Patient-centered Model Research Articles

Barriers and facilitators of access and utilization of mental health services among forensic service users along the care pathway

BackgroundThe verdict of Not Criminally Responsible on account of a Mental Disorder (NCRMD) is increasingly used to access specialized mental health services in Canada and elsewhere. This situation highlights the importance of ensuring timely access to services in the community to prevent violence and justice involvement. The objective of the present study is to identify individual and contextual barriers and facilitators of access to mental health services during the period preceding an offense leading to a verdict of NCRMD.MethodsThe sample includes 753 people found NCRMD in Québec, Canada. All episodes of mental health hospitalizations and service use before the index offense were identified using provincial administrative health data, for an average period of 4.5 years. Access was conceptualized as a function of the possibility of seeking, reaching and receiving appropriate health care services, based on Lévesque and colleagues patient-centred model of access to care.Generalized linear models were computed to identify the individual and contextual predictors of: (1) seeking mental healthcare (at least one contact with any type of services for mental health reasons); (2) reaching psychiatric care (at least one contact with a psychiatrist); (3) receiving psychiatric care, operationalized as (3a) continuity and (3b) intensity. Factors associated with volume of emergency mental health services were examined as exploratory analysis.ResultsGeographical considerations were highly important in determining who reached, and who received specialized mental health care – above and beyond individual factors related to need. Those who lived outside of major urban centres were 2.6 times as likely to reach psychiatric services as those who lived in major urban centres, and made greater use of emergency mental health services by 2.1 times. Living with family decreased the odds of seeking mental healthcare by half and the intensity of psychiatric care received, even when adjusting for level of need.ConclusionsFindings support efforts to engage with the family of service users and highlights the importance of providing resources to make family-centred services sustainable for health practitioners. Health policies should also focus on the implementation of outreach programs, such as Forensic Assertive Community Treatment teams as part of prevention initiatives.

A qualitative inquiry into the patient-related barriers to linkage and retention in HIV care within the community setting

BackgroundPeople with the Human Immunodeficiency Virus (PWH) experience barriers to care within the community that impedes their progress from when they discover that they are HIV positive to becoming virally suppressed. For individuals with HIV to achieve sustained viral suppression, they must be linked to care to start receiving anti-retroviral therapy and remain retained in care for continuous treatment. However, HIV surveillance data shows that many PWH are not linked to care and become lost to continuous follow-up care. Although pharmacists, PWH, and social workers interact with one another and are aware of their roles in HIV care, their perspectives on barriers to linkage and retention in care have not been investigated collectively. ObjectivesExplore the perspectives of PWH, pharmacists, and social workers on barriers to linkage and retention of HIV care within the community setting. MethodsConvenience sampling was used to recruit 15 stakeholders (five PWH, five community pharmacists, and five social workers) who participated in 1-h, semi-structured interviews based on three domains of the Patient-centered Medical Home Model including (1) experiences (individual and system-level barriers to care experienced by PWH), (2) activities (social workers and pharmacists initiatives that impact adherence to care)and (3) interventions (critical issues pharmacists can address in the community to engage PWH in their HIV care). We conducted a directed content analysis based on deductive coding. To establish rigor, we focused on Lincoln and Guba's criteria of rigorous qualitative methodology: credibility, dependability, confirmability, and transferability. Similarities and divergences of themes were discussed during data analysis and agreement was reached before interpretation. ResultsEmergent themes uncovered barriers to linkage and retention in HIV care as HIV-related stigma, having mental health illnesses including a history of substance abuse and social determinants of health such as homelessness, food insecurity, and insurance issues. ConclusionThe perspectives of pharmacists, social workers, and PWH can provide insight into barriers that should be identified and addressed in people living with HIV to enhance their linkage and retention in care.

HSD11 Evaluation of the Implementation Progress of a New Complex Intervention in a Multimorbidity Patient-Centered Care Model in Chile

Complex health interventions involve a process of organizational, structural, and cultural change that challenges health teams and decision-makers. During 2017 and 2020, a complex intervention was carried out for adult patients with chronic diseases. The Centro de Innovacion en Salud ANCORA UC (CISAUC) implemented a Multimorbidity patient-center care model in the public health system. This study aims to evaluate the progress in implementing the Multimorbidity patient-center care model in seven Primary Care Centers in Chile.

Can we help older adults to feel at home in a residential care facility? What we can learn from health care personnel.

