to having 28 or more teeth; the IRR for having 23 or less was 1.40 (1.22–1.60). Having periodontitis (1.10, 1.01–1.20), caries (1.12, 1.01–1.23), or apical periodontitis (1.16, 1.04–1.30) is also associated with a higher risk of diabetes.ConclusionOur epidemiological 10 years follow-up study suggests that the association exists between chronic oral diseases and diabetes, warranting close collaboration among patient's healthcare professionals.

Barriers and facilitators perceived by healthcare professionals for implementing lifestyle interventions in patients with osteoarthritis: a scoping review

ObjectiveTo provide an overview of barriers and facilitators that healthcare professionals (HCPs) perceive regarding the implementation of lifestyle interventions (LIs) in patients with hip and/or knee osteoarthritis (OA).DesignScoping review.Data sourcesThe...

EP.TH.602Exploring decision-making of healthcare professionals in patients with benign large non-pedunculated colonic polyps (BLNPCP) virtually using combined focus group and nominal group technique

Abstract Aim We aimed to elicit key factors that influence healthcare professional decision-making when deciding treatment for BLNPCP. Background Benign large non-pedunculated colonic polyps (BLNPCP) may harbour covert malignancy and opinions differ about the optimal treatment modality. There are several options available, including endoscopic mucosal resection, endoscopic submucosal resection, combined endoscopic laparoscopic surgery and surgical resection. Despite widespread availability of endoscopic resection techniques, there are high rates of surgery in the UK. Methods Three focus groups of healthcare professionals, comprised of either consultant colorectal surgeons, nurse endoscopists and consultant gastroenterologists, were conducted virtually utilising the Nominal Group Technique. Meetings were recorded and transcribed verbatim. Themes were devolved using the framework approach for qualitative analysis. A priority-ranked list of factors influencing healthcare professional decision-making in this setting was generated. Results Five main themes were identified as influencing decision-making: Shared decision making (patient preference, informed consent); Patient factors (co-morbidity, age, life-expectancy); Polyp factors (Location, size, morphology, risk of cancer); Healthcare professionals (skill-set, personal preference); System factors (techniques availability locally, regional referral networks). Nominal Group Technique generated 55 items across the three focus groups. Nurses and gastroentologists ranked patient factors (particularly drug history and tolerance of procedure) and shared decision making (patient preference) more highly then surgeons. Surgeons placed greater emphasis on polyp factors particularly location and the risk of submucosal invasive carcinoma. Conclusion Decision making is complex and multifactorial. These results support the benefits of complex polyp MDTs and patient involvement in the decision-making. The complexity of decision-making may underpin wide variation in practice.

Opioid-Induced Constipation in Patients with Cancer Pain in Japan (OIC-J Study): A Post Hoc Analysis.

Opioid-induced constipation (OIC) can limit the clinical benefit of opioid treatment. This post-hoc analysis evaluated the association between the Rome IV diagnostic criteria and other measures for OIC, including the Bowel Function Index (BFI), correlation between demographics and OIC onset, impact of OIC on pain treatment, and impact of patient–healthcare professional (HCP) communication on patient satisfaction. Patients recorded bowel habits in paper diaries for 14 days following opioid initiation. Study-specific questionnaires were used to evaluate patient awareness of OIC and satisfaction. Patients were ≥20 years old, initiating strong opioid therapy for cancer pain, had an ECOG PS ≤ 2, and had no constipation (≥3 bowel movements within 7 days of enrollment). A total of 220 patients were enrolled. The sensitivity and specificity of BFI for identifying OIC were 81.2% and 54.7%, respectively. Age <65 versus ≥65 years (odds ratio (OR) = 0.510, 95% confidence interval (CI): 0.267–0.977) and the presence or absence of comorbidities (OR = 0.443, 95% CI: 0.221–0.885) were correlated with OIC onset. The proportion of inpatients with sustainable pain control at week 2 was similar in patients with or without OIC (60.0% vs. 67.2%, respectively). By patient assessment, there was a significant correlation between an adequate level of patient–HCP communication and satisfaction with OIC treatment (OR = 9.538 (95% CI: 1.577–57.681)). Using BFI to screen for OIC represents a valid approach in patients with cancer pain. Patient–HCP communication is essential for effective management of OIC in patients with cancer pain.

138P Anaphylaxis and hypersensitivity in trials of intravenous pertuzumab + trastuzumab (PH IV) or the fixed-dose combination of pertuzumab and trastuzumab for subcutaneous injection (PH FDC SC) for HER2-positive breast cancer (BC)

PH IV/PH FDC SC is standard of care for HER2-positive BC and usually given with chemotherapy, all of which can trigger anaphylaxis/hypersensitivity. In the US, PH FDC SC can be administered by healthcare professionals in patients’ (pts’) homes. There is a need to further characterise risk of anaphylaxis/hypersensitivity with PH IV/PH FDC SC to support safe administration outside of clinics. We assessed occurrence, incidence and severity of these events in key Roche clinical trials of PH IV/PH FDC SC, and did a time–trend analysis (by cycle) for metastatic BC (MBC) and early BC (EBC) studies.

