Importance Of Patient-centered Care Research Articles

Patient-Reported Outcomes Following Systemic Antibiotic Adjunct to Nonsurgical Treatment of Periodontitis: A Randomized Controlled Clinical Trial.

Considering the importance of patient-centered care, we aimed to evaluate the impact of systemic antibiotics on oral health-related quality of life during nonsurgical periodontal treatment. This controlled trial addresses a gap in understanding how systemic antibiotics influence patient-reported outcomes, focusing on Stage III periodontitis. Sixty-one adults participated in a double-blind, randomized clinical trial, with participants divided into two groups: the test group, which received antibiotics, and the control group. All the participants received nonsurgical periodontal treatment. We conducted follow-up assessments at one and 3 months posttreatment, including recording clinical parameters and administering the Oral Health Impact Profile-14 (OHIP-14) questionnaire. The results showed a notable improvement in the quality of life for patients in the test group compared to the control group at 1 month (p value = 0.012) and 3 months (p value = 0.014) after treatment. While there were improvements in pocket probing depth, gingival index, and clinical attachment loss in both groups, it is worth noting that only bleeding on probing exhibited a significant improvement in the test group after 3 months compared to the control group (p value = 0.008). In summary, incorporating systemic antibiotics alongside nonsurgical periodontal treatments appears to bring about positive outcomes for individuals dealing with Stage III periodontitis during nonsurgical treatment, ultimately enhancing their oral health-related quality of life. Iranian Registry of Clinical Trials (IRCT Id): IRCT20201221049786N1.

A Comprehensive Literature Review of Osteoporosis Treatment and Fracture Outcomes

Background: Osteoporosis remains a significant public health concern, particularly among the aging population, where the prevalence of the condition and associated fractures continues to rise. The literature surrounding osteoporosis treatment and fracture outcomes has evolved considerably over the past decade, reflecting advancements in pharmacotherapy and the importance of patient-centered care. Literature Review: The foundational article by (Body et al., 2012) highlights the expanding pharmacological options available for osteoporosis management, stressing the complexities involved in treatment selection due to the limited comparative evidence. This article sets the stage for understanding the broader landscape of osteoporosis therapies, where both skeletal and extraskeletal effects of treatments must be considered for informed clinical decision-making. In examining the treatment landscape, (Fontalis et al., 2019) provides insights into the mechanisms of action of various agents, such as bisphosphonates and denosumab, and discusses emerging therapies that may enhance treatment efficacy. This article underscores the importance of understanding the long-term safety profiles of these medications, as adverse effects can significantly influence treatment outcomes. Moreover, (Lin et al., 2021) offers a comprehensive meta-analysis comparing the efficacy and safety of various osteoporosis treatments for postmenopausal women. This work is pivotal in guiding clinicians toward selecting appropriate interventions based on the relative effectiveness of available therapies, particularly in the context of fracture prevention. Conclusion: In conclusion, the literature collectively emphasizes a comprehensive approach to osteoporosis management that incorporates advancements in pharmacotherapy, addresses adherence challenges, and prioritizes patient-centered care. This multifaceted strategy is critical for optimizing fracture prevention and improving the overall quality of life for individuals with osteoporosis.

Decision-making around removal of indwelling urinary catheters after pituitary surgery.

Diabetes insipidus (DI) is a common complication following pituitary surgery, causing significant health issues if left untreated. As part of the diagnostic process, accurate urinary output monitoring via indwelling urinary catheters (IDUCs) is essential, despite risks such as urinary tract infections and hindered recovery. Research on IDUC removal after pituitary surgery remains scarce. To explore health professionals' perspectives on IDUC management following pituitary surgery. Employing a qualitative design, semistructured interviews were conducted with 15 professionals in the neurosurgical ward of a Dutch academic hospital. Four themes emerged: Concerns about missing identifying DI, patient-nurse dynamics, workload management, and lack of shared decision making. The findings underscore the need to balance clinical needs with patient care efficiency. There is a need for evidence-based guidelines and a multidisciplinary approach to optimise IDUC management, given the importance of patient-centred care and shared decision-making.