Most older adults wish to age in place—living, and ultimately dying, in their own home. However, at some point, some older adults need to move to a residential care facility (RCF), such as a nursing home or an assisted living facility, due to the worsening of their physical and/or cognitive conditions, the loss of family relationships, or the inability of their family members to take care of them. Moving to an RCF is a critical moment in an older adult’s life, as it separates them from significant people and objects in their life, disrupts their habits, and breaks their connection with their local community. These changes can negatively affect the physical, psychological, social, and spiritual well-being of older adults if they fail to create a new home in the novel environment.1 For older adults, feeling a sense of being “at home” is a multifactorial phenomenon influenced by several psychological, social, and built-environmental aspects.2 Health care personnel who provide care in RCFs, and the directors and managers responsible for organization of care and resource allocation, have an important role in fostering the sense of “home” for older adults residing in RCFs, as highlighted by the qualitative systematic review published in this issue of JBI Evidence Synthesis.3 This review synthesized the evidence derived from 7 qualitative studies from Europe and North America that explored the experiences of health care personnel in promoting a sense of home for older adults in RCFs using a meta-aggregative approach, which is the method endorsed by JBI for qualitative synthesis. This approach enables the creation of generalizable statements in the form of recommendations to guide practitioners and policy-makers.4 We learned from this review that physical factors (eg, building structure, design), work organizational features, and care culture of the RCFs, as well as national, regional, and local regulations, can influence the creation of a sense of home in older adults residing in these settings.3 If we want to make older adults feel at home in a care facility, we must create a home-like environment and not a hospital-like environment. This involves offering large, private rooms with en-suite bathrooms for each resident and common areas that resemble domestic spaces, such as private or common kitchens, television lounges, sitting rooms, dining rooms, and accessible outdoor spaces. We should allow older residents to bring furniture or other personal artefacts to foster familiarity with the place and continuity of life. These environmental standards should be included in national and local regulations and guidelines, along with safety standards to guarantee that the creation of a sense of home is assured in all RCFs. Moreover, we should replace a hospital-like work model with a home-like work model, which includes flexible organization of daily activities that respects residents’ autonomy, freedom of choice, and personal habits. Participation in domestic and recreational activities should be promoted according to residents’ preferences to make them feel like active members of the facility community. The maintenance of meaningful, reciprocal relationships between residents and family members, staff, and other residents creates a sense of familiarity and belonging to a larger community. We should embrace a person-centered rather than a patient-centered care model in RCFs. Residents should not be thought of as sick patients requiring medical care and assistance, but as persons with wishes and the potentiality of further growth who want to live a meaningful life, regardless of physical or cognitive impairments. If we want to make older adult residents feel at home in RCFs, we must not only provide a shelter, but we must listen to the experiences of health care personnel and help create an ambience that promotes meaningful relationships, a sense of purpose, and a fulfilling community. This review3 presents the available evidence on the sentiments of health care personnel regarding older people aging in RCFs. Although the level of confidence in the findings was classified as low due to dependability and credibility issues, evidence from this review seemingly reflects many of our own views about getting older and living our best lives, and supports a realistic and empathic way forward.

PCR206 Evaluation of a Multimorbidity Patient-Centered Care Model Implemented in the Chilean Public Health System: Users´ Perspective

PCR206 Evaluation of a Multimorbidity Patient-Centered Care Model Implemented in the Chilean Public Health System: Users´ Perspective

Multicomponent, high-intensity, and patient-centered care intervention for complex patients in transitional care: SPICA program.

Multimorbidity is increasingly present in our environment. Besides, this is accompanied by a deterioration of social and environmental conditions and affects the self-care ability and access to health resources, worsening health outcomes and determining a greater complexity of care. Different multidisciplinary and multicomponent programs have been proposed for the care of complex patients around hospital discharge, and patient-centered coordination models may lead to better results than the traditional ones for this type of patient. However, programs with these characteristics have not been systematically implemented in our country, despite the positive results obtained. Hospital Universitario de Canarias cares for patients from the northern area of Tenerife and La Palma, Spain. In this hospital, a multicomponent and high-intensity care program is carried out by a multidisciplinary team (made up of family doctors and nurses together with social workers) with complex patients in the transition of care (SPICA program). The aim of this program is to guarantee social and family reintegration and improve the continuity of primary healthcare for discharged patients, following the patient-centered clinical method. Implementing multidisciplinary and high-intensity programs would improve clinical outcomes and would be cost-effective. This kind of program is directly related to the current clinical governance directions. In addition, as the SPICA program is integrated into a Family and Community Care Teaching Unit for the training of both specialist doctors and specialist nurses, it becomes a place where the specific methodology of those specialties can be carried out in transitional care. During these 22 years of implementation, its continuous quality management system has allowed it to generate an important learning curve and incorporate constant improvements in its work processes and procedures. Currently, research projects are planned to reevaluate the effectiveness of individualized care plans and the cost-effectiveness of the program.

