Patient-focused Service Research Articles

Development and validation of a measure to assess patient experience of needling of arteriovenous fistulas or grafts for haemodialysis access: the NPREM

Abstract Background Needling is a key step in haemodialysis. Research suggests needling experience is sub-optimal; however, no validated measure exists to inform improvements. We addressed this by developing the Needling Patient Reported Experience Measure (NPREM). Methods We used mixed methods and co-production. All participants were adults with working fistulas/grafts from eight UK kidney centres. Phase 1: Developing concepts and items, In interviews (n=41), we explored patients’ needling experience and identified key aspects of needling using thematic analysis. This informed the 98-item NPREM(v0.1). Phase 2: Piloting the measure Cognitive interviews (n=16) assessed face validity. Items were amended or removed, yielding a 48-item NPREM(v0.2). A pilot survey (n=183) examined initial psychometric properties. NPREM(v0.2) showed good internal consistency (Cronbach's alpha=0.95). Review of analyses resulted in a 35-item NPREM(v0.3). Phase 3: Evaluating the measure's dimensionality, validity, and reliability Patients (n=468) completed the NPREM(v0.3), Vascular Access Quality of Life (VASQoL), EuroQol 5-Dimension-5-Level (EQ5D-5L), Patient Activation Measure (PAM), with a sub-set completing a follow-up NPREM (n=99). Items were evaluated with 28 items retained in the NPREM(v1.0). Confirmatory factor analysis confirmed a unidimensional model fit (CFI=0.899). Validity of the NPREM(v1.0) was good [convergent: VASQoL (r=0.60) and overall experience (r=0.79); divergent: EQ-5D (r=-0.31), EQ-5D VAS (r=0.24) and PAM (r=0.17)]. Test-retest scores were strongly correlated (r=0.88), demonstrating high reliability. Known-groups validity was demonstrated between centre scores (range 5.21 (SD 1.20) to 5.94 (SD 0.75)). Conclusion The NPREM measures patient experience of needling for haemodialysis. It offers kidney services a means of assessing needling experience, informing patient-focused clinical and service improvements.

Psychological and functional outcomes of horizontal squint surgery in adults with no preoperative diplopia using Quality-of-Life AS-20 questionnaire

BackgroundCorrective squint surgery has a significant psychological impact, affecting both the quality of life and mental health of patients. This study highlights the quantitative and subjective assessment of both the...

Factors That Influence the Compliance of Professional Nutrition Care Providers (PPA) in Providing Education to Patients and Families at RSUD Prof. Dr. H. Aloei Saboe Gorontalo City

Professional Care Providers (PPA) as an interdisciplinary team play a role in maximizing the implementation of patient-focused services, one of which is through providing education. Education is carried out to help patients and their families better understand the health problems they are facing. PPAmust comply with professional norms and ethics in providing education to patients and their families. This research aims to analyze the influencing factorsPPA Nutrition compliance in providing education to patients and families at RSUD Prof. Dr. H. Aloei Saboe Gorontalo City using descriptive research typequantitative approach. The data collection method was carried out through distributing questionnaires to Nutrition Care Professionals (PPA) at RSUD Prof. Dr. H. Aloei Saboe Gorontalo City. The research results showed that predisposing factors (knowledge and attitudes), enabling factors (infrastructure, work environment and socialization), and reinforcing factors (role of management and policy) obtained measurement results (score > 50%). Of these three factors, the predisposing factor is the factor that most influences the level of PPA Gizi compliance in providing education to patients and families at RSUD Prof. Dr. H. Aloei Saboe Gorontalo City.

Investigating the provision, nature and associated costs of unfunded pharmacy services: A nationwide study.

There is increasing evidence of pharmacists providing free or partially subsidised patient-focused services in order to meet healthcare needs. Limited information exists about the types of unfunded services and their value. (1) Identify the types of unfunded services provided nationally in New Zealand (NZ) and (2) Determine the costs associated with service provision. A continuous observation time-motion study was conducted across New Zealand to characterise the provision of unfunded pharmacy services and the labour costs associated with their provision. The time-motion study spanned one business day (between seven to eight hours) in each participating pharmacy. The primary investigator (YA) spent one business day in each participating pharmacy (n=51) and recorded details about the patient-focused services that were provided. Details included the type of service provided, approximate duration of the service and out-of-pocket costs borne by the patient. A total of 660 observations of unfunded services were recorded across the 51 pharmacies where 360 observation hours were carried out. Twenty-three types of unfunded services were identified, where minor ailments accounted for over half of the total observations. Labour costs associated with service provision were variable. Pharmacies across New Zealand are providing patient-focused services for which no funding is being provided.