Expanded Buprenorphine Prescribing Authority Gains Traction During Pandemic

Back to table of contents Previous article Next article Clinical & ResearchFull AccessExpanded Buprenorphine Prescribing Authority Gains Traction During PandemicTerri D'ArrigoTerri D'ArrigoSearch for more papers by this authorPublished Online:24 Aug 2021https://doi.org/10.1176/appi.pn.2021.8.22AbstractA survey suggests that prescribing buprenorphine for new patients with opioid use disorder without doing an in-person examination first can yield success. Is it time to make this pandemic-related exception to the rules a permanent option?As part of nationwide efforts to ensure continued access to medication treatment for opioid use disorder (OUD) during the COVID-19 pandemic, last year the Drug Enforcement Administration (DEA) exempted health professionals who have a Drug Addiction Treatment Act waiver from having to examine new patients in person before prescribing buprenorphine. Now a survey of waivered health professionals suggests that remote prescribing may have gained a foothold in practice: One-third of respondents who had prescribed buprenorphine in the year leading up to the survey had taken advantage of the DEA’s emergency provision and prescribed buprenorphine to new patients without in-person examinations. Furthermore, 87% of these health professionals reported that their new patients did not encounter any difficulties with buprenorphine induction. The findings appear in Drug and Alcohol Dependence.Patients must have reliable access to technology to benefit from remote treatment and prescribing, says Christopher M. Jones, Pharm.D., Dr.P.H., M.P.H.Centers for Disease Control and Prevention“These results suggest that emergency provisions helped to mitigate disruptions in care,” said lead author Christopher M. Jones, Pharm.D., Dr.P.H., M.P.H., deputy director of the National Center for Injury Prevention and Control at the Centers for Disease Control and Prevention. “It seems reasonable that we should consider what role permanently adopting these provisions can play in expanding access to treatment.”Jones and colleagues conducted an electronic survey of 10,238 DATA-waivered health professionals during the summer surge of the COVID-19 pandemic from June 23, 2020, to August 19, 2020. Most of the respondents were physicians, followed by nurse practitioners or others in the nursing profession, and physician assistants, at 68.4%, 25.3%, and 6.3%, respectively.A subset of 7,419 respondents had prescribed buprenorphine in the 12 months prior to the survey, and of those, 33% reported prescribing buprenorphine without an in-person visit after the DEA’s exemption went into effect. They reported communicating with new patients via laptop or desktop with video, telephone without video, telephone with video, and/or tablets with video. The 67% in this subset who did not prescribe buprenorphine to new patients without first conducting an in-person examination cited several reasons, including a preference for in-person visits, not having any new patients, and having kept their practices open for in-person visits during the COVID-19 pandemic.Respondents in the subset noted several challenges their patients faced in accessing care, with 48.2% reporting that their patients had experienced unreliable telecommunications such as a lack of phone, computer, or internet service.“Reliability in communication is important. We can allow remote treatment and change reimbursements for remote treatment, but if patients don’t have access to the technology, they don’t really benefit from these changes [in policy],” Jones said.Other barriers included unstable housing, lack of access to psychosocial services or behavioral health professionals, cancellation of in-person self-help or counseling groups, lack of transportation to the doctor or pharmacy, lack of access to psychiatric services for patients with co-occurring mental disorders, and an inability to find remote self-help or counseling groups.“These are all issues that often exist among people with opioid use disorder, and they show that there are other barriers that we need to attend to if we want to maximize access to buprenorphine treatment,” Jones said.Among all survey respondents, 20% reported that they had not prescribed buprenorphine for OUD at all since obtaining their waiver, and 7.6% reported that they did not prescribe buprenorphine for OUD in the 12 months prior to the study. The most common reasons for this were a lack of patient demand, concerns about managing patients with OUD, a lack of access to psychosocial services or other behavioral health care professionals for patients, and resistance from practice partners or lack of institutional support.“These [health professionals] are untapped potential. Even the emergency provisions did not entice them to prescribe buprenorphine,” Jones said. “While there’s no single solution to expanding access to buprenorphine, we have to think about the various motivations and barriers for providers regarding the practice of prescribing it.”Jones said that the pandemic has provided a “natural experiment” in providing mental telehealth services.“It has presented us with historic challenges, but has also spurred innovations. The challenge now is to document and share our experiences,” he said. “How can we use our innovations and experience to improve patient care beyond the pandemic?”The researchers reported no outside funding for this study. ■“Characteristics and Correlates of U.S. Clinicians Prescribing Buprenorphine for Opioid Use Disorder Treatment Using Expanded Authorities During the COVID-19 Pandemic” is posted here. ISSUES NewArchived

Motives to Report Adverse Drug Reactions to the National Agency: A Survey Study among Healthcare Professionals and Patients in Croatia, The Netherlands, and the UK.