Ефективність корекції фізичного статусу хворих з коморбідністю хвороби Паркінсона та старечої астенії засобами фізичної терапії як передумови обмеження активностей повсякденного життя

The purpose of the study was to assess the effectiveness of the impact of physical therapy on physical status and activities of daily living in elderly people with Parkinson's disease and senile asthenia. Materials and methods. The study involved 57 elderly people diagnosed with Parkinson's disease in combination with frailty. They were divided into two groups: group 1 – they were engaged according to the principles of polyclinic rehabilitation, and group 2 – they were engaged according to the developed program of physical therapy for 6 months, rehabilitation training was carried out three times a week. The aim of the program was to increase physical status and activities of daily living of patients with the implementation of active methods of physical therapy (kinesitherapy) and, thus, to maintain general physical activity; to increase muscle strength and flexibility; to facilitate the initiation of movements; to improve joint mobility; to maintain correct posture; to improve walking and maintain balance; to prevent pain syndromes and contractures; to prevent respiratory disorders; to adapt to the changed conditions of daily activity. The physical therapy program was created taking into account the specifics of each comorbid condition using functional training on the Prosedos platform, therapeutic exercises, massage, elements of occupational therapy, nutrition correction, patient education. We consistently achieved individual short- and long-term goals of rehabilitation in the SMART-format within the patient-centered rehabilitation model. This helped to select such elements of functional training, which made it possible to individually adjust the most affected movements in each patient, and interfere with normal functioning. The control group consisted of 24 people without signs of frailty and Parkinson's disease. The effectiveness of the program was assessed by the dynamics of the 6-minute walk test (distance traveled, level of fatigue according to the Borg scale), Mini-Balance Evaluation Systems Test, Barthel Activities of daily living Index, Lawton Instrumental activities of daily living Scale. Patients were examined twice – before and after rehabilitation measures (with an interval of 6 months). Results and discussion. In elderly patients with Parkinson's disease and sarcopenia, deterioration of physical status (expressed fatigue and a short distance according to the results of the 6-minute test), violation of indicators of static and dynamic balance and, as a result, violation of performance of instrumental and basic activities of daily life were found (p <0.05 of the parameters of the control group). The developed program of physical therapy caused a statistically significant better effect on the studied indicators of functioning and activities of daily life compared to the general polyclinic program for all studied indicators (р <0.05). Conclusion. Elderly patients with the comorbidity of Parkinson's disease and frailty need the development of physical therapy programs taking into account and correcting the specifics of each disease, which will increase the overall efficiency of recovery processes and improve the performance of activities of daily life

Patient priorities for research: A focus group study of UK medical cannabis patients

IntroductionThere has yet to be an evaluation of medical cannabis patient preferences with respect to future research. As such, prioritisation of research agendas has been largely driven by academia and industry. The primary aim of this study was to elicit priorities for research from medical cannabis patients in the United Kingdom (UK). MethodsPatients undergoing active treatment for health conditions with medical cannabis in the UK were invited to take part in focus groups from December 2021 to February 2022. An inductive thematic analysis of responses was performed. Participants also completed a ranking exercise whereby they assigned ten counters (each equivalent to £1 million GBP) to competing research priorities. Results30 medical cannabis patients participated across 3 focus groups. The following themes were identified as research priorities: adverse events, comparison between cannabis-based medicinal products, health conditions, pharmacology of cannabis, types of study, healthcare professionals' attitudes, social environment, agriculture and manufacturing, and the cannabis plant. Participants assigned the highest proportion of research funding to ‘assessment of effect on specific symptoms’ (26 counters; 8.7%). ConclusionsThis study highlighted specific themes within which to focus future research on medical cannabis. Clinically, there was a directive towards ensuring that research is condition- or symptom-specific. Participants also emphasised themes on the social impact of medical cannabis, such as knowledge of medical cannabis among healthcare professionals, stigma, and effects on driving and in the workplace. These findings can guide both research funders and researchers into effectively conducting research which fits within a more patient-centric model.

