Levels Of Patient Engagement Research Articles

Assessing patient engagement levels in clinical cancer research: Development of a novel evaluation tool and comparison between eastern and western countries.

11018 Background: Patient Public Involvement and Engagement (PPIE) is essential in healthcare and cancer research. Currently, there is no objective method to assess at which stage of a clinical trial PPIE is effectively implemented. In this study, we developed a simple method for objectively assessing PPIE with an international scale. Methods: A novel, simple scoring method was developed to evaluate the PPIE implementation in cancer research. It follows the EUPATI Patient Engagement Roadmap and assesses PPIE at eight steps: defining research priorities, fundraising, protocol, informed consent, ethical review, investigator meeting, study results reporting, and application. PPIE level was self-rated by investigators on a five-level engagement scale: no engagement, considered, informed, actively involved, and co-creation. It was submitted to 124 Japanese and 203 European principal investigators (PI) of non-commercial sponsor cancer research clinical trials, conducted between January 2018 and December 2022, identified from publicly available databases (EudraCT, UMIN, jRCT). Results: The questionnaire was answered by 66 (53.2%) and 45 (22.2%) of the Japanese and European PIs, respectively. Overall, the PPIE implementation was low in both regions, with a “no engagement” rate of 61.7% in Europe and even lower, 78.5%, in Japan. Forty percent of the European PIs actively engaged patients (“actively involved” and “co-creation”) in at least one research step, versus only 16.7% of the Japanese PIs. The percentage of PIs answering “no engagement” in all eight steps was 47.0% in Japan and 11.1% in Europe. PPIE was the highest for the informed consent domain, with 73.3% of the European and 20.3% of the Japanese PIs reporting some level of engagement. Similarly, 55.6% of the European and 18.8% of the Japanese PIs involved PPIE in the ethical review domain. PPIE was notably low in the earlier steps of the research. Conclusions: Our innovative PPIE scoring method allowed us to objectively assess PPIE in cancer clinical trials and compare its implementation among different countries. This 2018-2022 snapshot revealed low (EU) to very low PPIE (Japan) levels, especially in the research design. Future assessments should help to monitor the enhancement of PPIE in cancer research on an international scale.

Evaluation of Patient Experiences with PocDoc, a Web-Based Eye Screening Tool.

The efficacy of diagnostic and monitoring tools in ophthalmology is significantly influenced by patient engagement levels. This presents a notable challenge, especially in the context of developing tools designed for telemedicine applications. Ensuring consistent patient engagement is therefore crucial for the accurate and reliable utilization of these technologies. This study assesses patient perceptions and experiences after using a purpose-built web application, called PocDoc. A cross-sectional questionnaire-based survey was conducted among 440 patients recruited from general and specialist eye clinics between March 2022 and October 2023, both before and after using the PocDoc app. Pre-test findings revealed that 86.8% of patients thought that a remote eye monitoring application would have use, while 70.9% anticipated frequent usage. Only 16.4% found it overly complex, and 55.2% perceived it as easy to use. Additionally, 34.5% foresaw the need for technical support, while 72.5% believed they would quickly grasp its use. In the post-test questionnaire, 63.3% of patients still expressed intent for frequent PocDoc usage. The perception of complexity decreased to 20.4%, with 79.3% finding it easy to use. The belief in the need for technical support decreased to 36.5%, while 89.9% felt confident in mastering the application quickly. Moreover, 77.3% found the application's functions well-integrated, and 64.6% were very confident using PocDoc. Results suggest patient receptivity to web-based applications, confirming their viability for specific patient groups. Overall, our study contributes to the growing body of evidence indicating that greater exposure to digital health tools can significantly influence patient acceptance and perceived ease of use, an insight that has important implications for the implementation and design of these technologies in clinical settings.

