Improve Patient Confidence Research Articles

Follow-Up Care Provider Preferences of Adolescent and Young Adult Cancer Survivors.

To explore the experiences and perspectives of adolescent and young adult (AYA) cancer survivors regarding patient-provider relationships and their preferences surrounding type of healthcare provider for follow-up care. We recruited AYA cancer survivors who were diagnosed between the ages of 15 and 39 using the Utah Cancer Registry. Twenty-eight survivors participated in six focus groups held between March and May of 2015 in Salt Lake City and St. George, Utah. This analysis focuses on how survivors' preferences about type of healthcare provider may influence their transition into, and utilization of, follow-up care. On average, survivors were 6.3 (standard deviation = 1.7) years from their cancer diagnosis. A majority of survivors expressed a desire not to transition to a new provider and preferred continuing to see their oncologist for follow-up care. For these survivors, this was due to already having a close relationship with their oncologist and because they trusted their provider's knowledge about cancer and how to handle late effects. However, survivors placed emphasis on being comfortable with their healthcare provider, regardless of provider type. Our findings demonstrate the importance of formalizing provider transitions and roles after cancer therapy to improve patient comfort with new providers. By understanding the complexities of the transition from active cancer treatment to follow-up care for AYA survivors, these findings can inform programs undertaking post-care educational activities to ensure a seamless transition into survivorship care. Survivorship care plans can facilitate these transitions and improve patient confidence in follow-up care.

Confidence in correct inhaler technique and its association with treatment adherence and health status among US patients with chronic obstructive pulmonary disease.

BackgroundImproper use of bronchodilators is associated with poor disease control, nonadherence to long-term therapy, and poor clinical outcomes. Our current understanding of factors associated with correct inhaler use and adherence is limited. We measured physician-and patient-reported confidence in device usage and associations with treatment adherence and COPD-related health status.MethodsThis was an analysis of a US observational, point-in-time survey of physicians and patients. Physicians who met study eligibility criteria completed surveys for 5 consecutive, eligible patients who were then invited to respond to questionnaires. We assessed patient demographics, type of prescribed inhaler device(s), device training, COPD severity, comorbidities, physician-and patient self-reported confidence in device usage, treatment adherence, and health status.ResultsCompleted questionnaires for 373 patients were provided by 134 physicians. Complete confidence in device usage was observed for 22% and 17% of patients as reported by patients and physicians, respectively. Greater confidence was associated with higher self-reported adherence to inhaler usage. Physicians were more likely than patients to report lower levels of patient confidence in device usage. High physician- and patient-reported confidence were associated with more favorable health status. Predictors of confidence in device usage included fewer comorbidities, no depression, and higher education levels.ConclusionLow confidence in inhaler usage was associated with lower adherence and poor COPD-related health status. Choice of inhaler device tailored to patients’ ability to use specific devices and ongoing education to support optimal inhaler usage may improve patient confidence and enhance both adherence and health status.

A Shared Medical Appointment on the Benefits and Risks of Opioids Is Associated With Improved Patient Confidence in Managing Chronic Pain.

Objectives:To evaluate a shared medical appointment (SMA) on opioids in the treatment of chronic pain.Research design:This prospective study was conducted at an ambulatory clinic within a health-care delivery system. The SMA is a single 90-minute encounter, led by a physician. We included adult patients who attended the SMA and completed an immediate pre–post survey. Survey items were measured on a scale from 0 (worst) to 5 (best). Mean differences in pre–post responses were assessed by a paired t test.Results:A total of 130 patients were included in the analysis. Patients showed improvements in confidence in self-managing pain (+0.44; 95% confidence interval [CI]: 0.29-0.59; P < .001) and their providers’ ability to help manage pain (+0.28; 95% CI: 0.14-0.43; P < .001). Most patients (81%) were very/extremely satisfied with the SMA.Conclusions:An SMA on the benefits and risks of opioids was associated with prompt improvements in patients’ confidence in self-managing pain and in their health-care providers’ ability to help manage pain. Such confidence can lay the foundation for increased patient engagement and activation in pain management.

Examining patient-provider relationship (PPR) quality and patient activation in the Medicare population.