Simplifying hepatitis C care models: a crucial step towards hepatitis C elimination

In The Lancet Gastroenterology & Hepatology, Alain Litwin and colleagues1 present findings from the Hepatitis C Real Option (HERO) study: a multicentre, pragmatic, randomised controlled trial that investigated the effect of two patient-centred care models—namely, modified directly observed therapy (mDOT) and patient navigation—on hepatitis C virus (HCV) treatment uptake among people who recently injected drugs (≤90 days at enrolment). Participants were recruited from 15 community health centres and ten opioid treatment programmes (OTPs) across eight, diverse but mostly urban-based US sites.

Patient-centred models of hepatitis C treatment for people who inject drugs: a multicentre, pragmatic randomised trial

To achieve WHO targets for the elimination of hepatitis C virus (HCV) as a public threat, an increased uptake of HCV treatment among people who inject drugs (PWID) is urgently needed. Optimal HCV co-located treatment models for PWID have not yet been identified. We aimed to compare two patient-centred models of HCV care in PWID with active drug use. We did a pragmatic randomised controlled trial at eight US cities in eight opioid treatment programmes and 15 community health centres. PWID actively injecting within 90 days of study entry were randomly assigned (1:1) to either patient navigation or modified directly observed therapy (mDOT) using computer-generated variable block sizes of 2-6 stratified by city, clinical settings, and cirrhosis status. The randomisation code was concealed, in a centralised REDCap database platform, from all investigators and research staff except for an authorised data manager at the data coordinating centre. All participants received a fixed-dose combination tablet (sofosbuvir 400 mg plus velpatasvir 100 mg) orally once daily for 12 weeks. The primary outcome was sustained virological response (SVR; determined by chart review between 70 days and 365 days after end of treatment and if unavailable, by study blood draws), and secondary outcomes were treatment initiation, adherence (measured by electronic blister packs), and treatment completion. Analyses were conducted within the modified intention-to-treat (mITT; all who initiated treatment), intention-to-treat (all who were randomised), and per-protocol populations. This trial is registered with ClinicalTrials.gov, NCT02824640. Between Sept 15, 2016, and Aug 14, 2018, 1891 individuals were screened and 1136 were excluded (213 declined to participate and 923 did not meet the eligibility criteria). We randomly assigned 755 participants to patient navigation (n=379) or mDOT (n=376). In the mITT sample of participants who were randomised and initiated treatment (n=623), 226 (74% [95% CI 69-79]) of 306 participants in the mDOT group and 236 (76% [69-79]) of 317 in the patient navigation group had an SVR, with no significant difference between the groups (adjusted odds ratio [AOR] 0·97 [95% CI 0·66-1·42]; p=0·35). In the ITT sample (n=755), 226 (60% [95% CI 55-65]) of 376 participants in the mDOT group and 236 (62% [57-67]) of 379 in the patient navigation group had an SVR (AOR 0·92 [0·68-1·25]; p=0·61) and in the per-protocol sample (n=501), 226 (91% [87-94]) of 248 participants in the mDOT group and 235 (93% [89-96]) of 253 in the patient navigation group had an SVR (AOR 0·79 [0·41-1·55]; p=0·44). 306 (81%) of 376 participants in the mDOT group and 317 (84%) of 379 participants in the patient navigation group initiated treatment (AOR 0·86 [0·58-1·26]; p=0·44) and, among those, 251 (82%) participants in the mDOT group and 264 (83%) participants in the patient navigation group completed treatment (AOR 0·90 [0·58-1·39]; p=0·63). Mean daily adherence was higher in the mDOT group (78% [95% CI 75-81]) versus the patient navigation group (73% [70-77]), with a difference of 4·7% ([1·9-7·4]; p=0·0010). 421 serious adverse events were reported (217 in the mDOT group and 204 in the patient navigation group), with the most common being hospital admission (176 in the mDOT group vs 161 in the patient navigation group). In this trial of active PWID, both models resulted in high SVR. Although adherence was significantly higher in the mDOT group versus the patient navigation group, there was no significant difference in SVR between the groups. Increases in adherence and treatment completion were associated with an increased likelihood of SVR. These results suggest that active PWID can reach high SVRs in diverse settings with either mDOT or patient navigation support. Patient-Centered Outcomes Research Institute, Gilead Sciences, Quest Diagnostics, Monogram Biosciences, and OraSure Technologies.