Abstract PO1-10-10: Leveraging technology to optimize symptom management and patient empowerment in routine breast cancer care: implementation of a remote patient monitoring (RPM) pathway across 24 hospitals in Europe

Abstract Background: In clinical trials, RPM has been proven to improve the quality of life and toxicity management for patients receiving systemic treatment and is recommended by international guidelines for routine clinical practice (Di Maio et al., Ann Oncol 2022). Resilience is an oncology-specific RPM system (CE marked, class IIa medical device - mobile application [app] or web interface) which prompts patients to complete a weekly survey including core symptoms from NCI’s PRO-CTCAE questionnaire. Severe or worsening symptoms trigger an alert notification sent to the patient’s care team. In addition to the RPM system, the mobile app offers a large pool of breast cancer-specific educational, self-management, and patient empowerment resources that are personalized according to symptoms reported, disease stage, and treatments received. Here we present the implementation of the Resilience RPM pathway in routine breast cancer care across 24 highly diverse cancer centers. Methods: The implementation process followed a phasic process of Exploration, Preparation, Implementation, and Sustainability that involved close collaboration with technology providers, hospital managers, and care teams at participating cancer centers to coordinate, train, provide technical assistance, and respond to site-specific needs. In addition, monthly webinars offered participating centers an opportunity to share best practices and ways to overcome implementation barriers. A dedicated platform with educational RPM resources for healthcare providers was also available. A process evaluation according to the RE-AIM framework was performed assessing the reach, adoption, implementation, and maintenance of the RPM pathway in routine care. The effectiveness of the pathway was assessed as the ability of the care team to timely respond to alerts. Aggregated system level metric of RPM was collected covering patients with breast cancer under active systemic treatment followed by Resilience from 01-11-2021 to 29-06-2023. Usage data of mobile app resources was tracked from 01-01-2023 to 29-06-2023. Qualitative assessments with focus groups complemented this evaluation. Results: 985 patients, 1% male, 99% female, with a median age of 57y (range: 21-95y; P25-75 38.5-64.5y), were registered across 24 cancer centers. In the last 6 months, the predominant RPM interface chosen by patients was the mobile app (64.1 vs 35.9% for the web platform). Adherence to weekly ePRO reporting was 89.4% in the mobile app and 86.6% in the web platform. The median time from prompt receipt to survey completion was 5.6 hours. The median time for the nurse navigator (NN) to process an alert was 3h50min. Most alerts (91%) were handled directly by NN with 9% requiring the support of a physician. The mean number of individual content consumed per patient was 13 (6744 resources/523 pts, 100% of app users accessed resources). Preferred formats of content delivery were written articles (66.5%), followed by videos (23.1%) and podcasts (10.4%). Most assessed contents referred to: symptom management advice (16%), followed by information about breast cancer disease characteristics (12.5%), supportive care strategies (11.5%), self-guided exercises of mindfulness-based stress reduction (9.4%), and breast cancer treatment journey (8.3%). Qualitative assessments of the app interface, educational content, and self-management programs revealed high levels of satisfaction. The RPM pathway is sustained in the 24 cancer centers and implementation is expanding to additional centers. Conclusion: The Resilience RPM pathway was successfully implemented in routine care across a diverse group of cancer centers with elevated levels of patient engagement and responsiveness from NN. In addition, patients accessed evidence-based educational and empowerment resources, adapted to their medical profile according to their preferences and learning style. Citation Format: Maria Alice Franzoi, Arlindo R Ferreira, Juliette Fanton d'Andon, Thomas Grellety, Eliane Ithurbide-Dachary, Laura Polastro, Laurence Caravella, Joseph Rodriguez, Nathanaelle Leprevier, Elsa Blanchard, Stéphane Remy, Belen d' Ythurbide, Romain Rivoirard, Raoudha Boughzala, Joana M Ribeiro, Ines Vaz Luis. Leveraging technology to optimize symptom management and patient empowerment in routine breast cancer care: implementation of a remote patient monitoring (RPM) pathway across 24 hospitals in Europe [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-10-10.

Unmet Needs and Strategies to Promote Patient Engagement in the Arab World: Experts' Opinion.