Understanding the influences on hospital discharge decision-making from patient, carer and staff perspectives

BackgroundGaps in discharge planning are experienced by 41% of hospital patients in Australia. There is an established body of knowledge regarding the features of the discharge process that need to be improved to avoid subsequent hospital readmission and enhance the discharge experience. However, many of these studies have focused solely on factors related to unplanned hospital readmissions and there has been limited success in operationalising improvements to the discharge process. The aim of this study was to explore and describe the factors that influence the decision to discharge adult medical patients from hospital, from patient, carer and staff perspectives.MethodsA qualitative descriptive study was conducted in one acute medical ward in Melbourne, Australia. The study data were collected by observations of clinical practice and semi-structured interviews with patients, carers and staff. Participants were: i) English-speaking adults identified for discharge home, ii) patient carers, and iii) staff involved in the discharge process. Observation data were analysed using content analysis and interviews data were analysed using thematic analysis.ResultsTwenty-one discharges were observed, and 65 participants were interviewed: 21 patients, two carers, and 42 staff. Most patients (76%) were identified as being ready for discharge during morning medical rounds, and 90% of discharge decisions were made collaboratively by the medical team and the patient. Carers were observed to be notified in 15 discharges by the patient (n = 8), doctors (n = 4), or nursing staff (n = 3). Five themes were constructed from thematic analysis of interviews: Readiness for Home, Fragmented Collaboration, Health Literacy, Unrealistic Expectations, and Care beyond Discharge. A collaborative team and supportive carers were considered to enhance risk assessment and discharge planning, however fragmented communication between clinicians, and between clinicians and patients/carers was a barrier to discharge decision-making.ConclusionsOur study highlights the need for a more coordinated approach to discharge decision-making that optimises communication with patients and carers and multidisciplinary workflows and reduces fragmentation. The importance of patient-centred care and a personalised approach to care are well established. However, there is a need to design systems to customise the entirety of the patient journey, including the approach to discharge decision making.

“The healthcare system did fail me repeatedly”: a qualitative study on experiences of healthcare among Canadian women with Cushing’s syndrome

BackgroundAs a rare endocrine disorder, Cushing’s Syndrome (Cushing’s) is characterized by numerous symptoms and a non-specific presentation, leading to a delay to diagnosis for patients with this disease. To date, research examining the lived experiences of patients with Cushing’s in healthcare is absent in the literature. This preliminary inquiry into the healthcare experiences of women with Cushing’s aimed to examine the utility of this line of inquiry to support the patient centered care of individuals with Cushing’s.MethodsSeven women from across Canada with endogenous Cushing’s participated in the study. Semi-structured interviews were conducted examining participants’ healthcare and body-related experiences with Cushing’s. Results pertaining to healthcare experiences were analyzed for the current study using reflexive thematic analysis.ResultsFour themes emerged whereby women with Cushing’s experienced (1) a lack of patient centered care, characterized by provider miscommunication and medical gaslighting; (2) a misunderstanding of their symptoms as related to weight gain; (3) weight stigma in healthcare encounters; and (4) a shift in their quality of care following diagnosis.ConclusionsThe results highlight the importance of patient centered care as well as the negative impact of commonly reported barriers to patient centered care. Cushing’s specific barriers to patient centered care may include weight stigma as well as the rare incidence of Cushing’s. Further research is needed to better understand the healthcare experiences of people with Cushing’s in Canada.

Social determinants of health as barriers to care for vasculitis: perspectives of patients and healthcare providers.