P049 Barriers and facilitators to the delivery of insomnia management by general practice nurses: a qualitative analysis of patient perspectives

Abstract Introduction With insufficient providers of insomnia care, alternative approaches to the delivery of insomnia treatments are being explored. Research has demonstrated that insomnia can be successfully managed by primary care nurses but patient attitudes towards this care are largely unknown. This study explored patient perspectives towards barriers and facilitators to practice nurse-delivered care to inform the development of patient-centred models of care for insomnia. Methods A qualitative sub-study within a process evaluation of sleep health care delivered in a pilot study in one general practice in metropolitan Adelaide. Semi-structured telephone interviews were conducted with patients with insomnia offered nurse-delivered or nurse-supported insomnia management. Thematic Analysis was used to identify themes within the data. Results Eleven patients participated (6 males; age mean [range] 59 years [29-72]; time at practice 14.3 years [4-21]; Sleep Condition Indicator 9.5 [3-14]). Two major themes were identified: 1. Patients are supportive of nurses providing care for uncomplicated insomnia; 2. Trust in practice nurse-delivered insomnia care is influenced by relationships with the GP, the practice, and the nurse. Participants reported confidence in practice nurses providing insomnia management provided that they had sufficient knowledge. Established relationships with the GP and the practice, along with previous appointments with the nurse, increased patient confidence in nurse-delivered insomnia care. Discussion Patient acceptance of practice nurse-delivered insomnia care supports further research into developing a role for practice nurses within insomnia management. The findings of this work will be tested and explored further within a large implementation study conducted in multiple general practices.

DETERMINANT FACTORS OF PATIENT SATISFACTION AND TRUST IN PHARMACY STAFF AMONG PERSONS WITH NON-COMMUNICABLE DISEASES: PATIENT CENTERED CARE APPROACH

Patient satisfaction and trust are the main focus in the context of health care. Patient satisfaction is influenced by medication service factors, handling patient complaints and listening to patient needs. Important to develop and test a patient-centered care model as a tool to monitor, measure, analyze, and increase patient satisfaction and trust among people with non-communicable diseases in Public Health Center service setting. This study attempts to ascertain the effect of care on patient satisfaction and trust in pharmacy staff at the Magelang City Public Health Center. Cross-sectional quantitative research is used in this field. 212 people participated as the sample. Non-probability sampling using a purposive sample strategy was used as the sampling technique in this investigation. Structural Equation Modeling-Partial Least Square (SEM-PLS) is used for hypothesis testing. According to the study's findings, patient satisfaction is positively impacted by pharmacy staffs’ participative behavior and interpersonal communication (p< 0.05). Interpersonal communication and pharmacy staff participation do not affect the trust in pharmacy staff (p> 0.05). Patient satisfaction plays a moderating role in the association between pharmacy staff participation and trust in pharmacy staff (p< 0.05). Likewise, the association between interpersonal communication and trust in pharmacy staff is mediated by patient satisfaction (p< 0.05).

New Targeted Agents in Myasthenia Gravis and Future Therapeutic Strategies.

Myasthenia gravis (MG) is a chronic autoimmune disease for which multiple immunomodulatory therapies are available. Nevertheless, MG has a significant impact on patient quality of life. In recent years, experts' main efforts have focused on optimizing treatment strategies, since disease burden is considerably affected by their safety and tolerability profiles, especially in patients with refractory phenotypes. This article aims to offer neurologists caring for MG patients an overview of the most innovative targeted drugs specifically designed for this disease and summarizes the recent literature and more recent evidence on agents targeting B cells and plasmablasts, complement inhibitors, and neonatal fragment crystallizable receptor (FcRn) antagonists. Positive clinical trial results have been reported, and other studies are ongoing. Finally, we briefly discuss how the introduction of these novel targeted immunological therapies in a changing management paradigm would affect not only clinical outcomes, disease burden, safety, and tolerability, but also health spending in a condition that is increasingly managed based on a patient-centred model.

Application of the DanOBS questionnaire combined with a patient-centered consultation video for measuring teaching efficacy in a general practice course.

