Patient Care System Research Articles

'Two heads are better than one'-exploring the experiences of Ghanaian communities on the role of patient and public participation in health system improvement.

Patient and Public Participation (PPP) is key to improving health systems. Yet, studies have shown that PPP implementations across many countries have been largely tokenistic. Particularly, in Ghana, whilst PPP is prioritized in national health policies and legislation, there appears to be little research focused on understanding PPP's role in health system improvement. The aim of this study, therefore, is to examine how PPP is working across the Ghanaian health system levels, as well as to understand the perspectives and experiences of participants on how PPP contributes to health system improvement. The qualitative study was undertaken in six communities in three districts in the Ashanti region of Ghana. Data were collected from semi-structured individual interviews. The selection of participants was purposive, based on their PPP-related roles. As a result, findings of this study may not reflect the experiences of others who are not directly involved in PPP initiatives. Thirty-five participants, mainly health service users and health professionals, were interviewed. Data were transcribed and analysed descriptively using Braun and Clarke's (2006) thematic analysis approach. Overall, participants noted PPP implementation was largely limited at higher health system levels (i.e. national, regional and district levels), but was functioning at the community level. PPP also improved access to health services, responsiveness to patient needs, community-health worker relationships, health-seeking behaviours, empowered healthcare users and improved health outcomes. The study, therefore, recommended the need to undertake PPP across all levels of the health system to maximize PPP's role in health system improvement. Finally, the study suggested prioritizing PPP, especially for resource-poor countries, to complement government's efforts in improving accessibility of healthcare services to many communities and also provide a more patient-centred healthcare system responsive to patients' and public needs.

Attribute-based key management for patient-centric and trusted data access in blockchain-enabled IoMT

Internet of Medical Things (IoMT) provides real-time data collection and access services to medical entities by connecting their devices to Internet. However, within such a complex architecture, achieving patient-centric data access still presents trustworthiness challenges of transmission security and usage reliability. Ciphertext-policy attribute-based encryption (CP-ABE) and blockchain are both the promising primitives that support patients with secure access control over their data. Nevertheless, both have their unique key management issues. In this paper, we propose a novel patient-centric and trusted data access (PCT-DA) system in blockchain-enabled IoMT. Firstly, we develop an online/offline encryption and verifiable outsourced decryption CP-ABE scheme to relieve the computation pressure on patients and users. Secondly, we design a flexible attribute-based key management mechanism to overcome the security drawbacks of encryption and attribute keys, such as single point of failure, key escrow and privacy leakage. Finally, we build a trusted integrity audit contract to guarantee the incentive fairness between patients and users in access services. Moreover, theoretical analyses prove that the PCT-DA system not only achieves confidentiality, integrity, traceability and forward/backward security, but also guarantees static security under random oracles. Simulation experiments indicate that our proposal reduces the time cost by approximately 14.10 seconds over state-of-the-art and is more practical in blockchain-enabled IoMT system.

A novel questionnaire for evaluating digital tool use (DTUQ-D) among individuals with type 2 diabetes: exploring the digital landscape.

Effective healthcare currently incorporates a patient-centric system and accessible technology for patient self-management. This study aimed to develop and validate a novel questionnaire titled the Digital Tool Use Questionnaire for Diabetes (DTUQ-D) - a screening tool identifying the type, number, and frequency of digital tools used by Type 2 Diabetes Mellitus (T2DM) patients with within HMOs, online, and via applications. The questionnaire was administered to two ethnic groups and both genders. A mixed-methods approach was used. In the qualitative phase, the questionnaire was developed through phone surveys of 29 T2DM patients, two endocrinologists and two technology experts. In the quantitative phase, involving 367 participants, convergent validity, construct validity, and reliability were examined. Findings indicated that the DTUQ-D is valid and reliable, successfully identifying digital tools utilized by T2DM patients, notwithstanding variations in factor structures between ethnic groups. This questionnaire provides a foundation for future research, offering a standardized approach to evaluating digital tool usage. The study enhances understanding of the role of digital tools in healthcare, especially for T2DM self-management. It also can be easily adapted to assess digital tool use for other illnesses by adjusting instructions and the wording of certain items.

