Patient-centered Interventions Research Articles

Differing needs for Advance Care Planning in the Veterans Health Administration: use of latent class analysis to identify subgroups to enhance Advance Care Planning via Group Visits for veterans

BackgroundAdvance Care Planning via Group Visits (ACP-GV) is a patient-centered intervention facilitated by a clinician using a group modality to promote healthcare decision-making among veterans. Participants in the group document a “Next Step” to use in planning for their future care needs. The next step may include documentation of preferences in an advance directive, discussing plans with family, or anything else to fulfill their ACP needs. This evaluation seeks to determine whether there are identifiable subgroups of group participants with differing needs prior to delivery of the ACP-GV program and, if so, to use information about the subgroups to enhance the program offered to veterans in United States Department of Veterans Affairs (VA) healthcare settings.MethodsWe conducted a secondary analysis of national data from a quality improvement evaluation. Patient- and provider-level data from administrative healthcare records for VA users in all 50 states, territories, and the District of Columbia provides data on veterans attending ACP-GV during federal fiscal years 2018–2022 (N = 26,857). Latent class analysis seeks to identify the various subgroups of veterans based on their level of ACP self-efficacy before attending ACP-GV and any demographic differences across the resulting subgroups of veterans attending ACP-GV. ACP self-efficacy is derived from seven items obtained from a participant worksheet used during the group.ResultsAnalysis revealed two distinct groups of veterans, distinguishable by their pre-ACP-GV levels of one aspect of ACP self-efficacy: prior knowledge of ACP. Veterans with higher prior knowledge of ACP are associated with an identified next step focused on checking their current AD status and updating it, and veterans with lower ACP prior knowledge are associated with identifying a next step to discuss ACP more fully with family. Differences in age, sex, race, ethnicity, and marital status exist across subgroups of veterans.ConclusionGreater attention must be paid to ACP and veterans’ prior knowledge of ACP to consistently encourage annual review and status updates.

Empowering People Experiencing Homelessness for cancer prevention using the Health Navigator Model

Abstract Cancer poses a significant public health concern. Reports highlight that cancer-related mortality rates are double among people experiencing homelessness (PEH). CANCERLESS project delivered an innovative solution based on the Health Navigator Model (HNM). The HNM is an evidence-based patient-centred intervention that develops patient empowerment through health education and social support, promoting timely access to cancer prevention services. A pre-post design study conducted across four pilot sites in Europe (Austria, Greece, Spain, UK) involved 652 PEHs. Pilot interventions based on the HNM were implemented, with effectiveness evaluated at baseline and post-intervention. The study assessed the impact of the HNM on various factors including risk behaviors, lifestyles, quality of life, empowerment, health literacy, psychological distress and utilization of health and care services. Preliminary findings from CANCERLESS HNM intervention showed significant improvements (p= .000) in participants’ quality of life (55.82 (27.65) vs. 66.18 (22.27)) and sense of empowerment (25.58 (19.95) vs. 59.94 (43.10)). However, there were no observable impacts in health literacy (p= .509) or psychological distress (p= .140), which remained within acceptable ranges both pre- and post-intervention. Similarly, there were no significant changes observed in lifestyle or risk behaviours among PEHs. Nonetheless, the evaluation of effectiveness suggested that the HNM increase in the uptake of cancer prevention care, such as cancer screening (p= .000). The CANCERLESS HNM intervention significantly improved the quality of life and empowerment of PEHs. Additionally, it successfully promoted their involvement in cancer prevention efforts, addressing disparities in access to preventive healthcare services. Increased engagement in such initiatives can lead to early detection and treatment, ultimately reducing cancer morbidity and mortality rates, thereby positively impacting public health. Key messages • By promoting health equity and social justice, interventions like CANCERLESS HNM contribute to building healthier and more resilient public health systems. • CANCERLESS boosts cancer prevention awareness, tackles healthcare disparities, enhances cancer early detection, benefiting public health.