Introduction Diverse ways to measure course effectiveness in medical education exist, but it takes time to have the results. The authors have developed a tool consisting of a questionnaire (DanOBS) combined with a test video consultation. The students watched a consultation video and completed a questionnaire about patient-centered elements before and after the course. This study aimed to assess the utility of a new quick tool for measuring efficacy in teaching the patient-centered consultation model. Method Altogether 201 students from autumn 2019 were included in this study, assigned by the university to three general practice courses and six small study groups. After introducing the patient-centered consultation model on the first day of the course, the students watched a video consultation and completed the DanOBS online on their Mobile Phones. They watched the video and completed the questionnaire again on one of the last days of the course. The number of correct answers in each item was compared before and after the course. Furthermore, effect sizes for each item were calculated. Results The number of students completing the questionnaire before and after the course was 161. The number of correct answers increased after the course. Items where the teaching was a success, as well as items where it needs intensifying, were identified. The DanOBS instrument reflected the effect of strengthening the learning in some elements of the patient-centered mode. Conclusion A tool for measuring efficacy in teaching patient-centered consultation has been implemented and has given valuable information to teachers about where the students need intensified teaching. The tool can measure the effectiveness of various educational interventions.

A qualitative study of nursing practitioners' experiences with COVID-19 patients dying alone in Greece.

In Greece, there is still limited research on death in isolation due to COVID-19. This deserves attention because of the recent financial crisis, which profoundly impacted public health, and the high relevance of the Hippocratic tradition to the moral values of clinical practice. A prospective qualitative study using in-depth interviews with 15 frontline nursing practitioners working in a COVID-19 ward or intensive care unit (ICU) was conducted from July 2021 to December 2021. The inability of family members to say a final goodbye before, during, or after death by performing proper mourning rituals is extremely inhuman and profoundly impacts the mental health status of patients, family members, and nursing practitioners. Patients and their family members strongly desire to see each other. Epidemiology, liability, and proper nursing performance emerged as reasons for the enforced strict visitation restrictions. Participants emphasized that visitations should be allowed on an individual basis and highlighted the need for the effective use of remote communication technology, which, however, does not substitute for in-person contact. Importantly, physicians allowed "clandestine" visits on an individual basis. Nursing practitioners had a strong empathic attitude toward both patients and their families, and a strong willingness to provide holistic care and pay respect to dead bodies. However, they also experienced moral distress. Witnessing heartbreaking scenes with patients and/or their families causes nursing practitioners to experience intense psychological distress, which affects their family life rather than nursing performance. Ultimately, there was a shift from a patient-centered care model to a population-centered care model. Furthermore, we identified a range of policy- and culture-related factors that exaggerate the negative consequences of dying alone of COVID-19. These results reinforce the existing literature on several fronts. However, we identified some nuances related to political decisions and, most importantly, convictions that are deeply rooted in Greek culture. These findings are of great importance in planning tailored interventions to mitigate the problem of interest and have implications for other similar national contexts.

Development and implementation of a tool for measuring the training effectiveness of the patient-centered consultation model

Background: The patient-centered consultation model comprises four elements: exploring health, illness and disease experiences, understanding the whole person, finding common ground, and enhancing the patient-doctor relationship. This method is taught at the course in general practice at Copenhagen University. The aim of the study was to develop a simple tool consisting of a questionnaire about the patient-centered elements and a test video consultation. The outcome is the change in the students’ ability to identify these elements. Used as a pre-course and post-course test it can inform the teachers which elements of the patient-centered consultation need intensifying in the teaching. Methods: The students from a course in general practice volunteered to participate in all steps of the development. They took part in individual interviews to select items from an already existing questionnaire (DanSCORE). The preliminary questionnaire was tested for face and content validity, pilot-tested and tested for test-retest reliability. All video consultations were transcribed and assessed for patient-centered elements through a conversation analysis. The videos showed medical students seeing real patients. Results: The preliminary version of the questionnaire (called DanOBS) had 23 items. In the subsequent interviews, items were reduced to 17, each with three response options. After a pilot test, the questionnaire was further reduced to 13 items, all strictly relevant to the model and with two response options. The final questionnaire had acceptable test-retest reliability. The number of test consultation videos underwent a reduction from six videos to one. Conclusions: The DanOBS combined with a test video consultation, used as a pre-and post-course test demonstrates for teachers which elements in the patient-centered consultation need to be intensified in the teaching.

