Patient-centered Care Strategies Research Articles

Exploring Hybrid Prenatal Care: A Qualitative Analysis of Accessibility, Quality of Care, Attitude, and Preference Among Low-Risk Obstetric Patients [ID 2683577

INTRODUCTION: Patients' experiences with virtual prenatal care options outside of the acute COVID-19 pandemic remain relatively uncharacterized. Our study qualitatively describes obstetric patients’ experiences and general attitudes regarding hybrid care models (in-person and virtual visits) to evaluate strategies for patient-centered care. METHODS: At an academic institution, patients consented to this IRB-exempt survey during their postpartum hospitalization. A qualitative content analysis followed by matrix coding of free-responses was used to evaluate patients’ perceptions of hybrid prenatal care. RESULTS: Among the 200 patients who participated in the survey, 78 received hybrid prenatal care. Regarding access, patients highlighted the enhanced general access afforded by hybrid care, emphasizing flexibility and reduced travel time and time off work; however, negative aspects included unreliable internet, insurance coverage issues, and availability of home monitoring devices. For quality, virtual care was sometimes viewed favorably, but some respondents expressed concern for impersonal virtual care experiences or missing the fetal heartbeat. One patient stated, “I really needed to be able to hear the heartbeat every visit, so opted out of virtual visits….” Although many participants had a positive attitude towards hybrid care as an option, others stated a preference for in-person visits, driven largely by the desire to hear the fetal heartbeat. CONCLUSION: Patients expressed positive attitudes and experiences regarding improved access with virtual prenatal care. Participants stressed hearing the fetal heartbeat when citing concern for virtual care quality and preference for in-person visits. Future studies should explore patient-centric approaches to virtual care, such as incorporating home-based fetal heartbeat assessment.

A square peg in a round hole: treating hepatitis C.

Several barriers along the cascade of care reduce hepatitis C treatment access. We propose an investment in patient-centered care strategies to initiate and engage this vulnerable population with curative treatment, such as the implementation of community-based educational peer support groups. Barriers to implementing these patient-centered care strategies remain.

Characteristics of Inpatients with Diabetic Ulcers in Margono Soekarjo County Hospital, Indonesia: A Retrospective Study

Introduction: Diabetic ulcers, common complications of poorly managed diabetes mellitus, significantly impact physical well-being, afflicting 25% of diabetes patients. We conducted a retrospective study at Margono Soekarjo County Hospital in Indonesia to comprehensively describe demographic and clinical characteristics, aiming to inform prevention, management, and patient-centered care strategies. Methods: Using secondary data and a cross-sectional approach, we collected information from inpatients with diabetic ulcers at Margono Soekarjo County Hospital in 2020-2021, profiling age, gender, education, occupation, blood sugar levels, and ulcer sites. Results: Most inpatients were female (56.1%), aged over 60 (46.1%), with primary school education (33.9%). The majority had blood glucose levels >200 mg/dl (58.6%), and foot ulcers were predominant (91.8%). Discussion: Diabetic ulcers, affecting 25% of diabetes patients, result from poorly managed diabetes and significantly impact physical well-being. Our findings align with global trends, highlighting disparities in education and employment that affect healthcare access. Conclusion: Addressing these disparities and improving blood glucose management is crucial to mitigate the diabetes burden. Our study underscores the need for tailored public health strategies in Indonesia with potential global relevance.

Distance Traveled by Patients Globally to Access Radiotherapy: A Systematic Review

This systematic review aims to investigate the global travel patterns of patients seeking radiotherapy and examines the distance traveled by patients and its impact on secondary outcomes such as travel time and survival. The findings of this review will provide crucial information on barriers to accessing radiotherapy and inform the development of patient-centered care strategies aimed at improving access to this important form of treatment. A comprehensive search of four databases was conducted from June to August 2022. Studies were included if they were observational, retrospective, or randomized/non-randomized, published between June 2000 and June 2022, and reported the distance traveled globally for the treatment of malignant or benign disease. Studies were excluded if they did not report travel distance or were not written in English. A total of 176 studies were included. Most of the studies (69.9%) were conducted in North America, with the majority (68.7%) in the United States. The treatment modalities varied with external beam radiation therapy being the most common (17.0%). The most common disease site was breast (26.7%). Of the included studies, 49 reported the mean distance traveled for radiation therapy. The shortest mean distance was reported in the United States at 4.83 miles, while the longest was reported in Iran at 276.5 miles. It was observed that patients living in countries outside the United States traveled greater distances for radiation therapy than those living within the U.S. Additional factors such as urban vs. rural residence and treatment modality were also found to impact the distance traveled for radiation therapy. Our results indicate a wide range of travel times, with approximately half of the studies reporting values greater than 1 hour, which was the case for 100% of the studies on low-income populations (n = 4). Out of 176 studies, only 15% discussed patient survival and reported conflicting results between travel distance and survival rates, regardless of treatment, disease site, or country of origin. This systematic review is the most comprehensive to date on the global travel patterns of patients seeking radiotherapy. Results show that travel distances varied, but overall, patients in the U.S. traveled shorter distances for radiation therapy than those living outside the country. Treatment center location, patient residence, and treatment modality impacted patient travel distance, but the patterns were inconsistent. These findings emphasize the importance of considering the distance traveled as a barrier to receiving radiotherapy and highlight the need for strategies to improve patient access and prioritize patient-centered care.