This study examined patient and healthcare provider (HCP) perspectives on the impact of unmet social needs on healthcare barriers for patients with vasculitis. Two surveys were developed to gather perspectives from patients with vasculitis, and HCPs specializing in vasculitis care. The patient survey also included a 20-question social needs assessment. The data were analyzed using descriptive statistics. One hundred patients and 31 HCPs completed the surveys between September 2022 and June 2023. Fifty-six percent of patients reported unmet social needs, with poor social and mental health (30%) being the most common. Sixty-three percent of patients with vasculitis perceived unmet social need(s) as barriers to healthcare access. Financial insecurity (30%), poor mental health (29%), and poor health knowledge (25%) were the most common barriers identified. Overall, HCPs perceived SDOH have a greater impact on healthcare access than the patients surveyed. Most patients (82%) and HCPs (90%) believed rheumatologists should help in the management of SDOH, specifically health knowledge and mental health. Few HCPs (10%) felt well-positioned to address patients' mental health. Suggested interventions that address social needs and improve healthcare access included referrals to community-based resources, providing educational materials, and virtual visits. Through patient and HCP perspectives, the impact of SDOH on healthcare access for patients with vasculitis was explored. Understanding the positive experiences and challenges faced by patients is crucial for developing targeted interventions to enhance healthcare access. These findings underscore the importance of ongoing efforts to improve the healthcare experience for patients with vasculitis. Key Points • The impact of unmet social needs on healthcare access for patients with vasculitis, illustrates the complex relationship between SDOH and healthcare outcomes. • Unmet social needs among patients with vasculitis, included poor social and mental health, financial and food insecurity, and a lack of health literacy, which may exacerbate challenges leading to poor health outcomes. • The differences in perspectives between patients and healthcare providers regarding the impact of certain SDOH on healthcare access, necessitates the importance of co-production in the development of interventions to improve healthcare delivery. • The importance of patient-centered care and tailored solutions was highlighted by the need for various interventions to address social needs and improve healthcare access, such as referrals to community-based resources, educational materials, and interprofessional collaboration.

Patient experiences of information-sharing and patient-centred care across the broad landscape of primary care practice and provision: a nationally representative survey of Australian adults

BackgroundAustralian government strategies and frameworks have been developed in recent years to encourage the integration and coordination of primary care delivery; including patient-centred approaches to clinical and preventative care, and health promotion. This study aims to explore patient experiences of information-sharing and patient-centred care across various primary care clinical settings, with a particular focus on clinical encounters with GPs, naturopaths, osteopaths and acupuncturists.MethodsData about healthcare utilisation and experiences from a 63-item cross-sectional survey obtained from a nationally representative sample of Australian adults aged ≥ 18 years were analysed. Chi-square and Kruskal-Wallis H tests were used to explore differences in the experiences of knowledge and information sharing during GP consultations among those who also consulted with a naturopath, osteopath or acupuncturist, compared those who had not. Logistic regression was used to investigate correlations between participants perceptions about GP consultation outcomes, and the GP’s information-sharing behaviour or perceived experience of patient-centredness.ResultsAcross 2354 participants, verbal explanation (76.3%) and/or individualised handouts (16.8%) were the most common type of information shared in GP consultations. Individuals who consulted with a GP and a naturopath, an osteopath, or an acupuncturist reported a lower rate of receiving a verbal explanation from their GP but higher rate of receiving other types of information sources including handouts. Over one quarter of study participants who visited a GP did not discuss any of their health information with their GP. Information sharing was lower for individuals who also visited a naturopath, osteopath or acupuncturist. Participants scored their consultations with a GP as patient-centred, but these scores were lower among participants who also consulted with at least one other primary care practitioner type included in the study.ConclusionsPublic health and health services researchers, policymakers and leaders of primary care professions have a role and responsibility to ensure practitioners are confident and competent in sharing health information with their patients that considers their health literacy needs, and the importance of patient-centred care. Research focussed on a more in-depth understanding of the differences and relationships observed across the primary care landscape in this study is recommended.

STUDENTS GAIN APPRECIATION FOR PATIENT-CENTERED AND TEAM-BASED CARE PARTICIPATING IN A GERIATRIC CASE COMPETITION

Abstract Health science students must attain interprofessional teamwork and collaboration competencies to provide effective, patient-centered care to older adults requiring complex care. However, students typically learn in disciplinary silos and lack engaging opportunities for interprofessional teamwork. To provide students with an interprofessional learning activity the Geriatric Workforce Enhancement Programs (GWEP) at Saint Louis University and the University of Minnesota implemented a Geriatric Case Competition. We present the students’ experience with the 2022 competition. Students assigned to interprofessional teams with a coach had one month to prepare a 20-25 minute presentation of a comprehensive care plan using a simulated complex geriatric patient case. Judges scored team presentations using a rubric of core competencies for interprofessional collaborative practice. Each GWEP held local competitions with winning teams presenting at the inter-GWEP competition held via live videoconferencing. Top scoring teams received prizes. Students completed an eight-item satisfaction survey using a 5 point likert scale (5=poor to 1=excellent). Answers to open ended questions were analyzed qualitatively to find themes about their experience. 132 students joined the competition and 54 completed an evaluation survey (response rate 41%). Students rated their experience as good to excellent with mean ratings on 8 questions ranging from 1.5-2.2 (N=54). Themes included: the importance of patient centered care and the power of multiple perspectives/expertise. Students offered improvements related to student, coach, and judge expectations. In summary, the competition provided a very positive learning activity that helped students value the importance of patient centered care and interprofessional collaboration for older people.