Sodium-Glucose Cotransporter 2 Inhibitor Therapy in Different Scenarios of Heart Failure: An Overview of the Current Literature

Heart failure (HF) is a complex syndrome that requires tailored and patient-centered treatment. Sodium-glucose cotransporter 2 inhibitors (SGLT2is) constitute one of the four pillars of the medical treatment of HF. However, the 2023 ESC guidelines treat HF as a single entity without making clear distinctions in phenotypes according to etiology. This creates a “gap in knowledge”, causing much debate about the applicability of these drugs in peculiar clinical settings that are etiological and/or predisposing clinical conditions for HF. Furthermore, considering the variety of etiologies and different pathophysiological backgrounds of HF, one might question whether the use of SGLT2is is equally beneficial in all types of HF and whether certain drug-related properties may be exploited in different contexts. For example, SGLT2is can improve the metabolic and inflammatory state, which is fundamental in ischemic heart disease. Anti-inflammatory power can also play a paramount role in myocarditis or cardiotoxicity, while improving the congestive state and reducing filling pressure may be even more fundamental in restrictive heart disease or advanced heart disease. This review aims to gather the evidence currently present in the literature concerning the advantages or the disadvantages of using these drugs in these particular clinical settings, with the goal being an optimized and highly personalized treatment for HF.

Eliciting medication preferences of patients with type 2 diabetes under different insurance coverages in China

ObjectiveTo understand the medication preference of type 2 diabetes mellitus (T2DM) patients with different insurance coverages, and to provide reference for improving the patient-centered clinical treatment decision.MethodsThis study used Discrete Choice Experiment (DCE) to elicit preferences of T2DM patients with different insurance coverages in China. A multistage stratified cluster-sampling procedure for data collection and a total of 1,409 valid respondent were conducted.ResultsSeven attributes have significant influence on the preference of T2DM patients with Urban Employee Basic Medical Insurance (UEBMI) and Urban and Rural Residents Basic Medical Insurance (URRBMI) (p < 0.05). T2DM patients with UEBMI pay the most attention to Gastrointestinal adverse events, while T2DM patients with URRBMI pay the most attention to the Treatment efficacy/reduction in HbA1c. Patients with different medical insurance have different willingness to pay for Cardiovascular benefits, Mode of administration and Weight change. When Gastrointestinal adverse events is changed from higher (40%) to none (0%), patients with UEBMI are willing to pay ¥523.49 more per month, while patients with URRBMI are only willing to pay ¥266.62; When the Treatment efficacy/reduction in HbA1c changes from poor (0.5%) to Highest (2.5%), patients with UEBMI are willing to pay ¥518.44 more per month, while patients with URRBMI are willing to pay ¥328.33 more per month. The Gastrointestinal adverse events and the Treatment efficacy/reduction in HbA1c are the primary factors for T2DM patients with UEBMI and URRBMI, followed by the Hypoglycemic risk.ConclusionPhysicians should consider patients’ medication preferences in clinical medication treatment of T2DM patients with different insurance coverages, make targeted treatment decisions, and improve patients’ medication compliance to achieve better treatment results.

Maximizing the "Functional" in the Functional External Memory Aid Tool for Patient-Centered Treatment Planning in Mild Cognitive Impairment.

The Functional External Memory Aid Tool (FEMAT) is an 11-item performance-based measure that simulates everyday tasks (e.g., medication management) to measure one's use of compensation (e.g., pill organizer). The FEMAT is not a norm-referenced diagnostic tool; rather, it is designed to provide clinicians with information about a patient's function and compensation in a standardized format. To provide further evidence for validity of the FEMAT, the purpose of this study was to conduct a mixed-methods analysis of FEMAT responses to operationalize the types of behaviors elicited during test administration. We adopted an embedded single-case study design to analyze the FEMAT administrations of 12 community-dwelling female participants, ages 73-90 years, who met criteria for mild cognitive impairment. These participants were part of the original validation sample during which they completed the FEMAT (Version 1.0) in a single session with an assessor. Sessions were video-recorded and transcribed. We analyzed the data qualitatively in two phases using theme and subtheme codes and then quantitatively analyzed the data for response trends. Our thematic analysis revealed four themes to operationalize participants' verbal and behavioral FEMAT responses: (a) used an external memory aid (EMA), (b) described using a strategy, (c) discussed memory and comprehension, and (d) discussed functional information. While completing the FEMAT, most participants described using a strategy (85%) and discussed their self-perceived memory and comprehension (33%). Several subthemes also emerged within each theme (e.g., self-perceived memory strengths and barrier). Our analysis suggests that beyond a 4-point item score, the FEMAT elicits behavioral (e.g., used an EMA) and verbal (e.g., discussion of health information) content that may be useful for person-centered treatment planning. This study is part of a comprehensive research agenda establishing the evidence for the validity of the FEMAT to support its use to inform person-centered treatment approaches.