STRATEGY TO PROMOTE PATIENT CENTERED CARE PCC FOR IMPROVING PATIENT SATISFACTION: A LITERATURE REVIEW

Background: Patient satisfaction is playing an increasingly important role in care-quality reforms and healthcare delivery in general. Patient dissatisfaction with nursing services was still a problem in Indonesia and in other developing countries. Patient Centered Care (PCC) as one of the six dimensions of improving the quality of care.
 Objectives: The purpose of this study aimed to analyse Strategy to Promote PCC for Improving Patient Satisfaction.
 Design: This study using systematic review design refers to The Center for Review and Dissemination and the Joanna Briggs Institute Guideline.
 Data Sources: Search for articles was conducted from 14 December 2020 to 28 April 2021 by accessing four electronic databases (Scopus, PubMed, ProQuest, Sage). The article year is limited from 2015-2021. Keywords: “Strategy” OR “Promote” OR “Intervention” AND “Patient Centred Care” OR “Patient Care Management” AND “Patient Satisfaction” OR “Patient Acceptance”.
 Review Methods: Assessing the quality of articles using the JBI Critical Appraisal Tool and PRISMA checklist as a guide in article screening.
 Results: A total of 15 article were analyzed according to inclusion criteria. The selected article is divided in five broad themes about strategy to promote patient centered care. The five broad themes are enhanced communication (n=4), promoting patient participation (n=4), emotional support (n=2), intervention to enhanced patient centered care (n=3) and organizational culture (n=2).
 Conclusion: There are 5 strategies to promote patient centered care for improving patient satisfaction. Five patient centered care strategies to improve patient satisfaction involve enhance communication, promoting patient participation, emotional support, intervention to enhanced patient centered care and organizational culture.

Short communication: Relationship between social determinants and opioid use disorder treatment outcomes by gender

BackgroundSocial determinants of health (SDoH) influence health outcomes differentially across gender. Gender differences in SDoH have been identified at baseline in opioid use disorder (OUD) treatment studies, but less is known about how SDoH and gender intersect with OUD treatment trajectories. This study aims to identify social correlates of OUD treatment outcomes from five key areas of social determinants separately for men and women receiving buprenorphine for OUD. MethodsThis is a secondary data analysis of a cross-sectional survey with medical record review conducted with patients recruited from an office based opioid treatment clinic. Participants completed surveys between July-September 2019. A 6-month prospective medical record review was conducted to determine treatment retention, substance use recurrence, and buprenorphine continuation. Chi square, T-tests, and Mann Whitney U tested differences in social factors and OUD outcomes by gender. Gender-stratified multivariable logistic and negative binomial regressions assessed predictors of OUD outcomes. ResultsAmong study participants (n = 142), women were significantly younger (p < 0.001), more likely to live in a safe neighborhood (p = 0.046), and less likely to be employed (p = 0.005) or have substance use recurrence during the study period (p = 0.033) than men. For women, employment (AOR=0.19, p = 0.031) and education (AOR=0.08, p = 0.040) were negatively associated with treatment retention. For men, no social factors were associated with OUD outcomes. ConclusionsSDoH may impact OUD treatment outcomes differently by gender. Addressing MOUD stigma and implementing patient-centered care strategies may facilitate OUD treatment continuation among employed women in recovery. Gender-related social factors should be considered in OUD treatment research.

Professionalism in Family Planning Care Workshop.

