Patient Perceptions Of Health Research Articles

Peer support and whole health coaching to address the healthcare needs of homeless veterans: a pilot study

BackgroundHomelessness is a robust social determinant of acute care service utilization among veterans. Although intensive outpatient programs have been developed for homeless veterans who are high utilizers of acute care (“super utilizers”), few scalable programs have been implemented to address their needs.ObjectiveDescribe the development and pilot testing of a novel intervention that integrates the roles of a peer and whole health coach (“Peer-WHC”) in coordination with primary care teams to reduce homeless veterans’ frequent use of acute care.DesignSingle-arm trial in three outpatient primary care clinics at a Veterans Health Administration (VHA) medical center; pre/post design using mixed-methods.ParticipantsTwenty veterans from VHA’s homeless registry who were super-utilizers of acute care and enrolled in primary care.InterventionWeekly health coaching sessions with a peer over 12 weeks, including discussions of patients’ health care utilization patterns and coordination with primary care.Main measuresRates of session attendance and intervention fidelity, patient-reported satisfaction and changes in patient engagement and perceptions of health, pre/post utilization of acute and supportive care services, and qualitative interviews with multiple stakeholders to identify barriers and facilitators to implementation.Key resultsOn average, patients attended 6.35 sessions (SD = 3.5, Median = 7). Satisfaction scores (M = 28.75 out of 32; SD = 2.79) exceeded a priori benchmarks. Patients’ perceptions of health improved from pre to post [t(df)=-2.26(14), p = 0.04]. In the 3-months pre/post, 45% (n = 9) and 15% (n = 3) of patients, respectively, were hospitalized. Qualitative feedback from patients, providers, and peers and fidelity metrics suggested value in increasing the length of the intervention to facilitate goal-setting with patients and coordination with primary care.ConclusionFindings support the feasibility, acceptability, and utility of Peer-WHC to address the healthcare needs of homeless veterans. A future trial is warranted to test the impact of Peer-WHC on reducing these patients’ frequent use of acute care.

Novel Patient-Reported Outcome Measures for the Assessment of Patient Satisfaction and Health-Related Quality of Life Following Postmastectomy Breast Reconstruction.

Patient-reported outcome measures (PROMs) have become an integral part of the evaluation of reconstruction surgery outcomes. However, there are limitations in current PROMs when it comes to the assessment of well-being during inpatient stay, patient perception of health, relationship with partner, and vitality (i.e., mood and ability to work and pursue hobbies, carry out daily tasks, and sleep) following breast reconstructive surgery. The aim was to develop a novel set of measures to compare patient satisfaction and health-related quality of life following different types of postmastectomy breast reconstruction. A novel questionnaire was created and refined through cognitive interviews with patients and expert feedback. A field test study was conducted, including patients who had undergone delayed postmastectomy breast reconstruction with implant, autologous tissue, or combination of implant and autologous tissue. Based on the results, confirmatory factor analysis and examination of reliability of the questionnaire were conducted. Results of patient responses were analyzed using Chi-square test, Kruskal-Wallis test, and Mann-Whitney U test. Confirmatory factor analysis showed good model fit, and Cronbach's alpha indicated high internal consistency of the questionnaire. Besides that, patients with combination reconstruction reported significantly lower vitality than patients with implant and autologous reconstruction (p = 0.048). This novel questionnaire expands the current knowledge base of postmastectomy breast reconstruction PROMs. Results of the field test study showed that combination reconstruction was associated with lower patient vitality than other reconstruction types. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

A Summary of the Meetings of the Development of a Core Outcome Set for Therapeutic Studies in Eosinophilic Esophagitis (COREOS) International Multidisciplinary Consensus

A Summary of the Meetings of the Development of a Core Outcome Set for Therapeutic Studies in Eosinophilic Esophagitis (COREOS) International Multidisciplinary Consensus

Development of a Core Outcome Set for Therapeutic Studies in Eosinophilic Esophagitis (COREOS): An International Multidisciplinary Consensus

Development of a Core Outcome Set for Therapeutic Studies in Eosinophilic Esophagitis (COREOS): An International Multidisciplinary Consensus

Predictors of electronic patient-reported outcomes use in the survivorship setting.