Muscle Mass and Glucagon-Like Peptide-1 Receptor Agonists: Adaptive or Maladaptive Response to Weight Loss?

Recent studies have shown that pharmacologic weight loss with glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and combination therapies is approaching magnitudes achieved with surgery. However, as more weight loss is achieved, there is concern for potential adverse effects on muscle quantity, composition, and function. This primer aims to address whether muscle-related changes associated with weight loss treatments such as GLP-1 RAs may be maladaptive (ie, adversely affecting muscle health or function), adaptive (ie, a physiologic response to weight loss maintaining or minimally affecting muscle health or function), or perhaps an enhanced response to weight loss (ie, improved muscle health or function after treatment). Based on contemporary evidence with the addition of studies using magnetic resonance imaging, skeletal muscle changes with GLP-1 RA treatments appear to be adaptive: changes in muscle volume z-score indicate a change in muscle volume that is commensurate with what is expected given aging, disease status, and weight loss achieved, and the improvement in insulin sensitivity and muscle fat infiltration likely contributes to an adaptive process with improved muscle quality, lowering the probability for loss in strength and function. Nevertheless, factors such as older age and prefrailty may influence the selection of appropriate candidates for these therapies because of risk for sarcopenia. Several pharmacologic treatments to maintain or improve muscle mass designed in combination with GLP-1-based therapies are under development. For future development of GLP-1-based therapies (and other therapies) designed for weight loss, as well as for patient-centered treatment optimization, the introduction of more objective and comprehensive ways of assessing muscle health (including accurate and meaningful assessments of muscle quantity, composition, function, mobility, and strength) is important for the substantial numbers of patients who will likely be taking these medications well into the future.

Right knee ACL, PCL and MCL reconstruction with sports-related anxiety

Introduction: JM, a 20-year-old male professional ice hockey player, presented with a 2-week history of lack of range of motion, weakness, and pain in his right knee, after a 2-year post-medical collateral ligament repair of the right knee and 3 year-post anterior cruciate ligament, posterior cruciate ligament and medial collateral ligament reconstruction of the right knee. Case Description: In the course of history taken, it was revealed that 5 months prior to admission the patient had been informed by a psychiatrist that he had sport-related anxiety. With an unremarkable psychiatric history prior to age 18, the competitive nature of his sports career in addition to financial pressure may have contributed to his sports-related anxiety. His examination findings were consistent with a diagnosis of complete tears of the right anterior cruciate ligament and posterior cruciate ligament along with grade III medial collateral ligament injury. Discussion: The biopsychosocial model was used to explicate JM's case. JM's current injuries prompted reconstruction of the anterior cruciate, posterior cruciate, and medial collateral ligaments. Psychologically, JM's sports-related anxiety is not a rare phenomenon as recent studies have discovered an increased risk of sports-related anxiety amongst young professional athletes. Sports-related anxiety, along with competitive trait anxiety, may be factors that contribute to sports injury occurrence. Other psychological stressors can add to sports-related or competitive trait anxiety, further increasing the risk of sports injury reoccurrence. Summary: JM was admitted for a right knee open medial collateral ligament repair with internal bracing, anterior cruciate ligament reconstruction, posterior cruciate ligament reconstruction, and platelet rich plasma injection. As part of a holistic patient-centered treatment plan, a referral to psychiatry was made to address JM's sports-related anxiety with the goal of decreasing future risk of sports injury. Patient's Consent Obtained: Yes

Medical Maximizing Orientation and the Desire for Low-Value Screening: An Examination of Mediating Mechanisms.