Same-Day Versus Staged Spinal Fusion: A Meta-analysis of Clinical Outcomes.

Meta-analysis. This meta-analysis aims to compare same-day versus staged spine surgery, assessing their effects on patient care and health care system efficiency. In spinal surgery, the debate between whether same-day and staged surgeries are better for patients continues, as the decision may impact patient-related outcomes, health care resources, and overall costs. While some surgeons advocate for staged surgeries, citing reduced risks of complications, others proclaim same-day surgeries may minimize costs and length of hospital stays. PubMed, Cochrane, and Google Scholar (pages 1-20) were searched up until February 2024. The studied outcomes were operative room (OR) time, estimated blood loss (EBL), length of hospital stay (LOS), overall complications, venous thromboembolism (VTE), death, operations, and nonhome discharge. Sixteen retrospective studies were included in this meta-analysis, representing a total of 2346 patients, of which 644 underwent staged spinal fusion surgeries and 1702 same-day surgeries. No statistically significant difference was observed in EBL between staged and same-day surgery groups. However, the staged group exhibited a statistically significant longer OR time ( P =0.05) and LOS ( P =0.004). A higher rate of overall complications ( P =0.002) and VTE ( P =0.0008) was significantly associated with the staged group. No significant differences were found in the rates of death, reoperations, and nonhome discharge between the 2 groups. Both staged and same-day spinal fusion surgeries showed comparable rates of death, operations, and nonhome discharges for patients undergoing spinal surgeries. However, given the increased OR time, LOS, and complications associated with staged spinal surgeries, this study supports same-day surgeries when possible to minimize the burden on healthcare resources and enhance efficiency.

E2EE enhanced patient-centric blockchain-based system for EHR management.

To secure sensitive medical records in the healthcare clouds, this paper proposes an End-to-End Encryption (E2EE) to enhance a patient-centric blockchain-based system for electronic health record (EHR) management. The suggested system with a focus on the patient enables individuals to oversee their medical records within various involved parties by authorizing or withdrawing permission for access to their records. Utilizing the inter-planetary file system (IPFS) for record storage is chosen due to its decentralized nature and its ability to guarantee the unchangeability of records. Then an E2EE enhancement maintains the medical data integrity using dual level-Hybrid encryption: symmetric Advanced Encryption Standard (AES) and asymmetric Elliptic Curve Cryptography (ECC) cryptographic techniques. The proposed system is implemented using the Ethereum blockchain system for EHR data sharing and integration utilizing a web-based interface for the patient and all users to initiate the EHR sharing transactions over the IPFS cloud. The proposed system performance is evaluated in a working system prototype. For different file sizes between 512 KB to 100 MB, the performance metrics used to evaluate the proposed system were the time consumed for generating key, encryption, and decryption. The results demonstrate the proposed system's superiority over other cutting-edge systems and its practical ability to share secure health data in cloud environments.

Impact of different types of pain on organizational decisions in palliative medicine

In press This short scientific report reveals important aspects of palliative medicine use of narcotic and non-narcotic analgesics, antidepressants, and anticonvulsants. Specific indications and restrictions on their use, routes of drug administration (oral, intravenous, intramuscular, subcutaneous, transdermal, intrarectal) are defined. The issues of monitoring the dosage of narcotic painkillers by medical personnel and patients themselves, the administration of bolus doses, and the medical equipment necessary for this were discussed. Special attention is paid to such pharmaceuticals as morphine, oxycodone, buprenorphine, butorphanol, morphine. The study of pathogenesis, clinical manifestations, diagnostic methods and the arsenal of therapeutic agents for overcoming acute and chronic pain in palliative patients is important for the organization of hospice and palliative care (HPC). Different types of pain are described depending on the nosological forms, individual sensitivity to pain, sensitization to pain, ways of transmitting the pain signal from the peripheral to the central part of the nervous system, humoral mechanisms of increasing and decreasing the sensation of pain, pain assessment on the Visual Analogue Scale. The need for organizational solutions to improve the situation with analgesia in Ukrainian palliative and hospice institutions, in particular to increase the availability of effective analgesia for palliative patients, was identified. Improving the situation with pain relief corresponds to the national strategy of Ukraine for the development of the HPC system. The report makes a comparison with the development of such a system in Great Britain on the way to one of the best systems of medical care for palliative patients, and on the basis of the futuristic development models described in the literature, it is assumed that Ukraine is on a similar path. Keywords: nociception, somatic pain, visceral pain, neuropathic pain, narcotic analgesics, non-narcotic analgesics.