e14038 Background: Patient-reported outcomes (PRO) offer insight into patient perception of health and symptom burden. Despite a shift toward electronic PRO (ePRO), optimal administration methods are unclear. Our institution recently began ePRO collection in survivorship clinics: patients are invited via email to complete a health survey on our online patient portal prior to annual visits, enabling clinician review of symptoms in advance of the visit. Patients who do not complete an ePRO survey at home are offered an iPad or paper survey at visit check-in. In the first year of ePRO, 87 patients inadvertently submitted multiple responses to the questionnaire, across two modalities. This study aimed to 1) assess determinants of ePRO completion across modalities (portal, iPad, paper); and, 2) among patients who submitted multiple surveys, compare consistency of responses in surveys completed within 30 days of each other. Methods: We reviewed records for 10194 patients seen in breast, thoracic, colorectal, and gynecologic survivorship clinics over one year. Demographics, disease/treatment details, and PRO responses (symptoms, health behaviors, etc.) were extracted. For aim 1, we used multivariate regression to determine predictors of completion method. For aim 2, we calculated Cohen’s kappa coefficients to compare responses based on completion modality. Results: Most patients (65.6%) completed the survey on an iPad in clinic; 16.7% on the portal, 17.7% on paper in clinic. Younger age (p < .001), white race (p < .001), less fatigue (p = .01), and English as primary language (p < .001) were associated with portal use in multivariate analyses. In general, Cohen’s Kappa analyses revealed high agreement between surveys. Conclusions: Our findings highlight demographic gaps in ePRO acceptance. Although most patients completed an ePRO (portal or iPad), few completed it at home in advance of their visit, which has implications for clinic flow and clinician preparation for visits. However, our finding of consistent symptom reporting across mode and location of completion is reassuring. Future work should seek to improve comfort with ePRO completion at home among groups less likely to accept it and explore the implications of symptom burden on ePRO acceptance.

Predicting Patient-Reported Outcomes of Dental Implant Treatment.

To investigate whether pretreatment patient-related factors are associated with the outcomes of dental implant treatment through multidimensional evaluations of oral health-related quality of life and health-related quality of life using the Oral Health Impact Profile (OHIP) and the 36-Item Short Form Health Survey (SF-36) developed from the Medical Outcomes Study, respectively. Oral health-related quality of life was evaluated using the Japanese version of the OHIP, and health-related quality of life was evaluated using scores for the mental component summary (MCS) and physical component summary (PCS) dimensions of the SF-36. Data were collected before treatment (baseline) and 1 month after delivery of the prostheses (follow-up). Stepwise multivariate regression analysis was used to explore the associations of posttreatment OHIP and SF-36 scores and changes in these scores after treatment (dependent variables) with age, sex, educational background, number of missing teeth, Eichner's classification, pretreatment state, site of the embedded implant, number of implants, types of definitive prostheses, and baseline OHIP and SF-36 scores (independent variables). Data from 150 consecutive patients (mean age: 58.1 ± 11.5 years) who underwent dental implant treatment between April 2008 and April 2016 were analyzed. The mean OHIP summary score, OHIP dimension scores (oral function, orofacial pain, orofacial appearance, and psychosocial impact), and MCS score showed significant improvements after treatment (P < .05). The baseline OHIP and SF-36 scores were consistently and significantly associated with the treatment outcome (ie, dependent) variables (P < .05). Moreover, the site of the embedded implant was identified as a significant predictor of the posttreatment status and changes in the OHIP summary score, oral function and orofacial appearance dimension scores (OHIP), and MCS score. These results suggest that patient perceptions of health and oral health conditions may help in the prediction of the outcomes of dental implant treatment.

Attitudes of Individuals with Gaucher Disease toward Substrate Reduction Therapies

Type 1 Gaucher disease (GD) is the most common lysosomal storage disorder. Previously, treatment for GD was limited to intravenous enzyme replacement therapies (ERTs). More recently, oral substrate reduction therapies (SRTs) were approved for treatment of GD. Although both therapies alleviate disease symptoms, attitudes toward SRTs and patient perceptions of health while using SRT have not been well established. Electronic surveys were administered to adults with GD and asked about treatment history, attitudes toward SRTs, and perception of health while using SRTs as compared to ERTs, if applicable to the participant. ERT users that were offered treatment with SRTs cited potential side effects, wanting more research on SRTs, and satisfaction with their current treatment regimen as reasons for declining SRTs. SRT users expressed convenience and less invasiveness as reasons for choosing SRTs. Additionally, those using SRTs most often perceived their health to be similar to when they previously used ERT. Participant responses illustrate that attitudes toward SRTs can be variable and that one particular treatment may not be ideal for all patients with GD depending on individual perceptions of factors such as convenience, invasiveness, or side effects. Thus, individuals with GD should be counseled adequately by healthcare providers about both ERTs and SRTs for treatment of GD now that SRTs are clinically available.