Medical maximizing orientation is a stable, traitlike inclination to actively use health care, often associated with pursuing low-value care. Despite attempts to reduce the overuse of low-value care by targeting this orientation directly, such interventions have not always been effective. To design effective interventions to reduce the overuse of low-value care, it is critical to understand the underlying mechanisms that govern the impact of medical maximizing orientation. To examine whether risk perception (deliberative, affective, and experiential) and knowledge of the benefits and harms of low-value screening mediate the potential impact of medical maximizing orientation on attitudes toward screening uptake and screening decisions. A secondary analysis was conducted on data from a Web-based experiment examining various communication tactics in an information booklet regarding low-value thyroid ultrasonography among South Korean women (N = 492). Multiple linear, zero-inflated negative binomial and multinomial logistic regressions were used to examine the relationships between medical maximizing orientation and other study variables. A mediation analysis was performed to test mediating mechanisms. Medical maximizing orientation was associated with an increased positive attitude toward screening uptake and a lower likelihood of deciding not to get screened or being uncertain regarding screening decisions (relative to deciding to get screened). Knowledge and affective risk perception partially mediated the relationship between medical maximizing orientation and positive attitudes. Knowledge, deliberative, and affective risk perceptions partially mediated the relationship between medical maximizing orientation and the screening decision. Interventions should prioritize targeting more amenable factors arising from medical maximizing orientation, such as inflated risk perceptions, particularly affective risk perception, and limited comprehension or acceptance of information about the benefits and risks associated with low-value care. This study demonstrated that people's medical maximizing orientation can increase their positive attitudes toward the uptake of low-value screening and make them more likely to undergo it. This can happen both directly and indirectly by decreasing their understanding of the benefits and risks of screening and increasing their perception of disease risk.The study suggests that to effectively mitigate the excessive utilization of low-value care through patient-centered interventions, it is crucial to tackle 2 key issues associated with a medical maximizing mindset: inflated risk perceptions (specifically affective risk perception) and limited comprehension or acceptance of information about the benefits and risks of low-value care.This study contributes to developing a theoretical framework for interventions to improve evidence-based medical decision making by uncovering one mechanism by which medical maximizing orientation may affect the propensity to seek low-value care.

Staff Safety Alert Banner Program Against Workplace Violence at an Urban American Hospital.

Workplace violence (WPV) in healthcare has become an issue worldwide, with increasing prevalence after the COVID-19 pandemic. Notably, WPV in any setting has individual and systemic repercussions. However, despite extensive literature reporting the prevalence of WPV in healthcare worldwide, effective, standardized prevention policies have not been established. We developed and piloted a WPV initiative at an urban hospital in the state of Maryland. Here, we aim to describe our program development methods and implementation. The 6-month program utilized a reporting tool developed within patients' electronic medical records (EMRs) to request the display of a Staff Safety Alert (SSA) banner to alert healthcare professionals of patients who engaged in violent behavior and are at increased risk of subsequent behavior. This tool was piloted on 21 patient care units. A review committee either approved or denied case requests filed by frontline workers, with holistic consideration involving patient status, potential biases, and communication flaws. Twenty-one banner requests were filed during the course of the pilot. Of which, eight were approved, and 13 were denied. The multi-trauma intermediate care floor filed the most case requests for a safety banner. Our pilot program offers a patient-centered intervention program where extensive personnel training and patient-focused considerations were applied prior to the approval or denial of a banner display. The SSA program was the initial step in institutionally combatting WPV in healthcare as staff are encouraged to officially document unsafe events followed by careful action in response.

Development of the World Federation of Hemophilia Shared Decision-Making Tool.

The use of shared decision-making (SDM) in clinical settings is becoming more prevalent. The evolving and increasingly complex treatment landscape of haemophilia management has augmented the need and desire for SDM between patients and their healthcare team. SDM tools have been used in other chronic conditions and can be an effective form of education for patients and clinicians. The World Federation of Hemophilia (WFH) partnered with people with haemophilia (PWH), patient advocacy groups, and healthcare practitioners to form an expert working group to develop an educational tool for PWH and their caregivers. The primary objectives included educating PWH on the available prophylactic treatments and facilitating discussion between PWH and their healthcare team. The tool was proposed and developed by the expert working group, workshopped at conference round tables, and evaluated in two focus groups. The interactive WFH SDM Tool guides users through the SDM treatment journey and provides an opportunity for reflection on current disease impact and treatment preferences, educational fact sheets and videos, and a comparison between treatment classes. Two forms of the SDM Tool are available: an online platform with a summary page that may be printed and shared and a printable workbook. All evidence in the tool is based on the prescribing information or phase III clinical trial publications. The Tool will be updated twice each year. The WFH SDM Tool is the first available resource that translates published guidance on SDM in haemophilia into a practical, user-friendly tool aimed at facilitating patient-centred treatment decisions.

Perioperative interventions to enhance surgical outcomes for older adults with cancer: A systematic review.