Patient activation describes an individual's willingness and ability to take actions to independently manage health. Additional qualities of the relationship between a patient and provider may play a role in patient decision-making and motivation. (1) To describe patient characteristics for groups who perceive different quality levels of PPR. (2) To examine the association and determine the effect of PPR on patient activation. The Medicare Current Beneficiary Surveys was used to gather information on patient confidence, information seeking behaviors, and PPR. Scores for each variable set were categorized and described. Odds ratios were calculated using multinomial logistic regression models adjusting for sociodemographic variables. The study included 15,185 beneficiaries, 4198 (27.6%) were categorized as low PPR, 6752 (44.5%) were moderate PPR, and 4235 (27.9%) high PPR. Adjusting for covariates, patients with moderate PPR and high PPR were more likely to have higher confidence when making healthcare decisions and exhibit information seeking behaviors compared to low PPR beneficiaries. This study supports the notion that patients with stronger relationships with their providers are also more active in healthcare decisions. After adjusting for gender, race, age, education, and income, high-quality PPR was still found to be associated with increased levels of activation in the Medicare population. High-quality patient-provider relationships are associated with improved patient confidence and information seeking behaviors. Provider-centered strategies to improve patients' connections to their physicians may motivate patients to engage in the healthcare process.

The use of flange extenders to support patient care.

Pat Black, Senior Lecturer, St Mark's Institute of GI Nursing, St Mark's Hospital, explores one option for stoma care nurses to consider that could help improve patient confidence and comfort.

Dynamic consent: a possible solution to improve patient confidence and trust in how electronic patient records are used in medical research.

With one million people treated every 36 hours, routinely collected UK National Health Service (NHS) health data has huge potential for medical research. Advances in data acquisition from electronic patient records (EPRs) means such data are increasingly digital and can be anonymised for research purposes. NHS England’s care.data initiative recently sought to increase the amount and availability of such data. However, controversy and uncertainty following the care.data public awareness campaign led to a delay in rollout, indicating that the success of EPR data for medical research may be threatened by a loss of patient and public trust. The sharing of sensitive health care data can only be done through maintaining such trust in a constantly evolving ethicolegal and political landscape. We propose that a dynamic consent model, whereby patients can electronically control consent through time and receive information about the uses of their data, provides a transparent, flexible, and user-friendly means to maintain public trust. This could leverage the huge potential of the EPR for medical research and, ultimately, patient and societal benefit.

Evaluation of Student Pharmacist and Pharmacist Impact on Disease State Management and Patient Satisfaction in Adult Patients with Asthma

Abstract Objective: To measure the success of student pharmacist intervention, with pharmacist oversight, on improvement in asthma disease state control and patient satisfaction in an adult population with asthma Design: Prospective study Setting: Regional chain community pharmacy, independent chain pharmacy, and a university campus located in Pittsburgh, Pennsylvania Patients: Data was collected from all asthmatic patients aged 18-65 presenting with one or more inhaled medications within the study dates at five study locations Interventions: Asthma severity and control were assessed for each patient enrolled in the study through the use of spirometry screenings, inhaler technique checklists, the Asthma Control Test (ACT), and patient satisfaction questionnaires Main Outcome Measured: Patient confidence level with disease management and improvements in inhaler technique following student pharmacist intervention Results: Data was analyzed for six participants using repeat-measures ANOVA. A trending improvement in all areas was noted, in particular, improved patient confidence after the intervention. Conclusion: Results of this study show improved patient confidence in asthma control after student pharmacist intervention. This type of intervention could be easily performed by a student intern or pharmacist in a community setting.

Development and Evaluation of an Internet and Personal Health Record Training Program for Low-income Patients With HIV or Hepatitis C

Vulnerable populations face difficulties accessing and using the internet and personal health record (PHR) systems for health-related purposes. Populations disconnected from the internet also tend to be disconnected from health care services. To develop and evaluate an intervention to increase skills in health-related internet and PHR use for vulnerable populations with limited computer and internet experience. Preevaluation and postevaluation using quantitative surveys, semistructured interviews, focus groups, and ethnographic observation. Fourteen low-income Veterans receiving care at Veterans Affairs medical centers for human immunodeficiency virus or hepatitis C. Internet and PHR use, self-efficacy, patient activation, disease knowledge, predictors of medication adherence. At follow-up one (FU1), mean number of internet for health features used increased from 1.57 to 4.07 (P<0.001) as did number of PHR features, from 0.36 to 2.00 (P<0.001). Mean self-efficacy increased at FU1, from 7.12 to 8.60, (P=0.009) and was maintained at follow-up two (FU2). Patient activation increased only at FU2, from 3.42 to 3.61 (P=0.03). Disease specific knowledge showed borderline increase at FU1, from 67.9% to 72.2% (P=0.05), whereas there were no changes in predictors of medication adherence. Qualitative findings underscored the interest in using internet and PHRs and their contribution to increased engagement in care. Training cost per participant was $287. Group training of vulnerable patients represents a cost-effective method to increase internet and PHR skills, and improve patient confidence in finding health-related information, making online health-related transactions, and interacting with health care providers.