Retrospective analysis of the construction of the national system of hospice and palliative care in Great Britain

Today, Great Britain has one of the best hospice care systems for palliative patients in the world, which leads to interest in the path of building a Hospice and Palliative Care (НPC) system in this country. The hospice care system is mainly financed by the volunteer sector, which indicates a significant development of the state-society partnership in the organization of НPC. The national НPC system consists of inpatient care, day palliative care, care in the community and emergency hospitals. 2004–2008 is considered the key moment in the formation of the country's НPC system, which will be the focus of this study. For specialist palliative care, the National Health Service of Great Britain allocated almost £50 million a year in those days until 2004. At the same time, volunteer support was about 4 times greater. More than 220 volunteer support groups for palliative patients operated in the country. The success of building a national НPC system is described in the Palliative Care White Paper. A number of interrelated national programs may be used as a standard of palliative care in 20 years by many other countries. The development of the НPC system has influenced the British homes for the elderly, the system of primary care, the attitude to the НPC problem of doctors, local communities and society as a whole, increased the quality and availability of palliative care. Palliative care since those years has been provided 24/7, managed by coordination centers located outside medical facilities and hospices. High national НPC standards and mechanisms for monitoring their compliance have been created. Narcotic analgesia for palliative patients with chronic pain, the necessary medical, psychological, social and spiritual care is mostly available. The public debates the question of a dignified death without restrictions. The value for money of НPC is recognized by British society as acceptable. Therefore, studying the British experience of НPC organization as one of the "best practices" is useful for other countries with less developed НPC systems. Keywords: "best practices", place of death, palliative care quality standards.

A review of emerging trends in telemedicine: Healthcare delivery transformations

Telemedicine, characterized by the remote delivery of healthcare services using technology, has undergone remarkable transformations in recent years. This review explores the emerging trends in telemedicine and their profound impact on healthcare delivery. The paper begins by providing a background on telemedicine, tracing its evolution, and emphasizing its growing significance in the healthcare landscape. The primary objective is to shed light on the current state of telemedicine, identify key trends, and analyze their transformative effects on healthcare delivery. The technological landscape of telemedicine is examined, focusing on innovations in video conferencing, virtual consultations, and the integration of electronic health records. Furthermore, the role of artificial intelligence (AI) is explored, encompassing diagnostic assistance through medical imaging algorithms and the integration of chatbots and virtual health assistants. Specialized areas of telemedicine, such as mental health services and chronic disease management, are discussed in detail to highlight specific transformations in these domains. The critical aspect of patient and healthcare provider adoption is scrutinized, emphasizing patient engagement, overcoming technological barriers, and addressing the challenges faced by healthcare professionals in virtual settings. Anticipating the future of telemedicine, the review outlines upcoming innovations such as virtual reality applications and the impact of 5G technology. Simultaneously, it addresses persisting challenges, including health inequalities, ensuring quality of care, and ethical considerations. This review synthesizes the current state of telemedicine, identifies transformative trends, and provides insights into the future of healthcare delivery. It calls for continued research, policy development, and strategic implementation to maximize the potential of telemedicine in creating a more accessible, efficient, and patient-centric healthcare system.

Artificial Intelligence to Predict Quality-of-Life Outcomes for Vascular Intervention of the Leg.