Factors Influencing Emergency Department Preference for Access to Healthcare

Introduction:African-Americans are more likely than Caucasians to access healthcare through the emergency department (ED); however, the reasons behind this pattern are unclear. The objective is to investigate the effect of race, insurance, socioeconomic status, and perceived health on the preference for ED use.Methods:This is a prospective study at a tertiary care ED from June to July 2009. Patients were surveyed to capture demographics, healthcare utilization, and baseline health status. The primary outcome of interest was patient-reported routine place of healthcare. Other outcomes included frequency of ED visits in the previous 6 months, barriers to primary care and patient perception of health using select questions from the Medical Outcomes Study Short Form 36 (SF-36).Results:Two hundred and ninety-two patients completed the survey of whom 58% were African-American and 44% were uninsured. African-Americans were equally likely to report 3 or more visits to the ED, but more likely to state a preference for the ED for their usual place of care (24% vs. 13%, p < 0.01). No significant differences between groups were found for barriers to primary care, including insurance. African-Americans less often reported comorbidities or hospitalization within the previous 6 months (23% vs. 34%, p = 0.04). On logistic regression modeling, African-Americans were more than 2 times as likely to select the ED as their usual place of healthcare (OR 2.24, 95% CI 1.22 – 4.08).Conclusion:African-Americans, independent of health insurance, are more likely than Caucasians to designate the ED as their routine place of healthcare.

Self-rated health as a moderator of the relation between functional impairment and depressive symptoms in older adults

Objectives: The purpose of this study was to examine the relation between functional impairment, self-rated health, and depressive symptoms. Independently, self-rated health and functional impairment each contribute to depressive symptoms; however, it remains unknown how these variables are related to depression in combination. It was hypothesized that self-rated health would moderate the relation between functional impairment and depressive symptoms in a sample of older adults. Method: A community sample of adults aged 60 and above was recruited from primary care clinics (n = 106); 98 of these participants had usable data. Participants completed self-report questionnaires that assessed depressive symptoms, functional impairment, and self-rated physical health. Results: Self-rated health moderated the relation between functional impairment and depressive symptoms. For participants with poor self-rated health, greater functional impairment was associated with greater depressive symptoms. Conclusion: It appears that patient perceptions of health may be protective against depressive symptoms for those with functional impairment.

The Association Between Alcohol Screening Scores and Health Status in Male Veterans

: Alcohol use is associated with self-reported health status. However, little is known about the concurrent association between alcohol screening scores and patient perception of health. We evaluated this association in a sample of primarily older male veterans. : This secondary, cross-sectional analysis included male general medicine outpatients from 7 VA medical centers who returned mailed questionnaires. Screening scores from the Alcohol Use Disorders Identification Test Consumption (AUDIT-C) questionnaire were divided into 6 categories (0, 1-3, 4-5, 6-7, 8-9, and 10-12). Outcomes included scores on the 8 subscales and 2 component scores of the 36-item Short Form Health Survey (SF-36). Unadjusted and adjusted linear regression models were fit to characterize the association between AUDIT-C categories and SF-36 scores. Models were adjusted for demographic characteristics, smoking, and site-both alone and in combination with 14 self-reported comorbid conditions. : Male respondents (n = 24,531; mean age = 63.6 years) represented 69% of those surveyed with the SF-36. After adjustment, a quadratic (inverted U-shaped) relationship was demonstrated between AUDIT-C categories and all SF-36 scores such that patients with AUDIT-C scores 4-5 or 6-7 reported the highest health status, and patients with AUDIT-C scores 0, 8-9, and ≥10 reported the lowest health status. : Across all measures of health status, patients with the most severe alcohol misuse had significantly poorer health status than those who screened positive for alcohol misuse at mild or moderate levels of severity. The relatively good health status reported by patients with mild-moderate alcohol misuse might interfere with clinicians' acceptance and adoption of guidelines recommending that they counsel these patients about their drinking.

P03-381 - Quality of life improvement through depression treatment in oncologic patients

ObjectiveTo evaluate the impact of depression treatment over the quality of life in oncologic patients.MethodsA group of 27 patients, 14 male and 13 female, mean age 56,3, diagnosed with lung (n=7), gastric (n=7), prostate (n=5), colon (n=4) and breast (n=4) cancer, were also diagnosed with moderate or severe depression (Hamilton Depression Rating Scale-17 items score at the inclusion was over 14). These patients received a combined, psychopharmacological (escitalopram mean daily dose 15 mg, n=15 or mirtazapine, mean daily dose 30 mg, n=12) and psychotherapeutic (cognitive behavior therapy) approach for 3 months and were monitored using monthly HAMD, Global Assessment of Functioning and Lehman Quality of Life Interview (QOLI). Patients didn’t present any significant axis I, II or III comorbid condition.ResultsPatients responded well to the combined therapy, as the final HAMD (-11.2, p&lt; 0.01) and GAF (+12.3, p&lt; 0.01) scores reflected, with no significant inter-group difference (p=0.23). The quality of life scales regarding health, family relations and social relations from the QOLI registered significant improvement compared to baseline (+10%, +12.2% and +12.5% respectively, p&lt; 0.01). Patients who had the higher response rate to the treatment also had the higher rate of life quality improvement (r=0.65).ConclusionThe treatment of depression in oncologic patients is a necessity, due to the impact of depressive symptoms over the patient quality of life and is associated with a significant rate of success. The improvements are observed especially in the patient perception of health, family and social relationship and functioning.