Explaining a diagnosis of fibromyalgia in primary care: a scoping review.

Fibromyalgia is a common cause of chronic pain in the UK, with a huge individual and societal impact. Despite this, it remains difficult to diagnose and treat. The explanation of a fibromyalgia diagnosis can lead to difficult therapeutic relationships, with attitudinal issues and negative profiling of patients. This can lead to frustration, and have a harmful impact on health outcomes. To review how an explanation of a fibromyalgia diagnosis is provided in primary care in order to establish a model of best practice when educating patients on their diagnosis. Scoping review of articles written in English. MEDLINE, Embase, Web of Science, and grey literature were searched. Articles were extracted, reviewed, and analysed according to the inclusion criteria. In total, 29 records met the inclusion criteria. The following six overarching themes were identified: patient education; physician education; importance of the multidisciplinary team; importance of patient-centred care; the value of primary care; and useful resources. The literature illustrated that describing fibromyalgia using analogies to illustrate the pain sensitisation process can help patients understand their diagnosis better. This improves their willingness to accept management plans, particularly engagement with non-pharmacological therapies, which the literature suggested are best delivered within a multidisciplinary team. Key aspects of fibromyalgia should be explained to patients in order for them to gain a better understanding of their diagnosis. A 'one-size-fits-all' model for explaining the fibromyalgia diagnosis to patients is inappropriate because patients' experiences are individualised. Further research is required on whether different explanations impact patient outcomes.

Gender affirming surgery in non-binary patients: The importance of patient-centered care

Gender-affirming mastectomies are a growing necessity for transgender and gender-diverse patients. The preoperative evaluation and surgical outcome must be tailored to the individual, taking into consideration previous medical history, medications, hormonal therapy, patient anatomy, and expectations. Although non-binary patients constitute a significant portion of patients referring for gender-affirming mastectomies, current literature rarely acknowledges them as a separate patient category from trans-masculine patients. Retrospective cohort, demonstrating the single-surgeon experience with gender-affirming mastectomies over the course of 2 decades. A total of 208 patients were included in this cohort, patients identifying as "non-binary" in gender accounted for 30.8% of the cohort. Non-binary patients were found to be younger (P value<0.001) at the time of surgery, at the time of HRT initiation (P value<0.001), at the first feeling of gender dysphoria, coming out to society, and use of non-female pronouns (P value = 0.04,<0.001 and<0.001, accordingly). In the non-binary patient group, a shorter period of time passed from the first feeling of gender dysphoria to initiation of HRT and surgery (P value<0.001 and<0.001, accordingly). However, the average time from HRT initiation to surgery and from the first use of non-female pronouns to HRT initiation or surgery did not statistically differ (P value= 0.34, 0.06, and 0.08, accordingly). Non-binary patients demonstrate a significantly different timeline from trans-masculine patients in terms of gender development. In order to accommodate their needs, caregivers must take the information into consideration and develop appropriate guidelines and courses of action.

Patients' experiences of patient-centred care in hospital setting: A systematic review of qualitative studies.