219 Background: Older adults with cancer have unique needs, particularly in the perioperative setting, which likely influence surgical outcomes in the geriatric oncology population. Little work has sought to describe available literature investigating perioperative interventions to enhance surgical outcomes for these individuals. Our systematic review sought to describe the literature on perioperative interventions in older adults with cancer undergoing surgery. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we performed a comprehensive search using the Ovid MEDLINE, CINAHL, and Embase databases, searching for literature published from 1/2010-10/2023 (search terms used relevant terminology for geriatric oncology in the perioperative setting). We included randomized controlled trials (RCT) focusing on patient-centered interventions that enrolled adults >60 years old with cancer, excluding studies with pharmacologic, procedural, and radiographic interventions. Results: We included 11 RCTs with 2,177 patients. Patients’ age ranged from 60-95, and median number of patients per study was 147 (range: 44-690). Most studies included patients with colorectal cancer (81.8% [9/11]), all involving non-emergent elective surgeries. Half the studies (54.5% [6/11]) evaluated exercise interventions, and the remaining assessed geriatric assessment-guided interventions (27.2% [3/11]), nutrition optimization (9.1% [1/11]), and patient empowerment (9.1% [1/11]). Primary outcomes were as follows: postoperative complications, quality of life, feasibility of exercise programs, delirium incidence, inspiratory muscle endurance, hospital length of stay, and consistency of nutritional management. All studies had postoperative complications as a primary or secondary outcome. In studies with exercise-based interventions, all but one (83.3% [5/6]) found reduction in postoperative complications, and one showed improvement in quality of life (16.7% [1/6]). Studies focusing on geriatric assessment did not achieve significant differences in outcomes. We found implementation challenges that influenced several studies, including high drop-out rates and intervention fidelity. Conclusions: In this review, we found 11 studies focused on perioperative interventions in older adults with cancer undergoing surgery. Notably, interventions involved exercise, geriatric assessment-guided care, nutrition optimization, and patient empowerment. RCTs to date seem to primarily focus on exercise interventions and geriatric assessment-guided strategies. Although most studies met their primary endpoint, we found heterogeneity in intervention modality and outcome assessment, thus demonstrating a need for ongoing work to address the unique needs of the geriatric oncology population.

Impact of a Comprehensive Financial Navigation Intervention to Reduce Cancer-Related Financial Toxicity.

Although the need to reduce the impact of financial toxicity among patients with cancer is widely acknowledged, few interventions have been developed to address this issue. We tested a novel, multiphase, patient-centered financial navigation (FN) intervention at a large academic medical center. We developed a financial toxicity screening tool consisting of the Comprehensive Score for Financial Toxicity (COST) measure plus several additional items based on patient feedback. After systematizing the screening process, 50 patients from the North Carolina Basnight Cancer Hospital were enrolled in the FN intervention following a positive screen for financial distress (COST score <23). The FN intervention involved one-on-one consultations with a trained financial navigator and included an initial comprehensive intake appointment to determine patient eligibility for financial assistance and follow-up appointments to discuss paperwork and application(s) status. We assessed preliminary intervention effectiveness (preintervention and postintervention COST scores) and implementation (ie, fidelity, uptake, acceptability). All 50 patients assessed for study eligibility screened positive for financial distress. A total of 46 patients completed both the preintervention and postintervention COST instrument and other measures. Postintervention mean COST scores improved from 6.4 at baseline to 13.3 post-FN (P<.0001), indicating a significant decrease in perceived financial toxicity. Fidelity to the intervention was high and 96% of participants received financial assistance. A patient-centered FN intervention fully integrated into an existing care coordination model can help to decrease the burden of cancer-related financial toxicity among patients with cancer experiencing financial distress. Further studies are needed to test FN interventions in various oncology settings and among targeted populations.

Developing methods to identify resilience and improve communication about diagnosis in pediatric primary care.

Communication underlies every stage of the diagnostic process. The Dialog Study aims to characterize the pediatric diagnostic journey, focusing on communication as a source of resilience, in order to ultimately develop and test the efficacy of a structured patient-centered communication intervention in improving outpatient diagnostic safety. In this manuscript, we will describe protocols, data collection instruments, methods, analytic approaches, and theoretical frameworks to be used in to characterize the patient journey in the Dialog Study. Our approach to characterization of the patient journey will attend to patient and structural factors, like race and racism, and language and language access, before developing interventions. Our mixed-methods approach is informed by the Systems Engineering Initiative for Patient Safety (SEIPS) 3.0 framework (which describes the sociotechnical system underpinning diagnoses within the broader context of multiple interactions with different care settings over time) and the Safety II framework (which seeks to understand successful and unsuccessful adaptations to ongoing changes in demand and capacity within the healthcare system). We will assess the validity of different methods to detect diagnostic errors along the diagnostic journey. In doing so, we will emphasize the importance of viewing the diagnostic process as the product of communications situated in systems-of-work that are constantly adapting to everyday challenges.