IntroductionHealthcare professionals (HCPs) and patients have various motives to report adverse drug reactions (ADRs) to their national agency. These motives may differ between countries.ObjectiveThe aim of this study was to assess to what extent motives of HCPs and patients to report ADRs differ between countries.MethodsHCPs and patients from Croatia (HR), The Netherlands (NL), and the UK were asked to complete a web-based survey containing questions regarding demographics and ADR reporting. HCPs and patients could select all motives for reporting that applied to them, with a total of 23 and 24 motives, respectively. Descriptive statistics are presented and Chi-square tests were used to test for differences across the countries, with effect sizes calculated using Cramer’s V.ResultsIn total, 296 HCPs and 423 patients were included (60% and 32% from Croatia, 19% and 44% from NL, and 21% and 24% from the UK, respectively). For most of the motives to report or not to report an ADR, there were no differences between countries. Most HCPs from all countries would be motivated to report an ADR if there was a strong suspicion of causality (89%), if it concerned a severe/serious ADR (86%), and if it concerned an ADR for a new, recently marketed drug (77%). Most patients from all countries agreed that they would report an ADR if it concerned a severe ADR (96%), if the ADR influenced their daily activities (91%), and if they were worried about their own situation (90%). Differences across the countries (p < 0.05 and V ≥ 0.21) were observed for three and four of the HCP and patient motives, respectively. For HCPs, these differences were seen in motives related to legal obligation (65% HR, 24% NL, 38% UK), black triangle medicines (27% HR, 4% NL, 77% UK), and the reporting of well-known ADRs (53% HR, 85% NL, 69% UK). For patients, these differences were seen in motives related to a linkage between the ADR report and the medical notes (59% HR, 60% NL, 30% UK), complexity and time taken to report (25% HR, 13% NL, 40% UK), medicines purchased on the internet (59% HR, 39% NL, 65% UK), and the reporting of embarrassing ADRs (32% HR, 11% NL, 35% UK).ConclusionsHCPs’ and patients’ motives to report or not to report ADRs to the national agency were mostly similar across the three countries. Such motives can be used in general strategies to promote and increase ADR reporting. The observed differences provide guidance to further fine-tune ADR reporting at a national level.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40264-021-01098-4.

P–503 Focus groups with health care professionals, patient advocates and patients to explore how the potential need for multiple cycles is managed during fertility treatment consultations

Abstract Study question How is possibility of failure and potential need for multiple cycles discussed with patients during the first or repeat IVF/ICSI treatment consultation? Summary answer Health Care Professionals plan treatment on a cycle-by-cycle basis because it is the normative way to plan treatment, but patients see advantages in multi-cycle planning. What is known already Many patients need more than one round of IVF/ICSI stimulation to achieve their parenthood goals. A recent study has found around 60% of patients to be willing to plan for multiple cycles of treatment. However, it is not clear how patients are informed fully about the high possibility of treatment failure and the subsequent need for multiple cycles during their treatment planning consultations. Study design, size, duration Qualitative focus groups with health care professionals (HCP) patient advocates (April 2020) and patients (July and August 2020, respectively). Patients were eligible if they had had a consultation to start a first/repeat stimulated IVF/ICSI cycle in the eight weeks prior to participation, were aged 18 or older (upper age limit of 42 years for women) and fluent in English. Eligible Health HCPs and patient advocates were those employed at a fertility clinic or charity, respectively. Participants/materials, setting, methods HCP, patient advocate and patient focus group topic guides started with general questions about fertility consultations and progressed to discuss if and how the possibility of treatment failure and need for multiple cycles was introduced and discussed, and then preferences regarding planning IVF/ICSI on a multi-cycle rather than a single cycle basis. Focus groups were recorded, transcribed and analysed using framework analysis which allowed examination of shared, unique and incongruent thematic content across participant groups. Main results and the role of chance Twelve HCPs, 2 patient advocates and 11 patients participated in seven semi-structured online focus group discussions. Framework analysis revealed 52 codes (e.g., possibility of failure tentatively introduced; discussion of multiple cycles dependent on clinical/patient benchmarks) abstracted into 17 higher-level categories (e.g., Failure is a sensitive topic to approach; IVF treatment failure is the norm). Synthesis of categories revealed four themes and one meta theme The meta theme showed planning treatment on a cycle-by-cycle basis was the norm. This meta-theme was supported by four themes: (1) ‘culture of communication’ that dictated benchmarks (e.g., clinic, national live birth rate) and definition of key concepts (’complete’ cycle) that underpinned divergence between clinics; (2) ‘HCP-patient dynamics’ indexing degree of shared decision-making, advance preparation and involvement of partners in planning; (3) ‘tempering optimism’ that described tailoring, balancing and emotion management in giving personal chances of success; and (4) ‘transitioning to multi-cycle planning’ which identified worries of multi-cycle planning (e.g., need to learn from failure). Limitations, reasons for caution The majority of patients were women from private fertility clinics with no previous treatment experience recruited from social media websites, mainly associated with patient support groups. Similarly, the majority of HCPs were women from private fertility clinics. Informative comparisons across treatment stage, gender and funding source were therefore not possible. Wider implications of the findings: HCPs are hesitant towards multi-cycle planning. However, patients show openness, suggesting a cultural shift from the single cycle norm of planning IVF/ICSI may be possible. If adopted by clinics, HCPs patients and fertility organisations, multi-cycle planning could encourage patients to create informed treatment expectations and plans prior to treatment engagemen. Trial registration number MS200059_001