The Design and Development of a New Light-Weight Portable Oxygen System

Background: Patients with respiratory disorders such as chronic obstructive pulmonary disease (COPD) are prescribed oxygen therapy, but frequently fail to use it as intended and therefore do not receive the associated health benefits. Many of the reasons for this non adherence to therapy relate to the design of the equipment currently provided. We have designed and developed a novel system for portable oxygen delivery to overcome this problem. Method of Approach: There were five complementary workpackages (user involvement and exploratory work; ultra lightweight cylinder technology; embedded valve regulator technology; patient-driven system design; regulatory design &amp; manufacturing review). Each had specific deliverables supporting the end point of the program, i.e., to have a fully functioning prototype oxygen delivery system that had been designed and evaluated with maximum input from end users. Results: Patients primarily wanted a lightweight, long lasting, reliable, unobtrusive and ergonomically designed system with simple controls. To provide this, we have developed a new full wrap composite cylinder that has achieved weight savings of ∼12% over a comparative composite cylinder, or a doubling in cylinder design life. We have developed a totally new concept in valve regulator technology, conferring significant reductions in weight and space envelope. We have addressed form factor, flow dial design and flow setting indicator design to improve the ergonomics and esthetics of the system. The developed prototype system weighs 1.7 kg when full, is 34.2 cm in height and 8.5–8.7 cm in diameter, and is capable of 8 h operation at a flow rate of 2 liters per minute, using a standard conserver. Conclusions: Throughout this project, a significant amount of time was invested in establishing the views and perceptions of potential end-users of the new system. This has ensured that their views informed the design and development process. By combining novel cylinder technology with revolutionary valve technology (SmartFlow) we have been able to design an ultra-light cylinder oxygen system (IOS®) with accurate, reliable and stable flow. The weight reduction combined with the new easy-to-read gauge and user-friendly controls should improve patient confidence in the system and result in increased adherence to therapy.

A pledge would be more attractive if it was introduced for managers too

I doubt that a professional pledge for nurses would improve patient confidence in nursing or raise morale in the profession (analysis May 26). The Nursing and Midwifery code of conduct is clear enough and an extra pledge will only confuse the issue.

Would a pledge help to improve patient confidence in nursing?

Would a pledge help to improve patient confidence in nursing?

Dose Accuracy of SoloSTAR and FlexPen as Assessed in a Clinical Setting

This study aimed to compare the accuracy of SoloSTAR(sanofi-aventis, Paris, France) and FlexPen (Novo Nordisk, Bagsvaerd, Denmark) to deliver doses of insulin when used by insulin/device-naive people attending a local healthcare practice. For the determination of dose accuracy, SoloSTAR containing insulin glargine (lot 672) and FlexPen containing insulin aspart (lot SH70557) were used for all tests. The participants were given instruction by an independent monitor on how to use the pens. To be consistent, users were trained to hold the pens in situ for 10 s at the end of injection to ensure that the full dose was injected. Forty-eight subjects performed three dose deliveries of 20 units (into a sponge) with each pen type. The method of injecting into a sponge aimed to mimic real-life practice; this approach is commonly used to ensure the patient has a correct injection technique before the patient self-administers the injection. The delivery (n = 144) of individual doses of 20 units was not statistically different (P = 0.187) between SoloSTAR (mean +/- SD, 19.75 +/- 0.30 units) and FlexPen (19.80 +/- 0.33 units). In total, 2% of doses from both devices were <19 units; 98% were within 19-21 units. Both SoloSTAR and FlexPen were similarly accurate when used by device-naive subjects to deliver 20-unit doses of insulin. This is likely to have beneficial clinical effects in terms of glycemic control, as well as improved patient confidence that insulin pens accurately deliver doses of insulin.