IntroductionWhen clinicians feel negative emotions toward patients, providinge patient-centered care can be difficult. This can occur in family planning scenarios, such as when a provider is uncomfortable with a patient choosing abortion. The Professionalism in Family Planning Care Workshop (PFPCW), framed around professionalism values, used guided reflection to foster self-awareness and empathy in order to teach future providers to provide patient-centered care.MethodsIn the PFPCW, learners discussed challenging patient interactions and family planning scenarios to develop self-awareness and identify strategies for maintaining therapeutic relationships with patients when they experience negative feelings toward them. We implemented the workshop across the United States and Canada and collected pre- and postsurvey data to evaluate program outcomes at Kirkpatrick evaluation levels of participant reaction and effects on learners’ attitudes.ResultsA total of 403 participants participated in 27 workshops in which pre- and postworkshop surveys (70% and 46% response rates, respectively) were administered. Sixty-five percent of the participants were residents, and 36% had previously participated in a similar workshop. The majority (92%) rated the PFPCWs as worthwhile. Participants valued the discussion and self-reflection components. Afterward, 23% reported that their attitudes toward caring for people with unintended pregnancy changed to feeling more comfortable. Participants said they would employ self-reflection and empathy in future challenging interactions.DiscussionIn this pilot implementation study, our workshop provided learners with strategies for patient-centered care in challenging family planning patient interactions. We are currently modifying the workshop and evaluation program based on feedback.

Home Health Nurses’ Journey Toward Culture-Sensitive/Patient-Centered Skills: A Grounded Theory Study

Introduction. Home health patients, who are members of minority and vulnerable groups, suffer disparate outcomes. Patient-centered care (PCC) and culturally-competent care (CCC) aim to facilitate high-quality, equitable care. How home health nurses incorporate PCC and CCC principles into their assessment and care-planning practices has not been -investigated. This study answers the question, “ What is the process by which home health nurses develop their culture-sensitive/patient-centered assessment and care planning skills?” Methods. Home health nurses (n= 20) were recruited into this grounded theory study from agencies around the United States via flyers, websites, and contacts. We conducted in-depth recorded interviews using a semi-structured interview guide to ask questions about nurses’ assessment and care-planning practices, their understanding of CCC and PCC principles, and facilitators/barriers to CCC and PCC practice. Results. Participants primarily gained their CCC and PCC assessment and care-planning skills through a “seat of your pants,” trial-and-error process, with little educational or agency assistance. They combined caring, diverse patient experiences, and critical, creative self-reflection on their experiences to gradually learn helpful, though not optimal, CCC and PCC strategies. However, they reported numerous barriers that discouraged or distressed them in their quest to deliver culturally-competent and patient-centered care. Only a few nurses demonstrated the resilience to overcome these challenges creatively and happily. Conclusion. If we accept that patient-centered care and culturally competent care are key elements of high-quality, equitable care, this grounded theory may help home healthcare clinicians, administrators, educators, and policy-makers identify impact points for enhancing CS/PC practices.

Fluctuating interpretations: Striving to maintain a sense of self in early dementia

This study aimed to develop a conceptual framework of the experience of persons living with the early stages of dementia. A grounded theory approach examined the experience from the perspective of the patient. Data were collected from dyads of persons with mild dementia and their family caregivers (N = 17) using face-to-face interviews at three timepoints over a one-year period. Transcribed interviews were analyzed with constant comparative analysis. The core category was “Fluctuating interpretations: striving to maintain one's sense of self.” Interpretations were comprised of three subcategories: being a stranger to oneself, sense-making, and strategies for coexistence. Different situations influenced the process and affected individuals’ attitudes and behaviors. Interpretations were a protective vehicle and stabilizing force that enabled persons with dementia to coexist with disease changes. Perspectives of persons with dementia during the early stages should be considered when designing intervention strategies for patient-centered care.

Perceived work environment and patient-centered behavior: A study of selected district hospitals in the central region of Ghana.