From Hospital to Home: Applying a Co-design Approach to Determine Key Components of an Intervention to Support Transition-to-Home After Stroke

Abstract Background When people with stroke transition from the hospital back to their homes, they and their families frequently experience multi-faceted unmet needs and feelings of abandonment. Uncertainty surrounds the fundamental components of an intervention intended to support transition-to-home after a stroke. The aim of this study was to utilise a co-design process to identify key components for a patient-centred support intervention facilitating the transition home after stroke, and to explore what might be feasible within a real-world context. Methods The primary researcher, a larger team of researchers, and an individual with lived experience of stroke facilitated a series of three workshops for 12 people with stroke, 6 caregivers, 26 healthcare professionals, and 6 representatives from stroke organisations. World Café methodology and Liberating Structures facilitation techniques were adapted to meet the study aim. Data collection involved making observations during workshops, summarising findings, and reaching group consensus agreement on outputs. The final output was the consequence of facilitated consensus on a prioritisation task. Individuals with lived experience of stroke contributed to study design, ethics, and co-design outputs, providing input for future research and co-facilitating workshops with the research team. Results The co-design group identified 10 key intervention components to support people with stroke and their families during the transition from hospital-to-home. These components focussed on enhancing collaboration, streamlining transition processes, and facilitating post-discharge support. While a stroke coordinator was considered a top priority, increased cross-setting information sharing and community-based healthcare staff in-reach, were considered most feasible to implement. Conclusion The co-design approach, involving a multi-stakeholder group, was strengthened by patient and public involvement. This ensured that the identified transition-to-home intervention components are meaningful and relevant for people with stroke and their families. To further refine, and feasibility test the components for generalisability within the wider Irish healthcare context, additional co-design workshops are required.

Sociocultural features of lifestyle modifications among TB–diabetes comorbid patients in Satara, India and its implications for planning self-management interventions for TB–diabetes comorbid patients

BackgroundLifestyle modifications (LM) are crucial in managing comorbid Tuberculosis (TB) and Diabetes Mellitus (DM) patients, significantly impacting treatment outcomes and overall health. In view of this, a study was conducted to clarify sociocultural features associated with LM among TB–diabetes comorbid patients.MethodsA cross-sectional descriptive study among randomly selected 180 adult TB–diabetes-comorbid-patients was conducted using a semi-structured interview schedule. Mann–Whitney-U-test was used to examine differences in means between patterns of distress (PDs) and perceived causes (PCs) regarding TB and Diabetes for two identified LM strategies among comorbid patients. Stepwise logistic regression was used to study factors associated with these LM strategies.ResultsTB–diabetes-comorbid-patients reporting physical symptoms as PDs preferred to follow the LM-1 strategy for TB and LM-2 for Diabetes. In contrast, patients reporting health-illness-injury-related causes follow LM-2 for TB and LM-1 for Diabetes. Further patients reporting hypertension for Diabetes (AOR = 2.916, 95% CI 0.9262–9.1788) and concerns-about-the-course-of-TB-illness (AOR = 3.746, 95% CI 1.4683–9.5593) as PDs were 3–4 times more likely to follow LM-1. While those reporting prior illnesses (AOR = 4.255, 95% CI 1.3941–12.9837) and sanitation (AOR = 5.242, 95% CI 1.2028–22.8446) as PCs for TB were 4–5 times follow LM-2. Patients who perceived consumption of alcohol as PCs of Diabetes were 10 times more likely to stop addictions (AOR = 9.680, 95% CI 2.5555–36.6639) and follow the LM-2 strategy.ConclusionGiven significant associations of sociocultural features with LM strategies, consideration of sociocultural features vis-à-vis these strategies is indispensable for managing TBDM comorbidity, emphasizing the need for developing comprehensive, patient-centred self-management interventions to enhance adherence and improve health outcomes.