Kemampuan Perawat Dalam Menerapkan Patient Centered Care Di RSUD Dr. M. Haulussy Ambon

Patient-focused services or commonly called Patient Centered Care (PCC) have become the main focus in providing health care today. The PCC concept was first introduced by Picker in 1988 through the Picker Institute Europe in England. Regional General Hospital (RSUD) Dr. M Haulussy Ambon is a hospital that has been accredited and is required to be able to implement PCC in its services. Purpose this study was to determine the ability of nurses to apply PCC at RSUD dr. M. Haulussy Ambon. The research design used is descriptive quantitative using observational. The population in this study were nurses at RSUD Dr. M Haulussy Ambon as many as 302 nurses. The number of samples is 113 respondents. data collection techniques using a questionnaire. Results: Most of the nurses' ability to apply PCC showed good results but there were still a number of PCC dimensions that had sufficient results. The PCC dimensions that get good results are respecting patient choices and assessments, physical comfort, information and education, service coordination, and involving family and friends. It can be concluded that most nurses are capable of implementing PCC.

Community Engagement at Academic Health Centers

Academic health centers are essential in many communities, providing health professions education and patient-focused services. These institutions often serve as anchor institutions for community-engaged efforts to serve underserved populations. During the COVID-19 pandemic, the central nature of academic health centers, and the well-being of communities, were on full display. This special issue aims to contribute to and expand our understanding and inform empirically the evidence-based programming, interventions, and policies that strengthen community engagement at academic health centers.

Sexual and reproductive health services provided by community pharmacists: a scoping review

ObjectivesPharmacists are increasingly providing patient-focused services in community pharmacies, including in the area of sexual and reproductive health (SRH). Specific SRH areas have been the focus of research, but a...

Development of an Actionable Framework to Address Cancer Care Disparities in Medically Underserved Populations in the United States: Expert Roundtable Recommendations.

PURPOSE:Cancer disparities persist among medically underserved populations despite widespread efforts to address them. We describe the development of a framework for addressing cancer care disparities across the cancer care continuum (CCC), guided by the CCC domains established by the Institute of Medicine/National Academies of Sciences, Engineering, and Medicine (IOM/NAS).MATERIALS AND METHODS:An environmental scan was conducted to identify strategies and associated experts who are providing or have successfully provided community- and/or patient-centric IOM/NAS-defined domain standards to our target populations. A multistakeholder expert roundtable working group was convened for framework development. A premeeting survey informed agenda development, documented expert practices for target populations, and identified priority areas for meeting focus.RESULTS:The environmental scan identified 84 unique experts across 8 stakeholder groups and 44 patient organizations; 50 were invited to the roundtable and 33 participated. They broadly represented disease sites, geography, and experience with target populations and all CCC domains. The premeeting survey (16 responses) identified coordination of care or patient navigation (66.7%), community engagement (60.0%), and healthcare system changes (53.3%) as priority focus areas. The experts identified access and treatment barriers or gaps within and between CCC domains, specified key notable practices to address these, and developed an actionable framework and recommendations for each priority focus area.CONCLUSION:The framework and recommendations are intended to guide researchers, healthcare leaders, advocates, community- and patient-focused service organizations, and policy leaders to address and promote health equity in cancer care access and treatment outcomes.

Patients as research partners: how our approach delivers truly patient-focused services

Involving patients and carers in research around their own services is nothing new. This kind of work has been around for decades, but people often come away from these patient and public involvement and engagement (PPIE) experiences with little more than compensation and a cheese and pickle sandwich. So, are we truly co-producing research-led pharmacy […]

Are professional pharmacy services being offered for free in pharmacies? A feasibility study exploring the use of a time motion study in New Zealand.