Artificial intelligence (AI) tools created to enhance decision-making may have a significant impact on treatment algorithms for peripheral arterial disease (PAD). A Markov-based AI model was developed to predict optimal therapy based on maximization of calculated quality of life (cQoL), a patient-centered system of assessment designed to report outcomes directly linked to health-related quality of life. The AI model was prospectively interrogated immediately after individual interventions for PAD over a 12-year period to test predictive performance. Patient cQoL was determined at each patient follow-up visit. A total of 1,143 consecutive patients were evaluated, with a median follow-up of 18 months. Observed mean annualized cQoL was higher than predicted by the model (0.85 ± 0.38 vs 0.79 ± 0.18, p < 0.0001). Of 5 potential clinical outcomes, the AI model correctly predicted final status in 71.3% of patients, with insignificant model performance deterioration over time (-0.15% per month, r = -0.49, p = 0.063). The chance of having the condition predicted by the model was 0.57 ± 0.32, compared with a theoretical maximum of 0.70 ± 0.19 (p < 0.0001, mean ratio 0.79). The AI model performed better in patients with claudication than limb-threatening ischemia (75.5% vs 63.6%, p = 0.014) but equally well for open or endovascular intervention (69.8% vs 70.5%, p = 0.70). Graft or artery patency and amputation-free survival were better for patients with claudication and those treated with endovascular techniques. AI can successfully predict treatment for PAD that maximizes patient quality of life in most cases. Future application of AI incorporating better estimates of patient anatomic and physiological risk factors and refinement of model structure should further enhance performance.

Insurechain : Empowering You with Block Chain Insurance

The integration of blockchain technology into health insurance represents a transformation towards a secure, efficient, and patient-centered system. This content introduces a novel approach to insurance by utilizing blockchain data distribution, smart contracts, and privacy measures. The primary objective is to enhance application efficiency while safeguarding health information. The system operates on a permissioned blockchain network and employs smart contracts to enforce rules and ensure the verification process. The decentralized nature of blockchain guarantees data integrity, fraud prevention, and preserves patient privacy through encryption technology. Collaboration is facilitated through information systems that enable effective communication among stakeholders. Proof of concept demonstrates superior data security, accelerated data processing, and increased patient control over medical data. These findings underscore the immense potential of blockchain to revolutionize health insurance in alignment with the global trend towards digital transformation and patient empowerment.

Facilitating and barrier factors to the implementation of a transitional care program: a qualitative study of hospital coordinators in South Korea

BackgroundTransitional care is an integrated service to ensure coordination and continuity of patients’ healthcare. Many models are being developed and implemented for this care. This study aims to identify the facilitators and obstacles of project performance through the experiences of the coordinator in charge of the Community Linkage Program for Discharge Patients (CLDP), a representative transitional care program in Korea.MethodForty-one coordinators (nurses and social workers) from 21 hospitals were interviewed using a semi-structured questionnaire, and thematic analysis was performed.ResultThree themes were found as factors that facilitate or hinder CLDP: Formation and maintenance of cooperative relationships; Communication and information sharing system for patient care; and interaction among program, regional, and individual capabilities. These themes were similar regardless of the size of the hospitals.ConclusionA well-implemented transitional care model requires a program to prevent duplication and form a cooperative relationship, common computing platform to share patient information between institutions, and institutional assistance to set long-term directions focused on patient needs and support coordinators’ capabilities.

BIG DATA ANALYTICS IN HEALTHCARE: A REVIEW OF RECENT ADVANCES AND POTENTIAL FOR PERSONALIZED MEDICINE

This comprehensive review explores the profound impact of big data analytics on healthcare, focusing on its potential to revolutionize personalized medicine. Big data analytics, driven by technological innovations such as genomic sequencing, artificial intelligence, and wearable devices, offers transformative opportunities for precision diagnostics, treatment customization, and predictive healthcare. Despite the promises, challenges persist, including data privacy concerns, ethical considerations, and technical complexities. Overcoming these hurdles necessitates robust cybersecurity measures, bias mitigation strategies, enhanced data quality, and infrastructure and workforce development investments. Moreover, with updated regulations and ethical guidelines, healthcare policy and practice must adapt to accommodate the evolving digital landscape. Collaboration across disciplines and ongoing research and innovation are essential to fully harness the benefits of big data analytics, leading to improved patient care and healthcare system efficiency.&#x0D; Keywords: Big Data Analytics, Personalized Medicine, Healthcare Innovation, Data Privacy, Ethical Considerations, Precision Diagno. stics