Comment on the use of self‐reporting instruments to assess patients with rheumatoid arthritis: The longitudinal association between the DAS28 and the VAS general health

Recently, the use of patient self-reporting instruments instead of clinical, objective measurements to assess rheumatoid arthritis (RA) patients was proposed. This assumes a constant association between disease activity and the self-reporting instruments. The objective was to explore the association (in time) between disease activity and patient perception of general health, disease activity, pain, and functional disability in patients with RA. Data of 624 newly diagnosed RA patients who completed 3 years of followup were analyzed. Cross-sectional linear regression models and longitudinal regression models were estimated, with a visual analog scale (VAS) measuring general health (VAS-GH; 0 = best, 100 = worst) as a dependent variable and the Disease Activity Score (DAS28) without the VAS-GH as an independent variable. Other dependent variables were VAS disease activity, pain, and the Health Assessment Questionnaire. The DAS28 and VAS-GH were significantly associated in RA patients (P < 0.001). However, the explained variance was low (6.7%). From diagnosis to 3 years after the diagnosis, the intercept decreased given the same regression coefficient. The longitudinal regression model showed that the VAS-GH improved during disease course independent of a change in DAS28. Analyses on the other outcome parameters showed similar results. Patients' perception of health can be different with equal disease activity, depending on the moment in the disease course. Furthermore, our results indicate that self-reported measures on functionality, disease activity, and general health cannot substitute for objective measures of disease activity in RA in longitudinal studies; subsequently, both need to be measured.

Interventions to improve access to health and social care after discharge from hospital: a systematic review.

To determine the effectiveness and costs of interventions intended to improve access to health and social care for older patients following discharge from acute hospitals. Systematic literature review, following NHS Centre for Reviews and Dissemination guidelines, of randomised controlled trials evaluating needs assessment methods and patient discharge co-ordinator roles. These services targeted patients aged 60 years and over and varied depending on whether or not they selected frail patients (e.g. those at risk of needing nursing home care). Outcomes assessed included: referrals to or use of health and social care (15 studies); mortality (13 studies); patients' functional health status and disability (13 studies); and patient perceptions of health (five studies), quality of life (three studies), cognitive functioning and psychological well-being (ten studies), social support (two studies) and the adequacy of services (four studies). Fifteen randomised controlled trials (23 papers), mainly from the USA, were identified. The interventions provided and patient groups targeted by these services were heterogeneous. There was, however, some evidence that services combining needs assessment, discharge planning and a method for facilitating the implementation of these plans were more effective than services that do not include the latter action. The assessment of need may be insufficient in itself for the adequate provision of post-discharge care. Needs assessment should be combined with a service that facilitates the implementation of care plans.

Patient Perception of Health and Emergency Room Utilization before and after the Iraqi Occupation of Kuwait

This paper analyzes whether patients visiting the Medical Emergency Rooms (ERs) perceive their general health to have deteriorated, improved or stayed the same one year before the Iraqi occupation and one year after the liberation. The paper also examines the impact of such perceptions on the utilization of an ER. Data were collected by means of a survey of the ER attendees in Kuwait’s six general hospitals during January and February 1993. Sixty percent of the respondents perceived their health to have been better one year before the invasion, about 30% perceived no change, while 10% said their health had improved one year after the liberation. A significantly larger percentage of women and wealthier people perceived a deterioration. Regarding ER utilization, 56% reported at least one visit before and after the occupation. The average number of visits was 9.68 before the invasion and 10.09 after the liberation. Perception of health was not significantly associated with the number of visits.

The very old patient in ambulatory care.

The aims were twofold: to determine differences between the very old and younger patients in ambulatory care and to examine their self-assessments of health and whether these related to: subjective data such as symptoms and attitudes, objective data such as utilization of health services, and physician assessments of the patient's health. Although they had about one more diagnosis, the very old were similar in most respects to younger patients. Variables that discriminated the groups were physician ratings. About two-thirds of the older and younger patients regarded their health as good. Good health perceptions were associated with fewer symptoms, outpatient visits, and hospitalizations in both groups. Physician assessments were only lowly correlated with patient assessments of health. Patient perceptions of health were highly stable over a two month follow up. The subjective belief that one is healthy or ill may be more important than actual medical condition in maintaining good emotional and behavioral functioning.