Background:Pharmacists report to be providing patient-focused clinical services for which they receive no remuneration. Limited literature exists about unfunded services leading to difficulties in ascertaining an appropriate study design for such research.Objective:This study aims to assess the appropriateness of a proposed study design before launching a nationwide study to investigate the provision of unfunded patient care services.Methods:A multi-methods approach was utilised consisting of (1) continuous time motion study in community pharmacies (2) semi structured patient interviews (3) patient follow up (4) semi structured interviews with pharmacy owners/managers. All observations of unfunded patient care services were recorded, numerically coded and descriptively analysed. Semi structured interviews were audio recorded and transcribed verbatim. A semantic thematic analysis was carried out. Appropriateness of study design was dictated by the ability to characterise services and obtain patient perceptions.Results:Ten pharmacies took part in the feasibility study, across the city of Dunedin, New Zealand, representing a range of different practice settings and demographics. Ten patients were interviewed and six responded to follow up. Both pharmacy and patient recruitment proved challenging due to concerns around disruption to workflow and patient privacy. A continuous observation time motion study was found to be appropriate as it minimises disruption to workflow with no additional work required from the pharmacy teams.Conclusions:A continuous observation time motion study proved to be an appropriate method to investigate the provision of unfunded services on a national scale. The findings of the study suggest design changes such as length of observation time, increasing patient recruitment and additional patient questions to enhance the nationwide study.

Factors Affecting Hospital Service Innovation: Literature Review

Innovation at the hospital as a change in the delivery of patient-focused health services by encouraging healthcare professionals to work smarter, faster and better. Service innovation can provide an effective way to create a sustainable competitive advantage for hospitals. This study aims to analyze and examine the factors that influence service innovation in hospitals using the literature review method. The results were obtained from a literature search that discusses the major factors that influence service innovation, namely in the form of a good management system within the scope of the hospital. This big influence is that human resources, starting from the leaders and employees who work in the hospital, must work together for the advancement and empowerment of the hospital.

Optimising intervals for abdominal aortic aneurysm surveillance: A pilot study analysing patient opinion.

Optimising abdominal aortic aneurysm surveillance intervals will improve current surveillance programmes. To the author's knowledge, no known study has exclusively asked patient opinion with regards to their surveillance interval. The aim of this study was to therefore determine a patient's perspective of their optimal intervals, encouraging shared decision-making and creating a patient-focused service. Fifty patients, currently under abdominal aortic aneurysm surveillance, were interviewed. Patients were asked their opinions before and after seeing a patient decision aid. A patient decision aid presents information of risk in an easy-to-understand format. This specific patient decision aid, designed and created for this study, informed patients of the 'risk of exceeding the 5.5 cm surgical threshold' with regards to various surveillance intervals. The chosen optimal surveillance interval was recorded for each patient, and a median interval was calculated for each abdominal aortic aneurysm group. Groups were categorised based upon maximum aortic diameter (3.0-3.4 cm, 3.5-3.9 cm, 4.0-4.4 cm and 4.5-4.9 cm). After assessing the patient decision aid, the median surveillance interval calculated for each abdominal aortic aneurysm group was 24 months (3.0-3.4 cm), 12 months (3.5-3.9 cm), 12 months (4.0-4.4 cm) and 6 months (4.5-4.9 cm), respectively. The majority of patients (78%, n = 39) agreed that the patient decision aid was a useful tool to help make an informed choice. Overall, patients in abdominal aortic aneurysm groups 3.0-3.4 cm and 4.5-4.9 cm would choose to lengthen abdominal aortic aneurysm surveillance intervals. Lengthening the current surveillance intervals to 24 months (currently 12 months) for abdominal aortic aneurysm group 3.0-3.4 cm and to 6 months (currently 3 months) for abdominal aortic aneurysm group 4.5-4.9 cm would not only increase capacity but also reflect the needs and wishes of those using the National Health Service. The use of a patient decision aid is an effective way of communicating, to the patient, the risk of the proposed changes and thus alleviating potential anxiety.

What free services do pharmacists offer? Investigating the provision of unfunded pharmacy services in community pharmacies.