The significance of patient engagement (PE) is widely acknowledged as a crucial element in fostering positive health outcomes, elevating care quality, and streamlining healthcare systems. Despite its recognized advantages, the level of patient engagement in Arab nations remains suboptimal. A high-level assembly was convened in Dubai with 11 distinguished patient advocates from diverse Arab countries. Their collective aim was to dissect the obstacles hindering patient engagement in the Arab world and propose pragmatic strategies to surmount them. First, a series of five open-ended, comprehensive questions were posed and thoroughly deliberated upon. Second, the barriers to patient engagement within the experts' respective communities were debated. A qualitative thematic analysis was conducted and two reports were generated by two independent researchers from the original meeting recordings. This paper highlights the importance of patient engagement in advancing healthcare and categorizes barriers to patient engagement as patient-related, provider-related, or system/government-related. The experts identified the primary gaps in patient engagement and proposed strategies to promote it, with a primary focus on motivating both patients and providers toward shared decision-making. This paper amalgamates the insights and recommendations distilled from the expert gathering, juxtaposing them within the broader context of existing literature on patient engagement. Offering a comprehensive viewpoint, this article delves into the challenges and opportunities intrinsic to bolstering patient engagement in the Arab world. Moreover, it spotlights invaluable tools often overlooked within Arab countries. The practical insights provided here can serve as a roadmap for administrators and decision-makers, providing guidance to enhance patient engagement on both a national and institutional scale.

Remote monitoring of patients with rheumatoid arthritis in a low disease activity state: a mixed methods evaluation across six hospitals in London, UK.

This study evaluated the scale-up of a remote monitoring service, capturing monthly Rheumatoid Arthritis Impact of Disease scores and patient-generated text messages, for patients with rheumatoid arthritis (RA; in remission or with low disease activity) attending routine outpatient clinics across six hospitals. We explored patients and staff experiences and implementation outcomes. A pragmatic, mixed methods approach was used, with active patient involvement throughout. We undertook a rapid review, analysed service-level data, and conducted a patient survey and patient and staff interviews, informed by the Capability, Opportunity, Motivation, Behaviour (COM-B) and Exploration, Preparation, Implementation, Sustainment (EPIS) theoretical frameworks. The review included 37 articles, covering themes of patient and clinician acceptability, engagement, feasibility and clinical impact. Service-level data (n = 202) showed high levels of patient engagement with the service. The patient survey (n = 155) showed patients felt the service was easy to use, had confidence in it and felt it improved access to care. Patient interview (n = 22) findings mirrored those of the survey. Motivating factors included increased responsiveness and ease of contact with clinical teams. Views from staff interviews (n = 16) were more mixed. Some implementation barriers were specific to roll-out sites. Prioritization of staff needs was emphasized. Patients were positive about the service and engagement was high. Staff views and engagement were more mixed. Results suggest that equal levels of patient and staff engagement are required for sustainability. These findings further our understanding of the implementation challenges to scaling remote monitoring interventions for patients with rheumatoid arthritis in routine care settings.

Can screen-time help? An analysis of usage of patient engagement technology following colorectal surgery

BackgroundPatient engagement technologies (PETs) guide patients through the perioperative period. We aimed to investigate the levels of patient engagement with PETs through the peri-operative period and its impact on clinical outcomes. MethodsRetrospective cohort study of patients undergoing elective colorectal surgery from 2018 to 2022. Outcomes were length of stay, readmissions, and complications within 30 days of index hospitalization. Results359 (89.1%) patients activated the PET. Patients completed a median of 7 surveys, 2 in-hospital health-checks, and 1 post-discharge health-check. Median LOS was 3 days, 57 (14.1%) patients were readmitted, and 56 (13.9%) had a complication.Patients who completed no surveys had longer LOS than those who completed 2 or more. Patients who were readmitted and had post-operative complications completed significantly fewer surveys and post-discharge health-checks.Completion of surveys in more phases was associated with shorter LOS and lower readmission rates. Completion of more post-discharge health-checks was associated with lower complication rate. ConclusionsThe use of PETs improves patient outcomes and experiences in the perioperative period. Patients who engage more frequently with PETs have shorter LOS with lower readmission and post-operative complication rates.

Patient and Public Involvement in Inflammatory Bowel Disease Research-A Scoping Review.