Assessment of rehabilitation effectiveness in patients with COPD as part of the project "PulmoRehab – Access to healthcare services through a personalized care system for patients with COPD, including remote monitoring and tele-rehabilitation based on Artificial Intelligence methods"

Introduction. In the project “PulmoRehab – Access to Healthcare Services through a Personalized Patient Care System for COPD including Remote Monitoring and Tele-rehabilitation Based on Artificial Intelligence Methods,” SP ZOZ Specialized Hospital Ministry of Internal Affairs and Administration in Głuchołazy and 10 partners conducted research on tele-rehabilitation for people suffering from Chronic Obstructive Pulmonary Disease (COPD). The tele-rehabilitation program, based on personalized approach and technology, allowed patients to use therapy at home or a convenient location. The project aimed to reduce social inequalities in healthcare by providing remote access to health services for COPD patients. Materials and Methods. The study involved 80 patients aged 50 to 76 years, hospitalized at Ministry of Internal Affairs and Administration’s Specialist Hospital of St. John Paul II, meeting specific criteria. Qualification for the tele-rehabilitation program took into account the assessment of exercise tolerance, dyspnea, fatigue, lung ventilatory function, and saturation. The program included exercises adapted to the individual needs of the patients. Results. Analysis of the results conducted using XLSTAT software 2021.2.2 showed statistically significant differences between spirometric values before and after rehabilitation. Similarly, significant improvement was observed in the results of the 6MWT test and blood saturation. The tele-rehabilitation program proved effective in improving respiratory health parameters in COPD patients. Conclusions. 1. The tele-rehabilitation program improves lung ventilatory function in people with COPD. It reduces the feeling of dyspnea, decreases fatigue, improves SpO2, and increases exercise tolerance, demonstrating the beneficial effects of the rehabilitation applied. 2. The obtained results encourage further research on a representative group with the use of randomization.

Implementation of a Thrombectomy Stroke Center Triage Program in New York City Emergency Medical Services

Background Due to the increased morbidity and mortality associated with acute cerebral ischemia caused by large vessel occlusions, the New York City (NYC) 9‐1‐1 Emergency Medical Services system implemented the NYC Stroke Triage Protocol with the intention of improving access to endovascular therapy for patients with suspected severe stroke. Methods Successful collaboration between multiple stakeholders enabled the NYC region to develop and implement a new stroke system of care for patients treated by Emergency Medical Services. Descriptive statistics including medians (interquartile range) and proportions were used as appropriate. Continuous data were compared using Mann–Whitney tests for medians and categorical data were compared by using Pearson chi‐square test. Results Between April 1, 2019 and March 31, 2022, 1337 (83.5%) patients directly transported under the NYC Stroke Triage Protocol by the NYC 9‐1‐1 Emergency Medical Services system to a Thrombectomy Stroke Center had a stroke diagnosis. Patients transported to a more distant Thrombectomy Stroke Center traveled an average of 5.7 minutes longer compared with those who were delivered to the closest Primary Stroke Center but the overall time between first patient contact and first pass at a Thrombectomy Stroke Center was an estimated 98.2 minutes shorter. Approximately 24% of directly transported patients with a stroke diagnosis underwent a thrombectomy. Conclusions The NYC Stroke Triage Protocol increased access to advanced interventional stroke care for eligible patients by decreasing time to treatment through prehospital identification of patients with severe stroke and directly transporting them to a stroke center capable of providing endovascular therapy.

Ethical and legal implications of digital mental health applications

The digitization of mental health enables significant shifts in clinical practice by harnessing vast amounts of data derived from the use of apps and wearables to enhance medical research, patient care, and health system efficiency. However, this process brings forth pertinent ethical and legal risks. Ethically, concerns primarily revolve around safeguarding the privacy and confidentiality of sensitive data, alongside the transformation of the doctor-patient relationship through technological interaction. Within the regulatory realm, issues encompass the classification of these tools as medical products, ensuring normative assurance of effective protection of mental health data, and addressing potential legal risks within this domain. This article aims to provide an overarching view of this landscape, serving as a catalyst for the technological, ethical, and legal discourse necessitated by digital mental health.