Additional Benefits of Home Blood Pressure Monitors

To the Editor: We read with interest the call to action on the use of home blood pressure (BP) monitors by Pickering et al1 in the July issue of Hypertension . This article mentioned numerous benefits of having BP monitors and advocated use in several special populations. We suggest adding 2 additional benefits, improved BP control and improved patient confidence in self-management, and 1 additional population, indigent individuals. Possession and use of a home BP monitor has the potential to improve patient knowledge concerning BP control, enabling better decisions and promoting confidence in BP management. This is the basis of …

Adherence to antiviral therapy in chronic hepatitis C

Adherence or compliance with the prescribed treatment regimen is an important factor that determines the success of therapy in chronic hepatitis C. A multidisciplinary team approach is required in order to educate and communicate effectively with the patient, individually tailor the prescribed regimen, provide organizational support, develop dispensing aids, and deal with side effects or psychosocial issues. Such measures can only improve patient confidence with the proposed treatment, hopefully resulting in improved healthrelated outcomes.

Work-related low back injuries caused by unusual circumstances.

Expanding the knowledge of issues that surround work-related injuries allows for the development of more successful work accident prevention policies, treatment and rehabilitation protocols, and education programs. Specifically, clinical observation indicated that many patients did not perceive or report the circumstances of the injury as being part of their regular duties. The objective of this study was to investigate whether unusual activities or circumstances at work played any significant role in the rehabilitation of patients with disabling low back pain. Four hundred thirty-seven patients with severe disabling pain due to work-related injuries and surgery as an option for treatment were studied. The circumstances at the time of the accident were investigated, including demographic data, type of job held at the time of injury, rapport with supervisor, recent cutbacks in job force, and number of highly related injuries. Thirty-three percent of workers were injured while performing their ordinary job duties, with lifting implicated as the most common cause of injury (66%) followed by pushing/pulling (13%). In most patients (67%), the injury occurred under unusual circumstances or activities not normally described in the worker's job routine. This finding has not been previously addressed and implies that physical therapists can improve patient confidence about rehabilitation and returning to work by educating the patients about these circumstances.

Caring for the adolescent diabetic.

The management of insulin-dependent diabetes mellitus is a challenge for the adolescent patient, his/her family and the health-care team supporting them. If treatment is to be successful and the longer-term complications of diabetes averted or delayed, nurses need to understand the various psychological and physiological factors that contribute to the difficulties in maintaining glycaemic control during this life stage. This article examines some of these factors with a view to encouraging nurses to adopt strategies that will improve patient confidence and coping skills in diabetic care.

A Survey of 800 Patients?? Knowledge, Attitudes, and Concerns Regarding Anesthesia

The present study was undertaken to assess patients' knowledge, attitudes, and concerns regarding anesthetic management. A survey of 34 items was developed and administered preoperatively to 800 consecutive patients. Included were 303 men and 497 women with a mean age 52 yr and a mean educational level of 12 yr. Patients were interviewed on their knowledge of the role and training of anesthesiologists and on their preferences regarding anesthetic management. Patients also rated the intensity of their concern on 20 written statements expressing potential anesthetic complications. Results indicated that patients' perceptions of the anesthesiologist's training and role were accurate. Most patients preferred (a) general to regional anesthesia and (b) not to select their own anesthesiologist. Most significant preoperative concerns regarding the anesthesiologist focused on experience, qualifications, and presence or absence during the anesthesia. Patient concerns also included the possibility of not waking up postoperatively, experiencing pain, and becoming paralyzed. Intensity of concern was inversely related to age and unrelated to educational level or occupation. Variables related to type of concern included patient's sex, type of anesthesia, and proposed surgical procedure. Issues of least concern included disclosure of personal matters during anesthesia, experiencing impaired judgment postoperatively, and being asleep or bedridden for a prolonged period of time. It is suggested that anesthesiologists address significant patient concerns during the preoperative visit to enhance their effectiveness in patient care. Efforts to educate the public on the anesthesiologist's role in perioperative care should improve patient confidence.

The Impact of Fever Health Education on Clinic Utilization

We evaluated the ability of an office health education program to (1) increase parental knowledge about fever in children, (2) improve parental satisfaction with services, and (3) affect the number of fever-associated clinic visits. Randomly selected experimental and control groups differed only in that the former group viewed a slide-tape presentation. Testing of population samples before and after the presentation disclosed a highly significant improvement in knowledge about fever in the experimental population that persisted for almost 6 months. Monitoring of subsequent clinic visits revealed a 30% to 35% decrease in visits for fever and a 20% to 25% decrease in all visits for acute problems. These findings suggest that an audiovisual health education intervention can significantly improve patient confidence in managing fever as reflected by decreased clinic visits. This program is potentially useful in both the office and clinic in a health maintenance organization setting.