Interest in patient and public involvement in research has grown. Medical, health, and social care research has demonstrated several benefits of patient and public engagement, such as empowering user input and reducing attrition rates in clinical trials. To date, no study has reviewed patient engagement in inflammatory bowel disease (IBD). We aimed to describe the benefits, challenges, and best practices of patient engagement in IBD research. We performed a systematic search on MEDLINE, EMBASE, and Cochrane for all clinical IBD research studies in which patients were involved in the research process (1946- 2023). Patient input was considered in: (1) study design, (2) study execution, (3) research dissemination, and/or (4) other domains not specified here. Two authors independently screened and extracted data on type of engaged person(s), format of engagement, author-reported benefits, recommendations, and challenges. For each study, we reported the level of patient engagement and study adherence to standardized reporting guidelines. After screening 9,355 articles, we included 51 for final analysis. IBD patients were most frequently engaged in study design. Patient engagement in IBD research improved recruitment rates and promoted the creation of user-friendly quality-of-life tools. Selection bias and recruitment difficulties were common challenges in the application of patient engagement. Authors recommended continuous patient involvement to address emerging priorities and cognitive interviewing to improve questionnaire clarity. Patient engagement represents an important step in promoting patient-centred care. According to study authors, implementing cognitive interviewing techniques, continuous patient involvement, and standardized reporting guidelines may improve future iterations of engagement in IBD.

Challenges With the Use of Digital Sham: Systematic Review and Recommendations.

Digital therapeutics (DTx) are software-based products that prevent, manage, or treat a medical condition and are delivered through a smartphone app, web application, or wearable device. Clinical trials assessing DTx pose challenges, foremost among which is designing appropriate digital shams (or digital placebos), which should ideally mimic DTx (in terms of design, components, and duration of treatment) while omitting the active principle or component. The objective of our review was to understand how digital shams are being used in clinical research on DTx in neuroscience, which is the most common therapy area for DTx. We conducted a systematic literature review of DTx in neuroscience (including neurodevelopmental, neurodegenerative, and psychiatric disorders) with a focus on controlled clinical trials involving digital shams. Studies were identified from trial registries (ClinicalTrials.gov, the European Union Clinical Trials Register, and Trial Trove) and through structured searches in MEDLINE and Embase (both via the Embase website) and were limited to articles in English published from 2010 onward. These were supplemented by keyword-based searches in PubMed, Google, and Google Scholar and bibliographic searches. Studies assessing DTx in neuroscience (including neurodevelopmental, neurodegenerative, and psychiatric disorders) were included. Details related to the publication, DTx, comparator, patient population, and outcomes were extracted and analyzed. Our search criteria identified 461 neuroscience studies involving 213 unique DTx. Most DTx were extended reality based (86/213, 40.4%) or mobile device based (56/213, 26.3%); 313 were comparative, of which 68 (21.7%) used shams. The most common therapeutic areas assessed in these studies were stroke (42/213, 19.7%), depression (32/213, 15%), and anxiety (24/213, 11.3%). The most common treatments were cognitive behavioral therapy or behavioral therapy (67/213, 32.4%), physical rehabilitation (60/213, 28.2%), and cognitive training (41/213, 19.2%). We identified the following important issues related to the use of digital shams in neuroscience: shams were not validated before use in studies, they varied widely in design (from being nearly identical to the DTx to using different software programs altogether), and the level of patient engagement or satisfaction with the sham and the impact of the sham on study outcomes were infrequently reported. Digital shams are critical for the clinical development of DTx in neuroscience. Given the importance of sham controls in evaluating DTx efficacy, we provide recommendations on the key information that should be reported in a well-designed DTx trial and propose an algorithm to allow the correct interpretation of DTx study results. Sham-controlled studies should be routinely used in DTx trials-in early-phase studies-to help identify DTx active components and-in late-phase studies-to confirm the efficacy of DTx. The use of shams early in development will ensure that the appropriate sham control is used in later confirmatory trials.

Information provision and decision-making in the treatment of abdominal aortic aneurysm: A qualitative study of patient experience.