Exploring the current and prospective role of artificial intelligence in disease diagnosis

Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems, providing assistance in a variety of patient care and health systems. The aim of this review is to contribute valuable insights to the ongoing discourse on the transformative potential of AI in healthcare, providing a nuanced understanding of its current applications, future possibilities, and associated challenges. The authors conducted a literature search on the current role of AI in disease diagnosis and its possible future applications using PubMed, Google Scholar, and ResearchGate within 10 years. Our investigation revealed that AI, encompassing machine-learning and deep-learning techniques, has become integral to healthcare, facilitating immediate access to evidence-based guidelines, the latest medical literature, and tools for generating differential diagnoses. However, our research also acknowledges the limitations of current AI methodologies in disease diagnosis and explores uncertainties and obstacles associated with the complete integration of AI into clinical practice. This review has highlighted the critical significance of integrating AI into the medical healthcare framework and meticulously examined the evolutionary trajectory of healthcare-oriented AI from its inception, delving into the current state of development and projecting the extent of reliance on AI in the future. The authors have found that central to this study is the exploration of how the strategic integration of AI can accelerate the diagnostic process, heighten diagnostic accuracy, and enhance overall operational efficiency, concurrently relieving the burdens faced by healthcare practitioners.

Organizational Expectations Regarding Documentation Practices in Athletic Training.

Although guidance is available, no nationally recognized standard exists for medical documentation in athletic training, leaving individual organizations responsible for setting expectations and enforcing policies. Previous research has examined clinician documentation behaviors; however, the supervisor's role in creating policy and procedures, communicating expectations, and ensuring accountability has not been investigated. To investigate supervisor practices regarding support, hindrance, and enforcement of medical documentation standards at an individual organization level. Mixed-methods study. Online surveys and follow-up interviews. We criterion sampled supervising athletic trainers (n = 1107) in National Collegiate Athletic Association member schools. The survey collected responses from 64 participants (age = 43 ± 11 years; years of experience as a supervisor = 12 ± 10; access rate = 9.6%; completion rate = 66.7%), and 12 (age = 35 ± 6 years; years of experience as a supervisor = 8 ± 5) participated in a follow-up interview. We used measures of central tendency to summarize survey data and the consensual qualitative research approach with a 3-person data analysis team and multiphase process to create a consensus codebook. We established trustworthiness using multiple-analyst triangulation, member checking, and internal and external auditing. Fewer than half of supervisors reported having formal written organization-level documentation policies (n = 45/93, 48%) and procedures (n = 32/93, 34%) and an expected timeline for completing documentation (n = 24/84, 29%). Participants described a framework relative to orienting new and existing employees, communicating policies and procedures, strategies for holding employees accountable, and identifying purpose. Limitations included lack of time, prioritization of other roles and responsibilities, and assumptions of prior training and record quality. Despite a lack of clear policies, procedures, expectations, prioritization, and accountability strategies, supervisors still felt confident in their employees' abilities to create complete and accurate records. This highlights a gap between supervisor and employee perceptions, as practicing athletic trainers have reported uncertainty regarding documentation practices in previous studies. Although supervisors perceive high confidence in their employees, clear organization standards, employer prioritization, and mechanisms for accountability surrounding documentation will result in improved patient care delivery, system outcomes, and legal compliance.