Globally, pharmacists report to be providing free or partially subsidised patient-focused services in order to meet healthcare needs of their communities. Budget cuts to pharmacy contracts are reported to challenge the provision of such services. Limited information exists identifying the types of unfunded services provided in community pharmacies. To identify the types of services which pharmacists report to provide that are not reimbursed by the government, insurance companies or paid for by the patient. Semi-structured focus group discussions with pharmacists were conducted stimulating narratives from community pharmacists across New Zealand about the types of unfunded pharmacy services they provide. Discussions were audio recorded and transcribed verbatim. Inductive coding of the data was carried out using QSR International Nvivo 11 for Windows. A semantic thematic analysis was carried out. Twenty-four pharmacists took part in the focus groups across five regions in both the North and South Islands of New Zealand. Key themes identified from focus groups were: 'Standalone unfunded services', 'Services funded elsewhere' and 'Leakages from the current funding model'. Pharmacists reported that unfunded patient-focused services accounted for 15%-50% of their daily activities. Pharmacists stated that they believed these services often led to reduction of disease progression, hospitalisations and improved quality of life. Pharmacists also stated that given budget cuts, these services are not sustainable. Pharmacists report to offer many professional services without remuneration. In some cases, these services make up a substantial part of the pharmacist's time. Further budgetary constraints and increased competition may put these services at risk of being lost. Findings from this study can be applied to unfunded pharmacy services elsewhere, as worldwide pharmacy faces many similar challenges, particularly where there are budget cuts and decreasing revenue in other jurisdictions.

Learning from community pharmacists' initial experiences of a workplace-based training program

IntroductionTo prepare community pharmacists for the provision of clinical and patient-focused services, a novel postgraduate course for community pharmacists in the United Kingdom was developed. The program incorporated personal development planning against a personal development framework, workplace mentoring, employment of work-based assessment tools, activities that encouraged increased inter-professional working, reflection, and opportunities for peer support. Objectives were to identify course components that support development, describe the effect on practice, and explore the perceived advantages and disadvantages of this model of postgraduate education. MethodsInterviews were conducted with a purposive sample of 15 community pharmacists after they had completed approximately one year of the three-year course. A topic guide covering approaches to learning, rationale for course selection, course experiences to date, and impact on practice was used. Interview recordings were thematically analyzed. ResultsTwo themes were identified. ‘Support for learning’ describes the components of the course that provided support for learning, including opportunities to learn with and from others, workplace mentoring, and facilitated access to general practitioners. ‘Outcomes of learning’ encompasses how the course was a way of effecting change within existing roles and the increase in confidence and motivation to change practice. ConclusionsThe model has merit in supporting community pharmacists to develop the confidence and competence required for extended clinical and patient-focused roles. While this model of learning seems to provide educational value, further research is required to determine whether the additional resources required to provide workplace mentoring, use work-based assessment tools, and encourage inter-professional working are justified.

Kepatuhan dan Ketepatan Tenaga Medis dalam Pengisian Assessment Pre Dialisis di Klinik Hemodialisis Nitipuran Health Center

Background: The National Hospital Accreditation Standards (SNARS) state that one of the key indicators in patient-focused service standards is patient assessment. The purpose of this study was to analyze the level of compliance and accuracy of medical personnel in pre dialysis assessments at NHC. Subjects and Method: This study uses a mixed method with the Cohort Study approach. Research subjects were medical records for quantitative data and doctors, nurses and head nurses for qualitative data. Quantitative data analysis with descriptive analysis, and qualitative analysis with in-depth interviews. Result: The level of compliance and accuracy of medical personnel in filling the pre dialysis assessment at the Nitipuran Hemodialysis Clinic is not quite good. The implementation of pre dialysis assessment at the NHC includes physical status, medical history, history of drug allergy, assessment of pain, risk of falls, and educational needs. Constraints include time constraints, assessments are filled in immediately without checking in detailly, there are gaps in the hourly monitoring records. Conclusion: compliance and accuracy of medical personnel in filling out assessments must be improved.