Shared decision making (SDM) refers to patients and health care professionals working together to reach a decision about treatment/care. In abdominal aortic aneurysm (AAA) treatment options are influenced by patients' clinical characteristics, their preferences, and potential trade-offs between alternative interventions. This is a prime example of where SDM is essential to ensure the right decision is made for the right patient, yet we have little understanding of what happens in practice. This study explored patient experiences to understand SDM practice in AAA surgery. We used a qualitative approach to describe, and identify improvements to, current treatment decision making in abdominal aortic aneurysm (AAA) surgery. Two groups of patients were interviewed: those at the point of discussing treatment options (with corresponding digitally recorded consultation data) and following surgical intervention from one hospital. Framework analysis was used. Fifteen patients were interviewed, seven at the point of discussing treatment options and eight following surgical intervention. Timing, format and sources of information, verbal framing of interventions and level of patient engagement were key themes. Four areas for improvement were identified: earlier provision and more detailed written information along with signposting to quality on-line information; both intervention options, risks, benefits, and consequences, were not always discussed; some clinicians were somewhat directive in the decision-making process; and patients' treatment values/preferences were not explored-the only example was in one of the eight recorded consultations. Patients could feel overwhelmed by the information and decision and fearful of the impending surgery. More emphasis should be placed on the provision of full information and the exploration of patient values and preferences for treatment. Clinician training and support for patients, including decision aids, could facilitate the decision-making process. Providing written information earlier and guidance on reliable on-line resources would benefits patients and their families.

User engagement in a randomised controlled trial for a digital health intervention for early psychosis (Actissist 2.0 trial)

Digital Health Interventions (DHIs) can help support people with mental health problems. Achieving satisfactory levels of patient engagement is a crucial, yet often underexplored, pre-requisite for health improvement. Actissist is a co-produced DHI delivered via a smartphone app for people with early psychosis, based on Cognitive Behaviour Therapy principles. This study describes and compares engagement patterns among participants in the two arms of the Actissist 2.0 randomised controlled trial. Engagement frequency and duration were measured among participants using the Actissist app in the intervention arm (n = 87) and the ClinTouch symptom monitoring only app used as the control condition (n = 81). Overall, 47.1 % of Actissist and 45.7 % of ClinTouch users completed at least a third of scheduled alerts while active in the study. The mean frequency (77.1 versus 60.2 total responses) and the median duration (80 versus 75 days until last response) of engagement were not significantly higher among Actissist users compared to ClinTouch users. Older age, White ethnicity, using their own smartphone device and, among Actissist users, an increased sense of therapeutic alliance were significantly associated with increased engagement. Through exploiting detailed usage data, this study identifies possible participant-level and DHI-level predictors of engagement to inform the practical implementation of future DHIs.

Patient and Family Engagement: The Secret Behind Quality Healthcare Services (Literature Review)

World Patient Safety Day 2023 underscores the significance of patient engagement, aligning with the principles advocated by Don Berwick. This article underscores the importance of involving patients and their families in healthcare services, with a focus on effective communication, cultural differences, varied levels of patient engagement, access to information, privacy, and resource constraints. The concept of "Person-Centered Care" epitomizes the effort to engage patients in making decisions about their care, supported by theories and expert models such as the Patient Engagement Model and the Shared DecisionMaking Approach. To overcome the barriers to patient engagement, it is essential to provide training for medical staff, foster cultural awareness, ensure secure technology, and allocate resources judiciously. These measures will enhance the quality of care, safety, satisfaction, emotional support, and the efficiency of long-term care management. Patient and family engagement forms the cornerstone of quality and holistic healthcare in an increasingly complex healthcare landscape.

PCR110 Characteristics and Comorbid Conditions Associated with Treatment Discontinuation Among Patients Being Treated for Obesity

Obesity has multiple drivers that affect treatment outcomes, making sustained weight loss challenging. Heterogeneity among patients with obesity is apparent in the varied level of patient engagement with treatment and weight loss response to interventions. Though many patients with obesity successfully lose weight in response to behavioral and lifestyle changes, half of these resume their original weight within 5 years.

Examining Patient Engagement in Chatbot Development Approaches for Healthy Lifestyle and Mental Wellness Interventions: Scoping Review.