Clients’ and providers’ perspectives in informing a digital health intervention to improve linkage to care after Index HIV self-testing in Hai and Moshi Districts, Tanzania

BackgroundDigital health interventions have the potential to improve linkage to care after HIV self-testing (HIVST). This study aimed to understand clients’ and providers’ perceptions of benefits, and barriers of a digital health intervention designed to improve linkage to care after HIV self-testing in Tanzania.MethodsThis exploratory qualitative research study was conducted in Hai and Moshi, districts in Kilimanjaro region, Tanzania. Four health facilities were selected based on their involvement in an HIVST pilot program implemented by Elizabeth Glassier Pediatric AIDS Foundation (EGPAF) Tanzania through the USAID funded program. The study included female index clients and their partners, and healthcare providers at the healthcare facilities. We used a semi-structured interview guide with open-ended questions for data collection. Data collection was conducted from 16th January 2023 to 3rd February 2023. Thematic analysis of the qualitative data was conducted, guided by the Health Belief Model (HBM), and results were developed in collaboration with the community partners.ResultsA total of 42 participants were included in the study, comprising 9 male clients, 17 female index clients, and 16 health care workers (HCWs) (4 male and 12 female) who were involved in delivering HIVST services. The study’s findings revealed mixed feelings about the use of a digital health intervention. Majority of participants perceived digital health as a valuable intervention for enhancing linkage to care, improved health outcomes, improved communication with healthcare workers, and increased privacy. Therefore, they supported scale-up of a digital health intervention. Participants also expressed that the potential benefits of a digital health intervention include the convenience of accessing healthcare services from the comfort of their homes or any location. However, a few participants expressed concerns about potential risks associated with sending health-related text messages. They feared that recipients might not be in a safe space, leading to stigma and avoidance of engagement. A few female participants expressed concerns about confidentiality breaches, particularly regarding shared phones with family or friends. Fear of being judged or misunderstood by others could deter them from reading or acting upon these messages. Most participants recommended tailored strategies that prioritize confidentiality and trust. Recognizing these psychological aspects is vital for customizing digital health interventions to effectively address participants’ concerns.ConclusionsDigital health interventions may improve the linkage of HIV self-testers to care. Recommendations include personalized and culturally relevant communication and technical accessibility to make interventions effective and inclusive. This study provides valuable insights for designing patient-centered interventions for HIV care and treatment.

Therapeutic Advances in Psoriasis: From Biologics to Emerging Oral Small Molecules.

Psoriasis is a persistent, inflammatory condition affecting millions globally, marked by excessive keratinocyte proliferation, immune cell infiltration, and widespread inflammation. Over the years, therapeutic approaches have developed significantly, shifting from conventional topical treatments and phototherapy to more sophisticated systemic interventions such as biologics and, recently, oral small-molecule drugs. This review seeks to present a comprehensive investigation of the existing psoriasis treatment options, focusing on biologic agents, oral small molecules, and emerging treatments. Several categories of biologic treatments have received regulatory approval for psoriasis, including TNF-α, IL-17, IL-12/23, and IL-23 inhibitors. Biologics have revolutionized the treatment of psoriasis. These targeted therapies offer significant improvement in disease control and quality of life, with acceptable safety profiles. However, limitations such as cost, potential immunogenicity, and administration challenges have driven the exploration of alternative treatment modalities. Oral small molecules, particularly inhibitors of Janus kinase (JAK), have emerged as options due to their convenience and efficacy. These agents represent a paradigm shift in the management of the condition, offering oral administration and targeted action on specific signaling pathways. In addition to existing therapies, the review explores emerging treatments that hold promise for the future of psoriasis care. These include innovative small-molecule inhibitors. Early-stage clinical trials suggest these agents may enhance outcomes for psoriasis patients. In conclusion, the therapeutic landscape of psoriasis is rapidly evolving, emphasizing targeted, patient-centered treatments. Ongoing research and development are expected to lead to more personalized and effective management strategies for this complex condition.

How do the guideline recommendations work for you?Patients' perceived effectiveness of therapeutic approaches in arterial hypertension.