Patient-centred care (PCC) has been proposed as an appropriate approach for addressing current shifts in healthcare needs. Although the importance of PCC is generally recognised, PCC is poorly understood by patients in the hospital settings. To identify patients' experiences of PCC in hospital settings. This systematic review followed the Joanna Briggs Institute's (JBI) guidance for systematic reviews of qualitative evidence and the PRISMA checklist for reporting systematic reviews. The search strategy included peer-reviewed qualitative studies published after 2010 in English or Finnish. The databases searched were SCOPUS, MEDLINE, CINAHL and Medic. Unpublished studies and grey literature were searched in MedNar. Ten qualitative studies were included, and their quality was assessed by two independent reviewers using JBI quality assessment criteria. The data were analysed using thematic analysis. Studies were included if they had explored adult patient experiences of PCC in hospital settings. A thematic analysis produced 14 subthemes which were grouped into five analytical themes: the presence of the professional, patient involvement in care, receiving information, the patient-professional relationship and being seen as a person. This review suggests that the implementation and provision of PCC in hospitals is incomplete and patients' involvement in their own care should be in the focus of PCC. The majority of patients experienced receiving PCC, but others did not. The need for improvement of patient involvement was strongly emphasised. Patients highlighted the importance of professionals being present and spending time with patients. Patients felt well-informed about their care but expressed the need for better communication. Meaningful patient-professional relationships were brokered by professionals demonstrating genuine care and respecting the patient as an individual. To improve the implementation of PCC, patient experiences should be considered in the development of relevant hospital care strategies. In addition, more training in PCC and patient-professional communication should be provided to health care professionals.

Evaluation of a simulation-based learning activity for communicating about at-risk opioid behaviors in a community pharmacy setting

The purpose of our study was to evaluate a learning activity that included an objective structured learning examination (OSLE) focused on identifying and communicating at-risk opioid behaviors in a community pharmacy setting through student perceptions and OSLE performance. The activity included a didactic lecture and an OSLE with two opioid use patient cases. Third-year pharmacy students' communication skills were evaluated using faculty-created rubrics. A voluntary, anonymous pre-/post-survey evaluated students' skills confidence and OSLE satisfaction. Responses were analyzed using independent t-tests. An inductive conventional content analysis identified the impact on students' perceptions and future behaviors from post-simulation reflections. One hundred forty-three and 111 students completed the pre- and post-surveys, respectively. Students self-reported confidence in their ability to identify red flags and assess at-risk opioid behaviors, counsel on opioid risk behaviors, refuse opioid prescription fills, and respond to patients' nonverbal responses, all significantly improved pre-to-post. Students reported the OSLE was beneficial to their learning. The mean overall OSLE score was 34.2 out of 45 points (SD±6.21). Identified student reflection themes included: importance of patient-centered care, pharmacists' role in patients with at-risk opioid behaviors, recognition of judgement against patients taking opioids, and importance of communication and empathy as strategies to mitigate conflict. Implementing a new learning activity focused on communication regarding at-risk opioid behaviors allowed students to engage in difficult conversations with standardized patients in a safe simulation environment. Students demonstrated competent skills, increased their self-reported confidence, and were highly satisfied with the learning activity.

Nurse Educators' Perceptions of Teaching Patient-Centered LGBTQ+ Gender-Affirming Care to Undergraduate Students.

Nurse educators are uniquely positioned to equip students with the knowledge, skills, and attitudes to provide LGBTQ+ persons with culturally congruent inclusive care. Using Quality and Safety Education for Nurses' patient-centered care competency as a framework, this study used a qualitative exploratory-descriptive design to investigate nine undergraduate nurse educators' perceptions of teaching LGBTQ+ gender-affirming care. Three themes emerged from the interviews denoting challenges: importance of patient-centered care, limited knowledge, and barriers to curricular integration. Incorporating LGBTQ+ topics across the undergraduate nursing curriculum is necessary to support the delivery of person-centered care.

Attitudes Toward a Pre-authorized Concealed Opioid Taper: A Qualitative Analysis of Patient and Clinician Perspectives.