Chatbots are growing in popularity as they offer a range of potential benefits to end users and service providers. Our scoping review aimed to explore studies that used 2-way chatbots to support healthy eating, physical activity, and mental wellness interventions. Our objectives were to report the nontechnical (eg, unrelated to software development) approaches for chatbot development and to examine the level of patient engagement in these reported approaches. Our team conducted a scoping review following the framework proposed by Arksey and O'Malley. Nine electronic databases were searched in July 2022. Studies were selected based on our inclusion and exclusion criteria. Data were then extracted and patient involvement was assessed. 16 studies were included in this review. We report several approaches to chatbot development, assess patient involvement where possible, and reveal the limited detail available on reporting of patient involvement in the chatbot implementation process. The reported approaches for development included: collaboration with knowledge experts, co-design workshops, patient interviews, prototype testing, the Wizard of Oz (WoZ) procedure, and literature review. Reporting of patient involvement in development was limited; only 3 of the 16 included studies contained sufficient information to evaluate patient engagement using the Guidance for Reporting Involvement of Patients and Public (GRIPP2). The approaches reported in this review and the identified limitations can guide the inclusion of patient engagement and the improved documentation of engagement in the chatbot development process for future health care research. Given the importance of end user involvement in chatbot development, we hope that future research will more systematically report on chatbot development and more consistently and actively engage patients in the codevelopment process.

Commentary on Hyland et al.: Digital treatment for alcohol use disorders - challenges and opportunities.

Hyland and colleagues found no significant effects of an internet-delivered cognitive behavioral therapy intervention (iCBT) as addendum to treatment as usual in individuals with moderate alcohol use disorders. While findings can be attributed partially to methodological issues, future studies should focus upon patient preferences and include potential side effects of internet-based interventions. In the field of problematic alcohol consumption, digital interventions have shown promise in non-clinical populations [1]; however, little is known about their efficacy in clinical populations fulfilling criteria for alcohol use disorders (AUDs). Internet-delivered treatment has rapidly evolved as an option for various mental disorders. First meta-analyses show positive effects when compared to non-active controls in disorders such as depression and agoraphobia [2-4], but also for addictive disorders, especially behavioural addictions [5] and tobacco smoking [6]. Given that disorders due to alcohol and/or drugs are highly stigmatized, internet-delivered interventions might be a relevant tool for narrowing the treatment gap in the field. In their excellently conducted randomized controlled trial (RCT), Hyland and colleagues [7] found only weak evidence for an internet-delivered cognitive behavioral therapy (iCBT) intervention as addendum to treatment as usual (TAU) in individuals with AUDs compared to TAU. However, it has to be taken into account that, as comparator in this study, TAU included far more evidence-based components than would usually be expected in most treatment systems world-wide. The high rate of participants willing to take (and receiving) medication is particularly impressive: data from the United States show that only 16.3% of all speciality treatment programmes for alcohol use disorders offered any single medication for AUD treatment [8]. Furthermore, as all participants in the Hyland et al. study were self-selected, the initial motivation to change already might have produced strong effects, especially if we consider the high rates of unassisted recovery that are common in alcohol use disorders [9]. Another encouraging finding is that overall treatment initiation and completion rates are relatively high compared to digital self-help interventions in the field of affective and anxiety disorders [10], where efficacy of these interventions has already been demonstrated. There is no evidence that guided or unguided internet-delivered interventions for AUDs are associated with lower rates of treatment uptake compared to face-to-face delivery. A prior study from the research group of Hyland et al. on a therapist-guided iCBT intervention compared to therapist-delivered CBT showed no differences in uptake numbers between the two conditions, and both interventions did not differ on outcomes [11]. Another RCT on iCBT as a stand-alone intervention for individuals with AUDs [12] even showed that retention rates were better in the iCBT condition compared to therapist-delivered CBT, and that both conditions were superior compared to TAU (which included lower doses of treatment compared to the Hyland et al. study). Given that internet-delivered treatment requires a high level of patient engagement, future studies should take into account the interaction between type of treatment and patient preferences. Internet-delivered interventions might be a good option for some, but certainly not for all, patients suffering from AUDs. A systematic review on effects of matching patient preferences to treatment in the field of substance use disorders suggests that treatment effects might be improved, although findings were inconsistent [13]. Patient preferences have become increasingly important for the development of clinical interventions, and they could play an important role for improving treatment uptake and outcomes by affected individuals [14]. Finally, only recently have studies on the efficacy of treatment assessed potential side effects. A potential risk of digital interventions is that these interventions might incorrectly be viewed as sufficient by some individuals who otherwise would be willing to engage in other evidence-based treatments. The significant difference between the conditions in the Hyland et al. study regarding receipt of medication shows the need for further rigorous, well-conducted studies. For a more detailed understanding on processes of change in newly developed interventions, mixed-methods studies that include the experiences of patients are warranted. GB conceptualized and wrote the manuscript. None.