The Diversity Site Assessment Tool (DSAT), Reliability and Validity of the Industry Gold Standard for Establishing Investigator Site Ranking

Background: The purpose of this study was to evaluate the reliability and construct validity of the Diversity Site Assessment Tool (DSAT), a self-assessment instrument designed to self-report the extent to which best practices related to recruitment of diverse patient populations during clinical trials are used.
 Methods: A cross-sectional design was used. The convenience sample consisted of site representatives who are members of the Society for Clinical Research Sites and network site representatives that were approached via social media sites such as LinkedIn. A link to the survey was shared with approximately 17,000 aforementioned site representatives over a period of three months. The survey consisted of one section each for the indicators of best practice for the recruitment of diverse patient populations during clinical trials: 1) Site Overview (10 items), 2) Site Recruitment and Outreach (9 items) and 3) Patient Focused Services (6 items). These three indicators and the total of 25 items make up the DSAT. Each of the total 25 items on DSAT required participants to self-report on a 6-point scale. The fourth section collected background information about the participant and their site. After the survey was closed, two types of summative scores were compiled, one for each of the indicators and an overall summative DSAT score (range from 25-150). Higher summative scores on each indicator and the overall DSAT are reflective of increased use of best practices for the recruitment of diverse patient population during clinical trials. Internal consistency reliability (Cronbach’s alpha) and construct validity for the entire sample were evaluated and are reported. Bivariate and multivariate statistics were conducted to examine the relationship between site characteristics and their summative indicator and DSAT overall scores.
 Results: The instrument was deemed to have exceptional reliability. Cronbach's alpha coefficient for internal consistency reliability for the entire sample was 0.929. Construct validity established using the exploratory factor analysis indicated a three component solution accounting for 49% of the explained variance. There was no statistically relationship between site characteristics and their summative indicator and DSAT overall scores. 
 Conclusion: The DSAT has exceptional reliability and good construct validity. When paired with the findings that site characteristics have no statistical relationship with the DSAT indicators and overall summative scores, it is contended that this instrument could be used by different site backgrounds as a self-assessment measure to evaluate the extent of the use of best practices related to recruitment of diverse patient populations during clinical trials. The rigorous development of the instrument and exceptional statistical results make the tool easily the highest standard of measurement available related to this construct.

The Impact of Hospital Accreditation on Nurses' Perceptions of Quality of Care?

Introduction: Accreditation is the recognition of the quality of services that have met the National Hospital Accreditation Standards. In implementing hospital accreditation , it covers patient safety goals, patient-focused service standards, hospital management standards, national programs and integration of health education in hospital services. How is the impact of hospital accreditation on the quality of care, especially nursing services in accordance with the perceptions and attitudes of nurses in hospitals. Therefore, it is necessary to identify the impact of applying hospital accreditation in accordance with nurses' perceptions and attitudes towards nursing services. Methods: For this reason, articles data with a for publication from 2008-2018 are needed, of the 418 systematic literature articles taken from Scopus, Science direct, and Proquest. There are 15 articles chosen to search for literature with keywords; the impact of accreditation on nurses' perceptions and attitudes about the quality of care.Results: Five of the 15 articles that fit the design criteria that address the impact of hospital accreditation according to nurses' perceptions and attitudes in improving nursing services.Conclusion: The study results show that hospital accreditation make a nurses perception the quality of care. Quality of care is the one of impact from hospitals accreditation. Nurses in accredited hospitals feel a higher level of quality of health services.

Pengembangan Sikap Empati Perawat Dalam Pelayanan Yang Berfokus Pada Pasien (Patient Center Care) Melalui Transformasi Leadership Keperawatan: Literature Review