Standard opioid tapers tend to be associated with increased patient anxiety and higher pain ratings. Pre-authorized concealed opioid reductions may minimize expectations such as fear of increased pain due to the reduction of opioids and, prolong analgesic benefits in experimental settings. We recently observed that patients and clinicians are open to concealed opioid tapering. However, little is known about the “why” behind their attitudes. Based on this lack of data, we analyzed qualitative responses to survey questions on patients' and clinicians' acceptance of a concealed opioid reduction for chronic pain. Seventy-four patients with a history of high dose opioid therapy and 49 clinicians completed a web-based questionnaire with open-ended questions examining responses to two hypothetical clinical trials comparing a concealed opioid reduction pre-authorized by patients vs. standard tapering. We used content analysis based on qualitative descriptive methodology to analyze comments from the patients and clinicians. Five themes were identified: informed consent; anxiety; safety; support; and ignorance is bliss, or not. These themes highlight the overall positive attitudes toward concealed opioid tapers. Our findings reinforce the importance of patient-centered care and are expected to inform the design of clinical trials from both the patient and clinician perspective. This qualitative study presents patients' and clinicians' attitudes toward hypothetical scenarios for a trial of pre-authorized reduction of opioids. The findings indicate positive attitudes and the relevance of engaging patients with effective decision-making processes.

174 Increased Self-Efficacy in General Practice and Higher Psychiatric Trainees Following Simulation-Based EDUCATION TO SUPPORT INTER-PROFESSIONAL CO-CONSULTING IN PRIMARY CARE

Learning Together is a training model providing general practice (GP) and higher psychiatric trainees with peer learning opportunities across London in partnership with Health Education England. The initiative encompasses inter-speciality training days and joint clinics delivered by trainee pairs aiming to bridge the gap between mental healthcare in primary and secondary care. On the basis of this model, a full-day online simulation-based education (SBE) course for these groups was designed and delivered with a specific focus on inter-professional education and issues related to co-consulting The aim of this study was to use SBE to enable sharing of knowledge, skills and approaches to clinical practice to improve inter-professional collaboration in the context of co-consulting in primary care.A full-day online SBE course for GP (ST2/3) and higher psychiatric trainees (ST4 and above) was delivered to 64 participants over six deliveries. It included five live scenarios using professional actors depicting mental health presentations to reflect the overall learning objectives. Scenarios were followed by a structured psychologically informed debrief chaired by trained facilitators with support from an external senior GP. A mixed-methods evaluation was used. Participants completed the Human Factors Skills for Healthcare Instrument (HuFSHI) pre- and post-course, rating their level of self-efficacy in managing issues, such as ‘constructively managing others’ negative emotions at work’ and ‘working effectively with a new team in clinical situations’ (Cronbach’s alpha = 0.96) Responses from 51 participants were analysed (response rate = 79%). Median HuFSHI scores increased from 70 to 86 for the overall group (Z = 5.881, p &lt; 0.001). Sub-group analysis between both trainee groups (i.e. GP and higher psychiatric trainees) showed no significant HuFSHI score differences. High scores were reported for scenario quality (90% of participants) and provision of a safe and constructive learning environment (91.7% of participants). Ninety per cent of respondents would recommend the course to colleagues. Emerging themes from the qualitative data were positive reflections on the importance of patient-centred care and appreciation of the value of inter-professional collaboration and joint clinics.Findings demonstrated improvements in participants’ self-efficacy as measured by HuFSHI. Qualitative data suggest a deeper understanding and appreciation of patient-centred care and inter-professional collaboration. Considering the need for early intervention, prevention and delivery of mental healthcare in primary care, this early evidence supports the potential role of SBE in developing integrated care.

Implementation of a Diabetes Self-Management Education and Support Intervention in Rural Guatemala: A Mixed-Methods Evaluation Using the RE-AIM Framework.

IntroductionTo address the global diabetes epidemic, lifestyle counseling on diet, physical activity, and weight loss is essential. This study assessed the implementation of a diabetes self-management education and support (DSMES) intervention using a mixed-methods evaluation framework.MethodsWe implemented a culturally adapted, home-based DSMES intervention in rural Indigenous Maya towns in Guatemala from 2018 through 2020. We used a pretest–posttest design and a mixed-methods evaluation approach guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Quantitative data included baseline characteristics, implementation metrics, effectiveness outcomes, and costs. Qualitative data consisted of semistructured interviews with 3 groups of stakeholders.ResultsOf 738 participants screened, 627 participants were enrolled, and 478 participants completed the study. Adjusted mean change in glycated hemoglobin A1c was −0.4% (95% CI, −0.6% to −0.3%; P < .001), change in systolic blood pressure was −5.0 mm Hg (95% CI, −6.4 to −3.7 mm Hg; P < .001), change in diastolic blood pressure was −2.6 mm Hg (95% CI, −3.4 to −1.9 mm Hg; P < .001), and change in body mass index was 0.5 (95% CI, 0.3 to 0.6; P < .001). We observed improvements in diabetes knowledge, distress, and most self-care activities. Key implementation factors included 1) recruitment barriers for men, 2) importance of patient-centered care, 3) role of research staff in catalyzing health worker involvement, 4) tradeoffs between home and telephone visits, and 5) sustainability challenges.ConclusionA community health worker–led DSMES intervention was successfully implemented in the public health system in rural Guatemala and resulted in significant improvements in most clinical and psychometric outcomes. Scaling up sustainable DSMES in health systems in rural settings requires careful consideration of local barriers and facilitators.