Informing a collaborative-care model for delivering medication assisted treatment for opioid dependence (MATOD): An analysis of pharmacist, prescriber and patient perceptions.

Demand for medication assisted treatment for opioid dependence (MATOD) in Australia exceeds capacity, particularly in rural and regional areas. There is increasing recognition that community pharmacists are well-positioned to take on expanded roles in MATOD delivery, however there has been limited Australian research exploring attitudes of pharmacists, prescribers, and patients to collaborative models of care. This study aimed to better understand enablers and barriers to a collaborative model for MATOD, to inform implementation in regions where increases in treatment capacity are urgently needed. Semi-structured telephone interviews were conducted with pharmacists (n=11), prescribers (n=6), and patients (n=8) recruited from the Frankston-Mornington Peninsula region in Victoria, Australia, where transport and access to services have impacts on health care utilisation. The COM-B model was used to explore perceptions of pharmacists' capability, opportunity, and motivations for delivering collaborative care. There was strong motivation among healthcare professionals to participate in a collaborative model of care, with the main perceived benefits including improvements in accessibility, convenience, and continuity of care, and leverage of pharmacists' high level of patient engagement. Key barriers identified by both pharmacists and prescribers included a perceived lack of pharmacist skills in some areas (capability) and resources (opportunity) to deliver collaborative care in a community pharmacy setting. Established relationships between all stakeholders (social opportunity) and communication between pharmacists and prescribers were identified as facilitators. Barriers and facilitators aligned with seven key areas: skills, confidence, relationships, patient selection, protocols, communication and resources. Findings informed the development of a collaborative model that was individualised, protocol based, and supported by training and clear processes. This study identifies specific barriers and facilitators to a pharmacist-prescriber collaborative model of care for MATOD. The resulting model will be tested in a hybrid implementation-effectiveness trial in the Frankston-Mornington Peninsula region.

Interventions for supporting self-management in people with musculoskeletal pain, including focus on varying levels of health literacy: A systematic overview of reviews

Background: Musculoskeletal (MSK) pain is a major cause of disability globally, affecting one in three adults. Self-management is a core recommendation for managing MSK pain; however, most self-management programmes require a high level of patient engagement, which may be partly influenced by health literacy levels. This overview aims to summarise current evidence on supported self-management and the influence of varying levels of health literacy in people with MSK pain. Methods: A systematic search was conducted for relevant systematic reviews in databases (Cochrane Library, Medline, EMBASE, CINAHLPlus, AMED, and PsycInfo). Data on study populations (including markers of health literacy), characteristics, and outcomes of supported self-management such as self-efficacy in pain management were extracted. Quality of systematic reviews was assessed using AMSTAR 2, and strength of evidence rated using a modified GRADE approach. Results: In total, 40 systematic reviews contributed evidence to this overview. Based on intervention components and mode of delivery, three main self-management intervention approaches were indicated: structured self-management education programmes (10 reviews), self-directed self-management (four reviews), and combined self-management activity and education programmes (26 reviews). MSK patients with low health literacy levels were found to have poorer outcomes with current self-management interventions. The strength of evidence for self-efficacy in pain management was assessed as low (across the three approaches). Only one review systematically extracted data on measures or markers of health literacy, highlighting an important gap in evidence. Conclusions: A comprehensive summary and critical assessment of current evidence on supported self-management and the influence of health literacy levels among patients with MSK pain was presented. There is a gap in evidence regarding potential mediators of the effects of supported self-management among people with musculoskeletal conditions and low levels of health literacy, thereby limiting the opportunity to positively influence outcomes.