IntroductionQuality work environment has been established as a marker of employee value creation. A plethora of qualitative evidence suggested that sustained focus on employee satisfaction through changes in the work environment, communication of patient-centered care strategic vision, management of staff workload, and workplace social support are factors that stimulate Patient-centered care. Yet, it seems that the effect of work environment on the patient-centered behavior of hospital employees has not been statistically estimated, and it is unclear which of the elements of the work environment best predict patient-centered behavior.MethodsUsing a survey design and quantitative methods to gather and analyze data, a sample of 179 respondents from three district hospitals were included in the study using a multi-stage proportional sampling technique. Data were collected using self-administered Likert item questionnaires. Simple linear regression was used to estimate the influence of work environment elements on patient-centered behavior. Stepwise multiple regression was used to determine the best predictors of patient-centered behavior of hospital employees.ResultsPerceived internal communication of patient-centered care strategies (β = 0.23; P<0.001), supervisor support (β = 0.31; P<0.001), coworker support (β = 0.50; P<0.001), and working conditions (β = 0.18; P<0.013) had a positive significant effect on patient-centered behavior of employees. Good predictors of employees’ patient-centered behavior were perceived coworker support (β = 0.51; P<0.001) and job characteristics (β = 0.16; P<0.01).ConclusionThe work environment of hospital employees significantly affects their patient-centered behavior. Co-worker support and job characteristics were the best predictors of the patient-centered behavior of hospital employees. Hospitals Managers seeking to improve patient-centered behavior through employee value creation may consider improved job characteristics in combination with workplace social support and or communication of PCC strategies and goals.

Provider anticipation and experience of patient reaction when deprescribing guideline discordant inhaled corticosteroids.

Despite evidence of possible patient harm and substantial costs, medication overuse is persistent. Patient reaction is one potential barrier to deprescribing, but little research has assessed this in specific instances of medication discontinuation. We sought to understand Veteran and provider experience when de-implementing guideline-discordant use of inhaled corticosteroids (ICS) in those with mild-to-moderate chronic obstructive pulmonary disease (COPD). We conducted a mixed-methods analysis in a provider-randomized quality improvement project testing a proactive electronic-consultation from pulmonologists recommending ICS discontinuation when appropriate. PCPs at two Veterans Health Administration healthcare systems were included. We completed interviews with 16 unexposed providers and 6 intervention-exposed providers. We interviewed 9 patients within 3 months after their PCP proposed ICS discontinuation. We conducted inductive and deductive content analysis of qualitative data to explore an emergent theme of patient reaction. Forty-eight PCPs returned surveys (24 exposed and 24 unexposed, response rate: 35%). The unexposed providers anticipated their patients might resist ICS discontinuation because it seems counterintuitive to stop something that is working, patient's fear of worsening symptoms, or if the prescription was initiated by another provider. Intervention-exposed providers reported similar experiences in post-intervention interviews. Unexposed providers anticipated that patients may accept ICS discontinuation, citing tactical use of patient-centered care strategies. This was echoed by intervention-exposed providers who had successfully discontinued an ICS. Veterans reported acceding to their providers out of trust or deference to their advanced training, even after describing an ICS as a 'security blanket'. Our survey findings supported the subthemes from our interviews. Among providers who proposed discontinuation of an ICS, 76% reported that they were able to discontinue it or switch to another more appropriate medication. While PCPs anticipated that patients would resist discontinuing an ICS, interviews with patient and intervention-exposed PCPs along with surveys suggest that patients were receptive to this change.

Typology of patients with behavioral addictions or eating disorders during a one-year period of care: Exploring similarities of trajectory using growth mixture modeling coupled with latent class analysis

ObjectivesAddictions are not restricted to substance-use disorders, and it is now widely recognized that they also include behavioral addictions. Certain individuals with eating disorders also experiment their disorder as an addiction. The objective was to identify typologies of patients presenting with various behavioral addictions or eating disorders according to their evolution within the framework of care, and to specify the factors associated with the differential clinical trajectories.MethodsWe included 302 patients presenting with problem gambling, sexual addiction, compulsive buying, excessive videogame use or eating disorders. The patients completed a multiaxial assessment through a face-to-face structured interview and self-administered questionnaires, including sociodemographic and addiction-related characteristics, psychiatric and addictive comorbidities and several psychological characteristics. The assessment was performed at inclusion and then repeated after 6 and 12 months. The statistical analysis included a combination of growth mixture models and latent class analysis.ResultsWe identified five classes of patients with different profiles related to their trajectories during a one-year period of specialized care: “complex patients”, “patients with impulsive psychological functioning”, “patients with cooperative psychological functioning”, “patients with immature psychological functioning,” and “patients with resilient psychological functioning”.ConclusionsThe typology obtained brings interesting findings to propose patient-centered care strategies adapted to these disorders. Because the typology was independent from the type of disorder, it supports the general concept of behavioral addictions, and the similarities between eating disorders and behavioral addictions. The relevance of this model should be further examined in future studies.

Increasing comorbidity and health services utilization in older adults with prior stroke.