Pendahuluan: Patient Centered Care (PCC) merupakan paradigma baru dalam pelayanan kesehatan yang menempatkan pasien sebagai center of care. PCC melibatkan konsep caring, sharing, komunikasi dan membangun hubungan teraupetik. Banyak ditemukan keluhan pasien terhadap sikap perawat yang kurang ramah dalam melayani, perawat menanggapi kurang baik untuk keluhan yang dirasakan oleh pasien, perawat tidak merespon secara tepat untuk pertanyaan yang disampaikan pasien, dan kurang mempedulikan kebutuhan pasien. Makna praktek keperawatan yang mendukung keperawatan berkualitas adalah memenuhi kebutuhan pasien melalui interaksi yang didasari oleh caring, empati, bertanggung jawab dan menghormati keberadaan pasien. Menurut teori berpusat pada pasien (juga dikenal sebagai teori client centered), salah satu faktor yang mempengaruhi PCC adalah empati. Tujuan: Memberikan gambaran pengembangan sikap empati perawat dalam mendukung pelayanan yang berfokus pada pasien (Patient Center Care) melalui kepemimpinan transformasional. Metode:Literature review dengan mencari beberapa artikel jurnal penelitian yang dpublikasikan melalui data base eletronik. Data base eletronik yang digunakan: PubMed, EBSCO dan Cochrane Library. Dengan menggunakan kata kunci: patient center care, empati dan transformasi leadership. Serta menggunakan referensi handbook nursing. Hasil : Meningkatkan empati dapat menyebabkan peningkatan komunikasi dan hubungan terapeutik antara perawat dan pasien. Empati dibangun untuk mendukung peningkatan pelayanan patient center care dan perbaikan oucome pasien. Upaya pengembangan sikap empati dikembangkan dalam kerangka kerja kepemimpinan keperawatan transformasional. Kesimpulan: Pengukuran empati dan outcome layanan digunakan sebagai pengukuran evaluasi kualitas layanan keperawatan. Transformasional keperawatan mengubah kerangka pikir terhadap apa yang diharapkan pasien dalam layanan dan menentukan proses untuk mencapai tujuan layanan. Selalu mengembangkan proses-proses adaptif dan mempengaruhi stafnya mencapai tujuan layanan

The future of pharmacy practice research - Perspectives of academics and practitioners from Australia, NZ, United Kingdom, Canada and USA.

Healthcare is under significant pressure with the explosion of long term conditions, shift in worldwide demographics and is evolving through advances in technology. Aligned with this is the changing role of pharmacy from the traditional dispenser of medicines to having (in addition) a more advanced clinical role. This study aimed to understand what the pharmacy practice research agenda might look like from the viewpoint of pharmacy academics and practitioners across five high-income countries. Qualitative methods were used, and thirty one-hour interviews were undertaken with practitioners and academics from five economically advanced countries. These nations have comparable socio-economic status but differing health systems and include; Australia, Canada, New Zealand, United Kingdom and United States of America. Six key informants were chosen from each country, three academics and three community pharmacists. A general inductive analysis was undertaken to analyse the most common and recurring themes. These themes of research were based around current community pharmacy practice issues and the enablers to changing the profession. Specific areas pharmacy practice could be more involved with included long term health conditions. Some community pharmacists also believed that research into the impact of professional standards and policy change would be beneficial. The findings of this research suggest that current pharmacy practice research methods are sufficient, but need to be used more effectively. Participants identified a wide range of issues within community pharmacy practice. Academics largely focused on how research can be utilised in the community and how to implement findings to ensure sustainability of pharmacy practice research. Issues that community pharmacists would like to research are related to the current practice model, such as allocating time to provide patient-focused services in addition to managing a business.

Personalisierung von Gesundheitsleistungen – Gestaltungsempfehlungen zur Umsetzung

A strategy of customisation, and its subsequent practical implementation as part of personalised treatment pathways, is an appropriate approach to increase benefits for patients and to strengthen the competitive position of the provider of health services. This requires restructuring and/or reorganising measures to enable variants within the treatment pathway as a value creation process to be adapted to each individual patient and his illness, living conditions and preferences. This ‘mass customisation’ approach allows us to achieve the objective of a constructive interconnection of customisation and standardisation of health services. Major, rapid progress in information and communication technology plays a key part in this process. Focused design tools for mass customisation are the integration of patients into the service delivery process and the modularisation of processes and organisation. By taking into account the specificities of health services as a confidence good these design tools are featured and supported by operational and organisational tools in order to develop variants. This approach allows for high-quality health services that are perfectly tailored to individual patients’ needs and, at the same time, delivered in an economic way. On this basis, customised approaches for personalised health diagnosis and therapy provide patient-focused health services that manage to apply the concept of value-based healthcare in a sophisticated and effective form.