PERCEIVED ROLES IN MEDICATION SAFETY: PATIENTS' PERSPECTIVES

Abstract Community-dwelling older adults are vulnerable to medication safety-related harms. Prevention of medication-related harms in the outpatient setting starts with thorough and thoughtful medication reconciliation at each patient encounter. Comprehensive medication reconciliation is challenging for prescribers to provide in busy time-pressured practices. Older adults currently taking five or more daily prescription medications were recruited for this qualitative study. From the participants’ perspective, we explored the role of the prescriber, pharmacist, and patient in medication safety. During the COVID-19 pandemic, interviews were conducted from October 2020 to June 2021. Results from these interviews suggest that older adults recognized their role in medication safety supersedes just taking the pills as prescribed. Older adults understand that they must play an essential role in the coproduction of quality health services. Subthemes that emerged from the patient’s perceived role were “taking fewer medications,” “locking them up,” “keeping appointments,” and “reading the label.” Pharmacists were expected to inform participants of any changes in their medications, such as the color, shape, or dosage, and ensure no drug interactions. Primary care providers are expected to coordinate care between all specialists treating their patients and any medication prescribed by those specialists. There was a high level of trust in the provider’s knowledge, skill, and experience, along with a low level of patient engagement in decision-making around deprescribing. Among older adults, self-perceptions of their role in medication safety varied widely. Educating prescribers and pharmacists about the role expectations of this vulnerable population can help improve medication safety.

Recommendations for Early and Comprehensive Management of Type 2 Diabetes and Its Related Cardio-Renal Complications

Type 2 diabetes (T2D) is a global health problem accompanied by an elevated risk of complications, the most common being cardiac and renal diseases. In Lebanon, the prevalence of T2D is estimated at 8-13%. Local medical practice generally suffers from clinical inertia, with gaps in the yearly assessment of clinical manifestations and suboptimal screening for major complications. The joint statement presented here, endorsed by five Lebanese scientific medical societies, aims at providing physicians in Lebanon with a tool for early, effective, and comprehensive care of patients with T2D. Findings from major randomized clinical trials of antidiabetic medications with cardio-renal benefits are presented, together with recommendations from international medical societies. Optimal care should be multidisciplinary and should include a multifactorial risk assessment, lifestyle modifications, and a regular evaluation of risks, including the risks for cardiovascular (CV) and renal complications. With international guidelines supporting a shift in T2D management from glucose-lowering agents to disease-modifying drugs, the present statement recommends treatment initiation with metformin, followed by the addition of sodium-glucose cotransporter 2 inhibitors or glucagon-like peptide-1 receptor agonists due to their CV and renal protection properties, whenever possible. In addition to the selection of the most appropriate pharmacological therapy, efforts should be made to provide continuous education to patients about their disease, with the aim to achieve a patient-centered approach and to foster self-management and adherence to the medical plan. Increasing the level of patient engagement is expected to be associated with favorable health outcomes. Finally, this statement recommends setting an achievable individualized management plan and conducting regular follow-ups to monitor the patients' glycemic status and assess their risks every 3-6months.

Protocol for a pilot and feasibility study evaluating a complex nurse-led patient education intervention to promote cancer patient engagement in healthy lifestyle (O-PHE programme)

IntroductionLiterature suggests that patient engagement in healthy lifestyle is of crucial importance in ensuring a more effective management of side effects of cancer therapies and better quality of life for...

Quetiapine augmentation of cognitive processing therapy in veterans with posttraumatic stress disorder. Design and methodology of a pilot study

Background: The limited efficacy of first-line treatment of Posttraumatic Stress Disorder (PTSD) with selective serotonergic reuptake inhibitors commonly leads to the use of multiple medications that still fail to achieve symptomatic remission. VA/DOD guidelines identify trauma-focused psychotherapies as the evidence-based treatment for PTSD, but overall effectiveness is limited by reduced levels of patient engagement. Cognitive Processing Therapy (CPT) is the most widely-used trauma-focused therapy in the VA system for Veterans with PTSD. Our previous results based on a case series suggested that quetiapine mono therapy, but not risperidone or valproate, could increase engagement in CPT, thereby improving clinical outcomes through direct medication effects and indirectly through greater engagement in CPT.