S610 A Patient-Centered Model for Implementing a Patient Education Intervention for Inpatient Colonoscopies

Introduction: Inadequate bowel preparations are a common cause of delayed colonoscopies in the inpatient setting, compromising patient safety and quality of care. Patient education interventions have been shown to improve the quality of bowel preparations. However, high-quality, validated educational tools for use in the hospital are not widely available. As part of a quality improvement initiative, we aimed to develop an educational resource for inpatient colonoscopies using direct input from patients and subject matter experts from conception to roll out. Methods: We identified patients who recently had a colonoscopy in a large academic hospital system to participate in open-ended interviews. Consented subjects were asked general questions about the bowel preparation process and specific questions to guide the development of an educational tool. A patient-facing resource was created and reviewed by subject matter experts in Gastroenterology and health literacy. Readability was assessed using a validated measure. In a series of Plan-Do-Study-Act (PDSA) cycles, additional feedback was collected from patients and experts to further optimize the resource. The finalized resource was provided to hospitalized patients undergoing bowel preparation for a colonoscopy. Patients were later asked to complete a survey on their experience with the tool. Results: Feedback from 12 adult patients and 4 subject matter experts were used in the development of the resource. Patients desired a resource that is clear, thorough, and focused on the patient experience. Most patients expressed a preference for a booklet format over an online, video, or other printed resource. A booklet was adapted from existing materials found in the literature and outpatient settings and optimized in subsequent PDSA cycles.1 The finalized booklet had a Flesch Kincaid grade level of 3.9. Preliminary survey data (n=6) on the booklet showed an average rating of 4/5 for clarity, trustworthiness, and reassurance; and satisfaction ratings increased by 20% on average when compared to no booklet. Conclusion: We describe a dynamic model for implementing an educational intervention for inpatient colonoscopies using patient engagement principles and quality improvement methodologies.

Exploring provider roles, continuity, and mental models in cirrhosis care: A qualitative study.

BACKGROUND: Advanced cirrhosis results in frequent emergency department visits, hospital admissions and readmissions, and a high risk of premature death. We previously identified and compared differences in the mental models of cirrhosis care held by primary and specialty care physicians and nurse practitioners that may be addressed to improve coordination and transitions in care. The aim of this paper is to further explore how challenges to continuity and coordination of care influence how health care providers adapt in their approaches to and development of mental models of cirrhosis care. METHODS: Cross-sectional formal elicitation of mental models using Cognitive Task Analysis. Purposive and chain-referral sampling took place over 6 months across Alberta for a total of 19 participants, made up of family physicians (n = 8), specialists (n = 9), and cirrhosis nurse practitioners (n = 2). RESULTS: Lack of continuity in cirrhosis care, particularly informational and management continuity, not only hinders health care providers' ability to develop rich mental models of cirrhosis care but may also determine whether they form a patient-centred or task-based mental model, and whether they develop shared mental models with other providers. CONCLUSIONS: The system barriers and gaps that prevent the level of continuity needed to coordinate care for people with cirrhosis lead providers to create and work under mental models that perpetuate those barriers, in a vicious cycle. Understanding how providers approach cirrhosis care, adapt to the challenges facing them, and develop mental models offers insights into how to break that cycle and improve continuity and coordination.

Introduction to this special issue.

Introduction to this special issue.

"No One Truly Understands What We Go through and How to Treat It": Lived Experiences with Medical Providers among Patients with Orofacial Pain.

Orofacial pain affects 10–15% of adults, yet treatments are limited. The gaps in care are frustrating for both patients and providers and can negatively impact patient–provider interactions. These interactions are key because they impact patient-reported outcomes and satisfaction with care. Purpose: Our study aims to understand the nuanced experiences with medical providers among patients with orofacial pain. Methods: In a cross-sectional survey, 260 patients provided written responses describing their experiences with medical providers. Using an inductive–deductive approach to thematic analysis, we identified themes and subthemes and organized them into four domains based on the Patient-Centered Model of Communication. Results: Patients reported feeling hopeless about treatment options, frustrated with lack of provider knowledge, disappointed in ineffective care, and stigmatized and dismissed by providers. Patients also said they learned to advocate for their health, were grateful for effective care, and felt lucky when providers listened and showed compassion. Patients identified key barriers that interfere with care (e.g., insurance, transportation, limited providers, lack of team coordination). Conclusions: Findings can help inform training programs and psychoeducation that target patient–provider communication to improve patient-reported outcomes, the quality of care delivered, and health care utilization and costs.