Role of the prescriber in supporting patients to discontinue benzodiazepines: a qualitative study.

BackgroundGiven the prevalence of long-term benzodiazepine (BZD) prescribing, increased monitoring through the implementation of prescription monitoring programmes (PMPs) may be the necessary impetus to promote BZD deprescribing. Despite evidence promoting the importance of patient-centred care, GPs have not been sufficiently supported to implement these principles through current deprescribing practice.AimTo investigate patients’ perception of their prescriber’s influence on ceasing BZD use, including their willingness to take their advice, and to understand how a patient’s stage of change influences the barriers and facilitators they perceive to discontinuing BZDs.Design and settingAn online survey and qualitative interviews with 22 long-term users of BZD (≥6 months), aged 18–69 years, recruited from the general population in Victoria, Australia.MethodTwo groups of users of BZD participated, one in the process of reducing their BZD and one not reducing, and were categorised according to their stage of change. Data underwent thematic analysis to identify barriers and facilitators to reducing BZDs both at the patient level and the prescriber level.ResultsBZD patients’ perceptions of the prescriber influence were characterised by prescribing behaviours, treatment approach, and attitude. Barriers and facilitators to reducing their BZD were mapped against their stage of change. Irrespective of their stage of change, participants reported they would be willing to try reducing their BZD if they trusted their prescriber.ConclusionThis study illustrates that, with a few key strategies at each step of the deprescribing conversation, GPs are well positioned to tackle the issue of long-term BZD use in a manner that is patient centred.

Patient centred care in diagnostic radiography (Part 3): Perceptions of student radiographers and radiography academics

Awareness is growing of the importance of patient centered care (PCC) in diagnostic radiography. PCC is embedded within professional body publications and guidance documents, but there is limited research evidence exploring the perceptions of student radiographers and radiography academics. This paper reports Stage 1 and Stage 2 of the project from the perspective of radiography academic and student radiographer participants, and compares these to the perspectives of service users, clinical radiographers and radiography managers reported previously. Stage 1 used an online survey tool to gauge participant agreement with a series of attitudinal statements. Stage 2 used situational vignettes to promote discussion and debate about PCC approaches. Response rates to the Stage 1 survey were above the minimum threshold, with 50 responses from student radiographers and 38 responses from radiography academics. Stage 1 participants were asked to participate in Stage 2 on a voluntary basis. As with service users and service deliverers, care communication, event interactions and control over environment were the key influences on PCC. However, students highlighted differences between reported and observed levels of PCC. There is some way to go to embed PCC in diagnostic radiography practice. As impartial observers of radiography practice, student radiographers highlight the difference between service users and service deliverer's perceptions of PCC. Whilst the focus of clinical radiographers remains on efficiency, it is difficult for student radiographers to challenge the accepted norm. Role models are required to promote PCC behaviours and a holistic approach in radiography practice. A package of educational support and audit tools will be made available to support both service deliverers and student radiographers to deliver PCC.

The importance of patient-centered care during the COVID-19 pandemic: lessons from a rural ward in Japan.

The importance of patient-centered care during the COVID-19 pandemic: lessons from a rural ward in Japan.

Responding to the Series "Education in the Time of COVID-19".

The increasing awareness of the importance of patient-centered care reflects the need of educators to design experiences that both simulate care and stimulate problem-solving. Kudos to all the educators out there who are re-examining their approach to learning.