Blood pressure remains in the hypertensive range in nearly half of those affected by arterial hypertension despite it being an extremely modifiable risk factor, whereby morbidity decreases significantly upon implementation of lifestyle-based therapeutic approaches. There are significant discrepancies between the S3 guideline's recommendations and its implementation. In this cross-sectional study sampling 160 inpatients with arterial hypertension, we assessed patients' perceptions of secondary prevention therapeutic approaches recommended to them within treatment guidelines. Additionally, we used psychometric questionnaires to assess prevention factors. We conducted a latent class analysis to identify patterns in patients' views, and tested for group differences regarding gender, age, education years, body mass index, psychopathology, and blood pressure. Two latent classes could be identified: Class 1 tended to perceive all recommended therapeutic approaches as helpful and reflected individuals with high-normal blood pressure. Class 2 tended to view recommendations regarding weight reduction, and cessation of nicotine and alcohol use, as less effective and included those with mild hypertension. There were no statistically significant class differences regarding the socio-demographic parameters. We further examined the evaluation of therapeutic approaches independent of classes, with social support reported to be the most effective approach. In conclusion, persistently-elevated blood pressure may be linked to poorer perceptions of therapeutic approaches which are then not implemented. Furthermore, patient-centered treatment planning and concepts such as shared decision-making appear to be central in treating this population regarding secondary prevention.

Precision Medicine in Periodontics: A Literature Review.

Periodontitis, a widespread health issue, requires effective prevention and management strategies due to its increasing prevalence and detrimental social consequences. The chronic inflammation associated with periodontitis also exacerbates systemic conditions, emphasizing the need for advanced approaches in addressing this public health concern. The traditional methods of periodontal diagnosis, which primarily rely on clinical indicators such as pocket depth, clinical attachment loss, mobility, and radiographic measurements of alveolar bone loss, have limitations in guiding therapy due to the intricate and multifaceted nature of periodontal diseases. Precision periodontics is the amalgamation of genomics, bioinformatics, and advanced technology, mainly biomarkers reflecting a precise patient-centered treatment. However, implementing this approach in periodontology is new due to the lack of validated periodontal biomarkers for diagnostic use. This article explores the foundations of personalized therapy in periodontal diagnosis. It discusses the current state and prospects of periodontal biomarkers as a crucial step toward realizing a precision approach in periodontal practice.

Patient satisfaction with quality of care at out-patient departments in selected health facilities in Kumasi, Ghana

BackgroundHealth care is an indispensable element for economic growth and development of individuals and nations. Healthcare service quality is associated with patient satisfaction, ensuring the safety and security of patients, reducing mortality and morbidity, and improving the quality of life. Patient satisfaction with health service is linked to increased utilization following contendness with healthcare received from health providers. There is an increasing public perception of poor quality of care among patients visiting public health facilities in Ghana which translates into service dissatisfaction. Meanwhile, patient dissatisfaction will more likely result in poor utilization, disregard for medical advice, and treatment non-adherence. The study was conducted to assess patients’ satisfaction with quality of care at the outpatient departments of selected health facilities in Kumasi, Ghana.MethodsAn institutional-based analytical cross-sectional study was conducted among patients (aged ≥ 18 years) visiting outpatient departments of selected health facilities in Kumasi from October - December, 2019. A systematic sampling technique was adopted to collect quantitative information from 385 respondents using a structured questionnaire. At 95% confidence interval and 5% alpha level, two-level logistic regression models were performed. Model I estimated the crude associations and the effect of covariates was accounted for in Model II. The results were presented in odds ratio with a corresponding 95% confidence interval. All analysis were performed using STATA statistical software version 16.0.ResultsOut of the 385 participants, 90.9% of the participants were satisfied with the services they received. Being married [AOR = 3.06, 95%CI = 1.07–8.74], agreeing that the facility is disability-friendly [AOR = 7.93, 95%CI = 2.07–14.43], facility has directional signs for navigation [AOR = 3.12, 95%=1.92–10.59] and the facility has comfortable and attractive waiting area [AOR = 10.02, 95%CI = 2.35–22.63] were associated with satisfaction with health service among patients. Spending more than 2 h at the health facility [AOR = 0.45, 95%CI = 0.04–0.93] and having perceived rude and irritating provider [AOR = 0.14, 95%CI = 0.04–0.51] had lower odds of satisfaction with health service received.ConclusionThere is a high patient satisfaction with services received at out-patient departments which is influenced by a multiplicity of factors; being married, and agreeing that the facility is disability-friendly, has directional signs for navigation, and the waiting area is comfortable and attractive. The study findings call for the need to develop and implement health delivery interventions and strategies (i.e. patient-centered interventions, disability-friendly facilities, and sustainability and improvement of quality service) to improve and sustain patient satisfaction levels with health care service. These strategies must be directed towards addressing inequalities in infrastructural development and inputs needed for healthcare delivery in the health system.