Identifying the Barriers to Acceptance of Blockchain-Based Patient-Centric Data Management Systems in Healthcare

A number of recent studies have shown that wastage and inefficiency are a significant problem in all global healthcare systems. One initiative that could radically improve the operational efficiency of health systems is to make a paradigm shift in data ownership—that is, to transition such systems to a patient-centric model of data management by deploying blockchain technology. Such a development would not only make an economic impact, by radically cutting wastage, but would deliver significant social benefits by improving patient outcomes and satisfaction. However, a blockchain-based solution presents considerable challenges. This research seeks to understand the principal factors, which act as barriers to the acceptance of a blockchain-based patient-centric data management infrastructure, in the healthcare systems of the GCC (Gulf Cooperation Council) countries. The study represents an addition to the current literature by examining the perspectives and views of healthcare professionals and users. This approach is rare within this subject area, and is identified in existing systematic reviews as a research gap: a qualitative investigation of motivations and attitudes among these groups is a critical need. The results of the study identified 12 key barriers to the acceptance of blockchain infrastructures, thereby adding to our understanding of the challenges that need to be overcome in order to benefit from this relatively recent technology. The research is expected to be of use to healthcare authorities in planning a way forward for system improvement, particularly in terms of successfully introducing patient-centric systems.

Patient survey on cancer genomic medicine in Japan under the national health insurance system.

In Japan, comprehensive genomic profiling (CGP) tests have been reimbursed under the national health care system for solid cancer patients who have finished standard treatment. More than 50,000 patients have taken the test since June 2019. We performed a nation-wide questionnaire survey between March 2021 and July 2022. Questionnaires were sent to 80 designated Cancer Genomic Medicine Hospitals. Of the 933 responses received, 370 (39.7%) were web based and 563 (60.3%) were paper based. Most patients (784, 84%) first learned about CGP tests from healthcare professionals, and 775 (83.1%) gave informed consent to their treating physician. At the time of informed consent, they were most worried about test results not leading to novel treatment (536, 57.4%). On a scale of 0-10, 702 respondents (75.2%) felt that the explanations of the test result were easy to understand (7 or higher). Ninety-one patients (9.8%) started their recommended treatment. Many patients could not receive recommended treatment because no approved drugs or clinical trials were available (102/177, 57.6%). Ninety-eight patients (10.5%) did not wish their findings to be disclosed. Overall satisfaction with the CGP test process was high, with 602 respondents (64.5%) giving a score of 7-10. The major reason for choosing 0-6 was that the CGP test result did not lead to new treatment (217/277, 78.3%). In conclusion, satisfaction with the CGP test process was high. Patients and family members need better access to information. More patients need to be treated with genomically matched therapy.

Clinical outcomes and economic evaluation of patient-centered care system versus routine-service system for patients with type 2 diabetes in Thailand

IntroductionPatient-centered care in diabetes is another approach for outcome improvement, yet the supporting economic and clinical evidence remains limited in Thailand. ObjectivesThis study compared health outcomes and cost-utility of implementing Patient-Centered Care Systems (PCCS) in a primary care setting vs. the Routine Service System (RSS) in a hospital setting. MethodsThe economic evaluation was performed using a randomized controlled study design. The participants aged ≥18 were enrolled from Phimai City in Nakhon Ratchasima Province, Thailand from June 2022 to February 2023. Totally, 309 well-controlled patients with initial care in a hospital were referred to receive the PCCS at the primary care setting or remained receiving the RSS in the hospital. Outcomes of different approaches such as fasting blood sugar, Hemoglobin A1c (HbA1c), direct medical costs, direct nonmedical costs and utility were prospectively collected at months 0, 3 and 6. Fisher's exact test, t-test or Wilcoxon signed-rank test were used to analyze data, whichever was appropriate. An incremental cost-effectiveness ratio was calculated, and various sensitivity analyses were performed. ResultsThe PCCS showed significantly reduced HbA1c (p < 0.001) and a greater number of patients with improved HbA1c (p < 0.001). The PCCS were a cost-saving strategy due to incurring lower total costs (60.15 vs. 73.42 USD) and gaining more quality-adjusted life-years (QALY)(0.340 vs. 0.330) compared with the RSS. With a ceiling ratio of 4,659 USD/QALY, the PCCS had a 94.6 % probability of being cost-effective. ConclusionThis finding indicated that the PCCS in a primary care setting was a cost-saving strategy by lowering cost, providing a higher quality of life and improving glycemic control compared with the RSS in a hospital setting. However, generalizing the findings in a country as a whole, the economic evaluation of PCCS and RSS should be conducted among different levels of hospitals from all regions in Thailand.