To characterize comorbid chronic conditions, describe health services use, and estimate health care costs among community-dwelling older adults with prior stroke. This is a retrospective cohort study using administrative data from Ontario, Canada. We identified all community-dwelling individuals aged 66 and over on April 1, 2008 (baseline), who had experienced a stroke at least 6 months prior. We estimated the prevalence of 14 comorbid conditions at baseline; we captured all physician visits, emergency department visits, hospital admissions, home care contacts, and associated costs over 5 years stratifying by number of comorbid conditions. Where possible, we distinguished between health services use for stroke- and non-stroke-related reasons. A total of 29,673 individuals met our criteria. Only 1% had no comorbid conditions, while 74.9% had 3 or more. The most common conditions were hypertension (89.8%) and arthritis (65.8%); 5 other conditions had a prevalence of 20% or more (ischemic heart disease, diabetes, chronic obstructive pulmonary disease, inflammatory bowel disease, and dementia). Use of all health services doubled with increasing comorbidity and was largely attributed to non-stroke-related reasons. Total and per-patient costs increased with comorbidity. Main cost drivers shifted from physician and home care visits to hospital admissions with greater comorbidity. Our findings demonstrate the importance of community-based patient-centered care strategies for stroke survivors that address their range of health needs and prevent more costly acute care use.

Patient Experience Shows Little Relationship with Hospital Quality Management Strategies.

ObjectivesPatient-reported experience measures are increasingly being used to routinely monitor the quality of care. With the increasing attention on such measures, hospital managers seek ways to systematically improve patient experience across hospital departments, in particular where outcomes are used for public reporting or reimbursement. However, it is currently unclear whether hospitals with more mature quality management systems or stronger focus on patient involvement and patient-centered care strategies perform better on patient-reported experience. We assessed the effect of such strategies on a range of patient-reported experience measures.Materials and MethodsWe employed a cross-sectional, multi-level study design randomly recruiting hospitals from the Czech Republic, France, Germany, Poland, Portugal, Spain, and Turkey between May 2011 and January 2012. Each hospital contributed patient level data for four conditions/pathways: acute myocardial infarction, stroke, hip fracture and deliveries. The outcome variables in this study were a set of patient-reported experience measures including a generic 6-item measure of patient experience (NORPEQ), a 3-item measure of patient-perceived discharge preparation (Health Care Transition Measure) and two single item measures of perceived involvement in care and hospital recommendation. Predictor variables included three hospital management strategies: maturity of the hospital quality management system, patient involvement in quality management functions and patient-centered care strategies. We used directed acyclic graphs to detail and guide the modeling of the complex relationships between predictor variables and outcome variables, and fitted multivariable linear mixed models with random intercept by hospital, and adjusted for fixed effects at the country level, hospital level and patient level.ResultsOverall, 74 hospitals and 276 hospital departments contributed data on 6,536 patients to this study (acute myocardial infarction n = 1,379, hip fracture n = 1,503, deliveries n = 2,088, stroke n = 1,566). Patients admitted for hip fracture and stroke had the lowest scores across the four patient-reported experience measures throughout. Patients admitted after acute myocardial infarction reported highest scores on patient experience and hospital recommendation; women after delivery reported highest scores for patient involvement and health care transition. We found no substantial associations between hospital-wide quality management strategies, patient involvement in quality management, or patient-centered care strategies with any of the patient-reported experience measures.ConclusionThis is the largest study so far to assess the complex relationship between quality management strategies and patient experience with care. Our findings suggest absence of and wide variations in the institutionalization of strategies to engage patients in quality management, or implement strategies to improve patient-centeredness of care. Seemingly counterintuitive inverse associations could be capturing a scenario where hospitals with poorer quality management were beginning to improve their patient experience. The former suggests that patient-centered care is not yet sufficiently integrated in quality management, while the latter warrants a nuanced assessment of the motivation and impact of involving patients in the design and assessment of services.

The Veterans Health Administration: Quality, Value, Accountability, and Information as Transforming Strategies for Patient-Centered Care

The Veterans Health Administration is the United States' largest integrated health system. Once disparaged as a bureaucracy providing mediocre care, the Department of Veterans Affairs (VA) reinvented itself during the past decade through a policy shift mandating structural and organizational change, rationalization of resource allocation, explicit measurement and accountability for quality and value, and development of an information infrastructure supporting the needs of patients, clinicians, and administrators. Today, the VA is recognized for leadership in clinical informatics and performance improvement, cares for more patients with proportionally fewer resources, and sets national benchmarks in patient satisfaction and for 18 indicators of quality in disease prevention and treatment.